Where to next? (Medical practitioner question)

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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue Mar 06, 2018 4:30 pm

I'd go with the conservative approach - the muscles take a long time to knit, even when a simple separation. Glad to hear the leg is appearing better!

I'm coming along "nicely", I can walk without my limp being too apparent, but can't run... even if the spine allowed it. Much work underway on core strength, but it's pretty obvious that my left side isn't working all that well, balance and ability to exercise is limited down that side. But my L/R power on the bike is O.K., it's gone from 48/52 to 47/53 and I can live with that.

RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue Mar 20, 2018 9:39 am

Still alive - the physio is happy with the progress, but I've worked out that I can compress the left S1 nerve by standing a particular way, which takes a good day to get over. One of the guys at work, who's had back issues for year, has been off work since Christmas. He's too sore to get himself into a doctor for a referral for an MRI, and his chiro told him that it was probably ligament related. Given he can't stand for long without spasms and can't sit for more than about 15 minutes, I reckon it's a bit more serious than "ligaments" - which is also what *my* chiro told me years ago was the cause of my back issues. There's a lot to be said for scans and serious physio intervention prior to niggling issues become chronic disease or medical emergencies.

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Tue Mar 20, 2018 2:39 pm

Sounds like things are moving along nicely Rhapsody. Hopefully the left S1 nerve improves over time.

I am 3 weeks after surgery now, so about half way through the 6 weeks of rest. At about 10 days after surgery I developed a tightness down the back of my leg similar but much less to what I had in the first place.... but it is more constant an not much effected by my leg position. I was told by the surgeon that I may get some nerve pain for a few weeks about a week after the surgery, so I am hoping it will go away in a week or two. Not sure what would cause that, but I assume it is something about the repair process with nerves.

Other than that, things are progressing OK. The tightness is a little annoying but not really noticeable most of the time. I am walking a fair bit now, and making efforts to do lots of walking up flights of stairs at my work to strengthen the Glutes. The surgical pain is subsiding slowly, but is still quite limiting, and it feels right to take it easy for a few weeks still. At least I can sit in a chair at my desk for a few hours now... not comfortably... but bearable.

I did a bit more research on the surgical technique for a Schwanoma. I don't know if it exactly the technique used with me. The peripheral nerve has an outer skin which contains lots of nerve fascicles. Typically a Schwanoma will develop on just one fascicle, and the surgical technique is to clear that one from the others and then snip it on each side of the Schwanoma. So they are completely severing one fascicle. I am not that aware how nerves work. I assume that fascicle is associated with certain functions that would be effected. I read that nerves can grow back at 1mm per day and I am not sure if the severed fascicle can rejoin and function again... or whether the nerve functions rewire through other paths... or you just permanently lose that function. I expect that things will improve for many months and then I will be just stuck with whatever is left. Having said that, the nerve pain now is a minor thing compared to what I had.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Wed Mar 21, 2018 11:56 am

Hi Adrian - see here. I'd be expecting nerve budding/sprouting to come to the rescue.

I'm at 3 months, I'll be surprised if I get any more functional improvement in the calf, which is still weak. But good enough for riding. It's just my back which is limiting me now. :(

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Tue Apr 10, 2018 4:50 pm

My first ride back yesterday. So far my bilateral symptoms are unchanged which was to be expected since I had surgery to one side. I am hopeful that I can start some rehab soon that may help bilateral symptoms. On the side of the surgery, the pain in my butt is much improved... I really only have the residual surgical pain on that side in the butt. Also the pain when I stretch the hamstring is much improved, but I still get a feeling of tightness down the back of the leg that is worsened with activity but there all the time. It is different to before surgery where the pain would build up until I had to move to prevent it. Now it is just like the muscles are tight. The surgeon says it is likely scar tissue around the nerve pulling on it from the surgery that will dissipate over time and helped my movement and activity. I hope he is right. At the moment my most troubling symptom is bilateral numbness/pain in the arch of my feet. As Ckinnard has said.... I think I have some sort of central stenosis that is likely causing that, but as yet not identified. I am seeing a different neurologist soon that I hope can find out what that is.

On the bike, I felt pretty good. I did quite a bit of fast walking while not on the bike, and also some short runs over the last 2 weeks. I was surprised that my fitness was not that much worse from the break. I was able to ride at a good pace and felt pretty good. Pain in the butt did not get worse. I was feeling tight down the back of that leg as explained above, but more of an inconvenience than pain. I started with about 20 minutes of cruising, but went up a hill that got the HR up, and felt fine so kept the effort up for half an hour and felt great! Rode to work today, but just slowly. Will resume normal commuting!
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queequeg
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Re: Where to next? (Medical practitioner question)

Postby queequeg » Tue Apr 10, 2018 5:58 pm

vosadrian wrote: I started with about 20 minutes of cruising, but went up a hill that got the HR up, and felt fine so kept the effort up for half an hour and felt great! Rode to work today, but just slowly. Will resume normal commuting!


Welcome back. I just started riding again last week myself. My left leg is still recovering from the DVT, with my Left External Iliac Vein still near-occlusive, but with a spider web of collateral veins developing. My left leg is visibly larger than my right leg, from about 5cm above the knee where there is a large step up. You wouldn't really think anything of it unless you saw it next to my good leg.

