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.

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

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...