things seem very grim

[RockysMom]

Thanks KatieAgain and Snoopy,

I got to work with my original two therapists yesterday and they are more open to dissecting the movements for me which I must make when rising to standing position. Instead of just trying to hop up and hope for the best, I have taken their repeated and variable language explanations (same info said differently) and broken it down into steps I can remember easily.

For instance when I was taking a class to get my motorcycle license (many long years ago), they taught us starting procedures with FINE-C which stands for fuel, ignition, neutral, engine, clutch.

So now when sitting in the wheelchair between the parallel standing bars, and I'm ready to stand, which is not easy for me and which I hadn't been doing right for years! I just remember:

- 1) Elbows up
- 2) Head down
- 3) Lean out
- 4) Push down with feet
- 5). Lift thighs then butt
- 6) Push up with elbows
- 7) Stand and then
- 10) Walk like a penguin - or Frankenstein but I prefer penguin! (I can't do this yet but I know it's next and how I'm supposed to do it).

Still, it's very hard and my broken ankle foot is swollen and throbbing a lot. My boot is terrible and I'm getting a different one a week from today.

And I still miss all my furkids and feathered kids very much which is so sad.

*** Poppydarling - my neuro doesn't know if Tysabri will help a lot of not, I've only had one infusion but will stay here for the first 3...to see & take advantage of this.

[fishead]

Rockysmom,
How long have you been on Tysabri? I was put on Tysabri when I was unable to walk without a walker. I stayed on it and also went to PT to learn how to walk again. After quite a few months on Tysabri, and continued PT I was able to walk with just a cane. After several MORE months of Tysabri and continued PT-exercises, I am now able to walk without ANY assistance.

Please hang in there and know it could take many months, but it MAY just work enough for you to walk with minimal assistance!!

[RockysMom]

Thanks for that input fishhead. It's encouraging to know. I appreciate it!

I've only had one infusion.

[Kimba22]

Hi RockysMom,

I'm glad you had a better experience with your therapists the other day. I hope it continues and you have a better week this week in therapy.

So the reason I cant go home now is...
Because I can't go to the bathroom. One or both of our bathrooms need to be modified so that I can transfer to the toilet without standing. If I could, I could go home right now. But I can't.

Right now I can't stand without the standing bar things they have in the gym. And right now I'm only stand for 60 seconds top. To use our bathroom at home, I can't do a non-standing transfer because I can't get my scooter or power chair, etc. in the bathroom.

Right now I can't stand except when I'm in the gym between the parallel standing bars which I can use for support. I can't use a walker.

I would still recommend you stay where you are as long as you can, but something that might help with this is a sliding board and a drop arm bedside commode (which can go anywhere you have room to use it). If you are able to learn how to use this, it would enable you to use a commode at home independently or with minimal assistance.

I learned how to do this in hospital inpatient rehab, but was able to get more 'hands-on' training when I then moved on to a sub-acute rehab facility. (Where I finally got pretty proficient at it.) But, I did have to be insistent, since it wasn't something other patients requested.

Both PT and OT are trained how to teach patients how to do this, but it mostly falls under the realm of an OT. Your male OT can also teach you how to get your pants on and off using a pair of scrub pants (or sweat pants) that are larger than your normal size over your regular clothes.

Another thing recommended (although doesn't work to well for someone with urge incontinence) was to wear a skirt/ dress/ gown and go without panties.

It took awhile to learn how to do it and get good at it, but I'm glad to now have another "tool" in my MS "toolbox" that will help keep me independent for as long as possible.

I hope once you get your new boot it will help your ankle/ foot. I also hope that you are doing well enough to go home, soon.

[RockysMom]

Thank you Kimba22

Thanks for your thoughts. I appreciate them very much. I really do! I will stay here as long as I can to continue rebuilding to where I was.

Today my PT was about the same as Friday, there's no therapy on weekends. So being in the same progress spot as I was on Friday is good. PT is always tougher since it involves standing.

My anxiety about working with the female therapists was alleviated by working with the two original guys today and I'll also work with them the next two days but then who knows. I confided in the male PT about how the female therapists mix high pressure with a weird kind of mothering that is not good for me, treating me kind of childlike while pouring on pressure with unnecessary cheerleading. What I need is a logical, low key, low pressure approach. The male PT allows this.

