You will be in an altered state for many moons...

If your Achilles tendon is ruptured, torn, or even simply inflamed with tendonitis, your life is about to change. Mine sure has - so I decided to chronicle these events, and create a place for others to share their experiences, advice, resources and emotions during our journey toward recovery.

Nothing in this blog is meant to take the place of the medical advice of your physician. Follow the instructions of your medical professionals, not me.

Saturday, October 16, 2010

5. SURGERY and the hospital - good times, good times...

OK, I'm writing all this the day after my surgery, so please excuse any typos or weirdness - Vicodin is a powerful drug!

<em>'All doped up': Michael Jackson dangles his son Prince Michael II over a hotel balcony in Berlin in 2002.</em>

This is a picture of my team of doctors in the operating room:


http://www.transparencynow.com/MASH2.htm

Well, that's how I remember it, anyway.  But I'm skipping ahead.

My husband Michael was pretty smart - he quickly realized that we should take the car rather than his big truck, because it would be a lot easier for me to get into after surgery - and he was right about that.

So off we went - armed with our Kindles (which neither of us had time to even crack open by the way).  My husband made a mistake in judgment that your companion may want to avoid - he didn't eat before we left the house, and ended up not getting to eat anything till about 2 pm.  Between checking in, talking to both doctors, and prepping for the surgery, they kept us moving at a pretty quick pace.

Don't be alarmed if they have a little trouble "finding a vein" for the IV.  Remember, you are dehydrated at this point.  This makes your veins harder to find and tap into.  They had to try a few times with me, but they used Lidocain at the insertion points so it was not too painful at all.

If you tense up, you will bruise and be sore, so relax.  Don't look!

They'll hook you up to monitors for your blood pressure, heart rate, temp, etc. 

The nurse will ask you a lot of questions.  Be very thorough and honest in your answers.  Better too much information than too little.  Don't minimize anything - they really need to know detailed answers to these questions, especially regarding any allergies, surgeries, reactions and/or complications to anesthesia, etc.

The surgeon and anesthesiologist will come in to talk with you.  Don't be embarrassed to take out that list of questions you wrote up - they owe it to you to give you the time to answer any concerns you may have. 

I did something that my surgeon thought was hilarious - but he also said it's a good idea.  I took a Sharpie pen and wrote on the sole of my "good" right foot (upside down, I might add!), "Right foot, wrong foot!"  Then I wrote on the left sole (the messed up foot), "Left foot, right foot!"  He cracked up when he saw that, and whipped out his phone to take a picture!  But seriously - it's not a bad idea to mark the correct foot, and make a note on the other one as well.  Wouldn't it suck to have BOTH of them cut into?  People do make mistakes!

After all the questions, and laughter, they gave me a happy pill, which totally relaxed me.  I chose to have general anesthesia, but you can also have a block or epidural if for some reason general anesthesia's not the best choice for you.  Personally, I didn't want to be awake during the surgery. 

I remember cruising down the long hall to the operating room, and cracking some (I'm sure very lame) jokes about Six Flags rides, and I remember them saying, "OK, Melanie, let's move you over to this table" and they scooted me over, and then they said, "OK, ready?  This is going to be very quick."

And BAM - instant and total oblivion - not sleep, not gradually melting away - but sudden, total nothing.  I remember one instant of  "Oh, ___, here we go!" and that was it.

An hour and a half later, which seemed like, oh, one second, I heard a faraway voice saying, "You've had an operation, Melanie.  Time to wake up and go to recovery!"  (I think I must have said something like, "What's going on?" or probably something more stupid sounding than that!)  I woke up on my side, because they laid me on my side for the operation.  I am quite certain I was drooling on myself!

As soon as I realized where I was (in about five seconds of drowsy confusion), I suddenly started talking and asking questions, and someone said, "Wow, she sure did come alive quickly!"  I felt alert and pretty coherent within just a minute or two.

