There was no home health care barring once a week and my husband had to dress and pack the wound twice daily for 14 weeks apart from taking care of my infant son. He had to suffer severe strain because of this. Also because of mother baby separation and anemia during the first week of his life, my baby lost on a lot of precious breast milk. Entire trauma all caused loss of bonding and breast milk for my baby.
All during the hospital stay my baby was kept away from me in the hospital nursery and allowed only 2-3 hours per day for the first week of his life. Moreover he was discharged a day earlier and we had to make him sleep with us in the heart hospital room before I was allowed to go home. Any planning for baby no 2 definitely needs to wait a great amount of time due to the ongoing physical and emotional trauma
Friday 1 August 2008
Jan 17
All during the course, I was kept in bed with a Foley catherator and asked to lie absolutely still without moving my legs. Once it was determined that no PE or DVT exists, I was to be transferred to the OB floor on morning of Jan 17. The baby was discharged on Jan 17 mornings and it would have been easier for us to keep the baby on OB floor. However she does not visits me till late in the afternoon on Jan 17. At around 3.30 p.m. She arrives, removes the Foley and asks me to go home without checking if I am able to ambulate or urinate. I was only allowed to get out of bed once during these 7 days to bedside. When I expressed my hesitation and discomfort on ambulation, she leaves me in the heart hospital room and we had to make the baby sleep in the hospital bed with us because there was no bassinet available on the floor. I was discharged with continuous bleeding and indurations from the incision site and only hours after I was allowed to ambulate after 7 days in bed. She does not even visit me on the day of discharge (Jan 18). After that I had to visit her continuously for 14 weeks for wound care and treatment. Wound drained purulent thick bloody serous material for 6 weeks enough to soak 8 ABD pads per day and there was a big clot over the right hand corner of the corner of the wound. After 6 weeks the drainage changed to yellowish and continued for another 6 weeks. The wound was 13 cm long and an inch deep. I faced great difficulties in walking and urinating during weeks after discharge. Even today there is a 0.5 cm gap from where the incision closes to the point where it meets the rest of the skin.
What is coumadin
Coumadin is a widely prescribed blood thinner. At the request of the Food and Drug Administration (FDA), Bristol-Myers Squibb has strengthened its US label for warfarin (Coumadin) to include a black-box warning about the risk for major or fatal bleeding. It says that bleeding is more likely to occur during the starting period. Among others, the risk factors for bleeding include trauma, anemia and concomitant drugs
Coumadin label also reads that Coumadin is contraindicated with recent traumatic surgery resulting in large open surfaces. Potential adverse reactions to COUMADIN may include: Fatal or nonfatal hemorrhage from any tissue or organ. This is a consequence of the anticoagulant effect. Therefore, the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis. (Source: http://www.fda.gov/medwatch/safety/2006/coumadin_PI_april2006.pdf)
And yet I was given Coumadin following recent abdominal surgery (C section), in absence of any symptoms and inconclusive CT scan reports. And these were continued for next 5 days in spite of my repeated denial of all symptoms, bleeding from surgical site, drainage from c section incision, increasing anemia in spite of thrice a day oral iron, increasing WBC count on antibiotics, fever and complete wound separation.
The FDA Med watch announcement also notes that Coumadin prescriptions will also be issued with a new patient medication guide warning about potentially serious bleeding with the drug. FDA regulations state that such medication guides are to be provided with each prescription that is dispensed for products that the FDA determines pose a serious and significant public health concern. I was also not made aware of the possibility of bleeding on Coumadin.
Coumadin label also reads that Coumadin is contraindicated with recent traumatic surgery resulting in large open surfaces. Potential adverse reactions to COUMADIN may include: Fatal or nonfatal hemorrhage from any tissue or organ. This is a consequence of the anticoagulant effect. Therefore, the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis. (Source: http://www.fda.gov/medwatch/safety/2006/coumadin_PI_april2006.pdf)
And yet I was given Coumadin following recent abdominal surgery (C section), in absence of any symptoms and inconclusive CT scan reports. And these were continued for next 5 days in spite of my repeated denial of all symptoms, bleeding from surgical site, drainage from c section incision, increasing anemia in spite of thrice a day oral iron, increasing WBC count on antibiotics, fever and complete wound separation.
