Case 25: Non-operative treatment

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one year ago today …

February 19th, 2010 · 5 Comments

Exactly a year ago I ruptured my left achilles tendon in a basketball game. What a year!
I feel I need to update those interested in my journey with some results, good news and some not so good news. Thus, here we go:

I was one of the very first ones, at the highly celebrated sports clinic at my university, to go through the non-operative procedure with the PRP (Platelet Rich Plasma) injections. I can’t say I am completely happy with the results. I can run, jog, walk, swim, play most sports. I can’t jump, lift myself up with on the left heel, or come down the stairs smoothly (or without a handraili). The issue is that my tendon healed long! I have recovered full muscle strength, but eh, that isn’t just doing it. On top of that ,there is a consistent and constant pain every morning for about the first half hour.

On that note, I highly recommend everyone to take physio therapy very seriously. At the beginning the clinic I went to was just a cash drain. They did nothing substantive. The second clinic I went to (after the 5th month) they were fantatic, attending, caring, results oriented, scientific and methodical.

Overall, I am glad the year is over. Just mentally I am at ease. I wish everyone on this site, and all those sharing our pain, a smooth recovery.

Thank you all for your support!

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seven months post injury (non operative) - not so great results

September 30th, 2009 · 6 Comments

It’s been a while since I posted a blog here. But I feel this information needs to be shared.

Some of you may recall that upon my ATR injury back in February, I was treated non-operatively and was put in this study that injected blood plasma into the injury region. Well … 7 months has gone by and I am still in a less than promising situation. I still have pain (!) while I walk. I still limp noticeably and have difficulty going down the stairs.

I changed physiotherapist last week. He started measuring me up and discovered that my injured tendon has healed long! It’s a rather simple test: I would sit with extended legs in front of me; I would then try to point my tows towards me as much as possible. In normal cases the feet are parallel. In my case, there is a 30 degree angle difference!

The cause? Very likely has to do with the mistake happened at the emerg. The resident had given me a wrong cast and gave me no heel lift. My first appointment was 18 days post injury. So the flat cast/boot could have been the reason.

Now the surgeon wants me to continue more intensive physio. In 2 months he’s going to reevaluate the situation. He may decide to go in and “fix” things, as he said. The whole process will begin from scratch. I am NOT pleased with this.

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Almost 5 months and still limping!!

July 11th, 2009 · 2 Comments

OK. I need some advice!

Roughly five months ago I had my injury. My “progressive” university hospital chose to put me through a non-operative treatment. I’ve been out of the cast for 2 months now. But I am still limping! And certain times I have pain. On top of all that, when I look at my left leg I get depressed. The div is still there (not AS visible, but still is). I’m slowly gaining strength in my left calf but quite honestly, my calf muscle is more of a jello than those found in the dairy buffet.

I need some advice, please.
Those who have gone through this process, can you help me understand whether this is normal? Do I need to intensify my physiotherapy? Do I need to get checked out by other surgeons?

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At the three months mark

May 16th, 2009 · 1 Comment

Just over 12 weeks have now passed. My heel is healing, slowly. Around 3 weeks ago I went off the boot. I have intensified the physio, but I suppose I’m growing impatient regardless.  I don’t have any complains. I can walk short distances, from room to room for example. But longer distances really hurt my foot. My therapist says that it would take 8 more weeks before I can walk properly, without a limp, and a few months before I can run. At this stage I don’t care about running as much. I really hope I can walk more properly sooner, so I can enjoy the spring beauty.  - ah, jeez, this post sounds more like a rant. I didn’t mean it  to be that way.

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I almost reruptured the damn AT

March 27th, 2009 · 5 Comments

Yesterday was the 5 week mark. I have been partial weight bearing (PWB) for nearly a week now. I was walking with one crutch in a very awkward (and dare I say, embarrasing) way. The weather here in London Ontario (Canada) is getting nicer every day. I decided to get out and get a hair cut. So, I walked out of my office and in 10 minutes got to the barber shop here on the university campus. Once I was done, and looked kind of normal again, as I was getting off the barber’s chair my right foot (the normal one) got stuck behind the footrest of the chair and I flew in the air, landed HEAVILY on my left foot, the injured one. OUCH! For hours I thought I had reruptured it, that painful… back to two crutches and NWB for now!

