Sunday, March 1, 2015

Chilled and Discovering my Inner Georgia O'Keeffe

I made it out for another Fat Tuesday ride down along the river. So much fun are these rides. The trails are lacking for snow but that may be soon be fixed as there's a storm heading this way.

I forgot how much the blood-thinner coumadin leaves me chilled. I typically notice it just sitting around the house but yesterday afternoon on a ride I was having a hard time staying warm in temps (18ºf / -8ºc) that aren't usually a problem for me. I didn't do any outdoor riding when I was on the drug 3 years ago so I'm not sure if this is just an occasional thing. I seemed to do fine on other rides in the weeks since I've been back on it.

Being on coumadin means I can no longer use my go-to remedy for knee pain: NSAIDs -- or nonsteroidal anti-inflammatory drugs. Having them in my system can exacerbate a bleed and that wouldn't be good. I checked with my doctor and he was adamant that I avoid them. I'd typically take a couple of Advil at night and my knees would feel fairly good the next morning. There would still be pain but it was better than had I not used the drug. I do have one other option and that's another synvisc injection.

I meet with my doctor later in the week to go over the results of my Holter monitor. I'd been wearing it for the past 30 days since being discharged from the hospital to see if my heart has any issues with atrial fibrillation. My doctor doesn't think it's a problem but he needs to be able to rule it out. It was nice to finally be able to ditch it.

Today marks my 5th week away from work. I should soon have an answer one way or the other by the FAA's regional flight surgeon handling my case if I'll be approved to return to work . He should have all of the necessary paperwork this coming week to make his decision.

Tammy and I drove down to Rochester Friday afternoon to spend some time with Rachel. We went out for sushi (always something we look forward to) then kicked around the mall killing time before our painting class at Canvas and Chardonnay. Rachel had a cold but she was a trooper for still wanting to go out with us.

The class was really a nice time. I was only one of two guys there so I suppose it could be considered a chick thing to do but I didn't mind. It got really, really loud in there at times! Everyone was enjoying themselves. No experience is necessary or as they like to say: "It's not fine art, it's fun art!"

If you're unfamiliar with these kind of classes, you're instructed step by step in how to go about painting that night's subject. The final products are all somewhat similar but yet very different. Each session lasts a little over 2 hours.

Taking the class and seeing how we both enjoyed it has Tammy thinking about signing us up for a painting class through some local community education offering. I think that would be fun. But first, we really need to get back to Foci where we've been absent for over 6 months! That's not supposed to happen.

Got your lights on? Let's go for a Fat Tuesday ride!

Fat Tuesday and Rockin' the River Bottoms! from kevin gilmore on Vimeo.

Sunday, February 22, 2015

Go With the Flow Never Let Go

I was sidelined for a couple days this week while I waited for the level of coumadin in my blood to drop to a more normal level. I routinely go in to have my blood tested to make sure I'm getting just the right amount of coumadin (often referred to as blood thinner or rat poison). My INR is supposed to be between 2 and 3 but I registered a 5 on Tuesday. That's way too high and the nurse administering the test told me that I was at a high risk for a bleed and to go home and take it easy for the next couple days until the number fell to a safer level. It takes time to establish just the right amount of the drug to take each day. One's diet can have a big effect on their INR number. I'm back within range now and hopefully we'll soon figure out the proper dosage for me so I stay within range.

I took a drive with Toby Tuesday afternoon to Lake Pepin to try and capture some video of eagles flying the bluffs along the Mississippi River. We didn't see any but still, it was nice to spend a few hours alone with my special little guy.

Video from our drive.

Rachel makes her way from Rochester to Minneapolis for work 2-3 times a week via a vanpool that's made up of a diverse group of people: an older man, a foreign man, a quantum physics grad student, a chain smoking truck company owner, a former pastor and Rachel.

