normofthenorth

A cure for my addiction to AchillesBlog.com?

Written on November 1, 2010 – 2:18 am | by normofthenorth

So here I am, about 10.5 months after “getting the boot” and signing onto the UWO protocol, a few days after tearing my second AT. As some of you have read elsewhere on this site, I’ve generally been delighted with my pain-free and hassle-free recovery since last December, EXCEPT for the LONG wait to recover my full calf strength. I can “push off” normally at the end of any walking stride (for many months now), but I still can’t do even one full-height 1-leg heel raise.

I can finally do SOME 1-leg heel raises, but I’m still only getting an inch or so off the floor. My main exercise for it is the “2 up, 1 down” that Doug53 and others have recommended on various pages. It’s not a huge strength deficit, but it’s clearly there, as long as my knee/leg is straight. (With bent knee, I can do much better.) I’ve thought of going back to my Sports-Med PT clinic and paying for another isokinetic strength test, but this time with STRAIGHT knee, to objectively measure the deficit. Haven’t done it.

Many of you also know that I have been pretty solidly addicted to this site, since very soon after I was talked out of the operation I thought I wanted, last December. I keep coming back, checking all the new posts and blogs, and chiming in whenever I think I can be helpful (and that’s OFTEN! ).

What’s recently changed isn’t my leg, or even my interest, but my heart! For the past ~5 years, I’ve been having periodic echo cardiograms to monitor the progress of a congenitally deformed heart valve — the same Bicuspid Aortic Valve (they’re supposed to be TRIcuspid!) that Arnold Schwartzenegger, Robin Williams, Barbara Bush, Barbara Wallace, and a bunch of NON-famous people were also born with.

Roughly 2% of our species seems to be born with these BAVs, and they often work great — as mine has — until they start working not so great — as mine also has. For the last year, my Cardiologist has expressed more and more concern about my test results, and suggested that I schedule surgery to replace the valve with a new one, maybe this Fall.

When I came back from the inactivity and lack of fitness that accompanies an ATR, I was so out of breath from bicycling up hills etc., that I thought I might have been “symptomatic” for the BAV, which would support that decision. Then that passed! My fitness returned, and I could bicycle as fast as I wanted to, never missing a yellow light or skipping a hill. YAY!

My Cardiologist was more frustrated than pleased for me(!), and seemed almost angry when he conceded that my last Stress Echo Cardiogram (on a treadmill) was “undoubtedly a very good test”! Reluctantly, a few weeks ago, he agreed that I could postpone the surgery ’til the Spring, then we’d see if another postponement made sense or not.

WELL, my symptoms didn’t ACTUALLY start while I was walking from his office to the car, but that would make a better story — and it’s pretty close to the truth. It looks like I’ll be getting “zipped” open for the valve replacement pretty soon, maybe around the end of this month.

So, dear ATR pals, I’ve started two-timing you, and lurking at www.ValveReplacement.org ! And once again I’m the “newbie” with all the questions and none of the answers! I haven’t registered there yet, but I suspect I’ll be “normofthenorth” again, unless it’s already been taken.

As in ATR treatment, there seem to be some interesting new studies and evidence that hasn’t reached all the surgeons yet, and some of them inspire heated discussions and “agreements to disagree”. E.g., some doctors are VERY aggressive in pushing minimally invasive heart surgery, while most doctors still prefer the more established “big zipper” approach. I’m guessing I’ll go with the traditional cure this time. My surgeon seems to prefer it, and also prefers “porcine” (pig) valves compared to bovine (cow) or human-donor valves.

The new-fangled development that I’m going to TRY to get is a new GLUE that’s being tested out to glue the sternum back together after the surgery (in addition to the usual SS-wire sutures)! They call it Kryptonite, and it seems to make the recovery WAY less painful and quicker. (The heart tissues seem to heal a lot faster than the sawn-apart rib cage.) It costs $500/surgery(!), and it’s approved for skull surgery but it’s still in trials for chest surgery. But I think I’ll try hard to get it anyway, even if it costs me $500 and signing a waiver or two.

So if you got the idea that I’m really anti-surgery. . . I’m not! And if you thought that my wimpy heel raises were the main thing keeping me from rejoining my old volleyball team. . . also not.

I doubt that I’ll be quitting you folks Cold Turkey, but I do expect to phase out of this addiction — and probably right into the next!!

Good Luck and Good Healing — to ALL of us!

P.S. After ONE day of lurking there, I’ve already noticed some fascinating “cultural” differences between this site and www.ValveReplacement.org — e.g., here we all use cryptic IDs and show photos and videos that almost always exclude faces. There, many folks have self-portraits for avatars, FirstNameLastName for IDs, and display the date, valve model, and surgeon’s name in their signatures!

154 Responses to “A cure for my addiction to AchillesBlog.com?”
By gazroscoe on Nov 1, 2010 | Reply

Hi, I’ve only just started my journey, but have just been reading yours and I would like to say many thanks and hope that your next journey goes as well as this one, all the best for the future.
Gaz
By teresa1 on Nov 1, 2010 | Reply

What are we going to do without you!
You need to concentrate on preparing yourself for surgery, mentally and physically. Remember that a lot of the complications of surgery are not givens and are often avoidable with good care. Take a bottle of alcohol hand gel with you and don’t let anyone touch you without using it.
With my dietitian’s hat on, I can say that optimizing your diet prior to surgery improves outcome, at least five portions of fruit and veg a day and a good protein intake. After surgery, if you’re offered any high protein drinks after surgery, hold your nose and get them down.
Good luck and I hope you find someone as supportive as you have been on the other blog
By liverpoollass on Nov 1, 2010 | Reply

Good luck Norm, although you are going to be seeking your blog fix elsewhere I hope you keep the rest of us up to date on how you’re getting on. You have been such a tremendous support to so many of is, if there is any justice in this world you will have a better than perfect recovery.
By gerryr on Nov 1, 2010 | Reply

Good luck Norm. A friend of mine here in Billings, a guy in unbelievable physical condition, nearly died two years in a row because his bovine replacement valve somehow became infected. He now has a pig valve so we’re all calling him “Porky Pig.” Hope the surgery goes well for you.
By jla2010 on Nov 1, 2010 | Reply

All the best Norm. Thank you for your enthusiasm and support. Be sure to let us know how you’re doing. And after you’ve recovered from the valve surgery, get back out on the volleyball court- indoor or beach or both!
By PHIL on Nov 1, 2010 | Reply

NNNNNNNOOOOOOOOOOOOOOOOORRRRRRRRRMMMMMMMMMMMMMMMMMM

Hope things go well .
You wont be the newbie for long , me thinks .

BUT,
Don;t go , just yet .

Im being selfish here of course as if you leave it feels like Ive lost my AT medical advisor .

One of the my holy trinity ,
my surgeon ,
my physio and
YOU !!!!
By bronny on Nov 1, 2010 | Reply

Aw norm. You’re going to have lots of sitting around time over the next wee while which would be best used, i think, keeping up with AB. Maybe you can become a 2x pw visitor, rather than every day…
By normofthenorth on Nov 1, 2010 | Reply

Bronny, I still can’t figure out how to get down to 1x per DAY!!

Thanks for the kind words and good wishes, folks — I’m blushing!
By kaston on Nov 1, 2010 | Reply

good luck norm. i’m sure your surgery will go great. hope you have a speedy recovery
By northrancher on Nov 1, 2010 | Reply

Oh Nooooo!!!!! Sorry to sound so selfish, Norm, but how will I get through this recovery without you?

Of course, I’m grateful for all the help you’ve given me this past month, and I echo what everyone else has said–you will be missed.

I wish you the very best of luck with your surgery and all good things in your life–with your spirit and outlook you will do just great:) You’ve been very generous with your time and sharing your knowledge and have obviously made a significant difference here in the lives of many ATR patients, including me.

Your leaving (even temporarily) is a great loss to this site. I hope you’ll stay in touch and I wish you the speediest of recoveries.

Take good care,
Grace
By mikek753 on Nov 2, 2010 | Reply

Norm,

Wish you best and fast post op recovery.
Thanks for all your info and hours replying my questions.

Pls. keep us posted.

About head less videos - not sure what to be proud of to show my face.
I’m not actor and try to concentrate on ATR that’s way below head - just me.
By normofthenorth on Nov 2, 2010 | Reply

Thanks again, folks.

BTW, I’ve often wondered if there was a better way than Dennis’s “semi-manual” system, to help people register and create blog pages. Well, so far, I’ve convinced myself that it’s definitely NOT the fancy computerized system at valvereplacement.org ! So far, their computer FINALLY recognizes my sign-in, but the registration-confirmation e-mail went into the ether somewhere, so I still can’t post or do anything else but lurk/stalk!

The system here needs a little manual setup from D whenever a newbie signs up, but at least it WORKS!

I’m seeing the surgeon tomorrow — this time for an OR booking, I’m pretty sure.
By normofthenorth on Nov 4, 2010 | Reply

OK, the registration worked at my new addiction site — with the help of some nice human’s “manual” intervention!

Another striking difference between the two websites is that (AFAICS) there are no “personal blogs” there. Everything’s sorted by topic, with people either adding to existing threads or starting a new one.

of course, some of the new threads are along the lines of “Hi, my name is Norm, and I’m scheduled for ___ surgery on Dec. 1, and I have these questions. . .” And the questions may prompt more questions and answers, so it looks a bit like one of the “personal” blog pages here.

But if that’s all in the “Pre-Op” topic area, then it all ends — or the Original Poster leaves — when that OP goes for surgery. Here, we get the continuity of being able to follow each blogger throughout, while there, the subject areas are grouped together. Each way has advantages, I guess. (In this computerized era, maybe we should be able to “Sort by”, or use hyperlinks, to convert back and forth!)

Mind you, there’s a fundamental difference in the subject areas, too, because many people with (e.g.) my condition (Bicuspid Aortic Valve) have YEARS pre-op to think about it and worry about it and ask questions about it. With ATR surgery, two WEEKS is usually considered “forever”!!

Maybe in a month or two I’ll start forming (and sharing) strong opinions on how medical blogs should be organized!

Good healing, all!
By duke88 on Nov 4, 2010 | Reply

Good luck Norm. I appreciate your comments on my blog and wanted to catch up with your case. Interesting and glad you are making good progress without surgery. I am sure your BAV surgery will go well and we look forward to reports on your progress on that too!
By parisski on Nov 4, 2010 | Reply

Dear Norm - I have leaarnt pretty much everything of importance from your blogs and think it’s great that the BAV community are getting your input into their world. I am sure with your intelligent approach you will add huge value to them as you have to us. I wish you all the very best for this new phase of medical activity and hope that you have a speedy and successful recovery and tha if possible, you do indeed find the time to stay in touch with us ATR’s. Best wishes from Parisski.
By normofthenorth on Nov 4, 2010 | Reply

Thanks, folks — MORE blushing!

My surgery just got scheduled for Dec. 1. Angiogram this Monday — they’re talking about 5.5 HOURS in the hospital, including about 25 (unpleasant) minutes to actually DO the thing! I gave blood after my talk with the surgeon yesterday, but the nurse at the Angio place (same world-class institution) says it’s not the RIGHT blood, in the right test-tubes, heading for the right testing machines, so I’ve got to show up tomorrow and give some more. The first stuff is good enough for the surgery, but not for the Angiogram(!).

I’m really glad the actual surgery procedure is a well-oiled, well-practiced machine, because the preliminary stuff could use a bit of fine tuning!

BTW, the debate between replacement valves made out of tissue (usu. pig or cow, occasionally human donor) and replacement valves made out of metal or fancy pyrolitic carbon — aka “tissue” vs. “artificial” — reminds me a bit of the op-vs.-non-op debate here. The choice here (for people who get the chance to exercise it) seems a bit nicer, since both op and non-op usually produce a result that is eventually 100% recovery. Even without the 4 new studies, the competing downsides were about unlikely RISKS, like 10-15% re-rupture rates vs. 10-15% surgical complication risks. But for the 85-90% majority, EITHER way, recovery was pretty close to total.

The valve-replacement choices aren’t that good. Each way has serious risks, during surgery and afterwards. But in addition, there are predictable ongoing problems: mechanical valve recipients have to take Coumadin (anti-coagulation therapy) forever, which has both nuisance and some serious risks. And tissue valve recipients face the awareness that the tissue valves don’t last forever, and will likely have to be replaced later, unless the patient is already very old. (The “re-do” surgery has traditionally had higher risks than the first time around.)

Put another way: ATR patients have the luxury of choosing between TWO basic treatments, BOTH of which, if done right, have a high probability of producing a very full recovery, back to more-or-less “good as new”. Valve-replacement patients are still waiting for somebody to produce an option that good — the holy grail known in “the biz” as “the valve for life”.

There’s a few randomized trials going on now, to see how close the fanciest mechanical valve — the On-X — can come to that holy grail. They’re testing to see if they can get an acceptably low clotting rate with much lower doses of Coumadin, or even Aspirin alone (one normal tablet/day). Results should be out in a year, I think. If the results are OK on Aspirin alone, the market for tissue valves may drop like a stone. (BTW, my surgeon is “a pig guy”, and I seem to be heading that way. Making a surgeon squirm while I’m in an ankle boot is good sport! Making a heart surgeon squirm while he’s got my heart in his hand is a Very Different Matter!!)

Good Healing, all. Sorry for the hijack, but maybe the perspective will cheer you all up!
By drewt on Nov 4, 2010 | Reply

Pretty soon, if you keep this up, you may qualify as an android or something with all the things you are replacing! Good luck with the surgery! We will be thinking about you.
By normofthenorth on Nov 7, 2010 | Reply

Drew, there’s nothing artificial in my left (”newest”) AT!

I just discovered a new irony in my situation:
As many of you have discovered, becoming FWB and going to 2-shoes tends to mean that you use your ARMS a lot more than you used to, whenever you’re using your legs. DON’T walk up or down stairs without holding onto the banister, DON’T do balancing moves without leaning on a wall or a doorway, and use your arms to help sit down and stand up, etc., etc.

Even at almost 11 months, those new tips and techniques are still part of “the new me”. Well, I just read at valvereplacement.org that a good trick for heart-surgery patients, pre-op, is to practice EXACTLY the OPPOSITE! Because our shoulder muscles are ultimately anchored to our ribs (and my rib-cage is about to be. . . surgeried!), it’s suddenly important for me to learn to do all those things WITHOUT using my arms!!

I wonder if this adjustment is going to be EASIER for me than for a non-ATR person — heck, I just changed all those techniques recently, so I should be good at changing them — or HARDER, because I’ve moved from the middle to one extreme, and now I’ve got to move all the way to the opposite extreme(!).

If my ATR was life throwing me a curve, here comes the fastball!
By sullypa on Nov 8, 2010 | Reply

Hi Norm

I’ve been off for awhile, and your update was a surprise.

Best wishes for a successful operation. I know you will research the blazes out of those new blogs and have a speedy recovery.

Suggest you consider getting one of those OTC ankle support braces. I still wear one when playing sports, mainly to protect the tendon. It provides additional support and may reduce your need to grab something when descending stairs, etc.

Sullypa
By normofthenorth on Nov 8, 2010 | Reply

Thanks, Sullypa, good to “hear your voice”!

