Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

BIAA Unveils 2010 Legislative Fact Sheets

On March 3, 2010, BIAA made available its 2010 legislative fact sheets. The fact sheets outline the agenda for this year including, access to care for both civilian and military populations, TBI Act and research funding, TBI Act reauthorization, caregiver assistance, and support for the Congressional Brain Injury Task Force is now available on our home page!

Brain Injury Awareness Day 2010

Don’t forget that this year’s Brain Injury Awareness Day on Capitol Hill is set to take place on March, 17, 2010. 

Below is the schedule of events for the day:

10:00 AM – 1:00 PM - Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building

2:30 PM – 4:00 PM - Briefing: “From the Playground to the Pros: A Heads-Up on

Concussion”, Capitol Visitors Center – Congressional Meeting Room South

5:30 PM – 7:30 PM - Reception Celebrating Brain Injury Awareness Month, First Floor Foyer of the Rayburn House Office Building

Hope to see you there!

Health Care Reform Update

House leaders this week prepared a schedule to bring health care reform to a vote before Congress adjourns for its two-week spring recess, which begins on March 26, 2010. BIAA continues to advocate for provisions important to the brain injury community and will alert grassroots advocates if action is necessary.

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Skiing accident claims another life joing the ranks of celebrities Natasha Richardson and Sonny Bono.  Sadly, a skier who previously suffered brain injury, was again injured despite wearing protective gear and helmet.

Squaw Valley, home of the Oympics, is a popular ski resort near Lake Tahoe, California.  It is also close to Lake Tahoe, Nevada.  Lake Tahoe is partly in California and partly in Nevada.  You can stand with one foot in California and one in Nevada in the town of Southshore, about 45 minutes from Squaw Valley.  The Nevada side has hotels and casinos which abruptly stop on the California side.

ESPN reporter Micah Abrams:

Twenty-six-year-old C.R. Johnson was killed Wednesday while skiing at Squaw Valley, Calif. According to a statement issued by the resort, the Lake Tahoe native caught an edge on exposed rocks while entering the Light Towers area above the Cornice II lift. He fell through rocks before coming to a rest several hundred yards below the entry. Ski Patrol were on the scene within minutes, but efforts to revive Johnson failed. He was reportedly wearing a helmet.

Johnson was known in recent years for his inspiring return to skiing after a traumatic brain injury that he suffered in December of 2005. The injury, sustained when another skier accidentally landed on him during a run, left him in a coma for 10 days. He spent 34 days in the hospital and several months in rehab, but was back on snow by the end of that winter. He made steady progress in recent seasons and this winter finished third in the prestigious Red Bull Linecatcher event in the French Alps.

The ongoing injury and particulary brain injury that permeates so many sporting events, warrants the repeating..."Wear a helmet and protective gear."

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The Brain Injury Assocation of America posted this Health Care Reform Update.  Yesterday, President Obama and members of Congress and the Senate, Republican and Democrat, met to hash out a Health Care Reform Bill.  American Association of Justice President, Anthony Tarricone, appeared on Anderson Cooper 360: http://www.vimeo.com/9761801

Health Care Reform Update

On February 22, 2010, in the wake of the legislative hold put on Congress after the recent Massachusetts election, the White House released an 11-page health care overhaul proposal that would extend coverage to more than 31 million people, at a 10-year cost of $950 billion. The White House says that the cost would be offset by spending reductions and tax increases, resulting in $100 billion of deficit reduction. CQ

Also this week, a bipartisan summit convened to discuss the administration’s health care plan. The White House facilitated the six-hour summit to focus on controlling costs, overhauling insurance regulations, reducing the deficit and expanding health coverage. 

The group of 40 representatives and senators agreed on a new set of baseline insurance regulations but were still at odds about things like the cost of insurance premiums, patient choice issues, and deficit calculations. 

BIAA is monitoring the situation closely and will continue to advocate for a health care reform plan that will provide people with brain injury access to the full continuum of care that they need and deserve.

Brain Injury Awareness Month

As most of you already know, March is brain injury awareness month! BIAA will be unveiling its 2010 legislative agenda on Tuesday, March 2, 2010. Fact sheets outlining the agenda for this year including, access to care for both civilian and military populations, TBI Act and research funding, TBI Act reauthorization, caregiver assistance, and support for the Congressional Brain Injury Task Force will be available on our website starting Tuesday!

