This Boot is Made for Walkin'!

Back on September 8, when I first met Dr. Arcand, my surgeon, she said with a serious look on her face, "It will be three months before you can drive again...." waiting for my jaw to slowly close. She then spelled out the timeline after my surgery: "You will be non weight bearing for at least 4 if not 6 weeks. Then, if your healing looks good to me, I'll get you back in to the CAM boot and we'll start you on physical therapy."

Well, this past Wednesday marked six weeks since my surgery and, at my doctor's appointment that day, without much fanfare, Dr. Arcand said, "It looks good" and nodded me for to go ahead and put on the CAM boot I had brought along but had not stepped in to since our first office visit. The splint and ace bandage came off, revealing a truly grotesque foot (out of sight, out of mind, and totally gross). It was just covered with layers of dead, peeling skin, plus it looked like something out of a pirate movie: the last splint had been rather tightly applied and so my normal half leg (regular girth) was now nearly twice as big as the part of my calf and ankle that had been wrapped. I was told quickly that this should settle down in time, but eek, did it look nasty!

She gave me a prescription for physical therapy (which I can't get started on until November 6th because the guy I prefer to use, who is in private practice is booked up). She also told me a couple of pieces of good news for a change: I can do some partial weight bearing, such as a pivot from bed to chair and even so far as using one crutch on my affected side to take the weight off the right foot and moving around the house a little. The other big news is I can finally bathe like a normal person again....though I have yet to do this! I don't have a shower chair and my partner has been working overnight shifts all week, so I don't want to try anything too progressive without some help closeby, but be assured I will. My PT will be twice a week for six weeks and then, at our next appointment on December 9th, which is exactly 12 weeks after my surgery (meaning the all important three month mark), I should be cleared to drive and be totally weight bearing. Yahoo!

My partner, Lucy, in just the past few days, is already clucking about my overdoing it in terms of traipsing around the house on one crutch and even doing the stairs this way (albeit very slowly) but I'm letting my body tell me how fast/slow to go. I have always listened to it in the past when it comes to recovery and this time is no different. I have read many blogs by other post-surgical ATR patients who were partial weight bearing in 4 weeks and I have heeded the posts by some others who say, "at the first sign of pain or weirdness, STOP." So far, so good!

I've done well with my four hours a day working from home and my doctor is going to keep me on that schedule until we next meet. So, it does appear I won't be back in my office in any steady capacity until at least December 10th, something I know my supervisor will wish was a lot earlier. Still, I have to say I've accomplished a lot of work at home thus far: I have just about gotten caught up on the backlog of bereavement telephone calls that went undone in my absence, put in a proposal for a major conference next Spring, and am also setting up a very overdue Ethics Committee meeting that I am chair of. Not bad for a gimp with a limp, huh? Stay tuned for more fun and frolic as I attempt slalom downhill skiing....just kidding, NEVER gonna happen!

Working from Home...and the Walls are Closin' In!

Something that is not uncommon to hear a newly bereaved spouse or adult child tell me as a bereavement counselor is how they miss the very chaos that once drove them crazy. The constant phone calls, nursing visits, trips to the drug store,etc. All of it is exhausting when you are caring for a loved one and, of course on a different level, the same is true for those of us who do Hospice work. It is not for just anybody and yet, if it is for you, you really do go through a sort of withdrawal when you haven't done it for awhile...like me.

I began a slow return to work via putting in four hours a day on my home computer and telephone to make bereavement calls, sit in on meetings and document a number of things on my work computer through an amazing high tech option called "VPN" - don't ask me what it stands for, but it means you can access your work computer from your home computer and, get this, even print a work document to your work printer from home. Pretty cool stuff.I didn't realize how much I missed my own chaos until I took over four weeks off from it. I love my home, my cats, my computer station, my stack of books (still mostly unread) and even the Netflix videos I have coming in every other day...but it's not the same as having a consistent structure within which people need you, appreciate you calling, and your co-workers let you know unabashedly that they have missed you, your presence, even your warped humor.

