In Defense of the ER

When I woke up with a sudden onset headache at 4:00 a.m., I didn’t think anything was wrong. In my head’s defense, I hadn’t been sleeping and had a few long days and nights. In my doctor’s defense, I didn’t know anything was wrong the last time something was seriously wrong so I knew he would send me to the Emergency Room when I called him around 4:00 that same afternoon and told him I had blurred vision too. In my eyes’ defense, I was staring at a computer screen all day. In my doctor’s defense (again) that sort of thing never caused blurred vision before. In my defense, I knew what the outcome would be and the ER is time-consuming, expensive and sometimes inconclusive or seemingly even a waste of time. My doctor, seemingly the only one concerned about me (between him and I) by dinnertime, requested I head (no pun intended) to the ER to get a CAT scan. I did, begrudgingly, and told myself the whole way there I would tell anyone else in my shoes to go.

Hospitals never bothered me [before] so I wasn’t expecting the sheer terror I experienced when the nurse wanted to insert an IV. When asked why she said, “Just in case we have to admit you,” which completely sent me into an unexpected fit of tears. She and her summoned colleague decided against the IV and proceeded to stare at me for several minutes while I wiped the snot off my face and all over my sleeves. I went to sit in the waiting room while they ordered blood work, which – in my head’s defense – made me feel better.

Just about two hours (I consider myself lucky) and who knows how many thousands of dollars later, I had the CAT scan and was waiting on the results. The ER doctor came in and told me what I already suspected, “I don’t see a clot and I don’t see a bleed. I don’t see anything identifiable at the moment, but I am concerned about the headache.” In exasperation, I threw my hands into the air and exclaimed, “I knew I was overreacting!”

The doctor stopped shuffling papers, put down my charts, folded his arms on his lap and leaned forward, looking directly into my eyes. I stared back. I could feel the tears welling up, and I tried to focus on how kind and reassuring his eyes looked to me. He breathed deeply and leaned back again.

“This, unfortunately, is your life being on warfarin,” he said, “You never know, you never can tell. You have things going on. You have things working against you and a history that does not put you in a comfortable place medically. It could have been a bleed. It could have been a clot. It could be something neurological. I would rather see you here on an ‘overreaction’ than the way you were before. Nothing about this will ever be an overreaction. You’re a remarkable young lady. You have to take care of yourself and this is one of the ways you have to do it now.”

I stared at him and blubbered on about my story – my PE and everything I had been through in the last year or so – a job loss, relationship struggles, pain and fear and a loss of self that has still impacted me in a way I don’t recognize today. I don’t think I was uttering a bit of sense, but that doctor listened with all the sincerity and compassion he could. When his pager shrieked and a trauma was called out overhead, I knew he had to go; and he left me on the condition I could go home if I promised to 1) come back if my head was not better or worse in 24 hours, 2) follow-up with my doctor and 3) ask for a referral to a neurologist to hopefully get to the root of the problem. Only four hours after I first arrived, I collected my stuff, swallowed two Tylenol tablets and was discharged per the above contract.

My headache did not grow worse and lessened over the next several hours (with rest and quiet), but I am grateful I went to the ER. I followed up with my hematologist the next morning who confirmed I could never be sure with my clotting history and whether I was willing to or not, he was not willing to take the chance that I might have another clot. I might not get so lucky to survive the next time.

I left that ER feeling completely validated for even calling my doctor in the first place. I left feeling like I did the right thing and, aside from what could be going on with my brain, I actually left feeling like there was nothing wrong with me.

Today, I am passing that message of validation on to you. I know it is hard to go to the ER when you think something could – or could not – be wrong. I know money, time, effort and perceived consequences are the first thing on each of our minds. I know because it just happened to me.

I am here to tell you that if you have anything that causes you concern enough to wonder if something else might be going on, you are right in seeking medical attention. Do not not let anyone tell you or treat you differently. If you are worried due to breathing issues, chest pains/sensations, difficulty speaking or swallowing, loss of balance, headaches, nausea, blurred vision or lack of mobility – that is all the more reason to go. You never know. We just never know.

