ACC and Accelerated Decrepitude

““You are old,” said the youth, “As I mentioned before,
And have grown most uncommonly fat;
Yet you turned a back-somersault in at the door—
Pray, what is the reason of that?”

““In my youth,” said the sage, as he shook his grey locks,
“I kept all my limbs very supple
By the use of this ointment—one shilling the box—
Allow me to sell you a couple?”

“You Are Old, Father William from Alice’s Adventures in Wonderland By Lewis Carroll”

You would be forgiven for thinking you were in Carroll’s Wonderland reading this story of a 40-year-old woman who injured her ankle and partially tore her achilles tendon. She thought she had only sprained her ankle but, when it had not healed four weeks later, she sought medical help. Unfortunately the doctor initially thought she had only a tendinitis (an easy mistake as a partial tear by that stage would have produced a very inflamed tendon). Subsequent to this, she has had a scan, which showed an tear in the tendon, and multiple orthopaedic opinions, all of whom say that this is a traumatic condition. ACC have ignored everything but the initial consultation and the opinion of their “tame” specialist and say that this clearly traumatic condition is degenerative. In a 40 year old woman with no previous history of problems in her ankle. Perhaps she should have bought a box of Father William’s ointment.

This is not new. ACC have been denying soft tissue (non-bony injury) claims routinely, saying they are all degenerative. I currently have a less-than-30-year-old on my books with a “degenerative” back condition that miraculously appeared when s/he fell off a ladder. (Traumatic event has been altered in that last sentence to avoid identifying my patient – event was of similar level of trauma). None of this is surprising. ACC consist of insurance assessors with minimal medical knowledge. They have been trained only to pick up buzzwords like “tendinitis”, “arthritis” and “degeneration” – words which trigger  a quick trip to a semi-retired orthopaedic surgeon who has outdated opinions and a clear bias towards ACC, who are his meal-ticket. Instant degenerative change.

Unfortunately, degenerative change is by no means limited to old age or even overuse (as in sport). Trauma itself precipitates degenerative changes – often very rapidly. By the time a slipped disc in the lower back gets to an orthopaedic surgeon and an MRI (6-8 weeks down the track, commonly), there is already likely to be wear on the damaged disc (which is in a non-anatomical position) and wasting of the lumbar muscles. By the time everything is fixed, some people will not be able to recover core lumbar strength sufficiently producing ongoing pain and further degeneration. The same progress can be seen in knee and ankle injuries and in shoulder injuries. Trauma causes degeneration.

Even if there is some degenerative change already, it is complete nonsense to suggest that this is causing the problem after a traumatic event. Take the example of an older lady with arthritic knees. She is fully mobile and takes the odd paracetamol for her occasionally painful knee. She trips over her cat and injures her knee. The doctor finds a torn cartilage. ACC are quite likely to suggest that this is “degenerative” despite the clear link to a traumatic event. They will point to osteoarthritic changes on her knee X-ray to “prove” their point. In the intervening months while they wrangle, the older lady is unable to walk. She moves into an old age home. ACC finally relent and allow the surgery to go ahead, but it is too late. This elderly lady is never fully rehabilitated, remains in the nursing home and dies a year later from pneumonia. I have changed some details here, but this is essentially a true story.

Trauma accelerates degeneration. The sooner ACC learn this, the better. Anything that ACC does not accept will wind up in the public health service  - being paid for by the exact same tax dollars that pay for ACC. Therefore, I fail to see how persisting with this myth of degenerative disease benefits the country in any way, let alone individual patients.

Note to all patients declined by ACC: Gather all your information and supporting letters from doctors and take your claim straight to the disputes tribunal. You have only a small window in which you can do this free of charge, after that you have to make a formal legal claim, which is expensive. Most patients make the mistake of waiting for months before disputing the decision. Do it straight away.

““You are old, Father William,” the young man said,
“And your hair has become very white;
And yet you incessantly stand on your head—
Do you think, at your age, it is right?”

““In my youth,” Father William replied to his son,
“I feared it might injure the brain;
But now that I’m perfectly sure I have none,
Why, I do it again and again.””

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