Post-Myelogram Update

Justin · #1 (**permalink**) 02-15-2009, 05:24 AM

(Below is from the "Please post your myelogram experiences" thread and posted here for completeness)

Wow, I have to say I am overwhelmed with the support on this forum. To Everyone: thank you for your kind words and support.

I will finish my dose pack today. It has helped, but I am still having extreme pain in my lower back and legs. The pain is very distracting and makes functioning difficult (studying is a world of fun right now too!).

My Myelogram Results:

Well, my myelogram results demonstrate that there is a possible "smoking gun" to my symptoms. My entire patient profile (through Mark) has been updated and Dr. Bertagnoli will review it shortly (Dr. B and I decided to wait to review my case until my myelogram was done--it took me 8 freaking weeks of waiting after I scheduled my appointment to get the myelogram).

On preliminary review of the films, there is a substantial issue that will most definitely have to be addressed in one fashion or another. I will post a film shortly, so people can see what's going on--it's very evident even to the untrained eye.

Once again, God bless everyone for their support. I don't know any other way to put it, but I feel like I am slowly deteriorating--unfortunately, this is reminiscent of my time leading up to my ADR surgery.

____________________________________________

Well, I wanted to give everyone an update since I had my myelogram a couple of weeks ago. I think we have found the "smoking gun" to my bilateral leg pain.

Here's some background info that will help the films make sense: when I injured my spine snow skiing at 17 years old, I fractured the posterior aspect of my L4 vertebral body. As a result, it healed incorrectly (too well) and formed an "abnormal bony growth." Some surgeons thought it might be a contraindication to surgery at that level. However, Dr. Bertagnoli did not see it as an issue and we proceeded with the 2-level ADR surgery.

Now this is pure speculation on my end, but I believe that when I had my ProDiscs placed the osteo-integration of the artificial disc into the vertebrae caused the "abnormal bony growth" to increase in size as well.

As you can see from my films, this bony growth is pretty dramatic and looks to be causing all of my symptoms. I have not heard back from Drs. Bertagnoli and Fenk-Mayer, as they have only had my films since Wednesday. I am anxiously awaiting their reply regarding my myelogram--it should be interesting.

From my uninformed perspective, it looks like some sort of invasive intervention will be necessary at some point (if that is even a possibility considering the location and difficult access).

Well, I'll keep everyone posted. I'm doing much better a couple weeks out from my myelogram in terms of pain, but I am still on fentanyl, oxycodone, baclofen, and a couple others to keep things in check.

I'll update when I hear from Drs. Fenk-Mayer and Bertagnoli.

PS... look how beautiful the disc spaces are above the ProDiscs.

Terry Allen Blackburn · #2 (**permalink**) 02-15-2009, 05:03 PM

I sure hope this can be fixed Justin. I am very saddened by what has occurred for you. You have such a bright future ahead for you that, I have to believe that God won't let you remain in this condition. Elizabeth and I are going to continue to pray that this can be fixed and you will go back to being pain free.

All the best.

Terry Newton

phylly · #3 (**permalink**) 02-15-2009, 06:26 PM

Justin
I am so glad that at least you may have found out what needs to be done. I have been told to get several opinions before surgery. I am sorry that you are still in a lot of pain. The medrol pack can deceive you for awhile and gives you time to think but it does wear off. I hope you are able to get some great opinions soon. I know this is a busy time for you with school. Keep up your positive spirit.
Phylly

dshobbies · #4 (**permalink**) 02-15-2009, 07:20 PM

Justin,

I'm so sorry for your pain and suffering. It's easy to say but I know living with it has a profound impact on every aspect of your life.

Finding the cause must ease your mind some, but finding the cure will be second only to applying the cure.

I hope Dr.s B & FM come through and within a few months, the shorter the better, you'll be on the other side (again).

I hope you get what you're looking for, Dale

trkdoc714 · #5 (**permalink**) 02-15-2009, 08:17 PM

Justin,

I'm so sorry you still have to go through this new wrinkle in your battle. As much help and support you give others, you need to concentrate on Dr. J. I'm sure between you and your surgeon brainstorming, a (hopefully simple) procedure will permanently remove your pain.

Have you thought of having octuplets? It seems to have cured at least one lady's back pain. Ideas like this are the reason I wasn't accepted to any medical school. That and a diploma Ed's Refridgeration and Neurology School.

Seriously, my prayers and thoughts are with you,

Bob

Roblin · #6 (**permalink**) 02-15-2009, 09:40 PM

Justin,
I am so sorry to hear that it looks like something invasive will have to be done to take care of the pain issues. Please know that I care and will be praying for the right solution to fix the problem. Living with pain is definitely NOT COOL! I hope you find a quick and relatively easy solution. I am anxious to hear what Dr. B & F-M will have to say as I am sure you are even more anxious.
Hold on to your positive attitude!
Blessings,
Linda

New-disc · #7 (**permalink**) 02-15-2009, 11:51 PM

Justin,

Thank you for sharing your films with us. I was shocked to see what has happened to the bone above the disc replacement.

I'm praying that you can find a solution soon.

Please keep us all posted.

Todd

ans · #8 (**permalink**) 02-16-2009, 08:45 PM

Dr. J: I'm so sorry to hear this. Naturally, I have no idea what type of intervention(s) the doc(s) would do but you have my very best. Are you sure though that these aren't false teeth implanted? Allright, not funny..

Yours ~ Allan

Justin · #9 (**permalink**) 02-18-2009, 11:40 AM

Everyone: thanks for the support! My current situation is beyond frustrating, especially after being pain-free for the last 5 years.

I'll keep everyone posted.

Maria · #10 (**permalink**) 02-18-2009, 04:00 PM

Justin,
Looking at this from an entirely clinical perspective re more humanistic it's very interesting what could be contributing to your symptoms after being pain free for five years.

As the others I do hope there is something that can be done to alleviate the symptomology/problem and once again give you back a pain free life.

Thoughts/prayers/wishes for intervention that knocks out what's creating your symptoms and meanwhile the stamina to continue with the pain. Hope the meds are covering it adequately at least.

Justin · #11 (**permalink**) 02-22-2009, 03:44 PM

Drs. Bertagnoli and Fenk-Mayer were able to examine my case in which it took some time as per the "complex decisions" indicated by Dr. Fenk-Mayer.

Further surgery recommended:

Dorsal intervention with microsurgical decompression at uppermost ADR

Then augmentation with a Dynamic Stabilization System, DSS™ (pedicle-screw based, non-fusion technology)

Philosophy of the DSS™ // Features of the DSS™ // Indication for the DSS™

Now, the ball is in my court. I'm not sure how I am going to proceed at this point, as another surgery is not something I'm looking forward to but I can't keep living like this.

I'll post an update if/when I get close to a definitive decision.

Cindylou · #12 (**permalink**) 02-22-2009, 05:10 PM

Justin, I didn't see anything on how long the operation is, and how long the recovery is, on the information you provided. I'm so glad they took the time to really assess what your spinal needs are. Good luck during this time of deciding what you need to do. I know it's not easy, and none of us wants more surgery, but we certainly want our lives back. And deserve it. So, I will keep you in my prayers as you way the pros and cons of further surgery.

God Bless,

Cindylou

dshobbies · #13 (**permalink**) 02-22-2009, 06:50 PM

Justin,

I find it interesting that while most of us welcomed ADR surgery as the relief we long sought, even knowing in advance that a long recovery lay ahead with no guarantees, we are reluctant to jump that fence a second time.

I understand your hesitancy as well as the difficulty of your current pain situation. Your decision is not easy or definitive and you're living in never-never land with no easy way out. I so feel for you. I've no words of advise as I don't know what I would do.

Did you know that if he human race dies out, the next species projected to be dominant is the spider, an invertebrate!

I hate spiders, no I mean I really hate spiders, but maybe I'm just envious

I hope you find the solution you're looking for. It's bad enough to face these problems as you age but you're not even close yet. You are in my thoughts and I wish you well.

