The worker’s comp game

Not my spine, but I did have instrumentation like it in there for about 18 months, along with bone grafts at the front of the spine.

Let me tell you something up front—this is a game you never want to have to start playing. It is a merry-go-round from hell if you receive an on-the-job injury that will require ongoing care.

My odyssey began in late April 1989. I’d hurt my back at the previous hospital I’d worked at, but nothing to the point of daily back pain. Actually my knees gave me more trouble back then. I left that job thinking the job at the prison would have been easier. And it was, physically that is.

Like all acute back injuries, a little bit of time, a little bit of physical therapy and you are right back at it. This one was different. The next day the pain radiated down both legs, and I felt like I’d been driven over by a truck. I went to my internal medicine doctor who prescribed me muscle relaxants and a referral to a neurologist. I seriously should not have seen that neurologist. What an arrogant quack!

Unfortunately for me, he’d examined my sister years before he’d examined me. But with her drug-seeking behaviors, he assumed I was just like her, faking or acting out an injury looking for drugs. So he ordered an MRI scan which he claimed showed no reason for my out-of-control back pain. Yes, there might have been a tiny herniation or two, but that wasn’t the problem. This doctor eventually released me back to work because he did not believe I was as crippled as I was.

I then went to the prison’s comp doctor who referred me to the Spinecare Group in Daly City. Up to that time I didn’t even have a diagnosis, a full eight months after the injury.

So for 21 years now, I have been a patient of Dr. James Reynolds. I don’t doctor-shop, I don’t poly-pharmacy, and I don’t supplement my meager pain medication with street drugs, marijuana or heroin. I take only what this ONE doctor prescribes for pain. And I have not been on pain medication continuously for 21 years!

To read one of the worker’s comp reports, you’d think I am a drug abusing faking malingerer who should be out of their hair by now. So, State Fund denied treatment my doctor ordered back in November, and they sent the denial notice so late that the doctor’s office could not file a timely appeal.

Yesterday I got a letter in the mail saying the procedure was denied, and that they would no longer approve the refills of pain pills. The reason for denial was that my doctor did not specifically define what makes me "bad" and what I can do when I am "good" after a rhizotomy. His stating "she is more active and improved after she receives the injections" and "she does not walk very far and has more pain when she needs the injections" is not specific enough for some quack who has never seen me and doesn't have half the surgical skills as Dr. Reynolds.

Mind you, this is a case that was settled back in 1995. You’d think the rules that applied then apply now.

Nope. They write ‘em up as they go. The scheduler at the doctor’s office assured me that this is the usual game of a worker’s comp carrier after the worker’s comp reforms were voted in. Delay delay delay; deny deny deny. Eventually the patient will give up and deal with it in whatever way possible.

I voted for those reforms, because there is much waste and malingering and misuse. But you’d think that three prior spinal surgeries indicates that there was indeed something wrong, and despite “fixing it,” something of that magnitude needs follow-up care.

Back when the case was settled, State Fund offered me $65K to walk away from medical benefits. I did not.

I’m guessing State Fund has to be such a bunch of assholes to a legitimate claim to save face for being so screwed over by Octomom.

At any rate, the doctor’s office was going to call the comp carrier and complain that they did not receive paperwork in a timely manner, and I told the clerk that she could tell the insurance adjuster that I am no longer driving, that I can’t sit at my desk for any length of time because my formerly perfect special chair doesn’t work anymore, and that in the morning the pain is so excruciating I cannot stand straight and walk with a shuffle for about an hour. It takes about 3 hours for my back to loosen up enough to move around like a semi-normal person.

I don’t sleep well; the pain breaks through the medication. And I am not taking anything particularly nasty—Double-strength Vicodin, which does not impair me in any way. It takes the edge off and I accept I will never be pain free.

So the timetable is another doctor’s appointment on May 11, then another THREE months before the comp carrier has to make a decision. UNLESS of course my doctor gets pissed off and calls someone while I am on the premises.

All I need are four little needles stuck into the facet joints on either side of L3-4 and L2-3, and zap the little buggers. I won’t be pain-free, but the nature of the pain will change and I’ll be able to walk the three blocks from the light rail to work, when I am required to work onsite. I’ll be able to take my cats for strolls around the neighborhood. And I might be able to sleep more than an hour or two at a time.

