Disability-and-Health Books

This book is an excellent book for anyone who uses a wheelchair. It has tons of medical information, how to choose the perfect wheelchair, and even stuff on building relationships. I highly recommend it to any wheeler, new or old!

I found this book helpful even though I am quite a few years into my spinal cord injury. I think this book should be given out to the newly disabled so that they can see how full their lives still are. I know mine is...

A very pragmatic approach to "life on wheels", provides an insider's viewpoint with large amount of facts, references and helpful hints. Great book.

A wonderfully written, honest,and thoughtful account of life as a large person. It is engrossing and informative, even if you're a sylph.

We received Living Large at a book signing party and hadn't yet had the chance to read it. I found it on the shelves the other night and tore through it within several consecutive nights of reading well past the time I should have!

Mike has done a tremendous job of speaking to those who might know his experience, but he also offers a tremendous gift to anyone who cares about someone who struggles with weight or lives as a fat person. He tells the truth about himself -- the easy and the hard truths -- and allows the reader to see the world a little bit differently as a result.

I have recommended his book to my entire family in hopes that we can better understand those we love in our lives who struggle with this very issue.

I'm neither a man, nor overweight, but neverthelesss I found LIVING LARGE to be a fascinating book. I read it in two sittings. Berman's account of his struggle with food--with the yo-yo of weight gains, the humiliations of being fat, the sheer discomfort of the extra weight,his hard-won advice, the dynamic within his marriage--is very compelling. He's honest about the good things (and there are many) in his life, as well as the challenges.

I purchased this book for my boyfriend who now has an ostomy because I heard it recommended on a webcast where a doctor with an ostomy himself and an ostomy nurse talk about this condition. The book was highly recommended. The webcast can be found at yourhealthpress.com website and this book is apparently the only book that talks about relationships and ostomy. It was very useful for both me and my boyfriend.

This book packs a lot of information for us new ostomates. I bought it when it was recommended in one of the newsletters I subscribe to. Not only does it have everything a new ostomate needs to know, but it discusses some of the more embarrassing daily life issues. The chapter on sex with an ostomy is so helpful and necessary. The author also shares other ostomates' stories and struggles, which I haven't seen in other books, either. Plus, there is really good information about complimentary/natural products for ostomates. A must have for anyone coping with a new ostomy.

I recently had ostomy surgery because of my worsening bowel disease. The surgery has done wonders for my illness -- I haven't felt better in years. But having an ostomy is taking some getting used to. Of all the books on ostomy, I found this ostomy book by Elizabeth Rayson really helpful. It's written very clearly and addresses a lot of issues I'm facing as well as helping me with practical day-to-day care. This book tackles some unique topics you can't find in other books, such as sexual issues. Let's face it, partners can get freaked out once you tell them bout your ostomy. Elizabeth Rayson approaches the subject of sex and ostomy in a sensitive and understanding way. One point that really hit home was when she writes that if someone rejects you because of an ostomy, they weren't worth it anyway. Lots of wise words are bundled into this book.

My son (born in 2006) was born without his left hand and sometimes wears a prosthetic that he got from Shriner's Children's Hospital. His is not the myoelectric kind, like in this book, but it is still nice for him to have a story and pictures of another child his own age that has a "helper hand". I shared this book with the occupational therapist and prosthetist at Shriners and they loved it too. It's so nice to have such a young child in the book going through the same kinds of fitting procedures and doctor's visits that my son goes through. The story is really too wordy and advanced for him at this age, but I shorten and simplify it for him. It will be nice to share with other children and his teachers as he grows up.

My son was born without his right hand. This book details everything we went through getting his prosthetic. He is only 15 months old, but it is a great book to read to his four year old brother so he can understand and feel a part of what is happening. I plan on keeping this book around to present to my son's teachers to use as an aid in the classroom. The story is very easy for a child to understand, but also detailed enough that I had my family read it to see exactly how the process works. The pictures are amazing--combining real photos with drawings. Very unique. This is the only book of it's kind. I am gratefull someone is finally taking notice of upper limb differences and offering support to families.

I think this is a great book for kids to read with a grownup that can explain what is happening on the pictures. It helpes de-dramatize physical disbility in a natural way. Step by step description of how the doctor makes "Madisons very special hand" are very good. I would definitely like to recommend this to anyone that's working with or having children on their own.

This book is a very good help to anyone who has a child with Aspergers. I did not know that much about this syndrome until I read this book. It is very easy to read and gives many helpful hints and suggestions.

This book is a wonderful guide and handbook for anyone dealing with an Asperger child. It covers recognizing the signs, diagnosis, helpful hints on how to deal in difficult situations and best of all how to enjoy your child who has this disorder. She tells of the many problems one faces trying to get help in schools and much, much more. It is as easy to read as a humorous novel. Every aspect of what one can encounter with an Asperger's child has been explored. This is a publication that has been needed for years. Kudos to the author!

this book is fabulous. It is written in a style easy and fast to read. There are many, many Moms who really need this book because there is very little help on this subject.

