Tuesday, 14 April 2009

Permission- are you sure you want to sign it?

I agreed to go for the surgery, after I discussed the options with my partner. Not that you have much time before you have to give an answer. You sit there face the facts and here you are say what you would like. And what’s happening if I choose the surgery? He came with a paper, quickly recited the words and left me there.
“Consent Form – Patient Agreement to Investigation or Treatment “
Risk factor: infection, bleeding, nerve damage, stiffing, failed procedure, cast
complications…and I couldn’t read the rest . The funny thing is that you actually have to sign this paper before you are going to be treated. Which really looks, that if anything will go wrong, that’s not their fault. The “Responsible Health professional”s name was also included in the form - I actually never met him. TheStatement of patient” – I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience. – I’m not even sure what this means. “Appropriate experience” – this doesn’t sound something I would trust.
But in that situation you don’t really think. Your rational mind will switch off and you will go ahead with something your instincts suggest. What would happen if you weren’t overwhelmed with all those scary feelings and you would start to ponder? Would you really go for something were is actually no guarantee for anything. Well the Health business is a risky business but it’s all built on our vulnerable nature. We hope the best so doesn’t matter if there is only 1% warranty for a successful treatment, we would still risk our life. How should I trust the medic when I don’t even know who it is? Or the anaesthetist? I could fall asleep and I might never wake up. And the best there is no guarantee and I have to sign it.

Another question came up, something else to settle. Am I going to stay in the hospital until the surgery or I would like to go home and be called in when they are ready for me? I hate hospitals, so I would prefer to go home. The thought of being with strangers together in a crowded room, listening to their yelling would make me feel even worse. But on the other hand if you “occupy” a place in the ward, that would mean your are going to be one of the top priorities. The hospital can’t afford to keep patience for long, due to the huge “traffic” and the lack of the beds.

Anyway Dr Patel got my autograph and we agreed that I will go home and someone will call me when there will be place available in the “Theatre” as they call the operation room. He informed me that the waiting list is long; however he will try to push my case forward. Not that this makes any difference for me, but why should I care? I mean obviously a child, someone old or very ill would have top priority, but in this case you are able to see just your own piteous state. I wasn’t even sure when this person will call me, what should I prepare… You actually don’t receive the relevant information’s at once, you get some here and there and when you are clever enough to ask questions.

Finally we got to that point when a porter took me to the plaster room and I got a pink one. The guy tried to cheer me up with this girly colour. He also said that I have to count with at least 12 weeks in plaster. Whhhhhhaaaaaaaatttt? The doctor told me this can be 4 to 6 weeks if I undergo the surgery.
I didn’t even get the chance to complain, because the nurse placed me outside the room for another porter to take me back to the emergency room. I had to wait another half an hour for someone to get me. How I’m going to manage to work like this for 12 weeks? I wasn’t even sure that I can bear all the hassle for 6 weeks. Of course at that time I didn’t know that I won’t be able to work in this state. After a good while a nurse arrived, took me back to the A&E and I received my first crutches. And off you go!!!!!

Well, well, well….here I am fighting with those sticks. I thought it will be easy to get to the bus station which was two minutes away from the hospital entrance. Who will wait another half an hour for a cap, by the time the cab will be available I will be at home. I thought so…..until I started my tiring and long journey to the bus stop. The rain, my big winter coat, my bag, my weight were like constant obstacles. I had to stop every 10 meter. Why looks so easy if some one else does it? It was horrible, I thought I will never make it, and there was no help available. It felt like a big pain all over my entire body. I had to look really bad, struggling with myself and the world when a small car stopped next to me. The couple offered to take me home. Huge thanks for them, God bless them.

Monday, 6 April 2009

The specialist kindly informed me about the coming period and the options I can choose from. He explained everything nicely, but still remained my panic. He tried to make me believe that if I will decide to go for the surgery my time in the plaster can be reduced to 4 weeks. That was actually a lie, although that time I was happy to hear this.

There are two ways to correct this failure: surgical and a non surgical treatment. He explained both, not particularly going into details. At least I had a dim idea about what will happen. He also offered me to answer my questions, however since than I realized that this is also more like a kind offer than something what he honestly meant. Somewhat this is a standard attitude from the doctors (more about that later)

Surgery as a drastic intervention

Surgery is usually recommended for competitive athletes, younger people or those with a high level of physical activity
. There are two different types of operation you can choose from.

  • The open surgery is the standard procedure; there is a longer vertical cut on the back of the heel to reach the tendon to stitch it together.


