My 3 mo X ray - Discs tilted all over the place

[steve55]

Im not sure why I didnt bring this up earlier as I didnt initialy think this could be related to the current slipped disc, but since Sunday night, I suddenly developed a excrutiating throbbing pain from my around the back of my left shoulder, the shoulder itself, and upper arm. It does not travel below my left elbow. Ive had temporary "pinched nerve" sensations in the past that always slowly got better. But this one has not seemed to have gotten better and its wednesday morning now. The excrutiating pain is so bad that I couldnt concentrate on doing anything from eating to even watching TV. It hits really hard when it starts up. I took double pain killer(ultracet) and alleve just to relieve it monday night so I could actually sleep, and again, I took alleve and another pain killer to relieve it last night. Then this morning at around 7AM I was woken up with this excrutiating pain again. I seemed to be pain free at work yesterday without pain killers as it seemed to dissipate yesterday in the day only to return when I layed down in bed again yesterday evening.

Im starting to suspect now that this could possibly be related. Im not sure what the symptoms of a slipped disc are though. This current pain is not really similar to the pain I had before pre op. I expected it to get better and go away in 2-3 days as these kinds of things normally do but now Im not so sure. Given the continued severity of it, now Im thinking it very well might be related.

[jessmith07]

Steve, I happened upon this dermatome map today on Dr. B's site and it shows the correlations between the nerve root location as it exits the spinal column and the area of the body it supplies with sensation conduction...

Have a look and compare the pain that you're feeling and see if it corresponds with the map...

Dermatome Map

[steve55]

Well, according to the chart, the shoulder area where I am hurting the most correlates to C4. The shoulder to elbow shows C6/7. But the C6/7 also goes down to the hand which I dont have.

Im at work right now and for whatever reason, this pain doesnt hit me too hard in the day. It seems to be worse when I lay down in the evenings. But its excrutiating and quite severe, but at least its not the deep dull nerve pain like pre op. I am amazed at how severe the pain is when it does hit, its a unbearable throbbing sort of pain mainly in the shoulder and some in the upper arm.

I recieved my quote from Prospine to fix this and its $18,000 USD. Im not sure if that is a discounted price or not. Considering a single level ADR at prospine is around $24-$27K, I think it probably is a discounted price since removal is probably more challenging and difficult than inserting, PLUS, they are fusing after the removal also. I was hoping it would be a free revision like I heard that Stenum does if things go wrong, and I read 1 case where prospine fixed someone for free also. I guess no such luck for me, but, as I said, I also know its not Dr Bertagnoli's fault either. My bones just didnt hold well. I was thinking about seeing if my insurance would cover it here in the US if I could find a Humana doctor with a solid reputation at removing ADR's, buuut, gosh, it probably isnt worth the risk I guess. There probably are not many doctors who are really good at ADR removals. I guess I can always appeal for coverage as out of network. Medical necessity shouldnt be too hard to prove. Do US insurance carrier's deny these claims on ADR extractions? Maybe they will refuse to cover the extraction but agree to cover the fusion???

[chasswen]

hmmmm dr b is charging you for a bad placement of his own doing???
maybe you should get mark to talk to dr. bertagnoli it doesn't sound right to me.
SIGN
chuck

[steve55]

The TX back Institute called and told me that they dont do follow ups or even 2nd opinion consultations with patients who have had any surgery done with a different surgeon, whether its in the US or Germany. Kathy is an exception because they are a participant in her disc trial.

The lady went on to say "You wont find any US doctor who will see you especially if you went to germany". I told her Dr Peloza was seeing me and she acted all surprised and said I was very lucky to find one. Man, they dont just get jealous, they get spitefully, bitterly jealous when patients go overseas. At least thats my take. Dont doctors follow something called the hippocratic oath? Did I spell that right?

Anyways, I do trust Dr B, and Im pretty much planning to go back,....but its only prudent to get 2nd and 3rd opinions. I still am worried about the top C4/5 tilted bottom plate. Man, my bones just dont hold these discs in place too well. I just dont get it. I was EXTREMELY careful after surgery, didnt exercise, wore my brace religiously for the full 2 months, I took extra care in every way for a good healilng as you only get one chance to get it right.

[dshobbies]

Steve,

I assume Mark will be able to explain things better once he consults with Dr. B on your behalf. What you believe to be the hippocratic oath is actually the hippocritic oath. There are some good guys and I am generalizing but my experience with spine surgeons has been ego oriented, more interested in putting another notch on their scapal. My first neuro actually has framed thank you letters all around his office as well as a scrapbook of them for new patients to peruse. Yet he never warned me about the possible failure, not only related to my first surgery but my second as well, as the while knowing there was something better out there.

Dr. Regan in Beverly Hills has taken on difficult revisions but he does not accept (most) insurance and I'm told his consultation fee is $500. He cares for many of Dr. B's patients in the L.A. area.

As for insurance covering the entire revision?????? I guess you'll have to find a doctor who'll do it first.

