Lets Talk Surgery

[acklac7]

I wouldn't go to a podiatrist for anything but a corn or ingrown toenail or plantar fasciitis.

 

Seriously? :no:

 

Why no on Podiatrist? Do they not focus on Surgery as heavily on Surgery's in Medical School?

 

Don't take this the wrong way, I have every bit of respect for your opinion, but what makes the Doctors you mentioned so special over a General podiatrist?

[zeitgeist57]

Having been in a relationship with a girl that went to OCPM in Cleveland, and now having two brothers-in-law that are ortho surgeons at NASH, I agree that podiatrists are good for everything up to serious foot-and-ankle surgery dealing with tendons, ligaments, bones, joints, and injuries to any of those four.

 

My $0.02...my podiatrist gf was great at getting me fire-beetle extract for a wart I had on the sole of my foot. :\ Thaaaaaaaaaats about it.

[acklac7]

Said Podiatrist, looks like he does more then just superficial foot care? Dude is a great Doc/Great guy. Seriously everything about him is A+. That said, after reading this thread im definitely getting a second opinion.

 

http://wexnermedical.osu.edu/patient-care/find-a-doctor/michael-anthony-dpm-42842

[kshymkiw83]

Seriously? :no:

 

Why no on Podiatrist? Do they not focus on Surgery as heavily on Surgery's in Medical School?

 

Don't take this the wrong way, I have every bit of respect for your opinion, but what makes the Doctors you mentioned so special over a General podiatrist?

 

I got the same response from my other general surgeons and doctors when I told them I was going to a Podiatrist. Most general doctors from my experience tend to think of them as being like Chiropractors. Just what I saw with my specific issues.

 

That being said - All professional athletic teams have Podiatrists on staff for Foot/Ankle injuries of all kinds. My podiatrist does surgery for the Semi-Pro Hockey Team up here in Alaska, and also the college hockey teams. She was one of the few who said she could do it without hardware - which was my big thing. Most wanted bone anchors in my ankle and other stuff.

 

YMMV - but this is why I would always say get at least 3 opinions with one of them being a specialist in the body part/area you are having surgery on. You wouldn't go to a general surgeon for brain surgery, now would you?

[kshymkiw83]

Kevin,

 

I'm sorry your wife is in pain. Unfortunately, most people don't truly understand what the role of the surgeon is these days. It is illegal and dangerous for a surgeon to treat chronic pain with pain medication. Plain and simple. I never prescribe fentanyl. I could lose my license. The job of the surgeon is to physically correct deformities (be it chronic or acute), treat degenerative and acute issues with modification to one's anatomy, and surgically fix injuries. Be it a broken femur, cancer, knee arthritis, a hernia, or stabbing victim.

 

I don't treat high blood pressure, depression, and chronic pain with medication. It just doesn't make sense to do so.

 

I understand. I guess I was trying to state that when doctors assume someone who says they have a high pain tolerance actually doesn't it can hurt the patient to some degree. My wife has had the same surgeon for her orthopedic issues for 16 years now. In fact other surgeons and doctors will flat out refuse to see or touch her.

 

FWIW - she sees Dr. Dror Paley - http://www.paleyinstitute.org/ He is the best, in my opinion, Orthpedic/Deformity correction surgeon in the world. I would say the simple fact he has treated patients, and has people traveling from almost every country on the planet to see him supports this.

 

Perhaps you missed the part of my response where I indicated if someone has a difficult problem (like your ankle),I will almost always recommend another opinion---even if the patient insists they want me to do their surgery right away. When someone sees me in the office they are usually referred by a close family friend who I have fixed, or their family physician. My work speaks for itself in my small town, where word of mouth is everything. If I offer them surgery for a simple problem and they want another opinion, that's fine. What is annoying is if they schedule surgery, and cancel at the last second because they want another opinion. Sounds harsh, but when surgical time is billed by the minute, it is what it is.

 

Honestly - according to my Podiatrist it is a simple surgery - just one that general surgeons don't often do. She did my ankle and plantar fasciotomy in less than 2 hours. I would never suggest anyone get the plantar surgery....it is an absolute waste.