Dale

Terry Allen Blackburn · #14 (**permalink**) 02-23-2009, 12:42 AM

Justin:

At least you have an answer now, my friend, and a solution for your symptoms. How does this take the vertebrae off of the cord where it is compressing on the spinal cord itself? Did they give you any idea that this would allow you to live near pain free and, with all of your mobility? I would hope that they would have given you some kind of prognosis for your quality of life. I will pray for you and, will pray that this operation would be a success. I want my friend back in one piece.

You take care of yourself and let us support you in this difficult time and, through this difficult decision.

Your Friend,

Terry Newton

Kathy · #15 (**permalink**) 02-23-2009, 12:55 AM

Justin,
I am so sorry you are facing another surgery. I know that it is not a decision any of us want to have to make. Will your insurance cover this surgery? Or will you have to foot the bill? This is the last thing we should have to worry about; but unfortunately is still, for now, something we have to worry about. I will be praying for you and your wife as you decide the best treatment option for you.
God Bless,
Kathy

sahuaro · #16 (**permalink**) 02-23-2009, 02:27 AM

Justin:
I hope the proposed surgery provides the relief you need but I am so sorry you are facing another surgery at all. I've been following your posts with anxiety--one year out of ADR and feeling good, I still walk around with anxiety that something will happen to ruin it.

ans · #17 (**permalink**) 02-23-2009, 12:19 PM

Justin, I'm sorry to hear that you'll be "under the knife" again. You were doing so well! I wish you well and hope you can spend many moons eating Toucan under the tropical sun.

Bayla: I"m sure everyone w/an ADR wonders "what if". But thankfully, you've been doing great.

My best ~ Allan

Gil Denis · #18 (**permalink**) 02-23-2009, 05:15 PM

Hi Justin
It`s great to find a possible solution to relive your pain and move on. I understand that sticking a knife in your back is no fun

I`ll be think of you, just keep moving forward

Best Wishes

Gil

Roblin · #19 (**permalink**) 02-23-2009, 05:19 PM

Justin,
I am so sorry to hear the latest news. I will be praying for you to make the best decision possible. I am just so sorry.
Best wishes,
Linda

treefrog · #20 (**permalink**) 02-23-2009, 07:11 PM

I am sorry too, that it looks inevitable that you will need to have surgery again. It is a very difficult decision, and I wish you the best as you consider what to do.

Maria · #21 (**permalink**) 02-23-2009, 09:07 PM

Justin,
Putting myself in your shoes at your age doing what you're doing I honestly think I'd be off to surgery as soon as I could feasibly arrange it even if that was sometime within the following year.

There are times I'm very sorry I've put off surgery so long that I have habituated to the pain meds well enough for pain relief but so much so that I have allowed my body to worsen in terms of spinal condition (mostly speaking about osteoporosis here tho I'm sure there's more degeneration going on) and probably blown my chances for surgery at this date in this country.

Ahhh.. hindsight. Whatta thing.

Anyway, re your case I can understand the feelings of not wanting more surgery tho also realizing the impact the pain/condition has on your life now in all realms of being.

Wishing you the best and knowing you'll make the right choice for you~ Maria

fuzzy · #22 (**permalink**) 02-24-2009, 04:57 AM

Thank you for sharing your experience, Justin, all the way from the myleogram to the current prognosis. When I saw your scan I felt it would have to be come kind of dorsal decomp short of removing the ADR. I am interested to know the reason for the DSS. Does the ProSpine team believe that you have too much motion going on at that level, or does the need to have the DSS have to do with the decompression procedure?

I really do wish you the best in getting good care which I am sure you will get from the ProSpine team.

johnb · #23 (**permalink**) 02-25-2009, 01:50 AM

I too was wondering the logic behind the addition of the DSS. From the CT scan and subsequent explanation from your previous post, it seems apparent that some sort of decompression would be in order. If you don't mind elaborating, what is the logic behind the adding of more hardware to your spine? I understand that extensive decompressions can lead to instability and a PDS device can be used to offset this potential result. Is this the case here?

mmglobal · #24 (**permalink**) 02-25-2009, 08:16 PM

Later, I'll expand on this post and create a separate thread for 'posterior stabilization behind ADR'. I'll respond briefly now. This post is not specific about Justin's case, it's just a discussion of (my laypersons understanding) of the theory behind this sort of revision surgery.

My experience with this goes back 5 years as I've had 3 clients with Dynesys implanted behind ADR (2 Charite, one ProDisc). I've also been fortunate enough to attend the surgeons training for DSS and have observed many procedures involving DSS, Dynesys, Coflex and other posterior stabilization systems. I've also literally hundreds of sessions at the conferences on various posterior stabilization systems.

It should be kept in mind that when you get to revision surgeries, EVERY ONE IS DIFFERENT! Dynesys implanted behind prodisc that was done in spite of a pars defect has no relationship to Carmont's Dynesys implanted behind horribly tilted 2-level Charite that was a problem because of terrible placement by a less than careful surgeon, which has no relationship to Justin's anomalous bone defect behind a nicely implanted ProDisc.

I've successful and unsuccessful stabilization attempts. NONE were in cases even remotely similar to Justin's.

DSS is quite a bit different than Dynesys. A very important feature is the modular design that allows easy conversion of a dynamic segment to a fused segment, reusing the pedicle screws and associated hardware, simply swapping out the dynamic coupler with a fusion coupler.

DSS implantation with a modified Wiltse approach (developed by Bertagnoli) allows for a very low invasive surgery using muscle splitting techniques (separating the muscles along fascia layers) instead of more traumatic cutting of the great muscles in your back. It' very impressive when contrasted to the more invasive techniques.

DSS is solid hardware. The motion coupler has a calibrated, springlike motion segment that allows continued motion, while restricting it within a 'neutral zone'. Your pain and problem likely occur when you move out to extremes in your range of motion. Offloading the facets by restoring appropriate spacing in the posterior elements and allowing continued motion while restricting to a neutral zone, allows us to have motion preserved, while protecting the system with the additional support from the DSS hardware.

This additional support while restricting the range of motion to the neutral zone gives the surgeon license to do a wider decompression than she might have been comfortable doing in a patient without the extra support of the 'posterior stabilization' hardware. Without it, if they remove too much, they destabilize too much.

Justin's films are quite dramatic. Note that the axial slice (top right in original post starting this thread) is NOT a slice that reflects the biggest part of the defect. It's the lowest slice before the artifact from the prosthesis obliterates the image. A lower slice will reflect an even bigger defect. The reference line from the image on the left shows where the slice is... all the way to the edge of the keel.

I hope Justin will explain more about the origin of the defect. Is it related to the ADR or is it something unique in his history?

Again... more later in a different thread.

All the best,

Mark

Justin · #25 (**permalink**) 02-26-2009, 06:35 AM

Hey Everyone,

I will reply tomorrow to address all of the questions about the procedure (including Mark's below).

I had my 2nd surgery in the last 4 months today (NOT spine related), so I'll try to post at some point tomorrow.

Quote:

Originally Posted by mmglobal

I hope Justin will explain more about the origin of the defect. Is it related to the ADR or is it something unique in his history?

Mark

Liz · #26 (**permalink**) 02-26-2009, 09:10 PM

hi justin,

i hope your recent surgeries were successful... are you having fun yet?

i'm so sorry... i know you were hoping to sneak through w/just the decompression.

now that you've hopefully gone through some scream therapy, what do you think? your L4-5 Prodisc appears to go off its axis a little in flexion, right? Does Dr. B think this will become more unstable after the decompression? Or is it sliding off it's axis b/c of the bone abnormality and it could go back to "normal" w/just the decompression? i know that if/when i undergo a decompression i've been advised by a few docs that i have to stabilize the segment, but your case is also very different from mine.

there's not a lot of info on DSS, but i think this article explains it fairly well, as well as its theoretical improvements over the Dynesys --

Neurosurgical Instruments - DSS

my understanding is that the DSS is less invasive than the Dynesys like Mark explained, still any op involving pedicle screws is not trivial. You will lose some mobility in all directions, but not as much as a fusion.