We become accustomed to feeling like we are overreacting (because sometimes nothing is wrong), like we always have something wrong (because a lot of times it is), like we are always sick or a complainer (it’s easy to let others make us think this way) and given what we have all been through (which is not to be taken lightly), our bodies and minds deserve better than that thinking. You deserve better than that thinking. Please, I urge you and I always will, seek the medical attention you need if you are feeling like something is wrong. If you aren’t an advocate for your health, there just may not be anyone else who is either; and the chance we have been given is just too previous, in my opinion, to let slip away for a second time.

Be well.

Share your story. Have you ever gone to the ER and found nothing was wrong? Something was wrong? Do you feel like you are overreacting to the point of not going to the ER? What has (or has not) changed your mind? Do you go to the ER more since your clot?

There is hope for healing and you are not alone,

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How To Talk to Your Doctor about a Possible Blood Clot

Talk to Your Doctor about a Possible Blood Clot

Once in a while I get an email from acquaintances – or even strangers– describing what they fear is a symptom(s) of a blood clot in their legs. More often than not, the individual tells me they have already scheduled an appointment with their Primary Care Physician (PCP) and are waiting – and worrying – to find out what might be wrong. For many of these individuals, they have never had a blood clot before, and they want to approach their doctors with specific questions pertaining to testing and determining if in fact they do have a blood clot. And, many of these emails have concluded with, “What did you tell your doctor because I am worried he/she might not think to look for a blood clot?” I have found it is often difficult to decide how to talk to your doctor about a possible blood clot either because we don’t know what to say or are embarrassed to do so.

I always respond to these inquiries with the same information (starting with I am glad to hear you are listening to what your body is telling you) and explain that in my situation there was no time to contact a physician because by the time I realized something was wrong, I was struggling not only to walk, but breathe because the blood clot had traveled from my leg and lodged in my lung as a pulmonary embolism (PE) escalating from a manageable situation to a critical one. There was no time for preliminary discussions because I was admitted to the Intensive Care Unit (ICU) for immediate care and observation.

Still, I believe many blood clots – especially blood clots in the limbs (DVT) – are treatable before they dislodge and cause major problems to the heart, lungs or brain. If I had identified the pain in my calf as a serious and needing medical attention, I would have wondered what to ask my PCP when I was there. I would have gone in and said, “It hurts and I don’t know why,” and would still be hoping for the best possible outcome. Still, it is not always easy to say ‘It hurts’ because we often feel like we have to have something visibly or horribly wrong to see a doctor or fear being labeled a hypochondriac later – when something really might be wrong. Before my PE, I often felt like I had some sort of limit placed on the amount of times I could see a doctor with unfounded complaints before I would be hesitant to go back in.

I’ve thought a lot about what I would have said to a doctor before my situation evolved into an emergency and after doing some reading and discussing options with other survivors, I have come up with some guidelines for how to talk to your doctor about a possible blood clot. First and foremost, one should have an understanding of the symptoms of a DVT, which can be read here. It is important to note if you are experiencing symptoms of a PE, heart attack, stroke, having shortness of breath, chest pains or lost consciousness, please seek emergency medical help or call 9-1-1.

How to Talk to Your Doctor about a Possible Blood Clot
Before Your Appointment:
  • Call your PCP/Sports Physician/Specialist/etc. and request the next available appointment. It may be beneficial to say on the phone “I am concerned about symptoms A, B, C being a possible blood clot and would like the next available appointment.” If your doctor cannot work you in within the next couple of days and your symptoms do not subside or if they get worse, skip your physician’s office and head to an Urgent Care instead. You could also ask to be put on a cancellation list if you have to wait a couple of days.
  • If you have redness or swelling that is coming and going in, for example, your leg take a picture with your phone or camera to take with you in case your leg does not look the same the day of your appointment.
  • Write down symptoms you have that you are worried you may not remember on the day of your appointment.
During Your Appointment:
  • Explain your symptoms in as much detail as you can. This is where it would be helpful to pull out your picture or written note.
  • Explain why you think it may be a blood clot (especially if the doctor asks). For example, I recently had a friend say, “One of my friends had a blood clot in her lung that almost killed her and she didn’t know what it was ahead of time so I am here as a precaution.” Or you could say, “I have been reading about blood clots and a lot of my symptoms seem to fit, I would like to rule it out.” Or, “I have a history of blood clots in my family and am concerned.”
  • If you have a history of blood clots (yourself or family members), please inform your doctor. If you are taking medications that may increase your chance of blood clotting (i.e. oral contraceptives), please inform your doctor. Even if this information has previously been noted in your medical charts, be sure to remind your doctor during your exam.
If Your Doctor Does Not Agree:

