6 Weeks Post Op

Hello all Achilles survivors!

After my 6 week post op appointment I’m happy to report that all is well and I’m healing ahead of schedule (well at least my doctor’s schedule).  It was difficult to not break a smile when he started explaining to me how to put weight on the foot.  I just wanted to stand up and walk around the office, but didn’t out of respect.

I experienced no setbacks from putting weight on the foot at 4 weeks post0-op, and I’m very glad that I did.  It’s taken about 1.5 weeks for me to become very comfortable walking without crutches.  I experienced the tingles in the heel, the slight and sometimes abrupt pain in the Achilles area, and other minor pains in this process. When something hurts, I just stop.

At home, I’m able to walk around barefoot which I also believe helps strengthen and add balance to my foot.  I do have a slight limp.  My doctor just gave me an ankle brace to wear in 1-2 weeks (it’ll be on tonight so I can get used to it), and my next appointment isn’t until 9 weeks post op.

Some other points about my recovery are,

  • I never slept with the boot, just couldn’t do it.  The first night was a little ruff but the rest worked out just fine especially with an ace bandage.
  • I kept my crutches with me almost til the 6 week mark, and they definitely helped for longer walks;
  • I used a vibrating massager on the Achilles and calf to help loosen things up, which I think helped in the quick recovery;
  • Everyday, I puncture 3 vitamin E capsules and put it on the scar, then cover with gauze, and wrap with an ace bandage.  It’s healing very nicely.
  • I can do 20, 2 leg heal raises no problem;
  • I’m washing the foot good with warm water daily;
  • I haven’t made it to physical therapy yet, but hope to get in there in the next week or so;
  • I’m giving the scooter back tomorrow, which is sad, but definitely necessary.  I could ride that thing around the house all the time when even when healthy.
  • When racing with the dogs, I almost ran over one of their paws, but luckily I was able to abandon the scooter just in time to cause no harm.  Be sure to watch out for pets with the scooter.

That’s all I have for now.  Looking forward to wearing a pair of flip flops soon!

11 Responses to “6 Weeks Post Op”

  1. It sounds great, though I’m not a great fan of hiding things from my Doc.

    At 7 weeks, I let my boot hinge, from neutral (90 degrees) to way toe-down (plantarflexion). The only time it came close to getting me into trouble was once when I was walking fast with a bunch of friends. I got so far ahead of them(!) that I tried continuing to walk-and-talk by walking backwards. Well! Walking backwards is VERY MUCH harder on a healing AT than walking forwards!! ‘Nuff Said!

  2. My doctor asked if I was in pain and I answered honestly and said no. He evaluated my reflexes, which is something I do all the time via the Thompson test, and it all checked out.

    Having conversation about how I’m putting weight on my foot was not necessary, and I think if I was completely honest with him it would have undoubtedly lead to a more conservative protocol. My doctor doesn’t want or need to hear about how well I followed the protocol. He cares about the results like reduced swelling, discoloration, range of motion, strength, appearance of scar..ect.

    Hiding is different than not communicating. I think it’s important to answer the questions, but the doctor didn’t ask and I think this is standard practice for him. It increases his liability to have an aggressive protocol so why recommend one. Their recommendations are based on reducing liability and then healing the patient. Doctors are there to answer patients questions and by all means ask all the questions you want.

  3. Bio, I get off the boat when you say things like “It increases his liability to have an aggressive protocol so why recommend one. Their recommendations are based on reducing liability. . .” All of that is based on myths that have been proven false!

    Do you have any evidence that what you’re saying — even its “sign” (positive vs. negative), let alone the magnitude — is true?

    Early weight-bearing has found to be at worst neutral for AT healing and re-rupture, and at best beneficial, in a series of randomized scientific studies. That means it’s associated with LOWER “liability”, doesn’t it?

    Then there’s the risk of falling accidents and accidental AT re-ruptures — both of which increase with extended NWB, because using crutches is OBVIOUSLY MUCH RISKIER than walking in a boot!

    You may be right that many Ortho Surgeons do dumb and hurtful things to their ATR patients IN THE MISTAKEN BELIEF that their slow protocols (and the initial surgery, too) are “conservative” or “safe” or “helpful”. If you leave it there, I’m aboard!

    And speaking of liability, have you ever heard of an ATR patient successfully suing a doctor after getting a bad result? This website has lots of ATR patients who’ve gotten bad results, and I don’t recall ONE of them saying they’ve sued, much less gotten a nickel in a settlement. Even in the litigious US of A, I don’t think it happens. (I WISH ATR patients could sue for malpractice and get a cash settlement! I think you’d have a good case, and so would a majority of the bloggers here!)

