Post Op Leg #2

I’m home! I had surgery on Monday, February 12th and things seem to be going a lot smoother this time around.

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DISCLAIMER: Don’t scroll to the bottom of the page if you don’t want to see photos from the surgery.

For those of you that don’t know, this surgery was a little different than the one I had on my other leg. My left popliteal artery was being compressed whenever I went into plantarflexion. Luckily, it wasn’t damaged enough to require a bypass like the right one. The artery just needed to be freed up a bit from the surrounding muscle.

It’s difficult to tell exactly what is compressing the artery from imaging alone. The only way to know exactly what’s going on is when the surgery is actually performed. When they opened me up they found that the artery ran a slightly different path than it was supposed to – more medially. Plus, it was embedded in the medial head of the gastrocnemius (calf muscle) and was being pushed up against the tibia when I would move. Basically, it was being repeatedly crushed. My doctors said it was probably only a matter of time before that artery occluded like the right one.

There are various types of popliteal artery entrapment syndrome. I was told that my anatomy was a mix between Type 1 and Type 2, but mostly looked like Type 2.

paes 4paes 3My doctors took out the piece of muscle that was overlaying the artery. Hopefully now since the artery isn’t impinged by the muscle the blood flow will return to normal, and my calf pain will go away. Fingers crossed! There’s a picture at the bottom of this post that was taken during the surgery. My doctors were nice enough to take a picture for me of my leg before they closed it up and the muscle that was removed.

The surgery lasted 2-3 hours and everything went smoothly. However, waking up from anesthesia went a little bit differently and I’m still kind of confused about what happened exactly. The first thing I remember when I was coming to was someone saying, “Laurel, you’re just waking up from surgery. Everything went fine, but you need to stop moving. You’re gonna hurt yourself.” I was completely disoriented, but after peeping my eyes open and seeing the bright lights I pieced together that I was in the OR. Someone else asked, “Laurel, what’s wrong?” to which I didn’t really have an answer besides needing to cough after having the breathing tube in. Finally, I heard, “Okay, everybody stop touching her. Just let her be. Laurel, do me a favor and take some deep breaths.” I think at that point I finally started calming down. From what? I have no idea.

I then heard the staff talking about how younger people sometimes wake up really agitated, but that they don’t see it very often because most people having surgery are older than me. It’s called emergence delirium and happens mostly to kids, but it can happen to adults as well. To my horror, they discussed how I apparently kicked someone during the whole ordeal, which I have no memory of. I am so sorry to whoever that was! So embarrassing. I really wish I knew what the whole scene looked like because I can only remember bits and pieces.

The rest of my recovery was a lot less exciting luckily. This time around I have to wear a big knee immobilizer, which is pretty annoying. I’m constantly overheating from it. It’ll help keep my leg straight, though, which is good. They put a wrap around my other leg that inflated and deflated periodically. It’s supposed to help prevent blood clots. I spent most of my time in the hospital on the vascular floor. It was fun getting to see the nurses again, many of whom remembered me.

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the knee immbolizer

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helps to prevent blood clots

The fun part about this surgery was that I got to meet another person with popliteal artery entrapment syndrome! I had found a support group on facebook for people with PAES months ago, which has been extremely helpful. Another girl and I realized that we were having surgery on the same day, both at the University of Maryland Medical Center, and with the same doctors What were the chances of that!?

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The nurses called us the twins – same surgery on the same leg with matching gowns, knee immobilizers, drains, and crutches

This surgery involved both an orthopedics and vascular surgeon working together, which meant that it took a little longer to get a surgery date that both of them were available on. My guess is that they coordinated things so that they did two PAES surgeries on the same day.

This syndrome is very rare, and I know my doctor, who does more of these surgeries than most vascular surgeons, only does a few of these surgeries a year. The fact that both of us were having the surgery on the same day was pretty cool!

