Slowly getting back to Normal

Thurs 31 August
Its about 4 weeks since my last blog and time for a next installment.
I have continued to do my physio exercises - single heel raises - I can do ten of these with one hand on a table or chair in front of me. I have been trying to reduce the weight on my hand and just use my foot to lift and lower all my weight. This has not been easy and 4 weeks on I'm still only seeing very small incremental increases in strength and I still cannot do a heel raise without using my hand for support. Double heel raises - I'm able to do 50 or 60 of these without problem. Stretches are going fine and I've good range of movement. Doing a few balancing exercises now to try and strengthen the side mussels. These involve standing on bad leg with eyes clothes, standing on cushion, standing on uneven surface etc.
I have also been massaging the tendon which is starting to resemble a normal shape again. Before it was a rounded shape and it hurt when you pushed it, now its more like the other tendon. There is one really sore spot in the middle. I do have a problem with walking as I still have a slight limp. Basically as I raise my hell and roll onto my toes I feel a very slight pinch on the tendon which I think equates to the tender spot in the centre. I think this is causing the limp. I have broken into a jog a couple of times (running for Luas/train) and it felt OK. Not super by any stretch but not really painful either.
I have been swimming fairly consistently and feel some fitness and form coming back. I also have been cycling three times a week which is a lot for me. I feel some stamina coming back but I'm still a long way off on strength and I really struggle on any kind of decent hill.
I was back in at the physio this morning and he wants me to continue with the exercises and to do more balance work. He wants to give me another two weeks before coming back to try running on the treadmill. 

Week 13 - Back in action

30^th June 2014 – 13 weeks post-surgery

Over a month since my last post and the good weather coupled with my increasing activity being the main cause for the gap. After I saw the physio at the end of May. I had a big event (TriAthy) which I was pretty involved in (I was chief marshal) which meant I was on my feet for a long day and had to do a lot of walking. The ankle got increasingly swelled through the day and by the end of the day it was pretty swollen and sore. The next day it was still swollen and sore and it was only 3 or 4 days later that it was back to normal and I could start back on the physio properly. Lesson learned was that just walking and standing for a long day put a lot of strain on it.

Anyway, after I recovered, I was able to crack on with the physio double heal raises and single heal raises supported. I was also doing step ups and step downs. I was back in to see the physio on the 11^th of June and she was happy with progress. She continued to get into the calf and try and get the knots out of the muscles and also break down the scar tissue on the wound itself. Only one new exercise – balance on the bad leg.

We then had a week in France on a family holiday which was fine. Went down the water slide a few times with the kids which I don’t think was great for the injury. However, had plenty of time to do the physio exercises and I was on my feet much more than I would have been than if I had been working. Overall, it felt good all week and it didn't swell or feel sore despite the increased activity. We arrived back from holidays on Saturday and I went for a decent cycle on Sunday (1 hr 40).  

Last week was a busy week. Physio on Mon and Consultant on Thurs. However, when I headed off to work on Monday morning I felt a lot stiffer and sore. I think this was partly due to be being back in work shoes after being in cross trainers all week on holidays and partly due to a busy Sunday including the cycle. Anyway the physio picked up on this and wasn't happy. She did notice that after massaging the calf and wound site that it freed up a god bit and she thinks I’m tensing the tendon too much when I’m not using it. Anyway, I was given the same exercises and we would see what the consultant would say on Thursday.

In to see the consultant on Thursday morning, he was really happy with my progress. He said that normally you wouldn't be doing single heal raises until 16 weeks so I was 3 or 4 weeks ahead of where I should be. He stressed though that it wasn't a race and I still needed time for the strength to come back. He gave me the green light to cycle away as much as I can and said that I could start to jog in 6 to 8 weeks’ time but said that I wouldn't be able to go fast or change pace until about 3 months. He also said I didn't need to see him again until I get called for day surgery to have the plate and screws removed from the previous break which will probably be later this year.

Activity wise I have continued to swim 2 or 3 times a week and have been building up my cycling from 1 hr to 1hr 40. I notice with swimming that I’m quite slow and out of shape and I think that’s as a result of my overall fitness being poor and not doing enough swimming to bring this up (I’d normally do this through running and cycling). I’m also find the cycles really hard with no speed or stamina so I think I just need to stay plugging away. It’s pretty frustrating having to start from such a low base again.

Yesterday, was Ironman Austria – the race I was planning to do and was training for when I did the injury so it was a poignant weekend for me.  However, It was my triathlon Club (Trilogy)’s weekend away in Kilkee for Hell of The West Triathlon. I was planning to go anyway for weekend but a swim relay spot became free during the week and I decided I’d have a go. I really enjoyed the swim, it was calm, sunny and the water crystal clear. I felt tired on the swim because my swimming isn’t up to scratch but arrived back on the beach in 25 mins and was happy with that. 50 people must have run past me as I walked up the beach including a few people I thought would have been much faster than me. Anyway, very happy to be back participating just 13 weeks post-surgery. Thanks to the Kenco Angels for having me in their team and all the trilogy crew for a great weekend. Now to get my swimming and cycling back into shape!

Team Kenco Angels

Saw this in Aldi last week and thought it would have
been prefect for me immediately post surgery when
I had to keep my leg elevated. Please note these are
not my legs!!

Week 9 Post Op - back on the bike

22nd May 2014

Approximately 3 weeks since my last post when the boot came off and I started on physio exercises. I spent a couple of days weaning myself off the boot. One of them involved a day in Dublin watching the Giro D’Italia and so involved a lot of walking and standing so I was glad I wore the boot that day. Since then I’ve been bootless and walking in thick heeled shoes or runners with a heal raise insert on my bad side. The first few days I was walking very delicately and wasn’t really engaging the tendon in my gait. However, I have been doing the 3 physio exercises strictly and can really feel an improvement in strength when doing the exercises. I also found my walking has got more normal however I’m still not walking with a limp and if I don’t concentrate I tend to walk flat footed and not engage the tendon.

