8 wks post-op, PT #2–compression sox and devices?

Don’t get me wrong; it ’s not that I don’t want my PT–it’s just that it’s hard to deliberately make yourself feel worse, just because you have faith in the concept that it will make you feel better.   I have noted that in general I wake up and feel relatively strong, walkable, I get up on my two bare feet (not that I’m really walking heel-and-toe), etc.  By the end of the day, I move my leg as if it were one long stiff stump, i’m tired, my foot has swollen two sizes larger, etc.  And in the two days I’ve had PT exercises, all of that is exacerbated.

So there’s a little bit of a gumption trap–I know that Rehab Is All; sticking to the exercises is the only thing that has a chance of bringing me back to normal; and yet–.  It’s getting over the pain hurdle (”Wait–I’m about to make myself feel worse??”) that is difficult.   I’ve never been good at keeping resolutions (science provides a good reason for that–it doesn’t work), so I must retell myself the story every day, 2 or 3 times a day, that This Is Good For Me.  And not think about how I’ll be tired and a little sore afterwards.

I’m reminded of my Tae Kwon Do days from long ago–not only was there a lot of faith that all that repetition would actually teach me something, however bad it felt at the time, but also the perpetual knee braces, R.I.C.E. etc. due to sprains and bruises.  The brace was useful not only for encouraging stability and reducing pain, but also for keeping the swelling down.   So I’m experimenting with an ankle brace.  It feels good–but is it?  I suppose when I practice my exercises I should not be wearing it.

At least I got two new exercises at PT yesterday–the ubiquitous rubber band stretching (resistance work), and a little lesson in flexing my toes, involving scrunching up a towel on the floor under my foot.  So I’ll have plenty to do in the next week (I’ll be out of town and can’t visit PT)–as long as I do them.  Perhaps I can enlist my lovely Significant Other to remind me daily as to whether I’ve been doing them or not.   And I’ll be doing a lot of walking–my doc, supported by my PT, suggests taking my boot because I may be on uneven ground, and I use my cane when I go outside)–so I hope all this will be good and I’ll be stronger and more limber when I return.   I’ll keep you posted.

My first PT–or Am I lucky or what?

Seven weeks post-op., and my first PT visit.  I’m not exactly apprehensive, nor anxious–but I’m sort of pacing in anticipation.  I’m hoping for a next step (as it were). Am I doing OK?  Can I just proceed?   I’ve been practicing walking barefoot on both feet.  I’ve even tried to balance on my bad leg–since I read here that PTs might ask you to do that.

So, I arrive.  Matt the PT takes a lot of measurements–of course he does, I hadn’t even thought of that.  I appreciated seeing how precisely my foot didn’t work.  The good news was that I could flex up and down far more than I thought I really could.  What was really cool was that he asked me to go to the wall and do a double toe raise.  I thought “I can’t do that!”  But then I just reached down into myself (like in the good old Tae Kwon Do days), and tried it.  Yes I Could!  I raised up on both feet.   Yes, the left one hurt a little, and I was clearly favoring it–but I went up.   I really hadn’t believed I could do that, but because the PT expected that I could, I did.

I learned that while I could flex up and down a lot, and I could flex out, I could hardly flex in.  Again, a surprise.  It was quite remarkable–my right foot would flex way over, my left foot hardly at all. So Matt watches me walk up and down the hall.  ”Oh, yes; I can see just what’s going on.”  We practice a bunch of exercises, which he prints out.  He’s encouraging–says I’m healing well, and after a week or so of exercise, I should do a lot better.

And I feel different.  As noted, I’ve been practicing walking.  It’s not easy.  But–it feels different from two weeks ago.  Then, I felt fragile–I was worried about turning my ankle and re-injuring myself. I wore the boot a lot–not only because I was still supposed to.  Now, I feel strong.  Oh, not actually strong–but I feel that the tendon is healing.  It’s not about being afraid of breaking it again, it’s about making it supple, and making my calf strong, and being loose.

