Daveleft,
I laughed when I read your note about the shower…I, too, had my first standing up shower in months this week!!! I was using the chair (out of fear, I think) all this time. And you are so right about the simple things…who knew that a shower could feel so good! I still keep it in the corner, just in case, but hopefully I will let it go soon. Last week I actually went to the pool with my kids and “swam”. Scary but amazing.
Cheers,
hilary13

Daveleft - So glad to hear the wound woes are a thing of the past. You’ve definitely earned some good news.

Oh yes…Kristin, you will have a pretty leg again very soon. You are done with the hard part. And like you tell your kids: don’t pick at the scab.

Thanks for all the support. I have to say that this site truly helped me get through two ATRs and a wound complication.

My other huge milestone this weekend was that I took a normal shower for the first time in over six months! I had been using a chair the entire time. I can’t tell you how good it felt to stand there and let the water cascade. Wow. The simple things indeed.

Limp is getting better by the day, scar is in pretty good shape and I am wearing sandals. Next thing you know, I’ll be playing basketball again. But then again, not sure about that one. Thanks y’all! See you at Mile 26.2 soon!

No WAY! If I wouldn’t have seen the pics I wouldn’t have believed. Maybe mine will look like that soon!!! Thanks for your message the other day. I’m trying to stop the merry-go-round of Scab, Scab split, raw skin, scab, scab split, raw skin. Maybe I’ll swab out Bactroban with Silvadene and that will be the magic potion. I read Marianne’s comment about that lady that had the screw removed. Interesting, because the plastic screw broke off on my hard bones, so had to use a metal screw…hmmm… CONGRATS on CLOSURE! How PRETTY YOUR LEG LOOKS!

Dave, glad to see that your wound has healed and that you’ve overcome the infection. Your heel looks really good! congratulations!

Way to go Dave!

You’ve come a long way! Impressive stuff.

Hi Dave,

Thanks so much for sharing these pictures! A quick click and we get the “picture” of how much you have through

I met a lady yesterday with an ankle injury. She had been dealing with a open wound for nearly a year post surgery on her ankle. FINALLY the wound center got the Doc on the phone and said it wasn’t gonna heal unless he went back in and removed a screw and plate which she showed me. Ten Days post op post removal and so far the wound is closed and healing fine. Hopefully her broken ankle will be
healed now too despite having these removed.

Sorry you were one of the few with this problem but thanks for sharing this as it is a good resource to empower patients.

MarilynRD

Dave,

I’m a new fan, but a real one. Love your work, admire your attitude even more.

Big time congratulations,

Despina

Hi Dave,
Your wound is looking really good!! I am so happy you are healing. Your scar looks way better than mine, even after 3 surgeries! I am at 16 weeks from original surgery, but only 9 weeks from last wound surgery…and I cannot even imagine what you have endured with all the debridements in the office. I think in retrospect I am glad they put me out and just opened it up again. I don’t know. Just trying to put a good spin on it.
I hope that you are now putting this all behind you…and getting back to your life. Your challenges were so great, but hopefully you will feel an even greater sense of enrichment as you return to your regularly scheduled programs! Hurray for you!
hilary

OMG — what you have been through! You must have wondered many times over the last few months — why me? It really does not seem fair.

I think your last picture looks FANTASTIC! Congratulations on beating the double whammy.

Dave-Hey there! I have a scab question for you…and while I am the wound queen, you are the scab king. Do you still have my number? If not, can you email me with your number again? Thanks!

I am also doing home PT at Week 16 - ortho doc said at Week 8 I didn’t need PT. Yes,it’s cheaper! Meanwhile, a slight limp continues off and on, which I take as normal, and to be patient with. However, I was taking a busload of surgeons around on my tourguide job again, and mentioned this ATR. The one PT amongst them was SHOCKED that I had been given no PT, and that explained the limp, she said. I asked the busload, “Do you all agree?” The surgeons - mostly young, residents generally, shrugged. “Each patient is different, hard to say.” “Just give it time”; “There’s a lot you can do on your own, just walking anyway”. So the orthodocs and PT’s do not agree on everything, as I had surmised. One young surgeon asked how much experience my surgeon had had. I said, “Well, he was about 65, I think plenty of it; he was very casual about it.” The young fellow answered, “Then he knew what he was saying.” THe PT lady was outraged at such dismissal of her services. She insisted I go back to my “old ortho doc” and insist on PT being prescribed.
Mary

Thanks, y’all! The support here has been amazing.

