The post Insurance Information appeared first on Desert Spine and Neurosurgical Institute.
]]>We make every effort to work with patients’ insurance companies; however, responsibility for your bills rests with you alone. Before treatment, check with your insurance company to verify authorization and to determine whether you need a referral. Usually, new patients must be referred to see us by a qualified health care provider (medical doctor, nurse practitioner, physician assistant or chiropractor). If your insurance representative says you do not need a referral, please bring us either:
Your insurance company may also require you to pay a co-payment at the time of your appointment. Co-payments are due when services are rendered. We work hard to see all patients in need of neurosurgical consultation regardless of financial status and insurance coverage. Anything not covered by insurance will be your responsibility. If necessary, our billing company can meet with patients to establish payment plans.
Payment plans should be arranged in advance. If you lack insurance or cannot afford medical care, please let us know right away. Depending on your ability to pay, we can help you get reduced-cost or free care, possibly through referral to the appropriate hospital-based clinic.
If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at (760) 346-8058. Questions regarding your coverage and benefits should be directed to your employer or insurance company.
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]]>The post Diagnostic Tests appeared first on Desert Spine and Neurosurgical Institute.
]]>X-rays provide excellent detail of bones because they consists mainly of minerals which block xray beams. However, soft tissue such as discs and nerve roots do not have such minerals, so an x-ray does not capture an image of these structures. Therefore, xrays are not useful for the diagnosis of disc herniations. They give useful information about the alignment of the spine. Many different angles of xrays may be necessary to fully diagnose a disorder including but not limited to AP, Lateral, Flexion, extension or scoliosis views.
The most useful imaging study available for the diagnosis of the majority of brain, spine, and spinal cord problem. MRI scans provide highly detailed images of non bony anatomy.
No radiation is used to perform an MRI scan, and they may safely be done on pregnant women. However, patients with certain implants such as a pacemaker, spinal stimulator should not have an MRI scan because the magnetic field will cause the device to malfunction.
A CT scan is a highly detailed x-ray that can provide images of the body in different views. Like an x-ray, a CT scan works by shooting an x-ray beam through the body. Next, a computer is used to reformat the image into cross sections of the spine. Like xrays, they provide excellent bony detail, and are useful for evaluating fractures and other bony lesions. They do provide useful information about some soft tissue lesions, such as very dense tumors.
A myelogram consists obtaining xrays of a region of the spine after injecting a radiographically opaque dye (dye that can be seen on x-rays) into the sac around the nerve roots. When combined with a myelogram, a CT scan provides for excellent nerve detail. The myelogram adds additional risk to the CT scan( such as a spinal headache) but provides substantial information about the spinal cord, spinal canal and nerve roots as well as any lesions that may narrow the spinal canal. First the myelogram is performed by a radiologist then the CT scan is obtained.
A discogram is a test that can help to determine if back pain is coming from the discs. Discograms are also performed to assist in preoperative planning for candidates for a lumbar spinal fusion.
The discographer places a needle into the center of the disc through an area in the patient’s back. Radiographic dye is then injected into the disc, and if injecting the dye recreates the patient’s normal pain (concordant), it is then inferred that the specific disc is the source of pain for the patient. If the pain is unlike their normal pain (discordant) it can be inferred that even though the disc may look degenerated on an MRI scan, it is in fact not the source of the patient’s pain. The test itself is painful, but the patient needs to be awake and aware in order to tell the discographer what kind of pain is generated by the injection.
A bone scan is performed by injecting a small amount of radioactive marker into an intravenous line (IV). Three hours later, the patient is placed through a scanner and the radioactive marker will be concentrated in any region where there is high bone turnover.
A bone scan is sometimes performed to rule out an inflammatory process, or infection. It is also useful for diagnosing fractures not seen on an x-ray. It can also be used to determine if a compression fracture of the vertebral body is old or new, as an old fracture will not light up and a new one will.
An EMG/NCV is sometimes recommended to assess the electrical activity of nerves in the arms or legs. Compression or chronic irritation of a nerve will slow electrical conduction along that nerve. This can also result in changes affecting the muscle supplied by that nerve. By placing small needles into various muscles, these changes can be detected by EMG. Application of a small current can show slowing in NCV. They are used to diagnose nerve entraptment such as carpal tunnel syndrome, neuropathy and radiculopathy.