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we crutched our way over to look out the window

We were messaging each other the weekend before the surgery. We also ended up being roommates in the hospital, which made things a lot more fun than last time. If the Internet didn’t exist then I wouldn’t know anybody else that has PAES. It was so nice getting to talk to someone else that really “got it” and knew what I was going through.

I’m back home now and things are going smoothly. No blood clots, so I don’t have to be on blood thinners. At the moment, most of the pain is coming from my back, not my leg. Trying to find a comfortable position at night is extremely difficult. The knee immobilizer keeps my legs straight, and my back is NOT happy about that. I’m not used to sleeping with my legs straight! The incision is healing nicely. Fingers crossed everything keeps going smoothly!

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the muscle that was taken out during the surgery (part of the medial head of the gastrocnemius)

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Gearing up for Surgery #2

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my favorite park to walk at

Surgery on my left leg really snuck up on me. February 12th seemed like such a long ways away, but now it’s in just a week! I’m looking forward to just getting it all behind me and moving on with my life. It feels like I’ve been in limbo this past year. I’ve had to put my life on pause to deal with my medical problems. The past few months have just been full of medical appointments, making various calls to health care providers, and recovering from surgery. I need to be done with all this medical stuff and get my life back.

My nerves are definitely worse this time around compared to my last surgery. I think it’s better to be naïve and not know what to expect. This time I remember how much pain I was in after the first surgery, I remember feeling nauseous for days from the pain meds, and I remember all the complications I had to deal with afterward. The good news is that I learned some ways from my first surgery to make this time easier.

1. No Dilaudid because I’m apparently allergic. I would really rather not be up all night scratching my body because I was so itchy like last time.

2. I need a different tape than the one they used in the OR for the first surgery. I ended up with big red welts on my chin and forehead that lasted about a week.

Luckily, this surgery isn’t supposed to be as intense as my last one. I’ll be having a muscle release instead of a bypass because my left popliteal artery isn’t ruined yet. They’ll basically free up the artery by shaving away some of the muscle that’s compressing it. In all honestly it sounds more barbaric than the bypass surgery, but my surgeon said the recovery will be a little easier. Hopefully I won’t have to stay in the hospital for quite as long and the surgery itself should be shorter. Last time my mom said I was back there for 7 hours!

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The scar on my right leg has healed up pretty nicely.

I’ve been making progress with my right leg recovery. I went for my first run since surgery on January 5th! It felt a little awkward running, which is probably because I literally hadn’t run in a year. Plus, when I used to run it was almost never on a treadmill, so I felt a little uncoordinated. With that being said, it’s amazing to be back to doing what I love most. I begged my physical therapist to let me run before the next surgery even if it was just for a minute. I just wanted to know that I could still do it.

The other day I was trying to remember what my last run had been before surgery, and I reasoned that it had to be when I had the compartment testing last January. That was definitely not a pleasant run. First they measure the pressures in the four compartments of the lower leg with a giant needle. They somehow managed to hit a nerve during the process, which is one of the most painful things I’ve ever experienced. I involuntarily jerked my leg and let out a scream. After that I ran on the treadmill until my calf felt like it was on fire and my foot was completely numb. Then they get to measure the compartment pressures again. So in comparison, my first run since surgery was 100x better than the run when I had the compartment testing!

It’s pretty slow going with the recovery. I’ve only managed to get up to 15 minutes with 3-minute run intervals, followed by a 1-minute walk interval every other day. I have to keep reminding myself that I had major surgery, and it’s not going to be as easy as recovering from compartment syndrome surgery. Plus, there were definitely some complications after this surgery, which slowed things down. Luckily, I’m enjoying doing other activities like biking and hiking. I’m also working on strengthening my core and my right leg, which will be doing most of the weight bearing after this next surgery.

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me, Ned, and Samson have loved getting some hikes in

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Sam somehow grew an icicle beard on our walk

I’m not sure if I’ll be posting again before the surgery. If not, I’ll see you on the other side! Fingers crossed everything goes smoothly.

