Surgery

My surgery was originally scheduled for March 3. I had my pre-op physical, and was given an action plan to prepare. The surgeon's office filed a preauthorization claim in early February and we waited. My lovely insurance company took the full 30 days to review the claim, and on March 1, declared a denial of coverage.

The reason? FAI surgery is an experimental procedure and there is insufficient evidence that it is beneficial. I was devastated. I had everything in order - caretakers, work schedules, my house - and I had informed everyone I would be off in less than 2 days. Now I didn't know what to do.

I went online and found out this is a fairly common issue in the United States. While the procedure does get approved by some companies, others refuse to consider it. I have Principal Financial, who typically approves it, administered by Aetna, who typically denies it. That was a hard situation. As time went on, I found myself on the phone with my agent, who would say "If it were up to me, your surgery would be approved. But it's up to Aetna." Frustrating!

I found support from another blogger with the same insurance company (UNDERSTANDING FAI (Hip Impingement)), whose well-wishes and positive attitude helped me find the energy to fight my battle. And fight I did. Not a day went by when I wasn't researching, making calls, or talking to friends and colleagues. I'm afraid I became a bit obsessed, as my world fell apart and my pain kept increasing. But I was learning, and eventually I was able to put together a letter to my HR person, pointing out differences between our plan description and the insurance company's behavior. I also indicated I was filing a complaint with the state insurance commissioner. Within 24 hours, I was given a case worker from Principal Financial. Within a week, she had managed to convince Aetna to approve the surgery. I was in business! Also in shock, but in a good way - I had expected a 6-month long battle, and just over a month had passed.

I rescheduled my surgery for May 19. By this time (mid-April), the steroid injection from January was long gone, and I asked for another. Dr. Birmingham indicated that he would do it if I absolutely needed it, but repeated steroid injections can potentially lead to arthritis and he'd rather not increase my risks there. So, for the next 4 weeks, I toughed it out and found my limp was becoming more pronounced, as my capabilities continued to decline. Tick-tock, the clock is slow.

Finally May 19 arrived! Dr. Birmingham met with me before the surgery and reviewed the procedure and what to expect. He was quite supportive, alert, and all smiles. He put me at ease, and I was grateful. My only concern was whether or not my weight would hinder the surgery or my recovery. Dr. Birmingham assured me I would fine - the weight made the surgery a bit more complicated, but not unmanageable. Recovery would be the same.

I had many visitors that morning - nurse, admissions coordinator, anethesiologist, phlebotomist, and physical therapist. The therapist showed me how to walk and take stairs with the crutches. I was surprised to learn prior to the surgery, but my husband thought that was fantastic. He had a knee osteomoty a few years ago, and learning to use the crutches when on pain killers was not so good.

The nurse picked me up and I opted to walk into the operating room. It would be awhile before I could walk again, and I wanted to use my legs as long as I could. I hopped up on the table, and Dr. Cloud (yes, his real name!!) administered the anesthesia. I remember telling him he had a great name for an anesthesiologist, and he replied "thanks, but nobody here calls me Dr. Cloud. They call me doofus." I laughed, and closed me eyes. I woke up about 2 seconds later with a mask over my face.

The surgery had taken ~4 hours. The labral tear was stitched up, not debrided - yay! The goal is to retain as much material as possible, and Dr. Birmingham had retained it all. My acetabular rim was debrided, and possibly the femoral head (I don't have the surgery report, so this is all from foggy memory). There were no issues with the synovial membrane, so he didn't have to do a synovectomy. He did, however, have to release my psoas tendon. It was cut in two places to lengthen it so it wouldn't impair hip movement in the future. Then he started giving me numbers, which quickly washed away in the haze. Something about normal was 30 degrees, and I was 15, or vice-versa. If you know what this means, please let me know! I will get more information when I see him again.

I hung out in the recovery room, fighting the nurses to keep the mask off my face (darn claustrophobia). They agreed, as long as I could breathe deeply enough to keep my oxygen levels up near 100%. If the alarm on the monitoring unit sounded (at 80%, I believe), I got the mask back. I thought that sounded like a fun challenge, so I watched the monitoring unit closely while I tried various breathing techniques. Unfortunately, I kept falling asleep, and the alarm kept going off. They finally said forget it, and put a tube in my nose. Lovely.

Since Dr. Birmingham is new to the area, the hospital staff wasn't familiar with his protocol. They kept contradicting his instructions, and didn't know how to use any of the equipment he had prescribed. I have a Game Ready ice machine, and passive motion leg machine, and a hip brace. I couldn't believe they didn't know how to put on the hip brace, and I was getting frustrated with all the arguments about protocol, so as soon as I was able, I checked out of the hospital to recover in my own home, following Dr. Birmingham's instructions. So good to be home again!