|
2-Level ADR Patient
Hey Everyone,
I am so glad I found this support forum. It truly was the deciding factor as to what surgeons I would begin seeking out in the, hopefully, last stages of my journey. I will not go into all the details here about my injury and this long journey my family has been through because of my injury. But for those that may be curious, you can read/follow my blog. I hope this is okay to point to this because it really is a long story that I do not like repeating over and over; and this is just easier for me to do so I do not have to be on the internet very long. It is getting harder to do so every day because I am flat on my back over twenty-one hours now. I have already had a skype session with Dr. Willem Zeegers on 19-June-2016, and contacted Dr. Pablo Clavel, Dr. Bertagnoli, Dr. Bierstedt, Dr. Karsten Ritter-Lang, Wooridul Spine Center, Texas Back Institute, Dr. Carl Lauryssen, and Spine Institute of San Diego. As well as have been continuing to work with my current orthopedic surgeon Dr. Glenn O'Sullivan at Jefferson Spine Care, and also Dr. Sigurd Berven at UCSF Spine Center. As of 23-June-2016 I had all the information into Dr. Zeegers but have not paid/started the diagnosis yet, quoted at $1,100 USD, and do not know how much he will quote for a 2-Level ADR. I am still waiting on a response back from Dr. Clavel but the initial quote was $32,000 Euros. Dr. Bierstedt quoted me $32,500 Euros for a 2-Level ADR using the M6 at both levels. The Texas Back Institute quoted me $56,000 USD for a 2-Level ADR using the Activ-L (I do not want the Prodisc-L), and assistance through their lawyers to try and get insurance (BlueCross BlueShield) to pay for it or at least partial. And Dr. O'Sullivan quoted me $8,000 USD for his fee, $31,000 USD for the hospital portion, and then there would also be the anesthesia fee and possibly a surgeon's assistance fee as well. If I went through my current orthopedic surgeon we would be using the Activ-L as well. And of course if I go with a Hybrid, fusion at L5-S1 and Activ-L at L4-L5 it is a couple thousand dollars cheaper here in the states. However, after much research and careful thought my family has narrowed our top choices down to Zeegers, and Clavel from over sees; and the Texas Back Institute as well as my current orthopedic surgeon O'Sullivan from the states. This could change. But this is where we are at right now at least and have a peace about things. At the moment now I am waiting for my second court hearing to take place on 28-June-2016 which will hopefully be completely settled so I can get out from under Worker's Compensation and get the proper care I need. I cannot stand this broken system of very sub-par care they provide. Because they have stalled my care since August of 2015 I ended up losing my job in December. I was frustrated, angry, hurt... but in the end let it all go and I will not be pursuing it as my family holds fast to the sovereignty and providence of God in all things. And we have come to realize that this was probably best for our family; and we will accept what He has allowed to happen and will allow in our future. "Nevertheless, not my will, but Yours, be done." I really was away from my family a lot with the position I had in the phone company... call outs all the time, and many nights where I could not come home at all until the next evening. Since my injury I have been able to see my children grow and mature... something I missed out on before. And my relationship with my spouse has become so much better. She truly is my best friend, and these past thirteen years I have felt blessed to have met her, and to be where we are right now in our lives. Yes this injury has been hard. But I have a strong will and very high pain tolerance so I have been able to deal with this fairly well, but not easy. Personally I would rather feel pain anyway so I do not do something I should not be doing, therefore injuring myself even greater because I was masking the pain with too much medication. There are times I feel as though I am going crazy because of how hard it can be to control my brain and the amount of pain I am in. But there is not much else I can do because through this injury I have developed a severe allergy to NSAID's where I bleed internally, and other problematic symptoms to everything else my doctor has tried. I just have a very week system in being able to take medication... especially everything narcotic. So I am down to 1200mg 3x daily of Gabapentin to take the edge off of the nerve pain, and a small 4-5 oz. glass of red wine every evening just before bed. And lots of heat on my back throughout the day, a little stretching and a short walk to the mailbox daily. You have to keep moving no matter how bad it hurts. Oh, and I cannot forget that I brew our own tea from leaves to help with my health and pain too. I guess I will list what I have found to be helpful so it may be of help to others. In a small Muslin Cotton bag I put the following: 1/8 Tsp. Nettle Leaf 1/8 Tsp. Marshmallow Root 1/8 Tsp. Echinacea Purpurea 1/4 Tsp. Oat Straw 1/2 Tsp. Raspberry Leaf 1/2 Tsp. Raw Unprocessed Organic Honey 1/2-1 Tsp. Pure, Unrefined, Cold-Pressed Coconut Oil from Carrington Farms 1 Tsp. Lemon Balm 1/2 Tbsp. Chamomile Flowers 1x Calendula full Flower leaf or about 20-30 flower petals All of our herbs and leaves we buy from Mountain Rose Herbs. I boil about 40oz. of water and then drape the Muslin Cotton bag over the side of the tea kettle and let steep for 5-10 minutes, pour and serve. After the evaporation of some of the water due to boiling and steeping this makes me a 14oz. cup of tea and my wife and two of our children 8oz. each. I will post more once we make our final decision on the doctor we will be going with and/or what Dr. Zeegers or Dr. Clavel state in their diagnosis report. Wooridul Spine Center in Korea seems great, and there are excellent testimonials online. However, unless I know what surgeon will be operating on me, and unless I can view his success rate and credentials, I do not feel comfortable or confident in choosing something I know very little about. To be fair though, Wooridul has been very helpful and we have been corresponding back and forth quite a bit... so I give them credit for that. I will begin the diagnosis once we know how our settlement goes, and we know for certain how much we have to work with for my surgery. Again, I am glad I found this forum, and I hope what I have said can be of comfort and help to others. If anything, be encouraged and never give up hope. "Coram Deo" |
2-Level Lumbar ADR Patient
I forgot to mention that I am also looking into getting a bone density test done and also metallic allergy blood test done as well. These are two very important tests if you are considering an ADR.
