I ran into a former coworker who ruptured his achilles tendon about 20 years ago. When I told him the short version of my husband’s treatment, he said the treatment has changed a lot. Twenty years ago, he had surgery then spent 10 weeks in a plaster cast that extended to mid-thigh. Yikes. Then he went into a shorter cast for some duration that he couldn’t recall.
So, as grim as treatment is now, it sure could be worse.
My husband just came back from the doctor — the boot came off and a shoe went on. Hooray!
The doc removed the boot and felt the surgery site and said “good, the tendon is attached.” I said “sheesh, have you ever had to say ‘darn, it’s not attached’?” He laughed and said luckily he has never had to say that.
Next appt is in six weeks. In the meantime he said to continue with PT; he can add slight strengthening exercises with an exercise band but no toe raises; no running; no walking up and down hills…”nothing crazy.” He said walking is good [of course, we live in a hilly area]. He felt his calf and commented on the atrophy; I cannot remember his exact words but he said something that made me think that the atrophy might not happen to everyone.
On the walk from the clinic to the car, my husband kept saying “wow, this feels so odd” — he said there isn’t pain, everything just feels tight. I think he feels a bit vulnernable without the boot; it provided security and stopped him from doing something silly.
I asked the doc about driving [please oh PLEASE let him be able to drive!]; he said he can drive now but to take it easy; go to a parking lot and give it a try before hurtling down the road. He suggested keeping it on local roads for a while; no driving on highways or ice or anything too wild. As an aside, apparently in Oregon, it is against the law to drive with a cast or boot — doesn’t matter which leg is impacted. Hmm.
Another physical therapy appointment tomorrow.
I hope everyone has a restful holiday — let your loved ones wait on you, relax, put your leg up, have an adult beverage. And may all your holiday wishes come true.
My husband had his first physical therapy appointment today. It went really well — the therapist spent about an hour checking his range of motion, checking his leg and hip strength, showing him various exercises to begin doing at home, and best of all — how to walk using only one crutch. Yayyy! He focused on how to use the crutch properly (the crutch moves with the injured leg), and how to avoid thrusting his hip out to the side and tilting oddly to navigate the boot.
Things went really well and the therapist said “ok, now try walking with no crutches.” I could see my husband’s face blanch a bit, but, down went the crutch and he walked across the room with relative ease. The therapist said to let pain be his guide; elevate and ice when pain or swelling occurs.
He showed me how to massage along the sides of the incision (very small motions of moving the skin back and forth in a vertical motion); plus rubbing his lower leg to get rid of some of the edema (I think that’s the right word). He said to use an upward motion, starting at the top of the calf and working my way down to his ankle.
He’s a tired pup tonight, but, did walk around the house a bit without crutches or only one crutch. He said it felt SOOOO good to have a free hand.
This is good for his morale which I could see had dropped a bit in the last week or so.
Fun tshirt
I found a fun t-shirt on eBay for the Injured One. It made him laugh:
The head coach for the Portland Trailblazers ruptured his achilles tendon today:
by Associated Press
December 4, 2009 at 4:45 PM
PORTLAND, Ore. (AP) — Portland Trail Blazers coach Nate McMillan ruptured his right Achilles tendon during practice Friday and will need surgery.
McMillan will coach Saturday night’s game against Houston, but he will miss next week’s four-game road trip.
The Blazers say McMillan will have surgery on Monday.
Assistant coach Dean Demopoulos will take McMillan’s place starting Monday in New York.
The Injured One had his stitches removed yesterday and rec’d the go-ahead for easing back into work (4 hours a day). I think going from reclining in an easy chair for weeks to dealing with the work environment was quite a leap (he’s snoozing in the easy chair with his leg elevated as I type).
The surgical site looks good according to the doc. Next week is PWB — yay! Scheduling the first PT appt is in the cards for this afternoon.
Progress!
One of my best pals is an orthopedic PA; she is visting from another state for Thanksgiving. She took a look at my husband on cruthces and said “whoa — you need to adjust those crutches!” She said the height to underarm was good; but the hand grip position was too high; she suggested lowering them by two adjustment holes. She said he should be aiming for a 20 degree angle in the arms when holding the grips. My husband said that adjustment really helped; he feels far more in control. He looks more in control, too. He’s 6′2″ and those crutches looked like out-of-control albatross wings!
