Winning Isn't Easy Season 3 Episode 3: Dr Braun Interview About Degenerative Conditions of the Shoulder & Knee

Welcome to Winning Isn't Easy! In this episode Nationwide ERISA Long Term Disability Attorney Nancy L. Cavey talks about Degenerative Shoulder & Knee Conditions with a Special Guest Dr. Braun.

"Winning Isn't Easy" is a podcast dedicated to exploring the complexities of the Employee Retirement Income Security Act (ERISA) long-term disability world. Each episode, we delve into the challenges and triumphs of navigating this intricate landscape and bring to light the key issues affecting disabled individuals seeking benefits under ERISA. Get ready to listen in on a captivating listen as we uncover the truth behind "Winning Isn't Easy."

Resources Mentioned In This Episode:

LINK TO ROBBED: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO PROFESSIONAL BOOK: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/

Dr. Braun's Website and Information: https://www.bayareaorthofl.com/david-t-braun/

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Transcript

Nationwide ERISA Attorney Nancy L. Cavey: 0:16

Hey, I'm disability attorney Nancy Cavey. Welcome isn't easy. I'm gonna be talking about degenerative conditions of the shoulder and the knee, and I have a special guest, the local orthopedist we refer cases to Dr. Braun. Let's first talk about degenerative conditions of the shoulder. There are many causes of degenerative conditions. You can have spurs, you can have degenerative tears, you can actually have an acute injury to the shoulder or the shoulder joint. That can result in difficulty putting your arms above your yourself, your arms out in front of you. Sometimes we'll even have tingling and numbness of the fingers, and that can result in a disability claim, particularly if you have complications of injury or de degenerative condition, or you're having complications because of treatment. It's really also important that you understand how disability insurance companies, uh, view these claims. And they view degenerative condition claims in a manner that I think might surprise you. By that, I mean most of the time they're looking at acute injury cases. A person has injured their shoulder or injured their knee in a work related accident or all wheel accident or slip and fall at home. And they are looking at the acute nature of the medical condition, uh, the basis of the diagnosis, the treatment, and they expect a really quick recovery period of time. In fact, they use medical disability duration guidelines in a lot of these degenerative claims. And as you will hear when we talk to Dr. Braun, It's really important that this is a team approach. And by that I mean we wanna make sure that you are giving your physician an accurate history of your symptoms and how those symptoms impact your ability to function. So for example, if you have a knee condition, you might have swelling, popping, locking, you might have give way, you might have difficulty standing or walking. You might have to change positions freely, frequently because of the problems with the the knee. Uh, those are the kinds of things that you wanna be documenting in your medical chart. I love what Dr. Braun had to say about keeping a diary or an interval history form. That's something that we recommend in our practice. Why is that? Well, a disability insurance company is going to be looking at your medical records and as they're looking at your medical records, they're obviously, as I said, looking for the history. Uh, but they're also looking at the medical records for the objective basis of the diagnosis. What's the results of MRIs? CT scans, if you had surgery, what's the operative report show? What's your postoperative recovery course? Have you had physical therapy? Did you benefit from the physical therapy? Have you had injections, be it in your shoulder or your knee? Are you having ongoing symptoms that impact your ability to perform, uh, your own or any occupation? I think again, it's important that we're doing this as a team and finding a physician who is willing to take this team approach can be difficult. And having a doctor and their staff deal with you can be difficult. I love Dr. Braun's suggestions and comments on how to do this. Hey, I'm Nancy Cavey. Welcome to Winning Isn't Easy. And we've got Dr. Braun.

Dr. David Braun: 4:07

Hi Nancy.

Nationwide ERISA Attorney Nancy L. Cavey: 4:08

Hey, how are you?<laugh>? So I'm gonna ask a number of questions today because our viewers are interested in orthopedic issues, primarily shoulder and knee conditions. So tell us what are the most common degenerative conditions that you'll see of the shoulder and knee?

Dr. David Braun: 4:24

So for degenerative conditions, obviously arthritis is the most common one, but in the shoulder, uh, in particular, we'll see degenerative libral tears, we'll see degenerative rotator cuff tears. Um, you know, there's biceps tendonitis, there's ac aosis. There's quite a bit of things that, that we can, uh, go over in, in the knee. Typically, you know, just generalized osteoarthritis, but also general municipal tears, uh, as well as ligament injuries and things like that.

