DIAM vs ADR

[Katie]

Sorry, I forgot to answer your other question. No, there has been no talk about the C7/T1 from anyone (six different surgeons). Dr. Bitan said that the C4/5 will have ADR and C5/6 will be fused to let it repair itself as much as possible...stabilize it to let the swelling go down.

In the lumbar, he will be doing ADR at L3/4, then fusion at L4/5 and L5/S1. He said there is very little motion at those two bottom levels, and putting in the ADR above will minimize the adjacent disc syndrome, the likelihood of the next disc in line disintegrating from the extra load put on it.

It is a good compromise from all the other conflicting opinions we've had.

[Kathy]

Katie,
I am so glad you found a solution for your spine. I would go with cervical first, since 6 surgeons have all agreed on that. There is a reason they have the Dr. in front of their name and we don't! As much as we do know, they went to medical school and we didn't. Plus, I wouldn't want to take the chance of something bad happening (I'm sure lots of people have dodged the bullet; but you don't want to be the one who doesn't).
You are way braver than me having two surgeries so close together; not that you have much choice. It's probably better to get it all fixed at once and be on the road to recovery.
Did you get a surgery date?
Best Wishes,
Kathy

[Katie]

I had written such a lovely long letter explaining all of our plans and reasons why Dr. Bitan is doing what he is. Then POOF!, it disappeared when the computer timed out when I tried to send it. That will teach me, once again, to 'copy' before I press 'send'

We are planning on doing the cervical level first, with what he called a hybrid ...the ADR/fusion combination spanning two levels. It is critical, and he thought that there was a chance that some or much of my severe lumbar pain might be coming from there also, as well as bowel and bladder issues. Such a wonderful word, 'issues'...it covers so many touchy subjects so well

Dr. Bitan's assistant was pretty stunned when he realized that we would be doing everything in one week...guess that doesn't happen often! Whether it was the five levels or all surgeries in one week...not sure what surprised him the most

I must say that I've never met such a kind and caring doctor. He asked questions, and most importantly listened to my answers, then responded and made sure we both understood each other. Plus showed off his wicked sense of humour when I least expected it.

So, while we don't have any dates yet, we are hoping for late May or early June, if not earlier, if everything falls into place. 'Everything' being funding from the province, of course. It can take up to a month for approval (or not), but since I have been waiting three years already, and Dr. Bitan has made the urgency of my situation very clear in a letter, I am hoping that it will be pushed through much faster than that.

This will be the kicker...the $$$$. The cost for this is so far out of my league, it is insane. Well over $100,000 without insurance. But I am thinking very positive thoughts that it will all come together sooner than later. Fingers crossed everyone!

[treefrog]

That is wonderful, that you were able to get some answers and a plan. And it sounds like you feel like Dr. Bitan is the right surgeon for the job, that's very important.

I will hope that the funding comes through for you, and that you can have surgery as soon as possible.

[Katie]

Thanks Cathy. I am on a roller coaster of emotions right now, with worrying about the funding coming through, etc.

We did have a marvelous time in the Big Apple though. Our two year old Australian Shepherd was awed by the glass elevator...to put it mildly! After a few trips up and down, we didn't have to convince him to come in quite so much...and the tropical trees inside the hotel sort of messed with his mind as well, from a dog's point of view "But Mom...they are here for a reason!!!!" It took a quick walk in the morning to get him outside to the 'proper' trees.

Good news is that my neurologist has agreed to sign my application for the out-of-country surgery for the Insurance. After quite a lecture about what happens when 'something goes terribly wrong and our local doctors have to clean up the mess...." He then offered to put in an 'urgent request' to the NS who I was supposed to see eight months ago........I politely declined, unless there is no way in h#&& that I can get to Dr. Bitan

[Nairek]

Katie,
I am 12 weeks out from an anterior/posterior lumbar fusion which was performed by Dr. Bitan. I can tell you from personal experience that he is an awesome doctor. Although I hated the idea of having to have go through another discogram, an SI joint injection, & a facet block, I knew he was doing that to make sure that I was the perfect candidate for the surgery that he was going to perform.

