I was at work today, minding my own business, and my cell phone rang. It was my OS' surgical scheduler. And in a peppy voice, she said "Hi, I'm calling to schedule your surgery", as nonchalantly as someone would call and ask what I would like to order for lunch. I was a little caught off guard, but managed to hold it together long enough to get this done!
So, surgery #5 is scheduled for....drum roll please....December 1, 2011
I know a lot of you are drawn to my blog because of the battles I had with United Healthcare at the time of my last surgery. I hope my blog has been helpful to you. Now I am back in the trenches with them and extremely mad. This time, it is not about my hip, but it is about reimbursement. If anyone can share some advice on this, I would be grateful.
About a month ago, I had a bad infection on my hand that required me to go see a hand surgeon. I needed to be seen right away and ended up going to someone out of network who saw me that day. I paid upfront, she did a procedure in the office, and my hand got better. United Healthcare is allowing a fraction of the amount I paid the surgeon and reimbursing me very very little. Has anyone ever dealt with this before? I have to appeal this now, but don't have as much time as I did with the last appeal since I am currently working, and not home recovering from surgery.
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So after 6 months of pain, x-rays, MRIs, injections, talk of alternative therapies and talk of crazy surgeries, I think I have found my happy medium. I spoke with my OS and this is what we decided.
First of all, he is not upset at all that I went to see OS2, he said he prob should have sent me himself.
The only reason he has suggested open surgery for me is bc he feels that after 3 failed scopes, we prob should try something different. But at the same time, the scopes were all done for different reasons. Other than having to send a young patient for a hip replacement, one of the things he really hates is unnecessary open surgery. He told me there is nothing he cannot do arthroscopically that can be done with an open surgery. I think this was one of my happier moments of the past 6 months!
He said usually, in a scope, he will use an autograft from the capsule and rectus femoris to augment the labrum. Since my capsule is already compromised he will do it with an allograft. Since my capsule has already been repaired once and failed again, he will use allograft tissue there as well, he will also use a scaffold to strengthen it (this is apparently done often in shoulder surgery).
We discussed the ligamentum teres and my wishes for a new one! He said that u don't need it unless ur capsule is compromised. My thought is if ur already scoping me, just do it. He said it is EXTREMELY experimental surgery, they still don't know a lot about the biomechanics of it, and he wouldn't know how tight to make it, and he thinks I will hate it. He said right now I am having trouble bc the ligamentum teres is torn and getting caught. Once he debrides it and fixes the capsule, I will be happy again.
I am concerned about the post-op period, since I tend to be lax with the brace and weight bearing. I asked him to put me into a very restrictive brace post-op. He said absolutely, he will have me fitted for a hip dislocation brace and have it set to slight IR, and not allow more than 30' ER for the first 6 weeks. He warned me that I will hate it!! I'd rather be miserable for 6 weeks than be back to where I am right now in another 2 years.
I asked if he's ever scoped someone's hip 4 times, he said never his own patients, other ppls screw ups yes, but never his!
So I have to let him know when I want to do this, so he can plan accordingly, get his allografts and scaffolds together!
Even though it will be my 5th surgery, I am so happy that we have found a way to do it that doesn't make me want to throw up every time I think about it!
Surprisingly, I got a call back from the second opinion doctor's office on Monday, and they were able to see me on Wednesday due to a cancellation. I was so happy but a little nervous because I was not really prepared yet. To simplify things, he will be referred to as OS2. OS2 took about 30 minutes to go over my films, re-checked all of my angles on my x-rays, and read my latest MRI. He was wonderful, I explained my long history to him. He did a clinical exam. He found that I had almost no IR and about 90' of hip flexion (I was having a really bad day yesterday). The test he did for instability was positive, but not as positive as he would like it to be. He would have liked me to have jumped off the table with that. I dont know what to think, I don't think I have "instability", I think it is "micro-instability", so I am not sure what that test should show. OS2 then suggested that it would probably be a good idea to call my OS...uh oh!!!! This was a 'top secret' appointment. I explained to him that my OS hadn't sent me, and didn't know I was here. He assured me that he wouldn't be upset, that he would actually be relieved to have help with this complicated case. I told him that what I wanted to do was hear what he thought and what he proposed, and then decide if he should call my OS. He agreed to that!
He thinks I have a loose body in the joint. He does not think that my labrum is too small at this point and he is recommending a scope to look around and try to fix things. He thinks an open dislocation is a huge deal and thinks that by trying a scope I am not burning any bridges, and if there is a possibility that I can be helped with a much smaller surgery, then he sees no reason to try it.
I decided to let him call my OS and discuss. And he did, while I waited!! They spoke for a while, and I patiently waited. When they finally got off the phone, OS2 called me into the room that he was in to discuss.
He said my OS agreed to do a scope, he wasn't too keen on the idea since it failed so many times, but OS2 pointed out that my left hip is awesome! So I should have scope potential! OS2 said that he still doesn't think my labrum is too small or should be causing me issues, but my OS fought him on that and said he has been in my hip 3 times and knows what it looks like and it is definitely too small. So he will put in an allograft to create a new labrum, re-repair the capsule, and...here is the kicker....they will do it together!!! OMG...I was laughing so hard, but I was so happy. I've never been happier being told I need surgery, but a scope vs open.....I am thrilled!!!
I definitely owe everyone a quick summary of what has been going on lately with my hip, but today is my 10th wedding anniversary, and all I can think of is that I have been dealing with my hip for half of my married life. It is making me very depressed.
To quickly summarize what has been going on, my OS really would like to avoid operating on me, for the 5th time. I can't blame him! So he is proposing we try something called ARP wave therapy. No one really can tell me what it is, other than a certain type of electrical stimulation. No one really knows if it will work but it can't hurt, so why not. I will hopefully know more about it in the next week.
In the meantime, I have decided to get a second opinion from another surgeon, an unbiased, no baggage, black and white, second opinion. I think that my OS and I have too much history for either of us to make the right decision at this point. If in the end I do need surgery, I will probably go with my OS, but I would like someone else to look at my films and tell me what they think. Someone who doesn't know me, and frankly, doesn't care if I have more surgery or not. The appointment is not set up yet, I left a message for his office staff.
In the meantime, I go through good days and bad days, and of course, this makes the process so much more difficult. If I always had good days, well, you wouldn't be reading about this. If I only had bad days, I wouldn't question anything. Its the good and bad that make me doubt everything, make me question everything, and quite frankly, are driving me crazy. There is no rhyme or reason at times either as to why I feel the way I do. I wore heels for a few hours yesterday without a bit of pain. I can actually usually wear heels and my hip doesn't hurt. It does feel awful in the sense that I don't walk well with them, I feel unstable, and my feet hurt!! I actually often have a sense of instability in my right hip, I try to avoid extending it fully when I walk by doing a strange rotation thing with my pelvis. Very strange!!
So the waiting game continues. I am waiting to hear more about the ARP wave, waiting to see if it works, waiting to get an appointment from my second opinion, and waiting to see if this will all go away, just as quickly as it came on!!!