Updates - Recovery and Physical Therapy

Hey all, just a quick update - Have progressed to doing squats (extremely sore! In a good way though) and heel raises throughout the day pain free which is awesome - Pre-surgery those could simply not be done without the compartment syndrome high pressures stopping me ... tightness in the calf is abating more and more every day - This Monday I start bike and massage and I'll post how it feels....

Three Weeks Out - Physical Therapy, Recovery, and Questions

Hey all, sorry it's been a while - things have been busy. Last post explained my first post-op visit and left off with me excited for my first PT appointment. I went to a nice place in the Longwood Medical Area (for non-bostonians, that probably won't resonate) where they were recommended by my surgeon due to the volume of compartment syndrome afflicted patients they receive. I was still somewhat apprehensive that I might be assigned to a physical therapist that would not have significant experience with CS, but those worries were quickly placated when I met Jerry, who seemed to know his stuff.

He explained that for another week and a half, calf/ankle stretching and some very simple calf/ankle strengthening exercises would really be the only PT I would be doing, as the legs are still healing from the trauma of surgery. At about 4 weeks post-op, he explained, is when the real physical therapy would begin, with some bicycling, and, in his words, "massaging the hell" out of my legs (I assume that, among other things, it goes to break up scar tissue).

Interestingly, a reader of this blog named Tom has mentioned that his doctor advised that he should start running as soon as he could in order to break up the scar tissue. This seems to be in direct conflict with what both my surgeon and physical therapists have advised - Namely, to absolutely not run at least for the first 6 weeks, and to err on the side of not pushing it in any activity one might find themselves in. It seems that there is obviously two things that need to happen post-op - your legs need to heal, and scar tissue needs to be broken up (obviously there are additional factors, such as strengthening, but these two seem to be the crux of this conflict) - Now I would assume there would be an optimal time where the healing of the legs would reach a point that increased efforts to break up scar tissue would not compromise the recovery - the question is when that point is. So if anyone else who has been advised by a doctor as to what point they should begin running activities (and keep in mind that in both cases 4 compartments were released on both legs) then please speak up!

As for general updates on leg ability, I now can be on my feet all day with barely any pain, although I sometimes encounter swelling late in the day, however it is not too significant. Yesterday I walked all over the city, probably a combined two or three miles, with minimal discomfort. Stairs pose no issue. My right leg is still a little behind my left leg, in that the calf is tighter and flexibility is just not as far along. But overall they are still gradually improving. Next physical therapy appointment is Wednesday, so I'll keep you guys posted.....

2 Week Post-op visit - The Fun of Recovery Begins

With the swelling and numbness of the lower right leg somewhat subsiding, I was quite excited to go see what the surgeon had to say in terms of how my recovery was going. I also am planning on leaving the country in late May/early June, and wanted to understand if that would be detrimental to my recovery or not.

After quite a long wait (While this doctor is know as one of the best sports medicine surgeons in Boston, he also has a reputation for really shitty waiting times - Either way, I'll take that combination over the reverse any day), an awesome fellow came in to remove my stitches. I had 4 incisions on each leg, with 6 of the 8 being stitches that could dissolve on their own, and the other two being ones that had to come out. The fellow said she would also try to take as many dissolvable stitches out as my legs would let, as the rule of thumb is usually that the less foreign bodies in a person's leg the better. She got all the stitches out except for one dissolvable one, which was alright with me. As far as pain went, I've read in other places that people have experienced insane amounts of pain during stitch removal. Except for when the fellow tried to remove the one stitch that wouldn't go, there was barely any pain worth noting - she had hands of gold!

What was also good about this setup was that while taking the stitches out, the fellow was able to provide me with all sorts of reassuring information - Men do tend to fare better overall than women (sorry ladies), and she had a friend who got the procedure done a year and a half ago who is now doing triathlons. When I expressed to her concern that I had heard people who are a year and a half out of surgery and still can't go full throttle, she replied that recovery is really different for everyone, but that a substantial percentage of patients in my situation were really able to resume full activity around week 12.

