This whole vascular surgery journey has taught me a heck of a lot about the vascular system that I simply didn’t know before. Having all my previous surgical experience firmly planted in orthopaedics, this has been a roller coaster ride of learning and discovery.
It has now been 3 weeks since my last surgery, and time for a scan and an update on how the graft is doing.
Originally, before all the melodramas, I had planned to be off work for around a month. I think I had highly inflated and unrealistic expectations, which I am only coming to realise now, as I come crashing back to earth with a bang.
How is the graft performing?
Asn ultrasound scan of the graft was first. This was to check the entire length of the graft, both inflow and outflow and make sure that there are no narrowings or blockages.
As I explained in a previous blog, this graft is a very long graft, much longer than they wanted to do, or usually have to do: there was too much damage to the blood vessels in the lower leg, so this was the only option. First they checked the volume of the blood flow using a doppler and pressure cuff. The left lower leg has 50% of the flow it should have, compared to the right lower leg. However, the first scan that was done (when the blockage was originally discovered) measured 30% flow. Just a few weeks later when I had my surgeon’s pre op appointment, the flow was 0%. That is how much difference a couple of weeks can make when a bunch of medical staff in ED completely miss what were blindingly obvious symptoms of ischemia (insufficient blood flow to the leg at rest). So, 50% was considered to be a good result. The fact that there is no foot pain shows that there is sufficient blood flow for now.
Next they scanned he entire length of the graft to make sure it was all performing as it should. Yes, it all looked good. But, you know how my body likes to be a little bit unusual…. well, yep, here we go again.
Just below the bottom end of the graft (at the ankle) there is a very small artery – which is now blocked. But, the cleverness that is the venous system has already created a work around, so the surgeon is going to leave the blockage for now, it is not encroaching on the graft and the blood is still getting to the foot, through a system that is called collateral flow.
What are collaterals?
Collateral vessels can play a significant role in supplying oxygen, particularly when oxygen delivery is limited. Collateral vessels can be pre-existing vessels (usually small arteries and arterioles) that normally have little or no blood flow. Chronic ischemia (lack of blood flow to the limb at rest) can cause new blood microcirculatory vessels to form. These collateral vessels can help to maintain normal blood flow in the foot. It is all really clever stuff!
What next?
Since there is enough blood flow to the foot, the graft is still performing well and I have no nerve pain, we leave it all as it is.
But… because there is reduced blood flow to the lower leg, I am still getting hypoxia in the calf when I walk (pain caused by insufficient oxygen to the muscle). The only way to fix this is determination, persistence and calculated gradual increase in exercise. This will hopefully increase the collaterals, and therefore increase and improve blood flow and oxygen delivery to the lower leg.
Is amputation still a real threat?
Due to the fact that there is enough blood flow to the foot to stop the nerve pain for now, no, amputation is not an option that we would consider at the moment. The determining factors to revisit this as a solution would be constant foot pain returning, or insufficient function being restored. The latter of these would not bring this option onto the table for a number of months yet. there is a lot that I still have to try first.
What is the recovery time frame?
Here’s the part I hate. I have been told that recovery will be very slow, very long, and at times very tough to deal with. New blood vessels do not form overnight, it is a long slow process that will take time. It cannot be sped up.
I must work on my rehab for AT LEAST 6 months, before I can even start to reflect on whether I am seeing enough progress. The surgeon said she really wouldn’t entertain another conversation about this till preferably 12 months from now. Only then will I Truly be able to reflect and see whether I have got enough function back in the leg to walk and ride my bike like I want to.
12 months. That feels like ten lifetimes away.
When can I return to work?
The incision on my left lower leg is still not healed. It is leaking lymphatic fluid. Apparently this is normal because this type of surgery usually causes extensive damage to the lymphatic system, a very delicate fine filtration system that lies close to the skin’s surface. While this is still happening I have to be careful of how much time I spend on my feet, elevate the leg as much as I can when I am sitting and of course, until it is healed, swimming is out of the question.
Only after that is healed properly (possibly another 2-3 weeks at least) can I even entertain a gradual phased return to personal training. Massage could take a whole lot longer. I need to be able to spend time stood up without pain and swelling before I can even try this.
But, the fact of the matter is, I need to work on my own mental health before I can even consider returning to take client bookings. I have been through so much lately, I feel like I need some time to work on rehab, get a plan together and start to see improvements so that I am a happier person myself first. I think being able to swim will be a huge milestone in my own personal recovery.
At times like this, you need to put YOURSELF first. Unless I am looking after my own wellbeing, how can I possible look after other people’s?
Reflection
This journey has been the single most challenging thing I have ever had to do. I still feel heart broken when I look at my many – and very raw battle scars. This all happened so fast I did not even get chance to mentally prepare before I was in the middle of multiple emergency surgeries and talking about the threat of amputation. Just 3 months ago I couldn’t even dream of being in this position right now, with such a tough (and long) battle still ahead of me.
I feel like it isn’t fair. What did I do to deserve this? Where the heck am I going to get the strength (and patience) that I will need to fight this continuing battle?
That remains to be seen I guess.
Meanwhile, poetry is becoming my mental therapy. ❤
Melanie Magowan 