Does this sound right? (Ankle care)

[FieryPrincess]

fell on Jan 6.
Was told that "I'm 40 now, so it takes awhile to heal"
6 weeks later I complained of continuing and unabated pain.
1 week after that I had an MRI.
The day after the military refers me off post to a civilian (although former military) foot/ankle specialist. I am told to stop walkin and to start using crutches.
I get a copy so I can know what the heck is on that thing. It shows (layman's terms) a completely torn ligament, a bone bruise, and a "dent" in the articulated cartilage of my talus dome.
I get an appointment with the civvie doc a couple of weeks later.
He kinda looks over my stuff and puts me in a cast for 3 weeks.
Two weeks into using the cast I am in a lot of pain and want some pain meds just so I can sleep at night. We move up my appointment. At the 2.5 week mark, the cast comes off and a boot goes on.
Three days into wearing the boot I cannot get through the day without crying from pain. My husband makes some calls and I am finally prescribed a week worth of pain meds.
I wear the boot for 4 weeks. 75% of the time I was still using crutches because I could not stand the full weight beaing.
I still have pain.
Now I have a brace that I can wear for 6 weeks. In the beginning I can alternate between the boot and the brace as needed, but then I am go to brace only and start to wean myself off of that by the end of the six weeks time.
I asked about PT to strength the remaining tendons/ligaments in the ankle but was told that is not advisable at this time.

Conservative treatment sucks. I hate Tricare. It hurts, but the doctor doesn't believe in pain meds.

Everything I have read and based on my history (which no one else seems interested in), surgery is inevitable. Do these things really drag on like this forever? I can't go on walks, I do not get through the school day well at all, and this is seriously cutting into my ability to prep for a move.

I am angry that the doctor isn't more aggressive on treatment and it is rather a moot point now anyway with the PCS 4000 miles away. My husband thinks I have read too much on the subject and have become something of a hyperchondriac about it all. (Well, since I can't go play outside...duh!)

It is just that I am an active (if not athletic) person with a lot of responsibilities. I don't like having to go through it all while I feel like this.

Guess I just get to wait until I fall again and damage more stuff and maybe then it will be bad enough to actually FIX!

[siamcat]

I'm sorry your providers suck and that you're still hurting.

I would call Tri-Care and request a different doctor. Keep bugging them. There are some very good doctors and some very bad ones.

If at all possible I would seek another opinion from an independent doctor. Request the x'rays and a copy of your medical records for them to review. Maybe there is one that accepts Tricare so you only have to pay the difference between what they charge and what Tricare pays.

Good luck.

[FieryPrincess]

So I called. I have to have an appointment with my prima ry care doctor to request the second opinion and then if I don't like what the PCM says or does, I can do through patient advocacy. That appointment is set up for May 18.

In calling Tricare to find out what mess what going to be required to start this process all over again at our new duty station, I was told that I was pretty much screwed because I was going to have to start all over. That is only a slight paraphrase from what the guy said on the phone.

Which has put me on something of a warpath here in SA.

[Mestral]

It shows (layman's terms) a completely torn ligament, a bone bruise, and a "dent" in the articulated cartilage of my talus dome.If you have read the stuff right, this WILL require surgery.

So I called. I have to have an appointment with my prima ry care doctor to request the second opinion and then if I don't like what the PCM says or does, I can do through patient advocacy. That appointment is set up for May 18.

In calling Tricare to find out what mess what going to be required to start this process all over again at our new duty station, I was told that I was pretty much screwed because I was going to have to start all over. That is only a slight paraphrase from what the guy said on the phone.

Which has put me on something of a warpath here in SA.The only good news I can give you is that at a "new duty station" you will get a new set of doctors, and chances are they will be better than the clowns you have described.

Try to keep getting off post care. The military doctors are paid NOT to see the problem. (For 17 years, they told me I had a muscle strain in my back. When I got out, Dr Yarborough about flipped, when he saw my X-Ray.)

[FieryPrincess]

Mestral, I thought a lot about what you wrote and I have thought a lot about the colleague of mine who is also a military dependent who was almost killed by inadequate care.

So on my own dollar, I drove down to Houston for the day and went to the Texas Orthopedic Hospital for a second opinion/consult down there.

The specialist there confirmed everything that I believed and had researched on my own: my situation requires surgery (and might require two if the surgeon doesn't feel competent to resolve the TWO major issues at one time) to resolve the problems. So now, I am not just in daily pain, but I am seriously ticked off at being blown off by the orthopedic surgeon I have been referred to by the military. There is no way for me to have the required surgery and an adequate recovery time (6-8 weeks non-weight bearing and then 2-3 months of physical therapy) before we leave Texas for Alaska at the end of June.

When I called Tricare to find out the procedure to continue care up there, the guy basically said I was screwed and would get to start the process all over by waiting for an appt with a PCM and then for the referral to orthopedics.


I know I want to confront the current OS who has left me hanging. Additionally, because he is a civilian off-post doctor, I am pretty sure I want to talk to someone about having him removed from the referral system for flat out non-treatment. (Is that a form of malpractice?) I wish I knew exactly how to go about doing that.


From a diagnositc perspective, I am batting a higher percentage than docs. That just isn't right.

[mac]

wish i had read this earlier.

