Same Evidence-Based Decision-Making

Monkeys are just like squirrels: appealingly fuzzy, nimble, cute, destructive little stinkers

In mid June last year, a woman named Veronica - a nurse at the Holland Centre associated with Sunnybrook Hospital - told me that no surgeon in Toronto would give me a new hip. She said this even as we were looking at an x-ray clearly showing what had been diagnosed by an anonymous technician as "moderately severe arthritis" in my right hip.

I was perplexed by that pronouncement, and a number of readers of this blog were simply outraged. How could it be, we all wondered, that I could so obviously need one and still never get a new hip from any surgeon in Toronto. I got a lot of advice about how to deal with this problem, ranging from attesting to multiple falls to heading out on my own, knocking on surgeons' doors.

I ended up doing a combination of these things. 

The Holland Centre did nothing good for me, except plant the idea that a physiotherapist might be able to help me. A physiotherapist did help me. Adam Brown of Cornerstone Physiotherapy gave me both gratis advice about how to stay fit and the name of a doctor - one of those surgeons in Toronto who purportedly would never give me a new hip - who I could talk to about my options.

Hooking up with that doctor was a process of some months. First I had to get his name - Dr. Paul Kuzyk (DPK) - and then get that to my GP, so the slow-moving person in her office could send out a referral request. Then I had to wait to hear back from DPK. When I did hear, they offered me a date for an appointment early in December, when I was in Paris for the climate conference. So I called, from Paris, and arranged for a new appointment, which was this past Wednesday, February 3.

In all my other life's endeavours I have learned the best way to get the outcome you want is to arrive prepared. At the Holland Centre, I had brought only the short list of medications I take, leaving to the clinic and its processes to fill in all the other blanks about me. But, rather than ask me about quality of life or what I need to sustain a feeling of well-being, they asked me if I had difficulty tying my shoes or getting in and out of a car. Since I was OK with those things, by their metrics, I was just fine.

I had no idea how DPK would assess me. They had asked for the standard information about what doctors I see and medications I take, but I knew how far this had gotten me before. I wanted them to know my side of the story, too.

So I wrote it all down - just like they say you should when you're visiting the doctor. I considered claiming multiple falls, but ended up just setting out the plain facts of what I was going through and its effects on me.

I wrote about myself as "the Patient." Here's a sample:

The patient was an active person. Until onset of the arthritis symptoms (see next paragraph), she walked between five and ten kilometres a day and practiced yoga four to six times a week. The patient’s level of activity is important to her quality of life... and contributes to her overall feeling of well-being.

Around mid-January 2015, the patient began to experience severe pain and a feeling of weakness in the right hip and leg. The sensations were especially strong during and after yoga classes, while walking and at night when the patient was trying to sleep. ... The reported diagnosis by the patient’s family doctor was “moderately severe arthritis in the right hip.”    

I also brought along the x-ray from the Holland Centre. 

So this is what happened: an intern/resident came into the examination room where I was waiting and said, "I've been reading about you." 

I said, "And here's some more for you to read" and handed him the information I'd brought. He skimmed it and made some random expressions of "oh!" and "it's all here!" 

Then I handed him the x-ray. Again he said "Oh!" and "This saves a lot of time!"

Then he left the room.

The intern/resident returned a few minutes later with DPK in tow, a short, slightly built strange little dude whose skills as a surgeon, I hope, are inversely proportionate to his skills as a social animal.

DPK introduced himself, said "um" and "aw" a couple of times and then said, with a "I'm trying to soften the blow" tone in his voice, "your x-ray shows a level of cartilage loss that really can't be treated any other way than with a hip replacement."

And that, ladies and gentlemen, is all there was to that.

They couldn't give me a firm estimate of time-to-surgery, but August/September 2016 is probably in the ballpark. 

While I was finishing up the paperwork with the clinic receptionist (this is all happening at Mount Sinai Hospital, by the way), the resident/intern came by and said, "that was really great information you gave us." 

He stopped and thought a bit more. "Did you write that yourself?"

DPK may not be the only dude who needs to work on his skills as a social animal.

Thanks for reading!

Have a great week!

Karen