13 months: My final post…

Well, I had intended to close my blog at 12 months post-ATR, but that date came and went without much thought and no ceremony whatsoever. So, here I am at 13 months and I’ve pretty much completely forgotten my ATR (although I’ll always have my surgical scar and bulked-up repaired Achilles to remind me). Over the past 2 months I took 2 trips out west skiing (Big Sky, MT and Copper Mountain, CO) and skied hard without any hindrance from my Achilles. I continue to stretch my Achilles and strengthen my gastroc and soleus muscles (both legs), but not as religiously as I used to do. However, I’m hoping that keeping-up this regular routine will help prevent a 2nd ATR. Going forward, I may visit this site occasionally and comment if I think I can offer some sage advice to others, but I have no more reason to blog about my own recovery–it’s done. To those of you just starting this journey, my advice is to find a good PT and work hard at your recovery so you can come out even stronger than before–it is possible. Good luck and good healing to you all! -David

10 months: What ATR?

It’s been months since I’ve posted, or even visited this site that was such a regular part of my life not so long ago. I’m back to tennis as usual, captaining my men’s USTA team and playing both doubles and singles. I’m also back to my old ways of going for (nearly) every shot on court, no matter how far away, and feel like I haven’t lost a step at all. A few weekends ago I went downhill skiing for the first time post-ATR and had a blast. Prior to going, I was actually most anxious about putting on my ski boot, which is always an effort the first time out and a strain on my feet and ankles. Having accomplished that, however, the actual skiing was less of a physical hurdle. Just because it was my first time out since my ATR, I was a little tentative to start, but quickly got over that and went back to my normal style. I skied 2 full days with no problem whatsoever. With that first positive experience, I’ve now planned 2 ski trips out west over the next couple of months and am really looking forward to them.

Although not as religiously as before, I continue to stretch my Achilles, Soleus, and Gastroc muscles regularly and also work on my single-leg heel raises. I haven’t measured, but would say I’m back to full height now on my (formerly) injured leg. However, it took a while to get that last 25%. Key to achieving this for me has been to work primarily on gaining full height by way of a double-leg heel raise and then switching to one-leg and holding at full height before the eccentric contraction to the floor. In fact, I did this exclusively for a couple of months before going back to work on a single-leg heel raise. Now I do both.

Anyways, I just wanted to give those of you in the early stages of recovery some encouragement that you will get through this and you can get back to a very active lifestyle again. When it’s in front of you, it seems like it takes forever. When it’s behind you it doesn’t seem so long at all. The best advice I have is to really, really, really adhere to a physical therapy regimen. The more work you put in, the better off you will be–you may even be better than before your ATR! The healing power of the human body is quite amazing. Good luck and good healing to you all.

ATR Recovery: A Full Accounting (USD)

Well, now that I have all my doctor and PT visits in the rear-view mirror, I did an accounting of the expense of my ATR recovery. I know this is only tangentially related to the purpose of this site, but I thought someone might find this interesting and/or useful. As this was the largest medical expense I’ve ever incurred, I found it very illuminating.

The grand total billed amount for my ATR (ER visit, pre-op care, surgery, and post-op care) was $22,833. My health insurance company negotiated that amount down by 33.5%* to $15,192. Of this paid amount, $1,263 (or 8.3%) can be attributed to pre-op care, $6,247 (or 41.1%) can be attributed to my surgery, and $7,681 (or 50.6%) can be attributed to post-op care, mainly PT. After hitting my health insurance policy’s maximum out-of-pocket expenses shortly after surgery, I did not skimp on my PT as it was all covered. If it were my money, I wouldn’t have consumed as much (professional) PT as I did.

Clearly, another advantage of pursuing the non-op ATR recovery route is the expense. Over 40% of my ATR recovery expense came from my surgery–and 75% of that was for the surgical center and the anesthesiologist. The more I learn, the more attractive the non-op recovery route appears to me.

As an interesting aside, the day before my surgery my OS’ billing office called and offered me a 20% discount if I paid in cash tomorrow (i.e. before my surgery). I have a high-deductible health insurance plan and at first I thought what a great deal! However, after thinking about it further, I decided against their generous offer. I knew my out-of-pocket expenses as a result of this injury would be my annual deductible, so why pay anything any sooner than necessary. Also, I was curious about what my health insurance company would be able to negotiate–and at a 23%* discount, they did slightly better.

In the end, I’m very happy with my recovery outcome, but if I had to do it over again (I sincerely hope not!) I’m nearly certain I would go non-op–less risk, less expense, and very possibly the same or better outcome.

*33.5% was the dollar-weighted average negotiated discount for all of my ATR care, with a range of individually billed items discounted anywhere from 10% to 77%.

6-3/4 months: All Clear!

