# Opinions Please



## QtrBel (May 31, 2012)

Attachments


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## QtrBel (May 31, 2012)

Ok it is not letting me do this the way I want. Xrays are from ER. Photo is from UC (6pm)Wednesday 4th.


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## QtrBel (May 31, 2012)

From today.


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## tinyliny (Oct 31, 2009)

I"m, not a nurse or doctor, and can't tell much from the x-rays, but I am singularly unimpressed with the care you are recieving.


First of all, Pain relief medicine is for EXACTLY this sort of situation; an injury that will heal, but you need to REST in order for it to heal, so you need to take enough actual pain relief medicine to be able to rest. Thus, only a real pain reliever will do that, and that means codeine. Sorry, but that is the real blessing of this miracle drug; relief from agony. Don't be scared to accept this blessing. Don't try to 'get by' on less. For the first day or two, use it to allow the mind and body to rest. THEN you go to the tylenol pm and ibuprofen.


Secondly, pain to the degree of wanting to vomit (and since he hasn't taken any codeine, he's not feeling nauseous due to that), is trying to tell yo something; DON"T put weight on me!!!!




I think you should request an MRI. The tendons could have been seperated from the attachement points. Such a high degree of pain seems to indicate a soft tissue injury.


Remember, the squeeky wheel gets the grease, apparently more so in your situation.


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## waresbear (Jun 18, 2011)

Yes, agree with Tinyliny, request an MRI.


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## phantomhorse13 (Feb 18, 2011)

Pain to the point of vomiting is NOT ok. While nothing may be broken, I would be very worried about compartment syndrome from the crush injury.

I would add arnica to your medication regiment (got nothing to lose and it may help) and I would be back at the doctor's raising holy h#ll as the current plan is not working.


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## Dreamcatcher Arabians (Nov 14, 2010)

Be VERY careful with Compartment Syndrome, that's what nearly cost me my leg when Patti crushed my left foot. Just going on the pics you've posted, it doesn't look like that's set in or if it has it's not to a huge degree. When I had my foot crush and CS, I had swelling all the way from my foot up my thigh. Other things you're describing do sound like CS, but may not be. Beware of a doc who tells you, "You can't get CS from a foot injury.". BS, you sure can and it almost caused me a Below Knee Amputation. I ended up with 7 surgeries to remove dead tissue and bone chips (my metatarsals were mangled). I ended up on crutches for a year, no weight bearing at all during that time and even at the end of it, I could still barely get a flip flop on, could not put on a closed shoe or boot for probably close to 1.5 years and had severe pain & swelling in the foot even after several surgeries. From the XRays, I only see really one suspicious area but I'm not a radiologist, so take that with a bunch of salt. I would find another ortho doc and be really insistent about wanting an MRI. 

Here's a link to a decent article about Compartment Syndrome, you want to read the acute information. Acute Compartment Syndrome The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched. The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain. There may also be tingling or burning sensations (paresthesias) in the skin. The muscle may feel tight or full. Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.


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## QtrBel (May 31, 2012)

Thanks all. This is my line of thinking as well. 



Tiny I agree. He took the Percocet for the first three days but not seeing relief. Monday was Percocet only, Tuesday was percocet until late that afternoon when he got the tylenol and benadryl and then back to percocet for Wednesday with again a switch late in the afternoon. When staying with my mother codeine was prescribed for a cough he had. I am leery of it as he has had funny reactions to it when he was a baby. That is in his records but to them a suspected sensitivity even when two family members (one anaphylactic) have severe allergies to it is not enough to consider something else. He also reacts to benadryl if given several doses in a row but for a one time dose at night I know he'll sleep. With the way he is I didn't want to mix those two (codiene and benadryl). As he wasn't seeing relief or enough to matter to him we went with what we had. The 800 ibuprofen made more of a difference. I think it actually helped reduce swelling which was a big source of pain. He saw some relief with that.


The Urgent Care was concerned about compartmentalization but no mention from the ER. He has another appointment scheduled and will be evaluated this week by a P.T. I know, have worked with and trust. If he says MRI then the Dr will do as he asks so I will push for that. 



Dream, thanks for the link. So sorry you had to go through what you did. One of our vice principals is going through similar. I don't know why they want to shuffle that possibility off to the side so quickly.


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## 4horses (Nov 26, 2012)

I agree with Dream catcher Arabian. 

A friend on Facebook had her daughter crushed by an ATV that flipped over on her. She had multiple surgeries and was in and out of the hospital for weeks. Eventually made a full recovery but it was a very scary time. 

If it is that painful i wouldn't walk on it. Rest, elevate, and use pain pills to control the pain. 

I think an MRI would be a very good idea. The ortho doctor seems dismissive, even callous. 

I pulled a ligament in high school. It took 2 years to fully heal. Probably did not rest it enough. If i walked on it too much it would swell. Soft tissue injuries are more serious than broken bones- they heal much slower and need a very long rehab time. Obviously you are familiar with how long tendon injuries take to heal in horses. 

Call and request that MRI.


