goldman’s AchillesBlog

Hello ATR folks — does anybody have any experience or knowledge on boots from Coreflex? One of my insurance company’s durable medical providers works (only) with Coreflex products. I had never heard of them until 5 minutes ago when I got off the phone with the rep.

To accelerated and/or improve healing of the tendon I’ve been trying to keep on the healthy eating and clean pure living that I started on 3/17/2014. So it’s been about 22 days. My initial goal was:

• zero caffeine
• zero alcohol
• zero or very low added refined sugar
• zero cigars
• Diet: Healthy eating, more vegetables, less quantity, less snacking, and supplements during the healing process in the form of: fresh fruit smoothies, multi vitamin, vitamin C, collagen heavy soups.

The scorecard:

• caffeine: almost zero, but I consumed some ice tea lately.
• alcohol: very low, two nights earlier in the week a half glass of wine + 1/4 diphenhydramine (benedrill) to help me fall asleep.
• refined sugar: some due to a bit of processed food I consumed over the past week, but overall low, no candy, cakes, donuts, ice cream, nor any other sweet treat.
• cigars: zero
• Healthy eating: Yes, three meals per day but more controlled portions, plenty of fresh fruits, vegetables (mostly fresh-frozen variety), oat bran, whole grains. Some cheese omelets, but more egg whites than yolks, and less cheese and fat than prior to March 17, some fresh fish, and slightly better quality beef in the form of grass-fed. The wife made a giant batch of homemade chicken soup in week 1 post-op. I’ve slowly been consuming that as well to get additional collagen. In the past three days I’ve had a couple meals out at restaurants, so the quality of food degraded slightly.

The benefits or perceived benefits:

• Significantly reduced bathroom visits and can “hold it” much longer than pre March 17.
• Blood pressure: I still need to calibrate my new blood pressure gadget with the Doctor’s more accurate models, but it appears that I’ve gotten my blood pressure from what was high averaging around 145/100 down to 120/80. If that is true, I can drop the Losartan, a blood pressure medication I have been taking for years.
• Weight: I’ve been extremely sedentary (which I obviously am changing now, and plan to change more in upcoming days and weeks) but have managed to lose about five-to-seven pounds.
• Statins: I’ve been taking Simvastatin also for years, to improve my cholesterol numbers. The statin works great, with no perceived side effects for me. BUT recently I read some articles that seemed to indicate that statins could be bad for tendons. I need to get over to my primary care physician to have cholesterol levels checked, but for the moment I have taken myself off the Simvastatin…
• …which means if I can remain off the Simvastatin than, other than aspirin to prevent blood clots from surgery, my prescription drugs will have been reduced to ZERO. That would be a good thing: less cost, less long term unexpected side effects.
• Energy: I have the same energy level, but my constitution is more even now sans caffeine. On the other hand coffee is my all time favorite vice, so I doubt I will be able to permanently stick to no coffee. But for now it works, and I’ve forgotten to make or buy coffee so it’s all well and good and saving me some $$.
• Tendons: ?  who knows, but I have been getting quite excellent reports from the surgeon on the incision, and he likes the way the leg looks.

later in day blood pressure update: I went to the surgeon today to get my sutures removed. while I was there I calibrated my $20 BP monitor against their $2000 variety. Turns out my monitor is reporting 5-to-10 units low   Still not so bad considering, and may still mean I can go off the losartan. And now I just ran it and it’s reporting 120/70, which would be about 130/80, which is still significantly better that two months ago, or last year.

In 2011 I had to move myself, and then my family from Albuquerque New Mexico to Massachusetts. It was a difficult time in my life. Loss of job, then cross-country job search, negotiating the offer under high pressure and tight time constraints. My wife and I had let our health insurance lapse due to the high expense, and so me driving my old 1994 Ford pickup ahead of them alone and without any health insurance and a bit paranoid something bad was going to happen to one of us or our young child in the duration between old job and new job. At the time I did have terrible back pain, unbeknownst to me I was suffering from a slipped disc, treatable but I did not yet know the cause of the pain. I had to drive much of the 2242 miles with my butt off the seat, arched and contorted. Probably not the safest driving though I had no incidents.