|
Dear Nasakido,
I'm very sorry for what happened to you. I just had my ADR on 10-06 and am at home recovering. Mentally it's really hard, physically I thought it would be better, but learned on this forum that it will take more time than I thought it would. I just want to tell you about my surgeon, who is doing his job with a passion for helping people and not primarily for the cash. I'm still in touch with him over text messages and he even called at 8:15 pm last week. His name is Andreas Schmitz and his own clinic is located in Düsseldorf. He was one of the first in Germany to become a specislist for ADR. For 8 years he was an international trainer for ADR at the Charité in Berlin. I can only recommend this guy and unless you made up your mind already, I can send you the contact details. |
@Chris4377
Thank you for the information. For now I am going to continue with Dr. Zeegers or Dr. Clavel, and so far Dr. Bertagnoli caught an issue with my L1-L2 that was on my MRI report, but none of the doctors I have seen locally made any mention of that area being an issue. However, the MRI is obvious. The more doctors I can inquire of the better, so I will gladly receive whatever information you can give me so I can contact the doctor that provided care for you. My second court hearing is tomorrow with Workers Comp in settling my claim so I can actually get the care I need. But it came as a blow today when I found out that part of the settlement agreement is for me to resign from my current employer. Otherwise I get no settlement and they will continue not treating me. I could complain, but my family did pray for GOD to do whatever is necessary to keep us close to Himself and to trust Him fully. We got what we prayed for... As my journey continues on I will update this post, unless it needs to be moved elsewhere, so the decisions I make can be of use to others too. One thing though... never give up hope nor the fight. Mentally it is very hard, and physically it can be exhausting. However, you have to stretch properly, eat healthy, and exercise within the limitations of your body. Just keep moving, and do not lay around too much. Muscle atrophy is not easy to deal with. I know because this is the second time I have had it, and this time around I lost over 20 pounds because of it. I hurt and throb from my lower back to my feet. This is why I need my surgery bad because I am bed ridden right now. But, I am forcing myself to walk everyday even though it is causing severe pain, sleepless nights and my medicine to not work. It beats having muscle atrophy though and having to fight through it. And my greatest encouragement to you, and to everyone else, is to never stop talking with GOD. Prayer is not just something where you are on your knees or lying prostrate. There is a time for praying in certain postures. But I believe more than anything we need to strive to give GOD our full attention throughout the day. In times of being blessed, in times of having doubt, in times of joy, in times of pain... let your requests be made known to GOD. And from a reformed perspective, as my family is, come before Him out of reverence and fear for He is Holy and our attitude should always reflect this. Regards, Nathan |
Hey Nathan
I read part of your blog and also your posts on here and from one fellow believer to another I just want to encourage you. The pain and suffering you have been and continue to go through, is a "thousand times" worse than mine, so there is no comparison but I do understand some of what you are dealing with and will pray for you. I also wanted to share the verse. Isaiah 48:10.....See I have refined you, though not as Silver; I have tested you in the furnace of affliction..... NIV take care |
all things happen for our own good
@Ozphysician
Thank you for your kind words, and I believe prayer is critical as well. But we should only expect an answer in the way that GOD chooses to answer our prayers... for he works all things together for our good. "Also we know that all things work together for the best unto them that love God, even to them that are called of his purpose (or for His good will and pleasure). For those which he knew before, he also predestined to be made like to the image of his Son, that he might be the firstborn among many brethren. Moreover, whom he predestined, them also he called, and whom he called, them also he justified, and whom he justified, them he also glorified. What shall we then say to these things? If God be on our side, who can be against us?" -Romans 8:28-31 GNV However, to the sensation or internal feeling or process of pain I would not say I am worse simply because each person's brain processes pain differently. God has given me a very high pain tolerance. So even though I have three bad discs... my L1-L2 is not as critical or severe as my L4-S1, and I am mostly bedridden, to another they could be in tears with the same issue. So it makes me more sad to see others hurting. I cry more for others than I ever do for my own pain. But yes, I do believe that strengthening the brethren is very important. We must remain steadfast to Christ, and never give up hope. Today was some of the best news I have received in almost two years. It is over... Workers Comp settled and they will be cutting me a check in 30 days. And it should cover my surgery, travel, expenses, PT and any long-term rehab necessary. I may be emotionally drained, exhausted and feel dead because of how beat down I feel... but I can still utter with my lips, 'Praise GOD." Even if this day never came we are still called to live each day CORAM DEO, Take Care |
Nasakido, glad you are on your way into the journey. Welcome. And can I buy some of your tea?!
