I Am Going to Kill My Body

It’s been four weeks since my cardiovascular system mutinied. I feel perfectly fine. I plan on going for a long-ish ride tomorrow. I plan on not dying.

My body has recently decided that it’s not through screwing with me. I was up half the night with a pain in my foot. It’s the return of my Morton’s neuroma. (It’s an inflamed nerve that runs several inches between and behind my “ring” and middle toes. It felt like someone was sticking a knife in my foot.

The nerve finally calmed down after a couple of hours. I swear I could hear snickering coming from my foot.

Today I went to the dentist for my semi-annual exercise in mindfulness. I HATE going to the dentist. I get all tense expecting intense pain while my teeth are being cleaned. This is not without reason. I have had some pretty unpleasant dental visits including the time the endodontist prepared to close off the hole in my front tooth from which he had removed my root. The problem was that he removed only half the root. There was still a live nerve in the hole. I literally jumped out of the seat. He said, “That wasn’t supposed to happen.” I kicked him in the balls and said “Neither was that!”

Okay I lied about the kick in the balls. But the pain went straight up my nose into my brain. It was an Olivier/Hoffman Marathon Man moment. (Ironically, I ran marathons at the time.)

The blood thinner has caused my gums to get all inflamed in the past week. I tried a home remedy that seemed to calm things down. I just put mouthwash in my mouth and hold it along my gum line. It stings but the gums waved a white flag.

The cleaning today went much better than expected. Occasionally during the cleaning something would hurt. My hands tensed up waiting for that jump-out-of-the-chair moment. So, and here’s the mindfulness part, I focused on the fact that the pain was insignificant. I consciously relaxed my hands which relaxed my arms and my shoulders. And reminded myself that I am just anticipating pain that will probably not arise. And every time I found my hands clenching, I’d just repeat the routine.

It sounds pretty weird but it worked.

So my body tried to get me again but my brain triumphed. Until the dentist came in and said words I hadn’t heard in ten years: “You have a cavity.”

I go to the dermatologist next week. Do you think maybe I should reschedule?

 

From a Scan to Afghanistan

So it snowed a little the other night. Mr. Outside (that would be me) stayed inside and rode for nearly 90 minutes in the basement.

Big fun.

Not.

Today the temperatures broke 40 degrees. Cowabunga!

I rode 21 miles on my Cross Check stopping so I could get ready to go to the hospital.

We’re having fun now.

I went in for a CT scan of my adrenal glands. (They are located atop the kidneys.) My doctors are looking to rule out cancer because some cancers increase the propensity for blood to clot.

The scan is pretty hot. Literally. You lie on a table that moves into a donut shaped scanner. You hold your breath and the scanner activates. The table gradually moves back out from under the donut. This takes about five seconds. After three passes, a contrasting agent is injected into a vein in your arm. The agent flows back into your heart and then get pumped throughout your body. As this happens you feel eerie warmth spreading through you system. The spreading takes a few seconds so you feel it gradually advancing. Next, you get moved back under the donut for another scan. The warmth dissipates and you get one more pass under the scanner.

I have no idea what the outcome was. The technician is not allowed to tell me. She did, however, seem pretty upbeat afterwards. I’d be surprised if they find any cancer.

Which, of course, leaves us wondering what caused the deep vein thrombosis in my calf that released the pulmonary embolisms into my lungs? Don’t you just love a mystery?

A few hours later I drove to DC to attend a #bikedc happy hour at District Hardware at the recently opened Wharf development along Washington Channel. District Hardware is one part hardware store, one part bike shop, and one part coffee bar with beer and wine. I am not making this up. What a concept.

There were a few dozen people at the happy hour, most of whom are involved in the friendly, somewhat loony winter bicycling competition known as Freezing Saddles. I knew perhaps a third of them. I can vouch for their loony-ness.

One of the attendees not involved in Freezing Saddles recently returned from a year abroad. I met Lis Wilson several years ago at Friday Coffee Club. She’s one of those people that make DC such an incredibly interesting place to live in. Lis recently returned from Kabul, Afghanistan. She spent much of her time confined to a compound for her safety so, although the work may have been rewarding, the living was rather tedious. It was a terrific surprise to see her. She shamed me into forgoing alcohol. L’chaim indeed. Welcome home, Lis. We missed you. Maybe next time you can spend a year in someplace a little less edgy like Omaha. Or Elmira.

