Part 3: Back Surgeon Questions Vascular Problems

    In August of 1999, I saw Dr. Huepenbecker again because I was still having severe leg pain. He ordered a new Doppler test. As I had done in 1996, I asked that it be done with the treadmill, and I thought he had agreed. At St. Mary’s, however, I was told that if the resting Doppler was normal it was not necessary to do the treadmill. The resting Doppler readings were within normal limits, so with those results Dr. Huepenbecker definitively states, "focus on her back." The Doppler read 1.22 R / 0.98L. Little did I know then within the next five years, up until 2004, this resting Doppler would read about the same whenever they did this test, but when in late 2004 they finally gave me the Doppler with treadmill that I had asked for on multiple occasions, it would drop to -0.76 R to 0.25L.
     In the late 1990s, however, I wasn't challenging my doctors. I wasn't getting or reading my medical reports. I trusted Dr. Huepenbecker, and since he was convinced that my back could be causing the leg pain, I was convinced of the same. At Dr. Huepenbecker's recommendation to focus on my back, my primary caregiver sent me to a back surgeon. At the thought of finally getting at the source of my leg pain, I was hopeful once again that I might get my quality of life back.


On September 23, 1999, I was sent to a back surgeon, Dr. Bogdanowicz. He was reluctant at first to recommend back surgery from looking at my CAT or MRI scan. To really illustrate the concerns that Dr. Bogdanowicz had about performing back surgery on me, I want to draw heavily from the doctors' notes in my medical records. I feel the dialogue between the doctors' notes is illustrative of and testifies to the uncertain position and miscommunication between the doctors that led up to my back surgery. Yes, there were long standing back problems, but Dr. Bogdanowicz voiced severe concerns about proceeding with the surgery when he wrote on September 27, 1999:

 After walking a short distance or dancing one song she develops pain and weakness especially of her left leg- and this is the leg the stents are in. I want to discuss this situation with Dr. Huepenbecker to make sure he is absolutely, positively sure it is not a vascular problem and the vessel is OK. I do not want to put this woman through a surgical procedure when we need to put her on a tower table which might further compress her left iliac artery and stint and cause significant trouble. I need to be reassured that the vascular problem is open and clear.

     His notes from October show a similar concern that the problem might be vascular. On October 7, 1999, Dr. Bogdanowicz reiterated the degree of his concern about the back surgery. He wrote:

I touched the area over the stent and she winced, because of the severity of pain there. I really think that we should examine it carefully before we decide about back surgery. There is a strong family history of vascular disease and we know she has it because she was already treated. The very important question is, and the patient is very adamant about it, and I absolutely agree, is that before we touch the back, we should know absolutely for sure that most of the symptoms are coming from her back and not the vascular problem. If Dr. Kantamneni clears her, the next step would be to consider back surgery.

     In order to address his concerns that the problem might have stemmed from a vascular problem and might not be attributable to a back problem, Dr. Bogdanowicz suggested another Doppler test and requested that I go see Dr. Kantamneni. During the appointment with Dr. Kantamneni I asked him specifically that a treadmill test be included in the new Doppler test, and I asked again when I arrived at St. Mary’s for the test later that month. The nurses told me again that the treadmill was not “procedure” for the test if the resting reading was within limits. After the test, Dr. DeAngeles read the report. Even though the results showed a stable vascular supply when I was at rest, Dr. DeAngeles' impression was that, as he wrote, “vascular evaluation and/or arteriographic evaluation could certainly be supported based upon this study.” Interestingly, despite the resting test results, Dr. DeAngeles' impression was that my vascular condition warranted further investigation.
     When I met Dr. Kantamneni, my vascular surgeon, a week later, Kantamneni seemed to express no concern for or need to follow up on Dr. DeAngeles' report. In his notes from October 26, 1999, Kantamneni writes, “I have reassured the patient that she has good vascular supply.” This seems even more curious when it becomes evident that there was in fact something of concern to him in his examination. In his notes from the examination he writes “her popliteal arteries are difficult to palpate. She is absent dorsalis pedis on the left.” Dr. Kantamneni 's report, though, seems like it was unsatisfactory to Dr. Bogdanowicz. In Dr. Bogdanowicz's report from the following day, October 27, 1999, he still expressed concern about whether the problem was vascular related. On December 17, 1999, he wrote, “Dr. Kantamneni felt that the patient had a good vascular supply.” He himself did not feel confident that the problem was not vascular; rather he only notes that Dr. Kantamneni felt that I had a good vascular supply – this despite his own opinion and the opinion of Dr. DeAngeles!
     His uncertainty about the test results, the decision to proceed with the back surgery, and whether the back surgery would actually address the problems, persisted. Before the back surgery, Dr. Bogdanowicz said to me: “I guess we will trust the vascular doctors that your arteries are open and clear.” When he said that we would simply have to “trust” the vascular doctors, he did not seem too confident in the decision.