Day Twenty

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Pulmonary Embolism Recovery
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Met with my family doctor and the results of the liver enzyme tests were encouraging:

AST = 48 (normal 5 to 47 IU/L
ALT =201 (normal 7 to 56 IU/L)

A few days ago when I went to the ER for the second time, Saturday May 19, they were:

AST = 146

ALT = 301

I've been off the Lovenox since last Thursday and only been taking Coumadin. It hasn't been a full week since I've been off the Lovenox, yet my liver enzymes are still high(but decreasing).

 

Evidently, Lovenox is the culprit behind the elevated liver enzymes. This should not be a surprise, since there is ample evidence and documentation pointing to Lovenox causing liver problems. Google for "Lovenox liver enzymes" and you will find a lot to read.

Bad stuff, this Lovenox. But, essential for what the doctors like to call anticoagulant "bridge therapy"; whereby Lovenox is used for a few days until the Coumadin kicks in(which takes 2-4 days for full effect). Those few days on Lovenox can hurt your liver. 

I will be going back for blood tests on June 4 and meeting with my family doctor on June14@11:15AM. Hopefully, the liver enzymes will be back to normal by then.

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Theory of Clot being caused by arm clot from anesthetic IV(see yesterday's post)
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My  doctor didn't rule it out, but said that "superficial" clots in the forearms are typically not problematic, unless they work their way into the deep veins of the underarm. Of course, there's no way to prove that my forearm clot worked its way up the arm. My doctor still clings to the notion that the clots came from the surgical area due to pressure applied to an artery by someone in the operating room.

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Hernia Recovery
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I overdid it yesterday, having walked over 1/4 mile on a trail near my house. I was in a lot of pain(burning and pulling) from the incisions and had a difficult time sleeping last night; even after taking 5mg of oxycodon.

Day Nineteen

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Pulmonary Embolism Recovery
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Something interesting happened to me a few minutes ago and it may shed light into what's at the root of my bout with Pulmonary Embolism: 

About 15 minutes ago I was chatting with my neighbor, an RN who a few years ago worked with the surgeon that did my hernia surgery, and she told me that some time back she had a clot in her left forearm. The clot occurred after she received the anesthetic Propofol for a particular procedure.

She describe how the "clot" formed as a ball on her forearm, a few centimeters from where the anesthetic had been administered. The ball was about quarter sized, hurt a LOT and was "hot" to the touch.

Interestingly, I had the SAME experience! This happened on day five after the surgery. This is my post on Day Five:

The first setback that I notice is a lump on my left arm, where the IV was inserted. Not necessarily on the spot itself, but a bit further up the arm from the original point of entry for the needle. There is no color to the lump, but it hurts a LOT!

By night time, the pain in my left arm is unbearable; and this after applying multiple ice bags.

Although I didn't post it on Day Five, the lump was very hot to the touch!

My neighbor said that she had an ultra sound to check whether the clot had traveled up the arm; but it hadn't. I didn't have an ultrasound done because, frankly, I didn't think it was a clot! I thought it was a slight infection from the IV/anesthetic and nothing to worry about.

However, the very next day after having this pain in my arm I begin to feel the effects of the Pulmonary Embolism. Could this be a coincidence, or is it the root of my PE?!

Blog post from Day Six:

10:30PM - A *NEW* pain comes into the picture!

While lying down on the couch I feel a stabbing pain on the left side, below rib cage. The pain is excruciating! I can't even take a shallow breath without the pain causing me to scream!

I feel comfort when putting pressure in the area and I'm able to pass gas and burp. Evidenlty, the pain is due to trapped gas.

Sady, the pain lasts another hour and I am finally able to go to bed at 11:30PM, when the pain is tolerable.  

Could the lump in my arm be the culprit clot behind my Pulmonary Embolism?!

I'm meeting with my doctor tomorrow. Let's see what he says.


Went for blood work today with the goal of getting my liver enzymes checked. Tomorrow I have a doctor's appointment and will know if my enzymes have shot up or down. The measurement will determine whether or not I will keep taking Coumadin(see post from Day Sixteen for more details). 


