1 Condition, 3 Docs with Completely Different Treatment Plans...

[Harrison]

This rarely happens, but I lost this entire, helpful post. If anyone of you have your posts saved, or have cached this topic, pls do tell...

I am so sorry, as this was an informative & helpful post for so many reasons. I've taken the nec. precautions to prevent this from happening again (more IT $ for back-ups). Such irony...but it will NOT happen again.

[Harrison]

1 Condition - 3 Docs with completely different treatment plans! (ThomasL original post)

Well.
So far I've seen 3 docs about my problems... C5/C6 DDD, disc extrusion, 65% compression of spinal cord, central canal & foraminal stenosis, etc. C6/C7 DDD, central canal stenosis, foraminal stenosis... Headaches, Issues with hands dropping stuff, tingling, etc. Feet get "tired easy" lots of "pressure pain" etc. Sounds like a common story here.

Doc #1 - Recommends C5/C6 C6/C7 Fusion. Does not do 2 level ADR. Considers himself to be a ACDF specialist. Recommends procedure BUT says "you're too young.. What happens when you are 45,50. 30%+ chance of problems above/below in short time. "2 level ADR is not approved by FDA, will not consider. One level is not an option for me." Leaves the call up to me. Left me very reassured.

Doc#2 - Recomments C5/C6 fusion. "need to fix myelopathy issues - your too young to be having these issues" Again I hear the your too young line. Says C6/C7 can be put off for now and wants to fix my mobility issues. I asked about ADR, he said its possible but d2t to the age of my injury - 20 years ago - there is too much "crud" to be cleaned out and that I'm not an ideal case for ProDisc. He is willing to do prodisc but he sites references to ProDisc materials regarding my type of diagnosis.. Ive read whats publically available and the two don't line up.

Doc#3&4 - Recommends C5/C6 C6/C7 ADR. Just received eval tonight and will visit clinic weds. morning to discuss with Dr B. M . in Strausberg/Bogen Germany. Go figure. I'm visiting family in Germany now - and it seems multi-level ADR is very common here and part of the public medical system. Many specialists available to general public.

Have others out there seen such a variance in diagnositcs and treatment plans?

Thx,
Thomas
It seems each doc has a completely different view based on his personal experience.
__________________
Just Diagnosed 4/1 & Looking for options
• C5-C6 4MM broad based posterior disc extrusion w/spinal cord flattening . Sever bilateral neuroforaminal stenosis, foraminal disc protrusions and small endplate osseous spurs.
• C6-7 central stenosis with mild, subtile ventral spinal cord flattening. Moderate/severe Bilateral neuroforaminal stenosis secondary to foraminal disc bulging and endplate osseous spurs. Bilateral radiculopathy. Moderate DD.
• Other cervical discs have DD signal change.
ThomasL
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#2
05-04-2009, 05:45 PM
annapurna
Senior Member Join Date: Dec 2004
Location: northern Utah, USA
Posts: 780

This degree of difference in treatment plans is depressingly frequent. Be glad that you're not asking about treatment 3 to 5 years ago, the separation in potential treatment plans would have been worse.

First, any doctor that belittles your knowledge or restricts himself to quoting publicly available information has to be looked at with skepticism. You're going to the doctor because of their specialized knowledge. If they don't bring anything to the table beyond what you can easily find, you've got to wonder.

As for doctor 1 vs. doctor 2, that's going to be your call. Ultimately, I'd investigate a whole lot and ask yourself who you feel best about. Don't mistake bedside manner for skill but don't forget that you're going to have to be dealing with this doctor for quite a while from diagnostic work, surgery, recovery and any questions in between. My attitude for my surgeries was to find someone I felt comfortable enough with that, if the surgery went bad, I wouldn't kick myself for choice in surgeons.
__________________
Laura - L5S1 Charitee
C5/6 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems
Jim - no spine problem but lots of other fun medical challenges
"There are many Annapurnas in the lives of men" Maurice Herzog
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#3
05-05-2009, 05:01 AM
ThomasL
Junior Member Join Date: Apr 2009
Posts: 17

Depressing? No. Amusing? Yes. More so - a HUGE waste of time waiting for docs to make an appearance.

At this point I think its best to put the differences in treatment plans to the doctors level of continuing education. In 2009, I'm not comfortable with a treatment plan based on techniques that were developed 25 years ago. Its that simple.

