Featured Post

Friday, March 10, 2017

Week 7 - Progress Report

It's official. I'm basically healed. My leg can be fully extended straight, I can bend my knee so that my heal gets about 8" away from the back of my thigh.  I can stand straight up to walk with hardly any funny feelings of tightness. If only the swelling in my lower leg and ankle would go down permanently I'd be nearly good as new.  I did lose my good conditioning from not really exercising for three months, and I have gained 8 lbs, but I'm feeling good.

I've had my 3rd and 4th PT sessions, and in addition to the heat treatment, message, and weights, I've gotten on their exercise bike and done up to 25 minutes of spinning. At one point I had my heart rate up to 150 for a few minutes. I figure if disaster was to strike, I'd rather have it happen while I'm in a supervised situation as opposed to being alone on my trainer in my basement.

There is also a noticeable reduction in the hardness of my incision line. Near the side of my knee, where there is still swelling, my skin would clump up when the knee was in the bent position. It looked pretty grundy. But this week, even though it's nowhere near perfect, it is clumping less. This may be a natural progression of healing, but I'd like to think that my diligent messaging twice a day has also helped.

The rest of my scar looks good, especially above my knee. The PT guy pointed out that skin should be able to move in all directions.  You realize how important it is to keep working at the skin to make it move. I've been using a firm circular message right on top of the scar line to help free the skin from the scar tissue below. I would circle clockwise, then counter clockwise, then up and down along the line. I think it does a lot of good and I would highly recommend doing it twice a day.  I would also recommend searching for videos on YouTube to gather info on how best to treat scars and scar tissue.

The last thing I'll say as my 7th week comes to a close... My goal for next week is to get back on my bicycle and take a nice ez ride out in the fresh air of the open road. Once I accomplish that, my real road back to where I was begins.

Friday, March 3, 2017

Week 6 - Progress Report

By this point in my recovery I'm pretty much walking normally and have been out with my dogs for an 8 block walk. My limp is all but gone and I'm going up and down stairs with almost no visible difference than before the surgery. My incision line is all healed except for maybe a one inch spot that still has a hard scab. 

Improvement still needs to be made on the numbness behind my knee and along the incision line but I'm pleased with my improvement thus far. Even if I never improved any further, I would still be able to live a normal life from this point forward. But I am still trying to get the best result. 

And to that end, I began going to physical therapy. This was not offered by the doctor. I had to request it. And I'm glad I did. My insurance plan covers 20 sessions per year. I'll use them as needed, but not more than necessary. It's best to save the others sessions just in case something unexpected happens later in the year that might require PT. No sense in burning them all if I'm feeling good.

If you're like me, and never been to Physical Therapy, here's how it works.  On the first visit you will be assessed. Expect to answer a lot of questions as they devise a plan to best address your needs. They'll inspect your incision line and test your mobility. For me I was still unable to completely straighten my leg and there was still swelling on the side and behind my knee that was preventing me from making a deep knee bend. 

The therapy started with wrapping my leg in a hot blanket for a heat-treatment. It was really hot but it did feel so good. Then there was a lotion message of the entire leg with the therapist sharing some info about scar tissue. I guess it depends on the therapist but the guy I got was a wealth of information and was very willing to share what he knew. That was good for me and made me believe that no PT would have been a big mistake. He also showed me how to message my incision line to reduce the hard scar tissue that had developed.

Then he attached ankle weights and had me do a series of exercises to start the process of restrengthening my leg. Not easy at first, but by now I've been pretty much completely inactive for the past three months. I've also gained about 6 lbs, so getting back to exercising is way overdue.  I'm not someone who loses weight just be starving myself.  I really need to incorporate exercise, and without any exercise, I will not be able to keep myself from gaining weight.

So the good news is that everything continues to work well and I'm passed the point where I'm concerned about any complications. The only lingering issue is the swelling that remains in my calf, knee, and ankle. I keep hearing that it will go away in time, but certainly not fast enough for me.

