Thursday, January 31, 2008

A New Culprit

SARTORIUS!!!!!!!!!!!!!!! I waltzed into PT yesterday 40 minutes late and begged P to take me! He did luckily bc the tightness is making me insane. I aksed him to figure out something new, tear some tissue, break scar tissue, jump on my leg, surgically release it.......I was desperate and annoyed! After he calmed me down, he got to work. He palpated sartorius on each side and found it was more prominent on the right, more tight and more tender. Aha! So off he went to ART it and do his magic. He also continued with the PA mobs in prone with some ER followed by a serious hip flexor stretch with a dose of contract-relax. I felt amamzing when I finally had to get up and see patients. Best I have felt in a while!

Unfortunately, I worked a REALLY long day yesterday to cover someones vacation, and I am working today to cover as well, so after 8 hours straight on my feet, I was in pain and (gasp) limping a little. I am better this morning and getting ready for another long day in the office.

Interestingly, as P was working, he was feeling around my scope sites on my 'tender' area and it has become a little bit numb. Par for the course I guess. It still burns at times as well, and I keep forgetting to try the Lidocaine patches. Lets see if today I can remember!

Tuesday, January 29, 2008

Thank You To the Wonderful People in My Billing Department

I just received this letter in the mail:

Informational copy only. Original letter addressed to MSPT (my office)
Dear Billing Department:

We're responding to your 011708 inquiry about our processing Susie on 12/26/07.
We determined that we processed this claim accurately and no further payment is due. The reason (s) is listed at the bottom of this letter.

Network physicians/ other health care professionals/ facilities: Please refer to your administrative guide for further review options.
Non network physicians: Please refer to the PRA for any review rights that may be available to you.

If you have questions about this letter please call customer care.

Under the plan, notification was required but not received. Therefore, we have declined payment for the service because requirements of the plan were not met.

Let me explain the absurdity of this. First of all, I have been in PT for 10 months now (and counting). My plan only allows for 30 PT visits/ year, in or out of network. My office is in network, but my therapist is out of network (it is a big game we play with the insurance companies). To access my in-network benefits, authorization is needed by an outsourced PT company who will read P's notes and 'approve' x number of visits. Then he requests more, and it becomes a pile up of paperwork and a losing battle with the insurance company. I have out of network benefits too. These do not require authorization (i.e prior notification), and get billed at a higher rate and paid at a higher rate. So the billing department has been billing out of network. It is great for everyone. I get my deductible taken care of (they obviously don't charge me), P has no paperwork, and the office gets paid more. These out of network visits are also capped at 30, but no one seemed to notice, or someone in the billing department appealed them...who knows. All I know is that PT has been paid for, very well I might add, for the last 10 months. And I have definitely exceeded 30 visits (I think I exceeded 30 visits with one surgery alone! Dr.Kelly's PT protocol is for 1x/week x 1st month, 2x/week 2nd month, 3x/week 3rd month) At some point in time, it became more difficult to bill out of network so the billing people started billing in network. They have done so for a while, and now, United Healthcare realized there was no authorization. Oops!
I keep forgetting to count the total # of visits I have had, it is scary though! I have an appintment tomorrow that I am keeping!

I am finally feeling less tight in the capsule. Ironically, I have not been on my bike since Thursday bc of all the family outings. Tonight I am finally in bed, alone, and ready to sleep ALOT!

Sunday, January 27, 2008

Thank Goodness Tomorrow is Monday

I think this has been the longest weekend of my life. Let me explain.....My parents have had a trip planned to NY for a while, they were going to stay with us and my aunt and uncle decided to tag along too to see the kiddies. As luck would have it, my sister in law gave birth to twins this week, which has turned things completely upside down. See, Jewish people don't just have babies, they have babies then have parties and celebrations galore. So to join in the celebration, J's older sister plus hubby and 3 kids came to NY....and stayed with us. My parents ended up at a hotel. I hosted Friday night dinner and Saturday lunch here for 11. Plus a Tupperware party tonight (planned ages ago). So.....after cooking, serving, cleaning, dealing with family 'politics' and wearing heels ALOT, I think I am ready to cut off my right leg. We are having a huge issue bc it does not like when I wear heels, and, well, at this point, I am soooooo wearing heels. We are 2 1/2 months out from my revision scope, this is ridiculous. Even my ITB is screaming at me today, pleading with me to retire my high heeled boots (they are so cute, with a little flower on the side!)

