Which Type of Mattress is Best For Me?

As a Baltimore Chiropractor that spends the majority of my time treating headaches, neck pain, and back pain in Baltimore, I often get asked questions about mattress types and which option is the best for a particular patient. I wanted to use this blog post to talk about the most common types of mattresses so that I can shed some light on the subject. The three most common types of mattresses (in no particular order) are traditional innerspring, air mattress/bladder system, and memory foam.

The first type of mattress is the traditional innerspring mattress. These are the mattresses that we grew up sleeping on. They differ based on size and spring coil count. Originally these mattresses were made to be flipped and/or rotated every few months to help balance the pressure on the springs. Newer innerspring mattresses are meant not to have to be rotated. Most people (I would estimate 75% of my Baltimore auto accident and Baltimore chiropractic patients) sleep on a traditional innerspring mattress. When new these mattresses are great and provide plenty of support. Overtime as the springs compress these mattresses become less supportive. Many patients have a combination traditional innerspring mattress with some form of pillow topper. The pillow topper helps the sleeper not “feel” the springs in the mattress and can make for a more comfortable mattress. Personally, I have never really liked innerspring mattresses as I find that they produce too many pressure points and that they deform over time.

The second type of mattress is the air mattress/bladder system. I am not talking about the $20 air mattress that we all have in our basement for an unexpected guest to crash on for a weekend. These are the “sleep comfort adjustable beds” that we see commecials for. Typically they demonstrate a couple where the husband tosses and turns all night and the wife next to him sleeps comfortably undisturbed. The idea is that with two different bladder systems that can be filled or emptied of air both partners can sleep comfortably regardless of their individual preferences for mattress firmness. I have no experience sleeping on this type of mattress, but my parents sleep on it and from what I can tell they seem to enjoy it.

The final type of mattress is the memory foam mattress. This is the latest type of mattress to hit the market. Memory foam is a formulated material that is meant to compress and absorb pressure. Two common manufacturers of these type of mattresses are Tempurpedic and Casper. People with a lot of acute neck and back pain as well as people who are heavier tend to prefer these mattresses since there are no springs to compress or to cause pressure points. As someone who grew up sleeping on traditional innerspring mattresses, once I made the switch to a memory foam mattress, I became a fan for life. I get a better nights sleep, fall asleep faster, and stay asleep longer on these mattresses than I ever did on a traditional innerspring mattress. But that’s just me.

Many Baltimore auto accident patients ask me if they should change out their mattress once they have been involved in a Baltimore auto accident or Baltimore work related injury. I generally urge them not to switch out their mattress. Most mattresses are meant to last 10-15 years with an average use of 8 hours per day. Unless your mattress is approaching the end of its lifestyle it is probably not worth it to switch. Rather, try purchasing a pillow topper or a memory foam topper to place on top to give it a few more years of use.

Further, mattresses are very expensive. I have seen them cost in excess of $3,000-$5,000. Over the lifetime of the purchase, a mattress is a worthwhile investment. However, I don’t think you need to spend that much. I recently purchased a Casper mattress (King size) that was shipped to my house for under $1,000. They come with a 100 day love it or lose it guarantee, in which if you do not like it they will take it back and give you a complete refund. I am personally very happy with mine.

Research shows that neither a firm nor a soft mattress is best. That is, it all depends on the individual. Whichever mattress you can get to sleep on quickly and stay asleep for 7-9 hours a day is the best one for you.

If you have any questions about mattress types please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500.

Dr. Gulitz

Contrast Enhanced MRI Following Baltimore Auto Accidents

As a Baltimore Chiropractor that spends the majority of my time treating auto accident injuries, such as headaches, neck pain, and back pain, it is not unusual for me to treat patients that have extremity injuries as well. Often times a patient’s knee can bash against a dash board or center console, or a shoulder or hip can be injured due to shear forces resulting from a seat or lap belt. Just like with neck and back injuries following Baltimore auto accidents, these injuries are treated conservatively with passive modalities, stretching, and strengthening activities over the course of several weeks to months. If a patient does not improve as quickly as expected, it is not uncommon for me to refer these patients for advanced imaging such as MRI.

