The Leg

It’s pretty much impossible to bend around and take a picture of the back of your own leg. I am familiar with mirrors and gimbals and whatnot, but there’s never one around, when you need it.

So here’s what happened. Sunday I decided that I was going to stretch the cramp out by taking a walk and some muscle relaxant. That absolutely did not work. In fact my calf swelled up and got tight like a tick engorged with a blood feast. The muscle relaxant, however, put me to sleep pretty nicely and I woke up Tuesday with a situation best described as “things suck.”

It didn’t take a lot of reasoning and research to match the symptoms to a problem (blood clot!) and of course that’s not going to get better on its own, so I mothballed the door-painting I was about to do and headed in to the ER at Clearfield General.

No offense to the fine people who work there, Clearfield General is not my favorite place. It’s not even my favorite hospital. But I feel bad singling it out for abuse: most American small-town hospitals are pretty horrible. The nice hospitals are the private ones for rich folks, that have a pool and a golf course attached. When I got to the ER I sat down next to a young guy who had a badly broken leg; his foot was twisted around so it was facing backward, and he was writhing and moaning and semi-coherent. I asked him if there was anything I could do to help him, and he replied, “get me out of fucking Clearfield.” He was in a wheelchair and his broken leg was supported with those goofy flop-down footrests; I went to the nurse’s station and said there was a guy who needed to be on a gurney because he was heading toward the floor. They came and took him away; I hope his evening went better but I doubt it.

After an hour I was up in the queue and got EKG, ultrasound (both legs and arms) and chest Xray. Then, I was wheeled back to wait another 2 hours. After that, I got my own gurney and a ride about 30 feet down the hall, where I was parked against a wall. Apparently the other nearby hospital at DuBois was filled with COVID-19 patients so Clearfield was getting the overflow. I decided to distract myself by trying to make an argument about nihilism that I’ve not had the guts to explore, before, and pretty soon I was lost, tapping away at my iPhone and loathing its text interface. My battery started to wind down.

Across the hall was a 60-something man who was overdosing on fentanyl. The nurses were paying him a lot of attention; I did not begrudge him in the slightest. I was happy to be a slow-moving disaster. Bits of discussion came to my ears – they were sending the guy’s girlfriend to CVS to get an epi-pen and narcan. Apparently in 21st century America it’s faster to source your own pharmaceuticals. Anything involving opiates appears to be fraught with deranged regulations – the fellow with the broken leg was not offered any pain relief while he was in the waiting room because, apparently, the government is concerned that people will shatter their legs to get oxycodone?

There is a deep current of sadism in American medicine, and I blame it on christianity. They want sufferers to suffer the full experience – there is no reason for it, it’s some jackass’ aesthetic from the middle ages. Why can’t a guy with a broken leg get a shot of morphine? I understand that it can be addictive but “so what?” comes to mind. Why can’t a person in pain choose to flirt with addiction? It’s not the government’s business to keep a person in pain because not being in pain is bad. It’s as if the system simply cannot countenance a person losing control over their body – which is absurd because that happens all the time, especially when we die. And, yes, I have seen pain relief withheld from the dying, which is such a problem that the entire hospice infrastructure has sprung up to try to offer humane alternatives.

Around 8:40, when my battery was almost drained, the doctor and a nurse swung by and informed me that I had a blood clot, only one, and it was a fairly normal thing to deal with, by giving me some clot busters and it’d be OK in time. I should talk to my regular doctor and lose some weight and get more exercise. Exactly that I was in the mood to hear. Everyone was very nice and I was ready to go. One of the staff came by and took my credit card to charge me half the cost of the visit, and I was told I could leave. I had a prescription to fill, so it was off to CVS.

When I got to CVS, the pharmacy was closing and the doctor had written a specific prescription for “starter packs” which meant that the pharmacist couldn’t give me loose pills in a bottle, it had to be in that format, which they could have by the next day. I asked whether there was a problem with people hanging out in parking lots crushing and snorting blood clot busters…? “Hey, let’s go get thinned out, maaan.” Is there a problem with recreational clot-busting? Ha ha ha everyone laughed and I headed back to the ER and waited another hour for a nurse to bring me a dose of the clot busters that would get my body started clot busting that night.

