This morning (2024-09-25), after consulting with a vascular surgeon (with whom I had previously
not been acquainted), they had
granted my long-held desire to cease ingestion of the anti-coagulant known as warfarin (brand name: Coumadin). In the past (over a period of nine years), a number of physicians (including my main oncologist, and an unaffiliated vascular surgeon), had repeatedly denied my requests to end such treatment, with each stating something to the effect of:
"You will need to continue Coumadin treatment throughout your entire life." As of today, I am no longer required to intake said anti-coagulant (nor any alternative pharmaceuticals)! 'Happiness' does not even begin to convey my level of joy.
Background (lengthy, but 'fun'): Just over nine years ago, I had been diagnosed with a type of cancer. While admitted to a hospital, over the course of a week, I had received multiple chemotherapy treatments. With the knowledge that additional treatments would follow, but, in a clinical setting (rather than in-hospital), after being discharged, I had traveled (quite far) to visit with my ailing (though, relatively-young) grandfather (as I had believed that one, or both of us may soon assimilate ourselves with the planet). After meeting with him, I had felt as though I may have been suffering from the effects of hyperthermia. Shortly afterwards, I had begun to collapse (and had lost consciousness prior to striking the floor). A minute afterwards, I had felt my body being dragged across the floor... but, I had simply been too weak to muster enough energy to draw open the lids of my eyes. Apparently, I had been transported to the opposing side of the street (the location of a well-regarded critical care hospital). Over a short period of time, I had drifted in and out of consciousness (hearing had been nearly the only indication of this, as, usually, I had been too frail to utilize my sense of sight). There, multiple family members (whom previously had all been visiting said grandfather across the street) were told that I had experienced a 'saddle' pulmonary embolism (a massive clot which blocks the flow of blood to both lungs). They were asked to consent to the usage of tPA (tissue-type plasminogen activator, an incredibly-effective 'clot-dissolving' agent).
"It may cause death, but, without it, death is certain." They had agreed (I
know, how
very selfish of them
^_^). Eventually, hours later, in the intensive care unit, I had awoken to find that a rather uncomfortable endotracheal tube had been placed, and with my lungs receiving artificial respiration. I had learned that I had received cardio-pulmonary resuscitation (obviously, due to cardiac arrest) on three separate occasions (once in the ambulance, another in the computed tomography/CT scan room, and the last taking place in the intensive care unit). During this time, my arms had been restrained, as medical staff had been under the mistaken impression that I had been attempting to eject the tube (in reality, I had only tried to use my hands to make tactile contact with it with the aim of making a slight adjustment). After a day or so of repeatedly unbuckling the restraints, the endotracheal tube had been removed, and I had returned to a mobile state (which had alarmed the nurses). After spending ten days at this facility (the latter seven or so were only as a precaution), and having been provided with an open-ended warfarin/coumadin prescription, I had made the journey towards my home.
After having had only a few days to rest from that ordeal, another round of chemotherapy had begun. Two months would pass before I had been able to have my final session of treatment. Afterwards, my oncologist had recommended an intricate surgery to remove (at least) 57 lymph nodes (perhaps more, as there had been large residual masses). Prior to this surgery, in accordance with standad protocol for patients with a history of pulmonary embolism, it had been necessary to implant an inferior vena cava filter. After the implantation and a host of other tests had taken place (over a period of days), the operation had been allowed to proceed.
Soon thereafter, I had undergone said complicated procedure. Once I had awoken from the aforementioned surgery, everything had seemed fine, and I had been briefed on the success of the operation (meaning, there had been no additional need for further treatment via chemotherapy). However, immediately afterwards, I had noticed that my left arm had been disobeying my commands. It had felt as though it had been lying atop my torso, but, visually, it had clearly been placed at my side. In a calm manner, while using my right index finger to point towards my left arm, I had verbally notified the surgeon of this peculiarity:
"My left arm seems to be in a non-functional state." This had been very perplexing to them. Later, it had become known that during the awkward positioning of my body on the operating table, nerves within my shoulder had been damaged. Gradually (over a period of days), I had regained some of the movement of my fingers, wrist, and arm as a whole... but, there had been an intense tingling sensation within my fingers, along with weakness all throughout the limb. I had been able to lift items off of the side hospital bed table, but, I had been unable to gracefully lower my arm... it would simply slam down onto the surface. After spending a total of seven days in the hospital, I had been discharged.
