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Massive Blood Clots

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Massive Blood Clots

Post by DonSoule on Fri Jul 04, 2014 10:24 pm

I'm spending the 4th in Fairview Southdale hospital with blood clots in my left interior jugular vein.  Left arm is very swollen from blockage.  Might have been caused by pacemaker wires but don't know.  On heparin for now.  Vascular surgeon will probably do something to break it up tomorrw.  In for 2-4 days depending on what they do.   At least I now have a good excuse for my slower than expected time at Grandma's Marathon (5:08:34)

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Pacemaker, January 16, 2009
Boston Scientific, Altrua 60 S602
Fairview Southdale Hospital
Minneapolis, MN
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Re: Massive Blood Clots

Post by BA on Sat Jul 05, 2014 2:14 am

Sorry to hear Don, hope it all goes well. heal up fast so we can meet up in the twin cities!
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Re: Massive Blood Clots

Post by Dave Tuttle on Sat Jul 05, 2014 6:49 am

That sounds scary Don... We'll be thinking of you and hoping to hear better news soon.

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Re: Massive Blood Clots

Post by Tom price on Sat Jul 05, 2014 8:49 am

Well, as excuses go, that has to be one of the best!  Good luck with your recovery!
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Re: Massive Blood Clots

Post by twal on Sat Jul 05, 2014 3:34 pm

Please get better.

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Re: Massive Blood Clots

Post by Guest on Sat Jul 05, 2014 6:31 pm

Sorry to read this Don, get better.

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Re: Massive Blood Clots

Post by trishb on Sat Jul 05, 2014 6:39 pm

Take care Don!

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Re: Massive Blood Clots

Post by DonSoule on Sat Jul 05, 2014 9:00 pm

Thanks for your well wishes! Now they're saying its in the left subclavian vein which is connected to the left internal jugular vein. First objective is to dissolve the clots with a TPA drip along with the heparin. They did something like an angiograhm to look at it and put in something they discribed as a "soaker hose" to get the TPA drug to the clots. It could take 1 to 3 days to work. I'll go in tomorrow at 8am and they'll see how well it's working - then if it's working they may be able to suck out the rest of the clot or may send me back to my room for more "bed rest" until the TPA works. After the clots dissolve the will try to determine what caused it and do some type of preventive measure. They said they will try and rule out all other possible causes before looking into a possible pacemaker/leads/wire reason.

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Pacemaker, January 16, 2009
Boston Scientific, Altrua 60 S602
Fairview Southdale Hospital
Minneapolis, MN
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Re: Massive Blood Clots

Post by Rachel August on Sun Jul 06, 2014 10:34 am

Don, so very sorry to hear that this happened to you!!!! Thinking of you and wishing you a speedy recovery!!!

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Re: Massive Blood Clots

Post by DonSoule on Sun Jul 06, 2014 8:38 pm

It went better than expected this morning and they were able to go into the vein and finish breaking up and sucking out the rest of the clots so I'm doing much bettter and probably will go home on Monday. I'll let you know if they decide to keep me longer for some reason. Thanks for your concern. They decided it was due to the pacemaker wires so will be doing something about that but not right away. They will be sending me home on blood thinners first to make sure there are no more new clots and to continue dissolving any thing missed. Then in about four weeks will address the pacemaker problem so I'll be back in here for that. My cardiologist will have to deal with that so more appointments etc. in my future. I'll have to be careful about cuts etc. and I'm guessing no Marathon training this summer but haven't heard anything about my restrictions yet.

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Don

Pacemaker, January 16, 2009
Boston Scientific, Altrua 60 S602
Fairview Southdale Hospital
Minneapolis, MN
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Re: Massive Blood Clots

Post by Guest on Sun Jul 06, 2014 9:44 pm

DonSoule wrote: They decided it was due to the pacemaker wires so will be doing something about that but not right away.  They will be sending me home on blood thinners first to make sure there are no more new clots and to continue dissolving any thing missed.   Then in about four weeks will address the pacemaker problem so I'll be back in here for that.  My cardiologist will have to deal with that so more appointments etc. in my future.

This is good news Don.  Are you going home on Coumadin or some other blood thinner?  If it's Coumadin you don't have to be overly concerned, they'll have you go in for blood draws for your INR, to get you in range and then maintain that range.  Some folks get in range quicker than others, for what it's worth, it took a while to get me in range although I'm still on the same 40 mg dose a week since my surgery.  I also home test and call my INRs in to the Coumadin clinic monthly, so easy.     

DonSoule wrote: I'll have to be careful about cuts etc.  and I'm guessing no Marathon training this summer but haven't heard anything about my restrictions yet.
What you will find with Coumadin is that it takes a little longer to clot but you won't bleed out or anything like that.  If you get cut, apply pressure as you would if you were not on Coumadin.  I cut my finger with hedge clippers several years ago, went to ER, they stitched it up, bandaged, whalla.  Even if I were not on Coumadin I would still have had to have stitches.  Here's a link to HeartValvePatients.org.  These folks know a lot about Coumadin and management so you can browse through the stickys and learn from real life Coumadin users:  HeartvalvePatients.org

Depending on what they find with your pacemaker and the wires may determine your training more so than the Coumadin. Hopefully you won't have to be on Coumadin or some other blood thinner for the long term.   Smile  Keeping you in my thoughts.

