ulrichw’s AchillesBlog

I was scheduled to be the second surgery of the day, but my doctor had actually called me the previous evening asking me to show up early.

Normally I was supposed to show up at 8am for a 10am slot, but since her previous surgery was going to be a short one, she asked me to be there by 7:30am.

As anything but a morning person, this is probably the part that I dreaded the most!

I got out of bed bleary-eyed and crutched my way to the bathroom for my second anti-bacterial shower.

My wonderful wife drove me to the ambulatory surgery center and I registered myself for the surgery.

After a short wait, I was taken back to the prep area, where they asked me to get into one of those tremendously fashionable hospital robes (This one was actually not too bad - it actually pretty effectively covered my backside)

At this hospital they perform the operation under general, but also apply a nerve block. Part of my prep time was spent getting the catheter for the nerve block fitted.

Basically how this works is they take a long large gauge needle and poke it into your lower thigh until it reaches the sciatic nerve. They use an ultrasound machine to help guide where the needle is. A catheter attached to the needle is left in place and is used to inject a local anesthetic around the nerve. This basically has the effect of numbing your leg from the position of the catheter down.

In this case, the catheter actually had two purposes: 1. It was used for the surgical nerve block and 2. I would get a pump (actually a balloon) filled with anesthetic attached to the catheter to create additional numbing for 48 hours post-surgery.

Once the nerve block was in place, the main anesthesiologist came by to finish his preparation (which mainly consisted of monitoring my vital signs and checking the paperwork).

Pretty soon it was time to get wheeled into the OR.

An assistant was already there prepping some instruments, and the anesthesiologist started administering the general. I was musing that the patient’s experience of the OR is quite different from the doctors. Basically all the memory I have of the surgery is the prep time as the general anesthesia is started. For the doctors, of course, the main point is the surgery - but for me I just remember the anticipatory feeling of something about to start, and then - “Take a deep breath” - one breath, two breaths, three… and nothing.

Next thing I knew, I was opening my eyes in the recovery room, with my leg elevated in a cast.

This was my second experience with general anesthesia, and I have to say, I’m a big fan. I see great applications of the technology for things like trans-continental flights, etc. I find the total absence of a sense of time passing to be near miraculous - it’s like two hours were erased from my life, leaving me feeling slightly refreshed, as if waking from a nap! Meanwhile all of the ugly, painful surgery happened without my having any knowledge of it.

It helps that I had absolutely no negative reactions to the anesthesia - no feelings of nausea which are apparently common.

The discharge process was routine - they gave me some soda and crackers to get something in my stomach, and I was able to go to the bathroom. They then gave me my street clothes to change back into and shortly afterwards my wife picked me up to take me home.

As far as pain meds are concerned they gave me what the post-op nurse described as the “big guns.” I had a prescription of Oxycontin (time-release oxycodone) to take immediately, and then a second prescription of Roxicodone (non-time release oxycodone) to take, as needed for any “break through” pain. This was in addition to the slow drip of anesthetic hitting my sciatic from the pump (if you want to see what they gave me, google “On-Q pump”).

Since I was feeling no pain at all (the nerve block seemed to be effectively blocking my pain), I decided to forgo the Oxycontin until I started being more uncomfortable.

The pump also had a clip to shut off the flow, with instructions to use the clip if it was desired to reduce the numbness. Since my toes were quite numb, I decided to shut off the flow for the time being as well.

On the whole, the whole experience was very smooth - and other than being groggy from the residual affects of anesthesia and pain meds they gave me during surgery, I felt great.

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Tuesday morning, I got a call from the Sports-medicine clinic - They could fit me in at 12:30!

Shortly after that, the university hospital called - they had finally scheduled me for an appointment on Wednesday, and had a tentative slot for me on Thursday for surgery (if it turned out to be necessary).

I decided to still go ahead with the sports-medicine appointment - I figured it wouldn’t hurt to see two specialists.

This appointment gave me much more confidence. I was seen by a resident first, who immediately did a Thompson test. Shortly after this, the podiatrist came in and did the same test.

His diagnosis: “It’s at least 90% torn - You should do an MRI to be sure.” Basically he said that there’s a chance that some of the tendon is still ok, in which case surgery would not be necessary, but an MRI would determine the best path.

