ADR 5 years on

[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.

[Jim M2]

Thanks John, I just let things get derailed by not being more persistent with my family doctor. She means well, but she's very young. I strongly suspect she doesn't have a good understanding of the huge gap in health care that arises from the profit motive.

[mmglobal]

Most of the spine surgeons I know are very decent people who give the same recommendation to each patient that they would give to a family member. I have seen, first hand, many of the horror stories about doctors perscribing the surgery that's good for them instead of the one that's good for the patient. That said, I still believe that most of them are good people who got into medicine for the right reasons and manage their patients and their practices as best they can with the harsh realities of modern medicine and the uncertainty of spine surgery.

Spoken to every failed spine patient, the statement that the surgery should not have been done and conservative treatment would have been better, will most likely be true. The flip side of that is that so many successful patients would have lived more years in pain instead of having their successful surgery, and possibliy given up higher chances for success as their pathology worsened.

The reason that more conservative treatment was done in the past is because the surgical offerings were more horrific, less successful. There were no options in between conservative treatment and brutal fusions. Fusions have become less brutal, hardware has improved, as has patient selection. Intermediate treatments have provided excellent relief for many; with discectomies, micro-discectomy, endoscopic discectomy, interspineous devices, dynamic stabilization, ADR, nucleus replacements, facet replacements, biologics, etc... We now have so many other options besides PT and meds, versus the brutal fusion - AND if you need a fusion, those are better too.

Unfortunately, there is still such a randomness to failed spine surgery that we will continue to hear the horror stories over and over. I don't know if we'll ever get past this. I have seen clients with failed surgeries that may have been avoided. Their experiences will help me to keep future clients in similar situations from making the same mistakes. While our odds may seem like they keep improving, but I believe that we are close to a wall that represents the randomness and lack of understanding we have about pain and structural issues, especially in difficult situations. (I still see occasional, seemingly perfect candidates fail.)

Sorry for the long rant that may even be off topic. I too don't trust the data and have seen big money get in the way of effective medicine too many times. We are caught between so many competing interests and the players do not all have our best interests at heart. However, we can't lay it all on the evil empire of the money-motivated mega-corps or on the doc who "need to make the payment on their Porsche". Spine surgery sucks and under the best of circumstances, many of us will fail. If you can avoid going down the surgical path, by all means exhaust every reasonable possibility (without putting yourself at too much risk.) If you need to have surgery... do your homework... make informed decisions.

Mark

[johnb]

Right on Mark. If you were there during my initial consult I don't think I'd have had surgery with him as you would have known the dishonest statements or he wouldn't have made said statements because you were there. Better yet, you would have steered me towards a surgeon that you knew to be trustworthy, honest, and all that good stuff that you demand from someone dealing with your health. I've confirmed that statements my surgeon made were dishonest. If my surgeon had answered one specific question I had in an honest manner, I would not have had the surgery that I did. I have a different belief about the randomness. IMHO, there are reasons for everything but they are just not understood yet. The future of solving these problems will not come from hardware but from regenerating damaged tissue. Let's hope that with the new politicall environment, stem cell research will pick up and we can be closer to a more natural, physiologic solution that doesn't include non organic metal in our bodies. There are some nasty biofilm infections that the immune system cannot fight once they get attached to hardware in our bodies. Will the hardware makers go quietly or will they be like the big 3 automakers that still want to produce gas guzzling SUV's and go the way of the dinosaurs. I know many who will be glad to pay a premium for relief.

Okay, I've gotten off topic a bit Jim but I believe my experience can help other patients which is why I shared.

John