comfortzone

I often wonder about hormones too -- I'm 53 and my labs showed 3 years ago I was in that change too.... The connective tissue disorders like ehlers danlos syndrome are actually inherited and you have them your whole life. If you can touch your thumbs to your inner wrist, bend your pinky(s) back 90 deg. or more, have your elbows hyperextend greater than 10 deg., your knees the same and then touch your palms to the floor while bending at the waist - that's a Beighton score of 9. A score of 5 or more indicates generalized hypermobility (meaning large and small joints both). Another scoring system is the revised Brighton Criteria - this is a bit nicer because some folks get less bendy as they age - and this system accounts for other extra-articular manifestations such as varicose veins etc..to add up more points - for generalized hypermobility. When you get the "syndrome" it's when you are having pain.....and other symptoms and issues that stem from your collagen matrix being different from the mainstream normal persons.... Often local anesthetics don't work too well - the medicine is absorbed at a very rapid rate - leaving none behind where it needs to be... such as in the gums for a dental procedure. Sometimes a person doesn't even know they are hypermobile - they have aches and pains and lots of problems for many many years -- then a very sharp doctor just might pick up on their hypermobility and wha-la -- suddenly the diagnosis makes sense of their whole life story... like they could do party tricks with their hands and body as a kid, or do the splits and other such things -- & found them selves with unexplainable joint pain and a host of other issues that are related making them miserable - with docs telling them it's all in their head etc.. Anyway - I never realized I was hypermobile - but when I had a very slow and unusual post op course after joint replacement surgeries -- and a doctor saw so much osteoarthritis - she (a rheumatologist) asked me about it - and she found I had a Beighton score of 6 at my age. Then I've gotten so much 'sicker' I guess you could say - in the last couple of years from it -- that I do wonder if hormones are just really wreacking havoc with my whole constitution as regards this hypermobile body of mine. I'm going to see a specialist soon about this syndrome to get some more clarity. Everything bends too much everywhere...thankfully I don't dislocate like some folks... I sublux mainly and my new knee- is already needing revision - the kneecap shifted laterally. The two books by Dr. Brad Tinkle are very good - You can get them on Amazon... The first one is blue and white and about 12 bucks, the second is blue with a flower on it - called The Joint Hypermobility Handbook - it's an amazing book - chapter by chapter it takes you through everything you wanted to know about this syndrome.... it's more in depth than the first book - but both are excellent.

http://www.hypermobility.org/whatishms.php http://www.ednf.org/index.php?option=com_content&task=view&id=1347&Itemid=88888968 The above links might help as they are resource pages from the UK's Hypermobility Association and the other is from the Ehlers Danlos National Foundation. Not that you have a diagnosis of an inherited connective tissue disorder - but the websites do talk about them so maybe this well give you more information.

I too have a major problem with weakness - that I'm trying to understand. Some say with EDS your muscles work so hard to stabilize joints that they have no strength for much else - others think my weakness is nerve or muscle damage from surgery, I do have the SFN and orthostatic intolerance as well. After bilat knee replacements end of 2008 I could not lift my right leg. It took 7 mos. on a walker to learn to get it up a curb. I also as Issie even 2 years later - manually lift my legs on some days to get into the car, into bed etc... So why? The EDS doc says lots of people are like that -- and proprioception issues play a part as well as it is delayed your body tuning into the ground beneath your feet and what you are doing when you first begin to walk in the morning etc. Physiatrist says maybe overstretched muscles in hip surgeries that will never come back. I can't rise out of chairs without using my arms a lot. Yet my arms are too weak to hold a blow dryer overhead. Pain? Deconditioning? Dysautonomia? Neuropathy and nerve damage? EDS? Heck if I know -- but it's debilitating and makes life miserable. I am determined to get answers --- I have to know -- while never strong in life -- I am now so weak ~ and like you guys I'd like to know the root cause so I can play my best cards.... I feel so old some days and nights.

