Hamstring Injuries- the facts. Chapter 9

Once diagnosed and home I was keen to explore 🤓  more about this injury. I went straight to  Google only to discover it was limited in this regard. Particularly the NHS website  which states “grade 3 – a complete muscle tear. Severe hamstring tears  will usually be very painful, tender, swollen and bruised. There may have been a “popping” sensation at the time of the injury and you’ll be unable to use the affected leg.”

According to  the much more detailed Wikipedia “A grade 3 hamstring strain is a severe injury. There is an immediate burning 🔥or stabbing pain ⚡️and the individual is unable to walk without pain. The muscle is completely torn and after a few days  a large bruise 🌑 may appear below the injury site caused by the bleeding within the tissues.”

The Wikipedia description is more akin to my own experience.  My report on my initial visit to A&E was that the muscle was burning, on fire 🔥,  it felt like a dead leg and I was unable to walk or sit. Although not evident at this presentation, the bruising 🌑 appeared when we were in Harrogate 3 days after the event and was certainly visible on the second visit. I felt I had made the correct representation of my symptoms but it had not resulted in a diagnosis at either of these  visits to A&E and I’m still not sure why that was the case.

There were also a couple of blogs 📄 from doctors or physio’s who had also sustained  a hamstring strain but most of the information related to lesser injuries sustained as a result of training or sports  🏋️‍♂️ and threw no light on my situation.

However I did find some academic studies that  reported sufficiently on  Grade 3 injuries to suggest a diagnosis was possible. Grade 3s were more commonly  associated with slips 🤸‍♂️ and falls (caused by block heel boots). Individuals aged between 40-60  👵🏼 (I just made that) were more at risk  and women 👧  (definitely made that)  were approximately 3 times more likely to suffer hamstring strain than males with the majority of these being  from non-sporting scenarios.  (again those block heel boots)  Yep, it was all out there,  but I’m guessing Wikipedia is not on the trainee doctor reading list.😨

And, with the absence of diagnosis, of course comes the guaranteed lack of treatment. 🔬The recommended treatment for this injury is  the RICE protocol — rest, ice, compression and elevation.  This treatment is the same regardless of the severity of the injury, and should be commenced within the first five days.  RICE  is primarily used to reduce bleeding and damage within the muscle tissue. Of course this would have been useful if that was what I had been advised but the first and second visit to A&E failed to even identify the problem.  😳

In the immediate aftermath I needed to know this. Instead of going to Harrogate I should have been home with my hamstring  rested in an elevated position with an ice pack applied for twenty minutes every two hours.  Lower grade strains can easily become worse if the hamstring is not rested properly. Bleeding needs to be reduced but in my case this had not been addressed and my blood loss was significant. 🤭 Complete ruptures require surgical repair and rehabilitation but as I had not had my diagnosis for over a week the window for repair had apparently weakened and surgery was less likely.

On this evidence an apology from the consultant  does seem appropriate, but I have also raised this as a concern with the NHS so that others with the same problem get  the right help when its needed…….

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In Sickness and in Health. Chapter 8

The occupational therapist 👨‍🔬 was enthusiastically promoting the benefits  of the zimmer and raised toilet seat 🚽 to someone of my disposition when my husband returned.  I could see his eyes widen 👁 as I shimmied along on the zimmer, but it was the realisation that the  raised toilet seat  was also for me that made them water.  He wanted to be subtle but  his obvious horror🙀  was palpable. I knew he was doing everything he could to divert his thoughts from my ablutions and the assistance 🛀 he might need to provide. As I said in previous blogs,  our marriage 💑  vows ( much like my hamstring)  were being stretched to their limits.

I know him.  His  future flickered fleetingly before him; me in my  tartan slippers, rolled down stockings,  woolly housecoat and  curlers 👵🏼. But that wasn’t his biggest worry, no he was  wondering how the hell he was  going to get this equipment out of the hospital and into his car without anyone  👤 seeing  him. He didn’t hear a word any one said for the next ten minutes as he frantically worked out his escape plan.

