… plus a bit on external iliac artery compression.

 Today I did my first training session since my BIG operation … I managed to walk 500m (2 x rest stops) and it was so exciting to be outside again in the sun, “moving”, and at the beach. 

I’m recovering from my operation at Collaroy, one of the northern beaches of Sydney, Australia.  This beach is where I grew up, where my parents still live, where I learnt to swim, where I spent pretty much every holiday in summer, most of winter and even some school days when I should have been in class :)

 I got released from hospital 3 days ago, luckily for me the surgeon most experienced with this surgery in Australia is based in Sydney and the hospital was only a 30min drive from mum and dad’s place.

So what did I have done?

 I had an 11cm (4 1/2 inch) synthetic patch put on my external iliac artery (EIA) to stop it from “kinking” (bending), developing further scar tissue and blocking the blood supply to my left leg.

 Background on external iliac artery compression

 Anatomy

From the heart the monster aorta artery runs south, branching into the common iliac artery and then the external and internal iliac arteries in the lower abdomen.  The EIA runs to the groin, where it again branches, into the femoral artery amongst others.

Who gets EIA compression?

EIA compression, across the population, is a relatively rare condition.  However, it is most common in elite cyclists basically due to the way cyclists have an extreme bend at the waist while cycling.  With the hip flexed countless thousands of times the artery kinks, then builds up a type of callous as the body’s response to the kinking.  The callous can further impede blood flow to the leg.

 Compression can also happen when the hip flexor muscle becomes enlarged (iliopsoas muscle hypertrophy) due to all the training we do.  The EIA runs over this muscle so contraction of the muscle gives less space for the artery, leading to reduced blood flow to the leg – hence, compression can also occur while running.

 As is the case with the human condition, there can be many variations on the theme, and in my case I had a big variation.  My Professor/doctor/surgeon had never seen it before but my artery “complex” had shifted south into my pelvis, the key artery was narrow in diameter, and my hip flexor muscle was enlarged.  It only took a small movement of my leg to send my EIA into a non-functional spasm, which vascular specialists happen to call an arterial “thrill”.

Basically my EIA kinked easily, blocking off blood supply to my leg.  In my case there was only a little bit of callous, but the kinking caused me considerable grief in training for many months.

So of course Stuey’s latest comments are I’m kinky, and always causing a thrill – funny boy he is.

 My symptoms to get to this point 

Pain, numbness, tightness and weakness/lack of power in my leg, especially in higher intensity training, speedwork, and of course when racing.  Never in the same area, always shifting.  Worse when increasing speed and going uphill.

 It was a long time ‘till diagnosis (and commonly is mistaken for something else).  For me I could still train’ till a certain point (never totally symptom-free) but whenever the “crunch” time of the program came ie the last 5 weeks before an Ironman build – everything would go pear-shaped.  In my case the problem was repeatedly, and incorrectly, diagnosed as neural/musculoskeletal problems.

 I think I have prepared for 5 Ironmans over the last 18 months and only got to the start (and finish) line of one.  Although it has put a huge ???? for my year in 2010, I am so glad/relieved it has finally been diagnosed and treated.  Although still a significant amount of rehab awaits.

Some key points to note

10 zillion hours of core stability for 18months DOES NOT fix your “muscular”/”neural” problem.

10 zillion hours of stretching for 18months DOES NOT rid your symptoms.

Aggressive trigger point therapy into your psoas muscle daily by either you or your husband (under detailed physio direction he says) only relieves symptoms temporarily.

 All the passion in the world and dedication to succeed in the sport of triathlon plus love of training DOES NOT make the problem go away.

 And the big clincher, when you consider yourself a hill specialist, is when your “mature” husband puts 100m into you in 3 secs going up a small incline on the bike and you are trying your hardest to push the pedals but your leg feels like it’s going to explode with lactic acid, something is WRONG. (love ya Stuey).

