Saturday, May 30, 2009

Babies and Baby Fever

I've admitted it here before--I have baby fever! It seems like most of my friends are either pregnant or have had babies this past year.

So many people have asked when Matt and I are going to start a family. It's going to be a while. If we plan it perfectly, maybe Spring of 2011 after I graduate from anesthesia school?!?!?

I'm sure I'll be ready by then. I feel like I have learned from each of my friends during their pregnancies and some of my friends even let me "practice" on their kids! This past Thursday, my friends Kat & Paul went out to a movie while I kept their two precious daughters Ashley & Abigail. I have to say, they have the best babies. Ashley was fast asleep in her crib. I didn't even get to see her except on their tiny little baby monitor screen. Miss Abby woke up, drank 4 oz of formula, we talked and played for 45 minutes, then she fell asleep in my arms while I sang "You are my Sunshine" over and over. PERFECT!

After class on Friday, I met up with a couple of my high school friends, Sarah & Keva, at
Mi Cocina in Fort Worth. I haven't seen them in over 8 years! It was so nice to catch up.

After lunch we headed over to the
Fort Worth Botanic Gardens so Keva's kids could run around and we could talk and share pictures of our families. It was so nice to know that they are both doing so well and are happily married.

Unfortunately, we forgot to take pictures before Keva had to pick up her daughter from school. Matt stopped by and clicked a couple of pictures of Sarah and me. Sarah is almost 20 weeks pregnant--so cute!

I am really looking forward to catching up with more of my Rains High School class of 1999 friends at our 10 year reunion on June 13th. Especially, Catherine and Stacey who I keep up with in the blog world, but haven't seen in way too long!

Saturday, May 23, 2009

History & Letter to insurance company

It's true. I'm getting old.
I can't believe that I had to dig up information from thirteen years ago regarding my knee history. (FYI-hospitals are only required by law to keep records for 10 years!) Luckily, I was able to obtain all of my records; which I thought was impressive given the time frame and the fact that the hospital has changed ownership/management three times!

In order to plea my case for medical necessity with my insurance company, Carticel (Genzyme or US BioServices) reps helped gather all of my information to present to them as a package. I felt a little overwhelmed at all the information but knew that I could do a better job at explaining my history and current symptoms than all of those pieces of paper. So, I decided to write them a letter of explanation.

Many times patients will write a letter similar to this after their request for precertification (pre-determination of medical necessity) of procedure has been denied. I wrote this letter in hopes of gaining approval the first time.

So, for those you you that are interested in my medical history or those who wish to have a format or help with wording or content for your letter, see below.


Medical Review Board
P.O. Box 981106
El Paso, TX 79998-1106

Dear Sir or Madam:

I am writing to provide you a streamlined history of my left knee problems so that I might be of assistance in expediting the review process.

My left knee pain began in July of 1996 after I was a passenger in an MVC. Emergency room x-rays revealed a foreign body. Later that year, after intermittent locking and pain, I was seen by Sandy Bahm, M.D. In April 2007 Dr. Bahm performed an arthroscopy with foreign body removal. At sixteen years of age, not much could slow me down. I continued to be active in sports, running and cheerleading, but in 1998 the pain worsened and prompted me to return to my orthopedic surgeon. At that time Dr. Bahm ordered physical therapy for strengthening and I continued to treat the pain with NSAIDS, rest and ice. After about a month of PT, I had increasing pain with activity; a second arthroscopy was performed with microfracture of my lateral femoral condyle and partial lateral meniscectomy. Post-operatively I was involved in physical therapy but discontinued running and cheerleading per physician’s request. Pain remained at a basal level after that but never returned to a zero.

Again, in 2000, while I was an undergraduate in college, my knee began to grind and lock at times. After a few months of being symptomatic, Victor Ayers, M.D. performed a third arthroscopy. At that time a lateral meniscectomy was performed and “healing” of the lateral femoral condyle was reported to me.

In 2003, I graduated nursing school and began my career as an intensive care nurse. I continued to have intermittent pain that was mostly alleviated with NSAIDS and rest. I have maintained an active lifestyle with low impact activities like cycling and elliptical for cardiovascular health.

In February of this year, after riding a stationary bike at our fitness club, I experienced increased left knee pain. Over the next couple of weeks pain was not alleviated with NSAIDs, ice or rest and worsened with any activity. I saw an orthopedic surgeon (Bruce Prager, M.D.) and had an MRI done. When he suggested surgery, I consulted a personal friend who is a Sports Medicine doctor and he referred me to James Bothwell, M.D. Dr. Bothwell reviewed my MRI and examined my knee in the clinic. On April 9th 2009, Dr. Bothwell performed my fourth arthroscopy (see findings per OP report).

