Injury on the Job

leslie :-D · Jan 7, 2012

To make a long story short, my PCP and I strongly suspect it is an L4/L5 herniation that is impinging the S1 nerve. I am walking with a limp and have an inability to do a toe lift with my left foot due to the nerve issues. I was given a 10lb lifting restriction pending reduction in symptoms (numbness/muscle weakness) and some follow-up referrals.

"strongly suspect"?

isn't there a definitive dx?

i don't have any advice for you...

but know that wc cases can take yrs to settle.

if you are able to return to work with restrictions, then i would be focusing on that.

leslie

MBrickle · Jan 7, 2012

I can't go through my own insurance for a work-related incident. I have no choice but to go through workers comp and it's up to them to authorize the specific treatments I need - like an MRI. The dx won't be definitive until the MRI is authorized. I'm not looking so much to settle with workers comp - but rather have them authorize the treatment modalities I need to heal (PT and steroid injections, etc.) and then pay me my weekly compensation for lost wages until I can return to work. Returning to work with restrictions is not an option as per liability reasons, my company requires all nurses to be allowed to lift 50lbs manually.

nurseprnRN, BSN, RN · Jan 7, 2012

fwiw, i just put a big piece on recovering from this sort of thing on the nurses with disabilities board. is this back injury day on an??

because standard of care is not to do mri until after 8 weeks of physical therapy (unless pt makes it worse) you won't be getting a comp carrier to approve mri until then. but your regular health insurance wouldn't approve it yet either.

most pts will do an initial evaluation without prior approval; when you make your appt, make appts for the followup care appts then, so when the approval comes through you won't have to wait even longer. if the approval is delayed a few days, you can push the days back; a good back pt will work c you on this. (a little field case manager trick)

the doc you want to see is a physiatrist, a md /do with special training in rehabilitation, not a neurologist or an ortho, one who specialises in back rehab. tell your work comp adjuster you want a good nurse case manager to help you identify one. s/he will know who is good. and who isn't.

you can have symptoms like this from many causes, because nerve roots can be made angry (radiculopathy) on by muscle or ligament tear with associated inflammation, torn disk with extruded inner fragments, torn disk with extruded ring... backs aren't very smart when it comes to discriminating pain stimuli, because it all feels bad, whether it's a torn muscle, ligament sprain, gsw, knife, or disk. a good physiatrist will help you through this, and if you do need surgery, will recommend one whose patients get better fast.

i used to do this for a living-- if you were around here i could tell you just who to see .

fiveofpeep · Jan 7, 2012

get a lawyer now!!!

you will thank me later.

suanna · Jan 7, 2012

My wife had a simular injury and was off work for more than 8 years. Do as you like, but I would take advantage of one of all the lawyers that are going to be sending you greetings in the near future. Please- don't blame your employer if this process is difficult. State BWC departments are BROKE and make it difficult for any injured worker to get optimal care and timely intervention. A lawyer will protect your rights within the system.

We didn't get a lawyer for my wifes injury and that is why it took in excess of 8 years to resolve the issues. The cost for an lawyer will vary from state to state and practice-to practice, but most will offer you an initial consultation at little or no cost.

As to your primary question- these injuries are VERY inconsistant in thier length of resolution. The overriding factor I've seen is the expediency of treatment as it is important to pre

serve back muscle function. Sitting on it to see how it heals IS NOT THE PLAN I'D GO WITH. This is getting close to medical advice so I'll stop here. Good luck.

carolmaccas66, BSN, RN · Jan 7, 2012

Sorry, your PCP and you THINK you have a herniated disc?

Did you not get an MRI done? I would be asking for a proper scan and seeing a neurologist I think, to get a proper diagnosis.

leslie :-D · Jan 7, 2012

Sorry, your PCP and you THINK you have a herniated disc?
Did you not get an MRI done? I would be asking for a proper scan and seeing a neurologist I think, to get a proper diagnosis.

or, have your lawyer request this.

i know, i know...we're not supposed to assume.

but as soon as i saw wc, i 'assumed' you had an atty.

maybe you do, maybe not.

but if not, seriously...it would behoove you to get one immediately.

you will not get half the services you need, if you don't.

much luck to you.

leslie

MBrickle · Jan 9, 2012

The one constant I have read is that it is wise to get an attorney for this process. I have been in consultation with one, but will not seriously seek to retain an attorney until I get my WC "determination." I think getting started with PT is a good plan for right now - it will give me something to do and help expedite the healing process while I need to be waiting at home anyways until I am authorized to return to work.

As far as steroid injections, I'm not letting any Tom, Dick or Harry stab me in the back without a very accurate idea of what is going on. I've heard it's helpful to seek both the opinions of a physiatrist and a neurosurgeon who specializes in these injurys to make sure both stories match. I plan to get started on this tomorrow.

Any other advice would be helpful. I'm only 28 and really want to do everything I need to do to heal the root of the problem in my back so it doesn't become a chronic life-long issue, and I certainly don't want to get screwed by WC - it's such a slippery slope!

fiveofpeep · Jan 9, 2012

I just got screwed over by the W/C doctors and had to settle for a much lower number and am left with daily pain and I wasn't nearly as severely injured as you. I highly recommend getting a lawyer. I didn't want to be litigious but now it is one of the biggest regrets of my life. Never forget that your hospital is a business and is looking out for themselves...not you. Doctors will be charting against you from the beginning until you get one on your side.

brandy1017, ASN, RN · Jan 9, 2012

As it is WC you should have the options of seeing a doctor of your choosing, you don't want to get stuck in the WC clinic and their doctors, staff because they are not on your side. They are trying to minimize cost. Getting a lawyer is a good idea!

