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Old 07-02-2009, 10:10 PM   #1
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Advise on surgery

As I have just seen a neurosurgeon and am lining up a visit to an orthopaedic surgeon for a second opinion, I thought I would ask a general question. I have also had another MRI and as far as I could tell from what I read is that my back has deteriorated somewhat. But what I have been told is that surgery does not help if you have mostly lower back pain. And If the pain is mostly in the legs it would be an option.
Now I know that is a widely general statement but before the neurosurgeon even read the report she basically stated the same thing. So I get told again surgery will not help back pain.
Can anyone tell me if this is what they have come to believe or has this been the advice to anyone out there? Or is it a money problem as I am a pensioner without insurance.
Has anyone had surgery for lower back pain? I myself have got to the stage where I don't know which is the worst for me. I do have a lot of localised lower back pain when I sit, stand or walk. But I have bottom, leg and foot pain when I am laying down or even in a comfortable chair, along with muscle spasms and sometime neuropathy when I am at my worst. I have to use a muscle relaxant when I lay down so I can get to sleep or even to get some relief.
This is my thing I am stuck in the middle and don't know which way to push. I know the L5-S1 disc has lost it's moisture and some of it's mass as is it shows up black on the MRI and L4-L5 is almost as bad and has a tare in it, so I naturally thought that only surgery could help them now but the old story comes up again. Surgery or not? Do I want to go through all that if I only have a limited outcome(pain wise I Mean).

I just want to add that I believe I am having leg pain when I stand and sit but the pain that I have in my lower back masks the other to an extent. Sometimes I feel that I am in a lot of pain from my waist down. Just completely (had to find the word) all in pain.
Allan

Last edited by allanbruce; 07-02-2009 at 10:23 PM. Reason: Add to the thread

 
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Old 07-03-2009, 12:24 AM   #2
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Re: Advise on surgery

Hi Allan,

I assume you want my true opinion. Don't want to sway you either way with what I say. Just remember that this was my outcome. Everyone is different. That said......

For me surgery was the worst thing I ever did. It totally changed my life and not for the better. I started suffering with back pain around 1999. Had an MRI which showed a herniated disc L5. I suffered with pain and in 2002 went to a Chiropractor. He did adjustments in addition to me seeing a therapist. I also did the DRX machine. In 2004 I had another MRI because the pain never really went away. They made a mistake in the report and said "no Spondylolethesis found". I did therapy again. The therapy Dr. suggested pain management and sent me to the Neurosurgeon. As soon as he saw the MRI he said I had Spondy (slipped vertabra). He said surgery was my only choice. I tried meds, therapy several times. I did the epidural shots, nerve block etc in 2001. Nothing helped. He said if it slipped more I could lose bladder and bowel function and wind up in a wheel chair. So on 9/12/06 I had the surgery. It turned out they had to fuse L3 and L4. They removed the L5 disc which was almost gone anyway. They also said the S1 nerve was basically tied in a know and they had to untie it. I was told I would be out of work 3-6 months. Well, I never was able to go back. The therapist told me that when you get more then one level fused that you rarely come out pain free. It is true in my case. Before the surgery the pain was not this bad. It is 10 times worse now. It is permanent.

Please don't let this sway you against surgery. Please get other opinions with other surgeons if you can financially. Maybe your problem could be fixed. Do you ask the Dr. why she says surgery is not a good idea. Just curious. I think it depends on how extensive the damage is. I have a new herniation and now stenosis above the fusion surgery. Before the results the Dr. mentioned surgery for the disc. But now there is no way they can do surgery. So depends on how bad it is.

I hope it all works out. I feel bad typing the negative stuff but I know I would want honesty.

I had a great surgeon and I know this is not his fault. Good luck with everything.