I did my four hours rather effortlessly and had a lot of catching up to do on some things that had to be left for when I returned to work. In this past week, I spoke with some really sweet but hurting people who have lost loved ones and felt very relaxed and, here's the keyword, RESTED as I attended to them. Not only have I had this long hiatus, but I was also able to attend to people within the comfort of my own home. At the office, people are constantly popping in, the phone is almost always ringing and I am pretty much at the mercy of the pace of the working environment. Here at home, I have a list of calls to make, notes to enter into medical records, but it's extremely quiet...and, would you believe, it's kind of getting to me!

My partner has been working a lot away from home so I am having a lot more alone time than I am having time with friends and family. It's okay, but it's starting to wear on me a little. Lucy and I went out several nights ago to have a late night hamburger and I just reveled in actually being somewhere that had NOISE! Normally I abhor the sounds of plasma televisions in the background, but it was the night that the Phillies clinched another trip to the World Series, so it was kind of fun to eat some good food and occasionally glimpse over to see the score.

My four hours a day restriction is in effect through November 4th after which I may get the green light to go to five or six. But the reality still is that I can't drive until the three month mark which would be mid-December (unless I get an earlier clearance) so I think it will still be awhile before I grace my office and get back to a normal existence. Still, I'm just glad I have one foot back in the door and can truly appreciate the saying: You don't know what you've got till it's gone. In my situation, it's not "gone", but it sure has been missing in action!

Second Follow-Up with MD and other headlines

I hit the four week mark yesterday, October 14th, in my recovery from my surgery and actually have to confess it went by quicker than I thought. The first two weeks dragged a little because I had little company with me but then my sister visited, friends started dropping by regularly, and another friend from out of state also stayed a few days and made me feel well cared for. Before I knew it, I was actually having to carve out time to NOT be occupied with something or somebody, but I enjoyed it while it lasted.

Yesterday, I saw Dr. Arcand for my second follow-up and there were few surprises. She is quite pleased with my healing wound, no infection noted, nor has there been any pain or tingling like others have reported on their blogs. She had the splint and ace bandages removed and underneath it all was one nasty looking dry, shriveled up foot! I know it just needs some major treatment with Burts Bees lotion (which works wonders on dry skin if you have never tried it!) so I got over my attack of vanity pretty quickly.

She had another splint put on but this one just runs along the back of my calf to just past my toes and is held in place by one layering of ace bandage. This means it's very light, not bulky, and much easier to manage when I'm in bed. The plan is for me to see her again in two weeks at which time she will have me put the CAM boot back on for a trial run. This feels like positive progress to me (as if ANY progress could be negative, right?) so I felt pleased by the visit. She also felt I could take on 4 hours a day of working from home so I will start that on Monday, October 19th. As I crutched my way out of her office to the appointment desk, feeling pretty upbeat, I took a rather embarassing and unexpected semi-tumble but was caught by my partner, Lucy, before I could hit the ground. Lucy definitely seemed more startled than I did! A very nice office worker named Sue promptly got me into a wheelchair and carted me outside, waiting with me for Lucy to pull up the car which scored major points with me. I have encountered some really nice people during this process and Sue was one of them.

Today involved a number of calls between myself and my Human Resources worker who overloaded my brain by verbalizing all the necessary changes that are upcoming due to my going back to 20 hours per week. Of course, my worker's comp check will be duly reduced (and I got a certified letter delivered that drove that point home in black and white), and my sick time still needs to be used to pay for my medical insurance, 403b contribution, etc. I told her very quietly that "I'm really a visual person so could you send this to me in an e-mail??" She said sure, but continued outlining all the numbers and facts and figures while I silently tuned her out, trying to just stayed relaxed while she very intently rattled off all the details. I joked to a friend on the phone a little later, "Even Helen Keller's blood pressure would be spiked after a conversation like that!" Oh well.