I actually have no NEED to grab anything when doing any daily living activities. My leg has healed to 100% except when put to the ultimate test — 1-leg heel raises with a straight knee!

Rather, I’ve LEARNED to grab for things all the time, because it used to be very helpful and safe to do so, and scary not to. Now, it’s just a left-over habit — and it’s time to break that habit!

From online research, I’ve discovered a few things that I’d do differently from my Docs, but I expect to largely “go with the flow” with the heart surgery. Actually, I went fairly close to the flow with my two ATR treatments, too, just following different flows. (I did give my first, “conservative” surgeon, a very hard time pushing him to go faster, but he won most of the arguments!)
By ifixteeth on Nov 9, 2010 | Reply

All the best, Norm.
Will keep you in my prayers so that everything will go smoothly.
Thank you for all the information and encouragement you provided, especially for us non-op cases.
By the way, today was my first day back at yoga after more than 8 months. Was a little apprehensive with some of the moves, especially the downward dog. I was amazed at how much my flexibility had decreased. All went well though and felt great after.
By snapdragon on Nov 16, 2010 | Reply

Hi. Love your posts…
You contribute a lot and have an outstanding knowledge base. Patients will often develop knowledge of certain aspects of their problem in much greater detail than their specialist.
I wondered if you had any particular knowledge of where to look for more info about the different boots that exist. I am struggling to convince my orthopaedic surgeon to use a boot rather than cast.
He said I might get a boot later but the ones we see locally in the NHS weigh much more than a cast.
The Vacocast or Vacoped look very interesting and much nicer boots… how long would I end up wearing one?
By snapdragon on Nov 16, 2010 | Reply

Norm
I posted before I realised about your heart valve surger. Sorry to hear your news.
Norm - Nothing wrong with tried and tested approach. I would be happy with pig. If the valve surgery goes well it will go well, and it usually does.
Whether your sternum continues to give you pain afterweards is a seperate and interesting issue. My impression is whilst not life threatening it can take time to settle but does seem to eventually. Time to first cough / sneeze remembered.. I would try the glue if offered ‘cos it might reduce the problem.
By gunner on Nov 16, 2010 | Reply

Snapdragon: I am an extremely happy VacoCast customer. Got into it at about 3 weeks and was out, with heel lifts in shoes, at about 11, I think. You can follow my exact progress on my blog here.

I’m beginning to think I should ask for a commission from these people, but their product is a godsend. There may now be others like it, but none I found 10 months ago. best to you, gunner
By gunner on Nov 16, 2010 | Reply

Norm: Sorry to hear about your heart troubles but the good Lord has no doubt seen fit to elevate your contributions to mankind from the lowly Achillees to the big pumper! My heartfelt best wishes to you and your family.

Gunner
By southafrican on Nov 16, 2010 | Reply

wow u so informative . Mr Achilles .Im 11 weeks post op and feeling good but mentally can not go to two shoes …… i re ruptured Achilles at 3 weeks post op ……with no boot and now scared shittles to go two shoes ….. help !!! I had P T today WOW pressure points …. bad but needles on scare … 7 of them WOW not nice and wiggly them every 2 min bad day
By normofthenorth on Nov 16, 2010 | Reply

Snapdragon and I are doing a bit of a “dance” here: He e-mailed me with that question about the boots, and I (1) asked him to post it on AB.com so it could inform others, too, then (2) answered his Q by e-mail.

Here’s what I wrote:

I like hinged boots, though the evidence proving that they produce better outcomes seems thin at best — and maybe especially weak in the studies that left the boot free to hinge immediately, rather than waiting a few weeks. And the UWO study produced excellent results with a fixed (AirCast) boot.

I never cared much about the weight of a boot, myself. Most of us ATR folks are pretty active types who are exercise-starved during our rehab, so having to lift a boot off the floor while we’re NWB might be a plus. (Ankle weights, anybody?) After we’re PWB and FWB, it’s mostly on the floor anyway, so it should matter even less. Boot SIZE is an issue, though mostly for driving (for those who try that) and things like bicycling (which I did in a boot). The AirCast is pretty bulky, though not especially heavy.

I’ve never tried the Vaco, though virtually everybody at AB.com who has, sings its praises. Waterproof sounds good, if you have access to a pool — though I don’t think there’s anything in the AirCast that ISN’T waterproof. For both boots, it would be best to have a spare liner if you’re going in. (Wearing a liner that’s just been wrung out might be acceptable, but maybe not.)

My hinged Donjoy MC Walker worked fine after my first ATR, and again starting at 7 weeks after my second. My fixed AirCast worked fine for the first 7 weeks this time, but I enjoyed being in a hinged boot for the transition from boot to shoes. I saw what looked like a cheaper “good enough” imitation of the MC Walker online for something like US$100, which is a very reasonable price (for you or the NHS).

The AB.com bloggers also sing the praise of the customer service from Vaco, so that could be one good source of (presumably biased) info. There are also shops, online and “brick and mortar”, that sell multiple brands and types, that might have some good comparative info.

How long you stay in a boot depends completely on your (Doc’s) rehab protocol. I favor protocols that get you into a boot fast, and also get you out fast! My fave, the UWO protocol (at bit.ly/UWOProtocol ) puts non-op patients in the boot on day 1, and post-op patients on day 14, and prescribes “wean off boot” for all at 8 weeks. You’re already past day 1, but maybe not day 14? I continued to “wean” for a week or two after 8 weeks, so the boot didn’t get completely retired until maybe 10 weeks post-immobilization.
By normofthenorth on Nov 16, 2010 | Reply

SouthAfrican, we should probably discuss your interesting situation on your blog, no? Shots for a scar sound interesting, and new to me.

Fear and caution when going to 2 shoes is common, and beneficial up to a point. If you’ve got a hinged boot, and start padding around the house in bare feet or Crocs, I don’t see much or any harm in lingering in the boot on outings for several extra weeks.

After my first ATR, fixed surgically by a “very conservative” surgeon, I didn’t even get INTO a boot until around 12 weeks(!). At 17 weeks, I discovered that I could walk perfectly in bare feet, without even the little “dip” at the end of the stride, so I was definitely ready for shoes.

Then, same day, my physio immediately insisted that I do as many 1-leg calf raises as I could — BIG mistake! — and I went right back into the boot for another MONTH until the nasty pain at the back of my heel went away (AT-calcaneous junction). So I was at 21-weeks-plus when I finally kissed the boot goodbye. And my ultimate recovery was virtually perfect, and not crazy late, either. I was back to competitive volleyball at 10-ish months, and soon developed more confidence in the healed AT than in my UNinjured one (and for good reason, in hindsight). (I’m still less capable this time around, at 11 months.)

If you’ve got a fixed boot, then lingering in it will hold you back more than if it’s hinged, IMHO. But if you can bring yourself to start padding around the house without it soon after you’re supposed to be in 2 shoes, you’ll get that part of the benefit.

The benefit from losing the boot is only partly from the extra calf-and-AT workout. All the parts of your foot that provide balance and stability and feedback (”proprioception”) have also been snoozing, and need to be woken up and re-educated and re-strengthened before you are really “back”.
By normofthenorth on Nov 18, 2010 | Reply

My new addiction may well lead to controversy at valvereplacement.org, along the lines of “op vs. non-op” here. But as much as some post-op ATR folks don’t want to hear about the UWO study and its remarkable results without surgery, just imagine we were talking about the best replacement HEART VALVE!!!

The good news is that they’ve already been through many heated debates before I came along, whereas I seem to have “pushed” the UWO study, etc., harder and/or sooner than anybody else here.

Many of you know how pushy I like ATR patients to be with their Doctors. “Show him this study and its great results, and ask to see HIS results. . .” Well, I did something like that with my own Heart Surgeon last week!

I’d read online (SOMEwhere!) that “cow” valves seem to last several years longer than “pig” valves, on average. But my fancy surgeon, in a very fancy cardiac department at Toronto General Hospital, was planning to give me a pig valve. So I asked him why, when “the studies show” that cow valves last longer. He said that they had kept track of their own record, and it indicated the opposite. I asked to see the study — Heck, I AM normofthenorth!!

His assistant recently faxed me the study — entitled “Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?” by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? .

Wow!! Over 1100 identical pig valves implanted between 1982 and 2004, over 90% of them followed and tracked, stats and standard-deviations for almost everything, then a Comments section that compares their results with almost all the studies following up on cow valves, etc. Anyhoo, I’ve posted the link at VR.org, with multiple disclaimers and such.

Talk about a personal decision! And if there’s a situation where I DON’T want to make my surgeon uncomfortable, Open Heart Surgery has to be way at the top of the list, too! I so want to find out the truth, and spread it around to help everybody make smart decisions, but part of the audience for that truth is people who’ve already made their decisions, maybe half of whom have made a decision that your “truth” undermines! That’s tough enough to discuss rationally, without infuriating or alienating people, when discussing ATRs — but HEART VALVES!! Yeeyikes!

No drama yet over my posts, and I sure hope I don’t create any pains in the pit of the stomach for any bloggers there. And another guy’s been reprimanded for being brusque and unsupportive on one of the same threads.

Anyhoo, it’s reassuring for me to read that impressive study, authored by the very colleagues of my own surgeon, and looking like it proves that it’s statistically very likely that this pig valve I’m getting will still be structurally sound in 20 years, and likely even 25, if the rest of me makes it that long!

Another fascinating difference between the two websites, and the two groups of patients: Virtually NOBODY travels far out of town to get their ATR treated, but LOTS of people go far and wide to get heart surgery from a highly recommended surgeon, or in a big city, etc., etc. And if you’ve traveled far to be treated by a superstar, you’re REALLY not going to give him a hard time over the valve he likes to use, much less insist that he try out a new one on you!! Verrrry interesting stuff. . .

Good Healing, all!

BTW, the VR equivalent of being able to carry a cup of coffee into the next room on two feet, is apparently being able to sneeze without clutching a big pillow to your chest first, or yelling “OW” from the pain in the middle of your rib cage! And with luck, they come at around the same time, too, maybe 4 weeks post-op. You gotta love healing. . .
By parisski on Nov 29, 2010 | Reply

Hi Norm
Have had frantic week at work and just seen that your op is next Wednesday - I wanted to wish you all the very best for a successful op and a swift recovery. I hope they let you have a laptop in the hospital - I can’t imagine you without a keyboard! Very best wishes. Will be thinking of you.
By northrancher on Nov 29, 2010 | Reply

Norm, best of luck on Wednesday. I wish you a successful op and a smooth recovery. Like parisski, I can’t imagine you without a keyboard, but you deserve to take it easy and be pampered! You will be in my thoughts and prayers.
By teresa1 on Nov 30, 2010 | Reply

Hey Norm,
Best wishes for your surgery and a speedy and uneventful recovery.
I’m sure you’ll be a model patient.
Will be thinking of you
By dennis on Dec 2, 2010 | Reply

Norm - I hope your surgery went well, and we all hope to see you recover fully soon. Keep us posted, and we all wish you the best.
By normofthenorth on Dec 4, 2010 | Reply

Thanks, Dennis and everybody else. Still so far so good. I’m looking to being “sprung” on Monday 5 days post-op, walking up and down stairs by then — though NOT carrying heavy things when I do (or any other time for at least 6 weeks).

Little things mean a lot now — like being able to cough, sneeze (God Forbid!) or shift around a bed fast, all without serious thought and maybe notable pain, too!

Impressive team, though, and they tell me they had a good day and did good work. Amazing stuff, however you look at it!
By gerryr on Dec 4, 2010 | Reply

Glad to hear you are doing well Norm. Don’t watch any Marx Brothers movies for a while.
By normofthenorth on Dec 5, 2010 | Reply

Sorry I missed your post, Gerry! Actually, laughing isn’t too painful now. Not as bad as coughing, and I don’t even want to THINK about sneezing!

But after my first hernia surgery, maybe mid-70’s, Woody Allen almost killed me dead! I’d gotten part-way through one of his books of short stories — “Without Feathers” — and had left it on my bedside table when I went in for the surgery. After getting checked out, I went home, and fought my way through a supermarket. By the end, I was practically draped across the cart, quite exhausted. I managed to make it home, around the corner, with my shopping, but it was a huge struggle.

After I stretched out, or maybe after I napped, I picked up the book. I got to the first funny, silly, zany, unanticipated, nutty image, and I started laughing — and I COULDN’T STOP!! The more it hurt, the more I laughed, until I got so exhausted and out-of-breath I had to stop. But I couldn’t get the @#$%^& image out my head, so it started right up again!

I actually thought I was very likely to pop my stitches and bleed out right there. That surgeon did good work, I’d say. (And Woody? He can kiss my hernia scar!)
By aileenscotland on Dec 6, 2010 | Reply

Hi Norm, it’s good to have you back - we missed you.

Well, after my disappointment two weeks ago I decided not to give up, so I bought an aircast boot and I’m off to hospital tomorrow to convince my doc not to put me in another cast! I’m very stubborn.

Any last minute words of advice in case I need to work hard to persuade him? I’ll have a copy of your protocol with me :0)
By gunner on Dec 7, 2010 | Reply

Hi Norm: So glad to hear the surgery went well. When you get a chance let us know what key learnings you accumulated about the surgery and rehab. Lord knows many of us will have heart surgery of one type or another.

I spent much of a party last night regaling old friends with my AT tales and the legend of NOTN grows!
By normofthenorth on Dec 8, 2010 | Reply

Thanks, folks. Gunner, I LOL’d and blushed both! Tee hee, I say!! Thanks for the experience!
By mari on Dec 9, 2010 | Reply

Hey Norm, long time no see!
Good to hear surgery went well.
By normofthenorth on Dec 9, 2010 | Reply

Thanks, mari, good to “hear your voice”!

It’s been remarkably pain-free and “easy” so far, considering how amazingly invasive it really is. Who knew you could have your wishbone snapped & wired back together, and not need so much as a Tylenol ~3 days later?!?

I’m home since Tuesday, and REALLY enjoying being here. Venturing out today to the Doc’s, mostly to get my blood tested. (On Coumadin thinner for 3 months, and have to know how much to take.)

It’s maybe a 20 minute walk, might be within range if it were summer, but it’s really cold just now. If my lungs started biting, I wouldn’t know if it was the cold or the Grim Reaper. . .
By normofthenorth on Dec 9, 2010 | Reply

It seems to be ONE YEAR since I “got the boot”! Not much to report on that front, and not focused on it much, of course! I’m getting a great heel-raise “pop” at the end of my stride when I do my little heart-surgery-guy walks. Still no full-height straight-kneed 1-leg heel raise, maybe half height. And not many in a row.

It’ll be interesting to see if I’m better or worse at that when my heart and sternum heal enough to want it! Even bicycling may be 6-8 weeks away. . .
By normofthenorth on Dec 9, 2010 | Reply

In general, I assume that the presence of a heart-surgery guy here has slowed down some people who were really feeling sorry for themselves, as if an ATR is the worst thing in the world. And I don’t mind playing that role!

OTOH, there are a few ways in which an ATR brings MORE suffering than open-heart surgery! For example, I missed about 2 or 3 days max of being able to carry light objects from place to place, on my own two feet! Try THAT with an ATR!

Also, we OHS people are slow and weak and groan a lot, BUT many of us were in similar shape in the weeks BEFORE the surgery. (Me, not so much.) So it often doesn’t take long before OHS patients feel significantly better than pre-op.

Many ATR folks were active athletes, having fun in a fave sport until half a second before the ATR! And the psychological pressure of crutching around for a month and booting around for another month and then STILL not being back to the beloved sports (and only MAYBE being good as new in a year) is no trivial matter to the soul.

So if anybody’s giving you guff because “It’s only a leg injury!”, you tell them that I think it’s tougher than OHS in lots of ways, and I’ve done both!
By normofthenorth on Dec 12, 2010 | Reply

Here’s a heart-surgery update I just posted on PhilC’s page:
(He reports that ValveReplacement.org is unfortunately unfriendly to casual visitors.)

The recovery from Open-Heart surgery is going amazingly well, touch wood. Also less pain and fewer painkillers than most people’s ATR surgery (including mine in late 2001)!

I don’t know how it’s possible that they can slice through my “wishbone” and stitch it back together with stainless-steel wires (after drilling little holes in the bone first?!?) and the next day, it doesn’t hurt AT ALL (unless I pull on it or cough, etc.) without even a Tylenol?!? Boggles the mind.

Two days ago, I walked over half a mile, back from my GP’s office. Slowest and most segmented walk I’ve had since I was maybe 3 yrs old, but I made it and didn’t feel the worse for it.

My lungs — they are completely collapsed by the surgery — have recovered very close to 100%, based on the test-and-exercise “spirometer” gizmo they send us home with. The main incision and all my little wounds and bruises seem to be healing well and quickly.

Main disappointment is that my heart hasn’t really settled down near normal yet. I’m told this is normal, and will resolve with time. (It’s only day 10 post-op.) My cardiologist says a resting heart-beat in the 90s post-op isn’t “a symptom”, even if I could usually drop it a bit below 60 with the old parts.
By teresa1 on Dec 12, 2010 | Reply

Glad to hear you’re out of the woods, Norm. You have often counselled patience, and I think you are going to need all your reserves of patience now. You heart was probably pulled about a bit during the op so it will take a while to settle, it’s good that your pain is under control as being in pain will raise your heart rate.
Give it time and you’ll be better than before.
By normofthenorth on Dec 12, 2010 | Reply

Thanks, T. “pain is under control” really doesn’t state the extent of the miracle. My 2001 surgery after my first ATR hurt WAY more. I was popping pills, moaning, groaning, and I stayed in bed for a week. Now they chop my “wishbone” in half, then lace it together with SS wires, and it doesn’t hurt at all? Crazy, but I’ll take it.

Honestly, the feel of my turtleneck brushing against my “naked” incision is maybe 100 times more noticeable than anything internal — until I cough, of course!!

Good healing, all!
By jla2010 on Dec 16, 2010 | Reply

Hey Norm, I ‘m really glad you’re doing so well. My dad had to have his chest cracked open a few years ago and coughing just about put him through the roof for a while. We tried not to make him laugh cuz that was just about as bad. Like ATR, recovery from your surgery is not a race but knowing you, you’ll be going great guns in no time. Keep healing.
By normofthenorth on Dec 16, 2010 | Reply

Thanks, JLA. The good news for me is that laughing only hurt a little bit one time, when I was really howling. Laughing is Good! Coughing is still “interesting”, though I think it’s settling down now, 2 weeks post-op. Sneezing is probably still YeeYikes! Most moderate moving and lifting has become pretty normal already, too — slow, but otherwise normal.

The best news is that the worst thing for me, subjectively, by far, is the way my re-growing chest hairs grab my shirt when I move, or dress or undress. Some of those suckers are growing right OUT of the INCISION, and they’re prickly little beggars, so they catch on my shirt like sandpaper, and pull! The incision(s) is remarkably healed and neat and pain-free, but it HATES being treated that way!

That’s the best news because, obviously, if that’s my biggest problem, I have no big problems. . . On the other hand, it really IS driving me to distraction!
By ultidad on Dec 16, 2010 | Reply

Wow, Norm, I feel rather sheepish. Reading that you’ve been writing about, having and now mostly recovered from AVR makes me realize how little I’ve paid attention to this blog. I am so happy to hear that you’ve come through so well, but disappointed in myself for not being able to offer my experience as an anesthesiologist who has cared for 100s of AVR patients. Mostly, tho, I am very impressed that you felt up to posting only 3 days post-op!
By normofthenorth on Dec 16, 2010 | Reply

I would have been posting a day or two sooner, but I couldn’t convince the dear Wife to bring my laptop to the hospital until Day 3!

I was devoutly hoping to come out of that amazing heart-stopping surgery without any loss of grey matter, memory, etc., and I seem to have gotten that wish granted. I “negotiated” with two anesthesiologists about their choice of drugs. One persuaded me to change my mind (about avoiding all benzodiazepines).

In hindsight, the other one was humoring me, yanking my chain! I told him that I’d heard of some Open-Heart Surgery patients coming out with migraines or migraine auras. I grew up with migraines, and wanted no part of that risk, if I had a choice. He told me that the inhaled vapor anesthetics were more likely to have those side-effects than the IV drugs, so he’d down-pedal the former and accentuate the latter. It seemed like a sensible idea at the time. It wasn’t until AFTER the surgery that I realized that my lungs were collapsed during the operation, I wasn’t inhaling NOTHIN’, unless he was letting the heart-lung machine do the vapor-inhaling. Was this a “You’re not the boss of me” gag??

But somehow, I did wake up feeling just like “me”, and without migraines or memory loss. (YAY!!)
By jamieparent on Dec 20, 2010 | Reply

Hey Norm,

I’m currently doing the UWO protocol and I was wondering if I could contact you, email/im/phone to talk about your treatment. I’m keen to know more about how your PT went and what was involved. I live in Sudbury, just a bit north of you. Send me an email and we can hook up.

jamierparent at gmail.com
By normofthenorth on Dec 21, 2010 | Reply

Jamie, I’ve engaged in some private off-line exchanges with AB.com folks in the past, and I’ve usually ended up regretting it. Basically, a large part of the richness of the AB.com experience is that helpful answers to one person’s questions can end up helping another dozen or two Googlers and lurkers and later bloggers. (I keep hearing appreciative comments from people like that, who have benefited from the info I’ve posted, even though I’d never heard their “names” before!)

Is there anything in your questions that you consider embarrassingly private, or that is otherwise unsuitable to discussion on these open blog pages?
By jamieparent on Dec 21, 2010 | Reply

Hey Norm,

Nothing embarrassing, I just don’t like typing (I type all day long, I’m a computer programmer) because I’m lazy (re. I’m a computer programmer ).

Comedy aside, the issues I’m having is that personally I don’t know enough about this protocol . I’ve got the protocol in hand, and I’ve read the Willit study from UWO, but I’m still trying to get more granular information, the details if you will, on each little step.

As an example, what does Hydrotherapy really mean? Is it simply going in the pool and treading water? Are there specific exercises which can be done to achieve better healing performance?

I guess the real issue is I want to do everything possible to heal as fast as possible. The road to achieving that goal is riddled with questions with very few answers.

Thus far this site has been a terrific guide and your posts have been quite useful. I’m hoping that you can perhaps share some of PT treatment step by step, say based on the weekly scheduled defined within the UWO protocol.

Cheers,
Jamie.
By normofthenorth on Dec 21, 2010 | Reply

Jamie, you’ve got a slightly MORE detailed (”granular”) version of the protocol than my PT used. We used the one that the UWO folks faxed to my Surgeon, which I’ve posted at bit.ly/UWOProtocol . IIRC, there was no hydrotherapy in my version, and I certainly didn’t do any. OTOH, many bloggers here have RAVED about the physical and spiritual benefits of getting into a pool for some therapy, and I’m sure they’re right.

Basically, I was given diagrams of exercises that followed each interval’s description on the protocol. I think I’ve added some descriptions of what I got on my blog, back when I was at the appropriate step in my rehab. Exercises (including take-home), massage/manipulation, and a series of high-tech gizmos (ultrasound, electro-stim, lasers, ice collar, maybe more).

Personally, I think the main benefit in the first month or two is from getting your leg/foot mobile and “wiggling” and gradually moving to restore balance and proprioception.

Restoring dorsiflexion ROM was high on my PT’s list, but is lower on mine, because the consequences of over-doing the stretching are significantly worse than the consequences of under-doing. As soon as my ROM was close to where it should be, I backed off the stretches 100%. (The newest evidence on the “benefits” of pre-sports stretching is also negative, even for normal uninjured athletes.)
By bronny on Dec 21, 2010 | Reply

I think having been through the same thought process as you Jamie (as well as a similar healing process) I have come to the conclusion that the key to achieving the best possible result is (a) not to be in plaster for 12 weeks and (b) to start WB early.

I didn’t start ROM stuff early but once I started focussing on the stretches it has come pretty easily, similarly most of the other components.

I have been in the pool alot since about week 10, can’t recall exactly. My initial exercises were walk up and town focussing on heel to toe movement, then side-together walking (ie sideways), marching, then moved to forward and backwards. Also good for when you start doing proper exercises and jumping and stuff as doing it in the pool takes most of the weight off, so you can built the weight gradually by going to shallower water.

A huge benefit was the feeling of doing something NORMAL again!!

good luck.
By jamieparent on Dec 21, 2010 | Reply

Thank you VERY much Norm and Bronny. I really appreciate the time you’re taking to respond here.

I’ll be honest, I was freaking out when I got injured. On my blog which I have started here (http://achillesblog.com/jamieparent/) I talk about what I’ve done in the recent past. I felt crushed right at the moment of injury. I knew something was wrong.

You guys have thus far been able to lift my spirits and make me feel better about the treatment protocol.

Thank the both of you so much.

Cheers,
Jamie.

PS: Norm, send me an email at: jamierparent at gmail.com (replace the at with @, I hate net bots) and I’ll forward you a copy of the study.
By normofthenorth on Feb 19, 2011 | Reply

The study’s now posted on this site, at achillesblog.com/files/2008/03/jbjsi01401v1.pdf . That version doesn’t include the published version of the protocol, but it’s at the linked URL, at http://www.ejbjs.org/cgi/data/JBJS.I.01401v1/DC1/1 . I haven’t noticed any significant differences between that version of the protocol and the one that I’ve posted, but I haven’t held them up to the light.

The article and its numbers are interesting — on balance maybe not quite as glowingly pro-non-op as the early pre-publications, but maybe not too far off. I haven’t pored over it yet, either. We non-ops were significantly weaker than the “ops” at 240 degrees per second (which seems REALLY fast-moving to me), otherwise consistently a bit weaker, but not significantly. Not a unilateral ringing endorsement, and maybe not as good as the results from the NZ study from 2007?

There’s also a critical commentary in the same issue of the journal, and a critical letter about it (mostly complaining about the weak “power” to detect a difference in re-rupture rates) in the current issue.

Finally, I’ve detailed the current state of my OK-but-not-perfect AT healing, on Bronny’s page, at achillesblog.com/bronny/2011/02/18/update-6mths/comment-page-1/#comment-54 .

And my heart-surgery recovery is coming along pretty steadily, can’t complain. I’m wearing a “Holter” (EKG) monitor this weekend, to see if I can ditch the two pills I’ve been popping since I got home. We had a fine Whistler ski week, Jan/Feb. Pretty wimpy by normal standards, but still a blast at that stage of my recovery — and it seems to have “done my heart good”, and I mean physically!
By jonboy1968 on Feb 22, 2011 | Reply

Hi Norm. Ruptured back 4th April 2010. Conservative treatment. Out of plaster end of May. Physio started 17th June.

Fully weight bearing 25th June.

All going well initially but no real progress made since summer 2010. December 2010 had ultra sound and refered to ankle and foot specialist. He reckons tendon has healed too long and as a result not getting any power back into calf muscle. Also still no response to the Thompson test.

He wants to operate. Taking tendon from big toe and transplanting it into achilles.

This will result in being immobilised for a further 6 weeks. This is not happening until 1st June 2011.

So gone with a specialist sports physio. In 3 weeks he has gotten more out of the tendon and calf muscle than the NHS physio got out of it in 6 months.

I am almost at the point of doing a single heel raise and walking has become a lot better.

I am telling you all this because you seem to be the most knowledgeable regarding the conservative method of treatment, and would appreciate your advise and comments.
By normofthenorth on Feb 22, 2011 | Reply

Thanks for the info, the question, and the kind words, johnboy1968. I don’t think I have any special wisdom, just some pretty obvious truths.
1. People sometimes heal long, with and without surgery. And it’s always bad for “performance”, like strength and speed. I think I’ve got some of that myself (maybe gastroc but not soleus), following my own non-op rehab starting Nov. 2010. (My first one healed short, mostly because my surgeon did that on purpose. That was OK for performance.)
2. Several people here have had the big-toe-tendon graft as part of their ATR repair, either initially or after re-ruptures or other problems. As I recall, they’re all doing OK, though I think one of them has been having some trouble with wound healing or adhesions or some such. (. . . and then there’s loss of memory! )
3. Obviously, if a few more weeks, or even a couple of months, of physio can get you to a place where you’re happy, then it’s presumably not worth going through the surgery, even if the NHS is paying for it. A full-height 1-leg heel raise is actually a pretty tough test, especially the top part, and esp-squared if you do a bunch of them. (Mine’s only about half-height, alas — but I’m not even sure that the deficit will noticeably affect my volleyball play, and I won’t find out for a few more months, while I’m still rehabbing from open-heart surgery!)

The only part of your story that surprises me is your lack of response to the Thompson test. If you were in a prone position, with your ankle close to neutral position, I have trouble imagining how squeezing your calf would NOT make your foot move. Was the test done some other way, so your foot was already fairly far toe-down (plantarflexed) when your calf was squeezed? Virtually any AT that is continuous/connected should pass, and yours seems to be.
By jonboy1968 on Feb 23, 2011 | Reply

Thanks for the reply Norm. You have a thousand time more knowledge on the achilles than my consultant and previous physio put together.

First of all I hope your heart op recovery continues to go well.

1. Regarding the long healing. I too seem to get more out of my soleus than my gastro. Heel lifts with a bent leg are easier than with a straight leg. After the ultasound the consultant did say there was an tear to the calf. He did not specify if it was the gastro or the soleus.

2. On the planned surgery to attach big toe tendon. I am determined this is not going to happen. Dont need athletic performance. All I want out of the recovery is to be able to walk (at least 6 miles over rough terrain) cycle and do light jogging. I dont fear surgery, it the thought of being back to square one. I may as well push the physio at the risk of re rupture.

3. My heel lifts with the bad leg are only half lifts even with support.

4. The thompson test has been carried out by at least 6 different people, all with me face down with foot hanging over the edge of the bed. The only time anyone has got anything was after an hours excersise. It suprises everyone who has done the thompson on me. If you can do even half a supported heal raise then logic tells you that the thompson should work.

My current physio rekons it could be stiffness in the ankle joint. He is only getting about 30% plantarflexation. Even when the ankle is totally relaxed.

