Here is how to find a Medical Biling Advocate in your State who can help you keep from being taken advantage of by Hospitals.  Keep in mind these Advocates may charge fees.  Medical Billing Advocates of America.

Note:  We are in no way associated with this company nor are we paid referral fees.  We have not used these services, but you might want to consider them.

First edited and published by the Hospital Accountability Project of the Service Employees International Union. This project is a health care justice initiative of the Service Employees International Union. SEIU, America’s largest health care union, aims to make quality health care more accessible and affordable for all.
Look Before You Pay

Hospitals are an essential public service. Every day hundreds of thousands of Americans go to hospitals for everything from life-sustaining minor surgeries, to life-changing child births, to life-saving emergency treatment. We need hospitals. We are the grateful recipients of their services. We are also, eventually, recipients of bills for their services.

Those bills are the topic of this article. Americans spend more on health care than any other people in the world. Ten percent of our gross national product goes into health care, the fastest growing industry in the nation. And every year we spend more; for the past 20 years health care costs have risen at twice the inflation rate. Dramatic increases in hospital charges are a major contributor to those rising costs.

Hospital bills are extremely problematic—and not just because they are high and can be very difficult to understand. They are problematic because they are, most of the time, wrong. The U.S. General Accounting Office estimates that 99 percent of bills from hospitals have overcharges. (New York Times, Jan. 27, 1993). The insurance industry, which hires private audit companies to review bills for accuracy, has also found a high level of hospital billing errors. The largest audit company used by insurers, Intracorp, estimates that 80-90% of hospital bills contain errors. When these audits are done, they generally result in striking reductions of the hospital bills.

This article explains how hospitals overcharge. While most of the information presented here has been used by the Legal Assistance Foundation to argue against illegitimate hospital charges against uninsured patients, all patients have grounds to fight these charges. All health care consumers should be aware of this information.

This article was adapted from a much longer manual designed for attorneys who are representing clients who have been sued by hospitals. If you are being sued by a hospital for unpaid medical bills, you should consult with an attorney. In almost every case where patients fight back in the courts, charges are reduced or eliminated. Of the 184 hospital debt cases handled by the Legal Assistance Foundation between 1983 and 2001, for example, 128 (or 70 percent) had their debts completely eliminated. Of the remainder, all but one had their charges dramatically reduced.

But even if you, or your insurance company, can pay the bill, you shouldn’t be paying for services that the hospital has no business billing you for. Nor should you be paying for services that are overpriced.

The burden is on the hospital to prove that services are reasonably priced. Most hospitals provide services without a written contract or even verbal agreement. Illinois law makes it clear that under these circumstances, there is an agreement to pay a “reasonable price” for the services delivered. Specifically, the hospital must establish the following:

* The delivery of each good and service
* The method of pricing each good and service
* The reasonable value of each good and service

This is a tough task for hospitals because when held up to scrutiny, nearly all hospital bills contain errors. And the mistakes usually favor the hospital and overcharge you, the patient.

To check for the errors listed in this article, you need more information than just the hospital bill. As is aptly observed in Take This Book to the Hospital With You, “Translating the cuneiform carvings on the Rosetta stone was a lot easier than deciphering a hospital bill”. Besides that, your bill doesn’t tell the whole story.

You need to obtain the following from the hospital, which you absolutely have a legal right to do:

* An itemized bill
* Your medical record
* Your pharmacy ledger or record (an itemized list of all of the drugs you were provided)

With these documents, you can check for some of the discrepancies listed in this article. Health care is a service that you purchase, whether directly with cash or through your insurance. Those who provide that service must be accountable to you, the consumer. This article is designed to help you achieve that accountability.
The Top 20 Ways Hospitals Overcharge Patients:

1. Billing for Services not Rendered

You can be billed for many procedures that are never actually performed. This is where it is important to have all the medical and pharmaceutical records and itemized bills from the hospital. For example, the medical records may show results of six blood tests while you are being charged for nine.

Any billed procedure that is not reflected in the medical records can be challenged. Examine the bill for charges that make no sense, such as a charge for circumcision of a newborn baby girl. Look over the procedures listed and make sure they were all actually performed. For example, if you are charged $300 for a blood transfusion, did you actually receive this treatment?

2. Duplicate Billings

A frequent error is a duplicated billing in which you are billed twice for a service rendered but once. A slip of a finger on the computer keyboard can cause this problem.

3. Shoddy Testing

You shouldn’t have to pay for an X-ray that was botched. If two chest X-rays were administered in two days, find out if the second X-ray was needed because the hospital erred in the first test.

4. Phantom Charges

Some hospitals automatically bill for certain items ordinarily associated with particular services. Their computer program may automatically impose a wide variety of charges for a particular procedure. So if you are charged for a childbirth, for example, there should be no charges for sedation unless you actually received the sedative drugs.

5. Quantity Errors

Have you been charged for 200 facemasks rather than two? Again, a slip of a finger on a keyboard could cause such an error. A frequent error of hospitals occurs with respect to intravenous solutions that are administered on the day of admission. The hospital computer will bill you for a full day’s worth of IV solutions—for example, $189 for an IV ampicillin antibiotic solution. That is the daily rate. But if you are admitted late in the day, you may only receive four hours worth of solution and you should not have to pay for a full day’s rate. There may be several hundred dollars worth of IV solutions that the hospital did not actually provide.

Hospitals often charge patients for the use of operating rooms on an hourly basis. If there is a billing for eight hours in the operating room, verify this in the medical records.

6. “Unbundling” Related Charges

Proper billing procedures (and Medicare law) require the hospital to “bundle” related charges for a particular medical procedure. For example, the charge for removing an appendix will include the operating room, the operating utensils, and all other goods and services normally related to this operation. “Unbundling” occurs where the hospital separates some of the charges that should be included in the “global” charge for the appendectomy, thus duplicating some of the charges. For example, a bill for an appendectomy may wrongly include separate charges for the pre-operative physical, such as drawing blood, cardiogram, and interpretation of the cardiogram.

