Blood clot
I have had alot of people ask the status of my blood clot...after being asked so many times I guess I wasn't very clear on the whole thing so I felt I would share it here so everyone knows what is going on in the "clot" area of things.
Background (for those who dont' know)
I was diagnosed with a blood clot in my left atrium appendage in my heart in December just after Christmas when I had a TIA (aka mini stroke). I was 20 weeks pregnant at the time with August. They first ruled out a full on stroke through MRI, CT SCAN and a few other tests...but because of this "clot" it caused what is called atrial flutter (not quite atrial fibrillation) but borderline "Afib" so not a good thing...the first thing they would have done was do something called cardioconversion to get my heartrate back into it's normal "sinus" rhythm...generally when someone is in an irregular rhythym like I am they cardioconvert by using "paddles" that temporarily stop your heart and and restarts it (think of the medical shows when someone's heart has stopped and they use those paddles on their chest to get it starting again (that is exactly what they would have done) HOWEVER, because I was pregnant they felt that wasnt' safe so decided to cardio convert me in a similar fashion but going through my esophogus (aka a procedure called a TEE) and using a less invasive procedure to shock my heart back into rhytym...except when they did the procedure found the clot and therefore decided against cardioconversion because it could dislodge the clot causing a major stroke or sending a clot to the placenta and killing the baby or both...so they felt there was nothing they could do except put me on a blood thinner (LOVENOX) that is safe for pregnancy to stabalize the clot from "showering" (what caused the first TIA). A month after the diagnosis my cardiologist decided to do another TEE and see the status of the clot...it had not changed and was still very huge her opinion was that there was nothing we could do with the clot until after I gave birth. So we decided that we would wait until after he was born and move me to a bloodthinning drug called Coumadin (aka what Nathan and I like to call "rat poison") but it is the supposedly the strongest clot "dissolving" drug out there...in other words it can help my body absorb the clot in a safe fashion (unfortunately that process could take some time). So the plan was to have the baby, transition me from lovenox to heparin, wean me off of heparin for the delivery, then resume heparin and then bridge me to coumadin (as it takes 3-5 days) to get coumadin to a theraputic level so we had to do both Heparin and coumadin at the same time until my INR numbers reached 2. (theraputic level)
The scary part of the delivery is taking me off heparin (I cannot have a spinal/epidural) for the C-Section on a bloodthinning medication because it can cause paralysis (yes, not something any of us want/ed) soooo....making a long story short I would be off of blood thinning medications for 16 hours for the delivery (making my clot "unstable") so my biggest risks were in that 16 hour time frame of getting having a stroke or heart attack etc...) luckily we sailed through the delivery, got back on heparin and transitioned to coumadin a lot quicker than had planned...
but the question everyone was asking is how is the clot? Well, it is obviously stabalized but whether it is still there or not we really don't know...I assume the clot is still there and will be there for a while just because after some experiences after heart surgery with a "foriegn string" hanging from one of my wounds...I just felt my body knew it had an extra life it was supporting (aka August) and therefore could not communicate to get rid of the clot...and thus waiting for his birth...I feel now that August is here with us my body can get back to functioning like it once was and allow my body to communicate that it has this foriegn "thrombus" (aka blood clot) that shouldn't be there...and with the help of coumadin...move my good blood through there to help absorb the clot...(or so are the hopes and plans) because it does take on average 3-6 months for the clot to absorb back into the body with the help of coumadin we will not know if there has been any change in the clot until after I have been on coumadin for 3 months at that point my cardiologist will do another TEE to see what the clot is doing (and hopefully becoming smaller if not gone) so now if you would like to focus your prayers on resolving this clot quickly that would be appreciated but we won't really know the "status" of the clot itself until probably mid to late August if not early September...
if the clot does not change at all in that time (become smaller) then we will probably have to discuss open heart surgery to completely take out /tie off the atrium appendage...they actually generally take that appendage out with open heart surgery (because it is known to cause issues like this very one) in heart patients like myself but because they did my surgery less invasively back in 2007 they were in a position where they could not reach the appendage as it is behind the heart...meaning they would physically have to take my entire heart out (flip it upside down to reach this appendage...the surgery they did they were unable to reach it as they didn't crack my chest open down the center like a standard heart surgery they went in under my right breast to fix/replace my mitral valve) leaving the appendage unreachable during surgery...
soooo....we are hoping that the clot will resolve on it's own once they do that then they can cardioconvert me back into "sinus" rhythym (as I have been in atrial flutter since Decemeber) the atrial flutter "could" resolve on it's own but it has been stuck there for so long we are anticipating the fact that we will probably have to cardioconvert...HOWEVER, if we can cardioconvert then I can remain on a low dose of a beta blocker which will regulate my heartrate which will lessen the chances of me ever getting a clot again as the atrial fibrillation / atrial flutter is what caused the clot to begin with...
I am not sure that all made sense...but to put is simply we won't know anything else in regards to the clot until August or September after we have allowed at least 3 months for coumadin to do it's "job"...let's pray it works...
until then I am very happy with how things went with August's birth...a LOT of prayers have been answered and so thank you so much everyone for your thoughts and prayers....it meant ALOT to all of us...we are still flabbergasted by how quickly I was able to come home. I was in the hospital only one day longer than a regular C-Section day and that day was Monday (the day before the C-Section) to get me on to IV heparin to prep for the surgery...(okay maybe a day and half longer since with my other C-Sections I would generally go home the morning of the 3rd day) and I went home the evening of the 4th day...so no complaints I am just happy and thrilled to be home and to be feeling good and healthy!
