 Poster: A snowHead
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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noggy, sorry to hear about all that. I'm not a qualified medical person although I do like pretending to be one in bars and night clubs  . I'm sure a proper doc will be along soon.
Something to think about... is the trip sufficiently insured for cancellation? Suggest you discuss this with your insurer early.
As for you, if insured, your knee condition has now technically become a "pre-existing medical condition". Again, you should discuss this with your insurer. If you don't declare it and need to claim for an injury related to it, then you may find you're not insured. This would come to light if your medical records showed that you knew about the condition.
Just a heads up. Best of luck.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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noggy, in short he might be. If there's a fracture then it's almost certainly a no-no, however if it's soft tissue injuries only it depends on how quick he recovers, which as he is 17 and has the incentive of a skiing holiday could be fairly prompt. It's probably worth taking advice from your insurers now, but I reckon they'll tell you to wait and see what happens and let them know when you have more concrete news.
I quite enjoy pretending that I'm Bode Swiller when gadding about in London high society. 
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Kramer, so it's your bar bill I picked up the other day... that's a lot of Babycham.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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You'll need to Register first of course.
You'll need to Register first of course.
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| Quote: |
It doesn't matter whether the knee prob was there before taking out the insurance or after... it has become something that the insurer will want to be notified about. It's in all the small prints.
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Yeahbut...
THe insurance is invalid if it was a pre-existing condition (regardless of whether she lets them know or not, and the date that it became "known" will be sat in noggy's medical record), however if it has occurred since the insurance policy was purchased, Bode Swiller's advice holds because if you don't let them know before the trip, you are once again not covered.
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| Quote: |
THe insurance is invalid if it was a pre-existing condition
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No. The policy would be valid just not for claims arising out of that condition. eg you might have a dodgy knee but your policy would still work for say a heart attack or a lost bag etc.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Bode Swiller, I'm really not sure that you are correct. If you do not make a full declaration I believe that it invalidates the whole ploicy and an insurance company could (should they find out about your omission) chose to not pay out on any aspect of the policy (where is alex heney when you need him? )
If I've understood the legal aspects correctly (bear in mind I am a medic not a lawyer!), essentially you have no contract with them (to pay out) because of the false (as in details omitted) initial health declaration (in the small print you are signing to a form of words which says that you are healthy at the time of signing).
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Nick L, I don't think it is an acri-wotsit - it's in the centre i.e the joint with the sternum - which I think makes it rather less usual and trickier. He's feeling a bit more cheerful tonight. But thanks, all, for the advice - I think I shall speak to the insurers tomorrow. Incidentally, regarding my knee, when I renewed my family travel insurance on line the other week I was asked, naturally, if I had any existing medical conditions, and whether I was on a waiting list etc.etc. Of course I answered truthfully, knowing that any further complications on said knee would be excluded. The automated question came back 'Did I want to extend the cover to include the knee?' I answered 'Yes' and it responded by saying that the additional premium for said condition was the grand and extortionate sum of £0! So I signed up for that straight away! So maybe I am covered after all!!
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Nick L, depends on the insurer and the terms you sign up to - I've seen it both ways. And some allow anyone to buy but exclude all pre-existing conditions.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Thanks Nick L, looking more hopeful. He is meant to be going on a level 5 All Mountain course with Inspired to Ski, which might well involve a few tumbles seeing as it involves his first exposure to bumps and off piste. I was wondering if wearing some sort of shoulder protection would make any sense. Maybe somethink like a rugby protection vest (which if he had been wearing on Saturday may have saved him from all this aggro.) Any decent kit out there?
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You know it makes sense.
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Hmm, not sure what I think about his doing "pushing the boundaries" skiing. Will be interested to hear what the ortho surgeon says. Not sure that rugby body armour would be helpful; the way that he doesn't want to sustain an injury is by either falling directly onto the side of his shoulder, or alternatively on an outstretched arm.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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skiing will be fine - it is the falling to worry about !!
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Poster: A snowHead
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He's seventeen, it's early days, and it's looking like a soft tissue injury only. Although soft tissue injuries can be worse than fractures sometimes, young people do tend to recover quicker. There's a reasonable chance, from what you've said, that he may be right back to his normal self by the time that you go, in which case he'd probably be ok to ski wherever he wants (within reason). If he's still got some residual ache or pains, then he's probably worth taking it a bit easier.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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The thing to do is ask the Consultant next week - and he will probably advise you not to go. The joint injuries, particularly sterno-clavicular can take a while to heal - longer than a broken collarbone, and you have to decide between you whether you think it is worth the risk of falling again on the same side and possibly doing more damage that might cause long term problems when playing rugby, skiing or whatever. You should also check your cancellation insurance - they often exclude contact sports and rugby is definitely a contact sport! The All Mountain course will need him to be able to pole plant securely and this might be a problem for him.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Ok, Noggy, as a sports scientist and clinical physiologist, I think I'll offer some advice.
