Injury Medics - Levi in for surgery

[Saintly Viewed]

Saintly it doesn't surprise to see you as the poster who can see the big picture. Apart from a lot of lack of understanding of how the medical system operates in various posts I am struck by how we objectify and dehumanise our players in these discussions.

The decisions re surgery and treatment for these various players will be made between the player and the referring surgeon. That's the primary relationship and the surgeon involved should only consider the players welfare and needs not the club or the referring doctor. The player can involve or inform the club about what took place in the consultation but is also able to keep them out of the loop completely if they choose and that shouldn't be seen in a negative light. The player is allowed to think of their own health and needs as the primary issue. Employers dont have rights in this decision making. Put yourself in that position.

I know this is a utopian view and in the real world of AFL all sorts of pressures will be bought to bear. Still its not a bad starting point and a way to reflect may be to put yourself in their position and ask how much you would want your employer dictating your own health concerns.

That's correct.

Health is so precious.

Eg Daniel Chick had part of his finger amputated to sustain his career in football. I will presume that was his decision. Personally I could never do that, or at least that's how I feel without being in his situation.
What pressure his club placed, no idea.

To repeat a player decided to amputate.

To me health and prognosis is far beyond a cursory glance at the player and what's best for the supporter.
Because reading the threads it does sometimes come across the sole purpose of health diagnosis is how best to get the player competing at the optimum and as quickly as possible.
Not sure that's necessarily in line with the player's (human being's) best need.....


As an example, If people have been involved with severe back trouble, known people with same, dealt or discussed same with specialists, it's such a complicated and fragile situation.
No two situations are the same.
And interestingly in every case I've known of very closely, not one specialist advocated immediate surgery. In fact it was very much a last resort.

But anyway.... persons health overall must come first. No ifs buts

 

[frizzle]

No buck passing. The club doctors are not suitably trained or in a position to decide who needs surgery. It's always an outside specialist making this decision



So who are you replacing. The surgeon/s who treat our ankle injuries? The surgeon/s who treat our knee injuries? The surgeon/s who treat our shoulder injuries etc etc. Because there are all likely to be different surgeons. Who do you want to sack?

Our club doctors are not not wanting to make the calls so outsourcing rather they are usually not qualified or in a position to decide who gets conservative treatment v surgery. These decisions by and large are outside their call.



For medial ligament injuries it would be a surprise if a specialist opinion isn't sought as a matter of course. Our club doctors are not the one who are able to decide if surgery is required. Whenever surgery is one of the options you need the surgeon to make the decision.



It's not a third opinion. The club doctor is not sending the player to the surgeon for an opinion rather to manage the injury to a level the club doctor cant. They have different levels of expertise and their opinions are not equal. The club doctor would completely undermine the relationship if they tried to resume care they had asked to be handled by the surgeon. Just wouldn't work.



Again Bradshaw and especially Davoren would not have been the ones deciding on rest or surgery in these cases.

I've already been down this track with you GC after the Elliott mistake, yet here we are again. As I said, it's something we have to be better at. I don't know who has recommended rest when surgery was needed & i don't need to. I don't want a scapegoat. I just want my players to have the best pre season they can have. I'll bet we paid a high price for the advice we got on both those players & it wasn't good advice. Go elsewhere then.
We are p!ssing away important pre season months by taking the wrong course of action post season. Both of these injuries were there during the 2017 season & we had an opportunity to fix them in September & be 2 months further along than we are now. Both Elliott & Greenwood were advised rest would be sufficient to overcome their injuries. Both of those recommendations were wrong & the players had surgery in December. If you think we are all good to continue doing this then I'm not sure what we have left to discuss.

 

[BigCharlie]

For medial ligament injuries it would be a surprise if a specialist opinion isn't sought as a matter of course. Our club doctors are not the one who are able to decide if surgery is required. Whenever surgery is one of the options you need the surgeon to make the decision.

A surgical opinion is only needed if it was a Grade 3 sprain, and/or there was substantial meniscal involvement. Which there wasn't.

Our club Doctor's are exactly the people - in conjunction with the Physio staff - who should be deciding if surgery is required. Surgeons, unsurprisingly, are experts in slicing and dicing. Nothing else.

 

[Gone Critical]

A surgical opinion is only needed if it was a Grade 3 sprain, and/or there was substantial meniscal involvement. Which there wasn't.

