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Rotator Cuff Injury
by Gary F. Zeolla
This article is continued from Rotator Cuff Injury 2.0: Part One.
Letter to Insurance Company
Below is the letter I sent to my insurance company when approval for my surgery was denied. I have redacted or replaced the names of my insurance company, surgeon, surgeon’s office, and physical therapy center with generic terms, less someone sue me for saying something “nasty” about them.
June 25, 2022
Dear [insurance company],
You denied the request by my surgeon, _____, for right shoulder surgery to repair a torn rotator cuff tendon. You said I could appeal that ruling. I am doing so with this letter. Also enclosed are my “Medical information” sheets listing and describing of all of my other health problems.
The most important among these are my Multiple Chemical Sensitivity (MCS), Fibromyalgia, Stiff Person Syndrome (SPS), Restless Leg Syndrome (RLS), and organic tics. Because of the first, I rarely leave my home and doing so causes my sensitivities to flare up, which in turn causes the other four to flare up. That leads to me feeling terrible, fatigued, stiff, unable to sleep, and barely able to function for the next day or two. I am only able to be at all productive and to stay in shape due to having a home office and home gym, though I am very limited in the amount of time I am able to work due to these problems.
With that background, on March 14, 2021, I experienced pain in left shoulder and arm while working out. Over the next month, it got progressively worse. In April, I called my PCP and was told to go the emergency room. The ER doctor took an X-ray. That was normal. But we both knew what was needed was an MRI, but she could not authorize it. Only a surgeon could do so.
That is when I went to the surgeon’s office. I was given a cortisone shot. That reduced the pain for a few weeks, but then it came back. In the meantime, I was also given a prescription for physical therapy. I went to physical therapy (PT) for several weeks. That did nothing. In fact, the pain got much worse over those weeks. In addition, each time I went to the PT center, it would bother me more and more as far as my MCS goes, with the adjacent worsening of my other health problems.
Finally, by August, I was able to get an MRI. That showed I had two rotator cuff tears and a biceps subluxation. It was so bad, the surgeon told me before the surgery, he was not sure if he could fix all of it. But I am sure, if I had gotten the MRI back in April, it would have shown less damage. In other words, that four months of delay caused the problem to get worse, while causing me to go through months of needless pain and suffering.
But thank God, the surgeon was able to fix the problems. But it has been a long recovery given the amount of damage. I went to the PT center for a few weeks after the surgery and was progressing okay, but my MCS reaction each time I went got worse and went. Finally, by October, I stopped going, as I just could not handle it anymore. I told them and the surgeon I could finish the therapy on my own at home. Again, I have a home gym and workout regularly and have been doing so for decades, so I know what I am doing.
That was going well, until I had a setback in late November getting Christmas decorations out of the attic. That led to a recurrence of pain and a fear I had torn open the repaired tendons. The surgeon gave me another Cortisone shot. That did nothing, but it caused my organic tics to flare up, leading to three sleepless nights. I told him then, “There is no way I am doing that again.” That is when I got a second MRI. Thank God, it showed I had not torn open the tendons.
Eventually, that pain mostly subsidized. Now, ten months post-op, I still have some pain in that shoulder, and it is still weaker than it was before the surgery. But it is much better than before the surgery.
However, as I was rehabbing my left shoulder and just getting back into somewhat harder working out, in April of 2022, I began to develop the same pain in my right shoulder that I had experienced in my left. It greatly worsened on May 8 after a somewhat hard a bench press workout.
The next day, I called the surgeon’s office and scheduled an appointment. The surgoen ordered an MRI, and that was approved. It showed I had a “severe tear” and buildup on a tendon. The tear was halfway across. That is when we scheduled surgery for June 3, 2022.
I got all of the required tests that week (EKG, X-rays, blood test) and approval by my PCP. I thought I was all set. But come June 3, the surgery had to be cancelled when you did not approve it. We then rescheduled for June 14. The surgeon’s office sent you additional information, and the surgeon held a “peer to peer” call with one of you doctors. He was told then the surgery would be approved, but he was then flabbergasted, as was I, when the surgery was once again denied.
At that point, I asked the surgeon what the odds were of the half-torn tendon tearing the rest of the way if I resume normal activities. He told me there is a 50/50 chance of it doing so. That would probably put me in excruciating pain. And once again, it would take weeks or months to go through all of the rigmarole of getting another MRI and surgery, all the while with me in severe pain. That I why I want to get it fixed now, before that happens.
You sent me a letter detailing why surgery was denied. You say I need to undergo three months of physical therapy, try rest or a change in activity, take an anti-inflammatory for at least four weeks, and get a cortisone shot. However, I have already done all of that, and it has caused me problems due to the afore-aforementioned health problems.
