I thought I just had a nasty cold. In fact it was a killer lung clot
It’s the second biggest cause of sudden death, but it’s hard for doctors to spot
My first indication that this wasn’t going to be an ordinary Monday was when i coughed in to my handkerchief and saw, to my surprise, a big splodge of deep red blood.
‘ Oh dear. that can’t be right,’ i thought. But still i wasn’t too worried. four days earlier, i’d had surgery to repair a clavicle (shoulder blade) that i’d broken quite seriously in a riding accident. Add to that at least three broken ribs and it was no wonder i should be feeling rough.
Perhaps, i wondered, the blood might be some delayed result of my accident. Maybe the sensible thing would be to get back into bed and continue the nice long rest i’d been having since the operation.
But then it struck me that one of my friends on twitter was a surgeon. so i told him about the blood; and about how i’d woken up that morning, tried to take the dog for a walk, but been unable to continue because i’d been short of breath.
As an afterthought, i added that two nights earlier i’d woken up drenched in sweat, as a result of what i thought was a fever induced by fighting off a cold. ‘it would be wise to see your GP or go to hospital,’ advised the surgeon.
Even then i wasn’t sure. that word ‘wise’ didn’t seem very strong. Also, i was wary of bothering my wife with my worries. i’ve always been a bit of a hypochondriac, prone to depression and anxiety, and forever thinking i’m dying of some incurable disease.
the kids were home for half term. i’d already put her through enough anxiety, what with the accident and the surgery and my days in bed being waited on. so i left it another hour, to see if i felt any better. But i didn’t.
so at lunchtime, i found myself at our GP’s surgery with my not-at- allimpressed wife. ‘ And i coughed up blood,’ i told the doctor. ‘Not that much blood,’ said my wife, who is used to my exaggerations.
‘Excuse me, but you didn’t see it,’ i snapped. ‘i saw the handkerchief,’ she said. ‘Well the handkerchief gave you a false impression. Believe PlEAsE me there was a lot . . .’
don’t get t he impression that my wife is uncaring. she’d just had quite enough of me and my theatricals.
so you’ll imagine her irritation when the doctor, having found my pulse was racing and my breathing stertorous, referred me to the nearest hospital with a note saying the words ‘suspected PE?’.
Neither of us dared think what ‘suspected PE’ might mean.
frankly, we were both more concerned about the waiting time and the fact that we had two kids waiting at home, unfed.
it would be four to six hours before we could be seen by a doctor, they told us at A&E. i didn’t like the look of the place. it was a pokey cottage hospital, with all the doctors and nurses l ooking seriously overstretched and lots of patients sitting around being ignored.
if i was going to be ill, i decided, i didn’t want to be ill here. We snatched up the doctor’s note and headed instead for the large, university teaching hospital where i’d had my surgery done, in Coventry.
luckily they were able to see me much more quickly there. Within two hours i was being examined by a doctor — and not before time because now i was suffering some serious pain.
i felt it in my lower back, on the opposite side to where all the broken ribs were — and it got worse when he asked me to try to breathe in deeply, which i couldn’t, hardly at all.
Within 20 minutes the pain went from bad to excruciating. imagine the worst stitch you’ve ever had, multiply it by 1,000, and you’ll get an idea. i couldn’t even lie still any more it hurt so much.
finally, after an i nconclusive X-ray, a consultant appeared and gave a tentative diagnosis: it might be a pulmonary embolism.
A pulmonary embolism? i’ d heard of these things vaguely (i later realised the hospital had handed me a leaflet on the subject after my op, which i hadn’t read) and knew they were bad, but that was as far as it went.
they gave me an injection in my stomach with an anti- clotting agent called heparin just in case. it stung like a bee but by this stage i was too far gone to care.
My poor wife, now frantic with concern, had to drive home as i stayed behind in hospital, lolling and delirious with morphine. she looked up ‘pulmonary embolism’ on the internet and didn’t at all like what she read: it’s a blood clot (a deep vein thrombosis — DVt) which travels to your lungs and blocks a blood vessel.
it’s the second most common cause of sudden death after cardiac arrest, killing around 25 per cent of victims. My surgeon friend’s advice may have saved my life.
While my mother and my wife had a sleepless night worrying about me, i lay in a morphine-drenched stupor alternating pain with nausea.
No wonder. According to women who’ve experienced both, this pain was even worse than you get during labour.
the reason pulmonary embolisms hurt so much, i learned later, is that the membrane on the lungs is dense with nerves. Even with the anti- clotting injections it takes a while for the clot to clear. the severe pain lasted for at least two days.
A pulmonary embolism is hard to diagnose. Even when you’ve shown all the obvious symptoms — breathlessness, chest or back pain (especially when breathing deeply), coughing up blood, a slight temperature, a fast heart rate — they still can’t be sure till you’ve had a Ct scan or a VQ ( ventilation perfusion) scan. ThE
l atter, which i had, measures air and blood flow in your lungs. it involved being injected with radioactive albumin and l ying for 15 minutes under a machine with a heavy mask covering my mouth, breathing in radioactive gas — the albumin and gas show on a scan.
it was so claustrophobia-inducing i had to fight the urge not to scream and tear my mask off.
Unfortunately, it’s a necessary part of the process and it did confirm i had an embolism.
the news was far worse for my loved ones than me. they were all now half-convinced i was a goner (it’s estimated up to 60,000 people i n Britain die every year as a result of a pulmonary embolism); i, meanwhile, was as happy as larry on morphine and enjoying X-ray image: The orange area shows lung damage due to a pulmonary embolism being looked after by the lovely, friendly nurses.
After four days in hospital, i was discharged with a bag of pills the size of a small pharmacy. Even more so than the various painkillers — and the laxatives which, unfortunately, you need to deal with the effects of those painkillers — the key medicine was my supply of rivaroxaban, the blood-thinning agent you have to take religiously to stop the clot recurring.
Either that or you’ll be given warfarin — rat poison, basically — an older treatment which has the same effect, only with the disadvantage that you’ll need to attend several clinics afterwards to check your blood levels and make sure the dosage is right.
two weeks on i’m now on the road to recovery. i’ll be on the blood-thinners for between three and six months, during which time i’ll have to be extra careful not to have an accident or break (because of the increased risk of bleeding, internal or external).
Also, there’s a possibility that i will have done permanent damage to part of my lung, which might mean my oxygen intake isn’t as efficient as it used to be.
But in theory i’m unlikely to get a recurrence. that’s because my pulmonary embolism is ‘provoked’ (as distinct from ‘unprovoked’), meaning it was brought on by a specific incident, ie, surgery.
i still feel a bit ropey — tiring quite easily, breathless and frankly a bit low at times — but i’m definitely on the mend, getting stronger each day, happy to be alive.
Why did it happen? seems i was just unlucky.
As with DVts you can get pulmonary embolisms after long haul flights, after extended periods of bed rest and after surgery (especially for broken limbs). though people in any of these categories should be aware of the symptoms and ready to act on them, the chances of it happening to you are pretty slim.
Just don’t make the mistake i almost did and dismiss them when they appear: seriously it could be the death of you.