May have mis-diagnosed my post surgery symptoms

Had shoulder RC arthroscopic surgery last Monday (10/30). Post surgery fine until last Saturday (not yesterday but 04 Nov) started feeling like crap. Fever...(low grade - 100 to 101), splitting headache. Since I was coughing up bloody sputum and it felt like my chest was compressed, I took this to mean I had somehow acquired a post surgical streptococcal pneumonia (as the symptoms matched, including bloody sputum). My immune system is usually first rate...and I wanted to fight this with my own antibodies rather than relying on antibiotics, which are becoming increasingly useless against many bacteria. So I had 5 days and nights of hell...while I thought I was fighting this. FINALLY started feeling better yesterday. The blood I had been coughing up was all old blood and starting to dissipate. Still shortness of breath, but no more fever.

All along, since the day of the surgery, I was watching for standard DVT symptoms....leg/arm numbness, discoloration, trouble walking. No symptoms.

So today, I'm out and about a bit...mostly driving. Finally good to be feeling better.....


UNTIL......

An hour ago, when I notice my right leg is sore on back side of knee, and while there is no discoloration, there IS a bit of numbness....light numbness.

Sometimes, having too much knowledge can fool you. Make you as stupid as having no knowledge at all.

So the whole week I thought I was successfully fighting streptococcal pneumonia (which I was figuring I may have acquired from an anesthetic intubation, or from the recovery room) I MAY have actually had Pulmonary embolism... I made a mistake in directly associating a concomitant fever and bloody sputum as streptococcal pneumonia.

So first thing in the morning, I'm taking a trip to the emergency room and see what we can do about getting some warfarin. Might be staying there a bit. Hopefully not. Hospitals are actually one of the most unhealthy environments you can imagine.

NEVER second guess post-surgery symptoms!!!! Never minimalize them.

AKR

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Originally Posted by Alaskan Rover

NEVER guess post-surgery symptoms!!!! Never self-diagnose them.

AKR

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FIFY.
What did the ER say? Fever and bloody sputum could be just about any kind of pneumonia or viral bronchitis. Pain behind the knee could be a lot of things. Both pneumonia and DVT/PE would be pretty rare after arthroscopic shoulder surgery. Numbness on the back of the knee would most likely be from compression. My guess is viral bronchitis. Was I right?

You're right about hospitals--in your case because there are a lot of sick people in hospitals spreading their germs around. Not just patients. Drs and nurses are bad for going to work sick.

While antibiotic resistance is a serious problem, and while antibiotics should be used judiciously (ie not for viral bronchitis), the great majority of bacterial infections are treatable with simple antibiotics. OTOH untreated strep pneumonia often leads to empyema, trapped lung, and major lung surgery. Or death.

Self diagnosis and treatment--or diagnosis and treatment of family members--is one reason doctors and their families get shitty medical care. I've learned that the hard way.

but the internet!

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Originally Posted by old goat

FIFY.
What did the ER say? Fever and bloody sputum could be just about any kind of pneumonia or viral bronchitis. Pain behind the knee could be a lot of things. Both pneumonia and DVT/PE would be pretty rare after arthroscopic shoulder surgery. Numbness on the back of the knee would most likely be from compression. My guess is viral bronchitis. Was I right?

You're right about hospitals--in your case because there are a lot of sick people in hospitals spreading their germs around. Not just patients. Drs and nurses are bad for going to work sick.

While antibiotic resistance is a serious problem, and while antibiotics should be used judiciously (ie not for viral bronchitis), the great majority of bacterial infections are treatable with simple antibiotics. OTOH untreated strep pneumonia often leads to empyema, trapped lung, and major lung surgery. Or death.

Self diagnosis and treatment--or diagnosis and treatment of family members--is one reason doctors and their families get shitty medical care. I've learned that the hard way.

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Writing this from the hospital.

I did go to the ER after the the leg pain. I wasn't at ER main desk more than three minutes while triage typed my info into their computer, before the a door popped open and on a stretcher I went. They take that stuff seriously for sure.