Friday, February 24, 2017

Week 5 - Progress Report

Week 5 - Progress Report

I must say, and I don't think it was my imagination, but the morning of the four week anniversary of the operation, I woke up, stood up out of bed, and walked into the bathroom with hardly any uncomfortable tightness in my knee. It seemed like all of a sudden, I had really turned a corner to feeling better. I had been walking without a cane for a week, my leg still unable to get perfectly straight, but close, had a less sore feeling. My recovery was moving forward nicely.

Unfortunately, later that same morning, as I was leaving for work, I heard a strange "water running" sound, which upon investigation turned out to be a release valve on my basement boiler that had gotten stuck in the open position and was flooding my basement. Thank God for my new found feeling of improved recovery, because according to my FitBit, I had gone up (and down) 25 flights of stairs.... which was all me carrying boxes of belongings up from the basement and away from the flooded floor. 

And even though that morning I was feeling great, with all the labor I did rescuing belongings and shop-vaccing water off the floor and dumping it, by the end of the day my foot and ankle were very swollen and sore. It just proves that you can be doing well and feeling better, but over do it just once, and you'll pay the price.

I also put a call into the Drs office. I don't love the fact that after the staples are removed on the 15th day, there were no plans for me to see the Dr again until my 3 month check-up. In my opinion, that is just way too long, especially if you're someone who is a little more pro-active. This blog is written by and for an active person, and even though life has thrown a big wrench into your active life-style, don't just sit and let nature takes its course without doing everything possible to achieve the best result.

For example, I am soon completing my 5th week since the surgery and I still cannot completely straighten my leg. That might be totally normal, but exactly how would I know that to be true unless I speak with someone who has seen this surgery 100 times and knows for sure what is normal and what is not. I also still have that swollen numb area on the incision side of my knee. Exactly how long will it take for that swelling to go down completely... and will it ever go down completely. That swelling thickness, from a mechanical point of view, is the specific reason why I can't bend my knee more deeply. 

What I'm realizing now that the operation and early recovery period is behind me, I more focused on the future.  I need to be sure I'm doing everything within my power to recover as fully as possible. I'm anxious to speak with the Drs office tomorrow to try and get a prescription to start seeing a Physical Therapist. I just want to get some extra attention and care during that long 10 week period between having my staples removed and the normal 3 month check-up. 

I also need some encouragement to start riding my bike again. I was originally told to expect a 2 month hiatus from riding, but I see now after just 5 weeks that there might be a possibility to head out for a nice flat ride on the Jones Beach bike path sometime more sooner than later. I was a pretty good rider before all this surgery stuff happen and the bulk of my non-marital social life is bicycle-club related friendships, so needless to say, I'd like to get back to that place one day. Whether or not I can ever return to the level of riding I previously enjoyed is a completely different story. Time will tell. 
And then there's also the other elephant in the room... which is whether or not I should even try to regain my former fitness level and to return riding with the faster groups again. Or maybe this fem pop bypass was a warning shot I should not ignore. At some point somewhere in our later years, we all must accept that age has taken its toll on us and mature decisions need to be made.  Of course I love the idea of returning to vigorous paceline club rides, but never if that in any way endangers my life.

Friday, February 17, 2017

Week 4 - Progress Report

Week 4 - Progress Report

I stopped using my cane on the first day of the fourth week. I was certainly not walking perfect, but I felt I was stable enough to take that next step to independence. I was getting a little too used to leaning on the cane. My walking style had become stepping with my good leg, then stepping with my bad leg and cane in unison, while pressing most of my weight down on the cane. Even though I was motoring along very well, it was starting to bother me that I was making the cane part of my new style of walking. That's really not what you want. 

What you do want is... to get back everything you had prior to the operation and that was, is, and will be your goal. The sooner you kick that cane away, and start walking like a normal person, the better it will be for you. Even if you are walking at half speed, despite the leg still being uncomfortable and awkward, stand tall, elongate your step, and resist the temptation to limp. Go to a supermarket and grab a shopping cart. Then go walking around the store using the cart to help maintain good posture.  Concentrate on just walking normally.