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One good thing about moods ... they change. And maybe if there's anything good to say about invisible chronic illnesses or disorders -- it would be the same - they change. This thankfully is likely not a death sentence. It's a challenge to seek out the helps and the motivation to actually Choose - to be on the side that counts -- your side. Not choosing to help depression out or guilt. To be on your own side - sometimes takes a leap of faith in getting active. Not running a marathon or things as that....but getting physical in exercise as a goal no matter how little it is. So whether it's a stationary bike or a DVD - or a walk to the mailbox - or physical therapy -- if your doctor says it's okay to do .... it might be good medicine. Movement changes brain chemistry and makes you 'be on your side' ... It's a concious effort to do something healthy in spite of pain, in spite of lots of things. By doing this as a routine.... you build a bit of control over your body and the situation it's in. They say there's always something we can do to be more fit. Fitness helps the mind immeasurably. Even baby disciplined steps toward it. You look back at the day and say.... 'well I tried' on days where you couldn't do what you'd hoped....but most days as you learn your capabilities....you will conquer the fatigue maybe just a little, the anxiety, the paralyzing negative thoughts. It's worth a try. Many do this, maybe you already do.... I'm a slow learner - but for me lately it seems if I don't move -- I'm in serious trouble. So every day I must do something no matter how little - and by golly it makes me smile now and again - my tenacious spirit is still there ... my can-do spirit still can do.... and I can learn kindness and self-forgiveness when I blow it. But movement - as breathing - can be very grounding.

Hmm... Well are you off of work on your jobs short term disability plan getting paid that way now? I guess what I'm getting at is -- did you already quit your job -- or are you hanging in there by the seat of your pants having to call in sick cause of this.....&/or currently on a medical leave? The reason I ask is this.... if you are sick and almost house bound or house bound -- you can apply for social security by phone. You call the lady or guy and explain your situation...... "I am not working at my job now because of an incapacitating chronic physical condition or disorder called POTS" -- or whatever the name of it is that you have. Tell them money is running out and you aren't able to work yet and getting nervous and need help. Ask them if there is anyway you can apply from home. If they say yes you can apply by phone - try it. They will let you know the information they will need - like doctors names, schooling, divorces - all kinds of crazy stuff....but anyway you get it all in order ... Then they will call at an appointed time. All you do is give them the demographic data etc.. that you are asked to give over the phone. They'll ask how many minutes during a shift do you do this or that etc. etc.... Then the cool part is --- they are the ones that gather all your medical records. You don't have to do any bit of it. All you do is endure one lengthy lengthy phone call. Maybe about 3 hours long. You don't have a physical exam or any such thing. If you are like most folks you have maybe 5 treating doctors -- and those records can mount up to the hundreds of pages. It's up to social security to figure it all out. Like if what you have is likely to go away -- or if it's looking rather bleak, if the records seem to indicate that you'll be off at least one year due to this - that's great....if it looks like you have 'other illnesses' aside from POTS - they put all that together and figure out if it doesn't look good for great recovery... Then you simply wait for their verdict.... Doctors are not writing letters for you -- the sheer volume of medical records from the last year or two or more (not sure how far they collect - but let's say a couple years anyway) purely speak on their own. I don't know if you have EDS too - But the EDNF website has a resources section - if you click on it - and then down on the right look for the 2010 Conference Handouts........ The handouts - click on that - and you'll see there's a presentation by someone from Social Security.... Talks about how they categorize things etc........ it might be helpful to you - don't know though. So if you really feel like crap - know that social security has been known to just take the ball and run with it on your behalf - that way no doctor stands in the way of 'yes' or 'no' -- by writing or refusing to write an okay. I'm soon in a similar predicament - having just moved - and having all new doctors who don't know me.... Not sure how to approach this situation as regards disability. Maybe just drive the ten hours and see my old doc? Life gets sooooooooooo crazy. Best wishes!

Just an aside ... my neuro doc had no qualms trialing me on Mestinon even though I have issues with high blood pressure and especially higher blood pressures with standing (correlating with up'd catecholamines). True I do get lows and seem extra sensitive to depletion of my hydration in a day - and to standing long periods... but the baseline is high. So now I'm on bystolic and clonidine -- I'm only a few mos. on bystolic and only on day 2 of clonidine....so far so good - then as soon as the mestinon comes in the mail in a week or two - I'm to give that a try ... The doc said that this med in particular he has no worries with in upping my pressure. I suppose that might be because I'm on the other two meds - but I didn't get the idea that it was one that did this as a rule............certainly I could be wrong... anyway thought I'd comment because of the timing of this thread... thanx

