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Author Topic: Any Opinions on Who To See? Eakin or Steadman?  (Read 1862 times)

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Offline TracyS

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Any Opinions on Who To See? Eakin or Steadman?
« on: March 10, 2005, 11:25:35 PM »
Hi All,

I posted last week asking about Dr Paulos in SLC.  Didn't get any 1st hand feedback so I called Steadman's office to try to get an appt there.  Am still waiting to hear back from them.  I understand it takes a while to connect with the scheduler.  I've also been thinking of calling Dr Eakin and trying to get in there for another opinion. 

So perhaps I could get some opinions from you Eakin and Steadman patients on which doctor might be better for my particular situation.  My scarring is primarily around the patella tendon.  There is some in the joint but not debilitating.  My patella is somewhat tight but moves fairly well.  I also have full flexion and extension.  All my pain seems to be located below the joint around the tendon and it is excruciating.  Going down stairs, standing and walking for any length of time are next to impossible. 

So would one or the other doctor perhaps be better for patella tendon problems?  I would be most appreciative if anyone has any info to share. This is so difficult.  Neither one is very close so I want to make the right choice. Thanks so much.  Tracy
left knee: '90-ACL recon, '91-tibial screw removal
right knee: 12/00-ACL recon, lateral meniscus repair, 3/01-LOA, 10/02-patella tendon LOA, bone spur removal, tibial screw removal, 4/04-joint, patella tendon, pes anserinus tendon LOAs, 5/05-LOA, AIR, synovectomy, chondroplasty, loose body removal

Offline hottubpam

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #1 on: March 11, 2005, 01:04:46 AM »
Hi Tracy,

This is a decision you really have to make on your own.  I am a patient of Dr. E and think the world of him but I have never been seen or treated by anyone at the Steadman clinic.  I had significant scarring around the patella - it was frozen when I went to Dr. E.  After his first procedure it became and remains very mobile.


When I first decided to see Dr. E  I considered the following factors:

1.  TIME.  There was a several month wait to get into SH and I was rapidly approaching the period where the scar tissue would cause irrepairable damage.  Time was of the essence and I was able to get into Dr. E within 3-4 weeks.

2.  MONEY.  SH was not a PPO on my insurance, Dr. E was.

3.  MONEY & TRAVEL & INCONVENIENCE.  Both SH and Dr. E required me to travel - the travel to Palo Alto is slightly less espensive then the travel to Vail (especially in December when I was seeking treatment).

The only factor that Heather M and others have mentioned that SH has a clear advantage in is that they have a PT rehab facility right on the premises where you get access to therapists experienced in arthrofibrosis.

When I decided to see Dr. E, I knew I would at least go for the initial consult and listen to his treatment plan and evaluate the patient doctor relationship.  I was blown away at how thorough his examination was and how much time he spent explaining things to me.  I did see one other OS who was highly recommended but when I asked him what would we do to prevent to scar tissue from returning and he said "pray", I knew then I would go with Dr. E.

So you can see I am clearly biased and you should make your decision based on what's important to you, time, money, travel, inconvenience, ability to get a qualified therapist, etc etc.

Hope this helps.

Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline TracyS

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #2 on: March 11, 2005, 01:42:03 AM »
Hi Pam,

Thank you for your reply.  Your points are all well taken. 

One question right now.  If Eakin doesn't have a PT facility right there then what did you do for PT?  I imagine he must have some kind of protocol for you to follow.  Did you just take that home with you after surgery or did you stay in Palo Alto and go to a PT facility in the area.

Thanks,

Tracy 
left knee: '90-ACL recon, '91-tibial screw removal
right knee: 12/00-ACL recon, lateral meniscus repair, 3/01-LOA, 10/02-patella tendon LOA, bone spur removal, tibial screw removal, 4/04-joint, patella tendon, pes anserinus tendon LOAs, 5/05-LOA, AIR, synovectomy, chondroplasty, loose body removal

Offline hottubpam

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #3 on: March 11, 2005, 02:02:02 AM »
Tracy,

For me, Dr. E wrote a prescription for PT that I brought home and I jave been working with a local therapist that I know and trust.  I am not currently in PT because I still have stitches in and Dr. E wants to make sure the portal heals completely before I start working on flexion again.

Another one of Dr. E's patients (arsenal) is going to a therapist that Dr. E recommended and is right there in the Palo Alto area.  I don't know the details, but maybe she will see your post and respond.

Good luck with your decision.
Pam



ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline bajalady

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #4 on: March 11, 2005, 06:11:49 AM »
Hello,

Dr. Paulos knew what baja (from scarring in fatpad and tendon) was and how to "correct" it way back in the late eighties when it was really really rare. Now is a bit more common due to all the ACL tendon graft procedures that backfire. Paulos has an excellent reputation. He used to do a really big bone graft procedure to elevate the patella and not many even knew how to do it at the time.   

He's been around for a long time and has a reputation for taking difficult cases others pass on.  Advantage to him is that he can and does perform complex open realignment procedures as in the TTT and modified Maquet and osteotomy procedures. I know Steadman does not and I'm not sure about Eakin. If your problem is not too severe (as in a scope will do) the others, Steadman and Eakin should be fine.

Depends on your financial and personal situation of course. The travel for consult is one thing but if you decide to go for surgery way away from home, be prepared for anything as in complications and have a plan. You will be under the care of the surgeon so if something  goes wrong you'll have to jump on a plane unless you choose to stay in the city (Vail or Palo Alto for a month or so) Most on here do not get by with only one surgery so have that in mind and prepare for it in you head and you pocketbook and figure out who is going to take care of you post-op and for rehab etc.

I think you are the one who lives or moved to Utah? Why not see Paulos for a consult. Just a consult. Do not sign on as his patient just see what he says. 

Callie
Lft-- 1 open, mutiple scopes, combo Fulkerson- TTT and modified Maquet, more scopes.
RT--multiple scopes, one open
Baja, patella infra/contracture, DJD--Fibrosis

Offline Heather M.

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #5 on: March 11, 2005, 07:16:41 AM »
Sorry, I haven't had a chance to respond to the Paulos question.  He is a wonderful doctor, and incredibly thorough.  His exam pinpointed exactly what my problem was, and he had a plan to fix it.  I then saw Dr. Steadman a month later, and he came to the same conclusion with a completely different treatment plan.  Dr. Steadman's plan was more conservative--really, less aggressive.  His thinking was that it would be hasty to change the mechanics without trying to remove the scar tissue by scope and see if the body can then be encouraged to heal itself--without the need to move the tibial tubercle.  Dr. S. also was very, very concerned about an invasive open procedure causing more scar tissue.  Dr. Paulos did agree on that point, and said he'd tackle the mechanics first with a DeLee Osteotomy or a Maquet procedure.  Then, he foresaw another 1-3 scopes in the future to deal with the 'inevitable' scar tissue that the TTT would cause.

So really, it was just a completely different approach--tackle the mechanics, and then the scar tissue vs. tackling the scar tissue and seeing if more conservative treatment can't correct the mechanics.  This is the approach I took, with no regrets. 

Another factor for me was the PT facility in Vail was so incredibly impressive.  I really haven't seen anything like it--Dr. S. comes down to see patients in PT on a regular basis; if your PT found a problem like a leaking portal or something, he/she picked up the phone and either Dr. S. or a fellow would come down to check things out.  The PT's are all very, very familiar with the protocol--this, to me, is much preferrable to handing a PT a typed up protocol sheet and having the PT follow it without really having an in-depth understanding of the principals behind everything.

The PT set-up also was particularly important to me because Dr. S. stressed it so strongly--he said unless I was willing to stay in Vail for a month, it wouldn't be worthwhile.  That's because I had several failed LOA's.  Now, most LOA patients stay in Vail for 3-5 days, so the PT setup locally may not be as big a factor for them.

Anyway, I really don't think you could go wrong with any of the three doctors.  Keep in mind that one person's dream doctor is another's nightmare!  I decided to see Steadman because his approach was the most conservative. and kept in the back of my head the idea that if Vail didn't work out, then I could 'step it up' and see either Paulos or Noyes.  You may or may not know that Dr. Paulos was a fellow of Dr. Noyes lo these many years ago--probably explains his early interest in patella baja--he was exposed to it during his fellowship.

Now, I've never seen Dr. Eakin--he was Dr. Steadman's fellow a couple years ago.  Personally, it made more sense for me to see the teacher rather than the student--but I also knew that Vail was a better option for personal reasons.  That definitely colored my thinking and helped me make the decision.  I also really liked Dr. S's approach and bedside manner.  Can't say how it compares to Dr. E because I've never seen him!

So my advice would be, if you want the great PT that goes along with the surgery (i.e. can stay where you have surgery for a couple of weeks), I'd lean toward Vail.  Also, at this time of year the wait is down to 3 weeks--I got a call today and have a surgery scheduled on April 20th.  It's just the ski season that messes things up--likely you will find that with Dr. Paulos, too.  If you are planning on going home right after the surgery, the PT isn't really as important.  And to me, that's not something I was willing to do--I'd already had too many bad experiences with absolutely the wrong PT methods.  I personally felt the PT was MORE important than the surgery, along the lines of 60-40.

As for Dr. Paulos, I really think you should see him since he lives nearby.  I found his approach very different from the others, and more aggressive.  He gave me a 70-80% chance of reducing 70-80% of my pain; with such a huge procedure, and with my concerns about massive scarring after, I was quite frankly afraid to do the TTT.  I was having trouble at the time keeping tiny little scope holes closed--I was scared to death of what my body would do with a 5 inch incision.  Also, I got the impression that Dr. Paulos was more of a patella baja and PFS mechanics specialist, vs. Dr. S. being an arthrofibrosis specialist.  It's a small difference, but to me it swayed me toward Vail.  I also had Dr. Paulos in the back of my mind if the scope didn't work out.  This was because Dr. S. doesn't do the big, open patellar realignment procedures (since he works on athletes, not PFS patients in particular--it would be tough to be an Olympic athlete after a TTT).

So that was my rationale--to do the smallest procedure possible to effect a change, to go to the one who was the teacher and not the student, and to visit a one-stop shopping locale:  surgery, very close follow-up care, and specialized PT twice a day--starting one hour post-op!  I was also able to swing the off-season rates (early December).  Since Vail Mtn. is scheduled to close on 4/15, that means things will calm down shortly thereafter in Vail in terms of the wait.  The rates will also go down to approx. 1/4 to 1/8 of the high season rates!!

This was my decision making process.  It had nothing to do with skill levels of the doctors--they are all top of the line.  But it was the small details that made Vail a better decision for me.  Others might go the opposite way.

Hope this info helps.  Again, sorry for the delay in responding.  I've just kicked out, er, kissed goodbye my LAST set of guests for the spring.  I had three different prolonged visits from friends in the last 5 weeks--it goes with living in a very pretty area.  But they took a lot of my time, and I've spent a LOT of hours on my feet.  Knee not liking this....now I'm trying to catch up on this as well as all my gardening.  The darned plants think it's May, and are growing like weeds.  So I've got 13 bareroot roses soaking in my bathtub and a neighbor child digging holes all over my yard...hard work, but it will be worth it.

Ask any other questions you might have.  If I were you, I'd look at the setups of both out of state docs, and see Dr. Paulos because he is a wonderful, caring doctor with a high degree of specialization who is right next door.  He may be just the answer you are looking for, in which case that would be underscored when/if you see the other docs.

Heather

PS I actually think Dr. Paulos has moved 'up the hill' to Park City!  Or somewhere nearby.  He was at TOSH, the Orthopedic Specialty Hospital, and I got a letter a year ago saying he'd left Salt Lake and gone to Park City.  So you might have to do some digging to get his contact info--if the TOSH place is classy (which it was) they will give it to you if you call.
« Last Edit: March 11, 2005, 07:23:37 AM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline arsenal

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #6 on: March 11, 2005, 07:29:00 AM »
Hi Tracy

I see Dr. E and my reasons for choosing him was mostly for conviences.

My iinsurances, like Pams covered Dr. E and not Steadman.
I knew I had to stay for a month or more in the area I choose to have surgery, so if i went to Vail, I would have to pay for housing expenses. Where as if I went to Palo Alto I don't, because my mom lives about 1hr away from there. 
So for me Dr. E is the best decision I made.

This is my 3rd week out here. A week after my consult I had the surgery and a week after that I started PT at a facility he works with. It is not part of the Palo Alto Foundation, but it is near by.  The perscription was specificaly for that particular PT.  So far the setup is working out great for me.  I will be here until my next appointment and then hope to continue PT in Virgina. 

I thinkDr. E is great and I love his patient Doctor relationship. But he may be or may not be convient for you.

Wish you all best. Good luck in your decision making.

Tse
July 1, 2004 Repair Tibia Plateau Fracture - 5 screws + Metal Plate
Nov 18, 2004 LOA, MUA
Feb 23, 2005 LR, LOA, anterior interval release

Offline TracyS

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Re: Any Opinions on Who To See? Eakin or Steadman?
« Reply #7 on: March 12, 2005, 06:39:02 PM »
Hi All and thanks for all your very informative posts!  I'm really being spured into action.

I'm still in the Seattle area but trying to move to Park City hopefully by late summer.  So none of the 3 docs I'm looking at is really convenient but Paulos has the inside edge there as we have purchased a house in Park City so I would at least have somewhere to stay if I went to him.  But you know I've gotten to the point where it really doesn't matter.  I've reconciled myself to the fact that if I have to somewhere and stay until I get on top of this thing that's controling my life then so be it.  Same with insurance.  If I'm not covered then I'll just deal with it somehow.  It just doesn't matter anymore.  If we can't sell our house and move on schedule because of me that's just the way it goes.  It's gotten to the point where this has got to take precedence.

So, I'm playing phone tag with Rae to try to get in to see Steadman.  Meanwhile, my husband and I are going to be in Park City the last 2 weeks of the month working on the house so I got in to see Dr Paulos for a consult on the 30th.  I think I'll see how those 2 appts go and then decide whether to see Eakin.  But if Steadman's appt is way off I may see Eakin in between. 

So I'll let you all know how it goes.  And Heather, Paulos seems to be in SLC and PC!  I see his name in both phone books.  But my appt is in SLC and they didn't say anything about PC when I called even I said I would be in PC.  So maybe he's just working in the city again.

Thanks again for all your wonderful input.  Tracy
left knee: '90-ACL recon, '91-tibial screw removal
right knee: 12/00-ACL recon, lateral meniscus repair, 3/01-LOA, 10/02-patella tendon LOA, bone spur removal, tibial screw removal, 4/04-joint, patella tendon, pes anserinus tendon LOAs, 5/05-LOA, AIR, synovectomy, chondroplasty, loose body removal