REHABING A BROKEN PHYSIO: Navigating the Medical System

Many of my clients express frustration over the medical system. They're given poor advice, often don't get the answers they're looking for, or even worse, a diagnosis is missed, and all of the professionals they talk to say something different. 

WTF is going on here?? I thought we were in the 21st century. Can't we get the story straight and use technology to streamline the process?? The truth is that things are complicated and we have to make the best of the current situation. Otherwise you're in for a rough ride. Cop out answer? Yes, but here me out - my story isn't much different. 

May 17th: I had my bouldering fall, went to the ER for x-rays. The doctor there looked at the x-rays and sent me on my way after determining there were no fractures. 

Health Care Challenge #1

May 24th: I get a call back from my GP saying that the ER doc may have missed a talus fracture and that I would likely need a CT scan. I need to go back to the ER to get another x-ray.

So I go back to the ER and sure enough the second x-ray shows the same thing: a potential avulsion fracture of the talus; I need a CT scan to confirm the diagnosis. So off to Whistler I go for a CT scan. The CT scan shows a displaced avulsion fracture of the lateral process of the talus. In other words, I may need surgery to put the bone back together . 

Many of my clients have gotten angry about a missed fracture on an x-ray. How could they miss it? It's in plain site!! Things aren't so simple. The problem is that some of these fractures are notoriously hard to spot. Can you see it?

fracture image 

I took this picture on my cellphone that very night and studied the image extensively and I couldn't tell anything was wrong. It's not what I'm trained in doing. Though ER docs have training in reading x-rays, they're not as good at it as a radiologist. The upside is that we have fail safes within the medical system. Once the ER doc sends me home, the x-ray gets sent to the radiologist, who has extensive training in reading images. This is where the fracture was caught. He noted there was a potential avulsion fracture of the talus. He couldn't tell for sure so recommended a follow-up x-ray and perhaps a CT scan. That's when Dr. Rivers called me, sent me for an x-ray, which turned out positive again, and thus sent me to Whistler for a CT scan. Sure enough, the CT scan showed a lateral process avulsion fracture of the talus. 

Health Care Challenge #2

The very same day, I get a call from an orthopaedic surgeon. She mentions that she's consulted with another surgeon and they both agree that surgery would be beneficial, so she's going to put me on the emergency orthopaedic surgery list at Lions Gate Hospital. Here's when things get even more interesting. She also mentions that when I show up for surgery there's a chance that the surgeon doing the procedure may decide I don't in fact need surgery. Full stop. 

How can that be? I either need surgery or I don't. When it comes to fractures, it should be simple! It's not simple at all. It all comes down to the degree to which the bone has been displaced. Let's break this down: 

Diagnosis: a displaced avulsion fracture of the lateral process of the talus

IMAGE

In essence, a small piece of bone has become separated from the rest of the bone. They decide whether surgery is warranted based on how much the bone has separated. In my case, if the bone is displaced by more than 2mm, they use screws to put it back together. My fracture hovered right around the cutoff mark, so while 2 surgeons said we should operate, it's possible that the surgeon responsible for doing the operation could say "no, this is borderline, it's not worth your pain, or my time and the hospital's money to operate." I was in limbo.

The plan? I was to wait for a call from Lions Gate with instructions on when I would get surgery and when I should start fasting. They were hoping to get me in the very next day.

Health Care Challenge #3:  

May 24th: I get a call at 9pm saying I need to start fasting. No food until I hear from them again tomorrow morning when they'll know whether they'll be able to operate on me the next day. 

May 25th: I get a call at 11am from Lions Gate saying they won't be able to fit me in for surgery. They will call again tonight to let me know if I'm getting surgery tomorrow. 

I get a call at 8:30pm saying that I need to start fasting again and that I'm scheduled for surgery at 11am the next day. 

May 26th: My good friend Phil drove me to the hospital for my 11am appointment. I check-in at the ER, they take my vitals and take a second look. My heart rate is high, my BP is high. "Am I ok?" I admit I'm a bit nervous. They send me up to the operating floor and the nurse there starts to prep me for surgery. Vitals are taken again: "you sure you're ok?" Yes - still nervous. It's 11am - we're already running late.

1pm: the anesthesiologist talks me through options for putting me under. I can have my one leg numbed, my lower body numbed, or get knocked out entirely. I chose the later. Awake - no thanks!

2pm: I finally get to talk to the orthopaedic surgeon. He thinks I should get surgery too. 3 votes in favour, 0 votes against it. I agree to the operation. It's a go!

3pm: I get rolled into the operating room. I can feel my heart pounding against my chest, my mouth is pasty dry. The monitors show the same. "Are you ok Mr. Bateman". I nod yes. "Let's get you onto the operating table". The surgeon gets everyone's attention and confirms we're operating on my left ankle. He looks at me. I frantically nod in agreement. I rest my head on the table and the anesthesiologist comes to sight. "Here we go Mr. Bateman". To my right, a nurse is lowering a mask over my face. "Deep breaths Mr. Bateman". I take a breath in and out. "Another deep breath." I do it again. "Deeper this time, Mr. Bateman." I try to take a deep breath in. The monitors aren't very happy. "Maybe the air is escaping from the mask", I hear from another part of the room. She presses more firmly. I can't breath anymore. "Deep breath please". I barely suck in a breath. My fingers are getting tingly. She loosens her grip. I'm able to suck in a breath. My arms and neck are getting tingly. She changes her tactic. "Breath out, Mr. Bateman". That's better. The tingles start to subside, and she expresses content with a glance to the monitors. I was beginning to hyperventilate. The anesthesiologist brings in a massive white syringe and pushes it into my IV. Good night. 

I woke up shivering uncontrollably with two nurses by my side wrapping me in hot blankets. "You're coming to, Mr. Bateman. Everything went great." I don't know how long I lay there shaking. It couldn't have been more than 30 min. My ankle was wrapped in a massive splint. "That's not to come off for 2 weeks." Well shit, I can't put my pants over that. My wonderful partner had to run to Joe Fresh for a pair of shorts I could wear.