Migraine Headaches

Migraine headaches can be debilitating, and, in some cases, chronic.  In this post, we will look at some of the symptoms of migraines, how they are diagnosed, and some common treatments for migraines.

Overview

Migraines are characterized by severe headaches that usually involve throbbing pain felt on one side of the head, and can be accompanied by symptoms such as nausea, vomiting, and/or sensitivity to light and sound.

Migraines are the third most prevalent illness in the world, and can interfere with an individual’s ability to work and complete day-to-day activities, especially for those suffering from chronic migraines.  Some studies have determined that healthcare and lost productivity costs associated with migraines may be as high as $36 billion annually.  Migraines can affect anyone—in the U.S. 18% of migraine sufferers are women, 6% are men, and 10% are children.  They are more common in individuals aged 25 to 55 and in those with family members that also suffer from migraines.[1]

Symptoms

Migraine symptoms, frequency, and length vary from person to person.  However, they usually have four stages:

Prodrome: This occurs one or two days before a migraine attack and can include mood changes, food cravings, neck stiffness, frequent yawning, increased thirst and urination, and constipation.

Aura: This stage can occur before or during a migraine attack.  Auras are usually  visual disturbances (flashes of light, wavy or zigzag vision, seeing spots or other shapes, or vision loss.  There can also be sensory (pins and needles, numbness or weakness on one side of the body, hearing noises), motor (jerking), or speech (difficulty speaking) disturbances.  While auras often occur 10 to 15 minutes before a headache, they can occur anywhere from a day to a few minutes before a migraine attack.  Typically, an aura goes away after the migraine attack, but in some cases, it lasts for a week or more afterwards (this is called persistent aura without infarction).

Migraine: The migraine itself consists of some or all of the following symptoms:

    • Pain on one or both sides of the head that often begins as a dull pain but becomes throbbing
    • Sensitivity to light, sound, odors, or sensations
    • Nausea and vomiting
    • Blurred vision
    • Dizziness and/or fainting
    • Migrainous stroke or migrainous infraction (in rare cases)

Post-drome: This stage follows a migraine and can include confusion, mental dullness, dizziness,  neck pain, and the need for more sleep.

A migraine can last anywhere from a few hours to several days, and there are several classifications of migraines, including:

  • Classic migraine – migraine with aura
  • Common migraine – migraine without aura
  • Chronic migraine – a headache occurring at least 15 days per month, for at least three months, eight of which have features of a migraine
  • Status migraine – (status migrainosus) a severe migraine attack that lasts for longer than 3 days

Causes

The exact causes of migraines are not clearly understood but involve abnormal brain activity, including (1) changes in the brain stem and its interactions with the trigeminal nerve and (2) imbalances in brain chemicals, including serotonin.  Migraines are most often triggered by:

  • Food and food additives (often salty or aged food, MSG, meats with nitrites, aspartame)
  • Skipping meals
  • Drink (alcohol, caffeine, caffeine withdrawal)
  • Sensory stimuli (bright or flashing lights, strong odors, loud noises)
  • Hormonal changes or hormone medication such as birth control
  • Certain other medications
  • Stress or anxiety
  • Strenuous exercise or other physical stress
  • Change in sleep patterns
  • Changes in weather

Co-occurrence

Migraines have been shown to co-occur with several other conditions[2], including:

Treatment

There are a variety of options that doctors employ to both treat and prevent migraine attacks.

  • Pain-relieving medications (both over the counter and prescription)
  • Preventative medications (which can include antidepressants, blood pressure medications, and seizure medications)
  • Botox
  • Transcutaneous supraorbital nerve stimulation (t-SNS) (a headband-like device with attached electrodes)
  • Acupuncture
  • Biofeedback
  • Massage therapy
  • Cognitive behavioral therapy (CBT)
  • Herbs, vitamins, and minerals
  • Relaxation exercises
  • Sticking to a sleep schedule
  • Exercise
  • Avoidance of known triggers

Doctors also sometimes recommend keeping a headache diary, similar to a pain journal, which can help you track the frequency of your migraines and may help identify triggers.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

Cedars-Sinai, https://www.cedars-sinai.edu
Healthline, www.healthline.com
Mayo Clinic, www.mayoclinic.org
MedlinePlus, www.medlineplus.gov

 

[1] Migraine Research Foundation, About Migraine, http://migraineresearchfoundation.org/about-migraine/migraine-facts/

[2] Wang, Shuu-Jiun, et. al., Comorbidities of Migraine, Frontiers in Neurology, Aug. 23, 2010, http://journal.frontiersin.org/article/10.3389/fneur.2010.00016/full

[3] Id. (citing Von Korff M., et. al., Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication, Pain 113, 331-330 (2005).


“Transitional Own Occupation” Provisions

In prior posts, we’ve talked before about how an individual disability policy with a true “own occupation” provision is ideal.   Under this type of provision, you are “totally disabled” if you are no longer able to perform the material and substantial duties of your occupation (for example, you can no longer perform dentistry), and you can still work in a different field and receive your full benefits (if you are able and choose to do so).

Most doctors looking for a disability policy know that it’s important to get an “own occupation” policy, but may not realize that there are several, less-favorable provisions that are also styled as “own occupation” provisions.  These provisions contain the phrase “own occupation,” but also contain language that can dramatically impact a doctor’s ability to collect.  For example, a policy might provide benefits if you are no longer able to work in your occupation, but only if you are not working in any other occupation.   And some newer disability policies actually require you to work in another occupation in order to collect benefits.

Another type of restriction we’ve been seeing recently is a “transitional own occupation” or “transitional your occupation” policy.  As we stated above, under the true “own-occupation” policies prevalent in the 80’s and 90’s, you can work in another profession and still collect full benefits, regardless of whether you make less, the same, or more than when you were practicing.  With “transitional own occupation policies”  or “transitional your occupation policies,” you can work in another profession, but your benefits are reduced if your total income (from your benefits, employment, and other insurance benefits) ever exceeds what you made immediately prior to your disability.  So, with these types of policies, your earning potential is essentially capped at what you were making before you became disabled (if you want to keep receiving benefits under your policy).

Transitional own occupation policies may seem attractive because they may have lower premiums, but it is important to know that they are not the same as true “own occupation” policies, and they can result in a reduced benefit payment and/or limit your options if an lucrative employment opportunity should ever arise.

While many policies contain the phrase “own-occupation,” including “transitional own occupation” provisions, they often aren’t true own-occupation policies and you shouldn’t rely on an insurance agent to disclose this information.  Oftentimes, your agent may not even realize all of the ramifications of the language and definitions in the policy that he/she is selling to you. Additionally, most of the newer disability policies now contain language saying that you cannot rely on an agent’s statements and/or that agents cannot change the terms of a policy.  Consequently, you should always read a policy from start to finish and make sure you have a clear understanding of what you are buying, before purchasing a disability policy.


Spine-Related Musculoskeletal Conditions – Part 7 – Myelopathy

In this series, we have been reviewing spine-related musculoskeletal conditions that are frequently seen in dentists and surgeons.  In this post, we will be looking at myelopathy.

Myelopathy

Definition: Myelopathy is damage to the spinal cord caused either by a traumatic injury or a chronic musculoskeletal condition. The term myelopathy generally refers to damage to the spinal cord, but may be used in reference to a handful of specific conditions, including:

  • Cervical Spondylotic Myelopathy: This is by far the most common form of myelopathy and involves the compression of the spinal cord in the cervical spine (neck). We will discuss cervical spondylotic myelopathy further below.
  • Thoracic Myelopathy: This occurs in the middle region of the spine. Typically, the spine gets compressed due to bulging or herniated discs, bone spurs, or spinal trauma.
  • Lumbar Myelopathy: This is a rare condition because the spinal cord typically ends in the upper section of the lumbar spine; however, the if the spinal cord is low-lying or tethered, it can be affected by this condition.

Cervical Spondylotic Myelopathy

Overview:  Cervical spondylotic myelopathy is damage to the spinal cord due to spinal degeneration, most commonly in the form of spinal osteoarthritis. As the spinal cord is compressed (spinal stenosis) due to inflammation and osteophytes, it can cause damage to the spinal cord and lead to an array of neurological symptoms.