I attempted to roll off the bed into my crutches with all the glamour and class 💃  of Marilyn Munro but  in reality was  more like Patsy  from AbFab tumbling out of the car legs akimbo🤸‍♂️ with the Bolinger 🍾 unscathed.    My husband had already disappeared conducting a surveillance of the immediate environs for anyone that might know him. Leaving me  to pile my newly acquired  household accessories  high on the zimmer,  much like a Thai flitting on a moped 🛵.  I edged out of the cubicle hoping to achieve a seamless exit with a single manoeuvre, a big enough challenge without a hamstring injury. Needless to say I failed. 🌀

When he caught sight of me 😲, common sense returned momentarily as he put me on a seat, planked the gear at my side and revealed his detailed plan on how we could leave without fear of being noticed.  This plan worked reasonably well  until the electronic door  🚧 in the ambulance entrance closed behind him leaving me abandoned with the raised toilet seat in a hospital no man’s land. If it wasn’t for the morphine dulling my senses I would have cried,  instead I sat there numbly 🤐waiting for the next ambulance to arrive and set me free.

In that moment of solitude I had time to digest the discharge 🤯 advice; to rest at least for 6 weeks,  with the longer term repair likely to take up to 9 months. I’m a pretty active individual; was cycling 🚴‍♀️ , playing badminton 🏸, walking🚶‍♀️ and of course enjoying frequent holidays🌴🌞.   Suddenly the enormity of this situation hit me;  I was going no where fast in this corridor and it would be the same with this injury. It was going  to significantly impact on my social, leisure and working life  and I had no idea how I might get through it.🙊

Within minutes my hero 👼 was back, realising he’d lost me, laughing at himself and finally accepting the toilet seat 🚽 was his responsibility.  In that moment I knew he would  get me through this 💞and I was in awe of  his commitment to me, while he grappled with more immediate matters. With a swift gaze around the exit, he swung the toilet seat  over his shoulder shielding his face from the passing public and threw it in the boot. Such was his haste to escape unnoticed he drove 500yds before he realised the tailgate was still open and the whole world could see what was in the boot.🤣🤣🤣

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Strike #3 Chapter 7

I entered A&E for the third time somewhat relieved 😕 that, on this occasion,  I had a diagnosis. While waiting to be seen I heard a nurse 👩‍🔧 call out to everyone, and no-one in particular, that they were at 4 breaches (presumably of the four hour waiting time). The four-hour A&E waiting time 🕰 target is a pledge set out in the NHS Mandate.  The operational standard is that at least 95% of patients attending A&E should be  admitted, transferred or discharged within four hours. On this visit, as with the previous two,  I was discharged around the 4 hour mark.

I would argue this level of performance is more applicable to McDonalds 🍔  than our hospitals.🏨  It is only likely to hinder treatment and hamper diagnosis especially in situations a little bit more complex  than ordinary. It’s  not just patients🤒  who suffer,  staff  are likely to be frustrated and constrained 😡 in their effectiveness  by such measures.  It’s not unrealistic to presume that in my situation this measure did impact  on the effectiveness or  accuracy of my diagnosis.

Additionally, without question,  on each visit I made resources were stretched 🤯 to the limit  with the sheer volume of people presenting.  I have no idea to what extent the people waiting required to attend A&E but I’d put my pension on  at least a quarter of them being able to be treated elsewhere.  🤧 This compounds the 4 hour measurement exponentially and its not difficult to see why errors are made, it also underlines why our expectations can rarely be met.

There was a very different response on my third visit, and this was entirely due to the intervention of the Musculoskeletal Consultant Radiologist. 🤩 Thanks to his personal representation of the facts (and his opinion of them), the on call A&E Consultant managed my admission. This by no means resulted in favourable treatment, I still had to lay on a bed 🛏 in the corridor for the most part of the visit.   But she did have a purpose as I was to find out later.

