Insurance PreAPPROVAL!!!!

This is a bitter sweet entry.

Today, 6 weeks after Eddie submitted the paperwork for Pre-approval, I decided to leave him a message to check in. Afterwards I sent one email to both Dr. West and Dr. Yes (CCing Barbara). (If you want to know who's who among these names just click on the green "Cast of Characters" link in the right column.)

I was just FYI-ing both doctors about the pre-approval so they would know why things weren't moving forward. (I expressed my disappointment.) Having never met Dr. Yes, I wanted to stay on his radar. The email of course would serve both doctors to now have each others' contact info so they can begin to communicate about the procedures and post-op care as they need.

Coincidentally, only 5 hours after sending that email, Eddie called me to tell me the insurance had just faxed over the approval. Amazing! lol.

So here's the conversation:

Eddie: "So your insurance will cover this surgery."

Me: "Well wait, there is more than one surgery? It's four surgeries right?

Eddie: "Yes, Brachy, Bunion, Heel and Bunionette. But they approved only the Brachy and Bunion. The other two don't need pre-approval. So do you want to schedule this then?"

Me: "Thank you. Eddie I think you know by now that I'm a 10 question sort of person. (giggling) So I really need to get things clear before going ahead and doing this. I have a lot of things to organize and arrange. The flight, the care for my dog, my job, etc. So my insurance will only cover 90% correct?"

Eddie: "Yes that's right. The approval isn't a guarantee of coverage either, as this isn't a claim being submitted."

Me: "So do you all bill your clients for portions not covered by insurance?

Eddie: "Yes"

Me: "So when is that arranged? I don't really want surprises later and I want to be responsible. I don't have credit cards. I want to be able to pay in installments. Can I do that?"

Eddie: "Yes"

Me: "Do you charge interest?"

Eddie: "No."

Me: "OK. Because I do not want to take out a loan for the balance. My credit score is very very good though. I like paying me bills before they are due."

Eddie: "Well I could give you a close figure, but not exact."

So we agreed he would get me a close figure by end of week.  
Here is the BAD NEWS!

He told me that we would have to schedule in FEBRUARY of 2011!!!!!! I nearly fell off my chair! That's 3 months away! (It's already been 4 months with all this xray and going back and forth stuff) I told him I was very surprised and disappointed. He explained something about the holidays being on particular days and therefore they really lose almost half of December.

When our conversation was done I realized I had just sent an email to my doctors informing them of the insurance hold-up. So now I had to send them the news of more hold-up and why. (of course you realize that I'm emailing Dr. West who will know all these happenings from Eddie and Barb. But just in case the communication gets lost in the shuffle at their office, I'm informing him as if he didn't know) Again I expressed my disappointment in the email.

More than not wanting to pay for a Holiday-priced plane ticket, I wanted to get the left foot onto the 2010 papers. This way I would have no problem with the right foot on the 2011 papers. (Both in the same year.... I'm thinking I may reach some sort of cap or something?) (this concern turned out not to be a concern. It turned out to be more profitable for me to have both done in the same year.)

Anyway, so that's that.

One last thing. Dr. Yes answered my email right away. Just a reply to me though, not a "reply all". He shared his availability schedule with me because I had asked him to. So I know what month not to book the surgery. He also shared an interesting little thing with me:

"Incidentally, 30-60 days seems awfully long to get a pre-cert. Usually here in the East it takes 7-10 days at the longest, with most insurances within 72 hours."  ...hmmmmm.

Next steps:

I will discuss the estimated balance with Eddie by end of week. Then I'll have to shuffle things on my end to align my time off, dog care, see about flights, blah blah... then call Eddie back. Hopefully by then the two dates he gave me for February aren't taken. I'll schedule the surgery, THEN book the flights. ;0)

Let's see what happens... would be nice if after receiving my email Dr. West would find a date this year. But truthfully, everything has its time so I'm ok with February. There may be unforeseen blessings in having it then. ;o)


Tootles... 


pst...CHRISTMAS IS COMING!  ;o)

===============================================

WAIT! WAIT! WAIT!

I thought I was done— sorry! I logged off and sat to read my snail-mail. I just received a letter from my insurance carrier. The postmark on the envelope is Nov 3rd. The letter inside says, Oct 29th. (So does this mean that Eddie would have contacted me today regardless of my call into him and my email to Dr. West? I think this shows that it is a possibility.)

