Re: I got a copy of my records from Dr Bridwell today/Suzanne

[Guest guest]

WOW Suzanne. I feel your pain over those notes, I really do. I don't

think I'll be going to see Dr. B any time soon. I believe someone

else complained that Dr. LaGrone made similiar comments or worse

about her weight.

Kathy

>

> and I am a bit frustrated and curious how one page can say one

thing

> and another page can say something else entirely.

>

> first -- a review of the standing xrays by the radiologist in july

>

> there is moderate rotatory levoscoliosis centered in the upper

> lumbar spine, as well as a mile dextroscoliosis of the thoracic

> spine. In the sagittal plane, there is straightening of the lumbar

> spine, leading to a kyphosis at the thoracolumbar junction and

> straightenting of the thoracic spine. Because of this, the

> cervicothoracic junction is displaced anteriorly relative to the

> lumbar sacral junction.

>

> The vertebral body heights and disc spaces are normal, and there is

> no evidence of degenerative disease.

>

> then -- a review of prone xrays in october -- with comparison to

the

> earlier standing xrays

>

> there is unchanged moderate rotatory levoscoliosis centered at L#,

> as well as a mild dextroscoliosis of the thoracic spine. Attempted

> posterior fusion from T10 through L5. Degenerative dis disease is

> seen at L5-S1 with vacuum phenomenon. In the sagittal plane, there

> is lumbar hypolordosis and decreased thoracic kyphosis is prone

> positioning. The vertebral body heights are normal. Motion is

> present at L5-S1

>

> moderate thoracolumbar scoliosis does not change with prone

> possitioning, while thoracic kyphosis is partly reduced in the

prone

> position

>

> The doctor's notes in july

>

> heavy and overweight. Cornal balance not too bad. Pitched forward

> in the saggital plane. Has a CT and MRI study -- suspicious for

> nonunion at L1-L2. Definitely a nonunion with Grade II

> spondyloloisthesis and a vacuum disc at L5-S1.

>

> talked about potentially a three stage apporach -- first stage,

take

> out the implants, get fixation points, do whatever decompression.

> Second staage do either mulitple smith-petersen or a single pedicle

> subtraction procedure and instrumented fusion T10 to the sacrum and

> pelvis. Thrid stage four months later, anterior fusion at L5-S1.

> Whether we do the anteriorr fusion at 5-1 down the road or more

> recent would depend on whether it appeared that her leg pain was

> foraminal stenosis or more central stenosis. On the MRI, some

> places you can see her canal very well and other places there is

> some scatter. Talked to her about aerobic conditioning and weight

> loss as well.

>

> doctor's note in october

>

> her abdomen is absolutely huge when she is in a supine position. I

> do not think doing any kind of anterior operation on her would be

> wise. (and I weighed less on that visit!)

>

> looks 10-15 years older than her stated age. Has a component of

> fixed sagittal imbalance. Seems neurologically intact.

>

> CT-myelogram shows some stenosis at L5-S1. She does not have an

MRI

> (!!) We reviewed each and every one of a huge quantity of films.

>

> surgery would probably be a two stager. First stage removing the

> harrington implants and getting fixation points and the like.

> Second stage pedicle subtraction osteotomy at L3 and instrumented

> fusion T10 to the sacrum and pelvis. A 10-15% risk of weak

> quadriceps or weak foot on one side and roughly 1 in 1000 to 1 in

> 500 of paraplegia and 3-5% risk of major wound infection. She

> should have a thallium stress test because she is clearly much

older

> than her stated age. I am a little concerned about her overall

> hygiene as well. She seems to be a fairly nice and friendly

> person. Ideally we would want to structurally graft 5-1

anteriorly,

> but her 5-1 disc is very collapsed. I don not think it is a very

> good disc for a TLIF and I do not think doing an anterior of any

> sort on her would be advisable at all.

>

> it looks like when she is prone, her spondylolisthesis reduces at

L5-

> S1. When she is standing upright there is a 6mm or so

> sppondylolistthesis at L5-S1 and I think she has had a laminectomy

> there before.

>

[Guest guest]

as to the part about the weight, what really gets me is that I

explained that I gained 40 pounds the year I decided to exercise for

an hour every day. I assume that I must not do the darn stomach

crunches correctly, because my belly got much bigger that summer.

All I can say is, they must not expect us to read the notes. He was

much more tactful in person.

Too bad I couldn't have seen him last week instead of this Monday --

I was a lot thinner right after getting home from the Bahamas, but

after a week of being reunited with Dr Pepper, my clothes are not as

baggy!

> >

> > and I am a bit frustrated and curious how one page can say one

> thing

> > and another page can say something else entirely.

> >

> > first -- a review of the standing xrays by the radiologist in

july

> >

> > there is moderate rotatory levoscoliosis centered in the upper

> > lumbar spine, as well as a mile dextroscoliosis of the thoracic

> > spine. In the sagittal plane, there is straightening of the

lumbar

> > spine, leading to a kyphosis at the thoracolumbar junction and

> > straightenting of the thoracic spine. Because of this, the

> > cervicothoracic junction is displaced anteriorly relative to the

> > lumbar sacral junction.

> >

> > The vertebral body heights and disc spaces are normal, and there

is

> > no evidence of degenerative disease.

> >

> > then -- a review of prone xrays in october -- with comparison to

> the

> > earlier standing xrays

> >

> > there is unchanged moderate rotatory levoscoliosis centered at

L#,

> > as well as a mild dextroscoliosis of the thoracic spine.

Attempted

> > posterior fusion from T10 through L5. Degenerative dis disease

is

> > seen at L5-S1 with vacuum phenomenon. In the sagittal plane,

there

> > is lumbar hypolordosis and decreased thoracic kyphosis is prone

> > positioning. The vertebral body heights are normal. Motion is

> > present at L5-S1

> >

> > moderate thoracolumbar scoliosis does not change with prone

> > possitioning, while thoracic kyphosis is partly reduced in the

> prone

> > position

> >

> > The doctor's notes in july

> >

> > heavy and overweight. Cornal balance not too bad. Pitched

forward

> > in the saggital plane. Has a CT and MRI study -- suspicious for

> > nonunion at L1-L2. Definitely a nonunion with Grade II

> > spondyloloisthesis and a vacuum disc at L5-S1.

> >

> > talked about potentially a three stage apporach -- first stage,

> take

> > out the implants, get fixation points, do whatever

decompression.

> > Second staage do either mulitple smith-petersen or a single

pedicle

> > subtraction procedure and instrumented fusion T10 to the sacrum

and

> > pelvis. Thrid stage four months later, anterior fusion at L5-

S1.

> > Whether we do the anteriorr fusion at 5-1 down the road or more

> > recent would depend on whether it appeared that her leg pain was

> > foraminal stenosis or more central stenosis. On the MRI, some

> > places you can see her canal very well and other places there is

> > some scatter. Talked to her about aerobic conditioning and

weight

> > loss as well.

> >

> > doctor's note in october

> >

> > her abdomen is absolutely huge when she is in a supine

position. I

> > do not think doing any kind of anterior operation on her would

be

> > wise. (and I weighed less on that visit!)

> >

> > looks 10-15 years older than her stated age. Has a component of

> > fixed sagittal imbalance. Seems neurologically intact.

> >

> > CT-myelogram shows some stenosis at L5-S1. She does not have an

> MRI

> > (!!) We reviewed each and every one of a huge quantity of films.

> >

> > surgery would probably be a two stager. First stage removing

the

> > harrington implants and getting fixation points and the like.

> > Second stage pedicle subtraction osteotomy at L3 and

instrumented

> > fusion T10 to the sacrum and pelvis. A 10-15% risk of weak

> > quadriceps or weak foot on one side and roughly 1 in 1000 to 1

in

> > 500 of paraplegia and 3-5% risk of major wound infection. She

> > should have a thallium stress test because she is clearly much

> older

> > than her stated age. I am a little concerned about her overall

> > hygiene as well. She seems to be a fairly nice and friendly

> > person. Ideally we would want to structurally graft 5-1

> anteriorly,

> > but her 5-1 disc is very collapsed. I don not think it is a

very

> > good disc for a TLIF and I do not think doing an anterior of any

> > sort on her would be advisable at all.

> >

> > it looks like when she is prone, her spondylolisthesis reduces

at

> L5-

> > S1. When she is standing upright there is a 6mm or so

> > sppondylolistthesis at L5-S1 and I think she has had a

laminectomy

> > there before.

> >

>

[Guest guest]

SB,

Is it your plan to actually now go over these points with

DrBridwell? I would be wondering about a few things, aside from

the " tone " . I do remember that most of his patients have found

him " rough around the edges " until after surgery. Still, if you can

not have confidence in your relationship from here on out...you may

find that you " second guess " everything. I think the matter of trust

is of utmost importance going forward.

Also, for instance, would it be reasonable to say to him that after

reading your report you felt that he may not really wish to be your

partner in this endeavor? Assuming he really does however, and since

this really is elective surgery...is there a weight he would like to

see you at prior to surgery and would it be wise to attain that

weight before scheduling surgery? It seems to me either it matters,

or it doesn't....and if it matters a lot...and it has to do more

with things like anesthesia,surgical time, blood loss/volumes,

ability of the newly fragile spine to support the weight...then I

think it is reasonable to balance all of this into a decision about

timing the surgery.

