Question for a surgical consult...

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Draka
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Date Joined Jun 2009
Total Posts : 256
   Posted 3/15/2011 6:46 PM (GMT -6)   
Hello everyone,

Tomorrow afternoon I am having second surgical consult.... I think this time I am going to go through with the surgery.... I had a consult last year and put off surgery
I am at the point where I can no longer take the grating constant pain so I may go through with the procedure.

This is for my chronic neck pain.

The Dr I am seeing is very highly recommended and appointments usually take 3-6 months to see him... just from reading my MRI report his staff made my appointment in one weeks time.

I am starting at 11:45... I will first get another MRI, then CT scan followed by X-rays... my appointment with the Dr. is 3:30.

I am quite nervous and was wondering if anyone could help me with questions to ask the DR... seeing this time I am ready for the surgery.

Thanks in advance


Tirzah
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Date Joined Jul 2008
Total Posts : 2317
   Posted 3/15/2011 10:40 PM (GMT -6)   
Do you know what kind of procedure they are recommending?

If not, ask.
What other options might s/he consider? Why did s/he rule those options out?
Is the treatment considered experimental for your diagnosis?
How many of that particular procedure has the surgeon done & how long has s/he been doing them for?
Will anyone besides the surgeon participating (interns, residents, junior surgeons)? What are their credentials, if known?
What kind of closure is being used? Who is closing? [If it's important to you, you could ask if a plastics specialist could do the closure. Some surgeons are okay with that, others aren't.]
Who will manage pre-op & post-op pain meds (him, your PM, someone else)?

Beyond that, just the basic stuff: recovery time, risks, downsides, what is considered a "successful outcome", what if it fails/makes you worse, how long in the hospital, how long will it last (i.e., when will you likely need to repeat the procedure), etc.

hugz & prayers,
Tirzah

Draka
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Date Joined Jun 2009
Total Posts : 256
   Posted 3/15/2011 11:01 PM (GMT -6)   
When I went for a surgical consult last year with another DR. he suggested doing a ACDF (Anterior Cervical Discectomy with Fusion)

I thank you so much for responding Tirzah!

I appreciate it so very much.

I printed out your questions and am going to bring them with me tomorrow to ask the DR.

Thank you, thank you again!!

Post Edited (Draka) : 3/15/2011 10:14:26 PM (GMT-6)


desert
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Date Joined Feb 2011
Total Posts : 93
   Posted 3/15/2011 11:15 PM (GMT -6)   
Hi Draka. What kind of surgery are you getting the consult for?

I'm actually headed in to talk with a surgeon tomorrow about a possible fusion in my neck. What a coincidence, yeah? Anyways, I've been quite nervous myself about it and have had plenty of time to make up my own list so here's the big ones from my ~3 page list:

What are the risks for this procedure both immediate and long term? If the surgery failed for some reason, what would we do about that?

What is the recovery time frame for this procedure? What restrictions would I be under during recovery and when would they be lifted? Once recovery is complete, would there be any remaining restrictions on my activities?

How would this procedure specifically relieve pain for me?

Would I have to stay in the hospital after the procedure at all? How long? How long is the procedure itself? What will I need to arrange in terms of rides to and from the hospital?

What are the alternatives to this surgery? Are any of them less invasive? Is this the only option for a permanent fix? Why is this surgery a better choice than the alternatives?

How often does the surgeon do this particular surgery? What success rate has he enjoyed? What side effects has he encountered in the past?

What would the plan be for my pain medication leading up to the surgery? After the surgery (both for surgery recovery and continuing pain from the original issues)?

I had a bunch more that were either specific to my personal situation or the specific surgery I believe the surgeon will be recommending. If you want some of those too, shoot me a quick email and I'll get them to you. I hope your consult goes great tomorrow and please let us all know how it turns out.

-Jeff

Draka
Regular Member


Date Joined Jun 2009
Total Posts : 256
   Posted 3/15/2011 11:35 PM (GMT -6)   
Jeff,

Thanks those too are great questions to ask.... my printer is running again!

My consult is with neurosurgeon for my neck... I think it will be something like the opinion I got last year for a ACDF... we'll see

I'll let you know and keep me posted too... I am very nervous tonight and I know sleep won't be easy!

