And I was winning…….

Time for…(drum roll)…..Two shoes…..yes I wrote two shoes.  Had my post op visit yesterday 7 weeks from day of surgery.  Went in had the whirlpool for 10 minutes, ultrasound for 3 minutes then saw the surgeon.  Checked movement, range of motion, swelling and integrity of tendon.  ROM was full in dorsiflexion and plantarflexion with some mild restriction in inversion (probably from swelling around ankle).  Was given two braces for support. One was basically a compression sleeve for swelling that looks like a stocking and goes about mid calf.  The other is for the office, and my trip to the Grand Canyon.  It gives a lot more support around the ankle and tendon.  This is for prevention in case of any slips, falls or stupidity (most likely).  Will get a picture up for you to see.

Exercises are to increase in frequency and intensity.  NO weights at all for two weeks.  Full range of motion exercises with tubing in both eccentric and concentric contractions.  Start on proprioception (balance exercises) which is on the wobble board, etc.  Biking, swimming, walking to be done as much as possible, daily hopefully.  Based on the fact that he lengthened the gastroc in addition to the tendon repair I should expect muscular soreness and tenderness over the muscle.  Sounds like more massages for me :)  When asked about golf he said to chip and putt for 2 weeks, then gradually increase to full shots over the next two and then use a cart for the first few rounds.  Yahoo!!! golf in a month.

Out go the crutches and the boot.  Put away in the dark depths of the basement.  Or maybe we could have a ATR reunion barnfire. I’ll bring the matches, Brendan the beer and Dennis his digital camera.  Bad for the enviornment but just another reason to have a party.  We all need it.

So as you can see I am pretty excited, I know, go slow, and I am but you all know that this day made me smile.  We are all waiting for this visit, the range of emotions from day one has been hard for all of us.  I look forward to all of you having a similar experience soon.

I am ……one day closer to the end

Doc Ross

Here is a 4 week post op picture..

Off and walking…

4/9/08…..At this visit I was met with smiles as I had arranged for a delivery of an “Edible Arrangement” to the surgeon’s office…amazing what some fruit will do….Just my way of saying thank you…..then off to the whirlpool for 5 minutes, ultrasound for 2 and then examined.  Scar looks great, mobility 90% but some swelling around the ankle and tendon.  Was told to start FWB (with the boot on) but for long walks to use the crutch for support.  Due to the amount of swelling I was given a pull up ankle brace with gel cushions in it, which are located on both sides of the tendon.  Advised to keep this on throughout the day and take it off when sleeping.  It made a huge difference as when I took it off last night there was very little swelling around the ankle and I could actually see the tendon.  It almost looked normal…how encouraging.  At this point I am to start light rehab with tubing, start swimming, and to continue with physical modalities and ROM exercises.  No weights, no calf raises or any type of hard muscle contractions.  Will need to wait 2 more weeks before I am out of the boot and able to put on 2 shoes.  I am excited!!!  Next appt 4/23/08

As for work I can start 1/2 days by myself but full days will be tedious.  So hopefully just one more week of having to hire another chiropractor to help me.  Hiking down the Grand Canyon looks more doable as I have 5 1/2 weeks to be walking like a human being. 

My routine is as follows:

• Massage 2-3 X week…highly recommended
• Ultrasound 2 X week        
• Cold Laser 2 X week        
• E-Stim 1 X week
• ROM daily 
• Hot tub 2X week  
• Swimming  see how it goes
• Crutches as needed

 Thanks to everyone that contributes to this blog as it is great to see what everyone is doing, your stories encourage us all to get better, motivate us to move forward, challenge us physically so we get healthy quicker and can return to the activities we love.  So keep posting.

Brendan….tried to get a picture up but when resizing the picture it would not save it in the new form…any ideas??

Received the video of my surgery….amazing what you can do to your body and how they repair it.  Not sure how to post a video but I would welcome instructions on how if interested in seeing it.

I am………………one day closer to the end!!