I got a text from her this week:

"Picked up a new guy today who lives on a farm. Al is driving. As we pull forward into an area of what seems to be unshoveled snow, the new guy says, "uhh you're actually in the yard right now". Instead of backing up, Al proceeds to make a 5 point turn in the yard before getting out to the main road. *palm to forehead*"

She's told us a few "palm to forehead" stories like that recently about her experience with the group in addition to recalling for us some of the off-the-wall conversations that play out among them. I suggested that it would maybe be a good scenario for a sitcom. She agreed and said she's already thought of that. She has a close friend in Los Angeles who has dreams of someday making it as a writer. This may be her in.

It's a small world. Rachel also works at a long term care facility in Rochester as a nursing assistant. I'm not exactly sure how the conversation played out but a woman whose mother is a resident there commented that she reads my blog and recognized Rachel from my writings. How cool is that?

I ventured away from the trails I normally use with my fat-bike in favor of some exploring yesterday along the Minnesota Valley State Trail beginning in Shakopee. There's nothing at all technical about this trail but it has some beautiful scenery and made for a fun few hours.

Here's a map of my route.

Trails Southwest of Shakopee from kevin gilmore on Vimeo.

Monday, February 16, 2015

Que Sera, Sera

I met up with the Fat Tuesday group for my first night ride in decades. What a blast but what a workout! I'm not nearly recovered enough to be doing that to myself.
It didn't help that I was running a squishy 4 pounds of pressure in my tires making it a little slow-going when I could've easily been running closer to 10 psi. I was finishing near the back of the pack each time we'd regroup but I was smiling.

I didn't wear my glasses so I couldn't read my Garmin with its heart-rate data but I knew I was redlining at times. The graphic to the right shows what I'm talking about. I hit a max heart-rate of 177 at one point which is pushing it for this no-longer-a-young-pup!

I was so surprised to see how many other fat-bikers were out there in addition to the 23 in our group. The trails come alive at night and I had no idea! It's a much more happening place after the sun goes down than it is during the day.

My GoPro lens kept icing up in the steady, light snow that was falling so the video it captured was next to useless. I'll try again next week.

I stopped in at work Wednesday afternoon to pick up some paperwork I'll need to file in order get my medical back. It was nice to drop by the area and say hello to the people there. I felt somewhat like an outsider looking in. Perhaps there's some disconnecting on a subconscious level happening.

I've been off work for 3 weeks now since my latest blood clot scare and it's probably going to be at least another couple of weeks before I'm back, if ever. Que sera, sera.

Not having to show up at the salt mine makes it so much easier to get out and ride. I made it out 4 times last week and I've got the aches to show for it. It was -1ºf when I started out late yesterday morning. I had the trails mostly to myself but by the time I arrived back at my car there were several others just starting out.

I was clicking away on my laptop recently when I noticed a coyote walking on the street outside our window. My neighbor had also seen one last summer in the middle of the street between our homes. Our 3 small pups wouldn't stand a chance against a coyote so we're being much more careful to not leave them unattended when they're outside. Here's a recent Fox 9 news segment about the problem.

I had to laugh when I saw the video of Peaches, the cockatoo who mimics her former bickering owners. Get a load of not only her language but her body language as well. So funny!

Monday, February 9, 2015

Glenn Hamilton Has Left The Building!

I would've thought that with all this time off I'd have found time to update my blog before now but the motivation just hasn't been there. I'll try to do better.

Glenn Hamilton has left the building! Glenn has been a controller in my area of specialty for the last 17 years or so since transferring from Albuquerque Center. In all that time I've only ever worked with Glenn a handful of hours because of our schedules. He's a diehard Minnesota Vikings fan and would bid a schedule opposite mine that allowed him to take in their games. He always struck me as the kind of guy I'd like to have worked along side; very competent and easy going.

Here's a link to a set of photos I took at his farewell party. Glenn is just left of center wearing a Hawaiian shirt in the photo to the left. I believe Glenn chalked up 32+ years with the FAA. Wishes for many years of retirement bliss, Glenn!

I'm slowly making my way back to more normal health but I've still got a ways to go. I tire very easily. I've been out on my fat-bike down by the river a couple of times in the last few days but each time I had to pack it in earlier than I wanted. I arrive there with ambitious plans to do 25-30 miles but there's no way that's happening yet. I do my 14 miles between 35W and the Bloomington Ferry Bridge then head for home and I'm okay with that.

