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Achilles Tendon Rupture


Original Post
Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Hi MPers,
I'm looking for a little advice and help from those who have had an Achilles tendon rupture.  I'm scheduled for surgery this week and looking past it, and trying to recover and stay in shape as much as possible.  I had a little fall over a week ago that caused the tendon to fully tear.  There is a noticeable gap by my heel, and the MRI today confirmed this.

For those who have had such an injury what (if anything) were you able to do during the recovery process to keep your legs in shape.  There are certain things I already have in mind for the fingers and forearms, but I'm mostly concerned about my cardio and legs right now.  Any exercises you've done for the legs or the core that you could share would be greatly appreciated.

I'm also interested in hearing about everyone's recovery timeline.  My doc thinks I'll be putting weight on my foot within 3 weeks, active within 3 months, and "normal" again by 6 months.  The timeline is across the board from my own Googling so I'd like to hear from climbers who've had firsthand experience.  Thanks.

dmr · · Carlsbad, CA · Joined Aug 2011 · Points: 0

I had the same injury. You can probably "climb" in 3-4 months, but full recovery could be 12-18 months. Don't worry too much about your general fitness.  Focus on your recovery and PT when the time comes.

Get the nerve block if possible.  You can get sent home with nerve block pump/meds that will last a couple days and get you through the acute pain.  I only needed a few days of narcotics after that. Also, I'd spring for some of the fore-arm style crutches. I found them way better for daily use.  

http://achillesblog.com/derek/2014/09/03/hello-world/

Check your PM and give me a call if you want to chat.

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Derek,
Thanks for the link to the blog.  I'll see if I can manage without the meds.  I'm not in the right headspace to take them right now.  I'm usually pretty good with pain management, but we'll see.

Haven't gotten anything in the mail yet, but I just might give you a call when it comes.  Thanks for the offer man, that means a lot.  I'm happy to hear about the "climb" in 3 months but the year long recovery is heart breaking.  Gotta deal with reality though.  I'm going to need to read your blog a few times for all this to sink in and digest.  Your 8 week update is funny.  I have the same compulsion/idea.  A friend agreed to belay me tomorrow for one last gym session to clear the mind before surgery.  I was planning to do some 5-easy stuff that I can manage with 1 leg just to get out of the house.  Thanks again.

Jaren Watson · · Idaho · Joined May 2010 · Points: 2,506

Nothing to add other than to say best wishes for a speedy and full recovery.
My condolences on the injury. Positive vibes your way.

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Thanks Jaren.  I'll take all the positivity I can get right now.

Aerili · · Los Alamos, NM · Joined Mar 2007 · Points: 1,880

Have not had Achilles rupture but have known 3 people with partial or full ruptures. dmr is right, I was going to say that 6 months to "normal" seems extremely optimistic for a full tear from what I witnessed.

Eventually you may consider cycling with only the good leg on a stationary bike. The nervous system does seem to allow a contralateral or cross-education improvement when a single limb is trained.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465979/

 

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Aerili,
The stationary bike is already on my mind!  The only reason I haven't started it already is because I was worried about complications from a muscle imbalance.  I just have to find a friend with a truck/van with some time available to help me lug it into my place and assemble it.  

Hope and optimism is what I'm going to hang onto for now.  I've pulled off some miracles with past injuries and crossing my fingers I can do it again.  Thanks, and send whatever info and ideas you have this way.  I won't be doing much but reading for some time.

Brett K · · Somerville, MA · Joined Dec 2018 · Points: 0

I had a full Achilles tear on my left foot in the summer of 2016.  

Those other commenters are correct with the 8-12 month full (99%) recovered—you will never get that ankle back to 100% unfortunately.  I had one of the best foot and ankle surgeons in the country do my surgery, and a great physical therapist, who I owe everything too.  I am fully recovered, and have been extremely active since my surgery.  I cannot extend, or stand up on my tip toes as I used too, there is still a tightness compared to my right ankle, but that is the ONLY thing.

Start your physical therapy by doing hip and quad exercise on both your strong AND injured leg.  It helps to establish the mind-muscle connect in both legs, not just the injured on.