Many thanks to Lis and the many others who expressed concern about my health. And to Joe and Rachel for organizing this get together. I needed a social fix.

 

 

(Out)side Effects

Following up on yesterday’s post, I bundled up and hit the road today. It was a little over 40 degrees in the direct sunlight and there was no ice on the roads and trails. It took me an unusually long time to get warm. Normally, when I dress properly, I warm up within a mile or two. Today it took about five miles. I did end up riding 32 1/2 miles, but I was cold for the last five miles too.

I wonder if this chill is a side effect of the blood thinning medication, Xarelto, that I am taking. I wouldn’t be surprised because I have had two other side effects in my first 3 1/2 weeks on the drug. I noticed within a day or two of taking the drug that I itched everywhere. This itchiness went away only to be replaced by sharp nerve pain in my feet. These stabbing pains would last only a few seconds. They came and went. Ultimately, they left for good. Around this time, my dosage was reduced by 50 percent.

And my nerve pain was replaced by another side effect.

The other night I was flossing between my two front teeth. The floss broke off. It took several tries to get a smooth, floss-free groove between my teeth. It was as if my teeth were pushed closer together. As it turns out my gums are inflamed and red. The interwebs list bloody gums as a side effect of Xarelto.

I hope this side effect goes away soon. I have a dentist appointment on Friday. Maybe I can learn more.

I am still being asked on a daily basis how I am doing. All is well. There is nothing for me to do but take my medicine and wait for the clots to be absorbed by my body. This will take at least two more months, or more likely five.

It is what it is.

 

Winter Weather Wimp Gets Back into a Routine

I really am a wimp. It’s below freezing outside but there’s no ice on the roads so it’s safe to go riding. But I walk out the door and the blast of cold air pushes me down the stairs in to the basement where Big Nellie and Lincoln in the Bardo await.

I know I am a weenie because my bike commuting friends are out there slogging away to and from work. Although she doesn’t exactly slog, Mary the Coffeenuer is braving the cold and – for the most part – enjoying it. Her latest blog post pretty much is a call to arms, or pedals. So I resolve to get out of the basement as long as there is no ice on the ground. (It’s supposed to snow tomorrow night so this might be a pretty short lived resolution.)

An update on my recovery: I feel fine. I have my energy back. Mrs. Rootchopper says that my left calf looks bigger than my right. This is consistent with a deep vein thrombosis or big blood clot in my left calf. I have used a tape measure and I can’t find a difference. I also don’t feel any difference between the left and right calf.

I have ordered a mirror for my Cross Check just to decrease my chances of being run over by big metal things. And I have purchased a RoadID which is like a medic alert bracelet. It has my name and address, my wife’s contact numbers, my blood type and Xarelto, the blood thinning medication I am on. This is especially important in case I crash and hit my head and am knock out or concussed. Blows to the head can lead to runaway bleeding in the skull which can be fatal within a day or two. I want to make sure that EMTs and ER doctors know about my medication from the get go even if I can’t speak for myself.

Well, that was depressing.

My CT scan for tomorrow has been postponed because my insurance is flinching at having another one so soon after the last one. This is pretty routine.

Later this week I have a dental appointment. Hopefully I won’t need any crowns or fillings because I’d have to stop taking Xarelto for a couple of days and I really can’t do that right now.

I am getting back to the daily routine I was in before all this craziness took over my life.

  • Meditation for 20 -30 minutes – This is a hold over from self treatment of depression. I’m into my fourth year of sitting on a daily basis. Oddly, it’s also the last vestige of a friendship gone sour. Go figure.
  • Reading the newspaper over breakfast – I have been doing crosswords since college. Breakfast doesn’t seem right without a puzzle.
  • Reading – I am an obsessive reader. I can’t imagine living without books all around me. I am working down the pile of books I got for Christmas and as gifts for nearly dying. (I can’t die now, God.. I have four more books on my nightstand.) I should be coming up for air about May 1.
  • Riding – I am still searching for a good substitute for the best bike commute on the planet. And I have to get myself into some sort of decent riding shape because I fully intend to ride to Pacific waters this spring and summer.
  • Learning guitar – I am the least musical person on the planet. And I have small hands. So this is an uphill battle. Still, twiddling away at finger picking is strangely relaxing. And it’s a lot easier to learn these days because there are a bazillion instructional videos online.
  • Listening to music – This is something that has fallen by the wayside with all the bike riding that I’ve been doing over the years. I was browsing YouTube recently when I saw the name Brandi Carlile. I’ve heard her name many, many times over the years and never took the time to listen to her. Doh. She’s been making interesting music for 12 years and six (soon to be seven albums). So I am wearing out two of her CDs and I am about to buy all the others. This will tide me over until the next Neil Finn CD comes out later this year.
  • And doing at least one adult thing –  Today’s was driving my daughter’s car so its battery wouldn’t die. And doing a load of laundry. Hey, that’s two.

