Teens in Chronic Pain

I have one last shot at getting approval for my required medial meniscus transplant. We can send in any documentation that we feel shows why I should have this surgery to the insurance External Review Board. This board is “above” Blue Cross Blue Shield so what they say goes, but apparently this board rarely overturns the insurance company’s denial. Along with letters from my surgeon, pain specialist, and physical therapist, as well as studies showing how meniscus allograft transplants can improve one’s quality life, I’m sending the following essay:

To Whom It May Concern:

My name is Christy Hammond, and I am a 21-year-old student attending the University of Michigan. Blue Cross Blue Shield of Michigan recently denied my request for a medial meniscus transplant for my left knee, which my surgeon Dr. Frank Noyes believes will reduce my pain level by half. I am writing this letter to appeal to you and personally ask for you to please reconsider through the External Review Board.

While growing up in Michigan, I was the definition of a tomboy. I lived to play sports and was active around the clock and year round. Like many young kids, I wanted to become an Olympic sprinter. As I grew older, I soon realized that I would never be fast enough to achieve that dream. However, my love for the sport of track and field persisted. I ran the 100m dash and started the 4×100m relay in sixth grade and continued through tenth grade. As a freshman in high school, I took sixth place at regionals for my division.

In my sophomore year of high school (2003), I tore my ACL during the first hour of basketball tryouts. After a lot of hard work in rehab and countless hours in the weight room, I was able to return to my beloved sport. While my 4×100m relay team finishing fifth at regionals was certainly great, my proudest track accomplishment was actually improving my 400m time by nine seconds following my ACL reconstruction. Unfortunately, that race was my last one.

In the summer of 2003, my knee buckled while I was on vacation, and I was never able to run again. I do not know if I can ever accurately describe the emotional pain that I feel when I watch my friends and former teammates run. Running is such a beautiful joy that I miss terribly. When my surgeon told me that at the age of 17 it was unlikely I would ever run again, I cried and begged God to let me run again.

It is truly humbling to go from being a star athlete who is addicted to sports (I would spend my summers on my driveway running suicides and shooting hoops and then go run a mile or two around the neighborhood) to struggling to walk from my dorm room to our floor’s bathroom. I would give almost anything to sprint one last time; to feel my arms pumping, my quads and lungs burning, the crowd cheering, the adrenaline of competition, and the glory of competition whether it results in a win, loss, or personal best time.

Five years later, I have come to grips with the fact that I will never run or play sports ever again. Currently, I cannot swim, ride a stationary bike, or use an elliptical machine, which are all supposed to be cardio activities that are easy on one’s knee joints. After five minutes of any of those activities, I am bed-ridden for a week. I cannot even walk or stand without constant pain. It would be one thing if I was 40 years older and had lived a somewhat normal active life and you had denied my surgery. However, I am only 21 years old. I have my entire life ahead of me and that is why I need you to approve this surgery, which is my only chance to have a less painful future.

I want to get a job after graduating from college. I want to not have to worry about surgeries every year and this high pain level every single day at work. I want to get married and have kids. I want to be pregnant without worrying if I will be able to tolerate nine months without pain medication. I want to be able to teach my kids how to play basketball and soccer and teach them how to ride a bike. I could not do that right now with my current level of pain.

Currently, I have a hard time just standing through a three and a half hour college football game in the student section. By the time I get back home after the game, I am in so much pain that I cannot do anything else for the rest of the evening. The highest level of activity I can currently do is bowling and even that is painful for me. But I am not just struggling with fun activities like attending sporting events and bowling, my coursework has definitely been affected by my knee pain. I have to get to my classes early to ensure that I get an aisle seat, which allows me to stick out my left leg into the aisle. Otherwise, my knee gets stiff and starts throbbing so badly that I am unable to make it through the entire lecture. I have to spend one to four hours each day icing my knee to make it through classes and work. Sometimes I am unable to properly focus on the assignment or cannot even complete the assignment because the pain is too great.

