new to this forum, some of you may already know me from another board...

[laid up doc]

but i'm hoping maybe some other folks on here have some input on my situation. see my signature... my lumbar spine has just one problem, a bad L5/S1 disc. NO facet dz, NO bony changes whatsoever - how this is possible given that my initial injury was 5.5 years ago, i'm not sure, but i sure am grateful!

have a few issues going on that are making my surgery decision-making somewhat unique and very difficult:

1. i have a history of nickel allergy (and lots of other allergies aka am "atopic") and have developed several new allergies as an adult. don't appear to have had any issues w/ a titanium tooth implant that i've had for 2.5 yrs... but a weight-bearing ADR is another beast. am having patch testing by an occupational dermatologist (they see the most metal toxicity and sensitivity issues) and will get the LTT testing done even if i have to order it myself (for medico-legal reasons, i'm going to try to get the derm or my PCP to technically order it, but in the end i can since i am a physician and have an NPI #, and know a zillion people who can draw my blood).

2. my insurance is Aetna - one of very few insurance companies who have a clinical policy bulletin that denies fusion unless you have severe instability. they'll cover an FDA approved 1 level ADR - which would be great if the prodisc didn't contain some nickel and is a CrCo alloy - will know next week if i indeed am allergic to them, and by the next week if i have issues w/ titanium/aluminum/vanadium that are used in fusion instrumentation and M6. i have tried to reach someone who can discuss what happens if one is allergic to the only ADR currently being manufactured in the US (and charite' has same alloy anyway)... i find it really funny that they cover unlimited PT and have yet to deny or question my multiple MRI's, ESI's, and 2 discograms... but will only officially cover 1 procedure to fix my 1 bad disc, even though it is a widely held belief in medicine that 1 size does not fit all!

i have seen bigdog's posts about Aetna and conversed w/ another member here about getting out of country ADR covered. i'm preparing myself mentally and financially to possibly go to the UK or spain for an M6 as i think i may have a better shot at getting that covered. i'd plan to just pay and fight it out w/ Aetna and my PI suit later.

it's really hard to pin down Aetna on anything, and at the same time i just don't have the time/money to endure a lengthy appeal. i am fortunate to have a high paying job (for which i spent my 20's being a student and racking up 6 figures of student debt... which is in forebearance) - which also means i lose a TON of money by sitting around doing nothing. i have some retirement accounts i could raid and a few friends who may loan me money. i do have a neurosurgeon in the US who would do a TLIF, but since Aetna is so diabolically against fusion well... who knows which is the better option.

i can't help but feel frustrated and lost. like many of you, my personal relationships have suffered. i am no longer able to work at my physically demanding job. i am one of those for whom narcotics have all of the side effects and very little of the benefit - sometimes that's a good thing, but i often wish i could get a better respite from pain. i take a lot of non-narc meds to sleep more than 2 hours at a time.

i am having a phone consult w/ an ADR surgeon who works w/ my neurosurgeon Monday, and am working on arranging consults w/ Drs Boeree and Clavel. and yes, i am the same laid up doc who has posted on another forum... again, hoping to maybe reach someone who has dealt w/ a similar situation.

i will end this by saying that i am more than willing to "chime in" on other posters' various issues - but anything i say cannot be construed as medical advice, as i do not have a doctor-patient relationship with anyone here. i am an American educated and trained, board certified physician who sees a variety of problems, but i am not a spine or chronic pain specialist. i have, however, had to educate myself on spine issues and technologies, and am trained to read any medical literature and interpret research.

[KanRunMo]

Welcome to SPS. There seem to be catches no matter what one trys to do. I'm sure many of us will be picking your brain for information (not medical advice). As you may have read, Katie seems to be the expert on metal allergies and how to get around them with an adr and fusion. Good Luck on your quest.

[Justin]

Hi iaid up doc,

Welcome to the Spine Patient Society!

I am headed out the door, but I wanted to welcome you first. I would like to talk with you via private message or email, as we have a lot in common (I'm a physician-in-training). It would be interesting to talk about the challenges we face being in the medical field and having spine issues.

Once again, welcome...please make yourself at home. The SPS Members that frequent our Forums have "been through it all" and really have a unique perspective being the patient--most are well-versed and are very knowledgeable about all things spine.

[laid up doc]

Thanks Justin. Feel free to PM or email me anytime.

[KBear]

I second messaging Katie about her allergies. Through a series of events, she decided to be tested for metal allergies before surgery (she has a lot of allergies and has developed more as an adult). She was super sensitive and ended up getting non-metal or something of the sort, and is doing very well 1.5 years post op.

Nice to 'meet' you and sorry you are in this position, it's not a fun place to be.

[Justin]

Thanks Justin. Feel free to PM or email me anytime.

Thanks, laid up doc. By the way, did you see Katie's post regarding metal allergies?

To Our Newer Members: Warning about metal allergies

[laid up doc]

i "know" Katie from the ADR board - pretty sure it's her, under another name. i got the info on the LTT guy at Rush from her. talked to him myself for a bit, he's nice and helpful.

he said it's a total mixed bag whether a surgeon believes in screening pts for metal issues prior to ortho implants - some do it willy-nilly, some not at all, some only when indicated. none of the surgeons i've seen so far recommended ADR, so i haven't had the discussion yet. that will be Monday.... but i'm having the testing either way.

[Katie]

Hi doc! Yup, you've found me

I seem to be 'marked' on here for the go-to allergy girl There is another member here who is going through an allergy battle and has had a frustrating time of it, but seems to be finally making progress.

If you'd like to chat privately, let me know and I can call if you like, or PM.

Welcome to the light!

[Gilbert P]

You have been given some great insight,

Will post more need to go and lay down

Glad to see you here

Gil

[KBear]

I seem to be 'marked' on here for the go-to allergy girl

LOl... You are definitely the allergy girl! I'm the "had a baby after ADR" girl. I'm still surprised about how many PM's I get on the topic. Now that ADR is becoming so common, I'm sure there will be more like me out there. Glad you and I can help on hard to find topics.