I walk in shoes indoors, per the doc’s instructions.  I’ve been thru the exercises–they don’t hurt, exactly, but I can tell that I’m stretching.  Actually, it’s more work and exercise than I’ve been doing for the past two months, and it makes me tired.   Standing makes me tired. (My cane broke, but I’ve bought a new one–it makes me feel better.)   But mostly I feel that I have passed thru one stage, the I’m-not-well-yet stage, and moved to the I’m-a-whole-but-not-fully-functional-person stage.   I still like to have my heavy cane if I go outside–and my doc suggests I still wear the boot for icy or uneven ground.  And I’d like that.  And I still like to have my indoor cane if I’m moving around inside for more than a few feet.  But I feel I’m on the way up.

Watson update

I was wrong.  While in parts of the Holmes canon all it says is Watson’s injury is caused by a bullet thru his leg, in The Sign of Four Holmes is referring to a chase he and Watson are having and refers to it as  a “six-mile limp for a half-pay officer with a damaged tendo Achillis” [emphasis added].  So is is one of us.  Add him to the celebrity list (although, since he still has a limp years later, presumably he didn’t follow his PT routine appropriately.)

John Watson, M.D.–role model?

We saw the new Sherlock Holmes today.  In this version, Jude Law plays Dr. Watson–superlatively.  He manages to always walk with a limp, just as the original Watson did–even when he (Jude) is beating up the bad guys.   As we all know,  Watson was injured in his leg (well, originally his shoulder but the leg is better) while serving as an Army physician in Afghanistan.   While not apparently an Achillles tendon injury, having a bullet pass through it “did not prevent me from walking [although] it ached wearily at every change of the weather”.  So Jude plays this brilliantly.

While obviously a fictional depiction, the movie so successfully sucked me into its illusion that I felt amazed and thrilled at how well poor Watson, even with his ongoing injury, is able to thrash about knocking down the villians.  He also seems to know Gracie-style (Brazilian) jiu jitsu, as well as being a crack shot with a really cool swordcane as well.  Anyway, I feel inspired, even tho’ a PT earlier this morning told me he had an ATR and never fully got his strength back–although some people do, he hastened to say.   So I’m feeling anything is possible now.

Which is good–my earlier thought for the day is to realize that having this injury is like having a permanent distraction.  I was driving to a meeting, and while walking to it after parking I bumped my head on a street sign (hanging over at <5′8″ into the sidewalk) even tho’ I noticed it and tried to duck.  I was thinking during  a boring part of the meeting about what was going on, and i realized that while driving I was constantly thinking about my foot, and if it could be in a more comfortable position, and in what way did it feel wrong, and how could I make the irritation less, etc. etc.   I thought “this is as bad as talking on a cell phone”.  So maybe I better be careful about driving, and walking, and anything that really requires concentration that I can’t do while keeping my foot elevated and essentially without noticing it.  At least for now.

PS: the real Holmes really did know “have some knowledge, however, of baritsu, or the Japanese system of wrestling, which has more than once been very useful to me.”–especially in defeating Moriarty at Reichenbach Falls.    This martial art is probably a typo for “bartitsu”:

  1. “Bartitsu was created by British engineer Edward William Barton-Wright in the 1880’s. Barton-Wright studied martial arts during the few years he lived in Japan while working as a railway engineer and surveyor. When asked what bartitsu was, Barton-Wright said, “Bartitsu has been devised with a view to impart to peacefully disposed men the science of defending themselves against ruffians or bullies, and comprises not only boxing but also the use of the stick, feet, and a very tricky and clever style of Japanese wrestling, in which weight and strength play only a very minor part.
  2. When Barton-Wright returned home to London in 1898, he gave up his career to focus on teaching bartitsu. He established the Bartitsu Club or the Bartitsu Academy of Arms and Physical Culture as it was more formally known at 67b Shaftesbury Avenue, in London’s Soho district.
  3. He taught his special blend of the ancient Japanese martial art of jujitsu and French boxing as a form of self defense and as an alternative to the use of firearms. Rather than relying on aggressive moves, practitioners of bartitsu use their opponents own weight and strength against them to outbalance them. In fact, Barton-Wright showed his students how to defend themselves using only an overcoat - a move frequently employed by Holmes.”   Enjoy

Decisions, decisions

So–if I am authorized to walk around the house (but not out in the icy uneven surfaces of nature) in two shoes, but with a wedge, am I now in the 2 shoe category?  Am I Full Weight Bearing?   My own inclination is to wait for these two milestones until a week from now–when I am authorized to ditch the boot, even outside, although will still be with the wedge for two more weeks after that.

