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Psychological exam before stimulator trial
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caspertab posted:
I have had a stimulator implanted for 8 years and it is time to replace. I am going to change companies and I was informed before any trial can be done, the patient has to have a psychological exam before. I asked if that goes for me since I already have one and was told yes, the insurance companies are requiring this. Are other people being told this or is it just for we Floridians?!
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dfromspencer responded:
That is a very good question! I would like to know the answer to that, myself. I hope you find your answer.

Good luck!

Dennis
 
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chronic1008 responded:
I'm in IL and had a Boston Scientific spinal stimulator placed in Jan 2010 and yes I had to have a psych evaluation prior. I was told this is an industry standard. Because you already have one though, this sounds redundant. Why have a trial if you have had positive results for the last 8 years? Are you switching companies for a specific reason?
 
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ctbeth replied to chronic1008's response:
Greetings from Connecticut,

I had my SCS replaced, the entire unit, in Jan 2009. My initial SCS was implanted in 2007.

Initially I was told that I'd have to have the psych eval again.

This seemed silly and redundant, so I questioned via letter from my atty to the insurance company.

The insurance company agreed and the psych eval was cancelled.

Yes, it does seem ridiculous! We have to fight to get care that we need, then are offered, or required, to get care that we do not need!

Please let us know what becomes of this.C

CTB
 
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caspertab replied to chronic1008's response:
I had a stimulator from Advanced Bionics, one of the first battery charged stimulator. Later Boston Scientific bought them out. I was told it was guaranteed for 5 years, but the representative said it would go 8 years. I am at 8 years and can tell it isn't as effective. I am having other difficulties and the dr.who implanted it told me he likes the St. Jude product as it is guaranteed for 10 years and his patients are getting good results. Before he removes the unit, he is going to do a trial with another lead from St. Jude to see if I can get a wider range of coverage. I do see the reasoning behind a psych evaluation as a stimulator is an expensive investment and I have heard of people shortly after the implant, not liking it and having it removed. I have a pain pump from Medtronics and I tease the dr. telling him the implants are fighting over who is better! LOL. Can you give me a hint as to the questions I will be asked? Thanks and happy holidays.
 
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ctbeth replied to caspertab's response:
I have a St Judes SCS, but do not have a re-chargeable battery.

For me, this is the right decision.

The techs at St Jude looked at my usage patterns, after I had the second battery change, and determined that, at my level of use, I would require daily recharging. I do not want this, as I try to reject the, "sick role", in my life.

To have to check the time daily to be home to charge my battery requires too much attention to my injuries for me.

Regarding the psych eval: it was really simple and basic. The purpose, as I understood it, was to be certain that my expectations were not unrealistic regarding what this modality can and cannot do. There were no surprises.

I did not like that I had to see a psychologist for purely physical injuries, but it was what had to be done to get the SCS, so I did it.

For me, it was worth a little of my time and I swallowed my enormous pride and did whatever was asked/ required.

Again, the questions were mostly to assess my understanding that this surgery was not a miracle and that my expectations were appropriate.

When I had a rhinoplasty (yup, nose job) , I also had to have a psych eval for much the same reason- to be certain that my expectations were appropriate- that I didn't expect that my world would be perfect just because I'd have a smaller, prettier nose.

I cannot believe that I am actually confessing that I had my noise fixed! LOL
 
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caspertab replied to ctbeth's response:
Hi Beth,
Confessing to a nose job is nothing compared to what the celebrities confess to!! Thanks for the tips for my upcoming psyc. eval. I do see the reasoning, but I already have the unit, and it is being replaced due to age and not being effective. My daughter 20 years ago had brain surgery due to her seizures and she had a real intense psychological evaluation. That I understood why. I don't like insurance companies doing unnecessary appointments just to get extra money. As you say, I'll swallow my pride and jump through the hoops! Could you please educate me on the re-chargable battery? Thanks.
 
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ctbeth replied to caspertab's response:
Hello Caspertab,

I love to try to decipher the screen names that people use. My best guess is that Caspertab has to do with cats. Am I close?

I do not have a re-chargeable battery. Mine gets changed when it dies.

Initially, I had three annual battery changes. This is not supposed to happen; the battery should last between 5-7 years.

Ultimately, in Feb 2009, I had my entire SCS changed and have not required a battery change since then.

The tech checks the power left every few months. The plan is to schedule the battery change surgery when I am at 75%. This will give enough time for workers comp to deny it, schedule an informal hearing by which the commissioner will approve the battery change (this is, ridiculously, how it goes with wc).

The battery is accessed through the original battery incision. I do not have any sensation there, so I feel nothing. I do have it done under conscious sedation as the incision would probably cause dysreflexia, or at least, spasm that would make the surgery messy and difficult.

So, it is probably easier for me, because of my lack of sensation. I cannot imagine that it would be very difficult anyway. It takes about 1/2 hour to 45 minutes. I fall asleep with the sedation.

The staples get removed on day twenty. I get an IV antibiotic pre-op and po antibiotics until the staples are removed.

For me, this procedure is far preferable to having to recharge my battery.

For the most part, I do not even think about the SCS; I just reap the benefits!

If I turn the SCS off, the pain is relentless. I wonder how I lived like that for so long before SCS!

I know that most patients want the re-chargeable battery to avoid the battery change surgery.

For me, my patho-phisiology, pain magnitude, energy requirements, etc, I am very happy with the non-rechargeable battery.

I know a few on this site who have SCS, but I may be the only one who doesn't have to re-charge. I am quite content with my system.
 
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caspertab replied to ctbeth's response:
Happy Sunday,
You were correct with my screen name. We had two cats who died a year apart 3 years ago. One was Casper (all black) and the other Tabatha, an orange Tabby and her picture is what you see.

I am finding intercostal and chest wall nerve damage (I'm sure you read my story) not very common on this web site. I am also a retired nurse, but sadly said good bye to my license after 30 years in 2006. I appreciate your information on your type of SCS. I don't want to go through all the battery changes as I had three repositioning surgeries, one lasting 5 hours, and never again!! You have to be awake and again with my pain, getting stimultion to the correct area is tricky. I began with 2 leads, and am down to one.

I am my own advocate and keep myself educated about my diagnosis. I talked to a patient advocate from St. Jude's and got helpful information from him. He has had his SCS for 2 years. Do you have the paddle? I'm not going for that as I don't want open surgery. A year ago I suddenly began having severe pain at my pump site and tingling down my left leg. The doctor immediately said it wasn't the pump causing the pain. I have had a Myelogram, Discogram and a Discectomy and he feels the SCS lead is causing the nerve pain to go from the right side over to my left!! Next step is to replace the SCS and he likes the St. Jude's one and I like the 10 year useage as I am 65 and don't want to go through lots of surgeries in my life time! I am on the go with all my volunteering and don't mind the charging. If I am on one setting it takes 2 hours to charge daily, another setting 20 minutes. Go figure. Happy Holidays.


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