All in all, I really can't complain too much about things. I've had a nice, extended rest, and have gotten very cozy with my cats. So much so that now Lucy complains "they like YOU better than they like me". I reasoned with her that she is welcome to tear out the largest muscle in her body, have surgery and SHE can sit with the animals to her heart's content! (She declined to accept this kind offer of mine.) If you can go through anything like this and maintain your sense of humor (I have), you can't help but feel you are coming out ahead!

At Last - Back in my own Bed

When this whole ordeal first began, three of my friends met me for dinner and started going down a check list of things I would need for my recovery period. Funny - I hadn't even "gone there" in my own mind. I was quite the denial queen thinking everything would just work out.

One friend insisted I get a "day bed" for my first floor since there would be no way I could do stairs, at least not for a while. I resisted this idea, thinking it will just make my home seem more like Shady Pines than a homey residence. My other friends agreed this would be a great idea because I can sleep on the first floor where everything else is located, including a bathroom. Well, the day bed has been my primary bed since the date of the surgery (9/16/09) with my faithful partner, Lucy, sleeping on the living room couch, right around the corner from me, in case I need anything. What I have needed was sleeping with her back upstairs in our nice queen bed with the flannel sheets, keeping each other warm!

Nearly four weeks later, with me feeling more and more confident about going out for short trips, navigating stairs a few at a time with my walker or crutches, and noticing that my once painful left arm/forearm is much stronger now, I realized I was ready to do the ole "going up the stairs on your butt" trick and coming down the same way. I had zero confidence about navigating stairs just a few weeks ago, in fact I went into brain freeze when I encountered that task, but now it just seems rudimentary to me. So, on Saturday night, for the first time in a while, I very easily went up the stairs via my rear and, once there, pulled myself up to my walker and traipsed into my waiting bed which now had fresh linens on it, all ready for me! I cannot tell you what a huge accomplishment this was for me, so I went and did it all over again last night, too.

Mind you, my first floor cat fan club was a little confused by this move because they have been taking turns smothering me on the day bed, enjoying laying right on top of me, or on my pillow (which is not good because of my allergies to the very animals I adore!). So, early Sunday morning, first one, then two of my felines hopped onto the upstairs bed, walking rather gingerly for a moment and then realized "THERE she is!" and settled right in for a long snooze.

This whole ordeal has been metaphorically a journey of baby steps (pun intended) for me. I am not, by nature, a patient person, so waiting things out, going 1 mile per hour with a walker instead of pacing along quickly, etc., has been a bear for me. But I realized that, when you slow your life down, deprive yourself of some things you sorta kinda took for granted, they are all the more sweet once you rediscover them. I loudly said hello to my second floor for the first time in nearly a month and felt like a kid in a candy store (without the chocolate, of course). So, with some modified work assignments possibly coming up this week, more ease in leaving my home, doing stairs, and managing these wicked support devices, I guess it's fair to say "things could be worse!"

Time for "Modified Duty"

It's ironic that, when I first heard I would need this surgery and would have to be out of work perhaps 1-2 months and could not drive for three whopping months, I naturally panicked. I could not imagine being away from my job for such a long time, and the pressure on me before I left to set up things for whoever would cover for me was very intensive and all encompassing.

Three weeks later, as I face having a return to "modified duty" probably as soon as next week, I find myself feeling very differently, which surprises me. Contrary to worrying about how I will pull this off, I feel calm in knowing that our "tech guy" will set things up so I can communicate with my co-workers via a mobile connection between my computer and the agency's network, plus I also know I have to work from home. Last week, my doctor noted that the only thing I could do in an unrestricted way was to "sit". Standing is limited to 5 minutes at a time for no more than one hour a day and, of course, driving is off limits until probably December.

It's so quiet here in my home during the day that, faced with a list of calls I have to make and documentation to do for those calls, I can't imagine getting too stressed. Also, since I am in no position to make home visits or see people in the office (because I cannot drive there and I doubt the agency will want to risk the liability of having someone pick me up, drop me off, and have to assist me with the pain-in-the-butt transfers associated with all the stairs to my home), I doubt there will be more work to do than I can handle here. It's just odd to imagine doing my job in what is normally a very busy, hectic environment here in my nice quiet home. I think I may be asked to do four hours a day and will need to see if I can really find that much to do that will take four hours, but it's a wait and see kind of thing. The tech guy has been instructed to call me to set up the computer connection and the rest will just have to be day to day.

