Blood Thinners, Anyone?

Pulmonary Emboli

I couldn't let today go by without acknowledging an important one year anniversary.  Woohoo! Let's celebrate!  On this day, one year ago, I learned that I was the proud owner of "a shower of pulmonary emboli." They're gone now (at least, I think they are... once you do treatment, you don't actually test again unless you have symptoms!)  Thanks to six months of miracle drug Eliquis - a blood thinner that meant I bruised if I came even close to bumping into furniture - my lungs are back to functioning.  So now that the scare of having blood clots in my lungs is gone - and since this 2022 paper indicates that having COVID-19 can increase your risk of having a blood clot (deep vein thrombosis or pulmonary embolism), I figured I would share my story in case anyone notices anything related.  Here it is.

Before my parents got sick from COVID, my mom was pretty sick for all of 2020.  She was having regular blood transfusions and her physicians couldn't figure out why her iron levels kept dropping so low.  There were many months of hospital visits during which she had to go alone because of COVID.  She really hated that.  Anyways, feeling very helpless for my mom's medical condition, I started to donate blood.  As a non red meat eater, I had tried donating in the past, but had always been rejected from my own anemia. I knew I couldn't possibly provide as much as she needed - plus we weren't even the same blood type and lived 3,000 miles apart.  I know she appreciated it because we texted back and forth at our appointments and she shared what she was going through. Maybe someone else's mom got my blood in Seattle and their daughter was donating in Florida. 

Click to Donate Near You!

Anyways, I went to donate blood in early April 2021. As usual, first they checked my pulse and heart rate, and my pulse quality was OK, but my heart rate was 120. (Normal resting heart rate should be between 60-80 bpm so all these readings are high.  Maximum heart rate can be estimated by 220-age, so the maximum my heart rate should technically get is 184).They decided to check my iron and if that was good, they would give me 10 minutes to get rid of the "white coat syndrome" - which I guess sometimes even health care providers have, where your heart rate or blood pressure goes up because you're anxious at the doctor's office - but which I've never experienced before.  My iron was way too low to donate, so the nice lady at the donation center told me I should make an appointment to see my PCP.  I thought - no way! This hadn't happened since I started donating blood the year before, but my iron was often too low when I tried to donate in high school and college. I figured I didn't eat enough dark chocolate or spinach that week.  After all, the timing of this blood donation was in my third week back to work after being on FMLA and my grief felt like heavy fatigue for weeks.  I just went home, rode my bike for 20 minutes, and made a turkey burger for dinner. 

A few days later, I was walking up a flight of stairs with a coworker when he asked me if I was ok.  We had walked into work together many times before, always taking the stairs, so for him to notice my breathing was surprising to me.  I thought maybe I was breathing differently with the mask I was wearing that day, but I didn't feel bad otherwise. Thinking about the failed blood donation, I grabbed the clinic pulse oximeter and my heart rate was again in the 120's.  I felt fine, so I continued the day, treating my patients, not really noticing anything.  The next morning I showered, got dressed, and was tying my shoes and with the bending over motion, felt instantly short of breath.  I checked my heart rate by hand, but didn't believe my own count so of course I dug out my own pulse oximeter and my heart rate was in the 130's. Having a quick moment of panic, I recalled my dad having a heart attack when I was eight - he was 48 - and thought - maybe I should get this situation checked out.  So I hopped onto my PCP's patient portal and made an appointment for later that afternoon and went to work, figuring it was too late to cancel my morning patients and if I wasn't moving, I felt ok. 

At work I took the stairs again, but this time, when I got to the top, I had to sit down, unmask, and catch my breath. I was sweating and had a little bit of pain between my shoulder blades. Something definitely wasn't right. I told my boss right away that I needed to cancel my afternoon patients to see my doctor and explained what was happening.  It only took demonstrating one repetition of a 15 pound goblet squat to a patient for me to know it was getting worse.  I finished my patients, sat down to write my notes, rechecked my heart rate at my desk - now 154 - and felt the veins in my neck pulsing.

As previously mentioned in other blog posts, I have a BFF who is an emergency medicine physician. Everyone should have doctor pals they can call in an emergency... but this still didn't feel like an emergency.  Still, I called her as I was driving to my doctor's office and she advised me to cancel my appointment and tell them I'm going straight to the Emergency Department.  Then, instead of going directly to the hospital, I should go home, get my cell phone charger, a hoodie, maybe some pajamas,  my toothbrush, and a book, and then go to the hospital.  (If you EVER need to go to the emergency room and have enough time to make these sort of decisions, bring your cell phone charger!).  She also wouldn't hang up the phone until I got there.

