Tony's letter to the Medical Board of Queensland

Edit 19/10/2010: I have removed the name of a doctor after receiving a letter from his lawyers. Details here.

We received a copy of this yesterday evening. Please note Tony is a friend of mine and this is genuine.

To The Medical Board of Queensland,

My complaint is rather lengthy. It relates to an injury and subsequent treatment of that injury by various doctors and surgeons. I am not primarily complaining about any particular individual of the medical institution, rather, that I still have not been diagnosed and treated for my condition. I am desperately seeking diagnosis and a treatment. Some doctors may believe they have diagnosed my condition, but they have been wrong and this has been proven surgically. The best diagnosis available today is my own humble conjecture, which is terrifyingly inadequate.

On 28 July 2007, I suffered a severe inversion sprain to my right ankle. I'd suffered a few previous sprains, but this one was much worse than others. I was kicking a football rather hard when I landed incorrectly. I was not weight-bearing for about 5-6 days. During that time I was a very fit athlete playing A1-grade tournament squash and was very active with many other hobbies.

Over the following months after the injury, I tried returning to sport and I could feel I had something wrong in my ankle. I hoped it would resolve, but it didn't. I could not put my joint into dorsiflexion due to a mechanical impingement and this resulted in muscle atrophy. Subsequently, I became very ill. Nevertheless, I pushed on with my sporting endeavours expecting my body to overcome the problem like it had many others in the past.

Eventually I conceded in January 2008 and sought help from Dr. X. We tried various treatments including a cortico-steroid injection and obtained MRI radiographs. Over time, this condition worsened to the point where I was forced to discontinue sport in May 2008. I have not been active since. I sought help from an orthopaedic surgeon, Dr. Greg Sterling, who prescribed a Broestrom Repair and medial arthroscopy since my complaint was mostly anteromedial.

At the time, I was very medically-illiterate and put much faith in medical doctors. I assumed a positive outcome from surgery, simply because I'd had surgery in the past for various conditions and I was always better afterward. The procedure was performed on 15 September 2008 and the medial arthroscopy revealed deltoid ligament damage which was also repaired along with the ATFL and CFL.

I wore a cast for 2 weeks and an orthodic boot thereafter. Although I was in pretty intense pain, I'd attributed this to the recent surgery and thought it would resolve. It didn't. In October 2008, I knew I was in big trouble – I had similar symptoms to pre-operative but they were now much worse. I immediately sought help from Dr. Greg Sterling who requested another MRI but in November 2008, could see nothing wrong. He said “see you in January 2009”. The prospect of waiting so long in agony was traumatising.

Around the same time, I'd sought help from Dr. X who claimed I was exaggerating my symptoms and attributing too much attention to my condition. This blatant oversight added further to my trauma – and he'd almost convinced a member of my family of these falsehoods. I was suffering psychologically and I sought immediate help from Prince Charles Mental Health Unit.

I was discharged as an outpatient but I knew I was not mentally ill – I was in incredible pain and agony from a misdiagnosis by an orthopaedic surgeon. I set out to conquer the problem myself – scared and ill-educated on the subject matter – and was faced by the foreign medical protocols and language.

As my stress levels grew, I was admitted to the Prince Charles Mental Health Unit by Dr. John Reinders under a de facto ITO. I was also forced to take anti-psychotic medication. This is because of some of the desperate language I was using, for example, “do I have to operate on myself?” and Dr. Reinders felt I may be a harm to myself.

I'd never been so low in my life. When taking anti-psychotic medication, you are very much unaware of your surroundings. It was only during a lull in the effect of the medication, that I decided I needed to get out of the hospital and do what I can for my ankle – I was convinced the doctors had erred and that this was a huge mistake. I requested a Psychiatric evaluation and was declared “in severe distress, but mentally healthy” and I was discharged.

I set about understanding ankle anatomy, conditions of the ankle and general medical protocols. I quickly learned that I had at least soft tissue impingement. Indeed, I had tissue trapped in the joint that was under permanent pressure due to the recent surgery – even when not weight bearing. This is as painful as you might imagine it to be and a little more given multiple pathologies.

I sought help from Dr. Andrew Wines (Foot & Ankle Orthopaedic Surgeon) in Sydney who prescribed an arthroscopic debridement. This was performed under GA on 11 December 2008. To quote his remark, “you had a chunk of tissue about the size of my finger in there”. I was immediately weight bearing post-operative and the local aneasthetic provided some relief. As a result of this anaesthesis, I was under the false impression that my troubles were over. They weren't.

After a few days I knew I still had a severe and painful problem though I no longer had the problem of tissue impingement. It felt like I had bone impingement on dorsiflexion and I sought answers from medical literature. I eventually stumbled on Anteromedial Osseous Impingement Syndrome for which MRI radiography is inconclusive for diagnosis. I used my January 2009 appointment with Dr. Sterling to ask for a request form for a CAT radiograph and weight-bearing Xray. Dr. Sterling also made an appointment with Dr. Michael Lutz to determine if he could unravel this mysterious problem of mine.

Upon obtaining these radiographs, I saw immediately that I had a bone spur in the location of my pain. I sought assistance from Dr. Andrew Wines (again in Sydney) who agreed with me to some extent but wanted a second opinion in order to ensure he was not suffering a bias. I applaud this decision. I used my upcoming appointment with Dr. Lutz to achieve this second opinion. Dr. Lutz agreed that an open incision to excise osteophytes on my tibia may be appropriate and I was informed of the risks .

Dr. Wines performed an arthrotomic tibial ostectomy on 04 March 2009 under GA at Royal North Shore Hospital. I flew home the next day – I was weight bearing without assistance. Again, the anaesthetic provided a false belief that my problems were over.

Unfortunately, I still have the same problem I started with – I cannot put my ankle into dorsiflexion. Many doctors might attribute this to the recent surgery, but I know I am experiencing precisely the same symptoms that I have done for the last 18 months. Although the localised and extreme pain caused by a bone spur has been resolved, I still have bone impingement on dorsiflexion that is not localised. I also know that this is due to a very definite mechanical limitation, since I have had a Physiotherapist in the past attempt to push my joint past this point with intense force to no avail.

As a result of this inability for dorsiflexion, my muscles have atrophied up to my thoracic spine. Subsequently, I find breathing difficult and any position uncomfortable except for lying down. This has caused immense stress especially while I have maintained a full-time job (Computing Science Researcher) and I am considering indefinite unpaid sick leave. Unfortunately, a consequence of this is that I will no longer be able to afford regular flights to Sydney for treatment, radiographs and so on, therefore, I must continue the battle under all circumstances and despite exhaustion.

I have long maintained that my symptoms are only observable while I am weight-bearing and in an attempt at dorsiflexion. This means that surgeons who operate cannot check for resolution of these symptoms, MRI and CAT radiographs cannot exhibit them and the only weight-bearing Xray I have was not in dorsiflexion because the Radiographer would not allow it (images only per requesting doctor instructions).

Unfortunately, I still have quite a large battle ahead but I am at a complete loss with respect to how I should go about it and that is why I have written to you, my state medical authority.

Is there a radiographic machine available in Queensland that will exhibit my bone impingement while in dorsiflexion and while weight-bearing? Better still, is there a doctor who is prepared to do the hard work of figuring this problem out? I am more than willing to make many sacrifices to ensure it. These are rhetorical questions – I don't know what the right questions are.

I am desperately seeking a diagnosis and treatment, 19 months after an initial injury and I know that my time is limited with regard to the amount of stress and pain that I can continue to endure. This is simply unsustainable.

Please advise.

Thank you for your time. Confidentiality is not requested and you may share this information with whoever you see fit.