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[DrTex?]

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Hey guys, the old cliche, ignorance is bliss, was a bit off. It is misery.
For the past two years I have been living in Japan. In March, I managed to break my left humerous snowboarding, (Texas doesn't have mountains!) The Japanese doctors put a cast on it the day after I broke it, (not enough time for the swelling to go down,) and it wouldn't heal without surgery. They used internal fixation as you can see in the attached picture.
Well, being in the hospital awoke my childhood dream of becoming a doctor. I have been studying hard for the past two months and plan to go back to the US soon to start a post-bacc program for my prereq's.
My problem is, I don't have insurance in the US, and I have a rod in my arm. The doctor here plans to take it out from 6 to 12 months from when he put it in, (October to April.)

Sorry to include so much useless information, but here are my questions.
1. Would there be negative consequences to leaving the rod in my arm for a few extra years until I have US insurance again?
2. How complicated of an operation is it to remove internal fixation like that shown in the picture? Would it be costly? Any idea how much?
3. Any idea as to if it would be covered by insurance if I had it in the US?

I am sorry to ask so many questions, but I am really curious as to my options. I am only 25, but I would like to finish my pre-req's and get into medical school as soon as possible.... and to do that I must return to the US. I don't want to return not knowing what I can do with my bionic arm.

Please Help!!

 

[Meritina]

wow that's a pretty cool arm you got there

i don't think an insurance company would cover a surgery for an injury that occured while you did not have that particular insurance.

on the other hand, you mentioned going into a post-bacc program, i remember when i was in college we automatically had insurance which was covered in our tuition. they seemed pretty good about reimbursing hospital expenses, esp through the hospital at the school. i don't know if grad students get the same type of insurance though, you may want to look into that.

you should not wait until you can sign up with an insurance company to get that rod out if you need to. i have heard of people keeping rods in them, but this was regarding elderly patients. i'm not familiar with what they would do with a young individual like yourself

PS - there is an ortho forum you can check out -
http//www.orthogate.com
-go to OSRR Forum

 

[doc05]

if it's time to have the rod taken out, it must come out. leaving it in for a couple "extra years" is a very bad idea. get yourself into a free (eg resident-run) clinic if you have to.

 

[apellous]

nice nail. That looks like a polarus plus rod. Looks like they did a great job.

apellous

 

[ortho2003]

unless it is causing pain or preventing ROM, there is no rush to get the nail out, if you ever have it out. Come back to the US and go to school. Get the nail out if it causes you problems in the future.

 

[17shakespeare]

I'm not even in med school yet, but I worked with a orthopod for a number of years and have seen a few of these (including one in the office yesterday). I believe that the rod actually does need to come out in the 6-12 months after surgery, depending on the fracture and how it heals. Plates and screws can stay in forever (usually do unless they cause problems) but it is my impression that a humerus rod is designed to come out. They are strong, but the design is such that they can break after time, as the bone rebuilds. It is basically a race between the bone to heal and the rod to break, but the rod usually gives you about two years. Also, the screws in the picture dont actually keep the rod in place too well. they are basically pegs inserted to avoid too much movement, and loosen over time. I could be wrong about this, but the docs in the practice I work with remove these. This being said, the surgery to take the rod out isnt really as bad as it to to put it in. Its a short operation, and maybe an insurance company would pick it up, esp once you are a full time student. Good luck.

 

[apellous]

I believe that the rod actually does need to come out in the 6-12 months after surgery, depending on the fracture and how it heals. Plates and screws can stay in forever (usually do unless they cause problems) but it is my impression that a humerus rod is designed to come out

that is not true the rod is actually stonger than the plates. That is why you rod pathological fractures. (I know this is not a path fracture)

 

[Cassidy61]

the "docs in practice" that you were working with needed to "send the kids to college". first of all, the rod does not need to come out unless it is causing pain. second of all, once bone heals, the rod doesn't see stress (at least not enough to break it). so, while your comment about the healing being a race is correct, your application of the idea is not. we leave tibial and femoral rods in people forever and they do just fine. also, the rod is actually fixed in their pretty well. you would appreciate this if you had taken out some rods.

all this being said, rod looks very nice. sorry you had to have a giant hole put in your rotator cuff to get it!

 

[DrTex?]

Thanks everyone for your advice! I really appreciate all the feedback I'm getting. So far, four of you think that I should stay here, insured, and have it removed in 6-12 months. Two of you think that it is no rush and it can stay in for years.

Cassidy, I kind of had the idea that they were trying to milk the well insured white guy. It seems that in Japan, they fix most fractures with internal or external fixation. I have heard that the hospitals are poorly funded, and receive money from the government based on operations, (they have a semi-social medical system and the government pays for 70% of all work.) I still had to pay a couple of thousand. Now, my wallet is much worse off than my arm. Oh, and the rotator cuff is healing nicely. When I raise my arm there is some tenderness, but other than that...

apellous, glad to hear you think that they did a nice job. Going into this, I was scared as hell being operated on in the land of the little people. The outpatient care was crap... but once I got admitted and operated on, they were great. The doc's were friendly, and the nurses were all kind, cute, and wanting to dote on the first foreign patient in the hospital, (I'm in rural Japan.)

doc5, I am leaning toward just staying an extra year, getting the nail removed, saving money, and starting my formal studies summer 05, (I have started to study chem some on my own.) Thanks for the advice.

Meritina, thanks for the ortho forum. The arm is much cooler now that it is working. Living alone in rural Japan without a working arm was tough. The best thing about it was how being in the hospital reminded me about how I always wanted to be a doctor.

Once again, thanks everyone. I was really wondering about this. Keep the ideas coming if you have anymore!

 

[ortho2003]

So far, four of you think that I should stay here, insured, and have it removed in 6-12 months. Two of you think that it is no rush and it can stay in for years.
QUOTE]

You are scoring wrong at home.

Mertina said you shoudl get the rod out IF you need to (which you don't need to), but admitted to not knowing the medical necessity....one for unsure


doc05 says IF it is time for the rod to come out (which it is not) it must come out. The indicates they are not sure....that makes two for unsure.

Appelous, who seems to know what he is talking about since he could tell you the time of rod says it can stay in....That is one informed let it stay vote and two unsure votes.

I said it can stay in, I am a current ortho resident, so I would like to consider myself somewhat informed. That is two informed it can stay votes and two unsure votes.

Shakespeare, who is not in med school yet says he BELIEVES is does need to come out. Again, the believes and the fact that he is not in med school leaves me with an uninformed unsure vote....The score is not two infromed leave it in and three uninformed unsure votes.

Cassidy also seems to be fairly informed based on his post and says it can stay in. That leaves three informed leave it in if it isn't bothering you votes and three uninformed unsure votes.

Bottom line, it doesn't have to come out if you are not having problems with it. Personally, I don't think you should delay your schooling if that is truly what you want to do, especially for this nail. You will be insured soon enough in the US, likely with insurance that will pay more than 70% so you can have it out if it causes problems in the future.

 

[DrTex?]

Ortho,
Thanks for the feedback. That is a huge weight off my shoulders. I have been feeling trapped lately and not enjoying it too much here. Even if I stay for the rest of my contract, (2004-2005 school year,) knowing that I can bail if I want will make life much more fun.
It looks like I am too late for summer term, but I will investigate my options for the fall. I will also contact insurance companies and ask what their policies are for cases like mine. THANKS!