I'm actually glad I didn't have any leftover 3M Petrifilm that I could have done some swab testing with..as. I could have easily been dead. As streptococcal pneumonia was confirmed. Had I swab tested and got a positive, and with my acute symptoms gradually abating, I probably would have continued self-trratment had the leg pain not come up....which would have been a massive mistake.

"Massive" because they found with a Doppler ultrasound of my leg, a massive blood clot. CT Angiogram that same day picked up bilateral Pulmonary embolism....and that is on top of the streptococcal pneumonia!

The hematologist thinks the blood clot started in leg post surgery (odd it didn't start in the arm...but not odd to the hematologist, who said post surgical blood clots often start in the lower extremities regardless of surgical site) and transfered to both lungs.

The good news is they caught it in time.
I'm alive. I've been on a heparin drip since coming to the hospital plus courses of antibiotics through a different IV,. so clots will be diminishing. They will probably test that with new CTs.

Just wanted to let everyone know I'm okay.

Holy shit. Heal up, dude.
Scary stuff

Thanks! Yeah...I'm glad to be writing this. And has re-affirmed how gorgeous and beautiful life really is, and that what it REALLY is is a GIFT! And that is a good thing!

Jeebus, man. Right now I feel a little guilt for not speaking up to say, "why wait? Go NOW" after reading this a few days ago:

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Originally Posted by Alaskan Rover

So first thing in the morning, I'm taking a trip to the emergency room

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Heal up

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Originally Posted by Norseman

Jeebus, man. Right now I feel a little guilt for not speaking up to say, "why wait? Go NOW" after reading this a few days ago:







Heal up

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Thanks Norseman. Naaah....no guilt necessary....the important thing is I went in. 😃

Is it too late to delete my post? Shit. Making diagnosis by internet almost as bad as making diagnosis on self.
Have you had PE or DVT before, or risk factors for a PE? It is unusual after shoulder surgery, but obviously it happens. And strep pneumonia too? What did you do wrong in your previous life. Heal up man.

Thanks OG.

No history of blood clots after my two ACLs. No PE ever. Non-smoker (I have smoked a total of probably a pack of cigs total ..and 15 of those 20 cigs were just me and my friends acting "cool" in my convertible...not inhaling those noxious things !! When I did inhale those 5 cigs, I felt nauseous and sick each time...a pretty good mental preventative!!). EXTREMELY light drinker - no liquor... wine and ale only. And when I say extremely light, it takes me 4 to 6 weeks to finish a 6 pack of ale...and about the same time for a bottle of red.

But I grew up breathing a lot of second-hand smoke, due to my father who smoked like a chimney in our main living areas. We finally got him to lay his cigarette hand and ashtray by this special window outgoing fan we concocted, but we were mid-teens by then. He would NEVER smoke outside. Said as long as he pays for the houses and everything else, he's not stepping out to smoke. Isn't that great? He died of laryngeal and esophageal cancer.

Pre-incident, very active outdoors...BUT have substantially decreased my activities post rotator cuff rupture...almost to a point of minimal depression, which probably didn't help. When you receive a substantial reduction in your athletic pursuits, it affects you psychologically in ways you don't even realize. No sailing, no bouldering, no tree-climbing (a pursuit I've grown to love).

They have been doing a bunch of tests (factor five?) to see if I have a genetic pre-disposition to blood clotting, and other tests to see why I clotted so readily this time.

Doc, can having streptococcal pneumonia (which causes bloody sputum in its own right) be a contributing factor to why I developed blood clots in my lungs? My lung doc seems to think it's not co-related, as he thinks the blood clots in lungs traveled from my legs. But I've always been wary of filing things in the coincidence file.

I had two pulmonary embolisms following a crash that required surgery on both knees (good fucking times). The PEs were easily the worst part of the recovery. The Ortho doc taking 3 days to diagnose them likely didn't help. They took a bunch of X-rays as though that was going to show anything. Eventually a contrast CT picked them up.

