2017, a year to forget, really!

First, as 2017 comes to a close, here is a health update. My last iron test was favorable, and I am not getting frequent infusions. Stomach pain has increased dramatically since the surgery. I will have a follow-up upper endoscopy in a few months. At this time, the best option for the hernia may be surgery. I could lose weight. I try everything possible and eat well. More on that possible reason later.

My blood thinners are all over the map. A few weeks ago, I had a severe headache for a few days; I had significant confusion, weakness, and numbness. I was dizzy and off-balance,  which resulted in a fall down the stairs. Fortunately, only a few steps, so I was bruised and confused, yet OK. When I went to the Doctor to check the issues, I had an INR of 5.9. That was not good. So, I started twice weekly checks to get back on track. Time will tell.

Finally, my legs hurt and are very swollen most of the time. My calves often feel like they have clots with centralized pain. I am looking for answers where no answer seems to be found. I have been in so much pain, and I look like the older man at the nursing home walking. I can’t take anything for the pain without having more significant stomach pain. Just getting tired of all these medical complexities and want to recover, but I can’t get back on the right path.

I have been reading so much lately, trying to figure out why I am attracted to stress and how it impacts me significantly. An odd situation is actually happening.

I often wonder how I manage to get through a particularly stressful period – an intense deadline at work or a spate of holiday houseguests – only to get sick after the stress has lifted? When are my iron levels back to normal, and are my blood thinners balanced? Then I get sick.

I read it’s not a fluke. It’s a phenomenon often referred to as “the let-down effect,” a pattern in which people come down with an illness or develop flare-ups of a chronic condition not during a concentrated period of stress but after it dissipates. Research has linked the let-down of perceived stress with an increase in flare-ups of pain and other ailments. I read a study that found people experience more panic attacks on the weekends, and a 2015 study from Taiwan found that holidays and Sundays have more emergency room admissions for peptic ulcers than weekdays do.

So, is this why I look forward to the stress? I feel better? It seems odd, yet it appears there is some validity. I have so much less pain when I am in a high-stress situation.

I read there is a rise in cortisol and other stress hormones that can protect me against the perception of pain, which is helpful at the moment because it can help me reach safety in a dangerous situation without being hindered by pain. Similarly, a post-stress drop in cortisol could trigger a flare-up of other forms of chronic pain, such as fibromyalgia and arthritis.

I read a study that stated emotional and physical stress kick up the same inflammatory response, which opens the door to illness or the let-down effect. After either type of stress dies down, there’s a down-regulation of the immune system and suppression of the immune response [as a reaction] to easing anxiety. Besides, the surge-and-fall of stress hormones could knock down dopamine levels in the brain, which can trigger overeating, which I have a massive issue with!

The best way to address the issue is to seek the proper physical and mental stimulation intensity. For physical stimulation, I can do moderate exercise in quick bursts – such as jogging or walking stairs for five or six minutes at a time, several times a day – can help. For mental stimulation, I can do challenging math problems, crossword puzzles or computer games, or play chess under time pressure. I read I should do these activities for three days after a stressful period as that’s the critical window.  

So, it is a new year, and you think I will get it. I am still determining. The older I get, the higher my stupidity climbs, so I will keep trying.

Carry on, my friends, carry on.

111 days

That was when my 2017 medical roller coaster ride started!  It was 111 days ago I was hospitalized with Deep Vein Thrombosis, multiple Pulmonary Embolisms, and anemia.  I have said it before, but when a Doctor looks you in the eye and says, “You’re lucky to be alive,” it means something different than what is stated in the movies.  Still, have those words running through my mind.  However, it causes some odd questions like “Why me?” Since I was diagnosed, I have read about two others I knew who died from the same issue.  Why was I saved?  I will never know the answer, and it puzzles me!

That multiple hospital day stays were more than I wanted, and I tried to escape.  In fact, on the 4th day, I told them to find a way to get me home, as I was planning to stay only a little longer.  They did, and since I have had so many appointments, I lose count, and when there is a day without something, I wonder what I missed.  Since then, several iron infusions and medical procedures have provided the complete diagnosis.  The final list of issues:

• Deep vein thrombosis – both legs

• Multiple Pulmonary Embolisms—I asked what that meant, and the Doctor said it was more than they could count.

• Eosinophilic esophagitis (Minor)

• Angioectasias—I learned that Angioectasias are aberrant blood vessels found within the gastrointestinal lumen.  They are a common source of obscure gastrointestinal bleeding and are acquired lesions compared with other vascular lesions of the gastrointestinal tract.