This morning I was contemplating to visit my surgeon again and let him know what happened. Miracelously I ran into him just outside my office. He said in an encouraging way: “Good, I see you’re always wearing your boot.” Immediately I explained to him what had happened and that I was concerned I had reruptured it. He quickly looked at it and told me that… eh… nothing serious! I had just stretched the stiff muscles that had not moved for 5 weeks. But the tendon was not damaged. In fact, he showed me how the “hole” that I had earlier was not being filled in again. My reborn achilles was growing, so sentimental I suppose!

I guess tomorrow morning I’ll try to get back on PWB again. The only thing I liked about NWB was the fact that my boot was kept clean and I could take it in bed with me. Now, every night I have to pull out all sorts of chemicals (cleaning material) and wipe the boot spotless clean - so I can sleep with it. Has anyone else experienced this unease with wearing your boot in bed? I wish there were boot condoms I could wear in bed :)

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More info on the plasma injection

March 19th, 2009 · 6 Comments

Today was the 4 week mark!  I still remember the loud POP and the sharp pain…

I went to the surgeon again for the second (and last) plasma injection. This treatment is called an autologous conditioned plasma (ACP) injection, which involves removing some of my blood from my non-dominant arm and injecting part of the blood, the plasma, back into the ruptured tendon. The plasma contains platelets that release growth factors that may induce a healing process when injected at the site of the Achilles tendon tear. 

The objective of the study is to determine whether non-operative treatment plus an ACP injection will provide improved overall results when compared to non-operative treatment alone.

As part of my standard non-operative treatment protocol, I am still in an aircast boot with 2cm (approx. 1 inch) heel lift with protected weight bearing with crutches. My physiotherapy consists of active plantar and dorsi flexion to neutral as well as inversion/eversion below neutral. I must say that I am still undergoing therapeutic ultrasound and Functional Electrical Stimulation. 

Yesterday, for the first time since the injury (4 weeks ago) I put on my own running shoes and, under the supervision of the physiotherapist, I used the stationary bike for 5 minutes.  I was not very comfortable. It wasn’t quite encouraging.  I am hoping next time (in 5 days) I can do better! …. Let’s see.

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Non-Operative Treatment

March 13th, 2009 · 16 Comments

February 18th, 2009. I was playing basketball with my fellow PhD students. Roughly 30 minutes in the game (for which I spent a good 20 minutes warming up and stretching), I felt someone had shot me, with a gun, and hit my calf - or somewhere back of my left leg.

Half an hour later I made it to the “urgent care unit” of one London Health Sciences Network hospitals (London, Ontario). Soon enough I learnt that I had completely ruptured my Achilles Tendon. They put me in an aircast (aka the boot), gave me crutches and sent me home. The doctor that night told me that I should consider myself very lucky since the orthopedic surgeon who’s going to take care of me was a lead scientist on a massive study completed at the University of Western Ontario on non-operative treatment of ATR.

Thirteen days after the injury I went to see the surgeon. His assistant walked in and explained the whole study that they had completed on the non-operative treatment. Essentially they had a random assignment of 118 cases, over a span of 7 years, in two groups of surgical and non surgical treatment. At 12 and 24 months they had compared several conditions of both groups and were not able to detect any advantages of the surgical group. They compared range of motion, re-rupture rate, patient satisfaction, etc. There were no differences tracing back to the treatment. In fact, the cases in the surgical group had demonstrated some (and often normal) complications of the surgery, i.e., scarred tissue, etc.

So, the assistant was telling me that in that clinic, Fowler Kennedy, they now treat all ATR patience non-operatively. Being a phd student myself, I needed to see the study and check for any methodological issues that might have led them to wrong conclusions.  I didn’t find anything!  That day, I became a new patient being treated non-operatively. Soon enough I’ll write the details of the non-operative treatment.

The assistant goes on explaining that they have a new study going on now, that would draw my blood, put it in a centrifugal machine, extract the plasma part (all the warrior cells, in a manner of speaking) and reinject it back in the tendon. OUCH!   I signed up as - was then known as case #25!

Since then I have had 3 physio sessions, dorsiflexion, ultrasound and micro-electric therapy. Wednesday March 18th, nearly 4 weeks after the injury, I’ll be getting my 2nd plasma injection…. stay tuned.

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