Texas Flyer Achilles Blog

Currently at 5 weeks and 1 day since my surgery. Overall, I am feeling much better and much of it has to to with PWB.

A quick run-down; I was in a splint/soft cast for 3 Weeks post-op. Then, stitches out, into a VACOcast and further NWB for 2 more weeks. That meant 5 weeks total post-op NWB.

VACOcast: Initially, I found the VACOcast to be a b*itch. I was rather unhappy with the fit at 20º, the second strap was just putting too much pressure on the top of my foot, which is a little bony in that area. So a portion of the top of my foot was pretty severely inflamed, I tried putting some cut up fleece on top and under the plastic of the boot, but the damage was mostly done! After some long work and travel days, I started to get pain and moved the boot to 25º, which not only helped the fatigue and Achilles pain but also position the boot in a different manner so the top of my foot got a relief.

First Physical Therapy Session: At 5 Weeks I had my first PT appointment and it went ok. Apparently, I hadn’t kept my leg straight often enough during my 5 weeks post-op and now I can’t stretch my leg straight out entirely to where the back of my knee can touch the floor. It’s an odd feeling and perhaps should have been obvious during my recovery. But I did have some decent pain the first couple of weeks and all I could focus on was simply getting comfortable. That meant having my splint elevated and my leg slightly bent to take pressure off my legs, knee and calf. No one told me to keep it straightened out and work in some light quad/hamstring stretches during this period. Maybe shame on me? !

So the PT was concerned that I was going to have a pretty decent haul for recovery given that my Achilles ROM and flexibility was rather low too. I should note that I waited 18 days post-injury to get surgery, so I will have been nearly 8 weeks NWB. I will admit, the PT session was a bit scary given my 8 weeks time and I was apprehensive to push my Achilles too much, particularly in the straight-back stretch! At home, I’ve able to concentrate much better on these exercises and now am able to see some teeny, tiny improvements in just 2-3 days. My Physical Therapist recommended that I have 2, if not 3, PT sessions per week as they deemed I might be a little behind the curve in recovery.

PWB Finally!: Going PWB (as tolerated) with crutches was the saving grace at the PT appointment. Wow, what a difference. I’m actually slower now that I was at NWB on crutches, but that’s ok. I love being able to finally feel my body/ankle/Achilles, let it respond and go accordingly. When I put just a bit too much weight on it, there’s definitely a deadness/dullness sensory along a major tingle in my heel I think telling me to reel it in a bit. I’ve started walking about 30 minutes each day in addition to my ROM exercises 3x per day.

The "Small Achilles": Lastly, I was very frustrated at 3 weeks and being told still NWB for 2 additional weeks. I realize many (most?) on here start PT and PWB at 3-4 weeks. I was wanting to follow the University of Wisconsin protocol as it was recommended to me by a family member who is 10 months ATR. I sent the protocol to my Dr, PA and future PT at the time and voiced my frustrations. They came back and basically said that they do indeed like to start PT and PWB in most of their patients at 3 Weeks, but not me.

Given the severity of my injury, the fact that I walked on it for 5 days post-rupture, waited 18 for surgery, my age, desire to return to action sports, physiological makeup, they wanted to wait with me. They also stated that I have smaller than average Achilles and that was a major factor. I found this interesting and was a bit skeptical as all I wanted to do was start PT and PWB! But they said the size and diameter of both of my Achilles is smaller than the typical male’s and one for my size (6ft, 200 lbs), thus keeping a more conservative protocol. I have always noticed (or thought) I had pretty skinny Achilles along with skinny legs, ankles. So I did understand, to a degree. They said it was entirely genetics, wasn’t actually too uncommon and that it still didn’t contribute to it tearing. There’s also no real concern that there’s that much more of a propensity to tear again (or in my good one either).

My Ideal Timeline: According to my PT, they want me to be 0º in one month from the start of PT/PWB/Week 5. That means lower my degree of VACOcast 5º per week. 20-15-10-5 in 4 weeks. I think this sounds positive and then, if all goes well, I could get into shoes with a heel lift. But all of this is going to take solid PT and home-exercise work on my end.