I felt discomfort, like a tight, burning sensation, in my heel and up the back of my leg, but it was not at all unbearable.  They immediately asked me if I was feeling any pain, and when I said yes, they asked me to grade it (on a scale of 1-10 it was about a 4), and they immediately gave me something in my IV which worked in about two minutes.

I forgot to mention this earlier, but they had given me something for possible nausea before the surgery.  I didn't feel nauseous at first, but all of a sudden I got a wave of it.  They immediately gave me some sort of pill which worked quickly, so I never did actually throw up, and the nausea went away.  One weird note though - you would think I would be starving, since by then I hadn't eaten in 15 hours, but I had absolutely no appetite -then, that night, or even now (the next day). 

The doctor came in and talked with me and told me that everything had gone great.  He said when he got in there, the damaged tissue was easy to clean out, and that the tendon looked very healthy, except for the tear, which was easy for him to sew up due to the healthy stability of the rest of the tendon and tissues.  He didn't have to do a lot of debridement either.  He said that my recovery time ought to be really great.

I could pretty much comprehend what he was saying, but it was sort of like when you're a teenager and you come home drunk, but your mom catches you in the hallway - you're trying to act sober and talk straight, but it takes a lot of concentration - and it's probably pretty obvious you're not really coherent.

If I had not had an earlier negative reaction to morphine, they would have given me that, but instead they gave me Demerol during my recovery room stay, which worked well enough.  The pain abated from about a 4 to a 2 on that pain scale, but I could definitely tell that someone had been doing something to my ankle.

I had another reaction to whatever - the surgery, or pain meds, or something - my teeth started chattering, and my hands started shaking, even though I didn't feel cold.  It was really pretty funny, because my chin was wobbling like CRAZY - but after a couple of minutes of this, it was tiring.  The nurse took my temperature and it was 96, even though like I said, I didn't FEEL cold.  She got me some warmed blankets and put one around my head and shoulders and one across my lap.  Immediately the chattering and shaking quit.  So if this fairly common shaking starts with you - ask for those warmed blankets right away.  Heck, even if you're NOT shaking, ask for the blankets - they feel great!

After the chattering drama was resolved, they moved me from recovery to a regular room.  I was feeling pretty chipper and alert.  My husband helped me get my regular clothes back on, and the physical therapist came in with (TA DA!) THE CRUTCHES.

I'll cover those in the next post -they deserve one all their own. 

By then I was feeling more alert, but also more tired, if that makes sense.  I was ready to go home.

Michael went to get the car and they wheeled me out to the curb.  Suggestion - try sitting in the back seat rather than the front.  If you can navigate (with some help) into the back seat and stretch your casted leg out across the seat, it feels MUCH better than letting your leg dangle over the seat.  I have found that elevation is CRITICAL to keeping the pain at bay.  Even a few minutes of lowering my leg stirs up discomfort and pain, which elevation quickly decreases.

After calling me "Miss Daisy," my husband drove to the pharmacy to pick up the extra strength Vicodin with acetaminaphen, and I fell asleep in the car.  When we pulled up at the house, I got my first real taste of the crutches.

4. Speaking of work and time off...

When you return to work depends on a lot of different factors - your type and severity of injury, your self care after the surgery, and of course your work environment and responsibilities. 

Or, if you prefer, how much you can milk your particular system for!  I'll leave that to you, your doctor, your tendon, and your conscience.

You may qualify for short term disability.  Check into this as soon as possible and get the paperwork off to HR as soon as you have a firm surgery date, even if you do not plan to be off work more than two weeks.  You just don't really know how well you will be doing at that two week mark - leave your options open.

I work at a bank, and though it's a "desk job," there's a lot of walking involved, because it's a large bank.  The breakrooms, bathrooms, etc are spread out and pretty far from my office, and even the printer/copier/fax machine is a good thirty feet from my desk.  So before I left, I compiled a list of what I consider to be "reasonable accommodations" for this period of disability.  Your company is required by law to reasonably accommodate your situation, so hold them to it.  They will probably be fair with you - so don't feel like you have to push your physical limitations to please your boss.  They don't want you to re-injure yourself or impede your recovery any more than you do.  They want you to be healthy and agile again as soon as possible.

I requested a printer to be placed IN my office so I don't have to get up and down on crutches.  This would be difficult and would also probably worry my customers unnecessarily.  I made sure that my walkway around my desk was large enough to navigate with the crutches.  I am going to carry a little cooler with me when I get back, and stock it with bottled water, so that I don't have to get up just because I'm thirsty.

Make sure that you are able to elevate your leg often throughout the day.

Make sure that you have everything you need within arm's reach. 

Be sure that you have easy access INTO your business and work area.  If there are a lot of steps, you are going to need to find another entrance if possible.  Steps are difficult to navigate with crutches, and you may be asking for trouble!  I read one blog where a woman returned to work after two weeks, only to fall trying to get up some steps, and she broke her OTHER ankle and ended up in a wheelchair! Augh!

Walking with crutches will make you tired.  You may have to ease back in to your workday - maybe even cut the days short.  Prepare your boss for this possibility.  Stress to them that you absolutely will not compromise your health, and that if you need to adjust your schedule, that's just how it's got to be.  I did some checking into the typical Achilles tendon surgery timeline, and two to three weeks off work (for office work) is pretty much the minimum.  Your doctor may recommend even more time off.  Follow his/her orders first and foremost.

When you get back to work, you will still have follow up appointments, and, very importantly, PHYSICAL THERAPY appointments.  Don't be a "hero."  Take off the time you need in order to keep these appointments, and in order to heal properly.

3. 24 hours till surgery

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OK, countdown...

You may as well go to the guillotine, err, I mean surgical suite, prepared!

Ladies, my doctor didn't make me remove the polish from my toenails, so I invested in a pedicure just before the surgery.  If you have artificial fingernails, now's the time to remove them - you will not want to be sitting there at home looking at those nails wishing you could get them filed down or filled.

But whether you're a man or a woman, keep in mind that you will be staring at your toes for several weeks.  Ummmm, how to say this delicately...Take care of those toes now!

You will not be able to eat or drink anything, not even a sip of water,  from midnight till the actual surgery.  In my case, this was about 14 hours.  So - being the spoiled brat that I am, I told my husband, "This is like that last meal in prison sort of thing...so I want to go out for dinner, anywhere I choose!" 

We went to IHOP around 11 the night before surgery and I ate a huge meal - for once, guilt free.  And I am glad I did so - I didn't get hungry till right before my surgery.  And I wasn't hungry at all afterwards. 

The morning of the big day, I took a very long, hot bath - my last bath for weeks, maybe even months.  This was relaxing, and I needed that, being a bit nervous. 

When you get dressed to go to the hospital, remember that you will have a big cast over your leg when you leave.  Be sure you wear something loose and comfortable.  You will not want to change when you get home - you will want to collapse on the sofa after your first trek from the vehicle to the living room on crutches.

Don't forget your ID and insurance information.

Don't wear any jewelry at all to the hospital.  You will have to remove it and you don't want to worry about misplacing it.

If you get thirsty, you can suck on a little piece of ice - but no water, gum, mints, anything by mouth.

Sit down with your notebook and jot down all your questions for your surgeon and your anesthesiologist.  Your situation and list of questions will differ from mine, but here was my list of questions (and the answers I got):

