vito1281
02-24-2004, 08:12 PM
Hi all,
Brief history: fractured my fibula on xmas day last year. Walked around on the leg for about a week because I only had symptoms of a sprained ankle, and did not feel/know about the fracture at the time. Decided to go get it X-ray'ed, and that's when the fracture was discovered. I went to go see an orthopedic surgeon the following day (after x-ray), and he told me that I NEEDED to have surgery, or else I could end up having problems later on down the road (he mentioned having ankle fusion as one likely consequence). I was somewhat hesitant to have surgery for obvious reasons, and decided to seek a 2nd opinion. Another orthopedic surgeon was highly recommended to me by family friends, and I went to see him. His diagnosis was that I had 2 choices: (a) have surgery and it will take ~6 weeks to heal, OR (b) put a cast on w/out surgery and it will take 8 weeks to heal. Well, given the fact that I didn't feel good about having surgery, I opted for plan b.
A month after the cast was put on, I had my first follow-up visit. At about the same time, I started having chest pain on the right side, underneath my rib cage. During that appt, I asked the doc if he knew what could be causing it, and he said it's most likely just some muscle pain from walking on crutches. Well, it ended up being a pulmonary embolism!!! Actually, 3 emboli were lodged in my lungs, so I could've easily died or had a stroke or any other possibility with an embolism. He never told me initially about the possibility of having this, nor did he tell me that the pain could be a result of that. I ended up spending 4 days in the hospital, and am on blood thinners now. He also told me that everything was going according to plan, and that the fracture site started developing the bone callous. He scheduled another appt for 3 weeks later.
Well, today was that appt. Now, here's where it gets "interesting". I show up to the office, and they send me over to the x-ray dept. Nothing unusual here, so I go over to the x-ray dept. I spent quite a bit of time waiting for my x-ray to be taken, and on the walk back to the doctor's office, we (I was with my father) see my doctor walking towards us, going in the opposite direction of where his office is. On top of that, he had his coat on and his briefcase. As he walks by us, he tells us "I have a patient in the emergency room" and made a gesture with his finger as if to just wait a little bit, and he'll come back to see me. Thinking nothing of it, I returned to his office.
When I got to his office, I needed to use the restroom. When I returned from the restroom to the exam room, I see his assistant (PA-C after her name, not M.D.--what is PA-C???) explaining something to my father. Anyhow, I sit down and she starts telling me that they will be putting me in a removal cast and will see me in 3-4 weeks. At this point I ask her where the doc is, and she tells me that he had a dentist appt and left. What the ****??? I got a little irritated, and asked her how that could be. All she told me is that the doc is gone and there's nothing they could do. She offered to have the doc give me a call back tomorrow. Well, having no other option, I told her that's fine.
So I start asking her questions about my x-ray and situation. Firstly, let me mention that the x-ray was really weird, and didn't look like the x-ray's they've taken before. This one was at a very odd angle, and it was hard to see the fracture site, unlike the previous x-rays. So I asked her how the fracture is healing, and she tells me that she's not happy about the amount of callous there. I started telling her that I was told by the doc that it would take 8 weeks at most to heal, and she starts telling me that nothing is exact, and blah blah blah. Then she told me that I need to start bearing 75% of my weight on the leg while wearing the removable cast. I told her that before this I was told to put only 50-60lbs on the leg, so putting 75% of my weight (I weigh 215lbs) would be a big jump. Now she tells me that I should only put 100-125 lbs on it. Anyhow, I left VERY disappointed in the whole situation. She told me the doc will call me tomorrow.
Can anyone explain to me who the **** is a PA-C? Is this right of the doc to lie to me about where he's going? Is there any medical malpractice here? Do docs usually prescribe Aspirin to thin the blood while wearing a cast? He has a patient who's obviously had complications as is with the cast, and I was looking forward to this appt like nothing else. Instead, I got medical advice from some PA-C. Can someone explain to me what the heck happened? Should I switch doctors, and is it even possible that some other doc will take on my case now? I'm a little worried now that perhaps the first doc was right, and that only surgery was plausible. And now I can be at risk for complications later on down the road, such as ankle fusion. Can anyone share their thoughts/experience on something remotely like this?
Sorry for the long post, but I'm extremly pissed off and frustrated right now with my doc.
