Bode’s Recovery

My doc wanted me back for a 6 month checkup so I just show up for what I am not really sure.  After waiting for about 20 minutes the Dr. takes a look and says all looks good and I’m set free.  Wa la! That’s it, no party, no celebration, no dancing in the halls, no “you are amazing for making it this far,” nothing, nada, just a mere, “I guess you are set free.”  I mean come on people I have survived 6 whole months and I have paid you all thousands of dollars and that’s it?  Now don’t get me wrong here, I’m grateful for the excellent medical attention and glad to be recovered–it just seems like there should have been a bit more fan fare.  Well one thing I can truly be thankful for is that my injury occurred BEFORE the government takes over the healthcare system.  Yikes, that will be a scary day in America.  Let’s hope is doesn’t come to that.  Well, my ATR friends, thanks for all the great posts and comments–YOU all made a difference for me.  Seriously, this blog was a HUGE benefit in my overall recovery.  Keep up the faith, you will recover!

Wow, what a difference a few days can make.  Progress feels good.  I’m just about 9 weeks since surgery and just started PT today.  The first session was so helpful.  I was treated with a great session including massage, stretches, lots of education about what works well for stretches/exercises, ultrasound, and STEM.  All in all, it was very encouraging and I am feeling more confident in my ability to fully recover.  Learning to walk properly again is my first challenge. I also discovered that my good leg is very tight with only about 9% dorsiflexion when it should be closer to 15%.  So now I have some work to do on my good leg to build up more flexibility and strengthen my other Achilles to hopefully to prevent this from happening again. In case there are any other ATR’s here in the Twin Cities, I recommend Jon Groskreutz-from OSI Physical Therapy-he does a great job understanding the situation and setting up a plan for progress.  Cheers!

My doctor is moving me along now a bit faster than originally discussed and I am very happy about my progress.  I am following the plan outlined in an article titled, “Early Motion for Achilles Tendon Ruptures: Is Surgery Important?” written by Bruce C. Twaddle and Peter Poon and published in The American Journal of Sports Medicine, Sept. 20, 2007.   You can read the abstract here (the full article is available for a fee).

Here is a summary of my treatment plan so far and what is still to come.  I did not follow the plan in the article exactly from the beginning but plan to from now onward.  I’ll  first describe what I experienced and then give a quick rundown on the plan from the article.  Hope this helps.

My experience to date:

• ATR playing basketball on Jan. 27
• Surgery Jan. 29, spinal block, outpatient. 
• 2 weeks in a splint, toes pointing down @ 25 degrees, Vicodin for pain 3 days, then Advil/Tylenol 2 more days, lots of elevation and ice
• 2 more weeks in a fiberglass cast, toes pointing down @ 20 degrees. Advil/Tylenol for cast discomfort/agitation
• Moved into a boot, 15 degrees pointing down for 1 1/2 weeks
• Today–boot moved to neutral position (5 1/2 weeks post op) with partial weight bearing allowed 

Plan going forward: 

• Boot in neutral position, partial weight bearing moving to full weight bearing over next few days/week based on comfort level, daily exercises include moving foot up and down, massaging scar area, and light stretching with towel behind toes gently flexing toes, ice/heat as needed, no boot needed at night
• Continue with boot in FWB for until 8 weeks post op (2 1/2 weeks from today)
• Move to two shoes at 8 weeks and then begin PT, do toe raises with good leg supporting bad leg
• Next Dr. visit at 12 weeks post op

Now after reading the article I realize my treatment has been a combo of the more traditional approach of immobilization and this newer approach of early motion.  For those just starting out, you may want to research this further and talk to your Dr. before you start.  The study really impressed me as it makes the case for early motion and the results of this study showed similar results for both operative and non-operative treatments.  It seems that most people on this site have opted for surgery and according to this study the non-operative group did equally well as the surgical group.  It seems that the non-surgical method when combined with early motion may become the preferred method over time if more studies can confirm these results.  This is all very fascinating to me to see treatments vary so much among doctors and how they continue to find new and better ways of treating the same injury.

Here is a summary of the treatment as I understand it from the article (please read the full text for details).  The same treatment was given to both the operative and nonoperative groups.

• 10 days cast
• Move into a boot with 20 degrees of plantar flexion (toes pointing down) non weight bearing–here’s the cool part–every hour, remove boot and with leg hanging off the edge of a bed or something so your foot is off the floor, flex foot upward toward neutral  but not past neutral and allow gravity to let it fall back down.
• At 4 weeks–still non weight bearing, foot brought to neutral position, same exercises as above
• At 6 weeks–partial weight bearing, no boot at night, same exercises, moving to full weight bearing over time
• At 8 weeks–two shoes, toe raises using good leg to support bad leg, starting PT once able to do toe raises on injured leg
• no significant differences were found between the surgical and non-surgical groups using this method according to the study

I am now just about at 6 weeks and will be following this method going forward so it seems I did not lose any ground by being in the cast for 2 weeks as I am now in neutral position and starting PWB so I am hopeful that I can follow this protocol going forward and have a complete recovery.  I also got the okay from my Dr. to register for the Chequamegon Fat Tire Festival (a 40 mile mountian bike race) scheduled for Sept. 2009 in Hayward, WI.  She seemed to think I would be fine to ride so I am going to submit my application (they have a lottery drawing to limit the # of racers) so we’ll see if it’s meant to be or not.  It would certainly give me motivation to get back in shape.  So it was a great Dr. visit and I’m feeling positive about my progress so far.  Cheers!

