Monthly Archives: December 2007

Doctor not to pay $1M judgment


Doctor not to pay $1M judgment

BY JOSH MROZINSKI, Wyoming County Press Examiner 12/26/2007
TUNKHANNOCK – A Superior Court panel overturned a Luzerne County trial court decision on Monday that required a Tunkhannock doctor to pay $1 million in compensatory and punitive damages.

In September 2005, Luzerne County Judge Michael Conahan vacated a jury’s verdict, finding that the conduct of Dr. Asit Patel, “was a factual cause of harm and damage” to Linda Ferris who deserved punitive damages, according to court documents.


On Monday, the Superior Court stated in its opinion that the jury’s verdict had a reasonable basis.

“Accordingly, we reverse the trial court’s orders and remand the case with direction to reinstate the verdict,” the state court said.

Attorney Eugene Feeney, of Scranton, said that Dr. Patel, an anesthesiologist, had not paid any damages because the case was in the process of being appealed.

“I think it’s fair to say we were happy with the outcome,” Mr. Feeney said.

After falling down a stairwell at the Beaumont Inn in Dallas Township, Ferris, of Plymouth, was diagnosed with health conditions, including reflex sympathetic dystrophy, according to court documents.

In November 2001, Ferris was referred to Dr. Patel at Tyler Memorial Hospital for pain management treatment.

Ms. Ferris filed a complaint against Beaumont Inn owners James and Elizabeth Harkins to recover damages on March 20, 2002, and she was subsequently examined by Dr. Patel.

Dr. Patel indicated that he “doubted” Ferris suffered from reflex sympathetic dystrophy and forwarded his conclusions to Ferris’ attorney, according to court documents.

During discovery, Ferris’ attorney obtained an e-mail from the Selective Insurance Co. that stated that Dr. Patel is a friend of Harkins and thought the Plymouth woman was “not in much pain.”

The e-mail also stated that an employee at the insurance company told Harkins that, “the doctor would need to put his findings into a report,” according to court documents.

On June 13, 2003, Ferris filed a lawsuit against Dr. Patel, the Harkins and the insurance company.

Ferris alleged in the complaint that Dr. Patel conspired to delay a settlement.

A settlement for $945,000 was reached in February 2005.

About two months later, the Luzerne County jury found Dr. Patel liable for six counts, including intentional misrepresentation of material facts, breach of contract and invasion of privacy.

However, the jury did not award damages and determined that Dr. Patel’s conduct was not the factual cause of harm to Ferris and did not cause delay in the settlement payment, according to court documents.

The state court also indicated that testimony during the trial failed to show that Dr. Patel’s actions caused Ferris emotional harm.

Following the jury’s verdict, a post trail relief motion for a judgment notwithstanding the verdict or a new trial was filed on behalf of Ferris.

Scranton attorney Tim Lenahan said that the state court and the trial court did not address the request for a new trial.

Lenahan added that a motion for reconsideration will be filed so that the case is heard before the entire court.


©The New Age Examiner 2007

Click Here For The Original Article Online.

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Kara Loree’s crippling body slams have to get worse before she can get better

Overpowering pain

Kara Loree’s crippling body slams have to get worse before she can get better
Sunday, December 16, 2007

KATY MULDOON

The Oregonian Staff

Kara Loree broke down on a Friday, 11 days into pain boot camp.

The tub step-ins did it.

They’re tough. With an occupational therapist timing her, Kara had to step in and out of a bathtub as often as she could in one minute. And she had to beat her own record: 37.


That morning, on the 11th step-in, the 15-year-old Oregon City girl tripped and crumpled.

“I can’t,” Kara said, gasping.

Take a moment, therapist Cyndy Coughlin told her. Breathe.

In late October, Legacy Emanuel Children’s Hospital admitted Kara to a new program designed to cure young patients with certain debilitating, chronic pain — or at least teach them to cope. Doctors bill the program, one of a handful of such nationwide, as medicine with a tough-love twist: To help her, Kara’s medical team would make her hurt more than she had since constant, excruciating foot pain started in September.

Rule No. 1: Unless her doctor asked, she wasn’t allowed to whimper a word about her pain.

Kara leaned her head against the shower wall. Tears streamed down her cheeks, and her shoulders heaved as she sobbed.

“Everybody has a time,” Coughlin said gently, “when they need to stop and take a break and start over again.”

“No,” Kara said, her voice rising defiantly from its usual soft pitch.

“I am not doing it.

“I am not doing it.

“I am not doing it! And I really don’t like you!”

Kara’s pain seemed to come out of nowhere.

She hadn’t injured her right foot. It wasn’t infected. She hadn’t even slept on it funny.

Yet, from the Saturday the pain started, Kara said, her foot felt as if an elephant were crushing it. When anything touched it, drops of water in the shower or the soft swipe of a towel, her foot felt as if it were being pounded with a spiked hammer.

