Monthly Archives: October 2014

Day 6 Post OP – Pain in Calf / Cast Removed

IMG-20141029-WA0001It was on the Sunday after Achilles surgery when I started to feel pain in my calf. Initially, it didn’t bother me that much as I attributed to the re-engaging of my calf after the repair of my Achilles. However, the pain increased to the point where it bothered me when I rested and when I was on my crutches. I was also using my iWalk during this time to get around the house so I wasn’t sure if that had some contribution to it.

On Tuesday day 5 post operation, the pain became so immense that I decided to call the doctor the following day. I thought it was due to the cast being too tight around my calf. I called the doctor’s office on Wed. day 6 post operations. The nurse asked me how long has the pain been ongoing and I said 3-4 days. She expressed her displeasure that I didn’t call sooner. She relayed the info to the doctor and he wanted me to go see him right away! Normally, I wouldn’t mind going to see him but he was in his other office way out in Anaheim which was about 45 min away! I indicated that I wasn’t sure if I could get a ride that far out. He said he needed to ensure I didn’t have a blood clot and that I had to go to the ER right away.

This was totally unexpected. I didn’t want to incur another ER visit so I found a way and got a ride to Anaheim from a good friend. With just 15 min notice, I was on my way.

I arrived at the office and waited for about 20 min. While I was waiting, I had a conversation with another patient of Dr. J who had bone spur removed from his foot. That’s one interesting thing about orthopedic patients. You tend to feel this sort of camaraderie with others as the physical disability is so visible. I’ll share a bit more about this when physical therapy starts.

When it was decided I had to see a doctor for the pain, I knew the calf had to come off. Prior to this, I had penciled in the first doctor visit, which was another week away, to get the cast removed. I was a bit looking forward to this to see how the scar was and maybe get the cast removed early. I first answered a few questions with the same nurse who took my call then a cast technician came in to remove my cast using this Dremel like tool. There was so much padding that it kept coming out. The color of my foot was actually pretty good. Also surprisingly, no bad smell 🙂

The doctor came in and gingerly removed my foot from the cast. I wasn’t sure what to expect from my scar as this is the first time I had such an incision in any part of my body. At first glance, it looked like how I expected to look. The doctor said it looked really good. There were some slight dis-figuration along the actual suture but it was very straight and no discoloration or swelling.

He pressed on my calf in various areas and inspected it. He IMG-20141029-WA0003asked if I had any pain right behind my knee along my calf. I said no. The pain was more deep down in the main calf muscle. He was relieved and pretty sure it was not a blood clot but wanted me to get a Doppler ultrasound. We had trouble finding a place that could offer this with such short notice but I managed to find a friend whose neighboring radiology center had a unit and was able to fit me in. I never had a Doppler ultrasound but they basically use the sound of blood whooshing through my veins and blood vessels to see if there are any abnormality. The result was negative. What a relief! Another good news is that the doctor cleared me to wear my walking boot and didn’t have me go back in to get another cast.

 

 

Day 3 – Side Effects of Pain Meds

It’s only been two days since surgery medson my Achilles and the side effects of the medication has been quite evident. Recovery is going to be slow and I’ve pretty much been spending the day on the couch with my foot elevated. I started having very little sensation back on my toes which helps me to feel that I am actually moving them. I’ve been taking both the Morphine and Oxydocine together since the mistake I made the day of the surgery when I only took the Morphine and called for mama! With that said, the side effects was in full swing exactly as the doctor warned me. I was having constipation and actually had no BM whatsoever which was very odd as I have very good BM (apologies for TMI). I was also nauseous or just “dazed” after taking the meds. I did have anti-nauseous medication that was prescribed to me but I didn’t bother to take them as I wasn’t planning to leave the house and I didn’t want any more drugs in me. Driving was out of the question. I just enjoyed being pampered for a change. Glad my wife is a stay at home mom!

Oct 23 – Post surgery Day 1

IMG-20141025-WA0002First day out of my Achilles post surgery. Everything went smooth. I was wheeled out to my car and my wife drove me home while I was still a bit nauseous from the anesthetics. The drive home was not bad at all. It took all about 40 min from the 405 to my house which is amazing. I’m reminded again how great it was to have the surgery done so early in the day.

Considering just a few hours after the surgery, I was feeling pretty good. I don’t remember what I ate for lunch but I think I had some noodles. There were minimal pain but it was due to the medicine and the nerve block that was still in effect. I took some prescription pain meds and just watched TV while keeping my leg elevated.

