I NEED ADVICE!

This is one of the stops I'm making in my quest for as much information as possible to make a decision.

Here's the background.

My daughter is scheduled to get VSG on March 5th in Mexico. Thats less than 3 weeks.
It's a good 6 hour flight from here. Surgery scheduled on a Monday and Flight home on Friday morning.

About 2 weeks ago she had emergency surgery to remove a falopian tube because she was bleeding internally for about 3 weeks (slowly) and the OBGYN missed it during exams.
It was laproscopic and she came through fine.

She took a week off from work as a barista (fancy word for slinging Joe) and then went back to work.

3 days ago she started having symtoms of pressure/cramping so went back to the OBGYN, who said she is just healing and is probably doing too much at work. This was confirmed with a Cat scan and an ultra sound. Because she is scheduled for another surgery they told her to take another week off to heal. This doctor was concerned for blood clots because of the 6 hour flight after surgery.

Yesterday she had an appt for a physical with her PCP, who coincidentally, is also my PCP.
This doctor is not pro WLS. She actually told my daughter she did  not want to talk about the upcoming surgery in MX. She sighted concerns for back to back surgerys and the increased chance of blood clots primarily because of the 6 hour return flight.

Both doctors have mentioned blod clot concerns.

Is this a real concern?
Should I postpone the surgery?
Is there a precautionary medicine that can be prescribed? And if so: what kind? what are the side effects/concerns of this?
Is there anything else I should be concerned about that I'm missing?

I am going to speak directly with the surgeon today or tomorrow and I want to be prepared to ask the right questions.

I appreciate any help you can give me.

Thanks
donna

Preemptively Hi,

I do not know any of the answers to the great questions you are asking. I work for physicians who treat the condition with coumadin and see this a lot.

This is the issue though, you are supposed to stop the blood thinners before surgery to reduce bleeding out during surgery. Due to this, I doubt there is anything she can do preemptively  to reduce the possibility of blood clots with meds. I know even fish oils are to be stopped before surgery for the same reason.

She can wear RX support stockings which can reduce the possibility of clots while she is on the plane and after she lands until the surgery.

I am going to pray that your daughter makes the right decision, that she does not develop blood clots in any cir****tance, and that she stays healthy.

Blessings,

Sharon

No advice unfortunately but I will say a prayer for her that she will be able to get her surgery done safely. Maybe call and talk to her surgeon in MX about it?

Blood clots are always a concern with surgery now especially since she will be sitting so long. I would say have her talk to her surgeon and see if he feels there is a greater risk being that they are back to back surgeries. But also, I know in the hospital they gave me compression leg wraps that stimulated blood flow to my legs.. I wonder if you could rent or buy them from a medical supply store for the plane ride? That may help and I would definately also recommend that she get up at least once an hour and walk to the bathroom and back. May be a pain but will help to avoid a blood clot. Some other people on this board have mentioned that they were given blood thinners that they had to inject themself with after surgery.. If the DR sends her home with this it could possibly be helpful also..I would bring that up to him as well.

BLOOD CLOTS are indeed a VERY serious potential problem. You definitely might want to postpone surgery--However, having said that, the plane ride alone without having her recent history could be of concern.

Is it a straight 6 hours or in more than one leg? Even now after losing almost 100 lbs, I get swelling in my legs, particularly the left ankle up to behind the left knee where my first (old) and 2nd (new) blood clot was discovered in 2005 just days after driving 2000 miles then flying back (total about 6 hours). I make sure to always stand or walk in between flights or at least get completely horizontal in between. I was heavily medicated with coumadin and some other blood clot buster that I cannot recall the name of, and could NOT sit for 10 days, no driving. Laying or walking or standing. That's it. Then I was on coumadin for 6 months. Have been fine ever since, and seems that pressurized leg wraps are standard in just about every hospital situation these days so that part I wouldn't worry about.

On the other hand, I can sure understand her want and need to have this surgery!! Postponement would make me crazy and I can totally see myself getting on that plane regardless of my last doctor's visit.....and it wouldn't help if he/she was NOT on board with me.

Taking a baby aspirin a day and constantly flexing your calf muscles, rotating ankles, walking, not sitting in one position for too long is what will really make a difference for her. Depending on the size she is right now I don't know if that's possible or not?
I think that if she feels good and gets LOTS of exercise (even walking) between now and that flight, she should be good to go. I AM NOT A DOCTOR and I am not prescribing treatment. I'm just relaying what I would do in this position.

This is her call, sounds like, but good for you for being her support and helping her do research.

Is she on hormones?  They increase risk of blood clots too.  That was the first thing I got off of, months in advance just to be darn sure that I had one less risk.  They type of hormones are important as well because certain ones are more prone to blood clots than others.  

I have had back to back surgery, (appendix on the 5th, sinus surgery on the 7th) and I don't know that it made it any harder to recover, but two abdominal surgeries back to back might be.  I really think I might consider waiting a little longer on VSG if that is a possibility.  

I think they can prescribe blood thinners, but, that increases the bleeding risk during surgery and generally docs want you off blood thinners, asprin, NSAIDS, anything like that at least 2 weeks pre op. 

Besure and find out if she's taking hormones and if they're the kind that increase the risk!  Good luck!  Let us know how it goes!  These are great questions and I wouldn't mind knowing the answers.  

she deff should get up and walk frequently during the flight... and the med most freq used post op now is Lovenox... she would have to be taught to self inject (it goes sub cutaneously(in the fat) best place is the love handle) it's in the Heparin family which is much faster (has a shorter helf life) than coumadin... coumadin takes several days to build up in ur system and u have to get frequent blood tests to check levels... I would deff contact the surgeon in mexico and see what his feelings r but if they put her on lovenox and she gets compression stockings and agrees to walk around while on the plane, I would think they would be agreeable to it... good luck

Serious matter indeed. Good thing to talk to the surgeon and get their opinion on it... considering the problems she has had recently, my first thought would be to postpone the surgery from March 5 to maybe a month later, just to be safe. What if she gets to Mexico and has continued problems like she has been having and the surgery can't go on? Things to think about. Keep us posted on what you decide and what the surgeon says!

I can understand her desire to have the WLS but I think that her best course of action is to postpone it for a few weeks and talk to her DR in Mexico. No need to add risk to her recovery... I know 3 more weeks would be hard but in the long run what would it matter? It's more important that she go into surgery as well and healed as she can be. She will probably need the Lovenox shots post op and for up to 14 days afterwards but waiting will reduce the risk going in.
Will keep her in my thoughts/prayers
M

Thanks everybody.
Apparently she just got the Depo Provera shot on Monday!

Sometimes I wonder about the doctors. She told them she was scheduled for WLS in MX.
They warned her about the possibility of blod clots/flying after surgery.
Then they give her something that would increase her risk!

I have a request for a call back fromt the surgeon.

I'll keep you posted.
donna