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  • Criteria for picking a surgeon

    I was perusing the group here and noted several comments about going to multiple surgeons before finding the "right" one. I was just wondering how folks decide.

    In my case, it was a three-step process:

    1. Our orthopod referred us to him. Our orthopod no longer does surgeries and now refers all cases to our surgeon including the orthopod's own daughter. The latter fact, of course, inspires a certain amount of confidence in our surgeon, sight unseen.

    2. I reviewed his schools, qualifications, certifications, areas of specialty, etc. and they were all appropriate for posterior spinal fusion for AIS.

    3. During the consultation, he was very good with both my daughters and with me. I had earlier asked him if he did certain procedures and he was prepared to say what he did and what he thought of those procedures when we were there. I had formed some tentative opinions about various things and he held similar opinions. We were on the same wavelength it seems. He confidently took all questions and didn't rush us at all.

    Based on those three criteria, I am confident this is a good guy to do the surgery.

    He is the only surgeon we have consulted (not counting the orthopod who is also a surgeon and did these surgeries). I was just wondering if others had a similar approach to picking a surgeon.

    sharon
    Last edited by Pooka1; 03-08-2008, 09:10 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  • #2
    Hi Sharon,

    I took my daughter to five doctors total until we found the right one. From day one I told Jamie this was her Scoliosis, but her dad and I would be there with her every step of the way. What I meant by this was I wanted her totally involved in every step and I wanted to give her control over the situation. I checked all the doctors background, talked to their patients, etc. etc.

    Here's what made our decision:

    Doctor #1: Sent to by our family doctor who diagnosed the Scoliosis. Family doc said this would be a good place to start since it is a great children's hospital and it was close to home. Family doc said if we weren't happy there, he'd recommend going to DuPont where he took his own son.
    This doctor talked only to me and treated Jamie as though she were 2 y.o. instead of 12 y.o. He was very unwilling to make allowance when it came to her Milwaukee brace. Example: what 12 y.o. wants to wear a Milwaukee brace to a school dance? We saw him twice, I think.

    Doctor #2: Same hospital, but a woman. I thought I woman would be more understanding and could possibly help with the non-compliance of bracing wearing. She switched Jamie to a Boston brace, but only agreed to add additional hardware to the brace in order to address her Kyphosis after I insisted. She was only concerned with the Scoliosis and not the Kyphosis which was worse than the Scoli. I felt she didn't have enough experience with Kyphosis.

    Doctor #3: Excellent doctor! Great bed side manner. Talked directly to Jamie. He was with another hospital and was not a pediatric surgeon. He was honest with us and said that he could treat Jamie as long as she was in her brace, but if she needed surgery, he wasn't able to do it. So we thanked him for his honesty and told him we wanted a doctor who could treat her from start to finish. (Jamie's next follow-up will be just before she turns 18, so we will probably go back to this doctor since her surgeon has left our area)

    Doctor #4: Dr. Betz-Shriner's Philly. I'm sure you've read enough about him to know he is awesome! He was perfect for us and had decided that if doc #5 wasn't the doc for us, then Dr. Betz would do Jamie's surgery even though we were told it could be up to a year waiting.

    Doctor #5: Back to the children's hospital close to home where we saw the first two doctors. The first thing Dr. Segal did after introducing himself to Jamie and then myself was to ask why we were there? We must have given him a dumb look because he went on to explain himself. He said I see you've been seen by Dr. Betz, why are you here? You are in excellent hands with Dr. Betz. That alone sold me on him right away. Dr. Segal treated Jamie and I with respect. He always talked to Jamie first and asked if she had any questions. Then and only, then did he ask me if there was anything else I needed to ask. This is a doctor who welcomed and encouraged e-mails and phone calls. I e-mailed him once on a Saturday evening and he called me Sunday himself! I could go on and on about Dr. Segal, but this reply is already getting long.

    So to sum it all up, we felt confident with the ability of 4 out of 5 doctors. What it came down to was Dr. Segal was not only a great doctor, but a great human being who made sure we understood everything all the time no matter how look it took.

    Mary Lou
    Mom to Jamie age 21-diagnosed at age 12-spinal fusion 12/7/2004-fused from T3-L2; and Tracy age 19, mild Scoliosis-diagnosed at age 18.

