When legs simply do not show up 10 – “The External Iliac Artery Endofibrosis Fix 3”

The last time I documented my road towards fixing my blood flow issues was in June 2018 and the post was titled “When legs simply do not show up 9 – “The Fix 2””. At the time I had only done one procedure on my right side and I presented a diagram of what my scars look like.

And so what has happened since? A lot! I now have almost identical scars on the left hand side and the “artwork” is now complete; the sides are now almost mirror images.

On the 31^st of July 2018, six weeks after the first procedure, I was back on the operating table to get my left side fixed. It was supposed to be an easier operation, except I had two very unfortunate challenges that sort of shook me. First up, the day after the operation, my body was unable to build up my haemoglobin to normal levels – and so I battled with extreme lack of energy, so bad I could not even raise a finger. And because I did not know what was wrong, I thought I was going to die. I drifted in and out of sleep and when awake, I could hear what was going on around me but I could not talk. It was a very difficult few hours. I was given a huge iron dose through the drip but I was responding so slow to it that eventually decisions had to be made about getting a blood transfusion. After hours waiting for my blood and tissue match, and 3 pints of blood later, my energy levels were restored and I was allowed to go home the next day.

Then a few days after I was discharged I was attacked by flu!! I endured two successive days and nights of no sleep but it was when I started getting fever that I felt I needed to see my surgeon. I was hugely concerned that I might have post-operative pneumonia or some other related condition but mostly I needed more pain medication. The coughing and the sneezing came with such excruciating pain I was nearly passing out every time that happened. I spent most of the day in hospital doing x-rays, waiting for test result and working with the physiotherapist to help me dislodge the phlegm that was causing the cough. And eventually when the fever subsided, I was allowed to go home (same day) but with stronger pain medication to help me wither the flu storm.

I had a strong suspicion that these two incidents had a lot to do with the state of my physiology at the time of the operation. I was going through a particularly challenging time at work in the run-up to the operation – long hours, fire-fighting – and some team issues in the mix too. And so, after my operation, I was forced to also think about being realistic in terms of how long I can sustain that level of physical and mental demand from my job without impacting my health in the long run.

That aside, on the 17^th of August 2018, I started my training in earnest – anticipating a slow return to the performance levels I have last seen in 2014 - and that day I completed a distance of 1.5 km on the treadmill in 30 minutes, with a bit of a limp and a great feeling of achievement!!

Mountain Biking the Swiss Alps - The Trails

With MTBVerbier taking care of logistics, what was left was mountain biking and more mountain biking, on one of the most beautiful trails I have ever been fortunate to ride on!

The first day we started with a short 6km warm-up route to the lifts in Le Chable that took us from about 200m to about 830m where we caught our first glimpse of the magnificent mountain range. Verbier is a ski-resort and that means it is equipped with ski lifts that take skiers to the top of the mountain in winter. The lifts are designed to carry skis on the side and it so happens, mountain bikes must also fit the same hooks. But as a non-skier, it took me a bit of time to get the hang of how to quickly hook the bike and enter the lift safely! A few lifts we used throughout the three days were big enough to accommodate us and our bikes.

My bike fitting comfortably next to the door of the lift

The first 5km of the trail was flat and this was an opportunity to have a proper view on the mountain before getting into single tracks. This was followed by a fairly long downhill past the La Tzoumas (another ski resort) and lunch before hitting the only serious climb of the day, a long 5km climb on gravel, averaging 7% gradient over the distance. The trail took us into and out of villages where we were able to sit down for refreshments, and in total, it was a 60km ride that took us 7 hours (moving time 4 hours) to complete. It was really fantastic riding and breadth-taking views – sheer mountain biking pleasure.

Going up the lifts from Le Chable

Day 2 was just as fantastic, with great single tracks and wonderful views from the top. On the ride towards Siviez we came across a calm herd of cattle that seem to not mind our presence, some donning their signature Swiss bells, and so we had great fun riding amongst them. The highlight of the day, which easily I could call the highlight of the 3-day trip, was the Descente Col Des Gentianes (on Tour De Mont Fort) along what looked like a glacier. The views were absolutely amazing but the downhill was long and exhilarating. The downhill ended on the most amazing single tracks amongst really beautiful vegetation – all shades of green with blooming flowers of different colours. The distance covered on this day was 55km and similar to the day before, it took most of the day (about 7 hours) including all the pit stops and rides in the lifts.

We started Day 3 at Lac du Champex, about 30 min drive from the guesthouse, and as expected, there were great views and the rides through the villages were interesting. This ride had a fairly steep 1.5km climb which, thankfully, ended at a beautiful restaurant up the woods and this meant a well-deserved rest at the perfect time. This is the day we spent a lot of time riding on forest single tracks and this type of terrain is one of my favourite.

Riding the Swiss Alps is an experience that mountain bikers should really consider. If you have time, a self-guided trip is possible and I have come across a few sites that offer the basic information that you may need. I found that riding with a knowledgeable guide contributed significantly to the great experience and beautiful memories. I joined three other riders on the trip and to this day I still have contact with them and will hopefully ride with them again at some point in the future.

Mountain Biking the Swiss Alps -Logistics

I like mountain sports and I will take as many opportunities as I can to experience a mountain by either running, hiking (climbing) or riding it. Mountain biking tends to be my default, if terrain allows, because I find that opportunities to run and hike are many more. Mountain biking, however, takes a lot more effort to plan. It is not only a matter of carrying the bike but in most cases you need to carry spare parts, tools, consumables such as lubricant and bike-specific clothing including the cycling pants, helmet, glasses and gloves. Then considering items such as action cameras or other specialized photographic equipment together with their batteries, the planning gets that much more complex.

