We are at the UW Madison Hospital today morning.
Jitish gets his IVC filter taken out today. We are nervous. But Jitish looks completely composed. Restless even, wanting to just get it over with. The Doctor comes in and explains the procedure and the risks associated. My heart is racing. Jitish looks nonchalantly and urges the Doctor to speed things up. Amma and Atchan have their prayer books out and praying. Jitish prays with us as well. It is amazing how he has learnt and chants complex versus of the prayer.
The IVC filter is the gatekeeper. Blocking the blood clots from travelling to the lungs and heart, Keeping Jitish safe from the threat that the Deep Vein Thrombosis (DVT) poses. The IVC filter rests just below the Kidneys in the Inferior Vena Cava, the vein that carries blood back into the heart and lungs. We were fortunate that the teams placed the filter when the first small blood clots emerged in May of 2015. The pulmonary embolisms could not have been stopped by the filter, they were too small for the filter to catch. But in the worst case that a DVT forms, a filter would catch larger clots. Clots than can be fatal. We faced the worst case. Jitish had a DVT. But we were lucky to have agreed for an IVC filter placement. The benefits of having a filter outweighed the risks it posed.
Over the months and this whole year, his body has been reabsorbing the clot, with the help of a lot of blood thinners. Heparin, then Coumadin, then Lovanox and finally Xarelto. With increase in activity and movement, the body could break down the clot. Blood thinners were his only solution at the time. He was not stable enough to surgically take out the blood clot. They recommended Thrombolysis, a clot busting surgical method to super charge the body into breaking the clots down over several hours instead of months. The risks were too high.
Today, the IVC filter finally comes out. Jitish’s activity level is admirable, the DVT has resolved. Having the filter longer than required could instead cause clots to form because of it. The risks of having a filter have now become higher than the benefit of having it. Off with the filter then!
The removal of the filter is a surgical procedure. The first method, a standard, is done with an incision in the neck, a catheter travels through the Superior Vena Cava, until it reaches the filter and lassos on to retreive it. This can take anything between 10 minutes to a couple of hours. We are hoping it is easy, quick, and safe. The legs of the filter tend to bore into the walls of the vein, causing scar tissue formation that could make the removal challenging. Not impossible, but challenging. Jitish’s vein has become narrower, and they think the procedure might take longer than 45 minutes. We are hoping the best case scenario is the actual case scenario. The alternatives seem a lot more invasive, time consuming and risky. The risks are low, but present. Risks of the arms of the filter breaking off and migrating to other tissues, organs or bones.
We are praying this is not needed. So does Jitish. No risks. Clean and simple.
He is so brave. But not yet aware of what is happening. I walk alongside as he is wheeled to the operating theatre. I can’t get over how normal he looks. He looks like himself again. But how pictures lie. It is tough to see how nurses and doctors realize after the initial conversation of the effects of the traumatic brain injury. He looks a lot more present today. Knowing it is a surgery. Of some kind atleast. He is focussed. Taking everything in. Asking the staff and doctors their name. Memorizing.
I am now waiting by my phone, in the waiting area with my parents, to hear that the surgery went well and the filter came out safely.