Monthly Archives: June 2010

How to Keep It Safe When You Soak Up the Sun

It’s finally summertime. We’re all looking for things to do to keep busy in a safe way, and yes – to get out of the house!

Here are some quick tips on how to enjoy the summer sun while playing it safe:

•    Skin Protection – When we plan those day trips to the beach or lake, we generally remember to bring proper skin protection like sunscreen and hats. But what about when children are just playing outside, when you’re hanging out by the pool or when you spend the day at an amusement park? Don’t forget skin protection at every summer outing, and opt for sunscreen that’s at least SPF 15.

•    Drinking fluids in hot weather is key. Water is always a good choice, but if you’re looking for variation, electrolyte solutions like Gatorade or Powerade are also great options. Just keep in mind that most sports drinks are not sugar-free, so if you or your children are diabetic, it’s better to drink the sugar-free versions or just stick with water. To keep your drinks cool while you’re out and about, try freezing them beforehand.

•    Keep track of how long you and your family are outdoors. You may not think you have been out very long, but you can quickly get sunburned or dehydrated.  Remember, if everyone else is perspiring and you aren’t, you may already be dehydrated.

•    Cool wet towels can be draped around your neck to keep your body at a healthy temperature.

•    Pets – You may be cool, but don’t forget your pets! Make sure they have plenty of water and shade.

Let’s all go outdoors and enjoy the summer! Just remember that a little preparation can go a long way to prevent common summertime hazards.

Race you to the pool!

– Alesia J. Wagner, Regional Medical Director, Southern California

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Businesses, Employees, Marijuana and the State of California

California now finds itself with hundreds of Medical Marijuana Dispensing Clinics and is set to vote on legalizing it completely in November.

Yet its citizens still lose jobs over marijuana positive drug screens.

So is a Medical Marijuana Card a “Get out of Jail Free Card”; or is it worth about as much as me giving you permission not to pay your taxes?

The only straight forward part of this is the law.  It starts with the Federal Government, and the DEA.   Marijuana is still listed as a Class 1 drug with LSD, Heroin and several others.  That means a doctor can’t prescribe marijuana under federal law.  Despite all arguments, unless that changes the whole California initiative may be a bit of a moot point.

Marijuana is compared to alcohol all the time.  But this is fundamentally a false comparison.  Alcohol does a lot of bad things, but is a legal drug.

The big difference between alcohol and marijuana is verifiability.  A breath alcohol or blood alcohol test can easily determine if you are impaired by alcohol.  It is inexpensive and very reliable technology.  There is no way to reliably determine if someone is impaired by marijuana.  And there lies the rub.

Everybody agrees marijuana distorts the sensorium, otherwise what’s the point.  Right this minute most large employers, private and federal, state and local, fear most that an employee can’t be proven to be impaired or unimpaired.  This uncertainty clouds this issue like uncertainty affects the stock market (negatively, with a vengeance).

So the future of marijuana is not dependent on its many physiologic effects.  Rather it is dependent on the development of technology to monitor its use.

– Dr Don Bucklin, National MRO, AKA “Dr B”

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Laughter is the Best Medicine…Really

How many times have you heard that?

Did you know that there has been research done to show the benefits of laughing? Humor is infectious! The sound of people laughing is more contagious than any cough, sniffle or sneeze. And, when laughter is shared, it helps bind people together, increasing happiness and intimacy.

You might wonder why I was thinking about this. Last night, my husband and I went to see the new movie “The A-Team.” For those who remember the 1980s, this was a pretty popular television show featuring George Peppard, Dirk Benedict and Mr. T. Everyone remembers Mr. T, with his Mohawk and favorite saying “I pity the fool!” or the Hannibal Smith character saying “I just love a plan when it comes together.”

When we arrived at the theater, I had a slight headache and could have easily gone to bed early. Despite feeling sluggish, I thoroughly enjoyed the movie. It was laugh-out-loud funny combined with major action throughout the whole thing. At certain times, I had tears in my eyes from laughing so hard.

When the movie was over, I realized my headache was gone and I was no longer feeling like I wanted to go to bed. I was upbeat, laughing and smiling. The people in the theater seemed to feel the same way because when the movie ended, people cheered and clapped.

I decided to check into the benefits of laughter. Check this out:

Physical benefits of laughter:
•    Boosts your immunity
•    Lowers stress hormones
•    Decreases pain
•    Relaxes your muscles
•    Prevents heart disease

Mental health benefits of laughter:
•    Adds joy and zest to life
•    Eases anxiety and fear
•    Relieves stress
•    Improves mood
•    Enhances resilience

Social benefits:
•    Strengthens relationships
•    Attracts others to us
•    Enhances teamwork
•    Helps defuse conflict
•    Promotes group bonding

Laughter releases endorphins. These are the body’s natural “feel-good” chemicals that promote an overall sense of well-being and can temporarily relieve pain. A good hearty laugh will relieve physical tension and stress, relaxing your muscles for as long as 45 minutes. In addition, laughter improves the function of blood vessels and increases blood flow, adding protection against heart attacks and other cardiovascular problems.

