2 weeks to go

Two weeks from today I will have my surgery for CECS. If I said I was not nervous, I would be lying. I think that what I am most nervous about is the chance that the surgery will be a failure. Not in terms of getting an infection, or developing blood clots or some other weird complication. Failure in the sense that I may not regain my ability to run as fast and as far as I did in the past. Not that I was ever a great runner. Some would even call my 8:30 pace during a 10 miler quite slow. Oh well, the journey continues....

HIDE!!!! Its my doctor....

I was doing a pacemaker check today and I ran into my Cardiologist. He knew me when I was thin and running 40mi a week. Today I bump into him in the hall of the hospital where I am seeing a patient and we converse for a few minutes. He is a great Physician and worried about me because I have so many cardiovascular risk factors. I tell him that I will be having surgery in April for my CECS and he seems happy for me. He knows the long road that I have taken to get a Physician to seriously listen to me. I told Dr. S that I plan to lose this weight that I have put on and that with this surgery I can get back to running which is the way I lost my weight before. I am currently on two blood pressure medications. This is not about regaining my former level of exercise for my ego, it is about controlling a medical condition that could shorten my life. April 11Th couldn't come sooner for me.

Superficial Peroneal Nerve

Woke up at 5am today with leg cramping. I get it all the time. Took some motrin and sat down at the computer to do some internet surfing. In 2001 when the first fasciotomy on my left lower extremity was performed, I was left with some nerve damage or compression. Dr. L has warned me that when I have my left compartment released on April 11 that I may end up with permanent numbness to my left foot area. He is going to attempt to isolate the area where my Superficial Peroneal Nerve is compressed, but in doing so, I also risk permanent damage of the nerve. Personally, I already think that the numbness I have now is permanent. I found a cool picture on the internet of the sensory area of the Superficial Peroneal nerve.

The striped area of the picture represents the area of the leg that is provided sensory input from the Superficial Peroneal nerve. With Fasciotomy of the Anterior and Lateral compartments many people will feel numbness or tingling in that area until they are healed.

Sick of Winter

Went to the gym today for a workout. I would have rather jumped on my mountain bike or just went for a long walk around my house, but it is 20 degrees F and snowing with wind gusts at 20mph. I spent 20 minutes on an elliptical with no symptoms, however that changed when I jumped on the tread climber. After about 20 minutes of walking at 3.5 mph at various grades, my right leg began to cramp and burn as if I was running. I pushed it to 30 minutes. I look forward to working out and not being slowed down by this cramping type of pain. I also worked on some ankle strengthening exercises. I figure that the stronger I can make my ankle before surgery, the easier the recovery. Don't know if it will work, but I figure it cant hurt. A month to go......

Short Term Disability

Got the ball rolling today on setting up my short term disability. After spending 30 minutes on the phone with some guy from UNUM, I am going to get a bunch of forms mailed to me that I have to take to the doctors office, so I can get paid while I am off. I plan on being off for 2 to 3 weeks, even though the Doctor, with a wink, offered me 6 weeks...

Insomnia: too much on my mind

Woke up at 0300 today and can not sleep. Sitting here at my computer drinking a nice hot cup of coffee. As I peak out the window of my office, the street lights are reflecting off of the snow and ice that covers my subdivision. I can not believe it is going to be spring soon. I spoke to my neighbors yesterday and informed them of my impending surgery. Mrs. V is a Physical Therapist who is a stay home mom for now. She had some good ideas for equipping my bathroom with either a higher seat or using a walker to be able to sit down post surgery. I did not even think that with both legs being done, I really can not bear weight on one leg over the other... So something as simple as sitting could be painful... I also have to call Human Resources at my company today and figure out my medical leave. What a pain in the A**. I looked at some pictures of my last long race. I can not believe it has been 5 years since I was able to run a half marathon. These pictures were taken at the Rock n Roll half marathon at Virginia Beach. I ran hard for 11 miles and then I experienced foot drop. Totally lost the ability to lift my foot up correctly. Dragged it home for the next 2 miles and finished the race.



Mile 10. right before my foot drop. Like those compression socks?



The gang back in the room at Virginia beach. Notice the ice to my left leg. Foot back to normal within an hour after race.

I will get back!!!

Stryker Compartment Pressure Test

Wednesday, Feb 27th. I took the day off of work to go to the Hospital where Dr. L was doing surgery. He was going to test the pressures in the Anterior and Lateral compartment of both of my legs. Dr. L was well aware of the fact that every time I try and run, I have a horrific burning feeling in my left leg and a cramping pain in my right leg. About a 1/2 mile into a run, my leg starts hurting and soon after I can not run any more. My left leg feels numb below my Calf most of the time.




I went into the exam room and Dr. L and his PA came into the room and applied betadine to my bilateral legs on the lateral side of the leg near my calf. Then after Dr. L calibrated the machine he inserted the needle into my muscle compartments and measured the pressures. Here is the procedure being done on someone else.

After measuring the pressures in both of my legs at rest, I put my hat and gloves on and proceeded to go for a run in 14 degree temps and icy conditions. If there is any doubt that I want my legs fixed, then my commitment to running in those conditions should prove it!! I ran for about 8 minutes. My symptoms began occurring at the 4 min mark, but I pushed it a little longer since I was a 1/4 mi away from the hospital. When I got back, I jumped up on the table, pulled up my pant leg and the whole procedure occurred again.