Women who are too assertive make me feel powerless. At the same time, I just work better in general with men. I tend to inadvertently intimidate women who subconsciously react to this with power plays. I'm also overly analytical, can you tell? I told the PT guy I would address this directly with the women therapists if I'm unable to surmount the problem in less confrontational ways. Just thinking of working with the females had me tense as a turkey in early November this morning and it was wasted mental energy.

I'm going to post some of my OT anxieties in the Susan Dorne section to see if she might be able to offer some much needed advice. But basically, my fear is that I don't have the strength to stand longer than I did today which was 1 minute, 25 seconds. Plus it was too warm in the gym.

Then the OT guy told me my goal was going to be sitting in front of one bar and pulling myself up to standing position rather than sitting between the bars and pushing myself up. I tried pulling twice and I could do *nothing* and felt complete failure. He sensed it and said we could forget it. But still it upsets me that I couldn't do even a tiny pull.

Other than this, I do great with OT. And I do sliding board transfers to the wheelchair and back from the bed. I did squat pivots one day but they utterly exhausted me. So I stick with the board to save time. A bedside commode has been discussed. I don't have room in my bedroom for this. Plus, I'd have to stand to pull down my pants, Depends, etc. and pull them back up. This is how I broke my ankle. Dresses, skirts, gowns aren't in my vocabulary. I also can't go without underwear and I don't have time to use a bedside commode. I need to go pretty much asap.

Sorry this is so long but it is such a relief to be able to post this somewhere and have feedback. It eases my mind a great deal to have this resource!

[mjan]

WOW I appreciate how you are expressing yourself so well! Glad you could see the difference between the therapists approaches.

Why not practice what you want to say to the female therapist. Maybe you could write down what you just said to us. It is YOUR therapy and her approach makes you anxious, and perhaps uncertain. You need so much to keep mind over body to keep progressing right?

Again, I am glad you are coming here to air out this dilemma. I am on your side and cheering you forward!! If you also keep a diary of your rehab, and read it back, you'll see you ARE making progress..But we live in this "fast food" generation that wants progress to happen more quickly. I am sure you are much better than a few weeks back, right?

Sending you healing thoughts and healing hugs,

Jan

[palmtree]

Pressure always seems counterproductive. If there is no pressure it frees up a lot of energy to get something done.

I had an experience once where I was in so much pain I couldn't move. I was lying there and no matter how much I tried, I couldn't get up. I finally stopped trying and decided to get up without my body.

With the paralysis that MS causes, it may not be so easy. But it still helps me when I think of it that way.

I don't blame you for not wanting those two women PTs. That condescending cheerleading approach is so annoying.

[Kimba22]

Hi RockysMom,

I'm sorry my suggestion won't work for you. It was only a thought. I learned awhile ago how to watch the clock (I have urge incontinence along with post residual volume, and because of UTIs, learned to self-cath), which is the only reason it worked for me and my neurogenic bladder. I do understand what you mean about the pants. That was a tough one for me, too. I'm glad you know how to use the sliding board for other transfers, though.

The worst part for me in the sub acute facility was waiting for an aide. Once in awhile they responded fairly quickly, but usually I had to wait awhile. Not good when you are in desperate need to go to the bathroom! It didn't take too long to figure out the game some of them played, when someone would turn off the call light (response time to the call lights were recorded) and tell me they'd either be right back or were getting my aide. (I learned not to wait very long to turn my call light back on). From what you've said, it doesn't sound like that's been an issue for you. I'm glad that hasn't been a problem.

The ratio around here for each aide : patient is close to 1:20 (and the facilities I've gone to have the best ratings in the area). Needless to say, this also makes the turnover rate high. But, it also makes it so much harder when you, as a patient, require a lot of assistance.

Anyways, since I've been to these types of places several times, I have learned a lot. I do understand some of what you are saying about some of the therapists. I think part of the problem is because they are used to working with an older population. In all of my experiences, I've also only had one who was a neuro rehab PT (which is pretty rare). I've found orthopedic therapists also don't always understand how to work with us.

And, just like life in general, some people are easier for us to work with than others. Breaking down and explaining the mechanics of an exercise always helped me, too. I'm sorry your female therapists are causing you so much anxiety. I wouldn't want to work with them, either. Pressure causes stress, which we all know (but they don't) has a negative impact on our MS. Because I've been through so much over the years, I've learned how important it is for me to be assertive. There have also been a few times I've requested a new therapist.

