October 13th, 2010
To whom this may concern, I feel it is necessary, yet again, to contact the Health Board in our province. I am physically sickened by the health care standards of which we, in the Province , are forced to live by. I wrote last year on behalf of my daughter. On November 14, 2008, at the age of 27, she became a victim of pedestrian vs car accident.
After two years and two botched knee surgeries, she is still unable to walk or bend her knee in a pain free and unassisted capacity. This past August, she sent out 35 letters to surgeons and hospitals in the Province seeking their testament that the services she requires are or are not available in this province. The majority have not answered her letter for help, others sent “sticky notes” and a few sent formal letters, which I have enclosed a few copies. Most recently, we were utterly outraged and flabbergasted by the condescending and disrespectful treatment she received from a surgeon at ____hospital.
Please, we are asking for your help. This problem needs to be fixed now. She is not looking to sue or ask for any kind of monetary compensation for this gross negligence. She will not, however, review her case with another abusive doctor. It seems that objectivity and a real focus on what is best for her, the patient, are unattainable within the tight knit orthopaedic surgeon community of this province.
We now fear the worst; a lifetime of living with a crippling knee injury. She needs to have corrective surgery performed, yet no one in this Province is willing to a) do it or b) allow her to have it elsewhere. This condition could have been avoided had the correct treatments been performed when this horrific accident first occurred. We will not wait six months for an answer. Two years has been long enough. If we do not hear from your office within a week of receiving this letter, we will be forced to take other measures.
When a Service is Not Available in this province
The provincial health care must be provided with the following:
- a brief description of the medical care required; Enclosed
- a written request signed by two medical specialists (Obviously there are none) having recognized expertise concerning the disease from which the insured person suffers and attesting that the services required are not available in the province;
- the name and address of the hospital recommended for the hospitalization; Enclosed
- a summary of the person's medical record. Enclosed
Initially my daughter was treated for, head trauma, two broken bones in her pelvis, a broken sacrum, ruptures of three of the ligaments in her left knee at the _____ Hospital.
While the trauma unit and initial emergency care at the were acceptable, the care that followed at that same hospital was a true horror story. Being a new resident to this province, I naively counted on those who were supposed to know how to help me through the red tape. I was first mislead by a liaison who said, "The government takes care of everything!" If by "everything" she meant third world, third class medical treatment, then yes, she was right. If by "everything" she meant minimal (extreme minimal) compensation and justice, then again, she was correct. The hospital was pitifully understaffed, overburdened, ill-equipped and severely mismanaged. The nurses did not even have appropriate room for their equipment. At the time she also had surgery for a broken pelvis which required an external fixator, making it difficult for her to complete even the simplest of tasks such as eating. We were never advised on surgical options or necessary treatment when it came to repairing my daughter's knee.
November 22, 2008 surgery date, reconstruction of the acl, pcl lcl and repair of the mcl. No ice elevation or other basic R.I.C.E principles advised.
Rest: Stop using the injured body part immediately. If you feel pain when you move, this is your body sending a signal to decrease mobility of the injured area.
Ice: Apply an ice pack to the injured area, using a towel or cover to protect your skin from frostbite. The more conforming the ice pack the better, in order for the injury to receive maximum exposure to the treatment.
Compression: Use a pressure bandage or wrap over the ice pack to help reduce swelling. Never tighten the bandage or wrap to the point of cutting off blood flow. You should not feel pain or a tingly sensation while using compression.
Elevation: Raise or prop up the injured area so that it rests above the level of your heart.
We left several messages, even my brother had gone to the nurses station and demanded that we see the doctor before surgery. We only met him in January 2009.
My daughter was required to wear a "Dynasplint" brace on her leg after the surgery took place on November 22, 2008. Not only did the nursing staff not know how to use it, but they were not even willing to learn! This was my first lesson in caring for her post-op.
My husband took two weeks off of work, initially, so he and I could rotate shifts around the clock to be sure one of us was always looking out for my daughter's care. Mistakes were made in medication, pain relief wasn't available as needed, lots of mistakes in an extremely disorganized, unhealthy environment that could have led to greater disaster for my daughter. Due to understaffing, I fed her, bathed her, changed her clothing and bedding, attended to all matters of personal hygiene and took care of her bed sores. I never felt that she was in good, safe hands when I left. And the few times I took the long taxi ride home to shower and sleep, mayhem ensued. In trauma she was placed in a room with a screaming, shackled prisoner! (I had gone to the nurses station and told them if they do not shut him up that I would)She was eventually moved from that room to a room with 5 others, one of them with a severe gastrointestinal virus. That, of course, led the entire room to be quarantined - including my daughter.
She ultimately contracted Methicillin Resistant Staphylococcus Aureus (MRSA) from the open wounds in her pelvis, which delayed her rehab and further risked her recovery and life. The air mattress she was given in the hospital to help prevent her stage 3 bed sores was completely foreign to the nursing staff who did not know how to use it and caused further unnecessary stress to my daughter's body. Nor did they know how to use the orthopaedic bar over her bed to help with her physiotherapy. I, myself, provided the therapy, ice and massages that she needed daily not knowing what I was doing. I really thought in the beginning these people new what they were doing.