Glad you are doing your homework. Keep going. When you have done enough work, you will know when it's right for you. I, too, believe in the power of prayer. I tend not to discuss it much as I try to maintain a secular tone as the founder. That said, I will pray for you! :angel: |
Thank you
@Harrison
Thank you for your prayer. And as things progress I will be back here to update this post. Right now I am still waiting to receive the diagnosis report from all the doctors I gave access to my medical records. I know what both my orthopedic doctors and the doctor from my QME has reported... but I want to see what these foreign doctors have to say. Tea for sale??? I never thought of that one... LOL. :beer: It is quite good though. With the little time I can be up I love making tea and love making homemade Sandwich bread: 2 1/2 Cups water 3 Cups Great River Organic Milling, Organic Whole Wheat Bread Flour 3 Cups Great River Organic Milling, Organic Specialty Whole Wheat Pastry Flour 1 Tbsp The Spice Lab Finely Ground Pure Himalayan Salt 3 Tbsp Kirkland Signature Organic Sugar 3 Tbsp Authentic Menu Imported Virgin Sunflower Oil 2 1/4 Tsp Fleischmanns Bread Machine Yeast NOTE: We use the Sunbeam 5891 2-Pound Programmable Breadmaker for kneading only. We do not use the Breadmaker to bake the bread. We do not like the way it tastes nor is it very usable for sandwiches. Mix all dry ingredients, EXCEPT yeast, in a large bowl then set aside. Slowly heat the water until it reaches 120-125 degrees. Pour immediately into Breadmaker baking pan. Add Sunflower Oil. Then slowly pour the dry ingredients into the Breadmaker baking pan over-top the water and oil. Make sure that the dry ingredients completely cover the water and oil. Add Bread Machine Yeast on-top of the dry ingredients. Close the Breadmaker. Select the kneed only setting (our setting is #8). Push start. After 5 minutes open the lid and with a spatula make sure that all the ingredients are mixing/kneading well together. Assist the Breadmaker if needed until the dough is in a ball shape. Close the lid. The setting for kneading will take 1 1/2 hours. When finished move the dough to a USA Pan Bakeware Aluminized Steel 13 x 4 x 4 Inch Pullman Pan and softly spread the dough evenly in the Pullman, pushing down to make sure all air pockets are gone. Wet a thin dish towel with warm/hot water then squeeze excess water out... cover the Pullman and let sit at room temperature for one hour. Preheat oven to 350 degrees if your oven cooks hot or 370 degrees if it is exact. Remove the dish towel from the Pullman. Very carefully make sure the dough is not covering the top sides of the pan. If it is, then gently press the dough towards the insides, essential shaping the dough into sandwich style that slopes from the center towards all four sides in a curved shape. Then place the Pullman in the center rack in the oven with the lid off. Bake for 50 minutes or until golden brown on top. The darker the harder the crust will be. Remove the bread from the Pullman and place on a wire rack on the counter so the moisture can evaporate from the loaf, including the bottom, while it cools. This makes a very delicious healthy sandwich bread that has a perfect golden brown crust where the bread is soft yet thicker than most store bought bread. Enjoy! |
Diagnosis Consensus
Well, I have received a full diagnosis report from Dr. Ritter-Lang and Dr. Bierstedt and their synopsis is to replace my L4-L5 and L5-S1 with the M6-L. Out of the two Dr. Ritter-Lang wrote a pretty lengthy report of which I will quote a small portion here:
"L4-S1: surgical solution including removal of disc material, revision of the spinal canal and implantation of M6L-artificial disc... periradicular injection therapy L4/5 and L5/S1 on both sides will be performed to verify if a revision of the spinal canal from posterior is necessary, too. Should the decompression be required, we will do the anterior approach for the implantation of the ADR and the posterior approach for decompression in one operative session." Dr. Bierstedt did not go into great depth, but he also wants to replace both discs with the M6-L: "total discectomy by anterior surgical approach and disc replacement at L4/5 and L5/S1... M6-L, Spinal Kinetics." I did not receive a full report from Dr. Clavel yet because he wants to wait for my newer tests to be done. However, here is what he says so far: "I agree he needs surgery for L4-L5 and L5-S1 discs. But at L5-S1 I probably favour an ALIF. It is a somewhat small disc, with small facets. The left L5-S1 facet looks almost fused on the CT scan. I believe this level is too risky for an artificial disc. My preference is an anterior fusion at L5-S1 and artificial disc at L4-L5 with the same clinical result ( very good )." Also, Clavels assessment agrees with my two orthopedic surgeons here in the states, i.e. a Hybrid Fusion. So at least I am seeing some sort of consensus here between my surgeons and Clavel. This gives me more confidence than replacing both with the M6-L. Dr. Bertagnoli is still reviewing my case, and I should here back from him soon. And finally, I wait the 3 weeks for Dr. Zeegers diagnosis, as I paid him on the 22nd via wire transfer, and made sure he had all my current medical records to date. I am not sure if much will change as far as any diagnosis goes once my new MRI, four view x-ray, and bone density scan are complete. One thing is for sure though... it most likely will show me getting worse since my last MRI six months ago. My pain and spasms are increasing every day. Today's episode knocked me off balance into my wife's arms... which is not a bad thing at all because that's where I want to be anyway. All I could do was laugh the pain away. Most of this info can be found on my blog where I recently added a new post as of last night: http://www.impctech.com/2016/07/this...1-sink-or.html Coram Deo |
Good news
I think this is good news. You have enough info to make an educated decision. I wouldn't wait too long if auto-fusion is looming.
