Monday, April 7, 2008

Wunderkind Redux

If I have to have a myelogram because of you, crazy neurologist lady, I'm not going to be happy! Forget the myelogram; I'd rather have surgery. I know that's not rational, but since people have scared the bejeezus out of me about the myelogram based on their own experiences, I'd rather not. Plus I have a needle-spine phobia inspired by a story in Good Housekeeping that I read as a child in which a woman's daughter died after a lumbar puncture. That article is where I first learned what "code blue" meant. The mother was so grief-stricken she couldn't even remember her daughter's funeral, and she learned that it wasn't the meningitis or whatever it was that killed her daughter. It was the lumbar puncture, and if she had not had it, she would have lived.

To take a step back, I mentioned what the neurologist said about most doctors not doing surgery for that level of herniation; my husband's perception as well as mine is that Wunderkind took this concern seriously. He went back to square one, reevaluating the MRIs. Wunderkind said he wanted to run one more test, and I said, " long as it's not a myelogram," at which point he smiled and raised his eyes in a that-was-what-I-was-going-to-do way and I started sweating. To make a long story short, one view of the C5-C6 disc on the MRI is very grainy and he wants a better view pre-surgery, so for now I'm having to redo that portion of the MRI at the imaging center's expense since it was their error (two whole sheets, so it wasn't that I moved or something was wrong with all of that particular kind of image).

I can't have the Prestige disc because it's contraindicated for the osteoporosis and the giant screws probably wouldn't hold. Insurance also won't pay for it ($30,000-$40,000), which stinks for the people who could use it. The insurance companies want 10 years of data rather than 2 to 3, which is difficult to get once the clinical trials are over and insurance won't pay for it. Wunderkind doesn't have a lot of repeat surgeries for discs above and below the fusion, but the discs may continue to degenerate some over time, whether or not I have surgery, because of the degenerative disc disease issue. Wunderkind talked at length about the importance of keeping the natural spinal curve during fusion surgery so as to prevent more stress on the other vertebrae. My husband asked about the donor bone versus my own bone--donor bone is somewhat less likely to fuse and thus cause some pain, but I'm not sure I want to further weaken my hips since I've had a fracture. The donor bone would likely be much stronger than my bone, but I don't know if that would create a fusion issue. So those questions are all answered.

Now I'm worrying if Wunderkind will even do the surgery anyway since doctors have to be concerned about litigation, and the neurologist said most doctors wouldn't do the surgery. That doesn't mean she's right. This isn't her area of expertise, and she may think I'm rushing into surgery. And I am going into this fully informed. I don't think it would do me significant harm to have it fused regardless, though I recognize complications can occur, and it is actually likely to make the bladder symptoms, the hand and arm and shoulder symptoms, etc. much improved and allow me to sit up longer. If only medicine were more objective and less subjective.

I don't think this is something Wunderkind anticipated or that he thought it was an iffy situation whether to do the surgery, since he wouldn't have sent me to a neurologist that he thought would question his opinion. I think it is good for him to know about this since he's probably sending other patients to her. I don't like this metamorphosis from completely confident to completely confused.

I was working on my computer in the office, and I closed it quickly, worrying the radiology technician that I hadn't saved the open document. He said Wunderkind was once on a 7-hour flight with a lot of turbulence, so he kept having to shut the computer. Wunderkind said the following Monday that he wished there was a way to save what you were working on when you get interrupted so that you didn't lose your document--the radiology technician said, "Oh, you mean the save feature?" I guess a certain amount of absent-mindedness accompanies brilliance.

So MRI #7 Friday night and back to Wunderkind on Monday. And I may get the second opinion just to satisfy all of us. In my spare time.


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