Upcoming Surgery with Dr. Bierstedt
 

Hi everybody -- after a couple of years of sitting on the fence researching and debating ADR surgery, I've decided to go for it! I'm scheduled to have a two-level surgery next week (Nov 12) with Dr. Bierstedt. A big shout out to Harrison for creating and maintaining this site, and to everyone in this community for all of your many contributions. What a tremendous resource! If this community didn't exist, I'm pretty sure I wouldn't be going down the path to ADR surgery today (my fusion-centric US surgeons would have scared me off a long time ago).

A little background: I herniated L4/5 three years ago. Initially, I had excruciating back pain -- to the point where I couldn't stand for over 24 hours. A trip to the ER and a round of prednisone got me up and moving again. Over the next few weeks, the back pain slowly resolved and I regained mobility ... then the sciatic pain and foot drop (left side) kicked in. Good times. After 8 weeks of worsening sciatic pain and accelerating weakness in my left foot, I opted for a micro-discectomy. At first it seemed to work -- the sciatic pain abated, the strength began to return in my foot. I did have some residual numbness in my foot and toes and developed some new burning/tingling in my little toe and the side of my foot. If things had stopped there, I would have been a happy guy. Unfortunately, a few weeks after the surgery, my back pain returned on the left side. A few months after that, I re-herniated the disc simply by reaching out quickly to grab something -- since then, I've had constant pain on both sides of my back and in my hips and glutes. Some days are better than others, but overall, the pain has managed to really impact all aspects of my life (family, socially, work, recreation) and I am ready to put it behind me.

Over the past 3 years, I've consulted with a dozen or so surgeons and pain management docs in the US and Europe. US docs all over the map; Euro docs generally in agreement about ADR being the best option. I've also tried just about every conservative approach out there to reduce/eliminate the pain and avoid surgery: multiple ESIs, facet injections, medial branch blocks, acupuncture, intra-discal injections (Dr. Derby's "restorative solution" -- a cocktail with glucosamine chondroitin), PRP injections in my facet joints and intradiscally at L3/4 and L4/5, acupuncture, prolotherapy, neural prolotherapy, hypnosis, lots of PT, massage, daily stretching, walking, swimming, inversion table, chiropractors, and a bunch of different meds. I also managed to drop 30 lbs. None of the above did much for the back pain (it didn't help my wallet, either!). Walking, icing and mild doses of Percocet and flexiril have helped more than anything.

I initially thought the issue was coming solely from L4/5, but a discogram I had showed annular tears at both L4/5 and L3/4 (there was also concordant pain at both levels). On my MRIs, L4/5 is clearly degenerating, but L3/4 still looks OK. After discussing it with Dr. Bierstedt (and other surgeons), we've decided that we shouldn't ignore the results from L3/4 (even though discograms are known for false positives) -- since we are going to replace L4/5 for sure, the best approach would be to also replace L3/4 now rather than find out it's a pain generator after the operation and/or have it worsen down the road and have to go back in.

Question for those who have already traveled down this path: how nervous/scared/anxious were you before surgery? I gotta admit, after wiring the money yesterday (ouch!) and as the day gets closer, I'm scared sh*tless and am starting to second-guess myself. Had a hard time sleeping last and am doing my best not to let the doubt creep in any further...

Decision
 

Be ready for a long battle but you will see immediate improvements. As Harrison always says, slow and steady wins the ADR race. You are making the right decision. In my case, I needed subsequent cleanouts from the posterior to get rid of the stenosis (bone) that the anterior ADR does not always take care of. But again you have to do the ADR regardless.

Hi Dave,

I'm about 5 weeks to my one year back surgery anniversary. And yes, I did have concerns and worries, particularly since Dr. Bierstedt hadn't had many posts about him at the time and they seemed to be putting together their program. As a matter of fact they switched the post op accommodations to Medicos in the last week before we were to leave. There were a lot of emails between Malte and myself regarding that!
Take comfort for now that there are so many positive outcomes from not only Biestedt but other doctors as well. You'll take more comfort when you meet Dr. Bierstedt.
Once we took off on the plane, I felt a kind of relaxation, like I did the best research, made the best decision, and everything was on autopilot.

