No, I wasn’t dancing.

I’ve been postponing writing while I’ve tried to get the courage to take a photo of my foot, but I’m not there yet.  Even with a scar running from my heel to my calf, I’m still so vain that I won’t let anyone see my foot until my beauty therapist will wax it - and on Thursday, she still refused!  So I still have a really handsome furry boot coming halfway up my left leg!

So what did I mean when I said that my foot was pretty?  To say that my surgeon (let’s call him Dr D) was astonished when he saw how good my foot looked when he saw it last Tuesday, for my 8 weeks-post-op appointment, would not be an exaggeration.  Even I’m not totally grossed out.  I had not been doing anything but elevating it as much as I could, which has been:
a. at least half the weekend;
b. every day from 7pm until I go to sleep at around midnight;
c. 2/5 weekdays almost the entire day (I’ve pushed working at home to 2 days a week, in a very unofficial way!).

Dr D told me that I could go straight to FWB.  “Really?  You know I haven’t even put it on the ground yet, right?”.  He was for serious!  I can’t describe how liberated I felt - and that was before he said that in the next three weeks, he wanted me to go from FWB in the boot with 2 crutches, to FWB in the boot with 1 crutch, to FWB in the boot, to no boot but to two really sweet chunky heeled John Fluevogs I bought when I first tore my achilles (admittedly, he didn’t remember that they were Fluevogs).

Honestly, that’s a tip for the ladies: John Fleuvog makes great, supportive, nicely heeled shoes.  They are expensive, but you can often get them on special.  Actually, they make mens shoes also.  Check them out online: http://www.fluevog.com/

Anyway, after 8 weeks hopping around on crutches, it is a great relief to be able to put my foot on the ground and to even pretend to walk (but for the crutches I’m leaning on for support).  My PT isn’t sure whether or not we are going to make this all of a sudden ambitious goal of my surgeon, but we’re going to try.  When I saw my PT (let’s call him “A”) last, my foot was at -3 degrees.  A told me that it was at -21 when I started, and if it is to get to where my right foot is, it’s got to get to +19.  So I’m almost halfway there.

PT Exercises

My daily stretching routine is:
a. flexing and pointing my foot up and down for 5 sets of 20 slow and 20 fast, alternating sets lying down with my leg in the air and then sitting down with my leg ahead of me.  When doing the sets on my back, I need to hold my leg up in the air for 5 minutes;
b. foot exercises with a blue band, pushing right with left resistance, left with right resistance, and back with forward resistance; and
c. doing this crazy new thing whereby I try to isolate my big toe and move it to the right 20 times, and then isolate my left toe and move it to the left 20 times (activates foot muscles); and
d. holding both ends of a towel (one in my right hand and one in my left), looping it around the bottom of my foot, and then pulling my foot back to get the biggest stretch that I can, and holding for a minute, twice.

I do a, b and c at least twice a day, and d. 5 times a day.  Most times, I now rub some mederma (scar reduction) gel into the wound (but for that little part that is yet to completely close up).

Every night, I wrap my foot up in a bandage creating something of a splint to hold my foot in a not-quite-uncomfortable stretch, and I unwrap it each morning (unless I do what I did last night, which is unwrap it in the middle of the night because the bandage was digging into the palm (?) of my foot!

I go to see my PT on Monday, Wednesday and Friday evenings.  I started on the exercise bike on Wednesday: I lasted 4 minutes before my achilles was exhausted (I never knew that you used your achilles to ride a bike - I’m quickly realizing that you use your achilles to do almost everything!).  A told me that prior to each PT session, I should now come in for heat and a ride of the bike.  A wanted 10 minutes on Friday.  I did 15!  I’m planning to up it by at least 5 minutes per session from now on.  Maybe this week I’ll get to break a sweat!

How My Surgeon Dealt with a Shrunken Achilles

When I saw Dr D on Tuesday, I remembered to ask him “what it had looked like in there”.  He explained that because my injury was 9 weeks old, two things had occurred:
a. there was a lot of scar tissue around my achilles; and
b. the two ends of my achilles had shrunk away from eachother.

Both of these issues had to be dealt with.  The first was easy: he just scraped away the scar tissue, leaving “fresh” achilles with which to play.  The second was more difficult.  The two ends of my achilles were too far away from each other to just be pulled towards each other; they wouldn’t make it.  So he did something that he assured me was a recognized surgical technique:  Imagine one of those elastic resistance bands we use for strength building.  Cut it in two horizontally, and put the pieces a foot apart from each other.  If you stretch them, they won’t meet each other.  But if you cut a “V” shape in the top one, you’ll be able to pull it down to meet the bottom one.  That’s the technique: the surgeon basically inflicts a second acute tear on your achilles (albeit a much prettier one than you did yourself) to enable the two ends to be brought to meet each other and sewn together.  The new tear is also sewn back together.  Both tears heal at the same time (although I’m guessing that the second one heals quicker).  Interesting!

