Road to Recovery

I felt it was time I posted again on the blog as my progress has been so rapid over the last couple of weeks, I thought I would get distracted by the return to my hectic lifestyle and consequently never revert to updating this.   As you can tell, the good news is that my life has pretty much returned to normal — i’m walking confidently without a limp outdoors (in the boot), and gingerly around the apartment with barely a limp (without the boot).  My newfound mobility has meant, albeit the reduction in sporting activity, my daily routine and life is similar to what it was before. 

While not wanting to assume I’m on the home stretch, the rapid progress I’ve witnessed has really been due to the aggressiveness of my physical therapist.  My surgeon was somewhat conservative and had me NWB through 6 weeks, at which point he essentially ushered me off to PT and let me know I was in her hands from thereon.  Given that I am leaving for a trip to China at Week 9 1/2 mark (it’s funny to chronicle dates in weeks post operation, I know!), I felt I needed to overdose on PT if there was such a thing.  I’ve been going to PT sessions 4 times a week, an hour at a time for the last 2 weeks.  Every day, i’ve noticed an improvement in both my gait and psychological confidence.  Today, I was doing 50% calf raises and have had few issues with walking long distances around the city.

I realize progress plateaus at some point and don’t want to kid myself that I’ll be in two shoes tomorrow.  For security sake alone, I will be taking my boot with me to China… But, most importantly, I feel I have my mobility back and it’s the small successes that really make a difference.  To take a standing shower without the boot (and no cast cover) was a wonderful thing!

I’m slipping into a night splint now that I got from my PT today - she wants me to sleep with 5 degrees of dorsiflexion to keep my foot from getting lazy and tight in the mornings.  Let’s see if that works.

Continued well wishes to allow fellow recover’ers.

6 weeks post op…. and I thought this day would never come.  It definitely has seemed like a long time ago since the fateful “pop” but this day is a real milestone.  Fortunately (for me) the weather here in NYC has been pretty bad and, while misery loves company, I was actually thankful for the fact that nobody else would be enjoying the sun basking in Central Park.  Right around the corner from my apartment, crowds did gather for the opening of the High Line (overground Park remade from a disused railroad).  As a certified invalid, I however did not need to wait in line and was allowed special access at the 16th street handicapped elevator entrance!

Other notable perks that I have enjoyed over the last couple of weeks — special seating at a Broadway show and avoiding will-call lines, seats being offered to be at crowded meatpacking district bars (a rare feat indeed in this town), and people even offering me their cabs (an even rarer feat!).  Strangely enough I was at a gallery opening where the artist (photographer) himself  insisted on taking a picture of me for his archive — while somewhat offended, I think he wanted to highlight the “diversity” of his viewership.  Very strange indeed.

So I feel it’s about time I wean off these (very undeserved) perks and get back on my feet.  Unfortunately, my first steps after given my PT prescription and “WBAT” (weight bearing as tolerated) status were highly uneventful.  I saw the doc for a grand minute and was given the prescription and told to start PT…  I began my physical therapy yesterday and was excited to get started.  My amazing physio (who I have used before if anyone needs a midtown Manhattan recommendation) looked at the prescription and told me to start walking.  As I noted before, my left leg basically collapsed on me. 

I wish had been more vigilant doing leg lifts and movement to keep my thigh muscles strong.  Sadly, my whole leg had weakened enough that I could barely hobble along.  This was even stranger as my last injury (when I was 8 years younger), I recall having no issues walking and was immediately up and about again.  With greater age and perhaps a more sedentary lifestyle, I note that my body now doesn’t react quite the same way!

Well, it’s day 2 of physio now and I’m already feeling stronger and gingerly walking around (even if supported by crutches still).  I am doing a stringent PT regime — 4x this week and 3x each week subsequently for the next 4 weeks.  I had a trip to China that was planned for now that I had to cancel, and I have now postponed it to week 10 post-surgery.  The surgeon has ok’d my trip as long as I’m in the boot.  Fair enough!   It’s definitely something to look forward to and a goal to keep the physio on track.

Given my China trip though I succumbed and purchased a Vacoped boot.  My CAM boot, after only 3 weeks of use, has already started falling apart (and honestly doesn’t smell great).  I couldn’t imagine another 6 weeks with the CAM, let alone a trip to China in it.  Anyway, I just got the Vaco so will report later how it’s working.  So far it feels great — solid, safe, and with a bean bag type support system that feels very stable.  Through all my sports injuries, I’ve now sadly used all three types of boot - CAM, Aircast and (starting) the Vacoped.  I’ll report back with my reviews or ping me if you need any advise on comparing them.