Just got back from my doctor. Wound is now 1mm by 4mm…and closing. After debridement (digging out the junk), we couldn’t see the tendon! That’s a good thing, obviously. Got a few more stretching exercises prescribed–sitting with knee bent, pushing against wall–but no PT. Oh well, guess it’s cheaper that way. AT is feeling good and looking forward to the six month mark.

Dave, Im back to dipping BUT only when I play…prob is I play almost everyday, hahaha! Oh well Im glad you are doing well bud!

Daveleft - Glad to hear you’re continuing to heal. It’s been a rough road, but you’ve had the right attitude all along. Here’s to continued healing now that you’re back in two shoes.

daveleft - Glad to hear that you are 2-shoes now. Congrats! It was a long road, but you’ve made it in stride. Looking forward to reading your next post.

Congrats! My jeep also had the battery die due to lack of driving. But alas, am driving again!

Great Job….you have been through more than most. Good job not abandoning any kids.

Daveleft,
I was so so happy to read your post! Congratulations! Two shoes, wound closing, all good news.

And driving? I am so very jealous. I haven’t driven since July 13. Yikes. Will I remember how?

I am about to start PT today, but Kaiser only offers 30 minutes/week and I am wondering how this will possibly help? I seem to have a lot of scar tissue or adhesions or something under the scar…but then I read that your dr. doesn’t feel it is necessary at all? Just have to wait and see I guess. More adventures ahead, I am sure!

All my best on your road to recovery, enjoy the open road!
hilary13

You are sweet. But, pls answer the door….they won’t leave until you answer it. And, they are out of water, so pls set more out outside your door today.

Great you can drive! Sounds like your limp is better than mine. OK, so now I have this scab and it’s really big. I knew how to do wound care, but weird because now the Dr. has me putting cream on it if it’s really dry, but not covering. I cld him yesterday to ask why we are changing our tune from “leave it covered and moist.” He said that the skin will be re-molding and re-shaping itself over the next couple mths and that if we leave it covered now the skin won’t start acting like normal skin. I guess if you leave the scab covered all the time it will just be like you kept it in water for a long time. Still a little unsure of the new way of thinking, but it’s nice to leave it open. And, a little at a time, as you know, the scab will come off and hopefully the skin underneath will be great. I felt like I knew it all before for wound care, but I’m a little new with the whole scab care thing. Now, I keep looking at everyone’s post surgery incisions and mine still looks big and

Daveleft, you got the triple whammy - ATR, rerupture and wound closure issues…..so it was with great happiness that I read your post. People say that summer flew. I thought it was a long summer. But for you it must have been one of the longest and most frustrating.

I am so glad you are on the mend. Enjoy the boring and safe exercises — your time will come when you are ready.

Dave-Hey there! Well, today more than 1/2 of my wound is closed. And, there’s a portion at the top that still needs to close. Yeah! And, even when it’s closed it takes a while for the tissue to thicken up…so, we always have to be careful until enough time has passed. Anyway, I wanted to let you know that my wound folks have used that honey substance a couple of times on my wound. It’s supposed to help granulated tissue to develop. Bee-have…get it?!?!? Keep me posted on your little hole too.

Morning Dave,

Manuka Honey - absolutely swear by it. Lots of reasons, but the main one was last year I had a very bad chest infection and been on antibiotics for nearly 2 months and nothing would clear it, I started taking Manuka Honey (the high strength, they come in numbers from 5 to 25) it is quite expensive, but tastes terrific and after a week my infection had cleared. I take 1 teaspoonful a day now, either straight from the jar or on toast, yummy!!

It helps to heal in different ways, and you can also put it on wounds as well. We have a local TV and Radio celeb Chemist who is fantastic and we went to his shop and he told us about the honey.

Try it and see what you think.

