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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 10882
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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People, I am exploring whether it would be more respectful

Customer Question

People, I am exploring whether it would be more respectful of your time if I prepared my questions in an email with one or two illustrations (jpeg attachments). Are you discouraged from assessing "cases" that way?
Submitted: 1 year ago.
Category: Medical
Expert:  DrRussMD replied 1 year ago.
Hello
We have to stay on this thread and use this format.
What is your question.......exactly.
You can attach pictures here or upload them to photobucket.com and give me the link
Customer: replied 1 year ago.
Dr. Thomas; My understanding was that my card would not be charged until a satisfactory answer to my question was found. Instead I see my card has been charged $45. And that now, you are re-offering the "100% guaranteed satisfaction" result if only I submit an additional $35. Is that correct? (Note: that my account balance was insufficient when I submitted my initial question. The account was replenished an hour ago and on my return I see the full $43 has been processed.) Please advise whether the $35 now being requested is in addition to the $43 charge. ---- That said, my specific question falls into the realm of orthopedics. Broken femur (Mar 29th) was reset with a "nail" same day. Can submit photoshop representation of my post-op, xray that was shown to me at my post rehab (5th week) followup. The fracture produced an approx. 2" triangular chip located on the inside of my leg (rt. side). In the Xray the chip can be seen as not having been successfully pulled/tied back in to the femur. It looks (and achily FEELS - on my inner thigh) like a substantial effort was made. The post op inflamation was scary. Black and blue over the entire inner thigh. Even my scrotum and a third of my penis on that right hand side. They had me on Coumadin throughout my 5 weeks of rehab, plus another few weeks at home. At week 3 or 4 the black and blue had receded some 85%. Meanwhile I had some clue, since confirmed that an artery does run up into the area where the surgeon would have been attempting (if he did) to "Stich or graft?" the chip back, after the nail had been installed. The 1/4" (+/-1/16") offset would not concern me except that the sharpest shards of that chip are at the ends of the chip's mmm "hypotenuse" (if you follow) -- which is roughly parallel to how that "Deep"-Something Latin" Artery runs close to the Femur --- location being 3-4" below the Femur head - meaning pretty high up into the crotch area. A really difficult spot, given the proximity of nerves, veins and arteries, in the area of so many forces involved in the precise drillings for the nail ends plus the stabilizing pins. Mine now at 2.1cm longer than the other leg ---- none of what ever may have transpired during surgery to have resulted in the "floating bone chip" (considering possible long term complications) has been/was explained to me. ---- Whwhwhichchch.... leaves me wondering if they expect my inner thigh muscle tone alone will sufficiently induce the chip to find it's former gap and hopefully calcify there. If it does or doesn't those sharded tips of the chip are probably going to annoy me the rest of my life. As I had been attaining (Loftgren assisted) 95-100% weight bearing a week or so ago, another round of random pains, hear and there, up and down the leg (shins, knee area, middle thigh) came back a few days ago. So I backed off on the weight. ----- Meanwhile comes the VA and coverage/ or payment arrangements. The VA's third party "quasi-HMO" now handles appeals to coverage denials. I believe the matter will turn out in my favor. Ironically I made the mistake of going more than 365 days without visiting one their facilities for a Kleenex, whether I needed the Kleenex or not. The whole point being that before I call the surgeon's assistant's nurse etcetera I got to decide on some plan to not be mamby pambied (blown off or coddled) and cheerfully escorted back out to the front office. Incidentally. At the second followup, again Xrays were taken. But curiously this time around, she did not bring out the Xray. I did not insist on looking at it. Mostly just the leg length disparity was discussed, I got too focused on the window of opportunity for any adjustment at the lower end of the nail, relative to calcification complicating what is ordinarily an outpatient procedure. But now enter the VA bureaucracy. Meanwhile I have this non-VA surgeon who was on call the afternoon of my accident, who has not seen fit to counsel me at either of my follow ups (with his assistant/anesthesiologist).Please advise as to whether I should submit pictures. The discomforting shooting pains at this late date, keep making me think they gave that artery and nerve area a pretty rough time of it, or worse, for all I know at this point. Are random, load-bearing shooting pains common this far out (14 weeks) following a Femur nail implantation, is my question. I guess.
Expert:  DrRussMD replied 1 year ago.
Hello
I have nothing to do with your dealings with JA, the money or anything else.
You can attach pictures here
Customer: replied 1 year ago.
I should probably add that the surgeon used a nail installation method where they make only three less than 2.5" incisions. One at bottom and two just bove and below the center of the break.
Expert:  DrRussMD replied 1 year ago.
Don't see any attachments
Customer: replied 1 year ago.
"Hello
I have nothing to do with your dealings with JA, the money or anything else.
You can attach pictures here"
........................................................