I was on Warfarin for 3 month following. Be EXTRA careful when shaving since if you cut yourself it's gonna bleed for like 4 hours. I'd buy an electric shaver.

Good luck with the recovery.

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Originally Posted by The Tortoise

I had two pulmonary embolisms following a crash that required surgery on both knees (good fucking times). The PEs were easily the worst part of the recovery. The Ortho doc taking 3 days to diagnose them likely didn't help. They took a bunch of X-rays as though that was going to show anything. Eventually a contrast CT picked them up.

I was on Warfarin for 3 month following. Be EXTRA careful when shaving since if you cut yourself it's gonna bleed for like 4 hours. I'd buy an electric shaver.

Good luck with the recovery.

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Thanks! How was the period of time dissolving the clots? Lots of resting, I'm presuming.

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Originally Posted by flowing alpy

glad you caught it in time and your on the rebound, AKR

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Thanks Bobby! I'm glad, too!

Damn dude. Glad you're ok!

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Originally Posted by Alaskan Rover

Thanks! How was the period of time dissolving the clots? Lots of resting, I'm presuming.

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Well, I was in two splints and confined to a hospital bed/wheelchair for a few weeks. So rest was kind of implied.

Immediately after the CT confirmed the clots I was given a therapeutic injection of Lovenox. It cleared them up by the next day. It was quite remarkable, really. From what I gather, my younger age and the small size of the clots meant a quick recovery.

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Originally Posted by The Tortoise

Well, I was in two splints and confined to a hospital bed/wheelchair for a few weeks. So rest was kind of implied.

Immediately after the CT confirmed the clots I was given a therapeutic injection of Lovenox. It cleared them up by the next day. It was quite remarkable, really. From what I gather, my younger age and the small size of the clots meant a quick recovery.

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Thanks...I'll mention to my Drs about the lovenox. Although, as you had mentioned, the size of clots maybe an issue and if they use more than the heparin they've been using, might be like breaking up an ice shelf...creating little blood bergs to do mischief elsewhere.

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Originally Posted by Phildo_Baggins

Damn dude. Glad you're ok!

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Thanks Phildo!

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Originally Posted by Alaskan Rover

<snip> EXTREMELY light drinker - no liquor... wine and ale only. And when I say extremely light, it takes me 4 to 6 weeks to finish a 6 pack of ale...and about the same time for a bottle of red.

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Jeezus, dude. You need to drink more. No wonder the pneumonia kicked your ass. :D

J/K - heal fast, señor.

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Originally Posted by Alaskan Rover

Thanks OG.

No history of blood clots after my two ACLs. No PE ever. Non-smoker (I have smoked a total of probably a pack of cigs total ..and 15 of those 20 cigs were just me and my friends acting "cool" in my convertible...not inhaling those noxious things !! When I did inhale those 5 cigs, I felt nauseous and sick each time...a pretty good mental preventative!!). EXTREMELY light drinker - no liquor... wine and ale only. And when I say extremely light, it takes me 4 to 6 weeks to finish a 6 pack of ale...and about the same time for a bottle of red.

But I grew up breathing a lot of second-hand smoke, due to my father who smoked like a chimney in our main living areas. We finally got him to lay his cigarette hand and ashtray by this special window outgoing fan we concocted, but we were mid-teens by then. He would NEVER smoke outside. Said as long as he pays for the houses and everything else, he's not stepping out to smoke. Isn't that great? He died of laryngeal and esophageal cancer.

Pre-incident, very active outdoors...BUT have substantially decreased my activities post rotator cuff rupture...almost to a point of minimal depression, which probably didn't help. When you receive a substantial reduction in your athletic pursuits, it affects you psychologically in ways you don't even realize. No sailing, no bouldering, no tree-climbing (a pursuit I've grown to love).

They have been doing a bunch of tests (factor five?) to see if I have a genetic pre-disposition to blood clotting, and other tests to see why I clotted so readily this time.

