Pop goes the achilles

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.

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?

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

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

Plantarflexion

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

Zander - St. Patrick's Day

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

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

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

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.