Years earlier than, the affected person had fallen within the bathtub, damaged his ribs and punctured a lung. Blood crammed his chest and collapsed the lung. He needed to be rushed to the hospital. Sufferers who’re caught in mattress whereas within the hospital are susceptible to creating blood clots within the veins of their legs as a result of they’re immobilized. Clots type when blood isn’t transferring. These sufferers are often began on blood thinners to scale back that danger. As a result of this man had bled into his chest, blood thinners weren’t choice for him. Clots that type due to immobility block veins and trigger swelling and ache, however they will also be lethal in the event that they journey via the physique and find yourself within the lungs or mind. So his medical doctors had chosen to place a filter in the primary vein that introduced blood from his legs again to his coronary heart — a vessel known as the inferior vena cava — to catch any clots that fashioned and broke free.
These filters are purported to be eliminated a number of months later when the chance of clotting goes down, however many aren’t eliminated on schedule. This one had been left in place for greater than 15 years. What if, Slief urged after explaining this historical past, the filter had performed its job and captured clots they usually had been now blocking your entire vessel? May that trigger his positional hypotension? Centor listened thoughtfully. He’d been a health care provider for 45 years and had by no means seen this. And but it was an fascinating thought. Actually price contemplating.
One of many many benefits of the V.A. Hospital system is that it has computerized medical information going again a long time. Slief did a deep dive into this man’s medical historical past and hit what seemed like some promising outcomes. Seven years earlier, the person had a CT scan that confirmed an virtually complete blockage of his vena cava. Was it attainable that the additional blood that was purported to go from the legs to the mind when the person stood up didn’t get there quick sufficient due to the narrowed vena cava?
The Daddy-Longlegs Gadget
There was actually no strategy to take a look at this speculation, however it made sense. They defined to the affected person that the following step was to get the filter out. The affected person was wanting to strive. The staff reached out to Dr. Invoice Parkhurst on the College of Alabama at Birmingham Hospital, who specialised in this type of process.
The affected person was sedated for the operation. Parkhurst put a tiny tube via an incision into the affected person’s jugular vein in his neck and slowly superior it down previous the guts into the vena cava the place the filter was situated. These contraptions appear like daddy longlegs with tiny hooks at every foot to carry them in place within the vein. The place the physique of the insect could be situated was a small hook. Parkhurst used a tiny gripping instrument to understand the hook and pull the filter up via the vena cava and out via the small incision within the affected person’s neck. Subsequent Parkhurst inserted tiny balloons that he inflated to reopen the threadlike stream via the narrowed vena cava. He then positioned a stent to carry the vessel open. He continued this course of down the first vein of every leg. The process took six hours and required 9 stents, however lastly there was good blood move between the legs and the guts.
The primary time the affected person stood up after this process, he was amazed. The dizziness was gone. It has been 4 months and it hasn’t come again. No weak legs, no lightheadedness, no falls. His toes are nonetheless numb, however he can dwell with that as long as they continue to be on the bottom and he stays upright.
Slief is modest about making this obscure analysis. There are solely a handful of case stories within the medical literature. Nonetheless, Slief advised me, it does make you marvel if possibly that is taking place extra typically than reported. He’s actually going to be searching for it.
Lisa Sanders, M.D., is a contributing author for the journal. Her newest e-book is “Analysis: Fixing the Most Baffling Medical Mysteries.” You probably have a solved case to share, write her at [email protected].