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There are several reasons the damages in brain injury cases remain high, attorneys say.

One is the skyrocketing costs of medical care. In fact, Harper said, the legal system’s method of awarding damages cannot keep up with the cost of lifelong medical care because jurors are instructed to reduce the verdict to a present value amount. But medical costs don’t “reduce,” Harper said.

Neither do the costs of caring for the injured person in the home. “My goal is always to bring the client home. That is a cost that should be borne by the (party found to have committed the tort),” said Anoka attorney Fred Soucie.

Another reason is that brain injury cases are readily demonstrable, both by medical evidence and through changes in the plaintiff’s behavior and moods. A traumatic brain injury will affect the person’s personality, judgment and concentration — which in turn affect the person’s ability to earn a living.

When the injury is catastrophic, the damages usually are self-evident. “I have had jaded insurance company lawyers say that the person has no pain and suffering because they are [so injured that they are] oblivious. That’s immoral and tactically stupid,” Soucie said. If jurors feel that the injured person is aware and suffering, they will punish the defense lawyer who appears callous in the extreme, he explained.

But even a “mild” injury can be proven, Soucie continued.  In fact, calling the injury “mild” can be a misnomer. Technically, the term “mild” is defined by the period of post-injury amnesia or loss of consciousness but the effects can be severe. The person may change dramatically, and friends, family and co-workers can explain the difference, he said.

Emotional value for juries

Additionally, the injuries are very compelling to jurors, Soucie said. “There’s always some juror skepticism but their hearts and minds are easily wrapped around these injuries,” he said.

The injuries are also capable of medical demonstration, said Minneapolis attorney Peter Riley, who recently settled a $3.4 million case involving multiple skull fractures among other injuries. Often the injury will show up as a bleed on a CAT scan or on an MRI, he said. “The defense [then] has a hard time saying the injury is due to something else,” Riley said.

Additionally, neuropsychometric testing can test for memory and brain functioning, showing exactly where the brain is damaged, and the test results can be matched to the patient’s symptoms, Riley said.

The neuropsychometric testing also can reveal any compensatory measures the brain has taken to make up for the injury, Riley said. In those cases, the jury has to be educated about the test results. If his recent case had called for it, Riley said he would have “backloaded” the plaintiff’s testimony by educating the jury beforehand so they would not have an opportunity to form an inaccurate opinion about the brain damage.

Not all head injuries are the result of trauma that reveals itself physically. Bloomington attorney Richard Ruohonen recently received a $128,000 verdict for a man who received an electric shock. The defendant, the city of Glencoe, had offered $50,000. The man was injured when he touched a pole the city had installed in his yard, but which was connected to a power line. He received five to 10 seconds of electric shock.

An electrical injury is more diffuse than an injury to a lobe of the brain, explained Ruohonen. His client’s injuries included loss of attention and concentration, memory impairment, pain and headaches. He also had a sleep disorder caused by injury to the brain stem, Ruohonen said.

This was a case of a skeptical insurance company. “They basically were saying it was all in his head,” Ruohonen said.

Actually, the case would have been more valuable but the client had a subsequent workers’ compensation injury to his neck. “That was the day the city got lucky,” Ruohonen said. The case might have been worth as much as $250,000 without the second injury, he explained. However, he is pleased with the result.

It would be speculating to say that the economy played role in the size of the verdict, Ruohonen said. It could also be that people in rural communicates are more conservative or that there were a lot of younger jurors (under age 35), he said.

The personal injury business can actually pick up during a recession, Ruohonen said. He noted that he is getting more calls from people whose injuries are two or three years old, and thinks perhaps they are now more hesitant to pursue their own claims. Besides, he added, “people down on their luck can be more sympathetic plaintiffs.”

And jurors don’t have a lot of sympathy for corporate or commercial defendants right now, he added.

“You’ve got a lot better chance if you’re going against corporations or insurance companies because people are upset with them. Those are great cases to try right now,” Ruohonen said.
 

