I got a DVT on a plane ride to Edinburgh, which led to pulmonary emboli that didn't get diagnosed for almost 3 months! This is particularly scary in retrospect, and I've lost many hours of sleep thinking about what could have happened:
Scary stuff! Here's the story. I also kept an online diary during this period, and its interesting to read about my symptoms as they were occurring.
On July 21, 2005, Joann and I flew to Edinburgh to attend the annual conference Uncertainty in Artificial Intelligence, for which I was serving as general chair. I had just finished a two-day sculling camp in Seattle with John Riley, and I had started training with my Head-of-the-Charles eight. When I arrived in Scotland, I continued to work out every day, but it became more and more difficult to make it through even an hour of easy steady state. I assumed that my problem was jet lag or perhaps I was playing with a virus. I felt fine when I wasn't working out.
Joann and I returned home on August 7, and I took the next two weeks off from work. I was playing summer-league ultimate frisbee on Team Vince, and the playoffs had just started. I noticed immediately while playing disc that although I had my normal speed, I was getting fatigued much faster than normal. The symptoms were less noticeable but still present while rowing. I still thought that I probably had a virus, and I didn't think too much about it. On August 20, I played in a two-day ultimate tournament (Spawnfest 2005), and Vince won the B pool! During the tournament, I was cognizant of not being able to play more than a few points in a row (I normally have a lot more endurance), but I was feeling a little better and assumed I was getting over my virus. On August 25, Vince won the A pool final for the summer team league. I played a lot in the game, but I had to sub out after every point I played. I felt as if I had a pillowcase over my head.
In early September, I started to get scared about what was going on. On September 9, I called my GP and made an appointment. When I got in to see him, my doctor told me I was probably overtraining and/or not drinking enough fluid while rowing. This really pissed me off, and I insisted on getting some more tests. My bloodwork looked normal, and I had a chest X-ray that looked fine. My GP sent me to a cardiologist to get a stress test. The idea is to get an ultrasound of your heart both at rest and after you've run to exhaustion on the treadmill. I had this test on September 19, and my heart looked fine. The cardiologist said that my problem was probably psychological. I insisted on more tests, which the cardiologist ordered for me, but I was really depressed that I couldn't get a doctor to take me seriously.
On the morning of September 19, my eight did five by five-minute pieces at increasing stroke rates, and I could barely make it through the workout. I got to work and coughed up some blood, which freaked me out. The big race was only a month away, and I decided to drop out of the boat so that my team would have time to get a replacement. This was a particularly difficult decision for me; we had won the race two years in a row, and I was really excited about the possibility of a third, but I realized that unless I got better immediately, I was going to be a problem for the team.
Upon hearing of my problem, my coxswain got me in touch with a doctor of significant importance at the University of Washington medical school, and he in turn got me in to see a pulmonary specialist at UW who has done a lot of work with athletes. Unfortunately, because the specialist was on vacation, I didn't get to see him until Wednesday, September 28. My new doctor was great, and I really appreciated that he took me seriously when I said that I was experiencing a dramatic decrease in performance. We did all sorts of tests, including a VO2 max test on October 6. My VO2 max was really low, but other than that, nothing really stuck out as abnormal. In particular, I did not show any of the normal signs of a pulmonary embolism, and so the doctor was pretty sure that was not what was going on. He suggested that I take aspirin just in case, though.
On Thursday, October 13, I had another stress test on the treadmill with a cardiologist in Bellevue. I was feeling a lot better (most likely because I was now taking aspirin daily, as it turns out), and I "won" the test: the test increases in difficulty every three minutes by getting faster and steeper, and I managed to keep going until it wouldn't get any harder. That weekend, Joann and I went to Leavenworth for a chemistry conference, and I ran 5 miles at about a 7:30 pace, and it felt great. On Monday, I contacted my doctor and told him how great I felt. I had a CT angiogram scheduled for Tuesday (as a just-in-case test for a PE), and we discussed canceling the test. We decided to proceed with the test to be on the safe side. I was regretting that I had dropped out of my eight, and I contacted my fall-league team captains to tell them that I was ready to play again.
On Tuesday morning, October 19, I had the CT angiogram. The test itself was very strange. I could taste the iodine that was being injected into my arm, and my whole body got warm. I came back to work, and I soon got a call from my doctor to return to the hospital immediately: I had multiple pulmonary emboli! I got back to the hospital and had my legs checked for a blood clot, and sure enough, I had a DVT in my left leg! Presumably, this clot formed on the long plane trip to Edinburgh, and small bits were breaking off and getting stuck in my lungs, diminishing my ability to breathe.
To treat the PE/DVT, I was immediately put on heparin, which is a blood thinner that you inject twice a day, and I started taking warfarin, which is another blood thinner that you take as a pill, but for which getting the correct dosing is non-trivial. The idea is that once you get the right dosage of warfarin, you can stop taking the heparin. It turns out that I metabolize warfarin extremely well (10 mg per day is generally considered a high does of warfarin, and I'm taking 17.5 mg per day to keep my INR in the right range).
About a week after starting on blood thinners, I felt as healthy as I did before traveling to Europe. The real negative for me is that I need to be careful about getting bumped around too much due to my increased risk of bleeding. I've decided to not play competitive frisbee until I'm off warfarin, because I don't trust myself not to do something stupid during a game. After six months of treatment, I will get another ultrasound done on my leg to see if the clot has gone away.
March 2006 Update
I had an ultrasound in early March, and the great news is that my DVT has dissolved completely! After this great news, I had a number of tests done to see if I had clotting abnormalities that would require me to remain on warfarin for the rest of my life. Once again, I got good news!
I found a study showing that low-dosage warfarin treatment can dramatically decrease the chance of DVT recurrence, so my plan is to remain on warfarin for the next couple years. Because the dosage is low (I'm going to keep my INR around 1.5), I need not be so concerned about bleeding, so I can finally stop being so conservative while playing sports!