Hood’s AchillesBlog

WARNING: I AM INCLUDING SOME GRAPHIC PICS OF MY REPAIR IN THIS POST. FYI.

So it’s 1 day after re-repair of my Achilles. I spent the 11 days in between my injury and re-repair in a CAM walker. At first I couldn’t put any weight on it at all, but the day before my case I was walking around painlessly with just the boot. I could completely dorsi- and plantarflex without pain. I couldn’t walk around without the boot but it really made me doubt whether I needed the surgery at all. I planned to ask the surgeon prior to doing all the necessary stuff in the preop area, but they moved so fast at the hospital that I didn’t even talk to him before the anesthesiologist had given me some sedation, and at that point, I didn’t really care what they did.

I chose to do spinal anesthesia again with peripheral nerve blocks. I requested a short acting spinal agent so I would be able to hop up the stairs to my apartment after I got home. The anesthesiologist was surprisingly rigid in her plan and said she would give me a longer-acting medication in case it wore off while I was on my stomach. Being an anesthesiologist, I was less than pleased. For those of you about to have this surgery, it should only take an hour or so and agents such as mepivacaine and demerol will be more than enough. If they use bupivacaine (which is what I got), you won’t be able to stand on your good leg for 6 hours or so. They also convinced me to have the sciatic catheter again, even though last time I felt the saphenous block was more effective. I’m glad they did, because even now, my foot is numb and I have no pain. I don’t know why the catheter wasn’t this effective last time.

The block and the spinal went well and the surgery only took 40 minutes, which I spent listening to music. Here’s a pic of my tendon prior to repair.

My surgeon said (and you can see) that it was completely ruptured, so I’m glad I went through with it. Now a picture of what it looked like at the end of the repair.

After they closed, they put me in a splint, which I’ll wear for two weeks. After the surgery, I spent about 30 minutes in post-op before they tried to discharge me. My dad basically had to put his foot down and make them let me stay, as I couldn’t move either leg at this point. We hung out for about 90 more minutes, at which point I could move my left thigh but not my lower leg. I was wheeled out to my car and 3 people helped me into the car. We went to get my prescriptions and some dinner. Whole thing took about an hour, and by the time we got home I could bear a little weight on my left leg. I rode my scooter to the stairs and used the railings to get up, which wasn’t too bad actually.

Today I’m hanging out on the couch and watching TV. The sciatic catheter is still working well and I haven’t had to take any pain pills yet. I ordered another apparatus from goodbyecrutches.com so hopefully this week I’ll be a little more mobile at work and actually be able to do my job. This is what I got. Once I’m a little more proficient at it, I’ll get a picture up of it.

Well it’s been 7 days since my rerupture. They haven’t been the most fun, as I noted in my last post. Hopping around on one leg is terrible, but the knee scooter is really helping me out, yet again. If you’re currently on crutches and reading this, stop reading, and go here . You can also order these things on eBay for $200. They pay for themselves almost immediately.

Anyways, I made it down to Houston rather uneventfully. I had a packed bookbag, my crutches tied together and strapped to my back, and my knee scooter. It was quite the getup. I gate checked the scooter and shoved the crutches in the overhead. Everyone was very nice and accommodating. It could have gone much worse. I was able to drive myself back to my apartment, which was good, since I drive a manual. I have been wearing the CAM walker pretty much non-stop just to give me some stability. I try to sleep in it to avoid any weird calf contractions and the pain they bring, but I always end up taking it off in the middle of the night because it is so hot. My calf has completely atrophied back to where it was 3 weeks ago after a week of non-use.

