Brien Roche Law http://www.brienrochelaw.com Fri, 19 Sep 2014 01:09:01 +0000 en-US hourly 1 Child Head Injuries http://www.brienrochelaw.com/blog/child-head-injuries/ http://www.brienrochelaw.com/blog/child-head-injuries/#comments Mon, 15 Sep 2014 00:20:54 +0000 http://www.brienrochelaw.com/?p=9254 Child Head Injuries from Brien Roche Law

Child head injuries are potentially problematic cases for a host of reasons. They require the intervention of a multitude of professionals. Children naturally fear strangers. They frequently are uncomfortable with new people and putting them into a situation where they … Continue reading

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Child Head Injuries from Brien Roche Law

Child head injuries are potentially problematic cases for a host of reasons. They require the intervention of a multitude of professionals. Children naturally fear strangers. They frequently are uncomfortable with new people and putting them into a situation where they are forced to deal with new people is typically not pleasant. In addition, child head injuries expose a child to frequent interaction with health care providers many of whom may not be the most sensitive people in the world.

Child Head Injuiries Require Particularized Proof

In terms of handling cases like this it is important to assemble as many family pictures, home movies, videos of events that the child has taken part in and other evidence of physical or academic achievements. Likewise putting together any standardized test results and academic school reports showing the child’s pre-accident health and ability is critical. Records of siblings in terms of how they have performed in school and outside of school likewise can be helpful in terms of showing performance markers.

It is also critical to gather the mother’s pre-natal and pregnancy records dealing with the child. A healthy mother with a normal pregnancy and above average measurements for the child on all pediatric testing will dispute any defense contentions of some pre-existing problem.

Although the Glasgow Coma Scale is a frequent marker as to traumatic brain injury, this test may not be appropriate for children. Other tests that are more appropriate are the Child Health Questionnaire and the Pediatric Evaluation of Disability Inventory. The PEDI contain an activity scale that extends beyond basic functional skills.

Although a day in the life video may be useful, what may be even more useful is a video of a typical week of before injury and post injury.

In dealing with young people who have suffered from child head injuries it is critical to be able to relate to that child.

Child Head Injuries Economic Proof

In terms of proving future economic losses, this may well be dependent upon gathering evidence from family members, educators, and other professionals who can testify as to what this child’s capabilities were pre-injury. This creates a greater foundation for permitting an informed opinion as to future economic losses. In large measure that may depend upon having a vocational rehabilitation expert interview the child and parents and review all academic reports, medical records, and study the family’s academic history. In addition testing such as the Global Assessment of Functioning test is a 100 point scale that rates a variety of different types of functioning including psychological, social, and occupational. Lay testimony from coaches and neighbors who knew the child pre injury can have significant impact in terms of proving the scope of real damage as to child head injuries.

For more information about traumatic brain inury see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

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Platelet Treatment http://www.brienrochelaw.com/blog/platelet-treatment/ http://www.brienrochelaw.com/blog/platelet-treatment/#comments Sat, 13 Sep 2014 14:05:55 +0000 http://www.brienrochelaw.com/?p=9247 Platelet Treatment from Brien Roche Law

Platelet treatment, also called Platelet-rich plasma treatment, is becoming increasingly popular for a variety of different types of injuries.  The treatment involves injecting concentrated platelets, taken from the patient’s own blood, into the site of injury in order to speed … Continue reading

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Platelet Treatment from Brien Roche Law

Platelet treatment, also called Platelet-rich plasma treatment, is becoming increasingly popular for a variety of different types of injuries.  The treatment involves injecting concentrated platelets, taken from the patient’s own blood, into the site of injury in order to speed up recovery.  The evidence is conflicting as to the effectiveness of this treatment.  The volume of treatment being rendered has ballooned from $45 million in 2009 to what is expected to be $126 million by 2016. Questions however still remain as to whether or not it really works.  A study conducted by the Cochrane Collaborative, a group of independent medical experts, examined 19 different trials of this treatment and concluded that the evidence was insufficient to recommend it for musculoskeletal soft-tissue injuries. The treatment begins with drawing blood from the patient.  Next the blood is spun to separate platelets from the other blood cells.  This process creates concentrated platelets which are then injected into the injured area to promote healing.

