Glad your here- Almost lost all hope...

[dyates]

Hello everyone.

Back pain started in '98 at 26 years old. Now I am 38 and cannot function without surgery. It started with 3 levels and is now 4. Submitted predetermination last week to BCBS TX for 3 level ADR. Approved 1, but that will not do the rest.

The nice doctors said they have done and would be happy to do the full surgery for only $24000 per disc. (Hospital and Disc). Nice guys huh... My Dr. only makes $750k a year... and I have found that it is a Dr. owned hospital....

I am thinking of doing 1 level and fusing the rest, but I am worried about fusions. They are permanent and often cripple people from what I have seen.

Wrote a letter I plan to send to all elected officials. I don't see any hope otherwise. FDA and AMA only considers letters produced by MD's... and then it seems only to fit their agenda.

The biggest problem, I have been living in faith that my country and insurance company would take care of me if I was patient and let them test since 2002... Now I am out of time.

Lost my business, have no money to live on. Can't get a job in my condition now, and can't get the best surgery option approved by an insurance company that I pay $700 a month to, and have been with for over 15 years...

I hope I can find solutions here... I see some good resources... Thanks. Dennis

A quick note to the mods: Have you considered making a voting tag for successful ADR??? It might help the fight to see actual member data in regards to success/ failure rates... Statistics are always good info to publish.

[KBear]

Welcome Dennis,
I can relate to where you are right now and the hopelessness you feel. My insurance also denied my ADR (1 level) saying it was experimental. I felt very hopeless and thought I'd never get fixed. I ended up going into a clinical trial in Miami for surgery and received the Active L disc. There are lots of us who thought we wouldn't ever get the surgery we needed and then ended up with it, keep fighting the fight and researching and something will come through. Also, what levels are problematic for you?

[dyates]

I have C 3/4, C 4/5, C 5/6, and C 6/7.

The C3/4 just started in the last 6 months. They theink if I get 4/5, 5/6, and 6/7 done it will relieve the pain and prevent the 3/4 from getting worse...

[KBear]

I have C 3/4, C 4/5, C 5/6, and C 6/7.

The C3/4 just started in the last 6 months. They think if I get 4/5, 5/6, and 6/7 done it will relieve the pain and prevent the 3/4 from getting worse...

Have you had a discogram to confirm that those levels are causing pain? My L3/4 L4/5 and L5/S1 were all herniated, with L4/5 being the worst, the other two were small herniations. Turns out that only the L4/5 was causing pain, had it replaced with ADR and am now pain free. I still have the small herniations above and below, but they are not pain generators at this time. As you mentioned, my surgeon also believes that the ADR at L4/5 will protect the other two levels from getting worse.

[dyates]

Yep, I didn't mention it because I put it in my signature...

I have had two mri's, two discograms, chiropractors, physical therapy, tens unit, massage, more Rx than any human should be allowed to take. In fact they tried morphine and oxicontin and I'm allergic... That's why I have no choice but surgery immediately. The pain is keeping me from regular function...

With the discogram, 3/4 was 4/10- 4/5 was 8/9- 5/6 was 9/10- 6/7 was 10/10 pain level. I told the Dr. he better put me back under before I jumped up and hurt him... I know, that was wrong...

The day after I was in almost as much pain. I was curled up in a ball praying that God would just take me... In fact, If I end up like that after the surgery like some people say. Kiss me gooodbye. There's no way I could do it for more than 10 hours.

[KBear]

Yep, I didn't mention it because I put it in my signature...

I have had two mri's, two discograms, chiropractors, physical therapy, tens unit, massage, more Rx than any human should be allowed to take. In fact they tried morphine and oxicontin and I'm allergic... That's why I have no choice but surgery immediately. The pain is keeping me from regular function...

With the discogram, 3/4 was 4/10- 4/5 was 8/9- 5/6 was 9/10- 6/7 was 10/10 pain level. I told the Dr. he better put me back under before I jumped up and hurt him... I know, that was wrong...

The day after I was in almost as much pain. I was curled up in a ball praying that God would just take me... In fact, If I end up like that after the surgery like some people say. Kiss me gooodbye. There's no way I could do it for more than 10 hours.

I had read the signature, but have the pregnancy brain and can't remember anything... sorry for being redundant.

I completely understand the exhaustion of all the treatments. I did 3 years of continuous conservative therapy. I tried Pt on 3 separate occasions, had at least 5 MRI's, 2 discograms, Idet surgery, 10+ injections, tens unit, massage therapy on 2 different occasions, chiropractic on 3 separate occasions, and tons of medication. I was on daily morphine, vicodin, lyrica, and muscle relaxers. Sadly, this is most of our stories and I've had it relatively good compared to some of our other members. It can and does get better. It took me a year after surgery to get considerable relief, but it came. I spent 4.5 years in pain before becoming pain free. It is no fun being in pain and robs you of your life. I had a 2 week old baby and 2.5 year old when I was injured and wasn't even allowed to lift the baby because of my back. But I made it through it and you can get through it to.

