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  #1  
Old 06-03-2014, 12:13 PM
Missmolly's Avatar
Missmolly Missmolly is offline
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Default CONFUSED different Diag from Dr. Clavel and Dr. Bierstedt

Hi there

I have received evaluations from both of these doctors. I attached a copy of my cervical xray but not sure if I did it correctly

Have any of you have completely different treatment plans? Dr. Bierstedt suggested ADR C 5/6 and C6/7. nothing is regards to the higher levels. My neurosurgeon that I have seen here in Canada suggested ADR on C5/6 only but we are only approved for one level in Canada. He didn't have much to say about the upper levels either. Dr. Clavel said I was an "interesting case" not what I wanted to here but I thought the same myself looking at my xray!..I don't really know why my neck is like this..previous accident in early years..who knows. Dr. Clavel said ADR on level C 5/6 and C6/7 where disc degeneration is would not help my pain as he believes the majority is in the upper levels. He suggested fusion from C3-C5 if surgery is needed. Pretty much all my pain is muscle in between the shoulder blades and upper traps. Not too much actual neck pain. I am not sure if he is aware of the type of pain I am in as I have not spoke with him yet. I don't know if my muscle pain comes from disc degeneration or my upper levels. I am going to have a phone consult with both doctors to clarify and I think I will also have a consult with Dr. Zeegers just to get another opinion to confuse myself even more lol....any input would be great..

Kim
Attached Images
File Type: jpg image8.jpg (81.2 KB, 73 views)
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C2-C4 severe facet arthropathy
C2-C3 severe right foraminal narrowing
C5-C6 broadbased uncovertebral osteophytosis with mild facet degeneration
ADR C5-C6 suggested by neurosurgeon with Prodisc C
New MRI C5/6 and now C6/7 progression
March 2015 prodisc C5/6 & C6/7
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  #2  
Old 06-03-2014, 01:52 PM
drewrad drewrad is offline
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Wow. We are in the same boat EXACTLY with Bierstedt and Clavel. Well, almost. Mine's lumbar. Yours is cervical.

I will post my two diametrically opposed emails I received today from both doctors in a separate post and link back to here.

But, first, wow, your image is indeed interesting. Do you have a lateral MRI yet? Cause that could determine the level of herniation which can't be seen here.

But, what I can say in regard to your image is that I lean more towards Clavel in this particular case. By fusing the upper levels Clavel is trying to bring your neck back into alignment which should take the muscle pressure off your upper back from having to compensate all the time. That's just my layman's two cents BTW.

Don't know how bad your bottom level cervical herniations are though.

Sucks to have to make this kind of decision since it is so wildly different.

IMO, Bierstedt is much more straight forward and assembly line in his approach. Clavel is more of a 'creative'(think Don Draper from Mad Men). There does seem to be a retreat from 'M6' everything now, especially in Clavel's case. He is open to various options. Bierstedt is too since I just talked to a guy who had two M6's plus a TOPS over them. And another Bierstedt patient who had a whole trainload of gear installed in his neck and back, including a pair of Triumph discs which I wanted to hear about.

I'll link my responses from the two neuros in question shortly.
__________________
Weightlifter since 12 years old, now mid-40's and figuring out this wasn't such a good idea.

Chronic back pain started in 2010 while shrugging weights that a 40 yr. old shouldn't even try.

MRI in 2012 showing L4/L5, L5/S1 herniations and L2/L3 bulge.

L5/S1 taking on new shape, chronic sciatica, etc.

DEXA bone scan performed 5/7/14 showing mild osteopenia.

Surgery performed July 9th, 2014, Dr Clavel, hybrid three level lumbar.
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  #3  
Old 06-03-2014, 02:27 PM
drewrad drewrad is offline
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MM,

Another thing I forgot to mention, again in my layperson's opinion, is if you go with Clavel and get your upper segments fused, it seems to me you'd want at least one ADR below the fused segments to provide support for the newly fused column, especially if its already degnerated down there.

Does that make sense?

Anyway, its just an impression. I don't have the knowledge to give, but if it were my neck I'd at least ask about it.
__________________
Weightlifter since 12 years old, now mid-40's and figuring out this wasn't such a good idea.

