Elbows and knees were slow to heal, but out of D-H we go

One of the fabulously dumb insurance rules is that you cannot be fitted for a prosthesis in a regular hospital, because in that case, the hospital has to submit the bill for payment instead of the prosthetist submitting it directly. So my rehab at Dartmouth-Hitchcock continued without a prosthesis, and that wouldn’t happen until my knees and elbows healed enough to get to a rehab facility.

One of the reasons I spent so much time at Dartmouth-Hitchcock was the wounds on my knees and elbows. Being on the floor for as long as I was and trying to get up, crawling around and all wore the skin down to the bone on both knees and both elbows. And they took a long time to heal.

The wound care at Dartmouth was fabulous, with a dedicated team coming in just to check, re-dress and analyze the wounds . . . taking photos, sharing with doctors and surgeons. Fortunately, and it was close, I avoided surgery on my right elbow where there was a fear that it just wasn’t generating new tissue fast enough. With a wound vac working on my knees as well as the right elbow, tissue started to generate faster and the wounds were making progress . . . slow progress, but progress nevertheless. A wound vac is literally a small pump that maintains a vacuum on a wound that is specially dressed to be air tight. . . any fluid is sucked out and collected at the pump. Mine weren’t generating much fluid, they just weren’t healing.

As the end of my time at Dartmouth approached and we started to look for a rehab facility, the wheels seemed to come off the well-oiled bus a bit.

While rehab facilities say they’ll take patients with wound vacs or other “equipment,” the simple truth is that they won’t. The way insurance reimbursements work, they take a beating for anything beyond the most simple care, even IV lines. So that starts to limit the options . . . and the personnel on the discharge end at Dartmouth seemed a bit over their heads at times trying to figure out the insurance issues as well as rehab facility issues. 

One needs to find a “skilled nursing facility” (SNIF) for the rehab and the insurance match.

Valley Regional Hospital, despite a fantastic lack of knowledge about where they fit into the rehab game, ended up as my facility. In part because a couple of places wouldn’t take me with the vacs, one group lied about their rehab from amputee to prosthesis, another was full, and another eliminated itself after mistaking another patient’s chart with mine (would I really want to go to a place whose hospital rep made that kind of error?). Valley wasn’t sure exactly how it would work out, but they said it would.

So Valley it was . . . and my post-hospital rehab moved down the road a few miles to my local hospital. The wounds had healed enough so the vac could be removed, and my basic rehab at Dartmouth had pretty much maxed out. It was time to move on . . . The line of ambulances at Dartmouth included one that would take me there. This time a lot better off than I was the first time I paid them a visit in February.