runner's surgery blog, L4/5, 2008

[Cindylou]

Runner,

WHAT HAPPENED???????

[dshobbies]

Did your insurance nix the surgery or your doctor? What the h--- is going on? And nothing on rescheduling? I'll save my nasty comments until you explain.

[Cindylou]

Waiting to hear from you runner. I am so sorry for this most unfortunate turn of events. I am curious too.....Doc or insurance drop the ball??

[runner]

Cindylou and DShobbies,

Supposedly, it was my decision to have an ADR or a fusion (AlIF) at L5/S1, but my surgeon called me Sunday and told me he could not do an ADR.
Apparently, the surgery can be much more complicated than i realized with the scar tissue and if I had major complications, other doctors might have to be called in, etc...
The lovely people at you know who decided that i couldn't have an ADR, approved the ALIF reluctantly and told my doctor they would cover nothing related to the surgery if ADR was done. So that was an issue.
I had the hospital bill kind of taken care of and still my doctor was not comfortable doing the ADR.
So my choice came down to ALIF or nothing at all.
I could not undergo a surgery that is not the best surgery, according to my research and my doctor's opinion. Even if ADR and ALIF are comparable at L5/S1, there is still the issue of my SI Joints and the possibility of nonfusion and future surgeries. How could I do something that I may regret later on?

I am really upset, an understatement actually, but I was really caught between what I knew without a doubt was the optimum surgery (even though I could have problems from an ADR surgery, too) and a surgery i did not want if at all possible.

My husband talked to my surgeon Monday morning and the surgery was canceled.

I cannot stop crying. I feel better than i go down again. For whatever reason, my pain levels are way high. I am having trouble sleeping and I feel lousy.
I may lose weight, which is an upside, because my appetite for food is nil. I pray that something will break through, but it may take more than a year to even get approval.
The situation seems hopeless as I cannot work, go to school, drive, plan for the future, etc...
My back for whatever reason has decided it is in constant pain mode. Even laying down doesn't help. I probably will have to go up on pain meds, which i will discuss with the pain doc when i see him in two weeks. Maybe at that time, the back will have calmed down.
When/if I get approval, my doctor will do the ADR surgery.

[dshobbies]

Runner,

I had 2 surgeries prior to my ADR and was told scar tissue makes surgery more diffiuclt too. However, in all the posts I've read over the past 4+ years, no one was ever denied and ADR because of scar tissue and I don't recall any post op difficulties blamed on scar tissue.

I have heard of ins. claiming no coverage for complications down the road but again, I can't remember this being an issue, though my memory is not all that reliable anymore.

Sounds like just another denial excuse. So what comes next for you?

Dale

[runner]

Dale,

I think you misunderstood me. The surgery wasn't denied because of scar tissue; it was denied because of "no peer-review long-term studies, and not enough people in studies showing long-term effectiveness and safety".
A bunch of BS if you ask me.
It is "investigational," therefore not "medically necessary".

I would love to have one of them blow out a disc.
Last letter, said "replacement of my own disc with a synthetic disc". I don't even think they know what they are talking about.

What's next?
I wait.
I take one day at a time as I deal with increased pain.

[dshobbies]

Same bat time, same bat channel. Kind of makes you understand crimes of passion- rage.

I'm sorry - I also had my surgery cancelled 1 week before I was scheduled and know how you feel. Living is L.A. I was able to tap into my home's equity and went to Germany. I'm still both grateful and angry. What's your next step?