7. Excessive Mark-ups

When reviewing your itemized bill, look for specific charges that seem vague or too high, such as $75 for a laxative, $30 for a “thermal therapy kit” (plastic bag of ice cubes), $10 for a “urinal” (plastic cup) or $8 for a Coca Cola. Outrageous mark-ups are frequent and have been well documented. A December 1994 article in Money Magazine, for example, offered this illustration: “Dr. James is busy replacing a 64-year-old knee. He traces a line on her leg with a disposable skin-marking pen that costs the hospital less than $1, then tosses it aside for my sake with a flippant ’28 bucks’. That’s what the insurer will be billed for it. The plastic sheet on her leg: 59 bucks. Cost: $8. It’s a racket”.

Drug charges, in particular, are the target of excessive mark-ups. Modern Maturity, in its May/June 2001 issue, reported that “markups of 200 to 400 percent are common, but some drugs and small items are marked up as much as 5000 percent. A hospital can buy a Cepacol throat lozenge wholesale for 4.5 cents, then turn around and bill you $2.25 or more per lozenge”. In the same article it is reported that a hospital charged a patient nearly $14,000 for a used pacemaker which the hospital purchased for $6,700.

One useful technique to gauge the reasonableness of drug charges by the hospital is to compare their prices to those paid by Medicaid and Medicare. Medicaid and Medicare reimbursement rates for drugs are based on the “AWP” (average wholesale price). The AWP is the average price that wholesalers give to retailers for a given medication. Each year an “AWP Red Book” is published that lists AWP’s for thousands of drugs. If the AWP for a Tensilon tablet (10mg) is $1.09, the hospital shouldn’t be charging $56 for it.

8. Exceeding “Comparable Charges”

Some hospitals charge much more for the same services than other hospitals in the same market. The 1999 “Illinois Hospital Price Survey Report,” published by the Illinois Health Care Cost Containment Council, stated that Provident Hospital in Chicago charged $630 for a semi-private room while Illinois Masonic Hospital charged $1,053 for a semi-private room. Chest x-ray charges varied from $79 at Bethany Hospital to $226 at the Illinois Masonic Hospital. If you have been charged $220 for a chest x-ray, you should be able to use the information in this report to argue that the price was unreasonably high. Also, you can get a range of information on comparable hospital charges by filing a Freedom of Information Act request with the Illinois Department of Public Health.

9. Mis-coding the “DRG”

Mis-coding or inappropriate coding occurs when a hospital uses the wrong DRG (diagnostic related grouping) code to label—and therefore bill—for a procedure. For example, a patient who is coded as having a urinary tract infection has a much shorter authorized length of stay than the patient whose illness is coded urinary sepsis. Coding these procedures differently could result in a higher bill. Some hospitals hire specialists who are “talented” in selecting codes that maximize hospital reimbursement. Many hospitals have faced criminal or civil penalties for wrongfully “upgrading” the coding of procedures and illnesses. You will need to inquire into the DRG coding of your bill to investigate this possibility.

10. Unnecessary Staffing

Hospitals sometimes pad bills by unnecessarily overstaffing a surgical procedure. Find out if the surgical assistant—for whom you were billed $1,400—was necessary in the particular surgery performed. Medicare regulations, for example, will not allow costs related to assistant surgeons in many procedures.

11. Delays That Lead to Longer Stays

This is a delay that causes your hospital bill to increase as a result of some error or mistake of the hospital staff.

The most dramatic example of this is in the number of days you spent in the hospital—particularly where some of these days resulted from a hospital blunder. A study of about 1,000 hospital patients in the Boston area was reported in Medical Care, February 1989. A full 30 percent of the patients studied experienced delays averaging almost three days in their hospital stays. These delays amounted to a whopping 17 percent of all hospital days in the study. (See numbers 12 through 15).

12. Test Re-scheduling Delays

The main reason patients spent unnecessary days in the hospital is because the hospital erred in its test scheduling. Typically, a patient would be admitted on a Monday, for example, with a pre-surgery test scheduled for the afternoon and the surgery scheduled for Tuesday. But the hospital may have overbooked the particular test for Monday, resulting in re-scheduling the test for Tuesday. This means the surgery is pushed back to Wednesday—if possible—and you spent a needless and anxious extra day in the hospital. Then the hospital bills you for that day as if no mistake had been made.

13. Test Result Delays

Test result delays are a similar problem. The hospital may have a typical eight-hour lag to get the results of a particular lab test from the pathology department. But if pathology is running late or if they lose the results of the test and it has to be done over, you are going to have to pay for the hospital’s mistakes that lengthen the hospital stay. They will even have the nerve to bill you for two tests when they lost the results of the first test.

14. Surgery Delays

Another common foul-up is surgery delay caused when the hospital sets too many elective surgeries for one day. You may get bumped to the next day and have to pay for this even though the hospital was negligent in its scheduling.

Surgery may be delayed because a scheduled consultation visit by a consulting doctor does not occur when the hospital forgets to notify the consulting doctor. You can often find these problems described in the medical charts; you should not have to pay for the extra day caused by the hospital’s mistake.

15. Teaching Hospital Delay

One of the worst abuses regarding delays in discharge is where you are a patient in a teaching hospital and happen to have a rare disease or an unusual predicament. The medical staff of the teaching hospital may want a large number of the residents to have an opportunity to review your case; it may be their only chance to see this particular affliction during their residency. The hospital stay may drag on needlessly long to give every resident an educational benefit.

16. Late Checkout Effect

Some hospitals charge a late charge or even a whole day’s charge if the patient is discharged after noon. If you were discharged at 2 p.m. due to some hospital screw-up, you should not have to pay the extra charge.

