Surgical Consult

I met with the new foot and ankle surgical specialist on 11-13-12, two days after my “incident”.  It was a pretty straight forward visit. The PA came in first and removed the cast splint. Then he did the same exam that had been done by the PAs before in the ER.  He got the same results- basically my calf was no longer attached to my heel.  He explained the process of what all would happen during the visit that day and left to get the Doctor.

I think my experience with the doctor was pretty similar to what most people have gone through. But I felt like the most important part was the fact that the discussion revolved around me.  He explained the issues of surgical vs non-surgical treatments, recovery, rehab, management and future return to activity.  We both came to the conclusion that surgery would be the best option for me as I’m on the young side and want to return to a fairly high level of activity when all is said and done.

This was also the first time that anyone really took a look at my MRI to say anything other than ‘yup, it’s ruptured’. The Doc explained to me that my tear was higher up the tendon (closer to the calf muscle) and that while he thought surgery was still possible, it was going to be a little bit tougher.  It was also going to make it necessary for him to have a plan A and plan B in regards to his approach. And lastly it was going to make him want to tend towards the conservative side with time periods for my recovery.

Thus far in the whole experience, I hadn’t felt at all nauseous. But when we began to discuss that I would be NWB for 4-6 weeks and 100% NOT going to be able to work for a minimum of 2 weeks but more likely 4 weeks due to the nature of my work, I needed to lay down.  From reading the blogs on here I had certainly read and understood what I was looking to in the future, but it hits hard when it’s told to you and in terms of your life.  Once I picked myself back up a little, I was told that I would be sent home in a raised heel boot and could schedule the surgery for either that Friday or the next Monday depending on what my insurance would approve.

I was switched off of Asprin and onto Xarelto (which is apparently the newest ‘go to’ anti-coagulant for orthopedic surgeons). I was also given an Rx for a lot more Percocet. I was taking 1 tab about every 4-5 hours to keep the pain under control. And over the next week or so before my surgery, I would occasionally skip a dose if I wasn’t gonna be moving around too much.  That seemed to work out pretty well for me.

We scheduled the surgery for Monday, 11-19-12.  And over the week, sorted out all the details that needed to be in place for my future care.  I was very lucky that my family has pretty flexible work schedules/employers so they are able to basically come live with me until I’m more or less under my own power. It’s absolutely essential.  The week after the initial diagnosis can be extremely depressing when you start to think about stuff that you’re missing out on and just the shear amount of simple things that you can’t do while on crutches. Sure, I could get around a little on the crutches but it was painful and I couldn’t carry anything. I do suggest wearing hooded sweatshirts with the front pockets on the belly. It’s just enough to give you a little feeling of independence.

More to come about the surgery tomorrow.


#1 Lisa on 11.20.12 at 10:04 pm

As goofy as it may seem you should definitely consider a knee scooter. Best of luck with the surgery and recovery.

#2 kkirk on 11.20.12 at 10:49 pm

The best things I invest in were the knee scooter ( made cleaning and cooking possible) and a small gym pack to carry things while I was crunching around. It sounds like you are getting good care and explanations and trust me I know the feeling having been 6 weeks NWB and just about ready to move on to the next phase. Hence, the many, many posts on this site :)

#3 normofthenorth on 11.23.12 at 12:09 am

Yes, pockets, bags, fanny packs, backpacks. . . are all your friends while you’re on crutches. Also wheeled chairs and screw-top travel mugs that are actually waterproof (and coffee-proof)!

It would have been fun — or maybe just frustrating — for me to be a fly on the wall while you were being informed of the facts concerning your options. Many old-school docs continue to preach that surgery produces a stronger AT and calf, though the most recent scientific studies (randomized trials) lend no support to that theory. The latest one — “UWO” published in 2010 — generally shows a small and statistically insignificant strength bias in favor of the surgical patients, with one end-point showing a “significant” benefit on the surgical side. Meanwhile, the 2007 study from New Zealand also showed only one strength end-point that was significantly different, and the non-op patients were significantly stronger (in that one measurement) than the post-op, surgical ones. Not much to choose, if you believe the evidence, IMHO.

Similarly, I have seen NO evidence that going slower in rehab improves outcomes, whether it’s for upper-shin ATRs or any other kind. But most surgeons share a quasi-religious belief that going slower is safer, more “conservative”, and less likely to have bad outcomes. The evidence is somewhere between neutral (i.e., there’s no benefit of dawdling) and contrary (it leads to worse outcomes). Several studies examining both questions are linked from the Studies and Protocols page that’s on the Main Page of this website, if you like reading studies (or abstracts).

Finally, if you can install the ATR Timeline Widget, we’ll be able to answer our FAQs and keep up with your schedule, so our answers to your Qs are well informed.

Good luck, and good healing!

#4 alysbach on 11.23.12 at 10:13 am

good luck I was 7 weeks nwb and am still not allowed to work once you start moving progress is fast, this blog is great for information and support, please read my creased clothes post as I wish I had read something like it when I was so positive it would have helped to know that we all hit the bottom but honestly it has been all up since,

#5 brokenbride on 11.23.12 at 7:52 pm

I really don’t want to get into a non-op vs operative debate but I have to speak up and agree with Norm. Why? I hope that I can help future ATR patients make an informed decision.

I WANTED surgery - went back three times to ask for it. I was reading to much old info on the web that misinformed me. Every time I returned, my doctor said surgery could be done the next day, but he strongly recommended that I don’t do it. Finally I found this blog and was at peace with my decision. It makes my doctor laugh that a blog convinced me and not him.

I really don’t want to come off as smug, but I read this blog daily and have to say, I’m not suffering from half the issues most ATR patients are going through. I’ve had zero pain (other than when the rupture happened), no scar, very little swelling and I’m in two shoes 7 weeks later (they’re Crocs mind you - ick).

It upsets me when I hear doctors say “if you want to be active again, get the surgery”. I fully plan on being active again and will be skiing in March. Check out Brady Browne on youtube - he’s a non-op pro athlete whose livelihood relies on a full recovery.

Sorry Dog Doc for hijacking your post/forum and getting on my soap box now. I’ve been holding it in : )

Good luck with the healing. Stay positive and strong. K

#6 dogdoc on 11.23.12 at 8:40 pm

No worries. I’m a doctor so I didn’t go into this surgery oblivious. There is a saying ‘a chance to cut, is a chance to cure’. I’m, however, not a firm believer in that mantra. I just didn’t see any way in my head where the mechanics of the joint would be returned to pre-rupture status without surgery. I understand the concept of non-op and that there are studies that show it as having less complications. There are definitely two sides to the discussion but at this point I’m 100% committed to my surgical and post-surgical recovery.

#7 normofthenorth on 11.24.12 at 1:08 am

DogDoc, I admit that you almost have to believe in magic to believe that a torn AT (attached to a clenched calf muscle) can heal at its original length “by itself”, without somebody digging out the ends, sticking them together, then sewing them together. Except for the evidence that it does seems to work, provided a good rehab protocol is used. Not 100% of the time, but about the same % of the time as surgery.

But you’ve already had the surgery now, haven’t you? You’ve got lots of time to concentrate on healing and recovering instead of debating or second-guessing, while we here concentrate on supporting you and answering your Qs. And maybe if you’re active enough and unlucky enough to join me (and others) in the “Both Sides Now” club(!), you’ll eventually give the other approach a chance, too. ;-)

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