But everyone is correct, going to PT and PWB is a huge confidence boost and while I had to wait 5 weeks post-op (8 weeks total), I can halfway imagine walking normally again!

Today, I had my 3 week checkup post-surgery. A brief examination, stitches out and would have been fitted for a boot, but mine won’t arrive until Wednesday. But most importantly, I found out that I’m to be Non Weight Bearing (NWB) for two more weeks!

I’m bummed about this.

This was my second post-op visit, the first being after 1 week and, as I detailed in a previous post, my stitches looks "beautiful", clean and had not bled at all. This time, it actually looked a bit unsightly but the nurse and Dr said it still looked good. There had been some small bleeding which had to have been from my Days 8-10 of wicked heel pain, little sleep and much moving, shifting around (read from earlier).

The stitches, which I was a bit nervous about, were next to nothing. The area is so dull right now, there isn’t much feeling there. I could sense a tug here-and-there, but it was as painless as possible. I’m also surprised about the brief touch-test examination by the Dr., he prodded the Achilles up and down with some slight bending of the foot/ankle and it just feels…dead. I thought I’d be squirming in pain or yelping, but it just felt odd. Not many nerve endings there are active at the moment to tell my brain "yay" or "nay".

On still being NWB:
Originally, before surgery, both the PA and Dr had told me that after their standard 3 week in splint/stitches out appointment, they try to get patients into very initial, light PWB with crutches (of course), have first PT appointment and, I assume, begin the light foot/toes/ankle exercises at home.

But this was not for me. Apparently, his opinion on this does still relate to the severity of my injury (once they opened me up), the location of the complete tear (above the ankle) and the fact that I went 18 days after injury to have surgery (which included walking/hobbling on it for 4-5 days).

So by my first PT appointment in 2 weeks, I will have been 5 weeks NWB (3 in a splint, 2 in a boot). Based on what all I’ve read on here and also by the protocol that I was thinking about following from University of Wisconsin . It seems a bit long. Not only am I concerned about it being too long, I’m also a little bit disappointed as I thought I was going to be able to actually work on a few things in order to see some progress. Instead, it’s sofa and lounging for another two weeks.

As I’ve said in my previous posts, my Dr is young (40s), was a previous collegiate athlete and is also a team Dr for a local professional sports team. I mean like real-deal stuff. They’ve worked on Hall of Famers and very well known athletes. So while I don’t discredit a word he (and they) say, I am just frustrated at still being NWB at 3 and then until 5 weeks.

So here are my questions to the community:
1. At what point is the Achilles "healed"? What state is one at 3 weeks post-op? I realize that much of rehabilitation and PT is simply working your Achilles back up to a normal standard.

2. Should I attempt some simple home exercises? If I do something as seemingly low-stress as the toes-alphabet exercise, what should I look out for in terms of pain, swelling or bad signs?

3. Any other homeopathic remedies, supplements or dietary considerations that I could potentially look in to? Whether it’s anti-inflammatory (berries, cayenne, turmeric), blood flow (massages, acupuncture), other vitamins or anything that could promote muscle/tendon growth or strengthening, I’m all ears!

Well, I’ve ordered the VACOcast (and through the site link I was just not all that enamored with the options I could’ve easily done both with my Dr. (due to cost) and at a few local medical supply places. Essentially, I was going to be looking at $150-200 already for out-of-pocket, so why not splurge a bit more?

My 3 Week checkup is this coming Monday. Then, I’m supposed to get stitches out, splint off, checkup and then get my boot. But even with 2-day priority shipping as of Friday after 5pm EST, I highly doubt my VACOcast will arrive in time. So not sure whether to postpone appointment and wait for my boot to arrive or just have them put me in the splint for another day or two after get the checkup is done with and stitches are out.

Questions:
1. Anyone use the VACOcast lightweight liner? Like it or unnecessary? I am a bit skeptical of some of their additional accessories, why not make it more breathable in the first place?

2. Since you’re able to wash the liner of the VACOcast, how long does it take to air-dry? Is it REALLY necessary to get another liner for the time period that it takes to dry? Am I putting my Achilles at risk during those minutes or hour?

