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iSpine Discuss Wholy Brand new to this.......and Scared in the Main forums forums; hello. i have been online looking for information on spinal fussion vs. artificial replacements. I am Ali. I raise breed ...

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Old 03-19-2009, 09:24 AM
oes ali's Avatar
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Default Wholy Brand new to this.......and Scared

hello. i have been online looking for information on spinal fussion vs. artificial replacements.

I am Ali. I raise breed and show Old English Sheepdogs for 30 years now. I was a nurse (L&D) for 20 years. And am married to a wonderful man who works for the DOD and is now in South Korea after the pst 5 in Iraq working. We live in Colorado.

Showing dogs has never been easy, you stand on concrete and pound away in circles........ and my guys weight between 70=90 lbs. with brushing for 2-3 hours.

5 years ago i was in an auto accident and stress fractured 4 vertebra in my back and had kyphyoplasty I was up and walking the next morning and doing great. 3 days later i was home. 3 weeks later i was diving in Belize. That summer i 'specialied' my main boy from Mexico all the way to Westminster KC and to Switzerland to the Euro OES show.

Years ago i was thrown off of more horses than i ever knew....... i grew up in Texas/New Mexico and we rode.....

The problem is the past 3 years have been gettting worse and worse. I live on endocet........ i get no/zip/none/ nada help from Oxyconton. I have other stresses with the dogs too (dog club political crap) so i guess i am normal........ but this is so bad that there are days i don't want to get up now. I tried a dog show in st. Louis recently and ended up showing only 1 of 2 days i hurt so badly. I have been seeing my pain clinic doc for past 3 years trying to put off the inevitable of what was ahead and i didn't even know what it would be. I just know that something had to be done. I finally went back to my Orthopedist that did my kyphoplasty. He sent me in and i had a newer MRI (1st in 2 years) and i then had my discoderm whatever it was yesterday. I remember them waking me up to give them the how much pain was it................ and barely remember him telling me that no i wasnt crazy, i had 4 disc with problems. 2 totally 'gone' and 2 with bad tear's and severe leaking.

Where do i go from here.? Do i do nothing, fuse or new replacements? My life is showing my dogs, i need movement.

And then tonight in reading some of these, I had never thought about things going wrong or them not working and it has panic'd me even more.

I am going to have my husband come home from Korea for a week for th surgery........but other than that i don't know where to even begin to what to prepare for. What questions to ask the Dr.? I'm due to breed a litter this summer, how will that work out?

I'm sorry to stammer and go in many different direcrtions. I'm scared and have no one here to talk to.

Thanks.
Ali
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Old 03-19-2009, 01:51 PM
cls cls is offline
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Hello Ali,

What levels in your spine are causing problems? It is easier for the community to respond if they know if you are having cervical or lumbar problems.

I am 4 weeks post-op from a MIS TLIF (fusion) at the L5-S1 so this is the level where I have the most experience and information. I too live in Colorado and I have done quite a bit of research on doctors here so if you need a good NS, I can certainly recommend mine.

I love Old English Sheepdogs - we had a beautiful one growing up. My parents were ex-pats in Japan and took her with them, the kids there just loved her!

I wish you well on your research and hope you find the right solution for your back.
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Old 03-19-2009, 01:57 PM
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Welcome Ali,

I am very sorry to hear of your worsening condition. You have come to a great place to ask questions, receive support, weigh all your options as you move forward to return to the life you so love, of showing your dogs. As you have seen from perusing folks postings, there is definitely no black and white. So much gray to wade through, it can be quite daunting. Unfortunately, this is the reality of "what is the best surgery, the right solution, for me?" This does not mean you won't find that best solution. It just means there is alot of homework to be done. Some concerns that are important going forward, are things like: your overall health condition, despite your spine limitations; your age; have you had a bone density test performed to even see if you are a candidate for disc replacement?; are you a smoker? quit now, if you are even considering disc replacement; which discs are compromised? Knowing some of these answers will help us help you more effectively. There are many more questions and considerations, and other folks will chime in with them. We will gladly support you in any way we can, to help you help yourself. Again, welcome. We are here for you.

Cindylou
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bicycle accident 6/01: 2 compression fractures @ T12-L1; vertibroplasty; 4/06: right hip labral tear & arthroscopic repair; 4/07: lumbar prodiscs @ 3 levels, L3-6 by Dr. Bertagnoli; 7/02/08: ALIF L6-S1; 7/30/08: reopened to remove bone cement, leaked onto S1 nerve root; 8/08: pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion; ALIF fusion complete; 3/10/09: SI Joint Fusion by Dr. Stark; Jury still out.
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Old 03-19-2009, 02:01 PM
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4 levels? WOW! Well, when you are only dealing with 1 or 2 levels, Fusion is a viable option that according to studies, works quite well as long as you are ok with the high risk of needing further surgeries down the road (maybe 7-10 yrs down the road)as the adjacent discs also blow out due to the extra stress load placed on them by a "Stiff" back caused by fusion. The younger you are, the more time you have left in your life to experience more discs to blow and your back will just get stiffer and stiffer. No one can predict just how many additional levels will blow out/degenerate as time goes by. I can tell you that my doctor in germany is a HUGE outspoken proponent of the idea that not only is motion preservation with artificial disc better than fusion(for those who meet the ADR criteria, such as good facet joints etc), but he is especially outspoken about the more levels that need doing, the more critical it is that you go with Artificial discs. He told me this himself as we were discussing the issue. Technically, they have not proven here in the US studies that ADR prevents further adjacent disc degeneration, (this is because they only just started keeping records and doing controlled studies), but the doctors in Europe (who are clearly hands down way more advanced than the US doctors in back technology) seem to fully believe that ADR does indeed prevent adjacent disc degeneration due to its "Motion Preservation".