Doc Ross

Seeing progress, following everyones recovery is very informative and enlightening.  I am now in the boot and able to take it off on a regular basis.  The swelling comes and goes depending on my work and activity.  Luckily it dissipates with elevation, ice and therapy.  No pain except when I put some weight on it while in the boot.  Mostly a strange twinge in my heel….anyone else feel that??  It has felt wonderful to take off the boot, shower, scrub and clean up.  The scar appears to be a lot longer than the pictures on this site and although computer illiterate will try and get a picture up. 

Passive PT has commenced.  Very happy about this.  Range of motion-spelling the alphabet- one thing that is beneficial is to do it with both ankles simultaneously so you can actually see where you are restriceted and stiff.  Also massage, having it done 3 times per week, 3 times on the AT and full body once.  A definite must for all, increase circulation, relaxation, improved mobility and just plain ‘ol feels good. A welcome reprieve from a month of frustration.  Have started hot tubing.  Although I had increased swelling after, that was controlled with application of ice for 10 minutes.

So as of right now I feel pretty confident that my trip to the Grand Canyon mid May will go as planned.  Someone had asked about what part of the river and it is the lower canyon..a 5 day rafting trip after a 10 mile hike down to the river.  A definite challege ahead of me but one I am preparing for.  I appreciate all the comments and feedback as it keeps me motivated and excited for all of you as you reach milestones.  

Thank you all

Doc Ross

Date of Surgery: 3-6-8

Title of Operation:  1.Primary Repair, torn left Achilles tendon

                                   2.Vulpius Gastrocnemius recession, left

Anesthesia:   General

Procedure:

The patient was brought into the operating room theater, placed in the supine position upon the guerney, was then successfully intubated and placed onto general anesthesia.  The patient was then turned and placed in the prone position on the operating room table.  A pneumatic thigh tourniquet was placed in the proximal one third of the left thigh under which Webril padding was applied.  Left lower extremity was then prepped and draped with CholraPrep and sterile draping to provide a sterile field. The left lower extremity was the exsanguinated utilizing a sterile ace bandage, a pneumatic thigh tourniquet was insufflated to 300mg of pressure.

Attention was then directed to the posterior aspect of the left lower leg and ankle where a 13 cm linear and then lazy S incision from proximal medial , ending distal lateral, was made.  Dissection was carried down through the superficial fascia, down to deep fascia, and all bleeders were identified and coagulated utilizing electric-Bovie.  Immediately, a significant amount of hemorrhagic debris was identified.  Care was taken to try to maintain the cruciate crural fascia and the paratenon.  Dissection was carried down further, identifying hemorrhagic debris and once the cruciate crural fascia was incised, a significant amount of hematoma identified.  This was removed demonstrating a full, complete rupture of the tendo Achilles as well as the plantaris.  The devitalized tissue at the end of both sections of this tendon were debrided and then a Krackow suture was then placed within the proximal stump of the soleus muscle and gastroc aponeurosis.  This was from lateral to proximal, across and then distal medial.  This was then tethered and then dissection was carried out more proximally and a Vulpius gastroc recession to allow for additional length to be manufactured.  This allowed nice approximation of the tendionus edges.  The Krackow suture technique was then completed through the distal stump and then, once again, sutured upon itself.  Zero Vicryl was then utilized to augment this in a simple and cruciated type fashion medially, laterally, anteriorly and posteriorly.  The wound was then flushed with a copious amount of saline and kanamycin solutions.  The cruciate crural fascia was then reapproximated utilizing 3-0 Vicryl in a simple running fashion, the superficial fascia utilizing 3-0 Vicryl in a horizontal mattress fashion, the skin approximated using 4-0 Monocryl in a subcuticular manner.  A posterior splint was then applied in a slightly plantar flexed position and the patient was then rotated into a supine positon upon a guerney and the pneumatic thigh tourniquet deflated to note a pinkish return to all digits and the foot.   The patient was then taken from the operating room to the recoevery room in apparent satisfactory and awakening condition with vital signs stable and vascular status intact to all digits and left foot.  The patient will be followed up in our office postop.

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