adrienne’s AchillesBlog

Just another AchillesBlog.com weblog

adrienne’s AchillesBlog header image 1

First Post-Op or The Donning of the Christmas Stocking

January 5th, 2014 · 1 Comment

Dec. 26, 2013

I was very excited and nervous about my first post-op visit. Excited that I could tick off 2 weeks of recovery time and nervous that I might find out I wasn’t really recovering well at all. I drove myself to the appointment (it was my left achilles so thankfully i was still able to drive) and had to use the crutches as I couldn’t figure out a way to lift my knee scooter into the back of my SUV by myself. I really hate the crutches. I feel more unstable with them as I keep getting them caught on things.

The PA cut the splint and wrappings off and I was amazed to see how much my calf had already shrunk in 2 weeks!

Atrophied calf at 2 weeks.

I freaked out a little when I saw that purple line drawn almost halfway up my lower leg. The PA assured me it was just the pen marking and that the incision was only a small portion of it. Phew! She then began to remove the sutures. It was a really odd feeling. It didn’t hurt until we got to the very last suture. For some reason that one was stubborn, wouldn’t budge and really hurt. I tried not to scream, but apparently I was making some low growling noises as the doctor came into the room laughing at me. He took a look at the incision and said it was healing very nicely and that they’d wait until the next appointment to take out that last suture. I was so relieved not to go through that pain again that it didn’t dawn on me to ask whether it would hurt more if we waited. Oh well. Next they took me to get xrays of the foot to see how the calcaneus was doing. The incision site was very sensitive so I couldn’t lay my foot down at all on the table (I wasn’t allowed to stand on it obviously).

Incision

The last part of this visit was the fiberglass cast. I have never broken a bone in my body and so had no idea what to expect. They gave me a choice of colors: Purple. No, Blue! No wait, Red! Gah! Why couldn’t I decide? Is Rainbow an option? I finally settled on Red as it was the day after Christmas and I was kind of in the Christmas mood. Really cool watching them build that cast. It looked like a colored ace bandage that they activated with water and proceeded to wrap around my foot and leg. They placed a cotton tube "sock" and a bunch of cotton wrapping on the leg first. It took about 20 minutes or so to dry. It got really warm, cooled off and was hard as a rock. Cool stuff! My foot wasn’t set at any particular angle. It was wrapped as it hung down over the table - would that be the angle of gravity?

Christmas Stocking

Even though this cast was much lighter than the plaster splint, it was uncomfortable and took a while to get used to. However, after 1 week it feels fine. This is probably due to the continuing atrophy of my leg. Sigh!

Well back in 2 weeks (1/10/14) to remove that last suture and a second cast. I’ve decided to go with Purple. No, wait…..

→ 1 CommentTags: Post-Surgery

In-N-Out Surgery

January 4th, 2014 · 1 Comment

Dec. 12, 2013

Early morning surgery on a frigid day. Bless my friend for waking up super early to take me to the surgery center. It was pretty routine. Achilles debridement and calcaneal exostectomy. Funny, i was envisioning that, since i had to be face down, they’d have a cut out on the surgery table for my face. Kind of like those nice massage tables that have a donut-shaped attachment. Nope I had to turn my head to the side which was super uncomfortable as I have a bad neck. Oh well, I figured I’d be out soon anyway. I was put under general anesthesia (light) and then given a nerve block behind my knee to numb and prevent any movement. All I remember was being told to breathe deeply, breathing deeply, coughing and then nothing until I woke up in a post-op lazy chair with my leg bandaged below the knee. The bandaging was huge!

When they woke me up, I became pretty alert very quickly. Had some water and cookies, rested a bit until they were sure I was okay, changed and then I was wheeled out to the car. My friend came in to say hi and helped me dress. She told me that my doctor came out to tell her that everything went fine with the surgery and what it was that he did. She said she was so grossed out by the description, she couldn’t remember what he said, LOL. But she did say that he was HOT! I just shook my head and laughed. I love my friend!

