Pass the Diet Coke, please!

TJ passed the video swallowing and can eat and drink without restrictions and without danger of an aspiration pneumonia! The first thing I did was pour a diet coke on ice- he has several more lined up against his window to keep them somewhat cold. He really does not usually drink all that much diet coke- a 12 pack can last a long time around home, but he has been so dry it is what he has been craving. I left him with a lot of ice water as well.

The doppler of his arm showed no change in the clot. The doctor explained that some swelling may reoccur as one of the vessels in his arm is almost completely occluded. He will be on blood thinners for a long time. He is pretty exhausted with the therapy schedule, but making great progress! He was not, however, impressed with the counting money exercise in OT today.

My apologies with the lateness of this entry. A dear friend and her son came over to move furniture and clean to make room in what has been TJ's study to become our temporary bedroom. We have a splint entry home so if we left the bedroom where it is he would have to do a lot of stairs. Friday is the day they do "rounds" (or a care team meeting) on rehab to discuss progress and determine an estimated time line for discharge. I am working to be ready with the rearrangement at home by Monday or Tuesday at the latest!

Oh yeah, one more big item- the beard is growing back quickly. I really do love his beard as long as I don't have to try to trim it!

Many blessings and much thankfulness.

Q & A About the Clot

Somebody Asks:

I have a medical question, more for your consideration than for my needing to have an answer. I apologize in advance for the length of this. A little background first: My daughter had Thoracic Outlet Syndrome last year which basically was a clot in a vein in her right shoulder caused by compression of the vein. Because of this I think about TJ's clot issue.

For my daughter, they very aggressively tried to dissolve as much of the clot as possible within a week of the first occurrence. After that she was on Coumadin for a number of months.

So my questions ...
1. My impression is that the longer a clot remains the more it tends to adhere to the vessel wall and become permanent. Are they concerned that the clot has been there so long that it will be difficult to get rid of by dissolving, which could possibly lead to permanent issues for TJ's arm if no other method for eliminating the clot is recommended?

2. Is the clot in a vein or an artery? My daughter's doctor said that arteries are very sturdy and can be operated on successfully much easy than a vein can, at least in my daughter's case. I just ask this if they consider a surgical method of clot removal.

1. The doctors haven't indicated at this point that they are worried about it becoming permanent, and haven't been taking action that would suggest that they are worried about it. The good news about it adhering more strongly is that it is less likely to break up (see the next answer). However, I can't answer this question beyond that.

2. The clot is in three veins, one in his right arm, his right jugular*, and his right sub-clavian vein. Both the jugular and the vein in his right arm dump into the sub-clavian, much like two rivers coming together. From there, the sub-clavian goes into the Superior Vena cava vein, which goes straight to the heart's right atrium, which pumps the blood into the right ventricle, which sends the blood to lungs, and then back to the heart.

The significance of this is that if the clot breaks loose into pieces instead of dissolving it goes straight to the heart (in seconds). If that does not cause a heart attack the piece continues to the lungs which can cause a pulmonary embolism, which can also cause sudden death (or lesser symptoms). And if there still are no problems it goes back to the heart. Hence, having it adhere strongly to the wall is a good thing at this point.

No one has discussed whether a surgical operation is possible at this point, the need for it has yet to arise. The difficulty is (as I, the non-medical understand it) is that they usually go in through the sub-clavian for such operations, exactly where the clot is, which could limit options.

Below are some illustrations from Gray's Anatomy of the Human Body (20th Ed) from 1918. This edition is in the public domain and so can freely and legally be redistributed. Handy, as human veins haven't moved in the last 90 years...


These show the path the blood takes (all downward), and should give you an idea of the size of the clot.

*Technically you have multiple jugulars, right, left, internal, external, anterior, etc. TJ's clot is in his right internal jugular, which is the big one you can feel on the side of your neck.