freak of nature OR how I got into road biking
Remember in elementary school when you occasionally had to get checked for scoliosis? I was always the kid that had to go back for a second check-up with the school nurse. Finally in junior high, the scoliois-powers-that-be decided I needed to go to an orthopaedic specialist. And so began my life as an orthopaedic freak of nature.
I always assumed the Lee-jean-makers just couldn't make the legs of jeans exactly the same length...my friends with Guess jeans didn't seem to have that problem. The orthopaedic specialist at the Mayo Clinic shed some light on this jean phenomenon - he determined that my "scoliosis" was induced by a leg length discrepany (LLD). At the time, my LLD was about 1/2 an inch (1.25 cm/12.5 mm). The doctor apparently decided that this wasn't that big of a deal (a decision that would later really piss me off), and that I should just do some back strengthening exercises since I'd likely have back problems. I'm sure I did those exercises about two times...I was about 13 yrs old, I'm fairly certain I had other things on my mind.
I continued to grow, and my LLD became more noticeable, although only to the trained eye. My favorite shorts were "cut-offs"...I could cut one leg longer than the other so they'd look even when I wore them, and it was always funny when my college roommate borrowed them.
By the time I moved back to the Twin Cities after graduate school (when I was about 25), I had started having hip and back problems, and they only seemed to be getting worse as I was becoming more active. I'd end up limping after walking for an hour or two at a time, and running felt ackward and sometimes painful. Oddly enough, I was mountain biking a bit at the time, and I knew I pointed my toes on one foot when I pedaled (to reach with the "short" leg), and I pedaled pidgeon toe-ed on the other side (the "long" leg) and would often hit my knee on my top tube - but generally speaking, it didn't really bother me while biking.
I finally decided to go back to a doctor and have my LLD checked out again. The doctor determined my LLD was now somewhere around 3 cm (that's over an inch for you people who don't like the metric system...2.54 cm = 1 inch). For those of you non-cyclist types reading this, a cyclist can often have pedaling issues (sometimes even injuries) from a 3 mm discrepancy...mine was 30+ mm. The doctor recommended trying a lift on my shoe, and mentioned that there was a surgery for "leg lengthening". Huh? How do you stretch a leg? Or do you shorten the other? Creepy. I tried the lift. It turns out that only really "non-fashionable" orthopaedic shoes can even have lifts put on them - they pretty much have to have laces, mostly because the lift adds so much weight to your shoe that your heel pops right out if you don't have them laced-up tightly. I quickly decided that (a) I had way too many pairs of shoes (including athletic shoes and cycling shoes) to pay to get lifts put on all of them and only about one pair actually had laces and (b) I'm way too vain to wear "lifted" shoes (I couldn't get myself to wear them to work).
I decided to look into this crazy surgey. I met with THE specialist for leg lengthening for a consultation, and he did x-rays and made some measurements. He originally determined my LLD was about 3.3 cm. But x-rays showed that my "functional discrepancy" (i.e. the LLD that my body recognizes due to the differences in my hips...my pelvis tilted to make up for my LLD) was only 2.8 cm. So we talked options. It turned out that I could either lengthen the short leg, or shorten the long leg. He described these options that sounded more like medieval torture than modern day surgical techniques. After about two years of hemming and hawing and weighing my options, I scheduled surgery for October 7, 2002. I still didn't know if I was getting lengthened or shortened, but I knew my height was changing one way or another. I took my older sister with me to my last consultation appointment where I needed to decide which surgery to go with...after chatting yet again about my options, I asked about the pain levels associated with each surgery...and here's how my doc described the two surgeries: (1) the lengthening - "since your leg will be getting stretched approximately 1 mm per day, the pain is more of a sustained pain over a longer period", and (2) the shortening - "since your leg is shortened in one surgery, it's more of a gruesome pain, but over a short period". My sister and I looked at each other - "did he just say 'gruesome pain'?". Umm, yeah...Waiter, I'll have the lengthening with the sustained pain, and a side order of painkillers please.
Even though my discrepancy was split between my femur and my tibia/fibula, I had surgery to lengthen only my femur by approximately 2.8 cm. My first surgery involved cutting my femur in half - actually, they don't cut it - first they drill a bunch of little holes, then they use a "bone chisel and a mallet" to split it apart. The idea is that you want more surface area for healing, and a clean cut gives you the least amount of surface area. It's really carpentry...my dad liked to joke that his Craftsman tools would have done the trick, and he's probably right...except for that whole sterilization issue. So they cut your bone in half, push a titanium rod down the middle of your bone, then attach what is called an "external fixator". The fixator is attached to the two different bone segments using some serious screws (or "pins" as they call them) and has a little battery pack on it. I was really lucky...normally they use 3 pins for each bone segment, and that's what I had planned on...but at the last minute, my doctor decided to only use two on each segment (I think it's based on body weight because the fixator essentially becomes your bone and must support your body). The less pins you have, the less chance of infection...so it's very desirable to use less if possible. The battery pack gets programed to stretch the two bone segments apart by approximately 1 mm per day. The battery pack on the fixator was actually new technology when I had this surgery. Patient's historically had to turn a bolt in the fixator a quarter of a turn (1/4 mm) every 6 hrs using a hex wrench. There is a rhyme and reason for the 1 mm/day, but I won't go into more details...this is getting too long already. So I had the first surgery, was in the hospital for 4 days, then went home to spend the next 1.5 months on the couch.
