Felt Great - broken spokes

On Thursday, I decided to cycle to work. I felt better, but I was tired of nursing and no longer enjoying anything. The doctor said I could participate in the activity at a level I’m comfortable with. However, they must understand that my comfort level is much higher than usual. Those who’ve completed ultra-marathons know what I mean.

In February, I shared a post about the new bicycle I had ordered but hadn’t received yet. I upgraded the electric assist to one with more torque and range. Additionally, I bought a new bike, the Surly Long Haul Trucker, which is a significant improvement over my old (2006) Cannondale Quick 5. Some people might think electric assist is cheating, but I still need to pedal and maintain a good heart rate to get a workout. I’ve included an example ride with heart rate stats at https://connect.garmin.com/modern/activity/1878980545. For that 12.72-mile, 48.5-minute ride, my average heart rate was 127 BPM, with a peak of 161 BPM. The assist helps me go about 3 MPH faster and makes the hills much easier to climb. I rarely use any assistance on flat ground.

Now, it’s not a secret that I’m a heavier guy. When I bought my Fuji, I had a custom wheel made for it, and it has never broken a spoke, even after over 5,000 miles. However, I recently found two broken spokes on the Bronx rear rim, which was frustrating. I’ve even taken special care to avoid bumps. I was thinking about the words on the frame, “Fff fatties fit fine,” and realized that it means tires, not me.

On Friday, I had more blood work. Despite taking the same medicine dose, my INR dropped 0.6, erasing much of my progress above 2.0. My hemoglobin also dropped by 1.8. I left the hospital with a 6.1 (15+ desires) and an increase to nearly 9.0, but now I’m back below 7. I also had pain in my right calf, and an ultrasound found a new clot. Despite being on blood thinners for three weeks, they suggested I go to the hospital for additional tests. I’m often confused about this.

Until we resolve this issue, I will continue to administer 0.9 mL of Lovenox twice daily, take 10 mg of Warfarin once daily, and 65 mg of iron twice daily.  Let's see where the next week takes me.

All you quiet dreamers, carry on!

Released

Having been discharged from the hospital two weeks ago, I am still grappling with the challenges of my condition. Upon my admission, my hemoglobin level was 6.1 g/DL, which is significantly below the desired range of 15 g/DL. My International Normalized Ratio (INR) was initially 1.12, but after 15 days of Lovenox injections and 10 mg of Warfarin, my INR has improved to 1.8 g/DL, still below the target range of 2.0 to 3.0.

Despite my efforts to adhere to my medication regimen, I continue to experience exhaustion and sleep disturbances. While I did experience restful sleep for three days following the iron infusion, I have since been plagued by abysmal sleep and fatigue.

The combination of my medical condition, the demands of my work, and the concerns for my family members has taken a toll on my well-being. I find myself struggling with individuals I hold dear, making decisions based on their actions rather than my own best interests. While many agree that reacting to others’ actions is not advisable, I find myself in a situation where I feel compelled to intervene.

I am scheduled to meet with my pathologist next week to discuss this matter further. This issue, coupled with the stress of work and the concerns for my family, has become overwhelming. I am determined to find a solution that addresses both my medical needs and my personal relationships.

In one instance, a relationship deteriorated significantly after 16 months. One party is willing to abandon substantial life goals and objectives in an attempt to salvage the relationship, despite the evident toxicity and lack of healthiness. While this behavior may seem illogical to a rational individual, it is challenging to intervene when emotions become overwhelming. This situation is reminiscent of the distorted perceptions held by some individuals who believe their president is the most honest and fair person in the world, despite contradictory evidence. Such beliefs can cause distress to those who care about the well-being of the individuals involved.

On a positive note, this illness has resulted in a weight loss of 25 pounds. While further weight loss is possible, other priorities must be considered. It is crucial to follow the recommendations of medical professionals and those with whom I discuss these matters, rather than succumbing to impulsive actions driven by emotional turmoil. If others could recognize the importance of logic, it would lead to improved outcomes for everyone involved.

All you quiet dreamers, carry on!

