Thursday, 28 May 2009

Botox Therapy - Initial Treatment

Botox Therapy - Initial Treatment

Just over one week ago I received my first treatment with Botulinum Toxin (BoTox). The initial treatment of 5 injections per leg totaling 300 units of toxin. The gastrocnemius (gastrocs) and soleus muscles were targeted in hopes of reducing spacicity and tighness and improve my walking gait. The tightness pulling through the achillies always tried to keep my heels off of the ground even when standing. This was visable when walking as my heels could be seen rising up and out of my running shoes with each step I took. My hope was to improve on this action which might then translate to a better (upright) posture throughout my body.

Nerve endings blocked by Botox are permanent however peripheral nerves do regrow forming new pathways (circumventing the old bocked nerves) and the therapy must be repeated in approximately 3-4 months.

Injections were virtually painless and over in about 15 minutes.

After this first treatment, no ill effects were noticed nor was there any real noticable effect seen nor felt after one week post injection. The Dr. administering the treatment said that the toxin would take effect between 1 and 7 days post injection.

That's not to say there is no effect - just that I haven't personally noticed it either visually or through sensation. First thing in the morning as I place my feet on the floor and press down, I can feel a tension and tingling up the achillies as I press my heels to the ground. I'm using this tension and sensation as my guage in measuring the effacacy of the therapy. Perhaps my expection is misguided.

However, within 24 hours, my physiotherapist observed that I am taking longer strides with each step, so it appears that there is some benificial effect.

This, of course, is the initial treatment. It's my understanding that the doctor will assess the changes and adjust therapy accordingly. He spoke about videotaping my stride (walking with walker) over the course of the therapy in order to compare the changes over time and assess the progress.

Next appointment is two weeks post therapy for to assess effectiveness and adjust dosage and frequency of subsequent injections.

Again, 300 units from one vial was used in the initial injection at about $400-$425 CND per vial which is covered 100% by my private insurance.

Monday, 18 May 2009

Comments Made On This Blog

There are a few comments and inquiries made on this blog and my injury. For whatever reason, I did not receive notification by Blogger that they were added and therefore did not reply.
I apologize to anyone I did not answer as I probably did not get your message at all or in a timely manner. I have not ignored any legitimate questions on purpose and those wishing to inquire again - I will try to respond.

Sunday, 17 May 2009

BoTox Therapy

BoTox Therapy

BoTox or Botulinum Toxin therapy has been suggested as an adjunct to my physiotherapy. The problem lies in the stiffness in my feet and achillies. The release of acetylcholine keeps nerve muscle synapses contracting and has my muscles/joints tight. Stretching out has little effect in releasing the tightness for any period of time. Botulinum toxin permanently disrupts the signal transmission to relax the muscles however, unlike the spinal cord, peripheral nerves can regrow and in time new connections will re-grow and transmit the signal once again. Repeat injections may be necessary. With the therapy I should be able to stand upright better, at 90 degrees to the floor and not be pushed backwards because of tight muscles not allowing me to lean forward efficiently.

I figured that a micro-organism (Staph aureus) got me into this mess, perhaps another organism (Clostridium botulinum) producing BoTox, may get me out, if even a little bit.

I made an appointment some two months ago for an evaluation with a Physiatrist (Physician & Therapist) and he thought that I was a good candidate for such therapy. All I needed was approval from my health insurance carrier. I had phoned the insurance company some time previous at which time after playing phone tag and sitting on hold for about 15 minutes, I was verbally informed that I was covered for such treatment.

The doctor personally required this information prior to starting therapy so I filled out a form in his office and it was faxed off to the insurance company that day. Since that time (6 weeks+) neither I nor my doctor's office received any reply from the insurance company. Now I have to play phone tag with their customer service reps once more to find out what happened. My doctor's office insists the form would not be sent to their office but should be sent to me at home. The reason?
Patient confidentiality!

