November 24, 2012


Posted in Uncategorized at 3:14 am by Michael

That’s why I couldn’t be happier
No, I couldn’t be happier
Though it is, I admit
The tiniest bit
Unlike I anticipated
But I couldn’t be happier
Simply couldn’t be happier
(spoken) Well – not “simply”:
(sung) ‘Cause getting your dreams
It’s strange, but it seems
A little – well – complicated There’s a kind of a sort of : cost
There’s a couple of things get: lost
There are bridges you cross
You didn’t know you crossed
Until you’ve crossed

And if that joy, that thrill
Doesn’t thrill you like you think it will
Still –
With this perfect finale
The cheers and ballyhoo
Wouldn’t be happier?
So I couldn’t be happier
Because happy is what happens
When all your dreams come true
Well, isn’t it?
Happy is what happens
When your dreams come true!


Wicked, Glinda sings “Thank Goodness”.

I love Wicked in a way that I can’t really explain. It touches me deeply. It covers so many important ideas – from real motivation, to the complexity of people, to scapegoating. One line that I’ve thought about a lot is highlighted above: “There are bridges you cross you didn’t know you crossed until you’ve crossed”. This one really touched me – to think that big things happen – massive things – and you don’t know its either coming or has came till you can’t get back.

I’d like to tell you about the last six weeks, and the bridge that I’ve found that I’ve come over, and how it starts M() section 3 (like I knew that there was a section 3).

Back in October (11th), I woke up with sharp pain in my right chest. It felt a little lung-y, but it was right over where my gallbladder is. Being still young (no comments, please), I ignored it. That following Monday – October 15 was important for me. That was the day that the pins in Broken Finger were being removed (finally!), and I would be getting on there. A few days went by (to Saturday), and it felt worse. So much worse that I couldn’t lie down comfortably (the pressure on my back was more than I could take – either flat or on my side). I ended up going to the ER at about 4pm at night, and they tested for gallbladder. It wasn’t my gallbladder. They gave me some pain meds and sent me on my way, with an instruction to follow up w/my regular Doc if it got worse. Honestly, I felt sheepish. This hurt like hell, but I interpreted the diagnosis as “There is nothing wrong with you. Suck it UP!”

I went home, ended up having pin removal surgery on Monday (oh, in retrospect this was IDIOTIC more on that later) – which was fully out w/anesthesia, etc. Later that week, I did in fact feel better on the right, but the left started to hurt, and by Sunday I was winded and in significant, shortness-of-breath causing radiating pain on the left. Monday the 22nd I stayed home from work, with the diagnosis of “Feeling Shitty”, but yet I so deeply thought that I was malingering that I didn’t want Tina my EA at work to “Banner” my day as a sick day. I’ll snap out of it I thought.. Anh promised me to see Dr. Gromko, which I thought would be another snipe hunt. Mid-morning, they squeezed me in to see Mary Anne Maxwell, one of the ARNPs there saw me, blood pressure, heart rate (110), O2 sat of 95. This caused them to look ashen, and say they were calling 911 unless I got a ride to the hospital poste haste. Mary Anne didn’t like the idea of me driving home (5 blocks), but let me when I promised to stay connected to Anh the whole time. Mary Anne wasn’t sure what it was – but said it could  be “Blood Clot” – or some other heart ailment.

From our house, Anh drove to Overlake ( not that there aren’t great places in Seattle – they had my medical records there). The whole time there I was thinking this was a snipe hunt, and that I was somehow being a frequent flyer at the hospital. I don’t want to be dramatic, I don’t want to be fussed over. I didn’t want to waste their time.

I almost passed out just walking from the car, and they immediately got a bed, a big IV, some O2s and a bunch of wires to make sure I could be monitored properly.

I started to get a lot worse. My normal resting HR is 60 – I was at 110, and only 80-85% saturated on room air, with 95-100% with a goodly dose. They started w/the testing, including a D-Dimer test. The D-Dimer test came back positive, which means that you MAY have clots somewhere, and they need to do more testing. They then looked for clots in my legs w/ultrasound (nothing), in my lungs with a CT/CTA – contrast test – and a chest x-ray. Both the chest x-ray and CT/CTA showed a “shower” of pulmonary embolism, lots of fluid over my lungs, and areas where my lungs (esp the left) were damaged due to a “pulmonary infarction” (no blood). It wasn’t at all clear what the source of these clots were.

This Wikipedia art has a very good coverage of this area.

Once they found all this, they increased the O2, admitted me, and gave me a Lovinox shot, followed by Cumadin (Warfarin ) tablets. These are fast and slow ways to get your blood to not clot as much (but yet not zero clotting, because that would be too much.


My very basic understanding of this is that clotting/clotting breakdown is a very complex process that happens in your body all of the time. Usually, if there is a clot that happens somewhere in your extremities  (because of a broken bone, or that and arm or a leg doesn’t move for an extended time) and the clot has gotten too big and not broken down – it can break off and float back to your lungs, where the clot can get jammed in one of the many branches of your lung, and cut off the supply of blood to the lung (infarction, pain) as well as reduce how oxygenated your blood is (low O2s, out of breath).

There are dysfunctions that cause more clot to be formed. E.g, I have Factor V Leyden (heterozygous-ly). Also, as part of my transition, I was taking 6mg of estradiol a day (and had been taking that for more than five years). Estradiol slows the clots that are formed. These are all small risks in the abstract. The general risk for PE in the general population at my age (this baseline risk increases every 10 years) is only 0.02%. The Leyden risk is 6x, and the hormonal risk is 8x. If you calculate that all up, it’s still only 1.08%.

Uh, I can tell you what my risk is for PE. 100%. Without some positives, there can be no mathematical description.

All of this scientific explanation is masking the real issue that’s at the heart of this. Which is…. I’m off Hormones. Period. Not interested in any path on that going forward. The general mortality rate of a PE is north of 52%. I am damn lucky that after having a PE for more than 10 days, and being anesthetized in the middle of that I am not dead. I also don’t want to be lifetime anti-coagulated, as there is 1-2% yearly bleeding risk on that, with the biggest issue being uncontrolled head injury from things like skiing (check), rock climbing (check), volleyball facial (check), general head/bleeding injury in the middle of nowhere.

This has a real and immediate impact on how I look and how I feel. I am working out the life implications of that going forward.

My clear priorities are:

– Staying alive

– Being with my wife, kids

– Leading our life, experiencing much (sports, travel, food, wine+)

I had no idea I had crossed this bridge when I did on the 22nd. It’s crossed. There’s lots of country to discover in the other side of the bridge.