Kara’s mother took her straight to her doctor.

Lisa Loree is a registered nurse. She and the doctor thought Kara’s pain might be linked to granuloma annulare, a common skin condition that periodically caused bumpy breakouts on the girl’s feet. The doctor biopsied the bumps, prescribed the painkiller Vicodin and sent Kara home, advising she use crutches.

An artistic sort who sings and writes poetry, Kara decorated her drab new crutches with glow-in-the-dark puff paint and hobbled on her custom sticks to Gladstone High School, where she’s a sophomore.

Two days later, Kara phoned her mother from school, weeping. Pain screamed through her foot. She asked her mom to come get her.

In a hospital emergency room that day, doctors tried to calm Kara’s pain with morphine and Dilaudid, a narcotic analgesic. Neither helped.

Lisa Loree remembers her daughter pleading, “Mom, can’t they just make me unconscious?”

Pain is complicated, but in essence: Receptors on the skin trigger electrical impulses that travel to the spinal cord. There, pain signals can be blocked, enhanced or changed before they move to the brain, where chemicals called neurotransmitters combine to produce pain.

It can feel as quick as a pinprick, as achy as arthritis or as sharp and burning as the condition a rheumatologist diagnosed in Kara: complex regional pain syndrome, type I, or CRPS.

Doctors figure an abnormal reflex in Kara’s spinal cord might have caused blood vessels to constrict, causing pain. When Kara’s foot hurt, she stopped using it. The result was poor circulation, which caused more pain.

Research suggests that hormones, stress and emotions play a role in CRPS. The human nervous system continues to develop into the early 20s; hormonal, cognitive and psychological changes during puberty might affect adolescents’ vulnerability to pain.

Adults can get CRPS, too. Much about the ailment remains unknown — including how many people have it — but doctors say one thing is certain: The pain is real, not imagined.

Kara’s pain was stuck in a bad loop. It wouldn’t turn off.

Kara checked into the hospital Oct. 29. Her father, Derek Loree, followed doctors’ orders: He took away her crutches.

Kara knew she’d miss weeks of school, choir rehearsals, her friends, parents and 17-year-old brother, Colin. She’d have to skip several “Horde Nights,” as Fridays are called in the Loree home, where up to a dozen of Kara’s and Colin’s pals gather for pizza, games and sleepovers.

But the foot pain had spread to her right knee.

Doing dishes and vacuuming fell unmissed off her chore list. But the pain, she said, kept her from the things she loves. Like many youths who develop CRPS, Kara is driven — good at everything and a year ahead in math. She dropped that class because the pain exhausted her. At choir practice, she had to sit instead of stand. She couldn’t bowl with her church group or shop with friends.

Rail thin at 5 feet 4 and 106 pounds, she’d lost weight, saying it was too hard to get to the kitchen to fix food.

Some days, her mother recalled, Kara would cry for hours, saying, “Mama, make it stop. Mama, make it better.” All Lisa Loree could do was hold her hand and say, “Hang in there.”

So when the rheumatologist referred her to Emanuel’s hard-core pediatric pain program — a physically intense approach based on the work of Dr. David Sherry, a Philadelphia physician who has helped more than 1,000 children with similar problems — Kara agreed. She wanted her life back.

That first morning in the hospital, though, she was petrified.

“All I know,” Kara said, tears welling, “is I’m gonna get hurt.”

When she tried to put a shoe on the foot that hadn’t worn one in a month, Kara panicked. Hyperventilating and crying the second morning in the hospital, she dialed her mother.

Don’t call me, call your nurse, her mother advised. After all, the key to the program is teaching patients to solve their own problems.

At 9 a.m., when Michelle Swift, a physical therapist, arrived at room N3509 to collect Kara, a brown paper bag sat on the teen’s bedside table. Kara’s nurse had told her to breathe into the bag to quell her panic.

Her tone kind but firm, Swift insisted that Kara put on her shoes.

Kara fingered a medallion on a chain around her neck, a gift from her mother. Imprinted in it was one word:

Courage.

She pursed her lips, slipped into her ratty old Asics and stood. Limping slowly, Kara followed Swift out of the pediatric unit and into a stairwell leading to the therapy gyms.

If Rule No. 1 was no pain talk, then Rule No. 2 was no elevator. And more: Do everything the doctors, physical, occupational and psychological therapists ask. Take responsibility for improving. If an exercise is timed, always beat the previous time. If it’s repetition, always beat the count. If it hurts, tough it out. Don’t follow the rules, and you’re out.

“What’s the difference,” Swift asked Kara, “between a physical therapist and a terrorist?

“You can negotiate with a terrorist.”

A smile slipped across Kara’s face. Swift’s, too.

Walk like a duck, Swift instructed.

