meskigirl’s AchillesBlog

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meskigirl’s AT surgery & recovery - week 1 & 2

Filed under: Uncategorized — meskigirl at 2:28 pm on Sunday, December 1, 2013

About me: I am a 45 year old active female living in New England. I have been struggling with chronic AT tendonosis for years and have gone through all the traditional non-surgical treatments that are out there. Over the past year my left achilles has broken down to the point where I was in pain every day and had to stop any impact exercise/activity and also could not x-country ski.  I finally broke down and went to see a specialist and we decided the best course of action for me to be able to do the things I want to do was to resort to surgery.  He recommended an achilles debridement with tendon transfer.  After much research and soul searching I agreed and scheduled the surgery.  following is an account of my first few weeks- hope it helps others know what to expect!

Surgery Day:  After 2 months of preparing and waiting surgery day finally arrived.  I was all set.  House set up for me to be disabled, work schedule cleared, and family prepped.  I rented a knee walker and also purchased a used tempurpedic adjustable bed (in hindsight this was the best decision I have made in a long time!) to put in our livingroom close to our bathroom for my recovery.  Nothing to eat after midnight and only clear liquids after that up to 4 hours before surgery.  Got registered at the hospital and things moved fairly quickly after that.  They had me put on this johnny and slippers and pack my stuff in a plastic bag.  The johnny had a hook up that fed heat in to it which was great since the pre-op area was quite chilly.  They took my vitals and hooked me up to an IV.   The Doc came and talked to us and marked my leg for surgery.  Then came the block.  This was actually the most painful thing about the day  (and it wasn’t really that bad.)  They put a needle in the back of my leg and then in my inner thigh that bathed the nerves with novicane to numb my leg and foot almost completely.  They gave me some valium through my IV to relax me  and then wheeled me in to the operating room.  I was down in no time with meds administered through the IV and don’t remember a thing until I woke up in recovery.  I was in a bit of pain at that point so the nurse gave me an oxycodone and put something in my IV that helped immediately.  There was a HUGE splint on my lower leg which consisted of an open splint with a hard bottom and packed with some kind of casting material (soft) on the top to allow for swelling.  After a bit they put me in to the second recovery area where my husband could join me.  They fed me and let me use the bathroom.  I had felt pretty good up until the use the bathroom part - once I started moving around I got really nauseous.  They had given me meds for nausea before the operation but they did not work 100%.  I felt awful.  I had to endure this feeling for the entire 2 hour ride home which was not fun!

I felt better once home and in bed.  My leg stayed completely numb and pain free for 24 hours.  I did start taking pain pills to make sure that the pain did not surface during the night.  In the late afternoon of day two the block started to wear off.  The pain was very manageable.  The pain meds were making me very sick though.  Had a challenging couple of days but then things started to improve. The most uncomfortable part thus far are the random muscle spasms that happen just as I am going to sleep.  They happen all over my body and often in my operative leg.  It is painful and annoying at the same time.  I am told that it is normal an should subside in a few weeks.

Week 1 and 2

I don’t think I have ever spent this much consecutive  time in bed in my entire life!  The two weeks after my surgery are almost over.  I have started to work 1/2 days sitting in my bed with my computer in my lap.  I find that whenever my leg is not elevated it quickly becomes painful.  I have read, attempted to learn to knit, and have played more stupid games on the computer than I wish to admit.   I hate being reliant on others to wait on me to get what I need and have to keep reminding myself that I chose to do this surgery and that my positive attitude is key in my recovery.

The pain I have is very manageable.  I don’t take pain meds except at night to knock me out so I can sleep.  Have been doing leg lifts and other seated exercises daily and am feeling strong on my crutches and knee walker.  The swelling in my leg is nill.  I can move my toes (except for my big toe which was involved in the tendon transfer).  I can feel what I think must be my stitches rubbing against the splint and can move my foot around quite a bit inside the splint.  I have had one accident while on crutches and had to put some partial weight on my operative leg - it was very painful and reminded me to be extra careful as I move around.  I am looking forward to my next appointment which is in a few days where they will remove my splint to check my incision and remove the stitches and put on a hard cast.  I am told that it will be 8 weeks before I am allowed to put weight on my foot - if that is true I am only 25% through this first part of recovery.  So far, so good but 8 weeks is a LONG time!