Then, it was home. And I lay in bed staring at the ceiling and wondering whether I’d know what happened if the clot ripped loose, or if I’d just go to sleep and not wake up?  [more likely a lung embolism] I realized that I was terrified.

This morning I went in to CVS, paid the $900 for the medicine, came home, made tea and have been lounging around in bed ever since. Eventually, I’ll get up and go play some computer game (currently working on Fallout 4 in survival mode) and maybe watch a movie and drift in and out.

I have shop-work to do, but if I’m taking blood clot-busters, that would mean I need to stay away from lathes, table saws, bandsaws, and basically all the things.------ divider ------Last week I managed to jack up the metal lathe and install the leveling feet. And, the vintage Starrett level, shipped from the UK, arrived Thursday. So, I’m geared up to level the metal lathe, but I’m not going to mess with that thing while I’m on blood thinners, and I have painting to do.


  1. Rob Grigjanis says

    There is a deep current of sadism in American medicine, and I blame it on christianity.

    I’d say capitalism, but whatever works for you.

  2. Sam N says

    @1. In this case, why capitalism? Look I’m willing to blame a shit-ton on capitalism, but in this case, I truly do not see it.

    Wouldn’t giving people shots of morphine and charging them a fuck-ton be much more a capitalism project?

  3. Sam N says

    Maybe it’s the long game? Get them to use illegal sources, get thrown in for-profit jails?

  4. kestrel says

    I’m glad you were able to get treatment, even in the midst of the pandemic. That sounds horrible and I hope the blood thinners do their job and you are OK.

    The USA medical system is entirely screwed up and none of it makes any sense. I remember having dental surgery and, although they were happy to hand me pain killers, for some unknown reason it was incredibly difficult to get the antibiotics that I needed. It drove the Partner up a wall. We did finally get them, but it left us wondering why the hell there were such obstacles in the way of getting a prescribed medication. My feeling is the system is so incredibly broken we just need to wipe the whole thing out and start over. I’m not hopeful that will happen.

  5. Rob Grigjanis says

    Sam N @2:

    Wouldn’t giving people shots of morphine and charging them a fuck-ton be much more a capitalism project?

    If you’re sure you’ll get your pound of flesh, sure.

  6. Rob Grigjanis says

    On that note, just curious; how many people in the US die every year because they can’t afford treatment?

  7. dangerousbeans says

    nah, i’m with Marcus: western medicine’s attitude to pain relief smacks of Puritanism. a lot of the problems of addiction come from the substances being illegal, and it being treated like a moral failing rather than a medical issue.
    look at objections to safe injecting spaces if you want a clear example

    i hope the clot goes away without further issues

  8. dangerousbeans says

    @Rob Grigjanis
    a quick google suggests around 50,000? it’s a hard number to estimate, because lack of preventative care isn’t captured in the estimates. shitty medical system is a significant cause of death in the US

  9. Sam N says

    @6 Difficult to quantify. I know every time I’ve seen a physician they seem immensely concerned I did not show up sooner. I used to wait until my tonsils would swell large enough that I was concerned I may no longer be able to breathe. Let alone the immense pain. Unable to sleep, staying up all night. I learned after 3 bouts of that every 1 to 2 years and had my tonsils removed. I was still a graduate student in the UC system, with very easy to use student health.

    I’m sure someone with a background in public health could help out. Otherwise, I’d be susceptible to pubmed, etc. search and hoping for the best. This is not my area of expertise.

  10. Rob Grigjanis says

    dangerousbeans @7: Not sure what you mean by “western medicine”. That hasn’t been my experience in the UK or Canada. People in pain get medication for pain, and antibiotics if necessary. The issues of legalization and addiction are tied to moralizing bullshit, but Marcus is conflating those with routine treatment. Not at all the same in most wealthy countries.


    lack of preventative care isn’t captured in the estimates

    I was about to modify my #6 to specify preventative care (i.e. yearly checkups), which is covered in more civilized countries, and is certainly the most important single factor in public health.

