11th July 2009 MRSA positive screening pre-surgery

First post - ruptured my left achilles whilst playing badminton on 26th June 09.  I have read a lot about many such injuries happening to individual’s participating casually in sporting events.  Although I am in the expected age range for potential rupture (38), I have been far from inactive - triathlon is my preferred sport, although I am not very good at it (405 out of 418 at my most recent event, the Little Beaver triathlon!)

I recently took up badminton again after a long absence, as we started a sort of league at our office.  The day I ruptured my achilles was only my second outing and I was starting to get back some of my sharpness.  3o minutes into the session (although I did not bother to warm up as I thought it was unnecesary for such an easy outing) my tendon went.  Usual story, felt as though I had backed up into a low bench or something - looked around in amazement and whilst collapsing onto the floor knew instantly it was my achilles.  My co-competitors thought I was larking about at first, but quickly got help.  45 minutes wait for an ambulance, so we decided to drive there.  After about 1 minute the pain went almost completely away but I could not even stand up.  Felt pathetic!

We drove from the NIA in Birmingham - good sports hall by the way if anyone lives here - and not particularly well known - to City Hospital.  This was a mistake.  Although it is the nearest hospital to Birmingham city centre, where I live, it falls under the Sandwell trust.  This caused problems later on as I was asked to relocate to Sandwell for treatment, miles away and not a particularly pleasant journey for visitors etc.  I would suggest to anyone having any sort of injury in Birmingham to ask to go to another hospital, Selly Oak maybe or Solihull.

Usual tests at the hospital, including MRSA swab taken from nose.   7 hours in the hospital the first day.  Finally told that I could either have surgery or conservative treatment.  Surgery would not be able to be done until the Monday (Friday was the day of my injury) and they wanted to send me to Sandwell Hospital for the weekend.  I managed to persuade them to let me go home for the weekend and research the options, in particular to talk to one of my sisters who is a GP.  She managed to access research papers for me and I decided that surgery would be the better option, as I wanted to recover to full strength to be able to continue to do sport in the future.  A cast was put on and off I went.

Arrived home on Friday to find an answerphone message to say that I had screened positive for MRSA colonisation.  This is a fairly common thing.  I called them back and they told me not to worry, but that I would have treatment for this alongside the surgery. 

Went to Sandwell Hospital on the Monday, all packed up and ready to stay.  After a brief check up at the fracture clinic, I was relocated to the trauma ward.  Arriving there, a bed was arranged on a ward and I started to settle in.  I completed the patient questionnaires with the ward manager and casually asked about the MRSA issue.  He went a bit crazy when I told him I was MRSA positive - I was immediately bumped into a side room for isolation treatment.  The ward I had been on was then immediately deep cleaned.  There was a communication issue as City Hospital had not passed on the test results. 

The treatment for MRSA colonisation is fairly straight forward - full daily washes with surgical scrub and nasal antibiotics for 5 days.  However, as the surgery option was elective, that the operation would be delayed until the MRSA treatment had been completed.  This should have been done whilst I was at home, but another administrative cock-up and I was retained in hospital for 3 days with no cast or anything.  Finally, on the third day, after pestering everyone I came into contact with (including cleaners) I was fitted with an aircast boot and released. 

Readmission was on Wednesday this week.  Another MRSA swab was taken.  I was informed by Sandwell Hospital that this would take 48 hours and that I would have to wait for the results of this before they would do anything.  There is another test, which apparently looks at the DNA structure of the bacteria that may be present, which only takes around 1 hour to process.  I managed to persuade them to do this test instead.

Another day spent in the isolation room.  The surgeon spoke to me and I was now told that even if the new MRSA swab came back as negative, I would be treated as if it was positive.  I cannot see the point of them taking another swab if they are going to assume it is positive anyway.  I understand the reason why a negative result is not definitive proof - the bacteria could be present but not taken on the swab, but why bother taking another swab if the treatment will be the same?   Anyway, the surgeon informed me that I would not find a surgeon in the UK who would perform achilles tendon surgery when there is MRSA colonisation possibly present and that conservative treatment would be the only option. 

I was handed over to another surgeon due to timings, who said that he would be prepared to operate if I was prepared to take the risk!!  The potential upside - stronger repair, much lower re-rupture risk, the downside - if MRSA infection set in it would at a minimum destroy the tendon, possibly lead to the loss of my foot, and maybe much, much worse.  So I decided on the conservative option. 