Jeff.. are you located in south FL by chance?

nvrthesame98
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Date Joined Jun 2008
Total Posts : 6706
   Posted 3/16/2011 3:18 AM (GMT -6)   

Hey Jeff you already got alot of info and I cant add much more to it but wanted to wish you luck and make sure that your comfortable with the odds of the outcome your expecting,do your own search afterwards whenn you know exactly what it is he wants to do to you. The internet is an astonishing wealth of opinions and educational material and alot of times you have to sift thru alot of it but you will be able to see what others have gained or lost from this particular procedure.

 

Good luck! Please let us know how it turns out and I m sure you will be worn out after your long day ahead but just drop in drop a note when you recoup some.


desert
Regular Member


Date Joined Feb 2011
Total Posts : 93
   Posted 3/16/2011 7:38 AM (GMT -6)   
I like Tirzah's set too, my list (and therefore appointment) just got a bit longer :-).

I do hope you've slept well, Draka. And that you're feeling better about your meeting today.

I'm located north of Denver, CO. I've actually been in south FL a couple times this year to visit family, though.

This forum is a great resource. I've asked here before and, as nvrthesame98 pointed out, got a positive dearth of information on this type of surgery. I find that the more I know about a procedure the less nervous I get. If you're the same, definitely do a search or ask the questions.

Btw, thanks nvrthesame98.

-Jeff

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 3/16/2011 10:15 AM (GMT -6)   
Draka & Jeff
I have had two ACDF's done first in Mar 1985 C-6/7 and last inSep  2009 at C-5/6 and a Posterior fusion of the Articular Joints at C-3/4 the last two neck surgeries that I have had I have  been under  treatment for Chronic Pain, and both the last surgeries I had some major problems with pain control while in the  hospital for the surgeries. If at all possible I would talk to your PM Doc and arrange that he/she continue managing your pain control while in the hospital!  I know the my surgeon and the staff at the hospital just could not seem to get my pain undercontrol, and had a difficult time understanding that with my current pain meds that, that was not enough to cover and control the new pain requirements produced from the new surgery! So I would strongly urge you  to get this matter addressed  befor undergoing the surgery. I know the last surgery I had I was assured by the surgeon and hospital staff that this would be no problem, Well it was a problem, in fact a major! really major problem and made my hospitl stay much longer because of it! So I would recommmend that you talk at length with your PM Doc, and see if he has hospital privileges at the facility where you are having your surgery, and see if your surgeon and staff  have any  problems with your PM Doc joinging his/her team in your care and treatment. Assuming that your PM Doc will also do this! I would hate to see anybody endure what I did as far as pain management goes after ones surgery! If you have been treated for long term chronic pain prior to having surgery, you just can not be treated the same way, as the every day, normal person, who is not taking pain meds for the treatment of Chronic Pain. Believe me on this, it can really make a difference in your over all experience while undergoing this type of procedure!
 
Good Luck to both of YOU!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2317
   Posted 3/16/2011 1:00 PM (GMT -6)   
Jeff-
Glad I could help. You may want to prioritize your questions. I had a lot of questions when I was having surgery too & the NS was quite patient, but he did eventually need to move on to his next appointment.

Here are the questions you might look to get answered elsewhere:
1. Success Rate -- check online (healthgrades.com is good, so is google)
2. Long Term Prognosis -- ask neurologist, or ask to speak to other patients
3. Negative Outcomes -- ask PM re: chronic probs - neuromas, atrophy, etc.
4. Non-Surgical Options -- any other specialist (every other specialist)

Those made my list b/c it's usually pretty hard to get honest answers from an NS anyways. Between their huge egos & fear of litigation, they make it sound as if all your life's problems will be solved if you just have surgery. Be wary. Surgery is a "last resort" for good reason. It can & often does help, but many times brings with it it's own set of problems.

best wishes,
Tirzah

Draka
Regular Member


Date Joined Jun 2009
Total Posts : 256
   Posted 3/16/2011 10:39 PM (GMT -6)   
Again, thank you to everyone....

My appointment today went from 11 am to getting home at 8:30!