7 Comments »

2

Comment by kimc

December 1, 2013 @ 7:01 pm

Meskigirl,

Like you, I lived with chronic tendinosis for two years, trying all the usual conservative treatments before going the surgical route. I did not have a FHL tendon transfer, but did have debridement, Haglund’s excisions and removal of some bone spurs and calcification. I also had a couple of accidents the first two weeks, landing fairly hard on the surgical foot. No lasting damage, but a reminder to slow down. I am wondering about the 8 weeks of non-weight bearing you were told to expect. My surgeon put me in a hard splint, like the one you described, for two weeks. I was then put in a boot and used crutches as I progressed from partial weight bearing to full weight bearing. That timetable seems to be fairly common among the more progressive protocols. I expect you’ll hear from some of the more experienced posters on this site regarding earlier weight-bearing and its benefits. Many have had to “educate” their surgeons. In the meantime, congratulations on surviving the first two weeks with a great attitude!

3

Comment by alanweibel

December 1, 2013 @ 9:25 pm

Welcome to Achilles Blog and good luck with your recovery Meski.

4

Comment by normofthenorth

December 2, 2013 @ 12:38 am

Yes, best of luck, MG! And 8 weeks NWB IS a very long time, and is not associated with better outcomes than 2 weeks NWB in any of the studies I’ve seen. Recent studies mostly do 2 weeks (or even 1) of NWB, then a couple of weeks of PWB, sliding toward FWB at 4 weeks post or even sooner “as tolerated”. You can check out bit.ly/UWOProtocol for one very successful protocol from a study done on ~150 complete ATR patients, half of which skipped the surgery. On average, they all did quite well. The whole study is on the “Studies and Protocols” page that you can find linked from the Main page here. (That protocol is pretty close to what KimC went through, as she described above.)

More recently, a group at Exeter in the UK has had excellent results (apparently even better than UWO on the surgical side), going even faster than that UWO protocol. Maybe Hillie or Suddsy can give you a link to it, or you could search this site for terms like “Exeter”.

On the same “Studies” page, you’ll also find a number of studies that compared faster and slower post-op protocols. In the range of speeds they used, NONE showed a clinical benefit from going slower, and several showed benefits from going faster. But hey, if you can speed up getting back to normal by ~6 weeks with the SAME clinical results, why wouldn’t you do it?

Most of the real reason for slow rehab these days has nothing to do with the evidence (au contraire), but has to do with force of habit and outdated logical-sounding beliefs that have been given the lie by recent studies: “Better to take a few more weeks than take a chance,” “After all, you don’t want to go through this again,” “Let’s give your leg a really good chance to heal and strengthen before we put it to the test,” etc., etc. Those old saws still make sense to many OSs, years after the best studies have shown that they are somewhere between false and exactly backwards! It turns out that the reattaching and rebuilding of a strong AT depends on retraining it to be a TENDON at the appropriate times after it was ruptured or severed surgically. (Some Haglund-repair surgeries leave the AT attached to the heel bone, and those patients can usually proceed through rehab even faster than us ATR folks, and the ones in the studies.)

The best outcome for you and the next hundred patients is to educate your OS or the whole team to the new evidence. The other alternatives may work out OK for you, but will leave the next folks vulnerable to suboptimal practices.

5

Comment by hillie

December 2, 2013 @ 12:44 pm

Meskigirl

I posted the Exeter link at http://achillesblog.com/suddsy/2013/06/24/end-of-wk-2-wow-progress/. Lots of other good stuff there from a number of regulars.

Good luck

H

6

Comment by meskigirl

December 2, 2013 @ 1:15 pm

Thanks, All! I am doing my research and going in to my Doc’s office tomorrow armed with it! I had a last minute Doc change right before my surgery due to my regular Doc getting in to a bad accident. He seemed much more in tune with more current thoughts on this than the one I have now. I doubt I will talk him in to putting me in a boot tomorrow but will focus on him doing that on my late December visit for sure.

7

Comment by momto4peas

December 2, 2013 @ 1:42 pm

Your post reminds me of me! I had severe tendonitis since college and it finally got to a point of not being able to do anything without pain,including running to get my kids if they got to close to a street. My doctor ended up not needing to do the tendon transfer so my recovery may be slightly different than you. I was only two weeks nwb and that was long enough for me! By 4 months I was running slowly and for short distances. 6 months I was able to run without pain! While I was going through the recovery I was sad about my choice, because like you it was a choice, but now I am soo happy that I made my life better with this choice! Happy Recovery!

8

Comment by Ron

December 2, 2013 @ 11:50 pm

Meskigirl,

Good post. The good news is that things bet substantially better every single week, so you will go from counting hours to days, to week, to months.

Yes, there are a lot of protocols up here, and I have a few of them posted in one of my posts as well. Once you get 4-6 weeks out, your life will change in a good way (depending on your protocol).

However, you may have to really WORK WITH you Ortho and PT. LOL

Good luck and keep us posted.
Ron

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