I did some research on Dr. Byrd and found that he mostly treats athletes-not to hurt anybodies feelings, but I'm not an athlete. I saw an ortho here that is very well respected but mainly works on athletes. I felt very, very out of place with all the sports photos on the wall. He didn't give me, a 53 yr old woman with arthritis, the time of day. I already decided Dr. Byrd's not for me and your info sealed my decision, Donna. I think I'm going to stick with Dr. Barbaro.
I have an appt tomorrow with PM and I'm dreading it. It's a 1/2 hr drive there and then he's always late. Last time I was in the exam room 3 hrs for a 5 min visit that accomplished nothing. Sorry, but plain Tylenol doesn't cut it for this kind of pain, especially after trying to wait that long. I think I'm going to talk with him about seeing someone closer to where I live. They're in so tight with each other that no one will take you unless the other one refers you. I just wish I'd find someone that believes in PS.
Oh, Julie--I have an Ellie also. Mine is also from Empi and is a Promax. It's been a lifesaver but the pain is now to the point that even it barely takes the edge off. Ice helps and not sitting. What a life.
Shirley--sorry you didn't get the relief you were hoping for from the injection. What's next for you?
Leesa--it's frustrating to have to wait so long and move slowly to get to where you want to be--no pain--back to normal. Hang in there ladybug and try to at least soak in the warmth of the sun. We just had some more snow and the temperature is dropping again. I'll say my prayers that Filler follows thru on the phone call and it's a productive one for you.
Margie--Thanks for the info on Barbaro. I really liked the type of post-op care you received. It sounded like they were really there for you. Were you able to have the surgery the next day or did you have to come back home and wait awhile? I would really like to make only one trip for obvious financial reasons.
I am so pleased to have found this forum. It's been very uplifting knowing others really understand the pain and frustration that goes with PS. Thanks
I live very close to Dr. Barbaro. For me, the entire process took several months - but a good deal of that was because of my schedule not accomodating when they could see me. We had already scheduled several vacations and I didn't want to give those up. First I had to meet with Dr. Layzer, the neurologist who refers people to Dr. Barbaro. He's the one who did the MRN. He actually called me about a week after the MRN to give me the results. I was supposed to meet with him to talk about the results but since I was on vacation, he called me. He spent a good 15 minutes with me on the phone using a lot of big, technical words I didn't much understand but I got the essence of it. The most important part of the conversation was that he felt the results "might" be indicating that it was PS so he referred me to Dr. Barbaro. I met with Dr. Barbaro pretty quickly after returning from vacation. He did a visual and verbal assessment and then said his office would be scheduling me for the sciatic notch injection. Again, because of another vacation we had planned, I didn't get to have that injection for about a month. I had the injection in December, went on vacation again, met with Dr. Barbaro in January and was given a surgery date for February, which I rescheduled for March 14 because I had to attend my nephew's wedding in early March and knew that with a February surgery, I might not be up for flying on a plane 2 weeks later!
So......I'm sure it could go a lot faster but a next day surgery is highly doubtful. Julie will be able to give you a better idea as she's flying out to see Dr. Layzer on Wednesday. Those of you who are considering Dr. Barbaro should be able to get a good idea how long the process takes by following Julie's posts over the next few weeks/months.
And so with that, I'll pass the forum on to Julie. Take it away, Julie! :wiggle: (By the way, Julie can't wiggle like that because of PS.)
Looks like I'm trailblazing on this one. We're in the midst of packing for our trip right now. And, lucky me, we've gotta take a break around noon from packing so I can get a bilateral piriformis injection. The only time they could schedule it before the trip was today. So, I'm getting my butt injected today, hopping on a plane tomorrow and seeing Dr. Layzer on Wednesday. Depending on how it goes with Dr. Layzer I will know if I can see Dr. Barbaro.
What I can tell you is that this is no short process and will involve multiple trips out to SF. I'm assuming it will take a few months at least.
I will keep everyone posted on how it goes. Needless to say I'm nervous...
Good news here. I mowed, edged, fertilized and weed-whacked the entire half acre yard this weekend.
Very sore the next day but I did it.
Margie - fantastic
Leesa - the worm will turn, it just doesn't at the pace we want it too
Someone asked about my injections - had very limited impact on me.
Anyone heard from HG? Worried here.
I typed up a thesis in reply to Shurley Jackson's post and when I hit submit, the system had logged me off. Grrrrrrrrrrr!!! I'll try again later.
can you tell I'm in a hurry?