The envelope has my address on it, but the letter is written to Dr. West. My insurer sent me a copy. It says (verbatim):

Dear [Dr. West]:

We received a request for a voluntary predetermination of coverage for [patient's name] for the following service/procedure(s):

• Surgical Procedure Foot-Toe Brachymetatarsia Correction 28899-LT

After reviewing the information submitted we have determined the service/procedure(s) to be medically necessary and a covered benefit under the member's plan.

This voluntary predetermination of coverage decision is not a treatment decision, a medical consultation, or claim approval. In providing this predetermination information [X-Y-Z insurance] does not guarantee the service/procedure(s) will be covered. Claims submitted will be paid in accordance with the member's eligibility status and all benefit plan provisions in effect at the time the service/procedure(s) is actually rendered. All rights and obligations under the benefit plan are reserved.

If you have any questions.. blah blah.

I just wanted to share that with you. There are those of you who have always wondered about these dealings with insurance companies. Well this is one example of how it's being handled by one of the top insurers in the US. Bottom line? It's a risk no matter how much you try to plan, or figure you deserve the coverage for paying your insurance for years without a claim. Even after surgery you can be denied. That makes my heart sink.  ;o( Gulp.

But at this point, I'm willing to take the risk. VIVA LA VIDA! ;o)

(wooooo whoooo.. did you catch that by the way? "Medically Necessary"! I have to cry at this. It's like someone saying, 'Yes I understand your pain'.  ;o)

OK. I'm really going this time.

Insurance Update

I called Eddie to ask how it was going with the pre-authorization he submitted 2 weeks ago. He returned my call the following day. He said he touched base with them last week to make sure they had everything and it seems now we just wait for however long it will take.

I will be praying most of this will be covered by my insurance carrier.

Tootles! ;-)

Who Starts the Insurance Claim?

© buildinginsurancebusiness.com

I had a call into Dr. West's schedule/cost guy (Eddie). A day later he phoned back. I wanted to touch base with him about Do's and Dont's when calling my insurance carrier before-hand about the surgeries. I don't do this everyday, he does. I didn't even know if it was necessary to account with the insurance carrier.

I know that verbiage and codes are everything with insurance claims and didn't want to hinder my objective of having this all covered as much as possible.

I found out that Eddie would contact my carrier himself. 

1. He would first go into the "prior-authorization" stage. He made it sound that this has to be done with everyone and every carrier. 

2.This may or may not lead him to the "pre-determination" stage. Sometimes carriers require it, sometimes not. (I do not know how a carrier determines if it's something they will ask for.)

This pre-determination state is sort of a submission of paperwork on behalf of the doctor's office. Remember those questions Dr. West first asked me in his office? Well guess what? His notes on that get submitted in this paperwork. You do the math on how important my answers were.

Eddie said it takes 30-60 days to hear back from the insurance carrier on this pre-determination submission. Of course I am praying that through some heavenly provision it will be much less than that. I told Eddie that, the more time that passes, the more expensive my plane ticket will be because of the holidays. (Eddie also has to put in a request to Dr. West for all his notes to put into the submission, which would take a day or so.)

On the phone Eddie was reading my records to himself. He jotted off 4 long medical terms for what would be done on my left foot. So I asked, "So that's the Brachy, the heel (bone extraction), the Bunion, and the Bunnionette, right?"

So you guessed it, the insurance company will see this as 4 surgeries. 4 claims. And the bills I will get will most likely be segmented between all sorts of things. You are treated specifically by an anesthesiologist for your 4 hour snooze, he/she is paid separately I hear.... things like that.

Here is a BIG question I did NOT ask, but will next time I speak with Eddie. Dr. West gives an approximate cost in his preliminary paper-packet introduction to all this. About $8000-$9000. It includes Hospital/Surgery Center, Anesthesia, Surgeon's fees, AND FOLLOW UP OUT WEST FOR 6 MONTHS. — My question is: "For the patients that stay the 10 mandatory days there, but then do all the post-op with another doctor back home, is the price less?"

To me and many of us, we would expect that is should be. I'll get back to you all on this.

I have to also pay all the fees for all the post-op at home through Dr. Yes. I wonder how many claims that will be into my insurance carrier... to see him every 3 weeks, have the cast removed, xrays taken, and a new cast put on... for 12 weeks. And he is listed as OUT-OF NETWORK for me. On average, doctor's in the East charge more too. Just a lot to chew on is all I'm saying... and pay. ;-)

NOTE: I have also thought that having one foot addressed at the end of the year is a benefit! Because then the second will be in a whole new year. I'm hoping that when it comes to insurance red-tape, that it will work in my favor with any annual limitation caps. 

