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The snowHeads ACL rehab club !

 Poster: A snowHead
Poster: A snowHead
As I joined the ACL(?) club in Serre C this week, and I'm trying to understand the best option to get it fixed.

As I don't have any private medical insurance I'll probably need to go NHS, but I'm hoping to short cut by having say an initial private consultation and MRI.

Does anyone have a view as to if this would prevent getting the op on the NHS ?

Also, is there any view on the benefit in finding the cash and getting the op done ASAP ?

Thanks Happy


Last edited by Poster: A snowHead on Tue 29-04-14 16:27; edited 6 times in total
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AndAnotherThing.., I'm going through exactly this sort of conundrum at the moment. In January I was referred to an NHS hospital and asked them whether I would get to see a consultant more quickly if I went privately. They said possibly (though in the event, the NHS appointment came through very quickly indeed) but advised me against doing so, as I would 'fall out of' the NHS system altogether if I did that. Fast forward a few weeks and I am now awaiting surgery. The surgeon to whom I've been referred operates on his NHS patients at the NHS hospital (huge waiting list) and on his private ones at a private hospital (not much of a waiting list at all) and I am assured by everybody that, if at this stage I go private - just for the operation - I can slot back into the after-care arrangements at the NHS hospital without any problem.

I think the lesson here is, assuming my experience is anything to go by: keep asking along the way, seeking reassurance that you're not going to be booted right out of NHS care by side-stepping it at certain stages.
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AndAnotherThing.., I am sure that Lou will be along here soon - she did her ACL last year and also works in the NHS so has lots of views. Jolly bad luck for you though - and all those others.
Pedantica, good luck..
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Pamski, thanks, will certainly be glad when it's done and dusted.
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AndAnotherThing.., Weathercam's thread may be of use

http://snowheads.com/ski-forum/viewtopic.php?t=80426
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AndAnotherThing.., quite a lot depends on where you are in the country. If you are walking wounded then the best bet is to get your g.p to refer you to an orthopaedic triage service ( clinical assessment and treatment centre) providing you do have a bust ACL and you make the right noises (nicely) then you should be referred on for a surgical opinion. At that point you should be given 'choice'. Having already researched who specialises in ACl repair and the waiting times ( a few phone calls sort this) then you can make your 'choice'. Remembering of course to check which of your chosen surgeons do NHS work in private hospitals (which NHS has pre paid for) as very often the waiting times to see the same surgeon are shorter. That's the quickest non pay route.

And no, medics should no longer 'queue jump' their private patients into earlier NHS slots, it used to go on quite a lot but is now frowned upon. Can be seen as inducement, pay to see me and i will move you up the queue Shocked

Quickest NHS route i've known in my area is Gp to Cat service 2 weeks, then scan wait 2 weeks, then wait for scan results 1 week, then fit for surgery appointment 1 week, then orthopod appointment 2 weeks, then op date 3 weeks...............total 11 weeks and then the hard work started.

Just remember not all ACL's need an op wink
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AndAnotherThing.., I know my doctor is working on the 'more prehab = less rehab' line of thinking. I didn't push to see a surgeon sooner in the end because I did mine just as we were about to be fully booked for 7 weeks and it just wasn't going to be convenient for me to be laid up from an operation. Other doctors say get on with it as soon as possible so you don't risk more damage to your knee (I'm still wearing a brace and not doing much active leg strengthening - i.e. cycling - as I should have the op fairly soonish and I don't want to cause swelling and damage if avoidable). My doctor has said to me that already I'm in good enough shape for him to think I don't need to have the op and that I could hike this summer and ski next winter with a brace but that with my activity level etc. it's a good idea. My physio is strongly of the opinion I should get the op asap because he doesn't want me to do anything too active until I do, but does admit it is better to go into the op with full range of motion and some strength in the muscles beforehand. UK private and US seem to operate asap on all people though, not just pro athletes with loads of muscle mass and a career on the line. These are just my impressions from a bit of googling, though I stopped doing that too much as there are loads of quite depressing blogs and different opinions out there. I think staying positive is a major part of the recovery process, so I don't want to expose myself to that too much! It's obviously not the best thing to have happened, but it's certainly not the worst.
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cad99uk wrote:
AndAnotherThing.., Weathercam's thread may be of use

http://snowheads.com/ski-forum/viewtopic.php?t=80426


I disagree with this, I'm afraid! I find it most disheartening.

I was lucky to have private health insurance, so had the consultation with knee specialist & MRI within a couple of days of returning to the UK. However, if you had to pay for anything, I would get a good physio & get on with the rehab. As Sunnbuel says, not all ACL's need surgery.