 

I agree canceling at the last second is bush league. That would frustrate the living hell out of me. I also think though a lot of people feel a pressure when in the doctors office to make the decision that very moment. Most doctors from what I have seen with my wife and myself, present 1 side to the story. They don't often say "Well if you put it off for a year it won't hurt anything". It is always lets fix it now. I think this leads to people prematurely committing to surgical procedures, or other procedures in general.

 

I'm not in sales--am not selling anything, and don't need to convince people to go under the knife. With insurance companies being so strict about covering surgery, by the time my patients are cleared for surgery, they are dying to get it done. Not being arrogant, it's just how it is, and it's concerning.

 

I don't know how I feel about your response here, TBH. I have never had any issue scheduling a surgical procedure for my wife, or my procedure. I think medicine as a whole is kind of a sales pitch, to some degree. Yes it is your health, and life, but at the same time if people aren't going to the doctor, or getting procedures done then we don't need as many doctors and surgeons.

 

From what I recall this is always one of the arguments to things like Single Payer Health System, etc... Is that doctors don't want to practice, because they make a fixed amount or less than they do in an insurance driven market.

 

With regards to your ankle, I can't remember the last time i told a patient "we will just have to see when we get in there". That's what we call a john Wayne procedure and they are almost always unsuccessful. You know John wayne used to ride into town, not knowing what the problem is, but take care of business once you're there??? Doesn't work that way. Let me know if you want the name of the best foot/ankle surgeon in town. Sounds like you've gotten 7 opinions that are less than acceptable.

 

I was told because it was "soft tissue" that X-Ray and MRI weren't entirely clear what was wrong. It "looked" like the tendon and ligaments had torn, but it was hard to tell for sure. I would say on my wives surgery as well this has been the case. Her Ortho doc will just start "doing his thing" once he gets in there. I realize it isn't optimal, and not the ideal thing to do, but it is done quite frequently in medicine.

 

Doctors every day are taking educated guesses at what is wrong...and when it doesn't work they try the next most logical thing. This is why people unfortunately die in medical care, because they don't assume it is this super rare/uncommon condition, and are treating based on probability. Medical places/Doctors get sued every day for refusing to run the proper tests because they cost to much, etc....

[kirks5oh]

Seriously? :no:

 

Why no on Podiatrist? Do they not focus on Surgery as heavily on Surgery's in Medical School?

 

Don't take this the wrong way, I have every bit of respect for your opinion, but what makes the Doctors you mentioned so special over a General podiatrist?

 

I don't think you can learn enough in podiatry school and with the scope of their practice, to have a mastery of complex foot and ankle procedures.

 

Say you get ankle surgery and it becomes infected, necessitating emergency admission to the hospital and emergency washout surgery on the ankle---the podiatrist doesn't admit you to the hospital because they don't take call. Nor do they do emergency surgery. So they don't see enough of what can go wrong.

 

For bunions? Maybe. Some podiatrists do ankle replacements and complex fusion procedures which is nuts, if you ask me.

[kirks5oh]

I understand. I guess I was trying to state that when doctors assume someone who says they have a high pain tolerance actually doesn't it can hurt the patient to some degree. My wife has had the same surgeon for her orthopedic issues for 16 years now. In fact other surgeons and doctors will flat out refuse to see or touch her.

 

FWIW - she sees Dr. Dror Paley - http://www.paleyinstitute.org/ He is the best, in my opinion, Orthpedic/Deformity correction surgeon in the world. I would say the simple fact he has treated patients, and has people traveling from almost every country on the planet to see him supports this.

 

 

 

Honestly - according to my Podiatrist it is a simple surgery - just one that general surgeons don't often do. She did my ankle and plantar fasciotomy in less than 2 hours. I would never suggest anyone get the plantar surgery....it is an absolute waste.

 

I agree canceling at the last second is bush league. That would frustrate the living hell out of me. I also think though a lot of people feel a pressure when in the doctors office to make the decision that very moment. Most doctors from what I have seen with my wife and myself, present 1 side to the story. They don't often say "Well if you put it off for a year it won't hurt anything". It is always lets fix it now. I think this leads to people prematurely committing to surgical procedures, or other procedures in general.