Another thing to think about besides risk of further deterioration of the spine due to adjacent disc degeneration with fusion,.....it seems to me , based on my reading patient outcome stories with fusion vs ADR, that ADR has a much faster recovery rate and that a significant % of fusion folks seem to not get pain relief or still h ave pain issues even up to many years after the surgery. I have read too many stories of people still suffering after fusion but extremely rarely do I read the same with people who had ADR. This is just my own personal observation and opinion. Just read stories on spinehealth.com and its loaded with people complaining of being in pain months and years after fusion. DOesnt look good to me. ON the other hand, read patient stories on those who have had ADR and clearly, most are having far less issues and are overall far more satisfied with ADR than the fusion folks.You can register here to read TONS of ADR patient stories ADR Support (Hope its ok to post other board links here, if not Mark will delete I guess)

Also, if you go ADR, its unlikely you will get insurance to pay for it. My 3 level cervical ADR in germany cost $40K. If you are having lumbar issues its about 25% more in costs I believe.Insurance will cover however many fusion levels you need done.



Hope this helps

Last edited by steve55; 03-19-2009 at 02:28 PM.
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Old 03-19-2009, 03:47 PM
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Default Welcome

Hi Ali
Welcome! Sorry to hear about your problems> I also was lost about my lumbar spine and did my homework, research, asked tons of questions.
Visited many Doctors, several test XRays, MRI, Cscane, EMG,etc
The best thing I did was to contact GPS Mark
He explained everything to me in laymans terms.Super nice Person.
He may post here and ask you a few questions?

Take Care
Keep Moving Forward
Gil
__________________
L5-S1 lam 1994
L2 to L5 DDD
L3 -L4 hern Dec 2007.
L4-L5 Annular fissure with mild central stenosis and moderate facet hypertrophy.
L5-S1DDDDD
L2-L3 Right-sided neural foraminal narrowing at and L3-L4 related to posterolateral hypertrophic spurs and facet hypertrophy.
C3-C4 limited DDD
9 injections Depo. P.T. 13 months 5 dose packs,
Nerve Block Injections.4 ESI S1
L5-S1 foraminotomy 09
L4-L5 Microdiscectomy 09 Reherniate 4-2010
Coflex-L Implants L4 to S1

Last edited by Gil Denis; 03-20-2009 at 02:54 PM. Reason: Editing
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Old 03-19-2009, 06:43 PM
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Default Welcome

Hi Ali,
You came to a very resourceful place so I think you can gain some assistance here.

If you are not in an emergent place to make a surgical decision get several opinions. Mark can be helpful here IMHO and I'd have a talk w/him. ditto on previous poster's recommendation re checking out Mark's website at GPN Artificial Disc Replacement ADR

When you find the surgeon and the surgery you think will work best for your lifestyle then you will probably be ready to move on tho don't jump the gun w/o checking things out re surgery/surgeon.

Perhaps it'd be a good idea to plan on getting some help as well just in case your recovery is a bit slower than you expect and you need help to accomplish the things/goals you have planned for the upcoming near future.

You are starting in the right direction. You've had some diagnostic tests done and you're seeking some further direction. Keep going as you're on a path already.

Here's a good website to learn about the spine: ChiroGeek's Home Page

Reading there might help you forumlate and/or understand more of what is going on with your spine.

Good luck and welcome. Your career sounds wonderful!

Last edited by Maria; 03-19-2009 at 06:46 PM.
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Old 03-19-2009, 06:50 PM
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Hi Ali and welcome,

As all those who have come before you, the first thing you need to do is calm down and breathe. There is help out there for you, all of which is dependent on your circumstances as Cindylou, who just had surgery herself and is already posting for others , stated.

The first step is finding the right doctor which usually means getting 2nd or more opinions. You want a doctor that is well versed in all remedies available to you. You'd be surprised at how doctors who don't perform certain procedures won't recommend them and will even tell you how bad they are. Mark can help steer you in the right direction. Gil's web address was just a little off (globalpatientnetwork). The correct one is GPN Artificial Disc Replacement ADR. He's so calming and informative. Should you choose to use his services you'll need to have copies of your films and other records, which you should have anyway, but I'm getting ahead of myself. Mark underwent a 2 level lumbar ADR surgery about 5 years ago and is now facing cervical surgery. He's been there done that and became a patient advocate just to help those who don't know what to do next.

Then, when your brain starts functioning again, which will be soon, I promise, educate yourself. Ask questions and often. Don't be afraid to ask for simpler explanations when you don't understand something. This is your body and you have a right to know what's what.

Ali, we all know you're in pain and don't know which way to turn. Everyone posting here has walked in your shoes... EVERYONE. We all have spinal issues and we all understand.

