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

[Cindylou]

Steve, I truly am sorry for the predicament you are finding yourself in. I think the prior person raised a valid point that the two surgery options here and abroad likely have differing levels of expertise for what they are going to do, hence price point differences. Boy, I think if I were in your situation, all things considered, I would make every attempt to go back to Dr. B and let him do the revision. He knows your body intimately from the first surgery and he is so trained in this type of complicated surgery. He might see something else while he is in there and adjust the treatment even then. I do know money can and ultimately always is a huge consideration. Me personally? I'd live in a tent, just to be pain-free. No joke. I will keep you in my prayers in these days and weeks ahead while you make your final decision. My very best wishes to you whatever you do.

Cindylou

[dshobbies]

Steve,

This decision is yours and only yours.

to help complicate this decision, everyone has an opinion. Though Dr. B is the go to Dr. if any American doctor can do just as good a job and at a reduced price, why not? The question is, can he do just as good a job? He has an excellent reputation.

Honestly, I don't know what I'd decide. Apparantly, you're trying to decide too.

Good luck, Dale

[Maria]

(not probably more like most definately) Dr. Bertagnoli has whatever type of hardware at his disposal to use for supposed best patient outcome unlike here in the States.. but I don't know what that means re zero profile and how small are tiny titanium screws. This is Mark speak.. he'd know this kind of information.

Actually I don't even know what is available to the US surgeons anymore in terms of type of cages but it seems insurance companies rule too many decisions re what is used re cost here unless you're going cash pay

[steve55]

Originally Posted by Cindylou

Steve, I truly am sorry for the predicament you are finding yourself in. I think the prior person raised a valid point that the two surgery options here and abroad likely have differing levels of expertise for what they are going to do, hence price point differences. Boy, I think if I were in your situation, all things considered, I would make every attempt to go back to Dr. B and let him do the revision. He knows your body intimately from the first surgery and he is so trained in this type of complicated surgery. He might see something else while he is in there and adjust the treatment even then. I do know money can and ultimately always is a huge consideration. Me personally? I'd live in a tent, just to be pain-free. No joke. I will keep you in my prayers in these days and weeks ahead while you make your final decision. My very best wishes to you whatever you do.

Cindylou

Well, the way Im seeing it is that as long as Im going to one of the heavy hitter US docs, I should do fine. I went to Dr B initially because he is the multi level ADR guru and there were so many successful outcomes posted with him, and he has done so many of them while the US docs have done so few. It was a no brainer. But what I need done now is a BASIC fusion, and really, that is not a complicated procedure right? And extracting a disc shouldnt be either as long as you go with a reputable heavy hitter US doc. Dr bitan seems to have done many ADR extractions and Mark speaks very highly of him also. My local doc , dr peloza is also a heavy hitter (he was in newsweek, on german Sat TV and local TV alot), and Mark feels he would be a very good option also.
I think the US options (hardware/procedures) for fusion will be sufficient. Im not a "complicated " case anymore. Even Mark, who many have accused of being too heavily favored towards Dr B, hasnt suggested that I really need to go back to Dr B for the b est possible outcome.

Anyways, this is my take.

Im going to trust Dr peloza's opinion tommorrow when I speak with him. Mark said Dr B was going to call Dr peloza this week prior t o my visit. Dr Peloza is one guy I really feel will shoot me straight. He is really very conservative and doesnt come across as a guy who is looking for business. He never even suggested ADR, I think he would have suggested fusion if I had stayed with him. If he thinks I really am better off going back to Dr B due to better cages/fusion procedures or because he did the original ADR's, then Ill follow his advice. Ill be asking Dr peloza many of these type questions tommorrow.

[mark-perth]

Sorry to hear that your going thru this as well. I know how you must be feeling, its horrible but you seem to be doing amazing in the way you have dealt with this. You have achieved more in a few weeks than ive achieved in months so you are doing great. You have had alot of great advice here so I dont need to chip in apart from support you. Your post has actually helped me alot as well. I too contacted Dr Bitan and have been blown away at his quick response, within a day, thats just amazing. He seems like such a helpfull and easy to deal with surgeon, I understand the comfort you get from him puting you at ease as I had the same response. He cheered me right up today.
From the quote I got from Dr B I'd say that you have recieved a substantial discount although I do agree that maybe it should be less especially if he is still higher than in the US. It seems like he's maybe only charging for the costs that dont go to him like the hospital and hardware costs but not his fee maybe.
Do you know if Dr Bitan's cost of $15000 included the hospital costs or was that just his fee's? Will your insurance not cover any of the costs now or is just the surgery costs they wont pay?

