First Post

Greetings,

A little background to start things off: I think that I am genetically predispositioned to suffer ATR.  My father ruptured his left Achilles playing tennis ~13 years ago at age 58.  Knowing this, when I developed Achilles pain 3 years ago I questioned orthopedic surgeons and podiatrists (I am an anesthesiologist - so sorry if I toss in a little medical lingo) as well as physical therapists (I was going to PT after having a knee scope for torn meniscus) about my pain vis-a-vis my dad’s ATR.  All assured me that I didn’t have to worry: the tendons that ruptured were “out of the blue”, not ones that had a history of pain.  Around the same time, my younger brother was training for a marathon and complained to me about the Achilles pain that he had developed.  I told him of my conversations and told him that he didn’t have to worry about ATR.  So, when I started having pain 6-8 weeks ago, I took some Motrin and didn’t think much of it, remembering what I had been told a few years back.

More recently, I’ve been playing Ultimate Frisbee 1-2 times per week since last summer - the weather here in Denver cooperated last winter such that we were able to continue playing all winter.  I’ve been jogging 3-5 miles 1-2 times per week at a 8.5-9 minute/mile pace depending on how hilly a route I take.  And I’ve been cycling as well.  From other things that I’ve read, this may be the key.  I started mountain biking again for the first time in over a decade sometime in April.  In July, I bought my first road bike and got my first cleated pedals/shoes.  I got mountain pedals and shoes because I wanted to wear the same shoes on both bikes.  Initially with the roadie, I started getting some wicked calf cramps, which resolved when I lowered the seat.  Over the past few months, I’d been able to bike 2-3 times per week.  Overall, I am in better shape than I have been in years, getting some kind of exercise in 5-6 days/week.

So, two weeks ago I finished work early and went to play Ultimate with a new group of people.  7 others showed up, so we played 4-4.  I was playing great (isn’t that always the case).  I was running circles around some of the other guys, and a guy on my team even commented on how good of shape I was in (kiss of death).  After we had been playing for a half an hour or so, I was backpedaling, guarding my guy, when the other team turned the disc over.  I tried to sprint forward and felt and heard the pop that I am sure that we all know.  The guy I was guarding heard it as well.  My initial thought was to wonder why this guy kicked me, but that thought was quickly followed by knowing what had just happened.  The actual rupture really didn’t hurt.  In fact, when I finally stood up, the rest of the guys started playing again!  I guess I should’ve grabbed my leg and writhed around on the ground.  What did hurt was trying to take a step.  I got some guys to help me to my car and I grabbed my phone.  This is where being an anesthesiologist can come in handy.  I called my office to have them get the number of an orthopedic surgeon I know.  When I called his office to see if he was available, they put me on hold and after a couple of minutes, he picked up.  I told him that I had just whacked my Achilles and asked him what I should do.  He told me to come straight to his office and he would see me.  His office is a floor above mine, in a building that is next to one of the hospitals where we both work.  I got there and commandeered a recovery room nurse who was just putting a patient into their car to meet me in the parking lot with a wheel chair.  I was thankful for the good timing.

Exam revealed complete rupture.  My orthopod said that he was surprised, given that I had driven myself to his office, wasn’t complaining of pain and didn’t look like I was in pain.  He said that if he would’ve had to guess before examining me, he would’ve said that I had only torn some muscle.  He described the two options of a series of casts vs. surgery.  To a private-practice pediatric anesthesiologist with four kids aged 11, 11, 11, and 9 and a wife with a chronic illness, it didn’t seem like my life had room for the amount of non-weight-bearing that the casts would entail.  Besides, I agree with most surgeons that “the chance to cut is the chance to cure”.  He gave me a walking boot and some crutches and we set up my surgery for the next afternoon.  When he asked if I needed anything for pain, I repeated that I really didn’t have any pain.  He gave me a prescription for Vicodin anyway and suggested that I fill it so that it would be ready for after surgery.  He also gave me a script for Lovenox as prophyllaxis against blood clots.  I called my dad to commiserate during my drive home.  I also called my brother and told him to forget what I had said a few years earlier about pain not leading to rupture.

