Q & A with Dr. East

© www.123RF.com

In an effort to help those seeking to have reconstruction for their Brachymetatarsia (and Bunions), here are the results from my 1st visit with Dr. East.

This is quite lengthy, but VERY informative! (I hope.)

At first glance Dr. East thought both my Brachy and Bunions weren't too bad. He stated I might be a candidate for the "one-stage" method instead of the external Fixator. (I was surprised that he said this because his website only mentions the Fixator method. He may be lacking in Brachy surgery experience compared to Dr. West, and I would think even more so with the one-step method?)


After viewing my digital xrays and doing some measuring on them, he stated that I missed the candidacy for the one-step by a smidge. Turns out my conditions are actually worse when looking at the xrays. He showed me before and after photos of some of his patients. He mentioned that if I did do the one-stage, my fourth toe would not be exactly as long as the normal one on my right foot. With the Fixator however, the exact normal length could be achieved.


Dr. East uses a cadaver bone to lengthen the metatarsal. This is acquired from a "bone-bank" for about $1,000. The bone bank tests it for just about everything. But is there a chance you could get something from it? Yes, no one will guarantee anything in the health industry, and the chances are so slim they feel it's 'almost' nonexistent. The bone is dead. Has no marrow and looks like a piece of coral reef.

Sample of "a" bone
from "a" bone-bank.



My questions were as follows:




1. How many Brachymetatarsia surgeries have you done?

"A couple dozen. No one will be able to tell you that they have dome hundreds of these. But just this year I've done three."

(So let's say he's done about 30 at this point?)


2. Would I be anesthetized or would my foot be numbed?

"Both. Anesthesia would be administered as well as having your leg numbed."

3. You have a secondary location you work out of at a limited schedule. Could the surgeries be done there too?

"Yes. Either location."

4. Would you be doing the surgery or would another doctor from this office do it?

"I'll have assistance, but I do the surgery. Sometimes it's another doctor or an intern."

5. Are these surgeries usually covered by insurance?

"It's covered."

(I want to note something here. It is not a doctor's responsibility to know if your insurance covers any procedure. It is yours. DO NOT take a doctor's answer on this. Insurance companies find reasons to deny coverage AFTER a procedure all the time. Do the homework on YOUR insurer the best you can as to what is covered and what isn't. You will most likely have to pay something out of pocket.)


While he said "it's covered", that really doesn't translate into what actually happens because my coverage states they cover 90% of out-patient procedures. (and the rules may change even further if I have this surgery done out-of-state.) There are deductibles to consider and Annual maximums that will be reached, etc. Do your homework.


6. How much do the surgeries go for?
He would not answer this question at all. We went over it several rounds, but he wouldn't disclose a figure. I explained that I do not have credit cards, and being that my insurance company will not cover 100% of it, I was trying to gauge the portion I would be responsible for. He would not give a figure, saying insurance companies find reasons to change rules, etc. I expressed that I understood and in no way wanted to hold him to a number, I was just trying to be responsible with my portion of it. I didn't want to enter into a surgery where I can't afford to pay even the 10%.


After several rounds he said, "I'd be surprised if your responsibilities were more that $1000.00 (US)"

Which brings me to the question I never asked him, because I thought of it later....

7. He informed me that removing the External Fixator IS a separate "surgery". (several times)
This means I would have a total of three surgeries (billable that way, I'm sure) on my left foot:

• the Brachy
• the Bunions
• the removal of the Fixator

I would have to go under anesthesia twice for this foot. (and once for my right foot, IF the Bunionectomy doesn't require a Fixator too!)

So I'm now wondering if the $1,000 he mentioned was for the surgeries as a complete total, or was he talking about one specific surgery, Brachy for example? 


In the west, Brachy surgery goes for about $8000. I think it safe to say NY is more expensive. I'd venture to say maybe $10,000? Thus perhaps making his $1000 judgment reasonable. Which of course would mean that was on one of the FOUR surgeries I'd be having.(My out-of pocket just for surgery alone would then be $4000. Medications and post-op care would be more?)


8. How long would the Fixator be in?

"Four weeks. Your foot would be swollen the entire 4 weeks, and even 4 weeks after it's removed."

9. Would I have a hard or soft cast?

"Hard for the one-stage. No cast if with the Fixator."

10. How many visits would we have post-op?

"Once a week. Xrays would be taken at every visit to make sure you're turning the Fixator correctly and that the bones are doing what they are suppose to do."

11. What medications would you be prescribing?
"Vicodin, Celebrex, and Duricef."


12. Have you ever had an unsuccessful Brachy surgery?

"Yes, not often but yes. It requires another surgery to remedy things."

(I have actually read that this does happen with Brachy surgeries. Sometimes the toe springs up even after being the proper length. I think that is one of the reasons for being 'under' to remove the Fixator. That's a time when perhaps adjustments ca be made?) But let's be clear here, he didn't specify what went wrong with his surgeries.


13. Would my fourth toe still have the same mobility I have now? I have very good mobility now. It bends with all my other toes.

"I'm afraid not. You may lose that."

14. He showed me 2 demos on YouTube of Bunionectomies.

"If you choose the Austin (more popular), it's easier on you and the doctor. But you choose the one you want, don't worry about me. I'll do whichever. (He was sincere while saying this.) But in your case, if you've dreamed of always having a straight line that won't be possible with the Austin on your Bunions.

The Lapidus involves much more. More painful, etc. but it will give you that straight line."

Which one has a larger percentage of re-occurrence of a bunion?

"The Austin"

15. For the Lapidus, where would you do the incision? Top or side? 

"Top"

(He also mentioned to me during a phone call after our first visit, something about not being surprised if I wake up with two Fixators on my left foot. The Lapidus, after he goes in, may require that. Example below.)

© www.youtube.com/user/Big1531Lefty

Lapidus
I'm thinking this is sort of what he means. I have sent him this video so that he can confirm this for me. I'll keep you posted. (FYI, he never answered this.)


16. I also have Bunionettes on the outside of each foot. They are extremely painful when I wear flat closed shoes. Can these be addressed as well?

"Those we can just shave down a bit."

17. How long would I be on crutches?

"Six weeks?"

18. Have you ever had surgery on your feet?

"I've had surgery on my..."

(Sorry I can't remember his answer somehow, but it wasn't his foot. Something on his leg... having to do with a muscle or sports or something. lol.)


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If you're wondering, I did go in with a list of questions. This is feet we're talking about here. It's important. I appreciate my appendages you know. ;-) But I made sure to be upbeat and funny. I'm a big believer in getting the best out of teachers, doctors, etc. when you demonstrate some trust. It's important not to come across as paranoid and mistrusting.


We laughed during our visit, but I don't think he blamed me for trying to get my information straight. I will try to provide a checklist of questions for you in the future if you think it might be helpful to you. (See the " DR. Questions: tab at the top of this Blog.)


ONE LAST THING. I have also asked him to provide me with 4 referrals. (Including at least 2 patients with Lapidus and 2 who have had Brachy and bunion surgery on the same foot.) Patients who have had these surgeries in the last 36 months. It would help me a lot to be able to casually ask them about their experiences.


I told him, "I have no problem with privacy of your patients, if necessary my contact information can be given to them so they can call me."


That's enough for now. Thanks for following! ;-)