I have found this article regarding the zero profile fusion cages:

A New Stand-Alone Cervical Anterior Interbody Fusion Device: Biomechanical Comparison With Established Anterior Cervical Fixation Devices
Scholz, Matti MD; Reyes, Phillip M. BSE; Schleicher, Philipp MD; Sawa, Anna G. U. MS; Baek, Seungwon MS; Kandziora, Frank MD; Marciano, Frederick F. MD, PhD; Crawford, Neil R. PhD

A New Stand-Alone Cervical Anterior Interbody Fusion Device:... : Spine

send me an email if you want the full copy. It looks like its just a low profile fusion cage that is quite new to the market so may not be approved in the US yet. I would ask what type of fusion hardware they will be using, it cant hurt. Great to see that you are getting it dealt with so quickly and best of luck with your decisions.

Mark

[Cindylou]

Let us know how your appt. went with Dr. Peloza Steve. I think you have a solid plan in place.

My best to you,

Cindylou

[steve55]

WOW! Dr Peloza apparently wanted nothing to do with me. He woudlnt even answer my questions. All he said was "So, what can I do for you today". He would only confirm that C6/7 is subsiding and that C 4/5 looks to be ok despite what appears to be a tilt in the lower plate. Then, before I could even ask him if he would be interested in performing the revision, he blurted out that he had no interest in doing my revision surgury. He was so cold and uninterested up to this point, I thought to myself, "Dare I ask him why"?...... Naaaaa. I already knew based on his demeanor that it would get me nowhere. I then told him I was considering Dr B and a few other docs, and I asked what he suggested I do. He said I should just go back to Dr B and that was all he would say. No adding on to explain why, no expounding further, no nothing, just silence. So, I asked him if he was reccomending that based on the idea that Id have the best chance at turning out better or if he was saying that based on an ethics idea that you should always stick/stay loyal with the original surgeon. Both times he refused to answer me. He just kept repeating his answer and went silent. My next question I asked was if he knew a surgeon locally here in Dallas that he might reccommend if I didnt want to travel back to germany for this. He said he didnt know of anyone and again, went silent. I mean, he didnt want to talk at all, nunca, zilcho! I soon saw I wasnt going to get anything out of him and that this was all a waste of time. Oh, I did ask him if Dr B had called him as Mark mentioned was supposed to happen before my visit, and he said he had not talked to Dr B. Maybe Dr B did call and left a message that went unreturned (it wouldnt surprise me), either way, not a big deal in the scheme of things. Man, this was my doctor dating back to 2004, I had a plasma decompression surgury with him , several epidurals and discograms etc. I mean, Im ok if he doesnt wantto do the surgury, but at least talk to me, tell me something, give me some geniune answers, explain why. But instead he wants to avoid me like the plague, basically behaved towards me like "dont let the door hit ya in the ass on your way out". And I just wasted $230. It was only 2 weeks ago that I had Dr Ziglar at TBI tell his receptionist "Oh, I remember that guy" , as if to say "that sob who chose a German doc over us". Cant they understand that not everyone is independently wealthy and can afford 2 x the price for a surgury? I can understand if there are legal concerns or if they are afraid that they will be sued if the revision goes wrong, heck, they can at least act human and explain that if that is the reason. But thats not what I sense from these docs. I sense alot of resentment in these guys. I mean, there must really be some bruised egos out there. Its sad, really sad to see. And to think I waited an extra week in this horrible pain thinking he would be interested in doing the surgury. Man, was I ever wrong. Anyways, time to move on .....

Talked to Mark today and he hasnt heard back from Dr Regan after several messages, pretty much a sign that he is pretty booked already or perhaps just isnt as interested anymore in other doctors revisions also? Who knows. Im just speculating at this point. I told Mark it was ok, no need to bother with Regan anymore. I guess Im good with Bitan anyways. Seeing how so many surgeons coldly treat their former patients, it makes Dr Bitan stand out even more as just a super compassionate great guy. I guess he is able to lay down his ego and be more concerned about people's well being than anything else.