Thanks
Brief history: fractured my fibula on xmas day last year. Walked around on the leg for about a week because I only had symptoms of a sprained ankle, and did not feel/know about the fracture at the time. Decided to go get it X-ray'ed, and that's when the fracture was discovered. I went to go see an orthopedic surgeon the following day (after x-ray), and he told me that I NEEDED to have surgery, or else I could end up having problems later on down the road (he mentioned having ankle fusion as one likely consequence). I was somewhat hesitant to have surgery for obvious reasons, and decided to seek a 2nd opinion. Another orthopedic surgeon was highly recommended to me by family friends, and I went to see him. His diagnosis was that I had 2 choices: (a) have surgery and it will take ~6 weeks to heal, OR (b) put a cast on w/out surgery and it will take 8 weeks to heal. Well, given the fact that I didn't feel good about having surgery, I opted for plan b.
A month after the cast was put on, I had my first follow-up visit. At about the same time, I started having chest pain on the right side, underneath my rib cage. During that appt, I asked the doc if he knew what could be causing it, and he said it's most likely just some muscle pain from walking on crutches. Well, it ended up being a pulmonary embolism!!! Actually, 3 emboli were lodged in my lungs, so I could've easily died or had a stroke or any other possibility with an embolism. He never told me initially about the possibility of having this, nor did he tell me that the pain could be a result of that. I ended up spending 4 days in the hospital, and am on blood thinners now. He also told me that everything was going according to plan, and that the fracture site started developing the bone callous. He scheduled another appt for 3 weeks later.
Well, today was that appt. Now, here's where it gets "interesting". I show up to the office, and they send me over to the x-ray dept. Nothing unusual here, so I go over to the x-ray dept. I spent quite a bit of time waiting for my x-ray to be taken, and on the walk back to the doctor's office, we (I was with my father) see my doctor walking towards us, going in the opposite direction of where his office is. On top of that, he had his coat on and his briefcase. As he walks by us, he tells us "I have a patient in the emergency room" and made a gesture with his finger as if to just wait a little bit, and he'll come back to see me. Thinking nothing of it, I returned to his office.
When I got to his office, I needed to use the restroom. When I returned from the restroom to the exam room, I see his assistant (PA-C after her name, not M.D.--what is PA-C???) explaining something to my father. Anyhow, I sit down and she starts telling me that they will be putting me in a removal cast and will see me in 3-4 weeks. At this point I ask her where the doc is, and she tells me that he had a dentist appt and left. What the ****??? I got a little irritated, and asked her how that could be. All she told me is that the doc is gone and there's nothing they could do. She offered to have the doc give me a call back tomorrow. Well, having no other option, I told her that's fine.
So I start asking her questions about my x-ray and situation. Firstly, let me mention that the x-ray was really weird, and didn't look like the x-ray's they've taken before. This one was at a very odd angle, and it was hard to see the fracture site, unlike the previous x-rays. So I asked her how the fracture is healing, and she tells me that she's not happy about the amount of callous there. I started telling her that I was told by the doc that it would take 8 weeks at most to heal, and she starts telling me that nothing is exact, and blah blah blah. Then she told me that I need to start bearing 75% of my weight on the leg while wearing the removable cast. I told her that before this I was told to put only 50-60lbs on the leg, so putting 75% of my weight (I weigh 215lbs) would be a big jump. Now she tells me that I should only put 100-125 lbs on it. Anyhow, I left VERY disappointed in the whole situation. She told me the doc will call me tomorrow.
Can anyone explain to me who the **** is a PA-C? Is this right of the doc to lie to me about where he's going? Is there any medical malpractice here? Do docs usually prescribe Aspirin to thin the blood while wearing a cast? He has a patient who's obviously had complications as is with the cast, and I was looking forward to this appt like nothing else. Instead, I got medical advice from some PA-C. Can someone explain to me what the heck happened? Should I switch doctors, and is it even possible that some other doc will take on my case now? I'm a little worried now that perhaps the first doc was right, and that only surgery was plausible. And now I can be at risk for complications later on down the road, such as ankle fusion. Can anyone share their thoughts/experience on something remotely like this?
Sorry for the long post, but I'm extremly pissed off and frustrated right now with my doc.
Thanks
Sponsor
jdm
02-24-2004, 09:11 PM
I am not exactly sure, but I think that a PA-C might be a physician's assistant. I now that they do have medical training, but not as much as a regular MD. I would definitly check around for another dr. I am in a cast after surgery, and no one has talked to me abput blood clots. However, after reading several posts here, I am slightly concerned.
Hope all goes well with you. Good luck in your recovery.
