Friday, 31 October 2014

Not quite the end of season holiday we're used to: Surgery for iliac endofibrosis

A little over 3 weeks ago I had surgery to treat a condition called iliac endofibrosis. It's a condition that affects amateur as well as professional cyclists. In simple terms and as I understand it, repetitive hip flexion combined with high pressure blood flow causes the lining of the arterial wall to thicken, this in turn limits blood flow to the leg(s). In my case only the left iliac artery (located in the lower abdomen) was affected, but some people have the condition in both the left and the right arteries.

My symptoms started 3 years ago when I noticed that my left leg simply fatigued more quickly than my right, specifically I noticed the muscles in the left thigh (particularly the vastus medialis) felt empty with a 'lactic type acid' sensation. December last year the symptoms had become difficult to ignore; the whole of my thigh became heavy and painful during/after intervals and if I continued then the leg would lose all power and collapse underneath me. Dave had heard about the condition and he was pretty sure that's what I had. Throughout the year the condition deteriorated. It was highly disruptive from a training perspective - I often had to quit interval sessions - and during racing I would often have to back off several minutes after the start or if I rode near or above threshold. It was incredibly frustrating to be riding at an intensity lower than I wanted and mentally it was very difficult not to be able to complete training sessions.

We decided to wait until the end of the 2014 race season before we got it investigated because, although the problem was getting noticeably worse, I was still able to race and win. On September 21st I won the La Forestiere UCI Marathon. Three days later Mr Robert Hinchliffe at St George's Vascular Institute diagnosed iliac endofibrosis using blood pressure testing in my ankle before and after cycling. I cycled for 6 minutes in total, with only 2 minutes above threshold. There was a 50% drop in the blood pressure index at my left ankle compared to a small increase in that of my right ankle. Duplex ultrasound scanning showed thickening and angulation of the iliac artery. This was pretty conclusive so an angiogram was performed to look closely at my arteries.

Last race in 2014: first place at La Forestiere UCI Marathon
With a positive diagnosis it was time for us to think very carefully about my options. We reasoned that I had three options: do nothing and carry on cycling; stop cycling; have surgery. The first option wasn't dealing with the issue and we were aware that the condition can deteriorate, ultimately causing the artery to become completely blocked leading to emergency surgery to save life and limb. This left me with two choices: stop cycling or have surgery. Neither was particularly appealing but stopping cycling simply wasn't something I was prepared to do. Riding with - and almost being dropped by - my 65 year old father after the diagnosis made me certain that I had to have the operation; after pro-cycling I want to enjoy my bike for many years to come.

Waiting to go to theatre was the worse part of the whole experience!
The thought of surgery quite frankly terrified me and the days before my operation on October 6th were  spent anxiously preparing. It's so hard to find night dresses these days, well at least ones that didn't make me look like Little Red Riding Hood's Grandma! Mr Hinchliffe explained the procedure to me: I would have a 4-5inch incision in my abdomen to access and repair the artery. During the operation it was discovered that the area of damage was greater than first expected and another incision was made in my groin to extend the repair to the femoral artery. The damaged area was removed and the artery was patched. The porters wheeled me to theatre at 1pm and returned me to the ward at almost 9pm. The operation I believe took around 4 hours with the rest of the time spent in recovery. I remember very little until the next morning.

Post-op recovery: if only I could stay awake to watch The Great British Bake Off!
Room with a view, just a shame I couldn't see the Helipad

There was no pain; I had a morphine drip with a push button control. The nurses got me out of bed and in a chair the next day, which I spent dozing. The drain in my leg and the catheter were removed. Progress became about 'first's': first time I could go to the toilet, first time I could have a shower, first time I walked and tried a few stairs (30 hours after surgery), first time I went to the hospital's M&S cafe ;)

As a coffee lover it was great when my appetite for it returned after 4 days! 

Dave was amazing. Each morning I looked forward to him arriving at 8am, he stayed with me and helped the nurses until 8pm. The nurses and staff were so nice and made my time there more pleasant. After 5 days in hospital I was discharged.

Recovery and rehabilitation blog to follow…now it's time for my daily walk :)  

First long walk (5 miles) around Virgina Waters with a borrowed dog  (15 days post-op)

Two factors have been incredibly helpful throughout this whole process: being able to talk to other cyclists who've already had the operation - thank you for replying to my never ending barrage of questions! - and the availability, time and input from my surgeon and consultant Mr Hinchliffe, thank you a million times over.