There are surgeons in the US that are using the fusion version of the DSS, they just can't use the dynamic coupler. Still, if a surgeon that was trained to use DSS is located close to you it might be worth picking their brain, even if you have the surgery w/Dr. B.

as you probably know the Dynesys is the only FDA approved PDS; the others have been upheld for a variety of reasons.

let me know if i can help.
best,
Liz

ps... anyone else notice something unique about Justin's Prodiscs? or am i seeing things?

mmglobal · #27 (**permalink**) 02-26-2009, 09:45 PM

Liz, you have a pretty keen eye. Not many spine surgeon's I've seen would recognize this. You can see that the upper and lower prostheses are mirror images, making the lower level 'upside down'. This configuration is intentional and provides some mechanical advantage, typically at L5-S1 (L5-L6 in this case) when the lower endplate is not parallel to the floor.

Liz · #28 (**permalink**) 02-26-2009, 09:58 PM

thanks, that's what i thought, i just didn't want to give it away! i've heard Dr. B does that sometimes. Does having it upside down increase wear particles? Also, can you elaborate on the mechanical advantages of this?

mmglobal · #29 (**permalink**) 02-27-2009, 12:54 AM

I'm going to explain what I think the theory is. I am not an engineer. I may be all wet. I can't engage in a discussion about this, I can just pass on what I think I understand.

ProDisc comes with lordotic angles, 6 and 11 degrees. The lower plate that the core snaps in to is flat. The upper plate has the angle. The purpose of the angle is to bring the plates of the prosthesis near parallel.

With the angled plate being the top one, that configuration effectively brings the surface of the upper plate closer to parallel to the lower plate. If the lower endplate is parallel to the floor and the the upper plate is parallel to the lower plate, the ball and socket will have zero sheer force acting upon it (from the pull of gravity... you can load in other ways.) If the upper endplate of the vertebral body is not parallel to the floor, then there will be sheer force acting upon the ball and socket. If you flip the disc, instead of the angled plate bringing the upper plate parallel to the lower plate; the angled plate below will bring the lower plate of the prosthesis closer to parallel to the floor. (Clear as mud?)

It makes sense, but there is a trade-off. I believe that the flipped configuration MAY increase the likelyhood of migration of the lower plate as the sheer force doesn't just disappear. It is reduced on the ball, but I believe it still exists or may even be increased on the lower plate. IMHO, migration used to be a more serious consideration before they got good at sizing, placement and before we had the coated plates. IMHO, while the trade-off needed to be resolved in terms of less risk of migration in the early days of ProDisc, improvements made it more reasonable to work the trade-off towards less sheer force on the actual joint instead of on the bone-metal interface. This should result in less significant wear.

Again... I may be all wet here and may have this completely wrong. Take this for what it's worth... just my layperson's opinion.

Mark

trkdoc714 · #30 (**permalink**) 02-27-2009, 01:41 AM

That was a great explanation Mark. That's actually why I'm not considering any disc with polyurethane inserts. At my age (52) my spine will degrade naturally over time. All of the angles will be altered even if only slightly. The poly cores will not react well to that I fear.

That is one of the properties that makes the Maverick more appealing to me. With a single alloy used in both inferior and superior components, sheer wear is nearly non-existent. If only they offered a zerk fitting for lubrication.......

I had actually emailed Justin when I saw the inverted plate. Thanks for clearing up the mystery of the symetrical endplates.

Bob

johnb · #31 (**permalink**) 02-27-2009, 02:02 AM

I believe if I'd had the DSS and a better diagnosed and addressed decompression procedure, I'd be singing a different and better tune right now. There are many differences between the DSS and the Dynesys. A very important one is the fact that the dynesys is rigid in flexion which is big negative when you think about the implications. IMHO, that affected my situation with low disc height in a very negative manner. I'm 4 months out from removal and I need to update my thread. Mark, I've since read some even newer research on the dynesys and I'd be more than happy to contribute to your PDS discussion. A recent study shows that the dynesys does not slow disc disease and contributes to adjacent disc disease as well. My surgeon confirmed the latter part about the adjacent disc desease as he has seen it in some of his patients where he extended the dynesys. I'll gather up my links an update my progress and my thread as my own case may be of some help to others.

I want to thank Justin for sharing his situation with us so we can all learn and become more empowered regarding our own situations.

mmglobal · #32 (**permalink**) 02-27-2009, 02:28 AM

Bob, we all have to pick what we are afraid of. See the video of me playing tennis with Charite' pt. number 1 from 1984, before they new about oxidation, sterilization, packaging issues with poly, sizing, placement, etc.... Why would you be more afraid of poly wear as related to sheer force than metal ions? We reduce the risk of wear being an issue by getting a proper installation. For me, revisability is more of an issue than wear. Explanting a Maverick at L4-5 is much more difficult than a poly core device. Having said all that, I believe that properly implanted in a properly selected patient, they will all work fine. Avoiding improper implantation is the key to success.

John, rigidity in flexion depends on the tensioning of the cord. Extension limits depend on the size and retained rigidity of the spacer. Not all are fixed.

Dynesys results vary so greatly from one surgeon to the next. Some surgeons report 25% screw breakage/loosening, while others report zero or close to zero. Application of Dynesys for varying inidications has also been all over the place. I look forward to your update... I hope it's good.

I agree... thanks to Justin... this gives us an opportunity to learn a ton.

Mark

treefrog · #33 (**permalink**) 02-27-2009, 06:43 PM

Quote:

Originally Posted by mmglobal

Avoiding improper implantation is the key to success.

I agree... thanks to Justin... this gives us an opportunity to learn a ton.

Mark

Which is why I want to have Dr. B's opinion (and probably surgeon) on my back. I believe he, better than almost anyone else, will be able to tell me if and what type of surgery is best for me.

I don't know if Justin is too thrilled to be the subject of our learning opportunity though.

Justin · #34 (**permalink**) 03-05-2009, 04:18 PM

Before my hiatus on the forum, I wanted to give everyone an update as to not leave you guys hanging.

About the Surgery: the DSS technology looks very promising to me. From the publications I've read about the system in biomechanic journals, the studies look good and the DSS is accomplishing what it is intended to do (decrease unnatural flexion and extension of the spine). This device looks like it will work well in concert with my 2-level ADR. I know it hasn't been studied extensively, but the DSS design is based on -- unfortunately -- the failures of stabilization devices that are "too rigid" such as the Dynesys (sorry for everything you been through John). A plus in theory to this device is the relatively easy conversion to a "traditional" fusion (the dynamic coupler that is attached to the two screws would just be swapped out).

The surgery would last about 2 hours with ~3-6 day hospital stay. Cost around $26k.

Goal of the Surgery: to remove as much as the osteophyte as possible given difficult access and stabilize the spine minimizing the L4 anterolisthesis. This would relieve the compression on the cauda equina and nerve roots--hopefully reducing/eliminating my bilateral leg pain.

Surgery Date: the surgery is elective. This means the limiting factors are how much pain I can endure and if there are any signs of paralysis.

Recovery / Prognosis: Drs. Fenk-Mayer and Bertagnoli could not give me a definitive on this, which is completely understandable regarding my past surgical history, etc. Dr. F-M did say that I would be able to "take longer walks around the 3 week mark."

The Positives: I had a cervical MRI that came back clean before the new year and the rest of my lumbar spine looks really good. Most of my back problems have been the result of trauma, not widespread "genetic DDD."

$26k is a lot for a poor, extremely in debt student.

Kathy · #35 (**permalink**) 03-05-2009, 05:42 PM

Quote:

Originally Posted by Dr. J

not widespread "genetic DDD."

$26k is a lot for a poor, extremely in debt student.

Sounds like good and bad news. The good obviously being that you are 'fixable' and the bad being the cost! I have no idea how anyone affords to pay out of pocket. I would have, it there was anyway I could have done it. We already have a 2nd mortgage, so that wasn't an option. And we are just paying off my husband's college loans (he's 37, so that took some time). And we don't have any retirement, because we decided to get out of debt and then save like crazy (which with the stock market the way it is, I'm glad we didn't have crap to lose). The good news is, we are almost debt free! Although, I did have to put our trip to Miami on a credit card; but I'm not going to miss the opportunity for surgery, and a trip is a small cost for ADR.
Anyhow, enough of my money issues, or lack of

I hope you can find a way to get this surgery. I pray that Obama can make stuff happen with our healthcare system and get where we can get affordable, quality, timely healthcare.

Roblin · #36 (**permalink**) 03-05-2009, 09:00 PM

Best wishes Justin with all the decisions you will be making and coming up with the extra bucks. I hope this completely resolves all the bilateral leg pain issues for you.
Bless you abundantly,
Linda

Terry Allen Blackburn · #37 (**permalink**) 03-06-2009, 02:58 AM

I sure hope and pray that this surgery can take place for you Justin. You are owed a decent life for all of the good that you have done for others. I know that life can be unfair though I choose to be optimistic here that something will come through. Maybe Dr. B can do a courtesy surgery for all that you have given him in the past and, the future referrals that he can gain from you when you get out and practice medicine.

You hang in there my friend.

Terry Newton

runner · #38 (**permalink**) 03-06-2009, 08:37 AM

Justin,

Good luck. You have found out what is wrong, now it just has to be fixed. It's not that easy but I am sure you will find a way.
Sounds like you are in good hands.
We never know what life is going to throw at us and I truly believe things happen for a reason and who knows what this reason is but I hope soon that you will get rid of the leg pain.
I will be praying for you and a successful outcome.
Don't get too stressed out (remember doctors need to be cool under pressure).

Take care,

Runner

phylly · #39 (**permalink**) 03-06-2009, 06:23 PM

Justin,
I have good feelings with all the research you have done that this surgery will help you. Finding money when you are so in debt is huge and I hope you are able to find a way for this. Quality of life is so important. I want to see you out of pain. You have been so helpful to everyone on the forum. Is there any way your insurance will pay for out of the country surgery? I wish you the best and I will continue to send goo thoughts your way for a successful outcome.
Phyllis

Justin · #40 (**permalink**) 03-29-2009, 09:36 PM

Well, I haven't been on the forum all that much, but I wanted to give everyone an update.

Over the last 2 weeks, I have been going down hill rapidly. My meds are no longer cutting it, even with increased doses. I've been getting a deep tissue massage once every 2 weeks just to help me study, which has been an absolute delight. (The studying that is

)

I'm going to need surgery soon. Money is the main obstacle--I should "join the club," right?

Anyway, I'll keep everyone posted as I have a feeling that things are going to move real fast sooner than later. Thanks for the continued support--it is most appreciated.

Justin · #41 (**permalink**) 03-29-2009, 09:55 PM

I forgot to mention that I heard from Dr. Fenk-Mayer about how many of the DSS-"motion" devices Dr. B has implanted.

30 DSS-"motion" patients // only 5 patients with preexisting ADR(s)

I'll be in an elite club.

However, I have all the confidence in the world in Drs. Bertagnoli and Fenk-Mayer.

(DSS-"motion" = the DSS device with the coupler that allows motion [not FDA approved]. The "regular" DSS [without the coupler] is actually used in the US as a traditional fusion device)

Roblin · #42 (**permalink**) 03-29-2009, 10:19 PM

Justin,
I am so sorry to hear things are going downhill for you rapidly and you aren't even on skis. I can imagine it is extremely hard to study with the pain and all. I remember the last semester I was in rad school and trying to study with 2 patches on. It was no fun at all. I hope you get fixed up real soon so you can get back to the program with all of your mind not just part of it.
Hugs to you,(gentle, of course)
Linda

dshobbies · #43 (**permalink**) 03-29-2009, 11:23 PM

Justin,

They say misery loves company but from my experience the opposite is true. Those of us who have suffered wants the entire world to be pain free. Your pain is our pain and the sooner you get 'fixed', the better we'll all feel. Here's hoping it's sooner rather than later.

All my best to you, Dale

Rosy · #44 (**permalink**) 03-30-2009, 12:03 AM

Justin, I have PM you. Please check.

phylly · #45 (**permalink**) 03-30-2009, 02:58 AM

Justin
Are the patients with ADR's doing okay with the the DSS? Are you able to talk with any of them. Dr. B sounds spectacular and we want you to be spectacular also! I am sorry you are in so much pain and I hope that you will get relief soon.
Phylly

Justin · #46 (**permalink**) 03-30-2009, 03:09 AM

Hi Phylly,

I just hopped on the forum. Thanks for your kind words. Well, out of the 5 DSS/ADR combos only 1 patient is from the US and speaks English. Unfortunately, my situation is significantly different from this patient as well.

There is limited data on the DSS with the dynamic coupler, but I do know there are a few clinics that are using it around the world (Dr. Bertagnoli [Germany], Dr. Pimenta [Brazil] to name the few I know).

I hope you are recovering well...we need to catch up via email, as it's been a while.

Quote:

Originally Posted by phylly

Justin
Are the patients with ADR's doing okay with the the DSS? Are you able to talk with any of them. Dr. B sounds spectacular and we want you to be spectacular also! I am sorry you are in so much pain and I hope that you will get relief soon.
Phylly

Kathy · #47 (**permalink**) 03-30-2009, 05:26 AM

Justin,
That sucks that you are going downhill so fast. I know you have faith and that is the best thing you can have. I know without faith I would never have made it to this point. I know you will do your research and pick what is the best treatment for you with the best dr for you. I will pray for God to guide you to great information, to the right treatment for you and for him to open or close doors that will take you to the right place. It won't be long and you will be feeling good and wishing you had done the surgery sooner! God Bless and I am praying for you.
In Him,
Kathy

Justin · #48 (**permalink**) 03-30-2009, 11:53 AM

Dale, Linda and Kathy: thanks for your support.

It's really amazing that as spine patients we (well, most of us) get to the point where we are wishing to have surgery--it's like winning the lottery for us.

God bless.

Cindylou · #49 (**permalink**) 03-30-2009, 01:28 PM

Justin, I am so sorry for this rapid decline you are experiencing. And Dale is so right. We want the whole world to be pain free, especially the ones we love. That would be YOU! I hope you get on Dr. B's surgery docket asap. You have got a lot of living in front of you, and it's waiting for you to embrace. Please keep us posted. I am worried about you.

God Bless you,

Cindylou

Maria · #50 (**permalink**) 03-30-2009, 04:31 PM

Hey Justin,
what you said about wishing to have surgery is like winning the lotto.. been there (even done that tho not recently)..

My wish for you of course is like others that whatever is done is going to be whatever you need and will make you pain free and as functional as possible which of course I would hope would be *wildly so*!!!

Good luck and interesting stuff~ Please continue to update and keep us posted.

treefrog · #51 (**permalink**) 03-30-2009, 08:20 PM

I too am sorry that things have gone downhill so quickly for you Justin. I hope you are able to have surgery soon. Just as I am hoping I can have surgery soon too.

If you find out anything about medical loans that can be used for overseas surgery, please, please let me know.

Wishing for the best for you.

Justin · #52 (**permalink**) 03-31-2009, 08:30 PM

Thanks again for the support. Well I saw Dr. Balderston today at Pennsylvania Hospital.

He said I really need to pursue surgery ASAP and said if it was his back or his brother's that he would definitely have Dr. Bertagnoli do it. We talked about the upcoming Spine Arthroplasty Society meeting at the end of April in London. He will be presenting a few abstracts.

I also saw my pain management doc this morning and he increased all of my pain medications. He even doubled the strength of my fentanyl patch. Uggh.

I'll keep everyone posted... it looks like surgery is around the corner.

Kathy · #53 (**permalink**) 03-31-2009, 11:46 PM

Justin,
I am sorry that you have to go through more surgery. I know you have done your homework and have found the best surgery and best surgeon for you. Sounds like you are in great hands. I know that God will open a door for this to happen, if it is His will. I will be praying that you will soon be on the road to pain free days.

