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knee replacement Update


Lance A Lott
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On ‎3‎/‎19‎/‎2019 at 7:46 PM, Lance A Lott said:

Just had my right knee replaced about 2 hours ago. Now I can work on the Volvo again! Well in a month or so. We will probably have snow atleast that long anyway. I have to figure out why the abs dose not work, the left front brake grabs and I need to install the premium shifter and lots of other stuff, the longer I lay here the longer the list will get. 

I also want to make a binder to show law enforcement. Maybe I will even have time to post build pictures from last July.

Had a fatal heart attack and by the will of god brought back and to hospital. Come to in intensive care. Docter introduces himself and tells me I am a lucky man. I take his hand and thank him. When will I be as good as new? Why you ask? Well I go to drag races. When's your next race? This weekend. He didn't know what to say. My daughter says Dad you embarrass me. I went back to sleep.

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The whole reason for a thread like this is to share and to "encourage", don't put up with this crap, they have it well figured out and it's not as serious or dangerous as open heart, or other critical procedures. No, you are not going to "die". Surgery these days is a non-event. They put your ass out and wake your ass up. You have no clue until you wake up and something happened in between. This BS about waiting until you are old and  dilapidated is a leftover BS from days when these surgeries were less established. And yes they can go in there again. Friend's of mine father (in his 90s) was going in for a third one, he wore out the first two. Tell them you will give up skiing, hockey, cross country running, etc. That's what they worry about with younger guys, that they will start serious activities, the stuff they stick in the knees is metal, but in between is plastic, tough plastic but plastic.

Cortisone shots, if you are not too bad, kind of work. I had one done, lasted a week, marginally, but I was in a bad way like this.

Ri51n5Dl.jpg

Doc said we shouldn't fool around with shots or "draining" anything, said upcoming knee replacement will get rid of it all, he was right.

uF3epF3l.jpg

You don't realize how dilapidated you become physically all over trying to hobble and get around on lousy knees, hips, ankles etc., until you regain that mobility and get past the PT, about six months to a year. I've gained lot of respect for the PT people. Not only they helped me to get through the post operation period which is the toughest, but then they pointed out to all the "dilapidated" muscles and muscle groups that became part of the hobble existence and also contribute to the overall misery (besides the knees, hips, etc.). Once the knees and legs became fully "operational" I've instituted my own PT, as suggested by the PT pros and who showed me where the "issues were".

It's not the same PT like the original, but mostly exercise and stretching. I can honestly state that nowadays I can do things that were difficult 10 or even 15 years ago, it's a much more pleasant existence.

Don't wait and don't fret, DO IT.

Mr. Cob, the Vietnam Vet that I talked about is also 100% disabled and he didn't have the work done by the facility where he "belonged". He basically told them they were not competent (enough) for what he needed done, found where he wanted to be operated on and told them to pay for it. My BS meter is pegging hearing that they told you that because you are 100% you are stuck with any particular joint. 

 

Edited by phoenix2013
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Howdy Henry,

I have an appointment this coming Wednesday the 27th to talk to my primary care doctor in the va clinic.  This thread has got me motivated, peed off enough to start seriously looking into what the va will do for me.  I will tell you this, I have fought the va for over 40 years and have the medical records to back it up the work they have done on me so far is far from confidence inspiring, they rebuilt my nose, it was smashed by a rifle butt, telling me it would look better and work better.  I still have a face perfect for radio, the nose does look much better but it works worse then it did and that is after two complete rinoplasties.(sp)

I'll know after I talk to the doctor what can be done, I am going to take the information I have gotten from this thread with me and present it to him, I'll let you know what happens.  The seattle va is not known for providing that good of service, sad but true, it was one of the top of the list va hospitals that DID have lists of older vets that they let DIE rather then treat.  I have been told personally that the va doesn't have the money it needs to provide the care that is needed and as we vets get older we will be triage-ed  when it comes to the care delivered.  Of course the va will NEVER put anything like that in writing but an honest doctor will tell you that is what is taking place.