Progress

I found out at PT on Friday that I’d not been putting enough weight on my foot; A told me to go for it more.  Was initially apprehensive but eventually quite excited to be given permission to do so.  Yesterday, I walked from St Marks Avenue and Flatbush to the Prospect Park market (and back), and in the evening I walked from 6th Ave & W15th St to W23rd between 5th & 6th.  Felt just fine.  I’ve spent most of today working on the couch.  When walking, I’m trying to rely on my crutches as little as possible, walking just like a regular person (apart from the props!).  I’m finding that my ankle is a bit thicker than it has been when it was not suffering under the burden of my (now increased) weight, but that must be to be expected.  I’m told that once I build my calf muscle back up again, the swelling will subside.

I’m finding myself looking foward to my PT sessions every couple of days, even though A spends at least 5-10 minutes each time digging his fingers into my scar to break up the scar tissue underneath.  Now that I can ride a bike, I’m scared at how much I’m looking forward to it!  Maybe tomorrow I’ll bring my Ipod . . . !

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My goal for today is to write a blog entry that is not frivolous.  I’m going to try very, very hard.  So please find below my attempt to impart some knowledge / lessons learned / stuff that might help anyone who has just started on the road to ATR.

But before we even go to ATR, what if you don’t even know that you have an AT to R?  If you think that you have a serious achilles injury - say, because your ankle is a balloon, and has been a balloon for, say, the past two weeks - don’t feel bad about asking your doctor to refer you to a surgeon, just in case it is something more serious than a minor sprain.   Take it from someone who only found out that she had been walking around on the tiniest strand of achilles for 8 weeks after those few strands finally snapped under the enormous pressure of . . . walking across the street.  In high heels, just like she was told to do.

OK.  Here are a few things that might make your life easier post-surgery:

1. If the drugs make you sick, try dealing with the pain.  I was so much  happier after I stopped taking heavy duty codeine after a day or so; tylenol took the edge off enough for me to feel ok.

2. Feel no guilt about not doing very much at all but watching Project Runway reruns or whatever your bad-tv of choice is.  I know that you are probably normally a very active person.  But you can’t help that this is going to have to change, just for a tiny, little while.

3. Number 2. notwithstanding, get out of the apartment/house every day as soon as you can make it down the stairs/out the door.  Fresh air makes us feel better.  A little bit of physical activity by way of crutching oneself around will make you feel even better still.  Even better if it’s to your favorite local burger joint / cafe.

4. While you can’t do whatever it is that you normally do, do something else (ok, once the novelty of bad tv has worn off).  Others have given me this advice, and with good reason.  Always wanted to learn to play guitar?  Learn a language?  Draw?  There’s heaps of stuff you can do from the couch.

5. Cooking is not one of them.  Cooking requires standing up, something that I think that we are best advised to avoid during the prescribed elevation period (whatever that is).  Further, we’re  not nimble enough to deal with knives and pots and hot oil flying about etc.  If there is no one else who can cook, and if you can afford it, order stuff in: the more homemade-ish, the better, of course.   Order in groceries if you can, too. 

6. If you are going back to work prior to being able to walk because you have a desk job, work with whoever it is who will listen to you in order to make your workspace ATR friendly.  Have a good place to rest your foot while you work (I use a couple of upturned recycling bins).  If you have an office door, let everyone know that you are going to shut it every so often to stick your legs up against the wall, and if you don’t have an office door, find a place (a sick room, perhaps?) where you can have some privacy to do the same, there.  See if you can get a printer within arms reach, and if not, make sure that someone is prepared to fetch your printing for you.  I have someone fetch lunch for me when I order it, and I don’t feel any guilt about it; it’s what I need to if I am to go to work.

7. A few extra things for work.  Get a big, comfy backpack, and use it.  Carry a flask with you if you like to grab a coffee from a coffee shop, and ask them to use the flask for your coffee or just pour it into the flask yourself, pop it in your backpack, and you’re on your way.  Get some tupperware-type stuff, and put anything that you would normally need to carry from the kitchen into that (eg, I put my cheerios and milk into a container when in the kitchen, pop the container in my backpack, and crutch the few steps back to my office).

