Feb 24 2010
What does a Bulletin Board feel like?
Today I found out the answer to that question. Doctor pulled out the staples and everything looks good with the incision. Back into a cast with a little more stretch in the tendon. The cast is also about an inch lower than the previous one and wrapped very tight at the ankle. They really don’t want me moving it right now. I have to say I was not prepared for the amount of atrophy after two weeks. While I’m quite aware atrophy is part of the game I some how thought is would take a little longer. It appeared as is if my calf was already half it’s original size.
Doctor will move me to the boot in two weeks with 50% weight bearing. Two weeks later no crutches and PT will start.
It’s amazing, isn’t it? I thought I’d passed out when I saw my calf at one week’s time, hanging there from my bone..
Try not to move and keep elevated. Elevation is very important. 2 more weeks to go to next level, hang in there!
I was shocked the first time I saw my leg once the cast came off.
The repaired leg still looks smaller, but it is getting better…and I’m today at 14 wks post-op.
Take it easy and rest. PT will start soon and you’ll feel better.
“Slow and Steady Wins THIS Race”.
Hah! I was thinking of a COMPUTER Bulletin Board! I get it!
Yup, the speed of muscle wasting is very impressive. For a while I was wondering if there was some biochemical “signalling” going on, “telling” the calf to weaken to match the missing AT. But it seems to happen super-fast without tendon tears, too — like when astronauts come back to Earth after a few weeks in orbit and can’t stand up!!
Your post-surgical rehab protocol sounds virtually identical to the one I’m following without surgery — but I’ve “borrowed” it from a study that used it on both surgical and non-surgical patients. The study guys skipped the cast and went straight from a “bulky dressing/splint” to an Air-Cast boot two weeks post-op. (Details linked from the very first post on my blog.)
I find it very interesting there is no widely accepted practice for treating this injury. I asked my Dr. about his and he said because there is such variation in healing and treatments, most doctors go what they think works. At first I thought mine was being conservative, but once the cast comes off, I think he gets much more aggressive. I’m just going to keep working towards the milestones.
I think your Doc has it about right. Every approach sort of works. You can’t even tell the difference without a randomized controlled study, and they take time and money, so they’re rare for conditions like ATRs that aren’t life-threatening. And when the studies are done, most docs and physios don’t even hear of them (except from “noisy” patients!), and some of the rest don’t believe them or just don’t change their idea of “what they think works”.
Moreover, going slower sounds and feels safer to the professionals, while all the “costs” are borne by us — the patients — who have to spend more time than necessary (or even optimal) on crutches, in casts, disrupting our lives, etc. So there’s a natural built-in conflict of interest between us and our pros.
Moving from NWB to FWB between 4 wks and 6 wks post-op is probably a week or two (maybe three) slower than optimal, but it’s not nuts.