Going to get a new knee

About two years ago, I posted regarding swelling and immobility problems with my left knee.  It was really affecting rehab on the right Achilles.  Fast forward two years to April 2016 and X-rays show that he left knee is far better off than the right.  In fact, the right one is worn out on the lateral side (outside).  I am having it replaced at New England Baptist in Boston next week.  I cannot wait.

Both Achilles are solid though the calf muscles are still weak due to limits on exercise because of damaged knees.  It has been a long road since my first break in May of 2009.  I look forward to rehab and continued strengthening.  I have been working out with emphasis on the upper body in case everything fails and I have to walk on my hands.

15 weeks out and a rehab setback

Since I got back into two shoes 8 weeks post rupture, rehab has been going great. Slow strengthening and improvements all around.  I started with walking short distances and increased to a half mile or so and then joined my health club.  At the club,I did mostly Precor elliptical and stationary bike with some low weight leg presses and calf work.  After about a month of steady improvement,  I took a couple of longer walks.  A couple of 1 milers and one 2.8 miler.  Well that’s when things started going down hill.  Not with my achilles but with my opposite knee.  Looked like a flare up of previously diagnosed Baker’s Cyst ( a pocket of synovial fluid behind the knee).  Knee gets really sore, swollen and stiff.  Tried to ”RICE” it for a couple of days but ended up getting an appointment with my ortho doc’s PA.  She confirmed the disgnosis, took some X-rays to show that the underlying cause was most likely Arthur Itis. I knew I had it in my right knee but looks like It’s starting over there too.  My right knee crunches but never developed the Baker’s cyst.  My thought is that the left knee gets a lot of stress from the shortened tendons in that leg as a result of the left achilles operation and rehab not being quite as successful as the one on the right.  Funny thing is that my left and right tendons probably were rupture prone because they were too tight (short).  The right one healed naturally (no operation) whereas the left one was stitched up and probably made shorter still in the process.  I have had a lot of problems with the left leg with tight hamstrings and tight calf muscles at the top insertion.  

Well the PA popped a shot of Cortisone into the left knee and 24 hours later I am without pain and have mobility again.  I am seeing my PT specialist tomorrow with an open order to get both sides of my kinetic chain straightened out.  IT bands need work for sure and a little modality work ( ultra sound, electo stimulation etc) may help loosen things up.  Then I can resume my rehab schedule.  It is a process.

12 weeks post ATR

It will be 12 weeks this coming Sunday that my heel dropped while climbing the stairs to bed and I nearly went into shock, not from the pain, but from the anguish of breaking another achilles.  The recovery has been without pain or incident and I look back on the time spent in physical therapy, exercise and rest with no  regret to speak of.  The winter was bitter and it would have kept non-wounded Chuck indoors anyway.  I had no projects that I was particulary anxious to get back to.  Work was well paced with no travel demands.  Prices for a  South Beach getaway were too high this year for some reason.  I read 6 novels. 

I am pretty much back to normal, with weakness of course, but I am getting stronger by the day.  I am taking special care to strengthen my left leg as well because I feel I never did a thorough job of rehabing that one after my first ATR.  I know a lot more now and I know how committed I have to be to just get back to “normal”.  I read the other day that after age 40, one loses .5 pounds of muscle mass per year.  That is why people in their sixties just start falling over for no apparent reason. The’ve lost 10 pounds of muscle.  Leg muscles are no longer what they used to be and if you don’t work them baby you’ll start to notice that it’s hard getting out of a chair or getting off the floor.  I look at it this way: I have to overcome this ATR and stay on a path that is going to keep me as strong and coordinated as I can be.

For all of you out there that are finding your way with this very unique injury, have faith, allow time and nature to help heal,  keep working at making yourself better and learn as much as you can from your fellow travellers.

9 1/2 weeks post tear visit to Ortho

Well, this is the visit I was waiting for.  The one where I hoped to hear that I could get rid of the boot and wear shoes on both feet again.  First person is the office was a PA (physicians assistant) that works with my Ortho Doc.  She checked me for strength and range of motion and seemed very pleased.  I thought that maybe she was going to be it but she said her boss would be in shortly.  He joined her in a few minutes and performed some simple checks and asked me to walk a bit.  He proclaimed, “awesome”.  My heart leapt in my chest .  OK, I had a butterfly of excitement maybe.  I honestly think that they were blown away by the fact that a tendon could come back as strong as it did in such a short time without an operation. 

Bottom line: he wants to see me in 3 months and told me PT use was up to me.  He suggested getting some instruction from PT regarding strengthening.  Carry out the instructions at home and at the health club, go back to PT as needed for more instruction and/or evaluation.  Both The Doc and PT see me as motivated and compliant (which I am).  They know I’ve done my research and am faithful with my prescribed exercises so I guess I’m pretty much on my own.

It’s been freaking cold in the northeast and the roads are in tough shape so I will limit my walking to indoor malls for a couple of weeks.  I will join the Athletic club this weekend and carry out my instructions.  I know the achilles has a long way to go before it is not re-rupture prone,  but I am convinced that I made the right decision on this one regarding no surgery. 

It has been 7 weeks since I started rehab (2 weeks after rupture) and I know there is still a long road ahead.  I have a protocol for 6 phases of heel raise that run for 2- 4 weeks for each phase (3 months total).  If I follow it (can follow it) I should be in pretty good shape by the end of May.  In addition to all that, I have to straighten out fupped up knees,glutes,quads and hamstrings( the whole leg and butt kinetic chain).  Now if I can just convince my wife to give me back the keys to my CRV.  I think she likes me being dependent.  Not gonna do it.  I’m going to sneak out for a Taco Bell run one of these days.  Just you wait and see.

6 weeks post tear and boot at neutral

Went to PT on Monday and testing showed that my range of motion was virtually identical to the left foot with a 15 degree dorsal flexion with no strain at all.  Ginger (My therapist) suggested going right to zero degrees on the boot and really start the weight bearing in earnest.  She has me doing some marching in place, leg raises to the side and back as well as controlled heel raises while standing and holding onto a table.  I can do them but only slightly as I feel a bit of pulling at the tendon tear site.  The muscles are definitely hooked up though as I feel them flexing and tiring as I do the exercises.  Still three weeks until I see Ortho Doc for 3rd visit but I am perfectly happy at neutral position and one or no crutches.  I set the table, emptied the dishwasher and made my self a martini with no crutches last night.  You can do so much more once you ditch at least one crutch.

First Ortho followup post tear

Saw the Doc yesterday afternoon and he took a quick look at the ankle and said that the tendon was filling in nicely and that I had excellent range of motion.  He gave a glance at the PT report and told me to crank the boot down to 20 degrees this week and 10 degrees next week and then 0 degrees or neutral in two weeks. OK to put weight on it.  OK to sleep without it.  New PT orders with a directive toward strengthening.  I do believe he said that when I see him next (at the end of February) that I will be good to go.  Now, that could simply mean go without the boot but I got the strong impression that he was intimating that I would be released from care with the exception of maybe ongoing PT strengthening.  Wishful thinking?

4 weeks plus since rupture

Four weeks before the Patriots lost the AFC conference title was an even more painful experience for me.  I broke my Achilles(2nd one).  I’ve been in a boot now pretty much the whole time in a 30 degree down angle 24/7 except for shower and PT excercises.  I’ve had PT 3 times with a 4th tomorrow followed by first return trip to ortho Doc on Jan 27th.  Apparently things are going well as my therapist says my ATR ankle has virtually the same range of motion as my unaffected ankle and some measureable strength.  I am still NWB but excercise results are very encouraging and without pain.  The therapist actually confirmed my decision to go with no-operative and early rehab as a wise choice.  She said that I had this one figured out regarding the prospects of a solid non-operative recovery.  I explained that something told me that there was still a little something there (despite the class III tear diagnosis).  I keep working the toes and the ball of my foot.  Massage the tendon and calf whenever possible.  I can barely feel the indentation where the “dissociation” (as the docs call it) occurred.  It is definitely growing back.  I think it’s a freakin’ miracle if you ask me.  But isn’t all that stuff that goes on inside us without our even thinking about it a miracle anyway?  I will stay in this boot as long as they say I have to, but I believe this will be a done deal after 12 weeks total time ie into shoes at least.  Just a note, I had a cam walker boot left from my first ATR which, of course, I slapped right on after this rupture.  It occurred to me that the boot had been worn for 12 weeks in the hot summer of 2009 and here it was on me for another month and probably two more.  I figured the liner although not rank could use “updating”.  I googled BREG cam walker boots and they sent me to : http://www.braceshop.com/ I was able to pick up a replacement for 29 bucks and it is super.  Fits better than the first and doesn’t pinch my toes.  Interesting thing about this time around:  No operation means no surgical room, materials, meds,staff, athesthesiologist and surgeon.  I had my own boot.  I had my own crutches.  I still need PT and a couple of visits to the ortho doc but… how much money do you think this saved the health care system?  I’m not saying that non-operative is for everyone and I must say that I am putting a lot of  faith in the data and my own desire to make this work.  If this works, and I truly believe it will, I will be a witness.