By this time in your recovery, things have gotten much easier. You'll still not have a straight leg yet, but getting up from bed in the morning won't be nearly as uncomfortable. Week 1 and 2 were ridiculous while trying to get up from a seated position, or even worse, in the middle of the night to pee. Not fun. The leg was just too tight. As time passes, the worst is only when you initially stand-up, then in the time it takes to stand there and pee, the leg has relaxed to a much less uncomfortable straight position. This like everything else only improves with each passing day.

The other issue that improves is sleep. The first two weeks are rough. It's very hard to find a sleeping position that doesn't feel painful or uncomfortable. I sleep on my side or my stomach... and that's the worst. You need to somehow find a position that is both familiar and not causing awkward pressure to your incision. Otherwise, it will wake you right up. 

Another issue when it comes to sleep is the numbness you still feel (or not) in your lower leg and along the incision line. So many times while trying to sleep, I thought my leg felt like it was laying on irregular gravel, but it was just the sensation of the different spots of skin that had feeling or not. Eventually you'll find what works for you, but by this fourth week, sound sleep becomes easier to achieve.

When it comes to numbness, I'm not sure what the future holds. Just after the operation, everything seemed extremely numb, but again as time passes, it does seem like the little nerve endings are reconnecting and sensation to parts of my leg have returned. At this point, at the completion of 4 weeks, the only part of my leg that's numb is about 1" on both sides of the incision line from my groin to my ankle and the only areas with more numbness are located to the side and back of my knee...  and just above my ankle bone.  I'm hoping this will improve.

When it comes to swelling, I have had a couple days when I probably did too much physical stuff, like repeatedly climbing stairs, that caused my ankle to swell. You might be feeling pretty good at this point, and doing your best to get back to a regular daily routine, even though you're still limping, but if you do too much, there will still be a price to pay. For me it has been a swollen ankle and an occasional swollen foot. I compare the swollen one to the good one and that's all I need to know. Elevating the foot, even now so long after the surgery, still works to calm things down.

Here's a look at my scar.....

And here's a look at my swollen ankle and foot.
Notice when I flex my foot, you can't see the tendons.

Friday, February 10, 2017

Week 3 - Progress Report

Week 3 - Progress Report

The big event for me to begin Week 3 was was finally having those damn staples removed on Day 15. It was also the first time I saw the doctors since my hospitalization. Truthfully, I was really dreading the staple removing procedure. My leg up until that point was still very tender, pretty much all around, except for the parts of my leg that were still numb, and the thought of having 140 staples plucked out was a little unsettling.

Thankfully, those staples are far more shallow than I had imagined. In my mind, they were long like a box staple, but in actuality they're really only like an eighth of an inch long and removing them could not have been less painful. The Dr. has a special tool that lifts them up and out in the least invasive way possible. Don't sweat it, staple removal is a piece of cake.

But you don't go from staples to nothing, you go from staples to sterile strips the entire length of the incision. To my disappointment, the sterile strips seemed just as tight as the staples, but with the positive side being that they were temporary. According to the Dr, they would start to curl after 4-5 days and he was ok with me removing them when they looked ready.

I was still showering every day, even with the daily watering, the sterile strips were still all intact on the fifth day. So at that point, which was Day 20, I started taking warm baths. First, the soaking of my leg felt fantastic. It was still very stiff, so getting in and out of the tub required careful movements, but once in the water, it was great. Over the next few days every time I bathed, more and more of the sterile strips were removed. 

The last strips I removed were over the three areas on my calf where the incision line had a black scab. This was the area for the beginning where the skin had been stretched to the maximum and I'd imagine this is where the skin was struggling the most to reattach. Once the final strips were removed, I had three areas of hard scabs surrounded by redness. My wife, who works in a hospital said it was not infected. Instead she referred to those areas as being "angry". 

