Concussions and Non-musculoskeletal Injuries Following Baltimore Auto Accidents

Concussions and Non-Musculoskeletal Injuries Following Baltimore Auto Accidents

As a Baltimore Chiropractor that spends the majority of my time treating patients that have been injured in Baltimore auto accidents, I spend a lot of time diagnosing and treating traditional whiplash symptoms including headaches, neck pain, mid back pain, and lower back pain. One set of injuries that often go overlooked following Baltimore auto accidents is concussions and their symptoms.

Contrary to popular belief you do not need to have struck your head on an object in the vehicle (i.e. head hitting a head rest following rear-end collision) nor do you have to have lost consciousness in order to have a concussion. All you need is there to be contact with your brain and the inside of your skull. You can think of a concussion as a “brain bruise” and depending on where your brain impacts your skull there can be many different symptoms associated with a concussion.

There are several different type of concussive symptoms and rarely are two concussions the same in the same person. In no particular order here is a list of concussion symptoms:

• Headaches/head pressure
• Mental “foggy” feeling
• Amnesia- Trouble remembering the impact
• Confusion
• Dizziness
• Ringing in the ears
• Nausea
• Vomitting
• Slurred Speech
• Sleeping too much or too little compared to normal
• Fatigue
• Irritability
• Decreased appetite
• Anxiety
• Personality changes- people may say that you “don’t seem like yourself.”
• Apathy/Lack of Interest in joyful activities
• and many more

The difficult thing about concussions is diagnosing them. That is, there is no blood test for concussion. The best people to talk to about whether or not there have been behavioral changes that may indicate a concussion are the patient’s family and friends. That is, they knew the injured party when they were behaving normally and they know them now. This can help you understand any changes that may have taken place.

Due to the difficulty in diagnosing concussions conclusively, I routinely refer my suspected concussion patients out to a neurologist for evaluation. These neurologists can run a series of examinations, confirm or deny my suspicions, and even run T3 brain MRIs to confirm physical evidence of concussion.

Following a Baltimore auto accident it is easy to pay attention to physical injuries. Anything that can be “seen” as a physical injury and can be understood by most people. Concussive head injuries are difficult in that you can not see them in the person. If you have suffered a concussion as a result of a Baltimore auto accident injury do not simply neglect to tell your treating providers about your condition. Your very recovery may depend on it.

If you, or someone you know, has suffered from a Baltimore auto accident injury and has suffered a concussion please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

All-State’s Best Drivers Report 2014

Each year All-State ranks the top 200 cities in the U.S. based on the relative likelihood of their policy holders (drivers) being involved in motor vehicle collisions (auto accidents). They have not yet released their results for 2015. According to All-State (the results can be seen here) the top five safest cities for drivers include:

1) Fort Collins, Colorado, 2) Brownsville, Texas, 3) Boise, Idaho, 4) Kansas City, Kansas, 5) Huntsville, Alabama.

Now for the bad news. The least safest cities to drive in according to All-State are as follows:

195) Baltimore, Maryland, 196) Providence, Rhode Island, 197) Springfield, Mass. 198) Washington, DC 199) Boston, Mass. and 200) Worcester, Mass.

Clearly the trend is for older cities in the north east with old infrastructure and lots of residents to lead to there being more auto accidents. Residents of Baltimore where I practice need to be aware of the relative risk of auto accidents compared to other areas in the country.

In Baltimore, statistically drivers are likely to be involved in a motor vehicle collision every 5.4 years. In Washington D.C., our neighbor to the south, residents are statistically involved in a crash every 5.1 years. These numbers are in start contrast to the “safest city” Fort Collins, Colorado, where residents are statistically involved in crashes every 14.2 years.

With more and more people on the road it is becoming more important to limit the distractions, focus on driving, and arrive alive. Residents of cities such as Baltimore and Washington D.C. need to pay extra close attention due to the relative increased likelihood of being involved in an automobile accident.