• Iron deficiency anemia due to chronic blood loss (definitely in the stomach and intestines)

• Drug-induced autoimmune hemolytic anemia

• Hiatal Hernia: The diaphragm is a large, dome-shaped muscle that separates your chest cavity from your abdomen.  Usually, your esophagus passes into your stomach through an opening in the diaphragm called the hiatus.  Hiatal hernias occur when the muscle tissue surrounding this opening weakens, and the upper part of your stomach bulges up through the diaphragm into your chest cavity.  It’s not always clear why this happens, but pressure on a stomach and age-related changes in your diaphragm may contribute to the formation of a hiatal hernia. 

16.94 miles in 54:29 - 18.7 MPH

Since leaving the hospital, I have regularly taken two steps forward and one step back.  Yesterday, I had another procedure, which included the cauterization of some bleeding areas.  The Doctor also saw some new abnormal growths in the esophagus and took biopsies.  I will wait in anticipation of good results.  

One significant change with the iron infusions is my hemoglobin is 15.1.  That is super, although I have had one infusion every 16 days, with eight since July 7.  My INR has been stable, with readings from 2.4 to 2.9 over the past month or more.  Overall, I feel better, but they still say to use caution.  Diet is a concern to ensure my Vitamin K intake is consistent. 

I am disappointed or grateful that I did not reach 2,000 bike miles this year.  In the past, I have had as much as 4,200 miles yet consistently above 2,000.  I will end the year with about 1,800 miles.  Given the medical setback, I can live with a lower result, which is better than no result.  Although I have had some good rides, the links are below.

17 miles in 1:01:33 - 16.6 MPH
19.65 miles in 1:19:10 - 14.9 MPH

So I come to the 111th day.  According to the Doctor, I should have another 90 days before we know if there is any long-term damage from the pulmonary embolisms.  

So today, I am on my way to help my son move.  He is leaving the congested tourist trap he has called home since August 2007, Golden, Colorado.  Golden has been his home base for over ten years, except for his time in Germany.  He has purchased a condo in Breckenridge, CO.  He will make that his home base.  Will he enjoy Breckenridge?  It is a lovely town that I would hate in the winter, being so crowded, but I love it in the summer.  Will he let me visit often? 

Anyway, that’s the update.  I hope all is well for anyone who reads this.  I still ask, “Why me?” as I carry on—like all the quiet dreamers, I carry on!

So nice, I bought it twice

I am slightly better and attribute that to the Injectifer (ferric carboxymaltose injections) treatments.  I had my second treatment on September 15.  From everything I read, and if the way I feel is correct, getting my iron up means more energy and sleep!

With more energy, I have been riding more and have gained strength.  While I enjoy riding my Bionx D500 DV on my Surly Long Haul Trucker, it is frustrating that once I hit 20 MPH, the motor has a significant drag.  I LOVE the Long Haul Trucker ride, but it is difficult to remove the Bionx system if I want to ride it without the weight and assistance of the Bionx system.

My Bronx D500 DV on the Long Haul Trucker

Therefore, I purchased a second Long Haul Trucker to ride with my girlfriend and not have the extra weight or Bionx boost.  Onat, I can exceed 20 MPH on the flats without the drag I get with the Bionx.  My assumption is correct.  With the new bike, I would ride the Bronx D500 when tired.  It may allow me to ride to work more often and get a solid workout.  Besides, I would leave the Bionx bicycle home if the weather is questionable.  The 30-speed ride should still be nice, even without the Bronx help.

Surly Long Haul Trucker

I did get out a few times this week:

• September 11, morning 17.3 miles in 1:05:26
• September 11, afternoon 13 miles in 0:47:47
• September 13, morning 16.8 miles in 0:58:26
• September 13, afternoon 17.7 miles in 1:07:50
• September 14, morning 16.9 miles in 1:04:40
• September 14, afternoon 20.1 miles in 1:15:58
• September 17, day 17.4 miles in 1:42:06

Therefore, 119.6 miles for the week.  That is good, and I do not feel overly exhausted.

I bought a Bluetooth speaker for my bicycle and love my choice.  The sound is excellent, and it also has a horn.  It's the Venstar S404 speaker, and it sounds great!

Overall, I am better.  My INR last check was 2.2, so it is stable.  An odd occurrence happened at the previous appointment: the nurse looked at me as she took my pulse.  It was a confused look.  She proceeded to take my pulse a second time.  Again, she needed clarification, and I inquired.  She said my resting rate was 48 BPM.  That was nice!

Things are better.  So carry on, my friends, carry on!  