I authorized my doctor to inquire about therapy coverage from my insurer and they can't tell my doctor because of "patient confidentiality". Pretty soon they won't release information to the patient because of patient confidentiality.

At about $400 per vial, I can't afford to get this therapy out of pocket unless I know I'll be reimbursed. Unless I have it in writing, I don't believe anyone anymore.

Attempt To Return To Work

Attempt To Return To Work
(Including Regaining My Professional Practising Status)

Late August 2008:

So what could go wrong? I'm bored to death and LTD (Long Term Disability) income sucks so perhaps now is the time to return to work.

My Doctor's eyebrows raised when I informed him I'd like to return to work. Really?
I need a 'Return To Work' form signed by him in order to proceed.

Approached Human Resources at my workplace but they tell me Occupational Health handles any return to work issues. I motor down to Occupational Health and speak to them about returning to work. No! - return to work requests have to go through my Private Insurance Carrier, not my employer. So I contact my Private Insurer about returning to work. Unlike my claims reimbursement submissions which take weeks to be acted upon, I had a date set for an interview shortly thereafter.

The Interview: Did not expect this. A two hour interview on issues such as "what pets I have" and "how many rooms I have in my home". Now, if I had a pet monkey and lived in a one room dwelling, I can't see how that would be important in my returning to a job that I still have. I didn't have such an extensive interview on applying for the job in the first place, some two decades ago.

More forms and papers passed back and forth for signing.

As I am employed as a medical technologist in a hospital lab, my skill is 'licensed' by a regulating college. When I first came home after my injury I called the college and placed myself on 'non-practising' status as it was not only truthful but cheaper in these monetarily challenged times. My college informed me that I can switch to non-practising for a period of two years and then return to practising without any consequences. What they failed to tell me at that time was that if I didn't reach the magic number of 900 hours worked in the previous year, the year would count as zero hours, or not worked at all. I was just under so that year didn't count.

So when I tried to regain my practising status I was now informed that after 30 years in the business, 20 of which at the same job with the same employer, I was a few hours short and had to take a refresher course. Because I am still dependent on a wheelchair, I couldn't commute and needed something offered by correspondence. Two courses met my requirements and that of the college but one course was 5 hours short of the 60 hours the college stated I needed and they wouldn't bend on the issue.

After 30 years of employment 5 hours separated me from regaining my practising status!

Well I chose the other option and after some difficulties in getting registered I was enrolled in the refresher course rated at 80 hours, over 36 weeks which arrived in three 3 inch binders.
I took this issue seriously and crammed my 36 weeks into 4 strait weeks of studying. As I was familiar with most this material, it wasn't too difficult.

After 30 years in the discipline, asking me to take a basic refresher was akin to having an executive secretary returning to the workforce take a course on which is the business end of a pencil and what is a computer keyboard.

The refresher course was tested with 10 one hour exams which I wrote in three sessions and in about 5 hours. Now I'm waiting for the marks to arrive so I can forward them to the college for reinstatement.

Ergonomic Assessment:
I did have an ergonomic assessment at work to see how I could physically fit in to the lab. I felt I had very few problems. I wanted as few changes as possible as this was the real world and I could adapt or figure out how to do some task or reach particular items. Unbelievably, the assessor had me reach for various items while she took measurement of my arm to the item, of the item to the floor etc. Then the same was documented in photographs, Thorough!

Now, the only difference pre and post injury is that I am unable to step away from the wheelchair without a walker, why on earth do they want to get me an ergonomic computer keyboard? My hands and my reach are unaffected! Go Figure!

So, I've jumped through all the hoops and all I have to do now is to wait for my marks, forward them to my college and inform the Occupational Health Department of my status.

If the past holds true, I'm certain more obstacles will find there way into my path.

So, I started inquiries about returning to work in August of 2008 and now it's May of 2009.

My attempt to return to a job that I still have has taken about 9 months so far.