So the hunt for docs continues... And I meet with 2 very talented surgeons tomorrow. The only thing concerning is the $40k +/- out of pocket expense.
Thx,
ThomasL
__________________
Just Diagnosed 4/1 & Looking for options
• C5-C6 4MM broad based posterior disc extrusion w/spinal cord flattening . Sever bilateral neuroforaminal stenosis, foraminal disc protrusions and small endplate osseous spurs.
• C6-7 central stenosis with mild, subtile ventral spinal cord flattening. Moderate/severe Bilateral neuroforaminal stenosis secondary to foraminal disc bulging and endplate osseous spurs. Bilateral radiculopathy. Moderate DD.
• Other cervical discs have DD signal change.

ThomasL
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#4
05-05-2009, 07:49 AM
trkdoc714
Senior Member Join Date: Nov 2008
Location: Douglasville, GA
Posts: 123

Thomas,
I experienced the same process you're now going through. You've hit the nail on the head too. Doctors and surgeons are going to recommend a procedure they're comfortable with. They also have a tendency to choose procedures that are easily codable with insurance companies.

I noticed a pattern of the same (especially the insurance company limitations) in most of my visits. One of the surgeons outright told me it was too difficult to collect from insurance companies to even think about ADR.

Keep your chin up though. Keep researching your options. With the information and support of forums like this one, you can arm yourself with answers most doctors won't give you.

Good luck!
Bob
__________________
04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
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#5
05-05-2009, 06:18 PM
ThomasL
Junior Member Join Date: Apr 2009
Posts: 17

The way I look at it is that I'm making a 40k investment in a vital part of my body's skeletal structure. You only get one and if it's broke... Heck - I'm going to interview as much talent as necessary to get the best job done. Period.

Most of us spend more on a car that gets us to and from work. Heck - This allows me to get in my car and go to and from work.
Whether the money comes from my insurance carrier - or - from my pocket - I really don't care. I want the best hardware available that I will have to live with every day for the rest of my life. Period.

To put it as an analogy..... I have the chance to buy a 1984 Buick or a 2009 Mercedes AMG. This will be my "daily driver". Now to settle on the right design team (prodisc) and mechanic.

Feeln much better!
ThomasL
__________________
Just Diagnosed 4/1 & Looking for options
• C5-C6 4MM broad based posterior disc extrusion w/spinal cord flattening . Sever bilateral neuroforaminal stenosis, foraminal disc protrusions and small endplate osseous spurs.
• C6-7 central stenosis with mild, subtile ventral spinal cord flattening. Moderate/severe Bilateral neuroforaminal stenosis secondary to foraminal disc bulging and endplate osseous spurs. Bilateral radiculopathy. Moderate DD.
• Other cervical discs have DD signal change.
ThomasL
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#6
05-06-2009, 07:05 PM
steelskyway
Senior Member Join Date: Jan 2008
Location: Los Angeles
Posts: 173
Too many options

Hey Thomas!

For every surgeon there seems to be a "choice" treatment. The frustration is enough to make you pull your hair out. Your quest has just begun and hopefully you will find the appropriate information somewhere. If there was just a pill to solve the issue or a rack to make it all perfect.

To me it is like purchasing a computer. Once you spend the time and money something new and better comes along. Please keep us posted on your results from the engineering and mechanical teams.
Paul
__________________
MVA on 20AUG07 at work
L4/L5 Annular Tear
One failed epidural 12OCT08
Discogram 10FEB08
ADR Prodisc L 10JUN08
Discogram 08APR09 for gnawing 3+ pain when sitting results negative
Facet injection L4/5 upcoming 03JUN09 Cancelled because pain is subsiding
Follow up on 01JUL09 with Dr. D
steelskyway
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#7
05-08-2009, 05:59 AM
ThomasL
Junior Member Join Date: Apr 2009
Posts: 17

I spoke with another set of docs yesterday - and Dr. 's team. - in much greater detail - regarding their suggested treatments. It was good to better understand their rationality in treating my cervical issues in C56 and C67. All the docs want to treat the problem - just some are more aggressive in their approach - for good reasons.

Both C56 and C67 are shot:
C56 is is much worse shape and is putting too much stress on the central canal. (must be fixed - walking - urgency headache and neck/back issues)
C67 is more in the mid phase of degeneration and is causing posterior buildup with severe foraminal stenosis. (problems with hands/arms) I can take a band-air approach and clear the problem from the side, But the issue will return unless I remove and replace the disc from an Anterior operation.
Here is the question folks : I can buy some time with C67 - maybe 4 or 5 years if I am lucky. At that time, I'm sure we will be 2 more generations into ProDisc Technology - or - what ever is best .