For the first time bloods 💉 and blood pressure 📿 were taken. Both were low and explained by the large blood loss when the hamstring  ruptured suggesting why I was feeling so poorly and lacked any appetite.  My blood count hadn’t been taken on the first or second visits so it was difficult to see if it was improving 🔬 but on the plus side I had just managed to avoid transfusion this visit.

The Trauma Team (you may recall I was referred on the first visit) take referrals 📥 from A&E. They hadn’t yet contacted me but I was still  hopeful they would. However the Consultant disavowed me of that expectation; having  reviewed my notes  🗂 following the first discharge, they determined that their intervention in my case was unnecessary.

The Consultant  was surprised 😳 about this herself  admitting she had made an assumption that referrals for similar  injuries  would at least warrant contact.   I slowly realised why the radiologist had been so angry  and she saw this.  Without prompt she offered an apology on behalf of the NHS.  I could see this was an uncomfortable truth for us both and awkwardly 🙄  I dismissed it as if it didn’t matter, but it had. It mattered  a lot that she did that and  I was so thankful.

There’s very little you can do for a stage 3 hamstring other than wait for it to heal, but the consultant  re-referred me to the Trauma Team and summoned the Occupational Therapist to assess my mobility needs.  My husband was dispatched to collect my medication 💊💊 and I began to relax to the point of sharing a joke, we’d mended the professional rift between us, order had been restored. We even shared a laugh 🤼‍♀️ about the need to provide me (at my age) with some assistance at home.

Then the OT arrived with a zimmer and raised toilet seat…………………………………

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Blue Brogues with pink lining. Chapter 6

When the telephone ☎️ rings early in the morning, in our house anyway,  it’s generally been sad news. So the call at 8am the morning after Ben, was answered in trepidation, but instead  it was good news! 😀   I had an appointment with an ultrasound scan at 1030. I was elated and immediately guilty  that I had been so disparaging of Ben.😢

In stark constrast to last Friday when my preparations included getting my nails done and wearing block heel boots. 👢This Friday, owing to the fall,  I had to wear my clown 🤡shoes; (my husbands name for them) ultra comfortable, flat brogues in bright blue leather with pink leather lining. Suitably adorned with sensible shoes,  👞 loose clothing and crutches under arm my husband drove me to our local hospital. The journey, only 7 minutes long, was excruciatingly painful.😬

Again like Frankenstein🧟‍♂️  I stumbled  into the department where the scan would take place while my husband parked the car.  Rather nervously I gave my details to the receptionist fearing that someone had made a prank call👅 ( Ben?) and I  had  in fact no appointment at all. But after a few tentative clicks 💻 of the computer she directed me to have a seat.💺 Now, as you know,  this is not an easy manoeuvre for me but my options were limited.  I sat, clinging to my crutches and with the walk in taking its toll, my distress 🤦‍♀️ was palpable.

A nurse 👩‍🔧 wandered past and, wowed by my shoes, she stopped in her tracks to admire them only then noticing at this point I was wincing in pain.  She swung into immediate Nurse Mode and got me onto a bed🛏 , thank you so much shoes!  She then went off to try to hurry my appointment on but advised me I was being seen by a consultant👩🏻‍⚕️  so  would have to wait.   I didn’t mind this, it gave me some comfort, although I nervously admitted to my husband I was worried they would not find anything wrong. I had lost all confidence in my own assessment of my condition.😟

When the Consultant  arrived he was brusque 😠 and I felt instantly guilty at being there. He slaggered gel across the front of my leg and asked me what happened. I regailed the story in summary.  “When were you in A&E ?”   “A week ago” I whimpered  and  fresh from the Ben experience felt again I was wasting his time. “And last night” I added . He asked me to flip over. ( like it was easy)  and slaggered more gel on the sore bit of my leg. “ They have asked me to scan the wrong part”  he seethed.  He seemed astonished 😱 at the discolouration on the injury site  and asked if I was in pain or unwell.  “Both”  I mumbled. He sighed and muttered under his breath and I caught “ it beggars belief”. “OK”  he said “get dressed.”  “Am I ok?” I enquired.  “ You have the worst hamstring injury I have ever seen.” 🤐