|
Very True
@Romakis
You're right. And we have made our decision for the most part... just taking care of all the required testing before I go. As of today my Bone Density (DEXA) and x-ray (AP/LAT/EX/FLEX) is scheduled for August 1st, 2016, and my new MRI should be no later than the following week. My Orthopedic Analysis Kit arrived yesterday, so I am planning on taking my Orthopedic Analysis Kit to my local clinic next week to get my blood drawn... so that will be done. I paid for expedite service for my passport renewal and have that back. I have to upload all these new tests so my final diagnosis can be made. All the doctors except Dr. Bierstedt have stated that they want to see these newer tests to make sure nothing in my imaging, etc. has changed. By then my diagnosis should be back from Dr. Zeegers. I am mainly getting diagnosis's from other doctors so I can get a consensus between what all these doctors are recommending, and comparing to what my two orthopedic surgeons here in Cali have stated in their reports. However I am pretty firm on Dr. Zeegers or Dr. Andreas Schmitz (just recently started looking into this man and really like him). Then I expect it will take me another week to wire transfer the funds (at least that is how long the wire transfer took to pay Dr. Zeegers diagnosis fee). Once the funds clear I plan on leaving/flying out A.S.A.P. and am paying whatever price it costs to fly comfortably. If everything continues to go as is, I believe I can be flying out of here sometime in September... hopefully. I do not like to sit around idly. I pushed Workers Compensation and made appointments before they were approved to force results, and made sure everything got covered. That had it's negatives because they stopped treating me for 10 months, but not without me continuing to see doctors which is what ultimately made them want to reach settlement. I am going to stay on top of things here too. But, you are right I need to make a quick decision, so I have to keep at this until I get my surgery. |
I purchased my airline ticket with about 10 days notice to Europe this past May. I used a discount broker for business class tickets. Here is the one I used but, you can also Google it and find a couple of others. They should be able to save you about 60% off the price the airline websites will charge. I talked to two discount brokers and they came in exactly the same. Mike dropped his price $100 to undercut his competition. The competition was pretty upset with me but, I didn't have time to mess around with it anymore and I was more impressed with Mike's professionalism. (I started my dialogue and emails with Mike in 2015 but, then my surgery got delayed 10 months.)
Michael Flores Mobile (415) 424-8940 Work (888) 624-6133 Work Mike@wholesaleflights.com I'm not sure where you live but, I live on the west coast. Three legs of my trip were definitely business class and very comfortable. Delta put me on an old airline for the 5 hour flight from the east coast to home on the return flight and it was awful. Truly, the experience was pretty comparable to coach and I was in a lot of pain. I recommend you can get the model/age of the aircraft confirmed for all legs of your trip if you have the time and energy when you are ticketing. Also, be sure to tell them you want a transatlantic flight where the seats will lay completely flat. (I just screwed up and forgot to check the domestic aircraft ahead of time.) Delta's transatlantic flight was really nice in the pods where you can lay down. They did give me some money back on the last leg after I complained to them but, I would rather have been comfortable flying home which was the purpose of paying close to $4000 for an airline ticket. The airlines were quoting over $10,000 at the time! I checked prices on a ticket back to Barcelona for April 2017 recently, and Mike's price was still just under $4000 so, I'm not sure advance notice helps at all like it usually does when buying airline tickets from the brokers. British Airlines is supposed to be one of the best international carriers if you have miles or American Express points to offset the cost. When I wired my funds, I had confirmation from my bank later the same day. I then emailed the confirmation number to Yolanda. Dr. Clavel's office was able to confirm the wire the next day which may have been 48 hours on my end because of the time difference. I can't remember exactly. It should never take a week to wire funds because it's all electronic and that is why you pay a $50 wiring fee. It will be interesting to see what Dr. Zeeger's diagnosis is for you compared to the other surgeons. Dr. Zeegers has a good track record for his lumbar patients on this board! Good to see Dr. Clavel's opinion is in the pack. I trusted him the most but, I was a cervical patient and that may make a difference. Both Dr. Bierstedt and Dr. Zeegers told me two ADRs while Dr. Clavel said I needed to replace three. Having said that, Dr. Zeegers was not certain I was an ADR candidate! He was extremely conservative when discussing my case. Because he wanted even more than the updated MRI, X-Ray and a nuclear test done, I never did get a final opinion from him. He is definitely conservative in his approach! In the end, I definitely took a leap of faith because I couldn't get any of the surgeons to completely agree on what I needed done. I'm glad you have having better luck with that! I'll look forward to reading your future posts. You are on the home stretch! Best of luck for an easy recovery. |
Uh oh...
If I am understanding my Orthopedic Analysis Orthopedic Panel 2 Metal-LTT test correctly, I will "most" likely develop issues with Cobalt alloy, Titanium alloy and Nickel. So does this mean any implant with Cobalt alloy or Titanium alloy is a "No-Go" for me? What would be my options then? To make sure the disc is 100% Titanium or 100% cobalt. Or fusion or just deal with implant pain or even do nothing, and live the way I am?