She participates in achilles tendon surgeries regularly so it was interesting hearing her description of what it’s like from the surgeon’s perspective [stop here if you are squeamish!]. She said sewing the tendon together is a bit like sewing crab meat — the ruptured ends of the tendon are like ends on a string mop. They use special stitches to hold everything together “under the hood.” She drew a picture that looked like a long, wide, zig-zag sewing stitch running vertically down the leg. On the outside of the leg, my husband had dark purple lines running periodically up the incision — sort of like train tracks. She said they make those marks before they cut. When it’s time to sew the patient back up, they use those purple lines to align the skin back in place. When I said “really?…you need a map?!” She started to describe what the surgical site is like when it’s time to sew up the patient — she stopped when she realized it might be too graphic for the lay person. 
We have been venturing out into the world a bit more (10 days post surgery) — it makes me so nervous to watch him navigate with crutches (he’s 6′2″ and those crutches seem huge). We went into a restaurant yesterday and a few steps into the entry way, one of his crutches slipped on the wet tile floor of the restaurant. Scared him, me and the hostess senseless. He regained his balance and took one more step and slipped again.
Today we went to a local university coliseum for an athletic event (a friend was being honored). The whole navigation process with thousands of jostling and careless people made me crazy nervous. I’m ready to mount a bicycle horn and a strobe light on him so folks will give him space. I wanted to yell and start shoving “STEP AWAY FROM THE MAN ON CRUTCHES!”
The whole ADA access sure comes to the forefront — what a nuisance getting into the building with a long snaking ramp that popped us out nowhere near the entrance. It was pouring rain and I poked my head into the closest entrance and asked if we could go in that door. A surly, self-important employee barked “no…players only.” I mentioned the crutches and said “please…this crowd and rain is murder.” He just turned his back on us. Pah.
I called in advance to the sporting event and asked about seating — she said handicapped seating is reserved for folks in wheelchairs, but, the seating would be fine and easy for someone with crutches. The “easiest” seating was one step off the floor, but the step wasn’t a garden variety code-compliant step — it was really tall and the seat was set back some distance. He made it just fine, but, I could tell by his “oh sh*t” expression that it wasn’t easy.
Sigh. And so it goes!
Looks like something Darth Vadar should wear
The bad news about the boot is the cast cover we purchased won’t fit over the boot. Dang — back to garbage bags for the shower caper.
The patient was somewhat uncomfortable for the first 24 hours (ish) after transitioning from the cast to the boot — the angle of his foot changed quite dramatically and that was uncomfortable a bit. Not enough to take pain pills; just enough to be noticed.
We just removed the boot for the first time to change the dressing and wash the sock-like liner (day 10 after surgery). The incision looks good (and smaller than it appeared in the doc’s office a few days ago); no drainage. As I type this, he’s on the sofa with his naked leg on a pillow — relishing in the air on his leg.
One of my best friends is a PA in another state. She was really shocked the doc moved him to a boot already (1 week post op). She said the danger is some patients leap to the conclusion that they can start putting weight on the foot or doing foolish things. She said “wow…your doc is really aggressive.” That made me a bit nervous — was he too aggressive maybe?
The post-op visit was one week after surgery. The tech/nurse removed the cast — it was interesting to see how the cast was built. Lots of layers, and gaps in the plaster to allow for swelling. When she got to the skin, the skin was a lovely shade of yellow-ish orange due to the Betidine solution they used to scrub him before surgery. There was a lot of glued on gauze which she spent a bit of time removing. The incision looked good (as those things goooo) — no swelling, no infection. It is on the inside of his ankle a bit; maybe 3″ long?…4″ ? The doctor came in and examined the incision — he said “oh good, the tendon is attached.” (Are they ever NOT attached?!…goodness.) He said the surgery was straight forward; the rupture was about 1″-ish above where the tendon connects to the heel. He was happy with how things look.
To our surprise, he said the patient would move from a cast to a boot that day. We were not expecting that for quite some time. He did stress that the restrictions are all the same. Absolutely no weight on that leg. The PA came in and suited him up in a big black boot and spent quite a bit of time showing us how it goes on. He admonished that the boot can be taken off, but, he recommended we leave it on at all times; even when showering. He said the last thing you want to do is slip and stress the surgical area. He scowled and said secondary surgeries are much worse. At the heel of the boot are two small foam wedges to elevate his heel a smidge — less than 1″ I would guess.
The patient is much happier with the boot — it is far lighter than the cast (though I think it’s quite heavy); he says he feels more secure in the boot that the cast (in terms of support to the leg).
He said we should periodically check the incision and change the dressing; once it quits oozing, we can just use bandaids (keeps things from catching on the stitches).
