Blood Clots and Apricots

In November, when this whole surgery debacle started, the main complicated factor was this blood clot. If you remember, the clot was discovered when my right arm became swollen and for the first time in my life I had a waddle of flesh hanging from my body. After a confusing ultrasound (for the techs, not me – I almost fell asleep), it was determined that I had a blood clot beneath my right clavicle (possibly the superior vena cava, where the blood from the right side of the head and right shoulder drain back into the heart.).

It was that same day (I think) the growing mass in my left kidney was discovered during a CT scan of my lungs. They had seen the growth in 2007 and was something they would ‘keep an eye on.’ It had grown from 1.4cm to 2.7cm, they decided it was possibly cancerous and had to come out. How they were keeping an eye on it is beyond me – without that incidental scan it could have been another three years before they would happen to see it. Not complaining – but it is one of the several reminders of the ‘art’ of medicine I will relate in this post. Perhaps I’d been naively over-assured by the power and precision of medicine, covered by solid insurance.

This past week I had two pre-operative appointments to ensure everything was good to go before surgery. One was a standard check up to investigate any headaches, fevers, coughs etc. The other was a second ultrasound of my shoulder to see about that clot (or Deep Vein Thrombosis – DVT). If it remained, they might postpone the surgery.

I believe I wrote some about this last time – that ‘they’ say 3-6 months to fully resolve DVTs but no one really knows for sure. They keep people on the blood thinners for that period of time and the clots are resolved (proven in thousands of studies), though at what point within that time frame is unclear. They no longer do follow-up ultrasounds on DVTs because they are so confident the clots resolve in that time frame. My first thought was – on whom are these studies conducted? guessing not healthy-ish people in their 30s. My second thought was – unlike most people, I’m on a time-frame, balancing the clot against getting this growth and the kidney removed. Should it be 3 months and be on the safe side with the clot? Or 2 months and get the kidney out of there? I scheduled the surgery for 2 months rather than 3 with the blessing of my kidney doc – the fabulous Dr. Hall. What was a bit unsettling was that scheduling the date was my call.

The second call I made about my medical treatment came during my pre-op in the clinic. The doctor asked about all sorts of possible maladies and gave me a once over. Her supervisor, or ‘attending,’ (I should add that I go to a teaching clinic attached to Abbott NW), joined us and asked if I wanted to continue taking blood thinners after the surgery. Now, the doctor who followed me during the pneumonia episode in November, told me I will be on blood thinners for 6 months, suspend the treatment for surgery at 3 months when the clot risk is lower and then resume blood thinners afterwards. A different doctor asking if I wanted to stop blood thinners after surgery conflicted with that. I liked the second doctor better and decided to stop blood thinners after surgery. Just like that.

The ultrasound two days later was a repeat of the confusion of the first. There were again two techs rather than one, and they had a hell of a time trying to make sense of things. I had veins where there weren’t generally veins and they seemed to think some of them were flowing backwards. I didn’t doubt it – pulling the dialysis access out in 2001 had done some damage up there and my body had adapted. They spent 45 minutes scanning and taking photos and sent me on my way.

The next day I connect with the medicine clinic about the results of the ultrasound. The surgery is scheduled in 5 days, I have sub plans, I’ve made all kinds of arrangements with grad school, a lot of people have been wishing me well – I’m interested in having a clear reading of the ultrasound and moving ahead with surgery. The nurse tells me that the ultrasound was ‘unchanged’ from November. My heart sank.

I clarify – ‘unchanged?’ – ‘yes,’ she says. ‘The doctors read that to mean that you didn’t have a clot in November and you can stop the Coumadin today.’

Whell.

So I have a crazy vein structure in my right shoulder, but it’s working just fine. Surgery is a go for Wednesday. And I no longer need to worry about a pulmonary embolism ending me without warning. So – good news.

I’m gearing up for a big vulnerability I’m going to attempt, which is to share pictures of me pre and post operation, and write a bit about what that’s like. I’ll post a pre-op description of what is going to happen with whatever bits I can find online. Meanwhile, thanks for all of the thoughts and well-wishes – it makes a big difference to C and I; we feel it. Thanks for reading!