May 04 2009

Please take 5 minutes . . .

Published by schmeck under Uncategorized

This part is not about my (or anyone else’s) achilles.  In the broader blog purpose though, it may end up being about recovery.

My family got some trying news last Monday.  We had Zander (now 5 months old) at the doctor to follow up on something, and Kate had also brought a short list of questions.  One of the questions was about some very faint brown spots, about 7 or 8, that Zander has on different parts of his body.  The Nurse Practitioner took a look at them, asking to see them all, and then she had the Pediatrician come in and do the same.  He said it’s a sign of Neurofibromatosis Type 1.  Probably like most of you, we had never heard of this.  It’s a fairly common (1 in 4,000) genetic disorder which can have a broad range of symptoms.  The spots that Kate noticed (cafe-au-lait marks) are themselves harmless, but it’s a sign that there may (or may not!) be other things to come.  We are now waiting for a referral to a specialist.

In an attempt to raise awareness (May is NF Awareness Month!), my request is to please check one of these links just to make yourself aware of this disorder and its effects.

Children’s Tumor Foundation

Neurofibromatosis

NF Canada

 

Zander in his Car

Zander in his car

 

 

 

 

My achilles update:

One more appointment with the surgeon.  He said the repair looks great, and muttered something like “I should do it like this all the time”.  Did he try something new on me?  Who knows.  He said he was surprised at where I have my ball of scar tissue - it’s at the bottom of my soleus muscle, but my rupture was closer to my heel.  Anyway, it’s been going down in size.  Still no clearance for strengthening - he’s adamant about waiting for the 3 month mark.  So I guess I keep going to physio until they tell me I’m good to go.  I go back to see the doctor at the 6 month mark.

Walking is going well.  No calf strength, obviously.  Some irritation on the incision if I walk for a while, and a little tightness, but overall pretty good.  Can’t wait for the strengthening to start at the physio.

5 responses so far

Apr 27 2009

Physio and 2 Shoes

Published by schmeck under Uncategorized

I’ve basically weaned myself off of the boot at about the 8.5 week post-op mark, a little over a week before my next appointment with the doctor which is when he said I should be able to finish with it.  The boot started to piss me off because the velcro on the uprights was not sticking very well to the liner.  So if I put some weight down near my toe, the velcro would slip.  This effectively changed the limit of the range of motion.  I was also getting tired of putting it on and taking it off to do my stretches and range of motion.  If I had to do it again (please no!) I think I’d try to get a Vacocast.

 

Bump

Bump

 

 

The physio at the hospital has been good.  The ultrasound / massage / stretching has helped reduce the lump, although it’s still quite noticeable.  They said that when I get to the strengthening stage the fibers will doing some realigning which should also help with the lump size, although the doctor said there will likely always be something there.  My fears about the physio at the hospital being inferior were unfounded, I think.  I was surprised at how hard they stretched the tendon since my Dr. said no strengthening yet.  It was nice to know that it strong enough to take that.  The therapist did caution that the force of a stretch is nothing like what the tendon is subjected to during things like running or jumping.

My massages are nothing like this:

Zander Butt Massage

Zander Butt Massage

We went on a shopping trip this weekend (poor Zander wasn’t pleased with all the time stuck in the car seat).  I didn’t end up putting the boot on once and was able to walk all around the outlet center without any trouble.  (I think they should stop calling them “Outlet” centers, because most of the stores seem to be regular stores now selling regular merchandise, not clearance outlets).  I think I’m walking normally except that there’s no strength in my calf so I’m not really pushing off with my bad leg.  My heel stays flat on the ground until my weight passes to my good leg, then it lifts off as I move forward.  I’ve been very conscious of my walking, being very careful knowing that I’m vulnerable right now.

Unlike most people, I think, I haven’t experienced any pain or discomfort, especially since I ditched the boot (my heel would get sore in the boot - I think part of the reason for that was that I had the straps too tight).  I wonder if the pain level is related to the location of the rupture.  Mine was just above my heel, far from the muscle.  The daughter of the people across the street from me ruptured her achilles a couple weeks after me - she continues to have pain, and said that it hurt worse than childbirth.  Her rupture was just below her calf.

One more week to before I see the Dr.  Hopefully he clears me to start strengthening then.  I bought 20 buckets of balls at the local driving range in an on-line auction and I can’t wait to start using them.

One response so far

Apr 01 2009

From NWB to FWB in 5 minutes

Published by schmeck under Uncategorized

I had my 5 week post-op appointment on Monday, and every time I come away from the hospital I just have to shake my head and laugh.

At my last appointment (3 weeks post-op) which my surgeon was not present for, I was put in my ROM boot at a fixed 22.5 degrees and told not to dorsi-flex and not to put any weight on my leg, even in the boot.  As I said in my last post, I didn’t completely follow this advice!  After the post though I did heed the comments that I received (exactly what I needed to hear) and slowed the pace of my activities.

 

Reading

Reading

 

 

I was nervous before this appointment.  Worried that maybe I should have listened to Archie.  Worried that I did some damage.  Worried that I would be told to stay as is (NWB, no physio) for more weeks.

I was taken to the examination room and I took off the boot and waited for the Doc.  When he came in he asked how the boot was working out for me.  I said fine, and I asked if he knew that they had the same thing in the box over by the wall, for $100 less.  He said he thought they were different.  I told him Archie said they were the same so he went and checked.  The adjustment mechanism was slightly different, maybe the previous generation (and covered with a generation of dust), but functionally the same.  He asked, to himself, why Archie didn’t tell him about these boots when he asked about the CAM Walker, and I told him how I thought they got confused with terminology.  ”Huh, well now I know”.  I didn’t bother complaining about the poorly informed ladies at the store.  I had hoped that Archie had taken it upon himself to tell the Doc that they had a stock of boots right there, but obviously that didn’t happen.