Justin · #54 (**permalink**) 04-05-2009, 05:31 AM

Quote:

Originally Posted by Kathy Earhart

Justin,
I am sorry that you have to go through more surgery. I know you have done your homework and have found the best surgery and best surgeon for you. Sounds like you are in great hands. I know that God will open a door for this to happen, if it is His will. I will be praying that you will soon be on the road to pain free days.

Thanks Kathy. I'm finalizing everything on Monday hopefully. I have some exciting news that I'll share with the forum when it's confirmed the first part of next week.

Cindylou · #55 (**permalink**) 04-05-2009, 05:12 PM

Justin, are you looking at just days ahead for your surgery?? Only if you have the time, could you explain to me in "very layman terms" just exactly what happened? Some of the other stuff presented was over my head, but I really want to understand what has been happening with your spine. And how, what Dr. B is going to perform, will correct things. Again, only if you have time. I know your schedule is crazy and pain levels are high. I am relieved that your pain meds were upped, at least for the time being. I do so worry about you Justin, and join Kathy in praying that pain free days are around the corner for you soon. When you get to the other side of all of this, you will be one helluva doctor!! No patient of yours will ever be able to say, "Dr. J just doesn't get pain." Amen to that brother.

Many hugs to you,

Cindylou (ps: do tell, do tell of the exciting news!)

SandyW · #56 (**permalink**) 04-05-2009, 05:57 PM

Justin,

Somehow I missed your continuing thread. Am so sorry to hear of the pain and the possible upcoming surgery.

Read all the links supplied in the thread and even though Dr. B's and Dr. F-M's solution is fairly new, it sounds like an excellent (and maybe the only) way to go. Surgery or pain.

Just returned a message to Dr. F-M and added "may God bless all at Pro-Spine during surgery of "Justin" and "Mark" assuming she will know who I mean! at least God will know!! I am positive that you are both in great hands and amazed at the great work these doctors do.

Thoughts and prayers are with you in the next days and weeks. Sandy Wade

phylly · #57 (**permalink**) 04-05-2009, 08:09 PM

Justin,
I continue to have you in my thoughts and wish you well with the upcoming surgery. I'll look forward to any new info you post. Will you overlap with Mark?
Phylly

Justin · #58 (**permalink**) 04-05-2009, 08:47 PM

I just received an email from Dr. Fenk-Mayer. Dr. Bertagnoli is taking time during the month of April for a private vacation (rare) and he will also be tied up the last week of April at the Spine Arthroplasty Society meeting in London.

My surgery will be on May 14th. I wish it was sooner, but this allows me to get some things straightened out on my end ($$ among other things) before I'm back on the operating table.

CL, I reply to your questions soon...I gotta run as my pain meds are making me feel extremely nauseous right now...

Maria · #59 (**permalink**) 04-06-2009, 01:11 AM

Sounds good to me in terms of having time to tie up loose ends and get it together.

It sounds good to have surgery *after* Dr.B's vacation vs. before it. That's actually one of my questions that I ask when thinking of having surgery with someone if it's of major magintude.

Anyway~ Yipppeee Justin! You're on your way or at least the path that sets you on your way!

melodyl · #60 (**permalink**) 04-06-2009, 01:31 AM

You have been so helpful to everyone on this site! I'm glad to hear you have a surgery date with Dr. B. May will be here before you know it! You (and Terry) know much more than most of us about pain and medications.....hopefully you and your dr. will be able to control most of your pain without too many side effects until the problem is fixed. You mentioned that your fentanyl dose was doubled? I was on high doses of fentanyl.....it was fairly effective at controlling my pain..... but feeling fuzzy headed with fatigue and loss of appetite were a high price to pay. Please keep everyone here updated......we all care about you and your health. Obviously impossible.....but wouldn't it be nice if all of us spine patients lived close enough to each other to provide personal support to each other? I wish I could send you some homemade chicken soup right now! Speaking of soup and appetite.....for any of you dealing with nausea or loss of appetite......I found a new product "Muscle Milk Protein Shakes".....you can get them by the case at Costco. Pretty tasty for a pre made liquid meal (1000 x better than Ensure) and it has 20 grams of protein which is sometimes hard to get enough of if you don't feel like eating. Healing hugs to you. We will all be looking forward to your recovery. Melody

dshobbies · #61 (**permalink**) 04-06-2009, 02:44 AM

Justin,

Having a date one month out is better than not having a date at all. It will go by very fast, except for the pain and all that goes with it. Until then and even after, take care of yourself.

Hey look, another 5 minutes. Time's just sailing by

Dale

Justin · #62 (**permalink**) 04-06-2009, 03:10 AM

Quote:

Originally Posted by Cindylou

Justin, are you looking at just days ahead for your surgery??

I'm now going to have surgery on 5.14.09.

Only if you have the time, could you explain to me in "very layman terms" just exactly what happened?

To be honest, no one is 100% sure what happened. However, we are all in agreement that when I fractured the L4 vertebral body of my spine during my skiing accident in 1997 that the fracture healed incorrectly. In an attempt to "heal" the fracture, new bone was laid down in this area. This abnormal overgrowth of bone is called an osteophyte, or spondylophyte. Osteophytes are frequently seen in patients with Degenerative Disc Disease (DDD), as they are the body's attempt to help stabilize the spine seen during the degenerative cascade.

The osteophyte that is seen in my case was the direct result of trauma in which the area healed "too well." The interesting thing--I guess, unfortunate for me --is that this abnormal bony growth on my vertebral body is directly compromising the space in my spinal canal. Thus, the spinal cord, which is called the cauda equina at this lumbar level L4, is severely compressed due to this osteophyte--it's as if the cauda equina is being strangled by the overgrowth of bone.

In most cases, severe impingement of the cauda equina is seen following trauma, malignancy or substantial disc prolapse leading to one of the most feared complications in this area of the lumbar spine called cauda equina syndrome:

Quote:

Originally Posted by emedicine.com

Cauda equina syndrome (CES) has been defined as low back pain, unilateral or usually bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss usually due to mechanical compression of the cauda. Though the lesion is technically to nerve roots and represents a "peripheral" nerve injury, damage may be irreversible and CES may be a surgical emergency.

Luckily, I do not have any bowel or bladder issues and my symptoms did not present suddenly/acutely--these criteria would have required immediate surgical decompression of the impingement. These patients have a window of time in which to be treated in an effort to avoid the possiblity of permanent neurological deficits (bowel/bladder issues) and/or paralysis.

Some of the other stuff presented was over my head, but I really want to understand what has been happening with your spine. And how, what Dr. B is going to perform, will correct things.

Dr. Bertagnoli is going to "decompress" this area of abnormal bony growth through a posterior approach. It is a minimally invasive procedure and the technique used is muscle-sparing and only requires finger dissection of paravertebral muscles. In all honesty, this decompression is going to be very technically challenging. It is understood that Dr. Bertagnoli will probably not be able to remove the entire osteophyte. However, he will be able to remove a significant amount freeing the cauda equina of impingement (and hopefully freeing me of chronic, debilitating pain! )

The wide decompression required will inherently destabilize my spine, so Dr. Bertagnoli is going to place the Dynamic Stabilization System with the non-fusion coupler (DSS-"motion") behind my 2-level ADR. The DSS-"motion" will work in concert with my ADRs: it will continue to allow motion of my spine while providing much needed stability after decompression. The DSS-"motion" also helps eliminate/minimize unnatural flexion and extension.

Artificial discs are truly only "partial disc replacements." Thus, with the DSS behind my artificial discs it will create a "complete disc replacement." I'd be happy to explain what I mean at a later date.

Again, only if you have time. I know your schedule is crazy and pain levels are high. I am relieved that your pain meds were upped, at least for the time being. I do so worry about you Justin, and join Kathy in praying that pain free days are around the corner for you soon.

Thanks for caring about me. It's been extremely draining lately--an emotional roller coaster. The worst part is the uncertainty of my future health. Let's be honest here...I'll be 30 years old in November and this will be my 3rd spine surgery. When I was at Dr. Balderston's office the other day, I was by far the youngest spine patient in the room. This has been a constant in my life, as I've been sitting in waiting rooms regarding my spine since I was 14 years old.