17. Paying for Wasteful Hospital Practices

In December 1994, Money magazine published “Undercover in a Hospital”. The author exposes how most hospitals are extremely wasteful in that they use disposable, as opposed to reusable, supplies and instruments. The article notes that some operations call for the use of more than $1,000 worth of disposable materials and makes the point that many hospitals are now using re-usable goods and instruments to cut costs. Patients should not have to pay for expensive, disposable items when that is a result of wasteful hospital practices. These charges can be challenged.

18. Hospital-caused Infections

Another type of overlooked hospital negligence is hospital-caused infections. These are infections acquired during a hospitalization and produced by microorganisms that dwell in the hospital. It is not an infection that was present in the patient at the time of admission.

Between 5 and 10 percent of all hospital patients contract an infection during their hospital stay. A recent Chicago Tribune investigation by reporter Michael Berens found that, nationwide, roughly 103,000 deaths in 2000 were linked to hospital-caused infections. While most patients survive these infections, they pay handsomely for this “gift” from the hospital.

The average hospital-caused infection adds four extra days to a hospital visit at an average cost of $800 a day. Hospital-caused infections account for 15 percent of all hospital charges and end up adding between $2.5 and $4 billion to the annual American health care bill. In the November 1986 issue of American Journal of Surgery, it was estimated that surgical wound infections alone add an average of seven days to some patients’ hospital stays and $10 billion annually in direct and indirect costs. Hospital-caused infection rates have been found to be higher in large teaching hospitals than in non-teaching institutions, because the teaching institutions have more people floating around the hospital thus increasing the chances for the spread of infection.

Pneumonia is the most common hospital-acquired infection. Sometimes pneumonia is introduced into the lungs by contaminated respiratory therapy equipment, or by medical personnel coughing in close quarters like intensive care units. Other hospital-caused infections can be spread by improper preparation of hospital equipment or the failure of hospital personnel to engage in simple sanitary precautions such as frequent washing of the hands.

Find out whether your hospital stay was extended by reason of a hospital-caused infection. If so, you should take the position that you should not be asked to pay for costs that were probably generated as the result of the hospital not taking adequate sanitary precautions. Inquire whether the hospital has an active Infection Control Committee. If it does not, you will be able to argue that the hospital has not taken all possible steps to prevent the infection you contracted.

19. Padding Hospital Surplus

If you are interested in going beyond the particulars of your bill to make a more systemic critique of hospital charges, you may want to find out how much “surplus” (otherwise known as profit) your hospital generates. Get a copy of the hospital’s Statement of Patient Revenue and Operating Expenses or “revenue and expense statement.” Determine whether the hospital had “surplus revenue” for the fiscal year in which you were billed. For example, the non-profit Evanston Hospital had a $9 million “profit” in 1985 on total revenue of $147 million. This information could be used to argue for a percentage reduction of your bill. Non-profit hospitals are required by the Internal Revenue Service to file a Form 990 Report that lists sources of support, expenses, revenues and executive compensation. Federal law requires that the 990 be available for public inspection. You can probably access the hospital’s reported revenue statement at the American Hospital Directory under “free services”.

20. Discriminatory Billing

If you do not have health insurance, you could be a victim of discriminatory billing. This is also known as cost shifting or variable pricing. These terms refer to the policy of shifting hospital costs away from third-party payers (such as Blue Cross and Medicare/Medicaid) and onto the shoulders of self-payers. Whatever this policy is called, it amounts to this: different payers pay different prices for identical services. “So-called cost shifting then results in higher charges to individuals who personally pay for all or a portion of their hospital confinement,” says a report of the Illinois Health Care Cost Containment Council. Thus the poor, who do not have insurance, pay more for the same medical treatment than more economically advantaged patients do.

Here is how the New York Times reported this situation in an April 2, 2001 article:

“It’s horribly ironic,” said Paul Menzel, a professor of philosophy at Pacific Lutheran University in Tacoma, Washington. The care of the poor was once supported by the wealthy and the insured, but now the opposite is happening, he said. “It is the people who are most provided for, not the people who are least provided for, who get the benefit of cost-shifting,” he said.

Most patients paying the full fare have no idea that their bill may be many times that of the people next to them in the doctor’s waiting room.

For example, in an August 1979 report, Illinois Masonic Medical Center listed a three-tier charge system, whereby Medicare/Medicaid paid an average $279 daily patient fee, Blue Cross patients averaged $389 daily, and self-payers (the uninsured), averaged $463 daily. Discriminatory billing is the consequence of the practice of all hospitals of entering into reimbursement agreements (or “provider discount agreements”) with different third-party payers that call for differing reimbursement amounts to be paid for the same services. The more powerful the third-party payer—such as the government or Blue Cross— the greater the discounted prices they are able to negotiate with the hospital. All hospitals enter into these agreements with payers.

And don’t let semantics misguide you: many hospitals try to claim that they charge every payer the same amount. While they may “charge” the same amounts to all payers, the hospitals will accept as full payment from third-party payers amounts less, often far less, than the full charges.
Demand Accountability

We in the United States spend more than enough on health care—10 percent of our gross national product, to be exact. This care costs plenty even without the little “extras,” such as paying for services we haven’t received or paying for the hospitals’ mistakes.

As consumers who depend on hospitals, and as community members who support them through sizable tax breaks, we have every right to demand a higher level of accountability from hospitals. Using the tips in this article to scrutinize your hospital charges is one small way to demand such accountability.

For more information on actions being taken to hold Chicago hospitals more accountable to their communities, their patients, their employees and their charitable missions, contact:

Hospital Accountability Project
Service Employees International Union
40 N. Wells, Suite 300
Chicago, IL 60606
(312) 541-9566
Fax (312) 541-9650
Appendices
Appendix A:
Summary of Legal Assistance Foundation Cases Defending Those Who Have Been Sued by Chicago Hospitals, 1983-2001

Between 1983 and 2001, the Legal Assistance Foundation of Metropolitan Chicago defended 184 cases where individuals were sued by hospitals for back debt.

