I’m A Lot Like A Mole…Fortunately to Help You on a Legal Case!

Reading Time: 5 minutes

Okay, so I do something I’m not so sure many other people chose to do and it’s clearly an inherited trait.  Dad did it too. Okay, it’s…it’s…I’ll just come out and tell you. I use bar soap and I use the soap until it is totally gone. And I mean totally! 

I don’t waste soap

Like dad, I also save and reuse paper napkins if possible (but prefer cloth!) and keep paper towels (ditto) the same way he did, until they’ve been totally used up! He’d toss, recycle or burn what he had to.

Waste Not, Want Not

(Learned the saying from dad) and ya, it’s a proverb: if you use a commodity or resource carefully and without extravagance, you will never be in need, or, if one is not wasteful then one will not be needy. You get the point, and so did I back then and I still do today.

Dad would also say things like “It’s your nickel” back when the home phone rang in the 70’s with the cost increase to “It’s your dime” in the early 80’s! Which really both made no sense at the time. But the point is: my dad was cost conscious (boy oh boy am I too)! Dad was not wasteful and I greatly appreciate inheriting certain traits from him.

I miss you so much dad! I know you are a part of me that I will have forever.  Here’s a picture recently uncovered. It’s of my dad Dick and his baby Amy! I have no idea where we are and why I’m wearing silly glasses! Pretty cute though, huh! My dad, always a good looking man!

I still look like this!

I am also quite cognizant of what I throw away. I don’t want to be wasteful and I don’t want to worsen any landfill with un-recyclable garbage (read: plastic packaging). I know plastic has many very practical and very useful purposes. But when it is used once and thrown away…that bothers me. Especially when I’m at a conference in a “green/sustainable building” and they serve all food items on single use disposal yet non-compostable products.

I recycle everything possible (and feasible considering time and other factors) and started composting (thank you to my sister Julie who gave me her used Earth Machine)! To me, the smell of good natural composition of kitchen and yard waste is incredible and to think of how it was made by helpful microbes, worms and other organisms!

When mixed with your soil, compost will revitalize it, make it healthier and more productive, and increase moisture retention! Can’t go wrong there, huh!? So, I use compost and spread it out in my yard and garden. I don’t use chemicals and pick weeds by hand!,  plus I’m into the No Mow method of lawn maintenance (although Randy isn’t).

Viola! Beautiful lawn and it smells so fresh!

However, and much to my chagrin…we got moles. They must really like their meals found in our front and our back yard. The good can seem not so good when now my lawn is disfigured with raised soft ridges and scattered holes. So, this is all natural and meant to be, right??!

Have you ever seen a mole close up?

A mole is really interesting looking, lives underground and is nearly blind. There’s been a couple deaths ~ a baby and an adult mole ~ with corpses delivered by most likely my cat Alaska in the driveway and later buried by my animal loving  husband Randy. Yes, I made him dig a hole and bury. 

I read that although a mole can detect light it does not hunt using its eyes. Instead, it relies on smell (hence the interesting snout!) and on touching wriggling prey (hence those crazy nails) using sensory hairs on its face. So a mole is good for underground life.  Based on my research : )  A mole is also territorial, strong, a hard working solitude industrious digger, and a natural engineer (just like my brother Michael).

So to safely say, I’m a lot like a mole. Yes I need to get new prescription glasses, there’s nothing wrong with my sense of smell, my nails are natural, and I have a somewhat fuzzy face according to my husband. There may be other similarities, but I’ll let you make them on your own!

I’ve talked to people, including my sister Julie, who have attempted to wage all-out war on moles without success. What I’m realizing is that molehills are signs that the soil is in good shape.

And I can celebrate that fact!

But there is lingering doubt and some anguish over the mighty, mysterious and resilient mole. And I’ve concluded a mole deserves respect, and as often as I can offer it, tolerance.

I see value and purpose in everything that surrounds me.

That’s because I’m a natural rehabber!

So, with this post, I ask you, My Attorney Reader, if you could use help in helping your client through the difficult maze of their claim, please let me help.

I won’t come to court looking like a mole, but I will show up acting like an industrious mole:  ready to dig in, make use of forensic skills, realize the work won’t be easy, and never stop aerating!

I’m here to help you help your client. And, I love to help out using my forensic rehabilitation services! Thanks for reading my post. If you would, please read it again, and consider what I wrote from a metaphorical perspective. The point is the goal of my work is to discover new ways to highlight facts of your case.  Thanks for reading again!

Give me a call at 515-778-0634 or email me at amyebotkin@lcpresourcesplus.com to discuss your case.

___________________

My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

How Much Does Wisdom Teeth Removal Cost? How About Shoulder Surgery? Need Cost of Care During Litigation?

Reading Time: 6 minutes

The first part of this blog is about an experience many of us endured in our early-to-mid 20s: have your wisdom teeth removed! If you’ve been through this type of medical procedure, it is something you do not forget. I remember sitting in “the chair” having mine being removed way back when I was young!

wisdom teeth | The Daily Trip

In May of 2019, I took my Arin to have her wisdom teeth removed. I also remember taking my son Nick to get his out too awhile back. I can’t remember the date, but I’m sure he does. I do remember how he reacted to the “laughing gas” it was hilarious!  Jake, are you next? I promise I’ll be there for you, too!

Some quick research found that scholars say (I  personally don’t know who these scholars are), we have wisdom teeth as the evolutionary answer to eating raw meats, vegetables, and roots. (Well now, I did eat meat back then!) These third set of molars grow in some people between the ages of seventeen and twenty-five, or the wisdom years. 

Checkbox Pt. 2 "Check Wisdom" — River Fellowship

Did you feel you had wisdom between the ages of 17 and 25?

