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Pulmonary Embolism
Old 06-12-2009, 03:26 PM   #1
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Pulmonary Embolism

<<edit: Ooops, I see that there was another PE thread just a couple of weeks ago. Guess it's not uncommon.>>

I was sent to the ER on Saturday morning of Labor Day weekend by my doctor who suspected a pulmonary embolism (I had just arrived home the night before after traveling 30 hrs back from Asia, and was having extreme pain in the upper and lower parts of my right lung). I saw lots of doctors throughout the day, but most of them just came in to chat and tell me how serious a pulmonary embolism was. Finally 8 hours later the radiologist was able to break free and read my CT scan to confirm the PE diagnosis. I was promptly admitted to the hospital and given all the pills, shots, and IV bags and ampules and canisters that you can imagine. The medication relieved my pain, and I spent a restful night except for being awakened at midnight, 1am, 2am, 4am, and 6am. I was able to talk my way out of the hospital the next day, promising that I would continue my regimen of antibiotics, Lovenox shots, and rat poison, I mean blood thinner. For the next week or so I felt lousy...exhausted, chest discomfort, and weak...but after that I started to feel okay again. By now I'm still on Coumadin (for 6 months) but I feel just fine. I'm exercising and feel no ill effects from the PE episode.

Three points I want to make about this episode.

First, deep vein thrombosis and pulmonary embolism DO occur, and not just to the fat, out-of-shape other guy. I'm 50 and in good shape. I play basketball and tennis twice a week and was climbing volcanoes in Sumatra the week before this happened. So when you fly, take precautions. Stay hydrated, get up and walk around at least once an hour, take an aspirin before flying (talk to your MD if aspirin is a problem for you), and consider wearing compression socks/stockings on a long flight. Statistics (from the 60's, so maybe not so accurate) say that 1 in 6 will die from PE if untreated...not very good odds when you think of the low cost of prevention.

Second, I just got the statement from the hospital for my one day there. The bill (no doctors, just the hospital itself) was for $22K and change. After I paid my $150 co-pay, Blue Cross gets a $19K negotiated discount, and the final bill to the insurance company is $3300. Okay, fine, I'm glad that I was treated at a clean, reasonably efficient facility, but what about the guy next to me who doesn't have insurance? Why should it cost me (via Blue Cross) $3500 while it costs the uninsured guy $22,000 (his house or his kid's education)? And that's without the fees from the doctors! Talk about a system that's out of whack! Why would we set up a system that charges most to those who can least afford it?

Third, after realizing that I almost got hit by a Mack truck, I am enjoying the smell of green grass, the sound of giggling kids, and the joy of my son's Little League games a little bit more than I did a month ago. I'm going to watch my daughter graduate from college this weekend. Life is good!
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Old 06-12-2009, 03:45 PM   #2
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Second, I just got the statement from the hospital for my one day there. The bill (no doctors, just the hospital itself) was for $22K and change. After I paid my $150 co-pay, Blue Cross gets a $19K negotiated discount, and the final bill to the insurance company is $3300.
I feel your pain. Another symptom of a sick system. It is always amazing to see the sticker price and then what the insurance actually pays. If we could all pay the $3300 price, many folks would not be bankrupt by an overnight stay in the hospital.

Best of luck with your recovery.
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Old 06-12-2009, 03:51 PM   #3
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I'm so glad you're recovering and that is a good thing to remember re moving around and keeping hydrated while traveling, and also that even people in as good shape as you are can still suffer PEs.

Quote:
Why should it cost me (via Blue Cross) $3500 while it costs the uninsured guy $22,000 (his house or his kid's education)?
I'm going to bet your insurance premiums over time have more than covered the amount the uninsured guy will be charged.
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Old 06-19-2009, 02:16 PM   #4
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As the original poster of the previous thread on PE I empathize with what you have gone through and the question of who pays what for their healthcare. There has to be a better way that gives each of us at least a minimum level of care and healthcare security. I hope your recovery from your PE is going well. I am still not comfortable with the swelling in my leg. My respiration seems to be fine and I have no discomfort but it is certainly troubling at night to look down at my legs and see that the right one is about 20% larger than the left. It does seem to be getting slightly better, but very slowly. My INR as tested last night is finally down to 2.2 so that is actually on track now, after peaking at around 8, which scared hell out of me. And now, what is in store for the future? If we had one, will we be more likely to have another. My cardiologist told me I CANNOT have another one of these. How do I prevent it? After having two heart attacks, the second requiring a defibrilator, I always pictured myself dying like my parents, a sudden heart attack. But now not so sure.
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Old 06-19-2009, 02:32 PM   #5
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Best wishes for a complete recovery, Scrinch. In the last thread on this I pointed to some good information sources.