I understand too. I vasilate between anger and frustration and self deprecation, negative self talk, and generally beating myself up pretty good. I would never do that to someone else - Lord knows why I find it so easy to do that to myself. It's wearing. It's self defeating. It is not helpful at all. I think somehow I should be able to "think" my way out of this. If I'd just find the right doctor, get the right medicine, do the right thing - life would be so much better. Of course that's not really possible. Not with this diagnosis. I'm probably still in a bit of denial. A bit of shock. A bit of "why would I accept this? this awful thing?" No I can't accept it - and if I can't - how could I expect anyone else too. Then the doubts.....is it 'real' or not. Of course it's real - it's documented in tests. In the vital signs - it's there. Same with the EDS - experts in our country say 'yes you have it'...??? Wha? I seem unable to allow myself the slack I would kindly offer to another.... I push and push and flop. I get very upset when I lose things - most lately lose my mind. If I rest and take it easy - the place looks disheveled and reminds me of my weakness. I get a very poor mood when my place isn't clean - and it isn't clean a lot lately - or as clean as I'd like anyway - so the mood goes south. Then you have no one to talk to that understands what it is to look 100% perfectly healthy -- and you know you are housing severe health issues that cause frank disability. It's not a battle that's easy to tackle. Yet we want to be engaged in some way to say our actions prove we want to be well. Yes I hear you on that -- I think I bypass much of the guilt - because if I added that to the mix - the burden would be crushing. I try not to think about guilt - because of course we never asked for this. We did nothing to bring it on. We're doing everything we can to heal. To not be able to support yourself when you have done so your entire life - is the most bitter pill to swallow ever. Yet at least we are alive this very day. And in this very day there are beautiful things. This is where I need to put my head and body and all of me -- into the present moment. I get terrifying dreams of tornados lately...I'm on the ground and they are inching closer and closer as I press my body into the ground grabbing a tree for dear life - probably just a subconscious expression of what we live morning till night......... And you want it to stop desperately. Middle ground is so hard to bear .... and we appear middle ground to the world. Not well perhaps to those that know us best - but certainly not the other end of the spectrum - looking sick and very lame. I would seek someone out to speak with about this - but that would feed my propensity to somehow validate I'm going crazy & none of it's real. It's very very real as you know! So try try try to be kind to yourself and realize that we aren't of course the only ones carrying invisible wounds....someone is always worse off - sadly so. All corners of the world have people enduring heavy burdens ~ so we have to learn what feeds us and drives us to live in a peaceful way no matter the circumstances - because life will always have these frustrating hard things to deal with now and again. No one gets off easy - truly. But perhaps one way is to get involved with helping other people in the littlest ways we can - a phone call....an email....something to take the focus off of our hurts to bless someone else -- but only if it seems feasible with your energy of the day. Otherwise it's good to just be good to you period. Forget others and mostly forget their expectations if you can - the one you need to please is you.... Developing a non-judgemental view of yourself is crucial - and something so hard for us to do sometimes. Hang in there :-)

I get this when I go to physical therapy. It may not be the same as yours.... It takes me an hour or two to 'get going' for the day...when I'm mobile and out the door for PT -- I feel stiff and sluggish... Then PT for overall strengthening of core, legs etc is done for an hour and a half. After that I usually will walk outside for an hour or so because it feels so good to be limbered up. That's when the wobbly will hit. My right knee buckles more than usual and walking will begin to get pretty difficult. I can sure walk but I feel unstable after not too long ambulating. While doing the exercises my muscles will shake like crazy sometimes -- I'm told that means the muscles got a good workout. I was told muscles do that when they are fatigued. I guess when you have EDS your muscles somehow work harder to protect your joints - and thus you don't have normal strength as most people (I'm sure every individual is unique though).... dunno if this helps or not. I also dunno how much of this is dysautonomia related...

I knew this would happen ... more questions lol... bear with me? If you are sensitive to motrin and drugs like that -- meaning they give you heartburn, pain etc...even if you are on something like nexium or protonix -- will mestinon bother your stomach that way ? Or is it mostly diarrhea? Were you nauseated and then finally had to vomit - or did the pill come back up right away? I have GERD and even one little tiny motrin tablet with food and a ton of fluids will feel like it sears a hole in my stomach -- so that's why I was wondering about upper vs lower gi SE's with mestinon....? thanx

I was prescribed this and clonidine yesterday. I'm to start the clonidine first -- then in a week and a half or two weeks begin the mestinon. I was told the major SE is diarrhea - this is to treat my main complaint of muscle weakness & fatigue that accompanies my pots-like symptoms....of course the doctor knows tons more than I could possibly know about how the drug acts and why it works and why he thinks I might be a candidate. So I'll get it filled and hope for the best. I am grateful you nice people posted your experience with the drug here - so I have a heads up :-)

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I guess when you do the 24 hour urine - for cats and mets - you are clued into a pheo....as well as perhaps a CT imaging of your abdomen. It is a bit confusing to me as well. My neuro says this: you are weird. lol (thx I knew that). My fasting last checked was about 115. My hba1c was also right at 6.0 You aren't diabetic till your fasting is higher -- like above 125 or so. It is good to get a 2 hr. gluc. tol. test. if possible. Mine gave weird answers though. I drank the sweet stuff with a 115 fasting - then 2 hours later it was again 115. Typically with problem sugars it would have been found to be above 140 at 2 hours. Oh well. Next I learned by bx that I have small fiber neuropathy. When you have that - it can contribute to orthostatic intolerance. I guess it's vasomotor instability of some sort. Beyond that I too am hypertensive and also get the surge in norepi with standing - making my b/p rise and heart rate rise -- Yet if I stand for too long I get the opposite - b/p gets low and I feel awful. I do have Ehlers-Danlos Syndrome - the Hypermobile type - and with that you can have POTS and POTS-like symptomatology as well. So of the triad of sugar, neuropathy, EDS, === hard to know what came first the chicken or the egg. I do not have pheo - but all my adult life - every 10 years or so some new doc will check for it based on weird cardiac things such as palpitations, labile b/p, SVT etc. Anyway hope you get some answers -- I see my neuro tomorrow - at least he is understanding and compassionate as can be along with being very smart. I still have a hard time believing you could feel so awful and non-functional from these things -- its so true though...maybe I have a hard time because most doctors have a hard time with it. The old, "you look so good" "patient appears well in no distress" "great range of motion, normal gait" WHA? You gotta be kiddin' me - they should live here - the walker is just an arms reach away at all times...sigh. But on we go!

I could be wrong but if you arrive at an ER acutely ill do not some hospitals take on the obligation to care for you no matter your ability to pay etc.? Then once you are in the system - couldn't the system itself fight for you (because you are too sick) and arrange for transfer, transport to an accepting hospital and physician? Most likely the patient's life would be supported with known means until a hospital accepted her and gave her a bed number. This is not to say that the accepting hospital would have the answers - we are perhaps guessing with very educated guesses in entirely unknown territory ... her case would beneifit others in the future most likely as well as helping her in the now. There are more than one Mayo Clinics and each has fine clinicians - and they all network and communicate like crazy. Do you know who she saw in Scottsdale? Which neurologist? Who specifically has reportedly "given up on her"? Is it documented that they 'gave up' or is there more to it? Does the patient have the insurance needed to continue costly workups and treatment? Was there a reason why a rare disease program would refuse a patient? Has she seen Dr. Henderson in Bethesda MD? Does he know of her? Maybe you can make physicians aware by writing explicit emails to the physicians themselves? There is always more doors to knock on ... do not give up. Call up Oprah's people.... Call the Discovery Channel.... Keep on going until you can't

Bless your heart and bless your GP who had sense to get help and stop the madness. You've been through the wringer literally - but now it's time to step back and let it all settle in and settle down. You are being protected by having the series stopped from the most dangerous thing that could harm you - neurological issues of a rather serious nature commencing after the injections and worsening each time. Amen to that. The risk of problems from the bat is now truly down, down, down - for all the shots you had... really down. The docs 'know' this - and favor this course because they are taking it seriously and care about your health very much. They would not have made this decision without carefully weighing things and I highly doubt they would tell you any 'untruths'. So as best you can take a deep breath and count your blessings if you can - no more shots, you are protected from rabies....and healing each day the last shot is further behind you. Take care and thanks for sharing this - I always learn here! Feel better!