Then there was the day where I had a very unpleasant altercation with one of the staff, it was so bad that it was a nurse who reported the incident to the head nurse. My daughter still has nightmares of that horrible incident. (I will post that story on another page)
On December 16, 2008, she was transferred to a rehab center, they work solely with amputees, extreme head trauma patients, stroke victims, spinal cord injuries etc, not people with dislocated knees. Issues with the dynasplint brace continued at rehab, as well, with no one in the physiotherapy department knowing how that thing actually worked! She received inadequate treatment and rehab protocols. Her extension (which we now know is the most fundamental part of knee rehabilitation and should always be maintained prior to anything else), had not been worked on for over two months, dynasplint was not applied, again no R.I.C.E.
ROM (Range of Motion) was -10 extension deficit and 90 degrees active flexion, 110 passive flexion. You may ask yourself what the implications of poor ROM in a knee joint are?
According to Dr. Frank Noyes(of whom her former surgeon uses as a reference in his study of knee dislocations);
You cannot get by with a ten-degree loss of normal knee extension, as this will result in a limp, shortening, and patellofemoral arthrosis. You use your knee in normal walking from two degrees of flexion to seventy degrees of flexion. That range of motion is what you need to just walk up and down stairs and have a normal gait. If you walk with your knee in ten degrees of flexion (you have lost only eight degrees from the straight position), you will have a limp which can throw off your back because you have a shorter leg. Your limping gait will be very noticeable, not only to yourself, but to other people as well. The most important problem with a loss of flexion and poor gait is that high pressures are placed upon the patellofemoral (kneecap) joint which, over time, will result in damage to the articular cartilage (patellofemoral arthrosis).
Studies of the range of knee motion required for activities of daily living reveal further that -
93 degrees of knee flexion is required for rising from a seated position (ref 1)
106 degrees of knee flexion is required for shoelace tying (ref 1)
135 degrees of flexion is required to properly take a bath (ref 2)
A normal knee has at least three degrees less than zero (3 degrees of hyperextension), and that is what we really like to see achieved after a knee injury or operation."
"Any loss of extension is a problem. In the last few degrees of extension, something called the 'knee-lock' or 'screw-home' mechanism occurs, and the leg is able to support the body weight despite the quads being completely relaxed. This lock-back or screw-home cannot properly occur if there is an extension lag, that is, if the last few degrees of extension are missing. The quads - and the hamstrings, too - are put under enormous strain. The body has to rely on muscle and ligament considerably more for support and stability, resulting in fatigue, biomechanical problems, pain and increased risk of injury or re-injury."
This caused even more delays and setbacks in my daughter's recovery. To this day no one will tell me who transferred her there. We were simply told that her injuries were too severe for her to be sent home and we were deemed unfit to take care of our own daughter even though I had left my job to be home with her. They just needed to send the necessary equipment to facilitate her needs to our home.(at least at home she would not have contracted MRSA)
In early spring, of March 2009 on the insistence of her surgeon, my daughter transfers over to the surgeons private clinic to focus only on the knee. Originally the surgeon told her that she would not have a problem achieving 125 degrees of flexion and we were quite content with that thought, knowing that her knee would probably not ever be perfect with such a huge surgery.
Six weeks later, on March 31,2009, she brings up the fact to her surgeon that her flexion hasn't gone up much within the last month and if there was something else we could do. She also mentions the possibility of scar tissue after one of his students examines her knee and tells her something that needs to be done about the lack of motion. The surgeon examines the X-rays and tells her it is not scar tissue, it is in fact a calcification in the posterior of her knee and that this is the reason for the poor motion. He goes on to say it cannot be removed due to the location. “It is impossible.” He suggests that PT is not being aggressive enough with the bending. Her flexion was at the time 90 degrees active and 115 passive, her extension was still missing about 10 degrees but reached zero under pressure (according to her physiotherapist). Her surgeon then proceeded to tell her that he was happy with that considering the gravity of the injury.
She was crushed to learn the surgeon was happy with no progress. We had another meeting with the surgeon on May 19th 2009 and he says he doesn't want her to go beyond what she already has in terms of ROM. (90 degrees active and 115 passive, extension was still missing about 10 degrees) There had been no improvement. I took her to another doctor in Ottawa (Dr. Don Johnson) as well as another PT (He informed us at the time that it would be next to impossible to find another surgeon in this province due her current surgeons reputation and prominence), and all have said that the scar tissue needs to be removed. Dr. Johnson confirms that she does have scar tissue and arthrofibrosis. She feels relieved that someone has finally diagnosed her condition.
“Arthrofibrosis (from Greek: arthro- joint, fibr- fibrous and -osis abnormality) is a complication of knee injury or surgery where an excessive scar tissue response leads to painful restriction of knee motion, with scar tissue forming within the joint and soft tissue spaces and persisting despite routine rehabilitation exercises and stretches. The term may involve flexion loss, extension loss or both.
