Best of Our Blog: Rusty Nails and Working the Late Shift

We’ve culled through the statistics and pulled together some of our most-read blog items since we launched. Below are two of the favorites.

Rusty Nails, Dirty Wounds and Tetanus

This morning I heard a newscaster lament, “I was cut with rusty metal, and there is a national shortage of tetanus vaccine.”

Despite his concerns, this is not exactly certain death. Growing up in Southern California, I spent most of my youth barefoot, tangled with more than a few rusty nails and was on the tetanus-shot-a-year plan. This experience prompted an interest in the whole rusty nail tetanus connection.Read more

Working the Night Shift and Getting Enough Sleep

The struggle to get adequate daytime sleep when working nights is familiar to many of us. In fact, 15 million workers – or 20% – of the American workforce work other than the typical 9 to 5 shift. Some are swing shift, some graveyard and some even rotate shifts between days and nights. Many people simply do not acclimate to this unnatural pattern of waking and sleep. The resulting sleep deprivation leads to increased short-term illness and long-term medical problems. A much higher incidence of accidents and mistakes are associated with sleep deprivation. The loss of productivity alone is estimated to be in the billions of dollars.
Read more

Bed Bugs: Hazardous to Your Health or Just an Irritating Insect?

Bed bug infestations seem to be on the rise. So much so that some hotels are now putting warning cards on their rooms’ nightstands – tips on how to identify and avoid the little critters.

Just the mention of this unwelcome little parasite is enough to make many adults itch, so a small dose of fact may help dispatch this goblin.

What Exactly Are Bed Bugs?
They are insects; small but easily visible to anyone looking. They are brown in color, a half inch long and 1/8th inch wide. They usually hide during the day and are active at night. Having an exoskeleton, they must shed their skin, like a snake, to grow.

photo © 2009 lauren | more info (via: Wylio)

This is handy to know because the shed skin will be lying around and is more easily found than the hiding bed bugs. They live for about six months and reproduce with the usual enthusiasm, as is common in the insect world.

These little guys are blood suckers, like mosquitoes. In fact, they share many characteristics with mosquitoes. Both species are attracted to carbon dioxide in your exhalation and both favor feeding in darkness. The bed bug pierces the skin with a feeding tube, injects a little fluid that stops blood clotting, and sucks up their dinner a.k.a. your blood. This occurs infrequently, once or twice weekly, and the amount of blood taken is microscopic, so you don’t need to worry about anemia or bleeding to death.

During World War II, bed bugs were almost universal. In a short time after the war, bed bugs were almost eradicated. This great victory was made possible by the liberal use of DDT (yes, that DDT). Looking back, one might wonder if the treatment was worse than the disease. Now DDT is gone (almost), and bed bugs are back. Don’t make an emergency trip to a third world country to buy some DDT, however – other insecticides are much less toxic and still do the job.

How Do People Get Bed Bugs?
The eggs are almost invisible. They cling to clothing, bedding and furniture. This is called hitchhiking. Using a piece of contaminated clothing or sleeping on contaminate bedding can transmit the infestation. My 12-year-old daughter is practically a poster child for what not to do. She does sleepovers among an ever widening circle of friends and is constantly trading clothes.

photo © 2010 Rick | more info (via: Wylio)

What are the Health Consequences of a Bed Bug Infestation?
The first thing to point out is the word infestation, not infection. The bugs are not living in you. They live in the bed and bite you once in a while. The worst heath issue is a serious case of “the willies” (that is a technical term for totally freaked out).

Other than the anxiety, bed bugs, at worst, give you a red blotchy rash that might itch a bit. Bed bugs are not a vector for disease. You will not catch malaria or HIV from bed bugs. The bite is almost painless and any itching or irritation gets better on its own.

How Do You Get Rid of Bed Bugs?
Dispatching the creatures is more pest control than medical. You need an exterminator, not a doctor. Bedding should be washed in hot water and bleach, and cloth furniture should be thoroughly vacuumed. The eggs are easily washed off during normal showering. Some insecticide that is less toxic than DDT may be applied in your home.

The risk of bed bugs to your heath is minor. Armed with a few facts, we are effectively immunized against the worst of “the willies.”

Take care,

Dr. B

Are TSA Scanners More Than Embarrassing?

As you may have heard recently, flying hasn’t been this exciting since the Wright brothers took off from Kitty Hawk.

That’s because now just getting through recently imposed security procedures requires considerable bravado. The new X-ray based devices give Transportation Security Administration (TSA) employees delightfully detailed pictures of your every physical nuance.

But what are the health risks of these new body scanners? Are they dangerous?

photo © 2008 Steve Jurvetson | more info (via: Wylio)

Interestingly enough, it is much easier to find a platitude than an actual value of radiation exposure for these scanners. Every official source having anything to do with the devices says that you get more radiation in an airplane flight at 30,000 feet in two minutes than in a backscatter scanner. But what in the world does that even mean?

As you probably suspected, radiation is bad for you. This is a rather recent discovery in medicine, dating back only 100 years. For those who still had doubts about radiation’s badness, 1945’s atomic bombing of Hiroshima and Nagasaki brought that point home.

