How tight should a night time brace be?

[mariaf]

Do you find that to be the case with bracing? In my experience, lots of people start to brace and then stop, and I don't believe they stop because their doctors have recommended that they do so. I believe they do it because the perceived benefit falls below the perceived cost. I don't have any quarrel with stopping because the perceived cost is too high, no matter what the benefit - if you have a kid who's really suffering in a brace, then you stop. That's pretty clear.

Agreed. But stopping bracing because your child is suffering is not the same as stopping because Pooka said so, which was inferred by flerc's posts (at least that's how I interpreted them).

Perhaps I should have said that we, as parents, make initial decisions based on our doctors' advice. Then, going forward, we might want to 'tweak' the treatment plan after discussing it with the doctor. Speaking for myself, I am fortunate in that David's doctor welcomes my input - it's very much a team approach - but I am not making decisions because of what anyone here posts - and I give most folks credit for being smart enough to act similarly.

[mariaf]

While it's important to have an open mind, it shouldn't be so open that your brains fall out.

Great line - I've never heard that before.

Before anyone makes the wrong assumption, let me say that I am NOT making light of scoliosis (nobody has to tell me how serious it is, believe me), but in OTHER situations I may have to use that line. Like maybe when my teenage son wants to do something that is against my better judgment and he asks me to have an open mind.....

[flerc]

Yes there is still no good answer for lumbar curves. But as much of a shortfall as surgery is for lumbar curves, it still must be better than no surgery or else people wouldn't get it. Please just think this through. Please.

You are assuming that always people does the best. Why are you assuming that? A scientist would never say something like that.

That isn't the issue. The issue is whether the life is better with surgery than it would otherwise be. What you are not accepting is normal is that off the table. This is game of cutting losses.

The issue was evidence of surgery vs brace & PT. You said is much better for surgery and not justified it. A scientist would never do that.

Certainly in almost every of your post I may say the same. Any scientist not affected by scoliosis would have fun here reading what you say.. and pretending to be a scientist.

It is not important to me whether people understand I am a scientist. It shouldn't matter.

Yes it is important since really many people is reading your posts and of course they would give much more credit to all your confuse speech if you would be really a scientist. I perfectly know that none scientist in the world would say the kind of things you said here.. at least without having a particular interest. But it not necessary may be also clear for everyone. But everyone understand that a scientist would never deny to prove what says.

So again:

As you say in thousands different confusing forms every time that Braist study didn’t show anything very much significant about good brace effectiveness (even until maturity beginning), it would be just only one more confusing way to say the same. I continue waiting for your demonstration about so bold claim as I asked you many times. Do you believe you already gave it? Quote it please.

[Pooka1]

Too much metadiscussion. You can respond but I am done. I think you are being dishonest in your arguments.

[Pooka1]

I suspect you'd be uncomfortable if I followed your template in this discussion exactly up in the surgical section.

I'll throw out the most egregious example - the repeated and unsupported claim that bracing only delays surgery - and confine myself only to claims which the are actually supported for surgery.

What if I just greeted every parent about surgery with a long list of hey's blog posts about failed surgery in teens.

First of all there is no long list of failed surgeries in teens. That is dishonest.

Lumbars are not solved by conservative or surgical methods to any great extent. But would the people who get surgery be better off without surgery? That is the question you NEVER approach because if you did, we could all go home.

If people were better off without surgery then nobody would get it. Logic 101.

Young people coming to him for a second surgery.

Definitely not a long list. Dishonesty creeping in here in an effort to move away from the evidence.

And are you assuming that is due to surgeon error? All surgeons can do is take patients as they come and try to help.

[hdugger]

You can't do it honestly.

I suspect you'd be uncomfortable if I followed your template in this discussion exactly up in the surgical section.

I'll throw out the most egregious example - the repeated and unsupported claim that bracing only delays surgery - and confine myself only to claims which the are actually supported for surgery.

What if I just greeted every parent about surgery with a long list of hey's blog posts about failed surgery in teens. Young people coming to him for a second surgery. So I'd have a long list of these things (because we've seen many of these cases just on the forum.) And if sort of wring my hands about it, and talk about how sad it is. What if I just stuck to that. I wouldn't even bother with the research. I wouldn't talk about the sad lack of randomized studies. I wouldn't start talking about how emotionally difficult surgery was for these kids. I'd just have my own version of hey's failed teens which I helpfully posted every single time anyone asked about surgery. Could I get one parent to second guess t their opinion. I imagine I could.

It's not about logic or what the research shows or clear thinking or any of those things. If I wanted to keep a few kids off the operating table I could do just one of the things you're doing in this discussion and have that happen.

[Pooka1]

There was a lot of bad outcomes with Harrington roads.

Yes there is still no good answer for lumbar curves. But as much of a shortfall as surgery is for lumbar curves, it still must be better than no surgery or else people wouldn't get it. Please just think this through. Please.

There are not evidence of a normal complete life with surgery using new technology.

That isn't the issue. The issue is whether the life is better with surgery than it would otherwise be. What you are not accepting is normal is that off the table. This is game of cutting losses.

People believing you are a scientist as you said may be feel defrauded.

It is not important to me whether people understand I am a scientist. It shouldn't matter. You don't need to be a scientist to think critically and be skeptical.

[flerc]

Indeed. The evidence case is much better for surgery than for bracing and is MUCH MUCH better than the evidence case for PT.

You don't have any ground to stand on to make a case that surgery is not a net benefit for the vast majority who are in range and are medically fit. That case has not been made for bracing and certainly hasn't been made for PT.

You should get booted for gross misrepresentation in the service of unwarranted cruelty.

That's the difference. Honey.

There was a lot of bad outcomes with Harrington roads.
There are not evidence of a normal complete life with surgery using new technollogy. Not only not known evidence, there was never just only case known or unknown yet. You cannot say the same about brace or PT.
You are not get booted because there is a moderator here allowing to do the unmoral work you do.

When do you give the racional demostration I asked you many times? People believing you are a scientist as you said may be feel defrauded. They might became to realize which is your work here.

[Pooka1]

So, again, that's my point. It matters what people say here. Decisions are altered - lives are changed. That's all I was trying to say.

Yes. An example is CD took his daughter out of a brace after reading posts on this forum. And she made it to maturity under the surgical range without bracing as against medical advice. But CD is a scientist. He had an open mind, was able to consider the literature such as it was, and made a decision that helped his daughter immensely. It might be that only people with training in critical thinking skills can or should approach the literature.

But you will never show a case where someone took a child out of brace or PT and that made them surgical. It is impossible to show that. It is impossible to show the brace was necessary or effective.

All that can be shown is changes for the better.

[Pooka1]

The example was in response to Maria's post about parents' decisions not being affected by discussions on the forum. My point was that parents' decisions *were* affected, and I gave as an example that I could affect their decisions about surgery just by spinning the research in a certain way and playing up the whole cruelty aspect.

You can't do it honestly. That is completely different from how I operate.

You are agreeing with me, correct? And disagreeing with Maria?

No. I am confining this to honest approaches to the literature. Your example would necessarily be dishonest.

I am pro-evidence. People perceive that as pro-surgery because that's just the way the evidence falls out. I have no control over the evidence case because this is not my field. If the evidence case was like that for bracing and not surgery I would be viewed as "pro-bracing." By the way, being "pro-surgery" is a nonsensical descriptor. Nobody is "pro-surgery." People who are reality-based are sometimes viewed as "pro-surgery" though.

What you are not understanding is I follow the evidence. I don't come to the table with preconceived notions. My training is to try to avoid bias by being critical and skeptical. Lay people (which you are not which makes this perplexing) are not trained to do that and so may misinterpret what I am doing. All I can do is be intellectually honest.

with your strongly worded post that people should be tossed off the forum if they misrepresent information which could affect a medical decision?

This is an imaginary problem.

[hdugger]

. . .

The example was in response to Maria's post about parents' decisions not being affected by discussions on the forum. My point was that parents' decisions *were* affected, and I gave as an example that I could affect their decisions about surgery just by spinning the research in a certain way and playing up the whole cruelty aspect. You are agreeing with me, correct? And disagreeing with Maria? with your strongly worded post that people should be tossed off the forum if they misrepresent information which could affect a medical decision?

So, again, that's my point. It matters what people say here. Decisions are altered - lives are changed. That's all I was trying to say.

[Pooka1]

that I'd be swiftly booted off the forum.

Indeed. The evidence case is much better for surgery than for bracing and is MUCH MUCH better than the evidence case for PT.

You don't have any ground to stand on to make a case that surgery is not a net benefit for the vast majority who are in range and are medically fit. That case has not been made for bracing and certainly hasn't been made for PT.

You should get booted for gross misrepresentation in the service of unwarranted cruelty.

That's the difference. Honey.

[flerc]

But you agree with what Pooka1 is doing in the non surgical sections, certainly you are one of the main supports she has to do her work here if not the main.

Sorry Mariaf, I forgot the moderator, whose only ones interventions here are always to help Pooka1. As she has all the power here to delete posts, to close threads and banning members, her support is very more important than yours.
But not feel bad; think that instead of saying all this, we could be talking with Fahsai about night braces. The unmoral work Pooka1 is doing works! It’s a fact. And it seems to be the purpose of this forum of course and you are an important support although not the main, so congratulations anyway, you must to feel proud!

[flerc]

I deny that. Show me.

As you say in thousands different confusing forms every time that Braist study didn’t show anything very much significant about good brace effectiveness (even until maturity beginning), it would be just only one more confusing way to say the same. I continue waiting for your demonstration about so bold claim as I asked you many times. Do you believe you already gave it? Quote it please.

[hdugger]

I deny that. Show me.

"And even the "successes" could be just delaying surgery for all anyone knows.

Within the range of 30* to 40*, I think there is an ethical issue with 23/7 hard bracing especially since it could be that braces only delay surgery

Perhaps it is this subset who goes on to progress with bracing only delaying surgery."

and there are bunch more that say the same thing but don't use the exact phrase.

Now, find me the review article on bracing which supports your statement that bracing only delays surgery. You're repeating it like a drumbeat - where are you getting it from?