Father’s Day Is Sometimes Complicated

The holiday has caused such confusion and questioning that for a long time it was easier to ignore it and its significance.

I never knew how to feel about Father’s Day. 

As a little girl, I probably was obligated to make a card for my father in school. As I grew older and sparred with him verbally, I chose not to celebrate Father’s Day. My father was not the “World’s Best Dad” or “No.1 Dad” — I knew this at a young age. Then as adult, I eventually understood that he knew he had made mistakes as a parent and father, and I had started to meet him for lunch or dinner and share my life with him.

My father was not the “World’s Best Dad” or “No.1 Dad” — I knew this at a young age.

Last year he had another stroke, and I became his caretaker.

And then Sunday was Father’s Day.

It had occurred to me to get him a card, or enlarge a photo that he indicated he liked, or do something to mark the occasion. After all, he is still alive, aware of his surroundings and continues to make progress during therapy.

But making the journey from Orange County to L.A. for his appointments (three or four a week, depending on his therapists’ and acupuncturist’s schedules) is not easy, and the physical and emotional strain is high.

I accompanied him to acupuncture Saturday, and the coward in me thought it might be best to not acknowledge the holiday. If I did, I knew I would start crying, and then I would surely upset him. While I have told him that we both made mistakes and that I would prefer to have him in my life, there are so many little things we have not said.

As it turned out, I was in the area after all on Sunday.

My compromise with myself was to stop in on him at the skilled nursing facility, say hello, ask him how he was doing and let him know I’d be back in two days to accompany him to speech therapy. I told him my visit would be brief because I was on my scooter and wanted to get home before traffic became too heavy and the day became night.

He raised his arm and moved his hand in a way to indicate he felt so-so on this day, and after a few more questions I said goodbye.

The stroke has changed him, especially physically, but even before that, he had been humbled by other strokes and age. He was no longer the commanding and frightening authority figure. He became a man who waned to communicate with his children, although he lacked the tools to do so.  

The stroke has changed him, especially physically, but even before that, he had been humbled by other strokes and age. He was no longer the commanding and frightening authority figure. He became a man who wanted to communicate with his children, although he lacked the tools to do so.

I am certain I am not the only one who feels ambivalence or confusion on this holiday. Even the president of the United States has complicated feelings towards a father he hardly knew. It brought me some comfort to read the article about the trove of letters written by Barack Obama, Sr., preserved, sitting in a box, awaiting the day his son is ready to read them.

My father goes to acupuncture

A family member graciously allows me to crash on his couch when I plan to visit my father.

It is an extremely convenient arrangement, given that his apartment is a block or so from a train stop, and perhaps more importantly, only a 15-minute walk (or quick Lyft ride) to the nursing facility where my dad is currently a resident.

After an initial stay at a skilled nursing facility in Rosemead, which is ridiculously far from Los Angeles — officially 18 miles from my former Koreatown apartment and about 30 minutes without traffic — we found a better and closer place in Highland Park, northeast of downtown L.A.

My father has made progress after a stroke in March, but it seems he has hit a wall after so many initial gains. His mobility on the right side has increased, but he cannot move the left side of his body without assistance. He has difficulty swallowing, and does not speak.

He was refusing to participate with the speech therapist, perhaps because it is still very difficult for him to swallow, but I’m not sure. After the electro stimulation on his throat during speech therapy at the hospital, he was a more willing participant, but he coughed a lot after trying different substances.

When he refused to participate in some aspects of physical therapy, that therapist could talk him into it.

Something is clearly going on inside that head of his, but since he cannot talk, we have no way of knowing what it is.

Acupuncture after a stroke seemed like a good idea, but because he was dealing with so many complications, we waited to make arrangements for scheduling an appointment.

We are hoping acupuncture will help stimulate his nerves and remind his brain and body what they should be doing. If it helps with movement, swallowing, and/or his mood, those are all pluses. I have wondered if he is depressed, given he is now confined to a room, his movement determined by others, and limited to answering yes or no questions.

Full disclosure: I have used acupuncture regularly, most recently for a complicated ankle sprain involving stretched nerves and loss of control of my toes, and the subsequent pain. I turned to it when migraines were dictating my life. My father turned to it for his maladies and introduced our family to it. He took me to an acpuncturist in downtown L.A.’s Chinatown when I tweaked my thumb while playing volleyball in high school.

