Achilles Diary

Thought I’d add a few snaps of the “the scar” to establish my bona fides.

This first one is two weeks post op just after the cast came off and I went into the boot. The second is as of today (3 weeks + 1 day post op).

So far I’ve had no issues with the incision, apart from a little scare and some bleeding my first day in the boot.

I think my doc must have been top in sewing classes at med school as the incision is straight as a ruler and very neat. Looking at the two I’m glad I took them as it’s a visual record of how far I’ve come even in a few weeks. It’s a shock to see how swelled and bruised the whole area was just a week ago vs now. 

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Well it’s been a while since my last post and I guess that reflects my current status which is….waiting!

I’m mid way through my expected 6 weeks in the boot (if all goes to plan) and I think this may be the hardest part of the whole ATR experience for me. I’m itching to start the rehab process and feel like I’m really doing something to contribute to my own recovery. However apart from a little gentle toe wiggling and basic leg raises etc… there’s not much I can do at this point. I guess there’s plenty of horror stories out there of people going too fast too soon, so a little patience is a good thing.

On the positive side I made it back in to work for the first time today. Been working at home so far, but it’s great to get out of the house and have some social interaction. Also I’m very pleased that after a whole day at the office the only ill effects are a little tiredness and some barely noticeable swelling in the ankle.

Also a week after being given permission by my surgeon I overcame my fear of sleeping without the boot. In fact I think it’s really done the ankle some good as the incision is now starting to look really great with the increased airflow.

Finally I’ve been trawling the net for walking canes in anticipation of the boot removal. My first instinct for a sword cane has given way to reason and I’m looking at something sexy and modern in carbon fibre!

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Wow, I taught myself how to walk again, what a feeling! Still very clunky and at the moment I’m carrying one crutch around in case of emergencies, but boy does it make a difference having both hands available again.

I scared myself soemwhat yesterday as the incision stretched a bit and resulted in some bleeding, but seems to have closed up nicely overnight.

Hope everyone else is doing well and believe me FWB is like a new lease on life when you get there.

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Today was my second post op appointment and my first chance to actually talk to my surgeon after the surgery. I have now become quite good at squeezing in multiple questions in the roughly 5-10 minutes that I can keep his attention. 

All joking aside I’m really impressed with the doc so far and he has taken the time to answer my questions pretty fully. So the out come of todays appointment in bullet form is.

• The incision looks to be healing very nicely. Seem like my paranoid fear of infection and stringent efforts to keep it dry and sterile have so far paid off. I did have a full rupture, but it was pretty run of the mill surgery with no complications. Interestingly my surgeon uses a technique where he harvests a small amount of a lesser tendon that runs parallel to the achiles (have already forgotten the correct anoatomical name) to use as the material for the actual repair/suture on the achilles. Has anyone else had experience of this technique, sounded pretty cool to me?

• The swelling on my ankle is very much reduced, I can actually see my ankle joint again which is pretty cool.

• The doc has moved my boot settings from 15.0 degrees where I have been from the last week to 7.5 degrees. It feels a little odd to have some tension in the back of the foot again, but I’m sure I’ll get used to it quickly.

• The really awesome news is that he now says I can walk on the foot (with the boot) to whatever extent I can bear. I was expecting this, but it’s still a huge boost to my morale. Feel like phoning everyone I know to spread the good news! Having said that I have found out very quickly that saying you’re allowed to walk on it and actually being able to are two very different things. Right now am still using the crutches and just getting used to the idea of putting the foot down again. There’s not much pain, but a lot of nerve sensation in the foot and I definitely do not feel confident about putting my whole weight on it. Over the next few days I feel like I should be able to go down to one crutch around the house and eventually ditch them altogether.

• Finally the doc says I can sleep without the boot. I’m not sure how I feel about this yet as I tend to move around a fair bit at night, would be terrified of tangling the foot up in bedclothes and injuring it again. Also psycologically I think I’ve become a little bit boot-dependent at this stage and may take a while to wean myself off it.

Now I have another two weeks before my next visit at which time they’ll crank my foot up to 0.0 degrees for a final two weeks in the boot (6 weeks total post op) at which point I’m told I can begin PT. Originally I was hoping to get to PT a bit faster, but I think I’m fine with this timeline which seems to be at a midpoint between the ultra conservative and super aggressive protocols out there.