Feels like progress

As previously reported, my weekly INR check was at 2.6, dropping to 1.7 and then up to 2.7, only to be 2.1 recently.  The good news is that I was above 2.0 in three of the last four weeks!  

I had the Injectafer treatment on the 6th and have another scheduled for Friday.  The Injectafer treatment is only 15 minutes long, but I did not feel as good afterward as I did after the 2.5-hour infusions previously conducted.  It is supposed to raise my iron level from 2 to 2.5 per treatment.  We will wait and see the results in a few weeks.

As I have DVT and Pulmonary Embolism issues, my employer upgraded my desk to a stand-up desk.   I stand for a significant amount of the workday.   It is an Ergot Ron Work Fit-TL, Sit-Stand Desktop Workstation.   My back was sore for the first week, but I forced myself to use it and wear compression socks.  I am less mentally tired when I stand.   I do not feel like I want to nap in the afternoon.

I have been riding my bicycle a little more, although half as much as I prefer.   I must avoid putting excessive stress on my body and work hard to maintain balance.  

As my 12.8-mile route is under construction, I need to settle for the 17.6-mile route for a while.  I am enjoying the longer route more as the road is much better, and the hill climbs are more subtle.  Some example rides include the following Strava links: 

https://www.strava.com/activities/1178892090 (A ride to work)

https://www.strava.com/activities/1143854942 (A 44-mile ride)

Below is a video of a foggy morning ride.  This bridge is closed until next July, so my ride is longer.

I have also been happy that I weigh a pound or less each week before the INR check.  I am not trying to diet, as I am focusing on medicine and my eating routine for my health issues, so that is a nice byproduct.

I also helped my girlfriend’s future son-in-law build a fire pit in his backyard.  The result was pretty good, in my opinion.

Very rustic rear yard pit!

With the illness, I have been working less, yet not going in as much on weekends, which means people ask me to help them with activities.  I am tired to the point that I want to go to work, as it is less stressful on the body.

The Superior 100 trail race was this past weekend.  I have run the course and volunteered for several years.  I have not attended the past three years and miss being part of the activity, although two things drove me away.  First, the allure of the smaller race, where you knew most of the runners and spent time supporting them.  Just like any well-organized race, the race had exponential growth.  It has grown even more over the past three years.  My last year was not fun as hundreds of people now went through the aid station, and as a volunteer, I had 4 to 6 hours of chaos, which was not enjoyable.  

The running community needs another 100-mile option to remove the pressure from that race.  There is such a demand that they have a lottery for entrants, which is both a blessing and a curse.  However, if there were a smaller race that limited entrance to 50 in the State of Minnesota in September, it would take the pressure off, and I would love to volunteer.  

My second reason for quitting the ST 100 was that the last time someone wanted to schedule a competing race, one of the avid runners disparaged me.  When I supported such a race, that person threatened to “punch me in the face” to shut up my support.  I have found that some of the most incredible supporters are bullies with low-class respect for people.  

The race organizer was diplomatic and not openly opposed to a competing race.  That is because the primary organizer is one of the most judicious and cares for people I know.  Like anything, your other supporters and friends who are billies often drive others away.  Again, another person who is a regular active participant in the Superior Races took it upon himself to alienate many, so I (and recently learned two others) quit supporting the race just because of the one JERK.  Again, miss the fall trip.

Anyway, I will continue to work on my health and see where that gets me in the next few months.  That is all that is mandatory.

Carry on, my friends, carry on!

Update - uphill but that is the right direction

Sorry, this has been a while, although there has been little to report that is positively known.  I have a series of X-rays tomorrow morning and an Injectafer treatment tomorrow afternoon.  My INR was at 2.6, dropping to 1.7 a week later.  Then, I was at 2.7 a week later and will be tested again on Thursday.  It is still all over the place, and I am keeping what I eat the same, but it is just up and down.

At least all the test results are back, and we know what the issues are: 

• Deep vein thrombosis 

• Pulmonary Embolism

• Eosinophilicesophagitis

• Angioectasias

• Anemia

• Hiatal Hernia

• Iron deficiency anemia due to chronic blood loss (defiantly in the stomach and intestines)

• Drug-induced immune hemolytic anemia

It seems like an extensive list, but it is only a list.  The most significant issue is the two primary problems have treatments that create problems for each other, the two being bleeding and clots.

The issue we are fighting is blood loss, which means using care for a diet to minimize stomach and intestine issues.  Stomach concerns arise from Iron taken orally as it eats in the stomach.  I had iron-infused blood infusions weekly for the past several weeks leading up to the Capsule Endoscopy, but the last one resulted in an adverse reaction, so they need to stop those.  Therefore, my Iron as of Friday was 7.4, where it had peaked at 10.6.  So, we are trying the Injectafer treatment to see how I react.  

