Back at the Hospital

I was slightly tempted to continue my "Hello Blood Clot" naming theme, but I don't think I realized how many updates might be involved around this. Sooo....

Tuesday was an interesting day. I got two calls in the morning I didn't really expect.

One from an outside facility calling to schedule a referral appointment I didn't know about (see my Facebook post). And the second from my new doctor (who had been on rotation when we first went in for my blood clot) following up on me since being home and seeing how my medication was working.

Can I just take a minute to say how much I like this new doctor? Goodness, she's very much involved and really looking into my situation to make sure we get me the the best care. I had a followup appointment scheduled with her on Friday, so I really appreciate the call as an extra measure.

I took her call as the opportunity to ask several questions that had come up in the last couple days. One question was about expectations for my leg swelling.

Although the swelling always fluctuates, I had noticed that it wasn't really going down and was actually getting worse. Jake and I had tried measuring at home and kept getting numbers quite a bit higher than what was recorded at the hospital. Plus, I saw the swelling go into my ankle and foot and knee—places that hadn't swelled before. I didn't know if this was normal and expected or what.

Doctor thought this was concerning enough to have me come in—and she offered to squeeze me in on her lunch break. She wanted to check things out and possibly do another ultrasound on the leg to see if anything was changing and hopefully that they weren't getting worse.

This call was around 10:30 am and I was then scheduled to go in at noon. I hadn't driven in a few days but luckily Jake and I switched cars so he was driving my manual clutch (Thank goodness I insisted he become comfortable with driving it last year.) and I had his automatic.

The appointment was pretty quick. She went over everything, checked my vitals, measured my swelling, etc. And agreed that the swelling was more intense. She sent me to radiology and said to come back and she'd fit me in to go over the results and decide what to do. One of the initial options was upping my dosage of blood thinner. You typically match dosage to weight and, for a general example, I was at a 60 dosage where the weight would put me at a 65-75 dosage. But they don't have needles for that range. While I could take TWO needles of 35 dosage, she (and I agree) wasn't too fly on making me inject myself FOUR times a day rather than two The other potential option was to give me a 80 dosage needle and train me where to stop at to get the right dosage.

I quickly got to radiology and then had some waiting time while we waited for results and such. In the end, the doctor pulled me in and said that the ultrasound showed the same thing as my one from last Thursday. However, after talking with some other specialists, she recommended it best to switch me to a Heparin drip, instead of my other blood thinning Lovenox.

Pros: Heparin is supposed to work a little more effectively and a little more quickly. They can adjust more often to more exactly match my levels and could cater the treatment to exactly what my body needs.

Cons: The Heparin drip needs to administered via an IV, with staff to make the changes as needed, and thus I would need to be admitted back to the hospital.

The team of doctors looking at my case felt most comfortable with this approach in order to get a handle on my levels. They anticipated I'd be admitted for 4-5 days and then could return to my previously prescribed treatment at home, hopefully with more workable results.

Taking all the information in, I asked if this would be an immediate admittance. After confirming I didn't show signs of a PE (pulmonary embolism), she said it would be fine if I'd want to go home, pack a bag, etc. Whew.

Plan was made. I head back to the car on my crutches and a near dying phone and text Jake to call me when he got a chance. I made it home and started getting stuff together: clothers, laptop, chargers, magazines, snacks, pillows, etc. Jake called and I caught him up and he was able to meet me at home to take me in. (Before I told him what was going on; I emphasized that he was NOT going to be staying at the hospital but hopefully this could help him focus on his busy week and not worry about me so much since the hospital would be taking care of me.)

By 4 p.m. we were heading back to the hospital, but definitely feeling a bit more prepared this time around. We went straight to Labor & Delivery where they had scheduled a stress test for the baby. They hooked up a monitor and listened for about 20 minutes there. Then the general medicine doctor came in and caught me up on the plan and looked at my legs. Then they transfered me down to my room and started the admission questions, blood tests, and procedures.