 
Old 07-03-2009, 06:10 AM   #3
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Re: Advise on surgery

Yes I have been told that surgery can cause a lot more pain and cause irreversible damage to a percentage of patients and that is why I haven't rushed to make an appointment with the orthopaedic surgeon. I have the referal to see one and I will go and talk to him, but it does really worry me that there are so many things that can go negatively, Including infection. But I will at some time have to make a decision on where to go from here. I am concerned that if I leave it much longer there will be a lot more people waiting for treatment and I might as well get onto that list if I am suitable for any surgery. Also I am only going to be getting older myself so the sooner the better if that is the concern. But if I am able to continue with maybe some more physiotherapy and good pain management I might be better off without anyone cutting me up. I can see why the doctors are very cautious, they don't want to make any mistakes ether.
A friend of mine had disc replacement and that helped him a lot. He has a lot less pain and no problems with his legs now. So It can sometimes be well worth it. I am still confused. No one here has mentioned disc replacement, is that not very common? I have a referal to the same doctor that did his. Could this be an option to replace the 2 offending disc's. A lot of you here talk about fusion, is that the only option for you?
Allan

 
Old 07-03-2009, 11:22 AM   #4
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Re: Advise on surgery

Not an expert on this subject, so hopefully others will chime in. What I think is that ADR-Artificial Disk Replacement is fairly new here; in the U.S. I believe it's more common in Europe. Also, I "think" ADR can only be done on one disk. My story is very similar to Hessie's. I had six levels fused and am MUCH worse now, and on stronger pain meds than before surgery. I do believe it's been documented that more levels fused= a lower sucess rate. But there are those that find relief from a multi-level fusion; but they are few and far between. As I said hopefully others will chime in, however these boards are a little slower on the weekend;esp. this one since tomorrow we celebrate our independence and I didn't want to leave your post unanswered for too long. Hang in there--janiee08

 
Old 07-03-2009, 06:35 PM   #5
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Re: Advise on surgery

Quote:
Originally Posted by allanbruce View Post
Yes I have been told that surgery can cause a lot more pain and cause irreversible damage to a percentage of patients and that is why I haven't rushed to make an appointment with the orthopaedic surgeon. I have the referal to see one and I will go and talk to him, but it does really worry me that there are so many things that can go negatively, Including infection.
Yes, that is correct. Many incorrectly think that surgery is often a "cure for all"....it's not. For most complex procedures, I've often read where a third get good results, a third experience no change, and a third get worse.

I've not had any back surgery, but have experienced other major surgeries and I'm convinced beyond a reasonable doubt that at least one of my surgeries is responsible for a lot of the pain I have now.....Left a lot of scaring, nerve damage, and etc.

Every case is different and I don't think anyone can give you advice on whether to do this or not. I think you have to talk with your trusted physicians and make the best decision you can. The most important thing is that if things don't go according to plans, that the Docs don't throw you out on your own. I was fortunate in that my surgeon took care of me afterwards and treated my pain for a long time, before sending me to PM. He also was the physician of record for my disability application and backed me 100%. I am very thankful for all that he did because I'm not sure what I would have done otherwise. Reading posts on this site and you'll see that some have not been so lucky. Some surgeons are very ego oriented...They think they "fix" things and that all their surgeries are successful...That's just not the case. It may not be something they necessarily do wrong, but rather, one's body may not respond accordingly. Surgeries are very complex in nature, and that's why the risk(s) associated with such are often serious business.

Best of luck to you.

Regards,

Ex

 
Old 07-03-2009, 06:55 PM   #6
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Re: Advise on surgery

i have a similar story to hessie also been here longer. I ended up with with 3 opinions hoping for a better outcome. I was worse after the surgery. As far as i could tell there was more pain after the surgey and recovery was very very slow for me.
The surgon stopped the pain meds about month three. What i learned now that the nerves do not even start to heal till then. By month four i was with my neurologist that has been handeling my pain regement ever since.
While granted on these boards you mainly hear about the "failed back surgeries" rarely about the good outcomes. Just remember every one is different.....
I do wish you well and do not as Hessie said want you just to take our views on what happened.... But at least we can share with you our stories and that the surgery did not improve our situations......Truely understand the risks the benifits possible best out comes worst case senerio as well

Last edited by zoey1; 07-03-2009 at 06:55 PM.

 
Old 07-03-2009, 07:44 PM   #7
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Re: Advise on surgery

Hope you all have a good weekend then and I hope it distracts you from any pain. Thanks for your advice. My friend did actually have a 2 level replacement and I was myself surprised after reading here that they are only doing single level disc replacement. So I will not know anything unless I talk to the surgeon. I have an endoscope coming up soon so I might even get through that first. I will just follow my gut feelings I suppose. Thank you for being here. Allan

 
Old 07-03-2009, 11:41 PM   #8
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Re: Advise on surgery

Hey Allan,

Australia is very advanced regarding disc replacements and they are really quite amazing in the lumbar spine - best news is that they are fully covered by Medicare if it's for your lumbar spine and you don't end up with any movement restriction as you would with a multi level fusion. The discs that they've just approved are very advanced and my neuro did his first one in an international trial 30 years ago and his patient (that was in the trial) is still doing well. I just had a cervical fusion because replacement discs for your neck have not yet been approved and therefore aren't available on medicare - my out of pocket cost would have been $30 000+. Cervical replacement for free shouldn't be far away though thankfully. It's one of the good things about living in Aus.

As for whether or not you should have surgery, well, that's your gut instinct that you've got to go with. My thoracic surgery was a total stuff up but then it's also extremely complex surgery and some unexpected things happened during the surgery. My cervical fusion seems to be going well so far without anywhere near as much pain as my thoracic or liver surgery. I've also had surgery to remove a liver tumour and that was just absolute hell, but again, I've recovered ok. All of my surgeries have been 'have' to have so the decision has been taken out of my hands. I refused to have my cervical surgery for nearly 3 years because I couldn't cope with the thought of any more surgery but then I lost the use of my left hand and that was that. My thoracic surgery was a must and obviously my liver tumour had to be taken out.

My neurosurgeons both prescribe to Ex's 30% rule, so it really has to be your decision and you have to be sure about it. I think that you were told that you shouldn't have surgery because although you have pain, you don't have any weakness etc. Many neurosurgeon's (mine included) will not operate for pain alone because success rates are not particularly high when compared to weakness or other cord or nerve damage. I would recommend having a chat with your orthopod and see how you feel then. I would do it sooner rather than later because it sounds like you need some answers from someone who is going to give a proper diagnosis.

Good luck.

 
Old 07-04-2009, 02:43 PM   #9
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Re: Advise on surgery

I will make an appointment with the Orthopaedic Surgeon and see how he feels about it. I know it is going to be hard to have to live with pain for the rest of my life but if I am offered some other options I will certainly consider surgery even if I am only given the 30% chance of improvement. I feel like I am missing out on so much when I am stuck at home in bed because of pain. The patch has given me some extra relief but I am still scared that if I over do anything I will be struck down again with the neuropathy that I experienced over the last couple of months. It was so painful and as I said it also leaves me for a few days afterwards with increased pain. Thankfully my doctor has given me some endone in case my pain gets out of control again. I will try to remain positive about all of this.
Allan

 
Old 07-04-2009, 03:02 PM   #10
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Re: Advise on surgery

Allan, I have cervical spine problems and have heard the same thing about neck vs. arm pain and surgery. I don't know anyone stateside that has had ADR in their lumbar spine. I'm wondering if we even have it approved here? We only just approved ADR for the cervical spine here. Try the back problems board. It is good to remember though (as another poster mentioned) that you usually only hear the negative outcomes on boards like this. There are probably tons of people who have had back surgery and are living a good life, but they are not posting on a message board about it because they have no reason to! So, your audience is skewed a bit here.

 
Old 07-04-2009, 07:42 PM   #11
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Re: Advise on surgery

I too have been told about the "one-third" sucess rate by several doctors-after my surgery. My surgeon told me prior to surgery that the sucess rate was 80-85%,and dumped me like a hot potato when I didn't fall into this category. Anyways, if I had just one level to be done, I would go for the ADR. The website I just read said it was for a diseased disc between L4 and L5 or between L5 and S1. I'm not sure if we in the states don't do more than one disc here because the FDA has only approved it for one disc, or that is how ADR is. I forget. If your really interested in this put Charite in a search engine and there is quite a bit about the ADR. Best of Luck--janiee08

 
Old 07-05-2009, 09:06 AM   #12
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Re: Advise on surgery

hi allen. the one thing i don't see mentioned here that you did mention to me on the neuropathy board is that cord compression you have going on in there too. that is what i am most concerned about, espescially with the ongoing symptoms you are also having here. you mentioned that that finding actually showed up in the 2002 MRI you had? did i get that right? it was kind of hard to tell from how things were worded in your other posts?