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]]>The post Self-Referral Screening appeared first on Desert Spine and Neurosurgical Institute.
]]>New patient appointments are scheduled by referral from a physician to Dr. Shahin Etebar. Otherwise, patients who wish to refer themselves are required to undergo a Self-Referral Screening to determine if they will receive an appointment with Dr. Etebar,
which is free of charge.
In order to be screened, you must have had an MRI or CT myelogram or CT scan of the symptomatic region of your spine (or brain) within the past 12 months. You must submit the required material (see the checklist below) to Dr. Etebar’s office by mail or in person. Dr. Etebar will personally review the material you have submitted, for no charge. He will use the available information to determine if he can be effective in further evaluation and treatment. Within a few days, you will be notified by phone about whether you have been accepted for an appointment. If you have not heard from his office within one week, you may call us to check on the status of your screening.
The following material should be submitted to Dr. Etebar’s office, by mail or in person:
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]]>The post Patient Intake Forms appeared first on Desert Spine and Neurosurgical Institute.
]]>Note: This is a compressed PDF file and depending on your internet speed may take some time to download.
Click below to download this PDF file.
The post Patient Intake Forms appeared first on Desert Spine and Neurosurgical Institute.
]]>The post Your Appointment appeared first on Desert Spine and Neurosurgical Institute.
]]>Generally, our offices are open from 8:00 a.m. to 5:00 p.m. Monday through Friday, except for holidays and weekends. Dr. Etebar sets aside some days for office visits and other days for surgeries.
After checking in at the front desk with the required information, a careful history will be obtained in reference to your complaints and a physical exam will be performed. You will be shown your various diagnostic tests and their meaning. A lively discussion of the next steps will be encouraged along with answering any of your questions. We will help you arrive at a solution that fits your needs. We will help make arrangements to facilitate your appointments and scheduling.
We will spend all of the necessary time to understand your issues, discuss your test results and answer all of your questions. Since the amount of time necessary to accomplish this is variable, please be courteous if we are delayed. We will make every effort to run on time, but each person is important to us.
Due to the fact that we provide Emergency care to those with life threatening illnesses, even after you have confirmed your appointment, Dr. Etebar may be called away. Rarely, your appointment may have to be rescheduled as a result. We regret the inconvenience to you but hope you’ll understand our desire to help patients when they need us the most. If Dr. Etebar leaves for an emergency, nurse practitioner may see you, or Dr. Etebar may see you after a delay. Alternatively, we may have to reschedule your appointment. We make every effort to see rescheduled patients as soon as possible.
Please make sure you have read and understand all of our polices. If you have any additional questions please call us at(760) 346-8058
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]]>The post Decision for Surgery appeared first on Desert Spine and Neurosurgical Institute.
]]>Learning to ask the right questions — and getting the right answers — is vital to helping you decide whether or not surgery is right for you. Being a responsible health care consumer starts with getting involved in decisions about your health. That way, you’re more likely to feel calm and confident about whatever course of treatment you choose.
So how do you decide about surgery? The first step is to find out whether the surgery being recommended is emergent, urgent, or elective.
When surgery is needed to save a person’s life (such as to remove or decompress a large brain tumor with swelling or hematoma causing coma) or must be done immediately to prevent permanent disability (such as to decompress an injured spinal cord, or repair a fractured spine), it is considered emergent. That means there is little or no choice but to have the operation or risk serious consequence to a person’s future health. There is usually little to no time to explore other options and surgery is performed within minutes to hours of diagnosis. Fortunately, few surgical procedures are truly emergent.
When performing surgery is necessary to prevent the occurrence of, or progression of serious dysfunction, it is considered an urgent operation. These circumstances may allow for plans to be made, schedules to be adjusted while preparations for surgery is made. Preparations may include medical clearance or further preoperative testing. These procedures are performed within days of diagnosis.
Most surgical procedures involve some degree of choice for the patient. In some cases, alternatives to surgery exist, such as medications, interventional procedures or other ways of dealing with the problem. In other cases, surgery may be the only option for correcting a particular problem, but the symptoms don’t merit the risk of surgery. For example, many people with radiculopathy have no weakness and only intermittent pain.
