The MisfortuneSerious injury. Nobody likes to be majorly injured but for those of us used to an active lifestyle, it can be particularly traumatic from a mental standpoint. These are my personal reflections after having spent 14 months on the sidelines after a mishap at Joshua Tree.
I begin with the underwhelming story of how I got hurt. If you’re going to get seriously injured, ideally it should happen doing something like climbing a hard route or rescuing someone in dramatic fashion. Not me. I was climbing at JT with the California Mountaineering Club the weekend of December 5-6, 2009. We had had a good day of climbing on Saturday although it had been pretty windy and cool. Come Sunday morning, I had breakfast and decided to warm up for the day by taking a running start at and bounding up an 8-foot boulder near the campsite. I hadn’t been able to make it quite all the way to the top of the boulder so I decided to make maximum effort. I ran at the boulder hard and planted hard with my right foot on a tiny ledge on the boulder. CRAAAACK!! It was a loud sound and I felt the band that is my Achilles tendon separate. I landed on the ground and could put pressure on my foot if I rested back on the heel. Fortunately, I felt no pain. I knew what the injury was and confirmed it by sticking my finger into the gap at the back of my foot where the tendon had completely separated.
I told my buddies I would not be climbing today although I did not tell them how serious the injury was. They all encouraged me to try to “walk it off” but I knew that was futile. I took my leave and made the nearly 2 hour drive to an emergency health facility covered by my insurance.
Orthopedic DecisionsI first went to the emergency room. When I found out there was a “wellness” clinic I decided to go there as I figured I would be referred to an orthopedic surgeon quicker than waiting around in an emergency room. The Family Medicine doc who examined me gave me unwarranted hope when he told me it was a partial tear. But I suspected this was not the case and I turned out to be right.
I saw an orthopedic surgeon in short order. He put me in a cast and explained that surgery was an option, but that the tendon would also fully heal without surgery. He told me-and numerous other orthopedic surgeons I consulted confirmed—that the evidence is not entirely solid that surgery is the better option. They said the literature tilts in the direction that there is a less likely chance of reinjury when going the surgical route, so they advise athletes to go with surgery. Since I was not a college or professional athlete, I figured to forgo the surgery.
A week later when I saw the surgeon again I told him of my decision not to have surgery. I passed up an opportunity to have the surgery done that very afternoon. That weekend I decided to run my decision by my close friend and running buddy who lives across the street. He is a family medicine and sports medicine doc. He said if it were him, even as just a recreational athlete, he would go with the surgery without hesitation. I value his advice and it caused me to have second thoughts about my decision.
By Monday, I had changed my mind and called my surgeon to tell him I had decided to have the surgery after all. Alas, his schedule was by then fully booked past the period within which the surgery on a torn Achilles tendon should be done (within 10 days or so of the injury).
Fortunately, there are six docs who live right across the street from me. Again, fortunately, one is an orthopedic surgeon. So I went to Brad and explained my situation. Long story short, Brad set up surgery for me at his facility with his boss as my surgeon.
The Mental Hit
In the midst of all this I was struggling with the dark thoughts that I would not be climbing, or canyoneering, or running, or hiking, or even getting to go to the boring gym, for a long, long, time. Average time to heal an Achilles tear is 12 months. YRMV and I later talked to people who did not get to full healing for over 2 years! And I was dreading being in a cast and having to get around on crutches. It was a depressing time. Plus, as a litigation attorney, I had the extra challenge of getting around in a courtroom.
Surgery and ComplicationsBack to the surgery. It seemed to go fine. My surgeon, a wonderful personality named Bill, put me in a boot instead of a cast. This is a major advantage because you can remove the boot when you want. Still, it is miserable being on crutches. I took some falls during this time including one time when one of the crutches snapped in half. I was certain that I had reinjured the tendon and went to the emergency room but it turned out to be ok.
MY COMPLICATIONS began during the first week after surgery. Some abscesses developed along the scar line. They looked ghastly and they oozed. My running doc friend put me on antibiotics immediately. I went back to Bill my surgeon and he was optimistic the abscesses would heal soon. They didn’t. They oozed yucky stuff all the time, although it wasn’t pus, and I had to carefully bandage my foot each day.
THIS WENT ON FOR A YEAR. Actually, the tendon itself healed fully in half the time such injuries usually do. Mine healed in 6 months. So 6 months after injury I began doing some simple hikes. But the abscesses were still there and on one 7 hour hike the pressure from my hiking boot on the scar mashed the scar into hamburger. Now I had really done it. A plastic surgeon I consulted said I had set myself back to day one and that I should not expect to get back outdoors for another year at least from that time. Talk about depressing news!
More Time in the SP ForumsAll during this time my usual steady pace of contributing TR’s and other pages to SummitPost came to a complete halt. That was frustrating. I began to spend more time in the forums discovering how nasty the exchanges can get within the SP community. But I even felt guilty about visiting the forums thinking that I really didn’t deserve to be talking about mountaineering and climbing subjects since I wasn’t doing any myself.
A Reluctant Second Surgery and ResultsBACK TO MY LACK OF HEALING. So now I was approaching a year since my injury and my wound still had not closed. My ortho doc referred me to a plastic surgeon who advised against another surgery to see what was wrong because it would involve having to graft an artery and tissue from another part of my body. Not encouraging. My doc then brought in several other orthopedic surgeons to examine me. Three of them said the same thing. I ‘d had a bad reaction to the suture material (called Fibrewire) used to sew the tendon and the sutures needed to be removed. None had ever done this with an Achilles injury and they couldn’t opine on how difficult it might be.
My doc Bill was against the idea of going in to remove the sutures. What if he had to mangle the tendon to get all the sutures out? That would clearly mean reconstructing an Achilles tendon with the attendant complicated surgery and complicated healing. We decided to wait some more. But at the one year anniversary of my injury, my wound was still open and I could not wear shoes. Not a good situation. Finally, my doc and I decided we had no choice. Despite his lofty credentials and extensive experience, he had never done this procedure and I could tell he was nervous about it.
On December 16, 2010, over a year after my injury, I went under the knife again. When I woke up, Bill told me with a big smile that the procedure had gone smoothly and that the sutures had pulled right out. Now to see how the healing went. WITHIN FOUR DAYS MY WOUND HAD COMPLETELY CLOSED after having been open for over a year. I was on crutches only two weeks this time and within 4 weeks could walk in my boot. Praise the Lord! I was really healing.
About two months after the second surgery I began climbing back into the saddle. First, my son and I did a great snowshoe hike near the Wrightwood ski resort in the San Gabriel Mountains. I tested my foot further with a canyoneering outing in Bailey Canyon in the local mountains. No problems. IT FELT SO GOOD TO BE BACK OUTDOORS. My third outing was another canyoneering venture rappeling the thunderous waterfalls below Mt. Baldy in southern California. Next, I went skiing at Mammoth,CA. Then I did a snow climb of the Mt. Baldy Bowl in southern California in good order. Now I knew I was fully back.
Final CommentsThe tendon still feels very stiff and after exercise it hurts and gets a little puffy. But full range of motion is back and I can put any amount of pressure on it. My doc said don’t worry about any discomfort, just judge the healing by what I’m able to do. By that standard I’m fully back in the saddle.
That’s my story. CONCLUSIONS? MORAL OF STORY? I don’t know. Certainly nothing can prepare you to be incapacitated from your favorite outdoor activities. The dark, deflating, withering moods are inevitable. All you can do is understand that there is light at the end of the tunnel, all this shall pass, and take advantage of all those free weekends by spending more time with loved ones. My final thought is that I hope there is no one out there reading this story who is going through a similar experience. If there is, all I can say is HANG IN THERE. THE DAWN WILL BREAK.