On the physical therapy, from the time I first went to therapy for my left shoulder, I did all of the same exercises for my right shoulder and continue to do so to this day. That is because my right shoulder has never been quite right, with reduced range of motion and strength, since my bicycle accident back in 1999. I was hopping doing those exercises would help in that regard. It did not, and it did not prevent the rotator cuff problem from developing.
The point is, I have been doing physical therapy as prescribed by the PT center for my right shoulder for over a year. Thus, going for formal rehab would be nothing new. And again, it would cause me problems due to my MCS. In fact, it already has.
At my appointment at the surgeon’s office on June 24, I was given a prescription for physical therapy. On my way home, I stopped by the PT center to give them the prescription and to schedule appointments. Just being there for a few minutes left me in an allergenic state and feeling just plain awful. Then that was worsened when I later filled out forms they gave to me to bring back. Yes, just the smells on those papers caused a reaction. That is how sensitive my MCS is. As a result, I barely slept that night, due to my tics flaring up. The next day, I felt awful, stiff and fatigued. It will take me the entire weekend to recover.
But now, because you will not accept my already doing rehab on my own, you want me to go there for weeks. Each time, I will be left feeling awful for a day or two afterwards. I simply cannot go through that again.
On the anti-inflammatory, since this all began last March, I have been taking ibuprofen. It is the only pain medication I have found that alleviates the pain at all. Tylenol, aspirin, Aleve, and prescription Meloxicam I was given at the ER do nothing. But I have now been taking ibuprofen regularly for over a year. That has me very worried about what it is doing to me, but I have no choice. I talked to the surgeon a couple of times about my concerns already.
The point is, I have been taking an anti-inflammatory for far longer than four weeks already.
On the cortisone shot, again, I had a significant reaction to the second shot. My reaction to a third shot will probably be far worse, and I do not want to risk it. Again, my MCS is such that the more often I am exposed to something I am sensitive to, the more I react to it. I had a more severe reaction to my second Pfizer Covid shot than the first. The same goes for my two shingle shots. In both cases, I was virtually paralyzed head to toe for two days afterwards. And third cortisone shot will probably do the same to me.
On rest and change of activity, I was doing that for months after my left shoulder surgery. I don’t need more rest. I need to get back to normal activity. But with the fear of ripping the tendon the rest of the way, that will be difficult to do. I would prefer to get it fixed now, then rehab it, so that I can go on with my life and not live in fear.
The bottom line is, I am already doing all that you say I need to do. Delaying the surgery on my right shoulder will only enable the problem to get worse, leading to more pain and more damage, a harder surgery, and a longer and more difficult recovery, just like happened with my left shoulder. And forcing me to go to rehab will worsen my other health problems.
In other words, your refusal to approve the surgery at this time will cause me much needless pain and suffering. That is not acceptable. Please reconsider and approve the surgery as soon as possible, rather than making me suffer needlessly.
The “Medical information” sheets is basically what is found near the end of my
My Life Story (long version)
Final Powerlifts Workouts Pre-Surgery, Again
With my surgery delayed a month, I got through my monthlong rotation and did the actual powerlifts one more time. My work sets for these workouts went as follows (pounds/reps). My bodyweight was about 121 pounds at this time.
Squats with Sleeves: Raw: 225/10, Gear: 255/6, 267.5/4, 280/2
Squats with Wraps: Gear: 270/6, 285/4, 300/2
Bench Press: Raw: 105/10, Gear: 115/5, 120/3
Sumo Deadlifts: Gear: 295/6, 320/4, 337.5/2
Conv Deadlifts: Gear: 315/6, 332.5/4, 350/2
After the first workout, I eliminated the raw set for Squats and Deadlifts and lowered the reps with gear, so as to get in more powerlifting specific workouts. But I kept the raw set and somewhat higher reps for Benches. For them, it felt good to bench bodyweight for a triple. That is progress, despite everything. Squats and Deadlifts are also going well in all forms.
All of that might make it seem strange that I am pushing for another surgery. But, as I explained in the letter, if I don’t have surgery now, I probably will need to do so later, and then it will be even worse. As the old car repair shop advertisement said, “Pay me now, or pay me later.”
The point of the ad was, pay the lesser cost of routine maintenance or to fix a
minor problem now. If you don’t, that could lead to a major problem with a much
higher repair cost later. I don’t want to live in fear of that “later.”
Left Adductor Injury
In my next Squat workout after the preceding workouts, I injured my left adductor (inner thigh) muscle. I am not sure what happened. All was going fine for my warmup sets, but on the first rep of my first work set, a planned set of six reps, something seemed to “click” in the adductor. I didn’t think too much of it, so I did my next rep. That did not feel good, so I stopped, waited a minute, then tried another rep. That was a mistake as it really hurt. That was the end of the squat workout.
