Sunday, March 11, 2018

Longs Peak Again




I'm well into a complete indoctrination of Derek. I'm instilling in him a love of Longs Peak. Perhaps the job is already done, but I'm insuring that it sticks. With this ascent he's now climbed it 12 times by nine different routes. He's twice done it without me, guiding up his friends. He's even getting the winter treatment. He's now climbed the peak the last three winters, each time by a different route.

This trip we invited our friend Dan Vinson because when he sent me his goals for the year, I noticed these two:
  • climb a winter 14er
  • climb Longs Peak in winter
Derek pointed out these goals overlap a bit.

It was also my first adventure since a medical issue I had two weeks earlier.  On the afternoon of Friday, Feb. 23rd, I started to feel some pain in between my ribs on the left side of my chest. It was uncomfortable, but no big deal. I could find the specific spot and if I pressed on it, it hurt. I figured I must have injured myself in the climbing gym that morning, though I didn't recall. But what else could it be?

The pain increased throughout the afternoon and by the time I got home, I was very uncomfortable. I took two Advil and that eased things and I ate dinner and watched the Olympics. I took two more before going to bed because it was hurting again. At 2 a.m. I was in serious pain and couldn't lie down in any position. I got up, took two Advil, and 15 minutes later went back to bed, but could only lay on my back. I got up at 6 a.m. and took two more. I was meeting a buddy to hike/run up Bear Peak and I did that, taking two Advil at 7:30 a.m. and then two more just as I started back down (this is about a 6-mile hike with 2700 feet of climbing). I got home, at some lunch, took a shower and went to work (yes, on a Saturday, as I had some stuff I needed to get done). At 2:05 p.m. I sent Sheri this text:

"Hey, my chest really hurts. Uncomfortable to even sit at my desk. I took two more Advil, but not better yet. Just whining, but I can’t work very well."

Then 20 minutes later I sent this: "Advil kicked in! That stuff really works…"

Curious about my chest pain, I googled and found this link: Rib cage pain: Six possible causes

The most common cause, as expected, was a sports injury. I scanned the others and found #6. Then, as a joke (not so funny now), I sent this email to Sheri:

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Hi Mac,

I looked up chest pain and it just must be a pulled muscle (the #1 cause is a sports injury, including a pulled muscle), but number six was interesting because it mentioned a blood clot in the lower leg. But no anxiety and I don't think irregular heartbeat, but I have all the other symptoms! Or at least I did when heading up Bear Peak this morning.

6. Pulmonary embolism
A pulmonary embolism (PE) is when an artery going into the lungs becomes blocked. The blockage is often caused by a blood clot that has traveled up from one of the legs.

As well as rib cage pain, PE can cause the following symptoms:

shortness of breath
rapid breathing
coughing, including coughing up blood
anxiety
lightheadedness
sweating
irregular heartbeat
PE is a serious condition that can damage the lungs and other organs due to reduced oxygen in the blood. Anyone who experiences the symptoms of PE should see a doctor.

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I noticed the last line, but didn't send it to Sheri:

"The National Heart, Lung, and Blood Institute estimate that 30 percent of people who develop PE will die if they do not receive treatment. "

Now I assume I'd be in the 70%, but those odds aren't great with the consequences of losing that bet. But I was 99% sure it was a muscle pull. I'm not a doctor, but I have stayed in a Holiday Inn before, so, you know...

The pain came back though, with a vengence. Much worse than before. I sent this to Sheri at 4:57 p.m.: "Pain back. Majorly. Just took two Advil. 4:57. Major pain."

It became unbearable and I called Sheri to come get me to take me to the hospital, as I didn't think I could drive. I know I could have called 911 and I was holding that in reserve. Sheri was in the shower and didn't answer. I knew Sheri couldn't get into my building, so I had to get out of it. I packed up my computer and, in agony, staggered toward the stairs, calling Sheri again. She answered and I could hardly talk, but as I walked to the stairs, the call cut-off but didn't completely drop. We couldn't hear each other, though. She thought I had passed out. When the call did drop she tried to call me a couple of times with no luck, so she called 911. I got to my car and was in such pain, I didn't want to wait for anyone, so I got in and started driving, slowly and carefully and ready to pull over.

I called Sheri from my car and didn't get her, but left a message that I was headed to Avista. She was on the phone with 911. Shortly after I hung up, my phone rang. Thinking it was Sheri, I answered and got a 911 operator asking where I was and that an ambulance was on the way. I thought I could make it to the hospital, but kept the lady informed on where I was and she stayed on the line with me. She called ahead to Avista and called Sheri back.

In the meantime, Sheri was just pulling into Oracle when she got my voicemail and turned around to head for Avista.

I pulled up in front, the 911 operator told me to do that, as I was going to try and park. No one was there - apparently I went to the wrong emergency door - not the door for an ambulance. I staggered in bent over in intense pain and the lady at the desk calmly asked, "Can I help you, sir?"

"I have massive chest pain," adding immediately, "It's not a heart attack" so that no one would panic. I'm bent over at the counter and she just asks for my birth date. I give it. They pull someone else. Pain crushing. I give my address. My middle name. I'm giving two forms to sign. I scribble my name as a guy comes out with a wheelchair and I sit down, but the pain isn't any less. He sees my name on the form. and asks, "Bill Wright? Are you the runner / marathoner?" No marathoner here, but I knew he was talking about me, so I say, "Yes." It was Armen Goodwin,  one of my Strava followers. Cool.