Nationwide ERISA Attorney Nancy L. Cavey: 4:55

Well, obviously you're an orthopedic surgeon, that's why you're here. Can you tell us what are the most common treatment, uh, modalities that you'll see in both shoulder and the knee?

Dr. David Braun: 5:05

So for every patient, we always start off with conservative treatment. So surgery is the last resort option in, in our practice. So exercise is the, the number one thing that we see patients for. It's, it's remarkable how many patients come in and the only problem they're having is that they're not physically fit and they've done something that is outta the ordinary for them in their store, or they have some pain and that's the same soreness or pain that somebody who was physically fit would not have if they did those same activities. So quite often we are just prescribing home exercise programs for, for a patient, maybe, uh, a formal exercise program with physical therapy, but that is the number one conservative treatment.

Nationwide ERISA Attorney Nancy L. Cavey: 5:54

Right. And then what's the next step in treatment?

Dr. David Braun: 5:56

So the, the next step is oral anti-inflammatory medications. If you're able to take them, you know, those are like the ibuprofens, the motrins, similar medications like that, ice and heat stretching, all of those play a role. And probably, probably the most effective thing we have for acute inflammation or acute pain be a corticosteroid injection. And where these medications that we're talking about are non-steroid or anti-inflammatory drugs, corticosteroid injections are steroid anti-inflammatory medications that we can put right into the source of the pain and problem and hopefully decrease or eliminate

Nationwide ERISA Attorney Nancy L. Cavey: 6:40

It. And is that something you do or do they have to see another

Dr. David Braun: 6:44

Decision? No, that's something we do right there during their office visit. Uh, they come in, you know, we talk about early conservative treatments and, and the noninvasive things, but if they're pain is more than four out 10, then typically we recommend the corticosteroid injection and we provided right there on site.

Nationwide ERISA Attorney Nancy L. Cavey: 7:01

So at, at what point in your professional opinion experience does someone become a surgical candidate cause of problems with their

Dr. David Braun: 7:08

Shoulder? So really the, the number one indication for surgery in my book is failed conservative treatment. So if the oral anti-inflammatory medications, the home exercise programs, the injections are not providing with a significant level of relief, then it's time to move forward with surgery. So, you know, obviously we, we try to put that off as long as we can. But then for patients that you know, are 65 years of age or older, we are a little bit more aggressive because then you're starting to reach the other side of that window of opportunity for surgery. And the longer you delay something, the harder it's gonna be because you're gonna be older, you're not gonna be as healthy, you're not gonna be as strong. So typically, and especially for knee and and hip arthritis, once a patient reaches 65, my threshold for moving forward with surgery is very low just because we don't wanna put it off until they're 85 or 90 and then it's much more difficult or maybe they're not even a candidate any longer cause of health risk.

Nationwide ERISA Attorney Nancy L. Cavey: 8:14

So, um, based on physical exam or MRIs or CT scans, what makes a person surgical from a shoulder

Dr. David Braun: 8:24

Stand? So the number one reason is their subjective opinion. So if they say that they're unable to do the things that make them happy in my book, that makes them a surgical candidate, usually that is accompanied by radiographic findings, meaning the x-ray shows changes where we see sclerosis or hardening of the bones near the joint. Uh, we see osteophyte formation, which is just the bones actually trying to get bigger to spread out the contact pressure of, of the joint. You know, there are deformities, there are effusions, which is swelling, or people commonly call it water on the knee. And that is a direct indication that there is something that is injured that is not healing. So same way from the knee, what is it about a physical exam or an MRI or their complaints that in your opinion makes them a, a good surgical candidate? So when we're talking about knee replacement surgery, again it is just failure of improvement with the conservative treatments. The things that we see on physical exam are the same things that we see in the shoulders. Swelling, cre, which is like the creaking sound whenever we move the joint, you know, there, there's pain right along the joint line and there's certain provocative tests that we do that can indicate the patient's ready for surgery. Right.

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Nationwide ERISA Attorney Nancy L. Cavey: 10:07

Dr. Welcome back. You mentioned pain levels and pain scales. How do you use a pain scale in your practice and how does that influence your treatment?