This pain is not just a sharp pain that comes and goes depending on how active I am during the day. Instead, this is a constant agonizing pain that torments my body from the second I wake up to the second I fall asleep at night. It is a constant throbbing in the back of my knee that never subsides and only gets worse with activity. It is a pain that on bad days will keep me awake for hours at night praying that the pain will dissipate enough for me to fall asleep. It is a pain that often gets so bad during the day that I cannot focus on class, my homework, or even my internship. When the pain in my knee reaches its peak, my mind goes blurry and the throbbing intensifies. My knee pain brings me to tears. It is the release of years of frustration and disappointment. It is the daily pain that never leaves.

If I do not get approval for this surgery, I will have no other option aside from waiting for a knee replacement, which is many many years down the road. Currently, my knee has pre-arthritic changes at the age of 21. Now is the perfect time for a meniscus transplant to stop arthritis from fully developing in my 20s. Studies have shown that it’s important to have the meniscus transplant before the onset of advanced tibiofemoral joint arthrosis. I do not have arthrosis, yet. However if BCBS decides that this surgery is no longer experimental in three years, it may be too late for my knee, as I may have developed arthrosis by that point. If that happens, I will be forced to suffer and wait for 20 years until I am old enough for knee replacement. My window of opportunity is closing quickly and I am pleading with you to see how necessary this surgery is for my quality of life.

I am a perfect candidate for this surgery according to my surgeon, who was one of the first to perform a meniscus transplant back in 1987 (the year I was born). You denied my request because you believe this surgery is experimental. However, my surgeon has been performing this operation for decades. My surgeon believes it should reduce my pain level, and it is the only chance I have at this point in my life to reduce my current pain level.

How do I know this is my last option? My surgeon and my other previous orthopedic surgeons have tried to rule out any other possible alternative problem that would explain my chronic knee pain. It actually took me two years to convince my surgeon that my pain level warranted a meniscus transplant surgery. He only agreed to do so after he had ruled out every other possibility for my pain. A meniscus transplant is the only chance I have left to reduce my current pain level. The following list contains the other alternatives my surgeon and I have ruled out before deciding the transplant is the next and only appropriate step.

· I have had an EMG and seen two different neurologists to rule out nerve problems.
· I have had four bonescans to rule out Reflex Sympathetic Disorder (RSD).
· I have had a PET scan to rule out bone cancer.
· I have had over 10 MRIs and a CAT scan to rule out other possible structural damages.
· I have had a lidocain infusion test, which resulted in a toxic reaction, to rule out a pain disorder.
· I have tried cortisone injections to help the pain, but the injections only ended up worsening the pain.
· I have tried acupuncture, holistic therapy, hypnosis, and psychotherapy to no avail.
· I have had years worth of physical therapy, which has helped to strengthen my knee but has not reduced the overall constant knee pain.
· I have tried various pain medications from Vicodin to Kadian to Duragesic patches to control the pain. I take Vicodin to help with the pain, but it no longer is strong enough to remove the pain it just helps bring the pain level down a couple notches. I do not want to take pain medicine. I know that if I continue to take Vicodin and other over-the-counter medications daily for the rest of my life because I cannot get this pain under control, my liver will eventually fail resulting in more medical bills and issues. Other than my knee, I am a healthy young adult and the idea of my liver failing because of my pain medication scares me.

As you see, my surgeon has been very thorough in trying to determine the root cause of my knee pain. Between the nine knee surgeries I have had, the dozens of medical tests that have been performed, and the specialists I have seen, the meniscus transplant is the only step and the only appropriate option to reduce my pain by half of what it currently is. Please help a college student regain some normalcy in her life by granting this request. While this surgery will not take away all my pain and allow me to run once again, it will reduce my pain to make walking and standing bearable. Please approve the medial meniscus transplant I need to reduce my pain.

Sincerely,
Christy Hammond

Trackback URI | Comments RSS