thelifechangingpop’s AchillesBlog

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Save the last dance for me

Filed under: Uncategorized — thelifechangingpop at 6:59 am on Tuesday, November 12, 2013

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.

7 Comments

4

Comment by normofthenorth

November 12, 2013 @ 2:09 pm

Interesting stuff!

Your boot MAY be too large! It happens. Nobody’s born knowing how to fit a boot properly, and it’s probably not taught in Med School (etc.) either. If it can’t be made snug and protective-feeling with the straps and such, you may need a smaller size.

Now that I see what you thought “neutral” meant, I think your way makes more sense than the “right” way! But according to the standard lingo, the way the foot hangs in the air is NOT called “neutral”, it’s called “gravity equinus” — and it’s often the angle used for a first post-ATR cast or splint.

If you have a stool that wouldn’t be destroyed by water (I used a 1-step stepstool with a slab of cheap camping foam tied on top of it), it may make your showers way more pleasant than a chair. That way you can switch from sitting to kneeling during the shower.

I already had a “phone” (hand-held) shower on a long sliding vertical bar, which is also a joy during ATR recovery. Pretty soon you should be able to shower boot-less. Nothing is easy, and lots of things are scary, but if you can be cautiously creative, you may enjoy solving the new challenges. Showers SHOULD be enjoyable!

Finally, just stop worrying if the surgery worked! If THAT’s going to drive you nuts, just Thank God you didn’t go non-op!! It’s a great cure, but many non-op patients wish they could get an MRI or UltraSound every few minutes — like the famous farmer who kept uprooting his carrots and radishes “just to make sure”! ;-) Knock it off!

5

Comment by marcduff

November 12, 2013 @ 3:49 pm

You’re shower experience made me laugh. Not until I read your update had I felt the same. I’ve been having stressful showers for 8 weeks. It does get easier, I promise. I can stand with 70/30 on both legs whilst showering……the revitalising experience is returning.

Hang in there.

6

Comment by Ron

November 12, 2013 @ 6:31 pm

Hi Lifechanging,

LOL. I had that same experience with the shower and ended up using a chair. It takes a day or two to get used to, but it works and is worry free. It wasn’t until week 4 that I tried standing in the shower, when I was able to PWB. (Which made sense to me, but hey, who knows).

Regarding the boot, I agree with Norm - it must be too big. I use the VacoCast and it costs about $300 US, but is worth it because it will be snug, soft and comfortable. I had a pre-existing ankle issue and the Cam boots and splint hurt me EVERYWHERE. However, once I put my foot into the Vacocast - no more pain. I can also move the beads around for hot spots.

Regarding the weight of the boots, I also stressed my calf and leg over the first 2-3 weeks. However, your leg will adjust, and when you start PWB in the next 2-3 weeks, it will get better.

Lastly, I had the same fear of the surgery not being successful, especially after my second mishap, but Docs are not much use after surgery – unless there are complications. And since your PT session won’t start for another month or so, you are in stuck in the middle – but you have us\this blog. :-)

I also agree with Norm - luckily, you went OP vs Non-Op. That also worried me about going non-op (did it heal)? With that said, I’m sure you are fine, so don’t worry so much.

Unless you re-ruptured (which I doubt), it was fixed. That’s the good news, now just don’t re-rupture. Check out the list of things you may need from this site. Check out the list of things you may need.

Good luck, and keep us posted.
Ron

7

Comment by normofthenorth

November 12, 2013 @ 7:18 pm

I just discovered something about human legs from my new-ish right-knee-fixing PT, and it may be relevant to some of you NWB people. The bottom line: Holding your knee flexed “actively”, with the muscle at the back of your thigh, quickly causes cramping. That muscle isn’t designed to pull hard for more than a few seconds in a row!

In my case, I’ve been instructed to stretch my tight quads (the muscles at the front of the thigh), mostly by flexing my knee hard. I was told to use a strap while lying prone, since my quads are so tight it’s borderline whether I can grab my foot with my hand. But initially, I tried just doing it “actively”, with my leg muscles, and YEE-YOW! Does that hurt a lot and SOON!!

Anyway, I still remember the weeks I spent holding my injured leg — plus a splint or a cast or a boot — up in the air while I bounced around on crutches. I remember it was tiring, and I LOVED leaving padded stools and footstools and hassocks/ottomans around the house so I could KNEEL on them, on my injured-side knee. I don’t remember cramping back then, but I think the higher in the air you hold your cast/boot, the harder those hamstring muscles have to work. You don’t want to hold your cast/boot so low that you smack it on the ground (until you start PWB and put it down), but somewhere near there may be easier on that leg.

8

Comment by pamg

November 13, 2013 @ 5:24 am

oh I so know how you feel about showering! Strange how it’s what you’d think are such little things, that become the big things. Just carrying my own cup of coffee was such a milestone.
Also, strange how quickly you forget how bad it all felt at the time. Take heart, it does get better and you have all of us here who totally understand how you feel.

13

Comment by upstate2519

November 14, 2013 @ 7:49 pm

I’m not sure about the efficacy of post-op NSAIDs for ATRs, but I discovered why all the anti-inflammatories I took for my achilles over the years were probably a waste; what people call achilles tendinitis is rarely an inflammatory condition, which also explains why the meds never worked. I’m not a doctor (though do have an M.S. in sports medicine), but I suspect the NSAIDs may help with general surgical healing in your ankle but may not have an effect on the achilles itself. My ankle doctor did not prescribe post-op NSAIDs; my shoulder surgeon did. I’m not sure if it’s the difference in the joints/procedures or the difference in the doctors.

15

Comment by alanweibel

November 14, 2013 @ 9:33 pm

I too can vouch for the VACOcast. I had a check-up with my surgeon Monday and weighed their standard wedge boot against the VACOcast and the VACO was much lighter. Good luck with your recovery!

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