From Volley to Folly and Back

I guess I was off by a week on my last post, so technically I’m almost to Week 5, which I guess is a good thing.   Recovery is pretty steady right now, no big milestones.  I continue to do the range of motion exercises and try to push my ankle flexibility a bit more each day.  I did try removing the heel lifts in my boot to test if I’ve gained dorsiflexion range, and can now put my foot flat in the boot which means I’m at neutral.  At work, I’ve left the lifts in though, as the swelling decreases my flexibility and then it feels strained as the day goes on.  I think just a little bit more flexibility should take care of that issue though.  I did have some new pain in my lower calf / upper tendon overnight, but doesn’t seem too bad today - hopefully I had just had my foot in an awkward position for awhile.

It’s interesting how little the average person knows about this injury.  Most people are really surprised at the length of recovery time, as I’ve received quite a few comments from friends or coworkers being surprised that I’m ’still on crutches’ and assuming that I can sign up for the end of July 10K since that is ‘a long time from now’.  Usually when I point out the tendon and what actually happened to it though, they finally ‘get it’.  I sure am growing tired of telling the same story over and over though!

Ok, I got started late in filling out my blog but future posts will be up to date.  I’ll try to post some photos soon as well.  Today is the first day of week 5.  Not too much has happened since my first post-op appointment.  I have gone to two physical therapy sessions, which just consist of range of motion exercises - ankle side-to-sides, up/downs, ABC’s, circles, and swings with no weight.  I simple do each of those twice a day, 10-20 times each.  My therapist said from the first week to this week I gained 10 degrees of motion.  I need 10 degrees more to remove the lift in my boot and be ‘at neutral’, and 10 degrees after that to be able to have any kind of walking motion.  I feel like I could push harder on the up/downs, but I’ve been cautioned to not overdo it or pull too hard and I really don’t want to do any damage.  It’s difficult to know how hard to work at this point.

I’ve been back to work for several weeks now.  It has been difficult.  I have a desk job and have always gotten away for lunch - almost always to the gym.  With my wife driving and dropping me off, I’m stuck at my desk and my workplace doesn’t have any sort of lounge area where I can lay down over lunch and elevate my leg, so by the end of the day it is pretty sore and puffy.  When it gets this way even the boot is uncomfortable.  I brought in a large exercise air ball and the most comfortable position is with my knee and leg rested on that without the boot.

I did have one scary instance in week #3.  Crutches aren’t safe even for the seasoned crutches pro.   After showering I realized I didn’t have a towel and tried crutching too fast across the bathroom tile floor.  Hit a patch of water and hit the floor fast.  I landed on my back and my head hit the edge of one doorway and my good foot hit the wall, but I was smart enough not to try to correct with my bad leg.  It hurt and scared my wife to death who came running upstairs to check on me.  Other than a headache and a scraped foot, no damage done.  Let’s not do that again…

Countdown to July 6 and Post-Op Appointment #2!  I can’t wait to really test this thing out!

I was highly anticipating this appointment.  I wasn’t sure if I would get the ‘comfy’ boot back that they gave me before surgery or if I would get another cast.  I really wanted the boot back, as I could not lay my foot flat on the floor with the post-op cast.  It would also be nice to see the injury, get the itchy stitches out, and not have to bag up my foot to shower.

The appointment went as hoped.  A nurse came in and cut away the cast.  The stitches looked ugly but not horrible, the incision was held together nicely and I didn’t have a lot of swelling.  There was a small bruise on my calf and some bruising under my ankle that was there before surgery.  I also had a big spot of blood on my skin where they probably missed cleaning up after surgery - yuck.  I’m so glad I wasn’t a witness to the operation.

What a strange feeling - my foot felt so strange dangling there after being held in one place for so long.  I nudged it upward a little bit and immediately felt the ‘tightness’ everyone else describes.  Man is there going to be work to do before it eventually stretches out like before, BUT… at least I can tell it is attached again!

The resident doctor who assisted in the surgery came in and removed my stitches.  Painful but only short bursts of pain.  For me, the thought of the threads pulling through my skin was what was causing most of the pain, there’s something about skin injuries that is difficult to watch or think about for me.  I asked the doctor more about the surgery since he was present assisting.  He said it was among the more severe tears he had seen and that they had to do quite a bit of ‘cleaning up’ before reattaching it - whatever that means.

My surgeon then came in and inspected it and says it looks good.  I’m to go back to the compression stocking and boot I had before (good news).  Absolutely no weight until my next appointment in 4 weeks, as the tendons take 6 weeks to firmly bond together and in the meantime they are held together by only sutures.  I asked how long until I can walk without a limp - she said the calf will be the challenge because of atrophy but that I could be ‘active’ normally again in 4-6 months - hopefully that means more than just walking normally but I would even take just that.   I’m not about to argue about a weight bearing timeframe, I would rather have a slightly slower road to recovery than to go back to square one.  She did give me a prescription to start physical therapy in terms of range of motion and very passive stretching.

