United Brachial Plexus Network, Inc.

Hi Everyone

We took Michael for his appointment with Dr Waters today. Michael's glenohumeral joint is getting worse. He said that we would require another surgery to help with his external rotation. He mentioned a humeral osteotomy. When he said that I mentioned the Triangle Tilt Surgery. He is definitely not an advocate of it. He recommended that if we needed another opinion we should see Dr Kozin at Shriners. He didn't say anything negative about Dr Nath, which I wouldn't expect of course, but it seems that lines are definitely drawn with surgeons about this type of surgery. There are disagreements in regards to how successful this surgery has actually been and noted that some cases the end result has become worse. He said that other surgeons share information between each other to try to help benefit their patients and that no other surgeons have gone on board with Dr Nath. Now that could be since there isnt any research beyond the 5 year mark, but this has certainly left me more confused than ever. Dr Waters doesn't recommend surgery unless absolutely necessary.

Has anyone here been to see Dr Kozin? I was just wondering what his feelings are on the triangle tilt. I guess I am so worried on not going forward with that surgery because of the info I am getting and finding out 2 or 3 years from now that it was in Michael's best interest in getting it but because of his age it would be too late in getting the optimum performance from that surgery. I am sure I am not the only one on the board who has cried and prayed for the right decision. Thank you to all who responded before both here and privately.

We have been to both Kozin and Waters. And I agree with you, that Dr. Waters wouldn't recommend surgery unless it was absolutely what he thought could help.

Dr. Kozin is also not a "cut the air out of a balloon" kind of doctor. I will not speak for his opinion of TT, you will have to ask him. We will be down there for a check up later this month. I find him and the entire Shriner's organization to be wonderful. (On the other hand, I have complained ad nauseum to Dr. Waters about the long wait-we almost missed our plane once b/c they were so slow.)

I am fond of both docs, and find them to be wonderful to deal with and incredibly intelligent.

good luck,
claudia

Dr. Kozin does not recommend or perform the triangle tilt. I've talked to him at length about this surgery, but I wouldn't presume to answer for him as to his reasons; it is better if you speak to him directly about it.

I can say that it is not just a matter of the TT being a new surgery. Dr. Kozin has incorporated new surgeries into his treatment for BPI before, but only when the initial results are positive, well-documented and make good physiological sense. He begins with a small number of patients, very carefully and strictly studied, to make sure that the approach is properly studied. He began doing the ACR, developed by another surgical team here in California, when it had been around less than 3 years. This is the anterior capsule release done arthroscopically to treat glenohumeral joint subluxation and malformation. On his initial patients, Dr. Kozin had MRI scans done before and immediately after the surgery, and followed a strict protocol for documenting the results of the surgery. And he documented and shared his findings in order to convince other surgeons of the validity of the approach. His report on ACR is here:

http://www.ncbi.nlm.nih.gov/sites/entre ... h=17055299

I recommend that you take Dr. Waters up on his recommendation to see Dr. Kozin. They have similar philosophies and follow similar requirements for what they consider "proven" but Dr. Kozin does do some things differently and may be able to suggest another alternative for Michael.

Kate