Upon knowing that Nana had probably fractured her ankle again, Daddy Lim had decided to turn private this time. Uncle C had previously recommended a friend who specialises in children orthopaedic and had just turned private. We didn't take up the offer then, bcos Nana looked like she was healing well and just needed time.
This time, we didn't want to take chances. We wanted and needed to find out what happened. We connected with the specialist while we were still in Bali, and arranged for an appointment on Thursday morning. To maximise possibility of insurance coverage, we also did a Whitecoat tele-consultation to get a referral letter.
Daddy Lim was on leave on Thursday. I tagged along for the appointment, eagered to hear the diagnosis and rushing work in between. The clinic is in Mt Alvernia hospital.
Dr Lam is a kids' doctor afterall. Nana looked very out of place. Lol.
We have communicated with Dr Lam while in Bali. Based on the x-ray taken in Bali, he said that there appeared to be some displacement, meaning that the ankle/ bone has shifted. In cases like that, a surgery is likely. Back in mid April 23, the NUH doctor said that Nana had a bad fracture and a case that borderlines between cast and surgery. The doctor eventually decided to treat her conservatively and put her in a cast.
We took the opportunity to ask about why it happened, the pros and cons of a surgery, if there is anything else wrong with her (bones), aftercare, etc. Dr Lam patiently answered all our questions. We gave him consent and he was able to access to all of Nana's previous x-rays from NUH. He doesn't think that there is anything else wrong with Nana (bone), given that it is her 1st and only fracture so far.
He compared Nana's last x-ray from NUH (back in mid Jul 23) and noted that the displacement had already existed. He suspected that the bone moved while healing. Given so, it isn't the recent injury that had displaced the ankle and he now opined that it is a 50-50 between surgery and cast. Surgery gives more certainly in correcting the fracture but comes with its risk as it is invasive. When he showed us the last NUH x-ray (Jul 23), I was very surprised to see that the fracture line was actually still very visible. Back at the last NUH appointment, I was also shown the (same?) x-ray, but I couldn't make sense of it, didn't know where to look for the "line'. I was simply told that the line was still visible but faint and would further fade with time. I didn't know that it was so obvious. We probably would have taken more care if we had known.
Nana was sent for another x-ray. Daddy Lim probably discussed with her and when they came back, she was sure that she wanted a surgery. It is the belief that a surgery will fix things properly, better and faster. Ya, we are all sick and tired of her paika-ness.
Dr Lam looked at her latest x-ray and commented that the displacement looks the same, meaning no further shifting from the recent injury. He then went on to comment that the ends of the bone had started to grow and heal. It also means that she didn't fracture (break) her bone totally this time - it was a through fracture back in April 23.
After toggling with the many x-rays (she has many), including the earlier ones and in different angles, Dr Lam suddenly commented on one of the initial x-rays that the displacement was actually visible at the onset. However, it was small at 2mm and probably why the doctor decided on a conservative treatment. With that, and the fact that the ends of the bone has started to heal/ grow, Dr Lam now feels that we should give the bone another chance and time to heal. We could still opt for surgery but he would have to break and clean the already grown bone to set things proper. This means more trauma to the bone and not the most recommended option.
So, we were eventually sent home. There is no need for any plaster cast but to use back her aircast. The aircast needs to be on 24/7 except for showers, with the intention to immobolise the ankle as much as possible. Heng, I didn't throw the aircast. I was already contemplating.
Her foot is still very swollen.
This is Nana's latest x-ray. She is to come back 1 month later for the review.
So what the doctor though happened was that her bone was healing but not fully healed. Then, with the months of non-usage of her right leg, her muscles have not built back, though she has started exercising recently and even managed a 2km run on the treadmill. When she landed awkwardly, her muscles weren't strong enough to hold her and thus twisted her poor ankle again and refracture. Is it a new fracture? No. Did she refracture her ankle? That was the term that the doctor used.
She is likely to be in cast for another 2 to 3 months with no weight. There goes our snowboarding holiday. Fortunately, the snowboarding host is very accommodating and allowed us to shorten the snowboarding trip. Nana will be confined to the lodge when we do snowboarding. Daddy Lim had asked her to build snowman in front of the lodge or sing Christmas carols. We joked about returning from the snowboarding lesson to an army of snowman in front of the lodge. Lol.
We also tried claiming the travel insurance. I live-chat with the customer service and was told that the travel insurance would cover for medical expenses related to accidents up to 30 days after the trip. Fortunately, I had the foresight to obtain a referral letter via Whitecoat bcos that was exactly what was asked for. Thereafter, I will just have to try whatever is claimable from my company's insurance, which will be minimal bcos it is a non-panel specialist. We will find out in 10 days if the claim goes through.
Speedy recovery Nana. Let's pray that she will at least be off cast when we go to Japan. All holidays are good, cast or no cast, wheelchair or not, we will have fun.
Mummy Lim
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