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Showing posts with label achilles - rupture. Show all posts
Showing posts with label achilles - rupture. Show all posts

Tuesday, March 16, 2010

Was David Beckham's Achilles tendon rupture the consequence of one cortisone injection too many?

"Beckham stepped onto Qwest Field in Seattle with a trio of cortisone injections in his right ankle in an attempt to dull the pain of severe bone bruising. By the end, the effects of the shots had long since worn off and he was effectively a passenger, hobbling and aching."
Reference:  "This Beckham goodbye has different tone" (November 2009).
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Sunday, May 25, 2008

Achilles tendon rupture - getting help is easier said than done!

Hi Gary I would like to share my experiences with regard to an injury I sustained on 10th Nov 2007 which I contact you about in January after getting no support form ACC.

I ruptured my Achilles tendon at a fitness ‘boot camp’ I attend on Saturday mornings. (It happened as my left foot pushed off the ground in a bounce carrying all my weight ie high powered step up).

I was taken to A&E & there filled out an ACC form stating ‘ankle trauma’ – not really knowing at that stage what I had really done. After a wait I went to the fracture clinic where I was seen by a doctor who ordered my leg to be plastered up to the knee with no weight bearing for 8 weeks.

The doctor filled his part of the ACC form in stating that I had ruptured my Achilles & off I went thinking I would receive help from ACC. After 5 weeks of ringing ACC requesting help, each time getting told they needed more information from the Hospital, which I organised to be faxed to the Dunedin Office, I got a letter stating they would not cover me for this injury stating it was not an accident!

I feel this is the critical time when further injury can be done as I was unable to have help after paying large amounts of ACC fees all my life they were not coming to give me any support – compounding the original injury – and in the end costing me & ACC a lot more –however I continue…. I then went to my own GP – who promptly wrote another ACC form outlining the incident which was again sent to ACC.

In these 5 weeks, being self employed , I managed to get myself to my clinic doing limited duties as I was on crutches, still waiting to hear back from ACC as somehow I had to try to continue work as my business required me to be there to at least answer the phone. . Finally I got a letter from an ACC case manager half way through December saying that they would accept my claim & I needed to fill out numerous forms showing my earnings etc

After completing one lot I was told I had been given the wrong ones & I would need to fill out another………… All I really wanted was someone to help me with housework & everyday tasks around the house I was unable to do and a rehabilitation plan for my leg.

It was then Christmas & at the 7 & ½ week anniversary of my accident I managed to trip on a step & re-rupture the Achilles! After surgery to stitch the Achilles which by now had been completely ruptured, I got home and on the Monday started ringing my case manger requesting a written rehab plan & a face to face meeting with someone.

After searching the Net for information on how to manage an Achilles injury I found an article written by Gary Moller who has been extremely helpful in the steps I needed to take with my injury.

The meeting with ACC was finally organised for 24th January 2008, after a lot of frustration and numerous calls to answer phones,– 15 weeks after my injury! I wish I knew what I know now back on the 10 November 2007 - Annette
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Gary Moller comments:
Annette's story is not unusual; in fact it could be argued that this is usual of the standard of care by our hospital system and ACC (Accident Compensation Corporation). What is that standard: Appalling! Annette is an experienced health professional. Just imagine how a person gets on if English is their second language or they come from a country where asserting oneself against authority risks becoming an organ donor!

The motto for our hospitals should be "Patch 'em up and Push 'em out". ACC's motto should be "Obfuscate and Frustrate".

Effective rehabilitation is both timely and appropriate and Annette received neither, starting with substandard treatment for the first injury which should have been properly assessed and repaired. Recurrence of the injury was highly likely since the tendon was probably just hanging together by a thread despite several weeks of immobilisation. The second repair job was very good as far as one can tell. My message to the hospitals is to stop doing repairs on the cheap and to do it right first time round.

The service by ACC has been appalling by any standards, seriously stressing this self-employed person. What's going on here with ACC?

