"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.

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

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.

The Changes to the Florida PIP law have worked to stop fraud: True or False?

The Changes to the Florida PIP law have worked to stop fraud:  True or False?

Dr. Alan Himmel

The articles are beginning to come out stating that the changes in the PIP laws that occurred in 2012 have decreased the rate of fraud, and costs to insurance companies, and ultimately to consumers.  This is a good thing if its true.  It may be that the decreases in payouts are due to the $2500 insurance cut off, or the 14 day rule, which states that you better get to a doctor within 14 days or you get $0.00 in coverage.  It may also be due to the fact that now, there is no coverage for acupuncture or massage, two effective, safe, alternatives to medications and surgery.

As a practitioner who sees accident patients in FL, doctors now have two less options to offer patients when they are suffering from painful injuries from automobile trauma.  Plus, patients have to get better with 75% less insurance coverage than they had in the past, since not all patients will have an "emergency medical condition"  (EMC) which is supposed to allow the patient to have their full benefit.

So, I ask you:  What do you think is the true reason that insurance companies are reporting savings?   Could the answer be that there is now more opportunity for the insurance carriers to deny coverage, since the payouts are capped now in many cases?  Or, could it be true that the savings is due to less fraud?   I would be one of the first to start celebrating if I was sure that the savings to insurance companies was about the reduction in crime, but I am not 100% sure about that one.

Emergency Chiropractic Florida

Emergency Chiropractic Florida

Dr. Alan Himmel

I decided to create another website:   www.emergency-chiropractor-florida.com

I named it Emergency Chiropractic of Florida because I continue to see patients who have been to the hospital or other doctor after a car accident, and it has been determined that they have an "emergency medical condition."  The designation of emergency medical condition or (EMC) allows the patient to seek follow up care and be covered by his PIP insurance up to his full coverage limits. Without the EMC, he is limited to only 25% of the coverage he pays for.  Not all of my car accident patients actually do have a bonafide EMC, and as a matter of fact, the EMC is only present if certain medical providers such as an MD or DO say it is present.

Nevertheless, these emergency patients often end up calling me because of my experience and my knowledge in regard to the proper treatment, management, and documentation of these types of injuries.  This comes with practically 18 years experience.  If you have been injured in a car accident, please call my office.  The number is 954-659-8600.

Dr. Alan Himmel

FL EMERGENCY MEDICAL CONDITION PIP DENIALS BEGIN

FL EMERGENCY MEDICAL CONDITION PIP DENIALS BEGIN

Dr. Alan Himmel

Just as predicted, there are some companies who are ignoring Emergency Medical Conditions and denying PIP coverage beyond $2500.   So, a medical provider, in many cases a specialist, will look at and examine a patient, and say, "Yes, without medical treatment, this patient is likely going to suffer long term permanent impairments,"  and write it exactly as the law is written, and certain insurance companies are having the doctor's notes and records reviewed by one of their doctors to say that its not true.

I just had a patient with an shoulder impingement syndrome denied.  The patient cannot raise her arm up past 90 degrees in any direction.  She cannot take a half gallon of milk out of the fridge due to pain and weakness in her shoulder, and an insurance company doctor says she needs no further treatment. The MRI alone was more than half her PIP benefit.

Surprisingly, this denial is happening with major providers.  You would think that the small rip-off companies would be doing this, but as I said, even the big boys are doing it.

So, what do you do?  As a doctor who spends a lot of time with patients one on one (sometimes more than an hour), I have to make a decision.  The decision is whether to release the patient from care, or to continue treating in the hopes that in the end, a suit can be filed, and the insurance company will eventually pay.  SInce this whole EMC thing is a new thing in Florida, there are a lot of unknowns.

The first unknown is whether a suit can be won in the first place.  Lawyers cannot guarantee a win. And, as I said, this is a new program in FL, so there is not a whole lot of new case law.   Secondly, if a suit is won, will the WHOLE bill be paid, or will only part of it be paid?  What if a Judge says, pay the bill, but only 20% of it?  Can they do that?  A colleague of mine seems to think so.  He may be right.