The consequent pain may lead to the cascade of quadriceps weakness, patellar tendon adaptive shortening and scarring in the tissues around the patella—with an end stage of permanent patella infera—where the patella is pulled down into an abnormal position where it becomes vulnerable to joint surface damage. In severe cases of arthrofibrosis the disorder becomes progressive and the whole capsule may become thickened and tight with almost no movement possible in the joint.
Despite this potentially disastrous cascade of events, patients with developing arthrofibrosis and early patella infera may avoid the necessity for surgical intervention by participating in a closely supervised therapy programme. The key is early recognition and referral to a unit experienced in dealing with arthrofibrosis.”
He (Dr.Johnson) suggested arthroscopic lysis of adhesions with gentle manipulation, good pain control, and a (CPM) or Continuous Passive Motion Machine for several weeks after surgery. Unfortunately, he told us that we had “a small window of opportunity” to get this procedure done before the damage was permanent and the scar tissue could inevitably destroy other structures in her knee. He also states that he does not think that she needs any additional releases but this depends upon if the anterior release of scar tissue solves the blockage. He says that over time scar tissue hardens and begins rubbing on the articular surfaces of the knee and could damage the cartilage and this process is not reversible. He states that he is acquainted with her surgeon and will send him his recommendations.
Her next appointment in July 2009 we discuss her visit with Dr. Johnson and his suggestions. Her surgeon seems offended by us seeking a second opinion but after disputing the matter for several minutes with him and insisting that she needed this surgery, he finally agrees he will do the surgery but it will only get her a few more degrees since it is the calcification that is the issue and she does not have scar tissue. He will only do surgery if he opens the original central incision site, no CPM even though we insisted, he will not perform any additional releases even if her ROM is still not adequate after removing scar tissue from the anterior.
July 22, 2009 second surgery takes place (in the surgeons private clinic), in which he debrided "a ton" of scar tissue from around the patella and the tendon, he was amazed as to how much scar tissue was in her knee as he later told us. He said the calcification shouldn't be a problem, it was obvious that the scar tissue was the issue.
July 2009 she starts aggressive PT, therapist is able to push knee into 120 + passively, 105 active motion, 0 degrees extension passive, - 5 active, things seem to be going well at first.
July -Oct 2009 continue with aggressive PT, ROM numbers are going down and severe posterior pain is prevalent along with a hard end point on both flexion and extension, with poor patella mobility once gain. She complains to the PT to no avail. Obviously she is an advocate for the doctor and not for my daughter.
November 2009; Appointment with her surgeon, again he suggests that she is fine with the amount of motion obtained even though she clearly is not. Then he goes on to say “that everything that we have done up to this point has been wrong". He suggests that she has a "bad reaction to trauma" and that the "knee now needs to be rested". He says that the PT was much too aggressive and this caused more trauma within and around the joint only aggravating the situation. He suggests once again that her motion is fair considering the injury. In her research, she brings up the fact that there are many surgeons who do perform surgery on the posterior of the knee (concerned about the pain and the calcification in the posterior) and he agrees and says that he does do them if necessary however he does not believe that is the case with her situation. March 31, 2009 he told us it was impossible. She then asks to get an MRI to try and diagnose the severe posterior pain. He said there was no need that her knee was fine and the MRI would not show anything because the metal in her knee would interfere. He still refuses to listen to her complaints.
December 2009, motion is 0 degrees passive extension 5 active, 95 active flexion and 120 passive. She cannot walk more than ten yards without pain, cannot stand for any length of time do to not having proper extension, cannot run, do stairs, squat, kneel or do any "normal" daily activities. We have contacted many surgeons throughout Canada and the US (Steadman Hawkins Clinic being one of them) who have reviewed her case and they believe she is a good candidate to have the joint cleaned out again while incorporating needed releases along with that and proper rehab that will focus on keeping swelling down and not aggravating the joint that she should recover rather well after this type of care.
February 23, 2010, appointment with Dr. God Almighty(this is the breaking point for me)
This time I have a family friend come with us. As the surgeon looks at the PT report he is happy with what she wrote. My daughter informs him that those results are achieved when her knee is completely warmed up and the physiotherapist is forcing her knee into these numbers. Perplexed, and maybe intimidated by the presence of my daughter’s friend, he for the first time has her lie down and he actually examines her knee. He tries to bend it and only gets 95 degrees and maybe -5 extension. ( She wrote 110/120 for flex. and 2/0 ext.) Again we mention scar tissue and arthrofibrosis he refuses to listen. He firmly states to the three of us that she does not have “arthrofibrosis” let alone scar tissue. He says that he’s unsure as to why her knee is not bending or straightening properly. I am not sure if you have children? If so, I am sure you can sympathise with my plight as a parent. We ask him to write out a referral to Dr. Litchfield of Ontario who has treated arthrofibrosis and did his fellowship at the Steadman Hawkins Facility. He said, “I will not write a referral, that would mean that I need help. I do not need help.” I then state for him to write a note.
