ADR 5 years on

[Jim M2]

Here ya go, report from a radiologist who looked only at the 2008 x-rays you see in the postings above. This is the first time a radiologist has looked at my x-rays.

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General Diagnostic Text

Examination: Lumbar Spine AP/Lateral with flexion and extension
views (four views) 10/9/2008 at 0907

Indication: Low back pain
Comparison: None
Findings: A prosthetic disc is present at the intervertebral L5/S1 disc space. No evidence of hardware failure. Alignment is intact. Vertebral body heights and the remaining intervertebral disc spaces are maintained. No abnormal motion on flexion and extension views.

[Jim M2]

I cancelled the follow-up appointment with the NS after I read her office notes from the first visit.

"...He is here to see if there is any other technology or a newer intervention that could help his current situation, which is a chronic low back pain."

I'm pretty sure I told this doctor up front I didn't want to be screened for surgery. My primary interest was lumbar diagnostics. I wanted to know what was going on. I wanted information to support good decision making for pain management. I wanted to know of any developing trends. I was less interested in cervical. I knew prior I had multi-level cervical DDD.

I ended up with a cervical MRI that says I have DDD. The lumbar was dismissed as inoperable not because it is, or is not, operable but because it's obvious she just didn't feel like messing around with it.

[mmglobal]

Sorry Jim... It's too easy for them to dismiss us as 'no hopers'. All you want is diagnosis... you should be able to get on the same page with the doctors BEFORE wasting a bunch of time and money with them. Better luck with the next one... don't give up.

Mark

[johnb]

The surgeons don't keep the coffers full by running tests. It's really a testament to the problems with some (hopefully a minority) in the spinal industry. Let's do a little simple math for the sake of argument. Take 5 hypothetical surgical candidates who report low back pain and disc disease on MRI. Minimal testing will probably equate to all these folks recieving a surgical recommendation. Certainly not all, but many a surgeon will move quickly to operate. More extensive testing might reveal that 2 or 3 of the 5 might not be great candidates for whatever invasive/expensive surgery being served up. Those surgeons who put profit above the patients health will have all 5 on the operating table. Then take the probability that a certain % of patients will require more surgery after initially surgery and that sums up what is going on with some of the industry. More resources need to be put toward diagnosing pain generators instead of all the RD that goes into coming up with another variation of spinal hardware. The spinal industry's effort to maximize profits can conflict with what is best for the patient. My own experience is indicative of this.

[mmglobal]

IMHO, in most cases, your surgeon does not want to be your doctor... they want to be your surgeon. It's difficult for us to understand when they become non-responsive and disengaged. It's not because there is nothing to be done, it's because they no longer see you as a surgical candidate. For many of us, there is a huge disconnect as we try to navigate these waters because we are expecting a level of management from the surgeons that they'll only provide for their surgical patients. (In the worst case, it's only for their pre-op surgical patients.)

Mark

[dshobbies]

Ah-hah. That explains it

[johnb]

Jim, from one spine patient to another that has taken the risks and still has problems, I feel for you and hope you can get some answers regarding your situation. Recently, I've had the opportunity to communicate with two professionals that did not have a stake in my treatment and were outside the traditional doctor patient relationship. The conversations were candid. I only wish I had communicated with them a few years ago before plunging into my treatment decisions. The first is a retired orthopedic surgeon. He is a good friend's father-in-law and was nice enough to chat by phone. He said he was dissapointed with the direction of the industry due to the strong influence the hardware manufacturers had over the decision making process. He said if patients knew about the money spent by the manufacturers on "conferences" at beaches, manipulated research data, bribes and kickbacks masquarading as consultancy agreements, spinal patients would be concerned. He said there are bad apples in all professions but was dissapointed in the growing numbers in his profession compared from when he began practicing to when he retired.

The other professional is a neurosurgeon that is a fraternity brother's older brother who also agreed to share his observations. He's been practicing for 10 years and confirmed what the retired ortho said to me but had some other important observations. He said that the average spine patient isn't "sophisticated enough" and has to rely heavily on the surgeon's recommendations which can make spine patients vulnerable. The payors (insurance companies, medicare, etc) lowering reimbursement rates and rising malpractice insurance premiums are effectively reducing compensation levels so doctors are looking for ways to make up for the offsets in income. One of the obvious ways to make up for these offsets is to perform more surgeries. Candidates who would have been most likely steered toward conservative treatments like I was when younger in my 20's with no nerve involvement and still functional with limitations (very young with a lot to lose) or the elderly. I know of two examples that fit both these situations where the outcomes were awful.

The profit motive is in play and we all need to do our homework and make informed decisions like Mark advises. That simple advice cannot be repeated enough when you consider the high price that can be payed with a poor outcome that can leave you in more pain that is often resistant to treatment, interfere with bowel, bladder, and sexual function, among other serious, life changing complications.

Jim, I know I meandered from your topic a bit but I feel like the profit motive may be an inpediment to you getting answers to your questions. Maybe one day in the future we will go from our family care doc to an intervetional radiologist who does nothing but diagnose and no surgery.

John

[Jim M2]

Mark,

Well said. It leaves us to manage our own health by learning the options, risks...etc, Then armed with knowledge we have to manipulate these doctors into giving us what we really need.

You helped crystallize my thoughts on this when we discussed my situation with PM and Neurontin last year at your GPN Headquarters. For everyone else here's the story. After more than 5 years of chronic pain a PM resident at Univ of Washington teaching hospital prescribed Neurontin. It really helps me. The PM doctors I saw before this never prescribed Neurontin even though I was a perfect candidate for it. They screened me enough to know I wasn't a good candidate for an injection and they were done with me. Would they offer Neurontin to help me manage the pain? No way, they could care less. They wanted me out of there so they could concentrate on finding patients that qualified for an injection. $$ The last PM wouldn't even take 30 seconds to write a script for a CT/Myleo that Zeegers requested. My super cool family doctor at the time wrote the script.

To my way of thinking the same thinking for PM doctors applied to surgeons. If you go to Post#1 of this thread you'll see my original goal was to return to the UW teaching hospital. I was hoping to have a resident take the time to prescribe some diagnostics. FAIL. I'm back to square one. I suppose I'll go back to my family doc to request once again a referral to UW. I'll start a new thread when I do.