A TWIST IN THE RECOVERY
Posted onJanuary 26, 2009
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Been having some really bad sural nerve numbness and pain, so went to see my friend the sports med doc today (due to logistics, location, our relationship, he didn’t do the surgery, though he wanted to). Anyway, he was the one who 1st diagnosed the partial tear and put me in the boot so I could go on vacation before the surgery. He asked me to come in today because he knew of my nerve issues and wanted to ensure it wasn’t the size of the boot contributing to the problem.
Now, keep in mind that he is a sports med guy and an asst team doctor for a major league baseball team. The guy who did the surgery is also a reputable surgeon at one of the premier ortho hospitals in NYC (and partners with a close family friend). Anyway, my friend the team doc takes one look at my incision and is shocked at the length, particularly considering that we knew it was only a proximal partial tear going in. He’s very concerned about the amount of atrophy (I was in the boot almost 4 weeks before surgery due to vacation and the holidays) and was shocked to learn that my surgeon recommended non-wt bearing for another 2-3 weeks after getting in the boot and no therapy for a week or two after that. Given my age (40) and the fact I’m active and athletic, he feels I should be wt bearing in the boot NOW. He admits he is aggressive, but he believes given my extensive atrophy, swelling, edema and nerve entrapment, I need muscle stimulation and ultrasound 2-3x/week NOW, along with active motion and PWB with the crutches progressing to full wt bearing in boot in next 2 weeks. He fears i will never regain sufficient strength and will have “zero” calf if I wait much longer for therapy and that scar tissue and disuse will perpetuate my weakness, stiffness and nerve issues. In fact, he had his staff PT give me a gratis 15 minutes of stim and ultrasound and, i have to admit, it really made the leg feel much better and improved my circulation to the lower leg and foot. The PT actually commented that in her opinion my surgeon was treating me like i was 65 instead of 40!
So, now I’m torn. I’m going to dicuss with my surgeon my feeling that he is being way too conservative, particularly given the substantial atrophy and nerve issues, but I wonder which protocol makes more sense. Or maybe they both do. Any similar experiences or advice?
1ST POST-OP VISIT
Posted onJanuary 22, 2009
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Finally had my first post-op visit yesterday. How could 13 days feel so long?!? My bro (thanks Matt) took the day off to drive me into the city so my wife could be home for the kids after school. I was so anxious to get the splint and padding off that we were at the office an hour early ! The scar looked like so many of yours it was uncanny, but I have to admit I was still stunned at how puny my entire lower leg looked. Shocking.
Of course, nothing is easy. While my doctor was removing the sutures my calf cramped up fiercely (I guess the slightest movement was a surprise to my atrophied muscles) and it’s still tender in that spot (which of course has me paranoid about blood clots - maybe too much reading is a bad thing!). The worst part is that the outside (lateral side) of my left foot is numb from the ankle to the little toe, with occasional pins and needles or a burning sensation. I had some discomfort there preop (I was in the boot for three + weeks) but nothing as pronounced as this. My surgeon believes it’s a temporary result of all the compression of the last 6 weeks, and I hope he’s right. I’m worried it’s a sural nerve injury. anyone have experience with this?
Anyway, he put me back in the boot (keeping it a little looser becasue of the numbness) and wants me non weight bearing for 2 weeks. Then one week of half-weight and then a return visit and, hopefully, full weight bearing with the boot. After a week of that we’ll meet again and set-up PT. I convinced him to let me occasionally toe-touch for the next two weeks and I’ll do ROM exercises a few times a day. Frustrating, but I know from all of you I have to patient and let it all develop slowly. Hoping to get back to work Monday, weather and leg permitting.
When I got home from the visit, the first thing I did upon entering the house was slip on the crutches and full plant the foot! I was so terrified I’d done damage but it seems ok, just a little sore. It was great to shower today without the padding and the splint, although I’ll still use the cast cover for another day or two. This weather definitely makes using the crutches treacherous, but I just can’t see taking the rolling aid into the city, it’s so cumbersome.
A few questions - how do you sit once you’re non-weight bearing with the boot on? Foot on the floor? Resting on heel? Still keep it elevated?
Well, I guess the next update will be in 3 weeks. I hope everyone makes great progress til then!
Forty’s the new….
Posted onJanuary 19, 2009
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So here it is, my first ATR blog after almost two weeks of reading all of yours. Before I share my (cliched) story, let me thank all of you for sharing your experiences and your wealth of information. The comfort, advice, courage and knowledge imparted on these pages has been nothing short of invaluable.
I’m a 40 year old father of two (10 yr old son, 6 yr old daughter) living on LI and working in NYC. I wouldn’t call myself a weekend warrior - I’m pretty active for a busy lawyer - “crossfitting” five or six days a week for the last 2 years (see www.crossfit.com) and playing a regular fullcourt hoops game every Sunday for the last 10. Plus, how sedentary can you be with active kids, right?!? Unfortunately, it’s my judgment that is occassionally impaired, as I have a tendency to “do” without always considering the implications first.