Our club Doctor's are exactly the people - in conjunction with the Physio staff - who should be deciding if surgery is required. Surgeons, unsurprisingly, are experts in slicing and dicing. Nothing else.

So Levi doesn't have an injury which requires a surgical opinion but despite that has had a surgical opinion and even an operation.

You will have to explain that one further.

The club doctors and physios are deciding on who needs operations. Not the surgeons. Curious system you believe is at work here.

 

[Gone Critical]

I've already been down this track with you GC after the Elliott mistake, yet here we are again. As I said, it's something we have to be better at. I don't know who has recommended rest when surgery was needed & i don't need to. I don't want a scapegoat. I just want my players to have the best pre season they can have. I'll bet we paid a high price for the advice we got on both those players & it wasn't good advice. Go elsewhere then.
We are p!ssing away important pre season months by taking the wrong course of action post season. Both of these injuries were there during the 2017 season & we had an opportunity to fix them in September & be 2 months further along than we are now. Both Elliott & Greenwood were advised rest would be sufficient to overcome their injuries. Both of those recommendations were wrong & the players had surgery in December. If you think we are all good to continue doing this then I'm not sure what we have left to discuss.

Ok. So get new ankle surgeons and knee surgeons is your basic position?

You believe you have the capability to assess the advice given based on our paltry knowledge and facts of these cases. All that confirms is the base problem that you don't understand what you don't know.

 

[jmac70]

Josh Kennedy had ankle surgery too. Seems this is not limited to Collingwood.

 

[Saintly Viewed]

Josh Kennedy had ankle surgery too. Seems this is not limited to Collingwood.

Say what?
No?
Can't be, only Collingwood have surgeons on speed dial.

 

[Saintly Viewed]

So Levi doesn't have an injury which requires a surgical opinion but despite that has had a surgical opinion and even an operation.

You will have to explain that one further.

The club doctors and physics are deciding on who needs operations. Not the surgeons. Curious system you believe is at work here.

Ok. So get new ankle surgeons and knee surgeons is your basic position?

You believe you have the capability to assess the advice given based on our paltry knowledge and facts of these cases. All that confirms is the base problem that you don't understand what you don't know. As you say as long as that remains the case we have nothing left to discuss.

Sometimes in life, we just don't have the expertise or requisite knowledge.
Sometimes further, if we don't have the knowledge we the parade this lack of knowledge as a virtue.

Hmmm, they do say it's bliss....

 

[Horaceg]

These guys aren’t pieces of meat, they are human beings, it seems like some people on here think we should just open them up at every opportunity because it suits the need of us as supporters, get real please.

 

[Gone Critical]

I've already been down this track with you GC after the Elliott mistake, yet here we are again. As I said, it's something we have to be better at. I don't know who has recommended rest when surgery was needed & i don't need to. I don't want a scapegoat. I just want my players to have the best pre season they can have. I'll bet we paid a high price for the advice we got on both those players & it wasn't good advice. Go elsewhere then.
We are p!ssing away important pre season months by taking the wrong course of action post season. Both of these injuries were there during the 2017 season & we had an opportunity to fix them in September & be 2 months further along than we are now. Both Elliott & Greenwood were advised rest would be sufficient to overcome their injuries. Both of those recommendations were wrong & the players had surgery in December. If you think we are all good to continue doing this then I'm not sure what we have left to discuss.

Just to also give a flip side senario.

Imagine Elliotts management goes the way you say is the right way. He sees the surgeon who says rest may fix this but the other option is surgery immediately. That avoids the possibility of rest not being enough and you needing surgery anyway down the track into the preseason. Elliott decides on immediate surgery and the surgeon tells him about the success and failure rate of this surgical repair and what the risk of surgical complications are. Surgery is done, 10 days later Elliotts wound has turned red, the ankle has swollen overnight and become sore. He is diagnosed with an infective complication, probably a degree of osteomylitis (bone infection) involved. He has a another anaesthetic for a joint washout, commences on antibiotics for 6 to 8 weeks and ends up needing a further operation in 3 months to debride the scar tissue around the repair and redo the part of the surgery that came undone after the infection impaired healing. Elliott ends up returning to the VFL in May for his first game of the season.