There was a previous blogger Annie I think was her name. She too had no thompson response, and had problems walking. Not sure if she ever did get a thompson response but physio reduced the scar tissue and got her moving again. Hoping for a similar outcome.
By sullypa on Feb 23, 2011 | Reply

Hi Norm

Glad to see that you are still so active on this site. Good to check back periodically to see familar friends, especially after your heart work.

It’s been about a year ATR for both of us, my anniversary was Jan 25. It was good to compare notes with you as we both progressed, and gently pushed each other along. The buddy system really helped get me through the long recovery process, which I am still working on.

That push off will take a long time to equal my other foot, I know. You and I share an opposite foot that was stiffened by previous tendon surgery, mine the PTT, yours the shortened Achilles. So I wonder if it is fair to expect the ATR foot to match the strengthened other foot so soon.

I expect it to match at 18-24 months. I remember that kind of time for total recovery with my other foot.
By normofthenorth on Feb 23, 2011 | Reply

Johnboy, you mention that you’ve got limited heel lifts AND you’re only getting about 30% plantarflexion. Is that 30% of what your other ankle gets? If your heel lift is limited by stiffness, I’d expect that to feel different than if it’s limited by strength. Like hitting a different kind of “wall”, no? Can you tell what’s holding you back? Can you go higher by “cheating”, like using two legs or leaning on a counter?

I don’t want to encourage you to go nuts on your exercises, but you’d be a real statistical outlier if you re-ruptured at 10 months post-ATR.

Sully, I’m not even judging my new-ATR-foot strength against my old-ATR-foot strength, I’m just trying to do a good 1-leg heel lift, or a bunch of them. In fact, I could do a few of them at 17 weeks last time, post-op. Then I injured myself (doing a few of them! ) and took a month off and took it easy after that.

But by maybe 6-ish months (my PDA knows!) I did a bunch of them for my surgeon, though I was grunting and groaning with the effort. He told me to lay off volleyball until I could do them WITHOUT the grunting and groaning, and I was there by the time the volleyball season started, at 10-ish months.

So there’s no denying that my effective calf contraction strength in PF (the top half of the heel lift) is much slower returning this time than the last. Yes, it is true the shortened surgical repair helped me do 1-leg heel raises, at the expense of a bit of dorsiflexion. But this progress still seems abnormally slow. Sorry if yours is just as slow!
By jonboy1968 on Feb 24, 2011 | Reply

Norm, 30% total on bad leg which is about 20% short of what it should be. Think it is a combination of both stiffness and lack of strength. I can go higher if I cheat, but still not as high as I should be able to go.

Doing as much as time allows with the exercises. Every spare moment is spent either doing a 100 reps on the resistance band or doing heel lifts.

If it re ruptures, I am back to square one, but I will be back to square one in June anyway.
By normofthenorth on May 18, 2011 | Reply

Have I really not posted on my own blog here since February?!? Hard to believe!

The news here — long post-ATR and ~5.5 months post-OHS (open-heart surgery, aka valve replacement) — is that I had a new and “very good” stress-cardiogram on Monday, and got clearance to “walk-jog” 3 miles a day(!) 5x/wk as my Cardio Rehab. Or bicycle in a way that’s comparably aggressive, up to a heart-rate of around 145. That’s all much more of a workout than what I was “prescribed” even last week — and it’s not much wimpier than a standard “target heart-rate” for a healthy 66-year-old, either.

Yesterday, in my weekly Cardio Rehab class, I started the new walk-jog routine, though we had to quit (to attend a lecture!) after only 2 miles, not 3. It was a nice workout, and I was warm AND moist/wet when I finished, despite ~5 minutes of “cool-down”.

Between the ATR and the OHS, that may have been the first time I’ve actually worked out hard enough to work up a sweat since Dec. 2009! Moreover, the “jog” part of the workout — 1/4 of a mile in 4 1/16-mile segments, during a 2-mile walk-jog — was definitely the closest I’ve come to RUNNING since I tore the AT. And even MORE “moreover”, I don’t think I gave much thought to my left calf and ankle while I was doing the jogging, I just DID it — thinking more about the effort, the elapsed time, my heart-rate, and how much I was huffing and puffing (all of which were OK, too)!

Good Luck and Good Healing to all of us, folks!
By normofthenorth on May 30, 2011 | Reply

I’ve still been bicycling for cardio more often than the “walk-jog”, but I did walk-jog for 2.5 miles (before running out of time) last Tuesday, and again my ATR leg was glad to be running (OK, JOGging!) again. Assuming my CV shape keeps improving and I return to volleyball, it will be very interesting to see if my still-short 1-leg calf raise translates into a noticeable performance deficit on the court (or on the indoor beach, where I may well start).
By normofthenorth on Jun 16, 2011 | Reply

Last couple of Tuesday cardio rehab classes, they’ve been having us do “resistance training” (aka weights, etc.) rather than the walk-jog on the track. I bike down to my Sailing Club and back every Tuesday afternoon anyway, so I’m not short of CV exercise that day.
But I’m cycling enough during a typical week that I usually don’t take the time to do the 3 miles of walk-jog. The jogging is probably more interesting to my ongoing ATR rehab, because I’ve done so little running since the ATR happened. Still, what I’ve done has felt fine, leg-wise.
Also, the resistance training includes 2-leg Heel Raises with weights — in my case two 15-pounders. In addition to doing that circuit 2 days/week (more or less! ), it’s given me the idea to add weight to my at-the-bathroom-sink 2LHRs, while I’m swishing with mouthwash, etc. I just grab the sink-counter rail and hold myself down, maybe around 30 pounds-worth.

I think my 1LHR is still short and hard, but I’m pleasantly surprised how little it seems to matter for (at least gentle) running. And it matters not at all for my pretty aggressive bicycling.
By ahnadlass on Jul 14, 2011 | Reply

Hi Norm - I wanted to get your advice/opinion if you have a moment. I had a full ATR in April ‘11 and had a tenolig surgery, ( http://www.fhorthopedics.com/achille-tendon-tenolig-percutaneous.html ) which is a popular French surgery where the two parts of the tendon are pulled together with metal wires for 6-7 weeks - I live in France. Half of this 6-7 weeks time you are PWB. The wires were then taken out at the end of May and since then, I did basic PT (passive stretching, some cycling, balance exercises) but I never fully recovered my ROM and did not go to FWB. My PT is now concerned about a thin spot in the tendon at the site of the rupture because of the potential of re-ruptures, and wants to keep me on PWB. I went for an ultrasound (US) last week (approx 3 months after surgery) and at the rupture zone there is a 30mm-long thin spot, “hyper vasculaire”, with a cavity measuring 4mm diameter and 15mm length, but the tendon is continuous. This seems to be a very strange result as normally the tendon gets thicker and there are not many people who complain of thin tendons or cavities after 3 months, but maybe it’s because not many people get US so soon or maybe even errors in the US results. My PT after seeing the US believes that a new surgery (traditional surgery) may be now required to strengthen the thin spot. I am going to my surgeon next week to discuss options, and have a second opinion the week after.
All the best.
By normofthenorth on Jul 14, 2011 | Reply

Sorry, ahnadlass, but I have no special wisdom for you. I’m unfamiliar with the tenolig surgery, and with tendons that heal with a thin hypervascular spot.

That means LOTS of blood circulation, right? I’ve often heard that ATs rupture, and are slow to heal, partly because there’s so LITTLE blood circulation to the AT — so one might think that having an unusual excess would be good news. . .

It’s true that very few of us have US or MRI after 3 months — though almost all of us would, if it were easily available!

Of course, there are a small percentage of ATR patients who re-rupture, and it’s possible that some or even most of them had US-detectable thin spots in their ATs before the re-rupture, who knows? Also who knows if they would have healed properly if they took it easy, went slower, stayed PWB longer, etc.? We learn the truth from multiple large randomized studies, but this condition is too rare for that.

Many people complain about odd lumps and “divots” (thin spots) along their AT, post-op and post-non-op, and most of these do NOT end up in re-ruptures.

The studies generally show that early WB is either beneficial or neutral — I’ve never seen one where patients who did early WB came out worse. So it’s conceivable that your AT has been slow in re-building new tendon tissue (a succession of different types of collagen, apparently) BECAUSE you’ve been avoiding making it work much. Maybe. (How do you bicycle without being FWB??)

When people get re-ops later on (like you are), the surgeons often prefer adding grafted tissue to the repair. The studies comparing graft to non-graft surgery in initial treatment have generally shown no benefit, though the situation may be different for later treatments — Who knows?

Good luck, and do keep us posted on your progress. (If you pose this question in your own blog, it will stay visible on the Main Page longer than this exchange will, and it may attract more opinions and suggestions.)
By andee2k on Aug 7, 2011 | Reply

hi norm,

Congratulations on the success of your OHS and I wish you continued improvements on getting back to form with both your heart and tendons. You have been a great resource here and I was wondering if i could get your opinion on my situation.

I have been following your blog and posts with great interest and have found your thoughts and many others on this great site very helpful in my ATR healing. Your advice and confidence in the Non-op treatment with the UWO protocol also helped me with this direction that was recommended by my OS. I feel I was quite successful with it up until a couple days ago when I carelessly re-ruptered it rushing up a stair and missing most of the step as I tried to transfer weight off of it. I think I forgot I was injured for that split second and rushed the first step hearing my phone ringing. Stupid and I hate myself for being so careless after I had experienced such great results so far.

Anyways here are my stats:

- 41 y.o. active male
- ATR from volleyball May.15
- non-op into boot with UWO protocol May.16
- PWB at 3 weeks
- FWB at 5 weeks
- PT at 6 weeks
- out of boot at 8 weeks
- 90% normal walking gait at 11 weeks
- re-rupture at week 12

I was wondering if you would be so kind as to share your thoughts or suggestions on treatment direction of a non-op re-rupture? I have seen my OS who has confirmed a re-rupture and recommends surgery this time around. I have a 1cm gap on the tendon again but I’m fairly sure this is a partial tear this second time based on ROM, swelling, pain and first tear experience. I have an ultrasound done but have not had it analyzed yet as it is in transit to my OS. I was very pleased with the non-op results and would do it again if I had to, however having re-torn the same tendon I am certainly concerned on how well this protocol will work on a re-rupture. Although I am adverse to surgery in general, I would certainly do whatever it takes to get back to sports and activities pre-injury.

I have a copy of the UWO protocol results in PDF as well and noticed 4 of the 5 re-ruptures were treated with surgery. One of the surgery repairs had complications of a deep wound infection but the remaining four healed with no complications including a non-op original and non-op re-rupture at her own request.

Have you heard of any other cases that have been successful (or unsuccessful) with a non-op protocol on both an original ATR and subsequently a re-rupture? It seems like this is fairly undocumented territory and would truly appreciate any insights or recommendations you may have. Thank you for taking the time to read my post. I look forward to hearing from you.

Best regards,
Andy
By normofthenorth on Aug 8, 2011 | Reply

Andy, you’re unfortunately 100% correct that “this is fairly undocumented territory”, and I think “fairly” is an understatement. Essentially, ASSUMING that reruptures are different from primary ruptures, there’s virtually zero evidence. You seem to think that reruptures after non-op treatment may even be different from reruptures after surgical treatment, which would make the database even tinier. I’m a “Go with the evidence” kind of guy, and there’s virtually none to follow here. I’m not sure what to tell you, and I also don’t know what I’d do in your situation. (I was going to say “shoes”!)

We had somebody posting here ~6 months ago who went with non-op treatment for a post-op rerupture, and IIRC, his most recent posts were positive. (One data point!) More recently, suthernman is currently treating a non-op re-rupture non-operatively, mostly following UWO. He’s cautiously pleased with his progress at <5 weeks, still early times.

As you said, the UWO study protocol prescribed surgical treatment for their own reruptures (though there was an exception), and I suspect that most OSs — even those more open than average to non-op treatment of primary ruptures — would go that way. I can make arguments in favor of non-op rerupture treatment — e.g., the rerupture is extremely similar to a primary rupture in many ways (the essential immune/healing response should be similarly triggered, the torn ends should be subject to the same reactions as the initial ends, the paratenon should still be intact, etc.), protocol compliance should be way better than the first time, etc. But it’s all “should be” stuff, because we don’t know.

Regarding your ultrasound and the possibility that you have a partial rupture: (1) I had 3 ultrasounds (at 1-week intervals starting very soon after I got “booted”), and I got 3 contradictory indications of what kind of rupture I had! So I’m not a huge fan of US as the definitive diagnostic tool. (2) BTW, for other reasons, I am also quite suspicious about MRIs! (3) If you fail the Thompson test, and can’t climb stairs without putting “that” foot’s heel on the step, I’d consider it a complete rupture. (4) Though it sounds logical to assume that non-op treatment is more successful with partial ruptures than with complete ruptures, I’ve never seen a study that tests that assumption, and it seems that the majority of logical assumptions in this field fail the test of careful verification. (5) The one small study I’ve seen on the relationship between ATR gap size and non-op success (done on the UWO non-op participants who had US exams that measured their initial gap size), found NO relationship. (Another logical assumption apparently bites the dust.)

My own approach in making similar decisions has two (unfortunately contradictory) aspects to it, that may help:
(1) While you’re vulnerable, it’s nice to have support, and you may have a better and more supportive relationship with your OS if you “go with the flow”. He recommended non-op the first time (which gains “points” in my book!) but recommends surgery this time. You may feel lonelier if you do non-op this time.
(2) While it’s tempting to make choices based on expected outcomes or better-than-expected outcomes, I often find it enlightening to think about worse-than-expected outcomes. You’ve already had one personal example: UWO had 2 reruptures out of ~75 non-op patients, and you’ve experienced that unlikely (and rotten) outcome. You are kicking yourself for making it happen, but you’re not second-guessing your choice, or losing faith in UWO’s published results (as many humans would).
So here’s a test: Compare your imagined emotional/psychological responses to a comparably rotten outcome after choosing each of your options, and try to decide which would cause you more pain, depression, regrets, etc.: (a) You go non-op and it goes badly, e.g., with a big strength deficit or healing long or rerupturing again (and THEN go for surgery, if your OS hasn’t disowned you by then), or (b) You go with surgery and have serious surgical complications that compromise your recovery. If one of those is obviously less “dreaded” than the other, I think it makes some sense to lean that way.

None of this is even a recommendation for one choice over the other, obviously — because I really don’t have one, and I don’t think there’s any meaningful evidence to base one on.

Good luck! At this point, you should be due for some.
By andee2k on Aug 11, 2011 | Reply

Hello Norm,

Thank you for your very detailed introspective on my situation. Your thoughts made alot of sense to me and I would like to update you and tell you that I did decide to “go with the flow” and had the surgery yesterday after much contemplation. However after the results of my ultrasound showed a full re-rupture and failing all the other “tests” you described, there really wasn’t much to contemplate in my mind. I think I was in denial when I said I beleived it was only a partial re-rupture and was hopeful somehow that I might be able to continue a non-op protocol. At the end of the day surgical risks seemed a much better percentage than the gamble of the long term effects in a fairly undocumented situation.

Your last paragraph was bang on as I played out both paths in my mind and it wasn’t a hard decision to go with conventional wisdom at this point. I’m pretty sure had I continued with a non-op protocol and re-ruptured a second time my emotional/psychological responses would have been scarring for a long time. As I lie on the couch writing this post I certainly feel comfortable with my decision even though the surgery was quite an unpleasant experience or if there are wound complications to come. I will be keeping an eye on suthernman’s progress with interest.

I truly appreciate the time you have taken to provide such thoughtful comments. I will be sure to keep in touch and update you with any significant milestones.

Wishing you continued success on your own healing.

Best regards,
Andy
By normofthenorth on Aug 11, 2011 | Reply

Thanks, Andy. I’m glad my ramblings helped, and you’ve made a decision you’re comfortable with. I’ve talked a few ATR patients here out of surgery, and failed to do so a few times, but you may be the first one I’ve helped talk INto surgery!

Good luck and good healing. The surgery I had on ATR #1 was also “quite an unpleasant experience”, though my results were excellent. I hope you do as well.
By normofthenorth on Oct 24, 2011 | Reply

Played some volleyball (indoor beach) today, first time in 2 years! A hoot! Last game was 2-on-2 with some solid players, and I wasn’t voted off the island! (Afterwards, one of the ~25-year-old women on the other team couldn’t stop mentioning how “quick” and “fast” I was! She never said “despite all the grey hair”, but I know she was thinking it! )

Lots of stiff joints now, but all good.

I’ve still got only about half of a 1-leg heel raise on the left side, but it never held me back or caused me any worry while I was playing. I suspect it’ll be a somewhat bigger deal when I play court volleyball. In beach ball, I usually can’t jump high enough to spike downward (without “rolling” the ball) anyway, but on the court I do. . . or I did, anyway!

My other “tricky” 66-year-old joints didn’t hold me back, either — a knee, both shoulders, spine/neck. And they all feel stiff and sore now, the way I’d expect them to after a 2-hour marathon after 2 years off. I was rusty and still out of shape for competitive volleyball, but I already knew that.

I did wonder if I was getting my heart-rate above the range my cardiac-rehab folks are comfy with (or even higher than I’ve gone post-op in a stress-echo cardiogram), especially during that (tie-breaker!!) 2-on-2 game! But my huffing and puffing and “feeling like I’m going to die from exhaustion” were all pretty normal-feeling, too (for me), and I’ve suffered no ill effects afterwards.
By ali39 on Oct 26, 2011 | Reply

Hey good stuff Norm.I know an 82 years old lady who is fitter than many people less than half her age
Good to hear no problems afterwards.
By normofthenorth on Nov 6, 2011 | Reply

Last weekend I went for my second v-ball session. All 4-on-4, with some solid players. I was just OK. After ~1:20, we lost a game with a team waiting and rotated off. Nowhere to play for a while (and almost midnight!), so I hit the showers. Next few days I was NOT at all stiff in the buns or thighs or any joints, so it clearly wasn’t enough for those parts.
Last Tuesday, I went in for another stress cardiogram (at my cardio rehab center), at my request. The previous one quit at 150 bpm pulse rate, though I felt fine to go farther and the EKG looked fine then, too. I wanted to know if I could really “push” — like, say, 2-on-2 beach volleyball! — and still be OK, 11 months after the heart surgery.
After some discussion among the test-admission nurse, the attending cardiologist, and the two stress-EKG technicians (The nurse initially indicated they might stop the test at “140 or 150″, which I told her would be a waste of time.), they decided to go for a relatively short but very intense test.
They do their tests (at least with me) on a fancy bike, with ~12 electrodes and a hose in my mouth to measure my CO2.
The results were about what I expected/hoped for:
10 minutes starting @150KPM/Min, Resting HR 59 BPM, Peak HR 156 BPM (=101% of age pred max), Resting BP 120/60 mmHG, Peak BP 190/85 mmHg. [I think the tech told me he got me up to 1500KPM/Min at the end. I was pushing against hard resistance.]
Peak VO2 36.1 ml/kg/min or 10.3 METs (147% of age pred norms)
**That’s my fave reading, of COURSE!**
No arrhythmia except one isolated Premature Ventricular Contrraction in recovery (=~0 — YAY!).
All else normal, improved, above norms, etc., etc.

When I showed this to my Cardio Rehab nurse the next day, she was still withholding judgment until she’d seen the detailed report. So my target HR on HER exercise bike is still 143 at the end of my cycling “sprints”. Mind you, after 45 minutes of that, I’m dripping sweat and I feel like I’ve had a good workout, so I’m not sure I need much more (at 66 y.o., don’t forget!).

After the two sessions of beach volleyball, my 1-leg heel raise is still wimpy, apparently unimproved, and my left calf muscle is still a bit smaller than my right. But again, I’ve felt absolutely no functional deficit from that strength deficit.

This Tuesday night I plan to play my first COURT volleyball in almost 2 years. Between blocking, spiking, and floor defense, I expect to give my calves-and-ATs (and CV system) a number of informative tests.

The interim verdict so far is that there IS life after both ATs have R’ed (with and without surgery, respectively), AND after open-heart surgery, AND after turning 66!
By bcurr on Nov 6, 2011 | Reply

Excellent stuff Norm!
By normofthenorth on Nov 9, 2011 | Reply

Thanks, bcurr!

Tonight, I played some COURT volleyball. It’s a weekly pickup “league”, split almost evenly between ~45-80-yr-old “grownups”, and “kids” ~18-25. Skill and experience levels all over the map. I got in about 1:20 time on the court, all on a 5-man team. Two good “kids”, two solid “grownups”, and me. Three timed matches, maybe 4 or 5 complete (15-point) games and 1 or 2 “stubs” ended by the whistle. We won all the complete ones and were behind 5-6 (and gaining!) in the “stub” — i.e., we kicked BUTT!

I played OK, esp. considering it was my first court ball session in almost 2 years(!). And my bod felt pretty good. About 2/3 of the way through, I realized that I hadn’t THOUGHT about my AT or calf all evening, which is nice. I blocked a fair amount, jumping at the net, and jumped to hit a dozen or so OK sets. A few hit the net, and all went over but one, can’t complain.

I’ll have to play some more and scrape some more rust off before I can really tell if I’ve lost any vertical or not, but I can already tell that I haven’t lost enough to hurt my game in THAT crowd.

My court coverage was also OK, and also not noticeably compromised by my straight-knee calf-strength deficit.

I don’t feel like I’m compensating for anything, I just feel like I’m back in the game.

If there were competitions in 1-leg heel raises, I’d really suck. But so far I seem to be able to compete pretty well in my fave game (even though it seems pretty “heel-raise-intensive”) all the same.
By bcurr on Nov 9, 2011 | Reply

That sounds awesome norm. After all you’ve been through its pretty damn incredible really!

At a guess I reckon the more volleyball you are doing that calf is going to get back to normal super quick and single heel raises will be no sweat.
By ryanb on Nov 9, 2011 | Reply

It’s really great to hear that you’re doing so well, and are able to get back to the volleyball court.
By normofthenorth on Nov 9, 2011 | Reply

Thanks, folks. I do seem to be a bit of an outlier in my age group, esp. in beach volleyball. Ironic in a way, because I think the beach is easier on the joints and the tendons than a floor. But beach is “newfangled” to lots of oldsters, and it also draws a young crowd. And the “real” beach game is 2-on-2, which is admittedly a brutal workout (at ANY age).

bcurr, I’ll be pleasantly surprised if you’re right about my left calf. So far I’m just delightedly surprised how little that last bit of calf/AT strength seems to matter in “real life”. Obviously, if you don’t have enough strength to push off at the end of a walking stride, or to run normally, that’s still a problem. But I’ve got that much, and I think I’m reasonably strong when my knee is bent. But when it’s straight, the 1LHR is a hard grunting half-height wimpy thing, but life is good — even on a volleyball court!

I’m still suspicious that (a) after I get less rusty and fitter at volleyball and (b) when I got into a serious court game where I’m getting great sets on my favorite side, I’ll notice that I’m not getting the altitude I was getting 2 years ago, pre-ATR#2. Time will tell, if I can avoid all the other pitfalls and injuries!
By artweb on Nov 18, 2011 | Reply

Hi Norm,

I finally joined this blog (and made a little donation), as it was a great thing to be able to read during my 3 months since the rupture. It helped me so much to make the right decisions - from the very start till now!

But I want to especially thank YOU for all your great posts, with detailed, researched information and also with description of your personal experiences. Going non-surgical was great for me and I think everyone should consider to go this way very seriously.

I intend to start a blog to try to be of help to others too, with my own ups and downs and with little tidbits of knowledge that I gathered from this website as well as other ones from the web.

Best of luck to you, Norm, and thanks again!

Corina - from Sandwich, Massachusetts
By normofthenorth on Nov 22, 2011 | Reply

Thanks for the thanks, Corina, you made my day!
It’s always nice to hear that my compulsive rambles have helped somebody. It’s also always nice to hear that somebody’s done great following a non-op protocol. (Hearing that somebody — and a fan of MINE! — pitched in to help keep this site alive is always nice, too.)
Please do share your tidbits, the ups AND the downs!
By normofthenorth on Dec 11, 2011 | Reply

Still progressing in fitness and such, playing volleyball 2x/wk most weeks — court ball on Tuesday nights and beach on Friday or Saturday nights. Last night I played 2.5 hours of beach, starting with two 2-on-2 games. (Won one, lost one.) I estimate that I provided about half of the total age-years for each foursome!

Neither the heart surgery nor the ATR seems to be holding me back. I think about my heart whenever I’m huffing and puffing, but I’ve always done a lot of that, esp. when playing “twos”. Brutal game, and I hate losing points, and letting my teammate(s) down. . . (Ironically, I don’t really care much who wins the games, but I’m @$#%ed if I’ll let a point go!)
My spiking is still improving, on both surfaces. The sets are erratic on Tuesdays, but on a good night, I get a fair number of good ones, so I get a good chance to jump and hit. I haven’t noticed much or any loss of vertical, but I’ve never measured or anything, and it’s still relatively early times back at the game.
Haven’t actually tried a 1-leg HR for a while, but I don’t think they’ve changed; I think maybe they’re just over-rated as an index of fitness for jumping sports. . .
By normofthenorth on Feb 20, 2012 | Reply

Did my fourth Whistler (BC, Canada) ski week since ATR (#3 since heart surgery a couple of weeks ago), and maybe the first one that felt 100% “back to normal”. Heading back for another week in a month. Great place!

Skiing ungroomed steeps-and-deeps, left the pulse monitor in the condo all week. Two ski-release tumbles — 1 because I’d left my left heel binding setting way low since the ATR. I cranked that sucker back up to ~7! Mostly high-energy high-speed skiing on the groomed runs, and high-energy not-so-high-speed skiing on the UNgroomed runs. Over 20,000′ daily vertical, at least on the groomed. We got 2′ of fresh snow that week, so the skiing was work, esp on the ungroomed. I skied ’til I was whipped (CV/SOB and/or noodles-for-legs), rested a minute or two then did some more, just like when I was only 63! Great to be back. My thighs hurt!
By normofthenorth on Feb 20, 2012 | Reply

Back to 2x/wk pick-up volleyball now, both flat out. 1.5h court on Tues (4s, 5s, or 6s), ~3h indoor beach on Sat (2s, 3s, & 4s).

I just discovered that two of my new 20-something beach-ball buddies/teammates are actually 17 yrs old! Yikes! Wish I’d been that serious about volleyball at that age — I’d have way better fundamental skills now…
By kilomike on Feb 20, 2012 | Reply

Hey Norm,

I ruptured my left Achilles last week and I was also advised to go the non-surgical route by my orthopedic surgeon.

I just wanted to say thanks, I found your blog very helpful and informative. Good to hear that you are back in action.

Kevin
By normofthenorth on Feb 20, 2012 | Reply

Good luck, Kevin, and thanks for the thanks. ~~If you have the inclination, start a blog and tell us all your story, ask questions, get suggestions and tips, etc.~~ [I just noticed your first blog page! ] And don’t settle for an old-fashioned slow non-op protocol!
By normofthenorth on Mar 13, 2012 | Reply

One of the 17-yr-olds (though he now says he’s 20!) and I played some AWESOME 2-on-2 beach v-ball at the end of a 3+ hour marathon Sat. night. We played a couple of teams that should have won or close, and we CRUSHED them with good teamwork and ball-handling. Woo-hoo!! That rush was especially welcome because the earlier parts of the session were just so-so.

On Tuesday, I got to sub in my fave court volleyball league. 4-on-4 on a full-sized court, with a “ladder”, so the competition is always good. I haven’t played in that league since the night I tore my 2nd ATR — and we were on the same court, too!

I’m increasingly convinced that 1-leg heel raises are over-rated as an indicator of sports fitness! My spiking was very effective, and my blocking seemed fine, too — though the quality of play in that league has clearly inflated in the last two years. Most of the guys were very good players, and 4 or 5 of them hit the ball a TON!

It would be a better story if we won and went up, but no. Still a blast though. And no hint of functional impairment from the ATR in Nov ‘09 or the heart-valve replacement in Dec ‘10 (or being 30-odd years older than the 2nd-oldest player there!), so I’m happy, and grateful for Ontario’s great health-care system.
By housemusic on Mar 13, 2012 | Reply

Norm,
So happy to read about your v-ball adventures with those 17 year olds. You are such a great role model, I hope I can emulate your physical and emotional resilience.
By djh232 on Mar 16, 2012 | Reply

ruptured left achilles 2 weeks ago.
was in a cast 2 weeks and now got into my DonJon Mc Walker.
doc says no weight bearing for 6 weeks more. HMMMM
I am sick of these crutches already!
went NON op because I had no choice, No insurance.
Insurance kicks in mid may…..no figure
By normofthenorth on Mar 16, 2012 | Reply

Djh that’s way too long NWB. Check the UWO Protocol at bit.ly/UWOProtocol and “hit” your Doc with it. My previous thread (something like “The case for skipping surgery”) has much more info than this one.
One big advantage of non-op is that you can shop for a good compatible health professional! Many of us saw more of our PTs than our “non-op surgeons”. Anybody who’s comfortable & confident to supervise you while you and your boot follow the UWO protocol sounds OK to me.
You DO have to follow it, though — going faster OR slower seems to increase the risk of rerupture. Most older or not-first-in-the-class surgeons BELIEVE that slower is safer, despite the scientific evidence. Converting yours to the facts may be possible or not; beliefs are like that.
Good luck, get moving, start a blog.
By normofthenorth on Mar 16, 2012 | Reply

BTW, djh232, your Donjoy MCWalker is the same hinged boot I finally got from my first-ATR OS. First boot he’d ever prescribed for an ATR patient, and I FOUGHT for it! It worked so well then, that I dug it out of the basement 8 yrs later and used it again for my second, when I felt ready for a hinged boot. (Early on, I was put into an unhinged (”fixed”) AirCast, which basically worked the same as the MCWalker with its hinge locked.)
By djh232 on Mar 16, 2012 | Reply

I am having a hard time figuring out how to start a blog on this site. I have read all your post hours after I popped my Achilles. Good info!
I have always PT’d hard and always way ahead of schedule.
I have had 5 knee surgeries (2 acl , 3 scopes) both knees being fixed up and I would MUCH rather have another knee injury over this one! Years of football, US Army, and rugby took it’s tolls on my knees and being kinda thick at 230 makes it worse.
Please email me NOTN at : [email deleted by Normofthenorth]
I have a few Questons regarding going back to work an realistic expectations.
Nevermind, here is goes!
I have been working as a security contractor overseas for years. I just took a new gig which does not require toting a gun around daily and non “operational”.
BUT I am still headed overseas but to no combat locations. I Have to be up and walking through airports come mid may. If I can’t ….I dont have a job and can’t support my bills and family. That’s the way this gig goes I am on!
In my mind come mid may there is NO doubt I will be walking…….or will I?
I Am a little worried to be honest!!
Any advice, tips?

I ha
By djh232 on Mar 16, 2012 | Reply

I am in the DJ MaxTrax boot. One that you can pump air into. Boot is still pointed down and it drives me NUTS. I can’t take off to take a bath which is nice. But a man taking a bath is just wrong!
I stand without crutches alot but leg has to be out in front of me to stand. And put weight on the leg. I can and do flex my calf muscles alot and massaged the whole area lightly today.
I work out in the gym 3-5 days a week and do legs / calves 2 times a week! And I don’t mean lightly. I am hoping having muscular legs and calves might help me a little on this. I had ACL surgery last June on the opposite knee and was rehabbing Legs very well! I did calves one day in the gym and abs next trying to ad size to my calves. I hope in the recover process that might benefit me some!
By djh232 on Mar 16, 2012 | Reply

Sorry for any typos. Typing all of this on my iPhone.
Is it bad to stand with some weight on it? I don’t see how it could be since my foot can’t bend back??
I am at day 15 and in 13 days go back to doc =
Week 4. he will move the boot up for me a little bit then.
By normofthenorth on Mar 17, 2012 | Reply

DJH, I deleted your email so the ‘bots won’t send you endless spam. Most of us bloggers get to see the e-dresses of people who post on our blogs, BTW.
I’d check the UWO Protocol — bit.ly/UWOProtocol — to answer your Qs about when it’s OK to do PWB and FWB, and when you can expect to be walking in a boot, and without a boot, etc. And following it is also a good idea. At 2 weeks (~yesterday?) they have you beginning PWB, still on crutches, and in two more weeks you can do FWB, without the crutches. That is “walking”, although still in a boot. Walking without a boot generally starts at 8 weeks, around the beginning of May. Two weeks later is mid-May, and most of us still had a limp-dip at the end of our stride (and maybe a shortenend or asymmetrical stride) at that point, but definitely walking.

I’m assuming you meant that you CAN take the boot off to take a bath. But many of us did also take showers (though carefully), usually with some kind of waterproof stool in the shower. It’s not trivial or simple, but few things are when you’re still NWB or PWB. There are whole pages on this site that talk about special arrangements and equipment to make life easier and safer while recovering, and having padded stools around for sitting and kneeling on (including in the shower) is definitely on that list.
Being fit and strong and committed is helpful, though being “way ahead of schedule” can be hazardous — especially when you start with an aggressive, modern schedule like the UWO protocol. Lots of posters and bloggers here have re-ruptured, some by slipping and falling, but also some by doing exercises (some of them prescribed by dumb PTs) that were too much, too soon. I’d stick to the program, or pretty darned close.

Once you start seriously walking in your boot (FWB), you’ll want to build up your other foot/shoe to get your body straight, or you’ll risk messing up other body parts, and learning bad ways to walk, too.
By djh232 on Mar 17, 2012 | Reply

How will I be able to do full weight bearing without crutches? My boot will still be angled down. In order to get any PwB now I have to stand with my bad foot way out ahead of me because of the angle
Of the boot. Haha
I don’t plan on pushing far ahead of schedule and hurting myself.
I told the doc I leave may 18 and will I be out of the boot. He said you will be walking in the boot through the airport but not out of it. I was like no way.
If I am mobile and walking by that point what good is the boot doing?
I very much appreciate you answering some of my questions.
I am going to try to follow that protocol. I am in a boot now but doc does not have me in any heel lifts. Should I go get some?
By djh232 on Mar 17, 2012 | Reply

Also what’s a good shoe or boot to wear following removal
Of the boot?
Any advice on wearing a slip-on Brace or sleeve when I go back to work. I will be on my feet alot.
All these things I read on here people are on boots doing nothing at 12+ weeks. I will be out of the USA and no seeing at PT.
Should I take a exercise band with me or any exercises to do?
I am so paranoid i won’t be walking come mid may.
By djh232 on Mar 17, 2012 | Reply

When can I ditch the crutches and just walk in the boot? I guess when the doc cranks me up to flat or 90 I am guessing.
By harleylady on Mar 17, 2012 | Reply

djh232, Please Wear the boot till Dr says you’re out of danger on retearing, I was in on week 9 and in boot 3 weeks and didn’t even know it and I had to start all over. Now I’m on week 6 of second round. They say after week 12 chances of retearing are slim. I know its a pain to wear boot but just try to find shoe about same height to keep from throwing hips out.
I’m going to use some heal lifts after month of boot this time. Good luck believe me you could be worse off. I’ve only walked in boot 3 weeks since Thanksgiving. Now I’m in wheelchair and some on crutches.
By normofthenorth on Mar 17, 2012 | Reply

Djh, they call them WALKING boots, and they do it well. Even in toe-down position. The sole is rounded, you land on the heel and roll forward off the toe. The weight on your toe would normally be supported by your calf and AT, but the boot transfers it to your shin. When you’re nearly ready for 2 shoes you can reset the boot to hinge between 90 and many. Any confusion between walking and neutral position is just confusion!

Please read the protocol, which answers most of your questions.
By djh232 on Mar 18, 2012 | Reply

What does this mean?
-active plantar and dorsi flexion to neutral, inversion /eversion below neutral
By djh232 on Mar 18, 2012 | Reply

Where can I buy heel lifts?
By ali39 on Mar 18, 2012 | Reply

Hi djh. There are some photos and descriptions on the site which will help.(In Dennis’s blog photos for example, there is a photo of plantar flexion, or google images.
Neutral is the reference point for all movements. The foot is in neutral at 90 degrees. The other words are describing ROM - range of movement. Plantar flexion is when the foot is pointed downwards (as if pointing towards a plant on the ground). Dorsi flexion is the opposite - the foot pointing upwards. Eversion and inversion is when the foot turns outwards or inwards - away from neutral which is the reference point.
If you do the movements with your other foot, it will give you a reference for what is your normal range.
Active is when you move the foot yourself, passive is when somebody else moves your foot. AROM means active range of movement PROM is passive.
Hope this helps.
By normofthenorth on Mar 18, 2012 | Reply

Re: “Active is when you move the foot yourself, passive is when somebody else moves your foot.” The “somebody else” is usually YOU yourself — with a towel or a Theraband around your foot, or by moving your leg while your foot is flat on the floor. All of those (esp. the floor) can apply WAY more force on your AT than your internal leg muscles would, so they’re best left for later and started gently.
Also, re “Eversion and inversion is when the foot turns outwards or inwards - away from neutral which is the reference point.” “Neutral” in that terse note does NOT refer to neutral inversion/eversion (= straight ahead), but neutral plantar/dorsi. I.e., ALWAYS keep your toes pointed below 90 degrees when doing those (early) exercises — in fact, whenever you’re out of your boot in that early period. This is to avoid over-stretching the AT, both to avoid rerupture and to avoid “healing long”.
Heel lifts should be available in stores that sell shoes esp. athletic shoes, and definitely in those that sell and fit ski boots, snowboard boots, etc. They’re hard rubber wedges, typically 1cm thick tapering to zero. (If you had a page, we’d see where you’re from. Apologies if it’s Arizona or Zimbabwe.)
By djh232 on Mar 18, 2012 | Reply

Thanks for all the info AGAIN! Haha
So you are saying according to that study protocol, I can start active raising and lowering my foot? My Ortho told me no matter what when that boot is off do not raise my foot at all for a while!
That would be active dorsi/plantar flextion correct?
By normofthenorth on Mar 19, 2012 | Reply

Below neutral means what it says. If you plantarflexed all the way down and couldn’t raise it at all, you’d be stuck forever, right?
By courtneywhalen on Mar 20, 2012 | Reply

Norm,

I have been reading achillesblog.com for the last two days and learning a lot. ATR was 3/2, surgery was 3/7. I have been in a splint for two weeks and they are set to put me in a cast on Wed., two weeks post surgery. I think I am in the cast for a month. Now that I have been reading about the study and the UWO Protocol, not so sure I want to go into a cast. I am very active and in the shape of my life when I did this just over two weeks ago. I don’t want to come out of the cast all stiff with no muscle and have to work my way back. I am calling my OS tomorrow morning to find out options. I am sure I can stick to a more aggressive rehab protocol. One question though, my OS gave me a blesoe boot for the 2 days before surgery. It does not look hinged or like it has air pockets. I am SURE you have covered this many times before (I did read a previous post that included a review of boots but I can’t find it now). I am not sure if I need to look into getting a different kind of boot than the one I have. Thanks in advance for your help! It looks like you have helped many others before me.
By normofthenorth on Mar 20, 2012 | Reply

Good Q about the boots, CW, and opinions differ. I like hinged boots (of which the Vaco seems the current crowd fave), but the hinge hardly matters until you set it free to hinge. (Til then, heel wedges do the same job quite well ) In my case I did that around 7 weeks in, as a smoother transition to 2 shoes. Also, whenever I got back into the boot later for scary activities, it was also hinged. Lets you walk faster and more naturally, and start rebuilding calf-&-AT strength. But UWO got very good results with the un-hinged Aircast, so it’s not exactly life or death.

I also barely used the air bladders in my AirCast (fixed) boot — the one UWO used — and my hinged boot had none, and fit well. If your feet don’t “fit the mold”, though, they might be a godsend.

Other factors make some patients love or hate a boot: Is it so bulky you have to wear sweatpants? Does it fit well on YOUR foot? Can it be adjusted easily for fit & pressure points, etc.? Is the liner easy to clean, e.g., if your incision leaks or oozes? I’m skiing this week, and I’m always amazed by the variety iin ski boots, and how strongly people prefer their own faves. And nobody spends weeks in a row in a ski boot!
By courtneywhalen on Mar 20, 2012 | Reply

Thank you very helpful! The boot seemed to fit my foot pretty well. I could really get around on it prior to sugery. One last question, as someone that has never been in a cast before, what is the main downside to casting? Is it NWB by design or could I try PWB in it if my OS is determined to cast me? Just trying to get educated before I speak to him today. I want the best chance of recovery. Thanks again!
By normofthenorth on Mar 20, 2012 | Reply

There are “walking casts”, though they usu need an add-on “cast shoe” to work as well as a boot. Usu higher than a boot, need lots of lift on the other foot to walk straight. If the cast is plaster not FG, it’s not a walking one.
By normofthenorth on Mar 23, 2012 | Reply

Day 4 of 6 today, in my 2nd of 2 Whistler ski weeks this season. Alpine got foggy before I got there. Made do with ~28k’ of vertical and TWO of the gnarliest runs I ever do: Seppo’s & the Garbanzo Chair lift-line. 2nd GC l-l this week (a 1st for me!), first Seppo’s run in 5+ yrs, and first ever doing both in one day. Near my record vertical, too, despite the two long and SLOW runs. I’m baaaaack (tho’ my 1-leg heel raise still sucks!)!
By normofthenorth on Mar 24, 2012 | Reply

Yesterday I returned to a couple more amazing Whistler runs that I’ve missed for years. What a hoot! 5 times down Whistler Bowl, a huge steep field of VW-sized bumps. Skied it like an athlete, not a very good SKIER! Lots of force and effort, very little finesse or balance. Grunting AND groaning. All good.
By normofthenorth on Mar 29, 2012 | Reply

You know you’re skiing a steep powder “cliff” when:
1) You look down and go “Yikes!”
2) The snow you kick loose keeps rolling down forever.
3) Some of your turns feel like airplane turns.
And my fave (first time I’ve done THIS):
4) If you lose an edge and plant your hip on the snow, you just resume skiing when your skis swing back to the slope!!
How convenient is it not to have to get up after falling?
Yikes!
That was on our last day, on Harmony Bowl, Whistler Mountain. Gorgeous sunny day, end of a wonderful week.
By normofthenorth on Jul 24, 2012 | Reply

About a week ago, I developed a fever with chills and sweats, and got nervous about possibly having Bacterial Endocarditis — an infection of the heart valve(s) that can be Very Bad News for somebody like me with a replaced heart valve.

Long story short (wait, I NEVER say that! ), they told me I should take a Cipro-something antibiotic from the fluoroquinolone family. Well, I’ve read a few of the horror stories here from people who’ve taken those antibiotics and torn their ATs by “sneezing” (or so it seems), so asked them to look for a substitute. I’ve already torn BOTH of my ATs and a finger-extensor tendon as well (all playing court volleyball), and I didn’t think I needed to take a drug that multiplied my risk of tearing a tendon.

They prescribed another, non-fluoroquinolone, antibiotic that reacted fine with my cultured “bugs”, and I’ve been popping those pills. Feeling fine, fever resolved very quickly, and the “bug” I’ve got doesn’t seem to like attacking heart valves, so I think I’m OK.

The ER docs I was dealing with seemed surprised to hear that fluoroquinolone drugs increase the risk of tendon ruptures. (Sigh!)
By andrew1971 on Jul 24, 2012 | Reply

Great news on the swift recovery and even more impressive that you had your wits about you when discussing the drugs to be prescribed….

I think it’s been documented for a number of years now that fluoroquinolone based drugs are assiciated with tendon ruptures - surprising (or not if you’re synical like me) that our medics don’t know this…… but good that there’s a ‘norm’ around to educate them
By normofthenorth on Jul 24, 2012 | Reply

Those drugs seem to be a useful “go-to” group of antibiotics. I assume the FDA’s Black Box warning about tendon ruptures has been adopted similarly in Canada, but maybe not. The chemical name began with “cipro”, but nobody called it “Cipro” the brand name, so it may have been a generic variant.
By housemusic on Jul 24, 2012 | Reply

Hi Norm,
Very happy to hear you got over your bacterial infection! The antibiotic class for Cipro is Fluoroquinone.Unfortunately many doctors are unaware of its dangers and they routinely prescribe Cipro, Levaquin, etc., even for minor infections. They are “go to” group because they are wide spectrum and effective which makes them popular in the Emergency Room.
Here is the FDA link:
http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm126085.htm

I also had a recent infection, and ended up in the ER. These days the first thing I tell docs is to find an alternative to these aweful drugs. Once they culture the bacteria, they should find a substitute so you can avoid the danger. On this note, I did take a very high dose of Levaquin for a respiratory problem…and I did rupture my achilles a few months later.
By sheena on Aug 25, 2012 | Reply

Norm,
how are you? Sorry I didn’t quite know where to post to contact you? I have asked this question on my post but specifically wanted to ask you if you know of anyone who has gone non op after a re rupture. I re reptured last night after walking up a slight incline. I wasn’t thinking what I was doing and just pushed off normally, on the incline and it popped. I hope I haven’t done something bad in the realms of blog behaviour by posting here but I wondered if you could help at all? I am at the hospital Tuesday and it’s a holiday weekedn here…typical! I am so upset…
By normofthenorth on Aug 25, 2012 | Reply

Ghastly news, Sheena, so sorry to hear it. I’ll share what (little) I know on your blog.
By sheena on Aug 26, 2012 | Reply

What would you do Norm if you re ruptured or had at 13 weeks?
By normofthenorth on Aug 26, 2012 | Reply

I’d love to tell you, Sheena, but I don’t think I know. I often discover my own preferences when forced to decide — or even the next morning, when I find I’m relieved and cheered (or not) by the decision.

