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Different outcomes

Posted by J. King on 6/21/02 at 09:12 (088193)

It seems the outcomes for PF and TTS surgery are so different for so many people. I have read everything from horrible outcomes to very good ones. This gives me pause because I don't want to be one of the failures, but having my feet back would lessen my disability, depression and frustration. I guess when a person gets desparate enough they just do whatever they can and hope for the best. It seems we play at dice with the surgical results.

Re: Different outcomes

john h on 6/21/02 at 10:06 (088207)

J. King: you and only you know how you feel and whether you want to go the surgery route. When I had surgery I thought long and hard and decided I could not live like an invalid when the possibility that I could be cured or improved with surgery. I looked at the statistics and they were you have a very good chance of a cure or being made better. I also knew there were people on this board who had very bad outcomes. It is one of those tought decisions that we frequently face in life. Good luck on whatever you decide. Just be selective with your doctor and make sure he has done a lot of the procedures with good outcomes.

Re: Different outcomes

KathyB on 6/21/02 at 12:47 (088218)

I am still in the thinking stage. I am now on meds and they do limit the pain, but I think I will eventually hae the surgery. I think you have to look at not only other people's outcomes, but the relationship with your doctor. My doctor has already operated on me three times for the damage in both of my ankles. He has written articals in the american medical journal (or one of those). He takes the time to talk to me and does not put me down for doing my own research. I can argue with him on points and we can meet in the middle, he loves it when I do this. What kind of relationship do you have with your doctor, do you trust him enough? This surgery goes two ways, really good or really bad. You need to reasearch the newest meds, proceedures and talk with your doctor about them, if he does not like you doing this, get another doctor.

Re: Different outcomes

J. King on 6/21/02 at 16:43 (088231)

I am going to see a new orthopod and if he says to operate perhaps I will. I don't put anything in stone. It depends how I feel.

Re: Different outcomes

Ed Davis, DPM on 6/22/02 at 12:21 (088302)

Ask him what his success rate is with that type of surgery.
Ed

Re: Different outcomes

Joe S on 6/23/02 at 18:13 (088349)

Not to sound critical but anytime a physician sacrifices his or her standard of care to meet a patient in the middle, the physician is opening himself up to a fair amount of liability. Example, say a patient who had a certain surgical procedure where they are not supposed to perform a certain activity (bear any weight on their foot) and the patient pleads with the doctor who finally says yeah you can put some weight on your heel and the patient then develops a post op complication secondary to putting weight on that foot. Theoretically, the patient can hold the physician liable for this complaint with the reasoning that for this procedure, he deviated from his normal standard of care. You know what's next...a letter from a friendly lawyer asking for the medical records because you are now suing him. Case in point, I had a patient who underwent a bunionectomy. For my particular procedure I like to keep them nonweightbearing for 2 weeks with crutch assistance. I do not deviate. Well in the middle of the 2nd week, my nurse saw this particular patient at a night club dancing in her post op shoe with her fiancee. My nurse just casually said hello to her in passing. Told me the next day. We documented it very thoroughly. The patient developed a large thick scar over the incision and still has some pain. My point is that good communication between the doctor and patient is of utmost importance. If you don't like the way your treatment is going then you have the right to choose another doctor (unless you're on a HMO that has only one provider for your specific complaint). Personally, I never let a patient try and talk me into a certain treatment for their problem. Nor do I reason with them about my treatment course. You don't see endocrinologists reason with their diabetic patients about their blood sugar. I know of one who keeps feels that if their sugar is out of his acceptable standards then he pretty much gives them the writing on the wall. He doesn't say 'Well Ms Jones, as long as your sugar is under 200 you're ok'. He has a certain standard and if you're not playing by his rules he will let you go as a patient. The other docs on this forum may disagree with me but this is my honest opinion. I'm sure this is the way that most other physicians feel as well.

Re: Different outcomes

KathyB on 6/23/02 at 20:18 (088352)

When I say meet in the middle, I mean that I have as much understanding about what is going on as he does. I have meet a lot of people that did not even know what the doctor was going to be doing to them on the table. I reasearch new drugs, therapys, operations and bring these to his attention. My doctor does not and would not sacrifice his standard of care for anything, but the decisions of what happens to me and my body are mine. Do I go for the TTS surgery or do I stay on the drugs that control my pain but give me some nasty side effects. Those decisions are mine and mine alone, I would not go againist my doctors advice about danceing, walking, running or any other activity after surgery (for the exception of going back to work too soon, I work on a computer all day) I would demand more pain medication if I needed it, and would demand to be seen if I felt that something was not right with me. Please don't mixed up a good patient/doctor respectful relationship with someone who is just being stupid and foolish.

