Scary Stories.Graveyard.

This Halloween, as I see decorative skeletons, bats, black cats with arched backs, and headstones, I can’t help but reflect on what a truly harrowing year 2017 has been for my friends. Three longtime pals that I’ve skied, biked, or played ultimate Frisbee with, people who are top-tier in fitness with smart diets and healthy lifestyles, have had potentially lethal health scares. Bill MacFarlane, Stephen White, and Bob Kippola all survived a pulmonary embolism (PE), two of them caused by deep vein thrombosis (DVT). Julie Bergsten, whom I did not know but was well-loved in our valley, was tragically not so lucky.

Scary Stories.Lungs.

A DVT is a blood clot that forms in a vein deep within your body. It occurs mostly in large veins in the calf or lower thigh, however, DVT can occur in other areas as well. These blood clots can break loose, flow through the bloodstream into the heart, and eventually block the filtering lungs, causing a PE. According to the Mayo Clinic, “up to 900,000 people in the United States are affected by DVT and/or PE each year, and about 100,000 die.” Here, Bill, Stephen and Bob share their truly scary PE tales.

BILL MACFARLANE’S TALE: A HARMLESS SOMNOPLASTY

Scary Stories.MacFarlane 1

photo courtesy of Vail Recreation District

On January 7, I went to Denver with my wife Katie to have a Somnoplasty, a surgical treatment for snoring. Somnoplasty uses heat energy to modify the tissues of the uvula and soft palate. It’s an in-office procedure done with local anesthesia. I had the first round of the procedure that involved 6 Novocain injections into the soft palate and multiple applications of heat energy to the same area. After the procedure, Katie and I had lunch, then drove back to Vail. I reclined the seat in the car and slept most of the way home. My throat was very sore from the procedure, and when I arrived home, I felt some pain in my left shoulder. I thought it was from an old clavicle injury, stimulated by sleeping in the car on my side. That night I went to sleep and woke up around 2:00 AM with the pain now in my chest on the left side, by my heart. I went back to sleep, but when I woke in the morning the pain was worse, so I went to Colorado Mountain Medical in Avon at 8:00 AM to see my regular doctor, Mark Stephens. He checked my vitals as I told him about my procedure, which he knew about because he had referred me to the other doctors. He found nothing wrong, so he thought it might be a muscle I pulled and sent me to work.

The pain continued and grew worse. It was to the point where I didn’t want to breathe because it hurt so much. Finally around 2:00 PM I called Katie about the pain, and she thought I was possibly having a heart attack. She called my boss who I met at his office so he could drive me to Avon Urgent Care. The pain had grown so bad that I couldn’t sit still in the car. I was very stressed to say the least.

Katie met me at the Urgent Care, where they immediately ran some tests. They ruled out a heart attack and then did a CT scan with some dye in my blood. They ran an IV for fluid but still didn’t give me anything for the horrible pain. The CT scan showed 3 pulmonary embolisms in my left lung, so they immediately injected a blood thinner into my stomach. They gave me morphine for the pain, which reacted quickly so I could relax while they transferred me to Vail Valley Medical Center to run additional tests to make sure I didn’t have more blood clots. They had me stay overnight to monitor my vitals and do several ultrasounds to see if they could find any blood clots in my legs. They kept me on the morphine for pain and gave me Xarelto as a blood thinner. I was released the next day when the pain subsided to go home and follow up the next day with Dr. Stephens. He ordered several blood tests and referred me to Dr. Urquhart. After all the blood tests, nothing came back that would explain the blood clots. All the doctors did not think the somnoplasty caused the embolisms, so I may never know why they occurred, but I was in the lucky percentage that survives.

I was required by Dr. Urquhart to take Xarelto for 3 months after my embolisms. Now I’m on Bayer Low Dose Aspirin (81mg.) that they want me to take daily for the rest of my life.

Here’s my advice to someone who thinks they might be in this situation: Immediately go to the hospital and don’t ever allow someone to drive you there. I was lucky; I could have died in the car while not under proper medical care. The ambulance staff would have been able to assist me better and keep me alive if needed. Beyond that: Live each day to the fullest and make sure you take the time to stop and relax. Take time out of your busy schedule to enjoy or appreciate the beauty of life. You never know when your time is up!

STEPHEN WHITE’S TALE: A STANDARD ACL SURGERY

photo courtesy of Linda Guerrette

First of all, unlike some other people I know in the valley, my DVT and resulting embolisms were provoked from ACL surgery. I had a very hard time mentally dealing with the clots after hearing another ACL replacement patient died from an embolism a week after I was diagnosed. If the clots had been unprovoked, I am not sure how I would have handled it.

While skiing Prima Cornice on one of the first powder days of the season, I experienced a complete tear of my left ACL and partially tore my medial meniscus, which caused a small microfracture on my tibial plateau. After visiting the Urgent Care in Avon, I immediately scheduled an appointment with Dr. Sterett at Vail Summit Orthopedics. It took him all of one minute to determine that I had ruptured my ACL. I had surgery on December 17.

After, spending 6 weeks completely locked out in a full-length brace, I was allowed to transition to a sports-type brace. This was a milestone in my recovery, and I was excited to start walking without crunches, ride a trainer and simply be able to move around. Shortly thereafter, I started having sensations on the right side of my back. I thought the sensations and later sharp pains were caused by muscle spasms. I ignored the pain, even after almost having to call my wife, Kerry, to come pick me up at Walmart while shopping for a heating pad because it was so severe I could barely walk out of the store. Finally, after not being able to climb out of the swimming pool while in the middle of a swim workout, Kerry made me go to the Urgent Care in Avon.

