Saturday, July 28, 2012

MRIs, Coumadin, Dissecting Arteries, what else?

Through each year, it seems that I learn something about myself that I never knew prior.  Sometimes it is about pain, power thresholds, prioritization, equipment, races, etc.  Then there are years you find out ways around things like injuries (being hit by a car), family health needs, vacation…you know, ‘life.’  Then there is this year… the year when a curveball came and really stumped a lot of people.  Very few know the whole story. Those that do, were likely stuck with me in car for a long time, and unfortunately asked the question, “So what happened?”

Here is the gist (I laugh when I say that because there is no ‘gist.’  It’s a friggin’ story).  A couple months back I went to our 6th grade campout.  After getting off the bus at camp, my right shoulder area hurt quite a bit…kind of like a pinched nerve.  I figured it would work itself out.  After 4 nights of not being able to sleep very well because of the discomfort, I decided to schedule an appt with Dr. Brian Mather, my chiropractor for the following Monday.  Rolling into that Sunday prior, I showed up to our Master swim group and noticed that my right arm felt fatigued…kind of like I just had swum 6000 yards with XL paddles.  Kind of like my arm was 2” longer…or like I had been carrying an arm full of firewood for 2 miles.  You get it, right?  During the swim I noticed that I was compensating quite a bit…pulling harder with my left arm and kicking a lot more.  Not good for technique, but I was making the send offs.  Afterward, I just figured it was something in my back and I would be seeing Brian the next day.

Monday rolls around and I go to grab my first cup of coffee for the day and I can hardly reach up to grab a cup from the cupboard.  Dang, this isn’t good.  The whole day at work I was massaging my shoulder trying to figure it out.  That afternoon I met with Brian.  He made a few adjustments and ran me through a slug of tests for ALS, MS, etc.  He wasn’t sure what was going on; the symptoms just did not seem to add up.  I asked if I should see my general doc., and he said they would likely get x-rays…find nothing…then order an MRI and put me on prednisone.  Guess what, he was exactly correct.  BUT, the MRI would help rule things out, right?  Gulp, nope.

On Thursday I had an appt. for my MRI as well as an appt. with Brian immediately afterward.  At this point, I could no longer lift my arm.  What little I could move it, I had no strength at all.  Nothing hurt, I just could not move it any higher than about 45 degrees.  At about 2:00 pm, I went in to get my shoulder and neck MRI.  Before I did, I had to get injections…i.e. needles.  Deep breath.  The doc. administering the injections was a parent of a student I had last year.  I was trying to remember what grade he got…I guess I would find out based on the pain.  After the injection I went into the ‘tube’ fairly soon afterward.  I got the directions for what was going to happen. The tech told me at the start that I would have a safety button that I could push if I ever felt uneasy.  ‘What, me uneasy?  Come on, how tough can this be?’  As I was lying down on the platform, and was slowly being pushed in to the small mouse sized tube, I asked, ‘How long am I going to be in here?’  He replied, ‘Oh, about an hour.’  I immediately felt my heart rate increase, and nerves start to go awry. As I was in there for about 10 seconds, I opened my eyes and immediately felt like I could not breathe.  I was going to die for sure at this point.  I reached for the button thinking I needed to press it.  My legs were getting tingly, I was feeling cold…in other words, I was about ready to pass out.  I closed my eyes and started to think about other things.  What was Jessi doing right now?  Does Emma have swim today?  When is her next swim meet?  I immediately calmed down and did not press the button.  Whew.  But thinking about my family and what they were doing would only consume a few minutes.  I needed to think of other things.  Something LONG that would take some time to retrace.  Okay, Ironman.  I decided to reflect back on my first IM that I did in Cda.  The one that I flatted on the bike and walked/ran the marathon.  What could be longer? That got me though most of the MRI, so I had to throw in a couple sprints at the end as well.  Whew, done! After that, I like said earlier, I had a chiro appt. with Brian.  I headed straight there where he would have the results of the MRI I just finished.  I was excited to find out what was going on.  Little did I know…

I arrived a little late so I chilled in the massage chairs while I waited since they pushed me back a smidge.  Brian came out and said, “Let’s see what we’ve got.”  He looked over the MRI first identifying some early signs of arthritis (common) and some discs that looked a little thinner.  All in all, nothing that would suggest anything crazy.  THEN he said it was time to read what the radiologist’s report said.  Cut to the chase, it said that I had a dissecting vertebral artery between the C4 and C5 (neck).  Gulp, what does that mean?  Simply put: Arterial dissection refers to the abnormal, and usually abrupt, formation of a tear along the inside wall of an artery. As the tear becomes larger, it forms a small pouch which doctors call a “false lumen.” The blood that accumulates inside this false lumen can lead to a stroke.  Brian said that it was a little out of his wheel house, so he called the best sports med doctor around, Dr. PZ Pearce.  He said that if it was truly a dissecting artery, I needed to contact Dr. Madeleine Geraghty down at Sacred Heart who is a phenomenal vascular neurosurgeon.  So, that’s what Brian did.  After that, she said that I needed to get down to the Sacred Heart ER and get admitted for full brain MRI.  The concern was that the dissecting artery could have caused a stroke, which would explain the paralysis in my right arm.  Still, no good news.  I felt like a ticking time bomb.

As I left Brian’s office, I started to feel really concerned.  Could I all of a sudden ‘stroke out?’  Is this how it ends?  Will I make it to the hospital?  Just then, I saw a group of Tri Fusion members out on a run, and there was Jessi.  I stopped ahead of them and tried to calmly explain what was going on.  Hmm…how do you quickly and calmly communicate something with such urgency?  Fortunately we have such great people in our lives and things just fell into place.  Owen and Emma were immediately covered, and Jessi and I were off to the hospital.

Heading into the Stroke Unit at Sacred Heart just did not seem right.  I mean, I am only 40.  Am I that old?  Upon arrival to any ER you are greeted by some of the community’s finest injured people.  People who are convinced their life is over with the sprained ankle…or their pro basketball contract is out of reach now because of a jammed finger.  And for some reason, they need to be in a wheelchair as well…for a finger.  I started filling out the paperwork and before I finished, they called me back.  I was immediately set up in a trauma room.  IVs being plugged in and electrodes all hooked up.  I guess I was pretty safe now.

After introductions, I discovered that the ER dr. knew me from…get this…Strava.  If you don’t know what Strava is, think of it like Facebook for cyclists.  So we chatted about some routes and stuff bike related.  Kind of comforting knowing that he was a cyclist and knew me as a cyclist, though an injured one, rather than some random 40 year old potential stroke patient.

It was time for the brain scan MRI.  This MRI is even more accurate than the other MRIs I had earlier in the day.  It takes micro images of my brain.  I have to say some big concerns were racing through my mind.  Was this how it ends?  Is this where they find the golf ball sized tumors and Matchbox cars?  This MRI went a little better.  For some reason I was not as nervous.  Not to mention, the guy was talking to me the entire time letting me know how long each section would take.  Before too long, it was over…about 25 minutes.  Then it was back to my ‘trauma’ room to wait for the results.

As I entered the room, Jessi was there waiting and had contacted all the necessary people…parents, close friends, etc.  I did not feel that this was a “Facebook” status update item… sorry.  I really did not know what was going to come of it.  Mark Hodgson, best friend since 5th grade, was obviously getting antsy at home, so he came down with Arby’s for dinner.  Dang Arby’s food is ‘good mood food.’  I could not eat any of it at that point because we did not know what the next step was.  Possible spinal surgery?  Brain surgery?  Who knows.  Then I saw an older man come strolling in…the neurologist.  Gulp.  Deep breath.  I asked him light heartedly, ‘So, was there a brain?’  He said, yes.  I asked how it looked and he said it was fine.  I said, ‘Define ‘fine.’’  He said it all looked great, nothing to worry about.  Whew, good news finally.  He thought he had it all figured out, until I explained the sequence of events, again. Then he was stumped.  Eventually he retired to say, regardless of why your arm does not work, we need to address this dissecting artery.  He also said that I would be the topic of conversation the next morning at the neurologists’ team meeting.  Is that good?

After the news from the neurologist, I felt pretty good.  My right arm did not work, but my overall health was good and ‘hopefully’ this would all work itself out.  Though we were tired (it was 11:30pm) I felt a new sense of energy.  It had been such a downward spiral this afternoon, it was nice to have it belly out and regain control.

The next day started the onslaught of appointments.  First was with a vascular surgeon.  That was fun.  Ultimately I learned that though I was on coumadin, he said I needed to be on Lovenox (big ass shots) until my INR (blood viscosity) was stable 2x thinner, or, taking 2x as long to clot.  I hate shots.  I would need one in the morning and at night for a week.

So, since May my life has been about appointments, drugs, blood, and doctors contemplating what in the world was going on.  I can’t complain though.  It’s only ‘part’ of my right arm.  Could be worse.

As for the training, I have been able to ride a little.  But without full strength in the arm, it is kind of like riding with a broken collar bone.  I am also not too keen on crashing anyway, but if I did, I would have to deal with thinned blood.  So I rode 1x a week…short and easy.  Running was actually more difficult than you’d think.  When you run, your arms are naturally supported with muscles to hold them up, and allow them to swing and control the swing.  Without essentially 3 muscle groups working, others had to work in ways they normally don’t.  So I would suffer extreme muscle fatigue when running.  I felt like I was shaking out my arm every 5 minutes.  It has all been crazy figuring out what you can do and what you cannot.  Swimming has been different.  The first time I tried to swim, it almost made Jessi cry.  It was really weird.  I could get my arm out of the water, but once it entered, it could not resist the force of the water.  So it just got pushed back. Pretty much a worthless stroke.

Since the diagnosis I have been testing my arm each day seeing if it works better.  I ask Jessi “Does this look better?” many times a day.  Normally she just shrugs her shoulders and says, “Not that I can see.”  In the last 2 weeks I have regained a lot of range of motion though.  Not too much strength, but I can actually lift my arm above my head.  Pretty exciting.  So in about 2 months, things are starting to work again.  I feel like I am ahead of the curve.  Swimming is better.  Longer stuff (200s) is difficult because I have no endurance right now.  I feel like that it will only get better.  ‘Fast’ is not there though.  Cycling has increased since our 10 day trip to the coast, and running is getting better too.  So with a couple weeks of training now, I feel like I am slipping back into ‘training.’  Phase one.

Through this process, I had a lot of people ask about racing.  The most common question being, “Aren’t you bummed right now that you cannot race?”  Racing really was the last thing on my mind.  The fact that I could not pick up my kids, was waaaay more important.  Maybe it’s because I have raced a lot so the novelty it gone... don't take that the wrong way.  But the little things that you do day to day are far more important to me.

So what’s next?  Immediately, I plan to race our sprint regional championship this weekend (July 29th).  I am pretty excited about that.  It is a fun race and one that I have done in past years.  There will be some tough competition there, but it is really more about getting out and racing than it is trying to eek by someone and puke at the finish.  The benefit to this race is it is a current aided swim.  That means if I am unable to finish the swim, the current will take me to the finish regardless.  Cool huh?  After that, I will likely race a few more Oly races and end the season with a 5150 or Lifetime Fitness series race.  Still contemplating that currently.

You never want something like this to happen, but inadvertently it usually does.  I am so fortunate to have the support I do.  Jessi has been so amazing and understanding and level headed about this.  Never freaking out and looking at the worst.  I have also been so fortunate to have amazing people in the medical field that were, and have been, looking after me. I cannot imagine if I didn't have Brian Mather in my corner. A huge thank you to all my friends and family who have been there from the start asking how they could help.  It has made all the difference in the world.  I do not understand how people who live away from family can handle these situations.  I really feel blessed.

Sorry for the long blog, if you are still reading, nice work.  Believe it or not, this was the short of it.  Now you are all caught up.

Keep riding,