Re: Different outcomes

KathyB on 6/24/02 at 09:30 (088365)

I know my last message may have sounded a little harsh, and I am sorry if it did. I have been to so many doctors that have not wanted me to participate in the planning of what was to be done to me that I get a little defensive. I truly did not mean to imply that my doctor would lower his standards to treat me, he does however challenge me to understand what the options are and to make sure I understand completely what is going on and what is going to happen. No surgery is guaranteed, I know that, I have heard the speech many, many times. I do follow his advice, but I also learn all I can and in meeting in the middle he allows me to understand everything that I am able to and fills in the things I am not. I respect my doctor and know that he would never lower his standards and would tell me outright that I was wrong and why. I bring in my research and he goes over it with me and tells me what is good and bad about it. We work together so I have some control over this, but he is ultimately in control and I ultimately do what he says.

Re: Different outcomes

Joe S on 6/26/02 at 20:22 (088538)

You are ultimately in control of your own destiny and decisions. I think the point I was trying to make in my longwinded post was that when a doctor starts compromising his treatment protocol for a patient. I see inbetween 25 to 30 patients everyday. There is not a single day that a patient asks, do you think I can put weight on my foot that you just operated on last week when they no good and well that I emphatically stated in my preop instructions and informed consent what was expected of them postoperatively. This is what I mean. I don't mean that you blindly follow your doctors recommendations. You are your own best advocate. No one else.

Re: Different outcomes

Joe S on 6/26/02 at 20:31 (088540)

You bring up a good point with the thing you said about you bringing in literature and your doc going over it with you. I know from personal experience that some doctors are not aware of all of the treatment or studies going on for a particular condition. So the research you bring him will more than likely be the 1st time he's seen it. He may not admit it. But it is usually the case. None of us have the time (if we are busy) to read every article that comes out. There's just not enough time in the day. Anyway, I didn't take your last message as harsh. As an aside for Tarsal Tunnel syndrome, I have found that physicians specializing in Physical Medicine (they are called Physiatrists) really can isolate the problem. Alot of docs don't believe that Tarsal Tunnel Syndrome truly exist. Alot of people have plantar fascial releases and tarsal tunnel releases together and get no better. Hummm sounds to me like a misdiagnosis. Before I opted for a Tarsal Tunnel Release, I would have an EMG (an electromyograph) performed by a PHYSIATRIST (not Psychiatrist). If you truly have tarsal tunnel syndrome then your nerve conduction velocity should be altered. Anyway, sorry for another long post.

Re: Different outcomes

john h on 6/21/02 at 10:06 (088207)

J. King: you and only you know how you feel and whether you want to go the surgery route. When I had surgery I thought long and hard and decided I could not live like an invalid when the possibility that I could be cured or improved with surgery. I looked at the statistics and they were you have a very good chance of a cure or being made better. I also knew there were people on this board who had very bad outcomes. It is one of those tought decisions that we frequently face in life. Good luck on whatever you decide. Just be selective with your doctor and make sure he has done a lot of the procedures with good outcomes.

Re: Different outcomes

KathyB on 6/21/02 at 12:47 (088218)

I am still in the thinking stage. I am now on meds and they do limit the pain, but I think I will eventually hae the surgery. I think you have to look at not only other people's outcomes, but the relationship with your doctor. My doctor has already operated on me three times for the damage in both of my ankles. He has written articals in the american medical journal (or one of those). He takes the time to talk to me and does not put me down for doing my own research. I can argue with him on points and we can meet in the middle, he loves it when I do this. What kind of relationship do you have with your doctor, do you trust him enough? This surgery goes two ways, really good or really bad. You need to reasearch the newest meds, proceedures and talk with your doctor about them, if he does not like you doing this, get another doctor.

Re: Different outcomes

J. King on 6/21/02 at 16:43 (088231)

I am going to see a new orthopod and if he says to operate perhaps I will. I don't put anything in stone. It depends how I feel.

