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Frustrated, in pain, running out of options.
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| iSpine Discuss Frustrated, in pain, running out of options. in the Main forums forums; Hello fellas: I'm a 32 y/o firefighter who's been battling with DDD to my lumbar spine for ... |
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02-28-2013, 02:54 PM
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Frustrated, in pain, running out of options.
Hello fellas:
I'm a 32 y/o firefighter who's been battling with DDD to my lumbar spine for about 8 years after an on the job injury. As of the last 21/2 -3 years ive develop severe discogenic pain. Thankfully not sciatic pain unless I spend a long time sitting which I can never do bc sitting over 20 mins with the back pain I'm experiencing is a big no no. I have herniations and annular tears on L4 thru S1. Had a discogram to confirm it and it was positive. my L2-L3 is also showing sings of DDD. With that said I went to a very prestigious Dr in Miami (I'm located there) and he recommended a MI TLIF to L4-S1. I'm telling you right now. Not gonna happen I refuse. This would mean I can't be a firefighter any more besides affecting my activities which I have not performed in over two years anyways but had the hope that some day thru the advances of medicine(joke right) I'd be able to do. ( as far as I know there's no issues with my facet joints and my bone density should be fine) Enter ADR. I found out about this great option(granted not always successful but then I could live with the fusion knowing I tried everything and gave mysef a chance) Since Live in Miami I read around here and did some more research online and discovered I have a very good ADR surgeon in my backyard. Dr Rolando Garcia. Well as my luck has it I requested a Dr change to my WC manager and requested Rolando Garcia. All great but there's an issue. Garcia only takes WC that do pre-payments. Well my WC doesn't do pre -payments. So I just received the news from the case manager and I'm so depressed after hearing this. I really had my hopes on Dr Garcia. So now I ask the more experience people in here. Do you recommend or know any other Dr's the do ADR in South Florida? I went to my own Dr as well and he also said "after exploring all other non-invasive options I may have to consider surgery although he doesn't usually recommend it". I've had therapy, cortisone shots, rest, pain meds don't help anymore other than make me sleepy. I was a very active person. Water Polo player at a very high level, use to mountain bike all the time and take my dogs (4) out all the time. This all started to faced out of my life little by little and now I'm just a couch potato. I'm tired of living like this. I want my life back so any help you guys can provide I'll listen to. I've also looked at the M6 overseas but this is not a feasible option right now due to my financial situation. Sorry about the long post. 
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02-28-2013, 07:54 PM
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sounds like
Your on the right track with what you're looking into and hoping you are a candidate re ADR surgery. I don't have any suggestions re surgeons doing ADR in your area tho I have heard great things about Dr.Garcia. I do hope someone here will reply to you or you may want to address your request to Mark (mmglobal).
Would you consider traveling to another state to see a surgeon that does ADR if your WC was accepted w/o being pre paid? Good luck... I too "once was" very active. I'm a retired RN,NP and while I did have the opportunity to have a 3rd spine surgery and even a 2 level ADR I didn't take advantage of the opportunity. However I was already about 54 by then. Wishing you the best! Maria
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02-28-2013, 08:05 PM
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Thank you so much Maria. Answering your question about traveling is a definite YESSSS!!!! I'd travel anywhere where my surgery was covered with a reputable/experience ADR surgeon if I'm in fact a candidate.
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03-01-2013, 12:14 AM
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First thank you so much for being a fire fighter. I would hate to see you have to stop doing your career. It is bad enough when we loose out outside activities. I have had extensive spine fusion surgery. I have as of right now lost just about everything i did and it still is upsetting. I used to be a trail runner,then downgraded to a hiker (that was because of a hip replacement) and am still upset by it all. I am just getting started trying to walk again. But a lot of my problems stem from the fact that i broke my neck . I did have neck fusion of 3 levels and did fine with it until a fall which did my neck in.
Now i am fighting with my lower back. I was never a candidate for ADR do to poor bone density. Have you had yours checked to make sure yoiu are a candidate? I would think that would be a good step. I don't have any info on S Florida or other surrounding states or Workers comp. I think you will have to make a lot of calls to see what is allowed . Then find doctors, hopefully who would take you and i see here you are investigating. I hope someone comes on to help you more. Oh and don't worry about a long post, look at mine!! judy
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2007 ACDF 4-7 2008 hip , knee scope, hip replacement 2009 thoracic T-5 thru T-11fusion 2009 VATS T7-8, posterior only T11-12. removal of thoracic hard wear 2010 lung surgery 2010 T2-L2 kyphosis correction 2010 Kyphoplasty T-3, T-4 2011 Cervical osteotomy ,revision C4-T5 2011 Foot surgery 2011 Revision fusion T7 thru L4/laminectomy 2012 Hammertoe correction left foot 2012 Revision fusion T-12 thru L5 2012 Revision fusion L4-L5
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03-01-2013, 02:36 AM
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Thank you guys for replying and the positive thoughts.
So here is the deal with my WC and why lots of Docs won't take our WC. I work for the biggest fire department in the Southeastern US which is also part of the whole Metropolitan Dade County so we are self insured(boomer) well as luck has it last year around may our WC changed to a different program. Now they are behind in paying their bills bc of the whole conversion. Since they haven't paid basically most of the Docs since May 2012 most of them either ask for pre-payment or simply avoid my department at all costs. Lucky me right? This is the explanation I got from my case manager. I begged her and cried on the phone with her to please do anything within her power to help me reach an agreement with the Dr's office so I can be seen. She has apparently contacted the office manager for Dr Garcia and is trying to get an agreement of some type bc they keep saying they will absolutely not pre-pay(this suck). Truth is I'm not very optimistic at all. Regardless I have to just sit and wait. Again thank you all.