I am beginning to see how desperate people with back pain can become though. I am seriously considering packing it in, giving up trying to get jobs in the Bay Area, and return to crappy rural King City where there will be no jobs for me. I guess the advantage would be is I’d have lots of time to work on novels that may never be sold.

And it really scares me thinking I may be denied pain medication—will I turn to alcohol? Try pot? Or do what killed my sister and sister-in-law—go get stuff off the street? It makes me sick thinking about it, but I am beginning to understand the desperation.

Musings on What’s Wrong with the World

It’s tough to be positive sometimes the way things work in the early 21^st century. I really try to live the motto “Do onto others as you would have them do onto you.” I smile at cops. I hold my tongue when people I know and care about do silly, selfish things. I try very hard to keep my promises, even pushing my poor crippled back past its point of tolerance.

Which brings me to today’s bitchfest. I’ve been waiting for THREE months for approval on a procedure on my back which will allow me to walk more than half a block and not have to take pain medication every six hours (needing it more often than that, but ever-mindful of my family’s history of drug abuse). A couple of weeks ago, I received a denial notice in the mail. Why was the procedure denied? Because my doctor, a man with 30 years of experience in delicate spinal surgery, did not chart the specifics of how improved I was after the procedure. Nope, it’s not enough for him to say “She’s better and has less pain” after the rhizotomy. He’s supposed to go into a narration of specifics—for example, “When her back doesn’t hurt so bad, she can drive or sit in a car for more than five minutes without pain,” or “When her back doesn’t hurt so bad, she prefers to take the light rail to work and walk a couple of blocks to the office” or “When her back is better, she can go for 12 to 16 hours without needing pain medication.”

Because he failed to do that, some physician who has never met me has ruled I don’t need the procedure. Furthermore, this same god has ruled that narcotics for pain is bad, bad, bad, and that I should not take them, and that I need to be drug tested to make sure I’m not buying anything on the street or having multiple doctors write multiple prescriptions, or using multiple pharmacies.

This crap is a result of new worker’s compensation law here in California, something I voted for and still am in favor of. There was so much abuse in worker’s comp when I was hurt and worked in the industry in the mid-1990s. But taking a case that has been settled since 1996 and deciding someone with a back that’s been cut on three times is NOT in need of treatment or medication is taking things a bit far.

I have not yet had the energy to fight back yet.

Bitchfest #2: attorneys. They are all that is wrong with the world.

Don’t get me wrong. Some perform very necessary functions, like estate planning or prosecutors or defense attorneys to protect the public or wrongly accused individuals. Imagine this: what if everyone managed to live by “Do onto others as you would have them do onto you,” and we were kind and honest and ethical toward each other? And by “ethical” I don’t mean lawyer ethics, because those aren’t anything close to the ethics I believe are in the Bible. I guess if lawyers went by biblical ethics, defense attorneys could not defend their clients by shifting blame to others.

Attorneys run around wielding power and threatening action against people who have different beliefs than they do. There are some who choose to blog and share their own rants and irrational thoughts, and go on to read other people’s blogs and threaten the writer if they write something the attorney disagrees with. Many love to toss the terms “libel” and “slander” about to silence people who disagree with them.

I guess what ties these two thoughts together is truthfulness. Just be truthful … treat people the way you want them to treat you. If you disagree strongly with someone’s opinion, don’t threaten to hurt them physically or legally. Unless it’s life or death (and it seldom is, really), just shrug and forget about it. Don’t lie about the person whose opinion you disagree with to make yourself feel superior. Throwing around terms like “You are an uneducated trailer trash bitch,” or “You are stupid and delusional” are childlike and show a lack of rational thought.

Chose your battles carefully. And let people fight their own battles.

And to end this with something positive: in the race for California senator, a fiscal conservative, Tom Campbell, is polling ahead of the incumbent Barbara Boxer. I pray there are enough intelligent Californians who understand that today’s fragile economy is the most important thing we are dealing with, and that the democrat’s answer of “tax and spend” simply doesn’t work. It’s time government enjoyed some serious belt-tightening, and that elected officials start living like “regular” people and not elected royalty with bottomless pockets!

So frustrating ...

