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Old 05-31-2019, 01:55 PM
 
Location: Southern California
23,042 posts, read 7,977,789 times
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A second opinion can help, but get a second from other than a surgeon. Surgeons do surgery. They all pretty much think in that direction eventually.
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Old 06-01-2019, 11:48 AM
 
296 posts, read 138,373 times
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Quote:
Originally Posted by jaminhealth View Post
A second opinion can help, but get a second from other than a surgeon. Surgeons do surgery. They all pretty much think in that direction eventually.
A second opinion from a surgeon would be fine.

I do understand why others think that the surgeon's only mantra is "when in doubt, cut it out" (referring, e.g., to a mass), but good surgeons are trained in treatment protocols, and they begin with the non- or least invasive treatment and proceed through an algorithm to more invasive treatment options.

If they sometimes appear to "jump to" the surgical options, that may be because based on their training and clinical experience, they recognize that surgery is the only definitive treatment.

E.g., when I worked with a general surgeon, he didn't try to take out every gallbladder that came to him. Rather, his approach was the following:

1) if the patient has the relevant symptoms (e.g., intermittent pain in RUQ [= right upper quadrant]; sometimes radiating to the back, incited by eating a fatty meal, nausea, vomiting), and

2) positive findings on ultrasound (gallbladder wall thickening, sludge, and/or gallstones),

then they are surgical candidates. They need both -- if they only have one, they don't qualify.

Note: and sometimes he would order a CCK test as well: Cholecystokinin

I could relay similar stories from having surgically assisted orthopedic (specifically "hand") surgeons and neurosurgeons.

Think about it: it is in the best interest of surgeons NOT to operate on patients who will not improve.

Are there exceptions to the rule? of course

To conclude, be an informed patient, know as much as you can about your condition or disease, and evaluate your healthcare providers by relying on referrals (when possible), listening closely, and asking good questions.

Last edited by townshend; 06-01-2019 at 12:42 PM..
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Old 06-01-2019, 12:02 PM
 
Location: Southern California
23,042 posts, read 7,977,789 times
Reputation: 15037
There are so many opinions out there and just recently the D.O. I see for bodywork is saying, maybe my hip didn't need replaced, it could be my back which I have a long history of back issues. The hip replacement I went thru made everything worse, back and knee included.
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Old 06-01-2019, 12:21 PM
 
9,222 posts, read 6,161,671 times
Reputation: 17313
Quote:
Originally Posted by jaminhealth View Post
There are so many opinions out there and just recently the D.O. I see for bodywork is saying, maybe my hip didn't need replaced, it could be my back which I have a long history of back issues. The hip replacement I went thru made everything worse, back and knee included.

Hindsight is 20/20


Quote:
Originally Posted by townshend View Post
A second opinion from a surgeon would be fine.

I do understand why others think that the surgeon's only mantra is "when in doubt, cut it out" (referring, e.g., to a mass), but good surgeons are trained in treatment protocols, and they begin with the non- or least invasive treatment and proceed through an algorithm to more invasive treatment options.

If they sometimes appear to "jump to" the surgical options, that may be because based on their training and clinical experience, they recognize that surgery is the only definitive treatment.

E.g., when I worked with a general surgeon, he didn't try to take out every gallbladder that came to him. Rather, his approach was the following:

1) if the patient has the relevant symptoms (e.g., intermittent pain in RUQ [= right upper quadrant]; sometimes radiating to the back, incited by eating a fatty meal, nausea, vomiting), and

2) positive findings on ultrasound (gallbladder wall thickening, sludge, and/or gallstones),

then they are surgical candidates. They need both -- if they only have one, they don't qualify.

Note: and sometimes he would order a CCK test as well: Cholecystokinin

I could rely similar stories from having surgically assisted orthopedic (specifically "hand") surgeons and neurosurgeons.

Think about it: it is in the best interest of surgeons NOT to operate on patients who will not improve.

