Previous Pulmonary Embolisms
Dear All, I am scheduled to have a DS with Dr. John Rabkin in San Francisco on August 3. I have had two previous episodes of pulmonary embolisms as well as a strong family history of them. My surgeon wants me to stop my medication (Warfarin) five days before surgery and then have a vena cava filter inserted to ensure that if any blood clots form, they will not be able to get into my lungs. My primary care doctor is adamantly against this plan and wants me to do a Lovenox bridge (another type of anti-coagulation medicine). It appears that there are two opposing concerns about my surgery that my surgeon and PC doctor are having, my surgeon is worried about my bleeding out during the surgery and as a result, will not operate if I am on the Lovenox, while my PC doctor is more concerned with the possibility that the insertion of the filter itself could produce tiny clots that could result in pulmonary embolisms and that i would die from that. Are there any other people on this site who have had to use a vena cava filter or Lovenox bridge for your surgery?
Dear All, I am scheduled to have a DS with Dr. John Rabkin in San Francisco on August 3. I have had two previous episodes of pulmonary embolisms as well as a strong family history of them. My surgeon wants me to stop my medication (Warfarin) five days before surgery and then have a vena cava filter inserted to ensure that if any blood clots form, they will not be able to get into my lungs. My primary care doctor is adamantly against this plan and wants me to do a Lovenox bridge (another type of anti-coagulation medicine). It appears that there are two opposing concerns about my surgery that my surgeon and PC doctor are having, my surgeon is worried about my bleeding out during the surgery and as a result, will not operate if I am on the Lovenox, while my PC doctor is more concerned with the possibility that the insertion of the filter itself could produce tiny clots that could result in pulmonary embolisms and that i would die from that. Are there any other people on this site who have had to use a vena cava filter or Lovenox bridge for your surgery?
this is just me,but I would trust my surgeon on his. He is the one who is going to have you asleep on the table,not your PCP.
I can't speak from personal experience, but I can say that in the 10+ years I've been here and on other websites, I've seen many other people write about having an IVC filter placed for this reason. I think it would be helpful to have Dr. Rabkin speak directly with your pcp. Otherwise, you will be stuck in the middle and nothing will change. Dr. Rabkin would be able to tell your pcp that he has done the IVC filter for just this problem many times and that it works and that his patients have not experienced "tiny clots" from the filter. And if they did, those tiny clots would not kill you, the way a large clot could. He could explain his concerns about the Lovenox approach. Hopefully they would reach an understanding, but even if not, this isn't a problem that you will be able to solve yourself.
Larra
Good!
And if that doesn't work, file a grievance with Kaiser. Even if you get a denial from Kaiser, that will vest your rights to pursue an external appeal and get reimbursed IF you win. If you lose, you are still stuck paying the 9K, but at least that gives you your best shot at having Kasier pay for this part of your care.
Larra
