Posted on July 26th, 2010 by tony
Hi everyone- I was able to change Orthopedic Surgeons. The new OS was sort of aloof. I dont think he felt comfortable taking me after someone else did the surgery. He looked at the surgery report and said he would not have used the kind of sutures that my previous OS used. He also knew my previous OS and said he was having personal problems. I feel for him but hope that did not impact the work he did on me. I am disapointed with Orthopedic Surgeons in general. But he did allow me to move to my boot and I am 3 days into my fourth week. So no more cast.
He attempted to push my foot to 90 degrees or neutral and I was close to that but it was a real stretch, painful and scary.
I showed him my boot and what it was capable of doing but he was really not interested. In fact he didnt put it on me or adjust it. He simply said work to get to 90 degrees which is the foot parallel to the ground or standing flat footed in the next two weeks. Dont do any weight bearing at all for two more weeks. He gave me a script for physical therapy which i start in two weeks. That will be 6 weeks out from surgery and then he left the room.
One problem with the boot is that it has numbers for inflection and not degrees. So 0 is neutral or 90 degrees. Since i had been immobilized at what I supposed was -30 degrees I put myslef at 1.5 which is -15 degrees. I did this myself in the room after he had left. This was a bit demoralizinng but at least he took me on. I had the feelling that he did not want himslef or his staff to work with or put me in the boot for liability reasons. I just thought it was strange that he would leave the room and not attempt to get me set up in the boot.
The major point is that I am in the boot. I have read that I should adjust the boot 5 degrees every 5 to 7 days. I may adjust more aggressively to get to neutral at 5 weeks since I should be there now.
Does anyone have any thoughts on pushing to get to neutral in that time frame? Should I just force my foot into neutral right now strap the boot on and sleep with it that way?
Also, I have read that some are full weight bearing at 4 weeks. That seems aggressive to me. This surgeion explicitly told me not to put weight at all on it for two more weeks. I should think that I can set my foot on the floor right now in the boot. I have and it feels fine to do that even though that is weight bearing.
Anyway, interested in any thoughts on that.
Also, i feel a hot stinging pain moving from the outside toe, across the outside edge of my foot, under my ankle and into my Achilles. This happens when i straighten out my leg. I have no idea what this is and didnt get a chance to ask the doc.
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Posted on July 18th, 2010 by tony
Hello All
I am a 47 year old male living in Kansas City. I am in well above average physical condition. I exercise regularly and am mostly careful with my diet. I am writing my first blog entry while learning to use it. It is unfortunate that I only discovered this blog after my surgery. As I have read the experiences of others I have come to appreciate the importance of this blog. I write to help others as I have been helped, to get to know and make new friends through this trial (one of the few positives) and to make an account of my own experience. I want everyone to know how grateful I am for you all taking the time to recount your story. Especially some of you who seem especially focused and well researched. I really enjoy hearing contrary opinions in a truly objective and yet caring environment. As an aside I would note that this blog seems to have taken on an especially caring and dynamic culture. It is interesting that an ‘electronic’ community can develop such a warm culture. Probably the catalyst of common suffering that draws this tribe together
My son plays Strong Safety for Kansas State University. He was home for Father’s Day weekend. He and his friends were playing basketball on the driveway that I had especially designed for pick-up basketball games. I joined in and ruptured my Achilles. I jumped for a rebound with no one around me, came down, heard a pop and thought someone had kicked me in the back of the leg just below the calf. I had been playing for a little more than an hour. I have had many injuries playing sports but never this kind. I could not walk very well and I felt nauseous. I have enough experience having been around sports my entire life that this was not good.
I have a close friend that is a Dr and he was able to get me in to see the oldest and most prestigious Orthopedic Surgeons in the Kansas City area on that Monday.
The OS listened to my explanation, did the Thompson Test and schedule me for surgery July 1st. He seemed highly competent and confident and it was the most esteemed group. He spent all of 8 minutes with me.
He told me for the next two weeks I could work and put weight on it as I could stand it. So I spent the next two weeks working to get as much done as possible and had the surgery on July 1st. I wish I had spent some time doing a little research. I went in to this almost entirely unprepared. What should have been a warning sign for me in my abbreviated visit with my OS I actually took as a positive. He was the Sports Medicine surgeon, presented himself as completely positive, competent and self assured.
On July 1st I had my surgery late in the day. I will say from this experience have your surgery early. Late in the afternoon in an outpatient environment means that when you come around you are pushed out the door.