It will however, not help me in the $250 annual deductible cap I have. Any deductibles I pay this year will not go towards that starting the new year. Oh well, can't have everything. ;-) (Now 10mo after the surgeries, I can tell you that it worked in my favor financially to have both feet address in the same year, because I then met my maximum out-of-pocket amount by the time I had the second foot done. This was not planned, but it happened that way due to scheduling issues at my surgeon's office.)

I hope all this information will help you in your surgery plans!

Tootles! ;-)

Insurance Coverage— Preliminary Steps

Hi all!

Although not planned, a moment presented itself for me to mention my potential surgery to my boss. I thought it would be unprofitable for me later if I didn't take it.

So now my boss knows surgery is probable before the end of the year and I will be needing to work at home post-op. Preliminarily, it seems fine so far.

So this leads to Insurance prep and scheduling.

First,

I went online to check my insurance coverage:

      1. I went to my job's "Benefits" online, and

      2. My insurance carrier's website

On my jobs benefit site:

-I verified my annual deductible-cap for the year (The maximum you will pay in deductibles annually.)

-What percentage of "out-patient" procedures my plan covers

-and other things like cost of generic prescriptions, etc.

In my Insurance carrier's site:

-I re-verified that Dr. West is indeed considered In-Network (YAY!)

-I discovered that Dr. Yes is considered Out-of-Network (not sure if this is really bad yet…)

I want to avoid big surprises later so I also went online to see if I could find articles about how to verify coverage (the smart way) with my insurance carrier. This was not easy to find.

So I decided I would call the person at Dr. West's office who handles cost and scheduling (we'll call him Eddie) to see if he could lend some Do's and Dont's before I call my insurance company to verify the coverage of these procedures. (Remember, if Dr. West is able to work on all three of the issues on my left foot that means it will be submitted as 4 different surgeries.)

So now I sit and wait for him to call me back. ;-)

Hasta luego!

My Neighbor is Moving ;-(

Awww. I found out a few days ago that Mark and his sister, my neighbors across the street, are moving! ;-( I mean I know I was planning on asking him to drive me to do groceries during my post-op, but I'm actually just sad they are leaving. Pooh.

Counting The Blessings!!

© Photo: Danielle Smith

All this "trying to provide information", is leaving out a very important aspect...

THE AWESOMENESS OF THIS WHOLE THING!!! I AM SO EXCITED! (I just work a lot of hours and don't have time to relish in it. I need to try harder.)

Ten years ago I was looking this up! (www.google.com was only 1 1/2 yrs old then!) And now I am closer than I've ever been to this corrective surgery. It is truly amazing. Money is an issue for everyone, but I did read that Dr. West has "special discounts and simple payments plans, including financing....." I'm sure other doctors have similar programs in place, too. So don't fret!

It's time for me to step back and realize that this is an amazing time for people with Brachymetatarsia. Hurray for us!

One of the biggest blessings in my situation is that I have family out west. That is a huuuge! My family can help me during the 10 first crucial days after surgery. Is God awesome or what?!?! It's one less thing to worry about, I can rest knowing that while I'm on pain medication I will be in great hands.

Woooohooooo!

When I get back home I will train my dog, Missy, to do the laundry! lol ;-)

“Fear less, hope more; eat less, chew more; whine less, breathe more; talk less, say more; love more, and all good things will be yours.”   —Swedish Proverb quote

How Will I Get Along After Surgery?

© www.pixmac.com

I plan on emailing Dr.Yes this week to give the run down on why we are waiting, I want to remain on his radar. Once things are looking a little more secure at work I will email both Dr. West and Dr.Yes introducing them to each other. (I have to remember to ask each of them about their vacation times. I know that may be a bit personal, but I don't want to be disappointed later if I'm treated by a 'covering physician'. This is important.)

I have to call the finance guy at Dr. West's office to start tallying cost. I also have to think about the cost of the trip and travel reservations, cost & care for my dog, what do I do with my car so I don't get a ticket by the street cleaners while I'm away, etc. I also have to consider how food shopping and dog walking will get done post-op. (I live on the second floor. No elevator. I live alone.)