Platelet Treatment Downside

There is generally thought to be very little downside to the treatment other than the cost associated with it.

A study put out by the New England Journal of Medicine in 2014 concluded that platelet treatment is no better than a placebo for hamstring injuries.

The lack of uniformity as far as results from various studies may be a function of the absence of any standards of methodology for the delivery of the treatment.

Presently the treatment is used for a wide range of conditions including chronic tendon injuries, acute muscle and ligament injuries, osteoarthritis of the knee and also to speed recovery from surgery and fractures.

Platelet treatment does not fall under the control of the Food and Drug Administration (FDA) and therefore there is no strict governmental control.

Most of the treatment is provided either by orthopaedic doctors or pain medicine doctors; many of whom have found the treatment not only to be successful but also quite profitable.

One physician at the National Rehabilitation Hospital in Washington, DC normally recommends other approaches first such as physical therapy, medication, activity modification, bracing or even steroid injections before attempting plasma treatment.

In addition there is some dispute within the profession as to what is the best mechanism for preparing the platelets, what volume should be used, the frequency of treatment and how many treatments each patient should get.

Until there is some uniformity in that regard, probably any study results on platelet treatment are going to be inconclusive.

For more information on medical issues, see some of the other pages on this site.

 

for more personal injury news and views visit, Brien Roche Law

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Diagnosis-Misdiagnosis http://www.brienrochelaw.com/blog/diagnosis-misdiagnosis/ http://www.brienrochelaw.com/blog/diagnosis-misdiagnosis/#comments Fri, 06 Jun 2014 18:00:20 +0000 http://www.brienrochelaw.com/?p=9229 Diagnosis-Misdiagnosis from Brien Roche Law

Diagnosis-misdiagnosis are contrary terms but frequently go hand-in-hand.  Studies indicate that doctors make the wrong diagnosis in 10% to 15% of office visits for a new problem.   Diagnosis-Misdiagnosis Avoiding the Latter The average office visit with most physicians last … Continue reading

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Diagnosis-Misdiagnosis from Brien Roche Law

Diagnosis-misdiagnosis are contrary terms but frequently go hand-in-hand.  Studies indicate that doctors make the wrong diagnosis in 10% to 15% of office visits for a new problem.  

Diagnosis-Misdiagnosis Avoiding the Latter

The average office visit with most physicians last no more than 21 minutes.  The physician’s ability to make a diagnosis is dependent up the patient providing complete information, giving an accurate history and then being able to clearly articulate what the symptoms are. 

Some simple things that can be done to increase the likelihood of the physician making the correct diagnosis:

  • Make your appointment early in the day.  This increases the likelihood of being able to see the physician on time without having to wait too long and without running into potential problems with overbooking.
  • Have your complaints written out.  Put together a list of your various complaints in written form and list them in the order of priority.  You should also note the chronological order of any symptoms i.e., when they began, how long they have lasted and how they have progressed.   If you have been on any medication, you need to list in chronological order what that medication is and what you have been taking it for.
  • Bring your spouse or a companion with you.  This will not only get the doctor ‘s attention but the companion can serve as a prompt to your memory and can also take notes as to what the doctor is saying.
  • Ask focused questions.  If the doctor gives you a diagnosis, ask the doctor whether or not it is possible that it could be something else that is causing the problem.
  • Request a diagnosis.  There is at least one study that indicates that primary care providers fail to provide a differential diagnosis in 81% of the initial visits.  A differential diagnosis is a list of possible diagnoses/causes of the problem.  If no diagnosis is possible at that time then make sure that there is a plan in place as to how a diagnosis is going to be arrived at.
  • Take charge of any tests that are ordered.  If tests are ordered by the physician, then get a sense as to when those test results will be ready.  If they are not received within that time frame, then follow up and find out why.  Once you get the test results you need to ask the physician to assist you in interpreting those test results and whether or not there is additional testing that is necessary.
  • Monitor your progress.  If the physician indicates that you should be feeling better in a couple of weeks and you are not, make sure that you follow up with the physician.
  • Get a copy of the office note.  Frequently the physician hand-writes an office note that may be difficult to read.  In spite of that, getting the office note will tell you whether or not the doctor made note of the symptoms and the chronology that you gave to the physician.
  • Get a second opinion if needed.  If you have some doubt about the treatment provided or if your condition is not resolved within a reasonable period of time, then getting a second opinion is certainly justified.  Doctors are required by law to cooperate in terms of providing the necessary medical records to the physician providing that second opinion.  