[Update: After speaking with the doctor at my first post-op he told me that the surgery involved making a vertical incision in my achilles to access the calcaneus and cutting part of the tendon away from the bone. The outer portion of the tendon was left attached. He shaved off part of the bone, and only debrided 10% of my tendon. It was only the back portion, the part that rubbed against the bone, that was frayed. The rest of the tendon was good. I was so glad to hear that! Then he used 4 anchors to reattach the achilles.]

I got home and went straight to bed. The rest of the day went very smoothly. My leg was still numb so everything seemed fine. I did a lot of prep work for my apartment.

Prepping For The Gimp

  1. bought lots of food
  2. pre-prepared meals
  3. rented a knee scooter (this has been a life saver!!) I also had crutches to maneuver the stairs in my apartment building.
  4. ordered a bathtub stool so I could shower (my shower head already had a hose so I could use it as a handheld as well. Some people bought bags for the cast, but i just stuck my leg out of the bathtub and used the shower curtain to keep it dry)
  5. set up my computer bedside so I could work from home/bed while my leg was propped up
  6. scheduled a friend to stay with me for 1 week beginning the day after surgery (I didn’t think I would need her, but she insisted and I’m soooo glad she did)

Well Hello Percocet! I Hate You.

The nurse told me that I should take my percocet when I started feeling tingling in my toes to stay on top of the pain. I was told that the nerve block should start wearing off in 12-15 hours. But at 3 hours, I felt tingling so I popped a percocet. Ha ha. I was a bit premature with that. So I settled back, ate and watched tv testing my toes every now and then. At about 16 hours I started feeling the toes and all of a sudden I was able to wiggle them. In a panic, I rolled over, grabbed the percocet and downed 1. It was really amazing how quickly the nerve block wore off! I was in so much pain that I decided to take a 2nd percocet right away. For the next 3 and a half hours I was just doubled over in pain waiting for the time to pass so I could take the next 2 pills. After that, I was able to sleep, but in 3 hours I woke up again in pain and decided to only take 1 as I didn’t want to OD. I woke up another 3 hours later, in pain and took 1 more. At this point I felt awful. I was dizzy, nauseated and itchy all over. Seemed like I got a good dose of side effects. I got out of bed and knee scooted to my kitchen to try and put some food in my stomach. I almost hurled. I couldn’t even eat anything i was so nauseated. Luckily my friend came by and forced my to eat some saltines, apple sauce, ginger ale and coconut water. That made all the difference in the world. But anytime I took a percocet I still became dizzy and itchy.

Luckily I only needed the percocet for 3 days. Afterwards, if I started to feel any pain, I just took Tylenol. The doc said no to Advil.

First post-op appointment in 2 weeks….

→ 1 CommentTags: Surgery

How did I get here?

December 31st, 2013 · 13 Comments

Here I am, sitting at my desk looking out the window after a big snow storm (Hercules, which by the way i think it a stupid idea that the Weather Channel has started to name winter storms like hurricanes). My leg is propped up on my knee scooter and I’m thinking, "How the heck am I going to dig my car out?" I had surgery 3 weeks ago on Dec. 12, 2013. Achilles debridement and calcaneal exostectomy, which some call Haglund’s surgery - basically shaving off a piece of my heel. But I guess i need to go back and tell you a little about me and how I got here.

Let me apologize ahead of time for the length of this post. But it was a long time leading up to the surgery as well as an exhaustive effort to avoid it.

My Journey to Rupture

I’m a 48 year old woman who’s been active all her life. I’m a runner, a cyclist and a triathlete. I guess you can say I swim too, but that’s the most challenging leg of the tris. I also dabble in tennis, though I’m not very good. I just like to hit things –¬† the sound and feel of hitting the tennis ball well is weirdly satisfying. Anyway, I’ve run countless races (longest distance: marathon), a couple handfuls of triathlons (longest distance, half-ironman), and rode up Bear Mountain near NYC a few times (~85 miles). Yes, I enjoy being active.

Marathons have always been my achilles’ heel - pun intended. Training for them was never a problem. Actually running the races aggravated my left achilles. My first marathon in Alaska (1995) was problematic, but I suffered through it and finished. I didn’t run for a good 6 months afterwards and the achilles did calm down. Fast forward to 2010, after my tri season and my first half-ironman, I decided to run the NYC marathon. My left achilles got angry with me and decided to punish me. No matter how much I rested, running any distance became painful.

