What Is Going On In Here!?! -- I step out for a moment, come right back in ... and What's This?!???

I can hardly recognize what's happened around here in the past few weeks. I am certainly overdue for an update.

Okay!!! Way, Way Overdue...

It's hard to think of where to begin really. Where were we?

Facets, right? Well. They're still there, (I wrote earlier about "facet joints" that are a part of everyone's skeleton and sometimes the target of nicely effective spinal pain treatment.) I will definitely re-visit some of those salacious details and wrap up that part of the story || {tip for those who know I write 'long' and would like to know how far ahead to skip can skip to the next time you see "One of These":

"One of These"

and we'll be back into the details part again  {end of my tip}  ||  We got all ready for a third epidural. That meant that the anesthesiologist got a little financially cautious and asked his buddy if his buddy's office would file for a 'pre-certification' and any possibility that they would not be pre-obligated to pay for the procedure would be eliminated. Basically my doc wanted to be sure he'd get paid. Okay; fine. Good idea, really...
   Except until the moment when the insurance company only managed to give the nicely typed and properly -though admittedly "pro-forma" request for a pre-certification -- this first on the beaches ~ infantry-man document of our modern day bureaucratic skirmish -- got wiped out in less than 5 seconds of review [probably thanks to the recent "Getting Things Done" training class my insurance processing front office began using with great vigor since they were told that if they didn't get the rejection rate of pre-certifications over 60% by the end of the summer, it was already a 'guilded in gold' & 'known by everybody' secret that not less than 10% of the Pre-Cert department would lose their jobs] number of only the very very lightest of a very light once over.

   Oh here comes some more juicy information that is being skipped by those still looking further down the page for a teeny/tiny clock. Here is where I tell you about information I got from other conversations with certifiably knowledgeable & likely even owning a diploma or two in the area they will be addressing in my little story here. I'll not forget that you might appreciate a bit of background / side conversation between me and "My" surgeon here, too. Yeah; he's the one who is still waiting in the wings for his two and a half hours of fame - So; He said that pro-forma requests get denied 'all the time' and that my anesthesiologists' office would likely immediately appeal the denial and due to the severity of my pain and the highly specific procedure the anesthesiologist was following to ensure that an epidural into the facet joints was certainly a useful approach and had a good likelihood of reducing my pain -- would get a fast and judicious approval post appeal. {I'll just catch my breath for a moment here}



Okay; What's more, I did my own telephone calling to our centuries old and highly profitable insurance company. They gave it to me straight between the eyes - by phone {you see how efficient and cost savings oriented they are and all that} of course - that since I myself had given them an answer to a question that the percentage of relief I was experiencing subsequent to the prior injections was far, too far below their standard evaluation guideline for allowing another such dangerous and expensive procedure to proceed particularly in light of the the well understood and commonly known fact that the prior two treatments, shared a certain characteristic with the third that made a denial ever so much more than appropriate; it was even in my best interest to do what they could within the limits of their good offices even to the limits of the law perhaps, to keep my physicians from repeating a third, completely identical in every way, injection.

Wow; I don't know whether it was more impressive that my insurance expert was able to squeeze all of that information out of their mouth  or that they held all of that information in their head in the first place. Remarkable. Anyway; Before I began to ask whether they would discuss with me the issue of how identical the injections had been, I spent a while trying to get the number out of them for the amount of relief that would have been sufficient on a going forward basis. Though they did not want to tell me, they found I was persistent so they did tell me. Here is what I learned: My insurance company's guidelines are to see better than 50% pain relief from each of the preceding injections would be required before a subsequent injection would be endorsed. I wondered to myself if a third would ever make it pass review. The first injection would have to deliver at least 50% decrease in pain. The following would have to deliver a 50% decrease just as the first. And I realized why advanced math is taught in primary school.

Fortunately we did not discuss that much. In just a few minutes of further conversation, the insurance person and I were getting along so very well, I was considering asking them over for coffee and a bit of guidance on how to better proceed.



Before we could discuss that the fellow said that I would almost certainly get an immediate reversal - IF - the Appeal explained that the two prior epidurals had targeted two "different" locations and that the third was certain to be going for an entirely new location (I was at that point assured that my earlier blog post on Facets was NOT referenced in any of the pre-certification material delivered in advance of this, our potentially third epidural injection).

It seems though that there may not have even been any appeal at all.