I had pretty mixed feelings about this diagnosis - On the one hand, I felt vindicated: I had not been completely off target with my self-diagnosis. On the other hand, I was also upset at my primary care physician for being so nonchalant. Finally, I had read enough by now to know the long road toward recovery ahead of me.

I decided that I’d follow up with the university hospital since they already had a surgery slot scheduled for me.

(BTW: I had also read about surgical vs. non-surgical options by that time. My decision was that I’d opt for the procedure that had the best long-term outlook in terms of the tendon. Based on this doctor’s recommendation, and the research that I’ve read, it seems like the non-surgical option’s outcomes are *at best* the same as surgery, in terms of the tendon itself. There’s a significantly higher risk of surgical complications, of course (the majority of which appear to be soft-tissue related, like infection), but I figured that with my generally good health my risk from surgical complications would be lower than typical).

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Hello World!

This is the first blog I’ve ever attempted, so I hope it will achieve my goal of being both educational and occasionally entertaining.

I actually wasn’t going to start a blog, but my case has turned interesting (a bit of foreshadowing here), so I thought it’d be worthwhile to record things for posterity.

This first post rewinds in time to  Saturday, 1/26/2013, the day I ruptured my tendon.

From reading about the injury after the fact, I now know that I’m a bit of an Achilles cliche: Middle-aged (45), male, weekend-warrior playing tennis or basketball.

I’m fairly fit, but my sport of choice is road cycling. As a result, I have fairly strong legs (and calves), but don’t really do much weight-bearing or impact exercise.

I played tennis for the first time in years that Saturday. It was just a casual session - hitting the ball around with my Mom.

About 30-45 minutes in, a short ball was coming over the net, and I started to sprint towards the net to get it - I didn’t make it very far.

As I was pushing off with my right foot on the first step, I suddenly felt like my foot was violently pushed/punched out from under me and fell to the ground. At the same time, I heard a “pop”, sort of like a tennis ball hitting my shoe. As a matter of fact, my first thought was that it was something like that: I thought maybe somebody threw or hit a ball at my foot hard enough to trip me up.

The next thought was a little different; The pain started in my leg, and my brain processed all the events, and I realized what actually happened. I started yelling “Achilles tendon rupture!” and a few choice expletives.

While we were on the court, I decided to try some alternatives to the emergency room. I had heard of urgent care facilities that might be a good alternative, so I called the toll-free nurse number on my insurance card to see if they could help me. They asked a number of triage-like questions, but real general ones, like “how much pain are you in on a ten point scale?” (I said 7-8), “can you stand on the foot?” - I hadn’t tried, so I asked if it was a good idea to try - The nurse said her questionnaire needed an answer, so I tried (and failed).

In any case, the final answer was, “go to an emergency room” - not what I was hoping for. I then asked if there were any urgent care facilities I could try, and she was able to give me a number, which unfortunately ended up going to an answering machine.

By this point my pain was coming and going in waves, but getting more manageable, so with the help of my wife and mother we got into the car to drive home to try to decide whether to go to the emergency room or not, and to get some ice on the tendon.

At this point, I started doing a little more research on the injury and what to do about it (that’s how I first found this site). Seeing some of the advice on skipping the emergency room, we tried to figure out alternatives. We read about the Thompson test and tried it - it seemed like there was a marked difference in the amount my feet moved, but it’s always tough to figure out as a layperson what is normal and what is not.

t turns out my mom is acquainted with an orthopedist (unfortunately a hand/wrist specialist) who she was able to contact. We spoke briefly - and the doctor asked how it happened and if we had done a Thompson test. After hearing the whole run-down, she recommended scheduling an appointment with the foot/ankle specialists in her department as soon as possible on Monday, and meanwhile to apply an Ace bandage, elevate and ice as much as possible. She also recommended taking ibuprofen for the pain, and a regular aspirin every day to prevent clotting.

By this time, the ibuprofen I had taken was starting to work, and the pain was getting a lot more manageable.

My wife went out to buy me some crutches so I could at least get myself to the bathroom and move around a little, and I settled down to wait until I could make my appointment.

I’ll be posting my next few entries fairly quickly - trying to get caught up to today…

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