thelifechangingpop’s AchillesBlog

Long time no write but was mobile enough to get back to work and have been throwing my everything into my business since then, things still looking shaky, may need to sell my vacoped boot, ha ha.

Achilles wise things are coming Long. Nearly 5 months post surgery and am bit stiff in ankle and calf in morning and if I’ve been on my feet all day (usually the case) I’ll be limping quite badly by the end of the day. Sometimes some swelling, calf still smaller and can’t walk normally on my toes (no ballet career for me) but pbysio happy with my progresz. See her every 3 weeks for a good massage and changes to my exercises.

Things that helped me most to recover, thiz site, my vacoped boot and starting physio in the pool.

Good luck to all of you out there on your journey.

Not sure if we’re allowed to copy and paste but this is an essential read, thanks ryanb, you’re an inspiration http://achillesblog.com/ryanb/things-i-think-ive-learned/

Just came back from picking up a loan car while I wait for my automatic to arrive, strikes in the transport industry mean that my car is stuck up country! So first time that I’ve driven in nearly 6 weeks, kept on reaching for the gear lever to change gears and then remembering that there’ll be no more gear changing for the forseeable future :(.

I’ve been FWB for this week with my Vacocast at 10 degrees plantar flexion and allowing a bit of ROM, not sure how to measure this. Been fabulous to be mobile and to be able to carry things again. Initially no discomfort but then started with pain in my heel which became agony during a brief shopping trip. Moved the beads in the liner around and this helped a bit but definitely a limit as to how long I can stand on my feet. Was wearing a wedged flip flop shoe on my right foot as this evened things up nicely but ankle on right started to pronate quite markedly and the thought of slipping off wedge shoe and twisting my ankle was a sobering one. Started wearing my running shoe on the right foot and although not quite even certainly more stable. Chuffed that I could walk faster each day, the 20 minute walk to the physio can now be done in 8 minutes, yeehah.

I read Hopalong’s blog this morning, along with all the comments, thanks all of you out there, and realised that the change from rocker sole to flat sole may set me back a day or two in my biped status. Armed with this  I decreased plantar flexion to 5 degrees (instruction booklet with my Vacoped says that between 10 and 30 degrees rocker sole must be used) and swopped the rocker for a flat sole. Yup, one step back indeed. Strange feeling of almost walking on my heel and whereas before I was striding out with nice long strides I am now back to doing short steps somewhat gingerly. Pain in my heel much better though but haven’t done much walking today.

Have still not had any physio on my ankle. The physio work that I have had has all concentrated on my neck and upper back vertrebrae that have tied themselves in little knots due to my initial crutching, hours spent slumping on the couch and weird and wonderful sleeping positions in an attempt to share my bed with my Vacoped!! Did a bit of swimming in the last few days, Vacoped is remarkably bouyant so just let my legs float behind me and gave my arms a bit of a workout doing some lengths,  very slow ones, in the pool. Was good to feel weightless in the water and now that I can drive I will definitely be spending more time in the pool. Otherwise i do some very gentle hingeing of my ankle twice a day and 2 or 3 alphabets, the hingeing of my boot is no doubt improving my range of motion.

I don’t think that my foot was ever at 30 degree plantar flexion,  I think the term is equinus, and certainly I can’t point my toes on my ATR leg. When I take my Vacoped off to let my foot breath I would say that my foot is virtually in a neutral position when my leg is resting supported. Am still sensitive to the touch up the back of my tendon and the swelling shifts up and down the length of my scar. There’s a nasty sensitive lump of scar tissue at the point where the tendon was sutured back together,  am hoping that when I start with my ankle physio work they’ll do some mobilisation work on this.

Am seeing my surgeon on Thursday next week, a part of me wants to saunter into his rooms with my Vacoped but the “keep your surgeon happy” part of me thinks I should crutch my way in. I suspect he won’t even notice that I’ve changed boots, hee hee.

Gentle healing to you all.

My, I have a bad case of ATR blues.

Unless one has comprehensive medical cover, this is an expensive injury. My medical aid paid for most of my hospital costs but I have no cover for physio or any extra visits to the OS. My rainy day fund is experiencing a drought with all the extra costs such as taking taxi to physio, if friends and family can’t help out, paying for swimming pool access, physio treatments and all the expenses of having to employ a vet to locum for me at my clinic while I’m still on crutches.  I have an income protection policy but this only covers a portion of my salary.  Amazing how in retrospect I realise how many things I would have done differently from a business and financial point of you if I’d known how this kind of injury can destroy you if you’re self employed.

