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Old 04-26-2006, 05:32 PM   #1
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2nd Opinion - Boston Doc Says Non-Union

Hello To Everyone -
I wanted to start this new thread just so I don't derail other peoples threads. I sure do appreciate knowing my friends here have been thinking about me. Well, I made the trip to the big city. My sister who is seeing a hand specialist at this hospital (NE Baptist) came with me. Thank goodness for that cuz I'd have been lost, lost, lost!
Well, I should focus on the important parts. I had what has to have been one of the most thorough consultations ever. This neurosurgeon spine specialist spend 1 hr and 40 minutes with us. He asked me about 100 questions and actually took notes! That was a first for me. He did an exam. He asked me respectfully to share what my current surgeon's diagnosis was 'as I understand it'. He asked me what my current surgeon planned to do to help me. When I told him my doc would do a decompression at L3 at the least and possibly a fusion at that level- he asked if I would be so patient to allow him to review my latest MRI again. He asked to explain my surgeon's reason for refusing to use BMP. And here is the important part - he listened. He never hurried. I was able to go through all of my questions and concerns. What he said was logical and it was said with great calm. He requested the actual c scan before he would make a definite diagnosis on my hardware. Everything about him was professional. He did not make a single disparaging remark about my first surgery or my surgeon. He did not indulge in a single childish or egotistical slip. It was entirely a relief not to have to deal with any such nonsense.
Diagnosis: non-union (yep, failed fusion). This he feels is utterly unequivical. Every one of my diagnostic tests and all of my symptoms and my recovery history support the diagnosis. He feels my left L4 pedical screw is loose and and suspects the c scan may show that the right L4 screw is losening. He does not feel that the stenosis or the disks at L3-4 or L5-S1 is significant or requires surgical treatment.
Treatment: Revision surgery to fuse L4-L5 - would do a posterolateral and interbody fusion using cadaver bone and BMP (at my request) with instrumentation and an external electronic bone growth stimulator for 6 months or until substabtially fused. No brace. Aquatherapy at 6 wks. Out of work 3 months.
We discussed BMP in detail. I requested to use it for the posteriolateral fusion and he agreed. I was surprised to learn that he and the hospital are not using it for interbody fusion because of some more recent cases where the stuff 'got out' and entrapped nerves and created stenosis. He explained this policy may change as the details are learned that may put fears to rest but for now - no interbody use of BMP. Thus, that would have to be done with cadaver bone since a hip harvest would not produce the size of bone needed. And that is about it minus a hundred details.
I liked the man very much and his deportment and demeanor suit me to a T. I did not ask about his PA! But I will. So, I am very glad to say it was not a waste of time. QCook - I sure did think of you and do indeed wish I had a few more opinions lined up. But with full-time work, this is as fast as I can go.
I am not decided. There are some important issues to settle with my work and FMLA and so on. I am not sure if I will seek a 3rd opinion. I'm going to proceed with this surgeon and book the surgery. In any case, it would take 8 weeks to get me in so I should have enough time to get a 3rd opinion if I want it.
I'm so far beyond tired. I don't need sleep, I need a coma! I'm thinking about you, Schragie and Lori - thank you to all. I'm going to hit the hay and I'll talk to you tomorrow night. Suzy-Q

 
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Old 04-26-2006, 06:10 PM   #2
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Re: 2nd Opinion - Boston Doc Says Non-Union

Well, it certainly sounds like you found someone you can have greater confidence in. Isn't it wonderful to find a doc who LISTENS and who with whom you can get answers? It isn't always necessary to get multiple opinions, especially when you find someone who is thorough with an actual exam, taking notes, questioning, etc. It is just important that you are comfortable that you have found the doc that you believe you have the best chance of succeeding with.

Since you also have family there to help along the way, it sounds as though you at least can now concentrate more directly on your plan.

Now, I've not been around much lately and it is due to back problems, although not my own. Bless my wonderful spine surgeon, when I made a plea to get my mother in to see him, his nurse called right back and they booked us for the next morning just before his normal first appointments. He said he knew that I made a plea that she had to be suffering, because he knew how tough we were.

