Second post-op visit (20 days since surgery)

March 30, 2017

I’ve officially hit the boot stage of this process. I went in for a checkup and to get the rest of my stitches removed, and my doctor decided I displayed a cautious enough nature to graduate from his horrible, 3-ton plaster casts to a Breg Genesis Walker boot that I can take off occasionally for gentle ROM exercises and showers. (more on boot selection in a moment)

Everything appears to be progressing nicely. I can actually move my foot up and down a bit, so that’s a big change from the immediate post-injury phase when it was just flopping around. The incision site is less swollen and less squeezed and wrinkled up. The only issue was the assistant struggling to cut the remaining stitches out. On the first visit the PA got 6 out in about a minute at most. Today it felt like 10 minutes of picking and pulling and snipping. I guess the doc sewed them up pretty tight.

I’ll go back in 2 weeks, at which point I’ll be at the 5-week post-op point and will most likely move to PWB. After that, PT starts somewhere in the 6-8 week range. That seems to match up with the average times I see around here, or might be on the conservative side a tad, and that suits me just fine.

I’m so happy to be out of the cast. The 9 days since my last visit weren’t bad in terms of pain…it was more mentally challenging due to general cast discomfort. The last one was super heavy and didn’t quite conform to the shape of my ankle and foot like the previous one. By the end of each day it was so uncomfortable that I was seriously considering cutting the damn thing off and showing up at my appointment with nothing. The boot feels like it’s made of feathers in comparison. Now I can loosen the boot straps, adjust the air pressure, or even take the entire boot off if I want. It’s a big, if only temporary, morale boost.

I held off on the Vacoped purchase to see what the doctor came up with. My insurance company gave me mixed information about reimbursement for a purchase I made on my own, while having no issues with approving something a doctor ordered and put on a claim. I have to say I don’t mind the Breg too much. I know it’s early, but it has an air bladder system that’s not bad and the three wedges make it fairly easy on my ankle and tendon. The cost will be fully covered so I’ll give it a go and reevaluate the Vacoped option if necessary.

Now to fill the 2 weeks until my next appointment. I have a list of 3 recommended PT providers so I’m going to try to call or visit them to see how they’d approach rehab. More immediately, I’m going to beg someone to take me out to get a haircut as I’m 4 weeks overdue and going crazy. That was on my schedule the day of the injury but I wound up in the ER instead. The mop must be tamed! My son also has a friend’s birthday party to attend on Saturday so I’m hoping I can impress a bunch of kids with my futuristic bionic leg. :)

First post-op visit (11 days since surgery)

March 21, 2017

I was excited to get to this day. Last week went fast, but the weekend dragged along as I waited for my office visit. Nothing dramatic to report, thankfully. The doctor and his PA took off my cast and checked everything out.

The surgical site looked good but the doc played it safe by having half the stitches taken out (every other stitch). I’ll get the rest taken out next week. I’d have preferred getting them all out but what can you do? Better safe than sorry, I guess. There was some discomfort as they tugged out the stitches. Nothing too terrible.

There was more bruising than when I saw my leg before surgery (I had very little bruising at all from the injury). My ankle was swollen but not terribly so. The entire area felt stiff and I was scared to move. Petrified, really, like my calf, ankle, and foot were made of very thin glass. Still, it felt good to see that everything is okay and that I can already move more than before the surgery. I’ve had some random burning/tingling sensations around my heel and I was worried that was a sign of infection. As it turns out, it was most likely just discomfort from the cast moving around a bit.

I’m back in a lighter cast and we’ll see how things look next week. I was slightly disappointed about the lack of a concrete plan. The doctor said he’d like to put me in a boot when I can tolerate my foot being in a neutral position, which sounds a little different than what I’ve read here. He pushed gently on my foot and it was uncomfortable but not painful. Still, I’m not quite ready to think about moving anything anywhere just yet.

I’m going to bring up the VacoCast at my next visit. It sure looks good to me, and maybe that can prompt more of a discussion about how things will go after the initial recovery from surgery. I’m learning quickly that I’ll really have to push for info and be ready to help steer this recovery if I want to feel 100% comfortable with the plan.

Here’s a link to a pic of my stitches before half were removed. I also have a photo from surgery if anyone wants to see it (I didn’t add it in automatically in case it’s too gross). Surprisingly, seeing the stitches was more of a shock than seeing the actual ruptured tendon. Something about how the skin gets squeezed together weirded me out!

