One Year Ago...

One year ago, I was about to be rolled back to the operating room for bilateral fasciatomy surgery to alleviate my exertional compartment syndrome symptoms.

On Sunday, I'm going to run a half marathon. It's going to be hot, humid, and maybe even raining.  But this time, I am going to appreciate every mile.

Operation Change of Pace

"I come back to you now, at the turn of the tide."
 -- Gandalf the White

"There's always a reason to quote 'Lord of the Rings'."
 -- Brian

For most of my running career, I've been an approximately 10:00 minute-mile runner.  I was usually faster on race day (except the marathon, of course), but this was usually the pace I was usually training at.  I haven't been that fast since my surgery.  I've only gotten two miles under 20 minutes once, and I think I managed one under-30 minute 3 miler.  That's ok.  What's not ok is that I don't seem to be able to consistently replicate my pre-injury attempts at this pace.  Even though I'm not hitting my old speeds, just trying to run at what seems like my natural pace seems to be a recipe for compartment syndrome pain.

Meanwhile, my wife has racked up distance running achievements far exceeding my own: eight half marathons (her ninth is this Sunday) following this past weekend's Shamrock Half Marathon in Virginia Beach.  I've noticed that when I run with her, I feel ok.  She trains at an approximately 12-minute mile pace and also incorporates a one-minute walk breaks every half mile as per an adaptation of one of Jeff Galloway's plans.  In both the Kelly Shamrock 5K in Baltimore two weeks ago and the Shamrock 8K in Virginia Beach, both distances I hadn't been able to hit in the past two month without pain, I ran with Chris, followed her plan, and felt great.  I also ran 4 miles on Monday by myself in Virginia Beach at a 5mph (12-minute mile) pace and felt very good.

The sample sizes are pretty small:  The Sole of the City 10K last year, which I really had no business running; the Kids' Peace Orioles 5K in November 2013, and the aforementioned 5K, 10K, and 4-miler are all post-injury races that I ran with Chris or using her run/walk plan, albeit in varying degrees of fitness and preparation by be me, without any compartment syndrome problems.  Those aren't the only races I felt good in.  I felt good at Rocky Run 10K and Celtic 5-miler last year.  But what about all the training runs where my shins and calves burned or where I couldn't move my foot?  I can't handle every run being a roll of the dice.

Between weather, illness, and my legs feeling like crap, I haven't gone more than 2 miles since February.  On Saturday and Monday, I ran 5 and 4 miles respectively, and felt better than I have since November.  Could it be that my injury is less aggravated at that pace (or that there is something about my stride that is different?).  I recall, when I had my bout of ITBS in 2011, that there was an optimal speed at which to run to reduce symptoms (unfortunately, it was faster than I could go!  I will try to look up that article and update the post, by the way).  Maybe a change of pace can help this injury as well.

I think it's something to try, and my laboratory will be training for and running the Wild Half Marathon in May.  If I can get through the training miles and finish a half marathon without compartment syndrome symptoms, then I'll feel like I'm back in the long-distance game.  If I can't, it's probably time to admit that anything longer than a 10K is out of reach, and focus on shorter races and/or find new hobbies.

The motivation is back. I'm feeling better mentally and have been more focused.  I just have have to be able to get the miles in.

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.

Under the Knife

Since the end of 2011, I've been struggling off and on -- more on -- with seems to be exertional compartment syndrome.  I was diagnosed with shinsplints in January, came back after a month rest, faster than ever, and then symptoms -- pain in the ankle and shin, loss of range of motion in the left foot -- became persistent again in the fall.  I rested again, started running again in early 2013, but was seldom pain-free, and the the rather-intrusive compartment pressure test showed that I did indeed have compartment syndrome in both legs. 

I really didn't want to have surgery, even though my orthopedist said that it was the most reliable cure for compartment syndrome, so I tried physical therapy. His opinion was that it was worth trying, but he was pessimistic that it would work. It seemed like it worked when I got serious about running again in January...until it didn't, and symptoms returned.  I made the decision to have the surgery.  I met one more time with my orthopedist, who agreed, naturally, that if I wanted to train for longer races again, that surgery was the best course of action for me.

I met with the surgeon in early April, and he explained that the procedure involves making incisions in the layer of fascia around the muscles in my lower leg compartments, which releases the pressure and should relieve symptoms.  He said that was a relatively simple procedure, and that I could have both legs operated on at the same time, which would make my recovery harder, or I could do one after the other, which would make recovery easier because I would have one "good" leg, but would take twice as long to get both legs "fixed".  I opted to have compartment release surgery on both legs, and I was scheduled to arrive at Wellspan Surgery & Rehabilitation Hospital on Thursday at 7:30am for the outpatient procedure.