    Comment


    • #3
      Hi Sharon-
      The other criteria that immediately comes to my mind would be the hospital he/she performs the surgery at. One of the concerns would be that if any complications were to arise does the hospital have outstanding pediatric surgeons of many specialties - icu, cardiac, neurology, etc. The best of medical care across the spectrum...........

      Good luck!
      -Cara
      Cara, Mom to Nathan
      Diagnosed 24 deg. in July 2007, progressed to 38 deg. by August 2007
      Boston Back Brace 8/07 – 12/07
      VBS 12/10/07 Boston Children's Hospital
      Dr. Hresko
      40 Degrees before VBS
      11 Degrees now!! (2012)

      Nathan's VBS Video

      www.vertebralstapling.com

      Comment


      • #4
        Hi Sharon,

        While I do think it is wise to seek out more than one opinion, my experience with my 1st son was similar to yours. We also ended up staying with the 1st and only dr. we actually saw for a consultation. I was very impressed by his credentials and experience. I was also impressed by his manner when we had appts. He always talked to my son on his level and was very caring in making sure my son understood (as much as he wanted to) about what was going on and making sure all my son's questions were answered, not just my own. Yes, there was always a wait, but that's because he gives each and every patient all the time they need. He was always very honest, forthright and heartfelt in explaining why he thought certain treatment options would or wouldn't work. I felt confident in that he does 120-150+ surgeries a year. I also asked for references. I expected them to give me 3-4 names. I got a list of ten, and spoke to about 7 of them. All kids came through surgery ok, no complication and were doing well. All had nothing but positive things to say about dr. and hospital. I did talk/correspond with other drs. but I just knew in my heart that we would be well off sticking with our dr., and no regrets about our decision. As for my 2nd son, well see. He is still my dr. of choice, unfortunately he is not doing vertebral stapling, which I am interested in as a possible treatment option.

        Renee

        Comment


        • #5
          Originally posted by Snoopy

          (snip 5 doctor reviews)

          So to sum it all up, we felt confident with the ability of 4 out of 5 doctors. What it came down to was Dr. Segal was not only a great doctor, but a great human being who made sure we understood everything all the time no matter how look it took.

          Mary Lou
          Thanks for posting that, Mary Lou. I followed your reasoning.

          sharon
          Sharon, mother of identical twin girls with scoliosis

          No island of sanity.

          Question: What do you call alternative medicine that works?
          Answer: Medicine


          "We are all African."

          Comment


          • #6
            Originally posted by nate03
            Hi Sharon-
            The other criteria that immediately comes to my mind would be the hospital he/she performs the surgery at. One of the concerns would be that if any complications were to arise does the hospital have outstanding pediatric surgeons of many specialties - icu, cardiac, neurology, etc. The best of medical care across the spectrum...........

            Good luck!
            -Cara
            Hi Cara,

            Thanks of reposting that.

            I admit I didn't consider that. But I'm wondering how many folks would walk away from a surgeon who was otherwise the "right" guy if they thought the rest of the specialists were sub-par. And is that ever really likely to happen in real life? That is, a top-shelf surgeon surrounded by sub-par specialists?

            sharon
            Sharon, mother of identical twin girls with scoliosis

            No island of sanity.

            Question: What do you call alternative medicine that works?
            Answer: Medicine


            "We are all African."

            Comment


            • #7
              Originally posted by flowerpower
              Hi Sharon,

              While I do think it is wise to seek out more than one opinion, my experience with my 1st son was similar to yours. We also ended up staying with the 1st and only dr. we actually saw for a consultation. I was very impressed by his credentials and experience. I was also impressed by his manner when we had appts. He always talked to my son on his level and was very caring in making sure my son understood (as much as he wanted to) about what was going on and making sure all my son's questions were answered, not just my own. Yes, there was always a wait, but that's because he gives each and every patient all the time they need. He was always very honest, forthright and heartfelt in explaining why he thought certain treatment options would or wouldn't work. I felt confident in that he does 120-150+ surgeries a year. I also asked for references. I expected them to give me 3-4 names. I got a list of ten, and spoke to about 7 of them. All kids came through surgery ok, no complication and were doing well. All had nothing but positive things to say about dr. and hospital. I did talk/correspond with other drs. but I just knew in my heart that we would be well off sticking with our dr., and no regrets about our decision. As for my 2nd son, well see. He is still my dr. of choice, unfortunately he is not doing vertebral stapling, which I am interested in as a possible treatment option.