The following are statistics of those cases:

* 28 (or 69.5%) had their debts totally eliminated
* 55 (or 29.8%) had their debts decreased
* Of the cases where the debts were decreased, the reductions ranged from 26 to 94 percent
* In 48 of the 55 reduction cases, the reduction was at least 50 percent of the bill
* In all 184 cases, the total amount being sought was $852,617. After these cases were litigated, the total amount collected was $53,329.

Appendix B:
Resource List for Consumers with Hospital Debt
Legal Assistance Foundation (LAF) of Metropolitan Chicago

LAF provides free legal counsel on matters of civil (non-criminal) law for low-income people. LAF attorneys have represented many clients who have been sued by hospitals over unpaid medical bills, and usually gotten the debt either eliminated or greatly reduced. Attorney Alan Alop has written a manual for lawyers defending clients sued by hospitals for medical debt. LAF operates from the following locations:

Downtown/ Administrative Offices
111 W. Jackson Blvd., Suite 300
Chicago, IL 60604
(312) 341-1070

South Side
10 W. 35th St.
Chicago, IL 60616
(312) 949-5390

Harvey/ South Suburban Office
15325 S. Page Ave.
Harvey, IL 60426
(708) 339-5550

Westside Office
3333 W. Arthington
Chicago, IL 60624
(773) 638-2343

Northwest Side Office
1279 N. Milwaukee Ave.
Chicago, IL 60622
(773) 489-6900

Evanston Office
828 Davis St.
Evanston, Illinois
(847) 475-3703

SSI Advocacy Project
407 S. Dearborn
Chicago, IL 60605
(312) 427-5200

Public Benefits Hotline
Toll-Free: (888) 893-5327
Bankruptcy Lawyers

The following two firms are both dedicated exclusively to bankruptcy law. They each offer a free initial consultation. The Chicago Federation of Labor refers them as reputable firms.

Melvin Kaplan & Associates
14 E. Jackson Blvd.
Chicago, IL 60604
(312) 294-8989

Robert J. Adams & Associates
125 S. Clark St., Suite 1810
Chicago, IL 60603
(312) 346-0100
Workman’s Compensation Attorney

Farhan Younus
Louis G. Atsaves, LTD
200 W. Jackson Blvd., Suite 1050
Chicago, IL 60606
(312) 322-0001
Consumer Credit Counselors

Consumer Credit Counseling Service
70 E. Lake St., Suite 1115
Chicago, IL 60601
(312) 849-2227

Catherine Williams
Vice-President of Education
Toll free: (800) 698-6512

24-Hour Counseling Hot-Line
Toll free: (800) 762-2271

CCCS of Greater Chicago is a non-profit community service organization providing credit counseling services, debt management, and money management education at centers throughout the metropolitan area. CCCS is a division of Money Management International, the largest full-service credit counseling organization in the nation.
Medical Bill Analysts

Professional services are available to examine hospital bills to look for errors and overcharges. One study found that 98% of all hospital bills contain overcharges. Bill analysts charge a fee that varies depending on the size of your bill and the type of review they conduct. The Hospital Accountability Project may be able to review your bills at no cost. Professional service providers include:

Claim Relief, Inc.
2647 W. Morse Ave.
Chicago, IL 60645
(773) 274-0647

Claim Relief Inc. can analyze bills, advocate for you with insurance companies and medical creditors, and appeal claims.

American Medical Bill Review (AMBR)
1123 Hilltop Drive
Redding, CA 96003
(530) 221-4759

AMBR is headquartered in California, but offers services in all 50 states.
Other Sources of Help

Metropolitan Family Services – Legal Aid Bureau
(312) 986-4200

Office of Consumer Health Insurance
(877) 527-9431

Office of the Illinois Inspector General, Fraud & Abuse Hotline
(800) 447-8477
(800) 377-4950 (TTY)

Article Source:  Illinois Legal Aid

Cervical Discogram Fluoroscopy

I was told not to drink any fluids or eat any food for 2 hours prior to my procedure. I took this advice seriously as I didn’t want to get nausea or throw up with needles stuck in my Neck.

Arrival at the Imaging Center

I arrived at the outpatient scan center, filled out the typical mountain of paperwork and releases.  Here sign this… blah blah.  Who can really read and understand all that fine print when they are in pain?  My advice is to research Discograms BEFORE you have yours so you know what to expect.

After the paperwork shuffle was completed I was seated in the lobby and waited about a half hour until I was called back.  I changed into the standard hospital scrubs – a gown that opens in the back and a pair of the pants.  I then was taken into the operating theater where I was given an IV.

Preparation for the Cervical Discogram

I received 1gm of an inter venous antibiotic, and placed into position on the table under the fluoroscopic arm.  I was also hooked up to a machine to monitor my blood pressure.  The Radiologist that did my procedure made sure a full 45 minutes passed before he began (This is a precaution to prevent infection and possible Discitis).  During that time he took time to explain to me the procedure and the risks and answered my questions.

My main question was about swallowing during the procedure.  Having needles protruding to the center of your cervical spine and swallowing seemed like it was a potential problem, but it’s not. He told me it was okay, but at certain points during the test he would tell me not to.  I didn’t know if I would be able to talk with needles in my neck, but it was no problem. I also asked about the gauge of the needles.  He told me they would be 25 gauge needles.  I had read some Doctors use 22 gauge needles (Lower the gauge the thicker the needle), and sometimes used the 22 gauge to the disc, the slipped a thinner 25 gauge inside the thicker needle.  He said there was no reason to do this.

The worst part of the 45 minute ordeal prior to beginning the test was the alcohol based scrub that was pretty powerful!  The smell was a bit overwhelming so they placed oxygen in my nostrils to help.  They topped off the Alcohol based prep, with another thick yellow gooey prep.  And for the record, this is very hard to wash off… you have to just let the last bit wear off after a few showers.

