A few months ago I posted about getting lumbar microdiscectomy to deal with an L5/S1 disc herniation. This is a review of my experience. Unfortunately, it did not go well. To be clear, this is not an indictment of this surgical technique. I know people who have had excellent results with the procedure, and there’s a very good chance that I will be lining up again for a second go, but next time with a different surgeon. This is only a critique of this doctor and their team. If you’re just here for the TL;DR, there are plenty of competent spine surgeons in Chicago. Choose someone else.
My lumbar microdiscectomy was performed by Dr. Kern Singh at Midwest Orthopaedics at Rush in Chicago, and it was not successful. From a symptoms perspective, I am in a slightly better place today than I was in January. I can’t say if the difference is an artifact of time, or the surgery. I’m not in a position to definitively judge the performance of Dr Kern Singh as a surgeon. It’s impossible to say whether Dr Singh botched the surgery or whether it reherniated* sometime in the first two weeks. As frustrating as it is, the best answer I’ve received in subsequent 3rd party consultations was “it happens sometimes”. But as odd as it might sound, the surgical outcome isn’t the most important thing to take away.
While I can be disappointed that I’m going to have to do this again, it wouldn’t be reasonable for me to blame Dr Singh for things that could well be outside his control. So I’m just going to focus on the things that are completely within his control; like the after-sales experience provided by him and the supporting team at Midwest Orthopaedics. Which is, generously, indifferent to their customer’s time and suffering.
My L5/S1 lumbar microdiscectomy was scheduled for early morning on January 24, 2023. Interestingly, although not unexpected, and somewhat irrelevant, the procedure was actually performed in a surgical center at Water Tower Place where Dr Singh has a financial interest (I had to sign disclosures around this pre-surgery), and not the hospital. This part went very smoothly, the staff at the surgery center was very attentive and professional. I arrived around an hour before the 6:30AM procedure, and they had me out shortly before noon. The actual procedure took under an hour, so most of that time was post-surgery recovery.
Pre-surgery, during both of my telehealth/telephone consultations, I was told that it would be six weeks of limited activity, two weeks of physical therapy (PT), with a return to full function at eight weeks. It is possible that I was over-eager to believe the surgeon’s pitch. I was more than happy to latch onto the idea that I would be good-to-go in eight weeks. That definitely did not happen, but again that’s not the real problem here.
The real issue is that I was brushed off when I started raising complaints about ongoing symptoms consistent with a disc herniation (numbness in my foot, pain in my glutes, elevated discomfort at the L5/S1 area) less than two weeks after the procedure; which I later learned was when the steroids that were injected during the surgery would have worn off.
I raised these issues several times, including what was supposed to be our final checkup at the six week mark. Each time, I was told that the ongoing numbness in my foot and pain in my glutes/back was normal. That I needed to stick with PT and be prepared for the symptoms to last 12-18 months. Which is a little different from “return to sport” at eight weeks.
The final time I reached out directly requesting additional support (March 27, 2023), the PA who handled it responded with the same “suck it up” message, and then never replied to my follow up where I indicated, again, that my symptoms were not “normal” and requested additional support.
It wasn’t until eleven weeks after surgery, when my PT called them indicating that something was very wrong, that they took any action and we arranged a follow up. Unsurprisingly, the PA who saw me confirmed that indeed something was wrong, and ordered a second MRI.
With the benefit of hindsight, it is obvious that “suck it up” was not the medically correct response. I had two herniated discs (one small, one medium, putting pressure on the nerves) in January. I have two herniated discs (one small, one medium, putting pressure on the nerves) today. If I had trusted the messaging that Dr Singh’s team provided, it is extremely likely that I would have continued to suffer, needlessly, for the next 12-18 months under the incorrect assumption that this was normal and expected. I don’t know what the right answer is here, but “suck it up” probably isn’t it.
My final interaction with Dr Singh’s team encapsulates this indifference perfectly. After the MRI results were published, I reached out to see when we could schedule a phone call to review them. Only to be told that Dr Singh doesn’t use the telephone, er, do telehealth anymore.
I am old enough to remember a time when medicine didn’t require Internet access, but I am not old enough to have experienced a time when the practice of medicine didn’t include the use of telephones. I’ve never had a doctor refuse to ring me up to discuss test results. I’ve never even had to ask, they just did it.
For those who aren’t aware, traveling can be difficult for people with herniated discs. Sitting in random chairs that weren’t designed with the needs of people with herniated discs can be difficult. Getting in/out of a car can be difficult.
When I made the trip into the city for that appointment, I spent two hours driving, and over an hour waiting in a windowless room sitting in a chair that was not designed for someone of my height with a back problem. When I returned to my car, I discovered that even though I had intentionally parked well away from anyone, I was now boxed in on both sides. I can’t get into the car without pain. Being able to get in head-first, makes it tolerable, but when there are only six inches of space on either side of the car, that’s not an option. I could have waited for one of the people to come back to their cars, but I opted to “suck it up” and just get in the car. It was excruciating.
I did all of that to spend 10-15 minutes with Christopher McGee (one of Dr Singh’s PAs), where he confirmed that my symptoms, the same symptoms I had been raising continuously, were in fact real. I can recognize that even though that wasn’t an awesome experience for me, there was value in doing it in person. During this session he indicated that the follow-up discussion would be conducted remotely. A week later it was no longer an option when I attempted to arrange it after discovering that the MRI results had been posted on the patient portal. At no point did Dr Singh or anyone at Rush reach out to schedule this appointment.
When I mentioned all of these things, included the promise that I would be able to have the followup remotely, and requested an exception to this new policy. Lisa M, who handles scheduling, never responded; that was April 25th.
I really struggle with why it’s necessary for me to travel to the West Loop, and subject myself to the difficulties inherent in that, just to have a 10-15 minute conversation around the MRI. Especially since the results appear very clear, and there are only two paths forward. More surgery or crossing my fingers with the conservative approach. If there won’t be any hands-on, there is no reason why we can’t have this kind of conversation over the telephone, like it’s 1950; or even via the secure messaging service on the patient portal which we had previously corresponded.
The embrace of distance technology was one of the few positive things that came from COVID. Besides demonstrating indifference to my experience, both from a physical and time perspective. This policy choice is a massive step backwards, and counter to the direction that the medical industry is moving.
Oh, and for those wondering why I used the term “after-sales” for a medical procedure. It’s because I just can’t bring myself to call it “after-care”, because that would imply that I experienced some level of care from Dr Singh.
* Update: The new surgeon ordered another MRI, this time with contrast, and what looked like a reherniation is actually granulation tissue (aka scar tissue). So I won’t be getting another microdiscectomy, but I will be getting a hemilaminectomy. Which is a procedure to remove some bone and ligament material to make space for the scar tissue, and hopefully get it to stop pressing on the S1 nerve root.
It’s baffling that Dr Singh’s PA didn’t order a contrast MRI back in April. The new surgeon wouldn’t comment on why they didn’t do that, but his comments around why a contrast MRI is essential, and the new, critical information derived from it, doesn’t paint a flattering picture of the PA’s competence.