I don’t believe during those years in my life I was wise!  In fact, I’m hoping that to this day, every day I become a little closer to being considered wise. Here are ways for me to practice: put things in perspective, balance my world, keep my power, and think before I speak! Like Mr. Rodgers (AKA Tom Hanks) reminds us to always use the acronym: 

WAIT: Why am I talking?

However, when teeth aren’t being to kind to their neighbor, and the time to go has come, they need to be pulled out! So, what will this procedure cost and what will rehabilitation look like? 

Related image

From a quick review of costs found online, a simple removal can cost $75–$200 per tooth. Sometimes the teeth are impacted and cannot break into the jaw through the mouth. If impacted, removal can cost $225–$600 per tooth. So the cost range here is (x 4 teeth) $900 – $2,400

Luckily, none of AJ’s were impacted! She was quite pleased the clinical staff saved her pulled out teethers as a gift she could bring home, display, and brag about!   Image result for teeth as gift cartoon

I found out some surgeons will offer a discount for removing all four teeth at once, which can save $1,000 or more on the average cost of wisdom tooth removal surgery.  Now, can you see where and why the costs can vary?

There are a few additional costs associated with wisdom tooth removal, including the initial consultation, which for Arin’s procedure cost $100, and prescription medication for pain, and a special mouthwash for pre-and post procedure care, total cost ~$10, I was surprised in our Rx plan 20 Hydrocodone pills cost less than $2 (specifically the cost was $1.82.)

Out of pocket costs are different alright

Keep in mind when I’m costing out care or prescriptions, I’ve been trained to rely upon what a person would pay out of pocket (which means no health plan insurance, no collateral resources such as Medicare/Medicaid, nope, not even VA benefits). However, I can refer to these resources if it makes sense to do so.

My daughter agrees, and I somewhat recall from way back when I underwent the procedure in my early 20s, the recovery process is “a lot worse” than the actual procedure. Your face will enjoy lots of ice compresses. Rehabilitation involves time and follows basic self care, including how to de-stress your body when it’s trying to heal itself

Image result for self care cartoon

Coloring does relieve stress!

Thankfully, we have a good dental plan through my husband’s employer (and Arin is still on it); and just as importantly, she is really good with making and saving money.  Using her debit card the morning we arrived for the procedure, she paid the $750 that insurance didn’t cover. A few weeks after, the explanation of benefits from Delta Dental arrived in our mail box; and I noted the total for the procedure:  $2,015.  

One reason I’m costing wisdom teeth removal in this post is to let you  know I like doing it (costing out care and writing about it!). I can help you help your client who does not need a full blown life care plan. Perhaps, a  specific cost of care report would serve beneficially during litigation.

Need costs of care during litigation?

Here’s a little bit about a recent case I was involved in:  I was hired by an attorney to help him help his client. His client was a dentist (an oral surgeon) who had (because I’m not a doctor, I’ll describe the diagnosis in lay terms) ended up with: one bad shoulder. To not go into any detail, it was a lawsuit because the bad shoulder was caused by getting broad-sided at an intersection while driving in traffic. 

Shoulder Cartoon Clipart | Clipart Panda - Free Clipart Images

Keep in mind, I was not asked to help this case vocationally because the bad shoulder didn’t impact the dentist’s vocational earnings. (Think about it: dentists need strength in both their arms to perform their job duties.)  His income was not negatively affected because several months prior to the traffic incident, he had stopped performing surgical procedures.

To explain, he was referring out or having another dentist in his practice perform surgical procedures. This dentist was more or less a clinic administrator and he was making very good money.

I was asked to help on this case and to find costs of a shoulder surgery and any associated future care. This information was needed for litigation purposes.

Image result for costs of health care testing cartoon

Cost of care adds up quickly!

During my initial research, I found out that leading up to a shoulder replacement procedure involves several steps and communication to determine if the person would be a good candidate for an outpatient program, considering the person goes home the same day.

The treating doctor prospected the dentist would require a left shoulder reverse total replacement surgery (within 10 years) and more than likely it would be outpatient.  Here’s where I came in, to cost out what this surgery and the rehabilitation. I’m not going to give you all I found because I was paid to do that work. I will give you a you a bit of my report and what I found, for free here on my blog!

There is a pre-assessment teaching appointment with a joint coordinator included in the $18,000 outpatient procedure cost. A simple online health admit walks the patient through their medical history (for anesthesia purposes).

The pre-operative physical exam is usually with the PCP and could include a standard physical with a CBC, BMP  and EKG. X-rays at pre-op and post-op may not be necessary, and an MRI may or may not be. 

All testing and recommendation depends on the patient’s needs, and is dictated by the surgeon. Followup would likely involve physical therapy and home-based exercises. 

What did I do next after gathering this information? Did I cost it all out!? Yes, you are correct! And I also included research on the surgical procedure and expected rehabilitation goals.

Want more examples of cases? Let me know!  Want my help in helping your client with a case involving work and disability? Again, let me know!

Contact me at 515-778-0634 to discuss your case. I’d love to help you help your client. That’s what my job is all about! Thank you for reading.                 amyebotkin@lcpresourcesplus.com

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

 

 

 

 

 

 

 

Here’s a Dum-Dum Post! Want an Expert too?

Reading Time: 4 minutes

In February 2020, at the beginning of the awareness of Covid-19, I attended a large conference with well over 200 people in attendance. During lunch, I sat at a table next to an intelligent man and we had a conversation about our jobs and serving as an expert “in the field”. His field is neuropsychology and mine is forensic rehabilitation.

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Both interesting jobs involving brainwork, don’t you agree?

During our conversation, I explained how I want my courtroom testimony to be communicated to the jury in plain language so it is understand the first time they hear it.

The audience I’m communicating with is in no way, shape or form dum-dum, they simply don’t have “forensic expertise”. They do have good listening skills! I deliver my opinion using a matter of fact strategy that makes sense. This is rather easy for me, because I am a simple, basic person who has studied the case indepth.

I’m no dum-dum either

We continued to discuss how some experts use complicated language in court. It seems that expert wants the jury to believe the expert has incredible intelligence and cryptic knowledge of a complicated subject matter. I see this as a misguided attempt to manipulate the audience about how to view the facts. And I’m pretty sure each juror can see through the muck too! My lunch mate seemed to know the type of expert I was referring to. 

Perry Mason designs, themes, templates and downloadable graphic ...

I love it when Perry Mason eviscerates a pompous, stuffy “expert” on the witness stand!

My belief is that jurors deserve to hear the facts in a truthful, clear and simple manner. Yes, my lunch mate agreed. He summed it up by saying “jurors know the difference between corn and soybeans.” In other words, give us the facts and let us decide which is which because that’s our job in this case.

For fun, I did a little research on Dum Dums

The spherical lollipops originated from Akron Candy Company in Bellevue, Ohio, in 1924. The sales manager of the company, named them, thinking “Dum Dums” was a phrase any child could say.

Initially, there were 7 flavors: lemon, lime, orange, coconut-pineapple, cherry, grape, and butterscotch. Dum Dums are now made in 16 flavors, with new flavors rotating into the mix every so often.

Ewzzy — Once in generation a Mystery Flavor Dum Dum will...The “Mystery Flavor”

The “Mystery Flavor” is the result of the end of one batch mixing with the next batch, rather than stopping production to clean machines in between flavors.  Source:  https://en.wikipedia.org/wiki/Dum_Dums_(lollipop)

You can tell this decision saved time, and allowed the company to be creative with their product which likely increased interest and ultimately sales! Talk about not being a dum-dum!

Also, just FYI; if you have any Dum-Dums wrappers left, send them in ASAP because (after nearly 70 years), Dum Dums lollipops will be ending its program to exchange wrappers for toys and prizes. The company’s mail in program, which began in 1953, will come to an end on May 31, 2020!  (Sorry, that was yesterday, missed the timeline, but you could try!)

No more regulation-size rubber baseball and metal wastebasket that could be acquired for 15 cents and 15 wrappers…the “Dum Dums Wastebasket Deal”. I’m sure you’ve seen, or even had one similar, to play basketball in your office space.

Dum Dums Garden

Any legal decision is all about: what can be done to answer questions, solve problems, use time wisely, and make or save $$$ in a lawsuit. Because I work on the plaintiff or the defense side, my forensic work helps in any court case. Contact me and we can discuss your case. I’m here to help attorneys help their clients.
 
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If you want a dum dum, I’ll be happy to provide one on a stick (watermelon flavor is tasty!) If you want an expert, I’ll be happy to send you information on retaining me as an expert.
 
Thank you for reading my dum dum post!  Here’s another post titled Don’t be a Dumb Bunny! In this post, I write about using your soft skills…another valuable skill to use in a court room!
 
 

Vocational Resources Plus, LLC * 515-778-0634  * amyebotkin@lcpresourcesplus.com

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

Like Mother, Like Daughter, One Tough Cookie! Want One in the Courtroom?

Reading Time: 6 minutes

Thursday, May 28th, is my daughter’s 24th birthday. I am proud of her in every way (currently she’s into gardening)! She’s physically and emotionally strong, independent, and One Tough Cookie!  Off the top of my head, here’s a few memories of my daughter and her “toughness” over the years. 

One Tough Cookie!

Before she was born, let alone named, her birth cord was wrapped around her neck while she was being delivered. As I was pushing down as one is to do during natural child birth, the doctor told me to STOP!

What? Stop? So I did and, (not knowing what was going on) he very quickly cut the cord from around her neck, and blood shot above me onto the ceiling. Nice, huh, and yuck! My new baby girl scared her parents alright! She was just fine though and had a good APGAR. Rather quickly, the housekeeper came in the room and cleaned the blood off the ceiling with a mop as I was still lying in the bed. Yuck again! She was doing her job and it was much appreciated!

Pin on blouse mtrl

Arin was a calm baby!

I remember the first day of her life, Arin seemed to care more about how the nurses felt when holding her than actually being the new baby in the room. And her eyes were (and still are) so huge, she kinda looked like an alien with eyes on both sides of her head! 

Later in her babyhood, heck, I cut her toenails too short and they bled. I felt horrible, and this was my 3rd child, but she didn’t cry.

Around age 3,  Arin fell from a chair at the babysitter’s kitchen table while she was eating lunch. Upon facial impact with the floor, her  front tooth was knocked out, and said tooth landed down in the heater vent, where it potentially could have trace elements today.  She was whisked to the ER by her sitter, but there isn’t much one could do for this injury, other than wait! 

Baby With One Tooth ClipartIt took years for her new tooth to come in.

Last year around this time, she had four wisdom teeth removed. She was tough with that surgery and the healing time involved…and her poor face was so swollen. This link takes you to a blog for a bit on costs of the procedure!

When she was a little older, around 8ish, we were working in the basement and somehow the iron got knocked off its board and landed on her foot. Her big toe sure bled a lot and a deep bruise definitely developed and stuck around. Luckily the toe wasn’t broken and the iron wasn’t hot! Yikes!

