Setback

Last week I was brought in to hospital with a pulmonary embolism (blood clots in lungs).

Now that the scary part is dealt with, I am worried about my bariatric candidacy.

I just met the surgeon a week and a half ago.

Will they kick me out? Can someone with clotting issues have the surgeries?

The doctors can't find a cause, I have no risk factors other than obesity and birth control (which I'm told is a small risk factor).

Thanks

(In my extensive readings prior to surgery the only contraindications I found were:)

- Absence of effort to lose weight following an appropriate non-surgical medical program.

- Psychotic disorders, severe depression, personality disorders.

-Alcohol abuse and/or drug dependencies.

- Life-threatening diseases (in a short term).

- Patients who are unable to care for themselves or to participate and conform to the required long-term medical follow-up.

- Patients in very high or unacceptable anaesthetic risk.

(I also found that:) There is strong evidence that obesity is an independent risk factor for DVT and PE. Bariatric surgery is proven to be an effective means in the therapy of morbid obesity and its related co- morbidities, thus its prevalence is rapidly increasing. (Which means a PE related to obesity would be another reason to undertake a surgical option to reduce weight and further PE risk)

(Bariatric Surgery, RNY) is performed as a single stage procedure (which reduces the risk). (Although) The risk of VTE in patients undergoing elective bariatric surgery is high, (and why we go home on anticoagulant injections) attributable to obesity, intraoperating factors... Overall incidence of VTE in this population is reported to be 1-3%. Diagnosis of PE postoperatively in obese patients can be difficult due to physical limitations and consequently may be underdiagnosed. (But having the history may not be underdiagnosed in your case). Furthermore, although VTE is usually diagnosed as immediate postoperative complication, PE can occur in nonhospitalized patients, within the first month after surgery, despite pharmacologic prophylaxis.

(But that said, you would already have had a pe (very scary for you and your healthcare team) but it is a risk factor that they need to factor into your need for surgery to reduce your risk and to make sure you gat adequate anticoagulation prior to surgery and to monitor your factors and assess the right timing of anticoagulants stoppage and restart after surgery.)

(maybe messy to read, but the brackets are my two cents in and the balance it in brackets is from link to the article I read on DVT and PE in obesity and bariatric surgery. I would definitely make sure dr Klein and anesthesiologist and medical clearing doctor are aware and let them know you have done your research and ask the risks and how they would address them - in my humble opinion but I am a patient just like you, it is another reason to have surgery to lose the weight)

Paper reference below:

http://cdn.intechopen.com/pdfs/32202.pdf

This is something to discuss with your medical team. Most likely you will still go through with your bariatric surgery, but be on medication for blood clots.

Wow, that is scary! Glad you are doing ok.

My Dad had a leak in one of his arteries about 7 years ago, and discovered he had blood clots in his lungs, and the following day a clot in his arm, which he had to surgery on. He is doing well, and all recovered, but has to be on warforin (might be spelling that wrong) for the rest of his life.

Did they test you for any gene mutations? Although, with my Dad it was not the major factor of what happened to him, he does have a pro thrombin gene mutation, which makes his blood a bit thicker. And thanks to genetics so do i.

I have never had clots, but I had to do three weeks of blood thinner injections after my surgery. So having past clot issues I don't think will be a factor; however I do wonder if you still have the clot in your lung and your using blood thinners to slowly dissolve it (which is what the course of treatment was for my Dad...he had several though, took about a year for all of the clots to dissolve) whether they may wait or not until your blood clot has dissolved?

Talk to you medical team, only way to know.

Good luck!!

It might be a blessing in disguise as they can take extra precautions for you during surgery. My surgeon had me take Vit. K 3 days before surgery to prevent blood clots. We all like to be as helpful as we can but I don't think any of us are doctors so I would call your surgeon / medical team to talk to them about it.

Good luck!

Thank you all for your replies.

Of course I will chat with my team etc., but knowing it's not necessarily a hard NO is reassuring.

If I have to defer a few months I will be crushed but will keep on trucking. All the more reason to lose weight.

The clot was caused by birth control - the NuvaRing. I started it two months ago because of the bariatric program, actually.

At least I dropped about 10 lbs in hospital. Not the ideal way but hey, I will take it.