Your Old English Sheepdogs (cute puppies) had leaned on you for years and now it's your turn to lean on them, one of the benefits of having dogs. They want you whole.

Glad to see you have a pain managment doc. You can't think clearly when hurting clouds your mind.

I hope you find the solution you're looking for and wish you a pain free future, Dale
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Old 03-20-2009, 12:15 AM
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Ali,

You have a pretty good ortho clinic in Loveland, CO, Rocky Mountain Spine. You may want to give them a chance. I agree though, several opinions is the best course of action.

Good luck!

Bob
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05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc Surgery L5/S1
3 Ortho and 1 Neuro Surgeon, 3 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 Maverick ADR at L4/L5 & L5/S1
03/27/09 The Lord and Dr. Ritter-Lang returned my life to me.
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Old 03-20-2009, 12:32 AM
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Thank you all.
I think just everything hit me last night.
I am not sure exactly which we are looking at. I believe it is L4-5 and S that need the work done. Below where my kyphoplasty was done. THAT was a miracle surgery when it was done.

I have my followup with Dr. Sisson next Tuesday. Then my follow up with Ortho Dr. Grossnickle the next week. I will let you all know what is said and happens. I really have the best confidence in these two men. They both work out of Medical Center of the Rockies in Loveland and in Greeley and Ft. Collins. Dr. Grossnickle breeds and shows dogs too so that is something we both have in common and know what needs to be done and how i need to feel. An understanding level.

The best bet said last night was to "take a deep breath" Thank you. Just overwhelming right now. Getting things approved is next step, then getting husband home from Korea for Family leave act to stay for week will help.

In the meantime, i'm becoming a NCIS addict......on the tv.............

Thanks to all
ALi
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Old 03-20-2009, 12:39 AM
ans ans is offline
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So sorry you're here. This fellow has an excellent reputation:

Rocky Mountain Associates in Orthopedic Medicine

I lived in CO and loved it but was in good health at the time!

Best Wishes - Allan
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Old 03-20-2009, 01:21 AM
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Hi Ali

Sorry about the miss information on GPS.

I am sure Mark will contact you.

Dale thanks for helping on the correct information.

Take Care

Gil
__________________
L5-S1 lam 1994
L2 to L5 DDD
L3 -L4 hern Dec 2007.
L4-L5 Annular fissure with mild central stenosis and moderate facet hypertrophy.
L5-S1DDDDD
L2-L3 Right-sided neural foraminal narrowing at and L3-L4 related to posterolateral hypertrophic spurs and facet hypertrophy.
C3-C4 limited DDD
9 injections Depo. P.T. 13 months 5 dose packs,
Nerve Block Injections.4 ESI S1
L5-S1 foraminotomy 09
L4-L5 Microdiscectomy 09 Reherniate 4-2010
Coflex-L Implants L4 to S1
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Old 03-20-2009, 01:30 AM
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ans,

Thanks for the link ....

It's nice to read about the doctors who invented the Maverick disc.

Todd
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Surgery 10-19-07 ( L4-L5 Maverick disc )

For my true life story ...

go to -----> www.youtube.com

print -----> ADR surgery into the space bar

or ... http://www.maverick-disc.blogspot.com (my picture & movie updates)
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Old 03-21-2009, 03:15 PM
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Ali, Everyone has given you great advice, so all I'll say is ditto! Good luck in your journey, you've come to the right place. Sandy
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2004 excessive pain, x-ray, PT, MRI diagnosis cervical DDD
**PM recommended, meds, PT, massage therapy, chiropractor, injections
**Dec. 2007 numbness and weakness in left arm/thumb, x-rays, MRI, discs at C4-7 pushing on spinal cord, fusion or ADR out of country
**April 7, 2008, discogram at C3-4, surgery 4 levels, Prodisc-C, Dr. Bertagnoli, Germany
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Old 03-22-2009, 01:06 AM
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Hi All. Thanks for all the notes of welcome. I'm making my way thru them..

Today i received the notes from my Pain Clinic Dr. that is also a surgeon......that did the discogram.

I was a L*D nurse for years, have NO CLUE as to ortho......... but here is what his reports said:

Discograms:
L2-3 Opening pressure 15psi, pain to pressuree was 50 psi peak pressure was 84 psi. numeric pain score of 10. severely degenerative with full thickness posterior annualar tear.

L3-L4: Opening pressure 15 psi, pain to pressure was 45 psi peak pressure was 70 psi. Numeric pain of 8. The disc archetecture was moderately degenerative. P2 concordant pain response.

L4-5: Opening pressure 16 psi, pain to pressure was 40 psi and peak pressure 82 psi. Numeric pain score of 10. The disc archeticture was severely degenerative with both anterior and posterior annular tears.

L5-S1: Opening pressure 23 psi, pain to pressure was 55 psi and peak pressure was 85 psi. This reproduced pain down the left leg and in the low back. The disc architecture showd sever degenerative disc disease witha full thickness left posterior annular tear reproducing P2 concordant back and P2 concordant leg pain.