So, next time you are looking for something to do, try laughing. Find a comedy club, watch a funny TV show or movie or try telling jokes. Even the failure to tell a joke well will usually get your friends to laugh.

Here is my prescription: laugh as many times a day as you can…and share it with others!

– Alesia J. Wagner, Regional Medical Director, Southern California

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A Mechanic’s View of a Healthy Lifestyle

Consider your car for a moment.  It is a very complex, precisely manufactured and carefully assembled machine.  If you really think about it, the modern auto is nothing short of miraculous.  Does any one human being even understand all the workings of a car?

The same rings true for the human body, but interestingly enough, people are more willing to take better care of their cars than themselves.  Maybe it’s because the car came with an owner’s manual.

So here is a quick overview of my owner’s manual for bodies.

Guarantee: Probably 40 years, bumper to bumper. After age 40, things get a bit dicey.

Proper break-in procedure: I think we all took care of the break-in during our teen years. Some of us did not break in our bodies carefully, we over-revved our motor, and it hasn’t ever run well since.

Like your car, the body has limited annual maintenance and much more comprehensive service at less frequent intervals.  Annual service included an examination, checking high cholesterol and sugar.  Comprehensive service is on a schedule not too dissimilar to the 15, 30, 45 and 60k your car is on.

Like your car, comprehensive service becomes more involved and expensive as the body ages.  This service may include an EKG, mammogram or colonoscopy (think of it as a radiator flush).  What about owner-performed maintenance?

Some recommendations:
o    Don’t smoke
o    Get some exercise
o    Wear a seat belt
o    Stay trim
o    Get in a relationship (married people live longer)
o    Eat little red meat and lots of green vegetables
o    Keep blood pressure normal
o    Keep cholesterol normal
o    Try to be happy

What is surprising is what didn’t make the list – a whole bunch of stuff that isn’t proven to make you live longer, “good stuff” like organic foods, 98% of vitamins and herbs at the vitamin store, stretching and self-help programs.

Another idea that people hold dear is doing extra of one thing so you can skip another one entirely.  An example: Have you ever seen someone light a cigarette after leaving the gym? A certain amount of exercise is essential, but extra exercise does not detoxify nicotine.

And the notion that “Smoking/fast food/ (insert unhealthy vice here)_ makes me happy” is not taking a step toward longevity.

We all need to take better care of our bodies than of our cars.  Attend to these basic recommended owner-performed maintenance items, and your body’s engine should run long and prosper.

– Dr Don Bucklin, National MRO, AKA “Dr B”

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Expert predicts serious health effects from Gulf oil spill

This week, U.S. HealthWorks’ Dr. Donald Bucklin, AKA, “Dr. B,” was on ABC 15’s (Phoenix) morning show talking about the risk faced by workers cleaning up the oil spill in the Gulf.

For those closest to the spill in the boats, Dr. B warns that symptoms can include:

Short -term health hazards

Respiratory problems
Skin and eye irritation / rashes
Loss of coordination
Heat illness
Memory, hearing or color vision loss

Long-term health hazards

Kidney damage
Liver damage

Symptoms include:

Coughing / throat irritation
Redness / swelling of skin

You can watch the segment here.

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Quality Medical Care and Affordability – Wish List or Reality?

One cannot turn on the news without hearing about the need to have Quality Medical Care at an Affordable price.

Quality and Cost-effectiveness – can they co-exist? What are the issues that truly drive the costs of medical care?

To answer these questions, one must first define “Quality” and “Affordable.” The American Medical Association and the American Academy of Family Physicians defines Medical Quality as the degree to which healthcare systems, services and supplies for individuals and populations increase the likelihood for positive health outcomes.

But defining “affordable” is much more difficult.

Are we looking at the actual cost of each individual item in the healthcare delivery system? Or are we looking at the total cost to get the expected positive outcomes?

What is considered a positive outcome? To the patient, it can mean a cure, control of a condition with prevention of complications, or palliation. To the physician, it’s the ability to improve their patient’s quality of life, hopefully extend longevity and prevent disease, while making certain they follow their most basic of tenets: Do No Harm.

To the entity paying for the healthcare service (whether insurance company or the firm’s self-insured fund), a positive outcome means that cost is managed effectively. And if this patient is injured in the course of their employment, the employer considers a positive outcome to include returning their injured worker to his/her baseline pre-injury state of function, while limiting lost work time and permanent disability.