8. If you can work from home, do it.  That said, if you can go to work, do it.  Que?  By this, I mean do both.  I was home for the week prior to my surgery and then for the two weeks after my operation.  I could feel myself getting a bit depressed while I was at home.  On my first day back at work, I was so excited that I stayed until 12.30am.  Yay, people!  I’ve worked out a happy medium now: I stay home one day a week, and on other days, I leave at 4-5pm to go to my PT 3 days a week, and on the remaining day, I usually leave by 5-6pm anyway.  If I have more work to do in the evening, I do it from home.  Ditto on the weekends.  That way, I ’stay in touch’ with work, but I ensure that I am elevating my foot for a good chunk of the 4 days I’m at work, and for even more time on the other 3 days of the week.

OK, all this talk of work is making me think of it, and now I’m getting anxious.  Will post more tips later this week; I haven’t even gotten to the best way to take a shower!

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The Initial Injury

I used to play tennis all the time before I moved to New York from Australia over two years ago.  But dancing flamenco 6-12 hours a week is easier to do here than play tennis, and so I filled in much of my spare time stomping and clapping and generally making a lot of noise.

I jumped at the opportunity to play tennis at my firm’s outing on July 21, and perhaps I became a little competitive at deuce on my serve, and went a little crazy on the court, reaching for what was going to be a stellar crosscourt backhand, when someone hit the back of my left ankle and I fell to the ground.

“Did someone just hit me?”

Everyone looked at me like I was crazy.  No, I had just fallen down.  I was assured that it was just a slight sprain, and so I iced my left foot for an hour before making my way to the pool to hang out and go for a little paddle.  In the evening, I stayed for drinks, standing in my friend’s flip flops, and at home that evening I iced my foot some more.

The Initial Diagnosis

Upon seeing me walk the next day, the doctor told me that he was pretty sure that it was just a minor sprain, but that he would have a physical therapist check me out.  It was the physical therapist who broke the news to me that I had indeed torn some of my achilles and that I would need about 3 months of rehabilitation before I could dance again.  This was quite devastating.

We asked my insurer for an MRI to confirm the diagnosis, but they refused.  In the meantime, we worked on rehabilitating my achilles.  I was practically escatic when I had a workers compensation claim approved and was granted permission to get an MRI.  We had a few mix ups with the MRI place, and the first time I went there, they would not see me. 

Finishing the Job

After being rejected by the MRI place, I decided to visit my husband, Pete, at work, nearby.  As I walked, reading an email from Pete advising me to go home and rest my foot, I rolled my ankle and felt a much tinier slap than the one I felt when my achilles was first torn.  But I realised that I had just aggravated the situation.   It was not a happy day.

The Second Diagnosis

When I next saw my doctor, he sent me to a surgeon.  The surgeon advised me that it looked like I had torn my achilles in two, and it was his opinion that I had done most of the damage 8 weeks earlier.  He scheduled me for surgery the next week, and in the meantime, had his diagnosis confirmed with an MRI.   I liked the surgeon; he actually had interpersonal skills, which I understood was quite novel for an orthopod.

Surgery - Day 1 - September 24

I was given a local anaesthetic and sedated, which I highly recommend, even if you, like me, happen to wake up as soon as they’ve cut your leg open.  It was a little disconcerting to note the silence, only punctuated by sighs, amongst the doctors as they had the first chance to look at my poor achilles.  My surgeon then piped up, “well, it’s very old”.  I then listened as they worked out a strategy for how they were going to sew my achilles back together.  Towards the end, the anaesthetist assistant realized that I was awake and asked if I wanted more drugs, but I declined; it was kind of reassuring listening to the doctors.  I was glad to be awake at the end, when a person who I was guessing was a surgical registrar, gave the surgeon compliments such as, “awesome!” and “cool!”.

I was put in a splint and sent home once I had feeling back everywhere and could walk on crutches.  I then climbed two flights of stairs and watched Lipstick Jungle with my husband, Pete.  I felt ok.

Recovery Begins

I was sick the next day and the day after that, until I realized that it was the pain killers which were making me nauseus.  So I stopped taking those, preferring to deal with the pain with the help of over-the-counter tylenol.  The pain went away after a few more days, anyway.

I just elevated my foot for a week or so (my instructions were to elevate for a couple of days only!) and didn’t leave the house until a week after the operation, when I went for a ‘walk’ around the block to dinner.  I’m 34 years old and was fairly fit prior to the injury, but I think that the two months of inactivity prior to the operation rendered me pretty unfit, and just travelling the length of two houses on crutches was tiring, and I had to stop for about 30 seconds every so often.