I think your stated recovery time is too fast.  I think 3 weeks to weighting the foot will be more like 6... start your recovery slow and you wont regret it. I wanted to rush my recovery as I had a trip to Boulder CO planned, but I'm glad my doctor kept me in the walking boot for an extra 4 weeks. DO NOT RUSH, trust me.

Chris C. · · Seattle, WA · Joined Mar 2016 · Points: 327

I had a partial rupture a few years ago. I totally feel for you man.  For me it was actually harder on my mind than on my body.

I ended up doing a lot of core work for cardio, and I increased my upper body strength workouts in the gym.  Basically, I did anything that didn't require my leg. Once I could get back on it, I suffered from a lot of lost strength in the stabilization muscles and general mobility.  I ended up taking up hot yoga, which ended up doing wonders for me.  

Stay on the workouts and keep your motivation!  

Miguel D · · SLC · Joined May 2014 · Points: 503

Sorry to hear that! I feel your pain man.... I had reconstructive surgery for a fully lacerated left Achilles tendon exactly 5 months ago. For what it's worth, here's my timeline, but of course, YMMV.

I was non-weight bearing for a little over about a month. After that, I was able to walk on a walking boot for another month or so before taking it off for good. I was climbing at the gym with the boot on after 2 months or so. Given the rigidity provided by the boot, it felt fairly safe to TR with it, though some slopey or tiny footholds were very challenging. I climbed on rock for the first time (since injury) in early January (4 months after surgery). It was a 5.8 multipitch and I definitely noticed that I had to think about almost every single left foot placement. And I made very intentional efforts to avoid straining the tendon much (like putting a lot of weight on just the toes, like on a small foothold). The general swelling from surgery, combined with a bit more swelling from the climbing itself made the climbing shoe painful enough to wear that I had to take off the left shoe at each belay. I'd say for me at least that was probably a little too early to start climbing, but I didn't suffer any regression or permanent damage. Climbing at the gym is way friendlier since mostly it's overhanging stuff so it doesn't require you to put as much weight on your feet than a less-than-vertical route does.

I started ski touring and riding a bike to and from work after 3 months and that has felt pretty good so far. Running is still iffy and it doesn't feel super great, but it is doable. I loved playing volleyball too but that will take much longer to get back to. I'd say at about 3 months or so your day to day life will be mostly back to normal, but of course the recreational activities are what is limited.

Can't say I did much training or anything like that so I don't have much to help there, but of course, your calf with definitely get pretty skinny for a while. But after you get back to things it should come back relatively quickly. Overall I'd say I'm still at least 3 months away from what I'd call a "full" recovery

And last but not least... One thing that was a game changer for me during the non-weight bearing period was this thing. It really bothered me that I couldn't use my hands while using crutches and made it really annoying to wash dishes, use the restroom, or do many other daily activities. So this thing was awesome to have and definitely beats regular crutches or the knee scooter thing. If your insurance covers this, I'd highly recommend it. If not, let me know, I still have mine and don't need it anymore.

Good luck with your recovery!

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Bret, Chris, and Miguel,
Really, really appreciate you guys taking the time to add your experiences.  The thing I’m really struggling with most here is when to jump back on the horse and weigh the foot. My surgeon is cautioning me to wait 6 weeks and and I can walk again in 2 weeks after that he said.  It also seems to be popular these days to start weighing the foot after 3 weeks. Derek (member dmr above) started his recovery at that point and was incredibly helpful and open sharing his experiences with me this past week. Your comments do give me pause though Bret. I’m definitely in it for the long haul and cannot risk reinjuring this thing.

It’s been a hell of a week since I had my surgery last Tuesday. I saw the surgeon again today and they put me in a new cast, and dropped the heel slightly more. They will remove the staples next week. I look like Frankenstein right now though. I’ve been keeping brief notes day to day. I think I’ll post them up tonight and update them weekly or monthly with milestones so that future climbers/members have a base/timeline they can look at for expectations. It’s been a humbling experience. The mental aspect of being down and not doing anything is definitely the hardest part. Thanks again for sharing guys.

Chris, I’m definitely buying that iWalk!

Brett K · · Somerville, MA · Joined Dec 2018 · Points: 0

I'm glad you got some insights from others on this thread, and I'm glad the surgery went well!