My wife and I had sort of joked that we hoped the ‘evil’ assistant lady who had fitted my stocking and boot roughly before surgery would not be showing me the ropes again.  Fail.  After speaking with the surgeon I immediately began trying to get the stocking on before she came in but didn’t make it.  She saw that I was working on it and insisted on ‘helping’, muttering that I hadn’t started it on the right way, and was actually grabbing my achilles tendon for something to hang on to while she pushed and pulled on the compression stocking.  Then when it was on she felt the tape that had replaced my stitches and said ‘Oh, you must have had surgery - those are where your stitches were, right?’  Are. You. Kidding. Me.? Grrrrr….  I’m sure I’ll laugh about it someday…

So, it looks like my crutches and I will be buddies for at least another month, but at least there is one milestone to cross off the list…

The first few days home weren’t so bad, which happened to be  Memorial Weekend.  I was still taking pain meds which made me too dopey to get worked up about too much, plus my wife was home so I had company and help whenever I needed it.  We rented quite a few movies and just relaxed together.  During the day I didn’t move much from the couch, with pillows elevating my leg.  When I did get up I could feel the blood immediately rush to my leg and it would start pounding - it’s a good thing to keep it elevated (R.I.C.E’d) as much as possible!

Showers suck - a little tip though: a long sock works great to seal up the trash bag and keep the cast dry.  Use a trash bag with a drawstring and tie it up like a shoe snuggly above the knee.  Then, use a long sock to cover the top of the trash bag and pull it really tight (just overlap once, no knot).  Unless you are in the shower for a long time, the water won’t have time to get past the sock - I did this for two weeks, not a drop of water on the cast.

The third night after surgery it occurred to me that I had eaten a lot of good food since surgery but hadn’t taken care of some other normal business, an obvious side effect from the pain pills.  The next morning I spent two hours discovering why - this was way worse than any pain I could be having at this point so I immediately stopped taking the pain killers.

The next week was where things began to get difficult.  My employer graciously allowed me to work from home so I didn’t have to burn through my PTO (I’m a web developer so it’s not difficult to code away on the couch using a laptop), so that kept me fairly occupied during the day.  At home, though, with my wife gone is where I started really getting down.  I’m a very active and independent person.  I work out every day over my lunch break and my wife and I walk our two Huskies religiously, 1.5 miles around our neighborhood walking trail every day, rain or shine, snow or heat.   We had been counting down the days to summer weather all winter long during our frigid and bundled-up walks with the dogs, and here I was, out of commission at the start of the summer for who knows how long.  My wife would have to take the dogs by herself everyday (not an easy thing given her size and theirs) and all I could do was sit here… and sit here…  this is where all the ‘why me’, ‘what if’s’, and ‘not fair’ thoughts are difficult to fight off.

After about the third day of my wife taking the dogs out, I decided it wasn’t acceptable to just sit inside and miss out.  I tracked down a killer deal on an electric scooter (yes, the kind the elderly use in grocery stores with the basket on the front).  My wife and I went and picked it up and I started scooting along beside her and the dogs on our walks.  Plenty of friends and neighbors have gotten a kick out of me riding down the trail on an electric scooter, but my pride can take a hike for awhile.  Being somewhat mobile outside was a godsend - that little scooter was one of the smartest purchasing decisions I have ever made.

My goal at this point is to just make it to the first post-op and get rid of this hard cast!

I wasn’t particularly terrified of surgery, but was still anxious.  Having been dealing with some pretty bad insomnia, the part that had me the most worried was being put under.  I had myself convinced that somehow given my recent problems sleeping I would somehow be immune to the anesthesia or wake up in the middle of the operation in pain (crazy worries but I had them!).

After being wheeled in to the pre-op area, I changed into hospital ‘attire’, and was visited by the anesthesiologist and briefly by the surgeon.    I had read about there being two types of surgery, one with a single incision and one with multiple small incisions so I asked her about that, and she said it would be a single incision.  The anesthesiologist gave me an option for Regional Anesthesia (spinal block) or General Anesthesia with a leg block.  I really didn’t care to know what was going on during surgery so I chose the General Anesthesia and leg block.  After that things went so fast.  She had me insert the anesthesia tube in my nose and breath while she performed the leg block, and told me the next thing I know I’d be out of surgery - she was right.

Waking up was pretty unpleasant.  I was shivering uncontrollably and the feeling of coming to was not very comforting, but it didn’t last too long.  By the time I was wheeled to my room I was feeling more normal, and my wife came in (yay!)   At first I just wanted some water as the breathing tube also made my throat very sore - that didn’t last too long either though after I got some water.  I now had an ace-wrapped cast that was open on the front to allow for swelling.  There was some soreness but nothing much - with the leg block my wife could squeeze my toes and they might as well have been someone else’s toes, I couldn’t feel a thing!

