Doctors can make the most challenging patients, part deux

 I wrote about my recent soccer injury debacle and the nature of sprains, strains and fractures. You can read about that here. And so, after quite a “to do,” I was finally scheduled for reconstructive surgery the next Tuesday. 

This has been a very humbling experience. I tried to go through traditional routes for treatment, for my ACL reconstruction. But it seems that so many people need medical help now that there are long delays for appointments even in major metropolitan areas. (As my intro to Econ professor would say, “It’s about supply and demand!”) 

Long delays

I originally faced a delay of weeks for an appointment to review my MRI. Luckily I did get an MRI within two weeks of my injury! This seemed like an eternity though. I am eager to get back to my normal activities. I’d rather be going through the brunt of my 6-9 month recovery during the cold winter months than in the spring or summer when I would long to be outside biking, hiking or running. Following the wise advice of my partner who recommended that I give myself the same advice I would my best friend, I took advantage of the network of eager friends and colleagues who offered help.  

What I discovered is that with polite persistence, almost anything is possible. Random strangers on my flight home from the soccer tournament saw me on crutches and helped with my luggage. They helped with icing AND recommended a fellow teammate who was an orthopedic surgeon for my surgery. I asked former co-workers if they were familiar with this orthopedist’s work. It turns out he provides care for a professional sports team! Initially I thought, “Yeesh, this guy will be too busy dealing with multi-millionaire players to have the time or energy to manage a physician, mother of four who plays recreational league soccer.”  But I called the office. Initially their schedule was full. But this time I asked if I could be put on the “waitlist.”  Within one hour of my original call, I got a call back with an appointment in 2 days!  Persistent daily review of insurance preauthorization steps, multiple phone calls, emails and an extremely optimized treatment team had me on the surgery schedule right before the Super Bowl!  

 

Short-sighted insurance

Side note: It is strange what insurance will decide to cover and not cover. In my humble opinion, our current healthcare system is set for “quick fixes” for broken things with maximal interventions, yet does not appear to look at prevention, nor longer term solutions with the same eye. I had to pay an additional out-of-pocket expense to rent a continuous passive motion (CPM) machine professionally known as the Artromot-K3 to move my leg from a gradual 10-40 degrees of motion, increasing each day to 0 – 110 degrees within 2 weeks to enable early return of knee function (and to minimize stiffness).

This experienced team also STRONGLY recommended that I rent or purchase a cooling machine for the knee. Social media posts also recommended purchasing a Transcutaneous nerve stimulation unit also known as a TENS unit.  Although none of these were covered by my insurance, all have been absolutely critical to minimizing my pain and the need for narcotics. 

The motion machine rental was 375$. The Cooling machine was 200$. The TENs units can vary in price on Amazon by a factor of 10.  Being the frugal gal that I am, I bought a TENs unit for less than 40$ that does the job.  And the narcotic pain medicine was 22$- the only item covered by insurance.  

No wonder we have an opioid epidemic! As an emergency medicine I have witnessed first hand the progression of a catastrophic injury to the challenges of chronic pain, mobility problems and the eroding of independence and quality of health.  With my medical background, I have the privilege and the humble understanding that incremental forward slow steps will be required to successfully return to full activity. Yet, those patients with limited financial means, a misunderstanding of pain perception or the critical importance of early mobility may decide not to invest in these additional modalities. Or they may have less forward thinking physicians who do not even recommend a CPM machine, TENS unit or cooling machine.  

Setting yourself up for success

And it is hard work to park yourself in one spot for the machines, although ready access to streaming programs, books and podcast suggestions have made this much more bearable. (Feel free to send your suggestions to DecipherYourHealth!) And yet I prematurely decreased the time on the CPM/cooling machines due to the constant sound of creaking from the Artromot -K3 and running water with bright LED displays from the PhysioNatural cooling system affecting the sleep of my spouse and myself one week out. 

Boy, did I learn. Within 24 hours, I lost flexibility, my knee swelled and pain skyrocketed. Yup, this brings up the importance of consistency and showing up EVERY day.  And it brings up the importance of compromise. Ear plugs and extra drapes over the LED displays proved to make the next nights a bit more bearable with the TENS/CPM/cooling combination.  

Log progress

I also created a physical therapy log to document my progression.  Some may view it as a bit obsessive-compulsive to log the time on the CPM machine, the cooling machine and the TENS unit along with my PT exercises, yet if I fail to log this information, I will not be able to glean patterns 3 weeks from now if I again feel the temptation to slack off or face time constraints due to work and home obligations.  .  

So, key points. 

• Show up every day. 
• Do your best for that day (which may be 5 minutes, 15 or 50 minutes).  
• Review challenges (Don’t call ‘em failures!) 
• Review successes.  
• Optimize the use of your accountability coaches (family, friends, physical therapists, physicians, nurses or physician assistants).  

Couple a new (challenging) habit with one you already enjoy or at least perform regularly.  For example, I get to watch xyz Netflix show, while I do my PT exercises. Or I will do my hamstring curls while I brush my teeth. 

And don’t forget:

Rewards are important.  

Acknowledge milestones (even if it is just giving yourself a high five in the mirror)

Expect setbacks.  Visualization of success is the key.  And once again, thank you for joining me as I Decipher my Health!