Pulmonary Embolism

The day after my hospital discharge for my OHSS, I had to go back to the fertility clinic for another blood test to make sure my hormone levels were still on track. I continued taking the low dose aspirin and also doing my daily progesterone shots. I had to buy a few maternity clothes because even my t-shirts were too tight around my stomach. I liked the idea of seeing myself in these maternity clothes that I had been longing to wear for the past 2 years. But instead of framing a beautiful baby bump, it was serous fluid accumulating in my abdominal cavity. I had strangers congratulating me on my pregnancy and asking my due date. I didn't even know what to say, because most assumed I was around 7 or eight months along. Telling these people I was only 4 weeks pregnant brought on some bizarre reactions. I tried to tell myself each day that soon, my body would rid itself of this fluid and I would get to focus on just my pregnancy. Soon all these symptoms would disappear and I'd have the baby I'd longed for. That kept me going each day.

When I was 5 weeks pregnant, I started having a new symptom. I had a low grade fever. I thought maybe this was brought on by stress. My body was notorious for low grade fevers when I was dealing with stressful situations and lack of sleep. In fact, it was very common for me to start having a low grade fever, and then a week later be in a doctor's office with strep throat. I started trying to get extra sleep and hope it would resolve itself.

But a few days later, I felt much worse. My lungs had started to hurt and I was having even more difficulty breathing than before. I emailed Dr. R. He said the office was about to close, but that he wanted me to come in anyway. I rushed to get Meredith and myself ready as quickly as possible. When I arrived, he checked all my vitals and my lungs. He didn't see anything alarming, and told me that the issues I was having were all most likely from a pleural effusion. Some of the abdominal fluid had made its way into my lungs. This was another condition that should resolve itself, so I headed back home.

Over that weekend, I continued to feel worse. By Sunday, I asked my husband to page Dr. R and let him know that things were not improving. I told my husband that I thought I was coming down with pneumonia. I'd never had so much pain in my lungs before and my breathing was much shallower. My chest was also hurting every time I tried to take a deep breath. Dr. R called in an antibiotic and told my husband that he wanted me to come to his office the next day.

I started the antibiotic on Sunday, and by the time I was on my way to see Dr. R on Monday, I did feel that maybe I was on the upswing. At his office, Dr. R checked my vitals and my lungs. He said that he could hear something in my right lung that was most likely the pleural effusion. He was glad to hear that I felt better after starting the antibiotic, but wanted me to have an x-ray anyway. He also told me that he was concerned that I may have a blood clot, but that it was most likely just fluid. If the x-ray showed fluid or signs of pneumonia, we would assume that was the cause of my new symptoms. If not, we would go from there. Dr. R said he would also do an ultrasound, as I requested. The ultrasound still showed the signs of a single baby growing, but we couldn't see a heartbeat just yet.

Dr. R's office was located inside the hospital, directly above the radiology department, so having an x-ray was fairly simple. I was very nervous though, about exposing my growing baby to radiation, even if I was going to be wearing a protective vest. I was also worried that we hadn't seen a heartbeat during the ultrasound. From all the research I had done, I knew that the chances of having an early miscarriage after IVF were higher than for a naturally conceived baby. I prayed that during the next ultrasound, I would see a heartbeat.

When the results of the x-ray came back, they did show fluid in my lungs, so I simply continued taking my antibiotics. When I woke up the next day, I went in to brush my teeth, and had an overwhelming desire to cough. When I did, I felt a large amount of sputum in my mouth and I spit into the sink. It was red. I had never seen anything like that before, but I was convinced that I had pneumonia, and I knew that could produce rust colored sputum. I told my husband about it and he wanted to call Dr. R. "I'm feeling a lot better and my lungs aren't hurting as much," I told him. "Let's just wait."

The next day morning, was just the same. My lung pain was almost completely gone, but I was still having a pain in my chest when I took deep breaths. The lung pain had been so severe before, that I barely noticed the pain I was having beneath my breast bone. Now it seemed very apparent. My husband told me he was going to email Dr. R. He got a reply within minutes. The doctor told him to get me to the office and he seemed alarmed. He also told my husband that he was out of town and that I would need to see the other doctor in the practice, Dr. K. I didn't want to see a different doctor. Dr. R was so patient and kind and he really listened when I talked to him. But I had no choice.

When we arrived, I let the receptionist know that I didn't have an appointment. She must have already known that I was coming and the nurse emerged almost immediately from behind the door. The nurse led Doug, Meredith and me down a different hallway than I was used to and into a room. Dr. K came in very soon after. He had already been notified of all the symptoms and let me know that Dr. R was worried I may have a pulmonary embolism. He told me he didn't think it was very likely but it was a very serious condition and we needed to be sure. He listened to my lungs and asked me a few questions and told me he wanted me to have a CT scan. "How far along are you?" He asked. "I'm exactly 6 weeks," I told him. He asked if we'd seen the heartbeat yet. I told him no. He wanted to do another ultrasound.

