quote:

I’m just upset to find out how little management thinks of me.

^^^^^^^^^^^^^^^
This remark and the general tone. You may choose to wait, but their attitude towards you is a concern.

This remark of yours as well:

Apparently all it takes to have that thrown out the window is 2 months on light duty from an injury that occurred at work, on camera, and is medically documented

The “what motivation does he have to ‘heal’?” is what I find offensive (and I do not offend easily). It’s called integrity. A trait I’ve spent 15 years modeling… apparently not worth much.

quote:

Originally posted by ZSMICHAEL:

quote:

I’m just upset to find out how little management thinks of me.

^^^^^^^^^^^^^^^
This remark and the general tone. You may choose to wait, but their attitude towards you is a concern.

This remark of yours as well:

Apparently all it takes to have that thrown out the window is 2 months on light duty from an injury that occurred at work, on camera, and is medically documented

The “what motivation does he have to ‘heal’?” is what I find offensive (and I do not offend easily). It’s called integrity. A trait I’ve spent 15 years modeling… apparently not worth much.

The attitude is definitely a concern to me, but I don’t think it is actionable as they aren’t doing anything other than showing how they feel and that they do not trust or value long term employees. For now, I just chalk that up to “good to know” and I’ll make future decisions with that perspective in mind.

I’ve got 4 short years to go before I can collect my pension… my goal, for now, is to make it there, with a healed ankle.

quote:

I’ve got 4 short years to go before I can collect my pension

^^^^^^^^^^^^^^^^^^^^^^^
Given that information it makes sense to wait.

Just today, more than a month after the podiatry referral was placed by the main MD I got a call from the appointment scheduled.

The lone podiatrist at the orthopedic practice that I was referred to does not have an opening until May 16. I asked if one of the orthopedist could see me instead and the scheduler said no because the referral specified a podiatrist. So I took the appointment and then called the case manager.

She agreed that 3 more months was far too long and is going to try and work with the main Doctor to find a different practice or change the referral to an orthopedic doctor.

More waiting.

Meh. Bummer man.

quote:

Originally posted by tigereye313:
Meh. Bummer man.

Bummer indeed.

You are getting the runaround. There are podiatrists and there are othropedic surgeons who do the same thing. Might have to do with Workers Comp. I would see if your employer could help. I know plenty of CEOs who are able to get same day appointments. Is the lack of availablity due to workers comp? I have several friends in the orthopedic business who refuse to see workers comp. cases because of the hassle and low fee schedule.

quote:

Originally posted by ZSMICHAEL:
You are getting the runaround. There are podiatrists and there are othropedic surgeons who do the same thing. Might have to do with Workers Comp. I would see if your employer could help. I know plenty of CEOs who are able to get same day appointments. Is the lack of availablity due to workers comp? I have several friends in the orthopedic business who refuse to see workers comp. cases because of the hassle and low fee schedule.

Here is what I have gathered… this whole ordeal is my first foray into workers comp so I am figuring things out as I go.

When I was injured I was given a list of several healthcare providers in our area (8 or so) that I could choose. I chose one of the bigger names, Sutter Health, because I was pretty sure they had in-house radiology and I wouldn’t have to go to another office to get the X-rays I knew was coming. It hurt a lot that day and I had near zero mobility.

So that day I saw a doctor in their Occupational Health clinic. She kinda examined it (I’ve since learned it wasn’t a very complete exam) and had X-rays done, which she said were negative for fracture. She gave a boot and took me off work and set a follow up for 3 weeks.

6 weeks later I asked about PT. She declined and said let’s wait and see.

At 2.5 months when progress had halted (pain and swelling continue) she agreed it was time for an MRI and a specialist. She ordered the referral to a podiatrist and said he would order the X-ray.

3 weeks after that I saw her again, having not heard from anybody about anything. This time she ordered 8 PT sessions over 4 weeks as well as the MRI.

Fast forward another week and I called the case management company that coordinates the workers comp issues for my employer and spoke with the case manager. She said she had the Podiatry referral and it had been delayed due to a paperwork error (name of the practice selected to refer me to had been left off the referral) and that needed to be rectified. She said the OH clinic was the entity that selected the practice to refer me to. I thought this was odd as I know Sutter Health has in-house podiatry, but I don’t really know crap about this so I didn’t ask. She assured me the referral had been processed and I should hear from them very soon.

Fast forward 2 more days and the Podiatry office called with the earliest appointment being the one in May. I asked if I could see someone else, perhaps an orthopedist as I know from my quick googling that the tactics had at least 6 of them but only the single DPM. She said that wasn’t possible given the wording on the referral. I took the appointment and then called the case manager immediately.

She agreed it was way too long to wait but she couldn’t find a different practice on her how. She stated that the ordering doctors office is the one to select who the referral goes to and she would be working with them to find another practice that can see me sooner. I then asked her to please explore the possibility of referring to an orthopedic surgeon based on the advice of a doctor I know… he said he’d vastly prefer to see. The orthopedic surgeon over a podiatrist for my injury. She said she’d get on it.

That’s where we stand now. I don’t know when I’ll hear back. Does this seem a normal timeline for a case such as this?

It is too typical sad to say. It is a reason that docs often do not do w.c. cases. The first question the ortho asks is 'Why did you wait so long?"when you finally see him.

It is much TOO LONG to wait. Call the case manager every day to check on things. Document the time of the call and who you spoke with. Always be polite and courteous. Eventually the referral should happen.

When I moonlighted at Concentra years ago, they used to start PT within a day. Here, I typically start PT within 1 week of injury, if condition has not resolved or nearly resolved. After 4 weeks of PT, if there is no significant improvement, it's time to see a specialist. Or, when I deem that the injury is significant enough on initial visit, the MRI would be ordered right away.

6 weeks without PT is absolutely unacceptable. No MRI. No nothing. Sitting around doing nothing.

quote:

Originally posted by 12131:
When I moonlighted at Concentra years ago, they used to start PT within a day. Here, I typically start PT within 1 week of injury, if condition has not resolved or nearly resolved. After 4 weeks of PT, if there is no significant improvement, it's time to see a specialist. Or, when I deem that the injury is significant enough on initial visit, the MRI would be ordered right away.

6 weeks without PT is absolutely unacceptable. No MRI. No nothing. Sitting around doing nothing.

Pretty much the only 'movements' the OH Doc told me to do was "gas pedals".

Luckily a good friend is a ACE certified CAT with experience in Division 1 collegiate athletic programs. She's been working with me since day 3. Initially it was a lot of manual therapy to help reduce the immediate swelling and simple exercises. She's been wanting me to get into a real physical therapy practice with better facilities and equipment, and I've been asking for it every visit with the OH doctor. Thankfully it has finally been ordered, but hopefully it doesn't take a full month to be approved like the podiatry referral did.

As far as injury progress, it has stalled out, and in some ways regressed a little bit. I still have swelling, though the degree varies fairly widely. Pain persists at low levels, but is constant. The ankle still pops frequently, sometimes painfully. And in the last two weeks a new pain on the inside of the ankle has begun to ache.

Praying the case manager acts in good faith and stays on top of this. I'll take the advice and call her daily.

I spoke with my friend the CAT today and she said this sort of delay and timeline is all too typical in her experience as well.

Q: I'd like to read up on the pros and cons of the surgery that is done in cases where it becomes necessary. Are there any particular resources/websites available that a lay person wouldn't be lost trying to comprehend while still being helpful? Again, suspected, but as of yet unconfirmed, full tear/separation of the anterior talo-fibular.

Follow-up question: Tomorrow is 16 weeks post-injury. Is the lack of prompt PT a major concern that damage done may no longer be reversible? My apologies if that is a silly or improperly stated question... I'm clearly no medical professional.

MRI is scheduled for Sunday, hoping to get the official PT started next week.

The Podiatry consult is still scheduled for May but I’m bugging the case manager about that and when I saw the OH doc this week I expressed my unhappiness with that wait. She said she’d try to have me seen at an in-house DPM sooner.

So some movement but more waiting.

Saw a podiarist today and almost have more questions than answers...

I was skeptical about this DPM because his online reviews are very poor and he happens to be the only DPM in the practice who sees workers comp cases... a red flag in my book.

In any event, I went to appointment having had the MRI performed about a week ago. At the appointment he pokes my foot in a few places and asks where the pain is, then tells me he has both the MRI and the xray. He pulled up the xray and says there may be a small bone chip, but if it is there it isn't a big deal. However, he then says I have too torn ligaments and a strained tendon.

I asked him if torn meant partial or full and he said full. He then stepped out to grab an anatomy chart and pointed to the pair of ligaments, I think it was the anterior talofibular and the calcaneofibular ligament.

He then gives me another brace and says he wants me to wear it for a month (despite already been using one) and that he'll assess it at that time. He stated if the pain is better than "I'll be on my way". I asked if its not better than what and he said we will talk about that when it is an issue.

He put the brace on exceedingly loosely.... it truly isn't supporting anything.

I told him that the occupational medicine doctor ordered PT and that I was supposed to go for my first appointment today. He told me to cancel that and hold off and seemed surprised the PT had been approved by the workers comp company.

I didn't leave the appointment feeling very conifident to say the least.

While I was out running errands I picked up a copy of my xrays and MRI to have. When I got home I opened them up and looked at them, of course not knowing a blessed thing about radiology they don't mean anything to me. But I did read the report from the radiologist for the MRI and got even more confused. The report doesn't say there is a pair of fully torn ligaments, it states the anterior talofibular is partially torn, that there is "increased t2 signal and thickening of the calcaneofibular ligament", "increased t2 signal in the deep limb of the deltoid ligament", "increased t2 signal and thickening of the superficial limb of the deltoid ligament", "small amount of fluid around the posterior tibialis tendon", "increased t2 singal thickening of the Achilles tendon", "increased t2 signal and thickening of the peroneus longus and brevis tendons with surrounding fluid". Finally, it states "mild joint space narrowing and osteophytosis of the talonavicular joint and the navicular-cuneiform joints".

Obviously I don't know what any of that means... but it doesn't say two fully torn ligaments like the DPM stated.

What is going on here? Is the DPM wrong about the 2 torn ligaments or did he feel something during his very brief exam that the MRI didn't see? Does the MRI says 2 torn ligaments in non-plain language I don't understand? Should I be requesting a second opinion? Should I request to be seen by an ortho instead of a DPM???

Is the DPM's plan to loosely brace the foot for a month and then check it reasonable?

Ugh.

Is this severe enough?



If you are able, contact the Foot and Ankle Institute at the University of Washington. Dr. Brage was my surgeon and he (or his residents) did a fantastic job on my total ankle replacement. They are THE experts on all things ankle in the country.

Sorry to hear of this ordeal. Out of curiosity, I’d check the DPM for prior enforcement actions. Oftentimes those who accept W/C cases aren’t top tier.

https://pmbc.ca.gov/

Look under public documents.

quote:

Originally posted by jer830:
Sorry to hear of this ordeal. Out of curiosity, I’d check the DPM for prior enforcement actions. Oftentimes those who accept W/C cases aren’t top tier.

https://pmbc.ca.gov/

Look under public documents.

Well that was fun.

The state is trying to take his license, it seems, for:

1) gross negligence (regarding prescribing opioids)
2) repeated negligent acts
3) failure to maintain medical records
4) incompetence

fantastic.

Welcome to the World of Worker's Comp. Some places get it right, others are a shit show. I was in a on duty car accident with two knee injuries and a shoulder injury (turned out to be a stable fracture which I found out about after two weeks and going to my own doctor). When I was finally sent to the Orthopedic Surgeon, no MRI and he sent me a a "bake and fake" PT rehab place (put a hot pack on it and do some minor exercises). So 2.5 months later, and no improvement, in fact knees getting worse, especially the right knee. So Ortho Doc sends me to more aggressive PT which doesn't help and makes things worse. finally after 4 months they do a MRI which shows some damage. Doc decides to operate so another month until surgery. After surgery Doc says there was a lot of damage and even bone chips floating around in the knee....which of course all the PT sessions were aggravating injury further. Workers Comp with that employer was a massive cluster fuck of epic proportions. It was so bad, I had to get my own attorney involved early.

My current employer; you could be injured on Monday, see the first Doctor on Tuesday, MRI on Wednesday, results on Thursday, where she would refer you to an Ortho Doctor that you will see the following Monday.

Write EVERYTHING down, keep detail records of appointments, PT, how the injury is doing, etc. Hell, if your state allows it, I would even secretly record conversations with the Doctor who is under investigation. I had to do this with the Worker's Comp Ortho Doctor telling me and my family on how bad and messed up my knee was and how much it would trouble me going forward because at the end, he rated the injury at the lowest amount that is allowed. That recording bite him and the Worker's Comp Attorney in the ass in the Workers Comp Claim hearing with the Judge.

Get your own orthopedist. If that is not possible hire a workers comp attorney who will find one for you. This has gone one way too long.

Absolutely request to see another doc, an orthopod, not DPM. I don't know how Kali works, but here, the patient/inured employee has the right to choose whoever their treating doc or specialist is.

quote:

Originally posted by 12131:
Absolutely request to see another doc, an orthopod, not DPM. I don't know how Kali works, but here, the patient/inured employee has the right to choose whoever their treating doc or specialist is.

I was talking to a buddy who is a GP doc this evening. He says orthos in this area really don’t like to do ankle/foot stuff. He can only think of 1 and he said not to see him because feedback hasn’t been good from his own patients.

What a freaking cluster.