In addition to these daily activities I have a few other things I want to keep doing.

  • Socialize – I am trying to do at least one social thing a week so I don’t turn into a hermit. The weekend before last was brunch with folks from grad school. This past weekend was the wedding of the daughter of a former work colleague. It was at a mosque which made it especially unusual (for me at least) and interesting. This Thursday I am going to a #bikedc happy hour. I am not supposed to drink alcohol while on my medication but I think one drink in a two-week span won’t kill me. Then again, who the hell knows!
  • Advocacy – As a total introvert, I make a lousy advocate. Still, I hope to attend a meeting with National Park Service staff regarding the Mount Vernon Trail on Saturday.
  • Sportz – I don’t watch much sports but the NFL playoffs include the Patriots. I lived in Boston and Providence for 11 years during which time the Patriots were consistently mediocre. Their recent run of excellence has been fun to watch. I only watch during the playoffs. I don’t have time for the other 16 games.

 

 

 

 

 

Whoa Nellie

Many years ago, I was riding my Tour Easy recumbent to Indiana. I had just had the rear wheel replaced in Frostburg, Maryland. After a half hour I crested the aptly named Big Savage Mountain. With about 35 pounds of gear, all over my back wheel, I began the descent from the crest. The bike had a full fairing, a Lexan windshield, that made it super fast on downhills. And within less than a minute I felt like I was riding a bullet. I looked down at my speedometer and saw 48 miles per hour. I was just getting started. I’d never ridden this fast on a recumbent before and all I could think of was: I hope nothing goes wrong or I am a dead man. So, in near panic I yelled:

WHOA NELLIE!

I started riding the brakes to bring me down to a safe speed, all the while hoping the rims of the wheels didn’t overheat.

American sports fans my age well know that “Whoa Nellie” comes from sportscaster Keith Jackson. He was the voice of college football for decades. I don’t remember all that much about college football back in the day but I remember his announcing.

Image result for keith jackson

I named my recumbent Nellie after that crazy descent. (Today I call it Big Nellie because I named my Bike Friday folding travel bike Little Nellie after the kit helicopter in the James Bond movie “You Only Live Twice.”)

Keith Jackson died yesterday at the age of 89.

Whoa Nellie indeed.

Lifting a Fog

For several hours after yesterday’s tentative 20-mile ride I felt fantastic, the best I’ve felt since the roof caved in three weeks ago. Temperatures this morning were in the 60s. I know a sign from the bike gods when I see one. It was time to push things a bit further.

I rode from my house to the Lincoln Memorial and back. For most of the 30-mile ride, I was cruising on flat ground. I felt fine. My lungs and heart felt completely normal. Normal is awesome.

So was the fog. The warm air caused the ice on the Potomac River to create amazing spooky clouds. The southerly breeze pushed the fog up against bridges and buildings. I stopped at the Reflecting Pool in front of the Lincoln Memorial. I could only see a few feet in front of me.

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Mount Vernon Trail heading north out of Belle Haven Park
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The Reflecting Pool and Washington Monument

At the Virginia side of the Memorial Bridge, visibility was nearly zero. I could barely see past my front wheel. I stopped and the wind blew a gap in the fog bank.

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Heading toward Arlington Cemetery on the Memorial Bridge

The ride home was into a steady head wind. If anything would test my heart and lungs. this surely would. After about two miles, I settled into a steady, calm breathing pattern. Dang.