Even without exercise it is possible to work with a dietician and

achieve weight loss. If the difference between successful surgery

(or not) is 25 or 30 lbs....then I suspect it would be very

motivating to put the DrPepper aside and drink water for 4 or 5

months!

I know surgeons do surgery and sometimes it can be difficult to get

them to focus on the whole constellation of issues each patient

faces. In reality, most of the top surgeons will flat out not do

this surgery on smokers. Period. Likewise, if there really is a goal

weight for you I would think a prescription could be written so that

you could have coverage for dietician and PT services in advance of

surgery...in fact it would likely be a good investment for the

insurance company.

I think I would also be curious about the discussion about the

anterior approach...and what role the abdominal fat plays into

this....is it an unsurmountable problem or an inconvenience for him?

(I guess that information would have to then be balanced with his

thoughts as I outlined above).

I would ask him if his note about hygeine related to your hair, as I

believe you suspect. Was it not you that had a conversation about

your hair with him earlier when he expressed his concerns? If that

is his worry, I know it's just me, but I would have mine cut without

hesitiation. Its hair, it will grow back. In the meantime you can

experiment with a new look! Seriously, though...imagine yourself 6

months down the road dealing with a post operative infection related

to this issue...wouldn't you feel awful if it turned out the surgery

failed because of something that was within your power to control?

All body hair is a magnet for germs..thats why they shave so much of

it. Long hair will be a hassle when you are home recovering, it will

be a hassle during the hospitalization...you have enough other

things to worry about.

Thats my $.02 cents. I hope you have a good meeting on Monday and

come away with a good map/plan for the future. I will be anxiously

waiting to hear how it goes.

Travel Safe, Cam

p.s. As to the crunches, there isn't anything to the idea that you

can " spot reduce " . All the crunches in the world are not the answer,

so don't beat yourself up. Overall weight loss would be " the ticket "

the research says.

[Guest guest]

Hey Suzanne and Cam...

Been trying to catch up with posts... Doc's tone in notes definately

a concern. Cam makes good points on all of it, especially RX for

dietician and what IS ideal weight for you for surgery. I was

thinking same thing about hair and I do remember you contemptplating

this before. I vote same as Cam... it will make things so much

easier for you and decrease risks of infection.

Remember, my young daughter had dreads for 4 years. When she decided

to " lose " them, we began by cutting them shorter & shorter over a

couple of weeks. I bet if you just cut yours by HALF length (how

about to " back bra strap " length?), you would immediately feel

lighter, which is always a GOOD thing, would give you some instant

endorphins (sp?!, and make it easier for you to see what the

benefits would be to take MORE off. If you can work towards cutting

them up to 3 inches below your earlobe, then comb them out (yes, it

can be done...a few a day; I used a wide-tooth metal comb), your

hair will end up being about shoulder-grazin' length. From what I

recall, you do not wear dreads for religious reasons, right? I would

not want to push you to this decision if that was the case. I wore

my hair to hip length most of my grown life and have it to " cover

the shoulder blades " now. It does make life easier!

Wishing you only good things for meeting on Monday... get your list

of questions and concerns ready and BRING it with you.

Hugs, Marty

[Guest guest]

Gee, Kathy, would you really disqualify a surgeon on those grounds, even if he were the one best equipped to help you? I agree that if I were deciding between 2 equal candidates, I'd prefer the one who is more respectful to me as a person. I think these guys dictate their notes thinking of them as notes to themselves, and maybe a couple other orthopedists. They know we have the legal right to see our records, they SHOULDN'T make unsavory comments, but they are human and as such are prone to error.

