Newbie Firefighter

[mslizzy]

Hello, all -

My story is not a tragedy, but still life-effecting. First L5/S1 tear at work 11/08, then 4 months recovery, back to work for 6 months, and a re-tear 11/09. This re-tear is a whole other animal.

I've had great PT, and my core is stronger than ever. Movement for me is pretty good, pain is mostly an undercurrent if I take care of myself and avoid certain movements and activities. If I try to do too much, whether it be driving, sitting upright in a chair, or spend extended time on my feet, pain increases, and is demanding and insistent. Only rest and ice take it away (I hate meds).

I've been 6 months off work, and am at the point they wish me to consider surgery or retirement. I thought I was adamant about not having surgery, because I thought I could get by and manage the pain. I am stubborn. I find myself rethinking that position after finding this forum. And after a tearful weekend mouring the probable loss of my job.

Questions I ponder: How well can I work (anywhere) if I don't have the surgery? Is it too soon - should I wait 'til its really bad and am drugged up? Am I too young, if these things only last 40 years (my family lives to 100)? Might I get back to firefighting if I do get the surgery?

Seems to me I need to have a discogram to make an informed decision. Anyone know a good place to do this in the SF bay area? If someone's gonna make me hurt deliberately, I've got to trust them.

Thanks to you all -

MsLizzy

[Harrison]

Hey MsLizzy,

Sorry you are here, I hope we can help you. There have been many firefighters that have passed through here. You can find them by searching, e.g. "firefighter" or for docs, "San Fransisco."

You ask some tough questions that really address the quality of life issues for all of us patients. If you are properly indicated for surgery, and you have a good, experienced surgeon, you should be able to recover and return to work. But firefighting is tough work! Please do reach out to the other firefighters, EMTs, et al from this community and talk to them -- that's why this community is here!

[CharlesinCharge]

I live in the Bay Area, and there are numerous places you can get a discogram from a good doctor/spine specialist. I absolutely agree that the next step for you is a discogram, because you would not want to have surgery without doing that step first. A few possible places to contact:

1) Richard Derby (Daly City, 650-755-0733) - Runs Spinal Diagnostics, and is one of the top Pain Management doctors on the west coast.

2) Adrian Bartoli (SF, 415-509-6123) - Runs the San Francisco Pain Management Center, is my personal Pain Management doctor. He is an excellent doctor and a great diagnostician.

3) Hoyman Hong (SF, 415-353-6464) - With the San Francisco Spine Center, he performed my second discogram.

4) Peter Weber (SF, 415-885-8628) - Neurological Surgeon, he can examine you and refer you to someone for a discogram (which is what he did for my first discogram, which I had with Dr. Connor O'Neil).

You can also do a google search for "spine specialists Bay Area" and get these and many other names. In my opinion it is unlikely you can return to your career without surgery if your disc is indeed torn and degeneraged, but you would not want to make the decision to have surgery without consulting with a least 2 spine specialists and having a discogram.

Good luck,

[mslizzy]

Thank you so much for your information and responses. Everyone I have come in contact with so far - doc, physical therapist, surgeon (at 3 months from date of injury), co-workers- has encouraged me not to have the surgery, as I still have some decent quality of life with movement modification. It makes the decision harder for me. If I was continually narc-ed up, the decision would be relatively easy. I'm a glass half full, optimistic kind of girl, so of course I assume the best.

You're right of course that firefighting, no matter what, is a crappy way to treat a back, ADR or no.

But boy, having a more normal, pain reduced life is sure tempting. I actually crave being able to go for a run again. Who would have thought?...

My Occ Health doc has requested another consult for me, but with a surgeon (I believe he specified ortho, but I don't think the ins comany for the city will care). He wants the consult first and discogram only if the surgeon requests it, mostly to save me pain. I have a high tolerance, so I am not afraid of that, albeit not looking forward to it.

The names for SF are great. Thank you for that.

I received the video yesterday, so will watch that with my husband and daughter today. They are protective, and don't want me to have the surgery, even though I will have their full support no matter what. (My husband is changing from a job he loves to a new one to ensure that we have family healthcare, as we had it through my work. Trooper.)

A good weekend to you all, especially you military families out there.

