Dr. Williams had been my Hematologist for 5 years prior to the ITP, life changing moment. He is very quick to remind me every time he sees me that he almost lost me. To understand why I didn't immediately post a classified ad on Craigslist for a Gestational Carrier, you have to understand my history with coagulation.
Rewind 5 years:
I'm 24 and undergoing a routine cholecystectomy (gallbladder removal). The nurses are telling me in pre-op that I'm the perfect surgery candidate. I don't smoke and I'm a healthy 24 year-old with no prior surgeries or complications. However, as soon as I wake from surgery, my instincts told me something was wrong. The nurses give me more morphine and knock me out. I couldn't breathe. I wake up again in a panic. I wanted my family. I was scared. They nurses tell me "not until you calm down."
After I finally started breathing on my own and got to see my mother and husband, I lost it. I started crying and hyperventilated. I'm certain my reaction scared the $h!& out of Dusty. My mother came home with us and we all slept in the living room that first night because I was terrified. I didn't feel right. I didn't know how I should have felt, but I was afraid if I went to sleep, I wouldn't wake up.
I did wake up. A few days later, while reaching for oatmeal in the pantry on my tippy toes, I pulled a muscle in my calf. At least, I thought. My calf was tight and sore the rest of the week. I tried to walk the neighborhood. Tried being the emphasis. I could barely make it one lap at a snail's pace and getting up and down the stairs at home was a daily battle. Still, I was scheduled to go back to work the next week, so I was trying to regain my strength. I thought that what I was experiencing was normal. So when I went for my 1 week follow-up and mentioned the fact that I was a little short of breath as an afterthought, the surgeon insisted I get a CT scan as a precaution. He said that shortness of breath could be a symptom of a life threatening condition.
My husband and I went down for the X-ray and I was panicking. Waiting for the results, Dusty assured me that I would be fine. When the surgeon appeared he said he had to admit me immediately because I had multiple pulmonary emboli in both lungs.
I was admitted to the hospital and was introduced to a confident, charismatic man with a wit uncharacteristic of most doctors I've met, Dr. Williams. He administered Heparin, a very strong blood thinner via IV. I stayed in the hospital for a week before I was released to go home. At home, I administered Lovenox (a blood thinner) via injections into my stomach twice daily. Then I started to take a warfarin (an oral blood thinner).
There's not a moment when you know blood clots dissolve. I couldn't feel them. That charlie horse? Turns out it was a DVT (deep vein thrombosis). That DVT broke free and traveled to my lungs to form the pulmonary emboli. I didn't feel bad. I didn't hurt. The shortness of breath was my only symptom.
The only way to verify if you have blood clots (or they've dissolved) is to have a CT with contrast and doctors don't tend to continually run you through radiation to check. After all, radiation is bad. Instead, they check your blood for Prothrombin time (Protime, PT), which is a blood test that measures how long it takes blood to clot. A PT is also used to check whether medicine to prevent blood clots is working. A PT test may also be called an INR test. The doctors and nurses wanted my blood to be therapeutic, which results in an INR between 2 and 3. If results come back outside of that range, the blood is either too thick or too thin.
I remained on warfarin for a year following surgery. During my routine checkups with Dr. Williams, we would talk about my condition and the future. At that time, Dr. Williams told me if I were to get pregnant, I would have to give myself Lovenox injections twice daily for the entire 9 months. He explained that once you have a history of pulmonary emboli, which is a life threatening complication, you have a greater risk of recurring blood clots that can lead to more pulmonary emboli. Awesome. All of the hormones pregnancy introduces combined with the abdominal strain would make me high risk for clotting. He, however, encouraged me. He talked about all of his other patients just like me who had delivered healthy babies and had taken Lovenox their entire pregnancy. He sensed my trepidation. And he promised me that together we could keep me safe during a pregnancy. You could say that Dr. Williams encourages and promotes babies. And during that year under his care, he tried to alleviate my fears.
Back to 2012:
Surgery and anesthesia scare the bejesus out of me. I've undergone 2 major surgeries in my life: a cholecystectomy and a splenectomy (spleen removal). In both cases, I developed pulmonary emboli. For this reason, I will always require anticoagulation therapy. You can't, however, take anticoagulants during surgery. Thin blood + surgery = a bloody mess. In fact, something Dr. Williams brags about, is that I was the first surgery patient to receive the obscure NovoSeven during my splenectomy at Norton Suburban. NovoSeven was first used in 1999 to treat a wounded Israeli soldier in Tel Aviv and thereafter to treat soldiers who were casualties of of grenades. Major.
Despite all of Dr. William's encouragement five years earlier, the tables have turned. What he thought was an isolated event ended up being an underlying blood disorder that was undetected. Pregnancy has been removed from the agenda, but being the extremely optimistic, baby promoting doctor that he is, Dr. Williams is encouraging egg harvesting and retrieval. At the time, I wasn't 100% up to the challenge and risks, being that I'd just busted out of the ICU.
I did, however, take the referral to visit the fertility specialist recommended to me.
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