Now it appears I am returning the favor.

I arrived at the nursing facility about 15 minutes before our scheduled departure.

He was dressed and ready to be moved to a wheelchair when I arrived.

The driver arrived a few minutes later, and I walked with him as he wheeled my father to the back parking lot where a small, white van was waiting.

I watched the driver open the van doors, unfold and pull out the ramp. Seatbelts attached to the wheelchair and acted as pulleys to get my father up the ramp and into the back of the van.

The wheelchair was secured, and then a seatbelt was pulled across my father’s chest. He seemed at ease and nodded to indicate he was aware we were going to acupuncture.

Once we got on the road, my father took in the scenery, looking mostly to his right, at a world he had not visited in seven months.

He seemed to enjoy the view, and being away from the nursing facility.

From the front seat, I asked if he was OK. He turned away from the window and looked at me briefly, then nodded. It was almost like I had interrupted him, and he went back to looking out the window.

He was alert the entire ride over and watched the nurse practitioner intently as she took his blood pressure and jotted the information down in his file. He responded to the acupuncturist, who is also his primary care physician.

The doctor, who I met for the first time that day, asked him to hold his left hand with his right. It apparently helps the brain remember and acknowledge the other side of the body. (This reminded me of my physical therapy treatments for my ankle.) She asked him, in Mandarin, to raise both arms up to his face. He complied as much as he could.

Before she began to insert needles, she massaged his face, shoulders and head. She was a bit rough for my taste, but he didn’t seem to mind. He looked calm, and comfortable.

She and I chatted, and she looked me over before saying she thought I looked like him.

Once the needles were in for a bit, my father began to snore. He slept almost the entire way back. I plan to see him again this week, and will schedule another visit. I want to get a better idea of how often he can make the trip. He did better than I anticipated — I thought he might have difficulties with traveling, but it was quite the opposite.

download_20151023_133548 My father, in the back of the van, on our way to his first acupuncture treatment.

Baby steps: I walked across the front yard. And in some hot pink running shoes.

b

Photo from stuymsa.com

It’s been 169 days since I walked like a normal person. That’s almost six months.

Then came Friday. I did not waddle like a duck or quasi limp. I walked. I tried it at physical therapy that morning. My right foot rolled up off my heel instead of planting itself flatly on the ground. Then the left foot moved in front of the right. And the right foot mimicked the left. I felt like a baby, finally standing upright and starting to find her way around. I certainly giggled like one. 

A little later that day, I was able to walk across my mom’s front yard. And up the steps.

Baby steps. But without them, I would still be completely dependent on my metal legs. 

To celebrate my progress and for a little extra motivation, I decided to scope out some running shoes. 

It was magical. The attraction instant. The desire extraordinary.

It was like they were calling to me. Sparkling under the bright lights. Daring me to walk past their curves and bright colors.

I tried on a pair in hot pink.

My foot was wrapped snugly inside, supported and cushioned while I walked the few steps from the bench to the mirror. If they felt this great when I walked, surely they’d feel even better once i was able to run, right?

I did not give in to the temptation of buying these pink Nike Free Flyknit on the spot. But if you’re feeling generous, I wear a 6.5. 

The little things in life: wearing two shoes

2shoes

Hello everyone! I am so excited that I was not functioning correctly at the office this morning. I couldn’t get numbers straight – well, that happens often – but more so than usual today.

Great news: I am wearing TWO shoes!

Before you think I’m smoking something I need a doctor’s note for or popping one too many pain pills, please allow me to explain.

For someone who has been on crutches since April because of an ankle sprain (and minor fracture and partial tear and nerve damage), this is HUGE. My right ankle has been in a brace or wrapped up, and finding a sock to go over the wrap or thick enough to go under the brace has been an interesting experience. Those socks have a special place in my wardrobe as they have a special purpose. And now, I am able to wear two matching socks and, yes, two shoes.

If you’ve ever had surgery on a knee or ankle, or been on crutches for a prolonged period of time, you know that simple things are not so simple anymore. You may recall my previous posts about attempting to go grocery shopping at Whole Foods and almost falling over while reaching for Pirate’s Booty, and my first time driving left footed.

