Descriptions of (possible) procedures

I've gone and done a ton of research about the "possible" things the dr may do to my hip. I appreciate that they have to request all the possibilities for approval from the insurance company, but hey, inquiring minds want to know what could happen in there!

Here is what I came up with. If anyone has better descriptions then what I found on the web, please let me know.

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Psoas release
Vastus-Psoas release for acetabular exposure in revision hip surgery.A technique is presented for wide exposure of the acetabulum for revision total hip arthroplasty surgery in the presence of a solidly fixed, modular, or monoblock femoral component without the need for trochanteric osteotomy. The technique involves release of the proximal portion of the vastus lateralis, vastus intermedius, and vastus medialis muscles and the iliopsoas tendon form the femur and placement of the femoral head/neck posterior to the acetabulum. The exposure afforded by this release usually precludes the need for trochanteric osteotomy and/or removal of a well-fixed femoral component in revision surgery that is being done for isolated loosening of acetabular components, thereby decreasing operative time, morbidity, and the risks of complication of trochanteric osteotomy.

Arthroscopic psoas tenotomy. Wettstein M, Jung J, Dienst M
Department of Orthopaedic Surgery, University Hospital, Homburg/Saar, Germany.
Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months. Published 14 August 2006 in Arthroscopy, 22(8): 907.e1-4.

ITB release (Iliotibial Band Release Surgery)
What is iliotibial band syndrome? Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. Cause: ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury.
Title: Endoscopic iliotibial band release for external snapping hip syndrome.
Author(s) Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J
Institution Department of Adult Joint Reconstruction at the National Rehabilitation Institute of Mexico Orthopaedics Institute, Mexico City, Mexico. vichip2002@yahoo.com.mx
Source Arthroscopy 2006 May; 22(5) :505-10.
Abstract PURPOSE: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. TYPE OF STUDY: Prospective consecutive series of patients.
METHODS: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30 degrees arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect.
RESULTS: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity.
CONCLUSIONS: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures.

Excision of heterotopic ossification
Heterotopic ossification (HO) is the abnormal formation of true bone within extraskeletal soft tissues.

Debridement trochanteric bursitis
definition: SURGICAL DEBRIDEMENT - The surgical removal of dead tissue, debris, and contaminants from a wound.

What is hip bursitis? Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. In those few cases where surgery is needed, this can be done through a small incision, or sometimes it can be performed arthroscopically. Either way, the bursa is simply removed (called a bursectomy), and the patient can resume their activities. The surgery is done as an outpatient, and most often crutches are only used for a few days. Patient's do not need a bursa, and therefore there are few complications from this type of surgery. The most common complications are anesthetic-related complications, and infection.

Acetabuloplasty
ac·e·tab·u·lo·plas·ty (s-tby-l-plst) n. Surgical repair of the acetabulum; plastic surgery on the acetabulum intended to restore its normal state (as by repairing or enlarging its cavity)

Osteochondroplasty
Osteochondroplasty is an arthroscopic removal of excess bony osteophyte that affects the geometry of the hip. Treatment for FAI.

Labral Debridement
remove a tear in the hip cartilage

Labral Repair
repair a tear in the hip cartilage

you learn something new everyday

I came home one night this week to find a letter from my insurance company. I knew the surgery was approved, so I wasn't too concerned. The letter listed the Requested Services Summary and various service codes and descriptions of said service codes. One of the descriptions concerned me as I had not discussed it at all with the doctor. As I am prone to jumping to conclusions at the moment, I flipped out a bit. Thankfully my mum put up with my waking her and ranting on for an hour on the phone. (I owe her a couple of hours of sleep now :-) )
I emailed the dr's office the next day and thankfully they got back to me within a few hours, which is good for them. They asked for the codes and then sent me back a list of code descriptions that the dr uses. It seems the insurance co uses different descriptions, probably to intentionally torment you!
The email from the dr's office basically said (I'm paraphrasing)
"XXXXX is a very tricky insurance company. We have to get authorization for all of the possible codes he might do. If I know the CPT Code (service code) I can tell you what our description is. Each insurance company has their own descriptions and can confuse patients!"
This list helped a lot as it clarified what I was concerned about, but I will still discuss with him before surgery. I am going to bring a list to review before, I'm sure he'll love that!
So learn from my hysteria and talk to the dr before trusting what the insurance company says.
I've also now have a list of the technical medical terms and have done more searches on the web and printed out articles to read. Maybe not a good thing, but I am curious about the details of what will be done to me!

Bloody Hell!

Well it seems no matter how you try you just can't win!
I received a call back from Dr. Kelly's office quite quickly after my email. This it seems was not a good sign. I was told that even though my insurance said I have a DME benefit, that once they received the information the claims would still be denied, because you don't need a CPM for hip surgery and you can use ice instead of the game ready. Basically they go for the cheapest way out to not pay. Bugger! Plus, something I do not recall being mentioned earlier, I was told that HSS has a "very strict policy about DME's and where they are supplied from". Kickbacks anyone? Either way, I'm completely buggered and will have to pay out of pocket for both. ARGH!

On a different note, I am searching for a certain type of crutches that seem to be the best for me with my crap hands and shoulders. They are called Platform crutches, similar to forearm but not quite the same. Of course they're expensive and hopefully I will be able to get a hold of these if the PT approves. My main concern is not to destroy my hands whilst trying to save my hip.

Ain't life grand?

Well, the good news is that the surgery was approved, so I guess that is one less fight for me!

insurance insanity

I received the various papers from Dr. Kelly's office this weekend and did not really feel like dealing with them until today.
I guess if you can't plan a holiday, then planning surgery is an option!
I rang up the anesthesiologists office first to see if they are covered. They do not participate in any plans. Ok, fine, the dr's office warned me. However the woman I spoke to in their billing department was very helpful. She said to ring up Oxford and tell them that the Dr and the hospital both participate in the plan, and ask to what extent the anesthesiologist would be covered. Yippee! Ms. Crystal said that since both are covered then the anesthesiologist would be covered as "in network" status. That was definitely one thing off my shoulders.
The onto what is know as "Durable Equipment". I never heard this term before, but it seems the machines the dr wants you to use after surgery fall under this title. The dr's office did tell me that even though the insurance will say that they cover the CPM, when they see the diagnosis for hip they will not, as the machine was made for knee issues. A bit daft if you ask me b/c there is no CPM specifically for hips, but that's insurance co's for you! But it can't hurt to try to get some coverage! I asked Ms. Crystal at Oxford about this and she gave me a list of the nearest Ortho places that they work with for DE's. I rang up one and they referred me to their LI office, saying that all equipment can be sent into the city. They seemed most helpful when I rang, took down all of my information, and asked that the dr's office fax over a prescription for what I need. I've just sent an email to the dr's office requesting that prescription be faxed over (lets see how long this takes). If there is any way I can get some of this covered I'm sure as heck going to try! I have a feeling all of the incidentals are going to add up!

Expecto Patronum

"The Patronus Charm conjures an incarnation of the caster's innermost positive feelings, such as joy, hope, or the desire to survive, known as a Patronus. A Patronus can be viewed as the exact opposite of a Dementor. Even though it embodies all the positive emotions that a Dementor feeds on, a Patronus is conjured as a protector, and is a weapon rather than a predator of souls: Patronuses shield their conjurors from Dementors, and even drive them away. A Patronus "cannot feel despair, as real humans can, so Dementors can't hurt it." The conjured Patronus protects the witch or wizard that summoned it, obeys his or her commands, and fades away shortly after it is no longer required."
"Etymology: The Latin word patronus means "father" or (in archaic Latin)"guardian" (see patronus)"protector" . The plural of patronus is patroni, but the plural of the term as coined in the books is Patronuses. The incantation for the charm is Expecto Patronum. The Latin word expecto, means "I await." A rough translation of the incantation is thus "I await (my) guardian/father."
In the French version of the book, the spell is "Spero Patronum". Spero means "I hope" or "I expect," much as ex(s)pecto means "I expect, I await." This could mean that the spell is based on hope and faith."

Well, this brief history of the Patronum spell is to help me to remember what to do when I feel as I have the last few days - utterly depressed. I am not keen on whinging and would rather lock myself up alone than go on and on about all that is wrong.

So, lying in bed tonight, when I should have been asleep (crikey even those pills aren't working now!) I came to an enlightening thought. Of course this could be because I've recently finished the last HP book and only yesterday saw Order of the Phoenix. But never mind that. The thought that stuck with me is this, well, it's what Harry says - think of the happiest memory you can to create your Patronum.
Since nothing else has been able to get me out of this funk lately, I tried to do just that. And it was pretty simple. The memory I came up with was of the hugs I get from my nephews. So from now I on when I am feeling like crap, and I don't just mean physically, b/c that's 24/7, I will think of my two favourite people and the wonderful hugs they give me. And hopefully that will be able to keep those Dementors away!