Dr. Alampallam Venkatacalam Medical Negligence during Surgery of Total Knee Replacement , Internet

Lying is a habit which leads to more lies and the propogator is on a slippery slope. She has been repeatedly shown to be lying. What does she do when cornered? She attempts to pull wool over reader's eyes.

In her latest report, she does this precisely and contradicts her own comments in the same letter. Even an elementary school student with a knowledge of logic can spot her logical inconsistencies. For clarity, I am pointing it out here.

The link which restricts certain activities after knee replacement is this one.

http://www.kneesociety.org/web/patienteducation_totalknee.html

Reader's can click on it. The relevant paras are copied and pasted here for brevity

Recommended Activities

Cycling is an excellent aerobic workout.Calisthenics, swimming, low-resistance rowing, stationary skiing machines, walking, hiking, and low-resistance weight lifting all are excellent ways to maintain fitness without overstressing the implant.

Suitable activities include bowling, croquet, golf, doubles tennis, table tennis, ballroom dancing and square dancing. 

Other activities that are suitable but slightly more risky include downhill skiing, scuba diving, in-line skating, ice skating, softball, volleyball, speed walking, horseback riding, hunting and low-impact aerobics.

Discouraged Activities

In general, patients who have undergone total knee replacement should avoid high-impact activities that cause high stress loads on the implant and therefore may increase the risk of early failure.

Activities to avoid include baseball, basketball, football, hockey, soccer, high-impact aerobics, gymnastics, jogging, power lifting , rock climbing, hang gliding, and parachuting.

So how does she pull wool over everybody's eyes? She pulls up another article from somewhere which contains only a link to the knee society and which only has partial content from this actual link attached above.

In connection with the above point, she commits the fallacy of irrelevane ( pulling wool)

She commits the next fallacy in using pejorative terms with the word- *****red.  This is

There is ample proof in the form of intra op photos and post op x rays of her knee done by us which outrightly reject her notions.

In the above context, she commits the fallacy of Ad hominem ( pejorative remark without proof)

Then to crown it all, she relies on the naivety of her supporters and readers.  She cites the example of her mother dancing Salsa.

Here she commits the fallacy of Irrelevance. So what if her mother dances Salsa? The relevant quesion is does she dance with knee replacements?

Then she is so blinded by emotions that she forgets what she has said before and contradicts herself several times.

Readers will remember that at first she said that we didn't give her instructions from the Knee society.

We contradicted this.

Next she was provided with reference to the actual article from the Knee society http://www.kneesociety.org/web/patienteducation_totalknee.html

She evades this and distracts our attention to another article which leads to this article but does not have the same full content.

Then when cornered in her mind about Salsa dancing, she equates Salsa dancing with ball room dancing. This is not the case clearly as is evident from the above fact.

Here she is trying to re-write facts to suit her feelings.

Here she commits the fallacy of Equivocation.

She goes on to insert her immediate post operative expereince of nausea, vomitting which are irrelevant to her present condition.

She has repeatedly dropped context and is relying on the unconsicous minds of her supporters and readers. She is thus a parasite on their feelings and attempts to manipulate their feelings.  

http://orthopedics.about.com/od/kneereplacement/qt/activities.htm  link to restriction on knee replacement through Knee Society and dancing is not on the list to avoid.  They are all high impact activities listed. I have not taken part in any of these nor does my dancing cause any movements that would torque or put high impact on my knee.  Salsa is also a part of ballroom dancing which encompasses partners dancing together.   I am not a competitive dancer nor do I ever expect to compete or perform.  Even my 85 year old mother dances Salsa.

http://orthopedics.about.com/cs/kneereplacement/a/youngtka.htm   A doctor’s opinion but also another time referred to the Knee Society list of activities.  Still the same list and dancing is not mentioned at all.   

http://www.prlog.org/10530678-americans-journey-for-two-journey-knee-replacements-in-india-medical-tourism-account.html   It appears the Dr had this article written about me (without my consent).  The article shows his awareness from the beginning of my desire to dance but skiing and tennis were not a desire of mine to do.  He mentions pain control in the hospital.  After my last two revisions I know how pain control for knee replacement should be.  I spent the time in the hospital in India vomiting with a severe migraine headache.  I was in severe pain after the right knee replacement and was even given an added leg block after the surgery to my right knee.  I found the pain drugs not that affective even afterwards when the leg block wore off. Of course, with the amount of bone he butchered no wonder he had to use an added leg block.  This was not true with the left knee replacement.  

