Medical procedural questions (help in picking insurance)

[Mama Zappa]

So it's insurance "open season". Be vewwy, vewwy quiet, we'we hunting insuwance, ahahahahahaha.

In a near-perfect personification of that age-old children's classic "Head, and shoulders knees and toes", and helped by my turning 50... things are falling apart. The head = sleep study, that's no biggie. The toes = assorted foot problems, the occasional steroid shot / orthotics, again no biggie.

The shoulder: MRI will happen in January, but probably some problem with rotator cuff damage. Treatment may consist of physical therapy, maybe injections into the affected area, and possibly surgery.

The knee, also MRI in January, probably a combination of tendonitis and cartilage damage. may also require some arthroscopic surgery to clean things out a bit. This (and the shoulder) will obviously depend on the results of the MRIs.

The questions:
Shoulder surgery: usually inpatient or outpatient? Any experience or professional anecdotes welcome. Recovery times? How disabled and for how long?

Shoulder other: Are steroid (or other) injections commonly used? The doc didn't specifically say what the treatments might be; I'd suspect that PT would be step 1.

Knee, arthroscopic surgery: usually inpatient or outpatient?

Knee, other: having done PT for the knee many years back (and spent a year in near-constant pain, with no benefit except for really great calf muscles), I don't think that'll be on the table. Possibly injections (either steroid, or some sort of synthetic joint fluid). Any experiences with that, please spill! Steroid shots into my feet have been.... unpleasant so I'm not looking forward to THAT.

Anyway - at the moment, I'm trying to decide between various levels of insurance. I've already opted for the mid-level (no deductible but higher cost) and am trying to decide if I want to bump things up even further (lower limit on out of pocket but still higher up-front cost). Knowing more about the surgical options etc. will help me decide. It's fortunate that things have started falling apart JUST in time for open season.

[Pulp Friction]

I can help a little bit here...

Shoulder surgery: usually inpatient or outpatient? Any experience or professional anecdotes welcome. Recovery times? How disabled and for how long?

Almost always outpatient. Almost always a long, frustrating recovery (one year or more is not unusual, frustrating because of extremely slow, sometimes halted progress).

Shoulder other: Are steroid (or other) injections commonly used? The doc didn't specifically say what the treatments might be; I'd suspect that PT would be step 1.

PT for sure, including extensive PT post-surgery if you go that route. Steroid injections are usually but a temporary relief of the inflammation.

Knee, arthroscopic surgery: usually inpatient or outpatient?

Again, outpatient.

Knee, other: having done PT for the knee many years back (and spent a year in near-constant pain, with no benefit except for really great calf muscles), I don't think that'll be on the table. Possibly injections (either steroid, or some sort of synthetic joint fluid). Any experiences with that, please spill! Steroid shots into my feet have been.... unpleasant so I'm not looking forward to THAT.

If it is a severe, chronic condition, steroid injections are, again, just a stop-gap. If it is more of an acute issue - which yours does not seem to be - steroids can do amazing things. I don't know enough about synthetic joint fluids to speak to that.

Bear in mind that even outpatient surgery is crazy-expensive.

Best of luck.

[Mama Zappa]

Originally Posted by Pulp Friction

...(response to shoulder surgery).
Almost always outpatient. Almost always a long, frustrating recovery (one year or more is not unusual, frustrating because of extremely slow, sometimes halted progress).

PT for sure, including extensive PT post-surgery if you go that route. Steroid injections are usually but a temporary relief of the inflammation.

Well, THAT doesn't sound like fun any way I look at it. Obviously the course will depend on what they see when the MRI happens.

(knee surgery question)
Again, outpatient.

If it is a severe, chronic condition, steroid injections are, again, just a stop-gap. If it is more of an acute issue - which yours does not seem to be - steroids can do amazing things. I don't know enough about synthetic joint fluids to speak to that.

Bear in mind that even outpatient surgery is crazy-expensive.
Best of luck.

Thanks - yeah, steroid shots are not (as far as I can tell) the most likely treatment given that this is a chronic problem. Useful to know that it's probably outpatient. Actually from what I can read, I might pay *less* if it's inpatient due to the way one of the policies caps hospital expenses. Weird. I suppose I can manage a post-op asthma flareup or something .

Thanks very much for taking the time to reply. The inpatient vs. outpatient aspects of the potential surgery affect which plan is better so it helps to have an idea which way it'd be likely to go.

[Snickers]

I've no advice, sorry, but I did want to say that the second sentence of your OP rocks.

[3waygeek]

I had shoulder surgery two weeks ago to repair a small tear in the labrum (near the top where the biceps tendon attaches). I've been told that I should be at 100% in about 3 months. I'm still in a sling and will be for the next 4 weeks or so, and am doing PT, and did a couple months of PT before the tear was diagnosed via contrast MRI.

In my first post-op PT session earlier this week, the therapist told me that I'm where I should be at 6 weeks post-op, so things are going pretty well so far, well enough that I don't have to go back in for another couple weeks. One thing he did mention is that post-menopausal women are a bit more likely to have problems with the shoulder capsule freezing up post-op -- something Mama Zappa may want to consider.

[Mama Zappa]

Originally Posted by 3waygeek

I had shoulder surgery two weeks ago to repair a small tear in the labrum (near the top where the biceps tendon attaches). I've been told that I should be at 100% in about 3 months. I'm still in a sling and will be for the next 4 weeks or so, and am doing PT, and did a couple months of PT before the tear was diagnosed via contrast MRI.

In my first post-op PT session earlier this week, the therapist told me that I'm where I should be at 6 weeks post-op, so things are going pretty well so far, well enough that I don't have to go back in for another couple weeks. One thing he did mention is that post-menopausal women are a bit more likely to have problems with the shoulder capsule freezing up post-op -- something Mama Zappa may want to consider.

