A couple of weeks ago, I slipped on an icy sidewalk taking out the garbage and thought I’d sprained my ankle. (Nice timing: by the next day, all the ice and snow was gone!) Although I felt something go “pop” inside, I was sure it wasn’t broken because within five minutes I could put a little weight on it (I limped back into the house) and within an hour was able to put almost my full weight on it. I spent the morning elevating and icing it. At lunch, my wife came home from work and insisted she take me for an x-ray. The doctor assured us it wasn’t broken but took an x-ray just in case. Was he surprised to see a double break in the fibula just above where it meets the ankle. Also, the entire ankle was dislocated a few millimeters to the left. (And of course it was sprained too, but that goes with the territory.) I had surgery that night to screw a plate into place to hold things together and reset the ankle displacement.
Life is a hassle dealing with an immobilized leg and crutches: you can’t carry anything so someone has to fetch stuff for you, taking a shower is a major production, stairs are scary, and I have to keep my leg elevated a lot to keep my foot from swelling too much. So, that means only a couple of hours a day at the computer and sleeping in a spare bedroom on the main floor of our house. My poor wife Peggy: her work load about tripled: doing all of my household chores in addition to hers plus taking care of me. I’m going to owe her big time once I get back on my feet!
Fast forward almost two weeks. Feeling like my life is on hold for six weeks but getting through it OK. Virtually no pain in my ankle. We drove to Winnipeg for the Canada West Short Track Speed Skating Championships, which my son qualified for. After a day of watching skating on Saturday, I developed a low-grade fever and some back pain right after dinner. It cleared up Sunday, but then I awoke about midnight Sunday night to the most excruciating pain I’d ever felt. Every breath felt like someone was stabbing me with a knife in my left-side ribs. I took some muscle relaxants and after they kicked in, I was able to fall asleep sitting up (laying down was still too painful).
Monday was much better. Still had a low-grade fever but the rib pain was manageable. We drove back home from Winnipeg and Peggy and I discussed what could have caused the pain and fever. I was sure it was pulled muscles in my ribs: I’d been sitting in a cold arena for a couple of days, getting up and down the bleachers, probably straining muscles in the process. I had something similar happen about six months earlier: I sneezed while in an awkward position and pulled the muscles in my right ribcage, and this felt just like that. However, I couldn’t explain the fever, so Peggy had me Google “fever after surgery” on our iPad while I rested on the couch.
The most common cause is infection, but since I didn’t have any pain in my leg, I doubted that was it. A few others didn’t make sense in my case, but one thing did seem slightly reasonable: pulmonary embolism. Circulation in an immobilized leg is reduced and as a result, a clot can form. If part of the clot breaks off, it can travel up and get stuck in the lung, causing chest pain, especially when taking deep breaths, and low-grade fever. However, it’s also often accompanied by altered heart rhythm, shortness of breath, and other symptoms I didn’t have. Plus the pain really felt like it was in my ribs rather than in my lungs and I didn’t think muscle relaxants would relieve lung pain. I was about to write that one off too when a sentence caught my eye: pulmonary embolism is fatal if untreated. I mentioned that to Peggy and she insisted we go to the ER the next morning. I agreed, thinking we’d eliminate that possibility and find the real issue.
After some preliminary tests, the doctor figured it was either a clot or pneumonia. I told him “I hope I have pneumonia. Hmm, I doubt that’s a sentence that’s been said before”. He laughed but agreed with me. After more tests, x-rays, and even a CT scan, the diagnosis came back: pulmonary embolism. Crap.
Fortunately, the treatment is straight-forward: blood thinners for six months to prevent further clotting and eventually the existing clots will erode. Blood thinners have their own hassles—I have to inject my belly twice a day for the next four days with a fast-acting blood thinner; I need daily blood tests for at least a week to make sure the dosage of blood thinner pills is correct; certain foods, such as spinach, are off limits; bruises form easily; I have to wear a compression stocking after the cast comes off (like that won’t make me feel like I’m an 80 year-old); and alcohol is discouraged (nooooooooo!). However, the doctor and several nurses told me while I was unlucky to have this happen, I was lucky it was a small clot (a larger one could’ve caused sudden death) and that we came into the ER early (lots of people wait for days, hoping the symptoms will go away on their own).
So, there are two morals to this story (well, three: stuff happens, so deal with it):
- Don’t be afraid to get an unlikely, even exotic-sounding, potential problem checked out. No one will laugh at you. Google is definitely your friend.
- Always listen to your wife. Always. She is smarter than you.