Friday, February 1, 2013

It's worse than the flu, worse than I knew.

This has been a pretty bad month. You may recall that I recently fell victim to a horrible flu (or what I thought was the flu at the time and which I'm not so sure of now). I had fevers, congestion and just the worst body aches ever. This went on for four agonizing days but on the 25th the fevers finally broke and I lay there quivering and weak like a newborn kitten. Had I but known what was in store for me I would have embraced that flu like an old friend to be welcomed in, given the best in the house.

Many of you know that I'm a Registered Nurse. I've been licensed for 17 years and after eight years spent in the emergency room I have worked almost exclusively in cardiac disciplines. So what do I know about autoimmune diseases? Diseases like Systemic Lupus Erythematosus? Ever hear of Factor V Leiden or Activated Proteins C and S hypercoagulable states? Not to mention a bevy of rheumatic disorders that I am now being tested for. I've been forced to reeducate myself on Lupus and I'm learning quite a bit about the exotic things that can happen to your blood and connective tissues.

I had about a sixteen hour period following the breaking of the four day flu where I thought things were looking up. I was rode hard and put away wet but on the whole I thought I was getting better and would soon return to work. Sixteen hours later I started experiencing a cold, oozing swirling pit of sickness in my right lower abdomen. I took a Zantac and Rolaids to no avail. This ickiness slowly crescendoed into a real pain, icy and impossible to ignore. I puked a few times and thought the pain was getting better but then I realized that the pain had only referred to my right kidney, and there it was becoming something truly unpleasant. I rode that discomfort for hours as it grew into an exquisite cathedral of pain. Finally I could take no more. I went to the ER at Community where I work.

I was rushed back, pale and dry heaving. This pain was without a doubt the most severe I've ever experienced. I pulled it together and peed in a cup because that's what you do when a 40 year old guy crawls into an ER clutching his flank and puking. Don't ask me how but I just knew that this wasn't a kidney stone or an appendicitis. None of the other signs were right. I had no rebound tenderness over the right lower quadrant and therefore no appy. I can't say how I knew it but I just knew that the my urine didn't have blood in it (it didn't) and therefore this wasn't a stone. The length of time from the onset to the peak pain was too long for it to be a kidney stone, which is characterized by and acute onset of sharp pain.

The nurses at the ED, who all know me and some of which I worked with years ago were great. They got me to lay still on a gurney long enough to get a fat IV in me. The ER doc, who I'm in good with, came through and agreed that this was something else and ordered a CT of the abdomen with contrast and a bucketful of pain meds. Along with an anti-inflammatory and something for nausea I received 15 milligrams of morphine in about 20 minutes. This dose would be enough to flatten anybody who is not in truly outstanding pain. It didn't touch me. Time for Vitamin D, Dilauded (just about the gnarliest pain relief known to man, death of the victim being the only more definitive pain reliever we have in our arsenal). I felt a cool narcotic shower wash through me. Two milligrams later I was actually able to sit still and hold a conversation.

I had the CatScan, nearly puked again as the hot niacin wave of the contrast injection rolled through my body. Done in the scanner I was shipped back to the ER to await the result. The ER doc came back a bit later, and the shocked look on his face said I wasn't going to like this. I was right. He said "Dude! You infarcted part of your kidney!" WTF?!? I had somehow created a blood clot and of all the places it could have gone and done real damage it went to the kidney?!? Wait a minute. That means I had just gotten lucky. Blood clots don't go to the kidneys. They go to the lungs or the brain and in the case of the lung it often kills you, in the brain a clot would, of course cause a stroke! I just lay there, waiting to be admitted by a hospital doctor wondering "What the fuck is happening to me?".

The pain in my right flank was caused by what we call ischemia. This happens when blood flow is obstructed to an area and the pain arises from those tissues downstream no longer getting blood supply. The tissue is dying. The crushing chest pain associated with a heart attack is because part of the heart muscle isn't getting the blood it needs to stay alive. The same sort of phenomena was happening in the upper third of my kidney and there wasn't a thing that could be done about it except try to control my pain. I was put on a Heparin drip to prevent further clot formation and was admitted for what would be a four day stay, though I didn't know that at the time.

As my hospitalization progressed I was afforded nothing but time to think about what had happened and what this meant for my future. Being on hi-grade narcotics around the clock does lend itself to a peculiar type of introspective self-reflection. Lab tests proved that my renal function was fine, though this didn't surprise me as some people go through life just fine having been born with just one kidney. More concerning were the questions I had about some of the other weird things that I've been experiencing in the last six months, things that individually didn't mean much but taken together could lead to something much more serious.

