MM - 5 weeks post-op. Blood clot, ICU and now home.

Huh, I typed out a multiple paragraph review, but only the first sentence is showing. When I get a little more time I will try and re-write all that. ;)

Ok, so I am 10 days out and today I started thinking - what the hell am I doing? Anyone else have a 'this might be a huge mistake' moment? I think I am actually having a panic attack. So, I guess this is a good time to review my motivation.

When I got married in 2002 I weighed 118 lbs, I am 5'1". I got pregnant two years later and miscarried, twice. I had my little girl in 2005 and reached an all time high of 172lbs. Yikes! The last 7 years have consisted 3 cycles of being pregnant, having a c-section, nursing, and then focusing on losing the weight. I was down to 128 last year when I was put on a medication that helped me gain a little over 20 pounds in about 4 months. I've dropped 12 lbs of that weight through a 1200 calorie diet and excercise (insanity/elliptical), and weighed in yesterday at 138 lbs. I was really hoping to lose another 10 prior to surgery, but that isn't going to happen in 10 days!

I have never had a great body image, and that was further compounded by the 3 pregnancies and nursing for 3 years. My lower belly, inner thighs and upper back have always been trouble spots. Poochy lower belly with ugly c-section scar. Bulgy inner thighs that rub together. I had a party last night and a picture of me from the back surfaced on Facebook, back fat bulging bra band - lovely.

I am scheduled for TT, BA/BL and lipo to the flanks, hips and inner thighs on October 15th. I am really kinda freaked out about the scar, I'm afraid I am going to look like someone tried to cut me in half. I need to remember how infrequently I am completely naked, and staring at myself.

Also, I am perseverating on cc's. I am asymmetrical. I am having implants to even out my size and shape fill in the upper poles a bit. But, in no way to I want to be top heavy. I am wavering between 240-300 and 286-339. Logically I realize that 40cc isn't a lot, but emotionally it feels like a huge decision. Also, my PS is recommending I go with different profiles, not just different sizes, and I have to admit that makes me a bit nervous. He is recommending a style 10 on one side and a style 15 on the other. I haven't read anyones profile where this was done. Anyone?

Ok. I need to relax a little bit! Time to put this out of my mind for a minute.

I had a baseline screening mammogram on Monday, on the advice of my primary care office. I just got a call back that I have "abnormal" areas in both breasts and they want me to come back for focused images. I go in Friday morning to the diagnostic center. There will be a radiologist there to read the x-rays immediately and tell me either that everything is ok or that I need a biopsy. If biopsies are needed I will obviously have to reschedule my surgery. Plus, there is the fact that I have an abnormal mammogram. I'm trying not to freak out about that. Especially since this last week has been filled with Race for the Cure activities surrounding a friend who has stage IV breast cancer. And, my husband is out of town. This officially sucks. Trying not to loose it.

I had additional images (digital mammography) and then an ultrasound today. I have a 2.1cm solid appearing, lobulated mass in my left breast. The nurse said it "could still be benign". I have a biopsy scheduled wednesday morning and should know by thursday. Its probably benign, I know this. But its "atypical" enough to have me worried.
And, I had to cancel surgery. :( And, I might have cancer.

I really don't want to wait until Thursday to find out if I have cancer, this is torture. Radiologist said there is an 80% chance its a fibroadenoma (benign). But its more lobulated than he would expect. And fibroadenomas are more common in younger women (most common tumor type in women under 30). But that at my age he would suspect fibroadenoma over cancer. Hmmmm.....I suppose that should be comforting. Except thats saying I have about a 20% chance of having cancer. And even if it is a fibroadenoma, I am over 35 and there may be reason to just remove it anyways since it can ever so slightly increase my risk of cancer in and of itself. Blah.

I was able to get into a sister hospital earlier, so I had my biopsy yesterday afternoon. I would like to never have to do that again. The lidocaine burned, but wasn't too bad. But he didn't numb up far enough down, so the first biopsy was a little shocking and painful. The biopsy gun is spring loaded and makes this loud noise, its disconcerting at best. They took 5 core biopsies. I was ok until the local wore off, now its a lot more swollen and sore than I expected. Even with their recommendation to "take some tylenol and use an ice pack", I am still uncomfortable. And when my 2 y/o bumps it, it hurts enough to tear me up. ; / I am sure the reminder of what could be growing in my breast isn't helping. I should have path back today.