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Re: Massive Blood Clots

Post by echoguy on Sun Jul 06, 2014 10:32 pm

Sorry to hear about the bad break Don.... Glad things are well controlled now and that you have a game plan. You will be back out there on the roads soon!!

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Re: Massive Blood Clots

Post by DonSoule on Mon Jul 07, 2014 10:18 am

I'm going home today - they didn't schedule any Cardiac/Pacemaker follow ups and aren't planning on any changes.  The blood thiner drug he's putting me on is Xarelto - does anyone know anything about this or have any experience with it????   I'll be seeing the Vascular Dr in 2 weeks for a follow up exam and ultrasound of my veins.  I still have swelling in my left arm and hand which he said could take about 2 weeks to go down.  

He said I would have a lifetime restriction on swimming or over the head movements - also lifting granddaughter up high.  Maybe I could use a kick board without the arm movements?  Sounds like I won't be joining Mike at the senior games tri next summer.

I can start running again in 1 month which is good news  Very Happy  so Twin Cities with a walk/run should be doable but no BQ / PR tries in the fall.

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Pacemaker, January 16, 2009
Boston Scientific, Altrua 60 S602
Fairview Southdale Hospital
Minneapolis, MN
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Re: Massive Blood Clots

Post by twal on Mon Jul 07, 2014 11:50 am

I'm on Xarelto. You'll bruise easily at the slightest touch and when you cut yourself it will take longer to stop than you'd expect.

My biggest problem with it is that it is not a generic so it's like several dollars per pill.

Good luck with your recovery. You were turning in some really good treadmill times.

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Re: Massive Blood Clots

Post by mikenall on Mon Jul 07, 2014 9:01 pm

Hang in there Don. Do what they tell you and we'll see you next year for a caffeine free diet coke.

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Re: Massive Blood Clots

Post by DonSoule on Fri Jul 11, 2014 6:48 pm

Mike, I was hoping I could join you at the senior games but it looks like I'll have to settle for cheering for you  Very Happy 

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Pacemaker, January 16, 2009
Boston Scientific, Altrua 60 S602
Fairview Southdale Hospital
Minneapolis, MN
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Re: Massive Blood Clots

Post by DonSoule on Fri Jul 11, 2014 6:58 pm

If anyones interested in the medical details, I found some interesting reading in my online MyChart account:

IR UPPER EXTREMITY VENOGRAM LEFT 7/5/2014 9:50 AM

HISTORY: 64-year-old male with left upper extremity swelling. This
first began 2-3 weeks ago and has acutely been severe in the last 2
days. Patient has a history of a pacemaker introduced via the left
subclavian vein. Patient has also been actively exercising utilizing
his upper extremities during swimming.

COMPARISON: Ultrasound dated 7/4/2014.

Description of procedure: After obtaining informed consent, the
patient was placed in a supine position on the fluoroscopy table. The left arm was prepped and draped in the usual sterile manner. 1% lidocaine was injected for local anesthesia. Ultrasound was used to evaluate and document patency of the left basilic vein. Under sterile ultrasound guidance, access into the left basilic vein was obtained. An image was saved for documentation. A 6 French vascular sheath was placed. A venogram of the left upper extremity was performed.

FINDINGS: There was occlusion of the left axillary vein, subclavian
vein, and brachiocephalic vein. There was also thrombus extending into the left internal jugular vein as well as into the internal mammary vein.

INTERVENTION: A JB one catheter was able to pass a wire across the occluded vein segments. Over the wire, a 5 French 20 cm long infusion catheter was embedded in the thrombus. 2 mg TPA was injected into the thrombus. Catheter directed thrombolysis was started.

The patient tolerated the procedure well. There were no immediate
postprocedure complications. The patient's vital signs were monitored by radiology nursing staff under my supervision and remained stable throughout the study.

Medications: 2 mg Versed, 50 mcg fentanyl, 2 mg TPA.

Sedation time: 50 minutes.

Fluoroscopy time: 4.6 minutes.

Contrast: 20 CC VISIPAQUE

Impression
IMPRESSION: Occluded left axillary, subclavian, and brachiocephalic
veins. Catheter directed thrombolysis was started. TPA will be infused at a rate of 0.5 mg per hour. A 6 French sheath in the left basilic vein will be used to infuse heparin at a rate of 500 units per hour.

TPA check will be performed tomorrow.

FAREED SIDDIQUI, MD

Day 2 TPA check:

IR ANGIOGRAM THROUGH CATHETER FOLLOW UP 7/6/2014 9:42 AM

HISTORY: Left upper extremity DVT currently undergoing catheter
directed thrombolysis for the last 20 hours.

