Saturday, June 27, 2015

Walking on the acl

I have been off of norco for 2 days.  But my aunt dropped by yesterday and gave me a reason why that might not be good.

Right now i am still limping around tenderly putting pressure on my knee. The way she describes it, she says you should get doped up and push yourself harder.  So basically I might be doing worse for my rehab because I am walking around so tenderly, whereas if I tried to walk more normally (perhaps with the help of norco) I might rehab my knee more quickly.

What I am gonna do for now is stay off the norco and focus on walking more normally.  When I walk I am just gonna try and walk as normal as possible.

Thursday, June 25, 2015

48 hours after acl reconstruction

I went to the office and ran errands with my wife today and my leg was stiff all day. I took the bandages off at 48:02 hours and it is swollen and it turns out it is not the bandages which made my knee so big and prevented it from flexing.  I just try to straighten it out and I can feel the pain as it gets closer to straight

Norco after ACL Reconstruction - stop

So I decided to stop taking norco just before my 730 dosage this morning and I just took four ibuprofen before breakfast at Alia's 845 instead.  Walking around downtown and up in my office is a bit more painful but that could just be because I am also exercising it on the CPM.   will just do acetomenephin and ibuprofen for awhile.
  Since norco takes about 6 hours to get out of your system.  I should start feeling it about now (its about 7 hours now - I am a bit of lightweight with some drugs so it may take a bit longer)

One thing I noticed the last couple of nights was that I was itching.  I made a couple of comments about needing to scratch the meth lines outta me.  Well it turns out norco causes itching.  So I should not have anymore for a bit. 

Norco after acl surgery -2

After a couple of 2 norco pills I tool ome at 730 pm with only a few crackers on my stomach.  I then quickly ate some taquitos,  but I was high as a kite for the next 3 hours.  Eyelids were half baked or wouldnt stay open, I couldn't explain myself as sometimes I didnt even know what I was trying to say. I felt like I shoulda been passed out. 
I am not sure if it was the fact that I had not eaten much before I had norco, or it was the buildup of 6 doses at two pills each, but it was two much.  This was the type of high that people probably seek out but since I am such a skinny twerp I probably don't have much tolerance and 1.5 woulda been a nice high, but 2 is just too much.  Or perhaps I am just not that into being that far gone.  Either was, I have switched over to one and some ibuprofen an I think I am going to go to every 6 hours instead of four, so I can get off this shit.

I wrote this entry while I am on my CPM machine going from 0 to 76 degrees flex.  76 degrees is just about as tight as I can go with the brace on. But it does not hurt.  However 0 degrees does seem to be pretty far.  It hurts a little bit each time.  It seems that each time as it gets close I start to flex up a bit without conciously trying which could be adding to it. It seems as though the ace bandage and whatever is underneath that seem to be making miney huge which could add to how much Flex is being done on my knee. But I'm not sure if my knee is swollen or if they put a half inch of gauze on there.

I Think I Will Try It Without The Flex Brace next time. And see what comes of it.  Anyway I get to take off the base and check on my bandages this afternoon to see what's under there.

Wednesday, June 24, 2015

Impromptu office visit - don't be a wuss and walk on that leg

Today I went into Allied Orthopedic - Sean and Gael quickly brought me and Janae into the back office to help fit a hinged brace.
He said when we asked about crutches. You don't need crutches to walk on that thing. I am over here thinking that I should not be putting pressure on it and he says go ahead.
I realize that I have received all sorts of different advice from e hospital saying don't put any pressure on it for 24 hours then when I called in about the CPM device they said that no problem I can go ahead and start using it immediately so it was nice when Dr Sean showed up and described that I should quit using the Walker no crutches and just start putting pressure on it start walking. So I do but with the walker for a while important I just start walking around with a serious land and use occasional things around the house to put a little bit less pressure as it is quite painful.  
In a little while here I will get to move in on the CPM again and see if I can get it to bend quite a bit more. 
Kiss. I have been profusely pressure on it it will make it so that I have a slow recovery but the doctor's advice I now I feel comfortable that strong enough to handle it I just had to push through the pain and get to using it more.