Would you wait? Or get them both fixed now?
Thx!
ThomasL
__________________
Just Diagnosed 4/1 & Looking for options
• C5-C6 4MM broad based posterior disc extrusion w/spinal cord flattening . Sever bilateral neuroforaminal stenosis, foraminal disc protrusions and small endplate osseous spurs.
• C6-7 central stenosis with mild, subtile ventral spinal cord flattening. Moderate/severe Bilateral neuroforaminal stenosis secondary to foraminal disc bulging and endplate osseous spurs. Bilateral radiculopathy. Moderate DD.
• Other cervical discs have DD signal change.
ThomasL
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#8
05-08-2009, 09:22 AM
CharlesinCharge
Member Join Date: Sep 2006
Location: San Francisco
Posts: 95
Do you want 2 operations a 5 more years of pain?

Thomas,
You pose a tough question. I guess I would ask myself if the technology is going to improve enough in the next 5 years to make it worth having a second major surgery and also suffering the symptoms (pain, numbing, etc.) for 4-5 more years. Bear in mind that ADR is not like computers, where you buy one and within 2-3 years it is totally obsolete because the newer ones are so much better.

They are making advances in ADR, but not in leaps and bounds. To me, the main question is will they have stem cell or some other form of treatment in 4-5 years or will it still be an artificial disc (albeit a newer model). If it were me, I would not want to go through 2 major surgeries (which I did unfortunately because they did not fix all of my issues the first time) and suffer with the symptoms for 4-5 more years. But obviously you need to weigh the pros and cons and decide what is best for you.

Good luck,
__________________
Charles B. Fainberg
Back pain suddenly started 9/05, no injury or cause
DDD confirmed via discogram at L4/L5 & L5/S1 (with some issues at L3/L4 but no concordant pain) 3/06
Failed SED (Laser Endoscopic surgery) 4/06
2 level ADR (L4-L5 & L5-S1) with Maverick disc at Stenum 8/06
XLIF Fusion L3/L4 9/08
CharlesinCharge
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#9
05-08-2009, 09:24 AM
symara
Member Join Date: Apr 2009
Location: Southern IN
Posts: 32

I personally would probably weigh out my options depending upon the insurance also... they could possibly cover one, but not both, so maybe get the one, and then once later down the road you get the other when they are approving multiple levels?
__________________
Herniated L4/L5 May 2004 (Bed ridden)
Discsectemy June L4/L5 2004
Discssectemy L4/L5 January 2007
MRI May 5th - showed "moderate sizd protruding disk in the the left paracentral location at the L4-5 level which appears to a more porminent comparison to the prior examination" and "appears to impinge upon the exiting nerve root"
May 11th Dr Apptment - Told that another Discsectemy could be done.
Looking for Surgeon for second Opinion
symara
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#10
05-08-2009, 01:08 PM
JillFletcher
Junior Member Join Date: Apr 2009
Posts: 5
liked your approach

Hi ThomasL,

I am in a similar boat requiring C5-6-7 multi-level ADR. I find your attitude refreshing. Myself I have been emotionally overwhelmed by all the complexities yo have neatly laid out! I am now searching for a great surgeon in my BCBS plan with all the best experience and hopefully not too far from NC.

But you are making me think about the Dr. B option again and the sense it does make to generate a loan to get the best job done.

My other thought is if I can get by for a year or so maybe 2 level will be FDA approved. I just like that you are rational and a fighter. Will appreciate hearing about your findings.

Good luck.
Jill

[ThomasL]

1st day back in a while and there you go! On to the update.....

I took a quick trip down to LA for the big video game convention and talked to Dr. D. of the LA Spine Institute. Very knowledgeable - down to earth - and at this point, I can say I found my surgeon. I walked away from the meeting feeling that I've signed some great talent to take on my issue. There have been absolutely NO buyers remorse after my decision.

I've met with a total of 5 surgical teams. #4 was a team from a local university. Of the team, one Doc did 3 procedures and the other did 10. They were very reluctant to divulge their exact experience. While they clearly

Now its the waiting game. My company switches insurance carriers on 7/1 and we can schedule the surgery and start the approval process. Aiming for a 8/15 date. For now... I just have to deal with the symptoms - which as we all know can be a mixed bag. Good days & not so good days.

I have to admit, issues with walking and constant pain can really be a drag.

But.... Just knowing I'm near the end of a possibly 20 year old injury is great - I'm looking forward to recovery. It's about time.

Thx!
Thomas