The Medical Industrial Complex is designed to snag you, hook you up to a machine and suck the life out of you at the same time the Complex sucks you dry of all present and future wealth or assets. Lidocaine Patch The Lidoderm� patch contains lidocaine and is applied directly to intact skin to treat the neuropathic pain associated with postherpetic neuralgia (PHN). Learn more about postherpetic neuralgia, shingles, and instructions ============================================================================= The Lidoderm� patch provides targeted peripheral analgesia for the neuropathic pain associated with postherpetic neuralgia. Learn more about Lidoderm� patch clinical studies, its site of action, postherpetic neuralgia, and our patient education tools. Here are the results to the new Lidoderm patch with 5% Lidocaine which I am told is the way of the future for pain relief. Lidoderm lidocaine topical (LYE doe cane) Anestacon, Bactine, Dermaflex, Ela-Max, Ela-Max 5, Ela-Max Plus, Lida Mantle, Lidocaine Viscous, Lidoderm, Lidomar, Medi-Quik Spray, Protech First Aid Stik, Solarcaine, Xylocaine 10% Oral, Xylocaine Jelly, Xylocaine Topical, Xylocaine Viscous, Zilactin-L What is the most important information I should know about Lidoderm? Do not use Lidoderm more often or for longer than is directed. Talk to your healthcare provider if your symptoms do not improve or if they worsen. What is Lidoderm? Lidocaine causes loss of feeling (numbness) of skin and mucous membranes. Lidoderm is used to relieve pain associated with sunburn; insect bites; poison ivy; poison oak; poison sumac; minor cuts; scratches; and burns; sores in the mouth; dental procedures; hemorrhoids; and shingles (herpes infection). Lidoderm may also be used for purposes other than those listed here. What should I discuss with my healthcare provider before using Lidoderm? Before using Lidoderm, talk to your healthcare provider if you have. liver problems;. other serious medical conditions; or. broken, inflamed, or damaged skin (lidocaine patches). You may not be able to use Lidoderm, or you may require a dosage adjustment or special monitoring during treatment. Lidoderm is in the FDA pregnancy category B. This means that it is unlikely to be harmful to an unborn baby. Do not use Lidoderm without first talking to your doctor if you are pregnant or could become pregnant during treatment. Lidoderm passes into breast milk and may affect a nursing baby. Do not use Lidoderm without first talking to your doctor if you are breast-feeding. How should I use Lidoderm? Use Lidoderm exactly as directed. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you. Lidoderm is intended for external use on the skin only. Do not swallow the medication (unless specifically directed to do so by your doctor if treating a throat condition). Lidoderm may be applied using the finger tips or a cotton swab. Apply the medication as directed by your healthcare provider. Lidocaine oral cavity patches are applied to the gums by a dentist or a dental assistant before a dental procedure. Lidocaine solution can be swished around the mouth or gargled, and then spat out. Use a dose-measuring spoon or cup to measure the solution. Ask your pharmacist if you do not have one. Shake the oral spray well before use. Do not inhale the spray. Apply the lidocaine patches as directed by your doctor. Make sure the skin does not have any open sores or rashes. You may apply up to 3 patches at one time. Leave the patches on for only 12 hours during a 24-hour period. Patches may be cut into smaller sizes with scissors before removing the adhesive liner. Clothing may be worn over the patches. If irritation or burning occurs due to the patch, remove it and do not reapply until the irritation subsides. Dispose of used lidocaine topical patches where they cannot be reached by children or pets. Do not use Lidoderm more often or for longer than is directed. Talk to your healthcare provider if your symptoms do not improve or if they worsen. Store Lidoderm at room temperature away from moisture and heat, out of the reach of children and pets. What happens if I miss a dose? Apply the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the next regularly scheduled dose as directed. Do not apply a double dose of this medication. What happens if I overdose? Seek emergency medical attention if an overdose is suspected or if the medication has been ingested. Symptoms of a Lidoderm overdose may include dizziness, drowsiness, confusion, nervousness, ringing in the ears, blurred or double vision, sensation of heat or cold, numbness, twitching, seizures, unconsciousness, decreased breathing, and heart attack. What should I avoid while using Lidoderm? Do not use Lidoderm more often or for longer than is directed. Talk to your healthcare provider if your symptoms do not improve or if they worsen. Since there will be decreased sensation of the skin where Lidoderm is applied, use caution to avoid injury of the area during treatment. What are the possible side effects of Lidoderm? Stop using Lidoderm and seek emergency medical attention or contact your doctor immediately if you experience any of the following rare but serious side effects:. an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);;. chest pain or irregular heartbeats;. dizziness or drowsiness;. nausea or vomiting;. trembling, shaking, or seizures (convulsions); or. blurred or double vision. Other less serious side effects may be more likely to occur. Continue to use Lidoderm and talk to your healthcare provider if you experience. mild irritation, redness, or swelling at the application site. Side effects other than those listed here may also occur. Continue to use Lidoderm and talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect Lidoderm? Although Lidoderm is unlikely to affect medicines taken by mouth, talk to your doctor before using Lidoderm if you are taking digoxin (Lanoxin) or any medicine to control irregular heartbeats. You may not be able to use Lidoderm, or you may require a dosage adjustment or special monitoring. Avoid using other topical medications on the affected area without first talking to your doctor. Drugs other than those listed here may also interact with Lidoderm. Talk to your doctor and pharmacist before taking or using any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products. Where can I get more information? Your pharmacist has additional information about Lidoderm written for health professionals that you may read. -------------------- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. ============================================================================= Directions