Yesterday I went for my pre-op appointment at the OB and was, as usual, kept waiting for an hour. When she came into see me she basically talked me through the c-section process (nothing new to me). I asked her about getting out of bed and established it would happen that day (good for clotting reasons) and then we began to talk about anticoagulation.
Obviously when I had Dylan I had a pulmonary embolism and that's what we need to avoid again. I take currently anticoagulants to keep my blood thin, and I will again after the birth. The problem is the surgery itself is the high risk period, and you can't be anticoagulated during it or immediately after it because of the risk of bleeding, so you end up playing the odds and hoping that you get it right.
When I had Harry, they had me on a drug called Fragmin which is a Low Mollecular Weight Heparin, it stays in the system 24 hours, and I was on a low dose before the birth, stopped 24 hours ahead of surgery, and then started again 12 hours after. 24 hours after they upped the dose to a large dose.
This time, I've been on Lovenox, which is a similar drug to Fragmin, but they had me stop it a couple of weeks ago in favour of 'regular' Heparin. You can't take regular Heparin for too long as it fucks your bone density up amongst other things, but the benefit of it is that it is reversible and it lasts only 12 hours in the system - so this is preferable for pregnant women at the end of pregnancy.
The plan they had for me was to continue the Heparin until the night before the surgery, then have the surgery, make sure I get out of bed ASAP, use antihrombophilia stockings while in bed, then start on Heparin again the evening folloiwng the surgery for 36 hours, at which point I go back onto the previous low dose of Lovenox. With me so far?
Yesterday I expressed some concern to the OB that the dose of Lovenox was nothing like as high as that I'd taken of Fragmin, and when I'd taken Fragmin I"d not had a pulmonary embolism so could we discuss because I'm nervous of making sure we avoid one again. She ended up calling the pharmacy and getting all the equivalents so that we could figure it out, and she came back and told me ok, the dose I am meant to be on (60mg) is low, the max dose for me is 200mg, so we could do 200 or 150......... but that both of those are a little higher than the Fragmin was, so obviously the risk of bleeding for me is higher again. I suggested how about we compromise and do 100mg, and she agreed. So that's the plan. But now I'm fretting a bit because to be honest what the fuck do I know about this and she's allowing me to self medicate?
Then what wound me up was that she was still dithering over the date for the c-section. For ages it has been set to Thursday 28th June at 5pm but the other week she told me she wanted to change that because she had her kids birthday party (!!) . She told me they'd try for Thursday at 9am instead, which would be OK with me, but you can only find out a week before. Anyway then yesterday she tried to bullshit me saying she had a 'important engagement' (obviously forgetting she had told me the real reason) and that it absolutely could not be at 5pm and that she was also looking to different dates now too. This really wound me up esp. as Dad & Sal are coming over specifically to look after the boys, and booked their tickets around this date....... and to be honest the longer Harry gets with them before I go into hospital the better because he has to get used to them before being abandoned by his parents for 2-3 days, and if they were to move the date forward he'd have very little time to do that!
I left, frustrated, and had to go to the lab to get blood work done where this rubbish phlebotomist stabbed me multiple times in veins I told her never worked before finally getting the right one, so of course now my arm is covered in bruises.
Anyway - this afternoon I had a call from the OB and she has confirmed that we have been assigned the 9am slot on Thurs 28th so we are definite and a go for then, and I'm much relieved!!
Now just have the blood clots to worry about and the health of the baby which has started to plague me with concern the nearer we get, will she be OK, etc.......!!
See if they'll let you self-medicate when it comes to narcotics :-)
Posted by: Steve at June 22, 2007 09:08 PM