I suffered from the exact same injury! Only difference is that mine was done when rockl climbing and falling 20ft from the lip of an overhang. Don't try it, it's not fun!
I had an x-ray - inconclusive. Therefore the damage was most likely a tear in the ligaments between the sternum and the clavicle (technically a type of sprain). Diagnosis was right, except for one thing - I had also bent my collarbone in 2 places! Slight fractures in 2 places, one on top, one below. Not nice.
Now, as for the situation with Junior... I am hoping there is no bend, as this leads to longer-term complications. Ended my rugby days early, and we certainly don't want that for Junior!!
The Sternoclavicular sprain is a nightmare to heal, as it moves during deep breathing, not just shoulder movement. I can't assess the injury's severity, so I won't say whether or not to cancel your trip, but as for getting junior back on his skis ASAP I can give a few tips.
1) Ibuprofen - it's a non-steroidal anti-inflammatory (NSAID), so will help with the pain when moving and reduces the swelling. 500mg doses should do, any stronger would make little difference and is bad for the kidneys and liver if taken for prolonged time.
2) Plenty of water - helps to prevent negative effects of the ibuprofen.
3) Immobilise the shoulder - this prevents tearing the newly forming tissues, and minimises inflexible scar tissue formation.
4) Rest - Don't let junior play rugby. In fact, anything more than holding a bus ticket will be too much if he wants to speed things up! And nothing that requires deep breathing for long periods of time.
5) Glucosamine and Chondroitin supplements - Not essential, but will help to boost the building blocks to rebuild the tissue.
I hope this helps somewhat, and all the best with the recovery.
As for your knee.... well... I will reserve my judgement as I have seen miniscus surgery!
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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I'm sorry Fraggle but I really do take issue with some of your advice.
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You'll need to Register first of course.
You'll need to Register first of course.
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Fraggle, 1) No such dose commonly available in the UK, 2) Do you have any evidence for that statement? 3) I believe you are wrong there. 5) Absolutely no evidence for that statement.
I agree with Kramer. I suspect this is where you get stroppy and wave your qualifications in our face but for those of us who know anything about this - you have lost your credibility in a single post. 
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Ok... This isn't me getting stroppy, just trying to clear the air.
1) Typo, I meant 400mg. Apologies.
2) Continual dosages of NSAIDs can play havoc with blood plasma chemistry, particularly if there is reduced renal function (that's the kidney's folks). Now as I don't know the exact level of renal function in the case, I can only give a generalised point. If however there is any reduction in renal function, then prolonged use may result in symptoms such as hyperkalaemia (too much potassium in the blood). This increases the risk of arrhythmias, and as altitude has an effect on erythropoiesis (red blood cell production) and can lead to increased haematocrit (RBC concentration) in the blood, there could be a risk of the subject suffering a heart attack. So, in short, yes, there is evidence.
3) In the initial stages of recovery, immobilisation of the joint is massively important! Particularly if the skeletal damage is unknown! I'm not talking plater cast the whole torso, I was referring to a sling.
Or, you could just swing that shoulder around, screaming in pain as the bone gradually fragments and the rest of the ligament that is intact just withers away... good luck on skiing after that!
4) You didn't challenge this point, yet you challenged the immobilisation? Hmm... interesting.
5) Chondroitin and glucosamine supplements help to maintain joints. There is plenty of information out there about this.
Not being pedantic, but neither of you stated your level of expertise... Why was that? Would be interesting to know.
As for my credibility, I'm sure the institutions around the country currently researching into the effects of short and long term obesity on autonomic dysfunction in cardiovascular control and the response to exercise are not going to discredit my entire body of work based on 2 snowheads' "opinions"... no offence!
Science - If you're not p***ing people off, you're not doing it right! 
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| Fraggle wrote: |
| Not being pedantic, but neither of you stated your level of expertise... Why was that? Would be interesting to know. |
General Practitioner. Particular interest in musculoskeletal problems. 4 years experience working as an orthopod prior to training as a GP.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Oh, and too many fracture clinics to remember.
