My 3 mo X ray - Discs tilted all over the place

[steve55]

This is a standing straight face forward x Ray my doc took today. Looking at these disc tilts, one wouldnt think I was standing straight.




Does this make sense? Is this normal? I mean, it seems the bottom and top plates are tilting in all different directions, no rhyme or reason to it. For example, the top disc bottom plate is tilting to the lower right while the bottom disc's lower plate is tilting to the lower left. Why is the lower disc's top plate tilting way up to the right like that in a x ray that was taken while I am standing straight face forward? If anything, you'd think they'd all be tilting the same way at least. Yikes!

But Im in no pain so maybe I shouldnt worry about it. We'll see what Dr B has to say I guess.

[dshobbies]

Steve,

Looks can be deceiving . I tend to agree with you but with no pain, don't anticipate. Wait for Dr. Bs comments and rest easy.

Dale

[New-disc]

Steve,

Looks a bit strange... please keep us posted!!!


Todd

[Kathy]

I have no idea how to read x-rays. I do know mine doesn't look like that; but that doesn't mean anything. I would be very interested to know what is going on. Who is doing your follow-up? If it is Dr. Zigler, ask him what he thinks.

Keep us updated,
Kathy

[steve55]

kathy, the tx back institute wouldn't see me due to the ole "we don't do follow ups with other surgeons patients".They said due to legal reasons. So I just went back to dr Peloza's office. Dr Peloza's pain mgt doc was surprised when I told him that, just his expression of disgust and lameness said it all. LOL. No kidding, if only I could have snapped a pic of his facial expression.LOL. He said he only knows of one other doc who is like that, but from reading the boards, it seems many docs are like that. What the heck, some docs have egos and get their feelings hurt that you didn't let then do the surgury . Well that's my guess, of course they hide behind the lame excuse that they will expose themseves to getting sued.

[Katie]

I was told beforehand that if I was planning on seeing an 'outside' doctor, to be prepared for the local surgeons to refuse to treat me if something went wrong. When I pushed and asked if they would indeed refuse to see me, I was told that this would be illegal, but be prepared to have less than enthusiastic treatment.

And I have to look at outside surgeons because I cannot get anyone to see me in a reasonable length of time locally...within a year. Imagine what the wait time would be if they followed through with their 'advice'.

Seems like it is cross border discrimination

[Maria]

Steve,
Did I just read another post about how great you're feeling?? All-right! So you're discs look a bit tilted and here and there~ as long as you feel good and there's nothing really wrong w/the discs placement or how they're sitting, what they're doing~ it's seems like how you feel is what's most important not how you look

Really glad to read how well you're doing

[Kathy]

That's weird that the won't see you, I had surgery in Florida and they are doing all my follow up.

[steve55]

Originally Posted by Kathy Earhart

That's weird that the won't see you, I had surgery in Florida and they are doing all my follow up.

That's because they are participating in your disc's study : )

[steve55]

Originally Posted by Maria

Steve,
Did I just read another post about how great you're feeling?? All-right! So you're discs look a bit tilted and here and there~ as long as you feel good and there's nothing really wrong w/the discs placement or how they're sitting, what they're doing~ it's seems like how you feel is what's most important not how you look

Really glad to read how well you're doing

Completely agree. : ) I was only concerned about the long term implications,...i.e. Stress on facets etc.

[Kathy]

Yeah, I guess the trial thing is why the agreed to keep seeing me. I am surprised there is not an ADR dr in the DFW area who would be willing to do your follow-up. You would think that since Dr. B is widely known in the spinal world, that they wouldn't have a problem with it. What hospital is Dr B out of? Is it Stenum? Alphaklinik? ProSpine?

I agree about if you are feeling fine now; but would worry about long term implications. These look similar to the x-rays shown in the horror stories about Stenum in months past. The one lady in a wheelchair (can't remember her name), said she felt great at first. Then, the guy, John I think?, that had a bad experience (Mark commented on the poor placement of his). What do you think Mark? It doesn't look right to me?

[Kathy]

Found those threads, and the before x-ray, I can't really tell anything was wrong; but it shows the progression. http://www.ispine.org/forum/ispine/1...dr-stenum.html

Here is the other one:
http://www.ispine.org/forum/surgical...um-kc0iet.html

On another question. Have you/did you follow all the post surgery orders? Not sure the exact ones for cervical; but for lumbar it was no bending, twisting, lifting, etc. Did you fall or anything? Just curious, as I am terrified of my discs moving out of place. I am always relieved to see my new images, to know everything is where it is supposed to be. Oh, do you have any of your earlier images? Do they look like this? Just curious.

Oh, just read this in the old post, what Mark said (mmglobal) regarding the discs being gone, which takes the pain away; but is still not a 'success'. Here, I am copying and posting a portion of that post, as he explained it better than I can. (underlining mine)

Originally Posted by mmglobal

"First, notice the angulation of the Charite’ plates on the first picture. The implant is not centered well. This is causing the upper plate to ‘fall off’, lower on the left side of the image. This demonstrates one of the problems with mobile core devices. When this occurs, the core is pushed to the extreme right and stays there. That increases the angulation and increases the forces that push the core more off center in the wrong direction. This is why the Activ-L eliminated the lateral movement of the core. Every mobile core device I’ve seen will do this. Properly implanted it’s much less of an issue. I’ve had 2 clients with M6 cervical discs explanted, one for problems much like I just described, another one for serious complications that may have been exacerbated for these reasons. (Yes, they were both Stenum patients. I know of a third, but I was not involved in the case. I did get to examine the explanted disc though.)

That brings us to the second picture. Notice how far the back of the upper plate is from the back of the vertebral body. Notice how the teeth of the plate are literally on top of the anterior margin of the vertebral body. There is the appearance of more vertebra because of an anterior osteophytes. This kind of alignment increases the risk of migration by many orders of magnitude. I see these types of films presented at the conferences as if they are a device issue, but this is not a device issue. The picture of the configuration before migration is one of a disaster waiting to happen. The surgeon should know that and be focused on proper placement. The doctors at Stenum say that there are anatomical reasons that may make it impossible to get the disc further back. That is absolute BS. I have NEVER seen this type of failure from any of the other surgeons I work with because they take care to get it right. Accepting sloppy work because you are lazy, hurried or just not careful may not cause problems most of the time. However, when the stakes are soooooo very high, accepting sloppy work may doom patients that would have otherwise been successful, to lives of pain, meds, revision surgeries and more.

After I went to Stenum with MrBee, I made excuses for them, saying that they are probably doing the surgery the way they were taught to do it years ago. The reply from one of my favorite surgeons was, “If you are a bricklayer or a librarian, that may be OK. But if you are an astronaut, an airline pilot, race care driver or a surgeon, you have to be learning all the time. That is not an excuse.”

Here is a picture that I extracted from the original Stenum-and-back website. This picture stayed up there for many years until the patient community got wise to what it really showed.



I want everyone to keep in mind that this is the image of a successful surgery. The author of the website may even be in better shape than me. They point to images like this as if it’s evidence that it’s OK to do surgery this way. However, you do NOT want any ADR implanted this way. If the patient’s disc was his pain generator and they took it out, he experiences success. If he gets away with the horrible placement, that is dumb luck, not appropriate surgical technique. At the conferences they discuss the sequelae of configurations like this: increased risk of complications like migration and subsidence. In addition, there is the expectation of accelerated wear and degeneration of posterior elements, possibly adjacent levels (due to inappropriate kinematics), AND of the prosthesis itself. It’s like driving with your tires out of alignment.

Does this mean it WILL happen? Absolutely not! All it does is increase your risk. Poor surgery does not guarantee failure just as perfect surgery does not guarantee success. If anyone wants to have poor surgery because it’s OK most of the time, I would suggest that they don’t fully understand the issues."

[Cindylou]

I agree, looks can be deceiving. I remember when I saw some of my first x-rays of my 3 level lumbar discs, they didn't look right either. But then my doctor following me up here explained why. It's hard for me to imagine that Dr. B could have messed up...that said, I would still exercise caution and send them to him and have him read them for you, or Fenk-Meyer. Keep us posted.

Take care,

Cindylou

[steve55]

My US doc said he didn't see anything wrong with the x rays and if anything, it shows the ADR's are moving well. He said I might think I was standing perfectly straight at time of the x ray but I was probably leaning a few degrees to one side without realizing it.

Mark is running these by dr b in the next few days. We'll see what he says. But yes, I am very pain free now, so that should be a good sign.

[Kathy]

Just curious, who is your post-adr surgeon? Did he/she explain why they were moving in different directions? It just seems like if you were leaning in one direction, the discs would all be tilted in the same direction. How come the bottom one looks like the two metal ends are touching? Is this the nova disc design, where it can move that much? Is it a metal on metal device? Restrained or unrestrained? Does it have a polyurethane core? I had never heard of the nova until you got it, and don't know anything about it, so just curious. I am very interested in why and how things work.

Just curious what Mark has said regarding this. I don't understand how what he said about the previous x-rays from the Stenum debate wouldn't apply here. I am confused!

[dridobits]

I saw that several places had said they did not want do follow up for "legal" reasons. I was interested in specifically what those were and where in their contracts they stated that? I only ask because at first I was told my insurance company would NOT do follow up for me if I had surgery outside of them. I called my atty who told me to get the contract and let him read it. I did and they actually did have to cover me. I went back to them and showed them this in the contract and they were "Oh did we say we wouldn't treat you"? I just thought I would share this.

[Katie]

Sounds like the same thing up here. The neuro said not to expect any treatment here if I went away for surgery, but then said they would have to treat me, but don't them to be 'happy' to treat me. That they would really resist covering me. That could mean all sorts of things in my mind...years instead of months for treatment, etc. They have their ways.....

[steve55]

Well, I heard back from Prospine as follows:

"Regretably your x-ray newante.oyur perfect 3-months x-ray does raise major concern: The c67 ADR is tilted, and this is due to an apparent sinking of the upper plate component into the vertebral body bone. This does not have consequences for the width of your spinal canal, so no danger for the myelon – be put back at ease.

Dr. Bertagnoli recommends to correct this finding surgically now: reentering via the same approach. Removal of the ADR. Fusion of this semgnet by a zero-profile cage, which can be fixed with little titanium screws.

This would represent a estimated 1,5 h procedure, which of course he wants to do himself. This could secure an adequate position of this segment for lifetime.

