Went well. I liked him more this time than the last, and when asked how many multiple level Pro disc surgeries he's done, he said "over 100".. so that sounded good to me.

However, what he recommended for me is a "hybrid" surgery with fusion at L5S1 and Prodisc at L4 (discogram pending).

Reasoning for fusion is that now I am so collapsed at L5S1, he felt he would have to jack that level up too much and the distraction pain would be much worse than if he put in a cage with no screws, no rods, using BMP.. (or do I have that backwards)..

He said he wouldn't put a Charite in at L4 because of the load it would put on the facets (too much movement) and Pro disc would be a better choice for me.

My current OSS wants to do Charite at L4 and fusion at L5S1. He did mention using pedicle screws which I didn't want... I don't believe he's done nearly as many ADR's tho has certainly done as many and more fusions (he's older and practicing longer)..

My Nurse Case Manager said that the one level Prodisc and one level ADR would be authorized as soon as Prodisc is FDA approved which Dr.Bae said should be very soon..

He did add that he "could" put in the Prodisc most likely tho again, he thought the distraction pain would much more significant for me..

Re my past issue with burning pain lasting 5 years and bilateral.. he said yes, that I'd probably experience that again, altho he couldn't say if would be as painful or as long lasting..

He would use ESIs, nerve root blocks, and the same medication I'm on (Neurontin) or maybe something else to combat that..

My bone density is something that he said needs to be better than my '04 report. He'd rather see it at -2.0 (was -2.2) and if it's -2.5 or below he will put me on Forteo for a year or two..

So most likely I will go with his treatment as it sounds the most comprehensive at this point...

Tho I had to use a transportation service WC provided last yesterday and they sent out a person driving a regular small to mid size vehicle and I need something more like SUV to travel in as my arse was killing me on the way back stuck in rush hour traffic for over 2 hours!

Ok, that's it I think...

Well Maaria--

Congrats on wading through two different surgeons and approaches and coming to a tentative decision!

I'm finding the different discs appear to be more of a surgeon's personal preference than any real distinguishing factors (speaking for my case alone).

'Soon'. Another one of those vague, elastic words. Any idea of a range in your case?

Hoping things will clear soon and you'll see your route clearly paved!

Trace

Trace,
thanks for the reply!
Soon re FDA approval for Prodisc .. he thought it might be as early as "next week or next month".. but he was adament that it's soon~

I've actually had opinions from Dr.Bertagnoli via mail twice, Dr.Regan (LA by mail) once, Dr.Bae twice, Dr.Bradford in SF once (first time seen for ADR in '03) and my OSS who when I first mentioned ADR to him back in '98 he guffawed about it.. saying I'd never be a candidate.. then about a year ago, he even agreed that I might be a candidate for 2 levels, or at least one ADR and one level fusion..

First things first, schedule Bone Density test..then weigh in on results..either way both surgeons wanted to see that with a t score for lumbar spine of -2.0 versus anything below...

Maria,
You have really done your homework. It's great to see you making progress. I'm keeping my fingers crossed that your bone density is okay.

Mariaa,

Before my 3 level, Dr. B, Dr. Regan and Dr. Delamarter all agreed that S1/L5 was too narrow for an adr.

Dr. B ultimately did the adr instead of a fusion and I had and still have severe distraction pain.

Can't say for sure but if I had to do it over again, I'd definitely consider the fusion.

Dale

Was wondering about you the other day Mariaa. Good to see your post.

Was reading article today I think from NY Times(tore article from paper and pretty sure from the print it was Times, but can't tell for sure now if it was) about Medicare Aid and the Charite and in it they stated "Prodisc-1 from Synthes, a Swiss Company, is expected to receive final approval by Septemeber." For what its worth, hopefully for those waiting its sooner.

Article was critical of the study used to compare the Charite to fusion, saying it was comparing to a spinal fusion that is no longer state ofthe art and was only showing the Charite to be equivalent, not an improvement. Further stated, the data did not provide information on how well the disc would perform over two decades or more.

Other thing found interesting are some stats on insurance companies approving Charite surgery presently. Says about 60 insurers according to J & J, but only 2 are nationwide. About 25 percent of the regional coverage comes from worker's compensation companies. Our firm is likely going to be taking one WC carrier to a hearing shortly, we'll see where that goes.

Good luck and hope you can get moving on getting your problems resolved once and for all!!

Bill

Take care, and

Maria:
Have been thinking about you and your appointment but this is the first time I've been able to log in in a few days--glad to hear that you are still being supported for ADR but all these permutations must be confusing. Here's hoping your bone density results are good.
Barbara

Maria, I went to see Dr. Yue for my follow-up on Wednesday and he told me ProDisc was approved that day.
I would check it out, I would think he would know and I had expected to read something about and have seen nothing as of yet.
Judy

Thanks for your responses all..
Getting this last denial/non certification for 2 level ADR that shouldn't have even been sent in as the doctor who saw me doesn't do ADRs and referred me back to Delamarter's practice in Santa Monica where I had already seen Dr.Bae 2 years ago.

Now Dr.Bae feels I would be a better candidate for the fusion with BMP at L5S1 and Pro disc at L4 should L3 be Ok... however, I grow weary of the length of this process w/ WC and feel like packing it in and going to Europe~

To do so, I'd have to close out my case w/WC and lose my future medical benefits..

