>Sandy:
>
>I have posted a question to your forum as I am an insurance adjuster trying to
>address a case of TM being presented as a workers' compensation case. I will
>be very interested to see the results of your survey. I have been very
>interested in the fact that most of the people with TM are under treatment of
>neurologists. My research has mostly been with rhumatologists rather than
>with the neurologists here locally (Mid-west Missouri). I guess this has been
>because in my case the injured worker also has Lupus. The neurologists don't
>seem to understand that we are dealing with a disease process rather than with
>trauma. Just wondering if you have any insight whether or not this is the
>case in other parts of the U.S.?
>
>----------
>From: Srulyosef(AT)aol.com
>Sent: Sunday, February 23, 1997 8:29 AM
>To: tmic-list(AT)eskimo.com
>Subject: TMA
This message brings up an interesting point which has been a
concern for me ever since I have read about this "survey" being conducted.
It is fairly safe to say that this is an information survey based
on observations and experiences of members of this list. It is in NO way
scientific and certainly does NOT have nor will it have any "evidence" for
insurance companies. We all know there are thousands of people out there who
are excluded from this survey because they are unaware or uninterested in
the list or the association.
Where did you get the idea that neurologists don't understand that
TM is a disease process? I certainly have felt that way in the
physiotherapy gym but have NEVER felt that my neurologist thought that I
have traumatic spinal cord injury. I think that I am safe in saying that my
Rehab Specialist is also quite aware of the differences --in particular she
singled out myself and one other patient with spinal cord infarction when
she was giving a lecture on the long term outcome of spinal cord "trauma"
She specifically said that those "stats" did not necessarily have
applicability for us!
I do not want Sandy to loose her enthusiasm and I will be VERY
interested in the results of the survey, but we must remember that this is a
very select group of individuals who are replying. But as a scientist
myself (and yes psychiatry HAS come of age, thank you very much ;-), I
would be horrified to see an insurnace claim influenced by this "study".
I feel obliged to comment about what IS known (since some writers
seem to think nothing is known). There are lots of good neurology texts out
there with all sorts of information that quite clearly establishes the
process of transverse myelitis, distinguishes it from other "spinal cord
dysfuctions", like MS, Guiallan Barre, polio etc etc. As I have said in the
past there is a particularly interesting article showing the development of
TM in a patient who is also seroconverting to HIV -- giving a lot of
credence to the "post" viral theory. Whatever the "cause" the dysfunctions
are a result of demyelination. If a virus demyelinates, if a chemical
exposure demyelinates, if a genetic defect demyelinates, the basic defect if
the same. How much demyelination occurs obviously determines the extent of
initial symptoms and how much remyelination occurs obviously determines the
outcome.
The term transverse myelitis is used to describe a disorder at a
specific area in the cord (as opposed to a more extensive process -- and
lesions at c2 and c4 are still "limited" --my own lesions were initially
described from t6 to t12 --that dosn't make it multiple sclerosis
--certainly in the absense of sclerotic plaques.) And to quote "Current
Medical Diagnosis and Treatment" --regarding multiple sclerosis -- " ,,, The
diagnosis cannot be made with confidence unless the total clinical picture
indicates involvement of different parts of the centreal nervous system at
different times."
As a final word, for this posting anyway ;-) , it is not
impossible that a chemical exposure --who knows --even a radiaton exposure
--or a viral exposure in a health care seting could have brought on the
"insurance" patient's TM. Also after reading these extensive responses it
seems that some people are unaware that one can suffer from a number of
differnet diseases at the same time and they do not necessarily have to be
related.
And to comment about "personal attacks", my response some months
ago about insurance coverage in the good old US of A vs Canada was not a
personal attack. I was severely criticized, almost as tough I had
challenged the theory of relativity --only to discover that a number of
later postings referred to people having problems with their insurance
companies AND then to discover that that issue was significant enough to
appear as a question on the "questionniare".
OK,,,, that should be enough to increase a few people's blood
pressure!