The alternative of “wait-and-see” is sure out there, as you do not have relevant complaints. Yet as the vertebral bone stock within a vertebral body is spongiosa (“softer” than the endplate) further subsidence might occur. And then result in a “kink” in your cervical spine, causing pain. And which could affect the c56 position, which is at present perfectly functioning. In balancing the comparatively low effort of re-entering to this eventual course in the future, we recommend revision surgery.


Pro-spine will send you a cost-estimate for the proposed surgical plan, which of course will respect this very exceptional constellation of your case. . After reception please tell me, if you wish to be scheduled."

[runner]

Steve,

IMHO, I would do what Dr. B suggests. It is good that you raised concerns because it looks like now they are justified.
Sorry, he has to go in again. I think what he is saying about the wait and see approach, is to do something now before things get worse.
Subsistence is a potential complication of ADR surgery and I am sorry it happened to you.
i know you've gone through a long haul, with insurance issues and then going to Germany for surgery.
Good luck with your decision. I wish you the best.

[Cheryl]

Steve - OMG - I am sorry you have to face such a decision so quickly post op especially when you feel great.

I really don't understand why this happened - were your bones too soft?

[dshobbies]

Steve,

Don't know what to say. This is not good news but can be corrected. Not exactly what you want to hear just when you're healing from your previous surgery. You probably don't want to trek back to Germany for surgery, time or costs. But...

So what are you going to do. Wait and see, although an option, isn't the best one but the least intrusive.

What would I do? I'd suck it up and have the revision. I spent too many years with no life and put all my eggs in one basket. If my basket sprung a leak, yes I would get it fixed - and before anything else fell out.

Damn, Dale

[treefrog]

Steve, I am so sorry you are having to make this decision. I have to agree with Dale, I would be inclined to trust Dr. B.'s instinct's and it seems like he is indicating revision surgery is the safest bet.

Wait and see is always an option, but I see too many people, who regrettably wait too long. I am of the opinion that if you can do something now to head off disaster, you should do it. Your health is of utmost importance.

All that said, I'm sure you put a lot of money into going to Germany and having the first surgery. If there is any way that you can afford (well none of us can really "afford" this), to do it, I would do it as quickly as I could manage.

I can only give you a gentle cyber hug, and wish you the best luck with whatever decision you make.

[Katie]

Good lord, I am so sorry to hear this. This really makes a person pull deep down for even more inner strength. Thankfully it sounds like you still have a bucketful of that strength left, and can get this resolved.

Did you have a bone density test done beforehand? Either way, I hope they will be more than gentle with their charges. That would only be fair.

So many thoughts are running through my head right now, and I am praying for you. I hope I didn't offend with my comments...maybe I'm just very on edge because of my own worries on surgery.

Hugs and prayers, and please keep us posted.

[Jim M2]

Did he mention vertebroplasty as an option to stabilize the collapsed vertebra? He's done this before for the lumbar when the x-rays looked similar to yours. Maybe they don't do it for cervical for whatever reason.

[steve55]

Thanks everyone for the well wishes. Yea, nothing to say but "what a bummer". Im not really too worried about going through with another surgery, especially since Cervicals are pretty easy to do and access compared to if it were a lumbar ordeal. Im more worried about having a fusion done. Ive heard about fusions not being so reliable and having long recovery times, and causing adjacent disc failures, and many people with fusions not getting better etc. And of course, the cost factor is HUGE too.


I have no idea why this happened , but I dont blame Dr B. Im just t hat 1 in 50 patient who has subsidence occur, but man, it sure happened pretty fast huh? As far as I know, Ive got super strong bones, Ive played high school football and C league ice hockey and throughout it all, Ive never broken a bone. I also drink 2 gallons of milk per week. I know my bones are strong, but,.....then how did this happen? Whats weird is that Dr Fenk Meyer says that the top disc is subsiding into the bone but it looks more to me as if it is dropping to one side, like as if the one keel isnt holding it in well enough. The old prodisc had 2 keels on top to keep it in place. Ahhh well, Im just speculating.

Well, Mark will be able to tell me more as he said he was meeting with Dr B personally to review the X rays. I cant wait to see what Mark says, especially since so few patients have had this happen. I did have bone density testing done prior to surgery so if bone density was an issue, wouldnt they have caught that?

Now, Im also wondering about the top disc also, I mean, it also seems to be sinking to the right, is it not?

Ill probably just go ahead and do what Dr B. suggests, but I plan to get a 2nd opinion from Dr peloza also. Maybe from Dr Ziglar too but Ziglar wants $300 to $500 for a visit and even then, the TX back Institute wasnt sure if he would even see me. I sure hope Dr B comes in with a big times discounted quote.

Well, at this point just waiting to hear from Mark so I can ask more questions.

[Katie]

Steve, when I was totally confused, another member here talked me into contacting Dr. Bitan in NYC. He is very well respected, one of the top in the country, and convinced me after a three hour consult to try hybrids, ADRs plus fusions in my neck and lumbar. (Two levels in my neck, three in my lumbar)

He explained that the fusion will take care of the very damaged section of my spinal cord that has a lot of edema, and then the ADR next to it will give protection to the adjoining discs, along with the movement needed.

I was exactly like you...very afraid of fusion, but decided to trust this man. My cervical levels are critical, so I have to trust someone, fast. No one has sent me bad reports about this doctor, and I got a wonderful feeling after meeting him in person. He mentioned doing a number of revisions, so he may well look at your MRIs when you explain things. He only charged me for the visit, not to look at the images. AND he called me back immediately, when he saw that I had a big problem. I'm waiting for an answer from my insurance this week regarding surgery.

He will at least give you an honest opinion, and is much closer than Germany at this point. But I know he is going away at the first of the month, so you should do this soon, if you are interested.

Just a thought, and wishing you the best. PM for more details if you like.

[steve55]

Yea, I have heard of him. I just might do that. Im likely to trust Dr B as he has so much experience with these things but again, doesnt hurt to see what other docs say. If at all possible, Id like to stay as I am if its not causing pain. I sure would like to hear the other docs opinion of what usually happens when letting these things stay as is.

Thanks Katie.

[Cindylou]

I'm sorry Steve. Major bummer indeed. But I also would trust Dr. B's advice and get it fixed now. Excellent that you took such notice on the x-rays. I will pray for you in the coming days as you face decision time.

God bless,

Cindylou

[runner]

Steve,

Wouldn't hurt to get a second opinion, IMHO, but I wouldn't wait too long on this. The ADR can subside more from what I have read in the past literature.
Please be careful. Just because it doesn't hurt doesn't mean it shouldn't be fixed.
I'm praying everything works out well and make them mindful in Germany about your financial situation. Unless of course you are independently wealthy.
You may be afraid of fusion but if this is what needs to be done with the subsidence, then you have to have it done.
You couldn't have predicted this complication so don't beat yourself up.
I was told before lumbar surgery I would probably get a post-operative ileus, where the bowel stops working, and I did that and then some, getting a prolonged ileus which necessitated 10 days in the hospital.
I wanted to leave but I had to stay.
I'm going to have surgery again and maybe it will happen and maybe not. That will not stop me from having a needed surgery.

I may be reaching, so cyber slap me if I am but I worry about you waiting. I don't remember anything about anyone keeping their subsidence. All I can recall is the person having to have surgery again to fix the problem.
I feel for you cause no one wants a complication.
You are strong and can do this.

[treefrog]

Originally Posted by runner

I was told before lumbar surgery I would probably get a post-operative ileus, where the bowel stops working, and I did that and then some, getting a prolonged ileus which necessitated 10 days in the hospital.
I wanted to leave but I had to stay.
I'm going to have surgery again and maybe it will happen and maybe not. That will not stop me from having a needed surgery.

Kim, how did they know you would have ileus, is there some indicator?

[steve55]

Im not sure why I didnt bring this up earlier as I didnt initialy think this could be related to the current slipped disc, but since Sunday night, I suddenly developed a excrutiating throbbing pain from my around the back of my left shoulder, the shoulder itself, and upper arm. It does not travel below my left elbow. Ive had temporary "pinched nerve" sensations in the past that always slowly got better. But this one has not seemed to have gotten better and its wednesday morning now. The excrutiating pain is so bad that I couldnt concentrate on doing anything from eating to even watching TV. It hits really hard when it starts up. I took double pain killer(ultracet) and alleve just to relieve it monday night so I could actually sleep, and again, I took alleve and another pain killer to relieve it last night. Then this morning at around 7AM I was woken up with this excrutiating pain again. I seemed to be pain free at work yesterday without pain killers as it seemed to dissipate yesterday in the day only to return when I layed down in bed again yesterday evening.

Im starting to suspect now that this could possibly be related. Im not sure what the symptoms of a slipped disc are though. This current pain is not really similar to the pain I had before pre op. I expected it to get better and go away in 2-3 days as these kinds of things normally do but now Im not so sure. Given the continued severity of it, now Im thinking it very well might be related.

[jessmith07]

Steve, I happened upon this dermatome map today on Dr. B's site and it shows the correlations between the nerve root location as it exits the spinal column and the area of the body it supplies with sensation conduction...

Have a look and compare the pain that you're feeling and see if it corresponds with the map...

Dermatome Map

[steve55]

Well, according to the chart, the shoulder area where I am hurting the most correlates to C4. The shoulder to elbow shows C6/7. But the C6/7 also goes down to the hand which I dont have.

Im at work right now and for whatever reason, this pain doesnt hit me too hard in the day. It seems to be worse when I lay down in the evenings. But its excrutiating and quite severe, but at least its not the deep dull nerve pain like pre op. I am amazed at how severe the pain is when it does hit, its a unbearable throbbing sort of pain mainly in the shoulder and some in the upper arm.

I recieved my quote from Prospine to fix this and its $18,000 USD. Im not sure if that is a discounted price or not. Considering a single level ADR at prospine is around $24-$27K, I think it probably is a discounted price since removal is probably more challenging and difficult than inserting, PLUS, they are fusing after the removal also. I was hoping it would be a free revision like I heard that Stenum does if things go wrong, and I read 1 case where prospine fixed someone for free also. I guess no such luck for me, but, as I said, I also know its not Dr Bertagnoli's fault either. My bones just didnt hold well. I was thinking about seeing if my insurance would cover it here in the US if I could find a Humana doctor with a solid reputation at removing ADR's, buuut, gosh, it probably isnt worth the risk I guess. There probably are not many doctors who are really good at ADR removals. I guess I can always appeal for coverage as out of network. Medical necessity shouldnt be too hard to prove. Do US insurance carrier's deny these claims on ADR extractions? Maybe they will refuse to cover the extraction but agree to cover the fusion???

