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Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.
Friday, August 03, 2007
There's something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it's a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.
Stark and sudden, an above-knee amputation done in the "guillotine" fashion for infection is shocking. But, if you're a surgeon, you can -- maybe you must -- find pleasure in it; and I don't mean some poetic sense of helping one's fellow man. I mean in the actual act of doing it. Which is why I say it's a microcosm. Some things we do are terrible. And yet, within walled-off portions of the mind, divorced from the suffering of the patient, there's a place to go wherein satisfaction comes from the the work itself; the physicality, the artistry, even the transgressive brutality.
The foot, dying, has been wrapped in towels and covered in a sterile plastic bag. The leg, painted in iodine, protruding through a paper drape with a rubberized hole in it, is all you can see of the patient. With the knee bent, you place the covered foot on the table, and it holds itself in place. Holding in your hand the rough handle of a huge amputation knife, you reach as far as you can under the thigh and bend your arm back over the top toward yourself, curling the knife blade around and under the thigh as much as possible. Can you see what's going to happen? You're going to uncurl your hand and arm, drawing the knife, as deeply as you can, completely around the thigh; slashing -- if it works -- in a single circular motion all the way down to and around the femur.
If there were normal circulation, you probably wouldn't be doing this; so there's often not much bleeding. Still, you need to be aware of the femoral artery and be ready to clamp it quickly. Maybe you've placed a tourniquet of some sort above; or maybe you have a strong and big-gripped assistant who's squeezing the leg between both hands. In any case, once the bone is visible around its entire circumference, you reach for the Gigli saw -- that's what's pictured at the top of this post.
And, while someone holds the leg down, you place the wire under the femur, grab the handles between the middle and ring fingers of each hand, and stretch the saw nearly straight. Back and forth, fast as you can, making the toothed snake rise through the bone, which it does with surprising ease. It's a whirring sound, more than grinding -- high-pitched, err err err err. White until you get to the marrow, the fragments coming off are like gruel. And then the wire springs up with a flap and a splatter as it rises out the top. Start to finish, it's been only a couple of minutes. (Somewhere I read of the fastest such amputation, done in a few seconds, including the removing of a couple of the assistant's fingers.)
It's awkward lifting the leg off the table and handing it away. The balance point is hard to find. There's an awareness of mutual discomfort in this act -- in the giving and the receiving. (A gallbladder plops into a pan, free of emotion. Handing one person the leg of another: that's an exchange for which there are no words.) It's a relief to return gaze to the stump: concentric and clean. White bone, red muscle, brown skin. The anatomy is there, on end: hamstrings, quadriceps, neurovascular bundles. It's not a commonly seen slice.
Before the operation, there's been pain -- physical and emotional. There've been sad talks, bargaining. Nothing to feel good about, for anyone. After, there's the stark realization, the encouraging words that ring hollow. The relief -- mine -- of turning much of it over to rehab specialists, prosthetists. But there, for that few moments in the operating room, there's a separate, private, and possibly unspeakable pleasure. (And I must say the same can be said about other amputations I did throughout my career, hundreds and hundreds of times, as a breast cancer surgeon.) The dissociative and dramatic doing. The fact that, for an instant, I can remove from my consciousness the horror and find enjoyment in my craft, can see beauty even here -- that's something almost too terrible to admit, even now.
35 comments:
brrr. Not easy to read. Probably not easy to write either.
Well, your text gave me the shivers, but I'm extremely happy to learn about what the job of a surgeon is. (In Grey's Anatomy, they obviously have only sentimental problems 90% of the time and therefore don't have time for actual surgeries, let alone blog about them) - 8/03/2007 1:00 PM
- rlbates said...
Good post. The first surgery I ever scrubbed on as a 3rd yr med student was the amputation of a gangrenous foot. You are so correct in how hard it is to "hand" it over and to "receive" it. Yet it is pleasing to see the limb then heal (yes, I know it is no longer whole, but it is no longer "killing" the individual either). I found (find) it even more difficult to have to amputate fingers or an entire hand due to infection or injury. I am ever grateful for the orthotists who make "new" limbs when we can't "save" them or "find" a way to make a new one (great toes for thumbs).
- Mitch Keamy said...
Man, I hate giving anesthetics for amputations; I used to keep a cd-player/headphone combo in my locker so I could mask the saw sound for patients with spinals and sedation, when we thought that regional decreased the incidence of phantom limb pain. Now I just use general anesthesia.
- T. said...
Ditto on the general anesthesia...Just wanted to say Dr. Schwab how I appreciate the compassion in your writing and admire your expertise with both pen and scalpel. Like many other anesthesiologists who read your blog, I imagine, I would be so happy to work with a surgeon like you...
Good grief, Doc...this was not a pleasant thing to read only a few months after spending over a week in hospital with a nasty foot abscess, with a roommate who was having her foot amputated, no less! What is it with this penchant surgeons have for the graphic stuff that tends to scare the hell out of people? Fortunately I managed to leave with all of my appendages still intact, but the whole idea gave even this normally fairly calm and research-oriented patient a practical coronary! Still enjoy your blog, though...even if it did make me sit up and take unusual notice!
- Greg P said...
I've never seen an amputation being done, though I recall as a med student rotating in pathology have a leg arrive in a bag as a specimen -- these are pretty uninteresting to pathologists, it seems.
