Matt is Mean ... but he's doing it for my own good

Matt is not maliciously mean, it's just that PT with him is hard! Today he had me doing Plank push-ups - making me an absolute liar in even thinking my core was strong. I was very sorry I didn't take a pain pill before I went to PT.

I don't know what all I did Friday, but both my knees were incredibly sore on Saturday, and even today I am alternating icing them (the Game Ready went back this weekend).

Matt also wanted to extend my PT to twice a week for the next 3 weeks, as opposed to three times a week for the next 2 weeks. (My insurance has set a use by date of February 4th). The insurance coordinator at my PT center said no, but when I got home and called my insurance they said it would be possible if the PT center submits a letter (Either my insurance has a bunch of Johanna's in their call center or I got the same woman from last week). In the meantime, I am keeping my three a week schedule until I have a better answer.

It's the nonsense like this that gets to me. If my insurance has agreed to pay for ten sessions, what the heck does it matter if I use them twice a week or three times a week. Especially, if my therapist is saying that he wants to spread them out so I am good and ready for my next photo trip. I was told, in passing today, that my insurance originally denied any more sessions, something I probably should have been told. I guess the letter from Dr. Williams helped change their minds.

Perhaps members of the legislature should have to price out and pay for their own health insurance and then they would get their butts in gear and finalize a decent health care plan! (Of course, a large percentage of them would simply go on Medicare.)

Stuck In the Middle at 115 degrees

I reached 115 degrees today, I might have gotten a tad further (my goal for the day was 118) but the table was in my way. Yesterday I was able to climb and descend a flight of stairs using both knees. I still have more muscle strengthening, but I am definitely starting to feel there is light at the end of the tunnel. And in 5 months I can get the screws removed.

The only annoyance is the continued problem with swelling. I finished my anti-inflammatory prescription Monday and I today my left ankle and calf is noticeably more swollen then my right. Now that I can finally start trying heels again I don't want swollen ankles! I have already decided that I should wear (or at least bring and put on when I get there) a pair of my highest stilettos to my next Dr. Williams appointment.

As for the CPM confusion, I spoke to Johanna (sp?) at my insurance yesterday and discovered being a bit graphic can be helpful. She reiterated what the medical supply company said, that the approval letter had been sent by mistake. My insurance only covers CPM machines for total knee replacements and manipulations. This is where I got a bit graphic and said that I had a dead persons body part attached to my knee and felt that should make me eligible for the CPM. I made her a bit squeamish with the dead person reference and she slipped from the official line and agreed with me. She did tell me that because the surgical supply company is in the insurance provider network they are not allowed to bill me, even though my insurance is still denying the claim and that it is up to the supply company to argue the denial. I see this dragging on for a while with me getting pulled around a bit.

Celebration and Frustration

I take back every "not entirely their fault" thoughts I've had about insurance companies since my PT charged my insurance for doing nothing but icing my knee. I got a call today from the people who provided my CPM machine telling me that my insurance is refusing to pay for my first CPM rental because they mistakenly sent me the authorization letter approving it. Admittedly I did get letters both authorizing and denying the CPM machine (dated the same day), but the denial letter did not say the authorization letter was a mistake and at no point (until today) was the medical supply company told by my insurance company that the approval letter was an error. In fact I faxed a copy of the approval letter to the supply company and was told they spoke to my insurance company about it.

So now I'm being told it's not being covered, that I need to go have a fight with my insurance company and I may be stuck with the $175/week rental fees. (That loud noise you just heard was me screaming in frustration.)

On the plus side, I was able to bend on the wall to 113 degrees yesterday. And I got a new exercise involving a rubber ball between my legs that actually had me sweating and made my muscles a bit sore today. Add to that the shocking news (especially considering the previous paragraphs) that my insurance approved 10 PT sessions, and I may be done with PT the first week in February.

I’m walking normally most of the time – did you know you needed 100 degrees of mobility to walk normally? – and have even started being able to do stairs, I’m slow and still throwing my hip a bit. Finally, my knee isn’t tightening up the way it was when I’m walking around.

There was a woman in PT yesterday who had replacement surgery a month ago and was practically screaming in pain as her therapist tried to bend her. I remember that, but as I get better it feels a long time ago. I guess that’s the body’s coping mechanism (otherwise women would never have more than one child via natural childbirth).

I guess I no longer have any excuses for organizing my apartment and getting my life back. I don’t think I will feel truly healed until I can go out with my cameras and not have to worry I won’t get the shot.

For now, it’s back to trying to reach someone competent at my insurance company.

Go knee

Swelling is down some and I was able to bend pretty well at PT today. It was my last session with Dina as she is going on maternity leave and I am really hoping I am done by the time she comes back in three months.

I undoubtedly walked a bit more then Melissa would have liked, but I was able to bend my knee while doing it, though I am still throwing my hip a bit. While I know what I have to do to get better, I can't completely give up my life or I lose half the purpose in getting better. And I hooked up to the Game Ready as soon as I got home.

The fun part of my day involved confusion with my insurance. Here's a conundrum for you that I'm not sure I will ever fully understand. When I got to PT I was told I had no more authorized sessions. I have been diligent in keeping track and knew this was supposed to be the final session from my last approval. But here's the rub, if I get an authorization for four sessions, but my re-evaluation is done during my third session and the insurance approves another group of sessions before I have actually had the fourth session from the first authorization, I lose that session. So, if my new authorization is for four more sessions, instead of having eight sessions, I get seven.