Continuous passive movement machine - knee rehab after acl surgery

Today I started using the continuous passive motion machine from Allied Orthopedic. It was a little nerve wracking trying to make sure it was correctly fitted to my knee but with only a couple of adjustments for the length of my lower leg I strapped myself in and turned it on using settings of 0 degrees for my leg being extended and a 60 degree bend. It seems as though the 0 degree extension of my leg is not quite enough as my leg does not go all the way straight but I will probably mess around with that on the next time that I use it also the 60 degree bend is not a lot I will jump to 70 degrees next time I use it.

The 30 minutes went by rather quick my mom dropped by to chat just after I plugged it in. An interesting thing that happened was my restless legs kind of kicked in and at certain degrees my knee  felt the urge to twitch as they do with restless leg and that really hurt. However I think that the pain is a unfortunate combination of ailments that don't think that has anything to do with how my knee is or isn't recovering. Hopefully as the surgery pain goes away it will no longer be an issue.

Right after I laid down Gale from the Allied Orthopedic clinic called they would like me to come on and pick up a hinged brace since they would like me to start wearing it ( wouldnt it be awesime if they called because they were able to remotely monitor my progress and the progress looks so good that they wanted me come right in for the next big step)

Tuesday, June 23, 2015

Taking norco after acl surgery

After surgery my knee wasn't hurting too bad so we went to costco, I drove around on the cart. Got  some hot dog food on my belly and went to pick up some norco.  The cart hurt to sit in, with or without the foot elevated.  The car hurt, so I laid on the couch. And took one  norco at 730.  By that time it was hurting pretty bad so the pain never went away. We watched dumb and dumber to, ate a peanut butter and honey sandwich and had 2 norco at 1130 (as prescribed)  it's now 1230 and the pain has lessened but I still don't think I can go to sleep with the pain.  Perhaps reading a business book will get me to sleep.  Thank goodness my MBA professor prescribed some optional reading when class ended a couple days ago.
I took additional 2 norco at 1130pm, 330 and 730 am.  The pain is much more manageable but I still only get up in order to go the bathroom.  I think I would have been better off taking two norco last night to get started as it would not have gotten as bad as it did. 
Really, the norco has not really done much in the way of  making me loopy.  My mouth had gotten a bit cotton mouthy and I have gotten dizzy but I don't picture any addictive qualities yet

Day of acl reconstruction - treasure valley hospital - Dr Sean Hassinger

Today was the day of surgery. 
I got a call early today (or was it yesterday) telling me I should bring whatever payment I could afford to the hospital to make when i was checking in.
I said okay.
Today at 1245 Janae and I went to allied orthopaedic to pick up the continous movement machine which will help me move my knee.  They demonstrated it to me and it moves very sloooooow.  They said run it two times a day for 30 minutes, I said how about I just bend my leg three times a day  and call it good.  Anyway, we packed it up and put it in the car. I will plan to use it.

Next we headed over to treasure valley hospital where they quickly checked me in and I sat in a love chair with my wife (it was probably made for one 400lb+ person but we fit pretty cozy)
About 5 or so minutes later some rather stick in mud-ish guy came out and asked me to head out the corner.  That is where they asked me to sign payment, HIPAA and waiver info.
They also confirmed that I knew that the hospital is owned by the drs. The stick in the mud guy didn't appreciate humor, and when he wondered if we have any questions,  I asked once if they needed payment.  He said no, so I said ok.

I went to sit down. My wife left and I read a book for less than 10 minutes.  My friend and nurse came to get me and took me back to a room with 3 walls and a curtain facing the nurses station.  Before showing me my new home ahe asked if i neede to go to the bathroom and i said not really.  She asked me again in a very nonjudgemental voice that helped me to understand that I probably needed to try.  So I went over to a conveniently located bathroom and was able to empty was little I had.  I decided I shoulda gone with my gut and not even tried because peeing such a lile amount makes me feel the opposite of the "machismo" that I get with a [morning, race horse style pee]. Anyway, eleesha showed me the robe and socks i needed to wear so she left and I changed. i got to leave my underwear on.  She helped me to tie the gown a bit loosely so that it did not bunch up  when I lay down.  Then I got in bed.  She put an automated cuff on which took my blood pressure about a half dozen times over the course of 20 minutes.   my pressure was about 122 over 72 most of the time.  My pulse was just over 60 and as I settled down a bit to read an alarm kept going off. I dint pay attention since they had not given me any drugs yet, at this point I was just hanging out.  Finally some nurse came in and said that she will just turn off the alarm since my pulse kept dropping below 60, but since I looked like a fit guy it was not a problem. I spent the next 10 minutes breathing deeply and d lowly trying to lower my pulse below 50 to see if I could set off another alarm. I got it down to 52 before the nurse came in and through an airplane at me and she blew some bubbles at me. Some how my heart rate went up again to 56 and I couldn't get it down again.

