Showing posts with label blood clots. Show all posts
Showing posts with label blood clots. Show all posts

Thursday, 27 June 2013

Warfarin For Deep Vein Thrombosis





Well, it's certainly been a while since my last post but that's mainly because I've been doing a lot more things due to my improved health. For a while I was on my Clexane injections which was improving my condition along with my own rehab program that I've been doing and that improved my health to some extent. However, for the last month or so I've been moved across to Warfarin as my clot has now stabilized and it has been the best decision me and my doctors have made in the last 18 months.

Warfarin comes in tablet form so I no longer have to do twice daily injections which means that my overall pain has reduced (it's now only in my leg) and my haematoma have disappeared. Although there are some side effects and complications with Warfarin they definitely out weigh the side effects of Clexane.

With Warfarin I have to be careful with the types of food that I eat and even avoid certain foods as vitamin K can really effect how it's absorbed and used by the body. Things like sweet potato, dark green leafy vegetables, egg yolks and cranberry juice are a nightmare for your INR which is the value the doctors use to monitor how thick your blood is. 

As a women you'll also find out that Warfarin will make your periods a lot heavier than they used to be. Fortunately there are certain contraceptive options that can help to control your periods by introducing more progesterone to your body which will decrease the amount of active estrogen, therefore making your periods lighter. 

Two Years Later


It's now been some time since I have made the shift from Clexane to Warfarin and it has been a rocky road trying to get a stable INR where I'm not visiting the hospital every two weeks to have a blood test. I have to say that my anticoagulant nurses have been absolutely amazing at what they do and I couldn't have done it without them as they actually take the time to know you and to make an investment in your health. I trust these ladies so much that although I have moved out of the area I still make the 30 mile trip every time just to have them look after me.

One of the things that I have learned over the last two years is that you really have to pay attention to what you are eating every single time you eat. Going about your day and not concentrating on your diet can make your life a nightmare when you have to take Warfarin. Not only will your blood tests be more frequent but you'll also be putting yourself at risk by either having too thick blood and at risk for a blood clot, or you'll be suffering from random bleeds and risk a hemorrhage; I have experience 'bleeding skin' before where you have dots of blood simply make their way through you pores because you are bleeding internally somewhere (a bunch of capillaries in my case but it could be much worse).

I also discovered that not being truthful (or even simply forgetting) with your nurses can lead to problems as well. Having an altered INR score (higher or lower than your target) is one of the most frustrating things you can go through because you will be taking up your valuable time - as well as the nurses and other patients - trying to figure out what you have done differently that week (bearing in mind Warfarin works on a 3 day schedule with your body) and then debate whether or not to adjust your medication and when to see you next to check your INR. To avoid this you need to take note of what you are eating and drinking so that you can plan this with your nurses; it's ok to change your diet (eg. going on holiday) or go out drinking as long as they know about and can help you manage your medication and keep your next test as far in the future as possible.

I have (touch wood) now been on a happy schedule of every 6 - 8 weeks where I am now in control of my diet, I'm losing weight again, and I get it eat a wide variety of food doing so. This has been about 18 months in the making but had I listened to my nurses to start with and took the time to document my food and alcohol (on the rare occasion) I would have reached this point much much sooner.

Friday, 27 April 2012

Life Can be a Pain in the Clotted Vein - Rehab: Day 24

She Canny Take It Captain! (Pretend I'm Scottie from Star Trek [Original])

I've clearly done more than I can manage this week - I'm absolutely knackered! My pain has been right up this week and my sleeping patterns have been off the rail, for example, I woke up at 10 to 9 (8.50am) this morning when I'm supposed to be leaving at 9am to get the bus to work. Well, I can certainly say that I still got to work on time but I didn't have any breakfast so I had a tummy ache with my pain killers. Needless to say I am currently not a fan of Factor V.

Pain is a Bitch (OK you can stop pretending I'm Scottie now)

For those of you out there who suffer from any form of chronic pain (pain that's lasted more than six months otherwise it's known as acute) it can be very persistent, no fun and a really pain in the ass! I couldn't get comfortable last night and this evening my muscles are just seizing up left right and centre. I'm thinking of upping my pain meds for a couple of days as it's clear that I'm not as well as I thought I was, I'm still going to go to work (for one I need the money) but I can't be galavanting off all over town like I have done this week.

