Page 3 of 3 FirstFirst 1 2 3
Results 51 to 73 of 73
  1. #51
    Join Date
    Feb 2014
    Location
    Canadaland
    Posts
    3
    Dr. Heard did my knee in 2015 (ACL grade 3 and meniscus tear) and you are definitely lucky to have him as your surgeon.

  2. #52
    Join Date
    Oct 2008
    Location
    Somewhere else
    Posts
    5,676
    While I'm sure it's good to have such an experienced and competent surgeon operate on me knee, I feel quite certain the system here failed me to a fair degree.

    It's been a while since I posted on this, so here's a synopsis of how things played out for me.

    Through listening to what the doctors said at various visits I found out that this kind of injury is best dealt with in the order of days after the actual injury, and that "urgent" treatment of this kind of injury was possible up to about the 3 week mark. I'm not sure if that's specific to an injury to the PCL or if it's because there was so much associated other damage... I wasn't able to find that out. The problem is that I wasn't seen in a timeframe that would have allowed for the best course of action.

    I was told by the emergency medical team at the Banff Springs Hospital that I would need to wait 2 weeks for swelling to go down for the injury to be assessed, and at that time I would see an orthopedic surgeon that would handle my case, and that would be back in Banff at the same hospital. I live in Calgary but my understanding was that the wait times in Banff were shorter and that the best knee surgeons are there anyway so why not skip the longer wait times associated with going through Calgary only to get transferred back to Banff. I was told this while at the ER in Banff when I was given a choice on whether to receive treatment in Calgary or Banff. Based on a post earlier in this thread regarding wait times for urgent procedures, it seems like I might have been wrong about that assumption and that I might have been better of starting this in Calgary... but who knows.

    1 week after injury I was contacted by the surgeons office, and instead of getting an appointment with the surgeon right away, I was given a triage appointment at their sister clinic (the same company) in Canmore where a sports medicine physician would asses my injury and advise on the next step. At that appointment it became clear that the injury was very serious, and I was booked in for an emergency MRI in Calgary that I got within 2 weeks of this appointment in Canmore. MRI are rarely ordered for knee injuries in Canada and are even more rarely done that quickly so obviously this was serious.

    Despite the fact that this injury was very serious and the physician in Canmore assured me that I would be getting surgery quickly for something this bad, I didn't even get my appointment with the surgeon (Dr. Heard) until 2 weeks after this triage appointment... 2 days after the MRI and a full 4 weeks after the injury. At that point it was basically too late to be bumped up for urgent consideration and the only thing I could do was let my knee "heal" to a certain degree on it's own and get my leg as strong as possible to prepare for surgery. I was not told this at the time, I had to find this out later when I went for another visit to the physician in Canmore when he told me this kind of thing is best treated in days rather than weeks, and even used the fact that he didn't see me until 2 weeks after injury to try to explain why there's not much they could do, even though it was their decision to see me after 2 weeks and not mine.

    Ironically and of pure chance, one day in May or June of this year I was out for a long bike ride and had my brace on. I was walking my bike down the street and someone commented on my brace... which he recognized because he had actually had the exact same brace from a very similar injury (full ACL, MCL, PCL rupture while skiing) that he sustained in January that year, within days of my injury. He told me he knew someone at Winsport in Calgary and got assessed within a couple days of injury and had surgery scheduled right away. At that point he was out of his brace and on the mend and I was still 1-2 months away from my getting surgery.

    I get the concept of triage and that for most knee injuries that are the run-of-the-mill ACL rupture, not seeing the triage until 2 weeks or the surgeon until 4 weeks is going to be good enough, as those injuries will not get bumped up and the normal 9-12 month wait for surgery would occur. But what's very frustrating is that the system put in place by the team in Banff was set up in such a way that it seems like it was pretty much impossible for me to get the urgent care I really needed. This seems like a failure of policy more than anything, and the fact that someone with the same injury at the same time in Calgary can get treated properly really proves my point. The fact that it's possible to assess the true state of an injury within days in Calgary makes me wonder why I was told I have to wait 2 weeks in Banff. Clearly this other guys knee was very swollen when he was assessed within a couple of days, and honestly, when I was in the hospital right after the injury I had minimal pain in the actual joint and minimal swelling... and that really seems like the best time to asses the full nature of the injury. If that had happened and I had known how bad it was right away it would have been possible and even likely I'd have received treatment in a similar time frame as this other guy in Calgary.

