Vascular Visit

Today Brigham had a follow up with Sheryl in the Vascular clinic. She has not seen him since she removed the staples on August 24th. She was thrilled to see how good Brigham looked. She was in awe that he could walk without a limp and even play a little soccer. Sheryl again expressed that he is a miracle and I could have sworn she had tears in her eyes.  

It has been 3 months since his last appointment where they found the clot. Since then he has been on Eliquis to break up the clot and thin his blood.

Good news - today the grafts and blood flow throughout Brigham's leg were good. 

They have taken him off Eliquis and back to a baby aspirin.  He is under strict instruction if he has any symptoms of blood clots - - cramping, increased swelling, pain - - that he gets into the Vascular doctor ASAP. This stresses me a bit and I kinda wish they would keep him on blood thinners.  His next scheduled follow-up is in another 3 months. 

A few things we learned today.

Initial Surgery:  Brigham came into the OR with 4 people on top of him applying pressure.  Sheryl and Dr. Varela (trauma surgeon) each took over applying pressure by inserting their fingers into the vein and artery. During surgery when Brigham was finally stable they were ready to start the graft. Their plan was to take the saphenous vein from his left leg, unfortunately the ultrasound revealed that the vein looked clotted off and unusable. This is the moment that Dr. Akhtar said, "He is screwed (he actually used a stronger word)." And in the next breath he said, "he is only 20 years old what can we do?" During this brainstorming session they decided to do something that they had never done.  They decided to use the saphenous vein from the right leg.  This meant they had to do a bypass which meant completely cutting off the use of that vein in his right leg and use it to graft both the femoral artery + vein. Now his right leg is completely reliant upon his grafted artery and grafted vein. This explains the swelling in his lower right leg. It has only 1 way in (artery) and 1 way out (vein) instead of 2 veins. 

Risk: Brigham will always be at risk for blood clots. He will need to see a Vascular doctor at least once a year for the rest of his life. If he moves to another state he MUST find a new vascular doctor. They will monitor the flow and the size of the grafted vein.  Here is more information on the importance of monitoring, "After grafting, implanted veins remodel to become more arterial. However, the remodeling can go awry and the vein can become too thick, resulting in clogged blood flow. About 40% of vein grafts fail within 18 months of the operation." Dr. Sheryl gave us an example of a motorcyclist who 20 years after his accident his vein became thick and they had to re-graft the artery. This may happen to Brigham and it may not.  

Unfortunately, if it does happen he will have limited vein options to use for the 2nd graft surgery. They will have to use a vein in his arm or wait for a donated cadaver vein (just like any organ transplant it would happen with short notice). 

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Honest mom feelings: I don't know why this was hard for me to hear but it was.  I obviously understood that this injury would change the course of his life. I knew it would bring struggles and challenges as he aged. I think I have been so focused on the present and what we need to do now that I pushed off thinking of long term.  We often tease that right now he has a 20 year old leg (feels completely fine) and a 40 year old leg (gets tired and stiff). What will that leg be like when he is actually 40? This is where I again remind myself to give it to God.  I couldn't save him on August 7th and I can't save him from future pain or disappointment.  I will lean on my faith and the knowledge that Brigham is a son of Heavenly Father and he loves him.  

One of my favorite scriptures reads:

Proverbs 3: 5-6 Trust in the Lord with all thine heart; and lean not unto thine own understanding. In all thy ways acknowledge him, and he shall direct thy paths. 

This means something different to me today then it did when I was 15. Let's me real...This means something different to me today then it did January 2020.  Daily I am actively trying to choose Trust, have faith, move forward, be grateful and lean not to mine own understanding.  Not just in regards to Brigham but for all my children with their individual struggles and pain. 

It is clear that I am in a time of refining, learning, struggling, and growing through my beliefs and life. I have been through difficult times before - I know the fight is worth it and the lessons learned on the other side of the struggle are beautiful. It is all part of becoming who we are!