Shower-wise, she said I was all good to go, except that I should only let soapy water fall down on the lower legs, and there should be no scrubbing in that area. She also recommended knee-high compression stockings in order to allow the blood to flow easier throughout the lower leg and prevent swelling. When I went to the medical supplies store, they gave me two different compression stockings to try out - Medi, and Jobst. For me, Jobst was far and away much more comfortable than the Medi, so if you have the choice, I would really recommend going with it.

Finally the surgeon came in, said my legs looked great, and said that I was all cleared to start physical therapy tomorrow. While he said the physical therapist could give me a better idea, he recommended staying for at least 6-7 weeks from the start of physical therapy in order to get the greatest benefit. I guess I'll find out more tomorrow....

Some Encouraging News - Recovery from Surgery Seems to be Back on Track

Good News! Swelling in my right foot went down dramatically over the course of yesterday (Day 11), and like magic, my right leg's ability to carry out normal walking functions vastly improved. It is still not quite up to the left leg's recovery yet, but hopefully it will continue to catch up. Also, although it might be wishful thinking, tt seems as if I am regaining some feeling in the 4 square inch swath of leg that has been lacking any sensation for the past 4-5 days.

Also, a little comically, I tried to take an actual shower 2 days ago for the first time (rather than just washing my hair in the sink - yeah, do the math, it means I didn't really wash my body for 11 days - It was an experience). I was warned not to get the incisions wet and was told garbage bags could provide the necessary protection - MAJOR MISTAKE- By the end of the shower, both legs were pretty soaked, and since I kept my ace bandages on during the shower, the incisions were to a certain extent being continually kept in water. Since it was already day 11, I hope it wasn't to damaging (and it was also a pretty quick shower), but a word of advice - If, unlike me, you need to actually be a real person during the initial 10 days of your recovery, and thus actually shower, I would recommend investing in something like this - It seems a tad expensive, and I'm sure if you look around you could find something cheaper - But really, it's not worth putting your recovery in jeopardy by screwing with your incisions, so be careful.

My first post-op appointment with the surgeon is tomorrow, and I am hoping he will tell me I can begin physical therapy - We'll see how it goes....

Recovery Days 5-7 - Post-op fasciotomy - Surgery Fights Back with Swelling and Numbness

While days 1-4 went relatively peachy, 5-7 encountered myriad issues that warranted a couple calls to my surgeon's office in order to find out what constituted "normal". Moral of the story was, unless something is really fucked up, it's probably within normal variations of recovery.

The first problem arose the night of day 5. On day 4, I had accidentally knocked the inside of my right lower shin/ankle pretty hard, sending a strange sensation up my leg. I thought nothing of it, however, until numbness came on in the exact spot about 24 hours later. The numbness basically encompassed the upper half of my ankle bone, extending for a swath of about three square inches upward until one of my incisions. I knew numbness was one of the side effects of surgery, but I was under the impression that if numbness had happened, I would know right away post-surgery. This numbness, however, had taken me by surprise 5 days down the road. Worried, I called the office and spoke to a fellow. She explained that while it is somewhat unusual for the numbness to come on five days after, it's not unheard of and not too worrisome. If the numbness was actually caused by the hit to my ankle I sustained, feeling in that area could come back rather quickly, but if it had nothing to do with it and was a natural outcome of the surgery, sensation in the area could take anywhere from 4 months to a year to fully be restored. What was reassuring, however, was the doctor's assurance that the numbness in that area does not hinder recovery at all, and the numbness that doctor's worry about pertains to the foot, which thankfully so far, I do not have.

Days 6 and 7, however, brought a new challenge - moderate swelling in my right foot. Along with the numbness that I also experienced in the right lower leg, it was also apparent that my two legs were simply not recovering at the same rate, which I also found worrisome. The pain in the calf (which is what hinders one from doing strong heel to toe strikes) was strongly persisting in the right leg while quickly waning in the left. Cue another call to the fellow at the surgeon's office. She explained that the swelling in the foot is the most common and very expected, as it is the primary weight bearer, and that a combination of icing, elevation, and compression stockings would help alleviate the symptoms. And in terms of one leg recovering faster than the other, she added that it is the most common complaint from patients, and is simply natural - eventually they will catch up to each other.