  11. johnson catman says

    So, I’m geared up to level the metal lathe, but I’m not going to mess with that thing while I’m on blood thinners, and I have painting to do.

    If you (or your doctor) do not know what caused a blood clot, I would think they may keep you on blood thinners as a preventative measure to keep you from getting one again. I have a co-worker that got a clot in his leg, and his doctor told him he would likely be on blood thinners for the rest of his life.

  12. DrVanNostrand says

    I’m so sorry to hear about this Marcus. Hopefully you’ll feel better soon. The first time you blogged about this, I thought “This sounds kind of like how my dad described his DVT”. If it was a DVT like he had, you may be on blood thinners indefinitely. It’s not a complete nightmare because the common ones are easily counteracted with a simple vitamin shot, but it could leave you vulnerable in the case of a shop accident where you are alone without help available. Hopefully you and your doctors will be able to come up with a good plan. Best of luck!

  13. flex says

    While I know blood thinners save lives, my own experience with them was not all that positive.

    I had a blood test come back a few years ago with elevated d-dimer levels. Which is a indicator of blood clots. I had no other symptoms, no swelling in the legs, no spots on a chest x-ray, etc. But they put me on a blood thinner because they feared DVT.

    Within a month I was getting acute chest pains, about half-an-hour after taking my oral medicine. I also noticed that I felt tired all the time and started gaining weight. Going back to my doctor, he said to keep up the treatment, the chest pains may not be the pills, and maybe take food with the pills. Further, since gaining weight was something which makes DVT worse, I was not really certain that I was heading in the right direction, health-wise.

    So after about a year, when the chest pains started to occur even between doses, and after I had gained 20+ pounds, I took myself off the medicine. Within a month the chest pains stopped, my weight stabilized, and I felt less tired. My doctor doesn’t entirely approve, and I know I’m trading the risk of one health problem for another, but I’ve started losing the weight I gained and I’m going to try to continue to lose weight beyond that point in order to help reduce the risk of going through that experience again.

    I’m not suggesting that everyone reacts the same way to blood thinners. My mother is on the same blood thinner that I was prescribed and has reported no issues. It didn’t work well for me, but if it wasn’t for the chest pains I probably wouldn’t have really noticed the weight gain, or ascribed it to a different cause.

    I am saying that:
    A) Once you are placed on blood thinners because of a clot your doctor will very likely want to keep you on them. That seems to be the current standard of care. For what it’s worth, the thinner I was on didn’t prevent clotting and the small scratches I got from working around the house did not bleed profusely but clotted fairly quickly. So being on the blood thinner didn’t really impact my ability to do the projects I was working on. Feeling tired all the time did impact my ability to work on projects, and that may have been the proximate cause for my weight gain.
    B) Pay close attention to your reaction to the blood thinners (and your reaction to any medicine) because, regardless of what the doctor’s think, you are going to be the best observer of your general health. I’m not saying that you will be more knowledgeable about medicine than your physician, but you can be more aware of how your body is feeling and reacting than they will be. So if you notice other changes in your health which happen at the same time as starting a new medication, discuss those changes with your doctor.

  14. says

    Sam N @2: “Wouldn’t giving people shots of morphine and charging them a fuck-ton be much more a capitalism project?”

    Ah, the Purdue Pharma model of the Sackler family.

  15. says

    @flex: that sounds perfectly awful.

    These things cost $800 for 2 weeks supply. That’s not a longterm option. I’ll be consulting with my regular doctor as soon as I can. (Dread wading through the internet scheduling site)

  16. jrkrideau says

    @ 1 Rob Grigjanis

    There is a deep current of sadism in American medicine, and I blame it on christianity.

    I’d say capitalism, but whatever works for you.

    I’d vote for both. Those Puritains on that rock were a nasty bunch.

    @ 10 Rob Grigjanis
    I have heard that in Ontario, narcotic prescription drugs can be “rationed” a bit too carefully after the Oxycontin fiasco but that is at the family physician level. I would have expected Marcus’ fellow in the wheelchair to be triaged and send immediately for a quick screen and painkillers until an orthopedic surgeon was available. Well until someone who knew what a leg was was available.

