Apr 24 2008

7 week Post Op (#4 )

Published by ross under Post Op visit

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

23 responses so far

Apr 12 2008

Finally a picture

Published by ross under Picture

ross-ankle-4-5-08.jpg 

Here is a 4 week post op picture..

15 responses so far

Apr 10 2008

Post Op Visit #3

Published by ross under Post Op visit

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

6 responses so far

Apr 03 2008

4 Weeks Post Op

Published by ross under To The Future....

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

8 responses so far

Apr 01 2008

Operative Report

Published by ross under Operative Report

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.

Surgeon Signature

No responses yet

Mar 27 2008

3 Weeks post op visit

Published by ross under Post Op visit

Off and running….sort of.

Had my 2nd post op visit yesterday.  Took the cast off and received the ‘boot’.  Was amazed at the length of the scar, probably 10 inches long. Will try and get a picture up sometime this weekend.  Was informed that with my rupture the muscle shortened, contracted quite a bit (probably from my intense exercising and huge muscularity..yeah right..LOL) and that it was best to lengthen the gastroc by cutting the aponeurosis surrounding the muscle.  This would help with rehab and future return to sports.  Due to the amount of repair there was still a lot of swelling around the ankle and foot.  I even took off my other shoe and sock so I could compare.  At the office they did some ultrasound and a whirlpool.  The whirlpool primarily to wash off a lot of dead skin.  There was a tightening of the sole of my foot which is the plantar fascia and was told this normal due to the lack of movement.  No pain at all just stiffness.

As for rehab…need to be in the boot and NWB for 2 more weeks.  I can take it off in order to do passive modalities, i.e. ultrasound, laser, massage, ice, e-stim.  I can take showers, get it wet but no weight bearing.  Due to the swelling I need to hold off on swimming, and hot tubs for another week.  There is no chance of infection at this point as the suture is healing well and without openings.  In two weeks I have my followup appointment and barring any complications I can get started with rehab.  As a chiropractor I am fully stocked and even bought some new equipment once I get the go ahead.

Prognosis regarding activity..I should be stable enough for my Grand Canyon week long hike, rafting trip.  That was exciting news.  I and two buddies are leaving mid May for a hike of 9 miles to the river, raft 5 days and helicopter out and then off to Vegas.  So you could imagine my happiness knowing that although weak I should be able to do it.  He informed that PWB/FWB should begin in 2 weeks.  I am shooting to start then in the pool with walking, treading and swimming.

The office has still been a challenge.  If any of you have seen a chiropractor you know that we need our legs to adjust, balance and obviously move about the office.  Our office is busy and I have not been able to adjust and therefore needed to hire another doc for the office.  So for two more weeks I will conitnue to need help.

So that’s my latest.  I am grateful for this site and welcome your comments and questions. Today we’re one day closer to the end.

Doc Ross

9 responses so far

Mar 13 2008

More research

Published by ross under Rehab research, Surgery Protocols

overview of a lot of articles

http://www.jfas.org/search/quick

5 responses so far

Mar 13 2008

More research

Published by ross under Rehab research

Bored like me…..well start working out during the casting phase…..on the opposite leg….so get moving…crossover effect of muscles..

http://jap.physiology.org/cgi/content/abstract/96/5/1861

No responses yet

Mar 13 2008

One Week Post Op

Published by ross under 7 Days Post Op

Well one week post op….Have my follow  up in one week and based on research, my experiences, and my surgeon we are going to follow the weight bearing protocol.  So my hope is that the incision has healed to the point that I can get started.

Surgery was on Thursday the 6th and went back to work on the 10th.  Hired another chiropractor to help me with patients as I hopped on one foot adjusting patients.  Very fortunate to have the roll-about.  Took off the 11th and back to work on the 12th.  Full day of me rolling along, seeing patients, resting with leg up on desk, napping at lunch, doing paperwork and finally coming to the realization that “Just Do It” turned into “Can’t Do It”…so off for Thursday and Friday.   So frustrating but have to practice what I preach..Give your body time to heal so you can get better faster.   So back to the couch.

The next few days I will be trying to set some goals and actually accomplish something.

Things to do:

Golf season….Are there any exercises/drills to do to improve my game?

Working Out…. exercising means sweating which means more baths…is it worth it as taking a bath is a hell of a work out??

Hobby….Find something new to do….researching ATR, sudoku, TV, computer, reading…Is there something else out there?

Office…Obviously need to find an associate to work with me….hiring, training, protocols….

Blogging….amazing how this helps, never would have thought but the (mostly) guys have been great and I wish would could have an ATR seminar…somewhere exotic

Well kids are up and ready to go to school.  So need to throw some loving their way as they go tackle the world that I can’t.

13 responses so far

Mar 11 2008

Surgical Options

Published by ross under Surgery Protocols

Here is a great article on surgical procedures..albeit 10 years old but this is what a lot of MDs subscribe to

http://footandankle.mdmercy.com/research_pubs/pressItem59.html

Will post more but need to do the bathroom thing…bath, etc…so I’ll be back in about 2 hours….LOL….this sucks..

Ross

3 responses so far

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