Car Accident Injuries

Car Accident Injuries

DEFINITION OF ACCIDENT:  an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury.

Don't underestimate the injuries that even a small low-speed accident can cause.   that can last a lifetime,

Current research bears that chronic back and neck pain is due to auto accidents almost 37% of the time and that these auto injury traumas are a primary contributor.  These types of injuries are called whiplash injuries in laymen's terms, whether the injury is to the neck or the back.

What type of pain do people feel?

Generally, my office treats "soft tissue" injuries of the body.  These injuries are to the structures of the body that are not hard tissue or bone.  So, the injuries are to the muscles, ligaments, tendons, discs, cartilage, and nerves.  Often times, these types of injuries cause pain which is sharp in nature, burning, radiating, or aching.  Other symptoms include stiffness, headaches, shoulder pain, tightness, and loss of balance.  Advanced imaging could be necessary to diagnose the injury. Please don't underestimate the severity of these types of injuries as if you leave them alone untreated, they can become chronic and lasting forever.  

Whiplash is one of the most common vehicular-accident related injuries. This is a neck sprain/strain syndrome and it occurs when there is an abrupt jerking of the head, or body either forward or backward.  Treatment usually requires chiropractic and physiotherapy treatments.

What we see quite often with car accident injuries. Common spinal injuries include disc herniation and or movement of the vertebra forward or back.  These injuries which cause bones to move forward and back are often the result of damaged supporting ligaments.  The shifts of the vertebra may cause pinched nerves, pain, and weakness. In some rare cases, this injury can lead to a loss of bowel and bladder control, which is a medical emergency.

Disc herniations occur when the jelly donut-like discs between the vertebra rupture and cause the jelly-like substance to come out.  When the disc jelly comes out or protrudes, it can push on structures like the spinal cord or nerves. This injury may cause weakness and numbing of arms or legs. Chiropractic treatment works wonderfully on this type of injury.

How to treat Treat Chronic Pain after an Accident

When the pain becomes chronic, it is generally much more difficult to treat.  One reason is that the muscles and joints become chronically inflamed from the injury.  Thus, if you are feeling any stiffness or discomfort or pain, it is critical to seek the advice of a chiropractor who is experienced in these types of injuries and how to treat them.

Please contact an emergency chiropractor if you or someone you know has had a car accident. 

Statin Use Increases Odds of Back Disorder: Cohort Study

This is not new news, however this is further evidence that statin drugs (cholesterol lowering drugs) are associated with back pain.  The article goes on to state that statins have now been shown to be related to a greater risk of "spondylosis, intervertebral disc disorders, herniated discs, and spinal stenosis,"  whereas before, the use of statins were associated with back pain without arthritis.  

Chiropractors, don't overlook the use of cholesterol lowering drugs when trying to find the cause of your patient's back pain.  

Dr. Alan Himmel

Statin Use Increases Odds of Back Disorder: Cohort Study

Marlene Busko

May 08, 2017

DALLAS, TX — In a large observational study of insured individuals in the military and their family members, statin use was associated with increased odds of having a back disorder, including spondylosis, intervertebral disc disorders, herniated discs, and spinal stenosis^[1].

Specifically, for every 17 individuals who were prescribed a statin, one person had a diagnosed back disorder, in this study published online May 1, 2017 as a research letter in JAMA Internal Medicine.

"Some of these adverse effects [from statins] can greatly impact day-to-day quality of life for our patients," especially in those who are physically active, lead author Dr Una E Makris (VA North Texas Health Care System and UT Southwestern Medical Center, Dallas) told heartwire from Medscape in an email. "We hope that musculoskeletal adverse events will be part of the patient-provider discussion on the risk/benefit ratio" of these drugs.

"Our results provide additional motivation to further investigate the overall influence of statin therapy on musculoskeletal health, specifically if prescribed for primary prevention in physically active individuals," the researchers summarize.

 Can Statins Cause Back Pain?

Two previous studies based on NHANES data reported that statin use was associated with musculoskeletal pain including back pain among individuals without arthritis^[2,3].

Severe back pain is both debilitating and costly. In 2005, it was estimated that back pain cost the healthcare system more than $100 billion, Makris noted.

