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Help understanding NS

HaylieCatOwnerHHaylieCatOwner Posts: 117
edited 06/11/2012 - 8:31 AM in Back Surgery and Neck Surgery
Six weeks ago I saw my NS, who reviewed my latest MRI with me and said he wanted to see me again this past week because another surgery was likely in order because a disk fragment or a piece of cartilege or "something" showed up on the MRI that is pushing on the nerve 3 mm. (I saw the fragment (or whatever) myself and have the radiology report). He was concerned about my right foot, more specifically, my inability to stand on my toes on that foot alone (in other words, to stand on one foot, on my toes, with my leg straight).

I had my appointment last Thursday for him to discuss surgery options. Let me preface this by saying that he had told me on my last visit that the surgical procedure would be pretty much the same in the surgery -- go into the same incision site and remove the fragment, same recovery time.

I arrived (with my mom for support) on Thursday for my appointment, and the secretary had no record of it. She literally got defensive and rude, saying it wasn't her handwriting on the appointment card I showed her. They said the NS could still see me, which was good since both my mom and I took off work to be there. I didn't tell the secretary this, and I didn't get upset with her.

The doctor came in, and saw that my foot is a little stronger -- I still am not perfect on standing on one right foot, on my toes, but I can do it a little more since I've been practicing the past 6 weeks.

I don't know if it's because he wasn't ready for me since they didn't have my appointment, or what was the deal, but he was completely different in this appointment in terms of his thoughts about surgery. Last time I saw him, he said it was likely eminent, and it was bascially the same procedure. This time, he went into how there was a wider cavity around the nerve after the microdisectomy, which is always a concern, and he said they might have to do surgery down the road, and it would be exploratory surgery. He said they would go in and "remove more bone" and look around and do a laminetomy (sp). This really confused me, because they didn't do this last time. I mentioned the MRI and his statements last time. He still said he would see me in a few months (in August), and that I can lift up to 30 pounds -- this was weird because I have been on an 8 pound limit since my surgery, and the last time I saw him he said I needed to be even more careful. Otherwise, same restrictions -- nothing jaring, no running, be careful.

I told him I was concerned because I was only able to sit for 20 minutes at a time and spent much time lying down, that I haven't worked a 40 hour week since the surgery, and I wanted to know how long until I could have a normal life back. He said it would be at least 6 more months living like this because they didn't want to operate.

I was really confused by his statements because all along he has always said the MicroD went well (the disk itself looks good), and when we review the MRI last time, he said going in to remove the fragment (or whatever it is) wasn't a big thing and would get me on my way. Yet now when I see him, he talks like surgery isn't something he's interested in, that this pain is going to be long term, and that my life is going to be more of the same of lying down on my couch and being limited. Like that's no big deal.

He made other comments too that confused me. He said, matter-of-factly, that my reflex would never be normal again in my right leg (I had him repeat it because he said it like it was no big deal!). I asked him about the Lyrica -- which his nurse had said he wanted me to take (and I started taking 2 months ago) because it was supposed to help my nerve damage from my last surgery actually "heal." Well, when I told him I was concerned about the continued side effects, he told me I could go off of it -- he said it does NOT actually heal the nerve and wouldn't make any difference.

He then talked about other pain killers he could write me scripts for, and again I was confused because the whole goal was to move toward not being on the pain killers. I am worried about this being ongoing indefinitely, and the fact it's just fine with him that I have no life and have ongoing pain.

I'm weaning off the Lyrica because it makes me too fuzzy to do my job. The pain I had before going on the Lyrica wasn't serious enough to start it, in my opinion, but I went on it because the NS's nurse said it would help "heal" my nerve damage.

I am scared about just leaving things up in the air -- I don't want further nerve damage if that is a possiblity from the disk fragment being left in there.

I apologize for the long post, but I am really confused. I had braced myself for immediate surgery, and now it's like he's not interested in doing it at all? Part of me wonders if he was blowing me off as a patient, and I should go try and find another NS? I would think he was so pleased by my ability to stand on my toes a little bit that he doesn't want to operate, but everything he said about the sugery procedure was "off", making me think he wasn't really focused on the details of my particular case at all. Any thoughts would be greatly appreciated! (That is an understatement!)




  • I'm not sure either what is up with your doctor. All I know is that when things don't go as expected or you fail to improve, they get frustrated. Nobody likes to admit something went wrong or that they failed to relieve your problem. I think he wants to wait and see if there are any changes in your situation.

