Mr. AMA

Call me Mr. AMA. My life has become an endless series of medical appointments:

• Personal doctor to coordinate care after the pulmonary embolism
• Ophthalmologist for my semi-annual visit.
• Ultrasound office for a scan of my kidneys ordered by my personal doctor
• Pulmonary specialist to see how my lungs are doing and monitor my progress
• Annual physical
• Dentist for my semi-annual appointment
• Annual dermatologist
• CT scan ordered by the pulmonologist
• Echocardiogram ordered by the pulmonologist
• Pulmonologist again
• Hematologist

So far I’ve done the visits in italics. I have all the blood thinners a man could ever ask for. No clots made their way to my eyes (not that this was much of  concern, but the eye doctor takes a picture of my eyes once a year anyway). The ultrasound was to rule out cancer in my right kidney and adrenal gland. (This is a remote possibility but I have no adverse symptoms so no worries.) The pulmonologist said that I sound good. She was upbeat about my progress and ordered some scans of my heart and my lungs for a month from now. She also said that when all this is over, we’ll evaluate whether I can dial back my asthma medication. (This is unrelated to my embolism. She thinks the drug I am using is overkill.) Also, she green lighted exercise as long as I don’t get light headed. And told me I can retire the spirometer. (I may still use it to see how my lung capacity improves over time. And because I can be a stubborn competitive ass.)

She is aware of my problems climbing hills on my bike in 2017. (I immediately run out of gas. My legs just stop working.) And she thinks my May 2016 trip to the ER was probably caused by a pulmonary embolism. According to the interwebs, untreated pulmonary embolisms have a mortality rate of 26 percent.

Eek.

So it’s not surprising that my pulmonologist is operating under the assumption that my December 2017 crisis was actually (at least) my second pulmonary embolism. We will continue to search for a cause but may not ever find one. It doesn’t look like I have cancer (some of which increase blood clotting). I have no immediate family history. I take reasonably good care of myself. Even my leg where the deep vein thrombosis (DVT) is looks and feels normal.

Long story short my probability of getting another pulmonary embolism, if I go off blood thinners, is 17 percent. Given that 26 percent of undiagnosed pulmonary embolisms are fatal, the probability that I will have another embolism and die is 4.4 percent.

My probability of a bleeding mishap (which can be permanently debilitating or even fatal) from the blood thinners is 2 to 3 percent. This is for the average patient though. A clumsy person who rides a bike and hikes on rocky trails would be at greater risk, I would think. So maybe my odds of dying from the thinners is 4 to 6 percent.

Isn’t math fun?

The probability that I will need a good stiff drink tonight is asymptotically approaching 1.0.

My pulmonologist is inclined to leave me on the thinners for life. She said that hematologists are inclined to take patients off them after six months or a year.

Anybody got a pair of dice?