I met the anesthetist and he recommended a lower epidural. He also gave me some kind of nerve blocker that lasted for several hours post surgery. He put me under. The surgery lasted 45 minutes and the surgeon met with my family and told them all went well. It wasn’t frayed and he was able to put it together easily.
When I came around it was about 6PM and the place was cleared out. The nurse got me up, handed me some crutches and pretty much demanded I demonstrate my ability to use them. I was dizzy and still under the influence but I somehow managed to perform and I was out the door in a wheel chair and on my way home.
They gave me the lowest possible dosage of hydrocodone. We did not keep up on the drugs. Once we got behind we never caught up. I was in pain through the weekend and finally on July 5th when I was freed to take Ibuprofen I had some relief. The swelling abated and I was able to finally sleep. It was a tough stretch. I wish they had given me the strongest dosage of hydrocodone. Or something stronger.
I was casted and on my back with my foot elevated and then I began to research what I had gotten myself into. I came across this blog. In many ways it was too late. I had no idea that there was a non surgical option which NormoftheNorth has tried to help educate on. I did not know that there was widespread disagreement about treatment protocol either or that I should have interviewed my surgeon. Etc… I am mildly surprised at this in me as I normally don’t trust Doctors all that much.
After research on this site I purchased the I walk free crutch. It is helpful but hard to take on and off. Also, you have to cinch it down pretty tight and going down stairs can be harrowing, but thrilling if you like living on the edge. I will use it when I plan on being on my feet for extended times. You are hands free after all.
The truly exciting product I discovered was the VACOped Cast and the protocol that goes along with it. I was excited as there seemed to be some ray of light in this dark process. I asked my OS to prescribe it for me and he did. I have the cast in my possession and it is a stellar product. Also, Matt Carroll is extremely oriented to helping and instructing. BUY this boot is all I can say.
On my second week to visit my OS I came with the boot, and the results of my research work on the internet to support the change in protocol that I realized I was potentially introducing. I had highlighted the salient points in each study.
To my dismay my OS would not look at, touch or even consider changing his ultra conservative approach. He does not want to engage the patient in any kind of dialogue. He doesn’t even want to explain what comes next. He simply want you to get casted and come back in two weeks to find out what happens next.
I asked him to consider the boot and his response was that I would take it off and that was the sole and single reason I ordered it. I told him I wouldn’t take the boot off and he then said that his ex wife had lied to him and he didn’t need anyone else lying to him as well. I was shocked and didn’t quite know how to respond. What I had hoped would be an objective conversation now took on moral overtones to such a degree that if I left with the cast I essentially was admitting that I was a liar. This was highly unprofessional. He ended this brief monologue by declaring that after all it was my Achilles. That he was certain I would re-rupture and when I did he could not fix it and I would be permanently impaired.
I knew that if I chose the boot my care was now in my hands and he was essentially absolving himself of any further responsibility. I lacked the confidence and certainty to take this step.
So here I sit with a cast on my leg and the stellar state of the art boot sitting across the living room. I am uncertain as to how to proceed. He told me that I would be at least 6 more weeks non weight bearing. According to what I have read that is way overdoing the non weight bearing. In fact the atrophy will be terrible, the tendon stiff, the rehab elongated and the risk of adhesions increased. Perhaps I am wrong but that seems to be the conclusions to which I have arrived.
In summary I invite any input on these questions. I think and hope that any information will be helpful to others.
1. Should I try to find another OS to take me on that will embrace the boot and its protocol? I have heard that it is hard to get another OS to take you after you have had surgery from someone else.
2. Should I simply demand that I be put into the boot and write my own rehab protocol. I am very uncertain here as I feel that he has sort of threatened me.
3. If I do does anyone have a specific protocol that I can print off and follow?
4. Does anyone know of any Os in the Kansas/Missouri region that utilizes the VACO ped Pro or boot? Matt Carroll of VACOped has told me that he does not know of a single boot he has sold in the Kansas City area. I am going to call him and see if he has sold any in Columbia or St Louis.
5. Should I just continue the ultra conservative protocol that my OS has outlined? My brother in law is an Emergency Room Dr and one of my closest friends is a BHRT Dr. and both of them have indicated that I should consider this in the grand scheme as a bump in the road and just stick with him.
I know I have been long winded here. This is my first blog and I will curtail them in the future. Thanks to whomever for reading and providing any input you might consider helpful.
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