So I’m exactly at 2 weeks post-surgery and finally have been able to catch up with my contributions to the ATR blog. I hope my ramblings provide even one person some help as I’ve been aided by dozens of great ATR posters here.

Everything is going well again. No real pain, just some odd sensations every once in a while and I haven’t had any pain meds since Day 10. But my sleep cycle is completely out of whack due to numerous things. Earlier pain on days 1-3 and 8-10 and subsequent medications. But also, you’re mostly just sitting around. I’m working some, but not doing typical things throughout the day make my internal clock all messed up. Exercising, going out, socializing, running errands, traffic (do I miss traffic?!), cooking, cleaning, etc., all these things that make up any given day that give you and your internal clock hints as to when you’re tired and need to go to bed.

Admittedly, these first two weeks have just been mostly a bummer. And I know there’s still a loooong way to go!  From the time of diagnosis to today even, it’s frustrating. I’m not the type of person who can easily rally around cliches, metaphorical sayings and motivational posters like "it gets better each day" and "be positive!". Haha. This sucks and it does get better each day until it doesn’t! Ouch.

I can’t walk and won’t be able to for a while, maybe months. That sucks, bottom line!

And I’m a pretty down-to-earth, pragmatic person. Pretty positive, where and when it’s necessary.

I will have had to miss my cousin’s wedding, another wedding or two, forgo many social obligations and scupper plans to live in Miami for 2 months this summer, miss another cousin’s graduation, nix a week in Chicago, a trip to Austin and mostly, miss the beauty of engaging in spring and summer. Concerts, walking, biking, running, golf, baseball games, festivals, etc. Bummer!

I am hoping that the start of my PT will be the boost I need to start to really see the light and inch through the summer.

So, I’ve said earlier that (I think) I have a pretty high tolerance for medications and perhaps pain. I walked (or hobbled) on my torn Achilles for about 4 days after it happened. Medications, pain relievers, alcohol and other uh, things back when I was younger seem to not always take effect in a typical way.

Day 7 - I went for my 1 week checkup, scar inspection and re-wrap of splint. Everything was just peachy.

Day 8 - I woke up with pretty intense pain in my heel. It seemed to be the middle of my heel, then the bottom, then all over. It became INTENSE and painful. So turn the clock back a week and I was in wicked pain once more. I was out of my pain meds and didn’t bother to call for a refill since I thought I was home free from the pain.

Now, I must say that the pain wasn’t at my surgical area or on the Achilles, for this I was thankful. But I know the Achilles runs down to the heel and attaches to all sorts of important stuff, so I didn’t know what was going on. It was only 12 hours or so after my 1 week checkup and re-wrap of my splint. The wrapping didn’t feel too tight, it was the same splint and everything still appeared to be the same.

I called the Dr. office and the PA just told me that it was pretty normal. Since I had been elevating my leg and on my back (or butt) pretty much for a week, my heel was the first real contact with the bed, pillow, etc. and was absorbing all the weight from my foot and making contact with the none-so-pillowy cast. Well, that made sense, I suppose.

So, unfortunately I had to get back on the pain meds. Day 8 was intense pain, it was near awful. Couldn’t rest and couldn’t find a comfortable position. My heel was on absolute FIRE. I tossed and turned, yelled a bit and popped pills. This time some whiskey in addition helped soothe my body down.

Day 9 - The pain was still there, but it was a dull pain. A pain where my heel and the nerve-endings there was tired of fighting. Dull throbbing for all of this day and into the night. I didn’t sleep until 4am.

Day 10 - When I woke up from a deep, medication-induced sleep, the pain was gone and I think my heel had given up. My heel was still a bit sore to the touch but thankfully I could rest my leg up in any position and not be in pain.

And this is where I am now. Day 14 and no pain at all since Day 9, no pain meds since then and I’m back to getting around the apartment, showering, preparing some easy things in the kitchen and sleeping. Ah, it’s wonderful.

Regarding the intense heel pain, I read on here that it seems to happen with people are first getting into their walking boots to the beginnings of PT. I don’t know if it’s the exact same area and if I’ll have to go through this again when my heel and nerve-endings wake back up with PT and some movement. But it was not fun and the pain and discomfort was almost as bad as days 1-2 post-surgery.

Days 1-3 were hell. Days 4-7 were cool and I was getting into a rhythm.

Day 7 I went to the Doctor for my checkup with and to get a new wrapping with my splint.

As the nurse was cutting off my splint wrapping, it was weird and scary to have my leg/ankle exposed. The Doctor came in, felt up and down the Achilles and said that it was feeling great, was healing up and that my scar was "beautiful". Ok, I guess that’s a good thing! They also said there was zero blood in the bandages, which I thought was funny. During the days post-surgery your leg and surgical area is going through so much, I could’ve sworn that my scar was bleeding a few times. I felt it, I promise! But it was either just mental or nerve-endings playing tricks, or a bit of both.

My surgical scar is about 4 inches, which I hadn’t even known. As I’ve posted earlier, I went and got a second opinion before surgery from another Doctor desperately clinging on to the hope that I could avoid surgery. Well, that Doctor whom I did not go with, said I’d require an 8 inch incision from mid-heel up nearly to calf. Wow! That’s a bit scary there could be two set of opinions that different!

I asked my Dr. why it was so much smaller than the other Dr. had forecasted and he said, that "they" used to make much larger incisions. It wasn’t necessary for the most part and wasn’t for mine. So, here I’d like to reiterate that I recommend to finding a Doctor who specializes in Sports Medicine and maybe even progressive treatments and outlooks. My Doctor is young too, in his 40s and works with professional athletes. Many other Orthopedics I found were in their late 60s-70s and by my assumption might adhere to more dated practices and procedures. Just a thought.

After getting my splint back on, re-wrapped and on my way, my doctor said he’d like to keep me in splint and with stitches for another 2 weeks. So 3 total weeks post-surgery. Then a walking boot and light PWB with crutches to start, then ROM and PT and on it should go.

I realize that many here get stitches out anywhere from 1-3 weeks post-surgery. I can say that after seeing my "beautiful" scar after 7 days, it was nowhere near ready to come out, regardless of how clean it looked. It was still very much being held together and looked like costume makeup for Halloween!

I had my surgery on a Tuesday, that day was a blur for the most part. Wednesday and Thursday were utter hell, though. By Friday things got under control but not without a very high amount of painkillers (Hydrocodone/Acetaminophen) in my system by then.

At 4am, the morning after my surgery, the nerve-block wore off and I was in some pretty heinous pain. I had taken my painkillers per instructions after the surgery and into the night. But it didn’t matter, it was bad. It also didn’t help that my CVS put "every 6 hours" instead of "every 4-6 hours" for my dosage. At 10am I called my doctor and the PA said to take them every 4 hours while it hurts and I could cheat a bit at 3 hours to catch-up a couple times.

Well, I took my pain meds every 3 hours for the next 2 days to keep up with that pain.

On Thursday morning, at one point, I was nearly in tears it was so bad. I felt like I was going crazy. I was clenching my body, sweating and not able to watch tv, read or listen music to take my mind off it. Luckily, I got some sleep on Thursday night and Friday I was starting to feel better. It was a mixture of the painkillers really taking effect and my surgical area simply calming down. I took 2 last pills on Saturday and was fine after that.

I was in bed for these first days pretty much around the clock. The blood rush and swelling when you get up to use the bathroom was pretty wicked and caused more pain. I resorted to using a pee-jar, or urinal (ie: old Vlasic pickle jar), for most of my urinations the first couple of days. It was just too much pain and discomfort to get fully up for even a few seconds.

By Friday,  as I had been taking the pain meds about every 3 to 3.5 hours and that was starting to do the trick. Initially on Wednesday and Thursday, I noticed that the pain meds lasted about 1.5 hours and took another 1.5-hours to kick in. So there was a good deal of pain in between non-pain times. See my "Day of Surgery" post as I explain that I think I may have a high tolerance for medications, etc.

I don’t mean to scare anyone by my experience and pain, it was originally one of the things I was most scared about myself. But I’m fine now and was fine by day 3-4. But be sure to take your painkillers every 4 hours at least for the first two days (or as your doctor prescribes it). Then you can get off them as I did, which hopefully wouldn’t be more than 5 days or so.