As you could imagine, I was taking some serious painkillers...sometimes they helped, sometimes they didn't. After about 1.5 weeks, my doctor decided to "turn-up" my fixator so that it would stretch more than 1 mm a day (again, no need for details). But this made it hurt worse.
It wasn't much fun to leave the house...I was on crutches, I looked like a total freak so people were freaked out by me, it was hard to get around even though I was theoretically supposed to be trying to walk on my leg in conjunction with crutches, and I couldn't exactly wear normal clothes. My family and friends were all absolutely saints in my eyes - they stayed with me, came to visit, cooked me meals, did my laundry, helped me bathe, took me to doctor appointments every week, did my Christmas shopping...you name it, they all helped! I still get teary-eyed thinking about how lucky I am to have such a great support network in my life. I seriously could not have done it without them.
I was finally able to schedule my "fixator removal" surgery for Nov 11th, the day before my birthday. I was going absolutely insane from that fixator and being holed-up inside my little apartment, and I was no longer sleeping or eating much (go figure, you don't really have an appetite when you're not doing anything) and I couldn't even concentrate while watching tv (damn drugs). I'd also developed an allergic reaction of some sort to the pins in my leg and I had hives that were driving me crazy...so getting the fixator removed was truly the best birthday present ever.
The removal was a much more simple surgery of course...they take the fixator off, then lock the titanium rod (i.e. my temporary bone) in place with a couple of huge-ass screws, and I was good to go. Within a day, I instantly started feeling better. It was very liberating, to say the least. And it was exciting to get to wear my normal underwear! I couldn't really wear my normal jeans, because I'd lost about 15 pounds, and I had lost my legs and butt to atrophy a month earlier, so I had to purchase some "interim pants"...although I knew I'd quickly pack the weight back on. I spent another few months on crutches....two crutches for a while, then down to one. I was on crutches for a total of about 4 months. I had to go to physical therapy because I had a limp - it turned out my glute had stopped "firing"...so I essentially had to re-train my ass to "fire" so I could walk correctly. This was actually when I got my first road bike...my Croll that I used on the trainer was my only form of exercise - I was actually able to ride the bike on the trainer before I could walk without crutches. Getting on my bike was difficult and humorous, but once on it, I could spin all I wanted. I decided I really liked my road bike, even though it had yet to see the outdoor world. And that, my friends, is how I first got into road biking. And by the end of May, I was biking in Moab using my titanium-reinforced leg while the bone was regenerating. The following October, I had the titanium rod removed mostly because the big screw in my hip was bothering me, and I couldn't sleep on that side, and I really didn't need the rod anymore.
I now have about a 5 mm discrepancy...and one really long femur. As you could imagine, it really complicates my bike fit. Up until now, I haven't used any splints or shims on my cleats. But since I've been riding way more this year, I seem to have developed a slight IT band issue that may very well be related to all of my orthopaedic issues. I'm trying to get that taken care of before it gets too bad to race. Time will tell.
On a side note, I thought this story would be way more interesting than a Durand race report which would have gone something like this - warmed-up, got cold waiting for 30 minutes for the race to start, got dropped on the first steep hill, knee hurt, finished, then sulked since I got dropped so early. Lieselot got 3rd though, so that was cool.
SS
I always assumed the Lee-jean-makers just couldn't make the legs of jeans exactly the same length...my friends with Guess jeans didn't seem to have that problem. The orthopaedic specialist at the Mayo Clinic shed some light on this jean phenomenon - he determined that my "scoliosis" was induced by a leg length discrepany (LLD). At the time, my LLD was about 1/2 an inch (1.25 cm/12.5 mm). The doctor apparently decided that this wasn't that big of a deal (a decision that would later really piss me off), and that I should just do some back strengthening exercises since I'd likely have back problems. I'm sure I did those exercises about two times...I was about 13 yrs old, I'm fairly certain I had other things on my mind.
I continued to grow, and my LLD became more noticeable, although only to the trained eye. My favorite shorts were "cut-offs"...I could cut one leg longer than the other so they'd look even when I wore them, and it was always funny when my college roommate borrowed them.
