Tuesday, June 16, 2009

Discretion is the Better Part

So I Only Rode One Horse

Had another retirement dinner after school, so I got back home a bit late on another beautifully cool day. I decided to ride Tucker.

The goal was forward, every step. I did not challenge him by demanding he work on the bit. I rode nearly all the ride with very light contact, just asking him to stretch out and work with energy. Every time I felt him even think of backing off, I tapped him on the rump with my whip. I tried too not to nag with my legs but simply "bump" him along and then take the pressure off. Actually, by the end of the session he was very forward and was starting to press forward into the bit all on his own.

I did some halt, reinbacks too during the ride and after one, he really bounced into a forward canter stride from a halt which was really nice. At the very end, I put him in a true dressage frame for a few circuits on each rein at the trot, and it put a good finish on the ride.

My brain wanted to ride Chance next, but my body--knees--did not, so that's where the discretion came in. Normally, I just push on, but tonight, I decided to listen to the aches and pains and let that ride go by.

Now for the medical assessment. I do not have an ACL in either knee. That is where the problem lies. Because that ligament helps stabilize the knee joint, when I over do, the other ligaments and surrounding muscles get overworked and painful. The joint is trying to slide out of place and they are trying to hold it where it belongs. I blew the ACL in my right knee when I was about 14 or 15, so as long as the left knee was OK, I was pretty OK. For some reason, my knees tend to stay in place on their own. (Some people who have no ACL have chronic joint locking and dislocation.) But time and overuse, has been wearing me out.

So, up until this year, when all but two insurance companies changed their policies, I have been lucky enough to find a doctor who can treat my specific problems. Dr. Magaziner has been on the cutting edge of alternative therapies for a good number of years. For me, that means prolotherapy--kind of like in internal blister they use on horse's stifles. The idea here is to inject a solution that acutally causes the ligaments to thicken with scar tissue so they tighten. The other therapy is PRP which involves using my own blood platelets as kind of stem cells to both heal the damage to ligaments and to regrow some of the cartilage in my knees.

Both these treatments have helped enormously and the insurance company has paid for my treatments. However, during the last year, the insurance geniuses have decided both treatments are "experimental" or something and have decided to no long cover patients who opt for them.

I honestly cannot afford to pay for them without coverage. So I am stuck.

Options? Obviously, knee replacements. This would cost the insurer tons more both for the surgery and the followup physical therapy and after care. Duh.

My proposed route would be to have reconstructive surgery on the ACL's. However, until I consult my orthopedic surgeon, I don't know if this is a viable option. I guess it depends on how bad the rest of my joint is.

Needless to say, either surgical solution is not the best for someone who has three horses at home to take care of. Finding someone to do the work during whatever part of the recovery will lay me up is a problem. And, will I be able to take care of myself in the house even if I don't have to take care of the horses? Bit of a riddle, I fear.

I suspect, from talking to my vice principal at school who had ACL and other ligaments reconstructed, that surgery has a quicker recovery time provided you are agressive with the physcial therapy at the outset. I am a monster about PT mostly because I hate it and want to get done with it as quickly as possible.

Right now, though, I am disgusted. Facing the summer with knees like this is not a pleasant thought. I might be able to swing one more treatment with an insurance guarantee the school is obligated to, but after that, I am probably done.

I really resent these insurance companies having the power to make decisions as to what is best for my health and well being.

And if they'd really think it through, they might realize that my options would cost them far less money.


  1. Anonymous9:42 PM

    Sounds like you had an excellent ride on Tucker, even after a retirement dinner :). Sorry about the knees - they are essential, aren't they? Hope you can swing something with the insurance company - perhaps the "you covered this before and now you need to let me continue the treatment" route will work.

    There's an enormous amount wrong with our medical payment system and your case is a good example.

  2. Glad to hear you and Tucker had a good ride.
    Insurance companies are the absolute worst. I can't believe they would rather spend money on surgeries and recoveries which would cost more than the therapy you have now. It seems out of sync with common sense. But that's the way they work. I've seen it too many times to be surprised. Hope you figure something out and have a good summer with your knees.

  3. the real trouble with your health system, of course, is that it's big business and it's about the money.

    but you'd have trouble wtih those treatments under the NHS as well; we have NICE (national institute for clinical excellence) which decides what the NHS should spend it's money on in terms of new drugs and treatments...and i've a feeling they wouldn't like what your man's doing! despite the cost/benefit!

  4. Oh dear the insurances sound really complicated,common sense doesnt seem to come into these things does it!
    Hope you get it sorted soon.