The walk from the parking lot into the emergency room left me drenched in sweat.  The lady at the

waiting on CT Scan

check in desk asked me the COVID screening questions, none of which applied, but since I was sweating, she didn't believe that I might not have just had a fever breaking.  So she asked a nurse to come take my vitals right away, heart rate still in the 150's, but since my temperature was normal, I could sit and wait in the lobby.  It was a long wait.  Honestly, without moving, I could still feel my heart racing and some aching between my shoulder blades, but otherwise I didn't feel that bad.  When they took me in for my exam, the physician asked me what I thought was happening and I told her I thought I had a pulmonary embolus but that it was weird because I didn't really have any chest pain.  S

The next moment could have gone so differently, but instead of just shrugging off that I'm "just" a physical therapist, she asked me to defend my own diagnosis. I explained that my schooling educated me enough to know that if I saw a patient that described these symptoms, I'd be worried, but that one course in the cardiopulmonary system in grad school and another in college made me far from an expert.  I explained that I had flown across the country five times over a three week span just a few weeks prior without any hydration and immediately following my vaccinations and under intense stress.  (At no time did anyone, including myself, think that my vaccination caused these blood clots.  However - I did get sick from the vaccines, likely because I was not willing to unmask to drink any water or eat anything on my flights immediately following them. Plus grief.)  She asked if I took birth control, because "the chance of clots is 2 to 6 times greater among women taking the pill compared to those who don't use birth control" and when I said yes, for nearly 20 years, she felt confident that blood clots were the appropriate place to start the diagnostic hunt.  Let me tell you - some people get REALLY awkward talking about birth control.  I am not one of those people.  Three different medical providers AND a social worker came to discuss birth control with me.  I'm not sure why it was like that... but I do think we probably should be educating teenagers more about this risk if they're considering mixed hormone oral contraceptives, just so they're educated.  Maybe my doctor told me about this risk when I was 18... for sure I do not remember. 

The doctor applauded me as a healthcare worker listening to their body because I guess that's something we're really bad at doing.  I did wait several days, I guess, but it for sure could have ended much worse.  She felt that my assessment was reasonable, so after a Covid test, which was negative, we proceeded through a chest X-Ray and D-Dimer blood test.  When the blood test came back positive, there was a chest CT Scan and then a diagnosis of "a shower of blood clots" in my lungs. I was on blood thinner medication six hours after leaving my desk and held on observation in the hospital for the night.

At which time I finally called my sister in Connecticut and my brother in Washington, D.C., and told them where I was. Let me tell you - being alone in the hospital because of COVID restrictions limiting guests is horrible.  I didn't want to tell too many people where I was or make a big deal out of it because we had identified the problem and medication had been started.  The doctor told me I would feel better fairly soon, and I was back at work five days later with a 20 pound lifting restriction.  I spent my down time searching for research papers about exercising with pulmonary emboli because my doctor told me that I was OK to be active as long as my heart rate stayed under 150... but it was still 150 at rest, so it started with walking for 10-20 minutes or biking without resistance.  I used the elevator at work for a few weeks.  I didn't lift weights. And slowly, the pain between my shoulder blades started to improve and I was able to go up the stairs without stopping.

This week, I returned to the scene of the crime and I was able to donate blood again!  I have to take iron supplements and they make my tummy hurt, but I've found ways to manage that.  My resting heart rate was 84 when I went - still a little bit high, but considerably improved.  My cardiovascular endurance is still limited, but I can ride the bike for 45 minutes.  More difficult for me is the time it takes to recover.  I can't do cardio on back to back days and my legs sometimes feel like bricks after I ride.  I think it's more deconditioning... but it's slowly improving.  And my personal favorite - I can lift over 150 pounds when I'm deadlifting, working my way up to 200.  I feel like that's going to happen before the end of the WNBA season that's about to start.  Last season started about 2 weeks after I was in the hospital and I remember that I couldn't yell/cheer because forceful exhalation made me light headed to the point I thought I might pass out. I can't wait to test that out again!  Other than wearing compression socks and taking aspirin to fly on airplanes, I feel like I've recovered pretty well.  I don't recommend it for others, though.  It isn't fun. 

Please donate blood if you can.  It's basically a free health screening for you and a life-saving gift for another person.  It takes less than a half hour to do and you can repeat every 2 months.