Bridging, Surgery, and recovery

[Blanche]

You know how much I care for you dear one

You know how much I care for you dear one

The worst is over now. You have to put your energy into getting back to your productive self. It would be so easy to become negative and hateful about your experience, but that is not you...It is definately not you.

Your job now is to get well and heal yourself. I had a hateful hysterectomy years back. Somebody knicked something and I had all sorts of problems....for a long time. A sweet young woman was my roomate. She convinced me that what was happening to me was just temporary.

I believed the young one who was trying to help me. When she returned from surgery one her knee, I tried to help her as she helped me.

The worst is over. Things will be better. Every day you will see improvement. You have to believe that everything will be better each day.

Kind regards,
Blanche

 

[Lynlw]

Kristy, How are you doing today?

 

[KristyW]

Thanks for asking Lyn,

I'm actually doing pretty good. I had my INR checked (1.3) long way to go. Will start back up with the Lovenox tonight.

I saw my surgeon after that. She decided to leave the J-Drain in while I restart the Lovenox. So now I'm on antibiotics too (the drain is an infection risk). I go back in for an INR on Friday and then after that, staple and drain removal as long as there's no bleeding. I don't know the pathology results yet, but in this case... no news is good news.

I'm down to 1 Vicodin every 4-6 hours instead of 2. The pain really is manageable.

I did quite a bit of walking during the mid-day, so it's about nap time.

Thanks VR.com...you all are really special!

 

[ShezaGirlie]

Kristy ~~ I'm so sorry you had to go through another surgery and had/have all the worries and anticipation. Be extra careful in your recovery and take note of everything your body tells you especially the odd pains and a fever.

I say this because I lost my beautiful - full of life - loving stepdaughter after a dreadful hysterectomy gone wrong. She died at the young age of 49 just 8 weeks post surgery due to complications the doctors never admitted. This was not in the dark ages, it was 2006.

 

[KristyW]

Janie,

Thank you for the kind words of advice and encouragement. If I've learned anything, it's that all of the medical personnel and I are in this together. We have all learned so much from this experience. My surgeon and PCP have already altered their protocols for anti-coagulated patients undergoing surgery. Lovenox is ok before, but not after, surgery until you are damn sure that the bleeding has stopped.

I am listening to my body. I drink lots and lots of fluids (my kidneys are working great!). I rest, and I walk.

I am craving a nice juicy rare steak, baked potato with butter sour cream and chives and steamed and lightly buttered broccoli. Hmmm...down on red blood cells maybe? LOL!

 

[Adrienne]

It's too bad you had to be the guiney pig that contributed to their knowledge! Thank goodness you are feeling better.

 

[KristyW]

This is true Adrienne...but without guinea pigs, the Drs. would never get any experience. All of us would love to be the patient when the Dr. is at their prime and has really absorbed the knowledge out there, but that's not possible.

The best thing in my favor is that I'm an educated patient and when everything was going haywire, we were all listening to each other. If I wasn't as educated (due to this site) as I am, I wonder if the outcome would be as good.

Thanks everyone!

 

[Lynlw]

Thanks for asking Lyn,

I'm actually doing pretty good. I had my INR checked (1.3) long way to go. Will start back up with the Lovenox tonight.

I saw my surgeon after that. She decided to leave the J-Drain in while I restart the Lovenox. So now I'm on antibiotics too (the drain is an infection risk). I go back in for an INR on Friday and then after that, staple and drain removal as long as there's no bleeding. I don't know the pathology results yet, but in this case... no news is good news.

I'm down to 1 Vicodin every 4-6 hours instead of 2. The pain really is manageable.

I did quite a bit of walking during the mid-day, so it's about nap time.

Thanks VR.com...you all are really special!

So we'll up the prayers that after you start the Lovenox tonight, the drain stays a lovely clear color

 

[Ross]

Gots my fingers crossed. NO MORE BLEEDING.

 

[KristyW]

So far, so good. 1st Lovenox shot...last night at 8:00am, 2nd shot 8:00am this morning.

My drain looks good so far. Praying that it stays that way.

 

[Lynlw]

Thanks for the update

 

[COLLEEN S]

Kristy,
Scary that things of this nature can happen due to management or rather mismanagement of anticoags. So sorry to hear you are going thru a rough time. Hoping you are back to feeling better soon!

 

[KristyW]

Kristy,
Scary that things of this nature can happen due to management or rather mismanagement of anticoags. So sorry to hear you are going thru a rough time. Hoping you are back to feeling better soon!

