Dr Luiz Pimenta BRAZIL

[herniated C6-7]

What is overall patient care like in Brazil for the English speaker with no Portuguese or romance language background? Do other nurses and attending doctors speak English? Or is communication difficult?

How long were you in the hospital in Sao Paulo? How do the hospital standards with regard to infection prevention and suchlike compare with richer countries?

[Carson]

Mark Perth: Hope to hear from you soon. Please stop in and let us know how you're doing. Hope all is well with University and healing.

Carson

[Katie]

herniated, we had no problem with the language difference. But we also treated it as a bit of an adventure and challenge...just our way.

Dr. Pimenta speaks fluent English, as does a few of his staff. Rafael, his main assistant, has spent a year here in Canada learning English, and Leonardo, another at his office also is quite fluent. His assistant surgeon, while having difficulty with our language, does his very best to make himself understood, and his wonderful temperament helps. He is ALWAYS smiling. The anesthesiologist spoke fluent English as well, and met with us in our room the day before surgery. It was the smoothest surgery I've ever had, with NO problem with pain control. Even though it was not normal procedure, he agreed to give me an epidural during and after surgery, which I think made a huge difference in my comfort levels.

There is an administrator at the hospital, Marcos, who has lived in the US for awhile and would visit us every day to ensure all our needs were met in case of translation problems, while another English speaking nurse was made available for us day or night. We were there for eight days, and every one on staff in the hospital treated us like gold. Marcos gave us his home and cell number as well as his office number and told us to call at any time if necessary. You won't find that often here.

Sign language worked well if words didn't...like miming when I had nausea Many of the Portuguese words were similar to French and/or English, and we always had our grammar/translation books handy. And more than one is better, as they each seem to cover different scenarios. We just borrowed some from our library at home.

Our friends who joined us post-op had a fair bit of Spanish background as they have volunteered in Mexico, but we found it was more of a hindrance than helpful. There was just enough difference in the languages to make it confusing.

And the restaurants generally run on Japanese traditions in that no tipping is allowed. At least that's what several waiters told us in broken English. If they added a tip, they would be fired, and accepting one was not encouraged. I brought treats from home, like little bottles of maple syrup to thank them instead.

It is the fine nuance in conversation that gets a little sticky at times. Of course their diet and customs are different, but one of theirs I really enjoyed was having hot milk before bed. Since they always bring a bedtime snack, one night I thought I'd add yogurt to the list. Unfortunately the two requests got lost in translation...I ended up with yogurt mixed with hot milk Mind you, they gave me several chances to change my mind at the time...they kept asking 'together'? when I thought they understood 'at the same time'...yes, I kept saying...so I got what I asked for!

The hardest part of the whole process was checking in the day before...and I highly recommend doing it then and not the morning of surgery. It really strained our coping skills....and of course it was at the very beginning of our adventure, so we weren't as used to the language. If you go, I would recommend contacting the administrator there before hand. I can give you or anyone else his contact information before you get there.

The hospital standards were much higher than any I've encountered in the US or Canada. The hospital is spotless, just pristine. Parts of it are very old, and the wing we foreign patients stay in is newly renovated, but all of it is amazing. There isn't the 'normal' hospital smell anywhere. Plus the staff to patient ratio is very high. While busy, the nurses did not looked stressed or overworked.

While some of their post-op care is different than in N. American hospitals, it was more than adequate. I had gauze bandages over my three incisions for a few days, and was encouraged to shower every day right after surgery, then they would change them right away. I am used to graduated electric pumps for running IVs, but mine was just a drip, even when there was an additional drug bag added. But it all worked. I guess what I'm saying is that just because it is different doesn't make it wrong.

Every time I have had surgery, minor or major here in Canada, I've ended up with an infection. I had none with this surgery, even though it was quite long, over six hours, and I had three separate incisions. I was not given a preventative antibiotic either that would have affected that.

I would recommend going in the fall, (our spring) if possible because of the heat and humidity...it is less then. I can't imagine what it is like during their summer But our large private room had air conditioning which we could control, plus it cools off nicely at night and we would open the windows. (There are no screens anywhere, and if one rare little fly got in, the nurses would track it down with a vengeance ) After we left the hospital, we spent a couple of weeks in the city and traveling to the beach resorts to the northeast with a rental car. The cafe outside our hotel was convenient and we soon had our favourite dishes that we wished we could get at home. Acai berry desserts...wow!

I know this is more than you asked for and a bit long, but I want to give as good an impression as possible of our experiences there. Plus answer small questions that may help with your decision. We would go back for surgery there if necessary at the drop of a hat. And my recovery is as good if not better than can be expected.

[JRS11]

Dr. Pimenta actually was instrumental in the design of several ADRs, fusion devises and surgical approaches. While I still don't have the exact numbers of how many ADRs he has done in his 28 yrs of practice, I do know that he has successfully done ADR surgery on a close to 90 yr old woman. So age is obviously not an issue.

