Go Back   ISPINE.ORG Forum > Main forums > iSpine
Register FAQ Members List Calendar Search Today's Posts Mark Forums Read

iSpine Discuss Is it normal for a doctor not do a discogram? in the Main forums forums; I went to the doctors today to follow up on the cervical facet injections that didnít work. He told ...

Reply
 
LinkBack Thread Tools Display Modes
  #1 (permalink)  
Old 09-10-2008, 06:04 PM
Cheryl's Avatar
Member
 
Join Date: Feb 2008
Location: Charlotte, NC
Posts: 94
Default Is it normal for a doctor not do a discogram?

I went to the doctors today to follow up on the cervical facet injections that didnít work. He told me ďI donít think there is anything I can do for you now, I donít know what to tell youĒ. He offered me pain management only. He will not do a discogram. Is that normal not to do a discogram next? He said the results of cervical discograms are not conclusive therefore not worth the risk. I explained that I am at a pain level of 7 all day, I haven't worked in 7 months and I can barely care for my children at the end of the day due to neck pain. I understand the ambiguous results I went through all this with my low back. This ended up so ugly.

He actually raised his voice at me and I was in tears as he told me that the only option was fusion but it only works in 48% of the patients at c5-c6, there is a 12% chance of swallowing problems and 1or 2 in 1000 is quadripalegic. I asked if the quadripalegics are at his practice and he said no but they are in Charlotte and are in lawsuits.

I asked about disk replacement and he said he'd go through the appeals process but that United Healthcare isn't paying for it. Which of course I know all that. And I wouldn't let him touch me anyway at this point.

The MRI only shows mild degeneration which I guess is his hesitation but given my history wouldn't that be the next step?
__________________
44 Year Old, mom of 3
DDD - l4-s1- woke up Feb 2005 and couldn't walk
Tried PT, Injections, Accupuncture, drugs, etc.
2 level Prodisc ADR L4-S1, Feb. 18, 2008 Dr. Bertagnoli - Straubing, Germany - SUCCESS -

Now I struggle with Neck Pain likely c5-7
PT, injections, rhizotomy.......MRI and CT Myleo not consistent with pain symptoms, waiting that out, keeping my passport valid
Reply With Quote
  #2 (permalink)  
Old 09-10-2008, 09:19 PM
Senior Member
 
Join Date: Sep 2006
Location: N. San Diego
Posts: 220
Default

Cheryl,
I've always had the impression that in the States discograms aren't nearly as common as in Europe. Before lumbar ADR in Germany I had three U.S. surgeons recommend fusion and there was never mention of discogram. In fact one of them told me that CT-myleo was the last diagnostic preceding fusion.

48% sounds low. I've heard cervical fusions are generally successful, and certainly more so than lumbar fusions. There are surgeons today who just don't do fusions unless there is gross instability or other calamity. Your doc sounds like one of them, or for whatever reason he doesn't want to operate on you. Good riddance to him.

From what I've seen on these forums the amount of degeneration is not always a good indicator of pain or disc damage. Your thinking seems sound to me.
__________________
Jim

2003 L5S1 Charite
1981 L5S1 Discectomy
Reply With Quote
  #3 (permalink)  
Old 09-10-2008, 10:03 PM
dshobbies's Avatar
Senior Member
 
Join Date: Oct 2006
Location: Los Angeles
Posts: 1,597
Default

Cheryl,

Everytime I hear a story similar to yours, my blood begins to boil. There is much to much suffering at the hands of incompetent physicians and it's pretty scary. For a doctor to tell you to suffer because there's nothing else he can do for you... It's time for another opinion and possibly even another after that.

A thought, if your doctor refuses to do fusion and fusion or ADR are the only remedies, maybe you have a shot at coverage. You might want to read the book in Mark's library about ins. appeals. Mark, help me out here.

I hope you find a better doctor and good luck, Dale
__________________
3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
Reply With Quote
  #4 (permalink)  
Old 09-10-2008, 11:13 PM
Cheryl's Avatar
Member
 
Join Date: Feb 2008
Location: Charlotte, NC
Posts: 94
Default

I know my blood has been boiling all day. He was unbelievable. Although I can't believe I'm even surprised because I have actually met worse than him when going through all this on my lumbar spine. What I have noticed is that when I bring my husband along (which I did not do today) I get much better treatment. I hate that because I am so independent but it has been my experience several times.