    Lyrica doesn't cure nerve damage- nothing does unfortunately. It just treats the symptoms in the hope that the nerve will one day heal. Remember, it can take up to 2 years.

    Maybe you'd want to seek a second opinion about your case. Somebody needs to give you straight answers so you're not confused anymore. I'm glad my NS was upfront with me, and I knew what I was getting into when I had my fusion. I understand how frustrating it is to not be able to sit down without pain, or do anything without it for that matter.

    I hope things work out and you get relief from your pain. Take care
  • Thank you for feedback on this. The NS I have is supposed to be "the best" -- but I don't know what to think. Part of me thinks the MRI indicates something needs to be done, but when he saw what I can do (standing on toes somewhat) he thinks the surgery can wait?

    How do the neurosurgeons feel when you want a second opinion? Do I ask him for the MRI or go back to the hospital where I had it done?

    Thanks again,

  • I'm trying to make sense of all this. Did the surgeon have your MRI in the room while he was talking with you and did he look at it and discuss it with you?

    Do you have reason to believe he had your information in front of him? Is it possible he had another patient's file for reference? It sounds like he didn't really remember the specifics of your case. I have had my surgeons tell me slightly different things, but certainly not to this degree.

    It may just be that before the fragment was badly compressing the nerve and by now it has moved enough off the nerve that he feels it is OK for you to wait awhile to see what happens.

    How do you feel about your symptoms and level of pain? Does it seem like you have made progress from one appointment to the next?

    I guess if you feel you are going the wrong way, you may want to have a consultation with another spinal specialist. You can just call the surgeon's office and tell them you need the MRI for another appointment. (Or, if you think the MRI is stored at the hospital, call their records department.) You don't even need to tell them it is for a second opinion. You could be borrowing them to take to a PM doctor, a physiatrist, even a physical therapist. Remember, you are the consumer in all this. You paid for the MRIs and you have a right to them.

    However, IF you want this surgeon to do further surgery, if you should need it, you will have to assess what his personality is like, what his reputation is, etc. You are the consumer, but he also has the right to refuse to treat you...so, you'll have to decide what his reaction might be if you have a revision surgery with another specialist. Surgeons can be touchy about this.
  • First off, I love your cat! I have one who looks remarkably similar, and he's a character. If I were you, (easy to say) I think I would push for another app't. with this guy and remind him of all he said during the first post-op visit. It sounds to me like he doesn't really remember your earlier conversation. Its been my experience that these guys love the surgery aspect of their job, but aren't too interested in the human aspect. As though they look at talking with us as a hindrance to getting on with what they love. Don't get me wrong, I'm glad these women and men have the knowledge, ability and desire to do what they do, but some have pretty poor people skills. That's my two cents worth, I would write everything down that you can remember from the first app't. and ask him point blank about that fragment...it's obviously having a negative impact on your life and that is NOT acceptable. Good luck, Sweetie, and let us know.
  • Do you have my same NS??!

    I went through that in '07! I get told that I need to bring my husband in for my next apt., that I need to seriously look at surgery. I go in for the follow up apt, both DH and I had to take off work, waited 3 hours in the waiting room - and then nada - nothin' - zilch. The NS acted like it was just a routine hi-how-ya-doin'-things-look-fine apt.!!

    I did ask for a second opinion, some where in all this process, but was told by my insurance that NS's really frown on patients going doctor shopping. Like I was asking for drugs or something (I wasn't - I'm terribly anti-med.)

    I thought I was being wise - asking for a second opinion. Apparently that doesn't hold true in my area.

    My post-op opinion (for what it's worth) is GET that second opinion anyway. Not that I had a bad experience, just that I think it's important enough to make a stink over it.

    How are you doing on pain? Do YOU feel like you are getting better? You said you haven't been able to work a full 40 hours yet - I also can't lift up onto my toes with my right leg (the numb one) since surgery. It is what I would consider a big enough issue to want to get it fixed - particularly since nerve damage is SO touchy - the longer it's compressed the less likely it is to heal.

    I bet coming off Lyrica will help on the fuzzyness - I only managed 2 weeks of that stuff (pre-surgery) before I was a non-functioning blob and had to stop taking it so I could function again.

    Best of luck - wish I could do more...

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