Over the last 24 hours Penny's leg has continued to "inflate" and is now feeling quite heavy and can be painful if she isn't careful. In addition, she has some numbness in her other leg and some edema elsewhere as well.
Heparin-and-wait. The initial treatment plan was IV heparin to stabilize the clots and prevent new clots from forming while we wait for the clots to be dissolved and reabsorbed. The plan was to transition to oral blood thinners after 72 hours or so, and then to be discharged.
Thombectomy. Earlier today we had a conversation with the oncology team and then with interventional radiology. We have decided to do a thrombecotomy to remove the most problematic of the clots. It's located in the iliac vein, just below the inferior vena cava (where the two illiac veins join together to form a very large vein that runs from there to the heart). At the same time, a stent will be placed in the vein. The procedure isn't completely risk-free, but if successful it should (a) help speed up recovery from the current episode, (b) reduce the risk of permanent damage to the vein, and (c) help prevent a recurrence. The likely cause of the clotting is cancer pressing on the veins which restricts the flow rate and makes it easier for clots to form. The stent should help the vein "push back" against the cancer.
This procedure is scheduled for Friday morning, but could be moved up if there is an opening in the schedule before then. We've heard different things about recovery, ranging from a possible stay in the ICU for close monitoring to the possibility of being discharged later the same day.
While we're at it. Penny has been experiencing some discomfort with the GJ tube the last few days, and the scans done to look for clots showed that the tube is functionally, but not optimally placed. They had planned to replace the tube today, but now will combine that with the thrombectomy on Friday so that they only need to use the IV contrast (which Penny is allergic to) once.
Another ultrasound. In an hour or so, Penny will have an ultrasound of the "skinny" leg to check for clots on that side. We get the impression that clots in that leg are not likely, or at least not likely to be particularly problematic, but given her new symptoms and presence of clots elsewhere, they would like to see what's going on.
Waiting around. If the schedule holds, the next couple days will be mostly waiting around (either walking or with legs elevated) for Friday. Compared with other hospital visits, Penny is feeling much better. No nausea, not too much pain, and the best appetite she has had in some time. She finished another knitting project today. It's nothing like home, but so much better than severe pain and nausea.
Comments
Mary Hulst: Praying that all the procedures go smoothly and the recovery is fast.
Laura DeHaan: Thanking God for Penny's increased comfort and praying for a quick resolution with her clotting.
Scott Vander Linde: Praying for you both!
Stacey Wieland: Praying for you, Randy and Penny! Sending love to you both!
Pamela Plantinga: Praying that Penny continues to feel better, and that the procedures are straightfoward, without complications, and that they do the job they are intended to.
George Monsma, Jr.: Thanks for the update. Continuing to pray, now for success for the surgery, and for an opening before Friday.
Alisa Tigchelaar: Thank you for letting us know what specifics to hold up in prayer, Randy. So glad that dear Penny is able to knit. 💗
Glen Boer: I'm glad they figured out what's going on and have a good plan... We will be praying for you as always and say an extra prayer Friday for the Surgical team and the surgery...
Marie VanderLinde : Grateful Penny is feeling good enough to knit, praying for uncomplicated removal of clots. Remembering all of you daily!