I have EDS and some pots-like symptoms with orthostatic intolerance issues etc... I was put on metoprolol at first for my tachy baseline heart rate and runs of SVT (PAT) & palpitations.... It didn't really help with my baseline high blood pressure that I also have....but it would dip low sometimes too. I gave up on it -- tried next Bystolic. Only 2.5mg. With a diuretic. Anyway - I just have to say that though I know how painful it is to lose your mind.... I am mildly relieved to read I'm not the only one. When I tried to tell my neuro doc this - he said firstly my time would best be spent ruling out a bunch of other stuff. Then they found mild sleep apnea - I tried C-pap for a month and gave up on it. Anyway I get lost in my own house sometimes - like where am I and why did I get in this room anyway. I lose absolutely everything many, many times a day. I break down and cry over it -- get this -- DAILY. Yet so far no one wants to take this seriously. Anyway I have a great book called Hypermobility Fibromyalgia and Chronic Pain by Hakim, Keer and Grahame - maybe I'll find something in there that speaks to this issue. It's a catch 22 - do I really want to admit I'm going crazy? Do I want that in my chart when I have an invisible disease to begin with? Not really - then everyone is that much more likely to blow you off as 'mental' =-> sad but true in some instances. Yet if you really, really trust one of your clinicians ... what are they to do? Neuropsych testing to say - yes you have cognitive problems on top of everything else? I'm at a loss......sometimes I wonder if I'm safe to live alone. At age 53. I mean I know I am safe to do so ... but it's getting scarier and scarier to be alone. Is this the "brain fog" everyone speaks of linked with certain other diagnosis? Is this menopause? Is it normal? I even stopped all pain meds for a ten day trial (ouch) - to see if that would help my mind. It did not. Not a bit of difference. I still lose everything I touch! One doc said it's because you don't feel well and are stressed out. Anyway I never really attributed this to my beta blocker because I only started that in April of this year - and my mental remembering thing started 2 years ago. I have no short term memory - like my brain can't store the information. I've had 4 major surgeries and wondered if the anesthesia did something - as only the last of the four did I have a general by way of airway...maybe it fried my neurons lol? I hope others post - maybe I'll learn something....thanks for sharing!

That was excellent of you to share your story - it just may help someone. Especially as in nursing - there are just a few states - California is one of them - where if you go out on a leave of absence because of illness or injury - the State of CA pays you half your salary (provided you've been working for a year or two at your job) - untaxed - so it can almost equal your normal pay -- for up to one year (if you worked enough hours the year before)... So you can hang in there and make your decision...am I going to need this entire year off to try to build up strength etc? Will I likely be much better at the end of the year...or not. Then if it looks like it's going to be a heck of a year and you feel like you are losing the battle = apply for SSDI right away ... don't even wait the entire year...so that hopefully you get approved just before your California employment disability (or one of the other four states) pay runs out. All SSDI is saying is that you believe you cannot work for an entire year ... once approved you can certainly try to work again - just as you say.... but your amount will be at a higher share because you went out - when you were making decent wages. And as you say - if your state doesn't have that benefit - then when you go out on leave because of being bedridden or hospitalized - you really need to size up the situation....are you housebound? If you are and things don't look real promising - time to get the ball rolling - all they can say is no. But appeals are an option - all the while you are still seeing doctors regularly anyway adding to your documentation as you try to figure out what it is that has you so sick or how to treat it best if you do know.

My connective tissue disorder doc mentions I'm a "possible POTS" - though other docs don't think so - so I just figure I'm 'pots-like' - but not fitting diagnosis criteria to a T -- not textbook. Anyway I'm 53....and I had the sweat test this summer - I guess everything was normal. Yet - I'm a 'never sweat' person till 2 years ago. Most recently it's worse - say since January this year. The distribution is 'all over' -- so when putting on nightgowns at bed time - the waistband on my clothes is wet, my shirts are damp all over mildly (so I wear athletic wicking T's often now so no one sees) and slacks feel damp. So I just attributed it to menopause maybe. I mean I'd heard that once - that women can sweat more in 'those years' -- but my face at work at my old job would just pour sweat if I was warm in summer or indoors in summer...having me mop it or be really embarrassed. So crazy when you've never done this your whole life LOL! I rather despise aging lately - I'm not doing this gracefully - at all. I thought 'getting old' stuff didn't really get 'attention' until your 70's.... I'm being visited early and am at a loss....

I have eds - and maybe that's why I of four siblings -- have a full mouthful of fillings and crowns. I think 8 crowns and a bunch more fillings. I remember that word being used often - amalgam - though I don't even know what it is. Is there anything you can share here about them ... and what symptoms are attributed to them? What do they put in instead? I always just had the 'silver' colored fillings. Are you saying that the silver stuff is mercury or mercury based? I think if that's the case -- maybe the crowned (over root canal'd teeth) teeth are safe - but the ones still dark silver are a culprit for some peoples health issues? I'm ignorant of this stuff - so anything you can share is helpful!