I also had one more overall complaint for the doctor - It almost felt as I had regressed from Days 1-5, and I was not as comfortable on my feet nor proficient at ankle pumps as I had been earlier. Once again, the fellow dexterously assuaged all my doubts by saying that as patients feel more comfortable on their feet, they probably push their limits too far, causing the legs to stiffen up temporarily and recover.

So, what's the conclusion? First of all, that this fellow I spoke to should definitely be employed in some sort of suicide prevention program. I could have called in saying both my legs had fallen off, and she probably would have found a way to calm me down and make me feel that it was a normal process of recovery post-surgery. In all seriousness though, it made me realize that post-op recovery is not going to be a linear progression, and I need to be emotionally and physically prepared for the ups and downs that are coming. I just hope that at the end, I'll be back to where I want to be....

Days 1-4 post-op fasciotomy - Recovery Begins

For the first 4 days, everything was going alright. I was slowly able to progress from barely being able to lift my feet off the ground to being able to do some nice heel to toe strikes. On day 3, I was told that I was allowed to switch from the four-point crutch gait to the two point, which allowed for much greater mobility. Whenever I was laying down, (which I probably was 90 percent of the day), I would have my feet steeply elevated and be icing. After my second night sleeping on the first floor, I moved up to the second, and while a flight of stairs is certainly not easy, there wasn't any major problems or pain from doing it.

Starting on Day 3 -Three times a day, for about 5 minutes, I alternatively lift both legs in the air and do a couple sets of twenty ankle pumps, but quite lightly, as I was told it is important not to push anything, as the body is recuperating. By day 4, I was moving around the house without crutches, and even was able to drive to the post office to mail something. The doctor said that on walks that are longer than those one would typically take around the house, crutches should be used until day 7-8.

In terms of physical therapy, my surgeon told to me that under no circumstances should I begin any kind of PT before my post-op appointment on April 12th.
So far, no swelling or numbness to report, and I keep ace bandages on both legs tightly wrapped - Step by step, my recovery is taking shape.....

The Day of Reckoning - Surgery - Bilateral 4 Compartment Facsiotomy

I found it fascinating. In the weeks leading up to the surgery, I would always get asked the question, "are you nervous?". And I would reply truthfully, that I wasn't. But driving to the hospital at 2 in the afternoon on the day of surgery, it hit me. This literally would affect my entire life going onward. Either it would work, and I would be able to resume athletic activities, or it would fail, and I would be forced to significantly alter my lifestyle, as I had done for the past year. I guess relatively speaking, it wasn't nearly as big as some actual life-threatening surgeries people face every day, but still, this was important to me - and I was rattled. This was something that I absolutely could not control; I was at the mercy of my surgeon's abilities.

It was also eerie checking in alone - While that is probably normal for most adults having surgery, the last time I had any kind of procedure done with anesthesia was in 10th grade when I got my nose shattered by an elbow while playing basketball. Back then, my parents accompanied me. This time, however, I was alone. It kind of hammered in the point that this surgery was about me, and if it did fail, no amount of comfort in the world would allow me to be the same.

Alright, now on to the details that you all actually care about. My surgery was scheduled for 330, and I was told to arrive at 2. I got there, and switched into the always-oversized and forever-comical looking gown. Doctors came around periodically and almost all of them asked me the same questions about what I had eaten in the last 24 hours (I was not supposed to eat after midnight, and not supposed to drink water 2 hours before surgery). I could not tell if this was a case of unfortunate bureaucracy or if it is protocol in order to really make sure the patient isn't forgetting the entire pizza they ate an hour before surgery, I'm not sure.

