Question on doctor

June 16, 2005

Dr. Yashar in Kentucky >>>Sorry sweetie no insight on that doc either as for me personally knowing. And no place to extract information from that I couldn't find without a price tag attatched either. I'm also Kentucky patient~ nice 2 meet ya neighbor

Orthoexpert seems 2 B a good guide on it for 's doctor.... course what I read in the reports I found said the very same things. Never know... sometimes it's a very small world.

My surgery was scheduled just today for Aug 1.

>>>That's not too long of a wait.... could've been worse. Hopefully when all is said & done you'll B painful & find a new way of life 4 yourself~ I certainly wish U the best of luck & a rapid recovery. If you have any specific questions... shoot~ I'm this board is a valuable tool of "table turkey's view" as I call it. LOL Meaning merely we've all been there done that~ from the worrying 2 the pre-op testings to the helpful hints there after.... it's one thing 2 speak 2 your doctor about your concerns but chances R s/he's not gonna have enough time on their hands available 2 answer the BILLION QUESTIONS you've actually GOT about the matter <giggling> we've all been there too. But I'm certain U know well of all that having been a prior patient~ although things have changed ALOT in 20 yrs. of doing it. Benefit 2 speaking with table turkeys is you get the personal stories of the individual that's experienced what your waiting on.... it can ease your mind hearing the success stories or worry yourself wondering about the "bad turn outs" & list of what MIGHT BE's.

My biggest advise 2 U is~ chat 2 keep the time passing & address your inquiries.... but know that your case is a unique one just as all others R don't go wasting your time with worrying until U actually have 2 cross that problems bridge if ever! Wear a smile & hope that soon not only will U have a better leg but a healthier way of walking through your future. Things will B as they R meant 2 B and no amount of worrying will change the details, so try 2 think positive... and if by chance U don't get the "as planned THR".... just know that life is still good, but it'll only B what U make of it!

20 yrs. on a THR especially with the methods of "way back when".... is terrific~ I hope the revision buys U another 20 yrs. with a painless walk!

just need replacement parts. Yep, that's exactly how they explained it to me. >>>LOL I've gotten tickled over hearing that. I had 2 confirm my last surgery date... as I was a "forwarded moving slide" patient due 2 the nasty lil issue at hand. Meaning merely that my appointment date moved 4 times due to patients failing their scheduled date for various reasons... and I would move 2 their slot~ Nonetheless I called 2 check what was what... and lil surgery gal says "hummm we're kinda on hold 2 insure your parts R in". I started laughing so hard I couln't breath and when she questioned what the problem was.... I said man alive~ I was just calling on parts for my van last week here the same type of conversation~ Only somehow I'm starting 2 feel like a broken 70's model that needs a full overhaul these days~ think I can get that ordered ? LOL

I asked them to explain it so that I could understand. They were good about this...he actually showed me with my x-rays. >>>Good that U asked~ I've known some "2 embarassed" 2 question.... which is a REAL SHAME! Especially when someone is fixing 2 cut U open~ U should B ONE KNOWING WHAT'S GOING ON.... you'd B amazed though at how many DON'T question their doctors~ just merely suck in every word said as "the whole truth & nothing but" after all.... they couldn't B wrong their a doctor~ Sorry 2 say that even the best of doctors have their lil closest of mistakes.... just as we all do. Biggest difference being~ ours generally effects ONE whereas doctors ONE can effect MANY.

June 16, 2005

Here are some suggestions for checking out a doctor. I'd love to

hear from orthodoc as to what he thinks of how I do this.

Keep it all in folders and written down!

Asking your General Practitioner and any medical practitioners,

nurses and PT's is always a good idea. It's not enough, but its a

start.

1) First find out the top orthopedic hospitals. It's unlikely that

a good doctor will be found at a second rate hospital. Ask the

hospital administrators office for outcome data on infection, dvt

and returns on orthopedic surgery.

2)Many states publish basic information on doctors including how

often they have paid out on malpractice, criminal records, training

etc. A pay out on malpractice is not a definite negative, often

these reports will indicate if the payment was " Average for the

circumstance " .

3)I doubt you will find a surgeon in a US hospital who is not board

certified but I guess its possible. You also want to find surgeons

who are fellowship trained, a kind of apprenticeship. Where they

got their training IS important. Not all schools are equal. Your

general practitioner can give you some idea of what the best schools

are.

4)How many years has your surgeon been board certified? Many

surgeons have a second surgeon in the OR that will be working with

them. Who is this person? Is he more or less experienced, is he

board certified and fellowship trained (or is he getting training)?

5) Ask a candidate surgeon's office for his Vitae or Resume.

You will be asked to sign some kind of release before surgery. READ

IT. Is this an experimental procedure or is your surgery being used

for training. Not bad, but something you should know and understand

Here are some questions that I asked candidate surgeons. (In

addition to those about the device, my case and so on.

1) Are you receiving financial inducements from manufacturers that

could even be considered as a motive for your decisions?

2) Are you engaged in a research project that could conceivably

motivate you to try out a procedure, process or device that others

might not choose for me?

3) Will anyone be in the operating room during my surgery who is not

essential to my care and well being? (Eg: students, salesmen,

trainees).