If you, or someone you know, has been injured in an auto accident and require treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Financial Considerations Following Baltimore Auto Accidents

As a Baltimore Chiropractor that spends the majority of my time treating patients involved in Baltimore auto accidents, I often get asked by injured patients what their financial options are following their Baltimore auto accident injuries. Below, in no particularly order, are their options for paying for treatment while under my care for their Baltimore auto accident injuries.

1) Cash or “fee for service.” – Patients are allowed to “pay as they go.” That is, services can be rendered on a daily basis, and a patient can pay for these services at the conclusion of their visit. Typically the first visit is a bit more expensive since it involves x-rays and a new patient evaluation. Moving forward, subsequent treatments are less expensive. This option can be attractive for very minor injuries that do not require more than a few treatments or for patients that do not want to submit claims to an insurance company.

2) PIP/Med Pay – Maryland auto insurance is required to offer no-fault benefits known as PIP. This stands for Personal Injury Protection. PIP is a benefit that will pay to your providers money for your care, regardless of fault in a Baltimore auto accident. PIP is written in amounts of $2,500, $5,000 or $10,000 and is generally available to help pay for care unless denied in writing as of the time of writing of the insurance policy. PIP pays for any and all reasonable, customary, and usual treatment associated with Baltimore auto accident injuries. Additionally, PIP has a wage loss component as well. This allows for injured patients to recover some lost wages if they are unable to work as a result of their injuries. Typically patients can recover up to 85% of their lost wages resulting from their injuries and can be paid by PIP to help make ends meet while they are out of work. Med Pay is fairly similar to PIP in its design with the main difference being that there is no wage loss component to Med Pay. It strictly exists as a form of no-fault medical payments to treating providers. Med Pay is a rare add on in Maryland, but it warrants discussion nonetheless. If you are unsure whether or not your policy has riders for PIP or Med Pay you should speak with your insurance representative.

3) Health Insurance – Just like with any other doctor for any other reason, injured patients that have health insurance can use it to pay for their care in this office following a Baltimore auto accident. Patients electing to use their health insurance to pay for care must first make sure that we are on the health insurance panel and are “in network.” Provided that we are we can see them by collecting a copayment (copay) each visit. Typically Chiropractors are considered specialists by most health insurance companies, and as a result, copays are typically higher than in a primary care physician’s office. It is not unusual for a copay to be $30-$50 per visit for chiropractic services. This can be unappealing to injured patients following non-faulted Baltimore auto accidents, and as a result, it is not that common that patients elect to pay out of pocket on a per-visit-basis. Additionally, some insurance companies deny payment on behalf of their injured policy holders, citing that the injuries in question arose out of a Baltimore auto accident, and as such, insurance companies will try to wait for months or in some cases years to pay out because they want to see what the outcome of third party litigation is before paying. Needless to say, although possible, many injured Baltimore auto accident patients do not elect to choose this method to pay for their treatment.

4) Liens – Liens are an agreement between an injured patient and their treating provider to delay receiving payment for treatment until a later date. Typically that date is until the injured party recovers financially from an adverse insurance company. In these instances, care is placed essentially on an “IOU” or “credit card” type arrangement where services are rendered and the patient will defer repayment until they have the money to do so. Liens are never contingent on the outcome of litigation. That is, if an injured party alleges that they were the victim of another person’s negligence and they attempt to sue another insurance company or party but fail to recover any money, they still owe the treating provider for all services rendered while under their care. In this instance, debt is not just simply dismissed, but rather, then transferred directly to the injured party. In instances where the injured party then chooses not to pay their provider, or is not in a position to do so financially, their account is transferred to a collections service to help satisfy the debt. Many Baltimore auto accident injury patients do not feel comfortable in a third party lien type of situation (where they represent their legal interests on their own behalf), so instead, choose to hire a qualified personal injury attorney who can help protect their financial best interest while undergoing treatment. That is, the attorney can alert all treating providers to the fact that there is still pending litigation, and as such, can request that open accounts be placed “on-hold” for the time being with the expectation of being repaid upon conclusion of the legal proceedings.