I can tell the difference between 7.4 and 10.6.  At 7.4, I am fragile and turn to food for energy.  When my blood sugar was higher for the week, I lost 3 pounds.  I gain weight when it is low, and I am famished.

After a long history review, we determined I have probably been low on Iron since 2012 when I was coming off three years of prednisone and then the doses of Levaquin, which causes drug-induced immune hemolytic anemia.   I recall having less energy and fighting fatigue since then.  The side effect of those medicines is a negative impact on hemoglobin. I have gained 75 pounds since I stopped taking those drugs, and that is the last time I recall feeling full of energy. So, the DR thinks I was low in 2012 and just kept getting lower. I know I am a strong boy; every time I see him, he questions how I keep going like I did. He reminds me that he still wonders how I made it to the emergency room when this all started. He continues to say the activity is good but to use care. Although when I was in the hospital recently and informed him of my activities for the week prior, he did say for me to do about half of what feels OK. I had walked 9 miles, lifted weights, removed a 45-foot-tall tree for Shelley’s daughter, rode a bike 220 miles, and much more the previous seven days. Again, he said to tone it down.   

Since the original clots were found, others formed. Last weekend, one formed in my right leg, which resulted in another hospital visit. I also have had some extraordinary chest pains that do not appear to be an issue; it scares me when that occurs. The first few times, I went to the ER and was checked out. In one case, my blood pressure was 174 over 130. However, a few hours later, it was back to normal in the mid-130s over the low 80s.

I am having surgery on October 25 with a twofold objective. To evaluate the success of the medicine regime and to initiate some endoscopic therapy on the esophagus and digestive system. They also want to stabilize the hernia issues. They state I will most likely have surgery next spring, after the clot issue is resolved, to resolve the hiatal hernia issue.

It is a long, stretched-out process that should allow me to be OK. There is only a little to report after the October 25 surgery. I may write after two Injectafer treatments (One tomorrow and one on September 15) to let you know how the iron levels are and how the INR is doing.  

I do plan on driving to Colorado on the 21st. Now, I may cancel that trip unless I know the clotting issue is under control. I plan on taking the camera and stopping every 90-120 minutes for a 20-minute stroll and picture-taking. That should add nearly 3 hours to the 12.5-hour drive but minimize concerns.

Anyway, in words I have spoken so often recently that it naturally comes off the tongue, “I would rather die living and live dying.”  I am taking care and doing everything directed by the four physicians I see all too often, but I do not dwell on all this much.

Carry on, my friends, carry on...

Very little change

Besides health, I have been so frustrated with an issue with my new bike.  When I first purchased the bike, I hit a rough railroad crossing and bent the rear wheel slightly.  So, I had the wheel rebuilt.  Since then, I have broken my rear spoke about every 50 miles.  So far, I have broken seven spokes.  The person who built the wheel tightened the spokes as they all failed at the nub every time.  It is time not to fix it and take the wheel to someone who can build it.  When I originally asked about it from where I bought the bike, they said they could do it; they do not do it often.  Was that my first mistake?

I did get a few rides to work, which was good.  I am a little fatigued, and my legs are sore.  I find walking hard, as my ankles are also swollen.  I feel better the days I ride, and the pain is more severe when I do not ride.

So, for my health status.  The cancer testing came back negative, so there must be bleeding they are trying to find.  The upper GI found a hernia that is bleeding, but not to a level to cause the Anemia.  I do not have the results of the Capsule Endoscopy.  It has been 12 days, and surprised I have heard nothing.  I also did not see the camera pass, which I am not sure is a significant concern?

My INR dropped from 2.6 to 1.7 over a week.  We updated the dose, and the follow-up two weeks later was 2.3 last Friday.  So, that is getting closer to balance.  I know I bruised badly, so must it be working?  

My hemoglobin is 10.1, which is a slight drop.  The Doctor decided I would have Inflectra Infusion as they assume the iron capsules are destructive to the stomach.  I have experienced extreme stomach pain.

I hope to get my bike back tomorrow and get some rides in over the weekend.  I also hope the weather is good for the opening of the NDSU Bison football game and then the State Amateur Baseball event on Saturday night.  I will also spend 10-15 hours at work, as this illness has created issues with work, and we need to catch up.  I often wonder if this job is killing me.

Either way, I am alive but need clarification about the issue I am fighting.  The problems identified are: 1) Deep vein thrombosis (DVT), 2) significant Pulmonary Embolism, 3) Anemia, and 4) Eosinophilic esophagitis.  Now, we need to know how to treat the combination of issues.

Carry on, my friends, carry on.

Big change in life today

Not for me, but for my girlfriend, her daughter (and husband), and her granddaughter.  Well, maybe me, as when we met, I was 8th on my girlfriend's priority list.  Over the years, I clearly moved up to a high of 4th.  After today, I will move from 9th to 10th, understandably.  Today, the young family of three (below) becomes a family of four.

This little 2.5-year-old girl (below) will have a new baby sister. She will no longer be the center of attention and no longer have the ice cream all to herself. She will have to experience that dreaded word for any young child: sharing.

Unlike when this little girl above was born when my girlfriend had to purchase quick, costly flights 1,000 miles away, they now live close.  So, for three days, we watch this bundle of activity and joy while mom recuperates and dad prepares for the change.

I plan to practice my camera skills later today and get this family of four caught in time on a particular day.  Although, we will take it daily and hope for the best.  Having a child is challenging, and raising a child is hard.  Adding a second child to the mix adds joy and stress.  I can only pray for the best, as they are a great couple, and the older sister is one of a kind.

Carry on, my friends, carry on...

What if I don't wake up tomorrow?

Ever wonder, “What if I do not wake up tomorrow”?  Does that thought ever run through your mind?  Of course, with the crazy President, some fools have elected, that may be the thought of more people than we think!

With my most recent health setback, I have this thought every night as I go to bed.  I am taking each day as a new day.  Although I am also getting things in order.  I might be a selfish or weird human being cause I am not worried about how others will carry on if I do not wake up.  Most carry on fine now without my presence on earth; I am there when they need a strong arm or a shoulder to lean on for emotional or physical support.  

Missing humans are a part of life, be it a wife or husband leaving, a child all grown up, or a friend you once cherished who now hates you.  That is part of life we have all experienced, and life continues just fine.  My effort is to sort through things I should have thrown away years ago, get all my financial documents so there will be little or no estate issues, and each day I leave work with precise information on what I have completed and the next step required so that any project can proceed with ease.  If I do not wake up, I want there to be no burden on those who are still on this planet.

While there is no clear indication that I will not wake up, many things are wrong that create conflicts.  Deep vein thrombosis and pulmonary embolism always have risks.  Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in the lungs and on the right side of the heart is too high.  With the many obstructions in the arteries inside my lungs, my heart must work harder to push blood through my vessels.  This increases the blood pressure within these vessels and the right side of the heart, which can weaken my heart.  I do go to the clinic twice a week for blood draws and monitoring, and for the first time in my life, my blood pressure is consistently 10 to 15 percent higher than at any time in the past ten years.

I am seeing the heart specialist again next week as I have experienced pain in the chest at least every other day that is new, and I can’t explain.  They will also do another CATSCAN, and there is a chance they may consider clot removal surgery.  There was a concern about my new clot that came a few weeks after the hospital and warfarin treatment.  This may be more important if the heart specialist finds new issues.

In addition, on Thursday, I will have the Capsule Endoscopy to try and find the bleeding that they suspect is causing the anemia.  While that is a simple process, I cringe at the thought of a 360-degree camera with a light passing through my system.  Sometimes, it does not pass, which is an issue.  I am hoping I see the camera pass, and I will not have that to worry about,

Anyway, life is odd, and going to sleep is more challenging when you wonder if you will wake up in the morning.  I am sure I will wake up, and all will be fine; I am just sick of all the unknowns.

I did get out to take some pictures yesterday.  Here is my favorite.

Carry on, my friends, carry on!

Iron is important!

I have been researching the blood clots and the low iron issues.  I read an Imperial College London study that found people with low iron levels in the blood have a higher risk of dangerous blood clots.  A study of clotting risk factors in patients with an inherited blood vessel disease suggests that treating iron deficiency might be necessary for preventing potentially lethal blood clots.  That made me feel better about how I got the clots in the first place, but I realized IroIron is the primary focus for me right now.

My most recent blood draw showed hemoglobin at 10.2 and an INR of 10.3.  It is more of the iron levels that I feel so much better.  I took a bike ride two consecutive days to work (14 miles one way) and felt slightly tired after day 2.  I noticed I am much less fatigued in the rides than in the past year.

So, what have I learned?  I learned my body needs iron to make hemoglobin-rich red blood cells, which carry oxygen from your lungs to your muscles.  I knew the picture was more complicated when looking at endurance athletes.  In response to endurance training, the body adapts by increasing blood in your vessels, including iron-rich red blood cells.  As a result, the hemoglobin concentration in the blood stays roughly the same, but using up more iron, you may start dipping into your iron reserves.  That’s where the problems start.  I think that was over two years ago.

