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Pain and pulmonary embolisms
(1) How many here have experienced pulmonary embolisms?
(2) Did it hurt when you got the embolism? Can you describe the pain?
(3) Did it continue to hurt (less intensely) for years afterward?
Brenda D.
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53 Replies
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As a cancer nurse who has PAH, lung mets from ovarian cancer. I can tell you everyone is different. A lot depends on the size of the clot that break loose. A shower of small clots tends to be more survivable.
I never realized how much the lungs feel until I had my Aspira drain removed. The scar tissue causes me significant pain with every deep breath for it several months now. I suspect I will always be some awareness of the scar tissue.
Once you have blood clots in your lung your natural clean up cells will desolve them. You may have some your little air sacks that collapse, some will scar over.
So what do you do, be alert for other blood clots because you are at risk, follow MD instructions, avoid long air flights, get out and stretch frequently on long car rides, avoid crossing your legs. Report any redness, tenderness, swelling in your legs to MD. Legs are primary site for clots starting. Lastly cough and deep breath, try to expand that lower lung it helps with healing more than you know.
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Hi @darlarayne, how did I NOT recall that you were a cancer nurse? Wow, that’s so ironic that you not only have PH but lung mets with ovarian cancer. It’s so strange how many nurses find themselves on the patient side of a rare disease and other coexisting health conditions.
Your example and suggestions to @brendad53 are on point! Thank you for sharing this because I only knew this experience from nursing others.
Our lungs are sensitive for the most part. I have cracked ribs from coughing and had several partial lung colllapse episodes. I believe this has caused an increased heightened sensitivity in that area.
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Hi @brendad53, I haven’t encountered a pulmonary embolus (blood clot in the lung), but I’m aware some individuals here have. I hope they will be willing to share their experiences with you.
However, are you currently experiencing symptoms of an embolism? Have you already started taking blood thinners?
I want to share a few past discussions on both embolus and pulmonary embolus. Reading through them might provide helpful information to you.
Did You Know That March is Blood Clot Awareness Month?
Ever had a lung perfusion scan?
Have You Ever Suffered a Pulmonary Embolism/Blood Clot?
I’m concerned about your current situation, imagining you at home while experiencing these symptoms. It would be good for you to seek medical attention if you are indeed experiencing these symptoms. I wish I could offer more assistance, but my knowledge is limited to what I have observed and heard from others who have gone through similar situations.
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HI, Brenda! We’ve met occasionally on the CTEPH support group online meetings. I did indeed have problems that lead to my final diagnosis of CTEPH. Though I didn’t know it was a blood clot in my lungs, I was coughing far too much, and yes, there was discomfort, if not pain, especially at night when I was relaxing to sleep, or when I was breathing deeply. If you haven’t had a VQ scan (perfusion test), your doctor should order it pronto. Before my pulmonologist did, I had 5 years of ‘figuring it out’, with hospital stays each time a clot was discovered in a CT (I had two, one year apart). I assume you are on blood thinners, but for some of us, the body doesn’t do its normal cleansing and disburse the clot. They darn things stay and become a tough bit of scar tissue blocking the arteries. If there is any way I can help you , let Jen know. She can get in touch with me, and then I with you.
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Hey, Jen, Terese, and Darla, thanks for the feedback.
I’m an old hand at blood clots. DVT right calf in August 2009, December 2018, and November 2019.
PE with the DVT in 2019–though the DVT hit in March and wasn’t discovered until November. I felt it. Believe you me! But the scans didn’t show it until November.
I have had intermittent pain in my chest since the March 2019 PE. Yes, I have been treated for it. Yes, I am on Eliquis 5mg BID for life.
I was just wondering if the pain that I have felt in the location of the March 2019 PE is, truly, from the PE, or might be something else. Is it really residual PE pain?
(And yes, I have reason to suspect a new PE in a new location…but getting physicians to take it all seriously is another matter. As Mama Bear knows, because I’ve been moaning and b**ching to her.)
Brenda
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@brendad53, I consider it a privilege to be able to “hear” you vent. Has the hematologist ever got back to you about the result of your last test?
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It’s interesting, Mama Bear. I have also informed my pulmonologist, giving him the same info I gave the hematologist.
No one has said a thing.
I’m gathering my info to send to UCSD in San Diego, while I wait for my local Ollies to take an interest. In 20 more days, I’ll have another port flush and we’ll do another d-dimer test. If it goes down, then OK. But if it stays higher or goes higher, ….
