Ruptured Achilles Tendon - Physical Therapy Day 1

First Day of Physical Therapy!

The Therapist, Aaron, did a 20 min evaluation on Kevin. Kevin has really flat feet, so he wants to work on the Tibialis Posterior muscle, to help give more support to the arch, and pretty much all his leg and hip muscles. The stronger his leg muscles are, the less his Calves will need to do the work = less work for the Achilles.

1 bad thing is that since Kevin wasn't wearing his boot (and immobilizing the heel) his heel is a little "over stretched". so the therapist will need to correct it. Oops.

Session 1:
Stretch the calf with foam roller
2x10 windshield wipers

• in a seated position with knees @ 90 degrees, swipe the feet left to right, keeping the leg stabilized and the ball of the foot and heel touching the ground. 

Foot Movements with the band for resistance. 

2x10 - Point/roll foot inwards

2x10 - Point/roll foot outwards

2x10 - Dorsiflexion (point toes toward nose)

2x10 - Plantarflexsion (point toes toward ground)

2x30seconds Balance on 1 leg

2x10 - Clam shells 

• laying on your side, with your hips aligned, bend knees to 90 degrees. Turn top knee towards to ceiling, so your legs look like an open clam. 

2x10 - leg lifts

• laying on your side with your hips aligned and legs straight, lift top leg up to the ceiling. 

Stop the Itch - Method 2

Continuing from the prior post: Stop the Itch

I tried another method on the list. Now Baking soda did work pretty well to stop the itch, but it wasn't reducing the inflammation. So I wanted to try aspirin which should reduce inflammation.

1: using non coated aspirin (the ones that look like white disks) add drops of water to dissolve it into a paste.
2: cover the bite
3: I used athletic tape to hold it in place, you can use gauze or band aids or something.

This worked well to stop the itch. I went to bed with this one and it hasn't fallen off. Its been about 12 hours with this on, and no itch. :) I actually think I get itchy from the tape rather than the bites themselves.
I'm sure band aids would probably be better, but I don't have those big band-aids in my house and athletic tape was much cheaper :)

UPDATE:
After wearing the aspirin for almost a day, I removed the bandage and aspirin after a workout and didn't have time to reapply. After running some errands, 3+ hours later the area still has NO itch.
it could be the poison has finished the worse of its course, but I think the aspirin really helped.

Stop the Itch - Method 1

Lately, my friends and I have been tackling ~10 mile hikes each weekend.
However, as we get into the belly of summer weather.. the bugs have come out to feast.

Next time I'll be prepared with Deet, but on my last hike I unfortunately got 5 bites. Thankfully I was wearing longer capris, so only my calves and ankles got bite.

I havent gotten bit this many times in a looong time.. I forgot how itchy these suckers are.
I tried several different anti itch creams, that did nothing.. They'd work for a VERY short while, and the itch would come back. So I Googled..

I came across this site and "How to Stop Mosquito Bites from Itching":
 http://www.wikihow.com/Stop-Mosquito-Bites-from-Itching

I Love home remedies and this site offers alot of them.

So I tried the "Baking Soda Method" (I have lots of baking soda around the house)

1: add a little bit of water & baking soda to make a paste.
2: Cover the area with the paste.

Instantly, the itch and burning stopped. And the relief lasted a long time, (as long as the baking soda stays on your skin) As the baking soda dries, it will slowly start to fall off or rub off.

After having all the baking soda fall off, I used Athletic tape to hold it in place, That way you can wear clothes or go to sleep without it rubbing off.

Ruptured Achilles Tendon - Day 95 Post Op Day 83

Now the Days are coming close to the double digits which makes it a little hard to calculate.. So weeks are a little easier to grasp.

Weeks since :
Injury - 14
Operation - 12

So since the operation, Kevin was in a cast for 6 week and a walking boot for 6 weeks.
and Now finally he has a Physical Therapy Prescription!
Normally it shouldn't take so long to get a PT prescription, but Dr Smith wanted to be more conservative and let the tendon heal longer to avoid re-rupture, or over stretching. 

Kevin only wore the walking boot religiously for the first 2 days. Then he wore it on and off, and gradually more off than on. Pretty much by the 2nd week, he was hardly ever wearing the walking boot. He felt to no pain, and it seemed better for him to actually get some movement in his leg sooner rather than later.

Since Kevin got his boot, we were researching nearby PT facilities. Luckily we have the option of picking with a PPO.

We interviewed 2 offices, where all the therapists had a DPT from USC. Since Kevin has been walking pretty well without his boot for the last 4 weeks, when we walked into the PT office, the PT actually didn't even know what was wrong with him. I feel that's a good sign, that his PT will go faster and smoother than anticipated.