See, I am hobbling around the house, occasionally, very occasionally, in just my bare feet–certainly in the morning, when I take a shower standing up.   I can’t say that my doctor has told me to do this–but neither has he forbidden it. And since I’m mostly a ask-for-forgiveness-rather-than-permission sort of guy, who is nevertheless very careful, I’m not going to ring up his office to talk about it.  I might discuss it with my PT next week when I meet them for the first time.  Since I hear that they are in general pushy types, they might even approve.   As long as I’m careful (I’m 7 weeks post-ATR, and 6.5 weeks post-op).  Still, it’s not really fulltime FWB, and certainly I can’t lay claim to 2 Shoes when I’m wearing the boot out of doors.  So I will patiently wait to update my profile, while I slowly inch my way across Brooklyn.

On contemplating my left foot in a shoe

So, today I see the orthopod.  It’s day um 44? since my operation.   I’ve been practicing walking barefoot since Monday.  But the doc doesn’t even ask me to stand up barefoot!?*!  He does like the way it looks, mostly.   But he seems unhappy with a scab on the incision line near my heel.  It is, however, nothing more than rubbing against the back of the hard part of the boot. He is satisfied with that.

There’s kind of a swollen lump on one side, but he squeezes my calves for a while, and again is satisfied.  So he says I can lose the boot.  But, since it’s January in a 4-season area, I should wear the boot outside for the next week.  OK–I can live with that.  He says to start therapy, and writes a prescription for a PT group near my home.  (I later call them, after ascertaining that they are in my approved network, of course, and I start Wednesday.)

The next big question is: can I take a vacation, starting in about 10 days, in Hawai’i?   He says Yes!   Walking, hiking, swimming, it’s all fine.   Walking around on the sand–well, maybe a different story.   He suggests I take the boot along.  :-(   I do not want to do this.  We will see.

And he said I should wear a wedge in my shoe (well, both shoes, just to keep it even).  I don’t like this. It felt funny at first.  I think “hey, I’ve been walking around barefoot–why do i need to wear a wedge?”   But I don’t–there’s no point arguing with a surgeon.

I talk to the tech about the free styrofoam wedge; I try it.   She says there is a gel-type, but not covered by insurance.  Only $24.  I want to try them, and when I do they are definitely worth it.  I get a pair.  It feels funny, but I am walking in two shoes!  Or limping or shuffling or gimping or whatever.    I like it–even tho’ I am now back to using the cane.   If it’s an uneven surface.

He says “come back in six weeks”, and leaves.  I’m packing up, but I realize “does he want me in this wedge for //six// weeks/?”  The tech says she will find out.  As I get /both/ of my shoes on (I brought the left one hoping for this moment) she says “three weeks, then you can lose it if it feels OK.”.  Which I certainly expect it to.

I’ve spent the rest of the day walking around in my SHOES.  It’s a mixed blessing, but I want it.  I recognize that maybe I’ll have to take it easy tomorrow.  No talk about compression sox or anything, but maybe I’ll do that myself.  The doc says the swelling and thickening will continue for up to a year!  Looks like I won’t be forgetting this anytime soon, even aside from the limp.

I’ll take the cane out with me when I go out–you look better limping with one in your hand rather than just dragging your leg along.  I have some errands to do tomorrow; I’ll see how it goes.   But I’m very glad!

Boot–the last week (I hope)

When we returned from “vac”, which is more work than leisure, I began to feel better, as noted previously.   Then there was a marked improvement in the last few days.   I read a bunch of posts, all of which were about various (unnamed) people who were surreptitiously walking around in their bare feet before the doctor said they could <gasp>.   They tempted me.  I took off my boot, and stood up (which I had already done).   Then I took a halting step.  Voila!  I didn’t fall down!

