Subclavian Vein Thrombosis

So the big blue arm that I was so sure was nothing, and we were all poking fun at (or in some cases, actually poking) turned out to be a wee bit more serious than just a funny looking arm.

After having this arm since Monday morning, I finally drag my butt to my family doctor sometime around 7pm on Wednesday evening. My doc is fairly laid back, and not one to jump to prescribing drugs or worrying about stuff, but she took one look at this arm and sent me to the emergency room. So off I go, clutching the note the doc wrote for me in one hand, and frantically making phone calls to work, to my mom (who is also a doctor), and to Paul with the other. I arrive at VGH emerg around 8pm, wave the doctors note at the fairly unconcerned triage nurse, and take my seat in the waiting room. About an hour later, still waiting, my parents arrive. Both of them, and my Dad had taken a bath, shaved, and put on clean clothes (even his underwear!) for the event.

Blah blah blah, many many hours, dozens of blood tests and ultrasounds go by, and sure enough, I have this clot in my subclavian vein. Now when they said clot, I'm thinking some little nugget the size of a dime or something like that. No. This clot was nearly 40cm in length. It extended from my elbow into my chest. So I get admitted into the vascular ward, and they start doing stuff to me. Firstly, they do a venogram. This involves injecting the vein full of a magnetic dye, and taking pictures of the clot with a fancy sort of x-ray machine. They then use these pictures to help guide a catheter, which they insert into an incision in my elbow, up the vein and into clot land. They push the catheter as far as it will go (this does not feel particularly nice, but it was neat cause you could see the whole thing on a tv screen nearby) until the clot gets too thick, and they also reach a stenosis (narrowing) of the vein. So they stop there for the day. The catheter is full of teeny tiny little pores, and they are pumping a) 'clot busting' TPa medicine and b) heprin - blood thinning medicine, directly into the epi-centre of the clot.

I get wheeled up to the vascular ward on strict bed rest (can't get out, not even to pee) with tubes coming out of both arms, and the arm in question wrapped up in plastic as to hold all of the catheter tubing in place. I'm not allowed to move or bend that arm. The morphine they gave me for pain made me puke, and those little barf trays that they give you in the hospital are NOT nearly big enough, or were not big enough to contain the tidal wave of orange juice that came spewing out of me. So they changed my pain killers. But apparantly the clot busters are also contributing to my nausea. They give me sedatives, which are nice. They also wake me up every hour on the hour 24 hours a day to check my vitals, which is not so nice.

Paul and my parents were at my bedside for the duration of the first evening, but I kicked them out because I was feeling so unwell. Poor Paul went back to our apartment and didn't sleep a wink because he was so worried. He came back about 6am, saw that I was feeling a bit better, and promptly fell asleep in the chair next to me.

Round about 1pm on Friday, they take me back down to Angio (where all the vein stuff is done) where they do more venograms (take pictures of the clot) and horrah, it's about 80% dissovled. It's made space for them to shove the catheter the rest of the way into clot-zone, which is up under my armpit, and into my chest. This makes me feel vaguely like I'm having a heart attack ( I think, since I've never actually had a heart attack, but I am recieving similar treatment as if I were having one). Back up to my ward, where I am again feeling nauseated, but no barf this time. I have lots of lovely visitors, who bring me a slew of books, magazines, flowers, fruit baskets and other goodies, none of which I am feeling well enough to read or eat yet, but I really appreciated all of it. 8:30pm on Friday I go back down to Angio for a final time, where they take more pictures of the clot, are satisfied that it is nearly gone (a little nugget remains) and they are then able to deal with the stenosis by giving me an angioplasty, which is where they stick a teeny tiny balloon into the vein and blow it up, thus creating more room for blood to flow. That did NOT feel good, but I am pretty used to this not feeling good by now. They take the catheter out, but leave the sheath (a straw like thing about 4 inches long) in my arm to keep pumping the blood thinners right into the vein for a while longer.

Back up to the ward where there is a party in my room (I thankfully got a private room), my brother and sister and their partners, and Paul and Tatjana are all waiting for me. I don't feel very good, my lips hurt real bad, my chest hurts, I'm nauseated and all that good stuff. I have a fight with the nurse about whether or not I am allowed to get out of bed yet, and she wins (I am still in bed) but she also kind of loses, cause it means she needs to bring me the bed pan yet again. Bed pan is now a 4 letter word in my books. Not the most graceful way of doing your business.

Saturday morning the Doc's come to give me some options. I can a) stay in the hospital with the straw in my arm until Tuesday, or b) learn to give myself shots in the hip, and go home on Sunday. I choose the b option, so a nurse comes along to take out my straw, and then gives me my shot lesson. I pass. I'm feeling a bit better, and am starting to get a bit of an appetite back.

Sunday they take the other IV out of my other arm (which is totally black and blue from the twice a day blood tests I've been getting for the last 4 days), and let me loose. I immediately regret my decision and want to go back to the hosptial. No one is taking my vitals. No one is bringing me water and crushed ice. No one will be there if something goes wrong, and this is very very scary. I cry for pretty much all of Sunday. But really I am not alone, Paul is there, and my Mom is there, and so are all of my great friends and family. But my apartment is not the hospital and there is a mouse in my house and my arm feels funny.

So now my life revolves around an injection schedule and daily blood tests. This will go on for 3-6 months. I meet with the vascular surgeon on Wednedsay of this week, and he will tell me when I can do things like go back to school and work. Most likely next week for school, but 3-6 weeks for work. Hopefully less. It depends on my blood, how thin it gets, how I react to it, and all kinds of stuff. I am not allowed to do anything physically demanding, beyond going for short walks, or use the arm much at all right now.

And that is the story of my big blue arm. Lesson learned, if you have a big blue limb, you should go to the doctor, and quick.

Some Facts for ya:

The subclavian vein is the main vein running through the arm. Goes up the inside of the elbow, under the armpit, and into the chest.

Subclavian vein thrombosis accounts for only 1-2% of all deep vein thrombosis (DVT's), the majority being in the legs, which are not quite as immediately dangerous. The subclavian ones are bad because of the proximity to the lungs and heart. If the clot gets into the lungs it can cause pulmonary embolism, and if it gets in the heart it can cause a heart attack.

In the cases of subclavian DVT's, about 80% are in the dominant arm. Most are in young active people and are triggered by some sort of activity (tennis, weight lifting, baseball, rowing, swimming, etc). They are often accompanied by a stenosis (narrowing) of the vein. In my case, this stenosis was caused by the space between the clavical and the top rib being too narrow. There is talk of removing that rib, once I have been taken off of the blood thinners. Surgery while being pumped full of stuff that makes your blood not clot is apparantly a bad idea.