Well, the suspense is over. I have come to terms with what went wrong back at the Pentecost River and up to Ellenbrae homestead to the point that I can share it with my friends.

To recap; after being brought in to Ellenbrae Station on the edge of heatstroke I found that my lower left leg got really sore when I tried walking the 25 m to the cabin our hosts had given me. I thought it was a strained calf muscle and that it would come good after a few days, as they do. I wouldn’t find out what was actually wrong until getting to Derby hospital a week later.

At Derby I hobbled up to the hospital emergency and described my symptoms to the reception nurse (hiding behind a screen because of Covid 19 precautions). I am sure she would have written something like ‘man whinging of sports strain‘ on the notes, but she did book me in with an emergency doctor.

The doctor asked about my symptoms, examined my leg and then uttered those words no doctor should ever be heard to say, ‘Oh, this is interesting!’. It turned out the doctor couldn’t find a pulse in my foot, my foot was partly numb, somewhat cool to touch and apparently not as hairy as the other foot.

The diagnosis was a severely blocked popliteal artery (the main artery behind the knee that supplies the lower leg). Derby didn’t have an professional ultrasound operator on duty that day (all having a day off before the mayhem of the Derby Rodeo in two days) so Derby Doc booked me in to see the Emergency Doc in Broome in a week.

Broome Doc applied the magic portable ultrasound in the emergency department and confirmed the apparent complete blockage of the popliteal artery. As the leg was still functioning, he let me go with a referral to the Vascular Clinic at Royal Perth Hospital upon my return. I got a full sonogram as soon as I got back to Perth. The sonographer wouldn’t give a diagnosis on the spot but hinted gravely that I should see the vascular specialist very quckly.

The full sonogram was inspected by the RPH vascular specialist (now three weeks after the injury) who confirmed a 9 cm full blockage of the popliteal artery with the lower leg being kept alive by well developed collateral minor arteries. The presence of the expanded collateral arteries, combined with symptoms of mild foot numbness on strenuous fast bicycling for two years before the full popliteal blockage suggested that the main artery had been blocking progressively for a long time. What caused the blockage is unknown as there is no atherosclerosis of my arteries elsewhere (‘good condition’ according to one specialist, ‘pristine’ according to another). Best guess is that I had damaged the popliteal in some forgotten accident or strain, or that the blockage was an ‘overuse’ injury caused by the repetitions of pedalling for hours and days.

When I first saw the vascular specialist, I could walk only 250 m without significant pain in my calf muscle. His initial comment was ‘well, you can walk 250 m and you are 64 years old, what more do you want?’ Thanks mate, not.

However with the passage of time and with lots of daily exercise (walking as briskly as possible for 3 km a day, cycling initially 50-70 km twice a week with a couple of 500-800 km week long bicycle tours) I can now walk briskly for 750 m or unlimited distance if I slow to a comfortable amble and can cycle up to 100 km a day. This is a very good outcome, especially as according to the literature up to a quarter of the people with a similar blockage have to amputate the lower leg due to insufficient blood supply (on the other hand, about 5% of sufferers return to virtually full function as alternate blood supply vessels develop).

The last visit to the vascular specialist four months after the injury and with a CAT scan was much more hopeful. The CAT scan showed an 11 cm blockage.

The vascular surgeon saw the blockage but when he heard that I was walking and cycling well his advice changed to ‘continue doing what you are doing or want to do. We don’t know if exercising more or less will make the injury better or worse. What will happen will happen, if it gets really bad (leg or toes go black) we will do a bypass of the popliteal artery but don’t want to do this now because the repeated bending behind the knee will likely cause the bypass to block in 5 years or less and then it will be more difficult to repair again.’

I’ll go with that.

Sorry for the long write up but this is a life-changing event and has likely put an end to my doing harder 200 and 300 km rides in a day. Touring still seems possible. So a reasonably good final outcome considering what could have happened.

And finally, for those who don’t believe in a national health service (yes, you Americans!) the emergency department visits and subsequent scans and consultations with the vascular surgeon didn’t cost me a cent. Having a national health system available helps to encourage people to be more active in activities with some risk, and by making treatment affordable to everyone minimises the number of conditions that become chronic and possibly debilitating to end up costing society more in the longer run.