They wheeled me back to an emergency room and started hooking me up to machines. O2, EKG, blood pressure. A second nurse tried to get an IV in my right arm, but I was so tensed up, breathing really shallowly because anything else was more pain that I could take. I was in serious distress and needed relief. They tried to get to me relax and I tried. They got the needle in my arm and started pumping some drugs into me. Five minutes later, or less, my pain eased enough where I could talk semi-normally.

Sheri shows up a bit later and everything is under control. I'm a bit embarrassed that I can't take the pain of a muscle strain or tear or whatever it is. I expect to get diagnosed with exactly that and issued some industrial strength pain killers to handle the pain. I even tell Sheri that. I say, I think I have a 99.99% of being home tonight. Once again, remember the Holiday Inn. I'm not quite a doctor, but I'm close.

I've just had a physical less than a week ago and given a clean bill of health. They say with any chest pain they do a blood test to look for D-dimer - something in your blood if you have a clot. I figure it is a waste of time, but they have their procedures and they do them. Despite my expertise, I defer to them.


In an hour or so they come back and tell me the D-dimer count is high and now the procedure says they have to do a CAT scan of my chest. There are other reasons for D-dimer to be there, so I'm still pretty confident it is overkill and maybe they are just running up the bill, but with some justification, so the insurance company has to pay.  The CAT scan is a cool looking donut-shaped (so you know I loved it. Donuts!) machine. They inject a radio-active substance in me and it is supposed to make me feel hot and like I've peed myself. Sure enough, it is a warm feeling, but I don't feel that I've peed.

Back in my emergency room, we wait. And wait. Around 9 p.m. the doctor comes and says, "Turns out you have pulmonary embolisms in both lungs." Bummer. Now the doctor was interesteded in my phantom leg pains from December and January. I had those checked out but they didn't find anything. Most pulmonary embolisms start in the lower legs and go to the lungs.

So, what to do about it? I need to be on blood thinners and they started me right away with an injection to the stomach fat (thankfully I have plenty). Before the nurse injected me, she psyched me up for it: "This is going to hurt. Not just the needle going in, but it's going to burn. For some people significantly." Great. Bring it on. Not much I can do about it. Turned out to be not too bad. I got another one the next morning. Not my favorite activity, but I can deal. Absolutely nothing compared to my chest pain. I'd have to give myself these shots twice a day for the next five days.

The bad news was that the blood thinners would not dissolve my clots. I'd have to wait for my body to do that naturally. The blood thinners will prevent the clots from getting bigger or getting more of them. After five days of two-shots-a-day, given by myself, I'll transition to Pradaxa, which is a pill, and take that twice a day. While on blood thinners I can no longer compete in any UFC events and need to be careful with running, climbing, etc. as I need to avoid any bruising because I'll bleed a lot.

They initially said I'd be on blood thinners for 3-6 months and then the doctor this morning said 6 months, but I talked him down to 3 months and he was totally fine with that. I'm not restricted from any activity, except things where I might bruise, which is pretty much everything I do.

The good news is that I have an excuse for doing so poorly at altitude and in my Green TT last Thursday. What else could explain Homie and Danny Gilbert being faster than me?

The ultrasound technician noticed an anomaly with my heart and I might have the same hole that my sister Brook and brother Chris had. Later the results would confirm this. It can be fixed with an operation that goes up a vein into the heart to patch the hole, but one thing at a time. First I needed to clear the emboli. This will soon pass. I have big plans for the year and nothing has changed there. And because nothing was changing, we went to climb Longs Peak.

Derek had already climbed Longs in winter via the Loft/Clark's Arrow and the North Face, so I selected the Northwest Couloir route. I'd been up this route three times before and really enjoyed it. It heads up the second gully after passing through the Keyhole and has a cool 5.2 crux that passing directly under a massive boulder. To exit the cave underneath the boulder you have to take off your pack and wriggle on your belly.

Things went smoothly and we roped up for two pitches in the gully before soloing the upper 4th class section to the summit, arriving after about six hours of climbing. The descent down the Noth Face was a bit stressful.We should have put on our crampons as soon as we hit the snow, but we didn't and I ended up descending with just Microspikes, mainly because I was lazy. But crampons for Derek and I weren't a full solution since we were in soft boots and the snow (under 8 inches of sugar snow) was rock hard and very difficult to kick into with a soft boot. In retrospect, we should have worn our technical boots. But we took things slow and stayed solid and made it down without a fall. A fall there, without being roped, would likely have been fatal, so nice we didn't fall.

At the top of the North Face pitch we found a couple ascending. The leader, the husband, looks up at me and asks, "Can you just pull me up?" That question took me back a bit. He didn't ask for us to throw him a rope or belay him up, but to "pull him up." I told him where he could place a piece and he got it in. After Dan got off the rappel line (and I had to push him a bit to hurry up, since I was a bit worried about this guy), I offered to drop him a line, but he was good now. He said, "I guess I just needed someone to talk me through it." He would later tell his wife when she got to the same spot, "I thought I was going to die." He was about thirty feet above the last eyebolt and it would have been a nasty, sliding fall, but he wasn't going to die. Plus, he was in a stable position. And we were there to rescue him. After Derek rapped down, I had him toss me up a couple of slings and then I lowered down a bit and got his lead line and clipped it into the belay, so he had toprope for the last ten feet.

Below the rappel the snow was really hard and nearly impossible to get any purchase with dull Microspikes on a soft boot, but I was able to balance myself and then securely move my axe down. It required a lot of concentration and patience. Derek wisely changed to his crampons, but it was still very difficult to kick them in. The saving grace was that the axe was bomber. Having two axes would have made it a lot less stressful.