Rheumatoid arthritis treatment in 199 Oncology and Orthopedic surgery clinics in Americas

Got first-rate care, had a great experience and a positive outcome! Kudos to the Nurses, Doctors/Surgeons/Anasthesioligists, Physical Therapists, Dieticians/ Food Service, Fellows, Interns and Students.Special shout-out to my postoperative caregiver- Karina Valentine. She kept me going through the most challenging part of my surgical journey- enduring procedures to facilitate the OUT in outpatient. Lest we forget the unsung heroes that keep the hospital so hygienically safe and superior- I must now sing my praises to the custodial technicians: 🎶We could eat off of the floors But we don’t have to They give plates and forks Don’t spill dessert (I got strawberry shortcake 🍰)

Duke has reached a new low in Health Care. I'd give them stars in the minus categories if I could. My son had eye surgery and every time we went for an appointment we waited over 2 hours to be seen. I can tell you I read 150 pages of a book on one visit. We actually saw people leave without being seen because they had waited so long. My son objected to the long wait one day and was told by the surgeon that he was ruining her day. Because of the wait he asked to talk to the manager or an administrator. While waiting the police came made him leave because they said he raised his voice. He was not allowed to talk to the administrator and was escorted out. This is not the first problem we have had with Duke. My son was in the emergency room waiting for the specialist on call when the Emergency Doctor came in and told him that the specialist on call was already home and refused to come in to see him. We were told he should go to the specialist's off the next day. We did that and he was seen for less than 10 minutes and told to go back to another doctor. Seems the specialist could have cut through the chase and just told us that to begin with. My impression is that almost every one in the hospital system is very impressed with themselves and seems to think it below them to interface and deal with patient who have some real problems. I can, in no way, recommend any Duke Service. I could continue with examples but it would sound repetitive. I practiced Nursing for 45 years and never came up against any care that is this poor in quality. Giving them -5.

There is good and bad. I recently gave birth at Duke University Hospital and I want to say that my experience with Doctor Clifford, and nurses Lexi, Brenna, Tabitha, Josephine among others was phenomenal. I was blown away by the care and compassion I received so I will say it was a four star experience. However, I have one major complaint about the experience and feel it's important enough to try to voice it. The postnatal recovery rooms are terrible. They are the size of walk in closets and if you have a support person such as your husband staying with you, they have to sleep on what is essentially an airplane chair. My husband could not do it, and it made the end of my experience at Duke hard because I needed him there with me. I felt like me and my baby were locked in a cell and I was going crazy by the time I was discharged. Thank god I was discharged early. There were many people coming in and out of my closet those last few days and nights, and it was definitely too many people. After receiving an emergency C section, I felt I was improperly educated on the repercussions. I had no idea I would have trouble producing milk after my blood loss in surgery and I was not informed about any of the medication I was prescribed. Again, it would have helped if my husband could have been there because maybe I actually was given information but was too out of it for it to sink in.

I wasn't going to write a review (I'm so over all this), but I feel compelled to after reading a review that was extremely similar to what I experienced here for COVID-19 treatment. I tested COVID-positive on January 3rd and started Paxlovid. I saw my neighborhood doctor on January 4th. I am vaccinated (and boosted) but am at high risk with asthma. I was given steroids and breathing medicine. I was instructed to go to the hospital if I got worse. I got worse. The following evening, my oxygen dropped below 80. Scared, I called an ambulance and requested to be taken to this hospital as it was supposed to be the best. They took my oxygen in the ambulance and immediately gave me oxygen. I was on oxygen the whole time in the ambulance. I was taken off oxygen when I arrived as my saturation reached the high 90s. I requested the antiviral remdesivir. The doctor refused to give me the medicine. I explained how my condition worsened despite days on Paxlovid, steroid injections, oral steroids, bronchodilators, and rescue inhalers. He could not have cared less. I requested to leave as the doctor was not going to treat me (he charged me, though). The doctor told me there were other ID specialists. I requested to speak to one of them, and the doctor left. While waiting, someone else came in and said there were no other ID specialists there, so I paid and left. It should be noted my saturation had fallen to 92% by that time. I struggled at home with symptoms for the next few days. I continued testing positive after completing Paxlovid. My condition worsened, and I returned to the neighboring doctor about a week after leaving the hospital. Still symptomatic and COVID-positive, he examined me and found pneumonia. My labs were also abnormal, showing evidence I had developed blood clots due to COVID-19. He prescribed medicine for pneumonia and clots (which worked). All this could have been prevented. Trying to get my medical records from this hospital afterwords (for insurance) was like pulling teeth. It took forever to get my records, and when I finally did, I was shocked. The doctor noted that I said things I never did. My signature was forged on the documents. Worst hospital experience ever. Very expensive and received no treatment. The administration is a nightmare as well. Avoid it if possible.

