I spend time now talking to the “normals” about my fellow ATR’s (usually, I refer to all of you as ‘my blog friends’). They’re surprised at how creative this group is at solving everyday problems and at how we all seem to rally around each other. I wanted to just liberally sprinkle around the kudos to everyone and give you a chance to realize how special you all are!

Personally, I’m closing out a full week or working in the office. It was great. I had been getting a little bit of “cabin fever” at home (the first week as ‘vacation’ and the second week as telecommuting). Stuck at home, by myself, really didn’t cut it for me. It was ok at first - lots of movies, naps, and such - but after a while, I felt I just needed to be around people more. The week of the being in the office around people, seeing friends, sharing injury stories, and having lunch with other people was a real morale booster. So - props to the consulting peeps who were in the office and put up with the idiosyncrasies - you know who you are.

I did push the limits every day on how far I could go on the crutches. After a week of this, my upper body feels stronger, and the feeling of sore muscles was really a welcome sensation. It just feels like progress. Speaking of progress, in less than a week, I get into the boot and will be PWB. As a bit of an experiment, I’ve been flexing my foot to the extent that the cast allows. What was interesting is that I could push down with the ball of my foot against the cast - sorta like an isometric exercise mimicking a toe-raise. It was weird trying to get my calf muscle to fire after weeks of just being meat on the leg. Feeling pressure on my heel was both good and a little weird. I think I over did it a little - I had a little bit of swelling - but overall, it seemed like something I’ll do a little of over the weekend in preparation for “The Boot”.

Also, now that I’ve had a full week in a normal cast instead of the huge thing I was in before, I really appreciate the freedom to wiggle my toes. It really felt . . . claustrophobic to have my toes all wadded up and not be able to move them. Having them in the open and able to move has given me a sense of freedom and a little bit of recovery as well. It was a great “small win” to keep positive!

Parting shot to all of you: take the small wins where you can get them! They’ll take you through the tough times.

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For those of you who haven’t swallowed your pride and used a wheelchair for a long outing - do it. Do it now.

After reading the blogs (especially eriedutchgirl’s entry about wheeling around the beer festival) and struggling with being able to go farther than 40 yards on crutches without having to rest, I swallowed the pride and rented the wheelchair to go to the company’s quarterly meeting. This quarter, we held it at Universal Studios Hollywood, so there was some added incentive - if I was going to cruise the park, I knew I couldn’t do it via crutches. It was a great decision on many levels.

First, at all of the rides and shows, there were special lanes just for the handicapped, so the waits were manageable. We didn’t necessarily jump to the front of the line, but it was nice not having to jostle around in line with everyone else waiting to get stepped on. Second, just being able to get around. Crutches aren’t good for going any kind of distance, as we’re all finding out, and the wheelchair made it so much easier. It took a little getting used to maneuvering, but it wasn’t that bad. Third, because I got my wife to push me around, she got a little bit of a taste of how mobility takes effort when you’re not using your legs. Even though I think I’ve gotten used to the crutches and can mostly maneuver pretty well, it’s still significant effort to do anything on crutches. I don’t know how people deal with them long term. Even the doors at work are a pain in the behind. They are heavy and have the self-closing mechanisms, so opening the door without throwing myself off-balance and then trying to keep it open long enough to get through is a tough problem.

Overall, it was a good weekend. In addition to the quarterly meeting, we did some other outings. The ankle doesn’t seem to swell much, but I do get that uncomfortable feeling we’ve all noticed when I first put the leg down after having it elevated or even just level with my hip. Every now and then I do get some interesting twinges along the tendon and muscle. As noted in the operative report, the surgeon had to release the muscle which is part of the reason that I feel twinges in the muscle. It’s healing and I’m feeling the soreness. Since I now have a regular cast instead of the huge one in the pictures, I can flex my toes as much as I want. The surgeon actually encouraged this. What I didn’t realize was that some of the flexing is actually engaging the calf muscle and the tendon. After doing a couple of these, sometimes I feel the twinge in tendon repair site (I’m guessing that’s what I’m feeling, but it’s hard to tell with the cast). I also sometimes think I can feel the stitches, but I think that’s more of a false positive.

Anyways, slow but sure progress and I continue to look forward to next week when the cast comes off. I really want to scrub the foot. The dry, dead skin is bothering me. I can feel it itch at times, and the thought of being able to take the boot on and off to deal with that is keeping me focused on making steady progress and not jeapordizing the possibility of getting the boot.

I’m back in the office and having a flexible employer has really been a plus.

Miscellaneous crutches tip: Those plastic grocery bags that everyone hates because they are bad for the environment are pretty good as a stop gap little bag to carry things while on crutches. It’s easy to hook around your wrist or a couple of fingers if the load isn’t too heavy. Plus, you can just fold it up and stick it in a pocket in case you need it later.

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The Enormous First Cast
That’s the really big cast my surgeon put me in the first two weeks to encourage me to elevate the leg and not get too crazy with moving around.

wound picture

I had to be like everyone else and post a picture of the wound. It’s hard to tell, but it’s about 5 inches long with 13 stitches.

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Just a word before I put in the operative report. I’ve edited the report to remove names, etc. Other than that, it should be essentially as printed for me by the surgeon’s office.

Preoperative Diagnosis: Right Achilles rupture

Postoperative Diagnosis: Right Achilles rupture

Procedure Performed:

1.  Right Achilles tendon

2. V-Y fascial lengthening

Anesthesia: Politeal block with general

Tourniquet Time: Sixty-two minutes at 250 mmHg

Drains: None

Complications: None

Procedure:  The patient had a popliteal block. Brought to through O operating room and placed on the operating room table in the supine position. General anesthesia induced. The patient was then placed in the prone position on the operating room table. The pneumatic tourniquet was inflated to the right upper thigh. The right leg was prepped and draped in the usual sterile fashion. The right leg was exsanguinated with an Esmarch tourniquet and the tourniquet was inflated to 250mmHg.

A medial approach to the Achilles tendon was made. Skin incised. Nemostasis achieved. Thick clots were maintained. Paratenon was opened. A large gap was found in the Achilles tendon. The proximal stump had retracted. There was an approximately 3-to-4-cm gap.

The proximal stump was mobilized as well as the distal. Proximal stump did not approximate to the distal stump. It was then decided a V-Y facial lengthening would be performed.

With the proximal stump under tension, a V-Y fascial lengthening was performed on the gastroc. This allowed approximation of the two stumps. The fascia anterior to the Achilles wsa then opened to allow closure of the paratenon.

Then, #2 Orthocord was then placed in the Achilles in the proximal and distal stumps. Skin edges were allowed to be approximated with good tension of the musculotendinous unit. These were secured provisionally. With adequate tension these were secured. The repair site wsa supplemented with cross stitches.

The V-Y fascia sites were closed using 0 Vicryl.

The wound was copiously irrigated with normal saline. Deep tissues were closed using 2-0 Vicryl. The subcuticular layer was closed using 3-0 Vicryl. The skin was closed using 4-0 nylon. Marcaine 0.5% 10cc were then injected into the wound. Tourniquet was deflated as dry sterile dressing, compressive dressing, short-leg fiberglass cast were applied. The patient was awakened in the operating room and brought to recovery in stable condition.

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Today felt good. The appointment was pretty straight forward. They cut me out of the ‘ginormous’ / elephantine cast that they had me in (pictures coming soon) to control swelling and ‘encourage’ me to keep my foot elevated. The wound looked like everyone else - stitches, a little swelling, scabs, pen marks, wrinkles, etc. The doctor and the PA both agreed that it was healing nicely. They agreed to taking out half of the 13 stitches (every other one). At first, this made zero sense to me until I remembered that he was putting me back in the cast for another two weeks of healing. Because I’m going back into the cast, it didn’t really matter if they took out the stitches or not (in my non-medical opinion). In general, my surgeon is very conservative when it comes to the wound healing part, but the signals he’s sending me is that he’s a little aggressive on the PT. I’m good with that. PT doesn’t sound very pleasant if the wound isn’t really healed.

Removal of the stitches was a little weird. I didn’t watch, but it felt kinda odd. It was like someone was picking at a scab which they were, to a certain extent. There were some little pricks of pain and some odd pulling sensations, but it was just the fact that this was the first time I’ve ever had stitches out. Can’t really say that I recommend the experience, though.

I didn’t balk at being put back into the cast. For me, it looks like it gives me the best opportunity for the wound to heal properly - especially after I got the full debrief on my surgery. I’ll post the operative report later today, but the surgeon had to do a V-Y procedure (the real name escapes me at the moment) on my calf muscle to be able to put the tendon in the right spot because my tendon had retracted almost 4 cm and the muscle had really contracted. Anyways, I’m in the cast for two more weeks. Boot next time I go in, rest of the stitches out, and start of PT.

All said and done, it was a good appointment. I’m not setting any records in terms of healing time, but I’m not suffering any complications thankfully. If it was a performance review, I’d be “Meeting Expectations” and glad to get it.

I was thinking about my level of mobility and I think it’s roughly equivalent to my 1 year old niece. Neither of us can drive. We both struggle with stairs and don’t really deal with them upright. We have roughly the same speed capability (she just has to take 3 steps for every one of mine, even on the crutches). We both have similar total range for distance we can go before we need to rest. Our balance capability is roughly the same - we get wobbly every now and then, and turning can be an adventure. Where she has me beat, though, is that her dad can just pick her up at will.  Dang. it just bites being old :D

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