I had only a month or two to discover if the Massachusetts company that had hired me was good/stable/secure/sane enough to warrant moving my wife and son and 10,000 pounds of our crud cross country. I loved Albuquerque, though for sure it was not without its issues. Those of you who have watched the Breaking Bad series will have some understanding. Drugs were not as visible as in the TV show, but I knew enough people with substance abuse to resonate with the general theme. One thing that was accurate - the level of crime. The Breaking Bad glorifies it and Hollywood-ifies it, but in fact there was and I presume still is high crime rate in Albuquerque. We lived in a nice neighborhood, somewhat near downtown, yet we were periodically and regularly the victim of property crime. Luckily that was all that we suffered, but I never got used to it. I was always on my guard, waiting and watching for the next thing. A lot of people own guns there. Even your mild mannered next door Grandma has a gun. But I live in Disneyland now in the cold dense woods of New England. There is no crime here. I wouldn’t be surprised if the ratio of Albuquerque gun owners is 2x or 3x or even 10x the number of gun owners here. Yet even with all this, I loved that place. New Mexico is always sunny. The desert beautiful in its stark harsh living. One would not like living in Albuqueruque not liking or at least tolerating the color of UPS brown. The plants are brown. The dirt is brown. The buildings are brown. The people brown. The air is crisp and clean and you can see forever. The light is fantastically beautiful in myriad ways.

One of my prized possessions and take-away from my years in Albuquerque is a 2011 Triumph Thunderbird Storm motorcycle.

New Mexico is the ideal place to ride. Eight months per year, with 29 out of 30 perfect riding days per month. There are winding mountain roads leading to 10,000 foot vistas. Back country highways that stretch forever. I would sometimes start my day with a ride up Central Ave (Rte. 66) heading West out past the city limits. Five miles out of town the houses would melt and disappear until only scrub and a handful of businesses remained. I would arrive at the foot of a long 2 mile uphill grade. At which point I would gun it. The engine would scream and the Storm would shoot like a rocket. The acceleration nerve wracking and within seconds the odometer reading 100 mph. A terrifying thrill I would be white knuckle gripping the handlebars hunched low in the frame. My leather jacket tight as I could on my body but still wind whipped like a sail. After arriving at the top, exhilarated I would turn around and head back to start work, or if I was feeling particularly decadent ride North for a spin around Double Eagle Airport to watch small planes land at the strip. Nirvanna. Heaven on Earth.

And yet, it was short lived. Two months after buying the Storm my position was eliminated. I’ve lost a few jobs in my career, lifetime, but this was a particularly apple-cart upsetting one. Reason: I was tired of that unsure feeling of where the next job would come from. I was tired of the small high-tech industry there, mostly contract-to-government Sandia spin-offs. No job security. Thus began my cross country job search. Luckily I have Masters in Computer Science and even at the height, the worst part of the Great Recession, I was getting good solid leads and flown out on the interviewing company’s dime. It was hard though. Way out of practice at interviewing and in a rush to replace the lost wadges and insurance, several choice positions went by the wayside. The worst was not getting an offer to work for one of the top 10 companies in California. Live and learn. My favorite missed opportunity was with one of the high-speed algorithmic trading firms in Chicago. Long story but suffice it to say I discovered yet another industry that has money to burn, even in the middle of the recession it seemed as if it were the opposite for that company. Astounding. The other industry that never seems to run out of money is the government of course. Sandia was a fiscal conservative tax-payers nightmare. A great place to work if you are a worker. Not so great if you are on the outside. But more on Sandia in a future post. In any event I did finally secure a good, very apropos position at a company, in of all places my home growing-up town in Massachusetts. I still have family in this area, so it made sense to take the job, and move back home, so to speak.

And so I brought my darling 2011 Thunderbird Storm with me. Had it specially crated and shipped at great expense so that I could enjoy the rides among the New England evergreens and pines. The rolling hills. The beautiful lush green landscape. Ahh the joy of it, or so I thought. That is until I had to move four times in 2 years. What a royal pain in the butt to rent single-family housing in this area! Finally we sold our house in Albuquerque, bought a nice house in a suburb of Boston, with room for the Storm. The summer ended, and with all the upheaval I think I only took the Storm for about 10 rides in that two-year period, and that included commutes in to work.

