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Old 03-04-2009, 04:56 PM
Rein Rein is offline
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Default Fact vs. Conjecture

I’ve taken this to a new thread, as it really doesn’t bear on the subject of the thread where it originated

(http://www.adrsupport.org/forums/sho...7&postcount=27) (The Big File - Germany prices negotiable?)

In my search to ferret out factual information, I’m keenly aware of the differences between facts, firsthand accounts, secondhand reportage, conjecture and opinions. When I see something posted and it either doesn’t make sense or seems somehow not to agree with other posts, I ask myself whether it is factual information or something else. If I’m not sure, I do what I can to determine the truth.

In the above-quoted thread various claims were made about Stenum Hospital, the surgeons who practice there, the costs involved in surgeries, whether Stenum is a nonprofit organization, whether Stenum surgeons travel to other countries to do ADR, whether the Stenum surgeons have done more ADR procedures than any other surgeons, whether Stenum surgeries have resulted in complications and whether Dr. Rudolph Bertagnoli’s (Dr. B) ADR surgeries (at St. Elizabeth’s Hospital and other locations) have resulted in complications.

I have researched the Stenum Hospital website (http://stenumhospital.com) thoroughly and also looked at Dr. Bertagnoli’s website (http://www.dr-bertagnoli.com). Together with firsthand reports from patients in the above-quoted thread and elsewhere on this board, and have come to the following conclusions:

-The surgeons who practice at Stenum have extensive experience, with as many as 2000 ADR procedures to the credit of the primary surgeon.
-Full costs for ADR are clearly posted and are not negotiable.
-Stenum is not nonprofit.
-Stenum representatives travel to the US to freely analyze and dispense reviews of medical histories.
-Stenum does not perform ADR in the US.
-Stenum does have a history of bad disc placements and serious complications arising from ADR surgeries in the past.
-Some patients after 2006 have reported successful, complication-free procedures.

-At least one of Dr. Bertagnoli’s patients reported a bad outcome on this board.
-Dr. B performed over 3000 ADR placements by December 2008
-Dr. B is the most experienced ADR surgeon in the world and has never had an infection complication.
-Dr. B is the only ADR surgeon who has peer-reviewed analysis of the results of his work.

If you have a question about a particular surgeon or facility, your best option is go first to the appropriate website and read, read, read. It’s very easy to compare by having both sites up on your browser at the same time, to see the differences between two surgeons, for instance. If you have questions about specific discs, you can see at Stenum they have very limited prostheses available, where Dr. B has pretty much every one currently available (although it’s obvious Dr. B has his preferences, based on his own experience).

Once you’ve seen what the various surgeons and facilities have to say about themselves, then is the time to ask questions of those who have had actual procedures done, to see what their firsthand reports reveal. Being able to actually question someone who has just left a hospital is priceless, in terms of their experience surgically and how well-run a facility is and what the level of care is. Be aware, though, that firsthand reports within the critical 0-24 month period can vary widely and what seems like a bad outcome at first may eventually resolve itself. Just as easily, the converse may occur.

Another related topic I’d like to comment on here is the apparent surgical capability that can be ascribed to any one surgeon based solely on availability (over the phone, email, in person, etc.). I have to admit here myself, at first I too was awed by the fact that a world-reknowned surgeon (not Dr. B) would actually call me on the phone personally to go over various facts of my case (I posted this a while back). I had succumbed, apparently, to the same sort of star-quality mesmerizing that I always blame my wife for when she gets anywhere near any actor whose name has ever been in the limelight. Well, as it turned out, this surgeon later showed his true colors when he forced me to drive 6 hours round-trip, only to look at films in my presence that he’d already seen and had had for months, to tell me he wouldn’t operate on me. His sole motivation was that bookable hourly fee from my insurance company (for an 8-minute visit!). I relate this story to warn those who are easily impressed by a surgeon who will return phone calls or emails or actually show up in person for a 30-minute consulation. Orthopedic surgeons are the single most highest-paid medical specialty in the world and a little time spent schmoozing and recruiting pays huge dividends, especially if the trip can be written off and coincides with a medical conference. Plenty of post-surgical reports tell of wonderful bedside manner, etc., but I have to say, if it comes down to training, experience, knowledge, surgical capability and competent care vs. wonderful demeanor and touchy-feely bedside manner and availability of communication, I’ll take a precise diagnosis and trouble-free surgery any day. If I get touchy-feely too, fine and dandy!

