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Home Recovery – 05/02/2020

Home Recovery 05/02/2020 Photo Album

My first night at home, Sunday, was perhaps my most mentally draining. It’s a close call with Friday night in the hospital, when I was dealing with my highest pain level. I went to bed at 10:30 on Sunday night and immediately began coughing blood. The first sputum came from my lungs, and the discharge was a blend of clear phlegm and blood. This scared me.  Over the next three hours, while I attempted to sleep, I coughed up blood seven additional times. Each viscous collection after the first was a deep maroon color. I checked the instructions on my discharge papers, and the physician’s assistant noted that I should call him off hours, if I experienced “heavy bleeding”. Was my coughed up maroon phlegm heavy bleeding? I am a chronic worrier, and needless to say, this sequence of events was not aiding my attempts to sleep.

In addition to the blood, I was coughing. Did I contract corona virus, and now I was faced with a battle for life? These thoughts sound ridiculous now, but at 2AM on Monday morning while lying in bed with no access to medical assistance short of an emergency room visit, one’s mind can wreak havoc on a positive mindset. Somehow by 2:30AM I fell asleep, and a repeat of coughing blood never reoccurred. On Monday I called my doctor, and his assistant speculated that the blood was related to beginning my blood thinner treatment. A visit to the anticoagulation center on Tuesday confirmed the likelihood of this theory, as my blood thinner index increased from 1.5 in the hospital to 3.3 by Tuesday. In theory the thinned blood resulted in some bleeding in my nose, and that in turn created the nosebleed like sputum.

A highlight for Monday was my first bowel movement since my admission to the hospital on Thursday, This may seem like an event not worth chronicling on a blog such as this, but it was worth celebrating for me. If you ever experienced surgery and anesthesia, you will appreciate my joy at this turn of events.

The greatest challenge of my early days in home care was finding a comfortable chair and cushion configuration. Jane and I experimented with the kitchen chair, couch, office chair, and a large overstuffed armchair, that Jane miraculously hauled up from the downstairs recreation room by herself. I am still amazed that she managed this feat without getting injured. The main source of discomfort was the groin incision and the associated swelling. Any seat that was too soft aggravated and stretched the incision. Slouching and keeping my knees elevated and bent seemed to provide a modicum of comfort, but this position eventually induced lower back pain. I never found a complete answer to the dilemma, but a combination of a firm seat and several large pillows to support my back yielded the most tolerable position.

Throughout these early at-home recovery days, Jane was amazing. She was by my side at all times. In hindsight my balance was fairly wobbly, and I needed Jane to prod me to use the walker constantly. She prepared all my meals, helped me get comfortable in the chairs, and endured numerous trips up and down the stairs to transport my toothbrush, electronic devices, water cup, and everything one takes for granted until a time of need. She assisted with my showers and helped me dress and undress. Jane was on top of my drug dosages and helped take my temperature, blood pressure, heart rate and weight on a regular basis.

Speaking of drugs I was taking a diuretic, potassium chloride, and cuomadin on a regular daily basis. At night I started out taking extra strength Tylenol, but after two nights of restless sleep, I took the narcotic, norco, for three consecutive nights at bedtime. The stronger painkiller seemed to improve my sleep in the first five hours, but I struggled with an annoying tickle and cough each morning at 3AM, that made returning to sleep a problem. Finally by the sixth night at home I reverted to Tylenol and the coughing disappeared, and these were welcome developments with this recovering patient.

On Wednesday I had my first visit with the at-home physical therapist, Vanessa. She was very pleasant and asked me a batch of questions, before she implement a series of tests to evaluate my endurance and balance. First I walked in circles around the dining room and kitchen with the walker for eight minutes. Next she had me stand and balance, while she applied light pressure to all sides of my body. I walked in a straight line from the kitchen to the front door and back, and during loops three and four I repeatedly looked up and down. On the fifth and sixth passes I looked left and right. My final challenge was to scale the first flight of stairs and then return to the bottom, while she looked on. Vanessa turned my cardiac rehabilitation over to her assistant Jeffrey, and he visited me three times over the next two weeks for controlled exercise sessions.

Throughout the first two weeks my Drive walker became an indispensable aid to my mobility. The sixty dollar investment was money well spent. Having the smooth rolling conveyance allowed me to conveniently move from place to place with the convenience of a small storage bag and a seat to rest on should the need arise. Nice weather during my second week at home allowed me to complete my daily walks with the trusty Drive walker supporting my every step and available for rest stops. I highly recommend one of these devices to anyone undergoing significant surgery.

On Tuesday April 28 Jane and I drove to Boulder Heart for my follow up visit with Dr. O’Hair. In order to minimize trips from Denver to Boulder, I combined the doctor’s visit with chest X-rays and my anticoagulation appointment. During this visit the physician’s assistant, Ann, and Dr. O’Hair detected atrial fibrillation (a fib). The monitoring equipment in the hospital showed a similar event on Saturday. Dr. O’Hair told me that 30% of mitral heart valve repair patients experience a fib, and in most cases it self corrects, as the heart mends and recovers. He prescribed four weeks of monitoring with the hope that my body would resolve the erratic heart beat condition. If not, I will have an appointment with a cardiologist who specializes in issues with electrical impulses of the heart. I was not pleased with this turn of events, but I have little control so resolved to move forward with positive thoughts.

I am now in day 16 of my recovery and feeling reasonably good. I completed a 1.1 mile walk with the walker this morning, and I felt fine afterward. Climbing two flights of stairs in our house remains a challenge, and I generally stop to rest on the landing and then at the top before resuming. The physical therapy exercises prescribed by Jeffrey are a priority, and I resumed my finger, wrist and elbow exercises routine from my pre-surgery days.

Throughout the ordeal communications with my friends and relatives have been a significant positive. Each email that arrives in my Gmail inbox provides a mental boost. In addition I resumed reading novels, and several days ago I felt strong enough to migrate downstairs to my tying desk to whip out some flies. Today for the first time I successfully worked in my garden, and with Jane’s assistance I planted some leaf lettuce, beets and carrots. It felt great to do some productive outdoor activities.

The a fib concerns me and my incisions have not totally healed, but I am beginning to see a future, where I gain strength and return to a life more akin to my pre-operative state.

