Monday, February 27, 2012

On the Perils of Liquid Mercury

Oh, wow. It has been forever since I did anything at all with this blog, but it seems it's time to resurrect it as this season is shaping up to be one of the best. Though, before I jump on that, I thought it might be fun to address the compartment syndrome issue that I wrote about in my last post (written well over a year ago), and that did eventually force me off the bike entirely.

When I was holed up in Moscow, I did internet search after internet search in an effort to understand what I was going through and what I could do about it, and I remember reading post after post written by someone in the same situation as me, alone with more questions than answers. So, here's hoping that putting some info about compartment syndrome out there might prove useful to someone.

First off, here's some info about compartment syndrome courtesy of PubMed Health:

Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, similar to the way in which insulation covers wires.

Fascia do not expand. Any swelling in a compartment will lead to increased pressure in that area, which will press on the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the limb may need to be amputated.

Swelling that leads to compartment syndrome occurs from trauma such as a car accident or crush injury, or surgery. Swelling can also be caused by complex fractures or soft tissue injuries due to trauma.

Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running. The pressure in a compartment only increases during that activity.

Compartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm.

My c.s. was caused by cycling, obviously, and by September I wasn't capable of more than 45 minutes on the bike before the pain was too severe, and so I was jumping in the pool to swim laps, too, and boy was that boring. I missed my bike like crazy and so with no idea what else to do, I went to an orthopedic surgeon and explained my situation. Much to my surprise, his take was basically: You're a professional cyclist. You've done your research. You know your body. I trust you. When do you want the surgery? I was a little taken aback at his willingness to jump right in, to be sure. But even more strongly I felt relieved that he wasn't going to delay the surgery with time-consuming and painful procedures that would confirm c.s. And so, I scheduled the surgery for shortly after my return from my school's yearly backpacking trip. (Oddly, my compartment syndrome was a non-issue when walking.)

Here is a couple post-surgery pictures. (I'll limit it to two as they're kind of gross):Now, I've got little more than a white line on the side of each of my legs. What the surgeon actually did was put a long slit in the fascia covering my shin and calf muscles, thus allowing the muscles to swell as necessary. The story that circulated amongst my students, however, was that my muscles got too big for my skin. Which in some respects is true, so I didn't correct them.

People on the internet struggling with c.s. often wondered if they should have surgery and most people who responded to their posts often said they shouldn't have it because their c.s. came back. When I read those responses, I often thought one had to be careful about putting too much stock in them as it seemed to me that if one had a successful surgery, one would be unlikely to go online and write about it. Much more likely, that person would be out on his or her bike, or running, or whatever. And until about a year ago, I would have told anyone who asked me that surgery was definitely the way to go. I was back on the bike within 6 weeks and made it through the entire next mountain bike season totally free of compartment syndrome. But then, in September of 2011, after my end-of-mountain-bike-season break, I did a four-hour road ride, and slowly but surely felt the symptoms of c.s. return to my right leg. Needless to say, I went into full panic mode. But this time I wasn't alone as I had been working with a PT on general maintenance of my body, so I was in her office a day or two later, and within 40 minutes she eliminated the c.s. again.

And there's the rub.

My PT effectively eliminated in 40 minutes the very pain I had sought surgery for a year prior. And this wasn't the first time I found myself wondering if surgery may have been the wrong choice. I had spent the summer between surgery and this second bout of c.s. in Bozeman, MT and while there saw a massage therapist. It was her opinion that my surgery was unnecessary as she had helped other athletes overcome various ailments for which others had encouraged them to seek surgery, ailments similar to mine. And when I asked my PT point blank if she thought that was the case, she agreed. And so, I find myself grappling with what I think many athletes do: a willingness to do whatever it takes to get back on my bike, a willingness that can sometimes do me more harm than good when it isn't tempered by patience.

Recently, my husband shared with me an excerpt from a book he's reading titled, The Demon Under the Microscope. "In 1799 . . . when the former president of the United States, George Washington, was treated for a severe throat infection, he received state of the art medical care from the best physicians of the day. They gave him a compound of mercury (a poisonous heavy metal) by mouth and injection, administered a toxic white salt to induce sweating and vomiting, applied caustic poultices to blister his skin, asked him to inhale hot vinegar fumes that burned his throat, and bled him four times, taking a total of five pints. Then President Washington died. It is an open question whether his doctors might have saved his life by leaving him alone."

I understand why the doctors did what they did to Washington. Doing something, especially something dramatic, feels better than doing nothing, or doing something that might eventually work. In seeking surgery before ever seeing a massage therapist, or physical therapist, or bike fitter, I was doing what felt like the most proactive, and therefore most successful, thing I could. (And admittedly, that was partly a financial decision. It was much cheaper to have surgery than to pay for weekly massages or physical therapy appointments beyond my allotted amount.) But, I try to be more cognizant now of this propensity, and to be a little kinder and gentler with this body when it's not on the bike.


  1. First of all, I love that you’re sharing this information – I’m positive your perspective will be helpful for someone else in the future doing their own holed-up Google search on c.s. It is really important (and admirable) to share with others a potentially avoidable mistake/misdiagnosis.

    Secondly, I’m sorry to hear you went through all of this. Thank goodness for your physical therapist! What a wonderful thing that you’ve overcome your ailments through PT.

    Thirdly, I agree with your students that your muscles probably just got too big for your legs, because as I recall when I wanted to have coffee and scones Anna really just wanted to get in a really good workout.

    Hugs from Moscow,

  2. He he. I remember that, too. But in your defense you'd already been in the pool for an hour by the time we went mountain biking. Was laughing about running into the white Subaru the other day :)