I have a stick-shift (car) and will be unable to drive it. (from what I've learned I can put no weight on my left foot.) (12 weeks. Uhg!) I'm thinking of maybe asking my neighbor across the street, Mark, if he could take gimpy-me to Whole-Foods once a week. ;-)

Oh gosh I just thought about Laundry too. (I have to go downstairs, then outside, to then enter the basement!) We'll see how it goes. God is very faithful and hasn't brought me this far to abandon me on crutches. ;-)

Wait a minute... I just had a thought... what if my insurance would cover such care? Heeeeeeyyyy, that's something I'll have to look into. I think it's sort of like an Rx from a Dr.(?) Saying you need this kind of care/help. (?) Hmmmmm. Brains churning now.

So again, I'm posting all of the details, good and bad, to help those of you considering this surgery. Especially if it's far from home. I hope it helps. Tootles!!

"All of life is a journey; which paths we take, what we look back on, and what we look forward to is up to us. We determine our destination, what kind of road we will take to get there, and how happy we are when we get there."  
                                    —From A Little Book of Happiness

Found a Dr. for Post-Op Care! YAY!

© www.orthotape.com

While I wait some weeks for things to settle down with the changes at work (huge reconfiguring gong on, dunno what it means for my future), I figured I'd use my time wisely and try to find a podiatrist willing to do the post-op care once I return from my surgical trip out west. (Remember, Dr. West WILL NOT even schedule a surgical date without a willing post-op care physician in place before-hand.)

As you recall in my 2nd blog entry, I had several doctors reject me just for xrays, because I was honest and told them of my plan to have the surgery done by another doctor. Well, I depend on God greatly. I run to him in good and bad times, and so this little problem was certainly a time when I called on him.

I prayed. I asked God for help. I then put out an email to some friends asking if anyone had a fantastic podiatrist they could refer. I received a couple leads. One being from a girlfriend who is a Scrub. She called me to tell me she knew two GREAT doctors. However, when I told her the particulars, she told me what I've been telling you all. "No doctor wants to be responsible for another doctor's work." Even so, she said one of the two was a better candidate at saying "Yes" if she would explain that I was a friend of hers.

I don't like to count my eggs before they are hatched but "Hallelujah!" He said 'Yes'. I emailed him two weeks ago to thank him. He responded, "I have two people currently in my practice that we performed the lengthening on, so I am comfortable managing things post-op. I will have no problem calling Dr. West to discuss your case as well."

By now you know I'm a thinker and researcher. Normally I'd see him, ask him tons of questions, want referrals.... but there is such a thing as pushing your luck, so even though it is just about NEVER wise to have a doctor work on you without preliminary review... I'll take my chances considering the trouble I've had and his willingness. He (Dr. Yes ;-) was a positive referral! (and it's not for the surgery itself!)

Tootles. By the way, thanks for following this Blog! ;-) I need all your support out there!

Post-Op Care

This is Pia, she traveled from Denmark
to the US for this surgery!
© Pia Christensen

If you've read all the ups and downs with Dr. East you'll know that he said things like, "No one will be able to tell you they've done hundreds of these." Of course he didn't know that I already knew that wasn't true. That's a shame I think. (while there isn't many podiatrist who can say that I did know of one.)

In any event, I really wish Dr. East had handled things a little better with the whole DICOM thing. (It's not a crime to not be familiar with something, but I didn't appreciate being treated as though I was asking for something that didn't exist. And being made to go through so much to get something so standard.) I would have liked to be able to go to him for post-op care.

Call me stupid, but I thought it a great thing for Dr. East to be very amiable. This way he could be the post-op provider and be in contact with Dr. West. Perhaps begin a report with him and maybe, just maybe, end up partnering a bit with him for future patients who live in the east? Who knows where it could have lead. Dr. West could then perhaps offer more personalized post-op care for his patients from the east through Dr. West. Oh well, water under the bridge. And maybe things don't really work that seamless among practitioners anyway. Upward and onward. ;-)

Last night I found someone online who had the one-stage done! This person is identical to me. She has Brachy only on her left and also needed a Bunionectomy. I got to see photos online!

Dr. West has the experience where I don't need to ask him to provide patient referrals I can speak to. They're online blogging their results/progress.

Reading up on this person's experience, I found out the pump was surgically placed. The dose released is automatic, BUT it is set to end (run-out), etc. She didn't seem to have a problem and from her description— she needed it! So perhaps I need to reconsider. **grin**

I was able to see her bunion incision too. And it was exactly as Dr. West had described to me. On the side, towards the bottom! Awesome. Dr. East was going to do this on the top of my foot! I was also able to see the bruising that occurs. Even in the heel area where the donor bone is taken from.

In any case, I am thrilled having found a patient just like me. This week I am going to try and see if I can network to find a doctor here who would be willing to do the post-op care. I'm not willing to give up on that just yet. ;-)

Looking at her results I feel very confident about having both my issues addressed. Her xrays reveal her bunion seems to be about as serious as mine— and her results are beautiful. 