I've worked with several male PTs and OTs, and most (not all) of them were very good. I've had some good female PTs and OTs, too. But, the PT I liked the most, who happened to be male, would break down how to do each exercise and then explain the muscle group he was targeting. I found his approach very helpful. Now, I always question my therapists about the same thing, although I've found some are more receptive to this than others. Overall, though, it does seem proportion wise there were more men than women I thought were really good.

The 'cheerleading' never went over that well with me, either. The woman therapists would do that a lot with the older patients. I guess they are just trying to encourage and motivate their patients. It just seemed so fake when I barely accomplished anything.

Pulling up on the bar requires stronger quadriceps than using the parallel bars, where your arms are assisting you to stand up. I had a really hard time doing the same thing the last time I was in acute/ sub-acute rehab. That's also why I had a really hard time getting up from a seated position by myself, which is why I learned how to use the sliding board.

Unfortunately, there's no magic bullet to rehab and it is just going to take time. But, hopefully, you'll soon see yourself adding more and more seconds, and then minutes, to your standing time. It can be discouraging, but please don't ever give up. (I'm still working in the outpatient setting trying to get back what I lost several months ago.)

Good luck, we are all rooting for you!

[RockysMom]

I'm getting out of here before Christmas

Because of something management did today which is an acceptable to me. Several times I have had my little 8 year old, spayed house rabbit and snuggle with me in bed for about an hour when she visits me. she weighs about 3 pounds and she's very sweet and very cute. She loves me very much and is very distressed when she leaves and I stay here.

I asked the first day that I was here if I could have a couple of my little house rabbits come and visit me. And I was told by the person who I asked, who told me I could have my pets come and visit me that it was okay and she has also had a house rabbits before.

Today a manager from another department came marching in and announced very forcefully that I cannot have my rabbits visit me anymore because it is against their company's policies because they are not vaccinated for rabies. I told her they are not required by law to be vaccinated against rabies in this state or any state in the union. The only way that they could get rabies is if they are bit by a rabies vector species and if that happened it would be because they are dinner. These are Little house bunnies that are spayed and neutered and litter box trained and they have never even been outside.

They they didn't care they didn't give a darn. They just said that the patient would gravitate towards the bunnies and want to put them in could get it and could get rabies if they were rabbit. I do not let anybody touch my bunnies and nobody even saw them come in I don't even know how they knew about it except maybe decide on a camera they installed in the hallway. I have been told that I had permission and I had brought them in or my husband and now it's certainly not okay.

So I called my insurance company case manager and told her about it and explained it and she completely understood and we discussed what I would need to go home be able to go home. I told her I would need a hospital bed a manual wheelchair with removable armrest and a sliding board and the bedside commode. She said that is all covered except the bedside commode and I said that's no problem I will buy it myself. I said I would need home therapy PT and OT and she said that is also covered and no problem.

I have been so depressed since I have been here for two months now and I miss my little bunnies so much. And one of them has a benign but terminal cancer that he is being treated for but I will not be home when he passes away and this is just too much for me to bear. We spend thousands and thousands of dollars on vet care for these animals and to have them just dismiss this without even taking into consideration that their policy is causing so much stress and emotional harm is just unacceptable. And to tell me to that a little bunny that weighs less than 2 pounds is i'm going to fight somebody and get them rabies when no one even knows he is here is just absurd. And I am so done with this.

I still can only stand for about two minutes tops but there is no way I will be able to make any progress here. I will get better much faster at home where I should be & where I have a loving supportive environment. And where I can see my beloved harmless little pets. It may be hard at first but I have this resource, this form, to get some tips and suggestions and Kimba22 I will be using your suggestions.

I should be going home just before Christmas. I have my second Tysabri infusion a week from today and then the following week, sometime during that week I will go home.

I am the youngest patient in this facility by at least 20 years. I am 50. Everyone else here is on Medicare. And my insurance pays more than Medicare so I am paying more than anybody else and being treated like this. Just rubbish.

[dyin_myelin]

My former landlady had a fourteen year old cat and they were insisting at the vet to vaccinate it against rabies and the ll said, she doesn't go outside, she's fourteen, how can she get rabies? And the vet tech said, a bat could fly down the chimney and bite her. I would just have your husband smuggle her in if she weighs two pounds.

