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Which Is The Most Important Part

Which Is Most Important?

  • The Explaination of Man's Fall From Grace and the Need for Salvation

  • An Account of How the World Was Formed


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lucaspa

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Didaskomenos said:
Ever thought about opening a foot clinic thread, Dr. Scholls?
Foot and ankle is one of the areas the department is very weak in. It's not a big area of orthopedic surgery. The chairman is trying to recruit a foot and ankle person here; maybe after he/she has been on board for a while.
 
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Plan 9

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lucaspa said:
That was due to what is called "impingement" of the nerves. They are being pushed on by other tissue and compressed from the side. So you lose sensation.
I see. I've falen badly twice since then, and it's gotten worse every time/
The last time I had to have two month's physical therapy for my shoulder; I have a nerve pinched or something there now, but I got enough use of my arm back to drive with it and mostly dress myself, and things like that. Although I have pain when I drive and when I can't get my arm in just the right position when I'm lying down, can't put some clothing on, and I don't have full range of motion, those things are no longer important to me.
My arm is far more dependible than my leg, and I was so relieved that I hadn't herniated a cervical disc.
It wan't until much later that I realised that my back had sustained more damage, too.

Apparently, he only bruised some of the nerves and they are coming back. Also, sometimes peripheral nerves that have been cut can regenerate. It doesn't happen in the CNS (and the spinal cord is part of the CNS), but maybe some of the nerves cut were not at the level of the cord.
 
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lucaspa

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You are, to use the private language of the trade, a train wreck. Some train wrecks are literal (I was teaching the residents to enter CPT codes into the Resident Case Log system and we were using one guy and they had given me 4 severe fractures. I said "this guy is a train wreck" and he had actually been hit by a train!), some are trauma, some are associated medical problems like cancer, HIV, hepatitis, liver damage, etc.

But you are a train wreck because an orthopod made you one. Many malpractice suites against doctors are unfounded. Medicine is still judgement calls and things simply don't go well all the time. But this one isn't that. It's genuine malpractice as far as I can see. Culpable negligence.

For some reason when I was going through all this, orthopods always did one to two laminectemies bfore trying fusion (good lord! I just realized that I forgot one:
The laminectomies were attempts to get in to see and clear out the nerve channels. There should only have been one. It may have been two levels but once the lamina is removed, you don't have to remove it again. It doesn't grow back. Unless you are having disc collapse at other levels and consequent stenosis.

Here's one reason to sue.

Here's the second reason. There really should have been rods. The fusion must be stabilized or it won't take. If there is movement, the new bone won't fuse to the old and the rods are there to provide the stabilization. They can be removed later after the fusion takes. Now, you can get the operative notes for all your operations. They will be subpoened when you sue, and you will find out. I suggest you hunt yourself up a malpractice attorney. A good one, but even a bad one should be able to win this case.

Remember that mono is chronic. If you've ever had mono -- either Epstein-Barr or cytelomegalo -- you have it forever. So it may not be from the bone, or the bone may have had either virus. At least it wasn't hepatitis or HIV!

It sounds like I may also have pantopane damage, although you would be far more likely to know that than I, but something else is definitely wrong with my lumbar spine. Do you want me to go into that?
Let's hear it. It may be part of your lawsuit.

True, but in this case it is the only way to get justice for what was done to you. I hate suing because malpractice rates go up, but in this case you deserve compensation and perhaps you can get these quacks to get out of the profession and go earn an honest living.

The simplest things in my daily life can be such a struggle now that these were things I needed to know years ago, when I was in better health, in order to sue. Or else I would need to know that he victimized me on purpose. That would motivate me.
Even if it wasn't on purpose, this is culpable stupidity and bad medicine.

4. This city is too small for me to sue a doctor and ever be able to get a new doctor again here
You say you can't get an orthopod now. Are you saying your PCP would drop you?
5. It's been about 15 years since I had the fusion surgery, if not longer.
So? Doesn't make it any less malpractice.

So don't think about it except on the days it is happening. That's what I do with my chronic attempts to get my ex to pay what she owes for child support. Just think about it when it is happening.

No rods; sorry.[
Then sue. because it could not have possibly taken "at first". It takes at least 2 months for a fusion to take. You moved; you couldn't help it; and that destroyed the fusion. It never had a chance. Rank incompetence and you are owed for that.
 
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Plan 9

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That must have startled you, Paul! A figurative and literal train wreck! LOL

It's a great metaphor! Very descriptive!

Now that you've explained it, I can see that it was genuine malpractice.

I don't know why everyone wanted to do one. One factor may have been that no surgeon ever felt that my test scan scans and myelograms showed that much damage. They often said they were going by my symptoms and the results of the nerve induction test alone, and one told me that the surgery was exploratory and that he would proceed according to what he found out once he's had a look. That was the orthopod who would later do my disappearing fusion, and one surgeon thought I was faking it or mentally unbalanced.

What if he alters his notes? Can that do that with operative notes?
Dr. Chymo altered his office notes when I rquested them. He had forgotten having giene copies to my PCP years earlier, so I took them to him and we compared them. At the time it just struck us funny and we laughed over them, because I getting them to give to a lawyer at all.; Dr.Chymo jst assumed that.

Remember that mono is chronic. If you've ever had mono -- either Epstein-Barr or cytelomegalo -- you have it forever. So it may not be from the bone, or the bone may have had either virus. At least it wasn't hepatitis or HIV!
I've been checked for mono quite a lot, as you can imagine, and the tests have always turned out negative.
Good job, btw; the symptoms are mono-like, and if I could make it in to see my doctor right now, she might test me for it; she hasn't yet because I've stopped going in when I feel this fatigued, if I can avoid it, and I usually can.

I had heptatitus A as a child, but it's resolved. (I think that's the correct term.)

I was exposed to hepatitus C through rape, but my tests were both nagative.

Let's hear it. It may be part of your lawsuit.
When I began experiencing nerological problems related to my brain, a neurologist proposed a spinal tap so that he could send a fluid sample to the Mayo clinic for testing. He soon discovered that the well was dry in the lconventional area and began moving up a bit, and trying again. Eventually, he wanted to stop for the day because I was in considerable pain from the repeated attempts. I told him to go ahead. Finally, he was able to remove some from the thoracic area. Then he insisted I lie down on the table and rest for a while. I just wanted to go home until I looked at his face. His face had lost all color, and there were beads of sweat on his upper lip, so Laid down and rested for him. I have always him as having a rest himself. I don't know how I lokked, but he looked bad.
There's a possibly related problem everytime I get a myelogram now. The doctor doing it never believes it will be a painful or lengthy preceedure, but both are always true. They seem to have unexpected proplems inserting that needle.
My PCP sent me to a clinic for and the doctor there wanted to inject a seroid in my spine (again). He actually seemed to believe me when I said that previously these were both ineffective and painful, but siad that the others had been pshing the steroid in too quickly.
He gave me one pain shot and then another, so was that part was a nice change, but later, I not only lost a great deal of function had a huge increase in pain in my right leg, but my left leg was similarly affted. A friend who was a nurse's aid, who had originally come to stay with me for three days, just in case, becaome my roomate of two months, by her own choice.
By that time, my left lag had returned to normal, I had considerable improvement in the right, but I never regained my old baseline, either in pain level or function.
He refused to see me again and wanted me to enroll in his hideously expensive pain clinic program. They mailed me a consderalbel amount of amount of material, including a number of supposed psychological tests. Psyxholgy is (or possibly was) my field, so when I looked athose tests, I took the pile of lietature to my PCP, and we seemed in agreement that there was no reason to spend my time and the state's money on this program.
Because of that that, my experience with Dr. Pain may not be relevant, but I'm including it just in case.
I had assumed that the problem with the spinal tap and with the mylograms might be connected to the stenosis, but my doctor friend felt that pantopane damage might be responsible.

I don't like it that good doctors are punished along with the bad ones because of lawsuits, and I don't disagree with you that I should sue, since the length of time since the fusion was done isn't a factor in its success, but I've an expeosed nerve from a broken tooth since last Thanksgiving, and it's a lot worse than it was then, but I can't see my way to getting myself to my dentist. I'm in real trouble, and I need some allieviation or far more personal motivation to manage to begin a lawsuit. That's why I said that sustained anger would be extremely helpful. I know that motivates me to get justice, even when I know that the result won't benefit me enough financially to better my lifestyle.
Had I known I had a case earlier when I had a little more function, and a less crippling degree of fatigue, I would definitely have attempted to pursue it. Now, I can't imagine doing so.

You say you can't get an orthopod now. Are you saying your PCP would drop you?
So? Doesn't make it any less malpractice.
I don't think she would drop me, but my last PCP concluded that working at our medical center for Federal prisoners would be peferable to continuing to work for his HMO. He said that they had begun requiring that he see so many patients both in his office and in the hospital that he thought that there was a very good chance that he would be so rushed that he'd he's eventually make the bad mistake which could get one of his patients killed some somewhere down the line.
Because he was such a rebel, when I lost him, I lost half of my pain medication, a much more effective muscle relaxant, and much peace of mind. We knew each other very well, he had been though much of this with me and he was forthcoming with information which no other doctor has felt free to tell me. We joked around so much that I didn't home afterward with my mind on my physical problems.
If I lost the PCP I have now because she ceased to practice any reason and I had sued any doctor in town, I would not be able to get another.

So don't think about it except on the days it is happening. That's what I do with my chronic attempts to get my ex to pay what she owes for child support. Just think about it when it is happening.
That shows considerable self control, and I might have more now than I did, but I can't tell. I have done better while discussing my train wreck with you than I have ever done before, but you yourself are a significant factor in that. That's a compliment, btw.

Then sue. because it could not have possibly taken "at first". It takes at least 2 months for a fusion to take. You moved; you couldn't help it; and that destroyed the fusion. It never had a chance. Rank incompetence and you are owed for that.
I see. I was supposed to move, too. I wasn't advised to lie around in bed; the reverse was true---not that one can lie in bed for two months without moving.
Still, I could feel that my spine had been fused for a short while and it helped while it lasted. Getting real fusion would certainly gain me some improvement, if nothing went too wrong.

I think they're going to start a forum for disabled people to discuss their situations. If that happens, I'd be tempted to copy and paste this onto a thread there for the instruction of others--except that doing so might fill your inbox with PMs from total strnagers.
 
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lucaspa

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Plan 9 said:
That must have startled you, Paul! A figurative and literal train wreck! LOL
Yeah, it did! The residents set that one up quite nicely.

I don't know why everyone wanted to do one.
It's not "wanted", but either "have to" or "can't". If you go in from the posterior approach (back), the only way you can see the nerve roots is to remove the lamina of the spine. However, once it is done it is done! The only reason to do another laminectomy is because you are going in at another vertebrae! If you are looking at the same place, once the lamina is gone it is gone.

and one told me that the surgery was exploratory and that he would proceed according to what he found out once he's had a look. That was the orthopod who would later do my disappearing fusion,
This is the one you sue his *** off! You don't do "exploratory" back surgery! You only go in when you have some idea -- from x-ray or MRI that there is a problem at that particular level! You don't just open up the back, start removing laminae on the off chance you will find something! This is gross incompetence and/or desire for money and he should not be operating on other people.