For a brief period of time in the mid-1990s, when my surgically-repaired back was as good as it was ever going to be, I worked as a worker's compensation case management nurse for nearly two years. I was hired because I myself was an injured worker, having been injured on April 25, 1989 at Soledad Prison. I destroyed my back one night while keeping an inmate from flopping off a gurney onto the floor. I should have let him flop—when we arrived at the hospital, the ER physician quickly determined the inmate had been faking his seizures. I'd just completed an 8-hour shift with two inmates having uncontrolled seizures. Part of the treatment standard was to put their mattresses on the floor so they couldn't hurt themselves. But I'd have to squat or kneel every time I needed to re-medicate one of those men. At the end of my shift, and as the medical crew declined into a skeleton crew consisting of LVNs only, it was decided to transfer the seizing inmates to Salinas. I took what was thought to be the most unstable one.

Long story short, by the end of that 14-hour workday, my back was destroyed and my career as a bedside nurse was over.

It took eight months (and three physicians) to get a proper diagnosis and 10 months to have the first surgery. From April 1989 to early 1995, my life was consumed by surgeries, recoveries from surgeries, physical therapy. I honestly don't have a good sense of what was happening in the world at that time.

While I was working in worker's comp case management, I came to a conclusion about injured workers. They either are or they are not, and the ones who are not injured are the most troublesome. I had several clients who just did not act right, who claimed they were unable to do certain things after their "accident." We had a plague of deli workers at Nob Hill grocery store who "fell" and injured their backs. It was nearly impossible to get those people back to work. I had another client who claimed he could not raise his arm over his head following a shoulder dislocation and repair by a physician in Santa Cruz. I talked the carrier into a repeat surgery, this time by a doctor associated with the SF 49ers, thinking this injured worker would be impressed by this doctor's results with football players. Well, the guy had the surgery and claimed he was no better. I felt he was bogus, and he was surveilled and found to be repairing cars while drawing temporary total disability pay.

My back injury is long settled, and I am supposed to have lifetime care on my back. Sounds good, and when I get that treatment, it's great because I don't see a bill. But every since the worker's compensation overhaul we've had here in California—something I supported and voted for—it's been hell to get treatment.

Right now what is happening to me is a consequence of a two-level low lumbar fusion. The vertebra immediately above the fusion are not designed to bear the weight they do, nor are they designed to function like the lowest two vertebra. I'm having what is called facet disease, and according to my doctor, it's coming right on time, 15+ years after the fusion (fusion was in 1992). The treatment is pain medication and something called a rhizotomy, which is simply locating the offending nerves that are causing the pain and zapping them with an electrical current. Then I'm good to go, the pain is less, and I don't need to take as much pain medication orally.

After waiting three months for approval, I got a notice in the mail that the procedure was denied because my doctor had failed to document in specific ways how I improve after a procedure. It's not enough that he says it's so anymore. So I dashed off an e-mail and described what I do when a rhizotomy is working, and how I feel when it's not working, and the impact on my life.

And for some reason, the worker's comp carrier thinks I should not be having narcotic medications to treat pain. Huh? It's prehistoric thinking like that which will drive patients to do maladaptive things ... drink, acquire and abuse street drugs. I honestly don't know what to do if my doctor stops prescribing pain meds for me. I am very responsible with them; I don't mix alcohol with them, and I take them when I need them, or try to put off taking them.

So in a nutshell, when a neurotomy is on board and working, I can walk up to a mile and sit at my desk for hours, working. I can take the light rail to work and enjoy the three-block walk from the station to the job. I can do light housework and not be in immediate pain.

The consequences of not having the procedure: I do not sleep well, I wake in the middle of the night in severe pain and it takes up to two hours for the medication to work. I have my daughter drive me to work on those days I need to work onsite. I cannot work more than 4 hours, and need to take a pain med while at work because the chairs are so crummy.

I need an attorney to take on the fight and remind State Fund that we agreed on this years ago and they need to hold up their end of the bargain.

If I have to wait another three months for this, I may well be driven to drink.

Hooray for needles and Sharks' malaise

This is one of my favorite hockey cards, showing Owen Nolan and Ray Whitney back when both played for San Jose.

The good news is … I finally got my rhizotomy on my back! It’s not every day someone cheers about getting an IV started in a painful place and then six pokes in the back (which I of course didn’t feel, gorked out on Versed and Fentanyl and God-knows what else [there were three different meds]), but when I came to I knew the original pain was gone. The day I had the procedure, Monday March 2, was a miserable rainy day chock full of treacherous traffic in heavy rain. Naturally the rain wasn’t helping the pain one bit, but that’s what made this whole thing so remarkable—I walked out of the facility better than I walked in!

