Pop goes the achilles

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).