I've read 85% of people suffer from back pain at some time in their life and most recover on their own. I've been injured a couple times on the job and have recovered, but I have seen coworkers end up disabled and in chronic pain at the same time.

Even if you have lift equipment, which many of us still don't have, you still have to turn and move the patient in the bed and that is how I was injured one time just turning a 400+ pound stroke patient. It is insane what we as nurses and health staff are expected to do. How can you safely move and turn these people?

I thank God I recovered, but it is scary and frustrating to have to face these dangers on the job! I pray your back heals quickly.

nurseprnRN, BSN, RN · Jan 9, 2012

i posted this over on the nurses c disability board because there's a parallel discussion going on over there. i wanted to address the comment about "saving money." and do not get me started about attorneys who will advise injured workers not to go to therapy or other care because they'll look worse at the hearing and then get more money. of coure, sometimes by then the window for effective treatment is past, the patient is now beyond a place where therapy would help, and the atty has his fee. seen with my own eyes many times.

i did field case management for comp for more than 15 years and it's a great way to positively influence the outcome of a work injury. i was not employed or assigned via the state department of industrial accidents; i was an employee or an independent contractor of the insurance carrier.
one of the first things i said to a new patient was that i knew they or someone they knew was gonna say, "you don't care about me, you work for the insurance company, you just want to save money."
and i would say, "i was a nurse for a long time before i took this job and i am still a nurse. it would be unethical for me to do anything i knew would harm you, or by doing nothing to allow harm to come to you.
there's nothing inherently wrong with saving money. if we didn't have to worry about saving money it would be because we were all independently wealthy, and then neither of us would be working and we wouldn't be here today. so. are you getting paid more or less money on comp than you had in a regular paycheck?" (less, of course) "and on comp you're not accumulating seniority or vaca time, either. so you get more money if i help you get better faster, right?"
hmmm.
"you understand that work comp is a health insurance plan that your employer buys, like you buy car insurance, right?" (discussion) like with your car insurance, if you make a claim for an accident and the insurance pays for repairs, your rates go up. so does your employer's premium if he has a lot of injuries that the insurance company has to spend money on. so yes, he saves money if you go back to work, plus he doesn't have to spend money to hire and train a new person."
"and of course, if you get better, the insurance company saves money."
"so yes, i do help everybody save money. except me, i'm on salary." (this usually got a smile)
did i have injured workers who were fraudulent? sure, but they were the teeeeeny minority. most people really were injured, really did want to get better, and really did go back to work. there were always a few who would queer the deal for everyone else, and of course it was part of my job to figure that out. most of the time, though, if i recommended a specialist or a diagnostic test, the insurance company would approve it, because i was supposed to know what i was doing. as a nurse. doing assessment, diagnosis, planning, and implementing. nursing process, just not wearing scrubs.
and others with back injury, do not think me harsh when i say that pain needn't stop you from work. i have a ten-inch lumbar scar so i know what you're going thru. it's important to know that surgery cannot be expected to cure back pain *( the physicians don't usually make that too clear), it's only to stabilize unstable things. that said, people who bull through their pain, keep moving in spite of it, and do not fear do better in the long run.

most people who have back surgery for disks are in about the same place at ten years postop as someone who didn't have it (assuming structural stability). "ten years!" i hear you cry, "i can't live like this for ten years!" and the point is, you won't. the first year or so will be hard, but less so every month, a little bit at a time. if you keep moving and realize the difference between dangerous pain and nondangerous pain, you will get better. people who do less and less due to pain because they fear it get shorter and shorter muscles, they have more pain because their muscles are tight (not dangerous pain) so they do less and less, their muscles get shorter and more painful, and then normal activity hurts and scares them, and they do less....and they start getting into a real hole.

my goal postop was to have five minutes being pain free. just five lousy minutes. it took a few months, but then i got those five minutes. then my goal was ten minutes, then thirty, then sixty. i kept moving, kept doing what the pt made me do even though i thought she was gonna kill me, and walked for longer and longer distances. (the first time i went out for 1/4 mile and damn near had to crawl back to my car, couldn't move the next day. but the day after that, i went out again. for 1/4 mile. aaarghh.) by the time i was 10 months postop i was walking 3.5 miles in an hour and whistling. my goal was to have a day free of pain. then it was two days. then a week. sometimes it was a long time between pain-free days, but then they started to string together.

most people are told they have to be at an endpoint at 6 months postop, and that's ridiculous. you'll make yourself crazy if you think that how you are at 6 months is as good as it will ever get. give yourself permission to not be afraid; in europe they give people two years, and that's about what it takes.

my long-term goal was to forget i had ever hurt my back at all. then, "hah!" i said to myself, "that'll never happen. i ain't never gonna forget this." but you know what? now i go months and months without ever remembering that time. today's probably the first time in a year or so. there are days i get a twinge and it used to scare me, but then i remembered, "this is not dangerous pain," and ignored it. and it lost its grip on me, i got stronger and more flexible and....my pain went away.

i absolutely know how scary it is to think you will never be normal again, never work at your chosen life's work again, never get up off of the damn toilet without pain again.... but you can. good physical therapy and a good physiatrist (rehabilitation physician) with an interest in back pain will make it possible. and a good attitude.

after i got my back fixed, that's when (but not why) i started doing comp work. i used to say to my injured workers that if a fat old broad like me could get better from back surgery and carry a 40# backpack with scouts, they could too. so can you. well, if you like camping.

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