As most people are aware, MRI stands for magnetic resonance imaging. It is a form of electromagnetism that helps to three-dimensionally render a patient’s body from the inside. We can look at live anatomy and determine if there is altered morphology or injury. MRIs are considered the gold standard of advanced imaging. There is no radiation to the subject and the images are usually crystal clear.

However, MRIs are not perfect. Some structures do not appear well on standard MRI imaging. In these instances contrast-enhanced MRI may be used to better image a structure. In my daily life as a Baltimore Chiropractor that treats Baltimore auto accident patients, contrast-enhanced MRIs are most commonly used when imaging shoulders and hips.

I recently had a patient that had hip pain following a Baltimore auto accident injury. We had been treating her for a few weeks. Her headaches, neck pain, and lower back pain had been improving with therapy, but her hip remained a daily, constant complaint. I referred the young lady for a hip MRI, with the results being a negative MRI! Clinically it did not make sense. Based on her lack of significant improvement with therapy and her strangely negative MRI, we decided to try a contrast-enhanced MRI study.

Sure enough, we found some injury that we suspected all along. She had a labral tear in her hip that was causing a partial dislocation of her hip joint whenever she squatted or jogged. While most of the time a normal MRI is appropriate, if clinical indication suspects an injury that MRI may have missed, a repeat contrast enhanced MRI may find “hidden pathology.” That was the case for this young lady.

History, physical exam, and clinical intuition based on experience all lead providers to decision making. This particular young lady would have been stuck with years of hip pain had we not gone further and investigated her hip with a contrast enhanced MRI. Now she is scheduled for surgery which will hopefully fix the problem moving forward.

If you, or someone you know, would benefit from a second-opinion regarding injuries sustained in a Baltimore auto accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We would be happy to help!

Dr. Gulitz

The Application of PIP in Pedestrian Accidents and Bicycle Accidents In Baltimore, MD

As avid readers of my blog are already aware, I am a chiropractor that spends the majority of my time treating Baltimore auto accident injury patients. Typically these patients are occupants in a vehicle that either hits or gets hit by another vehicle. In these injury cases, the occupants of the vehicle have access to PIP under Maryland law. If you’ve read my other blog posts, you know that PIP (Personal Injury Protection) is a Maryland first party benefit for injured claimants involved in Baltimore auto accidents. The injured claimant has to open a PIP claim with their auto insurance carrier and then they qualify for PIP benefits. For those who may not have read my previous blog post, PIP is used both for economic/wage loss (up to 85% of wages) and to pay for medical and chiropractic care following an auto accident injury, regardless of fault. PIP is typically written in the amounts of $2,500, $5,000, and $10,000 but can be waived in writing at the time of underwriting.

During the summer as the weather gets better we typically see other injured patients/claimants that have access to PIP although they are not technically seated within a motor vehicle during the time of their injuries. Specifically, pedestrians and bicyclists fall under this category. Provided that they are following the rules at the moment of their injuries (i.e. pedestrians are walking within a cross-walk or on a side walk) and are not in any ways contributing towards their injuries, then both pedestrians and bicyclists have access to PIP under Maryland law.

Whether one of my patients in an injured bicyclist or an injured pedestrian, if they were struck by another motor vehicle, they have four sources of benefits to pay for their injuries. The order is as follows:

1) PIP of the faulted vehicle
2) PIP of their own auto insurance policy (provided they also have a car and elected to purchase PIP)
3) PIP of a family member over age 16 that they live with (provided that family member has PIP)
4) The bicyclist’s and/or pedestrian’s health insurance

I find this rule in Maryland to be particularly interesting. Obviously no one who is riding a bicycle or walking as a pedestrian wants to be injured in a bicycle vs. motor vehicle collision or a pedestrian vs. auto collision, but the state law makers have made it very easy for these injured patients to have access to medical care in these instances. I find it peculiar that although pedestrians and bicyclists are not required to apply for a license to ride a bicycle or walk (and therefore are not required to by insurance to do so) they can claim PIP benefits from the automobile that injured them. That is a benefit that is not the same in cases of Baltimore auto accidents between two motor vehicle collisions. It’s as if the pedestrian or bicyclist is “inside” the car that struck them at the moment of impact.

