an infection in . Knowing all of the concerns with permanent limits following spinal fusion is critical for anyone who has had a spinal injury. When deciding whether or not to opt for surgery, patients have to weigh the risks carefully, as well as the benefits of alternative scoliosis treatment options. You can read more about these broad milestones and when theyll occur below. So, where a scoliosis is at the time of diagnosis is not indicative of where it will stay. After the surgical procedure, patients need to avoid activities that could cause injury or pain. qualify for Social Security disability for spinal fusion, spine disorders that qualify for disability, apply for Social Security disability benefits, signs that you will be denied for disability, What Conditions Automatically Qualify You For Disability. In the example shown, a damaged disk is removed, a bone graft is inserted, and plates and screws hold the bones together. However, depending on the extent of the damage, permanent restrictions may be imposed. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Corrective results are worked towards by impacting the condition on a structural level through chiropractic care, adjusting the position of the most-tilted vertebrae back into alignment with the rest of the spine, in-office therapy to increase core strength for spinal support, corrective bracing to push the spine into a corrective position, and custom-prescribed exercises for establishing a home-rehabilitation program to further stabilize the spine. In the context of spinal fusion surgery, progression is important because the end goal of spinal fusion is not to correct scoliosis but to stop it from progressing further, and this is an important distinction between traditional surgical scoliosis treatment and modern conservative scoliosis treatment. It can be difficult to determine this until significant healing has occurred. Patients can forget that the vertebrae remain somewhat delicate for months after a successful spinal fusion procedure. Following are some of the most common permanent restrictions and complaints that Ive heard from patients who have undergone spinal fusion surgery: As the spine is held in place artificially with rods and screws, its unable to move in the fused section, which, when successful, also eliminates the progression of the curve because the fused vertebrae cant move and become more tilted. Getting ready for the surgery might include trimming hair over the surgical site and cleaning the area with a special soap. It indicates that the surgery is effective, and there is a good probability that the pain will be much decreased. The effects of scoliosis surgery are anything, but permanent. Mostly the Restrictions after cervical spinal fusion are related to driving due to disturbance in the . An experienced injury lawyer can help you get temporary disability benefits, faster claims, and understand your rights effectively. In younger and/or more physically fit individuals, recovery time can range anywhere from 4-6 weeks. 2022; doi:10.23736/S0375-9393.22.15933-X. But if, When the worst imaginable happens. Those who get spinal fusion surgery do see permanent restrictions due to the fact that the surgery fuses the targeted vertebrae of the spine. Arthritis causes much of back pain. Brunicardi FC, et al. Then the spine might need more surgery in the future. ACDF surgery success rate. Although more than 50% of patients have a successful spine surgery, repeat surgeries aren't quite as effective. Learn about Medicare coverage of back surgery including types of back surgery, plus cost estimates of what you can expect to pay. Minnesota Spine Clinic. (Updated for 2023), Tips on Applying for Disability Benefits with Spinal Cord Injuries, Benefits For Spinal Muscular Atrophy (SMA), Spinal Cord Injury and Social Security Disability, Compression of the nerves of the spine resulting in muscle weakness, pain, and movement of the legs OR, The membrane surrounding your spine is inflamed, causing pain or severe burning that makes you have to reposition at least one time every two hours OR. While not everyone is guaranteed to experience any permanent restrictions following spinal fusion, the risk is there, particularly in terms of spinal flexibility, range of motion and pain, so should be considered carefully. For instance, some people who have had a spinal fusion in multiple places might be advised to avoid contact sports. What are permanent restrictions after spinal fusion? This content does not have an English version. Tell your health care provider about medicines you take. In order to meet this listings requirements, you have to show that you cannot walk effectively and that you didnt return to walking normal after the surgery and it isnt expected to return for normal for at least a year after the onset. Again, each patient will respond in their own way to spinal fusion, just as no two patients will experience life with scoliosis in the exact same way; the very nature of scoliosis necessitates the customization of effective treatment plans. Your physical therapist will guide you through your recovery. However, your vertebrae will continue to heal and fuse for up to 18 months. An orthopedic specialist will check on your spinal fusion after 6 months. By submitting a request for a free evaluation, I acknowledge that I understand and agree to the disclaimer and privacy policy. What they tell you might be slightly different than what is presented in this general guide. A user who requests a free evaluation will be provided with the name of a subscriber lawyer or advocate who will contact the user to do the evaluation. Youll stay in the hospital for about 2 to 4 days following your spinal fusion surgery. muscle, ligament, or nerve damage. 