Friday, October 31, 2008

PAO - my insurance company's view

"Management of individuals blah blah blah with this malady blah blah blah includes: modification of activities to reduce excessive motion and burden on the hip, the use of non-steroidal anti-inflammatory drugs, and discontinuation of activities associated with the painful hip movement."

Their answer = stop skating and that will solve the problem. Therefore such surgery is "not necessary."

Of course, if I stop exercising I will gain 50 pounds (I like to eat) which will open the way to heart disease, high blood pressure, knee pain, and diabetes, and then the fuckers will get to pay for my treatment for those things.

The surgeon's PA is trying to negotiate with the insurance company through their contract agreement and should have an answer by June of 2009, which is why my surgery is penciled in for July of 2009. They asked me not to interfere unless that does not work and I will honor that. After that, I will be getting my attorney involved. Good thing I have one in the family.


Thursday, October 30, 2008


I finally got in to see the specialist today, after a 3 month wait. He specializes in people with my deformity, acetabular dysplasia, and he does a lot of pelvic reconstruction from trauma. He is very well regarded.

He told me that I was a good candidate for periacetabular osteotomy (PAO), and that a hip replacement or resurfacing would not work well because my hip sockets are so shallow. An artificial hip would probably fail fairly soon since there would be poor structure to hold it in place.

They took more x-rays and also did a CT scan to determine whether my legs were the same length and how much my femurs were misshapen. At the end of the day (and, with 4 hours of drive time, we are talking ALL DAY), it turns out that I have multiple problems. Very severe dysplasia, meaning very shallow hip sockets. Not a mild case. This had not been evident from the first films. I have stage 1 arthritis in both hips which, once pain is present, usually quickly degrades to stages 2, 3, and 4. Also, my femurs turn inward ("anteversion"), which I knew, but mine do so in the extreme, meaning my femurs are actually twisted. So that entails another surgery, where they break the femur and insert a plate. The PAO means they cut my pelvis up and reposition it, inserting screws. Some day I'll have a fully metallic pelvis - TSA will love me.

The upside is decrease in pain (although I may still have some residual pain), a more stable hip and leg structure, a slowdown or stop to the arthritis, and potentially no need for future hip replacement. If I do need future hip replacement, my bone structure will be much more amenable, meaning less likely to fail, after PAO.

Downside is that I may have less range of motion, although the femur revision may give me some more turnout. Normal turnout is 30 degrees, and I have less than 5 degrees - "essentially zero" as the doctor put it. I do have excellent "turn in," which is ever so ugly in skating. All of this means it didn't matter how many plies I did, I would never ever ever ever ever ever ever be able to do an Ina Bauer. The rhumba choctaw? Impossible for someone built like me (yet I do it ... my way). All the coaches and ballet teachers who said I just wasn't trying hard enough ... well, you know the gesture. I'm too emotionally drained to get upset about it again.

Another downside is that I will be in the hospital for 5 - 7 days, non-weight bearing for 8 weeks post surgery, and unable to skate for 6 months, at which time they will do the other hip! So this is really 4 surgeries and 2 hospitalizations and a year off the ice in total. The thought of getting my strength, stamina, flexibility, balance and skill back in my late 40's after going through something like that boggles my mind right now. I know it's possible, but will I just give up and take up golf? It's entirely possible.

Finally, my insurance doesn't pay for this. The total cost PER SURGERY is roughly $150,000. That's right, them's a lot of zeroes. And then multiply that times two. And oh yeah, will the insurance company pay for the special hospital bed I need at my home for a month, and the physical therapy, when they don't even cover the surgery? I'm thinking not so much. The doctor's billing assistant said they are working to get this covered and if I wait until next summer (which I have to do anyway), they may have made progress.

I could have raided my 401(k) or my home equity at one point, but in this economy that's just not an option. How to pay for it is a big question, but I have time to ponder that as they can't even schedule me until next summer. I am tentatively penciled in for July, pending the funding issue.

A year off the ice is an awful reality to face. I'm not ready for that. I am still improving as a skater! I am still competing! I am still testing international dances! I am not ready to quit and not ready to have a forced hiatus which I'll need to fight back from.

Hip replacement has a much shorter down time and is paid for by my insurance. But, if I trust what I heard today, it won't be very successful for me. It sounds like my options are limited.

Meanwhile I will continue skating until the pain gets too hard to bear. Right now it is pretty constant, but sleeping is the worst. Skating isn't as painful as sitting. Maybe I will get some crutches so I can keep the weight off it all the time except for that hour or so when I'm on the ice. No cross training as I can't risk it. But I vow to get through this competitive season - I've made a commitment to Tim which I think I can keep -- and then take the next step.

Tuesday, October 21, 2008

The good, the bad ...

You know the rest.

I woke up this morning feeling really good. Sleeping is usually an issue. I can't sleep on my right side since my right hip just can't take the pressure. I can't sleep on my left side because my left knee generally hurts if I do so (I am sure my left knee problems are related to my hip problems, but that is another story). And if I sleep on my back, well, my back starts to hurt.

But I usually do sleep on my back anyways, with a few tosses and turns during the night, and get 6 hours of sleep. I have good and bad nights but never pain free, until last night when I slept the entire night and woke up with nothing hurting. It was a great feeling! I should have known that it wouldn't last.

I went to the rink and all was OK until we did our first lift, and I felt my left inner hip socket pop. We tried a couple more times but I could not support my weight with my left leg as I have to do in this lift. The left hip is my "good" hip, or "better" hip anyway. We continued skating for the two-hour session.

Now here I sit with ice on both hips and inner thighs. The pain has radiated from the inside of the left hip to the outside and all the way to the right hip. It's as bad as the first time this all started hurting, when I was off the ice for 3 weeks and went to the doctor the first time. It hasn't been this bad since then. Shoot, what have I done? That is an easy lift and hasn't given me any problem until now.

I am seeing a surgeon to discuss periacetabular osteotomy next week. Perhaps I've taken a turn for the worse, I don't know. Tim is gone on vacation for a whole week starting Friday and I was going to work on my Cha Cha Congelado while he was gone, but it sounds now like I will be "resting."

Damn, damn, damn. Shit, shit, shit. I was hoping to put off any surgery for a while (a year, maybe two?) because things were going so very well for so very long. Maybe this is just a minor setback and not the start of my downhill slide into arthritisland. I'll find out tomorrow if I can skate, or walk, or not.