New Pain after fusion

[jbcool35]

Dale,
Trust me, I have seen about 5 different surgeons. Some orthopedic and some neuro. A few of them did ADR but they all said fusion is my best option. I would think Fusion at L5/S1 was a good call just because of the fracture and slippage. However, I always thought ADR would be more appropriate at L4/L5. Dr.Regan doesn't take my workers comp, I already checked. I'm pretty sure he would recommend fixing the L5/S1 fusion and ADR at L4/L5. To me it seems that's what they should have done to begin with. L4/L5 was bad when they fused L5/S1. So who knows? I've about given up. I wonder if my PPO insurance will cover anything? I doubt it since it was work related.

[dshobbies]

I know worker's comp is even more difficult to work with than ins. co's but well worth the fight. Perhaps you could pay for a consultation with Drs. R or D and use that to fight for your spine.

Most of us had to personally pay for our ADRs. Ins is coming around but very slowly and most still won't pay for it. I realize finances play a huge role in the ADR and spine world but it was well worth the debt.

Every minute feels like and hour and so on when you're in pain. Wearing you down is something the bureaucracy counts on which is easier when you're dealing with too much. Only you can decide when to give in or continue the battle.

You are caught between a rock and a hard place. Others have walked in your shoes. Only you can decide what to do and what comes next. Good luck,

Dale

[Maria]

JB,
You have to be careful when it comes to WC and what you do re surgery because if it's something not authorized by WC if you have future medical benefits you could stand to lose them possibly proceeding without their authorization altho that's a decision one has to make for self.

Also your PPO insurance if anything like mine might investigate the claim if it's after the fact and deny payment (even if previously authorized).

I think there is a way that PPO insurance can pay for something that is WC but it has to be with full understanding and knowledge of what's going on and an authorization prior to surgery regarding payment (something you could take into court if PPO decides to turn around and deny payment).

Medicare in my case makes me sign a form every so often stating my low back is covered under another policy (WC) so they don't get stuck with any diagnostics/treatment related to my low back. On that note billing for my cervical spine even has been investigated altho I have never had a WC case involving my cervical or thoracic spine.

It may depend on what state you're in as to the WC legislation and what the carrier is willing to agree to though I'd not do anything w/o knowing what you're risking (if anything).

I did pay for a consultation w/Dr.Regan just to get his opinion even tho he knew I wasn't going to be able to utilize him for surgery (re WC) and also paid for overseas consultation w/Dr.Bertagnoli via Mark's service (my first consultation re ADR that helped me forge ahead w/others here in the states via WC system).

In my own case when it came to my 3rd spine surgery (which I didn't have) WC had advised me if I proceeded with anything they didn't recommend/authorize and if I went out of the country I would forfeit my future medical benefits and everything would be terminated at that point with regard to my low back being covered anymore thru WC and of course surgery abroad would not be paid for even tho at the time it would have cost WC one third less than it would have here in the states!

I didn't have the $ for the surgery no way no how and didn't really feel what I was offered in the US would have been comprehensive enough (maybe it would have tho I didn't feel that way) so took my time and did nothing. As it turned out in my own case an OK thing do as my L5S1 autofused though this was after nearly 30 years from original injury (far longer than most people want to wait and nor would have I if my injuries were more recent).

Good luck. Pain is tough though so is the decision about what to do about it surgically so if you've the time make a well thought out well researched decision and hopefully you won't have "buyers remorse" re any new parts (or it will be less likely)!

[jbcool35]

Well thanks for the input guys. I fear L4/L5 is getting worse. That's what the x-rays show anyway. Looks like the nerve is being pinched pretty good now and my level of pain has going up. I really don't want another surgery. The first one I had put the fear of God into me. I also don't want to lose future medical just in case I do need another surgery or need medicine, etc. I wonder if getting the cyst removed would help? I wonder if L5/S1 fused all the way, if it would help? It is partially fused, well maybe like a 1/4 way fused. I'm pretty sure that L4/L5 is giving me some problems now but not sure how bad. I'm waiting for workers comp to authorize a nerve conduction study, still! I'll let you guys know and thanks again for all your input. I hope you are all doing ok.

[Maria]

That's right now I remember you're in CA too so you're under same WC legislation I am. My insurance carrier no longer auth's anything but meds for me now as they keep offering me Medicare Set Aside or to settle benefits. I too don't want to go there yet as cost of surgery will rise and I may need it in the future. L4 is still problematic for me even if L5S1 isn't that much.

My L5S1 area was the most problematic till it autofused. It was really bad. L4 is has been problematic as well tho so far not as much or at least so it seems. I'm sure things could get worse..tho hoping not to go there.

Good luck w/your nerve conduction studies. I have no idea if the cyst can be creating probs tho the nerve impingement if that's what you have I imagine can and/or maybe just the effects of the fusion and other stuff combined.

Hopefully whatever diagnostics you have will help the docs figure out where the pain is coming from. I completely get how you feel re more surgery as that's what my last surgery did for me as well.

Good luck/keep us posted!

[jbcool35]

Well on a different note, I've decided to try out working again. SSDI said I have some kind of 9 month trial period in case I can't do it. Just gonna try to get on with life. At the rate this country is spending money, SSDI will be gone. I'm scared of that besides I make less in a month than I made in a week before. If my nerve study comes back bad, then oh well. If I need surgery again, oh well. Nothing I can do about it. I haven't worked in 2 years and my pain is getting worse. So I may as well be working. Kinda strange why I have back problems and no one else in my family does? So much for genetics. Well I know mine was work related so never mind. Just thinking that different areas of my back and neck now hurt that didn't before. I wonder if that is caused by the surgery or if I have some kind of inflammatory/degenerative condition? It really bites whatever it is and has really messed up my life! I know all of us on here are messed up and a lot of people way worse than me. For some reason I'm starting to see people that jump, run and play around and it gets me angry that i can't do those things. I'm jealous. Well thanks for all the support guys. Wish me luck with work. Hope you all are doing better.

As far as the workers comp thing goes Mariaa, I don't know. I'm just trying to hold on. They have me at 55% disabled, so I think my lawyer is still on the case cause she feels she will one day get more money. She has been my lawyer since 12/2003 and hasn't missed a beat. I know your case is a lot older and I hope they at least keep giving you your meds. As far as medicare/medicaid goes, they aren't much better from what I hear. Guess it depends if you need the money bad enough then you might have to settle but like you said, I'd wait as long as I can and be sure medicare will cover you.

[dshobbies]

I know that occasionally we recommend seeking legal remedies for a bad surgical experience but the real truth is, there isn't one of us who doesn't want a complete life back instead of a single punitive penny. No amount of money can make our pain go away or make us feel better about not being able to run, jump (out of planes) or do 'normal' things. Unfortunately, it is the only equalizer available to some - however unfair.

Through the last several years, I've read some horrific stories. Choosing our surgeons and surgeries carefully is the only thing we can do for ourselves but even that carries no guarantee.

Spines are complicated and surgery is difficult. Decisions are often based on the better of two evils. BUT, when a doctor does something wrong, the simple result is we suffer. Ignoring our pain or hiding behind incomplete reports - and our choices become even more limited. I have no tolerance for avoidance of responsibility.

[jbcool35]

I agree. What's even sadder is that when the doctor does something wrong, he or she won't ever own up to it. They will try to make you feel stupid or that you did something wrong.

Sadly I feel medicine is just a business. They are there to make money. Who would want that responsibility unless they were making a boat load of money? Doctors, Big pharma, hospitals, lab work, surgeries all = big bucks!

I know medicine has it's place and many of us would be worse off without it, but like you say, it's hard to know who to trust.