Hospital Stay 2 – 04/30/2020

In my previous post I neglected to mention that the nursing staff moved me from the intensive care unit to a regular hospital bed around midday on Friday. Prior to this move they removed the hated drainage tube, but by this time the groin incision pain far outweighed the drainage tubes as a source of torment. After a torturous night on Friday in my new room, I awoke on Saturday morning with a slightly increased appetite. I also noticed that my new room contained a huge picture window with an amazing view of the fresh snow blanketing the Flatirons.

I ordered another breakfast of plain Greek yogurt, honey and strawberries; but on Saturday I supplemented it with a banana muffin and a banana along with a cup of black tea. The combination hit the spot, and after breakfast I called Jane and checked in with her. Talking to my wife after the rough unending nightmare of Friday night was reassuring. Jane informed me that a fly-by was scheduled ahead of the Air Force Academy graduation ceremony, and sure enough around noon the sound waves were shattered by a supersonic aircraft. I am always awed by the power exuded by powerful jets.

My day on Saturday consisted of further transitioning from hospital existence to self sufficiency, although I was a long way from that status. The physical therapist came to visit, and I completed several walks during the day. My goal was to get out of bed and walk for five minutes four times a day, and the nurses made sure I succeeded in achieving that goal. In the early afternoon an occupational therapist arrived to observe and guide the nurses in the completion of my first shower. They helped me undress, and I sat on a bench and sprayed my body with warm water from a hand held nozzle. The shower actually felt good, but it took an eternity afterward to reattach the wires and IV’s, and I developed a severe case of the chills. My thighs began to shake uncontrollably, until the nurses assisted me back in bed and covered me with warm blankets recently removed from an oven. These shivering episodes would plague me throughout my hospital stay, and I never heard a solid explanation of the cause.

My dinner on Friday night consisted of broiled salmon, broccoli, and rice. It actually tasted decent given my mental state at that time. For dinner on Saturday my appetite was absent for any sort of protein or salad, so I ordered some chicken noodle soup along with bread and more yogurt. The soup was salty, but overall it hit the spot. My caregivers on Saturday night were the same pair as Friday, but I was more aggressive in demanding narcotics, and the night was as pleasant as could be given the circumstances. The pace of time continued to drag at a glacial pace.

On Sunday morning I received a notification on my phone that Trump was backing the groups that were protesting the Stay at Home orders in response to the covid pandemic. With a daughter and daughter-in-law working in physical therapy and having spent four days under the devoted care of health care workers during the corona virus epidemic, I viewed Trump’s position as a huge middle finger directed at our most courageous people. I actually got teary-eyed over this action. Maybe I was in a fragile emotional state due to the drugs, but I think it was a reaction to the callous uncaring nature of our president.

On Sunday morning I was once again visited by a physical therapist. The young lady grabbed a red Drive walker from a neighboring room and showed me the capabilities. When she mentioned that it would make walks outside in nice weather more manageable, I was sold, so I texted Jane, and she immediately ordered one on Amazon for Tuesday arrival. This proved to be one of my better purchases. The stable walker easily supports my weight, as I roll about the house or outdoors, and it features a padded seat that lifts to reveal a small storage compartment. A padded carrying handle folds down to become a backrest for the seat should I temporarily tire. I was told that cup holders can be added as an accessory. Geriatric crowd, here I come.

I took another shower on Saturday morning, and the chill was controlled better than Saturday, but I made the mistake of ordering a strawberry banana smoothie for lunch. Unlike my mango smoothie on Saturday, the Sunday version was solid like frozen yogurt. Upon completion of the yogurt my body went into shiver mode, and I had to request two layers of blankets to regain my temperature equilibrium.

After lunch and a visit by Dr. O’Hair and PA Mark, the nurses began to prepare me for discharge. The first step consisted of removing me from the oxygen supply to which I had become somewhat dependent. Even after I was at home for several days, I imagined that the oxygen hose was still hooked into my nose on my upper lip. I transitioned off my oxygen dependency for two or three hours before my release.

Finally at 4PM Jane called to say that she was outside in the parking lot. She stopped at the pharmacy along the way to purchase a batch of cuomadin, since I was on a daily dosage for eight weeks. Because of the corona virus situation, Jane was not allowed to enter the hospital, so the nurses helped me dress and then wheeled me down to the curbside pickup area. Jane helped me climb into the passenger seat, and we returned to Denver. Cars were circling through the drive through area in front of the main entrance while displaying yellow banners in support of the health care workers. I was pleased to see this counter to the Stay at Home protesters.

Sunday was a pleasant day with the high temperature in the mid-sixties. I was very pleased with this circumstance given my recent history with chills. We opened the window, but for the first fifteen minutes of the drive I felt that I was verging on being out of breath. I suspect this was part of being weaned from the oxygen supply in the hospital room. In an effort to counter the slight oxygen debt feeling, I began taking long deep measured breaths, but this quickly led to light-headedness and a case of mild hyperventilation. Eventually I adjusted, and the last fifteen minutes of the drive were uneventful. It was quite a boost to be home and under the care of my loving wife. Phase one of mitral heart valve repair was behind me.

Mitral Heart Valve Repair – 04/27/2020

My second scheduled day of surgery arrived. My first on March 16 was aborted because of an ill-timed ski trip to Vail on March 9, which triggered the high country self quarantine. On Thursday morning, April 16 amid unfavorable driving conditions Jane and I cautiously made our way to Boulder Community Health. When I checked Apple maps, I noted that the Boulder Turnpike was yellow from just west of I25 until the exit on Foothills Parkway. Fortunately we allocated sufficient time and arrived at our designated 6.45AM check-in. We answered questions about exposure to corona virus and travel, and then proceeded to the check-in kiosks. My number appeared on the sequential appointment screen, and I approached the registration person. After answering some basic questions she looked at me from six feet away and said I was not authorized, and would I be willing to sign a waiver stating that I would pay the cost, if my surgery was not approved by insurance. My leaking heart elevated with this surprise turn of events. I quickly rejected this concept, as thoughts of a $200,000 bill rumbled through my brain. The receptionist jumped on the phone and talked to someone, and when she hung up, she said the system was corrected, and we could proceed. I heaved a sigh of relief knowing that my surgery would not be cancelled for the second consecutive time.