The next day was rather boring while I waited for my surgery.  I found that in the boot, if I did kind of a step-to with my good leg never going ahead of my bad one, I could get around the house without pain.  The only real incident was when my foot started to cramp.  I asked my wife to pull my big toe towards my knee to relieve the cramp.  She didn’t understand what I wanted her to do and she pulled my whole foot towards my knee!  Yeouch!  Fortunately, standing up both relieved the cramp and eased the first real pain that I had experienced.

Overall, my surgical experience was fine.  I is weird being on the “other side”.  I had to tell myself several times to just act like a patient.  Several of my partners stopped by beforehand to wish me luck.  I don’t recall anything after getting into the operating room (thank you, Versed).  And I don’t recall reporting much pain in recovery - although hearing how much morphine and fentanyl I got in PACU makes me think that I must’ve complained a few times.  The only rocky part was that whenever I sat completely upright, I got sick to my stomach.  My wife stayed home for the surgery, feeling that she would be better able to attend to me if she didn’t have to sit around in uncomfortable waiting room chairs.  Fortunately, one of my partners volunteered to take me home.  After seeing me spit up my post-op popsicle a couple of times, I asked her if she wanted to reconsider and have me stay the night at the hospital.  She said no, packed up a barf kit, reclined the seat way back and got me home without incident.  Of course, after getting up and inside the house, I had to throw up the rest of the popsicle.

The first several days post-op were not that bad.  It helped that it was Labor Day Weekend, that it was also the opening weekend of the college football season and that Notre Dame started the season off with a convincing win over Nevada.  Being an anesthesiologist and wanting to be able to titrate my pain medicine, I had gotten a separate prescription from my surgeon for oxycodone.  That way, I could take something every three hours, alternating tylenol with oxycodone, instead of taking Vicodin every 4 hours.  I also got him to write for some Zanaflex, a muscle relaxant, after my bout with the foot cramp.  Following what I tell my own patients, I kept myself on a pretty strict schedule of meds for the first three days.  By Tuesday, which was post-op day #3, I was down to taking just tylenol every 6 hours or so.  Also by Tuesday, I was noticing that my heel felt quite squeezed by the splint.  I ended up calling my surgeon Thursday morning to tell him about this tightness sensation.  He had me come in, removed the splint, sent me for a test to check for blood clots (just in case, since we all know that people in the biz have a higher rate of complications), which was negative and gave me a new splint.  He seemed pleased that I was down to taking just tylenol.

Week #2 had less of a good start, with Notre Dame being outplayed at the end by Michigan (yes, I love to watch football and yes, I’m a Notre Dame grad).  The real excitement of the week was trying to help my youngest build a catapult as an example of a complex machine for school.  I ended up doing most of the cutting work because with only one usable lower extremity, I couldn’t stabilize the mitre saw well enough for him, although, hand-sawing while standing on one leg really takes a lot of energy.  Things improved for me after I was able to set up a place to sit.  Would’ve loved, too, to let him use the drill press, but it was not set up and I couldn’t get it set up, so I had to do most of the hole drilling.  He did put in all of the screws and was very good at getting things up from the basement to the garage where we were doing our construction.  I scared the dickens out of my wife Wednesday evening when I lost my balance heading out to the garage (with tools in both hands) and fell backwards, tools, crutches and my bum making quite a racket.  Fortunately, I was unhurt and only had a few more things to do to complete my son’s catapult.  He was smiling ear to ear this afternoon telling me how well his project was received at school today.