You've been down a very long road and I'm so happy to hear you have concrete plans. Very interested to see how it goes. Good luck, you will be ok.
Thanks and nice to hear you are able to do that much yard work!
Glad to follow your recovery and success so far.
I too hope you find someone closer and glad you found us. I ve gotten so much support here.
I was given Dr Keppler information as the group of doctors I have been seeing all seem to agree that piriformis syndrome has to be my problem. Was this an invasion surgery, or minimally invasive?
We haven t heard from you in a while and we re all concerned. I understand you are losing hope but know that we care very much and want to know how you are doing. Have you been able to talk to Filler s office or another doctor? I hope you are getting help somewhere. This is the one place you can get emotional support anyway, which is so important for all of us. I m not sure what I would have done had I not found this forum.
There have been so many stories on this forum of people who have suffered for so long but they keep moving forward in hopes of a solution. Don t give up. I know there IS hope even if you don t think so right now.
Just remember we are here for you no matter what s going on.
After reading your responses, Dr. Filler felt that I should send one more blog response in follow up. It seems that this runner s blog is a venue for venting and piriformis syndrome support, so I truly do not want to impinge upon your group. However, if any of you are looking for solutions within this office.
Since it has always been our goal to provide outstanding patient service, I do appreciate all of the comments. We are always looking for ways to improve upon our practice and your statements are constructively used for improvements. As it is not my intention to participate in this blog on a continuing basis, hopefully, with this response I will have answered most of your questions and concerns. If not you are invited to contact our office directly so that we can respond to your individual needs.
Personnel changes can occur in any business or activity. A sudden departure can cause some short term disruption when it is unanticipated such as Ever's departure, however, it is simply not true that there is insufficient post operative care or follow up procedure in place. We all appreciated Sheila Butler s work but it is not the case that there are numerous excellent replacements waiting in the wings to start immediately. We are all working extra to assure good continuity of care while we search for an excellent replacement.
Our office uses a 90 day post operative protocol that is comprehensive and exceeds the AMA surgical standard of care guidelines. Our basic post operative guideline includes:
Written post op care instructions provided to patient
Prescriptions for pain medications, antibiotics provided to patient
Pain Management team consults for patient while in hospital
Patients are seen within one week post surgery for wound check
Patients are seen 2-3 weeks for progress and wound check (call or visit)
Patients are seen 4-6 weeks post surgery for progress (call or office visit)
Patients are seen 8-12 weeks post surgery for final post op (call or visit)
Any interim calls for pain medications, disability forms, clinical questions etc. are triaged daily by a registered nurse who consults with Dr. Filler to see that the clinical requests are resolved. In addition, Dr. Filler has an added clinic morning for follow up patients only. There should be no lengthy delay in getting follow up to patient clinical concerns.
Delays in returning phone calls usually result from incomplete records or form information. For new pain symptoms or emergent issues, ordinarily, you would be required to go to the hospital or to your doctor for an evaluation. Because it is not feasible for out of town patients to fly in and due to traffic even local patients simply do not want to drive in, we have offered the convenience of a telephone consult. In providing the courtesy of telephone calls rather than an in office visit, it is imperative that patients completely fill out the forms so that Dr. Filler can respond with correct information about your current condition. Patients must fill out an Oswestry form and write down exact symptoms, otherwise it is a lengthy process of trying to deduce your needs from thousands of miles away.
Your concern for your fellow members while well intentioned, is not indicative of the actual circumstance. From what I can see, one person is stating that after an initial relief of symptoms post op that she is now experiencing increasing pain symptoms. Out of town patients who are unable to stay in Los Angeles for the 90 day global period are urged to have a local provider designated to work with them during their post operative period. You should have regularly scheduled visits so that the local office can check your wound, review the contraindications for activity, and pain management. After the in office examinations, the local doctor can contact Dr. Filler to discuss any new plan of care or pain medications that might be indicated.
Courteous and efficient service is something that the office works very hard to provide. Our staff tries to respond proactively to patient complaints like long wait times and changes in appointments. Wait times are typically the result of preceding patients taking much longer than the scheduled time allowed. To avoid long wait times, I advise patients to come prepared so that there are no unnecessary delays in being seen:
1. Only records and images from one year should be brought, many patients bring records from several years of doctor s visits, surgeries, imaging, etc. It takes a long time to review years of medical history and usually the most recent year contains all relevant information and synopsis of your condition.
