Pop goes the achilles

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.

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:

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

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

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.

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.

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:

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:

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.

February 12th, 2009.

My wife answers the phone at about 10:30 in the morning - it’s the fracture clinic (which is in the hospital).  I have an appointment for a cast at 1:30 today, and another appointment on February 23rd (my birthday).  I guess they assume that you didn’t go back to work?

I’m happy because I didn’t have to wait until the following week, and I want to get the orthopedic surgeons take on the injury.  I drive myself in.  This time the parking lot is busy and I don’t feel eligible for the Emergency section, so I have about 100m to go, slightly uphill.  I’m worn out by the time I make it inside.  Again I don’t have to wait long.  As I follow the surgeon down the hall on my crutches, I see him taking a number of puzzled looks at Stupid.  He double checks my chart and verifies that it’s me.  I say “I see you’re admiring the handiwork here”.  I had removed all of my modifications, worried that they’d give me crap about it.

He says “No, not really.  For achilles?  That’s wrong.”  When I tell him that this is what they set me up with in Emerg. he says “They should know better”.  I’m thinking “Great!  Emerg sucks, but at least we’re on the same wavelength!”

I sit on the chair in the room and take Stupid off and my sock while the surgeon pulls up my record on the computer.  He asks me to move over to the bed.  I start to work my way over, too lazy to use the crutches, and he says “I recommend that you don’t put any weight on it.  Like you’re doing now.”  Oops.

My ultrasound images are now on the monitor and I’m looking over his shoulder.  He says “Don’t ask me what I’m seeing - I don’t understand ultrasound.  It’s just lines to me”.  Okay . . . I also don’t understand the images - I’m looking for a gap in the tendon, but I can’t even tell where the tendon is.

He comes over to me and takes a look at my foot.  The puzzled expression returns.  ”This is a partial?”  He starts squeezing my calf as my leg dangles down from the bed - the foot doesn’t move.  He squeezes the gap where the tendon has torn - the foot doesn’t move.  ”Let me see your other one”.  I remove the shoe and sock from my right foot.  He does the same squeezes on my right side and my foot jumps.  ”This is a partial?” he asks again, “I don’t think so”. 

“When did you see Dr. H?” he asks.

WHAT!  I thought he was Dr. H (the orthopedic surgeon).  Who the hell is he?  Another Dr.?  A nurse?  The Cast Applier?  The janitor?  They need distinct uniforms at hospitals - everyone wearing scrubs is no good!  I wonder if Dr. H understands the ultrasound pictures?

In my stupor I tell The Guy that I haven’t seen Dr. H. yet.  ”When’s your appointment?”  Still stunned, I tell him I don’t know.  He goes to the reception desk to check, and comes back and says that it’s the appointment on the 23rd.

So I say “If it’s not a partial but a full tear, shouldn’t I be looking at surgery?”  He nods.  ”So how do I make that happen?”  He says that Dr. H will decide after he sees me.  He asks again when it happened.  Feb. 23rd puts me two weeks plus a day from the injury.  

He calculates this and gives a slight shrug, “So two weeks”.  I’m pretty sure I’ve read that the surgery is generally (or best?) done within two weeks.  I’m not concerned with being a day over the two weeks for having the surgery, but I am concerned with waiting another week and half before even knowing if I need surgery, and then if I do having to start the recovery and casting process all over again.  I voice this concern and he says he understands.  ”So what can I do?”

So the situation boils down to this:

• Dr. H. was the orthopedic surgeon on call the night of the injury so I am his patient.
• His day in the fracture clinic is on Mondays.  I missed the 9th getting the ultrasound and waiting for the results, and the 16th is the holiday.
• Another surgeon, Dr. D. is on call this day, but she will likely refuse to see me since I am Dr. H’s patient.
• Dr. H. could transfer my care to Dr. D., but he is not on call and The Guy doesn’t know how to get a hold of him.

The Guy and I boil down my options to these:

1. Go back to Emergency and I might be able to see Dr. D.  Go back to Emerg and say what?
2. Call my family doctor and see if he can talk to Dr’s H & D and arrange the transfer of care.  Faithful readers will know that going to Dr. Socially Awkward is not really an option.  I can’t imagine him calling anyone.
3. Somehow get a hold of Dr. H and get him to request Dr. D. to see me. The Guy doesn’t seem to have any pull with Dr. H., so he can’t help there.

