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Surgery scheduled - having 2nd thoughts

Posted by Donna L on 8/23/02 at 22:13 (093385)

I am scheduled for surgery on 9/13. I am having an EPF and an excision of a ganglion cyst (outer side, below ankle). After reading these posts, I am really beginning to have doubts about the surgery. For the PF, I have tried NSAIDS, wrapping, and at least 5 injections. I was even in a fiberglass cast for 5 weeks (broke my 3rd metatarsal). Everything has helped temporarily. The pain has recently gotten worse. My foot seems to hurt more often now - not just in the morning.

My Pod attempted to drain the ganglion cyst, however nothing came out. I am having a hard time wearing shoes because of the position of the cyst, so I am unable to use my inserts for my heel.

After reading all the negative posts about the EPF, I am a little scared to have it done - the fact that I live in a small 3rd floor apartment (no elevator)is compounding my fear. I would appreciate some positive feedback to help me make my decision - it seems most of the posts sway to the negative.

Also, has anyone had any experience with Surgical Excision of the Ganglion?

Thanks,
Donna

Re: Surgery scheduled - having 2nd thoughts

DW on 8/25/02 at 01:57 (093448)

I had PF/heel spur removal w/nerve release done 8 months ago. It was the best thing I could have done. I'd had trouble with PF for years. I took (and still take) Vioxx, tried orthotics, and had 1 cortisone injection. The PF ruptured partially due to the injection and things went from bad to worse. When the dr did the surgery, he reported the PF looked 'necrotic' (dead) and removed it. I almost always wear shoes (especially Birkenstock sandals). I have some stiffness in the morning and after prolonged sitting, but nothing extreme. There are days when I can tell the PF no longer holds the arch...it's not a particularly comfortable feeling, but it doesn't happen alot. I can walk as MUCH as I want, which I never thought I'd be able to do again. I can't speak on the ganglion cyst, sorry. I *DID* go through 3 doctors before I found a very competent one. (The first two never even physically examined the bottom of my foot, just the ankle area. The first gave me a very painful cortisone injection and the second wanted to repeat the procedure....no thanks. The last doc actually probed the bottom and could not 'feel' the PF at all, due to the rupture.) The skill and the knowledge of your doctor are top priorities and do not hesitate to 'shop around.' I rarely come back here now, as I have no complaints and no longer look for answers to my previous pain. But I am completely satisfied with the result of my surgery. Good luck.
DW

Re: Surgery scheduled - having 2nd thoughts

kay on 8/25/02 at 09:57 (093466)

donna i had the endoscopic surgery 6 years ago. i missed 4 month of work and still had the same pain. maybe even a little more.
the orthopedic surgeon that just did my open partial release surgery told me that the surgeon cannot see good enough with the endoscopic surgery and he thinks that's why it fails so much.
my doctor does not believe in full release. he said that the tendon was there for a purpose. so he only removes 1/3 of it.
the open procedure takes many months to recoup from but if it helps it will be worth it. its been 10 weeks since my surgery. its a two step forward one step back thing for me. yesterday i did not use my crutches at all unless i had my boot cast off. my doctor told me to wear the boot cast until i can walk without pain. i am trying to take it one day at a time.
i waited years before i had my surgery. i suffered with p.f. for more than 20 years. the last year had gotten so bad i could barely stand working.
talk to your doctor again. hopefully a doctor here will answer your post and give his/her opinion on the epf.
good luck
kay

Re: 2nd thoughts are normal

BrianG on 8/25/02 at 21:39 (093527)

Hi Donna,

I know you are only looking for positive experiences, but I think you should be doing a different type of research. I'd ask my Pod for some referances of people that he has cured. Tell him you are especially interested in people that had cases similar to yours. Call, and talk with them, are they happy? If he balks, I'd think very hard about letting this man cut me. Once your cut, there is no turning back!