Jane accompanied me, as we made our way to the cardiovascular unit on the second floor, and we were ushered into a pre-op room. As was the case on March 16, I removed my clothes and stuffed them in a bag I brought along and slipped into my hospital gown. Hospital gowns come in one size; extra large. Unlike the previous aborted trip, I knew in advance that Jane would not be able to visit me in the hospital, so my bag contained a bath robe, toiletries, an iPhone, iPad, charging cables, and three magazines. I was traveling light for this engagement. I got situated on the bed, and one nurse pushed a vaseline substance up my nostrils, while a pair of female nurses got out the tools. The tools I speak of are razors. Because I would soon be the proud bearer of an infinite number of tubes, wires and hoses; the women began to remove hair at an unprecedented clip (get it). The nurse and anesthesiologist meanwhile occupied my mind with questions, while the hair removal assault continued. This pretty much ends my recollection of the morning, as the drugs were released through the IV tubes, and the surgical staff had their way with me.

My next recollection was around 4PM on Thursday afternoon, at least I think I was told that time. I was on my back in the intensive care unit with numerous faces staring down at me. It reminded me of one of those fisheye lens photos that folks sometimes impose on the public. I think someone phoned my wife, and I uttered some incoherent gibberish, but I would not swear to it. Apparently the removal of my intubation tube was in progress. A person kept asking me a question, but it was impossible to reply with a large tube in my mouth. Can anyone explain the logic of this? It was kind of like the dentist asking you something with his hands in your mouth, only much more uncomfortable. Eventually my major hindrance to voice was removed, but my mouth and throat were an irritated mess.

My next focal point was the drainage tubes that poked me in my back. It felt like I sat on a sharp stick that had been gnawed off by a beaver, and I was forced to hold that position for twenty-four hours. If you ever get invited to such a torturous state, please decline. In an effort to encourage me the head nurse told me that I would feel much better when the tubes were removed on Friday around midday. The effect on me was not positive, as all I could think about was eighteen additional hours of pain. One positive, however, was to divert my attention away from the burning, pinching pain emanating from the groin incision, where the heart machine had been connected. You will hear more about this later.

A certain recipe for laughs in our family is to bring up Dave’s incoherent speech after undergoing anesthesia, and Thursday night was probably no exception. In our family storytelling forum I recount my version of what I was saying, and my wife or guest then refutes my thinking and reveals my actual muddled mutterings. If you have never done this, you should undergo a surgery just to engage in the fun practice. In this case, however, Jane was not allowed to be present, so I was unrestrained. I often wonder what sort of a fool I made of myself. I can only remember that my savior throughout the night was ice. The head nurse constantly dropped nugget ice in my mouth, and without it I am not sure I would be alive to tell this story. As it so happens, during my working career I was the VP- Finance of ICE-O-Matic, an ice machine manufacturing company. After one session that included three mouthfuls of ice, I decided to lecture the nurse on the various ways of making ice. I wonder how that came out? I suppose I will never know, but I swear I was perfectly lucid.

The number one goal for Friday morning was to get out of bed and into a chair. The thought of it made me queasy, but with adequate assistance from my nurses I made the move. You may be surprised to learn that hospital lounge chairs are no more comfortable than beds. While I’m on the subject of hospital beds, let me rant for a bit on that topic. The bed can be controlled by some arrow buttons along the side, and it moves in two ways. The legs can be elevated or the back can be tilted. The one section of the bed that cannot be directly controlled is the butt section. Aside from the drainage tubes, my next source of excessive pain was the two inch incision in my groin between my abdomen and the inside of my right leg. The slightest stretch or movement in my leg elicited a sharp burning, pinching sensation. When the nurse elevated my legs, my butt section sank deeper in the hole, and this placed increased pressure on my groin incision. Raising the back of the bed simply brought my abdomen forward so that my body was in a folded position with my upper body and legs raised. That hurt. I felt like a human being folded into a taco shell. The best the attending care givers could do was to stuff old fashioned pillows in various positions, until I found a point of least pain.

In order to test the mettle of hospital occupants even more, somebody came up with the idea of a hospital gown. Mine was at least five sizes too big, and it came with a small pocket on the right front. Every time I got out of bed, the nurse moved a 6″ X 4″ X 3/4″ heavy electronic module from the side of the bed into the sole pocket on the gown. Guess what? Inevitably the heavy box would sag down to my groin and rest against or bounce against my incision. There must be a better way.

After I accomplished the amazing feat of getting out of bed and dropping into my chair, I ate my first breakfast (Greek plain yogurt with honey and strawberries, a cup of black tea and an untoasted bagel with margarine that would not melt because the bagel was cold). By the noon hour someone decided that it was time to remove the drainage tubes. I looked forward to this event all night, but now I can barely recall it. I remember that some pain disappeared, but I think the groin incision and my impossible position in the bed or chair dominated my thoughts, and the tube removal boost never materialized. I would compare it to opening a Christmas gift and discovering that you already knew you were getting it.

On Friday afternoon I requested my electronic devices, so I could open up communication with friends and relatives. I Face-timed with Jane (I think I was coherent), and I sent a few text messages. I remember getting extremely frustrated, as my addled state of mind, poorly functioning digits, and predictive text and spell check were absolutely abusing me. These hindrances combined with a person, who writes every communication as though they are submitting a term paper for an A is a recipe for irritation. I can only hope that the nurses in the hallway could not hear my less than cordial language.

Friday night was a nightmare. The head nurse and assistant changed shifts, and eventually I would grow to like the new crew, I was not pleased with them on Friday night. They were professional and efficient, but for some reason my previous attendants seemed more caring. Maybe it was the preponderance of ice from the Thursday night guy that won me over. Has anyone else ever noticed the glacial progression of time during nighttime in a hospital? Can’t someone install a booster in the clocks? At any rate Friday night, April 17 was certainly the worst night of my life. Somehow I let the pain get ahead of me. I was quasi-lying/sitting in an uncomfortable position that stretched my groin incision beyond tolerance. Have you ever over inflated a football to the point that the internal bladder is visible between the seams? My groin was the bladder and the seams were the incision. The center of my chest felt like someone rammed it with a digging bar, and the right pectoral area was so sore, that it was numb. I reclined in my least painful position in the bed and counted throb after pinch. It was incessant, and I began to wonder, if a person could die from pain. The prospect of constant future pain is what really demoralizes the mind. and the clock hands seemed to be frozen in time. At one point the nurse came in to check on me, and it was dark and felt like 3AM, and they told me it was 8:30PM. I was a grumpy, stressed mental case, so I did what any red blooded man would do, I began begging for morphine. Well, I’m not sure I specified morphine, but I asked for relief. They asked my pain level, and I didn’t even lie and uttered 8. Several doses of morphine got me through the night, but it was the longest ever. What happened to the fun part of doing drugs? All I ever felt was the negation of pain, but I was thankful for that.