Suffice it to say, being injured in a Baltimore auto accident is a stressful time. It is not uncommon to be irritated, injured, left without reliable transportation, and out considerable sums of money for several months all while taking time out of your day to treat for your injuries. Knowing up front what your financial options are following a Baltimore auto accident can help make your choices easier should you ever have the unfortunate circumstance of find yourself injured.

If you, or anyone you know, has been injured as a result of a Baltimore auto accident and you would like to discuss your financial options, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Maximum Medical Improvement Following Baltimore Car Accidents

As a Chiropractor that has been treating injured patients for nearly 7 years, one of the most common questions I get asked by new patients is “how long do I need to come in for treatment?” I suspect that this stems from the misconception that Chiropractic care is ongoing and that “once you go to a chiropractor you have to keep going for the rest of your life.” While I would argue that there are health benefits to getting routine “maintenance” spinal manipulation/adjustments, generally speaking insurance companies do not want to pay for this care stating that there are no clearly defined health benefits to long term manipulation in asymptomatic patients. Nonetheless, since the question of duration of treatment comes up quite often I figured I would address it in this article.

When it comes to treatment length, I never discuss it in terms of time (i.e. 2 weeks, 4 weeks, etc). Rather, I tell patients that I will recommend treatment until a patient reaches MMI, or maximum medical improvement. This is a med-legal expression stating that a patient is not expected to improve or worsen with the addition of any additional therapy or time.

Keep in mind, this does not mean that all patients that treat in my office for Baltimore car accidents and that have suffered Baltimore auto accident injuries are pain-free at the time of their final evaluation. Rather, it just means that additional therapy will not improve their condition. That is, there condition is stable. Ideally, this will occur once a patient has reached pre-injury status, but that is not always the case.

Here are two examples to demonstrate maximum medical improvement following a Baltimore auto accident:

1). Jane Doe gets rear-ended and presents for care. She declares no prior symptoms before the auto accident, but on day 1 mentions that she is experiencing headaches, neck pain, mid back pain, and lower back pain as a result of the crash. We treat her for six weeks and at the end of the six weeks she is completely pain free and feels “back to where she was before the crash.” In this instance Jane will be released at MMI since she is back to pre-injury status and since she does not stand to benefit from any additional treatment in my office or with any other specialists.

2). John Doe (No relation to Jane) gets rear-ended and presents for care. He declares that prior to this Baltimore auto accident he had chronic lower back pain stemming from a separate crash six years ago. He reports to be seeing a pain specialist once a month and has been since his previous crash where he undergoes lower back cortisone injections as needed. He reported his pre-crash lower back pain levels as being present approximately 3-4 days per week, intermittent (25-50% of awake time), and a pain scale of 4/10. Now, as a result of the new crash, he is reporting headaches, neck pain, mid back pain (all new complaints) and worsened lower back pain (that is now daily, constant (75-100% of awake time) and a 9/10. The key thing to note with Mr. Doe’s treatment is that as much as he would like me to completely eliminate his lower back pain, it is not something that I can actually do, since he reports a pre-accident level of pain. That is, I can only treat him until he reaches pre-injury status.  So let’s say he treats for 8 weeks and that his headaches, neck pain, and mid back pain have resolved. And let’s also assume that his lower back pain levels are now back at pre-injury levels of 3-4x/week, intermittent, and 4/10. At this point Mr. Doe is exactly where he was prior to the new crash. Provided that an addition or absence of treatment both in my office or with other specialists is not expected to improve or worsen his condition, I would also be releasing Mr. Doe from treatment at MMI at that time.

The point of the above example illustrates that MMI is not the same as being released pain free. MMI just means that more care (whether by me, by a physical therapist, pain management doctor, orthopedic specialist, etc) will not benefit the patient’s condition.