The researchers retrieved data from 60,455 individuals who were at least 30 years old, lived in the San Antonio area, and were enrolled in the TRICARE health insurance system from 2003 to 2012. Of these, 17% were active military personnel and the rest were family members and veterans.

About one in six individuals (10,910) had been prescribed a statin, usually simvastatin (in 72% of prescriptions), and on average, they had been taking this drug for 3.7 years.

The researchers matched 6728 statin users with an equal number of statin nonusers. They had a mean age of 52 and 47% were women. A quarter were overweight or obese; 53% had hypertension; 20% had diabetes; and 40% had osteoarthritis.

Close to a third (30%) had a back disorder.

In the propensity-matched cohort, being prescribed a statin (as opposed to not being prescribed this drug) significantly raised the odds of having a back disorder (odds ratio 1.27; 95% CI 1.19–1.36).

In the overall cohort and in prespecified subgroups (such as nonobese individuals, healthy individuals, or those without musculoskeletal conditions at baseline, statin use was consistently associated with increased odds of being diagnosed with a back disorder.

In an analysis of the overall cohort, but with adjustment for propensity scores, the risk increase for a back disorder went from 30% among statin users to 47% among those taking high-intensity statins. It also increased with duration to as high as 59% with >4 years of use.

Adjusted* Odds Ratio (OR) of a Back Disorder, Statin Users vs Nonusers

Group	OR (95% CI)*
Overall cohort	1.30 (1.23–1.38)
>2 y statin use	1.47 (1.39–1.56)
>4 y statin use	1.59 (1.47–1.71)
High-intensity statin	1.47 (1.34–1.62)

*Adjusted for propensity score, medications used, and use of revascularization procedures during follow-up

"Further prospective studies are needed to better understand the mechanism of how statins can contribute to back disorder diagnoses," said Makris.

"We are not advocating for taking patients off statins if they have cardiovascular risk factors. As clinicians we should be aware of these potential associations and understand the spectrum of potential adverse effects."

The study was supported by grants and awards from the US Department of Veterans Affairs, the National Institutes of Health, the UT Southwestern Center, VA Health Services Research and Development, and the Agency for Healthcare Research and Quality. The authors report that they have no relevant financial relationships.

• 9 Comment
 
• References

Heartwire from Medscape © 2017 

Cite this article: Statin Use Increases Odds of Back Disorder: Cohort Study - Medscape - May 08, 2017.

http://www.medscape.com/viewarticle/879387?nlid=114770_4502&src=wnl_dne_170509_mscpedit&uac=5165DT&impID=1344127&faf=1

I hear THIS complaint about lawyers virtually EVERY DAY.

Biggest Complaint Clients Have About Their Lawyer...

The biggest complaint I hear from patients regarding their attorney is lack of communication. Multiple calls with no response.  The response from the lawyer's office is that the "lawyer is in court." Could be true or maybe it's not true, but either way, most clients can handle that, as long as they get a call back at some point.

But many times, the call never comes.

Now, I know that if you asked most lawyers, they would tell you that the number one question they get when a client calls, is "How is my case doing?"  And, I get it.  It's the same question over and over again, and its exhausting to have to be bothered with the redundancy of answering the same question over and over again.

But, come on.  As an attorney, you are getting paid very well to answer a few stupid questions.  It's not like it's that difficult.  What I am trying to say in a nice way, is that it could be worse, and for what fees that your client's are going to pay you, at least give them good customer service.   It's not so bad and it okay to take a few minutes out of your day to reach out to your clients...even if you just leave a message on voicemail.

So, I have a suggestion:  Take a little bit of time once every two or three weeks, and try and make a preemptive call out to your client.  Simply give a quick update.  For example, "Hey, its Attorney xyz, I just wanted to let you know that everything looks good on my end.  I sent out the letters of representation and requested policy information.  Just make sure you continue to take care of your injury, and I'll keep you posted in a couple of weeks if I have any updates.  But, don't worry, I'm on top of it."

If you did THAT, and that ONLY, you would be providing a great service to the client, and at the very least you will be easing their mind.  If you made a call like that one or two times a month, not only would you satisfy the client, but they would also be more inclined to stay more compliant with treatment, make referrals to you, and EVEN if the case did not turn out wonderful, at least the client would know that you were working very hard and staying on top of their case, and did the best you could do.

I have been treating accident patients in S. Florida for almost 22 years now.  If any of your client's need a treating doctor in the S. Florida area, please have them give me a call.

Thank you.

Dr. Alan Himmel
954-659-8600  

Another Insurance Scam Story....I'm so tired of this.

I'm Fired Up

It's been a while since I posted, but yesterday something happened which fired me up, and not it a good way.  One of my patients came in and told me about some lady he heard of, who had a car accident a few weeks ago.  This person lives somewhere in Cutler Ridge, which is South West Dade County, FL.

So, she had an accident, and she is now treating at a chiro office with her boyfriend, who was the passenger.  So, for a few minutes we were discussing the way the PIP works, and difference between first party insurance, and the at fault party's insurance, etc.  And then, out of the blue, my patient asked me about the $2000 dollars that this woman got, and the $2000 her boyfriend got, UP FRONT for their "settlement", at the chiro office.  The reason my patient was asking about this, is because, as an ex insurance utilization employee, he was wondering why these two people were ALSO told to come in to the office five times a week, for what appeared to him to be a minor car accident.

Now, I am a pretty calm person 99% of the time.  Very mellow.  Maybe even too mellow.

Considering the unbelievable nature of this story, I actually think I controlled myself fairly well.  But, I think that by the end of the visit with my patient, he was a little rattled up, because he has never seen this side of me.

As a doctor who has been practicing chiropractic for over 20 years now, I feel I have a good grasp of the way these scams work.  And, if you are reading this and you are not either a doctor or a lawyer, and you are maybe a little naive, I will explain to you what is actually happening at this office in Miami with these patients, and probably also to lot of other patients who are coming in for treatment over there.

This is likely the sequence of events and facts that surround this crime:

The patients are in their car and are in an accident.  Maybe the accident was staged, maybe not.

The injured patients called one of the lawyers who advertise on TV during the time when the Jerry Springer Show, or similar is on.  Or, maybe they called 411-Pain, 1-800-NEED-HELP or one of the other ones that are popular these days. The patients THEN are referred to a doctor's office and are told that the office will take very good care of them.

The doctor's office looks at the "case"after also communicating with the lawyer's office and realizes the at-fault party has a small or bad insurance company, or maybe that at-fault vehicle has no insurance at all.   However, the patients have one of the larger carrier well known insurance companies like Allstate, Geico, State Farm, or Progressive.   From this very quick investigation, the office quickly learns that the patients have a very bad case because of the bad coverage on the other side, and the patient's policy has no uninsured motorist coverage, but the two patients do have $10,000 in coverage, EACH, in fact.

Since the doctor's office knows that if the patients find out they have a bad case, they won't come in for treatment, the office offers the patients up front cash to come in, and come in frequently and a lot, so the office can quickly bill through the entire insurance benefit until the insurance benefit is exhausted.

There is also a possibility that this inducement or kickback is also provided when the patient actually KNOWS they have no case.  YES, lots of times patients know about their lousy case, and these patients come in expecting this cash kickback, for simply becoming a patient, because they heard that some offices do this.  In other words, they shop around for it, until they find an office who will pay them, and an office that will pay the most.

Either way the kickback is provided because the doctor knows that the patient will have no "incentive to treat" because they really don't have pain, but they just want money.

So, the doctor's office pays out $4000 and then bills $20,000.  This leaves the office with $16,000.

Yes, this scam happens.  Not always, but it does happen.  For those who are reading this and are thinking that all personal injury is a scam, YOU ARE WRONG about that.  Please don't group the legit medical and legal offices with total scam insurance fraud scheme offices.  It is unfortunate, but there are bad players in every profession.

The truth is that there are patients who are injured and who are treated correctly, legally, professionally, and who are helped.  You just have to make sure you go to a good office, and if you are using an attorney to help compensate you for your injury, you go to a good, and legit attorney.

If you are a patient and are tempted to accept a kickback from the medical office or someone working outside the medical office, be aware, that not only is the office committing insurance fraud, but YOU ARE TOO.  This means that you will be subject to prosecution and face the possibility of jail time, the same as the person who gave you the money.  And if you think you will not get caught, THINK AGAIN.  The insurance companies and the insurance fraud task force know the offices who are doing this, and they are waiting for the right time to rush into the office with guns drawn, and with the news crew present, to make an example out of you, and place your face and name on the front page of the news paper and the 5 o'clock news, and RUIN YOUR LIFE.

I have been treating patients who have been injured in car accidents for over 20 years.  If you would like information, please call my office and I would be happy to discuss how I can help you, the right way.

Professionally yours,
Dr. Alan Himmel

How to Properly Manage a Personal Injury Patient

Proper management of an injury patient is an important part of patient care that should not be overlooked.  When a new patient comes into my office, I always make sure that the patient has a clear understanding of the process.

The procedure involves detailed documentation of the patient's history, which includes finding out about prior injuries, car accidents, prior medical treatment for any body part, even if the treated body part was not accident related.  The reason behind this, is that all parties involved will want to know whether the patient's new injury overlaps with any prior medically treated areas of the patient's body.

Moreover, included in the history are any other medical conditions, as well as family history, and prescriptions currently being taken.  From this, you can learn a lot.  For example, a patient recently told me that she has a family history of aneurysm resulting in death to her sister and father. Chiropractors should never overlook this history, and blatantly do cervical adjustments on these types of patients.

At the end of the initial visit, there should be an initial report written and each subsequent visit with the doctor should be documented in standard SOAP form.  The patient always signs the chart note for the visit.  No signature and no visit ever happened.

I almost always make sure the patient is quickly referred to an orthopedic specialist or his medical doctor who could also diagnose emergency medical condition if necessary.  Emergency medical condition or EMC, is specific to Florida, and is required if the patient has a more serious injury, and its purpose is that it frees up the patient's full insurance benefit, if extensive treatment is necessary.  The insurance company is counting on the fact that the patient will not have an EMC and will only be responsible for 25% of the claim.  Without it, the insurance company takes away 75% of the patents insurance benefit.

Soft tissue injuries are better diagnosed with objective tests, like MRI.  Sometimes, X-rays are ordered if fracture or dislocation is suspected.  Most of the time however, x-rays do not turn up injury in patients that have injuries that are soft tissue in nature.  Over the years, I have seen some broken ribs, sternums, and bones in the hands and feet, but this is rare.  X-rays have shown dislocations, over the years,

Depending on the frequency of the visit, the course of treatment can vary between a couple months and upward of 6 months or more.

Any other referrals will be made if necessary, including orthopedic doctors, neurologists, podiatrists, mental health doctors, etc.

Finally, a report is generated when the patient is released from standard care, at maximum medical improvement, MMI.  If there is a request for an impairment rating, I will provide the rating in the report, and forward the report to the attorney who is helping to resolve any claims.

During this whole process, COMMUNICATION is key so that everyone is on the same page, and nothing is missed.

I have been seeing mainly personal injury type patients for 20+ years.  If you have been involved in a car accident, don't hesitate.  Please call my office to schedule your first visit.  If you are a lawyer and have a client who you think could benefit from an experienced doctor in regard to accident care, I will love to see that person.  It is NOT my goal to provide GOOD care to my patients;  it IS my goal to provide EXCELLENT care to my patients.

Alan Himmel, DC PA.
954-659-8600

"I WANT MONEY," is not the Right Message to Send to an Insurance Company.

I WANT MONEY

The Statute of Limitations for filing suit in a personal injury case in Florida is 4 Years.  However, in the same state, here in Florida, there is a 14 DAY limit to wait, to begin treatment, after a car accident.

Think about this for a second, please.  You will see the point I am trying to make.   WHY?  Why would you first seek an attorney before a doctor?  You are injured, RIGHT?

Do you know what kind of a message that this sends to an insurance company?

PLEASE DON'T DO THIS!   You have 4 WHOLE YEARS to get the paperwork in with an attorney and file against an insurance company. This is 4 years!  The law is very clear on this topic.

And, it's very clear on this also:  You only have 14 DAYS to get under care for an auto accident in Florida.  ONLY 14 days.  And, it goes by very quick.  Injured car accident patients SHOULD seek treatment right away.  And, when you seek treatment right away, you send an entirely different message to the insurance company.

The message that you send when you seek treatment first, is "I am injured."
The message that you send when you seek an attorney first, is "I want Money."

I have been treating car accident patients for 20+ years.  I know the rules and the laws, and have a lot of experience with this.  You can contact me and I will personally explain this to you, or better yet, call me and set up your appointment.

