Author: amyr

Home>Articles by: amyr

By Dr. Norman K. Brown
UTU Medical Consultant

Most of us would agree that we should do all we can to preserve and protect the working of our brains, the part of us that makes us who we are and different from each other.

Aside from head injuries, the most common damage to our brain comes from circulation difficulties. These difficulties can occur from too little blood flowing to one area of the brain because of a clot in the blood vessel, or too much blood flowing to one place because of a sudden blood vessel leak, or hemorrhage. Both are commonly referred to as “strokes.”

There are steps each of us can and should be taking to reduce the chances of our having either of these types of strokes.

A cholesterol deposit in a brain artery triggers the most common clot-type injury. So, just as we can watch our diets (weight), engage in exercise, reduce or eliminate smoking, and control blood pressure and diabetes to protect our hearts, there are programs to protect our brain’s blood vessels.

It is always difficult to start and to stick to such programs, but your doctor will always be pleased to try to help you. Medications for both cholesterol reduction and blood pressure control are available to bolster your efforts. These medications have advanced greatly in effectiveness over the past 20 years.

The occurrence of the hemorrhagic or bleeding type of stroke, which is less common, is also reduced by attention to “blood vessel/heart healthy” programs — such as control of blood pressure.

Once the possibility of a stroke is present, there are some newer techniques for treating strokes that give us new hope — in particular, medications or lasers that help break up or dissolve blood clots and even devices such as snares and blades that are being developed to attempt removal of clot material. These last methods are still experimental, but for some people the results have been encouraging. In all cases, the time from the onset of symptoms to when treatment begins is extremely important.

When I say the sooner the better, I am talking about three to six hours maximum after the first symptoms. Former President Bill Clinton saved his own life by not waiting too long in the presence of symptoms of potential heart-muscle damage.

Let’s review some of the symptoms of early or threatened strokes:

  • Sudden onset of weakness or clumsiness or numbness in an arm and/or leg, usually without pain;
  • Walking or balance problems;
  • Speech difficulty;
  • Sudden vision loss;
  • Sudden onset of very severe headaches.

If any of these happen to you or a loved one, please seek medical help immediately.

Your health will always be way ahead if you think prevention because protecting your heart and the blood vessels throughout your body will help you to a longer, healthier life.

By Norman K. Brown, M.D.
UTU Medical Consultant

Difficulty getting a good night’s sleep has been a problem of men and women since the beginning of time. Stress, stimulants such as caffeine, illness and irregular work schedules all are well recognized by all of us as causes of insufficient or irregular sleep.

Some medical conditions, such as frequent urination or pain, may trigger restless sleep, nightmares and insomnia.

Another medical condition — sleep apnea — has only recently been recognized as an important cause of bad sleep. And apnea causes sleepiness during waking hours, which can be dangerous for those who operate trains, buses, automobiles and machinery.

Sleep apnea can in many instances be treated successfully, so let’s review some of the signals of its presence.

First, snoring is often a complaint of your bed partner. The snoring can be a result or a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep.

Your partner is usually the first person who first suspects the diagnosis of sleep apnea, because the snoring is coupled with periodic complete stoppage of breathing (apnea) for short periods during sleep. This causes fragmented and poor quality sleep, which is why sufferers of sleep apnea are tired during waking hours.

If you are experiencing snoring coupled with periodic stoppage of breathing, talk with your doctor. He or she may then advise a special sleep study, where you sleep while wearing monitoring equipment to confirm whether you do indeed not breathe for a few moments during sleep. The test also monitors the oxygen level in your blood during this apnea (no breathing) period.

It is important to understand that apnea can result in reduced oxygen levels in the blood that can trigger heart attacks and strokes. This is why it is so important to speak with a doctor if you exhibit signs of sleep apnea.

If such testing indicates treatment would help you, there are several options, and your doctor can help you decide which, if any, you should choose.

For example, there are medical devices called a c-pap and bi-pap available to keep the breathing passages open while you sleep. Certain surgical procedures may also help.

For many sufferers of sleep apnea, simply losing weight is helpful because it reduces the tissue mass that is blocking the airway during sleep.

If you suspect sleep apnea in yourself or a family member, consult your physician, as diagnosis and treatment is generally covered by your health-care insurance. Treatment can save your life and prevent a heart attack or stroke. It can also help you avoid a serious accident at work and solve the snoring that may be quite annoying to your partner.

For more information, visit the Sleep Apnea Association website at www.sleepapnea.org/geninfo.html.

Mammograms and Pap tests have saved many lives by detecting early, curable cancers at a reasonable cost and minimal inconvenience. Many more lives could be saved if there were more testing for colon cancer, which is a fairly common disease, but one which can be cured with a high success rate if caught early through testing.

Although these tests often are uncomfortable or unpleasant, they could well save your life or the life of your spouse. Catching colon cancer early is the surest way of eliminating it completely.

A colonoscopy – looking up the length of the colon with a fiberoptic tube containing a light on the end – has been recommended by the American Cancer Society for all those 50 and older. You should ask your doctor if he/she recommends this test.

A less intrusive test is providing a physician with three small samples of your stool by using what is called a Hemoccult kit. This test, completed at a medical laboratory, detects microscopic amounts of blood in the stool, which is a warning sign of colon cancer. The test is inexpensive and the kit is available through your physician’s office. Many physicians recommend this simple test annually regardless of how well you feel.

You also can do a lot to help yourself to better health through better living habits such as an improved diet, regular exercise and by not smoking.

Additionally, you should always be alert for any suspicious symptoms – such as a change in bowel habits or visible blood in the stool – and report to your physician immediately. Your physician is best equipped to provide you with the tips and tools you need to stay healthy and, in any case, you should obtain a physical examination annually – especially if you are at least 50 years old.

All Designated Legal Counsel (DLC) shall agree as a condition of becoming or remaining a DLC that he or she will be subject to and fully comply with the Rules of Conduct. Each DLC shall, as a condition of becoming or remaining a DLC, shall specifically in writing waive any and all recourse to any court of law or any tribunal to challenge any action of the officers and agents of the SMART Transportation Division which in any way relates to the DLC program.

All DLC shall agree as a condition of becoming or remaining SMART TD Designated Legal Counsel that he or she will comply with and be subject to the ABA Model Rules of Professional Conduct as well as the state-law professional responsibility rules and canons for the jurisdictions in which they practice.

The agents of the Union, its officers, staff, and representatives have a duty to exercise their authority solely on behalf of and for the benefit of the SMART TD and its members. The agents of the union must set aside their personal interests and act in the best interests of the Union and its members. No prospective or current DLC shall aid or abet anyone in the violation of their fiduciary duty.

Because an agent of the SMART TD must make each decision based solely on the best interests of the union, it is necessary that the agent be free of improper outside influences that would interfere with an ordinary person’s objectivity in making the decision. No prospective or current DLC shall offer or attempt to improperly influence any decision of an agent of the SMART Transportation Division.

Any DLC solicited for a payment or contribution by any SMART TD or UTUIA officer, staff member, employee, or member must report the details, including the date, time and amount of such solicitation to the International President and SMART TD Coordinator of Designated Legal Counsel immediately in writing. This is in addition to and not a substitute for any other legal or ethical requirement that may attach.

All DLC’s will be permitted to become members of SMART TD, paying all dues except General Committee of Adjustment dues, and should be available and willing to attend their local’s meetings and answer questions concerning the FELA and related laws.

No DLC, under any circumstances, at any time, shall become involved in union politics. DLC’s may, but are not required to, sponsor generic union social and fraternal events and Regional Meetings to promote unity and education among the union’s officers and members.

Any request by a SMART TD member for a political contribution for a union election from a DLC and any provision by a DLC of a political contribution for a union election of any kind including, without limitation, anything of value such as money, goods, services or entertainment to or on behalf of a candidate for union office is absolutely prohibited. Any such solicitation must be immediately reported to the SMART TD Coordinator of Designated Legal Counsel. The employment of or provision of office space to full-time SMART TD elected officers, staff or employees is prohibited.

Under no circumstances is a referral fee to be paid to any SMART TD member or union officer who recommends the DLC to an injured employee. If such a fee is requested, the International President and SMART TD Coordinator of Designated Legal Counsel shall be immediately notified.

As provided in ABA Model Rule 5.4: “A lawyer or law firm shall not share legal fees with a non-lawyer.” Each DLC and members of their firm must be willing to give advice concerning the rights and liabilities of union members for on-the-job injury under FELA and related laws. A DLC may charge a contingency fee of not more than 25 percent of the recovery, exclusive of costs, for cases involving a SMART TD member concerning an on-the-job injury under FELA and related laws. In the event that it is necessary to file suit regarding that matter, the DLC may charge a contingency fee of not more than 33 percent, exclusive of costs.

Each DLC and members of their firm must be willing to give advice concerning the rights and liabilities of union members for on-the-job injury under FELA and related laws.

Each DLC and members of their firm must be willing to handle all actionable injury cases, not only those of high potential recovery. They must also be willing to handle related matters on an injured member’s behalf at the Railroad Retirement Board and actionable claims under the Rail Safety Improvement Act.

DLC’s and members of their firm must be willing to give advice concerning the rights and liabilities of union members for on-the-job injuries, either by telephone or by interview, at no cost to the union member, and should return all members’ calls related to such issues.

Any civil, criminal, administrative or bar complaint, investigation or proceeding commenced against a DLC by any union member or governmental entity shall be immediately reported to the International President and the SMART TD Coordinator of Designated Legal Counsel.

If a state bar association or other body recommends a finding that a DLC or a member of their firm violated ethical obligations, or such violations are found by any court or other adjudicatory body, the DLC shall immediately notify the International President and the General Counsel.

DLC’s should immediately advise the SMART Transportation President prior to any significant change in the membership of their firms (e.g., merger, consolidation, departures, etc.).

The appointment and continued DLC designation is at the sole discretion of the SMART Transportation Division President.

The failure to comply with any of these Rules shall be cause for sanctions up to and including immediate revocation of the DLC designation by the TD President, and in the case of SMART TD members, referral to the International President for corrective action consistent with the SMART Constitution.

SMART Transportation Division shall adopt a complaint procedure to review inquiries or complaints concerning alleged violation of the Rules of Conduct. Any complaint shall be forwarded in writing to the SMART TD Coordinator of Designated Legal Counsel.

Question 1: Is there any change in the schedule of benefits under the CHCB or MMCP Plan?
Answer 1: Yes. The schedule of benefits has been improved as follows:
— The Comprehensive Health Care Benefit (“CHCB”) will now cover one physical per year (including testing and immunizations) for employees and eligible dependents, with 100% of costs covered up to $150, and 75% of such costs in excess of $150.
— CHCB will cover routine childhood immunization subject to applicable deductible and percentage of covered expenses payable.
— Under CHCB and Managed Medical Care Program (“MMCP”), existing speech therapy coverage is expanded to include as a covered expense speech therapy given to children under 3 for treatment of autism, development delay, cerebral palsy, hearing impairment, or major congenital anomalies that affect speech.
— PKU blood tests will be a covered expense under MMCP and CHCB when given to infants under age 1 in a hospital or on an outpatient basis.
— While MMCP will continue to require co-payment with regard to the first OB/GYN pregnancy visit, no co-payment for subsequent office visits for that pregnancy will be required.
— MMCP will not require co-payment for allergy shots.
Question 2: Are there any changes in the Early Retirement Major Medical Expense Benefit Plan (GA-46000)?
Answer 2: No.
Question 3: If an employee elects to “opt-out” of coverage under the plan and retires from service with the carrier in accordance with the 60/30 provisions of the Railroad Retirement Act, will that individual be eligible for coverage under GA-46000?
Answer 3: Yes. One of the eligibility requirements for GA-46000 is that the employee be covered under either the NRC/UTU or the Railroad Employees National Health and Welfare Plan when they retire and the “opt-out” election is a part of the above referenced plans.
Question 4: Will employees off work due to leave of absence, furlough, suspension, dismissal, disability, etc., be required to remit the cost-sharing contributions to the carrier in those months in which they are not working but continue their benefit eligibility?
Answer 4: No. Under these circumstances, if the carrier is not required to make the monthly health and welfare payment on behalf of the employee, the employee is not required to make the cost-sharing contribution.
Question 5: If an employee elects coverage under the no-cost Basic Health Care Benefit (BHCB), when will the employee be permitted to elect coverage under the Managed Medical Care Program (MMCP) or the Comprehensive Health Care Benefit Plan (CHCB)?
Answer 5: The employee will be permitted to select another available benefit option during the regular re-enrollment period and the benefit plan elected will become applicable on January 1 of the year following the year in which the election is made in the same manner as is currently being administered.
Question 6: Is there any change in the NRC/UTU Health and Welfare Plan allowing employees the option to select coverage through BlueCross/BlueShield?
Answer 6: No. Existing plan provisions not specifically amended by this proposed agreement continue in effect without change.
Question 7: Is there any change in the “in-network” MMCP benefit levels?
Answer 7: The only change in the benefits are those benefit improvements set forth in the proposed agreement. Existing plan provisions not specifically amended by this proposed agreement continue in effect without change.
Question 8: Where employee health benefits are provided through a hospital association requiring a monthly employee payment, what amount of monthly cost-sharing will be required for dependent health benefits provided under the NRC/UTU Plan or the National Health and Welfare Plan?
Answer 8: The cost-sharing contribution provided for in the proposed agreement will be reduced by the amount of the required monthly hospital association dues.
Question 9: How will the employee cost-sharing contribution be determined on a “pre-tax” basis?
Answer 9: It will be determined in accordance with the existing laws and regulations governing such “pre-tax” employee contributions.
Question 10: Will there be any changes in the benefit administrator options currently provided for in the NRC/UTU Health and Welfare Plan?
Answer 10: No.
Question 11: Should an employee “opt-out” of plan coverage, under what conditions can an employee revoke such “opt-out” election prior to the open election period?
Answer 11: An employee may revoke the “opt-out election” by providing the plan or its designee with proof satisfactory to it that, after the employee made the opt-out election:
— A person became a dependent of the employee through marriage, birth, or adoption or placement adoption;
— The employee loses eligibility under, or there is a termination of employer contributions for, the other coverage that allowed the employees to make the opt-out election.
— If COBRA was the source of such other coverage, that COBRA coverage is exhausted.
Question 12: When will employees returning to active service from leave of absence, furlough, suspension, dismissal, disability, etc., become covered for employee and dependent health benefits?
Answer 12: There is no change in the manner in which eligibility is determined under these circumstances.