During the two days that had followed, while at home, I had attempted to strengthen my left arm, making only slight progress (usage of a keyboard had been difficult). During the early morning hours of the third day (2015-11-20), I had felt very ill, experiencing pain within my abdominal cavity, accompanied by a high body temperature. Due to these symptoms, I had visited a local hospital. There, through the usage of a computed tomography scan, it had been determined that the previous highly-involved operation had resulted in the perforation of my sigmoid colon. After a number of hours, I had been transported to the hospital in which the surgery had been performed. There, I had undergone a bowel resection surgery, which resulted in a temporary colostomy (after a number of months this procedure would be reversed, operating under the assumption that my intestines were healthy enough). After this procedure, and, while receiving intravenous anti-biotics, my surgeon had been concerned with my elevated white blood cell count (from the infection caused by the bowel perforation).
Note: As a precaution (due to the infection) the large surgical incision had been allowed to remain 'open', in a non-stapled state. Another two weeks (in-hospital) would pass, with only faint whispers of the potential for discharge.
On one particular day (2015-12-03), a friend (whom coincidentally had been a nurse) had been visiting. I had practically implored her to stay and view a French film with me (for some odd reason, she had agreed). Approximately 30 minutes into the film, I had stated:
"I feel warmth spilling down my abdomen..." I had reached down to touch the area. Upon lifting my fingers away, it had been apparent that they were drenched with blood (and not the expected infection-related pus). She had immediately flattened the hospital bed, as I had weakly uttered:
"My vision is fading..." Quickly followed by:
"My hearing is fading..." At this point, I had lost consciousness (in my experience with multiple instances of near-death, hearing is
always the final sense to be lost). At a later date, I had been told that the following had occurred: During this episode, while the automated abdominal drain vacuum had exacerbated the problem by absorbing the free-flowing blood (causing the overflow of the contents of the connected cannisters... onto the floor), my friend had desperately attempted to locate the 'code blue' alert button (which had been hidden behind cabinetry). She had frantically ran into the hall towards the nurse station and had yelled that there had been a massive hemorrhagic event. Quickly, everyone had sprung into action, with a physician coordinating efforts to obtain and infuse donor blood (I had lost more than 50% of my total blood volume... an exact figure is unknown). It is said that between 20 and 30 people were working within this tiny hospital room, with
bloody shoe prints all throughout the hallway. Once I had been stabilized enough to be sent to interventional radiology, radioactive dye had been injected, with the purpose of identifying the artery of interest. The interventional radiologist had expressed bewilderment as the dye had "disappeared" at the location in which the left external iliac artery
should have resided. In a procedure, later relayed to me as being "non-textbook", two artificial arterial stents (composed of stainless steel and expanded polytetrafluoroethylene, as described
here) were joined in an overlapping configuration in order to bridge the gap from my left common iliac artery to my left femoral artery. This procedure had been successful. Apparently (based on the account of a certain well-versed party present at the time), after I had been re-located to the intensive care unit, due to prolonged lack of oxygen (worse than the three cardiac arrests occurring five months prior), it had been likely that
if I were to awaken, I would suffer from substantial neurological deficits. At some point (I do not remember this, as I had been heavily sedated with propofol), I had awoken, and had demanded (through the usage of my fingers, as I had yet another lovely endotracheal tube) a pen and an object to write upon. It is said that I had written messages, but, at this point, as my mental faculties were obviously intact, it had been decided to re-sedate me. I had been told that, I would absolutely not allow for anyone to remove the pen from my grasp... that is, until the propofol had taken effect. Evidently, my friends, family, nurses, and doctors were laughing hysterically at this. Upon witnessing my liveliness, some of my friends and family had wept in the hallway, as they were so relieved that, without question, I had
not suffered a hypoxic brain injury. Luckily, that same day, the endotracheal tube had been removed.
After a few days of remaining in the intensive care unit (even while experiencing a pulse nearing 200 beats per minute), I had been moved to a normal room. There, I had struggled to regain strength (as well as weight), and, of course, I still had my nerve-damaged left arm to contend with. Each time that I had been encouraged to walk, my pulse would soar, and I had grown weaker by the day. Eventually, a vascular surgeon (with a rather poor bedside manner) had casually entered my room (while some of my family had been present) in order to communicate the supposed urgent need for surgery to reconstruct my left external iliac artery (utilizing components sourced from a cadaver). They had threatened that the alternative is
amputation of the the entire left leg. My family members were sobbing, but, I had believed that the surgeon had simply been attempting to be emotionally-manipulative. On 2015-12-21, after an entire uninterrupted month, I had finally been allowed to return home. I would be receiving at-home medical care, as I still required intravenous anti-biotics. Vascular surgery had been scheduled... and mysteriously canceled.
Once home, I had instantly begun disassembling computers, and this had greatly helped to improve my mood, the tingling sensation in my fingers (but, this sensation did not fully disappear until a year afterwards)), and the strength of my left arm (as well as my body, as a whole). The second time in which the at-home nurse had visited, she had said that she would notify my physician that I no longer needed at-home care as I had been completely independent. Side note: I wholeheartedly wish that doctors would understand that some patients simply need to return to their home in order to properly heal... keeping them hospitalized may do more harm than good. After some time, from that which I recall, on two additional occasions, vascular surgery had been re-scheduled, only to be canceled yet again (for a total of three times). Later, in-person, I had spoken with the vascular surgeon whom had been selected to perform the operation involving the recontruction of my left external iliac artery (thankfully, this had not been the same physician as the one whom had visited my hospital room). I had respectfully asked for the reasons as to why the surgery had been scheduled and canceled multiple times. They had been refreshingly-candid, answering with something to the effect of:
"My superior - the one whom you had previously met, had been pressuring me to perform this surgery, but, I had felt that you were doing so well. At this point, I would only be harming you. Six (including myself) out of eight vascular surgeons were opposed to operating upon you, while my superior had been one of the two whom had been in favor of having the surgery. It was definitely not an easy matter to go against my boss, but, your stents had been holding. In operating, I could truly injure you."
After four months had passed (2016-04-06), I had been able to have my colostomy reversed. By this time, only my left thumb had been experiencing the tingling sensation. Also, I had been able to switch to orally-administered anti-biotics. Anti-coagulation (through the ingestion of warfarin/coumadin) had unfortunately still been necessary (as multiple physicians had feared a recurrence of pulmonary embolism). Why is this a problem? Via laborartory blood draws, one must have their international normalized ratio checked every few weeks (at times, more often). As it is a vitamin K antagonist, one must limit intake of foods high in vitamin K (such as kale and spinach) and/or consistently consume the same amount (which may necessitate a higher warfarin dose in order to counteract the effects of vitamin K). Also, bruises form easily, and warfarin causes delayed wound healing. Of course, there is also a risk of uncontrolled internal bleeding.
Once in a while, I would politely request alternatives to warfarin/coumadin, but, year-after-year, by each doctor, it had been stated that treatment must continue for as long as I live (which, at this rate, as all of this had begun while I had been of a rather young age, might be an additional 80 years... ugh!). In the latter portion of July of this year (2024), as my original oncologist had retired, my care had been transferred to another. During this initial meeting, they had been quite receptive to my request regarding potentially ending anti-coagulation treatment. Still, they had felt that I should be referred back to a vascular surgeon. Luckily, the vascular surgeon (whom I had only just met today) not only did
not mention the possibility of amputating my left leg, but, had also shared my belief that the the previous saddle pulmonary embolism had been provoked by a combination of cancer, chemotherapy, and prolonged immobilization (during the first week of chemotherapy in which I had been mostly confined to a hospital bed). After all of this time has passed, I have now been bestowed with the gift in which I had sought!
This is one of the happiest days of my relatively-brief existence. Tonight, unlike the prior norm, I will
not be ingesting warfarin!
(^_^) I apologize for the
extremely long post.
Edit: Inserted missing word, and had corrected a date (2024-04-06 -> 2016-04-06). Fixed quote formatting (blank initial line).