    The fact that I have to go through rehab on this knee twice because of policy decisions that I have no control over and that are set up in such a way that it seems like anyone with an injury like mine will not get the treatment they really need, is extremely frustrating. Actually, that is a major understatement. It's affected my ability to work, and it's royally fucking with my mental health.

    Sorry for the rant... but I guess it's important for me to post this so that anyone else in my area can know some of these limitations if theyhave an injury in the future... maybe they'll be more successful than me in getting properly assessed to avoid something like this happening to them.

    On the current state of affairs.... I got surgery on July 11th (complete allograft replacement of the MCL, ACL, and PCL). The surgeon told me everything went very will with no surprises or problems and confirmed that I have no meniscus damage so that's a big plus. The recovery from the surgery seems to be harder than the recovery from the injury itself. I've had some setbacks but seem to be getting a bit better at weight-bearing without crutches but my gait is still not great and I'm a little behind on moving to the next phase of exercises due to advice from my physio based on some setbacks I've had and how my specific situation is progressing. I'm hoping to be on phase 2 exercises by next week, and I'm really hoping I'm going to be allowed to start biking in October so I can get some exercise in before the snow flies. I'm told I won't be downhill skiing this season but I'm hoping to get to the point where I'm at least allowed to do some easy cross-country so I can actually get some exercise this winter.
    Goal: ski in the 2018/19 season

  3. #53
    Join Date
    Dec 2010
    Location
    Last Best City in the Last Best Place
    Posts
    7,272
    ^^Well that kinda sucks how it all went down, but I hope you heal up well. I guess you're kind of the poster boy for the Canadian system and its drawbacks, i.e. waiting for care. How much did the whole thing cost you? If you say nothing, then I might say maybe it was worth all that, provided you are okay in the long run.

    My ACL surgery cost me about six grand out of pocket...that was my deductible. Insurance covered everything above that. If you believe the bills they send, insurance probably covered about 25 grand above what I paid, for the surgery and PT. Although I suspect what insurance ACTUALLY paid was considerably less than that. Impossible to tell in the U.S. what anything costs for real. Health care is a big smoke-and-mirrors game down here.

  4. #54
    Join Date
    Oct 2008
    Location
    Somewhere else
    Posts
    5,676
    ^^^ surgery was indeed free. That is definitely a big deal and a good thing.

    Things that are not free and I've been paying for are things like drugs, crutches, and my knee braces... I've probably spent about $2000 out of pocket so far and that's with my most expensive brace being heavily subsidized.

    I'll still need to buy another brace for about $1800, and after my 7 free physio sessions that I get from the government because I underwent surgery, I'm on the hook for any more sessions I need.

    I also have no idea exactly what the government will be billed for this.

    I'd say all of this is still probably better than paying $100,000 or more for this myself (and someone suggested that number in this thread). And from what I have heard, I had one of the best surgeons available for this, and 6 months is actually faster than people with lesser injuries get treated. I think the frustrating part for my situation is that it's recognized that my injury should be treated more quickly, and clearly can be treated quickly in certain situations as evidenced by the guy I ran into, but I still fell through those cracks.
    Goal: ski in the 2018/19 season

  5. #55
    Join Date
    Sep 2015
    Posts
    1,279
    One of the things I found to be the case here, in my tib+fib was that I had to do all the research to determine what provider, what procedure, etc. I have a lot of friends in the medical field, docs/nurses/etc, so that helps tremendously. I think that "self-help" is SUPER beneficial no matter what system you're in - single-payer or a "greed-is-good" market like the US.