On March 9, 2010, a huge conflict rises up between the surgeon and my daughter. The provincial health care has reimbursed the money she had paid to the doctors private clinic for the surgery. However; they did not tell us they were garnishing his wages(Dr. Almighty). We call the provincial health care to discuss this matter and they state that even if we return the money to them, as Dr. Almighty wanted, he will not be reimbursed. He calls us and give us an ultimatum, either we give the money back or he discontinues his treatment. He sends a letter written in French for my daughter to sign and send along with the check back to the provincial health. This letter which I still have, goes on to say that he is a fantastic surgeon and without his treatment my daughter will have a very difficult recovery.
I found a local attorney and he translated it and said that the check belonged to my daughter. He says that the reimbursement by the provincial health care and the garnishing of the doctor are two separate issues. Dr. Almighty harasses us with numerous phone calls till the end of March 2010. On this day he calls again, asking if my daughter has cashed the check. Ironic he never called the house to see how her progress or lack thereof was going. After we spoke to the attorney, I told her doctor yes, she cashed the check. He then tells us that he will not be seeing her again and that he was required by law to send us a letter stating that he was passing her case to another orthopaedic surgeon. We waited for a letter that never arrived. I believe his arrogance clouds his judgement.
(While all of this is going on)February 2010 we try contacting the office of Dr. Whelan who is a specialist in multi- ligament injuries in Toronto. His office calls a few weeks later and tells us he can not take her as a patient due to the fact that she is from this province.
We wait frantically for Dr. Litchfield's call, who studied at the Steadman Hawkins Clinic in Vail, Colorado an institute well known for treating arthrofibrosis.
April 2010, Dr. Litchfield's office calls and tells us he can not take her as a patient due to the fact that she is from this province.
Desperate we go through the list of surgeons we researched last year. Dr. Ass Hole is the only one who was able to see my daughter and we get an appointment only for them to call a few weeks later to reschedule for the fall. Going back through the list we made up last year, we make some calls in the city area only to find out that those who answer the phone want to know what the ailment is. I tell them she has severe arthrofibrosis, they don’t have a clue as to what that is. Frustrated and fed up at this point in time, we look at surgeons we contacted last year in the U.S.
Since most of our research has focused around the expertise of Dr. Frank Noyes of Ohio, Dr. Mark Sanders, Texas, Dr. Thomas Gills, Boston, Dr. Richard Steadman and Dr. Peter Millet of Vail, Colorado we call them to see if at all possible to get an appointment. Surprised, Dr. Millett could see her right away. With the money the health care reimbursed my daughter, we flew out to Vail on August 2, 2010.
On August 3, 2010 For TWO hours Dr. Peter Millett and his assistant examine her from head to toe and answered all of her 32 questions that we prepared and then sends her to the physio department.
They take new x-rays and tells us that she indeed does have arthrofibrosis which is most likely encompassing most of the joint not only the anterior part and this is why she had little success the first time around along with the aggressive physiotherapy. He tells us that she will not gain any strength in her left knee until she is able to regain her range of motion. At that moment he measures her and gets -20° extension, 80° flexion. He explains what the surgery entails and that she could expect a positive outcome if she also has the correct physiotherapy to accompany the surgery. He goes on to say that 50% of recovery is appropriate surgical intervention while the other 50% lies in appropriate non-aggressive physio. He explains that aggressive physio aggravates scar tissue and actually causes more trauma leading to more scar tissue. His evaluation and physio therapy protocol is enclosed.
Team leader in PT department, Laura Mann, asked her what was the itinerary from her former therapist. Miss Mann was literally beside herself in disbelief upon hearing of the continuation of abuse. Such as strapping her down to the bed or putting a bucket beside her so she could throw up in it as the PT would fanatically thrust her weight to force her leg to bend. In so doing created more damage. For months she went through this excruciating pain with no results!
September 28th 2010 appointment with Dr. Ass Hole, at the_______ hospital. We were finally going to meet someone who I thought was going to help.(he had fantastic reviews on http://www.ratemds.com/) I had faxed all of the information and sent him the new x-rays prior to our visit with him. As we waited patiently for 4 hours we finally meet this doctor. Dr. Ass Hole’s assistant first examines her.
Initially after introductions Dr. Ass Hole gets right to the point and asks her what was her biggest concern was. She explains to him the lack of motion in her knee and the prevalent pain in the posterior. He takes a quick look at her leg with a pull and a tug here and there and has her sit up.
He then mentions the trip to Dr. Millett in Vail Colorado asking her why she had gone there. She tells him that the Steadman Hawkins Clinic is a world renown clinic that sees hundreds of patients a year from all over the world who are afflicted with arthrofibrosis. Their clinic has done countless research and written several articles on the subject. Then all of a sudden in a condescending and patronizing tone says: “Oh they must be smarter in the mountains, I highly doubt they see hundreds of patients with this condition.” Neither my daughter or I knew how to respond to that comment. I asked if he was able to perform the surgery that was outlined by Dr. Millett. He tells us no, that Dr. God Almighty was the only one in the Province to do this type of surgery. He goes on to tell us that “US surgeons are a business first, then doctors and that they purposely market themselves to lure Canadians.” While we were staying in Vail we met people from France, Austria, Holland and several from Vancouver with exactly the same problem, arthrofibrosis. These people traveled long distances to get treatment at the Steadman Hawkins Clinic.