While many pedestrians and bicyclists choose to engage in these activities for exercise and socialization, some who are injured do not have their own automobile insurance with PIP, and as such, without this rule would have no way to pay for their lost wages had it not been for this law.

As with Baltimore auto accident injury claims, if an injured party did not cause or contribute to his injuries as a pedestrian or bicyclists and they choose to open a PIP claim, their auto premium rates will not go up as a result.

The message is clear: speak to your auto insurance salesman. Ask them to review your auto declarations page. Make sure that you have PIP and make sure that you are purchasing as much as they will sell you. It costs pennies and is worth thousands. Hopefully you’ll never need to use it, but if you do, it is worth it.

If you, or someone you know, has been injured in a Baltimore bicycle or Baltimore pedestrian accident and have questions about how you will pay for your injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Chiropractic Care for Pregnant Patients

As a Baltimore Chiropractor that spends the majority of my time treating, blogging, and thinking about Baltimore auto accident injuries, I have noticed a trend in my practice. More and more patients, particularly women, are asking about whether or not I provide chiropractic care for pregnant mother’s or for their children. Truth be told, although Chiropractic as a profession has been treating pregnant women and young children since inception, I honestly have not had many of these patients. As I enter my fourth year in practice in Baltimore some of my original patients have started to get engaged, get married, become pregnant, and have children of their own. I suppose I should not be surprised by this but it is amazing to see how their lives change around me. It made me realize that in order to be of better service to my community that I need to expand my offerings to be able to better help those in need.

For many current patients this will come as no surprise, but if you have not been in the office in some time this may be news to you. Dr. Gulitz expanded his professional staff in August to include another Chiropractor. Dr. Erica Wise D.C. joined Mid-Atlantic Spinal Rehab & Chiropractic in August of 2015. She brings a very complimentary set of skills to the practice. She previously worked at Living Wellness Chiropractic in Baltimore, where she treated more pregnant and wellness type patients. She has over three years experience in this arena and she is able to bring this skill set to the table (pun intended).

Dr. Wise enjoys treating pregnant mothers through all phases of their pregnancy. She feels that throughout the nine month process she can help expecting mother’s to naturally and safely deal with aches and pains that are expected as they gain weight during their pregnancy. In fact, she recently helped the office aquire a new “pregnancy pillow” that allows for expectant mothers to lay face down comfortably and to not put undue pressure on their abdomens as they enlarge.  While she primarily focuses on treating pain in pregnant women, some women who do not have pain also present for care, with the hope and expectation that proper biomechanics and spinal motion can lead to an easier delivery.

So if you are pregnant and have developed neck and back pain as a result of your pregnancy and require chiropractic care for pregnancy in Baltimore, please do not hesitate to contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Do I Need an MRI After My Baltimore Auto Accident Injury?

As a Baltimore chiropractor that treats many patients involved in Baltimore auto accident injuries I am often asked whether a patient’s injuries from a Baltimore auto accident requires an MRI. It occurred to me that in my previous blog posts I have not spent much time discussing MRIs so I figured it was time to do so.

MRI stands for magnetic resonance imaging. It is a diagnostic test that involves having a Baltimore auto accident injury patient to lay down in a large tube in order to have a region of their body scanned. Typically following a Baltimore auto accident injury the regions of the body that I would typically refer for MRI include the neck, lower back, shoulder or hip. MRIs are fantastic tools to better help a practitioner appreciate the living anatomy of an injured patient. The school of thought is that if a patient is having pain in a region of his body and the MRI shows altered anatomy in that region, that the altered anatomy is usually responsible for the pain in that region.

