bobfv’s AchillesBlog

Today marks 9 weeks to the day since my ATR surgery. In my last post I wrote about my outing to the ball game in shoes (boots) over the weekend. The following day I had a great PT session, working on standing calf raises and gait normalization, then yesterday my wife and I flew from Washington DC to LA. I wore my Aircast boot and had no problem at the airport, went right through “TSA Pre” without any extra scrutiny, and had no problem boarding. We sat in first class so I had enough leg room, and I took my Aircast off and replaced it with a comfortable street shoe with a heel lift as soon as I was seated. It worked out fine, I used two shoes to walk from my seat to the lavatory. A couple of hours in to the 5+ hour flight I put my vaso-pumps on my calves and let them run  for about 90 minutes, a hedge against blood clots. When we landed I put the Aircast back on.

At LAX we picked up our bags and took the shuttle to the car rental place. I am an LA native and learned to drive here, my wife is a little nervous about jumping on to the LA freeways, so I took off my Aircast, put on my tactical boots (see previous post) fired up the rental car and jumped on to the San Diego Freeway at rush hour. I had not driven in about 2.5 months, but I had absolutely no problem. No pain, no issues whatsoever. My heel just rests on the floor of the car and I plantarflex to operate the throttle and brake. Piece of cake! I am so happy to be driving again!

When we got to our destination in LA my ankle felt fine but it was swollen from the flying and driving, and I iced it down. I had not had any swelling in weeks but all those hours with the leg down on the ground took their toll. The swelling went away after icing and I didn’t even need to take a Motrin or Tylenol.

Today, celebrating my 9 week anniversary, I got up early and went to the gym. I went in two shoes - I picked up a pair of Hoka One trail running high-tops to give me support in the gym and they worked great. I rode the exercise bike for 45 minutes, then I did most of my PT exercises including one leg balancing, step ups, basic proprioception, and 2-legged calf raises. I recommend these great shoes for transition workout shoes. I put a 1cm heel lift in the heel of the right shoe.

That’s where I am at week 9. I feel like I am making great progress now and getting my old life back!

My surgery was scheduled for the Reston Surgery Center on May 20, 2015, 10 days after my rupture.  The Reston Surgery Center is a large outpatient facility in the same building as my orthopedic surgeon’s medical group, on the campus of a medical complex which includes Reston Hospital Center, our community hospital. During my second opinion, I had asked the doctor about the safety of having the procedure done in an outpatient facility vs a hospital and he explained that statistically there is no greater risk, and that for an Achilles Tendon Repair (ATR) there is no requirement for any specialized equipment that would require that the surgery be conducted in a hospital.  I was comfortable with the Reston Surgery Center, I had a couple of procedures unrelated to my ATR done there over the years.

Prep was pretty simple, no food after midnight the night before the surgery, no aspirin for a week.  I was scheduled for surgery after lunch.

My wife and I went to the center at lunch time and waited for our 1310 showtime.  At 1415 they told us that the surgeon was running late, and shortly thereafter I went in.  The nurse apologized and said they were late because Dr. Kartelian was working on an unexpectedly complex case, setting an arm, but he would be done soon.

The nurse explained that I would get a nerve block which would numb my leg from the knee down for about 24 hours, and then I would be sedated during the procedure.  They gave me oral Celebrex, an anti-inflammatory, and IV Tylenol prior to surgery, and an IV anti-anxiety drug.  No narcotics.

I should interject here that I hate narcotics and they nauseate me.  The pain had been so bad since the Rupture that I started taking Vicodin several times a day along with Promethazine to prevent nausea.  Now with the nerve block and Tylenol they told me I would not need or get narcotics for the surgery.

An anesthesiologist came in to my bay and stuck a needle behind my right knee and in a few minutes I was completely numb from the knee down.  It was a strange and uncomfortable experience.  My toes tingled, but I could not feel anything from my knee to my toes and I could not move my foot.  I looked at it and “ordered” it to turn left or right and it just did not do anything.  It was like being paralyzed.  Before this had a chance to sink in, they took me in to the operating room, put me on my belly, and knocked me out.

An hour later I came to in the PACU, feeling a little woozy.  There was no pain, I still could not feel my lower leg.  I looked down and there was a big ball where my right foot should be - it was a dressing consisting of a spilnt and plaster with elastic bandages all around and my foot pointed down at a pretty sharp angle. This is referred to as a “plantarflexion splint” and I believe it is the typical post surgery dressing for ATR repair. I was instructed not to bear weight and I was given two pumps for my legs to prevent blood clots (more on those later).  I was wheeled out to my car and hopped in and my wife drive me home.

I was amazingly lucid that evening.  Because our bedroom is up a long staircase we set up a bed on the main floor of my house in a room we use as a small library. I relaxed, kept the leg elevated, and I applied ice frequently to the area right above my dressing.  I was not too uncomfortable and not in pain, but still freaked out about the numbness in my leg as the nerve block was still on.  I had purchased a knee scooter and I used it to scoot to the bathroom and to the bed.  It was a Godsend, I strongly recommend a knee scooter to help you during your non-weight bearing post-op period.

I did not take any narcotics that evening and at bedtime I took a Xanax to relax and fell asleep.

That wasn’t so bad.  My nerve block hadn’t worn off yet.