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Second opinion today...

KimD592KKimD592 Posts: 435
edited 06/11/2012 - 8:57 AM in Chronic Pain
and I'm still unsure of what to do. My current NS wanted me to go for another MRI in mid-November and possibly for a CT myelo if the MRI is not clear on which level is the culprit. However, he is pretty sure it is T10-11 and not T7-8 like I had thought. However, when I showed him where the pain is, it is up higher than it should be for that level. In addition, he said I had herniations from every level from T5-T11, which another NS had told me as well.

The NS I saw today felt strongly that it is T10-11 and agrees with the type of surgery my current NS recommended, which is basically to extend the original incision and do another discectomy posteriorly. He said the herniation is very lateral to the left, so there would be no need to go in from the side or the front, because it'll easily be accessed from the back. He said that based on symptoms and my most recent MRI, he would do the surgery. However, he thinks I should skip the MRI in November and just do a CT myelo. I told him about my horrific experience with the first one I had done, and I asked him if he could do it under sedation, and he said absolutely not. He refused to even listen to me and basically brushed off my concerns about it.

I brought my mom with me, and she really liked him. While he was very knowledgable and has a lot more experience than my current NS, who apparently has only been in practice for 9 years (I wish I would have known that prior to the surgery), I just felt like there were a lot of things he would brush off. Or I'd be trying to talk to him about something and he'd cut me off. For instance, I asked about what would happen if I were to wake up and still have pain and the pain were to continue despite having the surgery. My current NS said that being that this surgery would be disc #3, he would be hesitant to do another discectomy because it can lead to instability in the t-spine. So he said if I needed anymore surgery, it would require a fusion. When I tried to ask the NS today about this, he just danced around the issue and never really addressed it. Granted, he had a good point...I woke up from my surgery in July, and the right-sided pain I was having prior was about 90% better. Now I'd say it's closer to 95% better. So the odds are in my favor that the same thing will happen this time. Plus, he said he could cut the nerve altogether and it wouldn't cause any harm. He said I'd just have an area that would be numb, but it would be no big deal.

The other thing he mentioned was doing a foramenal nerve block instead of an ESI. He said the ESI is too risky and really isn't going to help with the pain I am having. He said the nerve block will be "less pleasant" than the CT myelo, and it takes longer than the ESI, because he has to inject the medication into a very specific location. He said it is used for pain relief AND as a diagnostic tool, because if I experience pain relief, then that means that is the disc causing the pain. At first I said, "NO thank you!" However, my hubby reminded me of something. My goal is to try to wait until February to have the surgery, because that is when I will be eligible for short-term disability, which I really need. We simply cannot afford for me to be out of work with no pay. However, that is 4+ months away and I have been in a lot of pain. So perhaps I *should* have the nerve block done, in order to help me get through these next few months. Maybe, just MAYBE, it'll actually provide me with a little relief. The NS said that it can provide relief for as little as a few weeks to a few months. Once again, he said no sedation. My biggest hesitation is, of course, the pain of the actual procedure. I've had SO many health ailments over the last 10 years, and I am just SICK and TIRED of being poked and prodded. It's almost easier having surgery, because at least they put you out for it. All of these tests where I am awake and being jabbed with needles...I can't effing stand it! And that's not to mention all of the IV's, bloodwork, finger sticks for blood sugar because of the steroids, etc.

Anyway, I thanks the NS for his time and told him I needed to think about it. I have a third opinion coming up in 2 weeks. Actually, the one today was scheduled last week. I was at work and a co-worker mentioned this doctor, who has privileges at the hospital I work for, and she said he is really good. I guess he operated on her mom for tumors in her spine. So I called from work last Tuesday, and they were able to get me in for this morning. The one I'm seeing in 2 weeks was the first NS I had seen prior to my surgery in July. He was also the one that first mentioned ankylosing spondylitis, which I have many symptoms of and I tested positive for the gene. I am currently under the care of a rheumatologist, but haven't been officially dx'd yet. So I'm curious to hear what he has to say. I am supposed to have another appt in December with what was supposed to be my third opinion but would now be the 4th. However, I figured I'll see what the NS in 2 weeks has to say, and I'll probably end up cancelling the last one.

In any case, the benefits of having the surgery with the NS I saw today is that it would be done close to home at the hospital I work for, so out-of-pocket costs would be low, and it would be easier for my hubby, especially if he wants to come visit me during my 1-2 day hospital stay. Also, this doctor has much more experience and definitely knows what he is talking about. Cons would be that I didn't really feel that connection with him, and I didn't feel like he was really listening to me, especially when I told him about my horrible experience with the last CT myelo. Also, when he asked me to show him where the pain was at, I showed him and described to him that it's like a band, 2-3 inches wide, that wraps around. He kept showing me where the pain should be from that particular disc. Well, that's all fine and dandy, but my pain is not just there. Grrrr! So those are some big dealbreakers, in my mind. Pros for my current NS are that he specializes in the t-spine, he is affiliated with one of the top hospitals in the country for their NS dept, he did my prior surgery so he knows me, and I feel like he listens to me when I talk to him and tell him things. Cons would be that I'd have to have the surgery an hour and a half away from home, which is harder on my family, so I likely won't get to see family or friends during my hospital stay. It's not a huge deal, being that it'll only be a day or two, however my last surgery was only supposed to be 1-2 days, and I ended up being there for 5 days. Unfortunately, with all of my medical problems, I typically end up with complications, so I don't want to go in assuming it'll just be that cut and dry. Another con is that recently my trust in him has started to fade. However, the NS today confirmed that he believed this new left-sided pain did not occur as a direct result of the last surgery. Oh, and another con would be that he doesn't have as much experience as the other NS, but that's not really a big one for me. I've worked with nurses who have been in their profession for years and are terrible nurses. Then I've worked with nurses who have just started and they are great at what they do, so I think the same goes for doctors.