I've also seen many an outcome of amputation, since I take part in the Amputee Clinic at our Rehab Unit. As you are trying to care for the amputee, looking forward to future fitting for a prosthesis, you begin to appreciate a beautifully done amputation, with care taken not just to oppose edges of skin but also to think about rounding, smoothing the underlying end of the bone, the padding underneath with muscle and other soft tissues so as to protect the skin. And for many, I'd say most, life goes on after the amputation, a bit differently, but all in all not so badly. - 8/03/2007 7:23 PM
- Sid Schwab said...
Greg: I didn't go into those details, but you're exactly right: doing those things that can make the stump heal properly and be right for a prosthesis make for a sense of satisfaction. In the case of the guillotine amputation, there's usually a second operation to revise and prepare. But it's a good example of that disconnect that goes along with much of surgery.
- make mine trauma said...
I fear ampution of my leg or legs second only to paralysis. I cannot begin to imagine how an amputee deals with the loss. It is one of those procedures that reminds me of just how fortunate I really am. I NEVER complain about having to walk too far or taking the stairs.
P.S. I liked the post you deleted better. Will it come back new and revised? Surely you were not offended by comments? - 8/03/2007 10:06 PM
- Greg P said...
Another thing about the amputated limb: one of the things the pathology department needs to know is the patient's desired disposition of the severed part.
Some apparently wish to have the part stored somewhere, so that when they die, the part can be buried with them. I have no idea where these parts go or how they are kept. - 8/04/2007 6:33 AM
- Mitch Keamy said...
Sid, leg amputations play an important role in the lore of anesthesia history. Prior to ether, leg amputations were performed commonly, with surgeons being respected for their speed (less than 2 minutes) and sang-froid (not distracted by the screaming) Ligatures hanging from button holes of blood-stiffened operating coats, etc. At Wisconsin, in the Anesthesia library, we had the bell mounted that summoned the "brutes" whose job it was to restrain the hapless patient...
- Bongi said...
your second paragraph about the terrible and satisfying nature of an amputation was spot on. i love amputations, yet it does not deter from how terrible they are. the worst i did was an arm. that to me really takes from the humanity of the patient. a leg is simply a leg but an arm is interwoven with the humanity of ther patient
not that I've seen such surgeries yet, but is that feeling of an amputation surgery similar to that of a harvest surgery?
- Sid Schwab said...
Harry: good question. In fact, I'd thought about using that example, since I've done several harvest operations, as well. I also half-wrote it based on mastectomy. The fact is there is much in surgery in which one most separate the craft from the tragedy.
- Bongi said...
"separate the craft from the tragedy" that is exactly it!! well worded, master blogger!
- Lynn Price said...
As always, Sid, you expose your world to the uninitiated with clarity and sensitivity. Very powerful post.
- Jeffrey Parks MD FACS said...
Great post. The horror of amputations didn't hit me until the chief year of residency. As a junior resident, I loved when I saw a BKA on the schedule; it meant I was actually going to operate. By the time I was ready to move on to an attending position, the sound of saw churning through bone sickened me. Granted, there is an art to it. Creating a perfect muscular flap that fits precisely, like a puzzle, without dog ears is quite satisfying.
I would hesitate to compare extremity amputation to mastectomy, however. A woman who needs a mastectomy is a victim of bad luck, genetics, and the vicissitudes of fate. A person who needs an amputation (other than traumatic amps) is someone who has repeatedly failed to heed medical advice. At the county hospital where I trained, I saw the same patients come in year after year. They have uncontrolled hypertension. They smoke. Their diabetes is uncontrolled. You read through their chart and they've had fem-pop bypass, re-do fem-pop, and then a fem-distal. First, a toe is amputated. And then wet gangrene sets in and you have to take the forefoot. And that stump doesn't heel so you have to do guillotine chop job to halt the sepsis. A few weeks later that gets revised to a formal below knee amp. Every time they come to the hospital, you note that blood sugar readings are always over 200. They forgot to fill ther blood pressure medicine scripts. And, frequently, they STILL SMOKE!!!!!. There's a bit of personal culpability in leg amputations.
Harvest operations are extremely different. For one thing, you're taking organs out of a corpse, for all intents and purposes. The man with an above knee amputation has to live with your handiwork. - 8/04/2007 5:08 PM
- Sid Schwab said...
B. Surgeon: the similarity among them to which I refer is the extent to which one is able to ignore the horrible reality while carrying out the operation, focusing on -- and even enjoying -- the craft in the face of tragedy.
- mscriver said...
Harvest amputations have a rather different meaning out here on the prairie this time of year. The radio reminds the guys on the machinery to take ice and zip-loc bags with them to the field in case they accidently lop off fingers. Those huge bale rollers, if they catch a finger or sleeve, will yank arms right out of their sockets. One man working alone lost both arms but was able to drive himself home with his feet. He said the worst part was getting the key to his pickup into the ignition and that everyone should remember to leave the key already there. The next worst part was trying to hold off shock until he could get to his wife.
Ranchers would recognize that saw. If a calf can't be delivered because of wrong presentation or too small a cow pelvis, the calf is sometimes sawn up in utero and removed in pieces. That avoids a Caesarean.