Let’s take an example. I am treating a patient for a Baltimore auto accident injury. I start their therapy off at 3x/week for the first four weeks. At the end of the first month (12 visits) I perform a re-evaluation where I re-perform orthopedic and neurological evaluations and I ask questions about the frequency and severity of their pain. Provided that the patient has been making an acceptable level of progress towards resolution of his chief complaints (>50% improvement per region both subjectively and objectively) we decide to move on with care on a reduced treatment frequency (say, 2x/week). If, on the other hand, the patient continues to mention daily pain, or radiating pain from the neck into the arms, or radiating pain from the lower back into the legs, that may be a different story. In those instances, I will typically refer out for an MRI of the region involved, in order to rule out a “worst case scenario.” These worst case scenarios are disc herniations, ligament tears, muscular avulsions, etc. Basically, these are conditions that exist that I can not treat as a chiropractor and that require specialist referrals.

So the question as to whether or not a patient requires an MRI following their Baltimore auto accident injury is not always straight forward. It depends on the patient, and it depends on their response to treatment. If they are not improving as expected, then I have my staff refer them for an MRI and we will take whatever steps we need to to resolve their injuries moving forward. Typically following a positive MRI my staff and I will make referrals to orthopedic, neurological, or pain management specialists for second opinions and future treatment recommendations.

MRIs are wonderful tools because they do not expose the subject to any radiation. A patient can undergo as many MRIs as often as they need to without any harm to their body. The pictures produced by MRI are considered the “gold standard” for advanced imaging, with resolution and clarity that greatly exceeds CT scan and x-ray.

If you are involved in a Baltimore auto accident injury give your injury time to heal. Commit to the process of treating for your injuries and give your body time to heal. If you feel that something isn’t right and after enough time the pain is still present, an MRI may be a good idea. It is truly a case by case scenario. Please contact Mid-Atlantic Spinal Rehab & Chiropractic if you have questions about whether or not your Baltimore auto accident injury requires an MRI.

Dr. Gulitz

Baltimore Chiropractor with Evening and Saturday Hours

In response to the feedback from our existing referral sources and current patients, Mid-Atlantic Spinal Rehab & Chiropractic has extended their office hours to better serve the Baltimore and Baltimore City community. By hiring a new chiropractor, Dr. Erica Wise D.C. and expanding office hours (see below) we pledge to serve you, the patient, better. We will offer quicker access to new patient appointments and faster appointment times.

You will notice that we are now open all day Monday and Tuesday, which allows us to better serve the injured weekend warriors and Baltimore auto accident patients that get injured on the weekends. Additionally, we now offer full days on Thursday and Friday for those heading out of town to travel or who are unlucky enough to have injured themselves throughout the week.  Finally, we are now back to offering Saturday morning Chiropractic appointments each Saturday, with Dr. Gulitz and Dr. Wise alternating. These changes should mean faster access to pain relief and less interruption in your days.

Effective 10/05/15, the new office hours are as follows:

Monday:     9a-1p ; 3p-7p

Tuesday:    9a-1p ; 3p-7p

Wednesday: Closed;  3p-7p

Thursday:   9a-1p ;  3p-7p

Friday:       9a-1p ;  3p-7p

Saturday:   9a-1p

Please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help with any of your Baltimore auto accident treatment or Baltimore chiropractic needs.

Dr. Gulitz

EMS vs. TENS after Baltimore Auto Accident Injuries

As a Baltimore Chiropractor that spends the majority of my time treating patients injured in Baltimore auto accidents, I often get asked what the difference is between EMS and TENS. These are acronyms used for two common pain modulating modalities. EMS stands for electric muscle stimulation. TENS stands for transcutaneous electrical nerve stimulation. In my clinic we utilize EMS following Baltimore auto accident injuries. So whats the difference?

