Monday, December 31, 2012

Year In Review (Part 2) - The Not So Fun That Was 2012

Another title could have been "How an ultra runner was diagnosed with high cholesterol, became a pescetarian, then fractured an ankle and tore a tendon before being diagnosed with deep vein thrombosis (DVT) and pulmonary embolism (PE), all in less than seven weeks". If that doesn't give away the content of this "little" blog post, just looking at the label list makes one think of a medical dictionary, from (A)nkle fracture to Blood Clot(z).


My review of the year that was would not be complete without at least trying to reflect on the events that took place just after I returned from my attempt at completing the "Pinhoti Trail Slam" (Completing the Double Top, Georgia Jewel and Pinhoti 100 Mile Endurance Races in one calendar year) in early November. Just one week after my Pinhoti 100 DNF ("Did Not Finish") and only seven weeks after completion of the Georgia Jewel 100 Miler, I stepped onto the soccer field to play in the final game of the Fall soccer season. I should have recognized a bad omen when Phil, my teammate and team manager casually reminded me that "now is the time to get hurt since this is the last game of the season, anyway" in response to some arbitrary comment I had made. 40 minutes later, unable to walk I was helped off the field by a two of my teammates.

Two weeks earlier I had been to my family doctor for the first time in years to get my very first annual physical exam. I hadn't had my cholesterol checked in over 8 years, but I wasn't really worried about anything. I was an extremely active individual and while I had very poor eating habits, surely that wasn't enough to negatively affect my health. Wrong! When my doc's nurse called me back a week later with my lab results, she informed me that I had high cholesterol (LDL >140) and she wanted to put me on Lipitor. "You're already extremely active physically, so this must be hereditary" she reasoned "and that's why I want you on Lipitor". I couldn't believe it, I just turned 40 a little over a year ago and I worked out almost every day. I wasn't ready to be on serious meds with serious side effects for the rest of my life. I contemplated it for a day and then decided to call back my doc to let her know that despite what she thought, I felt that it would be well worth it to try a change to a healthier diet to see of I couldn't get my LDL levels down below 100 naturally. If it didn't drop significantly within 2 months, I would start taking the meds to help me lower my LDL.

I knew I needed to stay away from anything that would increase my LDL and focus on the "good fats" that would help me increase my "good cholesterol" (HDL levels). My wife, a long time vegetarian, was very supportive of my efforts. I spent a couple of nights researching my options and I settled on a rather radical diet change. It became very clear very quickly that a certain diet (namely "mediterranean diet") had lots of health benefits when it came to heart and blood health when compared to many other typical western diets. This type of diet focussed on fish and vegetables as its staple foods. I planned to take it a step further. I knew I wasn't able to do anything just half way or half hearted. When I set my mind on something, I always have to do it 100%, so rather than just aim for a mediterranean style diet, I opted to follow a strict pescetarian diet, only allowing myself to eat fish and vegetables, no meats at all. In addition, I removed all high fat foods, fried foods, fast food, egg yolks, sodas, most sweets and generally foods with anything above 15mg of cholesterol per serving. I haven't been able to have my cholesterol rechecked, yet, but I've been on my new diet for 50 consecutive days and I'm keeping my fingers crossed that I am going to see the results I'm hoping for. As a positive side effect, tracking my daily food consumption (MyFitnessPal app) to stay on track with these goals has allowed me to drop 7 lbs. of those pesky "last 10 lbs." so far and I am hopeful that I will be able to continue this positive trend once the holidays are over.

I had been on a pescetarian diet for 2 days, when I played the last game of the soccer season. I was feeling no worse than any other day considering that I had run 65 miles a week earlier during my Pinhoti 100 attempt. A number of issues kept me from finishing that race (both physical and mental), but a foot injury wasn't one of them. There had been this tiny subdued twinge on the outside of my left foot, but it really just felt like a bruised bone or muscle, nothing that caused any pain while walking, running or playing soccer. I wrote it off as one of those discomfort things that would disappear in due time.

As I turned to chase down on opposing player headed for our goal, without any warning, I felt a sudden sharp pain in my left ankle, like someone had thrown a rock straight at my ankle bone or just plain kicked me. Funny thing was, there wasn't anyone near me when it happened. I went down in pain, unable to continue my run. A couple of minutes later, teammates helped me off the field. I hobbled home intent to see a doc in the morning.

Since the ankle specialist was unavailable, I was referred to the shoulder orthopedist, instead. One x-ray and an MRI later, he determined that it was "just an inflamed tendon". Wrong!!! I continued to hobble around in an aircast boot for another 4 weeks until the Physical Therapist that I was referred to noticed the "real" problem during my second visit to rehab my inflamed tendon. He quickly confirmed that my initial description of the symptom was actually spot on. My peroneus brevis tendon was literally jumping off its tracks (or out of its channel) and dragging across my ankle bone before popping back into its channel every time I tried to take a step with my left foot. He was certain that only surgery would be able to correct this problem, so he referred me back to the doctor who made the initial diagnosis. Only this time, he did what he should have done 4 weeks earlier, which is refer me to his colleague, the ankle specialist.

Another week later, I finally got to see the ankle specialist, who listened to the description of my symptoms and knew right away what the problem was. He identified an ankle fracture and a tendon tear based on the x-ray and MRI and walked me through the process of reconstructive surgery to get me back to running...or just plain walking for that matter. There were mentions of drilling into the ankle bone, carving a channel out of the bone, fusing tissue and even the use of cow, yes cow tissue to potentially assist in the bone, tissue and tendon reconstruction and repair effort. I finally had confirmation that I wasn't a crazy hypochondriac and that my symptoms were not only real, but a text book description of my injury, so much so that the surgeon told me that he would use me as a case study for his next medical conference. Hey, I'll be your case study any day, just fix me...that's all I was thinking.

He scheduled my reconstructive ankle surgery for the following week. He even planned to put me on blood thinners immediately following said surgery in order to prevent a deep vein thrombosis (DVT) like the one I had 3 years earlier after minor ankle surgery. I would be on crutches for 10 days, followed by removal of the staples and a cast for 4 weeks, followed by a boot and physical therapy (PT) for another 6 weeks. Still, all was good in the world and I was happy to finally enter the long road of recovery (and ultimately back to running and other sports) once the surgery had taken place.

This feeling of redemption and general content lasted...uhm..less than 24 hours. The following afternoon I sat at my office desk as I normally do, sipping coffee, reading emails and updating project statuses when I felt a slight pain near my lower left rib. It felt like a slightly pulled muscle. Either I pulled it as a result of limping for the past 4 weeks or I've got a bad case of gas. Either way, nothing I could do about it other than take some Maalox when I got home and make myself comfortable on the couch. As the afternoon continued, the pain continued to increase ever so slightly. Well, if it was a pulled muscle or even a cracked rib, the pain shouldn't get worse, I thought. If anything, it should stay the same since I wasn't really aggravating it.

I got home around 4:45 PM. I had already texted my wife to pick up some meds to settle my stomach and luckily, she arrived just 30 minutes after I got home. After an initial scolding from my wife for not having gone to the doc already and after initially stating that I didn't need to go to the ER, I changed my mind very quickly when any kind of movement became painful and it started to become more difficult to breathe. We got in the car and drove to the ER. 10 minutes later we arrived and I checked in noting "pain in my chest".

5 minutes later, the nurses were taking an EKG to check my heart function. The results were negative for any abnormalities other than an enlarged left ventracle, which appears to be common in runners. This first test combined with the initial blood work that was being done as well ruled out a hear attack. That left me with three options: 1. Musculoskeletal injury (e.g. cracked rib or muscle strain/tear), 2. Pneumonia or 3. Blood clot.

I was directed to one of the rooms in the ER and asked to put on the dreaded robe for hospital patients. The ER doc informed me of the possible scenarios and ordered a chest x-ray and a CT scan to identify the exact cause of my problem. The chest x-ray confirmed that it was not pneumonia. This left options 1 and 3 still on the table, which the CT scan should be able to narrow down. And narrow it down it did...

When I returned back to my ER room after what had to have been one of the most painful exercises in my life (moving from the gurney onto the CT scan table and back), my wife had left the room to call her sister and to let my son know that I was in the hospital, but that I was okay and I would call him tomorrow as I had asked her to do. I also asked her to call my mom in Germany. I just knew that both would be very upset if I didn't at least let them know that I had gone to the hospital. I planned to call them tomorrow when I felt better. After all, it wasn't all that serious anyway.

As my wife had left to make the phone calls, the doc reentered my room as the bearer of bad news. "Mr. Schneekloth, it appears you have blood clots in your lungs." "Did you say clots...as in multiple clots?" I responded. "Yes, pulmonary embolisms are rather serious." That's when it finally hit me...very hard. As he walked out and the nurse set an IV, I started to choke up a little and as my wife reentered the room, I could see that she had cried. Crap! Now I really felt the tears coming...damn! But, have no fear. We won't let you embarrass yourself by crying. Instead, we make it sooo painful to cry that you can't help it but stop immediately to avoid the physical pain it causes you. I had no choice, I had to stop crying as quickly as I had started. I tried to think of anything but my current situation and when that didn't work, I thought...oh well, no matter how bad it is, I'm already in the hospital, I'm save now. There isn't anything else I could possibly do to improve my situation so that has to be good enough. I wouldn't find out until 2 days later of how close I came to ...

After the IV was set to provide me with fluids, they gave me my first injection of blood thinners. They would continue to do so for the next 3 days, 2 injections per day into my abdomen. After day one, I started to take one pill of Coumadin per day as well. Around midnight, I was transferred to a room in the hospital. Luckily, it was a private room. Just after midnight, my son arrived (his mom had driven him) as well as my buddy Richard. I was glad to see them. By now, they had also started to provide me with some extra oxygen via tubes in my nose as my oxygen levels appeared to be to low. In addition, nurses would come in frequently to take my vitals and a couple of vials of blood. This would continue throughout my entire hospital stay.

The ER doc had also ordered an ultrasound of my legs once I had settled into my room, just to be sure. Of course, more grand news. I had two more blood clots (or DVTs), one in each leg. Are you kidding? No, really? Are you kidding? But I guess it made sense, this is where the PE came from in the first place.

Multiple doctors and specialists came to see me and many helpful friends and family showed up to help or just to cheer me up (you all know who you are, thanks so very much, it made the stay much much easier for me). It wasn't until Saturday or Sunday that my wife finally explained to me why she had been crying on the day I arrived at the ER. Apparently, my vitals looked pretty scary for the first 24 hours and the doc (probably common practice) wasn't able or willing to provide an outlook on my situation. Her research online only made things worse as she found out statistics about pulmonary embolisms (I won't go into details about statistics at this time, but suffice it to say they can be extremely scary). By Sunday, I was breathing much much easier and I no longer sounded like I was struggling for every single breath of air like the days prior. Once I agreed to it, morphine definitely made the pain moire bearable and allowed me to relax and try to get a few hours of sleep here and there.

Overall, my stay was made much easier because my of my loving wife, who literally stayed with me at the hospital day and night (yes, she stayed with me every day for 24 hours), my son who stayed with me the entire weekend, my awesome sister in law who provided food and drink and took care of our cats on a daily basis, my buddy Richard who showed up every day to check in and all the other friends and family that showed up to cheer me up. It definitely worked!

My Monday night, all doctors agreed to release me the following day. I have a long road to recovery ahead of me, but at least there is a road to recovery for me. There are blood test results to be analyzed for blood and genetic disorders, there still is a reconstructive ankle surgery to be scheduled once the DVTs and PEs are gone and all of this will impact how soon and how well my recovery is going. Will I need to take blood thinners for 6 months? For the rest of my life? Can I just take baby aspirins after 6 months? Will I have to give up any sports or physical activities? Will my ankle surgery allow me to get back to running and playing soccer like I did before? Are there other long term hurdles I will need to deal with aside from a 3 month stint in PT rehab for my ankle?

Then again, at least I have these questions still. It could have been a whole lot worse and a lot more final, if you catch my drift. Blood clots and blood disorders are nothing to take lightly, for anyone. Regardless of how things turn out for me in the short or long term, I have definitely found a worthy cause to support. As it turns out, "blood clotting disorders and their research" are not a high profile cause, yet thy are just as dangerous and can be just as deadly unfortunately as other better known diseases and disorders. I will be doing a lot more research on this issue in the days and months ahead, but I definitely have found a cause that I plan to support for the rest of my life, even if my voice or support is just one small contribution to a very large cause. For more information on prevention and supporting this worthy cause to "Stop The Clot", please visit the National Blood Clot Alliance. 

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