The FDA Med watch announcement also notes that Coumadin prescriptions will also be issued with a new patient medication guide warning about potentially serious bleeding with the drug. FDA regulations state that such medication guides are to be provided with each prescription that is dispensed for products that the FDA determines pose a serious and significant public health concern. I was also not made aware of the possibility of bleeding on Coumadin.
The next 5 days
The CTA was severely degraded by respiratory motion and inconclusive in its findings. At that point, based on equivocal report and in absence of any symptoms, heparin was started being fully aware that the patient has just had a recent abdominal surgery.. In the CCU, my HR stabilized during the night. Dr. Bajaj arrives next morning and instead of ordering definitive diagnostic tests, took the decision to start me on Coumadin and anticoagulation for a year and 5 days on heparin moving me to the heart hospital. Dr Bajaj also asks me not to breastfeed and says she will give me injections tomorrow to dry out my breast milk. This was after that fact that I denied all symptoms and insisted I was feeling fine. I was also not told that CTA was inconclusive and I was not allowed to see the report in the hospital and all requests for confirmation CTA were denied for 5 days. I was also not made aware of the possibility of bleeding on anticoagulants.
On Post Op Day 3, there was significant bleeding from the incision site and wound was opened with 4 staples. There was copious amount of serum and blood drainage (almost to soak fifteen to twenty ABD Pads and bed sheet completely) However still no definitive studies were carried and anticoagulation was continued. Also Dr Bajaj tells me that I should never have any more kids because of the severe PE I had. On Post-Op day 5 the entire wound opened up, again large amount of serum and bloody fluid was extracted from the abdomen. Again fifteen – twenty ABD pads and the entire bed sheets were soaked with blood. And anemia kept on getting worst in spite of oral Iron medication thrice a day. WBC count keeps on rising daily in spite of intravenous antibiotics for past 5 days. The wound which was superficial is now almost a centimeter deep. Still heparin and Coumadin are continued in spite of recurrent bleeding and repeated absence of any symptoms (chest pain, shortness of breath, leg pain, swelling etc ). I am also discontinued from telemetry saying that my tachycardia is due to anxiety and anemia. At that point I again requested them that since I am having no symptoms and I am bleeding and telemetry is being discontinued saying tachycardia is due to anemia and anxiety (And since tachycardia was only indication of cardiac consult) why don’t we order another CTA and see where we are at clots. But they dismiss me. On day 5 nights, I start running a fever due to loss of blood and weakness. However still heparin is continued. On Post op day 6 finally wound erupts and massive hemorrhage occurs. There was enormous oozing through gauze despite significant amount of pressure. I was on vitals every 4 hours and when nurse came to check vitals she saw me covered with clotted blood and gradually diminishing blood pressure. Since I was not on monitor even my falling vital signs were not detected. At that point five days late Doctor Bajaj finally orders a second CT scan, VQ Scan, and Venus Doppler study all of which rule out DVT and PE. At the end of 6 days finally she refers me to pulmonary doctor who rules out PE and DVT. On Day 6, Dr Bajaj tells me that we need to do a CTA to drain fluid from the abdomen and also because first was inconclusive so let’s now order a CT scan again and see if clots actually exist. It was determined that there was no PE or DVT and there was no evidence of PE or DVT ever, I was never required to be on anticoagulants.
