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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 didn’t work. He told ...

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Old 09-10-2008, 06:04 PM
Cheryl's Avatar
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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 didn’t work. He told me “I don’t think there is anything I can do for you now, I don’t know what to tell you”. 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?
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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
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Old 09-10-2008, 09:19 PM
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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.
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Old 09-10-2008, 10:03 PM
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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
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Old 09-10-2008, 11:13 PM
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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
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Old 09-10-2008, 11:13 PM
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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...
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Old 09-15-2008, 07:57 AM
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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.
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Old 09-15-2008, 04:28 PM
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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.
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Old 10-13-2008, 11:32 PM
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Default Possible way on how to get around a denied discography

Any way for you to get Cigna or Aetna? They will approve ADR.

My case is worker's comp (much worse than private insurance) and I was told that if my doctor requested surgery they would automatically do a discogram; So if my dr got authorization for surgery I could get the discogram and not have to deal with that appeal process. I haven't verifed if this was true, but after you get a new dr, maybe its something you could ask about.

Tip: To find a new dr. Print out spine & neuro surgeons from your ins. carrier website and do some research to find whether they do ADR. Also, maybe if you contacted Mark he could help you find some.
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Old 10-28-2008, 04:06 AM
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I have been asking my surgeon for a discogram for about a year now. He was playing the wait & see approach. He doesnt do discograms unless he's doing surgery but I still had awful pain and finally on my 2 year ADR anniversary, I told him I can't live this way and something must be done. He finally relented.

Well.....I went for my discogram....I got stuck like a piggy.....and I squealed! Sweety went with me to Manhattan for support. I have to say it doesn't get any easier the second time around. I was a little nervous because I knew to expect pain....with a capital P. I don't look forward to any additional Pain in my life.
I don't have the results yet, but the good/bad news is that the L5-S1 did finally react. When I had my discogram in 2006, the L5-S1 did not react, or maybe not signifigantly more than the L4-L5 to cause concern, but it did show an asymptomatic annular tear 2 years ago. Apparantly it was symptomatic. Maybe the L4-L5 just looked worse than the L5-S1 and maybe the L4-L5 reacted more because it was more painful than L5-S1.
If the only solution for an annular tear is a fusion, I guess I'm ready. L5-S1 is a good level for fusion. I wonder if there is a non-invasive surgery they can do. I'm going to see Dr. Goldstein in a couple of weeks to discuss options.
I doubt a fusion would be as painful as a disc replacement. A fusion should be a walk in the park compared to what I went through with ADR. The fusion patient next to me in the hospital when I had my ADR surgery was up and walking around way before I did. He left before me too and seemed pain free!

Glad I had the discogram. Keep the pressure on the doctors if you feel you need one.
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
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Old 11-12-2008, 06:34 PM
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Default Discogram normal?

My surgeon (Dr. Jens Chapman @ UWMC) is strongly opposed to cervical discograms. He advised me that cervical discograms were inaccurate, painful and possibly dangerous. Another doctor I was seeing for diagnostic injections had an opposing view and wanted to perform a cervical discogram on me. I trust my surgeon and did not have the discogram.

I need a 3 level cervical ADR surgery. Negotiations with my medical insurance company are on going.

Melody
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