My patient with shoulder impingement I am continuing to see and treat.  She is doing better and better. Without treatment her condition would likely turn into frozen shoulder.

Patient Brokering, Kickbacks, etc. First time in almost 8 years I get a call.

KICKBACKS, PATIENT BROKERING, SOLICITATION...  

Dr. Alan Himmel

I got one of those calls today.  You know, one of THOSE calls.  And, the call came in early on a Saturday morning from an area code that is a few hundred miles north of here.  Naturally, I answered the phone, like I always do, because phone calls to my office are forwarded to my cell phone which sits on my nightstand charging all night.  I never want to miss a call from a patient or a prospective NEW patient.

So, I answer the phone and the he introduces himself and asks me if I am seeing patients today.  I actually had plans to go to the beach, which is where I ultimately ended up anyway, but if someone needed me and it is a new patient, I would actually change my plans, if it was necessary.  Okay, getting back to the phone call:  He had a foreign accent but spoke pretty good english.  He told me there were two patients looking for a doctor to treat their injuries.  My next question to him was, "what type of injuries?"  I actually knew where this was going right from the beginning, but I had to ask.  Believe it or not, I haven't had a call like this in years, or at all, at Miramar Chiropractic.  Well, I haven't had a call like this since I left Dade County, which was about 8 years ago.  I am so glad I am out of there.  Dade County is such a cesspool of horrible insurance companies and desperate people, who seem to have nothing at all to lose.

So he said to me, it was a car accident.  I said, "Sure, I can see the patients; when can they come in?"

 So far so good, right?

He then told me he would like to have the patients come in, but he doesn't want to speak on the phone.  He wants to meet in person to speak privately.  And, he then said he actually has more patients... "about ten more, possibly."

Hmmm.  What to do, what to do?   Lets see.  It's pretty obvious by now what this guy is up to, even though he hasn't come directly out and said anything.  Do I pay a kickback to a guy for patients, which is fraud, is a felony, and would wind me up in prison?  Or, do I tell him to go take a hike?  Easy!  I chose the latter.

For those of you out there (doctors and lawyers, and everyone else) who do this stuff on a daily basis because you think its okay, let me put this into perspective:  First, I have to assume that if you are a professional, like a lawyer or a doctor, you are a fairly intelligent person.  Its not easy to get into professional school, get passing grades, get licensed, etc.  This is something that takes a certain degree of smarts, because if it didn't, everyone would be doing it, and they're not.  Secondly, what I don't understand, and probably never will, is WHY a doctor or a lawyer would risk EVERYTHING by committing fraud, and creating potentially the worse nightmare imaginable when the police come and slap handcuffs on them.  Even though its still wrong, I can see a desperate person, with nothing to lose doing this.  But WHY would a doctor or a lawyer do this?  You know, if every lawyer and doctor would refuse to participate in illegal kickbacks, then the dirtbags on the street who are doing this, would be forced to look for another career and possibly, just possibly, the Florida No-Fault system would be in better shape.  Those of you who are doing this type of non-sense, are responsible for the terrible changes to the no-fault system, and ultimately the repeal, which could happen eventually.  I have a family and bills to pay.  I resent you assholes who are ruining it for me.  I have a big problem with this and yes, I do take it personally, because what you are doing is taking food off my family's plate.

Keep yourself clean.  Refuse this illegal activity, even if you think you will never get caught. You will be able to sleep comfortably at night, and you will not propagate this type of activity, which is pathetic and ruins it for everyone in the long run.

Elimination (REPEAL) of PIP No-Fault Insurance in Florida.

The truth about the elimination (repeal) of PIP insurance in the State of Florida.  Is it a money saver or not?  What is it really about?

Dr. Alan Himmel

First, let me refer you back to an article that I cited a few days ago regarding the cost of No-Fault in the US.

States with the lowest no Fault Premiums

You can look at the chart in the article and look at the top 10 states that for insurance premiums.  I am sure you can find a complete list of all 50 states somewhere on the net.  It's important for everyone to be aware that first and foremost, Florida does not rank even in the top 10 for high insurance cost.  In fact, according to Insure.com, Florida ranks 34th in terms of cost.  This means that there are 33 states with higher insurance rates than Florida.  And, guess what?  The number one state for high cost of insurance is Louisiana, which ironically is not even a No-Fault State.    Louisiana is a state that requires you to sue to get your medical bills paid.  When people are injured as a result of an accident, the person must SUE to get his medical bills paid.  Claims will go before a judge, where if the plaintiff wins, the doctors get paid, the lawyers get paid and of course the injured person gets paid a settlement for pain suffering and injuries.

Is this a good thing?  Well we already established that states that have no first party PIP coverage do not necessarily have lower car insurance costs.  The insurance companies are always citing Colorado as a state that dropped no-fault and premiums went down.  This may be true, buts its also just one state.   It is one single state and probably multiple reasons that this happened.  According to Insure.com, however, the elimination of No-Fault does not guarantee lower rates.  They have the numbers.  I would believe their statistics rather than the information that insurance companies will tell you or politicians who are funded by insurance companies.

If you have not thought much about it, let me lay out a few things that will happen if and when they drop no-fault in Florida.  Of course, lets not forget that Florida ranks NUMBER 2 for the most UNinsured people in the US.  There is only one state that has more uninsured people in the US and that's Texas.  Okay, so you eliminate PIP, which covers hospital emergency care, therapy, diagnostic testing, physical therapy, and chiropractic care.  You now have a situation where medical care is expensive and people are going to have to make a choice between paying their electric bill and getting proper medical treatment for injuries.  If they do decide to get medical care, they will have to SUE to get the bills paid, which means expensive court  time and potentially even larger payouts by insurance companies.

The lost wage benefit will be eliminated if PIP is eliminated.  People who are injured and cannot work are entitled to lost wage coverage under the current No-Fault system.  That will be gone.  People will have to sue for this also.

How about folks that are injured and there is no person to sue?  What if YOU crash into someone and hurt yourself?  Who is going to pay your medical bills (and lost wages) if you are at fault?  You can't sue yourself.  So, these people also, will have no medical care for injuries.  If this person goes to the hospital and has a large medical bill,and he has no insurance or no recourse against an at fault driver, then he gets stuck with a bill that he cannot pay.  He will first be put in collections, his credit will suffer, and eventually he may file bankruptcy.  This sounds like good stuff, huh?

What about children who are in a vehicle and are injured?  They will have to go through the same nightmare, if the at fault driver is the child's parent.  No insurance.  No medical treatment.  If the parent chooses medical care, they will likely never pay the bill.

So, there is something fishy going on here.  Notice Rick Scott at first did not push to eliminate PIP last year.  He purposely made sure that the hospitals (we know his affiliation with the hospitals) were taken care of.  They are practically automatically entitled to the full $10,000 if a patient comes in due to an emergency.  Insurance companies will have a hard time fighting the $10k, if a person presents to an emergency room, if the doctor at the ER states the patient is suffering an emergency medical condition.

So, is it about the money?  What is it?  What do you think is likely to happen in Florida?  Another tweak of PIP or the total elimination?

Emergency Medical Condition: A Gaping Hole In The New Florida PIP NO-FAULT Bill, HB119

A GAPING HOLE IN THE EMERGENCY MEDICAL CONDITION AS IT IS WRITTEN IN HB119, FLORIDA PIP NO-FAULT LAW.

The following excerpt is DIRECTLY from Florida HB119, the 2012 FLORIDA PIP Legislation.

So, how do you interpret this statement, directly from the bill, lines 750-754?


750 4.  Reimbursement for services and care provided in 
751 subparagraph 1. or subparagraph 2. is limited to $2,500 if any 
752 provider listed in subparagraph 1. or subparagraph 2. determines 
753 that the injured person did not have an emergency medical 
754 condition.


Here is the link to the whole bill.  Its a PDF:
http://flsenate.gov/Session/Bill/2012/0119/BillText/er/PDF


Read the excerpt, and read it again.