I saw my new surgeon today. Granted I am bitter about my past experience, but I got a really good feel from this guy. The staff was nice and the office ran like a machine. He came right in and saw me and actually asked me questions, did a real exam, and quoted literature when explaining his thought process. From his exam, he thinks that perhaps there is a little bit of tendon still in continuity, but for the most part it is reruptured. He said that if I went non-operative for this one, it might be really hard for the two ends of the tendon to reapproximate. He strongly advised surgery (he’s a surgeon, that’s what they do), and said he could do it this week. So I’ll be having operation #2 in 2 or 4 days.I’m planning on spinal anesthesia again, with single-shot sciatic and saphenous blocks for post-op pain control. I don’t think the sciatic catheter helped much at all last time - just left me feeling numb in an area that didn’t really hurt. At least I hope it didn’t do that much. I guess I wouldn’t really know if it was or wasn’t working since I was completely numb.

My dad is being AWESOME and coming down from Maine to drive me home from surgery and look after me for a  bit. I am living on the 2nd floor of a new apartment complex and it will not be easy for the first few days. Another update to come in 2 or 4 days.

Well, I hobbled around for 3 days before my surgeon could see me. I kept the ankle wrapped in clean gauze and an ACE bandage to keep it somewhat immobilized. It’s weird - at first, the injury was only mildly painful, and I still had good dorsi- and plantarflexion. But as time crept on the pain increased. I got some significant bruising on my lateral ankle and dorsiflexing at all was very painful. I was back on my crutches/scooter, and reminded how terrible non-weight-bearing is. It really is awful.

A couple bad experiences while not immobilized: 1) when I start to fall asleep, my legs kick (I’m one of those weirdos). Every time they did this my calf muscles contracted and pulled on my retorn tendon. Not a fun way to fall asleep. 2) Trying to take stairs too quickly on crutches and falling down 5-6 steps. My wife, who weighs a little more than half of me, was at the landing below, and tried to catch me. It did not end well for her. She said that she would have felt terrible if she had just moved out of the way though. Just ended with some cuts and scrapes after that one.

Anyways, went to my orthopod yesterday. They confirmed the rerupture with the Thompson’s test. He said the defect isn’t as large as the first time, whatever that means, but he recommends surgical repair. He was less than sympathetic. I asked him if maybe I had been weakening the repair with all the walking I had been doing, since I had started having increased pain around my ankle. He said that no, that was a normal part of the rehab process, and I probably just overstressed it with my jump into the water. Ugh. Anyways, I got out of there with a new leg apparatus, which surprisingly is one that he never gave me during my initial recovery.

The weird thing is, it keeps me closer to neutral, which is more painful then just a splint with equinus.

If there’s any advice I can give to those in recovery, it’s not to rush the rehab process. It’s actually the same advice that the guy who sold me my knee scooter gave me, and I clearly summarily ignored. Don’t think that you’re going to be to 100% in 2 months. It just doesn’t happen. Take your time. It’s not worth throwing 8-10 weeks away.

I’m heading down to Houston in 2 days and am seeing a new orthopod down there. I assume he’ll also recommend surgery, which I assume I will have. It’s frustrating to basically waste 10-14 days in the walker before going to the OR, but I guess we have to do what we have to do. Another update to follow that appointment.

POD 61. Also happened to the day of my boards, which is the test that certifies me to actually do my job. It was a big day. I felt fine in the morning. Was gimping around the test center ok. Finished up the test and went down to Starbucks to wait for my friends. One of them came down and I suggested that we go to the grocery store to pick up some stuff, as we were heading out on Lake Michigan once everyone was finished. Why did I suggest this? I don’t know. I had vowed to myself to walk as little as possible this week, as I was a little worried about how bad my ankle had been feeling during my move to Houston. Instead I decided to walk 3/4 of a mile to the grocery store and then back carrying groceries. My ankle was not feeling great. We met up with the other test-takers and got in a cab to head to the dock. I got on the boat, took off my shoes, and put my feet up. I had a beer. I felt good. The biggest test of my life was over, I felt ok about it, and I was hanging out on a beautiful boat on Lake Michigan with sunny, 85 degree weather. Things were good.