[RockysMom]

Dyin

Cats are required by law to be vaccinated for rabies. Rabbits aren't. Our fireplaces are screened in but if a bat got in somehow and bit a bunny, the bunny would die within a few hours from bacteria. There's only been one documented case of a bunny in our state ever getting rabies and it was a wild hare, not a domestic rabbit (which are European descent). Rabbits are prey species and if bit by a rabies vector species it's because they're being predated.

Cats and dogs require vaccinations by law because they are a predatory species and when rabid, become more so.

I can't smuggle the bunny in, she comes in a carrier and I'm not subjecting her to anything weird. She's older and would suffer for it. This is a stupid regulation and just what I'd expect in this hick town - which I'm not from. I'm from the suburbs of a major metro area.

I'm going home in two weeks and I'll do better there and have home PT and OT and then outpatient of the same which will be more organized and personalized.

I need recommendations on manual wheelchairs, hospital beds and bedside commodes so I can get ready.

[DianeD]

Some ideas

I do understand what you are saying. I have a friend who had surgery on her feet and had to be off them. She had each foot done separately so she could at least get around with a crutch or her 'knee scooter'.

I'd never heard of a knee scooter. Do you think you could manage one? You put the bad leg on the scooter (on your knee of course).

I'm just throwing this out to let you know there might be ways to get around.

Would you consider a wheelchair or scooter? The motorized wheelchairs are slick. I even wonder if something like they have in the grocery stores (motorized shopping cart with seat) is available.

Have you used a transfer board? If you PT and OT people could show you how to use that you just might be able to transfer yourself.

I know these are 'iffy' ideas, but it might help you think up some ideas.

Best wishes, Diane

[RockysMom]

Hi Diane

Yes I'm using a wheelchair and doing sliding board transfers. No I can't use a knee scooter as I was standing but not really ambulatory before and broke my ankle on my good leg.

My record for standing in PT was 2 minutes 10 seconds. But I'll get home PT/OT and then go to outpatient of the same. I'll be trained on using a bedside commode before I go home too though that worries me a little. I'll also have a hospital bed.

[aitch10]

We got a Drive wheelchair when I broke my leg. I can wheel myself or have DH wheel me and the sides and feet come off.

[Kimba22]

Hi RockysMom,

I'm sorry about your rabbits. I've been thinking about you (which is why I couldn't sleep), and wasn't able to post earlier. I hope some of what I've learned will help you. This is really long, really long but I hope the information I share will help you make the best decisions.

First off, there is usually an administrator who sets the rules and enforces them. Whatever they say goes, whether it is for patients or employees. I can't speak to who the manager is that came in and told you that, but the managers are all below whoever is serving as the administrator.

If the manager is correct about this rule, maybe there is a good reason why they now have it? Or, maybe it's just something they changed somewhere along the line, for whatever reason. If it was changed, then the person who told you they were allowed was misinformed about the current rules.

Someone was misformed, be it the first person you asked or the manager. All the employees need to be aware of the correct rules at all times. You could ask to speak to the Administrator for further clarification. They should make themselves available to you in the next day or two. If it is against company policy, maybe they would explain why. (But, they don't even have to give you a reason, or one that seems valid to you.) They make and enforce the rules.

Who knows how this manager found out about your rabbits. It could have been another guest or patient who saw your husband with them, and questioned it. This is the manager who got the memo and felt they had to be firm with you about this rule (still doesn't mean their approach was the best way to handle it, though). If nothing else, you could let the administrator know about how bad the manager's approach made you feel. You already feel vulnerable enough because of your health situation, too many times they forget that part and we are left to feel like objects instead of patients with feelings.

The sub-acute rehab facilities I was at only allowed dogs, and valid papers supporting they were up-to-date on all their vaccinations were required to be on file before they were allowed to visit. They were also required to be on a leash at all times. There was a sign that included this information by the entrance and it was also included in our admission packet. That way, there was no question about their rules. This is from Oregon, but would apply in any state:

Administrative Control. The administrator or his/her designee shall determine which pets may be brought into the facility. Family members may bring resident's pets to visit provided they have approval from the administrator and offer reasonable assurance that the pets are clean, disease-free, and vaccinated as appropriate.

www.dhs.state.or.us/policy/spd/rules/411_086.pdf

You obviously love your bunnies, but please try to do your best to look past not seeing them right now. It would be in you best interest to be as realistic as you can about your abilities and stay where you are so you can get whatever rehab you can before you go home. You don't want to regret it after you get there.

