In the midst of all that is positive and progressing forward, it often seems that life decides to throw a lightning bolt and down a tree across my path just to see what I'll do. Will I get a chainsaw and hack my way through? Will I climb over it, navigating lichen and slippery moss? Will I try to find a way around, either by braving the roots and all the underearth creatures therein or will I untangle the branches and squirm through the crushed canopy? What new tree obstacle I am now assessing, you ask?
I just received notification that my Tri-Care insurance no longer deems my physical therapy necessary and so has decided to decline the referral requests from my primary care physician (who receives the progress notes from my PT, who just sent one that stated that continued care is necessary). I have 90 days to appeal their decision, during which time I get to gather more medical evidence that shows that if I don't go to therapy, I will end up with a laundry list of issues, which will result in me having to go back for intensive treatment, probably on pain medication and certainly, making surgery a pressing issue, something I have been able to stave off because of the regular physical therapy. What does my PT do to keep me in working condition?
Ultra-sound, ultra-sound, ultra-sound. Cross friction massage to disrupt the scar adhesions and separate them if they have bound across the fascia (which usually starts at around day 10-11 with no treatment). As my right side has the most damage to it, the supporting lateral and back muscles work harder, resulting in my hips rotating, sometimes in, sometimes out. This also affects my gait, my posture, and my pain level. Today she worked on those muscles still tight from last week's misadventure as well as my left ankle (the one I broke in April), leaving little time to deal with the actual scar tissue. (When I was fighting to get back to active duty, we did Russian stim - which consists of electrodes combined with ultrasound to send electrical pulses through the abdomen to get the muscles to contract. She was able to determine the extent of nerve damage, as it took turning the pulse signal almost all the way to max to get the any movement of the upper area, below the belly button, and still there would be nary a twitch in my lower quadrant. Just want to give you an idea of how much scar tissue we are talking about.) We also go through stabilization exercises and balance work and we even do practical applications for everyday activities (figuring out how heavy a grocery bag can be, for instance).
Why is the scar tissue such an issue? I seem to have rapid growth of scar tissue, which means that if there is even a micro-tear, my body aggressively works to repair it. This results in an overgrowth of scar tissue, especially internally, where I have already undergone surgery to remove excess scar tissue and undissolved mesh. It also means that whenever there is surgery, more scar tissue will happily replace the old, so my medical team is really working hard to NOT have to open me up again. (The last time, they had to go back in to cut out the scar tissue that had formed around the sutures, which wouldn't dissolve, so I had little round lumps along the cut lines.)
All of which comes back to the declination of treatment approval by my insurance provider - Tri-Care. This is not to bash them, they have certainly paid generously for the egregious mistakes made by those surgeons in the government employ; nonetheless, it is baffling to me that they don't understand that PT is not a nicety or a frivolous treatment - it actually allows me to function on a daily basis without heavy pain medication (which I certainly don't recommend as a single mom - been there, done that and it makes me a walking zombie), and also allows me to be physically active, something that being hopped up on drugs doesn't much assist with....
So, that's my rant. It's just a frustration that will require a little legwork on my part; it's just something I really don't WANT to have to deal with, and it takes energy and time away from those things on which I want to devote more of those two things. It is a necessity, though, so it is on my list of things to do, now re-numbered to have it pretty much at the top of my list. Darnit. Oh well. I'm thinking I'll climb over this one, no chainsaw required.