4) Who will be in the operating room and why? Will the person

responsible for anesthesia and vital signs be a Medical Doctor,

board certifed anesthesioligist?

5) Will you have any other surgical patients or responsibilities

from the moment that you make the first cut to the moment of the

last stitch? You would be amazed at how many prominent surgeons

actually work on multiple surgeries at one time with assistants

doing other phases of the operation.

6) How many orthopedic surgeries do you do a year? How many hip

surgeries do you do a year? How many hip surgeries on patients

whose case you consider similar to my own in terms of age, risks or

challenges? I would not get surgery from someone who does less

than 100 hips a year. I would not get surgery from someone who has

not done some significant portion of those on people like me.

7) You can not look for guarantees but a good surgeon has a goal for

you. What is it? What would he consider an " A " grade and what

would he consider a " B " grade. How does he do with other patients

in meeting his " A " goal?

Write your questions down before you go in. Be organized. His time

is limited and if you are organized, you will get more

accomplished. The surgeon may have his own list so make sure you

are both getting what you want done. If it appears you are

conflicting, discuss the agenda, who discusses what when.

> I have been reading these messages on doctors.

> Some time back I had written about finding out

> the qualifications of a doctor and how we might

> find out information on them.

>

> I was knocked off the internet for a time but went

> back to find that thread & seen where a few of you

> responded. I thank you for those responses.

> I did go to some of the sites recommended but found

> that they recommended docs that used their product.

>

> If that doc didn't use the particular product, they were

> not listed.

>

> My doc is Dr. Yashar in Kentucky. Has anyone ever heard

> of him?????? I am finding it difficult to find anything on him.

> My surgery was scheduled just today for Aug 1.

> It seems he is going on vacation and that is the soonest

> I can be worked in after his return.

> I am thankful as it still gives me time to try and find out

> something on this doc.

> Anyone heard of him?

>

> Just to refresh....I have had a Total right Hip done about 20

> years ago. The parts are worn out and has pushed up about

> 2 inches causing difficulty in walking and a lot of pain.

> The stem is still good...just need replacement parts.

> Yep, that's exactly how they explained it to me.

> Not to say they were not professional...After explaining in

> terms I did not understand I asked them to explain it so that

> I could understand. They were good about this...he actually

> showed me with my x-rays.

>

> Thanks so much in advance

>

June 16, 2005

I would agree with many of your points as being valid and worth doing.

There are some 'red herrings' though. I think that the best way to

find a doctor initially is by patient referral. If you trust someone

who had a good result and liked their surgeon, then that is a good

place to start. Primary care physicians and nurses are good too - but

they have their loyalties.

I'll go point by point for ya!

> Here are some suggestions for checking out a doctor. I'd love to

> hear from orthodoc as to what he thinks of how I do this.

>

> Keep it all in folders and written down!

>

> Asking your General Practitioner and any medical practitioners,

> nurses and PT's is always a good idea. It's not enough, but its a

> start.

>

> 1) First find out the top orthopedic hospitals. It's unlikely that

> a good doctor will be found at a second rate hospital. Ask the

> hospital administrators office for outcome data on infection, dvt

> and returns on orthopedic surgery.

Disagree here. There are many excellent total joint surgeons in

average community hospitals. If you go to the 'top' ortho hospitals

such as HSS or Mayo or Hopkins or Mass General- there is a very likely

chance that you will have a fellow operate on you with the attending

supervising- or in another room. That's what I did when I was a

fellow in a 'top' ortho hospital. The patients would come to one of

my attendings because they where famous and 'world-renown' - in the

end I (as one of the fellows) did the case nearly by myself.

Infection rates are good to know though. DVT rates are hard to determine.

>

> 2)Many states publish basic information on doctors including how

> often they have paid out on malpractice, criminal records, training

> etc. A pay out on malpractice is not a definite negative, often

> these reports will indicate if the payment was " Average for the

> circumstance " .

>

Agree. You don't want someone who is sued often. Some states have

many frivolous lawsuits thatget dropped, but may unfortunately show up

on the surgeon's record.

> 3)I doubt you will find a surgeon in a US hospital who is not board

> certified but I guess its possible. You also want to find surgeons

> who are fellowship trained, a kind of apprenticeship. Where they

> got their training IS important. Not all schools are equal. Your

> general practitioner can give you some idea of what the best schools

> are.

>

Disagree - esp. second part

You obviously want a board certified surgeon. A surgeon who just

finished residency or fellowship has usually passed their written

board exam just after residency. It takes two and a half more years

to sit for the oral boards and become board certified. The ABOS

requires ortho surgeons to practice for two years before they can sit

for the oral boards. There are many capabale young fellowship trained

ortho surgeons who haven't been in practice long enough become board

certified yet. It might be better to get this surgeon than his senior

partner who does general orthopaedics but only 20 TJAs per year and

never learned the newest techniques.

