Peled Migraine Surgery Blog

Information and knowledge about migraine relief surgery.

The Long & Winding Road

One of the most common refrains I hear from patients is that they are flummoxed by the lack of understanding from their neurologists or neurosurgeons

One of the most common refrains I hear from patients is that they are flummoxed by the lack of understanding from their neurologists or neurosurgeons or pain management physicians about the concept of surgery to treat chronic headaches. Unfortunately, many of these physicians have never bothered to read up on these procedures, even in that peer-reviewed medical literature. Moreover, many patients have been irritated by the fact that their insurance companies won't pay for these procedures because in their opinion, they are unproven. Never mind that the five-year results from these exact procedures were published over one year ago with incredibly positive and encouraging results. By definition, these procedures are not new and have definitely been proven to be very effective.

To all of my many patients and those of you out there who have experienced similar scenarios, I completely sympathize with your frustrations. I have fought many of those battles with other physicians and insurance companies and lost along with you. Having said that, I first have to say, please don't hate your doctors because many are trained to be skeptical about new things simply because they want to protect their patients from snake-oil salesmen. However, my biggest issue with other physicians is that they often discount off hand other MEDICAL LITERATURE only because it comes from plastic surgeons. I would be willing to bet that almost none of your neurologists or neurosurgeons have ever read Plastic & Reconstructive Surgery, our main scientific journal. Many of these other doctors believe all plastic surgeons are like Dr. 90210 and only care about liposuction and breast augmentation. Most of them have no idea that plastic surgeons have done many other incredible things. Joseph Murray, a plastic surgeon at the Brigham and Women's hospital did the first-ever kidney transplant back in 1954. I walked by the Nobel Prize that he won for that achievement many times while making rounds there. Plastic surgeons have pioneered face transplantation as well as hand transplantation, all concepts that are still very much cutting edge, but that are medical reality at this time. My mentor at Stanford University, Dr. Michael Longaker, has been a pioneer in the field of scarless wound repair, something that will likely become a reality within the next decade. Research like that has applications beyond making incisions in the skin and having them heal without a scar. If you think about it, when you have a heart attack, the dead heart muscle gets replaced by scar which in turn causes all sorts of arrhythmias and dysfunction with the pumping of the heart in the future. Imagine what would happen if you could prevent that scarring? Imagine what would happen if you could prevent scarring of the lung after pneumonia or the kidney after kidney infections and you begin to understand the implications of this type of work.

The issue with insurance companies is that they believe these headache operations consist of entirely new procedures that require new codes, etc. However the fact of the matter remains that plastic surgeons have simply applied tried and true procedures (and previously existing codes) to new locations for new indications with amazing results. While these operations are not simple, the basic principles are exactly the same as those of carpal tunnel surgery, something that has been performed for decades with great success and full reimbursement.

Unfortunately, I have found that the only thing we as patients and physicians can do is continue to fight the good fight. Eventually, because we are right, others will come around. However, we must recognize that the road is long and often difficult so that we don't lose faith too easily. And if you happen upon physicians with open minds, tell everyone you know about them because they are the good ones who actually listen to their patients when they bring them information that they may not have encountered on their own first.

A Pain in the Neck!
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