The joint lining is also somewhat damaged due to the infection and Elliott now has a much higher chance of developing problems post footy life due to arthritis in this joint, a complication that would have been avoided if rest had been tried and been successful ( in this senario we don't get to know if the rest would have worked or not)

Was the advice given here wrong?

 

[Baltimore Jack]

Josh Kennedy had ankle surgery too. Seems this is not limited to Collingwood.

Collingwood Bubble

 

[frizzle]

Ok. So get new ankle surgeons and knee surgeons is your basic position?

You believe you have the capability to assess the advice given based on our paltry knowledge and facts of these cases. All that confirms is the base problem that you don't understand what you don't know.

Don't need to understand. How come you don't understand that the wrong treatment was advised in both cases, when surgery ended up having to be done anyway? Now GC if you could kindly guide me to the part of my post where I state I have the capability to assess injuries? However in these 2 cases i could have tossed a coin, taken the big dollars for the advice & still not been more wrong than they were. Please tell me any of what I just wrote is not fact?
THEY GOT IT WRONG. We have to make sure in future we get it right a hell of a lot more often than not.

 

[frizzle]

Just to also give a flip side senario.

Imagine Elliotts management goes the way you say is the right way. He sees the surgeon who says rest may fix this but the other option is surgery immediately. That avoids the possibility of rest not being enough and you needing surgery anyway down the track into the preseason. Elliott decides on immediate surgery and the surgeon tells him about the success and failure rate of this surgical repair and what the risk of surgical complications are. Surgery is done, 10 days later Elliotts wound has turned red, the ankle has swollen overnight and become sore. He is diagnosed with an infective complication, probably a degree of osteomylitis (bone infection) involved. He has a another anaesthetic for a joint washout, commences on antibiotics for 6 to 8 weeks and ends up needing a further operation in 3 months to debride the scar tissue around the repair and redo the part of the surgery that came undone after the infection impaired healing. Elliott ends up returning to the VFL in May for his first game of the season.

The joint lining is also somewhat damaged due to the infection and Elliott now has a much higher chance of developing problems post footy life due to arthritis in this joint, a complication that would have been avoided if rest had been tried and been successful ( in this senario we don't get to know if the rest would have worked or not)

Was the advice given here wrong?

Yes yes - Nice absolute worst case scenario. My argument is based on what happened & yours is not.

 

[Saintly Viewed]

 

[Gone Critical]

Don't need to understand. How come you don't understand that the wrong treatment was advised in both cases, when surgery ended up having to be done anyway? Now GC if you could kindly guide me to the part of my post where I state I have the capability to assess injuries? However in these 2 cases i could have tossed a coin, taken the big dollars for the advice & still not been more wrong than they were. Please tell me any of what I just wrote is not fact?
THEY GOT IT WRONG. We have to make sure in future we get it right a hell of a lot more often than not.

My base point in all these musing is we never know if "they" got it wrong or right because we dont have the information or knowledge to tell.

To answer your question I will make a few assumptions so as to demonstrate how advice can be correct even if the hoped for outcome isn't achieved. Using Elliott as the example imagine him in the initial consultation with the surgeon. His injury is assessed and the surgeon presents 2 possible treatment options. He could try a conservative approach with rest, physio and then a graded reintroduction of activity. Full training should be possible by November. The chances of this being successful is 70:30 and if it doesn't work surgery in 2 months time will mean his pre season is put back so he may miss an early round or 2.

The other option, immediate surgery, has a 90% success rate and if undertaken he should be back in full training in December if there are no problems. It's more successful but also involves the small but not insignificant risk of surgical complications and the more severe of these could prove difficult to treat, set him back well into the season and increase the risk of permanent long term joint damage.

Elliott considers the advice given, gets some input from the club doctors and coaches because he wants their input, also asks his mum what she thinks because he values her advice also.

He then makes his informed decision. He consents to the treatment he has chosen and is the only person who can do that. The surgeon can advise but not decide. He is diligent with his rehab apart from injudicious pissing but unfortunately this approach doesnt work and when he gets into full training the injury hasn't resolves so the surgical option is taken.

Now I have filled in the unknown here by making things up but this is likely the sort of advice Elliott was given. It's the sort of advice any reputable surgeon would give.

Can you see here the outcome wasn't the one hoped for but the advice given was correct?

