Bionicwan

ok.

I have MORE ?'s than answers.

Appt was at 4pm - saw the Dr at 5:45 (I had been UP since 3a and worked all day AND THEN had the drive to Tampa) was not an enjoyable day at all.

Dr finally comes in and apologizes for the wait and asks me not to "kick him."
I told him all was fine & I understood he was having a busy day, however I should kick him for putting me through that Disco from hell with NO sedation - after some more chit chat, here we go.

He begins thumbing through my chart and my anticipation builds, and the BAMM.

NO DISCO REPORT~!!
The Dr that did my disco in MY town NEVER sent the report to him.

So, needless to say I was NOT happy. He was embarassed and all kidding aside I thought my hubby WAS gonna kick him, kick his butt more like it, and hubby verbally let him know he thought this a pile of crapola!

Dr will get results today - he promised... and said with out fail he'd have them AND discuss this with HIS staff and the Dr who did it.

Dr did ask me to verbally describe the pain I felt during the disco. When the dye was being injected. I told him NO PAIN, just pressure and I honestly did NOT think any of my pain was discogenic in origin before he ordered the disco, during or after. He said that just points once again to it being the fused level. He is to call me today with the disco results.

He of course was amiss what we should do or how to proceed without the info from the disco.

He spoke with us for an hour or more and was just as kind and communitive as ever.

He thinks:
In HIS "opinion".. that my pain is originating from the non union of the fusion.

He has thought that from the 1st day he met & examined me.

However, to date NONE of the tests he was hoping would positively confirm this, have.

The bone scan was negative for "hot spots" usually a sure sign of a non union.
The CT scan showed that the hardware is still in place.
The MRI (which I posted results of before in another post) showed severe DDD throughout entire lumbar area with arthritic changes at end plates & facets.

In a nutshell, I know (once again) NOTHING solid.

His position is this:

His hunch, his guess, and his gut, tell him it's my fusion failure. But, he said in all honesty he could not with 100% certainty say this is what is causing all of my pain. He said he is worried that IF he goes in now and opens me up and does an exploratory of the fusion level and puts cages and new screws in, THAT IF his "hunch" was wrong, then what else could it have been?

Said, the ONLY other things it COULD be are: facets, and or muscular weakness? Said IF he does the revison without being 100% sure going in that this IS MY PROBLEM, then it would be HIS fault for not having had me exhaust EVERY and ANY other diagnositc test, or conservative measure.

So, I was flaberghasted and an emotional train wreck.

Now, looking back objectively (couldn't yesterday) I kinda see his point and think I AM VERY lucky in having found someone who IS as thourogh as him and truly DOES want to help ensure this surgery IS the answer and it is NOT done in vain.

I honestly think many ANY other docs would have just said "Let's do it" and $$$$ would have been their deciding factor., $$ in their pocket.

He said having explained all this, of course it was our decision.

Hubby asked him point blank, "What is YOUR opinion and what would YOU do in her position?" Hubby told him what HE sees me go through daily and HOW severe my pain escaltes daily ~

He said he would hang on & continue pain management, try 4-6 weeks only of GOOD PT with emphasis on streching & strengthening (abs) and perhaps do one more round of facet blocks.

Then, if no improvement, he'd do an exploratory sx. For it now appears he is ONLY gonna know for sure if the fusion is a total failure when he gets in there. But by waiting and trying the PT & blocks, we would ALL know at this time that we had ruled out ANY other factor that we possible could have tried to.

I am so confused.

In my heart - I KNOW my fusion has failed. I KNOW the grinding & crushing unbearable pain I have is NOT - I REPEAT NOT muscular in origin.

But I do respect and trust this NS. I truly believe he has my best interest in mine. And so does my hubby.

Doc wants me to "try" PT 4-6 wks 4x* a week but he said I could GO to PT 2x a week IF I promised to do it myself at home the other 2x a week.

So, I guess I bite the bullet

Dr promised me he'd do regular x-rays and watch for hardware stress/failure or screws showing signs of toggling.

I had planned on going down in the next couple of weeks in hopes that I'd be back to work and semi-recovered by September and be able to work & have a Christmas and such with this surgery behind me.
Now, the time table has shifted and I will NOT do surgery until after the holidays, NO matter what. So I now start planning for sx after the 1st of the year.

Dr also said if pain gets worse interim to have PM increase the Duragesic, he DOES NOT want me to do the intrathecal morphine pump - said he has had TOO MANY pt's have numerous surgeries to fix things that had gone wrong - I told him I would still consider it, but I'd already decided that it will be done ONLY if the next surgery is unsuccessful in bringing the results I feel and hope it will. He said that was a good plan and he fully agreed with my thoughts and admired the energy and wisdom I'd used for thinking this way.

My hubby's opinion of all the "you need surgery IMMED" & me being told this and more on the 1st visit with the NS, was simply that after hearing all of my symptoms & doing a physical exam initially - Dr was confident in his dx of fusion failure and said this BEFORE he had the test, studies and data to actually back his "opinion" up with.

I agree. I think doc (then & now) thinks the same but can't in good consience say it without showing me proof. I understand and respect his position. Afterall this doc has to cover his butt too.

ok - I have rattled on......hope this makes sense, for it certainly did NOT for me at 1st ...or on the drive home.
I felt the tears of frustration building in the exam room, but held them til I got to the car. After calming down emotionally, I am getting things into perspective and actually agree with what he said and why he said it.

I did take a picture of my lower back in all it's glory. Red angry blotches surrounding my insicion and Dr said he'd NEVER seen anything like it in his career. Said something is obviously irratating me there. Duh

Thanks to EACH of you who wished me well and kept me in their thoughts yesterday.
I was just too mentally & physically wiped out to even go on the 'puter last night.

Hugs,
Bionic