Saturday, August 2, 2014

Bilateral Compartment Syndrome Surgery and Recovery

As I've run less and less over the past few years, these blog posts have become less frequent.  But in those few blog posts there's a lot of space given to complaining about (mostly) and trying to recover from compartment syndrome.  After two years of trying avoid surgery, I finally decided to go under the knife.  I described the lead-up to surgery a few months ago.  Now that I'm (hopefully!) well on the road to recovery, although not nearly as far back on the road to racing again, I figured I'd take the rare opportunity to write a blog post that might actually be informative.

To very briefly recap, I started having symptoms in December 2011. I'd have swelling and discomfort in my ankles and calves, more pronounced in the left one, and a noticeable loss of range of motion.  Shinsplints were the initial diagnosis, with compartment syndrome being the next "option" when my problems didn't really respond to the main treatment of shinsplits (rest).  Any time I took a few months off from running, I'd come back and my symptoms would be better, only to come back every time I got back into some consistency of running.  That's why I won't know if this surgery worked for a few more months.

At any rate, a compartment pressure test confirmed the diagnosis in Spring 2013, and I tried a long program of PT to avoid surgery.  No luck.  I had surgery on May 15, 2014.

As I said in that initial post-surgery blog post, I woke up in a fog of post-anesthesia and painkillers, definitely in pain, but not as bad as I feared.

(a few hours post-surgery)

Despite that, those first few days were bad.  I frequently felt nauseous from the vicodin, and when I moved my legs, I would feel a tearing sensation in my legs in the area of the surgery.  If I touched those areas, they would feel hot to the touch, although I think that burning sensation was in my legs, and not actually heat that I was feeling, since my legs were pretty heavily bandaged at this point.  I limped around the house on crutches.  I expected to sleep like a rock that first night, but got very little sleep, and because of that I probably crutched my way around the house too much.  I had big ice packs that I'd wear over my legs (or wrap around them with velcro as I got a little more able to sleep in different positions) for long stretches of time for the next several weeks.

Still, just two days after my surgery, I was at least out of the house for a quick Dunkin Donuts trip.  It probably wasn't worth the discomfort I was in going up and down the stairs or how long it took me to get from the car to Dunkin, but I'd wanted very badly to get out of the house, and my Dr. had said it would be ok to try things like this as long as I was careful.

I'd love to say I got better every day, but there were good days and bad days over the next few weeks.  I felt "pretty good" a week after surgery when I went for my post-surgery consult.  The doctor said everything looked good and that the procedure had gone well, and that I could start to s l o w l y ween myself from the crutches...which would go more slowly than I'd hoped. I was to start out by trying to get around the house without them, but using them when I went outside. 

(Looking great 7 days post-surgery)

I had my surgery on a Thursday, and went back to work the following Wednesday.  It's important to note that I work from home.  If I didn't, I probably would have wanted the whole next week, and it was probably another two weeks before I could really sit at my desk in my upstairs office comfortably.  My legs were most comfortable stretched out in front of me, and there wasn't really a comfortable way to do that at my desk. I could work downstairs on the couch, but I wanted to be up in my office as much as possible so that I could receive calls on my work phone line.  People at work have my cel number, but if that got established, even for a short time, as my "main" number, I thought that would be very hard to put back  in the bag.  

I also had a massive gout the Thursday after surgery.  My gout flares up, usually in one of my big toes, a few times each year, but it seemed especially bad in the weeks after my surgery.  If I didn't drink a ton of water (and even sometimes if I did), I'd have gout flare-ups the next day.  My orthopedist would later say that for gout suffers, it's not uncommon for them to be more susceptible to flare-ups after surgery. And I was stupid -- I think it was because the day of my surgery through Tuesday, I'd drank massive amounts of water -- oceans of water -- every day.  But once I went back to work, I wasn't drinking as much...since I couldn't carry cups of water up to my office with my crutches.  Sports bottles were the easy remedy for this. 

The second weekend after surgery was Memorial Day weekend, and I pushed myself too hard. Chris and I went to an outdoor music and wine event at a local winery with some friends, and I walked around more than I should have -- and tried to be more independent than I should have been.  My attitude was getting pretty bad at this point.  I didn't want to be dropped off closer to where we were sitting.  I didn't want to not be allowed to carry anything while Chris made multiple trips.  The next day, we went out to eat in downtown York, and walked 2 blocks from the parking garage.  These adventures definitely set me back a little, and I was tired and sore over the next few days, and on crutches more often than not, even around the house.

I'd taken vicodin -- one in the morning and one at night -- on Thursday, Friday, and Saturday, and then generally stopped.  I didn't want to continue it longer than I had to because it's addictive, and because I stopped it so quickly, I'm not sure that I'd say it helped a lot.  I did take them the day of my gout flare-up and then for a few days following the Memorial Day adventures.  I took one vicodin twice a day, half the prescribed dose, at my Dr.'s suggestion, since the anesthesia had knocked me out so easily.  Like I said, it's hard to tell if one vicodin at a time really helped.  I took two the day of my gout flare-up, when I was just in agony, and two vicodin definitely made a difference.  Not entirely good, though, I felt VERY spaced out and nauseous.

(My right leg on May 28.  My right leg had the worse swelling of the two, 
and looked worse here than it did a week after surgery.)

Once the calendar turned to June, I turned the corner.  I was walking mostly with crutches, driving short distances again, and feeling much better.  My ankles were still very swollen, but I was making steady progress forward.  At my second post-op appointment on June 11, my doctor said it would be ok to start light exercise with no resistance (Chris and I started going for walks), but I was still about a month away from running.  I went way for a long weekend with college friends, walked a ton and drove all around Philly and Atlantic City, and needed my ice packs, but was ok. 

At my third and final post-op, on July 16, my Dr. told me I had no restrictions, and that I could start running again.  

So where am I today?  So far, my legs feel mostly fine.  My left leg -- which was the worse-afflicted with compartment syndrome -- is better than the right leg.  On my right leg, I've got some numb spots (which are a known risk of the surgery, they might never heal) and a little bit of swelling around the ankle.  I have 3 incisions on each leg, and the ones on the outside of my ankles are the ones that bother me most, because they continue to be persistently itchy as they continue to heal.

Did I make the right choice?  Here, 2.5 months later, I'm confident that I did.  If I keep running, and my symptoms return, then there was another contributing factor and it's back to the drawing board and probably off the racing circuit, but I'll worry about that in a few months.  

Right now, it's time to run.

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