The trouble with radiation, in any dose, is it can cause damage to DNA, which is pretty important stuff, maybe the most important stuff in the known universe. It’s literally the blueprint for your entire being. Damaged DNA can be non-viable or can even be the start of cancer.

The dose of radiation for a backscatter scanner has been measured between 0.005 and 0.009 milli-rem (mrem). This needs to be put in context. Background radiation is all around us, fortunately in low doses. We breathe low levels of Radon gas and spend time in the sun – both are radiation sources. For comparison, a chest X-ray is about 6 mrem, and a year of normal sunshine exposure adds up to a cumulative total of 60 mrem.

So the dose of radiation from backscatter scan is actually quite low. This scan adds some immeasurably tiny risk of cancer. The concern seems to be more a perception of risk, rather than actual risk. The average patient will happily undergo a chest X-ray, roughly 1,000 times the radiation of a scanner, when he has high fever, cough and can’t breathe. The difference between radiation from a chest X-ray and a scanner is perhaps the medical radiation dose gets you a good diagnosis and effective treatment. The scanner gets you nothing personally, unless you count not getting blown up.

Little doubt, the whole new security process will be re-thought, re-engineered and hopefully improved as more and more people voice their displeasure.

I can’t help thinking that a completely incompetent would-be terrorist, who couldn’t even blow up his underwear bomb, has altered the course of history.

Take care,

Dr. B

Have a Happy (Healthy) Halloween

It was a dark and stormy night…

I always wanted to use that line. It gets you in the mood for Halloween. This is my kid’s second favorite holiday and perhaps yours as well. It doesn’t require a lot of preparation, it’s good fun and it’s kind of a low-maintenance holiday. You are perhaps asking yourself where I am going in a medical blog post about Halloween – sugar comas, scare-induced heart attacks?

We will start with night vision. Trick-or-Treating isn’t much fun until after dark. Humans unfortunately have one of the poorest eyes for night vision on the planet. Night vision involves using cells in the eye called rods. These are sensitive, lower resolution cells with even more sensitive light cells called cones. Since rods are not in the visual axis (the middle), they give a rather shadowy view. The rods are rendered useless after bright light until they regenerate their light active chemicals. About 80% of your night vision returns after 10 minutes; the remainder takes a good 30 minutes to recover. So try to spend 10 or 15 minutes in low-light areas before you hit the streets with your candy bag.

Interestingly enough, red light doesn’t affect the rods (that explains the red light in the control rooms in all the movies), so you can get or maintain your full night vision when in red light.

With Halloween being in late October, it’s a time of notoriously unpredictable weather. In some areas, like where I live in Phoenix, a mask and costume can set you up for heat exhaustion. In other areas, the light-weight material used in costumes can mean hypothermia. Masks also help people fall off curbs because they produce tunnel vision. Add a little ice in northern climates, and broken wrists are not uncommon injuries Halloween night.

And how can we forget the candy. Fortunately, poisoned or booby-trapped Halloween candy is largely an urban myth. I have never met anyone who could tell me they saw such evil deeds with their own eyes. There probably aren’t a lot of alligators in the sewer either.

Of course, the main danger of Halloween is your kids eating so much candy they throw up on the carpet. How bad is Halloween candy for you anyway? The calorie counts show 6 candy corns are about 30 calories, a roll of Smarties is 25 calories, and of course everyone’s favorite, a single Reese’s Peanut Butter Cup has a whopping 80 calories (most of which are fat). It’s probably a good thing that Halloween occurs just once one a year.

To those who have Type 2 diabetes, the dangers of a candy binge are very real. A heavy sugar calorie load, which gets absorbed rapidly, will drive a diabetic’s blood sugar into the stratosphere. The blood thickens, and a hyperosmolar coma can follow. Candy should be avoided at all times by Type 2 diabetics, even on the holiday that celebrates with candy – sorry.

Despite all of this, Halloween is still my second favorite holiday. Keep in mind – Halloween candy is well wrapped and stays fresh for months, so there’s no hurry to eat it all in one night.

Trick or Treat,

Dr. B

Carpal Tunnel Syndrome Made Clear in 10 Paragraphs

Carpal Tunnel Syndrome (CTS) is an occupational medical diagnosis that often gives employers, patients, and sometimes even medical providers, undue levels of frustration. Like a lot of other things in medicine, reasonably simple concepts are hidden behind Latin words. You just need a basic understanding of how things are put together – in other words, anatomy.

Let’s start with the hands. The hands are absolute miracles of micro-engineering. They are capable of generating tremendous force, while being compact and delicate enough to pay a violin. They pull this off by putting the muscles that work the fingers in the forearm. These muscles are connected by cables, called tendons, to the fingers. Contract a muscle in the forearm, it pulls the cable (tendon) and moves the finger. I never fail to be impressed by the cleverness with which the human body is put together.

Because the muscles are in one place and the hand in another, the tendons connecting the two must pass through the wrist. Where they pass through the wrist is a snug fit, and therein lies the problem. The tendons pass through a “tunnel” in the wrist, made of the arrangement of the wrist bones (carpals). This tunnel is shaped like a “U.” On the sides and floor are bones, and the roof is covered by a thick, gristly strap. Through this tunnel is where 9 tendons and the median nerve pass.

