Summer of No Fun

Saw Dr. H today (just fyi I don’t use his name because he has not chosen to be part of my on-line story, I guess. I would be happy to refer people to him off-line if you are looking for an excellent sport ortho in the N. Cal. Kaiser system.)

So…my new wound is very much more gnarly than the last one (before it got all funky). Much longer, further down my heel, lots of stitches. I now have a funny looking bump just where tendon meets the heel, which I didn’t have before. Dr. H said this is because after he cut away and dug out all the dead tissue, he had to pull and stretch skin from new areas so that healthy skin with a clean cut would meet together at the incision. While he was in there, he checked the tendon, it looked good, but he removed one of the metal loops that was possibly too close to the surface and a potential irritant.

I am in a half cast (splint) for the next week and a half, and I am not supposed to open it or change dressings at all. I am still supposed to elevate, ice behind knee, take aspirin and anti-inflamms (because no one told me to stop?). NO weight bearing at all. 4 doses of keflex per day, and may extend for another week. Might be allowed to begin PT on September 5, if no infection at next wound check. Might be allowed to weight bear after September 8 if healing is on track.

I try so hard every day to maintain a positive outlook, remember the good things. Appreciate my family, my beautiful children. Take care of myself, do everything I am supposed to do for optimal healing. But I would be lying if I didn’t admit that today my morale is very low. Leg feels terrible, and I am afraid of more wound issues…I know, wait and see. But my eyes and my body are telling me something different. Next week is my birthday, but to be honest, I want to wait and celebrate the day when this wound closes up and I can move forward with the rest of my recovery. Yay for THAT day!

Initial report from the surgery is good. No infection in the wound cavity and the tendon is healing well. All the dead tissue was removed, and the wound re-closed. I have a completely different scar this time. Lots of external stitches (all stitches were internal the first time). If the wound closes properly this time, it should move my healing forward. Yay.

On Saturday, day after surgery, I made a little detour to the ER. Turns out the post-op cast was too tight, and was pressing on a nerve in my foot. The pain was unbearable…and nothing could touch it. I think I took more percoset in the first twenty-four hours post-op than I took since this adventure began. My blood pressure was out of this world. Of course, all was improved by a looser cast…much to my relief. Never thought normal, post-op pain would feel so good!

Finally, my little guy started kindergarten today, and I made it to school to see him off. Big day for all of us.

Tomorrow I will be 5 weeks post-op.

Just saw Dr. H. Twice this week to monitor wound. It is just not healing and there is a lot of dead tissue all around the wound now. He started to clean it out at his office again, but just put the tools down and said he would prefer to not take any chances and do it in surgery. He will clean the wound, cut away the dead tissue, check to make sure that the repair is unaffected, and re-close the wound with the good tissue.

Naturally my husband is on the East Coast. So I will be dropping my kids off at camp, and going to have surgery! I’m a little worried. This wound problem has really rattled me.

Did anyone else out there have this kind of surgical procedure on their wound?

So I had to make a special visit to the surgeon today. The wound was painful and wet the last few days, and I can’t put any weight on it when standing, or find a comfortable position when sitting. Enough. Dr. H cleaned it out. He did a very thorough and deep tissue exam…He did not feel a lot of swelling or build-up under the tendon, inside the wound. When he squeezed and pressed around the incision, no pus came out, just a little blood. It seems there is a 1/2 inch wide swath of skin beside the actual incision that is dead and each time he cleans it away it doesn’t heal over. So that area has grown over the past week. Now I am not supposed to use steri-strips anymore. Just gobs of antibiotic ointment and gauze. And an oral antibiotic (keflex). I have an immune deficiency (IGA) that might be contributing to this…and I am very worried. I want this to close and dry up. Please. Going back on Thursday to have it checked again.

We moved back to SF on Friday. My four week surgery anniversary. Mr. C did a great job doing my workload and his, the packing, cleaning, kid wrangling, etc…and my dad continues to help us in any way he can (lots and lots of driving!) I scooted around doing some light cleaning and packing, and man did I break a sweat. That’s what four weeks on the couch will do! It is nice to be home, but I already miss the trees and the mountains and the sunshine. The kids are happy to be home, which surprised me as they loved Tahoe so much. One week of soccer camp and then school starts…summer went so fast.

