First post op visit 2/17

13 days after my surgery I was scheduled to see my Ortho.  At this point I was heavy into researching how other doctors throughout the world treat recovery’s.  I love the Internet and this site!  Think if this had happened to us 40 years ago…  My Ortho has a perfect track record of non rerupture’s after over 100 surgeries.  What he didn’t know was how his patients recovered once he turned them loose on the PT.  His protocol is very conservative, 2 weeks in a splint, 6 weeks in casts at different dorsiflection angles.  Effective for re rupture but not so good for 95-100% recovery…  Being an athlete in an explosive sport like beach volleyball I can’t imagine taking the chance of being in a cast atrophying away for weeks on end.  I even wondered why a cast is needed for this recovery at all.  With the amazing boot options out there why even consider a cast?  In fact I put together a pro con list to try to understand the benefits of casting. 

PROS;  Impact protection and taking chances while unprotected were the only two I could come up with.  Of course, the doctor sleeps better at night knowing you can’t get it off. 

CONS;  Can’t do light PT or ROM exercises, can’t  ice or ultrasound, swelling management (casts end up too tight or too loose sometimes), can’t massage, can’t make small adjustments to a cast to individual advancements in rehab, can’t clean your leg/wound, can’t get air and vitamin E to the wound, the slower the wound heals the longer it will be before you can safely consider pool rehab, cost (I’m out of pocket on this) and what it did to me psychologically to have a cast on. 

So 13 days postop I end up in a debate with my Ortho about the need for a cast when I had already ordered my boot (vacocast) which by the way, I LOVE.  My Ortho was so into casting that he offered to put it on for free and meet me half way on the timeline.  I was stuck, do I refuse his offer and strain the relationship or do I take the free cast.  He even told me in the debate that it would give him fewer grey hair’s if I were in a cast.  So, I figured take the free cast, keep the relationship healthy and save him some grey hair.  At first I liked the protection of the cast especially since my AT was pretty tight at the new angle of 5 degrees.  After two days the tension subsided and I then began PWB with crutches.  The angle made it tough to work on PWB so I took some towels and wrapped the heal with ace bandages to create a walkable cast.  After two days of this PWB I began FWB with little problem.  After two days of FWB I was ready for the next step.  That morning I spent a little time reading Doug53’s comments on his cast less recovery and was ready.   On day six of the cast 2/23 (19 days post op) I took a trip to the garage doctor and removed my cast with wire cutters, pliers and some gentle work with an box cutter.  This project took around 45 minutes and went without incident.  WHAT A GREAT FEELING TO HAVE THE CAST OFF!  I immediately started the next phase of my rehab with a shower, some ROM and some vitamin E for the wound.  I have photo’s and will create a link for them soon.  My wound was 2.25″ and looked the same as when the cast was put on.  Since then I can literally watch the wound seal up and heal.  Getting air and vitamin E did wonders for my wound.  Now with the boot at 0 degrees I was tight again for a couple days.  I went back to PWB until it was able to handle FWB.  To not over do it I would work a combination of FWB and crutch time.  My swelling has really fallen off now and I ice after a heavy day but it’s mostly in check.  I sleep with my leg on two pillows (without the boot) still but don’t really need to.  The recovery is really taking off now!  Yesterday D and I went on a bike ride to one of the local breweries for dinner and a beer in the sun.  Riding a bike works well with the boot on even though it is in a fixed position.  It is a bit risky but the boot is pretty close to the protection of a cast and I am being very cautious.  I love the freedom of being able to ride a bike again!  Today (3/1) my AT feels fantastic and the scar is sealed up enough to try a pool work out without worrying about infection.  Infection would be a big set back so I may wait until tomorrow (pool water can be nasty).  I have delayed my second post op visit as I don’t need his help or have any questions for him right now.  I want to spread these appointments out just in case I need him later.  The three post op visits are included in the price of the surgery so I want to milk it.

3 Responses to “First post op visit 2/17”

  1. Thanks for the LOLs, guy! Love your writing style!

    But that DIY cast removal sounds SCARY!!

    You know, the nifty tools they use to remove casts have finally bred DIY versions! They use a fine-toothed saw that micro-vibrates through such a small amplitude, that if (when) it encounters your skin, it just jiggles it, rather than cutting it. But the cast is so rigid, it can’t escape, so it gets cut. I think Dremel and others make versions of the thing now for “us”, with attachments to cut, or to scrape. Next time, promise me you’ll use one of those gizmos instead of the box cutters!!

    Interesting thing about returning to PWB to make a transition with the heel lifts. My protocol calls for a return to crutches as needed when weaning off the boot. I decided I had ZERO interest in returning to crutches after I’d said goodbye to them, so I made my transition from full heel-lift to none gradual (over maybe a week), and I stuck a hinged boot into the transition from a fixed boot to 2 shoes. The crutches stayed leaning against the wall the whole time.

    Good luck! I have a feeling that if your Ortho tries to give you a tongue-lashing over the boot, you’ll be able to handle it!

  2. Hey Norm glad we could share a smile or two. I mostly used the tin snips for the home brewed cast removal and only broke out the box cutter for the cotton material under the plaster. I would get under the cotton with the knife and cut outwards. I can’t tell you how much my mental state improved once that shackle was off. Plus, dogs don’t go out of their way as much now to sniff my foot.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  3. Funny about the dogs, eh? In addition to the sniffing, I noticed another effect: Some good friends who often have us over for dinner recently acquired a Great Dane “puppy” (more like a pony!) to add to their collection of (small) dogs in their big house.

    When the GD was pretty new to the household, I showed up with a boot, NWB, on crutches. Talk about terrified! (the GD, not me) They have a big island in the middle of their kitchen, and the GD walked backwards almost the whole circumference of that island in order to stay as far away from me as possible! Funny moves!

    The second time, I was in the boot, but FWB, no cane or crutches. The dog still avoided me a bit, but it was a much more moderate response. The last time, I was in shoes, and the GD and I are pals now!

    Of course, part of this could be the dog growing up and getting used to “strange” people (like me!), but I think some of it was the big sticks and funny boots.

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