Doc, can having streptococcal pneumonia (which causes bloody sputum in its own right) be a contributing factor to why I developed blood clots in my lungs? My lung doc seems to think it's not co-related, as he thinks the blood clots in lungs traveled from my legs. But I've always been wary of filing things in the coincidence file.

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I agree with your lung doc, not that I would expect you to put any credence on my opinion at this point. (My wife doesn't have much faith in my diagnostic skill either--when I dismissed her complaint of severe fatigue, until she turned yellow the next day. Hep A from oysters in NOLA.)

SWMBO got through a DVT with some quite small PEs 2 years ago. You are not kidding about the ER taking that shit seriously. We raised two kids in this town, and we're physically active, so we are quite familiar with the local ER and its delays. But mention the letters DVT and it's straight to a room, install a line, take a history, and get the doc in. Once the doc pronounces you're not going to die this hour, things slow back down to normal, but you do get bumped to the top of the imaging job list.

It's going to suck for a few months, running down to the ER every time you feel pain or dizziness, especially if you're the type who usually figures "pain, it'll go away if I wait long enough" the way most amateur athletes do.

Just remember life is good, and worth working for, and hopefully you'll be getting lots of exercise rebuilding that shoulder strength.

Any acute inflammatory process can cause clotting. Bacterial infection would be a more infrequent but not unheard of cause. A lot of the tests for inborn errors of clotting cannot be done while active clot exists so expect more blood work at a later date.

With no prior history I would expect s negative work up. But to NOT let ok would be negligence.


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Originally Posted by flowing alpy

rover, have you licked the oj jonesing:biggrin:

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Yes I have. Lol.

I did it by keeping nice frosty pitchers of ice water in the fridge where I usually kept the OJ. So if I was out biking or rowing, I'd down nice pints of ice water instead of downing half a carton of OJ standing at the fridge.

Now I can have a glass of orange juice on occasion without just downing the carton like an ape! 😂😂

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Originally Posted by skaredshtles

Jeezus, dude. You need to drink more. No wonder the pneumonia kicked your ass. :D

J/K - heal fast, señor.

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Thanks man! 😂

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Originally Posted by detrusor

Any acute inflammatory process can cause clotting. Bacterial infection would be a more infrequent but not unheard of cause. A lot of the tests for inborn errors of clotting cannot be done while active clot exists so expect more blood work at a later date.

With no prior history I would expect s negative work up. But to NOT let ok would be negligence.


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To elaborate--they SHOULD do tests for thrombophylia--tests to see if you're very likely to have another clot--after you're off the anticoagulants. If the tests were to come up positive you would likely need to be on anticoagulants for life. But like the man said--the tests will likely be negative so don't worry too much about for now.

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Originally Posted by old goat

To elaborate--they SHOULD do tests for thrombophylia--tests to see if you're very likely to have another clot--after you're off the anticoagulants. If the tests were to come up positive you would likely need to be on anticoagulants for life. But like the man said--the tests will likely be negative so don't worry too much about for now.

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Yeah, I definitely don't have a history of that....and I've had two ACL operations before.

The hematologist wants to see me on a routine basis in his office for 6 monhs of follow-ups, so he's on it.

And no, I don't value your opinion any less, Doc. Interwebz diagnosis is difficult!

People here tend to value your opinion. I'm sure you are right far more than you are wrong! You perform a great service to fellow mags, Doc! 👍👊

Thank you. I think I'm going to cry.

Wow bullet dodged. Heal up fast. Talk to you doc, bit generally movement and activity is a good thing in clot battles. Just don't cut yourself;). Warfarin is a bit of a pain testing at first but I didn't think it was tha big a deal and would rather takeout than some of the fancy pants anti clot stuff on the Rx shelf these days. If your on a hep drip already, lovonix is prob not necessary but sometimes they use as a bridge on discharge from hep drip iirc. It's been a while since I stayed at a holiday in so take it w a grain of salt;)

And Hep from Oysters?!?! Wtf is nothing sacred?