what exactly showed up with that particular finding on your new MRI? how badly is the cord being compressed right now? do you actually have your own copy of the newer MRI? if you don't, you really do need to get one. comparing the 2002 to the new one would really show how much more real impact or progression of the deterioration and the other findings have gone at this point too. when it comes to real cord compression, generally it is not something that should just be left alone. most compression just does become worse over time. this could very easily be what is actually most behind some of the more profound symptoms you mentioned both here and the neuropathy thread too. some of the neuropathic symptoms you have described and some other things too just would/could be there depending upon how much your cord is being impacted and exactly where it is in relation to areas of the cord and what they actually control or govern too.

just how are your leg reflexes right now? are they delayed/non existant, normal or hyper? hyper reflexes(when they tap below your knee, the leg would shoot out very quickly vs a bounce like response?) are usually more indicative of cord involvement, that is why i am asking.

if you do have a copy of that new MRI, if you could just type out that summary at the very end, it would really help us to get the best overall picture here of what you actually are dealing with. but knowing just how much your actual cord is being affected/impacted would really be most helpful considering the full range of symptoms you have been experiencing, including those 'knife" stabbing type pains you mentioned in the other board. just obtain that copy of your new MRI if you don't yet have one. marcia
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Old 07-06-2009, 06:05 AM   #13
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Re: Advise on surgery

CT Findings
L4/L5 there is a broard based posterior bulge of the disc annulus projecting backwards to efface the epidural fat pads. The disc bulge would be very close to the two descending L5 nerve roots in the central canal. The exiting L4 nerve roots, however have left the central spinal canal just above this problem.

L5/S1 There are very unusual appearances in the disc and are prominent Schmorl's nodes on both sides in the inferior L5 nerve and the superior S1 vertebral end plates. There is also broad-based posterior bulge of the disc annulus at this level, but not as prominent as on L4/L5 level. There is also marginal osteophyte formation encroaching on the two L5/S1 lateral canals which may also be compromising one or both exiting L5 nerve roots.

MRI Findings
Moderate disc degeneration at both the L4/L5 and L5/S1 Levels.
At L4-L5 there is a mild annular bulge Associated with a midline grade iv annular tare.
At L5-S1 there is moderate loss of disc height with patchy type II modic endplate changes demonstrated. There is a broard based annular bulge with no significant thecal sac or S1 nerve root compression.
There are moderate degenerative changes involving the facet joints at both levels.
The T2 weighted images also demonstrate mild peri fascial oedema at L5/S1 which may indicate an acute inflammatory component.
There are moderate forminal stenoses at L5/S1 which largely reflect loss of disc height.

(Disc and facet joint degeneration at both levels with moderate Forminal stenoses at level L5/S1).
-Another thing I was told is that the two disc's show up as a much darker colour and that shows how they are dehydrated and therefore they are not as flexible as they should be.

This doesn't sound as bad as a lot of medical conditions here, but it sure feels bad.

I have made an appointment in September to see the orthopaedic surgeon that arranged my first MRI and said I could come back later. I would like to take both films so he can compare them and give me his opinion. I am going to have to pressure the doctor who has them now. I don't know why he is wanting to hang on to them. I may have to tell him I will bring them back?
If there is anything surgical that can be done I am hoping he can put me through the public system, as I saw that he does surgery at the Royal Brisbane. His rooms are in the city at a private hospital so it costs $165 for the consultation, and I will get some of that back. So it is well worth seeing him even if He only fills me in on anything that the report may have missed. I did notice there is nothing said about the fact that the lower two disc's show up nearly black because of their deterioration.
So I don't know how much worse they are now but they sure give me a lot more trouble than at first.
Allan

Last edited by allanbruce; 07-06-2009 at 06:09 AM. Reason: mistake

 
Old 07-06-2009, 01:29 PM   #14
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Re: Advise on surgery