Thanks for the feedback! Was your shoulder the result of any particular injury, or did it "just happen"? (I suspect a combination of age and repetitive motion for mine).

I too had heard of the "frozen shoulder" concern and if we do surgery, I'll definitely keep an eye out for preventing that.

Snickers, glad I made ya laugh . We're big Looney Toons fans hereabouts

[3waygeek]

Originally Posted by Mama Zappa

Thanks for the feedback! Was your shoulder the result of any particular injury, or did it "just happen"? (I suspect a combination of age and repetitive motion for mine).

I too had heard of the "frozen shoulder" concern and if we do surgery, I'll definitely keep an eye out for preventing that.

Just happened -- it had been bothering me off & on for the last year or so, until it got to the point where I couldn't fall asleep at night. As far as I know, I didn't do anything to injure it -- it's my left shoulder, and I'm very right-handed. I've read that many people in middle age (I'm 47) have some degree of tearing in the labrum and/or rotator cuff, just from the normal wear-and-tear of normal life.

[AllShookDown]

Originally Posted by Mama Zappa

Shoulder surgery: usually inpatient or outpatient? Any experience or professional anecdotes welcome. Recovery times? How disabled and for how long?

Shoulder other: Are steroid (or other) injections commonly used? The doc didn't specifically say what the treatments might be; I'd suspect that PT would be step 1.

I had outpatient surgery in January to repair my completely torn supraspinatus tendon (part of the rotator cuff). I tore it either falling on the ice or while trying to get up from falling on the ice. There was no question as to whether surgery was necessary since it was a complete tear. I was off work for six weeks. The doctor would have let me go eight but I wanted my full paycheck back.

Oh, the horror stories I was told about what to expect. From people at the office, friends, the internet, the surgeon's nurse, etc. I was told it was one of the most painful surgeries one could have. He's going to drill holes in your bone! The nurse told me I was going to be in a LOT of pain! I was told I was going to have to have my arm in a sling 24/7 for six weeks.

I got home from surgery and set my alarm to take my meds every four hours and did that for about 6 days. After that I didn't even take so much as an ibuprofen. I had no real pain at all unless I bumped it against something. I did my passive resistance exercises religiously. At my two week post surgery visit I asked if I had to wear the stupid sling all the time and he said no. I asked about physical therapy and he said it was too soon. At four weeks I asked again and he said I didn't need physical therapy, that I didn't realize how well I was doing compared to most people that have the same surgery. I was afraid he was going to release me to go back to work the next week. (This was an older surgeon and I think his views on PT are old-fashioned).

I eventually went to physical therapy on my own because I was unable to reach behind my back without pain (hooking/unhooking the bra, holding heavy doors open, scratching my back). That helped a lot but I was in more pain from the PT than I ever was after the surgery.

At present, I still don't have all my strength back but I don't work at it much either. If you do have surgery, be prepared to be exhausted for the first couple of weeks back at work. Find out what pain meds they're going to give you beforehand and find out if it's going to make you constipated. That was the thing nobody warned me about.

[Mama Zappa]

Originally Posted by AllShookDown

I had outpatient surgery in January to repair my completely torn supraspinatus tendon (part of the rotator cuff). I tore it either falling on the ice or while trying to get up from falling on the ice. There was no question as to whether surgery was necessary since it was a complete tear. I was off work for six weeks. The doctor would have let me go eight but I wanted my full paycheck back.

Oh, the horror stories I was told about what to expect. From people at the office, friends, the internet, the surgeon's nurse, etc. I was told it was one of the most painful surgeries one could have. He's going to drill holes in your bone! The nurse told me I was going to be in a LOT of pain! I was told I was going to have to have my arm in a sling 24/7 for six weeks.

I got home from surgery and set my alarm to take my meds every four hours and did that for about 6 days. After that I didn't even take so much as an ibuprofen. I had no real pain at all unless I bumped it against something. I did my passive resistance exercises religiously. At my two week post surgery visit I asked if I had to wear the stupid sling all the time and he said no. I asked about physical therapy and he said it was too soon. At four weeks I asked again and he said I didn't need physical therapy, that I didn't realize how well I was doing compared to most people that have the same surgery. I was afraid he was going to release me to go back to work the next week. (This was an older surgeon and I think his views on PT are old-fashioned).

I eventually went to physical therapy on my own because I was unable to reach behind my back without pain (hooking/unhooking the bra, holding heavy doors open, scratching my back). That helped a lot but I was in more pain from the PT than I ever was after the surgery.

At present, I still don't have all my strength back but I don't work at it much either. If you do have surgery, be prepared to be exhausted for the first couple of weeks back at work. Find out what pain meds they're going to give you beforehand and find out if it's going to make you constipated. That was the thing nobody warned me about.

Yikes on all the people attempting to terrify you beforehand! I'm glad it was so much better than you'd been warned. And yeah on the pain meds, that's one of the side effects of the narcotics. I guess if I do go that route I'd better make sure to have a bottle of Fibercon handy!

I actually could just have gone straight for PT and not seen the ortho (my primary care doc would have written a scrip for it) but really, I wanted a better feel for exactly which things were damaged first, especially given my lack of success with PT 17 years ago.

I'd have hoped I'd be back at work a LOT sooner - like a few days - then again, I'm an IT person and could work from home, one-handed on the laptop.

[AllShookDown]

Well, that's just my personal experience with a complete tear. I'm not sure what they do with partial tears. If things don't have to be re-attached to the bone I'd guess that the surgery is less invasive and recovery time faster. I could have done keyboard work after a couple of weeks (in between naps) if I'd have had to.