Path came back fibroadenoma. Its NOT CANCER!!!! Whhhoooooooohooooooo!!!

Not sure how I feel about the reschedule date being Halloween. My husband thinks its going to be fine. The kids can't dress up for school, and usually we just do a quick trip around the block. In fact last year I stayed home passing out candy while my husband took the kids around the block. So, I guess its not that big of a deal. But I still feel a little bad about it. The next date they had was just before Thanksgiving. So, I guess I would rather be out for Halloween than Thanksgiving.

My boob is pretty swollen though and sore. But I can't believe how swollen it is. Makes me a little nervous for post BA/BL.

Anyway....have I mentioned its not cancer!! I am so relieved.

Making supply lists, grocery lists, etc. Feeling very nervous.

I am worried about post op pain. Can anyone tell me how many days/pills per day they took?

Also, does anyone have a CG recommendation? I would rather have an extra on hand so that I can wash them without worry...I'm worried that my lipo sites will ooze and sitting in a crusty CG sounds horrid.

Tomorrow is the day~

I thought my surgery was at 8, but it turns out its at 7. So, I have to be at the surgical center at 6. So, I guess I need to wake up at 4:30 or so. I didn't want to impose anymore on the friend that is watching my 2 y/o tomorrow, and picking up my older 2 from school if I run late. So, the plan was that h was going to drop me off at the surgical center, take the kids out to breakfast and then drop them off at my friends around 8 in time for her to drop the kids at school. Is this a good plan? I can't even think at the moment. Should I just drop them off at her place at 5:20 to finish their dreams?

Also, I am 138 as of this am. I had been hoping to get down to 132 or below. Guess there is no changing that now. I just need to accept it, and move on.

I am still really freaked out about implant size, and worried they are going to be too big. I just need to voice my concern in the am, and trust that Dr. V will do best.

OMG, I just hope I wake up.

I had my surgery today. It went smoothly per the surgeon. I don't remember much. I Remember going to the OR, and then waking upi in the OR. But I hurt, a lot, even with 4mg Dilaudid . Mostly in my lower belly/incision area, but also lipo sites and breasts. Got a quick sneak peak and my tummy looks good! I am bruising everywhere.

It took 5 mg of IV dilaudid to get me able to get to the car on surgery day. Surgery day and po day 1 I was counting down the time before I could take meds. It was hard to get comfortable in the recliner or bed. And I went through these spells of feeling totally and completely claustrophobic, almost to panic attack. I think it was a combination of not being able to move really well, and the CG. I had to get out of the chair/bed.

Post op day 2. I am really swollen. My thighs actually look worse than what they did when I went in! But, he took 3.5L of lipo fat/solution, which is equivalent to about 7.5 lbs of fat!! And that doesn't include the skin/fat removed from the TT. So, I know it has to be a lot of swelling. Plus they gave me 4L of fluid during surgery and I have been drinking a ton of water and am peeing frequently but very little. How long did it take for you guys to pee off your extra fluid? I know I'm third spacing a lot of that fluid.

And my bruising is horrid, I am black and blue from flanks to mid thigh. But, I am feeling better. I can actually get somewhat comfortable with only a little tightness in the lower belly while sitting perfectly still. I go to instant 7-8/10 pain when I move - trying to get out of bed to pee, lifting a book/laptop, etc. I dread going to the bathroom, but I know its good for me because it gets me moving. Getting out of bed and the first few steps are certainly the worst.

I have had a sneak peak, and can't believe how flat my tummy is! I am still afraid my boobs are too big, but have agreed to give them time to do their thing first. I might take a shower this afternoon. My belly button is bloody and I still have blue marks all over me. I will try and take some pictures after my shower.

I have no appetite and am eating only because I need something in my tummy when I take the narcotics or else I get nauseous. I have had 2 incidents where I went up to pee and the combination of pain having an empty stomach made me terribly nauseated and I broke out into a dripping sweat.

And the phantom itching is yucky. I go to scratch a place that itches only to find out its completely numb and scratching does nothing! I had to put a t-shirt under the CG to help with the itching (thanks for the advice AussieMumof3!). The material was driving me crazy.