For the person that just responded.  Please note that the doctor had me climbing up and down stairs in the hospital in India.  Maybe your father is much older than I or had a  problem with his recovery and never had the strength to do stairs.  I would suggest you to visit bonesmart.org .  This is a large group of people with firsthand experience in both knee and hip replacement.  They offer great support and awareness before, during and after knee replacement.  Even doctors and physical therapist post on this site.  There are other sites like this one but this is the largest and most active site I found.

 Medical tousism is a recent phenomenon. It is resorted to by patients who can't find affordable health care within their own state or country. Medical treatment is costlier or unavailable in certain countries because of many reasons. So when a patient decides to travel to another country, this context has to be kept in mind. Citizens of certain countries falsely assume that the laws of their country would apply automatically to the destination country.

This is not so.

Also medical procedures need follow up with the same doctor. This too has to be kept in context.

Patients travelling to another country are only paying for a particular operation and not continued post op care. They should assume responsibility for their post op care either with the foreign phycician or on their own. However, it is well known that their native physicians will naturally have an hostile attitude to a patient who so called slipped out of their net and fled abroad. Since they are not constrained, they end up making un justified comments while dropping context when a medical tourism patient comes to them.  

These factors have occured in the above case too. How can a physician sitting in a remote country diagnose what could be the cause of a particular symptom in a patient elsewhere? To assume that he could know is to assume omniscience on his part. Human beings are not like that. Now all possible evidence, including photos of the cut bone, intra op picture of the implant, post op x ray are all shown as evidence. We have nothing to hide and are confident about our procedures.

The post op x ray attaced by the patient in her reply shows that the femoral component has notched the femur. This happens when too much bone is removed during a knee replacement. This can be easily contrasted with our post op x ray which shows correct sizing and the implant sitting flush with the bone, neither too small nor too big.

When this post op x ray was shown to us more than a year ago, we predicted that it would fail. This is what happened. You see that facts are facts and can't be evaded.

If the patient genuinely wanted a follow up, she should have gone back to the same doctor. She didn't do so.

May be there would have been no necessity at all for her to undergo the first revision. It is very easy for another person to manipulate emotions in this situation.

 Let me say as someone who has had to be a caregiver of someone with knee replacment that not only is dancing banned, but any activity that would cause a clear strain on the replacment. I had to take care of my father during his knee replacments. I could go on and on about all the activities that were banned for ATLEAST 6 months. Just because the skin has healed over doesnt mean that your good to continue your activites. It means you have to be VERY CAREFUL in what you do. My dad couldnt even climb stairs until he was given the go ahead. So on one hand I can understand the docs frustration. He has a patient who did not listen to instruction and then comming back and blasting him for their failure to follow a doctors directive.

Its kinda funny really.

 Dishonesty's method consists of failing to correct contra dictions, evade facts, fake reality in the mind of the individual. It is not merely telling lies. Here the complainant is intellectually dishonest. She has evaded facts when confronted with them. The facts of prohibited activities after a knee replacement. The fact of the real cause of her symptoms. Later she contradicts herself in her own statements. There are inconsistencies in her averments which leave the reader totally confused. Content wise, she wants unjustified profits by bilking, extortion, blackmail. She ignores reality in another way. She is relying on the unconscious state of her supporters to back her claim. She cannot be confident if confidence means dealing with reality. She is not possessing integrity as her dishonesty has been established several times from her own averments and produced records. She has departed from Reality by her dishonesty and that is the cause of her Nemesis.

When this person was confronted with facts and proof, she denies this also.

1.Readers will remember that previously she had stated that no instructions were given to her about dancing. We contested it with producable evidence. We also cited the source from which instructions were given to her.

What does she do as a liar? She evades that and says that dancing doesn't have any effect on knee replacements.