Helpful in a very practical way, full of life and humor, precisely the two things one needs in order to do right by a child on the autism spectrum. I have an 11 year old son who was diagnosed with Autism, but who is actually probably an "Aspy". This book has wonderful ideas to help in many situations; QUICK, easy to execute plans of action. The book made me re-think some old notions about Autism and Asperger Syndrome. This book also contains a ton of information for parents with a newly diagnosed child. Man, I wish this book had been around 6 years ago when my son was diagnosed. I had a thousand questions about IEPs, therapies, interventions, disciplines.......the list goes on. Here are virtually all the answers in one place. A great book to get whether you have been dealing with this subject for years, or if you are just starting on the journey and have no idea what to do next.

WOW! There's another book, "Damn! Why Didn't I Write That?" which is what I was thinking when I read this book. It does an awesome job of telling a kid's view of having a very misunderstood condition and the fears that so often accompany a young mind when questions are unasked and unanswered. I spent my entire childhood terrified that "hydro" was something no one else had, and as I grew older, still without info, I indeed feared it would kill me. Perez does a beautiful job of explaining from an 8 yo point of view what it's like to live with a "difference" and the often-resulting ignorance and ostracism from peers. The book is written with true empathy for the child who has determined that s/he is "different" and in need of honesty and help with issues related to hydrocephalus.

I have some similar issues to the ones she does (weak, short leg due to long-undiagnosed and untreated hip dysplasia and scoliosis), and it was refreshing to see physical issues brought up in the story. I just wish I'd had this book 35 years ago! It's a must for every parent who has a child with "hydro."

There is a mention of a term that often bothers those of us who have/love someone who has hydro: "water on the brain." In this context, though, it works, as "Annie's" mom says that it's the simplest way to explain "hydro" to her. There is a more sophisticated explanation at the end of the book.

Thank you, Annette, for this wonderful book! My 14 yo son is autistic, and I really needed something more in-depth and "older" than the Barney the Beagle book. Even another book I also love, "All About Me (and My Shunt)" doesn't go into quite as much detail, so even though he'll also outgrow this one, I think it's a valuable tool to help him understand Mom's brain. Please consider writing additional books for older children. You have a true gift!

This is a wonderfully written book. There are so many features that make this book to be owned by anybody. For one, the book is bilingual. You can read the Spanish portion and learn from the English text as you go along. The pictures in the book, make this a book that is fun while dealing with serious content. And once you read this book, you will forever remember Annie. Her story is uplifting and helps reinforce the idea that no matter what differences we may have, with help and the will to overcome challenges, we can use our differences to better ourselves. This is a great book for the classroom and is a wonderful resource for anybody wanting to learn a little bit about a condition called hydrocephalus. Once you read this book, you will want all your friends and family to read it as well.

A BOOK EVERY CHILD (AND PARENT) SHOULD READ
By Constance Castaneda, Speech and language pathologist, New York


Imagine that you are born with a disability that affects your motor skills and makes your body do odd things. It makes one of your hands smaller than the other and nearly useless, and makes one of your legs weaker.
Imagine that due to this condition, simple tasks become difficult and hard tasks become practically impossible.

What if that disability made you the target of ridicule as a child, and now as an adult it still makes people stare at you, or pretend not to see you when you walk down the street?

What would you do?
Perhaps you should do what Annette Perez did; you write a funny, uplifting children's book about your experiences.

The New York City native of Puerto Rican descent, and York College (City University of New York) graduate, just released a children's book titled My Brain Won't Float Away (Campanita Books, New York) based on one key event in her childhood that changed her life forever, for the better I should add.

It's the story of Annie, an eight-year-old girl who, realizing there is something "wrong" with her, gathers the courage to ask her mom what is going on, leaving her mother with the tough job of explaining to her daughter that she has a condition called hydrocephalus (also referred to as "water on the brain," even though as you learn in the book, it has nothing to do with water). Her first reaction, as I am sure we all can imagine, is fear. Annie is scared of that strange-sounding label her mother has just placed on her, and terrified when she hears that she has "water on the brain." But knowledge is usually a good way to dispel fear, and with her newfound information Annie embarks on a journey of discovery that teaches her about hydrocephalus, but also teaches her about love, friendship, and courage. The book is a pleasure to read, and Ms. Pérez gives Annie a voice that sounds fresh, and authentic. As a person with a disability, she knows first-hand the daily struggle that so many adults and children have to go through to do what most of us take for granted. She writes about the time and determination that it takes to learn to live with a body that sometimes will not, and at other times cannot do what you wish it to do.
And she does it while telling a story that reads more like an adventure (which it is). That she also writes on the subject of being ostracized as a child for being "different" and how important it was for her physical and emotional well-being to be accepted by her peers, is a lesson that any child reading the book will relate to, without the need for lectures or a preachy tone. You have to read the book to understand how well it was written, and how much fun it is. Yes, fun.

Ms Pérez, who based the story on her own experiences growing up with hydrocephalus has covered so many bases that it feels like My Brain Won't Float Away is the only book that you'll need to buy for your kid this year. Funny? Yes. Suspenseful? Yes. Uplifting? Yes. Educational? Yes. Does it help you practice a foreign language? ¡Sí! I forgot to mention, My Brain Won't Float Away is also called Mi cerebro no va a salir flotando. The book is 100% bilingual in English and Spanish! That means it is also a perfect tool for any bilingual program. And it is a jewel in any language.