I have to admit I broke down in tears 😭 with relief at this statement. He outlined the size of the tear; width 5cms, the depth 6cms and length 18 cms accompanied by a massive  blood clot. He suggested I had lost a lot of blood 💉 and I should never have been sent home. He  summoned my husband into the room.  “Take her back to book her into A&E while I make this report personally”, he stated  “this  warrants it.” 🎉

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Strike #2 chapter 5

It’s never straightforward getting from A-B is it? The train ran  so late  we missed our lift. My husband organised a taxi to take me to the doctor then drive him to collect our grandkids👫.  The train had made us both late and stress 🤹‍♂️ levels were extremely high. The rabid dog 🐕 stuck  with me as we parted company for our respective appointments.

Naturally  the dog didn’t make it into my consultation but I was in some distress😢  by then and my  leg was swollen so badly I thought my jeans 👖 would need to be cut off.  The GP took one look at me and advised a second visit to A&E  🏩 for further investigation was necessary.

My poor husband was trying to make the kids their tea 🍱  when I summoned him back to my GP to transport me to A&E. He dispatched me rushing back to make sure the oven hadn’t incinerated the chicken nuggets.🔥

A&E was busy; I was informed at check in there would be a three hour wait. 3️⃣ OMG three hours…😩.  I grabbed a seat closest to the exit, but sitting down was just impossible. My containment of the rabid dog now manifested into  tears  😭 the pain, gnawing so much now, was unbearable, I was close to hysteria😜 .

Around me mayhem 👀 ensued, its hard to accept that everyone there was actually an emergency although I’m mindful of assumptions. Everyone appeared to contain their distress more than me, even kids. Some lovesick  👨‍❤️‍💋‍👨teenagers,  supported by their friends did well to conceal any obvious signs of ailment. 🤒  A number of kids in football ⚽️  attire  with blood stained 🤕 faces,  suggested  theirs hadn’t been  the friendliest  match, and numerous older people 👵🏼watched  every newcomer with nervous anticipation 🙀 that they might lose their turn.

After an hour I was called for triage where I was offered some pain relief 💊💊. With only a chair to sit in I was in major  discomfort. Once through the first tier, 🚑🚑🚑 3  ambulances arrived with more patients and I  was in this line waiting to move closer to a doctor.  Chaos didn’t seem to cover it.

Then it was my turn and we met Ben. 🧛🏻‍♂️ Ben is well versed in the habits of  hysterical women.  He has nice 🐝  manners. He has honed his bedside manner 🛏 to relax you.  He tried to establish what we really wanted as he noticed we had been at A&E  last week!  Isn’t it  tedious 🗂 these people who keep coming back?  “What do you need to happen?”  He was  acutely patronising 👺  and despite my GP referral it was evident he thought we were time wasting. “I need further investigation”  I sobbed 😪 “I need to be admitted to get the pain sorted”  But any idiot  🤪 could read the signs that was never going to happen.  Ben thought it appropriate to examine my leg  but he was perplexed.  As with his peers last week he didn’t know what was wrong. “I think you should go home and I’ll try to get a scan for next week”  he said washing his hands. “She needs pain relief”  said my husband, “ its 15p at Asda” he replied 🤫 smiling and  extending his  hand as he dismissed me. “ It was so  nice to see you in A&E.” It’s not a blinking holiday Ben!!!!!!

“I don’t think they believe me I wept” as I stuttered toward the car……………………..


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Rabid dogs and Frankenstein Chapter 4

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So one day into our Harrogate trip and it was evident it had been a big mistake ⚡️ coming here with my leg in such pain.  Although getting into  town was fairly easy,  I was walking like  Frankenstein 🧟‍♂️ and it was not a good look – I had to get rid of the crutches.