In your consideration of what has happened here you also need to consider Elliott as a person with the ability to decide his own course. In the postings you have put forward you dont seem to have conceived of the idea the Collingwood players should have any say in their own treatment. They are people before they are Collingwood footballers.

 

[Leviathan Pie]

Frustrating to see a player who should have had this sorted in the week following our seasons end, now go into surgery at this point of the pre-season.

Seems on face value a bit amateur-ish. But maybe theres more to it.

 

[left at home]

Resting, rather than surgery is not a collingwood experience, even the NFL it happens also. Most times rest works, it’s unfortunate that it has not in these occasions. Better now than mid season.

 

[Jasper84]

Resting, rather than surgery is not a collingwood experience, even the NFL it happens also. Most times rest works, it’s unfortunate that it has not in these occasions. Better now than mid season.

The funny thing is that there could be 30 or so other players training now, who were given the correct diagnosis of rest over surgery this preseason, only we don't give the medicos any props for getting them right. Instead we zero in the on the 2 outliers who may have been misdiagnosed.

 

[left at home]

The funny thing is that there could be 30 or so other players training now, who were given the correct diagnosis of rest over surgery this preseason, only we don't give the medicos any props for getting them right. Instead we zero in the on the 2 outliers who may have been misdiagnosed.

If they ever were. The chances of infection are real, so if rest is the best option so be it. Does not work then they still have the other option.
My only concern was the length of time to go down the surgery route, after they started to realise resting was not working, not the rest first option.

 

[frizzle]

My base point in all these musing is we never know if "they" got it wrong or right because we dont have the information or knowledge to tell.

To answer your question I will make a few assumptions so as to demonstrate how advice can be correct even if the hoped for outcome isn't achieved. Using Elliott as the example imagine him in the initial consultation with the surgeon. His injury is assessed and the surgeon presents 2 possible treatment options. He could try a conservative approach with rest, physio and then a graded reintroduction of activity. Full training should be possible by November. The chances of this being successful is 70:30 and if it doesn't work surgery in 2 months time will mean his pre season is put back so he may miss an early round or 2.

The other option, immediate surgery, has a 90% success rate and if undertaken he should be back in full training in December if there are no problems. It's more successful but also involves the small but not insignificant risk of surgical complications and the more severe of these could prove difficult to treat, set him back well into the season and increase the risk of permanent long term joint damage.

Elliott considers the advice given, gets some input from the club doctors and coaches because he wants their input, also asks his mum what she thinks because he values her advice also.

He then makes his informed decision. He consents to the treatment he has chosen and is the only person who can do that. The surgeon can advise but not decide. He is diligent with his rehab apart from injudicious pissing but unfortunately this approach doesnt work and when he gets into full training the injury hasn't resolves so the surgical option is taken.

Now I have filled in the unknown here by making things up but this is likely the sort of advice Elliott was given. It's the sort of advice any reputable surgeon would give.

Can you see here the outcome wasn't the one hoped for but the advice given was correct?

In your consideration of what has happened here you also need to consider Elliott as a person with the ability to decide his own course. In the postings you have put forward you dont seem to have conceived of the idea the Collingwood players should have any say in their own treatment. They are people before they are Collingwood footballers.

I agree with all of your post - This time
However don't you think that these guys would also be choosing the option with the best chance of success? Especially after it hampered them last season & stopped them from producing their best. Greenwood is out of contract at years end & for all we know he could also be cheesed off that he has taken advice that has set him back 2 months. He already missed games due to the knee at the end of the year. It will tough enough for him to earn another contract at the club. This has made it even tougher for him. Elliott is an extremely important player for us & any game he misses makes us winning considerably harder.

Oh & for those of you saying Josh Kennedy had ankle surgery it's not just us? He hurt his in the pre season unlike Elliott who already had the condition. It's not the same but good try.

 

[Gone Critical]

I agree with all of your post - This time
However don't you think that these guys would also be choosing the option with the best chance of success? Especially after it hampered them last season & stopped them from producing their best. Greenwood is out of contract at years end & for all we know he could also be cheesed off that he has taken advice that has set him back 2 months. He already missed games due to the knee at the end of the year. It will tough enough for him to earn another contract at the club. This has made it even tougher for him. Elliott is an extremely important player for us & any game he misses makes us winning considerably harder.