Sharon

[ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

WOW Suzanne. I feel your pain over those notes, I really do. I don't think I'll be going to see Dr. B any time soon. I believe someone else complained that Dr. LaGrone made similiar comments or worse about her weight. Kathy>> and I am a bit frustrated and curious how one page can say one thing > and another page can say something else entirely.> > first -- a review of the standing xrays by the radiologist in july> > there is moderate rotatory levoscoliosis centered in the upper > lumbar spine, as well as a mile dextroscoliosis of the thoracic > spine. In the sagittal plane, there is straightening of the lumbar > spine, leading to a kyphosis at the thoracolumbar junction and > straightenting of the thoracic spine. Because of this, the > cervicothoracic junction is displaced anteriorly relative to the > lumbar sacral junction.> > The vertebral body heights and disc spaces are normal, and there is > no evidence of degenerative disease.> > then -- a review of prone xrays in october -- with comparison to the > earlier standing xrays> > there is unchanged moderate rotatory levoscoliosis centered at L#, > as well as a mild dextroscoliosis of the thoracic spine. Attempted > posterior fusion from T10 through L5. Degenerative dis disease is > seen at L5-S1 with vacuum phenomenon. In the sagittal plane, there > is lumbar hypolordosis and decreased thoracic kyphosis is prone > positioning. The vertebral body heights are normal. Motion is > present at L5-S1> > moderate thoracolumbar scoliosis does not change with prone > possitioning, while thoracic kyphosis is partly reduced in the prone > position> > The doctor's notes in july> > heavy and overweight. Cornal balance not too bad. Pitched forward > in the saggital plane. Has a CT and MRI study -- suspicious for > nonunion at L1-L2. Definitely a nonunion with Grade II > spondyloloisthesis and a vacuum disc at L5-S1.> > talked about potentially a three stage apporach -- first stage, take > out the implants, get fixation points, do whatever decompression. > Second staage do either mulitple smith-petersen or a single pedicle > subtraction procedure and instrumented fusion T10 to the sacrum and > pelvis. Thrid stage four months later, anterior fusion at L5-S1. > Whether we do the anteriorr fusion at 5-1 down the road or more > recent would depend on whether it appeared that her leg pain was > foraminal stenosis or more central stenosis. On the MRI, some > places you can see her canal very well and other places there is > some scatter. Talked to her about aerobic conditioning and weight > loss as well.> > doctor's note in october> > her abdomen is absolutely huge when she is in a supine position. I > do not think doing any kind of anterior operation on her would be > wise. (and I weighed less on that visit!)> > looks 10-15 years older than her stated age. Has a component of > fixed sagittal imbalance. Seems neurologically intact.> > CT-myelogram shows some stenosis at L5-S1. She does not have an MRI > (!!) We reviewed each and every one of a huge quantity of films.> > surgery would probably be a two stager. First stage removing the > harrington implants and getting fixation points and the like. > Second stage pedicle subtraction osteotomy at L3 and instrumented > fusion T10 to the sacrum and pelvis. A 10-15% risk of weak > quadriceps or weak foot on one side and roughly 1 in 1000 to 1 in > 500 of paraplegia and 3-5% risk of major wound infection. She > should have a thallium stress test because she is clearly much older > than her stated age. I am a little concerned about her overall > hygiene as well. She seems to be a fairly nice and friendly > person. Ideally we would want to structurally graft 5-1 anteriorly, > but her 5-1 disc is very collapsed. I don not think it is a very > good disc for a TLIF and I do not think doing an anterior of any > sort on her would be advisable at all.> > it looks like when she is prone, her spondylolisthesis reduces at L5-> S1. When she is standing upright there is a 6mm or so > sppondylolistthesis at L5-S1 and I think she has had a laminectomy > there before.>

[Guest guest]

Hi...

I agree. I think doctors are taught to think of their notes as legal

documents, and therefore feel they have to mention everything that

goes through their heads. :-(

--

>

> I think these guys dictate their notes thinking of them as notes to

themselves, and maybe a couple other orthopedists. They know we have

the legal right to see our records, they SHOULDN'T make unsavory

comments, but they are human and as such are prone to error.

>

> Sharon

[Guest guest]

HI..

In that regard, maybe he was making a case for not recommending anterior surgery.

Bonnie

[ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

Hi...I agree. I think doctors are taught to think of their notes as legaldocuments, and therefore feel they have to mention everything thatgoes through their heads. :-(-->> I think these guys dictate their notes thinking of them as notes tothemselves, and maybe a couple other orthopedists. They know we havethe legal right to see our records, they SHOULDN'T make unsavorycomments, but they are human and as such are prone to error.> > Sharon

[Guest guest]

Hi Bonnie...I think it's a foregone conclusion that he wouldn't be willing to do anterior surgery.-- Re: [ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

HI..

In that regard, maybe he was making a case for not recommending anterior surgery.

Bonnie

[ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

Hi...I agree. I think doctors are taught to think of their notes as legaldocuments, and therefore feel they have to mention everything thatgoes through their heads. :-(-->> I think these guys dictate their notes thinking of them as notes tothemselves, and maybe a couple other orthopedists. They know we havethe legal right to see our records, they SHOULDN'T make unsavorycomments, but they are human and as such are prone to error.> > Sharon

[Guest guest]

Hi Suzanne,

I'm sorry that your doctor put that crap in your records. Whatever

happened to doctors who are kind and caring?