I am with Ex and Hessie on this matter...
My husband has severe back pain and so many very serious problems. But since he saw me after my 2 lumbar surgeries he refuses to hear about surgery for himself.
I was told by couple of surgeons that back pain doesn't mean you need a surgery, not every pain requires surgery.
More spinal surgeries we have - less success rate is since spinal surgeries make our backs weaker.
Usually if you had a trauma or car accident and damages are so severe that surgery is only option than they go in and fix what needed to be fixed. But for "what comes with territory" problems like DDD, Stenosis, tears, Arthritis, etc. surgeries usually are not the options since area still re herniates, arthritis sets up in that area again since any surgery on a bones brings more arthritis to the area.
I hate to say this, but I had 2 spinal fusions and lot more done during 2 years and ended up on disability and leave in severe pain 24/7. And can honestly say that I am in a lot worse condition now than before the surgery.

I am not a Dr and don't know your situation, but I just share my piece of the spinal story...
Best of luck to you and feel better!

 
Old 07-07-2009, 05:08 AM   #15
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Re: Advise on surgery

Hey Allan,

Thanks for putting up your scan results. The discs being 'black' is the same as the discs being degenerated - so they have commented on it but they just use different language such as desicated or degenerated. It does sound like there might be some L5 nerve root compression but it's difficult to say (not being a neuro or able to see your scans). The pain you're experiencing could be caused by the facet joint degeneration and I'd say that's why the neuro you saw just wants to treat it with RFD. Facet degeneration is usually treated quite successfully this way. The aching in your back (not the pain down your legs) that you experience and the pain on moving is also likely caused by the facet joints. The pains you experience down your legs could be facet related or they could be L5 symptoms - however, usually the leg lifting technique that they do will rule the disc as a cause in or out. I seem to remember you saying that the leg lift was ok.

It sounds like a lot of wear related issues. They say that the damage is 'moderate' which means that it's worse than mild but not severe (such silly language they use) - whether or not it should be operated on is something a surgeon should comment on, not me. You've certainly got problems there but as there is no actual definite nerve root problems showing up, but there is facet damage, I'd say that this is why they're hesitant about surgery. Lumbar fusions really limits movement in those 5 discs and puts the others discs under a great deal of pressure. Surgery won't fix facet pain unfortunately.

I have 2 neurosurgeons who work together because I also have thoracic issues which are quite complicated. Neuro's love to operate if there's evident nerve or cord damage and/or weakness and loss of sensation because this has a much higher rate of success. Operating to relieve pain in a patient that doesn't show either cord or definite nerve compression is much less likely to have success as far as pain relief goes, than a patient who does. My neuro's won't operate unless there is evidence on MRI.

BUT when I had to have emergency surgery on my thoracic (when I was living in Victoria - different surgeon's, thankfully) they found that my T8 nerve was completely crushed and had been for some time. The MRI didn't show this at all. I had been complaining of terrible pain and ending up in the ER not being able to breathe time and again but because it didn't show up on the scan (and thoracic surgery is so complicated) they didn't want to do it. If they had listened to my symptoms as opposed to just reading the MRIs, they would have found the damage and possibly the nerve would have been freed in time to heal. Instead it was a total failure due to leaving it too long.

I know I've just told you two seperate thing but it's because this is my experience - surgeon's are funny creatures for sure. If you feel that there is really something wrong then you need to speak up because scans aren't everything and twice for me they have gotten it wrong (my thoracic and cervical fusion both didn't show up in MRI half the damage that was found). Personally? I would avoid a lumbar fusion with everything I've got. Disc replacement? Totally different answer, I'd go for it if it was going to help. Fusions and disc replacements in the lumbar are relatively safe compared to other spinal surgeries but disc replacement means that damage to the discs above and below is much less likely. Also, from the sounds of it, you'd only need a single level replacement (unless your surgeon is very aggressive) so it wouldn't be so long in recovery.

There are also signs of acute inflammation - were you given a course of steroids after this scan? It might be worth doing that and then having another scan because acute inflammation can be a sign of quick degeneration that can then regress over time.

I'm really glad that you're seeing a surgeon in Sept. I know you would like for us to be able to help you (and we can certainly support you and give you our knowledge and information) but it doesn't replace a pro. Does he have a cancellation list? You may be able to see him sooner if so.

Take care,

j

 
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