Yesterday, I had my scheduled two-weeks post-op appointment with my surgeon.  He took off my splint, said things looked good and took out my stitch (one big long one).  I reported that I was mostly just taking tylenol (I did take some Vicodin Wed. pm after my little fall).  I was under the impression that I was going to be put in a walking cast at this appointment and was a little surprised when he said “OK, let’s get you a boot”.  I told him that I already had one, so rather than give me a new one, he wrapped my foot in an ACE and told me to put the boot on when I got home, which I did.  Now, maybe I wasn’t paying close enough attention, but I don’t remember being told that I was to be partial weight-bearing.  And remember, except for when my wife pulled on my foot pre-repair, I really hadn’t had much pain (that I could remember, anyway).  So after putting on the boot, I stood up.  OMG.  Not sure how much of my weight I actually put on my foot, but I think that anyone reading this probably heard my scream.  Hot assault knife attack is an understatement.  OK, now I know what the pain is that I’ve heard/read about.  I figured that I was not going to be getting rid of the crutches any time soon.  Still, a couple of Vicodin and some Zanaflex, and I slept just fine last night.

Which brings me to today (finally).  I went back to work for the first time since my injury today.  It is not that I couldn’t work while non-weight-bearing, but for both myself and my patients, I probably shouldn’t.  With at least being able to steady myself with my injured leg, I felt that I was able to safely care for my patients and everything went fine today.  I did have to get some extra help with getting to recovery - anesthesiologists usually help push the cart - but, other than that, I wasn’t really hampered.  I’ll probably sleep like a rock tonight since it has been the most that I’ve been up and around in two weeks, but, any more time off and I think I might have  started to go crazy.

That’s it for now.  Cheers, Ron

8 Responses to “First Post”

  1. Great post - unfortuneately welcome to the site - there are some great stories here.
    Loved the bit about the catapult and gosh did you have triplets?
    Take care - at least you can go back to work :)

  2. Sorry to hear about your story and I wish you a speedy recovery.

    Sounds like we have a pretty similar story (if there is anybody out there studyihng the statistics). I too was had previous heel pain (12 months prior), a family history and was feeling in the best shape of my life.

  3. Rainbow- thanks for the welcome, and yes, we do have triplets, and yes, we did have a 4th child 2 years later. So far, they’ve been pretty good at helping the old man get around.

    Bubble-congrats on getting to 2-shoes!

  4. Interesting to read that your dad did his ATR too. I found out that my father did his ATR around the same age (40’s) on the same foot as i did (right). I thought it might be genetic too. My brothers are also having heel pain as well so i will make sure they follow up on it. Good luck and may you have a very speedy recovery, you have plenty of little helpers!

  5. Sorry you’ve joined the club. Interesting to hear you (being in the business so to speak) chose the surgical route out of preference.
    Children can be surprisingly helpful.
    Hope all continues well.
    Sam

  6. ultidad - I had achilles pain off and on for a couple of years before the rupture too.
    Yep, I also ruptured my achilles back peddling and then trying to reverse my momentum and run forward. There’s been several others who tore their achilles this way. I make a conscious effort to not back peddle anymore when I am playing basketball. This article mentions “eccentric load” which is what could be causing the rupture for someone with already a weak tendon: http://espn.go.com/trainingroom/s/1999/0915/59775.html

    Thanks for your post. I enjoyed reading about your kid’s school project and best of luck to your recovery.

  7. Interesting the insights you gain by seeing things from the other side of the operating table isn’t it?

    You do have your foot in equinus in the boot don’t you? The only time I had pain weight bearing was when I slipped and planted my foot unprotected, and “hot assault knife” was a good description for that. In the boot I was fine, some tingling, ‘tightness’ and slight twinge of pain was all, went to FWB by week 3.
    Dylan

  8. Dylan- this marked my third time as the patient - appy and knee scope as well. I opted for an epidural for the knee scope and that was a mistake. If given the choice, I would’ve opted for general for this procedure anyway.
    I’ve got three pads that came with the boot on top of a folded up sock in the heel of the boot - maybe I need to boost my heel up a little more. Or maybe I should find some high-heeled boots and strap the lateral supports onto them ;)
    Ron

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