Recommendation(s)?

[JJames]

Thank you again, Gene.

I'm considering returning to my previous surgeon - Dr. Yue, now that I haven't smoked in over two years. That was a portion of my parting conversation with him since I still smoked at that time.

I don't see his name much on these boards - good or poor opinions. By any chance does anyone have any information one way or the other in regards to him?

I at least have some history, several previous tests & imaging, and his office(s) are only a little over an hour to get to.

Thanks again - Jeff

[JJames]

Okay, so I have an appointment with Dr. Yue (Yale, New Haven, CT) this Thursday, 02/20/2014. As stated earlier in this post, and I believe in one other recently, due to my impending loss of employment & medical insurance after September, my intention is to accept whatever surgical option is suggested ASAP which will be acceptable to my current insurance provider (BCBS). I feel that a bi-level ADR will be immediately refused, as it was when I tried years ago to get that covered with Dr. Yue. I am hopeful that a Hybrid may be covered - L4/L5 ProDisc ADR & ALIF for L5/S1.

As the days approach towards this appointment, my anxiety level is rapidly increasing. Naturally, a major surgery should create some anxiety and fear. Worse though, are my feelings that I am not thinking everything through clearly.

I have been able to survive all this time without surgery, but only due to an understanding employer (due to my 25+ years of dedicated service) and medication. My quality of life sucks, but there is little guarantee that any surgery is going to change that. It is quite possible that surgery could make things worse. I've been backed into a corner in which I don't think I have any choice but to roll the dice. I'm quite angry about that fact, but need to think ahead as to what future employment options would be in my current condition without a surgically corrected back and no meds. I honestly wouldn't even hire me.

My secondary concern is that I have made the decision to return to Dr. Yue. I know an appointment is just a consultation, and doesn't mean that I have to pursue anything further if I have doubts. I'm curious as to why when I was first directed to Dr. Yue (by my Ortho surgeon) back in 2008 or so, he seemed to be one of the most highly regarded ADR surgeons around, and since then I hardly ever see his name on these boards or anywhere else. Unsurprisingly, the many various "patient-review" sites on the Internet contain mostly the comments of the disgruntled, and must be taken at face value - most of those I've found pertaining to Dr. Yue are complaints about his office staff. I don't really care if the receptionist is super nice to me or not as the purpose of my visit is to see the surgeon! I'm not certain how much weight to give to this feeling like there may be something I'm missing, but should be aware of.

Lastly, I suppose it is mostly due to the fact that after failing in my initial appeals to get a bi-level ADR approved years ago, I haven't given a whole lot of thought about the recovery process for whatever surgical option may be taken. I've been reading and re-reading the post-op threads with a different viewpoint lately, and it truly scares the **** out of me! I was already overweight when I quit smoking back in January 2012, and gained more weight after quitting. Now I'm meeting with failure at all (continuing) attempts to lose it. I am fully aware that this is not only bad for my general health, but bad for me as a surgical candidate, bad for my speed of recovery, bad for my future back health, etc, etc.

Ugh, and then there are the legal issues which I must at least consult with a lawyer about in regards to exactly what may occur in regards to my severance package if I am still recovering from surgery, possibly on FMLA, when that date arrives!

Sorry for the rant. I guess I just needed a "sounding board" today. I feel like no one - spouse, family, etc - can really understand all of these feelings and issues. That's not to say they don't care, just that only those here really know what it is like to have a chronic, painful condition takes over at least a part of every thought, activity, and portion of your life....

Thank you all again ...

[JJames]

Since visiting with Dr. Yue last February 20, 2014 I was required by my medical insurance provider to once more go for several weeks of Physical Therapy before a new MRI would be allowed. Although I didn't honestly expect yet another round of PT at a different facility to "cure" my problems, I sure did my best once more - trying to do all of the stretches and excersises provided at home between appointments. No surprises - this didn't relieve any pain, and actually may have been detrimental in that now being 3 weeks removed from my last appointment I can barely exist without greatly increased pain in my lower-right back, right hip, and right leg.

My additional concern is my new MRI, which I was at least able to finally get done on March 20th. I must wait to go over these results with Dr. Yue, but in reviewing the imaging and the printed report, even after all these years nothing looks or sounds like I should be living in so much pain! This has always bothered me. I have no medical background, and feel that I am more ignorant than most on these boards and in the general public.

Has anyone else with LBP bad enough to go through surgery had an MRI report which "seems" (to me) to state that nothing too serious is wrong?

MRI LUMBAR SPINE WITH AND WITHOUT CONTRAST
Comparisons: MRI lumbar spine 12/28/06
Findings:
There is no MRI evidence for vertebral body fracture. There is no subluxation.
L1-L2: There is no significant neural foraminal or canal compromise.
L2-L3: There is no significant neural foraminal or canal compromise.
L3-L4: There is a mild disc bulge and facet arthropathy with mild bilateral neural foraminal narrowing, greater on the left.
L4-L5: There is a left laminectomy. There is minimal enhancement within the postoperative bed, compatible with mild granulation tissue. There is facet arthropathy and mild bilateral neural foraminal narrowing. There is no evidence for recurrent disc.
L5-S1: There is mild disc bulge but without significant neural foraminal or canal compromise.
There is no MRI evidence for spinal canal stenosis. The conus is at L1 and appears within normal limits.
Impression:
Postoperative changes L4-5, without evidence for disc recurrence
Mild discogenic degenerative change at L3-4 and L4-5

In reading the word "mild" everywhere, I can't help but wonder if I should really be considering such an invasive surgical option for this pain! I'm not truly asking for medical opinions here - I understand that I will need to discuss this with Dr. Yue - but does any of this mean anything to anyone?