When you get to the other side of all of this, you will be one helluva doctor!! No patient of yours will ever be able to say, "Dr. J just doesn't get pain." Amen to that brother.

Thank you so very much for your kind words. I've always had to work twice as hard as my peers, as I've suffered with chronic pain the greater part of the last 15 years. I will admit it has been a challenge and I've often asked "why me?" but I have to say it has shaped me as a person and will hopefully serve me well during my career. Even though my future spinal health is uncertain and this surgery has no guarantees, I do know that I will keep rolling with the punches.
Many hugs to you,

Cindylou (ps: do tell, do tell of the exciting news!)

About the exciting news: Hopefully, I'll be able to inform everyone sometime this week...I thought it would be much sooner, so we'll see.

Justin · #63 (**permalink**) 04-06-2009, 03:21 AM

Maria, Melodyl and Dale: thanks for your posts.

Maria, I agree about seeing Dr. B after his vacation and SAS. The man is a machine and deserves time off with his family. At least I have a date...I'm so blessed even to have a date with Dr. B.

Melodyl, I can send you my address...that chicken soup sounds good right about now! Ummm... The fentanyl has been a life saver, but the increased dose has been messing with me lately. I've been getting extreme waves of nausea. I'm sure it will pass with time.

Dale, keep that clock a movin'.

Now, all I have to figure out is when I'm going to take my Medical Boards...I was to sit for it on 5/14.

johnb · #64 (**permalink**) 04-06-2009, 08:12 AM

Justin,

Like many on this forum, I've followed your progress. There is one circumstance to your condition that I can truly empathize with and that is age. My DDD was diagnosed at age 24 after 5 years of pain. I can't tell you how many times someone has told me that I'm too young etc and it was even more frustrating when I was looked at with skepticism i,e., malingerer. I had a real tough time from a psychological standpoint in years past but have overcome that now. I guess my point is the we often measure ourselves against our age related peers and I get that. It's something that others will not fully understand unless they have experienced it. Spine problems are tough at any age, but they pose an extra set of challenges if they happen early in life.

John

runner · #65 (**permalink**) 04-06-2009, 09:53 AM

Justin,

You really couldn't have gotten a more complicated spine problem. I believe doctors and nurses make the worse patients.

You are only a month out from surgery and i am sure the time will go quickly as you are busy. It is good that the doc raised your pain meds. Despite what they say about opoids and pain meds, I don't know how we could function without them. I react strongly with the pain meds too and was really nauseous after I first took percocet and then it gradually dissipated.
I think pain meds can be a godsend as I don't think it is good for people to live in pain.

As for going through this, it WILL make you a better doctor, make you have more empathy for your patients. I think my problems have made me a better nurse and person but I could have escaped the drama and the pain.
Now, I have to deal with a perfectly good MRI and all these back and leg symptoms. I keep wondering what the heck is going on?

At least now, you have your answers and Dr. B has a plan of attack. I mean that is half the battle. The rest will be with you, healing after surgery. Think of it this way, you are young and relatively healthy and you should heal quickly. Dr. B seems to be the best doc in the world for spines so you will be in good hands.

Try not to worry too much and here's to a complication-free surgery and a good recovery. (cheers)

Kim

ans · #66 (**permalink**) 04-06-2009, 09:55 AM

Hi Dr. J,

Not here much but got the rundown. Am so sorry you have to go through this ordeal - especially dealing w/potentially incipient CES. You have done complete research and I hope that this w/be your last & successful one. My best Doc - Allan

Terry Allen Blackburn · #67 (**permalink**) 04-06-2009, 03:25 PM

Justin:

Your surgery sounds amazing couldn't take place with a less competent surgeon. You will be going to one of the best in the world so your results should be great. The DSS sounds like a system that should be put in place with all ADR's. I wonder if facet issues could not be avoided, if was utilized with ADR recipients, to provide better stabilization of the spinal column.

As far as being young, I can relate. I started rupturing discs in my 20's and have been on a downhill slide ever since. My first spinal injury was when I was 14. I was walking backwards to get an extremely large kite in the air. They had no gate covering a concrete culvert and I fell backwards, over the ledge, 15 ft. to the concrete below. I landed smack on my coccyx and shoved it upwards. It's been a thrill a minute since.

But, I am now approaching old age and still worry that I may not be done with surgeries on the spine so, I have to really take it one day at a time. I am extremely grateful for what I have today and that I can still walk.

You've become a good friend Justin and I think the world of you. Elizabeth and I pray that all will be okay and you will be able to resume your studies shortly to be the best physician that you will become. It's great to have a surgery date lined up and this will give you an opportunity to get everything all lined up.

Here's to better days ahead Justin.

Terry Newton

Gil Denis · #68 (**permalink**) 04-06-2009, 03:59 PM

Hi Justin

Just getting caught up on your progress i am looking forward to hear how you pain level is removed .I wish you the best and you will be in my prayers.

Thanks for your help in the past and wish I could help you.

Be strong its almost over

Gil

Roblin · #69 (**permalink**) 04-06-2009, 05:33 PM

Justin,
I'm so sorry you have to go through this and you couldn't get an earlier surgery date. I agree with the others though, better to get Dr. B. after his vacation when he is rested, hopefully. I wish you the best success and will be praying for you that all details will work out perfectly. You have been a great encouragement to everyone here and I thank you for that. I truly pray that you have a quick, complete and successful recovery!
Best wishes,
Linda

Rosy · #70 (**permalink**) 04-06-2009, 06:30 PM

Justin, just remember your positive thoughts/prayers for all the patients in this forum when needed, so God will not forget you. He will reward you thousands...
You were always there for me.

"When GOD brings you to it, HE will bring you through it".

Prayers are with you through this rough period.

Best of luck.

treefrog · #71 (**permalink**) 04-06-2009, 09:03 PM

Justin, I'm glad that you have a surgery date, though it wasn't as early as you might have wanted. But, like you said, there is a silver lining in having surgery after his vacation. Hopefully he will be fully rested and ready to go.

And thanks for posting about his time off, I guess there go my hopes of having surgery ASAP as well. Though my desire for a quick surgery are based solely on my employers need. Maybe this means we will be having our surgeries close to the same time. I am hoping to hear from Dr. Fenk-Mayer soon, my profile is now up and ready to be reviewed. It would be great to meet you in person, even though the circumstances aren't the best.

I hope this extra time to plan, is worth the wait. And I look forward to hearing whatever good news you might have.

Justin · #72 (**permalink**) 04-06-2009, 09:43 PM

Thank you Rosy, Linda, Gil, Terry, Phylly, Allan, Kim, John and anyone that has posted recently that I missed. Your support is amazing and I'm so thankful to have such a support system. It has been very therapeutic to post on this forum with others that "get it" and are going through similar trials. I appreciate everyone's support, as it is what gets me through most of these crummy days--every post of support is most appreciated.

Terry, I can't thank you enough for all of your help over the last year--I think I would have been admitted to the inpatient psych floor if it wasn't for you keeping me grounded through all of this.

Cathy, it would be great to meet you in person as well. I still keep in touch with the 3-level lumbar patient that had surgery the same day as me in 2003. It's great to hear that she is teaching tennis lessons again and her life is back to normal. I know your surgery will be a similar success!

Good luck with scheduling your surgery--Dr. Fenk-Mayer is an absolute life-saver! FYI: I'm pretty sure the first week of May is not available as Dr. Bertagnoli will be finishing up at the SAS meeting.

Keep me posted if you get a date, as I will be in Germany from 5/9 until the weekend of the 5/23-24. I'm still trying to finalize my return date.

