I finally met Dr today

[Guest guest]

I went in for the MRI first and thought I was not going to be able

to make it through the whole thing because I was on my back for

about an hour. It started hurting very badly fairly early on.

When I got to the doctor's office, I saw the PA first again. He

showed me on the MRI films that my L5/S1 disc is totally shot -- it

appears to be non-existent with the bone rubbing against bone. The

hole for the nerve root to pass through is extremely small.

The PA thought the doctor would want to remove my hardware since it

is broken anyway and that I probably have lots of pseudarthrosis and

so the hardware hasn't done anything for me anyway. He was

confident they could get it out. He also thought they might want to

fuse L5/S1 and put the little rods and screws in.

I asked him how many of these procedures have they done and

expressed my skeptism that a small fusion would be sufficient. He

said they have done 5 or 6 this year and he pulled out some xrays of

patients who had very severe kyphosis that they have fixed recently

(and the xrays were pretty impressive).

So, I said, ok, but you are the PA. How do you know what the doctor

would say. So, he told me that Dr is a very good surgeon and

that he trained with Dr DeWalt in Chicago and that he had gotten a

lot of practice doing revision surgery there. After leaving

Chicago, he was based in Loma where he also did a lot of

complex spine surgery until his wife's rear view mirror got shot out

while driving down the freeway. At that point, she urged him to

accept the invitation of one of his former colleagues to move to

Oklahoma. He has been here for 8 years and the PA has worked with

him for 7 years.

So, he calls Dr in to look at my films. He said he would do

an A/P procedure, separated by about 7 days and put a bone wedge at

the front of L5/S1 and also at L4 and the little rods and screws.

He would also like to take out all of my old hardware, but it might

not be necessary since it doesn't seem to have a function anyway.

He thinks that putting the bone wedge in MAY eliminate the need for

an ostetomy, but that if it didn't, I would be in much better shape

for the full blown revision surgery after the fusion and the six

screws had a chance to set well.

He also said that if I have surgery with him, he would insist that I

cut off all my hair first. (He said this as I showed him that I

could almost touch the floor -- and I actually did touch the floor

today). He was quite serious and stern when he told me to cut my

hair. Of course, I asked why, wondering if he was going to say my

back hurts because my hair is so heavy, but he said it poses a

significant risk of infection since I have dreadlocks down to my

butt. Ok, I can live with that as a good reason for getting a hair

cut.

The PA then told him that I had actually come in to get a letter for

my insurance so I could go see a doctor out of town. He asked who

and I mentioned Dr Rand. He said he had never heard of him, and

that of all the spine specialists in America, only about 10-15% of

them were qualified to do what I needed done.

I asked him what he would recommend if I were his wife or daughter,

and he said he would send me to Dr Bridwell. He and trained

together, but that has about 10 years more experience and has

the top spinal practice for flatback revision.

He gave me the MRI films and my xrays, and said he would write a

referral to Dr Bridwell and that I should definitely at least get a

second opinion. I am supposed to call back in about 10 days and get

a copy of the notes to send to my insurance, but the insurance

company would already have it in their records.

I actually thought he made a very good case for using the bone wedge

instead of cages -- he said that it is difficult to deal with the

cages if you get an infection in them and that it is harder to tell

if you have a good fusion.

When I told him that I had been reading flatback forums for about 5

years and was under the impression that osteotomies were necessary

to get good correction, he had me walk across the room and stand

up. I was wearing shorts, so it was easy for him to see how far

pitched over I am when I straighten my knees. That is the point

when he decided he should totally remove the hardware in case the

bone wedge doesn't restore enough lordosis and I have to have more

surgery later.

His thinking was that the smaller surgery might actually work pretty

well. He said he had done surgery on a woman in Chicago when he was

a fellow, and that they had gotten about 70% correction and about a

70% reduction in pain. The woman wasn't satisfied, so they tried to

achieve perfection and ended up causing a much bigger mess that

couldn't be fixed.

He said it is always possible to go back in and fuse some more and

cut some wedges, but that once you do the big surgery, there is no

going backwards.

I was surprised to find myself actually considering scheduling a

date. But, he thinks I should see Bridwell first, especially since

I am planning a trip to the Bahamas next month. He said I should

plan on at least 3 to 6 months off work.

The PA thought I should have surgery instead of vacation, but giving

up my vacation is not an option. I had been thinking about having

surgery next summer and taking a one year of absence (unpaid).

Quite technically, if I were going to ask for a leave of absence, I

should have done that before April 20.

I also asked about insurance. Obviously, he accepts my insurance,

but my husband is changing jobs on June 26. My husband will be

going to work for Saint 's hospital, which is part of the

Saints network, which is (I believe) nationwide. So, his insurance

will be better.

I asked him if I should wait until I can get on my husband's

insurance -- perhaps as secondary insurance and keep my free

insurance from my job. The PA said the more insurance, the better.

I asked the doctor if he was part of the Saints Network, and he said

not yet. Apparently, the big thing in the medical field now is to

provide incentives to stay within your medical group -- they pay at

a higher percentage if you do. We will just have to see how much it

will cost to add me to my husband's insurance and I assume he will

have a three month probation period before he is eligible.

I didn't get a chance to ask the doctor about pain management. I

have an appointment for Monday, but I see that the hospital billing

office has left a few messages on my machine that they need to speak

with me about my upcoming appointment. I wonder if there is a

problem since they have turned me over to collections.

The PA looked a bit horrified when I told him how many times I had

been for injections and that I had gotten SI joint injections, L5/L4

injections, and facet injections. He said it was overkill and that

three times a year was the recommended dose.

But, I told him I plan to spend at least 7 nights dancing all night

(or at least attempting to) next month and it has been about 4

months since my last treatment. He shrugged and said the decision

was up to me, but that pain management was not a good long term

solution. DUH!

I was surprised to find myself telling him that I am tired of always

being in pain and that it seems to be getting worse fairly quickly.

I still hurt even when floating in the hot tub and when sleeping.

They said if I decide to have surgery with them, to let them know.

But, that I should make an appointment to see Bridwell and get a

second opinion.