Conclusion: An awake and cooperative patient who gave consistent responses. There was not a normal control disc, however the patient was reliable. The patient had reproduction of her usual back pain at L2-3, L3-4, L4-5 and L5-S1, which was considered P2 concordant, and reproduction of her left leg pain at L5-S1 that was concordant also.


okay, someone explain all this to me Lucy?????
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Old 03-22-2009, 03:46 PM
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Hey Ali,
I think the more reliable and expert sources here can explain this discogram to you but it looks like to me that you've problems from L2-L5S1 that might need addressing. In other words.. no wonder you've so much pain!


Ok, I'm no expert in spine information either except being a long term lumbar spiney/more currently feeling the cervical issues going on.

We nurses really get stuck with some spine stuff going on...(RN/NP for nearly 3 decades/retired re spine issues).
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Old 03-22-2009, 06:37 PM
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Ali,

OUCH . I was surprised by the number of nurses complaining of back problems but after talking to a few of them, I no longer wonder. This is a serious issue and seemingly ignored by the medical community at large. I'm surprised w/c hasn't interfered. In CA, what about OSHA?

A discogram discovers which discs are pain generators and it sounds like you have 4 bad levels. Speaking only from personal experience with absolutely no expertise, you may be heading for surgery where your choice of doctors is beyond important.

Good luck and keep us posted, Dale
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Old 03-22-2009, 10:34 PM
oes ali's Avatar
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i've been trying to do some reading on the net, and i'm not sure if i'm reading correctly or not. Since i am looking at 4 disc's would i be able to do 4 adr's?

I think my problems result from a whole life of one thing or another! Nursing IS hard on the back, lifting patients, standing for hours on end.... and then I rode horses and was thrown more times than i remember, skied with many tumbles for years, and then went to the dogs........ lol literally. And i of course didn't pick an easy breed........ I stand a minimum of 3 hours to prepare on the day of a show, then for 15 minutes in the ring........ then another 30=1 hr to brush out all the stuff .......... and all my guys think they cannot get in the car on their own, they need to be 'lifted' all 90 lbs of them. not to mention all of the crates and equipment. My one crate alone is close to 80 lbs it is a big flight crate for when we fly.

I think we need to start educating our younger generation to proper back care..... as it needs to last a lifetime! We don't think about it when we are younger until it is too late. I'm only 50 but feel like 90.......... Oxycontin does absolutely nothing for me. They are 10 mg but zip nada. I take 2 - 3 endocet and they work better...
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Old 03-23-2009, 12:42 AM
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Hi Lucy

I agree we need to educate the younger generation,

My spine is falling apart and it is mostly from Construction, Sports, Skiing, Genetics

I am Almost 50 and need to be fixed in the near future

Keep us posted

take Care

Gil
__________________
L5-S1 lam 1994
L2 to L5 DDD
L3 -L4 hern Dec 2007.
L4-L5 Annular fissure with mild central stenosis and moderate facet hypertrophy.
L5-S1DDDDD
L2-L3 Right-sided neural foraminal narrowing at and L3-L4 related to posterolateral hypertrophic spurs and facet hypertrophy.
C3-C4 limited DDD
9 injections Depo. P.T. 13 months 5 dose packs,
Nerve Block Injections.4 ESI S1
L5-S1 foraminotomy 09
L4-L5 Microdiscectomy 09 Reherniate 4-2010
Coflex-L Implants L4 to S1
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Old 03-23-2009, 01:44 AM
oes ali's Avatar
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lol Gil

That is my standard Ricky Ricardo "you need do sum splaainin Lucy".....

Could someone kind of explain to me what each one of these mean? I've underlined the part that i 'think' is important. Other than i hurt, lol. We have a major storm moving in and barometric pressure is dropping like mad......... no percipitation all winter and now we are getting it.

L2-3 Opening pressure 15psi, pain to pressuree was 50 psi peak pressure was 84 psi. numeric pain score of 10. severely degenerative with full thickness posterior annualar tear.

L3-L4: Opening pressure 15 psi, pain to pressure was 45 psi peak pressure was 70 psi. Numeric pain of 8. The disc archetecture was moderately degenerative. P2 concordant pain response.

L4-5: Opening pressure 16 psi, pain to pressure was 40 psi and peak pressure 82 psi. Numeric pain score of 10. The disc archeticture was severely degenerative with both anterior and posterior annular tears.

L5-S1: Opening pressure 23 psi, pain to pressure was 55 psi and peak pressure was 85 psi. This reproduced pain down the left leg and in the low back. The disc architecture showed severe degenerative disc disease with a full thickness left posterior annular tear reproducing P2 concordant back and P2 concordant leg pain.

Conclusion: An awake and cooperative patient who gave consistent responses. There was not a normal control disc, however the patient was reliable. The patient had reproduction of her usual back pain at L2-3, L3-4, L4-5 and L5-S1, which was considered P2 concordant, and reproduction of her left leg pain at L5-S1 that was concordant also
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Old 03-23-2009, 02:34 AM
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pain response at L5-S1?

It's interesting that there are references to concordant pain at L5-S1 and L3-4, but not at L2-3 and L4-5 which were both rated 10/10 pain.

Do you remember the discogram and your responses?

I know people with 4 ADR's, but it's possible that some of the levels are too far gone to still do ADR... you'll need to be evaluated (BY SOMEONE WHO HAS THE OPTION OF DOING THE SURGERY THAT MAY BE INDICATED!) "Not a candidate for ADR," spoken by someone who could not do a big multi-level procedure may be a valuable opinion, or it may be colored by the experience level of, or options available to the surgeon.

