Left common iliac artery kink I've just spent a week in hell - AKA Melbourne hospital getting arterial surgery! If this is anything like having a baby, forget it! I can now say, the operation went well and I'm on the road to recovery but it wasn't all smooth sailing. So what sparked the idea of letting a surgeon cut right through my abs and cause me a shit load of pain? A couple of weeks ago, after hours and hours of tests in CT & MRI machines, X-rays, ultrasounds, stress tests, appointments with vascular specialists, treatment to my femoral nerve... I finally got an answer to the leg pain/weakness/fatigue I've been experiencing in my left quad for the past two years.
Day 3 Last year I rocked up to Kona in the best shape of my life and was unaware I had this artery problem. Looking back, I first experienced it in March 2015 during Melbourne Ironman but not knowing what it was or even exactly how to explain it I never told anyone except my husband. His initial reply was "it can't be too bad if you're still wining all your races and breaking bike course records" so I tried to forgot about it. In Kona however I pushed it further than before by staying in the TT position for longer than I ever have before and I ended up paying for it. I came away with a DNF after going in thinking I was fit, healthy and ready to have an amazing race. So as soon as I got home I explained all my symptoms to my doctor and began the investigations to get answers.
I had to carry my own blood bag Less than 10km into the bike leg in Kona it began. It started off as usual with the feeling of a belt around my left thigh with someone gradually tightening the buckle until the quad was completely suffocating. I lost strength in the left leg and then when I kept pushing through the fatigue and pain, the VMO (medial side of the quad) started to tighten up like a deep cramp that was gonna tear the muscle if I didn't stop. I've had this before though, for two years now, but gradually getting worse so I knew it wasn't going to tear so I kept pushing on. In past races when it got too intense I'd sit up off my aero bars and massage it until I felt some relief. As the bike leg goes on I'd need to spend more and more time either sitting up or preferably out of my saddle. In Kona however I refused to get up. I wanted this race win more than any other so I told myself "stop being soft, stay down and push through it". Little did I know that sitting up was actually helping, it was opening the hip joint and un-kinking the artery to allow the blood to flow to my leg. I should have realized that it was not just a coincidence that I did not get the symptoms on hilly bike courses when I wasn't in the TT position. As Kona is not a real hilly course, by half way (90km) I was in serious trouble but my mind was in race mode and I just kept telling myself it'd be ok. I began to sit up to relieve it. I didn't want to but I had no choice as it turns out there just wasn't enough blood in my leg for it to work.
Swelling & inflammation in my belly I'd thought if I could get back to T2 I would be fine running. In past races, even when I'd pushed the leg pretty far on the bike, after a stretch and massage in T2 I've been able to run. By 130km it was touch and go whether I'd make it back. My left leg, no matter how much I told it to keep pedaling, was completely shot. I did get back to T2 on one leg and still thought I was in with a chance. I was telling myself it was just a cramp and took salt, gels, massaged the leg and eventually hobbled out onto the run course. Every step I felt like I was tearing the muscle but it would all be worth it to stand on the podium. Every few km I'd stop unable to bear the pain but telling myself to pull it together. By 12km the left quad had reached a point that I felt the damage was becoming too serious and I was sure it was about to tear off the bone It was so hard to do, but I stepped off the course.
Kink the Lamb watching over me So this is what I explained to Peter, my doctor and he immediately thought it could be something called External Iliac Artery Endofibrosis. I looked it up and yes, this sounded spot on. But every test I got done came up negative. Why? Because every test I got done I was lying in a supine position. Finally a simple CT scan with dye in my arteries BUT with me crouched in a TT position showed it clear as day. The artery was kinked. It was a little different to most cases in that mine was in my left COMMON (higher up than the external) iliac artery. This artery supplies all the blood to my left leg and when bent over it kinked therefore shutting off blood supply causing the leg to be starved of blood/oxygen. Surgery became the only viable solution that I hadn't tried to fix this artery. Within 1 week I was in Melbourne seeing the best vascular surgeon in Aus who had performed this operation many times on professional cyclists and triathletes all with very good results. Tuesday 7th March I spoke to the surgeon in the morning and then in the afternoon I went into theatre. The surgeon cut me open through my abdominals, cut out the kink and thickening of the artery wall and sowed me back up. He was very happy with the surgery and I was back in my hospital bed recovering at 6pm. Too easy right? Well, it didn't exactly go to plan...