One thing to keep in mind, the va is probably the largest TRAINING hospital system in the country, a vet doesn't have any choice of who works on him or her, you get what you get and a lot of those who do the work are "practicing medicine" in the truest sense.  If anything I say trips your BS meter I would suggest you have it re-calibrated as I have NOTHING to gain by lying about the seattle va, I am a world class BS'er and teller of tall tales but when it comes to something like this my word is my bond and I take it seriously. 

Dave

 

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Mr.Cob, this procedure is only few years old. Not all physicians are aware of it and many orthopedic surgeon are too "invested" in the old procedure which they got good at after decades doing it. So here's a "primer" for you and your general doc.

The company that invented it is Conformis.

They take a special x-ray of your lower skeleton from hips down and turn it into a 3D computer model.

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The software then determines how "lousy" the situation is it starts rebuilding the joint and figures out how to fix it.

wsmHaTbl.jpg

The computer then figures out the perfect prosthesis for that individual and that knee to fix it.

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The doctor then gets not only a pair (or one) of inserts,

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but more importantly an extensive (custom for your knees) set of patterns and jigs to do the "installation".

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Once he "opens" your knee the jigs tell him exactly where to cut and where to drill to install the prosthesis.

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That's why the surgery only takes 45 minutes per knee. I'm very fond of mine, aren't they pretty.

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Show this to your doctor and tell him, "I WANT THESE". If you call or contact Conformis they will tell you who in your area is trained to perform this procedure. It's not rare anymore, there are plenty of surgeon all over the country who do it.

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Howdy Henry,

Thanks for the detailed post.  I will take this to my doctor, show it to him and do my best to report back in detail what his response is.  I am also going to do some internet reserch on this company myself to better understand the procedure and try to get  cost estimate as that is the number one priority when it comes to va health care, COST.

Dave

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I've done a lot of research before the surgery and after. The cost is very close. Making custom prosthesis and the surgery kit is more expensive than the standard. But the surgery is less expensive because its so short (time wise). Other "tidbist" I learned from my surgeon who used to do the older style surgery for years before learning how to do this one. He wanted to get away from the 80% success rate and try something that promised 95%, he says his patient report 95% or better satisfaction. Also the older style prosthesis used to be installed by driving long stems into the bones to mechanically set them in.

9SSo7mCl.jpg

That drives the stem deep into the marrow and causes significant bleeding to control. The Conformis parts have much shorter stems and are held in primarily with an adhesive.

I asked my surgeon if he ever had a failure and needed to go in again, he said once, the patient took a very bad tumble and landed badly on the knee.

Edited by phoenix2013
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15 minutes ago, phoenix2013 said:

I've done a lot of research before the surgery and after. The cost is very close. Making custom prosthesis and the surgery kit is more expensive than the standard. But the surgery is less expensive because its so short (time wise). Other "tidbist" I learned from my surgeon who used to do the older style surgery for years before learning how to do this one. He wanted to get away from the 80% success rate and try something that promised 95%, he says his patient report 95% or better satisfaction. Also the older style prosthesis used to be installed by driving long stems into the bones to mechanically set them in.

9SSo7mCl.jpg

That drives the stem deep into the marrow and causes significant bleeding to control. The Conformis parts have much shorter stems and are held in primarily with an adhesive.

I asked my surgeon if he ever had a failure and needed to go in again, he said once, the patient took a very bad tumble and landed badly on the knee.

Howdy Henry,

Again thanks for the detailed post.  I went to the Conformis, web site, signed up for the information, according to their web site they have 4 doctors within 50 miles of me that are qualified to do this work.  Of course these are all doctors who are in privet practice or work in conjunction with a regular hospital.  How your friend got the va to pay for this outside of the va system is something I would be very interested in getting more information on. 

