[fionab]

I've tried to educate myself as much as possible about SCS as I await my implants on Thurs. I had my pre-surgery consult with the nurse practitioner (the dr. was still in surgery, I was told) and she answered my questions. However, this morning as I thought through things, a question came to mind that makes me wonder if I'm going into this with unrealistic expectations .

The basis of this concern is the fact that I'm getting leads and not paddles. It seems (I say, I could be wrong) that paddles are put in individuals who are/were highly active prior to their injury/accident that required them to get the SCS. The other thread where Mark talks about resuming alpine skiing, mountain biking etc. and the thread where (please forgive me, I forget your name) the guy talks about doing stuff until he's got a real good sweat going which leads me to conclude he's a very active, athletic person, has got me questioning something.

I'm wondering, if the fact that I'm getting leads and not paddles, is an indicator that my dr. doesn't expect me to resume a very active lifestyle (as some of the aforementioned people will be able to do), and that it IS strictly for pain mgmt. and to just give me some quality of life back. I asked the nurse practitioner about leads vs. paddles and she said that my dr. only does leads as paddles requires a neurosurgeon. She said that he's never had leads move on a patient because he has developed a very good technique of making sure that doesn't happen. I, of course, didn't think to ask this question that I'm raising now because, frankly, I hadn't thought it all through.

I was discussing this with my husband and he's going to be happy if I can just resume some sort of social life and go on small road trips. I, on the other hand, would love to be able to do the things I haven't been able to do for the past twenty years....waterski, ride rollercoasters, ride a wave runner, go down a zip line...you know, FUN things, not just being able to run my vacuum again, drive myself to my dr. appts. I hope I'm conveying my thoughts here adequately.

What CAN one do if they ONLY get leads and not paddles? Do leads mean that one is not going to be able to live (or make up for years lost) a life of a regular person? I guess I'm looking for a reality check here. I know that I may have to just wait and see (that's what my husband is saying), but the hope of resuming the fun activities of life is what has had me really excited about getting these SCS's, not just the prospect of getting pain relief.

All thoughts, comments and even emotional outbursts are welcome.

[Rrae]

ahhhh, my dear comrade in arms......you do bring up some VERY valid points.

This is coming from a 'lead' person (percutaneous that is, not as in 'leader')
If you are confident in your doctor and know his techniques to be very reputable, then IMO that's a good sign. My Dr (similar to what yours sounds like) is so good at what he does that he actually crosses the barrier of 'regular confident doctor' over into outright COCKY! And in the beginning of our relationship i was a bit irked by this, but in hindsight it actually brings a sense of 'security' because his track record proves he is certainly worthy of his over-the-top confidence....... you may want to put your Peabody Award in a locked case......i wouldn't put it past him to feel HE is worthy of having it.

I asked him questions similar to what you are, and he said that he uses 'anchors' in strategic areas and also knows the 'exact' amount of 'give' in the leads so as not to be too vulnerable to stretching and pulling.....
And sent me on my way saying 'get out of here, go live your life'.

Your body will tell you where to draw the line as far as activities go.
However, there are always the unforeseen unmentionables, such as taking a fall, slipping on ice, etc.....which could render us back to the drawing board.
I have 7 horses. Would LOVE to ride. But I don't see me doing that in the near future (5 months out from surgery) and healed up wonderfully, except that I do have some lower back pain issues which more than likely are a matter of the muscles needing strengthened.
Now, down the road a way, I would like to think I'd be able to ride again, but I would want to make sure I'm on a very well-behaved older mare. I don't want to put myself in any higher of a risk bracket.....but anything can happen....with or without horseback riding in the mix.
I also enjoyed riding dirtbikes with my teenage boys (yeah, go ahead and laugh at the visual - a 40-something mom on a dirtbike) But here also, I'm putting that one on the backburner as well.

I'm curious to find out what the 'very good technique' your doctor uses per what the nurse told you. Ask him point blank. Ask him if he uses anchors. Ask about the 'give' allowance..... Let him know your concerns and make damn sure he gives you answers. Make sure he's talking to your eyeballs and not leafing thru your chart and whatnot.

I don't advocate one way or another on what approach is better. It basically boils down to the doctor/patient/SCS Rep communication.

I've heard some people say they were told they'd never ride again.
I've also heard that horseback riding is the best way to strengthen lower back muscles because it doesn't require bending.
Now when I say 'horseback riding'......I'm thinking in terms of riding blissfully along a prairie.....not barrel racing or bronco competing.
And yes, what if a snake lurks in the grass and makes my horse spook?
Well, that's one out of 1,549 scenerios that could possibly happen, just as easily as I could slip on a pebble on my way into a bingo parlor.....