Oh & for those of you saying Josh Kennedy had ankle surgery it's not just us? He hurt his in the pre season unlike Elliott who already had the condition. It's not the same but good try.

I don't know what their view was. For me they equally could have been attracted to the idea of avoiding surgery, getting into the pre season asap rather than starting a month behind the rest.

As it stands there were 3 main possibilities all with similar long term outcomes but differing times to get back

1 Rest and avoid surgery. If this works you get a full pre season and are not left behind at all

2 Immediate surgery meaning you miss the start of the preseason but hopefully catch that up before the season starts

3 Rest which doesn't succeed so later surgery. Delays your return the most and could even miss the start of the season.

It seems they were attracted to the option which got them back on track quickest. A very reasonable approach for Elliott and Greenwood to take.

 

[frizzle]

I don't know what their view was. For me they equally could have been attracted to the idea of avoiding surgery, getting into the pre season asap rather than starting a month behind the rest.

As it stands there were 3 main possibilities all with similar long term outcomes but differing times to get back

1 Rest and avoid surgery. If this works you get a full pre season and are not left behind at all

2 Immediate surgery meaning you miss the start of the preseason but hopefully catch that up before the season starts

3 Rest which doesn't succeed so later surgery. Delays your return the most and could even miss the start of the season.

It seems they were attracted to the option which got them back on track quickest. A very reasonable approach for Elliott and Greenwood to take.

We got option 3 for both & they are starting their pre season late & behind everybody. But apparently this is just fine & we should just suck it up & deal with it rather than do it better in future. Perhaps we could have advised them better? We will never agree here GC. No point continuing.

 

[Gone Critical]

We got option 3 for both & they are starting their pre season late & behind everybody. But apparently this is just fine & we should just suck it up & deal with it rather than do it better in future. Perhaps we could have advised them better? We will never agree here GC. No point continuing.

Now no one is saying that. I don't think anyone wants anything other than best possible outcomes. In this area I just have a better understanding of what's possible and reasonable than you do. You seem to have trouble accepting that there are pros and cons and potential adverse outcomes whether you go conservative or surgical treatment.

In my working life everyday I am discussing with patients the options they have for treating illness they have with conservative treatment v lesser surgical options v bigger surgical options. There are always pros and cons for each option. Different people have widely varying attitudes to surgery from a firm belief cutting it out is always best to an almost pathological fear of going under the knife. Some want to be very involved and active in their care others almost want a magic wand waved and their condition fixed. No treatment course is universally successful, I am not sure you understand that.

You are not considering so many options when you assert these players have been given wrong advice.

I know you are wrong in this instance because I work in the surgical field and so have a greater understanding of it. You may not accept that to be true but it is.

 

[frizzle]

Now no one is saying that. I don't think anyone wants anything other than best possible outcomes. In this area I just have a better understanding of what's possible and reasonable than you do. You seem to have trouble accepting that there are pros and cons and potential adverse outcomes whether you go conservative or surgical treatment.

In my working life everyday I am discussing with patients the options they have for treating illness they have with conservative treatment v lesser surgical options v bigger surgical options. There are always pros and cons for each option. Different people have widely varying attitudes to surgery from a firm belief cutting it out is always best to an almost pathological fear of going under the knife. Some want to be very involved and active in their care others almost want a magic wand waved and their condition fixed. No treatment course is universally successful, I am not sure you understand that.

You are not considering so many options when you assert these players have been given wrong advice.

I know you are wrong in this instance because I work in the surgical field and so have a greater understanding of it. You may not accept that to be true but it is.

I also know you defend your field with vigour. This is an ankle & a medial ligament we are talking here. We would be league worst & getting these things sorted first time. You can throw a whole medical book at me if it makes you feel better, but most other clubs are doing this better than us.

 

[Gone Critical]

I also know you defend your field with vigour. This is an ankle & a medial ligament we are talking here. We would be league worst & getting these things sorted first time. You can throw a whole medical book at me if it makes you feel better, but most other clubs are doing this better than us.

Not defending the surgeons etc at all. My whole point is I don't know if they have done a good job or bad. Scenarios I have described are just reasonable examples, I have no knowledge of what's really happened.

That's our only difference. I believe I have no idea if good or bad advice has been given here whereas you think you do. As you say we can probably go no further