From that day, I ensured that I went outside for a ‘walk’ every day, in order to get used to the crutches.  It worked.  My strength built up pretty quickly.  My arms are quite nice, now.  Pity about my disappearing calves and jello thighs.

Why this is a hassle

By great or terrible timing, depending upon which way you look at it, we had planned to move apartments 10 days after my surgery.  The great thing about this was that we were moving to a ground floor unit; the problem was that I wouldn’t be able to help very much with the move, and further, I wouldn’t be able to be of much help with unpacking, either.  It’s been a month already, and I still don’t know where a lot of my stuff is.

Each new leg immobilizer is a step forward

Anyway, recovery.  I saw my surgeon two weeks after the surgery, and he removed the splint, told me that my leg didn’t look as nearly as bad as he thought that it would, took out the staples that were holding my wound together, and put my leg in a fiberglass cast up to my knee. 

Back to Work

On Day 13, when I was put in the fiberglass cast, I was told that I could go back to work, and that while ideally I should elevate my leg, it wouldn’t hurt to keep it on the ground.

That, I think, isn’t the best advice I’ve received.  I know that elevating your leg is one of the best things that you can do to reduce swelling, and that even having my leg at right angles to my body for 8 hours a day is better than having it on the ground, and that having it resting above my heart is even better.

So, I decided to work from home for a day a week, and limit my time to work to regular business hours, taking work home with me to do in the evening on those occasions when I would have normally stayed at work.

Liberating my leg and learning that an achilles is not an elastic band

After 3 weeks in the fiberglass cast, my surgeon removed it, put me in a removable boot, and referred me to a physical therapist, with the strict instructions that there be no weight bearing, and that my visits be exclusively to stretch out my achilles to 90 degrees, prepping me for my next step, putting my left foot on the ground to attempt walking with the support of crutches.  I am seeing my surgeon at the 8 week mark, on November 18 to get the all clear to go ahead with this stage of the plan.

Day 44 Status Report

So, today, at Day 44, this is my status:
- I am not to allow my foot to touch the ground.
- I walk with crutches, wearing a boot for protection.
- my ankle is still swollen, but it is slowly getting better.  My foot doesn’t look so ugly, really.
- I go to physical therapy 3 evenings a week, at a wonderful place specializing in getting dancers back to dancing.
- my achilles will not yet let my foot go to a right angle to my leg, and has made little progress since my second physical therapy visit, last Friday.   My PT was going to ask my surgeon if he could apply a little more pressure to stretch it out; I will find out the answer tomorrow.
- my right achilles hurts sometimes from the extra strain.  My surgeon told me not to worry about it.  My physical therapist wasn’t so reassuring.  I am trying to not hop too much on it and rely on my crutches as much as possible.
- I do “point and flex” exercises every morning and evening (and sometimes during the day) , and foot strengthening exercises with a band.  I ice-heat-ice-heat-ice my achilles and ankle each evening.

What I should expect from my recovery

My surgeon advised me that due to the significant lag between the initial injury and my surgery, my recovery would be longer than usual, but that it would be complete.  Eventually.  He advised that I should be ‘pretty much’ healed after 6 months, but that I could not expect to run or do flamenco dancing until about a year after the surgery.  The litmus test will be single calf raises that scare the crappers out me just thinking about them.

Why I go a little loco every so often

I am usually a very active and social person, and not dancing, not walking about the streets, needing to avoid crowds and being reluctant to go to bars has been detrimental to my emotional well being.  I miss the buzz of exercise, I miss breathing fresh air in the park, and I miss just feeling free.

I have not been as productive at work as I usually am; it is difficult to work between home and the office, and half the time the material I need is not at hand.  I do not have the luxury of just working for 16 hours straight if that is what I feel like doing.

I dislike not being able to do housework, and I am frustrated that doing something very simple turns into a major operation, if it is going to happen at all.

I try not to dwell on the bad advice that I received when I first injured myself.  I cannot believe that I described to my doctor and my (then) physical therapist the large thud I felt at the back of  my foot, and that I was not referred to a surgeon.  My foot was enormous.  In the first week, I could hardly walk at all.  As it turns out, I was rehabilitating a few strands of achilles for 8 weeks.

Why I need to get a grip and get some perspective

But then I tell myself that it will get better, and that I should be grateful for the fact that this is not a permanent condition.  It is just temporary.  It’s time to catch up on the news, on reading, on writing.

These are the things I do to keep my mind off what has happened, and where I am right now, and what I am missing out on.  I’m just looking forward to each step towards recovery.

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