LAST CALL: "surgery for convenience?” Also, is the Cobb angle over-rated?

[titaniumed]

Jen
I agree. It was just a matter of time. The pieces of Amanda's puzzle are falling together....

I would let him decide on his own what is best......I like the idea of having "some" time, giving him time to think the case through carefully. These Docs do remember and think about cases very carefully.

When Brad wrote Dr Bradford after 25 years, he replied and mentioned "How could I forget!"

Amanda, was the use of BMP brought up? Do you have his e-mail? Can you ask a few questions by e-mail? If so, don’t overload him.

This is good news. Don’t let "luv" smoke over your logic ok? Maintain......LOL

Ed

[titaniumed]

Amanda

I see your sagittal issues.... Scoliosis is just one factor in the equation....I can see your lordotic and kypohtic curves are off.

If PJK was brought up, going short was questioned.

I'm wondering what lengths were discussed?

Ed

[golfnut]

Amanda,
Congratulations on finding the right surgeon and knowing the correct path to take for your future. Things are certainly looking brighter!

[Back-out]

Amanda,
Congratulations on finding the right surgeon and knowing the correct path to take for your future. Things are certainly looking brighter!

Thank you, Karen! I feel loads more hopeful about things, but I confess I'm still eating myself up over the lordosis (and A/P vs. P only) issue. SO hoping it works out - and without rationalization. I'm almost as good at that as at Denial! What derailed me for so long...

[loves to skate]

I doubt there is another adult deformity surgeon in the US with that dual certification - and there’s much else to make me feel my stars may FINALLY be aligning. OMG he's even at a relatively drivable distance, from Nowheresville, PA where I dwell. Facility is excellent too (I.e. if there's a "complication" I can be taken care of there instead of our local deathtrap). And he is such a MENSCH. No wonder I'm floating 6" above the ground. ))))))))))[/QUOTE]

Amanda, I am so happy for you. I know everything will work out well for you. Dr. Rand is also board certified in Ortho and Neuro and I know what you mean about being in love with the Doctor.
Sally

[naptown78]

Good for you

Amanda,
I know what you mean about loving your doctor! I love my second surgeon also...
He knew ALL my issues including the sagittal imbalance problem I had. Let your doctor decide his own surgical plan. I would hate to see you bypass your best guy just because you disagreed on the approach. I know your concern on creating lordosis. Mine was fixed with an osteotomy. It's good to see you optimistic!

[Back-out]

I doubt there is another adult deformity surgeon in the US with that dual certification - and there’s much else to make me feel my stars may FINALLY be aligning. OMG he's even at a relatively drivable distance, from Nowheresville, PA where I dwell. Facility is excellent too (I.e. if there's a "complication" I can be taken care of there instead of our local deathtrap). And he is such a MENSCH. No wonder I'm floating 6" above the ground. ))))))))))

Amanda, I am so happy for you. I know everything will work out well for you. Dr. Rand is also board certified in Ortho and Neuro and I know what you mean about being in love with the Doctor.
Sally[/QUOTE]

Thanks for your good wishes, Sally dear!
I know you've been agonizing with me. Dr. Rand sounds fabulous. And another dual-certified. Guess they're not quite as rare as unicorns!

[Back-out]

X

Amanda,
I know what you mean about loving your doctor! I love my second surgeon also...
He knew ALL my issues including the sagittal imbalance problem I had. Let your doctor decide his own surgical plan. I would hate to see you bypass your best guy just because you disagreed on the approach. I know your concern on creating lordosis. Mine was fixed with an osteotomy. It's good to see you optimistic!

Kristy - much appreciate your understanding (too) abt "love". I was starting to feel like a rock-hanger-groupie after posting.

I wonder (if you see this again) if you could comment on your pre-revision stats - especially the sagittal imbalance? Have you any Xrays to show? I'm starting to feel like kind of a freak. Not that it matters, but I don't think anyone else on this site has come on with a congenital flat-back.

Was your post surgical/pre-revision flat-back as, er, "bad" as mine?

I appreciate your advice on not coming on too strong. I think he'd be open to a discussion, but I hear you about being open-minded.

It's still a question worth answering, I'm afraid - as disappointing as it would be if it "disqualifies" him...There's a real risk of taking someone because I'm so terribly ready to want him, especially because of his dual certification. Also since I didn't expect him to take me, I felt thrilled at the opportunity. Kind of a psychological neediness.

But let's face it, I'm sure you had a good feeling about Doctor #1 when you first teamed up with him, didn't you? I think Ed is warning me against letting emotion direct me, too. I know everyone is "dying for me to settle down with a nice doctor and...etc" And for the very best of motives too. I sense the tension about my timetable on site, and it is touching and all too well justified.

OTOH I have to retain my critical judgment, and not just choose someone because I'm so terribly ready - and needy. It's so hard. I can hardly sleep as it is, with all the stress. Not just surgeon choice either....(SIL..).

Thank you VERY much for your frank input! Balances things. (And again, any Xrays of another sagittal imbalance-flat back?)

