I’m over 40 … and my timing stinks

A new study was published which concludes that the outcome of PAO for patients over 40 is “not as good as” the outcome of total hip replacements. While it doesn’t say the outcome with PAO is “bad,” for an insurance company this is denial fodder worth its weight in gold.

Thanks guys, please kick me while I’m down.

As of November 1st, my insurance company, along with most others, has unilaterally decided not to pay for PAOs. This probably means that they WILL pay for some, if you make a really great case on appeal, but that by and large they consider this rare operation, which has helped women for 30 years, to be “investigational.” Not enough large studies have been done. Hmmm, how many is “enough”? There are quite a few small studies that I’ve read, but how can anyone do a large study when this surgery is so rare? This isn’t like diabetes or heart disease – run of the mill maladies which every Tom, Dick and Harry seems to have nowadays. And oh, by the way, Tom, Dick and Harry probably don’t have hip dysplasia because the vast majority of people with this condition are WOMEN. We all know what whiners women are … with their subjective complaints and all. Those women, they want special, expensive surgery for all their silly little problems … we big insurers need to let them know that we know what’s best for them!

Believe me, if I could have a total hip replacement or resurfacing instead of a PAO I’d be overjoyed. Recovery time for THR is short, and one is only in the hospital for a couple of days. I’d be walking and full weight bearing the day after surgery, and probably skating again within months. Not that THR is a cakewalk, but compared to PAO it’s “hip surgery lite.”

The problem is that my dysplasia is on the severe side, and it’s coupled with severe anteversion. THRs are not designed for people built like me. They, and their cousin the hip resurfacing, are designed for people whose hips are fairly normal in mechanical construction, with perhaps small abnormalities, but which are diseased or worn out. While there is a “dysplasia cap” available for hip resurfacing, again, it is not designed for severe cases. Two experts have now told me that my best course of action is PAO, based on the severity of my mechanical imbalance and the fact that my hip joint is basically healthy. Why would I remove and replace a healthy joint! Why would anyone do that? It seems obvious to me that correcting the structural imbalance, preserving the joint, and avoiding multiple revision surgeries is my best course of action. I’m seeking a third opinion. How many expert opinions do I need to override Aetna’s blanket policy?

I will add that I am not your typical 45 year old. I like to think that I am in better physical shape than most. I am not overweight. I am very muscular. I have exercised all my life. What about the over 40 patients in the new study? How many of them were like me? Is the only thing we have in common that we are "middle aged"? Yes, I am over 40, but my life isn’t over yet. I’m not ready to take up knitting or lawn bowling. MY PERFECTLY HEALTHY HIP JOINT SPACES DO NOT NEED TO BE REPLACED … that is not my problem, oh stupid insurance company flunkie reading my file. What I need is better femoral coverage. Isn’t the solution obvious?

Giving Thanks

I haven’t written here in a while. I’ve been concentrating on living life, and trying not to think about surgeries and such. Things are mostly status quo, except walking is getting more difficult. I walked 6 city blocks to meet Perry at the optometrist last night – I thought driving would be stupid – and I’m regretting it today. It didn’t hurt much at the time, but I need to realize that the next day is always the killer.

My knee, elbow and tricep are also sore because of a fall Tim and I took on the ice yesterday. It was just a stupid fall during a free dance run-through, on our circular footwork of all things. I just went into a drape and fell for no reason, and took him down with me. I don’t think this fall was hip related, although I do notice that generally I’m not as steady on my blades any more and rely on Tim more for support. We got up and kept skating the rest of the session since we are so tough. I’m sure Dr. Mayo would not approve of any of this since I’m supposedly limited to “low impact” activities such as swimming, the elliptical machine, and sitting on "The Bean" watching TV. Ahem. Thank goodness Dr. Mayo's way too busy to read this blog.

The purpose of this post is not to complain as I usually do, but to give thanks. There are all kinds of reasons to do this. In frightening economic times, Perry and I both have jobs. We have health insurance (although it is doubtful mine will cover my PAO, but that is a story for a complaining post, not for a thankful post). Our parents are healthy. Overall, we are healthy, hips excluded of course. The kids are doing well in school and staying out of trouble. Other than our mortgage, which is at a low, fixed rate, we have no debt. Our home has lost a bit of value but we bought it at a good price before prices started to heat up; we plan to keep it for a while and we’re not under water. Our 401(k)s have taken a hit, but we aren’t planning to retire any time soon. We do feel very lucky that we are weathering these financial difficulties well, since we know that is not the case for everyone. Many of our friends have had setbacks and we can only be supportive.

I am thankful for all that I have, for my wonderful family and friends, and for Perry, who has cheered me up even when I don’t want to be cheered up. We are truly lucky.

New Product Review: AquaBells

I need to remind myself that hip dysplasia is not simply an excuse to buy new gadgets, although the upside to major surgery will be getting my very own "hip kit," sock-putter-onner, raised toilet seat, crutches and metamucil.

A pre-surgery gadget arrived today from Amazon: AquaBells, an exciting concept in hip fitness.

AquaBells are ankle weights which can be filled with varying amounts of water so that they weigh up to 4 pounds. I have started with about a pound of water and have gone through my hip exercise just fine. Once I am less of a wimp, I will be able to add weight slowly by adding more water. As long as they don't leak, I should be fine.

Since I travel, these will be handy to take with me since they only weigh a few ounces when empty. The one drawback is they are a little messy to fill from the faucet, but really not much -- it's a small price to pay for portable equipment which expands as I get stronger.

Lots of fun typos on the packaging ("Exercise quadriceps, hamstrings, inner thighs, and calf's ..."). Humor like this is always appreciated, especially during strenuous workouts. Overall I recommend these.

Fear

I haven’t really felt afraid yet, and that’s because my surgery is 7 or 8 months away (exact date still TBD). It seems so distant that I can’t be afraid of it yet. I’ve read many blog accounts of PAO surgery and I think I know what to expect. Some people would rather go into a surgery without knowing the details; for me, it’s better to know and get used to the idea of it than to be surprised. I’m such a control freak and I’ll be handing over total control of my body and all its functions to the anesthesiologist and surgeon for 5 to 7 hours, followed by weeks of dependence on others to take care of my most basic needs. But this is not my biggest fear.

I also fear doctors and needles. Even drawing blood from me is a major event. I have bad veins and a “simple” blood draw really hurts me. I have to get past this fear since there will be needles and tubes and drains and catheters and I don’t even know what other things attached to all parts of my body before and during surgery. But this is not my biggest fear.

I’m afraid of losing my abilities. Walking, skating, stretching, working in the garden. I stuck the skating in there casually as if it’s not too important, but who am I kidding. I have worked so hard on it the past many years that, to lose it all and never get it back would be a shame, a waste, something to cry about. Because of my hip issues, skating has been twice as hard for me as it would be for a “normal” person. Ice dancing is all about turnout. Those of you with turnout don’t know this … because you just think what you can do is the norm, and among skaters that is generally true. For those of us without it, everything is a struggle, even simple inside to inside Mohawks, about which I’ve said for years, “I can feel my hip grinding when I do this.” Doing the “simple” swing dance mohawk hurts like hell for me and it takes all my power of concentration to do that turn. That’s my version of “normal.” I stopped asking coaches about why it hurt and what I was doing wrong a long time ago and just did it, feeling and hearing the grinding at the same time as I forced my ankle to fake turning out my leg on the exit. A big smile usually hid the fact that my knee and hip were really turned in even though my toe was pointing out.

Tim and I are still skating and improving as a team. We’ve had a couple of great practices recently. I don’t even want to imagine him having to find another partner if I can’t get back to my current level of skating. I am terrified of that.

Back from the desert

I am back from judging the Pacific Coast Sectional Figure Skating Championships in sunny warm Scottsdale, Arizona. It was a good test of my pain levels, doing things that really should hurt. I sat for long periods of time in an uncomfortable seat at ice level which, obviously, means it was cold. I had to stand a few times to give critiques. I carried stuff. I slept in a hotel room bed that was not even remotely comfortable in any position.

Then at night Perry and I did some walking outside where it was warm. After all of that I would have expected a lot of pain, but I didn't really have much. I even went without the cane on the last day when we went walking around Tempe. I'm not sure why I felt so good but I suspect, sadly, that it's because I haven't skated in over a week due to a combination of a bad cold and being out of town. I guess I have to admit that skating is not good for me, even though it doesn't hurt much while I'm doing it ... the residual effect is what keeps me up at night in pain.

Well, being stubborn, I'm still not ready to let it go. I even have some goals for myself. I passed my Silver Samba in October, the first international dance for me. I'd like to pass the Cha Cha Congelado and perhaps the Rhumba before surgery next summer. The Rhumba is so much harder for me than for normal people. With legs that turn in, it's almost impossible to force those choctaws. I can do it but it's not pretty.

I'm starting to worry about all of the reports from post-PAO gals that their operated leg is still "gimpy" and their quadriceps (which are "moved" during surgery ... I don't know if that means "cut" or not, but I suspect so) are never the same after. I can't imagine skating on two gimpy legs when this is all over. It just won't work. I have huge quads and use them for almost everything I do on the ice, so it worries me to think they are going to be cut or moved or whatever and maybe never come back. On the other hand, the post-PAO ladies who seemed to be in better shape before their surgeries tend to do better and I'm hoping to be one of those. Plus I know what it means to work hard in the gym and not give up on my gimpy-ness.

Testing 3 international dances before I go under the knife will make me very happy. If I'm unable to skate at all post-surgery, I can always point to those tests and say that I used to be an ice dancer.

The Cane on the Plane

Ode to my walking stick, with thanks to Dr. Seuss

I like my cane
It’s very plain
It helps me walk
Avoiding pain.

My cane, my cane
Sometimes a pain
Rules out umbrellas
In the rain.

A lovely cane
It’s wood, nice grain
Tonight I’ll take it
On a plane.


I live in the Pacific Northwest. Granted, it doesn’t rain as much as we lead people to believe – some of that is hyberbole and meant to keep the rest of you from moving to our little slice of paradise. But for the past couple of weeks it has been pouring.

With the cane in my left hand and my backback on my back, I could in theory carry an umbrella. But usually I have a latte or a water bottle in my right hand, or something that doesn’t fit in the backpack which I’m carrying to a meeting across the street. Normally this is OK with me so I haven't been carrying an umbrella to work. However, last night I went to the salon, where they styled my normally curly/frizzy hair. If I keep it dry this style lasts a couple of days. Without an umbrella I’m doomed.

I pulled my jacket (no hood! Damn!) over my head and “ran for it” (meaning hobbled a bit faster) and made it with very little damage to my head. The return trip was equally difficult and the rain was coming down harder. Now I’m watching the frizz start to pop out everywhere on my head despite the seemingly hours-long blow dry session last night.

Luckily this won’t be a problem in Scottsdale where it’s warm and dry. We leave tonight and I’ll get to see how amenable TSA is to walking gear, which in theory could be used as a weapon. Stay tuned for a full report.

Sticker Shock

I got my insurance recap for the visit to Dr. Mayo’s office. A few hundred dollars for the consult, a few hundred for the x-rays, and a whopping $1,999 for the CT scan.

I guess I was expecting a large bill, but not quite that much. Since I’m paying out of pocket I am experiencing a wee bit of sticker shock. It’s a good thing we didn’t decide to renovate the kitchen this year! I needed a CT scan far more than that 36” range with double oven.

When Perry and I decided to do the high deductible health care plan last year, we thought it was perfect for us. We are healthy and pretty much never go to the doctor. Wellness was covered 100%, and that’s the only thing we ever utilized. Why pay high premiums when you don’t need to?

So last year we were happy with our decision to go on the high deductible plan. And this year too, until August, when I became the proud owner of an expensive medical condition. I’m just about to hit my $3,000 deductible, but not quite … unless something else unexpected comes along before the end of the calendar year, but let’s hope not.

I think it’s good that as a consumer I’m forced to know what health care “really costs.” That prevents me from doing stupid things, like going to the emergency room when I stub my toe or eating fast food every day. I already take responsibility for my body and my health but I know some people don’t, so I guess truth in billing is a good thing.

The CT scan was about 10 minutes (after more than an hour wait) of being put into a donut-shaped machine and holding really still. I know it’s expensive because the technicians are highly trained and have to calculate a whole bunch of variances based on what the CT scan spits out, and there were two of them, and the machine’s expensive, and it uses a lot of energy. I’m not disputing a couple of grand (and I’m happy to pay it since it proved I didn’t need to have a second surgery on each leg – the CT scan was much cheaper and easier to recover from).

But I suspect this is a harbinger of more shocking bills to come, so I am bracing myself. Since it’s open enrollment time, I’m also changing back to the more expensive health care plan offered by my employer. Even though I know Aetna is going to initially refuse to pay for my surgeries until I appeal and eventually threaten to sue them, I would like to know that at the end of the day my maximum out of pocket and deductibles will be lower. Guess it’s OK to start eating more fast food.