Popliteal Artery Entrapment Syndrome

Hey blogging world! Long time no see. I’ve decided to start blogging again to document what’s going on in my life right now. You see, this past year has been absolute hell to put it nicely. I’ve gone from being a marathoner to not being able to walk without pain.

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My feet after walking less than a mile. My right foot becomes very cold and pale because of the poor circulation.

It’s been a very long journey getting to this point. I first noticed symptoms last December, although I now realize that I had symptoms long before that. In the matter of about a week, I went from half marathon training to not being able to run for longer than 100 meters because my right calf would cramp so badly. I’m not talking about a little bit of aching. I’m talking about the feeling of trying to run with a Charlie horse. Within a matter of minutes of stopping, though, the pain would completely disappear.

At first, I thought that it was compartment syndrome again, but after repeating that fun test my pressures were normal. There were some other pretty weird symptoms going on too. My big toe is numb and sometimes I get weird tingling sensations in my foot and lower leg. Probably the weirdest one, though, was what happens when I walk. My foot loses color and starts turning a pale white. It’s pretty creepy.

I tried getting a deep tissue massage, didn’t work. I tried physical therapy, didn’t work. MRI didn’t show anything wrong. Then I was referred on to a vascular doctor and a whole new round of tests was done. Ultrasound, treadmill test, an MRA, and finally an arteriogram was done.

All the while my symptoms have been getting worse and worse. It’s now at the point where it hurts just walking. Standing for long periods of time is also painful. Even pushing down on the gas pedal when I’m driving causes my calf to cramp.

Hearing the diagnosis was absolutely shocking. The worst I was expecting was that I had compartment syndrome again and needed another fasciotomy. Instead, I found out that not only do I have popliteal artery entrapment syndrome in my right leg, but my left leg (which is relatively asymptomatic) as well. This probably explains why my right leg has never been all the way better since I had compartment syndrome. That’s probably why I couldn’t get past mile 20 in a marathon without my calf completely seizing up and why I get Raynaud’s so much worse in my right foot than my left.

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My right foot with Raynaud’s syndrome after going swimming. My left foot was a totally normal color. This picture was taken over 3 years ago.

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This is what my foot looked like after trying to do some calf raises.

I’m finally scheduled to have surgery on October 13th at the University of Maryland Medical Center. I will be having a bypass done on my right leg. Then I’ll have to wait another 2-3 months and get a muscle release done on my left leg. Even though my left leg doesn’t have many symptoms, they want to fix it earlier on to prevent needing a bypass like my right leg.

I’m looking forward to getting this surgery done so that I can get my life back. I’m a 23-year old marathoner that is in pain just walking. How wrong does that sound?! I want to get this surgery behind me and finally get on the road to recovery.

Thanks for joining me on this journey. I plan to make regular updates. I hope that sharing my story will bring a little more awareness to this weird syndrome. Maybe another “Laurel” will find this blog and be able to understand a little more of what to expect.

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Biking Adventures!

throwback to when my brother was teaching me how to ride a bike

throwback to when my brother was teaching me how to ride a bike

I like to bike. Does that surprise you? I’ve never really talked about it on my blog. Mainly because I run much much more than I bike, but every once in a while on a beautiful day I’ll take my road bike for a spin. After my compartment syndrome surgery my parents got me a great road bike for my birthday and I think biking really helped to speed up my recovery.

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My dad and I are going on a bike trip this weekend. It was originally scheduled for today through Sunday, but on account of horrible weather we’re leaving this Saturday and coming back Monday. We’d rather not get caught in a thunderstorm, you know? Might not be too fun. I’ll be bringing my computer with me, so I’ll hopefully be able to write a few blog posts along the way. We’ll be moteling it, so hopefully they’ll have wifi. We’ll see, but that’s what I’m hoping for. If not, I’ll definitely be using my instagram, so go follow me on that if you’d like to join the journey. My dad and I are planning a much bigger more exciting bike trip next summer, but more on that later. This will be a test run to see how everything goes.