For anyone reading this who dreads, as I did, the prospect of putting your life and work on hold for an extended period, I can tell you this: it has many plusses along with the minuses. You truly do get extended rest, whether this means you are napping or simply reading a book with your leg elevated. On the other hand, crutching your way around the house to the bathroom, kitchen and living room is exhausting - I really paid for it yesterday when I went out for a short drive with a friend. I was so incredibly spent just from using my walker and then my crutches to navigate my porch, then my walkway, then down five stairs on my butt (which actually was more doable than I envisioned). I was struggling to stay awake beyond about 8 p.m. and really fell into a deep sleep once I did go to bed. My body is learning the meaning of "everything within limitations" and, every so often, I have tested the limits and felt the results.

So, hmmmm, back to work. That will be interesting to try and do from home, but I figure if I can handle a traumatic fall that led to spraining my left arm and rupturing my right achilles tendon, undergo surgery for the rupture and then have the patience and determination to keep my right leg elevated (AT ALL TIMES) for two weeks....going back to work should be a piece of cake! Hopefully, it's german chocolate :-)

Discovering Reiki (it's not only for gathering leaves)!

One of the nicest "touches" (no pun intended) that we provide as part of our Hospice program are complimentary therapies, the most common of which is Reiki, something my sister, Karen, specializes in. She also refers to it as "energy work" and "healing touch" but don't confuse this with your standard massage at the health club. It is very much a two-way process: if you are not open to it, your success with it will be quite limited. On the other hand, if you are recovering from achilles tendon surgery and a very tender, sprained left arm, you find that you will try anything to feel like you are doing SOMETHING during a time when you have been told to basically do nothing but sit.

I have always had somewhat of a push me/pull you relationship with stuff like this. While I am very much a believer in psychotherapy and the social work I do, I draw the line with things that seem too far out in left field to me. That said, I am very comfortable talking with patients and families about such things as "nearing death awareness" and the most famous Hospice oxymoron of all time: "actively dying". I guess I am a walking contradiction at times: I consider myself quite the liberal, however I have my conservative slants as well, preferring that something "make sense" when, very often, there is no logical explanation for why it does.

All this said, I have pledged to myself to have this time away from work and my usual routine be one where I open myself to things that are not always comfortable for me, e.g., accepting help, being passive and attended to and, most difficult of all, remaining in one place for hours on end when I am itching to go out and enjoy a beautiful autumn day. When Karen visited this past week, she very lovingly took care of me, put up with my insane pickiness (you cannot just "warm something up" for me - it has to be so hot, the flesh inside your mouth melts!) and, best of all, she truly eased my pain. For this to happen, though, I had to let her which took some doing! Every evening, with Sarah Brightman's "Eden" CD playing in the background, and the lights dimmed in my living room, Karen did Reiki on my aching neck, shoulders, back, arms and, well, my whole being. I have not had much pain (other than my left arm and elbow and a dull ache in my neck and shoulders from using crutches), but I have been incredibly fatigued much of the time. Each night, when she was finished, I felt like I could just curl up and go to sleep....even in a subway station...and nothing would bother me!

She used certain crystals, a subtle touch, gentle pressure and a calm voice that basically was all I really needed. Pain killers and heating pads were not going to help me the way these treatments did each and every night she was here and I eagerly looked forward to them. The really interesting (but not surprising) result was that I had a reduced need for food (especially snacks that are usually my downfall) most of the week (that is, until today which is when she left!) because I was being nourished and fed in a much more effective way than a handful of Milk Duds could ever accomplish. So, if you are hurting, whether it be from recent surgery or not - consider treating yourself to some energy work, Reiki, healing touch or whatever some kindhearted person can offer you. When your body is working overtime to heal like mine is right now, it's not the Percocet that eases your pain, it's the love.