I do remember numbers of well over a thousand being discussed during the pre-op interview. I tried to play the recorded conversation from that meeting, but I think it was accidentally erased...hubby will have to try and sort it out.

Dr. P very generously gave me two books, one a text book on the XLIF meant as a medical publication which shows every step of the surgeries, including some very complicated ones of scoliosis..not ADR in that one, but many that do show the procedures. The second is a book documenting the stories from a number of patients, both with Dr. P and several others.

He also has access to a number of ADR devices that are not yet available here in North America. We spent a great deal of time talking to him before we left for Brazil, before surgery in his office as well as post-op. There is not an ounce of ego in the man. He is very humble and happy to answer every question both my husband and I had...he insisted on it before proceeding to surgery. No other surgeon other than Dr. Bitan in NYC showed that kind of interest and compassion, and I had contacted over a dozen. The surgeon from India, Dr. Kulkarni was also quite good and I would trust him as well.

Dr. Pimenta has been very busy with patients from all over the world, and seems to be just getting known in North America. During the three weeks we were there, he traveled to New Guinea for surgery, plus one other country. He runs a very organized efficient office which works like clockwork. I occasionally had difficulty in getting a response from his assistant Rafael, but it turned out that he was traveling at the time. Dr. Pimenta answered me personally when I ran into any problems with the process.

I think most North Americans are traveling to Germany because of the advertising with medical tourism, something that Dr. P. has not branched out into. Not that there is anything wrong with the European system...it helps patients find surgeons not available at home. Most of us that travel pay out of our own pockets after exhausting ourselves with insurance battles. Dr. P is much less expensive than others I contacted and that was the only reason I could afford to go. Price did not reflect the quality of work though, not by a long shot.

I would be happy to speak to you directly if you have other questions, and I'll keep digging for the information I'm sure I have somewhere

Interesting, my insurance turned me down for an X Stop. My wife is Brasilian and I have to be put on her insurance (which we can do when I go back to Brasil). It seems that Dr. Pimenta does not take her insurance, Unimed, but we will check to see how accurate this is, also I do not know if my pre-existing condition will be an issue. So how did I hear about Dr. Pimenta, my doctor at Yale, Dr. James Yue gave me his name as someone who could perform the X Stop surgery with his total confidence, and he would be willing to follow me in the US if needed. Sao Paulo is an hour or so by plane from my wife's condo in Florianopolis, so this might be ideal since to get the surgery in the US my doctor felt I would have to be on Medicare as he felt my insurance will not approve no matter what. I will try to go to the MA Insurance Commission but he was not optimistic...I hope he is wrong. Why the X Stop, spinal stenosis, also scoliosis which may or may not be an issue, as well as multiple levels of disc damage, so my back is a mess. I can continue for now to get the intraforamanal blocks and also start Lyrica, which I have been resistant to do.

I posted a week or two ago with no reply but then this old thread popped up in a search on the doctor. Any help is appreciated.

Joel

[Justin]

Hey Joel,

Dr. Pimenta is a great surgeon and I've spoken with a good number of Spine Patients that have seen him for their spine problems. In regard to the Insurance Commission--they are *usually* not that big of a help. When I was appealing my artificial disc replacement surgery denial in 2003, they essentially said they have to go by what the insurance companies have on their policies (unless there is some gross deviation from the insurance company's "benefit booklet"). However, every state's commission is different.

I wish you the very best in the steps ahead, and please let me know if the Spine Patient Society can help in any capacity.

Interesting, my insurance turned me down for an X Stop. My wife is Brasilian and I have to be put on her insurance (which we can do when I go back to Brasil). It seems that Dr. Pimenta does not take her insurance, Unimed, but we will check to see how accurate this is, also I do not know if my pre-existing condition will be an issue. So how did I hear about Dr. Pimenta, my doctor at Yale, Dr. James Yue gave me his name as someone who could perform the X Stop surgery with his total confidence, and he would be willing to follow me in the US if needed. Sao Paulo is an hour or so by plane from my wife's condo in Florianopolis, so this might be ideal since to get the surgery in the US my doctor felt I would have to be on Medicare as he felt my insurance will not approve no matter what. I will try to go to the MA Insurance Commission but he was not optimistic...I hope he is wrong. Why the X Stop, spinal stenosis, also scoliosis which may or may not be an issue, as well as multiple levels of disc damage, so my back is a mess. I can continue for now to get the intraforamanal blocks and also start Lyrica, which I have been resistant to do.

I posted a week or two ago with no reply but then this old thread popped up in a search on the doctor. Any help is appreciated.

Joel

[JRS11]

Hey Joel,

Dr. Pimenta is a great surgeon and I've spoken with a good number of Spine Patients that have seen him for their spine problems. In regard to the Insurance Commission--they are *usually* not that big of a help. When I was appealing my artificial disc replacement surgery denial in 2003, they essentially said they have to go by what the insurance companies have on their policies (unless there is some gross deviation from the insurance company's "benefit booklet"). However, every state's commission is different.