I made it through my low ebb, and the next installment will cover the final night and two days in Boulder Community Health.

The Next Challenge – 04/26/2020

Simply stated my life expectancy goal is to remain as active as possible for as long as possible. Of course I would like to live as long as possible, but the quality of life is important, and this objective drives me to exercise and eat healthy. My previous blog post provides much more insight on my views on this topic.

In June of 2019 my primary care physician diagnosed a heart murmur and referred me to a cardiology practice for further testing. In July 2019 I underwent an echocardiogram, and the heart specialist recommended a TEE. A TEE is a procedure, whereby, an instrument is lowered into the esophagus to obtain a clearer view of the heart valve. For various reasons related to insurance and referrals this procedure was never administered until January 2020.

During this time period I ran a road race in Stapleton, and although I placed first in my age group, I severely injured my Achilles tendon. The ache on the inside of my right heel was so severe, that I canceled all pickle ball and halted my running program. When the pain ceased to improve, I began attending physical therapy, and these sessions continued from September through November. July, August and September are my favorite months to fly fish, and my Achilles did not inhibit my stream time, so I was partially guilty of not pushing treatment for the heart murmur condition.

By October my Achilles improved, and I began a controlled return to running. Shortly thereafter the physical therapist approved a return to pickle ball, and I jumped at the opportunity. Unfortunately this action resulted in another delay in my return to fitness. During a pickle ball session in the middle of October, a short rain shower left the court wet. I circled back to the baseline for a lob shot, and when I planted my right foot, it slipped and moved twelve inches. I applied my muscles to prevent a fall, but the sudden action generated a popping sound. For the next several weeks my inside groin and the outside of my hip were extremely sore. I attempted to return to running and pickle ball, but the soreness after each session was significant, and I sensed that I was doing more damage than good. I returned to physical therapy in January, and the therapist diagnosed me with a severe right hip nerve impingement. Maintaining an active lifestyle during my aging was proving to be more challenging than I expected.

Also during this time period Jane and I booked two bucket list trips. The first was scheduled for May 17 to Kauai, as Jane and I never visited Hawaii. We also made a deposit on a June 6 boat and bike trip from Cologne, GER to Amsterdam, NED. The boat would transport 26 guests on European waterways. and the guests would disembark each morning and cycle for 20 – 25 miles and then return to the barge, as it floated down the river. Breakfast, lunch and lodging were provided by the boat and were part of the package. Needless to say we were quite excited about this new adventure.

By January the TEE was finally scheduled and approved by my insurance, and it took place on January 24. I called to make an appointment with the cardiologist who performed my procedure and learned that he was on vacation for two weeks, and the earliest I could meet him was four weeks later. Given the scheduled trips I did not wish to wait four weeks, so I opted for a different doctor. Within a week of my TEE, I met with Dr Decicco, and he informed me that I had a leaking mitral heart valve. The border for severe is 60 ml, and my leakage was 100 ml. My atrium, the heart chamber downstream of the heart valve was somewhat dilated because of my condition. I was shocked and dumbfounded by this news. I felt strong and fit and did not exhibit any of the leaking heart valve symptoms. Dr. Decicco told me that the rest of my heart was extra strong due to my fitness and compensating for the leak, but he advised that this could not continue forever. Eventually the condition would deteriorate, and in all likelihood the repair would be more difficult and the recovery longer. I agreed to pursue surgery, and Dr. Decicco prepared a referral. Another prerequisite to heart valve repair surgery was to undergo a heart catheretization. This step was necessary to confirm that the remainder of my heart was healthy, as the surgeons did not want a surprise.

Meanwhile my physical therapy was progressing nicely, and I resumed running and pickle ball. I began the running program by walking for three minutes and running for two minutes for a total of twenty minutes. Over time I increased the running over the walking and eventually the distance and time. I played pickle ball indoors, and my Achilles and hip held up well under the increased strain of my activities.

Concurrent with my fitness and health progression, the rest of the world began to display signs of distress from the corona virus. The first U.S. case was reported on January 20, so the timing of my heart valve evaluation roughly coincided with the covid progression in the United States. I scheduled the heart catheretization for February 7, and the procedure confirmed that my heart was very healthy other than the leaking mitral valve, and Dr. Decicco referred me to a doctor at CU Health, who was highly recommended, to perform minimally invasive surgery. Things were moving along, and I clutched at the hope of threading the needle with surgery without cancelling our trips.

I contacted the office of Dr. Rove at CU Health, and I discovered that she was out of network, but her assistant was very certain that I could be approved and treated as an in network patient. I made an appointment for February 18, but two days before the meeting, I received a call from my primary care office, and they told me the doctor visit was not authorized. I immediately assumed it was because of being out of network, but instead I was told that the referral was only submitted two days earlier!

Again wishing to expedite the process with the hope of completing our scheduled trips, I decided to pursue in network options. I did an online search for cardiologists who perform minimally invasive mitral valve repair, and as I did this, I cross referenced the doctors’ names to the United Healthcare provider search list. I found six in network doctors that could perform my necessary surgery. One stuck out to me, Dr. Daniel O’Hair, at Boulder Health. He did robotic minimally invasive mitral valve repair, and I experienced good results from robotic surgery on my prostate. I made an appointment with Dr. O’Hair and asked my primary care physician to generate a referral. Ultimately the referral for Dr. Rove was approved, and I ended up with back to back appointments with two cardiologists during the first week of March. In the end I elected Doctor O’Hair, because I liked the idea of robotic, and he was in network, thus, less risk of not being approved given my tight window before our scheduled trips.

The die was cast, and Dr. O’Hair’s office called fairly soon after my appointment to offer surgery on March 16. I gritted my teeth and signed up with the continuing hope of fitting the surgery and recovery in before our Kauai trip. During the week prior to my scheduled surgery my daughter visited from Portland, OR, and in an effort to take advantage of her stay, we spent a day skiing at Vail on March 9. On March 15, the day before my surgery, the rapidly rising number of covid cases in Colorado ski country caused the governor to self quarantine anyone who had been there in the previous 14 days. On Monday morning March 16 I reported to Boulder Community Health for my surgery. The receptionist in the cardiology area asked, if I had been in the high country, and I truthfully answered yes given our ski trip the previous Monday. She immediately tossed a surgical mask my way and asked Jane and I to sit down the hall, while she investigated the next steps since the protocols were only announced late on Sunday.