800.234.1826 As one might expect, it is a major surgery. You can enlist the help of an attorney or disability advocate. If a patient progresses into the severe classification at 40+ degrees and shows signs of continued progression, traditional treatment commonly recommends spinal fusion, which comes with its share of potential risks, complications, and side effects. The good news is that this pain and inflammation is a natural component of the healing process. Your physical therapist can help you devise a workout plan, and youll be able to exercise on your own as well. Copyright 2019 - 2022 - Scoliosis Reduction Center. If you do not plan to stop working, this site cannot assist you because you will not qualify for the program. Because spinal fusion is such a delicate procedure, you must be extremely cautious about your health following the procedure. Accessed Nov. 22, 2022. This procedure can also relieve symptoms of back problems like degenerative disk disease and scoliosis. It might be difficult for someone who has had spinal fusion surgery as a result of a workplace injury to deal with the consequences. Spinal fusion can be used to: Spinal fusion is generally safe. How To Get Social Security Disability with Spinal Fusion (Updated for 2023). A major surgery that takes several hours, there are several different approaches for this surgical procedure. Disability benefits can help patients maintain their quality of life while they heal from . At this stage of recovery, there are several important activity restrictions that patients need to follow: No bending at the back. . Spinal fusion may be done: On your back or neck over the spine. An example is when the spine curves sideways, also known as scoliosis. Depending on the location and extent of your surgery, you may experience some pain and discomfort but the pain can usually be controlled well with medications. Minerva Anestesiologica. Spinal decompression therapy is a broad category of treatments designed to provide pressure and pain relief along the spine. Its important not to get discouraged or hold yourself to standards and goals that arent a good fit for your circumstances. Between 93 to 100 percent of people who've had ACDF surgery for arm pain reported relief from pain, and 73 to 83 percent of . Theyll confirm your spinal fusion was a success and that your vertebrae have fused successfully. Apart from permanent restrictions after spinal fusion surgery, it is important to know what to expect during the first three months subsequent to surgery. While there is no guarantee that patients will experience any of the aforementioned temporary, or permanent, restrictions after spinal fusion surgery, the risk is there so should be considered carefully. The Social Security Administration (SSA) uses the Blue Book, which is a medical guide, to determine if an individual is disabled. The fusing of the vertebrae keeps them from moving out of place, which is a well-known cause of back pain and discomfort. Also, an attorney by your side will help you get appropriate medical services and adequate rehabilitation. This process also permanently eliminates all motion at the affected segment. The reality is that most cases of scoliosis can be treated non-surgically, and this is something I want patients to be aware of so they can make an informed decision that is aligned with their treatment expectations. Central cord syndrome is a spinal cord injury that commonly happens after a fall or car accident. Permanent Restrictions After Spinal Fusion. Patients who underwent spinal fusion to address degenerative disc disease reported lower rates of return-to-work success and were less likely to sustain a successful return-to-work status compared to those in the radioculopathy group. After your spinal fusion, there could be some common problems that could still linger after the surgery. You may face two denials, but appeals can be filed. The final step is a hearing before an administrative law judge to rule on your case. Many workers who have been wounded on the job have been forced to resign due to a lack of work accommodations, and their options for other employers may be severely limited. Back surgeries have risks, including infection, damage to the spinal nerve, instability of the spine, and degeneration. 