Letter I wrote to the peditrician

June 30, 2005

I am going to drop this off now, hopefully it is ok, I'm open to

feedback, especially if anyone thinks I left something out because

she will probably be calling me in the next few days. I used some

of the teplate in the files section of the group for a paragraph

about clubfoot being debated, etc. Here it goes:

June 30, 2005

Dr. Schlitt

Haddon Pediatrics Group

Re: Collin Yoder

Talipes Equinovarus (unilateral right clubfoot)

DOB – 8/24/01

Dear Dr. .:

I dropped by the office today to drop this letter off to you

(thought it would be easier then leaving this all in your voice

mail). Collin is currently seeing a great pediatric orthopedic

specialist, I believe he is the best on the east coast; he is Dr.

Herzenberg at Sinai Hospital's Rubin Institute for Advanced

orthopedics in Baltimore, MD. There are no doctors at all who

perform the ponseti method in NJ; Dr. Herzenberg is the closest

trained doctor to us. As discussed with you briefly before, Dr.

Herzenberg would like to do the following (most likely beginning in

September 2005).

• Put Collin in long leg corrective casts for a month

(probably change it every 2 weeks).

• Perform surgery to put on a spatial frame (external

fixator). He would be in the hospital for a few days. Then wear it

for about 12 weeks. He would go to a physical therapist about 3

times a week, and we would do physical therapy everyday at home with

him. We would have a chart to tell us when to turn the screws

(keys) on it. We would be briefed on pin-site care and infections

because they are common with it. I think they provide him with a

walker and wheel chair at certain parts of this process also.

• Have another surgery to remove it (usually out-patient

surgery).

• Go right into a cast for a few weeks (bones will be weak,

etc.)

• Go into an AFO (Ankle Foot Orthotic) for a year and continue

with physical therapy for some time after.

We are thinking about calling now to go ahead and schedule all of

the above procedures with Dr. Herzenberg. We didn't already because

I was sick and healing myself and know it was a while back when I

talked with you before about the surgery. This process takes about

a year; if we do it in September hopefully Collin will be done with

it by Kindergarten. He turns 4 at the end of the August.

For peace of mind, I really need to go for a second opinion with

another qualified Ponseti doctor. I know and trust Dr. Herzenberg

and think he is a genius, but I need to do it so I don't question my

decision in the future. We battled our Insurance company (Aetna)

just to get to see Dr. Herzenberg and won, they cover our visits as

in network even though it is really considered out of network for us

(because of the distance, he accepts Aetna but its just a different

network). They did this because I proved there are no other doctors

around here that perform the Ponseti method, etc.

I would like to take Collin to Dr. Ignacio Ponseti, at the

University of Iowa. (Notice the method is named after him!) I just

want a one time visit, then after that Collin's doctor can just call

him on the telephone/e-mail to go over what Dr. Ponseti thinks and

to see if he agrees with Dr. Herzenberg's suggestion for a surgery.

I will arrange so Collin and I can fly out there and try to stay in

the Mc House. But I want the insurance company to pay

for the 1 time visit it is about $300.00 from what I understand and

if he needs x-rays, etc another $160.00. Dr. Ponseti does accept

Aetna but because of the distance again it's a different network.

The insurance company told me if I want to try to seek approval for

this one time visit, that I must provide them with a letter from you

stating you feel it is medically important, etc for us to have a

second opinion with another doctor qualified in this method. So I

am asking if you would kindly write the letter for us. I would just

go and self pay the visit (seems like a lot less of a hassle), but I

actually had 2 surgeries myself this year and was out of work for

weeks both times so we are still playing catch up, etc. I don't

want to wait and save up the money because it could be months and if

we are going to have this process over by kindergarten, I have to

arrange for Collin to go into casts by September.

On another topic: Aetna also closed our file with our Case Manager,

because nothing was going on with his case. I explained to them

that was because I was sick, etc. But they said to give us our case

manager back they need someone from your office to call the pre-

certification line and request it. We have the case manager because

we just want to deal with one person who understands what is

happening it saves a lot of time, etc. That person also will work

with us to gain authorization on special shoes, braces,

appointments, etc. The pre-certification line is 1-.

Our case manager was Hawa (how-a) Jusu at 1- ext.

23897. I talked to her but she said she can't re-open it with out

his pediatrician calling and requesting it themselves.

The treatment of the clubfoot has been debated for nearly a

century. There have been advocates of conservative treatment as

well as proponents of early surgery. Numerous anatomic and outcome

studies have been performed in an attempt to answer the many

questions associated with clubfoot etiology and treatment. There is

a great deal of conflicting information furnished by individual

surgeons as well as in the scientific literature, however, I believe

this debate will be ending in the near future because of Dr.

Ponseti's method. I know the health insurance companies don't

realize the debate of clubfoot treatment but with time hopefully

they will become more supportive to us parents.

If you have any questions or comments, please feel free to contact

me anytime. My work telephone is , my cell phone is 856-

803-0701 and home is . I know you are always so busy

and it is hard to get an appointment usually with you when I call,

so I thought a letter would just be easier. But if you would like

us to come in to talk rather then the telephone we would be more

then happy to cooperate in anyway possible. We hope you enjoy your

summer!

Warm regards,

Michele Yoder

June 30, 2005