After a short time, however, Jane and I were ushered into a pre-op room, where I was asked to remove my clothes and get into a hospital gown. The nurse arrived and hooked my left arm up to IV, and I was starting to believe that I would sneak in under the wire. My optimism was unfounded, as a Dr. Ellis eventually appeared, and he told me that my surgery was cancelled, and that I needed to self quarantine for 14 days. In addition the hospital was discontinuing elective surgeries starting on March 17, so he was unsure when my surgery would be rescheduled.

I put my regular clothes back on, and Jane and I returned home. My stress level dropped considerably, but now what about the surgery. Given the progression of the pandemic, I was convinced that I would not be rescheduled until May or June. Did I even want to be scheduled for heart surgery during a respiratory virus epidemic? I decided to take advantage of the break, and I resumed my running and fly fishing. The Stay at Home order put a clamp on pickle ball, but outdoor activities remained in bounds when associated with social distancing. I continued to ramp up my running, until I was able to run forty minutes consecutively by April 14. When weather was cooperative, I managed five fishing trips to Colorado rivers and streams. I was making good use of my surgery hiatus.

On April 7 I was sitting in my home office, when the mobile phone rang. I answered and heard the voice of Beth, Dr. O’Hair’s assistant, who informed me that she signed me up for surgery on April 16, and was I interested? I told her the timing was perfect, but I was concerned about the safety given the corona virus crisis. She provided a host of reasons that the doctor and hospital felt it was safe, so I accepted the date. In the final analysis I felt that the hospital would not accept the liability, if they were not very certain that the risk was low.

Aging – 04/25/2020

Until recently I tried to avoid thinking about aging. The human body will inevitably break down, but I set a goal to remain as active as possible over my lifetime. My strategy included daily exercise, running, and an abundance of outdoor activities. My eating habits since childhood have generally been exemplary. My father always planted a large garden, and fresh vegetables were always available. I was the rare child that did not need to be prodded to eat my vegetables. I am lactose intolerant, so that eliminates fatty dairy products from my diet, and I elect to avoid red meat on a regular basis.

In 2010 I acquired an iPad, and at the time my weight had ballooned from the 120’s of my twenties to the 155 mark. I would not consider myself overweight, but I began to experience difficulty getting up when I fell on skis, and my impact while running was noticeably heavier. I decided to try a calorie counter app and downloaded FatSecret to my new iPad. I set a goal to finish each day at negative 500 calories. Later I discovered that a cumulative negative 3000 calories over time translates to a loss of one pound of weight. Counting calories was a significant eye opener. Early in the game I discovered some quick hitters to cut my calorie intake. First came sugary beverages. I was amazed at how many calories could be avoided by shifting from Gatorade to water or unsweetened ice tea, so that was an easy move. I regularly ate a whole bagel for breakfast, so I reduced that to one-half, and once again a small change in diet resulted in significantly reduced cumulative calories. While I was still working, I had a small scone along with my cup of tea during a mid-morning break. Can you guess how many calories a small scone has? I stopped buying scones. I am an avowed pretzel lover. Pretzels are actually a relatively healthy snack, but they are a carbohydrate, and they do provide calories.  Previously I could binge on a half bag of pretzels at one sitting. Once I understood the calorie impact of my addiction, I limited myself to two servings at snack time.

In the three months after acquiring my iPod I reduced my weight from 155 pounds to 135 pounds. Since that period of time I have been in maintenance mode. I continue to track my calories, but rather than be in a net negative position each day, I target to balance intake and burn. It is not unusual for me to tabulate my position after dinner with the hope that I am negative 800 and, therefore, eligible for an evening snack. Counting calories made me appreciate the value of my running program, as running burns significant calories in a short period of time. Running translated into more snacks for Dave. In addition, running along with cycling and hiking improved my cardiovascular strength and allowed me to enjoy outdoor activities that were out of reach for others my age.

Of course there are no guarantees in the game of life, and in 2016 I faced my first obstacle to a continued active lifestyle. I was diagnosed with prostate cancer in November 2015 and survived a prostatectomy in January 2016. The operation and recovery were a bump in the road, but I survived and eventually elevated my fitness back to levels before the operation. The next four years were golden years, as I maintained my weight and fitness and achieved record years in fly fishing accomplishments. I was retired and in good health, and Jane and  I maximized our opportunities for travel, hiking, camping, cycling, running and fly fishing. I was living the dream.

My Medicare plan provides for an annual “in home” check up, and during this event in November 2018 the nurse heard a heart murmur. She advised me to confer with my primary care physician, and I followed up with a physical in June 2019. My doctor confirmed the heart murmur and referred me to a cardiologist. In July 2019 an echocardiogram revealed a leaking mitral heart valve, and a TEE procedure in January 2020 refined the diagnosis, and my valve leak was placed in the severe category. In spite of this condition I remained without symptoms, and my cardiologist attributed this to my superb conditioning.

I was reluctant to proactively go from a healthy sixty-nine year old male to a rehabilitating heart patient, but the cardiologist reasoned with me. First there was the chart that showed that the life expectancy of a man with a repaired mitral heart valve was the same as a man without a heart valve condition. On the other hand, the life expectancy curve diverged rather rapidly when comparing a male with no heart valve problem compared to a man who failed to correct the condition. Facing death is always a sobering experience. In addition, I was a candidate for minimally invasive repair, and this procedure is far more desirable than invasive repair or even heart valve replacement.  Aging increased the likelihood of the latter developments, and aging also made recovery longer and more difficult. I was convinced and made the decision to undergo minimally invasive heart valve repair. My next post will resume the story from here.

Why a Blog? – 04/23/2020

Originally when I embarked on my blog journey in 2010, I was seeking a way to combine the text from my fishing logs, that I maintained in Word, with the photos that I accumulated in my albums. Ten years later I can unequivocally state that my blog has more than served its intended purpose. My son has been instrumental in the evolution of this forum, as he provided endless hours of technical support from securing a server and URL to digging me out of technical difficulties. The tabs for the fish counter and fishing analytics are purely the creations of Dan.

This site now contains ten years of entries that include every fishing outing during that time as well as other significant travel adventures. In many ways the travelogues are more fun to review than the fishing logs. My blog has evolved into a hobby unto itself, as I enjoy writing, and I chronicled a significant part of my life story. I am convinced that composing the blog improves my writing skills, enhances my vocabulary, and stretches my mind.

What role do I envision from this blog? Well it is sort of grandiose to even think that I planned a purpose other than logging my stories, but I repeatedly refer to it, when I project future fishing conditions based on historical experiences on the same rivers. Why start a day of fishing from ground zero, when I already possess clues about what tactics worked in the past? Change is constant in fly fishing, and one must be careful to match the variables before drawing conclusions, but many times the past has been a predictor of the future. In addition to this practical application of the Wellerfish blog, I also enjoy immensely simply reading about many of my fishing days and travel adventures. During the winter I relive days on the stream from the summer, and I particularly love re-imagining my travel adventures years after the fact.

What about the readers? Why share all this information with strangers around the world? I have spent upwards of thirty-five years fly fishing, and if another angler can pick up a tip or learn about a fly that propels them to success, I am all in favor. I constantly read about fly fishing and fly tying, but the best teacher is on stream experience. I truly write this blog for myself, but if it can help others, that is even better. The ten years of fishing reports contain a huge amount of information on flies, approaches and conditions. Most of the information is available elsewhere, but this blog applies it directly to a specific river or stream, and that is not always easy to obtain. I have curated an infinite number of fly choices for my part of the world, and I can cite results to back their effectiveness. Are there other, better and even more productive flies out there? Of course, and I constantly search for new winners, but it is reassuring to have workhorse flies that I know I can depend on. Why not read and take advantage?

But what if I create efficient fly fishing robots armed with killer flies that hook, land, injure and pressure local fish? First of all it is quite presumptuous to suggest that my humble web site could do that. I do not have that much power. But more importantly I am a strong believer that fly fishing success is not attainable from having the right fly or fishing in the best place. It requires days and days of practice and years of continuing education. two of the most overlooked aspects of fly fishing success are casting and reading the water, and these keys to achievement cannot be learned by reading. They require on stream experience. The majority of fishermen do not have the time or inclination to devote to fly fishing in order to develop a high level of proficiency. The risk of stream exploitation from this blog is infinitesimal.

I also utilize different techniques, as I explore the waters of the west and beyond. I am a huge believer in paying attention to the water type that produces fish during a given day at a certain time of the year. My casting becomes more efficient, if I know fish are holding at the tails of deep runs or in the cushion in front of large rocks. I can exploit this advantage, as I move from place to place and limit my casts to higher probability spots. Dry/dropper, double dry, single dry, indicator nymphs, and streamers are all possible techniques; and I apply them all. This blog provides feedback on what worked and did not work in many situations. In short, this blog can accelerate the learning curve of novice or beginning anglers. Are you the type of person that needs to be hands on and learn through success and failure? By all means go for it. Half of the fun of fly fishing is the process, but I like to gather as much knowledge as possible, so that I can accelerate my learning curve and become better faster.

This blog opens me to criticism over revealing secret spots and contributing to the escalating crowding on western streams. If folks are using this blog simply as an enhanced Delorme Atlas, I really cannot do anything about it. However, most of the rivers and streams that I fish are easily accessible public waters. There are books and online resources that reveal more details about hot spots than this blog does. I have no problem with identifying a creek or river, when similar information is available in the fly fishing universe. For large rivers secrecy is never a concern. It would be ridiculous to assume that a fisherman could catch more fish if they used my blog to identify a place that is better than the wide array of options available. And if you do, congratulations, there are an unlimited number of alternative places for me to seek out and find success.

I never keep heavily fished rivers like the South Platte River and Big Thompson River secret. In these places the game is about being a better fisherman than others as a way to achieve success. There are a few high mountain creeks that I protect. If I put in a lot of shoe leather and discover a hidden gem, I am not going to reveal the location. A small stream is too fragile to expose, and I like to lessen the chances of meeting competing fishermen. But these situations are rare, and nearly all of my posts refer accurately to the actual destination.

Why am I going through all this background? A week ago I had a mitral heart valve repair, and I am considering posting short pieces that chronicle my recovery. The last week has been a rough experience, and perhaps other readers are out there that could learn from mine. Besides, I enjoy writing, and a lot of new material is available to me in the health care industry. Stay tuned. Perhaps the purpose of this blog will expand to include my new physical challenges. It has, after all, become my life story.

North Fork of St. Vrain Creek – 03/06/2020

Time: 11:00AM – 3:00PM

Location: Buttonrock Preserve

North Fork of St. Vrain Creek 03/06/2020 Photo Album

A forecast of high temperatures approaching seventy degrees dictated a day of fishing on Friday, March 6. My last outing was February 1 on Boulder Creek, so I was overly anxious for another winter trip with spring in the air. I checked the flows on several front range options, but rather quickly I settled on the North Fork of St. Vrain Creek in the Buttonrock Preserve. The DWR chart exhibited steady flows in the 20 CFS range, and I knew from prior experience that these were decent numbers for a day of winter fishing. Temperatures in Lyons, CO, the closest town, were expected to peak in the upper fifties.

I departed Denver by 8:30, and after a brief stop for fuel, I arrived at the parking lot for the Buttonrock Preserve by 10AM. Several fishermen were gearing up, but my process was apparently more efficient, since I was on the trail by 10:20. Before my departure on Friday morning, I viewed a video on how to utilize the New Zealand strike indicator, that I received for Christmas, and I was impressed with how easy it was to add and remove from my line.

A Nice Pool

The access road was alternately dry, muddy and covered with ice and snow; but, I hiked for thirty minutes and arrived at a satisfactory starting spot and carefully backed my way down a steep rocky bank to a section of the creek that contained a series of short deep pools. I began my quest for winter trout with a peacock hippie stomper, beadhead hares ear nymph and Pat’s rubber legs; but after forty-five minutes of fruitless casting and covering a substantial distance, the fish count stalled on zero. I was bordering on frustration but reminded myself that the water remained quite cold, and warmer afternoon temperatures portended more active fish. During the morning time period I swapped the Pat’s rubber legs for an ultra zug bug and a salvation nymph.

Hiding Spot

Prince Nymph

At 11:45 I found a nice open area with large rocks perfect for lunch, and I took advantage to consume my light snack. After lunch I decided to modify my offerings, and I exchanged the hippie stomper for a size 8 yellow fat Albert and replaced the hares ear and salvation with a prince nymph and Craven soft hackle emerger. A tiny gray stonefly perched on my hand during lunch, and the soft hackle emerger was an attempt to mimic the size 18 insect.