Dear Stone, I am close to pulling the trigger on a two level ADR with Dr Bierstedt but it seems like the demand is much higher and they have less time for hand holding. Well success bring more success. I am glad to read about so many positive results and I look forward to reporting on mine in the near future. I am tentatively reserved for January 7, 2014. I guess I'll be rolling in the snow after surgery. Well there is always Barcelona! Best regards, Mike

Hi Mike,

Dr. Bierstedt and Malte are now working with a Dr. Illerhaus. Check out the website. Its one of those things, I went with Dr. Bierstedt, never speaking with him on a phone, asked Malte some hard questions that he answered and went with Dr. Bierstedt even without Medicos at the time. When I was there Dr. Bierstedt operated on another patient from Manitoba, (get this, 2 level ADR, 3 level fusion 1 hour for the docs to flip him as he had antireour and posterior surgery at the same time) as well as 2 from south america he had done prior to us. I also noticed a few Germans on the hospital ward. Don't know who did the surgery on them.
Dr. Bierstedt is human and needs his breaks, rests and vacation. I DO NOT BELIEVE THAT DR. BIERSTEDT OR MALTE would bring an inexperienced surgeon onboard with them. If you feel you need a earlier surgery date you might want to inquire about Dr. Illerhaus's schedule. And you might inquire about a lesser cost than Dr. Bierstedt since Dr. Illerhaus's reputation has not been globally acknowledged as Dr. Bierstedt.

Mike,
Further to, I never contacted Dr. Clavel directly I went through the Ritter-Lang contact, perhaps nievly thinking the rep, well, represented both doctors. Ie. if I went with the Ritter-Lang organization I could choose the doctor I wanted to go with, which would have been Clavel. I ruled out Spain because of the riots over the austereiour measures. Didn't want the hospital staff go on strike while I was there.
And yes, I thought about going to a warmer climate, a romantic city, and great scenery, but it came down to, I need my back to get better, and that was my number one goal. I eliminated all those nice things and focused on what I needed done.
That being said, post op, with my recovery going well we spent a few days in Paris. If you think you might add a bit of a holiday to your stay, I think tpatti and laurab have great ideas. It was cheaper for us to do a side trip rather than rearrange our initial flight arrangements departing from Dusseldorf. Saw the eiffiel tower and went to the Luge. Although it wasnt easy. But we got through it.
Remember on your flights let the the airline know you are disabled. They will pick you up at the plane and take you to the next gate.
If you want IM me and I'll send you the pics I took of Hattegin and Medicos.

Hi Stone! Well I really was not going to choose Barcelona for the tourism but I do hope that post surgery I would be in the mood to visit Paris; if my new back thinks it is a good idea! I am waiting to hear back from Dr Bierstedt's office for all of the details; I did not think to ask about Dr Illeraus although I did see him on the website. Have you heard about any of his success stories? And I hope that there are ONLY success stories!

Best regards, Mike PS, how do I IM you for the photos?

For RWS Dave
 

Dave
I have not got to the other side yet, but am going in for 2 level cervical surgery tomorrow after 13 years of trouble. The trouble has backed right down since being here, and I have had a few small patches of thinking 'what am I doing'! Especially when you sign the dotted line where you have to acknowledge the risks of the operation (albeit rare).
The thing that got me to this point and feeling good about it, is that I kept on asking myself this question "If I dont do this, what is the future?"

Always, the answer was that it will not repair itself now. If it fuses by itself, there is now spurs and osteophytes growing into the nerves that run out and into my arms/hands. And so this process will only worsen, if left unchecked, and it will squash the nerves in my arms as it does and I will lose use of my arms. I am an artist by profession. Its how I make a buck. Also the vertebrae have begun to bend into the spinal column. I have also pondered the potential catastrophic issues that could occur should I have a solid fall by accident, even slipping over. Things are too precarious, and spurs break off, and you can imagine the rest.

So I ended up counting my blessings that this medical technology was available to me, and that I could afford it. Two line crossers for me. That and of course to imagine a future if you DO NOT do it.

As for the surgeon? Dr Beirdstedt seems to be one of the best in the world, by his actions. Again like you, I am grateful for finding this forum so I did find out more about the finer points of ADR and the devices used, through the generous sharing of others here on the site.

