Pain Gate Ddsc 018 5
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On February 28, 2003, the United States entered into a settlement agreement with F & K Management, Inc., d/b/a Hard Times Cafes and Santa Fe Cue Clubs, to resolve a complaint brought to the attention of the Division's National Origin Working Group (NOWG) by the Sikh Coalition, a national Sikh advocacy group. The Coalition reported that on September 23, 2001, a young Indian-American Sikh was told by a manager to remove his turban or leave at its Springfield, Virginia club. The Division's investigation revealed that F & K had promulgated and posted a policy in its clubs prohibiting head coverings with the exception of cowboy hats and baseball caps. Pursuant to the agreement, F & K rescinded its head covering policy and replaced it with a dress code approved by the United States, posted nondiscrimination signs at the five (5) establishments it owns and/or operates, agreed to place periodic nondiscrimination ads in the Washington Post and local and national Sikh and Muslim publications over a 3-year period, and arranged for periodic training of its owners and employees by Sikh and Islamic organizations over the three-year term of the agreement. In addition, F & K's owner wrote a formal letter of apology to the complainant and provided free dinner and pool playing privileges for use by him, his family and friends.
On June 28, 2000, the United States signed a settlement agreement with a real estate company settling our allegations that one of its former agents violated the Fair Housing Act on the basis of race by engaging in a pattern or practice of discrimination in the sale of a dwelling. The settlement agreement obligates the real estate company, First Boston Real Estate, to implement a non-discriminatory policy, which will be displayed in its offices and distributed to any persons who inquire about the availability of any properties, as well as to all agents. There are reporting requirements and the Metropolitan Fair Housing Council of Oklahoma City, Oklahoma will receive $3,000.00 in compensatory damages.
On October 21, 2003, the court entered a consent decree resolving United States v. Pacific Northwest Electric (D. Idaho). The complaint, which was filed on January 11, 2001, alleged the defendants: Boise, Idaho developers, Walter T. Sigmont and Wirt Edmonds, Pacific Northwest Electric, Inc., Edmonds Construction Co., Inc., and architects Teal Whitworth Architects, P.A. and Capstone, Inc. discriminated on the basis of disability by failing to design and construct five Boise complexes in accordance with the Fair Housing Act's accessibility requirements for new multifamily housing. The five Boise complexes that were the subject of the suit are Grayling Place, Jade Village, Imperial Court, Eagleson Park and Harborview Station (formerly known as Lawton Apartments). The consent decree requires the defendants: to retrofit the complexes by, among other things: removing steps; reconfiguring kitchens and bathrooms to provide added maneuvering space; widening doorways; leveling sidewalks; and adding accessible parking and curb ramps at an estimated cost of approximately $300,000. In addition, the defendants are required to: pay damages in the amount of $29,000 to persons harmed by the lack of accessible features at the complexes; pay $5,000 in damages to the Intermountain Fair Housing Council ("IFHC"); and ensure that new construction complies with the Fair Housing Act with respect to new construction comply with the provisions of the Fair Housing Act. The consent decree will remain in effect for two years. The case was referred to the Division by the Department of Housing and Urban Development (HUD) after HUD investigated complaints it had received from the Intermountain Fair Housing Council ("IFHC").
Low-back pain is common. In fact, up to 80% of us will experience this pain. The lower back is a complex network of spinal muscles, nerves, bones, discs or tendons in the spine. An irritation, problem, or damage to any of these parts may cause pain in the lower back that often travel to other areas of the body. Fortunately, lower back pain often resolves itself and many find that their pain improves with simple treatments.
Spinal stenosis, a narrowing of the disk space, and disk protrusion (also known as a herniated disk) can cause pinching, irritation, and inflammation of the nerve root(s). As a result, people with one or more of these conditions experience low-back pain that can travel to their legs.
After a trial of physical therapy and oral anti-inflammatory medications, Matthew received an interlaminar ESI that provided significant improvement for 4 to 5 days. He is now frustrated that the pain has returned and requested one more injection before considering surgery.
We are seeing negative consequences to the high prevalence of ESIs, as the rates of back pain, expenditures, disability rates, and spine surgery [2-7] have increased steadily. In short, there are significant costs and risks to ESIs, which warrant closer study.
The Food and Drug Administration recently held a panel examining the efficacy of ESIs. Medicare and Medicaid have reduced reimbursement for these procedures sharply. The pain medicine community is reevaluating how we can limit the number of ESIs given and administer them only to the patients who will benefit from them.
We as a profession must find the courage to exercise self-restraint in selecting patients to receive ESIs and use the available evidence to determine the proper treatment plan and intervention. We must educate patients that ESIs typically provide relief for less than a few months. Lifestyle changes and physical therapy must be the cornerstone to any plan for managing back pain, not recurring injections.
However, Matthew is requesting that we limit our plan to only one more procedure before seeking surgery, which he perceives as the definitive treatment. Since he is only willing to pursue one more procedure, we want to administer an ESI with the greatest chance of alleviating his pain.
The argument that a 2-level injection is more likely to deliver steroids to pain source may or may not be true, but this notion is irrelevant because compelling evidence shows that higher local concentrations of steroids do not improve outcomes. Among the 5 studies that compared different dosages of steroids, none has found that higher dosages result in better outcomes [10-14].
We believe a 2-level TFESI is the best treatment option for Matthew right now, without any consideration as to the best course of action if his pain returns in the future. If his symptoms return after achieving significant functional benefit for a substantial period from an initial injection, we would repeat the same 2-level TFESI again. Although only single level TFESIs were investigated, the data from Murthy et al [7] suggest that repeating successful TFESIs yields nearly the same benefit as that of the initial injection.
My beef with streaming is the tech is just not that good yet. Controls are irritating. Apart from Netflix, which has an app on my BD player, I have to cast from my phone to my TV. Which is major pain, too. Streaming just is not convenient. And there is content on cable that I still cannot get from streaming.
Despite the potential for serious complications, most individuals with spondylocostal dysplasia live until adulthood. They may experience chronic back pain. Intelligence is usually unaffected, and neurological complications are rare. 2b1af7f3a8