Mslizzy

[msf]

Hi Mslizzy,

Your situation sounds-unfortunately- all too familiar. I also live in the Bay Area and have been making the rounds from surgeon to surgeon to find a good solution for my 2 level DDD. Like you I still have a pretty good quality of life. I got very close to getting surgery with my last bad episode and actually tried to get a 2 level ADR approved (unsuccessfully of course). I am currently having one of those fantastic "almost pain free" periods and I accredit this to my PT who did a video slow motion analysis of my walking, bending and lifting technique and isolated a bunch of bad bio-mechanical problems. He took a high speed video camera and filmed me while doing the activities. He then designed a new set of exercises that target mostly my lateral obliques and gluteus muscles. It actually seems to work for me. I have not had a bad flare up in weeks. Like you, I had been working on getting my core super strong for the last few years. I do think that I was working on the wrong set of muscles that were not addressing my mechanical problems. If you want to chat with my PT, here is his info:

Bob Baker, PT. Emeryville Sports and Physical Therapy. Tel: 510-653-5151

There was an interesting NYT article about doing the wrong core exercises recently:

http://well.blogs.nytimes.com/2009/06/17/core-myths/

For your discogram, I would also recommend Michael Park, MD in Oakland (not sure where you live). He's been doing all my injections and he is fantastic. Charles has already listed the best pain docs in the City as well as on the Peninsula.

Good Luck with everything!

MS

[mslizzy]

Thanks, MS, for the support and info. It is amazing what a difference it makes just to hear other's stories. Thank goodness for this forum and all those that participate (and yes, you, Harrison for starting this!).

My best new move is tightening my glutes BEFORE any bending, leaning, or squatting. It really buys me time and saves my back from otherwise nearly instantaneous complaint. I figured this one out for myself. I will definitely check out the NYT article. Your PT guy sounds great - very innovative.

I believe my first serious surgeon consult will be with Kenneth Light in SF. I am relieved to know of some good discogram folks. Thanks MS and Charles!

I am 6.5 months in on my worker's comp, so I feel a bit of pressure to figure out what to do, so all info is good for me. I need to know if I even am a candidate for ADR, and if I put myself at risk for greater complications or exclusion by waiting (from a leaking disk, scar tissue, chronic inflammation etc.).

It's amazing how life can change in an instant.

Thanks again to the masses. I read a lot of what is going on, but as I am new, my contributions are few due to lack of knowledge on the subject.

G'night

MsLizzy

[mslizzy]

Hey, I just read the article and I am proud to say that those exercises are a foundation of my pt workout. Very cool! Honestly, my core has never been stronger - even more than when I was doing P90X.

MsL

[mslizzy]

Well, I am beginning to get the feel for how things go. You ask, you wait, you are denied, and then you pick yourself up and try it all over again. Ins. co. for the city I work for denied my request to see an experienced surgeon to get his opinion. They will, however, let me see the one I have already seen that has virtually no experience with ADR (although I do believe he uses the pro-Disc, when doing the surgery).

I do believe it took the wind out of my sails. But, I've decided for now at least, no b**ching. The call is into the lawyer.

mslizzy

[CharlesinCharge]

MsLizzy,

Now you know why so many of us have ended up going overseas to have ADR surgery. Yes, they have been doing it in Europe longer than here, but there are still some great surgeons in the U.S. I would have gladly had Dr. Light or one of the other experienced spine surgeons in the Bay Area do my surgery, but Blue Cross refused to pay for it and I lost my appeal. It cost me $30,000 to have the surgery in Germany, vs about $100,000 here in the U.S. at that time. There are exceptions, but most insurance companies here still regard ADR as "experimental" and use that as a basis to refuse coverage. You have to get a fusion or pay out of pocket for your ADR surgery, and overseas is MUCH less expensive most of the time. This is slowly changing, but I still hear stories of people being denied ADR by their insurance company every day.

[mslizzy]

Charles,

Those price differences are crazy and criminal. I wonder how, as our healthcare system evolves, it will deal with innovation vs. known, proven vs. unproven technologies. We like to think of ourselves as leaders in all things, but sometimes we just don't get it..or see the ramifications. There are so many people on this site WITH INSURANCE that are struggling to get help and approval. I can only imagine how many more are out there.
And all of them just want to live normal, healthy lives.

Thanks for sharing your insights.

MsL

P.S. Lawyer sent a letter to the ins. co for the city stating why I am requesting an experienced surgeon's opinion, and also seeking specific doctors for the medical retirement eval. Didn't think I will be dealing with this simultaneously, but that's the way it is.
medical eval papers for disabil