The other day the newspaper had a photo of Bush with two veterans, one just a single amputee and the other double. They had "Stars Wars" legs -- no attempt to make them look human but they work good while moving. Standing still, it's necessary to get a grip on a prop, so they were both gripping Bush who looked a little stricken. The veterans were big, fit, tan men from the hips up. Bush, not so much -- from the soles up.
I sawed a big limb off my major yard tree the other day and had feelings faintly resembling what you describe here. No chain saw, just my bow saw. Had to be done as it was dead. Feeling of accomplishment once it was on the ground, but the question of what to do with it. There's something person-like in a tree, as well-illustraed in Lord of the Rings.
Prairie Mary - 8/04/2007 9:40 PM
- SeaSpray said...
Beautifully written.
Didn't think I was squeamish but think I might be if I saw an extremity separate from the body. Not toes - I've carried them but definitely the bigger parts would be unnerving. The internal organs removed wouldn't bother me but something about those extremities not being attached -not easy to think about. It was difficult reading about your cutting through the leg.
I don't know how the 911 workers did it down at ground zero. Must've been a lot of PTSD.
Surgeons must have a special calling on their lives. - 8/08/2007 8:10 PM
My mother had her leg amputated in 1983 due to cancer she was 25, with three young children. The guys from MD Anderson and the surgical team that consisted of seven of the top international surgeons deliberated for 15hours what the best course of actions was for her in order to perhaps extend her life. She asn my father drove to South Texas to go to the beach we kids were told and mom came back without a leg.
But it gave us two more years with her. She died of lung cancer in 85 I was seven. And for the two years I am thankful. - 8/13/2007 11:27 PM
my brother in law is having his left leg removed below the knee next week. he and my sister have a 6 year old daughter. he drove dump trucks and plow trucks in the winter, now he's losing his clutch leg, and most probably his driver's license (cdl). she has 2 teenagers from a previous union, and their daughter was born a premie, and has some developmental issues. now she will be the only bread winner for the forseeable future. funny hting is i wasn't even looking up amputations, i was just browsing reddit, and came accross this link. at first, when reading your blog, i was confronted by certain aspects of your description, words like pleasure, sound descriptions... but who am i to say, how i might deal with such a workday, where i had to perform such duties. we all have unpleasant days, and face uncomfortable situations. i paint walls, and sometimes old ladies make it painfully obvious i have been hired in hopes of some illicit sexual fantasies being realised... oh well, thank you for being who you are, all you people of the medical community. thank you for studying, and successfuly completing your studies, and dedicating your lives, to such unpleasantries. god, where would humanity be without you? thank you. peace
- Sid Schwab said...
blewsboy: thank you for your comments. I wish your brother in law well.
Was a surgeon at the 93rd Hospital in Vietnam and amputated more limbs than I can recount. No problem until returning to civilian practice and the multitude of vascular amputations. From the beginning of my return would do an amputation, finish and then go to the locker room and vomit. My staff protected me for many years. Martin
Was a surgeon at the 93rd Hospital in Vietnam and amputated more limbs than I can recount. No problem until returning to civilian practice and the multitude of vascular amputations. From the beginning of my return would do an amputation, finish and then go to the locker room and vomit. My staff protected me for many years.
- Sid Schwab said...
Martin: 93rd Evac was Danang, was it not? I was across town at the AFB; choppered a few of our injured there...
Found your blog through a diary on DailyKos, and started reading a couple of days ago. Very thoughtfully written, and thought provoking. I've almost written comments on several entries, but this one was personal, as I was on the other side.
The saw noise woke me up, twice. I saw the sheet between me and the source of the sound, one horrified attendent noticing me looking, but I felt relief to know it was happening. The last memory before that was telling the ER nurses beside me I was dying, one saying I wasn't, at which I look at my blood pressure monitor, and responded, "53 over 37, that's dying." When the car spun and ground my ankle and foot against the lamppost, a high pitched whine rang in my ears. Time stopped long enough for me to look down to see car metal touching lamp metal through skin and bone, a man in a red pickup staring at the redlight, to look up the sidewalk and actually feel relief no one else was there to get hit as all began moving again and the car careened away. (My first thought: "Here's something else to deal with.") The pain was intense; I think perhaps 3-4" held the remains of my ankle and foot on. Everyone has been burned; the pain builds and reaches a plateau and stays there a while. This was the same, except multiplied beyond description and there was no plateau. I managed to fall backwards, holding my leg up, scream for an ambulance, got one of the stunned men who gathered around me to give me a DAMN tie for a tourniquet ("Yes, I know it will stop my circulation!"), and have another call my mom to tell her I had a broken leg so she wouldn't panic but would go to the hospital (where she could panic safely). The other horrible sensation was my heart trying to beat normally. I feel it contract - whoosh, and then strain to pull blood back in. I got 9-11 units, I don't remember; a friend told me it was equal to all the blood in my body. (I do wish they'd asked before the Benedryl was injected for side effects - I'd have told themI'm allergic but instead shook and couldn't close my eyes for 3 hours, like speed.) I love my orthopaedist (as much as my oncologist, but that's a story from 10 years, now 20, earlier - level 4 melanoma). It took 2 years for all the surgeries, 5 initially and 3 the following year for graft clean-up and a bone spur. I still have pain, though low-level usually, like a small electrical charge. The bad ones come rarely now, which I equate to being plugged into a transformer, zinging from the tip of my stump to all parts of my body. I beat my leg with my fist and it helps a bit. If it last longer than 2-3 hours I hunt friends with pain med prescriptions. It is nerve damage NOT phantom pain.
I know I've written too much, and I could write more but then I should just start my own blog (The Patient?). I noticed how many comments are from medical professionals and figured a patient's view might interest some. Thank you for your indulgence, and a wonderful blog. - 9/29/2008 7:18 PM
- Sid Schwab said...
anonymous: thanks for a gripping story, well told. And for your words on my writing.
- Ms. Hermit said...
I realize this is much, much too late for any sort of real conversation, but reading people say how horrified they are at the notion of losing a leg always makes me sad. My mother effectively has an AK (birth defect)and she gets on fine. Chased three children around, worked retail (8 hours on your feet-not easy for those of us with all our limbs), bicycles, teaches disabled skiing, hikes, swims, and generally enjoys life. It's all about attitude. And surgeons who take into consideration padding the weight-bearing portion of the stump.
Also, "Star Wars" prosthetics are such an improvement from the old "door hinge." I remember my mother demonstrating - graffically, with twigs- why children's hands NEVER EVER go near the knee. - 7/20/2009 11:42 AM
I'm late to find your post. Laughably so, but it still hits home hard. Thank you for writing it. I have had several major surgeries (no amputations yet, thankfully) and have had the greatest difficulty understanding the position of a surgeon. On the outside, many seem brash, overbearing, laden with testosterone, and a part of me wonders if it isn't some coping mechanism. The remainder are diminutive by comparison, clean, fastidious, and always with a slight smile, as if they're enjoying some personal secret. In both scenarios, I can't imagine any surgeon being so close-minded as to be unaware of the incredible burden of responsibility they bear. Yet they act like it, compartmentalizing it somehow.
In the case of an amputation, I cannot begin to fathom difficulties involved with sleeping at night. On the one hand, a surgeon is doing it because a person may die if it's not done. On the other hand (if it still remains), one cannot ignore the fact that one is cutting off an essential piece of another human being. Prosthetics may be involved, but it's not the same. A person has been irrevocably altered, lessened, and I suspect in cases where amputations occur following car accidents or other such emergencies the patient must experience feelings of intense anger, violation, and betrayal. Yet a surgeon would not be able to carry out so complicated and delicate an art as theirs if they didn't find some beauty in it, some perverse interplay between horror and joy.
Is that why the patient is always covered? Is that why you can never look them in the face, take in who they are? Because the gravitas of the situation would freeze you? Because your knife would be stayed if you were struck by the profound realization that the person you're working on, the one who draws breath beneath your blade, will never be the same once your work is done? How do you cope with that?
And handing off the leg. How can you? You're throwing away a part of a human being. Something once and still needed, now bound for incineration. Do you need to get the patient's permission first for validation? I sure would. - 4/17/2013 3:55 PM
- Sid Schwab said...
Thanks for your thoughtful and insightful comment, Mr Richards.
Of course, unless it's some sort of emergency and an unconscious patient, surgeons interact very closely with patients prior to operating. Some more effectively and empathetically than others, no doubt; but you can't avoid it entirely.
The covering of the patient, which occurs after those interactions and obtaining consent, is mostly for sterility reasons. I've let awake patients watch some of their operation using a mirror. And I nearly always talked to them while I was operating; that's part of the fun of a local: making it painless and lessening their anxiety. - 4/17/2013 4:28 PM
Thanks very much for your quick reply. One other thing did occur to me: Have you ever had to perform an amputation following an emergency? If so, in what way did it differ than your usual approach with a patient?
- Sid Schwab said...
Read my book, starting on page 125. There's a story in there of a kid who developed "flesh-eating disease" (necrotizing fasciitis) and who refused to have his leg amputated. Age twenty-something. Said he'd rather die, which he would have...
Trauma, and any other sort of severe surgical emergency, changes everything: there may be no time to obtain "informed consent," and the patient may be in no position to give it. Sometimes you just have to do what you have to do, and be willing to take the consequences. - 4/17/2013 5:07 PM
It sounds like you're saying you carried out an amputation against the consent of a patient by citing an emergency in which informed consent could not be obtained... I'm sorry, but I'm not sure I want to read something like that.
- Sid Schwab said...
Up to you. It's a good story, with a happy ending.
Your style of prose is excellent. But, considering a kid had his leg cut off, I'm on the fence about that. What's the ethics of a situation like that, where a patient has refused treatment? How do you know what you're doing is right?
Moving this post to the head of the list, I present a recently expanded sampling of what this blog has been about. Occasional rant aside, i...
In no way is it false modesty to say that physicians are not healers. At best, what we do is to grease the way, to make conditions as favora...
Finally I'm getting around to writing about the gallbladder. Don't know what took me so long, seeing as how, next to hernias it'...
I finished the previous post with the sad story of my patient, illustrating diagnostic difficulties at the fringes of biliary disease. An...


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We may share Personally Identifiable Information you provide online with our company-related entities and/or business partners that provide services to Re-Vita. Where we engage third-party agents or contractors to perform services on our Site, we will require them to observe the intent of this Privacy Statement. From time to time, we may be required to provide Personally Identifiable Information in response to court order, subpoena, or government investigation. We also reserve the right to report to law enforcement agencies any activities that we in good faith believe to be unlawful. We may release Personally Identifiable Information when we believe that such release is reasonably necessary to enforce or apply our Terms of Use or to protect the rights, property, and safety of others and ourselves. Re-Vita, or its related entities, could merge with or be acquired by another business entity, or their respective assets could be acquired. Should such a merger or acquisition occur, you should expect that we would share some or all of your Personally Identifiable Information to companies serving you and other users of our Site.
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Your permission is always secured first. We will not use or share the Personally Identifiable Information collected on our Site in ways unrelated to the purpose for which you provided the information, including those described above, without providing you a choice whether to permit any such unrelated uses.
Accessing and Correcting Your Information
We take reasonable measures to ensure that any Personally Identifiable Information we collect on our Site is accurate, current, complete, and reliable for its intended use. If you wish to update or otherwise correct Personally Identifiable Information you have provided us, you may contact us as described in the "Contact Us" section, below.
Protecting Your Information
We acknowledge your trust and are committed to take reasonable steps to protect Personally Identifiable Information you provide online from loss, misuse, and unauthorized access. We employ physical, electronic, and managerial processes to safeguard and secure your information.
Use of Cookies On This Site
A "cookie" is a small data file transferred to your computer's hard drive that allows a Web site to respond to you as an individual, gathering and remembering information about your preferences in order to tailor its operation to your needs, likes and dislikes. Overall, cookies are safe, as they only identify your computer to customize your Web experience. Accepting a cookie does not provide access to your computer or any Personally Identifiable Information about you, other than the information you choose to share. Other servers cannot read them, nor can they be used to deliver a virus. Most browsers automatically accept cookies, but you can usually adjust yours (Microsoft Internet Explorer or Mozilla Firefox) to notify you of cookie placement requests, refuse certain cookies, or decline cookies completely.
Links To Other Web Sites
Links to third-party Web sites may be provided solely for your information and convenience. If you use these links, you will leave our Site. This Privacy Statement does not cover the information practices of those Web sites linked to our Site, nor do we control their content or privacy policies. We suggest that you carefully review the privacy policies of each site you visit.
Children's Privacy Protection
We take special care to protect the privacy needs of children under the age of 13 and encourage parents to be an active participant in their child's online activities. We abide by the requirements of the Children's Online Privacy Protection Act (COPPA) and other relevant laws. Our Site does not target and is not intended for children under the age of 13, and we will not knowingly collect Personally Identifiable Information from them. If we discover personal data from a child through an adult-oriented site, we will eliminate that data.
Changes To This Statement
Any updates or changes to the terms of this Privacy Statement will be posted here on our Site and the date of the newest version posted below. Please check back frequently, especially before you submit any Personally Identifiable Information at our Site, to see if this Privacy Statement has changed. By using our Site, you acknowledge acceptance of this Privacy Statement in effect at that time of use.


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1. In your view, what are some current of emerging trends that will beimportant to understand for a Recreation Specialist? WHY are these mostimportant? HOW would you integrate them into Mecklenburg Park and Recreation?HOW do you stay informed of emerging trends?WHAT resources do you use to track the industry and trends?
2. Describe an innovative program that will involve approximately (10) 55 and older adults. Prepare a timeline of all the steps needed to implement your program from beginning to end. Please include a budget for you program and creative funding sources thatcould supplement the program.
3. 4. Please describe two innovative partnershipprogramming ideas that would reach and be implemented for the following target groups: Teens (13-17) and older Adults (55+).
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Heirloom Tomato Salad with Pesto Vinaigrette |
Remove the cores from the tomatoes and cut them in various shapes and sizes (wedges, round slices, half-moons, etc.)...set aside.
Arrange the tomatoes on a platter. Season with salt and pepper to taste. Place several slices of onions on top of the tomatoes and drizzle with pesto vinaigrette. Arrange several basil leaves around tomatoes and sprinkle with additional cracked black pepper.


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ClearCorrect Braces Mountain View, CA
ClearCorrect® braces are an alternative to both traditional braces and Invisalign®. In our Mountain View dentist office, we provide this solution for straightening teeth discretely. If you live in or near the 94040 area and want to improve your appearance, we invite you to call (650) 967-1389 and schedule a consultation to learn how this treatment option can work for you.
What is ClearCorrect®?
Instead of relying on metal brackets and wires to move teeth, ClearCorrect® braces use a series of clear aligners to move teeth into place. The aligners are made of a clear and comfortable plastic that looks similar to a full retainer. By taking care of them and refraining from scratching their surface, aligners will remain clear and virtually invisible when worn. At California Family Dental, we can show you how to keep your aligners in perfect condition during the treatment process.
The aligners are created using an impression of your teeth and gums. Once received, the lab will create a series of aligners that start with the current position of your teeth and slowly move them until they are perfectly straight. A patient will wear each aligner for about four to six weeks. Afterward, the patient will replace the old aligner with the next one in the series. The aligners place pressure on specific teeth to gradually move the teeth for a more comfortable experience. By wearing all of the aligners in the series, your teeth will move from crooked to perfectly straight.
The aligners are given to you at the beginning of the procedure so that you do not have to visit our Mountain View dentist office every time that you need to switch them out. This allows you to spend less time in the dental chair than you would when wearing traditional metal braces.
ClearCorrect® vs. Traditional Braces
Traditional metal braces are extremely effective for straightening teeth and treating misaligned jaws. While metal braces are more comfortable than they were in the past, they are still noticeable and unfavorable to many. With the wires, brackets, and rubber bands, traditional metal braces can negatively impact the way that a person looks and feels. Many people find that traditional braces are distracting and do not fit into a busy or professional lifestyle.
Simultaneously, metal braces are difficult to keep clean as food can become stuck between the brackets, requiring a special floss to remove the bits of food. At California Family Dental, we can help patients receive the necessary treatment without having to drastically change their diet or skip out on some of their favorite treats when wearing braces. While only temporary, this can be inconvenient and at times, frustrating. Given the tendency for food to become stuck, those wearing braces, also need to spend more time brushing and flossing throughout the day.
ClearCorrect® ClearCorrect® is a far more convenient option than other methods for straightening one's teeth. Patients remove the aligners themselves when eating, so there are no restrictions on which foods you can eat. Patients also do not have to worry about something becoming stuck in the brackets or the embarrassment of feeling awkward while eating. Patients wear ClearCorrect® for at least 22 hours per day, leaving plenty of time to enjoy a romantic dinner, business meeting, or lunch without metal braces ruining one's confidence. This makes it possible for patients to maintain their current lifestyle without any further restrictions.
Another advantage of ClearCorrect® braces over traditional ones is that patients can remove the aligners while playing sports, a musical instrument or singing in the choir. As a dentist, we recommend that athletes wear a mouth guard during practice or a game. With braces or other teeth-straightening products, this can be an issue. With ClearCorrect®, patients can remove the aligners to wear the mouth guard. If you play sports on a regular basis and live in the 94040 area, we invite you to schedule a consultation to see how much easier it is to continue wearing a mouth guard when using ClearCorrect® to straighten your teeth.
Check out what others are saying about our ClearCorrect® braces on Yelp: ClearCorrect® Braces Mountain View.
ClearCorrect® Braces vs. Invisalign®
In our Mountain View dentist office, we offer ClearCorrect® braces as an alternative to Invisalign® and are confident that ClearCorrect® is the superior way to straighten teeth with aligners. When comparing the cost of ClearCorrect® with Invisalign® we have found that our solution typically saves our patients money over the course of their treatment. Another benefit of ClearCorrect® braces that we find, is that the aligners themselves seem to be clearer than those provided by Invisalign®. p>
At California Family Dental, we receive requests to straighten teeth as fast as possible. We understand this desire and offer possible solutions that will work with the patient's lifestyle. In general, ClearCorrect® has better and faster customer service than Invisalign®. Since they manufacture the aligners in the United States, versus overseas, the process is even faster. This enables us to provide you, our patient, with aligners in an expedited fashion so that you can begin treatment and have straighter teeth – faster.
They both have a similar method for treating teeth, applying pressure through aligners. However, with ClearCorrect® braces, you will receive phenomenal results, high-quality patient care, and beautifully straight teeth. If you are considering either of these options, we invite you to call 650-967-1389 and schedule an appointment with our Mountain View dental office so that we can discuss your goals and the ClearCorrect® procedure in further detail. Once you are ready to get started, we will walk you through the process and examine your teeth on a regular basis to ensure that they are responding as they should, so that you can love your smile again.
Helpful Related Links
- American Dental Association (ADA). Glossary of Dental Terms. 2015
- American Academy of Cosmetic Dentistry® (AACD). Home Page. 2015
- WebMD. WebMD's Oral Care Guide. 2015
About our business, license, and website security
- California Family Dental was established in 2005
- We accept the following payment methods: American Express, Cash, Check, MasterCard, and Visa
- We serve patients from the following counties: Santa Clara County
- We serve patients from the following cities: Mountain View, Santa Clara, San Jose, Palo Alto, Los Altos, Redwood City, Fremont, & Tracy
- Website Safety Ratings and Reputation – AVG Threat Labs. View Details
- Norton Safe Web. View Details
- Trend Micro Site Safety Center. View Details
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We are located minutes from downtown Rockport and other attractions along miles of pristine Gulf coastline, neighboring Aransas Pass and Corpus Christi, two very popular tourist and fishing hotspots.
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11.5" x 11.5" Scrapbook Overlay
Simply choose your color for your overlay, add your photos to the back of the overlay and add your favorite scrapbook paper for a background. You can leave the finished overlay as is or add some bling or embellishments for a further finished scrapbook page....
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Scrappin Every Memory's overlays are for PERSONAL use only, copying, reselling or making claims on any of our scrapbook overlays is prohibited following our ©2015 Scrappin Every Memory All Rights Reserved policy.
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Funded account agreement
Funded account agreement
Qualified evaluation account
The Trader
1. Personal Data
This TRADER AGREEMENT is made by and between Nextproptrader LLC, Business Center 1, M Floor The Meydan Dubai, UAE (the "company") and the individual (the "trader") below.
First Name: Heiko
Last Name: Slon
Address: Europa-Allee 139, 139
City: Frankfurt am Main
Zip code: 60486
Country: germany
Email: firstname.lastname@example.com
Heiko Slon (the "trader") has read and understands, acknowledges, and agrees to the terms and provisions contained in this Agreement. The Trader is responsible for all commissions, payout fees, and trading platform expenses. The trader is responsible for the accuracy of the data and must immediately inform Nextproptrader of any changes such as residence or contact information. The trading account may not be shared under any circumstances and may only be used by the trader.