For more information on diagnoses and personal injury matters , see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

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Back Pain http://www.brienrochelaw.com/blog/back-pain/ http://www.brienrochelaw.com/blog/back-pain/#comments Thu, 05 Jun 2014 18:00:16 +0000 http://www.brienrochelaw.com/?p=9230 Back Pain from Brien Roche Law

One in four adults experience back pain in the course of a year.  This is also a common reason for doctors’ visits.  Most people recover from back pain without any medical treatment. Back Pain Treatment The generally recommended treatment mode … Continue reading

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Back Pain from Brien Roche Law

One in four adults experience back pain in the course of a year.  This is also a common reason for doctors’ visits.  Most people recover from back pain without any medical treatment.

Back Pain Treatment

The generally recommended treatment mode is over-the-counter medication, rest and exercise  for what is called nonspecific back pain.  Nonspecific back pain is back pain that is not linked to a particular injury or disease.

Getting an MRI or X-ray is certainly reasonable for back pain related to a specific event or if the back pain has persisted for six weeks or longer.  In conducting an X-ray or MRI, what the physician is looking for is a herniated disc or bone spur.  

You need to keep in mind however that 25% of the population is going to show some pathology on an MRI or X-ray test of the back even though they may not be having any symptoms whatsoever.

Most competent orthopaedic surgeons will tell you that for chronic back pain, physical therapy should be attempted to strengthen the muscle support as well as activity modification, meaning ceasing certain activities that may be causing the problem.  

If the pain persists, then an injection of steroids or nerve block directly into the back may be recommended to provide temporary relief.  That temporary relief will then hopefully give your back enough time to heal naturally or allow physical therapy to hasten the healing process.

Dealing With Back Pain

Some general tips in terms of dealing with back pain:

  1. Over-the-counter medications such as acetaminophen or ibuprofen may be of great assistance.
  2. Use common sense in terms of making sure that you get sufficient rest, stretch the affected body parts and stay within your zone of no pain, that is do not push the body part into painful positions.  Staying within the zone of no pain simply means that you are trying to strengthen uninjured body parts so that they can better help with motion while the injured part heals.
  3. Keep moving.  Although rest certainly is necessary, total immobilization of the back in most cases is not going to hasten the healing process.

For more information on back pain and personal injury, see the other pages on this site.

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Vertigo Car Accidents http://www.brienrochelaw.com/blog/vertigo-car-accidents/ http://www.brienrochelaw.com/blog/vertigo-car-accidents/#comments Sat, 24 May 2014 18:00:42 +0000 http://www.brienrochelaw.com/?p=9215 Vertigo Car Accidents from Brien Roche Law

Vertigo is a feeling that you or your surroundings are spinning.  Car accidents can be the cause.  Vertigo itself is simply a symptom, not a disease.   Vertigo Involves Loss Of Balance Your ability to maintain proper balance is a … Continue reading

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Vertigo Car Accidents from Brien Roche Law

Vertigo is a feeling that you or your surroundings are spinning.  Car accidents can be the cause.  Vertigo itself is simply a symptom, not a disease.  

Vertigo Involves Loss Of Balance

Your ability to maintain proper balance is a function of fluid in the inner ear area that sends signals to the brain as to how to properly balance the body.  The inability of that system to properly function is called vestibular dysfunction.  

Balance is actually a result of several different contributing systems.  The skin, joints, muscles all relay information to the brain that allows the vestibular system to maintain proper balance. 

Vertigo Car Accidents

That balance can be affected by any sort of injury to the head, either as a result of striking something or as a result of whiplash motion.  

That injury to the head may cause increased pressure within the skull which can then influence the balance of fluids within the skull causing vertigo and/or dizziness. 

Aside from trauma, there are several other potential causes of vertigo.

Most often vertigo is simply defined as an illusion of motion.  It is associated with a spinning sensation.  Dizziness is a somewhat looser term that can include vertigo.

For more information on car accidents, see the other pages on this site.

 

for more personal injury news and views visit, Brien Roche Law

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Car Accidents Alighting from Vehicle http://www.brienrochelaw.com/blog/car-accidents-alighting/ http://www.brienrochelaw.com/blog/car-accidents-alighting/#comments Fri, 23 May 2014 18:00:38 +0000 http://www.brienrochelaw.com/?p=9216 Car Accidents Alighting from Vehicle from Brien Roche Law

Many people do not appreciate that car accidents involving alighting from a vehicle are frequently the fault of the person who is exiting the vehicle.  For instance imagine that you park on the right side of a one-way street.  Exiting … Continue reading

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Car Accidents Alighting from Vehicle from Brien Roche Law

Many people do not appreciate that car accidents involving alighting from a vehicle are frequently the fault of the person who is exiting the vehicle.  For instance imagine that you park on the right side of a one-way street.  Exiting from that vehicle on the driver’s side into a lane of traffic not only can be dangerous but can create liability.  The person opening the door into a lane of traffic has the obligation to make sure that can be done safely.  

Car Accidents Alighting

Likewise a person exiting from the passenger side of  a vehicle into a lane of traffic has the obligation to make sure that can be done safely.  

Once the passenger has exited the vehicle and is standing in a lane of traffic then it is the duty of that passenger to make sure that the area is safe.  The failure to do that may result in liability for that passenger.

Car Accidents Alighting From Common Carrier

Common carriers have a special obligation to make sure that their passengers do not exit into a lane of traffic.  That is why taxi doors on one or both sides may frequently be locked by the driver to make sure that the passenger cannot exit into a lane of travel.  

Although it may be more inconvenient for the passenger to have to crawl over a seat in order to get to the curbside door, that frequently is necessary in order to avoid injury and to escape potential liability.  

For more information on car accidents see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

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Construction Accidents-Rental Equipment http://www.brienrochelaw.com/blog/construction-accidents-rental-equipment/ http://www.brienrochelaw.com/blog/construction-accidents-rental-equipment/#comments Fri, 25 Apr 2014 18:00:39 +0000 http://www.brienrochelaw.com/?p=9208 Construction Accidents-Rental Equipment from Brien Roche Law

A recent article in the Trial Lawyers magazine reports of 3,945 workplace deaths in 2012, 20% of them were construction accidents.  The leading cause of such construction accident deaths are falls, being struck by objects, electrocution and finally being crushed … Continue reading

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Construction Accidents-Rental Equipment from Brien Roche Law

A recent article in the Trial Lawyers magazine reports of 3,945 workplace deaths in 2012, 20% of them were construction accidents.  The leading cause of such construction accident deaths are falls, being struck by objects, electrocution and finally being crushed between moving objects.

Construction Accidents-Rental Equipment

Much of the equipment used on construction sites is rental equipment.  This rental equipment can frequently fail.  Failing to provide equipment in proper condition and then renting it to unfamiliar operators can be catastrophic.

When a company rents equipment, it is required to rent it in the condition that the manufacturer specifies in the owner’s and operator’s manual or the service manual.

Frequent causes of these types of construction accidents are:

  • Failing to provide the manufacturer-specified safety devices.
  • Failing to provide sufficient operator training.  In some instances this training may consist of a three to four hour comprehensive program or simply consist of familiarization that takes 15 – 60 minutes.  Which type of training is appropriate depends upon the nature of the equipment.
  • Failing to check the customer qualifications to make sure that the equipment is being rented only to qualified operators.