We went to a little playground picnic for incoming Kinders, and I connected with some families from our school whose kids are in my third grader’s class, and now I am not quite as worried about all the logistics. I feel there is some support out there somewhere. As much as I loved being up in Truckee, it was isolating not to have good phone service, and being away from my home network. The logistical complications started to get the better of me.

I continue to be concerned about the wound (see 2nd post-op post), but will try to hang on until this Thursday, when I have my 3rd post-op appointment. I am supposed to take my last wedge out this week (before the visit), but am not sure I will make it. It is so painful without the last wedge, I may wait until Thursday…so on and on it goes.

This fourth week has been a difficult one for me personally. My morale has taken a nosedive, and I cry like I never thought possible, although today seems a little better already. Mr. C leaves Wednesday for a trip to the East Coast. I think if the wound would heal up, I might feel like I was making some progress….So just praying for that every night and every morning.

I am now 3 weeks post-op. I had my 2nd visit with the surgeon on Friday 8/8. Here’s how it went.

Dr. H was running about an hour late, but this is the very first time I have ever had to wait, and frankly, I could care less. I am just so glad to have found this wonderful surgeon at Kaiser, and I am so thankful that he really takes time to examine the injury and answer my questions. I had a lot of questions, but I brought my laptop so we could breeze through them.

I did really want to gauge what kind of recovery Dr. H had in mind…and it turns out that he does lean more towards the early weight bearing protocol with his ATR patients. But we talked about it, and he knows me a little from my ACL repair three years ago, and he could see that the idea of going too fast made me anxious! And that made me laugh, a hard thing to do lately! Basically, I want to make sure I minimize re-rupture risk and maximize my stability and wound healing so I can get back to my family in the best shape possible.

So that said, my wound did not look good. The incision is mostly closed with some scab forming, but adjacent to it there was an area (about 2 inches x 1/2 inch) that he said was dead tissue. He cleaned the area and said it was not too deep. He re-applied steri-strips and said to watch it carefully. I am to go in immediately if there is any change. I must say that my surgery wound is very wavy and icky looking. I thought it would be straighter, as many I have seen here. I didn’t have any external stitches, and I wonder if that has anything to do with it. Also, at my 1st post-op visit, Dr. H didn’t like the redness around my incision, and removed the steri-strips and replaced my dressing with xero-form dressing and gauze. When I went in on Friday, he was not happy with the dressing and asked who had changed it! You did! Yikes! So just hoping to get the wound healing back on track. Dr. H did say that I could now shower without covering the steri-strips, which I did this morning, and it was soooooo nice to have a complete body rinse.

Also on the agenda now is daily ROM exercise. I am supposed to sit with my leg hanging down in a relaxed position, and then point my toes and lift my toes as far as I can in each direction. No ankle movements. He was very specific about that. I am also supposed to begin putting pressure on my foot when I am standing up. I have to admit that I don’t stand up for very long unless I am using the knee walker because I still get ugly pain at the incision when I stand with my leg down for more than a few minutes. I forgot to ask Dr. H about this. Does this sound okay for three weeks post-op?

Well, I did the ROM exercises this morning. And all day I have had the most pain since those first few days after surgery. The ankle area on the outside of the leg is really nerve-y and painful, even though the swelling is very minimal since I am still keeping it up a lot. I almost feel like I am having a spasm or tightening of the tendon itself. Very uncomfortable. Generally the whole area feels very tight and stressed. Maybe icing would help…

Dr. H did say that he was very happy with the way the tendon itself is healing. Yay! I must say that it looks and feels almost like the other one. Very firm and slim, not thick and mis-shapen, which is what I was sort of expecting. So that is good news! Dr. H took out one of the heel lifts (now I am down to one), and I am supposed to take one out in one week. So by the time I return at week 5, I will be in a boot with no lifts, at 90 degrees, and putting weight on the leg. I seem to remember that several others here were taking steps at about 5 weeks? So am I falling behind due to this wound thing?

Dr. H also wanted me to start PT next week (week 4!). Due to my present circumstances (we are living up in the Sierras until next week, then the kids have a soccer camp far from home, where I will now have to stay at a hotel for a week, and then my youngest starts Kindergarten!), it turns out I can’t start PT until Sept. 5th. So I will actually be starting PT at week 7 post-op. This seems to be in line with many others who have posted here, yes?