Here’s another story of my dauther’s toughness: As were in the process of remodeling our house (in 2009), Arin would’ve been age 13, she was cleaning our new windows (with water and an ecloth!) and the larger kitchen window suddenly fell down (the type of windows that fold into your house), whacking her head.  Her head broke the glass, and the glass shattered on to the floor. Arin immediately felt a headache, but there was no blood involved and we didn’t take her to the doctor, but I certainly cared for her closely and watched like a hawk for any concussive symptoms! I informed the salesperson who sold us the windows of this mishap, and he showered her with gifts. He was probably pretty darn grateful that we didn’t, gasp: sue! But no we did not, and her strong head was fine. 

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Moving on into her middle school years, from what I was told by said daughter, she went snow shoeing on recess. Somehow her tongue landed on a metal pole, got stuck and she had to pull away from the pole. Yep, her tongue ripped and yep it bled and yep it hurt like he double toothpicks. 

She said this was a dare; the sticking her tongue out purposely onto a cold pole in the middle of winter. But in reality, I believe she fell into the pole because she wasn’t very good at snow shoeing. Again, nothing really you can do for this injury but give the tongue time to heal!Image result for tongue pierced cartoonA while later she got her tongue pierced anyway! She also pierced her septum; eyebrow too. Don’t forget thee belly button piercing! (I actually did that once, but let it grow back because it bothered me when I did a yoga pose or exercised on my stomach).

And speaking of, both her ears have pretty good sized gauge holes! I’m not including the numerous tattoos Arin has received.  To me, getting a tat seems a little too drawn out painful.

ColorColorful AJ

Colorful AJ

One last story off the top of my head at this time, and I’m not happy at all with how this happened. In early March 2019, Arin was at a birthday party held at a hotel for her friend Taylor. Arin was picked up and thrown (grrrr) into the pool. Kassidy, who she landed on, hurt not only her head, but bit down and injured her tongue; and Arin ended up breaking two ribs.

Image result for xray ribs cartoonHowever, Arin didn’t find out her ribs were broken until almost a week later when she was in much pain and having problems at work. On a Sunday she had to be taken to the ER which included x-rays and a pain prescription.  Again, this involved a long rehabilitation / healing period.

Okay, enough writing for now. Like mother, like daughter!  Yep, considering I was able to live through hitting a train headfirst!  I believe this “toughness” is heredity, and comes from my mom.

Last year (2019), my mom was experiencing an acute medical condition while visiting us from her home in Florida. As we were waiting at the airport for her and her new husband’s flight home departure, she took a dive (right in front of the drinking fountains by the rest rooms on the main level) on to her face, breaking her glasses. She ended up in the ER for numerous stitches rather than on the flight home. Mom didn’t cry or wince, or even complain a bit.

The bottom line of this post is to let you, my Attorney Reader, know that I am a strong “tough-minded” resilient person who has the capacity to face difficult facts and long odds with resolute optimism.

I define a tough-mind as having the resources, mental skills, and physical capabilities to confront difficulties of all kinds. And then afterwards, the resiliency to slow down and relax.

I know if I succeed, I caused it and if I failed, yep, I caused that too. (Don’t worry, I won’t say yep during testimony.) I will be tough for you and I will be tough for your client.

I won’t be so tough you may choke, but I will be tough enough with your case where it counts: in my reports and in the courtroom and in my resolve to never give up. I got this strong “tough minded” trait from my mom and have passed it on to my daughter and I am proud of it!

Thank you for reading my post. Let me know about a case I can help you with that involves disability and rehabilitation. I believe rehabilitation is the care that can help an individual get back, keep, or improve abilities needed for daily life. I’m a rehabilitation counselor who cares.

Contact me, Amy Botkin at 515-778-0634 or amyebotkin@lcpresourcesplus.com 

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Rights of the Expert Witness ~ I’ll Take a Veggie Slice, Please

Reading Time: 3 minutes

Rights of the Expert Witness

expert

I continually assess and evaluate (there I go again!) my rights, values, professionalism, and of course ethics (which I really enjoy!?!) and am hopeful to write more on these topics and my career in the field of forensic rehabilitation consulting.

As far as rights, I found this great listing online (website is referred to below), and yes I added the graphics! I agree with the following essential considerations for taking on the role of expert witness:

  1. I have the right to be paid for my work.  Dream of Getting Paid
  2. I have the right to be prepped in advance of my testimony.
  3. I have the right to ask questions about the case.
  4. I have the right to work for either side, without fear of retribution.
  5. I have the right to change my opinion from previous testimony, as long as my opinion is evolving (based on new information, science and/or experience) rather than revolving (based on which side I’m working for). 
  6. I have the right to say “I don’t know”, if in fact, I don’t know. Just because I’m the expert doesn’t mean I have all the answers. I am clearly okay to say “I’m sorry, that’s outside my scope of practice”.
  7. I have the right to solicit objective feedback about my testimony from  the attorney who has called (and of course, they have the right to  decline to give it).
  8. I have the right to set limits with counsel about the scope of my testimony. 
  9. I have the right to disagree with another expert’s practices or  conclusions, even when I perceive that expert to be: a.) more educated;  b.) more famous; or c.) more experienced. 
  10. I have the right to disregard the initial instinct to view opposing counsel’s expert as the enemy, but instead recognize everyone’s role in the process and share pizza and a bottle of wine with that expert after trial is over.

Pizza

 Truly, it’s all good work!

I am glad my career continually evolves! I accept responsibility when providing forensic services to be clear, truthful and comprehensive in my evaluation and report products, and in my role as an expert witness. Thank you for reading!

Please contact me Amy Botkin for more information ~ 515-778-0634 or amyebotkin@lcpresourcesplus.com

I’ll take a veggie slice and a glass of Chardonnay please. You?

Source for Rights: http://www.forensichealth.com/2011/07/13/10-things-the-fho-expert-witness-bill-of-rights/

___________________

 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Conflicting Medical Opinions? Handle With Care!