I have learned that we must be an advocate for our own health and have read countless stories where someone approaches medical staff with a concern and it is dismissed as something not to worry about. If you believe you are suffering from a blood clot (DVT) and your doctor does not agree, be sure to find out why he or she does not agree. If you are uncomfortable with the explanation, you are entitled to ask for a second opinion! If you do not want to wait to seek an additional opinion, there are specific tests you can request to rule out the possibility of a blood clot. This information is also helpful to have so you can understand if your doctor is considering the possibility of a blood clot by ordering these tests.

  • Request a Doppler Ultrasound (Also called a Doppler, a scan, an ultrasound, an image). A Doppler ultrasound test uses reflected sound waves to see how blood flows through a blood vessel and is the most common method of diagnosing DVT. It helps doctors evaluate blood flow through major arteries and veins, such as those of the arms, legs, and neck. It can show blocked or reduced blood flow through narrowing in the major arteries of the neck that could cause a stroke. It also can reveal blood clots in leg veins that could break loose and block blood flow to the lungs (Web MD). This test is simple and may be scheduled at your doctor’s office or walk-in hospital lab. It should only take a few minutes to complete a Doppler and the results are available immediately. It does not hurt (unless you have pain in your limb, because they will push firmly on it to get a clear image). Do not be alarmed if your doctor orders more than once Doppler a couple of weeks a part to monitor your situation.

Although less common and sometimes unnecessary depending on your situation, you may also request or your physician may order if imaging results are unclear (test descriptions compiled from Web MD):

    • A D-Dimer Test is a blood test that measures a substance released as a blood clot breaks up. D-dimer levels are often higher than normal in people who have a blood clot. A low d-dimer test result may mean that a deep vein thrombosis or pulmonary embolism is less likely. A high d-dimer test result may not always be caused by a blood clot in the leg or lung. This is completed by a intravenous blood draw, so please note it you have a sensitivity to needles.
    • Magnetic resonance imaging (MRI) test uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases MRI gives different information about structures in the body than can be seen with an ultrasound. MRI also may show problems that cannot be seen with other imaging methods. Using MRI to look at blood vessels and the flow of blood through them is called magnetic resonance angiography (MRA). It can find problems of the arteries and veins, such as a blocked blood vessel. Sometimes contrast material is used to see the blood vessels more clearly. This test is non-invasive, but requires you to sit or lay still for a period of time as the images are taken. Some people find this test uncomfortable if you do not like small spaces
    • A computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside of the body. During the test, you will lie on a table that is attached to the CT scanner, which is a large doughnut-shaped machine. The CT scanner sends X-rays through the body area being studied. In some cases, a dye called contrast material may be used. It may be put in a vein (IV) in your arm, or you may drink it in some cases.
    • A venogram is an X-ray test that takes pictures of blood flow through the veins in a certain area of the body. During a venogram, a special dye (contrast material) is put into your veins so they can be seen clearly on an X-ray picture. A venogram looks at the condition of your veins and the valves in your veins. It shows the veins in your body and whether or not they may be blocked. This test requires some preparation ahead of time and should be discussed in detail with your doctor.
After Your Appointment:
  • Follow up with any tests your doctor has ordered. If you have been instructed to seek further testing at a walk-in lab or hospital testing facility, call right away to get the hours of operation and do not delay further testing.
  • Follow up with your doctor regarding treatment if a blood clot is discovered.
  • If you are unhappy with your diagnosis, seek an additional opinion or if your condition worsens, seek urgent medical care.

Share your story. Did you request an additional test from your doctor and if so, what was it? How was your blood clot diagnosed initially? Did you visit your doctor with any concerns? What did you say to your doctor? Have you been an advocate for yourself in diagnosing a blood clot?

