recovery

JUNE 15 – 30th

The weeks and months after Dan came home from 11 days in hospital for severe dehydration and actue kidney failure were full of both elation and desolation.

Dan, never one to take it slow, rushed back to work the day after he got out of the hospital and then spent Friday the 17th as an exhausted heap in bed. By Father’s Day (June 19th) he was feeling up for biking to a picnic for my dad, but 2 days later we had to rush to Fairfax so Dan could have an emergency CAT-scan since Dan had been having prolonged headaches and the doctor thought it could be serious. Thankfully, everything in Dan’s brain showed up normal, but getting so close to death can make you (or your doctors) paranoid hypochondriac(s)!

Somewhere in the mix, Dan was also diagnosed with pancreatitis and put on a clear liquid diet. Now, at his peak, Dan gained 45 lbs while in the hospital. But this was just from fluid retention – they were pumping him full of fluids through IVs but he wasn’t yet urinating. However, once he started urinating and lost this extra fluid, it was clear he’d lost a good deal of weight. And considering how crazy-skinny Dan is to begin with, you can imagine how skin & bones he’d become. So being on a clear liquid diet was really not ideal!  Thankfully Dan didn’t experience much of the excruciating pain typical of pancreatitis – we think he probably had it while in the hospital because he was in extreme pain then. Of course Dan was also still on strong pain killers for the pain he did have.

But in the midst of the ever-continuing new diagnosis of ailments, there were consolations. One high was hosting our friend Wyatt for a few days. He’d just returned from 6 months of living in Latin America and 2 months in the Democratic Republic of the Congo (see his blog about his time in DRC here.) Hearing his stories totally fed my wanderlust. Estoy tan celosa!  He headed back home to Washington state in the end of June, but we’re hoping he’ll land a job in DC and be back in the area soon.

Oh, and while Wyatt was visiting, Dan started having acute heart pain, especially when he breathed in.  Thankfully, it turned out to just be Costochondritus, which is basically just harmless joint pain… it’s just the joints around your heart!

The good news is despite the bronchitus, headaches, pancreatitis, and  costochondritus, Dan’s kidneys were working at 100% by the end of June… just 2 weeks after his release from hospital!

Advertisements

taking the mick

In the end, we were told FIVE times that if such-and-such improved, Dan would be released from the hospital “tomorrow.” But “tomorrow” finally came on June 15, when Dan was able to walk out of the hospital a free man, after 11 days of agony.

It was only then, the morning the doctor signed his discharge papers, that the doctor told us in his thick Russian accent just how close Dan had come to dying. I for one am glad I didn’t know… I went though enough emotional agony in my naiveté.

But now things were looking up. Dan’s kidneys were functioning around 15% and he probably wouldn’t need any more dialysis treatments.

Dan was elated to be home… everything was experienced with joy and appreciation, like a little kid in a candy shop, jangling coins in his pocket and on a total sugar high. We even went on a bike ride for 10 minutes, Dan pedaling ever so slowly I’m amazed he didn’t topple over.

However, our joyous day ended abruptly as we got ready for bed. Suddenly, Dan began to cough and cough, while having chest pain and shortness of breath. Of course, considering what we’d been through, I immediately thought the worst – he was experiencing pulmonary edema or congestive heart failure. It didn’t help that Dan describe the feeling as, “my lungs filling up with fluid.”

So despite our absolute devastation at the thought of returning the the hopsital less than 6 hours since Dan had been released, we headed to the Emergency Room.

Thankfully….. we had a short wait and it turned out to just be bronchitus. By 3 am we were back home and in our BED for the first time in over a week.

Dead tired.  Sleep was sublime.

kidney krisis III

WEDNESDAY June 8th  – Dan was feeling a bit better Weds due to the dialysis and was even up for some visitors. This was especially good news because I had to leave my post by his bedside and return to work. On the one hand it was very hard returning to work, but it was also helpful to see the sights outside of the hospital and to not be 100% focused on the kidney craziness.

I spent a good chunk of time communicating w/Dan’s family in England and also my family here (both were supportive and superb), as well as sending out texts & Facebook updates to let people know what was going on.  It was beautiful to see so many people express their love and  prayers for Dan, but despite the “virtual friends” it was very isolating.  After 3 days of just me, Dan and a ever-changing stream of nurses and doctors, it was amazing to have flesh-and-blood visitors from Weds on.

After Dan started to receive dialysis he began to (finally!) show signs of improvement. He began producing more urine but his blood levels were still a disaster. All in all, Dan was more alert and awake and able to eat a little too (practically the first food he’d held down since last Friday). He still felt some nausea and a pain that he described as having a huge weight literally on his chest, but was less bloated since they removed excess fluids when they did dialysis.