I got an IV in my right arm for the Heparin drip. The left arm is used for individual prick blood draws every 4 to 6 hours to test my levels, which would then affect what's happening in the Heparin drip. I think we did those draws around 8 pm, midnight, and 6 am, and noon.

Wednesday morning
This morning I spoke with the general medicine doctor and my OB doctor. Both said that everything went great, almost better than expected. They were able to really quickly match my levels and match the Heparin where it needed to be. (I don't really exactly know what these levels look like or mean but oh well). Looking at my legs, the swelling looks MUCH better. Although the swelling has always fluctuated, we have never seen it that "normal" since before I first came in last week.

My OB is going to do some background work and research to see if there is any reason to keep me the initially recommended 4-5 days. If the positive results stay around for the next 24 hours, they may be able to let me go home earlier. She doesn't want to keep me if it's unnecessary but also doesn't want any concerns or having me wind back at the hospital again anyways.

While I'm here anyways, we're going to try to get my 28 week labs down and possibly a few other things usually scheduled for the beginning of the 3rd trimester. For example, I may have my glucose test while here and probably my flu shot.

I think that's it for now!! Again, I'm doing great and really am back at the hospital just to have this particular medicine administered. Baby is also getting a lot of attention and doing well!

Hello Blood Clot: Treatment and Moving Forward

We finally made it to the outcome and moving forward. (Again, I'm sorry I ramble so much.) Everything has happened in such a short amount of time that I know things are likely to change and I don't know what will change or come up.

So the doctors found a blood clot, or deep vein thrombosis (DVT) in my upper left leg. Having a blood clot while pregnant immediately puts makes this a somewhat "high-risk" pregnancy. (That seems SO weird to say since everything has been so low key and better than expected up to now.)

Aside from the pain and discomfort, the blood clot itself isn't the main concern; the potential pulmonary embolism (PE) is the bigger threat. PEs are life-threatening and occur when a clot moves to the lungs. There's also an increased chance of a clot forming in the placenta. A clot has to be treated with a blood thinner which could also cause complications come labor and delivery.

So here's what this means for me:

Switch in Doctor
My medical insurance is through the military and I'm being treated at the local naval hospital. Most pregnancies are handled through family medicine. With this new development, I am being switched to an OB specialist. This means I'll probably be seen more often and will have more ultrasounds and attention throughout the remainder of the pregnancy. I'm pleased with this because I wasn't super confident in my previous doctor and was considering switching anyways.

Crutches (For Now)
Before I was allowed to be released from the hospital, I had to meet with the physical therapy team. The doctor had requested I have some help since I had become so unable to walk. Initially they were thinking they'd send me home with a walker or cane (hello, grandma!). But after meeting with the team, they saw that I was young and typically active. We went with crutches because the problem wasn't balance (which walkers/canes help) but rather relieving pressure from the leg. The PT team made me practice standing up and sitting down with the crutches, walk all the way down the hall, and then practice going up and down stairs. That was the most activity I had down in a while and it left me really tired and sore. I'm hoping I will only need them for a week and can return to somewhat normal activity within two weeks. The doctors says everyone is different but definitely encourages me getting back as soon as I'm able to tolerate.

Monitor Swelling
My ability to return to normal activity depends on the swelling going down. The swelling causes pain and indicates that the blood thinners aren't quite working. Currently anytime I have to move a lot or

have been in a certain position too long, I'll have a noticeable increase in swelling, and thus pain.

Here is a look at my legs after my PT session (mentioned above) that probably lasted at most 10 minutes (left side) and Saturday evening after going to dinner with a group, sitting in a booth, and using crutches to and from the car. The difference in color is more noticeable on the left. Can you guys see the difference in size??? I swear my left leg seems twice its normal size. You'll also see the measurements still written on my legs from the hospital. (Yes, I've showered). Jake and I have continued measuring at home.

