Hi y'all

[Gringo]

Thanks. Yes I know those x-rays are pretty bad, they were taken locally. Then I tried holding them up with one hand, standing outside in the wind, while snapping a photo with a pocket digital camera. The ones the OS office took two weeks ago, they kept.

I don't know how many knees this doc does a year, I didn't think to ask and it does not appear to be on their website. 500 would seem to be a big number, since he only does surgery on Tuesdays and Thursdays. That would be something like five a day...does that sound reasonable? Probably not, at two hours or more each....

Picking a physician was not something I had a lot of freedom with. I have to fly to the US to even see an OS. If I had been trying to put together a number of them to see in the same week, it would have been difficult. Available apointments were weeks and in some cases months out. I cannot just hop on an airplane to Miami, then another one to Houston, with hotel, rental car, etc. for each doc that someone would recommend. There are dozens in Houston alone..and everybody swears by their own.

So, I basically picked one on the recommendation of a friend ( who was the hospital administrator when this doc was recruited, and who took his own mother to him for a knee) and after checking out his credentials, education, etc. But I don't know how many knees he does. He does other things, too. Hips, etc.

That's encouraging news that you don't see any reasons that a standard off the shelf knee wouldn't work!! Oh boy!

 

[Josephine]

Believe me, 500 is a low number. Anything less is merely a hobby. Quantity = skill so the absolute minimum you should accept is 2-3,000 per year which is a good level for excellence. Perhaps you could inquire by mail/email so you can short list some.

 

[Gringo]

I have already schedulled the surgery. It's a bit complicated,involving airline, car, and hotel reservations for a month, or possibly more ( I am trying for a month) plus a lot of the pre tests are to be done by local docs here in the TCI...which are being schedulled by the OS's office directly.

 

[Jamie]

Gringo, for me I would prefer a surgeon who specializes in knees alone, but getting a recommendation like you did is a good way to help evaluate someone. I understand your problem with the idea of interviewing multiple surgeons. I'm assuming you felt comfortable when you met this doctor.

What are your plans following the surgery? Normally you are only in the hospital for a couple of days then released. You need rechecks, monitoring and therapy. Have you looked into an in-patient rehab facility where you could go to begin your recovery?

I spent some time on your blog last night and it was a lot of fun to read. The photos were gorgeous. I'm so glad you took the time to put it all out there. I know how much work that is, even if you have lots of photos to work with. Now we have some ideas for places to stay when we plan a vacation to The Turks and Caicos.

 

[Jamie]

Believe me, 500 is a low number. Anything less is merely a hobby. Quantity = skill so the absolute minimum you should accept is 2-3,000 per year which is a good level for excellence. Perhaps you could inquire by mail/email so you can short list some.

Jo....did you mean to say the minimum would be TWO to THREE HUNDRED per year???

 

[Josephine]

No, two to three thousand. Remember I said that anything under five hundred is just a hobby so how would two to three hundred rate as excellence?

 

[Gringo]

Well, I will write his office and see how many he does a year, but since he only does surgery two days a week i seriously doubt it would be ten a week.

I have been googling the OS, and he has an impressive resume. His name is Dr. Albert Cuellar, with KSF Orthapedic in Houston, Texas.

 

[dw6928]

You are suggesting a surgeon that does in the neighborhood of 10-12 surgeries per day? People I know who have gone to surgeons that do that many felt they were in a factory setting with minimal personal attention.

 

[Gringo]

Well, that does seem to be a lot. If a surgeon took off say two weeks for vacation, and another two weeks during the year for Christmas, seminars, etc, that would leave 48 weeks a year to do surgery. Working five days a week for 48 weeks, the OS would have to average 8.3 knees a day to make the 2,000 per year number. I have been reading that the 'average' time to do one knee is 1.5-2 hours...meaning the surgeon would be working 12-16 hours a day miniumum, week after week. Is that realistic?

 

[Judles]

And you certainly wouldn't want to be the . (Point)
Three now!!!

 

[Gringo]

I never realized they could maintain that kind of a schedule. How do they keep from burning out?

 

[Judles]

All that extra $$$$ ?????