THURSDAY JUNE 9 though WEDS JUNE 15 – Dan was improving and they moved him to another room, where he didn’t need a heart monitor. We even entertained hopes of still attending our dear friend Russ’ wedding in the Adirondacks that weekend…. but it was not to be.

When Dan improved after disalysis, it was hard to tell if his kidneys were beginning to function, or if the dialysis had just done the job his kidneys weren’t doing.  The main way to know if one’s kidneys are working is if his urine output matches his fluid intake, so we kept a constant tally of every milliliter Dan took in and put out.  Peeing was also important because if Dan started retaining fluids, the fluids could fill his lungs, causing pulmonary edema or congestive heart failure.

Thankfully, the doctor was optimistic enough to postpone the operation to have Dan receive an permanent-catheter that would be necessary if he needed to have continued dialysis treatment after being released from the hospital. The catheter currently in his neck couldn’t be used outside of the hospital due to high risk of infection.

And so the rollercoaster continued. Every day we asked the nurses, what the prognosis was:

“Will I need more dialysis?”

“When can I get out of  hospital?”

“How are my blood test results?”

And they would reply, “You have to ask the doctor.”

But the doctor was usually only available for 10 minutes a day – which 10 minutes was hard to say!  And you don’t even want to know how much money they charge for that 10 minutes! But, actually, despite the limited contact, our nephrologist was great.

Not knowing is the hardest part.

And the better Dan felt, the more restless he was to GET OUT OF THE HOSPITAL! And after “camping out” at the hospital with him for 10 days, I felt the exact same way.

kidney krisis II

MONDAY JUNE 6th –  The first few days and nights at the hospital were horrible. Dan was termendous pain and didn’t even have the energy to watch TV. When the doctor spoke of Dan’s situation he said, “He has severe severe dehydration and very very very acute renal failure.”  And despite all the IVs and meds and nurses and doctors, he was getting MUCH worse.  Dan was constantly receiving IVs that kept pumping him with liquids in hopes that eventually the fluid would break down the myoglobins blocking his kidneys… but it wasn’t working. Dan’s creatine levels continue to worsen, and he was becoming a human water balloon since for 3 days he didn’t urinate at ALL. Monday evening he peed for the first time and it looked like black coffee.

The nurses were monitoring Dan’s heart and Monday night Dan had to wear an oxygen mask but that made him feel claustrophobic and panicky.

I spent about 72 hours straight at the hospital.  My neck ached from sleeping on the hospital bed-cum-chair and it was hard to sleep with all the machines beeping and the nurses coming in every hour (but never when you needed them right away)!

TUESDAY JUNE 7th – Dan’s kidneys still were at 0 function. His body was filling up with toxins since his kidneys weren’t filtering them out and he still was barely urinating.  His body was literally poisoning itself. So, Tuesday morning, Dan went into surgery to have a tube inserted into his neck – a catheter that they would use to give him dialysis.  Hemodialysis dialysis is basically an artificial kidney. They connected Dan to this huge machine that looked like something from Back to the Future. Blood comes out of a tube from Dan’s neck and is then “cleaned” in this machine. The toxins (which would normally in one’s urine) are filtered out and discarded down the drain from a tube that comes out of the dialysis machine. And then “clean” blood is returned to his body through another tube.  However, like most mechanical substitutes for human organs, there’s risks involved with dialysis… such as hypertension and cardiac problems.
The scarriest part, however, was that the doctor said there was a 50/50 chance of Dan having to continue dialysis for weeks, months or even years.  I think we both tried to not even think about the possibility of Dan being on permanent dialysis, as this would mean a dramatic change to our lifestyle… trying to thru-hike based on dialysis centers? Never being away from civilization for more than 3 days?  No, our brains could not go there.
Thankfully, Dan felt better after his dialysis and they also removed 1 litre of fluids from him.

kidney krisis I

EXCUSES – Well, I’m guessing most of you know by now I have a pretty good excuse for not blogging for the past month. In short, Dan ended up in the hospital for 11 days with acute renal failure after a 50 mile run. It was terrifying and lonely and even after his release from the hospital, new ailments seemed to pop up daily. I kept thinking “I’ll blog about this when it’s all over,” but it seems to be never-ending… So I’ve decided I can abandon the blog no longer.

Here’s the nitty gritty:

BACKGROUND – Dan hadn’t been feeling the best, but we thought it was probably just nerves about his upcoming 50 mile race. Even though Dan’s done over 30 of ultra runs, including a 100 miler, he hadn’t raced competitively in a few years.