Will keep posting and crossing fingers that all continues to go well for me and everyone else out there in ATR land.

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Do not assume that because a pair of crutches are handed to you by an ER professional they are correctly adjusted for your height/build. After hobbling about for 2 weeks in a slightly hunched position I actually took the time today to look up proper crutch techiniques and adjust my set up.  Moving my hand rests up one notch resulted in a massive improvement in gait, posture and overall comfort.  DOH!

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After the past few days increasing boredom today is exciting. I’m getting my laptop back and I have my first post op doctor’s appointment.

Another colleague swings by drops off my laptop and gives me a ride to the doctors. My surgeon is actually on vacation so I’m to see his medical assistant. Initially I’m a bit put off by this, but a few minutes after meeting her I’m feeling ok again as it’s obvious she knows her stuff.

The outcome of the appointment is wholly good, but a little bit mixed versus my expectations. She removes my post op cast and examines the incision which is healing really well. My surgeon has used beneath the skin, dissolving stitches so no need to remove those and as per his protocol I can now go straight into the CAM Walker or Boot. That’s the good news, the bad news is another week totally non weight bearing and unlike my surgeon his assistant is pretty emphatic about not driving whilst in the cast or boot. Her objection seems to be more legal than medical. As I’ve already checked with my insurer and they have no objection I resolve to take this up with the surgeon again at next weeks appointment. No one is talking about 1000 mile road trips, I just want to be able to drive the shops & back, there has to be some middle ground here?

The boot (DAS BOOT) is a joy after the half cast. I’ve read a few discouraging blog reports regarding the heaviness of the boot, but next to the cast it’s positively feather light and way more comfortable with much better airflow. It is bulky, but honest to god feels at least a third lighter than the plaster cast. Also, joy of joys, it can be removed to shower or bath which seems to me like pretty much the ultimate luxury right now. Amazing how your horizons and priorities can change.

My only reservation about the boot so far is that I can no longer easily see my toes or top of my foot. I want to start transitioning the leg from constantly elevated to more time in a normal position and previously the toes gave me a great visual check on any swelling that developed.

All through these last few days I’ve been elevating the leg as much as possible and icing it, initially very frequently per the post op protocols then 3-4 times a day as I feel the foot and ankle swelling or aching. Throughout the same period there have been occasional sensations in and around the ankle, heat and tingling in the heel, occasional shooting pains in the leg, some slight itchiness around the incision and deeper muscle pains and aches. None last too long and luckily for me as this is not my first surgery I recognize these as “good” pains associated with the healing process and am not too freaked out. If any of them lasts too long or becomes uncomfortable I’ll shift positions or ice the area, but so far I’ve not needed any pain meds since the day after the surgery.

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Over night I miss a scheduled pain med and wake up early in the morning to a lot of pain in the ankle. Basically a deep ache accompanied by occasional shooting pains up and down the leg. Knowing I have to eat with the pain pills I eat an apple wait a few minutes and take a couple of Norco. Instantly a wave of nausea hits me, I hold out for an hour, but eventually crutch my way to the bathroom and throw up the lot. Not wanting to take any chances I go back to bed and continue the ice routine (20minutes on, 10 minutes off) with no pain meds for the next couple of hours. It hurts like hell, but not unbearable and preferable to vomiting again. Gradually around mid morning I start to feel better and I risk 1 over the counter Advil with a cup of tea. That actually takes the edge off the pain perfectly well and from this point on I stick to Advil’s only with no problem.

By Saturday I’m starting to feel good, I get tired pretty quickly, but am eating well and not needing any pain meds. I continue the icing routine and transfer from my bedroom to the living room couch for a change of scene.

Unbelievably my work laptop (actually the only PC I have) goes on the fritz at this point, suddenly I’m cut off from work & private email and a major source of contact with the outside world. I arrange with a friend & colleague to come round on Sunday & take it in to IT. He comes over and brings food, we hang out, watch a movie and chat which is good for my now rather hermit like existence. It will later transpire that my laptop needs a new motherboard and screen and through a series of cock ups I will not get it back for three days. At the time I’m pissed, but boredom aside it may actually have been a blessing as I have a solid 5 days after the surgery totally unplugged from the world. All I have to worry about is looking after the ankle, maintaining elevation and icing and I think it contributes to a so far trouble free recovery.

At least I’m able to watch the British Open Golf in peace (poor Tom Watson) and I even start to take an interest in the Tour de France, As much as I love cycling watching it on TV has always bored the hell out of me before now.

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The same work colleague drops me off at the surgical center and also confirms that he’ll be able to pick me up and “sign” for me in the afternoon. It’s not my first surgery so I’m not too intimidated or particularly nervous. After registering I hang about in the waiting room for 20 minutes or so and am then taken through to be changed into surgical gown & cap and have an IV prepped for the anesthesia and other fluids.

I wait another 20 minutes or so for the anesthesiologist to turn up, which he does in due course. There are two options for anesthesia which is a new concept to me. Frankly I have no idea what to pick, but based on the fact that I hate being knocked out totally and it seems to offer fewer complications I go for the spinal block rather than general anesthesia. My surgeon pops his head around the curtain to say hi and mark up the leg and a few minutes later I hobble into the theatre at what I presume is my surgery time of 1pm.

The spinal block is painless, I feel literally nothing as it goes in. After a few minutes chatting to the surgical team I’m administered some sedatives and sleep through the rest of the procedure. I wake what must have been about 45 minutes later face down on the bed whilst out the corner of my eye I can see the surgeon putting final touches to the initial half cast. A few minutes later I’m transferred to a trolley and wheeled out to recovery. Everything below the waist is still totally numb, but feeling as well as pain returns over the next 20-30 minutes. I’m given a couple of Norco tablets and the nurse talks me through the pain management routine and post op procedures which are pretty simple. My ride arrives and we leave around 4pm slip past a pharmacy to collect my Norco prescription and by 5pm I’m at home in bed. Per the post op instructions you are supposed to have someone on hand for 24hrs, but my friends son has been taken ill and as it’s obvious I’m lucid and coping ok I tell him to head out, but just ring me every couple of hours to make sure I’m still alive.

The first afternoon/evening is fine. I stick to the pain relief regimen, stay in bed and keep the leg elevated and iced and even manage to eat a small but adequate evening meal of chicken & rice.

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Saturday & Sunday - In a vacuum of information, no firm diagnosis, no treatment plan etc…I start to trawl the net for medical texts, blogs and the like. Some of this is useful, most of it just downright terrifying. As near as I can tell I’m looking at 6-8 weeks in a cast followed by the same or more in the mysterious CAM walker + painful rehab and after a year I may get back 80% of the use of my leg. Holy shit, this can’t be happening, I’m a young fit guy, I cycle, hike, do weights etc..  on a regular basis. Now it seems like I could be 38, jobless, homeless and partially disabled. F%$K!

About this time I start to think about how I’m going to cope round the house. I’m a relatively recent transplant to the US from the UK and have no family close by and due to a punishing work schedule few friends. Ironically part of the idea behind the tennis was to try and regain some work life balance and widen my circle of acquaintances. (Over the next few weeks it turns out I have more friends than I thought and ultimately I’m very grateful for their support).

Safeway online takes care of my groceries and I start looking at maid services in case I need it. I work out a method using ropes and haul lines to get laundry down to the garage & back (I’m on the 2^nd floor) and after the first hideous attempt at showering I rig up a shower stool with the cunning use of an Ikea foot stool and a couple of large garbage bags. These small victories make me feel a little better. Also I’m adapting to the crutches, figuring out stairs and ways to carry stuff which is hard. There’s no way I like the crutches, but luckily I have reasonable upper body strength and good coordination so it’s not as much of a trial as some people have told me it can be. A friend comes round on Sunday night and takes me out to dinner at a local Indian Restaurant. I don’t feel like eating much, but I appreciate the gesture.

I also email my boss and team at work to let them know what’s happened. They are all very understanding and will in fact really help me out over the next few weeks with doctor’s appointments & the like. I feel very guilty about the whole thing, but it looks like at least I will have a job. I’m fortunate to be able to do a lot of work from home, it’s not ideal, but better than nothing.

Monday – I ring three orthopedic surgeons, two have no appointments for at least a week. The third, the one recommended to me is the same, but a colleague in his practice has an appointment for Wednesday, 4 and a half days after the injury, but the best I can do so I take it.

I’m actually quite glad to get this guy. Over the last day or so I’ve had a chance to read between the lines of some of the blogs and other material out there. It’s becoming apparent that there’s no set way to treat Achilles ruptures and a lot depends on which doctor you get. I’m determined to be on an aggressive rehab protocol. Reading a couple of accounts of people who’ve been out of a cast and into the walker in a few weeks has given me hope of a speedier recovery and I know that’s where I need to be. The Doctor I finally see consults with local sports teams and theatrical performers and is known to favor quick rehab. I’m reassured and spend the next few days trying to catch up with work and prepare for what I hope will be a speedy surgery date.

Wednesday – A work colleague who lives nearby generously gives me a ride into the doctor’s office in the morning. As soon as I meet the doc I feel good. He quickly confirms the diagnosis of ruptured Achilles with another Thompson test (No MRI or ultrasound required), tells me that recent studies have shown surgery has quicker and better results than non operative care and that he firmly believes in getting patients in the walker and weight bearing as soon as possible. This is absolutely what I want to hear and gibes with what I’ve been reading. In addition he checks and it seems there’s a possibility that he can get me a surgery slot the next day. I spend more time waiting while the slot is confirmed and booked than actually with the doctor, but that is surgeons for you I guess. I ask about protocols and he tells me that he will aim to have me out of the cast and into the walker in a week with weight bearing soon after depending on circumstances. I also ask about driving and he’s basically non committal, seems like he does not forbid it on medical grounds and that it’s basically a case of how confident you feel with the awkwardness of having your driving foot in a cast. I decide to raise it again as an issue after the walker goes on. For the time being my driving privileges are revoked.

I take a cab home and prepare in earnest for surgery. The doctor has allowed me to keep the cast off so I take long luxurious bath. Then I set up my bedroom moving in laptop, radio, bottles of water, snacks, books, tissues, Advil tabs and anything else I think I might need. Finally I do as much house cleaning especially in the kitchen and bathroom as crutches will allow. At 7pm I have last meal and go on fast for the anesthesia. In the morning I take another super long shower anticipating the cast and change bedclothes so I have as pleasant an environment to come home to as possible.

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Woke up this morning excited to play tennis for the first time in a while (probably about a year). However looking at the grey and overcast weather I have second thoughts, how I wish I’d skipped it as it will turn out to be a bad day.

I drive over to the courts and meet Pete & Ben who are part of a meetup group I’ve just joined. We start to knock about on the court, nothing too serious, not even scoring the points. About 30-45 minutes in I’m feeling good, ground shots are coming back and I’m even serving ok. We’re still just knocking about and then I decide to run for a ball that drops low over the net. POW! I feel an instant pain in my right heel and hear a faint pop, next thing I’m on the ground and I know something is badly wrong. Oddly it does not actually hurt too much, but definitely very uncomfortable. Rationally I knew the first second exactly what I’d done as roughly 5 years ago I’d seen it happen to my boss whilst playing squash, however denial kicks in and I hope against hope that it’s just a bad sprain. I’m given some encouragement in this by the fact I can still stand and walk albeit with a lot of difficulty. After a few minutes at the side of the court with concerned looks all round I tell the guys that I’m going to head home and see how it goes.

I manage to walk a block and a half to my car and drive home where I take a quick bath, still hoping it’s a strain, and change into clean clothes. As I still can’t walk properly or control the foot sanity prevails and I admit that I’m fooling myself. I get back in the car and drive to the nearest ER arriving about an hour after the injury happened. The drive if nothing else convinces me I’m in trouble as I really struggle to accelerate and especially brake, by the time I get to the ER I can barely walk and luckily a nurse going off duty spots me and gets a chair to wheel me in.

The ER staff is great, but there’s basically nothing they can do except a quick Thompson test and tell me they are sure it’s a ruptured Achilles. They put me into a temporary cast, hand me some crutches and tell me to keep the weight off until I can see an orthopedic surgeon. Astonishingly I now manage to drive back home using the left foot to brake which is scary, but you quickly get used to it. I’m in no pain so I don’t even bother to collect the Vicodin prescription they have given me.

I try ringing a few numbers of orthopedic surgeons including one recommended by a friend who had Achilles tendon surgery roughly a year ago. It turns out this is where I’ll go in the end, but on the Saturday I’m unreasonably frustrated by the fact that all the practices I call are closed, don’t they realize this is an emergency here?

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