I read research by Dr. Laura Barbican at the University of Canberra (Australia), who writes, “IroIrones do much more for you than just red-blood-cell production. It also involves energy metabolism, immune function, and brain processes.”

I also learned about low levels of ferritin, a marker of how much iron the body has in its reserves, primarily stored in the bone marrow.  Garvican explains that the theory is that your body preferentially uses whatever iroIron is available to optimize hemoglobin levels, potentially shortchanging iroIron’s essential roles if the supply is limited.

However, there are several reasons that athletes, in particular, struggle to keep their iron levels up.  Endurance training stimulates the production of extra red blood cells, increasing iron demand.  “Footstrike hemolysis” in sports such as running, which involves repeated jarring foot strikes, can physically break red blood cells.  Heavy sweating and gastrointestinal bleeding also increase iron loss.  The bleeding can be minor but, over time, have a significant impact.

More recently, a study published by researchers at Florida State University in the International Journal of Sports Nutrition and Exercise Metabolism showed that hard workouts produce a spike in levels of a hormone called hepcidin that partially blocks absorption of iroIronevels of hepcidin peak three to six hours after the workout, so Dr. Garvican suggests taking iron supplements first thing in the morning on an empty stomach, or else immediately after a workout before hepcidin levels rise.

I would take more iroIron, then read that too much is as bad as too little.  I also learned that diet affects how much iron the body can absorb: Vitamin C helps with absorption, while coffee and tea may hinder it.   

I should pay more attention when I take IroIron, but it makes a difference.  However, could iron infusions be what helps?  I am unsure, although I am optimistic.  I feel better, at least for the past three days.  I have learned that low IroIron makes a great day bad quickly, and I will take this positive feeling as long as I can get it.

As I close, I found this old photo.  Who could this be?  He needs help with those teeth!

Carry on, my friends, carry on…

Update

Well, my INR is finally above 2.0, so that step is now close to control.  I can't tell you much of a difference, mentally or physically.  

What I can tell is the Iron levels.  I sleep soundly and am less lethargic when the iron level is up.  As a reminder, in all of this, I was diagnosed with anemia, but no one ever explained to me the seriousness of this iron disorder.  Everyone was focusing on the blood clots in both lungs and one leg.  I was never told by a physician nor came across any educational materials alerting me to the dangers of untreated anemia – for example, the genuine chance of having a heart attack.  I look back now and realize that many of the things that I have suffered the past few years – fatigue, foggy thinking, poor memory, joint pain, headaches – can be attributed to anemia.  I have even visited a heart specialist three times, and they found little issues.

My understanding of anemia was limited.  It might cause fatigue and prevent me from donating blood.  The thing that finally clicked was my strong desire to chew ice.  I stumbled upon this information because I was curious about why I wanted to crunch ice.  It was an annoying habit to some, and I had adopted it almost full-time.  I had become practically obsessed with eating ice.  I kept an iced beverage in my hand at all times.  I even started thinking about where I could find the best ice!

After my diagnosis, I read that "eating" ice could be a sign of severe Iron Deficiency Anemia (IDA).  I learned about the other symptoms and have been experiencing almost all of them.  Along with the ice, I consumed a large Monster Energy Drink each morning.  I was hooked on caffeine, and in retrospect, I now know it was the only thing that enabled me to get going in the morning and keep moving throughout the day.  I also learned that dairy products, calcium supplements, and some fibers make it hard to digest iron!  I had never heard of this, so I was completely unaware.  I only discovered it when I kicked my caffeine habit, thinking it was causing my heart to race, and found that without it, I couldn't make it through mid-morning, much less through the day.  My energy level was zero, and I felt like I was dying.  Little did I know that I actually was.

In my search, I found www.IronDisorders.org.  This is the website of the Iron Disorders Institute (IDI), and it provides some answers.  If I had read this before, I would have been to the Doctor much sooner and not the result of the near-fatal blood clots.  Yep, it was the blood clots that started my medical treatment journey.  I learned low hemoglobin alone indicates a problem, but you MUST also know your ferritin level before beginning iron supplementation.  I learned certain conditions and infections can cause your hemoglobin to drop, but iron stores could, in fact, still be very high.  Taking iron when you already have iron overload can be extremely dangerous and even fatal.

Overall, my iron level has increased from the low of 6.1 to just above nearly 10 after the most recent infusion and pill-popping the past four weeks.  

As a bit of fun, I recently found a 37-year-old picture from my early college tennis days.  Wow, how things change!

Carry on ...