I wish you the very best in the steps ahead, and please let me know if the Spine Patient Society can help in any capacity.

Thanks Justin. I am not confident that insurance commission is the answer. A good friend of mine does testifying as an expert witness for both those that need help as well as against them (depending on who he is consulting for) so he can give me some good advise and help me with the paper work if he thinks it is worth it, which I believe he does, but I am not confident in this. I may just try to keep going for the next 5-6 years until medicare unless something happens for me to get it sooner, Dr. Yeu felt they would approve this approach. Interesting that they will approve a $100k surgery (lamenotomy, lamenectomy) and not the X Stop which he felt was a total of about $20k. When I asked him why he suggested that there is not enough published research. I for one am not ready to get the more aggressive surgery that might ultimately weaken my back further, and the doctor agreed with my assessment for now. He suggested I wait as long as possible before so I hope the injections continue to work (I have another set up for a month from now) and I will read the lyrica label that scares the heck out of this pharma rep, but I have been told that the label issues are not seen often, but who knows. I will have to have my wife ask me every day if I feel like hurting myself (I say as an ex psychotherapist).

Thanks again

Joel

[Justin]

Sure thing, Joel. Your expert witness friend should offer good insight & tips about the process. I wish you the best during your "wait and see approach." In regard to the lyrica, just remember they have to list every side effect that was encountered during clinical trials. Most drug inserts sound "scary," but the majority of the side effects listed are rare. The package insert, as you know, should give a breakdown of patients experiencing the more common side effects. As always, speak with your medical team in regard to medical changes or specific questions that they are better able to address.

Hang in there.

Thanks Justin. I am not confident that insurance commission is the answer. A good friend of mine does testifying as an expert witness for both those that need help as well as against them (depending on who he is consulting for) so he can give me some good advise and help me with the paper work if he thinks it is worth it, which I believe he does, but I am not confident in this. I may just try to keep going for the next 5-6 years until medicare unless something happens for me to get it sooner, Dr. Yeu felt they would approve this approach. Interesting that they will approve a $100k surgery (lamenotomy, lamenectomy) and not the X Stop which he felt was a total of about $20k. When I asked him why he suggested that there is not enough published research. I for one am not ready to get the more aggressive surgery that might ultimately weaken my back further, and the doctor agreed with my assessment for now. He suggested I wait as long as possible before so I hope the injections continue to work (I have another set up for a month from now) and I will read the lyrica label that scares the heck out of this pharma rep, but I have been told that the label issues are not seen often, but who knows. I will have to have my wife ask me every day if I feel like hurting myself (I say as an ex psychotherapist).

Thanks again

Joel

[Katie]

Hi Joel,

I'm sorry I didn't see your earlier post when you didn't receive a response. I've not been on as regularly as before, but I'm trying to change that, as there are so many new people with questions on here now.

You are certainly not alone with the insurance fight. There are very few here that have had success with that. I fought for almost five years for nothing.

You are so lucky to be so close to Sao Paulo and not having to spend twelve hours on a plane after surgery! I'm envious . If I may offer some feedback from my own situation and comments from various surgeons, I was told that the longer I waited for surgery, the lesser the chances for a full recovery. Dr. Pimenta said that I never would have waited so long for relief if I had been under his care from the beginning. Apparently 'memory pain' can take over, somewhat like phantom limb pain with an amputee, and the nerves keep firing even if the cause is gone. Thankfully that didn't happen with me, and even the neurological problems I had from my C5/6 with bladder & bowel, lack of balance, etc. reversed, which was not expected. Everyone knows their own limits, of course, and this is not meant to be advice, just what I learned in my search.

From talking to others here that have gone on Lyrica, the worst side effect they experienced was rapid weight gain...not sure if it was more noticeable because they were women though We tend to be a bit sensitive to that

Have you spoken to Dr. Pimenta about all the options for your back? Is the X-STOP definitely what he is recommending, or is that what Dr. Yeu thought was best? I am very impressed that he would encourage you to go out-of-country and would follow your care after the surgery. That is not common...he sounds like a very caring man.

Good luck with your insurance battle, and please keep us posted. I hope we can help in some way.

[spinches]

I tried to contact Dr. Pimenta through Rafael Amaral at the email address shown at the beginning of this thread. No one has replied after about a week. Does anyone have an updated email address for him, or do you think it would be best to contact Dr. Pimenta via the form on his website? I feel nervous about calling any of the numbers on the website, given that other members on this site have said not many of the staff in Sao Paulo speak English.

Sandra

[mwolf2022]

I tried to contact Dr. Pimenta through Rafael Amaral at the email address shown at the beginning of this thread. No one has replied after about a week. Does anyone have an updated email address for him, or do you think it would be best to contact Dr. Pimenta via the form on his website? I feel nervous about calling any of the numbers on the website, given that other members on this site have said not many of the staff in Sao Paulo speak English.

I sent a request over to Rafael at Rafael [Rafael@patologiadacoluna.com.br].
She responded around a week later.

Hope this helps

Mike