Obligatory 1 year post

Well, I missed my year anniversary of rupture and then surgery, but I suppose I still ought to post. A year ago, roughly two weeks past surgery, was not a pleasant time. Frankly, I can’t believe that much time has passed. I guess the message there is that it DOES pass, and you WILL get through it, no matter how bad it seems early on. I’d like to say that I am Olympic high jumping now or even back to playing basketball (how I ruptured) but that wouldn’t be the truth. The truth is that while I am pretty sure I would survive basketball, I am still paranoid about re-rupture or doing the other side. It is my own mental problem, and there are no real indications that this is a risk. I have no pain, ever, and really never even think about the achilles unless it is in the context of not doing sports. I will get there, but I suppose it will just be on my own time. I guess if forced to say why, beyond irrational fear, I would say because my calf muscle still doesn’t feel big or powerful compared to the non-rupture side, even though I can do the one legged raises, etc…. Does anyone else feel that way? In any case, I am rambling now and the real point here is that you will heal and year will pass. Best of luck to all and thanks again to all of you for your support last year. This site truly was a huge source of information and comfort.

Wow, 14 weeks

Can’t believe it has been 14 weeks today since surgery. Those were not the best of times. You never think the time will pass, but it does. These days, it is all about building strength in the calf. I walk normally now, but I need more push off to get back to athletics. So it is heel raises and more heel raises, the two footed variety on the way up, majority of pressure on the bad one on the way down. I don’t even want to try one leg yet…need to see some more muscle back there first. I did PT 2x a week for a few weeks back at week 8 and now I go once a week or every 2 weeks, depending. I still have a hard spot towards the top of the scar, so I am hoping the PT massage will help break that up. Other than that, I think I am fine on my own to do the exercises…just have to make myself do them more consistently. I try to go for walks on nice days and focus on pushing off - maybe 2 miles over varied terrain. I got a heck of a calf workout last weekend wading a freestone river flyfishing but I can’t get away to do that as often as I would like. I am horribly out of shape cardio-wise - found that out doing yardwork last weekend. Anyone have any tips for gaining strength faster or guidelines for when to return to sports? ach0423101

Stats

Saw a PT today and got some stats. Affected calf is 3cm smaller than the other and my dorsiflexion is 10 degrees less than good side. She seemed to think I was way ahead of schedule, but was unwilling to push things much with doc ordering boot for 11 more days (even though I told her I have been walking without it for 6 weeks). She gave me some basic exercises that don’t really push me at all, but psychologically, it feels good to be doing something to help my own cause. And getting what amounted to a foot massage wasn’t all bad.

Better than a sharp stick in the eye

So I finally saw my doctor again today after a long, long month. I was frankly somewhat angry after last appointment, given that the doc just removed a heel wedge from the boot and said “see you in a month,” when I was expecting to be given exercises and PT and kudos for walking around without the boot since 2 weeks after surgery. At that appointment, the doc implied that at this appointment, he would probably just remove another wedge and send me on my way for another month. Thankfully, that isn’t all he did today.

After a cursory look and feel of the tendor/scar, he again said that everything looked great. I was a bit worried on the scar side, since I haven’t been able to “work it with vitamin E” as was recommended due to my lingering rash issues (see earlier posts).For whatever reason, STILL, wherever I rub on my body brings a rash out, though things certainly seem to be getting better overall where that is concerned.

After his brief exam, he told me that I should remain in the boot for 2 more weeks and then get rid of it. It turns out that my considerable bulk (6′5″ 270lbs) has already compressed the remaining wedge into the neutral position, so that removing those wedges would put me at a negative angle. I then began my interrogation on what I could and could not do going forward, this time not telling him that I never wear the boot at home or that I played golf on Saturday. The main thing that he FORBIDS is the pulling up of my foot towards my head…(whateverflexion that is, the one that stretches the tendon). And he finally explained why - that he doesn’t want me to “heal long.” He went on to say that he had never ever had anyone “heal short” and that it just wasn’t time to push on the stretching side of things. OK, fine…at least I got a reason this time…hope I haven’t been doing too much of that stretching by walking outside the boot. What he said I could do suprised me. He said I could start doing 2 leg calf raises, which from this site I had come to view as the mother of all exercises. I guess I will find out. He also recommended the stationary bike as a better alternative to the walks I have been taking - since I can’t go in the pool due to rash issues. I also badgered him enough that he gave me a prescription for PT (last appt he said I might never need to go and that PT isn’t a mandatory part of the recovery process)! So I will see someone Thursday for an eval and go from there. What I really want to establish is a rehab routine that I can do at home. Hoping I get that from PT after a few visits.