On Sunday night, day 43 post-ATR, and day 39 post-op, I walked!  (like Amahl).   Haltingly, shufflingly, but I was on my own bare feet.   I had been worried that my poor calf muscles were so atrophied that I couldn’t even hold myself up.  Of course, I need both legs to do it.  I had also read that the PTs were going to ask me to stand on one leg–the bad one.  I tried this–maybe more than a millisecond, but less than two seconds.  Not much strength there.   But no pain–just couldn’t do it.

So Monday  AM I took a shower standing up–negotiating myself into the shower very carefully.  Fortunately when we had our bathtub replaced they included a built-in bar (not the drinking kind, alas) so I could put full weight onto that as I eased my good foot (thus putting weight onto my limp foot) into the tub.  I mostly stood on 1.2 legs, leaning against the shower wall.  It felt great.  One reason I wanted to see if I could do this is that on Tuesday pm I was planning to take my first flight post-op–and stay in a hotel room.  Could I take a shower without needing a handicapped room?   So I was practicing–and it worked.

Too well, of course.  Being a guy, I then began to get cocky.  Took another shower sans boot Tuesday am.   Went off to my car Tue pm with boot but no cane–tho’ with a suitcase and a messenger bag.   Finally I get to be the one to board early because i “need extra time to board”.   I stump along the runway.  Get on board into a window seat.   It works fine.

Hours later,  I get to my hotel.  It’s late, since the ground crew managed to break a headlamp which had to be replaced on the runway, taking over an hour.  I go to bed without my boot.

the next day, I spend all day from 9 am until about 10 pm dangling my foot–never putting it up the way I do at home.  I look at my foot Wed night–it’s really swollen.  And the more I lay in on the in-room hassock, the worse it feels.  I think “maybe I should put it back in the boot.   Heresy–surely I should work the foot.  But, I feel that maybe i should take care of myself and not outthink the medical profession.  So I put the boot on, including the air pressure.  It feels great.

I love taking an actual shower every day (very carefully).  I love being able to practically walk again, with the boot (just like a wooden leg).   I love taking it off and feeling the freedom of no pressure.

But it’s protecting me.  I know that when I get to  walk around, I’ll essentially regress for a day or days or even longer–back to the shuffle, limp, halting step of the infirm.  And the foot will swell.   I wonder what advice they will give me.

More tomorrow, after the doctor’s appt.

Boot: Days 15-25–Noticeable progress

I hope this is my last catch-up post.  I’m on day 28 with my boot, which I hope to get off tomorrow and start rehab.  But there is a significant stage I experienced during the last couple of weeks I wanted to document.

After Christmas, we (that is, she) drove back home the 10 hours from Michigan to eastern Pennsylvania.   Since our son accompanied us, I rode in the back seat with my leg up on the seat the entire way (other than rest stops).  The next morning, my leg felt better, and was less swollen, than it had been since I started with the boot.  Practically no throbbing, certainly nothing like pain, I felt great!  More energy, stronger, better all around.

My guess is that in the weeks prior I had been on my PWB leg a lot–the boot offers such freedom compared to crutches, and there is so much to do.  So I had been stumping around a lot, first at home getting ready to leave, and then while visiting for the holidays.  Yes, I took time out to get my leg up, and was usually assisted by a cane, but thru the retrospectroscope I think I was just on my feet perhaps more than was optimal.  Or at least I certainly felt the effects. 

The last week of 2009 was so much better.  During the course of those days, in which much was done for us by our visiting kids, I noticed a great improvement in my stride.  At first, with the boot, you put your booted leg forward a little, then bring up your good leg so its foot is pretty much in line with your boot.  A little better than a shuffle, but not much.   However, during this time, my good leg began to be able to swing past the toe of the boot more and more each day.  It’s not like actual normal walking, since the booted leg is still barely flexible, but it’s a lot better than shuffling.   And the cane pretty much stayed in the corner.  I’d take it out when I went outside, because it’s slippery in winter and uneven, but often even then, and certainly indoors, I began to simply walk without the cane–just me and my boot.

