any advice for a potential ADR newbie?

[patty]

David,
I am also a newbie to this group.
I am a patient of Dr. Mullins. I did not qualify for the study because I also need L4-L5 & L5-S1 replacement( determined via discogram June 2004). I have been through 18 years of back problems.I was treated only by a chiropractor during 16 of those years so the 3 independent weeks during those years that I spent laying on an ice pack, unable to walk, where not documented or investigated with MRI, CAT, just X-ray. Two years ago, I was further injured and chiropractic and PT became useless. My scans most recently show that I have lost 50% of the disk height at both levels with quite a bit of damage to both discs at the levels mentioned above. I am now 5'4" and I was 5'5" six years ago. Don't know exactly when that changed.
Dr. Mullin will not be performing the 2-level replacement for another year because, according to his office staff, "he does not feel comfortable with the data he has seen so far" from the study.
Because of this, I went to Chicago to see Dr. Geisler who has performed 12, 2-level ADR with the Charite. He is willing to do the surgery on me after I have been allergy tested for the metals. Unfortunately, my insurance, BCBS, when questioned by phone said that they would not cover the surgery because it is still considered investigational. They said that the doc would have to convince their approval board that it was medically necessary.
Dr. Geisler said that I needed to be persistant in asking for approval from BCBS, but not how to state my requests. He also incouraged me to NOT spend huge hours creating medical documentation to present to BCBS to convince them to cover this. I am still very confused about how to approach BCBS? Sorry, I am really clueless on this aspect and am quickly trying to figure it out.
After I asked him about going to Europe, the room got considerably "cooler". He discouraged me from attempting this because the insurance would not pay for any subsequent medical procedures related to this surgery.
Has anyone else been told this?

Does any know how a new medical procedure makes its way from "investigation medicine" to the "Gold Standard". Is there a process that is clearly defined?

Patty

Athletic up to 2 years ago.
Now limited to walking - can use steps( slowly ).
Age : 36
Dayton, Ohio

[NCFUSED]

alas, the only way it will be a gold standard, is A) a lot of Time goes by B) J&J drops the price of the device, or C) Someone sues the insurance company and wins a major settlement.....

[David]

Florian:

Danke fur alle die Worten. Sie mussen mir entschuldigen, weil mein Deutsch nicht am besten ist [konnten wir nur Spanisch sprechen? ]

Ich habe mein Deutsch an die Uni gelernet (und dann sechs Wochen im Munchen sein), aber uberhaupt spreche ich nich vieles Deutsch

Und dann muss ich ein bischen Englisch sprechen...
------------------------

I am not against less invasive procedures. I will keep an open mind for my appointment with Dr. Mullin and see what he says.

My basic feeling is that if I am going to have any surgical procedure in an attempt to help my back, why not go the whole way and have disc replacement.

Thanks.

David

[Tammy]

Hi everyone,
My discogram was scheduled for last Tuesday but the doctor decided to cancel it. When the nurse asked if I had been taking the same medications, I said yes. But then I also told her that I had just finished two doses of antibotics and that I had had a steroid shot and a Medrol dose pack since my last appointment. (All prescribed by my primary care physician due to a pretty severe case of bronchitis). Anyway, when the doctor was told he said that he couldn't do the procedure. He said that taking a steroid lowers your body's ability to fight infection. So, my discogram has been rescheduled for May 3rd. Even though I wasn't looking forward to the discogram, I was looking forward to a better diagnosis and treatment. Depending on the diagnosis, we were going to try an IDET or facet joint injections. But, for now, I'm just waiting again. Also, although my insurance approved the discogram, they said they would not approve the IDET. So, has anyone had an IDET? Did it help? Was it covered by insurance? Please let me know. Thanks,
Tammy

[bmills]

David, I don't have leg pain from nerve compression and I have fairly good disc space still. With my research and docotor's recommendation, I don't feel that I'm a good candidate for less invasive procedures like Micro-D or SED.

I chose against IDET so far because I don't think it will be permanent and it will just cause more break down of the disc. Jeff who just went to Zeegers in Munich for his 3 level has good info on IDET and several others here have tried it.

I tried the epidural and facet joint injections.

I also have L5/S1 that is ruptured and protruding. My L4/L5 now has turned up with a tear and leaked on the discogram. Yes discograms suck. Sometimes I wonder if a discogram can atually cause a disc tear.

Anyway, my L5/S1 definitely produced concordant pain during the discogram and leaked. L4/L5 is questionable because it actually did not seem to produce concordant pain.

I'm working with a good doctor here in Colorado. He's not the one that is nearest to my area but I think he is the best in the state even though there are many now doing ADR. I continue to talk to many of his past ADR patients to see how they are doing. The findings are good so far.

I'm also fighting the insurance at the same time. My first level appeal with Cigna was sent in last Friday. They have approved a two level fusion but turned down ADR. Very frustrating.

Getting ready to use an attorney for the 2nd level appeal if that is needed. I'm also going to file an insurance complaint with the Colorado State Insurance dept.

I know of another Cigna member that got their two level ADR approved recently. I don't know if he was with HMO though.

I don't know as much as many members on the forum but I have done a ton of research on the less invasive avenues and talked to doctors and doctor's offices about them. Let me know if I can help.

Also, please keep us posted with how your situation progresses. Hopefully the insurance companies come along very soon. Many of us are waiting in pain.

Sometimes I think they should give us the cash for the fusions they keep wanting to approve and then let us use that to pay for ADR. !!

In some ways I'm almost ready to pursue a fusion in order to improve but I know that will only lead to the breakdown of more levels.

Brady

[nodonutsforme]

Poncho.
Yes, I'm a newbie
I have 4 injured disc levels that are in major need of some help. I am only 36 and completely destroyed my lower back while working as a police officer due to seperate work-related injuries. (L5/S1, L4/L5, L3/L4, L2/L3) Two surgeries later on 2 different levels (discectomy)I now have 4 bad levels as proven by a discogram.
It took me 8 months of fighting with my employer, who is a self-insured city, to finaly accept all four disc levels as work-related injuries and have agreed to pay for ADR (pro-disc) in Europe. The city got thier medical insurance carrier to pay for half the cost of the surgery.
I was also told by doctors that the ADR, as opposed to fusion, would be my best chance of living a normal life again. I have read alot about the different procedures available for lower back injuries and it seems that Pro-disc is the best choice for me. Hopefully I will be having surgery sometime in May at Rudolfinerhaus by Dr Bertagnoli.
Two of my family members will also be going with me to Vienna so I won't get in too much trouble. If there is any information about what to expect at the facility and also lodging recomendations for my family, I would appreciate the help. Hopefully I will be the poster-boy for the only cop working with 4 artificial discs in his back.

[mmglobal]

Wow... great news about getting wc approval for overseas surgery. You are going to the right place for a 4-level. Such a large procedure is a big deal and I hope that your expectations are set at a reasonable level.

Thanks for joining us... I look forward to hearing of your success.

Mark