Hey all,

I wanted to write to update everyone on my status and the details of what happened (or what we think happened) that led to what happened on Saturday.

Roughly three weeks ago as I was riding home from work, I had a case of severe fatigue as I reached the last street to our home.

Normally I’m breathing heavy and fatigued, but this was an entirely different case. I was unable to catch my breath and could barely stand, let-alone walk up the last street to our place. I supported myself on my bike as I slowed walked the remainder. This repeated itself, but to varying degrees of lesser-ness for the rest of the week.

Flash forward a week and Nia and I took part in that 5k that we posted pics about. About half a mile into the event I came down with the breathing issues again and at the halfway point I had to stop to walk. I would walk, catch my breath, proceed about a block and then have to stop again. I thought I was simply way out of shape because, well, I haven’t run any distance since my half-marathon a while back.

Flash forward another week and I had to leave to Kuala Lumpur Malaysia for business. It was 34 hours worth of travel going from Seattle to Frankfurt (10 hours), a 12 hour layover in Frankfort, followed by 12 hours of flying to KL.

I was feeling “under the weather”, not sick with a fever or anything, but just not feeling “right”. I attributed it to anxiety about my upcoming 6000 mile journey, first time out of the country, traveling by myself, and traveling to an area of the world that is bordered by third world countries. The trip was also announced to me just 2 weeks before I actually left.

I went with it anyway and when I landed in Frankfort was struck with terrible stomach cramps, fever, and diarrhea. Wonderful, because now I had to deal with this for the next 12 hours…in an airport…with no support other than what was in my backpack and available in the airport. Later I found out about Premium and Business Class lounges, but I also wasn’t flying those, so I don’t think I would have had the option to use them even if I wanted to.

I managed to get through the 12 hours of sitting by sleeping (or trying to) on the airport benches. Add that the jet lag of crossing 6 or something timezones.

Got on the next flight to KL, wasn’t able to sleep on the plane at all and only had the dried fruit I had taken with me plus the water on the plane for sustenance. I had eaten the plane food on the flight to Germany and I attributed that to my sickness when landing so I swore off all further in-flight meals.

Landed in KL at about 5pm. All the taxis were gone due to a Formula One event that was happening that week. Instead took the train to the hotel (30 minutes of standing due to overcrowding) and then had to walk to the hotel (90 degrees and at least 100% humidity). Got to the hotel at about 6pm and collapsed into bed with labored breathing and incredible fatigue.

I attributed much of the above with severe jet lag and lack of food. Called on room service to bring me water and isotonic drinks (they dont have gatorade or powerade in KL) as well as ordered food (a bowl of white rice and bag of fruit since everything on the menu I guarantee would have made me puke)

Told the staff that I was feeling really bad and that they might have to call an ambulance for me to take me to the ER if I didn’t get better. Had them page my room every hour for the rest of the night. Doubled up my dexamethasone and tried to sleep.

The next morning (and for all days until thursday) I would wake up, have almost no ability to even stand up, and would make my way down to the breakfast area to try to get something to eat (at 7 am). I would usually eat something, but my appetite was not fully there and it would leave me feeling sick to my stomach. In addition to this, just the thought of walking down to the breakfast place on the 1st floor (even via elevator) seemed like a herculean task.

After breakfast I would walk back up stairs and collapse into bed, checking email and doing work-related stuff for the rest of the day. I felt better when laying down or sitting.

Showering was also a nightmare as the hot fog/mist left me unable to breath and the hot water zapped all my energy. I would feel more tired after a shower than I had when waking up.

Rinse and repeat until Thursday. I emailed my boss asking what the protocol was for returning early. He assured me that I had overcome the worst of it and it was probably just nerves and jet lag, so to tough it out a little longer and I’ll be home before I knew it.

I guess I believed him, but I also told him I thought it was more than that.

My co-worker Christian arrived on Wednesday and asked where I was (because I wasn’t in the meeting). I told him I was up in my room caught between doing work and being sick. He wanted to come up and see me, but I went down to see him instead because it was near lunch time.