Good luck
BrianG

Re: 2nd thoughts are normal

Joe S on 8/26/02 at 13:04 (093561)

That's a godd idea but the reality of the situation is that the doctor cannot give out another patients personal information without written consent. Otherwise the doc would violate Dr/Patient confidentiality. This is a big no no. Also, who's to say that the doc would only give numbers of people who had only good experiences with the procedure. That's the main thing I would be concerned about. Surgery, irregardless of the procedure is a big decision.

Re: 2nd thoughts are normal

Pauline on 8/26/02 at 18:14 (093609)

Usually the doctor does not provide direct information it becomes a patient to patient exchange. I've had doctors provide my name and phone number to some of their patients who in turn contacted me and we were able to discuss the treatment that I was facing.

Not all doctors will do this, however, it certainly can provide very informative information, ease fears, and create lasting friendships.

It think it depends on the physician and the way he/she chooses to practice medicine. In many situations even counseling and support groups are suggested prior treatments.

Patients are not keep isolated anymore by caring doctors.

Re: How are we to tell the quality of the physician's work?

BrianG on 8/26/02 at 21:53 (093624)

Hi Joe, why do I have this sneaky feeling that my Pod has had no, or very few, successfull EPF surgeries??? I saw enough people in his waiting room, to get this impression. If he will not admit his procedures are a failure, then how am I supposed to find out what type of surgeon he is? Please tell me...

BrianG

PS I thought I did my homework, but I did not ask for referances. Now I wish I had!

Re: Surgery scheduled - having 2nd thoughts

Dr. Marlene Reid on 8/27/02 at 00:48 (093630)

Well, I can tell you that unless you are not in good health, the initial treatment for ganglion cysts is surgical excision NOT drainage. Aspiration (drainage) causes a very high recurance rate and is not first line treatment. I would evaluate your doctor very carefully.

Re: How are we to tell the quality of the physician's work?

BrianJ on 8/27/02 at 10:15 (093663)

BrianG --

I'll tell you a true story. I had an unsuccessful EPF several years ago, but the pod must have assumed that -- because he didn't hear from me again -- things went great. Thus, a year after the surgery, the pod's assistant called me to ask if she could put me in touch with someone who was considering an EPF. When the assistant learned that my EPF had failed, she immediately clammed up and DID NOT put me in touch with the person considering EPF. The only conclusion I can draw is that this pod wanted potential patients to hear only positive stories, not negative ones.

Re: Surgery scheduled - having 2nd thoughts

BJC on 8/27/02 at 18:02 (093728)

Donna, it is always a tough decision, and only you can evaluate how PF is affecting your life. I had EPF 2 1/2 years ago, and have not regretted the decision a single day. It took almost 2 years to be completely pain free, and mentally it is still hard to believe that I won't reinjure the foot. I had faith in my doctor (pod), so much so that I had a second surgery (bunionectomy) last month so that I can wear 'normal' shoes with comfort. Good luck with your decision, and I hope your experience is as good as mine and lots of other folks.

Re: He may not have positive results, to share!

BrianG on 8/27/02 at 21:08 (093753)

This is what scares me. What if the Pod has very few success's with a procedure like an EPF? How are we to know? I think if I felt better, I might look into a class action suit!!

BrianG

PS: Is anyone looking at a doctor's healing vs. failue rate?

Re: Surgery scheduled - having 2nd thoughts

Necee on 8/28/02 at 00:35 (093777)

Donna, Please get another opinion maybe two before having this surgery.

Good luck and keep in touch,

Necee

Re: 2nd thoughts are normal

Joe S on 8/28/02 at 22:21 (093835)

The problem now is that our wonderful leaders have passed HIPAA. It's a patient privacy deal. The entire medical field is up in arms as what to do about this issue. Most offices are having to file for an extension for the HIPAA regulations. I'm in a practice with 4 orthopedists. We see a ton of patients. We are hospital based. We have patient's out the wazoo. There can be no evidence of patient records in sight that are left unattended. You can't discuss patient's without their written approval. I can't even send a referring doctor a copy of the progress note without getting the patient's written approval. It's a mess. Now I think if a patient started a listserv in the office such as a heelspur or PF support group, that would be ok. It's is patient driven. I do not believe (legally) that a doc can do this. Maybe some of the other docs have a little more insight on this issue.