I arrived, checked in, and was quickly taken back to remove my clothes (even my underpants) and change into a stylish surgical gown, and then put into a bed in a pre-op room to get ready.

As it turned out, my surgery almost didn't happen, because of this little guy:

This is Domo, aka, "The Fun Panther", our crazy little friend, who left an approximately one-inch long scratch ankle-level on my right shin when he jumped over my lap (I had my right leg crossed over the other).  When I was taken back for pre-op, the nurses quickly said that this little cut might cause my surgery to be delayed.  Cats have a lot of bacteria on their claws, and so they are extra careful with cat scratches because of the risk of infection.  After my surgeon looked at it, and said that it was ok to proceed because it was not near enough any of the incision areas, they shaved my legs and gave me an intraveneous anti-biotic and painkiller.  The anesthesiologist briefly visited and explained his role in the procedure, and then it was go time.

My bed was wheeled back to the operating room, and I slid myself over from the bed to the operating table, unintentionally giving some of the surgical staff a free show.  One of the surgical staff said that they would be giving me the anesthesia, and I would be asleep in about 60 seconds.  I don't think it even took that long...

...and the next thing I recall, I was in my bed with some nurses around me, my legs bandaged and painful, and my head feeling very groggy.  The nurses told me that I told the nurses I was going to make out with my wife and I asked them to bring me my kitty, neither of which happened, of course.

Apparently I made more incoherent conversation with the nurses and then Chris, who had talked with my surgeon while I was still asleep, was brought back so I could talk nonsense with her, too.   I don't really remember much of the conversation, but at some point I was moved from my bed into a recliner, and given my crutches for a brief practice with them, before being wheeled out of the hospital to Chris' car.  When we got home, I groggily made it up the stairs and plopped myself on the couch, where I've spent most of the past three days.

(My legs right after getting home.)

I was definitely in pain, intense at times, but I wouldn't call it excruciating.  I've got a prescription for vicodin, which makes my legs feel better but has made me nauseous at times.  Each of my three days since surgery I've less sharp pains in my legs but more muscle aches and pains.  I didn't sleep much at all on Thursday night, but slept very well last night, and somewhat successfully made my first post-surgery visit outside the house, when Chris took me to Dunkin' Donuts this morning.

I'll learn more about my rehabilitation next Friday, when I go for my post-op visit with my surgeon, and until then at least I'll be on crutches and quite useless.  I was told not to count on driving for four weeks, but that most people are back driving and feeling pretty well in 10 days to two weeks.

And my friend, Domo, who almost prevented my surgery?

He's been a nice little rehab friend.

For further reading about exertional compartment syndrome, here are two other patients' blogs that I've found to be very helpful:

Legs on Fire:  My Experience with Compartment Syndrome
http://legsonfire.wordpress.com/

Life After Compartment Syndrome
http://erana.co.nz/compartment-syndrome/life-after-compartment-syndrome/

Don't Call it a Comeback...Yet

My running goal for January was to be able to run two miles without any walk breaks by the end of January.  Nailed it.  Let's not talk about the weight loss goal.  January was a bad month for a lot of reasons, but I've got to get with it.

My goal for February is to be able to run four miles by the end of the month with no walk breaks.  I think I'm off to a pretty good start.  I ran 3 today, although I did take the "one-minute walk break every half mile" at 2 and 2.5 mile marks.  Total was 3.0mi in 32:18.  I can build on that.

What wasn't so good is that for the first time in several months I really felt the compartment syndrome symptoms.  I'm not going to panic, yet, because I don't think I was hydrated well, I haven't been as diligent with stretching and strength-training on off-days, and this was the first time I've tried a run this far since a sloppy 5K in December where we did a lot of walking just because of the muddy and snowy terrain.

So, while I'm not quaking in terror, I'm not jumping for joy, either.  

 

Compartment Pressure Measurement

Earlier in the month, I went to the orthopedist to talk again about the persistent calf and shin pain I've been having, mostly in my left leg.  With x-rays and MRIs coming back clean and rest, stretching, and calf exercises not doing much to help, the doctor determined that it was time to take the next step and do the test for Exertional Compartment Syndrome (which I'm going to call ECP).

Unfortunately for me, the test for ECP involves big needles being jammed into four places on each leg, then me running until my symptoms flare up, and then needles attached to a pressure-monitor being stuck in again.