We were taken into another room and I laid back on the table. Meredith played Hide-and-Seek with Doug behind a curtain as we waited for Dr. K to come in. When he started the ultrasound he stopped right away on a huge mass that was one of my hyperstimulated ovaries. It looked nothing like it did before the IVF. He then moved toward my uterus. He scanned around for what seemed like forever. Doug looked uneasy. I felt like I couldn't breathe. This time it wasn't from the fluid in my stomach or whatever was in my lungs. It was from fear. Fear that I wouldn't see a heartbeat. That I would walk out of that office that day and somehow go on with my life knowing I wasn't pregnant. I strained my eyes but saw no movement on the screen. Then there it was. A tiny flicker. My eyes welled up with tears. It was one of the most beautiful things I'd ever seen, that tiny heart beating. Dr. K then explained that I would be going back down to radiology for a CT scan. I don't even know what he said after that. The nurse had brought me a picture of the ultrasound and all I could do was stare at it.

We headed down to radiology, the whole time I stared down at my little picture. I dressed in a gown and they took me back to a room and I laid on the table. The radiologist explained the procedure. Then he explained that there were risks when a CT scan is performed during pregnancy. My heart sank. I had just seen the heart beating for the first time and now I was supposed to have something done to my body that might hurt the tiny baby growing inside me. I almost got off the table right then. But the radiologist told me that if I did have a pulmonary embolism it was much more dangerous to me and the baby if I didn't have the scan. So I gave my consent.

I sat there after the scan starring at my picture wondering what I had done. Then the technician told me I needed to go back up to see Dr. K. Doug had stayed downstairs with Meredith, where she could play. Dr. K met me as I stepped off the elevator. "You've got a pulmonary embolism," he told me. "You're going to be admitted to the hospital for a week and they are going to give you a drug that will break up the clot. Then you will be on an anticoagulant for the duration of your pregnancy. You'll have to see a pulmonologist for the rest of your life." I was shocked. I called Doug and told him they were taking me over to the hospital and he needed to come upstairs. I got in the wheelchair and looked down at my picture. "I'm sorry little baby," I thought. "I'm sorry you have to go through this."

When I arrived at the women's center in the hospital, I was immediately put on Heparin. Doug called his mom and asked her to come get Meredith. I called my mom and gave her the news and she left work to come to the hospital. My mom was there when the pulmonologist arrived. She was distressed as he explained how severe a pulmonary embolism can be. A pulmonary embolism is when a blood clot lodges itself in the lung or lungs. The problem with this is that blood can't flow freely through the lungs. This prevents oxygen from reaching the lungs and makes the heart have to put more effort into pushing blood through the lungs. It can permanently damage the heart. The pulmonologist, Dr. B, said he would send me to have an ultrasound on my heart to see if it had been affected. I would also have an ultrasound on both calves because in most cases, pulmonary embolism is caused by blood clots that travel to your lungs from another part of your body- most commonly, your legs. I was also told that the anticoagulant- Lovenox- that I would be on during my pregnancy would be a shot that would need to be administered every 12 hours. Then when I was approaching my due date, I would be taken off the Lovenox and an inferior vena cava filter would be implanted. This filter would protect me from another PE during labor, when I would be unable to receive anticoagulants. I was somewhat overwhelmed by everything, but looking at the picture of my little tiny baby made me feel blessed.

Dr. R called me a few hours after I was admitted to let me know he was on his way to the hospital. In the mean time, I was taken for ultrasounds on both my heart and legs. When Dr. R arrived he let me know that the ultrasound on my heart had come back normal and the ultrasounds on my legs showed no signs of clotting. Had he not put me on the low dose aspirin when he did, things may have been much worse.
The next few days in the hospital were tough. I felt like I was in a prison cell and I wanted to go home. The good news was, I had plenty of family and friends to come visit me and keep me positive. Plus, my body was finally ridding itself of the fluid I had been carrying around in my abdomen. Then there was also a trip coming up that Doug and I had planned. Every year we would go to the OU vs. Texas football game and it was something that I looked forward to the whole year. In fact, each year, Doug would tell me I could pick anywhere in the world I wanted to go on vacation, and every year I would pick that football game. The problem was, I had plenty of people who didn't want me going. I felt after all I'd been through I should be allowed to go on a vacation where I could focus on the future. It had been a stressful year and I was in serious need of an escape. Others were worried about my health and traveling so soon after such a serious medical complication. In the end, I decided to go. But it didn't go anything like I had planned.