Dear complainant, despite what you evade, feel in your lonely head, facts are facts. The statment from the American knee society specifically states that only Ball room dancing is permitted.

We have attached evidence in her own words that she had been setting records in other non safe forms of dance.

2.We asked her to produce a photo taken during the time of her first revision. She doesn't produce it and generally states that we should believe the American surgeon. Why? no answer.

Even if we were to believe him, on being questioned, why he didn't have the mandatory components during the revision surgery?

No answer. We should just believe him. He's the best according to her. Now if he was the best she should go back to him a second time after that loosening occured.

From her own averments she has gone to another surgeon.

When facts stare at her in the face, she evades them and appeals to the emotions of the readers by saying - Poor me! Trust me. Why should anybody trust her when she hasn't produced any proof to substantiate her allegations?

One can see who is dishonest. Dishonesty is liking faking reality.

In this case reality is her own consciousness and the end result.

What is the end result?

One un warranted revision surgery and another impending one.

Loss of credibility with the same circle of friends who advised her to go public.

Loss of credibility with the readers of this web site.

Loss of peace of mind.

Failure to accept the real cause of her failure and persistence which may jeopardize further knee replacements in both legs.

 Again the complainant has resorted to manipulating emotions- Poor me! When challenged with poof, her defense has just fallen apart. Reality is her Nemesis.

I think we all know where this is going.  I feel I have said enough and the doctor has gone to all extremes to discount me.  My dancing had nothing to do with the main problem of the knee failure and if you search the net you will find another complaint about this doctor.  Just beware he is not honest.  I leave it at that.

 The author of the report has eroded her credibilty by levelling an accusation without sufficient evidence.

Her personality and lifestyle would have been apparent to any reader of this report.

By her own utterances here and elswhere in the web, she has had to resort to one lie after another to cover up for the first lie.

It was never clear why she complained of instability. There is no substantiated proof from a specialist about the cause of her symptoms. In her averments, she thus commits the  informal fallacy of Argumentum Vera Cundiam. She says that an American surgeon told her that and therefore we should all believe it. That means appeal to authority without sufficient evidence. It is well known that facts are facts. The fact is that there are no facts to back her story. The immediate post op x rays and the intra op photo of the knee in India showed a well fitted prosthesis and a well aligned and sized knee replacement. I have already submitted a photo of the knee which can be exhibited here as Exhibit 2. Exhibit 1 is the bone removed during surgery from the femoral condyle which is very minimal and negates her other averment that too much bone was removed.

The prosthesis removed at the time of her first revision should have been shown without cleaning, removal of cement and attached bone. Then only it can be concluded that it just dropped off from bone. Her post op x ray after her first revision surgery don't support the allegation. The femur has been notched during the revision surgery. That means that bone was still attached to the original prosthesis during removal and hence this had to be cut with a saw. This then leads to the inference that the prosthesis was not loose.

I informed her that the revision knee was improperly done and it would fail early. This was becaused of the bone notching.

Another factor is her continued exertional physical activities which in her own words are record setting.
Her dishonesty has thus lead to her own harm and will harm others who will tend to believe her and also the millions of people who will be reading this report.

The dishonest lies in the facts. The real fact why she needed the first revision without a sufficient explanation of her symptoms is the first one to consider.

It is questionable if a revision knee replacement was the solution at that time?

If a famous surgeon undertook to do a revision knee replacement, why did he take up the case wihout adequate preparation of implants? She mentions that it was not planned to use a stem during revision. This is contrary to standard practice during revision surgery.

Even assuming that it was done, why didn't the surgeon warn her against vigorous activities? These are well known facts. If I could have provided her with those, why were they not given to her by her American surgeon?

So even if she says that I didn't provide her post op instructions ( which is untrue) , why didn't her famous surgeon do so? At the time of her first revision she was and is still young for a knee replacement?

By her own boasts elswhere, she has averred that she set sort of records in Salsa dancing. One has just to Google Salsa dancing and knee replacement and one will encounter her.

Again by participating in ill advised activities, she has caused damage to her self.

How can the second set of circumstances now be linked if at all to the first one?

The reality is that knees will loosen if the patient is not compliant.

