[Sacroiliac Joint Fusion / Dysfunction] My Right Sacroiliac (SI) Joint Fusion Surgery- 3/10/09

[runagain]

Cindylou,

Sorry you had a rough time.
Sometimes doctors do not like their toes stepped over. It is too bad your back doctor is not collaborating with Dr. Stark. Is your back doctor a physical rehab doc or anesthesiologist that does spinal injections?
What is the extreme altering of your spine? Is it the ADRs, the vertebroplasties (sp?)?, your hips?, the ALIF?
If you continue to have pain at unacceptable levels, I would get a few more opinions.
You might have to heal. Perhaps Dr. S said you did not need a spinal cord stimulator because he is thinking that is what your back doctor will suggest.
Is your gait off balance now?
Is your pain on one side of your back and not the other? If it is also on the other side, you could have an SI injection on that side, but you have to remember that your ligaments do not like repeated injections there as they will weaken the ligaments (from my understanding).
It is easy for doctors to say fuse the ADRs over. Is Dr. S pro ADR or anti ADR?
Is Dr. S thinking you have too much movement at the ADR levels?
Or are your facet joints bothering you?
There could be multiple reasons for you pain or just one.
I would go slowly on this one. And IMHO, I would not rush to have another surgery.
I don't know if you want to say it here. But are you on Celebrex? or a medication like that?
I have found when I am on Celebrex (and yes, there is some thought that it may contribute to heart problems, but I am on the low dose of 200 mg) that my joints feel a lot better.
It makes a big difference in how I feel.
Also one of your options may be sending your films to Dr. B, noting where you feel pain, and see what he says.
My point is do not rush to judgment.
I would be very careful.
Oh, and don't feel so bad about what Dr. S said to you. You are not a doctor and sometimes doctors forget that. They think you know that an SI J injection would not work in a fused joint since there is no ligament there, only bone. However, if there was inflammation at that area, an injection over that area might calm down inflammation, if it is there.
If it is fused, the back doctor should have realized it. That might be what threw Dr.. S into a tantrum.
You have two conflicting opinions. It sounds like Dr. S did not like your back doctor's opinion.
CL, you also have to remember, that given the amount of stuff that has been done to you, doctors might be callous about your pain. This is my humble opinion.
That is why i think if you got a doctor who looked at your pain problem with fresh eyes, that might help you. Do what they say to do on here, make out a list of very specific questions and interview the doctor. If he or she balks at answering your questions, show him or her the door.
Again, I am sorry you went through that. Sounds rough. I am glad to see that you stood your ground.
I think I might have told you one of my docs does not believe the SI joints move.
However, when I got an SI j injection, it stopped that area from hurting, so I am in the opinion, they do move.
Just because one doctor believes something, that does not make it right. Doctors can be wrong...sorry Justin, just an observation, no reflection on you.

Take care,

R

[Cindylou]

Thanks runagain, Carson....all of you. Believe me, I am not rushing into any surgery. Far from it. But I appreciate your reflections and questions runagain.....Carson too. You hit a number of nails on the head runagain with your questions. First, no, Dr. S. is not a big believer in pain management doctors. And second, bingo, he is not big on ADR, altho he has met Dr. Bertagnoli in person and talked with him about such matters. Perhaps I should say he thinks ADR is okay, but in a very limited population of people. And contrary to what you are suggesting, I think he thinks I have too many cooks in the kitchen already. The doc who gave me the injection is my pain management doctor. When I refer just to "my back doc" that is the doctor who initially recommended Dr. Bertagnoli for my adr's, instead of a 3 level fusion, because he thought it would be the kiss of death for me as an active person......altho he is a surgeon.....specializing in fusion as well as being one of the first docs here in twin cities (maybe MN?) who started doing 1 level lumbar adr's a few years back. He also has followed me for aftercare with my 3 Prodiscs, and had to do the ALIF about 16 months after my surgery with Dr. B, due to extreme pain still with my pars defect, etc. (this is the surgery, the ALIF, that Dr. B was supposed to do at the same time as the ADRS', but couldn't, due to the invasiveness of the 3 lumbar ADR surgery and the fact that I lost alot of blood and had to have 2 blood transfusions after my ADRS'. He said (Dr. B.) he thought it was too risky to go ahead with it then, so we always knew it still needed to get done, as it was a pain generator from the discogram. You always hope and pray that 1 surgery will cover all your problematic pain areas, but......Unfortunately, it became 2 back surgeries, instead of 1. And since I am reflecting back, for any who can't recall or care to know, it was the ALIF surgery that unfortunately caused the bone cement leakage before it hardened, and the back doc had to open me back up 1 month after it to chip the hardened bone cement off my S 1 nerve root. And that's when, after being opened up so soon after the ALIF again, I ended up by ambulance in the hospital for almost a week with my second pulmonary embolism, collapsed lung, double pneumonia, etc. So yeah, it ain't been no picnic. I had never thought of having the most current Cat Scan (of my SI joint....but it looks like it still shows my adr's alot) mailed off to Dr. B for consult. That is something definitely to consider. So, for right now, I am just going to sit on and chew over everything that Dr. S said, and that all of you have offered. I go back to pain management on either Monday or Tuesday next week, and will also discuss upping my meds for the time being, and perhaps changing my fentanyl patch every 2 days instead of 3. I am also going to try and focus on the positives, and especially enjoy today's break from our stifling humidity. It is downright pleasant outside! Finally have the central air off, and windows open. Tonight, here in Minneapolis, the lows are going to be 55-60's. Can't wait!