Are there exceptions to the rule? of course

To conclude, be an informed patient, know as much as you can about your condition or disease, and evaluate your healthcare providers by relying on referrals (when possible), listening closely, and asking good questions.

This is the best answer in this entire thread.
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Old 06-01-2019, 01:43 PM
 
Location: Southern California
23,042 posts, read 7,977,789 times
Reputation: 15037
Quote:
Originally Posted by mike1003 View Post
Hindsight is 20/20


This is the best answer in this entire thread.
Hindsight???? I entrusted the surgeon to do the right thing and if he didn't it's on him. I'll never know if I really needed a replacement or was it my back that needed more work and support. Doctors/surgeons make mistakes all the time.
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Old 06-01-2019, 04:20 PM
 
Location: Surfside Beach, SC
2,128 posts, read 2,624,754 times
Reputation: 4088
Quote:
Originally Posted by Surfertx View Post
I already went to my PCP and saw a orthopedic specialist. Honestly I didn't have much confidence with the ortho doctor I picked. He didn't seem to fully understand the pain I'm experiencing (sport injury) and prescribed a knee brace then micro surgery. So I'm not sure what should be my next step. Should I visit a sport medicine doctor and get a second opinion? I rather not get surgery as the MRI on the knee doesn't show any tears.
Since you don't have much confidence in the ortho doctor you saw, I definitely think you should get a second opinion. If I were you, I would go see another orthopedic surgeon who specializes in knees and sports medicine. Lots of ortho doctors do surgery and specialize in sports medicine.

Quote:
Originally Posted by jaminhealth View Post
Please don't rush to replacement surgery, it should be LAST resort when we get to resorts. If you have ligament issues, PRP and regular Prolotherapy are very helpful for many. We have a lot of threads here on Prolo work. I'm doing everything in my power to keep this 80 yr old knee working and walking. But you are probably a lot younger and there is so much to try. I'm back to D.O. osteopathic work and it helps all my joints. In my history of all this, the "need" for surgery is so overstated and overdone.
No one said anything at all about replacement surgery, except for you. Also, many osteopathic doctors are surgeons. There really isn't much difference between a D.O. and M.D. at all!

Quote:
Originally Posted by mike1003 View Post
As stated above, 2nd opinion with Sports Ortho specializing in knees is your best bet. You are lucky to be in Houston (ask around to find best knee specialist)
As I mentioned above, I totally agree with Mike on this.

Quote:
Originally Posted by jaminhealth View Post
A second opinion can help, but get a second from other than a surgeon. Surgeons do surgery. They all pretty much think in that direction eventually.
He needs to see the best surgeon he can find! There's a famous quote that is absolutely true:

Good surgeons know how to operate, better ones know when to operate, and the best know when not to operate.
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Old 06-02-2019, 02:41 PM
 
2,640 posts, read 1,517,907 times
Reputation: 3149
Definitely get a second opinion. Speaking as someone who has had three knee surgeries ranging from a meniscus repair to a high tibial osteotomy I would try everything you can to avoid surgery first. I have permanent nerve damage from my third one that led to chronic nerve pain and a condition called CRPS. I’m not trying to scare you I’m just saying if you aren’t comfortable or have any other options exhaust those first. And never use a surgeon you don’t feel comfortable with.
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Old 06-03-2019, 11:11 PM
 
4,955 posts, read 10,981,076 times
Reputation: 11740
Quote:
Originally Posted by Texas Ag 93 View Post
Correct, the Sports Medicine Doctors I mentioned are not surgeons, they are strictly nonoperative. They do some injections. They are Board Certified in Family Practice or some other primary care specialty. Incidentally, I think there are still a fair number of patients who incorrectly believe they are Orthopedic Surgeons, but they are not. They are more like those described in RamenAddict's post below. They are beneficial to have in a multi specialty Ortho practice from a patient's point of view because they are usually more accessible than a surgeon, and can handle most nonoperative issues. They are beneficial from the surgeon's point of view as partners because they can function as gatekeepers.

