Amazing Insights into Happiness - Top 5 Regrets People Have As They Are About to Die

A palliative-care nurse shared very thought-provoking insights from her life's work of caring for patients who were about to die. Scary to think that almost everyone regrets working so much....it definitely provokes self-reflection.

1. I wish I'd had the courage to live a life true to myself, not the life others expected of me.

"This was the most common regret of all. When people realize that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honored even a half of their dreams and had to die knowing that it was due to choices they had made, or not made. Health brings a freedom very few realize, until they no longer have it."

The overall theme here definitely seems to be authenticity. What a powerful sentiment! So many of us spend our entire lives subconsciously (or consciously) trying to conform to societal expectations of how we should look, what kind of work we should do, and certain standards of living we should strive for.

2. I wish I hadn't worked so hard.

"This came from every male patient that I nursed. They missed their children's youth and their partner's companionship. Women also spoke of this regret, but as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence."

3. I wish I'd had the courage to express my feelings.

"Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result."

4. I wish I had stayed in touch with my friends.

"Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying."

5. I wish that I had let myself be happier.

"This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called 'comfort' of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again."

That is why these nuggets of wisdom are so powerful; for those near death, the societal constraints they have been subjugated under are laid bare, and core principles come through. Prioritize family, friends, and a positive outlook. Of course work is important (and in many cases quite meaningful), but it needs to be correctly contextualized within the overall framework of your life.

Hip Impingement: Femoral Acetabular Impingement Musings (Compartment Syndrome as well as FAI)

I still can't believe I started writing here about seven years ago, crazy! No one knew who Lavar Ball was...simpler times.

As I've become further removed from both the bilateral fasciotomy (March 2011) and the left hip osteotomy/labral repair for FAI (February 2013, Cam Impingement), I've sometimes wondered about the nature of their relationship, and if certain aspects of my athletics training could have prevented the invasive procedures I chose to undergo.

My musings pretty much begin and end with....the hip hinge movement. I will go into detail in a later post, but just to start those of you off who came here with either chronic exertional compartment syndrome or FAI, here is a link explaining the importance of the hip hinge - .

Until next time, but glad to report that seven years later I am physically the healthiest condition I have ever been in (although a sprained ankle playing basketball has revealed itself to be an avulsion fracture of my navicular bone in my foot...I will get to that at some point!)

In the meantime, feel free to ask any questions about compartment syndrome or FAI surgeries and recovery times, as well as anything else that may be on your mind.

Much love!
John

She has the right idea (although too much arch in her back - we want to avoid lumbar extensions in this movement)

5 Years Later(!)

Might as well give a little update - The compartment syndrome symptoms have never returned.  While I had some other issues further up with the hip, it never seemed to be related to the fasciotomy, but rather to congenital anatomy that just isn't so great (if interested, feel free to look up femoral acetabular impingement ;).

You might have trouble with the split if you have FAI!

The only thing I notice is a slight weakness in left calf stability - If I enter a contest on who can stand on their left foot the longest, I will probably lose.  It doesn't really affect day to day functionality though.  

My advice is still the same as it was - If the issues are really localized to the calf and you test positive for compartment syndrome, get an experienced surgeon and do the fasciotomy.

However, surgery is still surgery.  Be diligent about ruling out confounding factors before going under the knife. Get second opinions.  Always get second opinions. 

Update One Year Later

Wow, it's been a long time since I've updated this blog.  The reasons for this were partly due to laziness and partly due to being unsure how to convey how I have progressed. 

The good news - beyond numbness on the inside of my leg above my right ankle (which does not really affect much), there are no lasting problems from the surgery.  Additionally, I do not have Compartment Syndrome symptoms and had an additional pressure test in which it was confirmed that the CS is gone. 

The bad news - The back pain that was thought to have been secondary to the CS has not improved, and I have had problems higher up the chain involving my left hip.

Now, from the perspective of people who have CS and are reading this for advice, the back pain issue probably should not bother you.  From what I can tell, most people whose lives have been compromised by CS are not also suffering from debilitating back pain, as I was (so that shouldn't be an issue).

The hip problems I have had (pain, decrease range of motion, can't really ride a bike....) may or may not be a result of the surgery, it's impossible to tell.   I'm wondering if anyone else out there has experienced problems in other parts of their bodies that they believe might have been due to the surgery.

It's entirely possible that I am a special case and my body might just be kind of fucked - The CS is gone though, and I have no regrets about the fasciotomy. 

My advice:  If it's severely impacting your life and you are young, find an EXPERIENCED surgeon (does at least 5-10 of them a year), and get it done.   Being active kicks ass....don't let anyone tell you to  accept what has happened to you and not do anything about it.

Getting There........

