Health Care Reform in Nevada

Posted on July 29, 2010 by Tim Titolo

Nevada Senator Harry Reid has helped the President accomplish the greatest social overhaul since President Roosevelt.  In July, Heath Care begins to reshape this country by providing benefits to those who were previously denied access to health care.  As with the creation of social security, more Americans can live with the security of health care.

As provided for in the Patient Protection and Affordable Care Act, on July 1, 2010, the Department of Health and Human Services launched the website www.HealthCare.gov to make accessing and choosing health insurance easier. By providing consumers with many informative health resources, this website will allow you to take control when making decisions regarding your health care coverage.

 How Health Insurance Reform Is Benefitting You

Pre-Existing Condition Insurance Plan – Nevada residents who are uninsured and have been denied coverage because of a pre-existing condition can apply for the Pre-Existing Condition Insurance Plan (PCIP) created by the Patient Protection and Affordable Care Act. PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available, even to treat a pre-existing condition. To learn more about the PCIP program and apply please visit www.HealthCare.gov.

Early Retiree Reinsurance Program – The rise of health insurance costs have made it difficult for some employers to continue to provide health insurance for their retirees. At the same time, Nevada’s early retirees who are not yet eligible for Medicare face serious difficulties in obtaining coverage in the individual market. In order to enable employers who are offering retiree coverage to continue to do so in these tough times, the Patient Protection and Affordable Care Act provides assistance for employers starting this year. To learn more about this program and to download the application please visit www.HealthCare.gov.

Money for Rate Review - Under the Patient Protection and Affordable Care Act, the Secretary of Health and Human Services will work in conjunction with state insurance commissioners across the country to place additional oversight on health insurance companies so that people are assured of value for the premiums they pay. While the new law will take over time, PPACA provided $250 million in funding to states from 2010-2014 to ensure they have the resources they need to review insurance premium increases. With this money, states can review premiums, and take action if insurance companies are not able to justify increases. This funding will provide the participating states the tools they need to work with consumers when examining health insurance premiums while we transition to a reformed health system. 

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Depression and Pain in Your Head?

Posted on July 26, 2010 by Tim Titolo

Dealing with Brain Injury symptoms and consequences quite frequently, I am exposed to the contention that Depression is the culprit when it comes to the subjectivity of pain.  Subjective pain is that which is rated according to the one complaining, not the observer.  Objective pain is that which can be observed independent of the one complaining.

Brain Injured Victims are often accused of malingering pain symptoms as a result of being depressed.  And the depression is dismissed as a personality flaw or pre-existing a brain injury.

Well this is the what came first argument: the chicken or the egg.  Certainly there is medical support for the statistics of depressed patients being more likely to report subjective pain symptoms.  Also there are statistics supporting the evidence that pain leads to depression.

It is difficult to weed out the two but that difficulty is not justification to dismiss complaints of pain due to depression or depression being the true source of pain.

 When it comes to pain, the two competing schools of thought are that it's either "all in your head" or "all in your body". A new study led by University of Oxford researchers indicates that, instead, pain is an amalgam of the two.  Dr. Chantal Berna and colleagues used brain imaging to see how healthy volunteers responded to pain while feeling low.

 The article is "Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness" by Chantal Berna, et al. Berna, is affiliated with The Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology and Nuffield Department of Anaesthetics, University of Oxford, Oxford, United Kingdom.

The article appeared in Biological Psychiatry, Volume 67, Issue 11 (June 1, 2010), published by Elsevier.  The authors' disclosures of financial and conflicts of interests are available in the article.
 

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What is Scoliosis

Posted on July 25, 2010 by Tim Titolo

According to Medilexicon's medical dictionary scoliosis is:

Abnormal lateral and rotational curvature of the vertebral column. Depending on the etiology, there may be one curve, or primary and secondary compensatory curves; scoliosis may be "fixed" as a result of muscle and/or bone deformity or "mobile" as a result of unequal muscle contraction.

Scoliosis is a condition in which the spine bends to the side abnormally; either to the right or left. The curvature can be moderate to severe. Any part of the spine can be bent in scoliosis; but the most common regions are the chest area (thoracic scoliosis) or the lower part of the back (lumbar scoliosis).

Scoliosis is thought to be caused by heredity but some other reasons are different leg lengths.  Scoliosis affects 2-3% of the population, or an estimated 6 million people in the United States, and there is no cure.