On 12/10/08, just three days before a planned family vacation to visit my folks in Fla and spend 3 days in Disney, I decided I would join my firm colleagues and play in my first lawyer’s league basketball game of the season that evening. My wife’s prophetic words that morning still ring in my ears (mostly because she has repeated them every day since while she waits on me hand and foot!): “Are you sure you want to play? What if you get hurt three days before vacation?” Ouch. I did everything wrong that day, and while I know the consensus is that this is an acute, unpredictable event, I’m still convinced I contributed mightily to my injury. That afternoon, I had a glass of wine during lunch with clients, and added a cup of coffee pre-game, just to really dehydrate myself. I got to the game late and didn’t engage in my usual pregame routine (jump rope, stretch, shoot, sprint), instead stretching for twenty seconds and playing. I played the first half, sat out and got cold at halftime, then went back in with eight minutes to go. Big mistake.
I took a three-point shot, hit front rim, and started to fall back on defense. I saw it was a high rebound, thought I could beat my man to it, and planted my left foot to “explode” to the basket. Pow! In my case, my calf cramped violently first, and then I distinctly felt something snap below my calf (but not at my heel). It was the worst pain I’d ever felt, but NOT like being kicked on the heel by a mule (my dad had a full tear, so I knew the story). I didn’t think it was my achilles.
Genius that I am, I drank some gatorade, stretched my calf (idiot!), and some friends got me back to my car and I drove home (worst ride of my life). All this when I was playing right next door to NYU Medical Center! I called a family friend who is an ortho, described the events, and he told me it sounded like my plantaris, not my achilles. I rested, iced and elevated for two days and bought some crutches for my trip. Thankfully, I represent physicians for a living, so I was talking to another colleague who is a sports med doc and he had me run through some tests over the phone (tiptoe and Thompson’s). He suspected at least a partial achilles tear and insisted I see him the next morning before my trip. He was right, it was at least a partial tear and he put me in an aircast for the trip. Needless to say it ruined the vacation, but the kids giddily called me the “Human FastPass” when we cut every single line at DisneyWorld because of my scooter!
When I got back, the MRI revealed a partial tear, and I was given the option of surgery vs. natural healing. Both sports med docs I saw recommended surgery and based on everything I read, I reluctantly agreed. Due to my vacation, the holidays and year-end change of insurance issues, I didn’t have my surgery until 1/8/09, four weeks after the injury! My calf had already significantly atrophied from the aircast before I ever went in for surgery, so I can just imagine what it’ll look like once I get the splint off on Wednesday. David Pereira at Hosp for Jt Diseases in NYC did the surgery. Good guy and, I hope, a good surgeon. Told me I had an unusual tear - longitudinal in the belly of the tendon rather than into two pieces - and they reapproximated it and sutured both sides to strengthen it. Then he put me in the front splint to prevent dorsiflexion and told me to rest, elevate, non-weight bear and work from home til he saw me again on 1/21.
So, like all of you, that’s what I’ve been doing since the surgery. Lying on the sofa (didn’t want to risk the bedroom upstairs), two or three pillows under my leg (turned on the side, not pressing directly on the wound really makes a difference in the intial pain reduction!), watching way too much TV. Been taking a baby aspirin a day to prevent clots. The pain was awful the first 24 hours (the kids were terrified of me when I got home the first night!), lousy the next 24 and has reduced substantially since. Pain meds helped but I stopped taking them a few days ago and seem to be ok. Borrowed a “rolling aid” (like a scooter you rest one leg on) from a friend and it feels ridiculous but is easier than crutches (which I also still use, especially to get upstairs to shower) and allows your hands some freedom and has a basket. I tried a “cast cover” for the shower but had trouble getting it over my bulky wrapping without straining my foot or unravelling the bandage, so I settled for saran wrap and a garbage bag (mostly works). Been using a shower chair and the hand-held shower head. Tedious.
My wife set me up in the den with a large cooler full of water bottles and snacks at the beginning, which was huge in the middle of the night when I was thirsty or needed to take pain meds. Now I can pretty much “scoot” around. Most helpful advice I saw so far was to put a chair next to the toilet so you can balance your “bad” knee on it while going to the bathroom. Question: What about when you need to sit to use the toilet? has anyone come up with a good way to do that? I can’t seem to comfortably elevate my leg, so I’ve been letting it hang with a pillow under the foot, but I’m still worried I might weight-bear and not realize it. Any suggestions?
I suppose the key is to be patient but it’s tough. I feel guilty not being at work and wonder what my partners think. Since i commute by train (I can drive if need be as my left leg was injured), I wonder when I can expect to go back to the office full or part-time. I’m very tempted to test at least tiptoe weight-bearing on crutches but I’m reluctant to try it before i see my doc for the 2 week visit. I wonder how much muscle atrophy will play a role in my rehab since I was immobile for 4 weeks before the surgery. I wonder if I’ll go right into an aircast on wednesday and start weight bearing or if I’ll have to wait. Most of all, i worry about how long the rehab will take and when I can expect to run around with my kids and play sports and work out again. A number of people have prodded me to be thankful I have something that can be fixed, and i am, but it doesn’t stop me from worrying about the length of recovery and the outcome. Should i look for PT with a pool?
Oh, I’ve also noticed that the outside of my left (bad) foot intermittently goes numb. Is that common?
I guess that’s it for now. Thanks again for all the hard work and input that’s gone into this site. It really is inspirational and comforting to hear everyone else’s advice and experiences. I guess I’ll post again after my 1st post-op visit on Wednesday. If anyone wants to suggest topics/questions I should make sure to raise with my surgeon, I’m all ears, thanks!