    I may be spoiled, I live 2 km from very good tertiary care hospital and med school.

  17. jrkrideau says

    @ 16 Marcus
    These things cost $800 for 2 weeks supply
    JHC, what are they?

    You may want to look into ordering in Canada. Canada Post and DHL seem to be still working cross-border.

  18. says

    $800!!?! I’d be tempted to just stop by the hardware store and pick up some cheap rat poison.

    On the christianity vs. capitalism argument, I’d agree with both: christianity thinks you deserve to suffer, while capitalism is going to milk you for every penny you spend on reduction of suffering. I currently have pretty good health insurance through my university, but it’s a trap: I can’t afford to retire, because I’d lose it. My predecessor clung to this position for as long as he could for the same reason.

  19. says

    Those Puritains on that rock were a nasty bunch.

    They really were. Remember: they were such unpleasant religious woo woos that the English threw them out. That’s … a dubious achievement, but it’s an achievement.

    JHC, what are they?

    Eliquis (apixaban)
    It sounds like it has some nasty side effects.

  20. flex says

    It may be the same stuff I was put on, although my price was $1300 for a months supply. That was both a few years ago and we all know that prices for drugs are like prices for airline tickets, no one ever pays the same as anyone else.

    I used an HSA until I hit my deductible on my health care plan. Then had to start over again the next year. Luckily I had an HSA I hadn’t touched.

    On the capitalism/christianity topic, while I think he just condensed commonly held beliefs I blame Max Weber. His 1905 pamphlet “The Protestant Work Ethic and the Spirit of Capitalism” was still used as a source in the economics courses I took in the early 2000’s for my MBA. By that time I had read the short treatise, and was disgusted with it.

    Weber’s screed is one of the most racist texts I’ve ever read, but gussied up with plausible sounding arguments about how Calvinism encouraged the acquisition of wealth, with the underlying subtext that people of northern European descent are smarter and work harder than any other group of people on the globe. That catholicism encourages laziness (just look at the Italians and Spaniards), that judaism (with no threat of hell or reward of heaven) encouraged greed, and that all the rest of the world would be productive and happy if they just embraced protestant christianity (take that people in Asia and Africa, you deserve to be converted or eliminated).

    I know that the ideas Weber promulgated only added a pseudo-scientific veneer on commonly held beliefs, much like The Bell Curve has done recently. But just like The Bell Curve it shouldn’t be read uncritically, and certainly shouldn’t be viewed in a positive light in economics textbooks used in college classrooms. I fear that a lot of the problems we have with capitalism today, as well as with racism, can be traced to generations of people having their opinions shaped by that book in the only economics courses they ever took.

  21. flex says

    @Marcus Ranum, #20

    Eliquis (apixaban)
    It sounds like it has some nasty side effects.

    Yeap, that’s the stuff I was on. I had problems, my mother is still on it and is doing fine. The other option is warfarin, which requires constant blood tests and the side affects are reportedly much worse, so if the choice is between the two, take the Eliquis. But, as with anything you put in your body, pay attention! We want you around here for a long, long time.

  22. says

    Maybe we just get clotty as we age. I’m not that old but have been on Xeralto (rivaroxaban) since last year because of that most fun of clot issues, pulomary embolisms.

    Yeah, plural. The first one wasn’t taken seriously by the (white male) doctor who said it was stress and gave me a muscle relaxant. I am wondering just how lucky I am that it went AWAY and then there was a second one weeks later, where in the ER the (Asian female) doctor did take it seriously and ran the meaningful tests.

    When I was leaving I saw her there and thanked her for this. She seemed touched. I think ER doctors don’t get thanked enough.

  23. Acolyte of Sagan says

    That’s some expensive medication. If it turns out that you need a long-term thinner it may be worth looking at Aspirin. It’s an effective blood thinner and costs pennies (at least it does in the UK).

  24. says

    900$ for medication? That is insane. But we all know that US healthcare system is neither about health nor about care, but about extracting money from the many into the pockets of the few.

