2 Weeks Post Surgery and Some Musings
April 30, 2014 by texasflyer
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.
19 Responses to “2 Weeks Post Surgery and Some Musings”
These are great posts! Fascinating info about shopping for an OS and getting the 50% self pay deal. I’m sure Norm and Cecelia will chime in and advise that you could have saved that cash and gone the newer non-op protocol route! Good to see that your pain has gone away and yes, this does suck - big time! My list of cancelled plans isn’t nearly as exhaustive as yours (maybe when I was your age pre kids, it would have been), but plenty has gone by the wayside. However…it does get better, especially when you can lose the crutches and walk around FWB on the boot, and start PT. I’ve never blogged before, and actually couldn’t really understand why people did - until I too finally jumped on here after trolling for a few weeks. It is so helpful to communicate with others that are experiencing the same thing along with you, plus those that are further ahead - now I understand why people blog! I’ve used so many references from achillesblog in my recovery thus far and continue to check it daily. Good luck - and keep posting. -Rob
Hi there, thanks for the comments. Well, my ATR was a complete rupture. I’m not sure how going non-surgical would have fused my Achilles back together! I realize non-op can be accomplished when it’s not completely torn. Please correct me if I’m wrong. Either way, re-rupture rates can be high. Something I don’t even want to begin to mess with. I’m 31 and while my wannabe sports star days may be over (hoops, soccer) I have full intentions on biking, jogging, hiking, golf, surfing, golf, etc. once again.
Don’t look at me - I had surgery 3 hours after my ATR! I’ll let Norm chime in on the non-op stuff - but yes you are incorrect. He can also make you feel better with his vast knowledge of statistics showing that most people get back to full strength and even better in some cases, so I wouldn’t count anything out in the future. You just have to slog it out for the next 6-12 months with all of us depending on how you heel.
Haha! Well, alright! And to think I knew it all
I expressed to both Doctors that I visited that I wanted to avoid surgery at all costs. They both said, “no way”! Luckily, as I’ve written, the costs weren’t as bad as I had initially feared.
Yea, I know many (if not most) people get back to doing all the crazy things again on their operated leg. Right now, I don’t even care, I just want to walk! I’ll cross the intense sports bridge at a much later junction, but it’s really not a priority to me at the moment or for how I envision my future.
Hi Tex
Many of us here had full ruptures and, thanks to the wonders of the collagen healing properties, ‘enjoyed’ healing times without surgery at least as good and sustainable as if we had surgery. Maybe your guys had real good reasons related to your injury (not just for the $) as to why you needed an op and that a more conservative rehab wouldn’t work for you.
What you do need is a good rehab schedule where you get mobile soon, full weight bear by 4 weeks and off the crutches, back to 2 shoes by around 8 weeks. The key person to make pals with? A very good physio.
Lots of good research stuff on the net which will educate more, just for interest of course.
Happy healing, hope it doesn’t get too sore!
Gav
Hi Gavin, thanks for the comments. Geez, well I don’t know why and how I didn’t read about the complete tear non-op people on here and elsewhere. I can’t do much about it now but how exactly does one tendon grab the other when they’re separated as much as mine were?
So, my 3 week checkup (boot, remove stitches and splint) is next Monday. In just 7 days I’m supposed to be FWB in boot with no crutches? I just don’t see how that’s possible, where can I read more about that specifically?
Also, what’s the downside to getting closer to FWB more quickly…or why isn’t is advocated more? Is it risk of re-rupture in the early stages just randomly happening while walking or is it about how the tendon heals and gains full strength months down the road?
Hi Tex, glad I found your blog today. I wish we all werent blogging about something this debilitating, but like others said, it helps the mental aspect of recovery greatly to discuss things with people going through the exact same thing. We are close in age (I’m 27) and we both are active, I was injured during a half-marathon, so a summer filled with plans and athletic events being adjusted I can also really relate too. I am a little bit different than your ATR in that I have a partial-rupture and went non-surgical. I am almost at 5 weeks and am having trouble weaning off the crutches to go FWB with the boot, even though I got the ok to do so by this stage. I am faster, and less awkward in crutches. This coming weekend I am going to spectate the Pittsburgh Marathon, for which I was supposed to be participating in, and is my first race I am spectating (and hopefully my last not participating in). As hard as it is to move now, there is a big difference in weeks 2-5. Even with crutches and a boot I could barely move. Almost 3 weeks later I am working on going FWB in the boot until I am back in two shoes. I guess what I am trying to say is even with this injuy being so notoriously slow to heal, you can see progress week to week. lookin forward to hear your progress over the weeks
The first 2-3 weeks are definitely the hardest. Don’t count out participating in your upcoming social obligations and summer activities. Obviously travelling to places can be complicated if you can’t drive but once you’re FWB you’ll be amazed what you can still do. OK you won’t be playing baseball for a while but concerts, festivals and socializing might be more doable than you think. Caution is key but I promise you won’t have to be a hermit all spring and summer!