On a last note, my cousin, Caley, is an awesome writer. He recently wrote a book called, “Legends of Allyoshmar, The Dreams and the Darkness.” It’s an epic fantasy novel about a princess who finds herself tangled in ancient conspiracies and is struggling to survive. He’s having a presale of the book so if you’re interested you should go preorder one on this site where he has also revealed the first chapter of the book!

Any weekend plans for you? Do you enjoy biking? Ever gone on a bike trip before?

My Compartment Syndrome Journey

Today marks exactly four years since my surgery for compartment syndrome. It seems like so long ago that I was that scared little 15-year old unsure if I would ever be the runner I used to be. I’ve come so far since then and am such a different person (and runner) than I was.DSC_9843

I hope that this post might help out some people that have/had compartment syndrome and provide some insight. I know that all I wanted to hear when I was in the midst of my injury was that everything was going to be okay. Compartment syndrome isn’t all that common, so finding information on recovery (specifically for runners) was pretty difficult. If I can just help one person out then it would be worth sharing my story.

What is Compartment Syndrome?

Compartment syndrome occurs when the pressure inside the muscle becomes too high. This causes decreased blood flow, which can lead to nerve problems, cramping, and just a lot of pain in general. There are two types of compartment syndrome – acute and chronic. The acute type occurs after a traumatic injury while chronic exertional compartment syndrome (CECS), which is what I had, is from exercise.

*** I wrote an update on 1/4/18 at the bottom of this post. ***

It all began after my very first cross-country race of my sophomore year. I ran a fantastic race – course PR, first for my team. Everything was going great and I was excited for the rest of my season. The morning after the race I knew something was up, though. I got out of bed and tried to walk around, but my calves just felt like rocks. They were so tight and crampy. The simple motion of trying to push off when walking hurt.  I had experienced sore calves after races before, but never like this. It wasn’t the normal achy sore, but something different.

 

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a picture from that race

Nonetheless, I got through that week. I still went to my running practice and got through the workouts. It hurt when I ran, but wasn’t awful. My race had been on a Saturday, so the really bad soreness was gone by Tuesday. I saw my physical therapist later that week to ask for some advice. I told her about how tight my calves had been, but that they didn’t hurt very much anymore. She gave me a calf massage and we made an appointment for the next Monday. I had another race that upcoming Saturday, so we were hoping the symptoms would still be present for the Monday appointment.My next race went the same. I felt fine during it (I ran pretty well too), but the next day my calves were so tight and sore I could hardly walk. When I went in for my Monday appointment she asked me to lay on my stomach on the table. She immediately noticed something that I hadn’t – the swelling. As my mom described it, “Your calves just looked like balloons.” My normal toned runner’s calves didn’t have any definition because they were so swollen. Plus, they were riddled with muscle knots.

The word “compartment syndrome” was thrown around, but wasn’t suspected because my symptoms weren’t the classic compartment syndrome case. I didn’t have any tingling/numbness, no foot drop/weakness, and my pain didn’t begin a few minutes after exercise. My pain began the day after my race, but exercise would make it worse. My pain was also in my calves, not in the front near my shins. Apparently anterior/lateral compartment syndrome is much more common than posterior.

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Anyways, I kind of limped through the rest of my season. My calves didn’t get a lot worse, but they definitely didn’t get better. The best way I can describe the pain is that burning feeling everyone gets when they’re running up a big hill, except that’s how they felt all the time. Even if I was just doing a light jog they felt like they were about to explode. My calves would be really sore for a few days after my race, then I would go to PT on Monday, and then would be somewhat better until my next race. It was hard to get the right workouts in because of the pain and my confidence went down. To be honest, I was kind of relieved when I got the flu a couple days before states and my mom wouldn’t let me go to school. My performance just kept getting worse and I didn’t have much motivation left.

I took a few weeks completely off after cross-country. The intense pain was gone, but I noticed that when I would do longer walks (from one end of my school to the other) my calves would start to ache. Just standing during concert choir would make my calves burn. When I started training again for indoor track, the pain came right back. I decided that I needed to figure this thing out because I did not want to survive another season like cross-country.

