Sunday, June 17, 2012

Hiking, Blood Clots, and Post-thrombotic Syndrome

Last Tuesday, after scratching incessantly at a mosquito bite, I noticed my left calf was swollen. I had no other symptoms, but, since I had a massive deep vein thrombosis (DVT) ten years ago in the same leg, I sheepishly asked for an ultrasound at the nearest ER. Sure enough, there's a blood clot in my left femoral vein. It's taken residence all along the vessel, from my knee to my groin.

My history:

In late December of 2002, an acute and extensive deep vein thrombosis (DVT) was found in my left leg and pelvic region.  Specifically, my iliac vein, common femoral vein, popliteal vein, and posterior tibial and peroneal veins were completely clogged.  I was 36 weeks pregnant at the time.  I was hospitalized and put on blood thinners (heparin), a temporary filter was threaded through my blood vessels and placed in my inferior vena cava, and I was carefully monitored.  Thankfully, labor went well and I delivered a healthy baby girl after six short hours of labor. Unfortunately, I hemorrhaged twice after giving birth, lost a ton of blood, and required emergency surgery.

My health, in other words, was a complicated mess ten years ago.  At least they caught the clot in time -- I would have otherwise died in childbirth (if not before), since parts of that clot broke free during labor (and were trapped by the filter).

Why the DVT?  I'm active, and I'm young (by DVT standards)!

One of my genes is to blame.  Specifically, methylenetetrahydrofolate reductase (MTHFR).  I'm homozygous recessive for a specific mutation that increases my risk for blood clots and certain types of cancer.  Pregnancy is an additional risk factor for DVTs; I avoided clots during my second pregnancy by giving myself daily shots of Lovenox (blood thinner).

What does all this mean for hiking?

To be safe, my doctors would like for me to wait another few days before heading off into the wilderness; they'd like me to be fairly stable on one of my my meds (coumadin) before doing any hardcore hiking.  Also, the risk for pulmonary embolism decreases with every day I'm on blood thinners.

I will still take the girls out, but we'll choose our trails and destinations carefully according to my medical status each week.  For example, Alex and I did the Lovequist Loop yesterday -- that's a gorgeous little one mile loop trail right next to a busy tourist area off Route 112.  If anything had happened to me, Alex could have quickly and easily gotten help.  Therefore, for me, the answer is NOT to stay at home.  Hiking is part of my recovery, and the White Mountains provide trails of all shapes, sizes and difficulties.  There's lots to explore out there; we'll just stick to low ground and/or short and straightforward trails for a week or so.  Life should be fairly back to normal by early next month, if not sooner; I'll just have to be extra-careful not to take a serious fall since, for the rest of my life, I'll bruise and bleed easily (blood thinners forever!).

When your leg feels like a cramping block of wood...

Post-thrombotic syndrome (pain and swelling after a clot has damaged the veins) will likely be a life-long hassle.  Which, actually, is nothing new for me.  I've had post-thrombotic syndrome for the past ten years, I'm just not the type to complain about it all that much.  It comes and goes, and is especially bad when wearing anything heavy on my left foot (snowshoes!!).  The leg feels weak and painful cramping occurs in my calf and thigh.  Exercise helps, stasis doesn't.  I'll probably have to deal with increasing pain and weakness over the years, but I'll still hike.  Also, I'll continue NOT to wear snowshoes unless postholing is extreme, and I'll never be able to break trail (uphill) for more than a few tenths of a mile (if that).  Still, I'll work with what I've got. 

The good news --

My first clot did not kill Alex or me.  Sage is happily on this planet.

I can still hike.

Life-long blood thinners will greatly reduce my future risk of DVTs.

The way to potentially save my left leg from severe post-thrombotic syndrome is to keep it moving.  In other words, not only can I hike, I should hike.

I'll post some more on all this later.  Heading out to visit a waterfall with MadRiver and Sooze.



Cindy Fey said...

Trish - I am so glad you caught the clot and got the right medical care. I hope your leg feels better soon and that you enjoy your milder choices of trails!

Patricia Ellis Herr, Alexandra Herr, and Sage Herr said...

Thanks, Cindy! Catching the clot is the most important thing, so I too am glad I suspected what was going on and asked for the ultrasound. :)

My leg isn't too bad, all things considered. The last time around, it was clogged so completely that my doctors thought I might have serious long-term issues with sores and walking. I got off easy ten years ago -- just some pain here and there, but little swelling and no ulcers.

My strategy this time around is to keep walking and moving as much as I can. As long as I'm anticoagulated, the risk of pulmonary embolism is fairly small, and there's research to suggest that walking helps the long-term prognosis of the leg in terms of post-thrombotic syndrome. I just need to keep the trails short and tame for a few days.

Thanks again for your message!

Arkie_in_CT said...

So glad you caught this. I admire your smart and sober approach to this problem, making the best of the situation. I wish you a speedy, thorough recovery.

-Chris Stratton/Arkie

Patricia Ellis Herr, Alexandra Herr, and Sage Herr said...

Many thanks for your well-wishes, Chris. I appreciate them. :)

Unknown said...

Thankyou for sharing! Makes me feel like i should prob get my leg checked out cuz I have had what i think is a blood clot behind my knee for over a month. Hope all is well!!

Patricia Ellis Herr, Alexandra Herr, and Sage Herr said...

Never hurts to go in and get it checked. A simple ultrasound can be a lifesaver.