I know that being patient through recovery is going to be tough. I already want to get up and around. And take care of my babies. H is doing a pretty good job. There have been a couple snags. Even though I know he is trying to help, I find myself very short with him. Yesterday morning my daughter had an orthodontist appointment. I had arranged for a friend to come over to sit with me, while he took kids to school and ortho appointment. But, he left her with my 2 y/o and told her not to let him up to see me because he tries to climb on me. WTH? So, instead of her sitting with me, she was babysitting him while he sat in the waiting room by himself. grrrr. And he also wants to dictate how I move, thinking he knows best on what would be easiest for me....which is really irritating. I just want him to let me tell him what I need him today, instead of him telling me how I should move.

Drainless TT means shower today! I will write more later. And maybe I'll be brave enough to post some pictures. ;)

I know I am totally swollen and having a lot of muscle spasm. But I just too a shower and saw myself naked for the first time. First, my boobs are huge! I hope they settle. Second, my belly button isn't center! Has this happened to anyone else? Will it look better after the swelling goes down? Can they revise this? Is it an in depth procedure? I just need to reserve any judgements for 6 weeks, right?

Ok, I wasn't going to post pictures. I find it very intimidating. But, you guys have been so great to me. Here goes. 2 days PO. Ate my boobs too big? I know I'm really swollen because I gained 2 pounds since surgery day and apparently he removed about 7 lbs of fat with lipo. Plus the lower belly fat/skin he removed.

The swelling is getting out of control! When can I expect to start peeing off some of this extra fluid? My thighs and hips/butt are 2-3x normal size. I even have some swelling down there! I am 4-5 pounds over my pre-op weigh in. I'm drinking a ton of water, taking bromelain and arnica, eating cucumbers and pineapple. The swelling is getting so bad that my tissues are painful. I'm swollen from my boobs to my mid thighs! Anyone have advice?

And let me add that I know it will take months for it to go away, but when is it going to stop getting worse. I feel like the 4L of water I have drank in the last 3 days has went straight to my tissues.

PO day 4. I showered and blow dried my hair. I am trying to get up and walk around every few hours, and I am surprised at how upright I am able to be for 15 minutes or so until my back and low belly start to spasm a little. I'm still worried about my chest size being too big and about my BB not being quite center, but I am trying to let that go until the swelling goes down. Its not just my BB not being center but the contours on each side of my waste are different. Hmmmmm. I am still really swollen, but not really in the belly. So I don't know that a drain would have helped. I don't have a seroma, there are no pouches of palpable fluid. Instead my butt, and thighs are hard and swollen. the circumference of my thighs is up a couple inches! They are also really bruised. I'm sure its a combination of fluid retention and bruising from the lipo. So, I am hoping that by drinking lots of fluid and walking every few hours I will help to work some of that out. Overall I feel so much better than I did 2 days ago. I hope to continue to feel better every day. Oh, but I did start to feel a little bloated today. So, I took a dose of MOM. Hope that helps.

Last night was rough. I think probably because I switched pain meds and I didn't set a timer. So I woke up half hour after my meds were due and was miserable. It took me 15 minutes to get up out of the recliner to go pee, and I groaned the whole time. Its mostly my lipo sites that are hurting - inner thighs, back, hips. My back is bad, and the muscles spasm something fierce. But, last night I also noticed my breasts felt really tight and sore too, especially towards my armpits and sternum. And my ab muscles were not happy either. I think the muscle relaxants really help a lot too. Guess I am not going to be one of those girls who is just on tylenol during week one.
My inner thighs/hips/a$$ are HUGE. The swelling is insane. I left the surgicenter with just an abdominal binder, but no compression to my lower body, and I wonder if thats why its so bad. I ordered a CG suit, and when I get it I will put that on and put the binder over the top if I feel like I need some extra mid abdominal compression.
Also, I have to admit that I have stepped on the scale. I know that is a big no-no. But, I figured he took about 10 pounds off during surgery between TT and lipo so I should at least come off even. I was not expecting to be 5 pounds over my pre-op weigh in at almost 7 days out. :( My lack of patience is once again rearing its ugly head.
Feeling much better right now after taking 2 pain pills and a muscle relaxant. But, at a week out I wasn't expecting to need so much medication. :/ Eventually I need to get back to my non-medicated life!!

