San Francisco - ADR physical therapist and pain management doc?

[CharlesinCharge]

Liz,

You will like Dr. Bartoli---he is an excellent doctor and will really listen to you and hopefully help you out like he did for me. I also had a very slow recovery and was in quite a bit of pain the first 3-4 months post-op. The pain medds that gave me to take home from Germany were not working (and I was not able to take Oxycontin because it make me sick), and Dr. Bartoli was a life saver because he kept giving me different medications until we found one that worked. I had some neck pain prior to my ADR surgery that went away but has come back since a car accident I was in last August, and he is treating me for that as well.

[ZorroSF]

well this is just a tragedy. I've been here in LA for 6 motnhs and it's nearly impossible to find a doctor that takes BC/BS. I finally found one (at cedar sinai) and he along with his collegues have always advocated no ADR for people who have scoliosis (Mild or by birth), and no ADR at L5S1. there simply isn't enough movement at L5S1 and those with scoliosis have high rates of facet degeneration.

Main problem with ADR is that they don't do a 360 ADR and replace the facets with an artificial device. I think there aren't really enough trials to determine the proper candidates for each device.

BTW if you look at flexicore it looks as if it can be taken out easier if needed, however you're looking at a much longer recovery time. something on par of a fusion. Although I would never want that thing in me because it's not anatomically correct and might give way during a car accident. Prodisc is also not anatomically correct, but I don't think there's any issue about it giving way unless it wasn't placed properly.

First I'd like to say that there is only one surgeon at UCSF who had any experience during the prodisc trial and her name was serena hu. or something like that. she too didn't have much experience as of jan 2007. There was one principle doctor and he took off by jan 2007. All the others had no experience or they had put in one charite disc or two, but not more.

I decided to go to St mary's. what a mistake.

What surprises me is Delamarter. I've heard just as many people come out of there in as much pain as you as I have read positive reviews about him. I skipped his advice because he wouldn't accept insurance. he takes cash, then he bills your insurance. good luck with that.

My neck pain stems from the upper traps locking up about a couple of hours after I get out of bed and lasts throughout the day. The only thing that ever worked was xanax and I could tell within 1.5 weeks that my body was getting used to that drug quickly. I decided to take a muscle relaxant (that doesn't do much) and my anti-inflammatory. Only on the days I must travel far, be up late at night for a meeting, or extreme pain do I take xanax.

I've never had migraines pre-op and rarely post-op. I had a cervical MRI post-op in May 2007 and from my perspective 5 levels didn't look good. I was told it was fine and that maybe I was losing water in one of them, but no advice. I always had some pain since 19 when I sprained my neck, but never as bad as post-op. I'm guessing the lack of intrinsic muscles supporting the spine had forced me to compensate to keep my thorasic and head upright causing all the muscles in my neck to sieze up.

with pilates I was able to relieve thorasic pain, but I have never been able to relieve lower back pain or neck pain. Also remember that any pilates instructor has no clue about physical therapy. However if they are willing to work with a PT correctly there can be significant recovery. The best PT is a blend of intrinsic and extrinsic muscle development that works out the muscle imbalances and retrains your muscles to fire and relax correctly.

PT's almost never work intrinsic muscles. they are just now beginning to determine the significance of it and some will incorporate small exercises, but they really don't know what to do. That's where the master pilates instructor comes in. Very few master pilates instructors have dealt with the worst cases coming out of hostpitals, but there are a few. And they can really help you, but you need to make sure they work with your PT to understand what's going on. Otherwise I consider them highly paid quacks.


You said you went to red hawk and saw the owner. Well that guy is the reason there are so many issues at that company. I suggest seeing Gina. She's not perfect, but she gets all the hard cases and make sure you time it with Wayne or Lucia to get proper attention to your exercises. If you can keep that up for half a year, then you can decide whether to go on or not. At the main office downtown they also teach pilates. I can't say I'm thrilled with tha instructor, so keep a close eye on what your body tells you.

Don't hit PT hard until 3-4 months. only do the baby steps and hit the pool everyday to relieve tension in the spine (not swimming, just some water exercises). Lucia teaches a water class at the YMCA downtown. it's good to try it and you might see people in the same condition as you. you can ask them questions if it pertains to your condition.

I never got around to pain management. After being prescribed oxycontin and dilaudid post-op I never wanted to trust another SF doctor again. I got off the drugs cold turkey, but I have never found a good pain reliever much less a doctor that wanted to test what will work. I know there is a pain management center in San Francisco, but I don't remember its name or location. I'm thinking it's on nob hill.

[Terry]

Zorro:

I wrote about this in another section but wanted to make sure you see this posting. It sounds like you need pain management but have had issues with who to go to.

A suggestion might be to see if you can find an addiction medicine specialist to see if they will prescribe Subutex or, Suboxone (off label) for pain management. It is being utilized in clinical trials for pain management and hopefully will get FDA approval for pain management. It does not develop tolerance issues like other opiate medications. It also does not have foggy brain syndrome which is common with the use of Methadone. It also does not have the difficulty with build up in the body which may compromise breathing caused by an accidental overdose. If you are interested in this further, please PM me and I will discuss it with you on the phone.

I am sorry you are struggling. Your story scares the **** out of me as I have scoliosis also and had 4 level ADR in November 06. I do have some facet and SI joint issues but have dealt with it fine with facet and SI joint injections. I just do not want to go back to the extreme chronic pain I was in before my surgery. That is a miserable place to be.

I hope you find some relief.

Terry Newton

[Liz]

charles -- i'm seeing Dr. Bartoli in 2 wks... looking forward to it. I have a lot of sensitivities/allergies to meds so i'm curious what he'll propose. i hope you're recovering OK from the car accident. seems like so many people post-op get into car accidents and i can't imagine what that adds to the recovery.

zorro -- like terry, your story scares the **** out of me, and i hope it prompts others w/scoliosis to really question whether ADR is right for them. when i was researching ADR and scoliosis pre-op there was little info on it. i knew it was a contraindication as noted on the trial exclusions, but when 4 surgeons tell you it should be OK you go w/that. i highly respect my long-time scoliosis surgeon at UCSF, Dr. David Bradford (now retired), whom requested numerous diagnostic tests and referred me to other doctors, PT, etc. The same goes for Dr. Delamarter... highly respected surgeon and i think he has the best staff. very responsive. even though i have an S curve, he thought my spine was in the neutral position at the ADR levels without rotation. only now am i hearing of several cases of failures from scoliosis patients, which makes perfect sense to me. i was having numbness in my right calf for yrs pre-op (which started as burning pain) but eventually resulted in foot drop, and that's one of the reasons i finally decided i needed to have surgery regardless of pending insurance battles. Dr. D is unsure whether i have permanent nerve damage or not. My foot no longer drops and i'm thankful i can stand/walk on it, but my exterior right calf/heel is still numb. however, i'll gladly deal w/that if the back pain lessens.

i hope you can find someone to work w/in LA to help you. Dr. Timothy Davis is the pain management doc in Dr. Delamarter's office and he's supposed to be good. He performed my 2nd discogram when I was trying to be part of a trial he's doing (OP-1). However, you need someone in your network. Maybe he could even recommend another doc in LA for you w/in BC/BS? For me, Dr. Delamarter's office bills my insurance and then I pay them. While he's not in my network, his hospital, imaging center for X-rays, and pathology lab/blood are all in my network. I have United Healthcare, which is horrendous.

i went to grad school at UCLA and went to windsor pilates... they had some decent instructors. as you know, pilates is very pricey unless you can bill it as PT. due to the cost of classes i bought a reformer a few yrs ago and i love it. it's in my bedroom.

thanks for the red hawk recommendation and for all of the other advice from someone whom has been there. i really appreciate it.

take care,
liz