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19 comments

To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

Posted August 04, 2009 6:00 AM by ShakespeareTheEngineer

Wait? No MRI? No Non-Surgical Options?

I injured myself on a Thursday night. I saw the orthopedic surgeon in the late morning on Friday. After failing his Thompson Test, he scheduled the first available surgery that I could have with any of the surgeons from the Orthopedic Associates of Saratoga. He said that there was no point in having an MRI. I had definitively failed Thompson.

We discussed options very briefly. If it wasn't a complete tear, which he was sure that it was, I could have it casted in the toes pointed position for 3-4 months, then a month in an orthopedic boot. Then it would be grueling rehab and range of motion for at least another 3-4 months. If I had it surgically repaired, it would be two weeks in a splint, six weeks in a cast, and then a month in the boot.

There were also some practical statistics in play. In terms of re-rupture, 15% of non-surgical repairs re-rupture the tendon. Only 5% of surgical repairs have the same relapse. In terms of the need for quick scheduling, if my tendon was indeed split in two, the longer I waited, the more difficult the surgery would be as the tendon would continue to lose elasticity. He had considered scheduling night or Saturday surgery, but thought that it was best that I wait for one of his colleagues, whom he trusted, on Monday. It took zero time for me to make up my mind, wishing I could have the surgery on the spot.

Good Morning, Shakespeare. We are Here to Stick a Needle in Your Spine

To make a long story short, I have a thing about needles in my spine, so I was quite happy to have general anesthesia. Complicating matters, however, was that I had to have surgery face down as the incision would be on my calf. General anesthesia would mean three orderlies would move me from gurney to operating table and back. I would also have to be intubated. It turns out that I have a bigger thing about being intubated than I do about needles in my spine. It took no more convincing. They took me to the OR, gave me a slight sedative, some lidocaine to numb the injection area, and then the injection. I didn't even feel it. Soon my legs were getting heavy. I rolled myself to a comfortable spot on the OR table and they placed the oxygen mask on to help me breathe while "semi-conscious" sedation set in. Beyond a bizarre tugging on my left leg, at which I tried to kick away with my barely usable right leg (and a foggy remembrance of being asked to keep still), it was a snap. No pun intended. Ninety minutes later I was out of surgery and in the step-down room, waiting for anesthesia to wear off and for feeling to return to my legs.

Related Readings (please note that hyperlinks will not work until future blogs are posted):

Part 1 - My Achilles Heel - Achilles Tendon Rupture
Part 2 - To Cut or Not To Cut? Not Even a Question!
Part 3 - Sew Happy Together
Part 4 - Casting Call
Part 5 - The Process of Getting a Handicapped Parking Permit
Part 6 - The Orthopedic Boot(y) Call
Part 7 - I'm Going to Rehab
Part 8 - Preparing for the Breast Cancer Run
Part 9 - Results from the Breast Cancer Run

Resources:

http://www.mayoclinic.com/print/achilles-tendon-rupture/DS00160/DSECTION=all&METHOD=print
http://en.wikipedia.org/wiki/Achilles_tendon
http://en.wikipedia.org/wiki/Orthotics
http://en.wikipedia.org/wiki/Achilles_tendon_rupture


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#1

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/04/2009 9:45 AM

Hope the recovery goes well.
Yeah, I don't think I'd like a needle in my spine...dodgy things spines even tho' us cats have more vertebrae than you stiff old Hoomans.
I think you took the best option all round.
General anaesthetics take a while to get out of the system.
Del

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#2
In reply to #1

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/04/2009 9:49 AM

I had some quick knee surgery in 2005 and I was under for it. It wasn't that big of a deal, but since it was only a 30 minutes surgery, I may not have had that much in my system.

I agree about spine work being dodgy. Not exactly the time you want to hear "whoops...slippery little sucker." Thankfully, I didn't have to.

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#3

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/04/2009 10:04 AM

I am glad that surgery went well for you! I am glad that I've never had to have surgery like that.

