NEW SERVICE: Progressive Goal Attainment Program

I recently finished specialized training to provide a structured disability counseling program - Progressive Goal Attainment Program (PGAP) that may be helpful for more serious workers' compensation, auto, or liability cases and for those who are having difficulty moving past their disability. It is a 15-week program designed to result in Return To Work (or in more serious cases improved quality of life). It is based on science and has numbers to back it up.

Injured or disabled: If you are like my other clients you are probably feeling very overwhelmed and cannot see your way past your current disability. This structured program can help move you forward in small, manageable steps. Email me for a free consult marysevinsky@icloud.com.

Professionals: I imagine this service might be effectively used to settle more challenging cases. I would even go so far as to say it could be used in place of "traditional" vocational services.  Email me for a free consult marysevinsky@icloud.com.

Here is more info, if you are interested: 

https://www.pgapworks.com/en/whatisthepgap/index.php 

Email me for a Password marysevinsky@icloud.com

From the PGAPWorks.com website: 

The treatment objectives of the PGAP® proceed from the view that return to work is the highest level of independence that can be offered to someone with a debilitating health or mental health condition. 


The PGAP® is currently the most researched risk-targeted intervention designed to reduce disability associated with a wide range of debilitating health and mental health conditions. 


The PGAP® is considered to be one of the most cost effective approaches for reducing disability and fostering return to work in individuals who suffer from a wide range of debilitating health and mental health conditions. 


The PGAP® has been shown to be effective in facilitating return to work in individuals who have sustained musculoskeletal injuries, individuals with chronic low back pain and fibromyalgia, as well as individual with debilitating mental health conditions such as depression and post-traumatic stress disorder. 

View  a brief, informational video here:

https://www.pgapworks.com/en/whatisthepgap/index.php 

Email me for a Password marysevinsky@icloud.com

Mary Sherwood, MS, CDMS, CCM, Occupational Consultant

Progressive Goal Attainment Program (PGAP) Certified 

Landline 302.644.1827 | Mobile:  410.444.1989 | Skype Mary.E.Sherwood | Google Hangout Mary@Life-Works.Info

WHAT IS THORACIC OUTLET SYNDROME

According to the Mayo Clinic, "Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This can cause pain in your shoulders and neck and numbness in your fingers."

Sometimes an injured worker will develop this after an injury or trauma to the neck and shoulder area.  There can even be a long delay between the trauma and onset of symptoms.  Motor Vehicle Accidents and repetitive use are also potential causes for this syndrome. 

Physical therapy and treating the pain can often resolve the issue.  Your physical therapist will work with you to improve over all posture as this may help lessen numbness and pain in your arm and/or fingers. Nerve gliding is a necessary exercise that can be painful to perform, but benefits you in the long run as it loosens the nerve and may eventually relieve the compression. 

If physical therapy does not relieve the symptoms surgery may be recommended.  However, the surgery is considered risky and should be carefully discussed and considered. 

If you have been diagnosed with this syndrome or plan to seek care because you think you may have it, be prepared by having a list of questions to ask your doctor.  The Mayo Clinic provides a comprehensive list.  Not all will apply to you, but refer to it and decide which are important for you to discuss with your doctor. 

There are actually several types of Thoracic Outlet Syndrome, depending upon involvement of nerves, veins and arteries, or and undetermined involvement.  For this reason it can be difficult to diagnose and several tests may be necessary to determine what is causing your symptoms.  

After a physical examination, your doctor may send you to one or more specialists. You may have to undergo tests including vascular scans, MRI (magnetic resonance imaging), MRA (MRI with contrast), ENG (nerve conduction velocity). 

Your doctor or the specialist may do some physical tests which require you to move in specific ways meant to reproduce the pain symptoms. While painful, this can give the doctor more information on what may be causing your symptoms and aid in developing a treatment plan for you. 

If you have Thoracic Outlet Syndrome, you will need to do a few things to keep the symptoms at bay, even after physical therapy.  It is important to:

1. Maintain good posture to reduce the compression on nerves, veins and arteries
2. Take regular breaks when working
3. Practice relaxation techniques to keep your muscles from impinging the outlet

This Syndrome can be painful and frustrating, both to live with and to diagnose and treat.  If you are having symptoms don't delay talking to your doctor about them and be persistent.  If you need to, consider changing doctors or getting a second opinion. 

Be your own medical advocate, educate yourself, and ask plenty of questions! 

What to expect when you have a lower limb vascular study

Your doctor may request a lower limb vascular study if you have pain or aching in your legs that keep you awake or make it difficult to walk.  Doctors will also refer you for a vascular study as part of pre-operative and/or post-operative screening.

Photo from: http://www.morguefile.com/creative/imelenchon

Usually you will be scheduled at a specific time and should not have to wait long.  You will be asked routine health/medical history type of questions and may have forms to fill it.  It is helpful to arrive 15 minutes early.  Bring your insurance card and driver’s license or other government ID.

Dress comfortably in thinner material, but long sleeve clothing as the testing area is air conditioned.  You will most like not have to undress for the procedure, but depending on the area of concern you may be asked to do so.

Several cuffs like blood pressure cuffs will be strapped by the specially trained vascular sonography technician around your legs and also on your arms.  The technician will attach each cuff to the identified wire to the scanning machine.  Each cuff will be inflated and your pulse taken with a special ultrasound receptor, also connected to the machine.

It is important that you don’t move during the scan as the measuring devices are quite sensitive. Typically the test is described as painless.  You may not be warned that you may have some discomfort – it can take more pressure to achieve the desired effect on the vein on some people. 

Plan on the study to take about an hour – it should take less time, but you will be safe if you plan on an hour unless you are told longer.  For more information on this and other types of scans, visit University of Maryland Medical Center.

Other articles that may be of interest:

Injured Worker Help Desk: Injured at work - What now?

Jan 01, 2012

Stay in constant communication with your employer - it is important that they understand that you want to come back to work as quickly as possible and where you are in your medical treatment. Arrange all documents you ...

http://www.injuredworkerhelpdesk.com/

Injured Worker Help Desk: What to expect when you have an ENG ...

Oct 09, 2012

If you need to have a Electronystagmogram (ENG) then you will likely be referred to a doctor trained specifically to conduct the test. You may be asked for a medical history and whether or not you have had X-Rays or MRIs.

http://www.injuredworkerhelpdesk.com/

Injured Worker Help Desk: Job Search Tip of The Day Review or Set ...

Sep 12, 2012

However, I know that not everyone has identifiable, attainable, and/or realistic goals. Certainly, if you have been injured and are facing a return to work after medical recuperation you may not have had the opportunity to think ...

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Injured Worker Help Desk: #1 Mistake Injured Workers Make

Jan 05, 2012

The medical system, the workers compensation system, the unemployment system…. Quickly, the worker who has been injured may come to feel like a statistic. Or, as one client recently described it, may come to feel like a ...

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What to expect when you have an ENG (Electronystagmogram)

Photo by http://morguefile.com/creative/LilJoel

If you need to have a Electronystagmogram (ENG) then you will likely be referred to a doctor trained specifically to conduct the test.  You may be asked for a medical history and whether or not you have had X-Rays or MRIs.

There are two parts to the test:  mild "shock" to various areas where the impact to the nerve can be measured and a needle that will be used to stimulate the nerve in specific areas. It may sound scary, but in the end it is not so much. 

YOU WILL FEEL BETTER IF YOU KNOW WHAT TO EXPECT

PART I

• The doctor will measure and mark skin along certain paths of nerves to be evaluated 
• He or she will clean your skin with cotton and alcohol
• Electrodes will be placed in specific areas on your skin
• Once the doctor applies the "shock" it may make your "digits" jump
• It does not hurt - it is more of a buzzing sensation that you will feel

PART II 

• During the second part the doctor will use a very slender needle
• He or she will insert it through your skin and into the nerve in order to measure reaction
• Since the needle is so slender you will barely feel most of the insertions
• If you do feel anything from the insertions you will likely not consider it painful
• The doctor will again follow the path of your nerves and take measurements through the electrodes

You will not be able to get the results at this appointment and the report should be ready in 1 -2 weeks.

What concerns do you have about your upcoming ENG?

Other articles that may be of interest:

Injured Worker Help Desk: What to expect when you have an MRI

Sep 26, 2012

What to expect when you have an MRI. You may be wondering what to expect when you have an MRI if your doctor has recently prescribed one. Most people do not undergo them regularly and it may seem a scary prospect.

http://www.injuredworkerhelpdesk.com/

I have a panel Interview: What should I expect? - Injured Worker ...

Aug 07, 2012

I have a panel Interview: What should I expect? Panel interviews tend to be more formal than other types of interviews and can be especially nerve racking if you allow it to! Panel interviews can be more time and cost effective ...

http://www.injuredworkerhelpdesk.com/

Injured Worker Help Desk: Jobless during Easter or Passover?

Apr 06, 2012

The negative emotions can be especially magnified at holiday time when Delaware familes join together and expect happy times. Well meaning friends and relatives often increase the sense of frustration and anger that can ...

http://www.injuredworkerhelpdesk.com/

What to expect when you have an MRI

You may be wondering what to expect when you have an MRI if your doctor has recently prescribed one.  Most people do not undergo them regularly and it may seem a scary prospect.  It IS a little scary, but if you know what to expect and how to prepare, it can go much more smoothly!  

Image courtesy of [FreeDigitalPhotos.net] /

The MRI will be over before you know it and your doctor will have the information needed to help you!

While you are undergoing the procedure, it may not seem like you will ever be done and out the door, on your way.  The technicians and doctor will do everything they can to make sure you are as comfortable as possible and want to give you the best service they can.

A few things to expect when you have an MRI:

1.     The MRI machine is loud.  They will give you headphones and music, but it is still loud

2.     The doctor or technician will let you know how long the scan(s) will run

3.     You won’t be able to check your watch; the average song is 2 ½ to 3 minutes

4.     The technician will ask you what type of music, but you will likely not be able to hear it too well

5.     You will be asked if you are claustrophobic.  It is ok if you don’t know

6.     Close your eyes before they slide you into the MRI machine and keep them closed

7.     Plan ahead what you will think about while you are in the machine – something you have to concentrate on or can focus on is good

8.     The technician will tell you he can hear you if you need anything; he or she can!

9.     You won’t want or be able to sleep in the MRI machine

The cave you enter holds the treasure you seek

 – Joseph Campbell

You can prepare for an MRI by following a few simple tips you will find your experience will be more comfortable:

1.     Wear comfortable clothing like a sweat shirt and top

2.     Make sure your clothing has only elastic – no zippers or snaps

3.     If you are a woman do not wear an underwire bra

4.     You may be asked to remove your bra of any kind – don’t wear a white top

5.     Don’t wear jewelry; removing any piercings you have anywhere

6.     It is usually cold, so dress a bit more warmly than you would typically

Good luck on your MRI!

What was your MRI experience like?