On Post Op Day 3, there was significant bleeding from the incision site and wound was opened with 4 staples. There was copious amount of serum and blood drainage (almost to soak fifteen to twenty ABD Pads and bed sheet completely) However still no definitive studies were carried and anticoagulation was continued. Also Dr Bajaj tells me that I should never have any more kids because of the severe PE I had. On Post-Op day 5 the entire wound opened up, again large amount of serum and bloody fluid was extracted from the abdomen. Again fifteen – twenty ABD pads and the entire bed sheets were soaked with blood. And anemia kept on getting worst in spite of oral Iron medication thrice a day. WBC count keeps on rising daily in spite of intravenous antibiotics for past 5 days. The wound which was superficial is now almost a centimeter deep. Still heparin and Coumadin are continued in spite of recurrent bleeding and repeated absence of any symptoms (chest pain, shortness of breath, leg pain, swelling etc ). I am also discontinued from telemetry saying that my tachycardia is due to anxiety and anemia. At that point I again requested them that since I am having no symptoms and I am bleeding and telemetry is being discontinued saying tachycardia is due to anemia and anxiety (And since tachycardia was only indication of cardiac consult) why don’t we order another CTA and see where we are at clots. But they dismiss me. On day 5 nights, I start running a fever due to loss of blood and weakness. However still heparin is continued. On Post op day 6 finally wound erupts and massive hemorrhage occurs. There was enormous oozing through gauze despite significant amount of pressure. I was on vitals every 4 hours and when nurse came to check vitals she saw me covered with clotted blood and gradually diminishing blood pressure. Since I was not on monitor even my falling vital signs were not detected. At that point five days late Doctor Bajaj finally orders a second CT scan, VQ Scan, and Venus Doppler study all of which rule out DVT and PE. At the end of 6 days finally she refers me to pulmonary doctor who rules out PE and DVT. On Day 6, Dr Bajaj tells me that we need to do a CTA to drain fluid from the abdomen and also because first was inconclusive so let’s now order a CT scan again and see if clots actually exist. It was determined that there was no PE or DVT and there was no evidence of PE or DVT ever, I was never required to be on anticoagulants.
The First CT Scan
I am asked to get a CT scan. So I am given a thick needle to inject in contrast. In the CT scan department they ask me to sign a form and pump and dump my breastmilk. I refused and said I wanted to go. My husband is called and told that Prachi will go into cardiac arrest. Finally he agrees
This poor girl does not knows that she is suppose to hold her breath during the CT scan and thus becomes the start of trauma, pain and suffering that she is to endure for a long time to come
This poor girl does not knows that she is suppose to hold her breath during the CT scan and thus becomes the start of trauma, pain and suffering that she is to endure for a long time to come
The next day
12 hours later, I still havent slept a bit. I am still shocked that what was a normal pregnancy had a serious complication. Nurses ask me how long I had known about my low fluid. When i said only for 2 hours, they all look surprised.
Because of loss of birth experience and dehydration, my heart rate continues to ran high. Dr Bajaj arrives at 12.00 and says I need to talk with cardiologist. I refused but she said I have to
So I have a barrage of medical interventions, everything is normal. Viles of blood are drawn and I am fine, just more and more tired. I had been awake for more than 36 hours at that point.
Because of loss of birth experience and dehydration, my heart rate continues to ran high. Dr Bajaj arrives at 12.00 and says I need to talk with cardiologist. I refused but she said I have to
So I have a barrage of medical interventions, everything is normal. Viles of blood are drawn and I am fine, just more and more tired. I had been awake for more than 36 hours at that point.
Emergency C Section
So we go to L and D. My heart rate is in 100-110. I am so pissed with the doctor. Because mine had been such an uneventful pregnancy, I had never gotten to test the medical acument of doctor. They were all so routine and I believed that because I was visiting her regularly she would have discovered if something was wrong. Neither of us had lunch. They admit me and put in cervidil to ripen my cervix. Say they will start pitocin in the morning after 12 hours of cervidil. I call up my neighbor to go in from the garage door and get my bag and Cord blood kit.
Within the next hour baby's heart rate dips again. RN calls my OB. She tells me that OB has said we wont start pitocin and do a c section in the morning if cervix doesnt ripen but she doesnt comes to see me
They give me oxygen and ask me to sleep. 45 minutes later, several people rush to my room. Arnav's heartrate is in 60's. Dr Bajaj is called again and we had to do an Emergency C section
Me who wanted to go completely natural had to have a C section without even laboring. Me and my husband thank my stars that we didnt listen to doctor and left. I even shudder to think what would have happenned.
