Pots: Interferring With Work - Now Adding Stress

[iheartcats]

I've had to take about 1/2 of my time off already and it's not even May. So now I have to meet with HR about how we can handle my upcoming appointments/time off for illness/cardiac rehab? etc in a fair manner.

1. I've read that FMLA can be taken in small increments The FMLA Web site mentioned you can take it for days for 'ongoing therapy/treatment' which, I would presume, includes Cardiac Rehab/doctor follow-ups/etc. This would give me more protection with keeping my job.

2. They've occasionally let me work from home when I'm exhausted (as I'm much worse in the AM), but this may be going away. I probably did it three to four times a month and it helped tremendously. But without this I'll be dragging myself in on 'bad' days and am afraid I'll just get worse and worse. But I need my job, so I may have no choice...just drag myself in no matter what.

3. They don't know about part-time (say 4 days/week work). This is a possibility, but I don't think it's highly likely. They also have to discuss if the workload here could handle me at 4 days week for 3-6 months (ie, can they accommodate that and balance everyone's work loads?) So that's scary. If it comes to that I might not have a job if I have to go part-time!

4. They mentioned using all my Paid Time Off and then going for non-paid days (instead of working from home) when I'm really sick. I wouldn't be able to do it much (don't want to push the limits) but at least I'd keep my job. I did mention I have one family event I have to go to this year...and they seemed understanding about that.

Any suggestions of what to go into HR with? They are going to tell me what they need from my doctors (and my doctors are aware of my very bad days, fatigue, etc).

Thank you so much. At a time when I don't need stress this comes up.

[Angelika_23]

Hello,

As a fellow POTS person, and an HR Coordinator, maybe I can help you out.

If your company has over 50 workers - and you have had one year of employment and worked 1,250 hours in the past 12 mos, then you are eligible for FMLA. FMLA can be taken continuously, or in increments (intermittently). I have had to use my FMLA time with my job. I used it for about 3 weeks continuously, and then after that intermittently. After months of using FMLA intermittently because I couldn't (and still can't) work an 8 hour day, my boss agreed to let me go part time.

You would need to get a certification of healthcare provider form filled out, and your company's request for leave of absence form as well. Since your condition is 1. a chronic illness and 2. will require ongoing treatment, you will not having any problem getting the medical part approved. Your company could decide to move you to an alternate position, with equal benefits and pay, if they so desire.

You are entitled to FMLA, it is there to protect your job. I would not let your HR department talk you out of using FMLA. If you used only 8 hours a week FMLA, it would take a long time to build up to 12 weeks. Your job would be protected the whole time (unless you were calling off for other reasons, or did something else to jeaopardize your job).

Angela

[deucykub]

Hi, Cat Lady:

I have been right where you are now, and it is terrifying. I truly hope you are able to work out a reasonable plan with your employer. I asked for accommodations back in July 2006, ended up in a 20 month battle, and was just forced out in a disability retirement (at 33 years old). Most people are probably willing to help; unfortunately, my supervisor was inflexible and unempathetic, and she had no problem with breaking laws. I'm now in a lawsuit with my employer (the federal government) for over $80,000 in back pay because they blocked my access to the workplace.

Mine is truly a worst case scenario, and the chances of something like that happening are really slim. If, however, you sense any red flags in your conversation tomorrow, get an attorney ASAP. My case would have gone much better had I involved an attorney sooner (I waited 10 months).

There is a lot of really good information on the FMLA and reasonable accommodations in this thread:

http://dinet.ipbhost.com/index.php?showtopic=8579&hl=

The best piece of advice I can give is be very careful disclosing information about your medical condition. If you seem too ill, they can claim your are incapable of performing the "essential functions of your position" which makes you unqualified for the job.

I am wishing the very best for you in your talk with HR.

[iheartcats]

I truly thank everyone for their help.

One unfortunate thing is I'll not be here 12 months for a few more months. I was at my last job for years, of course, without a problem!

So I don't have much 'job protection' and that does really scare me. I don't know if there is anything I can do in my case, then, because FMLA hasn't kicked in.

I'm really at the graciousness of my employer, then, and may just have to 'suck it up' at least until my year sets in?

I really will be careful about what I say in the meeting then...oh my.