    We do pay for medication too, a bit, but there is a yearly cap of about 200$ bucks and everything over that gets reimbursed by the insurance. And for people who cannot afford it, there must be alternatives without co-pay available.

    I do hope you will get better, blood clots are nasty and dangerous. Fingers crossed.

  25. Numenaster, whose eyes are up here says

    I’m glad to hear you got your clot busted up promptly. I am right there with you that the US health care system is bonkers about pain medications, and I speak as the widow of someone who died of opioid overdose (accidental overdose of her own prescriptions, no less). More than once I had to patiently tell the pharmacy that yes, I would pay four figures out of pocket to avoid having my dear wife be in agony until the insurance company could be convinced to cover it.

    If we hadn’t been white and rich, she wouldn’t have made it nearly as many years as she did.

  26. DrVanNostrand says

    My Dad is on warfarin. No major side effects (except that he bleeds a lot more from minor cuts), and for him at least, it’s cheap.

  27. says

    I am hoping I can do something like lose weight and improve my cardio, and take asprin. I hate the idea of paying $1600/month for drugs (the $800 is a two week supply) – I’m not worth that much, really. Well, maybe, but you know what I mean – it’s just absurd.

    I had been thinking of something like doing yoga,but then it dawned on me that I could try aikido. I don’t think it’s a f’real martial art but I could benefit from the whole “learning to fall” thing. I am meeting with my regular doc tomorrow to see if he thinks I can get away with losing some weight (this would be a good excuse) and improving my cardio and taking asprin and … just hoping.

  28. lorn says

    Bummer about the leg and the way they made you suffer. I would say that it is that way needlessly but, as with most things that seem broken in the US (world?) it only seems broken from a non-sociopathic (sadistic?) perspective. Here in the good-ol’ US the brokenness is usually a matter of things being optimized to favor, in this case, profits for major medical groups, insurance companies, and drug companies.

    Remember that intangibles like pain and suffering and humiliation and inconvenience, and things things that piss people off but they really can’t do anything about, are not part of any business calculation. If it doesn’t effect value or profit margins for any ‘invested’ party the issue is moot.

    Patients screaming in agony for hours mean nothing to the bean counters. Having to go get your own medications means some employee wont get paid to do it. Think lower overhead. Liabilities socialized and profits privatized. No doubt all possible angles for legal redress or action have been blocked with legal boilerplate buried in the forms you signed. Read the fine print and you might find that the medical group has a right to harvest your organs and Glaxo-Smith-Klein can use you for medical testing.

  29. Rob Grigjanis says

    Marcus @29: Have you considered a stationary bike? I mention it because, although my knee is so fucked* I can barely walk, I can still get a good workout on the bike. Not necessarily true for everyone, of course…

    *I’d probably have a new knee by now if it weren’t for the pandemic.

  30. bmiller says

    Another vote for Xeralto here. My leg swelled up. Like Marcus, I thought it was a pulled muscle. (I am an obsessive road cyclist so very familiar with pulled leg muscles). So anyways, I decided to go for a bike ride to try to work the strain out. I was literally riding by the Kaiser hospital in my town…the “strain” was not getting better and the leg was obviously swollen. Yep…clotted.

    They only kept me on it for a few weeks though. Xeralto is dangerous if one is in a situation where one might hit one'[s head or otherwise cause bleeding (there is no easy way to reverse the thinning)…like bicycling.

    Kaiser ain’t perfect (I think I got the clot because of undiagnosed COVID earlier that year), but I have a pretty good health plan overall. And Kaiser is really efficiently running the “vaccination hubs” in our area.

  31. Pierce R. Butler says

    Marcus Ranum @ # 20: … they were such unpleasant religious woo woos that the English threw them out.

    They threw themselves out, because the English wouldn’t let them oppress their neighbors enough.

    I second Rob Grigjanis’s recommendation @ # 31 for a stationary bike, particularly the Schwinn Airdyne.

  32. Jazzlet says

    Sorry to hear this Marcus, I hope your leg is starting to feel better.

