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Archive for April, 2008

Back on my feet again…

Wednesday, April 23rd, 2008

Yippee, I’m out of the hospital! After spending the last six days couped up in a hospital bed, tethered to all sorts of wires and tubes, it feels great to be standing free on my own two feet. Let me recap what happened over the past week…

Last Tuesday morning, I checked back in to Providence hospital after finding out that the blood clot in my left leg had reformed. This time around, the doctors used a different technique to clear out the clot. A special catheter, which releases the clot-busting drug like a sprinkler while simultaneously emitting ultrasonic rays, was placed in the popliteal vein behind my knee and threaded up to the top of my iliofemoral vein (upper pelvic area). Dr. Inamputti (an Interventional Radiologist) also did some work with angioplasty balloons to try and widen narrowed parts of the vein. I was semi-conscious through the process. After a couple hours, I was taken up to the CVIU (Cardio Vascular Intervention Unit) for around the clock monitoring, attached to all sorts of machines monitoring the ultrasonic catheter, IV fluids, heart rate, blood pressure, etc. For most of the day I slept. The first night I had severe spasms in my left leg that were quite painful. The nurse gave me morphine for the pain and apparently I was quite out of it for the next several hours, speaking gibberish and blaming everything on “the Canadians.”

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A shot from the Cath lab, you can see the “sprinkler” catheter up in my vein.

Each morning for the next three days I was wheeled down to the Cath lab, where dye was injected into my vein to gauge the status of the clot. Slowly but surely, the clot was breaking down.

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Then I would be taken back up to the CVIU where I spent all day and night stuck in bed, attached to the machines and restricted to a liquid-only diet.

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Friends and family came to visit and Jeff spent each night with me.

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Coaches Erik and Frode came by to visit.

Lab techs would come in every four hours to draw blood, even at 3am.

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Holding pressure on yet another blood draw (over 30 during my stay).  Looking a little beat up.

On the Friday morning (day four), I figured I was going home. I was wrong. While a majority of the clot had been cleared, there was still one major narrowing right at my hip joint that was concerning. Dr. Inamputti decided that they had pumped about as much clot-busting drug as was safe into my body, but that it was time to pull the main catheter out and let my body take over for a couple days. After more angioplasty balloon procedures and a quick blast with the angiojet, I was put on a heparin drip (a blood thinner) and sent back up to the CVIU for the weekend. It was certainly a blow to my morale to have to spend at least two more days in the hospital. At least I was allowed to eat solid food and get up and walk a little bit.

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Returning victorious from my 300m lap of the hallway!

Saturday crept by. My highlight was when I got up for 10 minutes to slowly walk about 300m around the hallways while pushing my IV pole. Then back in bed.

Sunday I awoke with much anticipation, ready to make a final trip to the Cath lab and get discharged. When the nurse came in with breakfast she said they would take me down at 10am. 10am came and went. Then she came back and said an emergency case had bumped me back to noon. Noon came and almost passed and then at last, they came to take me down to the Cath lab. Once more I was injected with dye to check the status of the clot. Thankfully, the narrowed part of the vein had cleared over the previous two days and I was deemed fit to go home.

I was taken back up to the CVIU for a few hours. Then the nurse removed the catheter sheath and I spent a couple more hours waiting oddly enough for a clot to form where the sheath was removed. Finally, at 6pm I was officially discharged. I got to change out of that horrid hospital gown and back into my real clothes. After being in the hospital for six days, I couldn’t wait to get home and take a shower! I said good-bye to the nurses and headed off with Jeff and my parents.

Just as we were approaching the elevators, my pant leg suddenly felt warm and wet. I looked down and my calf was soaked. I lifted up my pants and found my calf and ankle to be soaked in blood. Dang, I sprung a leak! (A hazard of being on blood thinners!) I quickly hobbled back to the nurses station. The head nurse rushed me over to my recently vacated bed and jammed her fist over the wound (not a pleasant experience!). Blood poured out from underneath the bandage.

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Initially there was talk of keeping me overnight. No way!!!! After consulting with the doctor, the nurses reasoned to just get the bleeding under control and maybe send me off in a wheel chair the next time. On the way home I was careful not to put pressure on my leg and luckily no more spontaneous bleeding occurred.

So, home at last! Now the recovery process begins again. The site where the catheter was removed is very sore and bruised, and it feels like I have a giant knot in the muscle behind my knee. That will hopefully improve day by day over the next week. I am walking with a limp, but none the less walking! I will have to wait for my leg to heal before I can get back to exercising, although I was cleared to lift weights with my upper body this week.