Surgery is appropriate when it is needed to:
Even if surgery is appropriate, it may not be the only choice of treatment. It’s always best to investigate all other options before choosing surgery.
If you feel anxious or nervous, take a friend or relative along for moral support. Then assess the information and decide what you want to do. It is usually appropriate to come to a decision after the appointment is over and you have had a chance to consider the information you were given during the visit. Make sure it’s your own decision. Don’t let yourself be pressured into having surgery.
Getting more information can help when you’re deciding about surgery. One way to do this is to get a second opinion, also called a “review of treatment”. A second opinion can help you make a more informed decision. Some health plans require second opinions before they will cover certain procedures, but others may not cover it. Check with your health insurance to learn whether a second opinion is covered.
You might feel uncomfortable asking for a second opinion, but most doctors today are used to this and are very cooperative. A doctor who responds with anger or refuses to cooperate with such a request may not have your best interests at heart. Dr. Etebar frequently performs second opinions for patients and other surgeons. Likewise, he would be glad to recommend other physicians or surgeons in the area and nationally.
Reason
Name and Procedure
Timing
Risks/complications
Experience
Cost
Except in certain emergencies, we must get your informed consent before performing a procedure such as surgery. In doing so, we will explain the risks and benefits of the procedure, alternative treatments, and the likely outcomes of not having the procedure. A form will be used to reinforce information given orally and to document that consent was given. If you do not understand any part of the consent form, do not sign it until we have addressed your concerns.
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]]>The post Your Hospital Stay appeared first on Desert Spine and Neurosurgical Institute.
]]>Prior to going back to the operating room, you will be prepared for surgery including answering questions about your current medical condition, meeting your anesthesiologist, and operating room staff that will be helping during your operation. Feel free to ask any remaining questions you may have to these team members. This is a good time to ask questions and make requests of your anesthesiologist concerning pain control, nausea and other issues you may have. The region of your body where your surgery will take place will also be identified and marked during this time period.
Due to a number of factors that are not under our control, the time of your procedure may vary from what you may have expected. Some operations take longer than expected. Some operations may be canceled just before surgery for a number of reasons. Some team members may need to complete a task prior to committing their entire attention to your care. As a result of these possibilities, you may elect to adjust to the schedule accordingly, or you may elect to reschedule your procedure. Feel free to discuss these issues with your pre-operative staff. Dr. Etebar may or may not be available to help in this decision making process as he may be dedicating all of his attention to another patient during their operation.
During your procedure, the team will be focusing their activity on you. Everyone has a very particular role that they know well and perform daily. Your nurse will update available family members at particular intervals. We DO NOT accept questions from family members DURING the procedure, as this is disruptive to the process. Remember that each operation represents a series of issues that are dealt with until the procedure is over. Some issues may require more or less time than anticipated, thereby extending or shortening the total operative time. It is important that family members understand this so they do not become worried by the length of the procedure.
When your procedure has ended, your anesthesiologist will control your waking up, and immediate post operative pain control. You will be transported to the recovery room. While you are recovering there, Dr. Etebar will discuss the pertinent Intraoperative events with your family according to your wishes. He will also answer their questions at that time.
After a brief recovery period, you will be taken to your room where you will receive your postoperative care. Team members will make rounds each day. Dr. Etebar will review your care each day. All critical decisions about your treatment will be made by him. Team members will address questions about your care and, at your request, communicate with your family. Any change in your condition will be conveyed to the nurse practitioner who discusses your care with Dr. Etebar.
Responsibility for your care rests with Dr. Etebar, who visits patients after surgery according to his schedule.
Once you have been medically stable, tolerating a regular diet, with good pain control and you are able to be active, you may be ready to be discharged. The decision to be discharged is made by you, Dr. Etebar, and other team members. You will be given prescriptions appropriate for you and discharge instructions. These instructions are also available on this site. Feel free to ask any questions you may have, realizing that you can call for questions at any time after you leave the hospital.
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]]>The post After Your Hospital Stay appeared first on Desert Spine and Neurosurgical Institute.
]]>Follow-up care plays a crucial role in your recovery. You will leave the hospital with a set of instructions. Please call our office within one business day to make or confirm your follow-up visit and to discuss follow-up care, which may include suture removal.