Re: How are we to tell the quality of the physician's work?

Joe S on 8/28/02 at 22:33 (093838)

This is my personal opinion and please take it for what it's worth. In my residency we did a few EPF's. More specifically, I did about 5 in three years of residency. If your gut feeling tells you to be wary, then you better be wary. EPF's can work. I know of one doc who has good success with them. I don't do them because I have only done a few in residency. I don't do many open procedures either. I guess you could find out if he is board certified. There's only one certifying board that's recognized and it is the American Board of Podiatric Surgery. There are many highly trained individuals who are excellent surgeons that are not board certified however. If you're sitting in the waiting room and here everyone in there still complaining with pain after surgery (EPF or whatever) then I'd be asking questions. It's your foot. Remember this, once you go under the knife there's no turning back. Also, when you here a guy say, I've done hundreds of these procedure's I'd also ask why. What's his cure rate conservatively? How long does he wait before recommending the EPF or whatever? If it's less than six months than I'd be worried. Are you considering an EPF? I'd get a 2nd opinion and probably a 3rd opinion to top it off. In the right individual, they work. In the hands of a good, well trained surgeon, they work. Open procedures tend to fail because the surgeon doesn't cut the plantar fascia. They tend to cut muscle which ultimately leads to a post op hematoma and wound dehiscence. I would say only 2-3% of my heel pain patients ever go on to surgical correction. Anywya, I know I ramble so I apologize. If you tell the general part of the country you're in I may be able to help you find someone who's skilled in the EPF or whatever you may need.

Re: He may not have positive results, to share!

Joe S on 8/28/02 at 22:41 (093839)

I think that is a very good point. The cure versus failure rate. There are a multitude of journal articles that talk about this. I have some somewhere and I will look for them. I will post them. DO NOT put any credence in what ANY DOC says about his success rate. No doc can ever guarantee a result. You just can't do it. I can tell you that for certain procedures (ie hammertoe repair etc..)our success rate is approximately 95%. That means that most people get better. Some dont. Some end up having a different problem that may be associated with the surgery. Well do you call this a success? Some may some may not. If the toe is straight then yes it's a success. However if the toe is straight but there is no feeling in it then how do you define it? I say it's not a complete success. For a true success versus failure for a certain procedure and independent investigator needs to define the criteria for success versus failure. He then needs to obtain a subset of patients who underwent the procedure from a Dr. X. He can then compare the success rate versus failure rate that way. Most docs don't want to know they're failures. That's bad business.

Re: Surgery scheduled - having 2nd thoughts

Joe S on 8/28/02 at 22:44 (093840)

I will disagree with you as the first line treatment for ganglion cysts. Aspiration of the cyst with a secondary infiltration of a corticosteroid works very well. I do see a high recurrence rate with excision if the contents of the cyst are ruptured during the surgery. Also, if the sac extends into a joint there is a high recurrence rate. If they are isolated over a tendon sheath they do much better.

Re: Thanks for the tips

BrianG on 8/30/02 at 21:34 (094036)

Thank you, Dr Joe. You are preaching to the choir. I have already had a failed EPF procedure on my right heel. This was by a young, cocky Pod, whose ex-partner had been trained by Dr. Barrett. He claimed some unbelevable success rate. I never thought to ask for patient referrels. I wish that I had!

I was only bringing these thoughts up, to warn potential patients that this procedure is not all it's cracked up to be.

Regards
BrianG

PS: What I need is a miracle, can you set me up with one of those in MA? :*) :*)

Re: Surgery scheduled - having 2nd thoughts

Ed Davis, DPM on 8/30/02 at 22:12 (094039)

Surgery is often the best treatment for ganglions.