Injections Twice Daily
I will be on blood thinners for the remainder of the pregnancy. This medication comes in the form on an injection I will need to perform myself twice a day, 12 hours apart. Yes, twice a day. Until January. I have to insert the needle in the fatty sections of my side and alternate sides with each injection. Tonight Jake helped me decide to do "Night, Right" so I remember to inject on the left in the mornings and on the right at night. These injections MUST be done 12 hours apart, but I do have about 30 minutes to work in adjustments. Because I received my first injection at 11:30pm Thursday night, I'm adjusting each injection by 30 minutes until I get it to appropriate times. I've made it to 10pm/10am, but think I may aim for 8:30. We'll see. Before leaving the hospital, the pharmacy delivered my medications for the next month (Left: my two large bags of medication; Right: a look at my injection needles)

Managing Pain
For now, I'm on Percocet to manage the pain in my leg. I definitely do not want to stay on this long term, but for now it's been necessary. I don't think Tylenol will ever do anything for me, but I hope that will do in an emergency after we get this leg pain and swelling under control. I have enough for a about a week depending on how much I take. We'll reevaluate my need at my follow-up appointment next Friday.

Be Ready for an Emergency
The doctor tried not to scare me but made it very clear that I need to seek emergency help should I notice anything concerning moving forward. I need to call 911 for ANY chest pain or difficulty breathing. Immediately. She advised me to also check out the other local hospitals to know which I'd prefer should the need arise (the naval hospital does not have an ER). I'll also look into the different labor units in case we end up needing additional attention.

Hello Blood Clot: At The Hospital

I was going to try to keep this short, but alas, I failed...enter the three-part series. 

So we get to the hospital and are escorted to Labor & Delivery where they treat most pregnant patients who come in for urgent needs (i.e. without an appointment with their regular doctor). Luckily they had a wheel chair to get me around, which I was really grateful. We were escorted to a room and pretty quickly had a nurse checking my vitals and getting an account of my symptoms. They also immediately checked for the baby heartbeat and made sure everything in that arena was ok.

The doctor came in 15 or 20 minutes after that. It was actually my regular family practice doctor who happened to be on rotation in that unit. So we had a familiar face to work with. He knew my activity level and low key history so far. After asking the routine questions about my symptoms, he took a look at my legs. He preformed some touch tests on the sensitive areas on my hip and pelvic areas. We noticed some swelling and discoloring on the left leg so he did measurements and look at the difference between each side.

There were mainly two possible causes for my issues: 1) normal pregnancy discomfort that we can't do much about; pain might be more of a injury somehow and would heal on it's own, or 2) blood clot, also known as deep vein thrombosis, DVT.

My only risk for DVT is being pregnant. Pregnant women have increased levels of estrogen which means blood clots more readily as it helps the placenta to work and prepares for labor. However, typically only 1 in 1,000 women will actually experience a clot. Other risk factors include previous blood clots, family history, obesity, smoking, prolonged immobility (bedrest or long distance travel), multiple births, or being older than 35 while pregnant.

I don't fit with any of those. After bringing in another doctor who again measured my legs, went through the series of questions about my symptoms and history, they consulted and decided to order an ultrasound of my leg. Both doctors really didn't seem to think DVT was the issue, but thought it better to be safe. Maybe they were just trying to be reassuring...

We had to wait for someone in Radiology to come in, so of course there was more waiting. As Jake and I hung out on my waiting bed, I actually found myself quite comfortable, more so than I'd been in a few days. But then I'd get up to go to the bathroom and the pain would come back. 

Finally in Radiology, the technician focused the ultrasound on inner leg up to the pelvic area. This seemed strange to me because my pain and been in the outer hip and down the front/outer part of the leg. So the area she was looking at wasn't the "problem area" in my eyes. Obviously these doctors and staff know more than I do. 

After getting back and waiting for a little more, the nurse comes in will six or seven test tubes and says he's going to put a catheter in my arm. Jake and I are like...soooo, what does this mean? And Jake asks, "Is she getting admitted?" I, of course, thought he was off and that wasn't going to happen. But sure enough, the doctor comes in shortly after and confirms that I do have a clot. 

And that we caught it early. 

They are going to get me started on a blood thinning shot and keep me overnight for observation. She said I could probably go home and be fine, but that they wanted to make sure I didn't have immediate negative reactions to the treatment. She explained a lot more about what this means for the pregnancy moving forward (see next post.) 