Everyone's recovery time will be different depending on the severity of the damage, surgery, body type, etc so take everyone's stories and comments with a grain of salt.  I am in my 20's, so while I knew my body would bounce back quickly, I also had a 95% tear.  My surgeon overlapped my Achilles tendon and sewed it together—I did not have staples like you, so things will be different. I think my doctor knew I was very active and wanted to get moving again, so I think he purposefully prolonged my stages back to weighting and made it slower. Again, in hindsight, I'm glad he did.  As slow as my recovery seemed at the time, I was running and snowboarding 6 months post-op.

You will know when you are feeling better, but it is all about baby steps.  Find a good PT and take the time for your body to recover correctly — your future self will thank you!  Best of luck with recovery.  

PS- After PT is over and all this is behind you, KEEP STRETCHING. 

Allen Sanderson · · On the road to perdition · Joined Jul 2007 · Points: 1,188

Full rupture, did the nerve block. Had a cast for a week - 10 days then went to a boot. You will not be weight bearing for a while. Do not tempt it. As for what to do while you are recovering. Find a PT/Pilates studio and do pilates that will keep the rest of your body moving. You will have significant atrophy, most will come back but not all. I was skiing 6 month later.

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Bret and Allen, you guys made my day!!! 6 months to being active again is music to my ears. Just in time for me to get back to the Sierra.

Had a full rupture like you Allen. I could basically squeeze the back of my calf and there was nothing but air. I knew I was screwed before even seeing the doctor and getting the MRI. The Thompson test confirmed it but really unnecessary with that staring me in the face. Surgeon said the good news is that the tear was low and away from my calf which made it easier for him, and the upper half didn’t retract too high.

I’m still dealing with a torn labrum/rotator cuff so I understand the benefits of PT and stretching these days. 

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Posting this here for any climber/member who may find this useful in the future if they’re unfortunate enough to have an Achilles injury. My timeline and notes from injury until I’m fully active again. I’ll update it sporadically when there’s something new to report or I’ve hit any new milestone.

1/12/19- injury to left Achilles falling maybe 10 feet while on lead. Suspect that it was due to crampons being caught during the fall.  Injury probably made worse from heel consistently dropping during postholes on descent the following day.

1/29/19 11:30 am- surgery. Home by 2:30 pm. Told that cast has to be on for 6 weeks instead of the original 3 estimate. Ankle is hurting due to foot swelling.  Decided to forego the nerve block and opiates.
7:00 pm- pain went from a 3 to a 5.
1:18 am- It’s an 8.

1/30/19- throbbing pain from the knee down all day. Worse than yesterday.

1/31/19- pain slowly easing to 5 or below except when I stand up.

2/1/19- pain easing more but foot still throbbing if I stand up for any length of time. The swelling has gone down and I can feel the staples more now.

2/2/19- starting working out upper body again, and continuing shoulder PT. Calf and foot feeling just discomfort now versus pain from the previous days.  Toes turned purple from sitting and standing too long.

2/4/19- surgeon removed cast and placed a new one on with the heel dropped slightly more. Staples left in and will be removed next Monday. Don’t click if you don’t like ugly staples and scars.

https://cdn-files.apstatic.com/climb/116511713_large_1549317829.jpghttps://cdn-files.apstatic.com/climb/116511712_large_1549317796.jpg

Pain is virtually gone. Toes still turning purple and Achilles still aching if I stand or sit for too long without the foot elevated.

2/11/19- saw the surgeon again to have the staples removed and a new cast put in. Atrophy of the calf is absolutely horrible. I have the calf of a starving man in a third world country.  Even the muscles on the right leg is breaking down from a month of minimal activity. Wound/scar looks the same but the surgeon said it was normal. Steri-strips put in. Removal of the staples wasn’t too bad.  Foot still swells up from standing or sitting too long without elevating it. Got outside Saturday and Sunday and paid a small price. Beer and sweets does not sit well right now. Back to a balanced diet.

2/12/19- swelling from sitting and standing has shown a noticeable improvement today.  Tried an hour of acupuncture to see if it’ll help.  Spoke with Jonathan from Kinetik who recommended I start leg exercises on the right leg. One legged squats and calf raises to start. Stated that it will be beneficial for BOTH legs.