I know, I know. Don't weigh yourself post-op. But, I did. Everyday. And, for the first time I am under my pre-op weight, on day 8. Whooohooo!! 138 pre-op, 143 post op (yikes!), and 137 today. My implants weighed 1.5lbs, so really that puts me at 135.5. Yipeeee!!! I expect to be around 130 when all the swelling/bruising subsides. And I do plan on dropping several more after I am healed. A friend has asked me to start doing Crossfit with her, which I am considering. I was doing insanity and the elliptical prior to surgery. And I really want to do a 5k, 10k, half marathon progression by next summer. I want to do the half marathon in my home town the summer of my 20th high school reunion.
The swelling is finally starting to come down. The pain is starting to subside in the incision sites. It feels like my TT incision and my breast incisions are healing well. They are kind of itchy, but thats a good sign! I have cut way back on pain meds. The sides of my breasts are sore. My low back still hurts, more than that the skin and muscles hurt. My back has to be the worst pain. Is it from the lipo, the restricted positions I've been in? The lack of exercise? idk, but ouch! That and my inner thighs.
OK ladies, does anyone else have a problem getting up and out of bed in the night and in the morning? It is my worst time of day. I'm usually in tears when I wake up. My muscles hurt, my skin hurts, I can't move without lots of pain. Once I am up and moving it gets a ton better, but that first 15-20 minutes is hell. Any tips?
I really think I need to start moving more. I've been trying to take it easy because I need to be back up to running my family at that 2 week post-op mark. But, I think the not moving is making me worse! So, I am going to start walking tomorrow.
I updated a boob pic. They are a lot bigger than I expected, honestly. But, they are growing on me. ha! And I think h likes them too.