Normal pressures in the muscle compartments of the lower leg are less than 10mm HG at rest. After exercise they should not increase very much. Any reading over 30mm HG is indicative of Compartment Syndrome. Dr. L was surprised when mine were in the mid 20's on both legs at rest. After I came back from the run and the test was completed the results were much higher. The Anterior Compartment in both of my legs had readings in the mid 40 range. My lateral compartment in my left leg was 66 and in my right leg it was 88. Dr. L was surprised at how high these were. I was just glad that I was not crazy or being a wimp.

Surgery is scheduled for April 11th. I am having both legs done. Dr. L thinks I am crazy (he prefers one leg at a time) but I just want to get it over with and I can take the pain.

For more information on CECS check out these links:

http://edition.cnn.com/HEALTH/library/DS/00789.html

Here is a link to what they actually do during surgery.

http://www.doereport.com/enlargeexhibit.php?ID=3478

EMG and NCS... Yikes!!!

So a couple of weeks ago I go in for these Nerve Conduction Studies of my lower extremities. For those who do not know what this is... The person conducting the test puts electrodes on your skin and then shoot an electrical current thru your legs and measure how quickly the nerve conducts... Each time the voltage comes the muscles contract and twitch... Not so fun... Not really painful, but the anticipation of the jolt drives a person crazy... Then the easier part, the EMG... Tiny needles are inserted into your muscles and you have to flex and tighten your muscles so that information on muscle weakness can be obtained.

My test showed delayed or slowed conduction at the level of my old fasciotomy scar from the 2002 surgery... No new surprises. Dr. L felt that the Superficial Peroneal Nerve was probably intrapped at that location in scar tissue.

I was then Scheduled for the Stryker Intracompartmental pressure test..

Diagnosis: 2008

In my previous post, I blogged about the first time that I was diagnosed with CECS. It would have been great if my story ended there and I had gone on to be this incredible distance runner. The truth is that with in one year of having the surgery, I was back to having some of the same symptoms as before. Whenever I would run too many miles, my lower leg would be come numb and sometimes swell. Over the course of several years I went Doctor shopping. I went to one Ortho who sent me to his partner who was a sports specialist who sent me to the nerve specialist but she did not know anything about muscle injuries so she sent me to University of Michigan and I saw doctors who recommend compartmental testing for high pressures but they cancelled my testing twice and I got frustrated and went to see Dr. Mendleson. If that sounded like the longest run on sentence ever, then you know how I have felt over the last 4 years. Multiple Doctors, many opinions and not much action. However when I went to see Dr. Mendleson, he was honest and told me that this problem was outside his area of expertise. I was bummed, but he told me that he knew the right guy. On to my 6th doctor....

When I walked into Dr. L's office, I was hesitant. I knew he had a good reputation and his whole practice revolved around taking care of only sports related injuries. But, so did the guy who operated on me in 2002. He came into the office and I began telling him about my last 4 years. He examined me and said, " we will find out what is going on here and I will fix it if I can". Oh, oh... been here before....

The start of my problems

Hi all,



For those who do not know me, I began running in 2001. I was trying to lose weight, life was stressful and I needed to get out of the gym into the outdoors. I cant say I was hooked from the beginning. Breathing so hard that I felt like I was going to cough up my lungs, shin splints, blisters, sore muscles and abdominal cramps... Running was hard work.

As the spring/summer progressed I increased my mileage to approx 30 mi a week. I had lost 50lbs. I felt great. My wife Debby and I ran several races together that year. A 10 miler and several 5k races. Racing had not only become a source of exercise for me, but it became a passion. I loved the feeling of a runners high. That feeling when I was into a long run and my feet felt light as a feather, my heart beating steadily and I am breathing effortlessly. It is a feeling I can not describe.

In 2002 my wife and I ran a half marathon in the spring. It was a trail marathon, wooded and hilly. It was tough, but I finished with a decent time as did my wife. I was pumped and my wife and I made a plan to train for the Chicago Marathon. I had increased my weekly mileage to 40. I was on a good pace to be ready for the Marathon. We ran with a group of experienced runners and they were helping in guiding Deb and I thru this process of training for a Marathon. Then my problems began.

I was on a 10 mile run during the weekend. I usually saved my long runs for Saturday morning. About 4 miles into the run, I noticed that my left foot was "falling asleep". I ignored it and kept on going. Over the course of several weeks, every time I would go for a run, I would get numbness to my left foot that extended into my big toe. When I would stop running it went away. On a Saturday, during one of my long training runs, the numbness came back. However, this time it did not go away.....

That week I got into see an Orthopedic Surgeon. The Sports Medicine expert. I told him my story. He examined me and did some xrays and MRI and diagnosed me with Exertional Compartment Syndrome. His diagnosis was based purely on symptoms. My numbness was due to the compression of the Superficial Peroneal Nerve as it exited my Anterior Compartment. In english, everytime I ran, my muscles would fill with blood, but the fascia covering the muscle would not stretch and the pressure went inward choking the nerve. He recommended surgery. A procedure call a fasciotomy. I agreed since he was the expert and I wanted to run. I was bummed out because I would miss the Chicago Marathon. The surgery went forward and my Left Anterior and Lateral Compartment were decompressed and I ended up following my wife around the course at the Chicago marathon on a mountain bike. She did a great job and I was so proud of her.....


Debby after the race!! Pete (in the hat) and I chasing Deb around the course

http://www.chicagomarathon.com/cms400min/chicago_marathon/