I've also been getting a bit of discomfort in my chest as well. I'm not sure if it's my asthma playing up or the filter. To be honest I have been very, very, very bad with my asthma medication this week, I haven't taken my long acting filter for at least two weeks and it might very well be catching up with me - SHAME ON YOU (ME)! I think it's best to start the inhalers again tomorrow to get that one sorted, at least I'll then know if it's asthma or the filter acting up then.

Actual Rehab

I'm going to be having a good ol' stretching session this weekend to lengthen out my muscles and do some work on my thoracic spine and maybe with a roller to work out some kinks in my back and legs. As for rehab this week I've mainly been focused on getting to and from work, so walking basically. I've been averaging about 2 miles a day if I go into town afterwards (as we've established that's not a good idea at the moment) but only about a mile if I only go to work. I have a neat little pedometer (like the one below) that sits in my pocket all day counting up my milage - they're actually pretty motivational as I set myself little goals to accomplish during the day.

Side Effects

I'm getting some more side effects from my meds so on Thursday I'll be reviewing with the hematologist about alternatives even though I'm fairly sure I'm stuck with the clexane injections for at least another month. Anyway, the side effects I've been getting are:
  • Sore throat
  • Lip, tongue and mouth slits/cracks
  • Hair loss - starting to come out in clumps again (sad face here)
  • Hematoma - lumps on the injection site that get quite tender when touched at all
  • Bruising - I have a random bruise on my right (good) shin and I have no recollection of hitting it
  • Bleeding - where I'm running out of space on my tummy I'm starting to nick the artery/vein areas and draw blood from the injection site, I'm thinking of injecting on my thigh but at the moment I can't grab enough fat to avoid the muscle with the current 120mgs but tomorrow's my last day of them so I'll try on the 100mgs.
  • Mood swings - I think this is mainly to do with coming off of birth control (aaarrrrrggghhh)
Anyway, that's my little rant over. Go have a look on Amazon for funky stuff to buy (you might have guessed that I LOVE Amazon, it's just that I have soooo many vouchers for them) or go and check out some related posts if you really wanted to. For now though I am off to bed to see the wooden Indians (a phrase my Grandmother used to say when putting us to bed) and hope that Mr Insomnia doesn't pay a visit - I NEED SLEEP!!

Here are some things you might like from Amazon

 

What's your favorite thing to shop for?

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Wednesday, 25 April 2012

Is Dr House a Kindred Spirit? Rehab: Day 23.

My new addiction is House, M.D, he is my DVT kindred spirit and knows what it's like to experience the pain and muscle death that goes with it. The stabbing pains that I get seem to be coming back with greater intensity and frequency. I don't if that's because of my increased mobility or whether it's because the muscle is dying or if it's because the clot is moving around or if it's because of some increased swelling but on the other hand it could be something completely different.

I managed to walk about 2 miles today walking mainly around town. I got a text from a friend this morning saying she was stopping in the area overnight and could we meet up, well conveniently her train got in as I finished work so we went for lunch. I also managed to get a free lunch - hooray - as I paid for it with vouchers I got from completing some surveys.

I also got my M.E referral letter through today which explained that I'm now on the waiting list to see a specialist at one of their clinics. They didn't say how long it would be - I reckon at least 6 months - but that I would be getting some more details in the post soon enough. 

Work is going pretty well so far, I'll be back on the phones tomorrow talking to those wonderful customers who do insist on calling me. I had a meeting today to run through everything so far and managed to gross out my supervisor by explaining how they would clean out the vein if that's the next step - his face was priceless!

Have you ever managed to gross a boss out? Leave a comment so we can all have a good laugh!

Anyway, I better get some sleep. The insomnia is still being a bitch and not playing nice at the moment ... sigh... It's horrible being knackered and not being able to sleep. The only good thing that's keeping me going for tomorrow is that I get to wear black jogging bottoms to work - yay! My leg swells up too much for my work trousers so my left side gets very uncomfortable while I'm constantly pulling up the right side of my clothes as they're too big, hey-ho that's life though.

Anyway, sleep. Enjoy the links and go exploring on amazon, it's fun!