Mine is the third image from the left. (© Pia Christensen - © DNC)

I will say this, I read through her chronological progress. Just reading it made me very restless! As if I could feel all the discomfort/pain she described while having her cast on for 12 weeks. (and might I add she was very high spirited and positive) Reading it line per line, entry after entry.... I wanted it to be over (as she did and many others). I think the realities are that it is difficult to not walk for 12 weeks. Difficult to remain happy as itching & discomfort develops, and tendons wake up several weeks post-op... in a cast! (FYI, her progress photos and detailed progress has been removed online. She had shared it on a site that was not her own. When that site went down her story went with it.)

Skin gets dry and cracks... in the cast. It can cause wounds. Rashes form. Ankle gets weak. One becomes restless. Heel pain forms. The toe in question isn't moved for so long that its painful once you do. It can stay numb too. It also can 'stick' to the toe beside it and cause discomfort and confusion for a patient. Also, within the 12 weeks one will have several casts and it seems sometimes it hardens just right while other times you feel it's 'off' somehow. It can cause a 3-week-discomfort. But as described with having children... all that seems to fade when full healing arrives. They'd all do it over again if they had to... I guess.

I think I need to come up with a game plan to try and make post-op a little less burdensome for me. I will be working with my foot up, but I will be unable to drive. Going up and down a flight of stairs to walk my dog three times a day is going to be a circus I think. If I can't find a doctor here at home for the post-op care it won't be too bad in that out West I'll have family to help me. But if I do find a doctor here, then I will have to bother people for help.


I will be drugged to the hilt first few days and unable to take myself to the bathroom! ;-D

Tootles! Thanks for following! ;-)

Q & A with Dr. West

© www.shepardinsurance.com

I have a lot on my plate lately, sorry for the delay on this. This is what came out of my consultation with Dr. West. (If you want to refresh your memory of my visit with Dr. East, see the entry Q & A with Dr. East in July)

Dr. West took a look at my feet. Did a little fiddling around and then grabbed his electronic tablet and began to write on it. It seemed to me, I was now "on file". ;-)

"So tell me about your toe. How does it feel? Does it hurt? In what way?"

As I answered I found that one-word answers were not going to do. I felt a bit of pressure as he asked the same questions, but rephrased. As if I was expected to give my woes and be as explicit as possible. Of course this is necessary, he wanted to get accuracy and make sure my profile was complete. And being from out-of-state I'm sure it was all the more important to have correct notation. I think I was just nervous. Too much build up to the event, you know. ;-).

Am I a candidate for the one-stage or the fixator?

"The one-stage, undoubtedly. I've done that surgery on patients who have a larger length defecate that you with success."

Would the foot/leg be numbed or would I be under anesthesia?

"You must be under anesthesia."

Do you use a cadaver bone?

"No! Out of all my cases, I have several hundred under my belt, I have used a cadaver bone twice, it hasn't favored well. I use bone taken directly from my patients. The heel. That area will fill in again with time— totally within 2 years. You will see a small dimple there." (10 month post-op I can tell you there is no dimple.. there is a 3" scar.)

What kind of bunionectomy would you recommend for me? Lapidus or Austin?

"Neither. I prefer a chevron osteotomy. Why? What has your other doctor recommended?"

Well I prefer to hear what a doctor has to say on his own. Not in contrast or comparison to another. I've researched both the Austin and the Lapidus.

"That is too severe for you. In my opinion that procedure is a little dated and overused in the East."

I was told that if I've been dreaming of a straight line that an Austin is the way to achieve that. The Lapidus will provide correction, but there would still be a bit of a bone-bump. I'm also concerned about the re-occurrence of the bunion itself.

"Why would you want your foot to look like this?"

He took by big toe and straightened it to a straight line.

I asked, "What's wrong with that?"

"You want this?" He pointed to the now huge space between my big toe and second toe.

I said, "Well not the space, but wouldn't my other toes be in proper position within some time?"

"No. Surely your 1st metatarsal is shoving them over a bit, but not this whole space. That is not natural. Square shaped feet are not natural. There should be a bit of an angle. You want it to look like this:..." He placed his fingers over my bunion so I could no longer see it. Then straightened my big toe a bit.