To unheed this advice is to unheed reality. Whatever you utter, slander, libel, extort, blackmail, - Reality still remains. It is untouched by you.

By being dishonest she has only harmed herself. Those who believer her story will do damage to themselves for this reason

If they conclude that it is alright to involve in contact sports and banned activities, their artificial knee will survive the assault, then they are wrong.

Those who read this report on your site and sympathise with her will get the wrong message.

In trying to cheat reality, even if one gets away, one suffers incalculable damage.

 The original report and its remarks once again reveal the several inconsistencies committed by the author of the report.

Here are her original comments from 2008.

 Mail dated Nov 2008.

I am having new xrays done of my knees to evaluate the changes from last year.  My pain has been increasing and I am having to take ibprohen on a more regular basis (which helps a little) and had cortisone injections which only helped a little. My knees appear to be more bowed.  My life style is slowing down which is very frustrating to me.  I love to dance salsa and I very much want to continue dancing and doing all the other activities I enjoy.  Even my bike riding and gym workouts are getting more painful.   

The following document from the American knee society was handed over after her knee replacement.

http://www.kneesociety.org/web/patienteducation_totalknee.html.

It very clearly restricts dancing to just Ballroom dancing.

2 She resumed her vigorous activities after her first knee replacement in Chennai.

The result was loosening of the knee.

Now she is uttering a lie when she says that no document was handed over to her which restricts her activities. Her discharge summary and the consent paper at the hospital say otherwise.

3. If that were not enough here are her comments about un precedented levels of dancing on cruises, dancing contests etc

2. guess I am a test pilot for Salsa dancing with bone smarties but while on the salsa cruise I met someone with two knee replacements dancing salsa, also. He had just started dancing salsa so he was not sure how his knees would do but had the replacements for four years. I have been dancing salsa for 8 years so I do tend to push the limits. On the cruise it was not just the knees sore also the feet, ankles, calves and back. The revision knee is defiantly larger than my other knee replacement of about 3 years. I figure it may take at least 2 years to look like my other knee especially with all the irritation I cause from my activities.
3.ust returned from my Salsa Dancing 7 day Cruise. I had a blast of course being in dance:happydance: heaven. The revision did OK but I was hoping more.:umm: The first few days real well then the stiffness started to set in more and more. I would ice, take Ibprohen, and wear a brace which all helped and kept me going but I also had to back off a lot of my dancing. I think the knee has it's way of telling you to back off. Pain was not bad maybe on a scale 1-10 stayed 1-3 but most the time a 1. Pain level has been at 1 for some time;standing, walking, dancing. It goes to 2-3 when I ask it to bend when standing, ride my bike (sometimes get a strong sting) or when I bend it for a while then try to strengthen. Is this normal during healing?:what: Maybe the thick spacer that was used has a lot to do with the stiffness. The one real good thing is the knee is stable like a rock! It will be 1 year post revision on Nov 17th.

It should be clear from her above remarks, that she didn't learn her lessons.

Here is her own account of the first revision going wrong after another "Salsa cruise"

I am pleased that the Doctor has responded as to me it show how negative he is and takes no responsibility.  In fact, he attempts to twist the facts and put the blame on me and my other surgeon.

1.  He was well aware of my activeness and did not advise me to quit any my activities.  Even my present Doctor says I should have no problems going back to my activities.

2.  My doctor clearly stated that the implant coming off was not because of my activities it was clearly a bad cut (he actually said my bone was butchered)!  There was not adequate bone left for the cement compound to adhere  firmly, the implant was oversized and the spacer too small.  I now have a 13cm stem up my femur to correct this problem.  Given the circumstances of the first surgery my present doctor had no idea what he was to find when he preformed the first revision.   He attempted to make my implant work by reducing the size of the implant to fit tighly and add a large spacer (which was needed).  It came to no surprise to him not working when I returned with the same problem due to the excessive bone cut from the first surgery.  Note:  My present surgeon Dr. Michael Kimball, San Diego, California trains doctors to do these implants and that is why I choose him and have my trust in him.  I first revision was scheduled at a surgery center not a hospital as the Dr. planned only for a spacer exchange due to a very loose knee.  Xrays and a bone scan did not catch the loose implant so that came as a surprise along with the bone cut!  For my second revision I was in the hospital 5 days with two surgeons and assistants.  I feel very lucky that Dr. Kimbal was able to put a smaller implant on at the surgery center but a total revision with a stemed knee implant was not the plan, at the time.  So, I strongly feel that Dr Venkatcalam saying the first revision proves his claim is wrong.  