We went into the hospital and got a new and fresh MRI of the areas including where the pain had been coming from in that sacral area. Femi and I ensured that copies of all those MRI images - now from August and the earlier ones from March were delivered along with the radiologists' interpretations to our anesthesiologists, our neurosurgeon and dear old Dr S who introduced me to the surgeon, Dr D.

I didn't notice any Batlight that night, but keep in mind that the pain I have does still require a heaping handful of hefty narcotics several times a day. Femi was on emotional pins and needles too, but she's never admitted to seeing any Batlight in our neighborhood anyway. And I might have been distracted anyway. I could only have guessed that they'd all been talking together sometime that night or first thing, early in the morning.

None of those fellows had been too eager to tried too hard to get the appeal I needed. But as soon as they saw a clear road to letting the surgeon go in, they all stood clearly back. Surgery got a quick and absolute "Yes" from all my involved physicians. Dr D was on the phone and we got a date for surgery set up pretty fast.

So on Thursday, August the 24th, I got a hemilaminectomy of the  L5-S1 root joint and the S1-S2 root joint with the goal of releasing pressure from the S1 and S2 nerve roots tightly tucked up in the narrow spaces there. Femi was there the whole time, but I came out of Recovery very slowly -- they really had trouble managing my pain after the procedure -- We started surgery at 8:30 am and got me to my room only about 4:00 pm. That's awfully slow really.

When the Operating Room gave us a 2 1/2 hour allowance in their schedule, they also added, though reservedly, a preliminary approval to go home. That was something I was very interested to achieve -- though  there had to be a few "IFs."  #1:  IF I could walk to the toilet, (#2) sit down/stand up from it and give the plumbing appliance (#3) meaningful usage -- I'd be enjoying a ride home. Too bad I bombed (or failed to bomb -- depending on the precise use I was supposed to make of the appliance) the (#3) durned test. Oh well, you can hardly imagine what a view you get for that kind of money -- Oh what a view. Wow. Though I might be exaggerating a bit again. I needed quite a lot of those pain pills and I might not have been too clear on how nice those lodgings really were. You can ask Femi if you want.





I woke up several times requesting pain medication and Femi was right there watching over me and making sure I was really cared for. Most of the time, the RN would just step aside and let Femi take care of me. That was incredibly comforting, let me tell you. I was in pretty rough shape and I just don't know how I would have got through it without her by my side.

Once the messy job was done, I still failed to understand the reasoning for a surgery being so easy to approve versus an epidural that would not have kept me overnight. One thing I did learn was that you must describe your pain using a numerical system. Words are too subjective for the nurse to interpret for your charts. Level 0 means no pain at all. Level 5 is moderate pain. Level 10 is the worst possible pain you can imagine.

I also learned that getting the insurance company to deny a five to six thousand dollar procedure was pretty easy. And getting them to approve a thirty thousand dollar procedure - using the same MRI images, the same medical history, the same everything -- well that was pretty easy too. Go Figure!


But it was like looking forward to opening Birthday presents for me. I mean, well you know -- since I'd already had over ten thousand spent on getting enough treatment so I knew just how to relax and take the right level of medication so I could get my pain go from 8's and even almost every day I would have 9's -- to get them to go down to 4's and 5's. Can you imagine how excited I was to find out how much better this was all going to work out now. Gosh! They were spending almost thirty thousand dollars to work on me this time. This out to really turn out great.

Well, it ought to have. But it didn't.

On next Tuesday -- in two days, it will be four weeks since that surgery. But the pain is -- aw it makes me so upset when I think about it. The pain is practically the same.

This seems crazy to me. What about about You? 

Oh well. Here we are and we're still moving forward somehow. If you've been around my blog very much, then here is a name that may ring a bell for you:  Dr S.  He is a great guy and I am getting a sense that he'll be featuring a lot in the story as we go forward again.

He is my oncologist. And he will be treating the cancer that is really the bunch of tissue that is pushing on those nerves that show up so clear in the MRI pictures. And he will get me back into Hackensack University Medical Center.

This time, so far as we know today, the cancer is very tightly grouped together. If the information about that doesn't change, we can use radiation to try and make it smaller so it stops squeezing against those nerves.

I started this story yesterday, found out I was too tired when I was finishing it last night, so it didn't make much sense. This time I hope it does.

If you have a moment to share a line; please do. It sure raises my spirits just to know somebody is reading this stuff.

And; Thanks!
              - Mark