I’ve also survived a successful surgical repair on my ATR #1. A couple of days of moaning, close to a week in bed, then no complications. A tiny scar I can hardly find, a tiny attachment I can barely make wrinkle my skin. And I’ve healed short, which I was recently warned about by a Podiatrist. (See my latest blog page.)

And I don’t think I’m half as surgery-averse as you are in general, after that ATR repair, 2 hernia ops, and open-heart surgery. So I might go under the knife, hoping to be done with it. Or I might go with my OS’s recommendation. Or I might give UWO non-op another try. I really don’t know, sorry.
By sheena on Aug 26, 2012 | Reply

Thanks Norm,
I will listen to what they say but I think I’ll go for surgery if they say that’s for the best. I think I will always be too scared otherwise. The only reason I hate surgery is the thought of not waking up again for my kids. I’m not scared of any pain just that if the truth be told.
By sheena on Aug 26, 2012 | Reply

One thing is for sure Norm, I will be in my boot at the end of week two…don’t care what they say.
What is the best link to the UWO study please norm. I did print off your protocol, I’m guessing it is the same yes?
By normofthenorth on Aug 26, 2012 | Reply

Sheena, you can always find the full text of the UWO study right on this site. Main Page, then click on the Protocols. . . Studies link in the left column, then look for UWO, down in the “Surgery vs. Non operative treatment (conservative treatment)” section. (The study was designed to compare op vs. non-op, but it generated excellent results in both groups with its relatively aggressive modern protocol.)

All of that leads you to achillesblog.com/files/2008/03/jbjsi01401v1.pdf — that’s the direct link to the study, in PDF format. You can save a copy on your computer, read it with Adobe or Foxit Reader or whatever, print it, search in it, etc. I’ve often recommended that ATR patients with “conservative” old-fashioned doctors should print it out, roll it up, and smack their doctors around the head with it!

And yes, as far as I know the two versions of the protocol — the official post-publication one that’s linked at the end of full-text study, and the pre-publication one that the authors faxed to my OS — are substantially identical. (If you find any important differences, please let me know.)
By sheena on Aug 26, 2012 | Reply

Thanks Norm!
You’ll find this worrying. In the ER room on Friday night the guy doing my scan told the other doctor to Dorsi flex my foot…..he got it wrong he clearly had forgotten which way that was!
By kkirk on Sep 22, 2012 | Reply

Hey Norm: again thanks for the info and as you know I just started my journey to recovery. Just set up my blog under kkirk and will keep you and everyone else posted. Take care.

Everyone: keep at it. I enjoy reading your stories and gather information to guide me during this process. Good luck with healing everyone
By sheena on Sep 26, 2012 | Reply

Hi Norm,
can I ask you a question please? I got my doc to give me the boot yey! 16 days, all looks OK at the mo. I read on an old blog of yours about you being a dove on dorsi flexion. My doc said I can active dorsi flex, does this mean don’t go beyond neutral, which I never would at the moment anyway? Should have asked him really. To be honest, I don’t feel like DFing at all. It feels so wrong at 16 days. The other gentle ROM movements feel fine but I’m so scared of tugging even a little on those stitches. Don’t want to move that injury even a mm. Thoughts?
By ryanb on Sep 26, 2012 | Reply

“Active” just means what you can do with your foot free. No towel, no floor, no rope, hand, or other device touching your foot to “force” a stretch. Hang your foot in the air, and pull your toes back (with your shin muscles); that’s active dorsi-flexion.

At 16 days, I’d even be a little careful with active stretching. Keep the ankle moving if you can, but I wouldn’t be working too hard to increase (dorsi flexion) range of motion yet.

Passive stretching is the opposite of course, this is where you grab/push/pull on your foot to extend it’s range of motion. To plantar flex (toes down) you would normally pull through your Achilles tendon, using your calf muscle. You can’t really do that now, so to maintain plantar flexion range of motion, I think now is the time for (careful) passive stretching in that direction. About now is when I started working my ankle pretty aggressively in every direction/axis *except* dorsi-flexion. I guess I’d call that passive aggressive stretching
By normofthenorth on Jul 12, 2013 | Reply

I just tripped over the following on heartwire.org:

EDITORIAL DISCUSSIONS
TRIALS AND FIBRILLATIONS WITH DR JOHN MANDROLA
Wide variations in CV care: A wake-up call for cardiologists

Sound familiar? A wake-up call for OSs will have to wait a bit longer, since nobody dies from 2nd-rate ATR care…
By sheepskin10 on Nov 14, 2013 | Reply

I am four weeks non-op and have been following your posts religiously. I am PWB with crutches and recently have felt numbness from the back of my upper calf extending to my knee. It has started since I got into the Vacocast. Any thoughts?
By normofthenorth on Nov 14, 2013 | Reply

Not much from me, Sheepskin — except that your hamstrings have been idle longer than ever before in your life since you first started walking. And most of us felt a number of odd sensations during ATR recovery.

As with any such problem, see if it persists, improves, or deteriorates, and call your Doc if/when it seems appropriate. And good luck.
By sheepskin10 on Nov 14, 2013 | Reply

I appreciate that response Norm. The surgeons in Santa Barbara, CA are pretty cut happy here and I have taken guff for opting for non-op. The ortho says he has presented non-op for 3 years now as his preferred option and only had 2 takers!
By fuegalicious on Mar 7, 2014 | Reply

The “cultural” differences between this site & the valve replacement site seems analogous to my aunt signing her wall posts on Facebook - even though her name automatically appears at the top of each post! Whether it’s generational, or more attributable to the type of individual that stereotypically undergoes each respective treatment, it truly is fascinating! Thanks for the insight. Who knew?
By normofthenorth on Mar 7, 2014 | Reply

I hadn’t thought of it that way, fuegalicious, thanks!
By normofthenorth on Feb 23, 2015 | Reply

Hi, folks. I thought that my open-heart surgery might cure (or replace) my addiction to achillesblog.com, but it didn’t. But maybe a month ago, Dennis emailed me to ask me not to post on anybody’s blog pages but my own, since he’d gotten some private complaints from people who’d been offended by some things I’d written.
He said he was happy for me to keep posting on these pages, but not responding elsewhere. Most of the offense was a propos op vs. non-op, but he didn’t want me posting elsewhere on other topics either.
I thought that might give me a chance to perfect one of my non-op pages — like maybe “The Case for Skipping ATR Surgery”, which got hijacked by a discussion about who was offended by what. But instead what’s happened is that I think I’ve finally kicked the habit! It helped that I was halfway through a Whistler ski week when Dennis changed the rules, so I wasn’t short of things to do — and I was madly shopping for real estate there to replace a timeshare that’s being shut down. (And I think I just got a new timeshare to replace it — yay!)
When I’ve returned here for a quick glance, it looks as if there are still many people here who have good info to share on many topics. Nobody’s indispensable, eh? I’d be tempted to bounce back occasionally and make a few comments — tapering off, like most people do — but if I can’t respond to any discussions that aren’t on my own page, that probably doesn’t work.
So, I’ve probably run out of gas before I pretty up any of my pages into an up-to-date compendium, though achillesblog.com/cecilia/protocols has done a pretty good job of summarizing both (a) the case for fast rehab protocols (op and non-op) and (b) the case for skipping the surgery. (It’s true that most of the fast and successful protocols listed there are non-op, but since most surgical patients are rushed under the knife partly by being told that they’ll recover faster with the surgery than without, so the point is made in spades.)
All the best to all of you, new and old, and to the next crop of ATR patients! I hope some of my pages and comments continue to add some wisdom and/or comfort where it’s needed.
By xplora on Feb 26, 2015 | Reply

Hey Norm - I had wondered what was going on and was even going to contact Dennis to see if things were OK with you. We have not always agreed but I have always been thankful for you open and honest comment. Having been here for some time as well I can understand the obsession but I tend not to comment much now as well. There is plenty of good support from those coming through. Your wisdom and thoughts have been appreciated by a far greater number and I feel it is a shame you have been moderated. In saying that it is also good for you to move on. All the best from me. To be sure, if the other one goes on me I will be going non-op and confident in the result. I would also have to manage myself because the nearest doc is just too far away. I was rushed into making a surgical decision based on outdated information.
By normofthenorth on Feb 26, 2015 | Reply

Thanks, Stuart, and much appreciated.
I have increasingly appreciated your take on things — yes, definitely not always identical to mine! — as time has passed. I hope you continue to find time for this evolving gang without rupturing your other AT!
By hillie on Feb 27, 2015 | Reply

You know, at one time I wondered if you and Dennis were one and the same person. That thought disappeared sometime ago and now it is totally clear.

I myself have been accused in the past of making others potentially feel that I was telling them what they had done wrong in selecting a form of treatment - in fact all I did was pass on my own experiences of benefitting from a fast, non-op rehab schedule and a great boot, which is surely a key purpose in this blog. I also noticed a few weeks back that another blogger here (ATRbuffie?) was severely admonished by Eric98? and that he didn’t like what was being said.

You and I didn’t always agree (like your thoughts on MRI scans) but at least it was healthy debate.

It seems that when some people are presented with new information on a technique or protocol which even they can admit perhaps being better than theirs, they are angry at the blogger, who is often just the messenger. Those who take comments as they are meant (positively), present any new evidence to their OS and in some cases this has resulted in an early out of the cast, or a boot at only 2 weeks, or early weight-bearing.

It’s not what one says that seems to matter - it is how one says it…

See you here soon!

H
By donna on Feb 27, 2015 | Reply

Hillie, you said: “It’s not what one says that seems to matter - it is how one says it…”

I agree. I’d also add that when one says it is also important. As well, I’d add this…as we all know this injury can be an “emotional roller coaster” and in this state we hear things differently that we might at a less sensitive time, receive with a very different response. We also have different emotional triggers.

I’ve found that as I move away from that initial “emotional storminess” that so many of us are prone to, (16 weeks now) I’m much more open and able to take what’s helpful and leave the rest…and at the same time I’m not as sensitive to the newly injured as I was in those first few months. I find trying to educate in a non-biased way, respecting others choices, trying to stick to the facts, and keep in mind the emotional aspect of this injury is a challenge. Again, especially as I’m moving out of that emotional phase. I’m working on presenting facts without the strong opinion, doing it at the right time and in the right place, and in a kind caring way.

What I’ve come to find is that research and real world practice regarding op vs non op for ATR’s have not caught up and yes, as part of the educational aspect of this site, it’s important to let people know of all the misinformation out there. There is a lot of it. But when/how we do that is just as important to me.

Just today someone said their Doctor said such and such and those of us who know non-op is as good as op with the right protocols just shake our head and go “really?”…I get the frustration for those of you who know what you know due to good science and personal experience and want to share it, however, there is a time and place for everything and I was not about to correct this guy when he’s afraid and already made his decision…but that’s just me.

What I experienced here early on was attempted and well meaning education, at the wrong time and the wrong place, said in such a way that it was easy to take offense and be turned off to the site.

I hope Norm that gives you some insight, whether you agree or disagree with my observations is irrelevant to me, in that I sincerely like you, found you challenging to deal with, but very well meaning.

You said: “I thought that might give me a chance to perfect one of my non-op pages — like maybe “The Case for Skipping ATR Surgery”.”

I hope you will do that as I’d like to refer others to your post who show up here specifically asking for information on op vs non-op.

Best to you always,
Donna
By hillie on Feb 27, 2015 | Reply

N, fwiw, imho, now look what you have me doing. I’m going for a lie-down!
By normofthenorth on Feb 27, 2015 | Reply

Thanks a lot, Hillie and Donna.

Donna, I was planning to refer to our experience together here — yours and mine — in my response to Hillie, and then you added your perspective.

There are certainly “truths” that are best unsaid, here and elsewhere. In general, debating the wisdom of decisions already made is at best a waste of time for those directly involved — though I do worry about others who read misleading statements that go uncorrected, and take them as true and agreed.

Your example above, Donna, makes perfect sense in a private conversation with the ATR patient whose doctor misled him, but your thoughtful decision to hold your tongue could mean that a later patient (or 100 of them!) gets a false impression.

There are a few areas where false impressions about ATRs are common online — (1) “ATR surgery is faster, stronger, and safer (against reruptures) than non-op”, and (2) “Going slower is safer — heck, you don’t want to go through this TWICE!” come to mind. And while those myths are still rampant, I do feel an urge to stomp on them wherever they appear, the way I’d stomp on hot coals while trying to put out a fire.

Meanwhile, the main thing I’ve been meaning to write here since reading Hillie’s comment is this:
I think the main issue here, in my current problem with Dennis and some of his friends, is actually CULTURE! I was raised to speak the truth, and to relish it when others speak it in my direction. (It’s also true that I was under-trained in sensitivity to the context, timing, needs of the listener, etc., etc., and I’m still developing that, here and elsewhere.)

I have often disagreed with others here — including all THREE of you who have been kind enough to comment directly above. And I’ve often ventilated those disagreements, and we have generally come to appreciate our different perspectives and value (and learn from) each other’s contributions.

Donna, you have become my best example of how two honest outspoken people can overcome enormous differences with open discussion — which is why I wanted to mention you in my response to Hillie. I don’t think I’m overstating (much) to say that I initially drove you crazy! You were vulnerable and emotional, and I was determined to speak the truth, and the combination was toxic, and you said so! You spoke your truth, out in the open, for all to hear/read. And it worked a charm. We both learned something, nobody was scared away from this great website (AFAIK), and we both remained energetic and constructive contributors. I love it!

In contrast, others have disapproved of some of my “truths”, and have responded by complaining to their like-minded pals (including Dennis) in secret. I don’t know whether those others and I could have overcome our differences the way Donna and I did, but it’s hard to believe that our disagreements were/are more fundamental or more toxic than those that divided Donna and me.

The difference, I think, is not the size of the disagreements, but the nature of the response. Donna shared her views with everybody — including me, the main source of her distress — while the others effectively wrote me off and shut me (and most of you) out of the discussion. They didn’t suffer in silence, they complained (at least to Dennis), but they did so behind closed doors.

Dennis is obviously a nice guy, and he values their opinions and their comfort, so he had a “Norm problem”, and he’s discussed that problem with me a number time over the years, including this time.

Of course I’m glad he came to me about it. This is Dennis’s web-site, and he’s legitimately and properly in charge of who and what appears on it, so he could have just banned me and deleted all my postings without exceeding his authority.

But I dream of an alternate universe where he responded by inviting his frustrated friends to air their grievances in public, on the forum, just as Donna did. And I’m guessing (hoping) that the results would be constructive, because we’re all grown-ups and we’re all here because we think this site is doing important work and doing it well. (As parallel universes go, that one’s not very different, and I think the difference is mostly cultural.)

But we’re in this universe, so here we are.
By hillie on Feb 27, 2015 | Reply

“while the others effectively wrote me off and shut me (and most of you) out of the discussion”.

