your opinion on drs

[Guest guest]

Hello,

I have a couple of things to share with you. First of all, I had an amnio a

couple of weeks ago due to a soft marker scare on our initial ultrasound at

the end of July. I know it is unconventional to have an amnio at 35 weeks

but this was the compromise my husband and I made so that I would know the

results before labour without risking the baby. Anyway, I got the call today

that the results are normal! Today is my birthday and I can't imagine a

better birthday present! I feel like I've been living with a current of

anxiety running through me for months and it feels like a weight has been

lifted!

The other thing I just wanted to run by you just to get some insight, is

your opinion on what you might do if you were may as it relates to what

doctor to choose.

I met with Dr. Kiefer on Tuesday and he was trained by Dr. Pirani from

Vancouver who is highly recommended by Dr. Ponseti.

Anyway, there are six orthopedic doctors that work together at the

Children's Hospital. I have now met with two of them who both seem to follow

the Ponseti method.

There were a couple of things Dr. Kiefer said that I wondered about. First

of all, he uses fibreglass casts (as does Dr. Pirani in Vancouver w/ good

results) but says that b/c of that, the babies are casted an average of 8-9

weeks as opposed to the avg of 6 that Ponseti states. Is this too many or

does using fibreglass increase the number of casts it takes to achieve

correction b/c it is not quite as rigid?

Also, he mentioned that Ponseti says that many kids need some sort of

surgery around 7-10 yrs of age when they have a growth spurt. I didn't say

that I think he is wrong about that....but I think he is wrong about that.

Isn't the whole point of Ponseti to avoid surgery beyond just the tenotomy?

He was very helpful in answering questions and said not to feel obligated to

any one doctor here or to him b/c we've had a consult. He did say that if I

am looking for a doctor that is a true Ponseti purist, that Dr.

would be the best choice. He uses only plaster b/c he doesn't deviate from

what Ponseti says. I think that sounds like the best option to me. He is

slightly more junior than Dr. Kiefer and maybe doesn't have quite as many

years of experience but it sounds like he is very committed to the method.

That's who I am leaning towards...what do you think?

If we start casting before the New Year, there is a week where Dr. is

gone and it would be Dr. Goldstein (who uses fibreglass, sometimes only half

leg casts but not always and generally would be further from true Ponseti

then the other drs there). Would it be okay to have the first cast by Dr.

and then have this other doctor cast for one week or might that mess

things up since he does his own thing it sounds like?

Okay (sorry this is long!), just something of interest is that one of Dr.

Hertzenberg's partners is coming up here to be a visiting physician in the

New Year sometime. That is great b/c I hear so many things about Dr.

Hertzenberg and his group. They are starting a study here in the New Year so

that parents choose either plaster or fiberglass casts and the dr must use

what the parents wants despite what they themselves prefer. They want to see

if the convenience of fiberglass casts is worth a couple of extra weeks of

casting or if the rigidity of the plaster has a positive effect on the

outcome.

Thanks for your feedback!

Take care,

Halley

[Guest guest]

Halley~

I too had an amnio during my pregnancy and know what it is like to wait for

those results. I can remember the relief that I felt upon learning that my

baby girl was going to be OK. I can also remember the sadness that I felt,

because there are so many parents that do not get that relief. I am

happy for you and your husband. So, happy birthday to you... hope you

are going to do something special

As for the casting questions... I do not believe that all casting is the

same. Our original doctor used the fiberglass casts and I believe that is

why we had the problems that we did transitioning to the shoes. The

fiberglass casts are softer and lighter, but they also have a more " give " to

them. I do not think that Maddie's feet were fully corrected using the

fiberglass casts. I should say that I do not know if this is because of the

manipulation by the doctor, or as a direct result of the casts.... Of

course I did not know any of this this at the time... When we went into the

shoes, with a 70 degree rotation, it was hell. Long story short, we

switched to Dr. Herzenberg, and EVERYONE is much happier.

Hind sight is 20-20, but my original doctor told me that it is not un-common

to go back into fiberglass casts after wearing the shoes for a period of

time. I can remember seeing other parents there getting

" re-casted " after going into the shoes. Knowing what I know now--- I would

have run after seeing and hearing that. I think that Dr. Ponseti has put

years of experience into fine-tuning his protocol and his results speak

volumes. Deviation from that protocol could (not saying that it absolutely

will) effect your results. I can tell you that Dr. Herzenberg uses the

plaster casts and follow the protocol strictly.

Hope that helps and best of luck you and your family. Keep in touch!

Kim

>

> Hello,

>

> I have a couple of things to share with you. First of all, I had an amnio

> a

> couple of weeks ago due to a soft marker scare on our initial ultrasound

> at

> the end of July. I know it is unconventional to have an amnio at 35 weeks

> but this was the compromise my husband and I made so that I would know the

>

> results before labour without risking the baby. Anyway, I got the call

> today

> that the results are normal! Today is my birthday and I can't imagine a

> better birthday present! I feel like I've been living with a current of

> anxiety running through me for months and it feels like a weight has been

> lifted!

>

> The other thing I just wanted to run by you just to get some insight, is

> your opinion on what you might do if you were may as it relates to what

> doctor to choose.

> I met with Dr. Kiefer on Tuesday and he was trained by Dr. Pirani from

> Vancouver who is highly recommended by Dr. Ponseti.

> Anyway, there are six orthopedic doctors that work together at the

> Children's Hospital. I have now met with two of them who both seem to

> follow

> the Ponseti method.

> There were a couple of things Dr. Kiefer said that I wondered about. First

>

> of all, he uses fibreglass casts (as does Dr. Pirani in Vancouver w/ good

>

> results) but says that b/c of that, the babies are casted an average of

> 8-9

> weeks as opposed to the avg of 6 that Ponseti states. Is this too many or

> does using fibreglass increase the number of casts it takes to achieve

> correction b/c it is not quite as rigid?

> Also, he mentioned that Ponseti says that many kids need some sort of

> surgery around 7-10 yrs of age when they have a growth spurt. I didn't say

>

> that I think he is wrong about that....but I think he is wrong about that.

>

> Isn't the whole point of Ponseti to avoid surgery beyond just the

> tenotomy?

> He was very helpful in answering questions and said not to feel obligated

> to

> any one doctor here or to him b/c we've had a consult. He did say that if

> I

> am looking for a doctor that is a true Ponseti purist, that Dr.

>

> would be the best choice. He uses only plaster b/c he doesn't deviate from

>

> what Ponseti says. I think that sounds like the best option to me. He is

> slightly more junior than Dr. Kiefer and maybe doesn't have quite as many

> years of experience but it sounds like he is very committed to the method.

>

> That's who I am leaning towards...what do you think?

> If we start casting before the New Year, there is a week where Dr.

> is

> gone and it would be Dr. Goldstein (who uses fibreglass, sometimes only

> half

> leg casts but not always and generally would be further from true Ponseti

> then the other drs there). Would it be okay to have the first cast by Dr.

> and then have this other doctor cast for one week or might that

> mess

> things up since he does his own thing it sounds like?

>

> Okay (sorry this is long!), just something of interest is that one of Dr.

> Hertzenberg's partners is coming up here to be a visiting physician in the

>

> New Year sometime. That is great b/c I hear so many things about Dr.

> Hertzenberg and his group. They are starting a study here in the New Year

> so

> that parents choose either plaster or fiberglass casts and the dr must use

>

> what the parents wants despite what they themselves prefer. They want to

> see

> if the convenience of fiberglass casts is worth a couple of extra weeks of

>

> casting or if the rigidity of the plaster has a positive effect on the

> outcome.

>

> Thanks for your feedback!

>

> Take care,

> Halley

>

>

>

>

>

[Guest guest]

Congratulations on the results of your amnio. On the fiberglass vs plaster

thing, our doctor told me that the plaster is better because you can get it to

conform to the foot better than the fiberglass so therefore it holds the

correction of the foot in better, iif that makes sense. I know several of the

Ponseti doctors do use fiberglass with success but that may be why it takes

longer with the fiberglass.

I would go with the Doctor that appeals more to your Mommy sense. I do not

think you can underestimate that Mommy instinct when it comes to your kids. It

would probably be OK for that other doctor to put on one cast but I would

insist that it not be a short leg cast. I have never heard of this surgery at

7-10 years of age. Maybe someone who has been around longer can shed some

light on that but that is not a standard part of the protocol to my knowledge.