Background (for those who dont' know)
I was diagnosed with a blood clot in my left atrium appendage in my heart in December just after Christmas when I had a TIA (aka mini stroke). I was 20 weeks pregnant at the time with August. They first ruled out a full on stroke through MRI, CT SCAN and a few other tests...but because of this "clot" it caused what is called atrial flutter (not quite atrial fibrillation) but borderline "Afib" so not a good thing...the first thing they would have done was do something called cardioconversion to get my heartrate back into it's normal "sinus" rhythm...generally when someone is in an irregular rhythym like I am they cardioconvert by using "paddles" that temporarily stop your heart and and restarts it (think of the medical shows when someone's heart has stopped and they use those paddles on their chest to get it starting again (that is exactly what they would have done) HOWEVER, because I was pregnant they felt that wasnt' safe so decided to cardio convert me in a similar fashion but going through my esophogus (aka a procedure called a TEE) and using a less invasive procedure to shock my heart back into rhytym...except when they did the procedure found the clot and therefore decided against cardioconversion because it could dislodge the clot causing a major stroke or sending a clot to the placenta and killing the baby or both...so they felt there was nothing they could do except put me on a blood thinner (LOVENOX) that is safe for pregnancy to stabalize the clot from "showering" (what caused the first TIA). A month after the diagnosis my cardiologist decided to do another TEE and see the status of the clot...it had not changed and was still very huge her opinion was that there was nothing we could do with the clot until after I gave birth. So we decided that we would wait until after he was born and move me to a bloodthinning drug called Coumadin (aka what Nathan and I like to call "rat poison") but it is the supposedly the strongest clot "dissolving" drug out there...in other words it can help my body absorb the clot in a safe fashion (unfortunately that process could take some time). So the plan was to have the baby, transition me from lovenox to heparin, wean me off of heparin for the delivery, then resume heparin and then bridge me to coumadin (as it takes 3-5 days) to get coumadin to a theraputic level so we had to do both Heparin and coumadin at the same time until my INR numbers reached 2. (theraputic level)
The scary part of the delivery is taking me off heparin (I cannot have a spinal/epidural) for the C-Section on a bloodthinning medication because it can cause paralysis (yes, not something any of us want/ed) soooo....making a long story short I would be off of blood thinning medications for 16 hours for the delivery (making my clot "unstable") so my biggest risks were in that 16 hour time frame of getting having a stroke or heart attack etc...) luckily we sailed through the delivery, got back on heparin and transitioned to coumadin a lot quicker than had planned...
but the question everyone was asking is how is the clot? Well, it is obviously stabalized but whether it is still there or not we really don't know...I assume the clot is still there and will be there for a while just because after some experiences after heart surgery with a "foriegn string" hanging from one of my wounds...I just felt my body knew it had an extra life it was supporting (aka August) and therefore could not communicate to get rid of the clot...and thus waiting for his birth...I feel now that August is here with us my body can get back to functioning like it once was and allow my body to communicate that it has this foriegn "thrombus" (aka blood clot) that shouldn't be there...and with the help of coumadin...move my good blood through there to help absorb the clot...(or so are the hopes and plans) because it does take on average 3-6 months for the clot to absorb back into the body with the help of coumadin we will not know if there has been any change in the clot until after I have been on coumadin for 3 months at that point my cardiologist will do another TEE to see what the clot is doing (and hopefully becoming smaller if not gone) so now if you would like to focus your prayers on resolving this clot quickly that would be appreciated but we won't really know the "status" of the clot itself until probably mid to late August if not early September...
if the clot does not change at all in that time (become smaller) then we will probably have to discuss open heart surgery to completely take out /tie off the atrium appendage...they actually generally take that appendage out with open heart surgery (because it is known to cause issues like this very one) in heart patients like myself but because they did my surgery less invasively back in 2007 they were in a position where they could not reach the appendage as it is behind the heart...meaning they would physically have to take my entire heart out (flip it upside down to reach this appendage...the surgery they did they were unable to reach it as they didn't crack my chest open down the center like a standard heart surgery they went in under my right breast to fix/replace my mitral valve) leaving the appendage unreachable during surgery...
soooo....we are hoping that the clot will resolve on it's own once they do that then they can cardioconvert me back into "sinus" rhythym (as I have been in atrial flutter since Decemeber) the atrial flutter "could" resolve on it's own but it has been stuck there for so long we are anticipating the fact that we will probably have to cardioconvert...HOWEVER, if we can cardioconvert then I can remain on a low dose of a beta blocker which will regulate my heartrate which will lessen the chances of me ever getting a clot again as the atrial fibrillation / atrial flutter is what caused the clot to begin with...
I am not sure that all made sense...but to put is simply we won't know anything else in regards to the clot until August or September after we have allowed at least 3 months for coumadin to do it's "job"...let's pray it works...
until then I am very happy with how things went with August's birth...a LOT of prayers have been answered and so thank you so much everyone for your thoughts and prayers....it meant ALOT to all of us...we are still flabbergasted by how quickly I was able to come home. I was in the hospital only one day longer than a regular C-Section day and that day was Monday (the day before the C-Section) to get me on to IV heparin to prep for the surgery...(okay maybe a day and half longer since with my other C-Sections I would generally go home the morning of the 3rd day) and I went home the evening of the 4th day...so no complaints I am just happy and thrilled to be home and to be feeling good and healthy!
