kickstand’s Nonsurgical

FINALLY FINALLY FINALLY NO MORE CAST!!!

Thursday, August 24th after 6 weeks in casts I am in the CAM walker boot! Words cannot describe the feeling of getting my hands back and getting rid of those damn crutches! If you’re driving on the 91 freeway in Orange County watch out for a pair of crutches cuz I’m seriously considering chucking mine out of the window!!! LOL!

When they took off the last cast my skin under my heel especially was really dried and peeling. I know TMI (Too Much Information) but this blog is to help so I’m being forthwith. I was able to wash my foot between each cast and only had minor peeling. I attribute this last episode of dry skin to getting in my spa with the Gumby Foot which must’ve torn slightly when I rubbed it against the side of the pool. At any rate when I took it off (after an hour of soaking) I discovered my cast was leaking water everywhere. Interestingly it dried out completely by the next morning, which is probably why I got in the spa the next week and got it all wet again

Okay, the ortho doctor said I could walk as much as I wanted with FWB and that I could actually swim or cycle (cycle with the boot of course). I am not allowed to run or jog even with the boot (as if anyone could possible do so). I’m to wear the boot for 4 weeks after which I can start using 2 shoes! Essentially, the boot is there to protect me from a re-rupture should I stumble forward on my bad foot.

He squeezed my calf and we both witnessed my foot move so I’m definitely re-attached. I’m truly amazed at how it has healed on its own without the surgery. I have some swelling still, which showed up sometime during the duration of the first cast. The little amount of bruising I had has gone. He said that I should come back in 6 weeks at which time he will begin the physical therapy. He mentioned that I might not have much to do since I didn’t have surgery. My Achilles shouldn’t be as tight as those that had the surgery so I may not have much difficulty getting my full range of movement back. He said my Achilles if anything is probably longer now.

The second best moment after freeing my leg of the cast was taking a shower and washing my foot! I’m happy to say all the dead skin washed away and my foot looks about normal. I’m still nervous and haven’t fully begun to trust the boot. When I take it off to shower I notice my foot isn’t working like normal (i.e. toes spreading out as I put pressure on them) and is still a bit "reluctant" to act normal. I’m sure with each day I’ll be more confidant and work towards my next big milestone in 4 weeks! Patience is the key definitely!

I got my 3rd and last cast at the 4th week mark (beginning). I had to go back to the full size which extended just below the knee. But in the neutral position this one is a lot more convenient than the first and second. When they took off the one (2nd cast) from the Cancun trip a bucket of sand poured out and my foot was a shade lighter than my upper leg!

I tried to convince them to let me go into the CAM walker boot at 4 weeks but the ortho doctor wasn’t comfortable with this since in the boot there is too much movement. No weight bearing until the boot!

Not much to mention except in week 4 to 5 I began to feel a slight tightness in my calf. After reading articles on healing again I think this might be the beginning of the shrinking of my collagen as it rotates and remodels into my new tendon. Reading about how scars shrink at the end of the repair cycle I’m pretty sure that is why I am feeling this slight tug.

As I get closer to the end of week 6 I can hardly keep my foot still in the cast. I’m extremely restless and I have the urge to move it more and more. I’ve always had a lot of movement and a good range of motion.

Counting down until the boot…

Not much information in this post if you’re seeking advice or opinions on non-surgical recovery. But I thought I’d share my adventure with cast number 2 and 90 degree weather!

I got my second fiberglass cast on the Friday we were leaving for Cancun. I still don’t know how I managed to pack and be ready for the trip.

After telling the guy doing my new cast that I was heading to Cancun that day he gave me a shorter cast that hit just below the calf muscle. He explained that you never want to have the edge of the cast hit in the center of a muscle like the calf muscle or you could be in some serious pain.

Anyway, I chose blue and later that evening realized that it had a slight catch at the heal. It was too late to get it fixed so I grabbed some tape and threw it in my suitcase.

Oh, I was able to swing over to a pharmacy that carried the swim sleeve they told me about at Fullerton Ortho. It was in Whittier. If you’re planning a trip where there is water this thing is worth every penny! I called it my Gumby Foot because it looked like a giant blue version of Gumby’s foot. Anyway, I couldn’t do my usual crazy pool volleyball but I went all the way out to the ropes in the ocean. In my mind I figured if a shark swam to eat me I’d offer up my Gumby foot with the crunchy center. My guess is the shark wouldn’t even want my cast!

If you’re going anywhere with a cast that involves an airport ASK FOR THE WHEELCHAIR! Can’t tell you how fast you get through security! Even in Mexico we breezed through immigration in a record 5 minutes! Even the timeshare people left us alone! I was at the taxi with bags and a margarita inside of 20 minutes–15 of which was waiting for the bags and margarita! I’m seriously thinking of wearing my CAM walker when I travel next!

I won’t bore you with all of the craziness being in Mexico on crutches. I will say that each day I had 4 bullets to use. I used up one hobbling down to the beach and one coming back up to the room. After that I had 2 to use between dinner and lunch–breakfast was a rare treat if I could manage to get down to it. Needless to say, there was no dancing on the tables or wild Tequila nights!

I probably cancelled out most of my vitamins with all the Tequila I did drink.  I was worried that after 6 weeks I could have an extra heel or some other defect from the Tequila. Oh well, life is too short.

3 days into the trip I’d ripped the heel off the cast and was leaking padding. On one of the trips into town we stopped at a pharmacy and I bought a knee brace which worked wonderfully to not only conceal the hole but to protect it from all the other hazards hobbling around in Mexico. Fortunately there was a washer and dryer in the room because it was too ripe each day to sleep with.

Funny thing there was another guy at the resort with the Gumby Foot thing and we sat around laughing at all the stupid things people were saying about us!

Monday after my ATR I called the original ER pod doctor, who’d scheduled me for surgery that Wednesday, say I’d opted to go non-surgical and that I was under the care of the ortho doctor. I also informed my ortho doctor that I’d decided to stick with the non-surgery route.

I put myself on an aggressive vitamin and protein regimen which included what I could find from reading various websites about healing. I’ll include the list here but I gotta tell you I can’t vouch whether any of it was the right thing to take or not. It’s just what I could find for the healing of broken bones, repair of tendons, and development of skin tissue.

Vitamin C (10k mg), Vitamin A (10k-25k), Zinc (80mg), L-Cystine (500mg x 2), Coenzyme Q10 (Co-Q10, 60mg), Calcium (1,500mg), Magnesium (1,000mg), Vitamin K (as recommended), and a protein supplement (I used GNC’s Super Whey with 40g of whey protein twice a day).

You have to spread the doses out and drink plenty of water. I tried to find the best natural form vitamin C available to assist with absorption.

Besides the total inconvenience of crutches I was still without pain. However, I really thought I was developing arthritis in my thumbs and shoulders from hobbling around on the crutches.

Oh, and I should mention the here-to-now unparalleled feeling of claustrophobia of having a cast on my foot; especially at night when I’m trying to go to sleep. I had wild thoughts of sawing it off (the cast ha ha) and taking my chances with an Ace bandage! But that feeling dissipated over the first few weeks and eventually diminished into just a feeling of despair about having it on for 6 weeks!

The first night home from the ER I spent hours "Googling" information on ATRs. I can’t say I what exactly I was searching for but I began reading more and more about non-surgical recovery. At some point in the night when I did a mental tally, I realized the non-surgical was winning out over the surgical route by 3:1.

I had scheduled a family vacation in Cancun, Mexico and we were to leave 2 weeks after my ATR. I have to say the idea of going to Mexico with a fresh surgery wound was not high on my list and surely was a factor in my decision to go non-surgical. And I was not about to cancel the trip!

Day 2

Except for the humongous Q-Tip on my leg I didn’t feel any pain or discomfort so I headed into the office. I’d placed a call into my personal physician about the accident and requested her advice. By now I’d spoken to my boss, friends, the pod doctor, and a slew of others all of whom insisted that I had to have the surgery done immediately and that was the only way to go. By mid-day I was probably somewhere around 60:40 in my decision with 60% going towards non-surgery.

I got a call from my doctor and she said that they referred all their similar cases to the Fullerton Orthopaedic Surgery facility. I was relieved that one of their orthopaedic surgeons could see me that afternoon. By the time I hit their door the pod doctor had already called and set a surgery date for the next Wednesday (ATR was on the previous Thurs.). I had another appointment to see him and I was required to get a clearance from my personal doctor even though I’d just received an all clear from a full physical end of May this year. Mind you, I was expected to do this by hitching rides with the goofy Q-Tip thing on my leg which barely fit in a car. Even the dog ran from it when I came at him!

Fast forward

At Fullerton Ortho they did an x-ray (first time in this ordeal) and when the ortho doctor came in and looked at it he started off immediately with “you definitely ruptured your Achilles and you basically have two choices: surgery or no surgery.” I almost jumped up on the Q-Tip puff leg and kissed him! Hearing him say that I had a choice and I hadn’t solicited it from him put me at a strong 95% vote for the non-surgical route! I don’t have anything against a podiatrist but I felt a lot better with my orthopaedic surgeon’s opinion.

After discussing the risks for both surgery and non-surgery I was still just slightly nervous about how functional I’d be after the 6 month milestone of healing and physical therapy. Mind you, all the comments pro surgery were still swirling around in my psyche making every factor doubtful. I shared with him my research on nonoperative results and specifically the studies done by the Journal of Bone & Joint Surgery and some other useful information from websites I’ve listed below:

http://www.jbjs.org/article.aspx?articleid=5839

http://www.jbjs.org/article.aspx?articleid=28810

http://www.shoulderdoc.co.uk/article.asp?article=1029&section=419

http://www.diagnose-me.com/cond/C136795.html

http://www.prolotherapynashville.com/how_prolotherapy_works.php

Seeing that I was wavering on the last 5% the ortho doctor helped me by saying he would cast me in a hard cast (fiberglass) that day and that I could call him the following Monday with my decision. If I opted to do the surgery they would schedule it that week. If not, I would stay immobilized in the hard cast for 2 weeks until they exchanged it for the 2^nd cast with my foot slightly adjusted up from the “ballerina” position.

I would have a series of 3 casts over a 6 week period. Each cast would reposition my foot until the last one, which would have my foot at the neutral position (or 90 degree position). After 6 weeks I would go into a CAM walker boot for 4 weeks. Physical therapy was not recommended to start until after the 3 month mark.

Still no pain and when they removed the Q-Tip beast there was barely any swelling or bruising. I could move my foot around pretty much with a lot of range. But the x-ray clearly showed a gap where I tore it completely.