    Mr J is on a blood thinner because he kept throwing medium vein thromboli in his lower arms. Apparently they’re difficult to detect just there so he had to see a particluar scan specialist each time. It was a little worrying the time he came out of a scan and said “I have to go to the Urgent Care Unit NOW!”. As this was around the time he was having one kidney and his appendix removed he was put on a daily injectable anti-coagulant as it was reversible immediately with another injection. When that palaver was all finished he was put on rivaoxaban, and has had no further clotting problems, neither clots nor excessive bleeding. He does bleed a little more than he would have, but it really isn’t an unstoppable torrent. The thing he has found is that he feels both the cold and the heat more, so he wears long sleeves more and more layers in winter, and just can’t spend as long working outside in summer.

    I hope you and your doctor can sort out something that suits you. I am sorry that the whole experience has reminded you of how inequitable the American health care system is, the prices you pepole have to pay for drugs are extortionate.

  33. MattP (must mock his crappy brain) says

    I’m getting tempted to buy a cheap recumbent exercise bike. Motivation issues have always caused problems, so I still cannot convince myself to regularly go into the basement to use my old mountain bike with the trainer/holder. Or the old unpowered treadmill also in the basement. The elliptical upstairs has an irritatingly limited range of motion compared to my normal stride for me to use it much, but the low/no-impact cardio works well for my mother and brother with their joint/back issues.

    Been wanting to hook up a brushless motor, rectifier, DC-DC converter, and LiFePO4 batteries to a bike or treadmill to make it essential for me to actually exercise to use any of my electronics, but lack sufficient motivation to even create that source of motivation to exercise like that…

  34. lochaber says

    I’m a big advocate of anyone considering taking a martial art, to consider something like Jujitsu, Judo, Aikido, or other arts that focus on throws and such. Because they also teach how to fall, and while hopefully most people won’t have to rely on martial arts training for a physical altercation, almost everyone falls at some point, and having some training in how to do so in a manner to minimize damage can literally save your life.

  35. says

    Because they also teach how to fall,

    Exactly my thinking.

    I did sparring in karate when I was in high school, and we also learned a bit of falling (not normally part of introductory Shotokan) – a year into that, I came off my bicycle at about 30 mph on road surface, hit, rolled, wound up on my feet with a small abrasion. Then a lady in the other car lane rolled down her window and chided me, “you shouldn’t clown around like that! I thought you were going to get hurt!”

  36. kestrel says

    In defense of the ER staff: the Partner just read this (the Partner works in the ER) and as a result I received a blistering lecture about procedure in the ER. So among many other things I learned: Covid patients take a super long time to take care of, because of all the cleaning/sterilizing, putting on protective equipment, wiping down everything, etc. If a hospital is overwhelmed with Covid patients, all staff are tied up trying to do that. They only have so many people to do the job and it’s not really enough – the hospital wants to staff for a quiet day, not for a more normal day, because the hospital does not want people sitting around being paid to not do anything. Then there are all the procedures, taking blood, taking it to the lab, getting results, waiting for X-rays, waiting for the radiologist (if one is even there), waiting for the ortho guy etc. It’s amazing to me they get anything done, sounds like a crazy place to work.

    Also, not everyone who goes on blood thinners stays on them for life. Your plan of more exercise and losing weight might just do the trick, and those are easy things to do really.

  37. says

    If a hospital is overwhelmed with Covid patients, all staff are tied up trying to do that.

    That is why I sat uncomplaining and blogged from my wheelchair. There were people much worse off than me, and I know it, and I didn’t fuss. If I had felt a heart attack or something, you bet, I’d have yelled, but as it was I was fine just being there.

    Your plan of more exercise and losing weight might just do the trick, and those are easy things to do really.

    Especially with sudden death pointed at my head.

  38. jean says

    I’m sorry you have to deal with this.

    I’m also curious to know if they inquired about when you were vaccinated and which vaccine you had. It would seem that from your other posts that this could be within the window of potential issues even though you did not get the J&J vaccine (and if they ignore other vaccines how do they get data that it’s not an issue?).

    Also, I don’t know if that’s part of a normal diagnosis but it seems that the vaccine blot clots are a rare type with a low platelet count so did they measure this? That type of blood clot is not something you want to treat with the normal blood thinners.

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