  4. Bio, very glad for your fast recovery.
    I’m at 14 weeks and I’m not pain / swelling free for a while.

    Norm, when you go for surgery you asked to sign “release” form at hospital that you understand all risks and etc.

    unless surgery went out of ordinary ( malpractice case ) not much you can do after hospital has your signature - IMHO
    meaning if you don’t heal fast or tendon shorter or longer - nothing you can do
    if somehow surgeon left something inside that again out of ordinary than you may have bases for the case

  5. You can bang your head against the wall trying to convince physicians, but the statistical evidence of your position is not quite there to make the impact you’re looking for.The sample sizes of the studies I’ve read are just too small. This is one of the major issues of health care, the cost to validate a theory. In this case, who’s going to pay for the clinical validation of the early weight bearing theory for lets say 1000 patients? The system will be stuck until this gets done. Is it necessary, you bet. What if pharmaceutical companies could release drugs with only a sample population of dozens or hundreds? There are even more variables with surgery, and this is another reason why it doesn’t get done.

    Since the evidence is not considered overwhelming by the medical community, doctors will do what they believe is necessary to minimize the re-rupture rate. Although there are a handful of papers, with a small sample population of evidence (needs to be thousands not dozens), doctors will follow the protocol which they believe reduces this risk. Does a medical provider evaluate a surgeon’s re-rupture rate, or success of surgery, to determine if that physician is effective? Will a physician have increased exposure with increased re-ruptures and injury rate after surgery? I believe so in both cases.

    My point is not to get in a debate about recovery protocols, but to better inform this community on my experience and beliefs on how the system works. Trying to change an established physician’s methods is very difficult. Healing is up to the patient and a physician’s recommendations in my case were too conservative. Instead of taking the approach following the physician’s orders I decided to take my own approach and progress at the speed of my body and it’s working.

    On the point of patients suing doctors, I don’t think my case is a good one for suing doctors. The doctor was not being negligent for recommending a conservative protocol, but rather practical….at least in his mind.

  6. Bio, your doctor’s “evidence” to support his super-slow protocol is tiny compared to the evidence in the 4 most recent studies, cited on my blog — and the other studies that specifically compare early WB to delayed WB, too. Those studies produced statistically significant results, so the burden of proof is on the people who say it ain’t so, not the other way around.

    Describing your doctor’s approach to the studies as if he’s read them and rejected them is fantasy, because I think you know he’s done neither.

    Look, the evidence that hand-washing decreases infection rates is pretty rock-solid, but all the investigations show that doctors and nurses can’t be bothered to wash their hands between patients! That’s why so many hospital patients get preventable infections like C-diff and MRSA and others. Wherever infection rates for hospitals are published, so patients can see them, that’s enough motivation — enough ACCOUNTABILITY — to change BEHAVIOUR, which changes RESULTS. Studies alone don’t do that.

    Do you really think your surgeon thinks his evidence is better than the evidence in the published studies?!? I don’t think you believe that for a minute, and you’d be lucky to get 10 minutes of his time to even ask him. He doesn’t have time to read the studies, much less digest them, so he does what he did 5 and 10 years ago. As you say, “Trying to change an established physician’s methods is very difficult.” NOW you’re talking!

    You say “Will a physician have increased exposure with increased re-ruptures and injury rate after surgery? I believe so in both cases.” First of all, nobody is publishing these rates, so you and I together don’t know if your own surgeon’s patients had a 1% re-rupture rate or a 20% re-rupture rate. And the rate of injury from falling down a flight of stairs in your 2nd (unnecessary) MONTH on crutches?!? Nobody but us would even attribute that injury to the crazy surgeon!

    My point about suing a surgeon wasn’t that you should do it. My point is that NOBODY does it, which is why your comments about “liability” are misplaced. Liability is a form of accountability, and surgeons who put their patients on unsupported or deleterious protocols don’t seem to face any accountability, whether legal or professional or commercial. That’s how loose talk and bad practice survive so long.

    Heck, in jurisdictions where hospital infection rates (like MRSA and C-difficile) are still secret, there’s still no accountability for the professionals who don’t wash their hands!

    The studies we’re talking about have investigated around 1000 patients, if not more. Your doctor wouldn’t care if it was 100,000, unless it intruded into his practice somehow. NO scientific study is going to do that, because he obviously doesn’t read ATR studies!

    You’ve quietly taken matters into your own hands and ignored him. That’s likely the right answer for you, but I bet 95% of his future patients will just assume he knows what he’s talking about, just as he assumes he knows what he’s talking about.

  7. Norm, you must have had some bad experiences because what you’re describing (and of often times embellishing many “facts”) is displeasure against all the medical community.

    Your points about MRSA and C-difficile COULD lead you to statistics of increased rates in countries like the UK. What a healthcare system they have…

    Your articles around 1000 MIGHT be located somewhere hidden deap within your blog. I’m not seeing them on pubmed, medline or highwire (my favorite since more full articles are available).