[chasswen]

hmmmm dr b is charging you for a bad placement of his own doing???
maybe you should get mark to talk to dr. bertagnoli it doesn't sound right to me.
SIGN
chuck

[steve55]

The TX back Institute called and told me that they dont do follow ups or even 2nd opinion consultations with patients who have had any surgery done with a different surgeon, whether its in the US or Germany. Kathy is an exception because they are a participant in her disc trial.

The lady went on to say "You wont find any US doctor who will see you especially if you went to germany". I told her Dr Peloza was seeing me and she acted all surprised and said I was very lucky to find one. Man, they dont just get jealous, they get spitefully, bitterly jealous when patients go overseas. At least thats my take. Dont doctors follow something called the hippocratic oath? Did I spell that right?

Anyways, I do trust Dr B, and Im pretty much planning to go back,....but its only prudent to get 2nd and 3rd opinions. I still am worried about the top C4/5 tilted bottom plate. Man, my bones just dont hold these discs in place too well. I just dont get it. I was EXTREMELY careful after surgery, didnt exercise, wore my brace religiously for the full 2 months, I took extra care in every way for a good healilng as you only get one chance to get it right.

[dshobbies]

Steve,

I assume Mark will be able to explain things better once he consults with Dr. B on your behalf. What you believe to be the hippocratic oath is actually the hippocritic oath. There are some good guys and I am generalizing but my experience with spine surgeons has been ego oriented, more interested in putting another notch on their scapal. My first neuro actually has framed thank you letters all around his office as well as a scrapbook of them for new patients to peruse. Yet he never warned me about the possible failure, not only related to my first surgery but my second as well, as the while knowing there was something better out there.

Dr. Regan in Beverly Hills has taken on difficult revisions but he does not accept (most) insurance and I'm told his consultation fee is $500. He cares for many of Dr. B's patients in the L.A. area.

As for insurance covering the entire revision?????? I guess you'll have to find a doctor who'll do it first.

One more thing; though this may not exactly be Dr. B's fault, but considering the travel expenses, etc. I agree that he could do better even though the 18,000 is probably allready discounted.

Unfortunately and fortunately, time and money will take this lose/lose situation and turn it back into a win/win.

I am so sorry this happened and I truly feel for your situation. Major bummer.

Dale

[Kathy]

Steve,
My surgeon in Florida, the co-inventor of the Active L disc, does revisions. I made sure of this before I had surgery, so I would be able to get it out if need be. Maybe you could fly out and consult with him. He was a very nice humble man and highly reccommended by fellow spineys (Justin and Mark both had good things to say about him). I would also make for absolutely certain that the top disc is fine. I completely agree that it is the prudent thing to do to get more than one opinion, regardless of who you have surgery with (I got 3 opinions before my first surgery, which is way easier than a revision). I also think that you should push for a more discounted rate. Also, I know on the billing I received for the surgery, it showed a seperate insurance billing for removal of the old disc and another for placing the ADR; so maybe you could get insurance to pay for the fusion part and just have to foot the bill for the removal of the old disc. Too bad Dr. B doesn't have the revision policy of Stenum, seeing as how the revision rate is low, doesn't seem like it would cost them much (unless they had tons of revisions). Seems like a great policy, too bad US dr's don't offer it (guess you need tons of confidence in your skill to offer a policy like that).
Best of luck,
Kathy

[sahuaro]

Steve:
I am chiming in late here because I've been trying to avoid the full impact of the implications of what you are dealing with. I am so sorry this has happened and that you are now in pain. As a cervical ADR recipient--with osteopenia--the prospect of subsidence scares me to death and I am impressed with your great attitude at this point!

Perhaps Mark can help you with getting second opinions in the U.S.? And I would seriously consider consulting with Dr. Regan, who did my surgery.

Also, since the pain seems to come with lying down, would a cervical pillow (e.g., Tempurpedic) help? Would sleeping in (ugh!) your soft collar, assuming you still have it, help?

I wish you all the best.

[steve55]

Yea, I guess I am bummed that I didnt get a little better discounted price for what clearly shows 2 tilting discs. No doubt the bottom plate of the top disc is sinking to the right, its quite obvious, yet oddly enough, they didnt even mention that one. Ill see what Peloza says about that top disc next friday. Again, not necessarily Dr B's fault and I still think he is a great surgeon and I appreciate he spent 6.50 hours on my surgery and he took the time to really make sure all my nerves were freed up. But gosh, I guess ya all are right, you'd think I would have gotten a little better break on the price given the circumstances. Oh well, I guess not.

Anyways, I spoke to the Humana rep today and she seems to believe that as long as we prove medical necessity, she thinks they will cover both the removal and the fusion. She didnt seem to think that the fact I had ADR's (a non approved procedure) would affect their decision to cover both the removal and fusion if its medically necessary. If she is right, then I have a good chance at either going out of network with a$6K deductible (which she said would apply if I went to Br B in germany) or staying in network with only a $2,000 deductible.

My out of network options would be:
Dr B -I still very much trust him , but ughh, I really dont want to deal with travel again. Too much hassle, connecting flights, crappy food, no freakin TV to watch (Ill go nuts watching CNN Europe or whatever that one channel is for 2-3 weeks), lots of extra expenses etc. Only positive is DR B's heavy experience with revision surgeries, I presume??. Will still consider him for sure.

Dr Peloza -My previous doc who treated me all this time before I went to Dr B and he is in the same class of surgeons as Delmarter, Regan, Biton etc. He is local. BUT, dont know how many revisions he has done though.

Dr Regan - Experienced revision surgeon right?

Dr Delmarter - NOt sure of his revision experience, anyone want to tell me?


My one in network option would be Dr Biton in NY (only $2K deductible) -not sure of his revision experience either. However, one person here did say Dr Biton seems to have done many ADR revisions. So, at this time Im leaning towards going with him if he has the experience Im looking for and if I can get Humana pre approval. It would be nice to stay local with Dr Peloza, and I would have a local follow up, but the extra $4,000 deductible difference is alot. I get free travel on Delta since my dad is a retired delta pilot so the cost of flying to see any of these surgeons for follow ups would be limited.

If it turns out that these US docs dont have extensive ADR revison experience, Ill probably just go back to Dr B to be safe. Experience is most important with these things.

[Kathy]

Steve, I have heard lots of great things regarding revisions, with Dr Bitan and Dr Regan. I think if I were you, I would stay in the US. Seeing as how it is not a multi level ADR being done, US surgeons have tons of fusion experience (it's really just the revision that you need to check for). You can watch Dr. Bitan doing a Charite implantation on the Charite website (google it and there is a link). Watching him do the surgery and online research is what made me decide to have ADR. I don't think I would spend the time, money and travel to go to Germany to get a fusion, seeing as how they are so commonplace here in the US and since it is cervical, not near the risk of a lumbar revision.

[phylly]

Steve,
Just an FWI, different doctors consider revision differently. Some do removal and others just fuse over the disc. If you have severe subsidence you may need it removed and not all doctors want to undertake that surgery. I was pretty lucky to have someone take mine out anteriorly. It is a BIG dangerous surgery. I wish you the best.
Phylly

[steve55]

Ill see what Dr peloza thinks. I think the Cervical isnt nearly as dangerous as the lumbar, and its pretty easily accessible.

In the meantime, Mark got back with me. He says Dr B is going to call Dr Peloza ahead of time and update him before I meet with him. So, thats nice he is is trying to do whatever he can to help out. Regarding the price issue, Mark made a good point. How many doctors in the USA or anywhere for that matter offer to do FREE revisions if it doesnt work out? None! Just Stenum only. So, that is something to consider before passing judgement on the price quote situation.

Ive spoken to another Humana rep and she also re affirmed that if my disc is tilting/slipping and there is clear medical necessity to fix it, they will cover it. They wont care that the artificial disc was something they dont cover in the first place. This means I can go out of network with only a $6,000 deductible, and then I pay 30% of their reasonable and alllowable rate. That 30% is likely to kill me if done here in the US. Who knows how high it may go to. However, with Dr B, their prices are so cheap compared to here, Im only going to pay the $6,000 + 30% ($3,600) of the 12K remaining balance, which totals $9,600.

Surprisingly enough, Mark did say that Dr Regan will likely do the surgery at some minimal agreed upon total cost. I think that his getting my $6K deductible plus 70% of the Humana allowables, (and letting me off the hook for the other 30%) he should be good to go. This is the feeling I got from my talk with Mark, if I understood him right.

So, in a nutshell, if Dr Peloza isnt willing to do this at the same rate as Dr B & Dr Regan, then Ill have to decide between the other two. Im inclined to stay in the US though.

Either way, I agree, I have to get this taken care of. My shoulder pain is now EXCRUTIATING! But the pain pills do a really good job of knowcking it out.

[steve55]

Dr Biton called me back already, as I had emailed him with my I phone picture of my x rays around noon. He's a super nice guy as katie said. He said he would work with me on the price so that it works out close to what Id end up paying by going back with Dr B. He said that he felt confident that he could probably waive my 30% in my plan. It seems to me some of these docs are happy even with only the Insurance co's 70% payment. He said he would not hold me to overages or anything the insurance co wouldnt pay for.

He did say that the top disc looks like it has issues too, and didnt think its only because of the bottom disc's effect on it. But he also said that I may not need to do anything about the top one as it's not that bad and as long as its not causing pain, I might be best to just leave the top one alone. Of course its all preliminary and he surely needs the originals and more work up before being conclusive with anything. He did put my mind at ease and said he didnt think anything serious could happen in the meantime, and said he felt the revision was a easy fix due to it being cervical and for me not to stress out about it. So, thats REALLY reassuring.

[dshobbies]

Steve,

Can't comment on Dr. P but I think you have 3 good choices with the 2 Dr. Bs and Dr. R. I think I would trust any of them and since the cost is not too much of a factor anymore, you can stay in the US if you prefer. Though the airfare would be less, the hotels in New York and Los Angeles are a lot more expensive than those in Bogan/Straubing but I guarantee, the TV is better.

If you come to LA, I'll be happy to take you to lunch.

Dale

[Cheryl]

Steve,

I am amazed at how well you are dealing with this. Great job moving forward. I know the calls alone can be ovewhelming.


Best of luck.