2/13/19- iWalk 2.0 was delivered. Plan to use it for cardio walk around the block whenever it decides to stop raining.

2/16/19- started lightly weighing the foot for just seconds at a time. Feels fine. Not full weight bearing yet due to doctor’s warnings more than actual pain or discomfort. Foot still swells if I stand for too long, but less so every day. Saw Paolo yesterday who gave me 3 different exercises to work out the right leg. Seated squats were definitely the hardest. Ankle hurts slightly today from not using it to balance properly for over a month now.

2/26/19- one month after surgery, foot still swells from standing or sitting too long, but the puffiness is down significantly. Continuing partial weight bearing for short periods of time like ironing clothes or washing dishes.

3/11/19- cast is off. Severe atrophy. The left leg is obviously skinnier but both look like they belong to someone starving in a third world country. Can barely flex the toes, feels numb and swollen.  

Doctor says to start full weight bearing with a boot for two weeks. Move to a regular shoe with the lift after that and start physical therapy.  Feels so damn good!  Able to walk around fine with a boot. I can walk normally up the stairs again!  Cannot wall barefoot. Calf muscle seizing up from finally being used for the first time again in exactly two months.  Muscles feels disgusting like jello.

3/12/19- braced myself and tried standing calf raises. There is zero strength and muscle memory. Calf immediately seized up not even an inch off the ground, and leg dropped. Like learning how to ride a bike for the first time. Seated calf raises worked wonders. Achilles very tight. Hardly any flexibility. Worked on rotating foot and wiggling toes. Very light 30 minute ride on stationary bike.  No pain from the Achilles tendon. Only minimal pain from the heel bone. It feels like the pad underneath the bone has shrunk significantly.

3/13/19- first day at the gym. Two hours of easy climbing with Rick.

3/18/19- surgical sight healing really nice after just a week of air.  Slowly walking around in sandals at home. Walking barefoot still hurts. Pain mostly from the heel bone and then around the ankles. Tendon feels tight but not painful. Continuing to constantly wiggle toes and rotate foot to get motion back.

https://cdn-files.apstatic.com/climb/116633346_large_1553191843.jpg

3/25/19- first day in two regular shoes. Using one crutch for safety margin.  First day at physical therapy.  Achilles feels fine. It’s the ankle and heel that feels weak and sore. Christi said it’ll take about a month before my body builds the fat under the heel bone back up.

3/27/19- 5.5-5.7 at the gym with Rick. No more boot. Climbing shoe doesn’t fit. Wore Five Tennies.

4/3/19- third PT session. Walking almost normally again. Slight hobble due to tightness of the muscles and tendons, not pain.  Left tendon about 3-4 times as thick as right tendon. Shane says I’ll have to deal with that. Tendon won’t shrink much further.

4/22/19- “released” from surgeon. He said I no longer had to see him unless I wanted to or if there is any unusual change. He said to continue working with PT and play it by ear before getting fully back into climbing and hiking/running. Cautioned against allowing the leg to swell up too much. This marks a day shy of 12 weeks post-op.

4/26/19- coworkers mention that the limp is barely noticeable now.

5/4- swelling has gone down significantly but Achilles on injured leg still a lot larger than the good side.

https://cdn-files.apstatic.com/climb/116835792_large_1557155876.jpg

5/9/19- one lap of Cowles Mountain. Took the gentlest way up, switchbacks via Barker Way, to minimize stress to the tendon. 1h10m to do 3 miles round trip and 900 feet of gain. First major milestone since taking the cast off. Cardio way off. +14 weeks since surgery. 4 months since accident.

5/10/19- swelling and pain minimal from hike yesterday.

https://cdn-files.apstatic.com/climb/116956478_large_1557541612.jpg

5/14/19- exactly week 15 post op. Cowles Mtn to Pyles Peak. 1,800 ft of gain, 6 miles round trip. 2h5m. Feeling better, although still gasping like a fish out of water, but happy with the gains so far. Minor discomfort towards the last half around the tendon. Overall doesn’t feel bad.

5/15/19- minor swelling from yesterday but not too bad. Taking the next 3 days off from hiking.