By the time I moved back to the Twin Cities after graduate school (when I was about 25), I had started having hip and back problems, and they only seemed to be getting worse as I was becoming more active. I'd end up limping after walking for an hour or two at a time, and running felt ackward and sometimes painful. Oddly enough, I was mountain biking a bit at the time, and I knew I pointed my toes on one foot when I pedaled (to reach with the "short" leg), and I pedaled pidgeon toe-ed on the other side (the "long" leg) and would often hit my knee on my top tube - but generally speaking, it didn't really bother me while biking.
I finally decided to go back to a doctor and have my LLD checked out again. The doctor determined my LLD was now somewhere around 3 cm (that's over an inch for you people who don't like the metric system...2.54 cm = 1 inch). For those of you non-cyclist types reading this, a cyclist can often have pedaling issues (sometimes even injuries) from a 3 mm discrepancy...mine was 30+ mm. The doctor recommended trying a lift on my shoe, and mentioned that there was a surgery for "leg lengthening". Huh? How do you stretch a leg? Or do you shorten the other? Creepy. I tried the lift. It turns out that only really "non-fashionable" orthopaedic shoes can even have lifts put on them - they pretty much have to have laces, mostly because the lift adds so much weight to your shoe that your heel pops right out if you don't have them laced-up tightly. I quickly decided that (a) I had way too many pairs of shoes (including athletic shoes and cycling shoes) to pay to get lifts put on all of them and only about one pair actually had laces and (b) I'm way too vain to wear "lifted" shoes (I couldn't get myself to wear them to work).
I decided to look into this crazy surgey. I met with THE specialist for leg lengthening for a consultation, and he did x-rays and made some measurements. He originally determined my LLD was about 3.3 cm. But x-rays showed that my "functional discrepancy" (i.e. the LLD that my body recognizes due to the differences in my hips...my pelvis tilted to make up for my LLD) was only 2.8 cm. So we talked options. It turned out that I could either lengthen the short leg, or shorten the long leg. He described these options that sounded more like medieval torture than modern day surgical techniques. After about two years of hemming and hawing and weighing my options, I scheduled surgery for October 7, 2002. I still didn't know if I was getting lengthened or shortened, but I knew my height was changing one way or another. I took my older sister with me to my last consultation appointment where I needed to decide which surgery to go with...after chatting yet again about my options, I asked about the pain levels associated with each surgery...and here's how my doc described the two surgeries: (1) the lengthening - "since your leg will be getting stretched approximately 1 mm per day, the pain is more of a sustained pain over a longer period", and (2) the shortening - "since your leg is shortened in one surgery, it's more of a gruesome pain, but over a short period". My sister and I looked at each other - "did he just say 'gruesome pain'?". Umm, yeah...Waiter, I'll have the lengthening with the sustained pain, and a side order of painkillers please.
Even though my discrepancy was split between my femur and my tibia/fibula, I had surgery to lengthen only my femur by approximately 2.8 cm. My first surgery involved cutting my femur in half - actually, they don't cut it - first they drill a bunch of little holes, then they use a "bone chisel and a mallet" to split it apart. The idea is that you want more surface area for healing, and a clean cut gives you the least amount of surface area. It's really carpentry...my dad liked to joke that his Craftsman tools would have done the trick, and he's probably right...except for that whole sterilization issue. So they cut your bone in half, push a titanium rod down the middle of your bone, then attach what is called an "external fixator". The fixator is attached to the two different bone segments using some serious screws (or "pins" as they call them) and has a little battery pack on it. I was really lucky...normally they use 3 pins for each bone segment, and that's what I had planned on...but at the last minute, my doctor decided to only use two on each segment (I think it's based on body weight because the fixator essentially becomes your bone and must support your body). The less pins you have, the less chance of infection...so it's very desirable to use less if possible. The battery pack gets programed to stretch the two bone segments apart by approximately 1 mm per day. The battery pack on the fixator was actually new technology when I had this surgery. Patient's historically had to turn a bolt in the fixator a quarter of a turn (1/4 mm) every 6 hrs using a hex wrench. There is a rhyme and reason for the 1 mm/day, but I won't go into more details...this is getting too long already. So I had the first surgery, was in the hospital for 4 days, then went home to spend the next 1.5 months on the couch.
As you could imagine, I was taking some serious painkillers...sometimes they helped, sometimes they didn't. After about 1.5 weeks, my doctor decided to "turn-up" my fixator so that it would stretch more than 1 mm a day (again, no need for details). But this made it hurt worse.
It wasn't much fun to leave the house...I was on crutches, I looked like a total freak so people were freaked out by me, it was hard to get around even though I was theoretically supposed to be trying to walk on my leg in conjunction with crutches, and I couldn't exactly wear normal clothes. My family and friends were all absolutely saints in my eyes - they stayed with me, came to visit, cooked me meals, did my laundry, helped me bathe, took me to doctor appointments every week, did my Christmas shopping...you name it, they all helped! I still get teary-eyed thinking about how lucky I am to have such a great support network in my life. I seriously could not have done it without them.