So just read what I’ve written and my level of self pity is vomit inducing, but they say a problem shared is a problem halved so thanks to all of you who braved their way through that paragraph of ‘poor me’.

So on the progress side of things, I did some FWB today,almost unconsciously,  just lifted my right crutch up and there I was walking like a biped,  terrifying feeling actually and don’t think I’ll do anymore today. Read Spacemonkey’s blog day before yesterday and it made me want to just lie very quietly on my bed for the next 2 weeks!!!!

Would be nice go get an idea of how often ATRs go to physio, once a week, twice a week? I read hoppymodo’s blog earlier today and she only had one physio visit. Would love to hear some opinions on PT, the good the bad and the ugly.

Gentle healing to you all.

Jen

Well I am at 3 weeks post op and am following a mixture of the Exeter accelerated rehab programme and a protocol from the University Hospital Lausanne Switzerland that the orthotist gave me. The latter protocol is for non op ATR rehab but seems fairly similar to the UWO protocol just using the Vacoped pro achilles boot.

I am PWBing well and have even taken some steps with my left crutch off the ground so certainly making my way towards FWB. I just allow my foot to rock over in the rocker sole which I have to use till my PF is at zero, probably at about 2 weeks from now. The pins and needles in the ball of my foot and my heel are not much fun and I see that this is a fairly common thing.  Also occasionally feel that there are ants biting at the incision site, gentle rubbing of the area seems to make it feel better.

The inside of my ankle is a lot less sore since I started PWB and the swelling on the outside is also improving. The outside of my foot still looks very flat and can’t really wiggle my baby toe. Am getting fairly good at doing the alphabet, practice 4 or 5 times a day and also gently (thanks Ron) hinge my ankle after each alphabet. Am really eager to start walking in a pool with my Vacoped on problem is that I have no way to get to the pool, blah, so wish that I had an automatic car. My financial advisor doesn’t think that my ATR is a good reason to buy a new car, ha ha ha.

Gentle healing to all of you.

Longest song title on the UK charts, Rod Stewart and the Faces.

Spent yesterday at a symposium on osteoarthritis in dogs and cats. All very interesting especially the hip replacements that they do in dogs and most interesting was the discussion on pain management.

I do a lot of sterilsation work for animal welfare and am always amazed to see how quickly these animals seem to recover from surgery. A dog that is spayed will be up and walking, admittedly they all receive a pain killer injection, within 30 minutes of surgery and the next day will be running around as if nothing has happened (obviously my post-op instructions stress that exercise is to be limited but try telling that to a labrador!).

However, when the same surgery, an ovariohysterectomy or usually a hysterectomy, is done for a human patient there is an extensive 6 week recovery period and even at the end of those 6 weeks many patients are still in pain at the op site.

So studies were done on dogs post surgery  and this showed that the body was having a pain response with all the associated responses in the body for at least 3 weeks post surgery even though these dogs do not show any signs of pain or discomfort.

So applying what I learnt yesterday to my achilles surgery, there will be a pain response from the tear in the achilles and from the surgery that was done to repair the achilles which also involved cutting through skin and subcutaneous tissue so therefore even more pain. Because we are in pain, we guard certain muscle groups and because we are initially not weight bearing we are underusing some muscles and overusing others. This results in myofascial trigger points developing in these muscles (basically a knot in the muscle fibres that further impairs muscle function which in turn creates further knots………..). So these myofascial trigger points create a constant path of pain impulses that then leads to referred pain, pain in another part of the body. So then the body starts guarding these areas where the pain is which leads to further changes in muscle use and flexibility which leads to more myofascial trigger points which leads to more referred pain……..I think I’ve painted the picture.

My pain management post-op was extensive. I was asked to score my pain on a scale of 1 to 10, initially I was moaning 11 and it took a huge amount of medication to get me comfortable and for the whole time I was in hospital I received pain medication every 6 hours, even when I said that I felt fine. I took anti-inflammatories and painkillers for the first 3 days at home and then just took anti-inflammatories as I didn’t have any pain from my ankle.  I just accepted that my other muscles would be sore, part of the healing process I thought but actually I was just winding my body up with pain triggers. A very vicious cycle. My treatment plan will now include drugs for the pain and a combination of acupuncture and trigger point massage from a physio.

In a nutshell, your body will heal better if you keep it in a pain free state.

Yesterday was a bit of a bleak day, thank you to Ron and Stuart for the advice, am back on the road to recovery.

