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  1. #1
    Join Date
    Feb 2007
    Posts
    41

    Default Best Treatment For L5-S1 Disc Degeneration and Bulge with Moderate Pain

    (This was also posted in "injured workers forum")

    My lower back injury happened approximately 60 days ago. It was reported immediately to my HR dept and I visited a doctor about 2 weeks after the injury. I am covered under NJ Workers Compensation.

    The first 3 weeks the pain was significant down one leg. The first doctor took me out of work and prescribed meds and 2 wks of PT.

    Symptoms:
    1. Lower back (mostly knot feeling in butt)
    2. Siatica down leg (extreme)
    3. Feeling of numbness in foot

    After Physical Therapy the Siatica in the leg reduced significantly. I learned to compensate my activity for less pain. 60 days later the pain has lessened although it remains to be consistant in the butt area and the numbness in the foot continues. The pain is about a 5.5 on a scale of 1-10. I would consider the pain mild to medium. It's not excrutiating pain, I am able to get around, drive, bend and pickup things. I can sleep with meds. I can induce the pain by stepping up my activities. Of course I am taking it easy and going slow and being very careful. Still out of work.

    MRI reads L5 - S1 disc degeneration with concentric prominent disc bulge with central focal disc protusion with slight left paracentral asymmetric irritation towards the left S1 nerve root with the .......

    Now I'm with a back specialist (orthopedic) who finds my symptoms classic. Again, I consider the pain to be mild yet the pain shouldn't be there either. The doctor is recommending Injections (steroid/epudoral?) under X-ray assistance. He's not recommending surgery yet, although I asked and he explained the simple procedure that would reduce the bulge of the disc that is pressing against the nerve.

    The doctor says that my options include leaving it alone, injections, or possibly surgery. He also advised that I could continue with the pain, but since I am lucky enough to be covered by the insurance that I could have it addressed. BTW, this particular doctor is a well respected doctor in my community (not just a run-of-the-mill WC doctor) and is also a well respected former employer of my mother-in-law.

    Do I need a lawyer?

    - My doctor told me to call and schedule the injection.
    - He did not schedule another visit during my last visit.
    - He also gave me a Patient's Work Status of Temporary Total Disability.

    I have not yet scheduled the injection. I needed to research first and see what I was getting into. I want to weigh out whether the medium pain and numbness in the foot that I am experiencing was bad enough to warrant the injection.

    1. Could the injection worsen the existing pain (beyond 48 hours)?

    2. Could the injection create new complications (beyond 48 hours)?

    2A. I'm a whimp , is this injection uncomfortable? (like taking blood?)

    3. If the injection works, is it possible that the numbness will reduce?

    4. What happens with the WC (NJ) if I choose not to do the injection?

    5. What happens with the WC (NJ) if I delay the injection?

    6. At this point how long at minimum should my employer expect me to be out?

    Thank you.

  2. #2
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    636

    Thumbs up Re: L5-S1 disc degeneration / disc bulge / pain is moderate / Injections? what to do?

    Dear NJWC,

    Hi I do understand everything that you have explained. I will say that you are now receiving more WC benefits than required by NJ WC law. As the injections are considered palliative treatment which is NOT covered under NJ WC law.In NJ the only care required to be renedered is corrective care, such as any treatment designed to correct the defect. The injections are only treating the symptoms and not the defect so therefore does not meet the requirements under the law. Your employer could at this point ask for a MMI from the treating DR then stop your TTD payments!!!!!!!!!!

    The injections of steroids is a safe conservative approach to back pain. Your condition is considered DDD Degenerative Disk Disorder. A lawyer will tell you the same thing I am telling you, at least if he/she has a clue as to what the NJ WC law says.I do think the injections is a reasonable recommendation and if you can get WC in NJ to pay for it I feel its the way to go. I will address each of your questions:


    1. Could the injection worsen the existing pain (beyond 48 hours)? YES THE PAIN COULD WORSTEN FOR MAYBE 7 DAYS BUT IF YOU DONT GET RELEIVE DONT WORRY YOU MAY NEED THE ENTIRE SERIES OF 3 INJECTIONS TO GET NOTICEABLE RELEIVE. IF AFTER THE SERIES YOU DONT GET ANY RELEIVE THEN MOST LIKELEY YOU WILL NOT RESPOND TO STEROID INJECTIONS

    2. Could the injection create new complications (beyond 48 hours)? YES ANY MEDICAL PROCEDURE CAN HAVE SIDE EFFECTS. BUT THEY ARE RARE IN STEROID INJECTIONS IF DONE BY A QUALIFIED MD. YOU MAY EXPERIENCE NUMBNESS DOWN THE TREATED NERVE ROUTES

    2A. I'm a whimp , is this injection uncomfortable? (like taking blood?) THEY ARE SOMEWHAT UNCOMFORTABLE, BUT FOR THOSE WHO DO GET RELEIVE ITS MUCH BETTER THAN SUFFERING FROM THE ORIGINAL PAIN THAT HAS SENT YOU THERE IN THE FIRST PLACE THATS 4 SURE!!!!!!!!!

    3. If the injection works, is it possible that the numbness will reduce? YES YOU MAY RECOVER TOTALLY WITH THESE INJECTIONS. EXPERIENCE HAS TOLD ME THE SOONER YOU GET TREATED THE BETTER THEY WORK, SO DONT WAIT!!!

    4. What happens with the WC (NJ) if I choose not to do the injection? LIKE I HAVE SAID YOUR EMPLOYER HAS ALLREADY EXCEEDED WHAT THE LAW SETS FORTH SO IF YOU CHOOSE TO DECLINE THE RECOMMENDATIONS OF THE TREATING DR I WOULD IMAGINE THE EMPLOYER WILL ASK FOR THE MMI (MEDICAL MAX IMPROVEMENT) STATUS, AND THIS WILL END YOUR TTD BENEFITS AS WELL AS YOUR MEDICAL CARE

    5. What happens with the WC (NJ) if I delay the injection? SEE #4

    6. At this point how long at minimum should my employer expect me to be out? WELL HE SHOULD BE EXPECTING YOU BACK VERY SOON!!!!!!!!!!!


    Hope this helps if you have any questions look me up or I will try to check this board

    Bug

    Quote Quoting njwc View Post
    (This was also posted in "injured workers forum")

    My lower back injury happened approximately 60 days ago. It was reported immediately to my HR dept and I visited a doctor about 2 weeks after the injury. I am covered under NJ Workers Compensation.

    The first 3 weeks the pain was significant down one leg. The first doctor took me out of work and prescribed meds and 2 wks of PT.

    Symptoms:
    1. Lower back (mostly knot feeling in butt)
    2. Siatica down leg (extreme)
    3. Feeling of numbness in foot

    After Physical Therapy the Siatica in the leg reduced significantly. I learned to compensate my activity for less pain. 60 days later the pain has lessened although it remains to be consistant in the butt area and the numbness in the foot continues. The pain is about a 5.5 on a scale of 1-10. I would consider the pain mild to medium. It's not excrutiating pain, I am able to get around, drive, bend and pickup things. I can sleep with meds. I can induce the pain by stepping up my activities. Of course I am taking it easy and going slow and being very careful. Still out of work.

    MRI reads L5 - S1 disc degeneration with concentric prominent disc bulge with central focal disc protusion with slight left paracentral asymmetric irritation towards the left S1 nerve root with the .......

    Now I'm with a back specialist (orthopedic) who finds my symptoms classic. Again, I consider the pain to be mild yet the pain shouldn't be there either. The doctor is recommending Injections (steroid/epudoral?) under X-ray assistance. He's not recommending surgery yet, although I asked and he explained the simple procedure that would reduce the bulge of the disc that is pressing against the nerve.

    The doctor says that my options include leaving it alone, injections, or possibly surgery. He also advised that I could continue with the pain, but since I am lucky enough to be covered by the insurance that I could have it addressed. BTW, this particular doctor is a well respected doctor in my community (not just a run-of-the-mill WC doctor) and is also a well respected former employer of my mother-in-law.

    Do I need a lawyer?

    - My doctor told me to call and schedule the injection.
    - He did not schedule another visit during my last visit.
    - He also gave me a Patient's Work Status of Temporary Total Disability.

    I have not yet scheduled the injection. I needed to research first and see what I was getting into. I want to weigh out whether the medium pain and numbness in the foot that I am experiencing was bad enough to warrant the injection.

    1. Could the injection worsen the existing pain (beyond 48 hours)?

    2. Could the injection create new complications (beyond 48 hours)?

    2A. I'm a whimp , is this injection uncomfortable? (like taking blood?)

    3. If the injection works, is it possible that the numbness will reduce?

    4. What happens with the WC (NJ) if I choose not to do the injection?

    5. What happens with the WC (NJ) if I delay the injection?

    6. At this point how long at minimum should my employer expect me to be out?

    Thank you.

  3. #3
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    636

    Default Re: L5-S1 disc degeneration / disc bulge / pain is moderate / Injections? what to do?

    I did want to make an addition to what I have said just to be clear on point. The first series of epidural steroid injections can be considered as reasonable corrective care under NJWC. However an employer can ask for the MMI afterwards or they can continue to support the injured worker by providing TTD while they wait for the time to pass for the patient to get the 2nd series of injections. It would be up to the employer, in my case my employer afforded me 1 injection and after it failed to produce results my employer asked the treating Dr for MMI and got it!! ( I understand I was lucky to get the one) There may have been something to this because years later I tried the injections again with the same results NONE actually I was unable to walk for the first 7 days afterwards then returned to my normal chronic pain


    Quote Quoting bugmann View Post
    Dear NJWC,

    Hi I do understand everything that you have explained. I will say that you are now receiving more WC benefits than required by NJ WC law. As the injections are considered palliative treatment which is NOT covered under NJ WC law.In NJ the only care required to be renedered is corrective care, such as any treatment designed to correct the defect. The injections are only treating the symptoms and not the defect so therefore does not meet the requirements under the law. Your employer could at this point ask for a MMI from the treating DR then stop your TTD payments!!!!!!!!!!

    The injections of steroids is a safe conservative approach to back pain. Your condition is considered DDD Degenerative Disk Disorder. A lawyer will tell you the same thing I am telling you, at least if he/she has a clue as to what the NJ WC law says.I do think the injections is a reasonable recommendation and if you can get WC in NJ to pay for it I feel its the way to go. I will address each of your questions:


    1. Could the injection worsen the existing pain (beyond 48 hours)? YES THE PAIN COULD WORSTEN FOR MAYBE 7 DAYS BUT IF YOU DONT GET RELEIVE DONT WORRY YOU MAY NEED THE ENTIRE SERIES OF 3 INJECTIONS TO GET NOTICEABLE RELEIVE. IF AFTER THE SERIES YOU DONT GET ANY RELEIVE THEN MOST LIKELEY YOU WILL NOT RESPOND TO STEROID INJECTIONS

    2. Could the injection create new complications (beyond 48 hours)? YES ANY MEDICAL PROCEDURE CAN HAVE SIDE EFFECTS. BUT THEY ARE RARE IN STEROID INJECTIONS IF DONE BY A QUALIFIED MD. YOU MAY EXPERIENCE NUMBNESS DOWN THE TREATED NERVE ROUTES

    2A. I'm a whimp , is this injection uncomfortable? (like taking blood?) THEY ARE SOMEWHAT UNCOMFORTABLE, BUT FOR THOSE WHO DO GET RELEIVE ITS MUCH BETTER THAN SUFFERING FROM THE ORIGINAL PAIN THAT HAS SENT YOU THERE IN THE FIRST PLACE THATS 4 SURE!!!!!!!!!

    3. If the injection works, is it possible that the numbness will reduce? YES YOU MAY RECOVER TOTALLY WITH THESE INJECTIONS. EXPERIENCE HAS TOLD ME THE SOONER YOU GET TREATED THE BETTER THEY WORK, SO DONT WAIT!!!

    4. What happens with the WC (NJ) if I choose not to do the injection? LIKE I HAVE SAID YOUR EMPLOYER HAS ALLREADY EXCEEDED WHAT THE LAW SETS FORTH SO IF YOU CHOOSE TO DECLINE THE RECOMMENDATIONS OF THE TREATING DR I WOULD IMAGINE THE EMPLOYER WILL ASK FOR THE MMI (MEDICAL MAX IMPROVEMENT) STATUS, AND THIS WILL END YOUR TTD BENEFITS AS WELL AS YOUR MEDICAL CARE

    5. What happens with the WC (NJ) if I delay the injection? SEE #4

    6. At this point how long at minimum should my employer expect me to be out? WELL HE SHOULD BE EXPECTING YOU BACK VERY SOON!!!!!!!!!!!


    Hope this helps if you have any questions look me up or I will try to check this board

    Bug

  4. #4
    Join Date
    Feb 2007
    Posts
    775

    Default Re: L5-S1 disc degeneration / disc bulge / pain is moderate / Injections? what to do?

    There is no clinical indication for reapeating the ESI's although there may well be a financial one. If there is no response after injection number two then there is no reason to continue to the third. At least according to the Pain literature.

  5. #5
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    636

    Default Re: L5-S1 disc degeneration / disc bulge / pain is moderate / Injections? what to do?

    I do agree with you if the first and second in a series of ESI dont give relieve the third is not recommended. However if after years of suffering and the pain is still strong and disabling many chronic pain patients have received good to excellent relieve by repeating the ESI series again because now you are in a different part of your recovery. There are just some who may never respond to ESI. Each patient is different and to use only one "standard rules such as mention may leave a patient suffering for years.

    I am sure there is evidence that supports attempting ESI later in recovery is recommended when the first series failed. I am not a DR but have had chronic LBP for many years and this was my findings through the years. I think we are talking about two different aspects of ESI. I agree with you if after the second injection there is no need for the third in series, but it is a good idea to retry this care later in recovery as there are many pain patient who have responded after the first series had failed.

    Good luck with you future care

    BUG


    Quote Quoting POR View Post
    There is no clinical indication for reapeating the ESI's although there may well be a financial one. If there is no response after injection number two then there is no reason to continue to the third. At least according to the Pain literature.

  6. #6
    Join Date
    Feb 2007
    Posts
    41

    Default Re: Best Treatment For L5-S1 Disc Degeneration and Bulge with Moderate Pain

    UPDATE L5-S1 DDD

    2 injections have been performed with no reasonable positive results. It was determined not to proceed with the 3rd.

    Symptoms remain the same and worsen with activity.

    TTD continues

    I now have a follow-up DR appointment where I expect to get the recommenation of surgery.

    - Should I schedule a 2nd opinion? My own DR or a WC DR?
    - WC is trying to get me to see another WC Dr - They claim he's "very good". Why would they do this? Should I see this DR for a 2nd opinion? WC says it's completely up to me.


    Employer:

    I'm a 20 year employee. Loyalties have changed significantly over last 4 years and stress had grown significantly as well. The 1st 16 years I experienced GOOD STRESS - it was exciting and fun. The last 4 years have been BAD STRESS (rough leadership, dropping morale, business growth slow, etc.) Suddenly 3 of my co-workers are also using WC or STD for various reasons. I had never experienced injuries prior to this one and I had rarely taken advantage of sick days. Now I've been out under TTD for nearly 4 months so far. I've stayed in constant contact with the HR rep from my company (it's a small company). I've heard through the rumor mill that one of the owner's mentioned, in mixed company, that [I] will not be returning to work. I have never mentioned anything to suggest that I intend on leaving. Regardless, what are the possibilities? I know that in NJ that I can be fired. When can an employee be fired while on TTD? What reasons can (or cannot) they fire an employee for in NJ?

    Is it time to get a WC attorney? How do I find a legitimate attorney? What should I expect to spend?

    Thanks.

  7. #7
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    636

    Default Re: Best Treatment For L5-S1 Disc Degeneration and Bulge with Moderate Pain

    Hey NJWC,

    Sorry to hear that you are still having back issues and at the level of suffering that u report. I think having the 3rd injection after the first 2 failed was an appropriate move, as these do have risks and most likely will not help at this point. However if you find yourself still hurting like this in a year or two you owe it to yourself to try the injection series again, you may be surprised at how you feel?? Its just a horrible way to live (that is in severe chronic back pain)

    As long as the treating dr rates you TTD your benefits & medical care will continue.If you ask me I would NOT see another treating DR as the opinion of the treating Dr will dictate your legal status on WC. This new Dr may choose to rate you at MMI which will end your TTD and medical care under WC.Its up to you but in NJ there are some Drs who are selected because they are what I call comp puppets and lean your care in the light that favors the payer.

    If it were my back getting cut I would certainly get another opinion, but you may have to pay for it out of your pocket, unless surgery is suggested there may be an automatic 2nd opinion required to support the surgery, I cant be sure if this is the case in nj. but I dont think they have the 2nd opinion rule in NJ.

    I will say that your loyalties are meaningless in a legal sense as far as what will happen under the law, yes its cruel but true!! It is your responsibility to remain in contact with the employer during WC.I would agree with the owner that if you dont have surgery and have been out 4 months chances are good that you have reached your medical max improvement and its only a matter of weeks before a Dr suggests this as well.At that time you will be given the FCE to see if you are able to return to work, need to find a new line of work, or if you are disabled from work all together.

    You can be fired on wc in NJ after 12 weeks which are guaranteed in the FMLA, how ever I strongly suggest that you NEVER sign the FMLA for a work injury as you may forfeit some rights you have under WC. You can be fired after 12 weeks if you are unable to perform your job description. You can NOT be fired based on discrimination.

    Well your outcome medically will determine if you need a legal EXPERT. Your employer will lose tolerance for your situation, and may just send you to this Dr they have suggested, as they know what his plan is.and is legal, unless you are covered by a work agreement that says other? You must report for each and every Dr appointment or risk having your case dismissed completely

    I can connect you with the leading authority in disability/WC, and can be verified by any WC JUDGE.! You will want the best if you are unable to return to work, I also have a check list to use when interviewing lawyers BEFORE you hire, but I am sure of my recommendation in NJ WC. If you want this please send me a message as many boards prohibit posting of lawyers as it would bring out all the blood suckers looking for a fast quick settlement, which you dont want

    I hope that you begin to improve and soon can return to work as that is the most convenient thing to happen, but convenience is not always the case. Good luck my friend!!

    BUG





    --------------------------------------------------------------------------------
    See what's free at AOL.com.


    Quote Quoting njwc View Post
    UPDATE L5-S1 DDD

    2 injections have been performed with no reasonable positive results. It was determined not to proceed with the 3rd.

    Symptoms remain the same and worsen with activity.

    TTD continues

    I now have a follow-up DR appointment where I expect to get the recommenation of surgery.

    - Should I schedule a 2nd opinion? My own DR or a WC DR?
    - WC is trying to get me to see another WC Dr - They claim he's "very good". Why would they do this? Should I see this DR for a 2nd opinion? WC says it's completely up to me.


    Employer:

    I'm a 20 year employee. Loyalties have changed significantly over last 4 years and stress had grown significantly as well. The 1st 16 years I experienced GOOD STRESS - it was exciting and fun. The last 4 years have been BAD STRESS (rough leadership, dropping morale, business growth slow, etc.) Suddenly 3 of my co-workers are also using WC or STD for various reasons. I had never experienced injuries prior to this one and I had rarely taken advantage of sick days. Now I've been out under TTD for nearly 4 months so far. I've stayed in constant contact with the HR rep from my company (it's a small company). I've heard through the rumor mill that one of the owner's mentioned, in mixed company, that [I] will not be returning to work. I have never mentioned anything to suggest that I intend on leaving. Regardless, what are the possibilities? I know that in NJ that I can be fired. When can an employee be fired while on TTD? What reasons can (or cannot) they fire an employee for in NJ?

    Is it time to get a WC attorney? How do I find a legitimate attorney? What should I expect to spend?

    Thanks.

  8. #8
    Join Date
    Apr 2007
    Posts
    35

    Default Re: Best Treatment For L5-S1 Disc Degeneration and Bulge with Moderate Pain

    Hi ,
    Hope this fines you doing a little better at least, I also work and live in NJ and I'm on workers comp. No they don't have a second opion rule here but some of the comp managers will have a second opion done for you . I had the same problems with I was hurt on the job but I had fractured spine in L1 in march 2006 they sent me back to work sept.2006 I lasted six weeks and the comp dr. pulled me back out as i was in bad pain as well as having alot of problems with my back. they ran all kinds of test and decided they needed to do surgery to take care of my problem as i had the injections but they did not help me at all. I had the spinial surgery to fuse the spine from L3 up to T11 so that was alot of area i have not done to good since the surgery. I'm now in PT which i was doing good with till one of the therapist streched me to hard and messed me up two weeks into my PT.now with five weeks gone i have just as much pain as i had in the beginning before the PT started.I have numbness in the buttox now that i never had in the beginning and bad leg cramps as well as alot of extended pain from what i did have the bad part with me is i'm allergic to steroids and tylenol so there is not to much they can do for my pain. I pray to go back to work this year in sept. when school goes back. as I'm tired of being in pain and tired of being home I don't see where anything they are doing is helping me.

    But this is my story with dealing with workers comp here in NJ . Hope you don't have problems with them I don't have any problems with them at all my case manager is really nice and gets everything done fast.my test she is told today and it is done with in three days , I'm picked up everyday for my PT and Dr.appointments but that is because my job covers that part when you have appointments they will pay for your travel.comp don't pay that at all. let me know how your doing you can email me direct if you would like to ask any questions Barbara413483@aol.com

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