Cheryl

[Katie]

I am so, so happy that you were able to touch base with Dr. Bitan so quickly. He did come through like I thought he might

What a relief, with the reassurances he has given you. It must feel like a ton of weight off your shoulders. Take a deep breath, enjoy the weekend, and know you are in good hands, no matter who you decide to go with. Congratulations on sorting this out so quickly.

[steve55]

This morning, I again was awaken early in the morning by unbelievable excrutiating pain in my left shoulder. It's completely bebilitating throbbing pain. It's very severe and something completely different than any pre op pain I ever felt. Ultracet only helps if I double or triple up on it. Dr Peloza's pain mgt doc called in some hydrocordone for me. I came home from work after a fairly descent work day , popped a hydrocordone , and went out to eat with my mom. Everything is fine when suddenly it hits again. It was so horrible and debilitating that I couldn't even stay at the restraunt to eat our food. It must be related to one of the tilted discs, its not even close to the recouperation pain ive had post op.I just hope I don't worsen between now and next Friday as I await to see dr Peloza.Im only waiting on dr Peloza cause I'd prefer to just get this next one done locally if the price is affordable.

I must admit, I was very impressed with dr bitan. I sense he's got the tools to handle my type of surgury and he seems more than willing to make it affordable.

[mmglobal]

Bitan does bring something special to the table. He spent many years specializing in scoliosis surgery (he was president of the pediatric scoliosis society.) This experience gives him a great deal of reconstruction experience. A such a heavy hitter in spine, he gets the difficult cases. I've watched him in the OR and he's pretty amazing with his efficiency and accuracy. The procedures I watched him do were very 'difficult to get right' procedures and he made it look easy to get perfect sizing and placement. I believe that the approach for cervical revisions is much easier and less risky than lumbar because of the small muscles they have to go through and no great vessels in the way. I've watched explantation of cervical hardware and it really seemed to be very straightforward compared to the lumbar revision surgeries I've seen. I think that all of the options you've discussed are very reasonable. I am very hopeful for a good recovery for you.

I have a slight tilt in my upper disc but it's not related to subsidence. It turns out that I was tilted before surgery and believe it's because of my posture and anatomy. When I get home, I will start working on trying to correct it with PT. Let's hope we'll not be brothers in tilt for too much longer. (I've got more time now... you can call my US or German cell, just be mindful of the time difference - pacific time + 9 hours.)

Mark

[steve55]

Well, dr bitan's people said that my humana insurance will not cover ADR removal (which they normally charge the insurers $25,000 for) but will cover the fusion. They said that humana reinburses at Medicare rates. So, they will get reimbursed about $4,000 for the fusion. Therefore, the best they could do was $15,000. Now, what I'm wondering is how is it that dr b's people are quoting me more for this revision surgury than a us doctor who doesn't really have any responsibility for my situation in the first place? If german prices are 1/2 as much as us prices, you'd think that dr b's people should be quoting around $8k for the revision instead of $18k. I don't get it.

I don't blame dr b for my disc failure, and in fact, he did a great job freeing up my nerves as all my pre op symptoms are gone, but I am a bit dissapointed to find that a us doctor (of great reputation by the way) is able to do this revision for less than dr b's team and the us doc bears no responsibility in this in the first place. It seems not right.

I guess this is one example of a situation where a place like stenum would have really come in handy with their free revision policy. After the quote from the us doc, I really find it hard to believe I'm getting any kind of discount on the revision with dr b's group. I don't know, am I missing something?

Anyways, I'll get a quote from my local doc, dr Peloza , this Friday. I have a feeling they won't be so flexible on price as dr bitan's group. We'll see. So far, I am again very impressed with dr bitan's team. They are very responsive and easy to work with. Dr bitan seemed very motivated and interested to help me, and very straight forward too. Mark is supposed to be checking with dr regan for me, but I have a feeling bitan's quote will be hard to beat. I'll need to make a decision by Monday. My left side of my back, neck, and shoulder are in constant pain (level 3-4). The right side is perfectly fine, so I'm confident removing the disc will resolve this. I just hope fusion doesn't create it's own set of symptoms.

[Jessica]

just wondering... not defending... I understand your frustration.
I wonder if there is any difference between the type of revision and fusion between the two docs. I saw that Drs. Fenk-Mayer was referring to some specific cage for your revision. I do not know anything about the surgery you are looking at, I just wondered if that might explain the cost difference.

We all know that Germany is usually less expensive. I spent 4 days in the hospital, as most people here talk about going home same day from cervical adr. Could that be part as well? Is it a comparable time in the hospital? Not that we all like to stay in the hospital any longer than we have to

[steve55]

Good point, I dont know anything about different cages out there. Perhaps I should ask exactly what kind of cage they plan to use? Does it matter? Are some better than others? DO I need to ask specifics as to the name of the cage Dr B or Dr Bitan would plan on using? I know nothing about fusions and the different cages/hardware for them. Maybe MArk or someone can step in and educate us a little bit. Dr Fenk meyerer did not specify what type of cage , she just said " Removal of the ADR. Fusion of this semgnet by a zero-profile cage, which can be fixed with little titanium screws."

[Katie]

Steve, I don't know anything about the different fusions either. I have been told by Dr. Bitan that I will be in the hospital for several days following my cervical ADR hybrid surgery. I realize that is different than just ADR but wanted to add this for you. There was no 'throwing you out the door' there. He was being very cautious with me.

I wish you luck, and have wondered about the costs with the original doctor too, from the very beginning of your posts. It just did not seem right to be charged for that situation.

I'm glad you have found someone closer to home, with a great reputation, to do the job.

[Cindylou]

Steve, I truly am sorry for the predicament you are finding yourself in. I think the prior person raised a valid point that the two surgery options here and abroad likely have differing levels of expertise for what they are going to do, hence price point differences. Boy, I think if I were in your situation, all things considered, I would make every attempt to go back to Dr. B and let him do the revision. He knows your body intimately from the first surgery and he is so trained in this type of complicated surgery. He might see something else while he is in there and adjust the treatment even then. I do know money can and ultimately always is a huge consideration. Me personally? I'd live in a tent, just to be pain-free. No joke. I will keep you in my prayers in these days and weeks ahead while you make your final decision. My very best wishes to you whatever you do.

Cindylou

[dshobbies]

Steve,

This decision is yours and only yours.

to help complicate this decision, everyone has an opinion. Though Dr. B is the go to Dr. if any American doctor can do just as good a job and at a reduced price, why not? The question is, can he do just as good a job? He has an excellent reputation.

Honestly, I don't know what I'd decide. Apparantly, you're trying to decide too.

Good luck, Dale

[Maria]

(not probably more like most definately) Dr. Bertagnoli has whatever type of hardware at his disposal to use for supposed best patient outcome unlike here in the States.. but I don't know what that means re zero profile and how small are tiny titanium screws. This is Mark speak.. he'd know this kind of information.

Actually I don't even know what is available to the US surgeons anymore in terms of type of cages but it seems insurance companies rule too many decisions re what is used re cost here unless you're going cash pay

[steve55]

Originally Posted by Cindylou

Steve, I truly am sorry for the predicament you are finding yourself in. I think the prior person raised a valid point that the two surgery options here and abroad likely have differing levels of expertise for what they are going to do, hence price point differences. Boy, I think if I were in your situation, all things considered, I would make every attempt to go back to Dr. B and let him do the revision. He knows your body intimately from the first surgery and he is so trained in this type of complicated surgery. He might see something else while he is in there and adjust the treatment even then. I do know money can and ultimately always is a huge consideration. Me personally? I'd live in a tent, just to be pain-free. No joke. I will keep you in my prayers in these days and weeks ahead while you make your final decision. My very best wishes to you whatever you do.

Cindylou

Well, the way Im seeing it is that as long as Im going to one of the heavy hitter US docs, I should do fine. I went to Dr B initially because he is the multi level ADR guru and there were so many successful outcomes posted with him, and he has done so many of them while the US docs have done so few. It was a no brainer. But what I need done now is a BASIC fusion, and really, that is not a complicated procedure right? And extracting a disc shouldnt be either as long as you go with a reputable heavy hitter US doc. Dr bitan seems to have done many ADR extractions and Mark speaks very highly of him also. My local doc , dr peloza is also a heavy hitter (he was in newsweek, on german Sat TV and local TV alot), and Mark feels he would be a very good option also.
I think the US options (hardware/procedures) for fusion will be sufficient. Im not a "complicated " case anymore. Even Mark, who many have accused of being too heavily favored towards Dr B, hasnt suggested that I really need to go back to Dr B for the b est possible outcome.

Anyways, this is my take.

Im going to trust Dr peloza's opinion tommorrow when I speak with him. Mark said Dr B was going to call Dr peloza this week prior t o my visit. Dr Peloza is one guy I really feel will shoot me straight. He is really very conservative and doesnt come across as a guy who is looking for business. He never even suggested ADR, I think he would have suggested fusion if I had stayed with him. If he thinks I really am better off going back to Dr B due to better cages/fusion procedures or because he did the original ADR's, then Ill follow his advice. Ill be asking Dr peloza many of these type questions tommorrow.

[mark-perth]

Sorry to hear that your going thru this as well. I know how you must be feeling, its horrible but you seem to be doing amazing in the way you have dealt with this. You have achieved more in a few weeks than ive achieved in months so you are doing great. You have had alot of great advice here so I dont need to chip in apart from support you. Your post has actually helped me alot as well. I too contacted Dr Bitan and have been blown away at his quick response, within a day, thats just amazing. He seems like such a helpfull and easy to deal with surgeon, I understand the comfort you get from him puting you at ease as I had the same response. He cheered me right up today.
From the quote I got from Dr B I'd say that you have recieved a substantial discount although I do agree that maybe it should be less especially if he is still higher than in the US. It seems like he's maybe only charging for the costs that dont go to him like the hospital and hardware costs but not his fee maybe.
Do you know if Dr Bitan's cost of $15000 included the hospital costs or was that just his fee's? Will your insurance not cover any of the costs now or is just the surgery costs they wont pay?

I have found this article regarding the zero profile fusion cages:

A New Stand-Alone Cervical Anterior Interbody Fusion Device: Biomechanical Comparison With Established Anterior Cervical Fixation Devices
Scholz, Matti MD; Reyes, Phillip M. BSE; Schleicher, Philipp MD; Sawa, Anna G. U. MS; Baek, Seungwon MS; Kandziora, Frank MD; Marciano, Frederick F. MD, PhD; Crawford, Neil R. PhD

A New Stand-Alone Cervical Anterior Interbody Fusion Device:... : Spine

send me an email if you want the full copy. It looks like its just a low profile fusion cage that is quite new to the market so may not be approved in the US yet. I would ask what type of fusion hardware they will be using, it cant hurt. Great to see that you are getting it dealt with so quickly and best of luck with your decisions.

