Brokenbride’s AchillesBlog

The Cast Clinic

I’m not sure how most Orthopedic Surgeons work, but in Calgary you have to visit a Cast Clinic at one of the three hospitals. It’s actually a very efficient system. The clinic is a large area with a series of little rooms just big enough for an observation table. There’s several Ortho Techs that go [...]

I’m not sure how most Orthopedic Surgeons work, but in Calgary you have to visit a Cast Clinic at one of the three hospitals. It’s actually a very efficient system. The clinic is a large area with a series of little rooms just big enough for an observation table. There’s several Ortho Techs that go room to room to cut off and put on casts. The doctor never waits, he simply goes from ready patient to ready patient. My Orthopedic Surgeon is Dr Duffy. I like him, he’s very personable, never speaks down to me and is very sympathetic to the timing of my injury. Dr Duffy is in the clinic on Mondays. That’s the only downside to the system - if you’re in a cast, you only have one day a week to book in with him.

I couldn’t see him the Monday after the wedding so I had to wait a week to put on my shiny new VacoCast. Dr Duffy got called into emergency surgery and was running behind by 90 minutes. I’ve had a couple long waits in the Cast Clinic and have observed that the majority of patients fall into two groups. Sadly, the first and largest group is seniors. I guess it makes sense since you’re more prone to broken bones with old age. These patients are the best “waiters”. They never complain. In fact they use this time to knit or read. The next group are men ages 30 to 45. It seems most of these guys got hurt on the job and usually have a leg injury. They tend to be more impatient while waiting and they like to share their “war” stories with the other guys. And I, I pretend to sleep.

One story I did find intriguing was the rodeo cowboy who got trampeled by a bull and had to be airlifted to emergency. He seems to be doing okay for how messed up he got this summer. Some conversations amuse me and I started jotting down things overheard in the waiting room. Below is a list of my favorites:

“pain meds are good”

“I’d rather be getting a rectal exam right now”

“Not sure how I ended up on that wall a second time. But that’s when I really broke my arm”

“And to top it off, I broke my ashtray from Mazatlan”

“…then my pee turned red”

Anyways, my ankle looks really good. A little bruise and a bit of swelling. There’s still a small gap but it’s healing nicely. The VacoCast is at 15 degrees (about a 2cm lift) and it’s nice to put some weight on my leg. The calluses on my hands were starting to crack and bleed from using crutches.

I left the clinic, went straight home and into the bath tub to have a full body soak without a cast. Heaven.

8 Responses

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as always you make me laugh! Great to get that leg into the bath isn’t it.

1 sheena October 31, 2012 4:54 am

Good stuff! Boots are better, and most folks here LOVE their VacoCasts. . .

2 normofthenorth November 02, 2012 4:51 pm

Thanks Norm, the boot is really working out well. When I saw my doc on Monday he put two wedges into my cam walker. The next day my VacoCast arrived and I set it at 20 degrees. It’s four days later I feel comfortable at 10 degrees and think I could go even lower. With the cam walker he told me to take out one wedge per week (so neutral after 6.5 weeks). I feel like I could be neutral fairly quick (even now at 5 weeks) without pain.

Here’s my concern - my doctor(s) keeps warning me of healing to long. They’ve all said healing to long is irrevocable and I should be patient. In their opinion the benefits of the fast protocol might not be worth the potential downside - healing to long and not being able to treat it.

I can still feel a gap, and the Thompson’s test is not great at this point. With the non-op approach I do fear healing to long.

Any advice? Thanks

[WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

3 brokenbride November 02, 2012 5:38 pm

Ryanb and I are both currently preaching the fear of healing long, and being gentle with stretching (dorsiflex direction), even when docs and PTs recommend otherwise. Nobody totally knows exactly what causes healing long — it could be slips and trips (and the muscular reaction to near-falls), it could be patients or PTs stretching too aggressively too soon, it could be immobilizing with insufficient DF (or “equinus” or “ballerina”), or it could be something else entirely.

We do know that the UWO study got excellent results, with non-op ROM and strength virtually identical to post-op results. They kept all their patients on 2cm heel wedges (in fixed-boot AirCasts) for 6 weeks, no transition, then on to neutral (0 cm, no lifts) for 2 more weeks, then “wean off boot”. From about 4 weeks on, all the patients were FWB, first with wedges then without. Details at bit.ly/UWOProtocol .

Given a choice between the traditional “TLAR” approach (”That Looks About Right”) and a protocol that’s actually demonstrated excellent results, I’m strongly biased toward the demonstrated excellent results. Some other logical-sounding approach (like removing wedges gradually, or going as fast as seems comfortable) might work better, or it might work worse. But for the century or so before ~2007, we went with “TLAR” and logic, and now those old protocols seem stupid, and their results seem unacceptable. The logic was OK, but the science was no good. So I kept a copy of the UWO protocol in my pocket during my rehab, and I think everybody should, until somebody demonstrates an even more successful schedule.

Mind you, I personally found UWO’s instant cold-turkey jump from 2cm heel wedges to neutral (at 6 weeks) uncomfortable (too big a “stretch”), so I spread it over a day or two — but still at 6 weeks post-non-op, not sooner. And as luck would have it, my own gastroc-AT-heel connection seems to be too long, and my completely-healed 1-leg heel raise is wimpy! So UWO’s statistically average results are very good (op and non-op), your results may vary, and mine did, but I’m still having a blast on the volleyball courts (court and beach), and usually being the oldest person in the building by 20+ years! (I hope this remains my biggest problem! :-) ) Also, my “2cm” heel wedges turned out to actually be 3cm, through a technician’s error at my sports-med clinic, which should logically have made my AT SHORTER than the standard UWO patient. . . but no. Mysteries remain, alas.

BTW, if you can re-install that ATR Timeline Widget, several of us will be able to give you better-informed answers, knowing just how many weeks and days post-treatment you are.

4 normofthenorth November 02, 2012 11:06 pm

Thanks again Norm for all the valuable advice.

Are my widgets not showing up? They are visible at my end. Please let me know. Keli

5 brokenbride November 03, 2012 2:36 pm

IO don’t see them at all

6 kkirk November 03, 2012 5:14 pm

Thanks for sharing such a good info with theirs.
good work

7 Mihcea September 04, 2019 2:36 am

Good to know that the Calgary have the specialists of the ortho. They have a high level of treatments for the person suffering from ortho diseases. You have to check cheapwritingservice.com reviews for those students who are ready to gain educational work. We should consider them as a role model to implement such kind of services in our communities as well. Be positive and try to learn from others.

8 Sternberg September 04, 2019 7:34 am

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