need help navigating

[Steve_Marlow]

Hi Magnolia - a couple of perspectives to offer: 1) at least you were diagnosed as having the hip issues relatively early. I wasted a couple of decades on ineffective back treatments and weak medications treating the wrong part of the body. Many of us do have legitimate back issues, but if the hips are the driving force, you have to deal with those in order to get relief. 2) Hip replacement ranks right at the top in terms of surgeries that improve patients' quality of life. That cannot be said about back surgery. THR has been performed in the multi-millions of times and as long as you get yourself a good surgeon, as I see you are working on, you can feel quite confident of a good outcome. 3) Even though some people on this site have had ongoing problems, that is not an accurate representation of the overall population. While some of us want to hang around and offer support to others following in our limping footsteps, most people who have routine, successful THRs never visit a support forum, let alone post for an extended time. And of course a great many people who need to replace their hips are in their 80s and aren't hanging out on the internet. Yet I personally know several who have been given a new lease on life. Maybe you'll eventually consider it good news that you have an issue that can be dealt with by a highly successful procedure. We're all here with you! Kim

Kim, that seems to be such a sensible post, I missed out on the forum during my pre-op stage and it would have helped so much. I think the site is wonderful, but as a newcomer the amount of info available is daunting and the detail on problems can give folks a scare. I'm only 10 days post op but I think you have reflected the successes very well. Steve

 

[grateful]

Steve,

I also didn't find the forum until after my surgery. In a way, I think that may be for the best as I went into it assuming all would work out. I don't think it would have done my worrisome mind any good to start thinking about the ways it might not. I also tend to research a lot, but after a certain point I decided just to trust in the surgeon and hospital I had selected. It's all different for each person, but I'm with you, sometimes there can be such a thing as too much information.

 

[MagnoliaMs]

Well--I can really understand the "too much info" stuff. I have had a bit of cold water hit me in this "navigating" thing. I thought I was on my way with two appts set-up and a real good feeling about getting the anterior near home--about an hour away--and liked the whole setup. But I inadvertently--while rambling around the web gettng info---discovered that both of my chosen surgeons are not yet Board certified.

One is board eligible and that is fine and he is probably a fine doctor. But I have two hips gone wrong and can't afford a glitch that might be something out of his range of experience. The other has wonderful credentials and is certainly impressive but he is not yet certified. I think he is just at the stage in his practice where he is going through the process and I am sure he will be soon. But what does that leave me with? :th_2hissy1:

One can't assume in this most serious of procedures that affects well-being for years to come. Is he almost there--is it a matter of months and a few more tests and he is well on the way. Or not---did he not even start the process.

And on the web site of the hospital it clearly says all of their surgeons are board certified. That is why I didn't question it earlier.

By the time one sorts out the generalists, the newbies, the too set in their ways oldies, the unknowns, the ones with questionable training, experience, or low ratings on the patient surveys---it starts to get a bit sparse out there.
I guess I will be checking my frequent flyer miles. :th_sigh:

 

[grateful]

Wow Magnolia -

That's not good. I'm sorry, you probably have said before, but where do you live exactly? I take it you're not in the center of a lot of top-tier medical facilities?

I have no medical expertise, but one thing I do know is that experience - preferably vast experience - is of critical importance when doing joint replacements. Even if someone is a fine doctor, and on their way to being one of the best, do you really want to entrust your hip and all that effects to someone who is only on their way? Especially when you've already had problems. What is the deal with the hospital claiming everyone is board certified?

When I was initially told I needed hip replacement, my GP referred me to a large practice in our city. That practice assigned me to a surgeon, probably the one who had the most availability in his schedule. I had a wait of several weeks to see him. In the meantime I did an online search on him and discovered that 1) he was less than a decade out of school, and 2) he specializes in ankles! So on my own I called a different surgeon, different practice, who is widely considered the "best" in the region for hips, and got an appointment for the following week. The day after surgery, the anesthesiologist stopped by my room to see how I was doing. He mentioned the surprise conditions that were found once surgery was under way, and bluntly told me that if a less experienced doctor had been working on me, the chances of a botched outcome would have been high. I shudder to think if I had gone along with the ankle specialist I was originally referred to.