You probably are a bit confused after reading the responses concerning plantar fascial release surgery. The bottom line is that irrespective of how well the surgery is done and how expertly the surgeon performs the procedure, some surgeries will succeed and some will fail.

This is the reason that we ask you to try as many conservative modalities as possible before moving on to surgery. You have listed very few conservative treatments that you have had for plantar fasciitis.
Ed

Re: Surgery scheduled - having 2nd thoughts

Joe S on 9/02/02 at 10:25 (094211)

Agree totally.

Re: Surgery scheduled - having 2nd thoughts

DW on 8/25/02 at 01:57 (093448)

I had PF/heel spur removal w/nerve release done 8 months ago. It was the best thing I could have done. I'd had trouble with PF for years. I took (and still take) Vioxx, tried orthotics, and had 1 cortisone injection. The PF ruptured partially due to the injection and things went from bad to worse. When the dr did the surgery, he reported the PF looked 'necrotic' (dead) and removed it. I almost always wear shoes (especially Birkenstock sandals). I have some stiffness in the morning and after prolonged sitting, but nothing extreme. There are days when I can tell the PF no longer holds the arch...it's not a particularly comfortable feeling, but it doesn't happen alot. I can walk as MUCH as I want, which I never thought I'd be able to do again. I can't speak on the ganglion cyst, sorry. I *DID* go through 3 doctors before I found a very competent one. (The first two never even physically examined the bottom of my foot, just the ankle area. The first gave me a very painful cortisone injection and the second wanted to repeat the procedure....no thanks. The last doc actually probed the bottom and could not 'feel' the PF at all, due to the rupture.) The skill and the knowledge of your doctor are top priorities and do not hesitate to 'shop around.' I rarely come back here now, as I have no complaints and no longer look for answers to my previous pain. But I am completely satisfied with the result of my surgery. Good luck.
DW

Re: Surgery scheduled - having 2nd thoughts

kay on 8/25/02 at 09:57 (093466)

donna i had the endoscopic surgery 6 years ago. i missed 4 month of work and still had the same pain. maybe even a little more.
the orthopedic surgeon that just did my open partial release surgery told me that the surgeon cannot see good enough with the endoscopic surgery and he thinks that's why it fails so much.
my doctor does not believe in full release. he said that the tendon was there for a purpose. so he only removes 1/3 of it.
the open procedure takes many months to recoup from but if it helps it will be worth it. its been 10 weeks since my surgery. its a two step forward one step back thing for me. yesterday i did not use my crutches at all unless i had my boot cast off. my doctor told me to wear the boot cast until i can walk without pain. i am trying to take it one day at a time.
i waited years before i had my surgery. i suffered with p.f. for more than 20 years. the last year had gotten so bad i could barely stand working.
talk to your doctor again. hopefully a doctor here will answer your post and give his/her opinion on the epf.
good luck
kay

Re: 2nd thoughts are normal

BrianG on 8/25/02 at 21:39 (093527)

Hi Donna,

I know you are only looking for positive experiences, but I think you should be doing a different type of research. I'd ask my Pod for some referances of people that he has cured. Tell him you are especially interested in people that had cases similar to yours. Call, and talk with them, are they happy? If he balks, I'd think very hard about letting this man cut me. Once your cut, there is no turning back!

Good luck
BrianG

Re: 2nd thoughts are normal

Joe S on 8/26/02 at 13:04 (093561)

That's a godd idea but the reality of the situation is that the doctor cannot give out another patients personal information without written consent. Otherwise the doc would violate Dr/Patient confidentiality. This is a big no no. Also, who's to say that the doc would only give numbers of people who had only good experiences with the procedure. That's the main thing I would be concerned about. Surgery, irregardless of the procedure is a big decision.

Re: 2nd thoughts are normal

Pauline on 8/26/02 at 18:14 (093609)

Usually the doctor does not provide direct information it becomes a patient to patient exchange. I've had doctors provide my name and phone number to some of their patients who in turn contacted me and we were able to discuss the treatment that I was facing.