Ill be posting in the post operative forum after tomorrow (as long as Dr Sleep wakes me up!):look:

You will be in hospital when I am at Medicos, by the sound of it. So hang in there and keep thinking of the consequences of not doing it! Sounds like you have nothing to lose except that serious pain.
Best Wishes
Heidi (helen)

Thanks, everyone, for your encouraging words, sharing your stories and perspective. As my surgery date approaches, it really helps to keep the big picture in mind. There are so many inspiring stories on here -- definitely makes it easier to focus on a future with less back pain. And when I compare that future to doing nothing, going forward with the surgery seems like a no-brainer.

Heidi - hopefully, our paths will cross at Medicos. I'm scheduled to arrive there on Monday, Nov 18. Can't wait to hear/read all about your successful outcome!

We made it to Hattigen. Flew SFO -->ORD-->DUS. All flights went smoothly (even arrived a few minutes early). Taxi driver was waiting at the airport as arranged. It's about a 30-40 minute drive to Hattigen through a bunch of small towns on mostly one-lane roads. We got to the Avantgarde Hotel, took a nap and then went for a stroll through the old part of the town. Since we arrived on a Sunday, just about everything was closed except a few bars, restaurants and an ice cream shop.

We are getting picked up tomorrow to go to Recklinghausen for some pre-op tests and a meeting with Dr. Bierstedt. I've heard a lot of good things about Dr. Bierstedt and also had good conversation with him a couple go months ago. Looking forward to meeting him in person, which I hope will help put some of my lingering anxiety about the surgery to rest.

Once we're done in Recklinghausen, it's back to Hattigen where I will get checked in to the hospital for surgery Tuesday morning!

Best wishes,
I have a hard time saying good luck to patients of Dr. Biestedt because I believe the doctor does things so meticulously that luck is not a factor.
Make sure you check out all the great breakfast buffets the hotels have.
Again best wishes.

You are in good hands. I keep you in my thoughts. If you have any questions while you are there that you think I could help with feel free to contact me.

Hang in there Dave. We're all pulling for you. Just remember you have good support and are in good hands.

Thanks, all, for the encouragement. Had a bit of trouble sleeping last night. Tried some better living thru chemistry (Jet lag meet Ambien), which helped. I'll plan on posting more after I get settled in at the hospital.

It all feels a bit surreal. Makes you really appreciate how brave others who have gone down this path have been. All the stories and shared experiences in this community really do help take some of the mystery out of it and prepare you better for forging ahead with surgery in a foreign country. Not to mention all the folks who were willing to speak with me over the past few months, many of whom are on this site. I plan on posting throughout this process so others can benefit as much from this great resource as I have.

Day 4 Post Op
 

Hi Dave
Welcome to Germany! Thinking of you as you come up to the starting gate.

Had a bit of a pain filled night, and surrendered to a few extra doses of Ibuprofen which sorted it out enough to get some good rest. They give you your 'normal' pain medication (taken at 3 meals), and then you can ask for extra Dave and I think its well worth doing that - mostly so you can get good sleep (heals the body more than anything). For me I havent had to take sleeping pills yet, as long as I can control the pain.

Its now 4 days post OP, and I had a chat to the nurse about how the night pain is worse now than the first days. Its tricky because in between you might actually feel great! She said that an increase in the shoulder pain post OP at about 3-4th day was very normal I found that the Ibuprofen alone (600mg) was quite all that was needed. My aim is to keep it simple if possible. She gave me something else in a little cup earlier and it only lasted a few hours - but the Ibuprofen got me through from 10.30pm till 4.30am. Its quite tricky because you may really feel great in between. As mentioned yesterday I have an issue with breathlessness. The doctor this morning is going to give me one of those breath trainers. I did do some googling on this, and it seems it can be a post op problem for some. If the training does not help he will send me somewhere to check this. Stuff like this makes you really get the point about how important the week in hospital is. So much trauma (not just from the site surgery) but from the trauma of 'surgery' itself with pipes and things going where they havent gone before! :sulkoff:

I note also that it is now Monday, and I am really hoping that we get some more of that lovely physio massage. I have only had one so far (Friday), and a great big hot wrap around the shoulders.