We have been living In 3 different countries for the past 9 years, never experienced anything as bad. We have a a top insurance but they “suddenly” only excepts credit card payment. Stayed for additional 5 hours because they did not let’s leave. No one speaks English except the doctors. However, doctors are very competent and reason for not one but two stars.

Absurdly (like, for real) expensive for a very mediocre level of service. I went to the urgency center, and i found it very useless that on every stage (reception, triage, first and second doctor) they asked me the same questions. The doctor took more than half an hour to arrive. The receptionist has misinformed me and I did a very expensive (since I’m traveling abroad) call which wasn’t necessary at that moment. Also, several times there were several people coming in at a time, also unnecessary, certainly didn’t create a feeling of comfort. The room in which I was attended was small and the door was never closed.

They have a terrible Surgeon, is name is José Antonio Soriano, he was my surgeon and the results of the operation were disastrous, he only cares about money , and not about his patients. I filed a complaint at the hospital and the didn’t do nothing

Terrible experience. I tested positive for COVID three days ago, and began Paxlovid and fever reducers immediately. After three days, I am still having symptoms and testing positive. I called the ambulance to bring me to the hospital. My oxygen was 81 (after a dexamethasone injection and tablet today). The paramedic gave me oxygen right away in the ambulance. The doctor was useless. He refused to prescribe remdesivir. In nonhospitalized patients with mild to moderate COVID-19 who are at high risk of progressing to severe disease, remdesivir should be started within 7 days of symptom onset and administered for 3 days. The doctors name was Dr. Diego Lecona. I showed proof of my asthma and low oxygen saturation from prior attacks. He did nothing to help me and didn’t give me the medicine. All he did was charge me over $300 for a useless consult. Never again

Unfortunately I became quite I’ll on a recent trip to Mexico City. The physician on call for the hotel direct me to this hospital. My care in ER was efficient, caring and appropriate. Lilliana and Mezil in Er were so caring and great communicators. I was admitted and again impressed with the care of the team. Very professional and respectful. When called received prompt response. My physician, Dr Jessica was knowledgeable, great personality and did follow thru with communication upon my return home. Highly recommend and hope in US we can rid our staff of the EMR demands that take them away from the bedside. Perhaps then we can be as attentive as the team in this hospital. Thank you to the nurses, housekeeping and residents as well!

This hospital is part of the inherited Mexico, with a staff with the excellence that experience provides, but fatigue periodically takes its toll, so as a patient, everyone will talk about how the fair went. The staff makes an effort for the shortcomings they work with and for such a diverse population. More hospital centers like this are needed for this city. Abroad, dozens and even a few hundred spend hours and even days waiting for care for family members, either for medical appointments and studies, as well as those who are hospitalized for days in these facilities. There are those who already go with a folding bench, others rent chairs, umbrellas and some institutions offer a tent for those who come from afar to accompany a family member during their hospitalization period.

Excellent

Exceente

A big thank you to the staff of Galenia hospital!!! During our stay this month, my friend became suddenly ill and had to be hospitalized. Being from the US, I must say that it was a bit nerve wracking to have to seek medical help in a foreign country. However, our experience was entirely positive!!! To the concierge staff - Eric and Alfredo - I wish to extend tremendous gratitude!!! Your translation services as well as your kindness and hospitality were both indispensable and greatly appreciated!!!! I also wish to extend my gratitude to Dr. Allejandro (I don't remember your last name); not only were you genuinely gracious, you discovered the problem quickly and got my friend back on her feet in no time at all!!! Again, thank you Hospital Galenia for such a good experience!!! You took great care of my friend and went above and beyond in showing us courtesy and consideration!!!