I asked to see the surgeon before, as I wanted to ask some last second questions in order to have some peace of mind before they put me down. I had 2 questions - 1. I reiterated the fact that my lateral compartment was negative bilaterally in the compartment syndrome test, and wanted to make sure that, with that knowledge, he still wanted to release it, and 2. If something does go wrong, what are some of the effects I might experience (I know, stupid to be asking 15 minutes before surgery, but I'm a glutton for punishment). For question 1, he repeated the same answer he gave before, that it would not compromise recovery if the lateral compartment was released, and would benefit me in that it would reduce my chances of symptoms returning post-surgery, which would obviously suck.

For 2, he told me that failures usually entail the returning of symptoms, and in 1 case of an older women, there was some permanent numbness in the leg. Armed with these somewhat reassuring answers, I was prepared to go under. The anesthesiologist gave me an IV, started pumping the good stuff, and away we went.

Surprisingly, I woke up quite comfortably. I could feel my legs were bandaged, and there definitely was a feeling that something happened down there, but pain was kept to a minimum. My mom also appeared, as she was going to drive me home. Apparently, the surgeon said that both lateral compartments appeared quite tight, so it's good that he released them despite them coming up negative on the compartmental test! After some saltines and a bunch of water, I hobbled up with the help of a nurse, and got into the wheelchair. Then I had my first real test when I had to get out of the wheelchair and into the car. It's hard to describe the feeling, but it was somewhat similar to my calves being locked, and if I tried to use them, some serious pain would result. So I somehow managed to get in the car, and then, using crutches, made it from the car to a bed I had set up on the first floor. At this point, walking consisted of shuffling my feet using the four-point crutch gait. Any flight of stairs that had more than 3-4 steps would have been immensely uncomfortable at that point. I had a bunch of pillows piled up at the end of the aero bed I was sleeping on so my legs would be seriously elevated. I also was given these nifty ice packs connected to coolers, so I could essentially pump cold water into the packs as needed. I basically got into bed, popped 2 5 mg pills of oxycodone, and drifted in and out of sleep for the next 12 hours. Pain was definitely there, but very mild. I did need to go piss a couple times during the night., though, and the most difficult part was standing up, as that required putting more force on my legs than they allowed, but I mainly just shuffled my way back and forth using crutches.

More updates to follow!

Fasciotomy Pre-Op Appointment - Cautiously Optimistic

Finally it came to the day I was looking forward to for a couple weeks. When I got called at the office, a fellow who works with the surgeon came in to take my history, and ask if there were any problems, etc. I explained to him that over the last couple weeks I had started to feel the effects of CS even when I was not exercising, as it manifested itself in a sort of uncomfortable, not getting great circulation feeling in my legs. He explained that this was not crazy, and sometimes is how compartment syndrome progresses.

Then the surgeon came in. He explained to me that even though I had only three compartments test positive for compartment syndrome, he thought it would be best to release all 4 on each leg. I asked him the reasoning for this, and he explained his reasoning: 1. I had explained to him that most of the pain I felt during running was actually in the lateral area, and thus he thought it would be foolish to leave the compartment alone and 2. He told me that there have been lots of cases where people get 1,2, or 3 compartments released and then are symptomatic later on for the fourth and have to have surgery all over again, so it was safer to release all 4 compartments in this case.

I was worried, however, that this would make the procedure a little more risky, just from the logic that the more compartments you mess around with, the more random things can go wrong. He responded that the releasing of the lateral compartment did not significantly compromise the success of the surgery, and that the benefits of doing so far outweighed the risks.

Then, on to success rates. The doctor told me that 90% of his patients experience full recovery, meaning they are able to achieve athletic performance levels that are commensurate with how their performance levels were pre-onset of exertional compartment syndrome. While in the grand scheme of things, that is not as high as I would like, after reading the literature and looking at online forums, it unfortunately seems that that is the best you are going to get. Plus, I would like to think that since I am still relatively young, my chances will be good.