Recommended for all Parents, Elementary Teachers, Special Education Teachers, ESL Teachers, Librarians, Counselors, and Occupational Therapists. A must have for Character Education Curriculum Collections. Children 6 to 10

Oliver is an octopus with beautiful green eyes and a constant smile. Although he doesn't believe himself to be physically challenged, Oliver only has five arms, rather than eight arms like all the other octopuses. Oliver's High Five, a children's picture book, is the story of how he ventured out into the world and how he overcame the rejections he initially faced. Beverly Swerdlow Brown has written several children's books and numerous short stories and articles. Margot J. Ott has two previous picture books to her credit. Oliver tries to find a job, but no one wants him because he is missing three arms. Then a pet shop has a big problem with a leaking fish aquarium. Oliver uses his five arms to plug the leaks, catch the birds, and pet the dogs--all at one time! He shows everyone that being different isn't a measure of his abilities. Ronald M. Andiman, M.D. the Clinical Chief of Neurology at Cedars-Sinai Medical Center wrote the foreword to the book. He says "This is a children's book that deals gently with a difficult topic. The simplicity of plot and language belie the complexity of issues relating to the physically challenged that are dealt with and hinted at in the small colorful volume. It is a book that will open up discussion, lead to further reflection and build greater understanding. It is a book for adults and children to share. Books like this help to repair the world." A copy of Oliver's High Five belongs in the library of every child, whether physically challenged or not. It's a book that teaches them how to "focus on their abilities, not their disabilities."

Sandra I. Smith Reviewer

This story teaches us all to never give up! Even though we face rejection and disappointments, if we continue towards our goals, we might succeed, like Oliver-the Five Armed Octopus! A wonderfully illustrated and entertaining book for the world and society we live in!

The plight of Oliver the Octopus and his struggle to become an accepted member of the workforce in the "world above the sea" is conveyed with warmth in this beautifully written, creatively illustrated book. Oliver's perserverance, despite the rejections he receives based upon his appearance rather than his abilities, is a potent testimony to the strength of his own self-image. The ignorance of discrimination is portrayed with honesty in a contemporary setting, which makes the book mandatory reading for all grade school educators and child therapists.

I bought this book out of curiosity after reading Finger's newer book, Elegy for a Disease, about her struggles with childhood polio and abuse in a disfunctional family. Her writing was good enough that I wanted more. Past Due did not disappoint. The writing was first-rate, although the subject matter could be - and often was - absolutely heartrending. Finger's pipe dream of natural childbirth at home with a midwife attending went up in scary smoke, ending in a complicated and emergency hospital Caesarian delivery. For months Finger didn't know if her son had suffered brain damage, and lived through a nightmare of special meds and equipment and midnight ER visits. There are scenes of intervention in the neo-natal ICU which will bring tears to your eyes. Here's one, where they couldn't get an iv line into the baby's arm, so attempted to put in into his head:

"'I'm going to to put a rubber band around his head,' the doctor says. 'It'll make his veins stand out.' ... The doctor taps her finger agains his flesh until a vein appears; she shaves a patch of his scalp; the needle goes in, but not into the vein, and she probes, pulling the needle in and out, in and out, in and out, while he wails in pain. He stares into my eyes and I cry with him ... 'Oh, Max,' I say, 'I'm sorry, I'm sorry, I'm so sorry.'..."

Anne Finger has much to say in this slight volume, and not just about the difficulties of a disabled woman giving birth, but about our society's attitudes toward the disabled, the helpless and the disenfranchised. This is important stuff, a book which should probably be read by all of those pro-choice and pro-life adherents - both camps. Too bad it's out of print and largely inaccessible now. I'm glad I took the time to read it. - Tim Bazzett, author of Love, War & Polio

This book was absolutely fantastic! I got it at a used book store and it was one of the best books. The author who had polio details he pregnancy and all the politics sourrounding it. It is an eye opener about what it must be like to be pregnant with a disability.

This was one of these books that made me stay up way too late because I couldn't put it down. The author tells the story of the birth of her child. A story that should be simple enough but, like most things in life that touch us deeply, it isn't. Her prior experiences of dealing with polio and her involvement in the pro choice / reproductive rights movement contribute to her decision on a home birth. When she and her baby experience severe complications, she faces the possibility of having a child with a disability. Apart from being very well written it engaged me into many silent arguements with the author on the very political but yet so personal issues of abortion, disability, birthing...It made me tink again about my own life-experiences with infertility, high risk pregnancy and dissability-rights (I have a close familymember, who is very involved). It reminded me how important choices and taking control are. And it reminded me that choices and control often turn out to be illusion. I highly recommend this book to anyone, who is interested in issues of disability and reproduction or who enjoys autobiographies. Your opinions might differ from those of the author but it will definetly be food for thought.

I recommend this book to anyone from physicians to workers' compensation adjusters. It is a great reference for anyone that deals with returning injured employees to work.