Chronic back pain started in 2010 while shrugging weights that a 40 yr. old shouldn't even try.

MRI in 2012 showing L4/L5, L5/S1 herniations and L2/L3 bulge.

L5/S1 taking on new shape, chronic sciatica, etc.

DEXA bone scan performed 5/7/14 showing mild osteopenia.

Surgery performed July 9th, 2014, Dr Clavel, hybrid three level lumbar.
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  #4  
Old 06-04-2014, 12:07 PM
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Missmolly Missmolly is offline
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Hi there

Wow..we are exactly the same!

Thanks for your imput, it is much appreciated. I agree that something needs to be done with my upper levels. My neurosurgeon in Canada said to leave it but I didn't ask why because I has so many other questions and was overwhelmed at the time. It makes sense to have fused levels above as the facets are very arthritic and adr's below. Dr. clavel did not mention adr's below. I am not sure how my ROM would be and that scares me and I would imagine if C3 and levels below are fused C2 would eventually need to be fused. I am sending Dr. Bierstedt, Malte, lots of questions today. by email and Dr. Clavel's report. Maybe Dr. Bierstedt does not want to do any more surgery then necessary at this point in time. I do know my C5/6 disc is bulging and I have lots of weakness and tingling down the right arm.

I am not sure of the terminology used with your evaluation but it looks like Dr. Clavel wants to do some kind of cage fusion? I assume this is to correct a curve,I also see you have mild osteopenia so they would use a different adr or wait until your test results are better and then use the M6. Dr. Biernstedt would only do the adr and not the cage? These are such hard decisions and it sucks that it is only ourselves that can make it. Either way whatever we decide we have to accept the outcome and be positive because it is what it is.

If you hear anymore news about your treatment plan please let me know and I will also post my followup questions from Dr. Bienstedt. Dr. Clavel wants more tests, if I can get them here then I will follow up with him through Skype.

take care
Kim
__________________
C2-C4 severe facet arthropathy
C2-C3 severe right foraminal narrowing
C5-C6 broadbased uncovertebral osteophytosis with mild facet degeneration
ADR C5-C6 suggested by neurosurgeon with Prodisc C
New MRI C5/6 and now C6/7 progression
March 2015 prodisc C5/6 & C6/7
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  #5  
Old 06-04-2014, 04:33 PM
drewrad drewrad is offline
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I can always talk if you need me to. My wife knows how much I talk to the folks on here over the phone and it does help. You'll get through this.

I go back and forth a lot. Last night I was reading up on pelivic incidence and learned a lot and even said to my wife, "I think Clavel's right" until I read more about how in some cases an L5/S1 fusion can lead to SI joint problems later on, then I went, crap, read about that, and then fell asleep dreaming about two M6s in my low back by Bierstedt.

Then, I wake up and do the research all over again.
__________________
Weightlifter since 12 years old, now mid-40's and figuring out this wasn't such a good idea.

Chronic back pain started in 2010 while shrugging weights that a 40 yr. old shouldn't even try.

MRI in 2012 showing L4/L5, L5/S1 herniations and L2/L3 bulge.

L5/S1 taking on new shape, chronic sciatica, etc.

DEXA bone scan performed 5/7/14 showing mild osteopenia.

Surgery performed July 9th, 2014, Dr Clavel, hybrid three level lumbar.
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  #6  
Old 06-05-2014, 10:29 AM
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Missmolly Missmolly is offline
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Posts: 24
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You made me laugh... sooo true isn't it. One minute one treatment plan makes sense and bam something negative comes up then back to the drawing board. I have been doing the same thing.

I sent Malte a bunch of questions through email yesterday so we shall see how much clearer things will be or not.

Thank you for offering to talk. If I didn't have this forum and someone to talk to I would be lost. Once the answers to my questions come back I will take you up on it.