Dr. David Braun: 10:16

Sure. So pain scales are, are very different for a lot of people. And the one thing that I would implore patients is whenever you go and see your doctor and they ask you about a pain skill rating, try to be as judicious as possible in selecting your answer. Don't say I'm having 12 outta 10 pain because that doesn't help anybody. Typically I tell patients 10 outta 10 pain is what you could imagine it would feel like to get hit by a train and one outta 10 pain is like a hang nail or paper cut or something like that. So, you know what I said in the previous, um, question was patients that have four out 10 pain, typically that's the level of pain that we try to keep patients at or below while they're in the hospital. So I use that same level of pain to determine whether or not a patient needs more invasive conservative treatment. And then obviously whenever the pain level gets to 7, 8, 9, 10, that's whenever it's time to move forward with surgery. So we talked about conservative treatment, but before surgery, are there any other other things that a person can do to help in their recovery so that they don't come surgery? Sure. So as we mentioned before, exercise is the, the number one thing, not only does it help with your cardiovascular fitness and your energy levels, but it also helps to increase your strength so that you can recover easier from a surgery or from conservative treatments. And exercise actually releases endorphins, which are are body natural pain relievers. So by exercising you can actually increase the endorphin release, you can actually lower the amount of pain. There have been plenty of studies done throughout the healthcare world that indicate that exercise is just as effective as Tylenol or Motrin in decreasing somebody's joint pain.

Nationwide ERISA Attorney Nancy L. Cavey: 12:13

So post-op, what can a patient do to improve their recovery to make that surgery a sucess?

Dr. David Braun: 12:19

Sure. So the number one thing and the easiest thing with is to follow the recommendations of your surgery. So whenever we, you know, prescribe physical therapy or home exercise program or if there are restrictions on you after your your surgery, you need to follow them. Far too often we see patients that feel great after their surgery. So they say, oh, I'm gonna go and do this, I'm gonna do squats. And they're clearly on their post-op instructions was do not put weight on your leg. So obviously in situations like that, you know, they can do damage, they can undo the work that we did during the surgery. So the number one thing is just to follow the instructions given to you by your surgery. The second thing that I think patients can help is ICE is a very effective pain reliever after surgery. It decreases swelling and decreases pain. Mm-hmm<affirmative>. So keeping ice on it and trying to minimize the amount of activity that you do immediately postoperatively just to allow your body to start healing.

Nationwide ERISA Attorney Nancy L. Cavey: 13:24

So if I've been in an accident at work or an auto accident or just slip and fall at home, at what point should I be asking to see an orthopedic doctor as such as yourself?

Dr. David Braun: 13:36

So typically if you are unable to put weight or pressure auto body part or a limb, that's whenever you should go in and, and, and see an orthopedic surgeon. There are some people that have pain tolerances that are really high. So my official answer to that is, if you get injured and you have pain, you should get evaluated just so that we're not missing anything and we're not taking something that's simple that can be treated conservatively and turning it into something that's more complex or requires basic treatment.

Nationwide ERISA Attorney Nancy L. Cavey: 14:07

So how about the shoulder? What's the answer there?

Dr. David Braun: 14:11

So if the pain doesn't go away in two to three days, I would say then it's time to go and see a specialist.

Nationwide ERISA Attorney Nancy L. Cavey: 14:17

So based on your experience, would functionality of the shoulder be also a determinative factor?

Dr. David Braun: 14:21

I t, it's a big factor, but there are plenty of people that can function and push through the pain a nd, a nd p ain t hat c an b e caused b y s omething t hat r equires s urgical intervention a nd t hen t hey j ust m ake t he degenerative c hanges o r t he d egenerative injuries a s a result of that acute injury worse and make the, t he surgery or the ultimate treatment more complex.

Nationwide ERISA Attorney Nancy L. Cavey: 14:44

Um, obviously one of the, the primary, uh, factors that you want is a cooperative patient, one who's gonna follow your instructions and, and work together as as a team. So what suggestions do you have for a person coming to your office to be the best possible patient they could be for your practice to be your ideal patient and to get the outcome that you know?