Food and diet in the first days:
I mostly ate bananas, leafy greens, yogurt, granola, fruits and drank lots of water. The painkillers cause pretty considerable constipation so you just don’t want to be eating very heavy, greasy foods initially. Would not be fun. I also took a stool softener, over the counter from CVS pharmacy. It helped immensely on Friday to have a bowel movement, but it was still 3 days, yikes! Also, since your leg is pretty much stationary and was just cut open, I’d recommend eating foods high in potassium. It helps with preventing muscle spasms and cramping, something you absolutely don’t want happening the first few days post-surgery.

I must admit, I was quite nervous on the days leading up to surgery and on the day of. But since it was about 18 days since my injury, I was ready to get it over with.

I never had surgery before, other than wisdom teeth and that was not too much fun. I kind of woke up in the middle of it, not feeling anything but seeing and sensing the Doctor pulling, yanking at my wisdom teeth! It was bizarre. It also took a bit on the latter side of typical timeframe to heal.

This first real surgery for my torn Achilles went well enough, I suppose. No food/drink starting at Midnight before surgery. Arrived at Noon and surgery at 1pm. I was nervous and told the anesthesiologist that I had a high tolerance for medications, narcotics, alcohol, etc. and I was worried about waking up again! Haha. He basically said, "don’t worry" with a grin.

I was wheeled into the operating room and lights out.

I woke up obviously dazed and confused. A couple of nurses were with me and I was swearing a lot due to who-knows-what (?!). I was also extremely cold and began to shiver/shake rather aggressively. They brought more blankets and a heater. I came to a bit better and started gulping down hot tea and water. I had never been so thirsty in my entire life.

Important : Going into surgery they will ask you if you want a "nerve block" to help with the surgical pain afterwards. It probably goes without saying, but say YES! But as I mentioned, I’ve kind of arrived at the conclusion that I have a high tolerance for medications, alcohol, maybe even pain and whatnot. They never seem to work or as quickly, at least not as they may do on others. Who knows. But the anesthesiologist said he’d give me the nerve block at the END of my surgery while I was still under so to let it maximize its effect for me post-surgery.

Well, the nerve-block did not kick in for a few hours AFTER my surgery. So as I was coming to reality in the recovery room, my leg HURT LIKE HELL. It was pretty bad. The nurses gave me some doses of liquid morphine and had to give me more. Then even more in pill form before I left.

I was in the recovery room for about an extra 1.5 hours after surgery which seems to be a bit on the long side of it. Oh well. By the time I was put in the car, THEN the nerve-block took effect and I was in lala land with all the narcotics I was on. It ended up being too much and I felt crazy, anxious and couldn’t sleep when I got back home. The first night, I only slept for an hour or two at the most.

THEN…the nerve-block wore off around 4am. I’ll address this in my next post. But it was not fun, to say the least.

Also, as a note, I was put into a splint with considerable wrapping. My doctor said he doesn’t do or recommend full hard casts as he feels they’re too heavy on the leg/foot, not conducive for swelling up and down post surgery and obviously more difficult to take on, re-apply for the 1 week checkup.

As stated before, I do not have insurance so I had to shop around for the best price. Initially it felt odd and I was scared it would cost me well over $10-12-15k, I had no clue. Thankfully, it all ended up being quite alright and somewhat manageable.

In total my surgery was around $4,200 in cost, plus initial office visit, MRI, crutches. This is with the 50% discount that my doctor gives for those who are "self-pay", it was all rather up-front and felt like perfectly normal practice.

Here’s the cost of my Achilles surgery with a 50% "self-pay" rate, with rounded numbers:
- initial doctor visit = $150 (this included exam by PA and Dr., the legendary Thompson test and some prodding, feeling of the Achilles)
- MRI = $350 (again a 50% discount and I got it immediately)
- Surgery costs:
• Doctor cost = $1600
• Surgical center cost = $2,100
• Anesthesia cost = $450
- other costs:
• crutches = $22 (from Walmart)
• second opinion from another Doctor = $170
• Pain meds for post-surgery (Hydrocodone/Acetaminophen, 50 count, CVS pharmacy) = $18

All in all, I was somewhat relieved. Now, I don’t have $5k just burning a hole in my pocket as I’m trying to build my own business, but I was able to pay some upfront, get a little bit of help from my folks and do the rest on a payment plan. The latter of which was through the surgical center and was a very reasonable plan over a 6 month period.