Things you (I) might like! Have FUN!

  


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Tuesday, 24 April 2012

Blood Clots and Factor 5 Leiden/ Rehab: Day 22

I had my scan today and from what I gather it's not looking too great at the moment. The main vein is still completely blocked from my calf to up my hip. The body will end up making new veins to cope with the loss but there's also the possibility of having muscle death in the surrounding areas - I'm not too found of being like Dr. House.

Work was pretty cool, I'm still catching up on loads of paper work, comms and product knowledge but I should be on the phones tomorrow for an hour or so just so that I can back in the game. I also found out that my holidays are all still booked so I can spend my birthday week day in Penzance with the family.

Rehab today has been walking 1.9 miles. I was planning on doing Jillian's 30 Day Shred but I'm still sore from Sunday's workout and my lats are sore from walking around on crutches - I guess it's an exercise in its own right. I think tomorrow I'll be up to scratch for another Jillian session.

My fatigue is pretty bad at the moment. I think it's because I'm doing a lot more activity than I'm used to over the last 3 months. I've been struggling to get up early but also struggling to get to bed on time, the insomnia is acting up again and I really need to get a handle on it otherwise I'll have some serious issues when I up my hours next week.

How do you deal with your insomnia episodes?

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Monday, 23 April 2012

Do not approach unless you have chocolate! Rehab: Day 21

Pain has been a bit of an issue today, my leg has been swollen and sore and my joint have been exactly the same because of the crappy weather. I hate being cold and wet as it make everything so much worse. I did manage to walk 1.5 miles today though and had a fairly productive day at work.

I really need to get organized during my day, at the moment it's a case of going to work and then coming home and doing whatever. I think with all of the writing that I need to be doing I need to dedicate a certain amount of time to each project so that I'm not wasting my time.

Tomorrow I've got a scan at the hospital to see how my blood clot is doing. I'm hoping that it has cleared a little bit, although with the pain that I've been getting I'm really not sure what's going on at the moment. Does anyone know if you get pain when a clot is being broken down? This is my first major internal clot so I have no idea what it's supposed to feel like while it's healing.

Anyway, I better get to bed with the hot water bottle. Even though I slept without the compression stockings last night they will be staying on tonight because of the cold and damp. I'm thinking hot water bottle, dressing gown, duvet and blankets for warmth tonight - over board? I think not, it's freezing here at the moment!


What is Venous Insufficiency of the Legs

Introduction and How the Veins Work

Showing correct valve flow             
Venous Insufficiency occurs when the walls or valves in a vein do not work as efficiently which means that blood is unable to return to the heart and blood may pool in the lower limbs. 

There are three kinds of veins: superficial veins, which lie close to the skin; deep veins, which lie in groups of muscles; and perforating veins, which connect the superficial veins to the deeps veins.

When you are standing up the blood in your veins must fight against gravity to return to your heart. In order for the blood to return the leg muscles squeeze the deep veins of your legs and feet to move the blood back to the heart. The valves (as shown above) keep the blood flowing in one direction, when the vein is squeezed the valves open to allow the blood to flow through and when the muscle relaxes the vein the valves close to prevent the blood from flowing in reverse. This entire process is called the venous pump.

What can Cause  Damage

If you are susceptible or have existing conditions then even sitting for long periods of time can stretch the vein walls as the pressure builds causing them to weaken and damage the valves. Other risk factors include:
  • Aging
  • Reduced mobility
  • Blood clots known as deep vein thrombosis
  • Pelvic tumors
  • Vascular malformations
  • Being overweight
  • Pregnancy
  • Sedentary lifestyle
  • Smoking
  • There are also unknown reasons too

What are the Symptoms and Complications

  • Swelling and tightness
  • Heaviness, tired, restless or achy
  • Pain while walking or shortly after stopping
  • Rashes, redness and sores on the skin
  • Itchy and flaking skin on legs and feet
  • New varicose veins