Kara crouched, waddled down a hall, turned and waddled back.

She squeezed her eyes shut and covered her face with her hands. The duck walk had worked Kara’s knees and toes, her most painful parts.

Swift handed her a box of tissues and gave Kara a minute to compose herself.

Scuttle like a crab. Move like an inchworm. Hop like a frog.

If one day feels like the next for any hospital patient, it felt doubly so for Kara. Day after day, therapists asked her to repeat exercises so they could chart her progress.

She rode a bicycle, walked a treadmill and hopped on a trampoline. She maneuvered through obstacle courses, balanced on tippy boards, and when she limped quickly down a long hall, Swift told her that — believe it or not — she’d run that course soon.

“Ready? Go!” Swift said, and Kara did pushups, her hands on a mat and her knees on a chair. After 16, she stopped.

“I can’t,” Kara said, huffing.

“You can,” Swift said. “Do you need to sit for a minute?”

“Can we do this tomorrow?” Kara asked.

“No,” Swift said.

The push-pull between therapists and patient would become routine as Kara’s motivation and emotions boiled and chilled. Her body and brain would find new ways to respond to pain signals, but the treatment came with its own stresses. Being away from home, school and friends so long wore on Kara.

During five- and six-hour days therapists distracted Kara with word games or personal questions — anything to make her think about something besides pain. Repeatedly, they reminded her of her goal: to be able to do everything a healthy teen could. Achieving that was up to her.

Her creamy complexion flushed with exertion, Kara got back into position. Swift resumed counting pushups. “That’s 20 . . . 25. There’s 30. Last 10, girl, you can do it.”

Swift punched a stopwatch.

“Nice job,” she said.

Kara sank to the floor, crying.

“It’s not all gonna be torture,” Swift said. “I promise.”

Auburn hair flying, Kara sprinted down a hall one week after she’d hopped into Emanuel on crutches.

A smile stretched from one side of her face to the other — and that wasn’t the only thing looking good. When she removed her shoes and socks, Kara’s right foot looked as pink as a piglet, not the bone-white shade of the week before. For the first time in weeks, blood circulated properly to her toes.


That afternoon, Swift put Kara through her paces: jump rope; crunches; lunges; jumping jacks. Kara completed them without complaint, and a surprise followed.

That first Monday in November, the sky shone a sapphire blue. Drifts of maple leaves turned the sidewalk on North Graham Street into a celebrity-worthy red carpet.

The two pushed open a hospital door and stepped outside.

“Sunshine!” Kara cried. She kicked her feet through the leaves and sucked in fresh air.

Her goal, Swift told Kara, was to walk with a steady, even gait — like a normal teen — down the steep hill.

Kara did.

Two blocks below, Swift suggested they race back.

Arms and legs pumping, Kara reached out and touched a pole at the top of the hill.

“I won,” she said.

Desensitization was the worst, and several times each day Kara required the tactile therapy designed to retrain her pain response.

Therapists massaged Kara’s foot. Or they asked her to submerge it in hot water, then ice water. Often, she ran a plastic brush across her toes and arches. To anyone else, it might have felt less like torture and more like a pampering pedicure.

On her 10th morning, desensitization meant walking barefoot in the dewy grass, and it pushed her over the edge. More than an hour later, Katie Harpster found Kara in a corner of the gym, her angular frame curled into a tight ball. She’d spent the lunch break sobbing.

“Kara, c’mon,” said Harpster, an occupational therapist. “Let’s go for a walk and a talk.”

The next day, Kara’s mood bounced back.

The day after that, she threw her, “I’m-not-doing-it” tantrum over the bathtub step-ins.

Neither the highs nor lows surprised Dr. Steve Janselewitz, the pediatric physical medicine and rehabilitation specialist who directed Kara’s care team. Since he and Emanuel’s Dr. Mark Shih started the pain program early this year, they’ve watched about half a dozen children ride pain and mood swings similar to Kara’s.

“It’s kind of nice to see them break down while they’re here,” said Janselewitz, “because then we can get them through that, and they can say: ‘Hey, I can do this.’ At home, they don’t necessarily have that support.”

On her 19th and last day in the hospital, Kara and Linda Krausse, a physical therapist, charged across a sky bridge and ducked into a stairwell.

Kara had plenty on her mind. Her team of therapists, doctors, a psychologist, teacher and social worker had armed her with coping strategies and a home exercise program she’d need to follow faithfully. Her foot and knee still hurt, but she could deal with it. She could run and jump and planned to glide around the Lloyd Center’s ice rink that weekend.

In a few weeks or months, Janselewitz predicted, Kara’s pain would subside, then disappear, as it typically does for children who can endure the treatment program.

In the stairwell, Krausse told Kara that together they’d run four stories up, then four down. Four times.

“You’ve come a long way, Kara,” Krausse said.

“I have,” Kara replied.

