New Era

On the way back to the OR from J6-6

My first patient today was a 41 year old man who ran a marathon last week in southern California.  He made several subsequent airline flights this week and 3 days ago noticed  painful swelling in his left leg. Not surprisingly, he had developed a DVT (deep vein thrombosis) in his leg.  I’m sure his relative dehydration post marathon coupled with the “trauma” of the marathon running and his air travel combined to precipitate the clot.  While the airline industry has published several studies denouncing a connection between air travel and DVT, the association has been drilled by anecdote into the public and medical psyche. Conflicting literature even cites an increased incidence of blood clots in highly trained athletes who travel by air explaining that the decreased heart rate in athletes may translate to slower venous blood flow (hence, more stasis and clotting).  Our patient’s clot extended from his calf through his thigh and pelvis all the was up to his Vena Cava (the main vein in the abdomen).  I successfully accessed his popliteal vein behind his knee and then we also got access to his Posterior tibial vein at the ankle.  We are now delivering lytic agents (clot busting drugs) to his entire left leg venous system.  The effectiveness of the drug is enhanced in the thigh and pelvis by the placement of a special ultrasound emitting guidewire inside the drug delivery catheter.  The EKOS catheter is used routinely to speed up the work of the clot dissolving drugs on both arterial and venous blood clots.  Although it is an expensive device it has been shown to reduce the amount of time for lysis AND the amount of expensive drugs required.

Ten years ago this patient would have been routinely consigned to heparin and coumadin therapy alone for his blood clot.  He would have had a painful swollen leg for many months and likely developed chronic venous hypertension.  The long term effect of that hypertension often results in skin breakdown in the form of venous ulcers at the ankle.  Hopefully this therapy will prevent that outcome.  Tomorrow will be very telling in that regard.

Well the last 48 hours have been life altering for me.  While making clear strides in my endovascular training with increased confidence and procedural skills I found out that “I can’t go home again.”  Jill (and I in absentia) reached an agreement of sale for our home of almost 17 years.  While on the market for nearly 14 months with many showings, we knew that our unusual design and layout was waiting for a special buyer.  We are quite pleased to have a young family looking forward to growing up together in this work of art.

The Barn

This home will always evoke great emotion for me.  It was an exploration of my own identity as well as the growth of our family’s identity.  Jill and I explored our likes, dislikes and tastes in designing this structure with George Zajacek.  We were able to marry very personal elements including the “goldfish pond”,  the open kitchen / family room and the covered flagstone patio with touches like hand wrought iron hardware, hand made doors and exposed “barn beams”.  I’ll always remember Chris and Drew playing every sport in the basement including “tennis” using boxes for a net.  As our boys have moved on, the upstairs loft lays quiet.  Dharma rarely ventures to the second floor anymore partly because age is making the trip harder but mostly because the futons filled with sleeping young men no longer beckon her for a romp.

Sycamores at Deer Run

Morning at Deer Run

I’m looking forward to the next chapter.  It certainly will be different.  Returning from Cleveland to …