1.  Will I get something to relax me before surgery?  (Yes, and it worked.)
2.  What will I feel or experience immediately before and during the surgery?  (Nothing - and they were right!)
3.  How long will the surgery last?  (About an hour - and they were right again.)
4.  How long will the incision and subsequent scar be?  (They said about four inches - and I haven't seen it yet but I'll take their word for it.)
5.  Will I get stitches or staples?  (Stitches)
6.  Please explain debridement to me.  (Debridement is a procedure used to stimulate healing - they make tiny cuts in the tendon after they clean out the damaged tissue and repair the tear.) 
7.  Will I need to have my tendon re attached to the heel with screws?  (Don't know till we get in there - in my case they didn't have to do that.)
8.  What type of cast will I have at first?  (Splint with gauze and gigantic Ace bandage, from toes to knee.)
9.  How will I care for the incision? (You won't - you won't even see it till your follow up two weeks later!)
10.  Can I return to work in two weeks?  (They asked me to explain my work environment, and said we'll just have to re evaluate at two weeks post op, but that with reasonable accommodation, I will probably be able to do so.)
11.  When will I start physical therapy?  (We'll see at the two week mark - the first two weeks, basically do nothing but keep OFF the leg, and keep it elevated as much as possible.)

Finally - relax as much as possible.  You've got your set up ready for when you get home, and you'll have plenty of pain relief available afterwards.  You're going to be fine - and better than ever once you've recovered.

2. Preparing your home and "cell" before surgery - THINK THINGS THROUGH


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When Dr. Langford told me I needed surgery, and I asked him about recovery time, I realized that my life was about to go through a (hopefully temporary!) drastic change.

First of all - I would have to be completely - COMPLETELY - off my left foot for two weeks, and non weight bearing for approximately six weeks, and then in an AirCast (able to bear weight) for another six weeks or so.  Think about that.  Non weight bearing means ZERO WEIGHT on the leg.  This means lots of elevation, a cast, crutches, and all the fun stuff that goes along with those things.  So here's my advice:

1.  Take a look around your house.  Determine where you are going to set up camp.  If possible, pick a room close to a bathroom, but not necessarily your bedroom.  I chose our family room, because it's also adjacent to the kitchen, and the sofa I claimed as my own private territory is able to recline, with a foot rest. 

2.  It is imperitave that you are able to elevate your foot, either in a recliner or at least on an ottoman.  During the first three days, you really should elevate your foot ABOVE shoulder level.  This will probably require several pillows - the firmer the better.  I ended up stuffing two firm pillows into one pillowcase, and combined with the foot rest in the sofa, this elevates my leg high enough.

3.  Find or buy a small table with shelves to put beside the chair or sofa, within easy arm's reach.  I found a great little side table at Pier One that has three shelves but measures only about 18" x 30" and is just a few inches taller than the sofa arm.  I don't think just an end table will work very well, unless it's very large and sitting right beside the arm of the chair rather than to the rear of it.  A TV tray or bed tray is great for your laptop and mealtime.

4.  Get a desk organizer thingie - one of those compartmentalized holders for pens, staplers, etc,  This is a LIFESAVER for all the little things you'll need (more on that in a minute).  Also - you will need a trashcan.

5.  Think about all the things/items that you usually get up to go get or do.  And then think about the fact that you will not be able to carry ANYTHING unless it's strapped around your neck or waist, once you're on crutches.  You do NOT want to try to carry anything in your hand along with the crutches, because this will really throw you off balance and you will probably end up wallowing on the floor hollering in pain. 

Everyone is different, so your list of "necessaries" may differ from mine, but here's what I determined I needed to have at my fingertips:

Laptop
Cell phone charger
Kindle and Kindle charger
Surge protector extension cord
Magazines
Disposable wipes
Roll of paper towels
Tissues
Spot for remote controls
Coasters
Spiral notebook (great for lists and instructions for your caregiver!)
Oh - you'll need a caregiver : )
Calculator
Pens
Scissors
Tape
Post It Notes
Toothpicks
Disposable toothbrushes
Hand cream
Body lotion
Mints
Brush or comb
Hand mirror
Fingernail file
Lip balm

6.  I realized that though I would be basically camped out here for two weeks minimum, that I want to be comfortable but I also want to feel as much like my normal self as possible.  After all, I'm not SICK - I'm just immobile.  My husband took two weeks off to help me out, and frankly, I like to be cute around him!  Also, people will drop by to see you - you don't really want your hair sticking up on end, chili down the front of your faded T-shirt, bad breath and body odor, do you?

So - I also packed a little cosmetic bag - powder, eyeliner, lip gloss, and a small bottle of cologne.  I also bought the travel sizes of deodorant and baby powder.

Being the girly girl that I am, I also packed a separate little bag with tweezers, cotton balls, Q-tips, and a few manicure supplies. 

All of this stuff fits great on the little table and the end table.

7.  Buy one of those clapper adaptors for your chairside lamp if the switch is hard to reach from a sitting position.  Be sure that your table, trashcan, chargers, laptop, chargers, etc are all easy to reach and use from a sitting position.  You will NOT want to get up much right after surgery!

8.  Give yourself a clear pathway from the bedroom, living area, bathroom and kitchen.  You will need about three feet of clear passageway to navigate on crutches.

9.  Get a couple of stools  - one for the kitchen and one for the bathroom.  They should be a comfortable height for you to sit at the counter.  This will be very helpful especially in the bathroom - think about brushing your teeth, blowdrying your hair, etc. 

10.  You MUST have a shower chair with non slip legs.  Don't try to make a plastic lawnchair work - they will slip.  If you fall, you will regret it, so don't risk it - bite the bullet and buy one of these ugly things.  Get a hook and hang it outside the shower, to hang up your plastic trash bags that you'll use to wrap your cast in (you cannot get that cast wet!).  Ladies, you may want to invest in a shower cap too.  I know - lovely, huh?  Trust me when I say that the more independent you can be at shower time, the better!

11.  Speaking of showers, remember that you may not be able to reach the interior shelves from a sitting position.  Get a plastic or metal caddy (made for bath or shower) for your toiletries - soap, shampoo, razor, loofah, etc.  Sit it on the floor of the shower if a shelf is not low enough.

12.  Apply non slip appliques or a shower mat to the floor - no slipping allowed!  This is going to be a bit awkward at first.

13.  You will not be able to carry things or climb up on stepladders for 2-3 months, so think about what's in your closet.  If you need to move seasonal things around, don't wait to try to do that on crutches.  Organize your closet beforehand.  Make sure that all you need is at eye level or lower if possible. 

14.  Catch up on all your laundry, deep cleaning, etc - anything that may drive you a little crazy as you sit, and sit, and sit for weeks!

15.  A big inconvenience is the inability to carry liquids while you're on crutches.  My husband had a great idea - he got me a little cooler to put beside the sofa, and he keeps it stocked with bottled water, juice, etc.  Resist the temptation to fill it with soft drinks - you won't want to get up that often to go to the bathroom, and soft drinks are hard on your kidneys anyway.

I also bought two travel mugs - one for coffee and one for cold liquids.  They have secure tops so I don't have to worry about spilling anything from the kitchen to the sofa. 

16.  Which leads me to an important thing to think about - you need to either wear a hoodie with a deep front pocket, or get a bag that you can sling around your neck, to help you carry things.  You absolutely cannot carry anything in your hands while you're on crutches.

17.  Ladies - if you don't have a large purse with a strap designed to cross your body (rather than tuck under your arm), here's your perfect excuse to go buy a new purse!  You won't be able to tuck a purse under your arm.  An across-the-body purse is very comfortable and convenient to use with crutches.   After all, you will eventually brave going out into the world on these darn crutches, so you will need a purse.  Trust me!

1. How it all began

Once upon a time there was a little girl named Melanie, who loved to play outside...



What's that got to do with a torn Achilles tendon 40 years later?  Well...my point is that I don't know how it began, or what caused it, and come to find out, that's fairly common.  Apparently, some people live their whole lives never realizing that they have a weak spot - that darn Achilles tendon...

One year ago (in October 2009) almost to the day, I fell off a step ladder and definitely stepped back hard on my left foot, but the pain wasn't severe at the time.  Over a period of several months, though, I noticed that my left ankle was very stiff in the morning, or after a few minutes of sitting still (like at my desk at work).  Then it began to actually hurt (quite a bit) after periods of rest, though the pain did subside after a few minutes, and usually didn't bother me again till I rested.  What got my attention was that my knee and ankle started "popping" a LOT - and it got to the point that the pain and stiffness was pretty severe UNTIL both the knee and ankle popped.

This began to affect my usual routine of walking for about an hour each morning.  First infringement on my lifestyle...

I think the "coup de grace" was when we moved in April (6 months after the pain and stiffness began).  We had a two story house and I must have run up and down those stairs 50 times.  Though I was careful to wear really good athletic shoes with good support, within a few days, I realized things had reached a critical point.  My knee and ankle were swollen and I had to elevate the leg, pack it with ice, and take lots of ibuprophen - all of which were effective.  But I was worried now, and finally went to my family doctor, who immediately referred me to an orthopedic specialist.

Now, I am going to sound like an old fart, but my first alarm went off when I met the doctor.  She looked like she was a small child. 


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Her "bedside manner" was basically nonexistent.  She looked at my foot for about 30 seconds, and sent me down the hall for an X ray.  When she got the results, she immediately said I had no arthritis, no fractures (honestly, I could have told her that), and that she felt that the very obvious lump on the back of my ankle was bursitis and that I also had a Achilles tendonitis.  She put me in an AirCast, telling me to wear it for one month, and return.  She said she felt my ankle simply needed rest.  She said I could take the Air Cast off when I got home each day from work, as long as I was sitting down for the most part.  My instructions were to wear the cast for most of each day.

INSTRUMENT OF TORTURE

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One month later, I returned for the evaluation.  There was absolutely no improvement.  At that point, the doctor told me (in under two minutes) that I would need to wear the cast for another 4 weeks, and begin physical therapy three times a week to stretch the tendon and improve my range of motion. 

Here's where I think things really got off track.  I believe I should have had an MRI at this point - because unbeknownst to us, there was a tear in the tendon - which was made WORSE by the physical therapy that I faithfully did for about three months.  Finally, I just stopped going to PT because it just didn't feel right.  I told them I was feeling burning and numbness and that things were no better, but I really got no response.  In fact, they told me that I could take off the AirCast, and just exercise that ankle every day, and that things would gradually improve.

Meanwhile, I was doing some internet research of my own on the problem, and realizing that Achilles tendonitis (which was my official diagnosis) was a long, slow heal, so I pretty much resigned myself to just pushing through. 

Well - pain is the great communicator, and my ankle began to communicate with me in a louder and louder voice.  From August through September the pain became so disabling that I was spending most of every weekend with my foot elevated and on ice.  I was going through bottles of ibuprophen like water.  And then my sciatic nerve rebelled (probably due to the limping and favoring of that left leg) and I went to a chiropractor. 

She gave me great advice.  She told me that she could make me feel better, but that anything she did was a temporary fix, because my Achilles tendon was the source of the problem.  She took one look at it and scheduled an MRI.

INTERESTING.  The MRI showed a two inch, lateral high grade tear, as well as tissue damage.  Basically, my tendon was hanging by a thread and could rupture at any moment.  My chiropractor (my new personal hero) immediately asked me if I had a preference of orthopedic surgeons so she could refer me, and fortunately - I knew a good one.

Dr. Michael Langford had operated on my husband's elbow a few years ago, and is one of the best orthopedic surgeons in the area.  He is swamped with patients, and the wait time to see him was months - but I asked if I could fax over the MRI results to him to see if I could get in earlier.  This was effective - as soon as I did so, I got an immediate appointment.

He determined that the MRI was correct, and after consulting with his team, they determined that I needed surgery, and that I should wear the cast till we could coordinate my husband's work schedule and my leave of absence, which was about two weeks.  He told me that based on the length of time I had been trying other methods, it was pretty obvious that a non surgical approach was not only not working, but counter productive - and I agreed. 

So...we scheduled the surgery for October 15.