I’ve been sort of sore all week, but the pain is different than before, and getting more my “normal” kind of pain. The next thing I have to fight for with the comp carrier is for it to continue to pay for my pain medication. The comp carrier’s brilliant utilization review physician, who of course I’ve never met, thinks I shouldn’t need pain medication 20 years after the injury! WTF, he should try living through a two-level fusion and then say there is no reason to have pain! But I have faith in my back surgeon, he knows how to work the system well enough to get things done.

So the Sharks are starting their end-of-the-year slump. I had to laugh. I especially enjoy losses where one of the main characters on the opposing team are former Sharks, and that was the case with the Minnesota Wild and Owen Nolan. Owen is another of my favorite players, though I am scared to death of him. When I was writing for Hockeycorp and doing features with players like Teemu Selanne, Scott Hannan and Marco Sturm (my three all-time favorite players to interview!), Owen was still around, but had a notoriously bad attitude. After practices, media were allowed into the players’ locker room to do interviews. By the time we were let in, Owen’s gear was swinging in the breeze, and he was long gone. Hockeycorp wanted me to get Owen to sit down and do a feature on hunting, but Owen wouldn’t talk to anyone. No fun features with him!

Still, I do recall how much fun it was to go to a game when the Sharks were struggling, when a win was something to hoot and holler about, and being a female fanwank, cheering on what us girls called the “fine line,” which consisted of Owen, Ray Whitney and Jeff Friesen. Eye candy on the ice!

I guess we’ll see if Sharks coach Todd McLellan rights the ship tomorrow night against Vancouver. It’s just so much fun to read Sharks’ fan boards and how they blame the refs, blame the ice, but fail to blame the players who have obviously been reading too much positive press about how the Sharks are the team to beat. Calgary made huge moves at the trade deadline. I’m thinking they are the team to beat …

Four months of back attack is nearly over!

After dealing with a back attack that started around Halloween, I finally have an appointment for a bilateral two-level rhizotomy on March 2.

There are some laughable observations and errors in the comp physician's report that I need to have corrected, but luckily I have been a bit too busy to deal with that. But there are things that need correction—I did not hurt my back as a result of having a seizure, as in "I" had the seizure. It was an inmate that was found to be faking seizures that caused my injury as I tried to make sure he didn't suffer an injury. The comp doctor also thinks there is no reason I should still require pain medication nearly 20 years later, so he wants comp to stop paying for that too! I'm on the stuff I'm on because I had a bleeding gastric and duodenal ulcer in 2001 because of NSAID use. For me, there are too many side effects from this family of medications.

Medicine nowadays is a joke! That doctor has never met me, and he went off on a "drug addiction" tangent, listing signs of drug abuse. Good lord, I lost my sister due to a combination of prescription and illegal drug abuse. I'm sure as hell not going down that path!

Fortunately my surgeon is a level-headed guy who also knows how to work the worker's comp system.

Still, it angers me that people like me who have legit injuries are looked at as malingerers, while the story about the woman in Whittier who had the octuplets unfolds and it is revealed she's been getting comp disability benefits for nearly 10 years, and in that period of time she managed to have 14 kids! WTF?

More on her when I have the time.

Finally ...worker's comp is doing something!

I heard from State Fund yesterday, and my file is at least in the hands of a utilization reviewer. Too bad my doctor is more qualified than any reviewer, but I digress. My file is also in the hands of a female adjuster who sounds a whole lot smarter than the last affirmative action beneficiary who had my file.

Now on to the not fun stuff. My contract was terminated by the community college district I'd been working for since the fall of 2005. I had been doing communications for this district, and doing a pretty darn good job. I was getting stuff placed in industry publications and to a lesser degree, in local medias. About six months into the job, in the spring of 2006, I was promised the full-time position (when it opened up and an official job description was created) by the chancellor of the two colleges and her assistant.

Last March I interviewed for the job. I showed up to the interview with a fever of 101 (something I'd never do for a normal job interview, but I felt my work spoke for itself), feeling like crap after working an event the previous three days that was produced by the district itself. My references weren't checked. Each were prepared to say I was the right person for the job.