But I digress.

I am wearing two shoes because my physical therapist says it’s time to start flexing my ankle and reminding my foot how it needs to move so I can walk. That means that while on crutches, I put my right ankle down (the injured one), and let my foot pretend it is walking – without bearing any weight on it. Apparently my foot and ankle seem to be remembering this well, as I am able to take some steps without my crutches. And I am able to stand up straight, on my two feet, like a normal human.

I never thought I’d say this, but receiving electric shocks during the neurology exam for my ankle proved helpful. 

Thank you PT. And thank you acupuncture for that first round of electric stimulation.

And Aetna, my offer still stands. I’d like to follow up with the orthopedic surgeon that correctly diagnosed my problem. You know, that condition that was making my foot blue and causing poor circulation. 

Appreciate the effort, Aetna. But I still don’t know why I can’t walk.

pt

Perhaps I thought that when Aetna contacted me last week via Twitter, offering to help me with the frustrations of doctors who don’t listen, it meant their involvement would provide me with an answer to what is wrong with my ankle and how we’re going to make me better.

Two months and 16 days after my ankle sprain, I still do not know why I cannot walk.

More than a month after my primary care doctor first heard me say how concerned I was about the visible bruising around my ankle and toes, the continued swelling, and the soreness I was starting to feel from being on crutches; and after waiting more than two weeks to get an appointment at an orthopedic hospital, I don’t have any answers.

In fairness to Aetna, they set up a referral for a knee scooter. It’s just that I would have to fork over some cash I don’t have at the moment. There are acupuncture treatments and massages I’m budgeting for that are not covered by my insurance but that I need to help with the pain and swelling.

Aetna also ruffled some feathers at the orthopedic hospital to get them to speed up the request for an MRI. Once that got to the medical group, Angeles IPA in my case, it was denied. Then denied again when Aetna requested someone higher on the food chain with clinical experience review it. The reason: I don’t meet the criteria for an MRI.

Apparently, Angeles IPA seems to think physical therapy is needed first. After six weeks or so and there are no signs of improvement or the situation gets worse, then an MRI might be approved.

I asked Aetna if this was standard practice — to send someone to physical therapy without knowing what exactly is wrong. I was told it is.

It seems there is literature about the overuse of MRIs in sports medicine and editorials from doctors who urge a more conservative approach, meaning physical therapy first. Sometimes an MRI can be a red herring, causing concern when none is needed. That 2011 New York Times article does say an MRI can be useful. (I would agree, especially if you can’t walk after an ankle sprain and it’s been almost three months since the injury.)

Physical therapists seem to agree with the philosophy that an MRI isn’t required for them to treat you, from the handful I’ve talked to about my situation over the phone. I have not had a physical therapist examine my ankle yet — I’m researching PTs that take my insurance.

But it seems to me that not being able to walk and having limited control of my toes after an ankle sprain on April 6 is a cause for alarm — and that proper care would dictate we do everything possible to figure out what’s wrong, and then settle on a course of action. I am also concerned about the possibility of making the injury worse with physical therapy. If there isn’t a break or a fracture, what’s wrong with my ankle?

As I’ve stated before, I am happy to go to physical therapy. My entire body needs it. My back and shoulders ache, my arms hurt, especially my left arm, and especially my left wrist. The pain in my wrist is trickling down to my fingers. I just want everybody involved in my care to be informed about what the problem is.

And what exactly is my diagnosis? A sprained ankle that refuses to heal?

I have the option of filing an appeal over the MRI, which I plan to do. I just need a few days off from what has felt like a stressful second job.

I filed complaints against my primary care doctor as well as the gum-smacking physician’s assistant at St. Vincent’s Orthopedic Hospital who carried herself more like a pouty teenager than a medical professional.

The PA also encouraged me to try walking and muttered about the bruising eventually going away around my toes near the end of our time together. I think she may have missed the part about me not being able to put pressure, as in stand, much less walk, on the ankle.

The California Medical Board may be next.

You can be sure that copies of my last few blog posts will be sent to Angeles IPA’s headquarters in Monterrey Park.

Aetna offered me the option of getting a second opinion with any orthopedic surgeon that works with them, meaning the surgeon can be outside my medical group.

