Tuesday, March 4, 2014

Diagnosing my running medical mystery: external iliac artery compression

For most of the past year (post-Boston Marathon) I have struggled with an unusual running problem characterized by a painful congested, burning, fatigued feeling of the left quad, numbness of the left toes, and more recently some discoloration of the toes. It is triggered by running up hills or running fast. There are times it stops me in my tracks and after a brief rest, it resets and I can run a bit more. I have finished many runs in tears from the mental warfare of my leg screaming to stop and my brain saying to keep going.

I have managed it all year by basically running flat, not too far, and not too fast. I've been on the treadmill a lot. On the bike I have some symptoms - numbness and some fatigue, but it's more of an annoyance there than anything.

I've tried therapeutic routes and a six-week cessation of running. I have bad weeks of running and less bad weeks of running (none good), but nothing has helped. It was my friend Lora who pointed me to this article about pro Triathlete Kelly Williamson's problem with her external iliac artery and while reading her description I remember thinking "this is exactly how I feel".

Soon after, I attended the New River Valley Bicycle Club Association party in January where I spoke with the area cardiologist (and cyclist) Jose Rivero who insisted I see vascular surgeon Dr. Jesse Davidson (also a cyclist) in Roanoke. I had an appointment with him for the end of January where he suggested my symptoms were consistent with an external iliac artery problem and we arranged a follow-up for diagnostics. In the meantime I of course googled "runner illiac artery" and found this article that was another case of "OMG this is me exactly!"

On Friday, February 28 I spent a couple of hours at the Jefferson Vascular Clinic. It was an hour of pressure testing (four cuffs per leg, one on each arm) and some kind of recording of my pulses at various places on my legs (Doppler maybe?), and the ultrasound of the artery from mid abdomen and down to both hips.

I had said I could fire up the problem with a 20 minute run, when in reality, on the little hill I used, it could have been 5 minutes. I was suffering almost immediately as I invited the very pain I had spent ten months working to avoid. It was the longest, hardest 20 minute run I have ever had to do.

I finished the run at the employee entrance where the vascular tech met me and took me swiftly back to the room for another 30 or so minutes of pressures, pulses, and ultrasounds. She went around and around from one ankle to the next, back to my arm, back around again, recording the changes in pressure and pulse over time. Difference were noted between the two legs. The reaction of the artery post-exercise was described by the technician as a "spasm then clamping down." I was taken to see Dr. Davidson almost immediately after and he personally called the radiology lab to arrange an arteriogram for me on Monday (yesterday). Blood work, scheduling...it all happened so fast.

So yesterday, despite the threat of snow and a possible closing of the clinic, the diagnostic arteriogram went on as scheduled. After getting prepped and valium-ed, Dr. Brozyna put a catheter in my right hip and injected dye, I would hold my breath, they would xray, and this was repeated over and over. You get this strange warming sensation (like being microwaved) from the dye. I wish I had pictures from that room, or of my images, but I don't :(

 Samantha, Niki, and Robin

Then it was off to recovery to lie flat for two hours watching some horrible TV channel with ads and programs about food (I hadn't eaten since the night before). I was finally allowed to sit up and eat. The radiologist said he had identified the area of elongation and narrowing. For a normal (read: non-running, non-exercising) person, it would not cause a problem. He suggested that the position of cycling has brought it on, even though it manifests more on the run. And if you look up "cyclists" and "external iliac artery" you will see that some elite level cyclists have been affected by this, and have bounced back following surgical correction.

So I have the diagnostic clues, but it's not fixed yet. Next I will meet back with the vascular surgeon, Dr. Davidson (he's gone this week) and see what he suggests for a course of action. One thing is for sure. If it can be fixed, I want the fix. I limped along all last year making the most of what I had, but running has not been fun for a long time.

Right now it's no training for a couple of days (and no shower until tomorrow, ugh), no pool swims for five, but then I'll get back to it. I'm not paying to register for any races at the moment, knowing I may end up facing a significant interruption of the season. If it brings relief, I am at peace with that. As I say, I am in this for the long haul.

Even if nothing could be fixed, even if this is just how it is to be for me, I remain grateful for all that I can do. This is just a bump in the road, and what did I quote in the last blog post? "The obstacle is the path." This is part of my path.

Thank you to all who have supported me along this bumpy path including Coach Jim, my family, and Bryan (who is an excellent trouble-shooter of all things).