CRISSP

Protecting Your Heart From Toxins: Reducing the Risk of Arrhythmias

kunj.patel — Wed, 30 Apr 2025 16:57:40 +0000

Arrhythmias—abnormal heart rhythms—can be triggered or worsened by various environmental and lifestyle factors. Below are key insights and recommendations to help you avoid toxic substances and potentially prevent or reduce arrhythmias.

Key Points & Recommendations

1. Alcohol Consumption

Even a single drink—whether it’s a shot, a glass of wine, or a beer—can significantly increase the risk of arrhythmias. Cutting back on alcohol or eliminating it entirely may help lower your risk.

2. Caffeine

Research shows caffeine can increase the likelihood of atrial fibrillation. If you’re sensitive to caffeine’s stimulant effects, consider avoiding caffeinated beverages at least 5–6 hours before bedtime. This can help improve the quality of your deep sleep and REM sleep.

3. PFAS “Forever Chemicals”

Where They’re Found: Non-stick cookware (Teflon pans), Dry Fit clothing, watchbands, and more.
Why They Matter: Over 99% of people have detectable levels of PFAS in their blood.
Reducing Exposure: Consider using cast iron or ceramic cookware, filter your water, and be mindful of personal products containing PFAS.
Testing Options:
- Quest Diagnostics PFAS Test
- EmpowerDx PFAS Test

4. Air Quality

Both outdoor pollutants (e.g., car exhaust, smog) and indoor pollutants (e.g., PM2.5, VOCs like benzene and formaldehyde) can contribute to arrhythmias. To reduce exposure:

Use a smart air quality monitor and/or air purifier.
Ventilate indoor areas by opening windows.
Opt for Greenguard or Certi-Pure certified low-VOC products.

5. Dietary Recommendations

Fiber Intake: Aim for at least 30 grams of fiber daily (typical U.S. consumption is under 3 grams). Increase fruits, vegetables, nuts, and whole grains.
Antioxidants: Polyphenols—found in coffee, tea, and dark chocolate—may help lower arrhythmia risk. If caffeine is a concern, opt for decaffeinated green tea (buy here) or other low-caffeine options.
Note: Avoid purchasing “low acid coffee,” as it may not offer the same potential benefits from naturally occurring antioxidants.

Video Resources

For more tips on minimizing toxin exposure, check out these YouTube videos by Dr. Patel:

Check out this video by Dr. Navara, on what atrial fibrillation is:

Rachita Navara Explains AFib

Disclaimers

Longevity SMAs

Our Longevity Shared Medical Appointments (SMAs) are wellness and longevity-focused sessions offered through the CRISSP Longevity Clinic (a separate, out-of-network practice). A separate fee may be required per session.

General Information

This blog post offers general educational information and product references. It is not intended to replace professional medical advice. Always consult a qualified healthcare professional before making changes to your treatment plan.

Affiliate Links

Some links may be affiliate links. If you click and make a purchase, we may receive a small commission at no additional cost to you.

Warm regards,
Dr. Kunj Patel & Dr. Rachita Navara
CRISSP Clinics
https://crissp.net

Regenerative Medicine & Neuromodulation for Chronic Pain

kunj.patel — Wed, 30 Apr 2025 16:52:05 +0000

Chronic pain is generally defined as pain lasting more than 3 months. Many conventional treatments aim to reduce symptoms rather than address the root causes. Two advanced therapeutic approaches—Regenerative Medicine and Neuromodulation—are increasingly used when standard methods fall short. Here’s a closer look at how they work and what to consider if you’re exploring them.

1. Regenerative Medicine

Platelet-Rich Plasma (PRP)

What It Is: A small amount of your blood is spun in a centrifuge to separate platelets (which are rich in growth factors) from red blood cells.
How It Helps: When injected into injured tissues, these platelets can promote natural healing and tissue repair.
Cost & Coverage: PRP injections are typically not covered by insurance. Our clinic offers PRP for approximately $750.

Stem Cell Options

What It Is: Stem cell therapy uses cells harvested from bone marrow or fat to deliver a stronger, more sustained regenerative effect than PRP alone.
Why Consider It: This approach may be beneficial for complex or long-term injuries.

Tenex (Water-Assisted Debridement)

Procedure: A minimally invasive technique that uses a specialized instrument to flush out damaged tissue, encouraging healthier tissue to grow in its place.
Setting: Usually performed in a surgery center.

2. Neuromodulation

Interrupting the Pain Pathway

Chronic pain can cause the nervous system to become overactive, creating a feedback loop that intensifies pain signals. Neuromodulation disrupts this loop by delivering gentle electrical impulses.

Peripheral Nerve Stimulator (PNS) & Spinal Cord Stimulator (SCS)

How It Works: A tiny electrode is placed near the affected nerve or along the spinal cord. Low-level electrical pulses help block pain signals before they reach the brain.
Trial Period: A 7-day trial is often done first. Continued treatment usually requires at least 50% pain relief during this trial.
Insurance Coverage: Many insurance plans cover these devices if certain criteria are met.
Learn More: Explore our deeper dive into Peripheral Nerve Stimulation on com/blog.

TENS Units

Non-Invasive Option: Transcutaneous Electrical Nerve Stimulation (TENS) devices are applied externally to the skin for basic electrical pain relief.
Accessibility: Often available over the counter or through insurance with a prescription.