Shopping  🛍 and eating🍱  out are among my guilty pleasures in life, so sair leg or not  I wasn’t prepared to forgoe either,  and  the crutches weren’t going to hinder me so I ditched them. However by 2pm my leg was throbbing so the promise of  fine dining was deserted for a reduced price Tesco Egg 🥚 sandwich. This decision of course gained maximum kudos from my husband as it   saved him  money💷.    By some miracle I stumbled and hobbled my way back to the hotel clinging to lampposts and moaning incoherently like a jakey despite the lack or pleasure of any wine🍷!   I immediately launched myself into the bath when we returned and  I  noticed extensive  purple bruising had started to appear on my leg😈.

By Wednesday I couldn’t sit  at all so tried to book a train home a day early.  Although possible it was costly 🤑.  Pondering this  in light of the egg sandwich decision, I  considered we could wait one more day since we already had first class tickets 🚞and all the comforts and extras  those promised.  In a strange twist of fate the  hotel owner noticed I was in agony and shared that she had slipped in the kitchen a few years ago and ripped her hamstring in two.  She’d spent 6 days in hospital and it took 9 months to heal. How bloody awful I declared, ha little did I know!🤪

On Thursday we set off home,  and I made a Doctors appointment en route because the pain 💊💊 was now as bad as it had been when I fell. We boarded the on-time ⏰  first train to York  but our luck  🍀 didn’t last. Because of Storm Ali the previous days trains  had been cancelled and now our train was over 2 hours late,  burgeoned with extra  passengers  and  devoid of  any seats and refreshments.  🙀

By now I was I was barking and snarling like a rabid dog  👹 trying to contain the pain.  All the money I had saved did little to endear me in this state to my husband who was wishing this particular trip to Harrogate had never happened. He was unable to provide any meaningful assistance and his best efforts failed to return me to the even tempered puppy 🐶 he started out with.

When the train arrived every seat, suitcase and  corridor floor space in first class was occupied. Despite hobbling among the crowds trying to look needy to the very important businessmen they  avoided my gaze 👩‍💻, perhaps my best Frankenstein impression scared them off.  The offer of a seat was eventually  provided by an elderly lady 😇 who availed me of my misery as we hurtled toward Edinburgh and home and I took it 🤭 (forgive me).  I just  hoped our train would get in on time.

My husband loves travelling by train but he had no seat until Newcastle and we were delayed a further hour on route.  We had nothing to eat or drink until we arrived in Berwick and suddenly the loaves and five fishes 🐟  appeared in the guise of bacon 🐖 sandwiches for those of us brave enough to be travelling on to Scotland 🏴󠁧󠁢󠁳󠁣󠁴󠁿. Not long now until I saw the doctor and all my problems would be resolved. I was salivating 🤤  like Pavlov’s dog at the thought of that ….




Harrogate, really? Chapter 3

Have you ever been to Harrogate? It’s a beautiful market town near York🌇. I’ve been loads and love the shopping and eateries there.   My husband has never been, so as a treat I booked us a trip there 😳. Except it was for the Monday after the fall and this was now a dilemma because I was in a lot of pain and had  to get around on crutches.  What ever we did  it was not going to be the romantic ❤️ few days we had planned.

Romance?  I know I’m no spring chicken 🐓 but I do still hamper for time alone with my man; enjoying some wine, 🍷 deep and meaningful chats and wandering aimlessly around the streets 👫 exploring. As a model its worked for us for about 36 years.  Now some of you maybe shouting GET a ROOM or more likely wondering how the heck we’ve survived this long with that approach?  Thankfully we did take marriage vows 💑 because  “in sickness and in health” was about to become the single most important commitment in our history.  Romance on this trip, sadly, would  not have a look in.

So until our departure I rested looking at the ceiling.  Rest you see felt  necessary but really we had no idea that anything serious was afoot.  We couldn’t cancel ⛔️ our hotel or the train (note to self make sure you take the cancellation offer next time Doh!). So bravely I took the decision to go, it was only for three days after all and I had crutches.✅  This behaviour  is so like me, just grit your teeth and get on with it……..