Its states that the benefits are limited to $2500 if an [MD, DO, PA, ARNP] determines it is NOT an emergency medical condition.

So, I ask you to read it again.  I am not going to try and explain it, since I am not a lawyer.

But, it seems that according to this statement, there must be a doctor who states it is NOT an EMC, otherwise the coverage defaults to the original $10,000.



Do you see this?  This doesn't seem to be what the insurance companies intended, but it looks like when you get a bunch of politicians who haphazardly write a bill to get it through, there could be some mistakes, and this seems like a big one.  Do you think they will "revisit" the subject during this year's legislation?  Possibly.  There have already been some word that they want to tweak the bill to possibly tighten it up a bit.  They cannot have holes in the bill like this.  If you are running an auto insurance company, this is not good, and you are not happy.

So, any opinions on this?

Dr.Alan Himmel
954-659-8600

WHIPLASH, POST CONCUSSION SYNDROME, MILD TRAUMATIC BRAIN INJURY, Emergency Medical Condition, EMC.

          WHIPLASH, POST CONCUSSION SYNDROME, MILD TRAUMATIC BRAIN INJURY.  Emergency Medical Condition.  EMC.

Dr. Alan Himmel

I thought this would be an interesting topic due to the fact that symptoms of concussion due to whiplash, many times are routinely overlooked.  Many times, a patient seeks treatment for whiplash pain due to an auto accident, only to be treated for the typical musculo-skeletal symptoms and neurological symptoms, which include but is not limited to neck pain, shoulder pain, radiating extremity pain, tingling and numbness.  These complaints are almost universal among whiplash victims.

But what about other symptoms like headache, vertigo, fatigue, irritability, impaired memory?  The more severe case includes convulsions, loss of hearing, seizures, and loss of consciousness.  (5) Over the years I have had dozens of patients tell me that ever since the accident, they feel like they are "in a fog."    They describe it as the inability to think clearly.  If you are a healthcare practitioner you should be cognizant of these post concussion symptoms as they are commonly caused by automobile accidents, and they are an indication that the patient may have a mild traumatic brain injury.  (1)  If you are a patient who is experiencing any of the above signs or symptoms, please do not ignore this potential emergency medical condition.  Misdiagnosing or ignoring this altogether could lead to serious and permanent long term disability.

It has been estimated that there are between 1.6 million and 3.8 million individual cases of injuries that cause post-concussion-symptoms. (2) And, concussions are seen in approximately 6 in every 1000 injuries. (3) I often wonder how much higher this number would be if all cases were diagnosed, because many people never seek medical care.  There are a lot of variables here.  In fact, this is an injury that is very prevalent in athletics and contact sports, like football and ice hockey, but on the amateur level, many times these mild traumatic brain injuries are simply ignored.  Time and time again, I even see the diagnosis of concussion being missed by physicians at emergency departments.

The concussion could occur when there is an impact to the head, or the head is thrown around due to  unexpected forces to the body, such as from a car crash, a serious football tackle, etc.

The image above shows how the brain which is surrounded by fluid for protection, is moved forcefully and collides with the inside of the skull.  

The image above shows the resulting bruise to the brain, which has just crashed into  the  inside of the skull.

To get an idea of the potential seriousness of these types of head injuries, you don't have to look very far.  There have been several incidents in professional sports, particularly football, where it is has been shown that repeated concussions to the brain caused very serious and chronic outcomes.  Over the long haul, patients who have had concussions suffer from depression, chronic headaches, mood swings, early dementia, memory problems and other psychological disorders.(4)

Treatment for concussion generally involves rest, including cognitive rest, by eliminating anything that requires concentration or memory, including taking time off from school.  Reducing physical activity is important and generally if the injury happened playing sports, the individual would be taken out of the game for a while, at least until all the symptoms have disappeared.  Once the patient is symptom free, he must be gradually be introduced back into the physical activity in small steps.  You don't want to just throw yourself back into the game, as symptoms could return.