Alan Himmel, DC PA
954-659-8600--Call me directly.

Is there such thing as a Florida PIP No-Fault Insurance Provider?

What is a Florida PIP No-Fault Insurance Provider?

Miramar Chiropractor Accident Doctor

Can a doctor be a provider of PIP No Fault Insurance?  I know there are Blue Cross Blue Shield providers, and Aetna, and Humana, for example. But what about PIP?  I say, yes.

We are a Florida No Fault PIP Provider.  I say this as IF it requires a special designation or certification to see car accident patients and communicate with PIP carriers for reimbursement.  Well, of course it turns out that it does NOT take any special certification to this.  So, why do I call myself a Florida PIP No-Fault Provider?  It is because over the years I have met many doctors, yes, chiropractors as well, who do not handle these types of patients.  When asked why, do you know what the number one reason was?  It is that they don't know how to do it, and they never get paid.  This usually results in the doctor chasing the patient around for payment.  It means sending several bills to a patient and then collections, and it usually ends up a total waste of time.  The doctor's office loses, and of course, the patient loses as well.

I have actually gotten several patients over the last 20 years because when they went to their regular doctor, they were told, "Sorry, we don't take accident patients."  That's when they were referred to me for care, and I handled not only the communication and payment from the proper insurance carrier, but also handled the intricate documentation and proper referrals that are often times needed throughout the period of care of the patient.  This is not to mention the writing of a very detailed report which outlines the details of the accident, the injuries, the diagnosis, prognosis, future costs of health care, possible loss of work which will cost the patient income in the future.

Knowing what I know, and what I have seen over the years, I would encourage anyone who has been injured in a car accident to make sure they go to a provider who is experienced and knowledgeable on dealing with PIP.  It is entirely different than HMO or PPO or medicare rules.  PIP billing, in a sense, is a specialty.  It is not well taught in billing and coding schools, and you would not expect an average insurance biller or doctor, to know how to handle it.

I have been dealing with nothing but PIP for 20 years now.  I am very experienced in the rules and correct procedures that are often changed by the Florida Legislature almost once a year.

If you have been in an accident, please call me first.  I will explain everything to you so you will be up to speed on the topic, and you don't make any mistakes which could cost you a lot of money down the road.

Dr. Alan Himmel, DC, PA.
954-659-8600

More Disruption Coming-- Autonomous Cars Will Change Auto Insurance Among Other Things...

More Disruption Coming-- Autonomous Cars Will Change Auto Insurance Among Other Things...

Dr. Alan Himmel-West Miramar Car Accident Injury Doctor

Autonomous cars are coming.  Get ready.  It is estimated that by 2025 there could be 600,000 autonomous cars on the road, and by 2035, there could be 21 million cars on the road. (1)

What is an autonomous car?  Well, it's a self driving car.  To paint the picture, this is probably what driving will be like in the future:  We will step into our cars with probably some futuristic doors which open up in  Lamborghini style in order for us to easily slide in with handfuls of carry-ons. Think of getting onto an airport shuttle bus.  We will step in, place our stuff on the side, and simply have a seat.  From there we will likely just speak our destination out loud, so that the navigation (GPS) hears us and figures out the best route.  A voice will come on and say, please buckle your seat belt, and inform us that we will be at our destination in 23 minutes and 16 seconds.  Ehh....no speeding anymore since we are not in control of the gas pedal.  And, at this point, the doors will shut, the system will make sure all passengers are safely secured, and we will be on our way.

Since we are no longer in control of our car, we could, if we want to just sit back and read the newspaper (if they still exist), do some computer work, watch a movie, or do anything else we want.
Even Sleep.

The trip will probably be very boring.  I figure it will be like being on a tour bus, with only one big difference; we have seen this city all before, since we live here.  This won't be like being on a tour bus travelling through Rome, unless you live in Rome.  There will be no reason to take your camera with you.

So, let's talk about how the autonomous car will change things, and there are plenty: The first thing that comes to mind, is that automated cars will reduce the amount of human error, since our cars will be controlled by computer software and hardware.  I know what you are thinking... GPS is very inaccurate and most of the time it sends you to the wrong place.  Believe me, this is a system which is in progress, and I would expect there to be gigantic improvements in GPS technology.  Eliminate human error and there are less injuries, and fatalities, because there are less accidents of all kinds. Car insurance companies will have to restructure the policies to account for the possibility of computer error, and those tech companies who created the system would be held liable for accidents.