I always thought of PM&R (a term which seems to be interchangeable with physiatrist) as its own specialty with specific residency training and its own Board certification etc. The ones I interacted with worked in Rehab Hospitals with patients across the spectrum of not just Ortho rehab, but stroke, TBI etc. I can see, however, where they might fall under the umbrella of Sports Medicine if they work within an Ortho practice as you describe above.



Maybe bluedevilz can chime in on how he sees these specialty terms used most often. He's the one who would know best.
You and Ramen Addict are both correct.

A Sports Medicine Physician is an internist. May be ED, family practice, internal medicine, PM&R etc who has done a Sports Medicine Fellowship. They treat non operative musculoskeletal complaints, typically in athletes and weekend warriors. In our practice, Sports Medicine physicians typically cover High School and College athletic events along with a trainer in addition to seeing patients in the office.

PM&R physicians or Physiatrists that I have worked with in Orthopaedics are also non operative providers, many tend to take care of back/spine issues and chronic pain. I have also known many that specialize in pediatric issues such as cerebral palsy, muscular dystrophy and similar conditions dealing with contractures. Haven't known any physiatrists personally that did Sports without a fellowship...

Sports Medicine Orthopaedic Surgeons have completed an Orthopedic Residency and subsequent Sports Medicine Orthopedic Fellowship which typically entails treatment of primarily shoulder and knee injuries in athletes....but may extend to other injuries as well.

Any generalist Orthopedic Surgeon could theoretically call themselves a "Sports Orthopedic Surgeon" and limit their practice to arthroscopic knee and shoulder procedures but folks who typically seek out Sports Docs are usually going to go with the Fellowship Trained individual.

Orthopedic Surgeons who are Sports fellowship trained are still excellent resources for non operative treatment of sports injuries/knee injuries as well. As others have stated, a good surgeon knows when and if to operate.

The vast majority of patients seen in a typical clinic session by an Orthopedic surgeon for the most part in any subspecialty are going to be treated non operatively for whatever condition they are seen. Orthopedic injuries for the most part are a function of anatomy and the disruption of anatomic structures....no one knows the anatomy of complex joints better than an Orthopedic Surgeon....
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Old 06-04-2019, 07:40 AM
 
Location: Northern VA
503 posts, read 621,143 times
Reputation: 616
I've had two meniscus surgeries performed by the same orthopedic surgeon. Six months after my second surgery and he can't figure out why my knee is still bothering me so much. Basically he's given up on me so he referred me to a sports medicine specialist. This doctor is an orthopedic surgeon and a sports medicine specialist. I'm not really sure what he can do that the first orthopedic surgeon couldn't, but I'll give it a try. According to WebMD he's highly rated (4 1/2 stars) and "performs a high number of knee arthroscopies and replacements compared to his peers in the area".
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Old 06-04-2019, 11:40 AM
 
Location: Southern California
23,042 posts, read 7,977,789 times
Reputation: 15037
Quote:
Originally Posted by djplourd View Post
I've had two meniscus surgeries performed by the same orthopedic surgeon. Six months after my second surgery and he can't figure out why my knee is still bothering me so much. Basically he's given up on me so he referred me to a sports medicine specialist. This doctor is an orthopedic surgeon and a sports medicine specialist. I'm not really sure what he can do that the first orthopedic surgeon couldn't, but I'll give it a try. According to WebMD he's highly rated (4 1/2 stars) and "performs a high number of knee arthroscopies and replacements compared to his peers in the area".
Our bodies do what they want to do with surgery or without and with great surgeons or otherwise. What we get from surgeries is what we get. I have a friend who 2 yrs later with knee replacement is struggling with the surgery. People just don't seem to "get it" the trauma of surgery. I can only imagine the complaints surgeons get from so many post op patients.
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