The day started well. At least for a Monday. Did the Manly Shelly swim with Denise and Marg Carney, always a great way to start the week. Raining lightly. Marg dropped me at scan centre in Military Rd, Cremorne on her way to work. Still raining. Had scan. No surprises – at least to me anyway. I do have a DVT – a deep vein thrombosis. Three of them in fact. Three blood clots in my right calf. Probably been there for months. I asked so many people if I had one and they said no. Should have backed my own judgement. And done it much earlier. At least it’s good to know.
Went straight from the scan centre to see Dr Matt Lyons, my surgeon, at his rooms at the Sydney Football Stadium. He seemed a bit surprised/embarrassed that I had clots, and conceded he should have been on to it earlier, given that I’d had one previously and my daughter, Catherine, also suffered them with her tibal plateau operation. I don’t blame him. He is not a vascular surgeon but I wish I’d known at the time when all the swelling came up that I should go and see a vein specialist. Nobody tells you these things. I don’t know how you are expected to know. (Maybe read this blog)
Lyons prescribed bood thinners and booked me an appointment with a vascular specialist for more treatment. I don’t have to see Lyons again until December. DVT aside, he is pretty happy with the healing process.
Went back to work and began treatment for clots that afternoon, after having difficulty finding medication – Xarelto ( Rivaroxaban) – at chemists around Martin Place. Finished the week with a broken leg, two parasites in my gut and three blood clots. Hey, that’s epic stuff. Trying to stay positive. It can’t get much worse. at least that’s out of the way and maybe the swelling will start to go down.
Actually I got off lightly. A note on veins. The veins of the leg drain deoxygenated blood and return it to the heart. They can be divided into two groups – deep and superficial:
•Deep veins are located underneath the deep fascia of the lower limb, accompanying the major arteries.
•Superficial veins are found just under the skin. They eventually drain into the deep veins.
As the name implies, a Deep Vein Thrombosis – clot- occurs in the big, veins buried deep in your leg. As a general rule, the deep veins accompany the major arteries in the lower limb – the arteries push the oxygenated blood down into the leg, the veins push the de-oxygenated blood back upwards to the heart. Often, the artery and vein are located within the same vascular sheath – so that the arterial pulses help the veins pump blood back to the heart.
Near your knee, the anterior tibial, posterior tibial and fibular veins unite to form the popliteal vein. I had a big clot in the popliteal vein behind my knee in 2002. That was pretty serious. The popliteal vein enters the thigh and becomes known as the femoral vein. It gathers blood from feet, calves and thigh. The femoral vein leaves the thigh by running underneath the inguinal ligament, at which point it is known as the external iliac vein. It is a super highway of blood running straight from the thigh through the groin to the heart. Get a blockage in the femoral or iliac veins and you are in a world of trouble. Blood clots can be of two types:
- Occluded meaning completely closed off – no blood flowing through and
- Non occluded meaning there is a clot but it has not shut off the vein completely. Blood is still getting through but not at the same volume as a normal vein.
In 2015 I had two non-occlusive clots, one in the peroneal vein and one in the gastrocnemius vein. I also had a completely blocked soleal vein.
Why are clots so dangerous? If a piece of the clot breaks away and is pushed by your circulation, up the big highways like the femoral or the iliac veins, it will end up in your heart or lungs and in some cases in your brain. It there forms a further blockage called an embolism. If you get one in a vital location you are very close to checking out. Get one of these bad boys in your heart or lungs and you will probably be able to hear the harps playing. DVT’s are so deadly because the site of the embolism which kills you eg heart/lungs/brain is nowhere near where the original clot formed. After a tibial plateau fracture, the clot may form in the calf or the thigh and you may not know until it turns up in your heart or your lungs at which point it may kill you.
Why I was lucky I was lucky because my clots formed below the knee. From that location it’s hard for the clot to break up and get up into the femoral or iliac veins and into the heart. If it’s above the knee watch out, you will be going straight to hospital and one of the things you will have there is a scan of your heart and lungs to make sure the clot hasn’t travelled. This year, one of my clots was near the knee, in the medial gastrocnemius vein. This vein feeds into the popliteal vein but it wasn’t on the main highway. It had blocked the feeder ramp but not the main flow of traffic on the popliteal freeway. My femerol and popliteal veins were clear.