BTW--is anterior surgery where they go in from your chest? Why is that

EVER an option except in worst case scenarios? I do remember when I

had my surgery, there was a girl that had that type of surgery and her

curvature was worse than mine. She also had one of the " halo " braces.

Hope you find a better doctor!

hugs,

Kim

[Guest guest]



Hi ,

Agreed. But he does need to document his reasoning.

Bonnie

[ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

Hi...I agree. I think doctors are taught to think of their notes as legaldocuments, and therefore feel they have to mention everything thatgoes through their heads. :-(-->> I think these guys dictate their notes thinking of them as notes tothemselves, and maybe a couple other orthopedists. They know we havethe legal right to see our records, they SHOULDN'T make unsavorycomments, but they are human and as such are prone to error.> > Sharon

[Guest guest]

Hi Kim...

Anterior surgery refers to accessing the front of the spine, either through the chest or the abdomen.

As to why it’s an option, I think there’s probably a really complex answer. I know that in many cases of flatback, the surgeon needs to add cages or bone discs to the front of the lumbar spine to get the patient standing straight. That can sometimes be accomplished from the posterior approach (PLIF), but not always. There are also cases, where the front of the spine needs to be fused to give more stablization, cases where osteotomies need to be performed on the front of the spine, and cases where the discs are removed to give better correct.

Regards,

On 12/16/06 11:10 PM, " " <kp72261@...> wrote:

BTW--is anterior surgery where they go in from your chest? Why is that

EVER an option except in worst case scenarios? I do remember when I

had my surgery, there was a girl that had that type of surgery and her

curvature was worse than mine.

[Guest guest]

thanks. The more I read, the more I know that I'm not emotionally

strong enough to go through surgery again!!

>

> >

> >

> > BTW--is anterior surgery where they go in from your chest? Why

is that

> > EVER an option except in worst case scenarios? I do remember

when I

> > had my surgery, there was a girl that had that type of surgery

and her

> > curvature was worse than mine.

>

[Guest guest]

Kim,

It sounds like you know yourself well. At least you will not be

blindsided by anything if you make a thorough investigation of all

that this surgery can entail. Surgery is only an option and it is

your " call " if you ever pursue it.

In the meantime...we are all here and will help you no matter what!

Take Care, Cam

[Guest guest]

Great answer, Cam.

Kim, are you the Kim that I've met in person? It was so lovely of you to visit me in the hospital. Sometimes revision surgeons can do the whole job from behind; sometimes they do so out of necessity. But often, as I understand it, an anterior approach means that a stronger fusion can be achieved, so they prefer to go that way.

It is scary. The idea of having my spine reached via my abdomen freaked me out enough to keep me on the fence for a good 5 years. The reality of it was kind of scary too, but I got past it. The first few days weren't much fun; I won't kid you.

It may be that you're not yet uncomfortable enough to warrant going through such extreme surgery, and there's nothing wrong with just living with flatback, if yours is still liveable.

I hope this is of some help.

Sharon

[ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

Kim,It sounds like you know yourself well. At least you will not be blindsided by anything if you make a thorough investigation of all that this surgery can entail. Surgery is only an option and it is your "call" if you ever pursue it.In the meantime...we are all here and will help you no matter what!Take Care, Cam

[Guest guest]

Thanks, cam. With the emotional problems I have (bipolar disorder & anxiety d/o) along with the constant pain, it's a lot to deal with. There's no way I could make it through surgery, especially if more than one surgery was needed. I don't think I could deal with any kind of treatment or test that required a spinal puncture either unless they knocked me out! Sharon, no it wasn't me who visited you. But I'm glad that you had support while in the hospital. hugs, Kim __________________________________________________

[Guest guest]

Ah, so we have another Kim among us. Welcome, Kim! And thank you; I did have great support from family and friends, from the group and from elsewhere.

I never thought I had the strength to go through all I did, but when the time came I got through it.

There are some revision surgeons who seem to prefer to do the whole thing in one surgical session, so if it turns out you really need surgery, and distance isn't too much of an issue for you, perhaps one of these surgeons will be able to help you.

I'm sorry you're having so much pain. I really hope you find the help you need, whether by conservative therapies, or surgically.

Hugs,

Sharon

[ ] Re: I got a copy of my records from Dr Bridwell today/Suzanne

Thanks, cam. With the emotional problems I have (bipolar disorder & anxiety d/o) along with the constant pain, it's a lot to deal with. There's no way I could make it through surgery, especially if more than one surgery was needed. I don't think I could deal with any kind of treatment or test that required a spinal puncture either unless they knocked me out!

Sharon, no it wasn't me who visited you. But I'm glad that you had support while in the hospital.

hugs,

Kim

__________________________________________________