 

 

 

I don't know how I feel about your response here, TBH. I have never had any issue scheduling a surgical procedure for my wife, or my procedure. I think medicine as a whole is kind of a sales pitch, to some degree. Yes it is your health, and life, but at the same time if people aren't going to the doctor, or getting procedures done then we don't need as many doctors and surgeons.

 

From what I recall this is always one of the arguments to things like Single Payer Health System, etc... Is that doctors don't want to practice, because they make a fixed amount or less than they do in an insurance driven market.

 

 

 

I was told because it was "soft tissue" that X-Ray and MRI weren't entirely clear what was wrong. It "looked" like the tendon and ligaments had torn, but it was hard to tell for sure. I would say on my wives surgery as well this has been the case. Her Ortho doc will just start "doing his thing" once he gets in there. I realize it isn't optimal, and not the ideal thing to do, but it is done quite frequently in medicine.

 

Doctors every day are taking educated guesses at what is wrong...and when it doesn't work they try the next most logical thing. This is why people unfortunately die in medical care, because they don't assume it is this super rare/uncommon condition, and are treating based on probability. Medical places/Doctors get sued every day for refusing to run the proper tests because they cost to much, etc....

 

Part of being a physician is listening to patients and having compassion. It's also important not to have people prey on that compassion. That doesn't mean ignoring pain.

Limb correction surgery is not an exact science, and yes, there is some improvisation during the surgery. There are very few situations in elective orthopedic surgery where this is the case. Orthopedic oncology is one such situation where there is always improvising.

 

I've never seen a plantar fasciotomy. Crazy, that someone would do that.

 

When I'm scheduling surgeries, if it needs to be done ASAP, and the patient wants it, we schedule it. Most of the time my scheduler gives the patient all the available options, and the patient calls back to schedule. It eliminates any pressure.

 

People will always go to the doctor. And with all the bs coming down the pipeline, physicians will be at a shortage. Supply/demand. And with the American public being more and more unhealthy........

 

I simply don't agree with a physician telling a patient "I'll take care of it when I get in there". For a non-straight forward case---a revision, I will tell the patient each of the five scenarios, and the most likely one. This is the 90% plan. If I'm not 90% certain what I will find during surgery, I haven't run enough tests to know what is wrong. Patients don't like surprises when they wake up from surgery. And docs over-order tests to cover their asses---you have it backwards. That drives up the cost of healthcare. I can tell you what the MRI will say in most cases before I order it. But most insurance companies won't approve certain surgeries without an MRI.

[sol740]

I don't see appendicitis being treated with antibiotics successfully, due to the fact most people don't realize they have it until it's about to rupture. And that is the most common general surgical procedure done. 7% of the population gets their appendix removed at some point in their life. Most surgeons have elective practices and take call for emergency purposes---they don't need the revenue from call to earn a living--that is my practice. I do 500 elective surgeries a year, and maybe 25-30 emergency ones. I don't mind call, but some people hate it. It doesn't pay the bills, and potentially keeps you up all night and ruins the next day's elective office or surgeries. But it's part of the job and a valued responsibility. some of these 25-30 patients don't have insurance, and no means to pay for services rendered. Doesn't bother me one bit---they get the Mercedes Benz, 110% effort every time. What does bother me is when some of these patients can be the most demanding, and least thankful. Quickest to get irritated when they have to wait in the office, etc.

 

Don't get me wrong, I'm not complaining about the surgery, or my care, or positing that my doctors purposefully steered me towards an unnecessary surgery. Clearly with the pain I was in there was fear of a possible rupture. It was just humorous that a story ran about appendicitis, as I'm recovering, likey in relation to the link below.

 

http://www.m.webmd.com/a-to-z-guides/news/20150616/appendicitis-can-often-be-treated-with-antibiotics

[kirks5oh]

Don't get me wrong, I'm not complaining about the surgery, or my care, or positing that my doctors purposefully steered me towards an unnecessary surgery. Clearly with the pain I was in there was fear of a possible rupture. It was just humorous that a story ran about appendicitis, as I'm recovering, likey in relation to the link below.

