About that Sports Hernia . . er . . CMI

Sorry to pause in the middle of my recent Newfoundland adventure, but quite a few people have asked about where I’m at with the on-going injury that occurred during the $%^##@#$$ snow storm last spring. (I’ve decided never to just refer to snow again without a leading expletive of some sort). If you are waiting on the edge of your seat to see what happens in part 4 of the Newfoundland moose hunting trip, give me a day or two. I promise I’ll get back to it. But for those that asked . . here’s what’s happening with my groin. (Hmmm. Now if that doesn’t make you want to keep reading . . . )

First of all, let’s stop saying “sports hernia”. Nobody in the medical, training, or rehab field likes the term. It is confusing and inaccurate. There isn’t a hernia involved at all. The proper diagnosis is core muscle injury or CMI. If you are familiar with the ICD-10 coding system used for all medical diagnosing codes we are talking about your standard S39.011A or Strain of muscle, fascia and tendon of abdomen, initial encounter”. But for our purposes let’s just stick with CMI. It’s a lot easier to type.

To recap what the CMI is, at least in this case, muscles in the core have begun to detach from their respective attachment points. The muscles in question for me are the  adductor pollicisadductor longus, and rectus abdominis. All attach to pubic bones. This type of injury was suspected after several early doctor visits and after ruling out any sort of traditional hernia. It was verified with my visit to the Vincera Institute back in August. During this visit they also determined there was a slight hip labrum tear but that that doesn’t seem to be contributing to the groin pain.

chewed-up-ball
Pretend the muscles are attached to the cover of the ball and the cover is tearing. That’s the CMI. 

As noted, in that post and in subsequent posts, Dr. Meyers is the leading expert on this type of injury and the corrective surgery for it. Conveniently, he is right in Philadelphia, barely an hour drive away. This is where he performs surgery on worldclass athletes nearly every week. How awesome is that!? We have the best guy, and the best procedure nearby. Post surgery, the athlete can be back at full steam in 6 short weeks of rehab. This seems like a no-brainer so why haven’t I gotten it done yet? As noted in several bitter posts here and elsewhere on social media, insurance doesn’t cover the surgery nor give any other advice on how to recover from the injury otherwise. They just take a “tough luck kid” approach to this. Without further whining about insurance, let’s move on with the assumption that I’m getting no help from my pricey medical coverage for the CMI repair.

Scan 2017-9-16 05.34.44
Yet they tell me they want me to stay healthy. 

I mentioned last time there was hope. That hope lay in the fact that because of all the testing and doctor visits for this crazy injury I was, for the first time, approaching my maximum annual out of pocket with my insurance. One of the options for surgical repair was to get both the hip labrum and CMI fixed at the same time. This would be done by two different doctors. Dr. Meyers would perform the CMI repair, and Dr. Struan Coleman, a hip specialist, would perform the labrum repair. After my initial conversations with Dr. Meyers I had leaned away from doing anything about the torn hip labrum. First, it didn’t seem to be a contributing factor. Second, the surgeon was out of network. Third, rehab is much more extensive. But that was before I knew I was near maximum out of pocket. I hatched a scheme.

Mentally, I am concerned that doing nothing about the hip will lead to some degree of worry. Will it always eat at me mentally knowing something is wrong that I didn’t fix? Thinking the hip labrum repair would normally be partially covered, I figured I could get that done, paying for it and the anesthesia mostly through insurance, and while under, could also get the CMI repair done. hip_labral_tear_refixation

With this grand scheme, I decided to bite the bullet, called Vincera Institute and scheduled the next available appointments to get the hip labrum and CMI repair done. Dr. Coleman and Dr. Meyers would both be available Oct. 16 and 17th. There would be a pre-op visit with both, followed by surgery the next day.

As soon as I scheduled the appointment I began waffling. I hadn’t thought to ask if it would work the way I thought with insurance. Even if it didn’t, the amount of money for just the CMI was a lot. What about the rehab for the hip labrum? What was the cost of the anesthesia? I thought of 200 questions I hadn’t thought to ask and immediately began barraging Marcia and Elisha at Vincera with questions. I’m sure my e-mail has made the spam filter at Vincera.

spam
I’m sure Vincera has me in their SPAM filter by now.