There is in my area a program called "Veterans Choice", this program will allow care outside of the local va ONLY if the veteran can't receive the care needed at the local facility within a reasonable time or if the local facility can't provide the care needed.  In my case the seattle va does joint replacements and could if they deem it nessisary, do it within what could be considered a reasonable time frame as it is not a life threatening condition. 

That said I am going to present my primary care doctor with this information, he will then setup an appointment with a specialist in the va system at some time in the future, could be a matter of weeks most probably months who will then decide if and when the work would be done.  I'll keep you in the loop.

Dave

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In my  case there is a couple of other reasons  why I am putting it off . I have a little under 1800 hours left till I retire  I am a concrete carpenter that deals with a lot of heavy work on a daily basis  Yes the doc doesn't want to do this til I turn 60 rite now I am 58. His reasons he doesn't want to replace it again when I am 80 to risky. Is this old school thinking? Yes when I started taking cortisone shots they where about 10 months apart now they are 6 months apart the a definitely loosing there effectiveness., Main reason is Money. Now with this being said for the guys that has been paying attention to my numbers they don't ad up. Let me try to explain them. In my field we have a retirement system that goes like this. Its called the 80 and out benefit. You take the credited years of service and ad them to your age if it adds up to 80 you can retire with full benefits. You are aloud 1000 hrs a year per credit. Currently I am scheduled to retire November 2020 in the mean time we will continue on grinding along. Thank you for sharing you info on this. Shure takes a lot of gloom and doom out of it. You can be sure the day after I retire I am going to get an overhaul on it. Thanks again for the info.

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11 hours ago, phoenix2013 said:

You don't realize how dilapidated you become physically all over trying to hobble and get around on lousy knees, hips, ankles etc., until you regain that mobility and get past the PT, about six months to a year. I've gained lot of respect for the PT people. Not only they helped me to get through the post operation period which is the toughest, but then they pointed out to all the "dilapidated" muscles and muscle groups that became part of the hobble existence and also contribute to the overall misery (besides the knees, hips, etc.). Once the knees and legs became fully "operational" I've instituted my own PT, as suggested by the PT pros and who showed me where the "issues were".

 

7 minutes ago, runaway parents said:

Is this old school thinking? Yes when I started taking cortisone shots they where about 10 months apart now they are 6 months apart the a definitely loosing there effectiveness.

It's more important to think about your mobility AND PAIN between now and the next replacement.  Yes that's old school thinking.  Besides that, I was taking oral steroids for something unrelated, and right after that, my already weakened Achilles tendon snapped.  the docs asked if I was on steroids, i answered affirmative, and they said it MIGHT be related.    Cortisone might cause other complications is the point here.

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my knee doc pointed out that I could get hit by a bus tomorrow, so if the status quo was interfering with life, get 'er done now. Everybody is correct about PT. Therapy will be your one and only chance to develop your range of motion. Have had my new knee for 12 yrs and it still works just fine.

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10 hours ago, mr. cob said:

Howdy Henry,

Again thanks for the detailed post.  I went to the Conformis, web site, signed up for the information, according to their web site they have 4 doctors within 50 miles of me that are qualified to do this work.  Of course these are all doctors who are in privet practice or work in conjunction with a regular hospital.  How your friend got the va to pay for this outside of the va system is something I would be very interested in getting more information on. 

There is in my area a program called "Veterans Choice", this program will allow care outside of the local va ONLY if the veteran can't receive the care needed at the local facility within a reasonable time or if the local facility can't provide the care needed.  In my case the seattle va does joint replacements and could if they deem it nessisary, do it within what could be considered a reasonable time frame as it is not a life threatening condition. 

That said I am going to present my primary care doctor with this information, he will then setup an appointment with a specialist in the va system at some time in the future, could be a matter of weeks most probably months who will then decide if and when the work would be done.  I'll keep you in the loop.

Dave

Dave, I just spoke with my friend who had his prostate surgery done outside of VA. It's tricky, he lives on west coast of Florida and the nearest VA "qualified" to do the surgery was in Miami about 2 1/2 hour drive for him across Florida. He is 100% disabled and he used that plus the fact that there was a massive wait time every time he got there and that he and his doctor (assigned) didn't 'click' well from their first meeting (he told the doc's supervisor that the doc was incompetent and he didn't want to deal with him ever). Once they approved the procedure outside of their system he found the place he "really wanted to go to" and forced them to pay for it.

He was an HDTer for years and fulltimed. His suggestion, get in the rig and establish domicile more than 50 miles away from VA (but close to a Conformis Dr.), better still close to a VA that "does not offer knee replacement".  Tell them, here I am, here's my domicile, I'm outside of the circle and you guys don't do it, here's a doctor and a hospital that does it.

The other bit of "wisdom" he offered particularly with knee surgery was that they approve it according to BMI (Body Mass Index) and if you are above 38 (whatever that means) they will not approve it. I guess when one is too heavy for height, etc.

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3 minutes ago, phoenix2013 said:

Dave, I just spoke with my friend who had his prostate surgery done outside of VA. It's tricky, he lives on west coast of Florida and the nearest VA "qualified" to do the surgery was in Miami about 2 1/2 hour drive for him across Florida. He is 100% disabled and he used that plus the fact that there was a massive wait time every time he got there and that he and his doctor (assigned) didn't 'click' well from their first meeting (he told the doc's supervisor that the doc was incompetent and he didn't want to deal with him ever). Once they approved the procedure outside of their system he found the place he "really wanted to go to" and forced them to pay for it.

He was an HDTer for years and fulltimed. His suggestion, get in the rig and establish domicile more than 50 miles away from VA (but close to a Conformis Dr.), better still close to a VA that "does not offer knee replacement".  Tell them, here I am, here's my domicile, I'm outside of the circle and you guys don't do it, here's a doctor and a hospital that does it.

The other bit of "wisdom" he offered particularly with knee surgery was that they approve it according to BMI (Body Mass Index) and if you are above 38 (whatever that means) they will not approve it. I guess when one is too heavy for height, etc.

Howdy Henry,

I live 51 miles from the seattle va hospital, that and the fact that going to the va hospital exasperates my PTSD big time has given me access to the "Choice" program which I use to receive acupuncture outside of the va.  According to the Conformis, web site, they have qualified doctors within 50 miles of my home. 

I am taking my lap top with me to the doctors appointment, I am going to show him the web site and ask that if I am approved at some later date, like I said that could and probably will be months from now, that I be able to have the Conformis folks work on me.  I sincerely doubt that such approval will be given but I am going to do the best I can to make it happen.  THANK YOU for providing the information that may help me get this done.

Dave

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4 hours ago, Sculptor said:

 

It's more important to think about your mobility AND PAIN between now and the next replacement.  Yes that's old school thinking.  Besides that, I was taking oral steroids for something unrelated, and right after that, my already weakened Achilles tendon snapped.  the docs asked if I was on steroids, i answered affirmative, and they said it MIGHT be related.    Cortisone might cause other complications is the point here.

Like maybe a torn rotor cuff?

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In 2001 I had an accident that tore up my right knee.  After two surgeries, I was told that they fixed it as best as they could but I was not 100% and never would be.  In fact, it would only get worse.  A few years later I mentioned to my primary care doctor that I was having some knee pain.  He sent me to an orthopedic specialist for a consult.  That doctor told me I needed a knee replacement but because of my age I should wait until it hurt so bad that I could no longer stand the pain.

I reached that point in 2015.  I did some research and found another doctor who specialized in knee replacements.  He confirmed that I definitely needed a knee replacement but wanted me to loose some weight before surgery.  He gave me an injection to help with the pain and told me to get back with him when the shot wore off.  

Three years later, and 55 pounds lighter, I had the procedure.  I could not be happier with the outcome.  The constant pain is gone and while I still have some mobility issues, it is better than it was.  As previously mentioned, proper PT (Physical Torture) was a key to a good outcome.

