Tag: pulmonary embolism

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…

 

 

 

 

Now We’re Getting Nowhere

The DVT/pulmonary embolism recovery marches on. No setbacks so far, knock wood.

Today I ran some errands in the car. I was not the least bit tired nor did I experience any shortness of breath. The spirometer indicates that my lung capacity is still lower than normal but there is no huffing and puffing and my heart rate isn’t jumping into the red zone with minor exertion.

Only a few days ago, I was having difficulty getting the spirometer up to 2,000 ml. Last night and today I hit or exceeded 2,500. I still can’t hold it in my lungs for than a second though.

After lolling around most of the day, I went into the basement for a riding and reading session. Today I lasted 1:03 and I pedaled much harder than yesterday. So I am calling the “mileage” at 12 miles.

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I was not the least bit uncomfortable during the ride. I didn’t feel that sharp pain in my left calf as I did yesterday. And there were no stabbing pains in my right lung.

I may be going nowhere but I’m getting somewhere.

I made appointments to see a hematologist and a pulmonologist in the coming weeks. The pulmonologist saw me in the hospital. She’s calming and is a good communicator. I will not be using hematologist from the hospital. He made it clear that he’s inclined to keep me on blood thinners for life. I want a second opinion. My doctor thinks very highly of a hematologist in his building so I am going with his recommendation.

 

 

 

Basement Riding to the Mendoza Line

At the doctor’s office yesterday, I weighed 203 pounds, six pounds more than on the very same scale a month ago. Perhaps it is a coincidence but in the last six days I have downed six apple fritters, prescribed by the mental health professionals Rachel C. and Katie B. Suffice it to say, my pants are fitting a tad snuggly. My mood is good though.

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As has been the case since I came home from the hospital, I felt a little better today physically. It snowed overnight. As much as I wanted to go out and shovel the inch of powder, Mrs. Rootchopper would have nothing of it and handled the chore with ease.

For most of the day I hung out reading and waiting for the mechanic to call about Mrs. Rootchopper’s car. The year and a half old battery died. Completely. It won’t even hold a charge. So the mechanics put in a new one. Then they checked the oil and found the dipstick dry. Oops. I hope this is not the beginning of old car syndrome, the affliction that kills both your car and your bank account.

While waiting for the mechanic to finish, I went into the basement and rode Big Nellie. It was my first ride or exercise of any sort since the embolism. I took it easy and noted a number of interesting things:

  • My megamileage base will serve me well. My legs were not the least bit stressed.
  • I felt a distinct cramping in my left calf. I never cramp so I am assuming that what I was feeling was the deep vein thrombosis, the source of the blood clots in my lungs. So there you are you little bugger.
  • About 25 minutes into the ride, I felt the familiar stabbing pain in my right lung. I backed off my pedaling, dropped to a lower gear, and the pain went away. (It’s a 3 out of 10 on the objective pain scale.)
  • I felt numbness in my calves. Since I have nerve issues in my legs whenever I ride my recumbent I thought nothing of it. The numbness went away once I stood up and walked around for a minute.

As I rode I read my book. Oddly, I read much faster when I am spinning my legs than when I am just sitting in a chair. I put the reading to a secondary use. I spent one page on each cog, going up and down the cassette in the middle ring. Then I shifted to the big ring and did the same. At no time was I out of breath but my heart rate was higher than normal for the effort I was putting out.

Big Nellie in the Basement
Big Nellie, Locked and Loaded

All told, I rode 52 minutes. I’d say the equivalent of about 8 1/2 miles at the pace I was going (about 10 miles per hour).

It’s not much, but it’s a start. Now that all the fritters are gone (oink) I can hope to gradually increase my time and intensity on the bike and drift ever so gently back below the Mendoza line.

 

 

 

Two Weeks. One Lung. One Expensive Cat.

Happy anniversary to my blood clots

Well, tonight is the two week anniversary of my pulmonary embolism(s). I think we should throw them a party then show them the door. They’ve stayed too long.

My energy levels continue to incrementally improve. I can actually feel the blockage in my right lung. Deep breaths are rewarded with a stabbing pain.

Today was a normal retiree day filled with car-based errands. I went to the drug store to drop off a prescription (for blood thinner). Then I went to a DMV to get a sticker for my son’s car. The DMV was closed yesterday so the wait was well over an hour. I bailed and went to my doctor’s office. The poor man! I hit him with so many questions. He answered them all with ease.

I am not in danger of throwing another blood clot as long as I am on my medication. If I hit my head, I am to stop taking my medication and go to the nearest ER for a CT scan of my brain. A head injury could turn into an epidural hematoma, runaway bleeding inside my skull. It is the injury that killed Natasha Richardson after she hit her head while skiing.

We’re having fun now!

Any other significant hits to my body below my head require a trip to the doctor just in case.

The doctor said that the team at the hospital speculated that my pulmonary embolism may have occurred on my bike trip. Now that I think about it, the only time I have had a significant fall was when I tumbled off the porch at a motel near the end of the ride. Did I whack my left calf during the fall? This would be good news because it would indicate that my embolism was a freak accident not something systematically wrong with my body.

At the doctor, a nurse took my pulse. It was 68. I told her it was very high and she said it’s perfectly normal. Normal for me is in the 40s. So just the act of walking from my car to the elevator and from the elevator to the doctor’s office caused my pulse to increase. This will give you some idea of how my body is coping. The doctor said it’s okay to exercise but that I should take it easy and listen to my body. At the moment my body is saying “watch a movie.”

Speaking of my body, I’ve gained 6 pounds in a month. Fritters and cookies and candies, oh my. Mario Mendoza phone home.

The spirometer and I are still not getting along. I am thinking about switching to a bong. (If only!)

My doctor had some samples of my blood thinning medication so I am good to go after losing a week’s supply somehow last week. They go great with corn flakes.

I am to follow up with a hematologist and a pulmonary specialist. No hurry though. This whole recover will take a few months.

I am scheduled for an ultrasound of my abdomen to check out the nodules on my kidney and adrenal gland that the CT scan discovered. On a scale of one to ten, my doctor’s concern level is barely a two.

After the doctor, I went back to the DMV without any luck. The wait was two hours! I gave up and drove home. After all this running around, I felt fine with no exhaustion like last week.

And now for something completely different

My favorite blogger these days is Blissful Britt. Britt hikes and travels and takes terrific photos and lip syncs (hilariously) on Instagram. While hiking in Arizona her cat fell ill. She okayed the cat’s medical care, because you wouldn’t want to come home to a dead cat now, would you?

The bill came to $5,000! Alas, Brittany doesn’t have that kind of, forgive the expression, scratch. So she launched a gofundme page. If you are in a giving mood or like cats or like crazy bloggers with cats, she could use a little help.

 

 

A Sort of Boring Day

Enough with this sitting at home nonsense. Today, I had Mrs. Rootchopper’s car towed to a mechanic to have its electrical system fixed. I followed in my son’s car.

After that I went to the drug store for a couple of prescriptions. I lost 1/2 of my blood thinning pills somehow. I think they probably got swept up in post-Christmas kitchen table cleaning and are now somewhere in the landfill in Lorton. It’s kind of important that I get some more. The pharmacy has called and faxed the prescribing doctor to no avail. The doctor specifically warned me not to miss a dose and said I should let him know if I misplace any of the pills. I have three left, enough to get through Thursday morning.

Tomorrow I get three bites at this apple. I will call the prescribing doctor myself and explain the situation. Later in the morning, I am going to see my personal doctor. Maybe he can fix this. My final option is to simply fill the follow-up prescription, which is a different dosage. I think I can tweak the timing so I get through the next week without a calamity. Good thing it’s only a life threatening situation. American medicine really is effed up.

After the pharmacy, I refueled my car. What the heck? Oh yeah. I don’t do this very often. I didn’t even remember which side of the car the gas tank was on.