Re: Different outcomes

Ed Davis, DPM on 6/22/02 at 12:21 (088302)

Ask him what his success rate is with that type of surgery.
Ed

Re: Different outcomes

Joe S on 6/23/02 at 18:13 (088349)

Not to sound critical but anytime a physician sacrifices his or her standard of care to meet a patient in the middle, the physician is opening himself up to a fair amount of liability. Example, say a patient who had a certain surgical procedure where they are not supposed to perform a certain activity (bear any weight on their foot) and the patient pleads with the doctor who finally says yeah you can put some weight on your heel and the patient then develops a post op complication secondary to putting weight on that foot. Theoretically, the patient can hold the physician liable for this complaint with the reasoning that for this procedure, he deviated from his normal standard of care. You know what's next...a letter from a friendly lawyer asking for the medical records because you are now suing him. Case in point, I had a patient who underwent a bunionectomy. For my particular procedure I like to keep them nonweightbearing for 2 weeks with crutch assistance. I do not deviate. Well in the middle of the 2nd week, my nurse saw this particular patient at a night club dancing in her post op shoe with her fiancee. My nurse just casually said hello to her in passing. Told me the next day. We documented it very thoroughly. The patient developed a large thick scar over the incision and still has some pain. My point is that good communication between the doctor and patient is of utmost importance. If you don't like the way your treatment is going then you have the right to choose another doctor (unless you're on a HMO that has only one provider for your specific complaint). Personally, I never let a patient try and talk me into a certain treatment for their problem. Nor do I reason with them about my treatment course. You don't see endocrinologists reason with their diabetic patients about their blood sugar. I know of one who keeps feels that if their sugar is out of his acceptable standards then he pretty much gives them the writing on the wall. He doesn't say 'Well Ms Jones, as long as your sugar is under 200 you're ok'. He has a certain standard and if you're not playing by his rules he will let you go as a patient. The other docs on this forum may disagree with me but this is my honest opinion. I'm sure this is the way that most other physicians feel as well.

Re: Different outcomes

KathyB on 6/23/02 at 20:18 (088352)

When I say meet in the middle, I mean that I have as much understanding about what is going on as he does. I have meet a lot of people that did not even know what the doctor was going to be doing to them on the table. I reasearch new drugs, therapys, operations and bring these to his attention. My doctor does not and would not sacrifice his standard of care for anything, but the decisions of what happens to me and my body are mine. Do I go for the TTS surgery or do I stay on the drugs that control my pain but give me some nasty side effects. Those decisions are mine and mine alone, I would not go againist my doctors advice about danceing, walking, running or any other activity after surgery (for the exception of going back to work too soon, I work on a computer all day) I would demand more pain medication if I needed it, and would demand to be seen if I felt that something was not right with me. Please don't mixed up a good patient/doctor respectful relationship with someone who is just being stupid and foolish.

Re: Different outcomes

KathyB on 6/24/02 at 09:30 (088365)

I know my last message may have sounded a little harsh, and I am sorry if it did. I have been to so many doctors that have not wanted me to participate in the planning of what was to be done to me that I get a little defensive. I truly did not mean to imply that my doctor would lower his standards to treat me, he does however challenge me to understand what the options are and to make sure I understand completely what is going on and what is going to happen. No surgery is guaranteed, I know that, I have heard the speech many, many times. I do follow his advice, but I also learn all I can and in meeting in the middle he allows me to understand everything that I am able to and fills in the things I am not. I respect my doctor and know that he would never lower his standards and would tell me outright that I was wrong and why. I bring in my research and he goes over it with me and tells me what is good and bad about it. We work together so I have some control over this, but he is ultimately in control and I ultimately do what he says.

Re: Different outcomes

Joe S on 6/26/02 at 20:22 (088538)

You are ultimately in control of your own destiny and decisions. I think the point I was trying to make in my longwinded post was that when a doctor starts compromising his treatment protocol for a patient. I see inbetween 25 to 30 patients everyday. There is not a single day that a patient asks, do you think I can put weight on my foot that you just operated on last week when they no good and well that I emphatically stated in my preop instructions and informed consent what was expected of them postoperatively. This is what I mean. I don't mean that you blindly follow your doctors recommendations. You are your own best advocate. No one else.

Re: Different outcomes

Joe S on 6/26/02 at 20:31 (088540)

You bring up a good point with the thing you said about you bringing in literature and your doc going over it with you. I know from personal experience that some doctors are not aware of all of the treatment or studies going on for a particular condition. So the research you bring him will more than likely be the 1st time he's seen it. He may not admit it. But it is usually the case. None of us have the time (if we are busy) to read every article that comes out. There's just not enough time in the day. Anyway, I didn't take your last message as harsh. As an aside for Tarsal Tunnel syndrome, I have found that physicians specializing in Physical Medicine (they are called Physiatrists) really can isolate the problem. Alot of docs don't believe that Tarsal Tunnel Syndrome truly exist. Alot of people have plantar fascial releases and tarsal tunnel releases together and get no better. Hummm sounds to me like a misdiagnosis. Before I opted for a Tarsal Tunnel Release, I would have an EMG (an electromyograph) performed by a PHYSIATRIST (not Psychiatrist). If you truly have tarsal tunnel syndrome then your nerve conduction velocity should be altered. Anyway, sorry for another long post.