Dr. David Braun: 15:07

So having a an injury journal or a symptom journal is a very good way of making sure you're prepared for your visit. We're gonna ask you questions like, how long has this been going on? When you feel the pain, how would you categorize the pain? You know, rate the pain level and if you, if you're having a good day or if you're having a bad day, your answers can be markedly different than you know, what you were experiencing a few days ago or a few weeks ago. So keeping a journal and just keeping tabs of, you know, all of those who, what, where, when, why questions about your pain or about your symptoms that you're having can be very helpful to us so that you can refer to them. And the other thing is people get flustered whenever, you know, they're in front of a, a doctor or an attorney<laugh> and they may forget, you know, about important things and just having some notes there helps to make sure you get all your question answered so that you don't leave office. Oh, I shoulda should, we're always happy to bring you back, just saves you a trip back to the office.

Nationwide ERISA Attorney Nancy L. Cavey: 16:12

So with my clients and I really harp on symptoms and functionality and I really want them to give a good interval history because people are reading that, that your, your chart. Other than keeping that kind of diary log, do you have any suggestions for a patient's how they give you a really good interval history that's meaningful, not only for you as a physician so you understand what's going on and what your treatment recommendations might be, but for the documentation purposes that they need?

Dr. David Braun: 16:40

Certainly. So anytime we add a treatment, it's important to continue with that log or that journal so that you can say, okay, I was experiencing these symptoms up until the point where I saw Dr. Braun, he prescribed ibuprofen and I started taking that regularly and from this date I had this amount of reduction in pain or I had no change in my pain level. You know, documenting things like that are very helpful both for me and I imagine for you.

Nationwide ERISA Attorney Nancy L. Cavey: 17:08

Absolutely. What's the best way, most efficient way for a, a patient to communicate with your staff because you're a busy surgeon? Sure. And you know, sometimes as you've said, people get intimidated by, by our occupations and we know that we're all busy. So what's the best way for them to communicate effectively with your staff?

Dr. David Braun: 17:28

So obviously the the best way is, is in person, uh, during your office visit, but you know, questions will arise and, and new information will come up. Phone calls are certainly the, the best thing, just so that we can have a back and forth and we can make sure we're asking the right questions and getting all of the appropriate information. Uh, we also have email and at our practice we have a patient portal where patients can log into their portal and send direct messages to their provider.

Nationwide ERISA Attorney Nancy L. Cavey: 17:55

What do people know should know about you and your practice and your philosophy?

Dr. David Braun: 18:03

The number one thing in our entire practice, and that goes for all four of our surgeons at Bayer Orthopedic Specialists, is we treat every patient as if they were a family member. We're not a practice that is gonna push surgery or push any kind of treatment that is unnecessary. We, you know, try conservative treatments first. We keep the patient's financial positioning. We, we keep that in mind whenever we were making recommendations and you know, certainly things that are costly but are unlikely to be successful, we would steer them away from and try to get them into the best plan for their particular issue.

Nationwide ERISA Attorney Nancy L. Cavey: 18:42

So obviously you're interested, uh, as a physician in their insurance and you try to work around their insurance issues and find adjuncts informs treatment that you office provide is,

Dr. David Braun: 18:54

And we, we do cash pay rates at, at our practice and our cash rates are very competitive. So much that we get patients from, you know, the surrounding five counties that seek us out just for, for our rates. But certainly, you know, different insurances have different coverages and there's outof pocket expenses for things and we, we try to take that, uh, into consideration whenever we make our recommendation.

Nationwide ERISA Attorney Nancy L. Cavey: 19:20

So what do you think of the Eagles<laugh>?

Dr. David Braun: 19:23

It's an unfortunate, uh, result for the Eagles, but they had a tremendous season.

Nationwide ERISA Attorney Nancy L. Cavey: 19:28

Go eagles. Thank you Doctor.

Dr. David Braun: 19:31

You're very welcome.

Nationwide ERISA Attorney Nancy L. Cavey: 19:32

Thank you.

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Nationwide ERISA Attorney Nancy L. Cavey: 20:09

At the end of the day, this is all about getting your disability benefits and keeping your disability benefits. Discipline carriers are gonna play games, they're gonna question the diagnosis, they're gonna question, uh, your response to the treatment. They may even question the nature of the treatment. They may question your activity of daily living compared to what it is you are doing on social media or what you're putting on your activity of daily living forms. The relationship that you have with your physician and in documenting this in your medical records is crucial to not only getting and keeping your disability benefits. I hope you enjoy this interview with Dr. Braun and if you have any questions, don't forget to give us a call.