My severe pain is gone. What the heck?

[laid up doc]

shay -

problem w/ not doing a control is that you need to know that the pt isn't just reacting to a weird sensation... imho the study that linked deterioration to discograms was iffy at best. i rest much easier knowing that my L4/5 is NOT a pain generator!!! well now post-op i know for sure... but i strongly suspect that many poor outcomes are related to inadequate identification of pain generators.

also imho - minocycline wouldn't do much for an infected disc. pretty narrow spectrum - really just used for acne type skin problems... not gonna penetrate a disc or have broad coverage. had you been on a "big gun" antibiotic, i would say possible. just my opinion

i also had a huge annular tear - very obvious while discectomy was being performed per Dr Clavel. they are tremendously painful... but also can get some scar tissue that can later re-tear. perhaps that's what's going on w/ you? or some muscle changes that are preventing aggravation? there are a ton of mechanical changes that occur w/ lumbar disc issues. i'm learning firsthand that they are also uncomfortable to UNdo.

I am VERY happy w/ Dr Clavel and the whole experience in Barcelona (and i'm very, very particular!) - have you consulted with him as well?

[Shay]

I have not consulted with Clavel yet. I got the impression he did mostly cervical.
Yes, it makes sense that the pain was from the annular tear.
Still a few more consultations to go and now that the holidays are coming up I doubt I will be having surgery till next year!

[laid up doc]

Clavel does plenty of lumbar work as well - i talked to him in depth about this. he doesn't do JUST int'l pts - dr's in spain do private and public work so his practice is more varied. he told me he's done well over 100 lumbar M6's (i think he might have said 150?)

[Shay]

Thanks Doc, I will look into Clavel again.

Well, yesterday had an apt with my local surgeon Dr. Chapman from UW.
His opinion of the new MRI did not change his treatment plan of one level fusion - since he can't do ADR here on L5-S1. He advised against getting too much done. Said if necessary in a few years when ADR is covered here we could get that done for L4-5. Clearly, he is conservative in his approach.
He also advised against going overseas if possible (funny as he is not US born) due to medical tourism, etc. He said he would trust Bertagnoli. When Yona told him Bertagnoli recommended a double level ADR or hybrid he didn't respond.
So, as usual it is up to us to figure this out.
However the good new is that he respects our decision and is willing to be our local follow up surgeon if necessary.

He was very riled up about the lack of medical judgement involved with the new policy changes regarding fusion. I guess after we sent him a copy of our 34page appeal he started doing his own research about Milliman Guidelines, and realized that his practice will change as a result. He also is a caring man.
I will go into this more in another thread.
But this leaves me questioning the double level. Still gathering opinions at this point so I figure questioning is good.
Dr. Boeree's consultation this weekend went great. Good stuff! Yona keeps reminding me that we are just gathering info now. I tend to be easily swayed.

[Jstuckey]

Another thing to keep in mind: "Doing too much" now / having more done later has it's risks too. Scar tissue can build up around the major arteries and veins near the spine. Mr Boeree, and many surgeons, use a barrier device, but it's not full-proof. Just something to add to your decision making (as I had to). "Doing it now" also has it's financial rewards of less expensive than an entire new surgery in a few years. I took my chances with the 3rd level that was "optional" and left it alone, hoping that the healthier levels below will keep it happy for all eternity.

[jss]

Originally Posted by Shay

... However the good new is that he respects our decision and is willing to be our local follow up surgeon if necessary.

Shay, this fact is huge; that you have a local ADR surgeon that cares about your outcome so much that he's willing to follow up and support you even if you opt for a treatment that is against his medical advise. I realize that ya'll are still researching. As ya'll have already learned, research is a LOT of work!

Good luck, Jeff