I decided to get in the water. I had read that swimming was good resistance training for the tendon, without putting too much stress on it. I got a little raft ready, stood on the edge of the boat, and hopped in. I knew right away that I had retorn it. I felt the separation before I hit the water. I reached down and could feel the discontinuity in the tendon. I can’t tell you how crushed I was. Almost 9 weeks - gone. I got out of the water and looked at it. My incision had opened up a little too, which was very weird, and I was bleeding a good bit. I wrapped it in gauze and an ACE bandage and got on the phone to my ortho friends. I am scheduled to see my surgeon tomorrow.

I don’t know what I’m going to do at this point. I start my new job in 5 days, but I assume I’m going to be non-weight-bearing for at least 6 weeks. Do I have surgery again or go non-operative this time? The advantage to surgery is reduced chance of rerupture. Right. Yesterday, I sat in bed and read all the rerupture blogs. They really helped. Thanks guys. Today I decided that I was done feeling sorry for myself and have tried to be productive. That has included making this entire blog. I guess I’ll have more to report tomorrow. Until then, I’m keeping it wrapped up, elevated when possible, and I’m back on the scooter.

The first two weeks in the wedges were very confusing for me. Was I supposed to be in any pain at all? Should I walk around a lot, some, just a little? Should I use my scooter or crutches sometimes, and just build up to more activity? Unfortunately, I couldn’t start PT as I was in between residency and fellowship, and didn’t have insurance. Apparently I had Cobra, but it was going to be a real pain to get it set up, so I decided to just start PT when I was down in Houston and had started my new job (August 6th). In the meantime, I did ROM and alphabet exercises 2-3 times a day. There were days when I felt great. My tendon always felt worse at the end of the day, rather than at the beginning, as it seems other people’s do. I was walking with a noticeable limp, which is normal, I guess, but I hated it. When I tried to walk normally, I could feel little twinges on the lateral part of my tendon.There were other days that were pretty miserable all around, and I was having pain pretty much throughout.

I moved into my new place in Houston on July 28th. I had to walk across some soft sod while moving furniture and my heel kind of sunk in the mud and really stretched the tendon out. I should have stopped then, but I finished up moving and hopped on a plane back to Chicago that day. After the move and walking through the airport, my leg was really hurting. I still had good range of motion and could do everything, so I assumed everything was fine. I got back to Chicago fine and got ready to take my boards on July 30th, 2 months after my injury.

I had my next appointment on July 2, 33 days after my surgery. I was told at my previous appointment that I would have the cast off that day and start with the heel wedges in my shoes. I was a little confused, as everything I was reading in ortho books and on Achillesblog was saying that usually people were in CAM walkers for many more weeks. However, my excitement to ditch the cast for good really blinded me here. I was the happiest guy in the world when I walked into my appointment that day. I hated that cast more than anything in the world. I had the cast taken off, and waited for my surgeon to see me. Here’s further calf atrophy (on the right, in case you couldn’t figure that out).

My surgeon came in, felt the tendon, said it felt good, and said 3 more weeks in the cast. I was absolutely crushed. Apparently there was some miscommunication on both ends at the last appointment. I told him that in 3 weeks, I wouldn’t be in town, as I was moving to start fellowship in Houston. He said, ok, 2 weeks is fine. I asked if he did CAM walkers, as I would be happy to wear one of those indefinitely, as long as I could shower and sleep like a normal person. But no, he doesn’t do those, so I was stuck in the cast. Those 2 weeks crawled by, but I had a countdown on my phone and busied myself studying for boards. Finally July 16th came, and again, I was the happiest guy in the word. This time the cast came off and stayed off. My surgeon gave me small gel wedges to put in both my shoes and gave me very vague instructions about what to do. But he made it seem like I was free to walk around normally with the wedges. He also wanted me to start PT. Here’s my calf at it’s puniest.

I wanted to jump for joy, but I obviously didn’t. I gingerly walked around the office and then to my car. I couldn’t believe that I was walking again without a large apparatus on my foot. It really felt great. I was on top of the world.