Hope all goes well with you. Good luck in your recovery.
kfs333
02-24-2004, 11:03 PM
A PA is a Physician's Assistant. They can do almost everything a physician does including writing prescriptions under a physician. Pulmonary embolism can happen which is caused from DVTs or Deep Vein Thrombosis, which are blood clots in the veins and usually in the veins from the legs.
I am due to have surgery on March 26th and will be in a cast for 14 weeks. After surgery,I will be starting an aspirin regimen. If this doesn't work, I will have to have a subtalar fusion.
I am due to have surgery on March 26th and will be in a cast for 14 weeks. After surgery,I will be starting an aspirin regimen. If this doesn't work, I will have to have a subtalar fusion.
vito1281
02-24-2004, 11:45 PM
I am not exactly sure, but I think that a PA-C might be a physician's assistant. I now that they do have medical training, but not as much as a regular MD. I would definitly check around for another dr. I am in a cast after surgery, and no one has talked to me abput blood clots. However, after reading several posts here, I am slightly concerned.
Hope all goes well with you. Good luck in your recovery.
jdm, thanks for replying. I'm going see what he says tomorrow, but I will most likely look for a new physician.
Good luck in your recovery as well.
Hope all goes well with you. Good luck in your recovery.
jdm, thanks for replying. I'm going see what he says tomorrow, but I will most likely look for a new physician.
Good luck in your recovery as well.
vito1281
02-24-2004, 11:47 PM
A PA is a Physician's Assistant. They can do almost everything a physician does including writing prescriptions under a physician. Pulmonary embolism can happen which is caused from DVTs or Deep Vein Thrombosis, which are blood clots in the veins and usually in the veins from the legs.
I am due to have surgery on March 26th and will be in a cast for 14 weeks. After surgery,I will be starting an aspirin regimen. If this doesn't work, I will have to have a subtalar fusion.
I figured it was an assistant, but that concerns me. It's not like my regular doc was there supervising her...He didn't even have a chance to look at the xrays because he left, so it was her telling me how much weight bearing I can do, her trying to read my xrays (which I'm not even sure were the right ones to take), and her giving me medical advice. I don't know if this is standard practice, but as a patient, I don't feel comfortable having a PA handle my care.
Anyhow, thanks for your response and good luck with your surgery.
I am due to have surgery on March 26th and will be in a cast for 14 weeks. After surgery,I will be starting an aspirin regimen. If this doesn't work, I will have to have a subtalar fusion.
I figured it was an assistant, but that concerns me. It's not like my regular doc was there supervising her...He didn't even have a chance to look at the xrays because he left, so it was her telling me how much weight bearing I can do, her trying to read my xrays (which I'm not even sure were the right ones to take), and her giving me medical advice. I don't know if this is standard practice, but as a patient, I don't feel comfortable having a PA handle my care.
Anyhow, thanks for your response and good luck with your surgery.
eko
02-25-2004, 08:42 AM
I'd like to add to the blood clot issue. I also had a pulmonary embolism from being in a cast following surgery and am having another surgery next week, a great toe fusion. My surgeon told me that I was his first patient in 18 years to have an embolism, and in all his years of practice, only about ten patients have developed DVT. Lucky me, I was the one that had it all. Anyway, the important things is to be aware of the symptoms of DVT, catch it early. I missed it and have been on blood thinners for 6 months. Anyway the key is leg exercises and getting around to keep the blood circulating. If you suddenly develop calf pain, call your Dr. - main sign of DVT. I am off of blood thinners the weeke prior to this surgery, but because of my history, my surgeon and well as my primary care physician have put together a plan to prevent this form happening again. Part of me is more concerned about blood clots then the surgery itself. Anyway, all of you take care and know the signs of DVT. -eko
twobadfeet
02-25-2004, 11:17 AM
eko,
I, and I'm sure a lot of folks here, would like to know what kind of leg exercises you do and how often is often enough to get up and move around? I'm aware of the dangers of total inactivity following surgery, but don't know EXACTLY what to do to prevent blood clots. Nobody ever tells you specifics, so as someone who will undergo a second bunionectomy, I'd really like to know.
By the way, thanks for adding to the information about this issue. I think that's a real service.
twobadfeet
I, and I'm sure a lot of folks here, would like to know what kind of leg exercises you do and how often is often enough to get up and move around? I'm aware of the dangers of total inactivity following surgery, but don't know EXACTLY what to do to prevent blood clots. Nobody ever tells you specifics, so as someone who will undergo a second bunionectomy, I'd really like to know.
