Rodrigo Hernandez

I believe the best way for me to start off is to say, right off the bat, being treated by Dr. Levine has been, by far, the single best thing that has happened to me since I sustained my injury, a re-rupture of my peroneal tendons. If you’re looking at surgery and your choice is between being treated by Dr. Levine or going somewhere else, as far as I’m concerned, look no further.

Now for the pertinent details. I’m a chef. On July 1st, 2014, I stepped into a small puddle hiding under a work table. As I turned to start off in another direction, my right foot hydroplaned across my body. As fast as the slip started, it stopped just as quickly. When my slip resistant shoe finally, suddenly stopped my skid before I could fall, I felt what I could only describe as an unraveling in the back of my leg. Funny enough, it didn’t seem like a very big deal…for about 4 seconds…until I took my next step. The pain was so intensely excruciating that in a split second I was covered in sweat from the top of my head right into my shoes. My crew saw the look on my face and thought I was having a heart attack.

I experienced a 3” diagonal tear in my Achilles tendon. A complete rupture. Along with that, I managed to completely rupture my peroneal tendons, longus and brevis. The original repair to all my tendons was done by a surgeon who had a fellowship at HSS. During my original surgery, my Achilles tendon was sewn back together; however I had mangled my peroneal tendons so badly there wasn’t much to piece together. She did what she could. She explained what the surgery would be like and what the unknowns were before, after and during recovery.

My immediate post-surgical experience was unbelievable in the sense that the pain was so profound that I was prescribed two oxycodone every four hours for at least a week to 10 days. On top of that, I was prescribed Lyrica to be able to sleep through the night. And probably like a good majority of people who may read this would say “I couldn’t do all those drugs”, which is what I said, unfortunately. The pain I felt from not doing what the doctor prescribed is impossible to describe except to say that I felt like I was part of some godforsaken medical experiment. Needless to say, I followed the directions to the letter from that time forward. That part really had nothing to do with Dr. Levine. I just thought I’d throw that out there in case you’re looking at surgery and think you’re tough.

The part that brings me to Dr. Levine is this, I had gone through a good 8 months of rehab, very tough rehab, and was back at work for three months already. Everything was coming along fine. Although I was far from 100%, I was in a much better place. I could see some daylight. I had organized my rehab so that it would best emulate how my day would go in the kitchen so that I wouldn’t run into any surprises. Then one day back at work, as I was walking up a flight of stairs at work, not carrying anything up a flight of stairs, just simply walking up stairs, I heard a pop. Inasmuch as I didn’t think anything was wrong, my previous experience dictated that I call the surgeon who immediately instructed me to go for an MRI. I experienced an unforeseen complication.

I had ruptured what was left of my peroneal tendons. It probably wouldn’t have happened to a younger man. But being a chef and being on my feet 8- 12 hours regularly over the last 20+ years didn’t really give me the healthiest set of tendons with which to begin. The surgeon who had done my original surgery recommended that I get a consultation from her mentors at HSS. That’s where I had the good fortune of meeting Dr. Levine and his staff.

From my initial consultation, Dr. Levine explained clearly what the different choices I would be facing were, the complications that may arise and my probability of a full recovery for each scenario. At that point, a whole new set of possibilities became available to me. When Dr. Levine explained the possibility of having a whole “new set” (that’s me talking not the doc) of tendons using my hamstring, I didn’t even take a minute to make up my mind.

The option I chose to repair my peroneal tendons was a hamstring autograft. One of my hamstrings was harvested and used to reconstruct the damaged tendons. This gave me the opportunity to have all the support and stability of “new” peroneal tendons that would get stronger over time. This was a much greater set of possibilities than I had been looking at even if my peroneal tendon didn’t rupture a second time. For instance, all throughout my rehab and even when I was healthy enough to go back to work, the most painful part of my post-surgical experience had been getting what was left of my peroneal tendon back in shape. My best possible outcome was that, over time, the peroneal tendon would respond to the rehab and eventually loosen up a bit and be less painful but every day was a pain ridden experience. On the pain scale, it was always ranging between 4-8. There were times when I wasn’t sure how I was going to be able handle the quality of pain I was experiencing on a long term basis. So, in a way, the rupture was a gift.

I’ve taken this long to cut to the chase only because I wanted you to know that when I made my decision about the hamstring autograft it wasn’t as if I hadn’t had any experience with this type of injury or ever did a lick of research. I had, and it was a new option I hadn’t read about or heard about. Going to Dr. Levine was a game changer. I was scared witless that I’d never be able to walk normally again or play around with my son or even get back to doing everyday simple things that one takes for granted. This was the second time I had injured the same foot and same tendons. I needed a game changer. Or how about, when a surgeon needs another surgeon, he’s the guy that got the call. The surgery itself is quite remarkable. I understood the process before getting the surgery. I didn’t do any in depth research before the surgery because I had done that once before and scared the bejesus out of myself. But when I was home recovering and read up on what was going on with my foot in order to be able to figure out how I could best approach my rehab it became quite clear how remarkable the surgery really is.