What was most challenging throughout the day was getting use to this cast. This thing is big and heavy! At times, it felt like the cast was going to do more damage than protect my injury. The cast had plenty of cushion and I was warned to strictly not to get it wet. I was also instructed to move my toes to make sure the blood flows. Honestly, I didn’t feel anything and couldn’t really tell if I was actually moving my toes or not. I had no sensation due to the drugs.

There wasn’t much fanfare throughout the day until I went to bed. The day before, I picked up Morphine and Oxycodone. Morphine was the long lasting pain med and Oxycodone was for short term as I remembered. I didn’t feel much pain so I figured I would only take the Morphine and it would be sufficient. Boy was I wrong! I went to sleep a little past 9:30pm but woke up at 11:30pm in immense pain. I had to wake up my wife to have her get me the other pain medication. I took the Oxycodone and after maybe an hour the pain rescinded. Hindsight, I should’ve taken both the Morphine and the Oxycodone before going to bed as that was going to be when the nerve block wore off.

Oct 23 – Achilles Surgery

The time has finally come for my Achilles surgery. I was so anxious to get the surgery done that I didn’t think much about the pain or have time to be scared. I suppose one can worry about issues and risks associated with surgery. I don’t remember the last time I was under general anesthesia. Maybe when I was in college for a colonoscopy. I digress. I just wanted to hurry and get the surgery done and start the recovery and get back on my feet.

The day started at 4:30am. We already dropped off the kids last night at the in laws who agreed to help drop off the kiddos at their schools. Hindsight, it was good the surgery was this early as I didn’t have to worry about any traffic or fasting throughout the day. It took about 45 min to arrive at the surgery center near LAX. We parked our car at the empty lot and got to the registration window a bit before and spent another 30-40 min doing paperwork. I was led into the prep room and gave my wife a kiss. She went to the car to take a nap lol.

In the prep room, I had to strip to my underwear and wear a patient gown. The one where only your front is covered. There were about 3 nurses who prepped me and 2 other patients in neighboring beds who were getting operated at the same time as well. IV was put in and several checks to ensure the right foot get operated. My ID band was to be worn on my wrist opposite of my injury. I was also asked to put an arrow using a washable marker where the injury was on my calf. Another nurse shaved my leg with a disposable razor without any soap. That didn’t go well at all. The nurses did a great job ensuring I was comfortable and chatted among themselves most of the time. The anesthesiologist came in to introduce himself. Asked about my surgery and if I had any allergies. He mentioned that he will put a mild dose of anesthesia into my IV and I should start getting sleepy soon. He explained the nerve block that will be put on my entire leg and that it should last up to 12-48 hours.

Shortly after I was wheeled into the surgical room. I took a quick glance and it was typical, sterile environment. Just a few seconds later, I blacked out.

Next thing I noticed I was in the recovery room with a huge cast on my left foot. I was extremely drowsy from the drugs and my head was spinning. It was just passed 10am and my surgery was a success. Just in time, I see my wife walk in. It was a bit of an odd feeling as I felt almost half asleep but can hear the other two patients in the room seem to have less side effects and ready to check out to go home. I took in some water and spent about 45 min in the recovery room. My bladder was also really full and had to get wheeled to the restroom. As I slowly recovered, the nurse tried to small talk asking about our kids and where we lived. She reminded us to make sure I take my pain meds.

Once I felt ok to be upright, I was wheeled to my car.

Dr. J. Surgery confirmed for Tuesday Oct 23

Oct. 21 (Tuesday) – I wasn’t thinking much when I went to visit Dr. J as I was fully expecting to be operated by Dr. L but the fact that I still have yet to receive the surgery date from his office gave me a great deal of concern. It was unsettling to not receive a callback as I wanted to be operated that week Friday the latest. The good thing about Dr. J was that he was very close to where I lived in Pasadena. I really just wanted a 2nd opinion even though my mind was set to go through surgery no later than this week.

It took no more than 10 min from my house which was very convenient. Parking was a different story. There is paid parking garage and the doctor’s office didn’t validate. There were street parking available but limited. With just one foot, it wasn’t the most ideal situation. After waiting about 45 min. (which I later found out to be unusual), I was led in after filling in the typical medical history forms. This visit is a bit different as I had my wife accompanying me and I had a digital copy of the MRI.

Dr. J. came in and after cordial exchanges, we went right into my injury and jokes about how he has seen several basketball related Achilles ruptures from men in their mid-30’s to 40’s. He came off as very knowledgeable and went into detailed about how he does the surgery and how he makes an incision on the edge of the ankle and not right over the Achilles. He believe that it sped up healing as it is less irritated. The more he explained the more my interest piqued as to having Dr. J. perform my surgery.

Then he said two things that pushed me to spurn my choice for surgery. First, he was in network for my insurance. It is an unfortunate reality that we need to make medical decisions based on our medical insurance. I do realize that I am very fortunate that I do have the choice of going to the doctor of my choosing but Dr. L would’ve been out of network. He did indicate that he would charge me in network price but how much out of pocket I would need to pay is unknown. However, Dr. J’s assistant did their homework and they were in network which would mean my deductible would be $3,000. If I do with Dr. L., although in network price, my deductible would be a whopping $10,000. Secondly, Dr. J. said he could fit me for surgery for Thursday! Yes, the DAY AFTER TOMORROW! I was so excited, I turned to my wife on her thoughts and she left it up to me to decide and would support me. They tentatively said 1pm which would conflict with our sons getting off school but we could manage. We gave them the go ahead to schedule us in with the surgery center.

It was still late morning so my wife and I went to lunch at nearby cafe in Pasadena. We sat down and let the information sink in. In 48 hours I would finally go through surgery and I can be on my way to recovery. I didn’t realize how nervous I was about getting surgery done in the recommended 2 weeks time frame. I mean, I am sure it would’ve been fine had it gone 3 weeks but I would’ve really been fidgety if I had to go through another weekend to wait for surgery. During brunch, I got a phone call from the surgery center. The surgery was scheduled for 7:30am and I had to be at the surgery center by 5:30am.

“Say that again?”, I responded.

This completely threw us off as we already made arrangements for our sons to get picked up. Now, not only do we need to worry about dropping them off school but the night before! We probably had to leave the house by 4:45am to make it to the surgery center. Thank God for our in laws and brother in law.

One last thing I had to do was to pick up my prescription. With only two days advance, I HAD to pick up my prescription medication for the pain post surgery. I was given a pre-operation packet which outlined everything that I had to do prior to surgery including the cessation of any pain medication which may thin my blood a week in advance. Oh well. I went to the CVS I frequent and they didn’t have one of the pain meds I needed. I anxiously went to another 24 hour CVS which they had both meds in stock.

Everything was set.

First Weekend with Achilles Rupture

Truth be told, I was just getting used to life with just one leg. I was actually scheduled to play in a soccer game that Saturday with my cousin who just moved to the U.S. That was out of the question.

Part of me was glad that I got the adjustable Maxtrax ROM Air Walker walking boot. I didn’t care much about the air pump but it did feel much more secure instead of the soft / hard splint I got at the ER. I was always paranoid about getting that thing wet.

There wasn’t much I could do other than wait for surgery date to be confirmed. We didn’t get any confirmation of the surgery date / time so my wife and I decided to find another orthopedic surgeon. We went with a referral from a friend who was an oncologist. He knew a orthopedic surgeon from his days in medical school. Upon calling the referral, the office indicated that he only worked on shoulder issues and referred me to their ankle and foot specialist. I guess a referral’s referral was better than finding someone blind. Appointment with Dr. J in Pasadena was made for Tuesday.

I spent the weekend at home icing my foot several times a day while keeping it elevated. I pretty much planted myself on the end of the couch with 3 cushions from our backyard patio set. The cushions were much more flat than any pillows on our house and stacked well.

A new norm

With this injury, I had to revise my daily routine which was the most inconvenient part of this injury. First of all, I had to humble myself to accept help from others. This included help from friends, neighbors, relatives, and especially my wife. God bless her. I actually help out around the house a lot from doing chores, grocery shopping, picking up the kids, and even cooking. All this was out the door for the time being. My primary goal during week one was to keep my foot elevated and reduce the swelling – in other words, just sit.

With the iWalk 2.0, I was able to somewhat do more than being on traditional crutches. But I was still very limited. I am fortunate to be able to drive as my right foot is fine but I kept my activity level at a bare minimum. This weekend, I only went to church and that was it.