    Unfortunately, not everyone has the kind of resources I do, in terms of medical advice. And I have no idea how to solve that problem. It shouldn't work that way - you should always get good advice and care from people who really do care, and aren't just doing their job without a lot of care/attention-to-the-details.

    But it sure seems to me, that the most usual course is, unless you have good advice and an inside track, you get shunted to the slow-boat crew and often get just barely competent care/treatment. It's not an aberration to get lousy care, it's the norm. It's people, like me, who have friends with good advice, who know-someone who knows someone who works in that office that gets the exceptional care.

    Sorry to hear you got left on side of the road, so to speak, to nurse your wounds as best you could. I wish I had some fool-proof method that would allow everyone to get excellent care - but I don't.

    ---
    As for OOP costs...
    It's nice to have insurance coverage. My OOP for a tib/fib fracture [much more trivial injury than yours] was ~$7000. That's in the US. I have to purchase coverage as an individual on the marketplace.

    My cost for *both* insurance [for my family] and the cost of the single tib+fib was in excess of $13,000 for the year.

    [I'm not complaining about having health-care, or the ACA [Obamacare] - at least not from the "it's too expensive," and we should go back to the shit loser-health system we had before. I actually think the ACA should have gone a lot further. Instead we're in a no-mans land where the premiums are very high in the individual market (because there's lots of sick people) and the "pools" of people are still segregated to a significant degree - instead of spreading the risk over the entire population. Sure that would mean that lots of people would pay more, but that increase would be pretty modest vs the amount more those in the individual pools pay. This is a complicated topic, so I'll leave it there.]

    In my case, the insurance company actually paid out about $28K for everything.
    Yet they got ~$7000 in premiums from me. [and while there were minor things they paid out for, other than the tib+fib, they were trivial - on the order of a few hundred bucks at most.] That means, they were net-negative, on a single year basis, by about $21K. If you figure a few years without incident, the tide shifts pretty easily. That means there must be a LOT of other really sick people in my insurance pool.

    I paid $7K in premiums, and nearly another $7K in OOP costs. I'm glad I had coverage, but it certainly wasn't a plush ride.

    And to make it worse, I did my tib+fib in mid-December, so a fair bit of the follow-up care was under my new deductible the next year. That kinda sucked.


  6. #56
    Join Date
    Dec 2010
    Location
    Last Best City in the Last Best Place
    Posts
    7,272
    Quote Originally Posted by gregorys View Post
    And to make it worse, I did my tib+fib in mid-December, so a fair bit of the follow-up care was under my new deductible the next year. That kinda sucked.
    Yeah that's a tough pill to swallow. I got "lucky" and injured my knee in January, so all my costs came in the same year. I guess I can be thankful for that.

  7. #57
    Join Date
    Oct 2008
    Location
    Somewhere else
    Posts
    5,676
    Good point about self help.

    I have really tried to do that in my case but met with a lot of resistance... people were not answering a lot of my questions or just being dismissive when I asked them... This includes the physicians, and the orthotist and the PT recommended by the surgeon, and the rep from the brace company. They were all talking to each other and dodging my questions when I started feeling like I wasn't being told the whole story.

    One major problem with the Canadian model is that because nobody is fighting for your business, you don't get the same interested level of customer care here. People also rarely go for a second opinion here either so the physician isn't worried about being contradicted or losing you as a patient.

  8. #58
    Join Date
    Sep 2015
    Posts
    1,279
    Quote Originally Posted by Shorty_J View Post
    Good point about self help.

    I have really tried to do that in my case but met with a lot of resistance... people were not answering a lot of my questions or just being dismissive when I asked them... This includes the physicians, and the orthotist and the PT recommended by the surgeon, and the rep from the brace company. They were all talking to each other and dodging my questions when I started feeling like I wasn't being told the whole story.

    One major problem with the Canadian model is that because nobody is fighting for your business, you don't get the same interested level of customer care here. People also rarely go for a second opinion here either so the physician isn't worried about being contradicted or losing you as a patient.
    Yeah, getting straight answers IS hard. That's why I think having friends who help select the best provider helps. A fair bit of luck is involved too. [I think when things go well, we tend to view it as a monument to our "skill" - when in reality it's probably a little skill, and quite a lot of luck.]

