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Thread: Sending X-rays safely

  1. #1
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    Sending X-rays safely

    I need to send four X-rays to Shriners in Philly from Raleigh, NC. These are one of a kind and can't be lost. How should I send them? They are large as you might have guessed.

    Also, is there any place that will copy them onto paper let's say? I could send that instead.

    Thanks in advance,

    sharon

  2. #2
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    Hi Sharon-
    I am not sure about this - I would call Janet Cerrone at Shriners and ask her - I know lots of parents have to do it, so I am sure she could tell you the best way. Sorry I couldnt be of more help.

    -Cara
    Cara, Mom to Nathan
    Diagnosed 24 deg. in July 2007, progressed to 38 deg. by August 2007
    Boston Back Brace 8/07 12/07
    VBS 12/10/07 Boston Children's Hospital
    Dr. Hresko
    40 Degrees before VBS
    11 Degrees now!! (2012)

    Nathan's VBS Video

    www.vertebralstapling.com

  3. #3
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    Sharon,

    Could they be put on a CD?

    I agree with Cara - just call or e-mail Janet and see what she says. I'm sure this is a question she is asked all the time.

    Good luck.
    mariaf305@yahoo.com
    Mom to David, age 15, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve
    Currently holding around 25 degrees over 9 years post-op

    Also mom to Nicole (22) and Danny (25)

    Link to VBS Website: www.vertebralstapling.com

    Janet Cerrone, PA to Dr. Betz (David's doctor) janetcerrone@comcast.net

  4. #4
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    Good point Maria. When I brought Nathan's x-rays & mri to Dr. Betz it was on cd.
    Cara, Mom to Nathan
    Diagnosed 24 deg. in July 2007, progressed to 38 deg. by August 2007
    Boston Back Brace 8/07 12/07
    VBS 12/10/07 Boston Children's Hospital
    Dr. Hresko
    40 Degrees before VBS
    11 Degrees now!! (2012)

    Nathan's VBS Video

    www.vertebralstapling.com

  5. #5
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    Yeah, I've had to pick up lots of results for my dad (xrays, dopplers, etc.), and nowadays they all seem to be on CD.
    mariaf305@yahoo.com
    Mom to David, age 15, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve
    Currently holding around 25 degrees over 9 years post-op

    Also mom to Nicole (22) and Danny (25)

    Link to VBS Website: www.vertebralstapling.com

    Janet Cerrone, PA to Dr. Betz (David's doctor) janetcerrone@comcast.net

  6. #6
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    Sharon,

    When I spoke with Janet last month, she suggested sending the films FedEx to ensure tracking and delivery. That is is how I sent my daughters' yesterday. I kept the films in their large envelope and then placed them in the large FedEx box which is available where you ship FedEx. They fit quite well, with only a slight cuve to the envelope, the box also assures they are not kinked or crushed. It is pricey however, the shipping fee is determined by the box dimensions and not the weight, $65.40 for mine.

    Joe

  7. #7
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    shipping x-rays

    We had to send our daughter's x-rays via FedEx also, and I had a terrible time with the Fedex clerks. First they insisted I roll them up and ship them in a tube, which would have surely ruined them. Then they tried to get me to place them in a box that wasn't really big enough, and they would have been bowed/possibly bent. The trick is they must be shipped flat. Finally I talked to the assistant manager, and told him I wanted them packaged flat like a calendar, and he understood right away! He gave me a huge box, laid it flat, then we trimmed the cardboard down to enclose the x-rays. Lots of tape and it worked great! I sent it insured and yes, it is very expensive, due to the package dimensions.

    X-rays taken on a digital system can be copied onto CD's, but some places still have conventional (film) x-ray systems, and there is no way to place these on a CD. These facilities with conventional can make copies of x-rays for you, so there is less worry about having the originals lost.

    Gayle
    Leah's mom, 6 y/o newly diagnosed with 30*T/15*, awaiting Philly Shriners eval for VBS in a few weeks

  8. #8
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    Thanks to everyone for the replies! I greatly appreciate it.

    Janet just said send everything I have (films, MRI, etc.).

    I asked the orthopod's office where the films were taken if they could copy them and they said no, not the large scoliosis films. I jokingly made some comment about being able to send a man to the moon but not copy large format films.

    So I guess it's going to be sending the originals via FEDEX. I am sending films for both girls.

    Something else my husband brought up... VBS is expected to hold the present curve but has some chance of correcting the curve through continued growth, yes?

    How many patients achieved correction versus holding steady?

