What the f*!$ is wrong with your leg? Part 1

Wow, what a great question. I have been asking myself that for about 6 months, since exactly September 20th. In my right leg, I have this wonderful happening called “chronic exertional compartment syndrome”. Lucky for me, it only affects 2 of 4 muscle compartments in my right leg, and none in my left. Most folks get it in both legs in all 4 compartments- YEOWCH.

CECS is a delightful syndrome that occurs most often while running/skiing/roller skating/other high-impact sports. For me, it started while I was running. I had been running since the New Year (2013) as the one resolution I actually stuck to. I was in the middle of training for a 5k, 10k, and half-marathon relay (just about 6.5 miles), and went out for a short run. Less than 5 minutes in, I got this terrible pain in my lower shin that felt like a pulled muscle. “What an odd place for a pulled muscle!” I said to myself. Then I looked down and saw that it was BULGING OUT OF MY LEG. Later I learned this is called a herniated muscle (yes, I’m basically a doctor after all my medical visits). I stopped running and the pain stopped almost immediately. Huh. I started back up, and so did the pain. What a dumb thing. I’d only run a half mile. I gave myself a week off and then tried to run again a week later while in Michigan for our anniversary. All i wanted was a beautiful 5-mile run on the lakefront! Is that so much to ask?!?!?!?!? YES. IT WAS.

Moving forward, I went to my PCP and she suggested CECS. She sent me to an orthopedic surgeon in Mercy Hospital. SURGEON?!?!?! THIS ESCALATED QUICKLY. I THOUGHT IT WAS A PULLED MUSCLE! Nah, that’d be too easy. If there’s one thing I learned in my life when it comes to my health, is that I am never lucky. The stomach flu that went around this winter? Yup. I got it twice.

Mr. Surgeon sends me for an MRI and X-rays just to rule out fun stuff like stress fractures. Again, that would have been too easy, and it wasn’t that, but he put me in a boot for 3 weeks anyway to see what happened (spoiler alert: nothing happened.). So I was told to take a month off running and then return to it slowly and see what happened.

Guess what?! The pain was still there. In January I called him and said “Yo doc, this isn’t going anywhere. Can I get that awful needle pressure test already?” and he said, “….sure… I need to find a place for you to do it first…. I’ll call ya.” He also used this opportunity to tell me that CECS is pretty uncommon, and was most prominent in young (me!) female (me!) runners (also me!). How delightful. He called me later that week when he found a place. Horray! And I could get the test done on Valentine’s Day. Excellent! Because nothing screams romance more than 4-inch long needles and forcing yourself to run until it hurts.

Getting a compartment pressure test might be on my list of top-10 things I would never wish upon my worst enemy. Maybe. It sucked, that’s for sure. FIRST- they make you wait in the waiting room for 50 minutes past your scheduled appointment (oh? that’s not part of it? just me? I digress.). THEN- they put some numbing agents in your muscles with baby needles so the big papa needles don’t hurt as much. Next, they take the “before” pressure readings. Normal pressures for un-aggravated muscle compartments are around 15-20ppi I was told. Mine were 19, 19, 20, and 21.

Finally, the fun part comes- RUNNING! What once was my favorite activity was now my worst enemy. He put me on a treadmill (which, by the way, are the worst. hate treadmills.) at an incline and told me to run until it was an 8/10 on the pain scale. Shit! Well, I was extremely out of shape by this point, having run only 2 or 3 times in 5 months. I got tired after about a mile, before I got to my 8/10 pain. That would have to do, he said.

Lucky for me, my pressure readings were high enough to be conclusive. My anterior and lateral compartments were 46 and 43 respectively! Anything over 30 they consider CECS. Wonderful (or something).

