John Cordisco Discusses Brain Injuries on WBCB

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Audio Transcript

Radio Host: Everything you wanna know about funerals, sort of paying scenarios, what if, how to take care of it. Mike Shiller does all of that and a heck of a lot more. In 40 some years experience and one of the things Mike that you do, is you network with a lot of people, a lot of different facets…

Mike: A lot of good people.

Radio Host: Yeah, right and you know the good ones from the bad ones too, I mean you’ve been around a long time and you become to rely on the people that can help the process along for you and so introduce.

Mike: John Cordisco, good morning John.

John Cordisco: Good morning Mike.

Mike: Is with us this morning and he’ll tell you what we’re gonna talk about he’s out there, but I did make the comment to John last time we spoke it’s just amazing how extensive the background work is on becoming or being a good attorney, which we regard John as definitely top shelf.

John Cordisco: Oh, thank you.

Mike: Your welcome. So what do you bring to us today John. You were in Tennessee a couple weeks ago and…

John Cordisco: Yeah, I was in Nashville for a national conference on brain trauma injuries, getting updates from the various leaders in their fields. Most of them, at this point, obviously the medical field and getting a better understanding of brain injuries. They are at this point considered the most disabling of traumatic injuries because they often lead to lifetime physical, cognitive, behavioral, and emotional impairments.

Mike: Okay.

John Cordisco: And I think with everything going on with the NFL and the concussions associated with them, with the players. That it’s brought this to the forefront and the attention of a lot more people within the medical community.

Radio Host: At the same time where does it go from there John, to when you discover and things like that, where does it go from there after that, for what you do?

John Cordisco: You know, it’s really interesting because in the past we kind of treated these like an event. Somebody gets injured and there’s a brief period of rehabilitation and doesn’t require much going into the future. In other words, let’s just say for instance you fractured a femur, so it heals usually for the most part, you get some therapy and you’re pretty much, pretty good. When you look at a brain trauma injury, it is more considered a disease today. As a matter of fact I have actually…

Radio Host: CTE then right? CTE I guess it’s called.

John Cordisco: Yeah, it’s… And according to the Journal of Neurol Trauma, this is pretty recent August of 2010, it says that it’s a chronic disease process and it fits the World Health Organization’s definition of having one or more of the following characteristics. It’s permanent, caused by non-reversible, pathological alterations, which require special training of the patient for rehab and may require a long period of observation, supervision, or care. We now know that the TBI, traumatic brain injury, it creates this long term mortality, it reduces life expectancy, it’s now been associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, psychiatric diseases, and as well as non-neurological disorders, none related necessarily to the nervous system. Such as sexual disfunction, bladder, bowel incontinence, and it’s pretty serious stuff.

John Cordisco: I gotta tell you at this point, I found that this conference was probably one of the most interesting, if not the most interesting I’ve probably ever attended. I got there and I had a head cold for three days, but I was in session from eight o’clock to 6 o’clock and I didn’t want to leave. It just was so fascinating as to…

Radio Host: Yeah and you’re probably also looking past that as well as a representative because it has more collateral damage in tentacles when you’re dealing with families of the victims too. So now you’re dealing with that as well and you’re talking about long term care and cost and everything else. You’re only just beginning really after that, right? So it’s…

John Cordisco: Yeah and it’s actually… Really it’s high end… With these types of injuries the individual physically kind of looks the same, the damage is done internally. So some of the triggering elements to determine whether someone is suffering from traumatic brain injury is the difference in there personalities over a period of time. I’ve had it where people have experienced these types of injuries and they almost act like they have Tourette’s syndrome. Whatever’s on their mind they say and they go from these, maybe congenial, very pleasant people to very nasty and very aggressive and they kind of act it out through this behavior. And then there’s a shift in their behavior once they realize that this is occurring, the concern is the control element, do I stop it and they subsequently become very depressed.

Radio Host: Families have a tough time getting a handle on it because they’re not dealing with the same person that they knew and loved for so long. That has to be quite a shock to deal with and have to sort of try to deal with that and it’s of course easier said than done.

John Cordisco: Very much because it’s something that either the spouse or the parents have very little knowledge associated with, especially probably in there own lives never seen it or heard of it. And then when it hits them they try to respond the same way that they would deal with to say that there was just an event that occurred, the individual was acting out from that event. There was something that they were told that was disappointing or, God forbid, something happened over the course of the day. But it’s not the case because the behavior doesn’t necessarily improve in a real sense. And sometimes obviously if it’s a pretty significant impact, an impact does effect the injury itself, but you see whether there’s some cognitive deficits that occur. There’s three really classifications they put into a mild, moderate, and severe and even today when they say mild it’s really fiction because if you have a traumatic brain injury, but you don’t have symptoms that put you in some type of really significant, disabling state, you still have the potential for a whole slew of things that may find themselves on your path of life.