I think the best thing I can do for you is pose a question. If your choices are to go for the type of surgery I originally had where they stitched together the remnants of a mangled peroneal tendon and that the best expectation given to you is that “there will be tightness” and that overtime it will get looser or having a hamstring autograft so that nothing gets looser but instead continues to become stronger over time, what would you choose? I would suggest the getting stronger option. And that’s simply because I’ve had both. Stronger is better…much better.

My post-surgical experience was night and day from what I had originally experienced with respect to pain. I didn’t have two major ruptures to deal with, but it was Dr. Levine’s expertise and skill with this type of surgery, without a doubt, that was the major difference. I’m not exactly sure how he was able to do what he did because of the intricacy. The back of my thigh was pretty sore to painful for a week from the hamstring harvest but nothing like my first experience. As a matter of fact, I remember Dr. Levine taking a moment to look at me in the face on one of my post-op check-ups and drive home the fact that although I was feeling much better than I could have imagined so soon after surgery, it was only his stitches holding the tendon together at that point. That’s when he explained to me that as I continue my rehab and everything else I do, remember to protect the graft.

My post-surgical visit at the hospital was with Lisa, a sweetheart of a person and his physician’s assistant, who gave me the prescriptions I needed and some instructions. The sad part is that I was all too familiar with the protocol. When she explained that I was only going to have pain meds for four days or so, I kind of freaked a little because of my last experience. Turns out she was right. I didn’t even finish what I was prescribed. I couldn’t believe it. It was like a dream. I still had to take it easy, obviously. I was still looking at another 7 months of rehab before I was ready to get back in the game. I can tell you this though, I felt better after a few months of rehab than I had felt when I had already been back to work after my first surgery with 8 months of rehab behind me and 3 months back at work in a very physical profession.

Dr. Levine, Lisa, Jadira, Gertrude: before I had the good fortune of meeting all of them, I seriously felt like I was on the precipice of an abyss of uncertainty. Honestly, a semi-psychological free fall. I walked in there purposely keeping my expectations very low yet refusing to believe that I couldn’t make a full recovery somehow. The idea of having to go through another surgery was daunting. The thought of the long road of rehab again was almost overwhelming. I am very grateful to have had all of them in my corner throughout this experience.

Dr. Levine’s concise explanations of what was happening at every step of the way with respect to what would happen in surgery and during my recovery was a perfect way for me to be able to visualize a time in the future when I would be walking around again. I think the quality I found the most comforting was his ability to answer the questions I didn’t fully ask or know how to ask and then addressing my concerns or in some cases his concerns about how I should be approaching my rehab. Lisa’s ability to help me help them understand where I was in my recovery was a clutch talent. She interpreted what I was saying into useful information for Dr. Levine so that he could address their issues about where I was in recovery with me and my concerns as well just like a well-oiled double play. Top notch.

Jadira was great. She is the go to person that helped me navigate all of the insurance details. I believe her gift is being able to help you get things done when you are not necessarily the star player on the team or even close to the best person you’re capable of being. She was the one, when I was at home worrying about everything all at once, going the extra mile, making sure that everything was in order and not feeding into my own internal dialogue of hysteria. That type of steady handed approach seems to be a trademark of that whole team.

If you’re facing a surgery that falls into Dr. Levine’s wheelhouse, don’t hesitate. Pull the trigger. You will not regret it. Every once and a while, the physical therapists I was going to would ask me to have a conversation to someone who was just starting rehab because they thought that I might be able to help somehow. Maybe just give them a glimpse to how recovery may look for them in a couple of months. They’d sit me next to someone with that 1000 yard stare of uncertainty, sitting at the edge of the PT table trying to use their toes. A countenance you can’t control. I know because I’ve seen it on my face on more than one occasion. I know it very well. I would say something like “People tend to get better…” and let them ask the questions. If you’ve gotten this far through this piece I offer you this, why wouldn’t you want to set yourself up with a surgeon that could offer you the best of all possible outcomes available?

I’m back at work now. On a slow day, I can easily walk 4-5 miles. On a busy day, I can easily do close to ten. I’m not doing any high impact anything because I’m still protecting the graft to some degree. I know from my previous experiences with respect to pain level and range of motion that Dr. Levine has put me in an excellent position to be able to see in my future a greater recovery than I even imagined before. I still have a way to go but it’s all about doing the work in therapy, listening to your body and keeping a positive outlook on what you can achieve at any given time as you’re getting stronger. That really is the key “as you are getting stronger”. I hope this has been helpful.

And to Dr. Levine and everybody, thank you for all your help and support. If this piece is a reflection of my gratitude, it only scratches the surface. I could go on for days about you guys. Thank you so much.