Disclaimers

General Education
This post is for general educational purposes and does not substitute for professional medical advice. Always consult a qualified healthcare professional before making changes to your treatment plan.

Longevity SMAs
Our Longevity Shared Medical Appointments (SMAs) focus on wellness and longevity, offered through the CRISSP Longevity Clinic (separate and out of network). A separate fee may be required per session.

Insurance & Fees
Regenerative procedures (e.g., PRP, stem cell injections) are typically not covered by insurance. Neuromodulation may be covered under specific guidelines. Discuss all financial considerations with our billing department.

Affiliate Links
Some links in our posts may be affiliate links. If you click on these links and make a purchase, we may receive a small commission at no additional cost to you.

Final Thoughts

Regenerative Medicine and Neuromodulation represent cutting-edge options for those dealing with persistent, hard-to-treat pain. By targeting the source of the problem—either through natural tissue repair or interrupting abnormal pain signals—these therapies may offer new hope for lasting relief.

Warm regards,
Dr. Kunj Patel & Dr. Rachita Navara
CRISSP Clinics
https://crissp.net

Benefits of Telemedicine

kunj.patel — Mon, 23 May 2022 04:04:22 +0000

Telemedicine, which means “healing at a distance,” allows health care professionals to gauge, diagnose and treat patients at a distance using telecommunications technology. This approach is becoming an increasingly important part of the American healthcare infrastructure and a quickly growing part of healthcare delivery. There are currently about 200 telemedicine networks, with 3,500 service sites in the US. In 2011 alone, over 300,000 remote consultations using telemedicine were delivered by the Veterans Health Administration. Some forms of telemedicine are now used by more than half of all U.S. hospitals.

What are the benefits of telemedicine?

Telemedicine uses modern technology to make it possible for physicians and patients to communicate virtually in real-time interaction. Typically, a smartphone or computer and the internet are all that must have a remotely secure live video and audio to supply clinical services to patients whenever and wherever needed. Telemedicine is often used for consultation, follow-up visits, chronic conditions management, medication management, and other clinical services. Studies have shown that telemedicine interventions, including telephone-assisted care, are variously associated with improvement in all-cause mortality, hospital admission rates, and improved quality of life. And the use of it makes it easier and less expensive for patients to keep control over their health. When used under the right conditions and for proper cases, telemedicine is as safe and effective as in-person care.

Convenience. Telemedicine allows people to access care at a place and time that is most suitable for them. Problems often occur at night or on weekends, making hospitalization the only choice even for less urgent problems. With telemedicine, you do not have to drive to the doctor’s office or clinic, park, walk or sit in a waiting room when you are sick. On-call doctors can conduct a remote visit from the comfort of your bed or sofa to decide if hospitalization is necessary. Virtual visits are often easier to fit into your busy schedule. You may not even have to take leave time from work or arrange for a child or elder care depending on your schedule.

Comfort. Telemedicine can also be a more comfortable approach to seeking healthcare for those patients who are reluctant to attend off-site appointments due to anxiety or even fear of social situations, particularly those feeling daunted by both medical professionals and their associated surroundings. Access to care. Telemedicine was particularly of great benefit to places such as rural, remote, and/or post-disaster communities, where there are no constant healthcare services that are readily available to these populations, or to places where transportation conditions are less than best, such as during heavy snow or hailstorm. Telemedicine supplies emergency healthcare for dangerous cases without the need for travel.

Control of Infectious Illness. Telemedicine adds a dimension of clinical protection for users by cutting the risk of picking up an infection or the possibility of transmitting COVID-19, flu, and other infectious diseases between healthcare professionals and patients. Telemedicine can be used by doctors to prescreen patients for possible infectious diseases. It also saves sick people, especially those who are chronically ill, pregnant, elderly, or immunocompromised, from having to come in and wait in the doctor’s waiting rooms and becoming exposed to other potentially contagious patients. Better Assessment. Telemedicine can give an advantage to some specialty practitioners because they can see you in your home environment, find clues in your surroundings that cause certain conditions, observe you, and assess your ability to navigate and look out for yourself in your home.

Family Connections. It always feels good to have someone who can help you when consulting a doctor. Telemedicine can connect your family member on the video conference if you authorize it, even if that person lives out of town, or even across the country.

Primary Care and Chronic Condition Management. Regular visits with doctors are essential to your family’s health. Telemedicine makes it easy to connect with your doctor or nurse practitioner.

Lower Cost. Telemedicine appointments typically cost less than in-person visits do. This reduces out-of-pocket costs, which allows more patients to have access to the care they need. Some studies also suggest that preventive telemedicine results in a decrease in the time spent in hospitals, supplying cost savings.

Insurance Reimbursement. Many private health insurance companies allow doctors to bill for telemedicine services. However, their policies differ in every state and insurance plan, so it is important to check before seeing a doctor remotely.

For Medicare patients, many restrictions are set by national telehealth policy on patient location, services provided over telemedicine, and facilities at which patients receive these services. However, the Medicare Chronic Care Management Program is a national policy that sets no such restrictions on practicing telemedicine.

Medicaid reimbursement varies from state to state, leading to a patchwork of various policies and reimbursement requirements.

