Lovenox

Today I had to give myself two injections of Lovenox, one in the morning, and another in the evening. Just finished the second. The morning's injection site is nastily black and blue. I don't know if it's because I mucked it up (wouldn't be surprised, since I've never done this before and had nothing to go on but the printed instructions -- in particular I do not have a steady hand) or if this is normal. The instructions require holding a fold of skin of the belly while giving the shot, so that the syringe has to be manipulated entirely with one hand -- and no prior practice.

Tomorrow I have to give myself two more, one in the morning, and one at night. And then Wednesday I go in for my operation: a pulmonary vein ablation, to correct my atrial fibrillation. The operation (according to my cardiologist) has a 75% success rate, and a 1% complication rate. In other words, it's pretty safe, but one in four get no benefit for their trouble. If I disappear from PC you'll know I'm enjoying a cool one on the slopes of the beer volcano.

It will be a few months before I know if it was a success, unless I'm dead, in which case I won't know anything. It takes that long for the scar tissue to form, which will, in the hoped-for outcome, block the signals that are causing the a-fib. I don't care whether anyone wishes me well, or prays for me, or "sends me good vibes" because none of that is going to matter. What matters is how well my cardiologist does his job. And he is supposed to be the best in the region at this operation. It also matters if my a-fib is actually originating in the pulmonary veins or not. It most often is, but they have no way to tell.

Needles hurt. I just told myself that if I can jump out of an airplane, I can overcome my fear of the needle. I'm also getting scared of the operation itself. Not as scared (yet) as on Mt. Fear, or the keyhole route to Kokanee glacier. But it's still a day and a half away. When I went to prison I didn't really start to get scared until the night before I went in. Just as well I'm not planning to drive to the hospital.

 

<div class='quotetop'>QUOTE(efusco @ Feb 5 2007, 08:13 PM) [snapback]385888[/snapback]</div>

My understanding is that there is a risk of a clot, either from the operation itself, or if my a-fib becomes serious during the three days I am off Norpace prior to the operation. Apparently people who are on Cumadin, to prevent clots due to the a-fib, have to be taken off the Cumadin prior to the procedure. However, I was not taking Cumadin, because my a-fib was not that serious. So I was on 81 mg of aspirin instead.

The Lovenox instructions say not to take aspirin with Lovenox, but my doctor's instructions, transmitted via his nurse, were to continue the aspirin. On the morning of the operation I am to take no medicine at all.

<div class='quotetop'>QUOTE(fshagan @ Feb 5 2007, 08:14 PM) [snapback]385891[/snapback]</div>

In very extreme cases, they will kill the A/V node (?) which would stop the heart entirely. Then they have to implant a pacemaker. But that's a much more drastic procedure than I am to have. And I don't need an implanted defibrillator because my a-fib starts and stops all by itself. The problem is that I cannot exercise while I am in a-fib, and that's drastically impaired my quality of life for the past year.

In spite of the relatively poor success rate (75%) I'd actually much prefer to do this, and have the chance of an actual cure, then get a pacemaker and have to wear it for the rest of my life, with a periodic operation to replace the battery, and all the worries about x-ray machines and cell phones and metal detectors and microwave ovens disrupting it.

<div class='quotetop'>QUOTE(Godiva @ Feb 5 2007, 08:15 PM) [snapback]385893[/snapback]</div>

The Lovenox has to be injected into fat. Apparently it's painful if injected into muscle. However, I am no less creeped out by the idea of thigh injections than belly injections. Otherwise, the instructions are as you describe. The hard part is handling the syringe, and pressing the plunger, all with one hand. And the mere idea of the needle. And the fact that I cannot look away, as I do when a nurse gives me a shot or draws blood. Fortunately, the needle is only half an inch long and extremely thin.

 

<div class='quotetop'>QUOTE(Godiva @ Feb 5 2007, 10:35 PM) [snapback]385941[/snapback]</div>

I think the buttock is muscle. Anyway, I think I have to see what I'm doing.


<div class='quotetop'>QUOTE(Wildkow @ Feb 6 2007, 03:08 AM) [snapback]385959[/snapback]</div>

Thanks for all the info. The bruise is about an inch by 3/4 inch, and is not hard. So no problem, and last night's injection did not bruise. In half an hour I do this morning's.

The "love handles" is where they tell me to inject. (That's what I'm calling "belly.") The syringes are stored at room temperature, not in the fridge. They say to hold it like a writing pen, but I think I'll try your method.

I think the reason they want me to keep taking the aspirin is that with this procedure there's more risk of a clot than of bleeding. There's no internal cutting. Just the penetration at the insertion sites, and the penetration of the heart wall. But there is risk of knocking a clot loose as they thread through the veins. This is all speculation. I will double-check with them, and I'll inform them at prep of all my meds, including the aspirin.

Again, there's only a 1% chance of complications, and most of those are treatable. The chances I'll keel over are much smaller than 1%. And except for the a-fib and about 15 lbs of excess fat, I'm in very good health. Chances are I'll be back on here Thursday or (if I'm too groggy Thursday) Friday. Or soon after that if for any reason they have to keep me longer. When I had my prostate operation they kept me one extra night because I had nobody to look after me at home.