Category Archives: doctors and medical

What’s in a Back Injury?

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Pain radiating down the leg to the small toe in the general pattern of the S1 dermatome suggests that a herniated disk may be pinching the S1 nerve root in the spine.

I hurt my back, and my doctor said it’s my “disc.” What is going on?

Obviously, you’ll want to speak to your doctor about the specifics of your injury, but below is a simple primer on the basic information of an injured, slipped, bulging, herniated disc.

Discs are in between your vertebrae in your spine. They are there as shock absorbers between the bone and also help provide the spine with mobility.

When you have an injury to your disc, you may have what’s called a disc herniation or a disc bulge. If you have a disc herniation, the gel-type substance in the disc has extended beyond where the disc normally contains the gel substance. In the case of a herniation, you can have an extruding disc (more prominent) or a protruding disc (less prominent). The herniation becomes a problem when it interferes or “impinges” or “entraps” the nerves in your spinal column.

A bulging disc is when the gel-type substance is outside the normal disc space, but the outer “shell” of the disc remains intact for the most part. Usually, a bulging disc is less severe than a herniated disc, and bulging discs are sometimes referred to as “protruding discs” as well.

Because the nerves in your spine control your arms and legs, often, your doctor can determine which disc is causing you problems simply by what part of your arm or leg tingles, goes numb, or hurts, along with the location of the pain in your back. For example, if you had a back injury and it now hurts on the outside of your thigh, across the front of your knee, and into your big toe, you likely have an issue with your L4-L5 disc (see the chart as an illustration).

Naturally, a doctor will use your symptoms in conjunction with other diagnostic tests to determine the location of the problem more precisely and will treat your symptoms accordingly. In addition, your doctor will be better able to explain the specifics of your injury more thoroughly and precisely. However, the purpose of this blog is to simply give you an overview of what it means when the doctor says you have a disc “herniation” or “bulge.” This disclaimer applies to the information supplied in today’s blog post.

Are Medical Doctors Willing Puppets for Cross-examination?

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It used to be that the most to fear from an examination scheduled by an insurance company would be an unfair or incomplete assessment of the work injury. Now it seems insurance companies are using doctors to essentially cross-examine injured workers and delve deeply into irrelevant issues in an attempt to embarrass, harass and probe where they do not belong.

 

-Do you have painful, frequent, or difficulty urinating?

-Do you have painful breasts, periods or intercourse?

-Have you suffered physical, sexual or emotional abuse?

-Do you have erectile difficulty?

-Do you get along with supervisors and other employees?

-Do physical or mental problems run in your family?

-Is anyone in your family disabled?

-Did you smoke, drink or use illegal drugs in the past?

 

These are some of the more disturbing questions asked by a doctor of a patient in a pre-exam questionnaire sent directly from the doctor’s office to the injured worker. You might surmise that this was a case of some sort of reproductive injury associated with mental duress of some type by looking at the questions. In fact, this worker only alleged carpal tunnel syndrome! Most assuredly, embarrassing facts about this worker would just happen to show up in the defense doctor’s final report for the Court’s review at trial.

 

Any time anyone other than your lawyer sends you something to complete, you should be very careful about filling it out. It’s probably unethical for doctors to send these reports to injured workers who are represented, but we’re seeing more and more of these go out. They are becoming more and more intrusive; in fact, this questionnaire was 11 pages long. It’s my practice not to have clients complete any of these pre-exam questionnaires from doctors.

Are Big Business and Big Insurance Making Nebraska Doctors Scapegoats?

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New legislation has been proposed to reduce the quality of medical care for workers under the guise of reducing costs

Evidence-based medicine and utilization review (EBM/UR) of medical care for workers’ compensation are currently being pushed by big business and big insurance interests.

We are facing such legislation in Nebraska this year.

One reason supporters of this way to control medical care for workers give seems to be that medical care currently provided is “inefficient.”

This is a euphemism for medical costs are too high. I view this as critical of physicians and other health-care providers who are taking care of injured workers. The Florida Medical Association (FMA) has recently responded to this type of criticism of the medical profession. In their case, the Office of Insurance Regulation (OIR) and National Council on Compensation Insurance (NCCI) say workers’ comp rates are being raised because drugs are dispensed directly by doctors. But an OIR report, according to the article linked below, “shows virtually no difference in the cost of such drugs whether dispensed by doctors or pharmacies,” so the FMA disagrees with blaming their doctors for rate increases.

This quote is from the story linked to above: “The truth is that the NCCI and carriers have used physician dispensing as a scapegoat for hundreds of millions of dollars in rate increases when other medical costs have been the real cost drivers in workers’ compensation,” the group charged. “The numbers are fabricated in an attempt to eliminate doctor dispensing.”

Reversing A Century Of Progress – Are We Back In Upton Sinclair’s Jungle?