 

[Josephine]

Well, it works out like this: (sure I've posted this before)

An average year is 46 weeks.
Average 8 joints per day x 6 days per week x 46 = 2,208 per annum.
Most surgeons only do the 'nitty gritty' meaning they have two ORs on the go and his assistant will be getting a patient draped up and ready for surgery, maybe even making the initial incision. In the meantime, the surgeon is completing another case in the other theatre. When he's finished closing the wound, an assistant will apply the dressing and see the patient into recovery while he goes and starts the prepared patient in the second theatre. Then the first theatre has a patient brought in and prepared, etc., etc. That way he can maximize his time.

His working day might well be 8am to 6pm or even later and these guys do six or seven day weeks as a norm. But the downside it that they can keep it up for about 10-15 years before it catches up with them. Such men are highly motivated, intensely committed and focussed people. Usually they are brilliant both professionally and academically, know their subject back to front and inside out and have prodigious memories. Their energy is inspired and those who don't have such a phsycological personality profile don't make it into the upper eschalons of specialised surgery.

Think of people like the DeBakeys, Mayos and Charnleys of this world; their lives were totally committed to the surgery 110% and was not unusual for them to work 18 hrs or more a day. I know some of the surgeons even at my local hospital who would do a day's operating 0830-1800 and then go on the treat trauma (emergency) cases through the night, perhaps getting home for 2-3 hrs rest and be back in theatre at 0830 again ready for another day's work! They are awesome people.

 

[Gringo]

That is pretty impressive.

Jo, maybe you should Stickey that explanation so you don't have to go through it again with your next batch of tin people..

Hey, Michael DeBakey handed me my second place trophy and ribbon in the Houston International Science Fair back in about (mumble mumble) long time ago.

Jamie, I am glad you liked the blog. Were you able to navigate back to some of the interesting stuff, underwater and exploring? If you need any info or advice about this little country, let me know.

 

[Rowdy66]

Gringo, Welcome to the forum. It is a great source of information and support.

Sounds like the surgeon you have comes highly recommended. My OS, also, does both hips and knees. He does the surgeries that are more difficult and is quite successful. I was not at all put off by his doing both although I understand there are some who are.

Good luck with your surgery. I hope your recovery will be as uneventful as mine was.

And before I forget, I took a peek at your blog and the pictures were lovely. Once again good luck, Rowdy

 

[Gringo]

hello Rowdy. I was driving myself nuts trying to figure out which of the 8-10 best orthopods in Houston to start with. Everyone you ask has their own favorite, and of course their favorite is better for all kinds of reasons. I finally just went with the recommendation of a long time friend (we were best friends in high school, roommates at college) who was a Hospital Administrator for many years. Dr. Cuellar developed the ultrasonic navigation system that Stryker patented, and he graduated Magna Cum Laude from Texas A&M in biomechanical engineering before he went to med school at UT. I still don't know why he said that a standard knee won't work in my case. He said he would be combining parts from different things, I think. I was still kinda standing there with my ears ringing because he prefaced all that by saying "IF I take this on..."

That's a scary thing to hear.

In any case, to just simplify my life I chose this one and I am going to stick to it. It would be a lot easier for me to just fly up to Miami for this ( one hour flight) but I don't know anybody in Miami, and I have tons of family and friends in Texas. Plus a doc that came recommended by someone whose professional opinion I trust. I think it's the best I can do under my own, foreign living circumstances.

 

[Jamie]

Gringo, you've obviously put a lot of thought and effort into your decision and I'm betting you'll be just fine. If you can't trust your old college roomie and BFF from high school, who CAN you trust???

Has Doc Cuellar agreed to take your case then? And if he takes parts from different knees to put in yours....that would give you sort of a Franken-knee, wouldn't it? LOL....a little bone humor......

 

[Josephine]

You're quite right, Gringo. Like many other things in life, we can drive ourselves insane trying to make unfathomable choices.

 

[Gringo]

Oh I was bouncing all over the place second guessing myself til I figured out I probably couldn't go too wrong with ANY of the top guys on the list.

Hey my old college buddy now runs a fly fishing lodge in the mountains in Montana. He will be down here this week to see if he wants to be a part of building a new bonefishing lodge here. He wouldn't steer me wrong.

 

[Jamie]

So there isn't much of an economic slowdown there in the islands these days, Gringo?