And if I have an other PE and croak, I hope my family sues the socks off of them.
Brenda
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Ugh, so sorry that you are not getting the healthcare providers to take this seriously, @brenda! That’s frustrating with your history of PEs! I do hope they will get back to you.
But if not, the UCSD PTE clinic would be excellent. I’m sure that @mamabear007 shared her experience and positive experience with them.
I’m happy you can vent to us and also to Mamabear! You are not alone, and we will be here and stand with you always. Take it easy, and keep us posted when you hear back from your HCPs.
PS. I await hearing from others at Duke regarding the PH clinic there. Have you heard anything from our newest columnist, Karen? I have not heard back from her yet. I did post the question on my FB, too. I’ll let you know once I hear from others who see those specialists there.
– hugs to you, and I hope you have a relaxing weekend, my PHriend!
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@jenc, while I don’t have any personal experience with Duke, I do know they now perform PTE surgery for CTEPH patients (one last month and another coming up this month — that I know about). One would assume that would bode well for their PH clinic.
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Hi @mamabear007, IDK the names of any specific PH doctor at Duke that Brenda wanted to know. But I have heard excellent things about their PH clinic in general.
I would assume that if they do now perform the PTE surgery for CTEPH patients, that would be an excellent place for Brenda to try and be seen. At least then her team would be closer without traveling to SD.
But I’m sure you’ve already shared that info with her. You two seem like two peas in a pod. I love that!
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Argh, @jenc! I hadn’t even thought of it. Gotta find where I stored my brain.
@brendad53, here’s the link for Duke’s CTEPH program. Can you ever forgive me for not thinking of you when I saw that two CTEPH patients had their PTEs scheduled right in North Carolina. I’m SO sorry! BTW, the page has links for all their doctors in the CTEPH program. It also includes a phone number.
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@mamabear007, it’s Friday, so I bet @brendad53 will forgive you for putting your brain away early to prepare for the weekend., Hehe.
Brenda, maybe you can call them and at least try to schedule an appointment there because I bet they will wait. Once you do that, you can put your brain away for the weekend and maybe have a nice cold treat to get you into the weekend vibe.
You are fine and so accommodating, Mamabear!Enjoy your weekend. <3
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Brain? Brain? Remind me of what that is again? I seem to have misplaced mine…assuming I ever had one! 🙂
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I find myself slightly panicking at the thought of going to Duke. I guess my twisted logic is that if I am rejected and dismissed from far away, at least it’s not close to “home” for me. But if I’m rejected and dismissed from right next door to me, it might “bleed over” onto my own docs. Or vice versa — my own docs’ rejection and dismissal may bleed over onto the Duke docs and color their perceptions…..
In other words, I don’t trust the independence of the judgment of the Duke docs simply because they are geographically closer to my own docs and might have an ongoing professional relationship with them…thus being reluctant to second-guess the original docs.
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Ah, but the doctors in the Duke CTEPH program likely didn’t start at Duke. Did you know that every hospital in the USA that performs the PTE surgery learned how to do it at UCSD? In fact, I recognized one of the names of the doctors. Dr. Auger (pronounced O-Jay) was on my son’s medical team when he had his surgery. In fact, it was Dr. Auger that I saw so many times while I was visiting my son. Not only is he very knowledgeable, but he has a wonderful bedside manner.
Just one such story that I witnessed… He walked into my son’s room. My son was sitting in the chair beside the bed, and my daughter-in-law was lying in the bed. Dr. Auger looked at my son, then looked at my DIL and dead-panned, “D— you’ve changed!” Everyone in the room cracked up.
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That’s funny, @mamabear007; I admire the doctor’s ability to find humor in situations. It speaks volumes about his character. Moreover, the valuable experience of working with him while visiting your son is an incredible perk.
@brendad53,
While I believe Duke could provide a more practical and budget-friendly solution, your previous posts indicate that you tend to overthink things like me. But I did notice the PH doc (Dr.Fortin)that I emailed you a few PHrtiends suggested is on the CTEPH page, too. I would call and schedule an appointment if it were me. -
Granted that I think about things very carefully and over considerable time. Sometimes that amounts to overthinking, for sure. Sometimes it’s just self-defense.
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Hi @brendad53, I can understand slightly when you mention self-defense. With your history of medical trauma and PTSD, working with and building trust with anyone in healthcare must be extremely difficult.
I’m grateful you have found a few to be on your team, and these are local, right? You will eventually get the answers you need, and these symptoms will be validated more.
Hugs to you, my PHriend.
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Jen, I saw my shrink this morning. He told me that my fear of getting another “she’s fine” diagnosis written into my EHR is watered down by the recent legit diagnoses I’ve received. At this point, and in this context, what’s one more “she’s fine” dismissal?
And given the fact that I have recent new pain that is like clot pain, it came after an airplane ride, and my d-dimer is above the “normal” cut-off level,…
AND given that I have a history of repeated clotting issues in leg and lung…
It seems reasonable to make sure that all of this isn’t a sign that Eliquis is failing me again.
That’s what I walked away with.
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Hi @brendad53, I’m happy you saw your “shrink” today. It sounds like his comments make sense. Taking that away from him, what are you feeling now? Are you less anxious? Are you more determined to keep PHighting and get things checked out soon?
I don’t want you to have a clot that breaks loose and travels throughout your body, my PHriend!
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A little less anxious, Jen. I am going to wait until I get my next d-dimer test, in a couple of weeks. If the d-dimer has continued to go up, I most definitely will be self-referring to UCSD.
Even if it doesn’t, I will probably still get an evaluation if possible at UCSD, because they’re the folks that led the way with CTEPH and have the most experience in seeing clots on imaging. Because my body doesn’t show things on imaging willingly, it seems. So let very, very experienced eyes re-check previous imaging.
It’s hard, though.
And expense is another consideration. Not just the travel expense, if I have to go out there, but the medical expense for the scans and labs and such that they might want done. <<sigh>>
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At brendad53, there are many nonprofit organizations that help with both medical and non-medical expenses. There’s even an organization (Angel Flight) that will arrange transportation on a private jet at no cost to the patient. They match up pilots with planes with the patients that need to be flown.
As for the cost of those medical costs done by UCSD… UCSD will do all the legwork with your insurance company to make sure everything (including all medical costs) will be covered by insurance. If you have any deductible or co-insurance that hasn’t been met by your out of pocket max, you will have to pay those, but your insurance should cover the tests with their normal deductible and co-insurance. Since my son had already met his out of pocket max before he went to UCSD, the tests and surgery didn’t anything.
You’ll be able to find some help for both medical and non-medical expenses here: https://phassociation.org/help
I’ll also be e-mailing you a .PDF file with organizations not listed on PHA’s site.
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Hi @brendad53, I can understand you are still struggling with some anxiety. You have a great plan in place, and I also know you are probably over-prepared with medical records for them to look over at UCSD.
@mamabear007 offers some excellent resources, so I am grateful to her. I used Miracle Flights once to travel to Boston for my PH team, and they didn’t fly me in a personal jet; they paid for my ticket there and back on a major airline. They were very kind to work with. It was over five years ago, so that may have changed. I know several resources, but I am sure MamaBear has them covered.
It’s great to go part of the year once you’ve met your max out-of-pocket for medical insurance. I’m there now, so I get a “break” for the remainder of the year. But then, January tools around again.
As she mentions, there are so many fantastic resources out there. @mamabear007, can I have the PDF you share for those not listed? I get patients and caregivers asking for financial resources often. My email is jen.cueva@bionews.
Brenda, maybe today is an ice cream or key lime pie kind of day.
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@jenc, you didn’t provide the entire e-mail. Is it .com, .net — or some other .extension?
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Oops, sorry, @mamabear007; I am happy you guessed correctly. It is .com. Again I appreciate you sending it to me. I’ll have more resources when patients and caregivers ask me for help.
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Sheesh! I was going to say, Jen, that I have neither ice cream nor key lime pie in the house. Then I remembered I bought raspberry sorbet the other day! I’m on it! 🙂 Thanks for reminding me!
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I mean, seriously. If I forget I have sweets in the house, you KNOW I’m not myself! Too anxious and preoccupied!
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Hehe, @brendad53, too funny! You must not have been in your right mindset to miss that you had sweets available! I’m happy to send you such an important reminder.