Liz · #73 (**permalink**) 04-07-2009, 03:47 AM

hi justin,

i'm glad to hear you've scheduled surgery. i know you've done as much research as possible and you'll be with a great surgeon whom you respect and trust. i truly hope all of your pain is removed and left in Germany w/that stupid osteophtye and i hope it never comes back... sianara! and sianara to all those nasty pain meds. i look forward to hearing about your success... you know everyone is going to want to talk to you since you'll be one of a few in the world with DSS behind Prodisc that speaks English!

you've been a big support to me off of this forum, which i'm grateful for, and of course you've also supported so many spine patients around the world for many years. i hope this surgery lets you get back to living the life of a "normal" almost 30 year old and helping more patients in your career.

be careful the next few weeks and i hope may 14 is here before you know it.

i also hope you can take the board exam before your surgery... get that HUGE stress off of your plate so you can focus on healing post-op.

take care,
Liz

ps... i have two guesses for the exciting news -- either would be wonderful!!!

let us know when you can.
2nd ps... when you have a chance will you please post the abstract from Dr. McAfee et al on rotational motion and deformity? it was in Spine in Sept 2006. i think it's one of the best articles at explaining why ADR alone can result in instability. thanks.

Kathy · #74 (**permalink**) 04-07-2009, 10:57 PM

Justin,
I'm not on here for a couple of days and you get a surgery date! I was bummed when my surgery was scheduled 6 weeks out; but it went really quick. I stayed busy trying to get all the loose ends tied up, making arrangements and all the preperation. My doctor also had a spine conference of some type and went on vacation. So, I also got the refreshed version and it seems to have worked out for me. I'm sure it will work out for you too.

I know how it feels being the 'young one' in the dr's office. Sometimes you get the people who stare, like yo must be in the wrong place. It's almost like you don't qualify for 'real back pain' because you are too young. My family has even said stuff like, just wait till you get older, then you will know pain or is it really that bad. I have even explained to them that eventually this can lead to major problems (bowel/bladder issues), yet it is like talking to a wall. It's like if I'm not laying around moaning, groaning and complaining; I must not hurt that bad (the miracles of drugs). I have tried to explain to them, that I function, because I must. I don't have a choice whether I get up and care for my children or not, that's my job. That I push through the pain and make myself do certain things that are non-negotiable and if I had the option, I probably would lay on the couch and moan all day. I have also tried to explain that while pain meds do help, there is always some level of pain in my body at all times, that the medication just 'takes the edge off'. I tell people now, that I realize I just thought that I knew what back pain was, prior to having real back pain.
I can't fathom being in pain for as long as you have and starting so young. I was injured at 25 and felt the young stigma, so 14 must be un-real. I just turned 29 last month (had surgery right after my birthday, told my surgeon he was giving me my life back for my birthday... no pressure) I plan to feel better and enjoy my 30's way more than my 20's and I will pray for the same for you! On a side note, don't you remember when 30 seemed like a dinosaur? Now, we are looking down it's throat! BTW0- Were you class of 98? That was mine, just curious. Incidentally, I don't think 30, 40, 50, or 60 is old. (and I know 70 year olds that are more active than me, my father in law is 76 and is way more active than me.)

Here's to our 30's being AWESOME!
God Bless and I am praying for you and your wife,
Kathy

Ps. Is your wife going with you?

Justin · #75 (**permalink**) 04-08-2009, 12:56 AM

Hey Kathy,

I end up laughing out loud every time you post.

You're too funny. I gotta run right now...but I'll answer two of your questions: I graduated in 1998 from high school and my wife is making the trek with me...thanks for caring.

ans · #76 (**permalink**) 04-08-2009, 10:57 AM

Wow, you're just a kid! I graduated in 1938. In case you get cold feet, I have a garage surgery theater available for you and anyone else. Well, maybe not the best option. Stay strong/optimistic and persevere - as you always do. I relate to having to study very hard to get good grades - but I'm a complete idiot unlike you. Best - Allan

Maria · #77 (**permalink**) 04-08-2009, 06:28 PM

ans,
liar liar pants on fire!!! I think we are the same age! Guess you want people to think you're more practiced than you really are re your Garage Theater Ambulatory Care surgical center! May I apply for a job there? I could do *bedside* histories (laying around all day)

Justin · #78 (**permalink**) 04-09-2009, 10:13 PM

Liz...you're awesome, but you know that.

Allan...how far out is your garage booked? I thought you told me you graduated in 1928? By the way, when are you going to hire Maria as your nurse?

Kathy...I completely agree with you. I've felt like a fish out of water for the better part of 15 years. It's funny (well, not really) when I walk into a spinal surgeon's office. The office staff and those waiting in the office look at me as if "wow, I guess he just injured his back...he looks pretty young." However, they don't realize that I've already had 2 spine surgeries and am quickly headed on to my 3rd one. I've gotten the -- "you're too young for spine problems" to the surgeons that just look at me in disbelief when I start rattling off my history. Good times.

Here's to our 30s:

rosedee · #79 (**permalink**) 04-09-2009, 11:43 PM

The point they stop saying, "you're so young to have such dreadful problems with your back" is when you need to start really worrying! After 25 years of regularly hearing that, I suddenly realised nobody says it any more - though I still see a spring chick when I look in the mirror! (I wish

)

fuzzy · #80 (**permalink**) 04-09-2009, 11:55 PM

I was told these comments for years by my gp, who I have been with for 20+ years. This guy is lost in time. Not too long ago he realized that my hair and beard are halfway white and I must not be a teenager anymore so mabe its ok after all to have spine problems, so he is getting a little looser on the meds ;-)

The astounding thing is the last lime I saw him a week ago he looked like a very old man, all hunched over, and stressed looking. Turns out he hurt his back real good and now knows how many pills it takes to barely keep moving.

Kathy · #81 (**permalink**) 04-10-2009, 12:14 AM

Love the picture... assuming you found that on the internet? Or is that you? I want to keep my beer in my frosty mug and then get it to my mouth. Although, I tend to wear half of my food on my shirt! I'm like a child when it comes to eating and drinking... I have a hole in my bottom lip!
Good Times!
Fuzzy- Crazy how quickly people get perspective when they are in pain. Sad that it takes that, to have compassion. Actually, I think the problem is all the liars who aren't in pain and then the DEA. Doctors are scared to prescribe and it end up being a user and not someone who is in pain. So many have lost their licenses over it. My family doctor actually told me that was why he was not prescribing me as much as needed (before he referred me out). For 3 years, I was treated like nothing was wrong with me and that I was just seeking pain meds. I have done every single thing the doctors have asked of me (stupidly in some cases). Done every procedure, injection, therapy, etc. and was still treated this way. It's like, trust me, if I just wanted drugs, I wouldn't be spending 10's of thousands of dollars on all this crap! Very frustrating.
Ok, gonna quit before I get myself all worked up. Sorry for hijacking your thread...
Best Wishes,
Kathy

Justin · #82 (**permalink**) 04-10-2009, 04:50 PM

Hey Kathy,

It's not me in that pic. I understand about the "treatment shuffle." It can be agonizing. I personally know a lot of docs that will not write for narcotics period. Most of them have been burned in the past and do not want to jeopardize losing their medical licenses. I completely understand this thought process, as there is a multitude of drug seekers. This is why these docs usually refer out to another provider.

Justin · #83 (**permalink**) 04-10-2009, 04:59 PM

Well, today is a very hard day. I've recently made the decision to take some time off of school.

I'm not doing well to be honest. My reflexes are significantly decreased and I've begun to have saddle paresthesias. My muscle strength has also decreased significantly and I am having trouble ambulating and issues with my gait. (Not to worry, as Dr. Balderston knows all of this.)

My wife and I are so sick of all of this--the pain that is--it's been a really hard year on both of us. I hope Germany really works out, as I can't keep living my life like this. I've held it together for too long now...and it's starting to take its toll on me.

May 14th can't get here fast quick enough. I'll keep everyone posted.

dshobbies · #84 (**permalink**) 04-10-2009, 05:08 PM

Justin,

I know the difficulty of putting your life on hold, waiting to get better. I'm so sorry. I know another month of waiting seems like a long time but it is what it is. Stay as comfortable as possilbe and May 14th will be here before you know it and the heebie jeebies will set in. That's how you know you're close.

That which doesn't kill us only makes us stronger. For such a young man/doctor, you'll have the wisdom of learning first hand.

