A Cautionary Tale; How a Bad Bus Ride and a Long Flight Home Nearly Killed Me
by Scott "Shroomer" Williams
This past summer, I had the good fortune to join Francis “Mr. Magoo” Tapon, his wife, Rejoice, and Sym “Symbiosis” Blanchard in Madagascar for two months of trekking and exploring that fascinating country. Jungles, thatch-roofed villages, rice paddies, baobabs, incredible swimming holes, a whole new culture, and lemurs, were just a part of the fun. I’d love to have taken a lemur home! And the jungles they live in were simply beautiful. Traveling by foot, taxi-brousse, tup tup, pus pus and cyclopus as well as old narrow gauge railways and Pirogues (dugout canoes) we had the adventure of a lifetime. The only seriously dangerous critters in the country are Nile crocodiles and crooks. And at least the dugouts kept us safe from the crocs. So, two months in Madagascar was fine, but the trip home nearly killed me.
Symbiosis in the lemur house in the Tana Zoo
And herein lies the cautionary tale. I suffered a Pulmonary Embolism a week and a half after returning home. Two full days of taxis, airports and almost 30 hours in the air was just too much for my old veins and arteries. A pulmonary embolism, as far as I understand it now, is a blood clot created somewhere in the body, in my case the leg (deep vein thrombosis). The clot breaks away and is torn into pieces as it passes through the heart. It then lodges in the lungs in many places, causing a sudden decrease in their ability to process oxygen. It’s as if your lungs instantly filled with a thousand little bits of buckshot, each lodging in the deepest part of the lungs it could find. The result, even though you’re breathing, only a limited amount of oxygen is getting to the blood. Now I was lucky that the clot didn’t find its way to my brain, or been stuck in my heart, as that could have caused a stroke or heart attack, and the results could have been much worse.
So, here’s the story. Shortly after arriving in Madagascar, Symbiosis and I had a very long bus ride to the East Coast where we were to meet up with Francis and Rejoice Tapon to join their trek of the island. Unfortunately for me, my seat on that bus was broken and over and over again during that long ride, slid forward, jamming into the back of my calves. I fell asleep several times only to wake up with that damned seat cutting off the circulation at the back of my legs, and unknown to me at the time, causing a blockage, the beginning of what become a blood clot much later, or maybe as early as that first week of travel in country.
Tsingi National Park, a wonderland of weathered limestone formations
When I got off the bus, I could hardly walk, and for the first few days in Toamasina, I limped wherever I went. When Francis and Rejoice and I set off into the bush, it was lucky for me, not them, that they were both suffering from ailments as well that slowed their pace. Rejoice was just getting over typhoid fever and Francis, a foot infection. So we all hit the trail at somewhat of a personal disadvantage and took a nice leisurely first few days. We traveled through jungles and high plains, got villagers to ferry us across the bigger rivers, and hiked along old railroad beds, which are often the best footpaths through the dense tropical forest. We ate whatever we could buy at the little villages we passed through and were always the subject of interest as we were probably the first Westerners with backpacks many of them had ever seen. What a hike! The pain in my calf decreased over the miles, and I figured I’d just suffered an internal muscle bruise on the bus. And at that point, it might have been just that.
Avenue of the Baobabs
A month later, Sym and I hiked across Isola National Park, a place of dry uplands, whose exposed and weathered rock formations reminded us of the American Southwest. All of this wonderfully weathered rock towered above river-carved gorges filled with tropical forests and crystal clear streams with the most beautiful swimming holes I’ve ever had the pleasure of bathing in.
Francis and Rejoice on top of Pic Boby, in Andringitra National Park
Early in the day on a steep climb, I experienced a sudden loss of breath and energy to my legs like I’ve never felt before, almost as if the air had been let out of a balloon. I thought I was just not feeling well that day, and swimming or walking downhill seemed to revive me, but in hindsight, and after experiencing a much greater pulmonary embolism once I returned home, I now think this was the breaking away of the first clot.
Inside Tsingi National Park
I returned home in August after an interminable number of hours in taxis, planes, and airports. But within a few days, I was back on trail, climbing Mount Diablo on my favorite Burma Burn path with its 42 percent grades, and did a 20 miler in San Francisco and several other good hikes over the hills in Martinez and I was feeling pretty good. Then one morning about ten days after getting home, I met up with a group of fast walkers to do a simple hike of Briones Regional Park. We set off at a brisk pace, and I felt fine. But 100 yards down a flat trail, I began to lose steam and watched as my friends just zoomed by me. As I tried to keep up, I found I could not move my legs any faster no matter how hard I pushed and I began to huff and puff desperately. I finally sat down on a log to catch my breath. Cyndi, one of the hikers, came back to make sure I was OK and I cavalierly waved her on, telling her I would hike at a slower pace this day, but assuring her that I was fine. I got up and did try to hike, but at the first bit of uphill, found I just couldn’t do it. An experience all new to me. I had no idea what was happening as I wasn’t experiencing any pain at all.
