Tuesday, April 23, 2013

4/23/13 Compartment Surgery Plans

The full name is Chronic Exertional Compartment Syndrome, or CECS.

The more typical shorthand is Compartment Syndrome.

And it requires surgery. Well, not necessarily. The choices are surgery, or stop running. So, for Nick, it requires surgery.

If the plans hold up, he'll be sliced on Tuesday, May 14.

Symptoms of CECS
There are classically 6 "Ps" associated with compartment syndrome and here's the first one:

Pain is often reported early and almost universally. The description is usually of exquisite, deep, constant, and poorly localized pain out of proportion with the findings on physical examination . . . and is not relieved by analgesia up to and including morphine.

In other words, it freakin' hurts.

The others are:

Paresthesia: pins and needles, in addition to the deep pain

Pallor: not sure how they could tell under all his hair, but no blood flow = gray skin

Paralysis: total numbness makes it a little hard to run, no?

Pulselessness: They couldn't find a pulse in Nick's foot, so an artery is involved

Pressure: tense and close to exploding, this is what they test by inserting a giant needle into each compartment to test the resting pressure (which was way high) and the pressure after exertion (even higher). It also only took 6 minutes of running to get his feet numb, which was very, very fast.

They ran out of numbing lidocaine doing all the pressure tests and the last compartment was done without any anesthesia. Ouch.

Then they decided, because of the worry over the lack of pulse/artery issue, they needed him to go for several other tests, including an MRI and an ultrasound to rule out anything vascular apart from CECS.

It appears all those tests are coming back clean and we're on for surgery as soon as Nick gets home for the summer. He's in line with an orthopaedic surgeon who specialized in athletes and we're hopeful Nick is going to set the world's record of fastest recovery. Normal recovery is set at 12 weeks. And Nick needs to be back to 100% by the middle of August. No pressure (that was a CECS joke...)


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