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#4
In reply to #3

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/04/2009 10:08 AM

Thanks, Jaxy. Just be sure to stretch well, keep up your hydration and potassium levels to avoid cramps and tight muscles, keep good shoes, and if you have flat feet, consider orthodics.

I might splurge once I have recovered and get some custom inserts because my feet are ridiculouly flat. But that is another blog entry, entirely!

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#5

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/05/2009 3:36 PM

I would like to wish you a very fast recovery! I feel your pain about the back injections. I have had a bad lower back for several years now and when it gets to the point of just not being able to walk I go in for a series of 6 facet injections on my first 3 joints in the lower back. When they do these you have to be awake for some crazy reason so all they can give you is the fast acting nerve pill to keep you calm. I hate needles just as bad as anyone I know and for me to lay there and get 6 in a row is just about all I can stand. Now my doctor is trying to get me to let her burn each nerve ending with electrical current while the needle is still in my back. I have been told that it hurts allot more than just getting the injections and really don't know if I can take it although the doc says it should last allot longer than the injection alone.

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#6
In reply to #5

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/05/2009 3:57 PM

I had nerve testing done in my shoulder, arm, and hand and they pretty much jabbed the needle in and sent current through it...in 28 different places, one at a time.

That said, it doesn't sound nearly as painful as burning a nerve ending. Hopefully it just means you get all of your pain out of the way at once.

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#7

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/05/2009 5:03 PM

Yes. Good luck with the repair. Regarding the spinal anaesthesia ,I went in for this last year for a hip op. I never met the anaesthetist but I was certainly communicating when he put the whitacre in as the nerves in my left leg jangled. Then he tried again at the same 3rd - this time it was the right nerve. He then muttered something about hairy backs, and had I had a spinal op - negative. He then went down to the fourth and injected. Apart from the feeling of suffocation which he managed to reverse, everything then went well. However, it is very important that you give the oke feedback as a needle resting in the nerve can leave you with damage resulting in loss of feeling or worse.

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#8
In reply to #7

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/06/2009 8:05 AM

Yikes. That sounds rather unenjoyable. Thanks for sharing your experience.

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#9

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 10:11 AM

Shakespeare - my story is so similar to yours, up to the anesthetic...scary. I just had my surgery Friday, and the pain is horrible. How long does it last? When I get up on the crutches, it feels like my leg will explode! Here's my story:

I am a 37 year old ex-athlete. I was a tomboy and played sports my entire life. I played lacrosse in college and stayed in pretty good shape throughout the years. About 5 years ago, I tore the ligaments in my ankle playing indoor soccer. The following year I tore them again, and I had surgery for that. It was painful, but bearable. I started boxing training (i was not actually going to box) a couple weeks ago. On Monday (august 10th) I was doing post boxing conditioning. I was doing a squat into a jump, and I heard a pop (same ankle as the last surgery), like a balloon popping, and was in excruciating pain, and saw an indentation where Achilles should be. The 3 people working out with me heard the pop as well. I went to the ER where they told me I had a complete rupture & to see orthopedist. Went on Wednesday because my doctor didn't have hours Tuesday. Turns out I have a complete tear of my achilles. I had surgery Friday (August 14th). My alternatives for anesthesia were either a spinal, which I initially said no way to, or general. Turns out with general, I you need a tube down your throat. As far as I'm concerned, the spinal was the lesser of the 2 evils, so Iopted for that. In addition to the spinal, I got a nerve blocker below my kneee and a sedative to put me out. My doctor put me in a splint/soft cast type of thing to allow for swelling. He said the Achilles was completely severed. I go back in a week to get the full cast. The nerve blocker lasted pretty much the entire first night, so I was able to get some sleep, but when I woke up, the pain was unbearable. My leg has been elevated above heart level all the time, except when i have to go to the bathroom. Then, the blood rushes down & it feels like my leg will explode. I have been taking percocets and even oxycontin 2 times a day, but the pain is still pretty constant. How long does this pain last? I go back to see the doctor next Tuesday to get the hard cast, which I'll be in for 4-6 week. Then I get the dreaded boot.