Online Psychiatric Support. Telemedicine is also a clever way to get mental health assessment and counseling. It can address therapeutic care for people experiencing stress, anxiety, or depression. It also allows doctors to supervise patients with other mental health issues and help them cope with the challenges associated with their chronic pain.

Missouri Workplace Safety Guide

kunj.patel — Wed, 18 Aug 2021 15:26:59 +0000

https://www.nstlaw.com/guides/workplace-safety-in-missouri/

Workplace safety should be a high priority for employers operating Missouri businesses. The risks of employee injury are present everywhere, and no employer wants an employee getting hurt on the job and taking civil actions for money compensation. If evidence shows that there was insufficient work training for the job, the plaintiff, or injured employee, could sue the defendant, or employer, for reimbursement of medical bills – if the employer was grossly negligent of employee safety, they may even face punitive damages. Thankfully, employers can employ methods to decrease worker injury and properly respond to them when they do occur.

This workplace safety guide will provide you with the information employers and employees need to prevent hazards and unsafe conditions in your workplace, creating greater protection for the company and employees.

COMMON CAUSES OF ACCIDENTS IN THE WORKPLACE

There are a variety of accident causes in the workplace, many of which are easily preventable by proper order and conduct. Accidents occurring at work are often due to one of the following:

Overexertion – this occurs when a staff or worker’s responsibilities include physical labor, and they work long days or nights without much time for breaks. The overexertion could be from a single incident, such as moving a shelf full of books in the office, or it could be a result of such motions that are repetitive, like using a cutting machine at a butcher shop or installing heavy tires on a car construction line. Overexertion can lead to long-lasting physical damage for individuals, especially when it is brought on by repetitive motion. Thus, it is very important that workers engaging in duties likely to bring on overexertion be properly trained on equipment use and be allotted adequate break opportunities. Injuries that result from overexertion can lead to major issues and hefty medical bills. Employers should provide employees with the support they need to prevent overexertion.
Slip and falls – A slip and fall is the result of a worker losing his or her balance on an unreliable surface, such as a wet floor. A fall can be serious enough to result in soft tissue damage, a traumatic brain injury, or even broken limbs. Like overexertion, slip and falls are preventable. Employers should take care to keep work areas clean and safe, monitoring them regularly.
Workers being struck, squeezed, or crushed by machinery or equipment – This type of injury occurs when machinery or equipment malfunctions during employee use. Alternatively, this may happen when the conduct of an employee is with flagrant disregard for proper machine use. Employers can reduce this sort of injury by providing sufficient training, including ongoing training.
Another common type of workplace accident are those involving vehicles. Whether it is a car, large truck, or machinery such as a forklift or crane, these machines pose a significant safety risk due to their size, motion, and weight.

BREAKDOWN BY OCCUPATION

Just as there are common types of workplace injuries, findings show that there are also common occupations that are prone to workplace injuries. This is because the inherent nature of the work increases the likelihood of injury. Some of these industries and occupations include:

Truck and delivery drivers – these sorts of drivers are responsible for transporting cargo for long distances. In fact, the risk of this job is so high that the National Highway Safety Administration imposes rules that limit how long a truck driver may operate a truck before he or she is legally required to stop for a break. It is most scary when these large trucks get into accidents with cars that are a fraction of their size. Again, the responsibility of this sort of workplace injury falls heavily on the employer, who is expected to regulate the driver’s hours.

Construction workers – those who work in construction zones are in hazardous territory. This is because the risk of a heavy object striking or falling on them is high. Whether it is a construction worker building a skyscraper or a home, this occupation commonly sees workplace injuries. Further, construction workers in especially unique environments, such as highway building zones, face the risk of getting injured not only by moving or stationary machinery but also by other things in their way, such as passing cars.

Roofers – Homebuilders, due to the lack of safeguards present when working on top of a house, face the risk of falling from a significant height. Roofers may also sustain injuries by losing their balance on an insecure ladder.

Electrical workers or linemen – these types of occupations face injury risks mostly associated with getting shocked or electrocuted by electric lines they are working on.

Civil workers – this line of workers, including police officers and firefighters, risk their lives every day on the job. In fact, it is the responsibility of public sector workers to physically put themselves in front of danger to protect individuals and families. Because of this, they are highly susceptible to being shot, stabbed, or getting stuck in a violent fire when trying to save someone inside of a house. Unfortunately, other than crime reduction efforts in the community and fire safety education, experts have not found many tactics an employer could use to reduce the likelihood of injury in this occupation.

Loggers – logging and other forestry work are considered extremely dangerous. A variety of factors, including using heavy equipment and chainsaws, the ability of trees to fall down or roll down a hill, and transporting wood, make loggers very prone to injuries. Because of the possibility of getting pinned down or struck by heavy trees, severe injuries to the back, neck, or brain can occur. While the self risks of logging are inherently high, proper oversight, working in teams rather than alone, and making sure wood is properly secured can reduce the chances of workplace injury.

Steel and ironworkers – this type of worker is responsible for assembling and installing large steel and iron structures. Sharp equipment is typically used to cut into these materials, which creates a high risk for injuries, including amputations, broken bones, and burns. However, mechanisms are available to lower the chances of injury, such as having fall protection or fall arrest equipment, securing toxic chemicals or sharp ends when not in use, and making sure electrical units are reliable.

