bobfv’s AchillesBlog

I awoke the morning after my surgery on Thursday May 21. I still had the cast/bandage on my right foot with the toes pointed down. My toes were still numb and the nerve block was still clearly in effect from the afternoon before.  I had prepared a bedroom on the main floor of my house in what is normally an office, since my wife and I have our bedroom up a full flight of stairs.  There is also a bathroom on the same floor as my makeshift "bedroom". I had positioned the knee scooter and the crutches next to my bed and sure enough, I had to wake up to pee the previous night, and it was fairly simple to just swing my knee from the bed to the scooter, scoot a couple of short steps to the bathroom, and I could even manage the act of urination while still on the scooter!

The morning of May 21 (the day after surgery) I got out of bed and scooted right over to my power recliner and just settled in.  My toes were quite swollen, so much so that I considered calling the doctor, but as soon as I got my foot up and put a little ice above the bandage I was fine.

About 1500 that afternoon, pretty much exactly 24 hours after my nerve block was administered, it wore off.  The tingling in my toes which had been so annoying disappeared, and I could now feel sensitivity around my stitches and had to make sure to keep my pressure off of that area.  I accomplished this by having the recliner footrest up with a pillow on top, then I just rolled my leg from side to side to keep pressure off the stitches.  The pain was quite manageable - the Vicodin which I had been eating like candy before the surgery was totally unnecessary now and even as I write this, a month after my surgery, I have not felt the need to take a single narcotic pain reliever since the surgery.  A couple of times I have taken two extra strength Tylenol but that is it - no severe pain at all.

So I did not go back to work for that first week and I remained non-weight bearing.  After a couple of days of having my wife bring me my meals, I decided to venture into the kitchen, which required going up two stairs.  Unfortunately, while I had practiced on the crutches before surgery, I did not practice going up and down stairs.  It is harder than it looks.  So the day after my surgery with my wife helping I got off the knee scooter and up on to the crutches - they are basic aluminum underarm crutches that I had gotten from the hospital.  With my wife at the top of the two small stairs I hopped up with one foot to the first step and lost my balance backwards.  I fell back but I knew I could not put any weight on my right leg so I just let myself crash onto my right elbow.  It was a spectacular crash and I severely bruised the elbow but thank God I did not put my foot down and rerupture the Achilles.  Lesson learned. I got back up and with my weight positioned forward managed to hop up the stairs and join my wife in the kitchen for dinner.

The rest of the week was just ice, rest, elevation. I went in for my first follow-up with the orthopedic surgeon on Tuesday May 26, six days after surgery.

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.