Now that my incision line was completely exposed, I began bathing twice a day. I wasn't soaking the leg for an extended period.  I don't think that is recommended, but I filled the tub with enough water to cover my leg in the stretched-straight position.  I just wanted to submerge my leg in water without having it soaked.  Because I was still walking with a cane, and my gait was not very graceful, I wanted to keep up with my stretches and massages. I found while being in the water, my skin was at its most relaxed, and getting improved stretching results became my priority. After each bath, I would rub Vitamin E cream into the incision line and Nivea on the rest of my leg. Things were starting to loosen up and I was just sticking to the routines that were aiding my slow improvment.

The only minor complication was those three angry spots on my incision that were taking their sweet time to heal. The redness around the scabs was a little worrisome, but given how good the rest of the incision looked, I wasn't that concerned. I did alternate between applying Bacitracin and allowing the areas to be exposed to the air. If it got any worse, I probably would have emailed a photo to the Dr. for an opinion, but it did appear to be slowly getting better. I was thankful that was my only complication.

Friday, February 3, 2017

Week 2 - Progress Report

Week 2 - Progress Report

In some ways Week 2 is more difficult than Week 1. During Week 1 you are really hurting and mostly flat on your back the afternoon with the leg elevated as often as possible to avoid swelling. However, because you are anxious to start really recovering, you will always be trying to get up and assert some independence. The problem with be the tenderness and rigidity of your repaired leg.

I came home on Day 5 using my walker. I used the walker on Days 5-7. By the morning of Day 8, I had completely switched over to a cane. And I must say, it was rough. Your leg is not even close to being straight and your are relying solely on your good leg to get upright. Once you start getting to the standing position, you need the leg to "settle down" and that takes a minute. I'm not sure of the physiology behind what "settle down" means, but it's almost like the rush of blood to your foot after having it elevated causes an acute momentary tenderness. For me it was around my ankle and around the curve where my lower calf meets my foot. 

After getting up and waiting for my leg to settle down, I always made the effort to slowly put weight on my foot, to stretch my back straight, and to open my knee as far as possible. I also started a process before attempting to stand. While lying in bed, I would do preparatory leg stretched... bending the knee and gently pulling it closed... then extending my leg however far straight it would go. I'd also wiggle my toes and stretch the toes back to stretch my calf. If I completed that routine prior to standing, it would make things easier. To walk, you will need to get comfortable with alternating your weight between your good leg and the cane.

I personally went to work on Day 9. By that time I was hobbling around pretty good. I drive a full size van so it wasn't terribly painful lifting myself up onto the seat. The motion was upward, as opposed to taking my sedan, where the motion would have been horizontal and down. Lifting myself to a raised seat was actually easier. To get myself out of the van, I simply turned and slid down my seat until my good leg touched the ground.

I work mostly sitting at a desk looking at a computer screen, which was very doable. I also need to walk into a small warehouse to pick merchandise, pack it in a shipping carton, then carry it to the UPS pickup location by my front door. The first day back was a very busy day, and I made the mistake of doing way too much. By the time I got home, my calf, ankle, and foot were pretty swollen. I immediately laid down and elevated my foot. This was pretty much my pattern for Week 2. I'd go to the office late, spend as little time there as possible, go home and immediately lay down.

Keep in mind that you still have all the staples in your leg and that Frankenstein incision line is starting to be bothersome. You're still struggling to straighten your leg. Your skin is starting to feel very dry and they tell you not to apply anything directly to the incision. I personally started thinking that all the pulling of my skin, which kind of felt like having a sunburn, was due to the extraordinarily dryness of my skin. I started applying Nivea moisturizing lotion to all the skin on my leg, really messaging it in, just to soften it's leathery.

I was also taking showers and had been doing so since Day 7. We have a handheld shower, so I could run a gentle stream of water down my leg, and I must say, that felt wonderful. I was imagining my leg just absorbing all the moisture and that thought alone made me feel better. By the end of Week 2 you'll be looking at those staples as if they're little clamps holding back your leg from making any improvement.