Not all doctors will do this, however, it certainly can provide very informative information, ease fears, and create lasting friendships.

It think it depends on the physician and the way he/she chooses to practice medicine. In many situations even counseling and support groups are suggested prior treatments.

Patients are not keep isolated anymore by caring doctors.

Re: How are we to tell the quality of the physician's work?

BrianG on 8/26/02 at 21:53 (093624)

Hi Joe, why do I have this sneaky feeling that my Pod has had no, or very few, successfull EPF surgeries??? I saw enough people in his waiting room, to get this impression. If he will not admit his procedures are a failure, then how am I supposed to find out what type of surgeon he is? Please tell me...

BrianG

PS I thought I did my homework, but I did not ask for referances. Now I wish I had!

Re: Surgery scheduled - having 2nd thoughts

Dr. Marlene Reid on 8/27/02 at 00:48 (093630)

Well, I can tell you that unless you are not in good health, the initial treatment for ganglion cysts is surgical excision NOT drainage. Aspiration (drainage) causes a very high recurance rate and is not first line treatment. I would evaluate your doctor very carefully.

Re: How are we to tell the quality of the physician's work?

BrianJ on 8/27/02 at 10:15 (093663)

BrianG --

I'll tell you a true story. I had an unsuccessful EPF several years ago, but the pod must have assumed that -- because he didn't hear from me again -- things went great. Thus, a year after the surgery, the pod's assistant called me to ask if she could put me in touch with someone who was considering an EPF. When the assistant learned that my EPF had failed, she immediately clammed up and DID NOT put me in touch with the person considering EPF. The only conclusion I can draw is that this pod wanted potential patients to hear only positive stories, not negative ones.

Re: Surgery scheduled - having 2nd thoughts

BJC on 8/27/02 at 18:02 (093728)

Donna, it is always a tough decision, and only you can evaluate how PF is affecting your life. I had EPF 2 1/2 years ago, and have not regretted the decision a single day. It took almost 2 years to be completely pain free, and mentally it is still hard to believe that I won't reinjure the foot. I had faith in my doctor (pod), so much so that I had a second surgery (bunionectomy) last month so that I can wear 'normal' shoes with comfort. Good luck with your decision, and I hope your experience is as good as mine and lots of other folks.

Re: He may not have positive results, to share!

BrianG on 8/27/02 at 21:08 (093753)

This is what scares me. What if the Pod has very few success's with a procedure like an EPF? How are we to know? I think if I felt better, I might look into a class action suit!!

BrianG

PS: Is anyone looking at a doctor's healing vs. failue rate?

Re: Surgery scheduled - having 2nd thoughts

Necee on 8/28/02 at 00:35 (093777)

Donna, Please get another opinion maybe two before having this surgery.

Good luck and keep in touch,

Necee

Re: 2nd thoughts are normal

Joe S on 8/28/02 at 22:21 (093835)

The problem now is that our wonderful leaders have passed HIPAA. It's a patient privacy deal. The entire medical field is up in arms as what to do about this issue. Most offices are having to file for an extension for the HIPAA regulations. I'm in a practice with 4 orthopedists. We see a ton of patients. We are hospital based. We have patient's out the wazoo. There can be no evidence of patient records in sight that are left unattended. You can't discuss patient's without their written approval. I can't even send a referring doctor a copy of the progress note without getting the patient's written approval. It's a mess. Now I think if a patient started a listserv in the office such as a heelspur or PF support group, that would be ok. It's is patient driven. I do not believe (legally) that a doc can do this. Maybe some of the other docs have a little more insight on this issue.

Re: How are we to tell the quality of the physician's work?