Today I had my 6th and, likely, final appointment with my OS post-ATR surgery. It was very short and rather anti-climactic, but in this case that’s a good thing. My OS had already been briefed by my PT and he did only a quick manual inspection of my Achilles and ROM for his own confirmation. He asked me if I had any concerns and, honestly, I don’t. Everything looks (and feels, and performs) good (well), and he released me without restrictions–no more asterisk on my all clear assessment! He doesn’t need to see me again–unless I want to see him. As I’ve stated before, this has been a traumatic experience for me–but one which has ended (so far) on a positive note and I feel stronger in many ways for meeting the challenge of it all. This blog has been a big part of my recovery and I’ll continue to monitor and share if I think I might be able to help someone else. My best advice to others is to be disciplined about your PT. Take care everyone–may you all come through this as well or better than me.

6-1/2 months: Last PT appt :-)

Today was my last PT session–my PT said he was graduating me! Next week I see my OS, and expect to be given the all clear. I feel very good about my recovery and feel very confident in my Achilles function and strength. It was a devastating injury for me, but in many ways I feel like I have grown stronger as a result. By my PT’s own calculations, overall I have regained about 95% of my strength and functionality when measured against my other leg. Given that my other leg (right) is also my dominant leg, there may have always been a slight discrepancy between sides and, therefore, I might actually be back (or even closer) to full strength. In any event, it’s close enough for my PT to cut me loose.

I am to continue working on calf strengthening on my own, but there seem to be diminishing marginal returns going forward. My PT measured my heel raises today, for reference. On my double leg heel raises, my maximum heights were 14.5 cm R and 13 cm L (ATR)–so, a 1.5 cm deficiency in my injured leg. On my single leg heel raises, my maximum heights were 11.5 cm R and 10 cm L (ATR)–so, the same 1.5 cm deficiency. These were all done with knees kept straight, but I am to practice knee-bent heel raises as well–to work on my soleus muscles. I’ll post again after my OS appointment next week, but then will likely sign-off from regular posts–as normal life resumes. Take care, everyone!

6 months: All Clear!*

Today is exactly 6 months since my ATR surgery and I feel like I’m nearly back to full strength and function. I’m not 100%, but close enough that I feel like I can now remove “Achilles recovery” from the number 1, 2, and 3 spots on my ongoing to-do list. At my weekly PT appointment yesterday my therapist gave me the Y-Balance Test (return to sport readiness) for the 2nd time. If interested, you can read more about this test on my blog entry from week 17 on July 10th, 2014. At that time (the 4-month mark) my results pinpointed a limitation in my active (bent knee) dorsiflexion and I’ve been focusing on that aspect of my recovery ever since. My test results today improved across the board, but most importantly in the area of weakness (anterior stretch) from my previous test. My injured leg continues to score higher (better) than my uninjured leg overall, but the difference is less (that’s good) and the between-the-legs differences in the different directions of the test are closer in alignment (also good) than before. All of this merely confirms what I already know and feel–that I’m fully ready to go back to sports and my PT concurs.

*The asterisk on my “all clear” refers to the fact that I don’t see my OS next until 3 weeks from now and will wait for the official word from him. But, at this point, I think it’s a formality. My activity is unhindered and my strength is nearing 100%. I rode my bike for 45 miles this past Sunday without any issues during or afterwards. I’ve been playing tennis now for the past month (limiting myself to doubles), but feeling like I could play singles. I continue to do stretching and heel raises (I can do reps of 30 single-leg heel raises at about 80% the height of my uninjured leg), but have otherwise significantly cut-back on my at-home PT. At my appointments, I feel as if my PT is running-out of things for me to do. Yesterday they had me do single-leg long jumps across a gym floor with the instruction to “stick the landing” each time. I did this on each leg–forwards and backwards. There’s only a slight difference noticeable between my legs and part of this is mental as I still have a little more confidence in my uninjured leg. My PT also places cones on the gym floor and has me run forwards, backwards, diagonally, and sideways with quick cuts at each cone–sometimes throwing a ball to me to catch and return at the same time. It’s a good agility workout for anyone, not just ATR patients, and I really don’t feel any difference between my two legs.

While my strength and function (including ROM) have been regained, I still experience some tightness in my Achilles and there remain telltale signs of my injury that will likely never completely go away. I still have a “fat tire” at the back of my ankle when compared to my uninjured leg–with a visible 3 inch “battle” scar from my open surgery. My affected leg’s calf girth remains 2 cm less than my other leg–although both have increased 3 cm since last measured at week 16 (now 38 and 40 cm, respectively). In all, it’s been a long road to recovery, but I’m very pleased with my progress and overall condition at this time. I’m also grateful for all the help I’ve received from my family, my OS, my PTs, my friends, and this blog community–I couldn’t have gotten to this point without all of it. The lessons I’ll take with me from PT going forward are to continue daily stretching and strength exercises and practice dynamic warm-up before sport and cool-down and stretch afterwards. There’s no guarantee this will prevent future injury, but I consider it an insurance premium worth paying to remain as active as possible as long as possible. The life lessons I’ll take with me are to be more patient, to not take my good health and mobility for granted and to be more understanding towards those less fortunate. I’ll post a follow-up note after my next OS visit and, hopefully, officially remove the asterisk from my preliminary “all clear” assessment. In the meantime, good luck and good healing to all of you!