We all deserve a special treat occasionally. Or maybe daily, depending on the week. Hehe
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Brenda, I have had several high d-dimers with following scans which were negative for PE. However they found a different issue. Anyway, the test in not just specific for PE as I found out after 30 years thinking it was. Heart and liver disease, pregnancy, being over 80, recent surgery are just a few. Evidently mine rise during an RA flare. Much like my Ca-125 that I follow like a hawk I must add a bit of disbelief and take in how I’m feeling physically into the mix.
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That’s why I am suspicious of the rising d-dimer results, Darla. I did have a set of symptoms that preceded the test results. So…. you combine that with my medical history, and it seems logical to suspect possible clots.
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In passing, I had mentioned clotting as an emerging issue to Jen and (I think) Colleen. That said, this thread looks like a logical — not to mention useful — landing spot. Not yet confirmed by pulmonary angiography but based on a recent note from my lung doc, it looks increasingly like CTEPH join PAH in my diagnosis bucket. I haven’t had the pain described here, just lungs and breathing not working the way they had been, exercise tolerance going down and de-saturation up.
The note, referred to on MyChart as a “Telephone Conversation” was a copy of Dr. Nick Kim’s (UCDC) reply to my lung doc sending him my records for an opinion. The gist is that he would recommend evaluation visit only, and a DSA (decoded by me as pulmonary angiography) to show if there were lesions amenable to either PTE or BPA (more likely judging by my CTA)
It does rather explain a bad year and slown comeback.
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@VanessaVaile, @jenc is right, that I’m a big fan of UCSD. They saved my son’s life, and I love all the medical team involved in his care. My son had to travel from Utah to California, and it was worth the 3-day drive (normally a 1-day drive, but his health at the time required frequent stops along the way).
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@mamabear007 ~ I did a deep dive into the program there after Dr. George brought it up. Very impressive to say the least. Even so, my daughter who would drive me has teen age boys at home and her work. Between age, PAH and now this, I find even relative close destinations quite tiring. Between National Jewish Health and Anschutz, I should be able to stay in Colorado for the time being.
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@VanessaVaile, it’s definitely more convenient to be able to stay in state. Because of my son’s distal clots, that wasn’t possible for him. I think he would have been thrilled if it had been possible to have the surgery at U of U.
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Hi @vanessavaile, what a perfect place to share this information and read some previously shared material. Dr. Kim is well known at UCSD, as is their CTEPH program. @mamabear007 is a huge supporter and shares her son’s journey with CTEPH and UCSD.
This would make sense, minus the pain. But I bet you experience many other symptoms like PH symptoms, too. it’s hard to differentiate.
When do you plan on having the angiogram of the brain? What is the next step for you with all of this? I hope you get answers soon and, hopefully, start to get back to your baseline a bit more.
Enjoy a wonderful 80th birthday this Thursday, my dear PHriend! Cheers to you!!!
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@jenc ~ Never is when I plan to have a brain angiogram, but that was also my first reaction to search results decoding a message delivered in medical code. Adding pulmonary after DSA to the search yielded pulmonary angiography, which made way more sense. Think of the procedure as the lung equivalent of a heart cath.
I’m aware of UCSD Health’s prominence in this area, but, since I’m in Colorado, getting evaluated at Anschutz in Denver makes more sense than going to San Diego for it. There’s no point in worrying about the what next until after evaluation, but I’ll bring up the “where” up with Dr. George when I reply to her message.
As for my baseline, like goal posts, that’s been moved. I’m still working on it anyway. In the meantime, I’d like to ask others on thread about their experience with the effect hotter than usual weather on exertion and oxygen levels.
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@vanessavaile it’s good that you are getting answers to why you have been declining but I am sorry you are going through this!
In regard to extreme heat, exhaustion and oxygen levels, my son struggled big time. I know his teachers weren’t thrilled but when he attended grade school/middle school he had a doctor’s note on file stressing that he was not to be sent outside in heat.
Hot weather would make his O2 dip, increase fluid retention, cause chest pain and make him so tired he couldn’t concentrate. I think others here can relate.
Ice packs and hats were his friends when he had to go out.
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Hi @vanessavaile, Aww, that does make much better sense. I was wondering, but then I thought maybe I missed part of your message. Thanks for clarifying that, so I’m not concerned about your brain.
I’m grateful you’re getting answers, and I understand your thoughts about Denver vs. San Diego. I know they were the first hospital and the only one to do the procedure for years.
