insurance looking glass

Health insurance is definitely a bizarre construct.  My plan covers (more expensive) in-home Occupational Therapy, but not the outpatient OT my doctor prescribed.  However, my plan covers outpatient Physical Therapy -- even without a prescription.  After many phone calls with various OT/PT providers and the insurance company, I was able to set up occupational therapy with a certified hand/wrist/arm specialist (overseen by the owner of the facility who's a PT) twice a week where they can also do the dressing changes that the doc wanted done at home.  It's just that nothing is easy.

Someone asked about whether I would need another surgery for reconstruction.  The short answer is no.  Because the numerous small clusters of cancer cells that survived radiation therapy that the oncologic orthopedist found and removed were all along the length and depth of a single muscle (the ECRL) they removed that whole muscle, but only it.  Being down one muscle, and this one in particular, means that OT will help me recover and learn how to compensate, without additional reconstruction. One example of compensating will be that I get a new cutting board which has spikes on it to hold vegetables or meat in place so that I can chop mostly one handed (altho maybe my left). Had he found pockets of disease in several different muscles, the outcome might have been different.  So that's one way I am lucky.

The other aspect of what's happening that I need to explain better is why the healing process is so much less certain this time around.  It has to do with the radiation therapy.  My tissue is now damaged, so it will take longer to heal, or might not heal as well.  Ordinarily, someone who has a temporary graft is ready for real skin in three weeks.  With me, it might be as long as six.  And when the graft is placed, it may not take smoothly at first or long-term.  They know that wound complication risks are greater for folks who get radiation therapy, but they still think it makes sense to do the radiation before surgery because it means a lower dose and fewer cancer cells. o, it's a balance. And how my body heals will also be a factor in how all of this plays out over the next few months, because that is highly individualized.