I used Aspercreme on it, then iced it after my shower. But it did not feel good at all. I iced it a couple of more time during the evening, took an Ibuprofen before I went to bed, and used more Aspercreme. But even with all of that, I had a hard time sleeping.
Then in the morning, the pain had flared up throughout my entire body, and I was very stiff, having a hard time getting out of bed. I am also feeling very fatigued. Those effects are due to my fibromyalgia and Stiff Person Syndrome.
I am not sure what led to this injury. I do not feel like I’ve been overtraining. Although, I had not taken my normal monthly extra day off since April 10. The reason for that is I keep thinking I will be having surgery soon, after which I will take several days off then start back with very light workouts. Therefore, I didn’t see a reason to take a day off just to take a day off. But I guess that was a mistake.
I also had taken to doings stretching in the mornings, whereas my pattern for many years has been to stretch after my workouts. But I was trying to shorten my workouts a bit. I guess that was another mistake.
But most likely, I was still somewhat stiff from going to physical therapy the day before, and again, three days before that. And that stiffness led to the injury. In other words, it was the ridiculous need on the part of my insurance company for me to undergo therapy at the therapy center, despite me already doing the exercises for my shoulder, which led to this injury.Whatever the cause, I am very worried about this new injury. It is all reminiscent of when I injured right adductor back in February of 2010. After that injury, I was also in pain and stiff all over and fatigued. But worse, as a result of that injury, I did not compete again for five years, until February of 2015.
I really struggled physically and emotionally during those five years. I fear this injury, coupled with my rotator cuff injuries could be it for me as far as competing goes or even working out just to stay in shape.
What makes it particularly upsetting is if I had surgery last month like I had originally hoped, then I would not have been squatting, with weights anyways. At best, I would have been doing bodyweight squats, and this injury would not have happened. Thus, I blame my insurance company and its incessant delays for this injury. You can add it to the previously described needless pain and suffering caused by those delays.
Otherwise, I got a letter from the insurance company that my request for an expedited review of my appeal had been denied. That means, it could be as late as June 27th before I hear one way or another about the surgery approval. With that approval date, August 5th would be the earliest I could have surgery. But with this new injury, I so wish I could have it sooner, since I won’t be able to work out anyway. It will be a wasted month for nothing.
is all so frustrating.
Surgery Scheduled for July 15
With my frustration with the delay in my surgery leading to my new injury, I called the surgeon’s office on Thursday, July 7 to see if there were any updates and to tell them about the new injury. I was told they had not heard anything new.
But much to my dismay, I was also told the surgeon would be on vacation the last week of July through the first week of August. That would mean, if I did not have my surgery on July 15, the next possible date would not be until August 19!
That had me in great distress. I simply could not wait another six weeks. In that time, I might just be making progress in rehabbing my adductor injury, only to have to start over after my surgery. It would just drag things out too much. I feared my health would really deteriorate with that long of time without being able to work out. But the surgeon’s office told me to call or even pester my insurance company to try to get them to act
I did just that. I was on the phone with the nice lady at the insurance company for 15 minutes. I told her about my new injury and explained all of the preceding to her. I emphasized over and over again, if I did not get the approval by July 14, so I could have surgery on July 15, then I would have to wait until August 19. But she just kept saying I would hear by July 27. I kept responding that would be too late. Even July 16 would be too late., I had to know by the 14th. But she said she would do what she could to move things along.
Well, my pestering must have worked, as I got a call the next morning that the surgery had been approved! I was also told they sent the approval notice to my surgeon’s office. I called there to confirm, and sure enough, they got the approval details.
I am now scheduled for surgery on my right shoulder to fix a rotator cuff tear and other problems in the shoulder on Friday, July 15, 2022. As with my previous surgery on my left shoulder, I will get a call from the hospital the day before to let me know what time my surgery is scheduled for and other final instructions. Although I guess those will be the same as last time, no food or drink after midnight, etc.
I thank God I finally got the surgery scheduled. I just wish it had been before I injured my adductor. But as it is, I will rehab both at the same time. In the meantime, I don’t think I will work out over the next week, except to go for walks. That will set me up to walk after the surgery to stay in shape, as I rebab the shoulder and leg.
Prayers are appreciated
that the surgery and my recovery afterward all go well.
Rotator Cuff Injury 2.0: Part Three
Rotator Cuff Injury 2.0: Part Two. Copyright © 2022 by Gary F. Zeolla.
The above article was first posted on this website June 25, 2022.
Updates were added as dated.
Dealing with Health Difficulties
Rotator Cuff Injury: Dealing with Health Difficulties
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