Repairing the Damage and Treatments

Like most diseases it is most treatable in its early stages. Medical professionals will prescribe a combination of treatments to help restore proper blood flow to the vein. These treatments include:
  • Compression stockings
  • Regular exercise
  • Lose weight
  • Elevate your legs when sitting and at a 6 degree angle when sleeping
  • Antibiotics to treat skin infections
  • Take care of your skin - keep it moisturized so that it doesn't crack and become susceptible to infections.
  • Blood thinners if you have blood clots
  • Sclerotherapy - by injecting a solution in small varicose veins they will collapse and disappear which can eliminate pain and discomfort and prevent further complications such as ulcers.
  • Endovenous thermal ablation - a laser or high-frequency radio wave to create heat is used on a vein and by doing so causes the vessel to close up. It is non-invasive and has a quick recover time for the patient.
  • Ligation - a vein is cut and tied off but requires surgery
  • Stripping - the larger veins are remove through two small incisions and requires up to 10 days recovery after surgery.
  • Microincision/ambulatory phlebectomy - small incisions are made over the veins and a phlebectomy hook removes the vein.
  • Vein bypass - a healthy vein transplanted from another area of the body is used to reroute blood from the affected area. 
Ideally the problem will be caught in its early stages and surgery would not be necessary. However, if previous treatments have failed the opting for a surgical procedure can really improve the quality of life for a patient.

Have you ever suffered from, or are suffering from venous insufficiency? Leave me a comment with your experiences.

Useful Books and Aids




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Sunday, 22 April 2012

Rehab: Day 19

I didn't really get up to much today. I went shopping in the evening and only managed to walk 0.37 miles. I've been getting some really bad pain in my ankle, calf and knee so when I have my scan on Tuesday I want them to look at the veins and arteries just to check if there are any other clots there, old or new. Something isn't right at the moment and the pain is getting so bad it's breaking through the Tramodol barrier.

I'll be resting up nice and easy tomorrow probably with some cycling or some Jillian thrown in there whilst I'm sat on my exercise ball.

Saturday, 21 April 2012

What is Post-Thrombotic Syndrome?

CC courtesy of Mr Thinktank, Flickr
Post-thrombotic syndrome is a condition that is often experienced by patients who have experienced a deep vein thrombosis. At least 50% of DVT sufferers will go on to experience leg pain, swelling, fatigue and sometimes skin changes including open sores and ulcers.

PTS is caused by the vein becoming damaged due to the clot. Quite often what will happen is that the liver will send out a series of enzymes to break down the clot but the body will also convert the clot into scar tissue which ends up narrowing the vein causing these problems. Contrary to popular beliefs the anticoagulants like warfarin that the patients are given do not break down the clots they merely serve to thin the blood to prevent further clotting.

However, the Society of Interventional Radiologists are looking at minimally invasive treatments to improve blood flow and quality of life for patients who suffer from post-thrombotic syndrome. In a recent study over 93% of patients who had undergone the procedures had a significantly improved symptoms and quality of life.

The procedures that they are investigating include angioplasty which is the insertion of a small balloon in the blood vessel under X-ray guidance to the blockage. The balloon is then inflated to open the blood vessel. Another procedure used was stenting, which is the insertion of a tiny mesh tube to hold the vessel open and used drugs that are inserted through a catheter in the blood vessel to dissolve the clot and restore blood flow (also known as thrombolytic therapy).

Although these procedures are not common place at the moment we can hope that as awareness of PTS is increased more doctors and specialists will recommend these procedures to PTS patients so improve their quality of life.

What are your views on these procedures?

Related posts:

Thursday, 19 April 2012

Rehab: Day 17

Today wasn't particularly exciting, I spent most of the day making phone calls chasing up sick pay, fit for work notes and prescriptions. I managed to get down the steps with only one crutch today and up the stairs without. I didn't do much today as I had a rough night with episodes of cramps in my bad leg so along with the dvt pain I've had cramp pain to contend with as well - not great for rehab.

My recovery from 30 Day Shred has been pretty quick, my upper body is only a little weak and I wasn't as tired as expected. My fatigue is taking on a deeper hold so I'm going to have to start rest more, especially as I am going back to work tomorrow. Although it is only for 3 hours I'm fairly sure it is going to take it out of me by the time I get home.

What are your favorite rest activities? Movies, reading, painting, music? Let me know in the comments.