Mark

[Cindylou]

Let us know how your appt. went with Dr. Peloza Steve. I think you have a solid plan in place.

My best to you,

Cindylou

[steve55]

WOW! Dr Peloza apparently wanted nothing to do with me. He woudlnt even answer my questions. All he said was "So, what can I do for you today". He would only confirm that C6/7 is subsiding and that C 4/5 looks to be ok despite what appears to be a tilt in the lower plate. Then, before I could even ask him if he would be interested in performing the revision, he blurted out that he had no interest in doing my revision surgury. He was so cold and uninterested up to this point, I thought to myself, "Dare I ask him why"?...... Naaaaa. I already knew based on his demeanor that it would get me nowhere. I then told him I was considering Dr B and a few other docs, and I asked what he suggested I do. He said I should just go back to Dr B and that was all he would say. No adding on to explain why, no expounding further, no nothing, just silence. So, I asked him if he was reccomending that based on the idea that Id have the best chance at turning out better or if he was saying that based on an ethics idea that you should always stick/stay loyal with the original surgeon. Both times he refused to answer me. He just kept repeating his answer and went silent. My next question I asked was if he knew a surgeon locally here in Dallas that he might reccommend if I didnt want to travel back to germany for this. He said he didnt know of anyone and again, went silent. I mean, he didnt want to talk at all, nunca, zilcho! I soon saw I wasnt going to get anything out of him and that this was all a waste of time. Oh, I did ask him if Dr B had called him as Mark mentioned was supposed to happen before my visit, and he said he had not talked to Dr B. Maybe Dr B did call and left a message that went unreturned (it wouldnt surprise me), either way, not a big deal in the scheme of things. Man, this was my doctor dating back to 2004, I had a plasma decompression surgury with him , several epidurals and discograms etc. I mean, Im ok if he doesnt wantto do the surgury, but at least talk to me, tell me something, give me some geniune answers, explain why. But instead he wants to avoid me like the plague, basically behaved towards me like "dont let the door hit ya in the ass on your way out". And I just wasted $230. It was only 2 weeks ago that I had Dr Ziglar at TBI tell his receptionist "Oh, I remember that guy" , as if to say "that sob who chose a German doc over us". Cant they understand that not everyone is independently wealthy and can afford 2 x the price for a surgury? I can understand if there are legal concerns or if they are afraid that they will be sued if the revision goes wrong, heck, they can at least act human and explain that if that is the reason. But thats not what I sense from these docs. I sense alot of resentment in these guys. I mean, there must really be some bruised egos out there. Its sad, really sad to see. And to think I waited an extra week in this horrible pain thinking he would be interested in doing the surgury. Man, was I ever wrong. Anyways, time to move on .....

Talked to Mark today and he hasnt heard back from Dr Regan after several messages, pretty much a sign that he is pretty booked already or perhaps just isnt as interested anymore in other doctors revisions also? Who knows. Im just speculating at this point. I told Mark it was ok, no need to bother with Regan anymore. I guess Im good with Bitan anyways. Seeing how so many surgeons coldly treat their former patients, it makes Dr Bitan stand out even more as just a super compassionate great guy. I guess he is able to lay down his ego and be more concerned about people's well being than anything else.

Ya know, I was so darn confused today between going back to Dr B or staying local with Dr Bitan. Im sure Mark could tell. But late today I started thinking, Mark had said that Dr Bitan has dealt alot with spine "reconstruction " surguries. Of course, he deals with the ADR's also and has done many ADR to fusion revisons. But Im thinking this reconstructive experience is actually a really good thing to have as that has to be much harder to do than just ADR placements and fusions. Not to say Dr B hasnt done similar type work, but again, if I can get the same talent locally, why deal with overseas travel? Plus, Dr Bitan exudes confidence that this procedure for him is very simple and straightforward. I can sense he isn't worried about the difficulty of the surgury or the outcome one bit. Thats means alot to me, and I think it shows the confidence he has in himself and his abilities. This is a good thing. Also, Ill need follow ups, and if something goes wrong, or starts to hurt, or if I need tests done to see if I am fusing, or if I need a bone stimulator, its a easy plane ride to get to him. Cant say the same thing about germany. I get free domestic airfares with delta since my dad is a retired delta pilot, so it really wont cost much to go back and forth to see Dr Bitan. I was also thinking, with my recent experience with my old doctors, if I need help after germany, geez, am I going to get the 3rd degree from other docs too? I sense these docs really hate to work with someone else's surgical patient and I dont want to be treated like that during any follow ups. Ya know what I mean? So, I am no longer confused. I will choose Dr Bitan. The only remaining variable I want to wrap up before finalizing my decision is seeing what type of fusion cage they would use, to make sure its cutting edge and not the cheapo method from 20 yrs ago or something like that in order to save costs. I will ask him about this "zero profile" cage dr B was suggesting to see if he has something like that he could reccomemmend. And, I really dont want to have my hip bone extracted if at all possible. I dont think that should be necessary these days to fuse. Dr Bitan and his team have been very responsive and he is clearly enthusisiastic to perform this surgury, and that couonts for something. And he is one of the heavy hitters too. I just need to call his rep and wrap up my remaining questions/details, and then probably go see him for an initial appointment ASAP!

Again, I have all the confidence in the world in Dr Bertagnoli, and I dont blame him one bit for my situation, and he sure cleared out all my old pre op symptoms. But gosh, I REALLY do HATE To travel so far , with connecting flights, etc. I really want to be within descent and affordable reach of my doctor for follow ups, and I dont want to be treated by a different doc for follow up who will act like he doesnt really care about me or my situation. Ive learned that this is VERY common and I want no part of a poor patient/doctor relationship like that. No thanks!! I felt like dirt today the way Dr Peloza acted so disinterested and unhelpful. I trusted him and trusted that he would at least be helpful and somehwat interested in advising me, especially considering how far back we go. But he behaved just like Dr Ziglar at TBI. 100% uninterested and had nada to say to me.

Thanks everyone for your inputs. All of it helps me to think more clearly about my decisions.

[Justin]

Steve, sorry to hear that Dr Peloza was the way he was. You have a lot on your plate right now and the last thing you need is all of this sideshow nonsense (and down right insensitivity). www.spinepatientsociety.org

You have a hard decision to make--good luck. I do check my PMs. Keep your positive attitude through this, as it will serve you very well post-op.

Keep your head up!

[mark-perth]

Thats just down right rude of Dr Peloza to treat you like that. If he obviously didnt want 2 help you from the start he should have told you that before even seeing you. To take $230 for nothing is so wrong. Ive had several secretary's call me back after making an appointment and cancel it and tell me that they dont deal with other surgeons problems. They seem to find it even harder when you didnt choose them to start with. Its just an ego thing for most.
Just one question for you. What was Dr Peloza original plan for you when you saw him before? Did he recommend Dr Bertagnoli for you?
I was told by several surgeons before surgery before I had my own that I would not get threated in Australia if I went to Germany and would have to go back there.
Im so sorry that you were treated like that, Noone deserves that, especially someone with enough on there plates as it is.
You are lucky that you have Dr Bitan who is fully there for you and will make it alot easier in the future if you need follow ups.
With your concerns with the hardware used, I think you will find that he wouldnt use hardware from 20ys ago but discuss it with him and also ask him if there are any other options available, even if it increases the costs alittle that may be better for you.
Id also search the internet and look at the companies that manufacter fusion cages and see whats available, probable search "spinal implant manufacturers". You may be able to find on Dr Bitans website which companies he uses hardware from which may help.
I used to have a list of all the companies that manufactered implants, ill see if I can find it as that may help in your search of whats available and post it for you.
Best of luck and dont let someone elses ego get you down
Mark

[Katie]

I was told not so long ago that if I went out of country for surgery, to not expect very good treatment here if I needed the help of a NS when I came back.

Since I live in the land of universal health care, I asked if this meant they would refuse to treat me. The answer? Oh no, they would have to treat you under the law, but don't expect them to be happy when they do it, or how good the treatment may be. I wish I had a tape recorder, but I did have someone else with me who took notes.

Since it takes at least a year to get an appointment here, can you imagine how long the wait would be if they were truly 'not happy' with me?

It seems like very few of these specialists have any ethics anymore. I am so glad that you were able to see Dr. Bitan, as he truly is one of the good guys. I am very sorry that you have been put through this hell, and hope that things will improve soon.

All the best.

[Cindylou]

Gosh Steve,

I guess the only good that possibly came out of that visit was helping clear the air and solidifying your decision. What state is Peloza in? I will never recommend him ever to anyone. Unbelievable. I wish you could have asked him, "so, Dr. Peloza, is this your standard code of ethics for how you treat patients? Because right now, I'm feeling like dog shit after this meeting with you. But thanks, or rather no thanks for your time." And then get up and walk out on him. I know. We always think of a good comeback later, but I can fantasize right?
Sounds like you are heading in the right direction Steve and closing in on your decision, and that is the good news.
Like Justin said, keep your head up. You will get through this.

God bless,

Cindy

[dshobbies]

What is it with doctors? Is all of this ego driven or are we truly missing something? A lawyer is happy to take on someone's mess, as is an accountant. I know of no other blue or white collar worker that won't jump in to fix someone else's work. Does the medical profession, or just basically spine surgeons, hold themselves higher than all else? (Steve, I'm not calling you or Dr. B a mess here)

I just saw a new PM and he was happy to see me. People are changing drs all the time with little problems. Even plastic surgeons advertise they're happy to take on other doc's patients.

Personally Steve, I think you're making a good decision, made easier by Dr. P. And just to stir the pot a little, I don't think I'd pay for a consultation where no advice was given. You have a right to expect a certain level or service for your money and you didn't get what you paid for. But then again, I tend to live in a black and white world... not too easy when everything is basically gray.

I hope you get an appointment sooner rather than later and get your surgery schedules without too much of a delay. Then I wish you so much luck and look forward to hearing about your pain free future.