The Actual Cervical Discogram Begins

After all the preparation it was time for the Doctor to begin testing my discs. I was given a small amount of Versed (Midazolam) through my IV drip and off we went. The Doctor said he would be testing 4 levels between C4 and C7. For those of you who are new to this the level tested is named after the LOWER Vertebra… so the disc material between C3/4 would be called the C4 disc.  You have 7 Cervical Vertebrae but only 2 Discs because C1/2 is a bone in bone joint.  Anyways… moving on with the test experience.

The Doctor did not tell me the levels he was testing (So I would not be biased in my responses). And I could not tell what level he was working on. With the first needle puncture he said (This is going to feel like a bee sting… and it kind of did), then he would push the needle in slowly to the disc.  He used just enough anesthetic to make the procedure unpleasant, but bearable.  When the point of the needle arrived on the edge of the disc, he would tell me then he would push the needle in and tell me as he was injecting.

I should mention that just before each injection I could hear the Fluoroscopic arm move into position.  For those of you who don’t know the Fluoroscope takes X-Ray images in rapid succession so the Doctor can see EXACTLY where he is placing the needles.

He asked me to describe the pain on a scale of 1-10, tell him the location of the pain, and if this was typical of my “normal” pain or different from my “normal” pain.  Then he would withdraw the needle.  At the next level he said “bee sting” and then repeated the process until all 4 levels were complete.

I was told the test would take about half an hour, and that is probably pretty accurate.  It’s hard to keep track of time when you have Versad flowing through your veins.

Your personal pain tolerance will no doubt be different than mine.  I have had many IV’s and Needle procedures so this was pretty commonplace for me.  Yes it hurt!  But it is really not much worse than having dental work done (Okay it’s worse then regular dental, but not much worse than a root canal and it takes less time for the actual test than a root canal!).  The needles hurt most going in, then only for a few seconds during the active injection of the contrast agent.  Not all my discs caused pain… 3 of 4 were painful.  Only 2 of 4 above the “5″ Threshold on a scale of 1 to 10.  What was surprising was the disc that hurt the most was NOT the one I expected to hurt the most. I know this because after the test I asked the Doctor which disc it was that caused the most pain.

On to the CT SCAN

Immediately following the completion of the Cervical Discogram I was wheeled into another room and placed in the CT Scanner.  I’ve had CT Scans before and they are pretty easy.  Because they needed to scan my C6/7 level and I have broad shoulders (Plus my neck was in mild spasm from all the needling) I asked for the straps to help pull my arms down.

The CT Scan was a breeze and only took a few minutes.  Unlike MRI’s CT Scanners are basically open so you don’t need to worry if you are claustrophobic. The Downside to CT Scans is RADIATION.  And they blast you with a pretty high amount.  Be sure to ask your Doctor BEFORE the test about the precautions they use to minimize your exposure.  You want the least amount of radiation possible.

After the CT was complete I asked to talk to the Doctor because I had some questions about followup pain and I was pretty sore.  He offered to give me an injection of pain medication (I declined because I was pretty much doped up from the Meds I had from the IV).  But he did write me a script for a few pills to get me through the next couple of days and told me to be sure to call in to the Scan Center or to my Doctor if I got a fever or felt ill.

I never went to a recovery area, and no one really came to check on me. I waited seated on the side of a bed for about half hour to talk to the Doctor and then got dressed and went home.  Total elapsed time start to finish in the Scan Center was about 3 hours.

And while I felt okay, later on that night I was pretty sore.  I am about 36 hours post procedure at the time of this writing and pretty close to my normal all day everyday chronic pain self.

About the Cervical Discogram Test

Is the risk worth the benefit?  Maybe.  It depends on your own condition and a whole host of other factors.  Most Doctors will not order a Discogram unless they are seriously considering surgery.  The point of the test is to correlate Discogenic Pain to your regular pain.  If your discs are not causing your pain then surgery may not be a good answer for you.  It’s more complicated than that, but that’s the theory anyway. Sometimes the evidence on MRI is so overwhelming that the test is simply not needed.  Other times patients have pain that is just not explained until they have the test. Discograms are subjective test, but can be valuable.  They are also quite expensive!

That’s it… another test another day.

Cervical Discograms are a Diagnostic Test and do NOT treat pain.

– Kevin McKeever
HealthDay
Posted: 2008-04-28 19:05:04

Note: This article was funded by ADR Manufacturer Medtronic, maker of the FDA Approved prestige Cervical Artificial Disc. The real cost of surgery is not just in the upfront expenses.

MONDAY, April 28 (HealthDay News) — Treating cervical degenerative disc disease by surgically implanting an artificial vertebrae onto one’s spine may cost more initially than a traditional disc fusion operation, but it saves the patient almost $6,000 within two years, according to a new study.

The cost savings is primarily from the patient’s ability to return to work sooner after surgery and his or her need for fewer follow-up procedures.

The study — which was funded by Medtronic, the maker of the artificial cervical disc — was expected to be presented April 29 at the annual meeting of the American Association of Neurological Surgeons, in Chicago.

More than 200,000 procedures are performed each year in the United States to relieve compression on the spinal cord or nerve roots. The most common involves spinal fusion surgery to unify two or more vertebrae in an effort to strengthen the spine and alleviate chronic neck pain.

A year ago, the U.S. Food and Drug Administration approved the use of the first, and to date only, artificial cervical disc in certain cervical spine surgeries. Medtronic’s PRESTIGE disc is a stainless-steel device with a ball-in-trough design, held in place with bone screws.

Researchers conducting a cost-benefit analysis on 541 patients who received either the artificial cervical disc (arthroplasty) or fusion surgery found arthroplasty saved the patient an average of $5,988 over two years following the surgery.

The cost of initial surgery, secondary procedures and medical devices per patient and the average initial procedure cost were both higher for arthroplasty patients than for fusion patients; however, the artificial disc recipients saved long-term, because they needed fewer secondary procedures and returned to work following surgery an average of 38 days sooner than fusion patients.