Ya know, I was so darn confused today between going back to Dr B or staying local with Dr Bitan. Im sure Mark could tell. But late today I started thinking, Mark had said that Dr Bitan has dealt alot with spine "reconstruction " surguries. Of course, he deals with the ADR's also and has done many ADR to fusion revisons. But Im thinking this reconstructive experience is actually a really good thing to have as that has to be much harder to do than just ADR placements and fusions. Not to say Dr B hasnt done similar type work, but again, if I can get the same talent locally, why deal with overseas travel? Plus, Dr Bitan exudes confidence that this procedure for him is very simple and straightforward. I can sense he isn't worried about the difficulty of the surgury or the outcome one bit. Thats means alot to me, and I think it shows the confidence he has in himself and his abilities. This is a good thing. Also, Ill need follow ups, and if something goes wrong, or starts to hurt, or if I need tests done to see if I am fusing, or if I need a bone stimulator, its a easy plane ride to get to him. Cant say the same thing about germany. I get free domestic airfares with delta since my dad is a retired delta pilot, so it really wont cost much to go back and forth to see Dr Bitan. I was also thinking, with my recent experience with my old doctors, if I need help after germany, geez, am I going to get the 3rd degree from other docs too? I sense these docs really hate to work with someone else's surgical patient and I dont want to be treated like that during any follow ups. Ya know what I mean? So, I am no longer confused. I will choose Dr Bitan. The only remaining variable I want to wrap up before finalizing my decision is seeing what type of fusion cage they would use, to make sure its cutting edge and not the cheapo method from 20 yrs ago or something like that in order to save costs. I will ask him about this "zero profile" cage dr B was suggesting to see if he has something like that he could reccomemmend. And, I really dont want to have my hip bone extracted if at all possible. I dont think that should be necessary these days to fuse. Dr Bitan and his team have been very responsive and he is clearly enthusisiastic to perform this surgury, and that couonts for something. And he is one of the heavy hitters too. I just need to call his rep and wrap up my remaining questions/details, and then probably go see him for an initial appointment ASAP!

Again, I have all the confidence in the world in Dr Bertagnoli, and I dont blame him one bit for my situation, and he sure cleared out all my old pre op symptoms. But gosh, I REALLY do HATE To travel so far , with connecting flights, etc. I really want to be within descent and affordable reach of my doctor for follow ups, and I dont want to be treated by a different doc for follow up who will act like he doesnt really care about me or my situation. Ive learned that this is VERY common and I want no part of a poor patient/doctor relationship like that. No thanks!! I felt like dirt today the way Dr Peloza acted so disinterested and unhelpful. I trusted him and trusted that he would at least be helpful and somehwat interested in advising me, especially considering how far back we go. But he behaved just like Dr Ziglar at TBI. 100% uninterested and had nada to say to me.

Thanks everyone for your inputs. All of it helps me to think more clearly about my decisions.

[Justin]

Steve, sorry to hear that Dr Peloza was the way he was. You have a lot on your plate right now and the last thing you need is all of this sideshow nonsense (and down right insensitivity). www.spinepatientsociety.org

You have a hard decision to make--good luck. I do check my PMs. Keep your positive attitude through this, as it will serve you very well post-op.

Keep your head up!

[mark-perth]

Thats just down right rude of Dr Peloza to treat you like that. If he obviously didnt want 2 help you from the start he should have told you that before even seeing you. To take $230 for nothing is so wrong. Ive had several secretary's call me back after making an appointment and cancel it and tell me that they dont deal with other surgeons problems. They seem to find it even harder when you didnt choose them to start with. Its just an ego thing for most.
Just one question for you. What was Dr Peloza original plan for you when you saw him before? Did he recommend Dr Bertagnoli for you?
I was told by several surgeons before surgery before I had my own that I would not get threated in Australia if I went to Germany and would have to go back there.
Im so sorry that you were treated like that, Noone deserves that, especially someone with enough on there plates as it is.
You are lucky that you have Dr Bitan who is fully there for you and will make it alot easier in the future if you need follow ups.
With your concerns with the hardware used, I think you will find that he wouldnt use hardware from 20ys ago but discuss it with him and also ask him if there are any other options available, even if it increases the costs alittle that may be better for you.
Id also search the internet and look at the companies that manufacter fusion cages and see whats available, probable search "spinal implant manufacturers". You may be able to find on Dr Bitans website which companies he uses hardware from which may help.
I used to have a list of all the companies that manufactered implants, ill see if I can find it as that may help in your search of whats available and post it for you.
Best of luck and dont let someone elses ego get you down
Mark

[Maria]

Steve,
I'm so sorry you wasted your time and energy on someone that was as tight lipped and arse'd as Dr.Peloza. I wonder if he's involved in some litagation that has done a number on his head.. or has the bruised ego thing going on but all you wanted was for him to be real.. maybe he doesn't want his words quoted on any forums but then again your experience/consultation doesn't exactly make me feel *warm and fuzzy* toward him either. Oh well, who knows what was going on there but I'm just sorry you wasted your money. Time perhaps not as you learned that this guy wasn't interested in giving you any information or doing your surgery.. so he was knocked off your list the hard way.

That made your decision a bit easier. I hope whatever you do with whomever you do it with will work out wonderfully. That is all that I wish for you~ besides regaining your health post a successful surgery.


Take care, good luck and truly sorry you had to experience that type of consultation esp. if you were paying cash for it.