Why I Decided on Surgery Instead of Non-Surgical Treatment
It was obvious my achilles left achilles was torn.
I arrived at the emergency room late in the evening and was put in a wheel chair and wheeled in to a curtained ER room. I hopped up on the gurney with my good leg. After the normal nurse duties of questioning my medical history, getting my weight and taking my blood pressure, the ER doctor came in.
The doctor immediately had me lay on my stomach and began the Thompson Test. He squeezed my right leg’s calf which constricted my achilles and moved my foot. He then tried the test on my left leg. My foot didn’t move at all and faced straight down towards the floor. My left foot was at a 90-degree angle from my leg when laying on my stomach with my feet hanging off the end of the stretcher while my other foot had a normal rest of about 120-degrees.
The doctor went over my options and sent me home with a splint. The splint held my left torn achilles at the same rest angle as my right foot. He instructed me that the podiatrist would give me a call the next day.
The podiatrist called and went over my options. By the time she called, I had already spend hours online researching which types of treatments were available. I immediately told them that I wanted surgery with a 2-week non-weight bearing cast, then I wanted to begin rehab with a walking boot.
Here’s why I knew what I wanted
I used to be really into music from independent music labels. I would follow all the new releases and new artists to try and find the next big thing. Diamonds in the rough. This was very time consuming, expensive and didn’t produce results all the time. It got worse when the internet made accessibility to music easier. I decided to optimize my search for new music by letting the experts do it for me. Instead of scouring for new artists, I found a handful of DJs that shared similar tastes as me. I basically trust them, as experts, to greatly influence my decision. I mainly listen to DJ mixes now, but still follow a few of my favorite artists.
I took this theory and applied it to my injury. NFL linebacker Terrell Suggs, NFL wide receiver Michael Crabtree and NBA superstar Kobe Bryant have all torn their achilles within the past couple of years. Kobe being the most recent. These guys consult like 10 expert doctors from around the world before deciding on how to treat their injury. It’s not just an injury, it’s a team protecting a multi-million dollar investment. It’s an athlete who has reached the pinnacle of their careers, wanting to go even farther. They require the best, most successful treatment available. I’m sure these doctors have treated hundreds of these type of injuries have read thousands of studies or completed some of their own. Do I trust a doctor on the phone completing their residency who has never met me in person or do I trust how a group of top docs treat athletes?
None of these professional athletes took the non-surgical path. Because of this, I barely researched non-surgical treatment at all.
Each of these players took very similar paths and each one has almost outdone the other in terms of rehab time. Terrell Suggs returned to the NFL 5 months after surgery and hasn’t shown any signs of slowing down. Michael Crabtree is on pace to return in November, 5 months after surgery. Kobe was walking normal after 3 months of rehab and is on pace to play professionally after 7 months.
Suggs, Crabtree and Kobe are professional athletes. They’re arguably some of the best at what they do. They’re beasts. I am very aware that I am none of those things, but I am athletic, in shape, young and full of optimism. I’ve played competitive sports in the past and want to play them again. From their choice of surgery to their modern rehabilitation techniques, I am going to try and follow the steps these guys have taken as closely as possible and come back stronger from this injury. I’m going to use their results as motivation.
My point in all this is that I feel surgery is what is right for me in my situation and my goal is to fully recover and get back to playing soccer in 5 months.
1:13 am - 11-1-2013
Would like to see Norm chime in here.
2:19 am - 11-1-2013
At your age and level of athleticism, I can understand why you chose surgery. It may allow you to “come back” quicker but at the one year mark, I don’t know that there would have been much difference either way. I have a feeling that you would be motivated enough to make the best out of any situation–op or non-op. Your blogging skilz are most excellent too. (I can barely get a picture inserted into my post and have no hope of ever embedding a link.)
12:55 pm - 11-1-2013
Hi KellyGirl, from what I have read, no there probably is no difference between non-surgical and surgical treatment for achilles after a year. You are absolutely right though, a year is waaaay to long for me to wait!
My embed image button in the wordpress compose-a-post area wasn’t working. I host my images on my website http://www.alanweibel.com and embed them using html. There are lots of other services that host images and give you an embed code if your wordpress embed is not working. Let me know if I can help.
3:01 pm - 11-1-2013
Alan, I think your approach is generally sensible and time-saving. The only problem with it is that I think it will be coming up with the same answer after the whole research community has come up with evidence showing that something else is better. Whether or not we’ve actually reached that point in op-vs-non-op is still a matter of opinion, how different people lean back and squint at the data, how you feel about small differences that aren’t statistically significant, and how you weigh or value serious (surgical) complications vs. a potential small strength deficit.
But it’s not hard to picture a world where the Next Best Thing has been proven and the studies published, BUT– especially if it superficially looks a lot like Your Grandfather’s Cure, as non-op ATR treatment does — every professional athlete takes advice from their teammates and their fave doctors, who all have experience (and decent success) with The Way We’ve Always Done It. So the people you’d expect to be leading the way in following the evidence are actually following each other like a flock of geese.