 

http://www.m.webmd.com/a-to-z-guides/news/20150616/appendicitis-can-often-be-treated-with-antibiotics

 

yeah, that would be kind of funny to see that article. appendicitis is often the diagnosis of exclusion, and the appendix ends up getting removed too often. full blown appendicitis, is a surgical condition, and it always will be. sometimes people have vague right lower quadrant pain, a CT scan is ordered, and the radiologist reads the appendix as 'abnormal'---these people currently get their appendix removed, but may be candidates for antibiotic treatment. when you're in there in surgery, the appendix looks ok, but you remove it anyways because you don't know if it is truly inflamed or not--the CT scan simply shows its thicker than what you would expect

 

a full-blown case of appendicits on the verge of rupturing is a different story.

[evan9381]

That is a nasty fx. Looks like they did a great job fixing it. Unfortunately, it could be a year until you're running again. Hopefully much less. But I've seen people still limping at 6 months. Sounds like you're ahead of schedule on your recovery. I'm assuming a serious fall caused that. Snowboarding or skiing, fall off a ladder, or car accident. That is one of the toughest fractures to fix in a young patient.

 

Pretty much. Was 65 degrees here on Christmas eve, so I decided to go out for a short bike ride. Hit a slick spot on a wooden bridge, rear tire slipped out, and down I went on the concrete part right after it. I was chatting with the surgeon about previous surgeries, including my wrist (and about how you referred me to Bickel a few years back) he said he knew you, and I can't remember if he said your brother or your dad...I was pretty high at the time. Richard Fankhauser was the surgeon though. He's been great. He said 2 months to be back to normal, and with the progress I've made in just under 4 weeks, I'm hoping that's realistic. I'm not a runner, but I'm hoping the low impact of cycling will be easy to get back into. Already got a stationary bike (per his recommendation) and it's helping with getting movement into my legs and loosening up the muscles a bit.

[gillbot]

Some people have an extremely high pain tolerance. Sometimes it's a younger guy. 90% of the time, in my experience, it's an older lady. I've done knee replacements on them, and seen them take nothing more than Tylenol. Blows my mind.

 

I had three surgeries in the past year, all three had me on Percocet for the first week or so, then I went to Tylenol for the next week, then nothing after that.

 

I had a Resection of Haglunds Deformity performed and was on Percocet for a couple days, then nothing. I was back on my feet months before the doctor expected me to be. Unfortunately it still bothers me, not faulting the surgeon at all as he's highly recommended. I just kept delaying the surgery for nearly three years past when he recommended having it done and I think I pushed myself back on my feet too soon due to lack of pain.

[kirks5oh]

I had three surgeries in the past year, all three had me on Percocet for the first week or so, then I went to Tylenol for the next week, then nothing after that.

 

I had a Resection of Haglunds Deformity performed and was on Percocet for a couple days, then nothing. I was back on my feet months before the doctor expected me to be. Unfortunately it still bothers me, not faulting the surgeon at all as he's highly recommended. I just kept delaying the surgery for nearly three years past when he recommended having it done and I think I pushed myself back on my feet too soon due to lack of pain.

 

A knee replacement has a way of humbling someone like no other surgery. Most people are on narcotics to some degree for 6 weeks. Even completely reasonable people may need occasional narcotics at 3 months. It's that painful.

[kirks5oh]

Pretty much. Was 65 degrees here on Christmas eve, so I decided to go out for a short bike ride. Hit a slick spot on a wooden bridge, rear tire slipped out, and down I went on the concrete part right after it. I was chatting with the surgeon about previous surgeries, including my wrist (and about how you referred me to Bickel a few years back) he said he knew you, and I can't remember if he said your brother or your dad...I was pretty high at the time. Richard Fankhauser was the surgeon though. He's been great. He said 2 months to be back to normal, and with the progress I've made in just under 4 weeks, I'm hoping that's realistic. I'm not a runner, but I'm hoping the low impact of cycling will be easy to get back into. Already got a stationary bike (per his recommendation) and it's helping with getting movement into my legs and loosening up the muscles a bit.

