Days 1-11

Hello all!

I am 36 years old, fairly active, worked out 5 times a week. Blew my Achilles playing tennis – POP, “blow” above my heel, and I am on the ground waiting for an ambulance. This happened around 5:30PM on Thursday, October 9. I was taken to the small injury department in St. Mary’s near Paddington.

There they did the calf squeeze test, and broke the bad news – a complete Achilles tear.

Now, I am new in the UK, and don’t know how to navigate the health system. I am fortunate to have private insurance, which I think may have done me a disservice (read on).

I asked one of the doctors whether I should use my private insurance, and he said that he personally would, so I followed his recommendation. In retrospect, I think I may have been better off going the NHS route, because it’s 10 days later I still don’t know who is going to treat me, where and when.

So – they took X-rays, put a temporary plaster on the front of my leg, told me to expect a call from a doc. All in all, I was in and out of the hospital, on crutches in about 6 hours.

Friday, October 10

I get a phone call from a doc, let’s call him Mr. Spine. Scheduled an appointment for Tuesday, Oct. 14, with a view to do surgery on Wednesday the 15th evening. I looked him up on the web – guess what – he turned out to be a spine surgeon. At this point I may have gotten paranoid, and decided to myself that I am going to get a second opinion from an orthopedic, and quickly booked an appointment (Mr. Ortho1) for early Wednesday the 15th.

Friday was also the 1st day I started running a fever.

Tuesday, October 14

During the appointment, Mr. Spine did not attempt to see the foot because it was covered with temporary plaster. When I asked him about his specialty, he said that he indeed specializes in spine surgery, but Achilles rupture surgery is so simple, he could do it with his eyes closed. But – if I prefer he’ll be happy to hook me up with a lower-limb doc, and immediately proceeded to call the other doc (Mr. Ortho2).

So, somehow I ended up with 2 appointments with 2 Ortho doctors – Wednesday the 15th with Ortho1, and Monday the 20th with Ortho2. This could be a subconscious slip – in my line of work we bid out every job to at least 2 vendors. Now that I think of this, some time off work is not such a bad thing – looks like my work practices are getting too intertwined with my personal character.

I weighed my options, and decided that I’ll pick one of the two Orthopedics to take this forward, and cancelled the Wednesday surgery with Mr. Spine. Perhaps I should have had more confidence in him, and would have been on my path to recovery by now.

Here is what £197 buys you nowadaysWednesday, October 15.

Mr. Ortho1 was a lot more thorough with his investigation – he took the temporary cast off, said that the foot is too swollen to cut it right now – the skin will tend to spread apart after the surgery. He also ordered an ultrasound for Thursday the 16th, and hooked me up with a boot.

Thursday the 16th.

The ultrasound doc told me that I don’t have a complete tear – that I have a complicated partial tear, very inflamed tendon, a lot of damage close to the calf, and a bad case of tendonitis. Now I don’t know whom to believe – the ultrasound doc, or the original ER doc, who did the Thompson test.

This brings me to my first question to the combined wisdom of this board:

Question 1: How is it possible to have a positive Thompson’s test with only a partial rupture?

Mr. Ortho1’s explanation was not convincing – he said that this may be due to pain (what pain?) and swelling. He scheduled a follow-up for Monday the 20th, and said that surgery is not necessary.

So – at this point I have 2 appointments for tomorrow: 1st visit to Ortho2, and a follow-up with Ortho1.

9 Responses to “Days 1-11”

  1. Hello addict,
    Bad luck with the injury old boy. You appear to have been caught between a rock and a hard place in terms of who the main organisors of your care are. The issues here are that the boundaries between the private health sector and the NHS are becoming rather blurred - it used to be that they ran independently of each other but now the need for efficiency and sound economics mean that they are increasingly working more closely (I wouldn’t say together ) Retrospectively what you should probably have done is let the NHS deal with it all and used your private insurance to get the best in terms of convenience for you. What I mean by that is many of the surgeons work in both sectors so you could probably have been seen by the same Doc all the way through your process and had the continuity that would have brought ‘

    Don’t be afraid to insist on a clear plan from now on - if you read my blog you’ll see how a bad decision can rebound on you later.

    Good luck, keep in touch.


  2. Hi Richard,

    Thanks for the note - read your story, it really must be crushing to have to go through this all over again.

    Regarding my case — you’re probably right, I should have kept my mouth shut about insurance. It might be just my perception, but I feel a bit like I was caught in the middle of favor trading between doctors.