In the end, I am just happy that my worst fears didn’t come true (e.g. - six more weeks in the boot and no exercises) today. I don’t see the doc again for six more weeks now, so by that time, I hope to hop on one leg into his office. Not that I won’t be careful…I may go fishing this weekend in waders (no boot) on slippery rocks…that would be a good test, but I will be very careful. Lord knows I don’t want to go through this again.

Stuck

Though I haven’t been cleared for nor advised to, I met with a PT gal today to discuss potential options for accelerating my recovery. She said my achilles looks great and that my range of motion is excellent…but she was unwilling to move forward without orders from my ortho at this stage. So…I am essentially stuck for now. Either I sit back and wait for my next ortho appointment March 15, at which time he may do nothing more than remove the 2nd heel insert and send me on my way, or I proceed alone. While this stage isn’t as bad as week 1, it truly does suck.

Oh yeah, the PT did also say to work the scar with vitamin E or aloe…not just for cosmetic purposes but to help with skin flexibility that I will need once I resume more normal activities.

Not nearly as aggressive as I had hoped

Rash still there...wound looking good.

Rash still there...wound looking good.

So I just saw the ortho who did my surgery exactly a month ago, Jan 15. I was excited, thinking that I would be on to something new and different; maybe some additional stretching/strengthening exercises, permission to go 2 shoes full time, etc… Turns out I was getting ahead of myself in a big way.

The doc came in, looked at the wound, and said everything looked great. He said I should start to massage the scar (not the achilles) to help make it stronger and more pliable. OK, no worries, I can do that. I just won’t mess with the achilles based on the experience of Gerry on this site.

The doc next did a brief test of my strength by holding my foot and asking me to push down. He was pleased with that test and then asked me to tense my calf by pushing on his hand while feeling my calf. He seemed satisfied with that, saying the muscle was “firing” well. He insisted that I continue to push down against my boot to continue minimizing calf atrophy. Fine, no problem.

Then came the depressing part. I admitted to him that I have been walking around without the boot for 2 weeks. He was not pleased. He said I was not to do that at all, citing the risk of re-rupture. I told him it wasn’t like I have been rolling over the ankle and pushing off hard, but that made no difference. In his mind, the risk of walking barefoot or in two shoes, both of which I can do no problem, is not one I am allowed to take at this point. I told him that I had heard (reading on this site) that the tendon is basically indestructible at 6 weeks - so could I resume walking without the boot then (in 2 weeks)? No way, he said…and countered that the tendon was perhaps at its most vulnerable around 6 weeks. Odd.

So what CAN I do? Well, for starters, he removed one of the heel inserts from my boot, so I am down to two (I can barely tell the difference except that my gait is less lopsided - walking barefoot is much flatter than 2 inserts). He said I could bike or swim, but only for general fitness, not for achilles strengthening (keep foot at a down angle on bike). Whoop de doo! I mean, I am glad I can do those things, but without moving the ball forward on the injury, I am not terribly excited.

Then came the crushing blow…I don’t see him again for a month! I asked what would happen then. He said he would take out another heel insert and I would be that way for another 2 weeks. Then, if all went well, no insert and start on shoes. So his program, while it began with FWB at 10 days post-op, it doesn’t officially move to “2 shoes” until at least week 10. I know I can’t complain too much as some folks are in casts until then NWB, but I had really hoped for so much more. If I were my father, I would completely ignore what the doc had to say and plot my own course. But…I will do my best to follow his instructions, although I can’t see completely throwing away the convenience of walking around the house barefoot.

At the end of the day, I am pretty bummed about this visit…and I am still dealing with this stupid rash, which just won’t go away…see pic above. On the positive side, he said I could sleep without the boot if I wanted…so I will end on that note.

Rash decision

Note rash

Note rash

So…the rash on my leg stayed annoying enough over the weekend that I went to see my ortho on Monday. He promptly referred me to a dermatologist, who I saw today. At the ortho, they removed the steri-strips leaving the incision naked for the first time. It looks nasty to me, but they seemed to think it looked great…except for the rash. Since my last visit to the ortho a week before (at 10 days post-op), I have gotten to the FWB stage in the boot. Since I was so surprised to have been allowed to FWB so soon, I asked at the rash appointment if I should try to walk without the boot. The answer was a resounding NO…so maybe this guy isn’t so crazy after all. Nor would he give me any additional exercises to do even though my point and flex range of motion is already beyond what he wants me to practice.