  • Another method the percutaneous surgery mainly used in private healthcare. In this case there will be a smaller cut to reach the damaged tendon.

After the surgery you will have a series of casts or an adjustable brace on your leg to help the Achilles tendon heal and to restore normal length and tension to the tendon and allow you to do what you could do before the injury. Most of the research so far found that surgery has one advantage: it reduces the risk that the Achilles tendon will rupture again. The disadvantages of surgery are the risk of complications such as wound infection, deep vein thrombosis, blood clot in the lung known as pulmonary embolism, a reaction to the anaesthetic or the antibiotics. There may be a lower risk if you have percutaneous surgery, because it reduces the risk of getting a wound infection.

Natural Healing can be a less complicated option

In this case there is no risk of infection, whichever can occur during the other process, and so it's suitable for people who may not want to jump in the unknown. But, there are a number of problems with the natural healing process left to itself. One, it takes a very long time. Inflammation goes down very slow and secondly the risk of re-rupture is higher. The Non-surgical treatment, in which case a cast or brace is used to help keep the tendon aligned so that it can heal itself, is not always the best decision. This so called 'conservative treatment’ can help the Achilles tendon because while your foot is pointing slightly downwards, which takes the strain off the tendon it will make it shorter so that it can knit together and heal. Conservative treatment may be suggested for older or less active patients, and for people wishing to avoid
In a nut shell, the body, if left to just rest, will heal itself as best it can, but if the tendon does not heal on its own, a surgical repair will be definitely advisable. Some sources state that as longer the waiting time is the bigger the risk that the tendon will get shorter and shorter.

The days before the surgery

Whipping silently on the examination bed. Couldn’t think on anything else, but the job and how I’m going to be able to do any sport. I was just about to sign up for another dance class, but taking everything into account I was sure this will not happen in the short future. I’m not a professional dancer, although it does mean a lot to me, plus the running and anything else where I would use my legs. I’m not a computer freak. So…

I never really had the chance to lead an active sport life. At the age of 5 I was so flexible that I got the opportunity to develop my skills. However my mum was afraid that I will get hurt, or I will loose my childhood and it all stopped before it even get started. All in all until a certain age I didn’t know what it means to enjoy a “free” life. No particular sport classes, no groups, except my fathers pushing attitude to go jogging. I hated it, and this got worse in the high school were the teacher decided to bring up athletes, because she enjoyed her time in New York in the Central Park.

Running from the devil or on the way to the heaven?

What the hell is so enjoyable when you got sweaty, out of breath, tired and your heart is pumping in your head? How can anyone feel a desire to do this willingly? One of my experiences: gym class at school and we had to run 2 km in 10 min. I knew at the beginning that in order to get the second lowest result I will have to push my self real hard. Obviously you can’t deny doing it, so I got going. After few meters when it started to be very inconvenient I just stopped.
The Professor got mental and she put me to start it all over again. When I finished I felt dizzy, my blood pressure was up in the sky, all kind of colours flicked in front of my eyes and I couldn’t move for at least ten minutes. Nice. Just what I’ve needed. After this exceptional experience even the thought of moving fast made me sick. Many years later for some absurd reason I tried again starting in a short circles around my flat. The first few occasions were disastrous, but strangely enough I kept going. I realized that there is something in this continuous moving. You put on your shoes and you start to feel the rhythm. The road and you are one. No thoughts, no doubts, no target, no aim just you and the air around you. I actually start to enjoy it, get a kind of addicted to it. It didn’t matter how tired I was when I got home, the only thing what counted was to get out on the road. I loved that. It was dark ,not many people around me, so that I could switch of. I never saw this coming, but the same was true for this injury, which at the moment is cutting me of from the road.

The orthopaedic doctor finally arrived. He at least was much better looking, young and much more friendly. He was my last chance. But will his diagnosis over right the previous statements? He examined me , asked me the same questions, squeezed that sour part on my leg and … And nothing changed.

Friday, 3 April 2009

Monday, 9th of March changed my life.

  • A sudden and severe pain may be felt at the back of the ankle or calf—often described as "being hit by a rock or shot."- My sensation was that someone hit me with a bar
  • no pain, but there will be a loud popping sound
  • Initial pain, swelling, and stiffness may be followed by bruising and weakness.
  • A 'flat footed' type of walk. You can walk and bear weight, but can not push of the ground properly on the side where the tendon is ruptured.

These symptoms mean something for a person who knows what to look for. I suppose my case was quite straight forward, except for me. I was sure that the girl next to me stepped on my ankle. I was convinced that one of us moved in the wrong direction and this caused the accident. Poor girl, she looked confused, now I understand why.