RACE DAY – SATURDAY JUNE 4 – Dan woke up feeling a bit nauseous, but he hadn’t been sleeping well and was now waking up at 3 in the morning  to run 50 miles in blazing hot sun. In the darkness, Dan and his running buddy, Bill, headed off to Algonquian Park, along the Potomac River, which was both the start & finish of the North Face Endurance Challenge Gore Tex 50 mile race.  They went out FAST…. their marathon time was under 3.30, but soon afterwards Dan started to lose energy, feel week and start vomiting. started vomiting (which isn’t unusual in ultras… imagine eating and drinking while also running almost 2 marathons back-to-back).  Dan’s memory’s of the race are a bit hazy but he does recall starting to lose balance if he slowed to a walk, so he kept running.

“Did you ever consider dropping out of the race?” I ask.

“No,” he responds simply.

So sure enough, he finished the full 50 miles.

And then he promptly collapsed in the grass, saying he didn’t feel well. But, heck, how many people feel great after running for a solid 9 hours? He still felt good enough to hang around the event for the rest of the afternoon – chilling in an ice bath, enjoying a free massage, having a few bites of his free lunch (I devoured the rest). Dan vomited once more and then we headed home. Since he’d vomited a fair bit, we made sure he drank lots of fluids and took plenty of electrolytes in to replenish.  Ultra runners’ thrive on the stories of the extremes they put their body through – bloody urine, inability to walk for days later, loosing 15 lbs in a day… With all the hype we’d heard, Dan’s situation didn’t seem abnormal or anything we should be concerned about. He drank even more water and then was off to sleep.

SUNDAY JUNE 5 – Around 3 am Dan vomited again and a LOT. This was not good.  “Ok,” I thought, “he’s not holding down fluids and is going to be seriously dehydrated unless we get him on an IV drip, we’ve got to go to the emergency room.” But Dan insisted he felt much better now that he’d thrown up and he didn’t want to go to the emergency room, he just needed to sleep more. I tried to fight him on it but he was stubborn so we compromised by having him rehydrate. But a few hours later that came back up too. We were able to schedule an urgent car appointment at Kaiser in Reston and went in at 1o am.

Dan hadn’t even showered after his race and was still wearing his nasty running clothes. He could barely walk but stubbornly insisted on walking to the car on his own.  Thankfully we had a car in the first place… normally our only mode of transportation is our bikes, but we were borrowing a car from some friends who were road tripping. We got to Kaiser and they put Dan on an IV drip. We were planning on going to the pool w/our friend that morning and then later going to the Textile Museum, so I figured our morning plans would have to be canceled but Dan would be up and running (ok, not literally) by the afternoon.

However, after Dan’d received 2 IV bags, the doctor came over to us and said, “Dan had acute renal failure, we’re transferring him to Reston Hospital.”

Acute renal failure? Rhabdomyolysis?

I’m thinking, “What?! I have no idea what that is but it doesn’t sound good.”  Dan was very out of it, mostly sleeping, and just moaning and saying one or two words when I spoke to him.  My mom came over to Urgent Care and we got the run down from the doctor.

THE SEMI-MEDICAL EXPLANATION – So basically when you exercise, you first drawn energy from carbohydrates in your body, then fats, and then… if there’s nothing left and you’re still exercising… your muscles. And when there’s a lot of muscle breakdown it’s called rhabdomyolysis.  Creatine phosphokinase (CPK) – a muscle enzyme – levels are normally around 200 U/L, you have rhabdomyolsis if your CPK levels are above 10,000 U/L. I don’t know Dan’s exact numbers, but the doctor said he had the highest CPK levels he’d seen in his 30 years as a kidney doctor.

Rhabdomyloyis is very common among ultra runners and even marathon runners (they call it Rhabdo), but generally the main symptom is weakness and the treatment is just hydration.  However, if enough big globs of muscle protein (myoglobin) are released into ones bloodstream, it can block the kidneys, leading to acute renal failure – or a sudden and complete shut down of the kidneys.

The kidneys basically function to filter toxins from our bloodstream, which we release as urine. If you have Rhabdo your pee will look dark like coca cola. If you have acute kidney failure, you can’t even pee. According to ultrarunning.com: “Exercise-induced rhabdomyolysis only very rarely progresses to acute renal failure. The reason for this curious but clear difference in the progression to renal failure is not known. However, in those very rare instances where rhabdomyolysis leads to renal failure in ultramarathon runners, it appears that a ‘perfect storm’ of factors seems to be present (extremes of hydration, non-steroidal anti-inflammatory drug (NSAID) and analgesic use, heat stress, recent viral/bacterial infection, low fitness).”