Friday, Feb. 27 I had my 2nd Dr. visit at 4 weeks and 1 day post op.  Here is a quick rundown of how it went-It’s a bit long but wanted to share some details that may be helpful to others just starting on the journey.  First of all, thanks only to this website, I was prepared at my first Dr. visit and had already lobbied for getting a boot at my 2nd visit because the original plan was to have me in two casts with my foot at different angles for 2 weeks in each cast after being in a splint for the first 2 weeks for a total of 6 weeks in a cast.  This all seemed like over kill and way too slow of a process after reading this blog.  So at my first visit, after requesting a boot, I was talked into a fiberglass cast for 2 weeks and was told that I may be able to get a boot on the next visit.  After suffering through those two long weeks with great discomfort, I was determined to not go home in another cast.

When I arrived for the 2nd visit they first cut the old cast off which is a non-event, a bit of noise and dust, unless a sharp blade that looks like it could chew a giant hole in your leg happens to freak you out.  To reassure me, the tech demonstrates that it will not hurt you pushing his finger against the blade while he grins as my 9 year old son looks on in disbelief.  I was prepared for a small calf muscle and it did not disappoint–very pathetic looking.  The wound looked pretty good once I cleaned it up.  

The Dr. says I can have a boot but it needs to be plantar flexion (toes pointing down 15 degrees) for 2 more weeks.  I groan and start to explain other methods of treatment that allow weight bearing by using a walking boot at 90 degrees with a heel lift but she does not go for it at all saying something about too many variables.  She does say I can start range of motion up and down with my foot as much as I want and says to come back in 1  1/2 weeks instead of 2 (I guess to make me calm down and be more compliant).  It’s really interesting to read all the different treatment protocols on this site.  What seems to make the most sense to me is the walking boot as soon as possible with heal wedges so you can bear weight but not stretch the tendon too far too fast as long as the patient knows the risks and is willing to take them.  This method does seem to carry more risk as a boot can be removed and a patient could then do something to cause a re-rupture.  However, it seems that the patient should have more say in what they are willing to take on for risk vs. the Dr. giving only one option (3 splint/casts for 6 weeks).  So I agreed to 1 1/2 more weeks of crutches non-weight bearing with the boot.  I’m trying to look on the bright side–all of the crutching my way around is at least helping build a bit more upper body strength.

Getting the boot after 2 weeks in a splint and 2 more weeks in a cast was a great improvement.  Getting my leg out in the air resting is excellent, getting to shower again (sitting down to reduce risk), putting on a sock, putting lotion on all that dry skin and being able to move my foot a bit is a huge step forward.  It finally feels like some real progress.  As for getting around better, I met a guy in the lobby on my way out and he has a knee caddy (4 wheeled cart you rest your knee on and power it with your good leg) and he tells me I can rent one from the clinic for just $25 a week.  Wow, and to think that no one in the clinic even thought to offer such a service.  It kind of boggles my mind that as patients we are not given more options, choices of treatment, tools available, etc.   Especially when I think of how much this event is costing me.  My first bill so far is something like $8,500+ and I have a $3,000 deductible so I’m paying a lot out of my own pocket and as a consumer it seems we might get a bit more service.  Now don’t get me wrong, I am super amazed at the great medical care we enjoy in America but there seems to still be more room for improvement in the options for care after you leave the clinic.

It really makes me appreciate this blog and all the people who are willing to share their stories.  It has helped immensely!!

Here’s a quick rundown on my first visit back to the clinic, 2 weeks post op.  Saw the PA-CJ, who is terrific and explained the rationale behind the next phase of my recovery.  I had read about early mobilization and was eager to understand options.  She explained that the risks of going to the boot to soon are that the actual tendon does not heal strong enough and can get stretched at spot of tear vs. getting stretched higher up where it attaches to the calf muscle which is where you want it to stretch once  you start working back the full range of motion.  This was her rationale for why I should go to a cast for weeks 2-4 and then look at boot options.  This made perfect sense to me and I flet a lot better about the cast.

So I left the clinic with a black cast, toe cover and cast cover to protect my foot from snow and ice if more should happen to fall in the next few weeks which is likely the case here in MN.  I’m allowed to do TTWB (toe touch weight bearing) only so trying to walk slower with the crutches and put my toes down with every step.  This takes longer because I have to be more careful that just cruising but seems will be better in the long run to keep my toes/leg at least a little involved in the process of walking. 

It sure felt great to have the splint  off for a few minutes and to get it cleaned before the permanent cast was applied.  The cast is solid and heavier than the splint and will take some getting used to.  It’s hard to be patient realizing I must live with this thing for two weeks but on the other hand, it’s much less time than without surgery so I am very glad I decided to go ahead with surgery right away.

The wound looked good, stitches came out easily, tape stays in place.  The cast guy was about to start and I says, “aren’t you going to take out those stitches” and he’s like, “oh yea I thought they were already out…”  It’s good to pay attention to what’s going on.  He actually was very good and put my cast on like it was a work of art–feathering the gauze so as not to leave a bump and smoothing it out, giving me an extra inch of room below the knee, etc.  Nice to find such competent help!

So far all is good as I begin running mile two of the ATR marathon!  Thanks to all who have posted stories.  I have learned a ton and laughed often–You all are terrific!  Cheers!!