Journey Begins with ???

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.

5 Responses to “Journey Begins with ???”

  1. Tony,

    I was in a similar position concerning rehab and simply followed my own protocol after getting into a boot at 3 weeks. I was happy with the surgery but not the rehab. Luckily I did not have to deal with your cast situation.

    Here is a protocol from the US Army: Repair WB08.pdf

    Another from a university PT program:

    If you go doc’s way and re-rupture you get more of the same style treatment assuming you keep the doc.

    If you go your own way and re-rupture doc may refuse to see you again but you’d probably want a different doc anyway.

    Good Luck

  2. JSKI
    Thanks for the helpful insight. It appears that I am going to have to structure my own rehab program. I may wait out this new two week period and when i next see my OS demand that the cast be removed and I make my own transition to the boot and get set up with a PT specialist. They may not even agree to treat outside of the surgeons approval.

  3. Tony, I’m in no position to complain about long-winded blogs and posts, as you already know! And I appreciated the details, too.

    I think you already know where to find the “UWO” protocol that a few of us here (and 145 patients in the UWO study) have followed, at .

    Your OS sounds pretty awful, or at least like a human being going through a tough patch and taking it out on the people around him. His approach and his protocol both seem archaic.

    Many surgeons, including yours (and mine 8 yrs ago) follow instincts that are basically backwards — they think that longer immobilization is safer, more “conservative”, and more likely to produce superior results, while the evidence generally points exactly the other way. In addition, they place no value on the lifestyle and psychological benefits of early weight-bearing and mobility, except to view them as a threat or a challenge to be overcome. And they give little weight to the non-trivial risks of injury from being on crutches for weeks and weeks.

    The only good thing I can say about that kind of ultra-conservative protocol is that I survived it myself (post-op, first ATR, 8 years ago), and the final results were just fine. Getting there was a real PITA, and I was constantly arguing with my OS — I eventually became his first patient EVER to be put into a (hinged) walking boot, instead of one or two MORE casts (I had THREE before the boot!). But I did get there, and I was playing competitive volleyball again, with no noticeable functional deficit, at around 10 months post-op.

    Buy the evidence (and some other anecdotes you can read here) shows that it’s not the best way to go, for sure.

    I hope you can do better, following one of your alternative plans!

  4. Tony, things are slightly different here in the UK. In fact treatment varies from one primary care trust to another and between hospitals in the same trust.

    While patients are treated under a particular consultant, it happens that you may see 5 different consultants but not the one you’re registered under! Each belonging to a different school of thought with regards to treatment options (op, non-op, boot, cast…)

    Your consultant is an asshole; he obviously doesn’t like being told what to do, esp from patients! Any chance you can see another consultant at the same hospital, try booking a different day slot.

    As norm suggested, the old school conform to immobilsation for min 6 weeks - which simply isnt evidence based.

    I’m careful not to encourage you to wear the boot, in the event he removes you from his care, which happens in the UK. You will forfeit any physio :(

    I got into a boot at 4 weeks and havent looked back since.

    Let us know how you get on.

  5. Issat,
    Thanks for taking the time to give helpful insight. Tomorrow I am going to see if there is another OS in the practice who is more progressive without mentioning i already had surgery.
    Also, I am going to call a couple in the KC area that I have come across that utilize boots.
    I think worst case for me is at the four week post surgery I simply refuse another cast.

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