MY HEALTH EXPERIENCE:I HAVE just injected myself in the thigh. Without weeping or flinching. It is Sunday, April 25th, and I am in the Rotunda Hospital in Dublin undergoing treatment for deep vein thrombosis (DVT), a blood clot that formed in my calf last week as a side effect of pregnancy and travelled up to my pelvis. Here's what happened.
On Sunday, April 18th, I am 13 weeks pregnant and recovering from sciatica. My left leg is stiff and my ankle is swollen, and I grumble that it’s a bit early in the day, the pregnancy and the year to be swelling. However, this baby was long awaited and despite the nausea and back pain I am not going to complain. Except to my husband, because someone has to hear about it.
By 8.30pm, my left leg is still sore and I am exhausted. Removing my boots, it is obvious that the swelling I noticed earlier has spread up to the thigh, but affects only one leg. I decide to overreact by phoning the emergency room at the Rotunda Hospital, which I am attending for pre-natal care. I describe my symptoms to the midwife on duty, who asks what colour my leg is. It has changed from freckled grey to mottled purplish red. “You’d better get in here now,” is the firm reply.
I squeeze my husband and two little boys extra-tight before hobbling out to the taxi. It is dawning on me that the midwife’s tone means she suspects something horrible, and my imagination is in overdrive.
After a few minutes’ wait in the emergency department, I am examined by the same midwife, and the doctor on duty confirms the midwife’s instinct. “You’ll need a scan, but it is almost certain that you have a clot in your leg.”
Clots, she explains, are unpredictable and can not only block veins but can travel, in whole or part, to other parts of the body. If a stray piece of clot reaches the heart, lungs or brain it can be fatal. So, it transpires, far from overreacting, my phone call to the Rotunda probably saved my life, and that of the baby (who I see later on an ultrasound jumping around, blissfully unaware of the drama unfolding in its great outdoors).
Two hours after the phone call, I am in a bed in the semi-private gynae ward. I am injected with the blood-thinning medication heparin, and given paracetamol; the pain in my leg is now excruciating, like a constant muscle spasm. I am also poured into a pair of thigh-high, industrial-strength compression stockings, known as Teds.
Next morning, my obstetrician, whom I have attended for the past seven years, confirms the diagnosis, and the day after that, when I am barely able to walk, I go to the Mater for a Doppler scan.
The clot shows up in the left side of my pelvis, stretching upwards until it is obscured by the baby. The cure, as well as daily heparin injections, is bed rest.
And so my family, friends and colleagues leap into action bringing books, magazines, newspapers, fruit, flowers, hand cream, pyjamas, a Lego scene and other goodies that turn my corner of the ward into something resembling our kitchen. The staff suspect my library is breeding in the night.
One morning, the doctor checks that it’s okay to bring in “a few” medical students to “venerate” my leg. Next thing, there are 10 people around the bed and I am feeling more vulnerable than venerable. Each lists a factor that can contribute to DVT. “Contraceptive pill”, says one (Eh, hello?). “Stasis,” says another. “Sitting around,” she elaborates. (“I ran a race last month,” I say, very indignant.) “Obesity,” says a third. (Did these people miss the lecture on bedside manner?) In my case, the trigger is pregnancy though there may be family history, in that my mother had suffered a mild stroke and some of her aunts’ sudden deaths were attributed, anecdotally, to clots.
After six long, uncomfortable days and nights, I have a leg that looks more like a leg, and although the pain is still strong enough to affect my sleep and mobility, I celebrate by wobbling to the lobby shop to buy the newspaper.
The next day, a Sunday, I mark my husband’s birthday with my inaugural self-injection, and he and the boys pay a visit. Being in a gynae day ward brings sensitivities, and sometimes it is just not appropriate to have children playing around women who may be distressed, unwell or having fertility issues – but most evenings, and at the weekends, I am alone.
A few days later, things are really looking up. My leg is more shapely but still has a touch of corned beef about it, and remains painful at night and in the mornings. I weigh myself, so that my heparin dose can be adjusted, and find I am 4.5kg lighter than on admission, as the trapped fluid is dissipating.
At last, after a final consultation with the doctor, who gives me a prescription for my incredibly expensive medication (never was a drugs payment scheme application form filled in more quickly), I bid my farewells.
At home, with my legs still clad in their elastic prisons, an internet search for stockings that aren’t blinding white or granny beige yields surprising results. Judging by some of the poses, this compression gear has a fetishist appeal that has bypassed me.
After a few days at home I get impatient and lose the run of myself, so that my leg swells up painfully and my foot goes numb. Back in the Rotunda, my pulse and blood pressure indicate that the clot is not moving and I am sent home to rest. Three weeks later, I return to work.
At 20 weeks, to our delighted relief, the Big Scan defines a healthy baby. It is the day that news breaks of all the parents who have endured devastation and despair following misdiagnosis of miscarriage. Words fail me.
By now, the injections are going very badly, and my thighs are lumpy and bruised. “You’re like a bad vet,” observes Dad. Now I jab myself in the tummy where there is, it must be said, more than an inch to pinch, and the bruising is a bit more subtle.
The June sunshine is tricky for those of us in Ted Fetish gear disguised by runners, tights and leggings, but with a rebellious thrill, I roll the stockings up over my ankles and fish out my flip-flops (though I abandon my beloved Rouge Noir polish, as one attempt makes me look as if I dropped a piano on my feet).
The pregnancy progresses with increasing nausea and decreasing appetite. I am monitored closely, and slowly my calf returns to its normal shape, varying from two to three centimetres larger than the other one. (After the birth, I will have to inject for two more months and come back to the Rotunda for blood tests to investigate the cause of the clot.)
Now it’s October and the baby’s birth is imminent. I am admitted the night before my Caesarean section (which has been scheduled since April, for reasons unrelated to the clot) and, as I am still panicking about bleeding to death, I sleep for two non-consecutive hours. In theatre, the anaesthetist is cheerily businesslike, the doctor is warmly reassuring and the nurses epitomise kind efficiency.
All of a sudden, heeeere’s Johnny; dotey, longed-for Johnny, a 3.68kg bundle of loveliness. And as I type, with snow falling outside and my stockings consigned to the attic, he snuggles into my heart, chirruping and snuffling, a newborn nugget of optimism.
DVT: WHAT IS IT?
Deep vein thrombosis (DVT) occurs when a clot forms in one of the large veins that run between the muscles deep inside a limb, usually a calf.
Symptoms include swelling and pain, and the leg feels heavy and warm, and turns red because the blood is diverted to the superficial veins. DVT requires immediate medical attention.
Contributory factors include use of the contraceptive pill and HRT, obesity, immobility, smoking, long journeys, surgery and family history of clots. Women run a one-in-1,000 risk of DVT during pregnancy, delivery and in the weeks following birth. Pregnancy causes increased pressure in the veins in the lower half of the body, and also boosts the body’s own clotting mechanism to prevent excessive blood loss during delivery. Treatment involves bed rest, anticoagulant medication and compression stockings.
A serious, though rare, complication of DVT is pulmonary embolism, where part of the clot travels to the lung. Symptoms of this potentially fatal condition are shortness of breath, sharp chest pain, bloody sputum and increased heart rate.