So I also asked about going to the gym for upper body work-out and got a very quick and flat NO. No sweating until this wound is closed. Okay, I get that. Regarding some of the other various questions…yes, continue the aspirin. Keep elevating for pain, but not needed for swelling as that looks good. Compression socks, optional. Driving, we can discuss in a few weeks…might be possible. I even asked Dr. H about cholesterol affecting tendon injuries, and he felt it was far more likely that the antibiotics I have taken over the years for chronic sinus infection (including a 4 month dose several years ago of Levaquin, I think, which was in lieu of having an awful sinus surgery of my rear sinuses) could have affected my tendon rupture. So, there it is.

I see the doc again in two weeks, unless the wound deteriorates (please cross your fingers), and start PT on Sept. 5th. I have my first big milestone to look forward to, and I am so happy to have it!

Tomorrow I see the surgeon for the 2nd post-op visit. These are some of my questions:

1. What is the overall plan? Conservative or more aggressive?

2. How is the wound healing? Still a lot of pain if the leg is down for more than 10 minutes or so. And the black color at last bandage change didn’t make me feel confident in the direction I’m going.

3. What is deep tissue pain at back of lower thigh? New and very uncomfortable, and I can’t sleep because all I can think about are blood clots now.

4. Can I do more than toe-wiggling? Can I do too much toe-wiggling?

5. Can I go to the gym and do upper body work? Is that too risky?

6. Will I have to go on cholesterol-lowering medication since I can’t do aerobic exercise for so long… I was trying to control it with diet and exercise, but it was already iffy.

7. After reading the study regarding high cholesterol and thinning tendons (esp. achilles) should I have an MRI on my left achilles to see if there is significant damage? Is there anything I can do to prevent another rupture?

8. Is there a smaller boot I can wear? My leg has shrunk so much, I can’t make this one very snug anymore.

Anybody? Anything I should be asking at this stage? Anything you were really glad that you asked, or wished you had asked or clarified for yourself? Thanks, I’ll let you know how it goes tomorrow. As always, thank you to everyone for your support and encouragement! GO Go go…

Today I dropped my computer behind the couch. And goddammit but I cried.

So every day I get up, wash my face on one leg, brush my teeth on one leg, put on clean loungers on one leg. Then I drag my ass down the stairs along with my crutches. I get my knee walker and scoot to the kitchen. I get my vitamins, a big glass of water and a cup of green tea. After several trips they are all at the couch within easy reach once I sit down. Oops, I forgot to get something to eat. How about some melon. Let’s cut it up on one leg without cutting off my thumbs (I’ll need them in case I can ever sit at the piano and play my beloved instrument again).

Then I get all set up on the couch, leg elevated, I log on and the day has begun. I do feel like my computer is my only real contact with the outside world. I am up in the Sierras with no cell phone and a house phone I can’t make long distance calls on. So email is everything. Not to mention all the crosswords and games that I can play with friends online. And this site.

Then an enormous spider ran across me, followed by several baby spiders. Do you think there might be a nest nearby? Nice. So while trying not to freak out (that leg can’t just be thrown around, don’t you know), but trying to brush them away from me, I managed to launch my computer behind the couch. It didn’t land with too big a thud, but when my good pal M. kindly retrieved it for me, there was a nice dent and some mangled metal around the body. I can’t quite say how disturbing it was to think that my only hope of communication was cut off. I was very relieved when the thing not only turned on, but connected with the wireless and generally behaved normally. Phew.

And that was the highlight of my day (besides wrangling my kids to get out and PLAY!).

Today I saw an article from Archives of Orthopaedic and Trauma Surgery regarding a study that found elevated serum cholesterol in patients with achilles tendon rupture. I myself have actually had very high cholesterol since I was a teenager regardless of my weight, exercise and diet. Still trying without meds, but close to being put on them (I am 42 now). Anyone else out there that this might ring a bell with? I have to buy the article to read the whole thing…

My dad (a retired orthopedic surgeon) just changed my dressing for me. And I thought I was going to pass out. I don’t have any external stitches or staples (?) so it was just a jaggedy black incision about 4 inches long from the looks of it. IMO it looked better at the office visit last week…cleaner, straighter and smoother, just a little red. Today it looked thick and black and jaggedy…well. I thought I might throw up. My dad says it is okay, no swelling, no acute pain, the bruising around the ankle is down. But I love to second guess everyone (even Dad) and so I am worried about how black it is. Very fearful of infection as I have an immune system deficiency. Is this just part of the normal scabbing process, or should I be worried? Can I stop sobbing now?