Maybe someone here will tell you it's not important to be board certified if other conditions are met, but I have a feeling that you will indeed be in a position of continuing to look, sadly. Good work on the research.

 

[MagnoliaMs]

Very insightful, Grateful! It just shows how much we need to be our own advocates. I realize now this preplanning is going to take however long it takes and I can't rush it to get it done tomorrow! I was thinking the same thing when you said they encountered a problem. Knowing ways around stuff, having a bag of tricks, and having solutions comes with experience.

We have a regional medical center here but this anterior approach is not available in my city but is available within an hour's drive--but then comes the Board thing. There is another possibility in Alabama I will check. Interestingly, I could find nothing for the anterior at Oschner in New Orleans which is just down the road from me.

I am going to take to heart what you said--experience counts!

 

[TEXAS JACK]

Dear Magnolia,
Saw your posts in my THR Thread. Sorry to hear about the latest wrinkle in your search.I'm sorry if I inadvertently started to sound like a salesman promoting the Anterior technique. I believe (authors emphasis) it to be perfect for me and consider myself fortunate to have it available locally. However, I would be quite satisfied with any of the other techniques performed by an experienced OS. I simply got lucky.

The most important point I can make to you is that once you identify an OS that makes practical sense i.e. proximity, insurance coverage, etc. and has the demonstrated experience...go with him regardless of which procedure he is expert in. The success rate for all THR's, done by all manner of methods is very high. I'm told in the very upper 90's.

The objective is to get you fixed. Issues of PostOp recovery, timing, etc. are really secondary.

Personally, I'd avoid the new guy. Your looking for the best mechanic and they don't get to the pits at LeMans without having a few rodeos under their belt.

Thinking of you and pulling for you.

 

[MagnoliaMs]

Thanks Jack! I pretty much had been set on anterior before reading your posts. I just feel with two hips it would make the most sense. Your thoughts on the new guy are well-taken. I do have other options--even though it may involve more planning. Appreciate your keen insights.

 

[Celeste]

Hi, Magnolia,
Like some of the others I didn't find this forum until after my surgery, but I understand how overwhelming it is to make the decision to have surgery (I spent far too long in pain and denial!) and more importantly who should perform that surgery.

I saw three surgeons before choosing one. I live in NJ but had my surgery in NYC at the Hospital for Special Surgery. My GP pointed me in that direction because I wasn't happy with the 2 local surgeons I had seen. I was fortunate that a friend of the family knew the chief of surgery at HSS and he recommended 3 surgeons for me. Since I needed both hips replaced one of his criteria was that I see a more experienced surgeon who has done hundreds of bilateral replacements.

I'm so glad I took my time choosing a surgeon. I am a little over three weeks post op and doing very well.

One of the things I learned while at HSS is that there are people who come there from all over the nation and all over the world. They are very experienced in making arrangements for people who travel to have surgery. I can only assume that other reputable hospitals make those provisions as well.

Keep interviewing those surgeons, Magnolia, until you find the right one for you! I wish you all the best!

 

[Jamie]

Excellent posts, Celeste and Jack!!! Thanks!

 

[MagnoliaMs]

Thank you so much Celeste. Yes--it is daunting. So you had both done.That is my preference and that is probably going to mean traveling for the experienced choice. But I am buoyed up by your great outcome and your reassurance about the arrangements. I appreciate your takinng the time to share.

 

[MagnoliaMs]

Hi Folks,
No update yet. Have an appt. this week for first OS on the short list though. So I am making progress. While getting my list of questions together I suddenly had a scary thought. I remembered when I was working at a Univ. with a teaching hospital and how the residents did some procedures and participated in care. Now I am all for learning---but not on my hips when I am paying for it. I figure if they want to learn then do it for FREE! LOL! But now I am wondering what one does to insure that the surgeon of record and not a resident or fellow actually does the surgery under supervision.