COMPARISON: Venogram dated 7/5/2014.

FINDINGS: The patient was placed in a supine position on the
fluoroscopy table. A venogram was performed through existing infusion catheter which had been positioned in the left axillary, subclavian and brachiocephalic veins.

There had been significant lysis of thrombus from the axillary and
subclavian veins. There remained occlusive to partially occlusive
thrombus in the left brachiocephalic vein.

Mechanical thrombectomy using an AngioJet device was used to clear thrombus from the left brachiocephalic vein. A stenosis in the central left brachiocephalic vein was revealed.

A 7 French vascular sheath was placed. The brachiocephalic stenosis was dilated with a 10 mm balloon and subsequently with a 14 mm balloon. Followup venogram showed improvement in luminal diameter and improved flow. There remained some irregularity within the central brachiocephalic vein at its junction with the SVC. This likely represents residual wall adherent thrombus. The left subclavian vein was also imaged with the arm in 90 degrees abduction and 130 degrees abduction. No significant extrinsic compression of the vein was noted on venography.

The left arm sheath was removed. Pressure was held at the puncture site for 10 minutes with good hemostasis.

The patient tolerated the procedure well. There were no immediate
postprocedure complications. The patient's vital signs were monitored by radiology nursing staff under my supervision and remained stable throughout the study.

Medications: 3 mg Versed, 200 mcg fentanyl

Sedation time: 60 minutes

Fluoroscopy time: 9 minutes

Contrast: 80 CC VISIPAQUE

IMPRESSION AND PLAN: Post 20 hours catheter directed lytics and
mechanical thrombectomy, there has been significant lysis of thrombus from the left axillary, subclavian, and brachiocephalic veins. Focal stenosis in the central left brachiocephalic vein was dilated as above. There is improved washout from the previously thrombosed veins.

Patient will be continued on intravenous heparin. Findings were
discussed with Dr. Foley .

FAREED SIDDIQUI, MD

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Pacemaker, January 16, 2009
Boston Scientific, Altrua 60 S602
Fairview Southdale Hospital
Minneapolis, MN
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Re: Massive Blood Clots

Post by twal on Sat Jul 12, 2014 7:11 am

Sounds scary. Any clue why this happened?

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Re: Massive Blood Clots

Post by DonSoule on Wed Jul 23, 2014 10:02 am

My first follow up with my Vascular Dr from Fairview Southdale Hospital yesterday went well Smile  He said everything looked good -  I tried to talk him into a different swimming  stroke than the front crawl but all he'd allow was floating on my back and kicking -No pushups. pull ups. any kind of weight lifting or lifting my 10 month old Granddaughter over my head either - I'm on the blood thinner (Xarelto) for the next 6 months when I see him again and then if the Ultrasound looks good, he expects I can come off the blood thinner and we'll discuss swimming strokes again.  Good news is I can return to running now - did 3.2 miles this morning and it felt great!!!  Very Happy  Very Happy   - so my fall marathons are on but probably a little slower than I had been planning (BQ attempt delayed until next spring)  Twin Cities Marathon here I come!! Smile

Tom W, all they came up with for a cause was my recent return to swimming (I was bragging on Facebook about 10 days before I went into the hospital that I did 1.25 miles which was my longest swim in my 64.75 years and I almost caught Gary on the last 30 days swimming leaderboard when he was do some unusually low mileage)- Dr Foley thinks it was the repetitive over my head front crawl stroke along with my pacemaker wires in one/some of the involved  veins that somehow caused the clots to form.  I did do some swimming a couple of years ago when I did a sprint triathlon in the summer of 2012 but didn't have any issues.  Lars posted on facebook that I probably had some unique clotting factor issues since he didn't think it was a common problem with pacemaker swimmers.  Dr Foley did do a lot of blood tests and said all my clotting factors looked normal and it didn't look like I had a predisposition to clotting problems so who knows why it happened???

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Re: Massive Blood Clots

Post by Rachel August on Thu Jul 24, 2014 5:51 am

That's good news Don about running again - glad to hear that! As far as swimming goes, it's more fun to jump in the water on a floatation device anyway (IMO) - or taking a ride in a boat.....but I'm not a swimmer....hope you can get back in the water in the future.


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Re: Massive Blood Clots

Post by Dave Tuttle on Thu Jul 24, 2014 6:57 am

Great news Don!! Glad you're back out on the road.

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Re: Massive Blood Clots

Post by Gary E on Fri Jul 25, 2014 1:03 am

Sorry that I haven't had time to check in here in the last month or so, but glad to hear you are doing well. I also just noticed that you were aware of my lack of swimming lately.  I think I'll continue that lazy trend just in case the doc lets you start again - just to be "sporting"...but don't expect me to always be so gracious!!!
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Re: Massive Blood Clots

Post by BA on Mon Jul 28, 2014 2:16 pm

Great news Don, see you in TC
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