I tried to read the rest of your posts, but i was unable to.

I would really appreciate it you wrote back and filled me in a little about the pain of recovery.

THANKS!

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#10
In reply to #9

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 11:22 AM

Hillary,

I'd be more than happy to share my experiences, and I see that you have registered with CR4, so welcome to the fold. My blogs for this are posted every Tuesday, so the next one will be up as of 6AM tomorrow.

But, for the time being, let me at least give you a head's up as to pain and my experience, as our experiences sound so similar. I ended up staying in the hospital for three full days due to low O2 levels, so I had a good regiment of pain killers and anti-inflammatory drugs. By the time I left, pain was pretty bearable.

I will tell you that the blood rush was so great that it made me dizzy and green for the first two days and I broke out in an immediate sweat as soon as I went more then 15 feet on crutches. This was an additional reason that kept me in the hospital, to make sure that I could get around on my own so I wouldn't pass out on the kitchen floor on the way to the bathroom.

When I made it home, the only place I was comfortable for the first three days was my recliner. Icing was tough because of the size and position of the splint and I had significant swelling along the outside edge of my foot. I found that valium (acting as a muscle relaxant for cramping in my calf) was more important than pain meds.

A week after surgery, I had to MC a banquet, and it was hard to be on my feet that long, especially as it was my first day back at work, but elevating it kept the pain at bay. By that point, pain was pretty much in check. I took my oxycotton twice a day, and kept it up on my desk at work.

The only time I had pain after that was when I tripped over a curb on my way to work the day I had my stitches removed. I came down with most of my weight on it and it looked so bad that people actually came outside when I did it because they said it looked like I was going to pass out my face turned so white. But once that subsided (and I doubled up on pain killers when I made it to my desk), I was pretty much in the clear.

In terms of pain after that, my foot swelled to almost comical proportions in the cast and pushed up against it. That was painful, but mostly from an abrasion sense. The outer edge of my foot had a thick callous from constant rubbing on the cast. It also looked grotesquely huge when the cast came off, but the Achilles gave me ZERO pain.

The Cam Walker boot is very comfortable. You can adjust the fit very well through straps and an air bladder and I was allowed to take it off when I wasn't on my feet which was much more comfortable. During rehab, swelling has caused my ankle to crackle from being stiff, but it has been since the first week of July that I have had any pain. Once I was in the cast, only discomfort in the foot, no pain in the Achilles.

I would highly recommend that you follow your doctor's orders of staying off of it to the letter. I have had a comparatively fast recovery (I go to full weight in the boot with no crutches in three days) and had my cast time cut to three weeks because I behaved and as an athlete, it has been hard to do. But I remind myself that I don't want to go through this again, so why would I undo all the early pain I made it through and the inconvenience of ten weeks of crutches to walk a few days early or to hobble a few weeks early.

Have hope. There is light at the end of the tunnel. I hope this helped and check back tomorrow morning for the next installment.

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#11
In reply to #10

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 12:19 PM

thanks so much for writing back. it's so helpful o have more of a timeline as far as the recovery goes. i had surgery 4 years ago on the same ankle, but the pain i'm feeling now makes that surgery seem like a scratch. i can't believe your story about the curb...i am cringing for you!

you describe the feeling much better than i do of walking on the crutches and the blood rush. i try to hold in going to the bathroom as long as i can for fear of that feeling. you're lucky that you got to stay in the hospital. i really think i should have too. ive been staying with my brother and sister inlaw, so at least i have some help.

i am following the doc's orders to a T. i'm an athlete, and always have been. so, the fear of screwing things up any more than they already are, is my incentive to play by my doc's rules. he seems to think i will be able to do most things by march, even snowboard...we'll see.

i'll def check out the blog tomorrow. one question... why can i only see your first 2 posts...my achilles heel & to cut or not to cut? i can't see any others...

thanks again!

Hillary

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#12
In reply to #11

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 12:24 PM

The series is just getting started and CR4 is running them every Tuesday, so only the first two have been published so far. Tomorrow is three, next Tuesday is four, and so on.