With that out of the way he took a look at my achilles.  With me on my stomach he looked at it, pressed on it with his fingers, and said “Good.  Looks good.”  That took about 8 seconds.  ”Do you want to start some physio, work on your range of motion?”  You bet your ass I do.  I asked if the bump on the back of my leg was scar tissue, and he said yes, and that it will probably always be there.  I forgot to ask if the scar tissue was on the tendon or the tissue around it, but it’s definitely higher up my leg than where the rupture was. 

People are probably tired about me complaining about these guys.  Plus I can’t remember the sequence of events well enough to do it justice even though it was only yesterday, so I’ll try to be more brief with the rest.

The Doc basically said that what I was doing as far and taking the boot off and dorsiflexing, having the boot range set from 0 (neutral) to full plantarflexion, and starting to put weight on it in the boot were all good things.  He called Archie in to tell him how he should have adjusted the boot.  He asked how long I had been walking on it and I told him.  He said I could ditch the crutches completely.  So I crutched in NWB (based on their last advice) and walked out FWB.  We knew that the Doc wasn’t going to be at the 3 week appointment - I wish he would have left better instructions.

I put the boot on and took some steps for him.  He said he wanted the boot locked at about 10 degrees dorsiflexion instead of 0 to prevent stretching the tendon.  He said I could still flex past that with the boot off, but he wanted the boot locked there for when I walk.  I set the boot to 7.5 degrees, but I don’t really understand why he wanted it like that and my foot doesn’t feel any different at 7.5 or 0 so I set it back to 0 when I got home because it’s so much easier to walk with it that way.

He said the physio is just for ROM. He doesn’t want to do any strengthening until 3 months post-op.  He said that’s when the tendon is at it’s strongest.  I asked about even doing thera-bands but he said no - nothing until 3 months.  That seems soooo cautious.  I can’t see myself doing nothing until then.  My next appointment with him is in 5 more weeks (10 weeks post-op), at which point he said I should be going to 2 shoes.  My physio is covered by our Universal health care if it’s done at the hospital, so he referred me there.  They called today and the first appointment they have open is next Tuesday.  The first one is just an assessment, then they schedule further appointments at that time.  I’m hoping that they’re well-equipped and that they’ll try to help with the scar tissue as well.  If not, I might try going to a private office.

My range of motion is pretty good as far as articulating from side to side and around.  Everything came back pretty quickly after the cast came off.  Dorsi and Plantar definitely need improvement though.  Walking around in the boot is great.  My heel got a little sore by the end of the day but the tendon area didn’t swell or get uncomfortable - I haven’t really felt any discomfort there since the surgery.  Once in a while I get a sharp little pain under my big toe or close to the ball of my foot - anyone else feel this?  It feels like a pin-prick or sliver.  I keep checking my sock and the boot liner to see if there’s something in there.  Of course there’s dog hair, which can be prickly, but I don’t know if that’s it or if it’s something internal.

I love the stairs now - it feels good to use the rest of my leg.  I’m not confident enough to try carrying Zander up or down them yet though - I need more practice.  I should be able to do it and keep one hand on the railing so it shouldn’t be too risky.  And as much as I appreciated the freedom that the iWalkFree gave me, I hope to never have to use it again.  It seems to be making my knee sore more quickly each day.

 

Zan-man

Zan-man

 

 

All in all a happy day.  You couldn’t beat the smile off my face with a stick - but don’t try.

7 responses so far

Mar 25 2009

Am I crazy? What’s this bump?

Published by schmeck under Uncategorized

So at 3 weeks Post-Op (5 weeks post-rupture) Archie the Ortho-Tech put my boot at 22.5 degrees, told me to not to try to move my foot up (dorsiflex), and put no weight on it.

Between then and now (4 wks + 2 days), I’ve gradually adjusted the boot to 0 (or 90, depending on your boot/perspective), been moving my foot, and started to put weight on it in the boot.  Actually today, I took some steps around the kitchen without crutches (does that count as FWB?).  I’ve also been doing toe raises, but just with the weight of my leg as I sit on the bed or a chair.  I don’t think I’ve been pushing it - I haven’t flexed past the point where I feel tightness, in the boot or out.

The incision closed up within a couple days after the appointment, and it looks alright.

Things feel pretty good.  I do have a bump on the tendon at the top of the incision.  It’s been changing shape a little bit, mostly getting smaller, so I’m hoping it’s just some scar tissue.  The tendon seems to go in a little just below the bump which seems a little stange, so I’ll have to ask the Doc about that.  Another blogger mentioned the surface of their skin being uneven and I had that for the first few days after the cast came off but I just have the one bigger bump now.  I though the unevenness was from where the stitches were.  There were a couple points that were tender when I touched them early on, but that’s gone now.

Leg at 4 Weeks

I don’t know if the Dr. will be pissed off that I’ve done more than he recommended - probably.  But he recommended to not do anything, which I didn’t like.  I’m debating whether I should set the boot back to 22.5 before I go see him on Monday so he doesn’t know, but full disclosure seems to be in the best interests of good healing.  Someone told me that doctors here can drop you as a patient if you aren’t following their advice - hopefully it doesn’t come to that.

The loose skin around my calf muscle has tightened up some, and at least my calf doesn’t seem to be getting any smaller.

I suppose the majority of people would say I should do what my doctor says, and they’re probably right.  Following the advice given to someone else by another doctor probably isn’t smart, but basically I’ve been doing what feels right to me, and picking and choosing from other blogger’s protocols.  Crazy?  Maybe.  Maybe.  What do you think?