First PT 24 days after ATR

Had my evaluation appointment with PT today.  I have used this group before while trying to straighten out issues quite probably related to my first ATR 4 1/2 years ago.  I have the dubious honor of being their only two-timer EVER.

I brought my Ortho Doc’s PT orders and a copy of the MRI report so that they would know exactly where the tears were.  Things went well.  Mostly measurements to get a baseline and some ROM and massage along with a laser gizmo treatment that is supposed to stimulate blood flow.  It is standard practice to measure the affected ankle against to unaffected one to establish expected results.  I wonder if anything makes sense when you are comparing a damaged foot to a previously damaged foot. When healed I will be weaker than I was on the right but the left was weaker than the right so now I should be evened out–right?

My directions are to stay in the boot but to work at range of motion and improving circulation via heat and movement 3 x a day.

PT is scheduled 2x a week for the next 8 weeks.  I feel like I am in good hands and it sure was nice to get out.




17 days post tear

Well, it’s January 8, 17 days since my tear and one week before I start PT.  I’m in my office (attached to my house thank God) and feeling quite good about everything.  Since I decided on a non-operative approach, I feel very much “in control” of my outcome.  I know that an operation would have stitched things tight and who knows maybe would result in a stronger tendon.  I’m betting not.

I’m  crutching with ease, boot on 24/7 and no weight bearing escept for a toe or heel touch once in a while for balance.  I sleep well, have no pain and certainly no pain from an incision that would have my lower leg in a cast or maybe not even there yet due to scheduling.  Looking back on my blog from 4.5 years ago, I realized how much discomfort there was from the operation itself; swelling, inflamation, infection.  Sure the tendon was cinched up tight but it still was not held by tissue but by mechanical sutures. 

The tendon was be shorter than before the tear but that is the nature of surgery and tying ends together.  I still feel tightness in my left tendon 4 and a half years later.  In fact I experienced tightness in my whole left leg for a couple of years.  Tight calf.  Tight ham strings.  I worked those issues out with PT, stretching, weight training, walking and determination.

The Doctor monitoring my healing on this one explained that my right leg may on have 80% of the strength of the left one due, in part, to the longer length of the tendon after healing naturally.  I suggested to him that this may be what my tendon wanted to be anyway and could have been why it snapped.  I tell you, after the tear (and it was a class III tear-complete), I felt very little of the pain that I did during my first tear.  Back then, something told me that there was no option but surgery.  This time I felt like there was still something there after the rupture.

I’ve read a lot as I am sure all of you have and I am very much encouraged by some of the new school of thought that evolved even since my first injury.  I am all for agressive rehabilatation with early PT.  I will be working with the same people that I worked with last year when I was trying to straighten out my “kinetic chain” as they call it.  They are good at what they do and I am going to be a good client.

Chuck’s ATR part deux

Well here it is 4 1/2 years since I broke my left achilles and now I have ruptured the right one.  A cruel joke?  God’s way of keeping me in balance? 

It happened Sunday night December 22 two days after I had been to an orthopedist that had been seeing me off and on for a year and a half.   I had informed her that I had been experiencing fairly severe pain in the achilles and calf attachment as I walked for the past two months.  I told her I had felt a slight tearing in two instances when I stepped once in the snow and once on the stairs.  She examined my tendon and declared that it was sound but said I had tendonopathy (what they used to call tendonitis I think).  She said my tendon was solid,  in no danger of rupture and prescibed physical therapy for 6-8 weeks 2x per week.  Never made it.  I was walking up to bed on Sunday night and my heel just dropped.  Pop goes the weasle.  Pain was not as bad as first one.  Swelling started immediately.  My wife came running and I started to shake like a leaf.  I couldn’t believe this was happening again but immediately became angry because I had a feeling I was headed in that direction.  Contacted the ortho office 8:30 Monday AM and explained my situation.  They said they would get back to me.  They did at 2PM.  On-call doc arranged an MRI the day after Christmas and agreed to see me tomorrow Tuesday Dec 31.  I’ve seen the MRI and it looks like some strands are left but what do I know?  Operation? Conservative splinting?  I’ll find out tomorrow I guess.