goldman’s AchillesBlog

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

Went to surgeon today ostensibly for sutures removal. He gave me an A+ for healing. I had followed the elevation, aspirin, and no-falling protocol religiously the past two weeks. On top of that — pure and free clean living, coupled with: a super healthy diet full of veggies, collagen rich chicken soup that my wonderful wife made, vitamin C, multivitamin, fruit smoothies with little to no processed sugar, bran muffins, eggs with low cheese, some Indian food chicken and vegetarian dishes, and only small portions of bread products, herbal teas and water… well except for the aches and pains from favoring my right leg I felt pretty good about the progress so far.  Zero infection, wound, nor any other issues. BUT Doc decides he, err we my wife and I are doing such a good job adhering to protocol best to rotate foot slightly dorsiflex, cast in nicer lighter fiberglass material, and return in one week for the real deal. Well there ya have it - my first two weeks post op.

The family drew nice get well messages on my new cast:.

new shiny fiberglass cast

4/8/2014 update: one important note: Even though I had an excellent first appointment post-op with surgeon it is possible to have too much bed rest. I spent the first 7 days in bed most of the time, as in 23.5 hours per day, elevating elevating elevating, working on the laptop, then elevating some more. And the 2nd week I probably spent something close to 20 hours per day in bed. Too much, should have gotten out of bed more and used wheelchair a little less and done more crutching — because it took the whole week last week of using crutches and wheeling around the house to start to get back and able to get around and feel somewhat normal. My 30 minute car ride into work yesterday courtesy of the wife - I used crutches around the office, and took the train home. But I could only take about 4 hours of that before I was exhausted and had to head home, and that included about an hour in the break room elevating and napping on the couch. Now, after some sleeps I feel much better. So we’ll see how the cast-suture appointment goes with Doc later today.

Like others on this site I analyzed my habits pre-injury and post-injury and, at least while I am recovering and healing, but hopefully moving forward I endeavor to improve my diet.

Four vices that I really enjoy, but think contributed to the reasons I suffered an ATR:

a) Caffeine in the form of coffee

b) Alcohol in the form of beer, mostly but occassionly wines and spirits

c) Refined sugar in the form of processed food treats: candy, donuts, cakes, etc.

d) Tobacco - once or twice a month cigar.

The most noticeable beneficial outcome of reducing all these four to ZERO or near zero levels (refined sugar is VERY hard to cut out because almost all processed foods are made with it) is less visits to the bathroom to pee, which for me during recovery means less in-the-middle-of-the-night-groggy-navigating-prone-to-error-and-falling episodes. So while surely the reduced bathroom visits are mostly due to the elimination of caffeine and alcoholic products, I figure getting rid of refined sugar (completely unnecessary for normal healthy living and functioning) and the tobacco are helpful as well.

4/1 update on this topic: I was thinking about how variety is the spice of life. And everything in moderation yada yada. So I think what I am coming around to is merely replacing a percentage of my favorite vices with exercise. So I don’t want to rule them out completely forever, but simply that I was spending too little time exercising, stretching, relaxing, and paying attention to diet, and more time consuming the delicious junk because it made me happy, or so I thought. But I am pretty unhappy with the current state of affairs, looking at weeks and weeks of no driving, the cast, the boot, the rehab, etc. etc. So for me, I was out of balance.