Non-op ATR treatment looks like the treatment we used to give geezers and sick people, while fit jocks were sent straight to the OR. That’s a PR/marketing problem, not a science or medicine problem. Non-op ATR treatment also looks a lot like Doing Nothing, while surgery looks like Doing Everything Possible. Ditto PR problem. And surgeons are always coming out with variations on their surgical techniques, so the term “cutting edge” can apply in both senses — a marketing plus. The experimental data are not impressed, but humans are, including athletes and pro teams and their investors.
The good news is that both ways — a variety of surgical techniques with a variety of rehabs, and non-op care with a SMALL variety of rehabs — seem to produce about the best overall results we have seen so far. With the exception of one surgical trial in Japan (noted on my “Studies” blog) which seems to have blown everybody else away! (If I owned a pro team I’d send my stars to Japan, based on that article.)
And the other good news is that your way of Finding the Right Answer Quickly has probably saved you so much time already that you’ll still be ahead even if it COST you a few weeks in ATR recovery. (No, I’m not saying that’s likely — just that you’d still be ahead even if.)
In my case, I saved a bunch of time after my second ATR by just assuming I’d get the same surgery I got for #1, which got me back to competitive volleyball in ~10 months with no noticeable deficit. My old surgeon wasn’t available, so I went to the fanciest sports-medicine surgeon in town (chief surgeon of Toronto’s pro football team). I showed up expecting him to schedule me for surgery, and to my surprise, he introduced me to the UWO study and talked me OUT of the surgery instead! (AFAICS, he has had less success talking the team’s players out of ATR surgery, though I’ve only seen one ATR reported in the press. I don’t follow pro football.)
So I may seem like the guy who did a tonne of research before deciding on a course of treatment (as I advise!), but I didn’t actually do that, and I’m in no position to criticize others for taking decision-making shortcuts.
Good Luck and Good Healing! (The BAD news is that none of the treatments comes with a guarantee.)
So you’ve started TWO blogs at AB.com??
3:06 pm - 11-1-2013
No, now it looks like ONE blog, but you show up as alanweibel and the URL shows the owner as dapdapdap. What ever happened to the KISS principle?!?
3:22 pm - 11-1-2013
BTW, do your best to get back to full speed at 5 months, and I hope you succeed. But please don’t treat it like a deadline, or something your self-worth or happiness is hitched to. Many of us here have LOST time by trying to go faster than our healing and reawakening parts could handle — in my case a MONTH, just for doing what my PT told me to do (when I actually knew better, and even told her so, then did it anyway!).
3:25 pm - 11-1-2013
Are you “Alan Who”? Very nice theme. Clear and visually striking.
9:47 pm - 11-1-2013
Hello Norm. Thanks for all the comments.
However, I have no interested in joining the rhetorical debate which ATR treatment is better than the other in general terms. There seems like a lot of that going on here. I am a proponent for individuals to choose what is right for them as an individual for their situation, activity level and personal goals.
I have been injured many times (though none as serious as the current) and my body responds well to, ‘walking it off’ or early light range of motion before my injuries stiffen up. After a day’s worth of research I was very confident in my decision. There were no questions. I believe surgery and the quick path to begin rehabilitation is the best for my body.
10:53 pm - 11-1-2013
Alan, good luck with your recovery. I went the OP route myself and started slow jogging at around 7 months. PT told me if could do single leg hopping on my toes I could start progressing to sprinting. This occurred around 9-10 months and went back to competitive soccer at 11 months.
I still have a strength deficit on my ATR leg and am down on pace and agility but being able to play again is great. Mentally, I started feeling much better and happier once I started jogging again. So it’s not just a physical recovery but a mental one.
This blog is a great source of info, but sometimes people go beyond discussing their own experiences and cross the line into subtly judging and questioning another persons freedom to choose what they think and feel is right. You’ve made an informed decision that you feel is the best for you and it’s hard to argue against this being the right decision.
4:27 am - 11-2-2013
Btan, if you think I question any ATR patient’s “freedom to choose what they think and feel is right” or to make “an informed decision”, I sure don’t. I think every ATR patient should be fully informed of the best evidence and given the choice. Alas, that hardly ever happens, AFAICS.
Treatment options often seem very tricky to those who take some time to read the evidence, and often seem simplest to those who’ve just made their own decision. A number of different treatment options have excellent well-demonstrated outcomes, so it’s an interesting and nuanced discussion for those who want to scratch their heads a lot.
1:15 pm - 11-2-2013
What’s up BTan. It’s nice to know there are fellow footy players on here!
Congrats on your recovery. I have a feeling my full recovery will be about the same as yours, which is fine with me. I have an aggressive goal to keep me motivated. I just want to get health and back out on the pitch.
1:56 pm - 11-2-2013
Norm, some people could argue that your comments here are backhanded compliments. I am not bothered by them personally, but please do not start arguments in comment threads on my blog. I don’t think they are productive or helpful to people that come here for information. I don’t want to have to close comments because one person is on a crusade to prove their point. Thanks for understanding.
2:23 pm - 11-2-2013
Didn’t THINK I was doing any of those things, but zipping my lip now.