Actually, eleesha was awesome and all of her friendly coworkers were great.  They had just purchased a bunch of toys earlier that dayo hence the bubbles, airplane and tiara,  I think normally the are for kids but i showed up as they needed to test them. Some nurses showed me cool tattoos,  others teased eleesha about being crazy, or awesome and after about 30/40 minutes of kinda hanging out with whoever wanted to talk I realized eleesha had been working as ll along.  She had all of my vitals.  She had a little pump / hose connected to my robe gown to blow air into it. There was a builtin air distribution contraption inside the gown which was kinda warm,  but made it so I did no sweat and was comfortable.  She had also had poked me wuthering a small needle to give me a local anesthetic before putting in a larger needle for the IV.  I had asked about the little air bubbles and she said that she is not worried about the little air bubbles.  It would take a lot of air to cause a problem.  After she had been feeding me some saline solution for about 20 minutes.  Stuff really started to happen quickly.

The nurse anesthesiologist came and asked if I had any questions. And I told him I thought I would be a light weight and that I might sleep a long time if they put me under. I Asked if i could watch and he said the procedure is too brutal.    Also He Said That If I Were Awake the my muscles would guard the joint and cause issues with the surgery. I understood and said no further questions

Next a full anesthesiologist came in to put a block on my knee. They brought in an ultra sound device and found a nerve in my inner right thigh.  He poked a large needle ( I don't know if the used a local to make the big needle less painful,  but I did not hurt)

He said he needed my help finding a bf that would block the pain.  So he asked that I tell him when I felt a twinge.  He moved the needle around a bit and I found the nerve,  it was odd I actually as I felt an electric shock (not painful, just a sensation,  travel 4 to 6 inches down my leg in two separate braches.  Then I think he poured in the juice.

After he left, the place got real busy.  A$ guy named Scott that I played soccer with for a couple of seasons on and off was a nurse there and he  recognized my name and came and tried to chat with me, but midway through the convo the registered nurse ( I didn't catch her name) interrupted to make sure I knew my name, dob, etc.  We started moving the bed and there were like 6 people in the 18 by 8 foot room for a bit.  They must of given me drugs by now because I don't know what they were doing.

Pretty soon they were moving the bed to the or, and the drugs must've been kicking in cuz I thing I slept fo a good part of the ride, so I don't know of it was 20 senond or 5 minute ride.

When I got in there I looked around and there were about 8 people with there backs all turned to men. Positioned along counters and areas around the room.

Someone told me to switch over onto another or bed so I did a kind of lame squiggle over on to the bed and I tried to make a joke about how it would have been easier for me if 4 people would have each grabbed a corner and they coulda done a movie style quick transfer.  Unfortunately, I did not even understand what I was trying to say and so I doubt they could either.  But that was the last thing I remember.

The next thing I remember I am waking up in a post op room.  Janae was there and said I was not making much sense. But I was waking up and it was only about 440.  Janae left with eleesha  ( who had apparently gone off the clock, and jumped into street clothes) to go get prescription drugs.   I made some joke about the drugs making me want cheetos.  But this lady was not into joking   she brought me vanilla pudding.  We had a coversation about warm tapioca but most of my question about what about the post op were not answered.  Really she told me that your wife has been briefed on that.  She was not as personable as my preoperative team.  She also seemed a bit confused by the information that eleesha was gonna drive me home we hole my we if went to get drugs.  (Seemed odd to her that their nurse we would be taking a patient home.  I thought better of the idea and decided not to say that we had formed a special relationship in preop)
Anyway all that was wrong. My wife was just waiting in the waiting room. She coulda taken me 15 minutes sooner.