The part about making sure the fellowship was from the 'best schools'

is completely false thinking. This traps many patients into thinking

they are getting a better doctor. While almost all doctors know which

schools are the best for medical school (Harvard etc.), when it comes

to residency and fellowship training, those top names change from

field to field. The last person that you should ask is the GP about

which ortho residency or fellowship is good. You can't even ask an

ortho surgeon with another sub-speciality which total joint fellowship

is goo. They won't know - just like I have no idea which are the best

spine or hand fellowships currently or back when I was in my total

joint fellowship. I'll give you an example. I know a surgeon who

went to the same 'less prestigious' state school for college, medical

school, and ortho residency. Certainly not a spectacular or 'premier'

education when comparing resumes. He then went on to do a hand

fellowship at Yale. All his patients and primary care referral docs

say " Wow! Yale! He's a great doctor with great training " . We laugh

about it. Especially because no one knows that Yale is not considered

a 'great' hand fellowship and my friend spent half his time hanging

out on his boat on the coast while the residents did his work for him.

But because he has the 'Yale' diploma on his CV and office wall, he

gets more respect.

As far as total joint fellowships, I did one at a 'premier' program

were I was fortunate enough to get excellent hands on training doing

6-10 TJA per week and getting exposure to famous surgeons with great

mentoring. There are other 'high profile' fellowships that are

prestigious just because of the name. The fellows do little more than

round on the patients in the hospital, and do research to boost the

resumes of the famous surgeons that they are working for. Their

surgical experience is weak. Not to single out a specific total joint

fellowship, but you would think that Stanford would be one of the top

ones. They aactually have trouble filling their one fellowship spot

every year because it is not considered a 'great' fellowship. That

reputation may be chaning. But wouldn't you rather see a surgeon who

had 'Stanford' on their diploma? Total joints are not profitable for

surgeons anymore so most residents chose to go into spine, sports, and

hand where the money is. Of the 500+ residents who graduate every

year, about 2/3rds do a fellowship. Of those, only 30-40 do total

joint fellowships per year. Even famous people like Dr. Amstutz and

Dr. Schmalzried have trouble filling their fellowship spot because of

the short supply of total joint fellows.

So the name of the residency or fellowship training shouldn't carry

too much with the patient, but it always will. Lucky for some like

me. If you are fortunate enough to get a total joint fellowship

trained surgeon to do your TJA, you are usually better off. Just by

spending the extra year to focus on TJA, that surgeon learns alot in

the decision making, planning and technical espects of doing a TJA -

especially revisions. With that said, fellowships are kinda a new

thing. They actually started back in the 1970's as a sort of

'remediation' year for surgeons who didn't have the skills to go out

and practice. Back then, everyone did general orthopaedics. In the

late 1980's, subspecialization began blooming and fellowships became

more like focused apprenticeships. I think that older high volume

general surgeons have training equal to (or superior to) fellowship

trained joint surgeons since they lived and worked through the

evolution of the TJA industry and have alot of experience.

> 4)How many years has your surgeon been board certified? Many

> surgeons have a second surgeon in the OR that will be working with

> them. Who is this person? Is he more or less experienced, is he

> board certified and fellowship trained (or is he getting training)?

>

Kinda disagree.

Length of board certification is not as important as training and

volume. I know several surgeons who have been board certified 20 or

30 years and they show me their disaster TJA cases that make me cringe

when I think to myself 'what were they thinking?' followed by 'how am

I going to fix this?'

Almost every total joint is done by a surgeon and their assistant.

The assistant is usually either one of their partners, a fellow, a

resident, or a PA. The qualifications of the assistant are usually

irrelevant to the success of the procedure since only the main surgeon

is calling the shots. If you didn't want residents or fellows

assiting, then you would exclude yourself from seeing about 90% of the

'best most prestigious' surgeons in this country. Don't worry about

that. It is good to ask " who will actually be doing the surgery? " .

The right answer should be 'we both will to some degree, but I (main

surgeon run the case). TJA is a team effort. The person in the best

position to hit with the hammer usually does it. I would say that I

do about 90% of my cases, and my assistant does 10%. That's the

honest answer for most surgeons even if they say 'I do it all' -

unless they scrub with only a medical technician who has no training.

> 5) Ask a candidate surgeon's office for his Vitae or Resume.

>

> You will be asked to sign some kind of release before surgery. READ

> IT. Is this an experimental procedure or is your surgery being used

> for training. Not bad, but something you should know and understand

>

Good advice

> Here are some questions that I asked candidate surgeons. (In

> addition to those about the device, my case and so on.

>

> 1) Are you receiving financial inducements from manufacturers that

> could even be considered as a motive for your decisions?

>

Agree.

Almost all the famous hip/knee surgeons are paid consultants or get

royalties for the implants they use. Think about that. You should

know that before going in.

> 2) Are you engaged in a research project that could conceivably

> motivate you to try out a procedure, process or device that others

> might not choose for me?

>

Agree

> 3) Will anyone be in the operating room during my surgery who is not

> essential to my care and well being? (Eg: students, salesmen,

> trainees).

>

Agree

At a teaching hospital (University hospital), you will get students.

That's the price you pay for not going to a community hospital. They

usually stand in the corner cowering.

Salesmen are often need to answer questions about implant dimensions etc.

> 4) Who will be in the operating room and why? Will the person

> responsible for anesthesia and vital signs be a Medical Doctor,

> board certifed anesthesioligist?

>

Agree

> 5) Will you have any other surgical patients or responsibilities

> from the moment that you make the first cut to the moment of the

> last stitch? You would be amazed at how many prominent surgeons

> actually work on multiple surgeries at one time with assistants

> doing other phases of the operation.