[Cindylou]

Oh, runagain....I think the extreme altering he is referring to is the prodiscs. That's my best guess. He, Dr. S., also thinks my L 5-6 prodisc looks "off." I do have some slight scoliosis around that level that Dr. B was able to straighten some (I recall him telling me that) during surgery, and perhaps that is what Dr. S. is referring to. Not sure.

[Cindylou]

So, I had my 2 year follow-up w/Dr. S. on Friday, 2 days ago. But let me back up a minute, to put things in order for all of you: My second ESI was scheduled for March 3rd, however, it got cancelled at the last minute, while I was actually waiting to go back to the room for it. I was hugely disappointed. What happened was, my p.t., who I saw right before the scheduled ESI, examined me and was/is certain it is the right SI Joint (that was fused by Dr. S) that is the cause of my continued severe, back pain. She told the Nurse Practitioner, who in turn consulted with the pain Dr. at the last minute, and he decided to cancel the ESI until AFTER my appt. with Dr. S., which was this past Friday. Ok, so back to the actual 2 year follow-up appt: Dr. S. started out somewhat prickly again, because I was telling him that my p.t. thinks it is my right SI Joint, that he fused, that is the source of my pain. That didn't go over so well. You know, some of these surgeons just refuse to believe that you are still in pain after they have operated on you. You're fixed, dammit! Anyway, he had me undergo a few x-rays then and there, which we proceeded to review: all of my 3 Prodiscs look placed well, however, it is looking like my L4-5 one is beginning to auto-fuse. You can see it on the x-ray. I'm not sure what this means, though, and what, if anything, should be done about it. I recall asking him, and now cannot remember what he said. (I get so intimidated by him, it flusters me) So, he did order a Cat Scan of my lumbar and SI Joint area, however, we leave in 2 days for Mexico, so not sure I will be able to have it done until after we return. I will call first thing tomorrow a.m. though, and see what's available. I am still experiencing pretty excruciating pain in my ribs though from my fall last week, so naturally, my back isn't high on my radar of pain at all. Isn't that interesting how the brain works like that? It can only concentrate on one area of pain at a time. Fascinating stuff. So, that pretty much sums it up. Does anyone know anything about artificial discs when they begin to auto-fuse? Justin, do you? Will keep you posted, meanwhile, can't wait to get out of this cold weather and into some Mexican sunshine. CL

[ajj1001]

wow he sounds like a charmer! is bone bridging the gap (maybe from osteophytes?) to perform the auto-fusion? I know what you mean about pain sources, my right ankle is ruling the roost at the moment. hope the hols in Mexico help settle things down.

[KBear]

So does Dr. S say that the SI joint is fused? Or is that why they are doing the CAT scan?

Have a great time in Mexico! Wish it were me!

[ajj1001]

Have a great time in Mexico! Wish it were me!

no you don't, you are going to get new baby snuggles next week. far better than any holiday!

[Cindylou]

So does Dr. S say that the SI joint is fused? Or is that why they are doing the CAT scan?

Have a great time in Mexico! Wish it were me!

Yes, that is why he is ordering the Cat Scan. He still thinks it is fused but no one else seems to, and he says they don't know what they are looking at, (other doctors) which, I think is probably partly true. But every doctor? I doubt that. So we shall see what the Cat Scan shows. Yes, Kathy....Alison is right! You have new baby coming next week....can't hold a match to that! CL

[Cindylou]

Oops, forgot to address to you Alison....it looks like osteophytes, yes. Sticking way out on the right, large osteophytes. CL (I should have asked for a copy of my x-rays...think I'll call and have them mail a copy of them to me)

[ajj1001]

Oops, forgot to address to you Alison....it looks like osteophytes, yes. Sticking way out on the right, large osteophytes. CL (I should have asked for a copy of my x-rays...think I'll call and have them mail a copy of them to me)

if the placement of the discs is good then it's odd that they are all forming on the right. is the core still performing good flexion/extension and level at rest? be interesting to see the x rays.