Good luck with your decision.

Jenni

Halley Prestage wrote: Hello,

I have a couple of things to share with you. First of all, I had an amnio a

couple of weeks ago due to a soft marker scare on our initial ultrasound at

the end of July. I know it is unconventional to have an amnio at 35 weeks

but this was the compromise my husband and I made so that I would know the

results before labour without risking the baby. Anyway, I got the call today

that the results are normal! Today is my birthday and I can't imagine a

better birthday present! I feel like I've been living with a current of

anxiety running through me for months and it feels like a weight has been

lifted!

The other thing I just wanted to run by you just to get some insight, is

your opinion on what you might do if you were may as it relates to what

doctor to choose.

I met with Dr. Kiefer on Tuesday and he was trained by Dr. Pirani from

Vancouver who is highly recommended by Dr. Ponseti.

Anyway, there are six orthopedic doctors that work together at the

Children's Hospital. I have now met with two of them who both seem to follow

the Ponseti method.

There were a couple of things Dr. Kiefer said that I wondered about. First

of all, he uses fibreglass casts (as does Dr. Pirani in Vancouver w/ good

results) but says that b/c of that, the babies are casted an average of 8-9

weeks as opposed to the avg of 6 that Ponseti states. Is this too many or

does using fibreglass increase the number of casts it takes to achieve

correction b/c it is not quite as rigid?

Also, he mentioned that Ponseti says that many kids need some sort of

surgery around 7-10 yrs of age when they have a growth spurt. I didn't say

that I think he is wrong about that....but I think he is wrong about that.

Isn't the whole point of Ponseti to avoid surgery beyond just the tenotomy?

He was very helpful in answering questions and said not to feel obligated to

any one doctor here or to him b/c we've had a consult. He did say that if I

am looking for a doctor that is a true Ponseti purist, that Dr.

would be the best choice. He uses only plaster b/c he doesn't deviate from

what Ponseti says. I think that sounds like the best option to me. He is

slightly more junior than Dr. Kiefer and maybe doesn't have quite as many

years of experience but it sounds like he is very committed to the method.

That's who I am leaning towards...what do you think?

If we start casting before the New Year, there is a week where Dr. is

gone and it would be Dr. Goldstein (who uses fibreglass, sometimes only half

leg casts but not always and generally would be further from true Ponseti

then the other drs there). Would it be okay to have the first cast by Dr.

and then have this other doctor cast for one week or might that mess

things up since he does his own thing it sounds like?

Okay (sorry this is long!), just something of interest is that one of Dr.

Hertzenberg's partners is coming up here to be a visiting physician in the

New Year sometime. That is great b/c I hear so many things about Dr.

Hertzenberg and his group. They are starting a study here in the New Year so

that parents choose either plaster or fiberglass casts and the dr must use

what the parents wants despite what they themselves prefer. They want to see

if the convenience of fiberglass casts is worth a couple of extra weeks of

casting or if the rigidity of the plaster has a positive effect on the

outcome.

Thanks for your feedback!

Take care,

Halley

[Guest guest]

Halley-

Congrats on your amnio results and happy belated birthday!

I have also been told that it's the " moldability " factor of the

plaster that makes it the preferred material for the Ponseti

method. My daughter had the soft fiberglass material before we

switched to Ponseti, and while it was light weight, it was also very

big and round, not contoured- so I can see how it wouldn't lend

itself well to the doctor being able to hold the foot " just so " when

casting. Having watched Dr. P mold and shape the plaster with his

fingers, and cradle the foot in a certain position for a few minutes

as the plaster set up- adds to my personal experience as to why I

would choose plaster over fiberglass....because it seems more of

an " exact " setting versus just wrapping the material around and not

being able to make the small indentions and formations like you can

with the plaster.

That said, Doctors like Mosca have used the fiberglass with

success. I would be curious to know if Mosca's average number of

casts are higher due to the fiberglass material also.

