So far, I'd done what
Dr. O'Connor had asked (with the exception of the tripping-over-a curb incident).
I hadn't been an idiot. Well, there was the matter of tightening a spark plug
on my lawn mower so that my sister could mow the lawn, but I was able to do
that while keeping my one foot off the ground at all times. Now I was hoping
for good news and a look at the incision.
Open vs. Arthroscopic
When Dr. O'Connor and I had briefly discussed open versus
arthroscopic approaches, he had explained that arthroscopic surgery of this
magnitude was very difficult and that he could do a better job by opening my
leg up, even though it could significantly increase the possibility of
infections such as MRSA.
My legs, from years of playing contact sports and lacking
physical finesse, landscaping, hiking, and general construction, were scarred by
cleat marks and errant swings of the hammer, as well as smashed by rocks, and
slashed by tree branches. I wanted to get the best repair I could, so I told Dr.
O'Connor to cut as far as he needed. As Keanu Reeves once said, "Chicks dig
scars." I don't know if he meant back-of -the leg scars, but I guess we'll find
out.
Off With His Splint!
Now came the moment of truth. Had my stumble the day before
and the ensuing, frightening pain re-ruptured the Achilles? Would it be back to
the hospital? Or would I get my cast and be on my way for six weeks? It turned
out that neither possibility was the answer. After examining the incision site,
Dr. O'Connor was significantly pleased with how it looked. Although I was only
ten days out of surgery, he ordered the stitches to be removed.
When I asked "How many stitches?", the PA said just one. Ironically,
I had what's called a "running stitch". Like a seamstress going after a long
seam, Dr. O'Connor had started at one end and sewed all the way to the other. Now,
he was so impressed with my recovery that he said they would try to get my foot
to close to 90° and, best of all, cut my cast time in half. Only three weeks
wrapped in fiberglass! (At "only three", I opted not to shell out $250-$300 from
my wallet for the Gortex waterproof cast). After getting some foul-smelling
liquid medical adhesive painted onto my leg (perhaps Mastisol?), Steri strips
were added to cover the incision.
The Process of
Getting a Cast
 With a bare foot, I
nervously crutched down to the cast room, where the PA and Dr. O'Connor got to
work. I hopped onto a table and they placed what looked like a T-shaped floor
jack under my foot, holding it in place just short of 90°. After I was
instructed to keep my leg relaxed and that the tech would keep it straight, they
put a thick stocking on my leg from mid-shin to the base of my toes.
Then it was cast color time. And there were a lot to choose from.
There was even one that is white during the day and glows in the dark at night.
I selected florescent orange to match my undying loyalty to the Mets and my
rather loud personality. The tech started with a roll of white fiberglass gauze,
explaining that orange only goes on the last two layers because a cast is
generally four layers thick.
The tech dipped the roll into warm water and then quickly
wrapped my leg. She explained that the fiberglass was activated by warm water
and that she had to work quickly because it hardens fast. Sure enough, within
15 minutes she had applied four layers and then some lotion to keep the cast
from being sticky. By the time I stood up, maybe thirty seconds after she had
finished, my cast looked dry. By the time Dr. O'Connor and the tech put a
protective boot on my foot (three minutes later), the cast was totally solid.
No giant hair dryer or Easy Bake Oven required, as I had imagined was necessary.
Water is Thy Enemy
In addition to being warned to adhere to a strict regimen
against idiocy, I was told how bad it could be if the cast became wet. Micro-openings
in my incision, body warmth, darkness, and lack of air flow combine to form a fertile
breeding ground for bacteria and instant infection. If my cast became wet, it would
have to come off - and by a professional. If the cast became damp on the
outside, I had to dry it quickly. If I fell in a pool or off a boat, I was to
report to the nearest emergency room immediately and have it recast. The tech
stressed this point several times.
Redneck Engineering
I write this with a smile because she then told me not to alter
my cast in any way (besides having friends write on it, which at my age
thankfully doesn't happen). I was not to shove anything inside the cast, including
pencils, pens, knives, coat hangers, or knitting needles. I was not to cut it with
scissors, tin snips, steak knives, Dremel tools, or a Skill Saw set to a very
shallow cutting depth. When I looked at her in disbelief, she said that she had
a story for each one of those options. There was also the case of a teenager
who just ripped his cast off because he "was way too OCD to have a cast for a
few weeks".
So I ask, for the sake of discussion, what stories have you,
faithful readers, of casts and stupidity? It can be something you witnessed or
something that you have done yourself. And when the comments flow (as I hope
they will), I'll tell you the story of being 12 years old and having a plaster
cast - and why I have crooked fingers on my right hand because of it.
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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Re: Casting Call (Achilles Tendon Rupture – Part 4)