I continued to shower using the sitting stool (the only safe way), but invariably took the boot off and very carefully let the foot lie on the bathtub floor.   Previously, I had kept the boot on but kept it out of the way of the water spray, and did a sponge bath of that foot separately.  I could literally feel it being stronger than it had been–I began to feel strength and tension in the Achilles tendon itself.

Now, my poor neglected calf muscle wasn’t so encouraging–no question that there had been muscle loss.   I was quite concerned about this, but had faith that it would be rectified later when therapy started.   More on that in the next post.  It was just a pleasure to feel, and see, progress being made in the physical realm, which certainly makes a big difference in the mental and psychological realm. 

I kept remembering to elevate my leg frequently.  As I discovered later, it’s just not good at this stage to never elevate your leg all day and all evening–even if you’re not walking on it.   I keep hearing that when I start rehab, doing the rehab is the most important thing.  I would say that during the first several weeks, letting your body heal itself, and not putting extra stress on it, is the most important thing.   It knows how to get better; don’t get in its way.

Boot–the first two weeks

Freedom is a relative thing.   The boot is heavy, awkward, and gimpy-looking and -feeling.   But not being on crutches is wonderful!  I took them with me going around the house for a day or two, but they have been resting by my bed since the 2nd or 3rd day I got the boot. I exclusively use the cane.   I consider this partial weight-bearing, since I’m clearly relying on the cane, not to mention the fact that it’s only my heel taking any weight.

The first day or two, my foot throbs.  But it feels so good to be able to let the air flow across my foot a couple of times a day.    I change my sox every morning, which feels great.   At first I have to take them off very very carefully.   Also, I learned the trick about showering while wearing the NWB cast.   You need something to sit on in the shower.  This works even while NWB in a merely wrapped-up leg.  By sitting, and keeping the NWB leg a) wrapped in a plastic bag and b) lying on the bathtub rim sticking out of the carefully-placed shower curtain you can take a shower–which also felt wonderful.  This method also works with the boot.  I don’t trust myself to tape up the plastic bag adequately enough to make sure it stays dry standing in the shower, so I don’t do that–tho it appears others here have done so.

I’m proceeding very cautiously–I don’t want any risk of reinjury, however mild. (Aside from doing some slightly crazy things like helping get ready for guests by vacuuming while still NWB–I’m very good at hopping, and our upright vacuum functioned as an adequate crutch.).   But we need to get the house ready for all of our kids, their S.O.S, and a couple of grandchildren who will be arriving right after Christmas, and we have to leave before Christmas–so there’s a lot to do. I hobble, pick things up, and keep on cleaning-slowly.   Even tho’ I stop fairly frequently, the heel swells and throbs–but no injury, I think.  And not real pain, not acute pain at least.

And the scar continues to heal w/o any sign of infection.   Yeah!

I am bright enough to realize that I’m not going to be cleaning the gutters or finish raking leaves anytime soon, so I hire some people to do that.  The gutter people finally show up, but the leaf people are slowed by rain and finally a 14″ blizzard, which occurs early enough not to keep us from setting out on our drive on day 31 post-ATR but not early enough for them to get it done by Yuletide.  Meanwhile, I’m still inside vacuuming (not balancing on one leg, this time.)  And shopping online–no malls for me!

It’s frustrating–you’re not as mobile as usual.  You get tired earlier in the day compared to pre-ATR.  You can’t sit in a chair very long without beginning to throb, itch, and feel a strong need to lie down or recline.  Going up and down stairs is a slow process.    Whenever you stop moving, you look for a place to rest your cane where it won’t fall over–picking things up is possible but not easy.   It turns out that putting weight on the balls of your feet is pretty important.  I am getting a much better appreciation of how the body works, and how the parts work together.   I’m glad about that.   Being  silver-lining and glass-half-full kind of a guy.