I realized he was speaking about bone structure and I was speaking about look. His demonstration is one I've done to myself many times. It's dreamy even. So I understood what he was trying to convey. Most of his answers during the entire consultation where not prideful, but confident. His statement about square feet, well, not sure I agree. I've looked at thousands of feet all my life. I've seen a whole lot of square feet! Even Anita's, the girl from Spain, are square to me. And I mean that as a compliment! But surely God did not create mine that way, even without bunions. So it's all good.

Have you ever done Brachy and bunion surgery on the same person, same foot?

"Yes, quite a bit of them. Pretty natural thing really, because the forth toe being shorter actually causes the other three toes preceding it to shift over."

Is the surgery done strictly by you? Do you have other doctors or assistants that work with you?

His eyebrows shrugged closely together in the center, taken aback a bit, but smiling, he pointed at himself.

"By me. I may have a tech working with me but it's all done by me."

Would I be in a hard or soft cast?

"Hard cast. 12 - 14 weeks. Removed every 3 weeks to make sure all is healing well, then a new one put  back on."

What medication will you be prescribing after surgery?

"Percocet (Oxycodone) and a pain infused pump."

(If this is surgically implanted (pump), I will flat out refuse. NOT DOING THAT.)

Any mandatory medications or nutritional supplements you recommend before surgery.

"No."

I've been taking Echinacea, Calcium, Vitamin D and Glucosamine for two months now. I really want to heal as well and as quickly as possible.

"There is really no evidence on that helping in these circumstances." Of course I do not care and will continue this. I believe they will help. My aim is to be the fastest and best healing person he's ever seen!

Have you ever had surgery on your feet?

"No. I'm too scared.;-)" He was pleasant during our entire time together. Confident, not egotistical. He had a good sense of humor and this came across here in his answer. He laughed a little. But it was delivered with a bit of admiration for those that do undergo surgery.

What about my bunionettes? They are extremely painful for such small things! I have stopped wearing really high heels so I keep my bunion pain under control, but these two little things are so painful, especially when I wear flat closed shoes!

"We can address those." He explained the procedure and options depending what he finds once he is in there. 

"I want to let you know that I have 4 hours in which to work. Actually, less than that. The anesthesia is for 4 hours. That is really the most for this type of foot surgery. The safest. My priorities will be as follows, 1. your fourth metatarsal (brachy), 2. Your bunion, and 3rd, if there is time, the bunionette." (God I am so praying he has time! They are so painful and I don't live around the corner!)

Doing the one-stage for my Brachy, can I expect the fourth metatarsal to be identical in length as on my normal right foot?

"Ye-es." The he looked at both feet again.

"Um, it would be amazingly close. It is possible that it might be 1 to 2 millimeters shorter. But that wouldn't be because of the bone we are extending, it would be because the toe itself is actually shorter than the normal one on your right foot. Most Brachy patients don't realize that this condition is sometimes caused by both, the shortening of the bone within the foot and within the toe itself. 

I have gone back in with some patients and done a tiny implant to extend the toe itself. It's no big deal really."

But that is considered a whole separate surgery is it not? With insurance.

"Yes."

Cost. What is the cost of these surgeries?

"I don't know. You'll have to speak with so-n-so (financial person in his office) about that. Call him up, he will be happy to work with you on all that."

The incision for the chevron osteotomy, where is it?

"I do the incision on the side of the bunion, a bit more towards the bottom."

Functionality. When I grip all of my toes on my left foot, even my short 4th toe grips very well. I demonstrated. What will this be like afterwards? Will I lose this?

"I'm afraid you will lose most of that."

What are the top three complications with Brachy surgery?

"Patient compliance". ;o) He gave a really big grin. 

He skid right past this one. Not sure if it was intentional on his part, but he did. I was speaking about the procedure on his end, not post-op really.

He explained that patients get really restless and want things to go quicker than they do. He is constantly dealing with morale and trying to keep his patients on a positive thread. He said being in a cast that long is difficult for people. This causes them to not follow direction, etc.

This was said in honesty and wrapped in humor. And because he had asked my three times already, "Anymore questions?" and I said "Yes" and continued to plow through, I decided to not restate this question.

Other things that came up during the consultation...

I don't really plan on wearing high heals after my complete healing.