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Truck driving safety is provided in the Federal Motor Carrier Safety Regulations published by the Federal Motor Carrier Safety Administration.  There are specific limitations on the number of hours a driver can be on duty.  Violation to these limits is unsafe and can create liability for a trucking company and its driver.  Fatigued drivers make highways and roads dangerous places for all of us.

A college student in Florida alleged that the tractor-trailer driver violated federal motor carrier safety rules by failing to take the required off-duty time after working a 24-hour shift as a county firefighter. Lymon v. Bohn No. 53-2007-CA-7728 (Fla., Polk Co. Cir. Mar. 20, 2009).

Kendra Lymon, 19, was driving through an intersection on a green light when Robert Bohn, driving a tractor-trailer truck, made a left turn into the intersection even though his view was obscured by another truck in the opposite turn lane. Bohn’s tractor-trailer T-boned Lymon’s car on the driver’s side, crushing the vehicle and sending it spinning off the highway.

Her injuries included brain damage that resulted in a motor speech disorder, difficulty swallowing, mild left hemiparesis, bowel and bladder incontinence, cognitive defects, and seizures. She also sustained a fractured left scapula.

Lymon’s mother, Vanessa, on her behalf, sued Bohn and his employer, Bynum Transport, Inc. Vanessa Lymon alleged that the trucking company had provided no ongoing safety training or defensive driver program for its drivers and that it failed to enforce federal motor carrier safety rules about driving hours and rest periods.

The plaintiff alleged that Bohn began his shift without taking the mandatory 10 hours of off-duty time after working a 24-hour shift as a battalion chief for the county fire services, a violation of federal rules. Furthermore, the plaintiff claimed, he violated basic traffic safety rules by turning without waiting for a clear view.

The jury awarded the plaintiff $65 million. The defendants have appealed.
 

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The  controversy over injury and sporting events including football and boxing gets a new "hit."

Boxer Hirokazu Yamaki died at a hospital recently after sustaining a traumatic brain injury during a bout in Tokyo, the Japan Boxing Commission said.

Yamaki, 26, suffered an acute subdural hematoma in his eighth-round knockout loss against Toshimasa Ouchi.

He remained unconscious after the fight and underwent emergency surgery at a Tokyo hospital to repair the brain damage.  Yamaki made his pro boxing debut in October 2003.

He was ranked 11th in the latest rankings in the Japanese flyweight division with a 7-9 record, including five knockouts.

In Nevada, we grapple with who pays for the costs of caring for the injury sustained by boxers since the Sponsors of boxers are only required to insure them for $50,000.  Care can easily exceed that amount and the costs are passed on to the hospital and ultimately the taxpayers of Nevada.
 

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In a new book titled "Religion and Psychiatry: Beyond Boundaries," the author considers why and how, when and where religion (and spirituality) are at stake in the life of psychiatric patients.  The interface between psychiatry and religion is explored at different levels, varying from daily clinical practice to conceptual fieldwork.

Religion is one subject that many people around the world feel extremely passionate about, either feeling strongly in their belief of a certain religion, or being against religions generally or specifically. Other people do not engage with religion at all. These choices represent a part of who we are, and as such it is essential for psychiatrists to understand and be able to relate to their patients' decisions and beliefs in this area.

Religion and Psychiatry is recommended reading for residents in psychiatry, postgraduates in theology, psychology and psychology of religion, researchers in psychiatric epidemiology and trans-cultural psychiatry, as well as professionals in theology, psychiatry and psychology of religion.

Religion (and spirituality) is very much alive and shapes the cultural values and aspirations of psychiatrist and patient alike, as does the choice of not identifying with a particular faith.  Patients bring their beliefs and convictions into the doctor-patient relationship.  The challenge for mental health professionals, whatever their own world view, is to develop and refine their vocabularies such that they truly understand what is communicated to them by their patients.

"The boundary between religious belief and the practice of psychiatry is becoming increasingly porous," say the editors in the Preface to Religion and Psychiatry: Beyond Boundaries. "No longer can psychiatrists in a multi-faith, multi-cultural globalized world hide behind the dismissal of religious belief as pathological, or behind a biomedical scientism, as they are more frequently confronted by distressed patients for whom religious belief may determine their choice of symptoms and their compliance with treatment."