>

Agree

Many surgeons (especially with fellows or residents) run 2-3 operating

rooms at the same time to increase their volume. They bounce back and

forth between cases. Anyone who does more than about 400 TJA per year

has to do it this way. So this may be a case where too much volume is

detrimental to the patient's care. There are 3 surgeons that I know

of that do 1000 TJA per year. Granted they dothem quickly, but they

also have fellows and run multiple O.R. rooms.

> 6) How many orthopedic surgeries do you do a year? How many hip

> surgeries do you do a year? How many hip surgeries on patients

> whose case you consider similar to my own in terms of age, risks or

> challenges? I would not get surgery from someone who does less

> than 100 hips a year. I would not get surgery from someone who has

> not done some significant portion of those on people like me.

>

Agree

Although THAs are done less often than TKAs. A surgeon is considered

a high volume surgeon is they do more than 300 TJA per year. That

usually comes out to be about 100 THAs and 200 TKAs.

> 7) You can not look for guarantees but a good surgeon has a goal for

> you. What is it? What would he consider an " A " grade and what

> would he consider a " B " grade. How does he do with other patients

> in meeting his " A " goal?

>

The surgeon would probably give you a subjective answer in a form that

you would want to hear.

> Write your questions down before you go in. Be organized. His time

> is limited and if you are organized, you will get more

> accomplished. The surgeon may have his own list so make sure you

> are both getting what you want done. If it appears you are

> conflicting, discuss the agenda, who discusses what when.

>

Good job.

>

> > I have been reading these messages on doctors.

> > Some time back I had written about finding out

> > the qualifications of a doctor and how we might

> > find out information on them.

> >

> > I was knocked off the internet for a time but went

> > back to find that thread & seen where a few of you

> > responded. I thank you for those responses.

> > I did go to some of the sites recommended but found

> > that they recommended docs that used their product.

> >

> > If that doc didn't use the particular product, they were

> > not listed.

> >

> > My doc is Dr. Yashar in Kentucky. Has anyone ever heard

> > of him?????? I am finding it difficult to find anything on him.

> > My surgery was scheduled just today for Aug 1.

> > It seems he is going on vacation and that is the soonest

> > I can be worked in after his return.

> > I am thankful as it still gives me time to try and find out

> > something on this doc.

> > Anyone heard of him?

> >

> > Just to refresh....I have had a Total right Hip done about 20

> > years ago. The parts are worn out and has pushed up about

> > 2 inches causing difficulty in walking and a lot of pain.

> > The stem is still good...just need replacement parts.

> > Yep, that's exactly how they explained it to me.

> > Not to say they were not professional...After explaining in

> > terms I did not understand I asked them to explain it so that

> > I could understand. They were good about this...he actually

> > showed me with my x-rays.

> >

> > Thanks so much in advance

> >

>

June 17, 2005

Good suggestions!

I mentioned in a post recently, I found that my PPO has a web site

that allows you to compare statistics for hospitals in your area. It

generates a fairly complete report and you can specify (generally) the

procedure. Apparently this is a service that is sold to insurance

companies for the use of their customers. It's worth looking/asking

whether your insurance company has such a service. The one I have

(through the First Health PPO) is from a company called HealthShare

Technology, Inc.

Do remember to write down your answers! After interviewing several

surgeons it may all start to run together!

> > I have been reading these messages on doctors.

> > Some time back I had written about finding out

> > the qualifications of a doctor and how we might

> > find out information on them.

> >

> > I was knocked off the internet for a time but went

> > back to find that thread & seen where a few of you

> > responded. I thank you for those responses.

> > I did go to some of the sites recommended but found

> > that they recommended docs that used their product.

> >

> > If that doc didn't use the particular product, they were

> > not listed.

> >

> > My doc is Dr. Yashar in Kentucky. Has anyone ever heard

> > of him?????? I am finding it difficult to find anything on him.

> > My surgery was scheduled just today for Aug 1.

> > It seems he is going on vacation and that is the soonest

> > I can be worked in after his return.

> > I am thankful as it still gives me time to try and find out

> > something on this doc.

> > Anyone heard of him?

> >

> > Just to refresh....I have had a Total right Hip done about 20

> > years ago. The parts are worn out and has pushed up about

> > 2 inches causing difficulty in walking and a lot of pain.

> > The stem is still good...just need replacement parts.

> > Yep, that's exactly how they explained it to me.

> > Not to say they were not professional...After explaining in

> > terms I did not understand I asked them to explain it so that

> > I could understand. They were good about this...he actually

> > showed me with my x-rays.

