I am currently taking the time to write this blog, since my vascular surgeon recommended it could be an interesting thing to do, in order to tell my story to others, in case other athletes that have been diagnosed the same vascular problem can have a glimpse of the behind scenes of it all, from initial symptoms, to surgery and recovery.
And since there’s a first to everything, why not make this my first blog … So here it goes!
The diagnosis was made last year under MRI and exercised induced ultrason : Endofibrosis of the left external iliac artery. It is an impingement of the artery that feeds the blood to the leg, and in my case, there were three problematic areas to treat. Why is this encountered in a young and very healthy adult? It’s actually a consequence and the result of repetitive movements from the leg turnover during cycling, along with years of long distance running. There might also be a hereditary component by which my iliopsoas, inguinal ligaments and underlying muscles and structures are very tight and impinge on this artery.
Before elaborating on all the cool surgical details, here is a brief summary of my beginnings as an athlete and how the symptoms first presented ….
I have been a competitive runner for many years now, mostly long distance running, and long distance triathlons in the 70.3 and Ironman distances… In the winter, I am an avid cross country skier and enjoy racing in various Loppet and marathon events. I am a podiatrist as a daytime occupation, and a full time *athlete in training* outside clinic hours, where I am often moreso than not, treating or talking about feet and running technique, just cause I like it so much ..!
Although I practice many sports, I am deep down inside a true long distance runner. I just love to run for hours at a time. I am located in the heart of Chelsea, Qc, which permits me to just leave my doorstep and head out to the infinite trail system of the Gatineau Park and just…. Run.
I started trail running couple years ago when I met the trail runners Gurus in my new Chelsea neighborhood, and they quickly took me under their wings and showed me what running was all about. And obviously I fell in love with the sport of trail running. I started to race long distance trail running last year in 2014, with my first race at the Ultimate xc 38km in St-Donat, Qc. I remember being very nervous the night before, and my Guru Dave McMahon told me not to be worried, that running is what I do best and to be myself in the trails, and most of all to have a blast! So that’s what I did. I ended up winning the race, put up a strong competition, and felt very happy and amazed of how I enjoyed myself out there. I kept on competing in various events that year; 50km trail race Chute du Diable, 50km i2p trail run, 50km trail Bromont Ultra, 50km National Championship Run for the Toad, 42km Gatineau Park marathon. Amazingly enough I finished 1rst female overall in all of them, yes, and even the National 50km Championships! I had an awesome season. I also ran the Ottawa Marathon and completed the IM Mont Tremblant, for the second year in a row, but my results of 11h13 hrs that year and overall feeling throughout the IM race could reflect my lack of specific training for that event, since I was so carried away by the trail running scene! During the winter, I just continued doing what I do, running and x country skiing.
For many years now I am running with the symptoms of claudication, which are mostly present at the start of every run, and will be there for the next few kilometers…. And by few, I mean 6 to 10km…. Eventually everything stabilizes (my blood flow) and my leg comes back to normal, so I can actually start my races then. Yes, that’s why I do well in long distance 50km races! The symptoms were not quite as heavily present as this year, but I remember having to stop on the side of the road during some half marathon events, fisting my left leg, not knowing at the time what was going on… These symptoms were present throughout every races described above, and every marathon completed to date. I always had to race under a certain threshold that permit me to keep running, fast enough to compete, but not past the trigger where the heart rate elevates to a critical zone where the symptoms suddenly violently appears . I started *playing* with the leg symptoms last year at the Ottawa ING marathon, where I usually finish between 3 :00 and 3 :05 hours. I tried to speed over the 3 hours pace bunny, but as soon as I do, my leg started to cramp as a result of decreased blood flow. This is also why my marathon pace is the same as my half marathon pace and the same or almost as my 10km pace…! And this, by never wearing a watch, just by feeling of what the leg can tolerate… Not bad eh!
The symptoms got worse as this year went by, where my cycling was greatly affected and so was my cross country skiing. I would not join group rides or group skiing, nor group runs, since I could not follow any pace, only my own leg’s pace. I was training mostly alone for that reason, building a very strong endurance base, with the inability to work in the higher thresholds most of the time.
