Here we are. Not nervous AT ALL. (Lies)

I swore I’d never come back, but here I am, my back against the wall and a ready-to-eat crow in my pocket.  We have 3 moms in our Facebook group who are patients of, and are very pleased with, Dr. Lerman.  Will we be the 4th? Only one way to find out, here we go.

One thing about Shriners, it really is a nice facility.  While I’m not super thrilled with their inpatient facilities, for a charity hospital, it really is great.  There are so many little things that make it great, like giving a “brand new” box of crayons to my girl, because we forgot hers.


We had to wait a little while, but she was coloring in full swing, and happy to wait.

When he arrived in our room, he seemed nice and very personable. (check) Not intimidating at all.  Okay, onto my stream of questions.  (If you want a blank copy, you can find them here.  (I omitted a few because they seemed unnecessary.)

Questions for Perspective Orthopedic Surgeons

  1. How long have you been treating Congenital Pseudarthrosis? A very long time. (we had to count) About 19 years
  2. How many patients have you treated in that time? I’m not really sure.  Quite a few.
  3. How often have you achieved union? That’s hard to say. Achieving union is one thing, keeping it is another. It really depends on the patient.
  4. How often have these kids refractured after achieving union? Exactly.  Some do, some don’t.  The important thing is being able to get on with being a child.
  5. Under what circumstances will you recommend amputation? Amputation is sometimes necessary.  When it looks like a child will have a fuller life with a prosthetic, then that’s the direction we move in.
  6. How often have you recommended amputation for your pseudarthrosis patients? I’m not really sure, but the ones who have are doing really well.  Walking, running, playing sports, all without pain.
  7. Did you ever feel you didn’t amputate soon enough? (I do wish I had asked this in retrospect. Darn!)
  8. Do you recommend surgery for my child at this time, or would it be best to wait until s/he is older? What sort of surgery? (Unnecessary)
  9. Would you recommend a brace for my child? How far up the leg should it go? Why? (Unnecessary)
  10. How long will it take to make, and when can we start? How can we protect his/her leg in the meantime? (Unnecessary)
  11. Are there any daily activities that we should limit? (Unnecessary)
  12. Should she wear the brace during sleep? Swimming? Bathing? (Unnecessary)
  13. How do you feel about telescoping rods vs fixed rods? Fixators? Why? Depends on the patient, and the circumstance.
  14. Do you regularly use BMP in rodding surgeries? Oh yes, absolutely.
  15. How do you feel about bone grafts? Where do you like to take them from? I think it’s best to throw everything possible at it the first time. The hip is usually the best place.
  16. How do you feel about using infused bisphosphonate? I don’t really have an opinion on that.
  17. What if we begin to notice a discrepancy in leg length or foot size? What       then?That’s something we can surely discuss when and if it becomes an issue.
  18. How often will we take x-rays and get new braces? She seems to be doing well, and has a well-fitting brace.  I’d say x-rays every 6 months, unless something concerning arises.  If so, then come right in and we’ll get new films. New braces as needed.
  19. Do you have an orthotist you prefer/recommend? Are you open to working with anyone I might choose? I’m happy to write a prescription for you to take anywhere you like, just know that you will have to work out the insurance part for that provider. 
  20. What about physical therapy? Do you think she needs physical therapy? If you feel she needs therapy, then we can explore that.
  21. What do you think of Dr. Dror Paley’s method for treating CPT? I think that if his method was that full-proof, that we would all be doing it. Yet, that doesn’t seem to be the case.
  22. What sort of outcome do you see for my child at this time? Hard to say. She seems to be doing really well, but things can turn on a dime with this disease, so you never know.

Questions for Patients with Intact/Bowed Tibias

  1. What is the emergency plan if I suspect a fracture? I’ll give you the number for Maria, our clinical nurse. If you suspect a fracture, or she has any other concerning symptoms, call her and we’ll get you in right away.
  2. If s/he stays fracture-free, do you plan to straighten the bone? If so, how? I think that’s a conversation for another day, far into the future.
  3. What else (if anything) to you recommend to protect and/or strengthen the bone? What about the leg muscle? I think she’s doing great.
  4. How do you feel about the McFarland Bypass procedure? (Unnecessary)

Overall impressions: He seems nice, knowledgeable, and confident without being arrogant. He does seem a bit standoffish though, which bugs me. But I also just basically interrogated him, so maybe that’s justified. He also seems kinda hands off… films every 6 months? Hmmmmmmmm…

I miss Dr. Hoffinger.

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