So, now we wait another 2 weeks and see what happens at my next opinion.


  • Wow, I am sorry that was so long. I honestly didn't mean for it to get like that. I think I needed to lay it all out there for my own personal thought processes, so I won't be offended if you do not read the whole post.
  • The positive is that neither surgeon is looking to jump right in, they both want to methodically monitor this to ensure they are recommending the best solution. Personally, I would try the block. I have not had one but my neighbor was using a workers comp doctor who's partner was the pm expert. This guy treated several people I met with esi and they never got relief and ended up back with the main surgeon for surgery.

    My neighbor realized this and called workers comp and said she felt this guy was not reliable and wanted to use an alternate, recommended pm doctor. Since wc was trying to solve her issue without surgery, they obliged. She had ESI again but in the right spot and it helped for a short bit. Then they did the block on both sides and she said while it hurt initially, after a few days she was doing much better. She is now back at work.

    Good luck...take you time. Remember, back surgery can be a slippery slope...
  • I agree with DNice that trying the block would be a choice I would make for myself. Especially since they are good diagnostic tools as well. If you get some relief, then it will give you that extra boost to make it through the next few months.

    It's a bummer that you have such a needle phobia. I have known doctors to give patients something to take orally ahead of time to "calm their mind" yet not sedate them. Just make it to where a person doesn't really give a hoot about what is going on and also tends to speak their mind without inhibition.

    I think it is good that you are not allowing the docs to influence you as to where the pain is. You feel the pain, they don't, so no matter what their books say about where it should be, stay strong and just tell them exactly where it is you feel it.

    I wouldn't worry too much about being a person who always has complications. I think many of us could write books about that. I only say that, because sometimes we can influence or cause something to happen or go wrong without consciously thinking about it. Just go with the flow and if something happens ... well you will deal with it.

    And yes, you did write a book! My eyes were burning from starring at the screen so long. :) It is good to write things down and see them in black and white. I used to do that with pen and paper, and now it's with computer keyboard and monitor.

    Good luck,

  • I love a good block- even if it only lasts for the day:)

    Kim I am going in soon for another CT myelogram very soon. The one lasy November wasn't so bad for me. I ended up with an arrogant DR (my scheduled DR was out on an emergency). This guy let me take my pain meds right before (I went to the heavy side of my meds). Which was good since I had to stay at the hospital for 7 hours.

    I am glad you are getting the extra opinions- I think they help soliidify your issues.

    Hang in there >:D<

  • The more I think about it, the more I think I may do the block. My only hesitation right now is that I wasn't too keen on this doctor and his bedside manner. So, I think I'll see how my appt in 2 weeks goes. I have a feeling, as long as he concurs with what the other two say, I will likely go with him for this surgery. I really liked him when I saw him last time, so we'll see what he says. I plan on talking to him about what he thinks about doing another CT myelo and perhaps a nerve block. If it'll help hold me over until February, it's certainly worth the added pain. Maybe he'll be more willing to offer me a little sedation. If not, I fully intend on knocking myself out with pain meds that day. Plus, the Oxycodone makes me very itchy lately, so I'd have to take 50 mg of Benadryl to cure that, which usually knocks me out as well. Lol!

    So, 2 more weeks...I can make it through that, right? Then, 2 weeks after that is my next MRI. However, if this next NS concurs and says he thinks I should have the CT myelo, then I'll probably go ahead and have that too.
  • Kim,

    The doctor connection is important. It's sort of why I left my first surgeon. He was capable but he just didn't listen when I said something wasn't right. He treated me as "I should be a success b/c of the large herniation he removed" vs. what I was experiencing. It took quite some time for me to convince him to do another MRI which proved, something was still wrong.

    Then I found another doctor that my husband liked and I 'sort of liked' but was not 100% about. I kept looking and then found a fantastic Neurosurgeon that BOTH my husband and I liked. This was a turning factor b/c the surgeon was conservative but could explain to my husband why his recommendation was different than some of the more 'aggressive' surgeons. He told us neither was right or wrong but that it's a personal decision and explained the different schools of thought. He never rushed us, he told us he was spending time with us b/c he wanted me to chose my next doctor for 'life' vs. trying to solve the immediate issue with the next surgery.

    He won us both over despite being at a very big teaching hospital. I never once felt like a number, I always felt like a patient with my surgeon as my advocate. I will tell you that right after surgery, I panicked a bit and said "Should I have had the fusion?" There were times I doubted him but he had a way of making me know that he was listening, he told me what signs to look for to know if I should call him or worry, he is very open about what medications are available but is not 'pushing them' on me and he tells me they do have side effects.

    So having a doctor that you like and your mom (or Husband) like is important.

    p.s. on the needle phobia, my neighbor was given 2 valium to take prior to the appointment for that very reason. They needed her not to move.
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