John Cordisco: The increase in the mortality rate there, your loss of expectancy of life is a reality and it’s statistically been proven. You’re more likely to develop epilepsy and brain tumors, seizures, you just don’t know when they’re coming. You would think from the regular accident the injuries are immediate. In this situation, unlike any other, it is like I said more of a disease oriented situation where it could lay dormant for a year, two years, three years, and all of a sudden these things start to surface and there’s really no explanation.

John Cordisco: Yeah and it’s tough because you’re trying to educate the insurance community to the same situation because they say okay, an orthopedist they look at this individual or a family physician and so okay, physically they look fine, there’s nothing there that we can pin point that indicates that there’s any kind of continued suffering of any sort physically. However, mentally and emotionally there’s other stuff… Other things going on and now you can look at an MRI and get a sense of potentially where there may be a bleed on the brain, which to the brain blood is toxic. That’s what creates the permanentsy in the injury itself, but know you can look at an MRI and maybe not necessarily see that there was any significant bleeding or lesions that are brain… They now have this micro imaging that has come forth. Where they can actually find parts of the brain that are so microscopic, but still have the same effect, depending on where on the brain the lesions are found.

Radio Host: Yeah, one of the things too is the overall bigger picture now, the statistics are overwhelming that more than a third and probably be a lot more will have to care for a loved one sometime during their lifetime, in some manner or another, and it’s gonna get even more prevalent as the years go on and longer life spans or different kinds of things like you’re talking about will require. So eventually families will be drawn in in a lot greater numbers throughout the years, so you’re right there with all the stuff and having the most kind of knowledge or at least an attempt at remedy is gonna be very important for the years to come.

John Cordisco: Yeah. Someone who’s a traumatic brain injury has a two times greater chance of having dementia later in life.

Radio Host: At an earlier age too.

John Cordisco: Yeah.

Radio Host: Yeah, so…

John Cordisco: [inaudible 00:10:29] As we see with these traumatic brain injuries, the cost associated with them, which is the same as any other disease that we are treating cancer or the like. They made an interesting analysis, they said with cancer it kills an organ, it potentially can kill you, a traumatic brain injury kills the soul. And that’s pretty strong stuff when you stop to think for a minute because it changes who you are and at times doesn’t let you really control who you would like to be.

Radio Host: Yeah and it’s kind of shocking, sometimes you see on a national level where a pitcher for the White Sox simply collapsed in the dugout and had an aneurism and was fighting for his life and now thank goodness they were able to save him, but it came out of nowhere and pretty soon family’s scrambling, what do we do, his career is over, maybe it is, maybe it isn’t. But there’s a lot of things that go on in a short period of time and you’re trying to get them answers and direction at the same time. That has to be very difficult when something like that just pops up, like you say, at random. Something like that it’s just…

Mike: Sure. Then where do you go?

Radio Host: We’ll have to work on that, what are you gonna do?

Mike: John, did they talk about… Many times I’ve seen on a death certificate the cause of death is cerebral accident and right away the family’s alarmed that that meant the person hit their head or the nursing home didn’t watch mom or dad close enough and things like that may have occurred, but I believe that’s an internal, they’re referring to something happening internal. Where wires get crossed or vessels are basically clogged or whatever in the brain.

John Cordisco: Well it’s hard to say because each situation is different, but if their talking it’s cerebral their definitely associating it to the brain. What happens is… Well they actually had a miniature model of the skull and the brain itself, it’s almost like watching jello itself when you’re looking at the brain. It copulated into the skull and as you watch jello, you shake it, it doesn’t stop shaking once you’ve stopped. So the brain itself when it’s traumatized, it’s inside and it’s now bouncing around off the inner part of the skull and how severe that shaking or that trauma will impact as to what will eventually happen to the brain and whether there’ll be a bleed of some sort. Sometimes you have such a severe injury or fracture, usually if you see something that’s along the orbit, around the eye, those nose fractures, you’ll see them, that’s the frontal lobe there, but you’ll no question be able to pick it up on a cat scan. Whether it’s considered one bleed or another, but when it’s not there on a cat scan that’s where the problem lies because it still may be there it just isn’t visible on that imaging, that type of imaging.

Mike: What was your role John, amongst all the doctors and everything else. Where do you… Where did you come in as far as the knowledge is concerned and how to act or where do you go from the symposium that you’re at, now where do you go from here for you?

John Cordisco: Well, I think that this is gonna be something that were gonna see a lot of into the future and I wanna be ahead of the curve. So, I have done some serious traumatic brain injuries, cases in the past and I think it’s my responsibility as an attorney if I’m representing my clients and put forth that I do personal injury that I know as much as can be potentially known out there today and so that I can probably represent…

Mike: Guide them.

John Cordisco: And also maybe give some help and direction, relevant to treatment.

Mike: Is there a part of the country that’s more prevalent than others to have this kind of thing or climate, is there anything involved with climate or anything like that.

John Cordisco: Yeah. A lot of it’s, obviously the more traveled the area, so my guess is probably in the metropolitan areas you’re gonna see a much more higher rate than you would probably in the rural areas. But that would be my only guess there, but you know an interesting statistic is because of the brain trauma also effects the ability to get a good nights sleep. I mean, sleep disorder is one of the top effects of a brain trauma injury, you gotta say okay what’s the significance of that? Well, 56,000 people die a year in motor vehicle accidents due to somebody falling asleep.

Radio Host: Wow, yeah.

Mike: They didn’t get a nights rest, right?

Radio Host: Yep.

Mike: They just nod off for a second, yep.

John Cordisco: So know all of those people aren’t people associated with brain trauma injuries, but there’s a good portion of them which would be associated to that because sleep is obviously critical to your regular, everyday performance. If you’re not getting sleep at night, if it’s a continued pattern, you can’t control it, you’re driving down a road and all of a sudden boom. And now you’re causing even further damage to potentially, God forbid, you’re involved in an accident involving another vehicle.

Radio Host: Alright, well do you need a?

Mike: No, we can call it… You wanna take a break and come back?

Radio Host: Well, were gonna go to break John, but when we come back maybe you could give me a heads up as far as listening to families after a persons past away, where possibly they’ve been involved in some kind of trauma or they’ve slipped and fallen. I believe, I was told by a surgeon over at Saint Maries that after 70, 75 the matter around the brain starts to shrink and the brains actually more agile or more able to move around than it was when you were younger.

Mike: And then also susceptible to falls.

Radio Host: A sneeze, a sneeze could out you away.

Mike: Wow, alright.

Radio Host: Yeah, that bleeding he was talking about. So maybe you could give us some pointers, what we should look for when a family’s explaining to us what happened to Mom or Dad or their loved one.

John Cordisco: Sure.

Radio Host: We’ll do that when we come right back. Advertisement: Have you started to plan for the future? There are many things to do, prearranging for your funeral is one that should not be ignored. Pre-planning and pre-arranging with Galzerano Funeral Home is easy and simple. Host a pre-made gathering at your home or business, earn discounts and a 250 dollar Visa gift card. Call Mike Schiller today at 215-945-8484 to find out more on the Galzerano approach to advanced planning. Take the stress out of planning with peace of mind with Galzerano Funeral Home, call 215-945-8484. Call today to find out more. That’s Mike Schiller at Galzerano Funeral Home at 215-945-8484. Advertisement: Affordable, dependable, and quality water and sanitary services what BCWSA delivers to over half a million customers daily. BCWSA also offers pipe maintenance services for your home or business when dealing with something as minor as a sewer drainage or water supply problem. BCWSA is the utility of choice. Call BCWSA at 800-222-2068 or go to BCWSA.net. Your partner for a safer environment, BCWSA proven.

Radio Host: In the final segment here, everything you want to know about funerals, to know whom to ask Mike Schiller is here and also attorney John Cordisco is here as well. We kind of left the break, John with kind of a scenario where, maybe advanced age you worry about falls and stuff. Something, somebody who is very healthy at one time is no longer. So those are the kind of things that can happen in flash, so you have to deal with all sorts of different scenarios and work ups I’m sure.

John Cordisco: Yeah especially, and we do quite a bit of nursing home neglect cases as well. I think we have touched upon that in the last segment, but you run that risk, you say okay, folks that are elderly that for one reason or another find themselves in a nursing home. And it’s not to say all nursing homes are bad, that’s not the case. But accidents happen whether it’s a good nursing home or not. You’ll see something where there’s immediate response to somebody who’s commonly, they fall and there’s a fractured hip involved.

Radio Host: Yeah.

John Cordisco: I think where you don’t see as much attention is to check to see whether there was any kind of concussion that may have occurred.

Radio Host: There you go.

John Cordisco: Brain trauma.

Radio Host: That’s what I was trying to bring out.

Mike: I think you were trying, yeah.

John Cordisco: I think that families need to be much more cognitive of that possibility that okay Mom and Dad slipped and fell. First question, did they hit their head in the fall? And the answer to that question is yes, then they would want that Mom or Dad immediately sent to the ER for at least a CAT scan, to see if there’s any immediate, physical bleeding that they could see because that will kill you. It effects the brain, the brain will shut down obviously organs and Mom and Dad, unfortunately could pass away from something that the children weren’t even aware had occurred. And so you see, unless they did an autopsy, which very seldom would occur, unless there was some reason the coroner wanted to see or pursue, some other type of harm existed or abuse.

