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Author Topic: Opinions regarding treatment in Japan  (Read 470 times)

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Offline spmcg77

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Opinions regarding treatment in Japan
« on: April 03, 2017, 09:35:16 AM »
Hello, I have some very broad questions and I'm afraid I don't have the lingo because I am navigating my care in Japan mostly in Japanese with the help of my wife and with some English.

My apologies for a longish post. I cut to the chase finally at the end.

I fell and tore my quadriceps on March 2nd and had surgery on March 21st (there was some delay in getting a proper diagnosis). I have been in the hospital since the surgery for two weeks with a full leg cast. Physical therapy has been in the use of crutches to get about and climb stairs.

Tomorrow they will let me put weight on my leg for the first time and this Friday they will remove the cast four days short of 3 weeks after surgery.

All of this seems a little out of step with the treatment I have read about. Most often immediate surgery is recommended, if possible, and while leg casts are sometimes mentioned, metal braces and almost immediate PT are more common. Also, leg casts seem to be removed after 6 weeks in some cases, so three weeks seems comparatively short.

I have been told that my knee will probably swell tomorrow, but they don't know. The nurses also don't know if they will provide a brace or not and the doctors won't guess until they see how the walking test tomorrow goes and what the condition of the leg is when the cast is removed on Friday.

So, one general question is whether the treatment I am receiving is within the norms? I'm not critiquing the treatment, in the U.S. I would have likely been out the same day or the following day and I appreciate being able to recover in the hospital given I don't have university duties until next week.

The second general question am I wishful thinking to think I will be able to teach next week or given that I have the option to postpone going back to work, should I?

The third general question is there seems to be some doubt whether I will get PT or not. Maybe they are waiting to see what things look like first.

Any advice regarding where to look in this forum or what to think about in terms of my care would be appreciated. Again, apologies for a longish post.

Offline John42

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Re: Opinions regarding treatment in Japan
« Reply #1 on: April 03, 2017, 04:17:33 PM »
Hi spmcg77

It is obvious that you are not getting the correct advices.

Go to Ruptured Patella/Quadriceps/Surgery and you will finds lots of buddies to give you correct information.

In principal, your should be in a cast or a brace for a minimum of six weeks, and then starts the physio which can be many weeks.

How did you sustain your injury/  Where do you live.

Suggest that you click on the undermentioned thread - you will find a collection of documents which I have put together with KneeGuru.

Ask questions - PATIENCE is a MUST.  Keep posting

JohnK/ Manchester UK



https://www.facebook.com/QuadricepsPatellarTendonRupture
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon

Offline spmcg77

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Re: Opinions regarding treatment in Japan
« Reply #2 on: April 04, 2017, 12:35:04 AM »
JohnK,

Thanks for the helpful reply. I will check the FB page for answers, too.

Part of the problem might be communication styles. In the U.S. I would expect a complete explanation of the treatment before, during, and after surgery (or I would ask for it), but here maybe it comes piecemeal.

If I understand it right, patients who have had the surgery are encouraged to put as much weight as is comfortable on their leg as soon as they can, and it seems like braces are more common than casts. It may well be here that they want to protect the incision for the first two weeks and I was told I might get a brace after they remove the cast, so maybe it's a mix. The metal device I keep reading about with the degrees of motion settings (sorry, still don't have the lingo) are not common here in Japan at all. PT seems to be different too. I might have to look for a sports clinic to get the kind of care I would expect elsewhere.

Patients here generally just do what their doctors order, but in our case the first doctor misdiagnosed my problem as a fracture and not as a tear in the tendon and we had to push to get a second opinion. The second doctor had already reserved a room for surgery the soonest we could see him when we saw him.

The other situation for me is the expert is only here on Fridays and is not a full-time member of the hospital, and the full-time doctors are a little more conservative. So, we are getting two different sets of diagnoses and that's one of the reasons why I came here...where there is yet another set of diagnoses. At least with the information I am getting from here and elsewhere I can ask perhaps better questions.

I have to hope they know what they are doing, but I am also trying to stay vigilant.