Please take care, Dale

SandyW · #85 (**permalink**) 04-11-2009, 12:56 AM

Justin,

Hopefully this break from being a student, will give you some precious time to rest. Hope that you will find some pain-free time to enjoy life. I can imagine it's a great disappointment to take time off when you were so close. Try to be patient and

- hang in there!

Sandy

ans · #86 (**permalink**) 04-11-2009, 02:58 AM

Justin: What a nice-looking couple you "guys" are!

I'm so sorry to hear that you're having balance problems and the sinister saddle parasthesia. You were such an ADR poster "boy" re: weight-lifting, living life.

Time off from school is OK 'tho it hurts. You take care of yourself and I agree, this w/make you (along w/your other trials/suffering) and incredible doctor.

My very best to you and your wife. - Allan

ImpOssibleOne · #87 (**permalink**) 04-11-2009, 04:01 AM

Sorry for all you're having to endure at such a young age but for what it's worth, this will make you a better doctor....no matter which specialty you choose.

Gil Denis · #88 (**permalink**) 04-11-2009, 01:31 PM

Hi Justin

This is such a short period of time in your life,You have many years to look forward to,It will all be over soon Please be patient hold on we are all pulling for you

Leaving FL today back to snow country only three months till spring

take care all the best

Gil

Cindylou · #89 (**permalink**) 04-11-2009, 01:48 PM

Justin, I am so sorry about you having to take time off from school. I am certain it was a decision not made lightly. I don't know what saddle para-? is, but doesn't sound good. I will google it to learn more. Boy, do I get the wishing surgery were here yesterday. When the pain is that bad you're just ready to jump on the operating table. I am just so sick over this, but I do believe much better days are in your future again my friend. Hang tight. It will be here soon, and then you can get on to the business of healing and living life again. With gusto!

I'm pulling for you. And my best to you and your wife,

Cindylou

Justin · #90 (**permalink**) 04-12-2009, 02:23 AM

Quote:

Originally Posted by fuzzy

I was told these comments for years by my gp, who I have been with for 20+ years. This guy is lost in time. Not too long ago he realized that my hair and beard are halfway white and I must not be a teenager anymore so mabe its ok after all to have spine problems, so he is getting a little looser on the meds ;-)

The astounding thing is the last lime I saw him a week ago he looked like a very old man, all hunched over, and stressed looking. Turns out he hurt his back real good and now knows how many pills it takes to barely keep moving.

Hey Fuzzy, it is so very true how pain "ages you." It makes people completely different in so many aspects of life. It's invaluable to see an empathetic physician.

Be well,

fuzzy · #91 (**permalink**) 04-12-2009, 05:10 AM

You made the right decision to take a break and take it easy on your spine. I hope you will be doing ok until your surgery date when you will have some of the best Dr.s in the world working on you. Your wife is very strong and this is hard on spouses. Mine wished I would go to surgery tomorrow in hopes of "getting it over with". I am sure your wife wished you could go tomorrow to have this important treatment.

Kathy · #92 (**permalink**) 04-12-2009, 06:03 AM

Justin,
I am so sorry that things are going downhill so quickly for you. I had no idea how bad it was. Pain sucks, figuratively and it literally sucks the life out of you. I know you are counting the minutes until surgery. When I was waiting for surgery and hurting like crazy, I just tried to remember all my blessings (it was the only way to keep from going nuts). I am praying for you and your wife, and for many pain free days ahead.
God Bless,
Happy Easter,
Kathy

Justin · #93 (**permalink**) 04-12-2009, 04:25 PM

Adrienne, CindyLou, Gil, Allan, Sandy, Dale, Kathy and Fuzzy:

Thank you all for your continued support...it means a lot. I'm counting the seconds until I leave--I know my wife is counting the milliseconds.

Well, I have to say I am truly thankful for the health I do have. I am very fortunate. I have had two close friends (my age) pass away from cancer this year. I know things could be much, much worse.

We are truly blessed!

I wish everyone a most wonderful Easter!

phylly · #94 (**permalink**) 04-12-2009, 08:03 PM

Any chance they could move you up if they have a cancellation? I am sure that can happen and then you can go sooner. A month is a long time to wait when you are in that much pain. I feel for you.
Phylly

Katie · #95 (**permalink**) 04-12-2009, 08:58 PM

Justin, you are a true inspiration. Your last line in your signature says it all....

I'm here to help

Even with all you are going through, you think of others. You will be one of the very fine ones some day soon. Keep the faith.

Maria · #96 (**permalink**) 04-12-2009, 10:09 PM

Justin,
Sometimes we look at things in a certain way like " I had to leave because of the pain/problems" but I think you stayed as long as you were able and you left when you needed to for your safety and the patient population as you could no longer put other people's problems or your program ahead of what was going on with you.

So you are moving forward because you took a step closer to being ready for your surgical endeavor.

I thank you for sharing as much as you do here, helping to further educate us and keeping us involved in your personal situation.

We all learn so much this way as well having the chance to be of some kind of support to each other.

I hope you are having a *comfortable* Easter and the days will pass like greased lightening till your surgery

labeng · #97 (**permalink**) 04-13-2009, 01:19 AM

Justin,

Been a long time since we have talked, we met at one of Marks luncheons some years back. Mark had introduced us and we sat at the same table for a spell. I had my 2 level ProDisc surgery around the same time you had yours, mine was done on 11/25/03 in Riverside, CA. Most memorable though was you were roughly half my age, I believe I was 46 at the time.

I had not been on the forums for quite a while. I had been doing quite well other than some facet arthritis, which was being controlled by rhizotomies every once in a while. I started having bilateral pain that could not be controlled any longer with the facet rhizotomies or any other treatment for that matter. That’s what has brought me back to the community…unfortunately. I was disturbed to see your posts, I am so sorry to hear of the troubles you are having.

I have read a good part of this thread and have digested much of the information that you have given regarding your situation. Although not quite as bad….yet, I seem to be facing a similar situation. I am suffering from stenosis as a result of osteophytes. It would appear that I am auto fusing around L4/L5. I currently am waiting for opinions on revision surgeries.

I hope the pain eases up for you while you await your surgery date. Pain has a way of taking a short time period and making it seem forever…I guess most of the people here can relate to that. Hang in there Justin and thanks for the support that you have given others!

Regards,
Larry

treefrog · #98 (**permalink**) 04-13-2009, 05:05 PM

Justin, I'm sorry that your pain and symptoms have gotten worse. I know you can't wait for May 14th to get here. I hope you find something to distract you, until the time comes to make your way to Germany. And I really hope that this is the last surgery you will need for your back. It really is time for you to get on with your life.

Justin · #99 (**permalink**) 04-14-2009, 11:36 AM

Quote:

Originally Posted by phylly

Any chance they could move you up if they have a cancellation? I am sure that can happen and then you can go sooner. A month is a long time to wait when you are in that much pain. I feel for you.
Phylly

Hi Phylly, as I understand Dr. B's schedule he is taking vacation the next couple of weeks (very rare vacation time). Then, he is headed to London the last week of April to the first of May. I think he also has prior commitments the first week of May, and I start my pre-op testing on 5/12 and I will be admitted to the hospital on 5/13 for surgery on 5/14. Dr. Fenk-Mayer did the best to squeeze me in to his first available date after vacation--she asked for my understanding, and I agreed without questions. Dr. Bertagnoli is probably has the most demanding schedule I've ever heard of--he usually in multiple different countries a week training other surgeons, etc. It's absolutely amazing actually.

Larry, it is great to see you posting. It has been quite some time since we last talked. I'm sorry that you are dealing with stenosis and autofusing at the L4/L5 level. I'm guessing you are experiencing pain as well? I hope your pain is manageable with medication. Please keep me posted on what you hear regarding revision. I wish you the very best.

Maria and Katie, thanks for your very kind words. I try to share what's going on, as when I had my 2-level ADR in 2003 it really helped to read the stories of others to know what to expect / what options were available / receive support / not feel alone facing surgery. Surgery is a life-changing event and I can't imagine not "giving back" to help others that may be in my situation, or one similar, down the road.

Cathy, thanks for your support...I do hope this is my last surgery for quite some time. These keep getting in the way of living my life.