I actually own The Insurance Warrior because we are in the process of appealing my two level ADR surgery but I feel like we are just going through the motions really.

And yes if this is a one level cervical ADR I should be able to have it covered but we all know the drill on that one.

I am tired, hurting and overwhelmed.

My only ray of hope is that my low back does feel pretty good after ADR so if I can get my neck in the same shape life would be manageable. I just can't get my head around the fact that I am going down this road again.

I know Mark understands
__________________
44 Year Old, mom of 3
DDD - l4-s1- woke up Feb 2005 and couldn't walk
Tried PT, Injections, Accupuncture, drugs, etc.
2 level Prodisc ADR L4-S1, Feb. 18, 2008 Dr. Bertagnoli - Straubing, Germany - SUCCESS -

Now I struggle with Neck Pain likely c5-7
PT, injections, rhizotomy.......MRI and CT Myleo not consistent with pain symptoms, waiting that out, keeping my passport valid
Reply With Quote
  #5 (permalink)  
Old 09-10-2008, 11:13 PM
Senior Member
 
Join Date: Sep 2006
Posts: 2,266
Default other opinions

Cheryl,
In most insurances a 2nd surgical opinion is allowed and compensated by the carrier. Are you able to check and see if this is possible in your case?

My experience has been that Neurosurgeons don't offer discograms but OSS's do. Then again my experience to date has been with lumbar discography for myself (and/or myelograms for my lumbar spine in past).

I would want to get another opinion no matter if it were one via mail and I would want to pursue what at least you think you are entitled as best you are able.

Please don't bank on one surgeon's opinion. Even if he's right, raising his voice at you didn't accomplish anything but to upset you further and with the concerns/situation you have that was unnecessary.

Hang in there. Get some other opinions even if via email (not in person). Stay hopeful...
Reply With Quote
  #6 (permalink)  
Old 09-15-2008, 07:57 AM
Senior Member
 
Join Date: May 2007
Location: Norcal
Posts: 101
Default

Cheryl,
I can relate to taking the husband with you. It is sad that you actually get taken a bit more seriously when your husband is there. If I have an important appt. or I have a lot of pain or new symptoms I insist my husband go. I am a nurse and I know my Dr.s and I still get that "neurotic female" treatment. I don't think it is intentional and I doubt they are aware of it. My husband being with me just seems to give them confirmation to my complaints.

So my Appt. last week it didn't work so well and I am just asking for a lousy MRI! Lets see...I might get the cervical MRI if the HMO LORDS approve it. However I was told that inspite of my continued back and leg pain 19 mos post Dynesys L5-S1 a lumbar MRI is not justified....wow...but yet he agreed and ordered the cervical without laying a hand on me and my cervical issues are new. He didn't even check ROM. Guess I am missing something here.
And the really bad news is, what he didn't tell me before my dynesys, I am not a canidate for ADR now. Seems he kinda brushed over that part before surgery....and this from a surgeon I worked with many years.
Seems I need to be less trusting and more proactive....
If I asked for a discogram I may have to give my first born child....
__________________
Annular tear L5-S1 1998
Herniated disc L5-S1 2004,PT,ESI's,discectomy 2005
Dynesys 2/2007

Last edited by fireyangel76; 09-15-2008 at 08:01 AM.
Reply With Quote
  #7 (permalink)  
Old 09-15-2008, 04:28 PM
Senior Member
 
Join Date: Sep 2006
Posts: 2,266
Default re the husband/other person factor

I edited this to say that if I want to bring strictly a support person along then I don't really care how much experience/education they have with regard to assisting me with my visit. By this I mean someone who's got my back as I'm just too exhausted to deal with it all.

Personally I've not found it that helpful to have my husband along except several times where he demanded I get more attention but not with my OSS visits. In fact I've found that at times the visits have been even more cursory/abbreviated. It probably depends on how the surgeon feels in terms of giving information/educating. Most of the times I've found that these are very busy people (surgeons) and they limit what they say unless you are a surgical candidate. Even then the information is often very abbreviated (IMHO). I was a practicing RN/NP for many years so this isn't surprising to me and doesn't stop me from asking as many questions as I can formulate on my own which is still limited when in shock sometimes from hearing something one doesn't quite expect.

