27 October 2009

BrainSurgeons and a Bionic Back

So I went to see a BrainSurgeon. Actually, I have seen two different BrainSurgeons and another NeuroDoc in the past few weeks. I guess, since the issue is my spine, that I should really call them SpineSurgeons, but BrainSurgeon is just that much more nerve-wracking. Nerve wracking -- get it? No? Fine, be that way.

Anyway, I initially saw BrainSurgeon1 on Oct 6. He's a good surgeon, and I have referred patients to him for 12 years. In fact, he operated on TheHusband's ruptured disc several years ago. He is extremely personable (yes, yes, he's a surgeon -- shocking, isn't it?). But he didn't listen to me and my concerns. We had a nice conversation -- we talked for about 45 minutes. However, much of that was him talking about using a dynamic stabilization device as part of the fusion procedure. Given that FDA has ordered companies that market these devices to conduct post-market studies in order to evaluate reported serious adverse events, I was understandably leery. But he just barrelled on, when I voiced my concerns. Given my other gait and spine related issues, I really think that these systems are a Bad Idea™. I am sure that no surgeon likes working on other doctors, especially one who is in a related field and Has Opinions. But those opinions should be listened to and acknowledged.

So after that exam, I spoke with a very nice and really smart Hopkins neurosurgery resident that I know. I showed him my MRI, described my symptoms, and asked him who he would let operate on his back if it looked my mine and he felt like I do. He gave me a name, called up BrainSurgeon2, and asked if he would see me. So I had an appointment with a Hopkins neurosurgeon within two weeks of that discussion. To be honest, BrainSurgeon2 works part-time at Hopkins and the rest at another Baltimore hospital. I tromped up there with MRI in hand last Monday. He took a history and did a quick neuro exam (very quick -- he's a neurosurgeon). Then he and I got down to brass tacks. He agreed with BrainSurgeon1 in that I need a spinal fusion (eeek!) as well as decompression of that freaking nerve root that is being compressed. He did not think that a dynamic stabilization device was a good idea (yay!), although he did have some other off-label device uses to suggest (NO!).

He then called up a NeuroDoc to see if he could fit me in soon. Turned out that NeuroDoc and I worked together a few years ago, so I got in 2 days later. Unfortunately, NeuroDoc zapped me with electric shocks and stuck needles in me, making me not like him quite as much as I once had. I swear that this is a test which is much better to perform on others than to have done on oneself. Conclusion: "If it walks like a duck, quacks like a duck, and is near a pond, it is a duck." He had to stick needles in me to come to that conclusion?

Given my sensitivity to medications, drugs to treat neuropathic pain are not an option. I've failed the majority of other conservative treatments (all those NeedleDoc appointments were in vain). So surgery it is. And thankfully I have health insurance (I will not mosey on down that conversational road right now -- I think that I am about as liberal as Eric in that respect).

So having received a 2nd opinion that I like better than the 1st one, and having failed conservative therapy, AND having refused a bionic back, I will undergo a single-level lumbar spinal fusion next week. Now all I have to do is convince myself that I won't die under anesthesia, wake up paralyzed, be worse off than I was before the surgery, or wake up during the surgery.

I haven't met the anesthesiologist yet -- I will certainly have some suggestions for him or her... Why do I suspect that I will be a really annoying hospital patient?

And let's not even go into the insanity that will be me when I am stuck at home for a few weeks.


ntsc said...

Hey good luck. I have had 'drill holes in skull' brain surgery to remove what was left of a blown AVM.

I have woken during surgery, local with something to make me fall asleep that ran longer than planned so I woke up. Surgery to remove Dupytren's growth.

The Doctors were discussing patents so I joined in. This freaked the resident but didn't cause the surgeon to even blink.

Keith has known me for 20 years now, he first set a broken metacarpal and has since operated to set two more and performed about 9 surgeries for Dupytren's Contractur. My wife has brought cookies for him to the surgery.

vince said...

I'm not a person who deals well with pain, needles, and people who want (or need) to cut on me. I've had surgery only once - a broken ankle that I insisted could be fixed without surgery and all around me told me I was insane (I was) and so surgery there was, and as a result I can walk.

The surgeon gave me a choice prior to surgery. I could have a spinal and be awake, or I could be put completely out. I didn't like either option ("can't we just forget the whole thing?"), there was no way I was going to be awake while they operated.

Hope all goes well with the surgery.

Janiece said...

I think it is INCREDIBLY NARROW-MINDED OF YOU not to agree to becoming the Bionic UCFer.

Because we need a BIONIC UCFer.

Oh, and good luck!

Tom said...

It seems to me than when you get a second opinion that doesn't jive with the first opinion, but you like better than the first, the second opinion has been promoted to a first opinion. If it was me, I'd now be looking for a new second opinion. I'd want 2 independent docs to tell me the same thing before I went under the knife.

But I have no medical education, so you are free to ignore me. I'm just a geek who works in a hospital, nothing more.

neurondoc said...

Tom, both neurosurgeons have basically the same surgical plan (hemilaminectomy, partial diskectomy and spinal fusion). Their approaches were somewhat different and the 2nd one listened to my concerns. That made the difference.

Anonymous said...

How long is the recovery likely to be, or should I not have asked that question?

Tom said...

So if they used a wooden stabilization device, could the procedure be described as a hickory diskory, doc?

I hope that at least makes you smile. Good luck with the procudrue and the recovery! We'll keep you in our hearts and minds.

Tom said...

Procudrue? My fingers have a mind of their own!

Random Michelle K said...

I'm sure you'll be a right horrible patient. :)

Though not much more so than my Dad, who teaches safety studies.

He lectured his nurses for recapping needles. Yeah, there's a good idea: annoy the person sticking needles in you.