Got out of hospital finally yesterday fitted with the same aircast boot.  I have been able to get out and about quite a bit - 9 hours of crutch walking yesterday.  The only problem I have so far are blisters.  Cycling gloves are ideal to stop this happening until my palms harden up a bit.

My experience now is very different from what others seem to be experiencing.  Although there is absolutely no response from my foot on the calf test and visually it is clear that the tendon is well and truly snapped, I have no pain whatsoever and can even put my full body weight on it.  Walking is hopeless and trying it makes me look like some deranged lunatic.  I know I shouldn’t do this, but I can’t be the only one who has tried it early on (2 weeks and one day after the injury).  I don’t feel the need to wear the boot unless I am going out and occasionally at night to make sure it heals at as good a length as possible. I have spoken to a very good friend who works at another hospital and she tells me it will probably start to hurt as the nerves repair, maybe in 4 weeks or so.  The only other symptom I have is weight loss - 5 kg per week at the moment - and my left calf is already starting to shrink.

I guess that many people who have had this inury ask the question why does it take so long to heal?  It isn’t the worst injury in the world by a long way - I was the most fortunate on the whole ward from that point of view, some of the injuries people were coming in with particularly from motorbike crashes were horrific - but it does seem to take the longest of any injury that is usually fully recoverable from.

The aircast is a great invention, mainly because it can be taken off to shower and when sitting.  I would definitely recommend it if is suggested as an appropriate option.  But I do seem to be the only one that has been given the boot right from the off, other than the first weekend when I was given a temporary cast to allow me to go home.

Off to the gym now.  I have been given an upper body workout schedule.  This cannot possibly replace my usually exercise regime (Saturday training  for example is usually a 55 mile bike route), but it is something.  I hope to be back swimming at least very soon.  The only thing stopping me at the moment is the worry that my foot position when swimming would not be conducive to proper healing.

5 Responses to “11th July 2009 MRSA positive screening pre-surgery”

  1. Gosh that sounds a horrendous few days. NHS failed me initially and I walked for three weeks before getting second opinion. Then I had the op.

    My concern with you is that you are putting weight on the leg, not a good idea! Do try and keep off it as much as possible as rest and elevation are central to getting a good repair.

    You would think with all the problems with MRSA that there would be a standard at all hospitals.

    Anyway, good luck and KEEP THAT LEG ELEVATED!!!


  2. What a nightmare!
    Hope everything goes more smoothly from now on.
    I’m 8 days post-op/4 days after getting cast and still getting used to it - no pain, just a bit of aching and occasional stinging. Trying to elevate as much as poss.
    Everything I’ve read on this site seems to point towrds taking things slowly especially the first couple of weeks - I’ve been told no weight-bearing at all for 3 weeks even after having the op rather than going down the conservative route.
    I too had no pain in the ankle post-ATR and pre-op although it ws bruised and swollen, but could put no real weight on it and needed the crutches already to get around.
    Do be careful.

  3. Hi Gareth, sounds as if you are going through the wringer with the NHS. I had ATR treated conservatively 12 months ago, and am back to playing cricket… so I am a big advocate of conservative treatment - though there are a few bloggers who have not been so lucky.

    Without wanting to worry you any more than you will have been, your treatment does sound a little unusual for the NHS. The foot would usually be immobilised in equinas (ballet point) in plaster or adjustable boot for the first few weeks. This is to allow the severed ends of the tendon the best chance of finding each other and knitting back together - the lengthier version of what surgery does. It is possible that your boot has inserts that angle your foot, but each time you remove the boot - and presumably move your foot - I would suggest you run the risk of separating the ends of the healing tendon.

    Those who try and weight bear through a recent ATR are usually on aggressive programmes following surgery.. usually overseas. You may be on such a programme in the UK… but it would have been nice to have been told!! It may be worth asking next time you are in to the clinic, or get another scan (not an option for many) to confirm that the ends are lining up.

    Take it easy.

  4. Sweet blog! I found it while surfing around on Yahoo News. Do you have any suggestions on how to get listed in Yahoo News? I’ve been trying for a while but I never seem to get there! Cheers

  5. Spectacular article…..would like to hear more on this subject.

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