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Fishing in the fog under the Woodrow Wilson Bridge in Jones Point Park

At 26 1/2 miles I decided to try climbing a bill. The Park Terrace Drive hill is well known to local commuters. I can easily break 30 miles per hour riding down it. Riding up it I am lucky to maintain 5 miles per hour. So It was pretty gratifying to see 4.9 on my speedometer only for a moment as I reached the top. It took a few seconds longer than normal for my heart rate to come back down but, having not ridden a hill in over three weeks, I was pretty darned pleased with how it went.

Sitting at home an hour or so later, I feel even better than yesterday. You might say I feel as if a fog has lifted.

 

 

 

Cue the Gene Autry Music

It was 50 degrees out. The sun was (however briefly) shining. There was just one thing to do.

I went out and I rode my damned bike. And, after a few miles adjusting to three weeks off a conventional bike, I settled right in. I stayed on level–ish ground. My windpipe felt a little raw but my lungs didn’t max out and my heart stayed out of the red zone.

Tomorrow will be another warm day. I might try a few hills and, maybe even, go to the gym.

The only downside to the ride was a bit of lightheadedness. This has nothing to do with the ride; it’s a side effect of the medication that I am on. I need to be vigilant lest I glide off into a roadside ditch or take a dip in the Potomac.

When I walked in the house Mrs. Rootchopper was humming the song that was running through my head.

 

Feeling a bit chuffed, I decided to stop procrastinating about setting up a WiFi mesh network in my house. Our house isn’t big but the router is located in a corner of the family room and barely reaches the upper two floors. Following @darsal’s example I bought Google WiFi. The hardest part was finding hook up points for the nodes in my 1960s house. I had to empty a book case to get to an outlet for one node and pick a suboptimal place for a second node because the best spot was next to a wall activated switch. Then I had to connect the printer to the new network. It all took about an hour and works just as advertised. Ta Da.

Okay, so two things went very right today. I have decided to settle in with a book and some tea lest I tempt the fates.

I could point out that it’s been 22 days since my last embolism (a bit like going to lung confession), but it’s better to focus on the fact that spring training starts in 34 days.

 

Recovery: Back to Normal-ish

Three weeks ago my medical crisis began. Today was a normal day like any other with the minor exception that I rode in the basement rather than outside. If I didn’t know any better, I’d say I was healthy, well adjusted person. Okay, let’s settle for healthy. We can’t expect miracles.

I was a busy boy today. I made two appointments for scans ordered by my pulmonologist, helped arrange for the appliance guy to come fix our dryer, drove to Marlow Heights to get a second key for the Millennium Falcon, my son’s rattle trap of a car, and drove to REI to try on new shoes. (I didn’t like them.) Then, after a meditation break along the river, it was back home to find out I needed to make another scan appointment. Yesterday’s ultrasound didn’t give a clear enough view of my adrenal gland so we’re doing another CT scan. (Certain cancers cause an increase in clotting so the search is on to find or rule out cancer somewhere in my body.) Next up was a 13 mile ride in the basement while reading my book. (It’s called Ramp Hollow. It’s about how the people of Appalachia came to be in their socio-economic predicament.) Finally, I did my complete set of physical therapy exercises including a shoulder stand.

I don’t want to jinx anything, but I feel pretty normal. The only real way I can tell is to try to do more normal things and see what happens. So I need to take a bike out and ride it somewhere. I suspect that if I can handle 20 miles outside on my Cross Check I’m doing just fine. If I can go up a hill without dying (not literally, I hope)  that would be another milestone. Still another test will be to go to the gym and lift weights. I am not Ahnuld so this is more to see how my heart reacts to pumpitude.

Anyway, feeling somewhat normal is pretty flabbergasting to me. It’s been three weeks since the clots decided to go site seeing in my lungs. I felt truly awful for the first week after the pulmonary embolism(s) came to play.

Since it came up in a recent twitter conversation, I should point out that I plan on riding while on blood thinners. Nothing heroic or adventurous just my usual everyday cycling. With a helmet on, of course. For the short term, I just want to see where my fitness (and balance) is. For the long term, I need to be active or I will lose my mind. (Just ask my wife.) How all this translates to bike tours and events is TBD.

I also intend not to let this medical mess turn me into a hermit. In addition to seeing plenty of medical professionals, I plan on going to several non-medical events in the weeks ahead. There’s a wedding on Saturday, a #bikedc happy hour next week, a meeting with the National Park Service about the Mount Vernon Trail the following Saturday, and the WABA Awards get-together in a few weeks. I doubt I’ll ride to these events. There will be plenty of time for riding when it’s warmer and lighter out. Lord willin’ and the clots don’t rise.