If I were to take a chance, I would say compared to the pain I am in now, the mild reaction would not be as bad. However, it most likely would introduce other issues that I would have no way of gauging the type of pain, if any, I would feel due to the implants. You no what... this will not stop me. I have lived with Leg Perthes since the age of six and have never had a day without pain. From six to seven I spent almost every night crying and in pain. I am pretty tough now, and I can mentally overcome pain. I just can't make my body do what it can't do because of my injury. I wonder...hmmm. What is the worst this reaction could do to me? Control cpm >> 795.3 Positive control (PHA) cpm >> 63632.0 Bone Cement (monomer) >> 1.3 Bone Cement particles >> 0.8 Cobalt alloy particles >> 2.4 Titanium alloy particles >> 3.2 Known Stimulant (PHA) >> 80.0 Aluminum 0.001 mM >> 1.8 Aluminum 0.01 mM >> 0.5 Aluminum 0.1 mM >> 1.4 Cobalt 0.0001 mM >> 0.9 Cobalt 0.001 mM >> 1.0 Cobalt 0.01 mM >> 0.4 Chromium 0.001 mM >> 0.8 Chromium 0.01 mM >> 0.7 Chromium 0.1 mM >> 0.8 Molybdenum 0.001 mM >> 1.1 Molybdenum 0.01 mM >> 1.8 Molybdenum 0.1 mM >> 0.7 Nickel 0.001mM >> 0.8 Nickel 0.01 mM >> 11.0 Nickel 0.1 mM >> 19.2 Vanadium 0.0001 mM >> 1.8 Vanadium 0.001 mM >> 0.8 Vanadium 0.01 mM >> 1.1 Zirconium 0.001 mM >> 0.8 Zirconium 0.01 mM >> 0.8 Zirconium 0.1 mM >> 0.4 Iron 0.001 mM >> 1.0 Iron 0.01 mM >> 0.7 Iron 0.1 mM >> 0.3 - - - - - - - - - - - - - - Cobalt Alloy Particles @ 2.4 is Mildly Reactive Titanium Alloy Particles @ 3.2 is Mildly Reactive Nickel @ 19.2 is Highly Reactive |
AxioMed Freedom Lumbar Disc
This looks promising except it definitely is Titanium Alloy.
http://www.axiomed.com/pdf/WPaperBiocomp.pdf |
FH Orthopedics
And for the FH Orthopedics LP-ESP (Elastic Spine Pad) I found the following:
"The prosthesis has raised teeth, making it possible to guarantee primary fixation between the vertebrae concerned. A porous, rough HAP (hydroxyapatite) coating on the undercoat of pure titanium (T40) ensures effective secondary fixation. Ribs, joined to the metal parts, make it possible to transform any movement of rotation between the two metal parts into compression and traction forces on the deformable inner part." This information was found http://www.fhorthopedics.com/lombar-disc-lp-esp.html OR http://www.fhorthopedics.com/index.p...action=Display |
Wow, I feel for you. I and Old Codger are the only ones I know of that have gone through the metal allergy nightmare!
I spoke to the "PhD in Immunology" in the lab at Orthopedic Analysis about their test before I sent them my blood. (Sorry, I don't remember his name. I left him a message through the receptionist there and he called me back.) He was very knowledgeable and helpful! I think it would be worth giving him a call. I can thank him for me getting my M6-C's! I was in the same situation as you for about 10 months before I figured out that my first MELISA metal allergy blood test was crap. It was the PhD that pointed me in the right direction because he understood the results of my first test. You need to understand the test results as they relate to the implant you want to get and the only way I was able to puzzle this out was by talking to the PhD plus, seeing an orthopedic surgeon who looked at the titanium I already have in vivo. Your test is non reactive for Chromium, Molybdenum and Cobalt which is what the Mobi-C is made out which is a cervical ADR that is not Titanium. The same metals are in the Prodisc ADR. I don't know what is in the "Cobalt Alloy Particles" that they grind up for their test but the PhD will know. You are more reactive to Titanium so, I would be considering discs that don't have much of it or none of it in them. I am mildly reactive to Aluminum (2.1) but, since the M6-C has so little of it in the end plates, I wasn't concerned about it. The M6's are made up of primarily Titanium. So, in the end, even though I was mildly reactive to one of the metals, I made the decision to get the surgery. It was a judgment call. My last thought on this is that for Titanium they had to use the particles because Titanium is not liquid so, they couldn't just put it in a dropper and drop some on the blood. They had to use particles. This takes me back to wondering what is in the "Cobalt Alloy Particles." http://myspineassociates.com/wp-cont...ient_Guide.pdf I'm not sure what the composition of metals are for the Activ L but, I would check before you call Orthopedic Analysis and ask to speak to the PhD there. It has titanium in it but, the question is how much? The manufacturer will be able to give you the breakdown. Dr. Clavel had the breakdown from the manufacturer for the M6's so, that's how I got that information. https://www.aesculapimplantsystems.c...n_Brochure.pdf Have you spoken to Dr. Zeegers about the Activ L or your test results? One thing I learned when my first metal allergy test came back positive for me being reactive to Titanium is that the surgeons will drop you like a hot potato, so do not show them the test results until you completely understand it yourself. They don't understand these tests because metal allergies are rare according to them but, at the same time, they don't want to take a risk on you. They have other patients lining up for surgery! Dr. Zeegers and two other surgeons in the U.S. dismissed me pretty fast after they saw my first blood test and that was the end of that. It took me months to research and figure out the problem with the first test. Once I proved to myself that I was not allergic to Titanium, I went back to Dr. Clavel. However, I had doctor's notes from an orthopedic knee surgeon from where I live that said it was his opinion I was not allergic to that metal. I have titanium screws in my knee and had to have an MRI of my knee, x-rays of my knee and several appointments with the doctor before we came to that conclusion. Do you have any metal already in your body? This is not an exact science and it was very hard for me to find doctors that knew anything about it. I even went to an allergist who basically said the blood tests for metal allergies are worthless. Don't give up and don't share the test with the surgeons yet. I think you need to know what is in the "Cobalt Alloy Particles" first. Here is my post #169 regarding metal allergies. Not sure if it has anything in it that will help you but, it has some of my research in it. https://www.adrsupport.org/forums/sh...=13049&page=17 Here is what I ended up with: Particles: all were Normal Ions: Aluminum 2.1 (Mildly Reactive) Chromium 2.1 (Mildly Reactive) Nickel 47.7 (Highly Reactive) Zirconium 2.3 (Mildly Reactive) |
@cynlite
@Cynlite
I did email Dr. Zeegers my results and he replied with this: "http://www.healio.com/orthopedics/journals/ortho/2016-5-39-3-supplemental/%7B92d802e1-1cb3-4b04-9394-08d84e60916e%7D/influence-of-surface-coating-on-metal-ion-release-evaluation-in-patients-with-metal-allergy http://www.orthopedicanalysis.com/about-us/testimonials http://www.kreuzschmerzen.org/en/pre...sufferers.html http://www.spineart.com/product-plat...era%C2%AEl/128 etc. etc. etc. the clinical relevance of your mild reaction is not clear at all !" But I don't think I have a real issue, yes with Titanium Alloy, but not with pure Titanium... the allergic reaction is not necessarily because of the Titanium alone, it is because Titanium is mixed with metals such as Aluminum, Tin, Vanadium, Palladium, Molybdenum, Chromium, etc. I may be all wet here, but pure Titanium should not be an issue for most people. FH Orthopedics LP-ESP uses pure CP Grade 2 Ti40 Titanium, and it is not mixed with any other alloys to my knowledge. Adding to what I already stated above about the LP-ESP, Hydroxypatite is found in our teeth and bones so it is naturally a good choice as the top coating over the Ti40 undercoating. This is my first choice. And any chances of corrosion from occurring when introduced into my body should be negligible. I have looked into the other discs, and I do not want the ProDisc or Activ-L (bio-mechanics are not that great... one can cause hyper-flexion, and the other limits your range of motion to not being able to go side to side), nor the M6-L because it does not cover the entire surface of the bone, and can potentially result in facet joint issues later on. I will continue to do more reading, and check out the links you provided. And I will call first thing Monday morning to get a better understanding of what my results imply. And "no" I do not have any metal in my body as far as implants or screws go unless it was done without me knowing... queue eerie music... Well actually everyone does from what they eat... hahaha. |
Baguera-L
And there is also the Baguera-L
http://www.spineart.com/product-plat...era%C2%AEl/128 This should also be an excellent choice because it uses pure Titanium. Dr. Zeegers just pointed this one out to me. |
Comparison of ADRs
I found this referenced site as marketing materials on the web. They appear to have been part of Spinal K's training of its sales force to show the benefits of the M6 over other ADRs. Maybe someone finds it useful in looking at various ADR's
http://www.spinalkinetics.com/wp-con...ompetition.pdf |
M6 or not
I received a response from Dr. Zeegers after sending him the referenced document / marketing of the M6 disc. Before I post his response I wanted to add that I completely agree with his initial assessment as I too have concluded what he asserts. The M6 is not a bad disc, it is just not superior to other choices out there. It appears that Dr. Zeegers really likes the Activ-L. But, there is the LP-ESP, the Freedom and the Baguera-L that are excellent choices as well.
" HAVE TO STUDY all 64 pages pdf doc, but in a glimpse i do not see any superiority of M6L over Activ L - the so called compression=damping effect has never been proved as significant. - cannot find really custom sizes of M6 implant, 2 sizes medium 35mm W x 27mm and large 39x30 only! (undersizing risk !) - no special M6 implant design for L5S1 (remnant L5S1 problems !) - the instrumentation tools from M6 are absolutely inferior to Activ L (no oblique approach, no reliable revision tools) + for example see superior size offer in Activ L discs in brochure pdf + for example see superior instrumentation offer in Activ L brochure pdf regards zeegers " Regards, Nathan Note: This hour of suffering... Part 32 - The End in Sight |
Disc size
1 Attachment(s)
Interesting comments by Dr Z. Can't say I disagree. Activ L does allow for repositioning, easier removal, more sizes. I rec'd the LL for cervical for M6, and it is still a little small according to Dr Clavel. It may not make any significant difference.
Lumbar and cervical are of course completely different but I think what we are all seeing is certain docs prefer certain ADR's. It goes back to what we have heard before....pick your surgeon first, disc second (unless you have metal issues etc). Dr Clavel mentioned that M6C removal was challenging but could be done with minimal risk by a skilled surgeon ( I assume he meant himself but was too humble to say so) Good luck. |
Completely Agree
@phillyjoe
I completely agree. If you do not have confidence in your doctor then you will not have confidence in what implant device your doctor chooses. I chose Dr. Zeegers because he reminds me of my doctor here in Cali. He has been very easy to work with, but I learned something about him that I have come to respect. He is very detail oriented, and precise. He expects people to be more aggressive with their care in that they are proactive not reactive to what needs to happen with what testing, etc. needs to take place. It is always a good thing to let a doctor advise, but the lead should be driven by the patient. I did not wait for him to tell me what needs to be done. I knew I needed a new MRI so I pursued it until it was approved. After I was forced to resign because of the settlement I applied for Medi-Cal, and they are so much easier to get things approved than BlueCross ever was. Next, I read that most of the doctors overseas like to see a Bone Density (DEXA) scan done, so I pursued it at the same time too, along with an X-Ray (AP/LAT/EX/FLEX). The only thing I paid for was the Orthopedic Analysis Metal-LTT test. This test is not full-proof as what I have learned it really reveals is a "potential" risk to hypersensitivity, but it does not necessarily mean you will develop hypersensitivity to a given metal. Especially if your test comes back with Normal or Mild-Reactive results. I started pursuing my surgery more aggressively once I learned Workers Comp was going to settle. Just to be done with them and move forward with my care I settled for just enough to cover going overseas, and then for physical therapy afterwards. Once I knew the settlement was going to happen, contacted Dr. Zeegers on June 19th. Since then I have contacted a total of seven other doctors, and have kept all of them up-to-date on my care. In the end, after careful prayer and thought, I decided to go with Dr. Zeegers. I wire transferred the money to Dr. Zeegers for the diagnosis fee on July 20th, and then scheduled my X-Ray, MRI, Bone Density Scan and purchased the Metal-LTT test, and had everything done and reports uploaded to Dr. Zeegers by August 18th. If for some unforeseeable situation should occur and I cannot continue with Dr. Zeegers, I at least am ready to pursue one of my other choices in the order I prefer, i.e. Dr. Biren Desai, Dr. Clavel, Dr. Bierstedt, Dr. Bertagnoli, Dr. Riiter-Lang, Wooridul Spine Center. I also was in touch with Dr. Rischke, but he is too expensive for me, and Dr. Andreas Schmidtz (never heard back even after four emails) I also agree that the implant comes second after your choice of doctor; and after you factor in potential metal hypersensitivity. I don't think my test results really say that much in regards to metal hypersensitivity. I pose as a risk, but there is not enough evidence to support whether mild-reactive results really are a risk at all. However, I still researched the snot out of all the current implants, and I would feel comfortable having the Activ-L, Baguera-L, Freedom or LP-ESP... still have my reservations about the M6-L being a viable option for the lower lumbar at the L5-S1 or L4-L5 level. This has taken a lot of hard work, and as I posted on my blog you have to run like you know the end is near, the final sprint to the finish line. You simply cannot be lax or slow down no matter what. This is my opinion though, and this is me. Everyone is different and deals with situations differently. Being hurt has turned me into a fierce fighter for my health. |
Poster "henry4956", I believe, went with Dr Z and ActivL for lower back. You might consider reaching out to him, though he isn't very active on this forum anymore
|
Dr. Rischke 2-Level ADR price confirmed
After emails back and forth over the last few weeks, my email this morning definitely confirmed Dr. Rischke's costs for a 2-Level ADR. He does seem like a great doctor, but here is my email sent this morning, and Dr. Rischke's response:
* MY EMAIL * "I received an invoice in my email that was titled "Estimate" and it showed a quote for 38' 600 CHF for clinic costs. I then received a second invoice in an email titled "Microsoft Word - 9524_Honorarvereinb englisch Hull.docx.pdf" and it showed a quote for 39' 500 Swiss Francs for the total amount. Is the 39' 500 the total amount for the clinic costs and the surgeon fees? So is this what I would pay should I agree to have the surgery? Or do I add 38' 600 and 39' 500 together which would equal 78' 100 CHF? Regards, Nathan" * RESPONSE * "Dear Mr. Hull, that’s correct. The amount of all clinic costs and the amount of the surgeons fees ( two surgeons and assistance!) summarize to 78’100,- CHF. best regards" |
Activ-L
I love to research prosthesis devices to find all the ins-and-outs of the implant. The Activ-L is different than I thought with what materials make up this implant. There is Nickel in this device. I received an email back from Aesculap today confirming this.
