Getting 2nd opinions

@shannonjp I think your son will need to call his insurance company and ask about coverage for second opinions. Typically insurance does cover other opinions, but you need to confirm this, and also confirm that every doctor and facility is in your network for your insurance coverage.

I'm sorry about having to have a spine injection to please the insurance company. They carry some big risks, and I think you could protest against it if he doesn't want to do it. I had a bad reaction to an epidural injection and I think it was an allergy to a component in the material injected which I think was polyethylene glycol. I won't do them again. The epidural injections are not FDA approved.

How does your son want to proceed?

I think he's feeling defeated. He's been having symptoms for almost a year.

@shannonjp I understand. I went through 2 years of surgeons turning me down because they didn't understand how my symptoms related to my imaging. I was just getting worse and afraid I would have permanent damage. During that time, I was seeing a physical therapist who was helping keep things somewhat stable up until I could have surgery. Then I found medical literature with cases like mine. I had to get another opinion because when they make a mistake and miss a diagnosis, they won't admit it. It shouldn't be this hard.

You could make the calls to insurance for him, but he would need to be available to give verbal permission for them to speak to you because of HIPPA laws. If you can help advocate, it gives a sense of control over a difficult situation. Don't give up. Insurance companies play games for profit to delay having to pay for expensive surgery. They are hoping you give up.

@shannonjp
Has your son had MRIs of both cervical and lumbar spine? Does it show any spinal cord flattening/compression due to bone spurs/disc bulging or herniation? That is usually a sign to consider surgery.

He should try the spinal injections to see if they help and at what levels they help. This would help pinpoint where surgery may need to focus.

I have spinal stenosis, degenerative disc disease, cervical myelopathy (spinal cord compression injury) and neurogenic claudication. I had injections in lumbar spine until they no longer worked and then moved to surgery. I did not get injections in my neck because I went straight to surgery after being misdiagnosed for 5 years since I had many symptoms and my spinal cord was being injured.

@shannonjp
Where do you live and what coverage does your son have? How old is he?

You should be able to get a 2nd opinion unless the medical coverage specifically states it does not pay for them (I would be surprised they wouldn’t cover a 2nd opinion).

Has your son been prescribed anything for pain? Gabapentin, Lyrica or Tramadol? Cymbalta? Has he tried Salonpas lidocaine pain patches, nerve pain creams or Voltaren gel?

Second opinions. You love them or hate them. Many doctors from different organizations differ in what needs to be done looking at the very same MRI or X-rays or lab results. My views are yes you must get a second set of eyes on your those reports. Case in point. One Hematologist looked at my lab results and states I have high risk Smoldering Myeloma. Went to Doctor at Mayo who looked at same reports and determined I have low risk SMM. Who to believe? Totally conflicting opinions. So this is the dilemma but it has to be followed thru for peace of mind in assurances that you are doing all that you can.

I believe he has Aetna through his employer in the Seattle area. He’s in his mid-40s. Normally I’m not this involved with his medical stuff but the fact I was going through an acute back problem at the same time had us comparing notes.

He’s been on 1800mg gabapentin (600 3x daily) but the doctor has just switched him to Lyrica. He has had X-rays and an MRI. The assessment of the MRI was that there were structural issues as I described in my post but that he should try PT with no mention of any other options.

@shannonjp
I have Aetna and I can see specialists without referral and can get a 2nd opinion unless his specific plan states this is not covered. Calling would help get answers on how best to use his coverage to see the specialists he needs to.

I do believe Aetna required PT and spinal injections for me before they would approve surgery. Your son’s doctor probably knows this. PT didn’t really help but the first 3-4 injections helped lumbar pain for 2-4 months each but then stopped working. I had moderate to severe stenosis and myelopathy spinal cord injury so they didn’t give me a hard time covering my surgery at that point.

That is good to hear about the steroid injections.

I know his plan does require referrals from his PCP for everything. I was surprised how restrictive it is. He can’t even get a referral from one specialist to another. Everything must go back through his PCP. It’s crazy.

Re: TOPS lumbar surgery
Can you qualify for this if one has SCOLIOSIS? I do not know the degree of Scoliosis I have, but
suddenly in the past year I walk bent forward and to the right.
I am healthy; proactive; determined; and semi-desperate.
Until 2 yrs. ago when I moved from Greenwich, CT to Sewickley, PA I was playing pickleball and golf frequently and served on my Town Government in CT.
But now my system seems to have gone into hibernation - QUALITY OF LIFE AND MENTAL ATTITUDE have declined.
I have been diagnosed and treated for: STENOSIS, SPONDYLOLISTHESIS AND SCOLIOSIS.
Will Scoliosis PREVENT ME FROM BEING A TOPS patient?
Strike 1: Will Scoliosis inderfere w/ TOPS?
Strike 2: Pls. keep an open mind. I am determined and ready.
This fact I must admit is that I am 84. I do not look it, feel it, or act it!!! At am strong, mentally alert and ready for an experiment. BTW, I was in P.T. 2024 for a year for severe neck pain and lumbar pain. Well, it worked - my neck pain improved 95% but my back pain did not.
Thank you for any info................