Published on behalf of the World Psychiatric Association, Religion and Psychiatry: Beyond Boundaries, addresses the impact that religion and spirituality have on shaping cultural values, as well as the choice of not identifying with a particular faith. With this book, Peter Verhagen and colleagues provide a framework to understand the importance of these factors in mental well-being, and how to develop and refine their vocabularies to ensure they truly understand what their patients are telling them.

This is the first time that so many psychiatrists, psychologists, and theologians from all parts of the world and from so many different religious and spiritual backgrounds have worked together to produce a book addressing these important issues.

The book discusses what religious traditions can learn from each other to assist the patient, as well as the neurological basis of religious experiences. It describes training programmes that successfully incorporate aspects of religion and demonstrates how different religious and spiritual traditions can be brought together to improve psychiatric training and daily practice.

In the Foreword to Religion and Psychiatry Mario Maj, President of the World Psychiatric Association, states "The WPA welcomes this comprehensive and multifaceted volume, produced by one of its most active Scientific Sectors, hoping that the effort will continue to clarify the issue and stimulate further reflection and research."
 

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I have seen the following article on Twitter all day.  I finally decided it was worth posting.  This is the source of the Twitter appearing as "Mild Traumatic Brain Injury, Not So Mild After All."  See Science Daily.  It appears to be a hot blog topic.

Douglas Smith, MD, director of the Center for Brain Injury and Repair and professor of Neurosurgery at the University of Pennsylvania School of Medicine, will present information on the molecular mechanism at play in mild TBI (mTBI), commonly called concussions. Although mTBI affects over 1 million people each year in the United States, it is generally ignored as a major health issue. However, this 'mild' form of injury induces persisting neurological and cognitive problems in many of these patients, exacting an enormous emotional and financial toll on society.

Despite the prevalence and impact of mTBI, little is known about how mTBI affect nerve cells and connections in the brain, and therefore clinical outcomes after injury. Smith and colleagues have begun to amass data from human and animal studies on mTBI at 2-4 days after injury using advanced neuroimaging techniques. They have found distinct changes throughout the white matter in the brain. Also, protein markers of brain pathology were identified after mTBI in the blood of mTBI patients.

The team proposes a potential molecular mechanism to explain their findings. Specifically, they found that the stretching and disconnecting of nerve-cell axons after mTBI induces problems to the sodium channels found on the surface of neurons.

"This is not inconsequential," say Smith. "Indeed, the observation that brain pathology can be detected after a concussion calls for much more extensive efforts to prevent, diagnose, and treat mild traumatic brain injury."

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 I am representing a man who was hit by a bus making a left turn in Las Vegas. The man was in the crosswalk and the driver simply did not see him. The man was hospitalized with brain injury. The Bus Company with Las Vegas offices alleged the man was walking against the pedestrian traffic signal. Somehow, the Bus Co. feels, this gave the bus driver the right to run him over. And the police officer cited the man who got hit!

The police report listed two witnesses who provided statements in Spanish. Today, I took their depositions. The witnesses were fine Mexican-American individuals, legally in this country, who told us that the bus driver was at fault and that the man had the right of way according to the traffic signal. The police never spoke to the unconscious man, and obviously did not understand or ignored the independent witnesses’ accounts. Instead police took the bus driver’s version of traffic control violation of the pedestrian had and cited the pedestrian.

This is a blatant example of how the wrong picture is frequently painted based on pre-existing prejudice. The two Mexican-American witnesses were simply discounted out of hand. The sad part was that the pedestrian had his citation dismissed partially because the cop never showed up in court, yet the stigma remains. And the bus company may have gotten away with it.

The witnesses not only stated the traffic signal allowed the man to walk into the cross walk, but that the bus was attempting, in their opinion, to flee the scene. Can you imagine: A bus company that hires drivers who would flee the scene after hitting a pedestrian and knocking him to the ground unconscious? The amazing thing is that the bus company’s own camera installed on the bus actually showed the man walk into the crosswalk; The bus make its left turn while the radio is blasting; and then the sound of “thud” when the bus hit the pedestrian.

These are situations when all the tort reform rhetoric falls short. These things really happen and consumers need protection from faceless corporations driven solely by profit and self-preservation.