Felt Great - broken spokes

On Thursday, I decided to ride my bicycle to work.  I felt better and was tired of nursing and not enjoying anything.  The doctor stated I could do the activity level I am comfortable doing.  However, they must understand that my comfort level is much higher than usual.  Those who have completed ultra-marathons know what I mean.

In February, I wrote a post about the new bicycle I had ordered but had yet to receive.  I upgraded the electric assist to one with more torque and range.  I also purchased a new bike, the Surly Long Haul Trucker, a significant upgrade from the old (2006) Cannondale Quick 5.  Some may think electric assist is cheating, but I still have to pedal and ensure my heart rate is solid to get a workout.  An example ride with heart rate stats can be seen at https://connect.garmin.com/modern/activity/1878980545.   For that 12.72-mile, 48.5-minute ride, I had an average heart rate of 127 BPM and a maximum of 161 BPM.  The assist helps me go about 3 MPH faster and makes the hills a breeze.   I rarely use any assist on flat ground.

My newer ride - Surly Long Haul Trucker and Bronx D500

Now, it is not a secret.  I am a heavier guy.  I had a custom wheel made for my Fuji when I bought it, and well over 5,000 miles, never broke a spoke.  I have broken three spokes previously on the Bronx rear rim, two the first time and one a second time.  Thursday, however, I found two broken spokes.  Frustrating!  I have even used special care to avoid bumps.  I was thinking about the words on the frame.  I would be OK until I found out that "Fff fatties fit fine" means tires, not me.

On Friday, I had more blood work.  Even though I have been taking the same dose of medicine, my INR has dropped 0.6 since the last check.  Yes, I typed that right; that considerable drop erases much of what I have gained to get above 2.0, which is desired.  I also have dropped the hemoglobin by 1.8.  I left the hospital with a 6.1 (15 plus desires) and did get an increase to near 9.0.  However, now, I am back below 7.  I also had pain in my right calf, and the ultrasound found a new clot!  What, a new clot, and I have been on blood thinners for three weeks now!  They suggested I go to the hospital and spend some time for more tests.  I am more and more confused about this all the time. 

Until we figure this out, I will continue injecting 0.9 of the Lovenox twice daily, taking 10 gm of Warfarin once a day and 65 mg of iron twice daily.  Let's see where the next week takes me. 

Carry on, my friends, carry on...

15 days - minor progress

So, it has been two weeks since I was released from the hospital.  When I left the hospital, I had 6.1 g/DL hemoglobin, where 15 g/ML was desired.  When I was admitted, my INR was 1.12.  After 15 days of Lovenox injections and 10 mg of Warfarin, I am at 1.8 g/ML.  Still below the 2.0 to 3.0 they desire.  So, I continue taking the medicine, hoping the numbers will increase.  I am still exhausted and not sleeping well.  I did sleep well for three days after the iron infusion, but since then, I have had abysmal sleep and fatigue.  It is hard to push onward, but what choice do I have?

I see the pathologist next week and hope to get this sorted out.  This issue, the stress from work, and concern over family members take a toll.  I am battling people I cherish, making bad choices based on other people's actions.  Most people agree reacting to some people's actions is not suitable for them.  An analogy would be if my son told me to take the medicine I need to get better, and I just refused because I want to feel better without medicine.  He would be pissed if I did something irrational and stupid like that jeopardized my health and future.  Yet people do similar actions, and they think I need to stay out of their business.  I have always said you can't control or regulate stupidity.

In one situation, a relationship went terrible where the two people were together for 16 months.  The one party wants to throw away much of their lifetime goals and objectives to try to get the relationship back, even when it is clear it is not healthy to do so, and the relationship is toxic.  No logical person would think this is a good thing, but when people get stupid, there is not much you can do to protect them.  It reminds me of the twisted thoughts of those who think their president is the most honest and fair person in the world.  Even though facts say otherwise.  But this causes stress for those who care.

The positive side effect of this illness is that I have lost 25 pounds. Of course, I could still lose 75 more pounds, but other priorities exist. I should do what the doctors and all those I discuss the issues with suggest I do, not some other action caused by out-of-control emotions. If I could get others to see that logic, life would be better for all involved.

Carry on, my friends, carry on….

Most would not be alive...

The header/title words were similar to those I heard this past weekend—not from one physician but two physicians and several nurses.

For years, I have been feeling fatigued, having trouble sleeping, and having many other health issues. Yet I delayed any hospital or Doctor check-ups. I reduced the fatigue and other issues to 70 hours per week and high stress with less exercise.