We're a Godfearing Faithfilled bunch of ButtBuzz Prayer Warriors.
Go with what your heart desires and have good communication with doc.

But at the same time, if you've got any red flags lurking somewhere within, don't ignore those.
Ask, pester, inquire, confirm, question everything until you feel satisfied you know what's goin on....... our Drs get paid VERY well for implanting these units...soooooo

God Bless

[Wherewolf]

My doctor said I'm the most active person he has ever treated, and he has to constantly remind himself that I am older than him. He knows I did weight training and serious mountain biking, and that I wanted to continue to do so. He also said I could mountain bike on the last day of my trial implant, and I did.

I had my implant almost three weeks ago. Both my doctor and SCS rep said I could resume activities at eight weeks. Until I found this site a few days ago I had never heard of the lead vs. paddle distinction. According to what people here are saying I have the lead type. However, the Medtronic website seems to use the word paddle differently than is used here. I just emailed my Medtronic rep to ask for an explanation. I'll let you know when he gets back to me.

I felt really confident my doctor knew what he was doing and he understood my goals. But after he made his diagnosis and treatment plan he sent me to Stanford U., where two other doctors both said he was one of the best at this.

[fionab]

Rae: I'll be certain to bring those points up about "what" exactly his technique is to secure the leads.

Wherewolf: I'd be very interested in hearing what your rep. has to say re. leads vs. paddles. It really encourages me to hear that someone as active as you also got the leads. Makes me feel better about being able to resume an active life again. I may not be able to do rollercoasters again but would like to know that this is going to give me more than just the ability to run the vacuum more or do more laundry

[Rrae]

Fiona - yes! That would be great for you to pass on this info regarding the techniques your Dr uses.....it'll certainly help our forum learn and be more enlightened!

And thank you Wherewolf, please share what your Rep says to your inquiry.

I think perhaps there is a bit of missing link in the explanation of 'leads' vs 'paddles'.....so maybe Wherewolf could get a clear 'quote' on what his Rep says......

We ALL have 'leads'......the leads are what connect to the battery charge unit (IPG unit).......the difference is HOW the leads were placed.....
Percutaneous leads - placed under the skin using needle via flouroscope (xray). This type of procedure is simple enough for a regular pain management doctor and/or anesthesiologist who've been trained to do it.
whereas
The 'Paddle' lead placement (via 'Laminectomy) is more involved, as it requires a small piece of bone to be cut from the spine to insert the paddles. It requires a Neurosurgeon to do this.

Depending on where the lead placement is within the dorsal column to target the pain, some leads have more electrodes than others and the electrodes are what the Reps can 'tweek' within the programs to give us several options of where the stimulation reaches.....
...something to that effect......
Maybe Wherewolf can give us a more clear account straight from the horses mouth

But, yes we ALL have 'leads'.

[fionab]

I came across this website, which if you scroll on down, gives some good info. on leads vs. paddles etc.

http://www.nationalpainfoundation.or...e-technologies

So, it seems the question is does one's dr. put in "percutaenous leads" or "paddle leads".

[Rrae]

Fiona that is a VERY informative website!!
I'm gonna see if we can get that put in the 'stickies' at the top of the forum!

Right on!

[vannafeelbettr]

Originally Posted by Rrae

ahhhh, my dear comrade in arms......you do bring up some VERY valid points.

This is coming from a 'lead' person (percutaneous that is, not as in 'leader')
If you are confident in your doctor and know his techniques to be very reputable, then IMO that's a good sign. My Dr (similar to what yours sounds like) is so good at what he does that he actually crosses the barrier of 'regular confident doctor' over into outright COCKY! And in the beginning of our relationship i was a bit irked by this, but in hindsight it actually brings a sense of 'security' because his track record proves he is certainly worthy of his over-the-top confidence....... you may want to put your Peabody Award in a locked case......i wouldn't put it past him to feel HE is worthy of having it.

I asked him questions similar to what you are, and he said that he uses 'anchors' in strategic areas and also knows the 'exact' amount of 'give' in the leads so as not to be too vulnerable to stretching and pulling.....
And sent me on my way saying 'get out of here, go live your life'.