The return to work alone yielded a gain in work productivity of $6,368, the report said.

“From a societal perspective, the economic benefits associated with these outcomes may offset the increased device costs associated with arthroplasty therapy,” said study presenter Dr. Vincent C. Traynelis, of the University of Iowa, in a prepared statement.

A 6’6″ tall basketball playing student was involved in a fracas with gate crashers at his sister’s birthday party and was severely beaten up by six soldiers. He subsequently suffered neck and arm pain and was seen at a hospital on several occasions and told that because his pain neck x-rays were normal there was no dramatic lesion. He presented two years later unable to continue playing basketball because of an insidiously evil and spastic paraparesis and evidence of bilateral C7 root lesions.

Myelography revealed a severe traumatic C6/7 disc lesion which required surgery. The root pain was relieved, but recovery from the cord damage was incomplete. This case exemplifies once again the dangers of accepting that normal x-rays indicate there is no abnormality.

Where a neck injury occurs in a patient who already has an abnormal neck due to cervical spondylosis. In such patients sudden flexion or extension of the neck following a simple trip or rear end collision in a car they produce acute root symptoms or even a cute cord damage. Usually the root symptoms are bilateral may affect multiple routes and the accompanying cord damage may cause an acute tetraparesis. The potential seriousness of even minor traumatic events affecting the cervical spine in this way in patients with severe pre-existing spondylosis must be recognized.

Source: Neurological Differential Diagnosis By John Patten

The U.S. Preventive Services, which made the recommendation Monday, reported finding evidence that the benefits of treatment based on routine screening of this age group “are small to none.” However, treatment often causes “moderate-to-substantial harms,” including erectile dysfunction and bladder control and bowel problems, the task force said.

The new guidance is the first update by the task force on prostate cancer screening since 2002. Its last report concluded there was insufficient evidence to recommend prostate screening for men of all ages.

In recent years, there has been a growing debate about the value of the somewhat imprecise PSA blood test to detect cancer, as well as the value of treating most prostate cancers. A positive result from the test must be confirmed by a biopsy. And even then, there is no foolproof method of identifying aggressive tumors from slow-growing ones. A number of experts contend patients are being over treated.

“The issue of screening for is frankly an area of medicine that remains somewhat unsettled,” said Dr. Durado Brooks, a prostate cancer specialist for the American Cancer Society. “While it’s clear there is benefit to a significant number of men, it’s equally clear that many men end up being diagnosed and treated for cancers that would likely not have caused them any significant harm.”

Most major U.S. medical groups recommend doctors discuss the potential benefits and known harms of prostate screening with their patients and make individual decisions. And most agree such testing shouldn’t occur before age 50.

The federal task force, which sets the nation’s primary care standards, reviewed past research in reaching its conclusion and “could not find adequate proof that early detection leads to fewer men dying of the disease,” task force chairman Dr. Ned Calonge of Denver said in a statement.

The cancer society’s advice for screening differs from the task force’s because it doesn’t set a fixed age to stop screening, Brooks said. It suggests that men shouldn’t be offered screening if they aren’t expected to live another 10 years.

“That’s because every 75-year-old is not created equal,” said Brooks.

While some have health problems and aren’t likely to live long, others are “very active, very vigorous and have minimal health issues, and many of those men are going to live into their late 80s or 90s,” Brooks said.

Prostate cancer is the most common cancer in American men — about 220,000 cases will be diagnosed this year. It is the second leading cause of cancer deaths in men. But most tumors grow so slowly they never threaten lives.

Earlier this year, a study found that older men who already had early-stage prostate cancer were not taking a big risk by not treating it right away. The vast majority were alive 10 years later without significantly worrying symptoms or had died of other causes.

Prostate cancer treatments are tough, especially on older men. Some doctors instead recommend “watchful waiting” to monitor signs of the disease and treat only if they worsen, but smaller studies give conflicting views of the safety of that approach.

The new guidelines from the Preventive Services were published in this month’s Annals of Internal Medicine.

http://www.annals.org/content/vol149/issue3/

So what is Neurography? It’s simply an MRI scan of your Nerves. The special sequence and frequencies allow the Radiologist to see nerves otherwise hidden during traditional MRI scans. How can this advancement go ignored by the Medical Community at large? Money! They don’t want to pay the liscensing fees. It’s not about your health folks, it’s about the almighty dollar.

You are probalby going to have to travel and pay for this yourself, but if you do not yet have a confirmed diagnosis it may just be worth it. Imagine having spine surgery and NOT getting pain relief? Neurography may isolate which nerves are the ture pain source, confirming a diagnosis and making fusion not only unnecessary, but saving you the pain of surgery not needed. Afterall what matters most is an accurate Diagnosis!

What is wrong with the insurance companies? Instead of helping you get back on your feet and enjoying a pain free life now, they would rather pay for medical proceedures and treatments for the rest of you life? It just doesn’ t make sense. It’s no wonder American Medical care is the most expensive in the World and not even close to the top 25 in treatment according to the 2005 World Health Organization reports. For more information please visit the inventor at Neurography.com

This is not a treatment rather a diagnostic test to show instability and injury that a typical static X-Ray may not disclose. While generally applicable to patients in auto accidents and trauma (Due to the high incidence of ligament damage) this may be a viable option for anyone with undiagnosed neck pain. This is a completely different technology and not related to Upright MRI. Upright MRI’s are NOT motion studies.

A standard flexion/extension X-Ray shows 2 of the 22 ligaments in the cervical spine. With the Motion X-Ray it’s possible to see damage that occurs to all 22! Properly trained Radiologists will note damage because the technology allows them to see the bones as they move; thus lax ligaments would not be supporting the structures properly. Unfortunately like the Upright MRI this is a new technology being driven by a single manufacturer. Perhaps a patent issue? In any case this means there are not that many imaging centers using this equipment and many Physicians will not be familiar with this advance. For more information you can contact the manufacturer directly – DMX Works, Inc. “Digital Motion X-Ray®”.