Zander - Another bath

5 responses so far

Mar 20 2009

1st to 3rd Weeks Post-Op

Published by schmeck under Uncategorized

I was waiting to post until I had some news, then our computer crashed, hard (who knew Mac’s aren’t perfect?).  In summary: it had started to freeze up occasionally, then over the course of a few days got to the point where we were constantly restarting.  I tried a few different things which didn’t make much difference, then I found a post by someone that said they had similar problems which were caused by the same back-up drive that we have - the solution is to update the firmware on the drive.  So I download the update.  The instructions mention a couple programs that you have to make sure aren’t running or you can lose all your data.  I can’t find them, but I figure I’ll do a restart and then copy everything from the hard drive to back up - I don’t care if I lose the back-up data.  Try to re-start, and it won’t!  Do some stuff which leads me to believe that the hard drive has crapped out.  So now I have no hard drive and a questionable back-up drive!  To keep it short, it turns out the computer had a burnt out power supply and the back-up drive worked fine, so we’re back in business.  The restoration with Apple’s Time Machine program was impressively easy and complete - all our preferences and settings returned as well. 

So, on to achilles news.

Kate and Zander returned, and that took some adjustment on all our parts - me no longer being able to worry just about myself, and Kate realizing I’m not as capable as her mother right now in helping with Z-man.  Once we settled back in to our routine it was good - the days go by quickly taking care of a baby (but of course the times that he cries feel like an eternity).

I got the Cam Walker boot from the place my doctor recommended.  It’s a new store opening up beside his office.  The ladies in there previously worked at a home health store, but they seemed pretty clueless about the different boots.  The prescription only said “Cam Walker”, so I got them to pull out the catalogue from their distributor and picked out the  Range Of Motion boot because early movement makes sense to me.  They said the rep was coming in the next day, so I told them to tell him that it was for an achilles injury, just to make sure it was the right one.  They weren’t sure of the price - one of them checked the price list and then guessed at around $300.  I knew my benefit coverage was up to $500 so I didn’t care.  When I picked it up it turned out to be $235.99.  She wasn’t set up with the electronic banking equipment yet so she had to use the old style carbon-copy imprint machine (which I had to show her how to use).  When’s the last time you saw one of those?  And it was new too - fresh out of the box.

I asked the lady if she could show me how the walker works.  It was apparent that the supplier had given her an overview but she didn’t really remember.  I was pretty sure I would figure it out on my own but I was hoping they might have some helpful tips.  ”Oh the doctor will know how to adjust it”, she says.  Yeah, but he’s not going to be at my next appointment, and I don’t know if Archie know how to use one of these.  At the last visit the Doc gave me an appointment card for a check-up in two weeks which I took to the receptionist to schedule.  When she checked the computer she said she had to go talk to him because he wasn’t going to be there on this day.  She came back and said that he said to come in and Archie would check the wound.  So I knew the cast was coming off, but I wasn’t completely sure if they’d want to put another one on or put me in the boot.  

Between the 1st week appointment and the 3rd week I don’t think I touched my crutches, just relying on the iWalk.  My mom and brother came back to help install the kitchen counter.  Very nice after living with a temporary set up for a little over 3 years - the old counter pieced together to fit the new layout, with some gaps.  Spending most of the day on the iWalk and lugging the counter around did a number on my back - very uncomfortable for a few days.

I found a new method to get down the stairs, so now going down is quick (hopefully not too quick).  Instead of going down on my bum or backwards, I’ve been holding myself up with one hand on the railing and the other on the wall, taking the stairs two at a time.  I don’t think Kate has realized this yet - I’m waiting for her to notice handprints on her new paint job on the wall.

The only time that I felt anything in my achilles region was when I tried to pick up one of Zander’s blankets with my toes.  It was strange because I had been moving my toes all around without feeling anything.  It was brief and sharp.  At first I couldn’t tell if it was the tendon or the incision, then I was worried that I could feel blood dripping.  When the cast came off it was all OK though.

The day finally came for the 3 week post-op appointment.  I put the Cam walker in my backpack and headed to the hospital.  I was excited about getting the cast off, but also a little anxious about how the appointment would go because I knew the Dr. wasn’t going to be there.  

After a short wait Archie comes and leads me to one of the two examination/casting rooms - not the one that I’ve been in every previous visit.  ”So what are we doing today, do you know?” Archie asks.

Hmmm.  I’m not sure if he’s asking so that he can tell me in case I don’t know, or if he doesn’t know why I’m there.  ”Well, I hope you’re taking this cast off and I hope you’re putting me in this boot” I reply.  I had taking the boot out and laid it on the bed.  He looked at it quizzically, mumbled something about checking my file, and left the room.

He came back and again looked strangely at the boot.  I was thinking that either he doesn’t know how to use it or the Doc’s instructions don’t mention it.  ”Where did you get that?”  I tell him, and he asks how much it cost.  I tell him that too, and he says “I was wondering because I have them here” and he nods towards the far side of the bed.  At first I just see a bunch of foam liners, then I notice the box that they’re sitting on, and I see the exact same boot inside.  EXACTLY the same, and it’s a full box of them - maybe 6?

“How much do you charge for them?” I ask.  He doesn’t want to tell me at first, but I tell him I won’t be upset because I’m getting reimbursed.  $140.  So, I ran around town dealing with people that had no clue so that I could pay $100 more for something they had in the next room.  I try to joke with Archie that the Doc must be getting kick-backs from the store, but he doesn’t laugh.  Then he tells me that he might be working there part-time.  Awkward.

At the last visit the Doc had asked Archie if he knew how to adjust a “Cam walker” that controls the amount of dorsi and plantar flexion, and Archie looked a little puzzled.  Now Archie says that the Doc should have asked him about a “Range of Motion ankle brace”, then he could have told him that there were some right there.  Confused by terminology, I guess, but it’s pretty surprising that 1) Archie didn’t make the connection, and 2) that the Dr. didn’t know what they had right there.  For me, I think any boot that has a not-flat or curved bottom is a Cam walker.  Though it seems like some manufacturers use CAM as an acronym for Controlled Ankle Motion.

Archie cleaned up the incision and said that there was a still a small opening that had a piece of suture sticking out of it, which is probably why it didn’t close.  He pulled that out and put some gauze over it with a light wrap.  I asked what angle he would set me at.  He checked my file again to see if the Doc had given instructions for that, but it didn’t seem like it was specified.  He said probably 30 degrees (as measured away from 90).  He started getting the boot ready by taking the pins out that lock in the angle, then he started to try to rotate the uprights.  He had to use quite a bit of force and he was looking at it like it was too stiff.  I said “I think those move easier if you loosen the locking screw”.  Maybe Archie doesn’t know how to use the boot.

He checked how far my foot could flex before I felt some tightness in my achilles, which he said was 15 degrees, then set the boot and put it on me.  When I got home it was actually set for 22.5 - I don’t know if he changed his mind or if he wanted it set so that there would be no tension on the tendon.  I asked about when I would start physio, and he said it would be after I get to 90 degrees - maybe after the next appointment in 2 weeks.  He told me not to try to bring my foot up to my shin but I could point my toes down, but he locked the boot that angle, which seems to defeat the purpose of a Range Of Motion boot to me.

I got home and headed outside to enjoy the nice weather.  Here’s what the leg looked like, with Roxy in the background.  The open part of the incision is at the very bottom.

 

3 Wk Post Op Leg

3 Wk Post Op Leg

I was pleasantly surprised when I saw my leg because it wasn’t as withered as I thought it might be after 5 weeks of immobilization, but when I started feeling around it actually seemed rather hollow - not much muscle inside.

Here’s my range of motion:

Dorsiflexion

Dorsiflexion

 

Plantarflexion

Plantarflexion

And just for kicks here’s one of Zander getting ready for St. Patrick’s Day: 

 

Zander - St. Patrick's Day

Zander - St. Patrick's Day

4 responses so far

Mar 02 2009

1st Week Post-Op

Published by schmeck under Uncategorized

The morning after the surgery I wake up and hit the next round of pills.  I try to pee into my pitcher while sitting down but can’t, but it sure feels like I need too.  That’s when I remember that I did hear the pharmacist say (over the drone of the floor cleaner) that I need to drink a lot of water.  I guzzle a bottle, stand with my good leg on the ground and the knee of my bad leg on the couch and the flow comes.

Not really hungry for the first day - just a little chicken soup.  Drinking tons of water.  Sleeping lots - nice little side effect of the pills.  I don’t move around too much, just to the computer to catch up on news, Skype with Kate and Zander, and do the blog.  Prop the cast up on the desk and lean back in the chair.  I can last almost an hour like that before the leg gets too uncomfortable.

By day two I’m taking more solid food and getting a little more mobile.

Day 3 I only take the Lyrica (nerve pain) pill, but in the afternoon I’m getting a little uncomfortable so I take the others as well.  I repeat the dose that night.

Day 4 it’s the Lyrica only, and that night I had already got into bed when I realized I left the pills in the kitchen.  Too lazy to go get them so I don’t take anything (and stop the Lyrica 1 day early).

It was a plaster cast that I got after the surgery (not a very exciting picture):

 

Plaster

Plaster

 

 

I send my Mom and brother home on day 4 as well.  I’ve got a poker night, birthday party, and a house party to go to on the next couple nights and it seems a little silly to have people to help me when I won’t even be here!  I want to get out of the house and this is probably more than half of my social events for the year so I don’t want to miss out.

Day 5 it’s raining.  I had neglected to arrange a dog walker but I don’t expect anyone is going out in the rain anyway.  By mid-day though the rain stops and the sun comes out.  The stand-by friends from work are due at the poker game so I don’t want to call on them, and the sun looks so inviting that I decide to head out to the woods myself.  I’m half hoping that I’ll see someone I know that can take Riley and Roxy around the trails, but the other half hopes that there won’t be anyone and I’ll have to do it myself.  There’s only 1 other car in the lot and no one around, so I grab the walking sticks that Kate bought me for my birthday, strap on the iWalk and head out.

It takes me an hour to do what should normally take about 20 to 30 minutes, but it’s nice.  Lots of breaks for stick and iWalk adjustments, and to catch my breath.  The flats are easy - the hills less so.  Up and down are both a bit of work.  I wouldn’t have made it far without the walking sticks - I get good tri-pod action between them and the peg-leg.  Aside from a few really icy sections I feel pretty stable.  The straps on the iWalk are bothering me by the end.  It’s less than 1.5km total (1 mile).

I lose at poker and head over to the birthday party.  I really didn’t want to miss this as there was a whisky tasting theme, and that’s my drink of choice.  I can only take try one small sample while I’m there as I’m driving, but I’m sent home with a plate full of samples in mini plastic shot glasses.  Would have been interesting trying to explain that if I got pulled over.  The “tasting” was actually a contest: 10 different anonymous samples of whisky (Canadian, Irish, US bourbon, single malt Scotches) - you have to taste them and guess which is which off of a list.  I try them out when I get home and my standing as a connoisseur is seriously dented as I only get 1 out 10.  I am in good company - 1 person got 4 right and no one else got more than 1.

I only last about an hour and a half at the next night’s party.  The iWalk is being a little annoying and it gets warm in the house from all the people - I feel like my foot is going to blow the cast apart.  The cold air outside on the way to the car is quick relief.

Day 7 and it’s back to the fracture clinic.  The plaster cast comes off:

 

1 Wk Post-Op

1 Wk Post-Op

I want to try moving my foot to see what it feels like, but every time I twitch a toe Archie (The Guy) gives his head a little shake “no”.  Dr. H. comes in right away and just glances at my leg. Archie asks him if it was a complete tear.  ”Oh yeah, totally”, Dr. H. says.  He tells me the surgery went fine, and starts talking about 3 more weeks in a cast.

“What do you think about a Cam Walker?  Not now, but maybe next week”, I ask.

“Do you want to buy one?”, he replies.

“I don’t care”, I say.  ”I’ve already been immobilized for 3 weeks and I’m worried about . . .”

“That’s not the reason to get a Cam Walker.  Pro athletes, or enthusiasts like you, get one so they can recover in 5 months instead of 6.  It’s riskier because you can re-rupture going through the physio.”  (That’s a paraphrase, but pretty close).

That doesn’t sound quite right to me based on other bloggers’ experiences but it’s almost enough to make me reconsider.  He doesn’t seem too averse to the idea though, so I say that I do want to go ahead with one.  If it will get me walking normally a month earlier I’m all for it.  He says he hasn’t treated anyone locally here with one before, but he writes a prescription for one and gives me a contact where he thinks I can get one (next to his office, of course).  He asks Archie if he has any experience in fitting and adjusting a Cam Walker, but somehow I missed Archie’s answer (I think it was a negative).

He never really looks at the leg again and doesn’t touch it.  He tells Archie to cast me up again and says he’ll see me in two weeks.  He says hopefully they’ll be able to get the walker in by my next appointment.

I go for green this time so I’ll be able to tell the stages apart by cast color.

 

Green cast

Green cast

I’ve called the orthotic place and received a call back.  They’re just setting up their office/store.  They’re going to check some stuff and call back again.

3 responses so far

Feb 25 2009

Surgery

Published by schmeck under Uncategorized

This is still the afternoon of Feb. 23rd.

So I’m back at the hospital with my mom, trying to show her where the nurses said that she could pick me up - at the recovery room.  I started going the wrong way and a nurse on her way home helped us out.  We got to the right place and there was another nurse at the end of the hall calling out my name.  She said that they were already asking for me.

She led us into a room which was empty at this time of day, but had about 6 bed areas.  She told me to go to one and gave me a gown and booties.  I got changed into the hospital gown but I did get to keep my underwear on.  I gave mom the peg-leg and she headed home to wait for the phone call to pick me up.  The nurse said (about 5 times) “oh, you won’t need those (the booties) because you won’t be walking anywhere”, but she wouldn’t take them from me.  More questions, and again “Are you staying overnight?”.  No.  I don’t know.  You tell me.

She got me on the bed and covered up and wheeled me over to another room/hall/waiting area.  I didn’t have my glasses on anymore so everything was a little blurry.  I asked her on the way if she knew if it would be a regional (spinal block) or general anesthetic.  She said that the anesthesiologist, Dr K., and I would decide, but she figured because I was young and healthy that the general would be their preference.  The regional requires a longer post-op stay in the hospital.  She said Dr. K. is very good.

She left me there.  There were a few people walking around, but no one acknowledged my presence for a while.  I felt like I had a private window into what goes on behind the scenes in a way.  Nurses talking about trying to get procedures rescheduled to suit them, doctors sauntering around, both just talking about procedures, not patients (i.e. “Is the thigh reconstruct finished?  What’s next, the achilles?).  Eventually (20 minutes?) a guy comes over and  introduces himself as the anesthesiologist, not Dr. K.  He’s got a young looking helper with him (keep that guy away from me!).  So he’s not Dr. K., but he’s quite friendly.  Maybe too friendly.  From the way he stroked the back of my hand to show me where the IV would go I thought maybe he was gay (keep that guy away from me too!).  So lots of questions again but there’s no discussion.  When he’s done with the questions he tells me what’s going to happen; nurse will start an IV (where he strokes me), then he’ll give me something to help me relax, then they’ll give me some oxygen, then I’ll go to sleep.

He and his helper leave and I see Dr. H. hanging around.  He comes over to confirm which leg is to be done and initials my knee (it’s pretty obvious which leg is damaged, but if he’s going to mark me up he should at least do the back of my leg so he can see it when I’m on my stomach).  I ask if I’ll be in a cast when I wake up and he says “Yeah, likely a cast.  I’ll do an evaluation and decide on a cast or splint”.  I ask if it will be in the equinus position, and he says yes.  I try to get more info out of him, like how long before I change casts, when does the angle change, etc., but he’s distracted.  He keeps trying to walk away and when I start saying something he says “Oh, did you have more questions?”  Give me a minute, dammit!  He’s pissed me off and I don’t want to talk to him anymore, so I say I’m done.  He says “It’s only tying up some tendon.  Piece of cake.”  

He walks away past my head.  I can hear that he’s still within range so I call out “Don’t give me an infection!”  Smartass?  Maybe.

His reply, “I don’t have an infection so how can I give you one?”  Smartass?  Definitely.

Someone says it will be about 20 minutes.  The nurses do talk to me a little bit, and after 20 minutes one of them says she might as well start the IV.  I tell her that I wouldn’t rather have anyone else do it than her (I better have someone on my side in that room!).  She says she’s worried that I have disappearing veins - they look good but they’re hard to get, but she does a great job.  Barely felt a thing.  When the liquid starts coming in it feels cold, and she slows down the flow.

We wait about another 15 minutes then they take me into the OR, where we wait some more.  They hook me up with sensors on my back, a blood pressure cuff, and a pulse monitor.  Wait some more, and I’m getting chills.  Finally, about 7:00 I think, Dr. H and the anesthesiologist and his helper arrive.  The A’gist gets his drug ready and puts it into the IV.  I can almost feel pressure in my veins - very uncomfortable.  Then a nurse brings over the oxygen mask and tells me to take deep breaths.  I do about 3, and she says again “Deep breaths”.  One or two more and I’m out.  I thought there was one more step in this - I wasn’t ready!

I wake up in the Recovery room to nurses calling my name.  Very disoriented.  There’s goop in my eyes and of course I don’t have my glasses so everything is a blur.  I’m talking but I don’t know what I’m saying.  I can kind of see there’s a cast on my leg and I can tell that it’s white and I’m wondering if it’s plaster or fiberglass.  I start poking at it with the big toe on my right foot and they tell me not to do that because it’s still wet.  I say “I don’t know what they gave me but one of those things is making me talk a lot”.  They laugh and agree.  I say “It’s too bad that my mom’s not here now because sometimes I can’t talk to her”.  The grogginess is slowly dissipating.  One of them asks about pain.  I tell her it’s about a 3 or 4 - other than when the Dr. pushed on my foot earlier today, it’s the worst that it’s felt.  She injects some morphine into the IV.

I get some kleenex to wipe my eyes, and one of them retrieves my glasses.  I don’t really know the timeline, but I get asked about the pain again.  It feels about the same to me, so I agree to more morphine (how many times do you legally get to try that?)  Some more time passes, and the pain still feels about the same.  Not terrible, but uncomfortable.  I don’t think I would be able to sleep like that.  She says that it’s normal to feel something - I just had surgery!  Then I get offered Tylenol 3 or Percocet.  I’d heard good things about Percocet, and I’ve had Tylenol 3 before but it didn’t seem to do much, so Perc’s it is!  Load me up!  It was 9:00 when I got the pills - maybe I was in there for half an hour before that?

They ask about nausea.  The room is a little unstable and spins sometimes, but I don’t feel too bad that way so I decline their offer of Gravol.  Kate and I did some travelling in SE Asia, and I would take Gravol before our bus trips to make sure I didn’t get motion sickness.  The stuff would knock me out.  We’d be crammed in, 4 people on a bench seat with bags and chickens all around, bouncing around on terrible roads, and I’d be asleep.  Then we tried it on a flight from NZ to Singapore and it did the opposite - made us jumpy and our skin crawl - couldn’t sleep at all.  So I declined partly because I didn’t want either of those things to happen.

After a while I get transferred to the 4th floor.  Why?  I don’t know.  But now my mom won’t be getting me from the recovery room.  Shouldn’t be a big deal, but she was already worried about getting me from the recovery room because she doesn’t know this hospital.  I get put in a room with a couple other guys, and get offered some juice, which tastes great.  My tongue has a big swollen section (still swollen now, 2 days later), which I guess is from having a tube in my mouth while I was out.

I again get offered Gravol, and again decline.  I had a newspaper in my bag, which I am able to read for short periods.  The nurse says she could probably call my ride now (about 11:00?), and I say OK.  She makes the call and then gives me my bag to get dressed.  I get my clothes on, but there’s some definite nausea happening.  I lay back down, and when the nurse comes back I say that maybe I will take the Gravol.  She says OK, but then comes back and says that she can’t give it to me after all - it was on my Recovery Room orders from the doc, but not Post Op, so she can’t do it.  She says I probably don’t want to eat much for the next day or so - just broth, juice, etc.  She also says that the prescribed painkillers might bung me up so I might want to get a stool softener, or maybe not because I’m young.

My mom happened to recognize my shoe as she was walking around and comes in.  The nurse gets a wheelchair and I get it.  I don’t feel too bad until my mom starts pushing the chair.  ”Whoa.  Don’t push.  I don’t feel good.  I need to move myself.”  Mom gets a bag from the nurse in case I vomit.  We make our way to the ER doors and mom goes and pulls up the van.  I make my way in and tell her “Drive smooth”.

The Shopper’s Drugmart is 24 hours and right on the way home.  I go in with my mom and ask her to grab a can of soup and some Gravol - I’ll risk either side effect now.  I give my prescription to the pharmacist and sit and close my eyes.  There’s a damn propane powered floor cleaner that a guy is racing up and down the aisles with - loud.  It doesn’t take too long, but I can barely hear what the pharmacist says because of the floor cleaner.  I figure that there’s always instructions in the bag so I don’t worry about it too much.  There’s actually another person in line in front of us so while mom waits to pay I head outside because I’m feeling pukey again.  A few minutes in the cold air helps.  We get home and I ask mom to make up the couch for me.  I don’t know how well I’m going to sleep so I want the TV available.  I pop a couple gravol.

Turns out I have 3 different pills, all painkillers.  

  • Lyrica (Pregabalin, 75mg), typically used for nerve pain.  1 pill twice a day for 5 days.
  • Tramacet (Tramadol/Acet 37.5/325), an analgesic.  1 to 2 every 6 hours as needed.
  • Ratio-Oxycocet (Oxycodone HCL/ACETA 5/325), a narcotic.  1 to 2 every 6 hours as needed.

I make it to the chair beside the couch.  I check out the pills, and I’m not feeling great so I take the full dose of everything.  Mom heats up the chicken soup which I eat a little of, then it’s on to the couch.  Another few moments of nausea, then I lay down and prop my leg up on a cushion and a pillow and I’m out pretty quickly.  I wake up a few times but it’s a pretty cozy sleep.

4 responses so far

Feb 24 2009

Frustration

Published by schmeck under Uncategorized

Here’s the summary (spoiler alert): I had the surgery, yesterday.  Happy birthday to me.

Here’s the appropriate Zander Emoti-con for this post:

dsc_0107

I went in to my appointment and picked up a Toronto Life magazine in the waiting room.  I found this article in it: Super-Bugged. (Don’t know how long the link will be active.)  Just the information you want when you’re in a hospital!  It sounds horrific.

I didn’t have to wait too long.  A lady took me to the same room I was in before to get my cast, and started asking me questions that I didn’t know the answer too.  Like: “Are you having surgery?”.  This ended up being a bit of a theme for the day.  She considered taking the cast off or leaving it on, decided to leave it on, left, then came back to take it off.  She rightly said that the Dr. couldn’t examine me with it on, and she was pretty sure that the first thing he would say is get the cast off.  I wanted the thing off so I could see what things looked like.  She asked me if Archie put the cast on.  Wait!  Could Archie be The Guy?  I asked if Archie was a Dr., and she said that he is an “Ortho Tech”.  So at least he wasn’t the janitor.

Here’s the cast:

Cast

Cast

She cut the front of the cast off and told me not to move my foot - keep my toes pointed down.  She left and while I was waiting I did my own little Thompson test, comparing my right and left feet.  I was hoping there would be some movement since it was supposed to be a partial tear and it had two weeks to start healing.  I squeezed my calf and . . . nothing.  Damn.  I kept trying, like going back to the fridge to see if some new food has magically appeared.  I did get it to move, but it was just the skin pulling, nothing else.  There were a bunch of Air Cast boxes stored in the room, and I was really hoping that I would be leaving with one but I knew that wasn’t going to happen.

Leg

Leg

 

 

I was surprised at the amount of blood still in my foot.  I thought it would have been gone by now, two weeks after the injury.  You can see the indentation in the back of my leg, just above the heel where the tear was.  I couldn’t resist doing a little prodding myself, and moving my foot a little bit.  It felt tight and hurt a bit when I flexed my foot.

Finally I meet Dr. H.  He asks all the same old questions, and I give all the same answers.  Then he gets on to looking at my leg.  He has me roll onto my stomach and starts the squeezing and poking.  I can feel his fingers go pretty far in at the tear - still no tendon there.  He has me take the shoe and sock off of my right foot to compare.  He has me push against his hand with my left foot and it seems like I’m able to exert a fair amount of force, but the whole time I’m sure I’m going to feel another pop.  We do the same on the right side, and he’s really leaning down on my foot with most of his weight.  Then he says to push again with the right, but with my toes curled up.  Again I hold most of his weight.  Now the left foot, with toes curled.  My foot gives way a little.  ”Push!” he says.  I push, but he pushes harder and my foot flexes.

“OWWW!”

“Sorry”, he says.  ”Yeah, that’s not a partial tear, it’s complete.  The ultrasound was wrong.  It’s your toe flexors that are making your foot move, not your achilles.”

Shit.  Archie was right.

Dr. H. outlines the options: surgery or conservative.  When he tells me that the re-rupture rate for conservative is 30 to 40% I know that he’s definitely pro-surgery.  I tell him that I’ve seen studies that say the conservative method is more successful than that, but he says that they don’t have the same orthotics that they probably used in the studies.  He goes on to say that he’s treated about 50 ATR’s, only 2 of which went conservative.  They were successful, but he says they were low-demand people, and all of his surgeries have been successful.  He can do the surgery tonight, but he has to know soon.

Damn, damn, damn.  I told him that if this would have been last week I would have said “OK, surgery, let’s go!”, but I’m not excited about starting over.  I ask a few more questions and hum and haw.  He doesn’t want to wait for me to decide - he says he’ll give me a couple minutes and come back.  I’m pissed.  I tell him “Alright, screw it, let’s do the surgery”.  He says OK and that he has to make some calls to set it up and I don’t see him again until that evening.

Archie comes in with a sympathetic smile.  He has me fill in a bunch of forms, somewhat haphazardly - some are signed, some aren’t.  My name is printed on some, not others.  He skips some forms, then changes his mind and has me do them.  Seems like the biggest concern are the form releasing the hospital of responsibility for a variety of things.  He leaves, comes back for one more form and has a bunch of stickers with my name on them to put on the forms where my name should be printed.  Surgery is set for 6:00 (my appt was 12:15, and it’s about 1:30 now).  He puts the cast back on me and holds it together with some tensors.  He says I should go to the day surgery area now to pre-register and get some information.

I go and register and the lady complains about all the stickers on the forms and missing signatures.  Asks me questions I can’t answer, sends me over to another area.  The nurse there turns out to be my friends’ aunt.  She recognized the name of my street on the form - we had met at one of my friend’s wedding in the summer.  It was nice to have a friendly and somewhat familiar face there because I was quickly going to a dark place.

I was told to come back at 5:45 because they close the desk / intake area at 6:00.  I came home and called my mom to make sure she would be here in time to take me to the hospital.  Then I called my wife.  My mom and brother arrived and I explained the situation, and outlined a few jobs that I was hoping they could do while they were at the house.  Then I told them that I was just going to go play my videogame for a while because I just didn’t want to think about anything.  About 4:00 I went upstairs and scrubbed my leg but then I put it back in the same dirty old cast, so who knows if that helped anything.  My hand slipped on the wall of the tub and I ended up putting some weight on my foot - OWWW again.

Tired - I’ll have to continue with the surgery story tomorrow.

2 responses so far

Feb 22 2009

Anticipation

Published by schmeck under Uncategorized

I had a dream about my achilles the other night.  I don’t know where I was, but it was shortly after the cast had come off.  The conservative treatment had worked like a charm.  No surgery, so no scar.  It was only slightly thicker than it was pre-injury.  Stronger!  I was feeling all around it with my hand; pressing, squeezing, poking.  Then I tried moving my foot around.  Up, down, side to side.  It all worked!  It was all good!

It was pretty disappointing to wake up to feel the cast still on my leg.  I must have spent too much time that evening on this website, looking at pictures of my fellow bloggers’ lower legs!  It was disappointing, but I also woke up feeling hopeful.

I’ve now got my head so wrapped around the Conservative treatment that I’m dreading that tomorrow the Dr. will say that I do in fact need the surgery.  At this point I don’t want it.  The non-surgical approach seems to be much more common in the UK (or at least it’s more common amongst the UK bloggers), so I’ve been reading many of their stories, and they seem successful.  I’ve also read some of the stories by people that have had problems with surgery (I feel for you, booklady).  

I’ve got about half an inch of space in the cast now, both at my toes and at the top of my calf.  I think it’s a combination of the padding compressing and my leg shrinking.  I started out just wiggling my toes to try to keep good blood flow through the leg, but with the looseness of the cast I can actually flex my ankle a little bit.  Very tentatively I began flexing my foot, first bringing my toes up.  I was concentrating on trying to feel something, anything, in and around my achilles.  Nothing.  Then I started flexing it the other way, pushing my toes down, pressing against the cast.  Without actually doing it too often, just in case I’m doing some harm, I’ve worked my way up to “full power”.  (Full power isn’t much, and yes I was a little worried that I would tear any connection that remains).   I can feel a wee little something at the bottom of my calf after I do that, but it feels . . . good.  Like a muscle after a good bit of exercise.  I like the idea of early weight bearing, so this is my version of that.  Maybe this is too early, but it makes me feel good.

I’m hoping it all performs as well when it gets a chance without the cast on tomorrow.  I’m assuming the Dr. will want to check it without the cast - he’d better!

Kate and Zander have been gone for 4 days now.  Friends and co-workers have generously taken Riley and Roxy out for some exercise.  Wasn’t enough to stop them from sneaking into the kitchen (from which they are banned) and eating a loaf of bread and a bag of pitas off the counter while we were out for supper though.  I accomplished a lot in the first couple days, but I’ve been enjoying resting and relaxing for the past two.

Good old peg-leg is my new best friend.  I’ve got the padding set up so that it rarely bother me any more, and I can get it on or off in about 20 seconds.  The return of snow to southern Ontario has not been pleasant though.  I’ve had a couple “whoops” after coming inside after walking/pegging in the snow.  I change my shoe, but it’s the same rubber pad on the bottom of the pegger and it has slipped a little on the wood floors.

If you like to have strangers start conversations with you (which usually happens to me exactly NEVER), then the iWALKFree is worth its price for that alone.  I went to the passport office to submit Zander’s application and had strangers start talking to me 3 different times.  Happened twice more getting groceries.  Most of them either had physio related jobs or had had their own foot/leg injuries, which explains their interest.

Now for the random part of the post: My TV watching has obviously increased recently, but they seem to be playing this commercial all the time now.  I loved it from the first time I saw it - literally made me laugh out loud.  Hope it does the same for you.  My favorite part is the guy putting the bucket on his head at the very end.

2 responses so far

Feb 17 2009

Peg-leg

Published by schmeck under Uncategorized

I picked up the iWALKFree and brought it home.  It was easy to get on but there’s definitely a learning curve.  I don’t recommend holding the baby until you’ve been around the house a few times.  I am no longer Frankenfoot, I am now Peg-leg.  Or Newt still works as well.

For any faults it may have, it does mean I can do things that I wouldn’t be able to with just crutches, like care for the baby on my own, and get my own food and drink, do the laundry, etc.  I’ve made it around the block with the stroller, too.  Here’s some proof:

Zander BathHanging Laundry

And here’s proof that Zander isn’t always angry - first time we’ve noticed his cheekbones:

 While I’m at it, I might as well add some gratuitous dog shots:

Flower Dogs

 

And last but not least, luckily one of the dogs can be useful: Riley Gets the Paper.

Anyway, back to the serious achilles-related stuff.  Life has kind of settled back into the pre-injury routine, which means everything revolves around Zander but at least I’m able to contribute.  All of the mom’s from our pre-natal class have been getting together with the babies.  When they heard about me being out of commission they all prepared or bought some food for us, which was very thoughtful and a tremendous help.  The peg-leg usually gets uncomfortable after a while, so I don’t want to have to spend a lot of time in the kitchen.  Although a couple nights ago I had it adjusted perfectly - I could barely tell I had it on.

As for the iWALK - stairs still suck.  Going up is better than with crutches, but down is still on done on my ass.  Twice I’ve lost my balance and fell backwards until the cast hit the ground.  Not good.  My toes were definitely helping to hold me up until I got stable again, but I think the cast stopped anything too bad from happening.  Those two instances were both in the first few days as I was getting the hang of it.

Here are a few things I’ve learned about the iWALKFree if anyone else happens to get one:

  •  Put the upper strap as high up into your crotch as you can, to give it more leverage.  It makes it much more stable.  Just be careful of what’s inside the strap before you tighten it!
  • The instruction say to put the middle strap as low as you can, but I find it much more comfortable to have it a little higher up so it’s not on my knee tendons as much.  I also added some extra padding to this strap.
  • The strap that goes over the cast rotates your lower leg when you tighten it, which can make your knee uncomfortable.  Pre-load your leg (rotate it in the opposite direction than the strap pulls) before tightening.
  • You’ll need a separate pad under your knee.  The cast holds your knee off of the built-in padding.
  • I make the straps quite tight when I’m walking for stability - be sure to loosen them when you’re sitting to make sure you’re not cutting off circulation to your leg.
  • The instructions say to cut the top of the aluminum beam off to suit your height, so if you’re buying one used, make sure it’s not too short for you.
  • I tended to put the peg-leg down too far forward when I was just standing, which made me tippy, to the back.  It takes some time to used to holding your leg further back than normal.  And it’s much easier to recover if you tip forward instead of back.

I’ve been feeling a bit of a cramp feeling in my lower calf when I wake up, which I gather from other people’s comments is pretty common.  Other than that there’s no real discomfort or pain.  One of the best ways to put Zander to sleep is to hold him while sitting on an exercise/yoga ball and bouncing.  Our first ball broke on me last week while I was still wearing Stupid.  A little scary - Zander’s head came pretty close to the coffee table - but it’s so effective that my wife went right out to get a replacement.  When I’m on the ball the cast rests on the ground.  I usually put a pillow or something underneath, but I’ve still worn through the padding at the end of my cast.  I don’t consider that weight-bearing - I don’t see how having my cast on the ground could affect my AT.  Does anyone know if that’s OK?

Other than that I’m just in a holding pattern until I see the surgeon on the 23rd.  I’m sending Kate off to her mom’s with Zander tomorrow for a couple weeks.  Trying to get some people to take the dogs for a few walks while she’s gone.  Worst case I’ll try to go a few hundred meters myself, or hang out in the parking lot at the trails until I see someone I know.  Have my mom coming on the 23rd in case I do have the surgery.

 

6 responses so far

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