Six days post-op - random thoughts.

March 16, 2017

Happy to report a small bit of progress - the pain from surgery seems to have tapered off and I’ve reduced the pain meds to almost nothing. I still get some odd sensations in my calf and ankle but nothing like the first three days. I’m glad to be off the stronger stuff (oxycodone/hydrocodone) because I feel sick when I’m on those.

I’m able to get through a half-day with my son without any assistance. My parents come over for a morning or afternoon spell to give me some time to rest. I’d like to work up to a full day at some point. Now that the pain is subsiding that feels possible.

The iWalk has been great…but I’m already sooooo tired of using crutches or the iWalk to get around. I stay in bed until the last possible moment each morning because the thought of getting the day started is so frustrating. I guess I’ll get used to that at some point. Another iWalk note: this thing is so creaky and squeaky after a week of use! That would be my only complaint to date.

My first follow-up appointment is set for 3/21. Not too far to go. It’ll be fun to see what the incision and stitches look like, and to feel like I’m slowly checking off some milestones.

My neighbor is a nurse at a nearby military hospital. She said they have 26 people in boots or casts like mine at the moment. ‘Tis the season for lower leg injuries, I guess. She’d never seen the iWalk before so maybe it can help a few of those folks out, too.

Three days post-op.

March 13, 2017

It’s been three days since surgery and I’m slowly working my way through a bunch of old TV shows on Hulu. Also playing Basketball Stars and Hill Climb Racing on my phone.

My leg feels decent overall but it starts throbbing if I’m on my crutches for more than a few minutes. It’s worse in the evenings, when no matter how I’m situated my ankle and Achilles area hurt more than any other time of day. Something about that 8 to 10 p.m. timeframe makes it the worst. Fortunately I’ve been sleeping through the night without much trouble.

I might strap the iWalk back on today to at least get it re-adjusted to account for this giant cast. This thing feels about 3x heavier than the pre-operation splints. It appears to be made of the same OrthoGlass strips…they just used a bunch more. Makes sense considering the nature of the surgery and need for immobilization. I wasn’t quite prepared for that extra weight, though. I mean, I read other people’s accounts of the heavy casts but it wasn’t until I felt like my leg was encased in cement that I actually understood.

There sure are some strange feelings around the incision (or where I imagine it to be). I’m not sure what I expected, really. Sometimes there’s a burning sensation, sometimes it aches, and sometimes it feels like there’s something moving around in there - stuff twitching, pulsing up and down the surgical site, etc.

We ordered a week of dinners from a “gourmet on wheels” service in the area so that took away one worry for the next few days. I’m the primary grocery shopper and cook so it’s nice to know we’re good on dinners up until the weekend. We used the same service right after my son was born and it worked out pretty well. My wife is off today but working the rest of the week so the fun is about to begin! Thankful to have my parents nearby for some help with day-to-day stuff.

I’m not sure I have any practical advice for someone entering the same early post-op phase. I guess my one tip would be this: once you find a comfortable position, don’t move, ever! I’ve been trying to eat well and I’ve added one mid-morning protein shake and a 500 mg vitamin C dose to my routine. The doctor has me on one aspirin a day, as well, to reduce the chance of a clot. I’m slowly reducing the oxycodone and hope to be done with that stuff soon (don’t like how it makes me feel).

Surgery Day.

March 11, 2017

I had my surgery yesterday and everything went well. What a long day, though. A long week, really, because Surgery Day had been on my mind since the moments after the injury. This is kind of long and rambling but I figured I’d write it out because I found other bloggers’ accounts very helpful over the last week. Maybe this can be of help to someone else down the road.

The day progressed about like most people have described here. A lot of hurry-up-and-wait, a lot of nerves on my part (never had anything like this done before), and then I woke up in the recovery room wondering what happened.

Initially I was doing okay until they wheeled me from the registration desk waiting area to the same day surgery wing. Going from relative calm to the busy pre-op/post-op section was a shock. I didn’t expect the room to be so open, or to see so many other patients in various stages of the process.

