lotus10’s AchillesBlog

Saw my ortho today, 9 weeks post-op. Short visit; he seemed okay with my progress so far. Probably no jumping/running sort of activity (=tennis) until ~January.

I’ve had 10 physical therapy sessions - oh I do not enjoy these at all. It irritates me to no end when I’m goaded on to do some exercises and am told “don’t be afraid…” because it’s not that I’m afraid. The leg just can’t do some things yet. I’m such a grinch at the facility. I don’t think I’ll ever do well with a “personal trainer”.

I am completely free of devices now, walking in clogs without backs.
The leg is fairly swollen most of the time, it still does not fit into any shoes except flip-flops or slipper-like ones. My PT recommended compression stockings… which cost $60 a pair! They do help though, especially when I have to walk a lot at work.

Walking is slow. There’s no pain. It’s just tight, in the medial calf region, not in the back where the tendon is - the surgeon said that’s the area of the soleus muscle, which also gets affected. Yes I do the exercises at home, reluctantly but quite diligently.

It’s so much better, I know, than the days on crutches. But now my recovery feels like it’s hit a plateau — I’m not seeing big milestones, like “I can walk with one crutch!” “I can walk without a cane!” — and I have to pull my thoughts out of being so glass-half-empty. I think I’ll start swimming.

I’ve had 2 weeks of physical therapy now, 2 times a week. I could have taken the boot off probably 2 weeks ago, but kept it on for work. My work for the last 2 weeks involved a lot of walking in the hospital for approximately 8-10 hours a day, so my surgeon and my PT suggested that I keep the boot on. I had been walking in the boot, without a cane, for the last 2 weeks.

Now I’m off that rotation for a while, so since yesterday I’ve not worn it morning to night. The problem is, what shoes to wear. Yes I was recommended to wear gym shoes, but frankly the bad foot does not fit! It doesn’t even look that swollen but it won’t fit.

Walking isn’t smooth - my upper body gets all out of sorts and it takes a lot of concentration. Yesterday I did take the cane with me when I went outside. Of the exercises, standing on the bad leg alone is the most difficult. I really don’t enjoy my PT sessions, but I am being pushed and I think that’s good. I resent being told “it’s because you’re afraid” when I can’t do certain things; sometimes my body physically cannot do it! I feel like my range of motion and strength are usually 1 week behind what is expected out of me.

Considering where I was 7 weeks ago, though, I know this is progress.

I was supposed to go see my surgeon for my second visit at 6 weeks post-op, but due to my work schedule, went in today. I worked this past weekend, and by the end my foot was quite worrisome: swollen to the point I couldn’t separate my toes, dusky and warm around the incision. Tried not to panic, although the warmth really worried me - took Advil, iced, elevated and it took 2 full days to look and feel like before the weekend. Also it felt unusually stiff and sore, it wasn’t so easy on one crutch anymore, I began to wonder if I re-ruptured it sometime while working. From what I read around here, some people don’t even know they tore it, right?

But the surgeon examined it and said it is indeed still attached. He also said it’s time to start physical therapy (2-3 times a week, 1 hour each) and that I could come out of the boot. “Um I don’t think so,” I told him, and also about my initial 5-heel-wedges. I had just got down to 2. He said, really, I should be coming off crutches, the boot, fairly soon. I was flabbergasted that I was behind his schedule - and insisted that I still need the boot, the wedges, and a cane instead of a crutch. I think he was a bit puzzled and said “well we can get you a cane but… really, you’ll come off all these soon…” and told me to come back in another 6 weeks.

I said humph to myself and went to the hospital’s pharmacy and bought a cane for $19.99. While I’m probably 80-90% bearing weight on the bad leg, there was just no way I was going to walk without some support.

And I went to physical therapy today. (I found out my copay is $40 a session and argued with my insurance company, “do you want me to be contractured and sustain another injury? huh?” but to no avail. I don’t think I’ll pay more than $600 for this whole ordeal including surgery, but PT is going to cost me more than that! Way to go US healthcare.)

The therapist evaluated me for an hour and apparently I am behind where I should be. I was like, I’m behind your schedule too? She wrote out several exercises for me, and although I should be grateful that I am far more mobile than 3 weeks ago, I have a feeling I am not going to enjoy this phase of recovery. It’s more the fear of re-rupturing, I know it happens but - right now, I just can’t think of going through this again.

Anyway, the surgeon and therapist both thought swimming would be good. I’m a bit afraid about slipping on the way to the pool. 4-6 months til tennis, even the machines, where I know the ball’s coming.

PWB-with-crutches really took me a while to get used to. It was like walking on eggshells. When I got home after the ortho visit, I went online and ordered more socks and more heel-wedges. The sole was barely touching the bottom of the boot. At first, the range of motion exercises were barely discernible. I wondered how the leg would ever recover to pre-injury shape.

Again I worked that weekend, but put the good leg in a platform-soled sandal. I know, horrifying to some. But it was the only way I could achieve an even balance. And it made a difference, to be at a level height.

When the heel wedges arrived, I stuffed until my leg was just comfortable, and it took a total of 5 wedges! This probably added up to close to 3 inches of height, then there was the boot itself. I questioned if I should even be in this boot, if it’s taking this much support - but after reading other people’s blogs here, figured I’ll remove a wedge every 5-7 days. I’m now down to 3.

Things didn’t feel that much better at first. Showering was still precarious, going down the stairs always daunting. But I realized that it’s close to impossible to re-tear if you’re in a boot - I’m sure it happens - but I tried to wear it as much as possible, until it got unbearably hot or a couple of times a day for ROM exercises - which was painfully slow, but I could tell small differences every few days.

Then about 2 days ago there was a breakthrough: I just knew that I could place the bottom of the boot with a little more weight on it than before. Then I was standing up from sitting without using crutches. And then I took a few small steps without crutches at all. It’s like Bambi learning to walk. I haven’t done a crazy amount of walking this way yet; I think, if it feels like “maybe it’s too much” you’re probably right. And reading the re-tearing stories has me paranoid.

I still don’t know the moral of my injury; it still pisses me off and go through moments of “why me?”, but slowly, things are better. I guess it’s the wonder of the human body, its ability to heal, in ways we don’t completely understand.

I saw my ortho 12 days post-op. It was one of those over-90-degrees days. I’ve tried to console myself by thinking, at least the roads aren’t covered in ice and snow (I live in Chicago) but sweaty on crutches can’t be much better.

The nurse practitioner cut open the cast with a pair of scissors, unwound the gauze, and voila, there was my leg. Atrophied. Orange, from the left-over betadine. And on the inside of the foot, a large bruise, black and purple. I was inspecting it when the ortho came in, with 2 residents in tow. He saw my not so subtle look of dismay, I told him it’s because “it looks like an old lady’s leg!” He took a look at the sutures, and I lifted my leg higher so the residents also could see, had me dorsiflex, which I could barely do. He told me to start moving around my toes, some gentle flexion exercises everyday, and come back in 4 weeks, when we’d start talking about physical therapy. I was cleared to start some partial weight-bearing, but mostly rely my weight on the crutches. This concept was completely lost on me, but I didn’t labor the point.

I told him I’m quite worried about the good leg - the Achilles on that side was quite sore - mind you, when I tore the other one, both had been sore from playing a lot of tennis. And all the hopping on the good leg, wasn’t helping. I asked him, “I couldn’t possibly tear the good one, could I?” He thought about it, and said it doesn’t usually happen while the other one’s recovering, he hadn’t seen it happen, but weird things happen to doctors, and you’re a doctor. Everyone in the room chuckled, me not so much.

I asked about the knee-walker, if he was opposed to the idea. I’d been thinking about it for use at work. He thought it’s okay, and the nurse gave me some information on local rental places ($25 a week, before/if insurance pays). Then the doctors left, and the nurse took out my sutures - this didn’t hurt at all, or even prickle - and put steri-strips over the incision. I was also told that I’ll be in a boot now, that I could take it off if I’m just sitting around, or in sleep (a matter of comfort, I was told), but if I’m moving about, wear the boot. I was about to tell them, “but all I do is to sit around these days!!” but I didn’t.

A boot-fitting person came in and got me in an aircast boot. First she put me in a knee-high sock, stuffed 2 heel wedges into the boot and had me insert the leg. My sole could barely touch the bottom of the boot, it was so stiff. She showed me how I could inflate/deflate all 4 sides of the boot to my comfort, but I couldn’t pay any attention because of the new strange sensation of it all.

I’m not sure how I got out of there, because no one really tells you this PWB-but-on-crutches business. I am very literal. I need to be told how much % at what angle and when and where goes what. I know, it’s often an impediment. Yes it was nice not to hop anymore, but the boot was so much higher than the good leg, and until I figured out, later, to even out the good leg’s height, I was all lop-sided and when I got home, my bad-leg-side’s hand had become numb. Great, I thought, now I’m going to lose my HAND.

I took Norco for about 2 days. The first day post-op was awful; I couldn’t eat anything from the pain, would take Norco then feel nauseous. A vicious cycle.

I spent the next week re-arranging my work schedule, cancelling other appointments, freezing my gym and tennis club memberships. I kept the leg elevated for the most part, wheeling around my apartment in a four-wheeled office chair. I could tell when my leg needed to be up, when the toes would turn dusky. I wanted very badly to reach inside the cast and wash away the left-over betadine. There was practically no pain, just discomfort - there’s just no comfortable position! - and intermittent strange sensations.

I was on the schedule to work that weekend though. I felt like, well my brain works okay. And I will be in the same state 2 weeks, 4 weeks from now. So I went.

I did get bewildered looks from families, amused and sympathetic. Charge nurses insisted that I’m an “occupational hazard” and shouldn’t be at work. Apparently if a nurse got injured like this, he/she couldn’t work on the unit - they’d have to do some administrative work or go on disability. I told them I’m just doing my job because I still can function, I’m just slow moving. It felt like a long weekend; thankfully there were fellows/residents that stayed in the hospital at nights, and I didn’t get called in.

So working that weekend was rather humbling. I realized I couldn’t do it all by myself. I also realized that no one else really understands what this is like - there were some careless, heartless comments; a receptionist in the hospital lobby actually said, looking me up and down, “No summer for you!” I mean, really. Some actually said, “it would have been better if you’d broken your bone.” Some tried to tell me that months from now my calves are going to be funny looking because they’d be unequal in size. Why, why does that need to be said?

Nothing said from malice, but clearly unnecessary, no? As hard as this is physically, it really takes a psychological toll. I kept wondering why ATR should happen to active people, trying to be healthy? And for us, not being to exercise and feel that rush - is torture. Of course I know I’ll walk again, this isn’t terminal, this is nothing compared to amputees… but it isn’t easy.

Pre-op procedures were fairly seamless. I filled out a form about my past medical/surgical/anesthesia history, faxed it, and waited until 4pm the day before to hear about my OR time. I was told 1:30pm, and to not drink or eat after midnight. I tried to argue - I should have known better - surely over 12 hours of fasting is a bit of an overkill? (Even babies can have clear liquids up to 4 hours before anesthesia - but I didn’t say that) But got shot down, and resigned myself to it. Luckily it was over 90 degrees that week, so there was very little appetite.

At 9am I got a call asking if I could come in a little earlier, because the surgeon is able to move up his schedule. It wasn’t a problem, I got to pre-op, registration, and things were moving quite smoothly. When the anesthesiologist came in was the first time I had to divulge that I am a physician. When in my work we meet families who, straight up, upon meeting them for the first time, tell you “I’m a doctor at U of…” or “My father is a head of …. Hospital”, it’s seriously off-putting. Same thing when they tell you “I’m a litigation lawyer” or “I work in malpractice” right away, before you can even talk. It’s like, so we should treat your baby differently? But maybe when it comes to your child, you go into that mode, to protect your own. Most doctors I know, even at their kids’ pediatrician visit, try to refrain from blurting out that they’re in medicine at all.

Then a resident came in. Also there was an ortho resident getting my consent. Now the date was July 2. Although many residencies start in the last week of June, we all chuckle, nudge, nudge, to each other about being hospitalized in July… when your doctors are brand new doctors, 2 months out of medical school. In fact, my friends told me, “request for no resident! only attendings!” I just couldn’t. We’ve all been there - I’ve had my first spinal tap, my first intubation, my first central line - so what if I was someone’s “first”? But luckily I fell asleep during the sciatic nerve block, and next thing I knew I was post-op.

I’d had high hopes that I would stay awake during the procedure and even see it on some screen, but looking back, I don’t think I would have enjoyed it. I was blissfully asleep on versed and propofol, and when I woke up my leg was in a cast very similar to the pre-op cast. I had to prove I could urinate, could walk up and down the hallway, drink water. My surgeon came in and told me that everything went well. I had meant to ask him, “was it way up there? was it all shredded?” but in my versed state, forgot to ask. He also said he talked to me before surgery… but I didn’t remember this part at all. Why would they talk to you when you’re all drugged up already for surgery?

I was getting my stuff together, when the nurse asked me if someone was coming to pick me up. I said no, I’m taking a cab home, and she freaked out. She said she cannot, cannot, discharge me to a cab! She had to see me being handed over to someone. I told her, yeah, the cabdriver, but that was not good enough. So reluctantly I called the unit where I work, asked my colleague to meet me at the hospital entrance. (if you’ve noticed, I am fiercely independent.) There was probably some eye rolling on both sides, like, “what is she thinking?” But happily I got my Norco tablets and was released from the hospital.

Upon their insistence, I gave in and decided to stay at a colleague’s place a few blocks from the hospital. (Yes, I’m lucky to work with very, very caring and nurturing people, and they know I’m stubborn.) It was 90+++++ degrees out, the long weekend was coming up. My leg was still numb, the World Cup was on, and I was rather content… until about midnight, when the throbbing began. I woke up wondering “WTF is going on???” and realized my block is wearing off. Which brought some relief, because, well, they didn’t completely damage the nerve! But then the throbbing came on and got stronger and stronger, it was like my heart was beating in the leg - thump thump, thump thump. I’ve had a ruptured appendicitis before and then I thought a drum was beating in my abdomen. Very similar. I took half a Norco tablet, then another, wondering if this is how Michael Jackson died?

I’m not really sure why my pictures aren’t coming up???

The day after I went to the ER, I was scheduled to be on call at the hospital. My work involves the ICU, I attend high risk deliveries and the unit can have 80-90 babies at a time… I don’t know what I was thinking, but I took a cab, hopped on up the elevators, thinking I can do this. My co-workers thought differently though, and we had to call in another colleague to come in for the night. That was the first time I cried in all of this, I just felt so terrible, an inconvenience to others.

But after schlepping all the way to the hospital, I decided I might as well sleep in the extra call room, and try to see an ortho first thing in the morning. A colleague had given me names of people to see, one who was kind enough to email me immediately and tell me to page him the next day so he could see me in between cases.

I wasn’t about to take him up on it, though; I mean, that’s taking advantage of my being a doctor, right? But the next morning, I looked up all the orthos at the hospital - what is up with all their specialities - hand, shoulder, joint replacements, etc etc? And started calling one after another, only to be told there was no appointment for 2 weeks?! I told them “I tore my Achilles!” but didn’t seem to get anywhere. Finally, at noon, the surrounding co-workers told me to page that guy. I resisted until one of them said, “my god, we doctors should get SOMETHING out of being doctors, you’d do the same for one of us!” and I gave in.

But let me tell you, we were all pretty clueless as to what would be done to my Achilles. Most said, “there’s no way they’d operate!” because “I was not a professional athlete”. I was quite eager to get surgery and get this thing re-attached surgically, but my audience (residents, hospitalists, attendings) tried hard to convince me that any surgery is fraught with risk, so stay away! Until one colleague, married to an ortho herself, texted him and he wrote back, “of course they’d operate, why wouldn’t they operate”. In his words, if you’re young, healthy and active, surgery is the way to go. And the room was abuzz again with discussion and telling me not to get surgery because I had a “better chance of winning the Nobel prize than the Wimbledon”. Seriously.

Sure enough he called right away and got me in between his OR cases at about 4pm. I told him how the injury occurred, and he said he’d have to see for himself, because “sometimes ER can be wrong”. After a brief exam and a couple of my “FOR THE LOVE OF GOD” and “HOLY MOTHER OF#*$&@)_”, he told me it was indeed a tear. My question “is it partial? is it complete” didn’t seem to have much weight, and he quoted the re-rupture rates, surgery complications, the logistics of surgery (regional block, outpatient surgery).

“Well let’s just do it!” I said, and hobbled home again, in a cast. I waited for 4 more days. There was no pain, but sometimes I swear, I could feel something - must be the gastroc - DANGLING.

I tore my left tendon on 6/25 playing tennis.  I exercise regularly, but had started taking lessons for a few weeks, loved it, and that night there was a "tennis party" at the club.  I’d thought it sounded too cheesy for a Friday night, but went anyway.  An hour into it, I served, turned, and heard it, the famous pop.  And felt the snap.  I tumbled forward; the pro told me to ice my leg, but in my mind I knew it was more than a "pulled muscle".  It didn’t hurt, and I could walk on it.  I even drove home, filled the car with gas.  By the next morning, I knew I’d torn it.  I am a physician myself - I’d studied orthopedic injuries enough back in medical school, I knew this was surgical.

So I packed a bag full of sets of clothes, a laptop,  hopped down the stairs to the street, called a cab, and went to the nearest hospital (not where I work).  Being a patient in the ER is agonizing.  After I told the triage nurse "I think I tore my Achilles", while to me it was an emergency, I saw a guy seen rapidly for a "chest pain" and rationally, of course that’s an emergency!  but I felt myself sigh and then felt terrible for feeling frustrated to wait,  I mean, this guy is probably having a heart attack!

When I was finally seen, though, first by the PA (physician assistant), she ordered an x-ray.  I tried to tell her, "um this isn’t a fracture" but she insisted, saying "just in case" and I was dreading having to put up my leg onto the x-ray machine.  Then the ER attending came in and shooed the x-ray tech away.  By exam, he said, this was an Achilles tear.  I said, fine, let’s do the surgery, I’ve packed my bags.  But he told me that this was not urgent - and put me in the immobilizing cast and crutches.  I did ask him, "but how do you know for sure?  Shouldn’t we get an ultrasound? MRI?" and he took pictures on his iPhone and showed me.  I hope these show up here.

I was told to see an ortho within a week.

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