Arrived in england

So my mom and I made it over to England. The flight was long and the eggs they served us for breakfast on the plane upset both of our stomachs so we are still a bit queasy from that. Unfortunately, the Internet at the holiday inn is very expensive, so we won't have constant access. Also the breakfast at the hotel seems to be about $21per person so we are scouting other food options nearby.

Hopefully, they have free wifi at the hospital we can use while we are there. Right now we are at a coffee shop about a mile from our hotel with free wifi. We have all day tomorrow to explore and I have my first pre-op appt. On Monday afternoon.

I got word on Friday morning that the wire payment went through, but I was hit by a hefty currency conversion fee of around 3% by the bank in england since my bank could only wire outgoing funds in us dollars. Had I known I could have payed by debit card and saved around $800 since my debit card only has a 1% conversion fee. Oh well, nothing I can do now.

Other than that I am pretty nervous to finally be here after so much planning. It's hard to believe this is really happening.

Flying on Friday

Only a couple more days before I leave for England.  I wired the payment over on Monday.  My bank needed me to get the address of the bank and the name on the account which was not included in the initial information I was sent.  That took a couple days since the financial person, Sam, was out of the office last Friday and the first part of Monday.  The wire can take a few days to process, apparently, and Sam said she would let me know when it was received.  No word yet, and I'm a bit nervous that if anything goes wrong, I'll be cutting it very, very close since they need the payment in advance of the surgery.  But it is out of my control, so I try to make peace with that.  I was approved for Short Term Disability for work (for the second time this year) and will be off work until Sept. 19th.  I'm now just tying up loose ends and finishing laundry so I'll have enough clothes to pack.

Tests done and sent

I had my MRSA screening and urine tests done yesterday, and everything looked fine.  These were required by the pre-assessment nurse, Julie, in the UK before leaving.  Luckily, my provider has an online portal where I can get my test results immediately once they were in.  I was able to export them and email them back over to the UK today, so it was a pretty fast turnaround.  Otherwise, I would have had to gone back up to pick up the test results and then find someone with a scanner or a fax machine to get them sent.  Nice to have something be simpler than I expected.  I haven't heard from the financial person they said would be contacting me so I sent an email asking about that and Jo, said she would go give that person a nudge.  I'm leaving a week from Friday and just don't want any surprises at this point that could jeopardize the trip.  This is something I find myself worrying about and it will be nice when it is all put in motion.

Hotel booked

So I booked my hotel, the Holiday Inn in Eastleigh.  I called the hotel and asked about the special rates that were mentioned on Dr. Boeree's website, but the lady on the phone said they didn't have any special rates so I went ahead and booked the room online.  I joined a points club called the Priority Club http://www.ichotelsgroup.com/h/d/pc/1/en/reg and booked through their website (thanks Joey Sue for the suggestion!) I think my stay should earn me enough points for some free nights someplace when I'm recovered.

Got my order for the MRSA tests from my surgeon and the appt. scheduled early next week to get that taken care of.  The nurse said it takes a day or two to get the test results back so I should be in good shape time-wise to get them send over before the surgery.

Date is set, flight is booked, leaving July 29, returning August 14

I got confirmation from Jo Haley, the PA to the surgeon in England, that I am on the schedule for August 3rd.  I got an email from one of the nurses with a form that I filled out and sent back and a request to get some MRSA tests that need to be done and the results faxed over 2 weeks before my surgery.  Given that I don't have much time before I leave, I need to get these done ASAP.  I emailed my surgeon here to get an order written for the tests and hopefully he responds quickly so I can get them done in time for the results to be ready.

I booked my flights today, 1 for my Mom and 1 for myself.  Just my luck, overnight the fares for the weekend days jumped by about $2000 for my business class ticket alone.  This means that my trip will be a few days longer than I was originally planning to get the better price (leaving July 29th and returning August 14th), but hopefully should provide an extra time cushion should anything go wrong like a delayed flight.  I'll need the business class seat for the trip back because they lay flat.  Sitting after the surgery can be quite painful for awhile so this was a must for the return trip.  They were sold out of upgrades so I couldn't use my miles to upgrade a coach fare to business class, and it wasn't any cheaper to get business class on the return trip only so I had to buy a roundtrip business class ticket.  A bit more expensive than I hoped, but nothing I could do about it.  At least I will be able to lay flat on the way over there also.

Next on the list is to book some lodging.  The cottages I was looking at are booked so it looks like it will be a hotel.  I think I'm going to go with the Holiday Inn.  It is about 2.2 miles away according to google maps and on the contact page of http://www.nickboeree.com/contact/ it says they offer special rates to patients of the Spine Clinic.  I've also heard from others that have stayed there that it is pretty good and they are used to getting patients from the Spine Clinic.  My mom isn't comfortable driving in the UK as it will be the first time out of the USA for her so hopefully the close proximity will cut down on cab fares back and forth.

My checklist keeps growing as I think of more and more things I need to get done before I go.  I have to admit I had a few, "oh my god" moments today as this just got really real for me.  I have been thinking about this for so long, hoping to get the ball rolling, and now the reality of it is starting to sink in that this is going to finally happen.

Tentative surgery date: Aug. 3rd

I finally heard back today from Jo, Mr. Boeree's PA, about potential dates for the surgery.  She gave me a couple to pick from and I picked the soonest one, August 3rd.  She is going to be out tomorrow and will finalize everything on Thursday so I can start booking flights/lodging etc.  This will mean I will need to fly out from the US on either July 30th or 31st depending on what time I need to be there on Monday for pre-op consultations/tests etc.

There is a lot I will need to take care of in the 2 and a half short weeks before I leave including booking flights, finding a place to stay, finding transport to Eastleigh from the Heathrow airport, getting any pre-op tests/procedures done, arranging for short term disability from work, getting the funds together to cover the surgery and having them wired over, and preparing and packing for travel.

I am looking at a couple of rental houses in the area:
http://www.kingsmerecottage.com/cottage/Welcome.html
http://www.winchesterholidayhomes.co.uk/Properties/Properties.html

I have emailed them both to see if they are available during the time frame I'll be over there (July 31-Aug1 to Aug. 12).  Since both my parents want to come over with me, I figured these would be more comfortable than cramming into a hotel room together for 2 weeks which I think would have a good chance of driving us all crazy.  I need something that is relatively close to the hospital (no more than 12 miles) since I'll have to go back there a couple of times after I'm released and I've read that car rides can be tough right after the surgery.  If these aren't available, I'll have to find a hotel in the area although, most appear to be at least as expensive if not more so than the rentals.

I also found a couple of websites for taxis that can take me to Eastleigh from the Heathrow airport.  The hospital can arrange transport for both way for £300, but I think I can find something quite a bit less expensive if I look a bit (hopefully more in the range of £200 total for both trips).


http://www.eastleighcabco.com/
http://www.londontobirmingham.com/TaxiFromHeathrowToEastleigh.aspx
http://www.southamptonairporttransfer.co.uk/taxi-fares.html

Feels kinda scary to have this becoming more a reality, but I'm also excited that it will hopefully get me back to doing the things I've missed for so long.

More info from England

I had requested the cost information for the surgery and I got it today along with some additional information.  The inclusive costs for a single level L5-S1 disc replacement with an M6-L would be £18,300 (you can do the currency conversion if you're really interested).  That covers everything connected with the hospital stay, including the pre-assessment visit and investigations, all the hospital charges, the surgeons and anaesthetists fees and physical therarpy while at the hospital (and afterwards at the hospital while you stay in the locality).

They also offer arranging a car to pick you up from the airport and driving you the 1 hour to Eastleigh and also the return trip for a fee of  £300 total.  I might look into finding a taxi service that might be a little less expensive.

After the surgery, I'll be in the hospital for 3-4 days and he recommended staying in hotel for an additional week or so after that before I fly back.

I also got a list of hotels in the area, although I am also looking into perhaps renting a vacation house for a couple weeks since both my parents are planning to come with and all of us in the same hotel room for a couple weeks might drive us all crazy.  It will be a matter of finding something available that is close enough as car rides right after the surgery can be tough, and I'll need to go back to the hospital a few times for PT.  They do allow you to stay at the hospital for free for a few days before the surgery.  They will allow you stay in the hospital after the normal discharge time (usually 3-4 days after the surgery) for £75 per night for the room and meals.

I don't have the exact date of my surgery scheduled yet.  That will be the next thing to get nailed down and then I can start booking flights, lodging, etc.

Phone consultation with Dr. Nick Boeree

I had my telephone consultation with Dr. Nick Boeree from England today.  My phone rang at exactly the time that his PA had arranged with me via email yesterday.  He assured me that he was ok, and had just had a bump on the head and apologized for having to reschedule.  I didn't ask specifically what happened as we moved right into other matters.  We first reviewed my history and it was quite obvious that he had reviewed the information I had sent and looked carefully at my MRIs.  He said that it looked like the L5-S1 disc was degenerating and had lost some height towards the back and was bulging out after the re-herniation.  He also mentioned that my L4-L5 disc looked like it had a very very slight darkening that was nothing to worry about now and would be more of a concern if I were going to get a fusion or a non shock absorbing disc (like those available in the US).  He didn't think it warranted any action now, but was more just something to keep in mind.  We also talked about my symptoms, where I had pain etc.  He advised that he didn't think getting another L5-S1 discectomy would be a good option since I didn't heal well from the first one and it would cause the loss of more disc height.  This was right inline with what I was thinking, but it was good to get confirmation from a pro.

