About this BLOG

The purpose of this BLOG is to summarize the treatment of my medical condition known as a DVT. This is the second occurrence of this condition for me. The first one was about 12 years ago.

History

I had been feeling the signs of this DVT for a few weeks, but didn't realize what it was. I was having a familiar feeling of dullness and heaviness in my leg. Eventually I could feel pain when I pressed on the spot just above my right calve on the inner rear side. This is in a different spot than my previous episode, which was in the lower calf (same leg).

Triggering Event

I suspect that my activities on May 4th my have started this DVT. I did the Mulholland Challenge that day, which is a 100 mile bike ride, with 12000 feet of climbing. The temperatures were in the 90's and I got severely dehydrated. Immediately after the event, we got in the car for a 2 hour ride home. I contend that the dehydration, which results in a thickening of the blood, combined with the reduced blood flow that is the result of sitting immobile, started the clot. It was a few days later that I started to feel the symptoms.

June 3 Initial Prompt Care Visit

After describing my symptoms, I came back later in the day for an ultrasound test to confirm my condition. The test showed both an SDV ("S" is for superficial) and a DVT a little lower in the leg. An internist was consulted and I was given two options:

• Option 1 : Check into a hospital few several days and receive Lovenox injections and coumadin. These are the standard blood thinning drugs given for DVTs.


• Option 2: Stay home, and administer the Lovenox injections on my own, and start coumadin under my doctor's care.

I selected Option 2.

Blood was also drawn for some testing, and I was sent home with a prescription for 10 Lovenox injections, and was told to come back for a follow-up the next day. The Lovenox is a fast acting blood thinner, as opposed to coumadin, which takes several days to kick in.

Later that afternoon a family friend of ours (Pam) who is a nurse, trained me on how to inject myself. I gave myself the 1st injection that evening in the stomach area. It was very easy. I spent the remainder of the day with my leg elevated, with a heating pad on it.

June 4 Follow-up Visit

The results of my blood test were reviewed by Dr Ohashi. He noticed that my hemoglobin numbers were a little low (13...down from 15 from a test taken in 2006). He requested a stool sample to see if I was bleeding internally

He gave me a prescription for coumadin (5MG) which I began taking that night. Below are my medications.

June 6 Follow-up Visit

I returned the stool sample and it was negative for blood. I saw Dr. Ryan, as Ohashi was out. He had additional blood drawn for an INR test, and additional tests to understand why my blood clots at a higher than normal rate. The INR test measures the blood's clotting ability. It is required so that the coumadin amount can be adjusted to bring the INR up to around 2 or 3.

I had always thought that this issue is related to a defect in my vascular system. But the doctors seems to think that the problem is with my blood chemistry.

I am continuing to take the Lovenox and coumadin. My leg feels much better. The swelling is already reduced, and the feeling of heaviness/dullness is much less.

June 7 INR Test Result

I received news regarding my INR level from yesterday's blood test. I am at 1.14. I need to be at 2 to 3, so they told me to up the coumadin dosage from 5MG to 10MG.

June 10 Follow-up Visit

On-the-spot INR test indicates a 2.4 reading. This is in the zone. Was instructed to lesson the dosage from 10MG to 7.5 MG. Scheduled a follow-up appointment for June 12 @ 11:00 AM.

Discussed with Ohashi that the low hemoglobin numbers could have been from the blood donation that I did about 4 days prior to that test. Most recent blood tests show that all is about normal. Mentioned hemochromatosos. Not a problem, as far as my blood tests are concerned.

June 12 Follow-up Visit

I cancelled this appointment. It was too soon after the previous appointment. Will get a blood check on the 17th.

June 17 Follow-up Visit

My INR blood test was 2.1, which is in the desired zone. I will stay at 7.5 MG of coumadin. I was given an authorization slip to get an additional blood test that measures clotting factors.

July 1 Follow-up Visit

INR blood test shows 2.6 which is close to the goal of 2.5, so the coumadin level is on target.

Now for the interesting part. I received the results of a blood test for the amino acid homocysteine. It is higher than normal at 18.3, when normal is 3.7 to 13.9. High levels of this are linked to blood clots. This could be the explanation for my condition. Unfortunatley, it is also related to otherwise healthy people dropping dead with heart attacks!

The good news is that the homocysteine level in the blood can be lowered by taking folic acid, which is in vitamin B complex. So I am to start taking 2 MG of folic acid per day, and will be have another homocysteine level test in about 6 weeks. Go here for more information on homocysteine. Go here for a more detailed article.

A note for family members: This condition of elevated homocysteine is hereditary, so at your next physical, have your doctor order the test for this condition.

September 2 - Final Checkup

Homocysteine level is now in the normal range (12.3). Ultrasound revealed that the clot has been reduced from 3cm to 0.7 cm. I will finish out my coumadin persription and am considering this incident to be closed.