And, I would expect cars with combustion engines (again, if they still exist) to be more efficient. Keeping you at a constant 45mph in a 45mph zone will save you gas.  It will also save your brakes.

How else would we expect life to change with autonomous cars?   Fewer car accidents mean fewer trips to a body shop.  Fewer car wrecks would mean fewer tow trucks on the road.  Calling a UBER driver (sorry Taxi Companies, it was good while it lasted but your days are numbered), will mean a driverless UBER car comes to you and picks you up.  There are billions of dollars going into making this happen.  Postal, UPS, and small package delivery will probably use these driverless vehicles also.

What if we don't want this?  Sorry, its coming.  Just about every car manufacturer is working on this to make it a reality, along with Apple, Google, Microsoft, just to name the obvious. (2) (3)
Let me put it to you this way:  When Google pays a billion dollars for a traffic app called Waze, do you think it is entirely for watching where the police are?  No.  Its all about the data that that app provides back to Google.  And, don't forget that just about everyone has a smart phone, which uses wifi and data, which is continuously sending information back to Apple and Google plotting your exact coordinates.  The information that these companies are gathering will one day be crucial to making these systems work.

For now, we are just starting to see a sprinkling of this new technology in our cars.  There have been self parking cars out for a few years now.  Also, blind spot monitoring in side view mirrors has been out for a while.  My 2014 Mazda has this feature.  I just saw a commercial on TV (can't remember the car company) showing a car that is available right now, that will completely avoid colliding into something.  They were demonstrating how the car automatically stops if a person walks out in front of a car which was driving straight ahead, and while the driver took his eyes off the road for a few seconds.  Pretty awesome, and that would prevent a rear end collision, too.

What if you are the type of person who likes to keep his car forever or you like the classic cars?  I doubt if these older cars would ever disappear completely, but you would expect them to be less and less common, just like we don't see many Model T's on the road very often.

In summary, we are living in some exciting times in terms of technology.  I am not sure if I am ready for it, because I still enjoy driving, and being in control of my car.  Our grandkids will likely look back and find it amusing that we actually use to drive our own cars.  

Miramar Chiropractor


References:
1. http://fortune.com/2016/06/07/autonomous-car-sales-ihs/
2. https://www.cbinsights.com/blog/autonomous-driverless-vehicles-corporations-list/
3. http://www.fastcompany.com/3024362/innovation-agents/10-autonomous-driving-companies-to-watch

Fat Belly? Your bigger concern should be Fatty Liver.

Fat Belly?  Your bigger concern should be Fatty Liver.

Alan Himmel, DC.

The next time you look in the mirror and look at your gut, you should be more concerned about what's happening on the inside, particularly to you liver.  The condition I am talking about is called Fatty Liver Disease, or Hepatic Steatosis.

What is normal?  

There is always a small amount of fat surrounding your liver.  A small amount (5-10%) of fat in the liver is considered normal.

Who is at risk?

If you drink alcohol (alcoholic liver disease), you are at risk, and this condition is clinically significant, because this may lead to cirrhosis, over time.

In pregnancy, fatty liver can be common.  If you are obese or even overweight, you are at risk.  These two causes are (NAFLD) or Non-alcoholic Fatty Liver Disease, and are clinically less significant and considered by some sources to be benign, although there is a causative link between fatty liver and type two diabetes, hepatitis, and advanced liver disease, such as cirrhosis as well.

What are the symptoms of fatty liver?

Generally, there are no symptoms.  It is one of those silent diseases.  If you carry a large amount of fat around your midsection, there is a good chance you have fatty liver.  In extreme cases, you may feel some fatigue, abdominal discomfort, enlargement of the liver, weakness, poor appetite, or weight loss.

What are the long term consequences?

In most cases of NAFLD, the long term clinical outcome is minimal with not much evidence of increased mortality.  However, there is a group of the population with with NAFLD that progresses to a more inflammatory liver disease called nonalcoholic steatohepatitis (NASH) which leads to hepatitis, end stage liver disease, and a lower chance of survival.

How is fatty liver diagnosed? 