My mom had heard from someone about this nurse practitioner that was supposedly pretty good with sports injuries, so we waited the three weeks for the appointment. Well, I had the worst experience I had ever had with a health care professional. She literally spent all of 10 minutes with me. I told her about my pain, she had me get up and do a few things like stand on my tiptoes. She then proceeded to tell me that “running hurts” and talk about her own experience doing Ironman triathlons and whatnot. No, I did not have decades of experience under my belt, but I had been running since I was in elementary school and had already dealt with shin splints and piriformis syndrome. I at least knew enough about running to understand the pain! She did not know me and shouldn’t have come to conclusions about me. She told me that she was pretty busy at the moment, but maybe by the end of the week she could contact someone to do the compartment testing. I spent the whole ride home crying. I was so embarrassed and hurt.

Aqua jogging was pretty boring, but at least I was getting a workout in.

Aqua jogging was pretty boring, but at least I was getting a workout in.

In the meantime, I had been going to a gym with a pool to try to aquajog. This did not cause a lot of pain, but still hurt a bit. I found that the elliptical and bike were too painful, so I resorted to the pool. An athletic trainer at the gym heard about my awful experience and was nice enough to call over to another doctors’ office and get me in that same day. Thank you! From there, I got an MRI (which did not show anything) and the compartment testing.

Diagnosing

Compartment testing basically involves sticking needles into the different muscle compartments of the lower leg to measure the pressure, then having you run on a treadmill until the pain starts, and measuring the pressure all over again. I had heard horror stories, but it really wasn’t that bad. My legs were numbed with local anesthetic, so that I could barely feel the big needle. I just sensed some pressure on my leg and then a kind of “pop” as it went through the fascia into the muscle. Once it was through, then it started to hurt, but not too much.

The needle used to measure the pressure

Before running, numbers in the teens are considered worrisome and numbers above 30 are not good afterwards. My numbers were mostly in the teens with a couple in the 20’s beforehand. After the test, some numbers were only in the teens, most in the 30’s, and one got up to 70. The compartment that read 70 was the last to be tested, so it had a lot of time to come back down. The fact that it still read so high was not good.

Based on the test, it was determined that I had compartment syndrome. My appointment with the surgeon was a couple weeks later, and my surgery was scheduled shortly after. There are other types of treatment for compartment syndrome, but most have shown questionable success. The fact that I had already completely avoided running and still had pain just walking/standing made my family and I decide to go ahead with the surgery.

I was so sick of playing the waiting game by this time. I remember counting down the days between each of my appointments. In high school, the sport seasons are so short. Waiting so long for answers was just excruciating. During this time I became pretty depressed. I had such a strong identity as an athlete that I felt kind of lost. Looking back I feel kind of silly for getting so down about it, but I guess it’s all about perspective. When I finally found out that I had compartment syndrome I just felt relieved. I wasn’t making it up and I could finally move forward to try and treat it.

The Surgery

Overall, it wasn’t that bad. I opted to be put out for the surgery, but now I kind of wish I had stayed awake. I think it would’ve been kind of cool. Once I woke up afterwards I was even able to walk to the bathroom on my own. The first few days post-surgery went fine besides getting sick from the pain medicine (bleh!).

haha, I look ridiculous!

haha, I look ridiculous! pre-surgery

post-surgery. a little out of it...

post-surgery. A little out of it…

My right leg started to hurt around day 6-ish I think. I had been able to kind of walk on both legs with the crutches, but started to only use my left leg because my right one hurt. A few days later it had gotten worse and now I had quite a bit of bruising on my right leg and couldn’t straighten it out all the way. After a trip to the ER we found out that I had developed a hematoma (bleeding) from the surgery.

normal leg

normal leg

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NOT normal leg

other normal scars

other normal scar

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I started PT after this with an awesome new physical therapist. Things started to get better after that. The hematoma slowly went away and after a few weeks (now 3.5 weeks post-surgery) I was able to walk without crutches with only a slight limp. Almost exactly a month post-surgery I started running again! From there I was actually able to start running with my track team (now outdoor track) again on their warm ups, then full practices, and then competition!

The Long Road

It took me almost a full year post-surgery until I would consider myself back to the shape I was in before I got compartment syndrome. Sure, I PR-ed in the 800 that track season, but there was no way I could’ve PR-ed in anything longer. I think this was partly because I developed some annoying shin splints that hampered my training for a couple months. My next cross season did not go very well, but during indoor I started hitting the times I had got my freshman year. I finally became better than I had been pre-compartment syndrome my senior year cross-country season. I didn’t have any injuries to slow me down and I really cranked up my training. I was PR-ing all over the place and finally reached my goal of breaking 20 minutes in the 5k.

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New Normal

I find it hard to compare running now to before I had compartment syndrome. I definitely don’t have the awful pain I used to have, but I would be lying if I said that things were perfect. After all, my calves started acting up last week when I was doing intervals. The best way I can describe it is that things are just different. I have to pay attention to my calves more. Occasionally (like once a month) they’ll get abnormally tight. However, if I just take  a few days easy and use the foam roller then I’ll be back to normal again.

The type of training I do now also suits my calves better. I’ve been trying out longer distance races, which don’t seem to bother my calves as much. I find that shorter speed intervals (200’s and 400’s) can really get them flared up, but marathon training doesn’t involve much of that, so it suits me much better! I also have given up on wearing my spikes for races. Those really can bother my calves. I’d rather run a slightly slower time than be sore for days after. However, most of my races are now road races, so I don’t need them anyways.

My scars are not very noticeable anymore. After surgery they were obviously red, then became a purply color, and then turned white probably a year later. I put athletic tape over them when I would be in the sun for the first year. This helped them to heal better and not get damaged from the sun. I definitely noticed some people staring at my scars once in a while, but hardly anyone ever notices them now. I don’t mind my scars. In fact, I think they look pretty badass!

my scars now!

my scars now!

Overall, things are pretty great. I’ve been able to get my mileage up way higher than I was able to in high school and it’s fun watching myself improve and try out new types of races. The surgery was definitely worth it for me. I haven’t had a serious injury in 3.5 years (knock on wood) and I’m just enjoying my running.

summer track meet

Another Blog

My friend Sarah also has a blog where she’s shared her whole journey with compartment syndrome. She had the surgery just a couple months after me by the same surgeon. I connected with her through her blog and she later became my cross-country coach. Now we meet up regularly to run together. She’s pretty awesome, so you should go check her blog out!

 

***UPDATE 1/4/18*** – It’s been almost 4 years since I wrote this post and a lot has changed since then, especially in the past year. I was diagnosed with popliteal artery entrapment syndrome (PAES), which I explain more about in this post. As of now, the exact relationship between PAES and CECS seems to be unclear. Since PAES is so uncommon there’s hardly any research or statistics to go off of. From a poll in a support group for people with this syndrome over half of the participants had been diagnosed with both CECS and PAES. So, the two conditions seem to be related. I’ve heard some people claim that PAES can cause high compartment pressures, but the bottom line is that there just isn’t enough information yet.

Either way, if you’ve been diagnosed with CECS it might be worth asking about the possibility of PAES. Although PAES is pretty rare, it could save you from having unnecessary surgery. It’s possible that if I was diagnosed and treated for PAES first that I wouldn’t have needed surgery for CECS. It’s also possible that my symptoms weren’t the “classic compartment syndrome case” because I also had PAES.

I still think it’s valuable to leave this post up even though my experience doesn’t fit the normal compartment syndrome story. The information about the process of getting diagnosed, the surgery, and the recovery are still valuable. I wrote this with the hopes that another person dealing with CECS could find the information helpful and it seems to have done just that. It makes my day when another athlete dealing with a similar situation reaches out to me after reading my blog.

If anyone has any questions/comments about compartment syndrome or my experience feel free to comment down below!