[deucykub]

Hi, Cat Lady:

I'm not sure about FMLA but Reasonable Accommodations require no vested time. In fact, an employer is required to provide them even to those interviewing for a job. There is protection for you under Reasonable Accommodations, and most employers will try to comply to avoid lawsuits (if not out of the goodness of their heart ).

Did HR request the meeting because you used 1/2 your paid leave, or did you request the meeting? If HR requested the meeting, that might give you some insight to their position.

EDIT: Adding Equal Employment Opportunity Commission's (EEOC) definition of "Reasonable Accommodation:"

Reasonable accommodation is any change or adjustment to a job or work environment that permits a qualified applicant or employee with a disability to participate in the job application process, to perform the essential functions of a job, or to enjoy benefits and privileges of employment equal to those enjoyed by employees without disabilities. For example, reasonable accommodation may include:

- providing or modifying equipment or devices,

- job restructuring,

- part-time or modified work schedules,

- reassignment to a vacant position,

- adjusting or modifying examinations, training materials, or policies,

- providing readers and interpreters, and

- making the workplace readily accessible to and usable by people with disabilities.

An employer is required to provide a reasonable accommodation to a qualified applicant or employee with a disability unless the employer can show that the accommodation would be an undue hardship -- that is, that it would require significant difficulty or expense.

ALSO - EEOC Guidance on Reasonable Accommodations: http://www.eeoc.gov/policy/docs/accommodation.html

[iheartcats]

Thank you for this. I have not heard of this, actually.

They initiated the meeting, but I will not have it until next week. I won't bring this up, though. I want to hear what they have to say, digest it, (come back here for advice?!)...and go from there.

I wish it would just be over with. I hate the waiting!

[deucykub]

Waiting has got to be the worst part. I feel for you!

You are very wise to not mention anything about reasonable accommodations at the start. It tends to make visions of lawsuits dance in the heads of the narrow-minded.

Be confident that the law is on your side, and you and your right to work are protected.

There are lots of ideas that could help you work, and showing a willingness to accept anything that works would probably be to your advantage. Of course, this is not legal advice, just a friend from far away who has been through the system.

One thing you might not have considered is working from a reclining chair in the office. For many of us POTSies, that helps our bodies last through the day by relieving the gravitational stress on blood flow.

The most important thing I can stress is "bite the bullet" and just talk with an attorney. I didn't think I had the money to early in my process, but looking back, I would have much rather lost $300 on a consultation (if it wasn't free, and even if it meant paying a few bills late) than the $80,000+ that I've lost now. An attorney can offer you advice on the best way to talk to your employer/HR rep and will probably set your mind at ease, too.

[ajw4790]

What kind of attorney etc. do you find for this kind of thing? How do you find a reputable one? Would this work for education as well as in a job situation?

Thanks!

[deucykub]

I'm sorry - I have no idea what laws apply to education. Here is a link to a guide on disability laws, though. It might give you a place to start? http://www.ada.gov/cguide.htm

Our union referred me to my attorney, but if you run a search for "disability discrimination attorneys" or "reasonable accommodation attorneys," you should be able to find attorneys in your area. I'm not sure about how to determine if an attorney is reputable other than to talk to him/her and maybe call your local Better Business Bureau and/or search his/her name online. Typically, I think attorneys that represent these types of cases practice employment or labor law.

[iheartcats]

This is all very helpful...I'm just practicing my poker face for the first meeting.

It's hard to keep emotions in check. I did talk to my cardiologist and he will write letters if I need them. One thing he notices with patients with POTS and other similar diseases is people often think they aren't sick...they look fine so they are just playing the system/it's all in their heads/etc.

That was very depressing to hear. I'd work 40+ hours a week and go to work 'extras' if I felt 100% again! It's not that I don't want to...but hardly anyone understands that.

[iheartcats]

Well... I won't know much of anything for more than a week.

I have to take in a list of 'limitations' from my doctor (not sure what this is?)...is anyone familiar with this? I know I have to have air conditioning at work and can't stand for hours on end. And we have air conditioning and I don't have to stand for hours. What else are they looking for? I don't want to back myself into a corner and out of a job.

I'm not eligible for FMLA for about five months. At this time I can:

1. Present the treatment plan and see if they accept or not.

2. Try to 'suck it up' and forgo treatment until FMLA kicks in and my job is legally protected.

My doctor thinks I can try some medicine (but I'm worried about a bad reaction) and needing time off even for that. When I get a flu or something I'm out for days...before POTS I 'rebounded' better. So that's part of my problem. I'm using up my vacation and sick time rapidly.

