Blood clots are rare, but.....

[macman 603]

I feel fortunate being able to sit here and tell my story to all of you. We all have had issues, concerns and problems that we have to deal with as part of our decision to undergo weight loss surgery. At least in my case I downplayed some of the potential side effects. I did not think they could happen to me. But they did; here is my story.

My insurance (BCBS of Illinois) required a six month managed plan before they would approve weight loss surgery. Although at times this seemed a long period of time, I learned a lot about the surgeries, my motivation to eat, the importance of following a food plan and taking on exercise, something I had never done. During the six months i received tremendous support from The Weight Center at the University of Massachusetts Medical Center. I felt particularly good about the center. Not only did they house one of the best Trauma Centers in Massachusetts, they also hosted a Medical School and one of the leading cardiac care centers in the northeast. It was good to know there was a level of support beyond the surgery itself.

During the pre surgery intake meeting I discussed side effects including blood clots with my surgeon, Dr Donald Czerniach. Blood Clots, although rare, do happen as part of any surgical procedure. I did not have a history of clots so no special attention was paid to this. He also emphasized that I continue with my 5-6 day a week cardio program right up until surgery. He made a point of telling me how important this would be in the recovery period. Little did I realize how critical this would be. During the six months I lost 42 pounds and felt very good about where I was going. My surgery happened on December 23. Everything went well. I was in the hospital overnight due to my use of CPAP. But pain was minimal, I stopped pain meds after 48 hours, I was able to drink Water and moved around well. I stopped taking blood pressure medication. Quickly I was able to get the recommended Protein levels and I felt good. In fact on my 2 week followup visit, I joked with the NP, wondering if 85% of my stomach had actually been removed. I got clearance to begin increasing my exercise levels, slowly building up cardio levels and they expanded my liquid only diet to include cottage cheese, yogurt and cream Soups. At that point I had lost 20 pounds and could have been the poster boy for a successful wls.

The next day, I began to exercise with 20 minutes of cardio. I felt good but later that day developed a cramp in my right calf, below the knee. The cramp would not go away. I went to bed thinking I had pushed it a little and the cramp would be gone in the morning. In the morning the cramp was still there, as I walked to the bathroom for my morning usual, I became light headed, nauseous and eventually disoriented. My wife helped me back into bed, where I spent the day resting and sleeping. When I got out of bed later in the day all the symptoms were still present, so we called 911. At this point I was not sure what was happening but I was thinking about blood clots. After spending 6 hours in the ER at UMass Medical Center, and doing about every test possible, the diagnosis was that I had a blood clot in my leg. I also had a blood clot in my lung, and it was very large. Their thinking was that the original clot had formed in my calf, behind the knee. They were very confident that it had developed from the surgery a couple weeks earlier. A large piece had broken off the original clot and traveled through the vein, through the heart and lodged in the opening to my lungs. I was admitted to the Cardiac ICU. They began a traditional therapy involving heparin to stop additional clots from forming and allow the body to begin the process of breaking the clots down. They were very concerned about the Pulmonary Embolism moving. We discussed using a TPA clot buster to break the PE apart but one of the dangers was increased risk of internal bleeding, especially with surgery a few weeks ago. We decided not to do it. After 12 hours they switched to shots of lovanox in my stomach in place of the heparin. The Doctors thought it a bit more aggressive in helping to break down the clot. Later that day I suffered what everyone now calls the meteor shower. The PE that was lodged in the opening to the lung started to move. It totally blocked the vein, causing a back up of blood into the heart. Blood began leaking from the heart. At this point I was in incredible pain and thought "this is it"! Morphine did not help, finally a dose of fentinol slowed things down and allowed me to control my breathing. Blood was still backing up. One of two things was about to happen; the heart was about to explode from all the built up pressure or the clot would blow through the opening in the vein and break open. Luckily the PE gave way first, causing a "meteor shower" of smaller clots that proceeded into the veins entering the lungs and also the lung itself.

I was one lucky guy! In the words of the Chief CICU, "I had dodged one very large bullett"!