I have a friend who had his happen with a simple gall bladder surgery and the resident cut too close and she has had years of infections from the liver because it doesn't drain well. Any thoughts? I guess this will be different in different countries.

 

[Jaycey]

But now I am wondering what one does to insure that the surgeon of record and not a resident or fellow actually does the surgery under supervision.

I had this same fear when I was contemplating spinal surgery. It's very simple - you just ask "will you be performing the surgery?" It's a very realistic question. If the OS seems in any way awkward about it then you know he/she is not for you.

Be sure and discuss any areas of concern with any OS you see. Being able to address any issue is important in making the choice.

 

[MagnoliaMs]

Thanks Jacey--I guess that is all one can do. It certainly seems unethical and perhaps, unlawful for this not to be divulged. My friend whom I mentioned did exactly that, but the resident participated anyway--she did win her lawsuit.

 

[Josephine]

Junior doctors have to be involved in surgery - they do the grunge work of holding retractors or limbs and cutting sutures for the surgeon. A very senior junior doctor (!) might sew up the superficial part of the wound for the surgeon but that's about it. But a surgeon cannot possibly do a hip or knee replacement single handed.

 

[MagnoliaMs]

Junior doctors have to be involved in surgery - they do the grunge work of holding retractors or limbs and cutting sutures for the surgeon. A very senior junior doctor (!) might sew up the superficial part of the wound for the surgeon but that's about it. But a surgeon cannot possibly do a hip or knee replacement single handed.

Yes, I can see that would be necessary. I was concerned along the lines of the junior mucking around near arteries and nerves. The situation in teaching hospitals here is that the critical parts of surgery can be done by doctors in training and the informed consent document can be worded in such a way as to allow that. It is sometimes called having a "ghost doctor". It is quite usual practice. The conflict is real--the need for education and training and the patient's right to know exactly who is doing the surgery. It is almost as though using a teaching hospital means giving this consent by default. So it becomes the patient's responsibility to veto it, it seems. :th_sigh:

 

[grateful]

Well put Magnolia. And now when I meet with my OS next week (for what is actually a post-surgery mtg. from 1st surgery), I will ask about his and anyone else's role in my surgery. I'm pretty sure he does all his own major work, not counting surgical nurse and maybe some other assistance. We have a large teaching hospital also in our town, and it is for that very reason I am happy to go to a different hospital, and also get the guy who is considered "the best" in town. It's selfish I know, but there are other people who don't mind playing that role for newer doctors.

When I was in, in November, a nurse stopped by my room and explained that she was a nurse there but also teaches nurses at a local college. She asked if it was okay for a student come in and work with me for awhile the next day. I thought that was a much better way of handling it than when you sometimes are presented with the student right at the time of the exam and asked in front of them if it was okay for them to stay. The student nurse took out my catheter, which I was really nervous about, but I didn't feel a thing!

 

[MagnoliaMs]

Yes, Grateful--it does make one feel a bit like letting the team down--I remember at the Univ. of Penna. hosp. which is a major teaching hospital having swarms of students around for every little minor procedure. That is ok with me. But not this.
Apparently in California they tried to get legislation that the consent form be more upfront and it was beaten down. Someone may be very happy to participate in training for a reduced fee or other incentive. But if I am traveling to a particular doctor and paying full price, I want that doctor.

 

[Josephine]

I was concerned along the lines of the junior mucking around near arteries and nerves.

Gosh, never seen such a thing as that! That would be in the realms of serious surgery and done only by the consultant or his senior registrar (also a trained surgeon and probably only months away from being a consultant himself). Junior doctors might be talked through doing an appendicectomy or removing a plate and screws but nothing more than that. Anything more intrusive is done in the anatomy room on donated bodies (which is where my mortal remains are ultimately destined! ).

 

[MagnoliaMs]

(which is where my mortal remains are ultimately destined! ).

Just like you Josephine--continuing to help even in the hereafter! :smile:

 

[Josephine]

Nope - just got this 'thing' about being buried! At least that way I will remain above ground for 12 months or more! :th_heehee: