Free the Finger! Cast-free after 9 weeks

I was very apprehensive and so excited to see my doctor at OAA today to get my damn cast off for an evaluation of my mallet finger.

The teenager texted me as I sat in the exam room.

“Free the finger!”

They had a devil of a time cutting it off— apparently after even five weeks in the same cast it was firmly on.

Both the hand/orthopedic specialist and the hand rehab office it’s unusual for patients to maintain a finger cast for so long. That doesn’t make sense to me, because why wouldn’t you do everything in your power to maintain agility and strength in your finger?

Free the Finger!

the Teenager

And don’t give me that “it’s too hard” or “I need my hand to do stuff.”

I work in the Stitch Fix Bizzy Hizzy warehouse folding clothes. And after my brief stint on short term disability to deal with my balance and hip issues stemming from cerebral palsy (and made more complicated by now not being able to rely on the left side of my body with this temporary injury), I went back to work and performed at 100% and higher with my finger in a cast and restricted hand movement.

That finger had so much caked dead skin and here’s the really fascinating part— my knuckle no longer has wrinkles because it has not bent.

In the beginning of my treatment, I found my doctor cold and impersonal but as he gets to know me I like him more and I get more personable interactions from him.

He told me I should gradually increase my finger flexibility with care not to hyperextend it (otherwise known as don’t bend it backwards) and splint it at night. For the splint, I could take my cast back. And tape it in at night.

“It’s cheap, but it’s dirty,” the doctor said.

Yeah, no thanks. I lived with that grimy thing long enough.

“The other option is to return to the Hand Institute and they’ll make you a splint.”

(Which, coincidentally Cigna, my insurance, does not cover. But as I do not cheap out on my medical care, I will pay for. Because right now my HSA is empty because having a disability and doing everything you can to keep yourself ahead of that disability is expensive. So please, consider this and how lucky I am that I can support myself because if I had to really on family and government benefits to subsidize my care, I’d be crippled.)

I imagine there’s a third option— buy an over-the-counter splint. And I was going to consider that. But to me, the cost of the custom splint comes with the knowledge and enthusiasm of the people at the Institute for Hand and Upper Extremity Rehabilitation. These people love and know hands.

And if I can only teach others one concept about your health, it is this: invest in yourself, meaning, find the right medical providers for your team that understand your needs and share your personal philosophy and concerns. This requires being vulnerable in a way that might be uncomfortable and it might mean having difficult conversations with people you don’t like. But it may also lead you to better understanding of yourself and of those people who seemed like callous know-it-alls disinterested in you.

I peppered my hand specialist with questions today— rapid fire as he typed my splint referral into the computer. And he respected them. The questions.

How much movement is okay? What should I watch for? I pack boxes and fold clothes and put things on conveyer belts. Should I splint the finger at work if it starts to feel weird? Is there certain motion I should avoid?

“There are no rules,” he said. “Just be careful and the occasional splinting wouldn’t be bad. I’ll see you in a month.

He made eye contact with me as if to say, “you know your body. Follow your gut.”

But he also knows I’m the patient who kept a finger cast on longer than the average Joe. So maybe, just maybe, he trusts me.

For previous installments on my finger injury: click here.

Also: a YouTube video

Do as I say not as I do, or fun with medical billing practices

I don’t think anyone will disagree with me when I say that medical insurance and medical billing in the United States makes no sense. It’s unfair to patients, unfair to doctors and makes the lives of medical office staff ridiculously complicated.

Let me just give a disclaimer that anything I say in this post is not a reflection of the skill of my physicians or the caliber of my care as both have been excellent.

But basing medical care on the decisions of private insurance companies attached to employment is reminiscent of the “company town” days when employees lived & worked in the same place and businesses profited on and controlled the life experience of their employees. Check out the old coal mines. I am from Pennsylvania after all.

I have spent much of the last year bouncing from specialist to specialist trying to learn how my body works as a 40-something with cerebral palsy and now, almost three weeks ago, I ruptured a tendon taking off my socks.

Last night, when I was already slipping into a fragile emotional state feeling lonely and physically broken (hey, it happens. We’re all human and have moments. Mine happen after dark while binge-watching medical dramas.), the teenager brought me the mail.

It was 9 p.m., I was curled in bed with an episode of The Good Doctor cuddling Louise, the tripod foster cat who deserves a permanent home because she’s such a doll.

I open my EOBs from my insurance company. Now, I know my recent misadventures will be expensive. I also know my therapist has recently sent me a $600 bill and apologized but said he can’t deal with my insurer anymore. But that’s another story and after almost 15 years with the same mental health professional… I will take care of it.