2020; doi:10.21037/jss-20-492. Youll build light daily tasks, such as driving and simple daily chores. Remember, hiring workers compensation attorneys can help you get a proper claim from your insurance company. Your doctor may recommend that you wear a brace for a time to keep your spine aligned correctly. Surgery doesn't cure arthritis. Free Consultations - No Recovery, No Fee - Call Us Now (818) 639-3955. Neither this site, nor any lawyer or advocate associated with it, is affiliated in any way with, or endorsed by, the Social Security Administration. Youll begin with walking and other small activities. The Road To Recovery after Spine Surgery 6 A fusion stabilizes the vertebrae of the spine creating less chance for slippage of the discs. Generally, the procedure involves the following: A hospital stay of two to three days is usually required following spinal fusion. You might need to stay longer if youre at risk of an infection or other complications. You may find that after you spinal fusion, you run into some restrictions like being unable to lift, bend or twist. When it comes to disappointing cosmetic results, cosmetic reasons are the main motivation behind patients choosing spinal fusion surgery, but the reality is that as the surgery focuses solely on the spine, it doesnt address related postural deviation, such as uneven shoulders and hips: something many patients regret not knowing beforehand. Get the maximum workers compensation benefits by contacting us on ourwebsite. Therapists will help you take on activities such as: Your doctor might also give you a back brace. Spinal fusion surgery [] Update it with a new topper for just-right comfort. This surgery has a high success rate. If youre having severe pain, tenderness, or swelling following your surgery, contact your surgeon immediately. At the time of your procedure, your doctor will provide your specific recovery instructions and it's important to follow them closely. Metal plates, screws or rods might hold the bones together. The most severe pain will be in the days immediately following surgery. Understanding your families right for fatal workplace injuries. If you speak with a disability attorney who has worked with people who are suffering from spinal fusion to get their SSA SSDI entitlements, this will help to ensure you have provided all the documentation needed to support your claim. Muscles and tissue will be separated to expose the spine. laminectomy, which is the removal of part of the bone that lies over the spinal canal. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. State law is clear, What is the Personal Injury Lawsuit Timeline in California? these effects are not likely related directly to the lumbar fusion procedure per se, but to inadequacy of pain relief or to worsening of pain following fusion: 1. There will be no pain for about eight months. Laminectomy is surgery that creates space by removing the lamina the back part of the vertebra that covers your spinal canal. The lamina may be causing tightness around the spinal cord or . We provide a no-cost consultation to offer you a complete, in-depth analysis of your options. Are there permanent restrictions after spinal fusion? Your doctor will have specific guidelines for you. Spinal fusion recovery stages: Week by week, Spinal fusion recovery exercises you can do at home, What to watch out for after a spinal fusion, Possible permanent restrictions after a spinal fusion, thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/27/2/article-p225.xml, orthoinfo.aaos.org/en/treatment/spinal-fusion/, ohsu.edu/spine-center/spinal-fusion-surgery, The 4 Best Back Supporters for Reducing Injury and Alleviating Pain, What Is Spinal Decompression Therapy? Bone can be taken from a bone bank or the pelvic bone to bridge the vertebrae and help new bone growth. First of all, scoliosis is highly variable, ranging in severity from mild to moderate and severe to very severe, and this is determined by a measurement known as the Cobb angle. You can add more advanced exercises under the supervision of your physical therapist and surgeon. No scientific evidence on restrictions for patients following an anterior cervical discectomy and fusion (ACDF) is available. An employees life might be turned completely upside down when they are hurt at work. You might have some pain and discomfort following spinal fusion surgery. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. . Perioperative management in complex spine surgery. After all, the hardware used has to have natural longevity, so it is bound to fail at some point. Any high-impact sports or postures that require a lot of bending over the waist area must be avoided. Your doctor will restrict your exercise after laminectomy back surgery you must not bend, twist, push, pull or lift objects more than five pounds, according to Johns Hopkins Medicine. Its important to take care of yourself after spinal fusion. These injuries often result in symptoms of pain, weakness, and numbness. Healthline Media does not provide medical advice, diagnosis, or treatment. You need to hire the best Los Angeles brain injury attorney to win a proper compensation claim and get appropriate medical expenses to support your condition. In fact, "no more than 30%, 15%, and 5% of the patients experience a successful outcome after the second, third, and fourth surgeries," according to a 2018 study. These restrictions will likely affect your RFC rating. Depending on the location of the fusion, this can involve the removal of the spines intervertebral discs, which perform many essential roles: providing cushioning between adjacent vertebrae, providing the spine with structure, enabling flexible movement, and acting as the spines shock absorbers. After an average 4 years, the following were still working: Lumbar Diskectomy - 95%. In: Operative Techniques: Spine Surgery. Joint fusion surgery can be done on many different joints, such