Farmers and agriculture workers – though this type of worker is not often discussed for injury risks on the job, farmers and agriculture workers nonetheless face injuries. Equipment such as tractors and pesticide sprayers can often lead to injuries. Also, pesticide use over a sufficient enough of time can lead to cancer, pulmonary disease, and difficulty breathing. For example, expert doctors and researchers have found links between Paraquat exposure and Parkinson’s disease.

Laborers and freight, stock, and material movers – Laborers are responsible for all sorts of job tasks. For example, they may be moving furniture for a family relocating to Florida or delivering stoves to a commercial kitchen. On the other hand, freight and stock movers typically use equipment to unload or load stuff rather than their bodies. For example, they may be using a machine to load pieces of wood onto a shelf at a home improvement store or stocking bags of rice into the bottom shelf of a grocery store.

Factory workers – these employees work in a factory setting where they often perform the same function repeatedly. Because of this, single incident injuries are uncommon. Factory workers include those who manufacture clothes or cars. A unique challenge of being a factory worker is dealing with heat elements. Discomfort from sweating may decrease productivity and hurt performance and concentration, thus increasing the chances of injury. Also, there should be regular inspection of factory belts and machinery.

Miners – Similar to many of the occupations discussed above, miners work with heavy equipment. Additionally, they encounter adverse heat conditions due to being underground and operating equipment that generates heat. Specific injuries that miners are susceptible to on the job include roof collapse, burn injuries, and lung congestion.

Refuse and recyclable material collectors – this sort of worker often rides on the back of a trash or recycle collection truck. This poses two dangers: First, the collectors rely on their ability to hold on to the truck and the safe driving of the truck operator. And second, the collectors are trusting that the drivers around them are not going to hit them.

Highway maintenance workers – these workers include those who oversee the building and safe administration of highways. The proximity to high-speed vehicles driving by poses a significant risk to them on the job.

Airplane and helicopter pilots – Pilots are operators of large vehicles that transport people through the air. This is a high-stress job due to the burden of safely transporting numerous people, having to potentially implement terrorist protocols, and limited landing ground in an emergency. In addition, pilots face injuries such as wrongful death, bodily damage due to smaller impact crashes, and even injuries due to passenger confrontation.

Oil workers – A unique type of occupation due to extended periods of time working away from home. Oil workers are typically stationed at a workplace and work long hours. As a result, pumping oil, particularly in water zones such as the ocean, raises the risk of injuries. For example, disastrous oil spills have occurred in the ocean, causing workers to drown or suffer from severe burn injuries.

According to the Missouri Department of Labor, transportation drivers were the source of over 5,500 injuries while on the job, a dozen of which ended in fatalities. As a highly populated area, Missouri is consistently increasing its workforce of truck drivers, delivery drivers, and refuse collectors to respond to customer demand. However, the more foot and transportation traffic, regardless of how safe the measures implemented are, the higher the likelihood that transportation workers will get injured.

Construction workers have less injuries compared to their transportation driver counterparts. In 2020, construction workers suffered from slightly over 4,000 injuries. Despite this smaller number, twenty of these injuries resulted in death. This is due to the heavy equipment and materials used in construction zones that aren’t present in transportation settings. St. Louis was one of the higher injury risk zones for construction workers due to the growing economy in the area. St. Louis is a highly visited tourist spot, which prompts new construction and presents risks to construction workers working on tight deadlines.

Electrical workers and linemen saw no fatalities in 2020 and suffered from under six hundred injuries. This is down by two hundred from 2019, demonstrating an increased emphasis on safety measures in electrical work settings. There has been improved oversight by the city and state with regulations on the industry and internal controls.

Steel, iron, and other lines of work requiring manufacturing of materials account for a large amount of St. Louis reported injuries. While down from 2019, the number of 2020 injuries here totaled just over 12,000. However, the industry did lower the average of injuries that was hovering around the 14,000 per year mark from 2016 to 2019.

Unlike their counterparts listed above, civil workers responsible for public administration and safety have actually seen a rise in injuries since 2017. Injuries in this category of occupation were just under 9,000 in 2017 and exceeded over 10,500 in 2020. Perhaps a factor in these higher numbers is the recent dangers associated with holding some public positions, such as a police officer or firefighter.

STATISTICS OF INJURED WORKERS IN MISSOURI

The table below shows the total injuries in Missouri workplace environments that occurred in 2020. About 9% of the total injuries resulted in employees losing time at work due to the severity of their injuries.

In addition to the statistics laid out above, the following industries were not shy when it came to reporting workplace accidents.

Scientific services – this profession usually includes chemists and physicists who work with chemicals and other structures. Due to the experiential nature of this occupation, injuries can and do occur. However, Missouri scientific service providers have boosted their response tool kit over the years, and the numbers show it. In 2017, just over 3,000 injuries occurred, and in 2020, there were less than 2,000 injuries.
Agriculture and fishing workers – Also a small contender, this field accounts for just over 800 of Missouri’s workplace injuries in 2020. In fact, this occupation has only seen five deaths in the last five years.
Health care and social workers – turning the page, these occupations see high amounts of workplace injuries. Uniquely, many health care and social worker injuries don’t arise from physical on-the-job activities, but rather interactions with clients. In 2020 alone, nearly 23,000 employees in this industry sustained an injury, with over a dozen of them dying. This fatality rate skyrocketed from 2019, which only had two deaths.