To fellow NYC’ers, thanks for the help and camaraderie through all of this.  If you see a guy peddling around town in a strange looking ski-boot, stop me and ask me if I’ve had any new perks lately (maybe a ski pass for Kilington next season?!).

Safe recovery to all.

The joys ... Epsom salt foot bath and "transformer" Vacoped

I’ve sadly avoided updating my blog for a couple of weeks. Like others on this site, the general lack of activity/updates are the primary reason for not writing more. So, instead of boring you with the mundane updates on my recovery, I have found the following (random and by no means comprehensive) list helpful to me psychologically as I get through this recovery:

- A calendar with dates to cross off and dates to look forward to
- A supply of multivitamins, MSM, Glucosamine Chondroitin (all likely placebos!)
- My iWalkFree crutch to allow me to use both hands around the apartment (though so ridiculous looking, I haven’t braved wearing it outside)
- A constant stream of lunch, drinks and dinners with friends (though the five restaurants within my 2 NYC block radius now all know me by name)
- A daily crutch walk round the block, where I wave at my haircutter, my laundry-guy, the doormen, dogwalkers, the car-wash guys, and the guys at the local deli (yes, they all know me by now and still keep asking my “how I did it”?!)
- Occasionally making up new stories as to the injury to make it more interesting (squash is just too simple, especially since most Americans don’t even know what squash is).

So, I’m sure you fellow ATR’s have your own similar list. To update you quickly on my progress, I went to the doctors at the 3-week post-op point, he took my hard cast off and put me into this boot:

The boot is made by Biomed and has an air pump. I had the choice of the Aircast or this boot and chose this mainly because it is black and less wide at the calf (so my trousers can fit over it). It also doesn’t require heels as it has a built-in gradient for adjusting plantar-flexion. Having had the boot for over a week now, I must admit maybe the aircast was more comfortable — it doesn’t have two metal rods either side for support. I’ve found this boot has been uncomfortably heavy and these metal supports have bruised my ankles when i’m sleeping due to the weight applied on them. In any case, my tendon is firmly locked in place, so as long as it’s immobile I hope it’s recovering ok!

The orthopedist put the boot at roughly 30 degrees plantar flexion, which is a little more dorsi-flexion than my hard cast. Initially it was a little uncomfortable so I inserted a gel insert, but now it seems at peace with only the occasional soreness. I have little pain except for the odd twinge when I move my foot around (in the boot) too aggressively. While the doctor said move my foot very slightly when I take it out of the boot, I have erred on only doing so when I am in the boot. Similarly, I only take the boot off occasionally when I shower as (remembering my last ATR injury) the only time I am susceptible to additional injury is when I slip in the shower. I don’t ever want to do that again!

Finally, I have posted a picture of my scar. I must admit it looks pretty good compared to my first scar from my right ATR injury 8+ years ago (picture on my first blog posting). I learned that my surgeon is actually the assistant physician for the Yankees, and has no doubt done many of these ATR’s before. I suspect (and hope) he well knows what he is doing and hopefully his sugical skills extended both to the tendon as well as the scar!

Only another two weeks and then starting PWB and some initial physical therapy. It seems like a fairly conservative protocal for a physician to the professional athletes, but since this similar timeframe worked for me last time (yes, my right AT that I ruptured 8+ years ago is stronger post injury), I’m comfortable moving at this pace especially since I’m older now.  I’m hoping I’m walking so I don’t have to crutch around when the heat gets sweltering here in NY!

Safe recovery to all.

Baby steps…
I was in and out of the surgeons office in a matter of minutes. “Buzz”, and within seconds my first hard cast came off as I layon my front with cast leg held upright by the physicians assistant applying her buzzing scissors. Intentionally lightly plucking the cotton padding off my foot, I couldn’t help but burst into hysterics due to the only ticklish part of my body being constantly teased. Within another matter of seconds, the doctor said “looks good”, “let’s pull out some or maybe all of these stitches”. I asked, “didn’t we use dissolving stitches” (as the surgeon had done in my last ATR surgery 8+ years ago), to get the quick retort, ” you don’t want to risk additional infection in this very delicate part of the body”. Again, goes to show, every surgeon has a different protocol.  A few pin-prick stitch extractions later, another hard cast is then quickly applied back onto the foot. I’m told to keep doing whatever I’ve been doing (i.e. nothing), and come back in two weeks.  I also had some quick back and forth about cancelling a trip to China at week 8 post-op, to which the surgeon suggested no long vacations (or rather, active vacations) for at least 3 months.  Bah.

Very unexciting, but I’m now back on the couch with leg held high. Other than some mild swelling and pain from being jostled around in the cab, to and from meetings and the doctors today, overall I’m feeling (or perhaps, sensing) some improvement.

Onwards and (leg) upwards…

I am now one-week post surgery and am beginning to feel the extra pounds around my mid-riff. While being fairly active prior to the injury, I resigned myself to a week of bed rest post surgery. Despite the limited movement around my apartment on the crutches, I did not risk (or will) any further exercise. Needless to say, comfort food was part of the recovery protocol for me — sadly, now I’m feeling the pain of having to lug around my extra weight on these crutches!

Speaking of lugging extra weight around, the biggest physical and psychological issue at this point of recovery is the inability to use your arms/hands. As I mentioned in an earlier blog, I am an unfortunate second-time rupture’r (last time right leg, this time left, and both playing squash!). My hardest memories from the last injury, over 8 years ago, was being unable to take care of myself. At the time, I was at business school and relatively independent/infallible prior to the injury, so the psychological effects of having to ask for help and crutch my way around campus were tough. This time round, despite being in much different personal circumstances now (not living in a dormitory, family to help, my own apartment, etc.), the psychological dependency issues still remain. So, what have I done about it? Since, my last injury I noted a number of new “inventions” have emerged that supposedly help people in our unfortunate situation. I refer specifically to those crutch-less crutches. After some research (primarily on these blogs), I dived in and bought the following two items (I didn’t get a wheely crutch as I didn’t want to be too lazy spinning around).

1) one-crutch (www.onecrutch.com)
and
2) i-Walk-Free (www.iwalk-free.com)

I plan to use these to help me bide the time at home and potentially find a way to get around more conveniently when I am outside.

I’m only one week post surgery (and still in a hard cast), so I’ve spent most of the week on pain-killers and with leg elevated, but my initial reactions from my limited use of these crutches have been mixed:

The one-crutch while simple in design, is a heavy piece of metal, that I feel I could have put together in a metal-work shop. It screws onto your (under-arm) crutches and supposedly you put the weight of your injured leg onto the one-crutch and have no need for the other. So far, I’ve found it to be a heavy crutch and very awkward to move around. It was $50, so I suppose it was good value for money, but I think I’m going to need a lot more practice to be as smooth as the guys on their web-site cruising around.  At least, it is easy to take on and off and is does not look like an alien-attachment….

I had high hopes for the i-Walk Free (especially since it retails at $400) and the web-site speaks wonders about it. If you watch the media video on the web, you I had to believe a young-ish athletic man can at least walk as well as the lady presented in their video?! Well, I have failed miserably on this belief to date. There is a lot of time and attention needed to alter the i-Walk Free device to your personal dimensions and perhaps I have not yet got mine correct. While liberating me to balancing on both legs (or one real leg and one peg-leg), I have found when walking, I need to move with a very wide stance (western style) and over-exaggerate lifting my good leg to move forward “smoothly.” Anyway, it’s early days yet, and despite some lower back pain from the awkward jagged movements, I have at least had some luck doing basic tasks with my i-Walk (e.g., making bed myself, getting stuff from the fridge, making tea/coffee, organizing my closet!). Normally, I wouldn’t do any of these tasks when I had both good legs, so I’m glad to say this injury is already making me into a better person!

More to report on the crutches and my improvement/practice in future posts.  Wishing all other ATR’s a continued successful recuperation in the meantime.

The "crutchless" crutches!

The only thing that was different than I had expected was that the anesthetist recommended I have local anesthetic (as opposed to general).  I came in assuming I would want to have general anesthesia, and have had no issues with this in my past operations.  In any case, I came around to the anesthetists recommendation and I lay out below (what I see) as the pros and cons of weighing the decision.  I was also commenting on Bennet’sblog page on the same topic earlier today, so I assume this is a topical subject for all of us:

General Anesthetic:

Practical Pros — Knocked out cold and little/no recollection of entire surgical procedure

Practical Cons — Possible medical ramifications on other bodily organs (minimal though if you have no history of problems or in your family history); Potential nausea post-op; Likely to be doped up for the remainder of the day

Local anesthetic:

Practical Pros — Awake soon after surgery; Pretty much mentally fully functional after surgery; Leg numb for 12-15 hours 

Practical Cons — Have to listen to/see initial wheeling into surgical room; Local anesthetic blocker applied to specific nerves (minimal complication risk); Numb leg for 12-15 hours feels like you lost a limb

I’m sure there are many other pros and cons, but these were the one’s that were top of mind as I write this.  Going back to my situation, I was hell-bent on GA.  My mother is a retired anesthetist and she wouldn’t recommend anything but it.  However, today, for some reason, the anesthetist encouraged me otherwise indicating for this “standard” procedure local will be more easy to administer and I’d feel much better for it.  He was right (or so I think at the moment) — I was wide awake a couple of hours after surgery while everyone else in the post-op waiting room were sound asleep (another surreal experience). 