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Health Care Is Just The Beginning

Many workers no longer have paid sick days.

At a time when a flu epidemic is exploding out of control, killing thousands of people, forty-two million Americans have no sick leave. Many of these people are lower paid, often work part time, and continue to work when ill because they can’t stay home to recover without losing their income. I am shocked and dismayed that many hard-working folk are forced to work when sick because staying home is not economically possible. Making matters even worse, these highly vulnerable workers often have no employer-provided health insurance so even serious illnesses go untreated, putting us all at a higher risk for infection from a contagious worker, like a server in a restaurant, for whom taking an unpaid day off is impossible.

…the trend toward low pay, long hours and few benefits is getting stronger.

I fear that if the current trends continue, the lives of the millions of Americans who struggle at low-paying jobs will remain miserable, desperate and be lacking in real hope. It appears that the trend toward low pay, long hours and few benefits is getting stronger. At the turn of the 20th century when Upton Sinclair wrote “The Jungle,” describing immigrants struggling in Chicago, the jobs were more physical, dangerous and just plain disgusting. However, millions of “New Jungle” workers still struggle and suffer today.

Class Warfare

After over 100 years of progress, the American middle and lower classes are under constant attack. The efforts to limit rights of workers are ongoing and supported by big business. Every day I read of measures being introduced in state legislatures to limit access to and decrease the benefits of workers’ compensation. The right to collective bargaining is being attacked as well. Local elections are overrun by anonymous innocent-sounding Super PACs funded by 21st Century versions of robber-barons who are using their wealth and power to squeeze out a few more dollars in profits to add to the tens of billions of dollars already sitting in their bank accounts. These are not job creators, they are their own personal wealth creators. Income equality is at an all-time low in the United States, and the trends are getting worse.

How can this be happening in 21st century America? How can we call ourselves civilized? Can we really allow such maltreatment of workers and disregard public health in what we call an “advanced,” “modern,” and frequently, an “exceptional” county?

A Path Forward

We are not without hope, though. Crusaders like Senator Elizabeth Warren are working hard to reverse the trends and preserve the American Dream for future generations. But our protectors are few. We cannot assume that someone else is looking out for us. We must engage with government at the local, state and federal levels so that the voices of regular working folk are not drowned out by a cabal of rogue billionaires trying to keep score by increasing their own personal fortunes at the expense of working people. I fear that if we sit by passively, our children will all be working in the New Jungle, America will have lost its middle class, and with it, the American Dream will be a distant memory. The time to act is now.

How To Manage Worry Without Medication

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Today’s post comes from guest author Kit Case from Causey Law Firm in Seattle. This is the third and final story in the series. This blog post about managing worry without medication shares some useful tips about how injured workers can address the worry that can comes both from the injury itself and the stress of uncertainty. These suggestions highlight resources that are available to perpetual “worriers.” States vary in how mental health concerns, such as worry, are addressed through workers’ compensation, so worry’s effects may or may not be “ratable permanent impairment” (as the story talks about) in a person’s specific case. In Nebraska, if worry causes a mental health concern that is the result of a physical injury covered by workers’ compensation, the mental health treatment can be addressed through workers’ compensation. If there are questions about a specific situation, it’s important to address them with an attorney familiar with the state’s laws where the situation occurs.

For the last few weeks we’ve been talking about the very real medical dangers of worry. For injured or disabled workers, worry can add an additional and very significant burden on the body. In this post, we’ll talk about some of the ways that worry can be treated or even avoided.

Much of the time treatments are simply medications that increase GABA. Cognitive therapy is prescribed depending upon insurance coverage. Addressing the physical and mental effects of excessive worry can aid in recovery from an injury or disability and can increase levels of success in vocational retraining efforts. In rare cases, worry and anxiety can become permanent fixtures in a person’s life, and the effects of this condition can result in ratable permanent impairment. But, the greater part of lay and scientific literature lists non-medicine tips to reduce worry, fear and anxiety to a more modulated level, thereby providing some relief from this constant invader that often creates unproductive and hurtful periods in life.

Here, summarized, are six tips cited in the literature to help manage worry without medication:

  • Separate out toxic worry from good worry: Good worry amounts to planning. Toxic worry is unnecessary, repetitive, unproductive, paralyzing, frightening, and in general, life-defeating.
  • Get the facts rather than letting your imagination run away. Analyze the problem and take corrective action.
  • Develop connectedness in as many ways as you can: family, social, information and ideas, organizations and institutions. Never worry alone.
  • Touch and be touched: in addition to massage therapy, seek out hugs and laughter – being around children or family can help.
  • Be good to yourself. Exercise, eat well, get enough sleep, meditate, do yoga and be aware of over consumption of substances detrimental to your health, such as alcohol.
  • Sing, read, cry, do what you love, look for what’s good in life and don’t sweat the small stuff.