Choosing a doc in E Central PA
 

I have been through this routine before with a ruptured L5-S1. After nursing a touchy back, it fell apart in 2001 in a most painful way:bawling:. At Hershey Medical Center, Hershey PA, Dr Stephen Powers did a microdiscecotmy that went very well. :jacks:

After a decade of nursing a touchy neck I have just been told my C6,7 has dried up and caused the vertebrae to become arthritic. Hershey recommended a ProDisc-C but I don't care much for the new docs.

I tracked down Dr Powers but he doesnt believe in ADRs :nono:
I'm in my early 40's and at this age I think a fusion would be foolish :insane:

I, like many here, don't need the guy they fly in when the POTUS is injured, but don't want to be a guinea pig either. I have asked around for recommendations but can not find consensus.

Searching by my own criterion:
Spinal Specialist
Spine Fellowship trained
Board Certified surgeon
whose 'toolbox' includes ADRs
within 2.x hour drive of PA's E Central coal country (since BCBS will cover it)
(am I missing anything?)

I have found this outfit:
Pennsylvania Spine Institute - Our Physicians
On paper they seem very impressive!

William J. Beutler, M.D. can see me in May :eek2:
The way I feel I haven't got that long to live.

Walter C. Peppelman Jr., D.O. can see me in two weeks! :jump: (I think the receptionist could tell I can not wait.)

If you read his CV he seems well educated on things arthritic, and did his fellowship at Pittsburgh, which seems to produce some top shelf spine docs... if I am reading it right. (How have I not heard of this guy?)
I don't want to waste any more time as I did with Hershey. I need something done ASAP.

I see doctor ratings for neuro and ortho but without the data being broken down to 'spine' and 'aneurysm' etc the ratings seem to be coarse.

If anyone can run Walter C. Peppelman Jr., D.O. through their spine doc check-o-meter, or tell me how, I'd appreciate it!

BTW this will be of interest to those here... a video of the two aforementioned docs installing a ProDisc-C

ORLive, Inc.: Artificial Cervical Disc Replacement Improves Mobility Artificial Cervical Disc Replacement Improves Mobility

i've heard good things about Balderston in Philly and McAfee in Baltimore.

If you can get to Philly, get in touch with 3B Orthopaedics. The main location is downtown at Pennsylvania Hospital and within walking distance of public transit. Dr. Balderston did a fantastic job with my L5/S1 ADR. I don't know if he does multiple brands/models of discs but I've been absolutely loving the Prodisc he put in my spine. There are other docs in the practice that also do ADR, but I can't remember who. The facility is great though and I was glad I chose them. A lot of area athletes actually go there for stuff. I used to work right down the street from there and my manager recommended them to me. My manager actually said he saw a member of the 76ers basketball team one time while waiting on an appointment. Being formerly athletic myself, I was sold. Haha.

Good luck with your doctor search! That's a shame your local doc doesn't believe in ADR. Maybe you'll be able to shine some light on the subject with a successful ADR. :)

~Sara

The medical "magic 8 ball"
 

Recap:
I didnt care for the Hershey docs who recommended an ADR.
For the full story on that it was more like two opinions. First the old timer (C. Schaiberger) that doesn't operate anymore said they will just clean out the spur. When the operating doc (M. Sather) came in he said the disc will be removed. The old timer then deferred to the op doc.
So I tracked down the guy that did my L5-S1 only to find out that he doesn't believe in ADR's.
Then I went to a doc I found with all the credentials one could imagine.
Update:
He (Walter C. Peppelman Jr.) wanted to send me to pain management:chainsaw: :insane:
So my family doc sent me for an EMG tiebreaker. I have nerve damage. (I have been telling people that since 2005 but after spending a few thou on inconclusive tests I gave up!)

I made an appointment with the doc that does not like ADRs thinking maybe I just need the bone spur removed. (I'm running out of docs I trust.)

And I have arranged for my MRI reading to be looked at by Dr. Balderston. I am waiting for his office to call back.

Does anyone know what criteria a doc looks for in deciding if a cervical bone spur will result in an ADR (or fusion:raspberry:)? The medical "magic 8 ball" right? :D(If you are under 40 don't even try to figure out that comment :laugh:)

Can't really help in the cervical question. But definitely, if you don't hear from Dr. Balderston's office within a week or so, call over to follow up. The one thing I'll say about that office is that it can get a bit crazy over there sometimes. They are located directly in Pennsylvania Hospital, so there have been a couple times I was there and had to wait a long time because an emergency case derailed schedules. I personally was willing to overlook that in lieu of the excellent care I received while going there pre and post-op. Plus, I've gotten to the point where I just always take entertainment to doctor appointments so I don't get bored... just in case. LOL

Good luck. Hopefully you get some good advice from Dr. B.

~Sara

Nope
 

I called Dr. Balderston's office a few times but kept being connected to Dr. Scott A Rushton's office. When his staff answered I was told that Dr. Balderston does not work on the cervical spine.:chainsaw:
I find it amusing that one of the big reasons I left Hershey is because they want to set me up with a neuro doc that specializes in epilepsy. In Philly they even specialize on what PORTION of the spine they want to work on!:clap:

I don't even know if Dr. Rushton does ADRs yet.

I ran across this US News Hospital ranking for what its worth...

Hospital of the University of Pennsylvania

That would not be too hard to get to. I'm researching them next.

Try the Medtronic Prestige website. It lists all of the docs within a specified distance of your zip code that are trained on the prestige disc. This means that they have attended a training course on the device and have completed the minimum number of proctored (by the sales or clinical representative of the company) cases (usually 5 or 10 cases). If they are on that list, you can assume that they are also trained on the Synthes product, as this is a very competitive business and the reps go after the same docs. If they list that they perform the procedure you can narrow your list of docs from there. You can also search the procedure code online and see which hospitals have billed that code (available from your state in FL its Floridahealthfinders.gov) the most often. From there you can figure out which docs are the busiest. You can also try to reach your Synthes or Medtronic Sales Rep and they can just tell you, but that may take more work... My advice (worth about $.01) is to find the doc that has done the greatest number of ADRs. This is simply using the theory that the doc who does the most, is most likely the most profecient with the actual device. The procedure is different from a fusion and requires some additional fitting and sizing of the actual disc. Those who have done more, will be more likely to be more profecient. Best of luck...

If I could just get the docs to treat the disease and not the symptoms
 

OK forget U of Penn hospital. No one there does cervical ADRs (as of 3/2012.)

I FAXed my records to Thomas Jefferson Hospital in Philly. Both their Neuro and Ortho have ADR surgeons. I'm waiting to see what they say.

That is good advice on finding those who do cervical ADRs:). TJ is known to be a very good hospital but if they fall through I will do as you say. Thanks!

This is why the call medicine "A practice"...no one really knows what they are doing!
 

Dr. Rushton does not do cervical ADRs:nono:... therefore for future reference, at least as of 3-2012, no one at 3B does cervical ADRs.

Nope they lied. TJ's neuro does NOT do ADRs:raspberry:. They send them to their ortho. I went to see Dr Jeff Jallo who could tell I was informed on the subject. He told me "I knew too much." It came up that he doesnt believe bone wax inhibits bone growth. He told me it only stops bone bleeding. Two seconds on the internet will yield rat studies showing inhibited bone growth but I didnt get into it with him. He seemed more interested in saying nothing so he could not be found wrong:flaming:. He wouldnt even talk about the pros and cons of the options given. Cant wait to see what his bill is:eek2:.

There is a consensus forming that an posterior foraminotomy will do the trick. Hershey is the one that sent me on this anterior ADR path. They also pushed the spur diagnosis. Hershey I think knew what my problem was but used all the wrong words for it :disgust:. It turns out that there is a C6,7 bulge (worst of my problem) and a rare posterior "spur" called "calcification of the ligamentum flavum" at C7,T1. No one but Hershey has thought an ADR was necessary. I dont know if Hershey wants to play with ADRs or if cutting (and stitching) the two muscles to do the posterior is a big deal or if they are thinking like I am a car and should put a new disc in while were in there or what. Everyone else says the disk spacing is fine and it is a reasonable option that the disk stay.:clap:

I was avoiding the doc who did a good job on my L5-S1 since I thought I needed an ADR and I know he doesnt do them... but since that changed...
He was very confident that an anterior foraminotomy / microdiscectomy will do the trick and he would clean out the 'spur' while he is in there:chainsaw:.
I know he did a great job on my back but its a bit creepy since Dr. Powers just operated on my neighbor's neck and they now complain of debilitating arm pain. I shouldnt let that bother me I know.

I scheduled the operation with Dr. Powers but I have not canceled TJ's ortho (US News hospital ranks#14 in the country for Ortho.)
I dont know if I need yet another opinion (which is a day trip to another dept of "I dont know anything kuz you are too smart.") Things are finally jelling. I think!

Huh... that's interesting that you found out nobody at 3B does cervical ADR seeing as how a guy I know spoke to Dr. Rushton specifically about his cervical spine about 10 yrs ago now and the only reason Dr. Rushton wouldn't go down that path was because he was a two level patient at the time and there weren't even two level studies being done at the time let alone potential insurance approval, etc.

I recall at the time of my own search for surgical help, Dr. Rushton just wasn't taking on non-surgical candidates and my MRI report was written as if I wasn't a surgical candidate despite the images showing otherwise.

That's really bizarre that your consult went so poorly just because you had a clue what you were talking about. It's amazing how some docs seem to frown upon people being informed patients. I ran into that prior to the c-section birth of my son in which the head doc in the practice actually told me to stop reading because it would only worry me more. :disgust:

You may want to double check on the fact that even though disc spacing is fine in your spine, that there isn't still a herniation causing the pain issues. I only say that because I think in some ways, that's part of why my original primary care doc blew me off after the x-ray I had. My L5/S1 disc space was just fine but I had a herniation centrally putting pressure on the nerves. Thankfully, I took care of it when I did otherwise I'd probably have started getting some real nerve damage as the issue worsened.

The guy I know that I mentioned previously, tried all kinds of stuff with his cervical spine before getting a double fusion, including going to a chiropractor. In the end, he probably waited too long to fuse because he has nerve damage which causes his one leg to react sluggishly now. It's definitely a fine line to balance on when it comes to these sorts of decisions. On one hand, you want to preserve the natural disc as long as possible and hopefully avoid a major surgery, but on the other hand, you don't want to wait too long and wind up with other lingering issues.

Good luck! Hopefully the surgery you have lined up will do the trick for you! Thanks for updating with the info on 3B's cervical ADR stance too. Definitely good info to have. I can only speak from the lumbar perspective.

~Sara

Past Dr. McAfee Patient & Dr. B in Bogen Germany
 

I live in Lancaster, PA.
I would travel down to Dr. Paul McAfee in Towson, MD
He was one of the first Dr. to do PRO-Disc on east coast.
He did the clinical trials.
Check him out on the Web, just google him.

Back in 2006, the FDA would not allow me to have ADR since I had previous fusions. So Dr. McAfee referred me to Germany to Dr. Bertagnoli.

I had MVA 14 years ago, followed by C-6,7 fusion, C-5-6 fusion, then C-4,5 Prodisc.
I would never have a fusion again. The ADR stopped the next level from herniating. Fusions do not promote natural movement of your neck.

Hope this helps,
Kriss

You are correct. The doc I picked the surgery date with claims he can take out what the MRI called a 'bulge with moderate to severe impingement' and what he called a 'herniation' by a microdiscectomy.

I doubt the pain in my neck can be solved without surgery. Also my arm is twitching and showing other signs of nerve damage. I will not hesitate in going under the knife for this ASAP!

I appreciate your kind wishes :)

I <3 Lancaster

I have an appointment yet with the Ortho dept at Thomas Jefferson. They (Dr. Jeff Rihn) do ADRs. They are supposed to be #14 in the country for Ortho. I will take their opinion, which if things stay on course they will not recommend an ADR. Then I will likely let Dr. Powers do the operation. Im not crazy about employing a non-spine specialist but:
- he was in there before and did me well (L5-S1)
- he was the first and only guy that seemed to know what he was talking about, and what he said even made sense :jump:
- I've already been out of commission for three months and TJ will take longer than just letting Dr. Powers do it

They are my motives to date. If anyone thinks I am making a mistake let me know!!

Thank you everyone!

When nothing makes sense...
 

Dr Rihn (Rothman Institute / Thomas Jefferson ortho) , get this, recommended a double fusion, C5,6&6,7.:chainsaw:
Dr. Rihn also said that he does ADRs but would not recommend one to me because of the extent of my arthritis, disc collapse (which he estimated at 50%), and because "no one knows if ADRs will last more than ten years.":eek2:

This opinion is an outlier to the range of opinions I have gotten so far. My X-ray states "There is loss of disc space height , osteophytes, and mild narrowing of the uncovertebral joints at c56,c67." MRI states "no significant spinal stenosis."

Considering what I have read about arthritis not being much of a contraindicator for ADRs and the 10 year comment I left there puzzled by the motives of "the #14 ortho clinic in the USA.":sus:

Are my discs up for the junk heap or not!!?:shout:

Wow, that's insane. So what if nobody knows if they'll last 10 years? I suppose some folks might care, but I would imagine a lot of us just want some relief no matter how long. At least... I speak for myself on that one. I think I even told one of the docs I worked with that I'd be happy to have even just one decade with little to no pain than to continue going along the path I was one pain-wise.

In some ways, I can understand some of the report inconsistencies, but only because of what I dealt with. My MRI report was written to make it sound like the disc bulging was mild at all levels bulges were visible, so the first surgeon I approached per a friend's recommendation, declared me a non-surgical candidate and didn't even bother to let me know until I called to follow up. So, I looked into minimally invasive options with another doc at the practice who took one look at the actual MRI images and said nothing minimally invasive was going to help! This was all after my primary care doc at the time completely blew me off with a declaration that it was only an arthritis issue. *facepalm*

Ugh... I'm frustrated for you on this one. Hopefully you get some kind of real solution soon. That double fusion bit would scare me too. As far as I'm concerned... fusion should be a last resort option anymore....

~Sara

It appears as thought mobility for my C6,7 has expired
 

I totally do not believe the 10 year number. I dont know if he was trying to scare me away or what! It seems like 40+ is a reasonable guestimate from what Ive read thought I would not wish to hazard any guess on the 3rd gen shock absorbing ones.

"Only arthritis" lol. As if that doesnt hurt. In my case it seemed all the minimalist time wasting went away when the EMG came back that I was a mess.

Since I am looking less and less likely to be an ADR patient I will start posting my saga over here.

Thank you all for your contributions!

J,

Moderate to advanced arthrosis (especially of the facets) is a contraindication for disc replacement. Bear in mind, with the link you provided:

- Dr. B is one of the foremost authorities on ADR, and his ability (and unique) techniques to "clean up" and prep the spine for ADR is a wee bit different than other spine docs;

- As is the case with other surgeons, e.g. Zeegers and Scott Young, etc.;

- As advanced as these spine docs above, few will perform diagnostics to assess systemic diseases (like Lyme disease) that affect the entire spine and other joints. In fact, Zeeger's clinic is the only one I ever heard of doing these kinds of tests and they do it well. At least they were for years, and I hope they are moving to molecular diagnostics if not already.

I had my my Charite' in 2004, my spine is well. Properly indicated patients do well with disc replacement, especially if they have a good surgeon, good OR team and good luck!

Very true. It would be quite the project to try for anything but the decompression at this point. Maybe an ADR will be possible for my C5,6 if that day comes.

I did check for Lyme. I need to know more about this possibility. Is there a link of what other things may be going on? I was told my spine looks 20 years older. If this can be stopped or understood my later years will be immeasurably improved.

J, regarding Lyme disease diagnosis -- it's a clinical assessment. That said, the doctors in this country are trained differently than in other parts of the world.

Way too much credence is given to poor quality tests that utilize the CDC tracking criteria (not diagnostic). Most labs don't regionalize their test assays to the 300+ strains of Borrelia, even fewer test for co-infections. In fact, most ticks (even non-deer ticks) carry Lyme and other bugs (bacteria, viruses, protozoa, etc.). This is well-documented in the literature and in my interviews with scientists across the US. E.g., see the one with Eva Sapi here.

One of the better blood testing labs accounts for all of these shortcomings:

Welcome to IGeneX, Inc.

There are others, but these guys have been doing it for years. They've been beat up by the various skeptics who wield great influence and power, but they've helped many patients and doctors and are CLIA certified.