Initial consultations are generally slated for a half hour to hour I believe (with xrays) and I like to have my questions ready on a list, tell the doctor/surgeon I have a brief list of questions that will go quickly and go thru them, cross them off while listening for any new or unknown that he/she might throw at me that I didn't have a question about so I can bring that up again or research it. I always ask for copies of my films and reports so I can go over that with the surgeon.

My preference would to bring Mark along to visits as I feel he is the most knowledgeable/experienced person that can review subjective/objective information and bring up pertinent questions and get the best answers (there's a comradery as the surgical experience is there and the surgeon jargon and all) and/or the next best possible educated/experienced advocate that I could find to bring along.

Otherwise I am probably bringing along someone more for support and that's helpful as well at times as what I might hear may be limited as I'm focusing only on what I want to hear/think/say and yes, my meds make me forgetful so perhaps someone not on medications would be pretty good to bring along to even write down what's being said by the doctor/surgeon. We can compare notes later and 10 to 1 I didn't hear something or remember it!

Last edited by Maria; 09-15-2008 at 04:48 PM.
Reply With Quote
  #8 (permalink)  
Old 09-15-2008, 06:17 PM
Senior Member
 
Join Date: May 2007
Location: Norcal
Posts: 101
Default

Maria,
You have a great point! It is really hard to be on your toes and ask all the right questions, comprehend the answers, and formulate any follow up questions when you are in pain and in a fog from meds, infomation ect. As is always said hind sight is 20/20!

Think that the only option may be taking Mark to an Appt! Even with all my reading and research it cant replace the "hands on type" experience he has gained. Just need my lotto winnings and to get out of the HMO nightmare!
How are you feeling?
__________________
Annular tear L5-S1 1998
Herniated disc L5-S1 2004,PT,ESI's,discectomy 2005
Dynesys 2/2007
Reply With Quote
  #9 (permalink)  
Old 09-16-2008, 01:25 AM
Senior Member
 
Join Date: Sep 2006
Posts: 2,266
Default Betsy

Mark accompanied me to one of my most important surgical opinions/visits/consultations as it was a 2nd surgical opinion to decide whether surgery would be authorized by WC for the 2nd time (meaning WC verbally authorized two level ADR surgery in 03 for me but then rescinded this authorization when CA WC legislation was changing in 05). It took till '06 to get authorization again (now written authorization documented) and Mark went with me to that visit and I felt his expertise was beneficial in terms of communicating with the Neurosurgeon and how the outcome of my case turned out. Actually without him I'm sure I would not have even made it as the time of the appt. was changed by several hours because of an emergency the Neuro had to attend. By the time of the appt. I was completely exhausted and not even able to think straight let alone speak clearly for myself without groaning (thanks infinity Mark).

Ok, anyway, I do know HMOs are a pain in terms of authorizing and esp. if out of network (worked for managed care/HMOs the last 14 years of employment) so I do wish you all the best~ please keep us posted!

Last edited by Maria; 05-17-2009 at 07:15 PM.
Reply With Quote
  #10 (permalink)  
Old 09-17-2008, 08:52 PM
Cheryl's Avatar
Member
 
Join Date: Feb 2008
Location: Charlotte, NC
Posts: 94
Default

Well after that last horrific appt this doctors nurse actually took it upon herself to schedule me an appointment with another doctor. She ran it by my doctor so as to be politically correct but I believe this says alot about what she witnessed. In addition, my general practicitioner is copied on all my visits with spine doctors. He read the report and called to tell me to seek another opinion (in his politically correct terms). At least I know I'm not the crazy one here.

So, I am going to yet another doctor on Monday and I have a great girlfriend coming with me who definately will hear what I don't. Because my husband is going to be living it up in Vegas. He's gotta have some fun after the year we've been through.

Of course I would prefer Mark to come but the different coasts causes a problem. I'm going to have him consult with the doctors after I get the reports.

Thanks for all the support.
__________________
44 Year Old, mom of 3
DDD - l4-s1- woke up Feb 2005 and couldn't walk
Tried PT, Injections, Accupuncture, drugs, etc.
2 level Prodisc ADR L4-S1, Feb. 18, 2008 Dr. Bertagnoli - Straubing, Germany - SUCCESS -

Now I struggle with Neck Pain likely c5-7
PT, injections, rhizotomy.......MRI and CT Myleo not consistent with pain symptoms, waiting that out, keeping my passport valid
Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On



All times are GMT. The time now is 12:22 AM.


Powered by vBulletin® Version 3.7.2
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.