Over the next few days they worked on stabilizing me and started a pain regimen that would allow me to go home. I learned that blood clots are broken down by the body over time. They anticipated four to six moths before all was back to normal. Today I am home after spending 10 days in the hospital. I am on oxygen because my breathing is still impaired by the clots. I am taking 50 mg of Oxycontin slow release, every 12 hours. This is to provide a background layer of pain relief in case the clots decide to break apart. And I have 5 mg of Oxycodone for any short term pain issues. I am still on my liquid diet, 29 days, and I am looking forward to moving to pureed foods later this week.

A couple thoughts:

1. I did a lot of research on wls. The sleeve was absolutely the best choice for me. I was warned about the possibility of blood clots, but I did not think it would happen to me. The reality is that it can happen to anyone, no matter how prepared you think you are.

2. When the surgeon talks about a pre surgery exercise program, do what he says. Pre surgery, I was out of breath after climbing stairs and knew I had to be better. Over 12 weeks pre surgery, I steadily increased my cardio levels until I was doing 30 minutes on a recumbent bike 5-6 days a week. The Chief of the CICU and my surgeon both told me I survived the built up pressure in my heart because I prepared my heart for surgery with cardio exercise. They said it was strong with no residual problems from the clots. I am thankful that I listened to the Surgeon and to members of the fitness challenge forum for motivation to push myself to my goals! Thank You

3. in making the original wls decision I choose to be involved with a major medical center, a program of excellence in bariatric surgery and a facility with all the life support I might need if something were to go wrong. I am glad I did that. It probably saved my life.

4. If given a do-over, I would do the surgery again. With the same doctors, hospital and support groups. The decision to do wls was not easy. But it is the right thing for me.

5. I knew ahead of time how important a support network would be in helping me through the plan. Little did I realize how critical it would become. I am thankful for the love and support of my wife of 34 years, Lynne. She has been an absolute rock and has been a huge, positive impact on my success so far. The importance of a support network can not be underscored. If it is family, friends, this forum; we all need one.

[Miss Mac 6,261]

I am so glad you made it through the fire, MacMan.

[whosaysyoucant 111]

Most importantly - you are ok!!! I think your post is great. Blood clots were a real concern for me as my family has a history of clotting issues. My surgeon took it very seriously and made my plan accordingly. Your post has some wonderful points and thoughts for others to consider and be mindful of!

[BestYet2Come 97]

Thanks for sharing your story, I am sure it will help others prepare for the surgery. You clearly did your homework and your commitment to a healthier lifestyle obviously saved your life. Congratulations on your perseverance and success!

[sleevie.wonder 306]

Glad that you are still here to tell us your story. Hope you have a speedy recovery!

[Jencovi 261]

So glad you are back home and on the road to recovery. And thank you for the reminder that I need to stay active. Just over 3 weeks til my sleeve.

[KCamp 40]

Macman, you have been through a tough time. I am happy to hear your spirits are up and your doing well. Blood clots are a fear of mine as well. I have a mutated f5 gene, so they actually put a filter in me. My question to you is were you on any blood thinners after surgery? I hope you continue to do well. Thank you for sharing.

Edited February 2, 2014 by KCamp

[pnwguy 29]

I'm glad you are OK! Thanks for sharing this.

[ribearty 544]

MacMan, so sorry you experienced this, and very glad you are here to tell your story. It goes to show you can do all your home work and sometimes things happen over which we have no control or through no one's fault.

[macman 603]

Hey thanks everyone for the good wishes. After surgery I was on lovanox while in the hospital, but nothing once I returned home.

My recovery after surgery was on schedule and I felt great. I was also pretty active. It was just one of those things!

As an update; I am off all pain killers. The clots are still there, will be for a few months. I no longer need oxygen and my blood oxygen is 97% or higher without the oxygen and a heart rate in the 70's. The clots are having no lasting impact. I have been cleared to begin exercising once again. I am going to start slow but I got to tell you it's on my mind. The sleeve is progressing well and I am currently on soft Proteins, losing weight and feeling good

[KCamp 40]

God bless you!