EMS uses a cycle of electrical current that allows the muscles to contract and relax, increasing blood flow and promoting healing. It helps to relax spasmodic muscles and sooth the deep ache of muscle pain such as that experienced in Baltimore auto accident whiplash injuries. As the name implies, the purpose of the EMS modalities to stimulate injured and atrophied MUSCLES. There is also a pain modulating effect, but it is not the primary goal of EMS. EMS helps to improve ranges of motion as well by reducing swelling.

TENS is thought to promote the production of ATP at a cellular level by stimulating NERVES and helping to modulate pain by overriding the sensation of pain prior to its interpretation in the brain. Typically speaking TENS units are usually sold over the counter and can be worn conveniently on a belt clip and can be taken with you.

Truth be told, utilizing either TENS or EMS following a Baltimore auto accident injury will help you regardless of which you choose. I often tell patients in pain following injuries that if they have a machine at home, regardless of which one they have, that they are better off using the machine than not using it. EMS gives the treating provider a few more options to help with muscle spasm and pain, but TENS works just fine.

Despite the benefits of TENS and EMS, not every injured patient can utilize these therapies. Patients with open wounds, eczema, patients with pacemakers, or pregnant women (over a gravid uterus) can not utilize these modalities for pain.

If you, or someone you know, is suffering from muscle and/or nerve pain following a Baltimore auto accident injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

ICD-10 Coding for Baltimore Auto Accident Injuries

Since approximately 1979 the health care providers in the United States have been using a series of 4 and 5 digit codes to represent our diagnoses for patients. This code base is called ICD-9, which stands for International Classification of Disease, 9th edition. For example, I may diagnosis a sprained neck as 847.0 cervical sprain/strain. While it is fairly fast and easy for Chiropractors such as myself to code with just four digits, it is not entirely accurate. That is, if someone sprains the zygapophyseal joints in their neck following a Baltimore auto accident, why should it be coded with the same codes 847.0 that also reflects a strained upper trapezius muscle? The problem with the “old way” of coding for health care was that one code pointed to many different conditions. And then, there’s the problem of “sidedness”. If someone were to sprain their right shoulder (840.9) or their left shoulder (840.9) there would be no way based on the numbering scheme to know which side was actually injured.

That’s where ICD-10 comes in. With the exception of the United States, the rest of the world has already moved on from ICD-9 and has implemented and been using ICD-10 diagnoses for years. Much like our desire to avoid the metric system, the U.S. has been burying its proverbial head in the sand and has only JUST NOW decided to implement a transition to ICD-10 coding.  As of October 1, 2015 (approximately 16 days away as of the time of the writing of this blog post) all new diagnoses for patients need to be coded in ICD-10 rather than ICD-9. Let’s take a look at some of the perils of this “instant transition.”

Hypothetically I could be treating a patient on September 30, 2015 and I can diagnose them with a cervical segmental dysfunction (739.1). If they return for treatment the following day on October 1, 2015 that same person with the same diagnosis is now considered to have a “segmental and somatic dysfunction of the cervical spine” (M99.01). That’s not too bad…

Let’s look at the cervical sprain/strain example from above. If that patient presents for an evaluation on or before September 30, 2015 their diagnosis would be 847.0. However, should they present on or after October 1, 2015, their diagnosis is now “Sprain of ligaments of cervical spine (S13.4xxA) (initial encounter) with strain of muscle, fascia, and tendon at neck level (S16.1xxA) (initial encounter)”. While it does make the diagnosis more specific, where one disease process is mapped to one code, it makes coding as a whole more difficult.