Frequently this construction equipment comes with an operator.  In that instance where the operator injures an employee of the customer, frequently the renting company will claim that the injury was caused by a fellow employee and therefore may be barred by workers’ compensation.  That is an issue that can vary from state to state.

Construction Accidents-Rental Equipment Failure Must be Fully Explored

Some critical documents that need to be obtained in the course of investigating a case like this are such things as the owner’s and operator’s manual, the rental company’s internal standards and practices, any proof of training that was provided by the rental company, the level of training of the rental company’s own operators and the overall qualifications of the customer-approved operator.

For more information on construction accidents, see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

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Truck Accidents-Improper Maintenance http://www.brienrochelaw.com/blog/truck-accidents-improper-maintenance/ http://www.brienrochelaw.com/blog/truck-accidents-improper-maintenance/#comments Thu, 24 Apr 2014 18:00:03 +0000 http://www.brienrochelaw.com/?p=9207 Truck Accidents-Improper Maintenance from Brien Roche Law

Truck accidents due to improper maintenance can be fatal.  A recently reported jury verdict in Texas involved a truck wherein the drive shaft broke off underneath the tractor-trailer and flew into an oncoming lane.  The 20-pound metal shaft crashed through … Continue reading

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Truck Accidents-Improper Maintenance from Brien Roche Law

Truck accidents due to improper maintenance can be fatal.  A recently reported jury verdict in Texas involved a truck wherein the drive shaft broke off underneath the tractor-trailer and flew into an oncoming lane.  The 20-pound metal shaft crashed through the window of an oncoming vehicle striking the driver and resulting in his death.

Truck Accidents-Improper Maintenance

The Plaintiffs in the subsequent lawsuit presented evidence that U-joint holding the drive shaft in place had melted because of insufficient lubrication.  This permitted the drive shaft to rip out of its placement.  The lawsuit claimed that the U-joint had not been lubricated for at least four to six months before the incident.  

The U-joint manufacturer recommended lubrication every 5,000 miles.

In addition the Plaintiffs asserted that the president of the trucking company knew that the fleet manager lacked the necessary qualifications to deal with these maintenance issues but allowed him to remain in that position.

Also a punitive damage award was sought on the grounds that the trucking company knew or should have known that the U-joint cross-piece would fail with potentially dangerous results.  During the course of discovery it was learned that a mechanic at the truck company knew about this and other U-joints in the fleet’s trucks that had failed because of inadequate lubrication.

Truck Accidents-Improper Maintenance Leads To Death

A substantial jury verdict was returned in this Texas case.

For more information about truck accidents, see other pages on this site.

 

for more personal injury news and views visit, Brien Roche Law

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Pediatric Heart Defects http://www.brienrochelaw.com/blog/pediatric-heart-defects/ http://www.brienrochelaw.com/blog/pediatric-heart-defects/#comments Fri, 11 Apr 2014 18:19:48 +0000 http://www.brienrochelaw.com/?p=9184 Pediatric Heart Defects from Brien Roche Law

A DC-Metro woman who is also a physician with the FDA gave birth to her third child in 2009; a seemingly healthy baby girl who nursed well and had gained weight before her very first pediatrician’s appointment. When the baby … Continue reading

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Pediatric Heart Defects from Brien Roche Law

A DC-Metro woman who is also a physician with the FDA gave birth to her third child in 2009; a seemingly healthy baby girl who nursed well and had gained weight before her very first pediatrician’s appointment.

When the baby was about 6 weeks old she began vomiting, had difficulty nursing and appeared to be in pain; symptoms of which her doctor thought could be reflux.  The doctor suggested to the mother that she change the baby’s diet.

A few days had passed with no apparent improvement in the baby’s condition so the mother made another appointment with the pediatrician.  That day when the baby went down for a nap, she cried a bit and then went silent.  When the mother went in to check on her, she discovered her baby lying motionless on her stomach and not breathing.  Her child was dead.