I posted some very helpful brochures in General Discussion >> Manufacturer Product Information >> Aesculap (Activ L): http://www.adrsupport.org/forums/sho...369#post114369 - - - - - - - Main Website: Aesculap Activ-L Patient Website for Activ-L: So Active, So Fast Attached are brochures and information regarding the Aesculap Activ-L (pictures without any information were deleted within some of the .pdf attachments to shrink the overall size, ONLY if they were not necessary for product marketing):
Material Breakdown: ActivL Superior and inferior end-plates
Additional Information: Bioactive porous coating Plasmapore® coated orthopaedic implants have been used successfully in joint replacement arthroplasty since 1986. The cementless implants are coated with a layer of fine titanium powder applied in a plasmaspray process under vacuum. The Plasmapore® pore sizes range from 50 to 200 μm with a microporosity of 35 % and a thickness of 0.35 mm. These characteristics are optimal for bone ingrowth. Plasmapore® is a very rough surface and supports primary stability better than alternative coatings. Highly crystallized calcium phosphate (CaP) is used as the bioactive material for Plasmapore® μ-CaP. The Plasmapore® surface is combined with a very thin CaP layer of 20 μm, which is applied electrochemically. This Plasmapore® μ-CaP surface accelerates direct bone-implant contact and resorbs without giant cell reactions within 8-12 weeks. Plasmapore® with Dicalcium Phosphate The well-known characteristics of calcium phosphates such as HAC (hydroxylapatite) and TCP (tricalcium phosphate), and various HAC/TCP combinations led to Aesculap’s selection of dicalcium phosphate dehydrate (CaHPO4 x 2H2O) for use with Plasmapore®. Dicalcium phosphate dehydrate (DCPD) is very soluble in vivo, and dissolves into calcium and phosphate ions. During the acellular dissolving process, calcium and phosphate ions are continuously released in a ratio of 1:1, which are then available for bone modeling. In contrast, the poorly soluble hydroxyapatite (HAC) releases only calcium ions from non-HAC calcium compounds (CaO) resulting from the manufacturing process, but almost no phosphate ions. The resorbable tricalcium phosphate (TCP) stimulates giant cell reactions, and is therefore not optimal for use with orthopaedic implants. In orthopaedic implants the transition between primary and secondary implant stability is a continuous process of bone remodeling, characterized by apposition and resorption at the implant surface. The DCPD layer supports the continuous release of calcium and phosphate ions and encourages the formation of new bone structures at the bone-implant interface. Due to the continuous dissolving process of the calcium phosphate, the pores of the Plasmapore® coating remain open for bony ingrowth. Improved bone contact The features of thin calcium phosphate surfaces are important in the short postoperative term. The dicalcium phosphate μ-CaP layer is resorbed within 8-12 weeks in vivo. The dissolving process takes place without any giant cell activity. Simulation tests of the solution behavior of HAC and μ-CaP show a different ion release of μ-CaP in comparison to hydroxylapatite ceramic surfaces. HAC surfaces do not release phosphate ions but in the initial solution phase, calcium ions are released from non-HAP calcium compounds (CaO) resulting from certain manufacturing processes. In contrast, μ-CaP dicalcium phosphate releases phosphate and calcium ions during the entire resorption period with a ratio of 1:1. These ions are available for bone synthesis. Due to the osteoconductive characteristics of calcium phosphate, the bone is brought into direct contact with the implant surface. |
Spine Art Baguera-L
I added information to General Discussion >> Manufacturer Product Information >> Spine Art Baguera-L
See http://www.adrsupport.org/forums/sho...371#post114371 - - - - - - - Website: Spine Art Baguera-L Material Breakdown: The BAGUERA inferior and superior end-plates
|
AxioMed Freedom Lumbar Disc
I added information to General Discussion >> Manufacturer Product Information >> AxioMed Freedom Lumbar Disc
See http://www.adrsupport.org/forums/edi...&postid=114375 - - - - - - - Website: AxioMed Freedom Lumbar Disc Attached are the Whitepapers for the AxioMed Freedom Lumbar Disc:
Material Breakdown: The FLD retaining plates and end caps
|
FH Orthopedics LP-ESP
I added information to General Discussion >> Manufacturer Product Information >> FH Orthopedics LP-ESP
See http://www.adrsupport.org/forums/sho...184#post110184 - - - - - - - Main Website: FH Orthopedics LP-ESP Patient Website for LP-ESP: Elastic Spine Pad [ESP] Attached is information regarding the FH Orthopedics LP-ESP:
Material Breakdown: The LP-ESP superior and inferior end-plates
|
update on Dr. Rischke
I have posted some very helpful information about Dr. Rischke in regards to surgery costs, etc.:
http://www.adrsupport.org/forums/sho...542#post114542 We stopped communicating back on August 22nd, but started again on September 7th. |
where has Dr. Zeegers gone?
So I guess I fall into the a familiar camp of being unhappy with Dr. Zeegers. Did something happen to him... is he okay or is this normal? It is now 7 weeks today from when he said he would have my diagnosis done.
I will be brief, because dwelling too much on negative things impacts your overall well being which can effect your health, and the way your body responds to pain. However, I did decide to use some humor below using "Smiles." I can assure you though that I do not get angry like where I placed the "Smiles." At my worst I may have a look of disgust, but I rarely say anything, and if I do it is just to express dissatisfaction. But even that is done so with care. I do not think holding onto anger is a good nor godly character quality to have. It is better to let things be, and simply move on. Besides, life is too short to be concerned about everyone else's behavior... enjoy what time you have been given because you never know when you are going to die. Enjoy the "Smiles" though anyway. I may have missed a few things, but I will do my best. So, here is the recap of our communication, and unless otherwise stated, all communication was done via email.
|
Overdue update
Without going into any detail here, other than what I already posted "Lumbar L4-S1 (2-level) FH Orthopedics LP-ESP - Nathan" in regards to the outcome of my surgery...
I posted a complete overview from my last blog update on September 25th until today, December 20th. An Overdue Surprise!!! |
| All times are GMT -4. The time now is 11:15 PM. |
© Copyright 2006-2023 ADRSupport.org All rights reserved.