Hey all,
Sorry I haven't posted in a while. Its been a whirlwind of a month. I started walking, mostly upright, about a mile a day at 3 weeks post-op. About 4 days into that I started having low back pain, just to the left of my spine/SI joint. Over the next few days the pain started radiating down my left leg and I diagnosed myself with sciatica the day before thanksgiving. Thanksgiving morning my leg was so painful I could barely stand. After struggling to get the turkey in the oven I told my husband I was just going to go sit in the shower for a little bit, maybe the hot water would help loosen up my back. And thats where he found me, 20 minutes later, sitting in the tub and looking at my significantly swollen, painful and purple left leg/thigh. Thanksgiving morning. Of all days. I actually made my h call the PS, to be sure for positive that I had to go in right then. Denial, party of one!! I knew. Fortunately I also knew at least one friend who was going to someones house for thanksgiving and not manically running around her own kitchen. She came over and watched our 3 kids while my h drove me to the local ED, she even basted my turkey. lol. I knew by the ultrasound sonographers face that it wasn't good, he turned the screen so I couldn't peek. I tried to joke with him about the fact that I was pretty screwed if he couldn't even compress the vein at my thigh, no turkey for me. He looked terrified. Within 10 minutes of him leaving I was in CT for a chest scan to rule out a PE (pulmonary embolus).
Doc came in and told me what I already knew, I had a massive blood clot. And a few things I didn't. No PE - Yay!!! And my clot extended from my knee up through my pelvis into the IVC - not so good. One of the biggest clots he has seen - uh, yay me? Then, for my little holiday miracle. An Interventional radiologist at another hospital was willing to accept me in transfer and try and dissolve the clot. This doctor, and his entire team, stayed late on thanksgiving for me. Talk about warm fuzzies. I'm tearing up just thinking of it!
So, I sent my husband home to relieve my friend and finish dinner for the kids. There would be no food for me for the next 3 days, let alone that night. But, my babies deserved Thanksgiving dinner. And there was no way I was going to intrude on anyone else's holiday. I didn't even tell my friends until the next day. So, there I sat, alone, in an ED room for a couple hours waiting until the receiving facility had an ICU room for me. The whole time wondering what the next few days would hold. And thinking heavily of a patient of mine 2 years ago, 42 y/o father who died of a PE in transit from our facility to another. Oh, the things that go through your head when you know enough to be dangerous and are drugged up on dilaudid.
The Interventional Radiologist met me within 15 minutes of arriving at the new hospital. I went almost immediately down to the IR suite. Even with conscious sedation, I could tell that the clot was almost completely occluding my vein. It took some time to weave the catheter, described to me as kind of like a soaker hose, from the back of my knee up the length of the clot. With the cath in place I went to ICU. TPA (clot busting drug) and heparin (anti-clotting drug) were run through the lines placed in the back of my knee.
Then the waiting began. There were a multitude of possible outcomes......again, enough knowledge to be dangerous. The drugs could dissolve the clot, my venous function could return, my leg would return to normal size and color. That was the best case scenario. Of course the TPA doesn't discriminate against new clot and old clot, so the possibility of all of my MM sites starting to hemorrhage existed. Or, I could start to bleed in my head, or stomach - I have a history of a NSAID induced duodenal ulcer. With TPA and heparin I could bleed to death in no time. Then again, the opposite could happen. A bit of that clot could break off and clog my pulmonary vessels, making it so that my oxygen depleted blood couldn't reach my lungs/oxygen. Effectively suffocating me to death. Also, not a pleasant outcome, and unfortunately what took the life of my patient a few years ago.
The TPA and heparin ran through my popliteal lines for about 36 hours. As time progressed my cath insertion sites started to ooze. Not wanting to make things worse the nurses just kept replacing the gauze over the top of the bleeding sites, which I would then promptly bleed through. Oh, what a site! When my thrombin levels dropped to 152, the TPA was turned off and the heparin was turned up.
The next morning I went back to IR. The new venograms showed almost complete resolution of the clot, what remained he obliterated intravascularly. And he found something else. May-Thurner Syndrome, or MTS. A congenital anomaly where the right iliac artery sits on top of, and compresses, the left iliac vein. He placed a stent into my vein in hopes to keep it from being smashed by the overlying artery.
It seems MTS was the cause of my clot. Sure, the MM increased swelling and decreased activity and certainly encouraged clot formation. But without my underlying defect, its likely that none of this would have happened. Even if I did form a clot, it would have started in my calf, like normal people. My clot started in my pelvis, which is why it spread so quickly and was so bad. The IR doc was actually surprised that I had gotten through 3 pregnancies and caesarian deliveries without a previous clot. Certainly that would have been worse. I can't imagine leaving my week old baby and being confined to an ICU. What would my husband have done with that?
The lines were removed from my knee that morning, thank goodness. I was eventually transitioned to lovenox injections twice a day and coumadin. 5 days after initial presentation I was allowed to go home, even though they would have liked me to stay another 3-5 day. My babies were starting to miss me. My 7 y/o was crying, asking me to please come home. My babies win. They trained my h to give me injections, I promised to find a GP, and I got to go home.
Its been a bit over a week since my discharge. I am still on coumadin, but had my (hopefully) last lovenox injection yesterday morning. I have near daily blood draws to check my INR (indicator of clotting function) I'm doing ok. I am still swollen. I have to wear medical grade compression hose, thank goodness its winter! I am only taking tylenol during the day, but still need narcotic pain medication at night in order to sleep. About 5 pm the pain starts creeping from my low back to the left side of my pelvis, down my inner thigh to the back side of my left knee. Improvement has been slow, but steady.
Coumadin is a difficult medicine. In order for it to work properly you need to minimize the amount of vitamin K you take in, or at least keep it a consistent amount. Unfortunately prior to diagnosis a great deal of my diet was high-mod vitamin K containing foods. Salads/leafy greens, spinach, broccoli, snap peas, garden peas, avocado, celery, parsley/herbs, kiwi..... I have been trying to minimize my vitamin K, but I think that figuring out a consistent amount may be a better option for me.
I saw my PS last week, just after discharge. I was afraid that the tension caused by the rapid swelling caused by the clot might have compromised my incisions, but he assured me they looked good. Also, ultrasound prior to discharge showed evidence of hemorrhage in my left thigh, which they think was from the inner thigh lipo which re-hemorrhaged in the presence of the TPA. He said it may take a little longer for the swelling should go down, but shouldn't effect overall results. I am spitting a stitch in my left breast. Thats annoying, isn't it? But, I guess in light of all that I have to be thankful for, thats a little thing.
I'll try and get some pics up in the next 7-10 days. Overall I'm very happy with the results. I am down about 10 pounds from pre-op. Of course I didn't eat anything for 3 days in ICU and really very little the following days.
One last note on Dr. Vath. He was amazing during all of this. He talked with my husband while he was on vacation with his family, on Thanksgiving. And then, proceeded to call him everyday for updates and to check on us. This degree of caring, compassion and empathy is not found in every PS. He is not only a great surgeon but a good man.
Lots of love to you chicas! Thanks for all the support.