Hi. I’m dr. Buttibaal P. Loki and back in the day to see a lot of patients who were involved in car wrecks. So now that I’m not doing it so much anymore I don’t really have to worry about what I have to say and I can be a straight shooter with you. So stay tuned and I’m gonna tell you everything you need to know about how to find a good personal injury attorney and how pick the right doctor. Most likely if you’re watching this Article, you or somebody you know has been involved in some sort of trauma or car accident where you guys are thinking about if you need an attorney. So let me go over a few things and we’ll discuss do you need an attorney? First let me start off by saying I’m not an attorney so I’m not giving you legal advice.
This is just for educational purposes and all the information I’ve learned over the years dealing with this whole system. Now the first thing people always ask me when they come in is, Hey do I even need an attorney? You know this injury is not that big of a deal, it is just a little fender bender, should bother with getting an attorney? What I found out over the years was people with an attorney usually got page two to three times more in their settlement. Understand that insurance companies have to deal with a lot of people who try to cheat the system. Insurance companies have people that fake all the time, or try and figure out a way to scam the system. So they’re usually very defensive about paying money.
On the flip side I’ve also seen insurance companies do some pretty slimy things where they will sweet talk someone into signing papers right away and settling the case. When this person has a lot more damage in this gonna have a whole lifetime of bills and they just really wanted money quick and they signed off and took the money right away. Sometimes patients don’t understand that the little injuries, something like five mile per hour whiplash injury ends up being a big deal down the road. Especially a year later when all the money is gone and you’ve already settled. What ends up happening is a person injured in their desperate for money and they just want to get it over with. An insurance company will come along and dangle a check in front of them for a ridiculously low amount and they’ll tell them over the phone that’s as high as we’ll ever go.
Then what happens is if you get an attorney all the sudden they find magical money and they can go higher. So I’ve seen people try to deal with insurance companies on their own in the just do not get very far. You might think a little fender benders no big deal and you know a little whiplash injury really its gonna hurt for a few weeks in be over but you’re wrong. whiplash can be very very serious. I want to explain a little more about whiplash injuries and how they work and this model spine will help me a little bit. What you’re looking at is this is like the base of the skull that has been cut off, the occiput and the cervical spine. I would be sitting this direction. What happens when you get a car wreck is your torso thoracic spine moves forward before your neck does. What will happen is your neck has to snap the catch back up and it snapped by going backwards towards the headrest and didn’t really hard forword.
What this does is injure this area that neck, the very top, it rips these ligaments up and the lower area around C5 and C6 gets damaged in this motion. It’s very very devastating because during the wreck your head accelerates to almost 15 G’s! That’s equivalent to having your head shot out of a cannon for a few milliseconds. That’s an enormous amount of stress on the spinal connective tissue and it does serious damage even a five miles per hour. Let’s first discuss the physics of the car wreck. A lot of it’s going to depend on what kind of car you were in when you were involved in your accident. A lot of older cars are ones made of heavy metal, you don’t really get that damaged in the wreck. In fact it’s usually just a couple dents on the bumper those are actually much, much worse because all that force goes through that steel frame it right into your body.
The cars that look like they really got busted up crumpled and mangled are actually much safer. Cars today are designed to crumple up and crush so they absorb the impact instead of your body. Some of the most horrible looking accidents where the cars are just crumpled wrecks, you’ll see the people actually get out of. If you compare that with an accident that happens in an older model car, where the car doesn’t take much damage, you’ll see people who get their neck broken at ten miles per hour. Conventional care after your accident will usually involve going to get some diagnostic studies at the hospital or another facility, where the x-ray and make sure nothing is broken and then what they usually recommend wants nothing is broken is to immobilize the joint, Do bed rest and some pain killers.
This is fine in the very beginning of the accident but after a few days you really want to take the brace off and start mobilizing area. If you continue to wear the neck brace it can cause a lot of problems with scar tissue down the road. It’ll help accelerate the formation of adhesions. The upper neck area and the base of the head are very complicated a lot of blood vessels and nerves and soft tissues run through the same area. Unfortunately this area is very susceptible to whiplash injuries and it can cause a whole host of problems. Also the base of the neck has its own problems. The nerves that come out of the base of the neck control everything that goes on in your arms and upper trunk. This causes a lot disruption when there’s twisting or the seat belt smashes into your shoulder.
It creates this traction during injuries which stretches these nerves and damages them. Over time these damaged nerves can heal but if they’re completely torn you’re in big trouble. During a whiplash injury it’s very easy to tear the muscles and nerves. Muscle tears actually called a strain. A strain can be very serious but most will heal in time. One of the worst parts of the injury is the sprain and that’s a tearing of the ligaments themselves. Now ligaments hold the bones together. They no longer hold the bones together well and it creates kind of a “sloppy joint”, where bones move too much. If the bones get knocked out of place and the ligaments are torn, you can start to have real problems with adhesions and pinched nerves. The big problem with ligaments is, once they get too stretched, there’s no way to unstretch them.
It is kind of like a rubber band, once a rubber band is all stretched out you can’t bring it back. Once that happens you will have joint instability the rest of your life. After about two weeks after the accident you enter what’s called the remodeling phase and at that point what your doctor is trying to do is keep tissue from sticking to each other. Ligaments and muscles need to slide while they heal, if you do not put a lot of motion into them they will fuse together in scar down. Think of it like a piece of gristle. You can get a good idea of what scar tissue looks like by checking out a piece of meat that white, fibrous connective tissue that’s really hard to cut that gristley stuff, that is scar tissue. One of the main reasons you want to go to therapy during your remodeling face is so this doesn’t happen to your muscles.
Muscles and connective tissue they touch need to be able to slide back and forth freely. After an injury, the swelling in the scar tissue will cause adhesions and stop that at healthy motion from happening Here’s a Article to describe it a little better and show you. What you have on top is the connective tissue and this is muscle moving nice and healthy. It is sliding back and forth along the tissue. Now I am going to compare this to an unhealthy situation. After an injury or whenever there’s pain and swelling, they don’t slide anymore. There’s the connective tissue on top but the muscles are sliding nearly as much. If that happens long enough actually form on the ligaments and you can see that here on this scan.
If you’re really unlucky those calcification knobs will actually start to press on the spinal cord itself, and that’s really bad news. Let me show you what a healthy curve looks like. This neck is relatively healthy. There is a nice curve and that curve is there to absorb shock. Your head like a bowling ball bouncing around on your neck all day so that curve is really important. What happens during an accident is that you can damage this curve get what’s known as a straight neck or a military neck. Now the joints no longer absorb shock and they drive into each other at full force. A lack of healthy motion will actually cause the joints to start fusing and forming arthritis. The disc will get damaged because the spine no longer pumps nutrients to it an it starts to collapse.
Over a few years you’ll start seeing something like this, where you see osteophytes and the bones using into one big bone. and that is also not good news. It can be slowed down and even prevented sometimes if you continue to get care after your accident. If this process is ignored in motion is it restored to the joints eventually they just kind of fuse into one big bone in like this guy. A sign of a good doctor is if the at least take a flexion and extension X-ray series including the Atlas movements. I am going to show you what that is. So here’s the flexion, when you put your chin to your chest and extension when you put your head back. What this shows is a lot more than a static x-ray and actually shows what’s moving on the spine correctly and what’s not.
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The problem with just taking a static x-ray of a spine and not moving the spine around in X-raying from different angles is that you can’t see how well the joint is actually moving. You really can’t see ligaments while on X rays so you kinda have to put the body in different positions to see if the ligaments are doing their jobs are not. This is especially important with the Atlas bone, which is the very top bone in your neck. the problem is this bone gets really easily injured and it’s extremely important bone because so much of the spinal cord in blood vessels run through it. To really get a good study it’s kinda hard with just regular X-rays I always recommend Article fluoroscopy or motion X-rays these are superior to regular x-rays and they really let you see the motion of the joint what stuck and what’s not what’s moving correctly.
You can see a head moving backwards and forward in your checking to see how well the joints are opening and closing. Here you can tell the atlas bone is not really moving as well as it should. It should be almost touching the back of the skull. Now this next one here is important because you need to test the rotation moving head back and forth. Right now you’re seeing the lower neck and shoulder area which gets injured a lot but what’s more important and usually really causes problems again is that atlas bone. You have to open the mouth to see it, so you can see lateral flexion of the Atlas joint, you have to open the mouth to see how well it’s moving. This motion X-rays kind of a little blurry but it does show the Atlas movement here you can see a transverse ligament rupture that bone is moving way too far away from the one below it.
The atlas bone is coming all the way off. Serious injuries like a transverse ligament rupture or a rupture to the odontoid check ligaments are often missed by hospitals and doctors because they don’t take motion X-rays. I can’t overstate the importance of using motion X-ray when you can. Besides ligament damage, the other thing that routinely gets injured is your brain. You have to remember your brain is sitting in a big liquid vat and when you get a whiplash injury the brain will actually slam against the front of the skull and then the back of the sckull. This is known as a coup contrecoup injury. If you’re unlucky enough to also hit the windshield then you can do double brain damage to the frontal lobe. This is pretty common. Conventional care will usually be an MRI or maybe CT scanning where they look for contusions like this one, that big white spot and if necessary they’ll actually drill in to the head in release the pressure.
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The injury that’s really hard to see is damage to the axons and that’s what you’re looking at here is a nerve cell dendrites growing there and those can get damaged by something called axonal shearing. The gray in the white matter in your brain have different masses and so what happens during the accident is they go different speeds in a stretch these axons that are between them these nerve cells. Again that’s called axonal shearing. Sometime this kind of brain damage takes a while to present it usually your loved ones start noticing your personality changing and some psychological differences. The signs of axonal shearing don’t really show up on regular MRI’s you need some special ones like a DTI MRI or SWI MRI. There are also some other tests that are quite useful to have. There’s something called a Spect-CT, and a MEG can also be quite helpful.
Again if you feel like you’re having some sort of brain disturbances you might want to talk to your doctor about ordering these tests. Now that you better understand the science behind whiplash cases lets talk about how to pick a good attorney. Now finding a good personal injury attorney can be tough what I suggest is you ask around your friends and go on social media ask if someone had a good experience with an attorney. Also actually pick up the phone and call the attorney. This will give you a good idea of their level of service. If all you ever get as an assistant and you can’t get past his gatekeeper move on. Those attorneys are really difficult to work with you want attorney that will actually sit down and talk to you and not pass the buck to someone else in their office. Also these days there are reviews of attorneys online.
You can go to Yelp and look somebody up. Those can be very helpful as well. Once you actually find attorney you like you can expect to pay anywhere from third to sometimes even a half of your settlement depending on how good the attorney is. But one thing patients don’t realize is you can negotiate this fee. So if you feel like you have a pretty slam-dunk case you know somebody hit you and is clearly their fault and you’re gonna have a large case you should negotiate their fee before you ever sign anything. Also you want to find a personal injury attorney that that’s pretty much all they do. If you go to an attorney that does you know I million other things they’re usually not as a depth building a really good case. You’re kind of taking your chances if you’re going with you know your girlfriends uncle who also does copyright title searches probably not the best choice.
Now that we discussed your lawyer we need to discuss your doctor’s it really want to go to a team of doctors. The captain of the ship should be your chiropractor you’re gonna see them the most and you’re probably gonna see them for about a year during that remodeling phase we talked about. It is also very smart to do your physical therapy at your chiropractor so the care is coordinated. Most the other doctors will mainly be used for diagnostics and testing. I would refer to other doctors for orthopedic evaluations, MRI’s, nerve conduction studies and I always said my motion X-rays out to a radiologist. When brain trauma suspected it’s also smart have a psychologist and also a neurologist check them out.