Today, I consider my knee recovered from my most recent arthroscopy but I continue to have significant pain with any physical activity. I am riding a stationary bike and doing strengthening exercises three to four times a week as tolerated. I have pain at times that renders me incapable of concentrating and unable to sleep at night. I continue to take NSAIDS on a regular basis and hydrocodone as needed.

Dr. Bothwell has discussed all of my options with me. He believes that I am a good candidate for surgery and that I will significantly benefit. My healthcare background gives me the ability to completely understand the procedures, benefits and associated risks. I understand that compliance to physician orders and physical therapy regime is pivotal in my recovery and success.

My knee injuries cannot heal on their own and procedures can only be successful if performed concurrently. I have had knee pain for over a decade and I am looking forward to this opportunity for restoration of function and some relief of chronic pain.

Thank you for your time in evaluating my case. Please feel free to contact me with further questions.


Friday, May 22, 2009

Knee News - Post surgical update

Thank you to everyone for your care and concern after my knee arthroscopy.

, it wasn't too bad and I was back on my feet after a few days.

, I got bad news on the results and another surgery is around the corner.

Those are my arthroscopy pictures. To the untrained eye it looks like a circle with white, black and pink inside. Actually, with a little help, I was able to see exactly what they were explaining to me.

So, here it is (diagnoses) :
1. Partial ACL tear

2. Femoral condyle articular cartilage defect 4.5 cm x 4 cm

3. Absent lateral meniscus

The plan is to reconstruct ACL, meniscus transplant and chondrocyte implantation (ACI) on the femoral condyle. These procedures are invasive, expensive and require special medical board review by my insurance company (Aetna) for pre-approval.

I have researched these procedures extensively on-line and have appreciated the few blogs that I have found that provided personal experiences. I hope to post information about my journey that could help guide others seeking knowledge.

In the mean time, I hope not to bore my casual friend and family readers!

Wednesday, May 20, 2009

Rossi's Haircut

My dog, Rossi, is the cutest Minature Schnauzer ever! We call him "Little Man" because he has always looked like a little old man with his long beard and eyebrows...but Matt took him for a haircut.

Honestly, I cried when I saw him. They cut his beard OFF! He didn't look like the same dog and he didn't even come to me (I think he knew that I wasn't happy)! Now, I'm getting used to his new cut and actually like it. I think he looks like a puppy--and that is good considering my Little Man is now eight and a half!

Tuesday, May 12, 2009

Grandpa's New Toy

When we pulled up at my grandparent's house this weekend, this was in the driveway.

That is the Can-Am Spyder Roadster

Pretty cool--especially considering that it belongs to a 70-something year-old grandfather of four and great-grandfather of two!

Grandpa generously let us take turns riding around his land and the guys ventured out on the road.

Yes, it is road worthy; with its three wheel Anti-lock Brake System, the Traction Control System and the Stability Control System it is relatively safe. Grandpa has logged over 2000 miles on it and has already take his first road trip down to Houston.

Monday, May 11, 2009

Happy Mother's Day!

This past weekend, Matt and I headed out to East Texas to visit with my Mom and Maternal Grandmother for Mother's Day. We had a relaxing day at "The Farm" where we enjoyed family, friends, good food, walks through nature and our own little photo shoot.

Sunday, May 3, 2009

Sunday Study Song

I know, how boring...another YouTube song post.
Sorry but my time is very limited. Final exams start tomorrow and all I have been doing is sitting here at my desk studying and listening to KLTY on the radio.
Of course the perfect song comes on--and always at the perfect time!
Hope you enjoy it too!


I was born in Tennessee
Late July humidity
Doctor said I was lucky to be alive
I've been trouble since the day that I got here
Trouble till the day that I disappear
That'll be the day that I finally get it right

There is hope for me yet
Because GOD won't forget
All the plans he's made for ME
I have to wait and see
He's not finished with me yet

I never really was that good in school
I talked too much, broke the rules
Teacher thought I was hopeless fool alright
I don't know how but I made it through
It's one of those things that you've gotta do
But I always had a knack for telling the truth

There is hope for me yet

Because God won't forget
All the plans he's made for me
I have to wait and see
He's not finished with me yet

Still wondering why I'm here
Still wrestling with my fear
But oh, He's up to something
And the farther on I go
I've seen enough to know
That I'm, not here for nothing
He's up to something

So now's my time to be a man
Follow my heart as far as I can
No telling where I'm ending up tonight
I never slow down or so it seems
But singing my heart it's one of my dreams
All I gotta do is hold on tight

There is hope for me yet

Because God won't forget
All the plans he's made for me
I have to wait and see
He's not finished with me yet!