Basketball Done Me Bad

Hi running doc. Thanks for the blog I too was at the Chicago R R and had a relaly great time. I am going to take full advantage of the blog and ask a couple of questions related to my run.1) I am training for the Chicago Full Marathon and a BQ (3:20). Based on my training up to this point I set a goal of 1:38-1:40 for the R R. After about mile 10 I was unable to hold this pace and finished at 1:43. I can’t think of anything I did differently (a little sleep deprived perhaps but not significant diet, prerace prep, shoes all the same). I know there are many reasons why runners have bad days what are some that I may not be considering?2) I heard two peices of advice at the expo from other runners that you may be able to comment on first, someone told me a more efficiant breathing technique is in through the nose out through the mouth seems odd to me; and second landing on the ball of the foot will result in a faster more efficiant stride. Please seperate fact from ficton here.

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Dave, great to hear the update and that you’re recovering well from a second ATR — which I confess right now would overwhelm me. Good that you can handle it. My respect & admirationfor you, man.

Ranui, I ruptured my left Achilles tendon in Oct 2011 but reasons I won’t detail here didn’t have surgery until January. This involved the FHL tendon transfer — quite possibly what your surgeon is recommending. More good info on that procedure right here: http://www.footeducation.com/flexor-hallucis-longus-fhl-tendon-transfer-to-the-achilles-tendon

(If the link doesn’t show, please google: Flexor Hallucis Longus (FHL) Tendon Transfer to the Achilles Tendon)

I’ll be six weeks out this Friday, and so can’t really give a progress report yet. But the procedure is fairly well established, and the web site gives good info.

All best to all!

Hi Dave,

Hope you are recovering well.

The first time I ruptured my Achilles tendon was during a basketball game in late October 2011. I have since re-ruptured my Achilles exactly 4 months later just from walking on it.

That fateful morning, I did the normal stretching I do in the morning and as I walked away after completing the exercises, on the 5th step I pushed off from my toes as I have been doing since the cast came off and POP it went, it was pretty much a “non event”, not much pain this time compared to the first time, but an immediate gaping hole in my Achilles was evident and an overwhelming emotional pain hit like a tsunami and flooded me. I almost went into hysterics, just thinking of what I had already been through and to have to start from square one was really hard to take.

After a few minutes I collected myself, accepted my fate once more, tried to look for positives and put things into perspective.

As timely as an Achilles re-rupture could be, the movie Touching the Void happen to on that night. Watching that guy go through his struggles, really made me feel lucky, but still can’t get over the

Hi Xsoccerplayer. Sorry to hear about your “journey.” I know your frustrations…I remember mine all too well.

My wound sounds different from your situation. After my second surgery, I had a spot of necrotic (dead) skin tissue. Plastic surgery and a skin graft was discussed but we were finally able to heal the skin. I’ll tell you what we did but with the caveat that it may not pertain to your wound.

SInce I had a circle of dead skin, at each visit he would debride it (dig the center out with a scalpel) and then I would apply silver sulfadiazine 1% cream (Silvadene) two or three times a day. I felt this cream, used for burn victims, was amazing in helping to heal the wound. Like I said, I don’t know if it will help you but between removing the dead tissue and then applying the cream, the wound healed in about two months (it had been there for two months prior).

I didn’t have any experience with stitches that were impeding the wound so I can’t offer you any advice on that. The other thing I learned the hard way, and others may tell you the same, is that you have to be your own patient advocate. This means if you are unhappy w

Daveleft, I have had two achilles tendon repair surgeries basically back to back. Now i have had a complication with healing. I have an open wound. My surgeon referred me to a plastic surgeon, who told me that one of the stitches in my tendon is very close to the surface, my skin is rejecting it and this will not let the wound heal.

THe plastic surgeon wants to open me up a third time and take out the stitches that are in my tendon. I would do anything to avoid another surgery. What can be done to help this wound heal without another surgery?

THank you so much for any insight you can give.

Thanks for posting! I really enjoyed the report. I’ve already bookmark this article.

Just to put my two cents worth in: IV contrast for an MRI (or CT for that matter) makes blood vessels stand out differently than they would without contrast. So, contrast is good for looking at vascular things or when looking for bleeding. So, yeah, contrast wouldn’t be needed to look at a tendon.

Dave, tomtom, Doug,

Thank you guys for such timely help. I had my MRI done toay and they confirmed that I did not need contrast. Now I need to wait my result sometime next week.

Thanks once again,
Marina

mshap & all - my MRI was done without contrast. The tendon was very clear in the image. However, my MRI was done 18 months after my initial surgery, so there was no swelling. I’m not sure if swelling plays a factor in the quality of the MRI. IMO, contrast wouldn’t be required, but I guess I would go along with the radiologist’s recommendation. I supppose it could be helpful if the tear is small/minor.

My MRI was done without contrast (or IV) because, as I recall, my doctor was looking simply to see if it was a full or partial tear. I suppose a contrast may be done if the doctor wants further detail to determine what extent there is of a partial tear (I was told that I could avoid surgery if it was less than a 75% tear).