Chose ‘Dancing in the Dark’ as my song for today as I have elected not to tell my surgeon that I have changed from his no name brand, heavy, uncomfortable moonboot to my beautiful Vacoped. Had an appointment with him this morning so put his boot on and crutched my way in. As per usual he had no interest in how I was doing. Changed my dressing,wound is looking good,his worries about it breaking down fortunately unfounded. He then changed his mind several times over when I should see him again, eventually settled on 3 weeks. Then he remembered that there were wedges in the boot and thought that maybe he should take one of them out but then said no weight bearing and he’ll leave the wedges in till I see the physio. Am allowed to take boot off to shower, yay yay yay but must keep wound wrapped in plastic and change dressing every 2 days.

So, yesterday I tentatively started touching my left foot down, such a great feeling to be moving towards being a biped again. Really enjoyed the feeling of rocking over in my foot, all done very gently and certainly lying in bed last night my calf could feel that it had done something beyond elevation and floating in a boot.

Today have done a little bit more partial weight bearing. Does anyone out there have an actual definition of what PWB should be or are we all dancing in the dark on this one too?

Aaaaaaaaaarrrrrrggggggggghhhhhhhhh such a frustrating morning.

Justin Rix, the orthotist that I saw this morning for my Vacoped boot was brilliant. He’s a fan of the Vacoped having worked with ATR patients with Vacopeds in the UK. He fitted the boot for me at 15′ as this was the angle that the wedges in my moonboot were giving me (thought it was meant to be at 30′ for plantar equinus, not sure that’s the correct term) showed me how it all worked and gave me an article with a rehab protocol. Really thought I’d found the right place for my achilles as there’s a complete physio team, biokinetisists, all the rehab equipment and a swimming pool however,  the physios there follow the resident surgeon’s protocol which is no physio and no weight bearing for 6 to 8 weeks. So now I start the search for a physio and a facility that will let me start early weight bearing and start with massage and active movement of my ankle?

Love my Vacoped, damm expensive R4995 which is about $500 or £310 and my medical aid won’t pay for it but know that this is the right boot for me……..this boot is made for walking, and walkings what it’ll do…….

Thank you for everyone’s feedback, so nice to know that there are so many of you walking this journey of recovery with me.

My error, my ankle not cast in neutral position but in correct plantar flexion with toe pointing down. Having spoken to my physio sister-in-law I now realise that neutral is the position foot is in when standing.

So being at home post surgery with instructions to keep my leg elevated and only move for the essentials was challenging. I run my own veterinary clinic so am pretty much used to being busy for most of the day and most days of each week. I also am a one woman practice so one of my big hurdles was to manage my stress over what would happen to my clinic if I wasn’t there and whether the bank account could cope with paying for a locum until I can get back behind the consult table.  My husband, stepdaughter, family and friends have been marvellous with looking after me, certainly I don’t know how easy it would be to make this journey without a strong support group.

Time has blurred somewhat over the past few weeks and its hard to believe that it’s been just over 2 weeks since I had surgery done.  My low point of each day is taking a shower, what used to be such a refreshing, soothing experience is now a mishmash of sighs, occasional foul language, dropped crutches and the urge to just climb back into bed and pretend the pop never happened. Having to wrap my back slab bandage and now my aircast in a plastic dustbin bag and then anchor it with elastic bands and then shuffle my way under the shower with the help of a garden chair is really soul destroying for me. Having to shower sitting in a chair just takes all the pleasure out of what used to be a revitalising experience.

I know this makes me sound like a spoilt brat as I know some ATR recoverers have to make do with washing their hair in the kitchen sink but this just is the one thing that seems to really make my altered mobility real. I’ve had more than one tearful moment and have to confess to throwing my crutches on the floor in despair.  Despite being active at work all day I’m not particularly fit, and am carrying a few extra kilos so having to crutch my way around has been hard. My right hip sometimes feels as if it’s goibg to pop out if I’ve been crutching for any length of time and certainly the weight of the moonboot has aggravated this.

I actually had my first follow up on Thursday 7th November. Surgeon removed the back slab and bandaging and then took wound dressing off. Quite an experience to see my lower leg again. Calf, which was never a great one, us now a sorry looking, piddly floppy structure and ankle is a mottled shade of bruised yellow. I thought the wound looked good, if it was my surgery I would have been chuffed but surgeon wasn’t happy. Stressed that he had told me that wound breakdown was a possible complication due to limited blood supply and minimal subcutaneous fat as well as the skin being very thin here. So applied suture strips and a dressing and said he wanted to see me back in a week, keep leg up in moonboot. No weightbearing but allowed to place boot flat which even with no weight means that tendon is taking 20% strain, wow!