I've had a cold the last few days and am feeling run down and where I originally said I was disgusted not deflated re the UR 5 page non certification, I'm now deflated... just so tired and weary with all the crap.

Oh well, I'll get a new wind once the cold is over and spring weather hits... thanks for your replies... the non certification took the least supportive Charite evidence and used that as a basis for non cert.. plus wanting years more studies/doc as in fusion (failure?).

Maria, Termination of future medical benefits appears common in Workers Compensation. I wouldn�t give in to their hostage situation last year. They denied me 2 level even before I made up my mind not to give up future medical. Does it make sense that these people who have not done the right thing all along should be able to demand a �We�re Even� settlement. I just spoke last night with one of Connecticut�s� worse WC cases. As seasoned as I think I am, I could hardly believe what he told me. I was shocked to learn they really are corrupt. He was injured in 1984 and settled in 1997, waiving future medical. Maybe the message is, �They will get you in the end�. I know you have held onto your WC medical benefits all these years. Where would you be today if you gave them up? My question I guess is: Does anyone know what we can do to maintain our future medical benefits which we certainly are entitled to?

Bill,
There is someone named Tamara at www.braintalk.org on the Workers Compensation forum and she is an injured WC attorney. She had worked in CA. so knows the law for this state tho is pretty good about giving info... anyway, you may want to go over there and see if you can make an inquiry to her. TamaraShadow is what she goes by..

I really don't want to give up Future Med as the Neurontin I take now and will have to take likely the rest of my days alone is very costly...not to mention other needs I may have if ADR leaves anymore residual pain or further diagnostics and procedures have to be done like I see here often...

WC sucks tho they do have some very caring employees that try to do their best to be advocates as best they can within the system, at least this has been my experience to date...

Hi Maria, I will give your suggestion a go right now. Thanks. Bill

I called Dr.Yue's office yesterday and inquired re the Activ L study.. guess I didn't have my head on straight as I should have been aware it was only a one level study as well as having exclusions such as multilevel degeneration and whatever else that makes me not a candidate for that study...

In fact, the person I spoke to was very nice (Laura) tho she referred me to Dr.Delamarter's office out here re getting a multilevel Prodisc or hybrid surgery~

I told her I had heard it would probably be around 2009 when the Activ L might be FDA approved and she said, yes, she thought that sounded right with the duration of the clinical study and all..

Ok, I'm clear there, got to either go to Europe, or move on here.. need to stop/prevent the domino effect.

One thing for certain, all that my regular OSS told me was true. I doubted him (or wanted to doubt him) tho he was correct, at least for what would be the best plan to get by WC if there is any chance currently...

Mariaa,

Asking you to forfeit all future medical benefits if you don't go along with 'their' recommendations when you're in pain, is clearly blackmail, coercion and intimidation. You would be signing such a document under duress, you're only mindset would be getting rid of the pain. This signed document, though done with your full understanding would probably not stand up to legal scrutiny. I'm not an attorney but suggest that with all the delays wc has put you through, I'd march myself to the nearest attorney's office. You have a right to a speedy relief.

As a past employer, I watched employees win wc cases quite quickly that had no merit because they had outside representation and others that should have been covered, denied. The bottom line with all insurance companies, regardless of the coverage, is the bottom line. I realize that we live in a sue happy environment but the reasons are we're being denied our rights by big business. To put it in the simplist of terms, they started it and sometimes we just have too much to lose. We need to fight for our rights and often need professional help.

Though I doubt you'd get wc to pay for surgery overseas, forcing you to give up future benefits when you're getting the best medical care possible, is wrong. You've been around the block too much already and you should be included in any choice made for your health. I wish you and everyone else in your situation good luck. Please remember that a bully is a bully regardless of what they call themselves.

Dale

Dale,
California Worker's Compensation has been under some legislative reform implementation since Oct.2005. Right now I think all WC insurance companies are mandated to go "by the book" tho prior to this date, while Utilization Review denied or non certified a request for a 2 level ADR for me back in 2004, the WC insurance co. itself was willing to pay, but I wasn't ready at that point to have it. (also was thinking if they want to pay, what's wrong?)...

I've had liftime future medical benefits since around mid '80's. Last time I used the WC legal firm that represented me thru original case and reopening, I then had to use some of my own funds to retain the law firm in the '90s. It was worth it as I won back that $ plus more thru penalties.. however, at this point, I don't really have anything to fight just yet as I still have a legal process to follow which is apply for authorization and appeal .. go to arbitration.. so forth which I believe at which point I might be several more years older, and more implants would be approved and more data around for backing up use of implants vs. fusion..

Anyway, I thank you for your support and wishes for myself and the everyone else that has to deal with the WC process~

BTW, I think there have been some cases where WC has paid for a few 3 level ADRs overseas.. or at least one already that we know of and maybe one pending...

take care and thanks ~ Maria

Hi Maria,

Sorry I have been out of touch, that�s what�s going to happen to you someday soon. Glad you liked Dr Bae. My prayer for you sister is that you can come to a decision that gives you piece. That you feel in side is truly right for you and your body. You will know when this happens and I think you may be close.

I was given that same fusion option at L5-S1 for the same reason. You can see my MRI in my Blog, now that�s what you call flat! Then again Maria you are much smaller then I and I did suffer from distraction pain but no where near as much as Dale.

Keep me posted on your decision.