Thanks for your input.

[deucykub]

Hi, Cat Lady:

I'm a little concerned that your workplace is asking you for a list of your limitations. They are going the formal route, as opposed to the "let's talk about this and figure out what we can do together" route. When my workplace went the formal route, it was because they viewed me as a potential lawsuit instead of a person looking for help.

I would recommend before giving them a list of limitations (I'll explain what that is in a bit ) that you talk to an attorney and ask him/her to walk you through this process. Your workplace doesn't need to know you have an attorney, but trust me, your workplace has one and is getting advice from them. It is your right to have someone advise you on this very, very complex process, and I can't encourage you enough about how important it is to understand from a professional who is on your side how this process works.

The second thing I would recommend is if after a week or two they seem resistant to help, start looking around for a new friendly workplace. AFter 20 months of fighting to get help, I am finally taking this step, and at the start, I am informing them about what I need to work. There are a lot of compassionate people out there who know that having limitations doesn't mean you can't do a job. So far, I am receiving positive responses from employers about my needs. If you find a friendly workplace in advance, you can move to the new job, or at least have leverage with your current job if they want to keep you!

Limitations... oh what a joy. Legally, a workplace with 15 or more employees is required to provide accommodations if you have a disability (keep in mind this is a totally different law than FMLA and you are covered by it immediately). A disability is defined by the ADA as "Has a physical or mental impairment that substantially limits one or more major life activities."

Major Life Activities

* Examples of major life activities listed in the Title

I regulations include caring for oneself, performing manual

tasks, walking, seeing, hearing, speaking, breathing, learning,

and working.

* Other examples of major life activities include

sitting, standing, lifting, and mental and emotional processes

such as thinking, concentrating, and interacting with others.

Below is the list I gave to my workplace from my doctor - WARNING - THIS WAS TOO MUCH, BACKFIRED, and CONVINCED THEM I COULDN'T WORK. I had given less information previously, but they kept illegally pushing for more documentation. First they thought I wasn't sick enough; then, they thought I was too sick. But anyway, it gives you an idea of what limitations are.

Deucykub?s specific symptoms related to POTS are as follows:

1. Her persistent symptoms include disabling fatigue, nausea, memory and cognition difficulties, chest pain and tightness, cyanosis on exertion, and sleep difficulties. Her resting heart rate is higher than the average for her age group and is often tachycardic, exceeding 100 beats per minute.

2. On sitting for approximately an hour, in addition to her persistent symptoms, Deucykub symptoms progress to an increased tachycardia, with heart rates as high as 120 ? 125 beats per minute, moderate shortness of breath, acrocyanosis due to blood pooling (feet, legs, hands, and lips), palpitations, moderate nausea with some vomiting, disorientation, dizziness, diaphoresis, shakiness, and increased chest pain. If she remains sitting following the development of these symptoms, they will continue to increase in severity.

3. On standing, Deucykub immediately develops progressively worsening symptoms that include, in addition to her persistent symptoms, tachycardia averaging 140 beats per minute and frequently exceeding 160 beats per minute, severe shortness of breath, palpitations, severe nausea with some vomiting, gastrointestinal symptoms, severe dizziness, weakness, darkening of vision, black outs, ringing in ears, acrocyanosis due to blood pooling (feet, legs, hands, and lips), imbalance, shakiness, and mental confusion.

4. On standing for approximately 5 to 20 minutes, Deucykub develops Neurally Mediated Hypotension with severe presyncopal symptoms. Her blood pressure drops significantly, often as low as 70/40. If Deucykub remains upright after this blood pressure drop, she will faint. However, Deucykub knows to lie down immediately if this should occur to abort the oncoming faint. She has not fainted since the summer of 2000.

Due to these symptoms, Deucykub?s Major Life Activities are substantially limited as follows.

Sitting:

Deucykub can only sit for approximately an hour before becoming symptomatic, experiencing those symptoms described in number 2., above. Following the development of these symptoms, Deucykub must lie in the supine position until they are alleviated. If she can lie down immediately on becoming symptomatic for 5 ? 10 minutes, she can return to a sitting position for approximately two additional one-hour periods before she needs to recline or lie down for an extended period of time in order to recuperate. The longer she is sitting the worse her symptoms become.