These tendons and the median nerve normally peacefully cohabitate. They are probably doing that right this minute in your body. The tendons are surrounded by lubricated jackets (like a bicycle brake cable), so they slide through the wrist with ease. If the tendons should swell because the tunnel doesn’t stretch, pressure is put on the nerve, which sometimes shorts circuits.

Since this nerve supplies the thumb, index and long fingers with sensation, these are the areas that become numb. There is also shooting pains in the wrist from pressure on the median nerve.

The most important thing to realize about CTS is this is a dynamic situation. Tendons can get more or less swollen in a matter of a few days. Sometimes all it takes to reduce swelling is a wrist brace or a change of work duties. Sometimes it takes more effort involving medication (anti-inflammatories) and physical therapy. Occasionally a cortisone shot fixes the problem. As a last resort, we cut the strap (cut the gristly hood of the carpal tunnel). This allows more room for the tendons and nerve.

It is important to treat CTS sooner rather than later. Early on, it will be easier to get the swelling out of the tendons, and the damage to the nerve will be minor and completely reversible.

Why do people get CTS, or conversely, why don’t we all have CTS? There are wide individual variations on what it takes to get a case of tendon swelling in the wrist. Some people get swelling in their wrist after one month of doing repetitive work; others will never have a problem. We do know that you narrow the carpal tunnel when your wrist is in ulnar deviation. That makes it a tighter fit and probably contributes to CTS.

Ulnar deviation is bending your wrist to the side. If you are sitting at a computer, you are doing that right this minute. This occurs because the keyboard is narrower than your shoulders; so you have to bend you wrist in ulnar deviation to line up your fingertips with the keyboard. This has caused the development of “V”-shaped ergonomic keyboards, which can be very useful in treating or preventing CTS. I am using one to type this article.

 So CTS is more like a dimmer switch than a light switch. It comes in a great variety of stages. It is relatively easy to get some swelling out of a wrist and get someone healed at an earlier stage. The earlier the intervention, the more likely it will easily and quickly resolve.

Dr. B

Working for Safety

Injuries are the sworn mortal enemy of every safety manager in the country. Many companies see zero injuries as both an achievable and realistic goal, and an opportunity for cost savings. Some companies even try to keep their injury rate low by denying there are injuries. Proactive measures generally work out better.

Let’s break down various ways to prevent injuries in the workplace:

Built-In Safety
An engineering approach to injury prevention is used whenever possible. This approach is the most sure-fire. Like the airbags in your car, no operator action is required; the safety is built in. There are many examples of this in various workplaces – non-skid matting, saw guards and electrical grounding of machines. An engineering approach is often used after an injury calls attention to a problem. It’s even better to go through the workplace with a safety expert to identify problems and look for engineering solutions proactively.

Training
The next avenue of injury prevention is training. While teaching someone to pump their brakes in an emergency stop will never be as good as anti-skid computerized breaking (an engineering fix), trained individuals will do better than untrained ones. Some work activities are inherently hazardous, even with the best safety engineering. In these instances, training and retraining are the best you can do. The more involved and participatory the employee is in the training, the better the outcome. Training needs to be designed to help keep someone’s attention (we all know what it’s like to watch those dreaded training videos). Repetition also reinforces the training. In the best model, the information is presented at intervals and in different formats to avoid loss of interest. Live demonstration is the best. Show people exactly how to do something and then evaluate how well they do it on their own; give them feedback and help them properly adjust their body to suit the task. Specialists such as U.S. HealthWorks know how to perform these critical evaluations. Ask them or other similar experts for help.

Motivation
Motivation is also used for injury prevention. Motivation, however, sometimes seems to follow the law of unintended consequence. Offering a reward for no injuries in a given month or quarter both motivates employees to work safer and to not report their injuries. On the surface, this would seem to be desirable to the employer. Unfortunately, not all injuries heal properly without care; some get considerably worse, and will end up hurting the employee and his employer much more. So, motivation is useful, but it needs to be carefully considered to avoid unintended results.

Occupational Medicine Providers
Picking a good occupational medicine provider is also useful in preventing injuries. Some injuries are minor and need little more than some evaluation (attention) and reassurance. Your provider should have the expertise to determine whether these are first aid-only visits.

Always Report
Some employers do injury “prevention” by intentionally not reporting the injury. This is not without risk in several ways. The Occupational Safety and Health Administration (OSHA) can impose some daunting fines for those who deliberately avoid reporting an injury. The untreated employee’s injury could worsen, sometimes into something permanent. That is a tragedy for the employee and can be a legal battle for the employer for years to come. Even a late reporting of an injury can cause problems when it’s finally evaluated – the claim is likely a mess. The late report calls the patient’s integrity into question by the carrier and even the physician which could result in delayed care, further compounding the patient’s injury.

Injury prevention is an active field of research. There are experts in the field that can help you safely lower your injury rate. Having a good working relationship with your employees goes a long way to getting their support in this quest. Having a doctor you trust also helps.

Dr. B