              Renee
              Hi Renee,

              Thanks for posting that reply.

              It didn't occur to me to ask for references from previous patients. I can see from all the responses that at least a few things didn't occur to me!

              I'm sorry you are dealing with two children with scoliosis. Both my identical twin daughters are affected, one worse than the other.

              What I'm dealing with now is that the one who will have the night-time bending brace is realizing she can only hope to hold her ~30 degree curve as opposed to getting an excellent cosmetic correction with the surgery that her twin is getting. Now I am trying to tell her that surgery is not justified for a cosmetic outcome and that, brace or no, if her curve doesn't progress to surgery territory, she will not be getting the surgery.

              Actually, it is hard to notice anything amiss with her in terms of her posture or the way clothes hang so I think she shouldn't be worried about this. I think she sees her twin's posture and thinks she looks like that. She does not.

              Shoot me now.

              sharon
              Sharon, mother of identical twin girls with scoliosis

              No island of sanity.

              Question: What do you call alternative medicine that works?
              Answer: Medicine


              "We are all African."

              Comment


              • #8
                Originally posted by Pooka1
                I admit I didn't consider that. But I'm wondering how many folks would walk away from a surgeon who was otherwise the "right" guy if they thought the rest of the specialists were sub-par. And is that ever really likely to happen in real life? That is, a top-shelf surgeon surrounded by sub-par specialists?

                sharon
                Hi Sharon,

                I actually know quite a few parents who did just that. My son's surgeon, Dr. D'Andrea, left Shriners Hospital of Philadelphia within the past year. She's considered one of the best spinal surgeons in that area. She opened a private practice with another doctor and they operate out of a small hospital in Pottstown, PA. I know several parents (whose children were either in need of fusion or who were interested in VBS, which she also performs) who said they were just not comfortable with not knowing the hospital's reputation and the quality of care that it offered.)

                Now, mind you, the other specialists who work there, and the nurses and other staff, may be great - but the parents said that there was just not the same comfort level that they felt with Shriners or CHOP - the two best known and highly-regarded hospitals in the area.

                Just thought I'd share.
                mariaf305@yahoo.com
                Mom to David, age 17, braced June 2000 to March 2004
                Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

                https://www.facebook.com/groups/ScoliosisTethering/

                http://pediatricspinefoundation.org/

                Comment


                • #9
                  Hi Mariaf,

                  Okay I see that example.

                  But I guess I would never have gotten that far. That is, I doubt I would even consider a surgeon in a small hospital in the first place.

                  Obviously, top-shelf surgeons operate out of small hospitals. But there are enough top-shelf guys in the big hspitals that I don't see that as an actual limitation in terms of access to top-shelf guys.

                  You know the surgeon is good only because you have used her. But put yourself in the place of a new parent who doesn't know any surgeon. The issue doesn't present itself at all.

                  sharon
                  Sharon, mother of identical twin girls with scoliosis

                  No island of sanity.

                  Question: What do you call alternative medicine that works?
                  Answer: Medicine


                  "We are all African."

                  Comment


                  • #10
                    Originally posted by Pooka1
                    You know the surgeon is good only because you have used her. But put yourself in the place of a new parent who doesn't know any surgeon.
                    I hope you didn't misunderstand me. I AGREE that it's very resonable to be apprehensive of using a small hospital.

                    These moms knew Dr. D'Andrea by reputation - that's why they wanted her - but they were nervous about not knowing how top-notch the rest of the staff was. I actually told each of them that, even having used Dr. D'Andrea, I still might have made the same decision they were making. After all, the surgeon is in charge - but very often it's the rest of the staff (residents, nurses) who care for you after surgery.
                    mariaf305@yahoo.com
                    Mom to David, age 17, braced June 2000 to March 2004
                    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

                    https://www.facebook.com/groups/ScoliosisTethering/

                    http://pediatricspinefoundation.org/

                    Comment


                    • #11
                      We took my daughter to 3 doctors before she had her surgery. The first said put her in a brace and I will watch her. He never xrayed her wrist to see if she was finished growing. I took her to another doctor in a different town. He xrayed her wrist, said she was finished growing and a brace would do no good. He referred us to doctor number 3. He talked to my daughter and asked her questions about what she like to do. Then he explained how surgery would impact her life. He also answered all of our questions and her questions honestly (the 1st doc said he could give her 100% correction - what a joke). You have to look around to find the doctor that will talk to your child and you. It helped a lot that I had had the same surgery 25 years earlier. We knew the questions to ask.
                      T12- L5 fusion 1975 - Rochester, NY
                      2002 removal of bottom of rod and extra fusion
                      3/1/11 C5-C6 disc replacement
                      Daughter - T7 - L3 fusion 2004

                      Comment


                      • #12
                        Personally, I would get at least 3 opinions from highly regarded doctors before putting my child through such major surgery. They will have to live with this new back for the rest of their lives, and I would always want to know that I did everything possible to make the BEST choice.
                        I spoke with 4 Orthopedic doctors who were highly regarded for their surgical skills and experience,(even flew to meet with 2 of them), plus spoke with many parents before my son's vbs surgery.
                        Even though I love the surgeon who performed Nathan's recent surgery, and completely trust him (Based on personal experience and reputation)if his curve progresses I will still get a second (or third) opinion before any surgery. And I know (based on the first time) that our dr. would completely understand that I felt I needed to do this.

                        Good luck, I know it is a long road.
                        -Cara
                        Cara, Mom to Nathan
                        Diagnosed 24 deg. in July 2007, progressed to 38 deg. by August 2007
                        Boston Back Brace 8/07 – 12/07
                        VBS 12/10/07 Boston Children's Hospital
                        Dr. Hresko
                        40 Degrees before VBS
                        11 Degrees now!! (2012)

                        Nathan's VBS Video

                        www.vertebralstapling.com

                        Comment


                        • #13
                          Selecting your Surgeon

                          The surgeon’s role is to educate you and assist with the decision making process, providing you with information about your full range of options, and describing what is technically possible, the difficulty and risk of the procedure and potential benefits. Therefore, it is important that you select a surgeon who is helpful in providing you the information you need to decide whether or not to proceed with surgery.

                          IS HE EXPERIENCED?
                          A very important factor is the amount of the surgeon’s practice devoted to spine surgery. A physician who focuses on spinal surgery is going to be far more adept and current in newer surgical techniques than the one who performs spinal surgery only occasionally. Feel free to ask the surgeon for his CV, which can be very informative and always make sure you do your homework and check that what his CV states, to be correct, peace of mind can be a main factor when choosing a surgeon.

                          MAKE QUESTIONS
                          Before surgery you should ask for the specific anatomic lesion being addressed. What is the natural course of the condition if left untreated? Why does the surgeon recommend this specific procedure? What are the alternatives to surgery? What is the risk/benefit ratio; the risk of a bad outcome as weighed against the chance of a good outcome? What are the long-term consequences of a proposed procedure; will it lead to additional problems later on? What will the procedure entail? What are the risks and possible complications and how are they treated? How will I feel after the surgery? How many days will I spend in the hospital? What is the expected postoperative course, such as a physical therapy; time to return to work, return to full activity?

                          THINK IT OVER
                          At the first consultation, the surgeon should recommend a second visit, giving you time to think about your options and write down additional questions. In general, your surgeon should be educational, describe the risks/benefits and possible implications of the surgery he is recommending, and state the reason for the specific type of surgery. If the surgeon is not open to your questions, CONSIDER GETTING A SECOND OPINION in order to feel confident that you have selected the right surgeon to do your procedure.

                          If he says that he can cure you indicates that the surgeon may not be acting realistically or giving full informed consent. The chance of having a good or excellent outcome of spinal surgery is at best around 90%. That is for herniated disk surgery. Much lower figures of about 70% are seen in degenerated disk disease and spinal stenosis. It means that there is about a 20% risk of not getting better and also a small risk of it getting worse. Therefore he should investigate conservative treatment options, including reviewing your previous attempts at conservative care to ensure that they were carried out appropriately.

                          Many surgeons will be qualified in the following:

                          * Acute and Chronic Back Pain
                          * Artificial Discs
                          * Disk Herniation
                          * Fractures
                          * Hip and Knee Replacement
                          * Microsurgery
                          * Minimal Invasive Surgery
                          * Orthopaedic and Spinal Surgery
                          * Shoulder Surgery
                          * Sports Injuries
                          * Whip Lash Injuries
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                          Twisted and Curved....I like that in a person
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