Workers Comp and the Achilles Tendon Rupture Patient

For those of you who incurred your achilles tendon rupture as a result of an accident, fall, or other mishap while at work, you might find this post interesting. I have never before had to utilize Worker's Compensation (thankfully) and, when this happened to me on 8/26/09 (seems you never forget the date of when such an injury happened!), I immediately panicked about "what the f**k is going to happen now? How long will this take to heal, how long will I be covered, for WHAT will I be covered, how much of a pay cut will I have to take?" etc., etc. It's not a pleasant worry to have (which of course is an oxymoron) but, if you can be patient with the process and trust in your Worker's Comp worker you should be OK. This person is not your employer, by the way, it is the "rep" they send their Worker's Comp cases to which is, in some ways, a benefit because it goes outside the workplace.

After getting some initial BAD information about how the Worker's Comp process works, I got the GOOD information I was needing to help me relax a little bit. Worker's Comp computes your last 52 weeks of NET wages (after taxes, but NOT including any personal deductions you take for medical insurance, your retirement account, etc) and comes up with an average. I'm blanking on the exact percentage you get of this average, but quick math tells me it is somewhere around 80%. At first glance, believe it or not, this does not appear on paper to be a huge difference between what you were bringing home for net pay and what worker's comp will pay you. The reason? Because all your "personal deductions" (see below) are not counted in this. The good news is your weekly check is not a lot less, the bad news is "how do I now pay for these personal deductions that used to be taken care of by payroll deductions?"

Here's an all important detail that no one in my circle could believe was true (but it is): For me, these personal deducations amounted to about $450 per bi-weekly paycheck (OUCH) and this would have been my personal responsibility to pay to my employer every pay period. I don't know about you, but I really don't have an extra $900 a month to shell out for these things. Before I could have a freak attack about it, however, my employer let me know that I could elect to use my sick time to pay for this extra amount. We figured out my rate of pay, how much I needed to come up with each paycheck (about $450) and it amounted to my needing to use about 20 hours of sick time each week. Luckily, I had six weeks of sick time available to me so, right off the bat, I knew I was covered for that amount of time. Should I be out of work longer than this, I would then need to go into my vacation and personal time banks to keep current.

In the employer's favor (which is NOT bad for either side here) is that they do want you back sooner than later and, believe me, after weeks of idle time, you are chomping at the bit to have SOMETHING better to do than hit the remote. So, if I come back on "modified duty" (which, for me, means using my own personal computer and telephone at home to do some office work for four hours a day), my employer certainly benefits and, for me, that is one less sick day (or vacation/personal day) I have to use to remain out of work on less than a full-time basis.

Worker's Comp sent me a letter at the beginning of all this (once my surgery was approved) stating it would be 23 (calendar) days before I could go on modified duty (which, for me, means October 9th) and 103 days before I can go back to full duty (most of this is due to not being able to drive for three months). My assumption is that they have plentiful case studies that show these "out of work" figures to be the average for anyone recuperating from an achilles tendon rupture, so you could probably expect to get the same kind of time off. People have already offered to drive me to work but I think it makes more sense to work from home until I get full clearance. Picking me up/dropping me off when I am on crutches could represent added liability to anyone who does this favor for me as well as for my employer if I just so happen to fall in their parking lot or building. Let's also not forget the stairs I need to navigate on crutches just to get from my front door to the car! However, back to "full duty" for me is somewhere in the vicinity of December 10th.

My purpose in putting all this information out there is that it truly is a jungle to navigate for the novice (which I was until about two-three weeks ago) and I hope someone can benefit from knowing how things went for me. So far, my checks have arrived consistently each Thursday and I know my health insurance, life insurance and retirement contributions are being taken out against my sick time at work by my employer. The less you can have things like this on your mind, the better you are going to be for the long journey of healing. Take it from someone who (already) knows! :-)

First Follow Up with My Doctor

I have been waiting for this day for two weeks, coping with boredom, inactivity, TOTAL dependence on others to do the most basic things for me, missing going out to the movies and restaurants and just being anywhere but the first floor of my house! Today at 10:00 a.m. was my first follow up with my surgeon, Dr. Arcand, since my surgery just over two weeks ago and it couldn't get here quick enough.