I wonder: would an orthopedic surgeon make a decision about surgery without seeing an MRI? Let’s say I do need surgery. Then what?

Let’s say the surgeon wants an MRI before making any decision or statement? Will an MRI get approved then?

Even if the surgeon says I am not a candidate for surgery, I want to know why. While I realize this person is an expert in her or his field, no one can know with absolute certainty what is wrong with this ankle without cutting me open or seeing the results of an MRI.

I plan to switch primary care doctors. As soon as I figure out which PT I would like to see, I’ll base my primary care doctor and medical group on that.

Aetna cautioned me about switching doctors and medical groups during treatment. No offense, I said, but I haven’t had any treatment. That’s the problem.

I’m going round and round, jumping through hoops, calling to see if referrals were sent, pushing people to do their jobs.

Aetna’s efforts are appreciated. But I want answers. As each day passes, something else hurts.

Photo courtesy of patient-health-care.org

My love letter to Aetna

aetna_02

I have exciting news, boys and girls. Aetna contacted me today via Twitter after my most recent post about my frustrations with the lack of care I’ve received. The reactions I get from the doctors and their staff sometimes make me wonder if I’m going crazy since I seem to be the only who thinks it’s problematic that I can’t walk two months after an ankle sprain. Well, besides you, dear readers.

I am glad that Aetna has contacted me and offered to help resolve the matter. But I won’t be raising a glass of champagne to them until I find out what’s going on with my ankle and get a treatment plan in place. And soon. Which in my mind translates to – you guessed it – MRI.

For your enjoyment and in the spirit of honest communication, below is my letter to Aetna. I spared them my stories of driving left footed in The Tank, not being able to shower, how long it takes me to get dressed, planning trips to the grocery store around other people (whom I totally appreciate), how I have to sleep kind of sideways so the weight of the sheet and blanket don’t hurt my ankle or toes, having to use a dining room chair to help me cook, and going down the stairs on my behind to do laundry. 

Hello,

Thank you for contacting me.

DOB: 12/17/XX
Aetna ID: XXVVXXVVXX

The back story:

I have been on crutches for over two months now due to an ankle sprain. The injury happened April 6.

The right ankle is not broken nor is it fractured, according to two X-rays. A third X-ray at the orthopedic hospital revealed there are no breaks or fractures in the foot. I still have a bruise on my foot, near my toes, and there is pain and some swelling around the toes on the top and bottom of my foot (and still minor swelling around my ankle).

Since signing up with Aetna through my employer I do not feel I have received proper care or treatment.

My primary care physician doesn’t listen, always ready to shove me out the door to tend to a more urgent matter.

I visited the ER at Good Samaritan just before the Memorial Day weekend because I tripped and fell and was in an incredible amount of pain. It’s possible I re-injured the ankle.

My PCP is aware of the fall. I told him about the pain and that I wanted an MRI to see why I couldn’t walk. He said to discuss that with the Ortho. I have also requested a knee scooter to no avail.

The physician’s assistant I saw Monday at St. Vincent’s Orthopedic Hospital seemed to be in a hurry and after the foot X-ray, offered me a cortisone shot. In her opinion, I had to show I was trying all possible ways of helping my ankle heal before an MRI could be done. She wants me to start physical therapy and said she could request the MRI six weeks into pt. I’m all for pt, but what exactly is the physical therapist going to do if he/she does not know what is wrong with my ankle? And wait two more months before knowing what’s going on with my ankle?

It took more than two weeks to be seen by a PA (I couldn’t get in to see a doctor despite explaining why this was urgent) and to have the PA say it would be a waste of time to request an MRI now is beyond ludicrous.

I’ve had three X-rays done. It’s been more than two months after an ankle sprain, and no one seems to think an MRI is urgent?!!!! I CANNOT walk after an ankle sprain. A sprain.

I plan to file a complaint against the PA. She said there was another way I could get an MRI. She added sarcastically that that would be by paying for it out of pocket. If that was an option, I would.

After more than two months on crutches, the rest of my body is in a lot of pain, especially my left arm and wrist. I am waiting for yet another appointment at the ortho hospital so someone can check my wrist and arm. Really? Do the doctors not realize everything in the body is connected? Will I then need to make a separate appointment for the pain in my shoulders and back?