Taking a shower was also out of the question as I was not allowed to get my splint wet and it was not possible to maneuver myself in and out of the shower safely. I resulted to submerging myself in my bathtub with my injured leg outside the bath. It was very straining for my back and extremely difficult to get in and out the bathtub. Not much choice and I really wasn’t looking forward to doing this for months to come.

 

Day 4 – Orthopedic Surgeon in Burbank

The appointment was early at 9:15am. It wasn’t the best time as my wife had to take the kids to school so it was the first time I drove myself since the injury. This wasn’t an issue as my injury is on my left foot and both of our cars are automatics. However, I won’t have the convenience of being dropped off the curb. It was also the first time I had to go at distance with the crutches. I actually had a handicap placard lent to me by a friend as I waited for mine to come from DMV so I thought I could at least park at the handicap spaces near the office. I arrived on time due to unusual traffic and to my dismay, all the handicap parking was taken. I guess it wasn’t that big of a surprise considering it was a relatively large medical office. I parked to the far end of the first floor parking. Hindsight, I should’ve went up another level and parked near the elevator. I gingerly made my way off the car and onto the crutches.

I struggled. I was out of breath and my armpit was tired from making my way from the parking lot to the medical building. As I entered the medical building, I realize the medical office was across the building! I then made my way for probably another 120-150 feet. Combine that with the parking, I probably traveled an industrial block on my crutches.

I signed into an office decked out with sports memorabilia such as signed jerseys and team photos of college and scattered professional sports players. Seems like this place had a high profile clientele. After about 20 min wait, I was called in by an intern probably from USC or UCLA. There were actually a number of interns staged in the back reviewing the patients for the day. I was asked basic questions about the injury, my current pain level, age, and general health questions. After about 10 min, the orthopedic doctor came in. He was a young Asian doctor who was probably the same age as myself. Maybe a bit more. Hard to tell with Asians. He was very emphatic and walked me through the available options. He was very honest about the conservative options to the most progressive treatment available at the moment. Conservative treatment was to not have surgery but set my foot at a steep angle so the tendon will fuse together. He said even for full ruptures, it can heal by itself although it will not be as strong. He also explained the most progressive option which was a new treatment where he opens a small incision to tie the tendons back together. However, it came with a comparatively high risk of nerve damage. The benefit would be a short recovery time. The most common treatment would be to make a large incision and tie the tendons back together. Without any pressure, he said he performs this operation the most and considers it very low risk with a high success rate. I agreed. I had to work with his surgery scheduler to see when I could be fit in. He led me to an in house x-ray room to ensure I didn’t have any structural damage. After x-rays, I was fitted into an adjustable Max Trax walking boot and off I went another city block back to my car.

There are crutches then there is iWalk 2.0

Growing up, I was very fortunate to not have to use a crutch for a very long time. The closest I got to using a crutch was in high school when I had a knee contusion which lasted only about 3-4 days. I lived in an area where everyone drove so I barely had to use my crutches to get around. This time it was different. I had to heavily rely on the crutches to get around within my house and outside. The morning after the injury, I woke up in the morning to the kitchen to make some coffee. It was a challenge but I managed to brew a cup while resting my full weight using my armpit. Then it suddenly hit me. I couldn’t move my coffee to the dining table from the kitchen as I needed to use both hands to walk with the crutch. It was a revealing moment of things to come and the challenge ahead. I ended up hopping my way to the dining room (which I do not recommend) and spilling coffee along the way. “Great…”, I thought to myself.

I did what I could to enjoy my coffee and breakfast then started reading online on Achilles recovery and surgery options. It was then when I came across an advertisement for iWalk 2.0 which was strategically placed at an Achilles surgery information website. I read the testimonials and studied the videos and I was sold. I’m usually very skeptical of infomercial type adverts but I was desperate and they sold me on exactly what I was able to still have control over. I went over to Amazon and read the reviews and pulled the plug.

The iWalk 2.0 arrived on Friday Oct 15th. It came in a well packaged box and assembly was IMG-20141126-WA0005simple. They had numerous warning to make sure you follow the video instructions, which I did, and was glad I did. There were numerous adjustments to be made to ensure the height of the knee rest was appropriate and the belts were snug. Assembly took me about 10 min with no tools. It literally took me about 15 seconds to get used to the iWalk. Almost immediately, I was able to move around my house with ease but most importantly, regained the use of my hands and arms. Not only am I able to use my hands to carry my coffee around the house, I was also able to cook and do the dishes to help alleviate my wife from doing everything.

Some recommendations. You need to adjust the settings to ensure the belts and latches are snug. If it is loose, you will not be able to walk and may be dangerous. Also, it is much easier to release the latches if you loosen the length of the belts before you unlatch them.

Now for some cons. If you are in an environment where you need to sit and stand a lot, this may not be your best option. Although, it is not difficult to take the iWalk off and on, it is a hassle as there is no way to sit down with this on. Getting on and off a car is a hassle. The item is quite bulky in its configuration making it difficult to lift it across you to store in the car. Lastly, you can trip and slip with this especially if you get caught on the exterior of your injury. I have this on my left foot and if I was moving to my left and get caught or trip over a crack, I will fall. There is no way to save yourself except to break your fall with your arm. You just need to make sure you left your leg as if you are walking and not drag your iWalk across the pavement.

All in all, I am very happy with this product. You will get A LOT of people approaching you inquiring you about your iWalk. Most of them are curious and simply want to know how it works. A lot of Amazon reviewers claim that you will get a lot of “looks” and experienced a bit of stigma in public places but I didn’t this. If anything, people took a quick look and then went on their own business.

Give it a try and leave a comment on how it goes!

Day 3 – MRI Result

Day 3 of my Achilles rupture was uneventful which I imagined. I just needed to get the result of the MRI and proceed to find an orthopedic surgeon which was in itself a challenge. I had never shopped for a surgeon before. The previous surgery I had was through a medical group where I was not afforded to select my surgeon. Everything worked out and it wasn’t a major surgery so I wasn’t too particularly concerned. This time it was different. I received a call from my chiropractor who notified me that I had a FULL rupture, not a partial tear. My mindset changed a bit. He reminded me that I am now a candidate for surgery. Whatever hope of conservative recovery option of non-surgery was likely off the table. I was planning on having surgery anyway but now the question is when. Most information I read regarding Achilles surgery indicated that the best time to have surgery was within 2 weeks. Below is not my MRI but this is similar to what I saw. I’m unable to extract my MRI without the proper software / device.

webmd

My chiropractor gave me a three names who he highly recommends and I went ahead and called them. Out of the 3, I was only able to reach the office of one of them located about 15 miles away. A bit further away than I would like but nonetheless I didn’t have much of a choice. They proceed to tell me that the next available appointment was the following Thursday. I dropped my chiropractor’s name and they fit me in the same Thursday. The first orthopedic appointment is booked.

Day 2 – MRI and diagnosis

Despite the trauma I somehow manage to fall asleep. After all, there wasn’t much I could do and I didn’t have much pain. The ER doctor told me that if it was a full rupture I wasn’t going to have much pain. I kept mum at the time as I thought it was a partial tear. I wrote a quick e-mail to my boss and fell asleep.

The following morning, my wife helped me look for available in network orthopedic surgeons in the neighborhood that were part of UnitedHealthCare. That’s one thing good about having PPO is that I can directly go to any in-network surgeon without going through my primary care physician (PCP). I first attempted to call a referral from the same physician’s assistant friend. However, they outright did not take my insurance. I was a bit disappointed but nothing much I could do. My wife then found another doctor nearby who was available the afternoon. I hesitated. I’m not sure I want to see an “unknown” orthopedic surgeon with no reviews available that is so available.

I then recalled my chiropractor who helped me previously with some aches and pains. I called him. His admin explained that he normally does paperwork on Tuesdays but after giving her my name, he came on the phone. I explained I likely have a partially torn Achilles and he told me to come in right away.

I showed up at his office in about an hour. He also did the Thompson test and confirmed an Achilles injury. Below is a picture my wife took. You can see a well defined Achilles on my right foot but my left Achilles has no definition. It is rounded out and blunt. If you run your finger over it, you will feel an obvious gap.

IMG-20141014-WA0004
His administrator helped me call an MRI center down the block and I headed over there.

The MRI
I soon realize this was the first time I have been in an MRI machine. I laid down on the bare table with a huge ‘Siemens’ machine which we see on TV but I like to think of it as a time machine. A time machine to when I am fully recovered (wishful thinking…). The technician asked if I wanted a blanket and handed me earplugs. He said it was going to be cold, loud, and would take about 30 min. I accepted his offer and was glad I did. The buzzing and whirling as well as the sub 70 degree temperature was somewhat bearable with the blanket and earplug. I tried to take a nap but found it futile.

30 min passed and I head on home, waiting for the result.