But this particular EOB charged me $200+ to see a specialist (fair) and a $2,000+ fee for surgery. Surgery? I walked into the office, an assistant removed my splint, he looked at me, he looked at the imaging done by Patient First, told me to get a cast and go back to work, and told me to make a follow-up for May 18 and left.

The assistant helped me put my splint back on, I left his office, went to another medical office (unaffiliated with him), filled out new patient paperwork, paid a $50 deposit, and received a cast.

Does any of that sound like surgery to you?

Being an anxious woman of a certain age with a hand injury, I did what seemed best at the time: I poured a whiskey and diet cola and grabbed the bag of sriracha pita chips and binged.

I ate all these chips, but no hummus or tea.

In the morning, I discovered I put my underwear on backward. I had two cups of coffee and a glass of water (I won’t eat until I get hungry) and called my insurance company.

“I’m not aware of having surgery so I’m confused.”

They arranged a three-way call to the doctor’s office.

The woman, who was polite and professional said, “so you’re not being treated?”

I said, “well yes I am.”

And she explained that’s a blanket term for tendon repair.

I replied, “Okay, so this was not explained to me. Let me just get some clarification. I paid the office fee, so the doctor could evaluate me, and he also gets an additional fee? Even though he sent me to a different doctor for the cast?

“Oh, she explained. “It covers any additional treatment in the next 90 days.”

Well then I hope that covers the office visits for all my check-ups and follow-up care.

I thanked them both— the representative of the insurance company and the billing clerk at my specialist’s office. But this is just another example of how the American medical industrial complex complicates and threatens patient care and a patient’s concern for if that care will financially destroy their stability.

** the title of this piece is a reference to me using binge eating as a coping mechanism

Neurology Update

So, I just received a phone call at work from my neurologist’s office. They want me to come in at 8 a.m. Wednesday, because “my” insurance company denied my CT scan.

I use the quotation marks because this letter comes from the insurance company that provided my Medicaid. I received Medicaid four months into my unemployment in November 2020, and I accepted my position at Stitch Fix one week later.

Stitch Fix provides medical insurance as of day one of employment.

To the best of my knowledge, I used Medicaid for one visit to my primary care physician that happened to be scheduled during that week.

I filled out the required paperwork to alert the county assistance office that I had a job, and insurance. I received some paperwork that implied my Medicaid would expire at the end of the year.

But as of January 1, 2021, it still seemed to be hanging around as a secondary insurance policy. Even though I never saw them pay for anything, and my primary insurance was a high deductible plan.

In Spring of 2021, I received a notice that I need to reapply for my medical assistance or it would be canceled as of 8/31/2021. I threw the paperwork away— because I don’t need Medicaid.

But the hospital and the network of doctors associated with it still insisted I had it.

So I thought maybe it would disappear December 31, 2021.

And December 28, 2021 they write the letter denying my CT scan that I photographed and posted above. I receive it around January 5, 2022.

To refresh anyone’s memory or for new readers— I have cerebral palsy but I didn’t really receive medical treatments or interventions as a child, which leaves me now trying to understand my body as it ages. I am approaching my 47th birthday.

My neurologist appointment was December 23 — you can read about that here (and more here) as it was my first ever. I now have an official diagnosis on file with my doctors.

The neurologist’s office scheduled me for a CT scan of my brain on Dec. 30. I was really excited for several reasons: I have never had any CT scan; I am very curious to see what brain damage will be revealed; and my deductible was paid for 2021.

But the office canceled it two hours before the procedure because the insurance company neither approved nor denied the claim.

I find out today that Cigna has approved the scan but Medicaid did not and the neurologist’s office didn’t want me getting a surprise bill.

They canceled a procedure that would have cost me a 10% copay, and now I will pay for it out-of-pocket as my deductible is $1,750. And my HSA will be empty as the teenager is getting hearing aids Friday.

In other physical related items:

  • Yesterday I experienced a lot of steady pain at work. By the end of the day, I couldn’t even reduce my symptoms and sleep was uncomfortable. I blame the fact that they changed our break schedule and we had our last break at 1:50 — leaving us to work three hours without a break, the last three hours of our ten hour shift.
  • I finished yesterday at about 80% of the daily metric.
  • Today, I had a high point at 3 pm of about 95% — and finished the day at 90%.
  • My back today felt better, pain at let’s say 4 instead of 8. But my toes on my right foot burn about 10 minutes out of every 90.
  • Interesting side note, I think the intense back pain involves some nerve activity as when my pain increases I can’t feel my need to urinate. Not at all. So that’s fun.
  • And the Mirena is doing it’s job. But for the first two months, I spotted most of the time. I think I had two days each month where I wasn’t spotting or bleeding. I think that has finally ended. My body seems to act like my body.
  • But today, for some reason, my right breast aches. Kind of like milk let down.
One of my orders today was 8 pounds of jeans