If this Dr. Keifer told you that he's not a Ponseti purist and told

you that another doctor in the group is.....well, I'd go to that

purist, personally...as long as you check to make sure that he is

indeed using the method successfully. I would also wait the extra 2

weeks to start instead of having Goldstein apply the 2nd cast. If

he uses short-legged casts on a regular basis, this indicates to me

that he doesn't understand the protocol and isn't manipulating the

foot correctly......so why bother even having him apply a long-

legged cast if you're not sure that he's actually moving the bones

in the proper sequence and not just " casting into the neutral

position " .

This is just what I would do.

Many, many of us started off with the wrong doctors for *months*

allowing them to manipulate the feet incorrectly.......it's better

to wait a few extra weeks to have your child start off in the right

hands versus going through the motions with someone that may

actually be doing more harm than good.

That's my 2 cents!

Regards,

& (3-16-00, left clubfoot)

http://ponseticlubfoot.freeservers.com/

P.S., about the surgery Keifer is referring to- it's probably the

ATTT surgery. It is referenced in Dr. P's documentation. I am

guessing that with the next round of studies that will be published,

since they are now having the children wear the FAB as long as

possible (age 4-6 instead of 2-3), the number of children who will

require the ATTT will be drastically reduced. I don't know this for

sure, but it does make a lot of sense to me- their regression rates

have dropped dramatically and the need for surgical intervention

therefore has dropped also.

[Guest guest]

I just want to add another two bits about the fibreglass casts. While Hayden

has not had plaster at all so I can't truly make a comparison, it appears to me

that Dr. Pirani does all of the molding with the first layer around the foot

before he adds the rest of it and yes it is somewhat rigid, but supple enough

that you can manipulate it it baby's toes seem squashed or anything. But two

things: First of all, I don't know what the restrictions are on getting the

plaster casts wet, but if baby happens to pee and a little of it gets on the

fibreglass exterior, then it is fine. The fibreglass can't get fully soaked,

not because of cast breakdown but because it will affect the skin underneath.

Second, if Hayden had received plaster casts, he would have broken them in the

first day over the last month because of the way he bangs his feet on the

floor/crib/me.

I am not trying to make one sound better than the other, because obviously

Dr. Ponseti has been using plaster for fifty years with great success, but I

want you to know that the fibreglass has it's benefits, too.

jennyandkelly wrote: Halley-

Congrats on your amnio results and happy belated birthday!

I have also been told that it's the " moldability " factor of the

plaster that makes it the preferred material for the Ponseti

method. My daughter had the soft fiberglass material before we

switched to Ponseti, and while it was light weight, it was also very

big and round, not contoured- so I can see how it wouldn't lend

itself well to the doctor being able to hold the foot " just so " when

casting. Having watched Dr. P mold and shape the plaster with his

fingers, and cradle the foot in a certain position for a few minutes

as the plaster set up- adds to my personal experience as to why I

would choose plaster over fiberglass....because it seems more of

an " exact " setting versus just wrapping the material around and not

being able to make the small indentions and formations like you can

with the plaster.

That said, Doctors like Mosca have used the fiberglass with

success. I would be curious to know if Mosca's average number of

casts are higher due to the fiberglass material also.

If this Dr. Keifer told you that he's not a Ponseti purist and told

you that another doctor in the group is.....well, I'd go to that

purist, personally...as long as you check to make sure that he is

indeed using the method successfully. I would also wait the extra 2

weeks to start instead of having Goldstein apply the 2nd cast. If

he uses short-legged casts on a regular basis, this indicates to me

that he doesn't understand the protocol and isn't manipulating the

foot correctly......so why bother even having him apply a long-

legged cast if you're not sure that he's actually moving the bones

in the proper sequence and not just " casting into the neutral

position " .

This is just what I would do.

Many, many of us started off with the wrong doctors for *months*

allowing them to manipulate the feet incorrectly.......it's better

to wait a few extra weeks to have your child start off in the right

hands versus going through the motions with someone that may

actually be doing more harm than good.

That's my 2 cents!

Regards,

& (3-16-00, left clubfoot)

http://ponseticlubfoot.freeservers.com/

P.S., about the surgery Keifer is referring to- it's probably the

ATTT surgery. It is referenced in Dr. P's documentation. I am

guessing that with the next round of studies that will be published,

since they are now having the children wear the FAB as long as

possible (age 4-6 instead of 2-3), the number of children who will

require the ATTT will be drastically reduced. I don't know this for

sure, but it does make a lot of sense to me- their regression rates

have dropped dramatically and the need for surgical intervention

therefore has dropped also.