Causes:  As discussed above, the inflammation and bone spurs (osteophytes) common to spinal osteoarthritis can exert pressure on the spinal cord and cause damage.  Bulging and herniated discs and thickened ligaments can also contribute to myelopathy.  In rarer cases an acute, traumatic injury to the neck can result in myelopathy.

Symptoms:  Numbness, weakness, and/or tingling in the hands or arms, loss of balance, stiffness in the legs, and urinary urgency.

Diagnosis: A CT scan with a Myelogram is used to reveal indentations in the spinal fluid sac.  In this procedure an opaque dye is injected into the spinal canal prior to the CT scan to create contrast and provide images of the spinal canal.  This is done in conjunction with an MRI, which provides imaging of the spinal cord and nerve roots, as well as the intervertebral discs and spinal ligaments.

Treatment: Surgery to decompress the spinal cord and prevent further damage is the most common treatment for cervical spondylotic myelopathy.  The precise nature of the surgery varies and depends on the severity of the condition and its location.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.


The Hartford Purchases Aetna’s Life And Disability Insurance Business for $1.45 Billion

Aetna has arranged to sell its group life and disability benefits to The Hartford for $1.45 billion dollars in cash.  While group life and disability insurance were a small portion of Aetna’s business (about $2 million in premiums for 2016, compared to The Hartford’s $8.3 million in premiums at the end of the third quarter), this transaction will allow The Hartford the become second largest group life and disability insurer, behind MetLife.  The Hartford will also obtain digital assets from Aetna, including absence, claims management, and data analytics systems, as well as a customer portal.   And, following the sale, Aetna will offer The Hartford’s group life and disability products through Aetna’s sales force.  The Hartford has also agreed to reinsure Aetna’s book of group life and disability insurance, on an indemnity basis.

While an Aetna press release states the two companies will work together to support their mutual customers, and the majority of Aetna’s 1,800 employees who support the acquired business will transfer to The Hartford, there are no details yet on how Aetna’s plans will be administered going forward, including for those already on claim.

The acquisition is expected to close in November 2017.

Sources:

Aetna, The Hartford Signs Agreement to Acquire Aetna’s U.S. Group Life and Disability Business, Oct. 23, 2017

The Hartford, The Hartford to Acquire Aetna’s U.S. Group Life and Disability Business, Special Presentation Webcast, Oct. 23, 2017

Japsen, Bruce, Aetna To Sell Group Life Business To Hartford for $1.4B, Oct. 23, 2017, 9:04 a.m.

Livingston, Shelby, Aetna to shed its life and disability insurance businesses for $1.5 billion, Modern Healthcare, Oct. 23, 2017

Otto, Nick, The Hartford to acquire Aetna’s life, disability business, Oct. 23, 2017, 2:39 p.m.,

Reuters, Hartford to buy Aetna US life and disability unit for $1.45 billion, CNBC, Oct. 23, 2017, 9:16 a.m.

Reuters, The Hartford to Buy Aetna Group Life, Disability Benefits Business for $1.45 Billion, Insurance Journal, Oct. 23, 2017


Spine-Related Musculoskeletal Conditions – Part 6 – Degenerative Disc Disease

In this series, we have been examining spine-related musculoskeletal conditions.  In this post, we will be looking at degenerative disc disease.

Degenerative Disc Disease

Definition: Degenerative Disc Disease (DDD) is the breakdown in the size and cushioning of the intervertebral discs.

Overview: The name of the condition is actually somewhat of a misnomer – it is not actually a “disease”, but rather a condition that is characterized by the degeneration of the intervertebral discs over time.  Over time, the pressure and wear of repetitive use can cause discs to lose some of their water content and volume, reducing their ability to cushion and insulate the vertebrae from one another.

Symptoms: The symptoms most commonly associated with DDD are chronic pain, weakness, numbness, and tingling in the extremities, and reduced flexibility in the spine. Not all people with intervertebral disc degeneration, however, experience pain or other symptoms.  This is due to the fact that the degeneration of the discs, by itself, does not bring on the symptoms described above. However, as disc degeneration becomes more severe, it can lead to other conditions that bring on the symptoms people normally associate with DDD (e.g., pain, numbness and tingling, weakness, etc.).  Some of the conditions commonly associated with DDD are spinal osteoarthritis, spinal stenosis, and foraminal stenosis.

Causes: Reduction in the size and cushioning of your discs is part of the normal process of aging, and magnetic resonance imaging (MRI) studies have shown that almost everyone over the age of 60 has degeneration of their intervertebral discs to some degree.[1]  Not all people with disc degeneration have back pain or other symptoms – in fact, individuals with relatively mild disc degeneration may experience no symptoms whatsoever.

However, age is not the only factor in DDD.  Deterioration of the intervertebral discs can be accelerated and exacerbated by other factors.  The culprit in many severe cases of DDD is stress-related damage in the form of repetitive use, trauma, injury, poor posture, poor movement, and obesity.  Among these, one of the most common factors is repetitive use.  For example, the repetitive, static posture of a dentist during clinical procedures creates (1) compressive forces on the cervical discs due to neck flexion, and (2) compressive forces on the lumbar discs due to axial loading.  When these compressive forces are applied year after year on a daily basis, the result can be an accelerated deterioration of the intervertebral discs.

Diagnosis: Diagnosis will generally begin with a physical exam in which the physician will perform a variety of tests to evaluate the patient’s strength and range of motion.  If the physical tests indicate DDD, an MRI is typically ordered to measure the disc space and check for cartilage erosion.

Treatment: Because DDD can cause such a broad range of symptoms and subsequent conditions, the treatment options vary widely.  Depending on the circumstances, treatment can range from conservative options such as physical therapy and anti-inflammatory medications to surgical intervention in the form of a discectomy, laminectomy, laminoplasty, or spinal fusion.

Our next and final post in this series will discuss myelopathy.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

[1] Degenerative Disc Disease, Arthritis Foundation, http://www.arthritis.org/about-arthritis/types/degenerative-disc-disease/

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.

 


SEAK Inc.’s 14th Annual Non-Clinical Careers for Physicians Conference, Oct. 21-22, 2017

SEAK, Inc.’s 14th Annual Non-Clinical Careers for Physicians Conference will be held on October 21 -22, 2017 in Chicago, Illinois.  The conference is intended for physicians looking to explore careers outside the clinical setting.

Many doctors and dentists find themselves unable to practice, whether due to a disability, fatigue, burnout, loss of opportunity, wanting more control over their schedule, hope of financial gain, or just the desire to try a different career path or become an entrepreneur.  The 375+ attendees at the conference will range from interns and residents to veteran physicians in their 70s. The conference aims to show physicians that switching to a non-clinical career is an opportunity with financial potential, and “is in fact a step forward, not a step backwards.”  Attendees at the conference will network, meet with employers and recruiters, attend workshops and presentations and participate in one-on-one mentoring with physicians who have successfully made the transition to non-clinical careers.  Several of the presenters have not only moved out of the clinical practice, but are also experienced life coaches dedicated to guiding other physicians into new careers.  Sessions discuss opportunities for physicians with insurance companies, medical device companies, the pharmaceutical industry, contract research organizations, healthcare IT and medical informatics companies, and in education as well as in the consulting, medical administration, patient safety/quality, medical writing, and entrepreneurial fields.

Returning speakers include Gretchen M. Bosack, MD, who has transitioned to the Chief Medical Director of the Securian Financial Group and is also an accomplished public speaker; Rishi Anand, MD, who transitioned to the director of the Electrophysiology Laboratory at Holy Cross Hospital in Ft. Lauderdale, Florida, as well as serving as a medical legal consultant and expert witness, and a successful real estate investor; and Savi Chadha, MD, MPH, a medical science liaison with Tardis Medical Consultancy.  The opening speaker, Philippa Kennealy, MD, MPH, CPCC, PCC, is president of The Entrepreneurial MD and the Physician Odyssey Program, where she helps physicians further their non-clinical careers.


Attorney Ed Comitz Addresses Disability Insurance Issues Faced By Professional Athletes

Ed Comitz was recently asked to speak at ASU’s Sandra Day O’Connor College of Law by Greenberg Traurig partner and leading sports agent, Dana Hooper, to address the key issues that professional athletes and their agents may encounter when dealing with disability insurance.  Topics included the types of insurance coverage most often purchased by professional athletes, the tactics insurance companies use to deny athlete’s claims, and the importance of an attorney and/or agent’s role in the disability insurance context.  The seminar also discussed the pros and cons of loss of value coverage for college athletes expected to go pro, and examined some of the challenges faced by injured athletes seeking to prove that a pre-draft injury caused them to fall in draft order and miss out on securing an upper-tier contract.

Mr. Comitz has represented high-earning professionals for nearly 25 years on the toughest insurance cases.  As a result, he is intimately familiar with the disability insurance industry, and uses this knowledge to assist athletes from the “big four” sports (NFL, NBA, MLB, and NHL) seeking to negotiate favorable contracts with the premier, high-dollar insurance companies.  He also advises professional athletes regarding the types of provisions to avoid in disability policies, the significance of the questions asked on disability insurance applications, and the importance of carefully reviewing insurance applications to ensure that they are accurate and do not provide the insurance company with any basis for voiding the policy, should a claim need to be filed later on down the road.  When athletes are approaching free agency and intend to test the market, Mr. Comitz helps the athletes assess whether they need to purchase insurance to protect anticipated future income, should they suffer a serious injury before they are able to secure a contract with a new team.  He also assists athletes with the legal issues that arise when an athlete is out for a few games, or an entire season, due to health concerns, and represents star athletes who have suffered a career-ending injuries and need to collect permanent disability benefits.

 

 


Subjective Conditions Limitation Provisions

In previous posts we’ve talked about mental health limitation provisions.  In this post, we are going to discuss a similar type of provision:  subjective symptom limitation provisions.

What are Subjective Symptom Conditions?

Insurance companies typically invoke these types of provisions when a claimant describes a disability or condition based upon self-reported symptoms, without producing objective medical evidence to back up the reported symptoms.  This can occur in situations where there is no standard accepted medical test to confirm a diagnosis, or when tests do not return any confirming or conclusive results, or when a claimant has not properly developed his or her medical records and/or simply neglected to have objective testing done.

We most often see these types of limitations in ERISA policies, but they are becoming more and more common in individual policies.  An example from an actual policy defines subjective symptoms as follows:

Some examples of conditions an insurance company might contend are encompassed by this provision include:

  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • Sleep Apnea
  • Paresthesia/Dysesthesia
  • Carpal Tunnel Syndrome
  • Myofascial Pain Syndrome
  • Lyme Disease
  • Orthopedic Conditions
  • Temporal Lobe Phenomenon
  • Vertigo
  • Migraine
  • Tinnitus
  • Irritable Bowel Syndrome
  • Osteopathic and Rheumatoid Arthritis
  • Generalized Pain
  • Epstein-Barr Syndrome
  • Valley Fever

Insurers also use these limitation provisions to argue that other conditions should be limited, even when there is some objective evidence.  For example, a dentist suffering from a musculoskeletal condition might report to his or her doctor that he or she is experiencing neck pain, or lower back pain. The doctor might order an MRI, which might show that the dentist has some issues in his or her cervical or lumbar spine, but even with the MRI imaging, it can sometimes be difficult to pinpoint the precise cause of the symptoms that are being reported.  Insurers know this and target these types of claims because, under a broad reading of the policy provision, they involve subjective reports of pain and the  physical source of the pain cannot always be conclusively verified using tests.

Why is this provision important to know about?

These limitations typically cap benefits that will be paid out, generally at 12 to 24 months.  After this mark has been reached, no additional benefits will be issued even if your symptoms continue and you cannot return to work.  In other words, a policy you thought would last for the maximum benefit period can end up being good for as little as a year.

Insurance companies want to avoid paying out claims and often construct policies in a manner that allows them to restrict or deny coverage. This can include hiding limitations at the end of a policy or in a vaguely worded provision.  It is not enough to simply look at a policy’s schedule page, because a limitation provision may actually be much broader limitation than you might think when you read “mental/nervous limitation” in your policy summary.  Subjective condition limitation provisions are often combined with mental health and substance abuse limitation provisions, so it is easy for a policy holder to skip over this sort of provision when scanning through his or her policy, assuming that it only applies to mental health disorders or alcohol/addiction issues.

The Takeaway

When invoking these limitations, the insurance company is not denying that a claimant has an illness or even that it prevents a policyholder from working.  Rather, the insurance company is seeking to take advantage of the limits of medical science and/or lack of agreement in the medical community regarding finding and establishing guidelines regarding conditions like the examples listed above. They then use the subjective condition provision to cast doubt on a claim and complicate the claim procedure.  Often, they will use multiple in-house physicians to contradict a claimant’s own physician and medical records.

Fighting an insurance company’s decision to classify a condition as subject to this provision can be a costly and long process, and can turn into an expensive war of attrition that can often end in litigation. For these reasons, these types of claims must be handled with care from the start and require the assistance of a supportive doctor to properly document and treat the condition.

When purchasing a policy, it is important to watch out for subjective symptom condition limitation provisions.  Always be sure to read your policy or potential policy carefully so that you understand the scope of the your protection.



Spine-Related Musculoskeletal Conditions – Part 5 – Disc Bulge, Disc Herniation, and Disc Protrusion

Our posts in this series have been reviewing spine-related musculoskeletal conditions that are frequently seen in dentists and surgeons.  In this post, we will be looking at disc bulge, disc herniation, and disc protrusion.

Disc Bulge, Disc Herniation, and Disc Protrusion

Definitions:

  • Disc Bulge: Protrusion of a spinal disc outside the vertebral body that has not fully ruptured through the disc membrane, known as the annulus.
  • Disc Herniation: Protrusion of a spinal disc outside the vertebral body that has ruptured through the annulus, exposing a portion of the nucleus – the gel-like center of the disc.
  • Disc Protrusion: A general term to describe any type of disc bulge or herniation, in which a portion of the disc protrudes beyond the vertebral body.

Overview: A number of terms are used to describe spinal disc pathology and the associated symptoms.  To complicate matters further, there is not a clear consensus among medical professionals about the precise meaning of each term.

There are thirty-three vertebrae in the vertebral column of the human spine, twenty-four of which articulate and move.  Between each of the vertebrae in the three articulating sections of the spine – the cervical, thoracic, and lumbar spine – there is an intervertebral disc.  Each disc, composed of soft jelly-like center (nucleus) surrounded by a capsule of connective tissue (annulus), provides shock absorption and flexibility within the spine. When the protrusion puts pressure on the spinal cord or a nerve root, it can lead to a wide range of symptoms.

Symptoms: Symptoms will vary based on the location of the disc:

  • Lumbar: Pain radiating down the leg (sciatica) is the most common symptom associated with a lumbar disc herniation. Weakness in the foot and difficulty when raising the big toe (foot drop) and numbness/pain on the top of the foot are also prevalent.
  • Cervical: Pain, weakness, numbness, and tingling in the shoulder, arm, or hand depending on the location of the herniated disc.

Causes: Disc bulges are often the result of the normal process of aging, and by themselves may not cause any recognizable symptoms. Bad posture associated with frequent sitting or standing and occupational hazards such as repetitive bending or standing can accelerate the formation of disc bulges.

Disc herniation is often a progression in severity from a disc bulge.  As discs wear down over time, they may degenerate and lose some of their water content.  This condition, known as Degenerative Disc Disease, is discussed in greater detail below.  As discs degenerate and degrade, they become more flexible and the annulus may be more susceptible to tearing or rupturing.  Disc herniation can also be caused by traumatic, acute injuries such as a hard fall or blow to the back.

Diagnosis:  Diagnosis of a herniated or bulging disc typically begins with a physical exam that tests the patient’s reflexes, muscle strength, walking ability, and sensory perception (light touches, pin pricks, etc.).  If a protrusion is indicated by the physical test, imaging may be ordered in the form of X-rays, MRIs, CT scans, and/or Myelograms.

Treatment:  Non-invasive treatment may include heat therapy, exercise, physical therapy, chiropractic treatment, therapeutic ultrasound, and medication.  Epidural steroid injections may be considered as an intermediate treatment.  For more severe cases, a microdiscectomy may be performed, typically in an outpatient setting.  In this procedure, a small portion of bone and/or disc material is removed to relieve pressure on the affected nerve root.

Our next post will discuss degenerative disc disease.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.