I'm a wuss.  I've been dreading this.  The doctor and his assistant put iodine on my leg and used a small needle for local anesthetic, and I'll be honest, the procedure itself wasn't as bad as I feared.  It was probably worse for the doctor, who had to put up with my nervous banter between him, his assistant, and Chris (who was kind enough to accompany me for moral support and to drive me home).  I think I did crack one good joke during the procedure:  As the doctor was using a pen to mark where on my leg where he would insert the needle, I deadpanned "that wasn't as bad as I thought."  It was pretty much downhill from there.

When I left the office with the assistant, who accompanied me to show me the likely direction that would be safest for my run, my calves still felt a bit numb.  The run itself seemed ok considering I didn't take any naproxen, I didn't stretch, and I didn't wear compression socks.  All of these anti-precautions were in hopes of making my symptoms flare-up badly and quickly.  Instead, I ran for 20 minutes and while my calves became very sore, I didn't have the level of shin pain that I normally have.  I did feel kind of stupid running around the medical center, but I never run on treadmills and so I thought it was best to go outside.

Despite the lack of shin pain, I sat down to check that my left foot didn't have the full range of motion and given the level of pain in my calves, I figured I was "good" to go back and be re-tested.

The second round of tests hurt a bit more than the first,  but not as much as the results (positive) and the aftermath (calves extremely sore all day).

The measurements showed that even at rest, the compartment pressures in both my legs was higher than normal, and after running the left leg compartment pressure rose even more, while the right leg stayed pretty much the same.  These results do confirm Exertional Compartment Syndrome, and confirm that it's worse in the left leg.

My best option is surgery, but with my doctor's blessing I'm going to try a few weeks of physical therapy first.  It probably won't work, but really don't want to have surgery.  I can't stress that enough.

A second is option is quitting longer distances.  Stop running or stick to the mile, 2-mile, and 5K.  I admit this option is tempting after a frustrating, often unenjoyable last 16 months of running.  But on the other hand...if I'm going to give up running, I really don't want to go out like this either.  I'm probably not going to be a frequent marathoner, ever.  But I'd love to get back to my 2011 form in which I could run 8-10 miles several times a week and train myself up to a half without much trouble.  More specifically, I would really like to be able to run the AC half this year and either the half or hopefully the full next March in VA Beach. 

I've quit a lot of things in my life when they got too tough:  tee-ball, soccer, basketball, cub scouts, jobs.  I don't want to quit running yet.

Still, before I get ahead of myself to the surgery/no-surgery decision, I'm going to cross my shins and hope that PT will do the trick. 

Follow-up Orthopedic Appointment: This is Not Good

Since my shinsplinty-things seem to be getting worse -- or at least more consistently present -- I'd scheduled another follow-up visit with my Orthopedist.

Here's what I hoped would happen:

My orthopedist confirms the diagnosis of shinsplints and sends me to physical therapy.  I learn a bunch of new stretches and exercises and go on to qualify and probably even win the Boston Marathon.


What really happened:

My orthopedist found that I have good strength in my leg and foot muscles and that -- regrettably -- it's time for us to more seriously explore Exertional Compartment Syndrome as a possibility.  This will involve a huge needle being jammed into my leg muscles both "at rest" and after a long-enough run to induce symptoms (so probably 10 minutes, roughly one mile).  If the test confirms ECS, then my best option is surgery.

Good.  Great.  Terrific.

Basically, Compartment Syndrome is when a fibrous tissue membrane, the fascia, around a muscle is too tight to account for the muscle's swelling during exertion.  (Please consult medical websites for a more scientific description.  I'm -- surprise! -- not a doctor).

Here's a website with a good picture that demonstrates this.  (Note:  DO NOT do a "Google Image Search" for "Compartment Syndrome".  Trust me, it's a lot of gross surgery pictures that make me want to retire from this running thing.)

http://www.physioroom.om/injuries/calf_and_shin/compartment_syndrome_full.php

I'd guess that my problem is going to be in the anterior compartment and lateral compartment on my left leg.

So, bad luck for me.  But, excellent for you, since if privacy regulations allow it, I'm going to have my staff photographers (me and my wife) take some pictures of the compartment syndrome test, and maybe Chris can even be in the operating room taking pictures and interviewing surgeons as they cut out parts of my leg.

The test is scheduled for April 16.  I may push it back if the doctor thinks that the test itself is traumatic enough that it will prevent me from limping through Sole of the City, with some help from anti-inflammatory meds, on April 20.

I'll keep everyone posted as I freak the hell out.