[Guest guest]

Wetness on the plaster can be an issue- not in small amounts, but

large amounts.....mostly, though because of the cotton layers

underneath getting wet, just like the fiberglass......then it would

get pretty rank.

I have seen them do a fiberglass overlay on the plaster for the kids

who are rough on them. =)

[Guest guest]

Actually that would have been cool - plaster with a fibreglass overlay!

jennyandkelly wrote: Wetness on the

plaster can be an issue- not in small amounts, but

large amounts.....mostly, though because of the cotton layers

underneath getting wet, just like the fiberglass......then it would

get pretty rank.

I have seen them do a fiberglass overlay on the plaster for the kids

who are rough on them. =)

[Guest guest]

Hi there Halley!

I think that has given you some really good advise here! I too

personally would just wait and see Dr. . I would be nervous to

have a doctor that applies short leg casts do the casting!

It will be nice for you to have that time over the holidays to have

with your baby free from casts anyway!!

Dr. Pirani has excellent results with the fiberglass and corrected

Grace's foot in 4 casts - no tenotomy. So I think that the *material*

is not really as important as the skill of the hands applying it.

I think that it is just awesome of you to have done so much research

and worked so hard to find the right doctor for your baby Halley! You

can feel confident that you know how things are supposed to go with

the casting process - you are already ahead of the game in that

regard!

I hope that Dr. is a 'Ponseti purist' (they all should be for

heaven sakes!!) and that he has been able to get good results!

Big Hugs,

& Grace

PS...hope you are keeping warm, heard you have been having quite the

cold spell!

Happy belated b-day!! And good to hear that you got good news from

your amnio!

>

> Halley-

> Congrats on your amnio results and happy belated birthday!

> I have also been told that it's the " moldability " factor of the

> plaster that makes it the preferred material for the Ponseti

> method. My daughter had the soft fiberglass material before we

> switched to Ponseti, and while it was light weight, it was also

very

> big and round, not contoured- so I can see how it wouldn't lend

> itself well to the doctor being able to hold the foot " just so "

when

> casting. Having watched Dr. P mold and shape the plaster with his

> fingers, and cradle the foot in a certain position for a few

minutes

> as the plaster set up- adds to my personal experience as to why I

> would choose plaster over fiberglass....because it seems more of

> an " exact " setting versus just wrapping the material around and not

> being able to make the small indentions and formations like you can

> with the plaster.

> That said, Doctors like Mosca have used the fiberglass with

> success. I would be curious to know if Mosca's average number of

> casts are higher due to the fiberglass material also.

> If this Dr. Keifer told you that he's not a Ponseti purist and told

> you that another doctor in the group is.....well, I'd go to that

> purist, personally...as long as you check to make sure that he is

> indeed using the method successfully. I would also wait the extra

2

> weeks to start instead of having Goldstein apply the 2nd cast. If

> he uses short-legged casts on a regular basis, this indicates to me

> that he doesn't understand the protocol and isn't manipulating the

> foot correctly......so why bother even having him apply a long-

> legged cast if you're not sure that he's actually moving the bones

> in the proper sequence and not just " casting into the neutral

> position " .

> This is just what I would do.

> Many, many of us started off with the wrong doctors for *months*

> allowing them to manipulate the feet incorrectly.......it's better

> to wait a few extra weeks to have your child start off in the right

> hands versus going through the motions with someone that may

> actually be doing more harm than good.

> That's my 2 cents!

> Regards,

> & (3-16-00, left clubfoot)

> http://ponseticlubfoot.freeservers.com/

>

> P.S., about the surgery Keifer is referring to- it's probably the

> ATTT surgery. It is referenced in Dr. P's documentation. I am

> guessing that with the next round of studies that will be

published,

> since they are now having the children wear the FAB as long as

> possible (age 4-6 instead of 2-3), the number of children who will

> require the ATTT will be drastically reduced. I don't know this for

> sure, but it does make a lot of sense to me- their regression rates

> have dropped dramatically and the need for surgical intervention

> therefore has dropped also.

>