Office #1 only had 1 therapist. It was closer, about a 5 min drive, but a smaller facility. When we walked in around 2pm, the sign in sheet was already 3/4 full, which shows he must be good, and very busy. Also he is open Monday - Saturday. The Saturday option is appealing in case we get busy during the work week.

Office #2 had a group of therapists, about 5 or more. It was a bit farther, about a 15 min drive, but still pretty close by to us. The facility was much larger, with lots of fancy new equipment. The downside of this facility is that since there are so many therapists, and so many different clients, it will get busy or crowded during peak hours. Also, even though the office is open Mon - Fri, the main therapists are only there M, W, F, which puts a damper if you have a busy schedule.

We ended up picking office #2. Kevin has a tendency to dislike certain qualities of trainers, having the option to change, was appealing to him.  Since there are different therapists there, Kevin would have the option of changing therapist.  Whereas office #1, he would be stuck with the same guy through the whole process.

His first evaluation will be on Monday. Excited to see his first session.

Ruptured Achilles Tendon - Day 53, Post Op Day 41

Good Bye Cast!!

Its been about 8 weeks since "the incident" and 6 weeks since the surgery. Today Kevin gets to lose the cast, and get his walking boot. Very excited to no longer need crutches.

BYE CAST!!

Leg Atrophy. 

Hello Walking Boot!!

fyi - its the same one that Kobe is wearing, so Kevin feels really cool. hahah 

There's a knob where you can inflate and deflate the boot. The silver bump is where you can "pump" up the boot. (just like those old pump basketball shoes) 

And after 8 weeks .. Kevin is WALKING!!! 

YAY!!!!!

Showering at the Gym.. one of life's great lessons

For years I wouldn't dare enter the gym showers with all the rumors of disease and bacteria. I was always one of those people who took really long showers like 20+ mins and always over packed. It would take me an average of 1 to 1.5 hours to get ready. I was never able to understand how a person could take a 2-5 min shower and get ready in 10 mins or less. Even when I tried to be quick, it never worked out.
 As odd as it sounds, I'm really glad I started showering at the gym.

I overcame my fear of the gym showers when I started swimming at they gym pool, (you really can't skip the showering part). After a week or so, I learned how to take a fast shower, because you  never know when someone is gonna "not know you're there" and open your shower door. And because its just too cumbersome to carry all the bathroom/makeup amenities, I learned how to bring just the necessities to the gym and find products with multiple uses, (ex. 3 in 1 shampoo, conditioner, and soap). Also getting ready at the gym, you need to be quick, else you'll get the death stare from other girl waiting for the mirror space.  (I'm also guilty of giving the stink eye to ladies who take up the whole counter and not just a spot.)

Its been years since I've spent a long time in the bathroom getting ready and I feel really proud of myself, as silly as it sounds.

Running in a Skirt?

While on my run today, I saw a girl running in a knee length pencil skirt, which a small slit in the back. Not one of those tennis or running skirts, an actual pencil skirt you could wear to church or work.

My immediate thought was, "huh, she must be new to this?"
Then I thought, "Maybe shes grabbing a quick jog during her break and didn't have time to change?" But in this heat, it'll be hard to get back to work not drenched in sweat..

As I watched her, I could tell she wasn't a rookie, which made me think more.. "could this probably be a new training method?"

With her minimalist running shoes, the pencil skirt forces her to shorten her gait and forcing her to have a forefoot strike. Genius!

I don't know if that was her actual purpose or she just wanted a quick jog before lunch.. but it was interesting to contemplate her motives and keep my mind occupied during mile 4.

I'm not sure if I'm ready to try it yet.. but its definitely something to think about.

First event for 2012

I know I said I wasn't going to race this year, but this is a new race from Nike (my beloved) and I just couldn't resist. Also its a 10k so I don't really have to worry about training for it. Its 80's themed so it'll be fun seeing bright neon colors and big hair. I wanted to dress up, but ended up not having enough time to plan an outfit.


Nike - She Runs LA 10K 


There's not much info online about it..except for a facebook page about it. https://www.facebook.com/NikeRunningLA/app_310399559009262

Some basic info


EVENT INFO

WHERE IS THIS RACE?
The race will begin and end at Paramount Studios, with an iconic out and back course along LA’s famed Melrose Ave.

PARAMOUNT STUDIOS
5555 Melrose Ave.
Los Angeles, CA 90038

WHAT TIME DOES THE RACE START?
The race starts at 10:00AM. Paramount gates will open at 8:00AM and runners are encouraged to carpool and arrive early.

Ruptured Achilles Tendon - Day 39 Post Op Day 27

Its been 6 weeks since the "incident" and about 4 weeks since Surgery. 

We got some 'good' news. The Doctor was aiming for 8 weeks in a cast, but we may be able to cut it down to 6 weeks (so 2 more weeks of a cast). Kevin was able to move a his foot from a 40 degree angle to  about 80-85 degrees right now. Originally, the doctor thought Kevin would only be able to move it to 60 degrees, but with his progress, hopefully in 2 weeks Kevin can go into a Boot and start weight bearing. 

I didn't think his leg would atrophy so much in just 6 weeks, but it did. His left leg is probably about 20-30% thinner now. 

I wasn't able to get a good shot because I didn't want to disrupt Dr. Smith working.  Also Dr. Smith has been really nice letting me get lots of photos in, and pausing so I can take photos. He must think I am one of those a crazy tourist that photograph everything.

Kevin looking happy to get a new cast.

Dr. Smith and The Saw that is going to cut off the cast. As creepy as it looks and sounds, it was actually safe to touch the moving blade. 

The Wound is healing well. 

Leg comparison. I wasn't able to get the legs side by side, next time. I'm sure in 2 weeks it will shrink even more. You can see how beefy his right leg is, and how smooth and delicate the left one looks. hehe 

Kevin's foot is placed on a contraption that allows him to bend his foot so Dr. Smith can recast him in that position. 

Almost at 90 degrees :) 

Recasted. 

We also asked Dr. Smith to lower the cast, so its not so high up on his calf to make things a little more comfortable. 

The Skin on Kevin's leg that was covered by the cast was by far the Grossest part for me! 

I don't mind looking at the wound, or pus, etc, but 6 weeks of skin not being able to shed by itself, left for Nasty-Flakey-Fish Scale looking skin. Thinking about it makes me want to vomit profusely. I made Kevin scrub the skin off. Begrudgingly, he did to stop me from shrieking and scaring the dog. lol. and NO I don't have a photo of the skin. 

Cast comparison

Ruptured Achilles Tendon - Day 26 - Post Op Day 16

Walking in crutches isn't easy, so Kevin asked Dr. Smith to prescribe him a knee walker. Its looks like a scooter where you rest your knee on.

However, Aetna wouldn't cover it if you are capable of using crutches. Incapable would mean you only have 1 arm and can't use crutches.
Stupid Aetna.

Luckily, you can RENT these things by the month. Kevin found a knee walker for $75/month. Its a good investment, and now Kevin can help me walk the dog :-D

Ruptured Achilles Tendon - Day 24, Post Op Day 12

Staple Removal Day!!

Today Kevin gets his staples removed and getting rid of the splint. It was uncomfortable, loose, and didn't offer much support on the sides. Kevin was very uncomfortable in the splint.
I'm surprised he was in a splint for so long, and not a hard cast right away.

We were hoping for good news, but due to the degree of "shredding" of his Tendon, he has to be in the hard cast longer than normal. Kinda Sucks.  Dr. Smith thinks he'll have to be in a hard cast for at least 6 weeks.
Right now, Kevin will be in a plantar flexion position (about a +30-45 degree angle) for 2 weeks. Then the following 2 weeks he'll slowly move the foot toward neutral position, probably 60 degrees. Then the next 2 weeks into a neutral at 90 degrees. Then Kevin will be able to wear a walking boot and be able to start weight bearing. After, another few weeks in the boot, Kevin will be able to start Physical Therapy.

I was hoping he could start earlier, so thus be closer to walking again. The longer PT gets pushed out, the longer it will be to regain movement. :(

I've studied other Achilles ruptures, and those patients were able to begin PT around 4 weeks after surgery, or as soon as the cast came off, but Kevin probably wont be able to start PT til 8-10 weeks after surgery. :(

Good bye splint!

Ew Staples..

Ew Removing Staples

Removing Staples

Bye Staples

Lots of swelling

Hello Hard Cast.

Ruptured Achilles Tendon - Day 16 - Post Op Day 4

Today was the first Post Op follow-up at Dr. Smiths.

He took off the splint to see if the wound was healing well and to check for infection. So far the wound looks good and he will be able to take off the staples in 9 days. 

Dr. Smith said most Achilles Tendon Ruptures will have a full distinct tear where he would sew the 2 ends together, but Kevin's tendon was "very" shredded so he had to sew it a different way, encircling and gathering the frayed tendon ends together to bunch it back up. Ew.. no wonder the tendon tore.. I can only image what the right leg looks like.. I fear its in a similar condition, and if so, preventative measures should be taken, asap. 

