Ask the Doctors April 2004 Issue

Ask Dr. Marks: 04/04

I will soon be in need of a total hip replacement. How do I find the best surgeon—and the best hospital?

The choice of a surgeon and hospital is critical to the success of any surgery. In spite of this, the choice is often made in a haphazard way. Patients frequently depend upon recommendations of friends or considerations of convenience when making a decision.

A surgeon practices in only one or two hospitals, and by choosing a particular surgeon you are also indirectly choosing a hospital. It is not always the skill of the surgeon that determines a surgery’s outcome, but the overall competency of the system—the nurses, anesthesiologists, operating room environment, aftercare facilities, and physical therapists—that will have the greatest impact on results.

Hospitals differ in their infection rates, mortality rates, procedure-specific outcomes, and overall patient satisfaction. It is easier to get reliable, independent information on hospitals than it is on doctors. U. S. News and World Report publishes an annual guide on the best hospitals and surgical departments in the country. The institutions listed have a number of medical as well as surgical departments that are known for their excellence. Last published in July 2003, the report is also available online at www.usnews.com/usnews/health/hosptl/tophosp.htm.

Although less reliable, there is also information available concerning the skills of surgeons. The publication Best Doctors in America (Woodward/White Inc.), for example, is based on a survey sent to specialists throughout the country. It lists doctors who are highly regarded by their peers, and is also available by subscription (www.bestdoctors.com). In communities where authoritative published information is not available, your primary care physician will be the best source of information concerning specialists.

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I was diagnosed with rheumatoid arthritis three years ago. I’ve tried four medications, but they played havoc with my stomach. Five months ago I started taking gold tablets, but the stomach distress made my life miserable. After four months, my doctor suggested gold injections. However, my pharmacist told me the product, Myochrysine, had been discontinued. My sister lives in Ireland, has RA, and has been using gold injections with wonderful results. Why is it impossible to obtain gold injections in the U.S.?

Gold injections have been used for many years in the treatment of rheumatoid arthritis. They have been supplanted by newer, more effective medications, such as Remicade, Embrel, and Methotrexate.

Gold injections are currently hard to come by due to the expense of the medication and its low demand. There are some patients, however, that need gold injections to control their RA, and such injections are available in the U.S. The medication Myochrysine (gold sodium thyiomalate) is available from Akorn Pharmaceutical (800-223-9851) by special order. It is likely the same gold preparation that your sister uses in Ireland. The only other injectable gold medication was Solganal, which was withdrawn from the market in May 2002.