Not only did I find my doctor and his practice to be the best, he was also the cheapest. Many other Orthopedics simply required insurance while the second opinion I did receive, that Doctor took only 30% off the costs.

Additionally, I guess these "surgical centers" are quite common and they are basically simple, out-patient surgical centers. They seem to be designed to be smaller, simpler, timely and less costly than hospitals. I don’t think they’re performing major in-patient type surgeries and there isn’t an ER section, it’s just scheduled (relatively) minor surgeries. This is what kept my costs way down as the second opinion doctor not only was more expensive he performed his surgery at a hospital, which charged the tune of $7,000! Whereas I spent $2,100. Wow!

Also, many healthcare plans nowadays have high deductibles, most new Affordable Care Act plans do too, and in the realm of "self-pay" ATR surgery, the cost was well under some of those deducible rates. I realize that $4-5k is a lot of money for some, it certainly is for me. But it was a rate that I was able to pay, get fixed-up and on my way. I was always dreading that it was going to be a LOT more.

If you don’t have insurance, have to "self-pay" or have a high deductible don’t worry about shopping around. The office staff will be able to give you costs and rates very quickly and without judgement.

I left my somewhat-cushy job with benefits a couple years ago to strike gold on my own. I began my own creative design firm, specializing in websites, logo, branding, apps, etc. I looked at individual insurance plans, yes, but at $350+/month I thought it was something I could forgo for the short-term. I had been to the doctor once or twice  since I was 18 years old.

Since my injury occurred on a Friday and I do not presently have insurance, I decided to wait through the weekend to monitor it. Somehow, I managed to hobble around an engagement on Saturday night for a while and go out to dinner.

I do not think it’s necessary to go to the emergency room if you think you’ve torn your Achilles. The pain is not fun but ice, Advil, whiskey and getting to a good Orthopedic / Sports Medicine doctor is the highest priority within a couple days. I would think the ER visit is just extraneous.

I also read a LOT of message boards, forums, WebMD, etc. and was holding out hope that it was a minor partial tear or simply a strain. Stupidly, I thought since I was able to kind of walk on it, it may be ok. IDIOT! Coming to terms with a full ATR was something I was avoiding.

By mid-week (5 days since injury) I took to the Orthopedic search and here are my tips :
1. If you are young, active and the injury occurred while being active, I would try to find a doctor who also bills themselves as "Sports Medicine". He/she will have seen this exact injury a hundred times.
2. Find an Orthopedic "surgeon" (obviously Board Certified) and make sure they would be the doctor who performs the actual surgery. It seems a large amount of Orthopedics don’t actually do surgery and will simply refer you to someone else in the pipeline. Thus, taking more of your time and potentially money.
3. If you don’t have insurance, like myself, you can totally "shop around". Simply call up Orthopedics’s, explain your situation and they will 99% of the time get you in tough with their "Business" employee. They will give you the exact costs. Luckily, my doctor is not only awesome but they give a 50% discount to those who "self-pay" and don’t use insurance. Another Orthopedic I visited for a second opinion only gave a 30% discount, big difference.
4. Look to see if your Orthopedic, the center or the hospital has a Physical Therapy unit attached or combined with them. Mine does and caters to normal people but my doctors are also the team doctors for a local professional sports team. Wow! I was really impressed. The on-site PT is convenient for billing and check-up appointments. It also has to be good for communication and being run effectively.
5. Have patience. You don’t want to rush this and you want to get the best doctor for you, whether it’s comfort, price, location to you, etc. You can wait a week or two. I know that sounds heinous but I called many doctors for days, most didn’t have availability, required insurance, didn’t call me back, didn’t perform surgery or they were like 80 years old.