Yes, the heat affects my PH symptoms like breathing, O2 levels, and swelling. Like Colleen shares, cooling cloths, packs, and hats help if you have to be in it. Otherwise, stay indoors in the AC.
Hopefully, you are enjoying your 80th birthday with your family today, my dear PHriend. Best wishes and many more!!
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Hahaha, the brain thing speaks to a not uncommon med-speak communication gap. Never an acronym fan, I’ve become even less of one but all the quicker to add “medical” to searches.
Btw the Pulmonary Hypertension Program at the Cleveland Clinic Respiratory Institute is another good one. On top of that, their site and YouTube channel make it a better publicly accessible patient education source than most.
The Anschutz program is smaller but solid and amply qualified for assessment purposes. Realistically, my age is a risk factor that makes feasibility less likely. It’s also possible that there may be a Medicare coverage age cut-off like there is for iron infusions. I accept this as possible. In the meantime my goal is management and mitigation.
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@VanessaVaile, if your local PH hospitals won’t do PTE or BPA because of your age, I found this on UCSD’s website: “People as young as 8 years and as old as 89 years, as well as those with complex coexisting conditions, have successfully undergone PTE surgery at UC San Diego Health.”
If you your local hospitals won’t consider you please let me know; there are non-profit organizations that can help with both medical and non-medical costs for PH patients. I can provide links for you.
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Hi, @mamabear007. Thanks for sharing that excerpt from the UCSD website. That’s incredible! It can also offer hope for those worried about their age and different programs. @vanessavaile, this is some vital information that you may find beneficial.
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@mamabear007, my comment about age as a feasability drew on the research report this PH News article refers to, https://pulmonaryhypertensionnews.com/news/balloon-pulmonary-angioplasty-risks-cteph/
Do you have NATF (North American Thrombosis Forum) in your CTEPH info collection? I came across their superb “CTEPH & YOU: A PE Patient Webinar Series” researching Dr Bull, PH & CTEPH lead at UC Health in Denver.
I’d throw in the link but sometimes the presence of outside links interferes with post submission.
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@vanessavaile, thank you for the link to that article. I haven’t seen the NATF webinar. If you message me (either FB or PHN), I’ll add it.
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Hey, @mamabear007 and @vanessavaile. Here is the link to NATF’s CTEPH webinar series. Thanks, Vanessa, for sharing. I’m sure others will also benefit from these.
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Thank you, @jenc. I’ve e-mailed the link to myself.
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It’s my pleasure, @mamabear007. Thank you for supporting all in the forums and the greater PH community.
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Hey @brendad53, I’m just checking in on you this week. I’m sure you’re busy with things. But how are you feeling?
I am thinking of you and sending you extra hugs, my PHriend.
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Hey, Jen. Well, first thing is, I’m waiting to hear from Mama Bear, who had cataract surgery today on one eye. I’m hoping she’s been doing well and is, by now, getting in the car to head home and be able to enjoy the scenery along the way with clearer vision.
Second, I suspect I’m becoming even more coagulable. I was having some “PE-like” pain in a new area of my left lung/chest this morning. This afternoon I had one of my usual port flushes and a d-dimer drawn. When the nurse drew the blood back, it drew part-way, then stopped. It wouldn’t draw. These kinds of trouble with my port, historically, have been linked to rising d-dimers and clotting activity. I don’t have the d-dimer test results for today back yet (eventually got port to draw alright), but suspect they will be of a piece with the general tendency my body is showing toward more clotting.
I have my packet for self-referral to UC San Diego’s CTEPH clinic almost ready to go. One or two more pieces of paper, and it will be done. Waiting, again, on today’s d-dimer result. To clot, or not to clot. THAT is the question!!
How are things with everyone else?
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@brendad53, I’m glad you’re almost ready to send the packet off.
I’ve already e-mailed you, so this is for everybody else who might be wondering…My cataract surgery was a success. A little more pain than I expected (which the surgeon said definitely was not normal, but by time I told him that it was hurting quite a bit, he’d already made the incision in my eye and had to keep going. I didn’t like it, but I do understand. Even with the pain (which is now completely gone), my eyesight has already improved better than it has *ever* been. I aced the eye exam, now having 20/20 vision at far distances. I’ll still need reading glasses, but I expected that. Much better to need glasses to read than to need them to drive safely.
