Get out of Jail - Free!

It’s week 13 post ATR and I was discharged from the hospital.

Although I was hoping for a scan to check the level of recovery at least I will not miss going to the hospital.

Humorously, a few days after I sent in a caustic letter to the hospital trust CEO he resigned!

It was front page news in the local paper. I’m not shedding too many tears as I don’t think he will starve, and possibly the clinic service will improve.

On a more practical note - despite Internet reports of 5mm max gap for non-surgical recovery my ATR re-joined despite a 17mm gap.

I’m beginning to get up and down stairs and going for walks of a couple of miles unaided. The shoe wedge is still in - but I am going to remove that very soon.

My current recovery plan as recommended by the excellent physio is  :-

15 x 3 elastic band foot stretches. The foot resistance is forward, backward and at 45deg.

15 x 3 heel raises - these are tough.

Stand from sitting 3 x 15

Balance on each leg 3 x 30s.

Exercise bike - 20mins.

My physio appointments are every 3 weeks.

I am doing no sports and won’t unless I lose at least 3 stone and have no problems for 6 more months.

This will be my last post - unless something goes snap.

So, keep positive, complain if necessary, don’t lose hope and keep exercising!

Progress - at last

Hi all,

I’m into week 8 post ATR and life is getting slightly more positive. The boot is off at night and my toes are wiggling with freedom.

In my previous posts I mentioned the poor treatment from the allocated NHS consultant.

I raised a complaint as directed on the hospital web site. The Patient relationship Team replied that they would ‘assess’ my complaint and get back to me

by 60 days - or longer. In this period I could probably grow a new limb, never mind an Achilles. This also left me in Limbo unable to get a date when I could return to work or be able to  drive/walk again.

So I had to do what I have done numerous times before - go straight for the top with a letter to the Trust CEO and a supplementary letter to the trust asking them to verify that they were taking full liability for any incidents caused by my

return to work or driving without a medical assessment.

An appointment came winging in for the next day with the top geezer.

This guy was excellent. Did a Thompson test and foot pressure test. We had a 2-way conversation, the bottom line being that there was recovery.

The 17mm gap had grown back - Yippee!

He said that it was not unusual to get recovery from this size of gap non-surgically.

The only down side was that he also stressed that my sporting days of  Volleyball/Basketball were over.

After 5 weeks I still have the gout/arthritis type pain in my other foot. This has caused my normal size 12 feet to swell to size 14.

We discussed if it was worth taking anti-inflammatories. His opinion was that if I’ve stuck for 7 weeks without any medication then I should carry on.

I do hope he is correct on this one and it’s not the onset of arthritis. The consultant thought that this was natural due to the inactivity whilst recovering from ATR.

His recommendation was to raise the foot - nose to toes level as much as possible.

I’ve created some exercise mat foot shape cutouts to put between 2 thick socks. This considerably helps to ease the pain whilst walking.

The consultants assessment was that I could probably return to driving/work in 3 weeks. Although I must admit to enjoy the comfort of working from home.

I’ve also had my 2nd visit to the Physio department.

They also verified that I may be able to tap-dance again, well at least walk up stairs properly.

Nothing else much happened there - they looked at my walking gait and were happy.

My stationary cycle time was upped to 15 mins a day.

The other exercises remain the same - standing from a seated position 3 x 10 per day.

As the boot was due to be adjusted I rang the Appliance department to see if I could do this at home - and save a 2 hr timeout from work.

The response was that I had to come in for ‘insurance purposes’ and have this done professionally.

Sadly when got back home I noticed that the boot variation had been incorrectly adjusted 15-30 deg and not 10-30, so I had to adjust it myself anyway.

However the appliance guys are very good (normally), just got one who was suffering from a heavy cold and was not on all cylinders.

For the last week I’ve been on 0-30deg boot and after a bedding in period this feel fine.

After every adjustment I take it very very easy and try and get my foot used to the new freedom.

Once the foot is used to this I do a few floor exercises trying to bend the foot very gently through the full 30deg.

My other favourite exercise of walking from pub to pub and imbibing is now severely curtailed although I may make a Christmas exception today.

Merry Christmas and Happy New Tendons everybody!

Physio - at last

Nearly up to the seven week mark and had just had my 1st session of Physio.

The lady doing the work was superb; very professional, caring and we even had some two way conversations. Chalk and Cheese in comparison to the hopeless consultant.

Incidentally, after two weeks I’m still waiting for the hospital to respond to my complaint about his terrible attitude and poor service.

The physio was surprised that he wrote off my ability to play sports again at our 1st meeting.

She carried out some foot bends and checked the tendon. A Thompson test showed some slight movement, but nothing to be cheerful about.

To me the leg still looks like a bag of eels.

After trying out some non-crutch aided walking there was 5 minutes on a stationary bike.

That all went well and I was instructed to try cycling each day and do 3 x 10 reps of standing from a sitting position.

I asked all the physios there if they had ever seen a 17mm gap heal without surgery. Although they did not sound hopeful they did say it was possible.

There was some tendon pain later that night from the stretching but otherwise all ok.

The other (good) foot is still very swollen. The doc thinks that I may have arthritis following on from the gout attack. To investigate I crammed in a blood test whilst I was in the hospital.

I am trying to walk around without crutches using a trainer 2 sizes bigger than normal - but even that is a tight squeeze.

At the least all the Christmas decorations are up now. It was a lot easier then last year as half of them are smashed.

This unfortunate incident occurred during my first week with crutches. I staggered and grabbed the bookcase that housed them all.

They came crashing down with gusto and there was a lot of dead snowmen and santas.

It could be worst. There’s lots of articles on the NBA guys, that even with the best treatment in the world had to stop playing.

And although not an Arsenal supporter I feel very sort for one of their players Santi Carzola who has had 9 operations on the Achilles in 14 months and lost 8cm ( and almost the foot) to a MRSA type bug.

The good news is that I’m shortly off to coach my Volleyball team in their 2nd league match. The expectation are high.

Tomorrow we are having our combined Basketball and Volleyball Christmas party involving a pub crawl and a Chinese.

Well I do need to exercise the tendon!

ATR and DVT - Double Trouble

Hi fellow sufferers.

Thought I would start up my 1 st blog to share my Achilles rupture experience.

Like many bloggers the problem started with Basketball.

I’ve played since high school and used to be up to county level when TV’s were in black and white.

Our weekly scrimmage was mixed, with a fair number of senior citizens (ok – 50plus). However we then had an influx of young, fast guys and some ex National League heavyweights.

It could only end badly – and it did. Trying to relive the glory days during one intense session resulted in an Achilles fire that would not go away.

Two visits to the doctor led to an appointment for an MRI scan in 6 weeks.

Lesson #1 (which I ignored) – Do not play any sport if your Achilles is telling you things. There is a high price to pay if you carry on regardless.

True – the doctors did not warn me to cease all activities – however I don’t think either of them had ever dealt with an Achilles injury.

My other sport is Volleyball and I play regularily and coach a very promising team.

We participated in an annual local tournament that pits Div 2 and Div 1 teams in the same pools.

My team had finished last in Div2 for 2 years. The first match was against a Div 1 team that had won the league on many occasions – and we were kicking butt!

Youthful exuberance was getting the better of me until an energetic jump was accompanied by a loud snap. Finito…

The local hospital was excellent and identified the problem using the Thomson test, ultrasound scan and X-ray (to identify any fractures).

As I had a history of DVT the hospital gave me two blood thinning stomach injections and told me off severely for not pill popping my Apixaban.

Christmas came early with a nice half cast, pointing down 30deg. and then a discharge home to ponder the errors of my ways.

Next day I had a call to return as the blood tests showed possible blood clotting issues. Another Ultrasound showed 3 historic DVT sites but no current issues.

A week later and it was time for my 1 st appointment at the Fracture Clinic.

All the staff were excellent, apart from the Orthopaedic consultant. He was totally disinterested, monosyllabic and dismissive. His answer to “when can I play Basketball /Volleyball again” was “You’ll never play again”.

When I asked about surgery, his comprehensive reply was “No surgery”.

Researching this site and the Internet pointed to possible reasons for non-surgery:-

  1. Age (although I could not find the magic cut-off point).

  2. History of vascular problems in leg

  3. Diabetes (Not something I am currently blessed with)

    I also suspect that my weight of almost 21stone could have influenced his decision. I will never know as he wasn’t giving away trade secrets.

    The good bit of the visit was that I got a free ski ‘Orthoboot’, with accessories!

    This was set so that the toes point downwards 30deg with a large wedge.

    It’s big and bulky and hogs most of the bed so I have to sleep on the floor.

    It also presents a lot of questions such as do you leave the vacuum at night (yes) and what is the best holding position for healing (vertical/horizontal) and why does it only come in a cheese flavour?

    To cut a long story, I did try and keep fit, even hobbling around the village on one leg and crutches, only missing a parrot. This may have done more harm than good as my one good leg got a pounding.

    By the time the 2nd appointment came around I was in a bad state.

    The AVR leg was ok and the only occasional pain was from the area below the strap across the top of the ankle and what may have been mild gout at the base of the toe.

    The right foot was on fire with what seemed to be gout in the ankle and toes.

    Ten nights passed in agony and very little sleep. My doctor did send over Proton pump inhibitors, Cocodemol and Naproxen. I gave these a miss as Naproxen can inhibit the healing process of the TVR and didn’t like the idea of the proton pump.

    I had to order an ambulance and wheelchair to get to the appointment.

    Upon meeting the consultant his first words were, “What are you doing here? You should have had a scan”. He appeared to have no recollection of our 1st meeting 2 weeks ago, despite the notes on the screen.

    I told him that the scan had been completed and the gap was 17mm.

    His response was “Well there is not much chance of that healing”.

    This is not what I wanted to hear with every aspect of home, career and leisure life on the line.

    I managed to ask him if Naproxen should be taken due with TVR. His response was “It’s up to you”.

    Possibly he had a bus to catch as he dashed out leaving my prepared list of questions unanswered. He did write something on two sheets before he left. A next appointment – set for 3 months time and an instruction line on the recovery sheet for the physio department.

    There was no one in the physio department who knew anything about TVR’s so they told me to make another appointment.

    They also would not adjust the orthoboot, so it looked like my 5hour trip may have been for nothing. Luckily the appliance guys said they would do it. They also spotted that the consultant had written instructions to set the boot to 10deg and not the correct 20deg. This slip could have set back my recovery or even caused a re-rupture.

    In summary, I would say that the best recovery facilitator you can get is yourself.

    I’ve been stuck on the Internet for many hours. There is a mass of information, but digging out the salient points is not easy.

    I’m not saying the following information is necessarily accurate, but this is what I dug out:-

  • <5mm gap is suitable for non-surgical recovery. This is worrying for my 17mm gap.
  • Surgical intervention is best if you are young(ish) without vascular problems and wish to return to sports quickly.
  • The Achilles will never be as good as it was (room for genetic research here!).
  • The NHS is usually superb. However if you get a poor consultant and can afford it then BUPA would be a good investment.

I guess the main questions that myself and possibly many TVR club members want to know is – has the tendon knitted or am I just dragging around this elephant foot for months as a decoration?

The other big question is what percentage of surgical and non-surgical treatments fail – or, to be positive let’s say – work.

I wish everyone well on the road to recovery – keep your spirits up.

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