Just after week two of the boot starts, we get in the SUV and start driving.  I sit in the front seat at first–I’m not ready to be exiled, but I accept my S.O.’s orders not to drive.  At the moment, I’m more worried about rest and recovery than I am about keeping active–and after a few days of a lot of hobbling around I’m happy  just to sit.   Although it doesn’t all go well:  the journey takes  a couple more hours than we thought, I find that there aren’t as many opportunities to put my leg up as there were at home; I’m walking (a good thing, ideally speaking) a lot (a bad thing, practically speaking), which even with the cane is not a picnic.   “I can’t get far on foot”.  My family learns that while they can start briskly trying to get from A to Z at a fast pace, I won’t be joining them until about twice as long as they were hoping.  I feel that learning to slow down is good–kind of like enforced meditation.  Instead of moving around to take a lot of pictures, I have only one POV–from a sitting position.   It’s different–but liveable.

Christmas Day, the end of Boot Week 2–I take out another wedge, making my heel a little lower and stretching my tendon ever so slightly.  This causes some throbbing for a day or two.  But I’m happy I can do it.  Then I think “why am I taking Tylenol?  For anti-inflammation I should be taking Advil.”  Which I’ve been staying off since frequent use exacerbates my pre-hypertension.  But a few days won’t hurt me.  The Advil works great, and I have the best night’s sleep in days.

Day 17: I get my boot!

Back to the orthopod the next Friday.   Unwrapped again.   They start pulling out stitches.  ”Oh, this looks good”, they say. It’s hideous, but whatever.   Then they cover it back up with Steri-strips.

“Do you have a sock?”  No; I thought about bringing one but didn’t.  They give me a compression stocking without toes.   But I get the impression I should start getting some sox soon.   Then the tech comes in with a big black thing, in two parts.  First they try to get my foot into it at all.   That doesn’t work, because my foot is wider than what they think of as normal–partly swelling, partly its natural shape. They search in the back room for a Large–yes!    It is large–honkingly so.  ”Oh, this will stick out way past your toes and help protect them.”   Yeah, my footprint now approaches 18×8 and 3 pounds–and it’s still snug.  They show me the styrofoam-like wedges in the heel, and explain that while it will seem as if I am walking heel and toe, it’s an illusion–my foot is still immobilized such that my heel will do all the work–but I can stand on it, insofar as I can stand it.

They want to use only 3 wedges (they nest together and are held on by sticky tape on the bottom of each) but that hurts too much, so they grudgingly allow me to use all 4 but say “try to get rid of the 4th one in a day or two”–removing from the bottom of the stack.  I stand up–it’s wonderful!    Tho’ not without a little pain, but who cares?

I still have my crutches, so I crutch to the car one last time.   At home, I keep them right next to me  but break out my cane–the swordcane I bought 15 years ago and have been waiting for a chance to use.  I limp, or gimp, very slowly.  I notice that I can only bring my right foot to be about even with my left foot–I can’t move it past the left foot.   I’m still on Tylenol–but only 3 tabs a day.

Two days later I remove the 4th wedge–it’s a little painful, but I can do it.  The boot is almost comforting.   I hobble into church to hear the Christmas cantata, and endure various comments.  I feel lucky when I hear a friend describe how he ripped his Achilles tendon apart–it was just frayed for several inches on either side.   The point being that surgery wasn’t an option–they would have had to cut away too much of the tendon.  So he was in a boot for nine months!!   At least I can look forward to better than that.

The doc said a) when I come back in January I might get it off!  (”We do aggressive therapy now”) and start therapy.  And he wants me to remove the 3rd wedge in two weeks (Christmas Day).  O–K—   I simply have faith that this will work out.   When I told him I was fairly pain-free he seemed surprised (muttering under his breath “maybe that anesthetic we put in the incision was a good idea”) but pleased.  And really–the scar irritates, and the heel area gets swollen and throbbing, but I wouldn’t say there’s pain.

So I start life hobbling around.   I can go up steps one foot at a time.  Slowly.   Everything is slow.  But being able to put my foot down is wonderful–except of course it hurts to keep it down.   Once again I’m told that I can drive, technically speaking, but shouldn’t keep my foot dangling for a long trip–like our ten-hour drive to Michigan coming up.    Luckily, I’m not the only driver–and if she has her way, I won’t drive at all.