Part four…Tendon Augmentation and Time For a Second Opinion, or Two.
Having spent five hours at the sports orthopedic hospital on Tuesday, I was not thrilled about coming back to see their foot and ankle specialist on Thursday. I knew it would mean starting from scratch, filling out more paperwork and more waiting, before we got the important conversation about surgery options. Sure enough, not only did I have to fill out paper, but somehow my file was not transferred from the referring orthopedist who I had seen in the same medical office not 48 hours before. Once I got everything straight, I was put in an exam room where I sat for close to an hour while I heard the foot specialist talking in the corridor. When he finally entered and we dispensed of my recounting details of the occurrence of the injury for what was now the fourth time, the foot doc interrupted to say that my rupture was very bad, bad enough that he felt there was no way to repair my Achilles with simple suturing and that he wanted to do an augmentation procedure. He felt that the best way to proceed was to remove my flexor hallucis longus (FHL) tendon, which runs from the heel to the “knuckle” joint of the big toe, where it bends, and weave this into the Achilles breach for support.
When I asked him what the negative ramifications may be, he said that I would lose some flexion and power in the push-off in the front of the foot. As an athlete, that didn’t sound like an attractive option; even if I am unable to play basketball again, I would still like to have power to push off to play tennis, or just run. I wondered whether I would even be able to negotiate stairs easily without that tendon. I asked if there were other options, and the doc said no, that was about it. He then left to go check on his surgery calendar for the next week so he could schedule me for the following week, and disappeared for close to another hour. Frustrated, I asked an assistant in the hallway to call the original orthopedist, who I had seen the other day. After about 15 minutes he re-appeared, with the foot man in tow. They reiterated the FHL x-fer choice and procedure, but when I looked into the eyes of the first doc, I couldn’t get what I could read as a 100% go sign. I like him and felt very comfortable with him; if we had gone through with the originally-scheduled routine AT repair on Friday it wold have been a done deal. But I didn’t feel confident in the foot man, and I didn’t like the way this new procedure was being thrust on me by him without any options. I asked that they do the surgery together as a team and they agreed, the first doc would do the achilles work and the foot guy would transfer over the FHL. I walked out behind them into the hallway where they could check the surgery schedule, and the original doc said he was available on the following Monday or Wednesday, but the foot man said he could not do it until the following Friday. That raised another red flag for me; I had read that ATR repair should optimally be done within 14 days of rupture, and this would take my surgery out to 11 days. I was facing a dire dilemma: I was ready to go and didn’t want to wait 8 more days, but this was Kerlan-Jobe, one of the world’s most pre-eminent sports orthopedic hospitals. And I wasn’t convinced abut the technique, or the doctor recommending it.
I decided to hit the internet that night. I also emailed and phoned a few other orthopedists. First I tried to learn as much as possible about FHL x-fer, but I could not glean much information. One of the articles I read said that I could lose between 20% and 30% of the power and flexion in the front of my left foot, which is my push-off foot in sports. I also began sending out leads to find another sports orthopedist in my area so that I could get a second opinion. The search was appearing futile, and as of Friday afternoon, I had not turned up a good choice. Then serendipity prevailed. I am somewhat of a “wine geek,” and one of the guys in my wine-tasting group works on a wine and spirits store. Feeling sorry for myself, I decided to drop in and buy a bottle of tequila. Though I rarely drink tequila at home, I thought this would be the weekend to do it, and after my fried recommended and excellent anejo we began talking about my injury. Out of nowhere, he asked if I remembered a guy who had been a gust at one of our group’s wine dinner this summer. He had great taste in wine, was buying bottles from my friend and, coincidentally, a sports orthopedist in the South Bay who works on some of the L.A. Kings and has achilles experience.
Five minutes later I was on the phone with the new doc, who told me to come down to his office, and 90 minutes later I met him face to face, carrying my MRI on a CD and my radiologist’s report.
(To be continued in Part Five…)