Dave if you can get your partner to see where the pressure points are in the shoulders (you will feel it when you are on it) this is a huge help in post surgery days. I can reach some of them myself at a pinch - and it does help more than anything to press on these for a while.

Dont forget if you like fresh air, they can open the window in a way from the top so it does not let the rain in. This is vital for me, especially with the breathing thing. I rather have the fresh air and put an extra jumper on. Much healthier too.

Yesterday a remarkable act of kindness was bestowed upon me by one of the senior nurses. She brought in for me a whole heap of fruit, plain yoghurt and little healthy Gluten Free nibbles. This has saved my sanity.. Faith in human nature is reaffirmed by these sorts of gestures. A gift she said! And I felt so much happier. The cheese and stale bread (with a gerkin at night) meals twice a day are bordering on insane. Thanks to the gracioiusness of staff helping me to source a bit of fruit, I have not had trouble with bowels.

I just don't feel quite right about the walk to the shops on my own. When I went outside the other day my airways felt too raw and vulnerable, and its too dodgy without someone to help if it gets too hard (especially with breathing issues). If you do go out, cover your mouth with a scarf I think.

Ok back to watching the 50th episode of Rich Man Poor Man again...

Hi Heidi - I hope you are feeling great! Thanks for your kind words of encouragement and advice. Apologies for not getting back sooner, but the past few days have been a blur. It looks like I will be on track to got to Medicos this Monday. Will you still be there, or is that the day you fly home?

Best,
Dave

I am sending positive vibes for surgery.

When you have time and are feeling better, I would really appreciate your thoughts on the disc restorative solution by Dr. Derby. I have inquired with his office and I am unsure if it is really worth my travel and time. I already had a stem cell injection that was unsuccessful and was warned by Dr. Eek (co-worker of Derby) to not have it done. I did it anyway.

Thanks, jevenson. I saw both Dr. Derby and Dr. Eek several times for consultations and treatments. I'd be happy to talk with you -- can you pm me your phone # and I'll try to get in touch with you later this week after I get back to the US?

Hi Dave my name is Henry and I received Dr Bierstedt's intervention plan today. I should not be shocked but it is a 3 level ADR L3-S1. I have not signed off yet, not even sure if I can borrow enough to cover costs. While I am hopelessly depressed about my condition, I was still overwhelmed when I saw that it was for 3 levels. I have mild or minimum facet arthropathy at L3/4 & L5/S1 and just plain 'facet arthropathy' at L4/5. I had a huge ruptured disk at L4/L5 in 2001 and it was repaired with laminectomy. I have read on this site that patients with prior laminectomies often don't fare as well and it scares the hell out of me.

Hi Henry - if you haven't already, I'd set up a time to speak with Dr. Bierstedt about the diagnosis and treatment plan. During your call, you can ask him how come he recommends 3 levels, as well as how your prior laminectomies will affect your outcome. I'd also discuss with him the facet arthritis you mentioned. My consult with Dr. B went well -- he answered all of my questions and made me feel that I'd be in good hands if I went with him.

The other thing you may want to do if you haven't already is get a discogram. Discograms are controversial and are said to have a relatively high incidence of false positives... On the other hand, 3 levels is a lot and you want as much confidence as you can get that all 3 levels are pain generators before moving forward.

That is exactly what I plan to do, I have a call scheduled for next Sat. I was expecting 2 but 3 scares me. I will also get another opinion

Do you know if he has any financial connection with the company that manufactures the M6? I'm sure it's a great device, however I have a lot at stake and want to be as thorough as I can be.

As far as I know, he doesn't have any financial connection with Spinal Kinetics (other than as a high volume customer). I never asked him directly as I had already determined that I was interested in the M6, so was more focused on finding a top surgeon who uses it.

Dr. Eek and Dr. Derby
 

Dave I sent you a pm and I sent it somewhere else also. I am just getting used to using this forum so I haven't checked it much until today again. Sorry it took awhile to respond.

Dave, I'll move this post to another forum. I believe this was your intro post, so I'll put it in the New Member forum (though it may also get copied into the international assistance forum...)

Sounds good, Harrison. I probably should have put it in New Members to begin with. Thanks.