SAFETY TIPS IN THE WORKPLACE

There are numerous ways that employers and workers can stay safe on the job and reduce the risk of accidents. Implementing the following types of policies is not only likely to increase safety on the job but to increase employee morale and productivity:

Develop thorough training programs to use company tools and equipment properly. This may be implemented through employee handbooks and manuals, website video training, and actual demonstrations. This training should be available for those that don’t speak the English language. While it would incur a cost, hiring a specialist to come in and display workplace safety measures associated with machine use would be highly beneficial.
Provide employees with a map and walkthrough of facility exit routes. Sometimes employees get injured due to being trapped in a location. It may not be feasible to gather all other employees before seeking safety yourself in such a case, so educating them ahead of time could prevent injuries.
Avoid worker fatigue. Many workplace accidents can be prevented by workers paying attention to the task in front of them. Being overworked, getting little break time, and performing repetitive and mundane tasks can cause injuries. Preventing burnout or working to reduce it is key.
Dress employees appropriately. If an employee should be wearing a hard hat due to the risk of falling objects, an employer should avoid cutting corners to save on the monthly bill. Not only does this increase the likelihood of injury, but it can cost the employer more later on down the road.

Without health standards and policies in place, employees may be subject to serious hazards. Therefore, a safety program is necessary to create a safe workplace.

MISSOURI LABOR LAWS

Other than maintaining the safety of employees, employers should be encouraged to implement strict workplace safety standards due to liability imposed by the laws and legislation. Some labor laws applicable in Missouri include:

The Fair Labor Standards Act (FLSA) – this federal law requires that employers establish pay standards for all employees. This includes adhering to an hourly minimum wage for all business days, providing overtime pay for non-exempt workers, and accounting for unique positions that allow for tips.

The Occupational Safety and Health Act (OSHA) – OSHA is a federally mandated law that focuses on healthy and safe working conditions and environments for workers. Independent Occupational Safety inspectors look for training implemented by employers, safety equipment provided, and hazardous conditions that may jeopardize employee safety. If OSHA determines an employer is violating a set regulation, it will impose a timeframe for correction and potentially a penalty such as a fine.
The Civil Rights Act of 1964 prevents harassment of workers based on categories such as race, age, or disability. For example, if a worker is pregnant, she must be accommodated if her pregnancy affects her ability to perform her job duties for a period of time.

UNIONS IN MISSOURI

Employers should also be cognizant of labor unions. A labor union represents the interests of laborers in particular industries to ensure they are properly treated and compensated in adherence to their human rights. Some well-known Missouri unions include:

Smart Union – boosting over $20 million in assets, this union oversees sheet, metal, and HVAC workers. They have been in business for over a hundred years and are prompt about responding to union needs such as strikes.
Teamsters – a national organization, Teamsters has many unions throughout Missouri. Teamsters is well known for focusing on employee wages and benefits. As a result, they secure, on average, nearly a third more in wages for their union members compared to non-unionized employee representatives.

It is important to know that an employee need not financially contribute to a union that is attached to their line of work due to recent federal court pronouncements. This means that an employer shouldn’t assume an employee doesn’t have representation from a union based on their ability to pay or interest in participating in union activities.

COVID-19 AND THE WORKPLACE

The Centers for Disease Control and Prevention (CDC) continues to monitor COVID-19 despite the issuance of a vaccine. COVID risk is highly prevalent in workplace settings due to the close proximity of employees, not knowing where employees have been, and not knowing who employees have interacted with.

Employers should take precautions to decrease the risk of their employees catching the coronavirus:

Encourage employees to wear face coverings. N-95 and other specialty masks are best for preventing COVID-19.
Require employees who test positive for COVID-19 to report immediately to their boss. In turn, the employer should communicate this to other workers who were near the infected employee.
Mandate a two-week quarantine period for employees who tested positive or are feeling symptomatic.
Allow flexibility in remote work where feasible and implement social distancing.
Encourage frequent COVID-19 testing. An employer may incentivize testing by offering to pay for or subsidize testing.
Encourage employees to get the COVID vaccine. However, employers should be cautious with this as political and social views are interconnected with vaccines.

RESOURCES AVAILABLE FOR INJURED WORKERS

In the case of a workplace injury, employers should take special care to show that they are interested in the employee’s recovery. However, this should not be tied or associated with accepting responsibility or issuing an apology. An employer can:

Offer a list of medical providers that the injured employee may go to and be covered under employer-issued insurance company benefits.
Refer injured employees to the Missouri Labor Division of Workers Compensation.
Refer injured employees to experienced lawyers who specialize in workplace injuries.
Inform injured employees that Missouri workers’ compensation benefits and services are offered to employees who are out of work due to a workplace injury. Typical benefits include coverage of medical expenses, lost wages, and permanent disability.

Employees have legal rights to work in a safe environment. Missouri employers can prevent injuries and potential lawsuits by abiding by all requirements from government agencies, the Division of Labor Standards, the U.S. Department of Labor, the Missouri Department of Labor, and consulting with legal counsel to ensure the company abides by workplace safety standards.

If you were injured on the job or if you have any questions about health laws and workplace safety, contact our experienced lawyers at NST Law today to obtain legal advice on Missouri workplace safety. Our St. Louis Workers’ Compensation Attorneys can help you recover the benefits you deserve for medical expenses, lost wages from missed work, and permanent disability.

Endoscopic Surgery for Spinal Stenosis: 3 Steps to Relief

kunj.patel — Mon, 04 Jan 2021 14:25:46 +0000

The spine is designed to have enough space for the nerves in the spinal canal. But as aging occurs discs, vertebrae, and ligaments degenerate or require more space. This results in narrowing or stenosis, meaning that the nerves will be squeezed or pinched and pain or loss of sensation will occur.

This is the definition of spinal stenosis and if managing it has proven ineffective; if conservative treatments are not alleviating pain; and if the symptoms have not lessened after a significant amount of time, surgery for spinal stenosis may be necessary.

When surgery occurs, it should be as gentle as possible.

Step 1: Access

For access to the vertebral canal, a natural opening is used through the intervertebral foramen or the interlaminar window. Through an incision about the size of a keyhole the surgeon creates a pathway to the narrowing structures of the vertebral canal.

Step 2: Removing Tissue

To reach the impinging tissue, different instruments are inserted to remove the bony structures that are causing pain. By using a specialized endoscope, the surgeon has an illuminated view of all structures in the vertebral canal.

Step 3: Review & Completion

Following the operation, the surgeon will confirm that the affected neural elements are moving freely. The instruments will be removed and the incision is closed with a small bandage. The patient is normally back on their feet within a few hours and able to return home the same day.

Don’t let spinal stenosis affect your quality of life and restrict everyday activities. Reach out for a consultation and MRI review with the only endoscopic spine surgeon in the Upper Midwest–Dr. Dan Hanson.

Alleviating Facet Syndrome With Endoscopic Denervation

kunj.patel — Mon, 04 Jan 2021 14:18:59 +0000

Facet joint syndrome (a.k.a. osteoarthritis) is a pain at the joint between two vertebrae in the spine. When cartilage is present in these joints, they can move smoothly against each other without grinding. Each joint is also lubricated with synovial fluid for additional protection from wear and tear. Without these joints, our backs would lack flexibility and be unable to bend and twist.

Combined with age, facet joint pain can result from a combination of:

Overexertion
Incorrect weight bearing
Obesity
Poor posture
Physical inactivity
Whiplash accidents

A swollen or inflamed facet joint causes pain, numbness, and muscle weakness which will affect different parts of the body depending on which nerves are affected. If the nerves affected are in your cervical spine, you may have symptoms in your neck, shoulders, arms, and hands. If the nerves are in your lumbar spine you may have symptoms in your buttocks, legs, and feet.

Conservative Treatment Options

Once facet joint syndrome is confirmed, your doctor will likely recommend conservative treatment options. Physical therapy sessions can alleviate inflammation and reduce pain, which leads to greater mobility and strength. These sessions may include the use of ice to decrease blood flow and reduce swelling. Massage, muscle stretching, and exercise will also help regain mobility and flexibility. Spinal Injections using cortisone will also calm pain and inflammation. This method is temporary and provides relief for several weeks or months.

Alleviation Through Endoscopic Denervation

If conservative treatment does not reduce pain, endoscopic blocking of the nerves can be an effective method. This treatment involves severing the pain-transmitting nerves so that pain signals cannot be sent to the brain. By using a miniature camera on an endoscope, a radiofrequency probe is inserted through a small incision to block the nerve fibers that are transmitting the pain signals. When the procedure is complete, the small incision is closed and the patient is able to return home later that day. When not addressed through conservative options or surgery, facet joint arthritis will leave bone rubbing on bone. This will lead to bone spurs pressing into the nerve roots and causing spinal stenosis. If you have tried conservative treatments that have not provided relief, contact Minnesota Spine Institute today for a consultation and MRI review. Their caring staff has helped thousands of patients regain their mobility using advanced pain management solutions.

Addressing Sacroiliac Joint Syndrome With Endoscopic Denervation

kunj.patel — Mon, 04 Jan 2021 12:34:54 +0000

The sacroiliac joint (called the SI joint) is the connection point between the spine and the pelvis. These joints are located on each side of the spine and attached to the sacrum. Sacroiliac joint syndrome occurs when the sacroiliac ligaments are damaged or torn due to age, strain, an accident, or hypermobility in the ligamentous structures. This syndrome is difficult to distinguish from other types of low back pain, making a diagnosis of sacroiliac joint syndrome very difficult.

Common Symptoms of Sacroiliac Joint Syndrome

Chronic lower back pain
Radiating pain from the lower back to the buttocks
Radiating pain from the upper thighs to the knees
Pain when bending forward
Difficulty sitting in one place for extended periods of time
Tenderness of the posterior aspect of the sacroiliac joint

How Endoscopic Denervation Can Reduce Pain

If conservative treatment options do not reduce pain, endoscopic blocking of the nerves can be an effective method for sacroiliac joint syndrome. During an endoscopic denervation procedure, a small incision is made through which an endoscope is inserted and guided to the sacroiliac joint. There is minimal damage as the surrounding tissue is carefully moved aside. Through the use of a miniature camera on the endoscope, a radiofrequency probe is used to block the nerve fibers that are transmitting pain signals to the brain. When the procedure is complete, the small incision is closed with a small bandage and the patient is able to return home later that day.

Although sacroiliac joint syndrome can be complex and difficult to diagnose, it can be more difficult to live with constant pain. The team at Minnesota Spine Institute is ready to listen. It is our mission to help patients regain their lives through advanced surgical solutions. Schedule an MRI consultation today and explore your pain-relief options.

Back & Neck Pain: Types, Treatments & Solutions

kunj.patel — Mon, 04 Jan 2021 12:24:16 +0000

Consider if you will that you are a patient with back pain. You have had pain for a while and have several questions like how long is this going to last and how do I get better? This type of pain does not radiate into your arms or legs. This is called axial back and neck pain. You notice that it can get worse with movement like bending forward, backward, or with rotation of the head or lower back.

If this pain just started or you have had it for less than 3 months then do some conservative treatment like physical therapy, chiropractic care, and add core strengthening exercises especially for lower back pain and you will likely get better.

If you have tried these conservative things and you still have pain then try to consider that you probably have a pain generator that is causing your pain. This concept of a pain generator is not new. In fact, this concept has been around for decades. Various physicians have performed injections that were able to isolate and identify the cause of pain in people with chronic low back, thoracic, and neck pain.

By targeting a specific structure in the back or neck these injections were either able to temporarily take away the pain that a person normally has or were able to exactly reproduce the normal pain that a person has. So what does this mean? It means that pain comes from only a few sources on most people and is simple to identify.

The sources of pain can be divided into a region such as the lower back, thoracic, and cervical spine. The other grouping of people with pain are the people that had surgery and have hardware in their back or a fusion was performed.

Diagnosing Pain

This needs to be done before treating the unknown. Remember that most MRI scans show normal age-related changes and do not show the source of pain. Confirm the source of pain before considering surgery. If this isn’t done first then you might be upset when you have now had a surgery that you thought was going to fix the problem only to find out that the problem or pain generator never was confirmed before you had surgery.

The Surgery People

This group of people had some type of back or neck surgery. If a decompression, hemilaminectomy laminectomy, or microdiscectomy was performed then standing AP and lateral flexion/extension xrays are needed to make sure there is no instability. Occasionally a CT scan is needed to make sure that a pars defect wasn’t caused by the surgery. A MRI scan with and without contrast of the operative area can help identify if there is ongoing nerve compression, infection, cysts, or other causes of back pain.

If a fusion was attempted, there are three general types of pain that needs to be ruled out in this group. Nonunion pain, hardware pain, and adjacent segment degeneration pain. First, a CT scan is needed to determine if the bone healed or if there is a nonunion. Second, if you have pedicle screws then have the screw heads injected with marcaine or another long acting local anesthetic to determine if this is causing your pain. If it isn’t a nonunion or the hardware causing your pain, then investigate the levels above and below the fusion to see if the adjacent levels are causing your pain. This testing is usually done with medial branch blocks and if these are negative then have a discogram performed on the degenerative levels in that part of your spine. (More later on medial branch blocks and discogram testing)

Chronic Back and Neck Pain

This group of people has pain longer than 3 months, has failed physical therapy, chiropractic care, and core strengthening. There are only 3 common causes of low back pain, 3 causes of thoracic pain, and 2 causes of cervical or neck pain. Generally, all three areas have normal mri scans with no signs of fracture, tumor, or infection and probably show normal age related degenerative findings like disc dehydration, bone spurs, and facet arthritis. If you don’t have radicular arm or leg pain, numbness, weakness, or neurological symptoms then it’s generally ok to disregard the mri findings of small disk herniations, slight foraminal or central canal stenosis while you focus on working up the back and neck pain. Working up the source of pain also depends on the findings of your physical exam.

Low Back Pain

Pain commonly comes from the facet joints, disk space, and sacroiliac joint. Facet based pain is most commonly worked up with L4/5 and L5/S1 medial branch blocks. Disk based pain is worked up with a discogram on the degenerative(dark) disc spaces. Sacroiliac joint pain is worked up with sacroiliac joint injections (therapeutic/somewhat diagnostic) and L5 medial and S1/2/3 lateral branch blocks.

Thoracic Pain

Thoracic disk herniations can commonly cause back pain with or without pain radiating around the side of your chest. This is often diagnosed with a thoracic transforaminal injection. Facet joints can cause pain and are evaluated with medial branch blocks. Disk based pain is evaluated with a discogram.

Cervical Pain

Facet based pain is worked up according to whether it is upper, middle, or lower. Two or three joints are usually evaluated with some overlap in the levels tested. Upper neck pain is usually the C2/3 and C3/4 facet joints. Middle neck pain is usually C3/4 and C4/5. Lower neck pain extending into the scapular/shoulder blade area is usually due to C5/6 and C6/7. Facet based pain is treated with either an ablation or endoscopic nerve transection. Disk based pain is usually evaluated with a discogram testing the degenerative (dark) disk space levels. I usually treat disk based pain with a cervical disk replacement. This helps to preserve normal range of motion and does not have the increased risk of a patient needing more surgery at adjacent levels like a fusion.