I was finally able to schedule my "fixator removal" surgery for Nov 11th, the day before my birthday. I was going absolutely insane from that fixator and being holed-up inside my little apartment, and I was no longer sleeping or eating much (go figure, you don't really have an appetite when you're not doing anything) and I couldn't even concentrate while watching tv (damn drugs). I'd also developed an allergic reaction of some sort to the pins in my leg and I had hives that were driving me crazy...so getting the fixator removed was truly the best birthday present ever.
The removal was a much more simple surgery of course...they take the fixator off, then lock the titanium rod (i.e. my temporary bone) in place with a couple of huge-ass screws, and I was good to go. Within a day, I instantly started feeling better. It was very liberating, to say the least. And it was exciting to get to wear my normal underwear! I couldn't really wear my normal jeans, because I'd lost about 15 pounds, and I had lost my legs and butt to atrophy a month earlier, so I had to purchase some "interim pants"...although I knew I'd quickly pack the weight back on. I spent another few months on crutches....two crutches for a while, then down to one. I was on crutches for a total of about 4 months. I had to go to physical therapy because I had a limp - it turned out my glute had stopped "firing"...so I essentially had to re-train my ass to "fire" so I could walk correctly. This was actually when I got my first road bike...my Croll that I used on the trainer was my only form of exercise - I was actually able to ride the bike on the trainer before I could walk without crutches. Getting on my bike was difficult and humorous, but once on it, I could spin all I wanted. I decided I really liked my road bike, even though it had yet to see the outdoor world. And that, my friends, is how I first got into road biking. And by the end of May, I was biking in Moab using my titanium-reinforced leg while the bone was regenerating. The following October, I had the titanium rod removed mostly because the big screw in my hip was bothering me, and I couldn't sleep on that side, and I really didn't need the rod anymore.
I now have about a 5 mm discrepancy...and one really long femur. As you could imagine, it really complicates my bike fit. Up until now, I haven't used any splints or shims on my cleats. But since I've been riding way more this year, I seem to have developed a slight IT band issue that may very well be related to all of my orthopaedic issues. I'm trying to get that taken care of before it gets too bad to race. Time will tell.
On a side note, I thought this story would be way more interesting than a Durand race report which would have gone something like this - warmed-up, got cold waiting for 30 minutes for the race to start, got dropped on the first steep hill, knee hurt, finished, then sulked since I got dropped so early. Lieselot got 3rd though, so that was cool.
SS
posted by Strats at 4:56 PM
12 Comments:
That's a hell of a story; all I can say is, "Wow!"
Wow indeed--I have no right to complain about bike fit issues again. You are seriously hardcore!
Well I was going to just type wow, because that was my intial response, but then I looked at your other comments and saw that was what everyone else put. That is an absolutely amazing story. Keep up the great work on the bike!
Yeah, Gilby, you could just have some major invasive surgery to make YOU fit the BIKE instead of vice versa!
Thanks for sharing this, Sarah. I'd always wondered about the scar but thought it might be rude to ask... you are seriously brave for going through with it and then becoming a racer on top of it all! (Although where were you last night, slacker? Jeez.)
Ironicially, last night I was at the bike shop working on my fit issues...seemed more important than Opus.
Gilby, if you want to make yourself fit the bike, I know some people...
Yeah...I'll pass for now.
Here, Here! I often find myself drawing inspiration from your toughness during those months of pain--now that I'm all laid up popping the oxycodone and surfing the web for entertainment myself.
What goes around, I guess...
[and to think I didn't have the horrible anticipation of surgery that you did--this is easy in comparison of time, intensity, and foreknowledge.]
I'm glad you’re back together and racing to boot!
Flood, you're alive! And typing! That's a good sign. Unless you got some voice recognition software that types for you? I don't recall being very tough during that time...drugged up and crazy maybe, but not tough...being nearly helpless is very humbling. And while the anticipation of surgery seriously sucked, at least I had planned for it. I'm fairly certain that what you've gone through these past few weeks has put a kink in your lifestyle that you could have never planned for. But I'm sure your nurse is as good as mine was...and has more medical training! I hope you're taking your metamucil with that Oxycodone. I'm glad to hear (from Pete, who heard from AP) that you're home and recovering.
Oh, my god. It's the closest thing I'll ever feel to giving birth! I almost cried (really) this morning...
ah, yes. As I recall, it's a lot of work for very little reward.
Man, you guys had better not still be talking about the Metamucil issue. One word for you: Colace. Seriously, call the doctor and stop sharing.
Simply amazing - you are an inspiration, woman. Thank you for writing and posting your fascinating and super tough journey.
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