After I changed into my gown, two nurses hooked me up to monitors and prepared to start an IV. Thus began the worst 45 minutes of the day. It took 4 attempts to get the IV going. I was so thirsty and hungry at that point, and so freaked out by needles, that I started to lose it. Fortunately, the first two nurses brought in a third - the “IV Jedi” - and she worked her magic. Everything got easier after that. My wife came in for a while to cheer me up. The nurses started some fluids. A little later the anesthesia team came in to explain their role and how things would go, and then my orthopedic surgeon stopped by to chat. Before I knew it they were taking me to the OR.

I’d tried to pick a couple of positive memories/moments to focus in on during the ride to the OR because I thought that would be the most nerve-wracking time, but to be honest after they goosed me with the initial Relaxation Juice I was pretty calm. Once I was on the operating table it was only a minute or two before lights out, and that whole experience was actually kind of pleasant. The table was comfortable, they piled some nice warm blankets on me, and off to sleep I went.

I woke up almost in mid-conversation with a recovery room nurse. We chatted for a few minutes as she gave me some pain medicine through the IV. I downed three cups of water as fast as she set them down, and after 10 or 15 minutes total she put me in the general recovery area. My wife joined me shortly after that.

I was really surprised at how quickly the anesthesia wore off. I was a little dizzy but I felt fairly coherent (who knows what I was really like, but I thought I got off a few good jokes and didn’t make a fool of myself).

We probably waited in recovery for an hour, all told. I wasn’t quite ready the first time the nurse asked if I felt good enough to leave — I was dizzy when I sat up and decided to enjoy a couple cranberry juices before I tried again. Everything started to improve when I got to the car. I had some crackers and water, the dizziness faded, and I was excited to get home.

The afternoon and evening were pretty smooth. I rested in bed and watched some shows on Hulu. There was definitely pain (and still is this morning), but ibuprofen worked well to get me through dinner time and oxycodone helped me sleep fairly well. I’m going to try to stick with ibuprofen today as I’d prefer to use the lesser-strength stuff during the day when possible. We’ll see how that goes. I won’t lie - when the meds start to wear off my leg hurts a lot. But at least I know I’m officially on the path to getting better now.

Here are a couple of random notes for anyone wondering about the process. These are things I was interested in before the big day so I thought it might be helpful.

General timeline: I registered at 9:30, was taken back for prep around 10, and was wheeled to the OR around noon. Woke up at 1:45 in the initial recovery area and was moved in to a room where my wife could join me around 2. Got home at about 3:30.

Cost estimate from the hospital was $11,000, and it looks like I’ll be on the hook for $3,000 or so with our insurance. Was asked for a “down payment” of $1500 at registration, which I thought was odd timing (felt like a car dealership).

Crutch life.

March 9, 2017

A random conversation with my son this morning. We’d had a short walk outside and I was worn out from hobbling around.

PJ: Okay, I need to take a break now so I’ll have to take off my leg.

(we just call my iWalk crutch “my leg”)

Son: Okay

PJ: So I can take a break? You don’t mind? You can play by yourself for a minute?

Son: Yes!

(I take off the crutch and sit down at the kitchen table)

PJ: Ahh, that’s nice.

Son: I need a snack! Need a snack! NEED A SNACK!!!

It’s going to be a long few months!

Surgery date set.

March 8, 2017

Well, I met with an orthopedic surgeon yesterday and we talked about my options. I do have a complete tear. He confirmed by squeezing the **** out of my calf, which freaked me out. I’m already so protective of that area and so afraid of it hurting that I spontaneously started crying before he even squeezed. It was bizarre. Probably the most uncomfortable I’ve ever felt. Anyway, the Thompson test confirmed that my leg is jacked up and I recovered my wits once I realized it still doesn’t hurt.

The surgeon didn’t pressure me one way or the other when we talked about non-surgical options. He admitted that his field in general doesn’t have a conclusive stance on which way to go, so his policy is to help the patient make an informed decision.

We talked for about 30 minutes. I won’t list out all of the individual points of discussion because a lot has been covered on this blog before. What I realized overnight (I took the day to think it over and confirmed this morning) is that, rational or not, I’ll have the most confidence with a surgical repair. That’s always what I come back to: what will I trust most as I begin rehab and beyond? It’s a personal, gut feeling and that’s about all there is to it. I certainly enjoyed reading through all of the studies and materials presented here…but now I have to trust the process and concentrate on moving forward (ha).