The cost of providing even the most basic of medical care continues to increase.  For physicians, expenses are increasing. Yet, it is a known fact that their reimbursements have either been stagnant or even decreasing.

Large governmental payors, like CMS (Medicare) and State Medicaid services, are decreasing their reimbursement to physicians. Most private insurance companies base their reimbursements on a percentage of Medicare.

While the money paid to physicians for care is frequently looked at as a large cost driver in medical care, there are many other cost drivers, including:

  • Employer commitment to Return to Work issues and transitional duty programs for injured worker
  • Relationships between employers, payors, and medical care providers, who specialize in workers’ compensation (occupational medicine)
  • Administration of medical care, including bill review and utilization review
  • Aging population
  • Increasing number of workers with chronic illnesses
  • Cost of prescription drugs
  • Medical errors
  • Diminishing number of physicians who are interested and/or trained in occupational medicine
  • Unrealistic expectations for outcomes
  • Issues of fraud and abuse
  • Issues of Lost time on the job, including temporary and permanent disability.

The aging population, along with the increased number of chronic illnesses in our population definitely drive the costs of medical care upward and can negatively affect the outcomes. Improving education for physicians regarding these issues is paramount.

Equally important is educating the general public on wellness and prevention. Of course, education is only part of the issue. Implementation is key. And, there is a cost for that. According to the Centers for Disease Control & Prevention (CDC) in 2005, more than one half of the American population lived with at least one chronic disease.

One would assume that improved education and information between physicians and patients, would allow us to reduce the cost of administering the healthcare. If physicians are compensated based on outcomes, the need to spend large amounts of monies on utilization review would diminish. This would account for significant savings.  If there were these savings, then there would not be the needs for bill review and the added expenses they incur.

This author believes we can have quality medical care that is affordable. But it requires focus in the following areas:

  • Produce and use better information for healthcare decision-making
  • Evidence-based medicine and outcome studies, including case durations and cost, disability management both in occupational and non-occupational environments
  • Appropriate use of technology
  • Reduce medical errors
  • Advance primary care
  • Electronic Health Records implementation
  • Promote wellness and enhance prevention efforts
  • Reduce the number of chronic diseases
  • Help population to address needs/issues in their control
  • With increasing use of electronics in home and work environments, include ergonomic education for prevention of injury
  • Align financial incentives with health quality and efficiencies
  • With the above in place, decrease the costs of administration of healthcare dollars

Quality medical care at an affordable price can be a reality as long as the medical providers and payor community work together with the patients to provide the best care without unnecessary intervention in the form of paperwork or frivolous case reviews.

Together the three parts of the equation can work together for the best outcomes for all.

– Alesia J. Wagner, Regional Medical Director, Southern California

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Can Dogs Relieve Stress?

At. U.S. HealthWorks, we generally encourage our patients to keep healthy through proper nutrition and excercise.

But there are some things that go beyond that textbook advice that help our health tremendously.

My husband I have two dogs, Razz and Kipah. There’s nothing that makes me feel as great as when I’m sitting with Kipah on my lap, her head resting on my laptop, or when I’m snuggling under the covers with Razz.

I regularly take my dogs for walks, which not only helps me “de-stress” but also gives me some exercise.

I was reading this article recently, and research shows that having a dog actually lowers high blood pressure, reduces anxiety and stress, and improves general health.

“Dogs help us psychologically,” wrote Toyoharu Kojima, author of Legacy of the Dog. “Tests have shown that walking a dog, or just having one as a companion, effectively helps speed recovery from an illness and aid in rehabilitative efforts.”

The article also notes that a UCLA researcher studied 1,000 elderly people and found that those who owned a dog required 20 percent less medical care than people without a pet.

So if you’re looking for additional ways to keep healthy, getting a dog might just be the solution.

– Alesia J. Wagner, Regional Medical Director, Southern California

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The Simple Facts about Drug Screening

We live in a drug screen world. 

Almost all employers have questions about drug screens.  Are they reliable?  Are they easily beaten?  What does a positive drug screen tell you, and not tell you?

Let’s start with Internet lore:

The Clean Out. This is a very old medical idea dating back to Hippocrates.  It is emotionally appealing, the idea you could take something that would magically clean out the bad stuff.  If this existed, we would use it to rid you of nicotine in your lungs or cancer cells in your body.  It is myth.  There is no chemical that cleans you out.

Chemical Additives to Urine. These are strong oxidizers.  Think of dumping chlorine in a pool.   Chemical additives would indeed make urine as clean as pool water.   Fortunately, like chlorine in pool water, these chemicals are easy to detect.