Everyday beginning with Week 2 there is a 1% improvement in your condition. This carries into Weeks 3-4 where slowly but surely the healing process is working. You're never going to make as much progress and you want, but without any unforeseen complications, everything seems to be getting easier.

Friday, January 27, 2017

Week 1 - Progress Report

Week 1 - Progress Report

Obviously the toughest week. It's the operation, the recovery room, and finally your ICU room. It's being flat on your back, beeping monitors, and nurses checking your vitals every two hours. You'll need to get used to very limited movements since you are seemingly hooked up in every direction. You can also expect to pee a lot. Your IV drip will be filling you with 100ccs of fluid every hour and what goes in will most certainly need to come out... and come out often.

It's also the reality of seeing a long line of surgical staples running down from your lower abdomen to just above your ankle. It's fighting back any thought that you might not get back to the life you knew before the operation. All I can tell you is... stay positive and take one day at a time. Don't let your mind wander too far off into the future. Things get better... just not that much during that first week. Your body has suffered a huge shock and it will take time for it to settle down. This is how it went for me:

Day 1: Operation at about 9:30. Lasted approx 2.5 hours
Day 2: Rested all day. Got out of bed and sat in a chair for a couple hours. 
Day 3: Took pain med - not needed. Made me groggy. Sat a few hours in a chair.
Day 4: Changed room. Finally did short walks twice with a walker in the afternoon 
Day 5: Walked longer distance. Passed PT test and discharged. Home and rested.
Day 6: Home all day. Walked around the house with walker. Tender and very limpy. 
Day 7: Used walker in the morning, then switched over to a cane, but did a lot of hopping.. 

Your leg will feel very tight. It's a real effort trying to bend it or straighten it, although you must continue to try. If you are athletic, you'll have a big advantage. Being well balanced while hopping around the short distance from bed to chair, or using a walker from bed to bathroom, and then finally short walks in the hospital hallway will be less of a challenge for you than someone overweight or in poor health. Move as much as possible, no matter how ungraceful it looks. And try to bring your own walker so the hospital staff doesn't need to find one for you.

Once you get home, try and locate yourself close to a bathroom. The toughest thing that first week will be trying to stand up. Your leg won't get close to being straight. You'll be putting a lot of weight on your walker/cane and really feeling the tightness in your leg. You'll be swollen from knee to ankle and the best relief for that is keeping your foot elevated. Don't spend too much time with your foot down or you'll run the risk of your calf-ankle-foot really swelling. Keep that foot propped up high. Excessive swelling will slow recovery and make walking all the more uncomfortable.

The hospital will give you instructions to do knee bending exercises from a sitting position. Be diligent. Do the exercises. You should also take it upon yourself to supplement the exercises with some gentle stretches. The ones I did were very simple: bend at the knee, then stretch the leg straight. You won't even get close it moving normally and that's mainly due to the swelling around the knee. I personally had a small clump behind my knee and also to the incision side. That extra mass really inhibits your range of motion, although I was told it was perfectly normal. 

I was sent home with medications. There was (1) my normal cholesterol pill, (2) also Flomax to help peeing (which I don't normally take), and (3) a stool softener (which I also don't normally take). I was offered pain medication which I declined, but did buy some over the counter Tylenol for some relief.

I'm sure people opt for pain meds. I personally don't think it's a good idea. I weakened on Day 3 and took a Percocet, but was very disappointed in myself for doing so. I was worried about how I'd feel trying to walk the first time, but the pill made me so groggy I wound up not even trying to walk that whole day. Very disappointing. I think it's possible I ended up staying in the hospital one extra day because I didn't try to walk on Day 3. My advise would be to tough it out. 

I can honestly say that I did not feel much pain that first week and I really don't think my tolerance to pain is very high. The fact is this... you are very uncomfortable and tender, plus you are very limited in your movements, but much of your leg is actually numb. My leg from the knee down, and maybe three inches to both sides of the incision is numb, including the actual stapled cut line. My advise again would be to tough it out.

Congratulations. You survived Week One!. And if the first week was complication-free, you are well on the road to recovery. Better days are most certainly coming, but not so fast. 

Friday, January 20, 2017

Preparation and Day of the Surgery

Preparation and Day of the Surgery

Before the surgery, be organized and make whatever preparations are necessary keeping in mind that you will be mostly useless and miserable for the first 10 days after the procedure. For me, since I have a retail business, I needed to stock up and over load shelves in advance knowing that carrying things will not be easy when I first returned to work. I also ship items to customers, so I pre-packed a lot of popular items in advance, so all they needed was a shipping label applied. I also piled those pre-packed items close to where the UPS guys pick-up, so I'd avoid any unnecessary carrying and walking. Just think through your work routine and be prepared.

Once you're procedure is done, you'll spend maybe three nights in ICU where they will monitor your vitals every two hours including a Doppler which checks the blood flow in your feet. It's very important that the bypass works and blood is flowing.

The first thing I noticed as I came out of the anesthesia was... there was a tube in my penis. That's not fun. It also makes your every move much more gentle so not to disturb that tube too much. They removed my tube on day three, but you're still unable to get out of bed to get to a toilet. Now your next little inconvenience is peeing into a plastic bottle... and because you're still receiving intravenous fluids, you are peeing like crazy. Like most men, I generally pee standing up. Peeing in the sitting position does not come naturally for me. If I could go back in time, I would literally practice peeing in that sitting-up-in-bed position. Don't laugh. It's not that easy.

Another thing that's not easy for me is sleeping on my back. You'll have tubes stuck everywhere and sleeping on your back is the only option. Again, going back in time, I might consider practicing trying to sleep on my back. It can't hurt. They say sleeping on your back is very healthy. And frankly, it will be a couple weeks before you can even get to even sleeping on your side.

I try to be prepared for everything and I anticipated that having a bowel movement would be another challenge. I was operated on a Friday and my first BM was not until the following Monday.... not my usual pattern, and you don't want to be backed-up longer than four days. On the Wednesday before the surgery, I took a laxative (ex-Lax) and completely evacuated my system on Thursday. It was a smart move which made waiting until the four day for my next BM not so critical. Consider it. And they won't let you go home unless they know your insides are working.

The first day you're zombified. Just accept being flat on your back. It may be the same for Day 2, but you should start right away trying to stretch the leg. I'm not sure how the surgeon would feel about this, but I started to stretch my leg straight very soon after the procedure. I would trap the Achilles of my operated leg between the big toe and long toe on my good leg... and lift it up gently. I could feel it stretch out the swollen area behind my knee. Then I'd drop the leg to the bed, shift to my left butt-cheek, and using the heel of my good foot, I'd place it against the lower shin of the operated leg, and gently pull my lower leg back in order to get my knee to bend. The swollen area behind your knee will prevent any deep angle bend, but it starts the process of getting that leg to bend. Be gentle, but committed. After a moment, I switch back to stretching the leg straight, then back to bending the leg, back to stretching straight, etc etc. I did sets of 10, three times a day, especially the last two days prior to getting out of bed and walking. You don't want to wait until day 4 before trying to bend that knee. 

Here's some last thoughts about the hospital stay. You will need a walker. Don't rely on the hospital to provide one. Just have someone bring your own. Also, avoid taking pain meds. I took a Percocet on Day 3 and it was a mistake. I misinterpreted being uncomfortable for being in pain. It's not the same. Had it not been for how groggy the pain Med made me, I might have been able to get up and walking a day earlier on Day 3 and possibly could have gone home one day earlier. There is a lot of discomfort, but the pain level was not that high for me.

And lastly, don't expect any privacy. I had never been hospitalized before and it was a constant struggle to keep my maintain a certain level of dignity as you pee in a jug, talk to strangers about BMs, and forget to cover up your man parts half the time. It was a blessing to get out of there.