BEWARE IF YOU ARE A TOURIST! My father was hospitalized on a family trip to Cancun. He was transported to this hospital and needed emergency surgery This hospital FAILED him. They wouldn’t even give him so much as saline or an antibiotic without payment in FULL. WE WERE CHARGED $4,000 FOR. He went 8 HOURS sitting on an emergency room bed when he should have been in surgery. THEY DEMANDED 50,000 DOLLARS PAID IN FULL BEFORE STARTING ANY CARE AND THAT WAS JUST FOR THE SURGERY. WE OFFERED TO PAY 25,000 SO THEY COULD START AND THEY REFUSED. WE OFFERED TO PAY THE REST THE NEXT DAY AND THEY REFUSED. WE TRANSFERRED MY FATHER TO THE OTHER HOSPITAL BECAUSE WE THOUGHT HE WAS GOING TO DIE. WE FELT USELESS WHILE THEY HAD ALL THE POWER TO DO SOMETHING THEY CHOSE TO DO NOTHING!!!!! THEY ARE SCAMMERS AND NOTHING MORE. ITS A MIRACLE MY FATHER SURVIVED AND ONLY BY THE HELP OF GOD WAS MY FATHER ABLE TO COME BACK HOME WITH US. JUST TO TOP IT OFF WHEN WE WERE PAST THE TRAUMA THAT THESE PEOPLE PUT US THROUGH THEY HAD THE AUDACITY TO BILL IS THE OXYGEN THAT WAS ADMINISTERED DURING THE AMBULANCE RIDE!! 2000 DOLLARS!!!!!!!! THEY WOULD RATHER WATCH YOUR FAMILY MEMBER DIE, I WILL NEVER FORGET THEIR DISGUSTING SMUG FACES

It feels very comfortable being there. Olivia is the best. She arranges everything for you when you are from outside the country of Mexico. You show up and all is prepared. Her personality is very welcoming and friendly. I love not having to worry about the stress of paper work especially since i don't know Spanish well. All her subordinates speak English as well and are all very nice. Galenia might be costly however the peace of mind you get not being stresses out with paperwork helps a lot. I don't even need to Contact my insurance. They do everything for you. Best service. The receptionist at imaging are a bit slow and don't know any English. But the staff attending to you in the radiation area are super friendly and helpful. I see many people complain about the price. This is a private hospital and will be costly. It is the same in my own country. Private hospitals cost a lot but if you have insurance and you are not from Mexico, then I highly recommend using their tourism concierge. They are a great help and speak English. They are all very nice and helpful. I have had the pleasure of meeting and being assisted by Olivia (who is the best), Ellen, Ricardo and another guy i cant remember his name. Not sure if it is Daniel or something with a D. That was over 2 years ago i met him. They arranged everything with my insurance prior to going there. I just showed up and Olivia walked me through everything. I was in and out as quick as possible. No long waiting. Use the concierge service they have. It really helps you from stressing about paperwork and payments. My journey at Galenia started September 2021 and I continue into 2023......

Make an appointment, it's simple... the specialist never arrived, they send you a message to ensure punctuality out of respect for the doctor's time but they do not respect yours, they left me waiting for about 30 minutes, they charge the consultation at $1500, not cheap for the service. a private clinic, anyway, thank you!

The doctor was very thorough. And a great help. Highly recommend this clinic.

I am an American on an extended vacation here in Mexico City and I saw Dr Luis Villalobos Perez. Hands down he was the best doctor I have ever seen in my fifty years of life. He truly took time to discuss my health problem and my history and he gave me a thorough physical exam, I feel like I have not had an actual physical exam since I was in high school. It is such a blessing to have found Mediland! Great staff, clean and modern facility in a beautiful neighborhood Don’t hesitate to go here if you are sick!

Do not reccomend to be attended by Dr. Jaime A. Estrella. Was forcing me to put workers comp when my injury had nothing to do with work, and threatend to report me as well for leaving half way through. Very bad doctor.

I've been go Almater Hospital twice now to have surgeries with Dr. Luque. I can't begin to express my gratitude for what wonderful experiences I've had. On both occasions, the staff both with Dr. Luque's clinic team, the surgical team, and the hospital staff have gone above and beyond to take exceptional care of me. They are patient with my insecurities and anxiety about the processes, they deliver excellent care, and are kind and considerate throughout. I'm a Nurse Practitioner by trade in the US and have had many surgeries in the US in the past. I can genuinely say the care I received at Almater hospital and by these medical professionals far exceeds any treatment I've ever received in the US. This will be my choice hospital for care with all procedures I'm able to utilize them for and highly recommend them to others.

