change of plans

Prior to yesterday, I had scheduled surgery April 7^th with Dr. B at St Jo. Fear got the best of me Thursday night and I began searching for neurosurgeon lawsuits (which are public records), and came across a public case for a patient with the last name Jenkins that was paralyzed by a local neurosurgeon at St Jo. I will admit this paralysis was not caused by Dr. B, but it still freaked me out a bit, rightly so, right? Anyways, after reading this I was glad I had agreed to my mom’s request that I get a 2^nd opinion. So I met with another neurosurgeon that operates and teaches at KU. My mom knows him and his office manager, and when she called and explained my situation/diagnosis, they offered to get me in the next day, which was yesterday. Yesterday’s appointment was much different from my 1^st neurosurgeons appointment. If you recall the 1^st neurosurgeon I met with, Dr. B. actually told me to go home and reread my MRI report, that it was obvious that I had a disc fragment causing my issues, and he actually made me cry, which is pretty hard to do! You may be asking why I would go ahead and schedule my surgery with him? Working in the medical field, I have a theory that bedside manners should be a mandatory class for physicians, because they spend so much time in school that some social skills are lost, but this does not make them incompetent in the operating room, just hard to talk to. Luckily, the 2^nd neurosurgeon, Dr. H., being a teacher himself, had a much better personality, and actually spent 2 hours with Chris and I, going over my test results.  After him walking us step by step through my CT, it was obvious there was a disc fragment causing my issues, and he explained it is something you know looking backward- once you operate. He said every patient that has this CT scan findings, he will go in and find the same thing, which is why it is obvious to a neurosurgeon, not a radiologist, who writes the CT report. So he said the 1^st neurosurgeon was right in his diagnosis, but wrong in the fact that the report did not diagnose this issue, it was something he knew by looking at the CT. He also said the 1^st neurosurgeon was very good, but he would also be happy to do the surgery, but this is where it gets more interesting. He offered me surgical options, where as Dr. B did not- sold! There are 2 options, and I will explain them. Option 1 (which is what Dr. B. wanted to do): an incision is made in the front of your neck on the opposite side of the issue, and they enter at a diagonal angle, push your “voice box” out of the way, and go for the bad disc. You will have the bad discs removed, and your vertebra fused using “donor” bone or a metal plate. Pros: higher reimbursement for the surgeon (seriously?!)and less pain for the patient because you don’t go through any major muscles… sounds good, right? Cons: loss of some mobility because your discs are fused, risk of complications from moving your “voice box,” which can range from permanent hoarseness to loss of the ability to talk, difficulty swallowing, which can be temporary or permanent, and I should mention that they do go right next to your carotid artery, which is a risk as well, oh, and no pregnancy for awhile, because your bones must heal first. Option 2: the “old school” approach, the surgeon will enter through the posterior (back), cut through a ligament, and pull the muscle away from bone to enter, remove the broken off piece of disc, and sew you up. Pros: you eliminate all the voice/swallowing/carotid artery risks, and they don’t fuse discs, or remove bulging discs that are not causing me issues, and pregnancy is not an issue, just as soon as your neck is healed.  Cons: lower reimbursement for the surgeon (which is why many don’t offer it), and the pain and recovery is more significant because the muscles are pulled away from the bone and must heal. Risk of paralysis is equal for both surgeries. Dr B. had also wanted to fix all my bulging discs, that are not causing me problems and have probably been there for awhile, but this would leave me with a multilevel fusion (AKA loss of more mobility). So Dr. H let me choose… drum roll, please! I will be going with the 2^nd option, and here’s why…. I fear complications, not pain; I don’t want my vertebral discs fused, because you are setting yourself up for osteoarthritis when you do this at 30 years of age; and I don’t want a scar on my neck… haha! Ok I am actually joking about the last one, because they hide it in neck creases, so you don’t really have one!  And I will be having it done Monday morning, instead of waiting. It just so happened that while I was there for an appointment, they had to move his 1^st surgery on Monday to the next week, because the patient is sick, and anesthesia won’t allow a sick patient to be put under, so he offered me the spot, and I agreed, but with a contingency- he would be the only one operating. Weird request? Nope, KU is a teaching hospital, and he is a teacher! He agreed, as long as I would agree to let the resident watch, since this procedure is not as common anymore, and I said they could watch, just not touch!  He said my loss of arm function was impressive (which I think is a weird way to refer to it!), and he thinks the sooner we do it, the better outcome I will have.  For once, I am glad I listened to my mom (yes, I am putting this on record), because I feel so much more comfortable with this procedure and surgeon, which I think will lead to a better outcome. I am a bit nervous about the pain and recovery, because I will be trying to return to clinicals 10 days after surgery, which means no pain meds while at work, but I am just hoping my body recovers quickly.  Oh, and I will be graduating with my class on time in May, and will finish clinicals the week after graduation. Yea!