For Grand Rounds this morning we had an ethics discussion led by an ethicist. It was on medical error from the patient's perspective. The senior resident said that what we should establish is a no fault insurance for medical error. The insurance pays the victim compensation for the injury done. Because the victim deserves compensation for the mistake. Then a board of fellow MDs reviews the case. They will be harder on the MD than the courts. From 3 Orthopaedic Surgery Departments I've been in and seen Morbidity and Mortality conferences in, this is true. Man, can they rip a colleague to shreds over an error in judgement. Anyway, the senior resident (he'll be practicing orthopod next year) wanted the review board to have the power to 1) forbid the surgeon from doing the procedure ever again and/or 2) revoking his license. As he put it, if the surgeon is incompetent he "should be squashed like a bug!" His words, not mine. And that's a pretty common feeling. If you aren't competent as a surgeon, then get a job at a car wash where you won't hurt anyone. Anybody can make mistakes, but you have to be able to cut it. If you can't, get another job.

Did you ever have an MRI?

What if he alters his notes? Can that do that with operative notes?
Nope. The op notes are done in ink and hand signed. Often they are done by hand. They are kept in at least 2 places: hospital and doctor's office. He can't change both.

Medical fraud. You can get his license revoked for that.

[quoteI had heptatitus A as a child, but it's resolved. (I think that's the correct term.)[/quote] "Resolved" doesn't mean that all the viruses are dead. It may simply be in control but be able to proliferate again when you are tired, don't eat right, and thus lower your immune system.

I was exposed to hepatitus C through rape, but my tests were both nagative.
OUCH! That's more than enough trouble for one human being! But if you were negative, then you didn't get infected. It just struck me how absurd this conversation is becoming. You know it's bad when the good news is that you weren't infected from a rape.

WHAT! He couldn't get spinal fluid??!! Oh, somebody really f----ed up!

I'm not surprised. Spinal taps are dangerous, and there is a risk of damaging the cord. Having to do several and not get anything and not know if you have gone too deep and damaged the cord probably scared 20 years off his life.

There's a possibly related problem everytime I get a myelogram now. The doctor doing it never believes it will be a painful or lengthy preceedure, but both are always true. They seem to have unexpected proplems inserting that needle.
Scar tissue.

I don't like it that good doctors are punished along with the bad ones because of lawsuits, and I don't disagree with you that I should sue,
Unless you live in Colorado, it's unfortunately the only way you can get compensated for medical errors. Unless the physician is really unusual. One attending told about an experience during his residency. The attending was doing a revision of a hip implant and it was badly infected. It was hard to see and he accidentally cut the sciatic nerve. Big, big oops. But the attending went right out after the surgery, told the family just what he had done, told them his office would be sending over insurance forms, then went and talked to his insurance company, and got them a check cut within a week.

I know that motivates me to get justice, even when I know that the result won't benefit me enough financially to better my lifestyle.
Why not? It would appear that, at a minimum, that you would get whatever wages you would have earned in your life and payment for treatment to fix, as much as possible, what is wrong.

If I lost the PCP I have now because she ceased to practice any reason and I had sued any doctor in town, I would not be able to get another.
I can't believe that they are that parochial or close-minded. They must know this guy screwed up and that you won't be coming after them just because he screwed up.

That shows considerable self control,
Nah. Just takes a little practice. Compartmentalize your mind.
I have done better while discussing my train wreck with you than I have ever done before, but you yourself are a significant factor in that. That's a compliment, btw.
Thank you.

I see. I was supposed to move, too. I wasn't advised to lie around in bed; the reverse was true---not that one can lie in bed for two months without moving.
Well, ****, there's no way the fusion had a chance! Idiot! He violated standard of care.

Still, I could feel that my spine had been fused for a short while and it helped while it lasted. Getting real fusion would certainly gain me some improvement, if nothing went too wrong.
Yeah, you got a little callus until the movement broke it again.

As long as they check my medical "advice" with an MD. You need to find a good spine surgeon. My chairman is one. Let me see if he knows anyone out in Missouri. It'll take a while. He's busy and hard to track down.
 
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