Sorry again for the longish post. I have a lot of time on my hands. I will go off and read more on the FB site. Thanks again for that and for your reply.

Offline John42

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Re: Opinions regarding treatment in Japan
« Reply #3 on: April 04, 2017, 07:21:32 AM »
Hi spmcg77

You should understand that you have sustained a very rare injury,  and that is why it is important for you to include in your questions to your PT  " have you seen this type of injury before?

Wish you well and keep posting.    Where do you live?

Best/ JohnK/ Manchester UK
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon

Offline spmcg77

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Re: Opinions regarding treatment in Japan
« Reply #4 on: April 07, 2017, 12:24:54 PM »
JohnK,

Thanks as always for the advice. Yes, finding a good place for PT is going to be a challenge. As before, the orthopedist this time is also recommending somewhere closer to our house in Inuyama, Japan saying they are all the same. I keep saying that we consider good care more important than a little inconvenience.

Today I had my cast off and they took some X-rays. The doctor seem to think I didn't need to wear a brace at all, but when a nurse double checked he said maybe when I was away from home it would be a good idea to wear one. The one I have is just a plastic brace held on with Velcro straps.

I'm a little frustrated because the care seems so different. I am in week 3 and in the West I would have already been doing exercises to strengthen my leg muscles. I have been able to walk without crutches and without pain with the cast on, so that is a good sign, but I'm a little leery about walking still with the brace on.

I'm taking one week off from my teaching jobs before I try making my way to work and teaching 4 1/2 hours a day. Even if I can sit it will be a bit of a strain to get to my university and my classrooms, I think.

We will try the local big hospital on Monday near our house to see if their schedule meshes with my teaching schedule. I am able to communicate relatively well in Japanese and my doctor speaks some English, but the cultural divide seems to be getting in the way, even with my wife's help with the Japanese. Hopefully the new place will be able to intrepret my doctor's guidance better than we can.

I have limited wifi access until tomorrow when I head home. I'll be able to read more on this site and others once I am up to speed, at least in terms of access.

Thanks as always for your suggestions. I will keep at it.

Offline John42

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Re: Opinions regarding treatment in Japan
« Reply #5 on: April 07, 2017, 05:35:31 PM »
Hi

You really must keep your brace on for a minimum of six weeks, and then you require a stick or walking cane - it takes up to approx 12/14 weeks for the tendon to heal and then the physio commences because the ROM will be in the region of only 30/40 deg.   

Remember   PATIENCE is required.

As suggested, go to the web page of KneeGuru   " Ruptured Patela tendon/Quadricep tendon/Surgery - gives you contact with many buddies - ASK QUESTIONS  - You have sustained a very rare and serious injury - will take many months to reach normality.

Best - JohnK/ Manchester UK
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon

Offline spmcg77

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Re: Opinions regarding treatment in Japan
« Reply #6 on: April 08, 2017, 10:02:51 AM »
JohnK,

I am home now. They removed the nearly full leg cast yesterday and took X-rays.  In the end the doctor doubted I needed a brace at all, but relented when a nurse I talked to asked him, at which time he thought maybe I could wear it when I am out of the house.

I am wearing the brace I got before until I can see the PT. I hope to find a good place, but hospitals won't make recommendations and claim they are all pretty much the same.

I am able to move about and put weight on my knee without pain. It was actually easier with the nearly full-leg cast and I am feeling a bit unsupported with just the brace.

I have full Internet access at home so I will read more. The differences are really surprising to me. This doctor is at an elite national university hospital, so I have to hope he knows what he is doing.

Thanks for listening and for your support.

Steve

Offline spmcg77

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Re: Opinions regarding treatment in Japan
« Reply #7 on: April 11, 2017, 09:17:02 AM »
Hello,

It is now just over three weeks since my quadriceps surgery. All along the way the doctors and physical therapists have suggested I don't need to wear a brace of any kind. I got my cast off 3 days ago and saw a physical therapist at a nearby large hospital, having been told that every place is the same.