    You may be right about the Canadian system - where there's an increased level of disinterest. But the US system is rife with influence of self-interested parties. [e.g. Lets push opioids because it makes us a ton of money. You can see that first hand, from the drug-companies (the worst offenders IMO) down to providers who run pill-mills.] There's a ton of evidence that if you make more money from X, you'll end up steering people that way, due to conscious or unconscious bias.

    On this exact topic - there's quite a lot of discussion recently - providers recommending [I think, in good faith] for debridement in meniscus tears. They say " See we did an MRI, and the meniscus is torn. The patient is in pain. We should fix it."

    Yet if you MRI the general population and check their knees, there doesn't seem to be a lot of correlation between knee pain and tears. People without tears have pain, and people with tears don't. So what's "normal?" What are you "fixing" and to what standard - what's a properly "fixed" meniscus look like?

    The answer is, we really aren't completely sure.

    Do a few searches on "Sham surgery."

    Here's a few to get started with...
    http://www.nejm.org/doi/full/10.1056...5189#t=article

    Eg: https://academic.oup.com/painmedicin...dFrom=fulltext

    Pretty nuts, eh?

  9. #59
    Join Date
    Oct 2003
    Location
    slc
    Posts
    17,891
    Quote Originally Posted by gregorys View Post
    Pretty nuts, eh?
    It's crazy that surgical procedures aren't subjected to the same rigorous standards of efficacy and safety that drugs are. Very few people are aware of it. Spinal fusions seem to be another one that are very much "buyer beware".

  10. #60
    Join Date
    Sep 2015
    Posts
    1,279
    Quote Originally Posted by Dantheman View Post
    ...the same rigorous standards of efficacy and safety that drugs are.
    Ha! While I'll agree it's easier to do double-blind placebo-controlled cross-over studies with drugs, I think it's also easier to game the system. I'm somewhat doubtful that efficacy and safety are all that much different between the two. [Irony: Statement made without a lot of concrete evidence. ]

  11. #61
    Join Date
    Dec 2004
    Posts
    934
    Shorty it sounds like you got someone who just didn't feel the need to have Ortho come in and address your knee when you were at mineral springs. The can and should have them come in. The "Banff wait list" is shorter idea is out the window. Calgary had wicked one clinics and surgeons. Mineral springs is still part of covenant health and make a ton of money off foreigners and locals for electives. For a system like ours that is still "pretty good treatment" though it would be nice to get out sooner. I see it quite often. As some one who works in the system i can say "you are your own best advocate"

    Sent from my SM-G930W8 using Tapatalk

  12. #62
    Join Date
    Jan 2008
    Location
    truckee
    Posts
    23,120
    Shorty--if you had been in the US (and had insurance) you would have had your surgery right away--whether you needed it or not.

    Orthopedists not coming to see patients in the ER unless they need admission and surgery during the admission is a pet peeve of mine. Patient gets a splint and has to come back to see the ortho. Sounds like the US and Canada are the same in that respect. The system is set up for the convenience of the doctors, not the patients. It happens in general surgery too but I don't think we're as bad. Patients should be treated like valuable customers, not as people who should be grateful for any care they get. After all, patients are the reason we live in big houses and have big boats and big cars. (OK--I have a shitty 40 year old little sailboat and a 2005 Forester, but that's because I'm cheap and the new Foresters are too big.)

  13. #63
    Join Date
    Oct 2008
    Location
    Somewhere else
    Posts
    5,676
    Quote Originally Posted by crashidy View Post
    Shorty it sounds like you got someone who just didn't feel the need to have Ortho come in and address your knee when you were at Mineral Springs.

    ....

    "you are your own best advocate"
    I agree that was a problem at Mineral, but once I was assessed at 2 weeks there should have been a mechanism to speed up then as well.