You have to listen to what the patient has to say and do a thorough exam.  Be aware that there a lot of forces involved even in small impact collisions.  Don't overlook or brush it off when a patient tells you that since the accident they are having a hard time concentrating.  Put the pieces together.  You may have a case of post concussion syndrome which is an Emergency Medical Condition or EMC.



1.  Rehabil Res Pract. 2012;2012:528265. doi: 10.1155/2012/528265. Epub 2012 May 22.

Postconcussion symptoms in patients with injury-related chronic pain.

Stålnacke BM.

Source

Department of Community Medicine and Rehabilitation, Umeå University Hospital, Umeå University, Building 9A, 90185 Umeå, Sweden.  

2..Phys Sportsmed. 2012 Nov;40(4):73-87. doi: 10.3810/psm.2012.11.1990.

Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches totreatment.

Maroon JC, Lepere DB, Blaylock RL, Bost JW.

Source

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. maroonjc@upmc.edu

3.   Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. (2004). "Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury". Journal of Rehabilitation Medicine 36 (Supplement 43): 28–60. doi:10.1080/16501960410023732. PMID 15083870

4.   Cantu RC (2007). "Chronic traumatic encephalopathy in the National Football League".Neurosurgery 61 (2): 223–5.  PMID 17762733 

5.  "Information about NICE clinical guideline" (PDF). National Institute for Health and Clinical Excellence. September 2007. Retrieved 2008-01-26.

14 day Deadline to get treatment after a Car Accident Begins in Florida. Patients and Doctors are OUTRAGED!

ATTENTION CAR ACCIDENT PATIENTS!

NEW FLORIDA LAW REGARDING CAR ACCIDENT CLAIMS IN FLORIDA!

You have only 14 days to get treatment if you have been involved in a Car Accident in Florida.

Do you know what this means? This means if you are in an accident, and think that the pain will go away by itself, but it doesn't after 14 days, your insurance company that you pay all that money to every month, will DENY your claim.

Don't wait! Call Now.  954-659-8600.  Dr. A. Himmel

 14 Day Emergency Treatment offered to Car Accident Patients in Florida.

We have doctors who will see you 24 hours a day and 7 days a week at your home or our offices in Broward, Dade, or Palm Beach Counties.



If you wait one extra minute over 14 days, you lose $10,000 in PIP benefits that your are paying for by law.

CALL NOW.  This is no joke.  You will be forfeiting $10,000 of your insurance benefit if you wait.  

We have doctors who will travel to YOU so that you can initiate your treatment before the 14 day deadline expires.  We file ALL the paperwork for you so that the ONLY thing you need to worry about is feeling better after your car accident!  Any questions, just call us at 954-659-8600.  Dr. A.  Himmel

Whiplash Syndrome. Is it a Medical Emergency?

Whiplash Syndrome.  Is it a Medical Emergency?

Alan Himmel, DC

This is another post on whiplash syndrome.  Again, I am not writing this stuff for the purpose of spinning something into something more than what it is.

Ask anyone who has ever been rear ended in a car accident, and they will tell you how it felt.  I remember one of my patients a couple years back described to me that it felt like he got his bell rung.  I thought that was a good way of putting it.  He was a huge guy also... almost like an NFL lineman.

Of course, some people, depending on how they are sitting, eg, if their head was against the head rest or turned (6) at the time of the impact, may feel less discomfort than others.  There are also other factors involved like whether your car is moving at the time it was rear ended. (I would actually like to get into that in another post, because what happens here is actually paradoxical to one's thinking.  I will explain in another post.)

So, in a previous post, we have already talked about the fact that more than 50% of  whiplash syndromes fail to resolve. But, what, for example is so terrible about a sprain/strain of the cervical muscles, or even a disc herniation?  What other things occur to a victim of whiplash, or an acceleration/deceleration injury?  I actually did a little research this morning.  www.Pubmed.com is a wonderful source for the latest research abstracts for virtually any scientific subject you may be interested in.  I use it all the time. And you should not take MY word on this topic, when there's tons of literature on this subject.