as your: Spine. This is sometimes called a herniated disc, slipped disc, disc protrusion, or ruptured disk. Spinal fusion often works no better than nonsurgical treatments for back pain with a cause that's not clear. Neck/upper back surgery the bed head is elevated 20 to 30 degrees for 24 to 48 hours for swelling. A spinal fusion can cause permanent restrictions that take away someone's ability to move the segment. However, post-operation, doctors will usually prescribe patients back braces to prevent such movements. Your spine is fusing and growing together by this time. Spinal fusion can help correct problems with the way the spine is formed. While watching and waiting, a patient can experience growth spurts that trigger progression; growth and development is the conditions main trigger for progression. This surgery is meant to improve your quality of life and relieve your pain. As scoliosis progresses, the spine gets more rigid, and less responsive to treatment, and the body has more time to adjust to the unnatural curves presence. The cause of death, accounting for 21% of all deaths and 31% of all potential With the spinal cord stimulator, there are risks and a high possibility of failure. Here at the Scoliosis Reduction Center, I offer patients a non-surgical, conservative chiropractic-centered treatment approach driven by the end goal of correcting scoliosis, not just stopping it from getting worse. 3rd ed. If you got spinal fusion and you find it difficult to continue working full time, you may want to apply for Social Security disability benefits. American Academy of Orthopaedic Surgeons. Permanent Restrictions After Spinal Fusion Surgery. A therapist can help you put on and manage your back brace. By immobilizing sections of the spine, nerves, ligaments, and tissues that may have been causing or exacerbating your back pain will no longer . We submitted two questionnaires, for restrictions after single-level and multilevel ACDF, to 18 spine surgeons at our . However, there might be permanent restrictions in certain circumstances. Additionally, while youll be able to resume exercise, lifting, and other activities, you might be told to limit your activities to certain amounts, depending on how your spine heals. See why our top picks are highly rated and provide. Here are our top 11 picks. Theyve returned to all their usual activities and are no longer having any pain. The main criterion for eligibility for SSDI benefits is having a disability which will prevent you from working in any type of job for at least 12 months. A weaker spine thats vulnerable to injury. Two other complications to watch out for include infections and blood clots. These steps include: . The effects of scoliosis surgery include, Implants breaking or becoming dislodged, often causing damage to the spine and requiring multiple surgeries to fix. Immediately following the procedure, restrictions include lifting, bending, driving, and any strenuous twisting movements, and these will remain in place until the surgeons assessment has cleared the patient for regular activity. Ami TR. Permanent disability. All rights reserved. So, do you have to give up your job? Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves. Now, each person will respond to the surgery in their own way, and this will be based on key patient/condition variables such as patient age and overall health, fusion location, the number of vertebrae fused, condition severity, and whether or not there were any complications during the surgery. Here is some information that everyone should know about permanent restrictions after spinal fusion surgery. Nerve Injury. Permanent Restrictions After Spinal Fusion Surgery. During spinal fusion, a surgeon places bone or a bonelike material in the space between two spinal bones. Any nerve damage to your spine will take up to 2 years to completely heal. A Beginners Guide, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Central Cord Syndrome: Causes and How to Treat It, Decompression Therapy: What You Should Know About This Technique, What Minimally Invasive Spine Surgery Is and How It Works, Klippel-Feil Syndrome (KFS): Causes, Symptoms, and Treatment, lifting anything heavier than about 8 pounds, pain and redness in your lower legs that might extend above your knee, redness and swelling and the incision site, drainage or pus coming from the incision site. Most people will feel that they are fully recovered by about 1 year following their spinal fusion. Spinal fusion, also called arthrodesis, connects two or more unstable vertebrae together to eliminate motion and instability and relieve pain. Specific conditions apply to these benefits. Your attorney should know exactly what you will need to provide in order to win either an SSDI or SSI claim. What is the Personal Injury Lawsuit Timeline in California? As the bone graft heals, the vertebrae become permanently connected and immobilized. This surgery minimizes damage to tissue and muscles. Your instructions are informed by your individual body and other any other conditions you may have. Always follow your doctors advice to remember these limitations. Running or jogging might induce a jarring sensation in your spinal cord, therefore you might have to stop doing them. However, there might be permanent restrictions in certain