Deep Venous Thrombosis

1. That could be a name for a band; and
2. I've got one. In my right calf. Which is just ridiculous.

What happened was this: on Tuesday afternoon, as I was sitting at my desk minding my own business, my right calf muscle began hurting a little bit. It was as though I had sprained it while running, or had a charley horse cramp. Weird, but no big deal. I was walking normally and it didn't hurt that badly and, yeah, so I hadn't done much exercise lately but these things just happen to muscles sometimes, right?

Except that it didn't go away. Sometime on Wednesday I started to think that I had a real problem, and began looking up my new (almost certainly non-pregnancy-related) symptom. Dr. Google said that Deep Venous Thrombosis, or DVT as the cool kids call it, was a possibility. But! I am not on the birth control pill, and haven't been at any point in this cycle. I am not overweight. With the exception of the past few weeks, I am not sedentary. The leg wasn't swollen or red or hot to the touch. And when I massaged it, it really felt like the muscle itself was sore and not any kind of underlying structure. So I just ignored it, and hoped it would get better.

By Friday morning it was clear that this problem was not going to neatly resolve on its own. I woke up to use the bathroom in the middle of the night and when I staggered back to bed my leg felt like it was on fire. I couldn't get back to sleep because of the pain. I decided at 4 AM that even if this was musculoskeletal, I clearly needed medical help to deal with it. When their office opened later that morning, I called my RE and described what was going on. They said I needed to talk to my primary care provider, who said I needed to get an ultrasound, and it took until 4:30 PM for someone to finally take that little wand to my calf in order to see what the heck was going on inside it.

"Okay. So you do have a clot." The ultrasound tech (and let me just pause for a second to say that I had forgotten how nice it is not to have a transvaginal ultrasound) found a DVT in my right peroneal vein, beginning underneath my knee and extending several inches down my leg. Um, what? But it was true. Even I could see that the image on the screen showing nice flowing red and blue blood on the normal section of my leg stopped almost completely when the tech got to the painful part. Cue me totally freaking out and telling her about the IVF, and I've been on all these hormones, and what do we do now, and all she could say was that she had to finish the exam and then I could talk to the doctor. I texted my husband, who of course also freaked out, and my parents, who did the same thing, and then I went back upstairs and tried to freak out very quietly in my doctor's almost empty waiting room (very fortunately, her office is in the same building as the ultrasound place. Otherwise this could have been even more exciting.)

When my doctor finally saw me - and it was now after 5 PM on a Friday evening so she is a rock star - I was surprised to learn that she didn't want to immediately start me on anticoagulants. (I had decided while waiting that the posted signs about no cellphone use did not apply to patients who were sitting in a nearly-empty waiting room watching the receptionist pack up, so I was back to asking Dr. Google what was safe to do for a DVT in a possibly-pregnant woman, and he had recommended Lovenox injections.) My clot is, happily, below the part of my leg that would put me at risk for part of it to break off and travel to my lungs and - ha! ha! ha! - possibly kill me. And starting me on Lovenox now, when we still don't know whether I'm pregnant, could have long-term effects since I might end up staying on it for the entire pregnancy and beyond. If I'm not pregnant, I would probably be on Coumadin rather than Lovenox, but we can't start me on that until we know I'm definitely not knocked up since it would be harmful to a developing fetus. Right now, she's recommending that we do follow-up ultrasounds every few days to make sure the clot doesn't extend up into the lung-killing section of my leg, plus I'll probably get a blood workup to see if I have any thrombophilia factors that might account for this having happened in the first place. In the meantime, I'm elevating it when I can and applying the occasional warm compress. And although I was really surprised that I didn't walk out of there with a prescription for some kind of blood thinner, or even a note of admission to the hospital, it is true that with this particular kind of clot anticoagulant treatment might not be necessary.

That's not to say that it wasn't exciting to receive calls - on a Friday night! at home! - from my regular Ob-Gyn and my RE. Both agreed with my primary care doctor's plan for now and said that it was crappy timing what with the whole no-way-to-know-if-you're-pregnant thing. And now I'm horribly conflicted about whether I think it would be a good thing to be pregnant this cycle. I mean, no amount of wishing or hoping or praying either way is going to change whether the embryo has implanted, and if it has, we'll take each day as it comes and manage the DVT as best we can. If it hasn't, then I want to make sure I am personally healthy before we make another attempt to create a new little person. I want to have a serious discussion with my RE (in his office, just the two of us, time blocked off on his calendar) about why this might have happened and how to prevent it in the future. His initial recommendation was that we do another cycle immediately while the endometriomas are still small enough to manage without more surgery, but my Ob-Gyn said that the only risk factor I really had for this DVT is that my estrogen levels have been high lately thanks to all the ovarian stimulation. I'd want to know how we're going to manage that in future cycles, and what other changes we can make (for instance, I think we can safely say that I will not be on bed rest after transfer in the future. It's not proven scientifically to help, after all.) I do wonder if this has something to do with my propensity to grow endometriomas, and grow them quickly. And of course if this cycle fails I will now wonder if that had something to do with a clotting problem, too.

At one point last night someone said "You know, you've just become a very interesting patient!" Yeah. I'm very flattered, but I could have lived without the medical mystery. I know that things could be so much worse and I'm unspeakably grateful for the medical care I have been given, and will continue to get. But I will say: this is just crazy. Who would have thought?