Tuesday, 17 April 2012

Rehab: Day 14

Pretty good day yesterday, I popped into work to get a load of paper work done. If my meeting on Wednesday goes well I should be returning to work part-time as of Friday. My bosses plan is to do 3 hours a day for one week, 4 hours per day the next etc until up back up to normal hours, now unless my OT (occupational therapist) says anything different that's the plan.

I'm absolutely knackered though, I walked 1.5 miles through the wonderful sun and parks from the bus stop and back. I think my insomnia should start to resolve itself again once I start going to work again as I'll be so tired that I'll just have to sleep, there wont be any doubt about it!

My clexane injections are giving me a bit of jip and the moment but it's because of a really good reason: I've lost weight. As you know (if you've been reading these posts) the injection has to be done in the fat on my lower tummy. Now, the problem I'm having is that my tummy is shrinking and I can't grab as much fat as before, this is causing a lot more bruising than normal and making it more painful as the needle sometimes goes into the muscle depending on the sight: that hurts sooooo much it really makes my eyes water and foul noises come out my mouth. Luckily I'm now decreasing my dosage because of the weight loss - yay!! Today I'm on 120mg in the morning and 100 mg at night, then 120mg in the morning and 80mg at night for 10 days then I'm on 100mg until they switch me over to Warfarin. I'm 'looking forward' to the 100mg, they should be easier to do compared to the 150mg they had me on initial and hopefully there wont be as much, bleed, bruising and pain.

I had a pretty rough night though. I had to put the compression stockings on again as my legs we killing me and I think tonight I'll need some more elevation. Even though the doc said that I can remove them at night I'm going to keep wearing them until the vein has recovered a bit more - I'm suffering from veinous insufficiency at the moment which means that the valves are damaged and don't work properly, but I'll be putting a separate post up about that as it can get a little complicated and is fairly interesting for health/biology nerds.

Anyway, that's enough for now I've got to get ready for Terauchi Sensei's course. I'm not training as I'm still too weak but just going to show my face and meet up with everyone.

Sunday, 15 April 2012

What is Heterozygous Factor V(5) Leiden Mutation?





CC courtesy of Valerie Everett, Flickr
As promised I'm going to try and explain what this genetic mutation is. Before I can explain what is actually 'wrong' with me I'll need to give you all some background information - I'm sure you remember you school days biology.

How Clotting Works - Background Information

The body's clotting mechanism is triggered when there is trauma to a blood vessel. The liver will make and release a variety of clotting factors into the blood stream along with platelets from bone marrow (made and released in the pelvis and breast bone). These clotting factors and platelets will then travel to the the damaged area where they will interact with each other and form a blood clot to repair the wall of the blood vessel. Once the damage is repaired the liver will make and release anticoagulants (clot busting enzymes) that travel to the clot, bind to it, break it down (dissolve it) and normal blood flow returns. 

What is Heterozygous FVL?

The naturally occurring anticoagulant Protein C works by attaching to a receptor on the surface of one of the clotting factors known as Factor V (there are 13 in total); this is part of the dissolving processes of a blood clot. The FVL mutation is a genetic condition associated with an alteration of the receptor on the surface of Factor V meaning it is relatively resistant to the effects of Protein C: it takes longer to break down the blood clot - imagine trying to put to bits of jigsaw together that don't quite match.
FVL was discovered in the 1990's in a town called Leiden in Holland. Heterozygous means that there is 1 inherited abnormal gene from 1 parent and one normal gene from the other. This form of FVL is seen in 5-8% of the UK population. It is inherited in a autosomal dominant fashion meaning that your own children will have a 50% chance of having the abnormality.

What are the Risks?

Being heterozygous for FVL increases the risk of blood clots by 5-fold, for women on the oral contraceptive that increases to 34-fold. The greatest risk of a DVT is after surgery and long haul flights.

What is the Treatment?

Compression stocking if you've already had a DVT, you're going in for surgery, or if you're going on a long haul flight. You may also need to take daily doses of an anticoagulant, which slows down the body's ability to clot. I personally need to take Warfarin for the rest of my life as well due to my previous medical history.

So there we go, as promised, my explanation of Heterozygous Factor V Leiden Mutation. I hope your brains haven't turned to mush. If you have any questions leave me a comment and I'll answer as best I can. 