~12 cm incision. 

Swollen

Staples

Staples

Ruptured Achilles Tendon - Day 13 - Surgery Day

Surgery Day!

Instructions prior to surgery:
Fasting starting Thursday @ midnight, or Friday @ 12:00am, no food or water.
Also to not wear contact lenses during the surgery, in case the lenses dry out and scratch the eyes.

We were instructed to arrive at the surgery center at 1030am, 1 hour prior to surgery to fill out paper work. Paper work took about 10 seconds. Kevin was finally called in to change around noon. The nurses asked him what he was allergic to, and set up the IV.  A little after 12:30, the doctor was ready, and Kevin was rolled away into the surgery room.
I left and the nurses said they would call me 20-30 mins prior to when Kevin was ready to be picked up.

While we were in the waiting room we joked at what Kevin was going to eat and stuff ourselves with afterwards because the fasting had him hungry and thirsty.

Kevin said he woke up around 2:45 from the anesthesia. But he was just very tired and uncomfortable. He had an appetite, but he wanted to lay down and rest more than eat.

His leg is wrapped up in a splint instead of a full cast. I wonder if that is better?

Photos:

In the waiting room

Initialing the leg by Kevin and his Doctor to make sure they operate on the correct leg.

Grump Kevin afterwards.

Ruptured Achilles Tendon - Day 11

2 more days until surgery (Friday). Its a love/hate situation because the sooner you get surgery, the sooner you can start healing. But the sooner you get surgery, the sooner things are gonna SUCK even more. At least now, before surgery, Kevin still has some mobility and tolerable pain, but after surgery, it will be no mobility and lots of pain.

I was hoping he would have had surgery within a week of the incident, but with the doctor we went with, and all the hassel we had to go through with the insurance company, it seemed better to stick with the original doctor, since they were there from the beginning. Aetna, the insurance company, really wants to make sure that you are as injured as the doctor and hospital say you are. (idiots)

Yesterday Kevin got his blood work done. The doctor said they need to do a red blood cell count 3 days before they can do surgery to make sure he wont bleed to death, etc.

Today Kevin said this is the most pain he's felt since the beginning. Its a dull achy feeling along the tendon and up the leg. I suspect the pain is from the swelling, and atrophy of the muscles.

The best we can do is elevated and ice it. 2 more days..

Rupture Achilles Tendon - Day 9

Today was Kevin's followup with Dr. Smith, the orthopedic surgeon, to evaluate the MRI results.

Dr. Smith confirmed that the tendon had a 4 cm tear. EW!

Surgery is schedule for Friday. In the meantime, Kevin needs to have a physical with blood work to confirm he is healthy enough for surgery.

The surgery should last 1.5 hours and the doctor will make an 8cm incision. Afterwards, Kevin should be in a cast for 3 weeks, and a boot for and additional 3 weeks. After that Dr. Smith will check on Kevin's progress to see if he can start physical therapy. If things go well, Kevin may even be able to start physical therapy sooner, but Dr. Smith thinks its best to wait about 6 weeks after the surgery to start PT.

So far his leg is pretty much the same as it has been for the past few days. It does get pretty swollen when it is not elevated. The most pain he feels is when he has to stand up and all the blood rushes down to his foot. But overall, he says it just feels uncomfortable.

Ruptured Achilles Tendon - Day 4

Today we were able to pick up the CD with the MRI images.
I don't know how to really "read" them (yet), but these were the images that I thought showed some pretty gnarly stuff.

Kevin still wanted to cook dinner, but standing in the kitchen really causes his foot to swell a lot..
But on the brighter side, the skirt steak he cooked tasted really, really good. hehe

Right foot - unaffected foot, notice the distinct curvature from the malleolus (the boney part that sticks out on the ankle) to his foot.

Left foot: Notice there is No curvature on this foot from the swelling.

MRI images:
Now I don't know exactly what I'm looking at, but these seemed pretty gnarly.
I call this the "curly pig tail!"

I call this the "dark abyss" 

I call this the "crackers"

Ruptured Achilles Tendon - Day 3

Good News: 1 day later - Aetna approved the MRI (like they should)
Bad News: the MRI company gave away our Wednesday morning time spot to someone else, so we were able to get an appointment Wednesday at 430p. However, that means Kevin would have to drive himself to the appointment.
He's able to drive, since it was his left Achilles that ruptured, but it is pretty cumbersome for him to get around.

He was standing longer than he should and the blood started to pool at the foot. When he took off his splint the foot was pretty swollen and bruised.

Later that night he slept with his foot elevated which helped reduce the swelling.

Bruising on both sides of the foot :(

Ruptured Achilles Tendon - Day 2

So first thing Monday morning, I called and we were able to get an appointment Monday afternoon with the orthopedic surgeon. Terrific :)

Dr. Smith performed a few special tests and felt that it is a full tear, but he wanted an MRI to confirm. However my PPO Aetna insurance company was being very difficult. It was seriously a 2+ hour ordeal just to schedule an MRI.
(I have had an MRI before under my other insurance, United Health Care, and it was so easy to obtain an MRI the same or next day. Not Aetna)
The MRI office wanted an approval code from our doctor, which the doctor would need to obtain from Aetna,. However, Aetna needed a procedure code from the MRI company to give the approval code. But the MRI company wouldn't give the code without the doctor's tax ID number. But the doctor didn't know his tax ID number, because he works for the hospital. So, the doctor had to call the very unresponsive hospital admin to give the tax-id number. FINALLY, everyone had all the #'s they needed. Then Aetna had to ask a billion questions to the doctor, "Whats his range of motion? Is this a prior injury? etc" Finally, they said it would take 1-2 days to give the approval for an MRI.
WHAT?!
Honestly, the doctor says it needs surgery, and you (the insurance company) need to approve an MRI? WTF?

Kevin said he felt the pain was more manageable. At least it wasn't getting worse. He doesn't use his crutches much around the house and doesn't elevate his leg as much as he should.

Ruptured Achilles Tendon - The Beginning.

One of my greatest fears, a ruptured Achilles tendon, has hit close to home. 

On Sunday, Feb 26, 2012 my boyfriend, Kevin, ruptured his Achilles tendon while playing basketball. As with most other ruptured Achilles, it comes without warning to most "weekend warriors". As he began to take a step, it felt like someone kicked him in the leg. He turned around and saw that no one was behind him, so he began to continue forward, it was at that moment, he felt the dreaded "pop".

He hopped off court, put an ankle brace on and elevated his foot. 

When he got home, he told me what he did, and as a person studying physical therapy, I ran some special tests on him and the results didn't look good. Looking at the leg, it was swollen with a visible depression where the tendon should be. The Thompson test showed that his foot didn't move. He was unable to perform toe raises or any type of weight bearing, which again showed positive for a ruptured Achilles. 

Since it was Sunday, and my orthopedic wasn't open, I wasn't sure where to take him. I called Urgent care and they said my b/f would need to go to the Hospital. 

So we headed to the nearest hospital around noon, and we didn't leave the hospital until after 5pm. It was a long visit. The doctor thought it was a partial tear and not a full tear because Kevin was able to put his foot into plantar flexion, (pointing down), but he was reluctant to say for sure. So he said we had to call the orthopedic surgeon on Monday and schedule an appointment. He wrapped up Kevin's left leg in a splint, and sent us home. 

Since Kevin is allergic to acetaminophen, its limited to what type of pain meds he can take, so he opted to not take any. He said the pain wasn't too bad to just tough if out.

Right leg - Unaffected leg
See the nice curvature of the Achilles tendon

Left Leg - Ruptured Achilles

So when's your next event?

Often I get asked this question, either by friends or family, someone at the gym, or another runner on the road. And I reply, "none, I train for nothing, I just like doing this".

 At the end of 2011, I decided to not do any events in 2012, and spend the year training on my weaknesses to get faster and stronger.
 During 2011, I had a lot of events lined up, and with a busy work and school schedule, I gave up quality for quantity. Given about 3 days a week to train with only maybe 1 or 2 hours at most to spare, I focused getting in my miles, and not even thinking about my times. If I'm going to do a half ironman, I'd rather finish the whole race instead of worry about my times.

 So, this year, my main focus is to shed 7% body fat so I can be lighter and faster. And in the process, get stronger arms and back muscles so I can be a better swimmer, and stronger hips and hamstrings so I run and bike faster. I still train and workout almost everyday. I love not stressing over getting in my miles, and just focus on my core of my legs.

I don't need to have the deadline of an event looming over me to "motivate" me, it actually stresses me out more. I love working out and training just because. If I wasn't doing that, I don't know what I would do. 

But...if given the opportunity, and if I feel I can perform decently, there are only 2 events in 2012 that I would want to do.
1- Nike women's full marathon in sf around Sept
2- Barb's race 70.3 half ironman around June to July (highly unlikely that this will happen.. Maybe 2013)

Happy trainings!