Signs and symptoms of scoliosis may include:

■Uneven shoulders
■One shoulder blade that appears more prominent than the other
■Uneven waist
■One hip higher than the other

The National Scoliosis Foundation can be contacted at  NSF@scoliosis.org  to help answer questions you may have or seek care.

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Mental Health Websites

Posted on July 22, 2010 by Tim Titolo

A selection of useful mental health website links and resources. Please note that Titolo Law Office is not responsible for the content on any of these external websites.

  • Internet Mental Health
    Information on the most common mental disorders, medications and recovery stories.
    http://www.mentalhealth.com/
  • Intervoice
    Information for people who hear voices (auditory hallucinations), their family and friends
    http://www.intervoiceonline.org
  • Mental Health Foundation
    A detailed A-Z database of mental health disorders - their symptoms, causes and treatments
    http://www.mentalhealth.org.uk
  • PSYweb
    Information on Anxiety, Depression and Schizophrenia - including online tests.
    http://psyweb.com/
  • The Mental Health Research Association: NARSAD
    Organisation supporting research into the causes, better treatments and cures for severe mental illnesses. Information available for Schizophrenia, Depression, Bipolar Disorder and Anxiety.
    http://www.narsad.org
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Brain Science Podcast

Posted on July 19, 2010 by Tim Titolo

I found a great podcast from my ITunes store called Brain Science Podcast.  Creator, Dr. Ginger Campbell, is an Emergency Room Physician.  She has created a great resource for general interest audiences in topics related to Brain Science.  She also has a blog on Books and Ideas.

The topics covered in Brain Science Podcast vary and are very interesting.  Personally. I love to catch up by listening while on my elliptical machine in the morning.  There are over 4 years of podcasts sure to keep even the most ambitious listener busy for quite some time.

 I recently wrote to Dr. Campbell, conversation below, and sadly discovered that she is considering discontinuing the podcast after her summer break.  In other words she may or may not restart the podcast in September 2010.  Granted it is a large committment and amount of work.

I propose that anyone who enjoys learning about the brain write to Dr. Campbell by leaving a comment on the Brain Science Podcast.  Personally, I always appreciate comments to my posts and the back and forth discussion that follows.  I think hearing from interested listeners might prompt Dr. Campbell back to the mission she has been up to these past 4 years: educating folks.

I especially reach out to my clients to leave Dr. Campbell a comment after visiting her site.  Alternatively, if you are more comfortable with Facebook, leave a note at her Facebook site.

Here is the discussion I recently had with Dr. Campbell:

Tim,

Thank you so much for taking the time to write.

 

One topic that I have not yet had a chance to cover on the Brain Science Podcast is Head Trauma. This does not reflect a lack of interest on my part, but it is a result of two things. One is that since I have created the podcast for a general audience I only talk  specifically about medical issues once or twice a year. Secondly, I generally base episodes on books that are accessible to general audiences and I have yet to find a good book on Brain Trauma. This may reflect the fact that our scientific understanding is still fairly poor. Until a few decades ago patients with significant brain trauma (and spinal cord injury) usually died, so the field is relatively young.

 

After you have made it through the first year of episodes you will have a clearer idea of what I have in mind. Maybe then you might have some book suggestions.

 

Right now I am leaning toward continuing only my other podcast Books and Ideas, which would leave me the flexibility to consider brain-related topics whenever I want. But it is too early to make that decision.

 

Thank you so much for sharing my podcast with others. Even if I quit producing new shows after September, there will still be 70 episodes available, and I intend to leave these on-line as long as they remain accurate and relevant.

 

You mention that you disagree with my position on evolution and I am glad that this is not an obstacle to your enjoying the Brain Science Podcast. One current cultural trend that disturbs me is the idea people ought to agree about everything, and never listen to opposing viewpoints (let alone ideas from their opponents).

 

Since you are a lawyer, I am curious! Have you read John Stuart Mills book On LIberty?

 

Ginger

_____________________________

 

 

Dr. Campbell

 

Thank you for taking the time to respond. No I have not read the book On Liberty. I will look for it at the bookstore.


