Achilles surgery

I damaged my Achilles tendons some years ago, and they have been limiting my activities since. For example, I can no longer cycle in the hills, only on the flatlands. And I need a rest day between bicycle commutes or after long hikes. The right leg causes most of the trouble, and finally it was time to do something about it.

Dr Saxena at Palo Alto medical foundation is a respected sports medicine specialist in this area. He says it’s a tight paratenon, the lining around the tendon, causing overuse pain something like a carpal tunnel, and by slitting the paratenon, the pressure can be relieved and the pain disappears. I think I will be off the trails for 4-6 weeks.

I checked into the PAMF surgecenter Friday afternoon. The waiting room has a good-sized aquarium with colorful tropical fish. I went over to have a look, and noticed tiny stalks from the rocks and gravel at the bottom. On closer inspection, I saw that they were animals, sea lillies, I think (crinoids). I bet nine people out of eight don’t notice them!

Friendly and helpful people, and I like their processes to make sure everything goes all right. For example, I was asked several times for my name, date of birth, and why I was there. Dr Saxena came in and marked the right ankle while I was awake and paying attention. I suppose it gets really awkward if they do a heart transplant on someone who came in for hangnail repair.

They have curtained-off areas for the prep work, changing clothes, final consultation, paperwork and such. As they wheeled me down the corridor on a gurney to the operating room, I was irresistably reminded of Calvin: “Wheee!”

Next thing I knew, I was talking with an orderly who offered me water (they don’t let you eat or drink, not even water, after midnight of the previous day). Good idea; I drank three glasses. Jacky was there to give me a ride home. I am wearing a boot that immobilizes the ankle. It has a rigid sole and comes almost up to the knee. They want me to leave it on until the post-op consultation Monday morning.

I have never used crutches before, and I’m clumsy with them. I suppose by about the time I begin to develop some level of proficiency, I won’t need them any more.

There are a couple of steps up to get into the house, so it’s an opportunity to figure out how to deal with steps. One at a time, that’s how. The habits of a lifetime make it hard to resist going for the next one in an alternating pattern: I find I have to stop, think about it, and plan the ascent, to make sure I do it properly. Possibly even more risky going down, where the same temptation is even stronger.

Obvious in retrospect, but somewhat unexpected: when my hands are occupied with crutches, I can’t carry anything. Jacky is very good about helping with things, and I strapped on my cycling belt pack, which allows me to more or carry around at least some of the things I need.

They want me to put an ice bag at the back of the knee from time to time. This is as close to the wound as I can get, with the boot on, and I guess it helps cool the blood a little bit, to help reduce swelling. I’m not convinced it really makes much difference, but I do it anyway.

I made it safely to the second floor at bedtime. Jacky put a fat pillow at the foot of the bed, and I elevated the booted foot onto the pillow for the night. I omitted all of the pain pills. Big mistake? No, not really. A little worse than the usual 20-mile hiking aftermath, but not all that bad. Not the best night’s sleep I ever had, but okay.

Saturday morning, and I made it down the stairs without falling. I can tell that my shoulders will be sore from the extra load, but it will be yet another day or so for the full effect to show up. Spent the day around the house, mostly, although I tried going for a walk in the afternoon. It was about half a block out, half a block back, enough.

By evening, I was ready to try some exercises, to see if I can keep the bad leg from losing too much strength and flexibility. I’m wiggling my toes in the boot, and waving the leg around in all directions, flexing the knee, and pretty much doing everything I can think of that does not require motion at the ankle joint. Better than nothing… I hope.

Saturday night was still awkward wearing the boot in bed, but there is very little pain at this point. That’s encouraging.

Sunday I tried a tub bath, foot up on a low stool that we put into the bathtub. Clumsy, also something I hope I won’t have to get used to. Then I adjusted the crutches for a better fit. We went out by car for breakfast, and they do seem to be an improvement.

Kudos to PAMF

After writing up the disastrous experiences of a friend at Stanford’s allegedly world-class medical center, it is a great pleasure to describe my own experience at Palo Alto medical foundation. I needed a 30,000 mile checkup, the sort of thing that involves a surgeon and anesthesia.

First, I stopped at the lab for a blood test (I passed), then I walked into the family practice group for a vaccination that was due. No problem. Off to the surgecenter, where I met several very nice people. Nice is nice, of course, but that’s not what impressed me most.

Three or four times I was asked (nicely) to confirm my name and date of birth, to help them make sure that I hadn’t been slotted into the wrong place. After changing into a nothing, I was offered reading material while I waited, but this checkup is no big deal: I told myself I had lucked out and gotten a flat bed on an international flight, and zonk! right out!

The surgeon apologized for waking me when he came in to chat, to make sure I was comfortable with what was going to happen. They wheeled me into the service bay, joking about my name (they thought it sounded like a movie title; I supplied the likelihood that it would be a midnight horror movie). Then they wanted me to state the purpose of my visit, again checking that everything was aligned. I told them that if they did heart surgery on me, that would be the wrong thing!

The anesthesia was said to leave me semi-conscious, but to remove all memory of the experience. The last thing I remember is the conscious decision to remember what was going on during the procedure. Next thing I recall is fragments of being walked out with Jacky to the car.

And in the morning, they called me to make sure there were no complications or questions.

Best practices, indeed. Good people to do business with, and as expected, the checkup says I’m good for at least another 30,000 miles.