Is this some sort of new math? How do I lose a PT session because I have been approved for more PT? My brain hurts from trying to find the logic in this. And we don't need health care reform?!

A Long Day in the ER

I wanted to talk about happy news today like the fact that I got a letter from Oxford, my insurance, yesterday stating that they had approved payment for my CPM machine, but even that was taken from me as today's mail brought a letter from Oxford dated the same day as the first, with the same reference number denying coverage for my CPM machine. And of course it is almost 5pm so the office is closed for the day. I don;t know if they will be open Sunday, or if this will have to wait until after the holiday weekend. And that just adds to my already long, crappy day.

I woke up around 5am uncomfortable from staying in one position all night and tried to get more comfortable and doze. Gave up on that around 6:30am, got up and had breakfast. While sitting on the couch I looked down and noticed that my left calf, ankle and foot were very swollen and a bit red. They had not been like this when I had my shower yesterday. The calf was sore, but I couldn't tell how much of that was after-effects of the surgery, the brace or the CPM machine versus something new. Around 7:45am I finally decided to call my surgeon's service. It took 3 calls of 5 to 10 minutes of sitting on classical hold music before I even got the service to answer the phone. I left a message and then after waiting some more called my wonderful neighbor and nurse, Lori (you may remember she supervised my nervous first bandage change). She came over and decided that I probably didn't have a blood clot, but wanted to take me to the ER anyway. After some hemming and hawing I finally agreed, so off we went to Methodist Hospital.

She dropped me off just before 9:00am at the side door closest to the ER entrance - which was locked, meaning I had to walk down the block to the main entrance and then walk the lobby, that can best be described as a perfect skate park, back to the ER. I was exhausted by the time I finally signed in. (Note to Methodist - if you want to keep that side door lock for security reasons set up a camera and a buzzer so that the ER receptionist can let people in!)

I saw the Triage Nurse around 9:30am. Told her my concerns, lifted my left sweatpants leg to show her the swelling, got an elevated blood pressure, but no temperature and went back to the low, uncomfortable chairs in the waiting room. Called into the ER around 11:45am. Another long hallway to get to my cubicle. Before I even saw a Doctor an Orderly came by to take me for a Doppler. I learned later it is the new procedure that someone - I guess the Triage Nurse can order tests so that when you see the doctor they have a better picture of your condition. (I'm guessing it will be the new thing Insurance Companies fight about.)

So just after 12:00pm I was up in Ultrasound and getting a Doppler scan on my left leg. One thing to be happy about today - no clot. Back in the ER by 12:30pm and the Resident, Dr. Hawkins, came to tell me that sometimes Doppler doesn't find the clot (enough, no clot makes Erika happy). She agreed my right calf and foot are colder to the touch then my right, but I have a pulse in my foot and could she look at my incision. She went to get more gauze and wrapping while I took off the brace and dressing. She seemed surprised that I was not expecting her to do everything for me. There was a red spot on the outside of my knee, I guess where the new ligament is located. It was hot to the touch - the only spot on my knee that was warm. She decided to have her Attending take a look at it.

At 1:54 pm (I had figured out where the tv remote was hidden and changed the channel from college football to CNN) the Attending arrived and decided that I may have an infection and gave me two prescriptions for antibiotics and sent me home.

When I got home there was a call on my answering machine from the Doctor covering for my Surgeon this weekend. He had been in rounds and finally called me back at 10:34. I had him paged. He didn't respond, so I called the service again - this time they answered. He called me back within 10 minutes.

He was happy I had had the Doppler, but was not happy the ER hadn't taken blood. He didn't think I had an infection and told me not to take the antibiotics, but to call again tomorrow if it was still red and hot.

So basically it was a very long day. I do have to say "thank you" to Lori for coming over and taking me to the hospital and Jan for coming to pick me up. My only request is that you consider lower riding SUV's for your next vehicles!

Frustration

Four days to surgery. I should find out today what time I have to be at the hospital on Monday.

Right now my frustration level is higher then my fear factor. Dr. Williams better be an amazing surgeon to make up for the problems with his office staff. It took 3 phone calls to just get someone to return my call and actually schedule the surgery. Then, despite telling me I would receive an e-mail with the list of blood tests and such I needed from my Primary, I had to call the office from my doctor's office to have them fax the needed tests. I finally do get an e-mail requesting other information and when I respond to that and mention that Dr. Williams wanted me to have an MRI so he could access any cartilage damage I never heard back - and that was a week ago.

Yesterday I got a call from a medical supply place saying that my insurance was denying coverage for one of the post-op equipment (a continuous passive motion machine) because I was not having a full knee replacement. So I called my insurance, who stated they needed a letter from my surgeon stating my need for it. Called the doctors office - explained the problem, was told I would get a call back that afternoon for more information. No call. Did I mention it is Friday and my surgery is Monday?

I suspect were I one of his pro-athlete clients I would be getting a better response from his staff. Believe it or not, I don't actually enjoy being a nag and I am sure he has other patients, but still.


I had a major internal debate when I started this blog on if I would list my surgeons name and the facilities where I was having surgery and physical therapy. I'm still not sure, but I will say if you are having surgery with him and you are not a celebrity or pro athlete be prepared to be frustrated with his office personnel.