Next up was the hospital. As I was being discharged, a doctor told me I’d need an MRI and that this would be arranged for me. That was 10 days ago. I haven’t heard from the MRI facility. I have no idea which doctor is submitting the order. In fact, the hospital didn’t give me a list of which doctors saw me. After walking all over the damned place huffing and puffing all the while, I found medical records. They gave me a list of specialists. I am sure the list in incomplete but it’s a start.

After all this was over, I put the expiration sticker on my son’s car license plate. Only one stuck. So tomorrow I get to go to the DMV to get a replacement. We’re having fun now.

Back inside the house I started to read my book (Beartown by Fredrik Backman)  Mrs. Rootchopper came home and fell asleep in a comfy chair. Now I know I am getting better. Despite the fact that I had a pretty normal day of running around from one place to the next, I managed not to need a nap.

I am also pretty consistently hitting above 2,000 ml on the spirometer.

I think this is a pretty boring blog post. After all the drama, boring is good.

 

 

 

 

Old Man Drunk on Apple Fritters

Rachel and Katie – Part Deux

As it turns out Katie and Rachel are the Lennon and McCartney of get-well gifters. It was Katie’s idea to get me the t-shirt that gave me a dose of chronological reality with a side of laughter. Rachel’s part of the gift came in the mail today.

A couple of years ago Rachel did an internship at the Hammer Museum in Haines, Alaska. Food in Haines is expensive unless you want to eat salmon three times a day. In sympathy and in recognition of our mutual love for really unhealthy junk pastry, I mailed her a couple of apple fritters by surprise. She returned fire with a handmade postcard that really knocked me out (despite my rather grumpy appearance in the photos in the link).

I opened the box and pulled out a bag of a half dozen apple fritters. I can assure you that I am allowed to eat these because my blood thinner has virtually no dietary restrictions. It will take some time (mostly to avoid massive weight gain and pancreatic malfunction), but I will set my Old Man determination to the task.

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Six Fritters – Each One the Size of a Saucer

Rachel and Katie kind of gave away the surprise by telling me to look out for a second package. I was half expecting salmon, to be honest. I am pretty sure my letter carrier was happy it wasn’t. (As am I.)

Thanks again you two.

But That’s Not All

When I went to pick up the fritter parcel at our front door, I found, not one, but two boxes. The second package was a complete surprise. It came from my sister-in-law Leah. My in-laws hail from southern West Virginia. I have heard so much oral history in the last three decades from them but it has lacked historical context. Leah’s gift fills the void; it is a book on Appalachian history called Ramp Hollow. (If you are from West Virginia, you know that the title is pretty much perfect.)

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Many thanks Leah. It sits on top of the formidable Rootchopper Tower of PE Recovery Reading on my nightstand. I can’t wait to read it.

A Note on My Health

It had snowed in the night. The light coating made for a pretty early morning. I am grateful that we didn’t get a significant accumulation.

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My Front Yard Early This Morning

I am in no condition to shovel or wovel, even. Mrs. Rootchopper reminded me that the doctors said no bicycling for three weeks. It is unclear whether that applies to geriatric basement riding on Big Nellie. So I will be a good boy and talk it over with my doctor next week. There is also the issue of doing exercises for my back. Most of these are yoga asanas. I seriously do not want to shuffle off this mortal coil while doing a shoulder stand. (I’d give money to see the face of a yoga-mad friend when she heard that I died of acute salamba sarvangasana.)

I have strength but no stamina. Each morning I get up feeling better than the day before but even minor exertion causes huffing and puffing.

I keep hitting the spirometer to increase my lung capacity. You suck on the tube and the blue thingie goes up the metered column. They should put a bell at the top. Not that I have gotten anywhere near the top, much less my supposed goal of 3,250 milliliters of air. Still, it probably warms the heat of many to say that I suck a little bit more every day. (Maybe I could write a book called Ten Percent Suckier.)

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My mental state remains upbeat, although as I get incrementally stronger I can sense some restlessness creeping in. It is already sufficiently annoying that Mrs. Rootchopper has asked me to back off on the caffeine.

I’d rather die.

Just kidding.