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A number of years ago I was involved in representing plaintiffs against Las Vegas Paving in a lawsuit alleging the truck driver's loads were routinely in excess of limits.  During one such run, the trucker crashed into my client near a highschool.

Similarly, in Bryant v. APAC-Tennessee, No. CV2006-0261CD  (Miss., DeSoto Co. Cir. Nov. 18, 2009) a teen and his parents sued the paving company that hired the truck’s driver, alleging the company failed to monitor his loads and supervise his conduct. The plaintiffs offered evidence that the driver had made multiple trips on the company’s behalf, each with hauls that exceeded the state’s maximum weight limit.

Ethan Bryant, 16, was driving his pickup truck on a highway. When he entered a controlled intersection on a green light, a loaded gravel truck driven by Chad McCarty struck the driver’s side of the pickup at about 50 mph.

Bryant suffered severe brain injuries, and a 16-year-old passenger in his vehicle was killed. Bryant was comatose for eight months and developed a disorder that limits oxygen to his brain. He now suffers from quadriplegia and periodic seizures and will require 24-hour care for life.
 

 Local trucking companies all too frequently break the rules of the road.  They ignore safety protocol and all too often injure users of public roads.

Factors may effect which rules must be met.  For instance, Interstate Trucking, driving between states, and intrastate Trucking, driving within one state, are subject to different regualtions.  Although many rules bring about some responsibility for truck companies and their drivers, it is important to know the difference.  Likewise, the weight of trucks and loads may apply to different regulations and it is important to know the difference.

I have been working more closely with organizations advocating safety for public roads. 

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The Las Vegas Review Journal announced Station Casino (Fertitta family business) affiliate has been sued by partner GCR Gaming (Greenspun Family business).  Both families have lawyered up.

The lawsuit alleges "wrongdoing" and of flagrant and continuous breach of "contractual and fiduciary duties" in their joint-venture partnership of the Green Valley Ranch Resort.

The filing alleges Station Casinos executives breached those duties, in part, by directing high-stakes gamblers at Green Valley Ranch to other casinos that were owned solely by Station Casinos.

This comes after Station Casino's filed for bankruptcy as a partner of operations at Green Valley Ranch Resort.  Whenever a bankruptcy is filed or pending, any claims by creditors, including lawsuits against the bankrupt entity or person are stayed.  In other words, no lawsuits are allowed while bankruptcy is pending in most circumstances.  While protecting the bankrupt corporation, this leads to denied or delayed justice for those injured by the property management's negligence.

Station's parent company filed for Chapter 11 bankruptcy protection in 2009.  Chapter 11, unlike Chapter 7, is a reorganization or debt payments.  Station has been attempting to provide the Bankruptcy court with a plan to repay its debts but needs cooperation from creditors.

The long and short of it is that GVR Gaming's lawsuit will require lifting the stay by the Bankruptcy Judge to proceed.  A motion was filed yesterday.

My office currently has 1 lawsuit pending where Station Casino is  a defendant.  That matter is not subject to Station's parent company Chapter 11 bankruptcy.  However, last year, before the Station Casino filed bankruptcy as to its Green Valley Ranch Resort, another matter was resolved in my office.  Fortunate for my clients, they will not be denied or delayed justice because of the recent bankruptcy filing.

Ironically, President Obama is in Las Vegas today to address the public at Green Valley highschool.  Worthy of note is whether Las Vegas Mayor, Oscar Goodman, will welcome President Obama in light of the President's recent comment “You don’t blow a bunch of cash in Vegas when you’re trying to save for college.” The comment also drew the ire of Democratic Senator Harry Reid.  “Lay off Las Vegas,” Sen. Harry Reid said in a statement issued shortly after the remarks spread through the internet.  He later went on to support President Obama.

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My ongoing investigation into the Diagnostic and Statistical Manual, anticipated 2013 release, reveals the following sources:

NPR: "Doctors use the DSM to diagnose patients, and insurance companies use it to decide on reimbursement, so it's incredibly important in the profession of psychiatry."

NPR reports on a change for children currently being diagnosed with bipolar disorder (also known as manic-depression): "The condition will be called temper dysregulation disorder, and it will be seen as a brain or biological dysfunction, but not as a necessarily lifelong condition like bipolar. ... By adding this new entry, the American Psychiatric Association is trying to use the considerable institutional power of the DSM to curb use of the pediatric bipolar label" (Spiegel, 2/10).