[Back-out]

Jen
I agree. It was just a matter of time. The pieces of Amanda's puzzle are falling together....

Hopefully not Rubik’s Cube!

I would let him decide on his own what is best......I like the idea of having "some" time, giving him time to think the case through carefully. These Docs do remember and think about cases very carefully.

Yes, I’m sure he will, Ed. He was straight-up telling me he had to think about my surgical plan - he hadn’t yet had time (which I MUCH appreciated!). However, he DID say he thought he could do it in one go, posterior - no, no anterior extras. As I said, not even an XLIF. That he “ thought he could get away with” one eight hour base op, with at least four more hrs to prepare me and mop up. I was stricken at the thought of not including an A stage since ALL (six) others have advocated it. His future talk intentions seem to be focused on fusion length (see later) but also based on my "thinking".

Thanks VERY much for your great feedback! I think I didn't make our interview clear and in fact, it was unusual. For one thing, he gave me plenty of time - w/i the limits of basically skipping the deformity issues, angles etc. And our interview followed his assistant's still longer one including quick check of colonic stuff. (Asst. was also an MD rather than a PA. )

Dr Shaffrey and I met only after he'd spent a LONG time reviewing all my imaging (there was a lot!) - all except for what their system couldn't "open". When he came in, he began with a long speech giving an overview of my case, starting with his conclusion favoring surgery as summarized. Much of this spiel, was warnings ("You could die...though it's rare", etc).. He spoke with warmth and calm aplomb but notably slowly until he saw I was keeping up.

After basic descriptions, we lept into discussions of neuro issues , mostly the incontinence and its history, wanting for info to be sent on that and other non scoli-problems (e.g. bone density. “It can change…certain things abt. how I do surgery”. I know what that means!). Nb., I’d come with a lengthy medical history - dropped at desk. Apologized for failure to edit it down as I/d meant to (highlighted it instead), including section “pertinent to spinal surgery/issues" . I THINK this helped as my med history is complex.

He began with a few fine-tuning questions, neuro stuff mostly AFAIR and others of special interest to him (e.g for some reason, he wanted to know why I’d come so far when there were competent “surgeons who can perform this operation, closer in PA”. He HAD sent me the name of a PA surgeon w/out my following-up. (I mention all this, since it threw me a bit). In fact, I HAD gone back and forth a good bit abt appts, because of the very high airfare - $750 RT plus car rental from airport and more (That’s twice SF and the same as London! GRRR). @ $2K+ a pop for me and helper, for all routine pre and post trips (not to mention, emergencies), I almost gave up since transport promised to cost more than medical out of pocket. Luckily, Google MapQuest gave me the low down on driving time and I decided to MAKE it work - somehow. (My reply – that Philly was only an hour closer by car than Charlottesville VA, more than satisfied him. I'm still a bit puzzled, though ).

I know he wanted to be SURE I’d return for required follow-ups. He actually makes it contractual, I think. Apparently, pts who do NOT, irritate him since they spoil his studies…. And maybe there’s some other motive? )

[Back-out]

*divided up to (try to) look less overwhelming...

To all intents and purposes, our talk skipped the mechanics of deformity surgery, general and specific. This was the big time compromise to enable us to get launched, reserving the time instead to my relatively unusual situation (neuro issues predominated).

Even the Q & A part for ME , scarcely dealt with the operation itself - nor were any angles or specs given. He politely heard me out and gave sensible answers which satisfied me and seemed to satisfy him ( I was familiar with studies referencing the main issues we discussed).

At the end, his acolyte checked his watch conspicuously, so I stopped myself asking if I could call/email with more questions as they occurred to me, speaking if needed, to Dr Lee (P.A.). To which Dr. Shaffrey replied he preferred we meet again soon as we had so much left to discuss in person, INCLUDING FUSION LENGTH.

He added that not fusing parts of T spine, could leave me some flexibility but there was a significant risk of -- [ hesitation] “PJK” -- and he wanted to present me with the data and discuss the odds, in deciding. Especially, after I’d had time to think through ALL the issues. He again stressed the gravity of the surgery, though the figures he gave me in rx to specific Qs (abt his personal success rate, his # deformity/ops/yr., my own look-out – personally and as a demographic - were all encouraging).

Nb., we discussed that 71% complications rate from the DSG article on “elderly” pts and their outcomes - the one LindaR recently posted in Abstract . He was first author, and for the record, he said yes, it included “hangnails” (my hyperbolic question).

If anything, his comments on help needed after surgery, struck me as WAY, WAY sanguine - very unhelpful in context, as my son was present w/ instructions to report to SIL who is making scary “copping out noises”!

Amanda, was the use of BMP brought up? Do you have his e-mail? Can you ask a few questions by e-mail? If so, don’t overload him.

No, I didn’t ask abt. the worrying (cognitive effects) BMP research – not YET! There was only a brief allusion to whether or not Medicare covers it (he said yes) - ref’g my insurance time-line. Yes, I have his email - on his site (! - Rare in my experience), but I'm going to ask permission to use it when I call his office coordinator tomorrow - unlikely to get through as it's their clinic day...Have some basic Q's I need addressed now (eg. abt cervical stenosis - remember that other thread?)