So I forgot to mention that the day after my surgery, about 24 hours after my saphenous block was placed, I started to have some pain at the incision site. I had some norcos that my surgeon gave me, and they took care of the pain pretty well. I was also taking ibuprofen. The norcos worked, but they made me just sleepy as hell, so I wasn’t too excited about taking them for long. I only took about 10 in total before I couldn’t handle being a zombie anymore. At about 5 days postop, I wasn’t taking anything for pain. The struggle was more mental - getting used to hobbling around and living without the use of a leg. I have so much more respect for disabled/injured people. We take so much for granted on a day-to-day basis.

I got around ok on my knee-scooter, only using crutches when I absolutely had to. I wasn’t sleeping well - my cast was so hot, and I felt sweaty all the time. Pretty miserable. I went back to work on POD 12, and coincidentally had another appointment with my surgeon that day as well. Here’s my incision that day, and then my legs after only 12 days in a cast. Injured leg on the right. My calves have always been pretty big, so the difference is really obvious here.

At this point they put me in a new cast, with a toe plate, and a slight "build" on the heel, that allowed me to partially weight bear. When the cast tech finished, and told me to take a step, I was super nervous. But I was assured by the surgeon and all my orthopod friends that since I was in a cast, it was virtually impossible for me to injure my tendon. Here’s the new cast, with the sweet boot they gave me.

I lasted 4 days with this cast before I couldn’t handle it anymore. The toe plate allowed no air to circulate and I felt like I was in a wet sock. On POD 16, I went into my surgeon’s clinic to get a new cast put on, without the toe plate. I still had the build on and was partially weight-bearing. I hated the cast, but being able to put a little weight on it was much better than the one-legged routine. Here’s further atrophy at POD 16.

I don’t have a picture of the 3rd cast, but I will offer this piece of advice: if you have the chance, opt for no toe plate. I couldn’t stand it.

So first, I would like to thank Dennis at Achillesblog and all the other posters out there for helping me through all of this. You guys have been invaluable as a resource and as a support group. Thank you.

So today, I’m 9 weeks postop. I’ll give you a short play-by-play. Tore my Achilles playing soccer on 5/29/12. Just lunged for the ball, heard the characteristic pop/thunk, and knew right away. Definitely didn’t stretch out. Oh, to go back to that day… I was sort of in a unique position, as I was an anesthesiology resident at the time. I called my orthopedic friends, and they saw me right away in the ER. The nurses were all very nice and I got splinted up and out of there in about 3 hours, which is fast for our ER.

Went to work the next day (5/30), and it just so happened that I was in an OR with a sports orthopod. I hadn’t had breakfast (very fortuitous), and the surgeon said if I wanted, he could do the surgery at the end of the day. Again, I had the unique position here, and was lucky. I chose spinal anesthesia with a sciatic catheter for post-op pain control. I didn’t have any sedation at all, as I didn’t want to say anything stupid in front of people I worked with, but I would whole-heartedly recommend it for anyone else getting a catheter. The needle we use to place the catheter is quite large and despite the local anesthetic numbing, you feel it. Anyways, the block and the spinal went fine, and I listened to music and surfed the internet on my iPad during my surgery. Before the spinal wore off, my anesthesia team also performed a saphenous block. I think this was the biggest factor in my post-op pain control. I went home that night with a completely numb foot in a splint with instructions to follow up in 2 days to switch the splint for a cast.

Came in that day and had the cast put on. Here’s the wound, 2 days post-op.

Had a sweet neon green cast put on that I classed up with some blue paint to match the wedding colors of my good friend whose wedding I was attending the next weekend.

I actually had the next week off from work, which was very, very nice. I would have liked to spend the vacation not sitting on my couch, but oh well. I lasted about 2 days on the crutches before I asked some people around the hospital about a knee scooter. I was connected with a medicine physician who had bought his because he had a prolonged, complicated course. He sold me it for $100, and it paid for itself within a week. It is far, far superior to crutches. If you’re concerned about the cost, I can guarantee you it’s worth it. Ok, I’ll cut this post off for now and start another with my next couple weeks.