Thursday, April 30, 2009

Do cancer patients deserve orthopedic surgery?

For reasons that are known only to Duke orthopedics, my dad underwent CT scans and was formally "cleared" by his Duke oncologist for orthopedic surgery.

1. Dad has Stage 4 cancer.

2. After a few rounds of chemotherapy in June and July 2008, dad was hospitalized for severe infections, including open, oozing sores at dad's inner elbow and ankle.

3. The two week hospitalization (August 2008) at Duke University Hospital culminated in a Duke Hospitalists refusing (literally) to communicate with dad's treating Duke Clinic physicians and surgeons. Among those treating physicians was a Duke orthopedic surgeon who had recently performed an ankle fusion. The severe skin infection was prominent at the site of the ankle fusion.

4. Dad was discharged via ambulance because his foot hurt so badly that he could not bear weight on his foot.

5. Dad was in the hospital for three weeks in November 2008 so that the Duke orthopedic surgeon could clean the infection out of dad's foot.

6. The Duke orthopedic surgeon required that dad be "cleared" from the plastic surgeon and the infectious disease doctors before he would return dad to surgery and complete the repair of the foot.

7. The anticipation and expectation was that the final orthopedic surgery would be performed in February 2009.

8. It is now May 2009 and my dad's foot has still not been repaired. (There was a lot of drama this year 2009 - like the Duke infectious disease doctor leaving Duke and no one picking up dad as a patient.)

9. The orthopedic surgeon came up with a new requirement - dad be cleared by his oncologist before dad can have the foot fixed.

10. Dad and I met with the Duke oncologist yesterday (Wednesday 04-29-2009) to discuss dad's CT scans. There is some increase in the lesions. But they appear to be slow growing. Dad's oncologist reiterated what he has said for many months - the foot is a priority. "Get it fixed." After the foot is fixed and my dad is again mobile then we will return to oncology to determine a game plan for the cancer.

The Duke oncologist told me that the Duke orthopedic surgeon wanted to make sure that dad would be alive long enough to justify the orthopedic surgery. That is COLD.

Dad has been unable to receive any cancer treatments since August 2008 because DUH Hospitalists ignored the foot infection.

Moreover, dad's quality of life is diminished since he has been unable to walk since August 2008. And Duke Medical is concerned that the orthopedic surgery would be a waste of their time and resources. COLD.

Perhaps I am naive.

I expected that the Duke orthopedic surgeon would have contacted me by now to get the surgery scheduled. Silence.

Do cancer patients deserve orthopedic surgery to increase their quality of life?

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