Your body will tell you where to draw the line as far as activities go.
However, there are always the unforeseen unmentionables, such as taking a fall, slipping on ice, etc.....which could render us back to the drawing board.
I have 7 horses. Would LOVE to ride. But I don't see me doing that in the near future (5 months out from surgery) and healed up wonderfully, except that I do have some lower back pain issues which more than likely are a matter of the muscles needing strengthened.
Now, down the road a way, I would like to think I'd be able to ride again, but I would want to make sure I'm on a very well-behaved older mare. I don't want to put myself in any higher of a risk bracket.....but anything can happen....with or without horseback riding in the mix.
I also enjoyed riding dirtbikes with my teenage boys (yeah, go ahead and laugh at the visual - a 40-something mom on a dirtbike) But here also, I'm putting that one on the backburner as well.

I'm curious to find out what the 'very good technique' your doctor uses per what the nurse told you. Ask him point blank. Ask him if he uses anchors. Ask about the 'give' allowance..... Let him know your concerns and make damn sure he gives you answers. Make sure he's talking to your eyeballs and not leafing thru your chart and whatnot.

I don't advocate one way or another on what approach is better. It basically boils down to the doctor/patient/SCS Rep communication.

I've heard some people say they were told they'd never ride again.
I've also heard that horseback riding is the best way to strengthen lower back muscles because it doesn't require bending.
Now when I say 'horseback riding'......I'm thinking in terms of riding blissfully along a prairie.....not barrel racing or bronco competing.
And yes, what if a snake lurks in the grass and makes my horse spook?
Well, that's one out of 1,549 scenerios that could possibly happen, just as easily as I could slip on a pebble on my way into a bingo parlor.....

We're a Godfearing Faithfilled bunch of ButtBuzz Prayer Warriors.
Go with what your heart desires and have good communication with doc.

But at the same time, if you've got any red flags lurking somewhere within, don't ignore those.
Ask, pester, inquire, confirm, question everything until you feel satisfied you know what's goin on....... our Drs get paid VERY well for implanting these units...soooooo

God Bless

My reply would be similar to Rae's post here. Including the "cocky" doc who is at the top of his game that I love. My doc is sooo good, I had faith in him giving me the best, up-to-date procedure; which was the leads with some leeway anchored in. Been over a year, moved in weird positions and stretches (have 2 young boys ) and I personally never felt nor felt nervous that my leads would disconnect. The only area I'm subconsciously aware of is the battery implants (and I have 2). Unfortunately, I can only give my opinion on the leads, as I'm not experienced nor educated as to the difference with the paddles.

You are smart to do your homework. And with that, I'm sure you will end up knowing they way to go for you.

Best of Luck Vanna

[Wherewolf]

From my SCS rep today:

"Yes, paddle leads tend not to migrate as often as percutaneous leads, however they still can migrate. Paddle leads also require a laminotomy (removing a small piece of bone from the vertabrae) to be placed, this is a more invasive procedure than percutaneous leads and is not fully reversible since you are permanently taking out bone, whereas percutaneous leads are fully reversible.

There are pros and cons to both. Depending on the neuroanatomy of one's back and energy use, sometimes it is better to implant perc leads, other times it's better to implant paddle leads. A doctor's past experience and technique can also play a role. Some doctors see better outcomes with perc leads, some see better outcomes with paddle leads.

In your case, I believe it was more appropriate to implant perc leads because there was nothing in your epidural space to impede the perc leads from reaching the appropriate destination and you were getting great stimulation during your trial. Moreover, it is minimally invasive compared to a laminotomy procedure and your neuroanatomy did not require a paddle lead to be placed. If your future activities cause the leads to move you can either have them moved back or choose to have a paddle lead place at that time."

[fionab]

Originally Posted by Wherewolf

From my SCS rep today:

"Yes, paddle leads tend not to migrate as often as percutaneous leads, however they still can migrate. Paddle leads also require a laminotomy (removing a small piece of bone from the vertabrae) to be placed, this is a more invasive procedure than percutaneous leads and is not fully reversible since you are permanently taking out bone, whereas percutaneous leads are fully reversible.

There are pros and cons to both. Depending on the neuroanatomy of one's back and energy use, sometimes it is better to implant perc leads, other times it's better to implant paddle leads. A doctor's past experience and technique can also play a role. Some doctors see better outcomes with perc leads, some see better outcomes with paddle leads.

In your case, I believe it was more appropriate to implant perc leads because there was nothing in your epidural space to impede the perc leads from reaching the appropriate destination and you were getting great stimulation during your trial. Moreover, it is minimally invasive compared to a laminotomy procedure and your neuroanatomy did not require a paddle lead to be placed. If your future activities cause the leads to move you can either have them moved back or choose to have a paddle lead place at that time."

Thanks for that info. from your rep. Helps put my mind at ease...if you can go back to doing the rigorous athletic things you're used to doing, then what I want to do should be just fine