Mark
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2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
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Old 03-23-2009, 03:11 AM
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Oh yes, i remember the pain!
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Old 03-23-2009, 03:49 AM
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Do you remember L2-3 and L4-5 as not being "your pain", where L3-4 and L5-S1 were concordant?
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2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
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Old 03-23-2009, 04:22 AM
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oh my no, i just remember how painful the test was!

i go back to see the anesthesiologist that performed the discogram on tuesday to discuss all of this. i'll let you know what happens.

Ali
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Old 03-23-2009, 11:53 PM
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well i am home from my visit with my Ortho. the Anesth. that is also my pain clinic Dr appt is tomorrow.

I am slightly down and dont know which way to go at this point. He said my back had too much...... 5 years ago i had Comp. Fx. in L3/4. He performed Kyphoplasty on them. He said he doesn't know if any of this is from that accident or ??. He says there is way too much to do it all. He is suggesting only replacement of L5/S1. That this will not take away all of my pain but probably the big part of my pain at this point. I'm just depressed i guess now. I don't want to live my life in this pain. I have a feeling that is not unkown here.
I don't know if i should go for another opinion to a different surgeon or? I have International Insurance and can go anywhere in the world. He went ahead and put in for approval to have the surgery. I would have to have my husband come home from Korea, and get the dogs down to Texas to my breeder/partner.

I just know i am miserable with sciatic pain and pain coming out of my big toes. I'm tired of taking meds that don't work..

i don't even know what to ask the anesthes. tomorrow at this point.
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Old 03-24-2009, 12:30 AM
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Default hang in there

I want to say I am lost too - but these guys on here are great with great insight - I am a chef and know about the on the feet all day - I meet with a surgeon this week and I have taken the advice from everyone and still reading to try to make an informed decision - read up and as dumb as it sounds only we can make the decisions that impact the rest of our lives. Good luck and post all of us and the more info the better I have found out.
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Old 03-24-2009, 09:56 AM
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Default intenational insurance

oops *international*~ (sorry my spelling is goofy at nearly 3a.m. I'm awake with unrelenting neck pain despite the various drugs I took to relieve this)!!!!

Wow!! I wish I had that(this type of insurance). I would have already had my surgery done in Germany with Dr.Bertagnoli I think..

I do think you should get more opinions and from surgeons that handle problems of this magnitude (multi-level) or can at least address what all might be done optimally vs. perhaps all that one is equipped to do because the job appears too big.

Or maybe your doctor is correct in what he proposes given your symptoms tho I'd still want an opinion or two from surgeons that handle multi level problems and have much at their disposal to work with re experience/skill.

We've made some earlier suggestions so I'm not sure if you've followed up on them and I don't want to sound pushy or anything tho if I had the opportunity to go freely where I wanted I'd at least get an opinion and/or consultation with some other surgeons that do more varying kinds of procedures as mentioned..

You may hear the same thing as your doctor stated, you may not tho at least it will be another very valuable opinion.

good luck and sorry you're in so much pain

Last edited by Maria; 03-24-2009 at 09:58 AM.
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Old 03-24-2009, 06:05 PM
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Ali,

I know the consensus is to not interfere with non-pain generators but dealing with you major pain, will that still leave you with pain and disability? To me, this is unacceptable if getting rid of all your pain is possible. I believe you need to seek out other opinions and with doctors who are comfortable dealing with multi levels. The best multi-level surgeon in the world is Dr. Bertagnoli in Germany. Mark works closely with him both is obtaining opinions via the internet and scheduling surgery (especially with international insurance - never heard of it).

If you doctor only wants to replace only 1 level, what would he the do if other discs became major pain generators? Back surgery is pretty major and you need to know what to expect or you can't make an informed decision. Are there any contra-indications to ADR?

Please don't accept this doctor's opinion until you have better educated yourself, asked all appropriate questions and obtained other opinions. This is your back and you have a right to the best care possible.

I sent you a pm... good luck, Dale
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3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
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Old 03-24-2009, 08:19 PM
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Ali, I ditto everything Dale said. You owe it to yourself to receive some more opinions by doc's. Hang in there. His is only one opinion.

We're here for you,

Cindylou
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bicycle accident 6/01: 2 compression fractures @ T12-L1; vertibroplasty; 4/06: right hip labral tear & arthroscopic repair; 4/07: lumbar prodiscs @ 3 levels, L3-6 by Dr. Bertagnoli; 7/02/08: ALIF L6-S1; 7/30/08: reopened to remove bone cement, leaked onto S1 nerve root; 8/08: pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion; ALIF fusion complete; 3/10/09: SI Joint Fusion by Dr. Stark; Jury still out.
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Old 03-25-2009, 12:20 AM
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Default Ditto

Hi Ali

I agree with Cindy And Dale. If your going to have one level done and other levels are pain generators I would do all Levels At once.