The following is just the tip of the iceberg when it comes to research on whiplash injury.  Matsui et al, at the Japan Neurological Institute studied whiplash victims and saw that many of these patients experienced various conditions such as chronic fatigue, headache, and vertigo.  Furthermore, his group saw that individuals who underwent treatment for these injuries had reported "good outcome" rates up into the 80% range. (1) Now, what they consider good outcome I don't know.  Good outcome and complete recovery may be two entirely different things.  I actually saw multitudes of studies on vertigo and whiplash.  It seems that vertigo is a common theme after getting rear ended.  Here is a a few articles:  Clinical Symptoms of Equilibrium disorders in patients with whiplash syndrome, Benitez, et al., and Postural  Control Disorders in Initial Phases of Whiplash, Cobo, et al (2,3).  Other authors concluded that 10% of whiplash injuries result in tinnitus, deafness, and vertigo. Trantor, et al.(4).  I can go on for hours finding new articles on this subject. Here is one that caught my attention:  Here is a young lady with minor trauma to the neck, and was diagnosed as having a whiplash.  Patient had normal X-rays, however had paraesthesia of the left arm.  Angiography later revealed the patient had a vertebral artery dissection. (5)

I don't think it is a very long stretch to see that whiplash injuries are very often medical emergencies.  They don't always present as medical emergencies, but the research confirms it.  Doctors should assess these patients objectively, however relating the patient's complaints back to the cause.  And, clinicians should not assume that all whiplash injuries are the same and require the same treatment.  These injuries very often cause permanent deficits of body function and use.  Tinnitus, vertigo, postural changes, and deafness are just a very small handful of the seriousness of whiplash injuries.   If you have been hurt in a whiplash type injury, you can email Dr. Himmel, or you can call Dr. Himmel at 954-659-8600.  I generally answer the phone myself.

Stay tuned.  My next post will be on the physics of the rear end car accident.

1. Neurol Med Chir (Tokyo). 2012;52(2):75-80.Cervical neuro-muscular syndrome: discovery of a new disease group caused by abnormalities in the cervical muscles.Matsui T, Ii K, Hojo S, Sano K.

Source

Japan Neurological Institute and Matsui Hospital, Kannonji, Kagawa, Japan. t.matsui@matsui-hp.com

2.  Acta Otorrinolaringol Esp. 2009 May-Jun;60(3):155-9.[Clinical symptoms of equilibrium disorders in patients with whiplash syndrome]. Uehara Benites MA, Pérez-Garrigues H, Morera Pérez C. Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital La Fe, Valencia, España. michel_u@hotmail.com

3. Med Clin (Barc). 2009 May 2;132(16):616-20. Epub 2009 Apr 22.[Postural control disorders in initial phases of whiplash].Pleguezuelos Cobo E, García-Alsina J, García Almazán C, Ortiz Fandiño J, Pérez Mesquida ME, Guirao Cano L, Samitier Pastor B, Perucho Pont C, Coll Serra E, Matarrubias C, Reveron G.

Source

INVALCOR (Laboratorio de Biomecánica), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Hospital de Mataró, Mataró (Barcelona), España; Universidad Pompeu Fabra, Barcelona, España. 34260ep@comb.es

4. J Forensic Leg Med. 2009 Feb;16(2):53-5. Epub 2008 Nov 1.A review of the otological aspects of whiplash injury.Tranter RM, Graham JR. ENT Department, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex RH16 4EX, United Kingdom. rtranter@uk-consultants.co.uk

5. Emerg Med J. 2008 Sep;25(9):609-10. Neck pain and minor trauma: normal radiographs do not always exclude serious pathology. Ribbons T, Bell S. Accident and Emergency Department, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, UK. tamsinribbons@doctors.org.uk

6. Spine (Phila Pa 1976). 2008 Jul 1;33(15):1643-9.  Head-turned postures increase the risk of cervical facet capsule injury during whiplash. Siegmund GP, Davis MB, Quinn KP, Hines E, Myers BS, Ejima S, Ono K, Kamiji K, Yasuki T, Winkelstein BA.

Source

MEA Forensic Engineers & Scientists, Richmond, BC, Canada. gunter.siegmund@meaforensic.com