01 October 2013

Beware: It’s A Lumpy World

I have a somewhat unique relationship with Dr. Foot Doctor. It’s much more of a teamwork approach with some friendship and a lot of respect thrown in in both directions. As such, there’s more interaction between us than you’d typically expect. Thus it was when I saw him last week for a foot-fix-follow-up that he chided me good-naturedly on how I tell him everything about what’s going on, but I’d neglected to tell him the important stuff, that being how my leg was so achy and uncomfortable in the week or so leading up to the Attack of the Planet of the Clots.

He was right, of course, but he also quickly acknowledged that I would have had no idea what I was feeling, as I had no idea to expect the outcome that came out. Doctors of course know about post-surgical clots, but they expect them quite soon after surgery, and they expect them in older and less active people. Patients generally don’t know about clots, post-surgical or otherwise, until they learn the hard way. In hindsight, that achy leg, both in the calf and spreading north, behind the knee and up into the hamstring, was a pretty clear signal. I just hadn’t taken the driver’s test.

What’s more interesting, and worthy of a mildly alarming warning to all, is that not only have I learned what a potentially developing clot might feel like, I’ve also learned how surprisingly common the problem is. Since publishing on my clotty adventure, I’ve heard of many more cases of this malady than I’d ever expected. This isn’t a case of misery loving company. This is a case of sounding a subdued but very real klaxon. Be it known! It’s a lumpy world out there! These things happen, and they can happen to you, healthy as you may be. To paraphrase the anti-terrorism slogan, if you feel something, say something.

That’s easier said than done. Nobody likes to sound alarms needlessly. The reaction of family, the hassle, the cost, the fear of what might happen to you (They’ll tell me not to run! They’ll confine me to quarters for a month while running tests! They’ll tell me to eat kale!), all conspire to make you conclude that it’s nothing major, and soldier on. And usually, it’s nothing major, and soldiering on is just fine. But not always.

This of course screams for the availability of affordable proactive health care. And it’s more than a bit ironic to be making this point on the day that our dysfunctional government has shut down based on the belief of a few that they can hold the country hostage and create mayhem until they get their way, which is nothing more than terrorism without guns. But let’s not deviate too far from topic here.

So let’s consider some of what I’ve heard in the past two weeks: A co-worker, considerably younger than I, discovered he had the luck to be genetically predisposed to clots, and now lives on anti-coagulants. A friend from church, my age, who runs (and is enjoying my temporary absence from the age-group standings in local races!), related his experience with post-op clots years ago. A runner in my local club, a few – but not that many – years older, told of how he not only was surprised by the appearance of clots, but was doubly surprised to learn he’d had an undetected heart defect – a passage between his atria – that allowed a (fortunately tiny) clot to bypass his lung filtration system and find its way to a worse spot in his brain. And probably the most telling of all these warning stories, a reader (yes, there are a few out there, hard to believe, but…) whom I’d met years back, and who, like me, never suspected what was going on, had no idea that something needed to be done, and unfortunately took permanent hit points to his veins. His story echoes so much of the runner experience: fitness masking symptoms, expectation of excellent health obscuring the idea of such an occurrence, and so on. In his words (slightly condensed):

Unfortunately, I too had a blood clot, but luckily it stayed in my calf. My vascular doc told me I got it traveling to the Paris Marathon in 2011. I noticed a sharp drop off in my performance after this race and couldn’t figure out why. Finally a couple of weeks ago, this doc told me I had a large clot in the vein behind the knee that pushes most of the blood from the calf back to the heart. I never had any symptoms, so never knew I had it, and as a result didn’t use any anti-coagulants.

The downside of this is that while your body gradually absorbs the clot over time, this process scars the vein and some of the valves and reduces its ability to efficiently pump blood back to the heart. Hence, my plumbing is permanently less efficient and I’ll never run as fast again. My doctor told me that if I had known I had the clot and taken anti-coagulants, there’s a very good chance of no scarring and no decline in running performance.

My doc also told me that the plane travel combined with being dehydrated and having a low pulse and blood pressure all make runners slightly more likely than the average person to develop clots. It took me two years of going to doctors to figure out what was wrong with me. Point being, blood clots in runners are more common than I ever knew. It’s worth a little warning so other runners may avoid this! Walk on the plane, stay hydrated and don’t cross your legs and stay in the same position for long.

I hadn’t even considered the low pulse angle, though since his story, I’ve heard it echoed elsewhere. A tale like his will have us all thinking hard the next time something doesn’t feel right. And we should.

After all this seriousness, a little fun is in order, so to close this week, while we’re talking about the demise of our bodies – certainly in the theme of this series on running in our masters years – I must relate a quick and amusing tale of the demise of the mind. As I near the date when I shed the dreaded walking cast boot, and having thinned my blood to the point where it’s safe to be back in normal society with knives and razors and other things hazardous, I’m feeling a more emboldened to resume the rock-n-roll life. So it was that I set off last week for my first overnight business excursion since before the Big Slice.

It’s not uncommon for me to pack in minutes, rush out the door, and find myself in Buffalo shy of something, which could explain the very large quantity of bottles of contact lens solution in my closet. It’s therefore also not unusual that in the first couple miles after exiting my driveway, I’ll run a mental checklist, and sometimes pull over before I’ve left town to check my bag to see if I really packed a given item. No point in coming home with even more contact lens solution!

As I left last week, Dearest Spouse also pulled out on a mission of her own. A mile down the road, my mental checklist hit a question mark, and I pulled over for a quick inventory check. Seeing me stop and not knowing this little quirk of mine, she circled back in mild alarm. What she found was me laughing heartily, because this time, it wasn’t a question of whether I’d forgotten something. I knew I’d packed it. The question was simply, with a boot on the left foot, had I packed the right shoe? I know, you really had to be there, but it was funny. Really.

The irony here is that this is the kind of issue you deal with all because you ran so darn much that you ended up in the state in which I ended up. I keep telling myself that this is all part of the healing process, all part of the game to get back on the roads where I belong, and that it won’t be long now. If only I could remember what it was…

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