Tuesday, June 30, 2015

Surgery day 0

Following the instructions for no food or water from midnight on wasn't too bad-- especially since we discovered that Dairy Queen is open until 11pm.  We spent last night getting everything set up in the
Icing room, charging all the various electronic devices I have, and letting me just freak out a bit.

Getting up at 4:30 so I can shower and scrub my leg and get to the surgery enter by 6 was less fun, but after a few more bits of paperwork to sign I was whisked back to change into the lovely backless gown, get an IV and get scrubbed yet again with chlorhexadine.  The anesthesiologist gave me a nerve block from the knee down, versed and fentanyl, and after three breaths in the mask and whatever else they pushed in the IV, I was asking Mark when they were going to start and he laughed and said it was over.  I remember nothing-- including most of the ride home.

Surgery took about two hours.  There were a few areas of calcification in the tendon itself that he had to reduce, and he cut off the bone spur and removed the Haglunds bone bump, and bolted everything back together.  I'm in a splint and wrapped with about two inches of gauze and bandaging, but everything is still totally numb.

The nerve block should last for 12-36 hours (although it could take up to 48) and while it's working, I  feel nothing, and can't move my toes.  It's the not being able to move my toes that's freaking me out a bit--if I think about it, I get all squicked out and anxious.  By the lack of any pain is good.

Im supposed to ice and elevate for the next 48 hours, and pretty much do nothing.  Slept the rest of the day, mostly.

Watched a bit of tv while ensconced in the Throne, and shimmed up the stairs on my butt at nine to sleep.  My leg is still numb, so once I got comfortable in bed, I was out like a light. Mark had me start on the pain meds just in case things wore off In the middle of the night.  So far, so good!

Monday, June 29, 2015

They're going to do what?

The surgery has been described to me as "detach the tendon, shave everything down, and bolt it back on".  Sounds fun, eh? Since orthopedic surgery can entail power tools and hammers, I'm a bit anxious.

I've got a good-sized bone spur and excess bone growth on the top of my heel, to go along with the calcification/damage to the tendon itself. So - shave all of that off (or chisel it, who knows what they do) and reattach everything.

While my surgeon isn't going to use this product, here is a rough idea of what they are going to do (don't worry, nothing really squeamish in the video, it's all animated).  A lot depends on how much of the tendon is damaged, so they may have to de-attach more or less of it).

Achilles Speedbridge Animation

When I went looking on line for information about the surgery --and here's a note: don't. Dr Google can scare you to death -- I found a bunch about surgery for a ruptured tendon and a bunch relating to removing a Haglund's deformity. I have microtears in the tendon, but nothing ever really ruptured, so it's hard to figure out just what applies.  BTW, a Haglund's deformity is also called a "pump bump", because it's very often caused by high-heeled shoes with stiff backs. In those cases, it's usually off to one side and rubs the tendon. Mine seems to be across the whole heel, but that might just be because of the long time I spent aggravating it. I don't wear high heels, nor do I wear shoes with hard, rubbing backs, so this is all because of internal stress, he told me.

Anyway, the big deal really is the recovery period, and I've seen estimates of anywhere from 6 months to "walking normally" to 12 months to "back to full activity". Some people report much shorter times, others are still struggling after a year. Basically, the general idea seems to be no weight bearing for 4-6 weeks -- none at all, not even toe touches, while you're in either a splint or cast/boot that keeps your toe pointed downward while the tendon re-attaches. Then partial weight bearing as they slowly stretch the achilles back to normal (for another 4-6 weeks) and then PT and walking in the boot to get back to a normal gait.

My surgeon says I may be PWB earlier, depending on how things go, or it may take the full 6 weeks. The risk is that the tendon doesn't reattach well, or gets pulled on while it's trying to grow back into the bone. Tendons don't have much of a blood supply, and neither does the heel, so it's a long time to get things solid again. I've been reading blogs (such as Haglund's Recovery, and a variety of sites devoted to achilles repair surgery and most of the info is pointing to a month being ever-so-careful to not even toe-touch with the foot, then in the boot and gradually working towards more weight-bearing. Sounds like about 3 months + before the boot comes off. There are some people who say they are up and walking in two or three weeks and back to teaching Pilates or Zumba class in two months. I think those people are crazy.
Ok. Enough dwelling. I still have to move my computer out into the Amazing Programming Throne that the Adorable Husband has built for me, mount the monitor and make sure I have everything else within easy reach. I've got a big shelf, a cantilevered bit for the monitor arm, and the whole thing is anchored to a base that goes under the chair so nothing will tip over.

There is approximately half a bottle of wood glue there, and at least ten huge carriage bolts. This thing could go into space and survive re-entry.

Returning after a long absence.....

Ok! I completely stopped posting here several years ago -- just dropped off the face of the earth, so I'm sure this is going to be a bit of a change. If anyone was actually checking for things here, I apologize profusely. (yes, yes, I know it's mostly family, but I suppose it's rather like one person in a conversation just walking away abruptly without a word.)

I'm not much of a facebook poster, really, so I thought I'd document my Achilles tendinitis/tendinosis and Haglund's removal surgery here. It's a bit more flexible.

So, for the last three years I've been struggling with heel pain and stiffness. It started after I took up walking on the treadmill for exercise (and started walking uphill on it), but I just figured it was stiffness or a slight strain and usually "walked through" the initial pain. I know now that is a common pattern for tedinosis -- hurts when you first start out, then as things swell up a bit, the pain goes away. But after a month of mornings where I couldn't do anything but shuffle from the bed, I finally went in to the orthopedist. That was almost two years ago.

An almost immediate diagnosis of insertional tendinitis of the Achilles, bone-spurs, and a decent sized haglund's deformity on both heels -- go home, ice, stretch gently, and cease activity until it feels better. Absolutely no treadmill.  Well, it did for a few weeks while I basically sat on my butt and didn't do anything more strenuous than walking to the kitchen. But even a short walk around the block meant that I was stiff and sore a few hours later, and the next morning, I waddled like a penguin because pushing off with my toes to walk normally hurt like h--ll until I was up and around a bit. Stairs became an issue -- up is fine, but walking down was a bad idea.

Back to the orthopod...and into The Boot. Well, really The BootS. Both feet in what is basically a walking cast, immobilizing my ankle and heel for two months. This helped some, but once again, as soon as I returned to anything remotely resembling 'normal' activity, things hurt.An elliptical machine had been ok'd for exercise, but even that was difficult after awhile. Exercise bike is ok, but I balked at having to spend two or more hours on the damn thing to equal the other exercise options. And, regardless of which option I picked, I felt so much better when I didn't do either. (with the unfortunate side effect of gaining back weight which added to the frustration). The limp was getting worse -- sort of a hop-step-flat-footed gait as I tried to avoid pulling on my Achilles, and I started doing stairs one at a time both up and down. Which one was worse, left or right, changed from week to week. I'd limp on one and it would stress the other heel and then that one would hurt more. Add in arthritis in my left foot and I never knew when a step was going to be painful or not. Mostly it was tolerable, just annoying. Mostly.

The doc suggested surgery back in November last year and I refused. Recovery is 6-12 months, and we had two vacations planned and while I knew it was going to hurt to walk, that at least was a known quantity. But the plan was to schedule when we got back from Germany. In the meantime, I kept activity to a minimum, and just sort of bulled through things. Mostly, it's not painful so much as achy and stiff. But the bone spurs and heel bumps got bigger. I kept telling myself that it would be fine, and I wouldn't need to have surgery. Look! It's fine today! No limp! Hahahaha. Denial is not just a river in Egypt.

Which brings me down to the present. Three weeks stomping about in Germany went okay (although seriously, it's hard to find ICE anywhere in Germany--once the Adorable Husband had to beg ice from the fishmonger in the local market). We walked all over, and tried to avoid stairs and we had a fabulous time. But once we were home, it was time.

Here's a pick of my left heel -- you can see the big bump and swelling around the tendon insertion point. I have calcification of the tendon insertion point and a really good-sized bone spur.

Nice, eh? The other one looks worse, to be honest.  

So, I'm scheduled for surgery on my left heel on Tuesday, June 30.  I've spent the last week collecting everything I can think of that I might need for recovery (crutches, a knee scooter, shower chair, etc) and now I'm just stewing in a low-level panic about having orthopedic surgery. More details on the surgery in the next post.