Seems like an epidemic. Isn't this the third post we've seen about this disease in recent weeks? Y'all need to keep your legs moving, wears support hose for air travel more than 5 hours long, and follow your doctors' advice.

My patients who have had DVT and/or PE and who face risky travel or similar challenges might get a prescription for an injectable anticoagulant (like enoxaparin, dalteparin) to use once before departure and once before flying home. There is no evidence to prove that this reduces risk, and none that it doesn't. If you've had more than one clot, a blood test for certain clotting factor deficiencies and mutations should be considered.
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Old 06-19-2009, 03:06 PM   #6
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Here's another perspective...

Ian Anderson and DVT - The Official Jethro Tull Website
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Old 06-19-2009, 03:20 PM   #7
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I don't expect rock stars to be prize-winning authors, but I'm always impressed by how articulate & funny he is.

The way he hops around on stage, too, I'm very surprised he'd have clotting...
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Old 08-18-2009, 02:29 PM   #8
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The PE seems to be doing fine now, the rat poison is doing its' thing, and all of a sudden, a glitch. With the original cat scan of the lung they find a golf ball sized gall stone. Attitude seemed to be that the big ones aren't as big a problem as the small ones. Except in my case. Midway through treatment for the PE the bile duct gets blocked by the stone and I am instantly sick. Thought it was another heart attack at first as the pressure was really crushing. Removal of the gall bladder was ordered, which in and of itself was not a big deal, the coumadin use was however. I had to lay there for two days while they treated my blood to get it to a safe level to operate. By that time I was really sick. But they finally got it out and all is progressing again. The lovenox was started immediately and it appears I got lucky with no lasting effects from the sudden changes. I am back to work after two weeks and the pain is gradually subsiding. I never thought getting old was going to be this difficult.
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Old 08-18-2009, 02:57 PM   #9
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Geez, lloyds. Some people will do anything for attention!

Glad you got through yet another crisis with your health. That'll be quite enough, thank you.

Speedy recovery.
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Old 08-18-2009, 04:29 PM   #10
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Good luck with your recovery. I'm on daily levonox shots for another two weeks. My doc put me on them to prevent DVT, because he said that's the most dangerous side effect of abdominal surgery, particularly cancer surgery. I also have to put my legs up on the easy chair as much as possible and walk a little bit each hour.
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Old 08-18-2009, 07:42 PM   #11
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First, deep vein thrombosis and pulmonary embolism DO occur, and not just to the fat, out-of-shape other guy. I'm 50 and in good shape. I play basketball and tennis twice a week and was climbing volcanoes in Sumatra the week before this happened. So when you fly, take precautions. Stay hydrated, get up and walk around at least once an hour, take an aspirin before flying (talk to your MD if aspirin is a problem for you), and consider wearing compression socks/stockings on a long flight. Statistics (from the 60's, so maybe not so accurate) say that 1 in 6 will die from PE if untreated...not very good odds when you think of the low cost of prevention.

Did you do the things you recommend and still have a problem?
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Old 08-18-2009, 08:10 PM   #12
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Stay hydrated, get up and walk around at least once an hour, take an aspirin before flying (talk to your MD if aspirin is a problem for you), and consider wearing compression socks/stockings on a long flight.
I am not aware of any evidence showing a preventive benefit of aspirin on the occurrence of DVT , though lots use it for this. DVT is not a "platelet thing." It was once touted that way, but no longer.