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I will be on blood thinners for at least the next six months. In eight weeks I will go back to the Cath lab for a check-up to see if my veins are staying open in those areas where the narrowing occurred. The doctors are convinced that I have May-Thurner Syndrome (where the vein is compressed by the artery) and will be looking to see if that particular area has stayed open after the angioplasty procedures. If there is still narrowing/compression, then I may need to get a stent put in or have surgery to re-route the affected vein. Neither option sounds that pleasant, so I’m crossing my fingers that everything stays open!

I will try and post updates as the recovery process goes on. Thank you to everyone for sharing your stories and encouragement!

arthritis

Back to Square One, Again!

Tuesday, April 15th, 2008

I’ve spent the last ten days waiting to feel better.  Post clot-busting surgery, the prognosis for recovery was a week of laying low and then a gradual start back into some light exercise.  The first day out of the hospital I was pretty sore.  Having a catheter jammed up your leg is bound to make any vein cranky.  Day two was more positive, I felt better, and walking around was much less painful.  “Sweet,” I thought, “I’m on the mend!”   Then day three was a step backward.  My leg was swollen again and much more sore.  I figured I had probably overdone the amount of walking around the previous day, and resorted back to the couch with my leg up.

On day four, I went in for a follow-up visit with a cardiologist.  My leg had been very achy and painful through the night and I shared my concern with the doctor.  He felt the pain was normal for recovery from such an aggressive procedure, and told me that I should expect the leg to be painful for the next week or so.  The treatment from here on out would be focused on getting my INR (International Normalized Ratio – a way to measure the thinness of the blood) into a therapeutic range.  Dealing with the pain was no problem once I was sure it wasn’t causing any harm.

The next several days were pretty similar.  My leg continued to be achy.  I just had to be patient.

This past Thursday, one week post surgery, I went in for another follow-up visit.  The results from the blood tests performed in Fairbanks were back.  It turns out I have a genetic mutation called Factor V Leiden that makes my blood more susceptible to clotting.  This would factor into my treatment plan, and I was referred to a hematologist for more answers.  An appointment was made for Monday.

On Saturday I attended a ski clinic put on by my friend Lars Flora. Usually I head out onto the trails with the little kids and have fun goofing around on the snow.  This year however, I was stuck in the lodge.   I spent my time inside explaining to parents and friends how I was feeling and what the prognosis was for recovery from my clot.  Everyone has been so caring and supportive, it’s amazing.  I missed being out on the trails, but at least I could still see the excitement in the kids eyes when they returned in from their ski.   It was a fun distraction.

By Sunday I felt like my leg was actually starting to feel a little better.  I could walk with less of a limp, and I could stand for longer without the tired, achy feel.  My spirits lifted a little.

Then we come to Monday, and the much anticipated visit with the hematologist.  The first part of the visit was very positive.  Despite having the Factor V Leiden disfunction, I would most likely be off Coumadin (a blood thinner) after six months.  By correcting some environmental factors (i.e. staying off hormonal birth control and  by staying active and hydrated during travel), I should be able to avoid future clots.  The doctor recommended that I go see a blood clot specialist in Oregon that has worked with athletes, as an added measure.  Then, just before leaving, he recommended that I get a follow-up ultrasound.  So I headed to the other end of the hospital and checked in with the Radiology department.

A friendly ultrasound tech then performed the ultrasound procedure up and down my left leg, while Jeff tried to understand what he was seeing on the monitor.  Having no clue how it went, we went back to the hematologist and waited for a report.  It took a little while for radiology to call back, and we ended up grabbing lunch in the hospital cafe while we waited.  Then finally we got the news:  the clot had reformed, and I needed to go back in for another surgical procedure of lytic therapy to once again break up the clot.  An appointment was made for 11:30am the following day.

So, I’m headed back to the hospital tomorrow.  The catheter is going back in the leg, along with the angiojet and more clot-busting drugs.  The doctors will again try to widen the compressed vein with the angioplasty balloons.  Due to the poisionous nature of the clot-busting drugs, I will most likely spend another night in the ICU, and then begin the healing process all over.  It’s back to square one.  Doh!

We’re crossing our fingers that this next procedure is more successful at removing all the clot and that this next recovery period will move a little faster.

