Opinions vary…

Well, I’ve seen three different consultants / Doctors so far.. and had three completely different opinions on the treatment I should receive. Don’t you just love the NHS? :-)

In the same Health district in two parts of the same hospital I have heard this so far:

1) The day I ruptured my Achilles I sat waiting in A&E for 4 hours to be told that yes, I had ruptured it fully (they could insert a finger into the gap where it was torn) and that I would probably have surgery. This Doctor quoted a 15% re-rupture rate without surgery and 10% with surgery. I was advised that the consultant would give me choices later in the week. My leg was placed in a front slab and I was sent home.

2)A few days later I had ultrasound to confirm a full rupture. It was indeed ruptured, described as ‘mush’ by the ultrasound tech who was looking at it. My leg was placed in a second fromt slab.

3) One week after the rupture I saw the next Doctor. He said that I didn’t need surgery as it was healing (no gap this time) and that I would now spend 3 weeks in a cast (full aquinas) followed by 2 weeks in another cast (mid aquinas) and then a final 2 weeks in a final cast (normal position). He was not familiar with using a boot and his eyes glazed over when I started taking about it and the forum… I was duly sent home in a full aquinas cast.

4) My appointment was delayed by a week (for some reason that wasn’t shared) so this Monday, 5 weeks after the ATR I had the cast removed and the nurse was about to put another cast on when we started taking about treatment options and she realised I hadn’t seen a consultant yet. He didn’t want to see me but she was persistent (thank you!) and he eventually turned up to see me. He couldn’t understand why I hadn’t had surgery and proposed a different strategy again. I am now in a semi-aquinas position in another cast for the next 3 weeks. Then I will be straight into 2 shoes with a heel insert. He muttered something about needing a treatment protocol for the hospital… No kidding!!

Something tells me I need to be very careful During weeks 8-12 (May)!!

5 Responses to “Opinions vary…”

  1. Sounds like you are getting some different opinions from one hospital over there on the other side of the forest from me. To me, I think the problem could be the lack of a treatment protocol for the hospital as your doc muttered.

    Still, you seem to be making progress, which is the important thing!

    Stay positive and keep us posted, I will watch with interest and see how you go.

  2. Wow. As jimminyc said rightly, stay positive and congrats on the progress so far. Otherwise,this Dr. Merry-go-round sounds like a hassle you really did not need.

    At least finally you have a treatment track — so that’s good.

    I’m ending week 10 soon — and hoping everything’s still on track. Caution, impatience, a bit of frustration, and a desire to test and push some limits: all there at the same time. I’ll take what you said as a reminder.

    All best.

  3. This is very frustrating — even for ME!! Both of those re-rupture rates are too high, and probably primarily the result of using old-fashioned slow casted protocols. It’s understandable that a traditional old-fashioned Doc wouldn’t be impressed with an Internet forum, but hit them with a peer-reviewed Journal article (like the excellent UWO study whose full-text is available on this web-site for downloading and printing out!), and they’ve supposedly been trained to take notice. UWO’s re-rupture rates were 2/75 in the post-op group, and 3/75 in the non-op group (way below 10% not to mention 15%!), using only a boot, and a MUCH faster (and way more life-friendly and convenient) protocol — online at bit.ly/UWOProtocol .
    So the simple question is: If a carefully randomized and peer-reviewed study got BETTER results with a faster and more convenient protocol than your local NHS hospital gets with a PITA protocol, why wouldn’t you just follow the protocol in the study?? (And why wouldn’t NHS do so, too?)
    Several NHS patients here have managed to squeeze a boot out of the NHS, and several others have ordered/bought/brought their own boots — mostly VacoCasts — and had their NHS Docs fit them. (That seems friendlier and safer than the few handy folk who’ve gone out to the garage and cut off their own casts!)

  4. It worries me that by the time I get to see my specialist I will of been (non-surgical) in an equinus cast for 5 weeks… already I am 1 week behind….. this is not the specialists fault - but the ultrasound was unable to see me until half way through week4 of my recovery.

    By the way, I insisted on only seeing the top ankle specialist, thats a good thing, the bad thing is that he’s only doing ‘outpatient’ appointments on a Tuesday and I suspect I will need an ultrasound before each appointment which can only be on a Monday or a Friday…..interesting that I have to manage my own appointments here at the Alexandra Hospital in Redditch UK.

  5. andrew1971 - When I had Ultrasound on my ATR in week 2 the Doctor described his view of the achilles as ‘Mush’. I kid you not! He said that all he could do was confirm it had been a total rupture as there was absolutely no definition to the scan. I saw 4 different specialists through the NHS (I never saw the same one twice) and only twice did anyone actually look at my leg before sticking the next cast on. One of those was my last visit (when I was discharged to the cario of the physiotherapy department) and the other was because I befriended the plaster technician and she insisted on my behalf!

    The best advice I can give is be patient. Read Normofthenorths blog (he’s quite prolific and full of great advice), try to persuade your Doctors to give you a boot and physio asap - but don’t be too downhearted if they won’t listen. I tried and failed to persuade them for fast treatment but did get my boot in the end.

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