Sorry we're going to miss lunch, Dale

[Maria]

Steve,
I'm so sorry you wasted your time and energy on someone that was as tight lipped and arse'd as Dr.Peloza. I wonder if he's involved in some litagation that has done a number on his head.. or has the bruised ego thing going on but all you wanted was for him to be real.. maybe he doesn't want his words quoted on any forums but then again your experience/consultation doesn't exactly make me feel *warm and fuzzy* toward him either. Oh well, who knows what was going on there but I'm just sorry you wasted your money. Time perhaps not as you learned that this guy wasn't interested in giving you any information or doing your surgery.. so he was knocked off your list the hard way.

That made your decision a bit easier. I hope whatever you do with whomever you do it with will work out wonderfully. That is all that I wish for you~ besides regaining your health post a successful surgery.


Take care, good luck and truly sorry you had to experience that type of consultation esp. if you were paying cash for it.

[Michelle Maree]

Im so sorry Steve,
It sounds as if you were being punished for going to Germany in the first place. He mays well of said "We told you so!"
At least it has made your decision clearer now, and from the sounds of it Dr.Bitan has compassion and wants to help YOU, rather than feed his own ego. (i wouldnt pay Palozo either)

I truly wish you all the best.
Michelle.

[Maria]

We shouldn't be punished for exercising the freedom to make a sound medical/surgical decision and act upon it.. many a good surgeon would likely do the same if he or she were hard pressed and in a similar situation I'd be willing to wager.

My PM is a die hard "there are plenty of good surgeons here in the US so why would you go to Europe??" He gets ticked off when I mention it so I stopped even saying I was thinking about going vs. just doing it here but lately he's now taken to saying things like "you think surgery will help your pain? think again"... that was last week when I mentioned the idea.

He's told me on 2 seperate other occasions he thinks surgery is not the answer for me re my lumbar spine condition..

This doctor has not seen me when I wasn't taking pain medication and how different my personality/presentation can be. Before pain meds I was writhing in pain most of the time, lying in bed crying all day long and wishing that I didn't exist.

So he has seen me pretty well maintained so to speak between pain meds and ESIs. I don't think he has much if any education re what's happening in Europe/other places with newer spinal technology and the incredible recovery stories like some here ~

How'd I get on this topic... oh yeah, not wanting 'tude for exercising freedom of choice. Isn't this country all about freedom? (now I'm really going off but you catch my drift)... losing business is one thing but it doesn't help to make people feel that they "shouldn't" do something when it's a viable option with a much more seasonsed surgeon in the newer technologic advances and where there aren't FDA and insurance barriers/hurdles/rings of fire ...

[Katie]

It's not like these doctors are short on patients, is it? They are all busy and making a good living, right?

Then why are their shorts in a knot? Up here, it takes a year or two to get an appointment just to see someone, let alone surgery, and yet I've been told the same...just try and get someone to look at you if you go out of country. !!

They aren't losing money, that's for sure...they couldn't look after all the patients in their lifetime, so what, other than ego, is their problem? I guess we know the answer to that.

[Michelle Maree]

Could it be because it is a 3 level ADR?

Is prodisc not approved for 3 levels in the US yet?

Excuse me for being uninformed, but maybe that is part of it.

I guess some people think we are volunteering to be guinea pigs before all the studies have been done and confirmed that more than 2 levels is safe and replicatable.

There is always going to be huge risks envolved when dealing with cutting edge medicine especially where the spine is concerned.
With ADR we are all pioneers of relatively unchartered territory.

But when you are in constant pain, dont have a life and suicide sometimes seems like a good option, sometimes we are willing to take this risk especially when we see it has worked for others.

It is easy for others to think you have made a stupid mistake, but have they ever had a spinal injury and been in your position?

Im sad Steve that you were one it didnt work for but I think there is still hope and you will be helped soon.

Michelle.

[Cheryl]

Steve,

I continue to be amazed at how well you are handling this. I've felt like dirt, had the silent treatments as well with these spine doctors. Your feelings really hit home.

Great job, I wish you the best.


Cheryl

[steve55]

Well, some potentially Awesome news! Dr John regan, of Beverly Hills, CA called me Sunday evening at 9pm and we spoke for about 10 minutes. He knew I was about to pull the trigger with Dr Bitan Monday morning for $15K and he said he can do it for $10,000!! (Plus they will also get 70% of my Humana payout for the fusion costs). His billing assistant is working with the hospital side and contacting humana to confirm his Quote. Its supposed to include all fees such as hospital fees, anesthesiologist , his fees, ...the whole shabang. I told him how much I appreciated that and thanked him for taking the time to call me, something very few doctors would do, especially the heavy hitters, Im sure they are busy enough as it is. Of course, it was a result of my urging Mark to contact him for me and ask him to call me. So Mark finally did come through for me in arranging this connection. We'll see if it comes to fruition. I should hear back by tommorrow. My aunt lives in Beverly hills so it would be kind of nice to have her available to watch over me after the surgury. I planned on sticking with Dr Bitan, after all, he was quick with his responses. But $5,000 is a HUGE difference!! And Dr Regan was very cordial on the phone similar to Dr Bitan. So, why would I not save $5,000?

Thanks for all the support everyone. I hope my experience will be of benefit for future patients who are facing ADR revisions.

[Cindylou]

Steve, this sounds like some potentially really good news. I sure hope this comes through for you. Let us know what you find out tomorrow. I do so admire your attitude and pressing forward gumption. Here's praying that pain free days are right around the corner for you!

[dshobbies]

Steve,

I think either dr. will do a fantastic job for you. Staying with your aunt will also help you save on hotel costs.

When is this likely to happen?

[Maria]

Steve,
I had a consultation w/dr.R thru Mark and he was so nice and actually treated me like a *person* vs. just spine case #2999292992999

He knew he was *just a consultation* for me as WC has auth'd surgery with Dr.Delamarter but truly I was impressed with Dr.R's consultation and explanations of things and just overall treatment of his me as a person foremost.

I also saw a PM in that office that was really incredible. He took the history and spoke to me intially.. and the way he looked into my eyes with understanding when I talked about my pain I won't forget. You know when someone *get's it*..

Good luck and I too think either doc would be great altho a $5000 savings can't be sneezed at..

[Katie]

Nuts Steve, I really wanted you to go first with Dr. Bitan Then I could get your first hand opinion about him...that has to be worth $5K, right!

I'm sure whomever you decide to go with will give you great 'service', and I wish you the very best. You have been through a lot, and have had a wonderful attitude about it all. I don't know if I would have been so graceful.

Would it just be polite to discuss this with Dr. Bitan again? I wonder if he could do even better for you? I should get you to do my negotiating

[steve55]

Dr regan's biller says she is still working on firming up my quote. I guess I just have to stand by. Once that is done and if they deliver on the quote, I expect surgury within 2 weeks. I'm a bit nervous though cause she said they didn't plan on my insurance not paying for the ADR extraction. Then she asked me what dr bitan quoted me. I'm not sure why she asked that, maybe she is thinking to up the 10k quote? I told her $15k cause dr regan already knows bitan quoted me that.

I hate waiting cause I'm in pain every day and I think the sooner I fix this, the better. I don't want this bad disc affecting the other levels.

[steve55]

4 days and dr regan's biller is still working on my quote. Dr bitan's person got me a quote in 1 day. It's been extremely frustrating waiting.

[Katie]

Is the money really worth the frustration? Will there be other problems down the road? I don't know anything about this doctor, but I am very frustrated for you.

Please continue to vent here, like I do...these forums are a blessing!

[mark-perth]

I know how it feels to be waiting on quotes. Thats such a hard thing when U just want 2 proceed ASAP.

Please dont take this the wrong way but isnt it about time to take the 100% success out of your signature line. I wouldnt count 3 months as a success, I understand U felt great for 3 months but thats definately not worth having major surgery for 3 months pain relief. if 1 disc is OK maybe thats more like33% success .

Hope U get your quotes soon. I dont think I would have waited, especially as I know first hand how great Dr Bitan is to deal with. I doubt there will be alot in it and I wouldnt be worried over a few $. Great service is worth paying more for. If Dr Bitan is that quick to help you now, he would be just a good if there are any problems later. Thats always a consideration especially as he is also closer but it depends who U have the best gut feeling for.
Best of luck
Mark

[dshobbies]

Steve,

Yes, the waiting game is frustrating regardless of what you're waiting for. I disagree however, that it isn't worth the wait.

Only you can make this decision. Dr. Regan has an excellent surgical reputation as does Dr. Bitan. I believe either one will do as good a job as the other. If you don't have a personal preference and can save $5000 plus hotel costs in Los Angeles, then yes, wait a few days more. Dr R's office staff may be waiting for confirmation from hospital, other doctors or whatever. Dr. Bitan may just know that everyone will come on board if necessary. You might want to call Dr. Bitan's office to explain your situation and see if they can't do better.

Personally, I was born and raised in Brooklyn and now live in L.A. If I had to travel,

This isn't exactly a heads or tails decision. All things are not equal.

Hang in there, Dale

[steve55]

Thx for the opinions everyone. Well, dr regan's biller still hasn't come through. She's been quite evasive in her replies to my questions, she has no eta for me either, when i call her about it, she won't give me a straight answer. She hasnt replied to my email I sent since Thursday. I have no clue what's going on. I've sent mark our emails so he can see what I mean. Maybe he might step in and get to the bottom if it all. Dr regan was shooting for 2 weeks to get me into surgury, here I am 1 week later without even a full quote yet, and not knowing when it will come. Yea, I appreciate dr regan's offer to get me in with a discount, but I don't think he counted on his biller person to take this long. What's worse is that for the first time, my hands are getting numb. Just great. Waiting on Peloza cost me a week, now this biller has cost me a week and still counting. $5,000 is a big difference but it won't matter if regan's biller can't get me a quote before I fall apart. I'm hoping mark can help out and see what her problem is, though not that he has an obligation to.. I'm just about ready to bite the bullet and get done what needs to be done with bitan. $5,000 difference is no small amount, i'm going to call bitan's biller Monday and see what can be done. I'm at the end of my rope dealing with this woman.

Markperth, I can see what you mean but dr b did get rid of all my debilatating pre op symptoms, I think he did spend a great deal of time freeing up my nerves. So, I still like the "success but needing revision" signature. Perhaps I could remove the word 100%.

[Katie]

Just to give you a head's up...Dr. Bitan is away till the 10th. That's not far away, and they can probably touch base with him if need be, but thought you would like to know.

Keep trying...you are much farther ahead than I am.

Plus you never know if Dr. Bitan will match it, if you don't ask

[SandyW]

Steve,

Just read your entire thread - OMG. I understand your feelings concerning Dr. B, I feel the same. BUT what caused this? Has anyone explained ?