Since I hadn’t eaten anything the night before, I was ready for food so my wife left and brought back some supper and snacks (Mike n Ikes are really tasty after surgery!).  That afternoon and evening I just watched TV and surfed on the laptop a bit - the Bulls vs. Heat series was on so that helped kill the time  The surgeon called and talked to my wife briefly - she was just checking in and let us know the surgery went well.  It was a complete tear in the middle of the tendon.

They wanted to keep me overnight to monitor the pain after the leg block wore off, which happened at about 2AM.  It wore off quickly and boy did I know when it did, but the nurses just added some morphine to the pain meds I had started taking and the pain was manageable.  After enjoying a good hospital breakfast in bed, I was discharged mid-morning with my prescription for more pain meds and was ready to be home again.

I called first thing Monday but the Orthopaedic Surgeon couldn’t see me until Wednesday.  In the mean time I just used the crutches I received from the E.R.  and was going to work (with my wife driving me in).  Crutches were nothing new to me.  Having played sports all my life I had dislocated a knee playing football and severely sprained / fractured an ankle playing basketball.  I also wasn’t in much pain to speak of either, and although my research told me better I still held out hope for a partial tear and a non-surgery diagnosis.  At the ortho office, they directed me to a visiting room and my E.R. XRays were pulled up on the computer in the room.  The doctor came in, asked what I had done, and had me again lay on my stomach on the bed as I had done in the E.R. Her test, however, was SO much quicker and less painful. She did a quick squeeze of both calf muscles (Thompson Test - wish they would have done this in the E.R.!) and said, ‘Yep, you have a complete tear of the Achilles Tendon.’  She explained the options and risks of surgery vs. non-surgery and recommended surgery.  She then said she had an opening the following day.  Scary, but as far as I was concerned the sooner the better so we scheduled it for 11AM the next day.   I was given the infamous ‘boot’ with a fancy air pump on the front and also given a compression stocking to wear.  THAT was not fun to get on, especially given that the assistant was pretty forceful ‘helping’ me put it on and didn’t even ask what my injury was until after she had grabbed my leg and forced the stocking over my ankle for 5 minutes!

We arrived at the E.R. in the evening and were seen pretty quickly.  The P.A. asked about the accident and XRays were performed on my injured leg.  While I was waiting they asked if I could put any weight on it and I tried briefly - it was a strange feeling, not a ton of pain but I just couldn’t do it.  The P.A. had me lay on my stomach and attempted to compare my good and bad achilles but squeezing various locations on each. Ouch!  She then went and retrieved one of the doctors on duty and he ordered another XRay on my good leg for comparison.  He also did the same ‘poking and prodding’ comparison (even more OUCH!) and then concluded that I had a full or partial achilles tear and that I wasn’t to attempt to put any weight on it in case it was only attached by a thread.  I was given a prescription for pain killers and given a referral to the one of the hospital’s Orthopaedic surgeons and told to schedule an appointment immediately on Monday.

The Injury - A Routine Tennis Outing

My injury occurred on Saturday, May 21.  My wife and I were visiting my family in Missouri, about 3 hours from our home in Omaha, Ne.  My dad is a high school tennis coach, and one of our favorite things to do as a family is play tennis.  In my high school and college years, I played tennis for hours a day, several times a week.  Now, at 31, the past few years my tennis outings have been occasional, maybe 5-10 times per year.  This was my first time on the courts this year.  I’m not in incredible shape as I once was, but not horrible either - I go to the gym almost daily over lunch - running, lifting, and participating in fitness classes held at the gym.  This is what makes the injury occurrence so perplexing.

After hitting around for about 15 minutes, I was rallying with my brother when he hit a routine drop shot and a ran up to get it.  No crazy effort, just a routine run at the net when ‘wham’, something smacked the back of my leg and I fell to the ground.  There were some teenagers playing around outside of the courts and immediately my mind went to blaming them for having thrown something at me.  I looked up at my family (who were all on the opposite side of the court) and asked if anyone knew what happened.  They were as confused as I was.  At one point I actually thought it could all be in my head as I had been dealing with a horrible week of pretty severe insomnia.  I tried to get up and walk it off but there was simply nothing there to stand on, so I hobbled off and sat on the bench.  I mentioned that I thought maybe it was my achilles, but that didn’t seem right to several of us as we had seen the horrible footage of an achilles snap on ESPN where it rolls up to the calf.  All I had was some moderate pain (I’ve had worse sprained ankles) and some swelling in the back of the leg.  I couldn’t walk though, so my wife and I decided to head back to Omaha and go to the E.R. at the hospital where I work.  A little Googling on the way home and I pretty much knew it was an achilles tear - now the question was, how bad?

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