Standing:

Deucykub becomes symptomatic immediately on standing, experiencing those symptoms described in number 3., above. If she lies down at the point those symptoms occur, she can alleviate those symptoms again in about 5 ? 10 minutes. However, on standing for 5 ? 20 minutes, Deucykub develops Neurally Mediated Hypotension as described in number 4., above, which would result in syncope if she was forced to remain standing. Following the development of these symptoms, which are even greater in severity, Deucykub must lie in the supine position for several hours, usually sleeping, to fully relieve her orthostatic symptoms.

Walking:

Deucykub experiences the same symptoms walking as she does standing (please see above). Walking also worsens her tachycardia, shortness of breath, and fatigue and results in hypotension. Approximately 100 feet of walking by Deucykub results in the shortness of breath experienced by a healthy person after 30 minutes of vigorous exercise. Deucykub is exercise intolerant, experiencing an exaggerated decline in her health for days following periods of exercise. However, we encourage her to exercise as tolerated to help avoid deconditioning.

Breathing:

When in the upright position, Deucykub experiences severe shortness of breath to the extent that her original diagnosis was severe, persistent asthma. On extended testing, Deucykub was found to have mild to moderate asthma, and the severity and duration of her shortness of breath was caused by POTS. The shortness of breath she develops in the upright position is exacerbated by any kind of exertion, including such limited activities as talking and walking.

Personal Care:

Because Deucykub becomes increasingly symptomatic in the upright position and on exertion, she is unable to shower. Deucykub bathes when she has the energy to do so but this exertion severely fatigues her, requiring a varying period of rest afterward before she can start her day.

Because of the exacerbation of her symptoms and the limited time she is able to stand, Deucykub cannot prepare meals more complicated than pouring a bowl of cereal or microwaving a pre-prepared meal. When she attempts to prepare a more involved meal, she becomes severely symptomatic and again must rest in the supine position to alleviate her symptoms.

House Care:

Because of the symptoms she develops in the upright position, Deucykub is substantially limited in her ability to perform most household tasks. She cannot fill the dishwasher in one attempt due to the concomitant symptoms on standing. She can vacuum one room in her household before becoming too symptomatic to continue. Laundry can only be completed in multiple steps over multiple days: sorting her laundry on the first day, washing and drying a load the next day, folding the laundered clothes the day following, and so forth.

Attendance:

Due to the disabling nature and severity of her symptoms and fatigue, there are days that Deucykub will not be able to work. However, with a flexible schedule and ample teleworking, it is my hope that she will soon able to return to an 80 hour bi-weekly work period as detailed below.

Reviewing Deucykub?s position description, it is my medical opinion that she is able to perform the essential functions of her position with minimal accommodation. Areas where she requires accommodation to perform her job follow; however, she is fully capable of performing the duties listed in her position description.

1. Extended periods of sitting ? this can be accommodated by allowing Deucykub to telework from home in a reclined position and granting periods for her to rest and lie down. Her ability to work in the office is quite limited but would be enhanced by her having easy and discreet access to a recliner in her work area.

2. Standing ? Deucykub should not stand for any extended periods in the workplace.

3. Scheduling ? Deucykub?s ability to work varies from day to day. Her symptoms are currently quite severe and can develop even after a few hours in a reclined position. This limitation can be accommodated by granting Deucykub a ?Maxi-Flex? schedule, which as I understand it, allows her to work any hours between 6 a.m. and 6 p.m., Monday ? Friday, and keeps her from having to use leave if she completes 80 hours within a two-week period.

4. Driving ? Deucykub should avoid driving a vehicle for periods exceeding 30 minutes and may require alternate transportation for longer trips.

5. Time to complete tasks ? Due to her symptoms of fatigue, mental confusion, and cognitive difficulties, Deucykub may require additional time to complete tasks; however, I do not anticipate that her ability to do so will be delayed to the point that it will negatively impact her workplace.

--------------------------------------

.... Anyway, I hope that will help give you an idea of what they are looking for. Again, don't go so severe that they say your condition can't be accommodated. It's quite a balancing act!

Really, really, really PLEASE consider talking to an attorney.

I am hoping for the best for you! Please keep us updated on your situation and how things are going at work.