Scott’s AchillesBlog

Well, today I’m back home and sitting with my leg up, icing it often.  Which is really what you’ll want to do for the next 2-4 weeks.

My surgery was ok, and I don’t want to scare anyone with details, but I also want to chronicle it for my reference and so people know what can happen.

I’ve had ankle surgery before, and the last time (about 2 years ago) I had it the anesthesiologist was doing a local nerve block, which is common for surgeries so you wake up in very little pain.  I had a reaction to the lidocaine and started getting hives all over under general anesthesia, then my face swelled up, and I started sneezing, all while being totally out.  I woke up to more than a dozen very concerned medical staff, unable to see out of one eye.  When my wife came in and saw me she started crying I looked so bad.

I’d had a less potent reaction to lidocaine before at a dermotologist and after this last episode was told to go see an allergist.  The allergist gathered the facts from the two situations, found there was no preservative used, looked at any similiarities between the two situations and concluded the only thing it could have been was the lidocaine.  Because of the reactions, the potential for anaphylaxis, and the only thing similiar in the situations being lidocaine, she concluded it was too dangerous to try a challenge to lidocaine to confirm and instead tested with Chloroprocaine (Nesacaine) of the Esther group to just see if that was a better alternative.  With that I tested fine.

The day of the surgery I made sure to put this on my form and my wife told everyone she talked to.  When I met with the anesthesiologist I made sure to tell her as well.  Her first impressions were that of unbelief.  She said allergies to lidocaine were very rare and questioned the fact that they never did a challenge.  She also said that lidocaine was the only local anesthetic they had on hand and went to get my doctor.

My doctor came in and explained the whole local nerve block to me.  Basically during surgery, lidocaine is applied to the nerve (I could be getting this wrong) and your leg is numbed.  What this allows is when you wake up, rather than feeling the results of the surgery, you are just nice and tingly.  My doctor explained to me that, without local anesthetic, I was going to wake up to a world of pain.  I didn’t necessarily want that, but I really wanted to actually wake up vs. the alternative of anaphylaxis so I asked for no local anesthetic as lidocaine was the only option.

A couple hours later I woke up from surgery and yeah, it was a world of pain.  I felt like a knife was buried in my ankle, they’d also had to cut and lengthen my calf muscle due to an abnormal amount of fraying (gastrocnemius recession), and I kept trying to hold my leg up with my arm to get pressure off of it.  But what the hell, I couldn’t see out of my right eye…  The anesthesiologist first said since I was on my stomach that it must be from just lying on the pillow.  She then went on to explain that lidocaine was accidentally applied to the breathing tube as is common procedure, despite having all of it out of the room.  She went on to say she felt this had nothing to do with it though and that I needed to follow up with the allergist for a lidocaine challenge…  I was rapidly given the painkillers fentanyl and dilaudid though so I gradually began to care less, besides asking over and over again if my eye was swollen.  My wife, on the other hand, was pissed.

A common side effect of the stronger painkillers is diminished respiration, which I started to have.  It was bizarre though, it wasn’t that I felt like I was gasping for breath, it was more that if I wasn’t told to consciously think about breathing, I just didn’t.   My pulse oxygen meter would drop below the threshold, an alarm would go off, and I’d have to breath in to this apparatus that was more like a toy designed to keep me occupied than anything else. It had a neat ball in it that I’d have to breathe at a certain rate to keep the ball in check, and they gave me goals as to how high it should go.

This obviously concerned the doctors and anesthesiologist.  It concerned them enough that at 5pm, they told my wife and I that I either needed to stay until 10pm when the painkillers wore off, or I needed to simply stay overnight on oxygen.  In a painkilller fog, I just wanted to get home with my family, not even thinking about my wife also caring for a 2 year old and a 3 month old.  At any rate, they told me to order dinner and I got some salmon, asparagus, a fruit cup and some apple juice.  It was the best hospital food I’d perhaps ever eaten.

Around 7 or 8pm, one of the two nurses who would be taking care of me all night convinced me and my wife that staying overnight was probably the better solution for me.  Not only would my wife not have to worry about me, but they could get pain management (remember no local anesthetic was used) under control and I could have supplemental oxygen all night.  This turned out to be a very good thing as I got sleep, my pain was very little, and I got fed all night long.  It was awesome and the two nurses took great care of me.  For purposes of protocol, I was given fentanyl and percocet while overnight in the hospital, the dilaudid was deemed to be ineffective and no longer used.  I was sent home with a prescription written earlier for percocet and dilaudid, but found the same thing to be true, dilaudid didn’t appear to do anything for me despite being the go-to painkiller of choice in the case of severe pain.  Percocet, on the other hand, worked wonders.  It’s bizarre to me how different painkillers affect everyone differently.  Throughout the experience I’ve been amazed at the lack of pain, even without painkillers.

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