BUT finally we were settled.  I was imagining and daydreaming of the rides that this spring and summer would bring. The pure utter joy. In prep over the winter I decide to try to “get back in shape”. The motorcycle is heavy at 746 pounds. I’m not a big guy so I need to be in strong shape to handle the monster, to feel safe riding it. I would need my strong legs to lift it were I to ever drop it. First some simple solo exercising. Then a friend tells me about an old-mans pickup basketball at a nearby town that he plays in. Very mellow he tells me. Ages range from around 40 to 70. Yeah! I think. That puts me right in the middle. So after hemming and hawing for a few weeks I finally make it to a game. It’s been years since I played but have a blast. I want to take it easy and only play in two games before heading home. I felt soo good, soo alive that even though both Achilles are very sore I commit to making it to the weekend game. It was the 2nd game of the morning — Goldman has the ball, drives the lane, fakes the defender quickly moving left, when pop! On the ground with that confused look of, “what the heck fell on my ankle from the ceiling of the gym!?” The other guys head over — “what happened?”  I dunno I reply, I fell, my ankle hurts. A couple of the veterans bend over, peer at my right leg for a second or two and pronounce: Achilles.

And so, that brings me to today approximately six weeks later. The spring is coming, but so is the beginning of my rehab. The Storm slumbers under my porch in its weather-proof cocoon. Waiting for the warm weather. Waiting to be ridden, fast. Waiting to shine in the sun. But by whom?

This post is about my preparation and experiences pre- and post-op for dealing with the unpleasantries of anesthesia, and minimizing the chances of other problems such as infection.

I had been researching and mulling and getting doctor second opinions on surgery for about 2.5 weeks post injury, but once I was offered a specific surgical time, I only had about 20 hours to prepare. I hate being nauseous and was concerned that the general would make me feel really crappy. So I decided to attack this problem head on in the hours before and leading up to the procedure. I constantly thought about feeling good, not dizzy. I convinced myself that If I followed all of the hospital’s advice on food and drink consumption beforehand that I would be ok. Additionally I stopped eating and drinking several hours before the hospital’s recommendations. I was aiming for as close to zero chance as I was able to control on the possibility of aspirating into my lungs during the procedure. In reality I think the number of cases that occur during surgery are pretty low, but I wanted to leave nothing to chance. The main thing I did in the 20 hours preceeding surgery was convincing myself that these actions would result in a good outcome.

While in the Orthopedics office the day before surgery we mentioned that we had read online advice for washing the leg with antiseptic cleanser, to reduce the chance of infection. The Orthopedic staff liked that we mentioned that and immediately hopped on to it to get me a special rinse. Ideally one would want to wash the area that is to be operated on for as much as 3 days prior to surgery. I only had one day, so I washed the leg twice: once when I got home from that appointment in the afternoon, and once at night right before bed.

After awaking from surgery and finding myself arriving at the recovery room, I assessed my condition. All seemed fine. No dizzyness, no nausea. In fact after a few minutes I realized that I was a bit hungry. The recovery nurses of course did not allow me anything to eat or drink. It wasn’t until about seven hours later that they give me go-ahead to order food from the hospital cafeteria — I opted for one overnight stay since I figured this would give my wife a break and the hospital nurses would be able to help me manage the situation — for example the pain meds, dispensing of the antibiotics through IV would be more efficient thereby reducing the chances of getting an infection at the incision site. The nurses in the hospital told me that their guidelines were to have patients wait until they passed gas before OK’ing eating and drinking. I presume this indicator helps to show that the patient’s plumbing is in good working order.

So all in all a great surgical experience with regards to general anesthesia and the after affects.

Tonight I stumbled on jacksprat’s 2008 post, jacksprat atr-resume. Being a computer scientist I love stuff like this, the concept behind it, and see real potential for some neat data mining to help future ATR sufferers. Anyway, So I wanted to endeavor to reproduce it, or at least some of it (it’s pretty long so I probably won’t enter in all the data).

I will start off with these sections, and add more as time goes by:

PERSONAL INFO (at time of injury)

Sex - Male
Age - 52 years
Weight - 182 lbs
Condition - Low fitness
History - Years 2004 to 2014 somewhat low fitness due to child arriving on the scene, multiple job changes, cross-country move from New Mexico to Massachusetts, followed by several more moves, finally ending so to speak with ATR on Feb 23, 2014.
- Prior to 2004: basketball, running were primary athletics

INJURY

Leg - Right
Type - ATR
When - 23 February 2014 time approx 11:30am EST
Activity - Basketball, pickup game

Response - helped off court; phone wife and friend

The following is what happened the first couple days of the incident

1) Sunday, day of accident: rode home with wife, and used a single crutch to hobble around that night

2) Monday: visit primary care Physician, who ordered X-Rays, and then arranged appointment with hospital facility to meet with Orthopedic specialists