They take my blood for tests and insert the catheter. Then they hook up me to some sort of system to keep track of my vitals (I think?). I was on two different types, but ended up with three trackers along my bra line and three higher on my chest. Then they move me down to the 5th floor to stay. The staff down there then checked my vitals, baby heartbeat, and got the rundown before things quieted down for the evening. 

 

Hello Blood Clot: At Home

I ramble a lot guys. I apologize for the excessive length of this post. It mostly serves as my personal documentation of my increasing pain and what led me to see the doctor. My next post will share more details about what's going on and what it means moving forward at this point. 

27 weeks.

Jake had Monday off for Columbus Day so we had decided to FINALLY visit the beautiful Pensacola Beach that morning. I don't remember exactly when I started feeling discomfort but I do remember loving the water for many reasons but most especially because my hip and back didn't ache while swimming.

So I think things started Monday morning. I attributed anything I felt to normal pregnancy stuff. Really it started very minor with some slight left hip and lower back pain. Since my belly had become more prominent in the last couple weeks, these things seemed like normal adjustments to the increased weight and alignment changes.

Monday evening I headed out for errands and after returning home told Jake that it felt good to move and that walking around helped my discomfort fade. That evening Jake was kind enough to give me a mini massage in some sensitive areas and rub some Doterra Deep Blue on my legs and back.

By Wednesday the discomfort had increased but was still bearable. I woke up sore and tried some foam rolling to ease out my leg and back. I usually walk 3 miles with some friends MWF, but was already feeling slower and ended up only doing 1.5-2 miles.

Thursday morning I woke up a couple hours earlier than Jake not being able to fall back to sleep or get comfortable. My hip pain seemed to be more intense and spreading down the front of my leg. At this point, my back didn't hurt much anymore, but my leg was increasingly unbearable. I had trouble moving from my bed to the couch and may have been whimpering a bit as Jake got ready for the day (:P). Before he left that morning, he made me promise to all the Nurse Hotline to see what I could do or if I needed to see someone.

After falling back asleep again, I woke up around 10 am and initially felt MUCH better. (Somehow I always tend to sleep better once Jake leaves the house.)

But then I tried to move (aka walk to the bathroom).

Immediately my pain was back. I called the Nurse Hotline and slowly walked around the house while going over my situation and symptoms with her. I was able to walk but was slow and uncomfortable. At the end of our conversation, she asked if I had taken anything for pain yet, to which I said I had not. (I'm not much of a medicine person even when not being pregnant.) She said at this point, I could probably still be treated at home. To take some Tylenol and the alternate between icing and heating my leg.

As I hung up the phone, I already felt disappointed. I think deep down I doubted those directions would do much for me. But I knew I at least had to try the advice. Problem: I didn't have Tylenol.

It was almost 11 am at this point, and I wanted to try the advice immediately so I'd know if I could teach my 5 pm Zumba class and/or so I'd know if I need to go to the doctor by the time Jake was done for the day. Despite not wanting to leave the house, I headed to my car to go to a little store nearby on base. I drive a manual car which was a bit tricky with my sore left leg but I made it work for that little two minute drive.

There aren't great parking options right by this little store and I made the mistake of parking in the farther lot. By the time I realized this mistake, I'd already walked too far to switch.

This walk to the store was very revealing to me. I had to stop a lot to let my leg rest and was struggling to hold back tears. But I made it to the store and quickly found the Tylenol I needed. I grabbed some Swedish Fish, Mambo's, and a too-expensive bottle of water as well. I knew I couldn't wait until I got home to take that medicine and needed water. When I was checking out, the lady asked if I was going to the movies. (The on-base movie theater is next door.) "No," I say. "I needed the Tylenol and just grabbed the others." And I'm pregnant. And in pain. And needed some pity treats.