Friday, 13 April 2012

Rehab: Day 10

CC courtesy of net_efekt, flickr
Yesterday was yet another hospital visit. My rehab involved walking a couple of miles and getting some long needed sunshine.

I do have some brilliant news though!!!

I HAVE AN ANSWER!!!!!

After 4 years of searching we're finally starting to get somewhere and it only involved nearly dying to get there. Although on reflection I'd prefer the near death experience and get some treatment than feeling like crap for the rest of my life.

So, the answer to some of my problems is a genetic mutation on a chromosome called Heterozygous Factor V (5) Leiden Mutation - bit of a mouthful huh? It basically means that my body has issues breaking down clots. 

Since I'm too tired from celebrating, being stabbed (injections and yet more blood tests), and walking around I'll be writing another post later on with a lot more information - how I got it, how do I treat it etc.

Catch you people later - and go celebrate for all the good things in life!! 

Thursday, 12 April 2012

Rehab: Day 9

CC courtesy of Tayrawr Fortune, Flickr
This is how my stomach feels. The bruises aren't that dark, they are still light red - yellow but the skin underneath is so sore. I'm rapidly running out of places to inject, I might have to start using my inner thighs but that is a risk for the clots that are there - what would happen if I nicked the major vein in my groin?

My planned rehab for yesterday just didn't happen because I felt so rough. Then pain was starting to come back in my left leg so I have returned to my stated dose of pain meds, clearly now is not the time to be reducing. I did, however, end up going out for an impromptu lunch with the other half and his uncle which was nice. I ended up having a small walk whilst we were looking for somewhere to eat so I don't feel that guilty about missing some rehab.

I'm going to the hematologist at the hospital today for my pre-op consultation. I really don't want them to take out the filter, I feel so much safer knowing that there is something preventing my death if a bit of clot comes off. I also need to talk to the about the heavy periods and sore stomach - there has to be a solution to these, I can't go on forever like it, it's just not possible.

I'll provide an update with the hospital, returning to work, and how my rehab went either later or most likely tomorrow.

Have a great day!  

Friday, 6 April 2012

DVT Rehab: Mobilization

You've just been diagnosed with a blood clot (DVT), got into a routine with your meds and may have been bed bound/on bed rest for a little while (in my case 11 weeks). You're probably wondering when can you start getting up and about so that you can get on with your life. I'm afraid the answer is only after clearance from your health care provider; once they are happy you can begin the road to mobilization.
Depending on how bad your DVT was - including another complications like pulmonary embolisms - will depend on what kind of fitness and mobility you have to start with. I'll be writing from my perspective which was pretty dire to begin with. On my first day of mobilization I could just about hop from my bed to chair; the chair was next to the bed and I essentially did a swivel bum movement. As I got some strength and appetite back and began to increase my activity - washing myself, going to the bathroom on crutches etc - I thought about why mobilizing as early as possible can be the best form of recovery: lying in bed all day is going to do very little to help you get your life back.
On my short escapades to the bathroom (unassisted I might add) I came up with the following tips:

Benefits of Mobilization
  • It increases the circulation
  • Improves the health of the distressed vein (the one with the clot)
  • Improves your lung function - this will have severely decreased if you've been bed bound
  • Increase your fitness - again this will have decreased from being bed bound
Tips for Mobilizing
  • Don't push yourself - at the first sign of fatigue or pain stop immediately and elevate your limb as this will help to flush the blood back to the heart. If your pain doesn't get better then see your health care provider straight away
  • Time your activity - I find doing my activity a couple of hours after my pain med is the best time
  • Drink plenty of fluids - as your fitness increases you may begin to sweat more
  • Rest - after your activity rest your limb so that it has a chance to repair and recover
Options for Increasing Mobility
  • No more than strenuous walking - don't go running straight away and if you get pain/fatigue stop, rest, elevate.
  • Cycling - this is great for increasing your range of motion and increasing the strength in your leg
  • Swimming - a non-weight bearing exercise that increases circulation and improves cardiovascular fitness.
Now of course you shouldn't be doing any of this without being cleared by your doctor and you would have (preferably) some physio sessions before hand to make sure you are will enough to be on the road to rehab. Don't forget to wear those sexy compression stockings as they help with your circulation.
If you have any other tips for rehab or want to share a story leave me a note in the comments, take care.