It does help arterial emboli occurrence (an entirely different disease), but not venous thrombosis.
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Old 08-19-2009, 04:43 PM   #13
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Thanks for your help Rich, and the encouragement of all of you.
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Old 11-09-2009, 04:10 PM   #14
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Okay, "Embolism Chapter 3". I was taken off the Coumadin around October 14th or so. The Pulmonologist didn't see any further need after tests and ultrasound. So I am sitting in another managers' office on October 29th. when all of a sudden I get this feeling of extreme uneasiness, like I am going to have vertigo or something. I tell her something is happening and we wait a minute or two and I realize I am having a stroke. I asked her to get me some aspirin and I chew up a couple as the stroke is really coming on. I was at a hospital within 15 minutes as the fire station and hospital are both within a mile of my office. I got horrendously nauseated on the way, which lasted for about a half hour. Every time they gave me something for nausea I vomited. Bad cycle there. After admitting, I asked about the clot buster drugs and they said they wait awhile before administering them because they are dangerous. I had never heard that before. The symptoms subsided after a couple hours and within a day I was almost normal. I have had multiple cat scans, an MRI which showed the stroke locations (there were apparently three) and several ultrasounds. All were mostly for the purpose of trying to find where the clots were coming from. Nothing was found. I have to see my primary caregiver next week and I am guessing she will suggest the esophagael ultrasound to be certain it isn't somewhere in the heart but we will see. I have returned to work after a weeks "vacation" and feel fine. I was terrifically lucky, again. Glad I kept that cat, I am now borrowing lives from him. Rich, or someone else with personal knowledge, what are the chances this is going to happen again. I can't help wondering if this isn't some residual thing from the surgery in end of August/first of September. I just hate gettting up each day wondering if this is going to be the day. I know that too will eventually fade but after all this in one year, it fades a lot slower.
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Old 11-09-2009, 04:37 PM   #15
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So sorry to hear of this latest setback. Theoretically, the two events should not be related to one another.

But.... just something rare to ask your docs about... if there is a small congenital "hole" between the two sides of the heart a venous embolism from the leg could cross through that hole and get into the arteries (via the left heart) and pass through to cause a stroke.

An echocardiographic "bubble study" might be in order. Maybe they have it planned during yoru TEE, but I'd ask about it.

Must be pretty scary stuff to experience. I am really glad you didn't suffer any permanent deficit. Keep us posted and best wishes.
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Old 11-09-2009, 04:40 PM   #16
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OUCH.....

Sorry to hear about all the problems... let's hope that what is causing the problem if found and fixed...

As for your OP... my sister came close to being killed in an auto accident... her head scrapped along I-10 after her truck rolled... she was strapped in, but the rollover push the top of the truck to the side enough for her head to scrap the pavement...

So now, she has her 'second birthday'... I just heard this recently... but she celebrates surviving... being born again... I hope you an do the same.
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Old 11-09-2009, 05:53 PM   #17
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Sorry to hear about this recent episode . Let's hope they find the cause and cure it .
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Old 11-13-2009, 03:16 PM   #18
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Looks like I'm the newest member of the ER thrombosis club (lloyds and scrinch, you guys can keep your senior status). My calf has been aching for a few days, I thought it was a pulled muscle, but when it was still getting worse after 4 days I got it checked out. The ER doc figured it was likely a pulled muscle, too, but he ordered an ultrasound and they clearly saw a blocked vein. So, it's coumadin pills and self-injections of heparin twice per day for awhile, followed by just the coumadin for a few months.

I'm fine, but just a little surprised as I'm not yet 50, in good shape, and hadn't been doing any travelling. Oh, well

Health-insurance tie-in: I'm in a government plan (Tricare Prime), and I tried to do all the right things to keep costs down. When my leg kept aching I tried to get an appointment through my primary care manager, but there were no appointments for 4 days. So, I had to use the ER. I'm hoping that whatever health care reforms the US makes will reduce expensive ER use, but I'm not sure the government plan I'm in is doing a great job of that.
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Old 11-13-2009, 03:46 PM   #19
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Sorry to hear that, Sam. Best wishies for a quick recovery.
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Old 11-13-2009, 09:39 PM   #20
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Rich,
Thanks for the good wishes. I gave myself the first shot tonight--I'd be a very skittish junkie.
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