The surgery itself

OUCH, more OUCH and bigger OUCH.  They cut through your abdo muscles, this is why the first 4 days post op are VERY VERY uncomfortable.  I have become a little bit more skilled every day in sitting and shuffling/walking.  I would have to say though that after this surgery you are quite dependant.

Hopefully all those zillion hrs of core stability will pay off down the road.

Happy training/racing everyone.

 We fly back to Darwin next Tuesday, warmth = good rehab.

Ali

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I took the opportunity last Friday to put some adventure into my training with a little running race.

 The Mount Kosciuszko run marked the 170th anniversary of when the Polish dude, Strzelecki, named our highest mountain here in Australia, Mount Kosciuszko (or “Mount Kozzi” for us Aussies).  It was an 11km  run from Charlotte Pass Chalet ( another ski village about a 50min drive from where we are living here in Thredbo) to the top, at 2228m. Fun fun. (Stu wants me to change these amounts to miles and feet but I think you guys should work it out :))  [ed - 11km=6.8miles; 2228m=7,310ft]

Since training  has consisted of LOTS of rehab exercises lately and a VERY gradual return to increasing the km’s, after being knocked about by a couple of back to back viruses, Stuey and I thought this would cheer up my training routine. Why not hey,  the weather has been sunny, warm and hardly any breeze…..till race day!

We  woke to cold, gale force winds and grey clouds- boo!  I was wanting to show off my new Timex gear, but seeing that was going to be no where near enough clothing I had to layer up underneath with thermals and the like.  Gloves, beanie and wind jacket also in-situ.  I don’t like cold much.

We arrived to race start with a Polish TV crew running around wanting interviews,” yay … I’m gonna be on Polish TV”, and then the introduction of two competitors who had won a swag of Olympic gold medals in walking that were also running.  Wow, a big event, ha ha, a mass total of about 25 competitors- shhhhh.

Stuey headed off on mountain bike to the top of Kozzi to cheer me on and have MORE clothes for me when I finished.  Well nearly to the top, bikers have to park their bikes and walk the last 2km to the top.  I did my best before race start to stay warm and get limber…bit hard when a freezing 60km/hr (37mph) wind is whipping past.

So, the race, well if you could call it that.  I found at this altitude, on gravel and up hill continuously with the first and last 2km’s extremely steep and with a gale in my face, I could only go SLOW . It was such a weird feeling to be at normal Ironman pace HR but a speed 1-2mins/km slower.  It was like watching life in slow motion.

One section,on pretty choppy gravel with a howling headwind, I swear I was running up and down on the spot. Oh how much I wanted to walk but my one goal was not to, even if it could have been faster :)

I actually felt better as the race went on, got into a SLOW, steady pace and enjoyed passing all the tourists that were walking the mountain- I was pretending they were my competitors.  I even had an inner chuckle, laughing outwardly used way too much oxygen, when a couple of school kids decided to race me for 100m or so, off they flew, only to end up bent over huffing and puffing as I ran back past them. Little smart ass teenage boys.

It was really satisfying to round the last steep bend to the top, it was actually quite hard going, and I must admit to feeling a bit nauseous.  Stuey was there to greet me, clothe me and give me a big congratulatory hug for 2nd place female, yay.  By the way the sun came out and it wasnt too cold during the race, but my layers served me well, as did my Timex Global Trainer –  its debut race (not sure if I’ll save that average speed though!)

The Polish were singing their National anthem at the top, waving the Aussie and Polish flags and generally enjoying the moment.  What a great little event.  But, it wasnt over yet…..we  had to get back down. Thanks to Stuey and his mountain bike efforts I got to free wheel back to the start  as he had his downhill running exercise for the day (I made him go fast too :)).

So I received  an unexpected lovely commemorative medal from the Polish Consul General (in a suit!!), a big block of Toblerone (yummy swiss chocci) and some pocket money for my efforts.  Gotta love a Kozzi mountain run; hope its on next year!

       

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