Welcome to the club, anyway AndAnotherThng & I hope you make a good recovery Smile
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sunnbuel wrote:

And no, medics should no longer 'queue jump' their private patients into earlier NHS slots, it used to go on quite a lot but is now frowned upon. Can be seen as inducement, pay to see me and i will move you up the queue Shocked


We did this with one of my Grandparents, who waited ages on the NHS for a cataract operation in one eye. Then when it started to appear in the other eye a few years later we got her a private appointment with the same consultant, then back to his NHS list for the op, but months ahead of where she would have been if had waited on NHS to see him for the assessment. I know that's a bit wrong, but it works (or did).

AndAnotherThing.., I hope you get fixed up soon, by whatever route!
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genepi wrote:
cad99uk wrote:
AndAnotherThing.., Weathercam's thread may be of use

http://snowheads.com/ski-forum/viewtopic.php?t=80426


I disagree with this, I'm afraid! I find it most disheartening.

..... As Sunnbuel says, not all ACL's need surgery.

Welcome to the club, anyway AndAnotherThng & I hope you make a good recovery Smile


+1 on all the above.
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Thanks so much to everyone. I'm going to sort an immediate appointment with a GP and go from there. It seems logical the first step will be to get an MRI sorted to ID the actual damage. Once we have that I guess an informed decisions can be made.


Still, I've found myself looking at a ski magazine scoping new ski's so I guess I'm still up for it. Come September I'll be gagging to be on snow again.

Quote:
..... As Sunnbuel says, not all ACL's need surgery.


Indeed. I found out today that an Instructor friend of mine did hers a few years ago. We've skied & trained hard so I know it can be good, so it's a possibility for sure.
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Pamski wrote:
AndAnotherThing.., I am sure that Lou will be along here soon - she did her ACL last year and also works in the NHS so has lots of views. Jolly bad luck for you though - and all those others.
Pedantica, good luck..


Not the ACL club for me Pam (ankle ligaments and avulsion fracture on right, wrenched left knee but thankfully ligaments are ok though it's not right!)

Hope you all have a speedy and thorough recovery, operation or not.

It is possible to mix and match parts of the process. It's a good idea to be advised by the surgeon him/herself as things vary locally and NHS waiting times are sometimes actually surprisingly good Madeye-Smiley
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A word of caution, although possibly a local thing out here in the sticks, the local private hospital whilst very nice well established etc, is not the best place to be IF there are any chance of complcations.
A friend of my father who has an ongoing breathing problem was refused treatment at the private hospital for a knee replacement as the risk was to great for them, so he had the op done by the same surgeon on the NHS at the local NHS hospital. All was well.
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I had some positive news overnight. A friend from our local slope emailed to say she did her's a year ago and she presented herself at A&E at our local hospital and is highly positive of the treatment and process. The same surgeons name keeps popping up who I think is based at Oswestry and seems to have worked on most of the people I know !

A&E beckons tomorrow Happy
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AndAnotherThing.., excellent. Good luck with it all!
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AndAnotherThing.., that is good news - it's great to have a personal recommendation.

Every week we get a new set of guests with at least one person who's done it playing hockey, netball, football, rugby or skiing (there are 4 of us here this week!) and everyone is happily skiing and boarding. Some did it 20+ years ago, didn't have the op and are fine. Some had the op, and they are also fine. In the meantime I'm seeing it as an opportunity to develop new skills that I've been meaning to for ages but never found the time - it's certainly motivated me to finally learn to swim different strokes properly as it's a sport you can do fairly quickly after injury (no "jambes de grenouille" though) and I've enjoyed doing some light pilates exercises that don't compromise the knee - something I've rarely had the self-discipline to do properly in the past - that seem to do good things for both body and mind.

Good luck with the journey home and the trip to A&E - it'll feel good to get the wheels in motion and find out about your options from those in the know Smile
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AndAnotherThing.. wrote:
I had some positive news overnight. A friend from our local slope emailed to say she did her's a year ago and she presented herself at A&E at our local hospital and is highly positive of the treatment and process...................................
A&E beckons tomorrow Happy


A couple of things to think about; In your case is it an accident and emergency situation? your injury is a week old? therefore probably not an A+E job unless the knee is really swollen and full of blood. Although you may be seen in 'minor injuries unit' - check to see if your local hospital has one.

If they don't send you away to see your g.p for referral (they often do) and you are processed then you will join that hospitals orthopaedic waits, outpatient clinic, diagnostics, and if appropriate for surgery - the op wait list. Might be quick or not wink

In any case you limit your choice.

Let us know how you get on.
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Lou, sorry about my confusion - all sounded nasty at the time and until you have had one of these injuries you don't really know all about them...
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UPDATE:

In the end I decided to drop in to A&E on Saturday evening. After a chat to the triage nurse who consulted with the on duty doctor, they sent be away but not before booking into the fracture clinic on Monday morning. At this point it looks like a good call and has saved a few days over seeing a GP.

I've been busy with the small exercises suggested by Sue and all feels pretty good, and the rage of movement seems encouraging. For reference I've also taken a note of my current thigh diameter and my weight.

Much laughter from the nurse when she spotted the bill from the pharmacy Laughing
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AndAnotherThing.. wrote:
Much laughter from the nurse when she spotted the bill from the pharmacy Laughing


Aren't we lucky with the NHS? Toofy Grin

Out of interest, what was the pharmacy bill? I expect you had crutches, brace, clexane injections and analgesics?

Good luck on Monday then Very Happy
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Lou, A bit over 200 euro for a couple of crutches, some paracetamol, aspirin and a brace. The brace was the killer. The doc's bill was 90 euro. 30 mins, an x-ray and a sheaf of standard letters. Not so bad really.

I was less excited by my (expensive) Winter Sports insurance 'emergency assistance', and really wonder how badly injured you need to be before they take an interest. I noticed on the plane that another chap with the same injury had been allocated 3 seats to keep his leg up, and can't help wondering if his 'emergency assistance' was a bit more pro active.
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AndAnotherThing.., its the brace always isn't it - we had to pay for one when I broke my kneecap about four years ago - put on at the medical centre and then my husband was asked to go to the pharmacy to get a new one to replace the one put on me. Met someone last week who had to do something similar - there must be a huge pile of braces delivered to the pharmacies in the Alps at the start of the winter. I think we got most of it back from our winter sports insurance together with the EHIC.

Interestingly, or not, my next door neighbour here in Les Gets broke her pelvis last year and was driven home by ambulance the whole way to hospital in Wimbledon whereas someone staying at the next chalet along broke her pelvis last year too and she was flown home - different treatment by difference insurance companies.
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AndAnotherThing.., not too bad imo. Braces and suchlike are very pricey.
My friend last week had three seats (we were lucky that she got the last one on the flight we were booked on). Another member of the group had already had to fly home so that gave her another. That was Easyjet and insurance with Direct Travel. Friend had wheelchair from desk close to check-in at Geneva to gate. At the other end she had help as far as baggage reclaim (which wasn't so good as we had to get out of the terminal to meet my OH) but we took our time. They weren't going to give her crutches but they were very useful and good for flagging up the problem for fellow travellers at least Very Happy
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Pamski, long drive with a broken pelvis Shocked Although less risky I would think, in the long run.
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Lou wrote:
Friend had wheelchair from desk close to check-in at Geneva to gate.


You didn't all get to hop on the buggy with the flashing light then? Laughing

I didn't realise you were allowed to get on a flight if you're in a full leg brace unless you get extra seats.
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Lou, yes, the one in the ambulance said it was all very peaceful, she had to lie flat and had a DVD player above her, went through the tunnel so she wasn't left in the bottom of the ship for the voyage!
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miranda, no! When I fly with my mum she can't understand why I declare a need to stretch my legs and promise to meet her at the next point Laughing
Funnily enough, when we came out at arrivals at LGW last week, I swear we saw Taj from Come Fly With Me but he wasn't on his pussy-wagon Toofy Grin

Pamski, the kind of situation when a catheter would be nice
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AndAnotherThing.., My OH went through the prescription before it went to the pharmacy & decicded I only needed the crutches - 85euros , which havs been refunded. I already had a knee brace from my previous injury & we also had ibuprofen & paracetamol (surely no one goes on a skiing holiday without them??) but the expensive homeopathic stuff, we both felt I could do without Laughing And at least it wasn't me that had to face the pharmacists disapproval when he crossed everything else off the prescription Laughing

Hope it's feeling better soon Smile Remember to ice it regularly too - everytime you're sitting down. Reducing the swelling really helps with the stability of the knee IME
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Yes, I was rather disappointed not to get a prescription for some proper drugs - I break an ACL and she offers me some paracetamol while my OH goes in - on my insistence - with a bit of a hurty shoulder a couple of years ago and got 3 months' supply of full on opiates but was in fact fine the next day.

