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Old 10-08-2004, 08:07 AM   #1
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kaybee HB User
Another surgery vs waiting question

The inconsistencies from one neurosurgeon to the next really have me concerned. In reading some posts, I noticed that some surgeons look at surgery as a last resort while others don't. Some think the condition is inoperable while another surgeon thinks it isn't.

In dh's case (dh is a computer term for 'dear husband'), he had gone through 12 weeks of that extreme radicular pain caused by a large herniation before insisting on surgery. During that 12 weeks, the only treatment he received were two epi's and electrolysis. The neuro suggested PT for 6 more weeks to see if it helped and dh wanted nothing to do with the thought of that much more time passing while in that much pain. As it turned out, because the disk had moved cephalad and pieces were broken off, sticking to the cord, PT couldn't have helped in that situation and neither did the epidurals.

The real kicker here is this - how many people on this board are going through the never-ending pain of epi's, physical therapy, meds, not to mention the huge expense, etc, only to find out that surgery is the only option in some cases? How does one really know?

kaybee

Last edited by kaybee; 10-08-2004 at 08:09 AM.

 
Old 10-08-2004, 10:40 AM   #2
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AlSmith HB User
Re: Another surgery vs waiting question

Kaybee, I can relate to your dh's situation. The first doctor I went to looked at my MRI and EMG results and decided I had a mild bulge at L4,L5 and I could rehab this and surgery was not called for. I actually felt a little better for a couple of months but had a big set back. I decided to get another opinion and went to a neuro (my previous doc was an ortho). He was concerned about my L5,S1 and sent me for another MRI. It turns out I had a far lateral herniation at L5,S1. My L4,L5 was fine. It was so big, he said surgery would help. He never told me you must do this, it was my decision. He did say that surgery was the only way I would get better. I had gone the epidurals route and had my shot in the L4,L5 so it was even in the wrong place!

My point is one doc may think the problems is one thing while another may see it differently. He may also not feel comfortable with the type of surgery needed. He may just be stupid. Trust me, there are some dumb docs out there. I hope your husband gets to feeling better soon. Are they recommending surgery for him now?

Alan

 
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Old 10-08-2004, 10:52 AM   #3
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tjwilli HB User
Re: Another surgery vs waiting question

kaybee,
I was down that road 10 years ago. 9 months of PT, Meds, epi's, and none of them were of any help. I wish I would have been like your husband and have the surgery much sooner. I did finally have the surgery, and have felt much better since. I am not 100% sure surgery is for everyone, but like your husband I was in severe pain 24/7, and the surgery was the answer for me.
I did however have an excellent young 31 year old neurosurgen who left the time to decide for surgery up to me, once we exhausted all other means.

I keep reading of many people on this bulletin board who are suffering with back pain and trying to decide if surgery is for them. I have felt that dam back pain, and really feel for many of you. I have been there done that. I wish the best for everyone, and can vouch that 10 years after surgery my back is still doing fine. I have flare ups once and a while, but those are a walk in the park from what it was like before surgery.

tjwilli

 
Old 10-08-2004, 11:22 AM   #4
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kaybee HB User
Re: Another surgery vs waiting question

That sure is encouraging, TJWilli. On a bit of a side note, the ortho knew that dh's condition probably wouldn't respond to physical therapy so at least he didn't have to try to endure that process. After the epidurals failed (dh refused a third injection) and the electrolysis hurt more than helped, the ortho sent him straight to the neurologist and his microdiscectomy was scheduled immediately. That was late July.

Alan, right now dh needs a cervical fusion but because he's having so much pain with his lower back - I guess there is still a bulge on the opposite side of where the herniation was - he has to go through six weeks of facet injections and physical therapy before they'll consider it. If the traditional approach doesn't work, then we're looking at a lower lumbar fusion but only if another MRI doesn't show re-herniation or new herniations in the area above and below the surgical site. All this is not taking into account all the other problems he's having with foraminal stenosis, advanced DDD, osteophytes, compressions and bulges. Neither did Social Security for that matter. Just claimed he's having minor lower back discomfort. That's another story...

Do you honestly think in your experiences that dh will ever be pain free? He also needs a total knee replacement and the other 'good' knee is headed in the same direction. None of this helps his back.

Last edited by kaybee; 10-08-2004 at 11:27 AM.

 
Old 10-08-2004, 11:52 AM   #5
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mel1977 HB User
Re: Another surgery vs waiting question

Some drs jump to surgery, others are more reserved. I don't know why, and I am sure we never will. I agree with you. It is like before, when I first had my bulge at L5-S1, I had the epideral, then was sent to ortho surgeon after the injection didn't work. I had no obvious nerve involvment, wasn't given any other tests. He said I could have the micro or live with pain. I opted not to live with pain. Now, this dr was well known, worked for the University of Missouri Hospital and Clinics. A teaching hospital that revolved around sports. My husband thinks to him, this dr was so used to this stuff it isn't a huge deal. Now, this time around, I have more problems. Bulge in neck w/spondylothesis, bulge at L4-5, L5-S1, DDD at both sites, a spur and tear. And this time, I have been to two drs (one ortho, a neurosurgeon and neurologist), I have had the injections, PT, EMG, nerve conduction test, and am waiting to have a discogram. I get frustrated b/c of how much stuff I have to do this time around. So, I too wondered why one dr went surgery first, and the other is pushing it off. I like both drs, this one (neurosurgeon) works for a spine center, not in a hospital. My husband believes it is just the mentality of drs, that they look at surgeries differently. Plus, here in Nevada, law suits are much more common, so the drs may feel the need to literally exhaust everything before looking to surgery.
So, does any of this make sense???

Last edited by mel1977; 10-08-2004 at 11:53 AM. Reason: add a word

 
Old 10-08-2004, 12:06 PM   #6
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AlSmith HB User
Re: Another surgery vs waiting question

Kaybee, you asked if hour husband will ever be pain free. I would say no, but, he can have improvement. I don't think I will ever be pain free but I feel so much better. My mother has 2 knee replacements. They have been a blessing for her. She had it done 10 years ago and they have made huge advancements since then. I wish you both the best and hope your dh gets started on the road to feeling better soon.

Alan

 
Old 10-08-2004, 12:58 PM   #7
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Mistina HB User
Re: Another surgery vs waiting question

I have been going through this for THREE years or more and have spent tons of money. I knew from the very beginning that a fusion was needed, really. I tried everything imaginable and nothing helped. Last summer I had a discectomy/laminectomy and medial facetectomy and I had a terrible feeling this wasn't going to help, but I did have high hopes. With research, I just knew my problems were deeper than that. I knew I had bone pain and my facets were grinding on each other because of the disc space being so 'thin'. I had tons of spurring that was trapping my nerves too at this level in which has grown back. My disc is collapsed to the point that the bones just keep rubbing and rubbing on nerves, etc. It's a vicious cycle. It took several doctos to listen and finally I got somewhere, slowly. I am having a fusion at this level because this is the only thing that will help me with the painful motion of the joints and so forth. I am VERY discouraged about all the money that I have forked out because the doctors like to try all that CRAP first. I know it works for some and that's great but for us that it doesn't, it really sucks! I'm still of course paying for the past treatments that haven't worked and will have yet more bills to come for this fusion. I'm annoyed by the fact that I knew and noone listened but I guess there is no way of telling that. The doctors do like to do the less extreme first and I don't think there is any way around that. Fusion is pretty much a last resort I guess you could say.
I'll get over the bills if this fusion ends my pain and immobility. I wish you luck, this is a hard question to answer.

Christina

 
Old 10-08-2004, 01:16 PM   #8
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lfoster21 HB User
Wink Re: Another surgery vs waiting question

Kaybee, recently I had surgery so I will give you my thoughts Originally, I did the P/T, the epi. and meds. I agree with trying everything before surgery, just because surgery is so invasive and has it's pro's and con's. I didn't expect P/T to help and I really wasn't comfortable with a needle in my back, but I do understand how Drs. and insurance co. reccommend the least invassive procedures first. After 2 full weeks of P/T (and actually doing what I was suppose to do) I told my Ortho. that I was getting worse and we stopped it. When the first 2 rounds of EPI only last 4-6 weeks, we ended that and I was given the option for surgery or to live with just meds and pain. I decided on surgery since I couldn't stand, sit or walk for more that 20 min. and I couldn't lift more that 3 lbs. So, I appreciate the fact that we 1st tried the other methods before surgery and was prepared and ready for surgery after everything else was tried. This is how I knew surgery was right. I hope this is helpful and I will keep you DH and your family in my prayers.
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Old 10-08-2004, 09:54 PM   #9
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injured betty HB User
Re: Another surgery vs waiting question

Mel: The answer would be, insurance, liabiltiy, and accountability in this litigious society.

Surgery is the most radical and last resort. They have to try everything else first for the purpose of justification.

 
Old 10-09-2004, 10:51 PM   #10
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injured betty HB User
Re: Another surgery vs waiting question

[QUOTE=kaybee]The inconsistencies from one neurosurgeon to the next really have me concerned. In reading some posts, I noticed that some surgeons look at surgery as a last resort while others don't. Some think the condition is inoperable while another surgeon thinks it isn't.

In dh's case (dh is a computer term for 'dear husband'), he had gone through 12 weeks of that extreme radicular pain caused by a large herniation before insisting on surgery. During that 12 weeks, the only treatment he received were two epi's and electrolysis. The neuro suggested PT for 6 more weeks to see if it helped and dh wanted nothing to do with the thought of that much more time passing while in that much pain. As it turned out, because the disk had moved cephalad and pieces were broken off, sticking to the cord, PT couldn't have helped in that situation and neither did the epidurals.

The real kicker here is this - how many people on this board are going through the never-ending pain of epi's, physical therapy, meds, not to mention the huge expense, etc, only to find out that surgery is the only option in some cases? How does one really know?

kaybee[/QUOTE]

You can't ever really know because the back is a strange animal. It may be out in one place but causing pain in another. Then there is the problem of money. I have always tried to figure out, do they suggest surgery more quickly if you have money or if you have good insurance? Is the decision dependent on whether or not the doc can make him high premiums this year? There are so many variables. I think that one thing is for certain, if you are having problems, such as loss of bodily functions, they try to take you into surgery ASAP. But, if there isn't that, no one ever died from pain so they have to figure out how to justify any decision they make to an insurance company.

I really believe that doctors, like lawyers, started out with the best of intentions, early on in their careers, but unless they are independently wealthy, they make a lot of their decisons based on money. Cynical, I know, but that is our experience, in our family.

My grandmother just broke her hip. Very healthy at age 100. She needed a hip replacement. But, because she is old, her insurance robbed her of that opportunity and just set it and put a pin in. (She was up and walking that day.) She has really good insurance. I guess that they thought, by looking at her age, not her, that she is not worth the output of money for the hip.

choose your doctors carefully and educate yourself as much as you can before agreeing to anything or settling for anything less that what you want.

 
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