Craven Soft Hackle Emerger

Finally after another fifteen minutes of casting, a fish slashed at the fat Albert, but a momentary connection was my only reward for an instinctive hook set. I did not wait long, however, before a nice ten inch brown trout crushed the fat Albert in a slow shelf pool on the opposite side of the creek. This prize did not escape, and I lifted the deep buttery colored brown into my net and snapped a few photos. I continued my progress upstream in the early afternoon and netted two small rainbow trout. They were both barely over six inches, and one grabbed the prince nymph, while the other nabbed the soft hackle emerger.

As I continued upstream, I arrived at a relatively deep but short pool, where the creek deflected off a large collection of branches and sticks. I spotted several fish at the tail of the pool, but they rose to inspect the fat Albert but resisted the temptation to eat. I decided to change tactics, and I removed the three fly dry/dropper configuration and tied on a size 18 stonefly adult. This fly prompted a refusal, and then it was treated with total disdain, so I once again executed a change. I replaced the small stonefly with a size 22 CDC olive hoping to cover a midge or blue winged olive natural. The move partially paid off, when a ten inch rainbow darted from the stick bramble and inhaled my imitation. I set the hook and played the fish for fifteen seconds, at which point it twisted free of the small dry fly.

Fat Albert Produced

On Display

I was back to the drawing boards, and I retained the small olive, as I encountered another long slow moving pool. Unfortunately the CDC olive proved to be a one fish wonder, and I once again contemplated a move. I remembered the New Zealand indicator system and decided to test it out. I crimped a split shot to my line and then deployed the indicator four feet above the split shot. For flies I chose a prince nymph and a sparkle wing RS2. The deep nymphing system lasted for thirty minutes, and I added a fourth trout to my count in the form of a six inch brown trout that struck the RS2. I grew weary of the indicator style of fishing and decided to try one last ploy before ending the day.

Inviting Pool

I inspected my fly box and focused on a size 14 gray stimulator. This struck me as a solid lead fly, and below it I knotted the RS2. I flicked the large dry fly to the top of a nice pool and tight to a vertical rock wall and allowed the two fly combination to drift along the rock and then across from me and downstream. On the third such pass a six inch trout nipped the sparkle wing, just as I lifted to make another cast, and fish number five rested in my net for a short amount of time. I progressed upstream a bit farther, but once again my fly was ignored, and at 3PM I decided to call it a day.

Friday was a gorgeous day from a weather perspective; however, the fishing was quite slow. I managed to land five trout during four hours of concentrated fishing with the largest being a ten incher that savored the fat Albert. The air temperature rose to the upper fifties, but the melting snow fields along the creek reminded me that winter was relinquishing its grip at a slow pace. I’m sure the melting snow kept the water temperature below the level required to promote more active feeding. The five day forecast projects more days with highs in the sixties, so I plan to venture forth on another early season fly fishing expedition.

Fish Landed: 5

Salvation Nymph – 11/17/2019

Salvation Nymph 11/17/2019 Photo Album

The salvation nymph clearly established itself as my number two producer, and it may have surpassed the beadhead hares ear nymph in 2019. Aside from being a premium fish attractor, it is relatively easy to tie, as well as being a very durable fly. The official name of the commercial version of this fly is tungsten salvation nymph, but I substitute a less expensive gold brass bead for the tungsten, and the fish do not seem to mind. If you plan to fish fast water, and you desire a rapid sink rate, by all means substitute a tungsten bead.

My post of 12/30/2011 provides a materials list and describes the tying steps required to create this fish magnet. I continue to tie my salvation nymphs in the same manner, as I did in 2011. Last year I applied Solarez UV resin to the nymph back, and I marveled at the results. This is the only significant modification that I made to the initial tying process.

Nicely Done

The salvation nymph yields peak results in the June through August time frame in Colorado. This time period coincides with pale morning dun emergences, and I suspect that the salvation represents a flashy version of a pheasant tail nymph, and thus, a reasonable imitation of a pale morning dun nymph. One should not, however, limit this fly to purely a PMD imitation, as it generates action throughout the season, albeit not quite as intense, as the months I cited. All the components of the fly scream fish attractor including the ice dub abdomen and thorax, the flashback and flashabou nymph back and wing case, and the flexible silli legs. It qualifies as an attractor nymph year round, and it also serves as a viable imitation of small stoneflies. Fish love it.

Macro of a Few Jewels

I performed my usual count of all the salvation nymphs in my various storage compartments, and I determined that I held 68 in inventory. My goal for the start of the 2020 season was 100, so I cranked out thirty-two shiny new versions and then added five for a friend. When I gaze into the salvation nymph compartment in my large plastic fly box, I get a warm feeling knowing that I am more than adequately equipped for the upcoming season.

32 New Salvation Nymphs


Oregon/California Road Trip Day 10 – 06/05/2019

Wednesday June 5, 2019 was the first leg of our return drive from California to Denver, CO. It was largely uneventful, but an interesting story developed toward the end of the day.

After we packed up our camping gear, we exited the campground and turned right on highway US 199. We followed this scenic road mostly along the Smith River, until we entered Oregon and then reached Grants Pass. At Grants Pass we merged on to Interstate 5 and followed the expressway eastward to Medford, OR, at which point we exited and continued on Oregon 140. This highway became our home for quite awhile, as we traversed southern Oregon. Eventually OR 140 dropped south into Nevada at the Sheldon Antelope National Refuge. Southern Oregon and northern Nevada contain a lot of wide open spaces!

At Denio Junction, NV 140 veered south, until it intersected with US 95, and this highway eventually transported us to the interchange with Interstate 80 at Winnemucca, NV. Prior to our trip we marked Elko, NV as our Wednesday night lodging destination, but Winnemucca seemed to be a large enough town to offer chain accommodations for the night. Elko was a larger city, and we stayed there seventeen years ago, when we returned from a trip to California to visit friends in Fresno. Jane and I remembered the presence of a significant Basque community, and we anxiously anticipated some Basque cooking. For these reasons we drove on and took a pass on the inviting environs of Winnemucca.

