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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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  #1  
Old 12-17-2005, 09:42 AM
Mariaa Mariaa is offline
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That a combination Fusion (at L5S1) and ADR at L4 with Charite implant would be authorized by UR.

I have to have a BMD DEXA scan done first, then a discogram w/CT by my current OSS who wants to do this procedure.

I have to decide whether to go with this or fight for at least a 2 level ADR (pending next discogram results).

In order to continue my quest for all ADR vs. fusion, I have to find a new PTP ( Primary Treating Physician) which I believe would be Dr.Bae at The Spine Center since I've already seen him.

I'd have to first, get transportation there and back (yes I drive tho am limited in distance in terms of sitting and numbness in right foot/leg so also stay off freeway..). I'm going to check out my local Disabled Rescources Center and see if that's something I might be able to acquire for a price that isn't as "pricey" as a taxi from my city to Santa Monica.

I'd have to transfer care to new Dr.(WC has to authorize). I have to get new Dr. to agree to build case for me in terms of rebutting WC UR decision when rendered that it won't authorize multiple level ADR.

I have to hang in there thru appeals and probably get a WC attorney if it goes to arbitration, then hope that the ruling would be in my favor with penalties attached for not treating (would get surgery done plus some $ and that'd be nice tho would settle for just the surgery)..

** I'm wondering how much difference it would make to have the fusion at L5S1 now, vs. the ADR..

I'm not sure if the issues I'm concerned with in terms of fusion are as valid as I think they are... like potential for more nerve root scar tissue, potential for SIJ problems, potential for difficulty with bone growth, potential for more surgery in terms of hardware removal, potential for longer recovery period due to fusion involved in surgery... less mobility at L5S1 (how much do I really even have now and can is that measureable other than being able to bend over?)..

I would hope an ADR above the L5S1 level would prevent adjacent disc problems with L3 (as I have an annular tear there)...

My OSS also is treating me for my knee and my cervical spine so to leave him is to lose care of a fair amount of my body.. however, striving to seek best possible option and still work w/i WC means.

Still, every conversation I have with NCM, I bring up option of going to Germany with Dr.B and having surgery done at multiple levels at much less cost and possible vertebroplasty to boot, and the many successes he's having with multiple level surgeries.

I have to wonder about the individual WC companies and how limited they truly are in terms of paying for these surgeries if tossing the UR decision to the wind..

Am going to check out book from nolo.com in terms of type of settlement I might expect with my duration (lifer) with WC claim. The NCM says "don't settle..loss of lifetime future med benefits is irreplaceable"....

Just have to put my thoughts out there. Now even Cervie Queen has left me in the dust with her recent surgery...
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  #2  
Old 12-17-2005, 11:23 AM
letteski letteski is offline
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Hi Maria,

First I want to let you know that I�m glad you are not taking NO for an answer or taking this laying down or crawling into your cave, as they would like you to.

Just a few thoughts if they would agree to 1-leval ADR they will agree to it because it is FDA approved. Does that mean they would agree to the Pro-Disc for 2-levels once it�s approved? Could you still get a 3-level, fusion at L5-S1 and 2 ADR�s above then? It a 2 level going to work for you if you have a tear at L3-4 too?

Just want the best for you my friend. Did you get Dr B comment on your case and if so what did he recommend? I have an appointment in Santa Monica the end of Jan maybe we can car pool together.

Merry Christmas and a Happy New Year!

God Will Provide
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ProDisc L5-S1 W/Dr Delamarter Aug 23, 2005
L5-S1 DDD Diagnosis 12/04
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  #3  
Old 12-17-2005, 12:31 PM
Mariaa Mariaa is offline
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Thanks Paulette for your reply and concern..
If a 2 level ADR Prodisc was FDA approved, and it had an equal to or better chance of recovery than fusion, and I was a candidate, yes, it "should" fly with UR. That is if anything flies...

I've heard UR is turning down surgeries left and right, however, I think I could build a case to get what I need done, as long as it's FDA approved..

L3.. we just don't know about that one. Had 2 opinions from Dr.B in the past and both were that they felt from the material I sent, a 2 level procedure would do, however, decision would be pending discogram. Possible vertebroplasty also pending BMD testing.

I just have this "thing" about the possibility of a steller surgery and recovery with Dr.B... however, my reality is a very different thing with WC ruling it. I feel like a bit like a fight tho....
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Old 12-17-2005, 08:44 PM
annapurna annapurna is offline
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Mariaa,
Congrats on at least making some progress against the WC "machine". I can shed a bit of light on one small concern you raised - the SIJ. If you already have a painful SIJ as determined by fluoroscopic injection, then you stand a good chance of having that pain aggravated by the L5/S1 fusion. If you don't already have a painful SIJ, the fusion may or may not do anything significant for pain in that area.

Have you tried just giving them a cost breakdown for going with Dr. Bertagnoli? I mean, holy cow, the Prodisc is going to get FDA approval any month now, so, they'd have a difficult time jerking your lifetime future benefits on the ground that you had a non-FDA-approved procedure. That being the case, I can't believe they would not sit up and listen if you proposed something that would save them about $100,000, which is very likely the difference between anything stateside and whatever Dr.B would propose. You'd think it would be like ringing the dinner bell.

Best of luck,
Laura
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

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  #5  
Old 12-17-2005, 11:30 PM
Mariaa Mariaa is offline
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Laura,
Each time I've been in PT, I've been told during the initial assessment that my SIJ is all out of whack and had ajustments done .. for years now~ like 15 at least.. haven't had the fluroscopic injec tho will mention it to my PM this next time so thanks..

RE Dr.B. Yes~ I gave my NCM a copy of the information and cost breakdown that Dr.F-M sent me last year. Still it was a no-go by WC, even the trial for 2 levels would have cost more than the proposed two level surgery w/Dr.B.

WC goes by ACOEM guidelines (American College of Environmental Medicine)~

One thing I think would be difficult to do at this time is to make Dr.Bertagnoli my Primary Treating Physician and this is what I must do if I switch docs to someone who will do all ADR vs. combo ADR and fusion.

It would most definately make financial sense, and I'm he has enough of his own study data to show the results he's having,however, I believe I'd have to have a PTP here that would be recommending the surgery there~ and then go from there...

It's all a big stretch at this point, tho whenever I read about fusion probs and the screws and such the feeling I have about fusion just gets reinforced more and more...

While I think WC wants to save $, I think they'd prefer not paying for anything surgical and they kind of have my number re "my doubts" (meaning they pretty much know what I will go for and what I won't)..

yes, they could stand to save quite a pile, but such is the broken system of WC here in Ca...
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  #6  
Old 12-18-2005, 12:23 AM
biffnoble biffnoble is offline
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Hi Maria:

Re: Dr. B. referral.

You could get a referral from Dr. Bobby Tay, UCSF, or Dr. Yue, Yale.

Tay is in SF. I know he's doing followup w/a 4 level cervical patient of Dr. B.'s. Tay is very bullish on Dr. B..

Maybe worth a look see?

Good luck.
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  #7  
Old 12-18-2005, 02:34 AM
luvmysibe luvmysibe is offline
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Hi Maria,
I'm glad you are narrowing down your surgical options and considering your possibilities. Knowing about CA WC firsthand, it would be a rare miracle to get approval to travel out of state, let alone out of the country for surgery. I certainly don't want to be a wet blanket, and I encourage you to weigh your options. How long can you continue to wait for surgery? Does the scale ever tip in favor of proceeding with options that would be approved now over waiting longer for the possibility of future surgical approvals? My NCM has also cautioned me not to sign off on my future medical expenses. Best wishes!
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  #8  
Old 12-19-2005, 05:16 AM
Judy Judy is offline
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Maria, Dr. Yue did in fact actually write in a letter to Cigna that he referred me to Dr. B. I don't know whether this actually helped but I am sure it did not hurt with my appeal.
I just heard Thursday Cigna is giving in and paying for my fusion portion of the bill which is everything but the two prodisc's. Is this a possiblity for you to handle if they would? Just a thought.
How many doctors in the United States have done this type of three level surgery? Can you use the basis of experience in this with workmans comp?

Judy
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  #9  
Old 12-19-2005, 10:27 AM
Mariaa Mariaa is offline
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Biff
Thanks for this information. I have seen Dr.Bradford at UCSF in '03 and was a candidate for trials there that shut down before my surgical date. Of course I'm sure they restarted but by then I was in the process of seeing Dr.Bae down the So.CA. way/Santa Monica.
Now I'm having more difficulty getting a referral again for consultation and being told it must come from my PM or PTP. PTP isn't into referring me out, tho I will be asking for 2nd opinion on this procedure should I seriously consider it.
PM would refer me out but he's part of a group in San Diego/Encinitas that does ADRs and he has wanted to refer me there.. (I moved out of SD county several months ago back to LA co.).

Crystal,
You probably know as much as I do re WC in terms of how difficult it's getting to forge on with any type of request these days... they are really tightening the screws in terms of what is being authorized, including consultations. I've had 3 to date regarding ADR and it's felt that 3 is enough I'm told.
I want to find out a bit more about what I'm legally allowed, and also would want a second opinion on surgery which I believe I'm allowed to pick... even tho WC is trying at this point to force their own choice of referral/consultation on me in terms of non ADR performing Neuro/Ortho.

Yep.. weighing options~

Judy,
Thank you for this info re Dr.Yue. The docs I've seen down here all felt my surgery could be easily taken care of with 2 level ADR or 2 or 3 level global fusion... I brought up Dr.B's name in each visit and one surgeon in fact said at the time that Dr.B' was "avant garde" for performing vertebroplasty with ADR... I'm sure eventually it's something that will bear out in terms of studies and eventually be performed here as well, and then it will be standard of practice in the community when "our" surgeons utilize it to help shore up against subsidence...
Anyway, it seemed the surgical opinion verbage I received at mention of his name and the fact he had viewed my films was by Dr.Bradford, reverence/great respect for his opinion, by Dr.Bae, "we can do this surgery for you as well", and from my OSS.. "don't go Europe and WC won't pay!"... and from my PM "we've got just as good surgeons if not better here in the US as in Europe"..

Thanks for all suggestions, I'm plugging away now at building my case, meanwhile considering my options, and hoping Pro disc will be FDA approved by the time I even get another BMD done here and that this test result will be improved vs. worsened!!! In fact, that one test may eventually lead me out of the ADR ballpark at all if it's not improving up or staying the same at the very least!
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  #10  
Old 12-19-2005, 07:53 PM
biffnoble biffnoble is offline
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Maria:

Good luck w/bone mass increasing. Eat lots of calcium rich foods over the holidays. Like....................... ice cream!?@?!?@?!?!?
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