A Partially Ruptured Achilles Tendon.

DocLightning · Mon Sep 07, 2009 6:37 am

So I was at Burning Man for my 8th year and there was this massive structure called "Darwin's Wedge."

It's basically a ~20'x100' slab of wood set at a 30° angle with the middle ~15' covered with astro turf and the yard or so one each side left bare with railings to hold on as you climb up. At the top, you sit on a nylon sheet and slide down into massive foam blocks.

I ran straight up it three times. On the 4th, my achilles tendon went. It's partially ruptured. An ED doc on-site diagnosed it, got me crutches, a splint, and a ride back to my camp.

So in 2 seconds I went from healthy athlete to temporary cripple. But I'm also a stubborn bastard, so I did the event I went to do, made friends with the organizers of Burning Man, helped secure the future of the event, and packed out and made it home.

I'll need surgery this week. Anyone done this to themselves?

Wolverine · Mon Sep 07, 2009 11:09 am

I've got problems with my right achilles tendon from time to time. Since a longer time, there is a visible knot inside the tendon, which moves, when I move my foot. I went to see a doctor many times. They did a MRI scan, but with no result, the gave me injections , but it only got worse, finally I had to wear heel wedges, to lift the heel and take of some of the tension of the tendon. But it didn't help. One of the doctors said, it's possible, that I ruptured it partially a longer time ago, and this knot is the scar inside the tendon. But no doctor saw the need for surgery...

Right now I only got problems when standing up, after I was sitting for a longer time.
But if it gets worse again, I hope, they will do surgery, and cut out that knot..

All the best for you!

Pyrex · Mon Sep 07, 2009 1:52 pm

Quoting DocLightning (Thread starter):
I'll need surgery this week. Anyone done this to themselves?

I tried to do surgery on myself once, after watching the first Rambo movie, but in retrospect that wasn't the brightest of ideas, given that I have no medical training and whatnot. I recommend employing the services of a skilled orthopedic surgeon instead.

In all seriousness, sorry about your troubles but, hey, I am sure there are plenty of reports of people making it back from Burning Man with much worse. All the best.

DocLightning · Tue Sep 08, 2009 6:02 am

Quoting Pyrex (Reply 2):

I tried to do surgery on myself once, after watching the first Rambo movie,

OK, I deserved that. Wink

oly720man · Tue Sep 08, 2009 11:10 am

Quoting DocLightning (Thread starter):
Anyone done this to themselves?

Not me but my father managed to completely tear his achilles when we were in the US on holiday. Lower leg in plaster for a while, lots of physio and massaging of the reattaching tendon... intrigued to find that you cease to exist as a functioning person once you're put in a wheelchair.

ManuCH · Tue Sep 08, 2009 11:18 am

Quoting DocLightning (Thread starter):
I'll need surgery this week

This brings up a question I've asked a lot of times to myself: is surgery always "needed" when they tell you so? In your example, could your achilles tendon heal by itself with rest or *must* it be fixed surgically in order for you to function 100% again?

AverageUser · Tue Sep 08, 2009 11:44 am

A thorough discussion in this dissertation: http://herkules.oulu.fi/isbn9789514284342/isbn9789514284342.pdf

DocLightning · Tue Sep 08, 2009 9:38 pm

Quoting ManuCH (Reply 5):

This brings up a question I've asked a lot of times to myself: is surgery always "needed" when they tell you so? In your example, could your achilles tendon heal by itself with rest or *must* it be fixed surgically in order for you to function 100% again?

From what I've read in the last few hours, surgery is not REQUIRED, but it will greatly improve recovery time and it will greatly improve the chances of regaining 100% function. In certain mild tears, surgery can be deferred in favor of purely medical management (letting it heal on its own), but for any significant tear (which I'm sure I have), surgery is the best way to go.

Nobody, least of all a surgeon, wants to expose a patient to the risk of an operation without a good reason.

Blackprojects · Tue Sep 08, 2009 11:53 pm

If they say Fix it with an OP let them Do it as it will Hurt like **** till they do it and for a while afterwards but once its fixed its fixed.

I had a lot of Sugery on My Right Foot and Ankle as a Kid and the Tendons on My Right Ankle are Miracles of Modern (1970s) Medical Science so Just Gritt your Teeth and Bear it.

The Pain Meds will help you through the worst of the Pain.

I Still Get Occasional Tears on the Under Side of my Right Foot Which Slow Me Down But Do not Stop me. alert

DocLightning · Wed Sep 09, 2009 5:08 pm

Well, the verdict is in:

1) Complete rupture
2) Surgery tomorrow
3) SIX WEEKS non-weight-bearing. That's the part that is going to suck the most. Sad

Phoenix9 · Wed Sep 09, 2009 5:57 pm

Quoting DocLightning (Reply 9):
Well, the verdict is in:

1) Complete rupture
2) Surgery tomorrow
3) SIX WEEKS non-weight-bearing. That's the part that is going to suck the most. Sad

Good luck with the surgery doc. Recovery from a surgery is always PITA but considering the alternatives, it is still good.

ManuCH · Wed Sep 09, 2009 6:15 pm

Quoting DocLightning (Reply 9):
Well, the verdict is in:

1) Complete rupture
2) Surgery tomorrow
3) SIX WEEKS non-weight-bearing. That's the part that is going to suck the most.

Good luck with the surgery. With a complete rupture there are no alternatives... and as you said, no surgeon would do surgery "just for fun". You as a Doc are probably the first to know this.

Don't worry, the six weeks will be over in no time. Just browse A.net till you drop! We will keep you entertained Wink

vaporlock · Wed Sep 09, 2009 6:27 pm

Quoting DocLightning (Reply 9):
Well, the verdict is in:

1) Complete rupture
2) Surgery tomorrow
3) SIX WEEKS non-weight-bearing. That's the part that is going to suck the most.

Oh no, sorry to hear this news. But just think, once you are done and everything is back to normal.... you'll be the bionic man again!!! lol

I'll be thinking about you and please let us know how the surgery goes.

Vaps

Type-Rated · Wed Sep 09, 2009 6:27 pm

Do you still have a taste for going out on weekends and acting like a wild man?
As a doctor you know that Achilles tendon injuries can still affect you even weeks after the 6 weeks of no weight bearing rest. Was it all worth it in the end?

DocLightning · Wed Sep 09, 2009 8:30 pm

Quoting Type-Rated (Reply 13):
Do you still have a taste for going out on weekends and acting like a wild man?
As a doctor you know that Achilles tendon injuries can still affect you even weeks after the 6 weeks of no weight bearing rest. Was it all worth it in the end?

I don't regret it. There's nothing I could have done to prevent it (other than stay at home and not go to Burning Man, which isn't acceptable).

If you read the back of the Burning Man Ticket you will come across: YOU VOLUNTARILY ASSUME THE RISK OF SERIOUS INJURY OR DEATH BY ATTENDING.

I voluntarily assumed the risk. I'll heal completely and I'll go back to my life. And I'll be back there next year. But I learned not to run up 30° inclines.

Type-Rated · Wed Sep 09, 2009 9:28 pm

Well, I do wish you a speedy recovery. Maybe next year you can enjoy yourself and have a safe time.

DocLightning · Fri Sep 11, 2009 4:57 pm

Well, general anesthesia was definitely quite a trip.

They started by giving me some midazolam and bit of fentanyl, which made me light-headed, but I didn't feel much. Then they gave me some propofol and had me breathe some oxygen. I remember commenting that my face felt hot. The next thing I remember is a feeling like I was comfortably sleeping (and I suppose that there was a brief sensation of coming out of a grey tunnel) followed immediately by, "MICHAEL, WAKE UP! Surgery's over!"

I believe the first words out of my mouth were "Wow! That was easy!" I felt like crud for the first few minutes while I tried to clear my head out (sort of like how you feel when someone wakes you up out of blissful slumber). Then the uncontrollable shaking kicked in, which was annoying, but that stopped in a few minutes.

As I started to check in with various parts of my body, I realized that my left leg simply wasn't there. They had done a nerve block, so it was completely dead. I've never had any part of my body paralyzed and numbed so thoroughly, so that was also a fascinating sensation (or lack of sensation!).

The other thing I noticed is that I had been very hungry before going in. But I had no appetite at all on waking up. That came back within a couple of hours.

Right now, I'm in bed. I've been diligently taking pain meds every 4 hours, so I'm a bit loopy, but I understand pharmacology enough to appreciate that if I don't take them, the blood levels of narcotics will fall and then I will be in pain. I have a bit of pain right now in the back of my ankle, but it's more of a dull ache. I'm hoping the meds will keep it from becoming much more painful. The nerve block is still partially effective, but wearing off.

I have a feeling that today is going to go down as "not exactly the best day of my life."

Phoenix9 · Fri Sep 11, 2009 5:00 pm

Good to hear your surgery went ok. So what did they put you on? Morphine drip?

[Edited 2009-09-11 10:02:50]

flpuck6 · Fri Sep 11, 2009 5:05 pm

Here's to a speedy recovery Doc !

AverageUser · Fri Sep 11, 2009 5:28 pm

I wish you a sound recovery! Why the general anesthesia btw?

DocLightning · Fri Sep 11, 2009 6:19 pm

Quoting Phoenix9 (Reply 17):
Good to hear your surgery went ok. So what did they put you on? Morphine drip?

No. I got some fentanyl during the procedure, but the best pain control was the nerve block. They flood the main nerves going to the leg with a long-acting local anesthetic, so when I woke up I was in no pain. I couldn't feel my leg at all, but that is far better than pain. It's also a bit disturbing to be paralyzed in one part of your body, but again, that's a lot better than pain.

Right now, I'm on "NORCO," which is basically twice as strong as "VICODIN." Two tablets every 4 hours around the clock. It's important to do that, rather than just taking it as needed, because it means that the drug levels in your blood increase and stay up. It's far easier to prevent pain than to stop it once it's started, so after a patient has had a painful procedure, we usually put them on ATC (Around-The-Clock) pain meds for the first 24-48 hours. I don't like taking all these drugs, but I know very well what will happen if I don't...

Quoting AverageUser (Reply 19):
Why the general anesthesia btw?

To do an Achilles repair, you need to have the patient prone (face-down) on the table. You can't keep the patient sedated this way because you can't control his airway, so the only way to do it is to intubate the patient. So I got general anesthesia and got intubated. And I'm glad I did; I certainly didn't want to be there for the surgery.

AverageUser · Fri Sep 11, 2009 6:46 pm

Quoting DocLightning (Reply 20):

To do an Achilles repair, you need to have the patient prone (face-down) on the table.

Wonder why the doctors here are able to use spinal anesthesia, from what I've read people say, preferably it seems? I could not find a proper scholarly link, but http://www.klokavskade.no/en/Project...ikofaktorer-for-Achilleseneruptur/ appears to have a study in preparation.

DocLightning · Fri Sep 11, 2009 6:50 pm

Quoting AverageUser (Reply 21):

Wonder why the doctors here are able to use spinal anesthesia, from what I've read people say, preferably it seems?

Very good question! I happen to have a disease of the back called ankylosing spondylitis, so a spinal block for me is not an option.

Pellegrine · Sat Sep 12, 2009 5:43 am

Quoting DocLightning (Reply 16):
and bit of fentanyl

Propofol anesthesia is weird, I had it before along with a manual respiration (the oval bag with the mask they have to squeeze?). The milk felt hot going into my bloodstream through the IV. They told me count from 10 backwards, I was out by 7. Woke up and I was all wtf...

Quoting DocLightning (Reply 16):

The other thing I noticed is that I had been very hungry before going in. But I had no appetite at all on waking up. That came back within a couple of hours.

Narcotics, narcotics!

AverageUser · Sat Sep 12, 2009 6:32 am

Quoting DocLightning (Reply 22):
Very good question! I happen to have a disease of the back called ankylosing spondylitis, so a spinal block for me is not an option.

Greetings, I'm a fellow sufferer, at least from my teens, but was diagnosed much later, which is typical for us I understand. I've been wondering how they'd perform a lumbar puncture on me if I ever needed one but have never asked. I'm taking the latest generation medication (Enbrel).

DocLightning · Sat Sep 12, 2009 6:49 pm

Quoting AverageUser (Reply 24):

Greetings, I'm a fellow sufferer, at least from my teens, but was diagnosed much later, which is typical for us I understand. I've been wondering how they'd perform a lumbar puncture on me if I ever needed one but have never asked. I'm taking the latest generation medication (Enbrel).

I'm also on Enbrel, which has been a godsend for me. And the answer to how you do an LP on someone with ankylosing spondylitis is: you don't unless you REALLY have to. Then they usually use some radiological guidance.

jetstar · Sat Sep 12, 2009 9:01 pm

Hi Doc, happy to hear you made it through the surgery without any complications, will you need any rehab or just let time and mother nature handle it.

Years ago I had hernia surgery and the surgeon who operated on me told me that he too recently had hernia surgery and he had it done under a local anesthesia so he could be awake during the surgery. He told me that after that experience never again, the next time he needs surgery he wants to be knocked out.

If you could have had a spinal block, would you have selected this option and been awake or still gone the general anesthesia route?

JetStar

TheCol · Sat Sep 12, 2009 9:24 pm

Quoting DocLightning (Thread starter):
I ran straight up it three times. On the 4th, my achilles tendon went. It's partially ruptured. An ED doc on-site diagnosed it, got me crutches, a splint, and a ride back to my camp.

Quoting DocLightning (Thread starter):
So in 2 seconds I went from healthy athlete to temporary cripple.

No country for old men. stirthepot

DocLightning · Sat Sep 12, 2009 9:56 pm

Quoting Jetstar (Reply 26):

If you could have had a spinal block, would you have selected this option and been awake or still gone the general anesthesia route?

I *HATE* the operating room. Besides, there is enough pressure on the surgeon without having the patient watching the procedure. I think it's impolite to watch.

So I was quite happy to have them shut me off while they were doing the repair.

Blackprojects · Sun Sep 13, 2009 10:39 am

So your fixed That Is good.

I am in the Repair bay at momment with Lorn Chest Muscles that are Healing but the Nice DR Gave CO-CODAMOL which may not have the same name on the other side of the Pond.

30MG of Codine and 500MG Paracetamol to allow the Pain to ease and me to sleep at Night 2 Twice a day when required and Ibuprofen Gel which is good stuff but to be taken at different times and for external use only.

So once i take the Pain meds i feel Fantastic but i have to eat with Food or risk getting SPACE OUT of my BOX!

Look after your self.

I wonder who will fall asleep at TGM this year and do the African Waiter for the Photographers?!?

DocLightning · Sun Sep 13, 2009 5:22 pm

Quoting BlackProjects (Reply 29):

30MG of Codine and 500MG Paracetamol to allow the Pain to ease and me to sleep at Night 2 Twice a day when required and Ibuprofen Gel which is good stuff but to be taken at different times and for external use only.

So once i take the Pain meds i feel Fantastic but i have to eat with Food or risk getting SPACE OUT of my BOX!

No, my stuff is more potent than that. Each tablet contains 325 mg of acetaminophen (paracetamol, as you Limeys call it) and 10mg of hydrocodone.

A tablet of VICODIN contains 325mg of acetaminophen and 5mg of hydrocodone, so these are twice as strong. And I do not like them.

PPVRA · Sun Sep 13, 2009 5:40 pm

Quoting BlackProjects (Reply 29):
Ibuprofen Gel which is good stuff but to be taken at different times and for external use only.

I assume that's a stronger, non-OTC stuff?

I used Ibuprofen Gel (OTC) recently and I don't think it really helped. Granted, it was just a wasp sting, and while it helped ease the itch a little the pills were more effective for longer.

Quoting DocLightning (Reply 30):
A tablet of VICODIN contains 325mg of acetaminophen and 5mg of hydrocodone, so these are twice as strong. And I do not like them.

Careful, you're starting to sound like this guy:

http://en.wikipedia.org/wiki/Gregory_House

Good luck with recovery, btw. Rupturing the Achilles tendon causes a great sense of affliction in people just by thinking about it.

[Edited 2009-09-13 10:44:01]

Phoenix9 · Sun Sep 13, 2009 5:54 pm

Quoting PPVRA (Reply 31):
Granted, it was just a wasp sting

Believe it or not, toothpaste really helps with the wasp/bee sting. By applying a thick layer, the itchiness and pain goes away in 5 minutes because of the cooling effect of the toothpaste.

Quoting DocLightning (Reply 30):
10mg of hydrocodone

That is pretty strong stuff. But hey if it keeps the pain away then who cares.

PPVRA · Mon Sep 14, 2009 1:37 am

Quoting Phoenix9 (Reply 32):
Believe it or not, toothpaste really helps with the wasp/bee sting.

I've heard about it. I didn't even think about it at the time (a month ago).

It's amazing the damage the toxin of those things can make. I can still see evidence of the hole, and evidence of the redness didn't dissipate completely until recently.

mirrodie · Mon Sep 14, 2009 1:54 am

Quoting DocLightning (Reply 9):
1) Complete rupture
2) Surgery tomorrow
3) SIX WEEKS non-weight-bearing. That's the part that is going to suck the most.

Just caught up. Anklosing Spond. plus that surg is not fun. Hope you are feeling better.

Tough year. Didnt you also get in a car wreck a few months ago and totalled a car?
Here's to a speedy recovery and a better year

baroque · Mon Sep 14, 2009 2:14 am

Glad you are getting better Doc, but I tend to faint at the description let alone the actuality of things medical.

Best I can offer as a similar trick was breaking wrist diving into a swimming pool - yes it had water and yes it took skill.

DocLightning · Mon Sep 14, 2009 6:00 am

Quoting Mirrodie (Reply 34):
ot fun. Hope you are feeling better.

Tough year. Didnt you also get in a car wreck a few months ago and totalled a car?
Here's to a speedy recovery and a better year

Yeah. I've had some bad and good luck this year.

I just took a near-spill coming home in the garage. It was raining out and my crutches, which had gripped the wet sidewalk so securely, slid right across the sealed concrete surface of the garage floor. And so the first part to hit the ground was the heel in question, which slid out in front of me, jamming the incision into the splint and putting some stretch on just the body part that had been fixed four days before. It doesn't seem to have caused any lasting damage, but it was quite scary at the time.

The pain is getting a bit more noticeable, probably because I'm trying as fast as I can to get off those abominable narcotics. They make it hard to pee (in fact, they pretty much mess up all function in that general anatomical region, which is making the boyfriend rather unhappy).

The bloody splint comes off Friday, only to be replaced by a big, heavy thing that is removeable.

stasisLAX · Mon Sep 14, 2009 6:27 am

Quoting DocLightning (Reply 36):
The pain is getting a bit more noticeable, probably because I'm trying as fast as I can to get off those abominable narcotics

Hope you heal quickly!!

Blackprojects · Thu Sep 17, 2009 9:26 pm

A Wee Gift for you DOC from Last Year in TGM.

http://img.photobucket.com/albums/v402/markredgwell/PICT2068.jpg

DocLightning · Thu Sep 17, 2009 9:39 pm

Quoting BlackProjects (Reply 38):
A Wee Gift for you DOC from Last Year in TGM.

Aww! I miss you guys! That was a GREAT day!

Blackprojects · Sat Sep 19, 2009 9:48 pm

I wonder if the African Waiter will re-appear?

DocLightning · Sun Sep 20, 2009 12:11 am

Quoting BlackProjects (Reply 40):
I wonder if the African Waiter will re-appear?

If there are men and booze, one of the men is bound to fall asleep...

DocLightning · Thu Sep 24, 2009 4:16 am

Well, today's post-op day #13 and a lot has happened.

I've started physical therapy, with increased exercise. I can kind of move it now. I can find most of the muscles down there and move them, although they are very weak from the immobilization. The swelling, which happens when a limb is inactive (normally, muscular movements help squeeze fluid back through veins and lymph ducts) is markedly improved; I can see the veins all the way across the top of my feet and the tendons are visible until just the very distal segment. I can move it around in the boot with a reasonable sense of how the muscles will react to my commands, but out of the boot, things are still a bit shaky. I barely have any flexion/extension, but I just started PT two days ago, so I'm hardly discouraged. The cool thing is: my tendon works.

I also started with a physical trainer at a gym. Every exercise we do is seated. I couldn't bear weight even if I tried. As soon as I do, I get shooting pains up the limb. I'm nowhere near ready for that, but I think I will be soon.

Except I went a bit hard yesterday... Today, I can barely straighten my arms because my biceps are so sore. This is called Delayed-Onset Muscle Soreness, or DOMS, which is a sign of muscle regeneration. But it's god-awful painful and the pain is very difficult to treat. And, while this would merely be a comical inconvenience in my normal life, I'm on crutches and...yeah... I know. I'm an idiot. Thank god this will only last a day or two. If I'm still this sore tomorrow, I'll sit it out.

Blackprojects · Thu Sep 24, 2009 1:20 pm

DOC in January i got taken of my Bicycle by a bad driver and got a similar Injury to my left Calf Muscle except I got very lucky.

It was just Partially Torn and Bruised so it is still occasionally Cramping up but then as I have a PIPE Stemmed Calf on my right leg i am Screwed due to having Corrective Experimental Surgery when i was 10 years old for a Club Foot my left Calf does the work of two of the Muscles.

I still get about OK and no one normally notices the very Slight Limp i have now a days.

You could probably read up on the Surgery as i was the 1st Patient to get the Operation which seems to be quite Common Now all over the Globe. The Surgeon was Philip Chong Limb a Genius.

DocLightning · Thu Sep 24, 2009 5:59 pm

Well, the new day has dawned and I'm afraid my arms aren't too much better. In my experience, this usually lasts about 24 hours and then it starts to go away. Then again, I've never had it this bad. Although it does seem slightly better today than it did last night.

So yeah, no gym for me today.

My ankle, on the other hand, is improving by... oops, I almost said "leaps and bounds." Today I took it out of its boot to do its physical therapy exercises and it helped itself out of the boot, just like it normally would when I go to put a shoe on it. You know how your ankle points out when you're going to put on a shoe, even though you kind of weren't thinking about it?

I still can't extend/dorsiflex it to 0° (foot at right angle to the leg) but I can flex/plantarflex it almost as far as the good foot. My 3 larger toes are getting their strength back, but the two smaller ones are lagging a bit. Then again, it's only day 4 of physical therapy.

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