There is hope for healing and you are not alone,

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Facebook is killing us

facebook is killing us

Facebook is killing us. What was originally created to be a convenient method for people to stay in touch with family and friends [without actually having to talk to them] has, in many respects, taken a drastic turn for concern and is actually becoming a detriment to our society.  Not only is it troubling that younger generations in particular may develop a misleading perception of what real human communication is, but our physical health is sure to be scathed by long hours spent in front of the computer (or TV or game console) without any pause for exercise or relief. Our minds are pushed to the limit, bombarded by distraction after distraction and even when we are sleeping, we often find it difficult to rest.  In the United States alone, obesity and diabetes – and deaths as a result of heart attack and stroke – are on the rise now more than ever and I believe it is in part due to our inactive lifestyle and inability to unplug. We won’t do it, we can’t do it. We are addicted to the constant flood of information inundating our news feed by the second.

logout of fb

But, even more than all of these things, Facebook in particular is dangerous to our health because we do use it as a primary source of communication. And like the all-knowing, all-seeing, all-believing Google, we usually turn to the internet for help before anywhere else. You know what I am talking about – how many times have you turned to Facebook for a cure to the common cold, advice on how to treat a sprained ankle or thoughts as to what ailment may be plaguing you? I see it all the time and I am guilty of it myself. So many times I see someone posting a question on Facebook – that I then find myself answering – when I am really thinking, “You probably need to see a doctor.”

So, why don’t we [see a doctor]? Facebook is free, it’s quick and it’s the surest way to get attention when you’re feeling bad and need it the most, right? There has come a time when we all need a little encouragement from a friend or family member saying, “Hang in there, that happened to me and I’m fine” or “I’m so sorry you’re feeling that way.” (Remember, we can’t pick up the phone and call)

What I find disturbing is when Facebook and the vast array of online resources becomes our only means of communication with the outside world. When we base our health on what Facebook says when we should be calling 9-1-1 is not okay, for anyone and it is in fact, why Facebook is killing us. For example, I am a member of many online support groups (and there is nothing wrong with a good support group by any means) and it is bewildering to me that so many people who have previously experienced a DVT or PE turn to the support groups for answers before contacting their doctors. This is compounded by the frequent posts beginning with things like “I NEED HELP, SOMETHING IS WRONG” and the person goes on to describe swelling, tenderness and trouble standing or walking on their legs. To my knowledge, Facebook cannot yet dial 9-1-1. When faced with a PE, death can occur within moments of symptoms and there is no time to waste on Facebook.

facebook dislike

It bothers me particularly in regards to these groups because I feel like one should know better. There, I said it. When I experienced my DVT and PE, I had no idea what was happening to me. I did not know the signs and symptoms of blood clots and I didn’t check Facebook to see if I should be concerned – I just wasn’t. I called my Dad who called the doctor who called me and ordered me to the ER – almost too late by my own accord, I might add (even without the help of Facebook).

My point in writing this is that if you are experiencing signs or symptoms of a DVT or PE, or even if you just don’t feel good, please contact your doctor before anything else like consulting Facebook. And if your doctor can’t see you, please don’t hesitate to go to the ER or Urgent Care. We have all been given a second chance at life and it concerns me that so many of us continue to play with fire. I know no one wants to go back to the hospital – myself included – but if I ever experience something like I did the night of my PE, you will find me there in a heartbeat, full knowing that it could be my last.

All of this said I do think it is also helpful to be a part of online support groups and there is nothing wrong with going in and posting your experiences or asking questions after the crisis is over. I don’t even think I am opposed to a back-of-the-ambulance post (which, yes, I have seen) as long as you are taking care of yourself first and foremost. But, please, don’t wait to get to the doctor.

I have found some wonderfully supportive, intelligent, helpful, encouraging support groups through Facebook (which you can see HERE) – just don’t let me find you there when your life may very well depend on it.

find-us-on-facebook

 

Share your story. Do you or have you turned to Facebook for help before calling your doctor? Does it concern you when others do so or do you notice? Do you think Facebook is killing us?

There is hope for healing and you are not alone,

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