3.  I sent my report from Dr. Kimball with the proper proof but the India Consummer Board did nothing.  I believe they do try to protect their doctors.  Maybe if I lost my leg or died they would consider it!  Also, not many doctors in the USA would get involved in this type of a problem unless they feel strongly that negligence was made.  

4.  My left knee just underwent aurthoscopic surgery to clean out the gutters which was causing locking of the knee.  If what Dr. Venkatcalam said was true of my dancing (I do not jog or compete in anything) then I should have needed the left to be revised, also.  Dr. VenKatcalam did both knees or bilaterterals during my visit to India.  I also was favoring my left which got more wear and tear then the right from the beginning after the first surergy.  So, why did this not happen to the left  and not the right? ummm something does not sound right here...   Dr. Venkatcalam does not even admit to problems from the beginning with my right implant even after my many emails to him and complaints that began the first few months after his surgery.  My very first complaint was that I could not stand still without dancing in place due to pain on my right.  This is not normal after surgery but if my bone was butchered...yeah that's a good reason why.  This lasted the first couple of months.  

5.  I think Dr. Venkatcalam should be careful what he says especially regarding my other surgeries.  He seems like he is also trying to foot the blame to Dr. Kimball.  

Bonesmart.org is a great site to visit if you are wanting to do a knee replacement or are having problems with your replacement.  Many people on that site sharing their experiences and knowledge.  Even some that have pursued skiing and marathons with no problems.  

 The patient in question is an American lady in her fifties. She leads a very active life style. Some of her activities inlcude Samba dancing, Ramba dancing, deep sea diving, climbing stairs on her yacht daily. She develooed knee arthritis in middle age. Doctors are reticent to advise knee replacements on such young patients as they have a higher failure rate. If the patient does desperately require, one then durable materials can be used. Post operatively life style modifications are mandatory. These have been issued by the American knee society. These prohibit dancing, sports, jogging etc. No artificial knee is capable of surviving through the prohibited activities.

Accordingly the proceudres were performed after a clear written consent. Also it is well accepted that cost of medical tourism are cheaper as there are no overheads involved like medical indemnity, insurance costs. The context of these have to be borne in mind before considering the veracity of any claim. To drop context is to be illogical and hence invalid in one's assertions.

In the specific case, this patient was provided with clear instructions to refrain from such activities. She failed to do so. Her failure is revealed in her own e mails to the surgeon, where she states that she was enjoying dancing and other vigorous activities.

When the right knee was giving her problems, it was a result of this vigorous onslaught. The surgeon who did her first revision informed the patient that the femoral prosthesis just fell off. However it is clear from the post op x ray that the femur has been notched during this revision surgery performed elsewhere. This means that bone  was adhereent to the first prosthesis during its removal. This straightaway contradicts her accusation that the prosthesis just fell off.

She failed to provide any evidence to support her allegation that the prosthesis was loose and just fell off. Any accusation without proof is arbitrary and needs to be dismissed. In fact the pictures of the primary bilateral knee replacements done in India show correct alignment and sizing of the implants. These straight away don't support her allegations at all.

It was predicted that this first knee would fail. It is now coming true and from the facts mentioned in this report, it is crystal clear. Therefore the failure of the first revision cannot be now illogically traced back to the primary knee surgery. This is what she is talking about now. If the revision surgery was to be successful, it should have been diagnosed and performed correctly.  The fact that she is requriing a re- revision now refutes this.

How is it now logical to blame the first surgery?

The patient tried her hand at extortion and black mail. It is now clear that the Indian board was justified in turning down her complaint as she had failed to provide any evidence.

This patient has no ethical standards.

Many international patients have had the same knee implanted by me and none have failed so far