Now what do i do?
 

:confused: Now i am having even more trouble! The W/C carrier hired a case manager, who is also a nurse, to tag along to the doc visits and schedule the tests. According to her, the only way to tell if i truly have RSD/CRPS is if the stellate ganglion block completely takes my pain away? Does this sound right? Especially since the doc already diagnosed me? I read on the RSD foundation site, as well as several personal stories on here that some people get several of these procedures done with no relief. So this tells me that she is wrong about that, but i may be wrong. The list of symptoms i have are swelling and discoloration of the hand with numbness/tingliness, painful stiff joints, loss of muscle tone in arm, burning pain through up past shoulder and into neck, somewhat sensitive to touch, cold, etc. Someone maybe let me know if this is it, and what i should do about this case man. Thanks

Hi Steve,
 

A lot of those symptoms go with Thoracic Outlet Syndrome. Have they considered that. RSD can come with it if you have surgery but I believe I had the RSD along with the TOS even before the surgery.

We have a Thoracic Oultet site also. You might want to go over there and read some of the stories on it to see if that might be your problem or at least part of it.

Ada

I know it can be VERY frustrating dealing with WC. I do not believe she is correct as I don't believe there is any procedure out there that can 100% diagnose RSD...but they should rule out everything else first. Which isn't a bad thing because if it turns out to be something that can be treated then that's a GOOD thing.

But as for the case manager...I had one of those. The best advice that I was given was to not worry about the things that are not in your control and just do what you need to do that IS in your control to get correct treatment. The case manager is NOT a doctor...if the DOCTORS say you have RSD and that you need certain treatments that THAT is what matters. She/He can say whatever they want as a case manager...but what matters is what the doctors say. Don't let them twist you up...that's what they do. Just stay focused on the doctors and your treatment and ignore the case manager.

I've had WC people try to diagnose me over the phone and it's just garbage. One even had the nerve recently to say that my symptoms sounded like I was PREGNANT! They will do/say anything to get you twisted up...so just realize that's their game. They are not doctors. When it comes to a judge in court...they're going to look at what the doctors say and ignore the "theories" of nurse case managers.

So take it easy and try not to stress too much. Focus on what IS in your control and go with the flow on the stuff out of your control because it's not worth stressing over. WC is just awful (in my experience anyway)...don't let them get to you. Focus on your health and your treatment.

Did you get a laywer yet?????

Hi Steve, Remember that she is doing what she is paid to do, work for the insurance company and not for you. Refrain from any casual conversation with her as anything you say can and will be held against you. It is kind of like an IME where the docs say what they are paid to say. Fortunately WC knows this and your own doctor's report and findings will carry more weight if you have to go to hearing. You don't say what state you are from, but I have been having the fun filled WC adventure for over 8.5 years. Stay cool and be your own best advocate.SandyRI is right, find an attorney soon, the system is too difficult for a person to navigate on their own. My son is an attorney and he won't touch my case because he knows that he does not have the specialized training to negotiate the system ( so glad I paid for college!). Be cool and good luck, Lisa

I did hire one
 

To answer your question, yes i did hire an attorney. He is experienced in handling RSD/CRPS cases, along with W/C. Also, I went a couple of days ago and had the stellate ganglion block. When I awoke from the procedure, my pain actually was almost gone. The doc said this was the numbing medication that he injected prior to the steroid. Unfortunately, I woke up the very next morning in more pain than I had to begin with. I called the anesthesiologist and he said this wasn't uncommon, and also agreed with the referring doc that I have every symptom of RSD, and gave me the official diagnosis. The case manager seemed very p.o.'d about this, and even tried to say that she still wasn't convinced. I had to remind her that she was a nurse and not even close to being a doctor, and her input wasn't worth the two cents she chipped in(HA HA!). If she wants to be like this, I will make her hate to come to my appointments, and even to speak to me. I am not a rude person, but it is so fun to treat the case mgr. and the insurance co. just as bad if not worse than they are treating me. So I do have another question, the case mgr. nurse says that there is no limit to the amount of blocks that they can give me, but the anes. doc. says he would try a couple more before he would stop. Does this sound right?

A doctor should ONLY perform a procedure if he thinks that it is medically necessary. They can make you see other doctors for other opinions...what they like to call INDEPENDENT medical evaluations...but what it really is is them shopping around for a doctor who will say what they want. The problem is that if your doctor thinks you need to do them then they may be able to say you need to do them. But if it increased your pain I am surprised that the doc would say he would do more. It's one thing if it does nothing...but another entirely if it made it WORSE.

I am so sorry that you have to go through this. Dealing with my own share of difficulties from work comp at the moment after complications after my lumbar sympathetic block. The funny (or ridiculous) part about when they make it seem like I am off for something not related to the initial injury is that as an executive manager I have 180 days of short term disability where they would pay me my FULL salary if it wasn't work related. Since I am paying my own medical bills at the moment through my own insurance...wtf? But until I know it's NOT related I'm not filling out any forms saying that it's a seperate thing.

Sorry... I have a tendency to go off on tangents. Just know you are not alone in this. You can post any time on this board and we will be here to support you. The sad truth is that the work comp comanies seem to see our pain as an advantage for them because it can make us make mistakes and get frustrated and just give up (some companies...not all). Hang in there and be careful with that case manager. It's easy to have your words twisted when it comes to something you said in anger. I just ignored mine and only answered direct questions. But yours may be trying to instigate something. Hang in there. I hope that the doctors are able to help you in this and take care of your pain.

Steve, as Lisa mentioned above, once you have a lawyer you shouldn't be speaking to anyone at WC at all...

didn't your lawyer tell you that?

From my experience, I only had a series of 3 nerve blocks. I too felt great right after the nerve block, but the pain always returned within 48hours so we only did a series to 3. Reason being was because it's effects were so short-term that the risks out weighed the benefits. After the nerve blocks I tried ketamine. I would look into that if the series of 3 dont work out for you.
I hope you get some long-term relief soon.
Sarah

From what I understand (not 100% sure) is that you can ask the doctor to make case mgr. wait outside the exam room for you to have privacy with doctor. I had a nurse case mgr. for my hands (bilateral everything is easier to say), she showed up once for the whole visit, which I did not care about, BUT she came for a second visit and get this, while waiting for the doctor to come in she tries chit chatting with me and then all of a sudden she goes completely pale and starts digging through her purse. this is how the rest of our chit chat went:

Nurse mgr: O my god, i forgot that i was supposed to call for jury duty today.

me: wow, well call them and explain your position and see if they can reschedule it for you. I believe we are allowed one reschedule w/in 6 months. (NYS)

Nurse mgr: do you think i should do that? or do you think i should lie and make up some excuse?

me: UUUMMM, honesty is the best policy.........

she ran out and i never saw or heard from her again!!! WTH!!

All the ones I have ever dealt with as far as WC goes are just crazy and love to twist words or to frazzle us. I had the one ask if I was pregnent because my symptoms fit pregnancy? Another went to great lengths to tell me in the parking lot that she couldn't come in because I had an attorney and she hadn't gotten permission yet but...oops...she gave her card to the doc already so could I explain to him why she wasn't there. So I did that...and the doc's work notes read like I mentioned my attorney on purpose and made a big deal out of it. That was first lesson learned. Just kept my mouth shut after that and let the doctor talk to that woman. You just can't act like a normal person around these people and it's sad.

steve6561, When i had my stellate blocks my Dr. told me they do help block the RSD cycle early on but if your RSD has become SIM(sympathetic independent pain) it wont help. That is why it is important to have blocks done early on. I know I had relief but not completely and by my last block i didnt get much relief at all. So just because a block doesnt work doesnt mean you dont have RSD.
You have the right to ask/tell the nurse to wait outside while you see the Dr. and then she can read the chart. A lot of Drs dont want the w/c nurse in there when they are talking to you. They can make the Dr. feel uncomfortable talking with you. If you get an attorney they will tell you dont let them in they can read the chart.

everyone get this!!!!
 

So, I finally told the case mgr. that she wasn't allowed in the doc's office with me. She said I had the right to do that and it was fine. So, I'm waiting in the office for the doc to come in, and hear the case mgr. talking with him, saying that she feels like I am taking too much pain medication. I hear him say to her, "So what are you wanting?" My heart dropped, as my suspicions of that case mgr. working with the ins. co. were finally proved. Now this is what I am taking, Neurontin 300mg 3xday, Vicodin ES- 1 to 2 every 4-6 hrs. as needed, and otc ibuprofen. The funny thing is that every time i get a new script, i have some leftover! I can understand that some people over do these meds and get addicted, but she straight-up called me an addict! So to make a long story short, I was taken off the vicodin, and told to take tylenol or aleve, and when I asked what if this wouldn't help, the doc's nurse simply replied, "well, then you will just have to be in pain"! Anyway halfway through the visit the case mgr. walks right in. I told her that I wanted privacy and she replied "you are finished here anyway" and the doctor sat and did nothing!
Then she asked yet again if this rsd could've flared up from 2 yrs ago when i broke my wrist, and the doc said there is no way to tell, but judging from my medical reports from the prev. injury, and evaluation by a pain mgt. doc whom said there was absolutely no way any chronic pain synd. was present, which i agreed. The only problem i had is they put a small pin in and from the incision, my skin was numb for a long time, and hurt now and again. The surgeon said this was normal due to the pin and the fact that i was on pain meds for 8 months consecutively, so i had "desensitized". Anyway back to the story at hand, the doc i saw told the case mgr. that if the prev. docs said i didn't have it then, then that was that. She kept repeating like a broken record, "but its possible right, but its possible right?" The doc said in these words, "anything is possible, but as for you and the ins. co. are concerned in a court of law if you cant prove one way or the other, but now the person has a condition from the latest injury, with a diagnosing doc's testimony, the decision will be in the injured person's favor most likely!" She seemed very upset and unconvinced. So, anyway thats whats happening now. If anyone has a good suggestion for me let me know! Thanks

My suggestion is to get an attorney (if you don't have one) and let them deal with this harassing woman. You do have a right to privacy with your doctor. She can read the notes after. If you feel she is dictating treatment to your doctor try to set up an appointment with the doctor to discuss how this is affecting you. As far as your pain and medication goes, she should not be able to tell your doctor what you should or should not have. Your attorney may have to start making calls or sending letters about her taking control of your appointments, medications etc. I would nip it now and do not be afraid of her. You control yourself and appointments and make that clear to her.

WC is EVIL! I find it unbelievable that a system that was set up to protect workers now does the most harm to them. I wish that I had back all of time I spent waiting for approvals, hearings and WC doctor appts. I am pretty sure that I would only be 46 instead of 50. Lisa

i so agree. Before i hired my attorney, i got into it on the phone with my adjuster (IC) and i asked her if it was her or her family member in this situation would she accept this kind of treatment? of course no response. I then told her that if it wasn't for people like us (unfortunately) she wouldn't have a damn job, i hung up on her!!!:mad: never spoke to her again thank god.

You might feel better after telling them off :cool:, but your still stuck with them til the claim is closed..:(
Just thinking - antagonizing them might make for more problems down the road.. the system is tough enough without making an enemy.

But I do think once you have an atty they should stop contacting you , unless it is something the atty OK'd an the atty should send a letter telling you what's happening. more or less.
I usually would receive copies of correspondence between my atty & the wc ins.

Definitely don't chit chat w/ the case manager, or your HR person at work, or anyone at work if you still go there or visit, as any of them might be loose lipped or even misspeak, and word will get repeated even if only by accident.

I just think it's better to keep mum on the wc case/claim, as well as any other activities at work or to anyone that might talk to coworkers.


TOS is not well known either and many symptoms do overlap with RSD - and many have both conditions, so if your pain & symptoms are mostly located in hands, arms and shoulders, neck it might be a good idea to read about it on our forum.
here is the link to the useful sticky thread , it has the main TOS medical websites & info sites listed in post # 1 - and much more info in the other posts too.
Thoracic Outlet Syndrome
Our Useful Links - Websites, Articles & Polls
http://neurotalk.psychcentral.com/thread84.html

Just in case you find it fits, or, if you might have both TOS & RSD then you need to have it added onto your claim as well as get proper treatment for it.

So very sorry that you have to deal with this all. I know that what you are saying brings back a lot of memories. It's just there game. Keep at it, vent to family and your lawyer and here, but just keep it professional with the case manager. I can tell you that nothing aggravates them more than you staying profession...the crazies don't know how to react to normal behavior.

Keep fighting for treatments to relieve your pain. You have the right to have your pain taken seriously. Don't read too much into your doctor asking what the case manager wants...that's a trick we even use in retail to get the crazies to shut up. Doctors don't like to deal with work comp any more than we do. That's why you need to fight for your treatments. Pain goes up, you go back to the doctor and tell them. They need to help you.

I know narcotics never helped with my pain so maybe the doc had other reasons for taking you off besides the work comp lady. There are other medications and it is all about finding the right "cocktail" so to speak. My first doc got it right on the first try...second doc switched everything and the pain went over the top (neurontin was absolutely useless for me). So maybe try asking the doctor for a different set of meds if the ones you are on don't help. That way it sounds less like "drug seeking" and more like you just need the relief and are willing to try anything. Read up on different things and bring in a list of things to go over with the doctor so that you can discuss if any of them are right for you or worth trying. This shows that you are really committed to getting relief from your pain and the case manager can't fault you for doing that.

Good luck with everything. All I can say is just keep at it...don't settle...and you will survive. I know it doesn't help with all the added stress...but you just need to keep at it and try not to think about them and focus on your treatment. Again...so sorry that you have to deal with any of this. I wouldn't wish it on the people I hate most in this world.

Sonny, I just try to remember that these people are just doing their job, like you and I did when we could work. I was in your angry place once, and once I thought it through it relieved a lot of stress. Like my grandma always told me, you can catch more flies with honey... Lisa

I agree. It was a mistake on my part back in 2006 (the beginning) to spout off at her. When I had to talk to her initially I was very calm and professional. I had all my ducks in a row. She asked me why I took so long to file the WC claim and that was a red flag to her. (3 months into the initial treatment with doctors and PT) It wasn't like I fell off a ladder and didn't report it, it was a repetitive motion syndrome that came on gradually. I simply said to her "Per the WC code in NY, I have 2 years to file." (Can't remember if it was 2 yrs. or 1 yr. but you get the point.) THAT right there set her tone with me. So I was nice, I tried to learn about WC and thought she was there to help me~ HA! I had never been in anything like this b4. So it was the next call I had to make to her and that is when I said what I said. Hung up and hired an attorney. I must say, now having my attorney, she doesn't skip a beat. Paid on time. authorizations go through in a day etc. BUT, this is my 2nd attorney. for the 1st attorney....it was useless! We all make mistakes, but regardless, I don't think they should take it personally and be rude to people, that was never in any of my job descriptions, even as a security guard, catching people stealing. I always treated them with respect...We never know somebodies story and should not judge on its face!:circlelove: