lotus10’s AchillesBlog

3 weeks post-op now; but first, how it happened

Posted in Uncategorized by lotus10 on the July 22, 2010

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.

One Response to '3 weeks post-op now; but first, how it happened'

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  1. normofthenorth said,

    on July 22nd, 2010 at 2:14 pm

    OK, Lotus, NOW you’ve got me waiting on tenterhooks to find out (a) how your treatment and AT-recovery progress, and (b) how your re-education progresses, after learning enough in Med School to “know this was surgical”! The fact that the hospital put you immediately in a cast rather than a boot suggests that they weren’t familiar with the latest evidence, either, though in a slightly different way than you weren’t. . . I’ve summarized the evidence on surgery vs. non-op at bit.ly/achillesstudies , and I’ve reproduced the aggressive-and-successful protocol from the newest of the studies at bit.ly/UWOProtocol . The Wikipedia article on ATR also reflects the new studies (since I edited it myself!).

    BTW, it’s not unusual to find an Ortho Surgeon who prefers to operate on ATRs that have had at least a few days, or even a week or so, to “mature” first. And preferably with the ankle immobilized, to make sure that the top of the torn tendon doesn’t slide farther up and away, inside the paratenon — though WHY anybody would do anything that would create that creepy feeling a SECOND time is beyond me! (I felt a tiny version of it when I first put my “bad” foot on a stairway step going up, after tearing my first AT in late 2001. The normal way, with my heel sticking out over air. When I started THINKING about shifting my weight to that foot, I started getting the creepiest feeling I’d ever had — INCLUDING tearing the thing! I stopped immediately, and never did anything like that again, ’til long after my surgery! I walked up stairs, but my heel was firmly planted on the step each time.)

    I’ve heard a couple of surgeons explain that the torn ends of the tendon usually start like spaghetti or a horse’s tail, then gradually consolidate into neater and tighter and stronger and easier-to-suture forms when left to “mature”. My first ATR was repaired surgically after 9 days and that surgeon said it was the second messiest tears he’d ever seen. My new surgeon (fancy sports-med ortho) put me straight into a boot after discussing the latest randomized-trial study with the authors, and deciding not to do any more surgical ATR repairs — but he told me he always liked the way the AT ends looked after a full 14 days of “maturing”.

    I’m staying tuned, glued to my screen! :-)

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