In terms of a recovery timetable, my surgeon said at 4-6 weeks I could begin to do cycling, 6-8, running, and at about 10-12, I should be nearing full recovery. While that is a substantial amount of time, I really don't care in the slightest if I will finally be able to do the things I love for the first time in a long while.

The surgeon also said he would be sending me for an MRI just to rule out vascular restriction in my legs, as apparently that sometimes causes compartment syndrome-like symptoms. With that, I thanked him profusely, and barring a rare case of vascular restriction, was set to go under the knife!

Choosing the right surgeon for compartment release

Once I had decided that I was going to need surgery, it was time to find a qualified surgeon - easier said than done. While almost any orthopedic surgeon will offer to do the fasciotomy (compartment release), it must be taken into account that compartment syndrome is still a relatively rarely diagnosed condition, and therefore, there are not a lot of surgeons out there who have done the procedure enough times to be truly considered experts.

So when speaking to a prospective surgeon, DO NOT be embarrassed to ask how many compartment releases the surgeon has done in the past year. While this might be a somewhat awkward question to ask, as it implies a certain distrust of the surgeon's abilities, it nonetheless must be asked. I first went to a highly respected surgeon (for those Sox fans out there, he was part of the surgical team that did the famous suturing of Curt Schilling's ankle in the 2004 ALCS against the Yankees). Unfortunately though, he told me that he only did about 1-2 fasciotomies a year. That just wasn't going to cut it. Even if his office walls were adorned with the autographs of the entire '04 sox championship team.

Eventually, I found my guy, who does tons of them, and came highly recommended (If anyone would like names, please contact me).

Now it was time for the pre-op appointment...

Rolfing (ouch!), Physical Therapy, Stretching - Helpful for some things, but not exertional CS

I now faced a decision - Do I decide to go under the knife right away, or do I try to convince myself that with a little alteration of activity and different forms of massage, I can live with the condition? Obviously the latter is a little less daunting, so I quickly devoted myself to all forms of alternative treatment.

First up - Physical Therapy - Went about six times (Over the course of this entire saga, I did feel partly guilty for taking advantage of the fucked up healthcare system we are all so privileged with in the U.S.) The physical therapist admitted that she had not seen anyone be able to actually overcome symptoms of compartment Syndrome, but she would give it a try. She did all different sorts of ankle, shin, and calf massages/manipulations, but over the two and a half weeks that I attempted treatment, there was simply no progress, and I decided to move on.

Second - Rolfing - While I had not heard of rolfing until I read this article in the NYTimes (http://www.nytimes.com/2010/10/07/fashion/07rolfing.html), it is a treatment that many people I now know swear by. Why it interested me particularly for Compartment syndrome, though, was the fact that rolfing is completely devoted to resetting all the fascia in the body. And what do you know? Compartment Syndrome is fascially based! I went to a rolfer that came highly recommended, and while he did say that he has seen people afflicted with CS overcome the disorder through rolfing, it was not a high percentage. I decided to give it a try (and at about 125 a session, it was not an easy choice). Now, granted, I was warned beforehand by many a rolfer devotee that rolfing was painful - but nothing, I mean nothing, can prepare you for the actual experience - Plain and simple, it fucking hurts. Thankfully, though, my rolfer was laid back, and thus didn't mind me lashing out at him into my pillow with language that most would not approve of. I went to five sessions with him, and while I sometimes did see small improvements, it was never substantial enough to allow me to conclude that the rolfing did actually help. My rolfer did however explain how my back pain could be connected to the Compartment syndrome, as he showed me quite a startling picture of someone's fascia cut out of their body, and it really is ALL connected.

During both the PT and the rolfing, I also tried doing at-home stretches that I found on the internet that I thought might help, but I really did not see any marked improvements (although by this time I was also extremely discouraged). A couple weeks post-rolfing, and my CS had progressed to where I could not even play an hour game of basketball comfortably, and the daunting realization that surgery would be the only option if I wanted to continue my athletic pursuits slowly began to set in.

It was time to tuck my tail between my legs and, with my test results in my hand, consult a surgeon :(.