As a side note, this was all done with commercial insurance (I am not old enough for Medicare).  The medical care that I receive while I was serving in the Army convinced me that I wanted NOTHING to do with the VA.  I realize that many years have passed and things change, but recent news articles and some of the stories recounted here make me think I followed the correct course of action.

Safe Travels...

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Howdy All,

Today I had an appointment with my va primary care doctor, we talked about knee rebuilds, he agrees that I need to have it done.  Then we talked about my serious reluctance to have this work done at the seattle va hospital, I took my lap top with me and showed him the web site concerning the Conformis, method of doing this.  Before anything can be done I have to have an exam by the va to confirm that I need the work done, the next step is they schedule to do it.

Now to get this done at a non va facility at least one of two things have to happen, ONE, I have to life 40 miles away from the nearest va facility, or TWO, they can't do the job with 30 days of its being approved.

Here's the kicker, I live 51 miles from the va hospital in seattle, but I only live 37 miles from the va clinic in Mt. Vernon where I get my non hospital care.  The clinic does NOT do knee replacements but it is a va facility so that option is not open to me.

So my primary doctor put in a request for me to be seen by the knee specialist, we are hoping that there will be more then a 30 day time lag before they can see me, if there is and if the Conformis, folks are willing to deal with getting paid by the va there is a small possibility that I might be able to have them do the job.  I am now in the processes of trying to call the Conformis folks to see if they will even consider dealing with getting paid by the va if the va will approve them to do the job.  An outside vendor getting paid in a "timely manner" from the va is like successfully storing ice cubes in HELL.  Years ago the va approved chiropractic care for me at a local one mile away chiropractor, I was getting a treatment a month by Doc Don, 11 months after Doc Don, started to treat me he showed me a check that he had just received for the FIRST treatment he had given me. 

I don't want to bore you folks, if your interested in how this saga plays out let me know and I'll continue with up dates as they happen otherwise now that I hopefully have the ball rolling I'll stop posting to this thread.  THANKS to everyone who has offered suggestions and advise on how to handle this situation.

Dave

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13 hours ago, mr. cob said:

Howdy All,

Today I had an appointment with my va primary care doctor, we talked about knee rebuilds, he agrees that I need to have it done.  Then we talked about my serious reluctance to have this work done at the seattle va hospital, I took my lap top with me and showed him the web site concerning the Conformis, method of doing this.  Before anything can be done I have to have an exam by the va to confirm that I need the work done, the next step is they schedule to do it.

Now to get this done at a non va facility at least one of two things have to happen, ONE, I have to life 40 miles away from the nearest va facility, or TWO, they can't do the job with 30 days of its being approved.

Here's the kicker, I live 51 miles from the va hospital in seattle, but I only live 37 miles from the va clinic in Mt. Vernon where I get my non hospital care.  The clinic does NOT do knee replacements but it is a va facility so that option is not open to me.

So my primary doctor put in a request for me to be seen by the knee specialist, we are hoping that there will be more then a 30 day time lag before they can see me, if there is and if the Conformis, folks are willing to deal with getting paid by the va there is a small possibility that I might be able to have them do the job.  I am now in the processes of trying to call the Conformis folks to see if they will even consider dealing with getting paid by the va if the va will approve them to do the job.  An outside vendor getting paid in a "timely manner" from the va is like successfully storing ice cubes in HELL.  Years ago the va approved chiropractic care for me at a local one mile away chiropractor, I was getting a treatment a month by Doc Don, 11 months after Doc Don, started to treat me he showed me a check that he had just received for the FIRST treatment he had given me. 

I don't want to bore you folks, if your interested in how this saga plays out let me know and I'll continue with up dates as they happen otherwise now that I hopefully have the ball rolling I'll stop posting to this thread.  THANKS to everyone who has offered suggestions and advise on how to handle this situation.

Dave

Dave,

While you certainly have more experience with our Mt Vernon VA Clinic than I have, I was told that if the local Clinic does not do the procedure that I needed done then they could refer me to an outside DR just by using the Choice Program.  Choice also told me that since I live more than 40 miles from the SLUMattle Clinic that I can request to be referred out to any Dr through Choice for any service that I need.  This worked well for me with my Cataract Surgery.  I'm following your trials and tribulations here though as I may be needing something with a hip soon.

Joe

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36 minutes ago, Striper said:

Dave,

While you certainly have more experience with our Mt Vernon VA Clinic than I have, I was told that if the local Clinic does not do the procedure that I needed done then they could refer me to an outside DR just by using the Choice Program.  Choice also told me that since I live more than 40 miles from the SLUMattle Clinic that I can request to be referred out to any Dr through Choice for any service that I need.  This worked well for me with my Cataract Surgery.  I'm following your trials and tribulations here though as I may be needing something with a hip soon.

Joe

Howdy Joe,

The "law" as it was explained to me by both the va patients advocate in seattle and by my congress critter states that if you live within 40 miles of a va facility even if that facility CAN"T provide the care you need that disqualifies you from receiving care from an outside source provided the va can provide the service to you at another va facility within 30 days.

Believe me I have fought these #^&$%@&^# for 40 years and for the last three years have had my congress critters veterans rep in my corner in a continues effort to get the care I need.  For example the va used to provide me with chiropractic care at a local provider who lives less then a mile from my home as at that time the va did not provide such care. 

Then they examined my back, neck and right shoulder and determined that chiropractic care was no longed in my best interest as the degenerative artherites (sp) was causing bone spurs to form on my joints and they were afraid that they could be broken during chiropractic manipulation and cause even more problems.  So the va authorized acupuncture.  Here again as they didn't have an acupuncturist they authorized outside care through the veterans choice program, this served me well for over two years.

When the seattle va employed acupuncturist, they took me out of the choice program and forced me to travel over two hours to seattle to receive the care I had been getting less then a half hour from home.  The acupuncture treatment given to me by the va in seattle in no way compared to the care I was given by the outside vendor, that coupled with the fact that just going to the seattle va greatly exasperated my PTSD finally after my congress critters veterans rep intervened convinced the va to again allow me to get the acupuncture care at the vendor who had been treating me the previous two years.

I know that there are many who have received great care at a va hospital, such has not been my case when dealing with the seattle va.  When I was traveling back in 2010 I had a motorcycle wreck in New York State, the friend I was riding with took me to the va hospital in Buffalo New York which just happened to be about 20 miles from the wreck, I presented my va ID card and within 20 minuets I was being treated for a broken collar bone on my left side along with three broken ribs, I was supplied with all the needed medications and follow up care the two weeks I was in the area before flying back home, when I got back home it took two weeks to get a follow up appointment at the seattle va to continue the care I needed. 

When I was visiting a friend in Russelvile Arkansas my knees were hurting so bad I couldn't hardly walk, he took me to the local va clinic in Russelville, they checked me out, contacted the main va in Hot Springs and over night shipped to me at my friends address a pair of knee braces something I had been trying to get the seattle va to provide me with for over two years.  The seattle va as huge as it is, is not known for providing the care that can be had at many other in many cases much smaller va facilities.  The seattle va is also one of those who was caught putting older veterans on a list to DENY treatment to, in fact it and the va at phoenix Arizona were the top two on that list of va centers that participated in this practice.

Dave

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Hi Dave,

All I can say is WOW.  I've known for years that the SLUMattle VA was a seriously messed up place.  Many of my retired friends actually refuse to go there.  I have had good luck with the Choice Program out of Mt Vernon, but then that has only been for one procedure.  Being Medically Retired from Silly Service, I have kept my insurance through them and the more I hear about your problems the happier I am that I did.

As for other places, a good friend lives in Harlingen, TX and has had nothing but stellar service from the VA there.  They even sent him to Baylor, up in Houston, for his Proton Beam treatment for Prostate Cancer. 

As a veteran, it really pi___s me off that we have to put up with stuff like happens in SLUMattle VA.

Joe

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