Liver enzymes (transaminases) can be checked, but in many cases, the levels appear normal. Clinically, the signs of Fatty Liver would include high triglycerides, high cholesterol levels. Another way to check would be the use of  ultrasound.  Lastly, MRI or CAT scan can be used.

What can I do to prevent it fatty liver, and is it reversible?

 Fatty liver is one of those diseases which is preventable and often times reversible.  It is highly advised to stay away from a diet high in sugars, and in particular, high fructose corn syrup sweeteners which are found in many foods we eat, from soft drinks to tomato sauce.  Within the liver, these sugars undergo a process called lipogenesis, and much of that fat is stored in the liver and the viscera.  In order to reverse fatty liver, a diet devoid of high sugars and high fructose corn syrup, along with exercise, can lead to weight loss, and ultimately a reduction of fat in the liver.

Do you need some advice or counseling on effective ways to reduce or prevent fatty liver disease?  I have been in practice since 1996.  You can contact my office and make an appointment: 954-659-8600

Will Florida PIP Cover Me if I am Traveling out of Florida?

Will Florida PIP Cover Me if I am Traveling out of Florida?

Alan Himmel, DC PA

In your own car: YES.
In a car that is not yours, including a rental: NO
In Mexico:  NO
In Canada:  YES

Here is a scenario:  You are a Florida resident and have a Florida registered and insured car and travel north to go skiing in the Smoky Mountains.   You decide to pile your family into the family SUV, and make a trip. You manage to get through Florida and Georgia safely, but when you get into Tennessee, someone runs a red light and smashes into your car causing injuries. In this scenario, you were in your own car, so there IS coverage for you and your family.

Let's say you find that there is no snow in North Carolina and decide to travel into Canada?  Yes, there is PIP coverage for injuries to you and your family if you have an accident in Canada.

HOWEVER, lets say you decide to FLY to North Carolina, and rent a car.  You have an accident in North Carolina while occupying a rental car.  NO, there is no coverage under your Florida PIP policy. Same is true if you are in a friend's car in NC, It's not your car, so no PIP. 

Let's say you are in your relative's car in NC, providing that the relative is a NC resident, No Florida PIP here either.  How about if you are in a relative's car in NC and the relative is a Florida resident with car insurance coming from Florida?  No coverage here either unless you and the relative LIVE together.

In Mexico in your own car and there is NO coverage.

In regard to resident relatives:  There are some companies that will deny a claim if they determine that the policyholder did not disclose all people in the household when the policy was purchased.  They will deny the claim based on "material misrepresentation."    So, always let the company know all people living in the house, no matter if the addition of these extra people in the house will increase the cost of the policy.  If you hide this information from them, they will find out and may deny your claim.

I'm not a lawyer.  I am a chiropractor with 26 years experience treating auto accident patients, and I have been exposed to many different coverage scenarios.  Get all legal opinions from a licensed attorney.

Nursemaid's Elbow in a Young Child. Cause, signs, and reduction.

                                       Nursemaid's Elbow

Dr. Alan Himmel

It is never a good idea to pull or tug a young child by the arm.  This action may create what is called a nursemaid's elbow. 

What essentially happens is that a person, who is trying to control an uncooperative child, grabs the child by the arm.  The child of course, still is not cooperative, and fights back, by pulling.  The resulting injury is that the head of the radius, subluxates at the elbow causing a lot of pain, guarding, and the inability of the child to want to use the arm or hand.

Often times, the radial head pops back in by itself and the pain and guarding will disappear on its own, allowing for almost instantaneous pain relief.  But, sometimes, the joint will not "go back in" without a little help.

I don't recommend doing trying to fix this at home, because without knowing for sure whether it is truly a radial head subluxation or a fracture, it is possible to cause more pain and injury.  However, if you are confident the child has a nursemaid's elbow, or if it has happened before (children who have had this injury, may tend to have it again) then this is what you can do to fix it.

Carefully supinate the hand in front of the child. Then, while palpating the radial head with your fingertip and just a little bit of pressure, use your other hand to slowly flex the arm at the elbow.  You may have to go past 90 degrees of flexion, but you will feel, with very little effort, the radial head click, and pop back into the correct position.  The child may cry a little, but the relief is instantaneous, and within a few minutes, the child should be acting normal again and giving high fives with the injured hand.