I have been able to swim and have swam every 2 or 3 days. It’s a big relief to be able to do some exercise after nearly two months of inactivity. The first swim session I felt really slow and weighed down – it was like I was wearing a big woolly jumpsuit in the water. The second session felt much better at the start but I got tired pretty quickly. The last few sessions I feel like I’m getting back to a normal. I still can’t kick off from the wall.

I’ve also been able to cycle on a static bike. I put my road bike on the turbo trainer and have taken off the cleat pedals and put on a pair of flat pedals. Again, this felt sore at the start but has started to feel a bit better. I have increased the time on this up to 40 mins. I have tried to stand up as if I’m climbing and I can handle the pressure of being on my toes but my ankle does get sore fairly quickly. So based on this I don’t think I can take the bike out of the garage for a few more weeks. This is the hard part especially when the weather is good.

I was back in to see the physio last Week morning and she was pleased with the increase in strength and flexibility (I haven’t been doing any stretching so this was a surprise). She messaged my calf muscle which was very painful at the time but has felt much better since. Also, she massaged a bit of the scar tissue either side of the surgery site. There is a lot more to do here as my tendon is really fat and hard along the scar compared to the narrow tendon on the other side. I have to continue with the band strengthening exercises on a green band now and introduced some shallow squats and increase the pressure on the heal raises. I have to go back in a weeks time.

Overall, at 8 weeks post surgery I’m very happy with progress. From a lifestyle perspective I’ve been able to function normally since about 2 weeks post op and start to exercise at 6 weeks. When I compare my recovery to some of the others I see then my progress does seem good. If you look at this guy who is only getting his cast off at 8 weeks and starting to weight bear now then I’m streets ahead

http://achillesblog.com/hoss/category/8th-week-post-surgery/

Update 29^th May

Things have continued in the same vain. I’m still doing strengthening exercises 3 times a day and I can feel the tendon very slowly getting stronger. I have been doing 35 or 40 mins on the turbo trainer every second night and swimming 2 or 3 times a week. Then last night, it was really sunny and warm so I said I’d try go for a spin on the bike. I did 40mins and it felt fine, well the ankle felt fine but I ran out of puff after about 10 mins. Just shows how quickly your fitness goes. My ankle is a little bit sore this morning so I’ll have to build back up slowly.

Back in with the physio this morning and I’m onto double heal raises and single heal raises whilst supporting myself with my hands on a bench or back of a chair. She has started to massage the Achilles itself trying to break down some of the scar tissue – theres a long way to go and a lot of scar tissue to break down. 

This is the bad leg - you can still see the
scars from the bike crash but the operation
scare has almost disappeared

This is the good leg obviously but is a
good contrast because you can see the
width that the Achilles should be and the
rest on the bad leg is scar tissue.

Week 6 Post Op

9^th May 2015

So it’s been nearly three weeks since my last post. There was not much happening for the first two weeks. I became increasingly mobile and could walk further and further on the boot. Generally, swelling has stopped and I don’t need to elevate my leg anymore. If I went on a long walk or was doing a good bit of gardening then my leg would get sore but this was more in the sole of my foot and I would need to rest for 10 or 15 mins after this.

There was very little that I could not do in terms of day to day activity, I could cook, pick up and walk with the kids, get around nearly everywhere on foot, etc. I even tried driving a few times with the boot on but decided it was a bit too clunky to take the car out on the road. I have been doing the resistant band weights every other day which has kept me some way active outside of the walking.

Then the last week has been a bit different. The consultant had told me to take off my boot occasionally when I’m sitting at my desk and do some exercises with my foot. These involved pushing my foot up with my toe to start very gently activating the tendon. So I did this for two weeks and then in the last week I progressed this further to putting on a runner and walking up and back really slowly in the office. I knew that they were going to let me take the boot of this week anyway so I didn’t see the harm in taking it off early and starting to walk.

I was back in at the clinic yesterday and the consultant seemed happy enough with progress. The wound has nearly healed up completely so I no longer need to dress it. I can take the boot off and walk in runners with a good heal and a heal raise inserted. The best news is that I can drive, swim (provided I can get into and out of the pool safely) and I can cycle on a static bike with flat pedals. All of which is great and better than I was expecting this early.

The real danger now is the risk of re-rupture – most people re-rupture between 6 and 12 weeks. The tendon has approx. 25% of its strength at the moment (although it feels much more to me) and this will build to 50% by 12 weeks. So I need to be really careful on stairs and uneven ground and to make sure that the tendon is not accidentally extended or I will be back to square one. The consultant also advised me to take the screw and plate from the break two years ago out – he said they don’t serve any purpose and so they booked me in to get those removed in Oct/Nov.

I saw a physio briefly yesterday at the clinic but I had to go back and see her earlier today in the physio department. She measure the degree of dorsi-flex (when I pull my toe towards me). Its 90 degrees on my bad foot and 84 degrees on my good foot. The initial aim is not to stretch the tendon any more as it needs to strengthen first. We will work on evening the stretch after the 12 week stage. She gave me 3 strengthening exercises; rubber band dorsi-flex; rubber band plantar-flex and then a supported heal raise). She also showed me how to massage my calf and try to loosen up the tension in that.

My aim over the next couple of weeks is to try do the physio exercises 3 or 4 times a day and also to focus on my walking gait and try to get walking without a limp. 

Calves at 5 weeks - I was expecting my right calf
to be much smaller 

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)