In June I received a letter saying I did not get the job. In July, I received an e-mail from the chancellor asking me to fix a news release draft written by the person who did get the job, and who would be starting in the fall. I can usually edit/fix anything, but that blob of words was impossible. To this day I am not sure what the thing was supposed to be about.

The person who got the job was a Latina with a history of being fired/asked to resign from a pair of high-profile PR jobs due to incompetence.

Because of the budget crisis here in California, the community college district cut all independent contractor contracts. Now tell me this, why not keep someone who costs you $40 an hour (and worked maybe 80 hours a month) versus someone who costs the district $100K (salary and benefits) and that someone cannot do the job? One of my duties was to produce a monthly newsletter, which means figure out what to write, research/interview, obtain photos and ultimately do an 8-page layout using InDesign and Photoshop. Once I'd been told my contract was no more, I was asked to turn over the work I'd done thus far, which I did. It was all done in InDesign.

The "new" PR gal had a fit because she does not know how to use the program! She is also having a fit because I did not turn over notes to the stories I was going to do—because I had taken no notes!

She's in her mid-30s, I am not. I have had three prior back surgeries. I have an advanced degree; she does not. She has been the beneficiary of affirmative action all the way through school; I have not.

What I want to know is this: what plans does the messiah have for people like me? I have no recourse regarding the "job promise" because there is no way anyone is going to admit to having told me that. But why is it once a person is "in" they keep getting chance after chance based on ethnicity? Answers ... anyone?

well, good news with the back doctor

When you've had back problems for as long as I have, it's just nice to know what is going on sometimes and that something can be done and that you are not crazy in the head or making things up.

I saw my back doctor today. His name is James Reynolds, and he's part of a group that does nothing but state-of-the-art spine stuff. Period. He's been my doctor since eight months after my on-the-job injury at the Soledad Prison. It took me that long to get to him because I was trying to stay local (a big mistake if you are living in a rural area and there are no hotshot doctors who care about publishing and teaching other doctors about the complexities of the spine), but had been released to return to work when I couldn't stand up straight or barely walk.

You see, my diagnostic tests were "normal" in the local doctor's mind. I did not have a big nasty herniated disc that would explain the severity of my symptoms. So, no disc herniation = no problem, and my inability to do anything was malingering. I was referred to the prison's "official" comp doctor who immediately referred me to Spinecare, two hours north of where I lived.

Spinecare's head doctor, Dr. White, had recently operated on the SF 49er's Joe Montana. We know how well that one went. The doctor I was assigned had assisted Dr. White with Joe's surgery, so I knew I was in good hands.

Right off the bat Dr. Reynolds knew why my back hurt. I had dessicated discs, and they were leaking disc fluid onto my nerves. So rather than the pain being due to compression it was due to a chemical reaction. As part of one special but very painful x-ray procedure, I could clearly see what he meant by dessicated—the disc itself looked as if it had been scratched by a cat.

Two months after I found this doctor, I had my first surgery, a two-level laminectomy, which worked beautifully. But I messed it up two years later cleaning horse poo out of a stall. I then had a two-level fusion, fused front and back (nasty surgery!) and then 18 months later, had the hardware removed (a normal thing for that kind of surgery).

So I have had a good 16 years that I wouldn't have had if I hadn't found a doctor willing to think somewhat outside what was then the conventional way of thinking.

So what's wrong with me? Normal for someone who has been fused where I am. The vertebra immediately above the fused area (I'm fused at L4-5 and L5-S1) are not designed to bear the load they now must deal with because the area below is one big fused bunch of bone. So last year I had only one level that was problematic, at L3-4, on the right side. Now I'm at two levels, L3-4 and L2-3, and both sides. But because I had great results last year, there will be no need for diagnostic blocks; they will be able to go right to the offending areas and electrocute the offending nerve. The procedure is called a median branch neurotomy or rhizotomy. It doesn't hurt to have it done; the doctors give conscious sedation medication and not only do I not remember the procedure, it doesn't hurt at the time. It does hurt for about a week, then I am good to go again.

The doctor told me I can have this procedure done as often as I need, and now that I have an established pattern, I can expect about 11 1/2 months of a decent functioning back. And I guess the best thing is I never see a bill! Worker's comp is a pain, but I suppose one could argue I am lucky in that I was hurt when I was, under the old law. I have fewer games I need to play, but worker's comp doesn't move quickly on back procedures anymore.

I sure hope this can be done by Christmas. I want my life back!