Achilles laceration, the beginning

Weeks -3 to 0 (this will make sense in a few paragraphs): The three weeks following the incident – I’ll just call it “the cut” were arguably the most stressful weeks I’ve ever been through. I’d had periods of time in my life before when I didn’t know what my injury was, or why I was feeling a certain way, but any emotions then pale in comparison to the last two weeks of November and the first week of December. In the ER that Friday afternoon, I was referred to an orthopedic doctor, whom I saw on Monday morning, the 20th. That weekend – marathon weekend – I pretty much spent trying to not be in pain and distracting myself by going out with friends. I had an MRI Wednesday the 22nd, the day before Thanksgiving. I worked all day every day Friday, Saturday, and Sunday of that weekend with no answers, on crutches in a splint. I hesistated to change my dressing and wrap, because I had a lot of shooting nerve pain down to my foot if I even slightly touched the skin near the outside of the cut, and also because I had no answers and didn’t want to move anything until I did. Sometime over the weekend I managed to chalk up the guts to look at my own MRI disc. It didn’t look like I completed severed the tendon from the images, but the images were also really grainy and I wasn’t used to scrolling through the layers; my last MRI was in 2012 and there were just flat images on the CD. The doctor had written the MRI script for the “right ankle,” and I didn’t question it since I assumed if he wrote it, it would show high enough over the ankle to see the cut. However, it seemed to me like the important part of the image was at the very top, and they just cut it off from view.

On Monday the 27th, the doctor called and said it looked like almost nothing, and I could come in and get a walking boot to use for awhile. I got it and managed to settle my foot into it with a heel lift, but I didn’t feel comfortable walking with it so I continued to use crutches. Sleeping without a splint or boot was stressful, as I still was not convinced the MRI even showed the right area. I called to make an appointment to review the MRI and was snuck in midday Wednesday. To my surprise, the doctor agreed to get a second MRI, this time calling the radiologist to make sure the area of concern (the cut) was marked and seen on the images.

On Thursday the 30th I got the second MRI of the “lower leg.” Stupidly, I figured since the doctor thought the previous MRI looked “like nothing,” this one would show “nothing,” just clearer. So when I got home, I loaded it and looked, and it did not look like nothing. I know a lot of people say they don’t know what they are looking at with MRIs, but I have to say, I do. Especially since I had researched a lot of Achilles MRIs over the past two weeks. I took out the CD and refused to look again. I was terrified and I absolutely hated that I could look at my leg and have no idea what was happening inside. I had no idea if being in the boot versus the splint was detrimental, or if I had done any healing whatsoever yet. I had no idea if I would be better in one month or in six. I had no idea if every passing minute was a step back. If I needed surgery, I wanted to have gotten it weeks ago, and since that didn’t happen, I wanted it within the hour. I just wanted it to be over so I could be put back together and begin to heal.

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An Instagram post from the day I was scared to death (11/30), of the little book I read to feel better.

The weekend of the 2nd & 3rd was rough, as I struggled to find distractions and be alone with my fears and questions. I worked all weekend as usual, still on crutches of course, and a bunch of my friends were out of town so there really was nothing to look forward to. On Monday the 4th, I knew the doctor would call, because he would get the report. I’d been told the radiologist who was writing the report was out on Friday, so I figured the doctor hadn’t called then because he had no information. I did a little painting in the morning on the porch to try to calm down and prepare for anything. The call didn’t come until around 4:00 in the afternoon when I was at work. And contrary to what everyone else said (with no real basis besides trying to help me not stress), I was right. I wish I wasn’t right as much as I am. I hate being right. So, surgery was scheduled for Thursday. The first thing that I thought of was my physical therapy school interview that was scheduled for Friday afternoon. Surgery needed to happen Thursday, there was no negotiating that (and I didn’t want to), but I also was not about to let it affect the thing I wanted most at this point in my life, which was getting into school. I could only hope for the best reaction to anesthesia and good timing for the nerve block.