Comments from my original blog - I merged the blogs.

wildknits

Thanks for the update! Hopefully, your hemoglobin has come up a bit since your hospitalization and iron infusion (blood transfusion, too?). I am curious if they have been adjusting your warfarin dose at all in the past 2 weeks (sorry - occupational hazard, I manage anticoagulation patients - warfarin patients - as part of my job). Usually, we adjust the dose of Warfarin to help someone get to their goal range as quickly as possible and get them off the Lovenox shots. Then, we try to determine the proper maintenance dose to keep them in range. It varies for different people and can take some time to decide. It is influenced by many other things (diet, exercise, health status, alcohol use, supplements). You are right in that it is stressful to have to sit back and watch those we care about make choices that seem bad to us. But as adults, we get to make our own choices, bad, good, or indeterminate. All are part of free will and autonomy. Sorry that you are going through this while also dealing with a major health crisis of your own. Hang in there! Wednesday, July 26, 2017 at 11:43:31 PM CDT

LDP

Lisa, I started with 5 mg for five days, and the count did not climb at all. We then increased to 7.5 mg for two days and subsequently decreased to 5 mg for three days, a slight increase. Then they went to 7.5 for three days and 10 for two days. Then we went with 10 mg, and I am getting checked tomorrow. So tomorrow brings us closer to what we expected. 

wildknits

I see from your other post that your INR has not increased, and they have found a new clot. Frustrating. I have patients who are on 12.5 - 15 mg of Warfarin (alternating) weekly. You may need a higher dose. It does make me wonder what is going on medically that you are on anticoagulation and still developing blood clots! Hang in there! Thursday, July 27, 2017 at 9:24:53 PM CDT

Roger Peters

Hi Londell. Can't read your blog because the background is so dark.  Friday, August 4, 2017 at 10:26:13 PM CDT

Wow - feel ill - Why am I alive?

Jordan and I returned from our bike trip to Golden. We had tickets for Spin Doctors and Blues Traveler at the Fourth of July event at Red Rocks. I was experiencing severe fatigue, shortness of breath, pallor, and leg pain. It took me four periods of rest to ascend the Red Rocks stairs.

Fortunately, Jordan encountered some individuals there, and I was able to depart early as I felt unwell. The cause of my condition remains unknown. Jordan and I were traveling back to Minnesota, and we departed early. It was that morning that I began experiencing memory issues and felt significantly worse. We returned home, and I resumed work on July 5.

Therefore, the header/title words were similar to those I heard this past weekend, not from a single physician but from two physicians and several nurses.

For several years, I have experienced persistent fatigue, sleep disturbances, and a multitude of other health concerns. Despite these symptoms, I refrained from seeking medical attention or consulting with a doctor. I attempted to mitigate fatigue and other issues by reducing my weekly workload to 70 hours and minimizing stress levels, while also increasing my exercise routine.

On Friday, July 5th, I reached a critical juncture where I could no longer ignore the signs of my deteriorating health. I was experiencing severe pain, and even ascending the stairs caused my muscles to ache and my heart to palpitate. Frequently, I found myself compelled to take breaks due to overwhelming exhaustion. If I had attempted to continue, I would have experienced extreme dizziness. Consequently, driven by my tendency to procrastinate, I decided to visit urgent care after work.

Upon arriving at the urgent care facility, I was subjected to a series of questions. I informed them that approximately 17 months ago, I experienced unexpected and intense pain in my right calf. I attempted to alleviate the pain through self-massage, the administration of ibuprofen, and the application of ice and heat therapy. Subsequently, a few months later, the pain manifested in my left calf. This pattern persisted until the pain was localized in my left calf, which was extremely severe. I had recently returned from a lengthy vacation. I explained that I had spent an excessive amount of time in a car on several occasions, including the initial onset of pain over a year ago. I speculated that I may be suffering from bronchitis, pneumonia, or a severe cold.

Despite my apprehensions, the urgent care facility declined to provide treatment and instead directed me to the emergency room. They even reimbursed my co-payment and indicated that the cost of the visit would remain unchanged.

I proceeded to the emergency room, where I began to recount the entire incident. According to the medical staff, I appeared rather pale. Subsequently, a series of tests was administered by doctors and nurses, which caused me to faint as numerous individuals surrounded me. The manner in which they handled the situation instilled a sense of urgency and fear within me.

After three hours, I was administered an intravenous infusion of Heparin. The attending physician, Dr. Pepper, entered the room and informed me that the following had been discovered:

• Pulmonary Embolism (significant - they used that word that said they do not recall seeing that bad - blood clots in each lung)
• Deep Vein Thrombosis – Ultrasound found several areas in the left leg and one large clot in the right.
• Anemia - A normal red blood cell in men. It’s 15g/DL; I have 6.1g/DL, and they are trying to find out why. The remaining possibility is cancer if they can’t find internal bleeding. They have sent the biopsies to U of M, and the results should be ready in the next few days.

During my hospitalization, I encountered the first individual who informed me that the majority of individuals would not survive. Consequently, I endured a series of invasive procedures over the subsequent four days, including an upper endoscopy, colonoscopy, several biopsies, and an excessive number of blood draws. Despite these extensive examinations, the underlying cause of my anemia remained elusive.

