| Mike Maiale Bilateral 1/29/09 - Dr. Su |
|
|
|
|
2/17/09
Vicky,
I wanted to thank you for your assistance in getting in to see Dr. Su and give you an update on my bi lat resurfacing.
I originally was scheduled for surgery on 11/23/08. About 4 weeks before a filing in my molar fell out and part of the tooth broke off. I got an appointment with my dentist about 10 days later but the dentist sent me to a specialist b/c the root was cracked. My appointment with the specialist was on the Tuesday, 3 days before my surgery.
They determined that there was some infection near the root of the
tooth, and put me on antibiotics. I contacted Dr. Su's office
immediately and his PA called back. When I told her what happened she
said we'd have to reschedule the surgery, Dr. Su would not operate
when I had an infection and apparently for very good reason.
We rescheduled surgery for 1/29/09. Meanwhile I got a root canal on the infected tooth and had a cap put on. The experience with Dr. Su and HSS was very positive. He told me during our consult that he thought he could do both hips on the same day but had some reservations b/c of the level of osteophytes on the hips.. On the day of surgery when he came to the pre op area to initial my hips he told me that he was going to do both that day. He did.
The pain management was excellent. I was in the PACU overnite, since my surgery wasn't completed until 5:30 PM or so. I stayed in the PACU much of the next day until a room opened up. Luckily, I got a window side bed overlooking the East River. The only thing more I could've asked for was a nightly glass of wine. They denied that request however.
The care, food, etc was very good. I did have a gripe with the Post Op Case Manager and the PTs. Dr. Su had originally suggested inpatient acute rehab post op b/c I was having a bi lat and b/c no one was home at my house from 8 AM to 7 PM. I communicated this to the Pre Op Case Manager, Meryl Coleman, and gave her two excellent acute rehab centers in the Philadelphia area, close to where I live.
The Post Op Case Manager didn't file the request for approval of inpatient acute rehab until Monday, despite the fact that she came to my room and said she filed it on Friday. Meanwhile , the PTs got me up and about on Sat., Sun, and Monday morning. I told the PTs that I want ed to go to inpatient acute rehab, in other words I didn't want to do anything that would cause the insurance company to deny approval. They told me not to go up or down steps and not to practice doing ADLs. I followed their instructions. However, with the PT as my side I walked over 250 feet with a walker. I thought that the application for approval of inpatient acute care had already been submitted. The PT didn't tell me otherwise. On Monday the Case Manager submitted the application for approval with all of the PTs notes. When Blue Cross saw how far I had walked they denied the approval. I appealed the denial and had to sit in HSS an extra 2 days pending the appeal. They denied it again.
I spoke to the admissions personnel at Bryn Mawr Rehab in Malvern PA, my first choice for acute rehab. They told me that bi lats are almost always approved for inpatient acute rehab. They held a be for me pending the appeal. I could've appealed again, but that would've meant staying at HSS for at least two more days. I left HSS on Wed afternoon, 6 days post op.
Luckily, Bryn Mawr Rehab had just begun an outpatient acute rehab program in August of 2008. The outpatient regimen is more advanced than the inpatient regimen according to the PTs in the program. You arrive at 9 AM. Get examined by a nurse b/t 9 AM and 10 AM. Get PT from 10 AM to 12 PM. Have lunch from 12 PM to 12:30 PM. Rest and ice down from 12:30 PM to 1 PM. Get PT from 1 PM to 2 PM. Rest and ice down from 2 PM to 2:15 PM. Go home. I did that for 6 days. They kicked me out 1 day early. As of Sunday I am off Percoset altogether. I was taking 3 per day for about 7 days before that. I take Arthritis strength Tylenol now 3 time per day. I am going to PT 1 hr/day 3X/week. On off days I walk and/or ride a stationary bike. I ride the stationary bike 30 minutes or so and walk with crutches about 1/2 mi or so. I could do more.
I emailed my PT regimen to Dr. Su when I began at Bryn Mawr Rehab. He said the program was very new and advanced. He did request certain modifications since the program was more accustomed to rehab for hip replacements. He took me off the treadmill and substituted the stationary bike. He also asked that I stand b/t the exercise bars so that I could use my arms to bear some of my weight when I was doing single leg standing exercises. He also recommended aqua therapy. They have a very nice heated pool and will provide aqua therapy but not until my incisions are fully healed.
I am scheduled for my 4 week follow up visit with Dr. Su next week, I am anxious to see the xrays of my hips and learn more about what was done and how I am progressing. The PTs are very happy with my progress to date. I sure would like to be able to drop the crutches soon, but I'll be patient.
Thank you very much for your assistance. I hope all is well with you.
Best Regards,
Mike Maiale
The 3 hr./day 7 consecutive day regimen was as follows:
Morning session (2 hrs):
Mat exercises on the PT table:
20 reps of ankle extentions.
20 reps of heal slides
20 reps of single leg abductor slides
20 reps of glute squeezes on the mat
20 reps of quad contractions on the mat
20 reps of glute bridges on a PT ball
20 reps of single leg leg raises in supine position
20 reps seated leg extensions
seated or supine hamstring stretches ( 30 secs per leg per rep and 2 - 3 reps per leg)
Walk two laps around the PT gym.
Standing Exercises at the exercise bars:
For bi lat I did these standing b/t the bars so I could use both arms to bear weight when
doing the single leg exercises. All single leg exercises were done with both legs. Towards
the end of the week as the standing exercises became easy I used a yellow theraband
around my thighs to increase the resistance.
20 reps of knee lifts
20 reps of single leg abductor lifts
20 reps of single leg hip extensions (to the rear
20 reps of squats at least 50 degrees if possible
20 reps of toe raises
20 reps of leg curls
Stationary Bike:
5 - 30 minutes (as capable) with no or low resistance. Resistance no greater than L3 on
manual mode.
Ice Down
Afternoon session (1 hr) :
Repeat most Mat (PT Table) exercises
Manual manipulation -
Repeat most Standing (Bar) exercises
5 - 10 minutes on the stationary bicycle.
Walk two laps around the PT gym.
Ice down
On going PT : they've added single abductor raises lying on my side in lieu of abductor slides, standing calf stretches off a step and leg extensions lying on my stomach. I will begin doing the standing exercises and more in the pool once Dr. Su gives clearance that my incisions are healed. They are very concerned about infections being caught in the pool.
|
| < Prev | Next > |
|---|