Thank you everyone for sharing your stories and words of encouragement!

arthritis

On the mend

Friday, April 4th, 2008

I just got out of the hospital for the second time in a five days. The back pain I encountered earlier last week turned out to be a massive blood clot in my left leg extending from my hip down past my knee, a condition called Deep Vein Thrombosis, DVT. I spent last Saturday and Sunday in the emergency room in Fairbanks where I received the initial diagnosis and started on blood thinners to prevent any more clots from forming. The doctors told me I would have to wait for the body to naturally take care of the clot. Fortunately, I was able to get out just in time to watch the men’s 50km classic race, and it was very uplifting to see my longtime coach Frode Lillefjell take third overall and win the National Championship.

Monday morning I flew back to Anchorage and mostly stayed at home with my leg up. My leg had swelled to almost twice the size of my other leg over the weekend. Thankfully the swelling went down a little after resting. (I think the blood thinners kicked in). On Tuesday I got an appointment to see a vascular surgeon. Upon reviewing my case he immediately suggested a surgical procedure called lytic therapy where they send a catheter up the vein starting behind the knee and go up into the clot and spray out a drug that disintegrates the clot (like Pac Man). The other alternative was to leave the clot and let the body take care of it, but because the clot was so extensive there was a good possibility that some of the clot would turn to scare tissue leaving me with an ineffective, painful leg for the rest of my life (which would have made skiing very difficult). So as you can imagine, I chose to go for the lytic therapy.

On Wednesday morning I headed to Providence hospital and checked in to the heart center. After checking my vitals, I was carted down to the radiology wing to the cath lab for the procedure. I was laid flat on a skinny bed, face down on my stomach. They gave me some sedatives and I only came about every once and a while to see the wire being pushed through the clot on a screen ahead of me. It seemed like only a few minutes but the procedure took four hours. When they were done I was taken up to the cardio intensive care unit. I was pretty sleepy, but I guess the doctors explained to Jeff and my parents that they were able to get about 70% of the clot out. The clot had actually been older than originally thought. Instead of being a week old like my symptoms, it appears the clot had been in there for a lot longer, perhaps all season.

I spent the night in the ICU still sedated and pretty sleepy. In the morning, I was taken back down to the cath lab for a second procedure to try and get out the remaining clot. I was on the table again for another two hours. This time they were able to clean out almost all of the clot and a balloon was used to widen parts of the vein that had been compressed.

Then I spent a few more hours in the ICU while they took the catheter out and made sure things were stable. Everything looked good, so I was discharged. When I first got up to walk, I thought the leg would feel much better. However, I found the leg actually hurt worse. I was given some crutches to walk around on.

A big lesson was learned here! The doctors seemed just as concerned with how the clot started as they were about how to deal with the clot itself.

At first it was hard to understand why someone my age, in such great health could develop such a blood clot. However, over the last week it’s been quite an education for me, learning about how clots form and what the contributing factors are. From what we can determine, the initial clot started months ago. Although we still don’t know what caused it, there are a few categories I fall into: May-Thurner syndrome, on birth control, and long periods of travel. Additionally, we are still waiting for blood tests to come back to determine whether I have any genetic predispositions for blood clots. These are some of the categories explained:

1) May-Thurner syndrome: a rare syndrome that happens in young, athletic women. May-Thurner syndrome is compression of the left iliac vein by the artery crossing over it, causing a narrowing of the vein.

2) Birth control: Women who use estrogen-containing birth control pills are at a 3- to 6-fold increased risk of developing blood clots. Since November, I have been using a product called NUVA RING. Currently there is a national class-action lawsuit against NUVA RING, as it has been linked to other instances of blood clots and DVT like I had.

3) Travel: This incident brings to light the need for more education for athletes about the risks with blood clots and DVT. We all spend so much time traveling, cramped on long flights. We often travel after competing which contributes to dehydration. We are healthy most of the time and we don’t respond to symptoms right away. This clotting has been in my iliac vein for a while, it just took a string of unfortunate circumstances (falling, sitting in a car and plane for hours without moving, and possible dehydration) to cause the clot to build up to a noticeable (and painful) point. I’m lucky I discovered the clot before anything really bad happened.

I hope we can all learn from this! Remember to get up and walk around every couple hours while traveling. Stay hydrated! And a note to all you female skiers taking estrogen containing birth control medications. Please talk with your doctor about the risks involved with blood clots!!

I hope to move on from this and get back to my normal self pretty soon.

Cheers,

Kikkan 🙂

arthritis