It was a long, long stressful day but I have finally decided to jump in feet first and booked a date in two weeks for surgery... this was my second surgical consult.

I was told the damage in my neck was done when I was 2-3 years old.... I'm now 43 so my time of suffering will soon be coming to an end. It's still so surreal.... it's been so long with the pain that I know nothing else....

My husband and I are very confident with the surgeon and the type of surgery.... my surgeon will be going in through the back of my neck to open up the spots where the nerves come out of the vertebrae... I will be having some pins and screws to.

I have two weeks to bring down my meds.... I see my PM next week so I will discuss this with him.

Jeff- I hope your consult went well today...

Thank you again

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 3/17/2011 1:23 AM (GMT -6)   
Draka
 
Are they also going to do a diskectomy and fusion? Or are they fusing the articular joints in the back of the spine? This last surgery I had they did the posterior approach and fused the articular joints, and then screwed in pins that are connected to little  rods on each side to stablize it and hold it together. Anyway the posterior appoach is much more difficult to recover from than the anterior approach. I have an incision from the base of my skull down to the beginning of my shoulder blades, it is the entire length of my neck.  My neurosurgeon warned me this was a ratther simple surgery for him, but a very difficult one for me, and he was right about that! The pain and healing time is much greater, so just as a word of advice, be patient with yourself, and follow the doctors orders to the TEEE! and you will do fine.
 
 I do wish you well, and hope it all works out for you!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

desert
Regular Member


Date Joined Feb 2011
Total Posts : 93
   Posted 3/17/2011 9:36 AM (GMT -6)   
Hi Draka. That is one long appointment! I'm very glad your consult went so well. It seems that you've found yourself an excellent surgeon who is going to fix you right up. You've been in pain for a long time, what are you planning for your new pain free lifestyle? It sounds like you're getting away without a fusion. That's great! Keep us updated on your surgery and results. Sounds like you'll have to go through a little while with increased pain from lack of your meds, but it'll be worth it I'm sure to finally be quit of the pain permanently. This is such great news, I'm so happy that the surgeon is going to be able to help you in a way you are comfortable with!

I have to admit I'm a bit jealous. My appointment didn't go quite as well. The surgeon said that the information we have justifies disk surgery. However my last MRIs are about nine months old and since my symptoms have progressed markedly recently he wants newer images before we jump in there. I agree with him on that one for sure (I'm a bit worried about what these new images will show). So more waiting is in my future. My insurance is not quick with MRI approvals, although hopefully they will be better about it since all the treatments they prefer to see done first have been tried on me many multiples of times. And getting a new appointment with the surgeon usually takes about a month. The biggest problem though is that I don't like this surgeon. Not at all. He's one of those doctors that doesn't listen. He asked me how I've been feeling and I had just enough time to tell him that my arm hurts before he started talking over me. So he doesn't know, for instance, that part of my hand and forearm have started going numb or that the pain has spread to my other arm as well. Then he left to order the MRIs and never came back. If he were my only doctor I would get to spend the next several weeks in unmitigated pain with even less sleep. Luckily I have an appointment with my PM today. So I'm going to do the MRIs since I do believe they make sense, but I'm now going to be on the hunt for a new surgeon. Probably a neurosurgeon this time. I'll talk about that with my PM today as well.

Draka, I am so happy your appointment went so well. I know I said that I was jealous, but really I'm not (I was just being funny, or trying at least). It actually helps mitigate for me that mine didn't go so well, knowing that yours did. My hopes and prayers will be with you these next few weeks that your surgery goes well and that the outcome is every bit as good as can be hoped.

-Jeff

Post Edited (desert) : 3/17/2011 8:48:25 AM (GMT-6)


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 3/18/2011 1:06 AM (GMT -6)   
Jeff

I think for this type of thing you should be dealing with a neurosurgeon anyway! And if you are not pleased or able to talk with a doctor or feel comfortable with him then you should definitely find some one that you are comfortable with! With your symptoms a new MRI is just about a must, in the mean time be extremely careful, don't do any lifting or anything that will strain your neck or back! And do your best at trying to get that MRI done as quickly as you can! And getting an appointment with a neurosurgeon. Above all just be carefull untill you have this looked at and reevaluated.

Good Luck to YOU

White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

desert
Regular Member


Date Joined Feb 2011
Total Posts : 93
   Posted 3/19/2011 1:12 PM (GMT -6)   
Thanks White Beard. Yeah, I'm always overdoing stuff. You'd think I'd get used to taking it easy after a while, but I still get frustrated by holding back and eventually do something that kicks everything off again. MRIs, yeah need the new ones of those. I'm not a big fan of surprises during surgery after all. I was warned by the office staff that the MRI approval may take a while because my insurance company is notoriously touchy about approving MRIs for some reason. They always want to try and retry other treatments first. But I guess my medical records were more than enough for them because I got the call to schedule my appointment two days after my visit (usually it's closer to a week) and have an appointment for Monday morning. I found a neurosurgeon I think I may like and so plan to setup an appointment with him as soon as possible.

-Jeff

nvrthesame98
Veteran Member


Date Joined Jun 2008
Total Posts : 6706
   Posted 3/20/2011 6:21 AM (GMT -6)   

Jeff as Whitebeard said please look into a different surgeon for this. You need to be comfortable with your surgeon especially and if he isnt listening to you now he wont be if you have complications or post-op pain.

Sounds as if he assumes each and every surgery follows the rules he makes!! I can assure you that is NOT so and you dont want someone who says this is what I do and it works for others it has to work for you as well.

There would be nothing worse then having post-op pain and the surgeon not treating it cause its different then say the last 5 he did shocked

Please think long and hard before allowing someone who treats all his patients on a peas in a pod syndrome.

A Neuro should be doing this type of surgery and they should be listening to what you have to say and how you feel period. I have a strong dislike to those kinds of Docs with the "God like complex"

Here is hoping you can get the right Doc that suits you and your needs and one that is compassionate and they sure are getting harder to find.


Disabled since 1999 from knee injury
DX: Bil knee meniscus removal with LTKR in 01. 6 knee arthroscopy for plica removal meniscus repair. Ank spondyl,ddd at L3-4 S1. disc collapse at L-3 with nerve impengement. legally deaf,copd,rt shoulder rotator cuff tear repair 06. some memory deficit post encephalitis,GERD
MEDS: methadone,xanax,cymbalta,zantac,maxide,K+,lasix,prempro,celebrex,combivent

desert
Regular Member


Date Joined Feb 2011
Total Posts : 93
   Posted 3/20/2011 8:56 AM (GMT -6)   
Thanks nvrthesame98. I'm definitely not letting any doctor I don't trust near me with a scalpel. And a big part of that trust is them listening to me. I found a neuro nearby that comes well recommended by a good friend and does this type of surgery. They also do surgeries at my hospital of choice. So it may be a good fit. I won't know of course until I talk to him.

Draka
Regular Member


Date Joined Jun 2009
Total Posts : 256
   Posted 3/25/2011 3:53 PM (GMT -6)   
White Beard said...
Draka
Are they also going to do a diskectomy and fusion? Or are they fusing the articular joints in the back of the spine
White Beard


Finally I got a ledgeable report.... my reports reads as follows:
posterior C2 to T1 decompression and instrumented fusion.
Laminectomy at C2 to T1 with right foraminotomy C2 t0 C7 and left C5 to C7 with arthrodesis C3 to C5 with structural rib allograft
and local verterbral autograft and at C7 with the same structural rib allograft and locat vertebral autograft and Vertex instrumentation
C3 to C5

Surgery date is next Thursday and I am scared cry

Thanks
... and Desert I am glad you are going for another opinion... best wishes!

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2317
   Posted 3/25/2011 6:08 PM (GMT -6)   
Draka,
I don't blame you; I'd be scared too if I had that much surgery scheduled. But you've spent quite a lot of time with the NS & hopefully have had all your concerns addressed. As long as your PM has some sort of post-op meds figured out for you, I'd say just try to sit back and breathe. Surgery is always scary & there are no guarantees, but a LOT of people really do feel much better after they heal up from a fusion surgery.

Sending warm wishes & healing prayers your way,
T
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