Monday this week was the day I got my portacath inserted for the second time. It was my 4th general anaesthetic in the last 12 months. The last one I had was put in in December last year, but thrombosed up the IJV by February, after my 2nd round of chemo. This rendered my alternating arms as chemo targets for the remaining of the rounds.
This time they inserted the portacath on the left side rather than the right side, as the right IJV was difficult to visualise on my most recent CT scan. Interestingly, when we dressed the wound this evening, the insertion in the IJV is much higher up the neck than the last one. It will be interesting to see if this becomes an issue, because I’m already noticing the fact that it is pulling on my neck much more than the last one.
Anyway, the whole thing serves as reminder as to the path I’m about to walk down. It brings home the reality of the fact that I’m about to hit more chemo, and the next little while will at best, bearable, and at worst, miserable.
Heres hoping its the former rather than the latter.
I have now officially finished round 2 of chemotherapy. That makes 1/4 of the way through all 8 rounds. This particular round was land-marked by the incident of thrombosing internal jugular veins, and the surgery required to get my portacath removed. Apart from that, I would not say that this round has been any worse or any better than the 1st round. All the symptoms were more or less the same, the only difference being that they tended to kick in a little sooner and last a little longer, specifically the oxaliplatin induced neuropathy.
So now I get a week for my body to detox, before Thursday next week when it gets flooded with toxic chemicals again. I’d like to take the opportunity to thank all those who have helped recently with bringing over of meals etc. They have been really good particularly while I was in hospital, and also when I cant do much more than move from the couch, it means Hannah doesn’t have to cook all the time :-).
On the whole, I have to say that I’m not particularly looking forward to the next 6 rounds, but that is life, and I have to deal with it :-). Peace out.
I thought I would briefly explain what exactly the Internal Jugular vein is, and why I had problems with it.
The Internal Jugular Vein (IJV) is one of two major veins that drain the deoxygenated blood from the brain and head back down to the heart so that it can be sent to the lungs for oxygenation again. Each person has two IJV’s as well as two External Jugular Veins (EJV’s), and these are the main tributaries for blood to return to the heart from the neck upwards.
What happened with me was that my portacath, a tube that ran from my chest to the heart, makes it’s way to the heart by inserting in the IJV, then follows the IJV down where it joins the brachiocephallic (this vein drains the arm), which then joins the Superior Vena Cava, which then drains in the Right Atrium of the Heart. At the point of insertion into the IJV, this is where a clot started to build up. Clots generally can be caused by a number of things, but having foreign body in your blood vessel can be a cause, also, in my case, having cancer is also referred to a ‘pro thrombotic state’, as well as the chemo drugs I’m on [For the medical students: Capecitabine is pro-thrombotic, yet its dose-limiting side effect is thrombocytopenia.. any ideas?]. This all added up to a reasonable risk, one doctors and myself were willing to take, to causing a clot.
So the clot started, and once it starts, unless you take away the source of the clot, it will continue to grow. The major risks of having a clot there are mainly that fragments could break off, flow downstream and into the lungs, block off the lungs, which then stops me from oxygenating my blood and causing me to die from oxygen starvation. This is called a pulmonary embolism.
The portacath was removed with surgery to prevent the clot growing, and I was also placed on regular clexane injections in order to assist the prevention of further clot formation. The body will do the breaking down of the clot in its own good time.
And THAT is what last weeks drama was about! 🙂
So, I had the surgery last night, finally!!.. and this means no more nil by mouth dieting regime, which I am happy about. As of this stage, I’m yet to be discharged, but am currently at home because I manipulated the system to give me leave. I’ll be going back in to the hospital in an hour or so.
My portacath has been removed, and I still have a giant clot in my right internal jugular vein. The clot should hopefully slowly resolve over the next few weeks now that the source of it has been removed. This will be aided by the fact I have to inject myself twice a day for 2 weeks with clexane, also known as low-molecular-weight-heparin. After two weeks, the injections will continue once a day for about 3 or 4 months, or till the end of my chemo to help resolve the clot, and to prevent any further from occurring. The injection is just like an insulin injection, except way more stingy. The needle itself doesn’t hurt, its the stupid drug that causes local stinging for about 5 or 10 min after the injection.
So, at the moment, we are just waiting for the vascular team (again!!) to give me the all clear on the discharge. They weren’t projected to visit till sometime this afternoon, which is why we snuck home, so I could have a decent shower etc. In the mean time, I’m gonna be a complete cripple until this clot resolves. My neck is REALLY sore, so much so that I took morphine this morning to make it a bit more functional. I cant even get dressed without help, any sneezing, coughing turning of the head etc causes pain. Anything that may cause an increase of pressure on the carotid sheath, or the surrounding structures is bad news.
Also, apologies on the previous posts being out of order… it has something to do with the fact that I was posting them from my iPhone, it re-arranged them for some reason.
Quick update – I have now been dishcarged, so don’t have to go back into the hospital!! – Still a cripple though.