My exhaustive "dress rehearsal" earlier this week trying to nagivate my steps proved to be rather easily remedied: just have a strong guy right there to let you put all your weight on him as you step down and also as you use your crutches to cross over his lawn to my waiting car! Jim was strong enough to support me and my sister and partner followed closeby just to remind me "you're almost there!" and ta da, I got to my car in one piece.

My early impressions of Dr. Nicole Arcand still hold very true: I just plain like her, her "bedside manner", her hearty laugh, and, most of all, her honesty and ease in explaining what is going on with me in a way I can truly understand. She told me my incision looked "great" today, lauding me for "obviously keeping your foot elevated and staying off of it these past two weeks, and that couldn't have been too easy for you!" I smiled very proudly because, indeed, I have been the "good, compliant patient" and very motivated to hear just what I heard today - you done good.

She reviewed her findings during the surgery wherein I had a shortened tendon that represented two challenges: not only reattaching the ruptured tendon so the two ends could securely heal again but ALSO ensuring that the tendon would reattach to the bone. This is the part that is very much "wait and see" right now. When I asked how she would evalaute the progress of this, she said "clinically" meaning she would be checking over the coming weeks my range of motion, ability to bear weight, etc. She told me that she used four "anchors" when reattaching the tendon to the bone (I think the usual number is more like two) to do her best to ensure proper healing. When I told her I've really had no pain in my leg or foot, she reminded me that this could be due, in part, to my neuropathy (secondary to having Type II diabetes) but also due to my being compliant in keeping my foot elevated and non weight bearing.

So, after removing my sutures (which hardly hurt at all, contrary to what others have reported), they changed my splint and put on a second one (which basically is just layers of ace bandages, and put my toes in a slightly downward position. I will go back for another appointment in two weeks at which point the splint position will be returned to a neutral positioning. She thinks that, in four weeks, I may be able to transition to the cam boot (which I had briefly before the surgery) and start bearing weight. The other BIG news is that I no longer need to keep my foot elevated. When you've been constantly doing so for two weeks and feel just how inconvenient and uncomfortable that can become, believe me, you hear this type of report and silently say a big "yahoo"!

Dr. Arcand also detailed what the Plan B would consist of, should my tendon not properly heal when attaching itself back to the bone. She would suggest grafting some tendon tissue from my toe to use on my shortened, less healthy achilles tendon and see if that would do the trick. It's interesting - I didn't flinch at all upon hearing this or tense up or say "Oh my God no, not another surgery!" I actually have come through all of this so far rather well rested, comfortable with who is treating me and also with who has been taking care of me, and all I want is to have a valuable quality of life back again: the ability to walk, enjoy the nice weather, and just feel plain unrestricted! Freedoms like these that have been denied for even a short time make them all the more precious to a person, so perhaps that is one reason I have encountered this time in my life. It truly has made me value those "little things" that don't seem very little at all right now.

And just for the record, I want to thank the following from the bottom of my heart (and not necessarily in this order, it's just what my memory pops into my mind at this time)!: My partner Lucy, my sister Karen, my Mom for all her great telephone and e-mail support, my nephew Ryan for calling me yesterday and just making my day by doing something so uncharacteristic for him (STAYING IN TOUCH!), my friends from work, especially Sabrina and Tina, my wonderful support network of close friends like Elizabeth P., Dottye B., Renee, Judy S., Norma C. and some acquaintances I didn't expect to really hear from who were such pleasant surprises. If I left you out, please don't take it personally. Just know that anything and everything people have done for me has made this bearable and even somehow important for me to go through. This has NOT killed me and it HAS made me stronger. Thanks.