He then goes on saying that Dr. Donald Johnson (Ottawa) who initially diagnosed her (with arthrofibrosis) and Dr. Millett wrote out these legal documents stating her affliction and surgical steps necessary for her recovery were made up because “doctors can make up whatever they want if they know they are not going to operate on you” We never asked Dr. Johnson to do any kind of surgery, as for Dr. Millett, he only knew he was not doing the surgery at the last minute. He thought she would possibly have the surgery the next day. Were these doctors just wasting their precious time for entertainment purposes? We could not believe what we were hearing from someone who is supposed to be a professional.
Dr. Ass Hole then insinuates that Dr. Millett was going to butcher my daughter. That he was planning on removing all the ligaments, all the hardware and doing random incisions in various places and in doing so could end up having her leg “amputated” or end up with a “floppy leg and have to wear a leg brace for the rest of her life” and that if he were her he would opt for the lack of motion and pain. He also said that he had patients that can barely get to 90 degrees and are in considerable pain. Something is definitely wrong there if he has that many patients who are in that condition. He also said Dr. Millett was going to undo all the beautiful work Dr.God Almighty had done. We could not get a word in edge wise, my daughter asked where does he say that in his evaluation? I asked if he had a chance to look at the disk(Xrays), he blurts out that the disk did not work. I said, funny it works perfectly at home.
He then says that he read the MRI report but according to him, the US and Canadian MRI`s are not the same. If he would have actually read the report he would have seen it was done right here in the same city. Since the report was in English did he automatically assume it was done in the US? Again unprofessional. Then he states that the only person capable of helping was Dr. God Almighty, that he did a beautiful job on her leg, and if we asked Dr. God Almighty “nicely” he would probably take her case back. How could he possibly know that? Is there a secret society? He also stated that she was not a candidate for another surgery, due to the fact if Dr. Almighty did not fix it the last time it wasn’t fixable. Dr. Almighty did not fix her the first or second time around what makes him think he can help her this time around? He summed that up in the fifteen minutes we were there? Then what slips out of his mouth next upsets us more. “The synthetic ligaments (LARS) are actually well known to cause stiffness and scar tissue.”
Then he quickly turns the subject around and says if you would have received “dead guy ligaments they could easily stretch out, or you could get aids or hepatitis“. Obviously at this point he was another advocate for the Almighty God, and not the patient. Never once did Dr. Millett speak negatively towards Canadian doctors or our medical system. These are obviously all scare tactics, my daughter went to him for help not to be verbally assaulted and made to feel insignificant and petty, she was absolutely devastated. This was pure malicious slander. A copy of this has been sent to Dr. Millett.
Finally I have had just about enough nonsense for one day I asked him if he had the papers necessary for the for surgeries performed outside of the province. He acted as if he did not know what I was talking about and then said that was for people with heart and cancer problems that health care system was not going to help us what so ever.
Nowhere in Doctor Millett’s notes does it indicate that he is going to “remove” all her ligaments and make random incisions all over her knee. What is does say is that while entering her knee through arthroscopic instruments and removing scar tissue from the front anterior of the knee, if this does not provide adequate results, then he may need to make a small 2 inch incision on the medial side to do the required releases for contracted tissue. It also states that if he finds that one of the cruciate ligaments is impinging and causing problems he may need to excise it.
I am dumbfounded as to where this man can get away with such disrespect to someone who went to him for help, this man is supposed to be a healer. Is this the kind of encounters we are going to experience? My daughter was extremely upset.
When we arrived home, we quickly start on our research on LARS. We could not believe what we were reading. Extremely controversial to say the least.
It is apparent that LARS synthetic ligaments cause stiffness and scar tissue, there is also evidence that they lead to greater problems, osteoarthritis and synovitis. Several countries will not approve this product. In fact, the US has not had them FDA approved because there is not enough long term research available to support the use of LARS on the general public. There are no long-term studies of how these ligaments hold up for in the long-run. In Canada the only province to use these synthetic grafts is in this province and even at that, there are only a handful of surgeons that actually use them here. (and that is only for one ligament)
In our research we also found a study authored by Dr. Almighty on the topic of knee dislocations and the use of LARS synthetic ligaments (paid for by the distributors LARS), we found it quite strange that all of these patients had functional ROM after the study. While in physiotherapy, in Dr. Almighty’s private clinic my daughter was with four other patients who all had multi ligament reconstructions by the same surgeon and all had stiff painful knees and almost all required a second surgery to remove scar tissue. According to Dr. Almighty’s study only two patients out of 109 knees, required a second surgery to remove scar tissue at four weeks to recover their ROM?
Furthermore the article states the use of artificial ligaments shows promise, but more studies are needed before they can be recommended for widespread use. This article was accepted for publication in 2003, my daughter had her surgery in 2008. Article enclosed. Notice post-op procedures, she never got any with the exception of the dynasplint brace that no one providing her healthcare knew how to use properly!