 

Fank is a great guy. He trained both me and my brother, and Brent Bickel. Sounds like you're way ahead of schedule. Keep up the good work.

[DKilbourne]

Jonathan feibel and Robert gorseline

 

 

Lee and berlet do a good job too, but are very aggressive with surgery. I wouldn't go to a podiatrist for anything but a corn or ingrown toenail or plantar fasciitis.

 

Gorsline is in hilliard on true man court....ask me how I know. GREAT surgeon and guy.

[DKilbourne]

Pretty much. Was 65 degrees here on Christmas eve, so I decided to go out for a short bike ride. Hit a slick spot on a wooden bridge, rear tire slipped out, and down I went on the concrete part right after it. I was chatting with the surgeon about previous surgeries, including my wrist (and about how you referred me to Bickel a few years back) he said he knew you, and I can't remember if he said your brother or your dad...I was pretty high at the time. Richard Fankhauser was the surgeon though. He's been great. He said 2 months to be back to normal, and with the progress I've made in just under 4 weeks, I'm hoping that's realistic. I'm not a runner, but I'm hoping the low impact of cycling will be easy to get back into. Already got a stationary bike (per his recommendation) and it's helping with getting movement into my legs and loosening up the muscles a bit.

 

Bickell aka Dane cook....haha. he and Martin did my 2nd biceps tendon surgery and cubital tunnel. I've seen a few of these guys....most recently Milan Herceg for my back. One of the best at shooting you straight and being a solid guy. Can someone hurry up and get an elbow replacement for me already!!!

[evan9381]

Bickell aka Dane cook....haha. he and Martin did my 2nd biceps tendon surgery and cubital tunnel. I've seen a few of these guys....most recently Milan Herceg for my back. One of the best at shooting you straight and being a solid guy. Can someone hurry up and get an elbow replacement for me already!!!

 

Bickel was awesome. To this day if someone I know has some sort of hand/wrist injury, I make sure to put his name out there. I really liked dealing with him.

[DKilbourne]

Bickel was awesome. To this day if someone I know has some sort of hand/wrist injury, I make sure to put his name out there. I really liked dealing with him.

 

He, like the other docs I have dealt with, shoot it straight. If Ben Roethlisberger and Dane Cook had a baby....it would be him. He is just WAY smarter and a surgeon

He helped me with some nasty issues from my 1st biceps tendon surgery. He and martin, that is.

[gillbot]

A knee replacement has a way of humbling someone like no other surgery. Most people are on narcotics to some degree for 6 weeks. Even completely reasonable people may need occasional narcotics at 3 months. It's that painful.

 

I don't doubt that at all. I have plenty enough metal in me holding shit together, prefer not to add to the list.

[Mace1647545504]

The only advice I have is DO NOT USE orthro nuero..the surgeon f'ed up my hand the lied in his followup paperwork. Then at a party spoke to a nusre talking about a doc and what a scammer he is i asked a question what practice?? Guess what ortho nuero

mace

[DKilbourne]

A knee replacement has a way of humbling someone like no other surgery. Most people are on narcotics to some degree for 6 weeks. Even completely reasonable people may need occasional narcotics at 3 months. It's that painful.

 

I will trade 3 months of pain for relief of my knee pain now.....Martin said if I was older it would have been done already. Sucks, but after having it for so long you just deal with the pain.

[BStowers023]

Do you recall your timeframe to be walking without any assistance? I was on crutches for 3 weeks, and working on transitioning to a cane for 3-4 days now...I just can't do it for long distances. Also, how long has it been, and are you back to where you were before the injury, or are you limited in some things/still feel it in there?

 

Not a common injury, like a broken arm or something, so I haven't found too many people to ask.

 

Sorry for the late response, I just saw this. Well, I also broke my Tibia as well along with tearing my MCL and Meniscus. So my injury was delayed a bit. I was non weight bearing for 8 weeks, and I was walking without assistance by about 4 months out. I'm currently 9 months out right now and I'm pretty close to where I was before. I can run but I'm not as athletic or strong as I was. I'm guessing that will just come with time.