Also want to add to your thread about some, not all, of our US surgeons with hugh egos. And will update my experiences with facet pain blocks after I catch up reading all the new posts.

Sandy

[steve55]

I continue to get nasty surprises in my search for a US surgeon(sigh). Dr Bitan's biller has now said that the $15K DOES NOT cover the entire procedure and that I would need to add on my 30% copay for the Anesthesiologist and the hospital. If those 2 are out of network, and I know for sure the Anesthesiologist is, then when they bill me at regular insurance rates, Im sure (well, Im presuming )the cost will jump to a total of $18-20K at minimum? I guess I did not think to clarify whether her quote was for the entire procedure. But when I spoke with Dr Bitan, we talked about this 30% co pay and issue and he thought we could waive the 30%, he must have meant his fees only. Though I did not get the impression that that was what he meant. When a patient discusses cost of a procedure, one would think that the doc or biller would presume that he or she obviously talking about the total cost. We as patients really need to spell it out I guess. I just didnt think I had to be specific, I mean, why would I as a patient only be concerned about doctor fees when discussing getting a quote? That wouldnt make sense. This all may turn out to be pie in the sky quotes in the end. We'll see though.

Dr Regan's biller is waiting for my insurance before going any further, but yet she wants me to start on getting local lab tests done here in the meantime to speed up the surgury date. But before incurring those costs, I think I shoudl wait for the final quote. If Dr Regan's quote comes in too high also, then Im going to have to bite the bullet and go overseas again. I hate dealing with the hassles of travel and fionding a different doc to do follow ups.

On a interesting note, one of Dr B's staff memeber emailed me asking me if I would like to meet with Dr B here in Dallas as he is passing through DFW airport June 20th. I thought that was nice to offer, despite they already know I plan on going to a local surgeon. Who knows, I might yet end up going to Germany after all. Seems Dr Bitan's quote is out of the picture now, and just waiting to see if Dr Regan's $10K estimate will come through. If it ends up significantly over that, I may as well take Dr B 's $18K offer and after insurance out of network $6K deductible and my 30% co pay of $3600 on the balance, total cost will just be $9,600. Im willing to pay a little more to stay in the US, but not more than 5K more.
Again, I would love for Dr B to fix this, but I honestly hate to travel so far again, man, connecting flights (cant fly direct 1st class on miles) and the wait time inbetween the flights, and dragging luggage around all these airports when HURTING, man it sucks to travel. I cant eat that german stuff they feed you at the hospital either.LOL. Only the soup and yogurt were edible. I was living off of Twix candy bars every night last time. LOL

Continuing to wait (sigh).

[Katie]

Steve, maybe it might pay to talk to Dr. Bitan in person about this. His people don't always know that he's spoken to a patient and made other arrangements. That happened to me, although it wasn't about billing. I would give him another chance to clarify things.

I haven't gone back to check, but was Dr. B's cost in Germany going to be $18,000 or Euros? I got confused about that once....but you probably are more on top of that than I am.

With all the travel costs (and the 'price' on your body with flying), would it really be that much more? I hear the frustration in your posts, and I'm very sorry that you are going through that. But it could be worse...you have three doctors to choose from Not many of us can say that!!

We are hoping for the best...keep on slugging.

[fuzzy]

Let me tell you, its worth the travel, it really is. Do you have a travelling companion? Is someone willing to travel with you? Keep luggage to an absolute minimun and have the travel companion carry your carry on stuff. One suitcase for both. Thats what I do. It can be done. I have done it and will do it again. I bet the over all cost will be less or close. Dr. B. did your surgery, let him do your revision. He is world class. The food? There's got to be a way to handle that, even if it means Twix, but I think the food is very good there.

Regarding the costs in the US. It is REALLY hard to get a complete total estimate and NOT get a surprise afterwards!!! They will not be able to beat Dr. B. offer.

Edit: I would like to add that Dr. B. is most likely doing your surgery for FREE and what you are paying for are the hospital costs. Your offers in the US are most likely surgeons fees only and do not even include all the other costs. Buyer beware...

[steve55]

Katie- Yes, I did tell Dr Bitan's biller that it was my understanding that he was thinking of waiving the 30% on everything, and I asked her to check with him again. In her reply, She didnt clarify if she did personally approach him about it, she just reconfirmed it did not. I guess I can make sure whether or not she actually personally asked him but she is saying he did not mean that.


Fuzzy- No, I have no travel companion who can take off work and help. The previous one cant take off work again. And even if I had someone, Id have to spend alot of extra money for their airfare, food, and hotel. Why do that if I can avoid it. Also, it sucks to drag your luggage in connecting flights , the airlines do not ship the luggage straight through, you have to go claim it in Canada and tout it through the airport. Then I connect thorugh London, tons of walking and waiting. It was killing me on the return. I imagine fusion will be even worse recovery than ADR. Having a 3 hour flight coming back sure beats a 20-24 hour total in transit time. The waiting and going through long security lines at london and canada and in florida killed me!! I dont want that again, especially on the return leg. I REALLY feel hesitant to deal with all that after fusion surgury. And Ill pull my hair out sitting in a hotel room for a week with 1 english channel at the hotel. Last time I had my best friend with me and it makes a huge difference, time passes with good company. I never did really find food I REALLY liked in Straumbing. Seemed every restraunt had a german twist on everything, even the lasagna at the best italian restraunts (I tried them both) and did not like either dishes. And I did not like the hamburgers either. They were extremely different. I ate a hamburger at the American 50's nastalgia joint and it was horrible and made me feel sick actually. Although I did like the hotel breakfast buffet VERY MUCH. That and mcdonalds was the only thing that tasted familiar. Im a picky eater I guess. The hospital food was often bologne type slices and little soft sausage thingies, and bread. I coudlnt eat any of it. Once in a while the dishes were sometyhing I could eat or even liked. Mark has ideas on how I can get better food, but that just solves one of many issue I wish not to experience again.

I would love for Dr B to do the revision, but if a equally competent doctor can do it locally at a similar cost, I just cant see myself putting myself through all that stuff in germany again, especially without a travel buddy this time. If I gotta sit in a hotel for a week, at least with a American hotel I can pass the time with great movies & TV channels, and 24 hr room service anytime Im hungry with great food Ill always like. Thesientore doesnt have a all day restraunt nor room service,... I had to venture out anytime I needed food other than breakfast. If my buddy wasnt there to go out and buy snacks that I could eat in the early days, gosh, I might have starved cause I was in no shape to go out and do it all myself. Maybe all this sounds finicky but after surgury, you really want to keep things as simple and accessible as possible. And my Aunt will be there to back me up too.

Im going to really line up all of Dr regan's estimates and make sure there wont be any potential surprises. I should know something within 2 days. If I feel they cant deliver, I guess Ill have no choice but to go back to germany.

[dshobbies]

Steve,

I agree with pretty much everything you say. Traveling alone for this surgery would make going to Germany very difficult. But... complaining about the food when it's only a couple of weeks out of your life. You sound like I did when I was looking for an excuse to stay in the U.S. The fact remains that you'd rather stay here. Traveling is difficult, the boring entertainment is lousy but suck it up man and eat what you can

Hope Dr. R comes thru for you - Dale

[fuzzy]

The travel companion is important. There are many times when its very helpful. I did have a fusion with my own bone there and that hip was very bothersome for a while so having someone to hold on to if need be was very good. I understand about airline transfers and would limit that to 1 transfer on the same airline, no fancy back and forth. Usually that can be had for not that much more. But maybe you have to fly with a particular airline (free, miles)?

The food would be another reason for the companion to scout arround and find things to make you feel more comfortable. I chased my wife to those awesome grocery stores to buy me my favorite foods. If you were my friend and were close by I would do it for you but you are a little far and I am actually in a similar situation, facing another surgery myself.

[Kraze Kat]

Where in Germany may you be going? Depending on how self sufficient you are, I have a spare room (though I probably will not be much help, as I am in the same boat). I eat American food, watch American (and British) satellite tv, listen to American radio, and yell at my cat in English (unless he's been really bad). It depends on the area of Germany you will be in. I am about 3 hrs from both Munich and Frankfurt (by car), with an international airport with a direct flight to Atlanta. (sorry that is the only direct flight to the states from here)

[Katie]

Sorry Steve, I wish I had more to offer. It is so frustrating when all the red tape gets in the way of getting what we need. It sure sounds like staying in the States would be better for you...stress can really interfere with healing. I hope you can make it happen.

[mark-perth]

I was worried that they may increase the price and were just talking about the surgeons fee's as I said in an earlier post as this has been my experience. Ive also heard that the hospital cost in the US alone are expensive, I thought that was 1 of the reasons why people went over to germany in the first place. I also said in an earlier post like Fuzzy that I feel Dr B has waived his fees and only charged for the costs that are not going to him like the hospital and fusion hardware. That was just based upon my quote from Dr B for my surgery. Did they itemize the quote and if they did maybe ask if Dr B would waive his fee if there is one. The big difference I found with the Germany quotes is everything is usually included on it and itemized so you know exactly whats included and how many days in hospital and have an all up cost. Most other surgeons are just talking about their fee then you have the anaethetist, hospital costs, implant costs, medications etc etc. The worst part I find is that they are all just estimates and if the surgery takes twice as long and you stay in hospital longer it costs you more at the end which you havent planned for and must pay before leaving there.

I do think you have taken this extremely well and looked into your best options and it is so great that you have 3 choices. I know how hard it is waiting for something when you are like you are, you just want it done immediately but it all takes time. Did Dr Bertagnoli tell you how long you would have to wait for surgery? Was he going to put you ahead of others? I know I was told that I needed to pay 3 weeks before the surgery which meant I would have had to wait at least 3 weeks for surgery.

You are extremely lucky for the offer to meet Dr B at the airport, it shows that he is concerned about you and obviously would like the opertunity to correct the problem. If this is not 2 far from you I think that would be a great opertunity to see him so he can see you for himself and maybe ask him in person if he would do the revision for free or cheaper. Maybe he can do it as a teaching case to be able to waive the costs for you. That may also mean that he wouldnt be able to operate on you for sometime if he is away. Did they say he was away for long? It doesnt look like you will get a final quote and date for surgery before then anyway. I have been told I have an 8 week wait but my disc hasnt subsided like yours so its no great panick aslong as I rest. Are you still managing to work? If so U R doing amazing.

