Three Cheers for Clots

Alright! Time to get serious about this blog thing. It has been an eventful past few weeks and as I start my high dose chemotherapy tomorrow I should catch up on a few things.

The major event of the week of the 11 of March was getting a additional central line placed. For all of my therapy I've had what is called a port, which is a central line access that is placed under the skin. The port is great for a number of reasons. Most of the drugs involved in cancer treatment are fairly caustic and over time destroy the veins in the arm if given through an IV. Furthermore, the unpleasant side effect of chemo seem to be diminished by introducing the drugs into a large vein, like the Vena Cava. For transplant, they (the doctors) like you to have three points of central line access so multiple infusions can be given at the same time without putting in an IV. On the 15th I underwent surgery to place a double lumen broviac, which like the port is a central line, but unlike the port, is external and does not require surgery to remove. On the 15th I was pretty beaten up, I had spent the week before in ICU for a suspected infection and had only been discharged on the 11th. After the surgery, I felt pretty bad and was very swollen. Over the next week the swelling came and went and I thought I was just experiencing some seasonal allergy type stuff and wrote it off. By the 21st I was in a great deal of pain and had marked swelling on my right neck. I asked some of the nurses I saw at the hospital and they seemed to think it was nothing. By Friday I was on pain killers, which is extremely rare for me, and came in to see the doctor on call. He examined me but couldn't find anything immediately wrong with me.

Come the next morning, Saturday the 24, I could hardly swallow. So once again I returned to the hospital and finally got to see my doctor, Dr. Giller, who was on call. After examining me, he ordered a CT scan and in the true hospital fashion I waited around 5 hours for everything to be worked out insurance wise for me to have the scan. By 6pm the results were back, I had a clot. At that point, that was all they told me. I was put on blood thinners and TPA, which is an anti-clotting agent used to treat strokes and heart attacks. In the morning I was re-imaged by ultrasound and saw a number of Doctors that specialize in clots and clot busting. I still was under the impression I had a small block. By the afternoon the pain was unbearable and pressure on my neck made it impossible to eat. On Monday morning I was again re-imaged by CT and the decision was made to try and surgically remove the clots. I was taken down to surgery without much idea about what they were going to to do. It was in meeting the surgeon that I got my glimpse at the size of the problem I was facing. It turns out that I didn't have a small clot, I had a HUGE clot that spanned from the opening of the right heart valve up into the inner jugular at the base of the ear. On top of that, there was a clot in the vein extending out to my right arm (sub-clavian) and a piece of broken off clot hanging out in my lungs. The surgical removal of clots outside of the heart is fairly risky business. These veins are thin and one false move can cause serious bleeding. The basic goal of the this first surgery was to insert a catheter into my right groin, thread it up through the heart and then, using, special tools, to tunnel through a majority of the clot. After the surgery, the cath was left in and TPA was dripped through it to the point of the clog to further break up the clot. On Tuesday, I returned to surgery to have the clot assessed. It was found that the surgery the day before had been successful, but that my sub-clavian (arm) vein was still  full of clot. A second cath was inserted, through the left groin, and the same process as the day before was repeated on the sub clavian clot. On top of that, both of my central lines where removed to make room for the insertion of four stints that would hold open my damaged veins. By Tuesday I was pretty beat up. The swelling in my neck and arms was extensive and painful. I still couldn't swallow very well and was on my third day without solid food. I was pretty much immobile due to the caths. The cath tubing is rigid and thus I had to lay in the same position in which the caths were placed, which was flat on my back.  Weds. I went to surgery one final time to have the caths removed and to have a new central line placed in the now stinted open veins. By Friday, the swelling had gone down and I was deemed stable enough to return home for a few days before my now delayed stem cell transplant.

On Monday April 2, I had a follow up CT that showed a clear Vena Cava, improved flow in my jugular, in which a little clot still present, and a total obstructed outer sub-clavian.  The doctors were not surprised by the sub-clavian, as it is too far out to safely surgically removed and has to be naturally taken care of by the body. Already the pathways around this vein have picked up the slack and I have not real symptoms from this clot.

As one would imagine, I am on blood thinners to prevent clots and will have to be watched VERY closely during transplant for any signs of bleeding. I am hoping that this is the last bump in the road and that I sail smoothly through my transplant and subsequent recovery.  Only time will tell if I am right.

"That which does not kill..."

If nothing else this has made me popular around the hospital, where I am known as the "clot kid"

The radiology team claims it was one of the biggest non-lethal clots them have ever seen.

I like the word non-lethal...I'll hang on to it.