As far as the sidedness argument. If a patient comes in and sprains both shoulders in a Baltimore auto accident on September 30, 2015, then they will be diagnosed with 840.9. If, however, they came in on October 1, 2015, they would have two separate diagnoses, one for the sprained right shoulder, and one for the sprained left shoulder. And if it is “more than” just a sprain, that is if there is any muscular involvement, we would have to code for both the sprain and the strain component of the injury, which is not uncommon. So here is what it would look like:

Right shoulder rotator cuff sprain (S43.421A) (initial encounter)
Left shoulder rotator cuff sprain (S43.422A) (initial encounter)
Strain of muscles and tendons of the rotator cuff of right shoulder (S46.011A) (initial encounter)
Strain of muscles and tendons of the rotator cuff of left shoulder (S46.012A) (initial encounter)

In that previous example, it is clear that 1 code (bilateral shoulder sprain/strain) mapped to four separate codes, inclusive of the right vs. left side shoulder and inclusive of the sprain (ligamentous component) vs. strain (muscular) component of the injury. While it is not that difficult to hit a few buttons on a keyboard, you can see how it makes diagnosis coding way more complex.

As with any transitions, errors and omissions will be made. These errors will not only be made by me and my staff but by health insurance companies, third party payors, patients, etc. It is not feasible to transition to an entirely new language over-night without a few bumps in the road. Gurus in the insurance industry are predicting a cash flow interruption for small offices of anywhere between 3-6 months worth of normal cash flow as the mistakes get ironed out.

So what does this mean for the auto accident injury patients of Baltimore and more specifically, of Mid-Atlantic Spinal Rehab & Chiropractic? Absolutely nothing!

Our proprietary software has the ability to duly code in both ICD-9 and ICD-10 languages and will retain that ability moving forward. You will still be bound by the contracts you signed with your health insurance provider and will still have to pay copays, deductibles, etc. Literally nothing changes other than the codes we use to record your injuries. So rest assured, it should be business as usual moving forward.

If you, or someone you know, is experiencing neck or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

The Role of Traction in Recovery From Baltimore Auto Accident Injuries

As a Baltimore Chiropractor that spends the majority of his time treating patients recovering from Baltimore Auto Accident Injuries I get asked many of the same questions each day. It finally occurred to me that I should address these common questions in a series of blog posts on my website. That way a patient can know what I am going to say before I say it (and it will keep me from repeating myself.).

One of the questions I get asked most frequently is whether or not my office offers “traction” therapy. The answer is quite simple, “yes, we do.” However, the question is somewhat incomplete. That is, there are two different types of traction that we offer and each are used for different types of injuries. Let me explain.

The first type of traction that most patients are referring to is called “mechanical traction.” It is a table where a patient is harnessed down such that their torso is fixed, and a gentle mechanical stretch can be applied to the neck, or conversely, their torso is fixed and a gentle mechanical stretch can be applied to their lower backs. I generally will use mechanical traction as a form of therapy when patients either fail to improve with traditional forms of chiropractic care and rehabilitation, or when traditional spinal manipulation is ill-advised. Many of my Baltimore auto accident patients with neck disc herniations or lower back disc herniations swear by mechanical traction to help open up their locked joints and to take pressure off of their inflamed discs. The machine is somewhat cumbersome and it takes about 20 minutes from start to finish between setting an injured patient up on the machine, and administering the desired traction effect. As far as I am concerned, as long as it helps my injured Baltimore auto accident patients then it is time well spent.

The second type of traction that we offer is called intersegmental traction, or more colloquially, the “roller table.” A picture of an intersegmental traction table (or IST table) that I might use on a Baltimore auto accident injury patient can be seen here. It is a machine that has a series of massage-type rollers on a moving conveyor belt. It travels from your neck, through your middle back, and down to your lower back. It focuses on lifting and gently separating all of the spinal segments of your spinal column, one by one. The nice added benefit from utilizing an intersegmental traction table is the soft tissue paraspinal massage that it offers the patients utilizing it. Many patients refer to their time on the IST table as their “favorite part of their treatment.” They feel relaxed, looser, and a lot less stiff.

In future blog posts I will address other modalities and therapies that we offer, as well as other commonly asked questions that commonly arise during Baltimore auto accident injury treatment at Mid-Atlantic Spinal Rehab & Chiropractic.

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

Dr. Gulitz

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