Furthermore, Dr. Almighty’s study uses Dr. Frank Noyes (world renown and well known for treating arthrofibrosis) as a reference, therefore it remains evident that the information on how to successfully treat her condition was accessible and at his disposal however he chose to ignore it and there is no excuse for this type of negligence. It is a surgeons responsibility to monitor their patients progress recognize early warning signs of complications and listen to the patients complaints and yet, due to his listlessness and the disesteem of those responsible for her recovery, my daughter has to become a victim once again.
The true tragedy of arthrofibrosis is that it is preventable!
Quoting Dr. Noyes from his course on arthrofibrosis:
“The vast majority of arthrofibrotic cases are secondary in nature – and that is why most are preventable. The rare cases of true primary arthrofibrosis - caused by an exaggerated inflammatory response to an injury or surgical procedure and not from other factors is rare 1%.”“It has become evident that the prevention of knee arthrofibrosis is extremely important and preferred over using the currently available treatment options for this complication. In my practice, the combination of our rehabilitation program and the ability of our staff to detect an early limitation of knee motion have resulted in a < 1% occurrence of a permanent arthrofibrotic condition. Patients who are referred to our Center with arthrofibrosis typically have had poor rehabilitation (or even no formal physical therapy at all) that lead to this complication. It can be frustrating because we know that this complication can usually be avoided.”
“Patients who sustain knee dislocations are at increased risk for developing motion complications and arthrofibrosis. In most cases, surgery is delayed with the limb immobilized in a posterior plaster splint or bi-valved cast for protection for a short period of time. Even in these severe knee injuries, it is possible to start immediate range of motion and prevent scar tissue formation that may compromise the outcome of a subsequent ligament reconstruction.”
Quote from Dr. R. Alexander Creighton in his article arthrofibrosis, Evaluation, Prevention, and treatment.
“Prevention is the best form of treatment, but when this entity does present, early recognition and a supervised physical therapy programs are often successful. If conservative treatment fails, operative intervention is warranted.”
Dr. Mark Sanders of the Sanders Clinic of the Houston Clinic, Quotes:“Arthrofibrosis is completely preventable through interventions before, during and after ligament surgery. The ways to prevent it include, avoiding surgery until the knee has full flexion, and extension, minimal swelling, and a normal gait.
In the OR, prevention includes appropriate placement of the drill holes, avoiding excessive tension on the graft, and clearly getting the knee to fully flex and extend before the graft is fixed on the second side.
After surgery, prevention of arthrofibrosis occurs by immediate active motion, weight bearing, and PT. At our clinic, if full motion isn't immediately achieved, I will do everything short of having the patient move into my house so I can supervise their exercises personally on the 24/7 basis. (That always does the trick) You see arthrofibrosis, is the doctor's responsibility to avoid, just like it is his/her responsibility to avoid cutting the main artery to the leg.
Because of my obsession with this problem, I have not had a case of arthrofibrosis since the mid 1990s. I do treat arthrofibrosis in patients who have come to me after someone else couldn't get the job done.”
21 months later, she has a difficult time getting in and out of the shower not to mention the difficulty taking a bath. She cannot walk for more than five minutes and when she does her gait is quite altered which in turn is causing hip, back and foot problems. This will in time cost the government more to treat. She is unable to do her own laundry or even stand long enough to cook her own meals.
What I want is the healthy, happy, self-confident young woman I knew almost two years ago to return to her normal, active life and career. What is worse is the time that has been stolen from her youth. I feel that time is priceless, you can not own it or keep it for the future. My daughter was a victim of a tragic car accident by no fault of her own and now she is once again a victim. I am asking for help.
Sincerely,
October 28, 2010
Subject: Medical authorization request
Services outside the province OU Canada
File number: @#$%^&*(#$%
Dear Madam:
Your request
On October 20, 2010 we received your letter on behalf of you daughter requesting that the Provincial Health Care cover the cost of the following medical services: a surgery by Dr. Peter Millett at the Steadman Clinic, in vail, Colorado, for a problem of the left knee arthrofibrosis.
Decision
Based on the information provided and further to an assement by our evaluating physicians, the Provincial Health Care refuses to pay for these services outside of Canada because:
- they are available in the Province and in Canada
- we did not received any written request signed by two provincial medical specialists requesting these services for your daughter....
If you believe that this decision does not respect the rights of your daughter, you may, within six months following the date this letter was mailed, apply for a review of the file.
February 23, 2011
To whom this may concern,
I respectfully disagree with Mme. Wantobe's denial for treatment outside of this Province and Canada. I am therefore requesting a review. Please note that this request is sent within the six month allotted time.
As my mother had written in her letter sent to the Health Care Department last fall; “It seems that objectivity and a real focus on what is best for her(me), the patient, are unattainable within the tight knit orthopaedic community in this province” She had all the details outlining the unethical, abusive and malicious encounter I had with Dr. Ass Hole at the ______ General Hospital. From what I understand, doctors have a legally binding obligation to provide unbiased and truthful opinions, however that has not been my experience in the province. It is now a year since I have been without a surgeon and my condition has deteriorated even more in the last six months. (Copy of CT scan report included) This past January, we met with the distributor of LARS, he confirmed our suspicions that Dr. Dr. Ass Hole had indeed spoken to Dr. Almighty prior to my visit on September 28, 2010.