It is just good doctoring to try to collaborate with this many specialists as you can, but one doctor needs to run the show or on informational just kind of get blurred and lost. Let your chiropractor do that because they see you the most. Chiropractors are really excellent a restoring nerve flow and keeping those adhesions from forming that I showed you before. You also help straighten out the joints which is nice. No other doctors are trained to reduce subluxations you just can’t substitute this kind of corrective care by going to just a physical therapist or just a massage therapist or just an osteopath. You need to go to a chiropractor. If you go to a doctor initially who refused to send you to a chiropractor is time to fire your doctor and get another. Even if your doctor says you’re not a good candidate for chiropractic care go to a chiropractor anyway in get a second opinion.
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They will be honest with you they can help you are not. I can’t stress enough the importance of going to a chiropractor first as you’re really missing the boat if you don’t. One last thing I want to discuss is that you need to be a good patient and what I mean by that is don’t make your doctor have to dig information out of you you want to be keeping records on your own. Especially if you feel that there’s some sort of brain damage you want to keep a psychological log things like maybe you feel depressed more than usual or that your headaches now seem a lot worse for you can’t sleep through the night anymore you’re getting nightmares things that disrupt your daily life. Now also if you took a lot of spinal injury you also want to keep a record of how it is affecting you with daily tasks.
Does it hurt to go to the bathroom now? Is it hard to shower? Can you actually hug your loved one without pain. These things your doctor needs to know and you need to document them. One other thing is when you first go in to a doctor you wanna make sure you list all your new complaints. Now remember the insurance companies only responsible for bringing you back to the level you were before the accident. they’re not responsible for fixing everything that existed before the accident. So you want to make sure that you honestly tell them what’s new now that could also mean that your old injuries that have existed forever are now worse. So if now you have even worse neck pain them before or your migraines or even worse or, now the numbers down your leg is even worse, you need to tell your doctor this when you first go in.
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Be sure to list any little mineut details no matter how small if you’re not sure if that’ll become a big detail later. Say you get a whiplash injury in your neck hurts really bad for two weeks and that’s all you really focus on but you know what you jammed your foot into the pedal really hard and your ankles not right. Well if you forget to mention your ankle when you go in, they are gonna think that it had nothing to do with the car wreck so even though you know you come into the doc and “oh my neck hurts really bad just fix it, fix it, fix it!” you also want to list every little injury that happened. My ankle is a little sore, my wrist is a little sore, I think I jammed some fingers, my teeth are not right, something came loose when I got hit. Whatever happened, you need to document it.
One of the questions are used to get a lot more people who got a wreck and then just kind of didn’t do anything about it but a month or two goes by and now they’re neck really hurts or their shoulder really hurts. Is it too late to start a case if it’s been a few months that has been rolling. The answer to that is no, but you’re probably not going to get the same kind of settlement you would have you come in right at the beginning and it was well documented. What’ll happen is, what happened during those two months that you didn’t come in did you re-injure it some other way it’s always different possibilities and without documentation kinda hard to prove that the accident was the cause of your pain two months later but you can still go to someone and they probably help you but don’t expect it to be a slam-dunk case like if you were to come in and do it right.
That being said please remember don’t lie and make stuff up just to get a better settlement. We doctors have special tests called malingering tests, which I can kind of figure out when your lying when you’re not and there’s some other tests we can do to just flat-out prove your lying. It always comes back in bites you when you try to settle this or it goes to court. Someone will find out your lying so just don’t do it. One last thing I want to say is please remember you can you fire your attorney or fire your doctor’s anytime you want. If you’re talking to your doctor and you really think some sort of test should be run, and they just don’t want to do it or they’re arguing with you, go to another doctor. Same with your attorney if you’re asking him what’s going on my cases you can give them a call you back or they’re just ignoring you, fire them, get a better attorney.
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You have to deal with these consequences in all the aftermath when the case is settled. So if you have permanent ligament damage your goning to be dealing with this the rest of your life. It is never gonna completely be the same where once your case is done attorneys don’t have to deal with you ever again and you know they just move on. Remember this is kind of a big game that one attorney will go after the other and fight like crazy in court but when it’s over they both go out to dinner together and hang out. You have to live with the consequences so you need to be proactive and be kind of a pain in the butt patient to make sure that everything is being done right for your case. If you thought this story was useful please share this information it’s free just put it out there. Favorite it so you could find that later.
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