womzilla | My Impromtu Vacation, or, Now I Sort of See the Appeal of Munchausen Syndrome

When I woke up, my back hurt right under the right scapula. It hadn't hurt that way when I went to bed, but it was definitely hurting now. Also, I was coughing some, unproductively, and my head hurt. I'd had a cold last week, but it apparently went away over the weekend, so this was bothersome and surprising.

I took some cold medicine with pseudoephedrine and acetaminophen expecting it to clear everything up, and I went to work, getting there at my usual 8:50. By 9:50, the pain hadn't gone away--if anything, it was sharper than before. My heart was racing and I was lightheaded, dizzy, anxious, and still coughing, a dry, unproductive, somewhat painful cough. Additionally, the underside of my right thigh was somewhat sore. Given how my brain was working--which is to say, dizzily, lightheadely, and anxiously, this all meant one thing:

Symptoms of pulmonary embolism may be vague, or they may resemble symptoms associated with other diseases. Symptoms can include:

Cough
Begins suddenly
May produce bloody sputum (significant amounts of visible blood or lightly blood streaked sputum)

Sudden onset of shortness of breath at rest or with exertion

Splinting of ribs with breathing (bending over or holding the chest)

Chest pain
Under the breastbone or on one side
Especially sharp or stabbing; also may be burning, aching or dull, heavy sensation
May be worsened by breathing deeply, coughing, eating, bending, or stooping

Rapid breathing

Rapid heart rate (tachycardia)

Additional symptoms that may be associated with this disease:

Wheezing

Clammy skin

Bluish skin discoloration

Nasal flaring

Pelvis pain

Leg pain in one or both legs

Swelling in the legs (lower extremities)

Lump associated with a vein near the surface of the body (superficial vein), may be painful

Low blood pressure

Weak or absent pulse

Lightheadedness or fainting

Dizziness

Sweating

Anxiety

One of the worst things about having the Sword of Embolism forever hanging over my lungs is this: It's almost impossible to accurately diagnose in oneself.

The classic triad of signs and symptoms of PE (hemoptysis, dyspnea, chest pain) are neither sensitive nor specific. They occur in fewer than 20% of patients in whom the diagnosis of PE is made, and most patients with those symptoms are found to have some etiology other than PE to account for them. Of patients who go on to die from massive PE, only 60% have dyspnea, 17% have chest pain, and 3% have hemoptysis.

So. Things weren't getting better. I wasn't thinking well. I stopped in the middle of a sentence with one of the traders, said, "I have to go to the hospital now", and walked away.

My boss Chuck--a former Naval fighter pilot who is excellent in crises--walked out with me, asked me reasonable questions to determine why I thought I should go to the hospital, and helped me figure out the next few steps--such as, which hospital. A few minutes later, I was on my way to Lenox Hill Hospital on Manhattan's Upper East Side. I called

supergee from the taxi and told him and

nellorat not to worry.

My vital signs indicated that, indeed, my breath rate, heart rate, and blood pressure were elevated* and I had slight hypoxia in my extremities. (Did you know that doctors can measure peripheral blood oxygen levels by shining a light at your skin? Sometimes the future is So Fucking Cool!) Given that, and the family history and my clotting disorder, I was taken to a bed in the emergency ward, hooked up to an EKG, and poked and prodded. (I called Chuck shortly after the EKG indicated that I was not in immediate danger, and he relayed the news to supergee.)

*As noted above, an actual several PE will tend to depress blood pressure, but like all the other symptoms, this isn't reliable.

Pretty much the definitive diagnostic for PE is a chest CAT scan ~~so they rubbed a cat all over me~~ (updated to add: illustration), so I was fitted with an IV--I complimented my nurse several times for the skillful job she did with my wretched veins--and eventually wheeled up to Advanced Radiography. The CAT scan itself was pretty uneventful; by far the strangest part was the sensation of the iodine-based contrast dye rushing through my bloodstream. The iodine produces a feeling of warmth as it first touches the lining of the vessels, so it was mostly this quasi-mystic sensation of being flooded with energy--until the dye reaches the kidneys, when it feels remarkably like having wet yourself. Fortunately, the attending nurse had warned me about this, so I didn't actually think I had developed incontinence on top of everything else.

The rest of the afternoon consisted of waiting for the results of the scan, which mostly meant lying (or sitting) in bed reading various things from my backpack, including three issues of The Onion and some printed-out news articles. This is where the appeal of Munchausen Syndrome comes in: there are far, far worse things in the world than lying in bed, relaxing, surrounded by people who are paid money to take care of you. I managed to not let the power go to my head (or block any major veins).

Anyway, after three hours of waiting for results, we learned that the CAT scan was completely negative, in the encouraging sense of negative--not only no clot in my lungs, no sign of a clot anywhere in my deep veins. It took a little while for the nurse to get back to remove my IV--by far the worst part of which was removing the packing tape from my hairy, hairy arms--and then I went back to the office to check my work-related e-mail, run a report, and then go home.

So, no embolism today. The best guess is that I wrenched my scapula over the weekend but hadn't noticed until today, and maybe a strong reaction to the pseudoephedrine. On a side note, I am still apparently not diabetic; my blood glucose level half an hour after eating a chocolate brownie and a peanut butter breakfast bar was 98.

So, yay my body! It hasn't managed to kill me yet.