Within the next hour baby's heart rate dips again. RN calls my OB. She tells me that OB has said we wont start pitocin and do a c section in the morning if cervix doesnt ripen but she doesnt comes to see me
They give me oxygen and ask me to sleep. 45 minutes later, several people rush to my room. Arnav's heartrate is in 60's. Dr Bajaj is called again and we had to do an Emergency C section
Me who wanted to go completely natural had to have a C section without even laboring. Me and my husband thank my stars that we didnt listen to doctor and left. I even shudder to think what would have happenned.
The D Day
It was snowing. So me and Bharat decided to work from home. It was a 11 a.m. appointment and I was going to drive myself but because Bharat was home he came with me. Bharat was on phone with his coworker and I drove. We had shirts that needed to be dropped for laundry in the back seat. On the way we debated where to have lunch
Dr Bajaj did an internal. She told me I am still closed. She did some other tests, told me I am not leaking any fluid and she doesnt thinks baby is coming for next 5 days atleast. She also told me baby's head is in position. Asked me to dress and leave
I dressed came out but then I asked her can we do some monitoring. I think something is wrong, mother's instinct. She told me I am still nervous. So I go down, have coffee, and then she puts on monitor for 15 minutes. This turns for one hour. She then comes in and tells me go to Labor and Delivery. There have been two periods of heartdip.
We reach L & D. There we get a message we need to go and see perinatologist for an Ultrasound. The US was the quickest. She said she is going to induce me right away. Baby is only 5 pounds 10 oz and has dipped from 46% to 10% for his gestational age.
Dr Bajaj did an internal. She told me I am still closed. She did some other tests, told me I am not leaking any fluid and she doesnt thinks baby is coming for next 5 days atleast. She also told me baby's head is in position. Asked me to dress and leave
I dressed came out but then I asked her can we do some monitoring. I think something is wrong, mother's instinct. She told me I am still nervous. So I go down, have coffee, and then she puts on monitor for 15 minutes. This turns for one hour. She then comes in and tells me go to Labor and Delivery. There have been two periods of heartdip.
We reach L & D. There we get a message we need to go and see perinatologist for an Ultrasound. The US was the quickest. She said she is going to induce me right away. Baby is only 5 pounds 10 oz and has dipped from 46% to 10% for his gestational age.
My pregnancy
My pregnancy was the most beautiful time of my life. I had an extremely uncomplicated pregnancy, not a single instance of morning sickness. I did not miss a single day at work.
During my 7th month, my friends at work threw me a beautiful baby shower. Then my friends threw me another one later at home. Bharat's work also had a baby shower for him. So we had lots of cute gifts and we were all ready and excited. My weight gain was perfect, I glowed, had luxurious hair, and basically looked and felt lovely. I had not felt better in my life.
My prenatal visits were routine, hear the baby's heartbeat, check weight and be back.I had an Ultrasound on week 30 at which baby was measuring 3lbs 3oz and everything looked great
I planned on going all natural, so kept on eating good, exercising and had decided against the use of epidural
During my last month of pregnancy my coworkers and friends started commenting that I dont look pregnant. I believed them because apart from my jeans, I was still fitting in my all clothes, my gowns, sweaters etc. I asked my Ob about it. She told me everything is fine, baby's heartbeat is good and I am measuring correctly. Turns out she was wrong. My amniotic fluid was reducing for some unknown reason.
During my 7th month, my friends at work threw me a beautiful baby shower. Then my friends threw me another one later at home. Bharat's work also had a baby shower for him. So we had lots of cute gifts and we were all ready and excited. My weight gain was perfect, I glowed, had luxurious hair, and basically looked and felt lovely. I had not felt better in my life.
My prenatal visits were routine, hear the baby's heartbeat, check weight and be back.I had an Ultrasound on week 30 at which baby was measuring 3lbs 3oz and everything looked great
I planned on going all natural, so kept on eating good, exercising and had decided against the use of epidural
During my last month of pregnancy my coworkers and friends started commenting that I dont look pregnant. I believed them because apart from my jeans, I was still fitting in my all clothes, my gowns, sweaters etc. I asked my Ob about it. She told me everything is fine, baby's heartbeat is good and I am measuring correctly. Turns out she was wrong. My amniotic fluid was reducing for some unknown reason.
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