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## SilverMaple (Jun 24, 2017)

I agree. MRI and second opinion. I had a bad fall in college and twisted my ankle horribly. I heard cracking sounds, but the ER dismissed it as a sprain and sent me home with 1 day of pain meds and instructions to RICE for a day or two, then start walking. It was excruciating. I couldn't sleep, I hobbled to classes in tears. It took months to heal to where I could walk without pain. I didnt use my left stirrup for three years or it would swell again. I still haven't taken a running step since and it's been 20 years. Last summer I had an MRI on that ankle for something unrelated and they asked when I'd ruptured all those ligaments and broken that ankle... I'll need surgery at some point when I mess it up again. The swelling after injury obscured the damage, and since I was a poor college student, they never offered me an option of an MRI or a follow up. 

I hope your son feels better soon.


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## gottatrot (Jan 9, 2011)

By now it is too late to worry about compartment syndrome. That won't be a concern this long after the injury. 

I agree you may want an MRI. You have been given some bad information. For one thing, your initial xray could not rule out soft tissue injury, only fractures. Tendon and ligament tears or strains in the foot can take longer than fractures to heal, and they require rest. Rather than being told to walk on the foot, he should have been told to rest, ice and elevate until it felt better. The bruising and swelling are pretty normal for a soft tissue injury. But recovery is slow and the pain can last for a long time. 

Foot sprains can be very painful, even if the ligaments are only stretched and not torn. There is very little space for swelling and many nerves involved. 

Walking boots can sometimes cause more pain, due to their weight, but you don't want the foot to twist in the night so if ACE wrap is more comfortable I would use that.  At some point it will be less painful to leave it off. 

If there is a serious tear to a ligament, it will usually cause instability of the foot. That means if there is no serious tear, the toes and foot should be able to be moved and controlled by a person even if it is very painful. 

So doctors should be able to diagnose if something like an MRI is needed. If the foot is stable and can be moved normally, but just painful, then usually everything is stretched out and sprained but still attached. Still, it may take six weeks of rest before everything heals and the foot can be used normally again. 

Forced walking on a sprained foot will not help anything. Rest is good and gentle return to movement as the pain subsides.


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## gottatrot (Jan 9, 2011)

Oops, meant to say tendons and ligaments can take 8-10 weeks to heal versus a broken bone which usually take 6.


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## QtrBel (May 31, 2012)

These are my feelings too so I will go with my gut. Callous, I agree. He also suggested that if my son was good enough he wouldn't need stirrups and could go ahead and keep riding. Fine for a light riding little later on a horse that would tolerate the boot but on his current mount I wouldn't dream of asking the BO or owner of the horse to accept that liability. 



Thanks once again for all taking the time to respond. I'll update later. He does have movement in the toes. Not to the extent that he should but that could well be pain avoidance. A bad sprain would be the best of outcomes. Well no sprain would be the best but I think we all know there is at least a sprain. 



Good to hear that compartment syndrome is not likely this late. He has that one spot that is just too white but there is feeling and it may just be contrast with the bruising making it appear whiter than it seems.


He came out to the barn to direct/oversee our work from the golf cart. His cousin is picking up the slack while he is out of commission.


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## Dreamcatcher Arabians (Nov 14, 2010)

QtrBel said:


> He came out to the barn to direct/oversee our work from the golf cart. His cousin is picking up the slack while he is out of commission.


If he can take riding in the golf cart already, then it's not compartment syndrome. Just the air blowing over my foot & leg made me want to scream.


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## QtrBel (May 31, 2012)

That's good to know. He complains about pain moving around but not so extreme as that. It is primarily when weight is placed though he is cautiously attempting this as in order to weld he has to be able to have the foot in his steel toe boot and be able to stand with both feet weight bearing for at least short periods. He fought hard to be accepted as the dual credit program does not take 10th grade/15 y.o. as a rule for this class. Right now there is enough background info and book work he hasn't gotten too far behind in the actual welding process. He took a forging class this summer and made his own knife that the instructor felt was exemplary and has been looking forward to welding.


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## Dreamcatcher Arabians (Nov 14, 2010)

QtrBel said:


> That's good to know. He complains about pain moving around but not so extreme as that. It is primarily when weight is placed though he is cautiously attempting this as in order to weld he has to be able to have the foot in his steel toe boot and be able to stand with both feet weight bearing for at least short periods. He fought hard to be accepted as the dual credit program does not take 10th grade/15 y.o. as a rule for this class. Right now there is enough background info and book work he hasn't gotten too far behind in the actual welding process. He took a forging class this summer and made his own knife that the instructor felt was exemplary and has been looking forward to welding.


I literally could not have put weight on that foot, air movement was excruciating and it was bad enough when they cut some 'ribbons' on my leg, it was relief. So, I'm fairly confident he's not got CS. GLAD it sounds like he doesn't. I wouldn't wish that pain on my worst enemy, never mind a kid.


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## QtrBel (May 31, 2012)

Update:


He is in P.T. several times a week. He has a re eval coming up Tuesday. So far they have denied the MRI request. Think we have appointments sorted as there is a therapist dedicated to the school for the school athletic department. When mine mentioned missing horse shows the Dr put athlete on his file so he is in a different category and eligible for at school services. The school training room is equipped with everything the physical therapist needs and the local ortho group provides the P.T. No more missing work or school. He is able to put some weight on it but still swelling quite a bit by the end of the day. He is wearing his steel toes as they actually are offering better support and more protection from knocks as kids are not paying attention in tight spaces and the teachers won't switch his assigned seat to keep him out of the traffic pattern. His passive aggressive streak has him setting the crutch where they take a rap if they encroach too badly now.


Thanks for all who have replied.


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