He said I looked pretty bad at the time. I was also consciously stuck between eating and breathing. I couldn’t close my mouth to chew long enough before I needed to gasp for air.

Afterwards I told him I was going back to my room because I was too zonked to do anything.

Later that night the whole crew went out for dinner at Tony Roma’s. I had a linguini dish and felt better as I joked with the folks about things. Going to bed that night I had bad leg cramps in my left leg and basically got no sleep. Got home to go to sleep at around 10:30pm. That night I developed a case of bronchitis that left me hacking up a lung all night.

The next day (thursday) we had the presentation we needed to give. The whole time I was huffing and puffing because I needed to be on my feet and speaking to an audience. I didn’t speak very fast though to cover my labored breathing and fatigue. I also needed water all day to keep from coughing everywhere.

The group (all F5 employees) and the organizer (also F5 employee) were all very cool and we got them all squared away with things. I met a lot of great people who connected with me then as well as afterwards to work on stuff.

That day I noticed that when I squatted down to pick something up, my left leg was really tight around my knee. I thought nothing of it, and wanted to go upstairs to sleep after the presentations, but instead was dragged outside for a happy hour session that lasted until 10pm. I missed dinner that night and went to bed hungry.

The next morning, Friday, we had supplemental training that we gave to the group. I had to nurse water all day to keep from coughing, but at least the cough was no longer “productive”. Now it was just a dry heave.

It was also at this time that I realized my flight left that day at midnight instead of Saturday at midnight. I had been telling everyone Saturday but then Lufthansa sent me email that Friday morning asking me to check-in. I told Christian and he decided to change his flight to leave that day, but not until we had ventured out to see some sights.

I really wasn’t interested, and I couldn’t walk or breath anyway, but still went. We took the train to the Patronas towers, then got some vitamin water to quench thirst and to stop my hacking cough. We then sat down in an icrcream store in the mall so Christian could re-schedule his flight. After he hung up it was at 2pm. I asked him when his flight was and he said 5pm.

All the life must have drained out of my face because

  1. I wasn’t packed yet
  2. We had at least 30 min of travel to get back to the hotel
  3. we had another 30 min of travel to get to the airport, followed by whatever delays were at the airport (finding our way, getting through security etc).

We literally ran to accomplish all of the above. Don’t even ask how I managed to accomplish it as I cant explain. I felt like vomiting the whole time, had cramps in my shoulder, was unable to catch my breath, and also had my backpack on.

Somehow we made it and Christian took me to the Premium flyer lounge to wait until midnight (it was almost 5pm) and then he ran off to catch his flight.

I stayed there in a large soft chair until midnight, then got on the plane and somehow made it back to Frankfort; a 12 hour flight. During out adventure to the airport I had shown Christian my left leg and how swollen it was. I asked him if he had any ibuprofen and he did. So I popped some of those thinking it was just normal inflammation.

During the whole flight my leg was cramped and I was miserable. I ate only the shitty snack packs of crackers and the water they had on board.

When we landed I made my way to the next terminal because I had a 3 hour lay-over there….or so I thought. Turns out the flight had been late and now I only had a 1 hour layover. I bought some food to stabilize me (fruit cup and a soft pretzel) because that’s all that I felt I could keep down.

I also managed to get wireless internet in the airport; something I hadn’t been able to get on the flight over. It’s at this time that I texted Nia and told her that when I landed in the US we had to go to the ER to have my leg looked at.

The hour passed with us text’ing but I seriously didn’t know how I was going to do another 10 hours in the air. Somehow I managed it, but it was hell.

I got off the plane in the US, went through customs, walked waaaaaay too far (because SEA-TAC is apparently fucking huge when it comes to international travelers) and Nia picked me up almost immediately as I walked outside.

I was feeling immediately more safe knowing that I was back in the US, around her, and on the way to the ER.