I am also looking at several levels with Dr B in Germany and sitting on the fence

Best Wishes

Gil
__________________
L5-S1 lam 1994
L2 to L5 DDD
L3 -L4 hern Dec 2007.
L4-L5 Annular fissure with mild central stenosis and moderate facet hypertrophy.
L5-S1DDDDD
L2-L3 Right-sided neural foraminal narrowing at and L3-L4 related to posterolateral hypertrophic spurs and facet hypertrophy.
C3-C4 limited DDD
9 injections Depo. P.T. 13 months 5 dose packs,
Nerve Block Injections.4 ESI S1
L5-S1 foraminotomy 09
L4-L5 Microdiscectomy 09 Reherniate 4-2010
Coflex-L Implants L4 to S1
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Old 03-30-2009, 02:12 AM
oes ali's Avatar
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Hi All.
Well i've had a week or so to digest all of this now, as well as other stress related items going on in my life.

I am going in on Thursday afternoon to have my epidural injections done again. I had not realized it had been over one year since i had them done. No wonder i was in pain and not realizing it had been that long.

What i would like to ask is I know i need to start keeping a 'file' for myself, and to take to other Dr's. when they ask to see what has been done. I have not been to a Neurosurgeon since i stress fx'd L3/L4 5 years ago. I never thought of going back to him until someone on here mentioned a NS.
My thoughts were just go back to my Orthopedic Surgeon as it was a 'bone' issue....... never dawned on me 'nerve' and i'm a nurse guys. Anything other than obstetrics........ be it human or dog i don't know.

SO my question is........ for this file for MOU (my own use) WHAT do i need to get from my Ortho and from my Pain clinic Dr.? What needs to be in this file? Shoule i go ahead and make an appointment with a Neurosurgeon? I am very very seriously considering an Appt. with Dr. B in Germany. I am planning on going to South Korea to see my husband late next month and will come back by Germany if i can get in to see him. I'm going to be breeding a litter of puppies hopefully due in June. so any surgery will have to be done after September!

Thanks for the thoughts and good healing prayers to you all!
Ali
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Old 03-30-2009, 02:29 AM
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Sorry for all of your back trouble and life stressors.

Google actually has something called "Google Health" that is great for organizing your information in one place (films, reports, meds, etc.) and it is free, secure:

Google Health

Regarding Dr. Bertagnoli: he is an extremely busy man and can be in multiple countries in the same week. It would be easier to send him all of your information online, as an appointment might actually be very difficult to arrange.

Dr. Bertagnoli Case Evaluation

Note: there is a fee for this, which is expected with the man hours dedicated to making clinical decisions regarding patients and the information they present. I don't have any financial relationship with Dr. Bertagnoli...I'm just fond of his incredible work.

Good luck and keep us posted.

Quote:
Originally Posted by oes ali View Post
Hi All.
Well i've had a week or so to digest all of this now, as well as other stress related items going on in my life.

I am going in on Thursday afternoon to have my epidural injections done again. I had not realized it had been over one year since i had them done. No wonder i was in pain and not realizing it had been that long.

What i would like to ask is I know i need to start keeping a 'file' for myself, and to take to other Dr's. when they ask to see what has been done. I have not been to a Neurosurgeon since i stress fx'd L3/L4 5 years ago. I never thought of going back to him until someone on here mentioned a NS.
My thoughts were just go back to my Orthopedic Surgeon as it was a 'bone' issue....... never dawned on me 'nerve' and i'm a nurse guys. Anything other than obstetrics........ be it human or dog i don't know.

SO my question is........ for this file for MOU (my own use) WHAT do i need to get from my Ortho and from my Pain clinic Dr.? What needs to be in this file? Shoule i go ahead and make an appointment with a Neurosurgeon? I am very very seriously considering an Appt. with Dr. B in Germany. I am planning on going to South Korea to see my husband late next month and will come back by Germany if i can get in to see him. I'm going to be breeding a litter of puppies hopefully due in June. so any surgery will have to be done after September!

Thanks for the thoughts and good healing prayers to you all!
Ali
__________________
-Justin
1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.
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Old 03-30-2009, 05:15 AM
oes ali's Avatar
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Thanks Justin,
I guess i am just not being specific enough but, I am one of those types that are please tell me exactly what it is i need to have in my folder as i don't have a clue...........

some ideas please would be appreciated........... a list.

And i will contact Dr. B as soon as i know my dates of traveling..........

Thanks!!
Ali
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Old 03-30-2009, 06:59 AM
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Most importantly you need copies of your MRIs, corresponding Radiology reports, report of the Discogram and records of other important tests or treatments you may have had done. Then to present to someone like Bertagnoly you need to write up carefully your current situation and the history that lead you to this point. I would like to highly recommend Marks GPN service for presenting your case to Bertagnoly, He will help you getting you records organized and placed on his website so then to submit to the doctors.

Best of luck and no more pain!
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Nov 07: STALIF Fusion L5/S1 ACTIV-L ADR L4/L5
Nov 09: Prodisc-C ADR 2 level C 4/5/6
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Old 03-30-2009, 11:48 AM
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Quote:
Originally Posted by oes ali View Post
Thanks Justin,
I guess i am just not being specific enough but, I am one of those types that are please tell me exactly what it is i need to have in my folder as i don't have a clue...........

some ideas please would be appreciated........... a list.

And i will contact Dr. B as soon as i know my dates of traveling..........