This book is better than "Occupational Medicine Practice Guidelines, Evaluation and Managemtn of Common Health Problems and Funcitonal Recovery of Workers" published by the American College of Occupational and Environmental Medicine. They cover simelar topics. The AMA book is shorter, more specific and has sharpter definitions. The ACOEM book frequently is more a commentary than a summary of the material they reviewed.

Here is a summary, from a mental health perspective.

Talmage, J.B. and Melhorn, J.M. (2005). A Physician's Guide to Return to Work. AMA Press.
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1. Why Staying at Work or Returning to Work Is in the Patient's Best Interest
This book focuses on the less obvious and less severe illness and injury situations in which many patient with similar problems work, and yet some patients consult with physicians, seeking disability certification.

Rest should have a black box warning. Warning: This drug is detrimental to your patient's mental, physical and social well-being! Therefore, you will harm the patient by giving them excess time off.

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2. How to Think About Work Ability and Work Restrictions: Risk, Capacity and Tolerance
Risk = Chance of harm to the patient or the general public. In response to risk are work restrictions. A work restriction stops a patient doing something even if they can do it and want to do it. There is little objective evidence for this stuff but there are consensus documents.

If there is not objective evidence of substantial risk or significant harm, the patient may choose whether or not to work despite symptoms. This means that, logically, it is still the patient's decision when they request disability certification.

Capacity = an individuals theoretical maximum ability. It includes things such as strength, flexibility and endurance. Current ability = an individual's current ability and is equal to or less than their capacity. Current ability and capacity can be higher, equal to or lower than the demands of a job. Work and other treatment improve current ability. Fitness can be measured in terms of metabolic equivalents. Functional capacity evaluation (FCE) does not measure capacity unless the person is already at maximum fitness. In the only published test of FCE for back pain, things were best when the results were ignored and the patient returned to work.

Tolerance = ability to tolerate sustained work or activity at a given level. It is a psychophysiological concept. It is dependent on rewards. It is not scientifically measurable. Tolerance will always be less than ability. When doctors hold differing opinions on this, they look stupid/dishonest and are trying to answer an unscientific question.

When objective pathology is dramatic, poor tolerance is more believable.

Where there is no objective pathology and symptoms are disproportional to pathology, most physicians agree working poses no major risk and can work if they wish. "... alleges intolerable pain when attempting to lift a postage stamp has an issue of tolerance rather than risk or ability."

Physicians can play secretary, try to assess tolerance, abstain and leave the decision to the patient. Should say "... there is no problem with risk or ability, just with pain. Only you can determine if working with the pain is worthwhile."

Evaluating Work Ability
1. Find about what the job requires.
2. Find out about the medical problem
a. Objective features
b. Subjective features
c. Relationship between objective and subjective features
d. Permanent/temporary
e. Helped with work/treatment/time or stable and stationary
3. Risk and restrictions
4. Current ability and limitations
5. Tolerance
6. Decision
a. If risk/restrictions acceptable and wants to return to work, they can
b. If risk ok, does not want to work and objective pathology is present: Specify that the patient is disabled but can work if they wish.
c. If risk ok, does not want to work and objective pathology is absent: medically unanswerable question.

Criticism of the chapter
1. The difference between a scientific question and a value judgment is not as clear as made out here. For example, acceptable risk is not a scientific question, just what the risk is.

2. The cascade they have is: risk, pathology, tolerance (where different decisions are made according to pathology). The cascade they should have is: risk, pathology, somatiform disorder, tolerance. In other words, the authors discount the existence of psychogenic pain treat the same pain differently depending on if it is due to a physical disorder or to hysteria. I suppose you could argue that tolerance, by their definition, depends on rewards, so it makes no difference if the decision is made consciously or unconsciously (!) but that is a bit of a stretch. It is not clear if the authors ignore hysteria for convenience, because they do not believe it exists as a disorder (beyond tolerance) (it is in DSM IV) or because they are following a societal convention in ignoring it.

In Australia, hysterical disorders are regarded as real. If a doctor has to make a value judgment about what it is reasonable to ask one to tolerate, giving more credence to someone with greater objective pathology has some intuitive appeal. On the other hand, this intuitive appeal might be because the presence of objective pathology is short hand for risk of exacerbation of the injury with work and it is intuitive forget that it is not ethical to worsen a patient's condition by allowing them to not return to work when they could (issues of autonomy aside).

3. With psychological injuries, insufficient tolerance is excessive risk, because distress is what is driving the condition. In other words, in psychological injury, capacity and tolerance blur into one another. Notwithstanding the central role of exposure to all psychological treatments.

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3. How to Negotiate Return to Work
Fundamentals: risk, capacity, tolerance. Focus on retained capacity rather than deficits. Accommodate while you remediate. Some bosses do not want the worker back until the worker is "100%," and some workers do not want to go back until they are "100%." First element of motivational interviewing is education. Negotiation and agreement.

Occupational injuries/occupational illnesses. Probability has a legal, rather than medical, definition. Impairment = loss of use or derangement of any body part, system or function. Disability = loss of capacity to meet personal, social or occupational demands (or statutory stuff). (Alternative: disability function and handicap role.) Might need to do an impairment rating.