I fume and debate.  I don’t want to leave without a cast, but I can’t imagine going back to Emerg or my doctor with it on.  The Guy says that if the decision is made on the 23rd that I do need surgery, it will likely happen that night or the next day. 

The guy checks my leg again.  He asks me to flex my foot up and down, which I can do.  He says that full ruptures usually can’t do that.  He then gets me to flex against his hand, like the dr. did on the first night.  He kind of retracts his opinion after I can exert some force, saying that there must be some connection there. 

In the end, being the pushover that I am, I tell The Guy just to go ahead and put the cast on.  Nice blue, in the equinus position (toes pointed down).  I never did find out who The Guy was.  I almost asked, but I think he was genuinely trying to help, and I’ve always been too shy.

So I get home not sure how to feel.  Maybe I’m on the first real step to recovery, or maybe I’m just in an uncomfortable holding pattern until the 23rd.  It doesn’t take me long to hate the cast.  It feels alright, but it’s pretty much impossible to stand or move without the crutches now.  With my toes pointed down I can’t rest my weight on my heel.  I almost miss Stupid!  (Stupid got left behind at the clinic).  I’d love to be able to move my ankle around.

Having my toes pointed down makes me feel . . . weird.  For some reason Newt, from the old Hercules cartoon pops into my head.  Hercules at about the 3:10 mark.  I’m walking around the house saying “Herc!  Herc!  Look out!”.

More checking on the internet and the achillesblog ensues.  I found Johnny Hopalong’s story (Johnny Hopalong’s page) while looking for posts by other Canadians and was immediately intrigued by the iWALKFree.  I found a used one on Kijiji, agreed on a price of $200, and made arrangements to pick it up the next day.

February 11th, 2009

1. We are renovating our house (ongoing for about 6 years) and we currently only have one bathroom - upstairs.  Trying to limit my stair action, I’m using a pitcher with a lid.  Don’t drink the Kool-Aid.
2. The two weeks that my wife (maybe I should ask her if I can use her name?) and child were going to be away was supposed to be a chance to get cracking on finishing some of those renovations, and get the main floor bathroom started.  Delayed until when?
3. As per my first posting, I was just starting to get back in to sports and I was starting to feel good.  I was running well, my cardio had picked up, and my energy levels were better.  Now I’m sedentary.  I’m looking forward to physio.
4. You can’t do shit on crutches.  You can move around, but you can’t do shit.  I made myself a nice snack after everyone else went to bed, poured myself a beer, and then realized that I couldn’t carry it to the tv room.  Aarrgh!
5. I’m on parental leave - i.e. not working.  What a waste!
6. Zander demands a lot of attention now.  My wife was already worn out before I got hurt.
7. It’s winter.
8. It’s hard to imagine doing any sport without thinking about the achilles at some point.
9. Our concrete driveway which we just got last summer has cracked.
10. It’s tradition in my wife’s family to have NO sympathy for the sick or injured, even without a baby around.

Yeah, some of those aren’t really related, but they don’t help!

Are there any reasons why this is good?

1. Finding the achillesblog is helping make it bearable.
2. As my friend Jeff put it after calculating my expected RTG (Return To Golf) date, minus the start of the season around here: “That’s 3 months that you don’t have to ask your wife if you can go golfing just to have her tell you “No”"

February 10th, 2009.

I’m posting like crazy because I’m trying to catch up with events up to the present.

The next day I continue Frankenfooting around in Stupid.  Mom arrives around lunch and she’s more than happy to help - with Zander, cleaning, cooking.  I use the opportunity to do some more research on the conservative method, and also to refine my heel lift to make it higher and more comfortable.  I’ve got a nice collection of blood just above my heel now - just like I would get after a bad ankle sprain back in my teens.  Looks like a nasty bruise.

After lunch I call the Fracture clinic.  I think they are supposed to call me with the appointment time, but I don’t want to take the chance that I’m waiting for nothing.  The lady puts me on hold right away, then comes back after a minute to say that my name is included on a list of names that she has sent to the Dr., and she is waiting to hear back from him.  She mentions something about Family Day affecting things.  Family Day is a recently added holiday in Ontario - this year it is on Monday, February 16th.  She says that she will call me when she hears from the Dr.  I’m thinking, OK, my appointment might be delayed a day because of the holiday.  Or, maybe the Dr. is on holiday this week, taking an extended vacation with the holiday.

I spend some time on my feet in the kitchen making supper, and by the end of it my heel is a little uncomfortable.  There is still some swelling around my ankle as well so I do some icing.  I had been taking ibuprofen to help with that.

My wife had been scheduled to fly to her mom’s place in NB with Zander today, but she postponed her flight.  I would have been fine on my own except for the dogs - if they don’t get a good run in the woods every day they drive us crazy.  Wouldn’t have been the end of the world, and I had tried to tell her to go, but I’m glad she didn’t.  We also weren’t sure if I’d be having surgery or not when she made the decision.

February 9th, 2009.  

I get up and continue to hobble around.  I’m putting weight on the bad leg all the time, but it doesn’t feel wrong.  I’m careful to keep my weight back on my heel and not use any muscle - I’m basically using it as a stump.  I get breakfast, take care of Zander while my wife walks the dogs (2 labs), then get in the bath since I haven’t yet cleaned up since the soccer game.  They call from the hospital to say my appointment in ultrasound is at 1:30pm.

I call a friend who’s been working at home to pick me up and take me to the hospital, since getting Zander into and out of the car seat can still be an ordeal.  I didn’t have to wait too long for the ultrasound.  There were two technicians - I’m not sure if the 2nd was being trained on using a different type of machine than she was used to, or on doing tendons instead of babies.  They had me lie on my stomach with both socks off - so they could compare the two sides.  It only took about 5 minutes.  I didn’t really understand what they were saying.  They did say that the radiologist may want to come and scan me herself, since it’s sometimes easier to interpret what’s going on by looking exactly where you want instead of just at the pictures that the tech’s take.  They left to consult with her and came back a few minutes later to say that she wouldn’t be checking me - she was happy with the images.  So I wipe off the goop and limp back out to Emergency.

It’s busy again.  Not quite as bad as the night before, but I end up standing for some periods again.  It’s a terrible set up.  The Registars are sitting behind a glassed in area.  They yell out your name through a little window when they’re ready for you.  Fine if you’re near the front of the waiting area, but you’re back in the corner behind the Coke machine there’s no way you’re going to hear them.  So I stand.  I’ve brought a book to read, but the magazine selection was actually pretty good last night.  I go through the same procedure - triage, registration, examination - then finally get called at about 4:00.  I get sent down the same hallway, but this time I don’t get a room, just a chair in the hallway.  I’m waiting so long that I fall asleep in the chair (although those of you that know me won’t find that remarkable).

The doctor calling my name wakes me up.  I recognize him - he’s the doctor that my wife saw when she had a miscarriage about 1.5 years ago.  I’m happy to see that it’s him because he was very personable.  He tells me that the ultrasound diagnosis is a “high-grade partial tear”, they won’t be doing surgery, and that the orthopedic surgeon wants to see me in the Fracture Clinic “later this week, or actually, next week”.  He said the surgeon wants me NWB until then.

Up to this point, I was totally prepared for surgery.  The first Emerg. doctor had mentioned it, and it is what I had focused on in my internet checking.  I had watched the videos on YouTube, knew what was involved, and knew that the common wisdom was that a surgically repaired tendon had a lower chance of re-rupture.  I said to the doc “So no surgery?”  and he said they don’t do surgery for partial tears.  I really didn’t have any other questions, so he said he would go find a splint for me.

About 20 minutes later he came back with something like this:

This is not the actual one I had - I don’t have it anymore and I neglected to take a picture of it, but it was just like this, minus the padding.  Maybe it didn’t come up quite as far this either - about 2/3rds up my calf.  The doc told the nurse to put some padding in it and left.  She put some sort of large gauze pad in it along the foot and upper portion, put my foot in, wrapped two tensors around it, gave me my crutches and a pat on the bum and said see ya later.  I paid for the crutches and called my wife to pick me up.

It didn’t take long for me to start calling this contraption the Stupid splint thing.  I’m not sure if that was before or after my lovely wife started calling me Frankenfoot.  She has more nicknames for me than I have hair left on my head.

I was back on to Google, now checking out what non-operative treatments were about, feeling pretty disappointed that I wasn’t going to have surgery.  I also quickly decided that the Stupid splint was not the correct thing to promote healing of my achilles.  I went into the basement and made up a wooden heel lift that I could insert into the Stupid, about 1.5 inches high.  It brought my foot to about 30 degrees.  Not ideal, but better than the 90 degrees of the Stupid.  It had the added benefit of making the Stupid a little more comfortable by keeping my ankle bones further away from the sides.  And although they had told me to be NWB, I couldn’t help resting on that leg.  Crutches suck!  I couldn’t do anything with them.  The Stupid itself was slippery, so I took a piece of floor-mat underlayment, the stuff that stops them from slipping, and put that on the bottom when I wrapped it up with the tensors.  The tensors didn’t cover the heel, so I had a good bit of sticky padding there which helped reduce the sliding and also the clomping.  (Sorry again - no pictures).

I started wrapping my head around the Conservative (non-surgical) treatment approach.  Already by this time, less than 24 hours after the injury, my expectations had progressed.  As I said before, initially my goal was walking normally and golfing.  Now, it was Screw That.  I’m young enough - I want to be able to do sports and run and play with my son without worry.  At this point I was thinking that surgery was the better option.

I was also having second thoughts about the ER doctor.  It didn’t seem like he did the right thing for me, and my wife also had to return to the ER after she saw him.  He didn’t actually do anything wrong with her, but he didn’t really tell her what to expect.  Maybe he thought the worst was over for her, but she ended up in a lot of pain and had to call the ambulance and go back to the ER while I was out with the dogs.  A nice guy, but I don’t know if I want to see him again or not.

My mom’s retired and lives a couple hours away, so I called her and asked if she could come and help out for a few days.  I think my wife would have had a breakdown if we were on our own.  We’re lucky that my mom could come.

I Frankenfooted my way around the house for the rest of the day.  At least I was able to take the Stupid off at night (was I supposed to?), and I could get a decent sleep.

February 8th, 2009.

So I drive myself to the Emerg. at the local hospital.  My wife’s at home with Zander and it makes no sense to get them out - it’s about 8:30pm on Sunday night, and they can’t help me.  Because I’m arriving in my own vehicle, I have to park it.  Most expensive parking in the city, and I still have to hobble 50m or so from the parking lot.

I walk in and it’s packed.  The Triage nurse is doing pre-interviews to decide who to triage first.  After the triage you have to wait to be registered and then wait some more to see a doctor.  There were some empty seats, but I didn’t want to squeeze in between some other sick people - pretty much everyone else looked worse off than me, and contagious, so I stood near the entrance.

I had already been wondering whether I should have bothered going to Emergency.  I wasn’t in pain, and I was pretty certain what was wrong - I thought I could have waited and called my family doctor on Monday morning.  The problem with that strategy is that my doctor is one of the most socially awkward people that I’ve ever met.  Being able to avoid the discomfort of interacting with him is worth quite a lot, but the backlog of people in Emergency had me thinking twice.  

When the triage nurse got to me, after about 30 minutes she asked “Do you need to see a doctor?”.  No, I just like hanging out with sick people.  Is there another reason I should be here?

I said “I don’t know.  I think I ruptured my achilles.  Do I need to be here or should I go see my doctor tomorrow?”  

She replied “Well, it’s painful”.  By this time it had started to throb a little, and she got me worried that it would get worse, so I stayed.

After another 30 minutes or so it was my turn to be triaged.  The first thing she did was what I later learned is the Thompson test (squeeze the calf and see if the foot moves).  I didn’t see the result.  She asked some questions: how it happened, on any drugs, what the pain level was (I said 2 out of 10), etc., and then it was back to the waiting room.  I was registered, and then later re-examined to see if my condition had changed.  Around midnight (3 hours after I arrived) I was put into an examination room down the hall - still hobbling with no crutch or wheelchair or any assistance.  I probably would have turned down anything they offered, but you would think they would suggest something.

A little more waiting and then the doctor came in.  He asked what was wrong and when I told him, his para-phrased reaction was “Oh no.  That sucks.  I mean, it’s a long recovery.”  In his defense, I do think he was genuinely concerned.

A few more questions (basically the same ones as the nurses), and some more feeling and squeezing (of my calf and ankle) ensued.  The very lower part of my calf was sore, like a bad bruise, especially when he squeezed it.  He also had me try to push with my foot against his hand.  I think I was able to exert enough pressure that he felt there was still some connection between my calf and my heel.  He decided on an ultrasound to confirm, and said I could probably have surgery soon after the ultrasound - tomorrow night or the next day.  He said I should use crutches, and left to check on the ultrasound details.  The best part is that I get to come back to Emergency to get the results of the ultrasound.

About 15 minutes later a nurse came back with my chart.  She said that the ultrasound department would call me tomorrow with my appointment time, and that I was free to go.  I said that the doctor had mentioned crutches.  She checked my chart to see if he had written anything on it about crutches, but he hadn’t.  She told me it was a $30 charge - you buy the crutches.  Our friends had recently mentioned that they owned crutches, so I crazily declined the crutches and hobbled back out to my car and drove home.

I made it upstairs for a brief update with my wife at about 1:00 am.  I came back down to hit the whiskey bottle and the internet.  There was an e-mail from one of the other soccer players waiting for me, asking me how I was.  I answered that, then as I told him in my reply, got on with the task of “Googling the shit out of Achilles tendons.”  (Can I say “shit” on here?)

I checked Wikipedia and then quickly came across the achillesblog.com (thank you Dennis!).  At this point I was just hoping I would be able to walk normally again, and hopefully be able to golf (and hopefully this summer - I’m on leave, dammit!).  I felt that I would never be able to risk playing active sports - I would be too worried about doing it again.

Went to bed around 2:30 and slept well.

February 8th, 2009.

I’m a 35 year old reasonably fit male.  Skinny.  Within the last 4 or 5 weeks I had started becoming more active in sports again - ball hockey, squash, indoor soccer.  I started a parental leave in January, happily helping to take care of little 10 wk old Zander - our first.  He’s not always as angry as he looks above, but I love it when the lower lip comes out.  The sports were giving a welcome opportunity to get out of the house for a few hours a week, and also a chance to get feeling fit without the distraction of work!  Before that, my exercise consisted of walking our dogs on some trails in the local woods. 

Through some guys that I was playing hockey with, I snagged an invitation to a soccer scrimmage in our new local indoor dome.  My wife grudgingly let me go to yet another event (4th sport plus one dinner that week).

I started out wearing my indoor shoes (completely flat bottom).  I had noticed in my only other time in the dome that they were a little slippery on the turf, but I hadn’t been able to tell if any one else was wearing outdoor shoes (cleats) and I wasn’t sure of the protocol.  After my first shift (and first - and last? - goal), I saw that another player on the sidelines with me had the same outdoor shoes that I have.  He said that turf shoes were best but the outdoor shoes worked well, so I switched.

About half way through the hour session I felt some tightness in both of my achilles.  It was a little strange, but I think I had felt that before.  I had progressed (regressed?) from being a thorough stretcher in my late teens to not bothering any more - I’m sure I read a study that said pre-activity stretching doesn’t lessen the chance of injury (probably published by the “We Aren’t Rich Enough Society of Orthapedic Surgeons”).  Anyway, I did a quick 10 second stretch, pulled up my socks of invincibility and carried on.

We had been given the “5 minutes” warning, and my side was making a final push.  The ball came out to me after a corner and I took a half step back and played it with my left knee to set up a shot.  When I put my left foot down to push off I heard (felt?) a “pop” and fell to my knees.  I’m a little confused about the next few seconds but I think I rolled over onto onto my butt.  I knew, immediately, that it was my left achilles, but I didn’t feel any pain.  I cautiously started to move my foot around.  I seemed to have the full range of motion, and nothing hurt.  I thought maybe a cleat had come off my shoe and that was the noise I heard.  Phew - I’m alright.  Someone helped my to my feet but trying to walk confirmed that all was not well.  It felt like a heel bruise, or almost similar to an ankle sprain.  I hobbled over to the bench.  When I felt around with my hand, there was the slightly sickening sensation of no resistance where the tendon should be.

Borrowed a phone to call my wife, packed up and drove myself to Emerg at the local hospital.  As someone said “He’s got the Lang!” (in reference to Robert Lang the hockey player that recently had his achilles severed by a skate).