I have seen this kind of thing happen often enough to conclude that ACC will, as a matter of course, decline every significant injury no matter how obvious the fact that it is an injury and not something else. Delay, delay, delay, complicate and bury the poor Claimant up to their neck in paperwork. Most people will simply give up with frustration and exhaustion, saving the ACC thousands, if not millions of collective dollars per year. By the time a declined claim is successfully disputed, the first few months of greatest need have passed and ACC refuses to back date costs incurred, such as the home help that the desperate claimant arranged privately in the absence of ACC funded assistance. The accident victim therefore bears the brunt of the costs of an injury despite having paid into the scheme through a tax on her wages. This is heartless money-grubbing by any standards.

Rehabilitation may be little more than a dozen or so of physiotherapy treatments. If recovery is incomplete and return to work has not been achieved, the Claimant is shunted off to a cooperative Occupational Physician who goes through the motions of a sham medical assessment and then writes a stock report for ACC stating that this person is capable of being a filing mindless clerical or toll booth operator, or something similar. Not to mention that that person was a highly skilled professional prior to the accident. Regardless of whether or not that person is able to do the job or if the jobs even exist, she is given a couple of months to find a job. If not, the hapless Claimant is shifted onto a welfare benefit and off ACC and chalked up as a success for the annual report. This bureaucratic process is not rehabilitation. As Annette's case illustrates, what I am describing does go on and I have come across many examples.

Sadly, I have no easy answers, other than to suggest that a Claimant hire a lawyer at the first signs that ACC is dragging its heels. Hiring a lawyer can be lawyer is costly; but doing so usually results in the best service ACC can offer. The first consultation is usually free, so there is nothing to lose nothing to lose and much to gain by at least a single legal consultation.

The long term solution is for there to be institutional changes within ACC that recognise that there is a difference between rehabilitation and process. I recognise that ACC does a lot of very good things; but it could be doing its job so much better. It has many dedicated employees (I should know since I was one for several years!) who need to be better supported and resourced to provide front-line services.

Beware of the Boot Camp
On another matter: Annette was participating in a "Boot Camp" style workout session at the time of her Achilles tendon rupture. I am wary of these relatively uncontrolled workout programmes because the possibility of injury is relatively high. These boot camps are really popular due to the influence of programmes on TV like the "Biggest Loser". What we never hear about are the casualties they cause along the way.

Annette placed her trust in a professional fitness instructor. It was an unfortunate accident as far as one can tell. In fortunate it may have been; it still is very poor form on the Instructor's part not to follow up on Annette. There was no follow up and when Annette contacted her; the conversation was cut short each time because her fitness instructor was in a hurry. Here is what a true professional fitness consultant would do for Annette:
  • Ensure that she gets prompt medical care and the best of care. She should help with her medical and travel expenses (The instructor might even have insurance for this purpose).
  • Follow up the next day with a personal visit, a card, flowers etc.
  • Offer to provide rehabilitation services Annette needed so desperately.

Monday, January 07, 2008

fluoroquinolone antibiotics and tendonitis

"The first reports of an association between fluoroquinolone antibiotics and tendonitis came from New Zealand and France in 1992.

There have been many since and by 1994 the FDA had received 25 reports of tendon rupture. Seventeen of these were of Achilles tendons but shoulder and hand tendon rupture was also described. The age range was 33-85 years, and the tendon ruptures occurred at therapeutic doses at a range of two to 42 days after first dose. Of these 25 cases, 14 were also taking steroids and four occurred in people of advanced years, but in nine there were no other risk factors.

Appropriately for a tendon problem, a prospective ultrasound study was conducted at the Hospital Universitaire Dupuytren. Some 23 subjects (15 female) were given a fluoroquinolone orally for two weeks. All had normal Achilles tendons at day 0. By day seven, 14 (61 per cent) had echographic tendonitis. Both sides were affected in seven, and two (7 per cent) were symptomatic.

The ultrasound features were of hypoechogenicity (50 per cent), peri-tendous effusion (28 per cent) and tendon thickening (22 per cent). For a volunteer study in healthy controls, no ruptures occurred.

The mechanism by which fluoro-quinolone antibiotics cause this problem is not clear. In animal studies, they can cause arthropathy. There is evidence of collagen depletion and disruption of the extracellular matrix. The antibiotics in this class available in New Zealand are ciprofloxacin and norfloxacin. They are best avoided in children, adolescents and pregnancy. Care should be taken when prescribing for those on steroids. If tendon pain develops, the antibiotic should be stopped and the patient advised to rest the limb and avoid exercise. Diagnostic ultrasound is the most convenient and cheapest way to prove the diagnosis."
For the original article, please go here.
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Gary Moller comments:
This is a horrific result: 61% showing physical damage to Achilles tendons after seven days of being on these drugs!