Thanks!!
Ali
No problem, as I know it can be overwhelming when just starting out. If possible, you should request a copy of your medical records from your primary care doctor as well as all specialists you have seen. It is also a good idea to request a copy of all films (most places put them on a CD now, but some still give you films). Here's the "meat and potatoes" that should be provided to your doctors:

1. Past Surgical History (Spine/Non-spine related) / Medical History (comorbidities: high blood pressure, cholesterol, diabetes, etc.)
2. Meds / Allergies (Drugs, Environmental, Food)
3. Diagnostics (xrays, MRIs, CTs, discograms, etc. [films with dictated reports])
4. A short list of conservative therapy you've tried (PT, meds, injections, etc.)
5. History of Present Illness: a concise description of your current symptoms describing:
--> the Location of pain
--> Quality (burning, numbness, electrical shocks, weakness and explain duration)
--> Quantity (pain on a scale out of 10)
--> Timing (when your injury(ies) occurred or when your symptoms became troublesome)
--> Better or Worse (what makes your pain better [rest, frequent change in position, heat, stretching, etc.] or worse [prolonged activity, what position is least tolerable])
--> Associated Symptoms (any associated nausea, vomiting, fever, etc. issues)

Good luck!
__________________
-Justin
1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.

Last edited by Justin; 03-30-2009 at 11:50 AM.
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Old 03-30-2009, 06:07 PM
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Ali,

Your file is pretty self explanatory. You should keep dates of doctors appt, who they were, your symptoms, what they did, recommend, diagnosis, prescriptions taken, reactions, all films and reports. and anything else you think even remotely might be relevent. After procedures, treatments, surgeries, keep a diary of your pain, swelling, reactions, meds, etc.

The easiest way to get through to Dr. B is going through Mark. GPN Artificial Disc Replacement ADR He can put your records, films up on his website and consult with Dr. B on your behalf in just a matter of days, and even schedule surgery should that be what you decide.
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Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
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  #36 (permalink)  
Old 03-30-2009, 06:48 PM
oes ali's Avatar
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Thank you all this is exactly what/how i needed to see this.
Right now i'm pretty well zonked out on 30 mg of oxycontin, not feeling very well really shakey......... as soon as i come out of this i will get started.
cant keep eyes open
Ali
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Old 04-10-2009, 05:29 AM
oes ali's Avatar
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Default Really hurting tonight........

hi guys. boy i am sorry i haven't been around. When i say i'm going thru a lot of other 'stuff' here too you just have no idea. Whatever you do in your life, do not get into showdogs. The politics are horrid and people are so nasty to each other you have no idea. I have a young pup (the one in my avitar i think) that everyone is saying is up for the next winner of Westminster/Eukanuba/our national etc.... he is that nice. And a guy that lives around me that is so not wanting me to do anything with him he is being so nasty etc.........so remember, dont get into dogs. Unless you have lots and lots of money and want to back my boy!

ANYWAY BEYOND THAT AND BACK TO BACKS

I had my epidural injections done a week ago. These were the first ones in over a year i have had done (didn't realize it had been that long no wonder i hurt). Today i am in such misery you guys probably know. I am sitting/lying here with sciatic pain 'STINGING' in each of my buttocks and burning hot pain coming out of each of my big toes and toes next to them. Hot flashes from the steroids i guess. They have put me on 30 mg of Oxycontin and all it does is make me sleep. LITERALLY.

They finally told me that the disc's being gone or leaking/torn WERE probably due to my stress fractures as they are all below that level from my auto accident. I've always wondered it.......and finally someoen admitted it to me. But what do i do right now? I am feeling like this last set is not working and i don't know what to do........ do i suck this up for anothe two weeks or so or do i call the dr. tomorrow??? What can they do go back in again??

I'm trying to get all my records together. seems like it is taking forever.

Can anyone recommend anyone in Texas to see? Remember this is Lumbar/sacaral from L2/3 down to S/1

Ali
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Old 04-10-2009, 02:57 PM
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Default Bone Density

Hi Ali

If you see Dr B he will want a bone density test done. You could do it here or he will perform one in Germany, I would do it here , Hate to find out in Germany not to be a patient for ADR because of low bone density.

Keep Moving Forward

Dr Zigler Texas Back Institute

Gil
__________________
L5-S1 lam 1994
L2 to L5 DDD
L3 -L4 hern Dec 2007.
L4-L5 Annular fissure with mild central stenosis and moderate facet hypertrophy.
L5-S1DDDDD
L2-L3 Right-sided neural foraminal narrowing at and L3-L4 related to posterolateral hypertrophic spurs and facet hypertrophy.
C3-C4 limited DDD
9 injections Depo. P.T. 13 months 5 dose packs,
Nerve Block Injections.4 ESI S1
L5-S1 foraminotomy 09
L4-L5 Microdiscectomy 09 Reherniate 4-2010
Coflex-L Implants L4 to S1

Last edited by Gil Denis; 04-10-2009 at 02:58 PM. Reason: addmore information
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Old 04-10-2009, 03:45 PM
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Ali,

Do what you can to stay comfortable. Mark is in Germany right now, having just had a 4 level cervical ADR on Tuesday. I'm not sure when he's coming back, or if his office can get your records up and running while he's over there and he can consult with Dr. B while still there.