Have you ever gone home, even if it was only for a few hours? That is not only allowed, but encouraged. You can even go home for an entire day, but you must be back by a certain time that day (no later than midnight was my experience, or else you'll be discharged by the facility, and won't be readmitted. (That's an insurance rule, not theirs). It is very helpful to have an idea of what you are capable of at home before you are discharged. But, then again, I don't know if you even have a way to get there and back.

As hard as it is there for you, it is always a lot harder once you go home. Home is not set up the same, and you are going to need help 24/7. Unless you have other arrangements, your husband can do it all, at least not for long. You still haven't mastered transferring to/ from and using a bedside commode. Learning how to do that efficiently can't be rushed, especially in your situation.

It takes practice and will depend on your abilities. Stay there, get trained, and find out what you are really capable of doing before even considering coming home. You have to learn/ see how you can do it without them before you leave. See if they'll train you do it alone with your husband, and with the aides/ nurses (but they would have to feel comfortable with your ability first).

Home health care is limited by how long they can make visits (from 4 - 8 weeks maximum, and only if you are lucky, you might be able to squeeze a few more weeks beyond that), how often they can come each week (2-3 x week) and the duration of each visit (in my experience, it was no more than an hour for each disclipine). It's been this way for me ever since I was dx'd 13 years ago, with several different private insurance companies, and through 3 different agencies.

Even in the most loving environment, in your condition right now, less therapy won't make you stronger, faster. I'm afraid because of that and the increased struggles you'll face at home, you will backslide. The home health care therapists also won't have access to rehab equipment, and if only 1 therapist is there at a time, they won't even be able to work on standing. You are too great a fall risk, and it is hard to get someone up if they can't help with their legs (Even if they do co-therapy with you, they still might not.)

Then there's outpatient therapy. It is tiring. Besides the therapy itself, you'll have to get ready (and you'll need to shower sometime,too), then add travel to and from the facility. I get worn out, and I can do more than you. It's even more work if you have to bundle up. Weather doesn't always cooperate, either. And, you can' t continue with therapy unless you show up regularly. You won't make any progress and your insurance will stop paying for it.

Do you know the maximum number of SNF days you are allowed per year? The good thing is the number of days you are allowed start a new Jan. 1. The bad thing is, once they are gone, that's it until 2016. (And there is no guarantee your insurance company will allow you to stay for your maximum number of days - that's determined by one of their medical directors, not a case manager.) I had no clue how that worked until I learned from my experiences. And your insurance company's bean counters would actually like nothing better than for you to go home right now.

I would not expect you to have any more than 12O days per calendar year with private insurance. A few years ago I had an insurance that allowed me close to 2 years in a SNF, renewable after 30 days. Had no idea at the time how short-lived such a generous policy would be. Policies like that are long gone now (unless you could afford to keep it and be grandfathered in).

(Medicare has a limit of 100 SNF days, but is per "qualifying episode." With medicare, SNF coverage can be reinstated after another "qualifying episode." Even though rules changed for Medicare in 2014 regarding their "no improvement standard" there is still a cap of 100 days per qualifying episode in a SNF)

I'm only sharing this part because it comes as a surprise to anyone who is not familiar with it. I don't want you to do you (or anyone else in the U.S. reading this) a disservice by not saying anything. I'd hate for you to arrange to go home and then find out when it's too late. There's something known as "custodial care." That is non-skilled care and includes toiletting, dressing, and showering. The only way any insurance, including Medicare, will pay for that is if you are also receiving "skilled care" (nursing, pt, ot, and/ or speech therapy), both in a SNF and with home health care. http://www.longtermcarelink.net/elde..._term_care.htm. / http://www.lifesprk.com/seek-on/heal...long-term-care

The only exceptions would be if you had a long term care policy or Medicaid. The latter is an option that may be worth checking into further. With that, you may be able to live at home even if you all you needed was custodial care. Today all 50 states and D.C. have at least one program that provides assistance to individuals living outside of nursing homes, be that at home, in adult day care or assisted living. But, it takes time to go through the process of being approved. http://www.payingforseniorcare.com/m...home-care.html

I'm sorry you are depressed at the SNF. No one can understand that like someone who has also been in a similar situation. I feel for you, and have had my own share of fears, along with some bad experiences, in those types of facilities. And, I too understand what it's like to be the youngest patient in one of these facilities. It's even harder to be faced with all that when everyone else you see is so much older. (I couldn't help but laugh when one of my aides believed for weeks I was only in my 20's. ~Ha - not quite ! ~ I joked that compared to the other patients they were around all day, I must've looked that young.)

