Monday, March 10, 2014

Caught On Video - What Now?

What happens if a private investigator takes a video of you mowing the lawn and sends it to your insurance company? Are you in trouble? Will your benefits be cut off? Will your lawyer not want to have anything more to do with you?

These are frequent fears that individuals have when they are receiving income replacement benefits from an insurance company. It is very common for private investigators, hired by your insurance company, to follow you around and take pictures of you going about your regular activities.

This does not make you a criminal, although you may feel that you are being treated that way. Rather, it seems to be more of a routine procedure used by most insurance companies, for most individuals making claims. This does not make it any less stressful for you. You are just one of the insurance companies cases and this is what they routinely do. It does suck though, not only for you, but also for family members that may feel frightened and intimidated.

In general, video surveillance can only make trouble for you if you are dishonest. If they catch you in a lie, and can show evidence that you lied with a video of you, this does hurt your credibility.

If you are mowing the lawn, usually for short periods of time, generally any video surveillance of this activity will not be a problem. Most people with accident related injuries are able to do activities for short periods of time, even mowing their lawn. Your doctor should know that you do try to do these activities when you can. This way if your lawyer sends a picture to your doctor showing you mowing the lawn, your doctor will not be surprised. In fact, your doctor may have recommended that you do as many activities as you can, again for short periods of time.

The most important thing that you can do to protect your credibility and your benefits is to be open and honest with your doctors, therapists and lawyer. Most limitations from physical injuries do not involve paralysis, but do involved limitations of endurance and stamina. Most accident victims are able to do many activities, but only for short periods of time. Unfortunately, it is very difficult to work when you can only be active for a brief time periods.

This is a very important topic and I will return to it over and over again in later posts.

Yours with Care - Mike

Monday, February 3, 2014

What Is Reactive Depression?

I am going to try to make this very simple.

Historically, there was thought to be two types of depression. One type, called endogenous, was thought to be mostly biochemical in nature and could happen to individuals even when there were no significant stresses going on in their lives. This type of depression was thought to be a true illness.

A second type of depression was called reactive. In this case, depression was experienced by individuals who are undergoing serious stresses or losses in their lives. This is the category of depression that would best describe the symptoms experienced by many people who live every day in pain, or suffer serious prolonged illness or injury. This type of depression happens to people as a reaction to what is happening to them. Clear examples would be, prolonged injury or illness, death in the family, divorce, job loss and prolonged unemployment, or almost any type of serious loss.

Even though the causes of these two types of depression were quite distinct, the symptoms are very similar. Treatment for both types of depression is also similar, and involves, usually, a combination of medication and counseling. Counseling involving cognitive behavioral therapy is the most common and most effective. For these reasons, depression is thought of, nowadays, as being of a single type. Depression is usually diagnosed with the term, major depressive disorder, regardless of the cause.

Although these terms are not used for diagnosis anymore, it is still often useful to explain the concept of reactive depression to patients who suffer from depression caused by their chronic or long-term pain. The idea of depression, as a reaction to the stresses and losses connected to living every day in pain, makes more sense. Importantly, it also takes away some of the fear and stigma associated with depression.

Yours with care - Michael

Monday, January 27, 2014

The Black Dog - Brilliant Illustration

Many people who live every day in pain feel like the Black Dog is hounding them. And it feels like the dog never gives up.

The Black Dog is one of the main characters in a brilliant cartoon put out by the World Health Organization. The Black Dog is a constant and heavy presence in the life of a depressed man in this cartoon. This cartoon perfectly illustrates the symptoms of depression and how it can affect almost all parts of our lives.

Many people who watch this cartoon will say that the Black Dog is like the constant pain they feel. The heavy and intruding presence of the Black. Dog is partly from pain and partly from the depression, caused by the pain. Sometimes, it is difficult to separate out these two parts, because pain is a much more vivid and salient symptom.

Over 90% of my patients suffer from chronic or long-term pain. Many suffer from pain + depression. The depression comes, not only from the suffering caused by their constant pain, but also from the limitations and losses caused by their pain.

What is depression? Let this animation with a dog sheds light on it.

Please check out this brief video. It is well worth a few moments of your time. Here is the link:

I hope this illustration can help explain the mysteries of pain + depression and help your life in even a small way.

Yours with care - Mike

Monday, January 20, 2014

Pain + Depression = More Disability

Many people with long-term pain, especially those that have experienced significant losses caused by their pain, also experience depression. This is an understandable reaction to having a life full of pain and losses, that continues day after day.

Even though it may be very difficult to acknowledge, it is important that depression is recognized as part of the overall difficulties for people with long-term or chronic pain. This is important for several reasons.