So my orthopedic surgeon calls me the following Tuesday and says “Hey Lydia! Want to come in March 7 to get your fascia sliced open?” and i said “Abso-f***ing-lutely.” at this point in writing my blog post, I have realized I haven’t even told you what chronic exertional compartment syndrome exactly is. Have I mentioned I have ADHD? 🙂

CECS is, according to the Academy of Orthopedic Surgeons, “a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.” Basically, when I run, my muscles swell in those 2 compartments, and the fascia that covers and protects the muscle doesn’t stretch enough to let them swell like they want to. This pinches my nerves and blood vessels and stuff and causes the pain! So, to fix CECS, they go in and cut the fascia on the affected compartments from ankle to knee to allow the muscles to swell. Phew, now you know. Back to my story, how rude of you to interrupt!

March 7. Surgery day. My parents came in town to take care of me and give moral support to my wonderful husband, mangosquash. We all drive to the surgery center and go in the entrance on the second floor of the parking ramp, like they told us. i approach the desk and say “hello! I have a 10:30 appointment with Dr. Irvine?” and she said “…he doesn’t work in this office anymore.” WHAT! “excuse me? i am supposed to have surgery with him today at 10:30! i was told to come here!” “oh, the surgery center is on the 1st floor. take the elevator down.” Don’t worry, my luck isn’t THAT bad.

So I got signed in, pay the amount due (insert happy-dance for being double insured), read a Pure Michigan magazine, took some selfies with my mom, walked around the office a few times, and finally I got called back. I was given a locker for my belongings, a very stylish hospital gown, booties, a hairnet, and a pee cup to make sure I wasn’t pregnant (surprise: not pregnant). Then I climb in my hospital bed, get hooked up to an IV, kiss my family goodbye and off I am wheeled!

selfie

Selfies with Mom are the best.

 

preop

Pre-op with a thermometer on my forehead.

Surgery lasted about an hour, which was great, because my poor family had been sitting there for 3 hours already. Side note: this is a good place for me to talk about my darling husband. He is the kindest, funniest, most patient and wonderful man, and I am so beyond lucky he loves me. Luckily I’m still head over heels in love with him when I’m high; I was chatting the nurses ear off that was wheeling me to recovery nearly in tears about how good of a Dad he will be and how sweet he is and how happy I am that he always does the dishes. She called me out on it later when I was teasing him about something, saying “Hey! You be nice to him! Weren’t you just singing his praises?”.

postop

Post-op with my lovely nurse, Annie.

Once out of my groggy state, I woke up famished (hello, hadn’t eaten in like 18 hours), thirsty, and in 5/10 pain. She brought me a 7up (even though I had given it up for Lent. Forgive me, Father, for I have sinned), some CheezIts, and my new best friend, Percocet. I swear, you don’t need to call NA for me, but man. Percocet. I get the appeal. I really do. Kills the pain, makes you happy, gets you through it. Unfortunately, it kept me from sleeping well. I would lay awake for HOURS in some sort of in-between state. I thought the craziest things during these times; I might have cured world hunger, mentally organized my basement, and figured out what I’m naming all my kids.

They discharged me after an hour or so of recovery with a script for Percy (the Percocet, told you he was my new BFF) and some antibiotics. My sweet mangosquash ran in to Target for me while I laid in the car and thought about my life. It’s a weird moment to think “It’s a Friday, I’m not at work, I’m so close to my work right now, what if someone sees me?” And then realize, “oh yea, I just had MY LEG SLICED OPEN, I don’t have to work for 2 weeks.” Excellent. A vacation of sorts. Take me home, Percy!

My parents were the greatest that weekend (ok and always). My mother stocked our fridge and pantry, did our laundry, cleaned our kitchen, bought us toilet paper, and washed my hair for me when I couldn’t shower. She has a true servant’s heart and I can only hope to be half as great a mother as she is. My father was a huge help also, with keeping mangosquash company and buying us some new patio chairs. We were so lucky that it was 75 degrees in early March that I hobbled outside to catch some rays (and catch them I did- I ended up with sunburn). I was so sad to see my parents leave Sunday but so ready to get on with my recovery and back to running.

Part 2 is coming soon and will detail my recovery. Sorry this is so boring, but it’s something I want to document. While going through the process of getting my surgery finalized, I read tons of CECS recovery blogs and found them extremely helpful. Hopefully this brings somebody the same comfort I received from other blogs. No! You are not alone! Yes! It sucks! But it gets better!

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