Annie

So glad that your hole is not as holey! Really, great news for you! Yippee! Yep, I know all of my ortho and his staff’s days off, vacation days, etc…we’re like family..but family that I don’t want to keep visiting all the time. At least I get free ace wraps every now and then. Woohoo…like Christmas!

Doctor’s appointment #…um…I lost count. For all of you who begrudge the fact you only get a few minutes of the doctor’s time, watch out what you wish for–I get to see my doctor (nice guy) every week (standing appointment on Wednesdays)! In fact, my doctor told me he woke up yesterday and was wondering if I was coming into the office that day (no) and was praying that my wound was healing (yes). The good news is that after debridement (digging a hole into my leg) of the slough (the icky yellow stuff), it mostly filled in with granulation (beginning of skin). The slough is about 1/3 the size it was a week ago. Knock on wood but I may have turned the corner. I continue to apply the Silvadene (antibacterial ointment cream) and will see him, yes, again next week. On Wednesday.

I am still in the boot after twelve weeks post-op. He is being even more conservative than I imagined. But no complaints here. I just want a healthy leg back. Hope the rest of Team ATR continues to heal.

Well hello, Doctor B! Appointment is tomorrow. But the good news, I think, is that the hole–after last week’s debridement–has rapidly filled in and is mostly granulation…the slough is now about 1/3 the size it was before. Needless to say, very pleased about that. Will see what the other doctor says tomorrow.

And thank you for all of your support. Now we have to help hillary13 along.

Dave-Hey! Dr. Brahm checking in with you. I think your Dr. appt is today. Let me know what your doc says. I asked the wound ctr why we nded to do 2 grafts, and if we didn’t do them would it have just taken longer to heal. They responded that it’s really hard sometimes for skin to grow over tendon. So, the grafts provide a barrier over the tendon to help skin fill in. Keep me posted.

Hi Dave,

I may be too late for advice re your wound. About 10 years ago I had a very bad deep burn to my foot, dropped a dish straigh from the oven onto my foot complete with food which by the time I scraped it off and had run to put my foot under the cold shower, I had really messed up my foot. After treatment by my local nurse practicioner nothing was working. Eventually it began to scab over but was still not healing underneath.

A visit to my local chemist shop solved my problem. …Plaster it with vaseline she said, keep it on in the bath, shower and night it is a perfect barrier but still allows healing underneath…. The result fantastic, healed incredibly quickly, it is still badly marked but very supple. When I returned to see the nurse she was very impressed. I now always have vaseline (not sure if it has the same name in other countries) and use it to cover cuts etc.

Annie

You are most welcome. My wound is hanging in there. Basically the hole has filled in to be level, and I have a little skin “island” in the center. So, what happens is lots of skin islands come in..and that’s what closes the hole. Also, I forgot to tell you, the pink stuff in your wound is good, nice granulated tissue…so, you want the pink stuff. P.S. My kids are on their way to you. They are in a gator ride-on toy, so it should be a few hours to go from Georgia to California. They’ll see you shortly, so please leave the light on for them.

Again…THANK YOU, Dr. Brahm! And thanks to your wound people. Appreciate the information.

And I hope your wound is going away as well. Wanna race?

I meant to say “black” part…not “back” part…typing too fast.

Dr. Brahm here-Hey there! I showed my wound Dr. your picture and here are his comments:
- the white stuff is what they refer to as “slough.” He said it would be good to remove some of that slough and also it would be good to stimulate the area
- the back part he said looks like a scab. And, some time the scab should come off. In the picture he couldn’t tell what’s under the scab, meaning…is there a hole under there or not a hole under there.
- it’s good it isn’t red around the area, that’s great
- Advises no to getting it wet because woudn center protocol is that water contaminates the wound.
So, like we talked about, it’s best to keep it covered and use the cleaning agents, and clean 1-2 times per week.
I hope that helps. May your wound get smaller all the time! -Dr. Brahm

Hi Daveleft,

Thanks for protocol. I was wondering if the re-rupture group had a slower protocol. Not wanting to be the only one on the planet to do this a third time — I am lobbying for the conservative approach. But I was not sure what that looked like. Thank you so much it is good to have an idea of what’s to come.

Catherine

You’re doing great 2nd timer. I’m happy to help. Behave yourself! In exchange for your Dr. visit cop-pays to me, you can pay me in babysitting. My kids are scheduled on the next flight out to CA. Thanks in advance for homeschooling them all year. You’re the best!

THANK YOU! Really appreciate the answer. Not only incredibly informative but gives me some serious peace of mind…just put on a small dab of Neopsorin (to prevent it from cracking), a fresh bandage and back into the boot! Now I know what I should be doing as opposed to guessing. Please thank the staff from me as well.

I was asking about the scar issue only from a functional point-of-view. I want to minimize friction and flexibility problems. My scar appearance is not a big deal to me…as a guy. More a badge of honor. A hard earned one, that is.

Although the wound center people seem great, hope your visits begin to curtail shortly. Thanks a bunch!

Dave-Hey there. I asked both my Dr and his nurse about your wound. The scab coming off was a good thing because it needed to come off so the wound will heal. And, wound ctr folks believe in moist healing. Moisture–an essential for keeping every cell in the body alive and functioning–is central to that ideal healing environment. That means, keeping the wound covered all the time. If you change dressing frequently, the wound area cools down..and it takes about 6 hours for it to warm up again. So, infrequent dressing changes, and a moist environment is good. The key is to provide the best possible healing environment and to simply let the body proceed with the healing process without subjecting the wound to interventions that interfere with repair like strong cleaning things..no no to betadine and hydrogen perozide. Also, if the wound is really dry you can use an antibiotic cream that has moisture like Bactroban. So, keep your wound covered. I asked them about the scarring issue to, but then they forgot to answer that one. I can tell you though…and I’m a girl…I’m not too worried about a scar…and mine’s been a big hole for a lo

Dave, Hey there! I’ll ask my team of little wound Dr’s tomorrow. I’ll let them know your scab opened up. And, what to do to promote healing and reduce scarring. I’ll update you tomorrow afternoon.

Thanks for any help! Going through my wound issues which, in the scheme of things, are minor compared to your issues, I have tremendous empathy for you.

I’m just planning to continue to air out my wound. I appreciate you asking your wound people. I want to know if I should treat it with anything in order to expedite healing and/or minimize scarring. It’s not bothering me and seems a little better every day. But, as you certainly know, it’s just such a slow process.

And hopefully, you will have the same scab questions too. Sooner than later, that is.

Hey there. I’ve learned a lot from wound care these past mths. I just went to wound ctr today, but I return on Thursday and I’ll ask the dr then on your behalf. They are experts and they’ve been awesome for me. I read the one person saying use hydrogen peroxide. I’ve learned that you only use that to initially clean a wound, but never after. Because you’ll remove the good cells too. It sounds like everything is closed so that’s great for you. For an open wound, they don’t want it to wet, not too dry. SInce yours is closed I would think it’s fine to leave it alone and let it get air. If it starts to itch a lot around the area, you could use an antifungal creme around it…that’s what they put on me. Again, I’ll ask on Thursday for you.

I really appreciate your blog. It is good to know someone else that is going thru a second rupture - although I am sorry that any of us had to go through this.. My second surgery was Tuesday, July 21. I am in a cast and will be for 4 to 6 weeks.
To help with your scab Is it ok to soak in warm water with epson salts? Would that help soften the scab? I wouldn’t do anything without doctor’s ok. BTW I changed doctors because my first doc was not a specialist in this kind of injury and didn’t seem to be very helpful with information. I like the second one much better. I just hope and pray that I will one day be able to walk again. -

Really appreciate the advice/opinions, Team ATR. Thank you.

daveleft ,

imo - there are pros and cons of a wound scab.
the pros - it keeps the wound closed to keep off infection
the cons - it makes healing slow

IF and thats a big if - we are doing wound care / management - usually it is preferred to remove the scab and treat it accordingly . but since you are not in wound care/management i think they just wat you to leave it alone till it drops off.

thats just my opnion .

I’ve been using a cream called bepanthen. It is used on babies for nappy rash and also i used it in tattoos for better repair. it has helped the scar look better

My doc was very explicit - NO neosporin - just soap and water. I have also been using hydrogen peroxide on it once a day.