“That must feel good.”

“You have no idea,” Kara said, “how good it feels.”

Katy Muldoon: 503-221-8526; katymuldoon@news.oregonian.com







Click Here For The Original Article Online.





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Collateral Meridian Therapy Alleviates Intractable Pain and Disablity in CRPS Patients

A904
October 14, 2007
2:00 PM – 4:00 PM
Room Hall D, Area N,

Collateral Meridian Therapy Alleviates Intractable Pain and Disablity in CRPS Patients

Sumio Hoka, M.D., Akifumi Kanai, M.D., Shan-Chi Ko, M.D., Asaha Suzuki, M.D.
Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

Background: Complex regional pain syndrome (CRPS) is a perplexing and challenging disease to treat. The validity of conventional pharmacologic therapies such as antidepressants and interventional techniques as sympathetic blockade is variable. Recently, collateral meridian therapy (CMT) has been reported to be effective on intractable pain in a CRPS patient (1). CMT is based on using two-point acupressure maneuver at the control point and functional point. The technique can effectively relieve acute injury-related pain as well as chronic pain and promptly restore physical function. We, in this study, examined whether CMT, a novel method in alternative medicine, would reduce pain and improve physical function in patients with CRPS.

Methods: Consecutive ten (two male and eight female) patients aged 15 to 75 years (mean age = 43 years) with CRPS, whose pain had not been changed for at least one month by conventional therapies, were enrolled in this study. Inclusion criteria was the pain intensity of more than 40 mm visual analogue scale (VAS) and the daily dose of oral drugs unchanged the last two weeks prior to enrollment. CMT was performed by applying acupressure maneuvers on meridian points of the extremities corresponding with the painful area. No needles and drugs were used for CMT. The pains at rest or touch were assessed with VAS before and after the treatment. Physical function was evaluated by behavioral changes in daily life two weeks after the treatment.

RESULTS: Symptom onset of CRPS until the initiation of CMT ranged between 1 to 60 months. Two patients, one with VAS 95 mm at the right leg and the other with VAS 70 mm at the left leg, could not elicit any pain relief after CMT. In one patient with VAS 75 mm at the left leg, the effect of CMT was transient and ceased only at several hours. In the other seven patients, however, CMT significantly (p<0.001) attenuated VAS from 73 (23) mm (mean (SD)) to 19 (15) mm (p<0.001). VAS of total ten patients was also significantly decreased from 75 (21) mm to 36 (32) mm (p<0.01). Among the responded seven patients, three patients unable to walk before could become to walk just after the treatment and even two weeks later. Physical functions of the seven patients significantly improved. No adverse effects of CMT were observed, except for transient painful sensation during acupressure applications.

DISCUSSION: Our results have demonstrated that CMT provides a prompt analgesic effect on persistent pain in CRPS patients with a few exceptions of un-responded patients. CMT is a novel treatment technique developed by Dr. Ko for various pains including low back pain, shoulder pain, and the other chronic pain. CMT consists of the idea that pain originates from the stagnation of life flow and thus pains can be nullified by regulating the stagnation using acupressure maneuver on corresponding meridians from the painful area. Our results suggest that CMT can be highly effective on intractable pain in patients with CRPS, and that CMT can improve physical function in disabled patients due to CRPS.

Reference 1: Anesthe Analg 2007;104:452.

Anesthesiology 2007; 107: A904

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New Jersey Trial Attorney Adam M. Slater Obtains $14.7 Million Settlement


New Jersey Trial Attorney Adam M. Slater Obtains $14.7 Million Settlement for Plaintiff Suffering From Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy

New Jersey personal injury attorney Adam M. Slater obtains what is believed to be the largest personal injury settlement in New Jersey for complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD).


Roseland, New Jersey (PRWEB) December 18, 2007 — New Jersey trial attorney Adam M. Slater of the law firm of Mazie Slater Katz & Freeman, LLC has achieved what is believed to be the largest New Jersey settlement of a case involving Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy , or RSD, in Ross Cohen v. Benzl Busch Motor Car Corp. The $14.7 million settlement was agreed to days before jury selection was to commence in the Superior Court of New Jersey in Newark. The unprecedented settlement amount was obtained due to the firm’s aggressive and creative approach.

News Image

RSD/CRPS is a chronic progressive neurological condition that affects nerves, skin, muscles, joints, and bones. The syndrome usually develops as a result of trauma to a limb, and some cases result from minor, seemingly inconsequential injury, such as a sprain. Pain may begin in one area or limb and then spread to other limbs. The condition is characterized by various degrees of burning pain, excessive sweating, swelling, and sensitivity to touch. Symptoms may become dormant and reappear again with the passage of time. The medical literature recognizes that it is crucial for a person suffering from this condition to obtain prompt, aggressive treatment from a physician who is knowledgeable about the condition.

The $14.7 settlement is yet another substantial recovery by Mazie Slater Katz & Freeman, LLC, an Essex County New Jersey law firm specializing in personal injury, professional and medical malpractice, product liability, and class actions.

For more information about this settlement and the other successful verdicts and settlements achieved by Mazie Slater Katz & Freeman, LLC please contact New Jersey Certified Civil Trial Attorney Adam Slater.

http://mskf.net/attorneyprofiles_slater.htm

Click Here For The Original Article Online.

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Man’s chronic pain disorder drives awareness campaign

Stephen Brilliant and his wife, Antoinette, are campaigning for greater awareness of Reflex Sympathetic Dystrophy Syndrome.

Man’s chronic pain disorder drives awareness campaign

By PAMELA SROKA-HOLZMANN
STAFF WRITER

HILLSBOROUGH — When Stephen Brilliant was injured in a car accident nearly 13 years ago, the Hillsborough man had no inkling it would affect the rest of his life.

As a result of the accident, the 42-year-old Brilliant said he suffers from Reflex Sympathetic Dystrophy Syndrome, also known as RSDS or Complex Regional Pain Syndrome, which is categorized as a malfunction in part of the nervous system. The disorder brings on chronic pain symptoms characterized by severe and relentless pain that affects between 200,000 and 1.2 million Americans.

Brilliant and his family are trying to raise more awareness about the disorder after a trip to meet with the state Senate Budget and Appropriations Committee on Dec. 1 in Trenton.

There, his daughter, Anna, 13, an eighth-grader at Hillsborough Middle School, provided testimony about the disorder and asked about 10 senators for their support in passing an educational awareness bill about RSDS.

On Dec. 17, that bill, the Reflex Sympathetic Dystrophy Syndrome (RSDS) Education and Research Program Act, was approved in a 38-0 vote by the state Senate. It was approved by the Assembly in June. The bill is sponsored in the Senate by Sen. Joseph Palaia and in the Assembly by Assemblyman Mike Panter, Assemblyman Eric Munoz, and Assemblyman Neil Cohen. Next, the bill will go before Gov. Jon S. Corzine.

Brilliant has lived with the chronic condition since the December 1995 car accident, and he said each day brings new and unexpected challenges. Symptoms can include persistent moderate to severe pain, swelling, abnormal skin-color changes, skin temperature, sweating, limited range of movement and movement disorders.

Brilliant said a simple bed linen over his foot can bring excruciating pain. When Brilliant — once an athlete — stepped on a thumbtack, he screamed for 10 minutes straight.

Despite the symptoms, Brilliant continues his full-time job as an accountant with his own business, attempts the grocery shopping list and attends day trips with his wife and three children. However, longer trips such as vacationing or holiday shopping through a mall require Brilliant to use an electric scooter to get around.

“It’s challenging, some days. I really wonder how I do it,” Brilliant said. “I’m a family man; I’m a father. I have to do it at times. And there are days I don’t want to get out of bed.”

How it happened

According to the national Reflex Sympathetic Dystrophy Syndrome Association, minor injuries — such as a sprain or a fall — are frequent causes of the disorder. One characteristic of RSDS is pain that is more severe than expected for the type of injury that occurred.

For Brilliant, it was a slow process learning what caused the pain in his foot, but all arrows pointed to the car accident in 1995.

He recalls the incident as if it happened that day. He was traveling along Interstate 78 westbound with his wife, Antoinette, seated beside him in the passenger seat and Anna, then an infant, strapped in her car seat in the back.

Another vehicle traveling eastbound cut off his vehicle, lost control for an unknown reason, bounced off the barrier into the eastbound lane, came across the express lane into the local lane and slammed into Brilliant’s car on the driver’s side, he recalls. But the worst was not over.

The vehicle that hit Brilliant proceeded to spin around and strike his car a second time on the driver’s side, he said. While glass shattered throughout the car, fortunately Antoinette and baby Anna didn’t suffer much more than a scratch.

“Stephen took the direct impact. He ended up with injury in his foot, shoulder and had glass in his eye,” Antoinette Brilliant recalled. “He took the majority of the impact.”

Being diagnosed

Following the crash, Brilliant began to feel more chronic pain in his foot. He described the feelings as a “stabbing pain,” with “extreme hot and cold sensitivity,” and often tinging sensations and swelling in the area.

“It was like shooting pains all the time,” he said.

Following several treatments — including a surgery that cut around a “crushed nerve” and put his foot in a cast — Brilliant realized something was not right. He immediately was in a lot more pain than most people would be following a surgery.

“The day I came out of the surgery, I said ‘something is wrong,’ ” Brilliant said. “I thought, ‘my foot hurts 10 times worse than before the surgery.’ My foot hurt and you couldn’t even put a sheet on it.”

Brilliant said it became a task just having to convince friends and extended family members that he wasn’t “overreacting” and the pain was real. In 1997, a physician at Westfield Orthopedic finally diagnosed him with RSDS.

“It’s amazing because even though I have this tremendous disorder, I look very fine and normal,” he said. “But if someone kicks me or steps on my foot or I step on a little pin, it’ll send me through the roof. It’s not something you can see, but there’s a problem there. You look at the book by its cover, and you’re not looking inside; it’s hard to look inside.”

Following the diagnosis, it took Brilliant a year to learn how to walk again as a result of having no movement in his foot.

Today, the severe pain in his foot still exists, and doctors say it will never cease because there is no cure for RSDS.

Legislative support

Anna told state representatives during her meeting that she wanted her Christmas wish to come true.

“I want you to know that every Christmas I only have one wish,” she said. “This is for my dad to get better and be in less pain. I know you can’t cure RSDS, but you can provide education to doctors who can find a cure. Please at least give me and other RSDS sufferers the gift of hope.”

Anna also recalled in her speech being a “hyper” child and always wanting her father to play outdoor sports and games with her. She said, “I was always running around or playing catch or practicing hitting for softball. My dad always tried to help me, but his help was limited. He couldn’t — and still can’t to this very day — squat, run, jog or put little to any pressure on his left ankle.”

She added, “By being unable to do these things, he was unable to help me as much as he would have liked.”

The bill establishes a reflex sympathetic dystrophy syndrome education and research program at the state Department of Health and Senior Services. The purpose of the program is to promote public awareness of the causes of RSDS, the value of early detection and the diagnosis of and possible treatments for the syndrome, and to promote research, through public and private sources, to accurately identify, diagnose and treat the syndrome, according to the bill.

The bill also will educate first responders about the disease so they learn the proper way to take an RSDS patient’s blood pressure and other techniques to minimize the pain of someone suffering from the disorder.

“I believe the bill can really be helpful because of what it can do to help individuals,” Brilliant said.

Under the provisions of the bill, the state Department of Health and Senior Services would:

  • Establish a public education program through the department’s Web site, to promote RSDS education, which would enable individuals to make informed decisions about their health. Information would include causes, risk factors, symptoms and treatments for RSDS.
  • Notify local health departments, hospitals, clinics and other health-care providers about the availability of information about RSDS on the department’s Web site
  • Promote research through both private and public funding sources, to accurately identify, diagnose and treat RSDS
  • Allows the Commissioner of Health and Senior Services to accept and expend any grants, awards or other funds to be made available for the bill’s purposes.

    “One of the main reasons that approval of this legislation is so important is because RSDS is commonly undiagnosed or misdiagnosed,” said Bruce Shapiro, Assemblyman Panter’s chief of staff. “For many patients, they may go months or years without being properly diagnosed because there is no single test such as a blood test that can be performed to diagnose RSDS. Despite the fact that RSDS has been around since the Civil War, many people still have never heard of this disease.”

    Shapiro said he also became involved with the legislation as a result of his father being diagnosed with RSDS following a car accident in 2002.

    “However, since then, I have met and spoke with so many people, both in New Jersey and around the country and the world for that matter, who have RSDS that getting approval of this bill is as much for all of them as it is for my father now,” Shapiro said.

    Brilliant said he is “moved” by the support of state legislators, as well as the first time he read his daughter’s speech.

    “I started to cry when I heard her read the first draft, Brilliant said. “It really hit home.”

  • Pamela Sroka-Holzmann can be reached at (908) 707-3155 or psroka@c-n.com.

    At a glance:

    Reflex Sympathetic Dystrophy Syndrome (RSDS) or Complex Regional Pain Syndrome (CRPS) is a malfunction of part of the nervous system. Nerves misfire, sending constant pain signals to the brain. It develops in response to an event the body regards as traumatic, such as an accident or a medical procedure. This syndrome might follow 5 percent of all injuries. The condition can be mild or severe. It affects between 200,000 and 1.2 million Americans.

    For more information, visit the Reflex Sympathetic Dystrophy Syndrome’s Web site at http://www.rsds.org.

    For more information about the Reflex Sympathetic Dystrophy Syndrome (RSDS) Education and Research Program Act, visit http://www.njleg.state.nj.us/2006/Bills/A4500/4208_I1.PDF.

  • Click Here For The Original Article Online.

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    Disorder puts patients in cycle of pain


    Lacey Berardi (right) and her mother, Vicki Walker, discuss Lacey’s experience with reflex sympathetic dystrophy syndrome, a chronic pain disorder.
    Randy Griffith / The Tribune-Democrat

    Disorder puts patients in cycle of pain

    BY RANDY GRIFFITH
    The Tribune-Democrat

    It is a pain that has been compared to undergoing an amputation without anesthesia.

    Characterized by chronic pain without apparent cause or specific treatment, reflex sympathetic dystrophy syndrome, or RSD, can strike at any age.

    “For a while, I thought I was going to die,” said Marci Carlson of Southmont.

    “There is a limit on how much pain your body can take, right?”

    In five days, RSD took 11-year-old Lacey Berardi from having a limp to needing crutches, then a wheelchair, to being bedridden, said Vicki Walker, her mother.

    “People who don’t have it can’t say they understand because they don’t,” Lacey, now 13, said at their Dormer Street home in Parkhill.

    “It’s the worst thing you can imagine.”

    Also called Complex Regional Pain Syndrome, or CRPS, the condition is considered the most severe of all chronic pain disorders. It also is one of the more difficult to diagnose, said Dr. David Carlson, Marci Carlson’s husband and chief medical officer for Conemaugh Health System.

    “That’s one of the typical problems with CRPS,” he said. “It often gets diagnosed later, rather than sooner.”

    Despite his years of experience in family medicine and hospital administration, David Carlson was frustrated in early efforts to help his wife identify and find help for her pain.

    The disease strikes the sympathetic nervous system, also known as the fight or flight nervous system, which controls the body’s response to pain and emergency. It often follows an injury, but the pain is out of proportion to the damage, Carlson said.

    “Injury sets up painful stimuli, but in RSD, the stimuli become abnormal,” Carlson said. “It sets up a cycle where it keeps getting worse and worse and worse. Normal things won’t make it go away.”

    Marci Carlson’s pain started after her second elbow surgery.

    “I knew something was very wrong,” she said.

    “It kept getting worse and worse and worse.”

    Doctors tried pain medicine and other tests, to no avail.

    “Finally, I went to a neurologist,” Marci Carlson said. “He said, ‘I know exactly what’s wrong: You have RSD.’ ”

    In some patients, skin becomes discolored or warm; in others, skin may become more sensitive, swell, or have changes in texture. But the key symptom is continuous, intense pain, according to the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.

    The syndrome originally was identified among Civil War soldiers recovering from horrific wounds on the battlefields of Gettysburg, David Carlson said – back then, it was called causalgia.

    Lacey’s pain developed in her back and later was linked to repetitive stress injury from cheerleading. Doctors treated her for a bruised kidney, giving her strong doses of ibuprofen, blood-thinning pain medicine that actually caused her some kidney problems, her mother said.

    “We went to the emergency room three times due to pain,” Walker said. “Every time, she left in the same condition she went in.”

    In December 2005, Lacey entered Children’s Hospital of Pittsburgh. A battery of tests confirmed RSD.

    “In medicine, we are used to making diagnoses with lab work or X-rays,” said Dr. Paul Rosen, clinical director of rheumatology at Children’s.

    “There is no lab test or X-ray for RSD. It is a diagnosis of excluding all the other possibilities.”

    Treatment is even more complicated and less precise. What works for one patient will not be effective for another, David Carlson said. Both Marci Carlson and Lacey were put on series of painkillers and nerve blockers.

    “The theory is that if you stop this crazy loop of pain for a period of months, you can make it better,” Marci Carlson said. “There is remission.”

    Other treatments include anti-seizure medicine and antidepressants, David Carlson said. An experimental treatment in Europe involves putting patients into comas for several days and hoping they wake up pain free.

    “You are trying anything you can to interrupt the pain cycle,” he said.

    Marci Carlson has found relief in technology that disrupts the nerve signals that create the pain. Surgeons inserted a spinal-cord stimulator, essentially an implanted electrode that targets the area of the spine connected to the source of the pain.

    Lacey’s remission came after several weeks of intense exercise therapy at The Children’s Institute in Pittsburgh. The daily, drug-free regimen is so intense, parents aren’t allowed to watch.

    “At first, I wanted to quit. It hurt so bad,” Lacey said. “It was really, really worth it. I’ve been pain free for a long time.”

    Conemaugh and its John P. Murtha Neuroscience and Pain Institute have several programs for RSD in adults, David Carlson said. Interventional pain management specialists work closely with patients and other specialists to diagnose and treat the condition.

    Because the condition affects so many areas, Carlson said the local hospital does not have the resources for serious RSD cases in children.

    Rosen’s work is part of Children’s extensive pain management program, which is gaining recognition and patients from throughout the Eastern U.S., he said.

    Lacey urges patients to stick with the treatment: “Don’t give up. It’s like my teacher says: You can’t say you are going on a diet and have someone else eat right and exercise for you. You have to do it yourself.”

    Recognition ‘problematic’

    When Lacey Berardi of Parkhill said her back hurt, her cheerleading coach thought she was trying to get out of practice.

    “Every time I complained about it, I had to do 20 pushups,” the 13-year-old reflex sympathetic dystrophy patient said.

    The lack of understanding is not limited to coaches. Many physicians miss the painful disorder, said Dr. David Carlson, chief medical officer at Conemaugh Health System.

    “Early recognition remains problematic,” Carlson said at his Memorial Medical Center office in Johnstown. “It can be very hard.”

    As the husband of a reflex sympathetic dystrophy patient, Carlson understands the need to raise awareness among physicians. Although the disorder is characterized by intense, burning pain, specific symptoms vary from patient to patient and even from month to month for a patient.

    “It is not necessarily at the top of the mind,” Carlson said.

    “There is not one single hallmark of the disease.”

    Lacey and her mother, Vicki Walker, have seen the problem. It took several months and three emergency room visits before Lacey found understanding from doctors at Children’s Hospital of Pittsburgh.

    Walker’s advice to doctors: “If you don’t know, refer.”

    Both Lacey and Carlson’s wife, Marci, stressed the need for more research into the condition. Lacey said she’d like to organize a support group for RSD patients and help raise public awareness.

    The pain affects every aspect of the patient’s life, extending into the entire family, Lacey said.

    “I got my first ‘C’ and my second ‘B,’ ” she said, adding that her friendships also suffered.

    “Your mind begins to turn,” Lacey said. “You become an angry person.”

    Her school, Conemaugh Valley High School, allowed her to wear shorts beyond the November deadline because fabric aggravated her skin pain. She was given extra time between classes and a student helper when she was using crutches. But she warns friends, family and school officials that the help can go too far.

    “I don’t like them making me feel different and left out,” Lacey said.

    “I can deal with it. I don’t like when people say you are different.”





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    Painful nerve condition can affect entire family

    Painful nerve condition can affect entire family

    By PAMELA SROKA-HOLZMANN
    STAFF WRITER

    HILLSBOROUGH — Living with Reflex Sympathetic Dystrophy Syndrome can be a new experience not just for the person diagnosed but for families who also adapt to the disorder’s conditions.

    Stephen Brilliant, who was diagnosed in 1997, and his wife, Antoinette, said a major challenge was deciding whether to have more children — at the time of the diagnosis, they had one daughter. They went on to expand their family with two more children: Nathaniel, now 11, and Jacqueline, 7, but gave up their dreams to try for a fourth child, Antoinette Brilliant said.

    The couple’s youngest children have learned they can’t “play rough” with their father or rub against him the wrong way because they could hurt him. Their older daughter, Anna, 13, is old enough to recall when her father wasn’t in as much pain as he is now.

    “All family members live with it, not just the person in pain,” Antoinette Brilliant said.

    When the couple vacationed at Walt Disney World in 2001 and in 2005, Brilliant missed out on roller-coaster rides and other experiences he once enjoyed.

    “If it is 80 degrees during the day and drops to 60 degrees overnight, his foot will start throbbing immensely,” Anna said.

    When describing a recent snowstorm, Anna said, “When we all woke to the beautiful snow, my dad had already been in pain due to the pending weather change. I swear my dad can predict the weather!”

    While RSDS is not genetic, the family also had a scare when Anna was a fourth-grader about four years ago and began to develop similar painful symptoms when she sprained her ankle during a physical fitness test in gym class. Once Anna thought the ankle healed, she resumed her usual activities of ice skating and other sports.

    “I ran around at recess and played softball. This unfortunately made my ankle worse,” Anna said. “So I went to three more doctors in New Jersey and New York. They all said that I had nerve damage, but it might be something more. I had to stop skating. I couldn’t participate in gym the whole third marking period and wasn’t allowed to run around anymore.”

    Anna then saw Dr. Alyssa Lebel, an anesthesiologist and neurologist at the Boston Children’s Hospital in Massachusetts, who confirmed the youngster only had peripheral nerve damage and not RSDS. Anna then had physical therapy three times a week for about 18 weeks. Then, for about another year, she had physical therapy once a week. Today, she can enjoy physical activities again but knows her father isn’t as fortunate.

    In helping other families cope with these and other changes, the family attends group support sessions monthly at Somerset Medical Center in Somerville. The sessions, “Living With RSDS,” help the family share experiences with others who have been diagnosed with the disorder. About 50 members throughout Central Jersey attend the support sessions.

    In the fall, the group took its efforts a step further and planted about 200 flower bulbs in pots, then sold the plants to various Central Jersey medical offices to raise awareness about RSDS. The group raised about $2,000 im various fundraising efforts to help other families with the disorder get the services they need.

    “I am living with RSDS, even though I don’t have it,” Antoinette Brilliant said. “I’ve been through everything with my husband. It gave us a different perspective on what’s important in life.”

    Brilliant said that for those who think they might have RSDS, early diagnosis is critical. His advice to those who have been diagnosed: “Don’t give up and keep going. That’s very important because I can see the difference with people with positive attitudes and those who don’t have positive attitudes.”





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