Cheers
Kim
__________________
C2-C4 severe facet arthropathy
C2-C3 severe right foraminal narrowing
C5-C6 broadbased uncovertebral osteophytosis with mild facet degeneration
ADR C5-C6 suggested by neurosurgeon with Prodisc C
New MRI C5/6 and now C6/7 progression
March 2015 prodisc C5/6 & C6/7
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  #7  
Old 06-05-2014, 11:42 PM
drewrad drewrad is offline
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Posts: 629
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Just keep getting the information. It's hard because these doctors are so busy and you could just schedule a procedure and they'd be happy to get you penciled in, but that's cart before horse. You want answers first. Communication first. You want to know the whys before the whens.

And so each email I fire off to Clavel and Bierstedt, AGAIN, I think I must be driving them nuts but I don't care. This is MY back and MY future and MY life and if I'm a pain in their *** for a little while that's small potatoes compared to a lifetime sentence of a wrong move. And so you have to push and push hard to get your answers, especially if there's a disagreement in each approach. A doc can't just say 'pelvic incidence' and then have you nod your head and go cool, now when can I book an appt.

You want to know what n the hell that means and if you believe the theory behind their magic words.
__________________
Weightlifter since 12 years old, now mid-40's and figuring out this wasn't such a good idea.

Chronic back pain started in 2010 while shrugging weights that a 40 yr. old shouldn't even try.

MRI in 2012 showing L4/L5, L5/S1 herniations and L2/L3 bulge.

L5/S1 taking on new shape, chronic sciatica, etc.

DEXA bone scan performed 5/7/14 showing mild osteopenia.

Surgery performed July 9th, 2014, Dr Clavel, hybrid three level lumbar.
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  #8  
Old 06-25-2014, 02:55 PM
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henry4956 henry4956 is offline
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Join Date: Oct 2013
Posts: 250
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If you are willing to pay between 600-1000 dollars, Dr Zeegers may clear things up for you. No offense to people who go for the 'FREE ANALYSIS', more times than not it's probably accurate. Dr Zeegers actually invests lots of time and digs into details and comparisons. I once told my wife - and I meant it, 'even if I should go with another surgeon - I won't proceed without Zeegers 'Perfect analysis'. It's costly, but worth it imo because you know it's way more than a casual look at a mri. just my opinion
__________________
Bad fall on A$$, Feb 2001 ice hockey
Lami L4/L5 April 2001, L5/S1 Aug 2001
Severe dislocated coccyx (same fall)
Un-diagnosed til 09. (Cannot sit)
Low back pain mild until 2011 - pull started a generator from knees.
rhizotomy Nov 2011 - zilch
Facet joint inj. 18 mo. (no impact)
Can only stand/walk for approx. 30 min
21 hrs/day in bed
L3-5 Activ-Ls (April 2014) Dr Zeegers - walk every day, swim 3 x week. Pain free, no pain meds. Extremely pleased with my decision
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  #9  
Old 06-25-2014, 07:19 PM
NJ Gene NJ Gene is offline
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Posts: 376
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I'm no expert at this, but perhaps a discogram would help to determine where the pain is actually coming from. That would obviously help the decision.

Gene
__________________
Car Accident 2002 - Small Herniated Disc C3/C4
1998 Larger Herniation and Cervical Fusion C3/C4
2005 Herniation C4/C5 - 40 epidural steroid injections from Oct 2005, - Oct, 2007
2008 - Foraminotomy at C6/C7 on left side
Feb, 2010 - Cervical Fusion C4/C5
Dec, 2010 - Lumbar Fusion L3/L5
2013 - Bulge on C5/C6; herniation C6/C7 right side
Mar 26, 2013 - Foraminotomy at C6/C7 on right side
May 5, 2015 - ADR with Dr Blumenthal of TBI for C5/C6 using Mobi-C
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  #10  
Old 06-26-2014, 12:15 AM
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Kelly4ADR Kelly4ADR is offline
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Posts: 259
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I can't imagine two experts giving me two completely different recommendations, that must a an additional element to the whole overwhelming process??? I sent emails to both DRs C and B (you know who they are) to see if they would view my films and now I'm thinking maybe I don't want to? My original thought behind this...while I'm waiting for my appeal/insurance approval, I might as well get more opinions? And then, maybe I should leave well enough alone.

Not trying to hijack your thread Molly. Does it concern you that there are two opinions? How do you sort through that?
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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