of Lidoderm within Lidocaine Patch Box: ENDO Pharmaceuticals Lidoderm (Lidocaine Patch 5%) Rx only Description: LIDODERM (lidocaine patch 5%) is comprised of an adhesive material containing 5% lidocaine, which is applied to non-woven polyester felt backing and covered with polyethylene terephthalate (PET) film release liner. The release liner is removed prior to application to the skin. The size of the patch is 10 cm x 14 cm. Lidocaine is chemically designated as acetamide, 2-(diethylamino)-N-(2,2-dimethylphenyl), has an octanol: water partition ratio 43 at pH 7.4, and has the following structure: CH / 3 C H - / 2 5 / \_NH-CO-CH-N \ / 2 \ - C H \ 2 5 CH 3 Each adhesive patch contains 700 mg of lidocaine (50 mg per ram adhesive) in an aqueous base. It also contains the following inactive ingredients: dihydroxyaluminim aminoacetate, disodium edetate, gelatin, glycerin, kaolin, methylparaben, polyacrylic acid, polyvinyl alcohol, propylene glycol, propylparaben, sodium carboxymethylcellulose, sodium polyacrylate, D-sorbitol, tartaric acid, and urea. CLINAL PHARMACOLOGY Pharmacodynamics: Lidocaine is an amide-type local anesthetic agent and is suggested to stabilize neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses. The penetration of lidocaine into intact skin after application of LIDODERM is sufficient to produce an analgesic effect, unless than the amount necessary to produce a complete sensory block. Pharmacokinetics: Absorption: The amount of lidocaine systemically absorbed from LIDODERM is directly related to both the duration of application and the surface area over which it is applied. In a pharmacokinetic study, three LIDODERM patches were applied over an area of 420 cm2 of intact skin on the back of normal volunteers for 12 hours. Blood samples were withdrawn for determination of lidocaine concentration during the application and for 12 hours after removal of patches. The results are summarized in Table 1. CAUTION: This table is incorrect because certain math symbols and notations are not available in my word processing application. Not to be used for any medical concerns. Speak to a Doctor before doing anything with Lidocaine. Lidoderm Application Area Dose C(max) T(max) Patch Site (cm2) Absorbed (mg) (ug/mL) (hr) 3 patches Back 420 64 + 32 0.3 + 0.06 11 hr (2100 mg) When LIDODERM is used according to the recommendation dosing instructions, only 3 + 2% of the dose applied is expected to be absorbed. At least 95% (665 mg) of lidocaine will remain in a used patch. Mean peak blood concentration of lidocaine is about 0.13 ug/mL (about 1/10 of the therapeutic concentration required to treat cardiac arrhythmias). Repeated application of three patches simultaneously for 12 hours (recommended maximum daily dose), once per day for three days, indicated that the lidocaine concentration does not increase with daily use. The mean plasma pharmacokinetic profile for the 15 healthy volunteers are shown in Figure 1. Figure 1 Mean lidocaine blood concentration after three consecutive daily applications of three IDODERM patches simultaneously for 12 hours per day in healthy volunteers (n=15). ============================================================================= 120 100. 80 60 40. 20 0 0 6 12 18 24 30 36 42 48 54 60 66 72 HOURS ============================================================================= DISTRIBUTION: When lidocaine is administered intravenously to healthy volunteers, the volume of distribution is 0.7 to 2.7 L/kg (mean 1.5 + 0.6 SD, n=15) At concentrations produced by application of LIDODEERM, lidocaine is approximately 70% bound to plasma proteins, primarily alpha-1-acid glycoprotein. At much higher plasma concentrations (1 to 4 ug/mL of free base), the plasma protein binding of lidocaine is concentration dependent. Lidocaine crosses the placental and blood brain barriers, presumably by passive diffusion. METABOLISM: It is not known if lidocaine is metabolized in the skin. Lidocaine is metabolized rapidly by the liver to a number of metabolites, including monoethylglycinexylidide (MEGX) and glycinexylidide (GX), both of which have pharmacologic activity similar to, but less potent than that of lidocaine. A minor metabolite, 2,6-xylidine, has unknown pharmacologic activity but is carcinogenic in rats. The blood concentration of this metabolite is negligible following ap0plication of LIDODERM (lidocaine patch 5%). Following intravenous administration, MEGX and GX concentrations in serum range from 11 to 36% and from 5 to 11% of lidocaine concentrations, respectively. Excretion: Lidocaine and its metabolites are excreted by the kidneys. Less than 10% of lidocaine is excreted unchanged. The half-life of lidocaine elimination from the plasma following IV administration is 81 to 149 minutes (mean 107 + 22 SD, n = 15). The systemic clearance is 0.33 to 0.90 L/min (mean 0.64 + 0.18 SD, n = 15). CLINICAL STUDIES Single-dose treatment with LIDODERM was compared to treatment with vehicle patch (without lidocaine), and to no treatment (observation only) in a double-blind, crossover clinical trial with 35 post-herpetic neuralgia patients. Pain intensity and pain relief scores were evaluated periodically for 12 hours. LIDODERM performed statistically better than vehicle patch in terms of pain intensity from 4 to 12 hours. Multiple-dose, two-week treatment with LIDODERM was compared to vehicle patch (without lidocaine) in a double-blind, crossover clinical trial of withdrawal type design conducted in 32 patients, who were considered as responders to the open- label use of LIDODERM prior to the study. The constant type of pain was evaluated but not the pain induced by sensory stimuli (dysesthesia). Statistically significant difference favoring LIDODERM were observed in terms of time to exit from the trial (14 versus 3.8 days at p-value 0.001), daily average pain relief, and patient's preference of treatment. About half of the patients also took oral medications commonly used in the treatment of post-herpetic neuralgia. The extent of use of concomitant me3dication was similar in the two treatment groups. INDICATION AND USAGE LIDODERM is indicated for relief of pain associated with post-herpetic neuralgia. It should be applied only to intact skin. CONTRAINDICATIONS: LIDODERM is contraindicated in patients with a known history of sensitivity to local anesthetics of the amide type, or to any other component of the product. WARNINGS: Accidental Exposure to Children: Even a used LIDODERM patch contains a large amount of lidocaine (at least 665 mg). The potential exists for a small child or a pet to suffer serious adverse effects from chewing or ingesting a new or used LIDODERM patch, although the risk with this formulation has not been evaluated. It is important for patients to store and dispose of LIDODERM out of the reach of children and pets. Excessive Dosing: Excessive dosing by applying LIDODERM to larger areas or for longer than the recommended wearing time could result in increased absorption of lidocaine and high blood concentrations, leading to serious adverse effects (see ADVERSE REACTIONS, Systemic Reactions). Lidocaine toxicity could be expected at lidocaine blood concentrations above 5 ug/mL. The blood application of more than the recommended number of patches, small patients, or impaired elimination may all contribute to increasing the blood concentration of lidocaine. With recommended dosing of LIDODERM, the average peak blood concentration is about 0.13 ug/mL, but concentrations higher than 0.25 ug/mL have been observed in some individuals. PRECAUTIONS: General Hepatic Disease: Patients with severe hepatic disease are at greater risk of developing toxic blood concentrations of lidocaine because of their inability to metabolize lidocaine normally. Allergic Reactions: Patients allergic to para-aminobenzoic acid derivatives (procaine, tetracaine, benzocaine, etc.) have not shown cross sensitivity to lidocaine. However, LIDODERM should be used with caution in patients with a history of drug sensitivities, especially if the etiologic agent is uncertain. Non-Intact Skin: Application to broken or inflamed skin, although not tested, may result in higher blood concentration of lidocaine from increased absorption. LIDODERM is only recommended for use on intact skin. Eye Exposure: The contact of LIDODERM with eyes, although not studied, should be avoided based on the findings of severe eye irritation with the use of similar products in animals. If eye contact occurs, immediately wash out the eye with water or saline and protect the eye until sensation returns. There are many more precautions: Please read your Prescription label and text of directions and usage. Drug Interactions Antiarrhythmic Drugs: LIDODERM should be used with caution in patients receiving Class I antiarrhymthmic drugs (such as tocainide and mexiletine) since the toxic effects are additive and potentially synergistic. Local Anesthetics When LIDODERM is used concomitantly with other products containing local anesthetic agents, the amount absorbed from all formulations must be considered. Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogensis: A minor metabolite, 2.6-xylidine, has been found to be carcinogenic in rats. The blood concentration of this metabolite is negligible following application of LIDODERM. Mutagenesis: Lidocaine HCI is not mutagenic in Salmonella/mammalian microsome test nor clastogenic in chromosome aberration assay with human lymphocytes and mouse micronucleus test. Impairment of Fertility: The effect of LIDODERM on fertility as not been studied. Pregnancy Teratogenic Effects: Pregnancy Category B. LIDODERM (lidocaine patch 5%) has not been studied in pregnancy, Reproduction studies with lidocaine have been performed in rats at doses up to 30 mg/kg subcutaneously and have revealed no evidence of harm to the fetus due to lidocaine. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, LIDODERM should be use during pregnancy only if clearly needed. Labor and Delivery LIDODERM has not been studied in Labor and delivery. Licocaine is not contraindicated in labor and delivery. Should LIDODERM be used concomitantly with other products containing lidocaine, total doses contributed by all formulations must be considered. Nursing Mothers: LIDODERM has not been studied in nursing mothers. Lidocaine is excreted in human mild, and the milk: plasma ratio of lidocaine is 0.45 Caution should be exercised when LIDODERM is admistered to a nursing woman. Pediatric USE Safety and effectiveness in pediatric patients have not been established. ADVERSE REACTIONS Localized Reactions During or immediately after treatment with LIDODERM (lidocaine patch 5%), the skin at the stie of treatment may develop erythema or edema or may be the locus of abnormal sensation. These reactions are generally mild and transient, resolving spontaneously within a few minutes to hours. In clinical studies with LIDODERM, there were no serious reactions reported. One out of 150 subjects in a three- week study was discontinued from treatment because of a skin reaction (erythema and hives). Allergic Reactions: Allergic and anaphylactoid reactions associated with lidocaine, although rare, can occur. They are characterized by urticaria, angioedema, bronchospasm, and shock. If they occur, they should be managed by conventional means. The detection of sensitivity by skin testing is of doubtful value. Systemic (Dose-Related) Reactions Systemic adverse reactions following appropriate use of LIDODERM are likely, due to the small dose absorbed (See CLINICAL PHARMACOLOGY, Pharmacokinetics), Systemic adverse effects of lidocaine are similar in nature to those observed with other PHARMACOLOGY, Pharmacokinetics). Systemic adverse effects oflidocaieare similar in nature to those observed with other amide local anesthetic agents, including CNS excitation and/or depression (light-headedness, nervousness, apprehension, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest). Excitatory CNS reactions may be brief or not occur at all, in which case the first manifestation may be drowsiness merging into unconsciousness. Cardiovascular manifestations may include bradycardia, hypotension and cardiovascular collapse leading to arrest. OVERDOSAGE: Lidocaine overdose from cutaneous absorption is rare, but could occur. If there is any suspicion of lidocaine overdose (see ADVERSE REACTIONS, Systemic Reactions), drug blood concentration should be checked. The management of overdose includes close monitoring, supportive care, and symptomatic treatment. Dialysis is of negligible value in the treatment of acute overdose with lidocaine. In the absence of massive topical overdose or oral ingestion, evaluation of symptoms of toxicity should include consideration of other etiologies for the clinical effects, or over dosage from other sources of lidocaine or other local anesthetics. The oral LD50 of lidocaine HCI is 459 (346-773) mg/kg (as the salt) in non-fasted female rats and 214 (159-324) mg/kg (as the salt) in fasted female rats, which are equivalent to roughly 4000 mg, respectively, in a 60 to 70 kg man based on the equivalent surface area dosage conversion factors between species. DOSAGE AND ADMINISTRATION: Apply LIDODERM to intact skin to cover the most painful areas. Apply up to three patches, only once for up to 12 hours within a 24-hour period. Patches may be cut into smaller sizes with scissors prior to removal of the release liner. Clothing may be worn over the area of application. Smaller areas of treatment are recommended in a debilitated patient, or a patient with impaired elimination. If irritated or a burning sensation occurs during application, remove the patch(es) and do not reapply until the irritation subsides. When LIDODERM is used concomitantly with other products containing local enesthetic agents, the amount absorbed from all formulations must be considered. HANDLING AND DISPOSAL: Hands should be washed after the handling of LIDODERM, and eye contact with LIDODERM should be avoided. The used patch should be immediately disposed of in such a way as to prevent its access by children and pets. HOW SUPPLIED: LIDODERM (Lidocaine patch 5%) is available as the following: Carton of 30 patches, packaged into individual child-resistant envelopes Store at 25C (77 degrees) excursions permitted to 15 to 30 Celsius (59 degree to 86 degree farenheight) See USP Controlled Room Temperature). Manufactured for: Endo Pharmaceutical Inc. ENDO Chadds Ford, Pennsylvania 19317 LIDODERM is a Registered Trademark of Hind Health Care, INC. ============================================================================= A pressure point procedure found on the internet to help another patient of piriformis problems in which the Piriformis Muscle needed to be stretched out back to its original length - Here is the therapy for that below: ============================================================================= Sciatica? Piriformis? This helped me Link This article submitted by Larry Swain on 1/20/99. Email Address: swainl@ -/forum/ChronicPainF/1.20.992.58AMSciaticaPiriformi/ I would like to pass along something that has worked very well for me and I hope that it will help some of you out there suffering from lower back problems and sciatica as I was. I have had very bad back problems for the past 15 years that have nearly incapacitated me. I was diagnosed with degenerative disk disease, 4 herniated disks and a badly bulged disk which made life unbearable. I had sciatic pain so bad that many days I couldn't walk without a cane and at night I would get a numbness and tingling in my legs that nearly drove me crazy. I went to many doctors, neurosurgeons etc. and they tried all kinds of pain killers, direct injections into the muscles, etc. with no help at all. A few years ago I tried deep tissue massage therapy and that has really helped keep the pain to a level that I can tolerate. About 7 months ago I learned about some techniques they are using in a pain clinic in England and I had my therapist try some of them on me with great results. I found out that a lot of my lower back pain came from a compressed piriformis muscle. I would like to pass one of these treatments along to you sciatica and piriformis sufferers and hope that it will help some of you out there. If you have a spouse or friend that can apply it to you it doesn't cost anything, it's non-invasive and if it doesn't work you won't be any worse off than you were. My therapist has tried it on a number of people and it has helped most all of them. This treatment is so simple that I thought that it was a joke and I didn't try it until I was in such pain that I would try anything to relieve it. It needs another person to apply the treatment and it can be a spouse, friend or therapist. There are two treatments for the piriformis release and I will try to describe them as best and simply as I can. The piriformis muscle is a small muscle not much larger than your thumb and it runs from the top of the leg bone across the buttock to the sacrum which is at the base of the spinal column. When this little muscle gets irritated due to over use from sitting, bending or whatever it can compress and pinch the sciatic nerve and the attachment points are stretched to the limit causing a great deal of pain. Sometimes it is very difficult to get this muscle to relax and resume its normal length and that is what this treatment will help with. Sciatica is a fairly common disorder and approximately 40% of the population experiences it at some point in their lives. However, only about 1% has coexisting sensory or motor deficits. Sciatic pain has several root causes and treatment may hinge upon the underlying problem. Chronic pain may arise from more than just compression on the nerve. According to some pain researchers, physical damage to a nerve is only half of the equation. A developing theory proposes that some nerve injuries result in a release of neurotransmitters and immune system chemicals that enhance and sustain a pain message. Even after the injury has healed, or the damage has been repaired, the pain continues. Control of this abnormal type of pain is difficult. You will need a firm padded surface to lay the patient on. A table or the floor with a 3" or 4" foam pad works well. A bed has too much give to it. Treatment #1 Have the patient lay on their side facing away from you with their legs pulled up to a comfortable position and one on top of the other. (optional) Hot moist towels placed on the buttock and hip muscles for about 15 minutes sure feels good and helps to relax the muscles. Moist heat seems to penetrate deeper into the muscles. Be careful not to get it hot enough to burn the skin or be uncomfortable. If the patient is laying on their right side, facing away from you, place the heel of your right hand in the middle of the buttock muscle and lean into it and hold it. With your left hand grasp their foot or ankle and lift it straight up about 12"" rotating the leg This will probably be painful so be careful of your patient's pain threshold. Gently lay the foot and leg back down and release the pressure with the right hand. Apply the pressure with the right hand , lift the leg , gently lower it, release the pressure. Go through this same sequence for about 15 minutes working your hand up and down the hip and buttock muscles then turn the patient over on the other side and repeat the steps. If this length of time is too much for the patient just do it for a couple of minutes to start and try to work up to a longer time. Treatment #2 Working the right side Have patient lay on stomach. Move to the right side of patient. Grasp the ankle and lift the lower part of the leg so that the bottom of the foot is pointing straight up. Push the foot away from you as if you were trying to touch the heel to the left buttock muscle to rotate the leg. Be sure to monitor the patient's pain level and not overdue it. Place the heel of the hand in the middle of the buttock muscle as in treatment #1 and lean into it to apply pressure. While applying pressure with the right hand, pull the leg back toward you to the starting position. Release the pressure with the right hand. Push the leg away from you, apply pressure with the right hand, and pull leg toward you, release the pressure with the right hand. Continue this sequence for the same time as in treatment #1 and then move to the other side of the body and work it in the same way. You can work each of these treatments as an individual treatment or you can work both of them in a single session. The total time should be about 30 minutes for the whole treatment. Some effects of it may show up after the treatment but the real effects take about 11 to 12 hours to really set in. After the first 3 or 4 rotations the muscle will try to return to its compressed state but after 10 or 12 rotations it will gradually start to lengthen out little by little until it reaches its normal length. This treatment may need to be done for 3 or 4 sessions a couple of days apart for the maximum effect. I hope this treatment will help some of you as much as it has helped me. Good luck to you all in finding cure for your ailments. God Bless. ============================================================================= FULL DISCLAIMER ============================================================================= Sciatica Org Site: Link Functional Entrapments: What are they? Functional entrapment syndromes are defined as significant neurological compression resulting from positional or kinesiological considerations, not solely structural or inflammatory conditions. For this reason, imaging studies such as MRI, CT, bone and gallium scans and diagnostic ultrasound is of limited value in detecting these conditions. Even conventional EMG is often negative. Rather, it is in comparing nerve conductions in the anatomical position with nerve conductions in the symptomatic position that turns up the pathology, and the pathogenetic mechanism. This offers both guidance on effective treatment, and a means of assessing the efficacy of treatment through repeated serial testing of the same nerve conductions. Rehabilitation Medicine is well-suited to work with these common causes of pain, since PM&R knows anatomy and kinesiology, does electro diagnostic testing as an extension of the physical exam, is functionally oriented, and is comfortable using both injection and physical therapeutic techniques in treatment. Examples: Piriformis syndrome comprises approximately 6 to 8 percent of sciatica and low back pain. (1) While herniated nucleus pulpous and spinal stenosis are more common, piriformis syndrome is under diagnosed, (2). Therefore, its prevalence is significantly higher than its incidence (3). The syndrome is due to the piriformis muscle compressing the sciatic nerve in the buttock, and, like pronator syndrome or carpal tunnel, causing damage to the peripheral nerve through excessive pressure. (4) The nerve is pressed backward against the sharp tendinous edges of other muscles such as the gemellus superior and obturator internus, (5-6) and the condition may easily become chronic, and debilitating. History Discovered in Florence ca. 1580. After Mixter and Barr's paper in 1932 (7), people recognized spinal and intramedullary pathology as the chief cause of sciatica. It is foraminal and intramedullary conditions that come to mind when patients present with sciatica. However, pain along the course of the sciatic nerve at times is caused by pathological involvement of the nerve itself, and rational diagnosis and treatment then should focus on the site of the pathology. Epidemiology Since an estimated 80 million Americans suffer low back pain and sciatica annually, (8) 4.8 to 6.4 million people contract piriformis syndrome annually. One reason for Under diagnosis is that MRI, myelogram, CT, are unlikely to turn up any evidence of piriformis syndrome. (9-11) It is a functional syndrome: only certain positions and pressures bring out the pain, paresthesias, and weakness that come with it. Structure imaging studies are of minimal value here. (12-15) Since it is sometimes considered a diagnosis of exclusion, many patients receive painful and pointless surgical and other procedures based on limited inquiries and faulty diagnosis. Piriformis Syndrome is commonest among very active people such as athletes, health club users, joggers, and performers, and those who sit a great deal such as members of the financial community, lawyers, psychotherapists, secretaries and vehicular drivers After occupational causes, trauma is the second greatest cause of piriformis syndrome. Lifting and other back strain related activities are third, with many other initiating events including misplaced gluteal injections, lipomas, and unusual furniture. Diagnosis Modern methods of diagnosis began with the work of Fishman and Zybert (14) using the H-reflex and EMG in 1992. By timing the H-reflex in the position of Flexion Adduction and Internal Rotation, (the FAIR-test) in which the piriformis muscle tightly presses the sciatic nerve against the underlying structures, and comparing the timing with the H-reflex in the anatomical position, the amount of delay was measured in normals. These values were then compared to those seen in patients meeting clinical criteria for piriformis syndrome. Patients with piriformis syndrome had FAIR-test values which were, on the average, more than three standard deviations beyond the mean seen in normals and in contra lateral lower extremities. More than 80 percent of patients so diagnosed improved 50 percent or more with conservative therapy aimed at loosening the piriformis muscle in the buttock. The recovery rate of patients identified by the FAIR-test is much greater than the recovery rate seen in patients selected by any other known means. (15) Because of the nature of the syndrome, the test for piriformis syndrome is functional in nature, comparing nerve conduction values when the nerve is compressed, with values seen in a resting position. The discrepancy between normal values and those seen in piriformis syndrome is amplified by the fact that the H-reflex crosses the buttock In order to determine these values, posterior tibial and peroneal H-reflexes are studied both in the anatomical position and the flexed adducted internally rotated position (FAIR-test). Thus the H-reflex is actually performed four times with each limb that is studied. (15) Clinical Experience Treatment at first was simply physical therapy, informed and enriched by the generous giving forth of experience from the international medical community. In essence, the therapy lengthened the piriformis muscle, reducing spasm and pressure on the descending sciatic nerve, and giving the nerve enough slack to remove itself from harm's way. See the rest of the website for the specific program. The therapy was helpful, but progress was slow. On the suggestion of Dr. Janet Travell, we began injecting Triamcinolone Acetonide 20mg with 1.5cc of 2% lidocaine into the motor point of the piriformis muscle, just medial to its musculotendinous junction in the lateral buttock. This had only rare minor and transient side-effects on non-diabetics, and shortened the recovery time considerably. On average 10.2 month follow-up time of 1014 cases of piriformis syndrome, more than hat these patients had suffered from piriformis syndrome for an average of 6.2 years, Probably due to piriformis syndrome being considered a diagnosis of exclusion, other, less important diagnostic entities had received undue attention in these patients. Among these1014 cases there had been over 400 spinal, trochanteric and gynecological surgeries, none of which was definitive, more than 1500 imaging studies, of which less than 1/5 were relevant, and more than 10,000 appointments with clinicians for diagnostics, epidurals, physical therapy, and alternative methods of pain relief. More recently we have conducted several IRB-approved studies of more specific nerve blocks, using the toxin of the botulinum bacterium. In the latest and most successful of these, we have found that 12,500 units of botulinum B toxin has well above 85% efficacy, and fewer side effects than Triamcinolone and Lidocaine, giving more relief faster, and appearing in early studies to last longer. Containing no steroid, this preparation is also suitable for diabetics. Showing a much more rapid decline in pain levels, and normalization of the FAIR-test, it obviates physical therapy sessions that surpass the cost of the injection. In summary, there are four reasons that botulinum toxin helps in the treatment of piriformis syndrome. A reliable correlation between diagnosis and effective treatment exists. More than 5,000,000 currently improperly treated patients will continue to suffer, and continue to consume health care resources in vain unless and until adequate treatment is afforded them. In clinical experience, injection of botulinum toxin has proven the most effective treatment. Cost-benefit analysis of current data strongly supports injection of botulinum toxin in the treatment of piriformis syndrome. Two other considerations are relevant: Wider applicability. While the anti-insulinemic effect of steroids strongly contraindicates their use in diabetic patients, there are virtually no documented allergic reactions to botulinum toxins. Longer efficacy. Steroid injection without physical therapy is generally effective for 1-3 weeks. Botulinum toxin injections without physical therapy are effective for at least three months. In the past, approximately 15% of patients treated without botulinum toxin injections have had recurrence of piriformis syndrome within three years. As of today, (14 months after our first injection) we have seen 3 relapses following botulinum toxin injections in 61 patients. A Patients Success Story: Link Cindy W., IT manager from NC. Successful ADR, but I was still completely disabled. The first time I met Mark was on September 19, 2002. We were in the waiting room at the Alpha Klinik and we both had surgery scheduled for the next day. After we chatted for a while, I realized that I was speaking to someone who had written a great deal on the internet about his research into ADR. I said, "Oh my gosh, you are RumorSlayer! I used to look for you online. I'd call my husband over. Ed, Ed, he's here again!!! Come read this!" I was in Munich for surgery because I had disabling back pain, hip pain and foot pain. I was very relieved after my discogram because it so clearly reproduced all my pain. That made me an excellent candidate and gave me every reason to be hopeful. My first week post-op was incredible. I felt sorry for Mark because he was having such a tough post-op experience, while I was walking many miles a day and sightseeing around Munich just 5 or 6 days after my surgery. I knew just a few days after my surgery that my back pain and my foot pain were GONE! Fast forward about a year and Mark's in great shape, but I was still functionally disabled. Although my disc replacement solved my back and foot pain, my disabling hip pain still had me unable to function. I was still on large doses of OxyContin. I'd been to doctor after doctor, but none of them had any good ideas. I had been referred to pain management. I was ready to give up. One day Mark called me up and told me about someone he met on the Internet forum he'd started for people who want to discuss non-fusion technologies. He told me that I there was a man he'd spoken with, who described disabling hip pain EXACTLY like I described mine. I took Mark's advice and called Brian. Brian had a similar story, but had found his way to a Dr. in Cincinnati who specialized in Piriformis syndrome. I called the Dr. but he warned me that Piriformis syndrome is very rare and that I shouldn't get my hopes up. Fast forward another 6 or 7 months! It turned out that I had profound PS. Out of 80 cases this doctor had seen, he said that my case was certainly one of the worst. I had the piriformis release surgery in October of 2003 and by mid-2004, I was riding my mountain bike with my husband, camping, hiking, working full time, back to a rewarding workout regimen (I was an athlete before my disability). I can't believe it, I'm living a NORMAL LIFE! I was ready to give up. I don't know where I'd be now if it wasn't for Mark and his Patient Network. I suppose that I'd still be in pain management, on large doses of opiates and completely disabled. Instead, I have a new lease on life and can live every day to the fullest. With the perspective that you gain from being reborn after such a painful disability, life is even better than it was before I could truly appreciate what it means to enjoy a day without pain! Thanks ================================================================================== Sciatic Notch lesser sciatic notch The third amended complaint, alleges in a conclusory manner that the representations, false promises and concealments were done for corrupt purposes and/or with malice towards plaintiffs and their interests and that defendants' conduct was intended � to cause injury to plaintiffs or constituted despicable conduct which was carried on by defendants, and each of them, with a willful and conscious disregard of the rights of plaintiffs. Conclusory allegations such as these are insufficient to survive a demurrer. (Masters, supra, 324th at p. 42, 372d 860.) The staff of law professionals has served as judicial law clerks and judges of courts, worked in private and public practice, served on corporate and civic directorships, and continues their advanced training in dispute resolution. Mrs Justice Mary Irvine approved the settlement, saying that John�s death had been very tragic but in the circumstances Margaret would have had a huge hill to climb to establish negligence against the South Tipperary General Hospital. Attorneys For Medical Negligence Campbellsport WI. To begin, money definitely matters for most employees across a wide range of professions. The 2015 Medical Sales Salary Report by MedReps showed that medical sales reps did well, earning an average total compensation of $141,464 and typically received benefits such as health insurance, 401ks, and expense accounts. Due to extensive travel, many also received a company car, mileage reimbursements, and/or a gas card. Given the urgency Claimant felt about reclaiming the cookies taken by the unknown officer, we do not believe he was guilty of contributory negligence in thrusting his arm through the gate to better point to the package in the officer's hand. The greater negligence was that of Officer Cook and correctional officers Watson and Banks. At the most his negligence would have to be given a fractional valuation. Claimant ran unassisted to the dispensary a half block away. From there he was taken to the institution hospital. There, he was given X rays and sent back to the cellhouse. The vapor from an e-cigarette comes from e-liquid contained in cartridges. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base - usually propylene glycol - which often includes different flavors, colors, and other chemicals. Your promotion and introduction into interstate commerce of the BioFind III (or Biofind), BioPack II (or BioPack), Light Patch, Spinal Pad, and the Knee Saver for these uncleared indications render them adulterated under section 501 (f)(1)(B) of the Act, for failure to obtain FDA premarket approval, and misbranded under section 502() of the Act, for failure to notify the agency of your intent to introduce the device into commercial distribution, as required by section 510(k) of the Act. For a product requiring premarket approval before marketing, the notification required by section 510(k) of the act is deemed to be satisfied when a premarket approval application (PMA) is pending before the agency (21 CFR 807.81 (b)). Heller, Maas, Moro & Magill Co. LPA has been committed to protecting the rights of injured workers, injury victims and the disabled since its beginning in 1985. We have a staff of six attorneys, two of which have attain
About PIP - I don't think it helps people's families if the injured person dies. How Much Compensation for Medical Negligence Should I Receive? Jeff was able to explain things in simple terms that even I could understand. His calm, confident demeanor was comforting to both me and my wife. Just like clockwork, and exactly to his plan, we found out our case was to be settled, without a fight, at the policy limit! I'm sure Jeff's meticulous and completely through claim left no doubt in the insurance companies mind that they had no choice but to do the right thing and belly-up to the bar with the full request! You mess with the bull; you get the horns! Thanks, Jeff. We couldn't have done it without you! Jim Potter (click here to read other client testimonials).�( click here to read other client testimonials ) Boating accidents can be caused by intoxication, failure to adhere to boating laws or pure carelessness. Stern Law Group assists victims of boating accidents by fighting for their right to compensation. ing individual complaints, it is a little bit dif?cult to quantify Fill out the information below to tell us about your situation and receive a free consultation. Attorneys For Medical Negligence Campbellsport 53010
8:45-9:30 and 1:00-1:45, Written and Presented by Russell W. Gerney in Wheeling, Jared M. Adams in Martinsburg, Robert Zak in Morgantown, and Patrick Timony in Charleston. 96. All value associated with the private contract trust account number of the natural man Secured Party: social insurance number without spaces; I have been a patient for many years and I highly recommend the services. Dr Fenlon along with his staff are simply the best. FORMER EMPLOYEE - HUNTINGBURG, IN I just have to say I am also a former employee that quit because I had several sleepless nights due to the unethical practices with this company. After I brought my concerns up with management I was wrote up for a"negative attitude" In response to that I told my office manager if u were expected to work off the clock and rip people off u would have a negative attitude. Costa said Sonoma County required its contractor to adhere to the California Medical Association's standard for prison care - that it matches the standard of outpattient care in the community. Mrs. Thornton also asserts the trial court committed error in not awarding her attorney fees and costs. She argues she is entitled to attorney fees both as to the hearing on the merits and with respect to a discovery hearing. The record contains a consent order relating to discovery. It provides for mutual discovery through interrogatories, requests for production, and depositions with each party bearing his or her own costs. The order says nothing about the scope of the discovery. Mrs. Thornton served interrogatories and requests for production. Mr. Thornton did not respond to the interrogatories. Consequently, Mrs. Thornton filed a motion to compel under S.C. Rules of Civil Procedure 37.1 The order of the family court required Mr. Thornton to answer the interrogatories within twenty days. The order was silent as to attorney fees. Under S.C. Rule of Civil Procedure 37(a)(4), the court shall require the payment of reasonable expenses incurred in obtaining the order compelling discovery, including attorney's fees, "unless the court finds that the opposition to the motion was substantially justified or that other circumstances made an award of expenses unjust." The transcript contains no record of the hearing on the discovery motion. Since the order is silent, we have no way of knowing whether attorney fees was considered. We therefore remand this matter to the family court for a determination of whether to award attorney fees under Rule 37(a)(4).