Princess: there are a couple of things you need to do today and monday.

on monday your guy needs to ask for a deferment, a deferred report date for the reasons you listed. they'll grant it and that'll remove a lot of the stress.

today, you need to sit down and very calmly write a non-accusatory letter to the director of the darnall hospital.....less than 2 pages. you've already got a good start on that. be sure you have the name of your primary care provider, he's the guy who's responsible for coordinating ALL of your care. The specialist's report of his findings etc would have been sent to your provider and would have included a recommend plan of care. the bottom line of your letter should be something like "Please ask my Primary Care Provider to provide you a copy of his treatment plan for me and then ask your quality assurance and risk management staff to review my past care and treatment and their assessment as well as recommendations of what I should do next".

Remember, very polite, very sober, nothing outrageous or extreme, you do NOT want to come on as a kook or else your letter will be considered a kook's letter. If you do it right you'll be on everybody's screen and people will move unbelieveably fast to get you the proper and most effective treatment possible......and anything else they can do to make you happy.......mac (i happen to agree with the doc's hesitancey to prescribe meds.......using pain meds will only allow you to do more damage than you've already done.....

[FieryPrincess]

Thanks mac.

I'll start with the letter. I fear we too far down the path of leaving to reverse course now. We have no place to live after June 30. While the possibility exists for me to follow later, I have no one who can take care of me while in the recovery phase.

The silver lining is that the completely torn ligamnent isn't likely to get more torn by the continued activity and the OCD will still require the same procedure even if it is worse when I get there. Most of the time will be in the car anyway, right?

I'll get started on that.

[FieryPrincess]

P.S. this has all been through BAMC in San Antonio. You know, the new joint military medical service and supposedly the best of what they have to offer from a medical standpoint once Walter Reed is all gone.

Be afraid for the troops and their families. Be very afraid.

[Mestral]

Our troops have the best third rate medical services we can get them, and if the medical establishment screws up, the resulting damage is considered service connected injury, not malpractice. It sucks, but pragmatically, it is what the nation can afford. The only good thing I can say about it is that other nations have it worse.

[CenTexDave]

And, Princess, when you'e done all Mac and Mestral has recommended and still get the runaround, write your Congressman ASAP.
Then get a good malpractice lawyer and sue the hell out of the system. That is all they seem to understand sometimes.

[FieryPrincess]

I'm venting here since it is cathartic.

I have started to experience a lot of pain in a new region of the foot/ankle area. I get in here (AK) to see someone and he actuallly listened. I was immediately referred to orthopedics and physical therapy. As the guy told me "it isn't rocket science to figure out that it is messed up and not improving."

I have been ordered back into the boot wwith crutches on mostly non-weight bearing. In addition the the fun problems listed above, it seems my Achilles tendon has started to protest the extra workload and has significantly hampered my ability to walk. I was also ordered of the dog-walking duty but there weren't any suggestions exactly on how they would "do thee business" out of the house without the walk :)

So I am hopeful here that someone will take me seriously And nervous that perhaps the level of care will not be as good as why I could have accessed in Texas. I suppose one can't have everything. I'll settle for walking normally again with most of the pain gone. Somehow I don't think it will ever be pain-free again.

Oh - and we are in middle of unpacking purgatory...you couldnt navigate this place yet on crutches on a bet!

[Mestral]

I know what you meant by cathartic, but can't help but say something anyway. I can't help with most of it, but might suggest, if you have a place that actually has a yard, but as you seem not to have a fence you trust, perhaps what is known as a "dog run (http://www.unchainyourdog.org/Trolley.htm)" would be useful. (BTW, where the diagram says 10' minimum, I would say it should be as long as possible, maybe 100 feet.)

[FieryPrincess]

Yup. We are allowed to rent a fence by the month on post, but where our house is situated, there isn't really enough room for a run. or a yard. :)

My husband and daughter are just going to have to pick up the slack for the long "poop" walk. For the morning and evening relief, I just stand on the porch with leash and use the command "tinkle!" The female dog will (8 times out of 10) tinkle on command and the male dog feels the need to mark her spot. :)


Just one more thing to figure out. A good routine will help and we are working on that.

[FieryPrincess]

Update:

I started over up when I got here. I went through Physical therapy for a couple of months and got a new MRI done. My injury is stable. It will certainly never heal, but the lesion isn't getting worse either. I only have a couple of pairs of shoes that I can wear comfortably - work boots and snow boots. Luckily, the teacher dress code here is more relaxed and no one cares if I wear jeans and workboots on a daily basis.

The orthopedist got here at about the same time I did, and we agreed that I didn't need to try to do my first winter with non-weight bearing and crutches, so the plan is to wait until school is out before we do the necessary reconstructive surgical procedures (more than one is needed). The only trick to it is if I take another fall and invert that ankle again. Then it is straight to surgery and darn the torpedoes.

So I wear my snow boots a LOT and I bought these nifty things called YakTraks. :)

I like the orthopedist here.

I also liked that the new PCM looked at my record and agreed with me that Fort Sam was stuck on misdiagnosing my other problems so we are back to the drawing board on that. I am hopeful that things will finally move in a positive direction.

[siamcat]

I'm glad things are looking up for you on that front.
Best of luck.