Hey canes, awesome! Thanks for the comments. 27, huh? Bummer, that’s a bit on the young side for these injuries, it seems. Did Dr say anything else, did you have history of tendonitis? Were you in a hard sprint or a controlled jogging pace during the half-marathon? That’s just wicked, at least I was chugging down the field at full-speed like an idiot!
My primary goal isn’t necessarily to play soccer or basketball again, it’s simply to get back to a healthy lifestyle with swimming, jogging, biking, hiking. I’ve run several half-marathons (never had a real desire to do a full marathon) and MAYBE I could make that a goal, but as of now…it’s not at the top of my mind!
Best of luck, I’ll bookmark your blog and continue to follow.
Hi cecilia, thanks for the comments!
No, I do agree with the plans. I think when I get into my boot I’ll feel a much more comfortable going out and simply not being in such a delicate, precarious position. Right now, it’s just dangling around in a splint. Making it to a social engagement, a bar, restaurant or a smaller concert venue shouldn’t be an issue. But crutching long distances at festivals, baseball games, other larger events like weddings, graduation in other places, just won’t be too much fun. Even if it’s PWB with or without crutches.
I’ll have to see at my first PT session this coming Monday as to when I can maybe expect to go FWB, that will be wonderful.
Tex,
For non surgical repair, the body produces collagen around the injured tendons, which then later matures into actual tendon fibers. So the ends don’t have to be completely touching, just close enough together for the collagen to form around them. Also, surrounding muscles relax quickly to reduce tension and bring the ends closer together. From what I’ve read, this all happens in about a week after injury, which is why early diagnosis and immobilization in plantar flexion is so important. But that needs to end after a week.
The few weeks immediately following the collagen gap closure involve tendon fiber maturation, which is largely determined by how well you train the fibers using whatever protocol you have. Missing that window seems to result in poorly trained fibers and a weaker tendon.
The same thing occurs with a surgical repair, except you have a physical anchor in the tendon and a much higher risk of complications but you don’t have to worry about re-rupture as much. However, it seems most of the re-ruptures in non-surgical repairs occur within the first 3-4 months of injury due to accidents, weak fibers from long initial immobilizations or pushing it too hard. Further down the timeline the rates of re-rupture are about the same.
From my experience, and what everyone posts on here, it seems weight bearing in the boot should be done as soon as you can tolerate it, which is different for everyone. Weight bearing shouldn’t risk re-rupture because the boot protects the tendon from any tension and the movement keeps the surrounding tissue in good health.
Wow, thanks there Roark. Interesting stuff and not sure how I didn’t fully come across this thought-process at the time of my research. I was very adamant and pretty desperately clinging on to the hope to avoid surgery and both of my Doctors knew this. I don’t hold it against them, certainly.
In earlier posts, I’ve mentioned that I walked on my ATR for 3-4 days a bit, just around house, to car, to a social obligation or two. I had an ankle brace or an Ace bandage and ice. Then after two Dr visits and 18 days, I had surgery. They did not state that my Achilles was fusing back together by then. But I also probably hadn’t done what was necessary to keep it immobilized ASAP.
Thanks Tex! The doc did mention on my first visit how I was on the younger side of these types of injuries. Unfortunately, my injury probably could have been prevented if I thought I was not invincible when it came to competing out there. I had about tenditis in that leg for about 6 months prior to this race, running a couple halfs in that timespan, just trying to stretch and cross train but never really taking a significant rest or getting it checked by a doctor. On race day, it was miserably cold and rainy with added weight to my sneakers. By mile 10 i started experiencing signficant pain in my right achilles, with the pop happening on a full out sprint up a steep hill near a finish. Recipe for disaster. Over the past month I have done enough reflecting to realize it happened, i cant change it, and i need to focus on healing. At my appt next week I will strongly suggest beginning PT with my doc as it will be a but over 5 weeks. He seems to be more on the conservative side. Although, he did say with diligent work I could be able to participate in a half marathon this coming November.
canes, wow. That’s bad, I’m sorry. You hate to call the Dr for every little ache or soreness you get while being active, working out, etc. I know, I hadn’t been to the Dr since I was 19 and had my wisdom teeth taken out.
Well, it seems like you are a good to great athlete and still young. No doubt, I’ve carried some extra weight on-off since college but have always maintained my running, biking and some hoops, tennis, soccer. It still couldn’t have helped me. Michael Crabtree a potentially great WR for the 49ers had to have been 23 or 24 when he tore his Achilles. Also, a rising superstar in the soccer world, in England from Belgium, Christian Benteke tore his at 23 and had surgery a day before me. So obviously it can happen to great athletes and at a younger age, as well.
Absolutely and thanks. I am treating my recovery/rehab as my next marathon now, and looking forward to the weeks ahead, next step for us both is becoming FWB and back to wearing two shoes
Roark, you told the story almost exactly the way I used to before I read the amazing new study by Dr. Wallace in Belfast. It’s summarized and linked in Cecilia’s great comparison of the newest and best (mostly non-op) protocols, on her blog. Wallace managed to get great non-op results — including a 2.8% rerupture rate and a 100% return to sports — with around 950 ATR patients. Most of the recent non-op ATR studies with great results (including UWO), restrict their patients to COMPLETE ATRs, not partial, and with whatever size AT gaps they had. UWO randomized the ones that got surgery and those that didn’t — and when they checked to see if the ones with small gaps healed better non-op, they found that there was no difference!!
Wallace managed to get the same or even better results(!) with reruptures and with “stale” ATRs, just by making sure that the immobilization angle “approximated” the two torn tendon ends! In a handful of cases — <30 out of 950-ish, IIRC — he couldn’t, and operated. But in all the rest, he could, and got those remarkably excellent and consistent results. I am shocked that the “stale” ATRs did so well, when — as you say — the “window” of mad inflammation and healing has closed. But facts are facts, and they trump theories and logic.
Yeah, I actually feel like the first week or so of inflammation and immobilization is the reason it is difficult to apply weight. Once the inflammation is down, its only sensitivity and surrounding tissue atrophy that needs to be built up. But I remember being able to fully weight bear even immediately after the injury to get back to my car. Just with no push off.
Its amazing how they spin some of those studies to support whatever they want. So many factors they just ignore. Of course a pro athlete in peak condition with optimal time, focus, facilities, nutrition and health is going to heal up faster and better from just about any injury than an average joe regardless of anything else. Should be criminal to publish studies with such minimal rigor.
@Roark, which study or studies are you railing at with your “It’s amazing how they spin some of those studies to support whatever they want. . . Should be criminal to publish studies with such minimal rigor.”?
Roark
You’ve done a lot of reading on how the collagen regenerates but not much on the stats reported and disciplines designed in the ‘real life’ studies - these were based on real people who statistically could not all have been pro athletes in peak condition.
You are used to reading about studies based on lab rats which could quite easily be spun as you cynically describe. In both UK studies (Belfast and Exeter), and UWO, (and NZ?) the results came after extensive patient study and recording, but the ‘magic ingredient’ in the rehab came from the early mobility and weight bearing, supported by physiotherapy from after 2 weeks.
Read some of the blogs here, such as Norm’s, Hilly’s, Suddsy’s (brilliant), and you’ll also see that in most cases, being operated on seems to make no difference to the effectiveness of the repair. Spin is about how things are reported, and how it can influence the innocently gullible. Get down to basics and you will even find that non-surgical failures mostly occured because the patients were careless - because they had no sutures, blood, pain they maybe forgot they were still vulnerable.
My rehab protocol was the same whether or not I had been operated on. At my med center surgery was ordered if it was medically necessary. It was believed, and proven, that unless the injury demanded it, non-op was the way to go - less risk, less pain, less of all the ‘bad’ stuff.
Isn’t this blog great? Don’t know another like it, do you?