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The [more] accurate, second MRI.
Surgery Day

I went to the surgical suite on Thursday the 7th at 8:15 AM for surgery at 9:30. I had a bag packed to be picked up after in my living room (I had to get a ride to surgery because my parents were stuck in traffic, but they were going to drive me home after for the weekend) that contained my interview clothes and prep notebooks, a left shoe for the interview, a bunch of much more comfortable clothing, and my theraband (because anyone can do clamshells post-surgery…why not?). The staff was so efficient and I was in the room-before-the-surgery-room within minutes. I was stressed about the anesthesia because I hate being nauseous more than almost anything, and I felt like that could be a side effect. I also didn’t understand the concept in general of being “under,” as it was my first time and I just didn’t understand how there was something in between being alive and being dead? I admit it is possible I thought about this too much. I could feel whatever they had in the IV hitting me, and that was a strange feeling, almost like those days I wake up in the morning and feel like my blankets weigh fifty pounds because I am still tired. I was wheeled into the room where the surgery happened during this time, and I was surprised that it had a ridiculous amount of natural light from big windows on one wall that faced the woods and the morning sun. They did have me transfer myself onto another “bed” face-down by just rolling onto it, and then I don’t remember anything else. I’m glad they didn’t put a breathing mask on while I was awake. Or count down or anything, that would’ve been strange.

I woke up in the room from before, sitting up. I saw a clock on the wall and it was around 10:20. I was relieved to realize I was completely aware of the time I had just spent in surgery and where I was. For some reason I was really concerned I would say crazy things, be confused, and throw up everywhere. None of these things happened. When the nurse approached me, I simply said that I’d been wearing a headband during surgery that must have come off with my cap, if she could find it for me? Can’t lose my go-to black Sweatyband to surgery! I had some ginger ale, and then she made me sit in a wheelchair instead of crutch, though I felt fine. My head felt slightly weird, but not bad. I was excited about this because it meant I could go to my interview! I doubted I’d feel worse the next day. The nerve block didn’t freak me out too much, as I had a feeling (ha, ha) what it would be like and was just grateful that it was working. It was injected just below the knee, so I could still easily move my leg around from the hip and knee normally. My doctor saw me before I left, after the surgery, and told me that while the MRI made it look like it was a full-thickness, full-width tear, when he actually went in there he discovered it was not full-width, which was really good. He called later that day to repeat that news in case I wasn’t with it when he told me in person. I was pleased by this, of course, but it didn’t really affect what I was going to be doing for the next three or four weeks (being non-weight bearing in a splint), so I didn’t exactly pop some champagne. Nor would that have been allowed.

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On the way home from surgery.

Weeks 0-2 post-op: The very nice and patient PA who works with my surgeon scared me to death about elevating my foot. I was now paranoid that I would have my foot down a second too long and the incision would burst open and I would have to have another surgery (I should make a list of some of my extreme irrational thoughts I have had throughout this process once it’s all over…). I was also not sure how I would know when it was swollen because I couldn’t really see, and for the first day feel, my lower leg. I was also unsure about the pain killers I was prescribed, because (common theme here) I was nervous they would make me throw up. I was also scared about how it would feel when the nerve block wore off, and if it would wear off before I had my interview. There was just a lot of things at play here I was not experienced with in the least. I am pleased

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On the way back from the interview. I used a crutch against the window to elevate my leg here.

to say that while I was the last person interviewed within the three-hour block, my nerve block decided to wear off on the car ride home (my friend drove me from Princeton to the school, my mom drove to and from Princeton from home) in rush hour on the Turnpike. During the switch from one car to the other, I put my leg vertical and it did not feel good. There was some pain but also just the awful feeling of blood rushing down and making my lower leg feel very heavy. The next day I watched Army-Navy on a screen while my family was there in the slippery, freezing snow (I wasn’t too jealous that I forfeited my ticket to be honest) and was in quite a bit of discomfort when the meds weren’t at their peak. Sunday I only felt pain in the morning, and didn’t need to take a second dose. I was even able to do some leg lifts, Myrtle hip exercises, core, left leg Romanian deadlifts without weight, and theraband clamshells! I figured staying still for so long was not good either. I had to take aspirin (for the first time in my life, actually) twice a day until I was weight bearing again.

I had the first week off of work because I had the PTO to use. I went out a couple times and kept my foot up when I got to where I was going. I had to go back to work at the start of week two due to the lack of PTO, but I modified things a bit so I could keep my leg elevated most of the day. This often meant making my knee and hip very uncomfortable, unfortunately. I got excited about the little advances, like managing to find pants that fit over the splint – hard to do when I always wear pants with very narrow leg openings…I admit I bought a couple new pairs online because I had nothing. 