This past spring/ summer I spent a total of 3 months away from home in the hospital, acute rehab, and sub acute rehab facility. That's a mere drop in the bucket compared to a few years ago when I spent 13 months away from home ... bouncing back and forth between the hospital, acute rehab, and sub-acute rehab facilities.

When I finally came home after being gone for 13 months, I spent another 10 months working with therapists from first home health care and then outpatient therapy. I had to take a break because of insurance coverage, and then spent almost another 5 months in outpatient therapy. That doesn't even include the fact I had to hire a caregiver to help me during the day for close to 11 months. (My husband works.)

This last time, it hasn't been nearly as challenging for me since I've been home. But, it still not easy and continues to be a fight. And after slowly, but steadily improving, I had another setback a few weeks ago. It's discouraging and frustrating. But if I hadn't fought so hard for 6 months, I wouldn't be where I am.

I have two children. My daughter and husband came to visit me almost every single day while I away from home. My son could only come sporadically because of other obligations in his life, and I know it made him very uncomfortable when he did come. It was taxing on all of them. I felt like I totally failed all my obligations to them. My heart ached not only because of what I was going through, but because of what I was putting them through. And I really missed being home with them. There were times I broke down and cried late at night when I was alone.

I was able to and came home for as I long as I could handle it on the weekends. Because I needed a lot of help when I was finally able to come home for those short intervals, I knew I had to stay where I was for as long as possible. It was only because I stayed at the rehab facility as long as my insurance allowed, that I was somewhat prepared for the reality I would face once I came home. Every minute of therapy I could get there DID matter, even if the progress seemed small. And, it's just not the same once you get home.

Something else you have to take into consideration is your Tysabri infusions. Will you be able to get out and go to an infusion center? Unlike other infusions, it can not be administered to you at home. It must be administered at TOUCH authorized infusion site, with a doctor or PA readily available. There are no exceptions.

It made me very sad to read that because of your pets, you were choosing to go home But, I can only urge you to PLEASE stay. It would be not only too hard for you, but also on your husband. Ultimately, it's your decision but I would only hope you would reconsider.

Your insurance will dictate what they approve for a wheelchair or hospital bed. You do need a chair that has a flip up arm rest, not removable, and elevating footrests with calf supports. The more lightweight, the better.

If possible, my only suggestion for your hospital bed is that you pay extra to get a full-electric frame bed, not the semi-electric you will probably be offered by your insurance. Otherwise, someone will have to manually adjust the height of it (from the floor) whenever you may need to change it. There are plenty of pricier hospital beds out there, but they are expensive. I wouldn't know what to suggest.

There are also many kinds of mattresses, but insurance only covers a basic mattress unless you have been diagnosed with stage 3 or 4 bedsores. (You might be able to have them cover a plastic blow up air topper). A friend I knew used to get that egg crate foam to help make their hospital bed a little more comfortable.

This may sound frivolous, but a sliding board that has two cut outs (one near each end) gives you a place put your hand so you can hold on, without always worrying where it's at. Your skin will stick to the board if any of it is exposed, in that case covering it with a pillow case helps. If you don't need a pillowcase over it, but do need something on the bottom of and end to keep it from slipping, two cutouts would be even more important.

Don't be surprised if the hospital bed and manual wheelchair are billed as rent-to-own. They'll be yours to keep in 12 months. Otherwise, they can be returned to the DME company before that time.

As far as the drop arm commode, the padded seat I used in the hospital was a lot more comfortable than the standard one. It also helped keep the sliding board from slipping while transferring, but rubber shelf liner taped on the bottom of one end of the sliding board also helped keep it from slipping. (Not much good if you have to use a pillowcase, though). Your best bet would be to get one from the internet, Walmart seems to have the best prices. You'll pay at a lot more (at least double, maybe even triple) if you get one from a DME store.

Good luck, I hope this information will help in making your decisions.