24 September 2013


Based on reactions I’ve heard since my adventures in the land of pulmonary embolisms, or PEs, healthy fit people apparently do not qualify for death. Besides obvious (and appreciated) concern, comments have ranged from mild surprise to outright shock. How could that be? You? The guy who runs marathons? News flash: I will die, Usain Bolt will die, and much to the dismay of Darling Daughter the Younger, his biggest fan, even Ryan Hall will die. We will all die, even us runners. We’re not immune. But we do like to think it might be just a little bit harder to knock us off.

With a last name that starts with the word cat, I should still have the majority of my nine lives left, though I can reasonably say that I used one up on this round. A seemingly scholarly source pegs the mortality rate of a PE around thirty percent if left untreated (Wiki hints that may be a bit high), but that same article states the figure drops to single digits with timely treatment. Ah, timely treatment, indeed. I am reminded of how I elected to gut out the pain overnight because, well, we marathoners do pain (really, there was more reason to it than that), and besides, I could find relief by sitting up. Further, I commented last week on how being a runner – with the accompanying well-developed lungs – effectively eliminated the number one PE symptom, shortness of breath. This raises the interesting possibility that being a runner, and thus masking the malady, may have actually raised the risk by delaying treatment. But I’d rather believe that the mortality risk comes largely from that same reduced lung capacity I didn’t suffer, and therefore I’ll credit running for saving me… again. Certainly fitness makes bouncing back easier. (Of course, we’ll politely ignore the fact that running got me into this mess to begin with.)

Many have asked about treatment, progress, and prognosis. You all know that I’m generally liberal with my HIPAA rights and gleefully publish any and all pictures of my innards, but I’m often vague and intentionally comical with details, not for fear of privacy, but simply for fear of boring you to a state where you too need medical attention. But in light of several requests, I’ll spell out some specifics in uncharacteristically chronological and detailed form.

Once we’d identified the source of my special agony, treatment was immediate. Since I wasn’t in any form of arrest, invasive or other emergency measures weren’t needed, but I was put on an intravenous anticoagulant, heparin. This, along with the other medications that joined the chem-fest, and which I lightly referred to last week as Drano are often called blood thinners, but they really don’t have any impact on the viscosity of your blood. They simply act on the proteins that cause your blood to clot. There are, I am told, powerful clot-busters available, but fortunately, I didn’t have to go there. Again, no critical arrest situation, so our goal was to let my body break up the clots that were already there, which will happen over a few days, and assure that no new ones formed and took up residence.

It’s worth pointing out a little human geography here. There’s a reason you studied this in high school biology. You just didn’t know that you’d care about it some day. Recall that your heart has four chambers; it’s really a set of two pumps, each with two chambers. One side takes the blood returning from your body via your veins and sends it to your lungs to pick up oxygen. The other takes the blood from your lungs and sends it back to your body via your arteries. The bad news is that a clot that forms in your body, notably in your legs, and breaks loose, will most likely pass through your heart and get filtered – and stuck – in your lungs. Bam! PE! The good news is that those clots will get filtered – and stuck – in your lungs, because they’re a whole lot worse if they make it to your brain. If a PE is no fun, a stroke is downright evil. (Clots that cause strokes originate elsewhere, such as in the heart itself, if certain defects exist that cause blood to pool where it shouldn’t.)

Thus it was my clot filter, alias my lungs, that held my collection of special plug friends, and there was really no way to say that more might not be on the way, departing the dry-docks where they were built in the shipyard of my leg, ready to set sail and land in the filtering marshlands of my lungs. That, and the fact that I was on a drip, made it a really good reason to hang out and eat hospital food for a couple of days. Hey, it wasn’t gourmet, but it really wasn’t that bad, either.

Treatment isn’t short-term, however. Protocol says you stay on anticoagulants for life it you’re prone to this problem, or for a period that was quoted to me as three months, six months, or even a year (depending on who we asked and what the current wind speed was) when the problem arises from a known event like mine, post-surgical. This means transferring to an oral med, and an extremely common one at that. If you don’t know someone who’s on Coumadin, alias warfarin, alias rat poison (really, it is the same stuff, though the rats are becoming immune to it so it’s not used so much anymore), then you’re either cloistered, clueless, lucky, or twelve. In short, this isn’t at all unusual. You just don’t hear about it much amongst runners.

Warfarin is a funny thing, though. It fiddles with the enzymes that cause clotting, but it first bumps up the ones that cause you to clot more before it gets around to bumping up the ones that make you clot less. So you have to stay on something else until it takes effect. The stuff in the drip, heparin, is, like warfarin, so dirt cheap that you could fill a bucket with it and have change left over from your five dollar bill, but it comes with a thousand-dollar-a-day delivery charge, that being, a hospital bed. The alternative, enoxaparin, alias Lovenox, costs a bundle, but you can sweet talk your Dearest Spouse into shooting you up with it at home. OK, full disclosure, I’m a needle wimp and really wasn’t keen on that idea. It’s far more accurate to say she sweet-talked me into it, and I nervously giggled in defensive angst the next few days while she deftly operated the syringe.

All of this less-clot stuff translates to a simple more-bleed, which tends to make you rather tense, especially in the first few days when you just don’t know what to expect. After all, I’d never seen a medication that literally stated in its user warnings, “Do not pick your nose.” Seriously, it really says that. But it’s more than a week later, and I haven’t bled out yet (though one of those injections left a nasty bruise, so clearly bleeding does happen), so things are hopeful. They haven’t kicked me out of the kitchen, but working as the executioner on the guillotine platform during the French Revolution is probably right out.

We’re still working on getting the dosage right through cycles of adjust, test blood, lather, rinse, and repeat. Yesterday, my number spiked, making me put an extra few feet between myself and the guillotine while we turned down the rat poison a bit. But at least that means no new clots. It’ll take a while to work this out. But other than that, if I don’t slice my finger open, fall down, or get in a car wreck, I really can’t tell I’m on anything. And I’m told this will in no way prevent my return to training, when the Achilles is ready. I’m feeling good, the progress is good, and the prognosis is good. Again, just don’t fall down.

With that in mind, this past weekend was designated as “Return to the World of the Living”. Freed from crutches, hobbling a bit more gracefully in the walking cast, I returned to the gym not only for some lifting (arms hurt, ah, good pain!), but for forty minutes on the recumbent stationary bike (butt hurts, ah, good pain!). Happily, the motion put zero strain on the Achilles, and I was able to put in my first aerobic work since the slice, followed by another round today. Thankfully, the poundage has remained stable despite this sedentary life coupled with continued consumption.

Sunday also brought one of our local favorites, the Forrest road race. Of course I couldn’t run it, and though I thought of walking it, brains overcame yearnings, and rather than risk damaging this repair for which I’ve paid so mightily, I instead stayed relatively still and directed traffic in my clunky cast, both to assuage my guilt for crashing the picnic afterward and to feel like I was back in the running world. Nobody else seemed to think that the volunteer work payment-in-kind was needed, but it made the beer taste better. Mostly, it was just great to be back with my peoples.

And yesterday marked a month since the slice. It’s healing nicely on the outside, if still somewhat tender on the inside. My fingers – and toes – are still crossed, hoping this works.

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