I want everyone to read this

[Mr I]

This is a literal transcript from a senior orthopedic surgeon that was handling my case prior to me taking matters into my own hands.

No I'm not going to sue for damages, I'm not like that when a good guy admits he made an error. But it highlights why doctors and consultants aren't always right no matter what training they had or what the text books they've been forced to learn from or the cpd they are required to adhede to. Bro science counts people and you know your own body better than anyone.


"You are right to feel let down by myself;* I feel that* I should have been more cognisant of your predicament and, in retrospect,* made more effort to ascertain exactly what your symptoms were and not have been falsely reassured by your previous visit to the Emergency Department. Whilst the literature* suggests that the initial management of your foot drop was appropriate, had I been better informed as to your plight* my* heart may have overruled my head and* I may well have been more inclined to ignore what the journals and books* tell me and expedite matters, for which I cannot apologise enough."

[Bouncer]

I believe you made that up. Sounds like your wording. I'll be in contact with my Facebook surgeon very good friends in London to confirm this Albert.

[Mr I]

If you give me your private email I will send you everything

[Mr I]

This is the full transcript of his email to me, wherein he responds to my numbered point I'd put in the previous email to his dept, in the same order. There are several emails and a letter from his dept before that;

Thank you for your recent observations,* with regard to which:

1) Factually, the drop foot started the morning of 11 April, not three days before. I started experiencing pain in my shin circa three days before. The drop foot is on my left foot not right as per the left prolapse, turned herniation

Apologies for*my factual error regarding the side*- this was based on Mr*Akula's*letter, which*in fact correctly identified the*affected side, but suggested that the weakness and shin discomfort began contemporaneously three days previously:

*

*I reviewed this gentleman who had a lumbar epidural L3/4 on 23 February 2016.*Following the injection his back pain is slightly better but he is having shin pain and grade 3 power in*dorsiflexion*of the left ankle for 3 days. The shin splint and foot weakness started three days ago.*Today on clinical examination he is denying any*cauda*symptoms and he is mentioning that he can feel his*peri*anal sensation clearly and on clinical examination his sensation is normal but the left ankle is grade 3*power.**have discussed this with Mr Burgoyne, as for the literature evidence we are organising MRI scan on an urgent basis as soon as possible and we would like to review him with the result of the MRI scan. I also informed*******to attend Emergency department if he notices any problems with bladder/bowl on an urgent basis.


2) In terms of the MRI I'm sure Mr Burgoyne et al have the ability to interpret hence why I didn't accept your initial position that we had to wait for a radiographers report thereon. Under the circumstances with symptoms presenting indicating further lateral movement, and probable nerve insult expedience was a key necessity here.

*

As mentioned in my letter , I was able to review the scan the following day. However, at the time *I was aware of only your foot drop**and* two episodes of loss of bladder control - the latter for which you had been previously seen in the Emergency Department where a*caudaequina syndrome appeared unlikely. You will note*from the excerpt*of the article* I sent you that, based on the information available, immediate surgery has not been shown to influence the out come*of a*L5*related foot drop compared to*non operative management.



3) When I then experienced loss of bladder control this should surely have indicated a worsening situation with surgery needed and if any resourcing problems were extant, St georges should have been called for emergency surgery.

When, on 28 April, I*became *aware that you had suffered further -*and more severe -*bladder problems since your presentation to the Emergency Department - I asked Ms. Day and Mr Akula to liaise with yourself and St George's Hospital with regard to an urgent neurosurgical*review with*a view to immediate surgical decompression


4) I do not accept the position that once drop foot ensues, a sit and wait strategy is in any way appropriate. Surely it is clear combined with the revised MRI if not also bladder issues that the insult needs to be gotten off the nerve, further,* from the reading I have done, the longer someone is left with drop foot the longer and less likely recovery will be.

*

Whist the recommendations*contained within *the literature appear counter-intuitive* - which is why I sent you the extract from the British Orthopaedic Association*Article - an expectant policy with regard to the management of foot drop secondary to irritation of the L5 nerve root has not been shown to result in a worse outcome compared to immediate surgery. This has been borne out in my own experience of operating on*three patient with a foot drop but otherwise stable neurology - not one of which noted an improvement in their weakness post operatively. However, when foot drop is accompanied by progressive neurological symptoms/signs then the argument for surgery v. conservative management becomes* compelling.

*


5) Contrary to Mr Burgoyne ' s comments of the revised MRI, the consultant neurologists at St George's considered in entirely indicative of a necessity for immediate surgery.

*

This comment was made in the light of your symptoms on the day you were seen - not on the symptoms which I was aware of when I reviewed you scan on 22 April and when your plight was discussed at our spinal meeting on 25 April; progression of a disc bulge, even if accompanied by the development of a foot drop in the absence of any other progressive neurological deficit, is not an indication for immediate surgery.


6) Because of your delayed action, Mr left drop foot worsened from the 3/5 examination at your clinic and I am now less mobile.

*

Whilst the development of worsening bladder problems was certainly an indication for* urgent surgery, even if this had not*occurred,*had the weakness associated with your left foot had been noted to have worsened since you were seen by Mr Akula on 11th April**when you*were due to have been*seen on 29 April this would have been another reason for considering urgent decompression. However, as mentioned previously, it was not until 28 April that I became aware of the significant deterioration of your other symptoms since you were seen in the Emergency Department on 13 April 2016.


7) Less mobility generally equates more likely health issues over time which could equate more cost to the nhs let alone my own quality if life.

*

Whilst your foot drop is undoubtedly quite disabling* at present, it is very early days and there may yet be an improvement in function for up two years following the onset *- although this is far from guaranteed to occur. Nerve conduction studies performed 6 -12 weeks after the onset of the foot drop can sometimes indicated whether a functional recovery may be likely to occur.


8) If it had not been for my tenacity of the day I fear I may have been in a far worse position than now. It was me that asked for your clinic to package all mri scans and correspondence and send it to St George's on preparation as I would take myself there. To be fair this was in conjunction with Anna who I do accredit some empathy and common sense of the day not to mention action in liaising.

*

Whilst you had kindly offered to collect whatever was necessary, as there is a standard referral process for an urgent neurosurgical opinion to St George's Hospital, once your agreement to be seen there had been obtained, the referral process was set in motion - including the electronic transfer of your imaging as clearly it was no longer advisable for you to be seen as planned in clinic the following day.


9) I fully appreciate the strain on resources caused my central government and I fully support the nhs. I do however on this occasion feel let down.

*

You are right to feel let down by myself;* I feel that *I should have been more cognisant of your predicament and, in retrospect,**made more effort to ascertain exactly what your symptoms were and not have been falsely reassured by your previous visit to the Emergency Department. Whilst the literature* suggests that the initial management of your foot drop was appropriate, had I been better informed as to your plight* my *heart may have overruled my head and* I may well have been more inclined to ignore what the journals and books* tell me and expedite matters, for which I cannot apologise enough.

*

As previously, please let me know if you feel it would help to meet once more or it, albeit too late in the day,* there is anything more I can do to help.

*

With best wishes

[Bouncer]

He's kissing ass cause he don't wanna be sued.

[Mr I]

He's being honest. That goes a long way with me.

[Bouncer]

To his advantage though. That's how I see it.