One more thing; though this may not exactly be Dr. B's fault, but considering the travel expenses, etc. I agree that he could do better even though the 18,000 is probably allready discounted.

Unfortunately and fortunately, time and money will take this lose/lose situation and turn it back into a win/win.

I am so sorry this happened and I truly feel for your situation. Major bummer.

Dale

[Kathy]

Steve,
My surgeon in Florida, the co-inventor of the Active L disc, does revisions. I made sure of this before I had surgery, so I would be able to get it out if need be. Maybe you could fly out and consult with him. He was a very nice humble man and highly reccommended by fellow spineys (Justin and Mark both had good things to say about him). I would also make for absolutely certain that the top disc is fine. I completely agree that it is the prudent thing to do to get more than one opinion, regardless of who you have surgery with (I got 3 opinions before my first surgery, which is way easier than a revision). I also think that you should push for a more discounted rate. Also, I know on the billing I received for the surgery, it showed a seperate insurance billing for removal of the old disc and another for placing the ADR; so maybe you could get insurance to pay for the fusion part and just have to foot the bill for the removal of the old disc. Too bad Dr. B doesn't have the revision policy of Stenum, seeing as how the revision rate is low, doesn't seem like it would cost them much (unless they had tons of revisions). Seems like a great policy, too bad US dr's don't offer it (guess you need tons of confidence in your skill to offer a policy like that).
Best of luck,
Kathy

[sahuaro]

Steve:
I am chiming in late here because I've been trying to avoid the full impact of the implications of what you are dealing with. I am so sorry this has happened and that you are now in pain. As a cervical ADR recipient--with osteopenia--the prospect of subsidence scares me to death and I am impressed with your great attitude at this point!

Perhaps Mark can help you with getting second opinions in the U.S.? And I would seriously consider consulting with Dr. Regan, who did my surgery.

Also, since the pain seems to come with lying down, would a cervical pillow (e.g., Tempurpedic) help? Would sleeping in (ugh!) your soft collar, assuming you still have it, help?

I wish you all the best.

[steve55]

Yea, I guess I am bummed that I didnt get a little better discounted price for what clearly shows 2 tilting discs. No doubt the bottom plate of the top disc is sinking to the right, its quite obvious, yet oddly enough, they didnt even mention that one. Ill see what Peloza says about that top disc next friday. Again, not necessarily Dr B's fault and I still think he is a great surgeon and I appreciate he spent 6.50 hours on my surgery and he took the time to really make sure all my nerves were freed up. But gosh, I guess ya all are right, you'd think I would have gotten a little better break on the price given the circumstances. Oh well, I guess not.

Anyways, I spoke to the Humana rep today and she seems to believe that as long as we prove medical necessity, she thinks they will cover both the removal and the fusion. She didnt seem to think that the fact I had ADR's (a non approved procedure) would affect their decision to cover both the removal and fusion if its medically necessary. If she is right, then I have a good chance at either going out of network with a$6K deductible (which she said would apply if I went to Br B in germany) or staying in network with only a $2,000 deductible.

My out of network options would be:
Dr B -I still very much trust him , but ughh, I really dont want to deal with travel again. Too much hassle, connecting flights, crappy food, no freakin TV to watch (Ill go nuts watching CNN Europe or whatever that one channel is for 2-3 weeks), lots of extra expenses etc. Only positive is DR B's heavy experience with revision surgeries, I presume??. Will still consider him for sure.

Dr Peloza -My previous doc who treated me all this time before I went to Dr B and he is in the same class of surgeons as Delmarter, Regan, Biton etc. He is local. BUT, dont know how many revisions he has done though.

Dr Regan - Experienced revision surgeon right?

Dr Delmarter - NOt sure of his revision experience, anyone want to tell me?


My one in network option would be Dr Biton in NY (only $2K deductible) -not sure of his revision experience either. However, one person here did say Dr Biton seems to have done many ADR revisions. So, at this time Im leaning towards going with him if he has the experience Im looking for and if I can get Humana pre approval. It would be nice to stay local with Dr Peloza, and I would have a local follow up, but the extra $4,000 deductible difference is alot. I get free travel on Delta since my dad is a retired delta pilot so the cost of flying to see any of these surgeons for follow ups would be limited.

If it turns out that these US docs dont have extensive ADR revison experience, Ill probably just go back to Dr B to be safe. Experience is most important with these things.

[Kathy]

Steve, I have heard lots of great things regarding revisions, with Dr Bitan and Dr Regan. I think if I were you, I would stay in the US. Seeing as how it is not a multi level ADR being done, US surgeons have tons of fusion experience (it's really just the revision that you need to check for). You can watch Dr. Bitan doing a Charite implantation on the Charite website (google it and there is a link). Watching him do the surgery and online research is what made me decide to have ADR. I don't think I would spend the time, money and travel to go to Germany to get a fusion, seeing as how they are so commonplace here in the US and since it is cervical, not near the risk of a lumbar revision.