Joe S on 8/28/02 at 22:33 (093838)

This is my personal opinion and please take it for what it's worth. In my residency we did a few EPF's. More specifically, I did about 5 in three years of residency. If your gut feeling tells you to be wary, then you better be wary. EPF's can work. I know of one doc who has good success with them. I don't do them because I have only done a few in residency. I don't do many open procedures either. I guess you could find out if he is board certified. There's only one certifying board that's recognized and it is the American Board of Podiatric Surgery. There are many highly trained individuals who are excellent surgeons that are not board certified however. If you're sitting in the waiting room and here everyone in there still complaining with pain after surgery (EPF or whatever) then I'd be asking questions. It's your foot. Remember this, once you go under the knife there's no turning back. Also, when you here a guy say, I've done hundreds of these procedure's I'd also ask why. What's his cure rate conservatively? How long does he wait before recommending the EPF or whatever? If it's less than six months than I'd be worried. Are you considering an EPF? I'd get a 2nd opinion and probably a 3rd opinion to top it off. In the right individual, they work. In the hands of a good, well trained surgeon, they work. Open procedures tend to fail because the surgeon doesn't cut the plantar fascia. They tend to cut muscle which ultimately leads to a post op hematoma and wound dehiscence. I would say only 2-3% of my heel pain patients ever go on to surgical correction. Anywya, I know I ramble so I apologize. If you tell the general part of the country you're in I may be able to help you find someone who's skilled in the EPF or whatever you may need.

Re: He may not have positive results, to share!

Joe S on 8/28/02 at 22:41 (093839)

I think that is a very good point. The cure versus failure rate. There are a multitude of journal articles that talk about this. I have some somewhere and I will look for them. I will post them. DO NOT put any credence in what ANY DOC says about his success rate. No doc can ever guarantee a result. You just can't do it. I can tell you that for certain procedures (ie hammertoe repair etc..)our success rate is approximately 95%. That means that most people get better. Some dont. Some end up having a different problem that may be associated with the surgery. Well do you call this a success? Some may some may not. If the toe is straight then yes it's a success. However if the toe is straight but there is no feeling in it then how do you define it? I say it's not a complete success. For a true success versus failure for a certain procedure and independent investigator needs to define the criteria for success versus failure. He then needs to obtain a subset of patients who underwent the procedure from a Dr. X. He can then compare the success rate versus failure rate that way. Most docs don't want to know they're failures. That's bad business.

Re: Surgery scheduled - having 2nd thoughts

Joe S on 8/28/02 at 22:44 (093840)

I will disagree with you as the first line treatment for ganglion cysts. Aspiration of the cyst with a secondary infiltration of a corticosteroid works very well. I do see a high recurrence rate with excision if the contents of the cyst are ruptured during the surgery. Also, if the sac extends into a joint there is a high recurrence rate. If they are isolated over a tendon sheath they do much better.

Re: Thanks for the tips

BrianG on 8/30/02 at 21:34 (094036)

Thank you, Dr Joe. You are preaching to the choir. I have already had a failed EPF procedure on my right heel. This was by a young, cocky Pod, whose ex-partner had been trained by Dr. Barrett. He claimed some unbelevable success rate. I never thought to ask for patient referrels. I wish that I had!

I was only bringing these thoughts up, to warn potential patients that this procedure is not all it's cracked up to be.

Regards
BrianG

PS: What I need is a miracle, can you set me up with one of those in MA? :*) :*)

Re: Surgery scheduled - having 2nd thoughts

Ed Davis, DPM on 8/30/02 at 22:12 (094039)

Surgery is often the best treatment for ganglions.

You probably are a bit confused after reading the responses concerning plantar fascial release surgery. The bottom line is that irrespective of how well the surgery is done and how expertly the surgeon performs the procedure, some surgeries will succeed and some will fail.

This is the reason that we ask you to try as many conservative modalities as possible before moving on to surgery. You have listed very few conservative treatments that you have had for plantar fasciitis.
Ed

Re: Surgery scheduled - having 2nd thoughts

Joe S on 9/02/02 at 10:25 (094211)

Agree totally.