Long story short, her back is suddenly collapsing with almost as many things wrong as with mine. It's bad at any age, but when you are in your 80's and already dealing with other major health issues, it is a rough road. Thank goodness I (now we) have such a wonderful spine specialist who is so good to work with our other doctors. Her confidence in him is already there, because of all the wonderful care I've received.

Best wishes and I'm so happy for you that you had such an impressive visit.

 
Old 04-26-2006, 06:14 PM   #3
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Re: 2nd Opinion - Boston Doc Says Non-Union

[QUOTE=Suzy-Q]Hello To Everyone -
I wanted to start this new thread just so I don't derail other peoples threads. I sure do appreciate knowing my friends here have been thinking about me. Well, I made the trip to the big city. My sister who is seeing a hand specialist at this hospital (NE Baptist) came with me. Thank goodness for that cuz I'd have been lost, lost, lost!
Well, I should focus on the important parts. I had what has to have been one of the most thorough consultations ever. This neurosurgeon spine specialist spend 1 hr and 40 minutes with us. He asked me about 100 questions and actually took notes! That was a first for me. He did an exam. He asked me respectfully to share what my current surgeon's diagnosis was 'as I understand it'. He asked me what my current surgeon planned to do to help me. When I told him my doc would do a decompression at L3 at the least and possibly a fusion at that level- he asked if I would be so patient to allow him to review my latest MRI again. He asked to explain my surgeon's reason for refusing to use BMP. And here is the important part - he listened. He never hurried. I was able to go through all of my questions and concerns. What he said was logical and it was said with great calm. He requested the actual c scan before he would make a definite diagnosis on my hardware. Everything about him was professional. He did not make a single disparaging remark about my first surgery or my surgeon. He did not indulge in a single childish or egotistical slip. It was entirely a relief not to have to deal with any such nonsense.
Diagnosis: non-union (yep, failed fusion). This he feels is utterly unequivical. Every one of my diagnostic tests and all of my symptoms and my recovery history support the diagnosis. He feels my left L4 pedical screw is loose and and suspects the c scan may show that the right L4 screw is losening. He does not feel that the stenosis or the disks at L3-4 or L5-S1 is significant or requires surgical treatment.
Treatment: Revision surgery to fuse L4-L5 - would do a posterolateral and interbody fusion using cadaver bone and BMP (at my request) with instrumentation and an external electronic bone growth stimulator for 6 months or until substabtially fused. No brace. Aquatherapy at 6 wks. Out of work 3 months.
We discussed BMP in detail. I requested to use it for the posteriolateral fusion and he agreed. I was surprised to learn that he and the hospital are not using it for interbody fusion because of some more recent cases where the stuff 'got out' and entrapped nerves and created stenosis. He explained this policy may change as the details are learned that may put fears to rest but for now - no interbody use of BMP. Thus, that would have to be done with cadaver bone since a hip harvest would not produce the size of bone needed. And that is about it minus a hundred details.
I liked the man very much and his deportment and demeanor suit me to a T. I did not ask about his PA! But I will. So, I am very glad to say it was not a waste of time. QCook - I sure did think of you and do indeed wish I had a few more opinions lined up. But with full-time work, this is as fast as I can go.
I am not decided. There are some important issues to settle with my work and FMLA and so on. I am not sure if I will seek a 3rd opinion. I'm going to proceed with this surgeon and book the surgery. In any case, it would take 8 weeks to get me in so I should have enough time to get a 3rd opinion if I want it.
I'm so far beyond tired. I don't need sleep, I need a coma! I'm thinking about you, Schragie and Lori - thank you to all. I'm going to hit the hay and I'll talk to you tomorrow night. Suzy-Q[/QUOTE]

 
Old 04-26-2006, 06:17 PM   #4
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Re: 2nd Opinion - Boston Doc Says Non-Union

[QUOTE=Suzy-Q]Hello To Everyone -
Treatment: Revision surgery to fuse L4-L5 - would do a posterolateral and interbody fusion using cadaver bone and BMP (at my request) with instrumentation and an external electronic bone growth stimulator for 6 months or until substabtially fused. No brace. Aquatherapy at 6 wks. Out of work 3 months.
We discussed BMP in detail. I requested to use it for the posteriolateral fusion and he agreed. I was surprised to learn that he and the hospital are not using it for interbody fusion because of some more recent cases where the stuff 'got out' and entrapped nerves and created stenosis. He explained this policy may change as the details are learned that may put fears to rest but for now - no interbody use of BMP. Thus, that would have to be done with cadaver bone since a hip harvest would not produce the size of bone needed. And that is about it minus a hundred details.Suzy-Q[/QUOTE]


Suzy, I'm a little confused. You say he will do interbody fusion with BMP and then you say "no interbody use of BMP". I'm assuming you are getting the BMP, but I'm not sure.

Do you mind telling me who the surgeon is and where does he practice?

Bobi

 
Old 04-26-2006, 08:08 PM   #5
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Re: 2nd Opinion - Boston Doc Says Non-Union

Hello Suzy-Q,

I'm so glad that you went for this second opinion.

It seems like you feel confident with what he's told you, and that this trip was well worth it. How far did you have to go for this appointment?

I'm checking into finding a good spine specialist here for my second opinion.
Thanks to you and many others here on this board, I will have lots of questions for him/her as well.

Take care and please let me know when you schedule your surgery.
Bernie

 
Old 04-26-2006, 10:16 PM   #6
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Re: 2nd Opinion - Boston Doc Says Non-Union

Suzy,

You were very smart to see another surgeon, I am SO glad you did. It amazes me how many people don't, when their surgeon can't tell them why they are in pain and even when they know the films can fool everyone. Thank goodness my surgeon knew and went back in, not knowing exactly what he would find or I would still be walking around in a lot of pain. Now know you have a non-fusion and can have it refused and hopefully no more pain.

I am wondering, since you didn't mention it, why this surgeon isn't having a hardware block done before he schedules surgery? It is a routine standard test and added insurance that it really is the problem and not something else. I think you need to ask him about that. I can't think of any reason not to do it, only to do it. I think it would be foolish to have this surgery without it.

I too was wondering about what you meant regarding the Interbody fusion with or without BMP. I had BMP for my double fusion, anterior/posterior and again for my refusion. I have never heard of not using it one way or the other. My surgeon has a BMP rep at my surgery, as the films all showed I was fully fused but my hardware block was positive. I got an extra dose of BMP on the sides of the vertebrae so it looks like I have little bridges on the sides as well as a huge fusion. I was glad about that, I am not up for anymore nonfusions.

I can't remember your history, did you originally have a single or double fusion. Was it anterior or posterior?

 
Old 04-26-2006, 10:20 PM   #7
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Re: 2nd Opinion - Boston Doc Says Non-Union

Hey Suzy:

I've been peeking in looking to see if you posted and am so pleased to hear you had a good experience with this surgeon. It's also a pleasure to hear that your surgeon is a grownup and doesn't need to snipe at others' work or make egotistical comments. It's such an important relationship and I really don't agree when people say it's okay for the doc to be a jerk if he or she is good at the surgery part. It's a gestalt thing and you need to feel comfortable with the whole person and have confidence in their technique and knowledge as well as trust them with your life. It also sounds like he had a very high-level conversation with you about everything, including BMP. If I remember correctly (and this memory of mine is awful these days) I think you mentioned that you were a researcher of some type so I am sure you impressed the guy as well with your knowledge. Ya know its funny -- I speak to people who have had back surgeries and they can't really tell me what's been done to them. For me, knowing a lot of details helps me through the process and takes away some of the fear. (I'm still a big baby thought about my scar which I swear is going to swallow my hand if i touch it again)

I only know a little bit about the bone growth stimulators but it sounds like a really good idea considering your history. Also, I wonder whether "revision" surgery is any easier than the first one but considering that it sounds like a redo I don't know. Did you ask about that? Congrats on the no brace and for the commitment to aqua therapy. I tried a hydrotrack shortly before my surgery and it was really cool and so much easier to walk in water.

Anyhoo, I am so glad everything went okay (although am of course sorry to hear that you had a non-fusion) and I hope you get some rest tonight and have a better day tomorrow -- just in knowing that there is someone out there to help you.

Qcook -- gluck to you with your mom.

Gnight, Schragie
__________________
4/2006:TLIF L5/S1
2002: C4-5 herniation
1/1999: ACDF C5-C7

 
Old 04-26-2006, 11:19 PM   #8
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Re: 2nd Opinion - Boston Doc Says Non-Union

[QUOTE=visions]Suzy,

I am wondering, since you didn't mention it, why this surgeon isn't having a hardware block done before he schedules surgery? It is a routine standard test and added insurance that it really is the problem and not something else. I think you need to ask him about that. I can't think of any reason not to do it, only to do it. I think it would be foolish to have this surgery without it.

.........My surgeon has a BMP rep at my surgery, as the films all showed I was fully fused but my hardware block was positive. I got an extra dose of BMP on the sides of the vertebrae so it looks like I have little bridges on the sides as well as a huge fusion. I was glad about that, I am not up for anymore nonfusions.

[/QUOTE]


Visions,

Would you share info on what exactly a hardware block is, and what the process means if positive? I'm not familiar with that particular term or process and I've had four fusions. Had lots of tests, etc, even had hardware removed after I fused, but I'm still learning. Couldn't find the term on the Spine Universe, so need your input.

Thanks.

 
Old 04-27-2006, 05:27 PM   #9
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Re: 2nd Opinion - Boston Doc Says Non-Union

Good Evening Good People -
What a treat to have so many responses to my post! It was so good to hear from one and all. I'll try to address questions without a whole lot of extra verbiage (I kind of like to talk, as you may be able to tall)
BobiM - the surgeon I saw is Dr. Chima Ohaegbalum (pronounced CheeMa OhayBahLoom) and he is with The Boston Spine Center and is affiliated with New England Baptist Hospital in Boston Ma. This doc said he would not use BMP for the interbody fusion due to concerns of bone growth in that space should any of the BMP 'get out' or move away from its intended home. There are other posts where Qcook has explained that this happened early on (2002-ish) and the product was removed or recalled until the makers came up with a cage and sponge type device to restrict the movement of the BMP. Out of concern for this, the doc I saw still does not use BMP in that interbody space. He would use BMP to do the postereolateral fusion, however.
Visions - I didn't ask this doc about a hardware block because I know my current hardware will have to go not only because it may be bent or damaged but simply because it has to be gotten out of the way for the interbody fusion. New, larger screws will go in and replace the old. But I did ask my first surgeon about having this test done at about 10 months post-fusion before the words non-fusion had even entered my mind. My doc said he didn't think it was worth doing since the MRI did not indicate any fluid around the hardware. That's all I know. My surgery was a single level fusion, posterior with a decompression and hardware - done for spondy with slippage at L4-5 and severe stenosis.
Hey Schragie - how are you doing? Always good to hear from you. I could not agree with you more - I need to be able to feel free in communicating with my doctor. Period. I also find knowledge to be the best medicine to quiet my fears and anxieties. It is not knowing that upsets me. I do indeed work in laboratories so I am not frightened by scientific language. And I appreciate a reflective approach to complicated matters like spine surgery. I do not like being asked a question and then being nearly cut off and told what exactly is wrong on the basis of a sentence fragment. I am too quick in my decisions at times and I know the consequences of that in my work. I was ultra aware that this doctor was listening and thinking through and just taking in the entire experience. I found that to be amazingly impressive.
Thanks you, Qcook for the wonderful support. I am so sorry about your Mom but I'm thinking she is danged lucky to have you and this excellent specialist for care-givers.
Unfortunately, I can not expect this revision to be any easier. It certainly may be. But the doc went over what I had read in many a published study: for all people a revision surgery is likely to require a longer surgery time, have an increased risk of complications, a longer hospital stay, more pain, a longer recovery time and a less good outcome. And that is just because it is a second surgery. We also covered that other piece of cheerful news: it is always possible that a perfectly successful surgery can yield a perfect fusion and some small number of people will yet experience chronic and debilitating pain. In other words, there are no guarantees because the source of your pain may not be known and a fusion may not affect the true source of pain. A total bummer, no?
Well, I must go. I am having a very long week at work and I have some work yet to do before bed. Do take good care and I'll keep posting? Any sign of Lori yet? Suzy-Q

 
Old 04-27-2006, 09:15 PM   #10
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Re: 2nd Opinion - Boston Doc Says Non-Union

Suzy,

Thanks for your reply and explaining everything. Let me see if I understand what you mean about your doc and the BMP. This new doc doesn't use BMP, even though they are using sponges with it now, but you want BMP and he is willing to do it? Is that right?

Now, he knows for sure you have a non-fusion? Did films show that for sure? Does he think you have a non-fusion because the hardware may be loose or did you have extension x-rays that showed it was moving around in there? Sorry to be so dense, I went through this whole process myself so I am interested in your case.

My films all showed I was fully fused, but my pain symptoms indicated a non-fusion, so he ordered the hardware block to see if the hardware was causing my pain. When it was positive, he knew he would at least be removing the hardware, but when he opened me up, he found the non-fusion. He took out my old hardware, had to in order to do the refusion, just like you will have, then after he refused the L4L5 he too put in new hardware with six screws this time instead of the original 4 and they were longer screws.

The surgery was a sucess and I recovered and had no pain, but eventually, I woke up with severe pain and couldn't move. Again, I had the MRI, CT Scan and it showed I was fused, but it showed that before, so you can never really be sure, but it was really pretty sure being the second fusion there with extra BMP. That made it most likely it was the hardware, and I had another positive hardware block and surgery was schedule for hardware removal. There was even a large fluid filled bursa in there from the hardware that they had to drain. It was good to know via the hardware block, that the hardware was causing my pain, because if it had been negative, then it could be something else causing the pain. I recovered an was no longer in pain. I told my surgeon I wanted my hardware, they don't routinely do that, but he did and I was blown away when I saw it. I had seen it plenty of times on X-ray, but it was much bigger in person than I imagined. And when I saw the nuts and bolts on the ends of the screws, it was and still is, hard to believe all that was inside me and I couldn't feel it. There's really not much back there between the bones and skin. AMAZING. I have had more fun showing my hardware to people and watching their jaws drop.

I wish you all the best and a totally successful surgery. Sounds like you have an excellent surgeon who is a nice professional person as well. After reading more you just said about your last surgeon, I know you did the right and smart thing going somewhere else.

I am with you all, I do not work with doctors that do not meet my criteria. I learned the hard way, that we employ them and we can fire them. As well as being an experienced professional, I need and expect a doctor to talk to me, not down to me, to explain things in detail to me, include the plan of action as well as what will happen if that doesn't work. I deserve all my questions answered without being rushed or clock watching and cutting me off. They also have to have a good bedside manor. If they don't treat you nice in the office, it will only be worse in treatment and post op any surgeries.

The nice thing now, I have all good doctors because I don't hire the bad ones.

 
Old 04-27-2006, 09:32 PM   #11
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Re: 2nd Opinion - Boston Doc Says Non-Union

Quitecook,

Sorry, I should have replied to your post before I went on more about hardware blocks. If you have ever had any epidural streroid injections in your back, a hardware block is done the same way by the same doctors who do those. Also done under floroscopy, the difference is this is a treatment procedure, used to try and calm down inflammation and hopefully end your pain.

Alot of times when a patient has pain return after hardware was put in, it is hard to detect if the hardware is causing the pain. So a hardware block, which is a diagnostic test, not a treatment, is done. They inject something like Novacaine, just like they use in the dentist office, into the places where the hardware is, thus numbing that area for about the next 6 hours or so. During that time, you are sent home with a pain chart where you rate the level of your pain every 1/2 hr, hour for 6 hours. You have already rated it before the block and now they are going to see if your pain decreased or stopped while you were numb from the injection. If not, then it probably isn't the hardware causing your pain, if it does improve/stop, it probably is the hardware. I say probably because anything is possible, but this is what usually happens. When the numbing pain med wears off, you pain should return to it's original pain level before the injection. You cannot have any sedatives before, during or after the injection because they could make you sleepy and fall asleep after the inject and then you wouldn't be able to rate your pain, which is the whole purpose of this test.

Both my hardware blocks were positive and accurate, meaning the pain totally stopped during those 6 hours and returned when the block wore off and both times it proved what my surgeon found during surgery. I hope I have explained that ok.

 
Old 04-27-2006, 09:57 PM   #12
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Re: 2nd Opinion - Boston Doc Says Non-Union

Thanks visions. You explained it just fine, and no, I never had that. Many different types of injections but we absolutely knew it the hardware was the problem without any further testing. It wasn't loose.

Had my hardware removed once it became painful, about 17 months after the first fusion (non-BMP). Doc had warned that so far as his patients, he had found that for less than 3 levels of fusion, the hardware had not bothered patients, but that 3 and above they normally wanted the hardware out after about 14 months because as they became more active it was painful as the muscles moved over the screws.

Thought I'd be different, as I tend to do the opposite of most things, but when I became really active there was no choice. Now, with 10 levels, he thinks we will not need to remove the hardware, since I can no longer bend my back, but said that if it became necessary, it sure will not be a 45 minute out patient procedure like the 3 and 6 levels were. This one would require hospital time and take more than 4 hours. Doubt that I would have the wonderful instant relief I experienced with the smaller amounts of hardware coming out. Was able to bounce right back from those surgeries.

Thanks again for the reply.

 
Old 04-28-2006, 03:14 AM   #13
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Re: 2nd Opinion - Boston Doc Says Non-Union

Hi SuzyQ, I am also being treated at NE Bapist Hospital. The Dr's there are great and yes it was hard to find at first but was well worth it.

Good Luck

 
Old 04-28-2006, 03:59 PM   #14
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Re: 2nd Opinion - Boston Doc Says Non-Union

Hello To One and To All -
I feel as though I have survived a battle. This past week was Nat'l Medical Laboratory Week! Hooray! It all added up to a boat-load of extra work for me just exactly when I could have used some rest. Oh well. I am very fortunate to have a job I love to do.
Visions - if I were to go ahead with the revision surgery in Boston, I would have a fusion in the inter-vetebral body space (he would remove a good bit of the disk at L4-5 and place cadaver bone there but not any BMP) AND I would have BMP placed posteriolaterally to creat fusion on both sides of my spine. This doc said I could use a hip harvest for the posteriolateral fusion but I requested BMP instead. I asked to use BMP for the interbody fusion as well and that is where he said he would not use BMP because of the risk of migration and possible creation of stenosis. He does not fear nerve entrapment by the BMP at the posteriolateral location. I am still thinking this through and trying to decide if I think this conservative use of BMP satisfies me. Because he would use the cadaver bone I will be saddled with the external stimulator for 6 months. I just don't know yet how I feel about this.
This surgeon felt my bone scan done in early March was, in and of itself, conclusive for a non-union. The report indicated increased activity at L4-5 posteriorly. He explained that at 12 months post-op there should be no increased activity at all. My c scan said that my xrays over the course of 6 months showed a gradual loss of the fusion and the c scan itself showed that the 'posteriolateral bony fusion is now nearly completely resorbed' m- just plain gone. My MRIs done at 8 months and 11 months were not clear right near the hardware but no fusion bone was detectible either. For reasons I can't explain, my current surgeon told me up until 10 mos post op that my fusion and MRIs and xrays 'looked good'. After the scans he felt things were equivical and the scans themselves non-conclusive.
I have no fault to find with this surgeon. He was attentive and always answered my questions and welcomed my opinions and input. He was willing to do the diagnostics and never questioned that my discomfort and pain were real. I am very unhappy with the PA and this is the guy that barks and blusters and cuts me off and declares in an instant what the problem is.
But what is really the driving issue between us is that my surgeon would essentially do the same surgery again, will not use BMP, and will implant a stimulator to try to get a fusion where this one failed. Of course I am a bit confused by his uncertainty about the non-union. But I know he is very experienced and so I just have to decide if I concur and wish to try it his way again. I'm thinking I will not. I don't want to wake up a second time with Angry Andy (the PA) barking at me and I want to try a different approach this time.
Hi Joe - yes indeed the trip to NE Baptist was an eye-opener for this country bumpkin! And isn't it a pretty perch sitting up on that hill? My brother is an orthopaedic surgeon in NH. He tells me NE Baptist is IT for orthopedics in this area. Gosh, I hope so!
Awful good to chat with you - I'm in the river- Suzy-Q

 
Old 04-29-2006, 08:06 AM   #15
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Re: 2nd Opinion - Boston Doc Says Non-Union

Good Grief! I've just realized I spelled the Boston surgeon's name wrong in my earlier post. It is Dr. Chime Ohaegbulam. Not Ohaegbalum as I posted before.
Sorry about that - Suzy-Q

 
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