5/18/19- Uneventful at Tahquitz. Rich offered to carry all the gear. Discomfort on the stems. Still able to lead 3 of the 5 pitches. Still can’t fit into climbing shoes. Wore Tennies on bad leg. Trail ascent and descent felt decent. Minor hobbling later in Temecula. Felt better at home. Still long road to go, but steady improvement.  Exactly 18 weeks since accident, 15 post-op.

5/19/19- sore, but no major swelling. Recovery going slower than I want but not too bad.

5/24/19- first time able to do single heel raise, even if it’s just about 2” off the ground.  Major milestone for me. Just last week I couldn’t even will it to budge a fraction; zero movement.

5/26/19- tendon definitely sore from Tahquitz yesterday.  Second time on real rock. Hanging belay didn’t feel good with tendon stretched from ball of foot against the rock, or with pressure from lay-backing. Taking a few days off.

6/6/19- 2 laps of Cowles, 2x Pyles. 3,600 ft of gain,12 miles, 3h15m. Tendon starting feeling slightly sore last 1.5 mile. Slow but steady pace.

6/15/19- first hike at higher elevations. San Jacinto Peak via Devil’s Slide, 15.5 miles, 4,400 feet of gain.

6/22/19- 20 weeks, 5 months post op. Able to get full day in at Tahquitz. Struggling with 5.9/10a. Achilles sore at end of day but manageable. No pain following day.

7/16/19- 24 weeks, 6 months post op.  Able to get 5 continuous and long days in at Tuolumne and the Valley.  Easy/moderate climbs with short approaches.  Heavy packs are still a chore.  Tendon is sore at the end of the day but recovers well the following day and is able to deal with the work.  Still lacking power and cannot do explosive movements like a sprint.  Slabs and edging are a major problem on climbs as the left foot doesn't have the strength to press down with authority.  I give up those pitches.  Otherwise, the tendon still feels fine, but will probably take a full year to recover per the doctor's and therapists' estimates.

Allen Sanderson · · On the road to perdition · Joined Jul 2007 · Points: 1,188

A couple of followup notes. I debated on the nerve block. But after doing it I tell folks to do it and do not think twice, best damn decision I made. The 48 hours of numb leg was so worth it as I took no other pain killers. My wife took them as I was a PIHA (still one). Amazed that you went two weeks between the injury and the surgery. I went 3 or 4 days. Interesting seeing your scar. I got sewn up rather than staples. And much less bruising and only about a 3" scar. Photos were not bad - I have some from my surgery itself.

I am now 5+ years out and there is still residual atrophy in my calf but it is as strong as my other. Still some tightness. The biggest reminder - my teleboots will rub the scar as they are not packed out.

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Hi Allen,
If it was my brother or friend, I would wholeheartedly encourage them to take the nerve block and/or painkillers.  Avoiding the happy pills was a purely personal decision for me, and not something that I would recommend to anyone else.  I won't lie, there were definitely a few tears shed the first night and second day.  It wasn't fun, but I don't regret my decision.  

I was pretty upset about the 2 week interval between injury and surgery.  There were a lot snafus and a lot of foot dragging.  I have a PPO and will say this, I won't go back to that hospital.  The worst was when I showed up for my MRI after having a flat tire the previous evening.  When I got to radiology, the nurse at the front desk told me the machine was down.  Didn't even bother calling me.  He said, "oh, we were going to call you in 5 minutes".  5 minutes after my appointment?  

Yeah, everyone is calling me Frankenstein now.  Don't care about the looks as long as I get back in the game like you guys I'll be happy.  I know I've said it before, but thanks.  Talking with friends and even strangers online these past few weeks have been therapeutic more than most people realize.  Hearing experiences from other climbers who have recovered and back climbing even better sometimes is great for the mind.  I can't get enough of reading other people's experiences.  I still have a torn labrum to deal with but at heart I'm more a mountaineer than rock climber.  At least with the shoulder I could get out and hike and do easy climbs.  Being stuck on the sofa waiting for people to come over is mental torture.

Rick Horwat · · Unknown Hometown · Joined Jul 2017 · Points: 0

I had full fhl transfer surgery in 2016. 1st surgery was a repair but even after all of the pt, etc it developed enough scar tissue that it was the size of my shin bone.

