Very unsupportive doctor?/Pls Advise…

Am currently 7 weeks post-op: am FWB since week 4, first in walking cast for 2 weeks, now in boot for 1 week. I am having some issues w/my doctor in that I am finding him pretty unsupportive and, in some ways, down-right dismissive. For example, the easiest way for me to get ahold of him is to send him an email/online message… naturally, since this is my first (and hopefully only) time going through this, I have had a lot of questions for him, and have probably sent him a msg/question maybe every 3 days or so.  However, at my first post-op appt he made the comment to me “so many emails, i should give you a limit” in a semi-joking way, though I knew there was some seriousness to his comment.  Then, this past week I asked him the same question I had posed here, as far as stretching/flexing my foot upwards towards my body to “stretch” the tendon: his actual response, verbatim was “(my last name) use common sense.  If it hurts, STOP.  When in doubt, don’t do it.”  Now maybe i’m reading too much into his response, but I felt pretty dimissed by this response.  Basically, the effect this has had on me is that I feel that I can’t really ask him any questions, as hey all seem to annoy him, but naturally I just want to make sure i’m doing the right thing and not doing anything to hamper my recovery.  Long story short, I’m not sure how i’m going to handle this… am trying to let it “sit” before I decide how to respond.  This is the same doctor who has now twice, in response to my requests for a referral to physical therapy, told me “the vast majority of pts don’t need PT.”  So, I basically feel that I’m in this alone and just kind of “winging it” though am very greatful for this forum/blog as it is really my only form of guidance through all of this, so thank you all.

Has anyone else been told that they did not need any physical therapy?  My doctor has basically told me “walking normally in the boot is the best kind of activity you can do.”

One thing i’ve noticed that i’m somewhat worried about is that last night (i’m basically 7.5 weeks post op) I noticed quite a bit of swelling in my lower leg, and especially my “bad” foot.  There is nothing that I did all that differently yesterday so I’m not quite sure what to make of this.  I’ve been trying to keep my leg elevated and iced today and that seems to have brought the swelling down somewhat, but it’s still much more swollen than I’m used to.  Is this sort of  “spontaneous swelling” something that others have experienced?  At what point should I become concerned?

10 Responses to “Very unsupportive doctor?/Pls Advise…”

  1. Hi, do use pain is a guide, and be careful even when you don’t have pain right now. I saw a private physio a few times which helped. I’ve had much advice/support from the blog at every stage in recovery.
    I am 5 months + and still get swelling, although it has much improved. I do wear a compression sock/flight sock during the day to help manage the swelling.
    All the best for a full healing.

  2. hi ali, thanks for the response… i completely get the need to be careful and use pain as a guide, but i guess the confusing part for me is that, in recovering from any injury, there is some degree of discomfort/tightness/minor pain that you have to be able to “work through” in your recovery…. this seems like such a tricky line to navigate and i worry that if i avoid “pain” at every point, that i’ll never be able to build my strength back… then again, maybe it’s my line of thinking that’s faulty and i need to start thinking differently?

  3. I look at my doc and PT as consultants. They work for me, and give me advice. Their opinions are important, and are factored accordingly into the decisions I make. But it’s my leg. I’m running the show. I decide when it’s OK to walk around without my boot, or stretch, or lift weights, etc. The great info I’ve found here on the blog is another important source of info, which (sometimes) weighs just as heavily in my decisions as the doctors advice.

    Unless things take a terrible turn for the worse, your surgeon was essentially done with you 7 weeks ago. There’s really nothing more he is equipped to do for you. He’ll of course want to keep an eye on you, and give you guidance about the post op protocol he’d like you to follow- but I’m not too surprised that he isn’t too interested in being a long term consultant for you. When he hands you off to PT, he probably will be even less engaged. Don’t take it personally, those guys are very busy.

    My doc told me he didn’t think I needed PT either. I was making great progress on my own. I told him that I thought they would probably be able to augment the exercise I was doing with things I don’t have access to (ultrasound, scar mobilization massage, some specific rehab equipment) and that I thought having an extra set of eyes checking me out once a week was probably a good idea. The PT didn’t cost my doctor anything, and he seemed happy to write the prescription when I specifically requested it. Again, it’s my leg, my protocol (I think my doc came to appreciate that approach), and when I asked for it, he seemed happy to give me the PT.

    I think spontaneous swelling is pretty common. I would only become concerned if/when it becomes persistent, or the frequency and severity seems to be increasing in ways not associated with increased activity levels. At the ~7 week mark, I seem to recall occasionally wearing a compression stocking on my leg to help control it.

  4. thanks ryan. i definitely get that the doctors are busy and don’t have too much time to be responding to 1000s of questions etc… just seems that my doctor is very “locked in” to his approach, which seems, for whatever reason, to not include PT as he has declined my request for a referral twice now. My thoughts re PT were 1: i could have someone else to help me monitor my progress and teach me some exercises or use equipment that i might normally not have access to, and also another way for me to monitor my progress… however, his response continues to be “90% of pts don’t need PT” which blows my mind… maybe i need to spell out specifically the role i feel PT may be able to play, but seems that he takes any “suggestion” on my part to be some sort of an attack on him/his approach… tricky to navigate and i need a referral from him to go to PT: i don’t believe i can just refer myself. you’re right though, when it comes down i call the shots in my recovery; just want to make sure i’m not doing ANYTHING that might get in the way of my recovery.

  5. Yeah, I do know what you mean. I didn’t know what was healing and what was pain, I still don’t sometimes but post op it was more confusing. I did find the PT provided some emotional support as well as physical advice if I am honest, that feeling of not being on my own with it helped!

  6. BTW I wasn’t referred formally - one question, do you have occ health at work or similar??

  7. yes,we have occ health.. funny thing is i actually work for the same company (Kaiser Permanente) here in CA where I am getting my tx. Not sure I can go to Occ health though as it was not a work-related injury?

  8. Hi, not sure how it works there but I referred myself - I didn’t realise I could do this initially. I have to be up on my feet for work. Worth a try.

  9. NP- I don’t think you need your surgeons prescription for PT… you just need a prescription. If your surgeon won’t hook you up with one, perhaps your GP would.

    Just a thought-

  10. I’m behind in reading posts, so forgive me for chiming in at this late date. I was getting irritated reading your original post about how snarky your doctor is. I’d fire him. I agree with Ryanb that the docs work for you. At a minimum they need to respond to your questions in a timely manner, without the attitude, and if they can’t pass that simple test you should move on. Find someone who will take an interest in your medical journey and help facilitate a full recovery. I don’t think that’s too much to ask. Sounds like this guy should have found another profession where sarcasm is appreciated.

    A good PT can help you navigate the road ahead. Even with a supportive doctor, the PT takes over with some very general guidelines from a doctor. So, assuming your surgery protocol was routine (no complications) I think that a PT with experience in achilles tendon repair rehab (that’s important) can easily deliver on the rehab plan for you and be your partner in healing. Good luck!

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