Each follow-up visit will be tailored to your individual needs. Please contact our office any time after your surgery if questions or concerns arise. Jeffrey Melton, ARNP will be happy to answer any question you may have. He will relate critical issues directly to Dr. Etebar.
Patients often forget to ask questions during office visits or think of new ones later. If that happens to you, call us. Unless your concerns are urgent, please phone during office hours.
When a secretary or receptionist takes your call, be aware that he or she cannot answer clinical questions, but will forward your message to the appropriate practitioner. A nurse practitioner will return calls about medical matters, typically within one business day. Some questions, though, require a review of tests and records as well as discussions among team members. In those cases, we may ask you to call back or await a call from us the next business day. Sometimes we will ask you to schedule an office visit.
Patients who have concerns outside office hours may call (760) 346-8058, and let the operator know your name and that you are a patient of Dr. Etebar. Explain if you have had surgery and when. As a member of the neurosurgery team, the nurse practitioner on call is available around-the-clock.
Please view here for all information on Prescription Renewals & Controlled Substance Prescriptions.
If you need emergency care outside normal office hours, call 911 or go directly to the nearest hospital emergency department.
Please make sure you have read and understand all of our policies found here. If you have any additional questions please call us at(760) 346-8058.
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]]>The post Pre-op & Post-op Instructions appeared first on Desert Spine and Neurosurgical Institute.
]]>The post FAQ for Patients appeared first on Desert Spine and Neurosurgical Institute.
]]>The post FAQ for Patients appeared first on Desert Spine and Neurosurgical Institute.
]]>The post Our Policies appeared first on Desert Spine and Neurosurgical Institute.
]]>Our offices are accessible to people with limited mobility. If you need other accommodations such as a language interpreter, please let us know when making your appointment as time may be required to arrange accommodations.
Controlled substance medications (i.e., narcotics, tranquilizers and barbiturates) are very useful, but they have a potential for misuse or abuse and are therefore closely controlled by state and federal government agencies. Clinical evidence does not support the effectiveness of taking pain medications every day for an extended period of time in the treatment of your chronic pain. In fact, the opposite is true. The longer the period of time in which the patient has taken daily narcotic and anxiety medications the greater their sensitivity to painful stimuli, and the less responsive they are to effective treatment modalities. Over time, chronic use of pain medications create increased pain ratings, disrupted sleep cycles, anxiety and depression, mood swings, decreased libido, an altered mental status, and a decreased motivation for participating in usual activities. Furthermore, there can be organ damage, which can occur within the stomach, liver and kidneys particularly with medications containing (Tylenol) acetaminophen.
Because we prescribe such medication to help manage pain while you are healing, and want to guard against abuse or inappropriate use, we require that you agree to the following conditions:
We do not automatically assume or prescribe medications when patients see us for their initial evaluation visit. You and your referring physician must understand that we prescribe medication for the treatment of postoperative pain. We do not prescribe medication for chronic pain conditions, nor for residual pain after the healing period.
If we do prescribe medications it is your responsibility to make certain you have enough medications to last between office visits. We do not phone in medications or refill prescriptions, especially narcotic medications, at any time during or after business hours or on weekends and holidays. Prescriptions for all your medications must be obtained while you are in the office. Medications must be taken as prescribed, if you take more than the prescribed amount and run out early your prescriptions will not be renewed early. NO EXCEPTIONS. You understand that you will have to have an office visit before your controlled substance medication can be changed. If your medications or prescriptions are lost or stolen they will not be replaced. NO EXCEPTIONS. You will not request or accept controlled substance medication from any other physician (this includes emergency rooms, dentists, etc.) or individual while you are receiving such medication from our office. You understand this may endanger your health in addition to being unlawful. You understand that there will be random drug testing at our discretion.
We adhere strictly to our policy. We do not tolerate medication abuse or misuse, or activities, which are suspicious for diversion of controlled substances. Patients who demonstrate patterns of behavior indicative of this type of abuse or misuse will no longer receive controlled substances prescriptions from our practice, and may in fact be discharged from our practice.
You understand that once the postoperative healing period is over you may need medication to manage chronic pain issues, and that your pain medication will have to be obtained from a provider who specializes in narcotic medication management. We will not be responsible for long term medication management.
If you need emergency care outside normal office hours, call 911 or go directly to the nearest hospital emergency department.
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