Do you have issues with pain medication in general? I do and have had major issues with being sedated during procedures and pain control afterward. I'm not allergic to any pain medicines, my body just processes them super quickly. There are several of us on here that have that problem. I would highly recommend asking for an epidural during and after surgery for pain control. I didn't have this and I prayed for death for 2 days after surgery- that's when you know what a 10/10 pain is. Hindsight is 20/20 and there is no way I would have the surgery without an epidural.

[bigdogchief76]

Hello Dennis -

So sorry for your situation. My nature is to fix things; I wish I could help you and fix this for you.

I'm a new member here at SPS as well. I have found many great resources and believe you will as well.

Recommend checking out the Insurance Forum where you can potentially find many levels of info for your appeal to the insurance company.

I am currently in a multiple level "attack" (appeal is the politically correct word) with my insurance company. Denied simple 1-level fusion of a disc that's been quite naughty for over 3 years (my heart breaks to read how long you have dealt with this) Sounds like the denial is a new method of the insurance companies of delaying needed relief to simply save a buck or two.

Find relief and comfort in this forum. There are some wonderful people on here that know what you are going through. I cannot relate to what you have dealt with, but, I do know what chronic debilitating pain is.

Hang in there, my prayers are with you.

MB

[Hooch]

Gday DYates,

Can't really offer any advice as I don't know US health system but can only sympathise that it's a godawful situation and you shoudn't be in it. The only thing I can say is that fusion works successfully for ddd, if it comes to that I wouldn't be terrified of it over adr.

I appreciate what you're saying about the country and insurance should do the right thing by you. Would be nice if they showed some citizenship and compassion.

Good luck.

[Justin]

Hello everyone.

Back pain started in '98 at 26 years old. Now I am 38 and cannot function without surgery. It started with 3 levels and is now 4. Submitted predetermination last week to BCBS TX for 3 level ADR. Approved 1, but that will not do the rest.

The nice doctors said they have done and would be happy to do the full surgery for only $24000 per disc. (Hospital and Disc). Nice guys huh... My Dr. only makes $750k a year... and I have found that it is a Dr. owned hospital....

Hey Dennis,

I believe I welcomed you in another thread, but if I didn't, welcome!

I am thinking of doing 1 level and fusing the rest, but I am worried about fusions. They are permanent and often cripple people from what I have seen.

Artificial discs should be thought of as "permanent" as well. Removal of an artificial disc is life-treatening (one SPS Member almost died on the table during her revision) and is an extremely technically procedure. Also, during the healing process after ADR surgery, bone actually "grows around" (I'm using this terminology very crude here) the artificial disc to make it "one" with the adjacent vertebral bodies.

Wrote a letter I plan to send to all elected officials. I don't see any hope otherwise. FDA and AMA only considers letters produced by MD's... and then it seems only to fit their agenda.

A SPS Member, Marti-in-benicia, is currently involved in changing the way FDA oversees and regulates medical devices, especially devices that have a proven track record in other countries.

The biggest problem, I have been living in faith that my country and insurance company would take care of me if I was patient and let them test since 2002... Now I am out of time.

In my opinion, insurance companies are the real problem--they dictate one's health care and, we as physicians (I'm a physician-in-training), essentially have our hands tied.

Lost my business, have no money to live on. Can't get a job in my condition now, and can't get the best surgery option approved by an insurance company that I pay $700 a month to, and have been with for over 15 years...

I'm so sorry to hear this...that's an insane amount a month.

A quick note to the mods: Have you considered making a voting tag for successful ADR??? It might help the fight to see actual member data in regards to success/ failure rates... Statistics are always good info to publish.

We have thought of this in the past--it's a great idea. However, polls online are unscientific at best and hold no real value in the grand scheme of things. Also, Spine Patients that have "successful ADRs" are out living their lives and do not frequent the Forums as much; as I'm sure you noticed, those Spine Patients with ongoing problems visit the Forums often. Other concerns: actual sample size (number of Spine Patients polled) would be relatively small, verifying the patient's identity (as anyone can assume a handle and post online), what constitutes a success or failure (someone that is no longer bed-ridden, but with a constant "8/10" pain might consider their outcome a "success," etc.)...I'm just throwing a few thoughts out there.

Hang in there--we are here to help!

[dyates]

Thanks guys and gals.

Forunately, my insurance is self funded by the Teacher Retirement System in Texas. That means they can make an "exception" for my surgery. BCBSTX is only the administrator.

Thanks to another member, a BCBSTX customer advocate, and some research I have been doing, I have a 120 page appeal that I am sending to Austin today.

My cover letter is five pages long telling the whole story. The BCBS advocate told me the facts are good, but they all know the truth, but go ahead and add alot of good stuff, not rambling Doctors that like to hear themselve in their head as they write (no offence Justin), so my main focus should be the letter. I need to bring out the human factor in the panel.


I appreciate the clarification on the permanent nature of the ADR. I saw that and figured that, I just figured they could always bolt on brackets to fuse me later. If I had made the components, I would put predrilled, threaded holes in the plates for that very reason. Last option fusion by just adding brackets.

I will find a place to put my appeal stuff and links to help others if I get a good response.

Thanks, Dennis