The bottom line, and what I’d like impart to anyone who reads this is; trust information that is documented. I implore you, if you ask a question and don’t get a clear, reasonable answer (or any answer), if you don’t get qualified references, links to research, etc., then assume what was said was opinion, not fact-based research or firsthand knowledge. Repetition of opinion doesn’t make it fact, only boring repetition...

The brutal truth is, if you want to trust your physical well-being to someone who freely offers their opinions, you might as well toss a coin. If you instead rely on your own time, well spent on your own research, you’ll be a much better informed individual with a much better grasp of your condition and prospects for the future. Only then will well-meaning opinions be valuable to you in your new, learned perspective.

If opinions and advice are free, most of the time you get what you pay for.
__________________
03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
  #2  
Old 03-04-2009, 08:26 PM
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trkdoc714 trkdoc714 is offline
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Very well put! There have been times when I was hesitant to post my opinions about certain surgeons since it precipitated several PMs, emails and phone calls. Aside from the supportive past patients, a lot of the responses were rehashing second and third hand information. Most of them had nearly impossible circumstances stated as fact.

Thank you Rein,

Bob

While searching for information I had come across two different people that had pretty bad outcomes from Dr. B. Of course these may or may not be firsthand even though they claimed it was so. Also, if you read of the problems people are having post lumbar ADR, you'll notice a greater percentage are patients of Dr. B or Synthes product recipients.

Bob
__________________
04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum

Last edited by trkdoc714; 03-04-2009 at 08:36 PM. Reason: additional info
  #3  
Old 03-05-2009, 03:29 PM
chasswen chasswen is offline
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well said rein. and i know which doctor you are speaking of without being told. LOL
chuck
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
  #4  
Old 03-05-2009, 03:48 PM
rhatzy rhatzy is offline
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Default !

Rein,

Why do you question my first hand account of my trevails. I went to Stenum because I wanted the disc they were using and I trusted them. I am now 100% recovered after one year and working. I doubt that Dr. B. has not had any problems or people with post operative infections after 3000 ADR procedures. As in my PM to you, You sound awfully condescending to me. I made the toughest desicion in my life and I don't need you to tell me that I made the wrong one. Just admit it, you just, for some reason, don't like Stenum. I see that you have not made a desicion about getting an ADR and so when you do, maybe you can talk. I don't question any one's desicion on where they went to get their ADR. I pray that where ever they go and get it done that they are successful.

Mark
__________________
L4-5 discectomy 1996
L3-4 discectomy 2007
Maverick L3-4, L4-5 January 08 Stenum
Multiple facet blocks and epidurals
L5-S1 annular tear 8-08 lased with ELD
October 08 back to work
  #5  
Old 03-05-2009, 07:31 PM
rhatzy rhatzy is offline
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Default !

Rein,

I want to know how many actual Stenum patients you have talked with and how many Dr. B patients you have talked with? "Some" Stenum patients have had good results since 2006? Who are the ones that haven't had good results? Where do you get this result? Out of 10 in the group that I was in, I personally know 7, including myself, that have had successful outcomes since I keep in touch with all of them. Where do get the info that only one of Dr. B's patient had a bad outcome? Have you talked with all 3000 of his patients? How do you know tgat Stenum is not nonprofit? Just a lot of misrepresentation from you.

Mark
__________________
L4-5 discectomy 1996
L3-4 discectomy 2007
Maverick L3-4, L4-5 January 08 Stenum
Multiple facet blocks and epidurals
L5-S1 annular tear 8-08 lased with ELD
October 08 back to work
  #6  
Old 03-06-2009, 08:18 AM
Rein Rein is offline
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Join Date: Apr 2005
Posts: 265
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In the words of the immortal anti-hero, Homer Simpson, “D’oh!”. Much as it pains me to admit this (after having spent innumerable hours crafting what I had hoped was a well thought out, well researched, well written piece), in rereading my original post (for the umpteenth time) I realize I made some positively unforgivable errors. For this I humbly apologize to the entire membership.

I know I committed those errors because I forgot my own first rule of writing—Never Submit A Piece Before Letting It Rest Overnight (Dummy!). Usually, the following morning, I read a piece one final time with a clear head and one goal in mind—to eliminate every last mistake of spelling, punctuation, grammar and initial over-editing. So, in the interests of clear-headed correctness (yes, I’m an alliteration junky), here goes: There’s a period missing at the end of the first sentence. The sentence about orthopedic surgeons should have read, “...are the single most highly-paid medical specialty...”. A section of the third from the last sentence should have read “...you’ll be a more informed individual...”.

Can the membership ever forgive me?
__________________
03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
  #7  
Old 03-06-2009, 11:28 AM
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CharlesinCharge CharlesinCharge is offline
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Posts: 140
Default Why didn't you answer the questions?