Friday night, I wore wedges to the baby party. I had so much pain, I wanted to cry. I left the party early, using the excuse that Jk had to go to bed, and was fine in the AM. But I really had groin pain, I don't think it was like pre-op pain, more adductors, psoas pain and of course capsule pain too. Saturday, I wore those shoes again, hell is all I can think to describe the state of my hip. Today I donned the cute boots, hell, changed into Uggs for an outing to the zoo, better, but not great, and then high heeled boots again for my party! I am in bed with so much soreness now, not so much pain anymore, but soreness. Adductors, ITB, TFL, all a mess.

To add to the fun and excitement, my numb/tender areas are burning again. If I can get it together enough, I will try a lidocaine patch tomorrow for work. But I am so tired, I dont know if I will remember! As I type, my eyes are closing....so, you get the picture, I overdid it this weekend in a housewife type of way!

Thursday, January 24, 2008

Iceskating, Cold weather and the Expected Aftermath

We all ice skated yesterday. Amy gave L a 'lesson', although L was more interested in seeing the ice on her mitten after each fall, and Jk dragged me around the ice on his miniature ice skates! A good time was had my all (except Amy's ankle and my IT band).

Truth be told, my hip held up amazingly well, I had the tender spot issues last night and of course the capsule tightened up again. It also clicks, did I ever mention that? Not snapping or popping, but clicking, but not like the labral tear clicking. Scar tissue maybe? Who knows?

Very interesting (and quite painful actually)- I went out this afternoon to pick up L from school and right as I got into the cold, my joint tightened up and became painful. It did loosen as I continued to walk, but it was so weird that it just tightened like that.

At this point, my only issues seem to be the joint capsule tightening issue and the nerve damage/ tender area issue. It is a fair trade-off for being able to have my life back!

Tuesday, January 22, 2008

As Tight as a.....

I can't think of a simile, but my hip is TIGHT. As I was riding tonight, I got into some standing sprints for the first time, but it felt as if there was a cord wrapping tighter and tighter around around my hip with each revolution, until I couldn't take it anymore. I kept saying to myself, 'it is not your problem, P will deal with it tomorrow...' but hell no, it is my problem now! Especially since Jk is asleep and I have no one to sit on my leg and stretch me!

Interestingly, I had a pretty shitty day on Sunday and Monday. Ironically, those 2 days were really really cold, the kind of days where you don't want to go outside unless absolutely necessary, the days where you drive down a street in Manhattan and there are no people on the sidewalk. Why is the cold bothering me so much???? I was between Tylenol and Darvocet, I was going to start with Tylenol and then take a Darvocet if it didn't help but it must have bc I never went for the stronger stuff!

I am going ice skating again tomorrow with hipster Amy, who has been banned from the ice by Dr. Kelly, but L really wants to learn how to skate! I am more nervous about freezing my ass off than breaking something since we are going to the Wollman Rink in Central Park, the indoor rinks are closed tomorrow or don't have public hours, I already started packing a bag with extra socks and sweaters! You can take the girl out of Miami, but you can't take Miami out the girl (did I ever mention I was from Miami, and have been 'stuck' in NY since college???)

On a positive note, I think I had the best ride tonight since my revision scope! YAY!!!
Just curious....should I still call scope#1 a 'failed hip arthroscopy' or 'part 1 of the job for my right hip'!
Also, I think I have to change my profile since I mention the 'twisting/popping' incident and really, it has nothing to do with anything, other than sending everyone down the wrong path on the ever so fun investigation of 'why does my hip hurt AFTER my arthroscopy?"
(I have to stop exercising at night, I have way too much energy)

Saturday, January 19, 2008

The Importance of PT (blah blah blah)

I returned to PT, again. I am going to stop being such a hotshot and STOP dropping out. I even made another appointment for Wednesday. See, I am having some joint capsule issues, yes, after hip arthroscopy, even 9 weeks later (or am I at 10....I have lost track) you can still have these ridiculous issues. It is a joke at this point, I am fixed, yet still having issues.