I understand your audience and desire to speak about the brain to a general audience. To a lesser extent, I occasionally post about human brain subjects that have nothing to do with TBI. Like I said, I am really fascinated with how the brain makes us who we are. I’ll explore neurophilosphy, religion and psychiatry, fiction (Crichton’s Terminal Man), Movies (The Lookout, The Soloist), Neuropsychology, Cognitive Neuroscience, Neuroeducation, http://brainandspine.titololawoffice.com/2008/06/articles/brainy-reviews/how-doctors-can-think-better/ .

 

I agree that healthy disagreement and the flow of ideas is vital. I look forward to working my way through the podcasts. There is no way I could get through reading all the books and I appreciate how you cover the content and describe the author.

 

 I posted on an interesting book entitled Another Day inThe Frontal Lobes, by Katrina Firlik. I was trying to review each chapter. Here is an example: http://brainandspine.titololawoffice.com/2007/11/articles/brainy-reviews/the-frontal-lobe-11/ If you link to my blog http://brainandspine.titololawoffice.com and click on Another Day inThe Frontal Lobes Reviews by Tim Titolo I have some other books I reviewed. I expect I will find some in your podcasts.

 

If it is OK, I intend to link to your site and podcast from my own blog. I really like the information. I had hoped we could list each other blogs on our sites. Yours is on mine. Check the right hand side of my blog (scroll down) to Links.

 

I am subscribed to your books and ideas blog/podcast although I have not visited it yet but will very soon. I love books. You are right about that blog giving you more freedom to explore brain books when they come up while still having the ability to explore multiple other areas of interest.

 

I see you are an emergency physician. Here is a problem worth considering. The care received in ERs for Brain injury or suspected brain injury is very poor. That is why, through the North American Brain Injury Society NABIS, we are advocating biomechanical professionals to be involved in ER care. Too often folks are sent home with complaints of headache or overwhelming pain from obvious injuries like fracture and lesions, and the brain injury (mild and moderate) diagnosis does not come for weeks and months. By then, the powers that be involved in damage control, defendants and insurance companies, deny causation etc. I simple CT or even more involved MRI routinely miss microscopic cellular injury, focal and diffuse.

 

I look forward to exploring the rest of the Brain Science Podcast and the Books and Ideas blog. Here is a link to books published by NABIS. http://www.braininjurybooks.com/  

Be Well and have a relaxing summer. (I love your dogs!)

 

Tim Titolo

 

Support the Brain Science Podcast.

 

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10 Commonly Broken Bones (or Parts)

Posted on July 18, 2010 by Tim Titolo

 

I just received this informative article on the Ten Most Common Broken Bones.

You haven’t lived until you’ve broken a bone. Most fun activities when you were a kid involved physical risk – like football, basketball, climbing a tree and fighting – though not all were condonable. As you get older, you might suffer a fracture while performing normal day-to-day activities. Often times, adults break their arms, legs and collarbones in car accidents or accidents within their households. Most broken bones are more of an inconvenience than a major medical issue, but you probably already know that. Here is a list of commonly broken bones; chances are you’ve injured at least one of these during your lifetime.

