Week 3 Post Op

Week 3 Post Op 21/04/14

I have now pretty much dispensed with the crutches as I’m able to walk around in the boot without any hassle. The screws in my ankle didn't give me any other bother and I seem to be recovering fairly well. I did catch the worse dose of flu I think I've ever had so spent 3 days or so in bed with that and still kind of suffering a bit. I went back to work last Monday, mainly working from home for the next few weeks and the leg held up fairly well. It didn't swell up too much but I was still pretty tired at the end of the day – I am able to elevate it especially when I’m on conference calls so I’m sure that helped.

On Thursday, I went back into the hospital. They took off the Unna boot dressing and put on a new simple rectangle dressing. The wound looks really good and has basically healed - see picture below. I can now shower and get the wound wet without any problems. I have another three week with the boot on and then I’ll be moved into shoes with heal raises in them – that’s at the 6 weeks stage. From 6 until 12 weeks is when most people re-rupture (usually from doing something relatively stupid according to my consultant) so I will need to take care then.

He said I can do most things with the boot on so I have been able to do practical things around the house like cooking, clearing up, putting the kids to  bed etc. so that’s not bad at 3 weeks. I've

even made a start on the garden and have been able to do manage some digging and mowing.

I’m still doing the weights with the resistant bands but hope to be able to make it to the gym next week and do some proper weights. Its another 3 weeks before I go back into the hospital so I don’t expect much to change in that time and getting the boot off then will be the next big milestone. 

Week 2 Post Op

My consultant said I could try to flatten my foot in the boot when it was comfortable. To help the Achilles heal initially they put a wedge in the bottom of the boot so that your toe is locked in a pointed position i.e. pointing down. So on Friday I removed the wedge and gently stretched out my foot to flat, it seemed a bit too much of a stretch so I put in a half wedge and wore that for a day first. After a day, I noticed that when I went outside and put the outside boot and full wedge back on, that I was able to put a lot more weight on the bad leg. So much so that I could walk with just one crutch. I stuck with the small wedge inside and in bed for two days until Sunday night and then took out the wedge and allowed my foot to go flat in the boot. By Monday it felt comfortable and by Tuesday I was doing short trips without the crutch - not exactly walking smoothly but comfortable enough. I have continued doing weights with the resistant bands at home every second day just to make a break from the lethargy of lying down.
On Thursday I had to go back to Jame's Hospital to get the stitches out. I got a lift up and was there fairly early. I had to wait for the doctors to book me in for stitch removal and dressing. Once this was done, the nurses sent me down to the dressing clinic. There they removed the dressing and bandages from the operation. These are usually black from the congealed blood that seeps out through the stitches. The nurse was really impressed with how well it had healed. I was pretty strict about keeping it elevated and not letting it swell - I really hadn't left the house in two weeks.
I had a good chat with the nurse and she told me a good bit about how they have changed how they dress the wound for Achilles repairs after stitch removal. There was a problem where sometimes the wound would open after the stitches were removed. This was due to the fact that this type of operation causes severe swelling. So they tried a type of dressing called an Unna boot. This is essential a zinc oxide pasted bandage with a compression dressing on top. Typically these were only used for treating ulcers but over the last year my consultant has started to use them as standard for Achilles repair.
Anyway, the nurse put the dressing on and it felt tight and secure and then I went back down to wait to see the consultant. I had a very long chat with the consultant and he answered lots of questions. I need to have the Unna boot dressing removed in week and come back to see him in 4 weeks. I have to continue to wear the boot for the 4 weeks and only take it off when I'm sitting or lying down. I can bear weight and do whatever feels comfortable with the boot on - as long as I have the boot on its difficult to do any damage. The injury will start to feel a lot better than it is and I had to be careful not to be lured into a false sense of security. If I try to put any body weight on my toes then I will probably re-rupture. The real danger period for re-rupture is 12 weeks so I need to have patience. To illustrate the need for patience he compared my recovery with that of a premiership footballer who will have 5 or 6 physio sessions, daily ultrasound and cryotherapy. They will be back to running after 6 months whereas I will be back in 6 and half months (€120k gets you a couple weeks).
I left the hospital pretty well informed and happy with my progress. However, on Thursday evening I felt a throbbing pain down the side of my ankle which got worse as the evening went on. I struggled to sleep that night and took a few pain killers but still the side of my ankle was really sore. I called the hospital on Friday morning and eventually they called me back and said I should come in. So I got a lift into town and hoped on the train to Dublin and I met the dressing nurse on the way in and she brought me straight in. She took the dressing off and it turned out that the compression bandage was pushing against two screws from when I had the plate put in two years ago. This was basically pushing the skin into the screws and hence the pain. So she redressed it with some padding around the screws and less compression overall. That's it for this week. Dressing comes off next week and then three weeks before anything much happens. I'm back to work on Monday - working from home so I'm probably over the most boring part. I still have to sleep with the boot on for another 4 weeks which I'm not really looking forward to.