On Monday we took a taxi to the station but the train to Edinburgh was cancelled. This was a sign surely ! (you canny make this up) Nope! instead of giving up we took a taxi 🚕 to make the 1030am train otherwise the ticket was invalid. There I was rocking back and forth trying to finesse  my swing action on these blooming crutches across Waverley to try to catch our train. The pain caused just by sitting in the taxi was already a sign this was a mistake but it was something else that determined that something was wrong.🤦‍♀️

We booked first class but our ‘lucky white heather’ 🌾  run wasn’t over quite yet. The cookers  were broken so they only had prawn cocktail sandwiches on offer 🍤 I cannot eat wet fish on bread. So I starved.  Although I must admit the  co-codamol  I was taking for the pain had  already killed my appetite. At least the seating arrangements brought me some comfort. 💺

Our good luck continued… we were late into York and missed our Harrogate connection. 😧After an hour or so waiting we were finally transported to our  final destination the Ascot Hotel.🏣  This is a lovely, small,  family run hotel on the edge of the town, so under normal circumstances would have been  well placed for our trip.  Harrogate is also a small town, you can navigate it all quite easily, but not on crutches which, incidentally  I didn’t add to my trip advisor reviews.🏆

On our first night we stopped at a hostelry and ordered a soft drink. I couldn’t face alcohol but to be sociable I later agreed to a wine. This should have been a big sign to me something was very wrong, because I couldn’t drink the wine. For those who know me, I will repeat this I could not drink the wine.  🍷🍷🍷

That was the moment I realised  something was very wrong!!

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Strike #1 Chapter 2

I don’t do public shows of distress (PSD). So when I  fell in spectacular fashion on St Andrews Square in Edinburgh, I was mortified when passers🚶‍♂️ by  rushed to my aid because, as I said before, I was howling 😭.  I had only one thing on my mind; I wanted to get to Bon Vivant and have my lunch🥗 🍷!

My body (not to mention my hair and make-up), however  had other ideas.  No sooner had I clambered back to my feet 👏 when I passed out 🌀 and was flat on my back again. This led to a growing number of spectators 👀 to summon an ambulance🚑.  Not me, I was against this from the start  and  quickly requested they cancel it. After all it was just a fall……..wasn’t it?  🌚

And in any case our bodies are pretty amazing.  Firstly,  despite the pain, my brain 🧠 status  automatically slipped to organise.  I was issuing instructions, handing my phone 📱 over to “ let the restaurant know we are not coming” and   “ let my husband know?”.  I noticed the latter caused quite a stir 🙀in the crowd; was this man with me not my husband?? I could see they were looking at each other trying to figure it out. (Although why I was even aware of these subtleties I have no idea!)

Secondly, however  it was the physical reaction 🤢that led me to take the sensible decision and go to hospital. Shock was screaming  at me very loudly through waves of nausea, violent shaking and spinning horizons.  ( Not due to alcohol consumption, honestly 🍹).  Not wanting to avail the Scottish Ambulance Service of their time for some silly 🤡 middle aged woman wearing the wrong footwear, the staff at Dishoom kindly  summoned a taxi 🚕to take my colleague and I to the Royal Infirmary in Edinburgh. (Bet they thought he was my husband too 🤫).

Despite my best contortions and effort to describe this accident🙇‍♀️ and pain, and an x-ray suggesting nothing was broken,  (although I felt I already knew that) the staff could not identify what ailed me. My left hamstring was on fire 🔥, I had excruciating pain when seated,💺 there was an agonising pain in both my pubic bone and the exterior of the left thigh between the hip and the knee. I was agitated because of the pain 🤦‍♀️and it was about 4 hours before they were able to get it under control. Only then could I allow them to touch my  leg.

After much deliberation the Doctors advised me I was a bit of a conundrum (nice😷),  they thought I’d likely have some bruising from this bad fall.  They agreed I could go home if I was able to use the crutches on offer.

So I did; I went home, not the least bit clear on what was wrong. I did have information that the trauma team would be in touch over the next few days but had no real advice on what to do.

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All fine, yep,   but what about our trip to Harrogate on Monday????