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03-01-2013, 05:42 PM
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re pre payment
I moved from CA to FL back in 7/2003. I had CA WC future medical benefits since the mid 80's so anything related to my low back was paid for by WC and no other insurance. Before I moved I made sure that I had some providers lined up to see me re Pain Management.
When I did move to FL and went to the PM's office they then said that they did not take out of state WC and I would have to "pre pay." My WC didn't want to deal with this so they wouldn't agree and I couldn't have afforded it anyway after buying a home in FL right before moving there. So then I tried 200 PM offices and no one would see me except for this one PM in Tampa who seemed to take everybody (like a mill) and he was the only person that would take my WC insurance. I saw him for over a year and then he wanted me to switch from getting lumbar ESIs to facet blocks even tho I did well with ESIs and had no radiologic reason or evidence to be getting facet blocks. My WC wouldn't approve it anyway so then he said I had the worse WC insurance and no one trusted out of state WC so if he didn't see me no one would. Right around then my husband got a job back in CA and we sold the house and moved and I was ever so glad! So even back then offices were asking for pre pay tho I guess it had to do with not trusting they'd get paid. My Nurse Case Manager back then assured the offices they'd get paid and at a higher rate (CA WC rate of reimbursement vs. FL) but it was "no deal." Out of state there is Dr.Bitan in NY I believe and CA has many surgeons that do ADR tho first you'd have to see if your WC will pay for you to be seen out of state and if the surgeons take out of state WC or WC at all. I wish you the very best and thank you as well for what you do for a living! It's weird tho I don't understand not wanting to help people that are in helping professions to get better and fighting over $$$ and then ending up using up more WC $$ just fighting us to get better and have our lives and professions back. Makes little sense to me...
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03-01-2013, 07:20 PM
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Again thanks far all the replies. It's been helpful.
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03-02-2013, 02:58 AM
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I am so sorry that WC is such a mess. Especially yours not paying providers for several months. It is also hard to fight when you are in pain. I had to fight with Aetna for surgery to fix my broken neck. I couldn't lift my head up for months waiting for the idiots to approve the surgery. It was clearly broken on the x-ray. At the present time i am again in a fight for a medication since last July. It is a big boring mess at this time.
I used to run to deal with great frustration like this , but my hip replacement made sure that is not an option. I feel for you and being so young and basically i think your hands are tied. I don't know anything about WC could there possibly be some little rule that would make things in your favor? I am just hoping. Good Luck and let us know if things change or just come on to rant , i sure do. judy
__________________
2007 ACDF 4-7 2008 hip , knee scope, hip replacement 2009 thoracic T-5 thru T-11fusion 2009 VATS T7-8, posterior only T11-12. removal of thoracic hard wear 2010 lung surgery 2010 T2-L2 kyphosis correction 2010 Kyphoplasty T-3, T-4 2011 Cervical osteotomy ,revision C4-T5 2011 Foot surgery 2011 Revision fusion T7 thru L4/laminectomy 2012 Hammertoe correction left foot 2012 Revision fusion T-12 thru L5 2012 Revision fusion L4-L5
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03-02-2013, 01:40 PM
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lawyer up
I 'know the laws in your state, but would think w/c has to find you a doctor to deal with your injuries, a layer is the best bet, I found one on the super lawyers search, they would have to have a list of qualified doctors, are you in the union, contact them and they should have attorneys or ombudsmen who can you can consult, if you are(union) they are given good money to represent you, get a hold of you state w/c for some advice, contact your state representative, turn over every avenue you can, you are a first responder and a person who runs in to danger and not away, one of our local heroes, they have and need to take care of those who serve the people, jmho
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03-02-2013, 07:54 PM
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Thank you guys for the replies and the advice. It's all well taken and appreciated. This is the first issue I've had with WC and since I have a very good relation with my case manager I'm gonna let her try to work something out which she promised she me to try everything within her powers to get it done. So that's a plus. So as of now I'm gonna give her a chance. If that doesn't pan out then I will follow your advice guys. Thanks so much for the support.
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03-02-2013, 10:56 PM
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watch your back, they are all sweet and kind right before they stick it to you, mine was that way too, but you may have a good one who knows, remember they are for the insurer not for the worker,,,,,,
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03-03-2013, 03:13 AM
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I hear you brother. I'm keeping a watchful eye. At this point I haven't reached the end of my options before I go the lawyer route yet.
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03-03-2013, 04:35 PM
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I had to go to their doc. and their doctor has an opinion on my condition, he wanted a qme to do the reports on me, because he was my primary, they refused and refused, so when he finally did it himself, the disagreed with it, he didn't like the way they were handling my case, and and now they say oh no, we don't like what you are claiming, now they want to send me to one of their qme's who probably will side with their opinion, so I said I better get some help, because I don't know the way it works and how far I can trust them, so I contacted a superlawyer that does comp as a specialty, I have done a lot of searching as to how comp has screwed with people and people are decimated because how their case was denied, and they held back funds because of reports they had from using qmes that were suggested from their adjusters, but, that is just my opinion, not fact, I don't want anyone to think what I say is factual, just my own interpretation,,,
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