I was discharged late yesterday after expressing my preference for receiving instructions from the medical team before departing. I am currently experiencing significant fatigue, which hinders my ability to perform full-time work. To maintain confidentiality, I refrained from informing my colleagues about the medical issue throughout the day. I adhere to a regimen of two daily injections and three distinct medications until the underlying cause is identified. Until then, I must persevere and exert my utmost effort to endure. While this task presents challenges, it is preferable to the alternative.

All you quiet dreamers, carry on!

Comments from my original blog - I merged the blogs.

wildknits said...

Oh boy! (my polite version of oh shit!) You are lucky to be alive. Those types of clots can kill (speaking as someone who deals with anticoagulation[warfarin/lovenox] daily for my work).   I am glad you went in, despite the delay. And that you are now home. Please take care of yourself and let us know (if you want to) how you are doing.  Wednesday, July 19, 2017 at 9:43:00 PM CDT

SteveQ said...

That's some serious stuff to deal with! Hang in there; we're all pulling for you.  Thursday, July 20, 2017 at 10:42:00 AM CDT

Jordan Canada to Denver last post

Jordan rested for a planned day, sleeping 11 hours and feeling sore in his legs. The weather was unfavorable for biking, so we decided to hike to Hyalite Canyon. The drive was a mix of sun, rain, clouds, and heavy winds.

At Hyalite Canyon, we hiked to Palisade Falls. The hike was challenging, especially for the old man, Londell, at over 6,000 feet. A heavy storm hit by 3:00 p.m., forcing us to have a late lunch. Jordan wanted to return home and nap. We have more energy-draining fun before returning to a regular routine.

After a day off, I woke up at 5:45 AM and packed. The clouds were heavy, and the temperature was 57 degrees. We organized to minimize issues over the next few days. Jordan woke up at 8:00 AM, and we had breakfast before finishing our packing. We could leave Bozeman and get him on the bike by 9:30 AM. The road was busy with constant cars and a small shoulder. After a few miles, he turned around to go to a minor road parallel to Highway 89, East River Road. This road had no shoulder, but it had little traffic. 

This is a link to a video where I tried to follow him on the ride.

As depicted in the video, we anticipated the potential storms that intermittently occurred throughout the day. Regrettably, 36.1 miles into our journey, we encountered a storm. We promptly loaded our bicycle and, given that we were less than 20 miles from Yellowstone National Park, we directed our course towards it.

By 2:00 PM, the weather conditions improved, although the traffic in Yellowstone National Park refrained from attempting to ride within the park—a decision that could be considered reckless. Consequently, we opted to engage in sightseeing, with the hope that the later hours would present opportunities for cycling.

Around 4:40 PM, the traffic finally eased up, and we could have started biking! But then, bam! It started raining! So, we decided to head back at 36.1 miles. But, oh boy, those miles were mostly uphill! So, maybe it’s best to call it a day; we both needed a good rest.

Ride Stats:

• Strava Link 36.1 miles in 2 hours, 10 minutes, and 53 seconds
• Speed: Average 16.6 MPH, Maximum 31.5 MPH

Posts will stop for the rest of the ride as Londell had health issues and Jordan received bad news. We headed back to Denver. 

Carry on, my friends, carry on!

Jordan Canada to Denver Day 4

We slept through the massive storms in Wisdom on a cool night. At 2:30 AM, Jordan woke and asked for his sleeping bag. At 5:45 AM, I saw a double rainbow outside my window. I tried to wake Jordan at 6:30 a.m., but he was still asleep. I processed photos and videos and prepared a blog post. Just before 8:00 a.m., Jordan woke up. We prepared for the day and left for Dillon at 9:00 a.m. The ride is half ascent, followed by a descent.

Jordan stopped at Jackson for a 10-minute rest (about 20 miles). His legs are fine, but his hand hurts. He looks tired and worn. He wants to complete 100 miles before the end of the day, making four consecutive 100-mile days. If successful, he’ll take Wednesday off before heading to Yellowstone. The steep climbs began from Jackson. Fortunately, the weather held, with only the high 60s—a huge reprieve after yesterday’s heat. By the time he reached the top, the clouds arrived.

To beat the storm's arrival, he aggressively rode down the road, sometimes reaching 50 MPH. In the video, he was traveling at 42 MPH, as indicated by the Subaru speedometer. He successfully caught up to Dillon at 1:30, covering 71 miles in under 4 hours, averaging over 18 MPH. However, the weather was dangerous, with lightning and dark clouds on both sides of the route.

The road became dangerous, so I gave him a ride for about 8 miles, during which time the road improved. He was racing the storm again, but this time, it was terrifying. After Three Forks, we realized he couldn’t outrun it. At 100.1 miles, we loaded the bike into the car. Within seconds, the downpour became atrocious, making driving difficult. This was our lucky day!

Ride (first 71 miles) Summary:

• Strava Link - 71 miles – 3 hours 56 minutes 13 seconds
• Speed: Average 18.05 MPH, maximum 46.7 MPH
• Cadence: Average 77 RPM,  Maximum 121 RPM
• Heart rate:  Average 113 BPM, Maximum 155 BPM
• Ascent 2,598 feet and descent 3,543 feet

TOTAL FOR THE DAY:

• 100.3 miles
• 5 hours 24 minutes 18 seconds
• 18.6 MPH

NOTE: Day 5 is a rest day.

Carry on my friends, carry on!

Jordan Canada to Denver Day 3

Last night, I felt stranded in a car during a snowstorm. Jordan had set the air conditioning at 63 degrees, blowing hard all night. I woke up at 3:30 AM, unable to breathe due to congestion. I turned off the air conditioning at 5:00 AM and started cleaning and packing.

Jordan slept until 7:30 AM, when I began packing. He was tired after two 100-plus-mile days and was getting ready to go. I replaced the chain on my bicycle, which had over 1,500 miles of wear. He had a solid breakfast of pizza, a bagel with cream cheese, and leftover salmon. I was pleased he fueled well to start the day.

We discussed route options and decided he’d leave the hotel and ride through Missoula to Lolo, where there’s a 51-mile bike trail. We’d rather ride safer roads than risk what we experienced yesterday. The forecast is hotter, so we’d prefer earlier, cooler hours.

The ride out of Missoula was nice, with dedicated bicycle routes and a slight grade. An extensive shoulder followed an on-street bike lane. He reached Solo without issue. The temperature rose several degrees every hour, reaching the 80s by noon. Jordan slowed down and drank a lot of fluids.

I decided to ride back to meet him halfway. I parked at Victor, MT, and headed toward Solo on the trail. Less than three-quarters of a mile in, I hit a significant edge on the bridge path and blew both tires. I called Jordan to warn him. He needed a bunny hop over the edge, possibly due to my weight. I was looking forward to the ride, but I will repair the tires instead. While repairing, I saw a young man and a woman touring.

Jordan reached Victor, MT, just before 1:00 PM, looking sun-whipped and tired. He rested in the air-conditioned car for 15 minutes. I suggested we pack it in for the day and try again later due to the heat. Jordan pursued the two touring bicyclists I mentioned. After 12 miles, we arrived at Super 1 Food at the same time. They’re college graduates riding the entire 4,228.5-mile  Transamerica trail They’ve been on the ride for 21 days and expect to be on it for another 50 days or more.

The temperature soared above 100 degrees, and the sun’s intensity was intense at 3,000 feet. Amazingly, Jordan survived the heat. Before Sula, the road was once again dangerous. We loaded the bike and drove a few miles. Jordan made it to the State line!

The fun rides began with mostly descents. He sped, going 42 MPH in a 25 MPH curve down the mountain. As a father, I cringed and sweated. As a 28-year-old, he wanted to do it again! I saw some deer, which distracted me.

He was thrilled by the 20-degree drop in temperature by 7:00 PM and continued riding. I set up the car for the night and met him. While driving, I thought I’d forgotten something. When I found him, I suggested I check, but he kept riding. The mountain weather worsened. Just before meeting him outside Wisdom, MT, lightning struck 60 feet away, frightening him. I was his only release valve.

We quickly loaded the bike as the rain began to fall. There was no phone service in the middle of nowhere. We drove a few miles to Wisdom, MT, and found a great restaurant, The Crossing at Feddy’s. Remarkably, it manages to survive financially despite its remote location. The staff said they get many visitors like us.

Upon arriving at the park at approximately 9:15 PM, we were prepared to rest. The park was well-maintained and operated on a donation basis. Notably, it featured an outhouse. It was a remarkable gem, and we discovered two exceptional secrets of Wisdom, Montana. Are there more such gems to discover?

He has averaged 103 miles a day for the first three days!

Ride (first 75.8 miles) Summary:

• 75.8 miles – 4:39:21
• Speed: Average 16.3 MPH, Maximum 33.3 MPH
• Cadence: Average 76 RPM; Maximum 101 RPM
• Heart rate: Average 117 BPM; Maximum 157 BPM
• Ascent 1,722 feet and descent 744 feet

TOTAL FOR THE DAY:

• 120.6 miles
• 6 hours 39 minutes 28 seconds
• 18.09 MPH

Carry on my friends, carry on!