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Hernia Recovery
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I went for an even longer walk today, covering at least 3/4 miles round trip, along a trail near my house. It was a warm, clear day and a perfect day for a walk. I'm a bit sore, but each day I'm getting better.

Day Eighteen

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Pulmonary Embolism Recovery
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NO blood at all in my sputum. This is the first day since my hospitalization for Pulmonary Embolism that I don't have any blood in my sputum. One positive, at least.

My left lower to mid back still hurts. Feels like muscles aches, but I'm worried that it's kidney-related. After all, the ER doc told me that the ultra sound showed that I have "enlarged kidneys".

I will know more on Wednesday, when I meet with my family doctor.

Continue taking Coumadin at 4PM.

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Hernia Recovery
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I took a long walk today. The longest since the operation. But, I was sore. I still feel burning in the area of my incisions and I take one Oxycodon 5mg tablet after my walk.

Day Seventeen

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Pulmonary Embolism Recovery
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No pain in my left side and little to no blood in my sputum.
Continue taking Coumadin at 4PM.

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Hernia Recovery
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I felt well enough to do some isometric and rubber band exercises. I felt a little sore later on in the evening, but it was well worth the effort. I felt like my body needed a workout.

Day Sixteen: Back to the EMERGENCY ROOM!

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Pulmonary Embolism Recovery
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I woke up with a pain on my left side, running from my left oblique muscle all the way to the middle of my left shoulder blade. The pain was so great that I went to the ER, again!

They did an ultrasound of EVERY organ to ensure that I don't have any clots in any of them. No clots were found and the doctors concluded that the problem is muscle spasms.

However, a significant problem was found during the blood testing: my liver enzymes were VERY HIGH!

AST = 146

ALT = 301

The doctors believe that the Coumadin is the culprit, but it could also be the Lovenox, which is known for raising liver enzymes.

This is problematic. If Coumadin is toxic to my liver, I will not be able to use it! I will need to go on another medication, but all others seem to have a worse reputation than Coumadin.

Doctor recommended new liver tests within a few days to see if the numbers go down. If they do, then the culprit is most likely Lovenox(which I stopped taking 48 hours before the blood test in the ER).

I really hope it's the Lovenox!!!

If that weren't enough, one of the ER docs, as he was walking out the door and telling me that I was being released from the hospital, said to me: "Oh, we did find that your kidneys are enlarged....but, we didn't find anything pathological."

WHAT?! ENLARGED KIDNEYS! Could this be why my lower back hurts?! The doctors insist that the problem is with muscle spasms and NOT with the kidney/s/

My "simple" hernia surgery is getting more complex by the day :-(

Day Fifteen

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Pulmonary Embolism Recovery
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First meeting with my Coumadin manager; a very nice and well-informed nurse practitioner.

He had the results of my Hypercoagulation tests, which indicate my genetic predisposition for coagulation problems. All tests were negative, except for one: Factor VIII, which was at 200% and should not have exceeded 150%.

However, the good news is that Factor VIII is not a reliable measure if the blood sample was drawn from a patient recently diagnosed for Pulmonary Embolism. This article shows how Factor VIII can decrease if the test is done a few months after the Pulmonary Embolism event.

I will ask my doctor to redo the Factor VIII test after my six months of Coumadin treatment. Hopefully the number will be lower than 150%!

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Hernia Recovery
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Not much change from the day before.

Day Fourteen

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Pulmonary Embolism Recovery
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Less blood in my sputum. I'm happy about that!

Today is my last dose of Lovenox at 9PM and moving forward I will only be taking Coumadin.

I meet with my family doctor who confirms that I did NOT have a DVT(deep vein thrombosis), hence a DVT was NOT the source of my Pulmonary Embolism. He was certain that the root of the clots was pressure applied(by someone in the operation room) to an artery during the surgery.  Hearing this didn't make me very happy.

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Hernia Recovery
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Each day I feel a little less pain, but progress is slow and I'm not moving around nearly as fast as I'd like to.