Wednesday, September 24, 2008

Advocating when doctors disagree

Today I underwent another nerve black on my saphenous nerve/vein. It is not a comfortable procedure. This is the second time within three weeks that this particular block was placed. First procedure was 10 September and the second procedure was 24 September.

Last week, nerves were blocked in my lumbar (lower back) to eliminate a different type of the pain to the leg.
The lumbar nerve block was the most painful thing that I can recall in recent memory. I have no experience with back pain and this was definitely back pain. I suffered through two (2) sleepless nights. I also became some heavy vaginal bleeding within hours of the procedure that took place on Wednesday 17 September.

[UPDATE: As of Sunday 28 September 2008, I am still bleeding heavily and nonstop since the Wednesday 17 September procedure. Hmmm. No one thought of that side effect.

I am undergoing these nerve blocks in preparation for leg and knee surgery. At this point, the sports medicine/orthopedic surgeon wants to "clean out" the saphenous nerve and, if necessary, cut the nerve.

But the anesthesiologist/pain management MD does not agree with the sports medicine/orthopedic surgeon. The anesthesiologist/pain MD advises me that I should not allow the surgeon to mess with the nerve.

According to the anesthesiologist, messing with (and especially cutting) the saphenous nerve could result in more damage that before the procedures started. And, most striking, the new nerve injuries are, according to the anesthesiologist, very often impossible to identify, diagnosis and provide adequate pain control.

The pain relief that I have received from the saphenous nerve bocks has been very short-lived and the pain returned very hard.

I have no way of knowing which advise is best. I asked my original Duke orthopedic surgeon (the one who "dumped" me off to a female orthopedic surgeon in Duke sports medicine) how I should handle the difference in apparent plan between the two doctors. Dr. Mark Easley advised me to tell the two doctors to confer and then let me know when they determine a plan.

And so I am going to ask the orthopedic surgeon to speak with the anesthesiologist and coordinate a plan.
Stay tuned . . . .

Some times the best way to advocate is to remind the physicians and surgeons that they are our advocates. Although the physicians and surgeons may only know each other casually, they work at the same facility. As such, the medical care professionals are in a far better position to determine a care plan.

Okay. Good example. There was always a stark difference between how Chris J. Dangles, M.D. (orthopedic surgeon from Carle Clinic Association in Urbana, IL) and
Mark E. Easley, M.D. (orthopedic surgeon with Duke University Medical Center in Durham, NC).

Example One: When my boyfriend and I met Dr. Dangles in October 2000, we wanted to know what I could do to be better, stronger to return to running now. Dr. Dangles immediately (without even ordering diagnostic imagining) recommended
tightening the lateral ankle ligaments, despite the fact that none of the ligaments were torn, frayed or injured in any way. My lateral ligaments were loose by birth!

My boyfriend and I told Dr. Dangles that Robert Gurtler, M.D. (team physician for local university, sports medicine orthopedic surgeon) recommended that I should avoid surgery because the result would be a change in the lateral usage of the ankle. Dr. Gurtler recommended bracing and advised me that university basketball and football players are also told to avoid the surgery (recommended by Dr. Dangles).

My boyfriend and I were shocked with Dr. Dangles' response - "Dr. Gurtler told you not to have the surgery because he does not know how to perform the surgery."

Later, Dr. Dangles testified under oath in the deposition in the civil case. Dr. Dangles was asked whether he ever contacted Dr. Gurtler to discuss my case." Dr. Dangles promptly answered "no."

Example Two: Now contrast the professional exchange of opinions and cases at Duke. Dr. Easley has regularly convened "foot meetings" about cases. And when the Duke Clinic where Dr. Easley practices did not have a podiatrist and orthotic specialist, Dr. Easley invited non-Duke medical professionals that could come to the meetings and contribute their expertise for the benefit of the patients.

Dr. Easley's recommendation to request that the doctors collaborate to formulate a plan is obviously not made in a vacuum. It comes from Dr. Easley's expectation of professional interaction and his appreciate of the importance of that interaction to a positive clinical outcome.

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