"You should! It actually helps give the proper range of mobility. Actually I'll tell you, when I do the second foot on most patients... when they are under anesthesia I actually take the big toe from the first surgery and crank it all the way forward! To give it a complete range of motion I know it's not getting. ;-)"

It was nice to hear the honesty. And great to know because I will now be trying to not keep my foot perfectly flat all the time post surgery. I now intend on doing my own bit of therapy even while sutchers are in if I can. I still don't plan on wearing rigidly stiff shoes that will rub against my bunion

Ironically, I bought an amazingly high shoe while out west. BUT it's a wedge heal (better support) AND the shoe is actually soft fabric! It's fleece material and conforms to any shape! So there is NO pressure on my bunions! YAY! This sort of shoe I think would help greatly in my recovery. It would provide the 'bend' Dr. West spoke about while applying no pressure.

I noticed that Dr. West was more surprised by the calluses under my left foot than I thought he would be. I just assumed he'd  seen worse cases, but his reaction was one of surprise. He used the word "wow" along with his reaction. ;-) I did not mind because he immediately went into notation on his electronic pad.

Lastly, I forget how it came up, but Dr. West spoke about a study that is soon to be released. It's based on his cases. About 200 of them. This would be the largest study thus far of it's kind.

I am very interested to see what it reveals!

Tootles! ;-) 


=====

UPDATE, about 2 weeks after this post I found a local post-op doctor. Solidifying my choice of Dr. West for my surgery.

Finally! DICOM images with Viewer. ;o)

I emailed the Rep yesterday from TigerView™ and asked if he has spoken to Dr. East. He said "No". He called twice and emailed once.


I then called Dr. East's office and gave them the Rep's name and number again.


Today I received an email from the Rep stating that the files were all set at Dr. East's office. He was able to work remotely through his computer to a PC in Dr. East's office and got it done himself.


The receptionist gave him access. (I'm sure this was done with Dr. East's permission.) But they had no CD to burn my xrays on.I would have to bring them one.

I went in with a CD today and had them burn the files for me WITH the Viewer. YAY!!!  (Incidentally, I saw Dr. East as I was waiting for the receptionist to burn the CD and he said nothing to me. I said "Hello Dr. East" and he smiled briefly.) He hates me now I'm sure. ;-(

I tested the CD on a PC and VOILA! I sent the files to Dr. West immediately. Now he will be able to measure and know exactly what we are dealing with when I see him soon. I'm curious to know if Dr. West feels I am a candidate for the one-stage surgery! I'm excited!!! 


Tootles!

Thanks for following! ;-)

Sometimes You Have to Take the Bull by the Horns ;-)

© www.freewebs.com - © DNC

OK. So I got myself to a PC and popped in the CD given to me by the hospital where I got my mammogram done. It was very easy to go in, get the image to display via the Dicom Viewer, and use the tools to make measurements. So at least I have proof of what I suspected and am asking for from Dr. East.

Wait to you hear the latest. ;-)

After figuring to leave things as they were, (accepting that Dr. East truly knows nothing about DICOM)... it really bothered me to then hear that the program he has, TigerView, can actually output what I'm asking for.

So I went onto the TigerView website and submitted an inquiry in their contact page. Asking for the steps on how to produce DICOM images from their software. Someone emailed me back right away, asking me for personal info to better help me. The info they wanted was based on them thinking I was a customer who had the program. I replied with a simple reason why I was asking and my phone number.

A day later I was called by a Rep from TigerView who asked me what I needed exactly. He understood and asked for Dr. East's name and location. He then seemed to be able to pull up Dr. East's account. He told me that he would "activate the module" needed free-of-charge so that this request could be facilitated for me. YAY!!! (This leads me to believe that Dr. East, in order to be able to provide any further request of this kind for his patients, would have to pay for the use of this particular module.... what an education I'm getting ;o)

The Rep said he would be contacting Dr. East to walk him through it.

I thanked him greatly and told him that I in no way wanted to upset Dr. East, but really needed this. The Rep called Dr. East and left a message on Friday. No response. I then gave him Dr. East's email address because Dr. East seems to answer very quickly via his Blackberry. An email was sent out on Monday to Dr. East stating the reason for the contact and I was CCd. It's now Tuesday. Let's see if Dr. East truly meant it when he said he really wanted to get me what I needed.

Tootles! ;-)

Anita's Success!!! Yay!!

This is Anita, the young girl from Spain I posted about last month. She's such a sweetheart! These are her new xrays. You can see where her new bone growth is be external fixation. Her 4th metatarsal surgery was a success on her left foot. Yay Anita!

(Note: you can also see her first metatarsals
do not have the deformation mine do. Bunions.)

My Education on DICOM (xray format you should know!)