Return to work can be delayed by communication, litigation, disputes, administration, lack of desire. Most common reason by Drs: not want to force back, employer has a policy against light duty work, caught between versions of events, conflict between two physicians, emotionally uncomfortable, differing opinions between stake-holders.

ENGAGE THE WORK PLACE CASE MANAGER. Modified work is the cornerstone or rehabilitation.

Job satisfaction, demands/autonomy, single supportive telephone call, happy to be rid of them, demarcation dispute. Look for the 5Ds: dramatisation, dysfunction, dependency, disability and drugs. Most people do not need any time off work at all.

Essential functions are those bits of jobs that can not be easily modified.

Motivational interviewing: in order to get the patient back at work fast, you must 1) educate them that you are on their side and 2) educate them that rapid return to work is in their best interest. Be firm on the science and soft on the patient.

Note: nociception, suffering, pain behaviour, and disability.

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4. Return to Work: Forms, Records and Disclaimers
Work guides allow a doctor to make recommendations that are not initially specified as limitations, restrictions or reasonable tolerance. Contents of files will end up with lawyers.

Initial report: in addition to usual stuff: onset of symptoms, relationship to the workplace, causation/aggravation/exacerbation, job in detail, current ability, accommodations, prognosis.

Interval reports: response to treatment, admin and relationship stuff that is impacting, treatment options, work guides.

Final report: if stable and stationary, if need vocational rehabilitation, work guides, determination of permanent impairment.

In records:
1. Return to work
i. Is the injury going to make it hard to go back
ii. Is the boss/workers going to make it hard
iii. Figured out a way to return despite the injury
2. The grocery store
3. The molehill sign
4. The obstacle

Terminology
* limited 0 to 12% of the day
* occasional 0 to 33% of the day
* frequent 34 to 66% of day
* constant 67% to 100% of the day

Each physician should develop their own standard return-to-work form.

Disclaimer. The above statements have been made within a reasonable degree of medical probability. The opinions rendered in this case are mine alone. Recommendations regarding treatment, work and impairment ratings are given totally independently from the requesting agents. These opinions do not constitute per se a recommendation for specific claims or administrative functions to be made or enforced.

This evaluation is based upon the history given by the patient, the objective medical findings noted during the examination and information obtained from the review of the prior medical records available to me, with the assumption that this material is true and correct. If additional information is provided to me in the future, a reconsideration and an additional report may be requested. Such information may or may not change the opinions in this report.

Medicine is both an art and a science, and although the patient may appear to be fit to work with the abilities and restrictions described above, there is no guarantee that they will not be injured or sustain a new injury if they chose to return to work.

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5. Evidence-based Medicine

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6. Causation Analysis
By Genovese, E.

Hill Criteria of Causation Analysis
* Temporality
* Biological plausibility
* Predictive performance
* Gradient
* Reversibility
* Strength of association (not frequency)
* Consistency of association (coherence)
* Experimental evidence / Analogy (from animal studies)
* Specificity

Presumption = disease process is legislatively determined to result from an exposure or in association with a particular occupation.

Precipitation = injury or exposure causes a "latent" or potential disease process to become manifest. For example, having a MI at work that would have occurred anyway.

Aggravation = a particular event or exposure permanently worsens a condition.

Exacerbation = an exposure or event temporarily worsens a condition.

Recurrence = signs or symptoms attributable to a prior illness or injury occur in the absence of a new provocative agent. For example a return of radicular symptoms in a situation that would not be expected to cause such symptoms.

Probable = 51% chance or greater.

Possible = Between 0 and 50% chance.

Causality determination
* What happened
* What happened since
* Other workers?
* Happened before?
* Medical problems?
* Hobbies and stuff?
* Like job, supervisor, coworkers?
* Doing now?
* Past problems with depression or drug use?

And
* Get collateral records
* Get history from employer
* Hill criteria consider and/or research

Later
* Progressing as expected?
* If Sx resolved, will they return if they return to work?
* If Sx not resolved, is there a physiological explanation?
* If there is a physiological explanation for symptoms, will return to work exacerbate them? If not, are there objective reasons why the patient is not back at work?
* If there are no physiological explanation for symptoms, is there a medical reason the person is not back at work?

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7. The Functional Capacity Evaluation: Is it Helpful?

20 separate functions can be measured, including walking, sitting, lifting, seeing, hearing, tasting and fingering. FCEs test tolerance, occasionally capacity and not risk. FCE can help measure progress, set goals and measure disability. FCE can measure current ability and match them to a job.

If someone reports pain during the test, vital signs at the time should be recorded to see if there is physiologic correspondence to pain levels. Vitals should confirm the stated ability to, for example, lift. Should have data, conclusions and reccomendations that are related to each other.

Validity = measures what it is supposed to measure. Reliability = reproducibility of test. Most FCE systems do not have these. Not good at detecting submaximal effort. On was sensitivity of 67% and specificity of 84%.

Avoid confrontation by always having the patient do useful stuff from the start, and have RTW on the agenda right from the start. This will mean that work-centered stuff will be on the agenda from the start. Better outcome if ignore the FCE of back pain and go back to work anyway.

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8. The Medical and Legal Aspects of Return-to-Work Decision Making
Waldner, P.F et al.

It is rumored that a lawyer might tell a patient not to go back to work. Can end up as a scam.

Questions
* Agree best to return to old function
* Agree job more important than claim
* Do you want me to be truthful

Find out the physical requirements of the job from the patient and the employer. If want to know when they can return to work, ask the insurer or employer.

In the USA, the doctor does not have a duty to third parties; if the worker's knee collapses and they drop a girder on someone's head, no problem. Form a friendly relationship with a trial lawyer.

The patient's confidentiality always belongs to the patient. On the other hand, if the court insists on records, make sure they are subpoenaed.

The disclaimer if you see the file and not the patient is: The opinions in this case are the opinions of the reviewer. The review has been conducted without a medical examination of the individual reviewed. The review is based on documents provided with the assumption that the material is true and correct. If more information becomes available at a later date, an additional service/report/consideration may be requested. Such information may or may not change the opinions rendered i this report. This report is a clinical assessment of documentation and the opinions are based on the information available. This opinion does not constitute per se a recommendation for specific claims for administrative functions to be made or enforced.

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9. Can This Patient Work? A Disability Perspective
LoCascio, J.

WHO disability definition: "... any restriction or lack... of ability to perform an activity in the manner within the range considered normal for a human being."

The patient is disabled if their current ability does not meet the needs of the job. Not the doctor's job to determine if stuff can be "reasonably accommodated." The physician does not determine if a patient is disabled, just what they can do.

Diagnosis does not equal disability. Diagnoses with pathology or less capacity for hysteria are better but not needed.

Impairment does not equal disability. By the above definition of impairment, an elite athlete who gets asthma and can only run an eight minute mile has impairment. They are not disabled, but, yet.

Functional capacity = current ability. Patient must be capable of something before they can be restricted. Symptoms in excess of findings are the hallmark of subjective R/Ls. Doctors usually assume that the patient is telling the truth and consciously and unconsciously wants to get better.

The test of symptoms in excess of findings in consistency. Dimensions to be consistent in include: time, observers, known syndromes, situations.

Psychiatric diagnoses are syndromic in character. On the other hand, can have neuropsychiatric tests and tests with faking scales built in done. Axis V becomes important (!)

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10. Medications, Driving and Work
Aronoff, G. M. et al.

Consider: medication, condition the medication is for, synergistic effects of medication, if ability is already reduced. Not able to drive does not mean not able to work unless driving is an essential part of the job. Benzos can increase risk by 50% and TCAs by 100%. Impairment in ability can also impair ability to judge ability. OTCs cam also be a big problem. You must warn the patient about the risk of driving, or you are liable.

Effected by
* Insight, judgment and poor insight into these
* Alertness, reaction time
* Vision, dizziness
* BP, EPSE

Synergy with shift work and drowsiness.

Ax: Sight, vision (acuity and fields), cognitive and motor. MMSE, using a calculator, trail making B, clock drawing. timed walking 10 feet and turning around, manual test of range of motion, motor strength. Guides are in HCP's Guide to Assessing and Counseling Older Drivers. Others: Aronoff test of reaction time, attn concentration, attention span, concentration, mood/affect.

Same rules apply to other stuff where you need to be alert, too.

Benzos: impair. Muscle relaxants such as cyclobenzaprine or carisoprodol impair. Opioids probably don't with long-term use.

CNS stimulants: should not drive commercially if need these for adult ADHD. The decreased alertness that frequently occurs with dropping blood levels can lead to mistakes.

Can enter in the chart "Based on today's evaluation, I find no basis to restrict this patient from driving or working, if he/she so chooses. They know that if at any time, they are not fully alert or if they experience any decrease in mental acuity, they are not to drive or engage in potentially hazardous activities."

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11. How the Primary Care Physician Can Help Patients Negotiate the Return-to-Work/Disability Dilemma.
Know the secondary gain and the expectations of the extended family. Communicate expectation of recovery. "Early activation" helps. Health and wellbeing of entire family at stake.

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16. Working with Common Neurologic Problems
Klimek, E.H.

Need an enabling philosophy. All return to work will involve some risk. Gainful employment (here) means competitive employment with reasonable accommodations.

Work autonomy means the ability of a worker to pace the work to suite the limitations and is related to the idea of workplace modifications. Without undue hardship to the employer.

Can be static or slowly deteriorating. Determination, motivation and effort can overcome established neurological handicaps. Shift work will make worse. Fear avoidance accounts for 70% of back-pain non returns to work.

Headache
Migraine: headache, autonomic, stereotypic, +/- aura. Will be persistent and debilitating rare without: infection, increased ICP, temporal arteritis and head trauma.

Acute PTH, up to 8 weeks, otherwise, chronic PTH.

In primary headache, risk is not an issue. Capacity is not effected by pain, nausea, fatigue(!) Tolerance is the issue.