As you are aware of the conflict of interest that took place with my former surgeon Dr. Almighty, concerning the reimbursement of my last surgery (July 2009) in which case Dr. Almighty gave me an ultimatum.;’ Either I give the money back or he discontinues his treatment.“ Dr. Almighty stated to my mother in their last conversation in March 2010 that he was required by law to forward me a letter stating that he was passing my case to another orthopaedic surgeon, that letter never arrived. Dr. Almighty continues to malign my efforts in getting treatment in the province. On my last visit with him in February 2010, he did not know what was wrong, that I did not have arthrofibrosis let alone scar tissue. (I brought a witness with me)
Dr. Ass Hole told us that he is the only surgeon in the province who does multiple ligament surgery with LARS it is therefore not available to me in the Province. I feel that the Health Care is accountable since they played a role in that conflict, as I am sure that this is not an isolated case. We could not anticipate or foresee the outcome. No one from the Health Care Department called or wrote to me explaining the potential chaos and mayhem that certainly ensued or to the fact that he was the only surgeon in all of Canada that does multiple ligaments with LARS.
I went to Dr. Ass Hole for help in hopes that he could perform the surgery as outlined by Dr. Peter Millett that is imperative and essential for my well being. He said no. I did not expect to be verbally abused, humiliated and belittled. He also refused to write a “written request” stating that the Health Care Department would not help me. Was that up to him to make that decision or to the Health Care Department ? After his outburst in regards to “LARS are well known to cause scar tissue”, we delved deeper into this statement . We found out that these surgeons are connected one way or another, especially in the private sector of orthopaedics, it seems that everyone that is associated with Dr. Almighty all regard him with absolute esteem and infallibility.
Something has gone terribly wrong with my case and no one wants to be accountable and say yes, there has been a mistake, let’s fix it. Therefore it is impossible to find surgeons to help me either with the surgery or with ”written requests” with Dr. Almightys animosity and gossiping about myself and my family to other surgeons in this Province.
I need a surgeon who is not only familiar with multiple artificial ligaments but also well versed in treating and preventing arthrofibrosis post-op. Someone who is unbiased, impartial and accountable to their patient. Since Dr. Almighty’s prominence and influence is obviously far reaching throughout the province I have no chance of recuperating from this condition in Province let alone trusting someone who is a fellow colleague of his. The lack of empathy these professional surgeons have shown us in this province is hard to conceive. Dr. Almighty’s relentless efforts of seditiousness continues to this day as Mr. Whatever (Lars distributor)told us;
- Dr.Almighty told Mr. Whatever that my mother is a bitch
- That we had gone to visit his “mortal enemy” (referring to Dr. Don Johnson which explains why he was so offended back in July 2009, I believe you have that on file in all of the letters my mother sent)
- that he had to go to a bank machine and had take out $6000.00 to pay the Health Care Department ” (for my surgery) etc.
Mr. Whatever informed us that Dr. Almighty is the “butcher“, not Dr. Millett (Steadman Clinic) of whom he had the highest of regards. He explained that what Dr. Almighty did to my leg in respects to the scarring would never be accepted in European Countries. Take a close look at the picture. He also informed me that Dr. Almighty was invited to Austria to learn how to implant the LARS anthroscoptically, however he refused to learn. Mr. Whatever also told us that Dr. Almighty does not believe in doing notchplasty surgery , which is the main reason why I am unable to extend my knee enough to walk.
I will again emphasize that Dr. Almighty’s study uses Dr. Frank Noyes (world renown and well known for treating arthrofibrosis) as a reference, therefore it remains evident that the information on how to successfully treat my condition was accessible and at his disposal however he chose to ignore it. There is no excuse for this type of negligence. Is it not a surgeons responsibility to monitor their patients progress, recognize early warning signs of complications and listen to the patients complaints? And yet, due to Dr. Almighty’s listlessness and the disesteem of those responsible for my recovery, I am once again a victim.
From Dr. Almighty’s article: Knee dislocations: Experience at the ________________
- …further studies are necessary before it can be recommended for widespread use. …this is the first study to show specifically a severe impairment in QoL in this patient population.”
- “In all, there were 109 patients…We performed arthrolysis in 2 patients when they failed to reach 90° of flexion at 4 weeks.”
- “…further research is needed” Written by Dr. Whoever; Dr. Almighty etc….
Furthermore the article states that the use of artificial ligaments shows promise, but more studies are needed before they can be recommended for widespread use. This article was accepted for publication in 2003 and I had surgery in 2008.