2. General
a. Performance Review
Nextproptrader monitors all trading activities and reviews the performance of the trader. Nextproptrader has the right to discontinue further cooperation at any time. The trader will be informed electronically.
b. Trading Platforms
Before the cooperation starts, the trader is aware of the permitted trading platforms. Trading on Nextproptrader can only be done via approved platforms. The trader is responsible for all platform and software costs. The market data is provided by Nextproptrader.
c. Account Balance
The trader is aware that the capital managed by the trader is the property of Nextproptrader. The trader acknowledges that he only conducts business on a separate account, which, however, is only processed in real terms by Nextproptrader.
The trader has no claim to the capital nor is he trading a real capitalized real money account at any time. The trader is provided with a separate simulation account with which he can trade the futures markets live in a simulated environment.
It is up to Nextproptrader whether the transactions carried out by the trader on the simulation account are processed by Nextproptrader on the trading account and in the name of Nextproptrader or not. The trader has the right to pay out the profits on the simulation account in compliance with the payout rules, provided no rules listed in the further course of the contract were broken.
Nextproptrader has the right to withhold any simulation credit from the trading account in full if one of these rules is broken. In this case, the trader has no right to a payout.
3. Definitions
a. The "Trailing Drawdown".
I. The so-called "Trailing Drawdown" represents the minimum account balance of the trading account and is first established when the account is created. The setting is based on the initial account balance minus the maximum loss limit of the respective account. The "trailing drawdown" is pulled up on the open profit. The "Trailing Drawdown" is the minimum account balance that the account must not fall below. The minimum account balance ("Trailing Drawdown") is always adjusted to the last highest account balance, but never adjusts downwards at any time.
II. The "Trailing Drawdown" is only adjusted upwards until the "Trailing Drawdown", i.e., the minimum account balance, corresponds to the account balance, which was set at the start.
III. The "Trailing Drawdown" i.e., the minimum account balance initially equals the following "Trailing Drawdown" when setting up the account:
$10,000 = $9,500
$25,000 = $23,750
$50,000 = $47,500
$100,000 = $96,500
$150,000 = $145,000
$250,000 = $244,000
b. The maximum contracts traded simultaneously.
I. The trader can only have a maximum number of contracts open in the markets at the same time. The limitations vary for each account:
$10,000 = Max. 1 lot
$25,000 = Max. 3 lots
$50,000 = Max. 5 lots
$100,000 = Max. 10 lots
$150,000 = Max. 15 lots
$250,000 = Max. 25 lots
c. The "Threshold"
I. The "Threshold" defines the minimum profit which must remain in the trading account and forms a profit buffer. This is never payable and only the profits above it can be paid out. The "Thresholds" are different for the different account models and are defined as follows:
$10,000 = $1,000 Threshold
$25,000 = $1,500 Threshold
$50,000 = $2,500 Threshold
$100,000 = $3,500 Threshold
$150,000 = $5,000 Threshold
$250,000 = $6,000 Threshold
d. "Effective Date" means the date the Trader executes this Agreement.
4. Compensation obligations
a. The Trader has fully read, understood, and accepted the terms and conditions and the privacy policy of nextproptrader.com. If the Trader does not accept these, they lose any right to use the services of Nextproptrader.
b. Trader will indemnify Nextproptrader and its members, managers, officers, directors, shareholders, employees, agents, and affiliates (collectively, the "Indemnified Parties") against and hold the Indemnified Parties harmless from and against all claims, demands, proceedings, suits and actions and all losses, liabilities, costs and expenses, including, without limitation, attorneys' fees and disbursements, direct, indirect, or otherwise, and whether paid in settlement or otherwise, incurred or suffered by Nextproptrader in connection with or arising from any act or omission of the Trader under this Agreement or breach of this Agreement or any action or omission of the Trader in connection with the Trader's trading and other activity that is in any way, directly or indirectly related to this Agreement or Nextproptrader.
c. Nextproptrader is not liable for any action or omission by the Trader. The Trader's obligations to indemnify under this Agreement will survive the termination of this Agreement.
d. You must be at least 18 years old to trade with us and to be able to enter into a business relationship.
5. Account rules
a. Nextproptrader deposits the initial minimum balance on each account in simulated USD currency; the accounts do not contain any real or legal tender.
b. Nextproptrader has the right and will deactivate all trading accounts that fall to or below the amount of the "Trailing Drawdown."
c. The Trader may not exceed the maximum number of contracts traded simultaneously as established for their account.
d. Fills in the Leader (Trader's SIM) account are subject to verification in the Exchange time and sales. Fill prices may be modified to the exchange recorded fill price if there is a discrepancy. Trades made during economic releases or other fast market conditions may report inaccurate fill prices in the leader account and must be verified prior to PNL calculation for payouts. Any attempt to exploit differences in fill prices between the Leader program and the Exchange time and sales will result in forfeiture of all trading PnL and may be grounds for immediate termination of the contract.
e. Nextproptrader has the right to eliminate any profits that were realized due to technical errors such as Rithmic problems. Similarly, with trades and profits that were realized during hyper-volatile market phases and could not be properly booked or processed, as the simulated Rithmic services could not keep up with the speed and therefore erroneously posted incorrect results to the trading account.
f. The Trader will verify all Account(s) in RTrader before trading and notify Nextproptrader immediately if any Account is incorrect, contains an incorrect initial balance, or has any other incorrect, incomplete, or inaccurate information, data, or parameters.
g. Nextproptrader has the right to modify and expand any rules. The consent of the trader is electronically requested. If there is no consent, Nextproptrader has the right to terminate any business relationship at any time.
h. The Trader will not trade or attempt to trade, directly or indirectly, on any account maintained at or by Nextproptrader other than his own Account, including without limitation any attempts to trade or trades under any account maintained at or by Nextproptrader held by or under the name of a family member, friend, business entity owned or controlled in whole or in part by the Trader, or held by or under the name of any other affiliate, agent, or alias of the Trader, or by any other means.
i. Nextproptrader will not establish the Account for the Trader until Nextproptrader has received all forms and identification, including without limitation a valid, current, driver's license or other valid and current form of identification issued by a governmental entity that is acceptable to Nextproptrader in Nextproptrader's sole discretion.
j. The trader may only trade at permitted times. All traders must close their active positions no later than 3:15 PM CST. A trading day runs from the opening at 5:00 PM CST to the closing at 3:15 PM CST. Holding positions overnight is forbidden.
k. Only permitted trading instruments may be traded. These include all instruments listed on the page: https://nextproptrader.com/faq/what-products-can-i-trade/.
l. Nextproptrader has the right to deactivate the trader's trading accounts at any time should one of the rule breaks occur.
m. Nextproptrader has the right to disable the account and retain profits if illegal trading strategies are used. This includes, for example, opening opposite positions on two or more trading accounts.
Traders Payments
6. Accounting and Payment
a. Nextproptrader pays the trader the requested commission, provided that the amount available on the trading account exceeds the payout threshold.
b. All withdrawal requests must be made via the online dashboard.
c. Payments are made to the bank account, PayPal or crypto wallet specified. If incorrect payment information has been provided, Nextproptrader accepts no liability for transfers to an incorrect bank account or crypto wallet.
d. Nextproptrader reserves the right to individually determine the number of monthly payouts.
e. Provided no rules have been broken, the payout amount will be fully paid out minus the profit share of 5% to Nextproptrader and minus the transfer fees, which depend on the payee. Accordingly, the trader receives 95% minus transfer fee, of his earned commissions.
f. Only amounts that are above the payout threshold, the "threshold", can be paid out.
g. Nextproptrader may, at its sole and absolute discretion, pay funds to the Trader from any Account in any amount and at any time.
h. Nextproptrader and the Trader do not intend to create an employer – employee relationship under this Agreement. The Trader is an independent contractor and has to take care of his tax matters completely by himself.
i. Payment requests will only be processed from Monday to Wednesday.
j. The trader acknowledges that he must have a valid bank account to which he can deposit USD. If it is a European bank account, Nextproptrader directly transfers Euros and calculates these based on the current day's Euro/US Dollar exchange rate. The trader also confirms the accuracy of his payee information and his data. Payments are only made to the trader's own account. Transfers to third parties are not permitted and will result in termination of this agreement and cooperation.
k. The trader bears all transfer fees in full. These depend on the individual fees of the corresponding banks.
l. Since the trader bears the transfer fees himself, there is no minimum payout amount.
m. The trader only has a right to payment provided no rule has been broken.
7. Trader Fees
a. Traders of Non-Professional status will pay Nextproptrader a monthly fee equal to $95 on the Effective Date. The fee only needs to be paid once per user and is transferred to all of their funded trading accounts.
b. Traders of Professional status will pay Nextproptrader a monthly fee equal to $112/exchange on the Effective Date.
c. To be able to operate, trade and receive payouts, your trading account must have an active data subscription. If payment fails, you must let us know via ticket or email email@example.com the same day payment failed or before the data subscription renews. If your payment fails, you must make a new payment immediately. If payment is not made within 24 hrs after payment failure your trading account will not be reconnected.
d. The monthly fee consists of one-time payments, which you must make independently via your dashboard. If no payment is made, your trading account will be blocked. The active term can be viewed in the dashboard and can also be extended in advance.
e. In addition to the fixed monthly account fees, which cover all technical costs, there are trading fees which are charged for each contract traded. For each mini contract traded per side, $2.50 is charged and for each micro contract traded per side, $0.50 is charged. The fees are deducted from the account balance after each trade.
Concluding remarks
8. Updates to policies and agreement
Nextproptrader may, in its sole and absolute discretion, update or revise the policies, terms and conditions, this Agreement, or any other document governing the relationship between Nextproptrader and the Trader, at any time without notice at Nextproptrader.com. The Trader may request copies of updates or revisions to this Agreement from Nextproptrader at any time. Manipulation of any content in this Proprietary Letter will result in the closure of all accounts and void agreements with Nextproptrader LLC.
Traders Signature
Please sign using a stylus, your mouse, or your finger below to authorize this contract. By electronically signing and saving this document, you agree to the terms established above. After the document is signed, you can proceed to print it and leave the page.
Client Information
Signed on Sat Oct 07 2023 04:21:45 GMT+0200 (Mitteleuropäische Sommerzeit)
IP Address: 2a02:908:1d5:6840:5806:ba19:afc1:c371
Even if no signature was provided, the contract was agreed to by clicking the Save button.