So the surgery will most likely be Friday. There’s a small chance of a scheduling conflict that could push it to Monday but I’ll keep my fingers crossed that I won’t have to wait over the weekend.

Oh, and I got a freshly made splint that’s more comfortable than the ER splint, so that’s nice.

The doctor was fine with me using an iWalk, which is good because I got it on Monday and have been practicing around the house. That thing is great - I can make dinner, hobble after my son, and otherwise feel 50% useful. I borrowed a shower chair from a friend who had knee surgery a while back. Also got a nice cast wrap from CVS that makes shower prep a lot easier.

Now it’s time to get back to Toddler Life. Glad to have my son around to provide some distractions. He’s already starting to use his toy tools to fix my leg so maybe that’s all I need!

Questions for first visit with orthopedic specialist.

March 6, 2017

I have an appointment tomorrow with a specialist and I’m making a list of questions to ask. I figured I’d post it here, too, in case anyone has any advice or additions. I’m sure I’ve only thought of 10% of it.

To give an idea of my mindset going in, my #1 goal overall is to be able to be active with my son as he grows up (he’s 2.5 now). It’s not important for me to resume league tennis or distance running at pre-injury levels, but I’d like to get as much strength back as possible. I envision swimming and biking as my primary modes of exercise when the time comes.

In terms of intermediate goals, I’ll wait for whatever treatment plan we come up with before fantasizing about milestones. I’d like to know when I can drive again but I don’t think there’s any point in worrying about that at this point.

  • what is the actual extent of damage (complete, partial, etc.)? I haven’t seen the MRI and only know that the tear is “nearly complete.” Side note: I’m sure that MRI cost me a pretty penny so I better get to see the damn thing :)
  • what is the recommended treatment?
  • what are the doctor’s thoughts on non-surgical outcomes and recent research? Is there a move toward nonsurgical treatment due to equal outcomes with either path?
  • how many cases like this has the doctor treated? what are the most common outcomes for my age and injury?
  • if surgery is recommended, what types of anesthesia are used (local block vs. general)? Is the surgery fully opening up the leg or are there less-invasive methods?
  • is there any way to ensure anesthesiologist is in-network? (kind of random, but I’ve been burned on this)
  • overall risk factors for surgical or nonsurgical paths
  • an explanation of DVT concerns with immobilization
  • safety of iWalk hands-free crutch use
  • is there any advice/strategy for ensuring health of the good leg?
  • could the currently functional Achilles be in jeopardy due to extra weight, awkward movements, etc.?

That’s all I have for now. I’ll add anything else I come up with, and please feel free to give suggestions in the comments!

Well, here we go.

March 4, 2017

I guess it’s both a bad and good thing that I found this site - bad that I needed to, but good that there’s such a great resource available. I’m 41, fairly fit, and have a “nearly complete” tear after hearing and feeling the dreaded, gnarly pop in my right Achilles while playing tennis yesterday. Seems like the classic move people describe - I had backpedaled to the baseline and made a sudden burst forward to get a short ball. Bam. It was like I was hit with a bat, or shot, or something. I was confused for about a second and then I knew exactly what happened. Unbelievable.

Decided to visit the ER because I was nervous about self-treating over the weekend, and they got me in for an MRI to confirm the damage. Then I came home with my leg splinted, some crutches, and some pain meds. I’ll meet with an orthopedic specialist as soon as possible this coming week.

I’m going through all of the different moods at the moment, but what I keep coming back to is being mad that I didn’t pay more attention to the signs of issues with my right ankle. I’ve had stiffness there for a long time. I wrote it off as something that just happens, and that goes away after I warm up. It might be hindsight talking, but I knew something was off and I ignored it.

I’m a stay-at-home dad and I can’t quite imagine how I’m going to get my 2.5 year old son through his day. Fortunately, I have my parents nearby and they’ll be able to help. I hate being a burden on them and my wife, but here we are.

I think I’ll feel better once there’s a plan in place. Right now I’m just hoping to get an appointment with a specialist soon. In the meantime, I’m practicing with my crutches and eyeing one of those iWalk hands-free crutches. I’m already quite tired of not being able to use my hands around the kitchen, etc.

It’s definitely cool to have this blog platform for sharing progress and results. I’m looking forward to writing, reading, and learning more about the community.

Always forward!