Anyhow…dermotologist today…she thinks it is a reaction to the post-surgery splint, probably brought on and/or exacerbated by my (rash) decision to shave my own leg (up to the calf) before surgery. What an idiot I am. I thought I was saving them time and making life easier for all involved when I did that…had I only known. So, the lesson is…don’t shave your own leg before surgery!!! I am supposed to take Zyrtec (next gen Benadryl), rub on steroid cream and take antibiotics to get rid of this thing. It itches like nothing I have ever experienced. Hope this helps someone avoid the same.

Aggressive!

So…went to the doc for the first time today, 10 days post-op. I have to say that after 10 days spent essentially on my backside indoors, getting outside and driving to the doctor’s office was a treat in and of itself. Fresh air does wonders for the spirits…wish I had crutched outside earlier than now.

Getting into the Dr’s office was a challenge, as I have only used my crutches around the house, niether visitng the basement, nor upstairs this whole time. Once in, the nurse cut off my splint, exposing the wound for the first time. Frankly, it looks NASTY (doc did a jagged cut on purpose instead of straight). Before the doc came in, I was able to indulge my urge to itch my leg everywhere down there, and it was heavenly.

The doc came in, looked at the wound and was very (in a smug way) pleased. He said he usually doesn’t take out stiches quite this early, but the wound looked so good (totally closed, no drainage, etc…) that he went ahead and yanked them out, replacing them with steri-strips. I was fearful that this would hurt, but it really didn’t - just a teenie bit of pinching sensation. I was more worried about my exposed foot getting hit somehow.

Once the stitches were out, it was time to discuss what to do going forward. He told me I could move my foot down as far as I could, and bring it slightly up - a kind of stretching exercise. No resistance. I was also told to press the top of my foot against my boot to tense the calf muscle - in an attempt to keep it from atrophying more. I said boot…he put my foot back into the boot that I had between rupture and surgery! And then he said something I didn’t expect. He said he didn’t care if I walked out of the office carrying my crutches! Now, of course, I didn’t…but the point was that he wanted me to be full weight bearing as tolerated. I couldn’t believe what I was hearing. I think that flustered me enough that I didn’t really ask all of the questions that I wanted to.

So to summarize, I have to wear the boot at almost all times (even during sleep), but can take it off to shower (no submerging for another week, not that I have taken a bath in 30 years anyhow) and work the foot a bit. And I can be FWB whenever I can take it (certainly not yet, but it is at least nice to know it won’t blow up if I use it to balance myself). The only thing I didn’t quite like is that I don’t see him for another 3 weeks now. So I guess it is on me now to make progress. Interested in everyone’s thoughts….

One week ago

I was under the knife at this hour. It has been a long, boring week in bed with my foot in the air. Here’s to hoping the weekend passes quickly, and that the doc has something interesting to say and something different for me to do come Monday.

First Post

So I think this means I have my own “space” here now? I definitely want to track my progress (none so far) and offer any support I can to new rupturees. I found this site extremely helpful to me in the 8 days between my injury and surgery.

My story is like most. I was once a fairly accomplished athlete. Some 15 years ago, in fact, I was an international level rugby player (not as impressive as it sounds since I am in the US, but you get the idea). After my active playing career was over, I certainly let myself go a bit and got to some 35-40lbs above playing weight. Sadly, I recently had lost some 20lbs or so and was getting back in decent shape. I was even considering an “old boys” return to the pitch. Then, a week ago this past Thursday, I was playing a mellow game of pickup basketball, in fact the second of the session, and felt the dreaded whack to the back of the leg. Like most, I looked around for someone to blame, and while there were people nearby, to a man everyone said that I hadn’t been touched. Nor was I doing anything particularly athletic or sudden. I think I was just moving to stay in defense of my man. I don’t recall hearing a popping sound, but I knew exactly what had happened anyhow, having had a guy I used to play basketball with experience the same injury. It definitely hurt at the time, but the pain subsided pretty quickly and I was able to drive home since the left leg was hurt, despite some light-headedness.

When I got home I got online and started reading as much as I could on this site and others. I read studies and stories for hours. I held out hope that because I wasn’t in that much pain and I could kind of shuffle around with full weight on the bad foot, I might be able to avoid surgery. In fact, from the body of literature I read, it seemed very promising that I might be able to avoid surgery and still fully recover.

I saw a general ortho guy the next day (1/8) and his Thompson test confirmed a rupture. I was not, however, impressed in any way by the general ortho’s knowledge, nor did it seem like he had a plan or methodology for dealing with the injury. I asked for an MRI, so that I could see “how bad” the rupture was, having convinced myself that if it was a partial tear, or if the gap was less than 1cm, I would go non-surgical.

At the MRI place, I spoke with a technician re: my reservations about the general ortho guy I saw and she recommended a foot and ankle specialist. It sounded good to me, so I booked an appointment for first thing Monday morning and took my MRI CD with me. As if I needed a reminder that I am getting old, I turned 38 over the weekend. Great birthday present this was.

On Monday, the specialist also Thompson confirmed my rupture and I got to see the MRI pics for the first time. Unfortunately, the specialist didn’t take much time to go over the picture or give me the “degree” of injury stats I was looking for, but it was clear even to the untrained eye that there was a substantial gap. No surprise, the specialist recommended surgery and I agreed, scheduling it for this past Friday 1/15, 8 days after the injury. Further confirming that I had made the right choice, the general ortho called with the official MRI reading on Tuesday and the gap was 2-5cm in various places.

I HATE hospitals and all things medical and so the idea of surgery freaked me out. I knew I had to do it, but I needed to know about every variable to get myself to the point where I could go through with it. Again, this site was an invaluable resource. From people who have gone through the surgery (some multiple times, unfortunately) to an actual anesthesiologist, I really got excellent information here. I wanted to be completely out for the surgery, but had heard that one would have to have a tube stuck down one’s throat with general anesthesia, given that one would be on one’s stomach for the procedure. The alternative is a potpourri of local options, most of which involve needles near spines…not for me either. In my head, I came to a point where general was the way to go, if I had the assurance that I would never, ever know or sense that there was a tube in my throat.

The 4 days between surgery scheduling and the acutal surgery went somewhat slowly but in reality all too fast. Part of me wished I had done the surgery on Tuesday that week, but that was too soon to arrange child care, etc… (I have 3 kids ages 5, 3 and 1). I also had a hard time reconciling the fact that I would have to get worse again before I got better. I was icing and elevating, but I could still shuffle around bearing weight on the foot, so things weren’t that bad.

D-day came, and off to the hospital I went. The whole experience was surreal for me, fighting my every instinct to get the hell out of there. I put the anesthesiologist through the ringer of questions when he came it…hope I didn’t piss him off to the point where he clubbed me while I was out. He didn’t really give me an option, having sort of pre-decided on general. That was fine with me since it was the way I had to go. He assured me I wouldn’t know the tube was ever there, though he did acknowledge that in strange 1 in 1000 type cases, people remembered odd things. He also said that I would be on my side during surgery, and not my back. That was the first I’d heard of that. I wish it had registered in my brain that the side would put me on is the side I can’t even sleep on due to a lingering injury, but it didn’t until I was back home and my shoulder was killing me. It was then time to go…they slipped me some happy juice to “calm” me while they were wheeling me into the operating room. I don’t recall being very happy or calm. Next, they were going to put me out with something strong and then do their intubation anesthesia stuff. Well, I remember being in the operating room chatting with the staff and even moving from one bed to another (maybe on to the table) and then all goes blank. I had hoped they would tell me before IV whacking me, but they didn’t…just as well. I woke up in some recovery staging area under the care of a nurse, who eventually gave me some ice chips and crackers. I say staging area because my wife wasn’t allowed where I initially woke up, and I still don’t know why. I also heard that when I first woke up, I was quite “agitated” but I have no recolleciton of this, nor did anyone ever tell me what form that agitation took. I was eventually reunited with my wife and got to go home. I arrived at the hospital at 11:45am and hopped back into my house at 6pm.

I was sent home with Oxycodone (5mg) and told to take 1-3 pills every 4 hours as needed. It simply wasn’t enough that first night. I didn’t get a minute of sleep as I couldn’t get the leg into a comfortable position. I wish I had known that night that I could supplement the narcotics with Advil…that really helped the second night after I had called the doc the morning after my bad first night.

But here I am on full day 3 after surgery, and I am totally off all painkillers. I actually took my last Oxy at 10am on Sunday and I think I felt terrible because of it later that day(coming down?) - not the leg, just me. I took my last Advil at 2am this morning and it is now 2pm.

Post surgery life sucks in every way except for the fact that the surgery is behind me. I pee in a bucket from bed, and getting to a restroom for #2 is a giant pain in the ass, literally requiring acrobatics to keep from putting pressure on the bad foot (in a splint). I have been out of my bed fewer than 5 times since getting home on Friday…it just hurts to take the leg from an elevated position to down…a lot. I am hoping this will get better with time…will let you know the next time I post. My wife and kids have been great throughout this young ordeal. I am depressed for sure about my lack of mobility but having them around really helps. I can’t imagine going through this without them. And I can’t imagine going through this without the help of all on this site. Thanks again.