To insist on discharge from hospital?

[Midori1999]

I'm 18 weeks pregnant. I came in last Weds night to be checked over as I has some minor difficulty breathing and have a history of clots in my lungs, plus a blood disorder that puts me at high risk of clots. I was already on a preventative dose of heparin. All my obs came back fine but to to my history they wanted to keep me in. They have done a chest x ray and two scans and although there's no confirmed clot in my lungs, they can't rule it out either and it's possible that there are several small clots present. So they are treating me as having clots, which means a higher dose of blood thinners and they are doing blood tests to make sure the levels are correct.

Each day they've indicated I may go home and each day they've said they can't. I was really expecting to be told I could go home today. My DH has to go away with work tomorrow until Friday. This means my Mum will be left looking after my DC, which she can manage, but she lives far away so my youbgest DD doesnt know her that well and i have never left her before eigher snd i certainly dont feel ready to leave her for so long. DD is only 23 months and still breastfed and is used to being fed to sleep. She can go to sleep without being fed, but me not being there for so long is clearly distressing her. She is asking for me and won't go to sleep at night until about 10 or 11 now in spite of no sleep during the day.

I saw a junior haematologist today and he cannot authorise me to go home as his boss 'does not cut corners' her own words to me on Friday when I saw her. However, the midwife has told me nothing is set in stone and I can ask to see his boss and ask her to explain the exact risks to going home etc. (although she is off this weekend) she is not my usual haematologist and I wonder if I can ask for my own haematologist to be consulted? I burst into tears today, which is embarrassing, but it's so frustrating.

I obviously don't want to put myself or my baby at risk. However, all my obs are fine, I would obviously be able to come back for a blood test (to check clotting levels) tomorrow and obviously if my symptoms came back or started worsening I would come straight back. They aren't increasing my medication at all, just waiting longer to do further tests, so I could be looking at several nights or more here potentially.

AIBU to ask for my own consultant to be consulted?

[girliefriend]

Well you are within your rights to discharge yourself but they will say its against medical advice so if anything does happen it will be your responsibility not theirs.

TBH though I would take the time to rest and try not to stress (eaiser said than done) ime they don't keep you in hospital unless they are worried/ have to.

[HollyBerryBush]

You do what you feel best, but with a medical situation, don't look for people to encourage you one way or the other and validate what you want to do. Which of course may or may not be what your doctor advises.

FWIW, does your DH really have to go away this week?

[YellowDinosaur]

Yabvu to expect your own haematologist to be consulted on a Sunday unless they are on call. YANBU to ask for the consultant on call to be contacted to confirm what the risks are for you to go home.

I am a doctor (not haematologist) and given what you have said if you are already on the blood thinners and can reattend /get the district nurse / do it yourself for the injections and testbed for any blood tests then as long as you don't live miles away from the hospital and could get back quickly I don't see a major issue in principle with you going home but obviously I don't have access to your records and there may be very good reasons why they want you to stay. But they should explain this to you better than 'my boss doesn't cut corners'.

Hope you get some answers soon.

[YellowDinosaur]

You would not be unreasonable to ask for your own haematologist to be consulted tomorrow assuming she /he is not on leave though.

[Sirzy]

They don't keep someone in hopsital unless they think there is a good reason to. Is it really worth taking risks where blood clots and breathing are involved?

[Meerkatwhiskers]

You will be unlikely to get an answer today tbh. It will be tomorrow as that's when the more senoir medical team will be in. But with a query PE i think the best place would be in hospital until your consultant haemotologist is happy that you are not at risk of developing further clots.

You will most likely be discharged on heparin i would think as with a clotting disorder i'm surprised you weren't already given heparin already to self administer during pregnancy as you are at a higher risk anyway.

[Meerkatwhiskers]

*senior even

[YellowDinosaur]

Meerkat. She was on heparin already and is now on a higher treatment dose

[LastTangoInDevonshire]

I think you must wait until tomorrow. Your DD is nearly 2 (not a tiny baby) and she will manage I am sure. The more you worry the worse it will be.

[Midori1999]

Thank you.

Yes, I was on heparin and they initially doubled it, then when they realisedy blood levels were actually the same as the last time they were checked on the lower dose (which hasn't been checked for a month or so) they increased it again, but still below the recommended treatment dose according to the manufacturer. Still also below the treatment dose I had when I had confirmed PEs (bi lateral) in a previous pregnancy now they have increased it to what I was on before, bloods still showing level is too low, but they think maybe tomorrow will be better. If not I'll have to stay in while they increase the dose again and check again.

It's particularly frustrating because these blood tests are apparently controversial and they certainly didn't do them last time, they gave me the recommended treatment dose, waited for my symptoms to improve and sent me home. This hospital have said they were in no way negligent to do that. I am on a different brand of heparin to what they usually use and I wonder if this is causing a problem due to unfamiliarity. I'm not sure how much difference there is between brands.

I also feel that being able to be more mobile, as I would at home, would be better for me than sitting in here trying to walk around the room for exercise. I do think they are being super cautious keeping me in.

Anyway, I'm going to stay in tonight and see what they say tomorrow.

[Meerkatwhiskers]

Sorry missed that bit

[Meerkatwhiskers]

I'm not familiar with heparin dosage at all as we use clexane (also called enoxoparin) at my hospital.

However if you are being given clexane i can speak that language and guide you on dosage.

[Midori1999]

Fuckwittery, I would have to come back tomorrow anyway, as I have an outpatient appointment. And Weds.... And Friday..... I was being seen at least fortnightly before this....

Meerkat, I am on clexane. It's a type of low molecular weight heparin. I know the dose I think I should have been on, based in my weight and the manufacturers guidelines and also what I was on when I had the PE's before, but they seem to have gaffes about a lot to get there and now it seems I may need a higher dose anyway. They are only increasing it very gradually, so I could be here for days yet....

Anyway, I'm here now, so I will see what they say tomorrow when hopefully I will see my own consultant.

[chocolatesolveseverything]

Midori, I don't know what to suggest, but just to say I understand your frustration. I pulled a muscle in my chest at 25 weeks pregnant and the doctors were so concerned in case it was a blood clot that they had me hanging around hospital all day then admitted me overnigh even though they said it was 99% likely to be just a pulled muscle. Just that one night was frustrating enough!

[Bosgrove]

I hope that you are ok, I have been through three pregnancies on clexane and worried the whole way though. Especially the first as they struggled to get the dose right for me and I bled a lot.

For me the right dose was less than the recommended 1mg per kg of bodyweight twice a day, but they gave me a blood test every 4 weeks or so to test to see if I was on the right dose, I think it was called Factor X.

For me I would have stayed put until I saw one of the haemotologists, but hated every minute of it. During my first pregnancy I was hospitalised three times for issues to do with my blood, but my situation was different as I didn't have another child at home.

You have to do what you feel is right for you and your family.

[MammaMedusa]

I miscarried early on a bank holiday weekend and was there until the Tuesday afternoon (three nights) as no-one had the authority to discharge me as they couldn't scan to check everything had gone.

I asked about the cost to the NHS of me staying versus going home and potentially coming back as an emergency again. The cost of me staying was far less.

Once I knew that, and once they had confirmed I was best being mobile, I just tried to relax and take lots of walks around the grounds, etc.

I know it is hard, but try to enjoy someone else making your meals for a while?

[Midori1999]

Thanks for the replies.

I'm still here. My blood results are 0.04 below the range they want. I haven't been able to see the haematologist since the results were back at lunchtime, they came before the results were in, then had to attend an outpatient clinic this afternoon. The midwife has spoken to the haematology SHO who basically didn't want to know and said keep me in and retest tomorrow. So I've asked to see the doctor on call. I can't see any reason to keep me in except they can't be bothered to discharge me at this time of night. I wouldn't mind so much if they'd actually bother to speak to me and give me a proper reason. I'm quite cross really.

[Loulybelle]

I was in the shame boat as you when pregnant with DD, i had the trouble bleeding, so i had to stay for a few days, til an x ray and to see how my breathing carried, i was also on Clexane, i know its frustrating, i was doing my nut, but its better to be safe than sorry.

[Loulybelle]

*breathing

[Midori1999]

Well I'm still sat here waiting to see a doctor and now my meds are late too.

Loulybelle, if I thought I was in here for my own good I wouldn't mind, but I think I am now here due to piss poor organisation and lack of giving a shit about my reasons for needing/wanting to go home.

[Loulybelle]

Midori, i was in the boat, had to wait 3 days for an xray, did my fucking nut in, just keep pushing at them, cry if you have too, they may genuine concerns but if they keep chopping and change their minds, we'd understand if you throttle them with an IV line.

[Midori1999]

Thanks!

As soon as the doctor got here she said I could go home, no arguement whatsoever. just waiting for paperwork etc now.

[MammaMedusa]

Yay!

[Loulybelle]

Halle frigging lujah.