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Kramer, as a GP, which parts of my advice are you taking issue with? Not arguing, this is as one professional to another! 
Of course as a GP with fracture clinic experience I'm sure you would also say that non-visual assessment isn't going to help on this, as it's all speculation, and the exact severity is unknown, as are the mechanics of the injury. Would you avoid steroid use too?
Again, this isn't me trying to keep the fire of contention well fuelled, it's more trying to clarify things for the benefit of the parties involved.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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AIR Agenterre (at the other end of the age spectrum) had a similar injury when falling down stairs  . He really suffered and took many months to recover. I am sure it was mentioned that the sternum end takes far longer to recover from than the shoulder end.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| Quote: |
As for my credibility, I'm sure the institutions around the country currently researching into the effects of short and long term obesity on autonomic dysfunction in cardiovascular control and the response to exercise are not going to discredit my entire body of work based on 2 snowheads' "opinions"... no offence!
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so lots of orthopaedic content then 
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Haha! CEM, I was referring to my credibility being outside of orthopaedic, but just because I specialise in one area, doesn't mean I know nothing about another! Everything in the body effects everything else in the body. If it didn't, no homeostasis, lots of extinction. And last time I checked skiiing when extinct is difficult... 
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You know it makes sense.
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| Fraggle wrote: |
| 1) Ibuprofen - it's a non-steroidal anti-inflammatory (NSAID), so will help with the pain when moving and reduces the swelling. 500mg doses should do, any stronger would make little difference and is bad for the kidneys and liver if taken for prolonged time. |
Ibuprofen will indeed help the pain, however the idea that it reduces swelling is outmoded. A dose of 800mg three times a day can relatively safely be given in a young fit person.
| Fraggle wrote: |
| 2) Plenty of water - helps to prevent negative effects of the ibuprofen. |
There is no evidence that increasing water intake reduces the incidence of renal or cardiac side effects of NSAIDs. There is some evidence that increasing water intake can delay healing and recovery from a multitude of ailments.
| Fraggle wrote: |
| 2) Continual dosages of NSAIDs can play havoc with blood plasma chemistry, particularly if there is reduced renal function (that's the kidney's folks). Now as I don't know the exact level of renal function in the case, I can only give a generalised point. If however there is any reduction in renal function, then prolonged use may result in symptoms such as hyperkalaemia (too much potassium in the blood). This increases the risk of arrhythmias, and as altitude has an effect on erythropoiesis (red blood cell production) and can lead to increased haematocrit (RBC concentration) in the blood, there could be a risk of the subject suffering a heart attack. So, in short, yes, there is evidence. |
In a roundabout way, you are getting the possible side effects of NSAIDs correct here, however ibuprofen is one of the safer ones, and the liklihood of these being clinically significant in a healthy rugby playing 17 year old is so low as to be almost nil. As mentioned before, AFAIK there is no evidence to suggest that increasing water intake prevents the incidence of renal or cardiac side effects with NSAIDs.
| Fraggle wrote: |
3) Immobilise the shoulder - this prevents tearing the newly forming tissues, and minimises inflexible scar tissue formation.
3) In the initial stages of recovery, immobilisation of the joint is massively important! Particularly if the skeletal damage is unknown! I'm not talking plater cast the whole torso, I was referring to a sling.
Or, you could just swing that shoulder around, screaming in pain as the bone gradually fragments and the rest of the ligament that is intact just withers away... good luck on skiing after that! |
The indication for immobilising an injury is generally for pain relief. There is fairly good evidence for most injuries that a small amount of movement actually speeds healing rather than hinders it. Shoulders are a special case, immobilising them unessecerily tends to lead to long term reduction in mobility.
| Fraggle wrote: |
4) Rest - Don't let junior play rugby. In fact, anything more than holding a bus ticket will be too much if he wants to speed things up! And nothing that requires deep breathing for long periods of time.
4) You didn't challenge this point, yet you challenged the immobilisation? Hmm... interesting. |
I'll challenge it. Agree that he should avoid repeated trauma to it until it's pain free, and so avoid rugby, also skiing if it's still painful, but to rest completely will lead to muscle atrophy and wasting, thus leading to a poorer outcome. Once he's painfree he can get back to whatever he wants.
| Fraggle wrote: |
5) Glucosamine and Chondroitin supplements - Not essential, but will help to boost the building blocks to rebuild the tissue.