What we do know about these drugs is the worst of symptoms do not typically appear after several weeks or months and much of the damage is permanent.

Damage to the collagen of the Achilles tendon is not just to the Achilles. What we are talking about is damage to your collagen. Collagen is what holds you together - tendons, ligaments, joints, cartilage, skin, your intestines, blood vessels, skin, hair, nails and bones. If you value your health, you do not do anything that might have even the slightest chance of messing with the health of your collagen.

These drugs should not be prescribed at all to anybody, given that there is at least 60/100 cases of tendon damage. Please read my other articles about quinolone antibiotocs.

Tuesday, October 09, 2007

Is a ruptured Achilles tendon the end of her sporting life?

Dear Gary,
I have a friend who is 35 yrs old, with young children, who has just ruptured her Achilles and is now in her third week of plaster. She was advised by a Specialist this week that her life will have to change now she has had this injury… his words “if you were a good tennis player before this injury then you will be a bad one for the rest of your life now”. I am enquiring on her behalf if her life will be as bad as this “expert” claimed as he has totally depressed my friend and she still has weeks left in plaster. He also informed her that she would be at great risk to snap in again if she is not very careful in the future. Can you offer any words of encouragement, advice?
Regards.
R.
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Gary comments:
There is hope - a ton of it.
As somebody who has seriously injured both achilles, including one partial rupture requiring 12 weeks in plaster, I can understand partially the distress your friend is going through right now. The good news is recovery can be complete and there are more successes than failures. I am a good example of that and so is my sister, Lorraine, who underwent at least one achilles operation and still managed to win a bronze Olympic medal. There is hope. That's for sure.

An achilles tendon rupture is a nasty, catastrophic injury and the best resources and expertise need to be mustered to ensure the fullest recovery. If it was a complete rupture, as you appear to imply, then the general consensus is that the tendon be surgically sewn back together and then immobilised for several weeks. If that has not been done for your friend, it is probably too late. This method of repair generally gives a faster and fuller recovery than placing the leg in plaster and hoping that ends meet and join back up again.

It is when the plaster comes off that the hard work really begins. Especially if the tendon was not sewn then extreme care must be taken when gradually mobilising the ankle because reinjury can happen without warning. Many years ago when I was working in the physio department of Dunedin Hospital, a young physio was giving a patient with a post achilles rupture some heel raise exercises. There was an audible snapping as the tendon snapped again. It was hard to tell who was the most upset - the patient or the physio. The lesson here is not to push things - to take one's time for a good 12 weeks or so after the plaster comes off while the tendon completes its recovery. Seek the services of a physiotherapist who has been working for several years, rather than an inexperienced Young Gun.

Recovery is probably well on the way about 12 weeks after getting out of plaster, but it is that final 10% that might take a good one-two years to be completed. The initial stages should be guided by an experienced physiotherapist who can guide your friend.

In the meantime, she is in plaster, and there are several extremely positive things she can do to aid her recovery:

Get into a gym and work out vigorously:

  • It is only the bottom part of one leg that is immobilised - the rest of the body is in perfect order, so here is an opportunity to get super fit, including working on all those lose and soft bits. Being super fit will improve circulation to the injured area and ensure that she does not put on excess weight which could be a burden on her leg when the plaster comes off.

Improve nutrition and healing:

  • Take some glucosamine and chondroitin which aids tendon as well as joint healing
  • Take up to 4,000mg of MSM per day. Perfect for tendons and fantastic for skin, hair and nails and a natural anti-inflammatory
  • Take up to 2,000mg of vitamin C per day for the same reasons as the MSM
  • The same advice applies for vitamin E which is traditionally used for softening scar and for promoting healing.

All of these are available through http://www.myotec.co.nz/

The good news is that a properly treated and rehabilitated achiiles tendon is very strong. Some argue that it can be stronger. I tend to agree. My experience is that if an achilles is going to rupture again 1-2 years following the first time, it is usually the other one! (Not sure if that is good or bad news??).