5-months: How time flies!

Today is exactly 5-months since my open ATR surgery. To mark the occasion, I played my first tennis match in as many months. In fact, I played doubles for 2 hours (3 sets) this morning and felt great! (I’m going to hold-off on singles, however, for a while–probably another month or two.) My game is clearly rusty, but I felt very confident in my Achilles and only pulled-up and/or let go a few shots that were wide or deep, but mine to go after. I bring this up because just a few months ago I was seriously questioning my return to tennis and sport in general for fear of re-rupture, but I have to say that that was not foremost on my mind today at all. So, for those of you at an earlier stage of recovery, I just want to let you know that not only will you physically heal, but as you do, your confidence will likely improve as well. I know it can be hard to see–especially when you’re hobbling around on crutches–but it will happen, so stay strong and keep up with your PT! Happy healing all!

Week 21: Getting stronger…

Not much new to report. My recovery continues to move forward and I feel like my Achilles and calf muscles are getting stronger every day now. My PT sessions have switched to hopping on 1 foot (at the balance bar), resistance walking (forward, backwards, and sideways–using a bungee cord tied around my waist), and agility drills running forwards, backwards, and sideways–somewhat simulating tennis situations. As I tell my PTs, this is far more satisfying than writing the alphabet with my toes–how far I’ve come! At home, I’ve begun light running this week and am alternating this with bike rides every other day. Tuesday and today (Thursday) I took a 13 mile bike ride in just under an hour. Wednesday I ran just over a mile, in 3 parts. There’s a park near my house with a paved path around it that’s just over a third of a mile. I’ve been alternating running and walking loops. On Monday I did two loops each (running and walking), while yesterday I did three–as Norm counsels, it’s all about incrementalism to avoid painful setbacks. This weekend I have plans to get back on the tennis court for a friendly doubles match, which I’m really looking forward to. I know everyone heals at a different pace and, after a slow start, I seem to be on the faster side now. I hope everyone gets to experience a fast “leg” at some point during their recovery. Next week is my 5-month mark (hard to believe!) and I anticipate reducing the frequency of my posts to monthly thereafter–hopefully, it’s all good news from here on out!

Week 20: Back on the tennis court!

I had my 20 week follow-up visit with my OS this week. It lasted all of 10 minutes–max. He asked me how I was doing and I said “good, although my dorsiflexion ROM was still tight”. He had me show him my ROM and he thought it looked excellent. At this stage, minimally tight dorsiflexion does not concern him at all–he would be concerned if it was too loose (i.e. healing “long”). Then he had me show him my single-leg heel raises and he seemed pleased. Finally, he said he had reviewed a report from my PT and said I was ready to ease back into sports which, for me, is tennis. He said go slow and start by just hitting and, later, playing some doubles. Wow! He wants to see me again in 2 months to, hopefully, confirm that I’m back to my old form–that would be great!

That was two days ago. Today I arranged to hit balls with a friend–I was both excited and a little apprehensive. Overall, it felt really good. I was pretty careful not to chase after wide balls and we only played for an hour. My strokes were, not surprisingly, rusty. However, this was a major milestone–to move back to both the scene of the crime (my ATR) and the sport I love. Hopefully, this is just the beginning of getting totally back to normal–it seems achievable now!

Week 19: In the Red Zone

Life is pretty good at this stage, but I feel like a football (American) team in the red zone where progress becomes much more difficult. I walk without a limp and my push-off strength is good. I can cycle reasonably long distances (I did another 30 mile bike ride this week) at nearly full strength. I’m up to 25 single heel raises, but my height is lacking–still only about 2/3 of my good leg, and that’s probably only the first 10. At PT I continue to focus on single heel raises, balance, stretching, and slightly more aggressive and light-impact movement: shuttle jumping, light (real) jumping, skipping, and side-shuffles. My main physical challenge now remains improving my dorsiflexion ROM, particularly with knee bent–this is still quite tight. My main mental challenge is to stay motivated to continue to work on my PT at home. At about 85% (my subjective measure) of my pre-ATR condition, the payback from PT seems a little less compelling and I’ve been letting it slide. On the positive side, my PT took some measurements today on my range of motion and I’ve added 5 degrees over the past 3 weeks: I now have 8 degrees (up from 6) of dorsiflexion and 52 degrees (up from 49) of plantarflexion–for a total of 60 degrees (up from 55). Next week I have my 20 week follow-up with my OS; I’m hoping for clearance to step things up a bit and get back on the tennis court at least for some hitting. I think I’m ready.