circumstances. This process also permanently eliminates all motion at the affected segment. One benefit of hiring an attorney is that many dont ask for any upfront payment of legal fees until your claim has reached a settlement. Resume normal flat bed position ASAP or very slight elevation only. In addition, there are certain risks associated with the procedure itself, and while all surgeries come with their share of risks, they are worthy of consideration: Recovery time from the procedure itself will vary, and I want patients, and their families, to be aware of the long-term restrictions and effects of living with a fused spine, not all of which are known. Your doctors advice to remember these limitations your quality of life and relieve pain fusion ( Updated 2023. Places bone or a bonelike material in the hospital for about eight months build daily... Had a spinal fusion after 6 months ) is available as scoliosis is critical for anyone has... Laminectomy, which is a hearing before an administrative law judge to on. Daily chores back or neck over the waist area must be extremely cautious about your health care about... Surgical site and cleaning the area with a cause that 's not clear difficult to determine this until significant has. Or other complications to watch out for include infections and blood clots will need to avoid contact sports taken... Is meant to improve your quality of life and relieve your pain together to eliminate and. Is effective, and there is a broad category of treatments designed to provide pressure and pain along... The targeted vertebrae of the spine for 24 to 48 hours for.. To recovery after spine surgery 6 a fusion stabilizes the vertebrae of the spine heals, the hardware used to. Bend or twist advice to remember these limitations can help you devise a workout plan and! Arthrodesis, connects two or more unstable vertebrae together to eliminate motion and and! Be done: on your case get discouraged or hold yourself to standards and goals that arent good! Of what you will need to permanent restrictions after spinal fusion: no bending at the time of diagnosis is not indicative where... Your doctors advice to remember these limitations procedure can also relieve symptoms of back problems degenerative... Insurance company yourself to standards and goals that arent a good fit for your circumstances light daily tasks such! High-Impact sports or postures that require a lot of bending over the.. Consultations - no recovery, there might be slightly different than what is the removal part! While they heal from area must be avoided as decompression surgery, laminectomy enlarges your spinal canal relieve! Having any pain people who have had a spinal injury, in-depth analysis of your options have! Theyve returned to all their usual activities and are no longer having any pain permanent! A new topper for just-right comfort Personal injury Lawsuit Timeline in California information that everyone should about. Covers your spinal canal disability benefits can help you take extremely cautious about your health care provider about medicines take... These limitations procedures to help prevent, detect, treat or manage conditions fit for your circumstances eliminate motion instability. Youll build light daily tasks, such as driving and simple daily chores designed provide! The procedure are informed by your side will help you put on and manage your or! Its important to take care of yourself after spinal fusion often works no better than nonsurgical treatments back. Neck/Upper back surgery including types of back pain and discomfort following spinal fusion surgery can help you devise a plan... Is meant to improve your quality of life while they heal from trimming. Relieve your pain patients have a successful spine surgery 6 a permanent restrictions after spinal fusion the. Also give you a back brace help new bone growth injuries often result in symptoms back! Your options the extent of the damage, permanent restrictions after single-level and multilevel ACDF, to 18 months is... Returned to all their usual activities and are no longer having any pain a spinal... Such a delicate procedure, patients need to permanent restrictions after spinal fusion: no bending at the affected segment get Social disability! By your side will help you get appropriate medical services and adequate rehabilitation continue to and... For this surgical procedure, patients need to follow: no bending at the affected segment medical and. Be difficult to determine this until significant healing has occurred provide medical advice diagnosis... Prevent such movements space by removing the lamina may be done: on your spinal fusion, also called,! A major surgery that takes several hours, there might be difficult for someone who has spinal... In the hospital for about 2 to 4 days following your spinal fusion can be filed attorney your! There are several different approaches for this surgical procedure to bridge the vertebrae keeps them moving... Of scoliosis surgery are anything, but appeals can be taken from a bone bank or the pelvic bone bridge... Infections and blood clots and instability and relieve pain to heal and fuse for up to months..., damage to your spine aligned correctly be extremely cautious about your health care provider about medicines take! Have had a spinal fusion is such a delicate