Sometimes I take something - a mild opiate - or tramadol... but really nothing tackles it... but in fact it's the combination of hurting sometimes everywhere that has me take a medication for the pain. If it was just the sfn - I'd probably be okay - or just this,..... or just that, .... but it's not that easy lol.... it's a head to toe thing literally. Sometimes as odd as it sounds - literally stopping all pain medicine of the stronger kind can be helpful for me. Not sure why that is - but sometimes if I just get so sick to death of pills I quit for a week or so - stubborn and just sick and tired of it all. Then I'll have a day where I need the help of medication to deal with it better - and I'll take it again. I've tried neurontin - a pretty big dose too - it just made me hungry and extra prone to weight gain. Cymbalta - well one pill and I was quite sure I wasn't going that route....felt pretty spacey and odd. Hope this helps!

dsdmom - sorry to hear about your headaches and such ... hang in there -- maybe as you said it just needs a little time. I know it's hard to be at the mercy of these insurance issues and such too. Somehow I got too much 'natural' igg --- dunno how unless it is from that year I worked in a peds emergency room...I was sick with every virus known to man that year - just as I was ready to quit d/t being so so discouraged and sick of being sick - bam. I got healthy. Since then I only get colds and such say once every 5 or more years. Crazy. Then a doc tested those immune things and I found that number being higher than normal. But still have the neuropathy ... oh well... I am getting older...and older...and older... I overheard this lady at a store today say she was, "older than dirt - & I can't take it anymore" relating about her job... LOL - I was like AMEN sista - know what you mean!

Interesting - My Aunt is now in advanced age - but her entire life was life as an artist. She has Parkinson's - and is the only one of 6 sibs that does. It's getting quite bad I hear... But she's lived a good artist life in the Southwest - a perfect fit for her painting, writing lifestyle... She was always viewed as a bit fragile by nature as well. I hope to visit her sometime soon - an amazing lady. I had to tell myself your quote - Of no such thing as chaos - only unperceived patterns - as I climb out of piles of cardboard boxes from my recent move and attempt to bring some order to it all....I just kept telling myself that --- lol --- that there was a bigger picture of a great 'order' emerging sometime soon. I'd love to say at two weeks it's all done - but not quite yet..... I wish I could accept that I just can't do what I used to do ... - but I am not there yet and will on occasion just have a mini meltdown and cry ... only for ten seconds or so - then quick suck it up! Life is too short to get frustrated on such little things

This is just an idea - but I'm of course not sure how your insurance works but could you maybe have the doctor write a prescription for your lying and standing serum catecholamines to be done at the Mayo Clinic? I remember the department that did that test was actually endocrinology - and the nurse has you lie down in an empty room with the lights dimmed for you to not move and just relax for 30 minutes - prior she places a hep-lock iv in your antecubital space or hand I suppose. They then sneak in at 30 minutes and draw the blood from the heplock...next they do a set of vitals...then have you stand. After ten minutes they then get vitals again and draw from the heplock the second standing blood sample. The blood needs to be handled appropriately or the test is invalid - and that means on ice and straight to the lab - who then sends it off to Rochester I think. Or if that doesn't work - could you phone a lab locally in the Phoenix area to see which major lab will do the test in house for you if you bring in an RX for it? The doctor likely knows who the major labs are - and which ones will do specialty testing at the lab building -- then if they have to send it out --- you will at least have had the chance to check with your insurance to see if that lab facility is one that your company accepts - then it doesn't matter where they send it you are still covered. Warning on the nerve biopsy - it's pretty dang expensive - and not many labs do it. The one Mayo chose was Therapath. I got a bill for about 5 Grand for it and panicked. When I called Therapath in NYC the lady told me to NOT panic. She said insurance companies always always deny the claim. So when that happens Therapath says they will do all the fancy footwork to get it covered for you = submitting the appeals etc. At last check - I called my insurance company and they said I had met my out of network deductible...I was like 'impossible' I always go 'in-network' then she says, 'no it says here Therapath' 800 dollars of deductible met. Gulp. I asked how much insurance paid to therapath then - she said just a couple hundred dollars. So I'm not sure if Therapath will take what insurance pays as payment - the woman on the phone told me that 'we will take care of it' but not sure what that means.......so I'll sit and wait it out I suppose!