At the airport - luggage for the week looking like I am emigrating

If the plan is to bike outside of your region or outside of your country, the planning must be much more elaborate. For example, taking a bike on a flight might ultimately influence your choice of airline(s) depending on how sports equipment is treated or whether they charge for it or not. You can easily pay 120 USD per leg for the bike (as an extra bag) and so it is worthwhile doing some homework before you even book your flights.

When I decided to visit my friend in Zurich, Switzerland in 2015, I wanted to spend a few days on the Swiss Alps  and after carefully considering all factors relevant to me, I settled on mountain biking.  If I was fortunate enough to have no limit on time and on luggage, I would have added an extra bag for gear and equipment to climb the Mont Blanc!

There is a variety of bike carriers in the market to transport a bike, but my trusted Evoc bag has never disappointed me. Depending on the weight of the bike, it is unlikely that you can fit anything more than a bike helmet and a few tools into the bike bag itself.  

Flying from Johannesburg to Zurich via London was fairly uneventful - the only discomfort is the size of the bike bag (had to be removed from the trolley occasionally as most escalators are narrower) and as “special luggage” it needs to be collected from special collection points at just about every airport I have been to.

I spent a few days with my friend before taking a train to Verbier, near Le Chable in the Alps. It was a very scenic and comfortable 180km ride (and a bit expensive, I must add) that took close to 4 hours from Zurich on Swissrail. The train ride from Geneva airport is much shorter, so anyone going directly to the Alps will find flying to Geneva the best option.

Because I had limited time to spend on the Alps, I eventually decided to use a mountain biking specialist in the region called MTbverbier (http://www.mtbverbier.com/) and this turned out to be a really good decision. Although I had already worked out my own plan to ride the alps (thanks to a few good websites that showcase the MTB route network across the whole of Switzerland), I soon found out that it would have been harder for me navigate on my own. The service at MTBVerbier was amazing and their knowledge of the mountain biking trails is extensive. They tend to take small groups and have their own comfortable guest house (complete with a bike workshop) where they serve all the meals. This ensures maximum time on the bike and therefore maximum fun on the trails!

View from the balcony of the MTBVerbier gueshouse

Great Service - All catering included

When legs simply do not show up 9 – “The Fix 2”

Considering my physiology, the extent of the endofibrosis and the need to use my own vein as patch, my highly skilled surgeon worked out in detail how he will conduct the procedure to maximize our chances of a successful operation.

My lay understanding of the process was this:

• Open the top of the upper limb and remove a spare vein that will be used as patch
• Make an incision and cut through my abdominal muscles to access the inguinal ligament to release it (I have blogged about studies showing a tight inguinal ligament is often cited as a possible the culprit)
• Open the groin area to access the external iliac artery, cut it open and conduct an endarterectomy (i.e. remove the endofibrosis from the lining of the artery)
• Close the artery by patching it with the vein that was harvested from my upper limb
• Close up and staple the skin together

Evidence?

Two gashes on the right side of my body making up 77 stitches overall as shown below.  This was obviously a major operation that requires time to recover - the best I can do is take it day by day.

"The evidence"

When legs simply do not show up 8 - The Fix

I found the pre-operation procedure at hospital to be rather hectic. Once you are allocated a bed, you get surrounded by a whole host of healthcare professionals who ask you questions on your previous medical history, do final physical checks, draw blood, attach drips and also make you sign consent forms! I did not mind the buzz, it sort of got me too busy to think about what was ahead of me, and what felt like no time at all, I was given a magic pill to put me to sleep so I can be wheeled off to theatre.

Just checked in - anxiously waiting for the signal to get ready

The next I knew I was woken up and there was this massive pain on my stomach…. As if I my entire torso was on fire and the area felt so tight that I could not even talk.  Then my doctor checked whether I could hear him and then gave me the summary – the four-hour operation went very well, the vein that was removed from my leg to patch the artery was competent enough and was able to cover the wide area. He was very happy. There was no need to kick the Plan B that would have meant the use of artificial material – that made me very happy too.

But the pain was unbearable, at least for a few while - and then got better. The first night I did not sleep much – I kept on asking for more pain medication and I was getting only marginal relief. Because of this, I had to literally keep still but every time I dozed off, I was startled by the massive pain, because I kept on trying to change my position in my sleep. On Day 2, I was not psychologically ready to try and get out of bed – I was still traumatized from the pain but by mid-day it was under control. The odd thing is around the same time at midday I started to develop some “airlock” in my gastric system that was causing so much discomfort that I could not eat. It got worse overnight and so for the second night in a row I could not sleep because this airlock was causing extreme discomfort.

On the morning of Day 3, still heavily medicated, on liquid diet in high care, my physiotherapist came to help me get out of bed to do a few steps. I have heard a few people talk about how painful this process is but still I was not prepared for what I went through. She assured me the same afternoon we will try again and it will be better – and I thought those were only kind words of encouragement, nothing more. She could sense the horror and mostly the despair in my voice at the first attempt. That same afternoon she came and I was amazed by the great improvement and so literally 24 hours later, with more baby steps and effort, I was able to get on and off the bed on my own and was able to walk to the hospital coffee shop!

First steps after operation

I am walking very slowly with a severe limp – still on pain medication and still connected to machines that monitor me closely, but I think the worst is over, at least for this time around. My focus right now is on healing the right side and making sure that I am physically and mentally prepared for the next procedure.