 

 

 

Mr. AMA

Call me Mr. AMA. My life has become an endless series of medical appointments:

  • Personal doctor to coordinate care after the pulmonary embolism
  • Ophthalmologist for my semi-annual visit.
  • Ultrasound office for a scan of my kidneys ordered by my personal doctor
  • Pulmonary specialist to see how my lungs are doing and monitor my progress
  • Annual physical
  • Dentist for my semi-annual appointment
  • Annual dermatologist
  • CT scan ordered by the pulmonologist
  • Echocardiogram ordered by the pulmonologist
  • Pulmonologist again
  • Hematologist

So far I’ve done the visits in italics. I have all the blood thinners a man could ever ask for. No clots made their way to my eyes (not that this was much of  concern, but the eye doctor takes a picture of my eyes once a year anyway). The ultrasound was to rule out cancer in my right kidney and adrenal gland. (This is a remote possibility but I have no adverse symptoms so no worries.) The pulmonologist said that I sound good. She was upbeat about my progress and ordered some scans of my heart and my lungs for a month from now. She also said that when all this is over, we’ll evaluate whether I can dial back my asthma medication. (This is unrelated to my embolism. She thinks the drug I am using is overkill.) Also, she green lighted exercise as long as I don’t get light headed. And told me I can retire the spirometer. (I may still use it to see how my lung capacity improves over time. And because I can be a stubborn competitive ass.)

She is aware of my problems climbing hills on my bike in 2017. (I immediately run out of gas. My legs just stop working.) And she thinks my May 2016 trip to the ER was probably caused by a pulmonary embolism. According to the interwebs, untreated pulmonary embolisms have a mortality rate of 26 percent.

Eek.

So it’s not surprising that my pulmonologist is operating under the assumption that my December 2017 crisis was actually (at least) my second pulmonary embolism. We will continue to search for a cause but may not ever find one. It doesn’t look like I have cancer (some of which increase blood clotting). I have no immediate family history. I take reasonably good care of myself. Even my leg where the deep vein thrombosis (DVT) is looks and feels normal.

Long story short my probability of getting another pulmonary embolism, if I go off blood thinners, is 17 percent. Given that 26 percent of undiagnosed pulmonary embolisms are fatal, the probability that I will have another embolism and die is 4.4 percent.

My probability of a bleeding mishap (which can be permanently debilitating or even fatal) from the blood thinners is 2 to 3 percent. This is for the average patient though. A clumsy person who rides a bike and hikes on rocky trails would be at greater risk, I would think. So maybe my odds of dying from the thinners is 4 to 6 percent.

Isn’t math fun?

The probability that I will need a good stiff drink tonight is asymptotically approaching 1.0.

My pulmonologist is inclined to leave me on the thinners for life. She said that hematologists are inclined to take patients off them after six months or a year.

Anybody got a pair of dice?

 

 

 

 

 

The Life of the Party

So you’re recovering from a pulmonary embolism. It’s been two and a half weeks. You can say about three sentences without coughing and gasping for air. So you go to a party.

And you spend the first two hours explaining the whole DVT/PE thing and how you could have DIED and how nobody seems to know WHY this happened or when it actually started. And you’re on a drug that works great as long as you don’t hit your head because if you do your skull will fill up with blood and you’ll DIE before they can find a neurosurgeon to cut your SKULL open and let all the red juice out.

Pass the lasagna please.

Then you get done with that party at 12:30 a.m. You drive 40 minutes to home and are in bed by 1:30.

You get up, shower, and drive back to a different house on the same road in the same neighborhood where you have brunch with a completely different set of people who ask you about the whole DVT/PE thing. And you explain it all again with 8 x 10 color glossy photographs with circles and arrows and a paragraph on the back of each one.

(I don’t actually have pictures of the DVT/PE thing but I got an awesome set of photos from my last colonoscopy. Not interested?)

At least I didn’t have to pick up the garbage.

I suppose this is going to go on for some time. I might as well get used to it.

As for me, I have to explain the whole thing to my eye doctor tomorrow morning because he’s going to ask why I’m on blood thinning medication.

So I’ll wait for it to come around on the guitar…