The Associated Press: The American Psychiatric Association "is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them. ... Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders -- such as dementia or schizophrenia -- based on early symptoms, even though there's no way to know who will worsen into full-blown illness" (Neergaard, 2/10).

USA Today reports on efforts to classify illness like autism as broader illnesses rather than a specific subtype: "DSM-5 proposes replacing diagnoses for autism, Asperger's, childhood disintegrative and pervasive developmental disorders with a single diagnosis, 'autism spectrum disorders,' based on deficits in social interaction and communication and the presence of repetitive behaviors and interests" (Rubin, 2/9).

To follow my other posts on proposed changes to DSM see http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

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All to often people who suffer from disease are unable to get care due to insurance company limitations and policies, lack of insurance or finances to cover expenses.  Sometimes folks are left with Social Security Benefit applications for their care.

In its effort to improve and expedite the disability determination process, the Social Security Administration (SSA) has announced that it will add early-onset Alzheimer's disease to its Compassionate Allowances Initiative. The initiative identifies debilitating diseases and medical conditions that meet the SSA's disability standards for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI). 

Social Security is launching this expedited decision process with a total of 50 conditions.  Over time, more diseases and conditions will be added.  A list of the first 50 impairments -- 25 rare diseases and 25 cancers -- can be found at www.socialsecurity.gov/compassionateallowances.

This recent development will lead to increased care more quickly for those who could not otherwise afford it.

Since 2003, the Alzheimer's Association has been advocating on behalf of individuals with early-onset Alzheimer's as they navigate the Social Security disability determinations process and welcomes the SSA's decision. Until now, individuals with early-onset Alzheimer's disease have faced a myriad of challenges when applying for SSDI or SSI, including a long decision process, initial denials, and multiple appeals.

Today's decision will simplify and streamline the SSDI/SSI application process and decrease the wait time for benefits, which for some has lasted as long as three years. There are currently an estimated 5.3 million Americans with Alzheimer's disease. Although the majority of Alzheimer cases are individuals age 65 and older, a significant number of people under age 65 are also affected by this fatal disease and have few financial options other than the Social Security disability program. 

This good news comes at a time when politics has brought the issue of universal health care to a stand still.  It always intrigues me that certain folks think the "right" to choose a doctor, hence stumping public/social or universal health care, exists.  While, at the same time, those folks shun the idea that anyone has a "right" to not be subject to Rendition based on suspicion, or the "right" of due process.

What ever your reflection on the matter, the recent Compassionate Allowances Initiative moves us in the right direction.
 

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I came across a new website directed at assisting with mental illness. Step Up on Second.

Step Up on Second announces the launch of its newly enhanced Web 2.0 site. Step Up on Second is a California non-profit organization providing support services for adults affected by severe and persistent mental illness, and young adults experiencing the initial symptoms of a mental illness and their families.

The interactive site provides resources for loved ones, clients, and family members in search of an organization that can provide help, hope, and a home to individuals affected by mental illness.

Step Up on Second provides help through comprehensive, integrated clinical programs for relapse prevention; hope through the embrace of community, opportunities for inclusion, advocacy, and empowerment; and permanent supportive home units for stability achieving self-determined goals.

Recently Actress Glenn Close posted on their blog.

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The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Risk factors include Osteoporosis (decreased density of the bones) which can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position or walking.

Interestingly, exercise, as we know, reduces the risk due to higher bone density in woman over 65.  The Archives of Internal Medicine released a study identifying the reduction in falls among those woman engaged in physical activity.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.  In 2007, more than 261,000 people visited the emergency room due to a distal radius fracture.

 The American Academy of Orthopaedic Surgeons (AAOS) recently approved and released an evidence-based clinical practice guideline on the Treatment of Distal Radius Fractures.

The final patient-oriented guidelines for treating distal radius fractures contain 29 evidence-based recommendations overall, some of which are included below:

1.  The research suggests that a rigid cast is better than a splint if the fracture was displaced.

2.  If a fracture was not displaced - as in a hairline crack - a removable splint can be worn.

3.  If a fracture has a tendency to fall back the way it was before the physician fixed it, research suggests that these fractures heal better if the surgeon operates on them, rather than treating them with a cast. 

