Did I choose the right procedure?
I consider myself a really savvy and well informed patient. After all, I have been working in the medical device business for over 20 years. When my low back pain got to the point where I could not stand it any longer, all I had to do was tell my family doctor that it was time. It took him three seconds to whip out the referral book. Within one week I had an appointment with the local, “best-of-the-best” Orthopedic surgeon.
Well, my new found doctor convinced me that he really knows what he is doing and, he has performed similar surgeries on hundreds of people so, the only way to ease the pain, especially since I had exhausted the physical therapy options, is to have the surgery. He explained that the implants he would be using were the latest and greatest, and that the rods and pedicle screws are as safe as Mom’s cooking.
When I asked about other devices or procedures, he flatly stated that there are many other companies out there that make similar devices to the one he uses but, in reality, they are all substantially the same. So, without further question, and assuming that my doctor would choose the right procedure for my personal case, I opted for the procedure.
I am not a medical doctor so, I can only explain in layman’s terms as my doctor explained to me. My case is not unlike many others. I have degenerative disc disease in my L3-L4 and L4-L5 discs. The nerves were compressed and causing radiating pain and numbness primarily down my left leg. The numbness on the top of both thighs was constant and radiated down the legs when the low back would spasm.
For the most part, the pain was mild and tolerable until a slight misstep or twist caused the low back to spasm. Ouch! Time for pain meds and muscle relaxers. Usually, the pain and spasm would only last for a week and then I would return to “normal”. It is kind of funny because every time I would go to my doctor he would ask me to rate my current pain level on a scale of one to ten. The “Macho Man” kicks in and I would hear a number of five or six come out of my mouth. WOW, was that a mistake! Knowing what I know now, the number should have been fifteen!
As for the stabbing pain that occurred during the spasm period, the doctor explained that it was caused by the nerve compression at the narrowed foramen. This was, in part, degenerative and due to advancing years. Fifty-six? Advanced? Oh, well….
The doctor explained my options as follows:
1. No action and continue the pain medications and muscle relaxers as needed.
2. A rigid physical therapy program to strengthen the surrounding muscles to better support the compression sites.
3. Traditional spinal fusion of L3-4 and L4-5 using two PEEK implants and a
pedicle screw and rod system.
Kill the first option. There is no way that anyone in their right mind should continue a lifetime of pain medications.
Option two. I had to try this first because, quite frankly, I am afraid of a major surgery and would do anything to avoid it. My doctor referred me to a licensed physical therapist for 10 weeks of PT. In my case, the PT only caused more pain. The therapist agreed that there was no other recourse for me except surgery.
Option three. At this point, I was in such pain that I could not stand it any more. My doctor explained the implant options and the procedure. A date was set. Time for the knife.
The result? In my case, there were several complications that made recovery difficult. I developed an Ileus (lazy bowel) that lasted three days. No one told me (or my wife) about the after surgery complications. Well, I made it through it.
Here I am, a year later. The back is pretty good. No major pain as long as I don’t do anything stupid. My lifestyle has returned to quasi normal. Pain pills are a thing of the past. Mission accomplished, right? Well, not exactly…… Are there any complications? Definitely YES! No one really explained the restrictions that are inherited with a multi level fusion.
One of the hardest things to do is to trim my toenails. Pulling socks on presents a challenge every morning. I now have an assortment of slip-on shoes because of the pain associated with tying shoes. Golf? I can’t bend over to tee up the ball anymore, I have to squat. Carrying anything more than 25 pounds presents compression pain. Running is totally out of the question. Going up and down stairs has a whole new set of rules. It seems that I cannot tolerate shock nearly as well as before, so I have to walk more on my toes. Balancing on one foot is near impossible. Water skiing? Snow skiing? Bike riding? All gone.
Remember the numbness? Well it is still there but, it is a lot different now. Instead of over the top of the thighs, it has permanently settled in my left leg and foot. No feeling in the foot below the ankle. The little toes are really bad, even to the point of cramping and waking me up at night. A few minor nerves may have been severed during surgery but, no doctor would ever admit to that. The good doctor said that nerves take time to regenerate and the feeling would be back in a few months but, it has not.
It seems that I have be really, really careful with compression and shock. Hitting a pothole while riding a bike or leg compression while skiing cause immediate sharp pain. After performing some research on the web, I think I found out why.
When a spinal fusion takes place, the natural shock absorbers (annulus) are removed and one or more levels of vertebrate are permanently joined (fused) and become one level. In my case, I had a two level fusion so, two of the four shock absorbers were removed. The remaining two shock absorbers now have to carry the stress load of four.
I guess it would be like taking the shock absorbers off a luxury car. It would ride OK until you hit bumps in the road. If you hit enough bumps, something else is going to break.
Monday morning quarterback:
Did I make the right decision? Did I choose the correct option? I think not! Well, you ask, the pain is gone, right? Yes, that is correct. You have returned to a normal lifestyle, right? Yes, that is correct. You are not taking any pain meds, right? Yes, that is correct. Well then???????
In fact, I made a few serious errors in my decision process.
1. I trusted my doctor.
2. I did not perform enough research on my condition.
3. I did not research other implant options.
4. I did not research the spinal industry.
5. I trusted my doctor.
Let’s take these one at a time:
Number one: I trusted my doctor.
It appears that my doctor had a hidden agenda that he failed to reveal. He is paid a consultant fee or a commission for using a particular brand of implants. I’m not exactly sure what financial arrangements he has made with the implant device manufacturer or sales representative but, somewhere along the line, someone is making money to promote a single line of devices. I may be that the hospital limits his choices also but, I have no way of knowing this.
There are many, many manufacturers of devices out there. Why did my doctor choose the one I got? Why did he not make me aware of the pros and cons of the other manufactures? How can I be sure that he was not biased toward the brand he sells?
Let’s make this really clear. A doctor (or hospital) is in business to make money. If there is more money to be made selling one product over another, that is the product he will sell. A doctor may genuinely care about the wellbeing of his patients but, if he can make extra money by pushing a particular product, he will. Think of your doctor as a car dealer. If you go into a Chevy dealer to buy a car, you will not be driving out in a Ford.
Number two: I did not perform enough research on my condition.
This is all on me! I believed my doctor when he told me what my condition was and how to resolve it. If I had done my research, I would still have had surgery but I would have ended up with a different kind of implant. As a matter of fact, I would have had the surgery at a different hospital and by a different doctor.
In my case, I had two adjacent levels, L3-L4 and L4-L5, that were degenerated. My doctor convinced me that a two level fusion was the only solution. When I asked, I was told that the motion preservation devices that are marketed by other companies would not work. I assumed that he was the expert and accepted his conclusion.
I did not have any other spinal conditions that were revealed to me. No curvature, twisting, excessive wear, fractures, or anything else that warranted additional attention. I simply had two degenerated discs.
Number three: I did not research other implant options.
My doctor convinced me that the PEEK plastic device that he installed in me was the best alternative for me. He explained the virtues of PEEK over titanium and stainless steel and, I must admit, I wholeheartedly agree. What he did not tell me was that there are other material options such as compressed regenerated tissue, bio-engineered material, Hydroxyapatite (HA) coated implants, and others.
Since my surgery, I have been fairly active, on line, researching other options that would have been better for me. Knowing what I know now, I probably would have opted for motion preservation devices that would allow more natural freedom of movement and shock absorption.
There are a few new devices on the market that allow preservation of motion. From my new found experience, I would be skeptical when reviewing their sales claims. Any device that is inserted bone to bone, would need explanation as to how shock absorption is handled.
Had I had spent even one day on the internet, I could have narrowed my search down to one or two companies that make motion preservation devices that would have spared me the ongoing restrictions I now tolerate. There is even a company, Raymedica in Minneapolis, that makes a pillow type device that replaces the damaged disc and allows full motion preservation and natural shock absorption. Of course, there are several other companies that make similar devices. I just wish I had checked out this technology before I made my decision!
If I had tried a device of this type first, and it turned out to be right for me, I would be able to bend over now without restriction. Also, with this type of device, if complications arise over time, the fusion route would still be an option. Once a fusion is done, it can not be reversed.
Number four: I did not research the spinal industry.
WOW! Dog eat Dog! Everybody makes spinal devices. I’m surprised that Wal-Mart doesn’t carry them! In reality, there are many companies that make spinal devices that are life saving and life changing. Every company markets their products and has a sales and distribution system.
Some of the larger medical device companies offer hospitals volume price discounts in return for exclusive sales agreements. Smaller companies depend on national or local sales representatives to market and sell their products. Still other companies offer surgeons investment opportunities in their companies to market and sell (use) their products.
All medical device companies depend on sales representatives to sell their products. There are thousands of jobs for sales reps on the internet and on company career pages. Without them, no company would ever sell anything. They attend seminars and trade shows and literally go door to door selling the company wares. They are paid big commissions to attract surgeons to use their products.
No matter how you look at it, there is money to be made in the industry. I should have asked my doctor if he had an exclusive agreement with a particular hospital, surgical clinic, sales representative, or vested surgeon. At the very least, I should have asked what products he used and, if I had done my homework, why he did not use others. For all I know, the devices in my back provided the highest profit margin for my doctor.
Number five: I trusted my doctor.
My doctor does not walk around with my back. I do! Putting my trust in one doctor was a stupid decision. At the very least, I should have obtained a second opinion. I don’t mean a second opinion in the same hospital either. A true second opinion should be obtained after researching other surgical options such as the pillow type device I mentioned earlier.
A trip to a doctor that has experience with alternate processes is not all that expensive or time consuming. As a matter of fact, a phone call to your medical insurance carrier is all it takes to get it started. Most insurance companies will assist you in arranging the trip and will provide financial assistance, especially if the alternate process is less expensive. Do not lose sight of the fact that the operating surgeon will be making a lot of money performing your procedure. Surgeons routinely offer free transportation and facilities as an incentive for using them and their products.
In my case, my doctor performed surgery and left me with a lifetime of restrictions. I truly believe that, had I been more diligent in my personal evaluation, I would have selected a procedure and a device that valued motion preservation.
I am still satisfied that my decision to have the surgery was correct. I have far less pain than I had a year ago. Did I make the right decision? Yes, I did. Did I select the right doctor? I will never really know. Did I have the right devices installed? I will never really know. Will I ever trust one doctors’ opinion? Absolutely not! Absolutely not! Absolutely not!
Had I spent just a few hours of research on the internet, I would have realized that there are a plethora of devices and procedures in the spinal world that may have better fit my needs. My results are final and irreversible. I can live with that but, what if?……