After my insurance company denied my request for ADR surgery, Dr. Bitan got on the phone with the medical manager to try & get them to change their mind. I believe he called them "narrow minded" when they continued to refuse to approve ADR surgery.

I spent 6 days in the hospital due in part to my body not behaving. Dr. Bitan stopped in to see me just about every day to see how I was doing. I was in total shock since I totally wasn't expecting that.

I can honestly say that you are in good hands with Dr. Bitan. I wish you the best of luck & hope that you get the relief that you are looking for!

Karin

[Katie]

Thanks Karin! I first read your response yesterday, but could not get logged into this site last night. I finally had success this morning.

As I said in my PM, you gave me such reassurance with the post here, but scared the c*#$ out of me with your other posts about complications. I was just about in tears last night before going to bed, as I read what I thought was very conflicting information....great feedback about Dr. Bitan himself, but lots of problems with pain control, etc. And that was with one level of fusion, and I am facing five levels over just a few days...two one day, then three more within a week.

AND, I know just enough about fusion to be afraid...I researched hard against it to force the insurance to approve ADR for me. Then came the conflicting information and here I sit...with an awesome doctor whom I have personally met and trust, who wants to do exactly what I didn't want...partly anyway.

I do believe that the fusion at the lowest levels of the lumbar will not be a bad thing, but I think I would rather have two levels of ADR and one fusion instead of one ADR and two fusion. What would be the reasoning for two fusion? I have no leg pain, but do have spinal stenosis, bone spurs and compressed flaval ligament in the lumbar. I understand the cervical more...because of the damage already done.

Would it be reasonable to ask for two lumbar ADR + one fusion? My problem is that I don't know what the indications are for that. How do they decide how many levels of which they are going to do, is my main question, I guess. Any answers out there? My MRI images, both cervical and lumbar, are posted on Pg 3 of this thread.

[Kathy]

Originally Posted by Katie

Good news is that my neurologist has agreed to sign my application for the out-of-country surgery for the Insurance. After quite a lecture about what happens when 'something goes terribly wrong and our local doctors have to clean up the mess...." He then offered to put in an 'urgent request' to the NS who I was supposed to see eight months ago........I politely declined, unless there is no way in h#&& that I can get to Dr. Bitan

Katie, I completely understand the lecture about the what could go wrong and we don't want to have to fix their mess stuff. I mean, in no industry do you want to have to go back and fix someone else's mess up. I think that there is the close mindedness toward the ADR surgery and they want you to stick with THEIR plan and do it their way. I get that too. But, when you know something is out there better, then you want to do that. I think you are making the best decision with the information you have. I'm sure my surgeon wasn't thrilled that I left the state and did the trial, as they were just ready to jump to fusion when insurance denied me. I knew that the best thing for me was ADR and I went with it. Trust your gut instinct and know you are in great hands! Let us know how it's coming along, Kathy

[Katie]

Yes, but this was almost a threat...'do this and you are on your own'. What he will not recognize is that I'm on my own anyway....no referals have produced a treatment plan for me. While he said he contacted the NS last summer, I have heard nothing. Yet all of a sudden he can put in an 'emergency referral'? My MRIs are from 07 and last fall, so my condition was the same then...urgent and critical....at risk for quadraplegia at any point from a small fall or bump.

So now he can get me in because I want to go out of country? This enrages me.

Also, another patient here has had treatment that did not solve her problems, and the acting surgeon then refused to see her again. Why is that acceptable when he is threatening the same if I go elsewhere?

Why are there no morals in health care anymore? My veterinarian cares more for my dog than the local doctors care for me. Dr. Bitan jokingly said that I should have gone to a vet....I would have been fixed my now, and he is right!