Tuesday, June 19, 2012

Keep Calm....

Keep Calm and Carry On was a poster produced by the British government in 1939 during the beginning of the Second World War, intended to raise the morale of the British public in the event of invasion. Seeing only limited distribution, it was little known. The poster was rediscovered in 2000 and has been re-issued by a number of private companies, and used as the decorative theme for a range of products. (copied from Wikipedia) 

Personally...I am typically the antithesis of what is considered "popular".  These posters from Royal British WW2 origins have seen a recent surge in pop culture and I'm sorry I just can't help it....I love them.  They're a quick, brief, to the point reminder that "hey, things could be a lot worse, so chill out!  And have a cupcake..."  And well, they're cute.  So there.  And now in further news, here's what's happening in my neck of the woods.  Hold your hats, ladies and gentlemen.  It's going to be a bumpy ride!

**I have a surgery date of July 13th with Dr. S in Atlanta.  He has taken the time and care to examine my diagnostics and consult with other hip experts throughout the country, to come to this conclusion: 

5/29/12: What I see wrong with both hips is that there is too much socket in the front of the hip (retroversion), there is a bump on the front of the femur (cam lesion), there are tears of both labrums.  That's the typical pattern for FAI, a little wrong with all the different parts.  You also have borderline dysplasia and I don't see any osteoarthritis.  There may or may not be some damage to the acetabular cartilage.  MRIs are not perfect at showing that even with the arthrogram.  The retroversion can be dealt with by rotating the entire socket (reverse PAO) or by triming away just the front part of the socket (either open or scope).  The labrum will need to be repaired either way and that is actually easier with a scope than during the PAO unless you combine it with a surgical dislocation.  The cam bump of the femur can be removed either open or with the scope.  I think some of your retroversion comes from posture.  If you have more lumbar lordosis then your pelvis is more flexed forward and then looks more retroverted.  With the CT scan you had done, we were able to upload the images and correct the tilt and rotation of your pelvis and the retroversion was very minimal.  The dysplasia was likely there from birth or shortly thereafter.  Your dysplasia is borderline and not at a point where I think you have to have corrective surgery.  Dysplasia doesn't hurt by itself.  Torn cartilage and a torn labrum cause pain.  Looking at your situation, I think the impingement is the major problem and not the dysplasia.  You probably developed the impingement morphology during growth.  Most babies have tremendous range of motion and are not born with impingement.  

**So, call me crazy...but I trust him.  Yes, we already did a hip scope which was unsuccessful, but now I'm beginning to wonder if it was the skill of the surgeon doing the scope.  Perhaps he saw all that mess in there and just didn't know what to do with it and wisely sent me on to someone who did?  Whatever the case... now we're getting somewhere!  Now I feel a REAL sense of hope, that relief is in sight...that I'll actually be able to walk normally again, without pain.  So, let's do this!  July 13th can't come fast enough!  Woohoo!!!

**In planning for the week Big Daddy and I will be in Atlanta for surgery and the subsequent weeks of recovery and intense physical therapy, we have a wonderful plan for the children, to help keep their worried minds off their Mama and have an awesome Summer!  Their grandparents are generously flying them up to Pennsylvania to stay with them for 3 weeks in July!  As much as it pains my mother's heart to think about being away from my (very grown up) babies for 3 whole weeks, I know this is the opportunity of a lifetime for them!  They'll get to see a part of our beautiful country and travel to places they're never been before!  And while I wish I could share in this experience with them, I am elated for them!!!  I am blessed with the best in-laws a girl could ever dream for...truly!  

**6/6/12:  Letter from Humana Military (a.k.a. Tricare)....
In the course of performing the authorization review on the HIP ARTHROSCOPY WITH DEBRIDEMENT OF ARTICULAR CARTILAGE SURGICAL TREATMENT, our reviewers have DENIED your request.  Our determination is based on the following: "The service is a non-covered benefit per TRICARE Policy Manual 6010.57-M, February 1, 2008, Chapter 4, Section 6.1, Musculoskeletal System (5.0)(5.10)(5.11), Issue Date: August 26, 1985, Authority: 32 CRR 199.4(c)(2) and (c)(3).  
5.10 Femoroacetabular Impingement (FAI) open surgery , surgical dislocation (CPT2 procedure codes 27140 and 27179), for the treatment of hip impingement syndrome or labral tear is unproven.
5.11 Hip arthroscopy with debridement of articular cartilage (CPT2 procedure code 29862) for the treatment of FAI is unproven.
You have the right to request a reconsideration in writing...  blah, blah, blah!

**Surgery is off.  My dear husband risks his life for this country and this is the thanks we get.  Out of date healthcare and "don't let the door hit ya on the way out!"  EVERY other health insurance provider INCLUDING Medicare (MEDICARE!!!) covers this surgery...and "stuck in the stone ages" Tricare does not.  You see when this policy was written (1985!!!) and when it was last updated (2008!!!)  I have very, very dear loving friends beating down the door of our Senator Kay Bailey Hutchinson with this news and with pleas to help, not only me, but other "hipsters" who are living with this excruciating pain like I am, with absolutely no help from Tricare in sight.  I am told by fellow hip chicks, this will be fruitless.  That since Tricare isn't exactly an "insurance company", but a government entity, that no one wants to get their hands dirty and take them on.  Yet, we press on anyways....

**And life continues to be on hold.  And pain continues to worsen, and I age years within weeks and gain weight by the minute while I starve myself to madness, and my muscles continue to waste away and my mind is filled with thoughts of just crawling into a hole and never coming out....but please throw me some Hydrocodone and ice packs and bread crumbs and water while I'm down here, thanks.  

**A tiny glimmer of hope:  I am told by a fellow "hip chick" that if the surgery is done at a military hospital, that if deemed medically necessary (well, duh!) it is covered by the military directly.  The only kicker is...hip scopes are no small deal.  And there are only about 2 or 3 surgeons in the entire military (according to her sources) that even do hip scopes!!!  And one of them is at Brooks Army Medical Center in San Antonio (practically in our backyard!).  Wait, WHAT?!  Why, WHY are we just now finding out about this???  Why doesn't Tricare disclose this up front instead of making us fight and go through the fruitless appeals process for YEARS!!!  WHY?!  Calling BAMC to get referral/appointment/donate blood/give my firstborn and hope for a surgery date before the decade is up....

**Stay Calm....and Stay Tuned!