More than 4,000 journal articles from around the world were analyzed over the course of a year and every article was graded on a five-point scale depending on the strength and quality of the evidence. Only prospective, randomly controlled clinical trials with enough patients to establish clinical and statistical significance could earn the highest grade, ranking as strong evidence.

Being aware of fractures in general, and especially in the population aged 65 and older, makes considering treatments important.  Being informed is the best place to be if and when the need to know becomes immediate as when an unexpected fall lands us in the hospital.

 

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Most interesting news pegging the tobacco-industry.

A UCSF analysis of published studies on the relationship between Alzheimer's disease and smoking indicates that smoking cigarettes is a significant risk factor for the disease. After controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors, the UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of Alzheimer's Disease, while independent studies showed that smoking increased the risk of developing the disease.

Study findings were published online in the January issue (19:2) of the Journal of Alzheimer's Disease.  

Alcohol Use Found in Cognitive Decline

Studies of alcohol use and cognition among the elderly are rare and have mixed results. A study of drinking among the elderly in Brazil has found that heavy alcohol use is associated with more memory and cognitive problems than mild-to-moderate alcohol use, especially among women.

Results will be published in the April 2010 issue of Alcoholism: Clinical & Experimental Research .
 

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 The Illinois Supreme Court recently struck down limits on jury awards in medical malpractice cases passed by the Legislature four years ago amid spiking liability costs for medical providers.

The court ruled that the caps on pain and suffering and other non-economic damages — $500,000 per case for doctors and $1 million for hospitals — are unconstitutional.

The court’s opinion upholds a 2007 ruling by a Cook County Circuit Court judge determining that the law violated the Illinois Constitution’s “separation of powers” clause, essentially finding that lawmakers interfered with the right of juries to determine fair damages.

It’s the third time the state’s high court has quashed limits on medical malpractice awards, having tossed out similar laws in 1976 and 1997.

The ruling is a blow to physicians, hospitals and malpractice insurers, who successfully argued in 2005 that frivolous lawsuits and runaway jury verdicts were driving up insurance rates and forcing physicians to leave the state.

The court’s ruling stems from a malpractice lawsuit filed in 2006 by the family of a girl who suffered brain damage during her delivery at Gottlieb Memorial Hospital in Melrose Park. Illinois’ trial bar selected the suit as its “test case” to challenge the law.

Liability insurance rates for Illinois doctors generally have held steady or dipped slightly since the caps took effect in August 2005, according to survey data from Medical Liability Monitor, an Oak Park-based trade publication. That’s roughly in line with national trends.  Mike Colias reports.

 The Wall Street Journal (2/5, Koppel) reports that the measure was initially intended to rein in increasing medical-liability insurance costs. Tort reform advocates saw the ruling as a setback, arguing that medical-malpractice suits play a large role in increasing healthcare costs.

        Reuters (2/4) reported that Dr. James Rohack, president of the American Medical Association, said the "decision threatens to undo all that Illinois patients and physicians have gained under the cap, including greater access to health care, lower medical liability rates and increased competition among medical liability insurers." But the Chicago Tribune (2/4, Japsen, Sachdev) reported, "Consumer groups and insurance industry officials say the fact that rates have stabilized" has "more to do with insurance market cycles."

        Crain's Chicago Business (2/4, Colias) reported, "In declaring the jury-award caps unconstitutional, the court's decision also scraps several other insurance reforms included in the original law that both sides have said helped ease liability costs." One such reform is "a provision that forced" the state's largest malpractice insurer "to disclose the data it uses to set rates."

        "Lawyers and other opponents of caps say those price controls were the real reason that malpractice insurance rates have gone down, rather than the presence of caps," the St. Louis Post-Dispatch (2/5, McDermott) reports. The AP (2/4) also covered the story.

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Since I recently posted on the topic linking high blood pressure to dementia, I came across my doctor's newsletter on Blood Pressure.  I reprint it here for those interested.

The leading cause of death and disability in the United States is from cardiovascular diseases, and the most common disease is high blood pressure.  High blood pressure, also known as
hypertension, usually does not have any symptoms – hence, the nickname “silent killer.”