Agree with genepi,'s advice on the icing - I didn't really do it enough at first. And also make yourself eat even if your relative lack of activity makes your appetite plummet - I'm sure that accelerated my thigh shrinkage... although the initial stuff was probably more water than muscle that went as it's much better now (though still very slightly smaller than the right leg) through a combination of eating properly and doing the leg strengthening exercises. I only twigged that it must have been more water than muscle when the brace was quickly getting looser and looser when a guest said, "darling, is that all? My seaweed wraps to take at least that off my thighs in just an hour" Laughing

At which point I did wonder if I've got this whole thing backwards - rather than trying to build up my left leg to be as big as the right, surely I should just brace the right until it slims down to the same size as the left? wink
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UPDATE:

I attended the fracture clinic at the local NHS hospital this morning. It really could not have gone better. The consultant ( a mountaineer wink ) checked the knee and made positive comments regarding the stability. I also managed to score an MRI as someone had cancelled that morning.

The knee specialist is in later this week and they are both going to check the scans and decide on the treatment from there. He did suggest that depending on the scans etc. that the knee surgeon may be keen to do it sooner rather than later, perhaps in the next couple of weeks.

I've had the 'OK' to try and work the leg, so will try and keep the muscle tone. Surprising how much has gone already.

Fingers crossed on the MRI results now.
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AndAnotherThing.., good result so far. Fingers crossed for you.
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AndAnotherThing.., sounds promising - work hard on keeping the leg strong - in my ACL thread there's mention of a really good piece of kit I keep hearing about which you can rent to keep the leg muscles working immediately after the Op - plus once you have a date for the Op but a Cryo Cuff (Google that) to keep the swelling down - I still use mine out here (Serre) six months post Op.

If you can get operated on ASAP then that is a result in terms of rehab protocol to be ready for next season, I had my Op put back twice from July to Sept and I would have ideally liked to have had a couple more months post Op before coming out here - though fine on piste and in powder but low down off piste sludge is areal pain literally.

Best of luck, and every time you brush your teeth do it on one leg (your bad one) bent with your eyes shut and the other curled up behind you, that will get the various muscles working!!

Though take note I did work hard on gaining fitness and was mocked for being too OTT however I think on this trip on a couple of big days I was glad I put the hard work in!
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Hells Bells, Weathercam, Cheers. It will be interesting to see the MRI results, but now the consultant has given me the ok to 'use' the leg I'm doing just that with the aim of keeping the 'bad' leg strong and be as fit as possible for the op.
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AndAnotherThing.., that is really good news and also very good news you have the go ahead to 'use' the leg so soon - it's amazing how quickly you lose it as you say but with some effort (by which I mean consistent practice and good habits as opposed to going hard at it at this early stage) you can make a big improvement.
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miranda, It's a funny thing. The consultant spotted muscle loss in the leg already and its only been a short time. This afternoon has been spent trying to walk with a 'normal' gait and doing stairs. I even managed to get in and out of my inappropriate car which if nothing else is going to improve my range of movement !

The strange thing is I feel whacked out this evening, odd given I've not really done that much compared to 'normal'. Will be interesting to see how the swelling is after an active afternoon.
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AndAnotherThing.., I should have said that you could have my seat on the way home...

I also went to the fracture clinic this morning. I saw the knee specialist who has said that I need a scan, physio and then review to see how (un)stable my knee is. He is a skier and has done knees one over twenty years ago and one about a month ago. I have visible loss of quads after eight days and am being encouraged to regain range of movement and full straightening. I have a very boring car and getting in and out is awkward. Hope things go well and that we hear from markspur soon Very Happy
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AndAnotherThing.., ianmacd, Boys - getting in & out of cars.....try to imagine you are wearing a short skirt, & sit your bum in first when getting in, & legs together & swing them out when getting out Toofy Grin wink Works a treat with bad knees too Laughing
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genepi, yep, I notice girls are very reluctant to wear skirts in my car. I want my money back wink

ianmacd, Glad you got home OK. I managed to get a row in the end but I'd forgot you guys had left early. Hope Markspur is OK.
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genepi, Laughing Laughing

Yes, in addition to offering the usual advice, it would be good to have a list of additional tips not found on medical sites. I love yours so far:

1) You should try to flex and straighten the knee as soon as possible. If you cannot straighten your leg, get your big dog to throw his full weight on it.
2) Gentlemen, imagine you have a short skirt on when getting in and out of your car. Best to observe Kate Middleton's technique rather than Jordan's.

I think mine would be: Ladies do not ski in skimpy pants. You run the risk of having a doctor remove your trousers, lie you on your side with your derriere facing the corridor, tell you not to move and then go away to do an X ray and examine the results whilst leaving the door open Embarassed I'm buying the biggest pairs of Bridget Jones pants I can find for next season.
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miranda, Laughing Laughing
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