> >

> > Thanks so much in advance

> >

June 17, 2005

Ortho Doc <orthospecialist@...> wrote:

I would agree with many of your points as being valid and worth doing.There are some 'red herrings' though. I think that the best way tofind a doctor initially is by patient referral. If you trust someonewho had a good result and liked their surgeon, then that is a goodplace to start. Primary care physicians and nurses are good too - butthey have their loyalties.I'll go point by point for ya!> Here are some suggestions for checking out a doctor. I'd love to > hear from orthodoc as to what he thinks of how I do this.> > Keep it all in folders and written down!> > Asking your General Practitioner and any medical practitioners, > nurses and PT's is always a good idea. It's not enough, but its a > start.> > 1) First find out the top orthopedic

hospitals. It's unlikely that > a good doctor will be found at a second rate hospital. Ask the > hospital administrators office for outcome data on infection, dvt > and returns on orthopedic surgery.Disagree here. There are many excellent total joint surgeons inaverage community hospitals. If you go to the 'top' ortho hospitalssuch as HSS or Mayo or Hopkins or Mass General- there is a very likelychance that you will have a fellow operate on you with the attendingsupervising- or in another room. That's what I did when I was afellow in a 'top' ortho hospital. The patients would come to one ofmy attendings because they where famous and 'world-renown' - in theend I (as one of the fellows) did the case nearly by myself.Infection rates are good to know though. DVT rates are hard to determine.> > 2)Many states publish basic information on doctors including

how > often they have paid out on malpractice, criminal records, training > etc. A pay out on malpractice is not a definite negative, often > these reports will indicate if the payment was "Average for the > circumstance". > Agree. You don't want someone who is sued often. Some states havemany frivolous lawsuits thatget dropped, but may unfortunately show upon the surgeon's record.> 3)I doubt you will find a surgeon in a US hospital who is not board > certified but I guess its possible. You also want to find surgeons > who are fellowship trained, a kind of apprenticeship. Where they > got their training IS important. Not all schools are equal. Your > general practitioner can give you some idea of what the best schools > are. >Disagree - esp. second partYou obviously want a board certified surgeon. A surgeon

who justfinished residency or fellowship has usually passed their writtenboard exam just after residency. It takes two and a half more yearsto sit for the oral boards and become board certified. The ABOSrequires ortho surgeons to practice for two years before they can sitfor the oral boards. There are many capabale young fellowship trainedortho surgeons who haven't been in practice long enough become boardcertified yet. It might be better to get this surgeon than his seniorpartner who does general orthopaedics but only 20 TJAs per year andnever learned the newest techniques.The part about making sure the fellowship was from the 'best schools'is completely false thinking. This traps many patients into thinkingthey are getting a better doctor. While almost all doctors know whichschools are the best for medical school (Harvard etc.), when it comesto residency and fellowship training, those

top names change fromfield to field. The last person that you should ask is the GP aboutwhich ortho residency or fellowship is good. You can't even ask anortho surgeon with another sub-speciality which total joint fellowshipis goo. They won't know - just like I have no idea which are the bestspine or hand fellowships currently or back when I was in my totaljoint fellowship. I'll give you an example. I know a surgeon whowent to the same 'less prestigious' state school for college, medicalschool, and ortho residency. Certainly not a spectacular or 'premier'education when comparing resumes. He then went on to do a handfellowship at Yale. All his patients and primary care referral docssay "Wow! Yale! He's a great doctor with great training". We laughabout it. Especially because no one knows that Yale is not considereda 'great' hand fellowship and my friend spent half his time

hangingout on his boat on the coast while the residents did his work for him.But because he has the 'Yale' diploma on his CV and office wall, hegets more respect.As far as total joint fellowships, I did one at a 'premier' programwere I was fortunate enough to get excellent hands on training doing6-10 TJA per week and getting exposure to famous surgeons with greatmentoring. There are other 'high profile' fellowships that areprestigious just because of the name. The fellows do little more thanround on the patients in the hospital, and do research to boost theresumes of the famous surgeons that they are working for. Theirsurgical experience is weak. Not to single out a specific total jointfellowship, but you would think that Stanford would be one of the topones. They aactually have trouble filling their one fellowship spotevery year because it is not considered a 'great' fellowship.

Thatreputation may be chaning. But wouldn't you rather see a surgeon whohad 'Stanford' on their diploma? Total joints are not profitable forsurgeons anymore so most residents chose to go into spine, sports, andhand where the money is. Of the 500+ residents who graduate everyyear, about 2/3rds do a fellowship. Of those, only 30-40 do totaljoint fellowships per year. Even famous people like Dr. Amstutz andDr. Schmalzried have trouble filling their fellowship spot because ofthe short supply of total joint fellows.So the name of the residency or fellowship training shouldn't carrytoo much with the patient, but it always will. Lucky for some likeme. If you are fortunate enough to get a total joint fellowshiptrained surgeon to do your TJA, you are usually better off. Just byspending the extra year to focus on TJA, that surgeon learns alot inthe decision making, planning and

technical espects of doing a TJA -especially revisions. With that said, fellowships are kinda a newthing. They actually started back in the 1970's as a sort of'remediation' year for surgeons who didn't have the skills to go outand practice. Back then, everyone did general orthopaedics. In thelate 1980's, subspecialization began blooming and fellowships becamemore like focused apprenticeships. I think that older high volumegeneral surgeons have training equal to (or superior to) fellowshiptrained joint surgeons since they lived and worked through theevolution of the TJA industry and have alot of experience.> 4)How many years has your surgeon been board certified? Many > surgeons have a second surgeon in the OR that will be working with > them. Who is this person? Is he more or less experienced, is he > board certified and fellowship trained (or is he getting

training)? > Kinda disagree. Length of board certification is not as important as training andvolume. I know several surgeons who have been board certified 20 or30 years and they show me their disaster TJA cases that make me cringewhen I think to myself 'what were they thinking?' followed by 'how amI going to fix this?'Almost every total joint is done by a surgeon and their assistant. The assistant is usually either one of their partners, a fellow, aresident, or a PA. The qualifications of the assistant are usuallyirrelevant to the success of the procedure since only the main surgeonis calling the shots. If you didn't want residents or fellowsassiting, then you would exclude yourself from seeing about 90% of the'best most prestigious' surgeons in this country. Don't worry aboutthat. It is good to ask "who will actually be doing the surgery?". The right answer should

be 'we both will to some degree, but I (mainsurgeon run the case). TJA is a team effort. The person in the bestposition to hit with the hammer usually does it. I would say that Ido about 90% of my cases, and my assistant does 10%. That's thehonest answer for most surgeons even if they say 'I do it all' -unless they scrub with only a medical technician who has no training.> 5) Ask a candidate surgeon's office for his Vitae or Resume. > > You will be asked to sign some kind of release before surgery. READ > IT. Is this an experimental procedure or is your surgery being used > for training. Not bad, but something you should know and understand> Good advice> Here are some questions that I asked candidate surgeons. (In > addition to those about the device, my case and so on.> > 1) Are you receiving financial inducements from manufacturers

that > could even be considered as a motive for your decisions?> Agree. Almost all the famous hip/knee surgeons are paid consultants or getroyalties for the implants they use. Think about that. You shouldknow that before going in.> 2) Are you engaged in a research project that could conceivably > motivate you to try out a procedure, process or device that others > might not choose for me?> Agree> 3) Will anyone be in the operating room during my surgery who is not > essential to my care and well being? (Eg: students, salesmen, > trainees). > AgreeAt a teaching hospital (University hospital), you will get students. That's the price you pay for not going to a community hospital. Theyusually stand in the corner cowering.Salesmen are often need to answer questions about implant dimensions etc.> 4) Who will be

in the operating room and why? Will the person > responsible for anesthesia and vital signs be a Medical Doctor, > board certifed anesthesioligist?>Agree> 5) Will you have any other surgical patients or responsibilities > from the moment that you make the first cut to the moment of the > last stitch? You would be amazed at how many prominent surgeons > actually work on multiple surgeries at one time with assistants > doing other phases of the operation.> AgreeMany surgeons (especially with fellows or residents) run 2-3 operatingrooms at the same time to increase their volume. They bounce back andforth between cases. Anyone who does more than about 400 TJA per yearhas to do it this way. So this may be a case where too much volume isdetrimental to the patient's care. There are 3 surgeons that I knowof that do 1000 TJA per year. Granted they

dothem quickly, but theyalso have fellows and run multiple O.R. rooms.> 6) How many orthopedic surgeries do you do a year? How many hip > surgeries do you do a year? How many hip surgeries on patients > whose case you consider similar to my own in terms of age, risks or > challenges? I would not get surgery from someone who does less > than 100 hips a year. I would not get surgery from someone who has > not done some significant portion of those on people like me.>AgreeAlthough THAs are done less often than TKAs. A surgeon is considereda high volume surgeon is they do more than 300 TJA per year. Thatusually comes out to be about 100 THAs and 200 TKAs.> 7) You can not look for guarantees but a good surgeon has a goal for > you. What is it? What would he consider an "A" grade and what > would he consider a "B"

grade. How does he do with other patients > in meeting his "A" goal?> The surgeon would probably give you a subjective answer in a form thatyou would want to hear.> Write your questions down before you go in. Be organized. His time > is limited and if you are organized, you will get more > accomplished. The surgeon may have his own list so make sure you > are both getting what you want done. If it appears you are > conflicting, discuss the agenda, who discusses what when.> I had fell about almost 2 years ago & my knee was mess up will bad in i never had any problem with it at all untill i fell up at a resturant on concreated sir. & i don't have arthrites at all either sir. i couldn't straighten out my knee at all i was walking on my tip toes for almost six months until my pt. got my dr. to put my leg in a cast sir . in it did straight it out

sir. in my dr. said later on down the rd. i'll need a knee replacement sir. m pt. is real great sir. i was in the cast for 6 weeks sir. of crouse my dr. must of been mad because he didn't see me when in after they put my cast on to tight sir. but he had to see me the other day sir because my knee went out on me it just pop in down i went sir. on my exrays sir on my right knee you can see a split in my knee it's like a big o spase in the middle sir just like the began too. it's from the same injury sir. in he said i had spurs inside my knee sir. why can't they do anything about that because i'm back on my walking cane sir. in i'm only 40 years old in i need to get well because my mom is a heart patient in they are talking about a heart by pass surgery too. in i got to hae pt for 6 weeks. but know other dr. will see me because i had 2 orthorpocropices surgery or 3 of those surgery done ok. i just can't spell that surgey word at all sir so i oablely speel it wrong .i don't know

what to do either at all . becaue if i didn't have my pt. i would still proablely be still walkig on my tip toes today sir. the Baspist MEDICAL park is really good .there on 9 mile rd.> > Good job. > > > > > > I have been reading these messages on doctors.> > Some time back I had written about finding out > > the qualifications of a doctor and how we might > > find out information on them.> > > > I was knocked off the internet for a time but went> > back to find that thread & seen where a few of you > > responded. I thank you for those responses.> > I did go to some of the sites recommended but found> > that they recommended docs that used their product.> > > > If that doc didn't use the particular

product, they were> > not listed.> > > > My doc is Dr. Yashar in Kentucky. Has anyone ever heard> > of him?????? I am finding it difficult to find anything on him.> > My surgery was scheduled just today for Aug 1.> > It seems he is going on vacation and that is the soonest > > I can be worked in after his return.> > I am thankful as it still gives me time to try and find out> > something on this doc.> > Anyone heard of him?> > > > Just to refresh....I have had a Total right Hip done about 20> > years ago. The parts are worn out and has pushed up about> > 2 inches causing difficulty in walking and a lot of pain.> > The stem is still good...just need replacement parts.> > Yep, that's exactly how they explained it to me.> > Not to say they were not professional...After explaining in > >

terms I did not understand I asked them to explain it so that> > I could understand. They were good about this...he actually> > showed me with my x-rays. > > > > Thanks so much in advance> > > > > > > > > > > >

June 18, 2005

My original doc from child hood was Dr. Leatherman..>>> Mine was actually De in IN bad when U loose a doctor that your used 2 dealing with which knows the details of your case in & out! Not 2 mention U MISS THEM when you've been there patient 4 so long~

He said he would have FUSED it. When I asked what that was, well, I did not like his answer at all. >>> Yeah I got that recommendation at 16 and was told 2 pick fixed seated or standing position~ my mother was actually CONSIDERING IT... which ticked my turd 2 say the least... When the doctor asked whether 2 schedule... I merely looked at my mom and KNEW her "study bout it look which meant U getting cut again" and said... I'll B back when I crawl & can't take NO MORE.... I left the office with my pants in hand, panties flashing the lobby nearly RUNNING 2 the car telling my mom~ I'll run away B4 someone does that CRAP 2 ME! Kinda how the 20 yr. wait happened in my case. LOL I wanted 2 put it off long enough that a VERY DIFFERENT OPTION was available 4 me before I HAD 2 HAVE something done about my leg. LOL

Sheesh..what a heart this man had. >>> It's sad that with doctors experience comes a level of "sucky bedside manners & lack 4 patients emotions" in some. I suppose with their career they become numbed by the heartache they see & the stresses of what they might've done differently 2 change their patients out come.... but a bad health issue can be overwhelming 2 a patient and of all things 2 have a doctor "seem like they could give a careless about it all~ they're just a chart number" can make it worse.

I have been reading these postings for some time and have seen things I never heard of...drop foot and such. >>> That's the thing... MANY don't research the details. They merely listen 2 what doc has 2 recommend and GOES WITH IT! After all their "suppose 2 B" the one that cares enough 2 fix US! People tend 2 see THR one sided.... because "the MAJORITY" have lil 2 no problems and it's not hard when U add coming 2 message boards and all everyone is speaking is the positive" side of it all. That's how it was for me when I sought information on the matter for my THR. I can't count the times I heard "your young, active... don't worry, it'll be terrific being painfree afterward"... BLA BLA BLA Although I DID research the list of complications & do my part... things didn't go "by the books" and I had one of the best doctors in state doing it. Sometimes your body has a different plan... and that's the way it goes! Some people believe the ONLY complication is infection during or dislocation aferward.... when there are MULTIPLE issues and these are not all possible issues but SOME~ take the time 2 research it for yourself and at least KNOW exactly what your getting into.... whether it's THR or buying a car~ an informed customer gets the best buy and at least KNOWS what their in for....

Complications during surgerical procedure~

Nerve damage (risk: 0.5-3.5%)

Vascular damage (risk: 0.1% for primary replacements and less than 1% for revision replacements).

Fracture (risk: less than 1% for primary replacements and 3% for revision replacements).

Foot drop (risk: less then 0.5%).

Cortical perforation (risk: up to 4.5%).

Leg length inequality (risk: 6% for primary replacements and 7.5% for revision replacements)

Death (risk: 2%)

POST OPERATIVE PROBLEMS~

Dislocation (risk: 0.5-3%).

Infection (risk: 7% for superficial infections and 0.5% for deep infections).

Trochanteric problems (risk: 9.5% for trochanteric non-union and 17% for trochanteric bursitis).

Bowel complications (risk: 1%)

Urinary complications (risk: up to 35%).

Cardiovascular complications, including deep vein thrombosis (risk: up to 26%).

Respiratory complications (risk: 1%).

Haematoma formation (risk: 3%).

Wound dehiscence, Prosthetic displacement, Knee pain, and Swollen ankles (risk: less then 1%)

Skin complications (risk: less than 1%)

Metabolic complications (risk: less than 1%)

Death (risk: 1%)

LONG TERM COMPLICATION FACTORS are~

Aseptic loosening

Bone stock loss

Component fracture

Late dislocation (risk: 2%)

Late infection (risk: less than 1%)

Bone fracture (risk: less than 1%)

Ectopic ossification (7% for primary replacements and 15% for revision replacements).