Friday, January 13, 2017

Symptoms and Diagnosis

I was riding in perfectly fine form. Between vacations and other commitments, I wound up being off the bike for most of September. Once I was back riding again in October I started struggling to keep up on regular club rides. I was even "dropped" a couple times (oh no!... that never happens to me). I mistakenly thought I was struggling due to recent inactivity. The only obvious symptom was a constant light cramping feeling in my left calf. I diagnosed myself... with a pulled calf muscle due to trying to ride myself back into good form too quickly. I also started wearing a compression sleeve over my sore calf to support the muscle. 

I went out for light-riding a few more times but the calf was now very sore. My last ride was on my mtb and when I finished, it was obvious to me that extended rest was needed. Riding through the pain was not working.

So I limited my activity to only walking my dogs. But by the time I finally made the long overdue doctor's appointment, I could barely walk a block without starting to hobble and needing to rest. I started experiencing the dreaded intermittent claudication. My condition had worsened quickly and now I was really in need of help.

I saw an orthopedist who sent me out for an ultrasound to check the blood circulation in my "bad leg". It revealed an aneurysm in my popliteal artery located just behind my knee which would require a "fem-pop artery bypass" procedure.  I could be off the bike for up to two months and may never return to my previous level of riding. Yet, I'm so very lucky.  Unfortunately for some people, aneurysms rupture and cause uncontrolled internal bleeding.  Wow.  And if I were deep into the woods, alone on my mountain bike, that could have spelled the end of me.

Once you reach a certain age, it is imperative to see a doctor at the first sign of trouble. Self diagnosis can be disastrous. Plus, even though I can't prove it.... I also think wearing that compression sleeve on my calf was a huge mistake. What may have helped a pulled muscle was very ill advised for what turned out to be a circulation problem. The top of the compression sleeve coincided exactly to the location of the aneurysm. The sleeve may not have caused the aneurysm, but compressing an already constricted artery during vigorous exertion may explain why this problem worsened so quickly. 

Before this blog moves ahead with more details about my experiences before and after surgery, I'd like to repeat my advise to you: Don't self-diagnose. Don't delay seeing a doctor. Any diminished performance could be an indicator of something brewing. Don't ignore warning signs. We all want to stay active and ride strongly into our old age, but we must be very mindful of how the years have affected our physicality. At a certain point, even those of us who have enjoyed a bullet-proof life full of active adventures must accept that our machines are running on worn parts, and more frequent check-ups are now required to maintain our performance. 

Ride strong. Ride smart. Ride safely. 

Friday, January 6, 2017

Blog Intro

I'm not a medical doctor and I have no medical training. Truthfully, I haven't hardly been sick in years and I'm the last person to give anyone advise on wellness. That's not the intention of this blog, however, it's exactly why this blog might help someone who's dealing with this specific circulation problem. It's a history of what I experienced prior, during, and after my Femoral Popliteal Bypass surgery and hopefully it gives a useful timeline to measure your own recovery against mine.

Unfortunately, when I searched the web for any information about femoral-popliteal bypass surgery (which I call FemPop), I was never able to locate information that really pertained to me. I'm a cyclist and an active person. I don't have a poor health history. I've never been hospitalized. I'm hoping that fellow cyclists, and other older athletes, who find themselves in this situation will be able to use the information herein to gauge for themselves whether or not they are on schedule for a full recovery. I was never able to find any information that would guide me during the different phases of recovery and I had no barometer as to whether or not my recovery was going well. That is where I hope this information will be helpful.

Most people who need this surgery have other health issues and much of what I found on the internet was extremely depressing.  It commonly addressed issues like leg amputation and life expectancy. This was not what I wanted to hear, and ultimately I realized that much of what you find on the web pertained to people whose overall conditions were much worse than mine.  I was sick, and I needed surgery to get healed, but my death was not imminent.  The web gave me general information concerning my disease, but I wanted more. PAD (peripheral artery disease) usually affects people older than me. Or they had one of the following problems: High-blood pressure, Diabetes, cigarette smoking, or some traumatic injury to the area. I had none of these. But it was the last most likely cause that got me: Family History.

In my father's final years, he was what I'll call a "slow walker". He could only walk short distances before he needed to rest his legs. After two minutes rest, he'd continue to walk as far as he could until his legs lost power and he needed to rest again. Today, I know this is called intermittent claudication and it was exactly what I was experiencing. The muscles in the legs get their energy from the heart pumping down a fresh supply of oxygen rich blood. If something impedes this flow of blood, like an artery blockage or an aneurysm, the muscle will deplete its energy supply and weaken. This will be accompanied by a light cramping feeling, a loss of muscle power, a diminished gait, and the need to rest. After a few minutes, fresh blood will restore energy to the muscle, and you'll be able to walk again until the point where the energy has been exhausted and you will again need to rest.

Hence, my fathers slow-walking. He realized that by walking slowly, it would delay the depleting of his leg muscle energy, and although he would fall behind the pace, he was able to walk further without stopping. My mother referred to their walks in the local park as "going from park bench to park bench".Back in the '80's there may not have been many options for relief. They didn't have stents, and even if they had a bypass surgery, my father was from the generation where surgery was only performed if it were a matter of life or death. Consequently, my Dad dealt with that limiting physical condition until his death. 

So... This is the point of this blog and why I've taken the time to document my experience before, during, and after the surgery. If you are way more alive than dead, and have an expectation to regain the active life you enjoyed prior to being diagnosed with PAD, then you and I are in total agreement. Whatever has led you to these entries, I certainly hope that my experiences and observations will somehow help you. But before we move ahead, let me tell you something about myself.

I'm a 59 year old male who has been mostly active and in good health throughout my life. I'm 6'2" tall and I weight 197-202lbs.  I was athletic in my younger years.  Nothing special, just very active with sports.  There was no option to play video games or surf the web. Back then you either watched TV, studied and stayed home with your parents, or got yourself outside. And that's what I did. I got the hell outside, and anywhere I went was under my own power by walking or bicycling. That's just the way it was back in the ancient times.

After college I was driving a cab and learned to play tennis which I did as much as possible including local leagues to satisfy my competitive nature. I was again riding my bicycle a lot. In 1982, I got the idea to ride my bicycle down the California Coast. I was 24 years old with no specific direction in life. I spent 6 weeks going from Arcata to San Clemente on my fully loaded Bridgestone Kabuki. In the Summer of 1983, I flew to London and road my Miyata 610 through SW England to the south of Wales, over the Irish Sea and up the east coast of Ireland, through Dublin and all the way to Belfast. From there it was over to Scotland and all the way up to a ferry for the Orkney Islands. Many times in my adult life I've looked back on those two Summers with such appreciation, and even though my life seemed impossibly off-track, I was still able to experience some great adventures and for that I'm eternally grateful.  

I gave up regular riding in the early '90's when a wife and baby altered my priorities. I did keep playing league tennis on and off, but admittedly allowed desk-work and inactivity to take hold. More and more, as I got further into middle age, the motivation to take care of myself waned. Eventually I weighed 223 and was taking medication for both high blood pressure and high cholesterol. Age set in and I was no longer what I once was. 

In 2009, my daughter left for college. By the spring of 2010 it was time to find a hobby. So one night over dinner a friend of my wife was talking about how she was currently training for a 100 mile ride with a local bicycle club. Suddenly I was reminded of a long forgotten love from my past and the thought of just riding my bicycle again was so exciting. I had six weeks to get ready for that century ride. No problem. I bought new tires and some upgrades for my old '80's Miyata ( which I kept all those years, despite numerous threats from my wife to throw it away).

That ride was the beginning of my new life and those 100 miles were easy as pie. After that I began riding my bicycles again as often as possible and started working my way up to faster and faster club groups. I did hundreds of solo and club rides, lost 25 lbs, and was taken off the high blood pressure meds. An average ride for me before the surgery was 40-50 miles with 1500 ft of climbing at an average pace in the 18 mph range. I'm not with the fastest guys of my age, but I was doing great... until I felt what I thought was a pulled calf muscle, but know now it was something much more sinister, and my life then took a very sudden and unexpected turn.