Rein,

Nice sarcasm, but why didn't you answer Mark's questions?? Is it perhaps because you don't have a valid answer? As a successful Stenum patient, I can say that there is no way you can find out all about their track record and other information just from their website and talking to some patients (same with Dr. B.). Considering they have done over 3,000 ADR surgeries (I was told this in a follow-up letter as an ex-patient), I would also like to know where you got your specific statistics and conclusions. Just posting a sarcastic reply that you made a couple of gramatical errors is not an answer, in fact it is perceived as a "dodge" of Mark's questions.

We can forgive you, but you sure lose credibility when you make enormous claims and statements and then can't back them up with your sources.
__________________
Charles B. Fainberg
Back pain suddenly started 9/05, no injury or cause
PT, Chiropractic, Epidural Injections - no help
DDD confirmed via discogram at L4/L5 & L5/S1 (with issues at L3/L4 but no concordant pain) 3/06
Failed SED (Laser Endoscopic surgery) 4/06
2 level ADR (L4-L5 & L5-S1) with Maverick disc at Stenum 8/06
XLIF Fusion (L3/L4) 9/08
  #8  
Old 03-07-2009, 01:59 AM
hezeronek hezeronek is offline
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I think it would be unreasonable to assume that any surgeon, in any practice no matter what their experience, can claim that they have never had any negative outcomes from their surgeries. Nobody is perfect, and there are absolutely NO GUARANTEES when it comes to surgery. Just because a surgeon has had a few negative outcomes does not mean he's a bad surgeon. And it doesn't necessarily mean that all of the bad outcomes were the surgeon's fault to begin with.

That said, surely some surgeons are better than others, and I would be more inclined to trust somebody with more experience, who also has a decent reputation within the medical community. (Which is why I have ultimately decided to have Dr. B do my surgery.)

Seriously, I appreciate the dissonance you are bringing to the forum. I have read about plenty of positive and negative outcomes here, and I think that criticism is healthy. Especially when it comes to our lives and bodies. It serves everyone well to research as much as possible all aspects of what we are going through. And your point about credibility is also a good one. Scientific articles and doctor input is definitely credible, but first hand accounts can also be invaluable when it comes to assessing the human side of the entire experience. I sincerely hope there aren't any "posers" posting misinformation here. Though I get the feeling that if they were and got caught, they'd be booted in a heartbeat.

I would like to add a bit of perspective to this debate, though. People who come to this forum are looking for support, but also for answers. The reality of our situations is that we all don't fit in the same bracket. What is right for one person may not be right for another. When we make our own decisions, we would like to believe they were the right ones for us. Sometimes they are, sometimes they aren't. But that is only really known through the spectacles of 20-20 hindsight.

All of us are doing the best we can with what limited information we have at the moment, all the while while we are mentally clouded from medications and chronic pain. It is absolutely impossible to be fully informed about any procedure or any particular surgeon. The same goes for doctors and surgeons. They are well educated individuals but they don't know everything. They are merely doing the best with what they've got. They will make mistakes and have their biases. That is why they call it medical "practice." A scary concept, yet very real. And, there's no denying that doctors are in it for the money. After all, they do deserve their paychecks too. That doesn't mean that I condone some of the exploits they use to augment their income, just that I believe the concept of "for-profit" vs "non-profit" to be mute when it comes to medical decision making on the patient's part.

Anyhow, I just had to get that out. I understand the anger and frustrations on the parts of those who've had poor outcomes, and those who care about them. I understand the skeptics and the believers. The important thing to remember is that there is no *cure* for those of us with chronic back problems. There are treatments, there are risks and there are choices. But, there is always hope. So long as we don't give up on ourselves, we can find ways to live full lives in spite of what has happened to us.

I'm going to get off my soapbox now.

I am interested in speaking with some of the people you found who had negative outcomes with Dr. B, or at least communicating with them online. Not that it is going to change my decision, but I'd like to know what went wrong. If mistakes were made, I'd like to learn from them. I'll be sure to post Oops-es too...
__________________
MVC 8/07

9/07 - MRI - herniation and moderate DDD L5-S1

10/07 - Lost job, unable to work

12/07 - PT x 2, not much help

2/08 - ESI #1, 2 day relief

3/08 - ESI #2 and LP, no relief, had CSF leak
3/08 - blood patch, sneezed & dislodged needed another

1/09 - MRI shows 10x9x8 left posterior-lateral herniation L5-S1 with nerve impingement, DDD worse