This is good news. Don’t let "luv" smoke over your logic ok? Maintain......LOL
Ed

More good advice. Looks like maybe w/ surgeons as w/ men (regular relationships ) there may be the risk of an all -or- none rx!
I definitely need to focus on that lordosis problem. 6:1 - so far - is a pretty heavy weighting in favor of an anterior op reinforcing my new lordosis .

And he’ll be starting from zilch natural curve and with that heavy -duty lumbar kyphosis looming above my (very) flat back. I hope I don’t essentially have to choose between expertise in neurosurgery vs. orthopedic (i.e. surgeons with a more architectural vision. ). Neuro vs ortho IS the only difference betw. him and them!

I’ve said for a LONG time to others, that it’s a fools’ errand to try to persuade a surgeon to take a tack he doesn’t feel comfortable with. Chances are they can’t do it as well as what they want to do. Hope this doesn’t test my theory… I’m SO tired of looking -- and worrying (and listening to the clock ticking).

Hope I didn't blitz you! I so value your opinion. It almost seemed to go in two opposing directions, though. All but the LOL - which always helps one think clearly more than it appears (feeling like I need a good joke suddenly - medicinally, mind you...*sigh*)

[JenniferG]

When do you see him again, Amanda?

[leahdragonfly]

Hi Amanda,

Just a quick reply here--I am very happy you had such a productive first appt with Dr S, it sounds like you are heading down the right track now.


You asked about other's experience with flatback--I remember seeing some before and after photos of flatback cases on Dr Pashman's site. Here is a link: http://www.espine.com/flatback-cases.htm

Take care,

Gayle

[naptown78]

Kristy - much appreciate your understanding (too) abt "love". I was starting to feel like a rock-hanger-groupie after posting.

I wonder (if you see this again) if you could comment on your pre-revision stats - especially the sagittal imbalance? Have you any Xrays to show? I'm starting to feel like kind of a freak. Not that it matters, but I don't think anyone else on this site has come on with a congenital flat-back.

Was your post surgical/pre-revision flat-back as, er, "bad" as mine?

I appreciate your advice on not coming on too strong. I think he'd be open to a discussion, but I hear you about being open-minded.

It's still a question worth answering, I'm afraid - as disappointing as it would be if it "disqualifies" him...There's a real risk of taking someone because I'm so terribly ready to want him, especially because of his dual certification. Also since I didn't expect him to take me, I felt thrilled at the opportunity. Kind of a psychological neediness.

But let's face it, I'm sure you had a good feeling about Doctor #1 when you first teamed up with him, didn't you? I think Ed is warning me against letting emotion direct me, too. I know everyone is "dying for me to settle down with a nice doctor and...etc" And for the very best of motives too. I sense the tension about my timetable on site, and it is touching and all too well justified.

OTOH I have to retain my critical judgment, and not just choose someone because I'm so terribly ready - and needy. It's so hard. I can hardly sleep as it is, with all the stress. Not just surgeon choice either....(SIL..).

Thank you VERY much for your frank input! Balances things. (And again, any Xrays of another sagittal imbalance-flat back?)

Hi Amanda,
I don't have Xrays to post. I was measured as 14 cm forward by the time I had my revision surgery. In reading this thread I saw that Leahdragonfly posted Dr Pashman's web site detailing some flatback cases. My xray looks almost identical to the first case of a 48 yr old woman or should I say LOOKED! This was after my first surgery. I notice she was fixed with a posterior only surgery with an osteotomy,and several other otomies. In my research, on sagittal imbalance and creating lordosis, the osteotomy is the important thing. I wouldn't try to convince a surgeon to do anything. He is the expert and has according to you done hundreds of cases a year. Let him answer your questions to your satisfaction, and then when you feel like you have what you need it will be your decision.
I am so glad you are feeling optimistic and I will send good thoughts your way :-))

[Back-out]

When do you see him again, Amanda?

Need to talk to the office abt this - tomorrow, hopefully. I was told explicitly as I left, that his coordinator would SEND me notification.

Seemed odd (and unworkable - what abt my schedule?) but I wasn't able to check it out until now owing to exhaustion after the trip and wishing to spend time with both sons - about to return to school. This was my only time for them in a year, in all (and who knows what lies ahead? ).

Hope no lack of (uber) enthusiasm was mistakenly felt by doc!

[Confusedmom]

Amanda!!! Very happy for you that this is starting to come together.

FWIW, I know we have very different backs, but I have had different docs recommend A/P vs. all P. Bridwell feels comfortable going all posterior, and I figure he's the expert. Sounds like your guy is, too, so maybe you should trust that (with of course covering the issue of your lumbar lordosis in advance).

Hope he can get all your neuro & scoli issues fixed soon so you can move on to other things!!! Keep us posted! How soon is he talking surgery?

Evelyn