The biggest problem with a possible re-rupture is that most doctors have little experience and, as a result, there is no consensus or strategy to deal with them. I discovered that you have to become proactive/self-advocate once you go into these uncharted waters.

I sent you a pm, mshap. Here’s hoping it is only a partial tear.

Dave and all,

I have had a surgery and a possible re-rupture. The person on the phone in the radiology office told me that I may be better off with contrast since I am post-op But she would not confirm.

I can not rely on my Dr who does not even talk to me. Any other suggestions?

You can get good MRI pictures of the Achilles without using contrast.

Did any of you folks who have had MRIs done have an IV placed to give contrast before your MRI?

Dave,

I really need your help asap, PLEASE. Do you remember if you had your MRI with contrast or not? I am going to get my MRI done and my jerk Dr does not know a thing. I need to know if the MRI has to be with or without contrast to show re-tier.

I appreciate your help in advance!

Sounds interesting. Thanks for info .I like You Now! (sounds weird.. should say I follow you Now!.. )

I took part of a course of one of the antibiotics in question 2 months prior to the rupture. Sad thing is it turned out I didn’t even have an infection (I had Burstis, which is not treated with antibiotoics) and was misdiagnosed - by two separate doctors- hence the reason normal antibiotics weren’t working.

I’m 6 months post surgery today and only just read this blog, and suddenly some reasons for the rupture are becoming clear.

Does anyone know if there is any evidence of long term tendon damage caused by the flouroquinolones? Or does the tendon recover a few months after taking the antibiotic?

I’m scared now.

hey there! Just checkin in with you to see how you’re doing? All is well here. Enjoying getting really moving now that my AT is really strong. Hope you are doing well!

I just found this link daveleft ….I guess I have to be the 1st on this website … http://www.medscape.com/viewarticle/588904

Hey, mandown. I wish I could answer how long it will take to heal but since it turned out I had a 100% re-rupture, a non-surgical procedure was never an option (nor discussed). If it’s any consolation, my wound issue delay probably put me on a similar time line to non-surgical and I am feeling 90% (some days 95%) at almost ten months. Even after two ruptures, my worries are lessening by the day and I am already planning to celebrate my one year anniversary by standing on the Green Monster for a ball game.

Also, from reading the blogs, it seems every re-rupture reported here was after a surgical procedure. I haven’t seen seen any non-surgical re-ruptures (although the sampling represented is small).

And like I mentioned, if it had turned out that my re-rupture was like yours, my doctor was hoping for non-surgical. Have you read mazmouza’s post:

http://achillesblog.com/mazmouza/2009/03/13/non-operative-treatment/

I wish you the best and wouldn’t stress about this. I look back at my first few months it seems so long ago and filled with so much needless worry. I know you’ll be fine.

hey dave would you know how long it would take to heal by not having the surgery after the rerupture. Mine tore about 70% and I am not having the second surgery. I am nervous about not being able to get to full strength ever again and how long do you think it will take where I do not have to be concerned about about another rerupture. Thanx

First, sorry to hear about your situation. Secondly, I will be glad to help you any way I can.

To answer your question in a word: yes. My second surgery was on top of the scar from the first. I didn’t have so much an infection but some skin necrosis. As we all know, this is one of the worst parts of the body to have surgery on because of the thinness of the skin and lack of blood flow. I had a spot that didn’t heal and filled in with slough (non-viable skin tissue). I have to chalk it up to bad luck.

I’m a little different from you because it seems you re-ruptured in the same spot. Mine was above the original rupture. Now that I’ve prefaced it, I have to be honest with you that it was much worse the second time. Besides the wound complication, my doctor and I decided to be ultra-conservative so I was in a boot for thirteen weeks. My muscle atrophy was atrocious.

But…the good news…I have almost recovered to the same size as my good leg. My doctor was very impressed. My AT is still a little stiff but it doesn’t prevent me from doing anything. The other good news is that you should be well-prepared as to wh

daveleft- do you think the second surgery caused the infection. What I mean is, did they reopen the same scar and that caused it not to heal? I’m not sure if they reopen or make a new incision. did you have any questions you wished you had asked prior to 2nd surgery. I was 5 weeks post-op, NWB, and tripped reaching for my crutches on Thurs. Having surgery again this week. They got my foot “back to neutral” last time, so I was hard cast for only 10 days. Thinking that will be worse this time. How was it for you?

I just saw…you are standing on your coffee table…how safe is that? Get OFF the furniture!!!

Aw…thanks for the shout out….I’m just now seeing your update…..a little behind…nice legs…thought you were waxing them though? (just kidding) I want to hear more about how you got your scab to finally be gone. I have silvadene, bactroban, vitamin E and lots of other potions but a little stumped. Come and visit! I met Craig during the holidays when he was in Atl. I think we need a convention! By the way…kids are still at your door…pls feed them.

daveleft - Glad to read that your calf muscle has regained a lot of its strength, and that your wound closed. Looks like your recovery is going well. Been waiting for your update, and it’s been worth the wait! Keep us posted!

Great news and great progress. Congratulations for beating the triple whammy.

Hey! Just found your site and read your story. Wow. Much admiration. Keep looking ahead and enjoying those simple things in life, Dave…it keeps getting better.

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