Small and big wedges for the  boot

Crutches with foam paddding

X-ray of my ankle from two years ago the 2
screws on the bottom left were digging into
my skin with the compression bandage

The new compression bandage

Week 1 Post Op

So I woke up in hospital ward on Friday morning after a fairly rough night’s sleep - Damo had the TV on until about 2am. The interim had suggested i might like some sleeping tablets which I turned down, now I know why. I was fasting so I had to pass on breakfast thankfully. The nurses said I should be called for surgery around 9.30am. I was still there at 12.30 waiting (and fasting) and getting very worried that i was going to be missed and left in over the weekend. Anyway, at around 1pm, the porter came to get me with a trolley, I had to strip off and put on a hospital gown - a lovely blue papery type garment. I also had to sign my iPad, phone and wallet into the safe - not that I didn't trust any of my fellow wardies.

Off he wheels me down to the operating theatres and into the holding area. This is my third operation in two years so I know the score at this stage. They leave you in the waiting area while the nurse does all the checks - makes sure you’re the right person, that they've marked the correct leg (as shown below) no allergies, no crowns etc. Then when they are ready for you to bring you into a small room next to the operating theatre where the anaesthetist does his work - they stick on a few monitors on your chest and then stick a catheter into your vain on the top of your wrist and he checks your name, date of birth etc. and then it’s the cool bit. He asks you to count to ten. 1, 2, 3, 4......

Next thing you know you’re waking up in the recovery room - there is a nurse beside you asking are you OK. Normally, you’re not as you can expect a dry throat, to be hungry and to be in pain. This time I was each of them multiplied by 5 - throat was killing me (they stick a tube down your throat during the op to ventilate you), your starving cause you haven't drank or ate since the previous evening and as the general anaesthetic wears off you start to feel the pain of the op. That's why the nurse is there, to help you manage the pain. I tell her the pain is a 9 (they always ask you for an out of 10 scale where 10 is the worst pain you've ever felt and 1 is an itch). She gives me 3 or 4 doses of morphine and waits a few minutes then she waits a few minutes. Pain still a 7 so a couple more doses, still a 7 so a couple of more doses. Finally, the pain drops at the back of my leg but I still have a severe cramp across the ball of my foot. The nurse goes to try and find the orthopod to see if he can have a look. I can see that its approx. 3pm so I was in about 90 mins.  I wait for an hour until he comes out and had a look opens up the boot and refastens it more loosely - this does the trick. 20 mins later the orthopod and his offsider come by and ask how I'm feeling. The specialist tells me to come back to his clinic in two weeks, to keep it in the boot and to start to bear weight as soon as the pain subsides.

It takes me another hour to get back to the ward and of course I've missed dinner. The nurses say that they'll get me something so they get some very dry sandwiches, a yogurt and an apple - not exactly the feast I was looking forward to after 20 hours.

Anyway, the nurses keep me topped up with pain killers that night which is just as well as I watched on as the entertainment for the evening unfold. Damo's brother comes to visit and was caught in the toilet with no shirt on - then there was a huge scene with the nurses and security until finally Damo's brother was turfed out. Thank god for the morphine.

Next morning I felt pretty sore but was able to get up and move around on crutches. My leg got very sore if it wasn't elevated. My sister collected me around 4pm and I travelled home lying across the back of the car with my feed up against the window. Kids and Steph were excited with me coming back so once I got rid of all the hospital clothes etc. I settled down on the couch for the foreseeable future.

For the first three days I was pretty much lying down all the time and only getting up when necessary. I stayed on the strong painkillers (Oxynorm) until Monday then just onto Panadol which I'm only taking in the evening but stopped taking yesterday. If I'm upright for more than 30 mins then I can feel my leg start to throb so I've been pretty much moving from couch to bed this week. I'm getting lots of reading done and I've downloaded the first 3 series of Game of Thrones and I'm hooked. I did manage to do a short weights session on Tuesday using a resistance band and a stool and some floor exercises and repeated that again yesterday. I also managed a short hobble outside yesterday - because I have to wear the boot in bed I don't want to be walking around outside with that one. As it happened, I got one boot when I went into A&E first and then they put on a separate one after the op. I brought both of them home from the hospital so I have an inside boot and outside boot. Still it’s a bit of a pain having to change boots every time I go outside.

Before: Note the scientific pinpointing of surgery site

The new Boot

Tea and Toast (the toaster was broken apparently)