Bonjour, I am new here, just had ADR in France

[Dutchman working in France]

and I will post my experience in the appropriate forum later, but for now I just wanted to say hi to my fellow backpainsufferers all over the world:
Bonjour! Hang in there!

Signed:
Dutchman working in France

[tmont]

Hi Dutchman,

Welcome--looking forward to hearing about your experience, and I hope you're doing better after your surgery. You certainly sound upbeat at least.

I assume you're a lumbar case? I'm a cervie here in France and have experienced the system as it pertains to cervical ADR; your insights will be a welcome window into the lumbar side of things.

Who did your surgery, and where? An insurance question for you: if you're Dutch, I'm 'pre-assuming' you were able to use your European citizen status to have part or all of the procedure covered; can you confirm? I know quite a few non-French (but European) cervie cases who would be very interested in your experience with coverage as a citizen of the EC.

Take it easy during your recovery and get back to us when you can.

Trace

[Dutchman working in France]

Thanks for the welcome, Trace.

I'm actually in a lot of pain but try to be upbeat nonetheless :-). I have been living with backpain and/or chronic sciatic pain for 20 years already.

Yes, I'm a lumbar spiney, L5/S1 to be exact.

My (medical) history:

In 1987, when I was 26, my back problems started. I did a lot of sports: tennis, badminton, squash, volleyball, etc. Somehow I ruptured my inter vertebral disk at L5/S1 in that year.

Sharp, intense and radiating pain in my left leg whenever I sat down, when I carried heavy things, etc. The pain always started in the left buttock, then radiated into the left posterior thigh, never in the calf, but sometimes also in the left foot. I visited lots of docters and specialists, followed every treatment program known in the Netherlands at that time but nothing helped.

Then one day my left leg suddenly was paralysed. Rushed to the hospital, they opened me up, going in through the back and the surgeon found the L5/S1 intervertebral disk in fragments, all the "gel" leaked out, and the nerve roots heavily inflamed/irritated. He cleaned the disk out, and closed me up. Then a long period of recovery started (but more in a "roller coaster" than "linear" way).
Meanwhile I finished university, found a job, and slowly things got better. Every once in a while I had sciatica pain but it usually went away with bed rest. I worked for ten years and then, in 1997, at 36 years old, the sciatic nerve pain returned in full force, and before long I couldn't sit on a chair anymore, couldn't drive a car anymore, etc. In December 1997 a second back surgery is decided upon: again going in through the back, this time they remove some bone above and below the nerve root to give the nerves more room; the L5/S1 disk is pretty degenerated and thin. This second surgery was a failure and relieved none of my pain. I went elsewhere to get other medical opinions but in the Netherlands at that time, the only remaining option was fusion of L5 to S1 with cages and pedicles. I researched it, didn't like what I found and decided to try to live with the pain.

I quit my job and in 1999 I moved with my partner to France when she got offered a job there. Ever so slowly my back improved; to the point that in 2001 I decided to start working again, for a French IT-company. This also means that I now payed taxes in France, and had my own "Carte Vitale", meaning that I was covered by the French Social Security system.

Unfortunately, the IT company went bankrupt in 2004. In that IT job I had been doing a lot of travelling, and that was slowly degrading my back again. Once unemployed I decided to do
something totally different: selling real-estate, the thought being that I could then work as little or as much as I want, since the real estate agency only pays me a commission on each sale, no salary, so I could work totally independent, where and when I wanted. Went quite well, for a while too. But then in the beginning of this year (2007), we moved house and (stupid, I know) I overdid it it and OUCH: the pain was there again: let's say 9 on a scale of 10. Long story short... after months of trying to avoid it, "a third back surgery" became an option again, since living in this much pain was getting harder and harder. The pain started waking me up at night too...

This was to be my first major experience with the French medical system. You need a referral from your GP, "medecin generale" but you can choose your own "specialist" or surgeon. I asked around and was given the same two names several times. I made appointments with both of them and immediately liked one and disliked the other.

I take a short break here because I just read somewhere that it is illegal in France to comment on medical professionals or even put names and contact details of medical personnel on a public forum.

Does anyone know what's up with that?

[tmont]

Hi Dutchman,

To my knowledge, doctors themselves are not allowed to advertise their services or post their contact info for advertisement purposes in accordance with Articles 13 and 19 of 'La Code de Déontologie Médicale', which state that medicine must not be practiced as a commerce. I'm assuming your French is pretty good; if you like you can take a closer look here:

http://www.vulgaris-medical.com/deontologie.html

However, patients are free to tell of their experiences as they do here. Being in France I'm sure you've seen Forums like 'Doctissimo' and others where patients speak about their experiences and contacts with doctors. I think you can feel free to proceed about your own experience, keeping in mind that 'doctor-bashing' could pose a problem if the indivudual(s) concerned interpret it as outright libel. People here though have been pretty frank at times and I have yet to hear of anyone having a problem (confirmation Harrison?).

So far it sounds like you've been thorough the mill. Where in France are you? Arriving with a bad back after 2 spine surgeries and unable to work, how in the world did you manage health care as a non-French citizen-- and especially meds-- for 2 years during the 'slow improvement' that let you go back to work-- and mess up your back again?

Sounds pretty awful so far. Hope it gets better.

[Dutchman working in France]

Regarding health care when I arrived in France: my partner worked for a French company, therefore she was covered and I was covered as an "ayant-droit" ("person having rights"?) because I was her "conjoint". When you're from within the European Union, you have this right to put your partner on your social security card (and no, it's not necessary to be married).

We live on the Cote d'Azur by the way, and I had my ADR surgery in Nice.

Of course, I wasn't admitted to the OR straightaway. First I had to undergo a MRI, a CT scan, a Bone scintigraphy, a dynamic Xray study, and a discogram study. Result: my L5/S1 disk was completely degenerated, completely black on the MRI, and my nerve root on the left was clearly compressed. So L5/S1 had to be replaced or fused, and also there was an annular tear in my L4/L5 disk, that the discogram showed (ouch!). However, the L4/L5 disk produced a different pain pattern than the one I was suffering from everyday.

After all these tests we discussed the result with the surgeon in Nice, and we agreed to do an ADR on L5/S1 (if at all possible; with fusion only as a last resort) and to leave L4/L5 alone for now (since the discogram required a pretty high volume of injected contrast before generating any pain).

Surgery date was set for June 13, 2007.
Before that I still had to visit to the dentist to do Xrays of my teeth to see if there weren't any hidden infections and to go to the cardiologist to do an electrocardiogram and to make sure that my heart could withstand such major surgery. That all checked out okay.

As I'm writing this I am already 10 days post-op, and I will start a separate topic for that part of my story on the ADR Surgical Outcome forum.

[tmont]

Very interesting . Just wondering, as the US health care system is a mess and people are starting to take a look at other countries' programs: you had a barrage of tests leading up to your surgery, and it sounds like they were imposed on you (or required by the docs, same thing).

How efficent was the scheduling and execution of these exams, and did you have to pay out-of-pocket for anything? If so, were you reimbursed promptly? Were you given a hard time when you presented the prescription for these tests? I AM curious, as there are slight variations in the system from region to region and all this is important info.

Sorry to bombard you, especially as you're recovering, but for once I've got a lumbar spiney in France to bounce questions off of...

[Dutchman working in France]

I am now about two weeks post-op and feeling a lot better, so I'll take the time to answer your questions, as well as I can. And remember: this comes from a Dutch man who has lived for 11 years in France now.

Tests and scheduling them.
All those tests mentioned above were iniated by the surgeon. I had told him about my previous back surgeries and my current problems. He then wanted more "hard" information so he wrote out the prescriptions for a MRI, a CT scan, a Bone scintigraphy, a dynamic Xray study, and some blood tests. He asked me to come back to him when I had all the results. That very same day I called the different places where I would do these tests (I could choose to go anywhere for the tests, but to make it easier for myself I did the MRI scan, the CT scan and the Bone Scintigraphy all in the same hospital (l'Archet in Nice). They all could fit me into their schedule within the next two weeks. For the dynamic X-ray study my surgeon preferred that I would go to a specific place where they did good work: "Dr Juncker radiographie", also in Nice. The blood tests could be done anywhere so I scheduled them for the next week also, right next door to where I live.

Between the last test and the earliest opportunity to see my surgeon again there was a gap of about one week, on account of him being fully booked.

When I saw him again on May the 22nd. He was pretty clear in his diagnosis: my L5/S1 needed ADR (or, as a last resort, a fusion). He wasn't sure about L4/L5, there seemed to be an annular tear visible in the MRI, so to check if that was causing any pain he ordered a discogram for that, while at the same time already setting a date for surgery. The earliest opportunity was June 13, _IF_ I was willing to pay extra for,"private", otherwise it would be later in "public" surgery.

The difference between public and private practice: some days he operates as a private surgeon, and you have to pay 1600 Euro; other days are "public" surgery days, you don't pay anything, but since it is a teaching hospital, it might be an intern, a "student surgeon" who operates on you. I didn't want that, I wanted him, so I chose "private" (also, we have a "top up" insurance which will reimburse us the 1600 euro.) This 1600 Euro would prove to be the biggest out-of-pocket expense by far.

Never was I given "a hard time" when presenting these prescriptions. I had to push a bit to get the discogram done in the time between the 22 May and June 13 dates, since I did not want to postpone the surgery date; but by explaining the situation we managed to get an appointment for the discogram very fast, shoved in between some other discogram appointments. You may have to wait a long time before there is an opening in the schedule of that day, they said, but in the end I only waited for half an hour.