Healthcare Providers | The Patient's Path

In yesterday’s post, I gave a brief summary of the medical challenges my mother, Marie Bond, has faced this year and described a procedure she was having yesterday for arterial disease. Here’s an update.

Yesterday, my mother had a right femoral angiogram, angioplasty, and insertion of a stent to increase the blood flow to her right leg. Access was by way of her left brachial artery, through the aorta, and down to the right femoral artery–a long way around from the left arm to the right leg.

The procedure was done fairly late in the day, but went well. Last night, she had to go back in the OR because of a hematoma at the insertion point in her arm, mid way between the elbow and shoulder on the inside. She takes Plavix (clopidogrel) and baby aspirin, both blood thinners (anticoagulants) used after a heart attack, and evidently hematoma formation (pooling of blood) is a common problem because blood pools in the wound area. The procedure to clear it up also went well, although they transferred her to the ICU instead of to a regular room. The original plan was to send her home today, but we’re still waiting to hear.

I just talked to my mother on the phone, and she sounds a big groggy from the two twilight anesthesias yesterday. Otherwise, she sounded good and said she felt fine except for her left arm, which is swollen and sore. The doctor checked her pulses and said they sounded great–in both legs. Apparently improving blood flow in one also has benefit in the other.

My mother is in a suburban Pennsylvania hospital that we’ve all been pretty impressed with, and she seems to have found a very good vascular surgeon.

So we do have things to be grateful for, even though we don’t quite know what our Thanksgiving will look like on Thursday. . . .

My Current Story, Continued – da Vinci Hysterectomy Scheduled for Friday, December 13

As I mentioned in the November 22, 2013 post, which really wasn’t much about me and was mainly about healthcare delivery and reform (it has important links–take a look), I need to go for my medical clearance visit with my family doctor today to prepare for the hysterectomy in 18 days (see the “My Current Story” posts and updates). Last week, I received three phone calls from her office about today’s visit after getting conflicting instructions about whether I had to fast for the blood work–I was given alternating yes and no answers, depending on whom I spoke with. I decided not to take chances and started fasting after breakfast this morning–you need to stop eating and drinking everything but water for 8 hours to be considered fasting, so I should be OK for the 4:00 PM appointment.

Medical clearance by a family doctor includes a brief physical examination; blood work (which is good for 30 days), including a complete blood count (CBC) and a complete metabolic profile (CMP–this is why I have to fast); urinalysis (UA); EKG (which I had done in October before the D&C and is good for six months, so that’s one less thing needed today); and a chest X-ray (which will be good for one year should I–heaven forbid–need another procedure). During the visit I also need to discuss when to stop taking prescription medications before the surgery.

I wish doctors would take a few minutes to educate their staffs about such simple matters as office-visit preparation, but maybe it just doesn’t occur to them (?). I’ll mention it, gently, when I see my doctor today.

Now, I have another story to tell–or at least to begin. This one is about my mother.

P.S. During my visit with the doctor this afternoon, I mentioned the confusion about fasting. She said you never have to fast for pre-op blood work and that a nurse probably told the receptionist I had to fast because glucose level is part of the testing. But the fasting was not in vain because she was also able to test my lipids (for cholesterol) so I don’t have to go back for that in two weeks, when I will be otherwise occupied. Also, I called the radiology center at 1:15 to try to get a walk-in appointment for my chest x-ray at 3:00 and did. So the appointments today went very smoothly for me. And I was grateful for that and for my family doctor, who is new to me (and young!)–she showed the right combination of professionalism and concern.

But things didn’t go quite as smoothly for my mother, as I will describe in tomorrow’s post.

My Mother’s Long Story, Ongoing – Procedure for Arterial Disease Scheduled for Today

Last March, my mother, Marie Bond, had a heart attack, for which she had cardiac bypass surgery. I will discuss heart disease and treatment in a future post–a very important topic.

But this was just the beginning of a very tough year for her. She had a major complication following surgery–not with her heart, which did fine, but with a MRSA (methicillin-resistant Staphylococcus aureus) infection in her feet that she had picked up in one of the medical facilities. This went undiagnosed for a few weeks. I will also be discussing this insidious problem in a future post.

Fast forward to June, after the MRSA had finally been identified and was being treated–but wasn’t healing, and my mother needed an urgent appointment with a vascular surgeon for poor circulation in her right leg. He found no pulses, which is why the MRSA infection wasn’t healing in that foot, and he also said she was in danger of losing her leg. She had known peripheral artery disease (PAD) that had gotten worse. I will also discuss this serious problem later.

The surgeon performed an urgent right femoral-popliteal bypass graft using a vein from the same leg and also a femoral endarterectomy to remove the plaque buildup in the artery to restore the blood flow in her legs and feet, which was successful. (Apparently, she obtained some benefit to her left leg from the surgery on her right leg.) Over the following months, she slowly got stronger. But she needed repeated visits to the Wound Care Center for an open, unhealed area in her groin and for the MRSA that was slowly disappearing from her feet.

Recently, she had an ultrasound to determine how good the blood flow to her leg was. It wasn’t. She saw the surgeon again last week, and today he is scheduled to do a right femoral angiogram, angioplasty, and insertion of a stent by way of her left brachial artery–a long way around from the left arm to the right leg, but he can’t take a chance on reopening the groin wound. The procedure should take about 1 1/2 hours. If all goes well, she will be in the hospital just overnight. Her left arm will be sore from putting the stent through it, but she should be OK to go out to Thanksgiving dinner with us on Thursday.

Thanksgiving 2013

This will be an interesting Thanksgiving. I usually have dinner here, but this year I’m giving myself a break. Next year, all the fancy linen and dishes will come out, and we’ll have a house full of people to celebrate with. And I won’t mind wrestling with the turkey at all (as long as there’s wine–I can wrestle with almost anything if there’s wine).

In the meantime, we do have things to be grateful for–including the medical interventions that are saving our lives. And my son, Matt, will be coming from Boston to join my husband, Farok, and me, along with my mother and her 91-year-old sister, Cecilia Braddock–who also has heart disease, but is doing well. It is worth noting that their mother, my maternal biological grandmother, died of heart diseas eat the age of only 42. My mother was still a baby at the time.

Look for an update on my mother soon, as well as more information about her various medical challenges–these problems affect so many people