I don't think I was as concerned till I read these things. Good to know there are things we should consider. >>>But it's good being concerned... because that ensure your curious enough 2 CHECK IT OUT!

That's where YOUR PART of the game comes into play. U have 2 make a WELL informed decision based on your specific case problems & LIFE NEEDS~ NO ONE knows your body better then U and I can promise U no one else will live with the results either! Make sure that U know the benefits AND DRAW BACKS in detail.... because it's a very real option that might B yours in the end. If hearing the list of possible complications bothers U... then U might want 2 consider another alternative because reality of it is.... there R NO PROMISES! The more complications your case history brings 2 the table, the added level of risk~ but then too.... take the time 2 look at the other side of that. Eatting is a risk which could kill U amoung other things~ sometimes we have 2 make choices which R a NECESSITY in our lives.... and R limited on our options~ that's when all one can do is make a well informed choice and roll with the bunches. Even with a "not so terrific THR turn out"..... life is only what U make of it. And matters could ALWAYS BE WORSE!

Thinking of mentioning this to Yashar so that he pays special attention. >>>I think the "real doctors" of the world~ meaning R with degree & doing what they do well (not quacks that fake having degrees etc.)..... do everything in their power 2 ensure their patient the best results possible out come. But I know first hand... even the well recommended, experienced, best known doctors still have 2 address complications with patients because of what their body limits them 2. Don't mean that their any "less" of a doctor because U don't get the "perfect out come".... just means on occasion~ that things R meant 2 B!

I wish U the best of luck .... for a wonderful out come on your THR and a rapid recovery! May U find a well walk soon & B painfree in the end.... you'll B remember in my prayers sweetie and I hope how soon it's all over & done for ya~ as I know the "waiting game" is one of the worst experiences about the whole thing! Take care~

June 18, 2005

Here are some suggestions for checking out a doctor. I'd love to hear from orthodoc as to what he thinks of how I do this.>>> I'm not Ortho.... but I say EXCELLENT JOB Geoff! Maybe Ortho got the "VERY SMALL" listing of what you've missed checking. LOL

June 18, 2005

Primary care physicians and nurses are good too - but they have their loyalties >>>Agree 100% valid point

June 18, 2005

the pt. i go to help me & my mom to get my dr. to foundly put my leg in a cast since it would not straighten out a all. after my accidentlly fell at a restarunt in my right knee was really badlly hurt in wouldn't straighted out at all i was & in out of the hosiptal i was walking on my tiptoes for six whole weeks . & he foundlly told the dr. to do his job. & now my knee 's staight foundly but they said later on down the rd. i'll have to have a knee replacement & the lother weekend i was just walking to the ice box to get something to drink in my knee just pop in went out on me in my nephew had to go & get my walking cane so i'm back on that . & my dr. still want tell why my knee on the exray show that i had a split or it might be call a spce inside my knee but he did say i had spurs inside of my knee sir. or miss. they said i had to wait until i'm 60 years old if not longer . & i'm only 40 right now in never had any problems at all with my

bones or legs or anything else except for cervical cancer which i had . & my mom is a heart patient who they are talking about doing a heart by pass surgey on her since she can't have any more stents put in at all since they said since she already have 5 of those stents in her heart . & she's only 68 years old. & i have 6 weeks of pt. again on the same knee again the dr did 2or three of those oropthrcopices surgery . wich i can't spell that word at all. but since you're a dr. you'll beable to know what kind of surgery i was spelling it has been almost close to 2 years since i fell & have never had any arthies either .had know proablem until i fell . & i was doing alright for a while & then my knee pop just like the loudest firecracker you have every pop & my knee went out & i went down on the floor & my nephew had to get up in go in get my walking cane in help me up . & bush is cutting everything now . i can't

afford the surgery if in when they say i can have done i can't even aford to go to my pt. next week because we are out of gas . me & my mom is very disabled too. i even found out when they did the locally in put the medicine in my back it's call the loccally intersteationes. make my mucles relax in to numb me or parallizex them it was the strong 1 even though i couldn't spell the guy who gave me the stuff told me & my mom not to have that kind .but they found out that it paralselices the wrong side of my muccles it did the left side frirst & then it foundly did the right side after they had to move the needle in my back to the middle almost like on the left side.in i'm still in alot of pain .in my knee is red in swollen in hurting real bad in this time is when he told us about the spurs inside my knee .the last time i had spider web inside my knee after i had fell down .SassyLouYou@... wrote:

Primary care physicians and nurses are good too - but they have their loyalties >>>Agree 100% valid point

June 5, 2008

Out of all the doctors in our area all of them believe in or enforce

vaccinations but I of course don't feel the same way and no matter

what I say it is like if I don't get them they almost won't treat my

kids or they look at me like I am crazy or stupid. There have been

vaccinations that I received as a child and still got a few of the

diseases they were supposed to prevent. Fortunately my oldest now 13

almost 14 has no signs of damage from having all vaccinations while he

was younger but now that he is going into 8th grade they want me to

give him a couple more vaccinations. So should I at the beginning of

the school year get an exemption form? Will that be all I need to do?

And what do I do about the doctors view of the vaccinations? Thanks

for any help.

June 5, 2008