This case involves a parent who underwent testing for the genetic markers of a particular form of muscular dystrophy. The mother originally requested the testing after having a son who was afflicted with the disease. After submitting to the test, the woman was informed that she was not a carrier of the disease by a genetic counselor over the phone. On this information, the plaintiff and her husband had a second child, who was also afflicted by the same form of muscular dystrophy.

I do not counsel patients with this disease specifically because they receive counseling in a specific clinic. However, I do counsel individuals with other X-linked recessive diseases. Patients are given testing results over the phone followed by a letter summarizing the information provided, along with a copy of any test results. I teach medical students and genetic counseling students about the process of result disclosure, documentation, and the unique aspects of X-linked diseases.

1. Do you counsel patients with this form of muscular distrophy? 2. What is the protocol to inform a patient of their testing results?

Genetic Counseling Expert Discusses Implications of Inaccurate Test Results

This case involves a man who was seriously injured after an accident in the bathtub in his hotel room in Washington. The man, who suffered from impaired mobility due to muscular dystrophy, was given a hotel room that was customized to ADA recommendations. Shortly after checking in to his room, the man attempted to use the shower. Immediately upon putting his weight onto the shower’s folding seat the seat collapsed, causing him to strike his head on the wall of the tub and suffer a debilitating brain injury. In addition, it was also noted that the shower lacked anti-slip strips on the tub’s surface. It was alleged that the hotel failed to maintain the room according to ADA standards, posing a direct danger to guests who were assigned the room.

I have worked a number of ADA bathroom cases. There are no ADA guidelines regarding slip-resistant bathtubs; however, all tubs should have a slip-resistant surface or, lacking that, some kind of applied treads. The primary duty of hotels is to (a) ensure that their ADA bathrooms meet specs, primarily for grab bars and spacing, and that (b) any ADA equipment be maintained in excellent condition. That the shower seat collapsed under the man's weight would suggest that it was not maintained to this standard. Well before ADA and ADAA, I worked to make bathrooms at my motel handicapped accessible. As needs and requirements advanced over the years, I have been aware of all compliance recommendations. As a college instructor in Hospitality Law, I taught a segment on ADA compliance.

1. Do you have knowledge of the industry standards for ADA bathrooms? 2. What steps do hotel/motels need to follow in order to keep ADA rooms up to date?

Location: IL BA, Economics, University of Illinois MBA, Illinois State University Certified, Hotel Administrator Authored, 200+ Publications on Hotel and Hospitality Management Former G****** M****** B*** W****** I** M**** Former P******** R********* C******* I** Former E******** V*** P******** S**** S***** A********* H**** D********* Former G****** M****** A********** H**** Former A******** P******** a** D******* o* H********** M********* P******* C******** C****** Current I********** H********** C*********

West Coast

Washington

This hotel/hospitality expert is a certified hotel administrator who has authored more than 200 publications on hotel and hospitality management as well bar and restaurant safety. He has been heavily involved in the industry for more than 40 years, including positions as General Manager of a Best Western Inn Motel, Executive Vice President of State Street Associates, and General Manager of AmeriSuites Hotel. He has experience with Hotel and Bar Management in the Midwest, including protocols with liquor operations, bar safety. He is a former program director/associate professor of hospitality management at a local college, and is currently a consultant in the hotel/hospitality industry.

Hotel Guest is Seriously Injured by Folding Shower Seat

This case involves an otherwise healthy female who initially presented to her pediatrician with a mass in her neck. Given the mass’s persistence over an extended period of time, the patient was referred for an biopsy of the affected lymph node. The biopsy revealed lymphadenitis. After the procedure, the patient lost a significant range of motion in her upper extremities, bone protrusions, as well as severe atrophy of many of her back muscles. She was never referred to a neurologist or an orthopedic for further review. The patient subsequently experienced sharp chest pains and sought the opinion of a cardiologist. She was diagnosed by the cardiologist with precordial catch syndrome.

I am a double board-certified otolaryngologist and facial plastic surgeon. I do plenty of lymph node as well as other mass removals from the neck. I have thankfully never had such a feared complication but have certainly seen and read about such complications. I almost always use a nerve integrity monitor if I will be operating near those neurovascular bundles. My initial thoughts are that there was likely a nerve injury at the base of the neck. I usually do 1-2 excisional biopsies of lymph nodes per month. Generally, the complication described is due to damage of cranial nerve XI, branchial plexus and or the long thoracic nerve. Based on the described location of the lymph node, these nerves are in the anatomic vicinity. I absolutely would get an MRN and EMG done. I would have the patient referred to an appropriate neurologist and possibly an orthopaedic or neurosurgeon. I don't think its really in question that this patient needs a referral to a peripheral nerve surgeon. As for the need for corrective surgery, I would defer to them as this is outside my area of expertise. It sounds like this was being done to diagnose and or rule out a lymphoproliferative disorder. Generally, I will only remove the superficial portion of the lymph node that is easily accessible in order to not endanger the deeper structures underneath.

1. How frequently do you perform excisional lymph node biopsies in the neck? 2. What are the potential causes of this type of complication? How would it occur? 3. In a patient with new post-op weakness, when should a MRN (MR neurography) of the brachial plexus be ordered and when should the patient be referred to a neurologist for an EMG/NCS? 4. Under what circumstances would you refer this type of patient to a neurosurgeon or peripheral nerve surgeon for brachial plexus exploration and possible neurolysis?

Patient With Infection Develops Severe Muscle Atrophy

Location, NJ BS/MD, Medical School of Tunis Internship, Internal Medicine, University of Pennsylvania Residency, Neurology, Temple University Fellowship, Electromyography/Neuromuscular Disease, Harvard University Fellowship, Neuroinflammation in Neurodegenerative Disorders, Drexel University Board Certified, American Board of Psychiatry and Neurology Published, 50+ reports, 6 books, 160+ abstracts Former, Adjunct Assistant Professor of Neurology, Drexel University Current, Associate Professor of Pharmacology, a major New Jersey university Current, Associate Professor of Neurology, a major New Jersey university Current, Attending Physician, at major hospital in the Tri-State region Current, Director, a muscular dystrophy clinic Current, Director, an electromyography laboratory Current, Director, a peripheral neuropathy center

This expert has reviewed 40 previous cases.

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Genetic Counseling Expert Discusses Implications of Inaccurate Test Results

Hotel Guest is Seriously Injured by Folding Shower Seat

Patient With Infection Develops Severe Muscle Atrophy

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