    Will S has a curve of 48 at present which is +/- 5. I understand they take patients up to about 45. Even if they did the stapling at 45, I am not sure that her back would be stable in the long term. I mean we can't count on any correction. With the fusion, they will correct it very much,I assume near zero.

    What is known about the long-term stability of a 45 degree curve? Do we know enough to say that the corrected spine with the fusion is necessarily going to be more stable in the long term than if she was stapled and held at ~45?

    W is at 31. For her also, I wonder if she is stapled and holds at 31 if that is going to be stable in the long run without a correction back to near zero.

    Is the reason some curves in the 30 degree range worsen after growth has ceased because curves of that magnitude and greater are simply unstable in the long run? If so, I wonder if even staples can avoid the forces involved in creating that instability over time.

    Thanks again for the advice.

    sharon

  9. #9
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    Pooka, I can't answer many of your questions but can give you a bit of an "anecdotal" feel....as Maria probably mentioned, there is a VBS forum at http://health.groups.yahoo.com/group/staplingsupport/ . This forum just became inactive for new posts (a new forum will be used going forward and the address is http://support.vertebralstapling.com...cussions.aspx). Anyway, quite a few people who have had VBS have posted there. Its interesting reading through the posts.

    I was just looking at that website at people whose curves had been in the mid to high 30s before VBS and there were several. Their initial corrections brought them down to the 15-25 degree range (i.e. decreased by 10 degrees or more). Of course this is a small group of people and certainly isn't a scientific answer, but it does give you a sense of what some people have seen. There are others whose curves were smaller to begin with (mid twenties or so) who had corrections that brought them into single digit or low teens. Of course everyone's experience will be different and nobody can make promises, but based upon the small universe (relative to the whole VBS world) of people posting, most seemed to get some initial correction. Some more drastic than others. The second part of the question is less clear since most of these children are still growing...that is we don't know if their initial correction will hold, will get better, or will get worse. You might want to read through the website to get more stories if you are interested (although it would probably take a lot of time to week through the history - you could skim)

    Also, you are right...the theory is that further correction in addition to the correction gained at surgery may take place as the child grows and my understanding is that has happened in the Shriners Philly experience (although I have no idea how many that has applied to). In fact although rare, there were apparently a couple cases where further growth led to overcorrection where they took the staples out. When I spoke to the shriners in the Fall, that had only happened to 2 out of the hundreds and hundreds of their stapled patients. (once the staples were out they found the "overcorrected" curve in the opposite direction started to decrease and apparently the surgery to remove staples is easier than vbs)

    Just a caveat, I don't have personal experience with VBS...I have just been watching the developments very closely in case it becomes an option for my daughter (they wouldn't staple my daughter's curves at this time because they are too small for VBS - but given her young age statistically she is highly likely to end up with curves that would require fusion despite bracing). What I'm posting here is certainly not scientific evidence, just the "story" of what I have seen by speaking to the shriners and listening to other's stories.

    I've been reading your various posts too - you mentioned W wasn't interested in VBS...but where she is lucky (in a perverse way because I don't think are children are lucky that they have scoliosis to begin with), is that she has a little leeway...even if her curve progresses a bit, she might still be eligible for VBS. The reason I think that is lucky, is because soon you will all see first hand what is involved with fusion (when S is fused, is that coming up soon?). And even though everyone's experience with pain and recovery time differs, you will have a real good idea of all the positives and minuses and won't have to rely on a doctor to tell you. Maybe when that happens W may decide that she really wants to try and avoid fusion at all costs (or alternatively maybe you will all decide fusion really is no big deal). If that's the case, and if she has been wearing her brace religiously in the meantime, she may still be a candidate for VBS should she change her mind. However, from the people posting on the website I referred to above it seems like the best correction during surgery is maintained with the smaller curves. In other words someone whose curve is in the 40s is not as likely to be brought down to the teens with the initial surgery (although if they had further improvement with growth it could be a possibility).
    I have also been extensively reading the fusion surgery postings on this websites and I do get the impression that corrections are more drastic than VBS...having said that I have rarely seen somebody's curves be brought down to zero or near zero. You might want to poke around the surgery websites and some of the people who posted have "signatures" that give a sense of the before and after.

    Again - caveat caveat I'm not an expert and others who know more than I may have drawn different conclusions.