  3. Addict: Uh, what was causing you to have a fever? Good job keeping your wits about you. I think I would be crazy by now. First off, who exactly read your ultrasound? Was it a radiologist or an ultrasound tech.? Even then, a radiologist knows a little about a lot of things. A specialist doctor (foot and ankle orthopedist) knows a lot about a few things. An ultrasound tech, (here in the US) knows basic anatomy and physiology and how to safely operate the ultrasound machine. They don’t get a “ton” of medical training here. They shouldn’t be reading an ultrasound at all. My point is this #1) I would NEVER allow a spine doctor to fix my Achilles (well unless we were stranded on a dessert island and he was all I had). #2 What was the education and specialty of the person that actually read your ultrasound? #3) If you do have some tendonitis, there may be an underlying problem that caused your rupture (like equinas) and probably only a foot and ankle specialist would think to look for that.
    I ruptured 2 years ago. I, not knowing, allowed an on call orthopedists to do the reattachment. He got the thing together. The whole process was much worse than it needed to be not because of his lack of expertise but because of his lack of specialty. I ended up in a bad place with my Achilles less than two years later and by a stroke of luck I was sent to a foot and ankle specialist. I have a long history Achilles tendon problems and with this information my first surgery should have been done totally different. I am now recovering from my second surgery which is basically a tendon and heel reconstruction. The procedure I had done is somewhat new and I have even had other doctors and nurses (in my insurance network) call me to follow up an learn about what I had done. If I were you, I would go for doctor #4 and I would make him a foot and ankle orthopedist. I hope you at least got a few good pain pills to munch on while you sort this out!!

  4. Smish, thanks for the detailed reply.

    Haha, yes, good drugs is always a silver lining in our situation. However, I hardly have any pain in my foot. So - I take 400 Ibuprofen every 8 hours to control the fever.

    Fever is a weird one - I’ve been running a temperature of up to 40 (104). Ibuprofen brings it down, but then it starts to climb back up again. I have absolutely no other symptoms – no coughing, sore throat, stomach problems – nothing. Just the temperature with the headache and weakness that it brings with it.

    I wake up a couple of times every night, cold and soaking wet. It’s been 10 days now, with no signs of improvement. Some of my friends said that broken bones can sometimes cause temperature. All the doctors are telling me that it is not related to the injury. To me it just seems too coincidental – started at the same time, and I have no other symptoms. Can Achilles rupture cause prolonged fever? Can this be a sign of complications?

    Regarding selecting the doctor – after reading your comments, I feel reassured that dumping the spine doc was the right thing to do.

    On the other hand, as days go by, I am wasting valuable time while the tendon is scarring. I imagine every day lost now will cost me 10 during recovery, plus I don’t get any “credit” for the time before surgery – if I need 8 weeks after surgery – the count starts after the surgery. Not sure where is the line between timely treatment and quality of care…

    The ultrasound dude was an actual “ultrasound” doctor, who read it and wrote the report. Which would you believe first – the ultrasound or the Thompson test?

  5. Addict: Tough questions. All I know is that the report I got from the radiologist that read my MRI gave a different diagnosis than the foot and ankle orthopedic that did my surgery. The radiologist thought a certain finding was a huge issue. The orthopedic said it was no big deal but a different finding was the big issue. I went with the specialist. I have not heard of people having fever with an Achilles rupture but I am not a doctor. I have also heard of people having their Achilles fixed weeks after a rupture and they ended up running and sprinting with the best of them. Good luck!

  6. Addict:

    I had a somewhat similar experience. Ortho #1 said complete tear, needs surgery, but humored me and ordered an MRI. MRI read a partial tear with lots of tendonosis. After Ortho #1 took forever to read the MRI and wouldnt return my call, I saw Ortho#2. He said he trusted the Thompson test more than the MRI - MRI could show partial tear even if its just the sheathing that is still intact. Ortho #2 convinced me to do the surgery and reported that I had a complete tear (that had retracted into my calf). Had I not had the surgery, it would not have been good.

    Hope my experience sheds some light…


  7. Addict,
    Bad luck. I have a similar story. When I got hurt, the urgent care folks said I had a complete rupture. Then it took my insurance guys about 3 weeks to send me a referral to see an orthopedist- a hand specialist! What a zoo. He told me I didn’t tear the Achilles, just a muscle tear and an MRI would be a waste of money. You’ll have to check my blog. It’s a long story. Finally 6 weeks after the injury, I finally saw an orthopedist who knew what he was doing and said he thought it might be a rough surgery & recovery because of scar tissue buildup. I’d been hobbling around for 6 weeks in a boot just like yours! I’d also been doing lots of ice & elevation, foot circles and toe wiggling. The short of it is, once he got in, thankfully, there wasn’t as much scar tissue buildup as he expected. I’m almost 5 weeks from my surgery and am out of my cast & in a boot, going a good part of my day 2 footed! When he did the Thompson test, he suspected I had some attachment as there was a very faint response. He found it hanging by a thread. Good luck on your surgery!

  8. Edforman, thanks for the note, it’s certainly reassuring. Orhto2 said there was no question that there was a complete rupture, and confirmed that ultrasound may be unreliable, if the ends of the tendon are just dangling close to each other.

    I ended up having surgery yesterday, will post more details shortly.

  9. gw0508, read your story - it’s great that you can write with humor about this kind of stuff! Also happy to see that your recovery is going well now, after all that trouble with finding the doctor.

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