He then explained the disc replacement procedure which was pretty similar to the information he has on his website, which is very detailed and clear.  We also talked about some of the risks of the surgery, but he said that they would be very minimal for someone of my age who doesn't have any other major medical issues.  He said that he really would have no reservations at all about doing the surgery and while there were always risks and he could not absolutely guarantee no problems, he felt that I was an excellent candidate for a disc replacement.

We then talked about his experience with disc replacement surgery.  He has been doing them for about 10 years, using the Charite and ProDisc before switching to the Spinal Kinetics M6 which he felt was a far superior disc.  He has done multiple 100s of disc replacement operations and usually does 1-2 per week on average, with the rest of his time spent doing other spine related surgeries.  He went over some of the testing they do for the M6 which simulated a lifetime's worth (or even more) of usage with no problems.  I said my only concern was how the polymer based materials would stand up over 20 or more years of usage in the body with regards to the polymers oxidizing and becoming brittle over a long period of time and he said that the materials used in the disc had been used in other medical applications such as knee and hip replacements and had shown no/very little signs of that type of degradation.  He was also careful to say that as the disc is still relatively new, it has not had time to amass years of a proven track record so there could be unknown factors that could arise in the distant future.

He stressed that he had no monetary interest in the M6, owned no shares of the company and used it solely because he thought it would give the best outcomes to his patients compared to any other discs on the market.  He also stressed that he was very committed to providing 1 on 1 treatment for a specific patients needs and was not running a "surgical factory" where he was just trying to get as many patients through as possible.  He said his highest goal was not to make loads and loads of money, but to make sure his patients got the best care he could provide.

I asked him about activities that I would absolutely want to avoid after having recovered from a disc replacement (it takes around 3 months for the bone to grow into the disc to secure it in place) and he said that I would have very few restrictions but did warn that things like bungee jumping, trampolining, and sky diving would probably not be advisable (but pullups would be ok, since I like to do these as part of my workouts).  He said that even though the disc itself is much stronger than a natural disc, the place that a failure would most likely occur would be that the artificial disc could possibly become separated from the bone in the event of an extreme hard landing while the spine was in extension (ie bending backwards).  He said it was hard to give absolutes and guarantees about what would be unsafe, but he said to use common sense and err on the side of caution.  In general, it would take a pretty traumatic event to cause a problem, but that doesn't mean one could do the extreme activities without some risk.

He talked for the entire 30 minutes before having to move onto another patient consultation.  He said I should think it over and if I wanted to proceed, that I should email him or his PA.  The lead time for getting the surgery is usually 3-4 weeks at a minimum but he did mention that he was vacationing for a week in July so it would probably be in the August time frame at the earliest. 

My general impressions were that Dr. Boeree was a very kind, thoughtful, honest, articulate, humble, and intelligent person.  I got no sense at all of any sort of arrogance from him. I felt very comfortable talking to him and at no time did I get the impression that he was trying to pressure or persuade me to get the surgery.  He simply laid out the facts and the risks and his opinions.  This is in line with all of the other numerous reviews that I have read from other patients of his.

I emailed back to get a price quote just to make sure, even though I had a good idea of what it will run as well as information about lodging, transportation, etc. and barring any unforeseen surprises, I'm pretty much set on getting the surgery from him.  Now will just be a matter of nailing down the date, and working out the logistics which will be no small task.

England surgical consult delayed

So I received an email from Dr. Nick Boeree's PA to set up a telephone consult a few days ago.  I send my credit card information to cover the $400 fee and was scheduled to have the consult this morning at 10:30AM.  So I gathered all my information, did some last minute additional research to have the info fresh in my mind, and wrote down a list of questions I wanted to be sure to cover.  Unfortunately, by 10:50AM, I had still not gotten the call.  As I was about to send off an email to ask what was happening, when I got a call from the PA saying that the surgeon had taken a little fall and bumped his head.  They said they didn't think it was serious as he was walking and talking just fine, but wanted to get him checked to make sure.  She said he might contact me yet today, and if not, they would reschedule for next week.  Jo (the PA) was very apologetic and very nice on the phone.  She had also sent an email in addition to calling.  I guess it is just one of those random things that you can't foresee.  I just hope the surgeon is OK, for his own sake and for the sake of his other patients (a lot of whom are much worse off than myself).  So keep your fingers crossed for him.