Very bad hospital to get treated. I went for a procedure on my low back (cyst) and they charged me over 9,000 pesos for just medicine, and wanted to charge me 50,000 for the procedure. Of course they only told me the price after I had asked how much it was going to be. Also they charged me 1000 pesos extra for using a different doctor that supposedly is filling in for another. They wanted to keep me over night for no reason, I would have just been laying in bed (I assume to make more money of me). Communication between the workers is bad. Not recommend at all. Prices are way overpriced and the service is bad. Save your time and money and go to a different hospital

Absolutely horrible service. My father broke his arm and we had to wait like 10-15 minutes just checking in. And then they gave him a terrible cast and diagnosis. We had to come back to the US and go to our local Kaiser Permanente to get actual care for my dad. Please avoid this place, especially if you are visiting from the US. Por favor, nunca buscas ayuda aquí, especialmente si vienes extranjero de los Estados Unidos.

We have used the services of Valmar Hospital, including surgery and emergency care. Could not ask for better service and care. Having so many specialists at one location is so helpful. Received excellent care from Doctors , nurses and staff.

Horrible service. Showed up here with a case of Food Poisoning and was turned away because my symptoms were "similar" to Covid-19. The front desk person told me to wait outside, didn't even ask me simple questions such as if I had a cough or shortness of breath and after "speaking with her supervisor" told me I had to go to the General Hospital because Velmar was "full". Such a lie! If it was full, why wasn't I turned away when I first showed up? I went to Clinica San Fernando after and was seen by a great doctor there. My cardiologist and urologist have their offices at Velmar and I will let them know I won't be able to attend our appointments anymore at this hospital, because they deny service to people in need.

Clean hospital. But extremely expensive. They didn't inform us of the costs and we had to pay 10 times of than other european countries.

Terrible service. Completely disorganized, does care at all about their patients. I was begging them for help in resolving a billing issue and every department just ignored me. Do not go to this hospital. I went to this hospital to get an outpatient procedure done which required that I have an attendant with me. The hospital organized for an attendant to be provided, at a fee, from an outside company. On the day of the procedure I was brought to the billing department by member of their "concierge" team, Fernanda. They have an international "concierge" service which basically provides translators so that you can navigate the hospital if your Portugues is not great. At the billing office I was presented with a bill for the cost of the procedure. I agreed to pay it and was then given a credit card machine to make the payment. When the machine arrived, the amount they were requesting was higher than the quoted amount. When I asked Fernanda, she explained that the additional amount was for the cost of the attendant. I paid the invoice and was only provided with a little slip of paper that showed the amount that I had paid. It didn't say what services I had paid for, just that I had paid a certain amount. I then went and got the procedure done. I was put-under, so I don't know how the actual medical procedure went, but from what I saw before I went under, the medical professionals seemed like they were doing a good job. After the procedure was finished, I was brought to the payment office and presented with a new bill. The bill included the additional cost of part of the procedure, the cost to have a biopsy analyzed and the cost of the attendant (which I already paid for). For the next 3 weeks I was going back and forth with the International department, the complaints department and the billing department, trying to get them to acknowledge the fact that I had already paid for the attendant. No one from any of those departments did a single thing to try to help me. Each department passed me off to another department. The complaints department didn't even reply to my complaint. I had to call them up weeks after I had filed a complaint and they were fully aware of the situation, but didn't have enough respect to let me know that they were working on my case or bother to email or call me to help get it resolved. Neither did the International department. When I asked them to help me resolve the issue they just said "this is not my department, I don't know anything about billing" even though FERNANDA was there and was the one that explained to me that I was paying for the the price of the attendant. The billing department just kept sending me the same invoice over and over again and never acknowledging that I had paid for the attendant. It was only when I finally decided to go to the hospital and pay the bill that anything got done. I had to physically go to the International department and demand that they resolve the issue that instant. I spent another 2 hours going to different departments with the "concierge" lady, getting into arguments and explaining over and over what had happened. It was only then, that they acknowledged that the woman who processed my payment allocated the entire amount to the cost of the procedure, which was why this bill for the attendant was still outstanding. At my insistence they finally removed the charge and I was able to pay the invoice. If you go to a Brazilain Hospital, make sure that you get an itemized invoice for every single payment that you make. A little slip of paper with the amount on it is not enough. They will change the amount that you owe them and you have no proof of what you have already paid for. At the end of the day, I probably wasted about 4-5 hours of my time writing emails, sending messages on Whatsapp and arguing with the staff at the hospital. Not to mention all of the frustration it caused. This could have been resolved after 1 email, had anyone at the hospital taken ownership of the problem and been accountable. DO NOT GO HERE - THEY DON'T CARE ABOUT THEIR PATIENTS

