Where do I go from here? Long..

[horsegal301]

I’m trying to figure out what’s going on in my life and where my horse is supposed to fit into it.

3 months ago I had surgery to take out some fraying and torn parts of my medial meniscus. In the time I got the okay to try to ride (about 2 months), I’ve attempted to ride my horse twice - which included incredible pain while mounting and dismounting, and sitting at a halt and an incredibly slow walk for about 8 minutes before I couldn’t handle it anymore.

I am currently battling with insurance, who won’t cover any more PT because my knee pain went up (they declared it no longer medically necessary) and the knee pain has gotten worse from not being able to access the equipment/machines at the physical therapy office. I don’t know when, or even if I will ever, be allowed to go back to PT. I have been incredibly concerned in my “recovery time” which has been getting even longer, and looking less like recovery as each day goes by.

I had a post op check up with my surgeon last Friday and explained to him the pain I’ve been feeling around the area where he put the scope in my knee and he found a lot of inflammation in the outside area of my knee, and found that the joint is not doing too great and could feel them rubbing - it is not just Crepitus, which has been present in my right knee for trying to take the brunt of everything. I got a cortisone injection, which ended up doing absolutely nothing besides causing extreme pain for 2 days… and now I’m back to the pain I was feeling before my visit.

When I asked my doctor what my next steps should be… he really just answered with “Well, we’ll try to get you back into PT, and if the cortisone shot doesn’t work, we can try to get you the viscosupplement” to which he followed up in saying that out of the hundreds of times he’s requested just a TUBE of this stuff, he’s only been approved by my health insurance provider once. I just don’t understand where I’m supposed to go from here if I’m being denied PT and it was the only thing that was helping me, but I also can’t see a therapist to give me a home program to work on because my insurance won’t cover it. I’m already doing the most amount of exercises possible that I can do on my own at home that my therapist gave me previously.

I know I’m not 15, but I’m also not what I would consider “old,” so I don’t know what to do. I’m only 27, and I still can’t go up and downstairs normally, I can’t sit for more than an hour before the pain kicks in, which is another huge problem since I sit at a computer 40 hours a week. I was riding pretty regularly and doing agility with my dog, and even running. I can’t do any of that right now and I feel like I’m about to have an anxiety attack every time I try to think about what is possible.

I am having trouble coming to terms with what is going on with my horse and what I’m suppose to do. I have been paying someone to hack him once or twice a week, thinking I would be improving and I’d be able to get on him, but it all seems pointless. It’s incredibly depressing. I’ve even had thoughts of selling him because I’m so depressed and frustrated about the situation that I can’t get myself to go out to see him. It’s been almost a month since I saw him last. I feel like a horrible person and a bad horse owner for not wanting to go see him because I can’t figure out what to do next.

A friend suggested looking into carriage driving, so I’m trying to see what the possibilities are there… but am I supposed to just give up on riding? I don’t know what to do anymore and hoping for someone else to have some words of advice on where to go from here.

[showmanship]

How concerned was the surgeon in regards to the inflammation in your knee? I’d be thinking about wanting a second opinion… Maybe it’s the tone with which I read this, but he seemed dismissive. I’m just speaking from experience… I had shoulder problems about a year ago, the doctor I saw recommended PT and possibly a cortisone shot. Nothing changed. Saw a different doctor and low and behold my muscle was completely torn up. I know you just had surgery to fix the problem, it just seems odd to me that it’s still inflamed and that painful. Are there any exercises that you did at PT that you could replicate yourself at home? They may be willing to work with you… When I was getting the PT for my shoulder (after the eventual surgery), my insurance changed and the cost skyrocketed. They gave me at home exercises and said to just call if I had a problem.

Sending positive vibes your way for sure.

[horsegal301]

[QUOTE=showmanship;8252326]
How concerned was the surgeon in regards to the inflammation in your knee? I’d be thinking about wanting a second opinion… Maybe it’s the tone with which I read this, but he seemed dismissive. I’m just speaking from experience… I had shoulder problems about a year ago, the doctor I saw recommended PT and possibly a cortisone shot. Nothing changed. Saw a different doctor and low and behold my muscle was completely torn up. I know you just had surgery to fix the problem, it just seems odd to me that it’s still inflamed and that painful. Are there any exercises that you did at PT that you could replicate yourself at home? They may be willing to work with you… When I was getting the PT for my shoulder (after the eventual surgery), my insurance changed and the cost skyrocketed. They gave me at home exercises and said to just call if I had a problem.

Sending positive vibes your way for sure.[/QUOTE]

I have actually been thinking about trying to get a second opinion - he was actually my second opinion when I had first done something to my knee. He wanted to see if he could repair the meniscus that they saw was torn in my knee instead of just scooping it out like the first surgeon I saw. Turns out that wasn’t an option when they actually went in there with a scope, but I’m thinking maybe it’s time to get another opinion. To me, he seemed somewhat dismissive, but I’m not sure if it’s a mix of him not sure of what to do since I can’t get PT and that was helping me before, or that he isn’t sure what’s possible with my health insurance… or he is just used to people complaining about pain all the time, I’m not sure.

I was a relatively active and healthy person before this. No surgeries, no other problems. Not obese or sedentary, so it’s hard trying to figure this all out.

I am doing a HANDFUL of exercises everyday that I can actually do at PT, but since they evolved week to week in PT, I’m not sure if they’re useful anymore, because they don’t seem to be providing any relief. I wish that I could at least go and talk to my therapist to try to get a more planned out home program in the interim, but that’s not possible without paying out of pocket and I can’t imagine how much that would cost. Bad idea for me to go with a high deductible health plan this year. :no:

[AmarachAcres]

I don’t have a lot of experience with your health, but I’ve been there with my back.

I got a standing desk at work, you can also order things that lift up and make any desk a standing desk. That really helped me take better care of my back. I stand all day (right now even).

How much would PT be on your own? Have you thought of fighting the denial of PT Legally?

[horsegal301]

[QUOTE=AmarachAcres;8252616]
I don’t have a lot of experience with your health, but I’ve been there with my back.

I got a standing desk at work, you can also order things that lift up and make any desk a standing desk. That really helped me take better care of my back. I stand all day (right now even).

How much would PT be on your own? Have you thought of fighting the denial of PT Legally?[/QUOTE]

To be honest, standing isn’t much easier, especially for long periods of time. There’s only 1 standing desk here at my work (that also accommodates sitting), and I don’t think they’d purchase another just for me. I’ve tried to help myself out by getting a crate to elevate my left leg and not keep it bent all day, but that’s still not enough. I suppose if I put up a big enough stink, they would give me the standing desk, I’m just not sure it would be much better.

PT would be $140 every visit for me, and my therapist wanted me in 2 times a week at least for another 2 months, then paring down to 1 time a week. That is just not possible for me to afford on my own.

I am currently appealing the decision that it wasn’t medically necessary for me to continue PT. I wrote a letter, accompanied with a letter from my PTherapist, and a script for more PT from my surgeon, but they denied an expedited appeal because it apparently didn’t fall under the category of being expedited (no real reason given), so I’m still waiting to hear back… Of course, I did get a strange phone call from an insurance rep 2 days ago saying “I might, but might not” get a phone call to hear back about the decision overall the next day. Still haven’t heard anything.

If they end up denying it, it will have to turn into a legal situation. That is actually the only other step they listed on their letter to me if I wasn’t happy that they denied my appeal.

My stomach is in knots waiting to hear. I am scared they’re going to approve me for something silly like 6 more visits and accept that just those visits would be enough for me to really regain maximum function of my knee, heck, even normal function. FWIW, my insurance carrier is Anthem Blue Cross Blue Shield, and under benefits, I get 60 visits per year. I got denied beyond 15.

[CHT]

Lease out your horse (if you own one) and put that money towards PT. Don’t pressure yourself to ride now if it is hurting. Even if you can’t afford PT twice a week, do what you can, and do the rest at home. You are only 27, so take the time to get better: there will be lots of time to ride if you take care of yourself now.

Is there a pain therapy clinic in your area? Will your insurance cover that?

[arabiansrock]

You need a second opinion. A meniscus trim just shouldn’t hurt like that after 3 months, heck it shouldn’t hurt like that after 3 weeks!

[Kyrabee]

Yes…for meniscus repair it shouldn’t take this long…PT or no PT.
I had scope for a meniscus tear in my shredded knee (tore the crap out of it in high school and later had a patellar tendon transfer to keep my kneecap from spontaneously dislocating) and I was pain free in about 6 weeks with no PT. Something is amiss and I would be getting a 3rd opinion.

I am having similar problems with failing body parts although I am heading up on 60…not 27. It is super frustrating. I had my right hip replaced in February. It went well and feels so good and then my left foot crapped out on me. So, here I sit in a cam boot when I should be getting fit after the hip surgery. Boo hiss…

Jingles you can get some relief and things turn around quickly.

Susan

[ElementFarm]

DH had miniscus surgery last year, and he was walking on it (carefully) almost immediately after, and is mostly pain free now, a year later. He is able to ride, sit, stand, job, etc. I think he had about 6 followup PT appts and that was enough for him. I know everyone’s different, but it sounds like you need a different opinion, maybe from a specialist, and find out what’s really going on in there.

[Bristol_Bay]

So sorry you are going through this.

As far as your horse goes, he isn’t going to forget what he knows if you put him in a low cost pasture board situation for a few months. Heck, there’s a gal at the barn who had two shoulder surgeries that kept her from riding, and her horse was at a retirement place for the whole year. A trainer worked with him for a few weeks when he returned, then she took over. Basically, you need to not worry about the horse or the money until you are “sound.”

Definitely get another opinion. You’re entitled to it by law. What you’re experiencing does not sound like healing to me.

[BasqueMom]

Another get another opinion person who had similar problems way back when
and scope surgeries and nothing like what you are going through. Riding was painful but got better as the knee over all got better.

Something is very amiss when you haven’t hit your limit on PT and they start denying it but not sure how much more you can do to take care of it.

And go visit your horse…you could use the hug!

[OverandOnward]

I realize 3 months is a long time to be dealing with a recovery. But it is not a long time in the course of your life - it just seems longer when you are only 27 than it will 20 years from now.

IMO you are trying to make life decisions WAY too early. Cut your forward thinking down to about 6 months or a year. It may even be a couple of years before you have the answers you need. Believe me, I know this sucks.

You need time to heal, and it may be a long time. But you need to give yourself that time because it will pay off long-term.

If you are concerned about supporting your horse for that length of time, or your horse being out of work, then make a near-term decision. A 6 months / 1 year decision.

• Would you rather put him on turn-out until you are ready to come back?

• Would you like to keep him in training with a lease or arrangement for someone to take lessons on him with their trainer?

• Or - not a lifetime question, just a for-now question - would you rather sell this horse now (let a trainer who can ride him sell him) and buy another horse when you ready to ride again? You will be at a different point in your riding then and may need a different horse. (?)

That’s how I would recommend looking at the options in your situation. You have many open questions with no clear answers coming in for some time. That’s not the time to try to figure out the role of horses in your future life.

It is understandable that all kinds of possibilities are starting to come home to you, especially with the pain. Don’t get sucked in by it, just focus on healing and doing what’s best for the time being. Things have a way of working themselves out, if we let them.

[QUOTE=CHT;8252924]
Lease out your horse (if you own one) and put that money towards PT. Don’t pressure yourself to ride now if it is hurting. Even if you can’t afford PT twice a week, do what you can, and do the rest at home. You are only 27, so take the time to get better: there will be lots of time to ride if you take care of yourself now.

Is there a pain therapy clinic in your area? Will your insurance cover that?[/QUOTE]

Excellent advice.

[Where_sMyWhite]

Can you join a fitness center and access equipment similar to what your PT was using? It isn’t the same as the therapist isn’t actually there but the work you could do would help fill the actual PT gaps (as long as you do the exercises properly).

[cayuse]

I am with everyone who says it sounds like you need a second opinion. Something doesn’t sound right and I would not make any life changing decisions until I found out what exactly is going on with that knee. Definitely see a different doctor.

[tarynls]

Second opinion ASAP and I would request a new MRI to see what’s really going on in there. What you describe is not normal for post-menisectomy. There may be an additional tear, you just don’t know without imaging.

I would hold off on any exercises beyond range of motion stuff until you see a different doc & get new images of your knee. If there is something else going on in your knee, you could do additional damage. This is coming from a former orthopedic medical assistant.

[horsegal301]

My horse is still young enough to the point where I wouldn’t want to lease him out. Unfortunately I don’t have enough money to pay for him to stay in training, but I also haven’t looked into the idea of pasture board yet.

That being said, I took your advice.

Called my doctor this morning just to make sure they knew the injection didn’t work. The nurses I talked to asked if I had been taking the steroid pack (???) and I was completely dumbfounded because I wasn’t given a script beyond one for more PT from my doctor. Then they told me I couldn’t get the script for the steroid pack because it had been too long since the injection… and then told me I should be taking NSAIDS every day.

I am so frustrated that all they want me to do is take some sort of drug instead of trying to address the problem.

Immediately after, I called another doctor that came highly recommended by people I work with… only to find out he won’t see me for a second opinion until I’m a year out from surgery. Is this common? I am at work now, on the verge of bawling my eyes out because I can’t get thid situation dealt with.

[tarynls]

[QUOTE=horsegal301;8255720]
Immediately after, I called another doctor that came highly recommended by people I work with… only to find out he won’t see me for a second opinion until I’m a year out from surgery. Is this common?[/QUOTE]

No, that is not common… that being said, some surgeons don’t want to “inherit” another surgeon’s problem. If you want to see the new doctor mentioned above, call his office back and explain that you have had zero relief in symptoms since prior to the surgery & you are concerned you may have another (new?) problem. Tell them you feel your concerns are not being addressed at all by your current surgeon and you need a fresh set of eyes to look at everything.

If you’re in the NJ/PA area I can give you some recommendations for doctors to see.

To give you an idea of what is “normal” for a meniscectomy - I walked into the office the following morning, no crutches, but pretty sore. I was lightly riding again after 3 weeks with just mild discomfort when mounting/dismounting. I would say 99% of my patients had a similar recovery. We were the ortho surgeons for a major league soccer team & our soccer players would be back on the field in about 3 weeks.

To put it in perspective - My husband is a farrier. He had both knees replaced at the same time and started shoeing horses again 3.5 months after surgery. A simple scope like you had should not be causing you these issues, this far out from surgery.

In the meantime, if something you do hurts (exercise-wise), don’t do it. The surgeon I worked for would say pain (like you’re experiencing) is your body’s way of telling you something is wrong & if it hurts, you can cause additional damage.

I would, personally, take the NSAIDS in the meantime just to give yourself some relief while you’re trying to figure things out. Even ibuprofen (Advil) or naproxen (Aleve) taken on a regular schedule, with food, should help (assuming you’re not allergic to it or have any stomach issues like heartburn or ulcers). Disclaimer…I’m not a doc, just speaking from personal experience.

Regarding the visco injections (Synvisc, etc.) no insurance company will approve it unless you’re over 60 years old with documented osteoarthritis and even then it’s a hassle to get it approved (part of my job was getting people’s injections approved).

Hang in there, PM if you have any questions I might be able to answer.
Taryn

[Sabino]

[QUOTE=tarynls;8256010]
Regarding the visco injections (Synvisc, etc.) no insurance company will approve it unless you’re over 60 years old with documented osteoarthritis and even then it’s a hassle to get it approved (part of my job was getting people’s injections approved).[/QUOTE]

Not true - my husband got his first one about 6 months ago (and is due this month for the next one) and is 46. I have BCBS of MN and we had absolutely no issues with them paying for it.

[horsegal301]

Well, lots and lots of phone calls to doctors within my network later… I finally got someone to look at me after pleading with a nurse, stating I just wanted someone to at least look and consider letting me have another MRI… won’t be able to get in until the 25th, but it is much better than no one seeing me until October-April.

Fingers crossed. Thank you to all who have given me advice so far, I very much appreciate it.

On another note because I received a PM about it, I do think I could possibly handle riding sidesaddle and have done it with my previous horse, my guy is just too young yet to be able to handle that sort of thing. Having more of a game plan makes me feel better for my future with him.

[ThreeHorseNight]

I’m sorry to hear you are going through this. You are way too young to be thinking about never riding again because of one surgery. Stay proactive. It’s frustrating, but do get that second opinion and if that doctor is of no help, try for a third. Do you have a good primary care doc? If so, I’d talk to him or her and see if s/he can help in any way (sometimes a primary care doc can get you in to see a surgeon). Maybe another doc will be more proactive in getting your insurance company to approve more PT.

Can an you talk to the physical therapy folks and see how much they would charge you for a few sessions if you pay for them yourself? The rate they bill your insurance company is not normally what they bill a self-pay patient who is paying cash. You might be able to work something out with them to get in for a few sessions so they can evaluate you and give you exercises to work on. Also, a good physical therapist is essential. Some are just going through the motions while others are doing a great job.

As far as your horse, hang in there. It’s common to encounter bumps in the road that get in the way of your riding - a crazy job, family problems, surgery or illness. You have many more years of riding ahead of you. Is there any way you can cut costs associated with your horse to have more money for PT? Keep him barefoot, do pasture board, etc. ? I’m not normally an advocate of charging things and not paying them off, but if you have a low-interest credit card could you charge something? You really need to get your knee taken care of so you don’t end up with a chronic problem.

Good luck to you. Let us know how things go.