07.01.08
Conservative in San Francisco … who knew?
In a city where gay marriage is no more taboo than jaywalking, where “green” is not a color but rather a way of life, where the political parties are Democratic and Progressive, conservative ideas are alive and well. Where? My orthopedic surgeon’s office at Kaiser Permanente. Oh no, no. Don’t get me wrong. Everybody who works there still embodies left-of-center ideals, still hates Bush with a passion. But when it comes to the healing process of my Achilles tendon rupture, they are probably more conservative than McCain would ever be!
Now, before I start offending any more people, I should explain. I went in for my third post-operation exam last Wednesday. After reading about all the varieties of treatments our bloggers have had, I was prepared to ask about the next step. My progress so far seems to be normal. A week after the operation, I went in, had the stitches removed, had my foot put in an “equinus” position (which makes me think of a horse for some reason, but in this case, means having my foot pointed downward), had a cast put on, done. Two weeks later, had the cast removed, had my foot pushed more toward neutral, had a cast put on, done. Rinse, lather, repeat. I had a feeling that my third meeting, which was 5 weeks after my operation, would probably be same, but I was hoping for something more. Obviously, I haven’t take a survery (but now I kinda wish I did), but based on everybody’s blogs, it seemed to me that a lot of people were moving on to partial weight bearing or a boot or whatever by the fifth or sixth week, if not earlier. I started to have fantasies of a boot, something I can remove, so longingly, I was like a man shipwrecked on a deserted island, fantasizing about the first thing he’d do once he got back to civilization.
After sawing off my cast, my doctor did a few flexes, a few squeezes, and said how wonderfully everything was healing. I looked back at my leg (I was lying on my stomach) and what I saw was anything but wonderful. It looked disgusting! Scabs. Swelling. Colored splotches. I knew he was probably right, but I still felt it kinda funny how anyone would look at my leg, in all its puffy scabbiness, and call it “wonderful.” But I digress. Since everything was looking so wonderful, I decided to talk about … the boot. With full confidence, I started:
“So, everything looks great, huh?”
“Yup. I did a pretty good job if I don’t say so myself.”
“Awesome. So, doc, you know, I’ve been reading online …”
“Uh-huh.” (with that “huh” part dragging out a little longer than I wanted to hear, and that dip in intonation)
“… and it seems like a lot of people move on to a boot or something by the fifth or sixth week, so …”
“Yeah, but we don’t do that.”
The directness of his statement almost stopped me dead in my tracks. A quick left jab I wasn’t expecting. I was hit, but not down, so I pressed on.
“Well, yeah, I know we’re not doing that today. But I’m thinking at the next meeting, we’ll be switching, right? By that time, it will have been seven weeks and …”
“I don’t recommend it.”
Another quick left jab, but this one quicker … and left-er (if that makes any sense) and harder. But I wasn’t finished. A change of tactic then.
“Huh. So, why is that? I mean, I’m sure there’s tons of ways to recover from this thing, but it just seems …”
“Well, it’s how the operation is done, for one thing. When we operate on your Achilles, we don’t depend on the sutures to strengthen the tendon. We make sure to connect the tendon well, but let the body heal itself. I think this works best. It’s organic. It’s your own strength, so you’re not depending on something we put in you. I’ve had years of experience on this and this way has been very successful.”
Each one of his statements were like blows to the head and the last one was the knockout punch. I was down for the count. Weakly, I tried to come back.
“Ummm …”
“In my opinion, it would be an unwise decision to move on to a boot so soon.”
My best defense at the time was wanting to say, “But I want to be unwise ….” But I realized how stupid that sounded. The bell rang. The champion was declared. I lost.