One of the best hospital in South America

Dr. Ramon Rivero was fantastic. I had gotten a really bad ear infection during my stay at the senator from the pools. Dr .Ramon Rivero helped me out, made sure I wasn’t in pain and was comfortable. Truly a great experience, very friendly and welcoming. 10/10 great experience.

Traveling internationally with young kids is stressful enough, but when a baby starts running a high fever, it takes the stress to another level. Edwin De La Cruz was a calming voice for us. His knowledge and expertise were great, and his willingness to explain what and why he was evaluating, was appreciated. It’s clear to see he loves what he’s doing, and we appreciate his time and support.

My experience with this clinic was exceptional. I went in with symptoms of numbness and was taking care of very quickly. Dr. Ramon Riviera suggested I go to the hospital and he arranged everything for me even helping with contacting insurance and emergency room so there would be no waiting. Overall a great experience.

* Good facilities * Good equipments * Bad communication * Bad attention and follow up on the patient. * Really slow process in “emergency” area. * Bad management.

Sandinista Revolution Really??? still rich ladies came in where we where all waiting for more than two hours just because they knew the doctor and were rich where overpassing a pregnant lady this is a disgrace to the honor of the memory of our great hero that kicked out twice the US marines the revolution was useless there is no such thing like equality in my beloved Nicaragua

MY FRIEND RECENTLY VISITED THIS HOSPITAL AND HE STATES HE HAD A GREAT EXPERIENCE! EXCELENTE STAFF:) BUT MOSY IMPORTANTLY DR ALTAMIRANO WAS VERY PROFESSIONAL, HUMBLE & COMPASSIONATE . VERY KNOWLEDGEABLE EXPLAINED EVERYTHING DETAILED AND MADE SURE HE UNDERSTOOD, THAT SHOWED US HOW MUCH PASSION SHE HAS FOR HER JOB SHE IS THE BEST DOCTOR HIGHLY RECOMMEND ANYONE TO SEE DR ALTAMIRANO WISH I COULD LEAVE A 10 STAR FOR HER ⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️

EXCELLENT ATTENTION!!!!!

Expensive but, you get what you pay, cheaper than USA hospitals, around 70% cheaper, excellent doctors, recommended.

Omnilab opens 24hrs. All covid tests available.

Bad Service, the doctor didn't examine my girlfriend Anna properly, we paid 70€ and after two weeks she is still sick.

Extremely bad hospital. One people doesn’t understand what doing other.. Contract’s conditions always changing same with fraud. On the start they promise one but finally u will left money more more more that for same service in USA! Stupid management!!!

Very stupid international service!!! They change conditions more than 4 times before baby delivery!!! They want much more money but don’t understand self final conditions. Finally in last week we was need change hospital.

The place is old, but the people who serve are super friendly, they went overboard!!!

In general it is old, the elevators are bad, slow and it is super big, the facilities are a little poorly maintained, the elevators and in my case to access the arrhythmia secretariat you have to go with a map and counting the steps go up to 5 and then go down to 4 because there is a closed part of the hospital. But as excellent quality specialists and within everything they comply with everything. (There is very little availability of hours).

Terrible attention. This place needs better customer service.

My wife gave birth to our daughter here. Amazing staff on rotation. We were there for 3 night and had an amazing experience from the food, the quality of the rooms, and the experience in the staff that always made us feel that we were priority.

PCR test done very quickly, good hygiene results the next morning. Not crowded, almost no waiting time, but people smoking marijuana, literally 2 meters IN FRONT of the entrance of the respiratory emergency... there should be security at the gates.

I had the best experience with all the staff at hospital. Everyone was super friendly even though I didn't speak a word of Spanish. Even other patients helped me out with translating information to the staff.