I wonder how many you think have complained. Probably not many as you can guess from the very many positive responses over the years - over 2 years in my case although I’ve had a ‘blog break’ recently. Not because of you, but because it was becoming mildly addictive, as well as frustrating to read that many of our fellow members of the human race were receiving the levels of treatment that we’ve all read about.

Debating decisions already made is maybe not a great choice of words, and in my case, when I mentioned ‘debate’, if anything it was to use previous cases and research findings, as case studies for future ‘victims’ to consider. For those already on the path to recovery, of course it is too late (this time round).

Also, look at other blogs, especially tech ones, and see how rude and ill tempered many of their contributors are. Achillesblog is almost totally polite and very well-meaning almost 100% of the time.

Got to go now, blog posts to respond to…
By normofthenorth on Feb 27, 2015 | Reply

All agreed, Hillie.
By donna on Feb 27, 2015 | Reply

Oh my goodness Norm…I really had hoped that my response to you would be the end of this for me but I feel to respond again because I get the impression you think I haven’t spoken to Dennis and I have. However, I didn’t write to him to complain about you and had I been able to delete my blog I would never have written to him at all. As you said, I was quite open in my frustration with you in public. I wrote him for the sole purpose of asking for technical help. He asked me why and I didn’t tell him anything I hadn’t said in public. It’s not my way to name names or do a he said, she said. I will say that in my opinion he was very sincere and was looking for clarity regarding a difficult situation. He expressed to me that he didn’t want to censor the community as it was distasteful to him, yet he had to address complaints and that he had had many over the years. I don’t know the history. I feel like the person in the “middle”. I simply gave him my point of view when specifically asked. Since I may have inadvertently been the “straw that broke the camel’s back”, and if it would be helpful for you to see what I shared with him, I would be more than happy to forward the email I sent to him, however, without his permission I wouldn’t be comfortable sharing his to me. You have my email address so let me know, I don’t have yours because I no longer have a blog.

With that said, I’d like to address a few more things from your comment. I agree totally with what you said here:
“There are certainly “truths” that are best unsaid, here and elsewhere. In general, debating the wisdom of decisions already made is at best a waste of time for those directly involved — though I do worry about others who read misleading statements that go uncorrected, and take them as true and agreed.

Your example above, Donna, makes perfect sense in a private conversation with the ATR patient whose doctor misled him, but your thoughtful decision to hold your tongue could mean that a later patient (or 100 of them!) gets a false impression.”

And honestly Norm I am as concerned as you about this…I don’t have the answer to how we can deal with that, except on a comment/blog post by comment/blog post basis. I don’t want false impressions either but they are happening daily, as I said earlier we can see them just today. Is there a best answer? I don’t know but I am open to finding one. I’d wished I could speak to you several times this last week when things came up so we could find an appropriate response together that would be helpful, supportive, and educational but without perpetuating falsities. As you’ve said our different ways of approaching things does create a balanced view.

Also, you said:
“The difference, I think, is not the size of the disagreements, but the nature of the response. Donna shared her views with everybody — including me, the main source of her distress — while the others effectively wrote me off and shut me (and most of you) out of the discussion. They didn’t suffer in silence, they complained (at least to Dennis), but they did so behind closed doors.”

And later you said:

“But I dream of an alternate universe where he responded by inviting his frustrated friends to air their grievances in public, on the forum, just as Donna did. And I’m guessing (hoping) that the results would be constructive, because we’re all grown-ups and we’re all here because we think this site is doing important work and doing it well. (As parallel universes go, that one’s not very different, and I think the difference is mostly cultural.)”

In response to both statements…I’d like to point out that yes it may be cultural…we all have different perceptions shaped by our life story so in that I agree. I also feel that some people do not like confrontation and to suggest they are wrong to go “behind closed doors” may be harsh. And though I did not intentionally go behind closed doors because it is not my way, I support those whose way it is. I believe we are all unique and inherently worthy despite our ways. It is really uncomfortable for some people to air their grievances in public Norm and to suggest we should all be able to do that is questionable and perhaps worthy of more consideration. I believe that taking it to the “boss” is a worthwhile strategy if open discussion is not your way. That’s why we have things like mediation and anonymous ways to express ourselves. Like you I wish there were a world in which we could all be grown-ups but that isn’t our reality so we have to deal with what is, because it is, what is.

I think Dennis has given this lots of thoughtful consideration and came to a clarity that he felt comfortable with despite the difficulty. In my estimation this was not easy for him, he did his best to resolve it over a very long period of time, gave it ample thought, sought out others viewpoints, and did in the end what he felt best. As you said, he did involve you in his considerations by discussing this with you over the years. I’d have to say a man who can make difficult decisions and implement them almost always gain my respect.

In closing, I’m glad you are still here…and I truly appreciate you, especially when you are able to see things like this and express them in public: “…(It’s also true that I was under-trained in sensitivity to the context, timing, needs of the listener, etc., etc., and I’m still developing that, here and elsewhere.)” I believe we are all a “work in progress” One thing I like about you is I don’t find you arrogant, but sincere and real…there is no phoniness about you…I freely admit to calling you overzealous. Big smile for you. One thing we have in common is that we both post rather long wordy comments…ha ha.
By xplora on Feb 27, 2015 | Reply

I think we all have to realise this is only a blog spot and there are hundreds of armchair experts who will give advice based on their single experience. I am a bit like Norm when I see the wrong thing posted but I take a backward step sometimes and think that people must be responsible for themselves at some point. If they choose to take the wrong advice without verifying then it is their responsibility. I also like to present the facts and suggest people make up their own mind. I have a science background followed by law enforcement which makes me question almost everything. Once I have been shown the evidence I would make a decision but I would never rely on or blindly trust the word of another. That could get me into big trouble. I think Norm you have by and large pointed people to the evidence but as Donna has said we are all different and mostly in a very emotional state early in the healing. The written word can be read very harshly and we often read into it things which were not intended depending our emotional state or attachment to the person writing. There have been plenty over the years here who have irritated me and no doubt I have done the same. Not many stick around as long as you have Norm but I understand why. There is a level of experience you bring to the table but the take home lesson for all of us is how it is delivered and maybe even IF if you (not meaning exclusively you Norm)need to be the one to say it. Support and encouragement still flow through these pages and I am glad this blog spot is not like most of the others or I would not be here.
By normofthenorth on Feb 27, 2015 | Reply

Thanks and agreed and appreciated, both of you!

Donna, I support and defend people’s right to accuse wrongdoers confidentially in a number of other contexts, though it smarts to be on the receiving end, especially after the experience we shared (and I shared with others), of being able to work out our differences. And I don’t mean to suggest that my “culture” is better than the others. But it is mine!
By normofthenorth on Feb 27, 2015 | Reply

Donna, this is off-topic here, but elsewhere you just wrote: “if you have a rupture and are not diagnosed for a long period of time you will find yourself in a situation in which you have to have surgery to repair it, thus loosing your chance to choose to go non-operation”. With great respect and affection, that USED to be the “agreed truth”, but it has now been contradicted by Wallace’s amazingly successful results with his “chronic” ATRs.

His study is called “Belfast” at achillesblog.com/cecilia/protocols . (I just created the short link http://bit.ly/3protocols to point to that excellent page.) Admittedly, SOME of Wallace’s “chronic” ATRs would not cooperate — the torn tendon ends would not “approximate”, so they were repaired surgically. But the vast majority would, and they had just as low a re-rupture rate as the ~900 that were treated promptly.

That result was considered impossible by virtually everybody (including me!) until Wallace published his results. I still don’t understand just how it could possibly be true, but they say that the first principle of Physics (maybe Science!) is “If it exists, it must be possible!”

And pretty much the same thing can be said about non-op treatment of RE-ruptures. Pre-Wallace, it was at best unproven, and generally frowned upon. Post-Wallace, it looks smart to me!
By donna on Feb 27, 2015 | Reply

I’m always willing to be wrong…that seems to be a big theme we haven’t labeled…the need to correct others who inadvertently misinform in their sincere attempt to be helpful.

I don’t think it’s my job to correct others on this blog, but I don’t mind doing it, if I think it may be taken well and helpful overall. Sometimes I just keep my mouth shut. However, I just sent a private email to someone who misinformed others with two of the all time ATR myths. I would not have sent a private email had we not already had a personal relationship via earlier emails they initiated…and hopefully they took the correction well…I certainly have taken yours well because of how you did it. Thanks.

YAY YOU! …what you said was Well said, timely, and appropriate Norm. It was well received and I stand corrected! Just so I’m clear…are you saying that with Wallance’s non-op treatment you can still get great results even if long periods of time have gone by between the rupture and a correct diagnosis? Is that what you mean by chronic cases? I did not know that he had good results with going non-op with re-ruptures…that is great news. As far as I knew most re-ruptures need surgical repair.

The other day I read on a well established medical web site the usual misinformation on ATR’s, what surprised me was that the ATR page had just been reviewed that day by a Doctor,…and I wanted to scream…I thought of you. HA HA. I wanted to sic you on them!

I’m sorry that you were “smarting” earlier…isn’t it funny that we both know what that means? We’re showing our age, though I do see you as an older wiser brother who I need to occasionally remind that it’s not what you say but how, when, and where you say it…and you need to pop me out of my pollyanna viewpoint when I forget to mention the facts thus perpetuating misinformation…or as you just did, to skillfully and kindly correct me when I get them wrong in a sincere attempt to be helpful. YAY US!

I think there is room here for everyone, and I’d go as far as saying that I don’t think anyone could not see your value here. Your ability to breakdown science for the everyday joe is wonderful and much needed here. Your breadth of knowledge on this injury and it’s recovery is immense! I’ve observed, since you have adhered to Dennis’s request to not write other than on your own blog page, that there has been lots of misinformation gone uncorrected, however, I’ll risk offense and say, for me at least, there has also been less tension, though it is my greatest hope that you don’t take offense.

I had to develop the ability to correct and be corrected as an educator because working with teenagers at the high school level and training teachers at the collegiate level on how to educate teenagers in science calls for nothing less than the ability to be wrong and then to stand corrected. I had to learn to do that daily (correct others and be corrected) because teens see right through bullshit and you will lose all respect if you can’t admit you were mistaken…and they also need to be corrected daily in the classroom in a way that built them up and didn’t knock them down. It’s not easy and I’m a work in progress.

I learned that with the right approach almost anyone (but not all) can take correction and actually feel good about themselves in the correcting. But I don’t always get it right. We are human and we sometimes read things wrong. It’s an art and a science.

There are several people here that are very very good at doing what I’m talking about. They correct without offending. I’m trying to emulate them more. I admire them. Overall I think you are way better at the science and I think I’m better at sensitivity, timing, and the needs of the listener. Together we’ve all got this!

No tension today…it seems as if everyone is being more aware today. Here’s to progress!

Overall I hope Dennis reads this and sees how his creation is doing more than supporting ATR bloggers it’s helping us grow up together. Why not learn a little bit about how to get along while we’re here? It’s good for the soul I say!
By normofthenorth on Feb 27, 2015 | Reply

Donna, I love that post! And yes, we’re all Works In Progress — at least on the GOOD days! And I took no offense at the part you were worried about, either. Of course there’s less tension — at least less visible tension — when nobody contradicts stuff, even if it’s demonstrably incorrect. But if I could dish it out but couldn’t take it, I’d be a bad joke.

As for your “are you saying that with Wallace’s non-op treatment you can still get great results even if long periods of time have gone by between the rupture and a correct diagnosis? Is that what you mean by chronic cases?” The answer is YES! Amazing, but apparently (reportedly) true!

The only caveats are these 2:
(1) The technique Wallace used includes a trick he introduced that should be universally required globally, but is unfortunately unusal: Before immobilizing an ATR patient’s ankle, Wallace manipulated the ankle until he found (by looking and palpating) the plantarflex angle that just “approximated” the torn Achilles Tendon ends, i.e., just brought them together. And THAT angle is the angle he used to immobilize them for the first 2 or 3 weeks. (He used casts, followed by Aircast boots.) And
(2) Although he claims 100% success at approximating the torn AT ends of all his “primary” (prompt, non-chronic) ATR patients AND all of his re-ruptures, he conceded in the article that several of his chronic (delayed, neglected, mis-diagnosed) ATRs could NOT be “approximated”, so they were sent to surgery. I forget the actual number or % of those chronic ATRs that would not approximate, but I think it was in the neighbourhood of 1/4, and definitely a minority. Of course, his article remembers, and it’s linked from Cecilia’s page at bit.ly/3protocols .

I haven’t read about anybody duplicating Wallace’s amazing results, or even about anybody using his (obviously brilliant) “trick”.
By ericm98 on Mar 2, 2015 | Reply

“I also noticed a few weeks back that another blogger here (ATRbuffie?) was severely admonished by Eric98? and that he didn’t like what was being said.”

For the record, I didn’t post what I posted to ATRBuff b/c I disliked something he said with respect to something being wrong or good. I posted what I posted b/c I don’t care for his relatively passive-aggressive attitude in which he feels entitled to trivialize others. Zero to do with anything related to his take on a specific treatment protocol relative to my situation.

Glad you’re back Norm!
By hillie on Mar 4, 2015 | Reply

Hey Eric

Just read your latest post - doing well!

As for the spat with ATRBuffy over the way something was said, I can barely recall what it was all about now but probably best left behind now. Except first could you explain what ‘relatively passive aggressive’ means? Not being funny or difficult, I simply don’t understand your term, and maybe others don’t either.

Thanks

H
By goldman on Jun 2, 2015 | Reply

NORM !

Thank God you are alive! Phew. I was really starting to get worried.

I have not been on achillesblog much in the past six or nine months; every now and then I check back and see what’s up, see if I “know” anybody who posted recently. I always expect(ed) to see _the Norm_ around and usually followed trails of your comments.

A few months ago in the winter, I guess right around the time Dennis confined you to quarters, so to speak, I noticed that I wasn’t seeing any of your posts. At first I thought maybe you were still skiing in Whistler or something. By the end of March I was convinced something awful had happened, imagining that your residence had burned down with all your computers and tablets and smart phones sending you into complete blog-post-disarray. By April I was sure something horrible had befallen you. I don’t know why it took me until May to think to look at your blog… I guess I got so used to seeing your comments responding to other people’s woes. The unrestrained joy at seeing your writing, confirming you were still around… why I almost shed a tear I definitely did 30 or 40 calf raises in celebration

Well Norm, I am sorry that Dennis put restrictions on you. I always appreciated your insight, thoughtful comments, and humor. Perhaps it is for the best, I mean after all you have contributed so much material to this site. I bet if you scraped and vacuumed all the blogs that you have contributed to, you would end up with a quite large and sizable web site of your own. Unless of course you actually are Dennis, as another person speculated. Oh well, I guess it doesn’t really matter. I am just glad to hear your “voice.”

Take care and all the best,
Jon
By normofthenorth on Jul 13, 2015 | Reply

Hey Jon (Goldman), I don’t think I saw your great post a month ago, but thanks for the nice words and thoughts. Suddenly there’s a rush of non-op ATR folks asking Qs on my pages, so I’m hanging around here (”in my room”) again for a while. (I think the “rush” may mostly be two or three people!)

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