I turned around and slowly walked back to my car and drove myself home. What an idiot! I should have called an ambulance, but I really didn’t get it till I got home and had trouble walking up my driveway, which is not a big climb. My wife, Katie, heard me huffing as I reached the door and whisked me off to the County Hospital Emergency Room.
They admitted me, and over the next two days, I was lucky to have nothing but wonderful doctors, nurses, and clinicians of all stripes. Thank you, County Hospital! After hearing my story of the recent long flight back from Madagascar, the Emergency Room Doctor diagnosed it correctly within just a few minutes. And after numerous tests to confirm it and rule out anything else amiss, the ultrasound found the clot right at the spot of that early bus trip injury, at the back of my calf. That broken bus seat had done some real damage. The heart work concluded that other than the blood clot, I was very healthy, a nice thing to hear when you’re hooked up to IVs and monitors.
I learned a lot about pulmonary embolisms over the next two days. Common to people laid up in bed after surgery, or during pregnancies, it also affects those who are involved in high-level sports, who travel around the globe on planes, buses, trains, and cars, to compete. One of the clinicians equated our long distance hiking to an Olympic sport, and me, and all of us hikers by association, to Olympic athletes. Wow! Also nice to hear when you’re in the hospital and quite immobile.
It turns out that pulmonary embolisms are somewhat common to this group. An extreme athlete travels to another country to compete, then pushes 150 percent in their sport during competition (not much different than us knocking out a 35 or 40-mile day, day after day) causing micro tears within the circulatory system. At home where we stay active, this is usually not a problem, but in this case, having a long flight home, these micro tears may become the locus for a blood clot to form. Back home, and bang, pulmonary embolism soon after.
Although age is a factor in our proclivity to create clots, it often happens to very healthy young people too. Just after my hospitalization, I learned that a dear friend in her mid-twenties had suffered a PE just when I was having mine, brought on by bed rest after arthroscopic knee surgery. She’s also an extreme athlete and in great shape, other than forming a blood clot. The good news is that these extreme athletes usually have a complete recovery. Thank God!
I prescribed Eliquis, an anticoagulant drug, and after a few days at home, I got my doctor’s OK to drive across country with Katie and continue my summer’s adventures, but with a few caveats. He wanted me back to my usual hiking as soon as I could do it. What a great prescription for a long distance hiker! In essence, to hike as hard as I could, as soon as I could, with the knowledge that the tiny clots in my lungs would cause this to be self-limiting until they dissolved on their own over the ensuing months. I wouldn’t be able to go any faster than my degree of recovery had progressed. He also wanted me to pull over every hour when driving across country and run around the parking lot! I’ll be traveling differently from now on and did so for all of my autumn adventures. But here’s some of what I learned.
How to Lessen your Chances of a Pulmonary Embolism
Finally, the meat of this long story:
Keep moving as much as possible on long flights or train journeys etc. and get the heck out of bed as soon as possible after surgery.
When traveling long distances, wear full-length compression stockings as they decrease the chances of your blood pooling.
Don’t cross your legs or otherwise allow constriction of the circulation in the legs when sitting for long periods.
If driving, stop every hour to take a short walk, even just running around the car a few times helps.
If in flight, get up as often as possible, stretching your legs, standing on tiptoe, performing squats, anything to circulate the blood in your legs. When I flew back to the Gathering last September, I made friends with the flight attendants and just stood and talked with them for hours. When they heard what had happened, they were more than happy to talk my ear off.
While sitting in a car, bus or plane, move your feet, stretching them back and forth and twitch as much as you can. The movement helps keep the blood moving.
Take a baby aspirin before a long flight as this thins the blood. While all the doctors I dealt with told me that there are no clinical studies to prove its effectiveness, they all said they do this before long flights. I think I will too.
The bottom line is to keep moving as much as possible.
So, with that said, will I be lessening my travel? Hell no! I’ll just keep moving all the more. Not a hard thing to do for a long-distance hiker. See ya on trail!