[evan9381]

Sorry for the late response, I just saw this. Well, I also broke my Tibia as well along with tearing my MCL and Meniscus. So my injury was delayed a bit. I was non weight bearing for 8 weeks, and I was walking without assistance by about 4 months out. I'm currently 9 months out right now and I'm pretty close to where I was before. I can run but I'm not as athletic or strong as I was. I'm guessing that will just come with time.

 

oh shit. yeah, that's a bit worse. this weekend I realized I can walk unassisted for short distances (around the house), but it's with a pretty bad limp. BUT, being where I am ~4 weeks out and knowing how much pain I was in right after surgery, I'd say it's getting better quicker than I could've imagined.

 

Thanks for the response. Hope your healing goes well.

[DKilbourne]

oh shit. yeah, that's a bit worse. this weekend I realized I can walk unassisted for short distances (around the house), but it's with a pretty bad limp. BUT, being where I am ~4 weeks out and knowing how much pain I was in right after surgery, I'd say it's getting better quicker than I could've imagined.

 

Thanks for the response. Hope your healing goes well.

 

One day at a time. Good to hear that you are progressing well.

[acklac7]

I don't think you can learn enough in podiatry school and with the scope of their practice, to have a mastery of complex foot and ankle procedures.

 

Say you get ankle surgery and it becomes infected, necessitating emergency admission to the hospital and emergency washout surgery on the ankle---the podiatrist doesn't admit you to the hospital because they don't take call. Nor do they do emergency surgery. So they don't see enough of what can go wrong.

 

For bunions? Maybe. Some podiatrists do ankle replacements and complex fusion procedures which is nuts, if you ask me.

 

Kirk, no offense, but I forwarded a few of your comments to my Podiatrist, here is his response:

 

Hey AJ,

 

That's quite all right. No one should go to surgery without having questions.

 

As far as this procedure goes, I would say I have done hundreds in my career with many more scheduled to be addressed in the near future. I have and do deal with people with CMT as I deal with foot and ankle issues which those with CMT develop.

 

As far as your buddy Surgeon goes, as a Podiatrist our focus is the foot and ankle, anything below the knee. With that, we are foot and ankle surgeons. A good portion of my practice involves surgery/fusions. I have surgical cases every Monday so I better have a pretty good Idea behind surgery/fusions as that's a good portion of what we do. Where as an orthopedic spends their residency learning all of general orthopedics (hand, spine, joint, oncology, ect...), the orthopedic foot and ankle specialist just does a year of fellowship in their specialty to learn their trade. Our three year residency is focused primarily on foot and ankle surgery so I'd say our training is more then sufficient. But with anything, there are good physicians and bad, that's with any specialty.

 

 

At any rate I decided I really couldn't trust a Dr. that I'd met just once to do a procedure on my foot. I've known Dr. Anthony for three years; he was initially my Dads podiatrist, then became my podiatrist once it became evident I was going down the same path as my Father (CMT).

 

Honestly, we're on a first-name basis, I don't even call him Dr. anymore (his preference). I fully trust any and all procedures he recommends/preforms. I just couldn't gain that much trust for someone i'd met once.

Edited February 24, 2016 by acklac7

[acklac7]

Now, on to the Surgery.

 

Had Surgery last Monday; everything went great, until the nerve-block weared off, then HOLY-FUCK... PAINNN!

 

Gulping down Percoset pain.

 

Like someone standing infront of you Sawing off your toes pain (no shit).

 

Nothing like feeling wires and screws thoroughly penetrating every inch of your toes/fore-ankle, fucking blissful experience that was.

 

FOR THE RECORD (And I wish someone told me this earlier, perhaps they did, sorry if I missed it) The first three Days are horrid; after that things improve exponentially. 8 Days later and I don't even need over the counter pain medication.

 

That said, (and Im going to tell my Dr.this tomorrow) there is absolutely no excuse not to get a full-strength, pure-opioid pain prescription for the 3 days following invasive Surgery. None. I know Ohio is in the midst of a pain-pill/heroin epidemic, but shit, thats still no excuse. Im not asking for a month-long prescription, not asking for a week, just 3 days of the pure-bomb-shit after Surgery; i'll never have another operation done without said prior medication consent.