ER update: Pulmonary embolism

The lung CT scan showed that there is a small blood clot in Steve's lower right lung -- pulmonary embolism.

Pulmonary embolism is often fatal because the clot breaks free, heads to the lung and blocks an artery. Dr. B, the ER doctor, says those folks usually don't even make it to the hospital.

Steve's clot, thank God, was very small.

As you may recall, a blood clot was discovered in Steve's right leg a few weeks ago. An IVC filter was placed in a vein in order to catch the clot in case it moved up.

So, the filter mostly did its job. It stopped a giant clot from reaching Steve's lungs.

But the filter can't always catch every little bit. A little bit of the clot got through and settled into his lungs. The clot is what is causing his shortness of breath, fatigue and low blood pressure (discovered today).

The big question now is how to treat the clot that's there. Dr. G, the attending oncologist at St. Paul, believes strongly that Steve needs to start taking Heparin to break up the clot and prevent further damage.

The problem is Heparin and Avastin (the bio-agent that Steve last received Thursday) and brain tumors don't always mix well. There is the risk of bleeding at the tumor site.

So we are forced to weigh the risk of more damage from the clot vs. the risk of damage to the tumor. Dr. G wants to treat the clot. I don't know yet what Dr. M prefers.

Steve and I are both nervous about Heparin. In the few minutes we had with the internal medicine resident, Dr. S., we expressed our reservations and asked lots of questions. At any time during the Heparin dose, we can say "Stop."

And, of course, if Steve's vitals indicate a problem from the Heparin, the medical staff will say "Stop." (He won't be on a telemetry floor, but he will have remote telemetry, meaning machines will be monitoring his vitals, and someone on another floor will watch his information in real time.)

Dr. S understands our hesitation and says there's no clear-cut answer here. But we have to protect Steve's ability to breathe. And Heparin is the best chance we have at that.

She also said that everyone needs to say extra prayers tonight that Heparin will do its job without causing damage.

I have no doubt that you all will join us in that prayer.