Knee problem is progressing...but excruciatingly slowly. Bit by bit every week I have more confidence in its stability - Played a hard game of basketball the other day, and felt pretty great (Compartment Syndrome-wise) - Still have not attempted long distance run, but hopefully will within the week.  Either way, a good, hard game of basketball was not possible pre-surgery, so that is encouraging.  Still going to Physical therapy for the knee though, but will hopefully be done in a couple weeks...Otherwise, no complaints - My back has been stable for the longest period in a year, and my functionality in every day life (and my disposition) have improved greatly - I hope the progression continues


ALSO - Over the course of my posts, there have been a lot of people who have described just being out of surgery and in the early stages of recovery - How about some updates?  Comment on this post with all that you want to share about your experiences; I guarantee you many people will find it helpful!

Quick Updates on progress and recovery after compartment syndrome surgery

Hey all, the primary problem seems to be awesome. My shin/calf/entire lower legs feel great, and my back pain has completely subsided.  Only problem is, I still have this lingering left knee issue (possibly patellofemoral syndrome) that I have not been able to shake.  It has been making progress, and I hope to start running again within the next two weeks, to really be able to test out if the CS is completely gone.But besides for the left knee, my legs do feel great.

Strides and Set Backs

CS type pain that I talked about last post has basically subsided - Unfortunately, I have come down with an annoying case of what has been diagnosed as patellofemoral pain syndrome in my left leg - It's a problem with the knee - Anyone else have any experience with it?  Otherwise, I do feel like I'm on the verge of a big breakthrough - Physical therapist and surgeon says a lot of cases resolve in 4 weeks, so I'll keep you guys updated!

Ups and Downs - Running, Biking, and Some Pain in Between

Hey all, sorry I've been away for so long... The past 3 weeks have been quite scary, as my left leg has felt like the Compartment Syndrome was back and rearing its ugly head even stronger than before.  The right leg, however, has been doing swimmingly, and has felt great (Interesting, due to the fact that for the majority of my recovery, the right leg lagged behind the left - moral of the story: Recovery is a fucking roller coaster).  There would be a constant sort of burn/pain in my left outer shin/ankle, and going up steps would exacerbate it (although interestingly enough, jogging and biking kind of made it feel better?  Anyone have any idea what the that could be?)

The surgeons and physical therapists both claimed that it is simply too early to tell if what I am feeling is an indication of the compartment syndrome coming back and the fasciotomy being a failure.  I am currently about 10 weeks post-op, and they say I need another 2-3 to see where I'm at.   My physical therapist even claims it might be due to weak peroneals in my left leg.  Either way, I am happy to say that there has been a steady improvement over the last 4 days with regards to the left leg, and now the symptoms are just a sort of constant burning sensation over the left shin/ left foot area, but are not exacerbated by activity.  I sincerely hope it is just the pains of getting better, but we shall see. 

In terms of activity, I am alternating days of running about a mile and biking about 7 miles.  While running, my legs feel pretty good, although I've noticed that there is an imbalance strength wise between my right and left leg (right leg is much stronger), and thus I have been instructed to go to a chiropractor to make sure my alignment isn't out of whack and throwing off my form completely.  Appt. is on Wednesday, and hopefully I'll update everyone on what's going on.

Compartment Surgery Recovery - Elliptical Baby Steps

Got on the elliptical today and felt no pain - Granted, it was only for 5 minutes, as the physical therapists say it's important to take it slow and not aggravate things.  It was a baby step, but a significant one.  Tomorrow or Wednesday I'll ramp it up to 7, and hopefully in about a week I'll begin light jogging.

Encouraging Progress Continues....

Biked 5 miles yesterday and had absolutely no pain in the legs - Also, after identifying that I had almost completely lost all glute/hip activation while doing day-to-day activities, I have started to do certain strengthening exercises, such as X-band walking and the first two exercises detailed in this video, and my back pain has been gradually subsiding, which is awesome.

Numbness in Right Leg - Updated Good News

Also, just a quick update on the numbness I have felt in the lower inside area of my right shin, as detailed here - It has been gradually improving, and a large percentage of the numbness has dissipated. There is still a line of numbness, but it has been getting gradually smaller for the last couple of weeks, and has no effect on day to day activities.

Some Good Signs

Biked on Friday for 10 minutes - No issues, but still haven't ramped it up yet - Either way, it's progress.... Start Elliptical in a week, and running in two...I'll keep everyone posted

Recovery Behind Schedule - Some Frustration

Went to Physical Therapy yesterday, but unfortunately had a 24 hour bug of some kind and it was mutually agreed upon that we'd wait until Friday to start the bike - Which will be about 5 weeks after surgery, when I thought it'd be 4. Maybe I'm just in a bad mood because I also felt a little burning sensation while doing some rehab exercises yesterday that eerily reminded me of the CS symptoms. I was told that this was due to intense muscle fatigue, but I'm still worried. They also began to massage the hell out of my legs - and wow! It was very close to being as painful as rolfing - a good pain, but still, excruciating... Hopefully it will start to get rid of some of the scar tissue and be able to increase my range of motion in the muscles - I'll keep you posted Friday on how the long awaited bike trial finally goes.....

In terms of every day activities though, there are absolutely no issues

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!