Tuesday, June 11, 2013

Listen to you body

I’ve been hesitant to write this post until after I had more information and to be honest, it’s a little embarrassing, not sure why I feel that way but I do.  However, I’m going to lay it out there.  I feel that athletes are in tune with their bodies in a different way than the average person.  Because we put stress on our bodies through training we usually know the difference between something being sore from a workout and an injury.  Last week as I was up and about, off crutches and back to exploring the world, my calf began to ache again.  I’ve had calf pain associated with this injury since going to California, which was week 1 of my injury.  My doctor thought it was part of my initial injury as all of the tendons connected to your ankle and foot go up through your calf.  Last week on Wednesday, I knew there was something really wrong.  My calf and behind my knee were excruciating.  I had been able to walk in the boot with minimal pain and now I was back to literally crawling on my floor to get to the bathroom.  I called the doctor and made an apt for Friday.

When I got there he did all sorts of tests on my knee to make sure I hadn’t torn anything in my knee from the original injury or from walking in the boot.  When I said my knee felt fine and that the only pain I was experiencing was from the pressure of his fingers on my calf during the test he said that he would look via ultrasound at my leg.  He said that as a sports medicine doctor he’s not trained to look at veins/arteries but that he would take a look.  He and two other doctors including the head of the sports medicine clinic all reviewed…and agreed that I needed to go straight to the hospital for a vascular ultrasound to be checked for a DVT.  DVT is a deep vein thrombosis, aka a blood clot.  I went straight to the hospital for my scan and was told that I sure enough had blood clots (yes, multiple).

I had suspected a blood clot after traveling to California but I had none of the symptoms except pain.  I wasn’t swollen, my leg wasn’t hot…I also had few of the typical risk factors, I’m not a sedentary person (I’m a triathlete!), I’m not obese, I don’t smoke, I don’t have a family history of clots.  I did have a few risk factors: broken bone/immobilization via crutches and non-weight bearing, travel and birth control pills.  Let’s just say suspecting a clot and being told you have one(s) is not the same; the latter is much scarier.

After a call from my sports medicine doctor and my primary care doctor (who is handling follow up, I really like her so at least I’m being treated by someone who I already know and like), I knew a lot more about the clots.  I have four clots in the distal femoral vein, which starts at your groin and goes all the way to your ankle.  Mine are located in the popliteal vein (behind the knee), gastro vein (in the muscle of the calf) and the other two are farther down…in the posterior tibial and peroneal (in the calf but closer to the bone).  The good news is they are stable looking and not in the thigh.  The risk with unstable clots and ones that are higher up is you are more at risk for a pulmonary embolism (aka when a part of the clot breaks loose and travels to your lungs or brain both of which can be fatal).  Sound scary?  Well, it is!  I’ve spent a lot of the last 5 days thinking about how this happened to me since I’m a healthy, active, 30-year old and being scared out of mind since this is clearly not something to mess around with.  I’m freaked out that even after the clots dissolve (which they will in time) that I’m now at a much greater risk for reoccurrence.  This means I can’t really sit for long periods of time, I can’t go back on the pill for birth control, if I ever get pregnant I will need to monitor how my body reacts, etc.  They are currently doing a full blood work up to test for all kinds of things (including a bunch of other scary sounding stuff like blood clotting disorders, blood disease, blood cancers, etc) which will inform my chances of reoccurrence.

My treatment plan, until they get the blood test results back is a super fun shot (in the abdomen, thank goodness for an amazing husband b/c I couldn’t give myself the shot) and pills.  I get my blood levels tested two to three times a week for several weeks until they get to me to the right level of INR (international normalized ratio which stands for a way of standardizing the results of prothrombin (aka clotting) time tests).  Talk about being thrust into the medical world very fast.  I am usually just a once a year to the doc kind of person but I’m going to get very familiar with the doctors office.  Couple of things with the medication: 1) I have to be very mindful of what I eat, foods high in vit K (including my coveted lunch salads, broccoli, kale, etc) actually help the blood to clot so I have to be consistent in how much of these items I eat to ensure the medication levels are right; 2) as an anticoagulant I have to be careful and monitor any bleeding that should happen as I am at increased risk for bleeding out…but only in extreme circumstances such as head trauma; 3) no alcohol and limited caffeine (I’m not a huge drinker but depending on how long I have to be on this medication, no alcohol really?!?!  Caffeine is the much more important problem here.  Coffee, I love it.  I’ve been allowing a few sips in the morning to help prevent massive caffeine headaches but I’m getting those too.  Plus, with the lack of sleep due to the pain I need my coffee!  Unlike the studies on alcohol which all point to no-go the studies I’ve read on caffeine are a little looser, I’ll be asking my doc about this one for sure).  The length of time I have to be on the medication will vary, if my blood tests come back negative for the scary(ier) stuff my length of time on the meds is 3-6 months; if anything is positive they will reevaluate depending on what is positive.

So, what does this mean for being a triathlete?  Not sure yet.  If the scarier stuff gets ruled out, it’s possible that I will still be able to train for races this year, exercise is a good thing.  Right now everything is pretty painful, except swimming.   Also, I do still have a fractured foot so I have been careful not to screw that up too much.  I have transitioned out of the boot, recommended by the doctors, into a shoe with an ankle brace.  My foot at the fracture site does get achy but there are other aches in the foot which I’m keenly aware of and am hoping are not stress fractures!  If they get worse, I’ll be having those checked too.  Needless to say, training is kind of the last thing on my mind.  While I am do really really want to get out there, I’m focused on getting myself healed first.  As time goes on I’ll know more how things will go.

At the end of the day, if you read nothing in the post, I hope you read this part…listen to your body, you know yourself better than anyone.  If you think something is wrong push the doctors for more answers or testing, especially if the test is non-invasive.  I wish I had insisted on the ultrasound when I first noticed the calf pain, despite not having any major symptoms I wish I had insisted.  Listen to your body and trust your instincts.