My capsule is so tight, P did work hard (thanks P) and is surprised at how tight I get. The mobility within the joint is poor (not my ROM, but the joint accessory motion), I am stiff. Since we are having so much fun already, m gait becomes stiff and I begin to lose extension, again. So I walk slightly 'off', and now my back hurts AHHHHHHHHH.

Luckily, it is stiffness in my back, and luckily, the people I work with are amazing and can quickly help me. Interestingly, the pain travels along my vertebrae. Yesterday, I pointed to where it hurt and P said it was L3-4. He did a manipulation on it, and it was better. Then my thoracic spine hurt, so I recruited another PT (I was too embarrassed to tell P something else hurt) so he manipulated my T-spine. I think every vertebrae 'popped' with one quick manip! When I got home, my lumbar spine hurt again and I really needed to 'crack it'. Clearly, J is not skilled or trained in this, so I have been doing this twisty rotation thing hoping to elicit a pop, I have not been all that successful.I did go on my foam roller for a while and it helped, but I need some PT too!

Back pain is worse than hip pain bc I can find few positions that alleviate it, other than lying on my stomach with a pillow under me.
And the fun continues! When will this end?
I do plan on ice skating this week though, back pain or no back pain.I had grand plans to go rock climbing this weekend but the gym I chose is closed for a competition, so it will have to wait! But I am so excited to do it again!!

Thursday, January 17, 2008

I am in Adductor Hell

Poor P, he just doesn't get it. He is going to be shocked tomorrow at how things have deteriorated in the 'PT addressable area' tomorrow (as opposed to the 'surgeon addressable area'). My muscles and joint capsule are so tight, it hurts so much. I contemplated taking a Darvocet today the adductor was so bad. I ended up lying on the floor in a FABER position and having Jk sit on my knee to stretch it out. I want it to 'pop', or something, I think I am developing scar tissue in there and it is contributing to my problem. So it has been a rough day!

To top things off, I took the kids to CVS, which for some reason unbeknown to me, makes them wild. So we finally got out of there in one piece and Jk needed a diaper change. It was snowing and cold, but we had no choice. So I started doing it in the passenger seat of my car, but then realized I ran out of wipes. "Shit', I said. To which L replied 'Mommy, that is not a nice word.'

Someone actually asked me today if I can 'feel the cold' in my hips. I am not sure if any of this is weather related. I like to think it is not, since I reserve thatfor 90 year old little old ladies with arthritic hips (so I fit 50% of that description). Hmmmmmm, maybe I can!

Everyone is in bed, I am also getting ready to get in bed soon and watch Gossip Girl on Tivo.

An Update to Last Night's Post

My adductor is in a knot, causing me to believe I am having joint pain. Due to the close proximity of the insertion of the adductors, I have been on the verge of losing it (again). Luckily, I decided to stretch last night, and low and behold, adductor was the culprit. It REALLY hurts though, to the point that I am considering a Darvocet to get through today, until I see P tomorrow and he can 'make nice' with my adductor!
*********My Joint is fine**************

Wednesday, January 16, 2008

Just To Keep everyone on the Edge of Their Seats...

My hip hurts. I am pretty sure the muscles are acting up, but I am f___ing annoyed. See, we are past this. It is like a relationship, we should be done with the awkward, getting to know you part, and be on to the 'romantic walks on the beach', or rock climbing and spinning together. I have yet to 'poke around' the area to figure it out. Yes, instead of sitting my lazy butt in front of the computer, I should be stretching, but I had such a great ride tonight I want to relax a little.

Maybe it is wishful thinking (I am rambling again...I know), but before the FAI was bulldozed out, I could literally take my index finger and point to where the pain was. This pain is readily identified with the entire pinky side of my hand, from the tip of my finger to my wrist, right in the joint crease.

Also, pesky adductor is acting up again. I need to get off of the computer and stretch....I did make an appointment to see P on Friday morning, which means I am, once again, not a PT dropout. Lets keep me at PT PRN status. I actually received a prescription from a doctor today which said PT at 'my discretion'! So I am doing the same....but for myself.

I play this game called 'what if I was my own patient', to see how I would handle this muscle issue. Firstly, I would not approve of rock climbing or ice skating yet. Maybe spinning, but low-level. Definitely not what I have been doing some nights, like tonight. Did I mention I hurt more now that I am off of the bike than I did before I got on? Oops, I left out some important details. I also had a crazy day at work plus I cooked dinner for 2 other families tonight. Ok, so maybe I don't practice what I would otherwise preach. But this hip shit is getting really old.

Rough Day in Hipville

L was off of school today for some teacher preparation/total BS day. So I decided to be super mom. I took both kids to an indoor nature center. They had fun, petting snakes, chinchillas and ferrets. Since things were going so well, we headed to the supermarket, where they both decided to have meltdowns, until cookies magically appeared. Since the cookies calmed them down, I decided to push my luck and headed to a craft store.

Let me backtrack on the craft thing. I am not crafty, at all. I felt so out of place in the craft store, like I needed a few more piercings and Birkenstocks. For the longest time, I have wanted to try a project. It is called BeautiFill. I have an empty bowl with compartments, and you are supposed to fill it. Hard to visualize so I have included pictures. (see below) I decided to fill the bowl with silk flowers, it looks great! The kids were a disaster in the store. They were exhausted and weren't letting me put my things int he cart, crying for stickers, books, candy.....you get the picture. Luckily, we made it out alive, with a few dirty looks from complete strangers, and safely into the car. They both fell asleep in the car!



I left them at home and proceeded to Target (where else), where things began to go achey...again. I even thought about calling P to squeeze me in tomorrow, but being that it is 1AM and I am on the computer, no where near ready for bed, I am glad I did not, I would never get out of bed that early. I am not 100% sure what is going on, and have been pretty busy so haven't been able to sort it out. I think it may be psoas (I hope it is psoas) as opposed to some joint crap. I am no where near ready to deal with any thing possibly going downhill in the joint. Maybe 30 years from now when I begin thinking about my THR or resurfacing, but this better not be an indication that it may be sooner. Obviously, I am sure the FAI has been wiped out. But there is always the fear that the cartilage damage has continued, or that scar tissue is running rampant in there. Or maybe I need to take a step back and say 'Chill Out!' I am only 9 weeks out, there are ups and downs, and this is just a down. It happens. I have had much worse 'downs' in the past. Don't freak out. Clearly the FAI is gone and that is the most important thing. Maybe I do need to haul my a$$ back to PT like a good, compliant patient and stop rock climbing on my off days!

My evening did end on a funny/ embarassing note though! L is into the Cha Cha Slide. The singer goes through a verse where he says 'funky funky funky funky'. We were getting pizza for dinner and L started singing the song, but she leaves out the 'N' in funky, boy was I embarrassed.

L has some new bones she knows, to date she knows: Scapula, humerus, radius, ulna, phalanges, clavicle, sternum, ribs, femur, patella, tibia, fibula, calcaneus, phalanges. Plus Gluteus maximus and hamstrings. Now, when I ask her if she knows what a hip looks like, she does that classic fist with one hand, other hand over it, then she takes the cupped hand and says 'this is the acetabulum'. She is a genius!





Monday, January 14, 2008

Rain, Rain Go Away

I woke up early this morning, anticipating 6 inches of snow, so I had to give myself plenty of time to dig out my car and make it to work. I woke up to rain. Yuck. But better than snow! It rained all day, it was a dreary, cold, January day in New York. The weather made my hip feel achey. Like an old lady. I could 'feel the rain'.

I was hoping for a snow day, the office would have been slow, yesterday we all took a continuing education course, so a slow day would have been great for practicing! But what I got was a rainy, achey day.

Being that I was at my office yesterday, and P was there too, I took advantage and had him mob my hip. I have been getting tight again, the same joint capsule, stiffy feeling. Not the clamping down feeling, more like tight and stiff. So he worked his magic and I was happy. I don't think that counts as 'PT', so I am putting myself back into dropout status.

My tender area near the top of my thigh, around my scope sites miraculously got better the day I picked up the Lidocaine patches. It is not 100%, but it has gotten better. I have been having some burning too, in the tender area as well as directly above my knee, where I was numb immediately post-op. I have not tried the patches yet.

To add to all of this fun, I think I am entering into a Crohn's flare-up. I have upped my meds and will self treat for the time being! I had a feeling it was coming, I have been exhausted the past few days and wasn't too sure why. Now I know!

Maybe we will have a snow day later in the week and can practice our new techniques. I finished a continuing education course yesterday and signed up for a new one in April. I think I will be going alone though. It will be difficult to go with no friends, especially since I am always embarrassed at all of my postural 'dysfunctions'! Yesterday, I was having trouble with my hand placement for a technique, so the instructor came over to help me and asked if I could pronate my wrist more, since it looked like I wasn't fully pronated....Nope...I am tight all over!!!! Oh well, I still 'got it', and now officially work for the best PT practice in my area, as voted so by the residents!!!

Saturday, January 12, 2008

The Cost of Hip Arthroscopy and its Associated Procedures

Amount Billed Vs. Amount Paid by my Insurance Company

Surgery #1
X-Rays $206 $35
MRI $1984 $1614
Intra-articular Injection $1545 $1329
Hip Brace $1100 $684
Surgery $25600 $2268
Anesthesia $2015 $2015
Hospital Bill $15677 $6642


Surgery #2
X-Rays $297 $36
MRI/ Injection (bundled fee since it was done in one day) $3538 $3044
Hip Brace $1100 $684
Surgery $31700 $2831
Anesthesia $2635 $2635
Hospital Bill $18582 $12192


Surgery #3
MRI $1997 $1776
Intra-articular injection $867 $340
CT Scan $467 $467
Psoas Injection $321 $181
Surgery $23100 $1991
Anesthesia $2170 $2170
Hospital Bill $16210 $7849


Many Thanks to United Healthcare for footing the bill, leaving me with no out of pocket fees other than a few co-pays for office visits (not included in this list) and not requiring authorization for any test or procedure. Also, many thanks to J's company for providing this fabulous health insurance!

*Not included in this list are radiologist fees for reading each scan and scans associated with injections and surgeries, office visits, lab fees, cost of the gameready and CPM, plane tickets purchased by my mom, change of fare fees made by mom when extending her stay, co-pays for many, many narcotics, Millennial crutches, lost wages at work, parking garage fees in Manhattan!! (tack on $50/ surgery and a little bit less for office visits!!)

Added on 11/1/10
After successfully fighting and winning my appeal, here is what was billed and paid for in surgery #4

Surgery #4
Billed vs Paid
Hip MRI $2197 $1887
Intra articular injection (cortisone)$1064 $268
Capsule Injection (PRP) $1034 $449
Synvisc One $884 $692
Intra articular injection (Synvisc One) $1064 $298
CT Scan $835 $835
Surgeon's Fee # 4* $19600 $6750
Hospital Fees # 4 $19831 $8533
Anesthesia #4 $2864 $2857
Post-op MRI $2310 $1898


*After appealing to UHC since this procedure was initially denied

A list of ICD-9 and CPT codes used for my surgeries

Thursday, January 10, 2008

Landsickness

No, I am not being facetious. I have friggin' land sickness. I have been off of the boat since Monday morning yet my body feels like I am rocking. Clearly, it is all in head, or brain, or ears...or something! I have discovered these acupressure sea bands that seem to be helping, but I have to always wear long sleeves to cover them up for fear of looking like a bigger lunatic than I already am!

The cruise was great, rock climbing was incredible. It was definitely a personal achievement, not bc I need to climb walls to feel accomplished, but my hip can handle it, which makes me feel awesome! Kudos to P and Dr. Kelly for making it happen!

At this point, things are great. I can feel like there is 'something' in my hips, the left one (6 months out) feels more 'confident' when I walk, run, ride....The right still has occasional adductor issues. Time will heal!