He said I would probably be in a cast, getting around with crutches for another 4 weeks, bringing the non-weight bearing total to 9 consecutive, excruciating weeks. Sensing my despair, he conceded that his methods were indeed more conservative, but they have shown excellent results. I know I should listen to him. The last thing I want is for something to go wrong. I think I really would go insane if I re-ruptured during this process and I felt so sorry, angry, and terrified when I read about that happening to a couple of our bloggers here. But at the same time, I really don’t look forward to 4 more weeks of climbing three flights of stairs in my elevator-less apartment building; 4 more weeks of this long shower ritual I now need to go through that I’m sure everyone’s familiar with; 4 more weeks of feeling the pain of my foot swelling against a hard cast. OK, time to remind myself: Happy thoughts! Happy thoughts! Sunshine! Smile! Celine Dion!
He said that at our next meeting, he’ll test me out. Mentioned something about a walking cast, possibly a boot if I can remain at neutral, but most likely not. Nine weeks in a cast and on crutches. Sounds extremely conservative to me. Has anybody else’s doctor prescribed that?
Oh, and by the way, after last week’s Get Smart, this week I saw The Diving Bell And The Butterfly on DVD. Wonderful story. Very inspirational. You get to see just how strong the human spirit can be. It’s the true story of Jean-Dominique Bauby, former editor of French Elle magazine, who suffered a terrible stroke that left him nearly completely paralyzed. Yet with optimism and determination, he was able to write a memoir using only blinking as his way of communication. A must see. It made me forget about my troubles for the day … until I had to shower. =P
annieh said,
July 1, 2008 at 2:11 am
Morning from England,
Loved the story, made me smile as I start work at 9 a.m. here.
Anyway, as you say, I digress, when I first saw my consultant he said immediately 9 to 10 weeks in plaster. I was shocked and he said that was what he found to get the best repair. I was just over 9 weeks in the cast,
then he just said, right you can walk out now!! I was terrified at first but managed to leave the hospital OK.
Now third week out of cast and started physio therapy (or phisical terrorist) as my late father-in-law used to say), went yesterday I was in awful pain all day, she really put in through it. Going again Saturday then twice a week for next 6 weeks, as I am nearly 59 I think my recovery might take a little longer than most.
Anyway, back to your comments, if you were in England I am sure that 9 week rule would be the norm.
Annie
annieh said,
July 1, 2008 at 2:18 am
Ooops, forgot to mention, I didn’t just ‘WALK’ out of hospital, I am still on two crutches!! Told I will need 2 crutches for at least another month, then down to 1.
Annie
Linda Renwick said,
July 1, 2008 at 3:39 am
Hi from Scotland
I too was over 9 weeks in cast then left hospital on crutches wih heel inserts. I was told to wean myself off the crutches gradually and eventually just use a walking stick for balance. I loved the freedom of showers without having a seat! My calf muscle is still very weak despite following all PT instructions etc. I can walk without a limp but I still take baby steps going down stairs. Still at the back of my mind is the fear of the dreaded re-rupture. My ATR was 1st Feb but I walked on it for 4 weeks due to misdiagnosis by doc so I think this accounts for the weakness in calf muscle. I only had 4 PT visits but have an open appointment for 4 weeks if I have any problems.
Good Luck
Linda
edforman said,
July 1, 2008 at 6:23 am
I can only imagine how you are feeling right now - I know it felt like a death blow - but you are more than half way there. Also, remember, that tendon is healing in the cast so when it does come off, you will be as healed as those of us who have been booting it. In the grand scheme of things, its 4 weeks - I know, feels like an eternity, but you will get there.
We choose our surgeons usually based on their good reputations or based on referalls from people who we trust. We don’t always know their exact methods when we start with them, but we must trust them. Before surgery, I got a second opinion because I just didn’t trust the first surgeon - and I am so glad I didn’t let him operate on me - I would have always second guessed. Just keep trusting that he is doing what is best for you…
As to what your leg looks like, I’ve been in a boot for 10 days and still have a scabbed over, swollen, blotchy incision, so you are not alone there!