1 week post surgery About 6hrs later, in the middle of the night I started experiencing pain like I've never felt before. I tried to tough it out but then I started furiously ringing my nurses call bell. I guess they get a lot of complaining patients wanting stronger pain medication so they gave me a neurofen and told me to relax. Half an hour later the pain was not easing, it was getting worse and I was almost ready to pack it in and say goodbye to the world. Something was not right but they just weren't listening and kept telling me to calm down. I started questioning my pain tolerance but after about half hour more, my body now shaking and for some strange reason my teeth/jaw chattering (I wasn't cold) I demanded the surgeon come back. When he arrived and saw the state I was in he said "this amount of pain isn't normal, she's got a bleed". What does that mean? I am gonna die? At that moment I'm pretty sure I wasn't too disappointed with the thought of dying. He seemed calm but explained that I had to go back in and get cut open again. Not cool man!!!
At 3am on Wednesday I was back in theatre. When I came out the nurses were a little nicer this time round (but still wouldn't let me eat... 25hrs and counting...) and maybe a little too cautious. Every half hour without fail I had to get my temperature, HR and BP taken. With a resting HR of 25 and a nut case ironman athlete who willingly puts their self through pain on a regular basis they now realized I was a little different to my 87yo hospital mates. The second operation went well. By Saturday the surgeon was happy for me to leave the hospital but not quite ready to fly home. Another examination Monday and I had the all clear to fly home Tuesday afternoon. Yay, I'm going home. Maybe I was a little excited Tuesday morning cos I got thrown one more curve ball before leaving.
At 3am on Wednesday I was back in theatre. When I came out the nurses were a little nicer this time round (but still wouldn't let me eat... 25hrs and counting...) and maybe a little too cautious. Every half hour without fail I had to get my temperature, HR and BP taken. With a resting HR of 25 and a nut case ironman athlete who willingly puts their self through pain on a regular basis they now realized I was a little different to my 87yo hospital mates. The second operation went well. By Saturday the surgeon was happy for me to leave the hospital but not quite ready to fly home. Another examination Monday and I had the all clear to fly home Tuesday afternoon. Yay, I'm going home. Maybe I was a little excited Tuesday morning cos I got thrown one more curve ball before leaving.
Starting to get a little shape back I jumped out of bed, perhaps too quickly, and rushed down stairs to say goodbye to my friends' 9 year old daughter who was off to school for the day. I got three steps from the bottom when I was so dizzy that I knew I had to stop and sit down. I sat there holding on hoping I could keep it together. Next thing I found myself waking up on the ground at the bottom of the stairs in a pile of sweat. Who knows which way I fell but I felt sick when I woke up and had a sore head so I'm guessing maybe I dived down head first. Would love to see some footage of me playing rag doll 6 days after major surgery.
So after a week in hell and a couple nights home in my own bed I'm happy to say I am recovering well. I wish people would stop telling me jokes and being funny cos I swear I almost burst a stitch last night. My doctor is very happy with my progress and says that not only will this fix the problem I get on my TT bike but should also help my running as the artery must have still been kinking to some degree with hip flexion when I ran. My recovery plan from surgery date is 2 weeks till swimming, 4 weeks till stationary biking and 6 weeks till running. I'm pretty excited about my future and I'm so thankful for all the tremendous support I've had this week from sponsors, friends and family.
So after a week in hell and a couple nights home in my own bed I'm happy to say I am recovering well. I wish people would stop telling me jokes and being funny cos I swear I almost burst a stitch last night. My doctor is very happy with my progress and says that not only will this fix the problem I get on my TT bike but should also help my running as the artery must have still been kinking to some degree with hip flexion when I ran. My recovery plan from surgery date is 2 weeks till swimming, 4 weeks till stationary biking and 6 weeks till running. I'm pretty excited about my future and I'm so thankful for all the tremendous support I've had this week from sponsors, friends and family.
Kink will always be a reminder of this surgery!
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