Reflecting on 2017

This past year has by far been the most difficult year of my life. It’s been over a year since I’ve been able to run and began this wild goose chase to figure out what was wrong with my leg. I went from marathon running to being in chronic pain just doing the simplest of activities.

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Santi and me before the Manchester Road Race in November 2016.

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Ellie and I after the Cambridge Half Marathon in November 2016

I started graduate school last summer still not having any idea what was going on with my leg. All I knew was that I was in constant pain. I was in pain walking to and from the train station, I was in pain standing up for hours in the cadaver lab, I was in pain just walking up the stairs to get to class. I remember telling my mom that I couldn’t make it through another semester like this. I was absolutely miserable.

It was pretty shocking to find out in the middle of the semester that I had a rare medical problem causing my right popliteal artery to become completely blocked and my left one to become problematic as well. Then it was just icing on the cake to be told by my doctor during finals week that he didn’t know what to do. The ultrasound showed that I had small veins, which wouldn’t be great to use for a bypass. Granted to say, I had to leave school to find some answers.

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That’s some pretty crappy circulation

I’m now so thankful for what I used to take for granted. I’m thankful that my foot isn’t numb after walking up a few flights of stairs. I’m thankful that I don’t have to grit my teeth while I’m driving because I’m in so much pain from pushing on the pedals. I’m thankful that I can go hiking and walking outside again. I’m thankful that I’m able to use the elliptical, and will hopefully begin running soon. I’m thankful that the first surgery was successful even though there were some complications. I’m beyond thankful to just have some answers and a clear course of treatment.

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This is what the incision looks like now. Not too bad after gaping open a few weeks before.

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Samson and I love going to this park.

I’ve got the next surgery date scheduled; February 12th! I’m looking forward to just getting it done, so that I can get back to my normal life. 2018 has to be better than 2017, right!? It feels like my life has been flipped upside down this past year. I learned that life doesn’t always go as planned and that some things are just out of my control.

In 2018 I want to get back to running. Even if that means just running a few miles a day instead of marathon training I’ll be happy. I want to do more backpacking and bike touring adventures. I miss that just as much as I miss running. I want to get back to school to become a physical therapist.

Most of all, I just want to be happy.

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Feeling happy standing on the Continental Divide during our 2015 bike tour.

Good riddance, 2017! And here’s to a good 2018!

Here are two videos I made from trips I took in 2016. I hiked the Long Trail and bike toured in Alaska. Hopefully there’s more times like this to come in 2018!

8 Weeks Post Op

CT Scan Results: The graft is working beautifully! I saw the scan and it was really interesting. You can see exactly where my popliteal artery becomes blocked and the blood stops flowing. Then you can see the vein graft going around the blocked portion of the artery and it is wide open and working great.

I also had a repeat ultrasound done since the wound is basically all healed up and they could actually look at the popliteal vein. Luckily, it showed that there are no visible blood clots. Woooohoooo!!!!! That means I can also get off Xarelto (blood thinner) and just switch to aspirin now. I still have to wear compression socks, though, which is a pain. At least I’m pretty used to them at this point.

The incision that opened back up is basically closed again. It’s pretty amazing how quickly that healed. When it first opened up it measured 4cm deep into my leg! It’s just scabbed over at the top now. The scar now reminds me kind of a half smile. I had a little fun with making some artwork out of it. I had to figure out some way to laugh at the situation. Yes, I already know I’m weird.

I got cleared to drive again, which has been fantastic. I never realized how much I like being able to drive myself around until I couldn’t do it. The best part is that it doesn’t hurt to drive anymore. My calf used to cramp up when I’d press on the gas/break, which made driving kind of a miserable experience. Now I’ve gone for a 30+ minute drive and my leg felt completely fine. It’s nice to also have some solid proof that the surgery really did work.

