Tim Samoff // Weblog (old)

September 27, 2007

Sure, go ahead and trust everything your doctor says...

I learned (and was reaffirmed in) a few things this week:

1. I am a medical anomaly. Ask any doctor that I’ve seen in the past few years and they will agree. (And, no, it’s not very cool to have a team of doctors under your arm).
2. I went to see my hematologist on Monday and… I am most likely going to have to start taking Coumadin again. While no one can confirm that my blood disorder is what is actually causing all of the things I’ve been going through, they don’t want to discount it either.

1. There are good reasons to get second opinions.

Today, I am going to elaborate on point #3 a little with a short play about an unsuspecting patient with a life-changing disease. All of the names and situations have been retained in order to show you that this is all very real… Oh, so very real…

ACT 1

SCENE 1

UNSUSPECTING PATIENT enters a cold, minimalistic examination room. The lights are bright. A painting of a sterile landscape hangs on a wall next to a calendar that was supplied by some med rep or another. The tongue depressors are in the same spot as they are in every examination room that the unsuspecting pateint has ever been to. There is a knock at the door and DOCTOR 1 enters the room.

DOCTOR 1:
Tim, I’m sorry to tell you this, but the X-rays show that you have bilateral avascular necroses.

UNSUSPECTING PATIENT:
But doctor, what does that mean?

DOCTOR 1:
Well, we’re going to have to replace both of your hips. Here, check this out.

DOCTOR 1 reaches over and grabs a scale-model of a hip joint and shows it to UNSUSPECTING PATIENT.

DOCTOR 1:
If you’ll notice, we use ceramic material for both the femoral head and the joint. It’s been used for about five years now and we’ve had a very high success rate.

UNSUSPECTING PATIENT looks at the scale-model and nods his head.

DOCTOR 1 (continuing):
The good news is, that the ceramic joint has much longer wear factors than, say, the older plastic joints. In fact, you should never have to get a ceramic hip replaced.

UNSUSPECTING PATIENT:
But, doctor, are you sure about the diagnosis?

DOCTOR 1:
Well, we’re going to have you go in for an MRI, but your hips have progressed so far at this point, that the MRI will only confirm my diagnosis.

UNSUSPECTING PATIENT leaves the examination room in shock and depressed.

SCENE 2

It’s been a couple of weeks since UNSUSPECTING PATIENT had the MRI scan. Since, DOCTOR 1 has called him to report that the MRI scan was conclusive. UNSUSPECTING PATIENT, after doing a lot of research is now EDUCATED PATIENT and tells DOCTOR 1 that he is going to get a second opinion.

ACT 2

SCENE 1

EDUCATED PATIENT enters a cold, minimalistic examination room. The lights are bright. A painting of a sterile landscape hangs on a wall next to a calendar that was supplied by some med rep or another. The tongue depressors are in the same spot as they are in every examination room that the unsuspecting pateint has ever been to. There is a knock at the door and DOCTOR 2 enters the room.

DOCTOR 2:
Tim, I’m sorry to tell you this, but the X-rays show that you have bilateral avascular necroses.

EDUCATED PATIENT: Yes, doctor, and…?

DOCTOR 2:
Well, we prefer to only operate on areas that are symtematic. That means that if your left hip is the only place where you’r having pain, then that’s the only place that we will operate?

EDUCATED PATIENT:
Really, doctor? What about the necroses in the other hip?

DOCTOR 2:
It’s kind of hard to say, Tim? We don’t usually do bilateral surgeries here. We can, of course, but when you have that much surgery at once, you’re really raising your chances that soemthing goes wrong. By performing one surgery we can reduce the chances of blood clots and infection… And, if something does happen, we’ll know exactly where it came from.

EDUCATED PATIENT:
But, what if I have my left hip fixed and then my right hip just follows right after? I just can’t take that much time off from work?

DOCTOR 2:
What if? But, that’s all that a “what if?” is. And, since you don’t have pain in your right hip, we really can’t tell when it’s going to give out. Who knows? It may never gove out. It could be months, or years, or it may even spotaneously heal… We have seen it happen, you know.

EDUCATED PATIENT:
Wow, doctor, so… What kind of replacement hip material do you recommend? Do you use ceramic?

DOCTOR 2:
Well, ceramic hips have only been around about four years and we’re starting to see a number of them come back in for replacement. And, do you know why?

EDUCATED PATIENT shakes his head.

DOCTOR 2 (continuing): They squeak! It’s the oddest things, but people with ceramic hips are complaining that they are sqeaking!

EDUCATED PATIENT:
Wow. So what do you use?

ACT 2, SCENE 1 ends with DOCTOR 2 explaining the diefferent methods and materials used during hip replacement surgery. It makes a lot of sense to EDUCATED PATIENT, who decides to go with DOCTOR 2 as his surgeon.

END

But, what does all of this really mean?

• Only one hip is going to be replaced.
• The hip will either be metal-on-metal or vitamin E-doped Polyethylene.

• My recovery may only take 6-weeks, rather than 6-months

Of course, I’m still pretty worried about my right hip. I really don’t want it to get to the point that my left hip is at now. But, my doctor’s explanation of why we should wait was pretty logical.

So, my surgery is now scheduled for October 30. Let the fun times begin (again).

Posted at 12:53 pm

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