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Jeans!

I did some online Christmas shopping and some painting, but not as much as I thought I would get done. It should be noted, in case it wasn’t clear, that I have not been able to drive since the day the cut occurred. I likely won’t be driving until March.

On December 20, about two weeks from surgery, I went to my post-op appointment, where my splint was removed for the first time. I was nervous but looking forward to this, as I knew it was progress. I was now able to shower without the cast cover (still using the stool to sit of course), and was instructed to do ankle pumps up to but not past neutral three times a day for about five minutes. The first day, I could hardly move it at all. I was unsure how on earth I would ever get to even fifteen degrees plantar flexion, yet alone neutral!

Weeks 3-4: Starting with three days after I was able to remove the splint several times a

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The first picture I took post-op, on 12/23 (because I noticed the bubble).

day to move my ankle, I noticed a small bubble of fluid on the incision. As usual I got concerned and asked some people about it who would know about such things. They seemed to think it was fine, just a normal thing to happen when I start moving. Over the next week, however, the bubbles started to bleed and dry and harden in cycles, and I just was not sure that was what it was supposed to do, since the lower part of my incision was not doing that and seemed to be healing the way it should. It didn’t help that it was about ten degrees and my skin was super dry. Being outside crutching around with just a sock or two covering my toes, with very bad circulation to the area, was not pleasant, by the way. I called the doctor on Tuesday the 2nd, and went in to get it checked out the next morning. This appointment was not fun. It turns out I had stitch abscesses, which occurs when the body rejects dissolvable stitches and wants them out. The doctor explained that this used to happen often, but better stitches were made and those are the ones they use now. “It almost never happens now,” he explained, “but you’re special.” Not something you want to hear at the doctor’s office. I was already only the third case of an Achilles laceration he had ever seen, and he has probably been practicing for almost twenty years. So, the stitches needed to come out. This was the first time I felt pain since the dull pain that came after the nerve block following surgery. I was face down on the table and he had to dig out the problematic stitches just below the skin on the incision line as well as the sutures that closed the incision on either side of it. I couldn’t see what was happening luckily, but I saw blood on the floor once I was wrapped up. That’s always lovely. I had to go on an antibiotic for the next ten days and shower with the cast cover again. That all happened before a nine hour workday, and I took Lyft to and from the appointment…one of those Wednesdays.

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Before & after stitch removal! I debated posting these photos but then I remembered how much I searched online every day to figure out if my stitches were healing normally. So, the photo on the left is not normal, everyone.

Weeks 5-6:  The stitch issue kind of set me back a week at first, as I stayed in the splint now until week five, which was my original appointment anyway. So on January 10, I went back and he said I could wear the boot and ditch the crutches whenever I felt comfortable. I had two heel lifts and I coud start with both and ease my way down to one. The next two days were quite the experience, as it was a huge stretch for me to go from the splint down to two half-inch heel lifts in the boot. I was behind with my range of motion because the stitches leaking made me nervous to move my leg as much, despite the doctor telling me I was fine to still do it three times a day. Wednesday and Thursday, and maybe part of Friday, I had a constant ache in the back of my leg as I was in the two-lift boot setup. It is funny how the body adapts, though. These few days really made me understand this on a new level. Each day the stretch felt less aggressive, and I was able to use just one lift once the pain subsided completely on Friday. It was never “bad” pain, I knew it was just an unfamiliar stretch-pain from being in a new position. I was still using crutches but trying to transition to weight bearing in the boot. Once the pain went away in the one heel lift, I took my first unassisted steps on Sunday morning. Throughout the workday that day, I left one or both crutches somewhere across the store, and made my way around without them. I couldn’t swing my left leg through past my right, though, making me extremely slow. For this reason, I still crutched distances that weekend and the next week, such as to work and anywhere else that was farther than across a room. I was also very accustomed to crutches by this point, so my crutching muscles were conditioned and it didn’t tire me out like it did in November.