    Whatever you do, good luck with your decision for W and with the surgery for S!
    daughter, 12, diagnosed 8/07 with 19T/13L
    -Braced in spinecor 10/07 - 8/12 with excellent in brace correction and stable/slightly decreased out of brace curves.
    -Introduced Providence brace as adjunct at night in 11/2011 in anticipation of growth spurt. Curves still stable.
    -Currently in Boston Brace. Growth spurt is here and curves (and rotation) have increased to 23T/17L

  10. #10
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    p.s. I may very well be wrong...but intuitively it seems to me that a stapled spine with a 30 curve would be less likely to progress during adulthood than an unstapled spine with a 30 degree curve....just speculation though.
    daughter, 12, diagnosed 8/07 with 19T/13L
    -Braced in spinecor 10/07 - 8/12 with excellent in brace correction and stable/slightly decreased out of brace curves.
    -Introduced Providence brace as adjunct at night in 11/2011 in anticipation of growth spurt. Curves still stable.
    -Currently in Boston Brace. Growth spurt is here and curves (and rotation) have increased to 23T/17L

  11. #11
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    Quote Originally Posted by Pooka1

    Something else my husband brought up... VBS is expected to hold the present curve but has some chance of correcting the curve through continued growth, yes?


    Absolutely. Some correction is usually achieved right on the operating table. And as the child grows, very often more correction can be achieved. Of course, it doesn't happen in all cases, but remember the MAIN goal of the VBS is to hold the curve. That being said, the vast majority of cases I am familiar with achieved between 10-20 degrees correction.


    How many patients achieved correction versus holding steady?

    Most got correction.

    Will S has a curve of 48 at present which is +/- 5. I understand they take patients up to about 45. Even if they did the stapling at 45, I am not sure that her back would be stable in the long term. I mean we can't count on any correction. With the fusion, they will correct it very much,I assume near zero.

    I don't know about fusion getting a 48 curve down to 0 (my limited understanding is that's not the norm). However, for some larger, more rigid curves, fusion is the only way to get correction. Dr. Betz will tell you if this is the case. Most patients who are turned down for the VBS are told their curves are too large/rigid for VBS to be likely to work.

    What is known about the long-term stability of a 45 degree curve? Do we know enough to say that the corrected spine with the fusion is necessarily going to be more stable in the long term than if she was stapled and held at ~45?

    Again, Dr. Betz will have to decide what the likely outcome would be based on S's specific case. I will say again that if he feels the curve is too large/rigid to benefit from long-terms results from VBS, he will not accept her for candidacy. He doesn't want to see anyone undergo an extra surgery if there's not a likely chance for success.

    W is at 31. For her also, I wonder if she is stapled and holds at 31 if that is going to be stable in the long run without a correction back to near zero.

    My gut feeling is that W is a much better candidate for the VBS (not saying that S won't be for sure). Assuming she is pretty flexible and they can achieve a 10-15 degree correction (not uncommon in kids who started out around 30 degrees), there'd be a great chance of long terms success. I was told once by Dr. Betz that if the original post-op xray is 20 or less, these curves almost never progress. In other words, the most stable curves are those under 20. However, even in cases like my son's (10 degrees correction at four years postop), and holding at 30, Dr. Betz is optimistic that there is NO reason why we won't keep moving in the right direction.

    Is the reason some curves in the 30 degree range worsen after growth has ceased because curves of that magnitude and greater are simply unstable in the long run? If so, I wonder if even staples can avoid the forces involved in creating that instability over time.

    I think Jill mentioned that a "stapled" curve, of say 30 degress for example, would be less likely to progress than an "unstapled" curve of the same size. How much less likely I don't know.


    Thanks again for the advice.

    sharon
    Hi Sharon,

    Jill post was very much on target. She's obviously done her homework!

    I've added some thoughts above.
    mariaf305@yahoo.com
    Mom to David, age 15, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve
    Currently holding around 25 degrees over 9 years post-op

    Also mom to Nicole (22) and Danny (25)

    Link to VBS Website: www.vertebralstapling.com

    Janet Cerrone, PA to Dr. Betz (David's doctor) janetcerrone@comcast.net

  12. #12
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    Quote Originally Posted by jillw
    p.s. I may very well be wrong...but intuitively it seems to me that a stapled spine with a 30 curve would be less likely to progress during adulthood than an unstapled spine with a 30 degree curve....just speculation though.
    Jillw,

    Great posts.

    S is scheduled for her fusion surgery on 26 March. I mistakenly emailed Janet Cerrone that it was scheduled for the "36th" of March. She must think I'm addled. And she would be correct!

    In re the long-term stability of a curved spine with staples... if rods can break on a much straighter spine, I have to wonder how the staples would hold up given the likely forces on a much more curved spine. I mean I'm no materials scientist/engineer but if a thick rod can fail, it isn't obvious why or how the staples can holdup in the long term. My husband has a degree in M.E. and has had a few courses in materials science. I'll ask him.

    sharon

  13. #13
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    Maria, most of what I (think I) know is because of you, the people I have "met" online because of you, or the research I found because you and Amanda and the others pointed me in that direction!