I’m now able to walk without a limp. My leg still feels stiff after I’ve been lying down or sitting with my legs bent, but loosens up pretty quickly now. I’ve been able to walk quite a bit and get back over to my favorite trails and bike paths, which has felt great. I’ve been told that I’m walking a lot faster than I did pre-surgery. I can now walk up hills and walk at a decent pace without my calf cramping.

I think my dog, Samson, is excited that I’m more mobile too because it means we can spend more time at the park. I’m an outdoor person at heart, so having to be housebound has been really difficult. Just getting outside and feeling the sunshine always makes me feel better.

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5.5 Weeks Post Op

The recovery keeps moving along. I guess this time more smoothly than it has been. The wound that opened back up is now almost closed. It’s pretty amazing how quickly that healed up. Originally, the wound was about 4cm deep and is now probably less than 1cm. I still can’t quite picture what it’s going to look like once it completely heals up. The edges need to come together more. I really hope I’m not left with a giant ugly scar. The scar after surgery looked so neat and thin before it reopened. Luckily, my scars fade pretty nicely. The scars from my compartment syndrome surgery are now barely noticeable. Unless someone is seriously inspecting my legs they really don’t notice.

I’m now able to walk without crutches (for the second time). I still need to work on regaining my full range of motion, but I’m definitely seeing a lot of progress. I’ll be starting home PT soon, which apparently I can get because I’m still having a visiting nurse help with my wound care. The wound has now healed enough that I only need a new dressing every other day instead of every day. Yay!

I’ve been feeling a lot less tired than I was. I think the anemia has improved even though I don’t have any test results to show that. I don’t feel lightheaded as easily and I have more energy. I guess I’m feeling less like a zombie compared to how I was a few weeks ago.

I had a CT angiogram yesterday, which will look at the arteries in my leg to see if the graft is holding up. My worry is that the hematoma that formed after surgery might have impacted the graft. It was a pretty significant hematoma; 3x4x10cm. My doctor also said that depending on the results of the angiogram I might be able to get off the blood thinners. I really hope so because I am so over these blood thinners! They’ve made my already dry skin even drier, and I’m sick of bleeding everywhere.

Now is just the hard part of waiting for the results of the angiogram. My guess is I won’t hear anything until next week because of Thanksgiving and all. I have an appointment next Wednesday, so at the latest I’ll hear then. Who knows, maybe the wound will be all healed up by then?

I always find waiting to be the hardest part of this whole process. I’d take physical pain any day over the anxiety I’m feeling right now. Luckily, there’s a holiday tomorrow with lots of good food and family to provide a distraction. Happy Thanksgiving everyone!

4 Weeks Post Op

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“You got this.” I’ve been telling myself this every day of the recovery.

Slow and steady is the name of the game. The reopened incision is slowly healing and will just be a matter of time. I found out that the reason the wound reopened was definitely due to bleeding. Since I had a blood clot after surgery I was put on blood thinners, which meant that my blood couldn’t clot as well as normal. I ended up with a hematoma (bleeding) in the wound. This was evidenced by an MRI I had a week ago. Over time it built up so much pressure that the incision opened back up.

The blood thinners have been a bit like a double-edged sword for me. Now, obviously blood thinners were necessary because of the blood clot. Left untreated, blood clots can potentially be fatal. However, the blood thinners also caused a hematoma to form, which then reopened the incision and has delayed the healing process by quite a bit. I sure hope I don’t get a DVT during the next surgery and need to be on blood thinners again. I’m getting pretty sick of compression socks and accidentally bleeding on everything.

It also makes me wonder if there’s something about me that makes me prone to hematomas. I’ve only had 2 surgeries and both times I developed a hematoma. Come on! The second time makes sense because of the blood thinners, but not the first.