This year, 2015, I concentrated on trail running events, and lots of miles on the bike (no IM this year!). I raced a few local trail running races, in order to prepare for the TransRockies 6 days trail run which totals close to 120 miles in 6 days, in altitude varying mostly between 8 to 12 000 feet, reaching the occasionnal 13 000 feet summits. A good test for the leg, but I can’t lie.. it got beat up quite a bit! Everyday of that journey, at every race start, I was stopped on the side of the roads or trails a few kilometres away from the start, from painful claudication, until the symptoms could go away and I could resume my race and start building up speed to catch the girls in front! Interestingly enough, I podiumed in each and every one of the stages, and finished as a 3rd overall winner (but it hurt quite a bit!) !
I then competed in 3 other events in October – November. I did great overall results in all those races, but the symptoms were quite painful at times. I had to remind myself that the pain in the leg was not normal, and that I would have to address this in order to be able to push again, and to run without pain. At this point, my decision was made to go through with the surgery.
I had my yearly follow up in October with my amazing surgeon, Dr Prasad Jetty, in order to assess the evolution of my symptoms. Unlike last year, this time I was ready to go through with it … and that early December would work best (for me…!) in between trail running and x country skiing, a perfect time to be OFF I thought (never been OFF sports for more than… 2 days? In the last… 10 years or more ??). So things went underway pretty quick from then on. Had my CT angio scheduled two weeks after, and another exercised induced ultrasound, along with my follow up visit with Dr Jetty early November. Results from that ultrasound were quite astonishing since my ABI on the left side dropped to 0.4 after only 2 minutes on the treadmill. We signed papers for the surgery, and scheduled a date : December 2nd … perfect….
Surgery went great. I was under general anesthesia for the full 4 hours of surgery, and on IV for pain management and that worked great for me! I could get up to go to the washroom the next morning, (day 1 post-op) so the nurses took the catheter out. I was on dilodid IV under my own voluntary control and heparin was given to me IM every morning to reduce risks of blood cloths. As I was walking more and more on day 2 post-op, I opted to take the IV medication out and keep taking oral tramadol and tylenol which worked very well for pain relief. I took advantage of the hospital stay to sleep, walk a bit, and sleep, which was pretty awesome since I don’t do enough of that at home! Surgeon kicked me out on day 3 post-op… Yay! Dr Jetty’s feedback on the surgery was that he was very pleased with how things went, and was really surprised on the severity of the impingement, mostly the one closer to the aorta. He does not understand how I could keep running with this very narrow artery it had become. It’s actually very good to hear, because funny enough, you are always doubting yourself to know if the symptoms are only in your own mind…
Throughout the week, I was in too good shape to just sit around, so I took my walking poles and did nordic walking starting the day I was kicked out, and throughout the week, building speed, core, and fluidity of movement. After 4 days of this, I was walking straight as an arrow, no pain, incisions beautifully closed, almost no medication or the occasionnal tylenols, and could actually speed walk and jump from rock to rock in technical terrains and even lightly run some trails. I am now at 1 week post-op and feel like I am in week 4 of my recovery. And this is where I am at!
Recovery is different for everybody. I am used to putting my body under impressive daily amounts of stress with the long runs and the long miles on the bike, the long distance skiing in the winters, and my body got adapted to it with time. However, this amount of stress can have other consequences such as the one described above. I will continue to build a solid base to return to running, and will slowly add intensities in the next few months, as suggested by my surgeon. Snow will arrive for Xmas (I asked for it on my Santa’s list) and x country skiing will be the perfect way to add more fluidity to the movements and help build a strong core and good form.
I took this experience with a very positive approach… just like a race preparation. I trained until the last evening before surgery, felt completely ready and relaxed when I went in the op room that morning, and enjoyed for the first time a good post race recovery.
Yes, this was by far the biggest most important race of the season!
Until next season! … should be a very interesting one!