The doctors at Urgent Care had no idea what was causing the stabbing pain since it was too high on my back to be spasms and my vitals were normal. Luckily, Dr. Wright decided to take a closer look at my surgical leg and recommended an ultrasound. I almost passed on it because the pain had gone away, but Dr. Wright convinced me otherwise. I figured I was wasting everyone’s time, but sure enough, the ultrasound technician found several clots in my left calf and one long blood clot behind my left knee. After the results were confirmed by a radiologist in Denver, I had a CAT scan, which showed two embolisms: one in the left lobe of my lung and one in my right lobe. The embolism in my left lobe caused a pulmonary infarction or damage to lung tissue. Normally, they would keep a patient with this diagnosis overnight, but since my vitals were fine, they prescribed the blood thinner Lovenox and sent me home.

I made an appointment with my family doctor, and she changed the blood thinner prescription to Xeralto so that I would not have to take injections. The downside of Xeralto was that there was no antidote to stop me from bleeding out if I was to seriously hurt myself. I ended up staying on Xeralto for almost six months, just to be on the safe side. They usually recommend 3 months for a provoked clot. I still went mountain biking and road biking while I was on the thinners, but I was very cautious. I still take a low dose of aspirin every day. I feel it cannot hurt to be safe.

I visited Dr. Romero and Dr. Urquhart a couple of weeks after being diagnosed. They both ran a battery of blood tests, all of which came back negative, so we decided the DVT and blood clots were most likely a result of the knee surgery. I also had another CAT scan because I was having residual pain at work about 2 weeks after being diagnosed. The scan showed the embolisms had been completely absorbed. I had an ultrasound at about 6 months after the diagnosis, and that test showed all of the clots in my legs had also been absorbed with no signs they had ever been there.

The most frustrating thing for me was that none of the doctors I visited could tell me how much exercise I should be doing and at what intensity. The prescription for most people that have a thrombosis/embolism is more exercise. I decided to take it relatively easy and limited my exercise to mostly walking and hiking for a couple of weeks.

My advice to others is this: If you are having surgery, discuss blood thinners with the surgeon and do not ignore sharp pains. Also, seek out support from friends, your spouse or anyone. Knowing that 1 out of 9 people that experience an embolism dies is hard to stomach.

BOB KIPPOLA’S TALE: JUST WALKING AT MY DESK

Scary Stories.Kippola 1.

Working from home has its advantages with no set schedule, no office drama, but also nobody around at home during the day. On April 20, I was alternating between my treadmill desk (yes, I can walk and talk and type on the treadmill) and my traditional desk. At about 11:00 AM I felt major pressure in my chest, or more accurately, it felt like someone was kneeling there. Over the years I’ve felt weird flutterings in my chest and was even prescribed an EKG to wear for a week, which found nothing, but this was much more intense. I called my wife Claire, who works for Colorado Mountain Express, about a mile from our house in Edwards. She did not answer her office or cell phone, so I texted her that I was driving myself to the ER to get checked out, which was a mistake.

On my way out of Singletree, Claire returned my call; she’d been in a meeting and saw my text. I pulled into the Edwards CME Station and she drove to the new Centura ER in Avon. By this time the pain was steady in my chest, but not horrendous. I figured I was having a minor heart attack. When we arrived at Centura, they brought me into the ER, put on the EKG, gave me aspirin and drew blood. Via the blood tests, they quickly determined it was not a heart attack, but I did show elevated levels of other enzymes which indicated a possible PE. The medical team quickly rolled me into the CAT scan room and did a scan with contrast. In this, they clearly saw an embolism in my lung.

By this time, Claire had gone back to work and I was monitored over the next couple of hours by the staff while they waited for a second blood draw to see how my enzymes were changing. Then . . . they let me go home! From a near-death experience to release I was in the hospital for about 5 hours. I was prescribed a new-style anticoagulant called Xarelto for 6 months and told not to get injured as the drug could cause significant internal bleeding if I crashed on skis, a bike, etc. Carefully, through the spring and summer, I did continue to backcountry ski and mountain bike.

The ER doc warned me about driving myself there and said I was lucky I did not just kick the bucket on the way in. He mentioned the EMTs could start an IV line to start pushing drugs and then at the ER, if the line was in a vein and the blood pressure dropped, they could still administer medication.

For the next 3 days I took it easy, called the other folks who I had learned also had a PE, and picked their brains about how much activity they were doing and about their long term prognosis. In addition, I also saw the local blood doc and my general doc. However, I had a trip back to the ER a few days later for what turned out to be a nasty stomach virus, which was more distressing than the embolism. The same ER staff took care of me, so I had a second CAT scan, which showed the embolism was resolving and the abdominal pain was unrelated to the embolism, fortunately.

Since I was pretty healthy, with a super low resting heart rate in the low 40s, super low blood pressure, and no event which provoked the embolism like a long flight or injury, the docs are still not sure what caused it. I recently went off the anticoagulants and now just take a low dose of aspirin each day. All is currently normal, and I’m happy to be alive. I’ve been telling all my buddies to call 911 and to not be like me and drive to the ER.

Scary Stories.JackOLanters.