As far as seeking surgeons elsewhere in Canada, I have tried to no avail. I had a consultation with Dr. Donald Johnson, who’s secretary told us at that time, that he does not take patients from this province. I had contacted Dr. Daniel Whelan and tried several times with Dr. Robert Litchfield and others. I could not understand why these surgeons would not see me. All have said; “they do not take patients from this province“. Which leads me to conclude two reasons;
1) Fact: the rates that the health care pays to physicians here in this province to deliver medical services are on average the lowest in Canada which means patients such as my self are refused non emergency medical care in other provinces.
And/Or
2) Fact: The Lars ligaments they placed in my knee are too controversial and too complicated since LARS is only available in this province and only a handful of surgeons in this province use the LARS, and that is only in cases of isolated ligament tears.
While I was in PT there were others that had LARS ligaments put in and not one of them is NORMAL, so either there is an issue with LARS or the surgeon? The Health Care Department and your team of “evaluating physicians” tell me. On another note, I ask why my own tissue was not used since they were free. I‘m sure that the LARS were quite expensive? There was no rush for me to get back to any high level of activity since my pelvis was fractured in two places. These LARS ligaments should have been a last resort not someone’s science project.
As you see in my MRI report; ”The findings were: ” Hoffa pad and intercondylar notch are keeping with severe arthrofibrosis. Possible previous PCL repair. The graft is not well seen and this ligament is probably torn.” In the CT scan; “We note mild to moderate joint space narrowing of the medial tibiofemoral compartment, associated with some marginal osteophytosis, in keeping with moderate osteoarthritis. Early osteophytosis is also seen at the patellofemoral joint, and some spurring is also noted at the proximal tiblofibular joint etc.
Now I have questions; Why weren’t I, or my parents not given a choice let alone any options? Again, I believe that it was the doctors legally binding obligation to provide me and my family with any and all information regarding LARS ligaments, including the risks and consequences. My “right” to choose was taken away from me. LARS has been in clinical use in Canada since 1993, yet there have been no long term studies made available to the general public, or peer reviewed studies on multiple ligaments, (acl, pcl and lcl) using the LARS system. Where are the long-term research studies on the product?
What we have found are several articles stating;
“…surgeons have been successfully using combinations of autografts and allografts for complete knee ligament reconstruction.”
(Evaluation of reconstructive surgery using artificial ligaments in 71 acute total knee dislocations.
Written by no other than DR. Almighty and his colleagues.)
This article was sent to my mother via email from Dr. Jacques Phillippe Laboureau, the "founder" of the LARS devices. Both Dr. Jacques Phillippe Laboureau and Mr. Whatever told us that if LARS ligaments were to be implanted, they needed to go in right away to prevent further trauma, not eight days later.
“…results may suggest that a full return to activity may be hastened by using the LARS artificial ligament…”(McGill Journal of Medicine January 2008)
“…patients quality of life may suffer.” “Knee reconstruction with artificial ligaments …seems to affect quality of life in this population.”
(Journal of Bone & Joint Surgery, Acute knee dislocation, Evaluation of reconstructive surgery using artificial ligaments
Written by; Dr. Almighty and his colleagues)
If LARS was as good as it claims to be don't you think that all the major sportsmen and women who have had this problem would be using it? Who has actually used it and is really world class - Ernie Els, Tiger Woods, Bodie Miller, Alan Shearer, Michael Owen all have had major ACL replacement surgery in the past few years using what is known as "old school methods". The careers of each of these proven elite sportsmen are dependant on having a successful long term outcome. They were mostly operated on by either Steadman (Clinic)or one of the elite group of surgeons trained at the Steadman-Hawkins Clinic(such as Dr. Litchfield). None of them had a LARS ligaments implanted. Top European sportsmen and women fly to the States to be operated on by sports injury specialists because their livelihood is completely dependant on the outcome of this surgery as does mine. None of them have had a LARS ligament, despite the time that it has been available (well over 18 years). And those who do have them implanted have the money to seek out top surgeons in the US when things go wrong. I, unfortunately, do not have that luxury.
In conclusion, the fact remains, regardless that I am not in a life threatening position, I am unable to return to my normal work as a result of the multitude of illnesses directly linked to my injured knee (chronic fatigue, weight gain, swelling, my gait is quite altered which in turn is causing hip, back and foot problems, posterior knee pain, anxiety, just to name just a few) Even simple daily tasks such as tying my shoes is impossible. As you will see in my CT scan that my knee is now deteriorating, within the span of six months I have developed osteoarthritis because of the entrapment of structures in my knee due to scar tissue. Am I left to fend on my own and no is accountable? The Government Insurance Company implies that their hands are tied due to that they are dependant on the Healh Care Department’s decision. A decision that can be reversed and not place such a huge financial burden on myself and my family that adds even more stress to an extremely stressful situation that is not my fault to begin with. I have always been willing to do whatever I can to aid in my recovery; however, I find this struggle with the Healh Care Department both defeating and debilitating. The quality of my life has already been greatly minimised. There is nothing more precious to me than the ability to function once again as I use to, but, this is not possible with out your help. The decision does not “respect my rights“, it shows a lack of sensitivity and understanding of the underlying conditions that I suffer from on a day to day basis. I therefore plead with you to reconsider your decision.