My main complaint this week actually hasn’t been about the wound, though. I’ve been more bothered by how low my energy level is. At the ER I found out that I’m anemic. I’m so tired that I feel like I could sleep all day and still not be rested. I also get out of breath so easily it’s ridiculous. Plus, my already pale complexion looks even paler if that’s possible. I’ve never been anemic before, and I’m really not liking this. I’ve been a vegetarian for the majority of my life and have been proud that my iron levels have always been fine. I’ve even donated blood before. I guess it makes sense that I’m anemic now given how much blood I’ve been losing. I’m working hard at eating iron-rich foods and a multivitamin with iron, so hopefully I’ll feel better soon.

Good news! I had an ultrasound done on my leg to look at the veins this week and check on how the blood clot is. They found no visible blood clots in the veins in my legs! Yay! Of course they couldn’t see all of the popliteal vein because of the open wound that was bandaged up, but above and below look good as well as all of the rest of the veins in my legs. At first I thought the blood clot was just in my popliteal vein, but when I looked back over my medical record it actually said there were small clots in the popliteal, posterior tibial, fibular, and gastrocnemius veins. I’m beyond grateful that they don’t see any blood clots there anymore. I was expecting it to take a lot longer! Maybe this means I won’t have to wait a really long time to have surgery on my other leg.

Anyone have any good TV show series that they would recommend? I’m running out of ideas of what to watch on Netflix and Hulu. Thanks!

3 Weeks Post Op

I had originally started a post last week just updating that my recovery was going smoothly and that I kept improving. I had gotten to the point where I could walk without crutches for short periods and had even gone on a stationary bike (very slowly) for a couple minutes. The incision looked like it kept healing nicely.

Unfortunately, that status changed last week. Saturday night when my mom went to go change the dressing she noticed that a small part of the incision looked like it was spreading apart slightly. Naively, we redressed it and decided to go get some steri-strips in the morning thinking that would be enough. Let’s just say that when we went to redress it in the morning the incision had not stay closed. I will not be sharing pictures, but I’m sure you can guess what it looks like.

After a trip to the ER we’ve got things sorted out. I guess the theory as to why it reopened is mainly due to the blood thinners I’m taking for the DVT. Apparently there was a lot of bleeding into the wound, which created swelling and pressure, and therefore reopened the wound. I’m counting down the days until I can stop the blood thinners, but I’ve still got a few more weeks. I’m sure it doesn’t help that the incision is on a joint, so it’s being stretched whenever I move. The incisions up by my groin where they got the vein for the bypass is healing quite nicely. Again, this is probably because it’s not on a joint.

I don’t think we have all the answers as to why the incision reopened. Whatever the reason, I’m still on the road to recovery, but just with a bit of a setback. I was told it will take 3-4 weeks to heal up. The wound has to heal from the inside out. If a few stitches were just put to hold the skin together then that wouldn’t be good because the inside isn’t healed.

A visiting nurse comes every day and cleans it and redresses it, which is not a fun process. It’s not that it feels really painful, just extremely weird and uncomfortable. It also doesn’t help that I know they’re literally in the middle of my leg. I find myself starting to freak out if I think too much about what’s going on. I can’t believe there’s literally an open wound on the back of my leg. The good news is that it’s not infected. Everyone keeps telling me that it looks clean, which is great. I’m on some antibiotics just as a preventative measure. I also have youth on my side. I’ve been told multiple times that I’m going to heal much quicker from this than someone just 10 years older than me.

Yes, this is a bit of a setback. However, I’m thankful that I can already tell some improvement in my right leg after surgery. Just at rest I can visibly see that my right foot is now pinker than my left foot. What used to be my “bad” leg is now my “good leg” and vice versa. Even with this complication from the wound and a DVT in the popliteal vein the circulation has already improved. For that, I am beyond grateful! That means more to me than anything. Check out the pictures below comparing pre-op to post-op.

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PRE-OP

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POST-SURGERY: My right foot is now pinker than my left! Yay for Circulation!!!!!