I definately understand your concerns with travelling back to Germany and would also stay closer if possible, it would be worth the extra costs. I think also a fusion will be alot worse than an ADR. After the ADR you are allowed to move alittle but after a fusion need to take it much easier and the long travel by yourself would be horrendous. Is there any chance that your aunt who was going 2 look after you in the US would be able to come with U if you did go back there. I know it adds onto the cost but is definately needed to ensure a proper recovery. The other thought would be to go in a wheelchair if you did go back to germany. At least then you would be helped and looked after hopefully.

I hope that you get some answers soon but I would definately keep questioning that it includes all costs associated with the surgery. You may be able to work out what costs are associated from your initial surgery costs because surely that would have similar fees or atleast state what fees to expect.

Stick with it all, you are doing everything you can and going about it the best way possible.

Take care
Mark

[steve55]

Well, it looks like I'm finally going to be on my way! Mark jumped in and re-kick started things with dr Regan's insurance precert person. I had waited 2 weeks with no satisfactory updates and I begged mark to intervene to see why they are taking so long and not providing any ETA either. After mark called her, lo and behold suddenly things started happening again. The precert lady said that humana had lost her precert request as it got hung up for a week in some fax basket over at humana. ( yea, whatever), I'm thinking, even if this is completely true, if she was following up properly, we could have corrected this a long time ago. If I wasn't in so much discomfort and experiencing numbing hands, I wouldn't be so impatient. Mark thinks he didn't do anything special except ask her what was taking so long, but still, he got this thing moving again. Since mark's call a few days ago, I've made tremendous progress. I've pretty much pinned down all the costs within each division, and by golly, unless I'm being misled, it looks like dr Regan is going to truly deliver his estimate!! Possibly come in under near $9,000. If this ends up true, it will show that dr Regan has a good handle on his estimates as compared to dr bitan. Bitan's quote of $15k was only his fees. And kudos to dr Regan for not upping his estimate even after they found out that humana won't cover ADR removal costs. Personally, I think his biller was going to increase the cost cause she did mention it would cost more if insurance did not cover it, but I did tell her dr Regan personally quoted 10k Sunday night, and I bet she consulted with him about it and he probably told her to waive it. She seemed certain it was going to cost more but it never did in regards to his fees, but in is supposed to slightly increase the hospital fees. The hospital was willing to take just the 70% insurance payout but now that is expected to change a little to where I'll have a little out of pocket on that.

I'm going out on June 23rd and surgery is June 25. One problem though. I have a feeling I'm going to need c4/5 removed and fused also. I mean it's clear as day that it is also well tilted with the bottom plate sinking. Mark now is thinking the same thing after getting a closer look at my x rays I mailed him. I meet dr b Saturday night at dfw airport and I'll let him look at my x rays and take his opinion along with dr Regan's and do what needs to be done. I hope the c4/5 subsidence is within tolerable limits so I can keep that disc. I don't like the idea of fusion at such a mobile upper level. If I need 2 levels done, I've been told I'll have to fly back home and wait again for new precertifications (ughhh). Anyways, I'm still working full time and just dealing with the pain. It's really draining the life out of me same as preop, super hard to get out of bed. Weekends I just lay in bed all day mostly. Hands usually 30% numb too. I'm not in good shape at all, but at least I'm able to work still. I need the $$$.

[steve55]

Forgot to add,....Kudos to dr Regan getting me in so fast!! I only confirmed my surgery date yesterday. As busy as he is, Im thinking they must have made a special exception to get me in so fast. Part of my conversation with dr Regan that Sunday night was that I was also weighing how fast he, dr bitan, or Bertagnoli could get me in. He said it would only take 2 weeks. Given it's been 2 weeks already, he must have wanted to honor his initial quote in that regard also. Im just speculating of course. I'm really appreciating how dr Regan is keeping to his word in every way. I really have to think he is pulling strings in costs and date, he is to popular to be having such immediate surgery dates available. Just my thinking.

Oh, and I go in to my local family doctor tommorrow morning for all my prelab tests.

I still can't believe I'm having complete ADR meltdown in two discs. Ughhhh!!! Why me??? I went to the best!! I haven't read any of dr b's cervical, or lumbars having subsidence issues and I read maybe 30-50 patient stories. I'm that 1 dam outlying statistic I guess. And hell I got strong bones, I played football junior high through high school, played c league ice hockey, I motor crossed and had many wipe outs. NEVER have I broken a bone! And ive drank 2 gallons of milk per week throughout my life. But for some dam reason my spine bones must be like soft puddy. Well, at least I don't have cancer right? That's how I manage to stay positive. I'd rather have spine surgery than so many other diseases Im darn glad I don't have. The sugery itself doesn't bother me much, it's the fear of not fusing properly or not becoming pain free afterwards that scares me. I've heard too many people still in pain up to 6 mo to years after fusion. On the positive side, dr b did a absolute terrific job on cleaning up my nerves. After all, dr b did specifically mention that my normally 3 hour surgery took 6.5 hours due to his having to free up my nerves. I was 100% pain free for about a week until this subsiding disc started hurting me.

[dshobbies]

Well it's about time! Glad things are finally beginning to move forward. I don't know why 'lost' papers can't be refaxed, remailed, re-anything. My comments are not printable. But, good news on top of the bad.

One question - I thought Dr. R operated out of either Cedars or Doctor's. Has Humana taken over Doctor's which I heard had gone bankrupt? Where is this hospital?

Whatever, you're only one week out and I wish you the very best of luck. Perhaps not exactly what you want but at least your pain will hopefully be history.

My fingers are crossed, Dale

[Michelle Maree]

Glad to hear things are moving full steam ahead for you Steve.
Thanks for the post,
Michelle.

[steve55]

Well, I met with dr b for about an hour in the baggage claim area at dfw airport. It turns out he was at the tx back institute just 3 minutes from where I live and if he had known, I could have met him there. Oh well. The airport suited us fine. My main purpose in meeting with dr b was to get his opinion again regarding the c4/5 ADR, especially if dr Regan might recommend that I need 2 levels revised. I really wanted two opinions. But as it turns out, dr b said he recommends I hold off from surgery and give my body a chance to correct itself. He says the subsidence isn't that bad and now that he has a 2nd set of x rays to look at, he can confirm it is no longer subsiding. Needless to say I was shocked. Here I am looking forward to surgery in 5 days and even already paid dr Regan a $3500 deposit, all based on dr fenk meyer's email telling me to fuse NOW. And now the spine god is reversing directions and telling me to wait and see for 5 more months. So, what else am I to do but follow his advice? He wants to see if massage therapy and physical therapy and time can resolve this pain. He says I'm not in any danger of nerve damage and that the episodes of mild numbness in my hands is not something to worry about. He also suggests I get a MRI and CT scan to get a better view of everything. What's odd about all this is that the original email I got from dr fenk meyer said dr b had reviewed my x ray and reccommended immediate surgery due to risk to the middle ADR if I continue to subside, and risk of curvature of the spine called kiosis or something like that. I think his current thinking is that because the x rays show I'm not subsiding further, we can afford a wait and see approach. Meanwhile, he wants me to take ibuprofen, lyrica, and therapy to try to keep the pain at bay while we wait to see if the body somehow adapts and fixed itself.

And he recommends I see dr ziglar or guyer at the tx back institute. I told him that dr ziglar already turned me away with his secretary/receptionist remarking "he remembers you and he doesn't see other surgeons patients". Dr b said he would get me in to see dr guyer instead. My best friend came with me and we all three got a good chuckle at the idea of a resistant dr ziglar cutting on me, LOL. Not the ideal situation. LOL. So, of course I cancelled with dr Regan for now, but I emailed him explaining everthing and thanking him for all he did, and told him, I may yet still need him down the road, and that I still would love to have an opinion from him once I gathered a MRI and ct scan along with my x rays for him to look at. I really wonder if dr guyer and dr Regan will agree with the wait and see approach. I would have thought a fusion surgery 5 months from now would be more difficult than doing it now due to the ADR cementing in position even tighter. But dr b says it doesn't matter.

Oh well, I can agreed it's best to be sure before jumping into surgery. Dr b did say that as safe as most spine procedures are, such as fusion, you never know what might go wrong. He said surgery is always high risk and should always be considered a last resort. Dr guyer is top notch and I believe dr b and him together will guide me in the right direction. I'll try to wait this out as long as the pain is held at bay. So, my saga continues after all. (sigh)

Lastly, he did say my c4/5 is perfectly fine. He explained the obvious slant of the lower disc plate being due to my natuural vertebrae slant. Strange, but ok.

[Katie]

That's all I can say. After all the other consults, including his own, that's what he comes up with? Holy crap.

Sorry Steve, god or no god, what if he is wrong, and further waiting will make this damage permanent? I understand your wanting to believe him, but has Dr. Guyer seen your case? What happens if he (and Dr Regan) disagrees and then you are perhaps stuck with a much higher bill or worse? I would have perhaps checked before canceling that quickly .

I am terribly sorry to throw this opinion out there, but no one else at the beginning thought that this was much to worry about since Dr. B did it either. Perhaps he doesn't want to admit to any 'mistakes', even if they weren't preventable? I'm playing devil's advocate here for your benefit.

Again, I am so sorry that you are in this position, truly. But in your heart do you truly believe that leaving your spine that crooked is good in the long run? Even if the numbness subsides, what is going to happen in ten or twenty years? What about the damage to additional discs from that pressure? He hasn't answered those questions for you, has he?

As to the 'obvious slant of the lower disc plate being due to my natuural vertebrae slant', was that really there before all this went wrong, or even before surgery? Take a hard look at that. I still believe in going with the multiple opinion theory and not jumping too fast.

Again, I may be waaaay out of line here, and I apologize for that, but I am truly worried about this decision. It sure doesn't feel right in my gut.

[dshobbies]

Wow Steve,

And the saga continues. I really thought about this and though you never really know what you would do in a similiar situation unlil actually faced with it, if your most recent x-rays show any sign of improvement, that says a lot. I doubt Dr. B would offer bad advise to save face and if waiting will cause no further damage but might spontaneously correct itself, then I think I'd give myself a little more time. If massage and pt help with the pain... well you must be thinking all these same things yourself.

The question, how much time is he talking about? Another 3 months might be reasonable but longer? How much longer?

It's your back and your decision. Making the right one . You just want to scream.

Good luck and keep us posted. Dale

[Michelle Maree]

Hey Steve,

Just checking in to see how you are and if you have made a decision on what course of action to take.
Hope you are doing o.k.
Michelle.