nlbarber

I haven't been posting updates on the ankle pain, I guess since the second round in the boot (air cast) after an MRI showed a very small tear in the achilles tendon. That was May or so. Unfortunately the lack of updates was not from lack of pain, but from lack of progress--I continue to have this low-level pain in the right ankle off and on. About 6 weeks ago, it started up in the left ankle as well.

The last round with the podiatrist had me trying to start walking some--that is, walk for exercise in addition to normal activity--and try a brief period without the custom orthotics in case that was the problem. Neither of these were an immediate success, so (again on the podiatrist's advice) I'm keeping the orthotics in but continuing the walking as long as it doesn't make the pain worse. Straight walking usually isn't painful, you see--things hurt when I turn the ankles in different positions when sitting, and if I stand for long periods as when baking, and stuff like that.

The latest diagnostic attempt was to get a vein study--by where the pain is located, it's either the tendon (but the tear is not in the right place to be the source of the current pain), a nerve, or the vein. Thursday I hied myself over to the Emory Clinic Cardiology Department for a look at my leg veins. It's an ultrasound test, it turns out--I found it interesting to turn my head and watch the tech find the vein, measure it, squeeze my leg above or below the measurement point, and measure again. The legs ended up rather messy with the ultrasound goop, but beyond that it was a low-annoyance test as such things go.

And the result? My veins are fine, and are not the source of this problem. One vein was showing a little sign of aging in that the diameter increased slightly "downstream", so the Nurse Practitioner recommended wearing support socks to try keep that from getting worse. Never saw the cardiologist whose name was on my referral, and indeed didn't need to--as it turned out, he wasn't even in that day.

I'll go back to the podiatrist next week, and meanwhile will keep walking. If the pain stayed at the level it is most of the time, I'd be willing to just wait, keep up the exercise, and see if it eventually heals. (Other times, I'd say this is uncomfortable enough I'd like to fix it soon.) The podiatrist, though still without a firm idea of the source of the problem, feels that it will likely get worse and not better. I'll see what her next suggestion is on Friday.

MRI at 9 this morning: let me just say I hope I never have to have one of these over more of my body than the lower leg. It's amazingly hard to stay absolutely still for an hour--things want to twitch involuntarily. At least my body does.

Dr. E called mid-afternoon with preliminary results, mostly to make sure I was in the boot already and to make sure I stayed there. I have a partial "intrasubstance rupture" of the achilles tendon involving about 10% of the cross-section of the tendon. Translation: it's where the tendon attaches to the bone, not the muscle, and this is good because it's much easier to treat.

The options are
-get back in the boot for 4-6 weeks, more rigorously than before. IOW: don't get out of bed without it (though she didn't say I needed to sleep in it), and I can still take it off to drive.
-get a cast to limit movement even more. Dr. E was not enthusiastic about this one, as she said "I have more patients injure themselves using crutches..." I'd be unable to drive.
-surgery, option a: full repair of tendon, then would be in a cast while it healed.
-surgery, option b: "oblation" of the area (making micro-cuts, I gather), which is less invasive, the goal being to stimulate blood flow and promote healing. Poor blood flow to this area is a big problem with this type of injury, making things slow to heal. Oblation would be done outpatient, but would still mean no driving for the first 2 weeks after surgery.

I'm starting out in the boot, and will see Dr. E next Thursday to see how things are going and to go over all this in person (and based on the final radiologist's report). I'm leaning towards trying the boot alone, and if it's not progressing, consider the oblation surgery. Must coordinate this with various work activities (trip to Denver in early June, short trip to Washington DC in late June) and the schedule of the folks next door, whom I would need to lean on if I end up with a period when I can't drive.

This morning was my twice-a-year visit to my internist for blood work--check the cholesterol, the thyroid (both being treated with medication), and liver function (because of the cholesterol medicine). I also mentioned again that the tailbone pain from last August (that started sometime in February 2007, but I didn't get in to the doctor until August) was still present. Better, perhaps, after taking extra aspirin for inflammation and sitting on pillows to keep pressure off it, but still there. He's referred me to a non-surgeon orthopedist, perhaps headed for a cortisone injection to see if that helps. Yikes! Googled the orthopedist, and find that he is actually a Physiatrist--new term for me. Double yikes! His practice has a YouTube video of their doctors and staff. [shakes head] What's the world coming to?

But that wasn't really the interesting part of the visit. Since my last visit, this clinic has made big strides in converting to electronic medical records. ( More on the system... ) I suggested that the next wave of doctors wouldn't make any notes with pen and paper, but he's skeptical...but then, he graduated from medical school in 1965. His habits are pretty well set. <g>