Another day, another doctor, another medicine

Spent Tuesday afternoon with Dr. Goldberg, who had been described to me by Dr. M. Kelly as a hematologist who excelled in his field -- an opinion I heartily endorse. Here is the edited version of his written report to me:

"You have a history of several blood clots, some of which have been dangerous and uncomfortable (Ed. note: Yea, verily). The blood clots that you had in the 1990s went to your lungs (Ed. note: And how!) You have a filter that won't allow big clots to go to your lungs now, but little ones may get through (Ed. note: Yikes!). 

"You had extensive blood clots when you had the meningioma removed (Ed. note: And they linger still). 

"We can attribute reason for all your clots. However, few people have clots even under these circumstances (Ed. note: Aren't I the lucky one). Therefore, it is possible that there is some other additional issue causing your clots.

"The value of looking for additional problems after the age of 50 is small (Ed. note: Not sure how to take this). We will, however, do a test for lupus anticoagulant (Ed. note: And to do that you needed to draw all that blood?)

"To take care of your clot now . . . the safest course would be to give a direct thrombin inhibitor. An oral drug . . . is available and would allow outpatient treatment (Ed. note: Hooray for that). 

"I will start you on the medicine. In the meantime, we will try to adjust your Coumadin again (Ed. note: We're off to see Lisa, the Coumadin lady, this afternoon) and at the same time petition your insurance company to see if they will cover it (Ed. note: They will, so hooray for Premera and for my working wife who lets me tag along on her coverage).

"I want you to come back Thursday or Friday (Ed. note: Appointment made for Thursday). We will check the level of the direct thrombin inhibitor. If other clot-related problems occur -- shortness of breath, etc. (Ed. note: Nasty details omitted by the taste police), call us right away. We will admit you to the hospital (Ed. note: Is that a threat?) and put you on a direct thrombin inhibitor intravenously."

So let's all get in the corner of the oral direct thrombin inhibitor because I have other things to do on Thursday night.

I imagine the direct thrombin inhibitor plays a lousy trombone and scares away the clots with out-of-tune blatting or poking the clots with the trombone slide. Quick, doc, I think the drugs are taking effect!