Anyway,  she came back and they transferred me to a wheelchair, out some side door and down a ramp that woulda dumped me into the bark and bushes if I'd been a more momentous dude.  Dr hassinger was out there,  as he was as lso leaving.  I Said my thank yous and awkward ly fit my straight leg into my front seat bt perching my butt on the edge of the seat so my leg was straight in to the legroom area.  I drove away...

Sunday, June 21, 2015

Bike hand pump -not enough pressure

I recently went to performance bike to get a bike pump for my mountain bike and I learned something interesting.  The portable hand pumps have the internal works to be able to provide high pressure, but it can be difficult to get the tire to those pressures with the short compact pumps which require you to push the pump plunger directly at the tire while the other end is connected to the valve.
So it seems there are really two simple options. A larger  floor style pump(which you can drive you pressure into the ground with more force to get a higher air pressure in the tube) or co2.  After looking a bit more though I found an little more bulky hand pump with an airline off of it which allowed you to connect the line to the valve and then pump the body against the ground in order to get enough pressure.  This option works pretty good and will make sure I don't run out of CO2 and can still get a high enough pressure on the road.

EMBA Course Complete

I finished the first year of our boise state emba course on saturday  (6/20/2015)
It feels good to have a month off but I really enjoy the networking I get with the other on the class.

On Saturday an awesome team chose to help my company go to vietnam to open an a sattellite office of programmers. Brent Layne Mark and Shannon.

I don't know how I am going to avoid working on it all summer.

Wednesday, June 17, 2015

Google reigns

Today I realized that even though I am pretty tech saavy, Google has not quite infiltrated my life near as much as my childrens generation.

I was giving good directions to where I wanted to meet my son and on about the third sentence he says "Dad, I'll just Google it".

Tuesday, June 16, 2015

Great dane puppy eating to fast solution - muffin pan

I'd been noticing that as out great dane was eating. She has been trying to eat faster and faster.  We have always free fed our dogs allowing them to eat when ever they want and Beatrix basically does, however when she does eat she seems to attack it with vigor.  It seems as though she would make herself sick. 

Janae researched it a bit and finally heard the vet suggest that we feed from a muffin pan.  The smaller size only allows he to take smaller bites.  It certainly dies slow her down naturally and it only takes her about 50% longer to eat.

Thursday, June 11, 2015

Knee Price Research - meniscus and ACL Reconstruction

So,  I dont have an ACL any more,  the MRI confirmed it,  I have a tear in my meniscus.

I need surgery.  I have the choice on whether I fix one both or neither,  so I ask Dr. Lewis whether it is cheaper to do both,  he says,   it will probably be almost the same price to do both of them at the same time,   he described that the cost of his time is minimal compared to the other costs.  So.  it is time to do some research.  hopefully someone else finds some use in this information.

I went into to ISMI in boise with DR Lewis who told me I needed the surgery and I connected with Penny Dunlap, RN in their office for some surgery scheduling.  I asked about the procedure codes and costs and she gave me two,   the Meniscus surgeryis 29881  and the ACL Reconstruction is 29888.   She said their is also a discount if you do both of them but she did not give them to me.
  • Dr. Lewis ISMI Fee - 29888 - $2875
  • Dr. Lewis ISMI Fee - 29881 - $1590
Penny helped me to understand that there are two other fees I have to worry about,  the fee for the facility I would be going to,  as well as the anesthesiologist fee.  She gave me the number for the Treasure Valley Hospital,  where she said the cost is most efficient,  and I can ask them for the cost of the Surgery facility,  and i can also ask them for the contact information from the anesthesiologist so I can get the cost from them.

It takes a couple of days to get a call back from Treasure Valley as it turns out it is done by a single person,  not a department.  (Leslie @ 208.373.5057)  In the mean time I figure I will do some searching at other local facilities to get some perspective on cost.
St Als - Boise
St Als provides their prices right on their website where they list the prices at 
  • 29888 - $21316.56
  • 29881 - $9450.41

Wow!  that is speedy,  especially compared to the amount that the surgeon would make,  I am imagining that the cost will be significantly lower at Treasure Valley,   but I will wait to hear back,  I needed a bit more,  and since I had done a cost comparison on my MRI and found that the cost of an MRI at the Imagining Center of Idaho was only 575 cash price (compared to something like $1500 out at Treasure Valley imaging)  I decided to also call a surgery center out in Caldwell to find out if there is a significant price difference.   So I called Idaho Surgery Center.  I also left a message for Deb out there,  but this time I left on her voicemail the numbers of my procedures,  and I gave her permission to leave the costs in a voicemail if she was unable to get ahold of me.  We will see who calls back first.

Treasure Valley Hospital
I called again on a third day and left a detailed message about what I was looking for with TV and this time Leslie from TVHospital called me back very quickly.   She confirmed my insurance information after I asked about both a cash price as well as the insurance price.  I told her I was Blue Cross of Idaho and she explained that their deal with BC of I was so good that I would certainly want to use that.  She called me back after 10 minutes or so of research to give me the  pricing details.

  • Self Pay for both procedures 29888+29881 is $10450
  • Insurance Price for both procedures  29888+29881 is $5562.07
She went on to explain that their policy is require payment of half of the cost upfront for unmet deductibles. so in this case it would be $2900 upfront.  She further went on to describe that if needed we would likely work out a payment plan on the rest for up to a year and then it could go to collections.  In this case it sure seems like the insurance price is better,   even the higher self pay price is  less than half of the cost of St Als (unless St Als also does some discounting for combining procedures)

Leslie then gave me the number for the Anesthesiologist , (800.275.8752 x 2855),  Which was answered quickly by someone saying "Anesthesiologist consultants".  They transferred me to someones voicemail where I told the person a bunch of information about what I was looking for

Anesthesiologist Consultants
So,  anesthesiologists provide a different service and there fore have an additional cost.   Heather from the company called back within a few hours and since I left the information about the procedure codes on the voicemail she was very prepared when she called me and had details of the costs.   I had told her it was 90 minutes of OR time,   and there was to be a femoral and or knee block. (Penny from ISMI told me all of this).  Heather told me that for 90 minutes of time the self pay cost is $935,  and the Blue Cross of Idaho rate  is $610 dollar.
  • Self Pay $935
  • Insurance Price $610
It seemed to me that the cost was a little bit low so I asked if that included the drugs in the case that I had a Femoral Block or Knee block,  and she politely explained that those products are not provided by them.  the only thing they cover is the time for the anesthesiologist. So I have to go back to Leslie @ Treasure Valley Hospital to make sure the cost of the drugs is covered by the procedure quote they gave me.

Combined
With the information I had above I need only two additional pieces of information,   
  • Whether the cost of medications administered by the anesthesiologist are covered by the procedure cost quoted by Leslie at TV Hospital
  • What the discounted cost from Dr Lewis/ISMI would be when combining both 29888 and 29881.   (I am also curious about the cost through Blue Cross of Idaho or for the self pay rate)
I received calls back from Leslie at TV Hospital and Penny at ISMI,  and I found a little bit more information about the costs.
  • Leslie confirmed that all of the costs of the procedure are indeed included in the codes she described to me.   On thing that helped me understand a bit more about the way that TV Hospital prices,  and Blue Cross of Idaho pays:    The costs of the two procedures was based on the first (more expensive procedure) at full price and then the second procedure code was reduced by 50%.    Anyhow,  she confirmed that the total cost from TV hospital would be $5562.07.
  • Penny described in more detail the cost break down of the ISMI Dr (Dr. Lewis)  The cost is 
    • 29888 - $2875
    • 29881 - $1595 - Blue Cross discounts this second procedure by 50% so the amount I have to pay towards it is 797.5
    • She also identified a new cost,  the cost of an assistant for the surgery.   I am a bit confused about the cost of the assistant as it oddly coincides with the full cost of 29888 but my understanding is that the cost of the assistant is also $2875 but that BC discounts that price to 20% which would be $575.
So,  the total of the costs are
  • ISMI - $4247.5 (2875+797.5+575)
  • TV Hospital - $5562.07
  • Anesthesiologist - $610
For a total of 
  • $10419.57
 
------- edit to add

But wait,  there's more I decided I would move forward. And when they asked when I would like to get this done I said "Monday"  because I want to get it over with so I can be healed up when I travel internationally to Vietnam. (Also I need to get back in shape, I've already gone too long without soccer)

She says well we can't do it for 5 more weeks at treasure valley (since dr lewis only has thursdays at TVH) But we can do it in two weeks at St als since they are not as booked up.