Ed
damacar said,
July 1, 2008 at 10:39 am
Well, i’m up in Eugene (OR), for those of you who don’t know, this city is about like San Francisco on the social and political level. Consider us Berkeley Jr. or Santa Cruz Jr. How fantastic to have the Olympic Trials for track and field here! (along with all of the protestors downtown, “Free Tibet!”) Thankfully, I have a happy medium in my surgeon, however, there are surgeons in his same group that are at both extremes. A girl I work with ATR’d in January. She has a really ugly scar. (staples) When I saw it, I freaked out of course. I didn’t have a choice, but I really didn’t want a caterpillar crawling up my leg! I asked my Dr about it, he said,”Why, in this day and age, would anyone use staples? It takes 3 more minutes for stitches. I haven’t used staples for 18 years.” So, then I saw my scar. Granted its about 4.5 in long, but it looks like a dull pencil line.
As for the healing…..I’m 8 weeks post-op and the last little spot finally went from scab to scar this week. The lack of blood flow to the area is why this occurs. It’s the least vascular part/area of the body.
Keep on castin!
damacar
hoss said,
July 1, 2008 at 7:16 pm
Wicked post. Your doc sounds like mine so I won’t even bother asking him the same questions when I go in for cast #3 in a few days. I will try and mess with him a bit but I am going to come to terms with being in a cast for at least 9 weeks in total.
We will get there soon buddy.
Recover well!
marianne said,
July 1, 2008 at 7:45 pm
Great post, tennisfreak…..I now live in Bakersfield, but grew up in S.F. —went to Cal, etc. so I loved your comparisons. Today was the day my 3rd cast was put on, much to my reluctance. I’ve been suffering from claustrophobic panic attacks in the evenings from the cast/swelling–very tough stuff…..i hope i survive:( I go back in 2 weeks which will be 6 weeks post-op and will get the boot for PWB…..will be posting pics…….i had those nasty staples ;(
We will all get there…..tomorrow I celebrate my 50th B’Day laying flat on my back looking for the light at the end of the tunnel.
Marianne
~M said,
July 1, 2008 at 8:30 pm
Nice post.
So this is what you have been up to! Writing and sharing your common experiences has some therapeutic value, hmm?
Be patient and stay the course so you can recover fully.
As for your laundry, find a smallish Asian woman who can lug it down the street and do it for you. Oops, you already have that!
~M
matts said,
July 2, 2008 at 2:44 pm
Worse case scenario, you have a tendon that will be very much healed up. It is easy for me to say because I am walking around after 8 weeks, but you know when that cast comes off that the tendon will be prety much healed 60-70% I believe they say it is…We all end up the same after a year and that is 100% better
Mary Mekko said,
July 12, 2008 at 5:30 am
Hello from San Francisco! I’m a local SF tourguide and tourbusdriver, was living temporarily in Piedmont, and got the ATR from dancing to Harry Belafonte on YOUTUBE, “Mommy look a-boo a-boo” on June 13th, a Friday. JA JA! Surgery at Highland Hospital with a doctor well-known in the four hospitals of Oakland, and about 50 years’ experience. He did not use stitches or staples, but a tape which dissolved into the skin and from what he said, not what I could really see, it was a good and clean wound after 14 days. Yesterday I got my first cast, and he has me walking ON IT! Even said that I didn’t need to use the crutches except if I thought they helped with balance… I was astounded, for I had read many blogs, as you had. “Doctor, only 14 days after surgery!??? Can’t it open up?” He was very casual, “No, don’t worry, that’s why it is in the cast, to guard against harm, don’t worry.”
Well, here I am, the opposite case from you… and worried. I can put the foot down, but I have not abandoned those crutches. Where are you living in SF? I have moved back for this recovery time to my parents’ house, to my old basement hideaway in the Excelsior District, will then go back to Piedmont and the sunshine, where I was share-renting. My friend has taken my car and drives me around, but I stay home 99% of the tiem and read. We should talk to each other….
You can call my cellphone at 415/370-7660. I would be delighted to talk to another Achilles’ Tendon person in my own backyard.
Mary