© DNC -
www.brachymetatarsia.blogspot.com

Yesterday was a back-and-forth-day with both Dr. West and Dr. East. (This is actually the short version... Many emails. ;o)

I sent a third request to Dr. East via email asking for my xrays in the DICOM format. (Having to pay for such an expensive visit with him and then having to pay for another set with another doctor just didn't make sense.) Part of my email: "...It is normal and legal practice for xrays to be provided on CD as DICOM images along with the "reading" software. Not TigerView, but with the PC AutoPlay DICOM Viewer....."

He called me back within 20min. He was not rude, but seemed confused. He expressed not knowing what I was asking for. He barely let me get a word in, going on about his confusion. I had to actually ask him to give me a moment.

The result of his call?
He's only able to provide: TIF, JPG, either of those placed in a MS Word doc, or a paper printout. I thanked him, but expressed 1. I could do all that myself, and 2. It was not what I needed.

He asked, "what are you trying to do?!" I repeated what I had said before: "I want any hospital/physician to be able to make measurements."

He said he had never heard of DICOM..... blah blah. Also stating, "Most podiatrist don't even do DIGITAL xrays as we do." I left it at that and thanked him (for nothing).

I contacted Dr. West via email with the following:

• While I have an upcoming appointment with him in two weeks, I was still trying to get the xrays from Dr. East.
• I informed him of the unfruitful results with Dr. East.
• Researching I discovered 2 things
    1. I can save out a TIF into DICOM format (.dcm) with
        Adobe Photoshop
    2. There are free DICOM Viewers he can download
        online to then view them.

       (FYI: a Dicom VIEWER is sort of like Adobe Acrobat
       READER. The acrobat program cost something but
       the READER does not.)

• I sent him two .dcm files
• I sent him a link to a free PC downloadable DICOM Viewer (I had tried this myself on my Mac and was able to view the DICOM files in the Mac version of a Free DICOM Viewer.)

He got back to me very quickly (meaning he probably did not download the viewer and try it at that time.) He informed me however that:

"You can convert the TIFFs to Dicom via Photoshop, but the original file must have the proper registry. Therefore your file will not work accurately and can't be used for surgical planning. By the way, TigerView does produce DICOM images." cosmeticfootsurgery.com 

I had already been thinking about my call with Dr. East and decided to give him the benefit of the doubt, that he really was unfamiliar with the whole DICOM thing. Even though based on Wikipedia, it seems like a standard thing 'now-a-days'.

I thought that I should send Dr. East all the info I had gathered on this so he could be informed and ready for other clients who may request the same. I mean, if it's something his fellow physicians know about, perhaps he should too. (Seems strange to me. His website really gives you the impression that they have "state-of-the-art" equipment, yet he doesn't know about the DICOM format or its practice.)

leepodiatry.com

But now Dr. West was telling my that TigerView (The program Dr. East uses) is able to save out files in DICOM format!! Uhg.

© DNC -
www.brachymetatarsia.blogspot.com

I was still waiting for Dr. East to reply to a request for my left-foot xray without his red markings on it, when I sent him another email informing him that TigerView can be saved out the files as .dcm format!

I asked that he do this and I sent along with it:

1. a TigerView toturial/ statement pdf I found online about how to do this. (pg7?)

(I wasn't going to just take Dr. Wests' word for it. I looked it up.)

2. A link to a webpage mentioning DICOM and TigerView in the same breath

I received an email from his office stating:

"At the moment we are unable to process your request. As our prior conversation, here is your left-foot image as a jpg. Thank you."

I'm not naive, I'm inclined to believe this email was sent by one of the receptionist from Dr. East's office. They know how to save to jpg and email I'm sure. He had called me before from his cell, so I'm sure he was off-site at the time.

I can only hope that he'll look into my request further and be pleasantly surprised that he could do it all along.??  It would be great if this would happen in two weeks before I leave. If he never replies back then he knew all along or is not inclined to be in-the-know?

In any case I've done all I can at this point. What will be— will be. ;-)


One last thing, I did notice that Dr. West's office as a whole stays out of things. They kept quiet and never told me about the difficulty I'd have finding a local doctor to take xrays (yet they knew I would); while I explained all the difficulties in getting the xrays in a format they wanted, they really never went out of their way to help me get them from Dr. East. I will say, my emails were never completely ignored, in time they did answer them all at this point.


But I guess I was hoping that maybe they'd write something out to help me ask for them properly (I did request this)— in the right medical verbiage or something. Or maybe go the extra mile and call Dr. East to get what they needed. But they never did that. They stay out of it. You have to fend for yourself.

Here are some things for you.

You and your image records

TigerView and DICOM

I'm pooped! ;-)