5) Chondroitin and glucosamine supplements help to maintain joints. There is plenty of information out there about this. |
There is some (not very good) evidence that Glucosamine may help prevent further degeneration in osteoarthritis of the knee, however this does not translate to other joints and injuries and comes with risks and side effects. AFAIK Chondroitin is not currently recommended.
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| Science - If you're not p***ing people off, you're not doing it right! |
This isn't science, it's medicine.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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| Quote: |
This isn't science, it's medicine.
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And Medicine isn't science? Of course, it's not, it's plucking magical fairies out of the air and asking them to do us favours... Of course medicine is science! Everything that medicine uses is based on science. It's called pharmacology, not pharma-magical-use-of-let's-see-what-this-thing-does. I think you have missed on that argument...
As for the immobilisation of the shoulder... we're talking about a sternoclavicular injury here, not a acromioclavicular one. Very different. The structure of the 2 joints is vastly different! Surely you should know that there isn't a "cure for all ills"?
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to rest completely will lead to muscle atrophy and wasting, thus leading to a poorer outcome.
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The suggestion that rotator cuff muscle wastage would occur in a short period of time is bogus. The injury was sustained on saturday, so a sling would be of very high importance right now. A couple of weeks time is a different matter.
Glucosamine and Chondroitin I will leave down to personal opinion, as I agree, there is insufficient evidence to support either case. However what is "recommended" on the NHS and what isn't doesn't mean it's the gospel truth. *cough*Heparin*cough*
Now the most contestable thing you have said... If you are suggesting an increase in ibuprofen intake and not maintaining adequate hydration then you might as well write a speedy recovery off. But more importantly if you are suggesting that an increased haematocrit induced by altitude, along with even slight hyperkalaemia and dehydration won't affect the subject's cardiovascular system or general health in any way, then you should head back to medical school, via a psychiatrist.
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Poster: A snowHead
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| stoatsbrother wrote: |
| I suspect this is where you get stroppy and wave your qualifications in our face but for those of us who know anything about this - you have lost your credibility in a single post. |
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Sorry, but there was no stroppiness, merely debate.
And I don't believe I waved any qualifications about then... I fail to see your point in your last post, other than suggesting that I have lost credibility. Which I will leave up to the opinion of the individual receiving treatment.
Of course, I will ask noggy to let me know if the consultant says a sling is a stupid idea.
But Kramer, congratulations in offering an intelligent response to my last post.
Then again, you more important things to do as a GP than sit on forums all day... how full is your waiting room?
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Fraggle, Ibuprofen - like all NSAIDS tends to cause fluid retention already - inreasing fluid intake may actually be harmful. Yes at altitude we all need to drink more - but that is independent of the ibuprofen. And the entire point of a sling is that it doen't really 100% immobilise. And there is absolutely no evidence for chonrdotoin and very little for Glucosamine (and all of it for OA knee). So stop pretending to be a scientist until you can walk the walk..
Kramer, told you so...
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You need to Login to know who's really who.
You need to Login to know who's really who.
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| Fraggle wrote: |
| Sorry, but there was no stroppiness, merely debate. |
| Fraggle wrote: |
| you should head back to medical school, via a psychiatrist. |
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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You'll need to Register first of course.
You'll need to Register first of course.
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My money is on the two Docs. Odds anyone?
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| Quote: |
If you are suggesting an increase in ibuprofen intake and not maintaining adequate hydration then you might as well write a speedy recovery off. But more importantly if you are suggesting that an increased haematocrit induced by altitude, along with even slight hyperkalaemia and dehydration won't affect the subject's cardiovascular system or general health in any way, then you should head back to medical school,
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This strikes me as being the kind of pseudo scientific balls that gives 'science' a bad name. It is gibberish.
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Internet Medicine. Never Good.
Go and see someone qualified to give you some advice.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Not wanting to stir up the previous 'excitement', but just to report that Noggy jnr saw the consultant again today, after more X-rays, and it appears nothing broken, and all that remains is some soft tissue damage which is healing well. He's certainly not up to swinging a golf club just yet, but the consultant sees no reason not to go skiing in 3 weeks time. So hurrah! And I also have a date for my knee arthoscropy which is 31st December. So although my David Brent impression might have to be disgarded that evening, it could mean that the planned boys-only (but 2 girls too) trip at the end of February could be back on the statute book, as well as the family Easter trip and, who knows, maybe EOSB too. So, a good day all around 
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Well, all in all, a most entertaining thread.
Thoroughly enjoyable medical hissy fits and what sounds like a happy ending for noggy Jr.
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