Reading Time: 8 minutes

Upon referral of a vocational case, I review a variety of  medical data (for example: treating physician reports, Functional Capacity Evaluations, Independent Medical Evaluations) and/or psychological data (for example: psychometric testing, psychological evaluations, psychiatric evaluations) found within the file.

During a workers’ compensation litigated claim, or on any claim that involves work and disability, it’s important for me to understand the individual’s medical situation based on the data contained in these records.

Related image

Good thing I’ve had medical records training and enjoy the review!

If a file contains more than one FCE and/or IME, I can expect the reports to have conflicting opinions. For example, one physical therapist will recommend the claimant has the physical capacity for light work, while the other physical therapist says medium work. Often the therapists also have conflicting information about the individual’s maximal (or lack of) effort put forth during the evaluation.I Did My Best

The claimant needs to honestly and sincerely say “I Did My Best!”

Assisting the individual (who can be referred to as the injured worker, the claimant, the patient, the testee, the evaluee, and potentially the client)  in returning to work following an injury is a central role in my specialty of placement. This involves finding the best occupational match within the individual’s own labor market. A person’s “doctor imposed restrictions based on an FCE” should not direct the provision of placement services. A person’s knowledge, skills, interests and abilities should!

Image result for opinionWith conflicting opinions from professionals, what data should I rely upon to perform a beneficial service?

To resolve discrepancies I first ask myself, why is an FCE being used for this specific claim? The utility of this type of scientifically based evaluation, the training sources, performance methods, test protocols and standards to measure them are numerous.

Conflicting options are influenced by components of context and can be derived from subjective views. 

Professionals may have opposing views for their own reasons but I must be able to articulate their reports into vocationally-relevant terminology and tell a story about meaningful and gainful work. And it can be challenging to do this if I don’t understand the conclusion of the FCE report to begin with!

WORK

I love reading medical data rich in detail about a person’s world of functioning!  And I love writing reports rich with detail about a person’s world of work! 

A functional capacity evaluation is actually a term with various definitions, purposes and constructs. The purpose is to  evaluate an individual’s capacity to perform work activities related to his or her participation in employment. It seems that in essence, by having a functional capacity evaluation a person is likely to be put in an unfortunate position of deciding whether he or she is willing to return to work. 

If willing, there’s a way. If not, there’s no way.

From what I know, there are approximately 10 different types of commonly used functional capacity evaluations. Here in Iowa, I am most familiar with FCEs with names like the Isernhagen Work System, the Blankenship, Matheson, WorkWell and X-RTS. The reliability or validity of any system is somewhat irrelevant to me because the testing is already entered into “evidence”. What is relevant to me is whether or not I comprehend the results and recommendations contained within the evaluation. Sometimes I can, sometimes I cannot. I always use a “Does This Make Sense to Me? test!

Image result for conflictingIt’s up to the dualing physical therapists to make their best points during litigation, I’m not in that ring!

I feel fortunate of connections with several physical therapists allowing insight into their clinical practice. I attend continuing education programs, and recall one that helped me understand various approaches to FCE’s specifically the X-RTS Lever Arm.

Thinking Cap

The X-RTS Lever Arm passes my make sense test!

So within the context of my vocational consulting work while cautiously putting any judgment aside (which seems hard when I know I know certain things), I analyze and compare each FCE while considering the testing results.

I note whether the FCE report is readable and user friendly. I assess if I understand terminology and methods used, how long testing was administered, what actually was administered, the claimant’s behavior during the test, and how the evaluator came to his or her conclusions about the results. Does the conclusion make sense?

Are there concrete and realistic recommendations regarding strengths and weaknesses in relation to performing physical demand levels of various work situations? In other words, are there recommendations regarding real jobs found within the person’s labor market? Do the recommendations make sense?

I definitely look for the goals and expectations for the evaluation, and whether maximum and consistent effort was made by the evaluee. Comments on the suitability of the testee’s future employment options along with the evaluator’s observations are valuable and should be included.

It’s important to note what body part/extremity the therapist focuses on in relation to what body part/extremity was injured. For example in one report, the therapist discussed lower extremity activities, when in fact it was an upper extremity injury. If the report cites examples or uses too many percentages, it’s important to understand how the therapist justifies examples. I’m familiar with a therapist who changes the percentages of the same examples from report to report. That doesn’t make sense to me.

No sense

I try really hard to make sense of most things and situations!  

If I am able to square an FCE in my mind after careful and prolonged study, is it possible the evaluee could do the same? That  would be  fortunate, especially if the therapist offers good recommendations that make sense!

How does the evaluee, when not truly the therapists’  patient when referred for an FCE by their own work comp attorney; with an additional FCE visit to a different physical therapist by the defense attorney  (that makes 2 different reports prepared by 2 different therapists) perceive discrepancies in the results? Sadly, in my eyes the FCE often gets “interpreted” through an attorney. The repeated pattern of thinking of one’s functional capacity as “poor” does not help anyone return to work.

If there is an IME (Independent Medical Exam), it may seem more geared towards one of the FCEs. Regardless, I try to comprehend all reports, noting the one I understand the most. I’m not so sure that an IME is really a “fresh set of eyes” in the workers’ compensation cases I’ve worked on. This topic is another blog in itself.

Putting both, or multiple opinions in a vocational report and making use of other documentation to support my ultimate and final opinion is a great idea, however I have to be cautious to not put myself in a role that isn’t mine (which is making a medical opinion which I can’t do).

If I am able to provide a doctor (ideally the most recent treating occupational health or rehabilitation doctor) detailed information directly related to a specific occupation or line of work and any resources that could help the doctor understand how such work is performed in a smart, safe and effective manner, many benefits arise.

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Clean your lenses!

There’s a clearer understanding of the vocational rehabilitation process and with agreement from all involved, there’s a higher likelihood one could see a successful common outcome (return to work). This certainly helps solidify my vocational opinion and make reasonable recommendations. Yet, this type of opportunity is not frequently available (it is for me to though through processing a life care plan!). Please know I always search for a way to best express my vocational opinion.

In my reports, I document what medical records I’ve reviewed and then use the actual words from the individual during an interview (or deposition review) describing how s/he details their physical impairment.  Often I hear verbatim what one doctor wrote in their restrictions. The evaluee will respond to my open questioning about any physical limitations (sometimes after the evaluee refers to his/her doctor’s letter) and read or have it memorized saying: “no lifting over 20 pounds, avoid twisting, bending, stooping, sit and stand as needed.”  No sense

What do those words really mean in real life? The individual doesn’t seem to know either. Ask an employer if they have a job that involves no lifting over 20 pounds, no twisting, no bending, no stooping, no this, no that…and that’s not talking their language!

The evaluee who responds to me in this fashion (using verbatim restrictive words) needs future vocational counseling. Vocational counseling (which may or may not be provided depending on the nature of the litigation) helps to gain a clearer understanding of how the person’s medical situation has changed their daily living (especially in the context of their own world of work). This understanding leads to the ability to articulate the individual’s capacity for success to others (family, friends, job interviewers, etc.).

Please keep in mind, the term “restriction” is not conducive to a successful job search. The ability to explain who you are and what you can do from a functional perspective to help a business make or save money is what is conducive to a successful job search. Restrictions should never be the focus of job placement. Skills are!

Rehabilitation counseling is especially important if the individual is searching for a job, requiring job seeking skills training on how to or (how not to) disclose disability or any functional limitation. The personal attributes gained from training helps the placement process move forward with common goals avoiding getting stuck within a few words that don’t apply to working reality.

WORKWhile staying true to my convictions and firm beliefs that a person can work if the person wants to work and has the capacity to work, I need to understand the dichotomy between science and clinical practice is more imagined than real.

If healthcare professionals submit conflicting reports on the same individual, I need to be able to resolve inconsistencies to better understand and appreciate the opinions offered. It is not my role to determine which opinion is correct. It is my role to utilize available information, provide a beneficial service, and make a sound vocational opinion regarding the individual’s strengths and weakness in relation to work capacity and employability.

Matching People With Their World of WorkIt’s rewarding when I can clarify a person’s sense of their own world of work.

I strive to extend the value of FCEs in the litigation process. I am trained not only in understanding a client’s functional abilities at work, but at home and at leisure.  Together, my knowledge with those of other experts, contributes to decisions about the economic losses, or damages, for which the person receives compensation.

Thank you for reading this long post! I’m here to help attorneys like you help your client. Contact me at amyebotkin@lcpresourcesplus.com  and let me get to work for you!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

It Happens, Things Go Wrong. Need Help with a MedMal case?

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[Original post date: March 29, 2018] Time for a health update blog, a personal one, difficult to write with a mix of questions and a couple stories about medical practice and procedures. The point is my attorney reader, I want you to think about me as a forensic rehabilitation consultant, and how I can help you help your client who is involved in a medical malpractice lawsuit!

Randy’s heart took a detour late last summer, 2017 when the ticker was running really fast.  Randy doesn’t participate in races (I’m the competitive one!), but his heart sure was! He does however donate blood on a regular basis. In fact, he was donating early on a Saturday morning (he’s donated 14 gallons according to the sticker on our front door!) when the nurse at the blood center told Randy she thought his pulse was “strange.” His precious blood was still drawn (double reds)!  

Randy is a popular Type A- donor.  

Questioning here ??? Should the nurse have continued with the blood draw knowing the pulse was “strange?” Well, she did! Luckily, no harm done. When Randy got home (rode his bike at what speed I don’t know! to/from his blood donation date which is common cuz he’s an avid biker!), I took his pulse and in fact, it truly was “not right”.

A couple days later, he had a doctor appointment (I scheduled it out of wifely concern); and sure enough, we got tachycardia…going 144 bpm. This means a cardiologist is needed. BTW, thank you to the nurse at the blood center for catching this.

Following an array of testing, diagnostic procedures, and preparations, he received an ablation early November 2017. Thank God it worked! Randy’s back down to a regular beating heart and a normal pulse (his BP was never a concern.)

His cardiologist did an excellent job and Randy was back riding his bike in a short period of time. He wasn’t happy to be told not to ride! In fact, I know he disobeyed his doctor’s orders one day.

We expect our doctor to always be right. We expect our nurse to always be right. We expect all our health care providers to always be right. We in fact, expect our bodies’ to become “right” whenever we receive treatment in the medical field.

But things can go wrong and a patient can become injured during the course of treatment. That’s why we have attorneys to help, right!?! And yes of course we expect our attorney to always be right, too!

“Dr. NeverWrong”, the cardiologist who performed the ablation on my husband’s heart has this nickname! Charlie the RN, one of Randy’excellent nurses while hospitalized told me of this nickname and the fact that the cardiologist has a fan base (being only one of few docs in town we were told who performs ablations).  Because the doctor was humble, gracious, and ever so respectful, I’m sure he would not want to be called  Dr. NeverWrong! Can you guess who I’m referring to? What? Attorneys don’t guess! 

Okay, now on to me. Recently, I was involved in a medical situation which could be worthy of a claim. How do you help your clients decide whether to file a claim? If there’s been harm done? Here’s the abbreviated personal story. 

Image result for patient gown cartoonWhen preparing for a mammogram last October 2017 (sitting quietly in a heated gown!) and waiting for the machine set up, I informed the technician of an unusual skin issue I was experiencing thinking it was poison ivy. I’ve had my share of poison ivy issues, even a four day hospitalization for a severe case in the past (contacted through an outdoor camp fire.) Watch out when you burn wood, my reaction was horrible. Anyway, the technician dismissed my concern and we went ahead with the mammogram.

To not go into detail  uggh ; [   I ended up with a severe skin condition I believe was spread by the mammography machine.  Let it be known I truly love big machines, (especially cranes), yet this large machine is not one of my favorites following what I experienced.

I was absolutely miserable and the condition lasted too long. I ended up going to the ER once on a Sunday and urgent care twice during the weeks that followed. I made these visits because I couldn’t stand the physical and emotional toil…and my doctor’s office wasn’t open at the time of my needs!  Not until I went back to my personal MD to finally get the correct diagnosis and a prescription did I begin to feel a little better.  

Image result for skin cartoonBut the prescription did NOT help and in fact the condition worsened. I literally had to just wait this one out and deal over time with the largest organ in my system: the skin. I was so distraught I even sought mental health care. I’m okay now, thank you! Whew!

I didn’t file a claim, should’ve/could’ve I? The time, energy, money and definitely my mental health was compromised and consumed in a fashion that I certainly didn’t choose. The only time I have filed a legal claim was when my parents sued the railroad for their negligence leading to my car/train collision and subsequent injuries, hospitalization and rehabilitation (there’s much to this personal story).I think the key into what makes or doesn’t make a person seek a lawyer when they think they’ve been wronged has to do with respect (or lack of) by a medical provider. Of course, everyone makes mistakes. But negligence, followed by covering up issues and not telling the truth is where the wrongs and not the rights come in to play.  That’s not where I come in just yet, that’s where you, the attorney is on the field. I enter the game by sorting out what the plaintiff needs and the costs of those needs.

If you need a life care plan for a client who has filed a medical malpractice claim, please contact me.  Following a needs assessment and subsequent life care plan, my recommendations are grounded in rehabilitation. I’m not saying I’m always right myself.  But I will tell you I care and I will do what I can do to help you help your client.

Please don’t contact me if you will act more like the red devil lawyer on the left. Sorry, I’m not interested in helping. However, if you are a good attorney like the white angel on the right who truly cares about your clients, contact me! I’m here to help!

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

 

Patience, Persistence & Perseverance Dominate! Time for Spring!

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There’s not much growing in our back yard at this time, but crocus which tells me it’s about time! Spring begins a new time in life, with excitement for what will arise out of the soil!  In fact, time is the essence of all life and an honored resource.Crocus

Crocus, a perennial favorite!Crocus

I believe patience, persistence and perseverance are incredible qualities found in a person and in a beautiful flowering plant! All things produce when the time is right. Nothing can, could, will or should ever change this. It makes the most sense to follow Mother Nature’s lead and work with her rather than battle against her!

Back to my backyard where not much grows because of 2 main reasons, #1: our dog Bella the Aussie who loves the backyard and has many a good day carrying on in her canine best; and #2: the very large sugar maple tree with a huge trunk  covered in shaggy bark that supports many branches that tower into the sky!

Referred to as the Monster Tree!

Someday that part of the backyard will present itself in a better light! A professional limb trim helps, as does maintenance work and cleaning up in any home and yard (and business!) during seasonal changes throughout the year.   

I try not to grumble about picking up scattered mounds of dog poop and the thousands of sticks, branches and pieces of bark. Thank you oh monster tree for your beauty, shade and for housing the squirrels, birds and other wild things! 

A harbinger I love to note is my first Robin sighting of the year! 

It’s impossible for me to embrace progress without patience, persistence and perseverance. I’m encouraged to find purpose in almost everything I do and strive to keep on keeping on until it all makes senseImage result for crocus

Image result for crocus

I’m able to find comfort in what I’m doing now and can find that the powers-that-be will grace me with accomplishment in the future. What matters to me most is finding happiness and success in everyday life with even the most simple things! My mind is made up that way!

success If you’re going on a road trip this Spring, feel free to take this map along!

Success is found after driving safely through Patience, Hard Work & Perseverance. Hopefully you didn’t veer off Dreamer’s road and got lost; or end up in Pain because I hear it’s a bumpy trip!

Contact me to discuss how together we can help your client uncover the road that leads to a successful litigation outcome.  Keep in mind even detours can lead to places you may not have ever traveled. 

I hope you, my reader, will contact me if I can help you on a legal case involving work and disability. I completely understand each case requires patience, persistence and perseverance. 

May we all experience Patience, Persistence & Perseverance through this pandemic.  Stay healthy and thank you for reading!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

 

A Bouquet of Gerbera to Share, Along with My Vocational Assessment Services

Reading Time: 4 minutes

I’d like to share a beautiful bouquet of gerbera daisy with you, my Attorney Reader:
With these flowers, I remind myself of how valuable you are to me as my client and how I am specially equipped to serve you as your consultant. Thank you for taking some of your valuable time to look around my website. 

On this site, I share information about my work background, including the fact that when I first started my vocational consulting practice in September of 1999, I was working part-time at a flower shop (Doherty’s on 2nd Avenue) as the “flower processor”.

My job in the shop involved duties to clean up the backroom, the upstairs storage spaces, the walk in cooler, and any other area that needed it, along with the best part of my job, which was to process incoming freight. This involved (♥I loved it!♥), opening the boxes of flowers after I signed off for the delivery; and preparing the beauties for use by the floral designers. 

Image result for gerbera

My very favorite flower to process is the gerbera daisy!  They are great for adding color to any room or garden, with flowers that often measure 7 inches across!

Image result for gerbera flower

Why You Ask?

Do you want to ask me, so Amy, why is the gerbera daisy your favorite? My answer is: Because of the ease of cutting the stem! But the cut has to be just right for the bloom to last as long as possible! It’s not just about cutting the stem, it’s about thinking about the care involved in cutting the stem!

On-the-job, I was taught how to unwrap the shipment of assorted flowers that arrived, prepare a liquid solution, cut the stems and place them in the solution, then store them in the best place in the large walk-in cooler. When an order from a designer came through, it was again my job to bring the specific flowers out from the cooler and cut the stems perfectly before re-placement back in the cooler, marking the order, and just in time, as required for best results!

I used a really big stem chopper a lot. It looked like this: 

Image result for stem cutterWatch the fingies, Amy!  No, I never got injured!

I really enjoyed this part-time job because I was working with live beauty, and I was continuing to follow my passion. You see, growing up in the 70’s, I  was a member of a garden club. I excelled in flower arranging, even entering fair contests and winning ribbons!  Thank you Marie Hubbard, my neighbor mom, who was the club leader and one great teacher!  To this day I continue to enjoy arranging flowers!

Related imageWhere’d my show ribbons end up?

My job as as a flower arranger was short lived because my consulting business started getting busy and I could no longer take calls in the bathroom without feeling guilty. 

It was at this time in my life (by the way, the week before Valentine’s Day is very hectic at a flower shop…chop chop chop!), that I decided the only job I wanted to focus on was my own job as a consultant, which lead me to make a change for the better!  

In a nutshell, the decision was made to only have one boss from now on! And that’d be me. 

My plan for 2020 is to to continue to utilize my website for the purposes it was intended when I started it in the Spring of 2011, which is to write and share my talents!

Could your plan for 2020 include contacting me to help you help your client who is involved in litigation involving work?  You see I can also help you with a self employed client, because I understand what it takes to run a small business. 

If you need any sort of vocational assessment, I am definitely one of your choices and would like to be your preferred chosen choice!

Although not easy to prepare for because each one is unique, the assignments I accept are fulfilling and I appreciate the opportunity to help and to use my creative resources.  You’ll find I truly care about my work.

To discuss your case and how I can help, give me a call 515-282-7753 or email amyebotkin@lcpresourcesplus.com   Thank you for reading and maybe you could take some time today to stop by your nearest flower shop and splurge!!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

Time to Get Level During the Divorce Process With an Earning Capacity Evaluation!

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As an Attorney, do you work with divorcing couples? If so, have you utilized vocational expertise to help level out the uncharted territory for your client? 

Postit marriage

My company, Vocational Resources Plus LLC, offers vocational consulting services, and specifically, an earning capacity evaluation will benefit parties in a divorce in many ways.

Whether employed, unemployed or underemployed, an earning capacity evaluation offers valuable information regarding a person’s working world. 

If you need a clear, objective picture of a divorcing husband’s or a divorcing wife’s earning potential, and not just what he or she is currently earning during the divorce process, but how their vocational background could unfold with options and corresponding wage information, let me help!

As a vocational expert, I know what skills are in demand in today’s employment market, and what income these skills can command in various careers.

Career pic

I report on the evidence and am always prepared to back it up through expert testimony!

An evaluation provides recommendations on the person’s functional capacity, personality, work skills and abilities, transferable skills, work values, aptitudes, interests, motivators,  work readiness and ideas for employment.

Any recommendation or opinion is backed up with supportive data that highlights the individual’s vocational presence.

Based on individual circumstances of employability, hireability and placeability (3 of my favorite ability descriptors!), other factors are assessed, for example, job seeking skills and job search records.

Most importantly, during a divorce your client’s personal story deserves to be heard, especially when discussing talents that include job skills and the career the person gravitates towards.  

Results of all assessments and analyses are explained accordingly in a clearly written report.

Tell Your Story | Anxiety Sufferers Canada - Physical Abuse

I can help tell your client’s vocational story realistically and persuasively.

In one case I’m aware of, the divorcing woman declined to hire her own expert (umm: me) and found herself at a serious disadvantage. The “opposing” vocational expert sure did a number on what he declared she would earn in today’s workforce in central Iowa, even though she hadn’t worked anywhere in 12 years (and when she had worked it was in a different country!)

There were inaccuracies, false statements and numerous errors in this expert’s report on a specific career (it was teacher). This made made me wonder if he (the opposing expert) had actually ever talked to a teacher about their job in real life! (Ahh, try being married to a teacher like me!)

The opposing expert did not make sense! In central Iowa, a teacher does not start out the first year earning a $50k salary (especially when the individual has an outdated bachelor degree from a non-accredited college, no teaching license, no certification(s), and no recent teaching experience)!  The person wouldn’t even qualify to interview!

Talk about needing a true earnings capacity!

Earnings $

Knowing your client’s earnings ability will directly impact the resolution of the economic aspects of the divorce case.

Even following divorce, my services can help an “ex” find appropriate work. With the results of interest and aptitude tests, along with professional guidance, the value of hiring a vocational consultant is enhanced should the cost of placement services be included in the alimony proceedings.

Contact me to discuss how I can help level the playing field so the divorce process moves in a fair and equitable manner. It makes sense to have a person’s earning capacity known early in the proceedings.

Know what you need to know about your client before a different report may try to say otherwise! Having valid and reliable information on earnings directly impacts the resolution of the economic aspects of any divorce.

Time to Get Level

Call me ~ Amy ~ at 515-778-0634. If I don’t answer, please leave a message! Or  email me at amyebotkin@lcpresourcesplus.com and I’ll get back to you.  Thank you for reading and I look forward to helping you help your client!

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.