    Pooka, I have a feeling Janet is used to dealing with a lot of addled people!

    With regards to liklihood of staple breaking I have a couple thoughts (not answers) - First, the staples allow for some flexibility at each staple site as opposed to the rod which is totally stiff along the whole length of the fusion...i'm not an engineer, but wouldn't the force exerted on one long unyielding material (rod) be greater than the force exerted on a serties of shorter more flexible sites? (stapling)? Isn't that why skyscrapers are purposely built to sway in the wind...if they were inflexible they might not remain standing? So while a thinner staple may not be as strong a material, per se, the fact that the vertebrae still have some "give" may subject it to less pressure? Just thinking out loud - the engineering types would have more accurate say on that concept and could support it more than with mixed analogies! Secondly, if a staple does break or become dislodged, presumably it would be easier to remove a few broken staples over a big metal rod? Or maybe I should say the operation and recovery would probably be much easier for removing some staples compared to removing a rod? I think you raise a good question because any "human hardware" seems to be subject to a limited life - whether its a tooth filling, a knee replacement, etc. And unfortunately while a 20-30 year shelf life for a knee replacement for somebody in their late 50s may seem acceptable if not ideal, that same time frame for rods or staples installed while still a teenager is not. Some may be lucky and get a good 50 years or more, but I think we should expect some failure with both rods and staples over that time period. I'd be interested in hearing what your husband has to say.

    Just curious what the three kinds of xrays you need (you posted elsewhere about that). I assume one is a plain vanilla posterior xray? Are the others saggital and bending?
    Last edited by jillw; 02-28-2008 at 06:40 PM.
    daughter, 12, diagnosed 8/07 with 19T/13L
    -Braced in spinecor 10/07 - 8/12 with excellent in brace correction and stable/slightly decreased out of brace curves.
    -Introduced Providence brace as adjunct at night in 11/2011 in anticipation of growth spurt. Curves still stable.
    -Currently in Boston Brace. Growth spurt is here and curves (and rotation) have increased to 23T/17L

  14. #14
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    Quote Originally Posted by jillw
    Maria, most of what I (think I) know is because of you, the people I have "met" online because of you, or the research I found because you and Amanda and the others pointed me in that direction!

    Pooka, I have a feeling Janet is used to dealing with a lot of addled people!

    With regards to liklihood of staple breaking I have a couple thoughts (not answers) - First, the staples allow for some flexibility at each staple site as opposed to the rod which is totally stiff along the whole length of the fusion...i'm not an engineer, but wouldn't the force exerted on one long unyielding material (rod) be greater than the force exerted on a series of shorter more flexible sites? (stapling)? Isn't that why skyscrapers are purposely built to sway in the wind...if they were inflexible they might not remain standing? So while a thinner staple may not be as strong a material, per se, the fact that the vertebrae still have some "give" may subject it to less pressure? Just thinking out loud - the engineering types would have more accurate say on that concept and could support it more than with mixed analogies! Secondly, if a staple does break or become dislodged, presumably it would be easier to remove a few broken staples over a big metal rod? Or maybe I should say the operation and recovery would probably be much easier for removing some staples compared to removing a rod? I think you raise a good question because any "human hardware" seems to be subject to a limited life - whether its a tooth filling, a knee replacement, etc. And unfortunately while a 20-30 year shelf life for a knee replacement for somebody in their late 50s may seem acceptable if not ideal, that same time frame for rods or staples installed while still a teenager is not. Some may be lucky and get a good 50 years or more, but I think we should expect some failure with both rods and staples over that time period. I'd be interested in hearing what your husband has to say.

    Just curious what the three kinds of xrays you need (you posted elsewhere about that). I assume one is a plain vanilla posterior xray? Are the others saggital and bending?
    I'll ask my husband when we get a spare few microseconds!

    I like your analysis. I'll present that to him as a reasonable answer.

    The regular one, one from the side, and one bending I think to see how flexible the spine is. She referred to one as a "P and A" I think but I have no idea what that is.

    Did everyone else have to send 3 views?

    And isn't a 13 yo with a Risser of 0 expected to have a VERY flexible spine? Is this really in question?

    sharon

  15. #15
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    PA films

    "P & A" is correctly referred to as a "PA" film. The P means posterior (the back), the A means anterior (the front), so a PA film is taken straight-on, back to front. This is the standard view for scoliosis, the one used to measure a cobb angle. It is the same view as "AP", there is just a technically semantic difference (both show the same thing). A side view is referred to as a lateral.

    I hope this helps,

    Gayle

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