Ugh!

[jss]

Jeff,

We've seen images here, that even to our untrained eyes, looked terrible; except the poster was having only "mild" symptoms. We've then seen images posted that didn't look bad at all; but the poster was in debilitating pain. Everyone is different and perhaps you're one of the unlucky ones that needs only a "mild" pathology to cause incapacitating symptoms?

Your history shows two positive discograms. Does Dr Yue believe the two level surgery will address your pain generators?

Good luck, Jeff

[pittpete]

One thing people forget to mention is MRI's are taken lying down.
When you stand or sit especially if someone is overweight the load on your spine is increased.

[JJames]

Jeff,
Much earlier in my painful journey, it was Dr. Yue who had ordered the discogram which resulted in the determination that the 2 discs were torn and were concordant pain generators (L4-L5 & L5-S1). He strongly felt that ADR was the proper treatment back then, but my medical insurance won on that front and denied it. Now that I have quit smoking (January 2012), and remained a non-smoker still, I am thinking that if bi-level ADR is once again shot down, I may at least have the option of the hybrid surgery.

pittpete,
I actually had a "sitting" MRI once as I'd discussed that very issue with Dr. Yue. Unfortunately, it didn't show anything more conclusive than a typical MRI in my case.

I most certainly realize I am putting the cart before the horse in a way here - I need to see what Dr. Yue says. I am just somewhat of a pessimist I suppose - he is a surgeon, and will almost certainly suggest a surgical fix. Even surviving in so much pain, I can't stand the ambiguity of test results like these! I'd prefer a more straight-line, clearly identified problem with a standard solution, even if the problem and solution were not "pleasant". Test results which read like these do make me feel like the pain is all in my mind - like I have some sort of mental disorder causing this miserable agony . I'm sorry if I'm not making much sense. Way too much going on in my mixed up, roller-coaster life these days!

Thanks again for your replies. The people here are quite an incredible bunch, even if the reasons we've all come together isn't very pleasant.

Jeff

[drewrad]

For what its worth, as short as a few days ago, a member here who just had overseas surgery told of a radiologist arguing with his surgeon saying surgery wasn't necessary. Meanwhile, the surgeon pointed at his patient lying on the floor. *ahem* Lying. On. The. Floor.

Point is, MRIs while not entirely meaningless, are not very meaningful when it comes to VAS scores. And there's also an argument that VAS scores are meaningless since they are subjective and arbitrary. And we all have good days and crummy ones.

So... the best way to look at it is this way. Functionality. What can you do and what can't you do? Can you sit for long periods of time? Can you drive a car? Can you stand? Can you lay down? How long can you lay down before pain starts to impede?

Functionality is the only real way to determine whether or not you need surgery. Not VAS scoring. Not MRIs. Not even pain necessarily since it drifts in and out, but function. How is your function limited by pain? What are the actual constraints placed upon your life at this point?

Me? I never sit down, ever. I have other people drive me around. I don't go out to a restaurant. I don't carry heavy things. Not even moderately heavy things. I don't go to movies(because I have to sit).

So... then I have to ask, how much is sitting to me worth??? Is it worth the money and risk of surgery? Just to sit? At least eventually? I can live a life without sitting no problem, but what if it advances to another level and I can no longer stand either?

[Jerry5]

JJames,

First, this is NOT in your head.

(lose track, I lose track of the threads, I do not come here every day, sorry, thought this was another one, but here is my take)

I have pulled many a muscle in my back and other areas, and when you damage a disc and this impinges on nerves, or better yet, the nerve root, the pain is no comparison and this can increase and decrease, all times of the day.

I can wake up in the morning, and walk around for awhile, and by the time I get ready for work, drive to work and get my first cup of coffee, I can have tears in my eyes.(the worst of times)

For Me, The ADR is the way to go, Hoping to have this done soon.

The more movement you have, the more you will relieve pressure on the other parts of the spine.

[JJames]

Jerry5 & drewrad,

After all of these years of back pain I "know" that you are both correct. My daily pain and poor quality of life cannot be allowed to go on forever unchallenged. A large part of my frustration is that I feel additional anger and fear about being forced into this corner to get something done while I am still employed and have medical insurance. The future beyond October 3rd - my severance date from my employer - seems to be so rapidly approaching, and will already place me in completely uncharted waters.

Follow-up appointment scheduled with Dr. Yue in about two weeks. For now I guess I just need to wait and see what he has to say ...

Thanks again all - Jeff

[drewrad]

Hang in there, man. I know all about the anger, frustration, sense of betrayal and lonliness. BTW, there is always COBRA extensions post employment up to 18 months I believe, not that that's any consolation to your situation.