    And it's difficult to be your own advocate when you don't know where the problems can occur, or the nature of the injury, and the questions you do ask are not answered properly. I really did try my best to be my own advocate.
    Goal: ski in the 2018/19 season

  14. #64
    Join Date
    Oct 2008
    Location
    Somewhere else
    Posts
    5,676
    Quote Originally Posted by old goat
    Patients should be treated like valuable customers, not as people who should be grateful for any care they get.
    Oh man... so much of this.

    I get this feeling so often when receiving health care here.
    Goal: ski in the 2018/19 season

  15. #65
    Join Date
    Oct 2008
    Location
    Somewhere else
    Posts
    5,676
    Quote Originally Posted by crashidy View Post
    The "Banff wait list" is shorter idea is out the window. Calgary had wicked one clinics and surgeons. Mineral springs is still part of covenant health and make a ton of money off foreigners and locals for electives.
    I'm sure Dr. Heard is a great surgeon, but do you think maybe locals in this area are perpetuating this speed myth in part when we say things like "he's the best"? Like, maybe all that was true at some point and calgary was slower but that was 15 years ago? It's almost like there's some mythology about him and about the Banff clinic.

    What's funny is that I was told Banff is faster by the ER in Banff and also by some at the acute knee clinic in Calgary at the time of injury... which you have provided links to contradict that with facts.
    Goal: ski in the 2018/19 season

  16. #66
    Join Date
    Dec 2004
    Posts
    934
    Quote Originally Posted by Shorty_J View Post
    I'm sure Dr. Heard is a great surgeon, but do you think maybe locals in this area are perpetuating this speed myth in part when we say things like "he's the best"? Like, maybe all that was true at some point and calgary was slower but that was 15 years ago? It's almost like there's some mythology about him and about the Banff clinic.

    What's funny is that I was told Banff is faster by the ER in Banff and also by some at the acute knee clinic in Calgary at the time of injury... which you have provided links to contradict that with facts.
    Banff can be faster if you get on the wait list but so can calgary. I would say the average wait time for knee surgeries seems to be at least 6 months. Part of the problem/issue is people being able to select an approximate time frame (ie. Spring or fall). A friend of mine did some acl, lcl damage in April. Went to foothills waited 8 hours on a Friday night to be given a date 2 weeks later in the white one injury clinic. He got a surgery date in November. Got a call that a cancellation occurred in Banff in July if he was willing to take it. He did.
    I'm not sure if he(heard) still does but he used to do clinics in golden also. He has cut down how many knee surgery days he does as his is pioneering shoulder replacements.
    Banff is tight on OR space. The others there do great work as well.



    Sent from my SM-G930W8 using Tapatalk

  17. #67
    Join Date
    Dec 2004
    Posts
    934
    Quote Originally Posted by Shorty_J View Post
    Oh man... so much of this.

    I get this feeling so often when receiving health care here.
    I don't mean to say you are at fault at all for the "you are your own best advocate" but simply saying the majority of our health care isn't looking out for your best interest. We are just part of the que waiting for our turn.
    As old goat highlighted the biggest difference between our systems. We have a cash strapped system where anyone with a stuck fart, a pimple or a missing leg can go to emergency and recieve health care for zero dollars. Only going to get significantly worse. Dr's are getting paid no matter what and there is always a line to see them.
    It sucks for those that really need to get fixed and back to work. I guess that's why there is the push for a semi private system.

    Sent from my SM-G930W8 using Tapatalk

  18. #68
    Join Date
    Oct 2003
    Location
    slc
    Posts
    17,891
    Quote Originally Posted by gregorys View Post
    Ha! While I'll agree it's easier to do double-blind placebo-controlled cross-over studies with drugs, I think it's also easier to game the system. I'm somewhat doubtful that efficacy and safety are all that much different between the two. [Irony: Statement made without a lot of concrete evidence. ]
    Touche. At least there is system in place for drugs, even if it is manipulated.

  19. #69
    Join Date
    Mar 2008
    Location
    northern BC
    Posts
    30,885
    Quote Originally Posted by old goat View Post
    Shorty--if you had been in the US (and had insurance) you would have had your surgery right away--whether you needed it or not.