Time for professional help. Saw a podiatrist, a sports doc. Went into a walking cast for a bit. Nothing helped. It was suspected then that I had an inflamed retrocalcaneal bursa. Went to get an ultrasound which showed minimal inflammation, but we decided to try an ultrasound guided corticosteroid injection into the bursa anyway. Wow, the relief I got from that was amazing AND I was able to race my 2nd half-ironman a few weeks later. But of course it didn’t last. I started to feel pain again in about 4 months and went back for another injection. I asked the doctor about the risks with these injections affecting the tendon. I had heard steroid injections into achilles tendons¬† can lead to rupture. The doctor assured me that the injections were only into the bursa with no leakage to the tendon. Well, in less than 1 year I ended up having 3 injections.

July 31, 2012, a few weeks after my third injection, I was walking to the bus stop on my way to work. Saw the bus and ran for it. First step, pop! I knew I had done something to my achilles. I had to hobble my way back up a hill and a flight of stairs to my apartment. In tears and in major pain, i made some phone calls and found an orthopedic surgeon in New York. So I changed my clothes (I was in work clothes and had sweated through them due to the incredible pain I was in), hobbled to my car and drove into the city. I parked the car in a garage and had to hobble to the office - all without crutches. Sat in the waiting room for over an hour then was told to come back to one of the rooms. I was pissed off that the attendant told me to take my time and walked away. Could she see I was in pain and couldn’t walk? Thankfully a lady in the waiting room got up to help me and then demanded that they get me a wheelchair. I was so grateful for her!

The doctor saw me for maybe 10 minutes and diagnosed it as a calf tear, put me in a walking boot (no heel raise!), gave me crutches and sent me on my way with a follow-up appointment 1 week later. Mind you, I told him I thought I had torn my achilles. A week later, he saw me again and I reiterated that I really thought I had torn my achilles. By this time the area around my heel was black and blue. He palpated the calf and said I may have partially ruptured the achilles. Shouldn’t I get an MRI? He agreed and sure enough, the MRI showed a 60% tear of the achilles and a split tear in the peroneal brevis. He didn’t recommend surgery. Instead, 2 months in a boot, with heel wedges, non-weight bearing. Then PT afterwards.

My Quest for a Non-Surgical Fix

6 months of PT. The tear was healing, but still had insertional achilles pain. Ok, time for another orthopedic surgeon and a new perspective. My goal was to avoid surgery. His recommendation was to try PRP injections. The last-ditch effort before surgery. He claimed he had 90% success rate with his patients, although studies showed lower success rates. His explanation was that he only performed PRP when he thought they’d be successful. 2 painful PRP injections later and a couple thousand dollars gone, it felt worse! Ya, I was frustrated and pissed. His next recommendation was surgery. Obviously, I had lost all confidence in this doctor and it was time to find a 3rd.

It’s now the fall of 2013. After researching, I finally found an orthopedic surgeon who specializes in foot and ankle reconstruction and whose office was very close to my home. I visited him and really liked his demeanor. I immediately felt comfortable with him as he was very open and honest. I told him about the PRP injections and interestingly he said he does PRP as well, but never for insertional achilles pain. He said that it’s always something else that’s aggravating the achilles. In my case the heel bone. In fact, he palpated my heel and sent me through the roof in pain - he knew exactly where it was. He also recommended¬† surgery. Debridement and shaving off part of the heel bone and a possible FHL transfer if he had to debride more than 60% of the tendon. He said he couldn’t tell until he saw the tendon, but that his gut feeling was I wouldn’t need it judging by the MRIs. That was good because I used to be a dancer and not being able to point my toes would be tragic!

Decision Made

So I opted for surgery. I had tried everything and was going nuts not being able to run or ride (not to mention i had gained so much weight). I also felt good about this surgeon. So Dec. 12, 2013 it was.

The next post will be about the surgery. I promise it’ll be much shorter. :)

→ 13 CommentsTags: Pre-Surgery