FRUSTRATED AT FIVE WEEKS

Prior to surgery for TKR there is a required class, a pile of paperwork, binders full of information all about the pre-op process, the surgery and preparations and equipment needed  for the  home. We are told there will be a call to set up PT appointments and a couple of follow up visits with the surgeon's staff. 

At the time time it seemed like a lot of information.  I was anxious about the realities of  recovery, but I  assumed there would be more guidance offered along the way.  Bad assumption. The last tab in the binder is "Follow-up".  There is one sheet of paper with a phone number. The number is for a general appointment call center.

At two weeks I saw the PA. he took off the dressings and advised on care (basically, do nothing to it - no creams, etc.) renewed the Percocet prescription while suggesting I should start reducing my use, asked about PT and that was it. 

I moved from home based PT to a class twice a week.  We rotate from exercise equipment and stretches and are measured to determine our level of flexibility. I am aware there are goals, but they are not discussed... We are told to do the stretching 3-4 times a day at home, not to spend too much time walking around and over using the joints.  The PTs are very nice and very reluctant to discuss any issues other than the class related exercises - we are told questions should be referred back to orthopedic staff.

So I have been waiting longer to take the pain medication, using ice and elevation more to help the pain, doing my stretches many times during the day, taking breaks between tasks so I don't cause additional swelling, only using the bike once a day as I was told - in other words, doing my best to be a good rehab patient.  I have seen the small increases in flexibility and mobility but wonder if I ould be doing better.

So why am I frustrated at five weeks?  I am still very stiff and experiencing a lot more pain than I was in the first post-op weeks.  I am very pain tolerant - not one to whine.  I find myself whimpering and screeching in pain quite a bit.  I am not afraid of getting hooked on opioids, I have been fine with taking the meds as I feel I need them, but there have been many days and nights the pain has gotten ahead of the medication and there lies much misery. One day I go 7 hours before feeling the pain building and another night I'll wake after 4 hours in throbbing pain and can't sleep. So how do I do this?  I need guidance. 

I emailed the surgeon's office and requested a consult.  They referred me to my GP who offered me a phone consult a week away.  Sigh.  If it is like the last phone consult I had with him, he didn't even know why he was on the phone with me and was not prepared.  It was a complete waste of time.  So I called my future daughter in law, a nurse, to discuss whether I should add an OTC between doses  and how much.  She was a great help.

There doesn't appear to be anyone in the orthopedic office available to discuss the rest of my questions, goals and concerns.  I have a follow up appointment on the 28th, so I hope there will be some answers then.

The other issue weighing on my mind is going back to work.  I can't even imagine it right now.  I can't sit for 8 hours at a computer being kind and helpful when I am in pain after about 20 minutes of sitting and need a break to move around and stretch out.  Can't exactly strap on my ice machines while at my desk!  So how do I get there from here?  I am expected back at work in less than 3 weeks - will everything suddenly turn around?

It doesn't seem reasonable to cut me apart, add new parts and sew me back together and then leave me to figure this out on my own.  Right?

FOLLOW UP...

I finally got the lab test codes from my doctor - I think even he is amazed at how hard it was to find out the cost of the tests he ordered.  The cost for 3 blood tests comes to about $400.00.  That is nearly 2 weeks take home pay for me - ironically due to the high cost of my medical insurance.

So - knowing most tab tests are done by machines and not even by real trained people with jobs - why so much? One blood draw, program the machine and send the results. I don't think lab tests cost this much when done through a regular insurance plan, why so much for one where I am paying out of pocket before my deductible is paid?  A doctor asked and answered this question:

I can think of at least two reasons an insurance company might price services so outrageously high on certain policies. First, that would punish anyone who buys inexpensive insurance with a high deductible (both of these patients did). Second, they keep you from finding out how much (little) medical service really cost. Patients with high deductibles pay for most of their own medical care. The insurance companies make sure that these patients see a much higher price than the “real” price that they could pay. Just as with generic prescription drugs, insurance companies, not providers determine the price of everything. They can hide their real costs, and punish you for not buying a more expensive plan.

I have to admit I didn't realize that the insurance companies were quite so devious.

I did know that they spend a lot of money touting tort reform as an answer to high medical costs when legal costs are actually only 2% (mostly for their own lawyers.).  But I didn't know that the highest cost for insurance companies - 56% of their expenses - is for product design, underwriting and marketing. 

So the design and marketing of my high deductible plan is the reason my out of pocket/pre-deductible blood tests are so outrageous.

Wow. That is twisted.