Where do I go from here? Long..

[Kyrabee]

Has the PT not given you home exercises? Most exercises can be adapted to do at home. Some of the machinery at the PT office can target specific areas but they should be able to adapt it for home, especially if you have limited visits.
Quad sets can be done anywhere and should be done multiple times a day.

Make the most of your 8 visits and be sure you get a home program. YOU have to do the work whether with a PT or at home.

Jingles you can get your knee feeling better. I had surgery (back in the dark ages of the 70’s) to correct what you are dealing with. It worked very well but now they deal with it almost exclusively with therapy so I imagine it will be a work in progress. Good luck.

Susan

[horsegal301]

[QUOTE=Kyrabee;8308694]
Has the PT not given you home exercises? Most exercises can be adapted to do at home. Some of the machinery at the PT office can target specific areas but they should be able to adapt it for home, especially if you have limited visits.
Quad sets can be done anywhere and should be done multiple times a day.

Make the most of your 8 visits and be sure you get a home program. YOU have to do the work whether with a PT or at home.

Jingles you can get your knee feeling better. I had surgery (back in the dark ages of the 70’s) to correct what you are dealing with. It worked very well but now they deal with it almost exclusively with therapy so I imagine it will be a work in progress. Good luck.

Susan[/QUOTE]
My PT did not give me a home exercise program. Problem was, the way the third party business approves more visits is about 4 at a time, so she thought we would have a lot more (like 2 more months worth of 2 visits per week) before it got to the point where she would want me to only be in a home program.

When they cut me off for good, I only had the exercises I had been doing at that time, so they didn’t do much to help beyond what it was already doing. I am going to make sure that is what we really focus on and make those 8 visits count and be absolutely sure she has a plan in place… even if it’s a home program that evolves into me having to pay for my own visit a month down the road to check up and evaluate progress, I could at least save for that.

[stargzng386]

I would find a different PT place that will give you more home exercises. That is really going to be key in your recovery. Usually they have sheets they hand out that have the progression of exercises for your specific problem area that you can follow and move through as you get stronger. I’ve been to PT for a number of joints and have never not been given a home plan. Be up front and say I have 8 sessions, I must continue this at home or a gym can you help me when you are calling places. Also look into paying out of pocket. How expensive is it? Can you swing it once a week to continue to be given new exercises? I have chronic back pain and my chiro isn’t covered but I go once a month and just pay out of pocket $64, I consider it a cost of living for me to stay comfortable. If something happens that throws my back out of wack I go once a week until it’s better and then go back to once a month.

[horsegal301]

[QUOTE=stargzng386;8308974]
I would find a different PT place that will give you more home exercises. That is really going to be key in your recovery. Usually they have sheets they hand out that have the progression of exercises for your specific problem area that you can follow and move through as you get stronger. I’ve been to PT for a number of joints and have never not been given a home plan. Be up front and say I have 8 sessions, I must continue this at home or a gym can you help me when you are calling places. Also look into paying out of pocket. How expensive is it? Can you swing it once a week to continue to be given new exercises? I have chronic back pain and my chiro isn’t covered but I go once a month and just pay out of pocket $64, I consider it a cost of living for me to stay comfortable. If something happens that throws my back out of wack I go once a week until it’s better and then go back to once a month.[/QUOTE]

I will definitely make it apparent that I only have 8 sessions. Before I was cut off, I was going 2 times a week. If I paid in full by myself, it would be $130 every time, which really isn’t feasible for me to do, unless I did actually consider selling my horse to make up for it… or find a different employer and different health insurance that is better supportive of my injuries/benefits.

[stargzng386]

Definitely ask around. Sometimes they will only charge you the rate they would charge your insurance for out of pocket. My Chiropractor is usually over 100 but they charge me the reduced insurance rate of $64 out of pocket so it’s worth asking different places if they would do the same.

[Calamber]

[QUOTE=horsegal301;8275838]
I just looked into NYS Dep of Insurance and it looks like I can do an external review with them.

I am unsure whether or not it’s better to file with NYS or go through with the external review through anthem. I want to make sure I take the right steps.

I did call my doctor and ask him “what now?!” now that my insurance has denied me again. I also called the insurance company to find someone who can go through line by line why they denied me, when according to their criteria, I meet medical necessity.

Is asking for the reviewer’s notes something I can do? I don’t see why not if it regards me and my appeal, but I sure would love to see what that is.[/QUOTE]

Yes, review with the state and at the same time, put the pressure on through your US Congressional and Senate office. What BCBS is doing is illegal, it is written in your contact that you receive 60 visits and you have gotten 15. There are Federal agencies whose job it is to provide oversight and your representatives know who they are and should help you.

Edit to add that I did not read about your “success” with the external reviewer. Pursue the federal side, that will get some attention I guarantee you.

[horsegal301]

Update!

Turns out I had more than 8 sessions - my insurance screwed up the way they notified my PT (of course), and I ended up having 24!

Here I am, a little while later. I can finally walk pretty normally, can sort of go up and down stairs, but still haven’t tried riding yet. I’m about 12 sessions in and just started exercises that will help strengthening my leg enough to try riding. That being said, my left leg is still incredibly weak and I still can’t run or knee, or sit/stand for long periods of time (more than an hour).

I had a check up with my surgeon/knee doctor yesterday and he was concerned over the feel and sound of my leg, being so far out, even with the PT. He started talking about potential surgery again, but likes that I’m doing PT since it’s giving me some sort of relief… but then he started talking about how I can’t do PT for the rest of my life to just try to maintain this plateau – and started off about the viscosupplement injection again.

I’m feeling a little lost, I don’t know who to talk to because every time I talk to someone about it, I get anxiety and sad and don’t know what to do. Husband has been supportive, but he’s just telling me things I already know. My doctor made it seem like I should just be icing my knee and whenever my PT says I’m good to be done, to talk to him about the injections.

… I told my therapist about it today at PT and she started talking about getting another MRI when I informed her about what he said… but then that discussion didn’t go anywhere. I guess it feels like no one has a real plan for me because they have no idea why I’m not getting back to normal. Top that off with my company being bought out and our insurance in a state of flux, and I have no idea what is going to happen after I finish this round of PT sessions.

I’m wondering if anyone has had these injections, which sound a lot, if not exactly the same, as what people give their horses. Of course everything I find online is either a horror story about infection or studies saying it’s not really effective, if not less effective than a cortisone injection, which did nothing for me. I’m just trying to find a plan for myself, and if I only have a month of insurance left, I might as well get on trying to see if my insurance will cover the injections if they’re worth it.

[equescool]

My husband, who is 90 yrs and mentally amazing, is physically struggling with pain in his right hip (arthritis) and knee while having an arthritic left ankle (he can only walk short distances with a brace). We have gotten a mobility wheelchair, but his pain level was still up. One of my vets told me she took Arthrosamine ( http://www.arthrosamine.com/ ) so he agreed to try it. Within five days his pain had reduced by 75%. We consider it pretty much a miracle. He started out with six capsules a day and now takes four per day. He had gone the cortisone route, but it just wasn’t effective. He has been able to discontinue ibuprofen.

You have had a tough time. Good luck.

[OverandOnward]

[QUOTE=horsegal301;8376218]
Turns out I had more than 8 sessions - my insurance screwed up the way they notified my PT (of course), and I ended up having 24!

Here I am, a little while later. I can finally walk pretty normally, can sort of go up and down stairs, but still haven’t tried riding yet. I’m about 12 sessions in and just started exercises that will help strengthening my leg enough to try riding. That being said, my left leg is still incredibly weak and I still can’t run or knee, or sit/stand for long periods of time (more than an hour).
…[/QUOTE]

Well that part is good news!

I can understand you feeling that no one in the medical/PT field seems to be taking responsibility for a long-term plan for you. I sometimes get the feeling that too many doctors these days just kind of get through today’s appointment, make a few notes and remarks, without a real feeling of ownership for managing the patient’s condition on a long-term basis. I sure didn’t go to medical school – I’m relying on them, and sometimes I wish I felt there was more to rely on. I don’t know if that describes your situation, but I can sort of hear the same frustration in what you write.

Have you asked the doctor and the PT: What is their long-term goal for your recovery, and what is their plan to get there? How did they respond?

But also take into account that you’ve been through a bad time. And that perhaps the worst has been a long period of uncertainty about your future. That brings people down. I suggest also letting your doctor know you may have a bit of depression and could benefit from anti-depressants. I know of people in recovery from severe conditions that were prescribed anti-depressants, and it made a strong positive. It might help you, as well, to keep a positive sense of direction and perspective.

It does sound as if you are considerably better off than when you first posted! Yay for that!

[red_mares]

Sounds like things are looking up a bit.

The injections depend on what they are injecting for. For meniscus/cartilage issues, the synvisc could be worth the effort.

My doc mentioned it in passing for me, but not seriously - I have inflammation & lots of scarring - the synvisc isn’t really designed to fix that.

If you’re showing improvement with PT, there’s a good chance your insurance will approve more if it’s needed. If there were no improvement, then it’s a different story.

Also, to some extent your doc is wrong about PT for life. I have incorporated it into my regular work-out. If I don’t, my ankles collapse and I end up doing more (real) PT!

I second what was said about depression. It happens. BTDT. I couldn’t take anything b/c of my job. Also don’t let anyone minimize what you’re going through.

I got hurt at 23; some well meaning soul sent me a copy of “Don’t Sweat the Small Stuff.” It was a good thing I got it in the mail, if I’d been in the room with them, I would have thrown it at them. I wasn’t “sweating the small stuff” I was sweating large stuff, very large stuff: how well will I be able to walk, will I keep my job, what will I do if I lose my job, will this ever really heal? That book just p!ssed me off.:lol:

Hang in there, it’s trite but I’ve found that God (or whomever it is for you) doesn’t give you more than you can handle. I’ve been fighting my body for almost 20 years. Invariably, when things get really black, the depression kicks in, and I feel like I just can’t deal with it any longer, something happens that makes things better. Maybe not all the way better, but at least climb out of the current black hole better.

[horsegal301]

@OverandOnward;8378810

Have you asked the doctor and the PT: What is their long-term goal for your recovery, and what is their plan to get there? How did they respond?

Thank you for asking this. I find myself blanking when I see my doctor and this whole situation makes me seem like my PT is useless, considering the insurance company didn’t care what they said. MY PT did leave the company I was with as of the 30th, but tried to bring another PT on and updated about my situation. I asked the new one last night these questions, and specifically about riding, because I chose to try to get on and ride this weekend.

…which was absolute sh*tshow, I will say. I got on for about 5-10 minutes, walking, and getting on and moving my leg was so hard. The act of having my foot in the stirrup and bent was excruciating, but mentally I felt good because I was finally on! Fast forward to Sunday, where I couldn’t walk, and yesterday where I was experiencing stabbing pains that I was getting when I wasn’t doing PT. The whole last week they started me on exercises they thought would help me with riding, but it made the pain in my leg worse. Not a good sore pain, but hurting pain.

Well, the new therapist told me not to ride, told me not to do exercises that I felt were making me hurt all last week, and when I asked her what her long term goal was for me, she said “to be able to ride – you should know you will still have all the symptoms and that you’re going to plateau and at some point, PT won’t help” and I kind of just took that as she wasn’t going to be helpful anymore. I told her the insurance was trying to block me again, saying that I only have 5 more days to finish 12 more sessions, and asked if she would talk to them about it, to which I was met with a non-answer.

I’ll be calling insurance today to see if they’ll let me continue until the end. She says she wants me for 6-8 more weeks at least, but I can’t imagine how hard it will be to get more, considering the restrictions on the ones I just had and the fight it took to receive them.

Fingers crossed. I’m trying to avoid talking to someone about depression. I feel like it’s probably a good thing, but what I’ve been trying to avoid this whole time is being on medication on a daily basis… even if I could get some sort of outlook or plan, that might make me feel better. I have heard of synvisc in passing, not sure if it’s the same as the other stuff?

[red_mares]

If I were you, I would find the closest guy on one of these lists and plan a road trip. BTDT, best decision ever. A couple days going to Pittsburgh, Philly or NYC would be time and money well spent.

Even if they tell you the same thing as your current doc & PT, you will feel better about it.

https://ryortho.com/2014/02/the-top-22-north-american-knee-surgeons/

https://ryortho.com/2014/05/top-28-north-american-sports-knee-surgeons-2014/

If you really can’t swing a road trip, then look for someone closer to you who was trained at one of these practices. It really does make a difference.

After a couple years of crutches etc, my shoulder was getting angry. I’d had rotator cuff issue some years ago. I looked at the orthos available local & not so local. The hand & shoulder guy, where my ankle doc is, trained with one of top Philly ortho programs. He was very thorough, much more so than my average local docs. Turned out I just have crappy posture & desk job.