    I believe, and have witnessed, new medical practices being accepted into our health care system. I have attended the conferences of physicians reviewing new procedures, and I can report that many of them are not like those you describe.

    My physician was well aware of the research, and even published many articles of his own. You might be surprised to learn that many physicians, especially those associated with research organizations, are actually credible and tremendous professionals. You just need to find them.

  8. Bio, you’re welcome to debate the evidence, and I’ve tried to engage your earlier claims about the evidence, and about the motivations of the medical establishment. But I don’t find it helpful when you imagine stories from my past, or accuse me of embellishing many facts, without making any testable or refutable statements.

    BTW, I have the highest respect for lots of clinical doctors, and I tend to get along very well with my own. Most of all, I usually have no trouble “finding” credible and tremendous professionals in the medical field — despite your strong suggestions to the contrary. In fact, my own experience with my recent ATR is an excellent case in point!

    When I tore my AT in December, I phoned several and saw two, all of whom acquitted themselves admirably. When I went to arguably the most prestigious sports-medicine surgeon (the Chief Surgeon of our pro football team!) in the great city of Toronto (a very fancy medical/hospital city, and I’m originally from Boston!), he told me that he himself had stopped doing ATR-repair surgery completely 4 months earlier, after hearing a presentation from the authors of the U. of W. Ontario study, and discussing the results with them. (I think that was all at a big conference in the US.) I have seldom been so impressed by a doctor, and I wish all the other bloggers here had access to health care as impressive as I got.

    I went to this surgeon looking for surgery, on the assumption that my understanding from late 2001 — that surgery was the obvious way to go for an active athlete — was true. The LAST thing I expected was that a surgeon was going to talk me out of surgery!

    He had internalized the evidence, convinced himself that the UWO study was a good one and its results were valid — i.e., that there was NO statistically-significant benefit from ATR surgery and some significant risks — so he stopped doing the surgery!

    Like car repairmen, dentists, renovation contractors, and university professors, some surgeons are WAY better than others. And the systems of accountability are different, too, so it’s easier to spend your whole career, until you reach retirement age, as a lousy university professor (or ortho surgeon) than an incompetent car repairman, IMHO. (Heck, incompetent car repairmen sometimes even get FIRED and have to change careers!)

    I’ve linked 4 recent randomized studies that all compared surgical and non-surgical treatment of total ATRs. Admittedly, the most recent one (from U.W.O.) hasn’t been formally published yet in a peer-reviewed journal, but I’m told it’s “forthcoming”, and the results have been published in abstract and presented at a number of major conferences, so I’ve included it.

    All the studies I link are on a single page, Bio, with a title talking about studies, so I don’t think you can miss it. D has also linked that page from the “ATR Rehab Protocols, Publications, Studies” page that’s linked on the AchillesBlog front page — easy-peasy! If it eludes you, just ask and I’ll post the direct link.

    The UWO study had about 150 randomized patients, and the other three averaged maybe 100 each.

    There are also maybe 5 other studies — comparing the results of faster and slower rehab protocols on randomized Post-OP patients — linked from D’s “Studies” page, and several other randomized studies cited in some of those linked articles. Add up the patients, and I’m willing to bet it’s well over 1000, and NOT ONE of the studies found that the faster protocols were associated with more negative outcomes, and several of them found that the slower protocols were.

    And I doubt that that you’ll find ONE of those studies that validated the slow protocol that your Doc has recommended for you (and which you’ve — wisely IMO — rejected and ignored).

    If your Doc has published something that we can all learn something from, or if he’s told you why the new randomized studies aren’t to be believed, please share. I don’t claim to know everything in this field, not by a long shot. I will also continue to assume that your motives are pure, and that we’re all just trying to get to the truth and help future ATR patients get the best treatment. I’m pretty sure that’s what I’m after!

  9. As I’ve said before, I think the key issue here is approachability, teachability, willingness to change. With the web and what we’re doing here, there should be an increasing stream of new ATR patients coming to the orthos with knowledge of studies and options both on the repair and the recovery side. If the doc is any good, he will hear the evidence, put aside his/her historical bias and make an honest decision as to his/her recommendation. That’s what I got and, although I would have preferred someone with the independently developed research of Norm’s ortho, at least I did not have an instransigent “know it all” ortho with whom I could not work.

    That should be the least we all ask for, in my opinion.

  10. hi i put some weight on my foot at about fuor weeks i walk no problem by fifth week with the boot , am about a week behind you on my recovery i rupture mine on april 30th . i’ll keep checking on your progress to compare it with mine.

  11. Aw, this was a really nice post. Finding the time and actual effort to generate a superb article… but what can I say… I
    put things off a whole lot and don’t manage
    to get nearly anything done.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

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