"Don't see any attachments"
.........................................................Doctor et al,Please see the attached jpeg file.Also, I understand that any actual physician should not be burdoned with dealings with the VA or whatever the JA is, "or anything else" as you phrased it. I provided that info as an explanation of why I am here.I have been charged $45 dollars. It seems to me that since you are more familiar with the site than I would be, that you or SOMEONE would be able to explain the additional $35 being requested to cover your "offer" to help. Please. It is the internet. And this isn't even email. It's a modified chat room. For all I know you may be doing this pro bono on the side or to work of some community service time, or not, but how likely is it that you would do pro bono for a commercial venture like Justanswer.com. My surgeon is an orthopedist with a very specialized practice in sports medicine.This is probably not going to work for me, unless I will be able to consult with or "chat" with someone who would be qualified to assess whether his assistant has provided sufficient post-op information to me about what to expect during my recovery. No offense doc, but a drop down box on here, gave me the choice to select Orthopedist, which I did.Please tell me what happens if I decline your offer to wait for an orthopedist. Tks.
Customer: replied 1 year ago.
The illustration is from memory of the Xray taken and shown to me on the day of my 5th week followup exam.I can only guess what the weight of the detached bone chip can or will cause to happen over time if not properly addressed.
Customer: replied 1 year ago.
At my 9th week followup exam, none of the Xrays taken that day were shown to me. The matter of my new Leg Length Disparity seemed to be something of a diversionary primary focus. Before I knew it she'd gracefully and compassionately shuffled me in and out of her exam room in under 15 minutes.
Customer: replied 1 year ago.
Here, again from memory of the only Xray shown to me, is the nail placement.One other thing in that Xray caught my attention. But please allow me to reserve that until I see how much detail/$'s I can expect from this forum.
Customer: replied 1 year ago.
Let's try this script out again, shall we?
Customer: replied 1 year ago.
The location of the "nail" in my illustration is likely at least 1" lower than actual.
Customer: replied 1 year ago.
An orthopedist will be familiar with the stabilizing pins used at top and bottom of the nail. I have questions about those pins and about any long term discomfort that would be normally associated with those.
Customer: replied 1 year ago.
But overall I am naturally concerned about how far to take the exercising given how painful certain ones like simple seated knee raises can be at the upper end of the upper thigh muscle, for example, after a couple sets of 15.Sorry.If I sound a little paranoid, maybe it is because I am.My wife (73) is a 2006 stroke survivor and by coincidence last year her youger sister had to have one of her legs amputated, eventually to the hip, just because of some genetic vascular defect she, and to a lesser extent my wife, was born with. My wife's pre-stroke walking discomfort was in the same approximate area as my mild achiness is located after any extended amount of walking around or into stores with a Loftgren crutch. The upper inner thigh.
Customer: replied 1 year ago.
I thank you for your time. Forgive me for not understanding how the site works. For all I know only a Vascular specialist or Neurologist would be best qualified to assess and/or allay my concerns. Again I thank you.
Expert:  Dr. Rick, MD replied 1 year ago.
Hi. My name is***** and I am online and available to help you today. Thank you for your patience.
I see that your expert has opted out.
No pictures have been uploaded.
Question and answer is just one of the services I offer. I can also provide you with additional services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.
That being said, I think you would be well served to obtain a second opinion in person. Please allow me to explain:
At this point I think the best thing for you to do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.
The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.
I know that it is going to take significant effort on your part, but I believe that going to one of the "Medical Mecca's" is your best chance to – finally -- get to the bottom of what is going on.
Does this make sense to you?
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned the top rating in all areas, please let me know what I can do to meet your expectations.
Thanks in advance,
Dr. Rick MD FACS
Customer: replied 1 year ago.
Dr. Rick, --- While your suggestion of seeking help at a teaching hospital makes some sense, in my case I'm not sure it will be necessary to go to that extreme. At this time, in advance of getting a post operative review appointment through the VA, I am simply trying to ascertain whether my risks of developing clots have been addressed completely enough. Is it true that you are unable to access the two graphics which I have already posted onto this "thread", "chat", whatever justanswer.com professes this "service" to be. Doc. The links to those graphics still appear above on the same page which includes the box into which I am typing this. If on your end you are denied the ability to read my entire thread, including the previous "offer" my question elicited, and the 2 preliminary graphics I submitted to that individual, then how would you be able to determine whether you could provide information that was more helpful than the last. Hint. justanswer.com probably likes it just fine the way this script is set up. Please note that from the consumer/patients end this site is annoyingly vague about what get's billed, when, and for what. Not bad advice.. but my tolerance for complicating the administration picture, and names to remember, could probably be solved much more easily by being less cooperative and calling a lawyer, which up till now in my life I have previously thought to be sleazy and ungrateful.
Customer: replied 1 year ago.
Dr. Rick, If you decide to retract your offer, could you please confirm that on your end, no info about previous offers to me or any patient-x are readable. Thank you. Maybe there is something I need to learn about the 5-star rating system. About all I can say explain is that I am more in need of an answer that is more scientific in nature. Again. Thank you.
Expert:  Dr. Rick, MD replied 1 year ago.
I do not know how to retract the offer for a phone call...but just don't click on it and it will just go away.
I wish you the very best.
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you can please give me the top rating in all areas. It has been a pleasure to assist you today.
Thanks in advance,
Dr. Rick MD FACS