Despite not really ever mastering walking in the boot, I was only in the boot for a week, which meant I was technically allowed to be in two shoes at six weeks as the doctor planned. That appointment was on January 17. I had a really full work schedule the next two days, however, and I just needed some time to figure out how to do this and see if it was something I coud maintain all day. On Friday the 19th, I stayed late at work to

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First day in two shoes, January 19th.

patiently try walking in two shoes (with the heel lift) with no distractions or obstacles (and also many things to hold on to if needed). This was an emotional moment, as I ended up walking just as badly as I was in the boot, confirming that it wasn’t the boot that was preventing me from dorsiflexing and following through, it was my body. It was understandable that I would be ridiculously tight and not able to do it right away. It was just crazy to almost forget how to walk normally, and realize all of the small things that made up what we think of as such an innate movement. At work the next day I stayed out of the boot for about seven hours and tried to get used to feeling the ground again. Despite the lack of dorsiflexion, it was a relief to find out that I had no issues with weight bearing, even on one foot for a second.

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Standing in two shoes! January 21. The cut is easily visible here. I love my Pegasus 34s for getting me comfortably through my first days in shoes.

 

 

 

Getting into two shoes seems like a good place to publish this post and move on to the next! I’m looking forward to sharing what I have been able to do exercise-wise over the past couple months as well as little tips and tricks for getting through the routine of each day, plus musings about physical and mental adaptation.

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Catching up

I finally managed to log in to my WordPress account! Turns out my old bookmark no longer worked. A lot more than that has changed, as you might have expected. The last time I wrote, I was planning on juxtaposing my negative reflection on 2015 Boston with a recap of the perfect race that was the Philly Marathon that year(3:15), but life got in the way and I never wrote that post. At the time of my last post, I was in a confusing place regarding how to take the next step toward a career and general self-fulfillment. In chronological order, I’ll do a little catch-up. A summary for now, of course….

December 24, 2015: After contemplating the thought with healthy amount of fear for the past few weeks, I broke down and admitted out loud that what I really wanted to do was become a physical therapist. That never truly changed. Although I was unsure exactly how I was going to be able to afford what it would take to get there, the past year and a half or so of feeling somewhat lost and inferior through my own eyes was enough to motivate me to start somewhere and just keep going.

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Starting the new year with a win (and a bike-run-bike brick) at the Resolution Run 5k on 1/1/16.

Winter & Spring 2016: I re-took the first half of Anatomy and Physiology, and for the first time in awhile I felt like I was exactly where I should be. I continued working full-time and racing. In the winter, I did club swim workouts in the pool Monday and Wednesday nights with a couple friends (pseudo club team members). I learned when you actually do workouts swimming isn’t so boring! I had decided not to register for Boston that year despite qualifying, just to try to do some shorter races and maybe some other interesting athletic endeavors. My freezing cold morning speed workouts and Princeton Intervals evenings paid off in March when I matched my 5k PR from the previous May at the Adrenaline 5k (the official time was two seconds off at 19:13, though). I rode Hell of Hunterdon a few weeks later, learning that a.) you don’t actually need to ride over 40 miles to prepare for an 80-mile hilly ride, and b.) there were so many unpaved New Jersey roads I hadn’t been on that were the best. I think I was on an elevation-nature-exertion high for two days straight. In April I won what I believe was the first and only

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River Horse 6k first place prize was a tap handle! Sans beer….

River Horse 6k in Ewing, holding off a DIII Al-American and finishing with a 5:59 mile in the process. It wasn’t as fast as my 2014 USATF Club XC Nationals 6k time, but it was still under 24 minutes. The best race of the season was at the Bucks County 10 Miler on May 1st, when I ran 1:06 and change to take the win on a muddy towpath in the pouring rain. I was going to run a half that day but couldn’t manage the logistics with work (while the ten miler was great, I still kind of regret this…but only because I think I could have ran 1:27 that day. But what are numbers…). After that I got pretty sick – bronchitis, asthma symptoms, all that. I couldn’t breathe normally even at the annual Jerseyman Tri at the end of the month, but I did suck it up and swim in the cold lake.