AMBULANCE – So Dan got a ride in the ambulance to the hospital and I ran home to grab some items and drop off our dog at my parents.

And so for the next 11 days, we called the hospital our “home.”

tired

Sunshine after the Rain

9/7 – 9/9 – The next section, from Twin Lakes to Salida, was one of the hardest yet. Being with Claire & Casey had been so much fun and we missed their company. Now that we were back to carrying our full packs they seemed absurdly heavy. Our trail food lacked luster, we craved Claire’s homebaked goodies.  We also have definitive evidence that the women who runs the store at Twin Lakes SELLS things that we gave her to be part of a FREE hiker box (a box of goodies that hikers leave/take items they want/don’t want).

Dan enjoyed walking part of the Leadville 100 route – a 100 mile ultra run that leaves from the town of Leadville and then goes past Twin Lakes and up to Hope Pass. Walking only 25 miles of that trail was exhausting…. to run it + 75 more miles is insanity. But Dan’s hoping to run the Leadville Ultra in 2012.

Autumn is here

Lows included two days of rain, getting a bad cold, blah scenery up and down through the trees.  Highs included passing through the historic “town” of Winfeld, seeing the first aspen turn the hillsides buttercup yellow, seeing the first frosting of fresh snow on the highest peaks and standing above little meringue clouds at Lake Ann Pass.

First Snow

Even though we’d passed through quite a few towns, our last Zero Day (where we did zero trail miles) had been back in Lander, Wyoming. That was a looooooong time ago. In short, we were utterly physically and emotionally spent when we finally arrived at Monarch Pass on 9/9 to hitch into Salida.

C&C Magic Factory

9/5 – We awoke in a celebratory mood. First, it was our year anniversary for having completed our first thru-hike from Mexico to Canada along the Pacific Crest Trail.  The overwhelming emotions of that day will not soon be forgotten. Second, we were to meet our good friend Claire in a few miles at Tennessee Pass. Dan met Claire while working at Georgetown University Outdoor Education Program in 2005. Claire was one of the student leaders (GOATS) who Dan worked closely with to plan lead rock climbing, kayaking and backpacking trips. Together Claire & Dan discovered ultra-running, first setting up a home-grown 50k and later competing together in their first race – the Laurel Highlands 70 miler.  Fast-forward 5 years… Claire had moved to Colorado and we’d done some hopping around ourselves so it had been 3 years since we’d met up. Now we were eager to reconnect and also meet her boyfriend Casey.

Casey & Claire arrived at the pass at 8:30am and after a dose of shrieks and hugs, set to work cooking us a gourmet breakfast on their MSR whisperlight stove. They prepared us a feast of french toast, bacon, soysage and fruit salad. They’d even brought a bottle of champagne and orange juice for mimosas!  Wow!  As it turned out Casey had hiked the Appalachian Trail in 2006 (his trail name was Casey Jones) and so he knew just what a thru-hiker needs!  In addition to the deluxe breakfast they had devised an elaborate plan to have Casey take our heavy loads in the car while Claire, Dan & I set off with day packs and hiked the 13 miles to Turquoise Lake, where we’d reconvene that afternoon. It was the perfect opportunity to slackpack (hike with just day packs) and catch up with Claire.

The miles on the trail flew by, in part because of conversation to catch up on the past 3 years and in part because Claire set the pace at just under a jog. Claire had brought homemade brownies and fresh fruit to supplement our picnic lunch and we enjoyed easy hiking under an endless banner of blue skies.

We reconvened with Casey at Turquoise Lake and then C&C brought another trick out of their bag – ingredients to make fresh guacamole on the shores of the cobalt waters. Then we drove into Leadville, where they’d booked us into the hostel for the night.

Leadville, Colorado is the highest incorporated city in the US at 10,152 feet. It was much more reminiscent of the old mining towns we’d gone through in Montana than the sleek and shiny cities we’d passed through in Colorado. It was a old boom mining town that now survives mainly on tourism and the perseverance of its rugged and working-class townsfolk.  We walked around the town admiring the old architecture and the view of 14,000 foot peaks Elbert and Massive on the horizon. We then devoured a quality carmelized onion, spinach, Portobello mushroom, and roasted red pepper pizza from Mountain High Pies. The Leadville hostel was great – clean, cozy and kitschy with a family atmosphere and years worth of collecting contributing to its eclectic decor. We finished off the night with a game of spades where we discovered Casey’s quick wit and Claire’s club prowess. It had been a magical day but now we needed to rest: tomorrow we would climb the highest mountain in Colorado!