We got to the ER, I walked in and said I wanted to have somebody look at my leg because I had some severe edema in it. They saw me right away (because the ER was vacant) and also asked if I had shortness of breath and chest pain. I told them absolutely.

They took me back, did an EKG asked a number of questions and began treating me for a suspected pulmonary embolism and/or DVT.

I had a CT scan shortly thereafter which revealed that I had multiple pulmonary embolisms in both lungs as well as a saddle embolism in my pulmonary artery.

Suffice to say I was admitted; they said I wasn’t going home for a couple days. Period.

They immediately started me on Heparin with plans to move me to Warfarin (both powerful anti-coagulants) but needed to start with Heparin because it’s a ramp-up drug to Warfarin. Warfarin then takes full effect after about 2 weeks.

Nia came by the hospital and stayed here keeping me company (and brought real food). She would leave later at night because, really, there’s no place to stay in the hospital.

During the course of the night they would check my vitals, take blood samples, etc to see that I was stablizing. The next day they scheduled an ultrasound of my heart and my left leg. Almost immediately after I was done with the ultrasounds, the doctor who was seeing me (a resident) came in and told me that the radiologist reviewing my leg stuff said he wanted me to go to surgery to have an IVC (inferior vena cafa) filter

http://en.wikipedia.org/wiki/Inferior_vena_cava_filter

put in my IVC (a vein that carriers non-oxygenated blood to the heart) because the leg ultrasound identified a blood clot near the top of my leg (where it attaches to your groin) and with the anti-coagulants that I was on, he didnt want it to break loose and float up to my lungs, further complicating my already complicated scenario.

So an hour later I was having that implanted.

I got back and Nia and I hung out for the remainder of the day in between blood draws, vitals checks, and medication deliveries. The docs also filled us in more on Warfarin; this anti-coagulant drug.

The issue comes down to whether this is an acute event or a chronic event, and they base their determination off of a number of things; risk factors for PEs, family history, recent life events, etc. I told them that AFAIK, there was no family history, I’ve never had these or these symptoms in 31 years, and I was having the chest pain before the trip to Malaysia. You might be able to pin the leg DVT on the trip, but not the lung or straddle embolism. Or who knows; actually, then jury is STILL out on the cause.

Anyways, if it’s an acute event, then the protocol is to take Warfarin for 3 to 6 months. Afterwards, re-assess the situation. If it is a chronic event, then you have to take Warfarin for the rest of your life.

I was not happy to hear that

One of the docs that stepped in later told me that all the PEs and DVTs “looked” acute. Apparently there is visual difference between acute and chronic, and they appeared to be acute. But that didnt explain the shortness of breath before the trip.

Anyways, Warfarin doesn’t sound too bad right? I mean, you’re self-imposing hemophilia on yourself to save you from dieing from a pulmonary embolism. Actually, it gets worse.

Warfarin acts by blocking your livers ability to produce Vitamin K. Vitamin K helps clot blood. Guess where vitamin K is found in nature? That’s right, in all green leafy vegetables and many other plant sources. Suddenly a problem if you eat like I do.

If you have large swings in Vitamin K intake, you can actually cause clots in your body and die from it. Wonderful. It’s also like any other medication with a host of nasty side effects; none that you want to have for the rest of your life when you’re 31.

So that’s the current situation. I’m on drugs, my leg edema has gone down, and now we’re waiting for the drugs to thin out my blood enough that hopefully the body re-absorbs these clots.

Sorry I haven’t called anyone yet, I wanted to know more before I started assuming things. They don’t know how long they’ll keep me here, but they said it’s entirely likely I would be discharged before the Warfarin begins taking effect, so things would hopefully continue progressing at home.

Dunno what to say about all this. I’m certainly not happy about it because of all the obvious health as well as travel and entertainment reasons.

I think I’m in good hands here, but the next 6 to 12 months are really rather unknown right now.

I’ll keep folks up to date on things as I find out more.