 

Summer 2016: I finished up the A&P sequence but had to commute to the Trenton campus. It was a strangely fun experience taking public transit (bus) or bike commuting three days a week for five or six weeks. After the class was over, I went to Maine with my family and had several adventures including biking the Mount Desert Island Marathon course (I took my bike on a ferry!) and hiking Mount Katahdin. I also went up to Lake Placid to catch the tail end of the Ironman and spend a couple days camping, swimming in Mirror Lake, and biking one loop of the course. Unfortunately I did most of that alone, but it was still fun. Last, I finished up the summer by taking a solo mini-trip for two and a half days to the White Mountains with a stop in Boston (which included a 50 mile bike ride) on the way home. The 20 miler I did in New Hampshire is worthy of its own post, if not for the hilarious extent to which I suffered (in the midst of marathon training, mind you) then for its contribution to my trail running and racing hunger.

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Fall 2016: This season was nothing short of crazy, now that I really look back on it. I faced my nemesis, Chemistry I. In September, I did the Savageman 70, which is considered the hardest triathlon in the country. It at least has the biggest hill of any tri…and probably the second and third biggest ones too. I was convinced to do this by someone who ended up bailing on the whole thing, including just the trip down there for support with less than a week’s notice. It was my “birthday weekend” (if you believe in these things…I do), and I had a campsite reserved. I was not going down there solo, so I somehow recruited two of my best (non-triathlon) friends to come down and go through this experience with me. It was hard. I came really close to getting my brick in the road, but did not. I came in 7th or 8th female. But I don’t think I’ll be going back. I was also training for the Mount Desert Island Marathon. Long runs had been so-so, I was just way more tired than usual all the time. I made that weekend into a little trip with my mom. Logistics were easy, we stayed alone in my aunt and uncle’s house on the ocean and my other aunt finally got to see me race. The race itself was going well until mile 16, when I started coughing (I had had more chest-cold issues this fall again), which led to acid reflux and that was a bad, downward road to follow. You know what happens next. I somehow managed to stumble into Main Street in Southwest Harbor in 3:28. The rest of 2016 racing-wise was rough, it was just a tough order of race distances. The Princeton Half was bad, and I really just felt obligated to race it even though I didn’t feel great. The turkey trot was abysmal. I was doing fine workouts and all, I was just wiped. I suspect my iron was probably off, but I wasn’t bothered enough to get it checked.

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With my bib for the MDI Marathon. And a ship.

Winter 2017: I finished Chemistry I and started Chemistry II. Homestretch? I pretty much worked until 7 or 8pm every night, then go to the library until 11 or 12. I couldn’t stay any later than that. I felt much older than I did in college…. I ended up having a pretty good training cycle for Boston, but I think I managed to do a 18-21 miler and not have to go to work right after maybe once. Still did them all, and then went to the library at 5, and then totaly crashed at 10. The most memorable run was a 20.5 mile run that I did starting from Washington Crossing that took my up the towpath to New Hope, and then across to Lambertville at mile 10, up and over Goat Hill, and finishing cutting over Baldpate Mountain at mile 16. Talk about hill placement. It was beautiful and I cherished the lactic acid like never before. That evening, after, was the most relaxed I think I’ve ever been. Nature and running almost three hours on hills make quite the happy pill.

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Spring 2017: I ran Boston, but over-hydrated with Gatorade and water from the start. I got acid reflux almost immediately and gagged my way to the finish line. It was about 70 degrees – 20 too warm – but the liquid intake was the main problem. And the nerves about the heat. It was 80 the day before, Easter. I finished in 3:23 and then threw up Gatorade in a fancy hotel lobby bathroom. Then I walked like 3 miles, not on purpose, don’t ask. I hardy felt beat up the rest of that week. I thought maybe I was getting used to this thing, I just needed to get my esophagus to stay behaved. I finished Chemistry II, battling until the end. I started volunteering at a new physical therapy office, but could really only go for a few hours each Monday morning due to the class and working full time. Oh, and I still did Hell of Hunterdon with even less bike training, because why not. I ran the E. Murray Todd Half in March as well; I came in second and was actually a bit satisfied with the time given the course and the cold. The best race of all was The North Face Endurance Challenge NY (Bear Mountain) Half Marathon on May 14. This was kind of unexpected and I put very ittle pressure on myself until the race began. I ended up coming in second overall female and having basically the time of my life. It made up for every disappointment in Boston and I will definitely have to write more about it in another post.

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100% happy place.