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I read ya’, loud and clear, V.R. I got my first pair of glasses at age 7 and have worn corrective lenses (95% of the time glasses) ever since. In my mid-60s I was able to get cataract surgery, and it was a game changer. Welcome to the world of the sighted! 🙂 I’ve enjoyed being here, and hope that you will, too. 🙂
BTW, if you want to experiment around with styles of glasses now, try Readers.com. That’s where I’ve gotten most of my readers. My favorite pair is a John Lennon pair, but they are so fragile that I don’t use them often.
So good to hear that all is well, and hoping intensely for more of the same for you going forward.
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@mamabear007 I was holding my breath as I read about the pain because I was worried your update wasn’t going to end well. I’m sorry you went through that but also happy you went through it?! It sounds like it was worth it.
My dad had cataract surgery and was happy with the results yet we had to convince my mom to proceed. Now she is so glad she did. I don’t think she realized how much she needed it and how much it would help her.
I appreciate how you pointed out that the same person can have completely two different results. I think that is something to keep in mind in regard to many things.
Enjoy your improved vision!
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@colleensteele, I knew I needed it when I could no longer drive safely. Looking through my right eye, anything further than 100 feet away was blurry enough I couldn’t tell what it was. However, until I got my right eye fixed, I didn’t realize how blurry my left eye vision was. Not as bad as the right eye was, but definitely bad enough that I know it needs fixed. My left eye is scheduled September 14th. Four weeks later, I’ll get my vision checked so I know what diopter to get for reading glasses.
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Hi @mamabear007 that seems to happen with many others. One eye is fixed, and you then notice the other eye also needs help. I’m grateful you realized you could not drive safely and scheduled appointments to check your eyes.
Next month, you’ll see much clearer once both eyes are done and you recover. Thanks for sharing.
Like @brendad53, I have used Readers.com, where you can find some cool frames and great deals.
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I am sorry about the issues with your port flush, @brendad53. It makes sense that this correlates with clots. But I’m grateful that you are almost ready to self-refer to UCSD.
Hopefully, you’ll have your results and the last few papers to send this packet and get you closer to being seen at UCSD. I’m worried that you will continue to experience these symptoms, and still no answers! Again, I applaud you for your perseverance and patience, my PHriend!
And clear!@mamabear007, I’m grateful you are seeing so much better. But I hate that you experienced pain with the surgery. Manny had surgery several years ago and had no pain; he was still “floating” when I drove him home.
Otherwise, things should be much slower at my house this week. I’m going to roll with the flow and enjoy it!
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Thank you, @brendad53 and @jenc. Since pain during cataract surgery is unusual, I’m hoping next month’s eye will be easier.
Kinda reminds of the two sections where I tried to stay awake. The first epidural for my middle child didn’t work, so they had to put me to sleep — and then when I woke up, the epidural was working beautifully because I was totally numb below my ribcage. The second epidural (third child) worked like a charm, and I was able to see him as soon as they removed him. In other words, I realize the same person can have two completely different results with the same anesthesia.
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Yes, so true, @mamabear007. I hope and pray your second eye cataract surgery goes smoothly without any pain. You know from your experience with childbirth that anesthesia can affect people differently.
By the way, has anyone else experienced an increase in shortness of breath (SOB) for a few days after a procedure with lighter anesthesia? Just curious to hear other people’s experiences.
Thanks for sharing your anesthesia experience and highlighting how our bodies can be both strange and fascinating at the same time!
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Yes two episodes of Pulmonary Embolisms 2010 and 2012 bot lungs involved. No DVT-deep vain embolismswith either episodes of lung clots. I’m a Genetic variant TBX4 PAH/CTEPH. Extremely large extended family history of PAH dating back 140 years.
No pain with Pulmonary Embolisms just extreme shortness of breath were symptoms symptoms. It wasn’t until 2020 that I was diagnosed when I did wake up with mild chest pressure and went to ER where d-diner negative but cT scan showed pulmonary hypertension
No new clots noted. I had been experiencing increased Shortness of Breath for a few months unable to walk 2 feet without being out of breath…thought it was my asthma!!!
This led me on an adventure to get diagnosed and doing my family’s and extended family’s medical ancestry history which led to a 150 year genetic TBX4 over the last 3 years. Which connected me to a 3rd cousin who recently passed away this past August who was a true PH Warrior Princess many of you may have known who truly will be missed for her beautiful upbeat courageous “White Shadow” spirit.
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