I wore the brace I received from before the surgery until I could see the new PT person, and she said that I really didn't need a brace and suggested that I at least go without one at home. She worked on my knee for about 30 minutes and got me from 40 degrees bend to 62 and said that reaching 90 degrees by the end of two weeks as suggested by the doctor should be no problem, except I was too tense.

The reason I am tense is because everything I am hearing here in Japan is different from what I've read about any other treatment anywhere else. However, you have to dance (so to speak) with the person who brung ya, and my dance card is filled with people who view treatment very differently.

I remember seeing somewhere on this board that someone wrote about a more aggressive approach they had experienced, maybe in France? Switzerland? If anyone could point me towards that post I'd appreciate it.

Sorry to keep singing the same song. It's the music I'm dancing to.

Thanks as always for any advice.

Offline spmcg77

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Re: Opinions regarding treatment in Japan
« Reply #8 on: April 11, 2017, 09:29:25 AM »
Sorry, one more thing. I found this reference that conservative and aggressive treatment.

http://www.physio-pedia.com/Quadriceps_tendon_tear

The top of the page states there are some problems with this write up, but still it's the only citation I've found so far that suggests any other kind of treatment. I'm going to see if I can get access to the four references given through a university library account and then to see if I can understand them. I don't know what the evidence levels mean, except I guess they refer to the quality of the literature support.

[6]. West J et al.; Early Motion After Quadriceps and Patellar Tendon Repairs: Outcomes With Single-Suture Augmentation; The American Journal of Sports Medicine; 2008 February, 36 (2): 316-323;
Evidence level: C, [Link]

[7]. Yilmaz C. et al.; Tendon lengthening repair and early mobilization in treatment of neglected bilateral simultaneous traumatic rupture of the quadriceps tendon; Knee Surg Sports TraumatolArthrosc.; 2001 May; 9(3):163-166;
Evidence level:D, [PubMed]

[8]. Levy M. et al.; A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization.Preliminary report; ClinOrthopRelat Res.; 1987 May;(218):297-301
Evidence level:D, [PubMed]

[13]. James Edin Lyle et al.; quadriceps tendon rupture; Medscape; 2011
Evidence level:B   [Medscape]



Offline spmcg77

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Re: Opinions regarding treatment in Japan
« Reply #9 on: April 22, 2017, 05:43:07 AM »
Hello all,

I don't know if anyone is interested in these posts or not, but I will post this follow up anyway.

I finally got the chance to ask the knee specialists what treatment they did when they did the surgery. It may seem late to know this. We did ask a lot of questions of a lot of people, but things also happened pretty quickly.

It turns out they used about 1 cm of a Leeds Keio ligament in my knee. Apparently in those cases patients are allowed to put weight on their knees quite early on and that was true in my case. I was allowed to put weight on my knee as tolerable after two weeks. They also did not think a brace of any kind was required.

Maybe I have been lucky and I don't know what the future will bring, but I did not have much pain after the surgery and was able to get around on crutches without a brace after three weeks. I returned to my full-time teaching job after a week out of the hospital. It was a tough week, but just because I got tired, not because of pain.

The rehabilitation is going OK, too, but it does not seem common for the therapist to give much of an overview of what they are doing or why. My doctor asked them to get my knee to 90 degrees 4 weeks after the surgery and I have only made it to 72. The doctor seemed OK with my progress after the most recent weekly visit yesterday. He also suggested that returning to work was therapy in itself.

I am worried about what the goals will be after I reach 90 degrees. I've heard that progress is slow and painful, which is why I have such a hard time when the PT therapist tells me to just relax.

Anyway, probably this isn't all that helpful or interesting. The main thing I came away with is the benefit of having a doctor who can speak English (even with a spouse who can translate) because they sometimes go into Western mode in English and explain more. It also seems a little easier to ask questions and get answers in English. The old adage about getting a second or third opinion and being as proactive as possible in the care is very true. If we hadn't been on the ball I would be about 2 weeks behind where I am.

That's all, I guess. I really appreciated the resources available though Knee Guru. If anyone has any information about Leeds Keio ligaments that would be very helpful. The earlier reports were a bit worrying for treatment of quadriceps injuries,  but it seems like they are more positive starting around 2008 or so.

--steve