Summer 2017: I did a few triathlons, but was mostly saving my money for physical therapy school applications and associated fees, so I think I only paid for one. I did the Jerseyman Du, Pancake Tri, and the West Point Tri. In between, I had a great time having adventures in Lake Placid and Maine. I ran up and down every mountain I could get my eyes on, and started dreaming about running more trail races. I found that all the races that had the most hype were super long, but I really liked the idea of trail races that were ten miles or half marathons, just for the amount of effort you can give without regard to nutrition and bonking and the like. And because there is nothing quite like racing through the woods on a mission. As for my applications, I got started on those in July and that process escalated extremely quickly. I also got hired as a part-time aide at the physical therapy office once one of the aides left for school.

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I took two of my brothers on a running adventure up and over Cadillac Mountain, and to a bunch of other mountains and lakes on MDI. I’m so glad they are old enough (and fit enough) to take along now! I really needed a whole week just to run MDI trails, there are so many!
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With Jen after the West Point Tri!

Fall 2017: In the summer I realized I wanted to train for a marathon again because it didn’t seem that hard anymore. I figured I might as well train to go 3:10 in Philly, and see how things went in training. If I felt sluggish I would bail, if things were going well I’d go for it. Unlike 2016, I was now used to being busy all the time and handling a lot of physically exhausting things. I started doing marathon-pace tempos, something I had never actually done before. I kept the Tuesday night speed routine, and did my tempos Thursdays (or Tuesdays if I skipped the speed…) after working mornings at PT. In the spring, I’d done weekly tempos, but was running closer to half marathon pace or a bit slower, and no longer than seven miles (I think I did eight once). I got my MP tempo up to ten miles, with a mile easy on each end. That was on Halloween, making one of the best holidays even better, of course. I had a great training partner on Sundays in Sara, who was also running Philly. We even got to do the run to Lambertville in October! We started from her house instead, but I think the route was just as good. I submitted most

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Baker’s Revenge, looking for the finish line and running away from the men.

applications the last week of September, and hit a few other deadlines throughout October and November. Aside from marathon training and the app grind, I put my trail running to the test on September 16, at the Baker’s Revenge 10 mile trail race at the Watchung Reservation. I meant to get up to a course preview run this summer, but only managed to run there once on my way back from something in north Jersey…and I got pretty lost. I somehow managed to follow the flour (get it…) and pink ribbons enough to do the course correctly (it was a little long!) and place first female, second overall. It was super fun. I went with Kristine (who I didn’t know in 2015 – crazy!), my roommate/running friend/general friend who has accompanied me on many running and other adventures this year. We drank PBR and ate donuts after. It was quite the event.

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A magical run I had by myself in NY on Labor Day – also will get its own post.

So, now it is February 1st. I was really excited to race Philly, as I was finally feeling super good and I tapered well. On Friday, November 17, I took out a bag of trash from my kitchen. It touched the back of my leg and a broken coffee mug cut my Achilles. After the worst three weeks possibly ever (so many unknowns and wrong tests and false hopes), I had surgery on December 7. The second MRI (kind of like the first…) was actually misleading, and it was actually only a partial-width (full thickness though) tear, which my doctor was excited about. I’ve come a long way since then, and am now “walking” (trying to) in two shoes. I’m ahead of where I thought I would be at this point, yet it still isn’t an easy process. One of the hardest things is that I hadn’t had a running injury in years, and spent a ton of time preventing anything from ever happening. I guess you can’t prevent accidents. The other hardest thing is that I can’t really do anything I consider fun. But that’s commentary for another time. I am overjoyed to be able to ride my bike for commuting purposes outside withy my boot on (to prevent over-flexion) now! This means I can go places without anyone’s help. It is my right leg, so I haven’t been able to drive since November. I was back to working 45-50 hours a week by week three or four, which is somewhat unfortunate, ha. But obviously a good thing.

So, I am starting my blog again because I have missed writing so much, but also because I have been scouring the internet for stories from people who have had Achilles repairs, and doing so has only made me want to write about my own process more! I am looking forward to recounting the past eight weeks since surgery in my next post(s), including what I have done to stay fit since the day after surgery, how I have gotten around, tips from #crutchlife for those who may be looking for that, and what I have learned.