PH Testing Video Explanation

Don’t expect your body to be healthy and in an acidic state. I was shocked to find out I was Acidic. My Allopathic Primary Care Doctor said I was “A healthy Guy” and to “Eat a balanced Diet”. What a load of crap! I then went to a Naturopath and had complete blood work which showed many mineral imbalances but the real shocker I was highly acidic. Most people are completely unfamiliar with the concept of acid/alkaline balance in the body. Did you know that Cancer cells can not grow in an alkaline balanced body? It’s because an alkaline balanced body is an oxygen rich “Healthy” body and cancer grows in an environment void (or at least with very minimal) oxygen.

The foods we eat determine an alkaline or acidic state. And it’s not the acid in the food itself (Lemons for example are highly alkalizing, yet they are very acidic themselves). What matters is what the food you are eating turns into once your body “cooks” or digests the food. Lemons turn in to an “alkaline ash” and grains and meat turn into an “acidic ash”. Aside from keeping the body’s tissues oxygen rich there is another major factor at play here and that involves mineral depletion. Your body uses ionic calcium (and other minerals such as phosphorous) to keep your bloods PH in balance at a constant 7.35 to 7.45 otherwise you die.

So as you become acidic your body literally “pulls” minerals from your body’s reserves. Calcium from bones and teeth. This is a GOOD thing otherwise you would die! The problem then becomes what happens when my mineral reserves are depleted? You guessed it – illness. So check your PH Balance and eat the foods that make you healthy.

Find Your Optimal Acid Alkaline Balance (pH Balance) and Get Healthy

To maintain optimal health, the body will constantly seek to neutralize the excess acids that irritate the it and deplete it of important minerals. The principal organs responsible for the elimination of acids are the kidneys. Under normal conditions, urine pH should fall between 6.75 and 7.25. By testing the amount of acid present in the urine, you can determine whether your body is eliminating a normal quantity of acids. If the acid excretion rate is higher than normal, the urinary pH will be more acidic. Low urinary pH can be an indication that the body is too saturated with acids, thus the body is overly acidic.

Another good indication of your body pH can be revealed in the pH of your saliva. When your body is abundant in mineral reserves, these minerals will show up in a saliva ph test as a pH reading of 7.0 to 7.50. Low saliva pH readings may indicate that your body is mineral depleted. m

There is a strong correlation between the pH of the body’s internal terrain (tissues, cells, fluids) and that of the urine and saliva: urine and saliva become acidic when the body’s internal environment becomes acidic. You can discover the pH of these fluids by using Alkalive™ pH Stix™. These pH test strips are made specifically to test saliva and urine, and are the most accurate and economical test strips on the market.

Alkalive™ pH Stix™ are superior to pH paper and litmus paper. They give a clear indication of pH in .25 pH unit increments, and test a range of 4.5 to 9.0. Because they are “strips” (plastic strip with reagent pads), they are a lot easier to use and read when wet than floppy, soggy pH paper.

This is what Christopher Vasey, N.D., author of The Acid Alkaline Diet has to say about pH Stix™: “pH Testing is very important in order to gauge the health of your internal environment. I used to recommend using pH Paper, until I discovered these excellent pH strips. They are a lot more effective in helping one determine precise pH measurements. I advise all of my clients to use pH Stix.”

It is recommended to test saliva before and after meals. The pH levels of your saliva should be greater after meals because there is an abundance of alkaline-rich minerals in saliva. Test your saliva 60 minutes after a meal. If the pH level is lower than 6.75, your alkaline mineral reserves are too low.

Source: Part of this article post is provided by a manufacturers web site… www.phstix.com – this is the brand of testing strips we choose to use as they use a 2 color method, are inexpensive, and very easy to use.

MRI Magnetic Resonance Imaging Reports and Terminology as it applies to Spinal Disorders

MRI (Magnetic Resonance Imaging): A special imaging technique used to image internal structures of the body, particularly the soft tissues. An MRI image is often superior to a normal X-ray image.

How it works: MRI uses the influence of a large magnet to polarize hydrogen atoms in the tissues and then monitors the summation of the spinning energies within living cells. Images are very clear and are particularly good for soft tissue, brain and spinal cord, joints and abdomen. These scans may be used for detecting some cancers or for following their progress.

Understanding Magnetic Resonance Imaging Terminology can be difficult because one Reading Radiologist may use terminology to describe a condition that is totally different from another Radiologist’s reading. And just like language dialects there are variances by geographic location and the school where they received their education. However, any radiologist should be able to read another report and fully understand the condition. However this is not always the case as the whole process is open to interpretation and experience.

Terms Used to Describe Spinal Pathology on MRI Reports

Desiccation – loss of disk water

Disk bulge – circumferential enlargement of the disk contour in a symmetric fashion

Protrusion – a bulging disk that is eccentric to one side but < 3 mm beyond vertebral margin

Herniation – disk protrusion that extends more than 3 mm beyond the vertebral margin

Extruded disk – extension of nucleus pulposus through the anulus into the epidural space

Free fragment – epidural fragment of disk no longer attached to the parent disk

Osteophytes – protrusions of bone and cartilage (aka “Bone Spurs”); a pathological bony outgrowth

Widely Patent - affording free passage : being open and unobstructed, thus a “Wide” open unobstructed finding

Spinal Stenosis – is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves

Bony Edema – Edema is another word for swelling and is indicative of injury to an area. Edema is commonly seen around an area that has sustained an injury. Therefore, the structure may appear normal, but the edema may show where the injury is located. Edema may be seen within a bone (a “bone bruise”) or within the soft-tissues