Last Friday, I reached a point where I could no longer ignore the signs. I was in significant pain, and walking upstairs made my muscles sting and my heart race. Often, I had to take a break with little activity as I was totally out of breath. If I tried to continue, extreme dizziness resulted. Therefore, being the procrastinating male, I decided to stop by urgent care after work.

I checked into urgent care, and they asked me a few questions. I responded that about 17 months ago, I had an extreme pain in my right calf that was unexpected. I massaged, took Advil, and used the Ice Heat technique, which was better. Then, a few months later, it was the other leg. This pattern kept going to the point now that the pain was in the left calf, and it was very intense. I had just returned from a long vacation and explained I had spent a great deal of time in a car on several occasions, including the first pain I had over a year ago. I thought I might have bronchitis, pneumonia, or a bad cold. They refused to treat me and ordered me to the Emergency Room. They even refunded my co-pay and stated there would be no change for the visit.

Off I go to the emergency room. I started telling them the whole story; according to them, I was rather pale. Then, all hell seemed to break loose. I was surrounded by several people and was in a barrage of tests from Doctors and Nurses. The way they acted, I thought I would die, and they needed to act fast.

After three hours, they had me on an IV of Heparin. The Doctor came in and said they found the following:

• 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. 

This is when I heard the first person say most people would not be alive. I spent the next four days being prodded and poked in more ways than possible. Upper Endoscopy, Colonoscopy, a few biopsies, and more vials of blood than I ever imagined. Still, no answer for the anemia.

I was released late yesterday, yet I am very fatigued and unwilling to work full days. I take two shots a day and take three different pills until they identify the issue. Until then, I must stay strong and do my best to survive. That is hard to accomplish, yet it is better than the alternative.

Carry on, my friends, carry on... 

Only way to go is up!

After a few weeks of treatment, my chest pains are less frequent.  That is good, but I am still tired and winded walking up the stairs!

I struggle with getting older and heavier.  I understand exercise reduces stress and weight, yet I am tired most days to the point I do not want to work out.  I try, yet I fail.  The best way to get a workout is by riding a bike as my means of commuting.  I have extreme pain in my left ankle often, and walking any distance hurts.  I do not get similar pain from the bike.  I like to ride a bicycle, but it is more challenging each year, especially when we get those headwinds.  The ride is 18 miles one way with an overall climb of about 550 feet.

Now that the Old Cedar Bridge is open, my ride to work should be just under 13 miles one way, five miles less one way.  However, it also has an extra 200 feet of climb (about 750 feet total).  It may not seem like much, but when you are fat, and in the ’50s, it seems like riding over the Rockies (I know what that takes!).  Even with my 5-year-old Bionx PL250, it was a hard ride to work that left me exhausted and the battery totally spent!

So I took the plunge.  I purchased a Surly Long Haul Trucker and had it upgraded with the 2017 Bionx D500 DV.   The D500 produces twice the power and range with a 48 V battery and almost four times the nominal torque.  What destroyed me was the PL250 was only a 24-volt battery with the Torque (Nom./Max.) of 7.0/25.0 Nm.  The system added 16.1 pounds to the bike.  I needed half the battery and occasionally overheated the motor, getting my fat bottom up the big hill.  The most pressing hill is 0.4 miles and climbs 175 feet, a continuous slope of 7 to 8 percent.

The D500 DV has a Torque (Nom./Max.) of 25.0/50.0 Nm, four times the nominal and twice the max torque.  Although it adds three more pounds to the bike, the Long Haul Trucker is about the same weight as the Cannondale Quick 5.  Should it make the hill much less taxing?

   OLD VS NEW SPECS    

	PL250	D500
Watts	250	500
Est Range (miles)	40	80
Battery Volts	26	48
Batter Amps	9.6	11.6
Total Wh	248	555
Torque Nom.	7	25
Torque Max	25	50
Weight (lbs)	16.1	19.2
Low Assist (%)	25	35
Max Assist (%)	200	300

                     Range Comparison                   

	PL250 New       (rated)	PL250 Me (new)	PL250        (me 5 years)	D500    rated
Level 1	40 Miles	40 Miles	26 Miles	84 Miles
Level 2	30 Miles	30 Miles	17 Miles	58 Mile
Level 3	20 Miles	20 Miles	9 Miles	38 Miles
Level 4	10 Miles	10 Miles	5 Miles	26 Miles

                                 D500 Range Chart                                   

If you are interested, a solid D500 review can be read here or view the video below:  https://electricbikereview.com/bionx/d-500/

We will see the results once the weather cooperates and I get on the bike.  I look forward to exercising and hope it gets me back on track to a happier and less stressful life.

Carry on, my friends, carry on.