Radio Host: Right. Sometimes in cases, you don’t want to sound so sinnicle, but the facts are hidden there and you have to uncover. Like you said, somebodies trying to cover their own rear end and you have to deal with that as well, sorry to say, that’s the nature of the business every once in a while too, is it can be very unpleasant going for you as well.

John Cordisco: Well, I mean you gotta understand the one principle, which is when you have these hemorrhaging at a progression of a contusion, it’s called a HPC. That can contusion kind of marks tissues within the brain, essentially totally becoming unrecoverable loss of function, so when this occurs it is permanent in nature. So you may, good example, Mom and Dad may be in the nursing home and recovering from something else, let’s just say they fell at home and fractured their hip or whatever the case may be. Now they’re at the nursing home for rehab and something occurs and you see a change, a personality disorder, you see a change in their behavior where they could regress, they become depressed or they become aggressive. When you start to see those changes in behavior, that’s a warning sign, something has occurred. And like I said depending on what part of the brain has been impacted will pretty much correlate to what you’ll see in some of the changes in the behavior as well.

Mike: Right.

John Cordisco: But I think because I think at this point it’s more of a disease than event, people don’t really have the exposure to this type of an injury and therefore don’t know what to look for and I was hoping today with the show, like I said and even I’ll be much more involved in attorney conferences and talking to us and family physicians and having conversation and say hey you may want to take a look at these things just to make sure that you just don’t miss it. Because as you said where does the negligence begin and where does it end? Whose responsibility to identify it and then whose responsibility was it to treat it?

Mike: And the way you’re going you have to, you’re rattling old medical terms as if you’ve been in medical school, you have to be up on everything, the knowledge is the power. That’s what you’re looking to do.

John Cordisco: It’s amazing, they even did an interesting thing, a program on biomechanics. And interesting enough the fellow that did it is one of the top in the country, he’s from South Dakota state, he works with the Department of Defense. I had used him for a case 15 years ago, before he had all the accolades he’s getting now. In a case where a door at an airport, garage door had come down and struck a man and it knocked him down, requiring surgery in both shoulders. The argument that was posed by the airport was listen the door has sensors and it picks up anybody close by and this was his own negligence. I said well, if it’s supposed to pick somebody up, it didn’t pick him up, that’s why. They said, well even if it hit him it comes down so slow that the amount of impact would not necessarily knock someone down. So this guy comes in and I thought he was a little out there because he comes and puts kind of this space suit on and he gets his dummy, puts it underneath the door. He comes back and says yeah it’s the amount of pressure that’s exerted to the brain would unequivocally have caused this injury. We were able to show that their…

Radio Host: No question.

John Cordisco: Argument about the sensor was not accurate. The sensor, on the outside picks somebody up, the sensor on the inside would only pick up something that was like one of those mobile carts that was moving, it would not pick up a human.

Radio Host: Different ball game all together, no question.

John Cordisco: But this guy was actually showing us that you could get hit by a tractor trailer going 15 miles per hour. The amount of force that goes in is the amount of force that goes out. It may push you 15 miles per hour or whatever the weight differential may be, but it’s moving you at about .4, .5 seconds. So picture your body being thrown at 15 miles per hour in less than a second. So you then get an appreciation of just the effect that that has on the brain because there’s a space within the skull that is kind of like the inner coding there and then the and then you have the brain, so when it’s thrown or it’s hit with that kind of pressure. I mean, it’s just rattling around in there and the more the greater the impact you can then really attest to…

Radio Host: It paints a picture too.

Mike: Paint the picture and see whatever the significance of that brain injury may be.

Radio Host: Well, we probably have to get back and more than a few times get some updates here, but were just running short of time, but you’re out there working and educating the audience as well. Lot of great knowledge you bring and hope to get you back to do it again very shortly.

John Cordisco: Well, if there’s one thing I can leave your listeners with, whether it’s a child, a young child, an adolescent, a parent, or even a spouse. Someone involved in any kind of accident involving either a fall or a motor vehicle accident, watch them, watch them closely, it may be three or six months before you see something that is indicative, but most likely you’ll at least see something early on. If a change in behavior, a mood swing, a personality change, if that happens you should seek help.

Radio Host: You bet, alright thank you so much for the time. Mike, a final, should we wrap it up?

Mike: Thank you John, that was great. I’m glad you were like a sponge down there in Tennessee. It’s always nice to know you have somebody you can refer to so if I hear any clients that have second thoughts as to what happened to their loved one, we know who to call. Thank you so much.

Radio Host: Thanks John.

John Cordisco: Thank you, appreciate it guys.