I stopped at the bench outside the store entrance. I scrambled to tear open my medicine bottle and get that darn cotton swab out of the way. And then just sat there and wondered how I'd make it back to my car. I people watched for a minute and wondered if people would think it strange if I asked them to go get my car for me. Maybe drive me home. Instead I opened my Swedish Fish, had a couple bites, took a deep breath and started my what-seemed-to-be journey back to the car. I know I looked ridiculous limping along pregnant, in running shorts and Jake's oversized t-shirt, with my head down and trying not to cry. But I made it back to my car. And home. And inside. To my couch.

I sat down to rest and Jake arrived home for lunch a mere 10-15 minutes later. I told him about my trying excursion out and he wished I'd be able to ask him to pick it up for me. But Jake doesn't have phone access during the day and often doesn't come home for lunch until 1, sometimes later, if at all. He only had 20 minutes home and I was currently icing my leg. He got a bunch of snacks together for me, prepped my stuff for future heating and icing and insisted I only leave the couch for bathroom visits and discarding ice. My store visit had definitely opened my eyes to what I was capable of...I also arranged to cancel my Zumba class that evening.

I was able to take another nap but aside from feeling my leg numb from the ice, experienced no change in my pain. I took my second set of Tylenol as soon as allowed, so around 4 p.m. Jake got home a little after 5 p.m. and after talking with him, I called the Nurse Hotline again.

It was during this phone call (and with Jake's eyes helping) that I noticed that my left leg was a bit swollen and a different color. Jake and I were getting ready to head to the hospital even while talking to the nurse, and luckily they also confirmed that I needed to go in within the next 8 hours. Jake was starving and I hadn't eaten much of substance so we stopped at Chick-fila and got some food to eat on the way to Labor & Delivery. I think we got there by 5:30pm.

To be continued.

Pregnancy Update: Week 26

Well, it seems like the last two weeks have been the most eventful as far as my pregnancy progress goes. I most definitely have a bump now.

I had my 24 week doctor's appointment, which was basically a routine checkup. Around that point, my bump was not so noticeable. People were still finding out I was pregnant and surprised. I'm definitely bigger than I was 6 months ago, but without a prominent bump, any growth would go unnoticed (not to mention so many people didn't know me 6 months ago).

In addition to my bump, I also have VISUAL movement. I experienced this for the first time yesterday afternoon and got Jake a show later in the evening. Just a little earthquake type movement across my still soft belly. Kinda crazy for me but I'm enjoying it and basically want to sit and stare down at a bare belly all day long just to catch the next set.

Until this point, all of the movement I've felt as been very low. Definitely well below the belly button, below any resemblance of a bump. But everything is moving upwards. It kinda seems random to all happen at one time, but now I'm getting most everything above/around the belly button.

And apparently this is my last week until I hit the trimester 3 mark. (Everywhere seems to have a different definition of when that starts but I'm just sticking with week 27.)

My pregnancy has continued to be very low maintenance with few symptoms. We'll see how we finish out...

Aside from all that fun stuff, I can't believe we have been in Pensacola almost five months. It seems like we just got here...I should probably officialyl unpack those last couple boxes stashed away in closets. We bought new bedroom furniture so I sold our old bed finally and someone is coming next week to pick it up. We basically have two rooms still operating as storage rooms (with Jake's desk set up in the side); so I'm hoping to clear stuff out and have some place to put baby stuff. Jake has had several more people from his graduating class join us in the last few days, and it's weird to be the veterans sharing our experience here so far.

I'm still trying to get used to my new schedule, or should I say lack of schedule. The job market in the area is pretty bare, even if I were looking to get a full-time job. I had hoped to build a fitness schedule and either continue more of my client business from home or find a part-time something...but again, the fitness opportunities are bare and part-time semi-communications related jobs are non-existent here. Not the area for PR I suppose. I am working from home still, teaching a couple classes, and trying to fill my schedule with other activities. But I have yet to find balance. One week I feel completely overwhelmed with everything I have (even though it is not much...at all). The next I feel like I have absolutely nothing to do (even though nothing has changed). It's just a mind set thing and I need to work on my ability to function effectively from home. (And yes, I definitely wonder if I am up for any sort of full-time stay-at-home mom gig.)

Anyways, that's about it for now. I'm going to go back to staring at my belly.