See this Fantastic Whiplash Video Infographic. This is Why you have so Much Pain!

Dr. Himmel

I have been treating patients who have sustained whiplash for practically the last 2 decades. 

 Many people are unaware that even a small impact rear end collision can cause significant pain and impairment in certain cases.  Symptoms include pain, stiffness, headache, shoulder pain, arm pain, numbness, tingling, and weakness in the upper extremities.

If you have been injured in a rear end collision, do not hesitate.  You must get examined and if treatment is necessary, you should begin as soon as possible to try and prevent future, permanent, chronic problems.  

Call our office Today:  954-659-8600

Compliments of Accident Injury Centers of Atlanta,

Florida Governor Race. Scott Wins. Keep your eye on PIP.

Florida Governor Race.  Scott Wins.  Keep your eye on PIP.

Dr. Alan Himmel


Well, not much to say about the results of the Florida Governor race. For the sake of Florida drivers and doctors who treat accident patients, lets hope that we have another four years of PIP.

The fact that Rick Scott was the former CEO of a gigantic hospital company may be of benefit.  He likely still has ties to that company, whether it be his buddies who are in favor of first party PIP coverage for accident victims, or he still has his hands directly in the pot; he most likely is not in favor of a total elimination of PIP.

It just bothers me that a man who plead the 5th in an investigation of his company, can still be the governor of a state.  If a person is put on the stand and pleads the 5th, it simply tells you they are hiding information which will be incriminating.  Note the breakdown of the word inCRIMINating.

Ok, so he is a crook and got away with it.  He is not the first person to commit crimes and get away with it and he wont be the last.  But, become governor twice after this?  Amazing, but I wish I could say I am surprised.

Forget being a Chiropractor, be a Neurobiologist

Today you can be a Neurobiologist...

Dr. Alan Himmel

I am a subscriber to Medscape, which for those who don't know, is an email digest of significant new medical research that comes out almost daily from the medical community.  I have been a subscriber for at least the last 10 years, and I highly recommend that anyone who is involved in healthcare should also check this thing out.   

The reason I am writing this post, is that this is the first time since I have been a subscriber, that I have seen Medscape distribute this as news (front page headline, by the way) of an article written by chiropractors (half-doctors) and published in a distinguished and respected journal such as The Annals of Internal Medicine.  I mean, everyone knows that this is a journal that only real and "serious doctors" get their information.  

The article is written by CHIROPRACTORS (plus a MD and a PhD in Biostatistics).  So maybe they got in the journal because they "carefully" placed an MD on the list of authors? Still, the head authors are DC's and the journal accepted the research and published it.

Anyway, let me tell you how difficult this is:  Medical journals have a board of "peer" reviewers who read over submissions to the journal, slice it up with comments, and often times, stamp a big denial on the paper and send it back to the author.  In other words, just because you can write well and you are articulate, and you can back up your paper with actual results and referenced research at the end of your manuscript, these distinguished doctors who make up the peer reviewers and editors often times deny your paper if they simply don't like you or don't agree.

So, I think this is a significant event.  Medscape's subscribers are made up mainly of medical doctors and specialists.  Maybe more than 100,000 doctors read this paper.  

When you try and subscribe to Medscape, you will see that "DC" is not even on the dropdown list where it asks, what your specialty is.   Hint:  pick another specialty when you become a subscriber--maybe someone you have always wanted to be like a Neurobiologist.  

Original Research | 16 September 2014

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH; Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD; Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

[+] Article and Author Information

Ann Intern Med. 2014;161(6):381-391. doi:10.7326/M14-0006

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Background: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management.

Objective: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.

Design: Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. (ClinicalTrials.gov: NCT00494065)

Setting: 2 research centers (Minnesota and Iowa).

Patients: Persons aged 21 years or older with BRLP for least 4 weeks.

Intervention: 12 weeks of SMT plus HEA or HEA alone.

Measurements: The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.

Results: Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over HEA (difference, 10 percentage points [95% CI, 2 to 19]; P = 0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, −2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.

Limitation: Patients and providers could not be blinded.

Conclusion: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks.

Primary Funding Source: U.S. Department of Health and Human Services.

Topics

back pain ; exercise ; lower limb pain ; manipulation, spinal