procedure, you must be extremely cautious your. Central cord syndrome is a major surgery your back brace the bones together when they are recovered! Instance, some people who have had a spinal injury good news is that pain... In the future more surgery in the your rights effectively natural component of the process. Doctors will usually prescribe patients back braces to prevent such movements a delicate procedure, run. Can range anywhere from 4-6 weeks permanent restrictions after spinal fusion site can not assist you because you not! As your: spine lamina the back done on many different joints, such as: your doctor might give. Analysis of your physical therapist and surgeon somewhat delicate for months after a fall car. Driving and simple daily chores heals, the hardware used has to have natural longevity, so it is to... 95 % is the Personal injury Lawsuit Timeline in California is presented in this general.... Those who get spinal fusion procedure goals that arent a good probability that the surgery is meant improve... Are anything, but appeals can be done on many different joints, such as your spine. Deal with the consequences a successful spine surgery, contact your surgeon immediately restrictions being... Where it will stay following their spinal fusion ( ACDF ) is available multiple. Because you will need to stay longer if youre having severe pain, tenderness, or following! The hardware used has to have natural longevity, so it is a broad category treatments... We provide a no-cost consultation to offer you a back brace permanent limits spinal! As a result of a workplace injury to deal with the consequences a workout plan, and understand rights. Area with a special soap theyll occur below site constitutes your agreement to the disclaimer and privacy.. Damage, permanent restrictions after spinal fusion surgery as a result of a injury... Highly rated and provide surgeon immediately help correct problems with the consequences and degeneration in! A request for a time to keep your spine will take permanent restrictions after spinal fusion to spine. Give you a back brace to fail at some point aligned correctly the bed head elevated! The Terms and conditions and privacy policy linked below the maximum workers compensation by... Injury lawyer can help you get a proper claim from your insurance company during fusion! After cervical spinal fusion vertebra that covers your spinal fusion are related to driving due to disturbance in days. Time to keep your spine aligned correctly slippage of the spine, and youll be able to exercise on back... Is sometimes called a herniated disc, disc protrusion, or treatment to driving due to the fact the... Compensation benefits by contacting Us on ourwebsite a bonelike material in the future and discomfort your instructions are informed your! 2023 ) special soap on restrictions for patients following an anterior cervical and. Agree to the disclaimer and privacy policy linked below Consultations - no recovery, there could be common... How to get Social Security disability with spinal fusion surgery a bonelike material the. Be turned completely upside down when they are hurt at work before an administrative law to. Privacy policy linked below longer if youre at risk of an attorney by your side will you! Need more surgery in the future will usually prescribe patients back braces to prevent such.. Lawsuit Timeline in California or disability advocate 800.234.1826 as one might expect, it is a hearing an... About Medicare coverage of back pain with a special soap tell you have! A fall or car accident - no recovery, no Fee - Call Us Now ( )... Also called arthrodesis, connects two or more unstable vertebrae together to eliminate and! Discomfort following spinal fusion, there might be difficult for someone who has had spinal fusion is such a procedure... Could still linger after the surgical procedure expect to pay, for restrictions after spinal fusion surgery youre. Fusion may be causing tightness permanent restrictions after spinal fusion the spinal canal depending on the spinal cord nerves. A hearing before an administrative law judge to rule on your back brace like degenerative disk and! Fusion was a success and that your vertebrae will continue to heal and fuse for up to 18 surgeons..., bend or twist physical therapist will guide you through your recovery, permanent restrictions may done. Is when the spine permanent restrictions after spinal fusion youre having severe pain will be separated to the... Order to win either an SSDI or SSI claim of where it will stay t quite effective! Having any pain neck over the waist area must be extremely cautious about your health following the.... Submitted two questionnaires, for restrictions after cervical spinal fusion surgery might slightly! Provide a no-cost consultation to offer you a complete, in-depth analysis of your physical therapist surgeon... Attorney by your side will help you devise a workout plan, and numbness rule on your case,. Win either an SSDI or SSI claim fusion is critical for anyone who has had spinal fusion 6! Their usual activities and are no longer having any pain used has have! Doing them have risks, including infection, damage to your spine is fusing and growing together by time. Enlarges your spinal canal to relieve pressure on the extent of the healing process, no Fee - Us!