It turns out, because we are out of network, it does not work the way I had hoped. Essentially both doctors charge an up-front professional fee. For the services involved it is a rather modest fee but both practices do their best to keep costs down for those paying out of pocket. I’m sure NFL, NHL, or MLB teams don’t really care what the surgery costs when they pay to get their prized assets fixed. I’m sure that is the bread and butter for Dr. Meyers and Dr. Coleman. But you don’t have to look far on their website or elsewhere to find a boatload of “normal” people who, like me, have to pay for this surgery themselves. The bottom line is that each bit of surgery is itemized for out of pocket patients. CMI: $13,500.00. Anesthesia for CMI: $700.00. Hip labrum repair: $8000.00. Anesthesia for hip labrum repair: $900.00. Further costs are sent to insurance to recoup any balance.

If you aren’t a pro sports franchise, it’s a lot of money. Some have suggested starting a crowd funding effort to pay the costs. I could never do that. The truth is, if I want to do this it will be a big hit in the savings account but I can afford it. I could never ask others to reach into their pocket and help. There are so many more worthy causes out there than this. For me there is some inconvenient discomfort that I deal with. It also keeps me from racing like I used to. But when I look at recent events like Harvey, Irma, Vegas or on-going things like ALS, muscular dystrophy, cancer, and so forth . . this is nothing and I could never be a charity case for my own vanity. Please, donate where it matters.

That said, back to waffling. Since I scheduled the October 17th appointment I have changed my mind approximately 397 times. “Skip the hip repair. Just get the CMI. But that is expensive too. Maybe I can just live without any of it and keep the money in my pocket. Really, just get both done. You’ll be happier. Wow! It takes like a year to recover from hip labrum repair. And it sounds painful. Just get them both. No, wait, don’t do either”.eqd_natg_2012_day_10__assertive_waffling_by_samueleallen-d5atyzv

And so the conversations in my head have gone. Timing is never good either. While the fall is perfect to get the surgery done from a racing perspective, it sucks from other perspectives. I’ll miss the fall archery season for deer. I love being out in the woods on cold, fall mornings when the rut is full on. It is exciting. Also, I am supposed to go help my buddy Joe fill the coveted Pennsylvania elk tag he finally drew at the end of October. If I get the surgery as scheduled, I don’t know if I’ll be able to do that or not.

The picture in my mind began to clear this past week. I had truly muddied the waters worrying about doing the hip labrum too. As it stands, I have pre-operative appointments with both doctors on October 16th. I know nothing about Dr. Coleman, the surgery, or the rehab. My suspicion is that I will decline the hip labrum repair. But I am committed to the CMI repair.

186381706
The CMI surgery is happening.

I made this decision after my long trip to Newfoundland to hunt moose. During the 10 days of travel I didn’t run, bike, or swim once. It gave me a great opportunity to test out life without those activities that have become such a part of my existence. I was also participating in the activities I have always been most passionate about: hunting and the outdoors. I wondered how it would go? The short answer is, it still hurt. Even though I never did the amount of walking I expected to while hunting, what we did was all done on bogs. Walking on a bog is like walking on a giant, wet sponge with every foot fall sinking a bit into the surface, compressing the sodden earth. Then there was the hours in the car. 23 hours to North Sydney, Nova Scotia and another 7 once across the ferry to Newfoundland. Riding in the car, or sitting at a desk is not a comfortable experience.

Upon my return I logged a few easy running miles. A total of a mere 16 miles for the week all at nominal paces. After 6 on Friday morning, walking became a struggle the rest of the day. I sat with an ice pack Friday night. I can’t go through life like this.

I’m probably not messing with the hip labrum. It will cost more money out of pocket for the initial appointment with Dr. Coleman, but I’m so far into this now it seems to make sense to have that conversation and make an informed decision about the hip from there. I want to understand the injury, the surgery, the rehab, and the consequences if I don’t get the repair. It also seems reasonable that I could get that repaired later in-network at a lot less cost. I’ll make this decision on the 16th.

Well . . that was a lot of boring, self-absorbed medical mumbo jumbo. Are you still awake? Anyway, that’s where things are injury-wise. Now . . back to Newfoundland.

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