I asked my surgeon how he knew that surgery had worked, was hoping that he wasn’t going to see if he could find a gap in my tendon to poke his finger in as he did at my first consult! In response to my question he just crossed his fingers and smiled at me - not very reassuring. Have realised that my surgeon is not going to be much use with providing info about the way forward and where I might be when, so I am so thankful for the achillesblog.

My moonboot is most unpleasant. It’s very heavy, I’ve pulled a muscle somewhere in my thigh just lifting my leg to put it in an elevated position. Boot is also too big and feels as if it might slip off at any time. Quite hard to get a good night’s sleep in it as the weight of it in conjunction with my 2 cats that have taken to wedging themselves on either side of me means I wake up everytime I want turn over. Am tolerating the cats as the frequency of their purr promotes healing!!!!!

So have been researching the Vacoped/cast and with the help of a bunch of good people from this site and elsewhere,  am now seeing an orthotics guy who specialises in them tomorrow morning. Will go armed with a list of questions so that I can present a convincing argument to my surgeon when I see him again on Thursday.  The pro-achilles boot is not cheap, I’m expecting to pay at least R4000 and paid R1800 for my current moonboot. My stiletto loving soul shrivels at the thought of paying such money for such unflattering footwear. However, I do feel that this will be the best treatment plan for my tendon. Has anyone got any tips on how to best convince a surgeon that there are other treatment options, that their plan may not be the best anymore?

I have started taking painkillers again, a paracetamol and tramadol combo since I started wearing the moonboot. Does anyone have links to the benefit of longterm anti inflammatories for cases of ATR? I have read articles on longterm use following bone surgeries to minimise arthritic changes in associated joints but not sure if there’s any associated joint change following ATR. I routinely put all my dog orthopaedic cases onto 3 months of anti-inflammatories post surgery.

Will let you know how my session with the orthotics guy goes.

Gentle healing wishes to you all.

So I undertook to follow the advice “dance as if no one is watching” and initially did so in high heels then kicked these off and jumped around barefoot to all the 80s greats. Such fun. Then upon jumping up from my  chair, and taking an enthusiastic step towards the dance floor for the final song, I suddenly had no left achilles. Initially thought that I must have kicked the back of calf against a chair as whole lower leg felt numb but realised when I couldn’t really weight bear that I’d done something major.

Fortunately had plenty of good cabernet sauvignon in my system for pain relief and once I’d managed to convice my veterinary colleagues that this was not the kind of injury that just needed another glass of Cabernet I went to the emergency room at the clinic conveniently located across the road from the hotel we were all staying at for our 2 day Veterinary Business Forum.

So this happened in the very early hours of tge 23rd October 2013. The emergency doctor made a diagnosis of tendon tear but wouldn’t commit himself to saying whether it was complete or partial. Put me in a back slab, gave me a set of crutches and  an injection of painkiller and told me to be back at 8 for an ultrasound. Total rupture, 4cm from distal insertion point of tendon made with aid of ultrasound. Was interesting to see the pictures. If I’d been thinking clearly I would have asked him to ultrasound my right tendon as have a niggling fear of the right one copying the left, gulp.

Back to emergency room for another back slab (support cast that runs from toes up back of calf, bandaged on) to keep ankle in neutral position.  Box of painkillers and instruction to have surgery as soon as.

Flew back to Cape Town from Johannesburg that afternoon and saw surgeon on Thursday morning. Surgeon told me pros and cons of surgical vs non surgical repair and based on his info that surgical repairs healing faster with less chance of rerupture, and having dobe a few surgical repairs of ruptured achilles in dogs and cats I opted for the surgery. Went home in moonboot, similar to aircast boot.

Surgery was done on Monday 28th October 2013 and leg put in back slab with soft bandage. The surgeon had said that I would go straight into moonboot after surgery but he changed his mind, am realising that this surgeon does this often!

Discharged next morning after I’d seen the physio who told me to wriggle my toes often and gave me a series of exercises to do with my injured left leg in order to keep muscles strong. Follow up appointment scheduled with surgeon for 11th November.

At home spent most of time with leg up. First 3 days needed to take painkillers every 6 hours. Also on an anti-inflammatory and taking Traumeel, a homeopathic remedy.

More history to follow…….