As for your records, the most important things are your films and reports. Put together a list of surgeries and/or procedures even if you don't have the actual records. Even without a whole picture, your films will probably be sufficient enough to paint the picture. Don't wait until you've completed all other tests because you can always add to your online profile and Dr. B will also let you know whatever else he needs.

I know this can be overwhelming and all you need to do is actually get started. The rest just seems to fall into place.

Just get started and call Mark's office (Angie), if that's the route you want to take.

Good luck, Dale
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3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
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Old 05-01-2009, 04:11 AM
oes ali's Avatar
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Default update

Hi guys......... i've not been on the forum for a while. Thought i would update you a bit. I had another set of epidural injections 4 weeks ago now. I see some days as it helping but lately not that much. My L3-L4 disc area 'stings' and pains down my legs again with my toes freezing most all the time.

I also am gathering all my info up (physical info from Dr's) and am driving next week to a dog show (yeah i know BUT i am not going to be the one showing now! my partner in crime is going to show them for me) in Denton Texas, and the following Tuesday I have an appointment with Dr. Ziegler in Plano. Thank you for whoever it was that recommended him for me.

I also bought a new sleep number bed and today is my first night on it. I'll let you know how THAT goes! lol. So far Peepers kitty is very happy with it..... lol.
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Old 05-01-2009, 05:27 AM
oes ali's Avatar
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Default OH Forgot

OH I forgot, i have 2 books that i have ordered.

I heard a woman on tv talking about her experiences.
Lynne Greenberg The Body Broken
and
Dr. Nathaniel L. Tindel, M.D., I've Got Your Back - The truth about spine surgery


I've only read a little of both but they appear to be very good. Different styles of books. Dr. Tindel is a board certified ortho surgeon.

i'll let you know what i think of them after i've finished.

on another note. The day after i see the Dr. in Plano, i leave to go visit my husband in Korea for 2 weeks......... I've something to be excited about!
Ali
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Old 05-01-2009, 01:01 PM
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Default Insurance issues

Hey Ali...since your husband works for the Fed, they will cover ADR, but may only cover one level...and you'll probably have to fight with them to get them to cover that. The insurance companies that insure federal employees go by the guidelines that, if it's FDA approved, then it's not "investigational". However, the FDA has only approved a single-level disc replacement.

Here's my two-cents worth on getting around this...go to Germany. Dr. Bertagnoli's team provided me with everything I needed to give to my insurance company for a 2-level ADR, but without actually CALLING it a 2-level ADR. Plus the fact that it's about half the cost over there vs. here, so the insurance company doesn't "inspect" the foreign claims too closely...they even told me that (because they're still saving money, and they know it). I had to fight with them for a few weeks, but I won.

Plus, in my opinion, and I think a lot of people here will second this, Dr. B in one of the top spine surgeons in the world. I have a great neurosurgeon here in the States, but I'm scared to death of this surgery, and I know that my surgeon only has a few ADR procedures under his belt. That's not good enough for me...if I'm going to do this, I want the VERY BEST, because experience and track records speak volumes. So I'm leaving for Germany in 3 weeks.

If your insurance company gives you any crap, send me a private message...I'll try to help you.

Jess
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36 year old mom of 7 in SC.

MRI 4/2008 shows bulging disc with annular tear @ 4/L5 and and complete herniation at L5/S1.

9/11/08 Laminectomy , successful to a point...relieved nerve pain, but after 4 months was still having severe disc pain.

Treatments tried: epidural shots, oral pain killers, NSAID's, TENS massage, chiropractic care, deep tissue massage. Oh, and plenty of our homemade wine!

May 26 2009, 2 level ADR, L4-S1, Dr. Bertagnoli, Straubing, Germany

Last edited by jessmith07; 05-05-2009 at 06:27 AM.
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Old 05-01-2009, 01:21 PM
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You are going to love Dr. Zigler! He is extremely down to earth, takes the time to listen and explain things to you, in a way that is easy to understand. I really liked him and was going to have my surgery with him. He is one of the best surgeons in the US and world. He has done hundreds of ADR's, has been an investigator in clinical trials and has a great track record. It was funny, when I was turning in all the research and trial information for my Pro-Disc surgery, he had written some of it (as in published in a medical journal research, which is a big thing for a dr). It turned out that I didn't have surgery with him; because my insurance denied it and I was excluded from the clinical trial for spinal litigation. I went to Florida and was in a different clinical trial and I follow up with Dr. Blumenthal at TBI. That entire office is great. Go to their website and read the history, it is very interesting. They have been on the cutting edge of spines for decades. They were in the clnical trial that proved MRI's were more effective imaging for spines (which now is crazy to think that that was ever a question). He is brilliant and a great doctor. You can google his name and find tons of great information on him.
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34 years old-
1/06- In wreck with 18 wheeler
Numerous MRI's, PT, chiropractic, accupuncture, TENS therapy, massage therapy, facet injections, epidural injections, Nerve study, Discogram, confirms pain in L4/5, IDET, decompression, Bi-lateral neurotomy L3/4/5, denied by insurance twice, in Active L clinical trial, had surgery March 17, 2009 in Miami, FL- received Active L disc
Had Baby #3 after ADR!

Last edited by Kathy; 05-01-2009 at 01:26 PM.
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