I’ve missed writing over here on the DiabetesSisters blog for the past couple of weeks.  Unfortunately, I have been in the hospital dealing with some severe blood clots!  The treatment has been unpleasant, and I have been away from my computer for the majority of the time, using my droid to check emails from the hospital. This has been a completely frustrating, painful, and anxiety-provoking time

I went to the Emergency Room on November 21, thinking that I was more overreacting to the situation than anything else, but wanted to be safe. My right leg was swollen, and it had become extremely swollen from the side of my abdomen through my thigh – probably double, at least, the size of normal. I spoke to a nurse from Vascular Surgery before going to the Emergency Room as I’ve had a DVT in my right leg before (caused by a central IV line), and she told me to get to the ER as soon as I could.  She would let them know that I was coming so that the process would hopefully go more quickly, and they would know to get me upstairs for an ultrasound to check for clots. I was so thankful that the process went quickly and smoothly. They even did all of my triage and registration in the back so that I didn’t have to wait to start treatment! The ER staff was wonderful! I got an IV started and was given some medication as my blood pressure and heart rate were through the roof high, and I usually have a low blood pressure and heart rate, but the pain was causing both to be extremely high. Then, they got me straight upstairs to the Peripheral Vascular Lab and did the ultrasounds. Unfortunately, they found the ultrasounds positive for clot in both my right and left legs! I was completely and utterly shocked to find out that I had clot in my left leg as it did not seem swollen to us, or to have any abnormal symptoms. They sent me back down to the Emergency room, and the doctors came in to tell us what the vascular team told me upstairs, and that I would be admitted. The admission process was a bit rocky because I was admitted to a general medicine team at first, and because I’ve been through DVTs before, and I have a history with vascular surgery, we needed to have vascular surgery involved. The team was reluctant to call vascular in, but finally, we had vascular surgery come by and consult, and they agreed that it was going to take more than the standard heparin drip and Coumadin (Warfarin) or Lovenox to heal the clot that I had. My clot extended from ankle to groin from what we could see on the ultrasound, and that is all that can be seen on an ultrasound. Once I was in with vascular surgery, I was scheduled for a venogram, where dye is put in through catheters fed through the legs to see the extent of the clot. I unfortunately had clot up to my liver. If the doctors didn’t know that I had an IVC filter in place, they initially would not have known that I had one because I clotted through the filter and around it, then up and around my liver. It was not a pretty sight.   I was started on lytics therapy, where catheters are inserted into the legs and places where there is clot, and TPA, basically a really strong clot-busting medication, is delivered directly to the areas with clot to break it up. I was also receiving a heparin drip through a peripheral IV. Every day, a new venogram was done to see how much clot was left and to decide whether or not to continue lytics therapy. I had therapy for three days. Then I was transitioned to lovenox shots and Coumadin pills. I’m finally barely in range with my INR levels and was just able to stop the Lovenox shots this week. I still don’t have normal blood flow sounds when ultrasounds are done in my legs, but the doctors don’t think that doing anything else will improve that right now. I see the doctor in hematology in January, but my primary care doctor told me that she is happy that I’m seeing the hematologist though to expect that I’ll be on anticoagulation therapy for life.   While I was in the hospital dealing with the blood clots, I had to lay flat on my back for lytic therapy. I had to be in a step down unit because we were dealing with both TPA and heparin, and everything was required to be monitored closely. The nurses did not know what to do about a patient on an insulin pump! I had to fight to keep my insulin pump. They told me that since I would be NPO after midnight and not eating until after my procedure every morning, I shouldn’t need my insulin. Excuse me, but my basal rates?!? Luckily, I was able to advocate for myself, and my parents were there to back me up, and they let me keep the pump on. My endocrinologist was also on call while I was in the hospital, so she quickly wrote an order for me to be able to keep my pump on at ALL times (except in vascular radiology… we don’t want the radiology equipment to damage the pump!). The highpoint of my hospitalization was just before discharge the second time when one of my CDE’s popped in. We were talking about diabetes and diabetes advocacy. So many of the doctors and nurses are so quick to ask patients to remove pumps, and so many patients do just remove pumps when they come through the ER. It is CRAZY! They would have had me on glargine (Lantus), which I’m pretty highly allergic to if I didn’t put my food down and say that I needed my pump. It was nice that one thing stayed in control – through all of the blood clots and then return emergency room visits and respiratory infections. I think that my pump helped me play a huge role in that one. Whether I’m eating a holiday meal, lunch on the go between class and another activity, or not allowed to eat before a procedure, I need insulin, and my pump can help me deliver teeny tiny doses, percentages of my normal doses, and for me, is easier to manage than vial and syringe.    Everyone needs insulin… it just depends on whether your body makes the insulin or whether you have to take the insulin via injection or subcutaneous continuous insulin infusion (insulin pump).