I understand what you mean about being an athlete. Even though I am on the wrong side of 30, I am not ready to hang them up yet and if I am serious about my rehab, I may be able to be back to rugby by next spring.

I am also going to try to do the breast cancer run on 10/3, but my physical therapist thinks that might be pushing it (I am a big guy). If not the run, then I will do the walk, but I am not ruling out the run until the week of.

And please feel free to ask questions. It is one of the main reasons that I am writing this series.

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#13
In reply to #12

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 1:21 PM

ah, i understand about the blog now.

yea, i'm on the wrong side of 30 as well...37. i am not ready to hang them up either. my doctor said he thinks i may even be able to snowboard by the end of the season (end of March), so i'm hoping for the best. the downside is that i have already had surgery on this ankle, so my doctor said i will only get back to 90% at best. i'm not too big, so hopefully that works in my favor. i'll cross my fingers fr you as far as breast cancer run goes.

again, thanks for getting back to me. it's good to talk to someone who knows exactly what i'm going through because it's very hard for me to explain the pain i'm in.

thanks,

Hillary

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#14
In reply to #13

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 1:33 PM

Snowboarding is killer on the legs, so it would be awesome if you could come back and do it so soon. That pain will subside. You are only a week out (you said 8/10, right?) which puts you exactly seven weeks behind me, to the day.

And I also think that if your body is used to training and your mind is use to overcoming physical adversity, you can heal faster. I really feel like I am way ahead of schedule with recovery. My original target date for walking without a boot was 9/14, but it was cut down when I had my cast time reduced from six weeks to three and if all goes well starting on 8/20, I might be walking in sneakers by 8/27.

Like I said, not only have I been there, I am there, so feel free to ask questions or just advice, or even stop by for emotional support. You will make it through. You are already through the worst part!

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#17
In reply to #14

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 1:42 PM

yea, it took me a while after the last surgery to get back to snowboarding, etc, but i did it. i was never able to play lacrosse, tennis or soccer after last surgery though. my old doctor advised against it because of the stop/start motions.

i actually injured it this time on the 10th and had the surgery on the 14th, so, it's only been 3 days since surgery. i get impatient. :) it's actually the discomfort & pain that is bothering me the most, and the fact that i have to stay with my brother because i can't really take care of myself yet. you are lucky you stayed in the hospital. i came home the same day.

you are definitely way ahead of schedule. good luck for the 27th! i hope i'm as lucky as you. like i said, i'm not going to push it, and i'm going to follow this doctor's instructions completely.

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#18
In reply to #17

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 1:50 PM

Then you are just getting out of the woods. The first three days were by far the worst. Having to rely on other people is tough, especially when you have an injury as an athlete because it feels like you are putting yourself in harm's way on your own. But realizing that this could have happened doing anything that involves explosive motion: jumping into a truck, running up stairs, etc., made me feel a little less horrible about needing help.

I will say it nearly killed me to have my sisters come over yesterday to move some items at my house because I only had one free hand. You will be through this before you know it.

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#19
In reply to #18

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 2:58 PM

yea, i hear you. i had several warning signs that day at boxing and i just thought i was tired...my calves were real tight and i was just tired in general. it never crossed my mind that this could happen. then everything went so fast from the pop, to the surgery, to now. in a way i think it's best that it happens this fast so you really don't need to think about it. as soon as i heard the pop, i was prepared for surgery. i just knew.

i just had to have my sister inlaw take me back to my apartment to get more sweatpants, t-shirts and contacts lenses. i can't even stay at my own place yet. patience is not my strong suit, but i am going to be very patient with this.

the pain meds are making me a little nauseous too, which sucks.

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#15
In reply to #12

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 1:33 PM

is 'sew happy together' posted? when i click, there's nothing there.

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#16
In reply to #15

Re: To Cut or Not To Cut? Not Even a Question! (Achilles Tendon Rupture – Part 2)

08/17/2009 1:35 PM

That is tomorrow's.

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