The reason that determining MMI is important is because (and this is more so true in worker’s compensation claims) patients can have permanency ratings based on their residual injuries. These permanency ratings can be equated to a financial payout for the injured claimant (or worker). While it is true that auto accident patients/claimants can also be given permanency ratings, it does not occur that often. When permanency ratings are indicated, I typically refer my patients to noted orthopedists in the area who are more familiar with the AMA guidelines for permanent impairment and who can properly evaluate and assign a rating.

So to reiterate – Following a Baltimore auto accident, if you ask me how long you need to treat, the answer will be the same. I will treat you until you reach maximum medical improvement, nothing more and nothing less.

If you, or someone you know, has been injured in a Baltimore auto accident, and you wonder whether or not you have reached maximum medical improvement, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

How To Be A Good Patient Following A Baltimore Car Accident

As a Baltimore Chiropractor that spends the majority of my time treating patients injured in Baltimore auto accidents that have developed Baltimore whiplash, headaches, neck pain, mid back pain, and/or lower back pain, I have spent a lot of time in this blog discussing the appropriate management of patient’s condition. I have implored patients to ask good question and to hold their medical team or providers accountable for the very best care. Recently I had a patient ask me what THEY could/should be doing to help mitigate their pain and to be the best patient possible. I found this to be a refreshing idea. As a treating provider all I can do is give patients my best intention, care and treatment. It really is up to a patient to be the best patient possible. After all, a patient and a doctor form a team, and how good is a team without proper communication?

I have assembled a list of things that Baltimore auto accident patients as well as Baltimore chiropractic patients can do to help be good patients so that they can make a complete and speedy physical recovery.

1). Have a good attitude – Having neck and back pain is not a fun thing and very few patients “want” to have to come to treatment. It is a stressful time in your life, as it is in mine as your provider. Take a deep breath, answer my questions to the best of your ability and trust that my staff and I want to help you. In previous blog posts we discussed that having expectations of a quick and complete recovery can actually lead to positive outcomes. With this in mind, please be optimistic about your recovery.

2). Be disciplined – Following an initial evaluation and diagnosis a treatment plan will be given to you. It will detail how often you should be seen in the office, any other doctors that I want you to follow up with, and any home-based activities that I expect. Please keep in mind these recommendations are for your benefit. Patients that follow our recommendations to the “t” end up doing well. We do not make recommendations just to make them, but rather, they are based on sound science and my personal experience having treated thousands of patients in Baltimore with Chiropractic joint pain and/or whiplash injuries.

3). Be committed – Alert your employers and your family to your injury and your desire to recover. Having other people hold you accountable will help you stay committed during the dark times. Explain that you may need to spend time taking care of yourself and that it may temporarily alter your normal schedule. They will understand.

4). Be consistent – Even as you feel better with treatment (and you will!) don’t rush back into all of your pre-injury activities. I want you to resume your activities at 25%, then 50% then 75% then 100%. The key is slow and steady progress so that I can monitor your complaint and so that you don’t suffer from any setbacks while you heal.

5). Be flexible – At Mid-Atlantic Spinal Rehab & Chiropractic we offer some of the most flexible office hours in Baltimore for providers that treat Baltimore auto accident patients. We offer morning hours so patients can come in before work, we offer lunch time hours so patients can get treatment during their lunch breaks, and we offer evening hours so patients can receive treatment after work and before heading home for the evening.  Additionally, we offer some Saturday hours for those patients that just can not make it during the week. While these hours are long it is our commitment to help our patients reach maximum physical recovery that drives us to accommodate everyone’s complex schedule. Don’t be afraid to shake up your normal routine in order to help your body heal and feel better following your injury.

In general, just remember that we want to help you recover from your Baltimore auto accident injuries and/or your Baltimore neck pain and Baltimore back pain. We are committed to being here and being ready to serve you. In order to make a complete physical recovery from your injuries, patients need to commit to their treatment as well. It is unrealistic to expect to be “fixed” overnight or without committing to the treatment plan provided for you. Patients and healthcare providers must effectively work together as a team to reach the best clinical outcomes.

If you, or someone you know has been injured in a Baltimore car accident and has suffered from Baltimore auto accident injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz