2.6 cm Gap. Op or No Op???

November 4, 2016


I’m Heidi and this is my 1st post after my Achilles snapped 9 days ago. I’m not really expecting anyone to read my blog or anything, but I’m really keen to document everything about my injury so that I can see what works and what doesn’t work in terms of rehab both physically and mentally.

A bit about me, just in case anyone does drop by… I’m a 44 year of mother of 3, a self employed project manager, and a hugely enthusiastic sports person.  I LOVE to ride my bike, this summer just gone I did my 1st ever Alpine sportive which was awesome, I love to lake swim and generally get sweaty and active whenever I can.

Wednesday 28th October: Snap Day

How did it happen?  Playing in a charity Netball match, I was WA, just moved off from the center line, when BAMMM, it snapped. I knew as soon as I heard the bang, then looked round fast to see what idiot had kicked me in the ankle, realising no-one was there, just me.  Time goes slowly as the reality of it hits you.  Everyone knows someone who’s done it, who has been forced out out of action by the dreaded achillies snap.

All I could think was, how long will it be til I’m back on my bike? Crap - I have leaving drinks at work tomorrow, argghghg how will I get my little girl to school?  Ohhhh no, new job, it’s in London and I’m starting in 2 weeks, will they still want me? OMG I’m going to get really fat…

2 of my work colleagues carried me to the car park, where my sister met me and took me to the hospital. In the car the tears came. It was starting to dawn on me how long it would take to get better and what an impact it was going to have on day to day life.

The A&E staff at the Royal Berks Hospital in Reading (UK) were great. The triage nurse knew what it was immediately and sent me up to get a cast.  The cast ladies were also lovely and gave me some peace of mind.  However it was at this stage I realised I wan’t going to be driving anytime soon.  My middle daughter comes home from the US on 19th December and I just figured I’d be back to normal by then, but now this just seems like a fantasy.

Thursday 29th: Laze about in bed all day - research research research.  When will I bet better? How fast can I play sports again? Op or no Op?

Friday 30th: Scan Day. I woke up like it was Christmas morning, excited to get going… this is weird right? I was full of hope it would only be a tear or I’d have a little gap and they just stitch it up and that’d be that.  I was treated by a guy called Matt who listened to my concerns and was really helpful. He took the time to listen and understood my worries and was happy to offer advice.  He measured the gap between the 2 parts of the tendon and said it was 2.6cm, and that he’d expect the surgical team to operate, given my appetite for sport. He also told me he had the same op about a year ago and his gap was not as large as mine. He also told me the team would be likely to act fast as this was best.

I went to see the doctors feeling sad about the prospect of an operation, but contented knowing that this would likely give me the best result. I was a little emotional before I saw the doctor and a kind nurse took me to one side and asked what was worrying me, I told her my fears. I’ve got kids to get to school and commute into London for my job (I’m also self employed so no work no pay) and the fact that I LOVE sports.  She reassured me that an op was probably cleaner and had a quicker time to heal and it’d all be ok.

I then saw a registrar – who told me very little, he advised me to wear the cast I had.  He explained that I would probably be in the cast for 2 weeks and then be moved into a boot for another 4 to 6 weeks.  There was no mention of an alternative option. I asked about surgery and he said the team had decided this was not the correct course of action for me and conservative treatment was best. But this was without discussion with me, the patient. I asked him who had made this decision and he said the consultant, but he could speak to the foot and ankle team for advice if I wanted.

He was gone for less than 5 minutes and came back and told me they agreed with the decision.Again, I was gobsmacked that no-one from this team had come to speak with me. He explained that they were in a different area across town and he’d called them, but how can such a quick diagnosis be made without discussion with the patient?  I said I wanted to speak with this consultant at the foot and ankle clinic, and he said it’d be a few weeks as he was very busy. (This was without consulting a dairy I might add) I was still asking too many questions so he asked if I wanted to speak with the consultant in the department.

A orthopedic consultant, gave me more information. He said that the RBH doesn’t operate on Achilles injuries anymore and that this was their policy.  He told me that there was a high risk of infection which could result in skin grafts and tendon reconstruction and was a terrible place to be. I can see that and of course I don’t want to have surgery unnecessarily, I just want to understand what the best option is for me given my individual situation. When I asked what the percentage of cases which result in infection and the bad place to be, I was told about 1%. But he did go on to make a appointment for me to see Dr Mahadevan, the foot and ankle specialist on Tuesday. Only 5 mins earlier Mr Dhaliwal had told me this would take weeks. My trust in the team had now gone.

Booked a private appointment to see a foot and ankle specialist on Monday.

I really felt fobbed off and 80% convinced that the decision they’d made was based on finances not patient welfare.

Sat & Sun: Laze about at home eager for Monday

Monday 31st: Went to see the private guy at the Circle Hospital in Reading. It was a totally different story. This guy had time for me. I got the same advice but it was presented to me as a choice, where I was given options and treated like I had a brain in my head. Alaun explained that the rupture wasn’t a clean cut, but that the 2 ends of the tendon would be like cooked spaghetti and stitching them back together was a bit of an art rather than a science. Guess work would be involved to approximate where the stitches would be. Yes the tendon is likely to be a bit stronger and a bit less likely to re-rupture , but there were risks associated with the surgery.  Infection being one of the most common problems. Nerve damage and potentially the need to reconstruct the tendon if things go very wrong. I pushed him to answer my question, what would you do??? He said treat conservatively. BUT he did say if I wanted the op he would do it and it would be on the NHS.

I was so glad to have seen this consultant, without his advice I would have been lost. I feel sorry that it takes a pushy strong woman who isn’t afraid to ask questions, and who has the finances to pay for a private consult, to get this level of treatment. What about those who don’t? I am pretty mad about that. How many people are left feeling scared and vulnerable?  That was how I felt the whole weekend.  Without the time of Alaun on Monday I’ve no doubt I’d be feeling like that now.

Tuesday 1st November: Specialist consultant day at the RBH - or is it? Armed with a heap of more advice I went to meet the foot and ankle specialist at the RBH.  My good friend Mick came along with me for support as he also suffered with the same injury a few years back and was well placed to ask questions and to help me.

After a 1.45 minute wait, I got to speak with a doctor. However it was not Dr Mahadevan. No explanation why not, but not the main man I’d been promised. However, Harry who I spoke with, a young but seemingly knowledgeable man said the same as Alan the previous day.  If I hadn’t been to see the private guy the RBH would have left me disappointed again.

Anyway - after lots of discussion I decided to go non operative. No real reason than the fact that it all seems to be a bit of a grey area around what is best.

Research suggests that the healing time to about the same for both treatments, that eventually, providing no re-rupture, I’ll get back to sports. I don’t care if I can’t play netball or basketball or badminton really well. I want to minimise my chance of something else going wrong so have decided not to tempt fate and treat it gently and let the body heal it’s self.  Then maybe if I have to, there will be an op as a back up plan, a last resort. I’ll be the best patient and will do everything I’m advised.

So - decision made, and it feels good!

Next Post: http://AchillesBlog.com/vietzy101/its-not-all-bad/

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