The next day early in the morning I visited the Emergency not far from my home. I got on the bus and walked into the hospital. I was still smiling and not worried at all. After like 20 minutes there was finally a doctor who was willing to see me. Not polite at all. He didn’t even introduce himself. No kindness in his eyes and not even the slightest sympathy. But it didn’t bother me, until…

How is an Achilles tendon rupture diagnosed?

  • The doctor who examines you will ask about the symptoms and about the activity when the injury happened.
  • You may have to stand or walk on your tiptoes
  • An ultrasound scan, which uses high frequency sound waves to produce an image of the Achilles tendon to look for any damage
    an MRI (magnetic resonance imaging) scan, which uses magnets and radio waves to produce two- and three-dimensional pictures of the leg that can help your doctor see if there is damage to the Achilles tendon
  • 'Thompson's test' (also known as the 'calf squeeze test'). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called 'plantar flexion'). This is quite an accurate test for Achilles tendon rupture.
  • With the Simmonds calf squeeze test (also known as Thompson test) the doctor can identify the gap if the tendon is completely torn

…until he spit it out: “Achilles tendon rupture, needs an operation and 6 weeks in plaster.”

As I said earlier my case was more than obvious. I wasn’t able to walk properly, my leg was swollen and the squeezing test clarified everything. First I was sitting there socked, than I explained this can’t be, because someone stepped on my leg.

To be certain, he called one of his colleagues to examine me, but this didn’t changed the fact. They sent me to the X-ray room. I assume they made sure that there are no broken bones.

I’m not a baby, but I was crying. It took me by surprise and I felt devastated. I couldn’t believe that this is happening. What’s going on now? How? When? Plenty of questions. Operation ? I never had a serious injury! I didn’t know what to expect. I was still hoping that this is a nightmare and someone will inform me about the wrong conclusion and I can go home. The whole world crashed and went down the drain, while I was sitting on the examination bench waiting for the orthopaedic surgeon.

Thursday, 2 April 2009

The Beginning

Did you ever had a serious injury? Did an accident make you temporarily disabled? Did you ever had to take a long time off from work? Did you had to depend on others?
Well an Achilles tendon rupture is certainly one of does injuries which will immobilise you for at least two months and you will need someone’s help to deal with your everyday life.

Until few weeks ago I wasn’t even sure what exactly the Achilles tendon is, and I wasn’t aware that it can actually tear apart. I had some slight memories about a Greek called Achilles, but nothing worthwhile. I searched for it and I found a quite interesting definition on the Wikipedia site:

“The tendon passes behind the ankle. It is the thickest and strongest tendon in the body. It is about 15 cm long, and begins near the middle of the calf muscle. It serves to attach the gastrocnemius (calf) and soleus muscles to the heel bone. The soleus is a powerful muscle in the back part of the lower leg. It runs from just below the knee to the heel, and is involved in standing and walking.”

Oauuu! What’s this all about? To be honest I had no idea. If you have a closer look to the downloaded photo it will explain everything. And why Achilles tendon? That’s also an impressing story :)

“The name Achilles' heel comes from Greek mythology. Achilles' mother, the goddess Thetis, received a prophecy of her son's death. In order to protect him, she dipped him into the River Styx, which protected his entire body from harm. However, in order to dip him into the river, she needed to grab onto his heel. During the Trojan War, Achilles was struck on his unprotected heel by a poisoned arrow, which killed him.”


It was a gloomy Monday. I finished my work in the office as usual and I was heading for my dance class. To be honest after Saturday I wasn’t sure that I really would like to do further exercises, but I’m a stubborn person :) And on the other hand I really love dancing. I think this was the driving force on the weekend, which made me book 6 dance classes in a row. Actually it was seven, but I skipped the last one. My feet were soar and I literally dragged myself home and fall into the bed.

But hey ho two days later this didn't matter at all and I found myself again on the dance floor with my fellow colleagues. Jumping, turning, more and more….and just when I started to enjoy it the most I felt something very strange. Like someone hit me with a metal bar. First I thought that I stepped too far behind and accidentally came up against something. I turned around to check when a sudden pain hit me in the head. I fall down and than I was already sure that someone stepped on my heel. One of the guys brought me some ice and I started to feel better. I was ready to go home on my own; however I had to realize that this won’t be as easy as I thought.

The teacher gave me a lift, I hardly can thank him for this. My partner started to get worried. I was calm and didn’t really care, I was certain it will get better in few days and I will be back on the “stage” by Wednesday. Although he convinced me to visit the closest Emergency department. That's were my nightmare started.
more to follow