2/09 - ADR scheduled 5/8/09 with Dr. B in Bogen, Germany
  #9  
Old 03-07-2009, 02:06 AM
hezeronek hezeronek is offline
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Quote:
Originally Posted by rhatzy View Post
Rein,

Why do you question my first hand account of my trevails. I went to Stenum because I wanted the disc they were using and I trusted them. I am now 100% recovered after one year and working. I doubt that Dr. B. has not had any problems or people with post operative infections after 3000 ADR procedures. As in my PM to you, You sound awfully condescending to me. I made the toughest desicion in my life and I don't need you to tell me that I made the wrong one. Just admit it, you just, for some reason, don't like Stenum. I see that you have not made a desicion about getting an ADR and so when you do, maybe you can talk. I don't question any one's desicion on where they went to get their ADR. I pray that where ever they go and get it done that they are successful.

Mark
When I read through Dr B's website, they said they hadn't had any "serious" post-op infections. They named some graded classification that I can't remember at the moment. That doesn't necessarily mean that they've never had to treat a patient post-op for one. The statement wasn't very user friendly, but I don't think it was a misrepresentation.
__________________
MVC 8/07

9/07 - MRI - herniation and moderate DDD L5-S1

10/07 - Lost job, unable to work

12/07 - PT x 2, not much help

2/08 - ESI #1, 2 day relief

3/08 - ESI #2 and LP, no relief, had CSF leak
3/08 - blood patch, sneezed & dislodged needed another

1/09 - MRI shows 10x9x8 left posterior-lateral herniation L5-S1 with nerve impingement, DDD worse

2/09 - ADR scheduled 5/8/09 with Dr. B in Bogen, Germany
  #10  
Old 03-07-2009, 07:45 AM
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trkdoc714 trkdoc714 is offline
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Posts: 137
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Rein,

When I first read your post, I thought you were trying to clear the air of the Stenum gossip. It's become clear you only intent is to muddy up the water further. It's a good thing you have great writing skills because you failed horribly at your research.

I've posted some responses to your bullet points. Maybe you should do more (better) research before you disgard past Stenum patients opinions. These are first hand cases. You took your "facts" on Dr. B off of the first page of his site. That's kind of like using Cliff Notes isn't it?

I'd like to see a response to Mark's questions.

-The surgeons who practice at Stenum have extensive experience, with as many as 2000 ADR procedures to the credit of the primary surgeon.

The primary surgeon has done over 2,500 as of 12/08.

-Full costs for ADR are clearly posted and are not negotiable.

Transparency is a good thing.

-Stenum is not nonprofit.

I noticed that Stenum's prices are substantially lower than other clinics. If they make a profit at those prices, does that mean that a higher price at a different clinic would be classified as price gouging?

-Stenum representatives travel to the US to freely analyze and dispense reviews of medical histories.

This practice is convenient for the patient. It also gives the surgeon a chance to give a physical exam (intead of just looking at films) for an accurate diagnosis. They don't charge 250 Euros for this service. It was free.

-Stenum does not perform ADR in the US.

I didn't realise Dr. B was licensed in the US. If so, why would a patient travel to Germany for his services?

-Stenum does have a history of bad disc placements and serious complications arising from ADR surgeries in the past.

Name them. I've "heard" of 2, one of which wrote a book on his near death experience from surgery. It was blamed on Stenum and not the subsequent unnecessary revision surgery in the US 3 months later. The other surgeon in your comparitive has been documented as implanting ADRs in an inverted position because he thought it would provide a better angle. Additionally, read the posts in the forums and pay particular attention to the patients that, post surgically, are having problems. My guess is your count will be a shocker since you display bias against Stenum.

-Some patients after 2006 have reported successful, complication-free procedures.

"Some"? Please reread comment on bias above.

-At least one of Dr. Bertagnoli’s patients reported a bad outcome on this board.

At least one? Please do some real research. Read the painful journeys of some of the ProDisc patients. I'm not saying Dr. B is a bad surgeon but I get the impression his mistakes get glossed over more so than other surgeons.

-Dr. B performed over 3000 ADR placements by December 2008

Good! I wonder though, does this mean it's a race with other surgeons? When is the competition over and what is first prize?

-Dr. B is the most experienced ADR surgeon in the world and has never had an infection complication.

He states on his site he has never had greater than a level 2 infection. You'll have to search his site for that information.

-Dr. B is the only ADR surgeon who has peer-reviewed analysis of the results of his work.

Who are his peers? Are they also heavily invested in Synthes/ ProDisc?

Bob
__________________
04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
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