And, to make matters worse, it takes a week for the PA’s notes to be typed up by someone. The “dictation” cannot be sped up/rushed/marked urgent and only after the dictation is done will an MRI be requested. And then, it is up to Aetna whether it will even be approved. REALLY?!!

Is this good care?

Please advise when I can receive an MRI and when proper care will begin.

Thank you.

And thank you, Twitter.

Oh, for the love of Aetna

Thank God, Allah, Buddha and La virgen the Paris Baguette bakery is nearby.
Thank God, Allah, Buddha and La Virgen the
Paris Baguette bakery is nearby to help me through trying times.

Today, boys and girls, we’re going to hear about a physician assistant at an orthopedic hospital who lacks bedside manners. We’re also going to hear about the continued frustrations as a certain someone navigates the health care system, hoping to find an answer for why she still cannot walk, two months after her injury occurred.

For those of you following along, you may remember I had an appointment scheduled at the orthopedic hospital today. The first appointment I could get was with a physician assistant (PA), which was a little more than two weeks after the referral was authorized by Aetna. I decided to take it, thinking the sooner I got to the specialist, the sooner I would have an answer about this ankle of mine.

I guess insurance companies don’t work on logic.

The PA said we’d have to try a variety of things before the insurance company would authorize an MRI. As I stared back at her and noticed how much make up she was wearing, I wondered if I was really hearing this woman correctly. After an xray of my foot (not the ankle) revealed there is nothing broken or fractured there, the PA offered me a cortisone shot. For the pain, she added, after my mouth fell open.

“No offense, but I’m not interested in just dulling the pain,” I responded. “I would like to know why I cannot walk. It’s been two months since this happened, and I’ve been on crutches for two months. Do you see my wrist?” I held up my bandaged wrist, which is hurting as I type.

“My arm and wrist, and entire body hurt. From the crutches. Because I cannot walk. So I would like an MRI. Don’t you think that if my ankle isn’t broken or fractured, I need an MRI to figure out what is going on?”

The PA bows her head, like I’ve hit her across the forehead with my crutches, and takes a deep breath.

“It’s not me,” she said.

Apparently, the insurance company will likely not authorize an MRI at this point, in her experience. They will want to wait six weeks to see how the physical therapy goes and if there is any improvement or change. She says requesting the MRI now could just be a waste of time.

A waste of time? I’ve already spent two months on crutches. Waiting. Initially, I was waiting for my insurance application to be authorized. Then for referrals and more authorizations to specialists, who all seem to be quite busy. When I get in a visit to my primary care physician, he seems to smile and nod a lot and say, “Hang in there.”

And what exactly is physical therapy going to involve on my ankle if they aren’t even sure what’s wrong with it?

I’m glad we ruled out the possibility of any broken bones in my foot.

But why is there still a bruise near my toes? And why can’t I stand for more than a few seconds without any pain, let alone walk? Why do I still have pain in my ankle when the PA touches it. (Initially, I thought she was just squeezing it really hard. But when she touched the left ankle the same way, we both realized there is still pain there. I guess I’m just getting used to the constant ache.)

To wrap up our conversation, the PA mutters something about the bruised tendons that will eventually heal and how I should check in after six weeks. I’ll get a call in two weeks about physical therapy and if the MRI was approved.

Oh, there is one other thing I could do if I want the MRI now, the PA said.

I could pay for it.

The $3,000-$5,000 it would cost if I paid for it out of pocket.

“Yeah, sure,” I say.

And for the pain in my wrist and arm, I have to go back to my primary care physician so he can request another referral for the orthopedic hospital to see me about my arm and wrist. Then, maybe, I will get physical therapy for the rest of my body.

I’m guessing that if other patients are getting the same run around, that $10 co-pay starts to add up.

To help me through my frustration, I picked up some pastries from the Paris Baguette down the street from my place.

I did get a nice ankle brace out of today’s visit. I can wear two matching socks again. For the uninitiated, with an ankle wrap/bandage, you need to find a loose sock to wear over it. Your other foot can still wear a normal sock. But I’d rather have an MRI than a new ankle brace any day.

a2