    Orthopedists not coming to see patients in the ER unless they need admission and surgery during the admission is a pet peeve of mine. Patient gets a splint and has to come back to see the ortho. Sounds like the US and Canada are the same in that respect. The system is set up for the convenience of the doctors, not the patients. It happens in general surgery too but I don't think we're as bad. Patients should be treated like valuable customers, not as people who should be grateful for any care they get. After all, patients are the reason we live in big houses and have big boats and big cars. (OK--I have a shitty 40 year old little sailboat and a 2005 Forester, but that's because I'm cheap and the new Foresters are too big.)
    that a good thing^^ the pro from vancover dropped by in the am came to see me pre op and said "so we are operating on the left leg"

    NO man its the right leg!

    Buddy took a felt marker out of his scrubs and put a big X on my right foot

    I think you always have to advocate for your self in either system becuse shit can just fall thru the cracks
    Lee Lau - xxx-er is the laziest Asian canuck I know

  20. #70
    Join Date
    Feb 2011
    Location
    The Land of Subdued Excitement
    Posts
    5,437
    The ER bill for my broken fibula was 1200 and some dollars. They took xrays and put a split on. Like half plaster or something and then wrapped in an ace bandage.

    The first visit to the orthopedic surgeon was almost 1100 dollars. The regular Dr visit blood pressure and stuff with a nurse, a couple minutes of the Drs time, and a nurse put on s real cast.

  21. #71
    Join Date
    Dec 2010
    Location
    Last Best City in the Last Best Place
    Posts
    7,272
    Quote Originally Posted by XXX-er View Post
    that a good thing^^ the pro from vancover dropped by in the am came to see me pre op and said "so we are operating on the left leg"

    NO man its the right leg!

    Buddy took a felt marker out of his scrubs and put a big X on my right foot

    I think you always have to advocate for your self in either system becuse shit can just fall thru the cracks
    Surgeon came into the patient's room after amputating the guy's leg and said, "Well, I've got good news and bad news. Which do you want first?"

    Patient: "The bad news, I guess."

    Surgeon: "I amputated the wrong leg."

    Patient: "What?!!? You're kidding me! I can't believe it! What could POSSIBLY be good news after that?!"

    Doctor: "The good news is the other leg is getting better!"

  22. #72
    Join Date
    Jan 2008
    Location
    truckee
    Posts
    23,120
    Quote Originally Posted by yeahman View Post
    Surgeon came into the patient's room after amputating the guy's leg and said, "Well, I've got good news and bad news. Which do you want first?"

    Patient: "The bad news, I guess."

    Surgeon: "I amputated the wrong leg."

    Patient: "What?!!? You're kidding me! I can't believe it! What could POSSIBLY be good news after that?!"

    Doctor: "The good news is the other leg is getting better!"
    I had an amputation to do. I went to mark the leg in the preop area which was unusually crowded--no pirvacy, so I lifted the sheet just enough to see the leg and marked it. When I got her in the OR the mark was on the wrong leg. She had had her legs crossed when I marked it. Fortunately the record, the or schedule, and the appearance of the bad leg made the proper leg obvious--for which I was very grateful.

    There is a lesson there, besides the obvious--don't shortcut privacy. It can be very inconvenient to get privacy in a busy ER or pre-post op area, or even in a 2 bed ward when you have to ask a teenager (or anyone else) about their sexual or substance use history or other sensitive subjects--so sometimes things that should be discussed don't get discussed.

  23. #73
    Join Date
    Jan 2008
    Location
    truckee
    Posts
    23,120
    Went to a joint replacement class at Tahoe Forest in Truckee with my wife who needs a couple of knees. Someone asked the retail cost--about 70K per knee.
    Here's an example of the American entrepreneurial spirit--when my wife was a discharge planner she arranged rental equipment for a woman who needed both hips replaced, one after the other. Walker, bedside commode, wheelchair, some other stuff. When the woman came back for the other hip 6 weeks or so later she asked about equipment. My wife asked her what about the equipment she had already been given. Turns out the lady sold it and was planning to sell the new stuff after the second operation.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •