Today I had an appointment with my doctor, Kent Griffith. Mainly I was there to have my clotting time checked, to see if my medications are doing what he wants them to. This is actually a bit more problematic than one might expect. Firstly, adjusting the dosage of anticoagulants is tricky to begin with. Anyone who wishes to hear all about this in the context of another Gathman can check out older entries under “medical drama” on Cabell’s blog.
Secondly, the dosage turns out to be not quite what it should be. Wednesday evening they had me give myself a shot of Lovenox at the hospital*, so I’d learn how to do it, and then they sent me home. We couldn’t get the prescription for it filled until the next day. So, Robin went in to Schnucks** yesterday morning to pick up the prescription. Since it’s individually loaded syringes, it comes in a big box, and the girl had to first find the little prescription bag with the paperwork, then locate the box on another shelf. Robin said she seemed pretty clueless.  I gave myself the first injection at home, and was off to a day of sitting on the couch reading. About 1 in the afternoon the phone rang. It was the Schnucks pharmacy. “Could you look at the name on our label on the box?” It wasn’t my prescription. It was half the strength it was supposed to be. They apologized profusely, and sent a guy out from town to swap for the right stuff, and I called Griffith’s office to tell them. Griffith called back and said not to worry, just use the new stuff for the nighttime dose, and it should be okay.
This morning I gave myself my morning shot, and suddenly thought, “Did I do this last night?” Yeah, that’s right. After all the hoopla, and a fair amount of dissing Schnucks pharmacy, I forgot my nighttime shot. Oh, well. Griffith didn’t seem too worried about it today. But my INR is only 1.2 right now, and he wants it between 2 and 3. So we’ll see.
Meanwhile, Griffith asked if I would mind talking to an intern who was shadowing him, and I said sure. He sent in this very young Indian woman (Dr. Kulayat, I believe — didn’t see it written down, and not to be confused with Dr. Kulaylat, my nephrologist), who asked me how I felt. This isn’t that great of a way to elicit a medical history, to my mind, but pretty soon I just told her the entire story. She of course asked if I was dehydrated during my ride (no), if I smoke (no), if I’ve had any clotting problems before (no), etc. She was puzzled, but she can join the club.
Griffith says he may eventually send me up to St. Louis and possibly having me be a subject in the “Grand Rounds”, where I guess they show interesting cases to all the doctors they can rustle up. I’m still hoping for a co-authorship on whatever paper comes out of this.
*It’s just subcutaneous. Really easy. My friend Harry back when I was a boy scout was diabetic, and he had to inject himself with insulin daily. We all thought it was the coolest thing on earth.
**The local grocery store chain, and pharmacy. It’s actually based in St. Louis, where there are actual Jews, but I guess people get used to it. Here nobody even sees it as a joke. I had a friend in Tucson whose last name was Schmalzel, and people always thought he was saying “Schlemazel.” This led to some occasions when people actually refused to believe it was his name.
Will they be less interested in your case if it turns out you do have Factor V, or does the arterial nature of the clot make up for that? And why didn’t anyone put ME in a special weird medical condition show?
Also, you have to do two Lovenox injections a day? I only had to do one.
I hope you are a special case. If you are the subject of an article can you still put it in for promotion/tenure papers?
The hematologist didn’t feel like Factor V Leiden would explain the symptoms at all. And yeah, I’m injecting 60 mg of Lovenox 2x daily.
any history of endocarditis…or something else that could push a clot from somewhere else into that artery?
Erin –
No such history, and in any case, I had both transthoracic and transesophageal echocardiograms, and my heart was perfect in every way, like Mary Poppins.
This is why I’m such a fascinating case. There’s nothing wrong with me except the fact that I’m sick.
I just got back from a 6 day trip (kayaking in Oregon) and read back through your posts with a growing feeling of sympathy and dismay. I have had kidney stones (plural, large) which were missed on early scans and thus allowed to grow for several years before being pulverized so they would come out.
I have never, ever in my life experienced pain like that, and I’ve had some rather painful experiences.
I hope that the problem goes away as quickly as it came on, and that the docs can figure things out to prevent a recurrence.