With return to work, have a challenge of graded activity and exercise with a headache diary and headache scale. The failure to adhere to the graded increase allows social and personal barriers to emerge and be addressed without being complicated by workplace stressors. So start exposure with work-like activities. Identify that work helps headaches.

Debilitating chronic headache rarely occurs without amplification of other, normal body sensations. Patient who experience chronic headache also seem to confuse responsible therapeutic drug use with drug misuse for symptoms common to everyday life, which they understand as warning signs of serious disease. Some thereby express emotional distress constrained only by cultural and familial rules.

Epilepsy
In the UK, 53% of employed people with epilepsy chose to conceal their illness. The reasonableness of accommodation is not a medical issue. Crux is prognostication for recurrence for work tasks to be addressed. Patients with first seizures are not a homogenous group. Recurrence within 2 years of first tonic/clonic seizure is as high as 40%.

Ask about previous epilepsy-like Sx, EEG within 24hrs of seizure, sleep deprived EEG, MR. Most people have a standard letter about driving and other risks.

Consider predictability and aura when considering return to work. The major risk factor might be poor attendance and productivity. Drug side effects can decrease productivity.

Risks: driving, heights, machinery. Capacity is usually ISQ. Tolerance is an issue of patient choice.
Brain Injury
Mild traumatic brain injury (MTBI): headache, dizziness, lethargy, memory loss, irritability, personality changes, cognitive deficits, perceptual changes. If able to follow commands less than one hour after the injury, some studies say no long term problems, other says only 49% chance of "good recovery." MBTI paradox is that can have # and contusions and get back to work, or nothing much and not get back to work.
MS
Kurtzke Extended Disability Status Scale. No risk to self. Tolerance: no mental fatigue in early stages. Fatigue/weakness that can not be objectively defined is a matter of tolerance. Personality changes can be a problem through motivation and effort. Without a limitation of walking (EDSS 4.0 or greater), this is rarely an obstacle to function.
Polyneuropathy
Driving skills will rarely be effected, but hypoglycaemia and retinal disease can be issues. Risk of falls and hazardous equipment and skin ulceration are risks that might need work restrictions. Capacity and work limitations. Usually no issues of tolerance.

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18. Working with Common Psychiatric Problems
Pro, J.D.

See AMA guidelines for evaluation of permanent impairment.

Presenteeism is a common problem. More than 80% of lost production occurs with patients who are at work. Understand how symptoms interfere with functioning.

Find out about: ADLS, social fn, concentration, ability to tolerate stress, and if

Find out
* ADLs +/- instrumental
o Self Care
o Communication
o Physical activity
o Sensory function
o Nonspecialised hand functions
o Sexual function
o Sleep
o Travel
o Shopping, banking, cleaning
* Role function
o Work
o Social
o Family
o Spiritual
* Ability to tolerate stress
* Ability to tolerate work-like events (some instrumental ADLs)
o Personal affairs
o Meetings
* MSE
o General MSE, cognitive testing and psychiatric neurological examination and...
o Concentration
Attention
Memory
o Persistence
o Pace
o Pain behaviours
o Beliefs about injuries and other's responsibility

Risk: Occurs in safety-sensitive jobs. Note homicidal ideation to coworkers - not to return home. Paedophilia...

Capacity assessment: decreased with psychotic disorders.

Tolerance assessment: as discussed.

Major Depression
Capacity: cognition, judgment, motor retardation, sleep deprivation. Those with mild depression can work - issue is tolerance.
Pain Disorder
Distorted beliefs about pain common. Can become suicidal with work. Capacity is not usually decreased but can become reconditioned. Tolerance: involve with setting goals.
PTSD
Half resolves in three months. 80% comorbid with other mental disorders such as panic, agoraphobia, MDD and substance abuse. Capacity... modifications and accommodations. Tolerance: desensitization.
Adjustment Disorder
Risk: if the stressor is conflict with a person at work or a situation at work, the physician may be justified is restricting work. Analogy: occupational asthma. May chose to change employers or careers.
Treatment Planning
Moderate or marked impairment in work ability without concomitant at least moderate impairment in other areas of mental function does not occur. A few people, because of their job description, might need to be taken off work.
Return to Work
Do this when most ADLs are ok and has adequate social stuff, concentration, persistence and pace. Demonstrate tolerance in a work-like setting. Be in control of anger. Side effects of medication should be ok. Stuff organised with the case manager and supervisor. Arrange discussions between the patient and his supervisor as this can dramatically improve work stress tolerance. Patients should agree that they are ready to return to work.

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19. Working with Common Functional Syndromes: Fibromyalgia and Chronic Fatigue Syndrome
Talmage, J.B.
Risk is not an issue. Capacity is generally not an issue in fibromyalgia. F and CF can have a decreased exercise capacity documented on treadmill testing. See if the test is stopped by fatigue/tolerance long before the predicted maximal heart rate is reached (exercise testing) or anaerobic threshold is crossed (cardiopulmonary exercise testing). If cognitive complaints effect the job, get formal neuropsychological testing. There is no logical reason for temporary work modification because the conditions are long-term.