I tried a helmet mount for my GoPro, setting aside my pride in favor of a full-blown geek look hoping it would result in less shaky videos. It didn't. The videos were even more shaky than anything else I've done and I was really surprised by that.

I got an invite from a friend (Hynek) to join a group ride tomorrow night along the same river trails I've been riding lately. The ride doesn't begin until 6:00 so this will be my first experience with both night riding and a fat-bike group ride. They had about 20 riders last week. It sounds like a blast! I went out tonight and bought a light at Erik's Bike with hopes that it will see lots of use in the years to come. Tammy lets me do pretty much whatever I want but I actually ran this one past her first to get her okay considering all I've put her through lately. She and Rachel both shot down plans I had to do some night road riding years ago but this is different because I won't be mixing it up with traffic.

I have no idea how well my GoPro Hero 2 will do capturing video at night but I'm about to find out.

Tammy is down to 21 work days and counting until she retires. I think I'm looking forward to this for her nearly as much as she is. I anticipate she'll be much busier in retirement with all of her plans for volunteering than she is now. We're still kicking around the idea of just having one car when we're both retired. I hear very few people say that that's a good plan but I really think we could make it work. We'll see.

Charlie gave us both a laugh this morning. I was on my way out to the garage with a bag of trash in hand when Tammy opened the bedroom door for them to come charging down the stairs looking to eat. I greeted them and continued toward the garage. That wasn't good enough for Charlie. I heard him run back upstairs to where Tammy was and bark loudly at her, twice, as if to say, 'hey, dad's leaving and we need you to feed us'. It was just so funny.

I'm in the middle of a month off that I'm taking from work as I steadily get my health back. The decision to retire or go back and finish out the last several months of my career still hasn't been made, or has it? There's a real possibility that I won't get my medical certificate to work traffic again and in that case I'll be done. The plan is to try and get it back then go from there. I'll begin jumping through those hoops tomorrow while taking it one step at a time.

In the meantime I can practice being the retired guy who watches the squirrels outside his window in the morning while sipping his coffee with chocolate creamer and marshmallows. I've got this down!

Squirrel Antics from kevin gilmore on Vimeo.

Sunday, February 1, 2015

Perhaps God is Laughing at Me Now

This is part 3 of 3 about my most recent blood clotting ordeal. Find part 1 here and part 2 here.

I wanted to say a little about the staff on the vascular floor (3rd floor) of Southdale Fairview. They are such a caring group of people. Everyone I came in contact with there was always so pleasant and I made a point of learning their names and showing the same warmth back to them that they were giving me. They are such good people! Also, the staff in Interventional Radiology: I actually looked forward to being wheeled down there each time (3 total) to have a procedure done. They were the ones who restored the blood flow to my leg and I have them to thank for their efforts in saving it for me. But they were also a pretty cool group of people and I enjoyed our conversations.

Also, I've never had more people praying for me than I have this past week and I very much appreciate that. Trust me when I say that for all of you who have offered up your prayers and well-wishes or stopped by or offered to stop by to see me, from the bottom of my heart I appreciate all you've done for me.

Dr Foley came by my room before 8:30 Wednesday morning to talk with us about where we go from here. He said he'd had a change of heart about going forward with surgery after speaking with Dr Johnstone and comparing notes. He talked about the patency of the surgery and how there's a "bit of a dance you do when deciding when is the best time." He said that ideally it's best to put the surgery off until there's an expectation that I'll die of other natural causes before any complications from the surgery present themselves years down the road.

Dr Johnstone seemed to think we could afford to wait but for how long I'm not exactly sure. Yes, I do have some clots that could break free into my bloodstream at any time and that's a concern but what's also a concern is how many years I can expect to get out of the surgery.

Also, what I haven't mentioned in all of this is that the aneurysms and the blood clots of my common iliac arteries are two separate things. The aneurysms I have aren't near the point where they're ready to burst so they don't present an immediate problem. They will be monitored, I assume with routine CT-scans but eventually they will have to be treated surgically. Hopefully there won't be any additional blood clots developing within me now that I'm on a blood thinner. I should also add that a blood thinner doesn't actually thin the blood, it just helps to prevent additional clots from forming but will do nothing to erode away a clot that already exists.

So, my main concern now is for the clots in my iliac arteries that could potentially break free and cause me problems. My doctors say they appear to be smooth and stable and not at all impeding blood flow around them. I'm fine as long as they stay put. There's definitely a risk associated with waiting but there's also a risk when I ride my bike on highway 169 during rush-hour traffic catching drafts off semis as they pass by a few feet off to my left with my body feeling more alive than ever. I don't anticipate I'll change my lifestyle all that much or invest too much time in thinking about the what-ifs. I've done enough of that already this past week.

As we were finishing our meeting with Dr Foley he asked who my primary care physician is. I told him that I didn't have one, that the doctor I'd been using for the last 20 years had recently retired. He asked if I'd be interested in having him become my primary care physician. He said he'd like to continue to monitor me closely and that if I have any issues whatsoever he'd make room for me in his schedule no matter what. I jumped at his offer.

There's another question that's been on my mind lately. Am I retired? I really don't know at this point but it's a question I've been asking myself again and again as if it's on a loop in my brain. I had a conversation over the phone from my hospital bed with a retired controller and I told him that I was pretty sure I was done. I hung up shortly after I said that and my eyes welled up with tears. Did I really mean what I'd just said? Was this the way I was going out because this wasn't at all how I ever envisioned my career ending. A part of me pushed back and said ''re not making this decision in this state of weakness from a hospital bed!'

I remember my last night of work last Saturday as I got out of the sector for the final time that night, I stopped to chat with Steve, plugged into sector 36, on my way out. We touched on plans for retirement as is often a topic of conversation with many of us. I told him my tentative plans but qualified them by saying, "Wanna know how to make God laugh? Tell him your plans."

Perhaps God is laughing at me now. I'm okay with that.

Saturday, January 31, 2015

Weighing Our Options

Part 2 of 3 about my most recent blood clotting ordeal. Go here for part 1.

Dr Foley ordered an echocardiogram bubble test to check if there was a hole in my heart between the two upper chambers. It's actually a common occurrence that affects upwards of 25% of the population and is referred to as PFO, or Patent Foramen Ovale. It can lead to a DVT (deep vein thrombosis clot) moving from the venous side of the heart to the arterial side which appears to possibly be what happened in my case.

Without a PFO the chances for a DVT posing a stroke risk just aren't there. The clot moves via the veins back to the heart and into the lungs where it's stopped and results in a pulmonary embolism or PE. Where a PFO is present the clot may migrate to the arterial side of the heart and work its way to the brain and cause a stroke or it may become lodged in any number of places as the clot is carried along via the arteries. In my case a clot became wedged in the popliteal artery.

My bubble test was positive for PFO but it shouldn't pose a risk to me now that I'll be anticoagulated the rest of my life. More than anything it's simply important information to have when trying to sort out the puzzle of my clots.

Keith came by Tuesday afternoon just as I was being wheeled back from Interventional Radiology. He spent over an hour with us. It was really nice to see him. I've always felt that I wouldn't be one to want to have all that many visitors if I were to ever find myself in the hospital as I was but I've changed my mind. Visitors are now welcome!

By Tuesday evening I'd been flat on my back for 55 hours but I was about to be given the go-ahead to sit up. The catheter used to deliver the TPA to two of my clots had been removed and was no longer a concern for being crimped if I were to sit up. What a relief!

In Dr Foley's search for clues about my clotting he turned up the CT-scan taken after my bike crash back in September and something leapt out at him. He noticed what appeared to be aneurysms in my left and right common iliac arteries. The scan wasn't definitive so he ordered a nearly full body CT-scan to have a better look at that particular area and whatever else the scan would reveal.

The scan was performed Wednesday morning and not long after it was completed Dr Foley came into my room, stood before us and announced, "I know the reason for your clotting: you have iliac arterial aneurysms!" Say what? This sounded like good news but I couldn't be sure. Good news in the sense that he was on to something more than just the fact that I have Factor V Leiden. He talked briefly to us about the surgery involved in remedying this problem but he preferred to leave most of that discussion for us to have with the surgeon who would be performing the operation.

He told us that the scan I'd just had done showed a new clot in my common iliac artery that wasn't there last September. I picked up on a sense of urgency to not delay in moving forward with the surgery and Tammy and I were both all-in. He told me that my arteries were otherwise pristine and that given my health, I was an excellent candidate to tolerate the surgery. We cooled our heels the rest of the day and into the late afternoon waiting for the meeting with our surgeon in anticipation of surgery the next day.

Dr Johnstone showed up at our room around 6:30 that night and began our meeting by telling us that all of the doctors on the cardiovascular floor know who I am and are familiar with my situation. She had been talking about my case throughout the day with all of them, getting input to be able to better weigh the options for how best to proceed.

She sat down with us and drew a diagram of what's going on inside me. Tammy (more than I) had been studying up on that particular area of the body throughout the day with hopes of being able to fully follow along so we weren't just a couple of bobbleheads with glazed looks over our eyes not grasping any of what was being said. Not to worry. Dr Johnstone was very thorough in her explanations. She said the clots I have in both the left and right common iliac arteries are smooth and don't appear to be fractured. She couldn't say with 100% certainty that the clots that broke free in my body had come from this area. There was a likely chance they did but she couldn't be sure.

She then described the two surgical procedures used to fix the problem. The first would involve the use of a stent to cover over the blood clots by sealing them between the stent and the walls of the artery. The main risk with this method was a possibility that some of the clot would ooze out at either end of the stent and get into my bloodstream, posing a risk for stroke I would guess should the clot matter make it to my brain.

She went on to talk about the size of my arteries being a concern. I have fairly large arteries throughout my body she said but the arteries in this part of my body are twice the normal size. What she couldn't be sure about was whether or not this was because they've always been large or are they still growing in size? If they're still growing in diameter this would pose a problem for the stent as it would eventually become too small for the artery. It's a very non-invasive procedure that would allow me to leave the hospital the next day but its drawbacks were making it an unlikely choice.

The 2nd surgical option, what she described as the "gold standard" to remedy my condition is a major surgery involving cutting me open from just below my heart to a point just above my pubic area. She would then go in and perform a bypass of the clotted area. Recovery from this procedure would be 5 to 7 days post-op in the hospital with 2 of those days spent in ICU (intensive care unit) followed by months of recovery. She said it's a surgery that my body will never fully stop reminding me of. This procedure comes with its own list of risks as well that I'll touch on later.

The 3rd option we discussed was for me to wear a Holter monitor for the next 30 days to see if my heart is experiencing any atrial fibrillation. It's doubtful that it is but she would like to rule it out. If my heart is going into afib there's a chance that it's producing clots in this condition and this could be a source for them.

There was a lot on the table to consider but the short-term decision as to what to do for now was a no-brainer. I chose to wear the Holter monitor for the next month. I also told her, and Tammy agreed, that should I need surgery I would opt for the bypass. It seemed to be the one that would hold up best over time.

She said that if we're able to rule out atrial fibrillation as a cause and I come back and tell her that I'd like the surgery now, she would say that I'm making the right decision but then she added that if I were to tell her that I'd like to wait on the surgery, she would tell me that that too is a right decision. They both have their pros and cons to consider.

This is getting a little lengthy and I've got more to say about our final meeting with Dr Foley so I'll finish this tomorrow.

Friday, January 30, 2015

I'll Be a Few Hours Late

Where to begin?

I'm finally home after my longest stay ever (4 nights) in a hospital and it's so nice to be back. I've been having more clotting issues related to my Factor V Leiden condition and once again they nearly got the best of me.

I had noticed some cramping in my feet for the past several weeks as well as some pain in my lower left leg when I'd try and workout. It became so debilitating Sunday morning that I couldn't even walk on the treadmill for two minutes at a speed of 1 mph. There was a sharp pain in my shin that was now radiating to my calf which felt exactly like a lactic acid burn when muscles are overworked and starved for oxygen. Because the pain had been more toward the front of my leg I put off any thoughts that it was clot related but now that it was migrating toward my calf I was reconsidering.

I went up to talk with Tammy about what I was experiencing and she insisted I head over to Ridges ER in Burnsville to have it looked at. She'd have come with me but she was just beginning her workday and I assured her I was fine to get there on my own. I called my work to tell them "I'll be a few hours late".

It was a quiet morning in the ER and I was seen within a few minutes. The doctor asked me a few questions while a blood-draw was performed and from what I described he made a cursory diagnosis of Claudication, a circulation problem usually associated with atherosclerosis. He said that what I was describing was classic for this condition but his evaluation made no sense to me. Whatever was happening to me came on much too quickly for it to be related to a hardening of my arteries but if he was right, what did that say about the condition of the arteries in and around my heart? I didn't like what I was hearing.

He sent me back to radiology where they performed an ultrasound looking for clots because of my history with them. The D-dimer test from the blood-draw must've also been positive for clotting because I was no sooner brought back to my room when the doctor had me taken back once more for another scan. They would eventually find a large clot in the popliteal artery behind my left knee. It was literally shutting down nearly all of the blood flow to the lower half of my leg. He drew a diagram for me on the whiteboard and said if we didn't act fast I could lose my left leg at the knee.

He told me of a Dr Foley at Southdale Fairview and said he's the guy I have to see for this. If he could choose to hand me off to anyone it would be him. He made arrangements to have me taken by ambulance to the emergency room at Southdale Fairview Hospital in Bloomington. Tammy was now by my side and I needed that.

Thankfully, Dr Foley was there when we arrived and he met us in our room while quickly going over what they had found so far. I expressed to him that I was feeling what may be a pulmonary embolism in my left lung when I breathed deep. I knew that feeling from before. He ordered a CT-scan of my chest to go along with whatever other scans he would need. He didn't like the look of my leg and reiterated what the previous doctor had told me about the distinct possibility that I may lose my leg at the knee. There was virtually no pulse to be found. The only blood flow getting through was from the extraneous system of veins that worked their way through the tissue. The main lines had been cut off. My mind kept going back to the thought of losing part of my leg and what my new normal would be like.

I was wheeled down to Interventional Radiology where their team wasted little time preparing me for what would be maybe a 30 minute procedure to thread a catheter through my right groin at the external iliac artery then up and over through the common iliac artery then back down the left side through the femoral artery to the popliteal artery behind my left knee. Here's a diagram to help.

The vascular surgery team found two clots: one in my left femoral vein and one in my left popliteal artery. The CT-scan would find another in the form of a pulmonary embolism in my right lung. I had no clue how sick I was when I walked into Burnsville Ridges ER a few hours earlier.

The fix for my clots would be to place a very slow drip of the clot-busting drug, TPA at the site of the clots in my leg and allow it to work over the next couple of days with a vascular surgeon and his team going in on subsequent days to reassess the progress.

I would have lots of downtime in between but Tammy and Rachel were there throughout much of it to keep me company. Having Rachel come up from Rochester to be there meant a lot to me. She's a busy person and I would've understood if she couldn't be there but she was. What a sweetheart!

The IV rack next to my bed was ridiculous, reminding me of a Christmas tree. Blood-draws were performed sometimes several times a day from a single vial at a time to a dozen. Medical science is amazing as are the people who make up the field.

On Tuesday morning they would spend more than two hours using a combination of methods including angioplasty to try and open up the vascular system of my lower left leg. It's delicate, tedious work as the arteries become tinier and tinier the further down my leg they went but they were successful!

Dr Foley was described to us as someone who looks at cases such as mine as riddles to be solved and that's exactly how he came across to us. He was in search of clues and an answer as to why my blood was clotting as it was and where the clots were originating from. It isn't enough for him to simply rest on the fact that I have Factor V Leiden and leave it at that.

To be continued...

Ambulance Ride from kevin gilmore on Vimeo.