After the wakeup call: First steps of a wellness journey

“Bilateral emboli involving the left distal main pulmonary artery with left upper lobe and lower lobe segmental extension as well as the segmental branches of the right upper lobe, middle lobe and lower lobe … ” My doctor paused reading the results of my CT angiogram and looked over his glasses at me.

I shrugged. “Anything worth doing is worth doing well. What else does it say?”

“ … heart and coronary arteries unremarkable in appearance. No evidence of pericardial effusion. No evidence of thoracic aortic aneurysm. No evidence of mediastinal masses or lymphadenopathy,” he went on, “and no evidence of acute or active pulmonary parenchymal disease.”

“What about my elevated BNP?” I asked. “What did the echocardiogram show?”

“BNP was probably elevated due to right ventricular strain during the acute event, which should resolve,” he answered. “The echo was good; good wall movement, all valves patent, no regurgitation. The venous Doppler showed thrombi in your left distal femoral vein, popliteal vein and posterior tibial vein.”

“Three clots or one great big one?” I joked. “The ultrasound tech wouldn’t say, but I think she was quite impressed that I had been walking around with that for a year.”

“This was quite serious, Kelly.”

“I am aware of that,” I nodded. “So now that my vitals are all back to normal and I’m feeling better, I can go back to work, right?”

“You had severely compromised blood flow to nearly 100% of both lungs,” he said flatly. “No wonder you couldn’t breathe.”

”Yeah, but I can breathe now,” I countered.

He rolled his eyes in exasperation. “Do you have any idea how close you were to dying?”

“Yeah Doc, I had a pretty good suspicion last Friday night. But right now, I have to earn a living. What are my limitations? Am I risking anything by going back to work?”

“The Eliquis will prevent propagation of further emboli and gradually dissolve the existing thrombi,” he sighed. “We’ll re-evaluate in 6 months. By then, the clots should be gone and you can stop taking the Eliquis. Your only limitations are how much pain and exertional dyspnea you can tolerate.”

“That’s not so bad,” I said brightly. “My tolerance is pretty friggin’ high.”

“Kelly,” he warned, “the problem with people testing their limits is that they often find them.”

The start of my wellness journey

I sounded cavalier in the doctor’s office, but believe me, I was scared when it happened. I know how close I came, and I didn’t need test results to tell me. I’m back at work now, and so far, so good. We’ll see what happens when I work my next cardiac arrest, but my role in those is usually to run the resuscitation; not exert myself doing chest compressions. I just dread the next casino call where I have to push a loaded stretcher through a mile of plush, ornate carpeting to reach a patient who likely doesn’t want my services in the first place, but the casino EMTs are too risk-averse to obtain a refusal themselves.

I told you in my last column that this has been the wakeup call for me to get myself in shape and start taking my health seriously – both mental and physical. I need to lose weight and regain my cardiovascular conditioning, and I can’t let my depression whisper to me that tomorrow is the perfect time to start.

It started when I walked out of the doctor’s office.

A caloric recipe for success

I also promised that I’d share my tips and progress with you along the way and try to keep you motivated in improving your health with me. So here’s my first tip, the diet I am going to follow:

Every day, I’m going to expend more calories than I consume.

That’s it. There is no secret formula. I’m going to count my calories, and track my steps and activity with my Apple watch. I’m not going to obsess over fats and carbs. By limiting my caloric intake, I’m going to avoid most calorie-dense foods, which also happen to be foods rich in … fats and carbs.

I’m going to wean myself off my beloved Coke Zero. Even though it has zero calories, it probably increases my kidneys’ propensity to form stones, and my creatinine and glomerular filtration rate could use some improvement. Lots of water should help that.

For now, most of my walking – 10,000 steps a day when I’m not working is my goal – will be done in a pool until I lose enough weight that my creaky knees can tolerate walking and jogging. Who knows, maybe when my knees aren’t supporting twice the weight they should, I can have them cleaned out and still keep the OEM parts. I’ll move my exercise bike to the ambulance station and try to do as many miles as I can between calls.

I’m already down 20.2 pounds from my heaviest weight. Everyone tells me it’s much harder to lose weight in my fifties than it was in my twenties and thirties – and I could really shed pounds when I was motivated – but lose it I shall, regardless of how tough it will be.

The only limiting factor will be my stubbornness, and we already know that’s off the charts.

I encourage you to take this journey with me, and update me on your progress by emailing editor@ems1.com.