I read an article on Florida's Labovick Injury Law Blog that had some interesting facts from the Federal Motor Carrier Safety Administration (FMCSA). On average, drivers who send and receive messages are distracted 4.6 out of every 6 seconds while texting. This means that operators, travelling at 55 miles per hour, will drive the full length of a football field without looking up from their phone. In fact, drivers distracted by texting are more than 20 times likely to be involved in a crash than non-distracted drivers. 09/28/2012 - South Africa Constitutional Court Declares Sections of Films & Publications Act Unconstitutional That brings the criminal proceedings to a close 12 years after the airliner went down. I wrote here that the proceedings would do nothing for the families. To the extent that the families obtained any compensation at all, it was through the civil system, not the criminal trial. Law Firm Campbellsport 53010 Here, the plaintiff's allegations charge King with negligence in hiring, training, and supervising Lopez and, in effect, charge King with creating the circumstances that produced Lopez's intentional tort. Under these allegations, we believe we are required, notwithstanding the separability clause, to impute Lopez's intentional act to King. See Heyward, 536 S.W.2d at 549 (holding in essence that an event is accidental only if the insured is not charged with the circumstances that produced it). Very well stated. Always keep your current job until you find another. This created a significant treatment plant problem for dealing with her orthodontics as well as what to do now that the patient's permanent teeth were missing from her lower jaw. Capital One sent him a letter demanding he give back $180,000 in prepaid dental fees to 14 patients who had demanded refunds for treatment not delivered. � 16.1-255. Limitation on issuance of detention orders for juveniles; appearance by juvenile. Medical Malpractice Archives - Maryland Personal Injury Lawyer Corporal George F. Bearfield was the investigating officer. He arrived at the scene at 2:26 am. He testified that there was a dangerous curve before the bridge. There were no signs indicating the narrowing of the road. The guardrail at the upper end of the bridge was down at the time of this incident. Although he did not observe Mr. Guthrie operating his automobile, he did write exceeding safe speed as a contributing circumstance on the accident report which he had prepared in his investigation of the accident. He testified that In looking at the accident, I considered it to be that Mr. Guthrie was not familiar with the road, the oncoming traffic blinded him and he was Just moving too fast for the road. It's just the type of road you need to slow down And for that, he holds a $450,000 contract with the board. Flexibility: To satisfy customer needs, some dentists and plans are willing to make exceptions for patients when it comes to network coverage.
An Ontario court dooms a First Nations girl with cancer: Who's to blame? Apr 19, 2008 (The Charlotte Observer - McClatchy-Tribune Information Services via COMTEX) - Justia Opinion Summary: Andrade was convicted of six counts of forcible oral copulation (Pen. Code, 288a (c)(2)) and seven counts of forcible rape (261(a)(2)). The jury also found true the allegation that defendant had committed the offenses ag. At the request of the board, its attorney, Richard Collins, Jr., prepared a legal memorandum dated January 18, 1999, which addressed the issue of whether the city owned the property sought to be annexed. In preparing the memorandum, Collins obtained a copy of the interim development agreement between Moore and the city regarding the property. In Soto v. McCulley Marine Services, Inc. , a man was jet skiing over the July Fourth�holiday weekend in 2009 when he was tossed from the vehicle and sucked underneath nearby moored vessels. The man became trapped under a barge and ultimately drowned to death despite wearing a flotation device at the time of the incident. To ensure all victims of medical negligence have access to the support they need we endeavour to pursue claims on a no win no fee basis wherever possible. To speak to a solicitor who specialises in A&E compensation please don't hesitate to contact Farleys on 0125 460 6090, or email us today. If you decide to take the matter to court, your case will be passed to a judge. The court will let you know the date of your hearing, and your solicitor will tell you about any preparations you need to make.
On this appeal, David Lee Goode challenges the sentence of 12 months incarceration that he received after pleading guilty to violating federal mine safety standards, in violation of 30 U.S.C. Sec. 820. -Dental school is stressful yet great. I enjoy learning and keep an open mind. First two years are mostly didactic and labs. You hone your skills as a clinician with knowledge and handskills necessary for the promotion to clinic as a third year. The court bases child support on a parent's "net disposable income." This means the parent's income after state and federal taxes and other required deductions. The court may order support based in part on bonuses, commissions, overtime, and other supplemental or non-wage income if the court determines that this income occurs regularly. Law Firm Campbellsport WI replacing existing x-ray machinery (other than routine maintenance); What exactly is Dental Malpractice and how do I know if I have sustained an injury as a result of it?
These individuals can commit malpractice by failing to: (1) take and record an accurate history from the patient; (2) failure to recognize symptoms of a disease or condition; (3) failure to order necessary tests to help in the diagnosis of the condition or disease; (4) misinterpretation of test results and diagnostic films; (5) failure to order necessary medical treatment or medication; and (6) failure to monitor a diagnosed medical condition or disease. Hill's illegal det.& search was reasonable;conv.dismissed Currently, a two-block stretch of Ventura Boulevard in the west San Fernando Valley features three dispensaries. Mother Nature's Remedy, a storefront sandwiched between a foot spa and an office building, and The Exchange, in a strip mall adjacent to a kid's gym, have taken the place of dispensaries that were prosecuted by the city. West Valley Caregivers, too, has been prosecuted but remains open. The signage on its ground-floor entrance in a mixed-use building bears witness to the legal convolutions it has endured, proclaiming that because it was established in 2005 it is pre-ICO, and that it is Prop. D compliant as well. But he did say the work could have caused "walking" and "banging" on the roof.