Recovery: 2021

What a journey. Closing in on 60 years of age, it has been a tradition for as long as I can remember, odd years are better years for me. Given 2020 involved so much, I just knew 2021 was going to be a stellar year for me. As it turns out, things did improve. I was privy to an early vaccination, which brought me peace of mind from COVID-19, and the business my husband and I own began to see improved revenue as a result of improving pandemic conditions.

What I didn’t count on was a sudden difficulty in walking. In late-March, I began noticing a real discomfort when I would walk. Not lengthy walks, but walking from my office to the car. Or, when Spring began to show early signs in late-March, I noticed a significant difficulty in completing a simple mowing of the yard. It felt as if my left leg was seizing – almost like a “charley horse”. When the community where we have a small summer place opened at the end of March, I went up to do the first “clean up”. I was barely able to finish mowing our postage stamp-sized yard before I had to sit down and rest. I knew something was up.

Doing a little research, I made an appointment with a vein and vascular specialist to determine if I had a blood clot in my leg, given I had all the classic signs. As it turned out, xrays confirmed a sizeable clot just behind my left knee cap, which was blocking significant blood flow to my leg. The immediate course of action was to go in and get the pesky clot before it moved elsewhere. While at it, the specialist surveyed the rest of my body to determine if she could find the source of the clot. Nowhere in my body did it seem to originate, as there were no signs of a “clot breeding location”. Perhaps just an anomaly. Regardless, the clot had to be removed if I was to walk with ease again.

Surgery was scheduled with the mission to go in through catheterization. Having experienced a heart attack the year before, and the placement of two stents, I knew about catheterizations. My heart cath was performed by going through my wrist. The blood clot cath would have to go through my groin. I wasn’t looking forward to the 6-8 hours of lying completely still afterward to enable the site to clot back up and avoid “bleeding out”. When the surgeon entered the vein, she discovered the clot had embedded itself into the vein, making it near impossible to remove it. She decided to try administering medication directly into the cath site for about 24 hours to see if it would clear the debris (plaque build up) and loosen the clot. She did not want to damage the artery. The medication cleared the vein, and left the clot for her to remove. Again, she attempted removal, but it had somewhat “grown onto” the wall of the vein. Removing via cath was not the best option. She removed the sheath and I had to lie there again (for over 24 hours) to get the site to close. Immediately, I noticed a considerable “lump” there. She stated it was not uncommon to get a small hematoma, especially since she had been inside that area twice.

We moved onto the next option (“Plan B”) – actual surgery. This would involve a 6″ cut into the side of my leg, going through the calf muscle and getting to the artery that way. The surgery was scheduled immediately.

She performed the surgery and was able to get nearly all of the clot, but had to leave a very small fragment that had embedded deeply into the wall of the artery. She stated once a vein or artery has been exposed to a clot the area is prone to them again because the vein/artery has developed ridges and a roughness that can be a great breeding ground to catch debris (plaque/clots). The blood thinner Xarelto was immediately prescribed.

Following this surgery and a short stay, I went home.

Soon afterward, I noticed a continued slow swelling in the leg, and a growing inability to put any weight on it. The thought of simply hanging my leg off the side of the bed was excruciating. Eventually, the discomfort prompted a visit back to the specialist. The remedy was back to the operating room to open the site back up and clean out the fluid and any other debris which was causing fluid retention.

Following that surgery, I went home.

Not long after, swelling began again. A revisit to the surgeon prompted another surgery. This time, the surgeon went in and cleaned out the area, and installed a wound vac to continually keep the fluid pulled from the site, and to promote a more proper healing given the size and depth of the wound. The 3rd surgery appeared to make a big difference.

