Hibner TIG combined with inpatient ketamine

[quilter]

I have a similar post under Pain Mgmt/Medications - thought it might be better in this category. Pending exam, Dr. Hibner thinks I'm probably a good candidate for re-do left TIG with immediate inpatient 5-day low-dose ketamine infusion managed by Valley Pain Consultants. Please reply if you've had this dual procedure with these two practices in the past year. Since I haven't seen Dr. Hibner or Valley Pain yet, my questions so far:

1. With the PN newly decompressed, is the ketamine more likely to be effective? From what I read here, ketamine without surgery has very mixed and short-term results.
2. Does Medicare (with Blue Shield secondary) cover the inpatient ketamine Rx? Somebody posted about a substantial fee up front, which would be a challenge unless there's major reimbursement. I called Valley Pain, who said to get procedure codes from Dr. Hibner (closed today), then they can give me some idea of coverage.
3. How many of these dual procedures have been performed by Hibner/Valley Pain? For those who've done it, what case # were you and what are your results so far?
4. What other questions should I be asking prior patients, and Dr. Hibner/Valley Pain when I get to Phoenix? I want to go into those consults fully prepared.

Thanks, and have a great weekend!

[nyt]

1. I can only speak of the use of Ketamine in individuals with CRPS/RSD. The published literature shows most individuals have relief for 3 months and then the drug has worn off, for those who get relief with Ketamine. Ketamine does not work for everyone. I do not know the statistics of indidivudals that Ketamine does not help. However, on the forums there are individuals that Ketamine has permanently decreased their pain or cured them. One example is on this forum, I forget the gentleman's name, but he had several high dose rounds of Ketamine in Europe after his pudendal surgery and his pain is gone. I think his story his on the home page. There is some literature that suggests that Ketamine may help reduce any nerve damage from surgery and might even promote nerve healing but that is more speculation than actual experiments that demonstrate nerve protection during surgery.

2. Medicare will cover Ketamine for CRPS. I do not know how they will code it for patients with chronic pelvic pain. They may code it for CRPS of the pelvis, I do not know. However, unless something has changed since I was there in March 2013, you still have to pay upfront whether your insurance will cover or not. My insurance has always covered my Ketamine both in Phoenix and in Rochester, NY and they still told me I had to pay upfront. Same with botox now. My insurance has always paid for my botox and when I was their in March 2013 I had to pay upfront for my botox. They started upfront payments of botox in Oct 2012. Things change quickly in Dr. Hibner's office so it could have changed since I was there. Dr. Sparlin is the one in charge of the infusions and she is a wonderful physician. I was quite impressed with her.

3. I was Dr. Hibner's first inpatient Ketamine patient back in Oct. 2011. I was admitted to the ICU for 2 days after I had botox. Because insurance companies do not like to pay ICU fees he had to stop admitting patients for a while until they got approval from the hospital and the appropriate equipment to administer Ketamine on the regular nursing ward. For a while every patient who had pudendal surgery got 24 hours of inpatient Ketamine infusion. I do not know how many before he had to stop doing that because insurance companies weren't paying and the hospital had to write off a number of bills. It is my understanding that now Dr. Sparlin is the only one allowed to give the approval for someone to have Ketamine and that she is working closely with Dr. Hibner on the patient's that he would like to have Ketamine.

4. Dr. Sparlin has a standard dosing procedure for Ketamine and how it is increased. Make sure you get the details on how they will dose the Ketamine, what they will give you if you have problems with hallucinations, nausea, or anxiety. Found out if anesthesia will give you any during the surgery or a some type of bolus to start with or will they just start it in the recovery room or on the floor. Ask how soon after they stop the Ketamine before you can travel to return home. Ketamine really does a number on my memory, I made phone calls to friends when I was receiving it that I have no recollection of. You might feel "out of sorts" for a few days even after it is stopped.

Things are always changing with how things are done in Dr. Hibner's office so just because it was done a certain way when I was their in March doesn't mean it still applies.

[quilter]

Dear NYT and others:

Thanks for all the info on Dr. Sparlin and starting my list of questions. I just found out they've arranged for her to see me at Dr. Hibner's visit 9/18. I try to be prepared; it's impossible to ask things after you walk out the door. Can't just pop in from CA and see her another time. They've already sent me the financial info.

If anybody can think of anything else I should ask Dr. Sparlin about ketamine (maybe more for yourself than me), make suggestions and I'll do the best I can.

Will post after I've recovered from my trip. Airports, planes and shuttle vans are not PNE-friendly. When booking the shuttle van I always reserve the reclining front passenger seat, and have never been refused. Every minute of lying back helps! If only the flight crew would let me stand in the galley like they used to 3-5 years ago. Other than takoff/landing, I stood reading or knitting the entire flight. FAA says no more but I'll try anyway.

[Violet M]

Good luck, Quilter. I don't have any advice but just wanted to let you know I'm thinking of you.

Violet

[hopeman]

Nyt

Did Dr Hibner cut your SSL and repaired.

For you, did cutting SSL lead to your pelvis instability?


Hopeman

[nyt]

Dr. Hibner cut both the STL and SSL. He repaired the STL but not the SSL. I do NOT have any pelvic instability problems. I do not know if he has changed his surgical procedure since I had my last surgery.

[quilter]

When I saw Dr. Hbner in consult in Sept 2013 he said that several months earlier he had changed the incision into the ST ligament and because of this no longer needed to repair it with the Achilles tendon cadaver graft (used with my prior surgery in 2007). The new incision to the ST ligament is no longer a straight line, but an elongated zig-zag, so the edges of tisssue fit more tightly together like puzzle pieces. He had found that this is a more accurate closure because it's easier to line up the 2 halves and they fit more tightly, it's stronger and therefore eliminates the need for the cadaver graft, heals better, AND because it's not a straight line cut there isn't that hard ridge of scar tissue to deal with postop.

My PT (for both surgeries) has been very pleased with my scar healing from the 2013 surgery: much faster, far less scar tenderness compared to 2007, and way less need for that fun scar massage. Because of my severe adhesive allergies the wound vac could not stay attached as many days as normal. I never had any sort of SI joint dysfunction before or after the 2007 or 2013 surgeries.

[Charles555nc]

Could someone tell me if Hibner still accepts male patients. Some rude woman on the phone says he has stopped seeing ALL male patients but I could still fax over my records. Dont love the discrimination...

[quilter]

No clue; I don't live in AZ and haven't seen Dr H since 1 month postop. The answer you seek should be on the forum. Haven't followed it since I'm not affected. Something I read (somewhere) several months ago indicated that the ruling had been modified to allow male patients to be seen on a case-by-case basis.

Bypass the unhelpful people who answer his phone and demand to speak to the practice manager. Many of hs patients (current and hopeful) have complained. A year ago the manager was Mary Steigenwald. After weeks of getting nowhere wtth the drones up front, it was only through Mary that I managed to get the process moving for appointments and surgery. Good luck!

[Violet M]

My understanding from talking to Dr. Hibner in September is that he is not accepting any more male patients this year but may in the future.

Violet