By the way, thanks for adding to the information about this issue. I think that's a real service.
twobadfeet
jdm
02-25-2004, 12:19 PM
Regarding the bad clots, I have been getting up about every hour and doing a "lap" around the house. I also have been doing leg lifts. Hey, the cast makes for great weight training. I am becoming a great arm chair athlete. Thanks for the warning signs and advice.
Jennie
Jennie
kfs333
02-25-2004, 01:25 PM
I was reading a DVT site and they said leg lifts and changing positions or moving around about once an hour. Keep the legs elevated as much as possible. I'm wondering if pilates is good for this problem?
carlos95
02-25-2004, 02:47 PM
Does it have to be a cast that can cause blood clots, or can it be a regular compression wrap (having it too tight)? Or is it purely the inactivity that causes it?
Thanks,
Carlos
Thanks,
Carlos
Jess0018
02-25-2004, 02:48 PM
I have seen PA's many times in the doctors office and they are especially common in an orthopedic's office. I am a student who is pursuing a medical career so I shadowed several PA's and they are very knowlegable. They get their orders from the doctor and the doctor is responsible for their mistakes. I know many people as well as myself that have been in casts and not been on blood thinners. Unless you were at a particular risk I don't think your doctor made a bad decision as far as blood thinnners go.
vito1281
02-25-2004, 05:06 PM
First, let me say thanks to everyone for sharing their experience. As far as blood clots are concerned, they are EXTREMELY rare when you're casted WITHOUT surgery. They usually occur when you're casted, thus immobilized, and have had surgery. As a matter of fact, when you have ortho surgery, you're usually given blood thinners to take at home. However, from what I was told, it's very rare to have a clot with just a cast.
The clot is caused because of immobilization and poor circulation in the casted area. In my case, the cast prevented me from moving my calf muscle at all, and when people develop a DVT in the lower extremity (below the hip), it's almost always in the calf. Looking back, I remember feeling a cramp-type pinch in the calf from time to time, but it never escalated to a fullout cramp, so I just attributed it to being in a cast. Knowing what I know now, I would have probably went to the doctor when I started feeling those things. I didn't have any other DVT symptoms, and only knew I had a PE when my lungs started to hurt.
Also, I spoke to my doc today. He told me that the xray is the correct one, and is simply a blown-up version of the other ones, and he can see everything he needs to see in it. He told me that he's not seeing much callous given the amount of time that has elapsed already, and told me to come back in 4 weeks. At that point, if there's still no healing, I'll have 2 options: a bone growth stimulator or fixation surgery. This really drives me nuts because I chose this OS because he ensured me that surgery was not NECESSARY, and that I would simply have to wait 8 wks instead of 6 wks to heal. At no point in time did he discuss the possibility of a non union and the likelihood of one with and without surgery. If it turns out that I need surgery, then I'll be back at square one, and would have simply wasted several months waiting for it to heal on its own.
Has anyone had a similar situation, where healing was delayed, but then sped up after a certain amount of time? I was looking forward to yesterday because I could see the light at the end of the tunnel, but now there's no light, and more uncertainty.
Any advice would be appreciated. Thanks.
The clot is caused because of immobilization and poor circulation in the casted area. In my case, the cast prevented me from moving my calf muscle at all, and when people develop a DVT in the lower extremity (below the hip), it's almost always in the calf. Looking back, I remember feeling a cramp-type pinch in the calf from time to time, but it never escalated to a fullout cramp, so I just attributed it to being in a cast. Knowing what I know now, I would have probably went to the doctor when I started feeling those things. I didn't have any other DVT symptoms, and only knew I had a PE when my lungs started to hurt.
Also, I spoke to my doc today. He told me that the xray is the correct one, and is simply a blown-up version of the other ones, and he can see everything he needs to see in it. He told me that he's not seeing much callous given the amount of time that has elapsed already, and told me to come back in 4 weeks. At that point, if there's still no healing, I'll have 2 options: a bone growth stimulator or fixation surgery. This really drives me nuts because I chose this OS because he ensured me that surgery was not NECESSARY, and that I would simply have to wait 8 wks instead of 6 wks to heal. At no point in time did he discuss the possibility of a non union and the likelihood of one with and without surgery. If it turns out that I need surgery, then I'll be back at square one, and would have simply wasted several months waiting for it to heal on its own.
Has anyone had a similar situation, where healing was delayed, but then sped up after a certain amount of time? I was looking forward to yesterday because I could see the light at the end of the tunnel, but now there's no light, and more uncertainty.
Any advice would be appreciated. Thanks.
smartgal
02-25-2004, 05:58 PM
You should really get a second opinion. This doctor sounds like a joke to me. He does not seem to have a great deal of concern for his patients and has obviously lied to you before. You've already lost too much time with him, don't invest more.
sweetficus
02-25-2004, 09:06 PM
another thing about pulmonary embolism - it can also be caused by long car rides or long airplane rides. I take a lot of airplane trips and always take an aspirin for a day before the flight and flex my toes and calves on the plane every now and then
after my bunion surgery I had chest pain and I went to the ER right away b/c I was worried that I had a PE but it was just heartburn apparently (that I have never had before or since)
after my bunion surgery I had chest pain and I went to the ER right away b/c I was worried that I had a PE but it was just heartburn apparently (that I have never had before or since)
twobadfeet
02-26-2004, 11:35 AM
jdm and kfs333,
Thanks for taking the time to respond on the issue of post-op blood clots and what to do to prevent them. After my bunionectomy I tried to limit my trips to the bathroom because of the pain, so the first week I was pretty inactive. I (briefly) had some minor leg cramping and minor pain in my right lung, and breathing became a little difficult. It seemed a minor annoyance at the time and since I was occupied with the pain and inconvenience of the bunionectomy, I didn't pay much attention to it. It passed fairly quickly--within a couple of days and I didn't think anything more of it until these posts about DVT and pulmonary embolisms (yikes!) It may have been nothing, but then again it may have been DVT and I could have dodged a major bullet.
Surgeons really should tell you about these things and how to prevent them. With my second bunionectomy coming up, I plan to be more careful to get up every hour to move a little and to do leg lifts periodically. Thanks for responding with more information, both for my sake and others on the list who may have known as little as I did about how little it takes to stay out of serious trouble.
twobadfeet
Thanks for taking the time to respond on the issue of post-op blood clots and what to do to prevent them. After my bunionectomy I tried to limit my trips to the bathroom because of the pain, so the first week I was pretty inactive. I (briefly) had some minor leg cramping and minor pain in my right lung, and breathing became a little difficult. It seemed a minor annoyance at the time and since I was occupied with the pain and inconvenience of the bunionectomy, I didn't pay much attention to it. It passed fairly quickly--within a couple of days and I didn't think anything more of it until these posts about DVT and pulmonary embolisms (yikes!) It may have been nothing, but then again it may have been DVT and I could have dodged a major bullet.
Surgeons really should tell you about these things and how to prevent them. With my second bunionectomy coming up, I plan to be more careful to get up every hour to move a little and to do leg lifts periodically. Thanks for responding with more information, both for my sake and others on the list who may have known as little as I did about how little it takes to stay out of serious trouble.
twobadfeet
eko
02-27-2004, 09:13 PM
Regarding DVT ...
I saw my GP today for my H&P before surgery next week. Since I now have a history of clots we discussed the plan to hopefully avoid them this time around. I can tell you the the Dr. who is doing the surgery will not be using a thigh touriquet, and I will not have a cast this time. Following surgery I am to start with Lovenox injections for nine days. If I am not up and moving by then, then it will be another week of Lovenox and back on Coumadine. To avoid clot, exercises that stretch the calf muscle and flexing the ankle help (easier said then done in a cast). Leg lifts help and getting up and moving every hour is also good. Also when elevating your leg, try not to put to much pressure behind the knee. The deep vein runs behind there and to much compression can contribute to clot development.
Hopefully none of you will ever have a problem with this. Take good care!
-e
I saw my GP today for my H&P before surgery next week. Since I now have a history of clots we discussed the plan to hopefully avoid them this time around. I can tell you the the Dr. who is doing the surgery will not be using a thigh touriquet, and I will not have a cast this time. Following surgery I am to start with Lovenox injections for nine days. If I am not up and moving by then, then it will be another week of Lovenox and back on Coumadine. To avoid clot, exercises that stretch the calf muscle and flexing the ankle help (easier said then done in a cast). Leg lifts help and getting up and moving every hour is also good. Also when elevating your leg, try not to put to much pressure behind the knee. The deep vein runs behind there and to much compression can contribute to clot development.
Hopefully none of you will ever have a problem with this. Take good care!
-e