almost certain it'll be Clavel/lumbar M6/Barcelona!

[laid up doc]

Metal allergy tests are in - am sensitive to nickel and a bone cement.... and nothing else!!! So prodisc is still out (has nickel and many ppl cross-react w/ chromium), but M6 is IN!!!!

See my post in the spinal roundtable at estimates for a fusion in the US. in a word - INSANE.

Have emailed Drs Clavel and Gilete w/ some additional questions and request for a date.

Waiting to talk to a travel agent to get a whole row w/ my companion for the way there, then he'd come back before me, and I'd take a laydown seat coming back.

Hoping to nail down a VRBO or apartment-type hotel once I have a date. The hotel that they recommend in the quote doesn't have any kitchen facilities and you pay a LOT to have a suite-type room. They deduct about 1000 euros if you don't use their hotel.

Now I gotta raid my retirement accounts and get a small healthcare loan. Whew...

And once I have a date... I can think about applying for a job! Takes about 3 months to get a license and credentialing and all that jazz.

[Slackwater]

Originally Posted by laid up doc

Metal DEL.TEXT but M6 is IN!!!!

See my post in the spinal roundtable at estimates for a fusion in the US. in a word - INSANE.

Whew...

Metal - flip of the coin, at least you know the facts, Good to Know.
M6®-L Artificial Lumbar Disc: M6 - in is OK, good choice so far. There may be something published about M6 results for 2011 EuroSpine, nothing so far though (LINK).
TLIF v. ALIF: you are a professional and your judgement is better than this side.

Fusion Cost is / was higher than ADR from my single case by an approximate factor of 2.

2-level 360 / circumferential $ xxx,000
2-level ProDisc-L $xx,000

I got an approximate from a private Ortho Surgeon on fusion and similar from UCSF for ProDisc-L.

Insurace Company negotiated discounted rates for surgeons, anesthesiologists are measureable. Again, you have more context than the patient on this side.

For others: CPT = billing codes, or Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical ... CPT is profession.

[annapurna]

Side note on food: we used grocery stores and a few add-hot-water meals that we brought along for our overseas trips. You can buy dual voltage immersion heaters to make hot water and there are a few, very few, healthy meals from places like Mary Jane's Farms. That way we weren't reliant on kitchen facilities or eating out.

[MeggieLynn]

Doc,

See this article, just found tonight, re: association between biotin deficiency and nickel allergy in mice.

Biotin Status Affects Nickel Allergy via Regulation of Interleukin-1β Production in Mice

I started checking into biotin def. when was looking up stuff on my supposed sapho syndrome and palmar-plantar pustulosis. Found a Japanese MD treating patients for this with biotin supplements and a particular probiotic strain that does not feed on biotin in your gut. Apparrently Lactobacilli strains are heavy feeders on biotin. It made sense to me as I was taking a probiotic daily w/high numbers of L. acidophillus. I cut back on it, started eating greek yogurt w/other cultures, took some extra biotin, and my hands started clearing up in few days. Doubt that it will "cure" me, but it certainly made a visual difference from the outside.

Long-story shortened - Maybe you should try some extra biotin....

[laid up doc]

ML -

my main concern i/r/t nickel was not getting an implant w/ a trace in it if indeed i'm allergic. i buy better earrings and don't wear much other jewelry. braces are off. i avoid it as much as i can.

what i do need to dig into is the preservative they said i reacted to - i gotta find the sheet they gave me b/c it was a long chemical name that even i can't recall off the top of my head. but - i suspect this may be the source of a lot of my mystery reactions. also found out i'm allergic to neomycin - so no more neosporin for me, gotta get the single abx ointment bacitracin.

[laid up doc]

i have made all of my inquiries and feel quite good about my decision.

I know that Vicki recently changed her mind - after having spent 30 min on the phone w/ Boeree and nearly and hr and a half total w/ Clavel - i think the difference is style.

here is my take:

Boeree is much more direct about certain things, and talks a lot more about details right off the bat. He asked me about my BMI (cuz you can tell on my CT that I'm no supermodel - but not obese), and we talked at length about stopping oral contraceptives well before surgery. He is older than Clavel, did older ADR's before the M6, and has therefore more numbers. he is the consummate professional British gentleman.

He was very reticent to talk much about travel planning and whatnot, deferring to Jo. I think the biggest negative about his practice is that it is in such a remote location - lots of extra logistics involved. From my number crunching - surgery cost is not much more than Clavel, but getting there/around/housing/food are significantly more. You also have to factor in the trip from Heathrow or Gatwick. The housing options are much less plentiful unless you plan to 1. rent a car or 2. take lots of taxis and stay in Southampton or Portsmouth.

Clavel is more than willing and able to talk to you about whatever you want to know - just his general "spiel" is much shorter. He has answered every nit-picky question I asked in a quite satisfactory manner. I sorta "tested" him a bit when it came to my history and imaging - and he knew about all of it. His personality is really quite different than Boeree's - he readily admits that he is quite laid back - and i inferred that he really relies on you being cleared on your end for surgery. most people who are willing and able to fly to Europe and have spine surgery are otherwise reasonably healthy, and you'd be silly not to pass a once-over by your PCP before spending thousands on even the trip planning. imho his ADR numbers are more than enough, and he also does a lot of non-adr lumbar surgery.

Logistics to me are much better in Barcelona - no lengthy airport transfer, plentiful housing options, and all of the convenience of a major city in regards to public transportation, entertainment for travel buddies and hopefully me the last few days, food, shopping, etc. Clavel's assistant Dr Gilete is the logistics man, and has answered all of my emails very promptly i/r/t neighborhoods and whatnot.

In general... I'd rather deal with either of these surgeons than nearly every spine surgeon I know or know of in the US. They're personable, and you can tell that they care about you as a person and not just a number. I have had non-surgeon US physicians provide that level of care, but the only surgeons I know in the US who do that sort of care are cash-only and still aren't quite as good. These guys are cash only too, which does help... but spine surgeons here are NOT suffering (other than the fact that many of their patients never... go... away).

I feel much more comfortable with the whole setup in Barcelona, and connected very well w/ Dr Clavel. I talked to him a lot about surgical approach, what factors go into who does well, when he does or doesn't cut the PLL... etc etc.

For anyone looking to talk to him anytime soon - better hurry, because he's going to be in the US for meetings the last part of October.

[janaya3]

Originally Posted by laid up doc

i have made all of my inquiries and feel quite good about my decision.

I know that Vicki recently changed her mind - after having spent 30 min on the phone w/ Boeree and nearly and hr and a half total w/ Clavel - i think the difference is style.

here is my take:

Boeree is much more direct about certain things, and talks a lot more about details right off the bat. He asked me about my BMI (cuz you can tell on my CT that I'm no supermodel - but not obese), and we talked at length about stopping oral contraceptives well before surgery. He is older than Clavel, did older ADR's before the M6, and has therefore more numbers. he is the consummate professional British gentleman.

He was very reticent to talk much about travel planning and whatnot, deferring to Jo. I think the biggest negative about his practice is that it is in such a remote location - lots of extra logistics involved. From my number crunching - surgery cost is not much more than Clavel, but getting there/around/housing/food are significantly more. You also have to factor in the trip from Heathrow or Gatwick. The housing options are much less plentiful unless you plan to 1. rent a car or 2. take lots of taxis and stay in Southampton or Portsmouth.

Clavel is more than willing and able to talk to you about whatever you want to know - just his general "spiel" is much shorter. He has answered every nit-picky question I asked in a quite satisfactory manner. I sorta "tested" him a bit when it came to my history and imaging - and he knew about all of it. His personality is really quite different than Boeree's - he readily admits that he is quite laid back - and i inferred that he really relies on you being cleared on your end for surgery. most people who are willing and able to fly to Europe and have spine surgery are otherwise reasonably healthy, and you'd be silly not to pass a once-over by your PCP before spending thousands on even the trip planning. imho his ADR numbers are more than enough, and he also does a lot of non-adr lumbar surgery.

Logistics to me are much better in Barcelona - no lengthy airport transfer, plentiful housing options, and all of the convenience of a major city in regards to public transportation, entertainment for travel buddies and hopefully me the last few days, food, shopping, etc. Clavel's assistant Dr Gilete is the logistics man, and has answered all of my emails very promptly i/r/t neighborhoods and whatnot.

In general... I'd rather deal with either of these surgeons than nearly every spine surgeon I know or know of in the US. They're personable, and you can tell that they care about you as a person and not just a number. I have had non-surgeon US physicians provide that level of care, but the only surgeons I know in the US who do that sort of care are cash-only and still aren't quite as good. These guys are cash only too, which does help... but spine surgeons here are NOT suffering (other than the fact that many of their patients never... go... away).

I feel much more comfortable with the whole setup in Barcelona, and connected very well w/ Dr Clavel. I talked to him a lot about surgical approach, what factors go into who does well, when he does or doesn't cut the PLL... etc etc.

For anyone looking to talk to him anytime soon - better hurry, because he's going to be in the US for meetings the last part of October. I am scheduled for the 19th.

So it is an M6-L with Dr. Clavel. Since I know that you WILL DO just marvelous after your surgery and with your new ADR, please don't forget to post about your positive results and experience so that we continue to support others with similar condition(s). Good luck on your trip. We need more positive, optimistic and favorable post regarding ADR on the forum. It will all work out for you in the overall scheme of things. I was quite the nervous wreck and stressed out prior to my surgery- being that I am an over analyzer of every detail . And speaking of posting positive remarks and experiences on the forum, I have been guilty of not following through on my own advice. It is that I have been truly blessed and seem to be enjoying life once again....mostly physical therapy 3-4x/week and following home base regimen as well that have been keeping me busy. Oh yeah and 2 children and a wife.

As a matter of fact today during PT being only approximately 5 weeks post op in comparison to my baseline 3 week post op mark (which is when I started PT), I nearly have all my flexibility and strength back. I was almost completely able to place the palms of my hands on the floor while bending at the waist pain and almost discomfort free. My only issue was upon coming back up I felt this minor but tolerable discomfort on my left side. And as a side note my left side had always given me issues pre-surgery so the PT and I are working on strengthening this. I am sure that I am not quite ready to return back to work yet and meet those demands but just trying to sound encouraging for those who still don't believe that ADR is the next best thing or are questioning it!

[laid up doc]

thanks for the words of support janaya... i can't wait for the last few years of my life to be behind me. i think i have a lot of things working in my favor physically, and am working to be as mentally positive as possible. i'm finding it's easier to be positive as more decisions have been made - 1. to have surgery, 2. to move, 3. to pursue an M6, and 4. to go to Dr Clavel. now i have a ton of planning to do - and planning is my forte!

[MeggieLynn]

Good luck, Doc. You'll be back in the ER in no time - not as a patient, I meant. Okay, maybe not so funny. But I do wish you all the best - Can't have anymore of your years of valuable training wasted or put on the sidelines because of back pain. From your unique perspective of having had chronic pain, I have a strong suspicion you'll be back at work with more passion and compassion than you could have ever imagined from your initial med school days. Have fun with your planning and organizing - it'll help get you back into that sweet spot/zone. With hope and optimism.

ML

[Vicki_in_Florida]

I have a question for you...
what made you decide that ADR was the better option than having a fusion?
Would be interesting to see how one who is a doctor came to this conclusion,
if you don't mind sharing this.