The patient's plight is similar to that of patients with nonspecific regional arm pain or mechanical lower back pain. Tolerance is not an area of medical science, so reasonable doctors will disagree.

This book is written by physicians for physicians to give some guidance about work restrictions/limitations and uses common sense, art as well as the science in work-related injuires and illnesses. At the same the authors helps to translate and make sense our of the legal definitions of the work comp world of lawyers, case managers, and employers. I wish I had read a book like this in medical school or residency. Easy to read and understand.

This is an excellent, highly readable book on the cultural meanings behind and around several of the medical "miracles" of postwar America, including prosthetics, plastic surgery, hormones, and sex-change operations.

You do not have to be an academician or versed in medical knowledge to enjoy this look at how these technologies changed the way Americans viewed "the body," and how certain alterations (or lack of) had consequences to one's sexual/gender identity and even one's standing as a good American citizen. This book is perfectly balanced to provide the rigorous research a historian would require as well as the sheer fun a pop culture reader like myself seeks. (Although parts of this book have truly heartbreaking stories, there is also a lot of unintentional hilarity from the "expert" pronouncements of the 1950s medical establishment and the media treatment of individuals.)

Serlin's work is really a view of the 1950's from a unique angle--one that doesn't repeat the same old stereotypes about repressed housewives. He uses fascinating archival sources (i.e., the Hiroshima Maidens chapter includes personality profiles of the maidens by their Quaker patrons plus an appearance on the TV show "This is Your Life" where the maidens, hidden behind a screen due to their 'hideous' burned faces, are surprised with meeting the co-pilot who dropped the bomb on Hiroshima!) and photographs to vividly recreate the 1950s milieu and mindset. The chapter on Christine Jorgenson, the first transsexual "star" is worth the price of the book alone.

As this book explores concepts such as race, gender, sexual orientation, national identity, and all their intersections, I would recommend it to readers interested in disability studies, gay/lesbian/transgender/queer studies, American-Japanese relations, the Harlem Renaissance (amazing story on cabaret singer Gladys Bentley), and of course, the history of the cold war. I'm looking forward to the author's next book!

At least in my historical imagination, the 1950s tend to stand out as an extremely stereotyped decade. It reads as the triumph of the (imagined, and demographically limited) white, middle-class, suburban family of extremely confirmative values. David Serlin's Replaceable You is a fine contribution to 1950s socio-cultural studies; it subtly and meaningfully drawing out stories that focus roughly on the fifteen years from 1945 until the end of the 1950s. It fleshes out an array of interesting issues from this period which leaves the historiographical face of this period in a more complex and exciting state than popular imagination (mine included) would normally have it. Moreover, these stories provide gripping and accessible entrance points to larger issues of the era, but without forfeiting either the integrity of the personal stories nor reducing them to merely their historical context. While all the stories involve 'working' on the body in some form (from hormones to prosthetics), David Serlin manages to become neither too scientific nor too specific in his writing (he does not burden the reader with an endless technical vocabulary; instead he deftly crosses issues ranging from race, gender (masculinity, femininity, and stuff inbetween), sexuality, economic location, all the way to architecture. If nothing else and, perhaps, most importantly, David Serlin's book is accessible, readable, and, most laudably, human.

I really enjoyed Replaceable You. Overall the book was excellent-a well-written, lively, and often surprising mix of insightful analysis of how medical advances had such a huge impact on the American psyche and, above all, body, in the decades following WWII. It's also clear from the start that Replaceable You is, as the first review noted, by no means straight history of science, but rather social history at its best. The conclusions Serlin draws in his four fascinating case studies about how people (often with much societal pressure) wished to remake their identities were quite convincing. In addition, the expert discussions which frame the specific analyses are especially effective in illuminating the larger context of Cold War America, on issues like McCarthyism, civil rights, consumer culture, and prescribed gender roles. Serlin also does a very good job showing how these issues intermingled-both with one another, and perhaps most importantly, within the discourse of what it meant to be "American" at the time. As William Smith says in the second review above, the result is a fresh look at the often stereotyped late 1940s and 1950s. What also made the read so entertaining were the artifacts of popular and high culture the author chose to analyze in presenting his arguments. Serlin doesn't limit himself to written primary sources, but makes skillful use of photographs, advertisements, pamphlets, comics, etc., of which he conducts close readings. In taking this kind of approach, where the reader is guided by the author as they together examine documents for historical meaning, Serlin makes the book not only more accessible to any reader with a general interest in science and society or the Cold War, but also more enjoyable. To go along with the author's vibrant narrative as he looks at the intersection of patriotism and prosthetics, race and hormone therapy, the bombing of Hiroshima and plastic surgery, or gender and Americanism, is to gain a more nuanced understanding of Cold War culture, and more specifically, how as a result of social, political, and medical developments people go about making themselves both look and feel more like... themselves. Replaceable You also struck me as having a special relevance given today's obsession with the body in popular culture, especially evident in television shows like the "The Swan," where plastic surgery is performed on women so as to make them into pageant girls. David Serlin's original book reveals not only that interest in medically changing one's body has been around for longer than we may think (and is ever increasing), but also that this interest has a distinctly American face.