Frustrated...

Frustrated is how I feel, so I am blogging my thoughts. They are random and probably do not make much sense, but I just need to get it out.

In 2005 I was diagnosed with low back problems. I visited a chiropractor for over a year trying to alleviate some of the pain. In 2006 my family doctor referred me to an orthopedic specialist, Dr. Lilo. Dr. Lilo proceeded to take MRI readings of my back and X-rays. It was determined at that time there was a disk bulge and disk protrusion in my lower back. To help ease the pain, I was given a lumbar epidural (steroid injection). This worked quite well. My pain was eased for the next two years.

In the middle part of 2008, I once again found myself at Dr. Lilo’s office with recurrent back pain. The pain had gotten to a point that it was beginning to interfere with my life. I was unable to assist around the house and lift things that I normally could. I found myself in significant pain when leaning over to fold laundry or help my son’s with their homework. Dr. Lilo repeated the MRI and it was determined that my lower disks were still showing significant damage. Dr. Lilo repeated the lumbar epidural injection in February 2009 (it had to be delayed due to gallbladder surgery in December 2008). After one month, the pain was still quite intolerable. Dr. Lilo repeated the injection for the third time. After one month, the injection failed to eliminate the pain. Dr. Lilo then proceeded to inject with a joint facet injection. Directly inserting the steroid into the joints to help alleviate the pain. This injection also failed. The next step Dr. Lilo insisted on was physical therapy along with wearing a back brace. I went to physical therapy three times a week for over a month, with absolutely no relief. The physical therapists indicated that they were unsure how to help with my pain. After this, Dr. Lilo tried a sacral iliac injection (putting steroid directly into the sacrum area where the joints come together.) This injection also failed.

Finally, Dr. Lilo suggested I see a spine specialist because he was unable to treat me further at this point. I saw Dr. Rick Sasso the middle part of August and after reviewing my information he suggest a test called a discogram. This test would pinpoint specifically where the pain was coming from if it was coming from the disks. The test was completed on August 25 under Dr. Lilo’s care and it came back positive with degenerative disks at the L4/L5 & L5/S1 disks. Dr. Lilo’s referred me back to Dr. Sasso.

I met with Dr. Sasso and he gave me two options. Leave it alone if I felt it did not debilitate my daily living or surgery. By this time I have went from using pain medication for relief maybe twice a week to every day. My opinion is that is does impair my daily living, so Dr. Sasso and I agreed the only other option was surgery. The surgery consisted of a lumbar spinal fusion.

My surgery was schedule for Tuesday, September 29. On Thursday, September 24 I received a letter from my insurance company (Anthem) indicating this surgery was not medically necessary. This is the same insurance company that has covered each and every one of my prior visits, including the discogram. I filed an expedited appeal on Friday, September 25. I called Dr. Lilo’s office and they faxed to my insurance company the documentation from the past four years.

Monday, September 28, 2009 I received a call from the insurance company that the appeal has been denied.

I live in severe pain each and every day. I cannot function to the ability that I normally function. I must get up every 20 minutes or so and walk while I am working. If I am standing for more than 20 minutes I must sit down. I cannot exercise as it puts too much stress and pain on my back. I cannot lift items, I cannot do my laundry because it requires me leaning over to put items in or picking up laundry baskets. I cannot sit in my classes to finish my education. I cannot sit to do my homework, the pain is too unbearable. If I take my pain medication I get sick to my stomach. It makes me drowsy, therefore I cannot take it while I work, drive, or go to school. I have had to leave classes early due to the pain or the medication. I have missed work because of the amount of pain I am in.

I work 40 hours a week and take 14 credit hours in college. I am a mother to four boys (ages 14 – 10) that are active in sports. I cannot even sit in the bleachers to watch their games because the pain is too severe.

I do not want to live on addicting pain medicine for the rest of my life!!! I have taken all the necessary steps to take care of this problem and treat it, but my insurance company is telling me fixing it is not necessary.

So am I supposed to go on disability? Am I supposed to quit my job because I can’t function? Am I supposed to quit school because I can sit in the sits and I can’t take pain medicine to make it through the night?

What is someone supposed to do in this situation? I pay a lot of money for health care that is supposed to help me. It isn’t helping me, it is forcing me to become sedentary and lose what abilities I have. Is this the kind of nation that we want? I do not live on assistance from anyone. My husband lost his job more than 3 years ago and we NEVER once asked for assistance. We work hard and thought we lived in a nation that takes care of its people. How can insurance companies dictate my standard of living?

I want to be healthy and free of pain. I am aware the surgery may not get rid of it 100% but I want to be able to function again. I want to wake up and not groan because I would rather be sleeping where I am pain free (when I can sleep.)

What is an American citizen supposed to do?

I have filed a 2nd appeal but I have since had to cancel my surgery. I had made childcare arrangements for my children while I would be in the hospital. My husband (who has found part-time work) made arrangements with his employer to be with me. I made arrangements with my employer to be off 6 – 12 weeks (without pay) and now I cannot have the surgery. I even had to pay $25 (out of my own pocket) for special insurance forms for my employer. That is what the doctor’s office charged to fill out FLMA paperwork and now I am out that money!

I am angry, hurt, frustrated, and in severe pain!!! What is a person supposed to do? I even had to leave class early last night because the pain was so severe and the medication made me so sick that I couldn't function.

I need this surgery to return to a somewhat normal life. I need relief from the pain...even the possibility of that is far better than what I deal with on a daily basis.

I am continuing to pray for a miracle. I am continuing to pray that the insurance company sees that it is creating a much worse environment by allowing its members to suffer.

I am continuing to put all my love and trust into God. It's all I can do.