In the meantime, the hematoma from the original cath site began to grow in size, and became more uncomfortable. The site also began to open up and bleed. The first two episodes had me shuffling off to the ER. Eventually, we discovered simple pressure seemed to stop the bleeding, but you could almost set your watch to the fact that every 24 hours, the site would open. Sometimes it would be a reasonable amount of blood, and other times, it would look as though I had been stabbed nearly to death. My laundry basket looked like I had committed some heinous cringe,.as nothing I wore didn’t have some amount of blood on it. However, I knew something wasn’t right about the growing size of the hematoma and the fact the site was opening up so frequently. A home health nurse came to tend to the leg wound, and upon hearing my tale, and seeing the size of the hematoma, recommended I call my doctor right away. I did just that. Upon explaining the situation, the doctor’s office nurse told me to come in right away, and not to worry about an appointment. I was given an ultra sound. It was determined I had developed a pseudo aneurism. Remedy? You guessed it. Surgery. Not only surgery, but immediate surgery. I was advised to leave the doc’s office and immediately go to the hospital. They operated and cleaned up the site, put a stitch in the artery, and placed a small Jackson-Pratt drain to keep fluids out of the surgical site and to promote healing.

Things were going well until one evening, I woke up to find the drain full of blood, and the surgical site large and very painful. I knew something was wrong, and I needed immediate attention. Remember, we’re talking main artery here. A breach, and I could’ve bled out rather quickly. At 3am, I woke Jamie up and off to the emergency room we go. By the time I got there, I was covered in blood, and appeared to be losing it pretty steadily. Jamie ensured I got taken right away through a little foot stomping and louder-than-usual insistence. I was immediately given a room? Based on the ER physician’s initial assessment, it appeared I was not in immediate danger of bleeding out. The thought was to wait for the surgeon’s arrival in the morning, despite the enormous pain I was in, and the growing size of the bleeding area. About 20 minutes later, I began to feel lightheaded as though I was going to pass out, and Jamie noticed my blood pressure had dropped to a very serious low. He stepped out of my small room and hollered, “I need help in here right away!” The ER doctor came in with the nurse, noticed my condition and stats, and decided he would need to call the surgeon in “stat”. While we awaited the surgeon’s arrival, they quickly sent me for an MRI. I was also given a blood transfusion to compensate for the blood loss.

The surgeon arrived, assessed the situation and called for immediate, emergency surgery (#6). The results of the MRI confirmed a vein or artery had been breached and was creating a cavity in my groin, filling it with blood. They got me prepped for surgery, and she went in to fix the problem. She found an ancillary vein had ruptured and was producing the blood. She stitched it closed, cleaned out the site, and installed a wound vac to that area. I was admitted to a room, where I remained for 5 days for recovery and observation. Given the fact that both surgery sites had given me such a fit closing and healing, she wanted to make sure this surgery didn’t also end in complications.

Before any of this, I was taking a daily regimen of Plavix and a low-dose aspirin. This was prescribed as a result of the heart attack in 2020. When the surgeon added the Xarelto (another anti-coagulant, similar to Plavix), she began to suspect the combination as being too much thinning/anti-coagulating going on in my body, and creating these situations in which the surgical sites could not appropriately heal. There is strong evidence to support a reoccurrence of a heart attack if Plavix isn’t taken once stents are placed, so she was not able to remove that from my regular prescriptions. For a short period, she removed all but the Plavix to allow my body to heal the surgical sites. Eventually, there will be the add-in back of the low dose aspirin. We will not be returning to the Xarelto. It has been made way too apparent it is simply too dangerous in combination with the other medications. While she would like to have more than a simple low dose aspiring to ward off future clots, anything more is “too much”.

Two procedures and six surgeries all going after one clot. What’s so crazy is the clot was gotten relatively quickly. It has been my body’s inability to heal from the surgeries that has been so problematic. We are not a week out from my discharge, so I’m far from declaring victory just yet, but things appear to be looking good. Time will tell, and time (a considerable amount of it) will be required to recover from all this. My body has definitely been put through the wringer over the last 3 weeks. I’m hoping it will be able to recover and return to normal in time.