2. Try to fill out your follow up forms and update demographic information a day or two before your appointment. Call the office if you have questions about how to complete the forms. Make sure that you have your address, referring physician, and insurance information.
3. Make sure your images and test reports are in the office and available for review or even bring a copy in with you at the time of your appointment. It takes a long time to call around to your imaging center back home and try to get them to fax a report.
4. Prepare a list of questions or concerns so that you can check off your list and bring a pencil to write down Dr. Filler s response so that you can review later. Sometimes, there is so much information given that patients become overwhelmed and keep asking the same kinds of questions prolonging the consult. A list keeps things focused.
5. Get copies of your orders and proactively schedule your next appointment to avoid lengthy delays in your next visit. If you wait to call back or wait to schedule your next appointment after you complete your test, then you must realize that the delay allows other patients to fill up earlier time slots.
Any change in appointment is the result of an unexpected occurrence such as a call from the hospital. We always try our best to accommodate our patient s needs, but it is simply unrealistic to expect a surgeon to function as an internist or general medical office. For example, an internist will step in and fill a prescription quickly since he is seeing patients in the office everyday. However, a surgeon does have surgical time bookings and will not necessarily be in the office to immediately to meet with you. Some of you are well outside of your 90 day post op global period, yet you still expect this surgical office to provide prescriptions and refills without recent physical evaluation or even documenting your status by completing your forms. If you can not come in to the office, then you need to identify a local provider who can work with you in consort with our office to ensure that your pain medications are being prescribed safely and in accordance with your current symptoms.
It would be nice to take a single pill that is free and have immediate permanent relief of whatever problem you happen to have. In complex spinal surgery, success rates are in the 65 to 70% rate and a front and back multi-level lumbar fusion may involve a surgeon s fee of $50,000 to $100,000. Many of the nerve surgeries have surgeon s fees ranging from $2,500 to $20,000. This is a small fraction of what thousands of spine surgeons charge despite the poor outcome rates of spinal surgery.
Dr. Filler is a complex spine and peripheral nerve neurosurgeon with a track record of excellent outcomes and his fees are comparatively well placed as average. Our office has clearly disclosed that we are not contracted with any insurance carrier. When a patient complains of insurance billing problems this usually equals problems with insurance reimbursement. These are issues that need to be addressed directly with your insurance representative. I advise patients to:
1. Plan ahead and set aside funds for high deductibles or participate in a pre- tax health savings account
2. Obtain written verification of out of network benefits prior to every procedure
3. Understand that written authorization is not a guarantee of benefits
4. Ask your insurance for a written copy of your insurance plan fee schedule
5. Submit a request to your insurance for written disclosure of their payment rates
As a non contracted provider we have no contractual obligation to provide insurance billing assistance, we extend the courtesy of billing assistance for the benefit of our patients. This courtesy is sometimes taken as an obligation by the patient. Especially when your insurance does not meet your reimbursement expectations, it is regrettably viewed as our failure. Hopefully, you will take control of your healthcare costs and will pursue your reimbursement and appeal rights directly with your insurance carrier.
My final comment relates to questions about MR Neurography. Please be advised that it is a patented technology and is exclusively licensed by The Neurography Institute in Santa Monica. Since the Neuorgraphy Institute is the sole licensed user of the technolgy, then any other facility including the University of San Francisco is performing neurography without license and is infringng upon a patent. You should ask for proof that the imaging facility is licensed to perform neurography. If the facility is licensed they should be able to provide a valid license for use of this patented technology.
Any imaging facility claiming that they are doing MR Neurography without a license is infringing upon patented technology. Any provider claiming to perform neurography is doing so without authorization. Anyone promoting patent infringement is jointly and severally liable. The 5560360 patent and license for exclusive sole use is on file at The Neurography Institute offices in Santa Monica, CA.
Good Luck to you all,
Shirlee B. Jackson, INM Manager
First, I sincerely appreciate her comments on this forum. With rare exception, comments from a health care provider are not usually available for a public forum. Again, thank you.
After giving her comments a great deal of thought, a few points come to mind. First some background.
Dr. Filler began supervising my care in in October. In early December , he performed my surgery and apparently did a pretty darn good job as evidenced by my recovery and as described in my previous posts. I do not perceive Dr. Filler to be "a quack". Quite to the contrary, I believe he is a very gifted surgeon and an expert in his area of expertise. With the exception of Dr. Filler being tardy to scheduled phone consults, I was initially very pleased with the level of follow-up care, all the way to the point that Sheila Butler resigned. At that point, the level of care dropped. Combined with some of the comments from other patients of his, both on and off of this forum, I am forced to conclude that there may be some "issues" with the management of follow-up care from his office.
When you cut to the chase, we are customers of Dr. Filler. I know his schedule is full but so is mine. My time is valuable. Very valuable. I too am a professional and I am one of the best in my area of exertise and in my industry. I help manage a $30MM per year business that stretches over 3 states. I don't say this to impress anyone but only to emphasize that all of us are busy, all of us are important, all of us are accountable to someone and all of us accountable for others. That applies whether you are a physician, an attorney, a realtor, an engineer, a Mom or a bus boy. Whether we realize it or not, we all have customers that need to be satisfied. Not because the customer has status based on the number of initials that follow their name or the size of their wallet but because a customer, by definition, has an investment in your service.
I, and several others on this forum, have made signficant investments in Dr. Filler's practice. We have paid dearly with our time, our trust and our money. In essence, we have a contract of sorts with Dr. Filler. We exchanged our trust and money in exchange for his expertise and management of our care. As such, I think I/we have earned the right to expect prompt phone consults, prompt responses to questions, prompt responses to prescription re-fills, etc..
I do understand that he is busy. However, no one associated with that office is any busier than the rest of us. Like Dr. Filler, we stop work and/or defer attending to our loved one's needs or cancel other plans to make sure that we fill out the necessary paperwork and make sure our schedules are adjusted to be available for phone consults or to pick up the phone/type an e-mail to ask a question, or request a refill. When we find that we could have kept going with our day for another two hours, it can lead to some frustration.
Put more simply, if I was 2 hours late to a meeting with a customer/client or failed to respond to an order request for several days, I would lose that customer. I should lose that customer. I would get fired by that customer. In our case however, it is very difficult to fire the surgeon who opened and worked on our bodies and who knows our case better than any other. It is even made more difficult by having a surgeon who is arguably the world's foremost expert in the field of which we suffer. Although I believe we all recognize this to be true, I also believe that this should create a heightened sense of responsibility and sensitivity on his part.
With regard to the comments on this forum. Word will spread regarding any business. Good news or bad news, sometimes that "word" is exaggerated, sometimes that "word" is taken out of context, sometimes that "word" is misunderstood as it passes from post to post, mouth to mouth. My take on this is that this negative "word" regarding Dr. Filler would have never started if his business had been taken care of to begin with. As long as the "word" is not slanderous or untruthful, then there is nothing inappropriate regarding people exchanging information about a business. It happens every day in every industry about every business. Dr. Filler, at the end of the day, is running a business.
The above represents my philosophical expectations of Dr. Filler or any other service provider.
The reality in my case is that he and his office, again with the exception of being prompt for phone consults, have met my expectations. I even held back my irritation regarding his lack of promptness to phone consults because I believed that he was late because he was simply busy being thorough with other patients. I still believe this. I have received nothing but excellent care and attention from Shirlee, Essence, Jodean and Sheila. I have had minor billing issues but these were resolved in a courteous and professional manner. The truth is that I have had far more trouble with my insurance company than I have had with Dr. Filler's office. The bottom line is that I was completely happy all the way to the point that Sheila left and then the level of follow-up care dropped. Since Sheila left, I did have unacceptable problems with prescription re-fills. However, Jodean has since stepped in and made this an easy process once again.
In summary, I firmly believe that Dr. Filler is an excellent surgeon. I have received the attention that meets my expectations, at least for the most part. I think Dr. Filler's only real sin is that he let Sheila get away(recognizing that we all know that is sometimes unavoidable) and that has created many issues for his office. I do believe that sometimes very gifted people and businesses sometimes let their success cloud the fact that, at the end of the day, they are simply service providers with customers. In this case, the customers are real, hurting people who are tired of hurting. These same people make investments of tens of thousands of dollars and they expect, and deserve, excellent, prompt and courteous treatment in exchange.
It doesn't mean that these customers receive a guarantee of health for their money, only that they are treated with compassion and sensitivity as they travel to, and arrive at, the health conclusion. Customers will talk. They always talk. They will talk whether the news is good or bad. Unfortunately, in this case, lately the news has been less than stellar. It wasn't this way earlier and as long as the conversations are truthful, it's not the customer's fault that the exchanges have not been as glowing as before.
Sorry for the long and rambling post. LOL, you were warned.
I really think they are trying.
As I stated above, even when Ever left, Jodean made sure I had what I needed. I can't ask for more than that.
Thanks for your well written posts to the group.