dijous, 29 de novembre de 2018

The revenge of the DVT

[Català/English post]

Let’s start at the beginning. Summer 2013 I was diagnosed with a Deep Vein Thrombosis (DVT). I wrote about the 6-month experience here (link). Two years later, summer 2015, I suffered a thrombophlebitis or superficial vein thrombosis, which I also blogged about (link). After that the doctors ran a test on me to see if I had a genetic disposition (a mutation of the Factor V Leiden) to thrombosis problems. The results said I had inherited this problem but only from one parent, which isn't so bad. Not good, but not bad. After seeing various experts, the conclusion was the same as back in 2013 – just bad luck, and advice to keep wearing the compression stockings, every day, summer and winter. Which I have done. 

But, a month ago, October 2018, I was diagnosed with another DVT in the same leg! A similar process, extreme pain in my lower leg, swelling, a bit redder and warmer than the other leg... when the GP saw it (30 October), he recommended going to the hospital Emergency department straight away for tests to rule out (or not) the possibility of it being a new DVT. Six hours later, blood tests and an ultrasound scan done on my leg, it turned out I’d got a DVT again (and in more than one vein from what I understand). So we then relived the 2013 moment – serious doctors telling me seriously not to worry, they’d get me through this etc, but for God’s sake, don’t move around! Go straight home, bed rest and don’t move for several days. Plus those anti-coagulant injections and some Sintrom pills (the equivalent of Warfarin in the UK I think). So I spent a couple of panic-stricken weeks at home, lying still except for the need to carry out specific bodily functions or eat something, and just getting up to go back to the hospital to have my blood tested and Sintrom dosage adapted accordingly. I won’t be seeing the ‘expert’ until December when I have an appointment with either the hematologist (blood consultant) or vascular doctor (vein consultant), so until then I don’t really know what’s next. Keep taking the pills of course. 
As to what I should do now, 4 weeks into the problem, I’m combining intuition, experience from 5 years ago, and Google research (I know, I know!). Because one of the main problems or worries now is, what should I be doing. The Emergency Ward doctor told me the first day to stay still, at least a week, maybe two.... but now four weeks have gone by and I still won’t be seeing the specialist until week seven. So, following my research, I think (but I’d love to ask a doctor!) I should be trying for a balance of rest, and not doing anything daft, but gradually moving about a bit as probably the worst moment has passed. As I said in a previous post, the worst moment actually lasts a few weeks and it’s when the blood clot can break free and travel around your veins and block your lungs and cause serious damage or, speaking clearly, kill you. I think/pray that risk is now reduced substantially after 4 weeks on the pills, which is more or less what Google’s telling me. But still, those nights when you lay awake paying attention to every single twinge, ache, pain, even trapped wind, thinking ‘Is this it? Do I need to get off to the hospital NOW? What about the kids? Where are my shoes? etc’ until you eventually drop off to sleep and wake up the next morning realizing you’re fine....
So, I’ve been off work for a month and will probably be off till Christmas I imagine. I can, and have decided it’s best to, move around the house and garden now, going out from time to time (for example, round the supermarket), and just lie down for an hour at a time to ease the pain. When I get up, I do light things around the house, but can only sit down for short periods as that’s the most painful moment. In a couple of weeks I’ll see the consultant and hopefully get a clearer picture of where I am and what I should be doing, and, more importantly, find out if they have any idea why this “one-off” problem has happened again despite my precautions (not sitting down for long periods, feet exercises, liquids galore, expensive stockings, reasonable fit and healthy, anti-coagulant injections before flights).
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Començarem al principi. A l’estiu del 2013 em van diagnosticar un trombosi de vena profunda (TVP), el qual em va tenir patint fins gener 2014, i de la qual vaig escriure aquí (link). Dos anys després, a l’estiu 2015 vaig patir un tromboflebitis a la mateixa cama, probablement a causa de la TVP anterior (link). Vaig tornar a fer la ronda de metges. Em van fer una prova per assegurar que no tenia cap problema genètic (com una mutació del Factor V Leiden). Vaig rebre el OK i un ‘No pateixes’, i em van recomanar portar mitjons de compressió tot l’any, estiu i hivern, dia sí, dia també. Amb això pensava que ja estava tot arreglat...
 però... sorpresa, ara a l’octubre 2018 han tornat a trobar un TVP a la mateixa cama. 
Vaig començar a notar un dolor agut, vaig anar al metge de capçalera, i em va dir que donat els precedents, millor anar a urgències a fer les proves per descartar que fos un TVP. Sis hores d’urgències desprès, i, sorpresa, les proves (una de sang, i l’ecografia de la cama) donaven positiu. Llavors va passar el mateix que el 2013, cares serioses dels metges, paraules recomfortants, i consells de sobretot no moure’s en absolut durant uns dies o setmanes, donat que (com vaig explicar el primer cop) el coàgul que està tapant la vena pot començar a ‘flotar’ dins de la vena fins arribar a tapar l’entrada al pulmó i l’historia acabaria molt malament. Et donen les típiques injeccions per fer la sang menys coaguladora (¿), i les pastilles famoses Sintrom. Llavors, quieto a casa, menys els dies que has d’anar a l’hospital per fer el control del Sintrom – que és el dia quan decideixen si tenen la dosi ben calculada o no, i t’ho van ajustant. De moment fa 4 setmanes que estic de baixa i crec que arribarà fins nadal. D’aquí uns dies toca visita amb l’especialista, o l’hematòleg o el vascular.
Crec que ja ho he explicat en posts anteriors, per mi el pitjor d’això és no saber que passa, no saber fins a quan hi ha perill, fins a quin punt no t’has de moure, o sí que has de moure. Surts de l’hospital amb instruccions de no moure’s en absolut. Però llavors no veuré el metge fins que hagin passat 6 setmanes. Mentrestant, que? He d’estar 6 setmanes enganxat al llit tremolant de temor? O pots fer alguna cosa? I aquest perill de tapar-te un pulmó, com ho notaria, que passarà? Si em moc la cama és possible que jo mateix posi en moviment el coàgul?
Amb una mica d’intuició, i els records de fa 5 anys, i una buscada per Google, he deduït que a partir d’un parell de setmanes has de buscar un equilibri i començar a moure una mica però evitar segons quines accions o postures... diuen que hi ha perill de que el coàgul es mou durant unes 4 setmanes. Faig molt de llit/sofa encara, però ara, a 4 setmanes, m’aixeco cada horeta, em moc dins de casa o al jardí, i minimitzo les estones de cadira que és quan em fa més mal. Però clar, això que diuen de que tens aquesta cosa a dins i es pot moure i et pot matar, pos, cada nit quan no pots dormir (o sigui, cada nit!) comences a analitzar cada sensació, cada petita molèstia o punxada... he estat molt a prop de sortir corrents cap a urgències diverses nits, però al final he esperat i ha passat, ja que evidentment són les petites sensacions ‘normals’ d’un cos. Però com que no sé com se sent tenir un coàgul tapant-me el pulmó fins que passi, pos, jo, a la deriva. En fi, ja tinc moltes ganes de parlar en l’expert per fer-li mil preguntes, saber que puc (no) fer ara, i sobretot si tenen alguna explicació del perquè m’ha tornat a passar.
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