When I asked why this happened the surgeon told me my body just likes scar tissue. After a MRI I was thrown options and the best remedy was full fhl transfer.

I followed the rehab protocol to a t.

Healing from 2 surgeries, going through the pt protocol 2x, and the time involved was a real pain in the ass.

Well here we are.

2019...  I already did a few 70+ mile snowshoe solos with big weight on my back(solo + no resupply) and am prepping to climb Rainier in the summer of 2020.

If it goes well I will then go for Blanc, Cotopaxi, and a few others prepping for Denali, then off to the next. 

I can leg press 600lbs without much quibble. It does feel tight in the morning but that goes away once I get moving.

Im not a summit nut. Its not about that for me.

If it happens great, if not oh well.

Its about the journey not the trip.

I will pull the plug on my ascent quick if I feel its the right thing to do.

Not just about me up there.

Ive deep 6d trips before because it didnt feel right so Im definitely not above it.

Especially when folks are on the lines with me.

....again, its not just about me and surely isnt about the summit.

At least for me it isnt.

Some chase summits and that is okay. Just not how I roll.

Ymmv

Ero Sennin · · San Diego, CA · Joined Jul 2018 · Points: 155

Thanks for adding your experience Rick.  Reading about others' experiences these past 3 months has been tremendously helpful.  It's also been surprising how vastly different the protocol has been for different doctors and therapists.  Some appear to advocate getting back at it as soon as possible and pretty aggressive, while others are definitely more conservative.  There does not appear to be a consensus from what I've gathered.

I just passed the three month mark since post-op and my doctor said I no longer needed to see him unless I wanted to.  Basically got the clearance to work exclusively with PT, and try things out on my own.  The therapist working my Achilles expressed some concern about the size.  The tendon on the affected leg is about three times as large as the normal leg.  I tried putting on a climbing shoe and it wouldn't fit.  He said he's never seen anyone else with that amount of scar tissue and actually told me to tone it down.  MP poster dmr above has been especially helpful during this entire time and fielded all questions I've had throughout the months.  He experienced similar scarring, and his Achilles grew about the same amount but he's had no complications and climbing better than ever.  My second therapist doesn't think it's an issue, so I'm at a loss.  I'm taking things slow (I think...for me at least).  I've only been on a stationary bike and on light resistance settings, and top roping at the gym on ridiculously easy stuff.  I've been wearing one climbing shoe on the good side and Five Tennie approach shoes on the affected leg.  Trying to find some climbing shoes right now that isn't too aggressive by the heel.

PT and everything is ramping up next week.  I experience tightness in the tendon when I first wake up, and minor swelling towards the night.  During the day, walking on flat ground, most people wouldn't be able to see the slight change in my gait.  It looks practically normal.  Regarding the scar tissue, I've been kneading and scraping the hell out of the tendon every night (with the approval of my therapist).  Hearing about your leg press and snow shoeing is awesome!  70+ miles snow shoeing is no joke!  I just bought a bench and some weights to do leg extensions at home to get some muscle back in the quads.  They and the both calves have atrophied significantly, but I've been warned against aggressive calf exercises right now.  Can't lift the affect heel off the ground even an inch.  My therapist gives me hope though.  He thinks I can get really aggressive at the four month mark, and fingers crossed if everything goes well I can be back to "normal" at six.  He's an outdoors guy and says I should be able to head up to the High Sierra and Yosemite by late Summer/Fall.

Good luck on Ranier next year and Denali; you just might see me.  Also, agreed on the experience and adventure versus the summit.  Best to you.

Rick Horwat · · Unknown Hometown · Joined Jul 2017 · Points: 0

Yeah man, I think you will be good.
Just get out there and get at it.

Biggest thing for me is listening my body.

Gonna be my approach. It will let me know if its not right well b4 things ever go south.

Just gotta listen to it. 

Wesley Neill · · Sequoia National Park, CA · Joined Nov 2016 · Points: 578

Just tore mine on a lead fall on Moro. The MRI tech wouldn't tell me how bad cause she wasnt allowed, but she let slip that "it looks like a bomb went off in there".

Waiting to see a doctor to get the full scoop. Thanks to all for the information here.

Guideline #1: Don't be a jerk.

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