Types of Testing

Medial Branch Blocks
Two medial branch nerves innervate each facet joint. Therefore, testing lower back pain from the L4/5 and L5/S1 facet joints would involve testing the L3/L4/L5 medial branches. Three nerves innervate two joints. This test is repeated and if positive twice, then either a rhizotomy (radio frequency ablation) or endoscopic nerve transection is performed. A rhizotomy typically provides pain relief for 6-18 months and an endoscopic nerve transection typically lasts for many years. A rhizotomy can fail to injure the medial branch nerve if there is an aberrant or abnormal medial branch, bony overhang or thick ligament covering the medial branch. I have identified all these reasons for a failed rhizotomy when performing an endoscopic medial branch nerve transection after a rhizotomy was attempted.

Discogram

A discogram is performed on the degenerative levels and a normal level above and below the degenerative levels. This test increases the pressure in the disk space trying to cause reproduction of your normal or concordant pain. Surgical treatment based on these results typically involves either a disk replacement or a fusion. A disk replacement is a great option for most people and depends on disk space height and whether there is instability.

Sacroiliac Joint Pain

If pain improves 50% or greater at the time of a sacroiliac (SI) joint injection then your pain may be due to the SI joint. If this test doesn’t identify your pain then testing to see if the pain from the SI joint is “posterior mediated” or travels along the posterior sensory nerves is tested by performing a L5 medial branch block and a Sacral 1/2/3 lateral branch block. If this test is positive then it is repeated to rule out a false positive result and if both tests are positive then either an ablation or endoscopic nerve transection is performed. An endoscopic nerve transection should theoretically provide longer pain relief than a rhizotomy.

If you have one of these conditions and would like to discuss your situation, schedule an MRI consultation today and explore your pain-relief options.

Is Minimally Invasive Spine Surgery Covered By Insurance?

kunj.patel — Mon, 04 Jan 2021 12:06:15 +0000

If you suffer from back pain, chances are you want to explore treatment options. Whereas some back pain may be fixed with physical therapy or medication, some issues must be treated surgically. Surgery can be costly, so researching your options will be imperative.

While traditional surgery may be a viable option for some patients, minimally invasive surgery is also an attractive option. This procedure boasts a faster recovery, less pain, and only a small incision. It may seem like the obvious choice, but only a handful of doctors are skilled enough to practice this form of surgery.

Minimally invasive spine surgery is performed with many different surgical implements, including lasers, endoscopes, computer-assisted navigation systems, and operating microscopes. This allows the procedure to be performed through a small incision. The decision to use a specific technology is based on the needs of the patient.

Luckily, most insurance plans should cover minimally invasive spine surgery.

Spine surgery is only performed to treat an actual medical condition. Because it is not a cosmetic procedure, insurance companies should cover the cost of spine surgery as long as a doctor determines it is medically necessary and the patient has completed the conservative care requirements set by their specific insurance.

How Much Does Minimally Invasive Spine Surgery Cost?

The cost of minimally invasive spine surgery can vary depending on the patient’s condition, the length of the procedure, and the surgeon’s fees. However, it is a much cheaper alternative to traditional surgery. A 2011 study published in SAS Journal showed the cost of a minimally invasive transforaminal lumbar interbody fusion was $14,183.00 on average while the cost of open surgery was $18,633.00. The cheaper costs are due to the fact that a minimally invasive procedure does not have to be performed in a hospital setting. It is an outpatient procedure, so many take place in surgery centers. Patients are able to go home after outpatient procedures, eliminating the cost of a hospital stay.

How much you pay out-of-pocket will depend on your own insurance coverage. You will have to consider your deductibles and copays because they vary across insurance plans. If you have a high deductible and copay, then you may pay a substantial amount out-of-pocket. If you have a high premium, then you may only have to pay a small amount out-of-pocket, or nothing at all.

You will also need to make sure your doctor accepts your insurance plan. Some surgeons may not accept various private insurance plans because some insurers won’t agree to pay the amount the surgeon believes they should be paid for each service.

Each year, doctors and insurance companies negotiate prices for every service they offer. If the doctor doesn’t believe the insurance company is being fair, then they won’t accept that insurance at their practice.

Does Medicare Cover Spine Surgery?

Typically, Medicare should cover spine surgery that is determined medically necessary by a doctor as long as the patient has completed the conservative care requirements set by their specific insurance.

However, how much you end up paying out-of-pocket will depend on where you receive the surgery and how you receive your Medicare benefits.

Medicare may only cover doctor and procedure fees. Therefore, you may have to pay a facility fee. Depending on where the surgery takes place, this cost can vary. Some surgeries may be performed in a hospital, whereas some can be performed at a surgery center. Surgery centers may be physician-owned or specialize in a certain procedure. Dr. Hanson performs minimally-invasive surgeries at both hospitals and surgery centers in the Twin Cities and Duluth.

Original Medicare (Part A and Part B) does not have an annual out-of-pocket limit. However, Medicare Advantage plans (Part C) have an annual out-of-pocket spending limit. This means that if you spend over a certain amount of money out-of-pocket, you may be reimbursed for the cost of covered services that went beyond the out-of-pocket limit.

There are certain portions of a surgery that can and cannot be billed through Medicare. Because of these complexities, we encourage everyone to contact our off i ce to learn about financing options.