Ok

Imagine being in a wheelchair, trying to get into urgent care for a surgery you had there, and not being helped about when you arrive, somehow managed to get into the triage and then be left alone, then get the need to use the bathroom at a place not clearly design to be used for people with mobility issues, then the only person available to help you is another patient passing by. It's such a shame that all of this happened here, where I have yet to get medical attention for my urgent needs.

One if the best hospitals in Cali. Modern, well staffed, good service

Ralf Stephani: In this hospital at the beginning of March, I was given great help in eliminating my hip pain. The team around Dr. Moore worked absolutely professionally with great success. Thanks, couldn't be better! May/ June 2023 After I received such great help on my right hip in March 2023 and I had an unshakeable trust in Dr. Jose Luis Moore Velasques, I asked him to operate on my left hip as soon as possible. Already on May 7th, 2023 I had an operation on my left hip because of unbearable pain. In several clinics I was told that 12 months should elapse between operations. Not so with the doctor I trust. Just 4 days later I flew back to Curacao pain-free. The painkillers were left untouched in the bedside table! Suddenly being able to walk pain-free again was Mr dr Jose Luis Moore Velasques to me. No helpers, no pitying looks, no pain! Being able to participate in normal life again was wonderful. My physiotherapist told me he had never seen such a professional surgical scar in his 20 years of experience. I would like to thank you again, Dr Jose Luis Moore Velasques and your team for starting my new life worth living I remain respect Her Ralf Stephani DANKE

Do not come here even if you think that your dying or have any serious medical problem, absolutely terrible care and attention takes 6-12 hours for them to even do simple blood test or any real examinations. Really there rating should BE honest and lower then where it currently is, also technologically speaking their WAY behind.

If you need immediate medical attention do not come here this is absolutely the worst hospital I've ever had to come, unfortunately, I almost died here from a heart attack and they did nothing to help me except treat me like a ragdoll. Absolute garbage attention and no care for the patients, I literally had to waddle my way out of that hospital as If this is a movie, I would give them ZERO STARS if I could, save uour time and go elsewhere.

Be aware of the medical assistant of Dr Dueñas ( third floor, big tower, " Jennifer"). She treats you wonderfully in front of the doctor, but when you ask for the results or extra important information at the reception or on the phone, she is the rudest. Staff needs to be trained in HOSPITALITY 101.

I see quite a bit of negative reviews which made me nervous going here, and I know it’s all subjective but I had a good experience. Although I do have international insurance so I’m sure that played a part. They got me in fast and the doctor was very friendly & helpful. She was gentle with my hurt shoulder and even offered pain meds in hospital although I declined. it may be a bit expensive in Peruvian standards but if you are coming from North America it is still a small fraction of what you would pay back home( just the X-rays alone in the US would have been significantly more than my total bill here) All in all not a bad experience at all just make sure you have cash or insurance because you pay at the time of visit not like in North America where you can do a payment plan

Simply THE WORST!!! I do not recommend this place at all, don’t even bother to call them because Janet (the secretary or receptionist) will transfer you or hang up. Don’t try to explain them why are you feeling sick because she will yawn and laugh at you. Bad bad experience!!!

I call and call, of the three phones, no one answers 📞 one needs to know about their relatives, visiting hours and other questions. They should improve this telephone information service

My elderly mother was hospitalized, and was very well attended and cared for, as well as her guardian being promptly informed of her condition. I am very grateful for the attention she received there, because they even made sure that due to her position she would not get more bedsores. I was really very afraid because I had two terrible experiences in other hospitals (Barros Luco, the worst, and another that is not even worth giving the name).

Super

Facilities are very clean, the staff is professional, and respectful! Best in the country. Also the food in the cafeteria is very good.

It is a expensive hospital, but it is worthy. My 1 year old baby was diagnosed with testiculo tumor, he needed to be operated ASAP. Now he is 100% out of danger. Thanks God and the doctors. Never felt more comfortable in a hospital.

I have been a patient at Vivian Pellas for over 9 years in that time I have had 4 surgeries and my wife had her hip replacement done there. My past experiences have been good up until a little over a year ago. Went in for what I thought was hemorrhoid surgery. According to all my papper work which I still have but instead I received a sphincterotomy and no hemorrhoid present at the time. Be carefull there! Still having ongoing problems as a result