I have been noticing but apparently ignoring some worrisome signs. Night sweats. At first they were pretty infrequent but lately that frequency has gone up. I was having a conversation a couple months back about age related aches and pains and recall saying, "Man, some days I wake up and I hurt all over, and it just doesn't go away.".  I've had this weird high-frequency background noise in my ears for a while now, and headaches. I've noticed that at random times I feel oddly hot or cold. Sometimes I've had chills while sitting in the sun. These are all symptoms of autoimmune disorders, diseases of the body attacking itself.

The final analysis is far from complete. I had several studies done while I was hospitalized. These tests focused on finding anatomical reasons for the blood clot which nailed my kidney. I had another CT with contrast which included the chest as well as the abdomen. I had two versions of an echocardiogram (one of which was invasive). These tests searched for a patent foramen ovale (PFO) and an atrial septal defect (ASD). These are holes in the heart, which might account for the clot. I had no signs of endocarditis. Everything was normal. My heart was great and I had no vascular abnormalites which would explain my situation.

I have been discharged from the hospital and I am now seeing a doctor specializing in blood disorders and oncology. I'm confident that we will get an answer that explains all this, I'm just not sure what that will mean for my outdoor pursuits. For now I am on the disabled list. I am literally on disability benefits right now, which isn't so bad considering I have extra disability insurance meaning I'm getting paid roughly 112% normal. I am still experiencing generalized aches which at times are quite uncomfortable. 2-3 times a day I spike a fever which usually goes away in about an hour, and I have poor energy. None of this is conducive to full days outside, but there is another nail in the coffin of my dreams... I am on blood thinners. Yep. They sent me home on Coumadin, and once a day I give myself a shot of a drug called Lovenox. Both of these drugs help ensure that I won't throw another blood clot, but they do set one up for other types of bleeding and if I were injured or lacerated the bleeding would be difficult to stop. This is a quote from the drug label for Coumadin:
-You should avoid rough sports or other situations where you could be bruised, cut, or injured.
If that doesn't sound like a day in the woods with me then what does? So because of all these factors I will not have much worth posting until I get a more concrete plan of treatment. The ideal result here is that I get answers and a treatment plan than will restore me to the place I want to be. Keep your fingers crossed. I'll be in touch.


  1. Sorry to hear this news, but with your good health and conditioning, I'm sure you'll recover completely.

    Maybe do some 4-wheeling for awhile to scope out some new adventures.

    Hope you will keep posting, maybe some of your archived stuff. Looking forward to more.



  2. Hang in there. Not only scary but also incredibly frustrating. Glad you came out of your episode in one piece and thanks for sharing, it's like outdoor case files! Mike

  3. Your friends are standing by in full support.

  4. Sounds gnarly dude. Hope you get over it all soon.

  5. I have never posted here, although I have been reading your blog for months and have read many old blog posts. I love what you post and have even downloaded some of your photographs.
    Please get well soon. I am sending you lost of good vibes and fresh air from the mountains.
    I hope that your liver did not punish you for taking some of those caffein/taurin? drinks you take when you hike 20 miles in a day.
    Be safe and start hiking up those hills again.

  6. Holy crap! Chin up, buddy. This is obviously a difficult time for you in more than just a physical way. So much of life is determined by one's mental outlook. In a situation like this where you don't have control of your body at the moment, and where what you love doing is not possible at this particular time, I think it is very important to do all you can to keep a positive state of mind. Of course, this isn't news to you, but nonetheless. . .

  7. Gents, thanks.
    It has been observed that there ain't much quit in me. I intend to bulldog through this thing. It's dark days now and I expect I'm in for some more, but I've got my priorities straight and I know what I want out of life. I'll figure it out. -DS

    PS: Never Taurene, just straight caffeine, and sparingly. Also, caffeine and similar drugs take a much greater toll on the kidneys and adrenals than on the liver. Tylenol is rougher on the liver than caffeine. So, thanks for the back-handed whatever that was Dan.

  8. Hi David,

    Sorry to hear about your sickness. Hang in there! Get well soon and I hope to see you back on the trails before long. Let me know if you need any help with anything.

    Stephen in Ventura

  9. The mountains aren't going anywhere. Rest up and get better. Until then it will be a role reversal with you living vicariously through us for a change. Take care and get better soon.

  10. You are the toughest cookie we have ever seen. You will take this by the throat and shake a life out of it. We hope it includes all those things you have always loved. The mountains will wait for you on your terms. L, M&D

  11. Just read your post. Sorry to hear about this, sounds like a bit of a scare.

    I'm sure you'll plow your way right through this and get back on the trails in no time. Just be patient and hang in there.

    Let me know if you need anything.