Unfortunately, one-third of those who have high blood pressure do not realize it and are not aware of their risk for heart disease. Therefore, many people live years without treatment, possibly damaging their heart, blood vessels, and kidneys.

Lifestyle choices (e.g., weight control, tobacco use, proper nutrition, regular exercise) can help
prevent and/or control high blood pressure. The following are common questions and answers about blood pressure.

What is blood pressure?

It is the force of blood against the walls of arteries. Systolic pressure (the top number) is the force as the heart beats. Diastolic pressure (the bottom number) is the force as the heart relaxes.

A blood pressure reading of 120/80 mmHg is articulated as “120 over 80.”

What is the meaning of the numbers?

A systolic pressure of 120 or less is considered normal. Diastolic pressure of 80 or less is considered normal. Therefore, 120/80 or less is a normal blood pressure. The chart below shows normal blood pressure levels, as well as the levels of high blood pressure.

What are the dangers of high blood pressure?

High blood pressure places an additional strain on the circulatory system (i.e., heart and blood vessels).  This strain results in arteries becoming thicker, narrower, and weaker, sometimes causing an obstruction.  A completely obstructed artery often leads to heart attacks, strokes, kidney disease, and dementia.

Is low blood pressure a health problem?

The training effect of regular exercise, especially when working out rigorously, is a lower blood pressure. At times, an individual who does not exercise may experience regular low blood pressure. If symptoms do not accompany the low pressure, it usually is not serious. However, if
blood pressure suddenly drops, it may indicate an underlying problem causing inadequate blood flow to the heart, brain, and other vital organs. Symptoms may include dizziness or lightheadedness.

What are some tips to prevent/control high blood pressure?

Healthy living is at the heart of preventing and controlling high blood pressure. Are you:
 Maintaining a healthy weight?
 Engaging in regular physical activity (fi ve 30-minute sessions of aerobic exercise and two
30-minute strength training sessions per week)?
 Eating a low-fat, high-nutrient diet (fruits, vegetables, low-fat dairy foods, low sodium)?
 Limiting alcohol consumption?

References:
1. NIH – National Heart, Lung, Blood
Institute, www.nhlbi.nih.gov
2. American Heart Association,
www.heart.org
3. Blood Pressure Association (United
Kingdom), www.bpassoc.org.uk
Exceptional Doctors. Exceptional Care. Exceptional Results.
LivingWell
The Link Between Heart Health and Blood Pressure
February 2010
 

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 Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities. I previously wrote about the link between Hypertension and Alzheimer's disease.

This is especially relevant to those who are not controlling their blood pressure. Blood pressure is not something one feels is high or low. Specific medical evaluation, blood pressure test, is necessary. 

Data from an offshoot of the Women's Health Initiative found that participants' baseline blood pressure was strongly correlated with volume of lesions in their brains' white matter, according to Lewis Kuller, MD, DrPH, of the University of Pittsburgh, and colleagues.

Along with earlier studies linking blood pressure to clinical dementia, the evidence "supports tight control of blood pressure levels, especially beginning at younger and middle age as a possible and perhaps only way to prevent dementia," Kuller and colleagues concluded online in the Journal of Clinical Hypertension.

Treating hypertension in the elderly appears to protect against dementia and cognitive decline.  Uncontrolled hypertension in older patients increases the risk of cognitive impairment. Hypertensive patients had a 70% greater risk of non-amnestic mild cognitive impairment compared with nonhypertensive patients according to Christiane Reitz, M.D., Ph.D., of Columbia University in New York. (C Reitz et al. "Hypertension and the risk of mild cognitive impairment." International Society of Vascular Behavioral and Cognitive Disorders meeting, July 11-14, San Antonio. Final program and abstract book. Abstract O-6)

For each year an individual took medication to lower blood pressure, the risk of dementia decreased by about 3%, found Rita Peila, Ph.D., an epidemiologist at the National Institute on Aging and a scientist at the Pacific Health Research Institute in Honolulu.

My question is whether a person who controls their blood pressure and hypertension with medicine can decrease their risk of dementia to that of someone without hypertension.  I predict that other risk factors would need to be accounted for but, other things being equal, can a person with controlled high blood pressure eliminate the risk of dementia?

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