I asked whether they have another surgeon that could do it and she said, well we don't really do that.  I responded thouh that I do that. (My point being that the dr i paid good money to doesnt own my business) then she said that none of the ISMI surgeons would take someone else's patient. 

So now I have to look at the amount that blue cross is contracted to st als for.   I call at als at 208.367.cost and a lady by the name of Gaye picks up and let's me know the combined price of my two procedure codes was more than 20k.  

So it looks like the decision to me is whether 3 weeks of wait time it worth 19k instead of 5562 for the hospital portion.

You would think that with this decision I would just decide to save my insurance company some money and go with the July 23rd surgery time.  But no, ISMI has left a bit of a bad taste in my mouth by introducing their politics into my ability to choose,  I had to keep looking.

I ask a nurse friend of mine if she knew any other surgeons that might be able to get things done more quickly.  Turns out she did.  She recommended that I look up Sean Hassinger at Allied Orthopaedic.  They are located in the same building as DOC, which is the walkin orthopedic facility and he got me in same day.  I don't think he would have been able to do this for just anybody but it sounds like he extended his day on a favor to the high powered nurse friend.  So here I am again seeing another Dr to potentially schedule the surgery.  The only difference now is that I understand all of the costs (Dr hassinger provides surgery at treasure valley) and the entire patient visit is predicated on a plan for a quick turn around surgery.

Dr hassinger is in network at blue Cross so the pricing is the same as ismi.  My nurse friend and I exchanged text messages about it on Tuesday late nite. She talked with Dr hassinger at non we essay and he ft me into a busy schedule at 4pm that day.  He agreed I needed ACL reconstruction and meniscus repair, but differently than dr lewis, he was able to test me knee and from a fail confirm that I had a  missing ACL.  While lewis had said it was optional hassinger said they would not do the Meniscus removal/repair without the acl.  Since my body had maybe been coping with the acl as the primary knee stabilization for 20 years.  To have the secondary stabilization partially removed (Meniscus)  would leave the knee in bad shape.  Additionally he had a recommendation that at my age I go for the cadaver tendon in my acl reconstruction I stead of using my own tendon from my patella.  The recovery with the cadaver is 3 month longer but at my age (sheesh) the extra 3 month is nothing compare to the horrible pain of the patella bone cutting and knee slicing they have to do for the patellar.

Then,  he awesomely scheduled me for surgery only 6 days later. (June 23rd )

His office immediately contacted me to tell me about the continuous movement machine that will help for faster recovery.  They said the machine was mobile and j will need to put my full leg in it 3 times a day and it will keep my knee flexing for a period of time to keep the scar tissue down.  This is 50$ day and since he was not able to get me in to a post op appt for 17 days (he normally likes to see you 7 yo 14 days after) the cost will be 850$ for the machine. This cost is not anything I expected and neither of the the drs or offices described the potential for the cost before the surgery.  For future procedures I will be sure to always ask about any post op items.  Anyway, they also said that blue cross will cover the cost and it is already pre approved.  I did not check the rate it is preapproved at since the time between the pre op and surgery appt was 6 days and I had hospitals calling and  3 days of MBA school including a culminating presentation and a smaller pitch for year two to complete in that time.  The 50$may be the blue cross rate or it may be the precontracted rate. Either way it adds 850$ to my procedure.
I am sure I will find out about the additional costs of a physical therapy regimen at the post op.

Sunday, June 7, 2015

Great dane puppy. Pool

Today we spent a little bit of time on the top step of the pool.  Only 2 or 3 inches of water.  And she jumped in and out on her own a couple of times.  She seems to like it, but barked at roxy and ran around the pool with some urgency as roxy did a couple of laps.  She pawed  at the water and took a couple of accidental spills onto the economy step which had her whole body immersed except he head.  She had to get out immediately.  We will try again soon.

Thursday, June 4, 2015