Pediatric Heart Defects-Diagnosable

The medical examiner said the baby died of total anomalous pulmonary venous connection (TAPVC) which is a heart defect related to critical congenital heart disease and that the child lived longer than would have been expected.  It turned out that this was a condition that could have been remedied if the hospital had only performed an extremely low-cost test that could have detected a congenital heart defect in less than 60 seconds.  The device used in this test is called a pulse oximeter which is a hand-held device that measures oxygen saturation in the blood through a sensor connected to the fleshy part of a baby’s hand or foot.  Abnormally low levels of blood oxygen are associated with congenital heart defects.  Once something is picked up in this low-cost and non-invasive test, further testing can be done to isolate and treat the problem.  If treated quickly enough, 98% – 100% of those children can be saved.

Pediatric Heart Defects- Metro DC

With one in every 100 live births being affected by congenital heart defects, it is surprising that this simple test that can cost less than $1 per baby isn’t mandatory in all 50 states.  Maryland hospitals have been required to administer this test to all newborns since 2011 and Virginia now has mandated that hospitals with maternity wards screen for this after previously allowing it to be done on a voluntary basis since 2010.  In the District all hospitals use pulse oximetry screening as part of a screening program recommended by Children’s Hospital.  As of the beginning of 2014, 35 states have passed legislation that require this testing.  There currently is no legislation covering the 5 to 6 percent of babies who are delivered by midwives.

For more information on medical malpractice see the other pages on this site.

for more personal injury news and views visit, Brien Roche Law

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Uterine Fibroids http://www.brienrochelaw.com/blog/uterine-fibroids/ http://www.brienrochelaw.com/blog/uterine-fibroids/#comments Thu, 03 Apr 2014 18:00:58 +0000 http://www.brienrochelaw.com/?p=9182 Uterine Fibroids from Brien Roche Law

Uterine fibroids are noncancerous tumors or growths in the muscles of the uterus.  These fibroids can get quite sizeable and as a result of their size cause heavy bleeding, urinary frequency, constipation, bloating, pain and interference with the ability to … Continue reading

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Uterine Fibroids from Brien Roche Law

Uterine fibroids are noncancerous tumors or growths in the muscles of the uterus.  These fibroids can get quite sizeable and as a result of their size cause heavy bleeding, urinary frequency, constipation, bloating, pain and interference with the ability to become pregnant or carry a pregnancy.

Uterine Fibroids-Unspoken Problem

The unspoken problem with uterine fibroids is that many women ignore them and wait many years before seeking any help from a medical practitioner.  

The traditional treatment over the years has been a hysterectomy.  That however frequently can be avoided through the use of what is called a myomectomy, which involves cutting out the fibroids.  

These fibroids can be on the exterior of the uterus or they can be internal to the uterus.  The ones that are external tend to be less problematic.  The ones that are growing in the lining of the uterus frequently are problematic.

In terms of the cause of these fibroids, there is no clear answer.  A woman’s hormones can certainly play a role in fibroid growth but in large measure fibroids are thought to be genetic.  There is some evidence that diets that are heavy in red meat and low in green vegetables and citrus fruit increase risk of fibroid growth.  

Uterine Fibroids-Treatment

The traditional treatment of hysterectomy, although it obviously eliminates the fibroid, carries with it several potential risks including infection, bowel and bladder problems, increased risk of osteoporosis and heart disease.  

The other alternatives aside from myomectomy are that of hormonal treatments and various radiological procedures to shrink the fibroids.  Another alternative is simply watchful waiting i.e., to wait and see if the fibroids shrink over time.

The hormonal therapies are temporary measures and do not eliminate the fibroids.  

The radiology procedure tends to cut off the blood flow to the fibroids and thereby kills them in that fashion.  

The surgical treatment of fibroids frequently involves medical malpractice issues.  If you or a loved one has been exposed to such a surgical procedure that has gone awry, contact medical malpractice attorney Brien Roche.

for more personal injury news and views visit, Brien Roche Law

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