ouch

  • Arm
    According to emedicinehealth.com, arm fractures account for almost half of all adults’ broken bones, and forearm fractures are the second most broken bone among children. Most broken arms occur during direct trauma or falls. Direct trauma is caused by a foreign object, and such breaks typically occur during car accidents. Breaking a big fall by stretching your arm beneath your body usually results in a hospital visit.
  • Collarbone
    This is the most commonly broken bone among children. Breaks usually occur while they’re participating in sports, though such occurrences can be prevented by wearing proper equipment. Shoulder pads in football, for example, protect the clavicle from direct trauma. Adults are more likely to suffer a fractured clavicle during a car accident.
  • Ankle
    Fractured ankles often occur when people roll, twist, or extend their foot in a manner that’s unnatural. Gravity can also be a factor – if you fall from a high place and land onto your ankles, the force can cause it to break. When serious, the injury can prevent you from walking, and surgery may be needed. Wires, screws, plates and rods could be inserted in order to ensure the bone heals correctly.
  • Foot
    The human foot contains 26 bones. So given how much we depend on them during our day-to-day activities, it’s no surprise that the foot accounts for one out of every ten broken bones, according to emedicinehealth.com. Broken feet are more common among children because their ligaments and tendons are generally stronger than their bones.
  • Toe
    Few experiences are worse than the pain felt when your toe comes in between your bare foot and a door, wall, table leg or any other piece of furniture. Here’s an informal statistic: walking increases your chances of breaking your toes by 100 percent. Most cases aren’t severe enough for any kind of special treatment; taping it and keeping it immobilized will enable it to heal.
  • Hand
    The human hand is composed of 27 bones – one more than the foot. More so than any other extremity, losing use of your hand can make the easiest of activities difficult, especially when it’s your dominant hand. Most breaks are caused by the misuse of tools, sports injuries and falls.
  • Finger
    Although fingers are a part of the hand, they belong in a class unto themselves – they’re that important. It’s not unlike the relationship between your feet and toes. Informally, we recognize a broken toe as just that – a broken toe. Broken fingers can hinder your ability to write, eat and do just about anything. It’s not fun.
  • Leg
    A broken leg entails a broken femur, tibia, fibula or patella. Because the bones are so strong, it usually takes quite a bit of force to break them – like a large fall or a major car accident. An open fracture may occur during a serious injury. This is when the bone breaks the skin and becomes viewable.
  • Nose
    A broken nose is the least attractive break you can suffer. Noses that have been broken multiple times can lose their form, becoming asymmetrical and unrecognizable to their owners. Typically, the injury occurs as a result of fights, contact during sports games and car accidents (of course).
  • Jaw
    The second most common broken facial bone after a broken nose is a broken jaw. It’s much more common among men than women – three times as many suffer the injury, and it occurs most among men aged 20-29, emedicinehealth.com asserts. Also known as a mandibular fracture, it’s caused by direct trauma.

 So there you have the 10 most commonly broken bones.

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Helmets are not Just for Kids

Posted on July 5, 2010 by Tim Titolo

Friend and attorney Tom Doehrman recently and successfully represented a lawyer who sustained mild traumatic brain injury in Indiana after being hit by a car while riding a bicycle.  Mr. Doehrman's website can be viewed at http://www.tortslaw.com/html/doehrman.html.

The New York Times recently did a piece advocating usage of helmets as safety gear for adults.  After opining that helmets, these days, are stylish, inexpensive, and smart,LESLEY ALDERMAN tells us in Grown-Up Cyclists Need Helmets, Too:

Here is how to make a smart buying decision.

LOOK FOR A C.P.S.C. STICKER The sticker ensures that the product has met the federal Consumer Product Safety Commission’s standards. The commission requires that helmets be tested for impact resistance on special rigs, that they offer adequate peripheral vision and that their straps be sturdy, among other measures. Helmets are tested in a variety of conditions: when they are hot, wet, cold and at room temperature.

CHEAP CAN BE SAFE According to a study by the Bicycle Helmet Safety Institute, a nonprofit organization based in Arlington, Va., $10 helmets from Wal-Mart Stores and Target held up just as well as more expensive models from high-end outlets.

Last spring, the institute had an independent lab test six helmets in different price ranges. The report summarized its findings: “When you pay more for a helmet you may get an easier fit, more vents and snazzier graphics. But the basic impact protection of the cheap helmets we tested equaled the expensive ones.”

GET A GOOD FIT If the dork factor has been holding you (or your children) back, spring for a helmet in a color and shape you love — or at least do not hate. Check out the models from Nutcase, which feature bold graphics (stripes, flags, flames and such) in streamlined skater shapes. For more sophisticated styles, look at the options from Giro.

Whether you are buying for yourself or a child, be sure the fit is snug and comfortable. The helmet should sit two finger widths above your eyebrows, the straps should come under your ears and you should be able to open and close your mouth comfortably.

If your head tends to sweat, look for a helmet with vents.

LIGHT OR BRIGHT A helmet in a light, glittery shade makes you more visible and less likely to be hit on the road. If you ride in the evening, it is helpful to have a reflective helmet: The largest number of bicycle deaths in 2008 occurred between 6 and 9 p.m., according to the highway safety institute.

ONE FALL PER HELMETMost bike helmets are lined with expanded polystyrene foam, typically abbreviated as E.P.S. When you fall, the foam compacts (even though your helmet may look perfectly fine) and so will not cushion a subsequent blow adequately.

Because materials degrade over time, it is wise to replace your helmet every five to seven years. If your helmet dates from 2003 or earlier, buy yourself a new one.

BE A ROLE MODEL Wearing a helmet sets a good example for other riders and for children.

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