Colleen,

I am feeling better, Thanks. I do need a good rare steak though! I need to build up red blood cells! LOL

On a more serious note. I can't say that this was mismanagement. Like Al Capshaw says, you can ask several different surgeons, several cardiologists, and several primary care doctors about what to do, and you'll get different answers each time. There is no generally accepted protocol. We're all still learning. The bridging with Lovenox is an "off label" use. In other words...that's not what it's intended use was, but it seems to work. As we look back, in both Ross's case and my own, we're finding that adding the Lovenox too soon after surgery creates complications. Again this really is a trial and error with a critical balancing element. There is no right or wrong answer; we just need to be vigilant and communicate with our caregivers.

I've said all along, I do not blame my doctors one bit. They were doing everything in their power to save my life when this cascade happened. They were good about listening to me and my concerns, and talking with me about the reasoning behind their decisions.

We say here over and over...it's easy to replace blood cells, but impossible to replace brain cells. Well, the doctors were concerned with just that...how can I blame them or complain?

 

[Susan]

Kristy,
What an awful, scary experience! It sounds like you're doing better now. Hopefull, it won't take your INR long to get back in range. It's so scary when your INR is so low. I've been there. Especially when they give you Vitamin K. Then you end up getting really low. It's so mentally draining. First, you worry about bleeding to death, then you worry about having a stroke.
I work as a certified coder in an OB/GYN clinic. I have never seen one fibroid that wasn't benign. I don't know if you know your results yet, but I bet it will be benign.
My upcoming surgery isn't a hysterectomy, but will be an open procedure. I'm worried about the fact that it's an open surgery and the whole bleeding aspect of it all. Since hearing of you having a hematoma, it worries me even more. Just curious, how many days total were you in the hospital the first time?
Sending good thoughts your way on a speedy recovery.

 

[KristyW]

Susan it was scary, and I am well on the road to recovery. Now to your questions...I was admitted to the hospital on Wednesday, 10/28, surgery scheduled at 9 am but it didn't start until about 9:40 (we had a snowstorm here), out of surgery about 11:30. I had some bleeding issues on the operating table as the surgery wasn't "routine". The fibroid had encased the left ovary and fallopian tube, and it was growing through the walls of the uterus. It was also about the size of a Honeydew Melon. In recovery for an hour, and up to my room. I was up and about the next day after they took the foley cath out. Walked the unit multiple times. I thought I was going to go home on Saturday, but my incision was starting to ooze around my belly button. The Drs. wanted me to stay another day for that to clear up. It did, and I went home on Sunday. So I was in the hospital for a total of 5 days the first stay.

My suggestion...make sure your doctors are sure you are not bleeding before they start heparin, lovenox or fragmin. The coumadin is ok to start right away. Who manages your anticoagulation? Will they be involved during your hospitalization?

PM me if you have more questions. Nice to meet you!

 

[Susan]

Kristy,
Your lucky to have been in for only 5 days. Like I had said, I was in for 10 days before they let me go home with my last surgery. That includes going in 2 days prior to the surgery. They wouldn't let me home until my INR was in range. It seems like they had me start back on Coumadin pretty soon after the surgery. Maybe the next day-I can't remember for sure. My cardiologist will be the one handling my INR's during my hospital stay or a hospitalist. Not sure. But day to day, it's my cardiologist nurse. If you read my post to Ross under Upcoming non-cardiac surgery, you can see how she doses me.
Did they make you wait until you were in range before they discharged you? Or am I just unlucky when bridging and surgery?
Nice to meet you too.

Susan

 

[KristyW]

Kristy,

Did they make you wait until you were in range before they discharged you? Or am I just unlucky when bridging and surgery?

Susan

No Susan...they didn't make me wait. I was discharged on Saturday with an INR of 1.3. I had 4 days worth of Lovenox at home, with orders not to start it until Monday. At that point with an aortic valve, the risk of clotting was less than the risk of bleeding out from the surgery.

Some Doctors are more cautious than others and want to wait. I have coverage with the Lovenox, so I'm not worried.

 

[Lynlw]

Kristy, everything still looking good? Do you still have the drain?

 

[KristyW]

Doing great Lyn...today was another quiet day...that's ok. I need to remember I've had 2 surgeries a week apart...It's going to take a while.

Still have the drain...no bleeding!!! I take my last Lovenox shot tomorrow morning. I get the staples and the drain out on Friday. Woo-hoo!

 

[KristyW]

Update

Update

Ok...everything is going great! I got my JP drain and staples out today. Hooray!!!

There has been absolutely no recurrence of bleeding. I'm down to 1 vicodin every 8 hours (although I did take 2 at lunchtime today for the shrapnel removal), and best of all, I'm back sleeping in my own bed!

I was supposed to get my INR checked today, but my PCP was out of strips and I refused to let anyone try to punch a hole in my veins right now. (They're very sore and scarred.) So, I'll do that on Monday.

Thanks again VR.com!