I am in limbo with PT! The day I left for the cruise was the same day as I had the horrible capsule issues after scope #2 (7 weeks, 5 days). That day, the joint capsule started tightening. Shit, I thought, its happening again. But I tried to stretch it as often and discreetly as possible (in the airport and on the plane) and warded off an attack by my angry joint capsule. I did take Darvocet that day, just to be sure I wouldn't have issues. I didn't take any again bc I was on vacation, without the kids, so drinking was a must :-) I even went off of my antibiotics for the weekend (I know, me being smart again).

I saw P on Wed., we focused mostly on joint mobs for the capsule, we are definitely being preventative on this. I have no appointments set up for the future right now. We will play it by ear. I have not been on my bike since returning due to my dizziness issue, which sucks, although I think it is better than nausea bc I can function for the most part, and I am not throwing up (knock on wood). If by Sat. I still feel dizzy, I will ride anyway. My goal for 2008 is not to see doctors...dizziness included!

When I first began my 'hipscope research', there were so few success stories. I am proud to be a success story x 2!
p
Stay tuned.....The Cost of Hip Arthorscopy....coming the next time I post!

Monday, January 7, 2008

Thursday, January 3, 2008

I am No Longer a Drop-Out, I am a 'Crawler Backer'

Today is the one year anniversary of my first appointment with Dr. Kelly. Who would have thought that after a long argument with his receptionist 13 months ago, who almost refused to give me an appointment because my injury was not 'sports related', that I would be recovering from not 1, not 2, but 3 surgeries...all done by him. I told you so!!!!

I have been busy the past few days, J and I are going away for the weekend, without the kids. We are going on a weekend cruise to the Bahamas, and my in-laws are watching L and Jk. I have been furiously cleaning up he apartment, not cleaning cleaning, but putting things away.Like all of my maternity clothes which were stacked on our treadmill, someone wanted to borrow 1 shirt, so I had to pull all of it out, and then repack it. The desk is a mess, , my Spinning Bike is in the way.......basically make it look like I didn't have surgery 7 weeks ago and my nanny is really not on vacation!

I had to return to PT. To add insult to injury, P said 'I knew you would be back...it was only a matter of time.' I think I am hitting my 7-8 week dip.This has happened in the past, I regress for a while but eventually do come back.I have been having a lot of muscular pain, mostly adductors and TFL, maybe some psoas and occasional piriformis spasms (nice). My anterior capsule is also pretty tight, this is why I developed a limp a few days ago, I have lost extension, yet again. Since this was a sudden decision, I had to go in today, on a day I don't normally work. Even though P really mobed the heck out of it, I am tight. He also worked my psoas, iliacus, adductors and stretched my hip flexors. I am typing in bed, and just took half of a Darvocet to take the edge off. Just a reminder...the last time I took a painkiller was post-op Day 2. I am not a happy camper...plus I have to begin (and finish) packing for my trip.

I received a call form one of Dr.Kelly's people yesterday, I was supposed to call them at 6 weeks post-op to report on my progress. We discussed the tenderness issue, and she said it sounded like a 'nerve thing'. She said they don't write for Lidocaine patches, but she will discuss it with him.I told her that he had said that if the nerve issues got bad, he could give me Lyrica...which I DON'T want. She admitted that she doesn't think it works anyway!!! I am waiting to hear back...no call today though...surprise surprise!!!

I am a little bit nervous since I am exactly where I was after scope #2 when the post-op pain got really really bad. Hopefully this won't happen...but I am taking Darvocet on the cruise!

Tuesday, January 1, 2008

Joy rides Are Not Always followed by Joy

I am dealing with the aftermath of last night's ride. It clearly exacerbated my thigh pain thing. Plus, I was/ am pretty tight today. I am actually considering crawling back to PT!! We had a busy day today, since all the malls and stores were open, we went shopping. By the time we got to Target (store #3, after the mall), I was limping. I was not really in pain, but my gait was funky. I am skipping my bike tonight since I am not sure what tomorrow will bring and will reassess tomorrow!