Myelopathy – any disease or disorder of the spinal cord or bone marrow

Foramin (Foramina – plural) – vertebral foramen is the foramen formed by the anterior segment (the body), and the posterior part, the vertebral arch. A small opening, perforation, or orifice

Discitis – Inflammation of an intervertebral disk or disk space which may lead to disk erosion. Until recently, discitis has been defined as a non bacterial inflammation and has been attributed to aseptic processes (e.g., chemical reaction to an injected substance). However, recent studies provide evidence that infection may be the initial cause, but perhaps not the promoter, of most cases of discitis. Discitis has been diagnosed in patients following discography, myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anaesthesia. Discitis following chemonucleolysis (especially with chymopapain) is attributed to chemical reaction by some and to introduction of microorganisms by others

Degenerative Disc Disease – <radiology> Plain film: narrowing of disc space; osteophytes; bone sclerosis, disc calcification, vacuum disc phenomenon (nitrogen at sites of negative pressure) MRI: endplate changes (Modic and deRoos), Type I (4%): decreased signal on T1; increased signal on T2; vascularised fibrous tissue, Type II (16%): increased T1; isointense T2; local fatty replacement of marrow, Type III: decreased T1; decreased T2; advanced sclerosis sequelae: disc bulging, disc herniation, disc sequestration, spinal stenosis (I’ve written and entire post on what constitutes DDD and there is no real agreement in the Medical Community on an exact definition).

Vertabrae Photo

I’m hoping this image will help you to visualize what is going on in your Spinal MRI. Knowing the Spinal anatomy will take you a long ways towards understanding your MRI Reports.

Please visit this link for a brief Overview of Spinal Anatomy.

Take a Look at the Images below of the SAME Patient. The first is taken with a Traditional Supine Recumbent “Lie Down” MRI and the second with an UPRIGHT (Stand Up MRI). In the first image you’ll see there is fluid in the Thecal Sac (the “white space”) and in the second the disc is being pushed directly into the spinal cord. A Doctor looking at the image taken on the traditional MRI would conclude there is not a significant enough problem to warrant surgical intervention, however the second image proves this may not be the case. Give yourself the benefit of the doubt and get an Upright MRI.

Back Pain Patients this technology works even better for you! Click on the Fonar Link lower in the article to be take to the Fonar Website where you’ll find amazing images of the Lumbar Spine and how amazing this technology is in helping diagnose spinal instability, slipped disc, and bulges that are actually herniations.

Again Please Note the Photographs above are taken of the SAME patient. Upright MRI was the KEY to a proper diagnosis. Upright MRI was essential in my diagnosis as well. I can not tell you how angry I was with some of the Hotshot University Surgeons (Surgeons with more than 20 years experience under their belts) who kept telling me there was nothing wrong and to look for “Organic” causes. What a load of crap!

How can a present day University Professor (The head of the Fellowship Program) ignore this critical diagnostic tool? I found Upright MRI through my own research and had to travel out of State to have mine done. It’s CRIMINAL of the Medical profession to ignore this technology. I had a Herniations pressing on my Spinal Cord for 18 months unnecessarily and may have incurred PERMANENT damage as a result of the inability of 6 Different Orthopedic and Neurosurgeons to diagnose my problem while the technology to do so was clearly available. This is life saving, life altering technology.

Upright MRI’s are much easier to tolerate for anyone who is claustrophobic. The process is more open and you are sitting upright on a chair and you can even watch Television while the scan is being made! You do have to maintain a perfectly still posture (Your head is secured and you have an adjustable bar to rest your arms on).

The following Discussion is from a report compiled by Medical Doctors in Zurich, Switzerland.

“FMRI (Front Open MRI) revealed dynamic changes in the size of disc herniations and of the dimensions of the central spinal canal and neural foramina not detectable by recumbent imaging. In practice, with on-site real-time patient interview, this enabled a more precise linkage of the medical images with the patient’s clinical syndrome, thereby allowing a targeted therapeutic regimen to be undertaken. Initial experience in central continental Europe with this FMRI unit revealed that a significant amount of clinically significant spinal disease is overlooked (“missed”) on recumbent imaging.

Visualizing both the bony structures as well as the underlying soft tissues non-invasively, FMRI for the first time places the physician is in a superior position to make accurate decisions regarding treatment options and alternatives that would not be considered if the entire disease process was not depicted in the patient’s imaging examination. The goal of FMRI is an elevation of patient outcomes facilitated by the optimal linkage of functional (upright-kinetic) MRI with the clinical physical examination data.”

Upright Positional MRI Makes Sense

Traditional Supine MRI’s are taken with you lying on your back in a position which puts the LEAST stress on your discs. You’re body is made to move! Standing, bending, sitting, flexing your spine to the left and the right, looking upward or downward all apply different pressures to your spinal discs. It only makes sense! I have had this procedure and the results are nothing short of amazing!

You probably have not heard of this technology – because there are only 32 machines currently installed in the United States (As of December 2005). Update July 2008 – I could not determine and exact number but from browsing press releases it appears the installed base has doubled. This means you should not have to travel very far to find a machine close to you.

The Upright MRI machines are manufactured by a company called Fonar. You’ll probably have to call to find a machine near you. I had to leave the State to get my Scans done. The results are amazing, discs that are only mildly budging in a supine MRI can be seen pressing into the cord when the spine is placed under load. For more information you may also want to visit Rose Radiology n Florida. Rose Radiology purchased the first Upright MRI machines and have considerable experience. The cost is not inexpensive but very close to traditional scans – I paid about $2,000 for 5 cervical scans – normal, flexion, extension, left bending and right bending. You’re insurance WILL cover this just like any other MRI. This technology is NOT investigational. You may have to force the issue with some companies, but it’s worth the effort.

And good news for those of you who are claustrophobic – this is OPEN MRI technology, no more being pushed up inside a casket like tube!I sincerely hope this will help you get the diagnosis you need to more accurately pinpoint the source of your back pain.