This is blog post #2 in a series of posts about the journey I am on to recover from complications of back surgery.
While I was in inpatient rehab in Silver Cross hospital, I sometimes would have calf pain. I attributed it to the fact that I didn’t walk very much and my calf muscles were tight from lack of use, so when I would walk or stand, the muscles would cramp. I also knew very well that calf pain could be a sign of blood clots — deep vein thrombosis. But since I was on a blood thinner (heparin), I didn’t think blood clots could be the culprit.
I told my rehab doctor about the pain — it was specifically in my right calf. She checked my legs — no redness or swelling, just tenderness to the touch. She ordered ultrasounds of each calf just to be safe. Ultrasounds revealed no blood clots — whew!
But the following week, I had pain in my left calf. I mentioned it to my surgeon when he came in to do a follow up. He did the same exam my rehab doctor had done a week before — no redness, no swelling, just tenderness to the touch. He also ordered ultrasounds of both calves to check for blood clots. I was a bit irritated — after all, I had this done just a week ago! I had the all clear. Why did I need to do this again?
Guess what? I had DVT — in both calves!!!!!! I was shocked! How did that happen so fast in just a week? And while on blood thinners? The doctor decided to order a CT scan of my chest to be sure none of the clots had caused a pulmonary embolism. Not long after the CT scan while I was back in my room, sitting in my recliner relaxing, my nurse came in and said I needed to get into bed. I knew that meant nothing good. Sure enough, I had multiple PEs despite not having any symptoms — my blood pressure was normal, I had no chest pain, and I was breathing normally.
I was freaked out big time about the clots. After all, everyone knows the damage blood clots can do. Plus, I was terrified of being on bed rest — how much progress would I lose by missing physical therapy? I cried — tears of fear and tears of frustration. My surgeon and now my hematologist decided I needed an inferior vena cava (IVC) filter placed to catch the DVT should they decide to move. That was placed while under twilight anesthesia (I remember none of the procedure). A small incision was placed in a vein on my right collarbone and the filter threaded through there until it was placed properly. Once it was placed, my bed rest restrictions were lifted. I was also switched to a different blood thinner. I started getting Lovenox injections. Those were worse that the heparin shots, let me tell you! Both blood thinner injections are given normally in the belly, and they can leave significant bruising. The Lovenox injections also had the added “fun” of burning like hell upon injection. I started having to have an ice pack on my belly 15 minutes before an injection to help minimize the burning. Luckily, once I was discharged home, I was switched to an oral blood thinner (Eliquis).
Maybe you have the same question I had — how did I develop blood clots while on blood thinners, especially since I have no history of blood clots? Here is what my hematologist explained: normally, after back surgery, there is a higher risk of bleeding so it is uncommon for a patient to be given blood thinners. However, since I was so immobile, they knew I would be at risk for clots so they started me on heparin, but only about half the usual dose given to typical post-surgical patients. The immobility combined with the lower dose of heparin allowed the clots to develop.
I am very glad that my couple of days of bed rest and missed therapy sessions resulted in virtually no loss of progress in my recovery. I work very hard every day to keep myself healthy and safe so that I don’t ever have to worry about any loss of progress!