From a treatment point of view, help with your depression, even depression that is caused by your pain and losses, can help reduce the severity of your long-term pain. Medications and psychological treatments for depression can help with physical pain. These can also help with sleep, energy and tolerances, all of which are important for  individuals struggling to cope with long-term pain.

When individuals are applying for disability benefits, it is important to have your physical injuries, sources of pain, and secondary psychological reactions acknowledged and accepted. All of these factors combine to create the overhaul limitations that can interfere with an your capacity to work.

Sometimes people in pain only discuss their physical injuries. This can hurt you when you are making claims and are out of work. When you only discuss one part of your overall limitations, insurers are bound to underestimate just how limited you may be. It is important for treatment providers and insurers to understand not just the causes of the problem, but also all of the secondary complications and factors that can limit you.

When it comes to secondary psychological reactions of depression, sometimes a simple formula can help us all understand it a little bit better.

Pain (including multiple sources of pain) + depression =  more disability

Essentially, this means that an individual is more disabled by 2 problems (or many problems) than they are by just one problem. Simple, but true.

This is an important topic and I will return to it over and over again more detailed information - what is depression.

Yours with care - Mike

Monday, January 6, 2014

Sudden Onset Matters

Over 90% of my patients, over the past 25 years, have suffered from chronic or long-term pain following car or work accidents.

What makes long-term pain from accidents different from other types of long-term pain is the sudden onset of injury and pain. If a person has long-term pain from arthritis, this pain may have gradually increased over many years, sometimes even decades. The pain can still be very difficult and limiting for the person in pain and their families. It is a little easier though, when a person has years to try and accept and adapt to their pain. They have some time to make changes in their lives to accommodate to the limitations that are caused by their pain.

When pain and injuries are caused by accidents, there is no time. One day, you may be healthy and living life to the fullest. The next day, you may be racked with pain, out of work and frightened of how you are going to manage. This can be a big shock for you and your family.

Sudden onset matters and makes it all the harder to cope and survive long-term injury and pain. people are more at risk for additional stresses, anxiety and depression, under these conditions. I will discuss these implications more in later posts. Please stay tuned.

Yours with care - Mike

Monday, December 16, 2013

Time of Year Matters

When injuries occur near very memorable times of year, it can be much harder on you and your family.

Having a bad car accident at Christmas time can mean that every Christmas after that will be tainted by memories of your accident. If your injuries heal up, and your losses are restored, the intensity of  these memories will lessen over time.

If you continue to suffer from serious pain symptoms, injuries and losses, you may relive the accident when the anniversary time approaches each year. Your emotions and vivid memories may be even more intense if the accident was a frightening or life-threatening one. The combination of emotional trauma at the time of the accident and long-lasting pain, injuries and disabilities is a powerful one.

This pattern doesn't just relate to religious holidays. It can occur near wedding anniversaries, birthdays and even Valentine's Day. Some of my patient's have been injured soon after they bought their new home. Now, having to pay their mortgage with money they don't have brings strong and vivid memories of their accident back to them.

The time of year, or connection between the onset of your injuries and important dates in your life, does matter. Vivid memories and powerful emotional reactions make it all the harder to cope with injuries and pain.

Yours with care - Mike

Monday, December 9, 2013

Aggressive Insurers (and WSIB) Will Lose Everytime

Over 90% of my patients, over the past 25 years, have suffered from various types of long-term (or chronic) pain. Often, high levels of relentless pain plus heavy losses trigger depression. This then becomes an added source of limitation, creating even higher levels of disability and loss.

When insurers (or WSIB, Worker's Compensation) place undue pressures on such people and terminate their income or treatment benefits, what is the most likely outcome? This is not rocket science. Of course, most people under these conditions experience much higher stress levels. Most people get worse. Their pain levels, often from multiple sources of pain, escalate. They become more depressed. They lose hope. Many feel defeated and give up. Now, they are even more limited and more disabled, because their injuries have worsened.

Unfortunately, some people, under such harsh conditions, need to go to the emergency room for help with their soaring pain levels and severe depression. Suicidal risks are significantly elevated.

Does this turn of events really help anyone? Injured people and their families suffer more and lose more. Insurers and WSIB are at much higher risk for losing any appeals, tribunals, arbitrations or court cases.

In the last few years, I have seen fewer of these unfair and self-defeating actions from car and disability insurers. Unfortunately, WSIB is behind the times (as usual). WSIB has decided to become more aggressive. As more and more appeals are won, I can't see that their actions are really helping, even themselves. Sadly, they leave  many injured worker's suffering in their wake.

Yours with care - Mike