The main impact I have noticed is that while the right leg is cruising along, the left leg gets fatigue because the venous return is restricted. Presumably this means the de-oxygenated blood trying to get back up to my lungs and heart is pooling like a partially blocked drain. I suspect that this will reduce over time as my External Iliac vein recanalises. It's been slowly shrinking in size, so I am hopeful that my body just chips away at reabsorbing the hardened clot and eventually the vein opens up again.
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Wed Apr 11, 2018 11:25 am

All the best with your recovery Queequeg! I don't plan to hit good form at the moment if ever. Just enough to commute to work and do some fun social rides at the moment. Hopefully some miracle happens and my issues go away and then I would plan my big comeback!! :D
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue Apr 17, 2018 2:19 pm

I threw myself sideways off the TT bike at 16kph this morning when the chain skipped on the cassette. My first actual ride of the TT bike since before surgery...

Elbow, knee, sore ribs - but my back is no worse! Hence avoiding a difficult conversation with The Minister for Finance, Household matters and & Health services.

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Thu Apr 19, 2018 1:12 pm

Ouch RhapsodyX.... be careful mate! Don't set yourself back months with a fall! Maybe stick to the road bike!!
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Fri Apr 20, 2018 8:15 am

It's all good - I was back on the roadie the next day to deliver replacement first aid supplies to my coffee shop. A few sore spots, and it only hurts when I breathe deeply. My wife is non-too impressed though, and my physio reckons the ribs & shoulder area are going to be sore for a while.

And... physio has noted that my left glute is visibly smaller than the right, and it's the left side that often says "enough!" these days. Yet, left/right power balance on the bike is still pretty much the same (47/53), and on efforts it goes to 50/50. And even though I feel like my life is on hold, possibly never getting back to some semblance of what I consider "normal", he reckons I've actually made more rapid progress than he expected.

RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Mon Apr 30, 2018 10:03 am

Onto the serious exercise/core stuff now. School holidays gave me a lot more flexibility with my time, so I got out more to try things out. 250+km cycling last week, mostly without side effects. I'm very weak down the left hand side, glute exercises and side planks really show up the asymmetry - which the L/R power on the bike doesn't. I'm still not doing any serious hill work, but I am doing some VO2/MAP level efforts from time to time. Basically - all going well.

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Mon Apr 30, 2018 11:23 am

Physios etc. tell me my right leg muscles are noticeably more developed than left, but my power meter typically reads within 2% of 50:50... mostly being bang on 50:50. Also the other cycling dynamics parameters are very close left to right.

I think I am fairly quad dominant in my cycling and the muscles that are different in size are glutes/hamstrings which I do not use much in cycling. I am trying to strengthen the glutes at the moment, but I think for me it is more than strengthening. I have to teach myself to activate them for normal activities as I think I largely have learned to use other muscles instead.... in fact I think that could be a large part of the cause of my issues.

I am currently seeing a Chiro (that works more like a Physio) that does Active Release Technique... That is why I wanted to see him as that technique has a lot of success in lengthening hamstrings. But so far we have only been doing release and strengthening work to address a twisted pelvis. I don't feel I am making any ground, but only 2 weeks so far. I feel once again like I am doing the same things that have been unsuccessful in the past. Would really like to find someone with a proven track record in fixing pelvic muscle issues, but not having any luck. My hamstrings are ridiculously tight, and I am not sure if that is a cause of my pelvis issues or the other way around. I initially went to this chiro to address the hamstrings to find out, but it has not gone the way I thought it would.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue May 29, 2018 1:41 pm

Still not dead. I'm pretty functional these days, unless I (1) over-do it or (2) make the mistake of trying to rotate the spine. I'm back at about 80% fitness (FTP 310 down from 370W)... and I've decided to be happy with that. I try and get two short HIIT sessions (seated repeats at > MAP) and two LT1 longer rides a week, along with as many pool sessions as I can squeeze in and daily core work. Still no TT bike as yet, I just can't get my head around riding in that position (fear factor).

It's pretty good as long as I'm not stupid, but it only takes a bit of sitting the wrong way or a bit of rotation before I end up with numbness/tingles in left leg or both legs. The core work has really shown up the weakness on the left, even if the L/R power doesn't. But I can see the (smaller) light at the end of the tunnel now.

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foo on patrol
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Re: Where to next? (Medical practitioner question)

Postby foo on patrol » Sat Jun 02, 2018 8:30 am

8)

Foo
I don't suffer fools easily and so long as you have done your best,you should have no regrets.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Mon Jul 09, 2018 1:03 pm

Still alive, but some of the muscles in the calf don't fire properly so my left foot rotates outwards if I try and engage the calf muscle when climbing. Float has been locked out, so now I have to re-strengthen the VMO because I've allowed it to de-train. And the left side lower back is still weak - it's a lot closer to the right side than it was, but on the left I can only to a plank to the knees as going to the feet causes instant pain (and not down the leg).

And the left side nerve is still trapped, despite surgery - I still fail the "slump test". But it's only triggered if I rotate at the lower back when I've been over-doing it. And apart from numb toes on the right foot, no real sign of the bone spur.

I highly recommend daily core strength activities. Stuart McGill is my go-to.

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