The toughest thing about the local was being fully aware as I was being rolled into the operating room and seeing all the doctors around me (felt like a bad dream).  The subsequent psychological damage, if any, was having to listen to the anesthetist and his junior anesthetists poking around my leg with a needle and ultrasound imagery to find the “nerve” to block.  This was a little uncomfortable with a couple of mildly painful shots, but soon subsided.  Within minutes, they hit me with some strong sedatives (anesthetist said they were “valium like”) and I didn’t wake up until the post-op room.

So, here I am at home, almost 10 hours after surgery with my leg up on a chair buffeted by a big pillow.  The advise to raise your leg above heart level is pretty unwieldy, so I asked my dad about this (who is a plastic surgeon) and he said try to keep your leg at least above groin level… this is a little more comfortable at least.

With that, I’m going to go back to watching some more dumb TV, reading the papers, and having a nice glass of wine (not too much though, as I’m likely going to need the heavy pain killers as soon as this local anesthetic wears off!).  Good night all.

Better get used to this leg-up position...

First and foremost, thank you for this amazing blog. I have never blogged before and am not very experienced at this, but for such a great cause, I felt I had to get involved and share my story.

So, here we go again…. yes, sadly this is my THIRD achilles rupture. I have ruptured twice before on my right leg and, this time round, it’s unforunately hit me in the left leg. I guess I saw it coming, as they say, those that have a tendency to rupture in one leg, will equally likely do so with the other. Having said that, it’s been over 8 years since my last rupture so I at least had a good run in between.

So, how did I do it? Well, like many others on this site, I am an avid squash player. Last time round in 1999, I was in a tournament and heard the classic “pop” and didn’t know what it was. I even walked (or limped) my way to the railway station to head back to my parents home to get some care and attention. The second time round was also on the squash court again, but I blame myself for jumping back into the game way too soon (I was probably at around 14 weeks) even though I was only practice hitting.

My first injury was treated “conservatively” by the surgeon - i.e. there was no treatment whatsoever other than natural recovery in a boot. At the time, I was just starting business school, so it was a psychologically traumatic and humbling experience. The hardest thing was having to fly to the US (from the UK) alone and arrive at school not knowing anyone. Having to rely on others, make new friends, and still do well at school while jumping around on one leg was not enjoyable to say the least. To add insult to injury, it was the middle of winter at a New England school — ice and snow everywhere. I won’t share the horror stories of falling in the ice, but as you can imagine there were many such unfortunate situations. The upside of this whole story was that, by peddling myself all over campus non-weight bearing for 8+ weeks, I was in great shape — even getting up and down steep staircases (looking back I was crazy to do that given a fall could have resulted in much more severe injury).

After the second rupture, I went back to the original surgeon (who felt terrible) and surgery was decided for the next recovery.  This time round, he stitched my tendon up good and tight. The healing process went well and I was back on my feet in a matter of 3 months, though didn’t play competitive squash again for at least a year .

So, it’s over 8 years later now, and this time round I was just recreationally playing on a Thursday morning. While I have been good about stretching and taking care of myself, I knew I was pushing myself for: 1) playing first thing in the morning when my body is naturally stiff, and 2) playing every other day in training for a club tournament where I was in the semi-finals. While stretching in the morning, prior to the game, I felt my left tendon being a little tight but foolishly thought it was nothing serious. As a right handed player, most of the stress is on my racket foot (right leg) so generally, I have not worried as much about my left foot. To all other squash players, don’t make the same mistake I did — stretch both achilles religiously!

While in the fourth game, I heard the tell-tale “pop” again so knew instantly what it was. This time round though, I went straight to ER. After 4 hours in ER, even though I knew what the diagnosis was, and 3 medical Residents poking at my leg, they told me the inevitable — go see the ortho. I was able to get an appointment to see my orthopedic surgeon the same afternoon. He was understanding and suggested I go into surgery the following Monday (5 days post injury). While my inclination was to get surgery asap, he informed me that there are only possible surgical difficulties after 7 days. He did however encourage me not to fly before the surgery as I was planning a trip to Miami… now cancelled.

Tomorrow is the big surgery day. I’m a little anxious but having been through this before am hoping the day goes by quickly, and that i’m drugged up on percoset before I know it back at home on my bed. I’ll report back in in the next day or two to let you know how it goes.

Here’s a picture of the scar from my previous right foot achilles surgery. Come next week or the week after, I’ll no doubt be looking at a similar looking scar on the other foot. At least, I can keep using the shark-bite story from my Scuba diving trips (claiming I now got bit on the other foot coincidentally).

8 years later still looks ugly!

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