The key is to keep it out of the boot as much as possible - for me, at least, the boot was the wound’s worst enemy…

Ed

wow. i have never heard of this before, but like so many others, i have taken these drugs many times over the last 3 years for recurrent sinus infections. in fact, i was on levaquin for 4 months about 2 years ago because it was that or sinus surgery at that point. oh dear. really good to know for the future.

Here’s some more info:

http://achillesblog.com/posts-worth-reading/drugs-that-can-increase-your-risk-of-atr/

Wow - I have taken about 4 courses of Levaquin over the last 5-6 years, for recurrent sinus infections. This is very interesting . . . I think I will avoid it in the future!
Jen

Thanks for doing my homework Dave.
-Jim

This is insane. In the 3 months before my injury I took 2 courses of Cipro generic meds to combat an ear infection. This warning has come a bit late I guess!

Hey, I took Levaquin a week AFTER my achilles surgery for a UTI. It was given to me at the ER. I had developed a fever and had called my achilles surgeon and he wanted me to go to the ER we thought maybe Ihad an infection. It worried me because I thought it would affect the healing process and I’m wondering now if its causing the scar tissue tearing? I dunno, who knows anymore about this stuff.

Cathy

From Reuters:

The estimated risk of tendon ruptures is about three to four times higher with fluoroquinolones, said Dr. Renata Albrecht, head of the FDA’s division of special pathogen and transplant products. The rate in the general population is about 1 in 100,000, Albrecht said.

Most cases involve the Achilles tendon, which attaches the calf muscle to the heel. Less frequent ruptures affected tendons in the shoulders, biceps, hands and elsewhere

On the same theme of drug interactions I noticed in a web search the other day that statins (cholesterol related drugs like lypitor and crestor) show up with tendon related side effects and occasional rupture. I wonder how many of us are taking these ? I was prescribed crestor 8 months prior to my atr incident. Any of you guys on these drugs also ?

P.

That is quite frightening.

It is not a drug I have heard of, so I don’t think I have every had it, but I will certainly check any antibiotic in future and check it out thoroughly.

Great bit of research
Annie

Wow, I just saw this too. I have taken ALL of the drugs listed (except one) over the last four years to counter recurrent kindey infections. I have had more antibiotics in my system in the last four years than I have had total in the rest of my life. If ever there was a candidate for this to happen to…

I have to read more about this.

Wow.

Jim,

You piqued my interest. This is from the FDA site:

“Tendon rupture can occur during or after completion of fluoroquinolone use; cases occurring up to several months after completion of therapy have been reported.”

http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm

And this is from a longer AP story:

“FDA officials said they had received several hundred reports of tendon ruptures, but would not cite a specific number. Sidney Wolfe, of Public Citizen, said the number was 407 at the end of 2007, with another 341 reports of tendinitis.”

The thing I can’t seem to figure out is whether this is only while taking the drug, for a specific time afterwards, or once you have taken the drug, the damage is done. None of these articles mention that.

Dave:

My doc put me in a knee-high aircast boot - has been working well. The air pockets are particularly helpful - I forget who on the site recommended this, but messing with how inflated the pockets are allows my AT and calf more or less mobility (depending on how I am feeling and whether I want to stretch it a bit)…

Ed

David - It looks like link doesn’t work.. can you post the picture again? I’ll also put it on the main site and mention that it’s not as supportive as the knee-high boots. thanks.

Thanks, Dennis. Changed the dressing and it’s getting closer to being healed over. Man, it’s taking a long while this time.

My first boot was only up to mid-calf:

http://achillesblog.com/daveleft/files/2008/05/boot.jpg

I have to say my new boot, which goes up almost to my knee and has three support straps on the leg, really does feel a thousand times more supportive. I was told the first boot helps prevent calf atrophy. Well, it might but it also leaves you at severe risk for a re-rupture…IMHO.

daveleft -

Glad to hear that you are progressing nicely, and that your incision wound is getting better..
Tall boot? Did your original boot that you re-ruptured on come up to your knees?