When we stopped in Winnemucca for fuel, we switched positions, and I became the driver while Jane navigated. Part of navigation duty was researching lodging in Elko, NV. We were in for a surprise. Jane checked all the major chains that we favor, and each one signaled no vacancy. Elko is one of a limited number of stay over cities, as travelers cross northern Nevada, but full hotels on June 5 was hard to comprehend. Finally she called the Comfort Inn, and the recipient of the call referred Jane to the Scottish Inn. Given the dearth of options, Jane immediately connected with the front desk person and reserved a room at the independently operated Scottish Inn.

Two hours later we arrived at the Scottish Inn and checked into room number 26. We were happy to have a bed, but the accommodations could be described as barely passable. It is ironic that we felt this way after sleeping in a tent for seven nights!

By now it was 8PM, so we quickly jumped back in the car to search for some tasty lamb prepared as a Basque specialty dish. This was my dream meal. The Star Hotel advertised Basque cooking, so we quickly found it on the corner of W. Silver St. and S. 3rd St. A parking space was not readily visible, so I turned right on a side street hoping to find parking. We passed three or four brothels, and Jane’s desire for Basque cuisine from the Star Hotel faded.

I executed a U-turn, and we returned to Silver and found Luciano’s, an Italian restaurant directly across the street from a public parking lot. Given our hungry state and level of frustration, we jumped on the Luciano’s option for dinner. When we walked through the door, we were overwhelmed by the loud din of voices and the number of patrons swarming the small restaurant. Because we were only two, we were seated immediately next to a wall and next to a large table of ten.

It was not long before the waitress approached our table to take drink orders, and I asked her why Luciano’s and Elko were so crowded, and we discovered that our visit coincided with a week long mining expo. We endured a similar situation several years ago, as we passed through Des Moines, IA during a pork convention. Never take lodging reservations in any U.S. city for granted.

Big Thompson River – 10/22/2018

Time: 11:30AM – 3:00PM

Location: Four miles below Lake Estes and then near the downstream border of the special regulation water

Big Thompson River 10/22/2018 Photo Album

Mild autumn weather continued on Monday, October 22, and this stroke of good fortune prompted me to make a drive to the Big Thompson River below Lake Estes. I arrived by 11:15AM, and after I assembled my Orvis Access four weight, I was on the water casting by 11:30AM. The air temperature was in the low fifties, so I wore my long sleeved Under Armour undershirt, fishing shirt, and a gray fleece. When the sun was out, I was a bit warm, but when a cloud obscured the sun, and the wind kicked up, I was dressed appropriately. The Big Thompson flows were 47 CFS, and this seemed on the low side, as quite a bit of the riverbed was exposed, but adequate deep pools and pockets provided cover for the stream residents.

Vegetation Absent Since the 2013 Flood

I began my day with a single size 18 gray deer hair caddis, but the ten minute trial period was a resounding dud, and the tiny caddis adult was very difficult to track in the shadows and glare. I swapped the caddis dry fly for a peacock body hippy stomper and added a beadhead hares ear and ultra zug bug. With this three fly combination I was confident that I would attract attention, but after an hour of futile casting I could point to only one small brown trout as my reward for perseverance.

At 12:30 I found myself below a very high bank that was recently excavated during the reconstruction of US 34, and a SUV with a rod vault was parked along the shoulder of the highway. I never saw another fisherman, but given my lack of action I surmised that perhaps a fisherman or two disrupted the water ahead of me. I decided to pursue a fresh beginning, and I returned to the car and then drove east for another three miles, until I was just above the downstream border of the catch and release section.

I crossed the highway and found a welcoming rock and paused to eat my lunch, while I observed the water. The river in this area consisted of huge exposed boulders with deep pools and pockets interspersed with fast rapids and chutes. Very little vegetation was present, as the the flood of 2013 scoured everything in its path.

After lunch I began to prospect a nice deep run along the opposite bank, and on the second cast a very nice trout rose and smashed the hippy stomper. I quickly lifted my rod to set the hook, and a rainbow surfaced, splashed and quickly ended our brief association. After the slow frustrating morning I was very disappointed with this turn of events, but I was at least encouraged to attract attention from a respectable fish. I reeled up my line, and I was disgusted to note a curled end of my leader. All three flies were lost, as the line broke at the knot that held the hippy stomper. I was relieved to remember that I tied five new peacock body hippy stompers on Sunday night, but I now faced the task of re-configuring my line.

I extended my tapered leader with a section of 5X and then attached my one remaining carryover hippy stomper. Below the foam attractor I added a beadhead hares ear and sparkle wing RS2, and I was quickly back in business.

First Decent Fish on the Day

Another juicy pool presented itself above the scene of the unfortunate separation, and I tossed the three flies into the sweet spot. Almost immediately a fish attacked the hares ear, and I quickly stripped in a five inch rainbow trout. The second cast resulted in a similar response, but on the third drift a ten inch rainbow crushed the peacock stomper. The contrast between this downstream section and the area that I visited in the first hour was dramatic.

I released the rainbow and continued to lob casts to the center of the quality pool, and I connected with another six sub-catchable rainbow trout. What was going on here? I moved on and continued the upstream progress, and the sequence of events that I described in the previous paragraph persisted for the remainder of my time on the river. I managed to elevate the fish count from two to seven. All of the counted fish except for the first were rainbow trout, and three were very nice brightly colored pink striped fighters in the twelve to thirteen inch range. The rest were very small bows barely over my six inch minimum standard for counting.

Big Surprise

This account of my day on Monday, October 22 would be incomplete, if I failed to mention the other thirty fish that attacked my flies. They were all rainbow trout in the three to five inch size range. They were actually a persistent nuisance, as they consumed time to release, and in several cases they created moderate line tangles. At least another twenty tiny trout grabbed my flies temporarily, but with my approval they fell off before I was forced to release them.

I concluded that the Department of Wildlife stocked sub-catchable rainbows in the areas where CDOT made emergency repairs to the highway. Five years after the flood the road construction work was completed, and as promised,  stream improvements were finished. I am guessing that efforts to repopulate the river with rainbow trout are in progress. These are merely my own personal assumptions, and I have not read about any DOW population enhancement projects.

The Entire Flock of Five

At any rate Monday was a somewhat frustrating day. I managed to land seven trout including three very nice feisty rainbows. The weather was delightful for October 22, and I encountered a small herd of bighorn sheep, when they crossed the highway and approached the river for cold refreshing drinks. Dealing with the ongoing nuisance of handling and releasing countless small trout was an unforeseen negative to my day on the Big Thompson River.

Fish Landed: 7