Dilution. This is also much talked about. We all have experience with dilution: urinate after hard work in the summer and urine is dark yellow; urinate after a couple of glasses of iced tea, and it’s mostly water.  So we are discussing dilution by drinking lots of water before the test (not adding tap water to urine).  This is rarely helpful to a donor trying to avoid detection.  Most positives are not borderline positive, they are very positive.  The only time over hydration might help a donor, is if the donor’s specimen is positive by only a couple of nano grams   A dilute specimen can always be recollected.

What information does a urine drug screen deliver? The most common question I am asked is: was the donor impaired?  A urine drug screen identifies drug use, not impairment.  The amount of drug in the urine is not the same as in the brain.  A blood test needs to be performed to identify impairment.  Since recreational drugs are illegal, it is usually useful to know if someone is taking them.

So the bottom line is that the urine drug screen is a useful detection tool for identifying drug use; the results are dependable; and your employees are not crafty drug addicts who are beating the system – their results really were negative for drug use.

– Dr Don Bucklin, National MRO – AKA “Dr B”

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A New Frontier in Workers’ Compensation

From the Spring 2010 issue of the Journal of Osteopathic Physicians and Surgeons of California

By Minh Nguyen, DO

Look around and you see signs of a troubled economy everywhere – businesses closing, high unemployment numbers, and fewer crowds around shopping malls. No doubt businesses are struggling, and keeping costs down is a priority for businesses.

One of the areas where businesses are looking to contain costs is in workers’ compensation claims. As occupational medicine physicians, we play a significant role in helping employers effectively manage the care of their injured workers. Today’s environment provides us with an opportunity to reduce cost for businesses in the area of workers’ compensation without compromising the quality of patient care by incorporating a stewardship model of care.

Occupational medicine physicians serve as the steward of care for the injured worker. We are in the best position to facilitate communication, education, and participation of all stakeholders through this process. Being a steward of care requires identifying causation, secondary issues, and contributing co-morbidities while recognizing the behavioral and circumstantial realities as well as social and workplace issues.

At the initial visit, the treating physician establishes expectations including participation and compliance with the treatment plan. The treatment plan is re-emphasized and reviewed at every subsequent visit. Effective communication with the injured worker and the employer regarding expectations, responsibilities, and treatment plan is essential to getting the person back to his/her usual and customary job quickly.

The injured workers also need to be aware of the basic functioning and process of the workers’ compensation system. Understanding that the system’s ultimate goal is returning them to their pre-injured state, as well as knowing their rights and the limitations and strengths of the system, will help to reduce medical legal costs which represent a significant portion of the cost in workers’ compensation.

Over the past several years, the rise in California’s workers’ compensation costs has been attributed mostly to nonmedical costs and administrative costs. According to the Workers’ Compensation Insurance Rating Bureau, from 2005 to 2007, medical containment costs such as utilization review and nurse case management are up 51 percent, and medical legal expenses are up 59 percent during the same period.

Developing trust between the occupational physician and the injured worker by communicating all aspects of the care with the patient and involving the patient in the decision making process will help to foster a positive relationship that can help reduce unnecessary medical legal costs. Many studies have shown that legal costs are reduced when patients feel that their physician is empathetic towards them and has their best interests in mind.

Educating employers is also an essential role of the treating physician. Evidence has shown that early intervention and treatment of the workplace injuries and illnesses can positively impact outcomes. The treating physician has an obligation as the steward of care to educate the employer about this positive impact. Understanding the importance of having a return to work program is crucial. An injured worker is much more motivated to get healthy whey they stay in the work environment through return to work programs.

However, it is imperative that the occupational medicine physician communicates effectively regarding specific work restrictions. Restrictions should clearly define the functional capabilities of the injured worker. This will ensure that the injured worker will not be endangered while enabling them to still meaningfully contribute to their work place.

The occupational medicine physician is in a favorable position to exert positive influence on all stakeholders in the process. The measure of success is heavily dependent on good outcomes, and therefore delivering high quality of care is of the uttermost importance.

Evidence based medicine should be the standard of care, with recognition that each patient is an individual and that variance from common treatment guidelines may be needed in some cases. Practicing occupational medicine consistent with the American

College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines as well as other established occupational standard of care provides the foundation for an effective treatment plan in accordance with best practices. Adjusting treatment plans as needed based on progression or regression of the condition through frequent communication and re-evaluation of patients is important.

The stewardship model for treating the injured workers seems simple, yet sometimes the simplest things can be the hardest things to accomplish. According to the Work Loss Data Institute’s 2010 State Report Cards for Workers’ Comp that was released March 15,

2010, California Workers’ Comp scored a grade “D” based on the state’s performance from 2000 to 2007. The report card provides five different outcome measures in the areas of incidence rates, cases missing work, median disability durations, delayed recovery rate, and on key conditions and compares the results among the states for each year.

There is room for improvement. The occupational medicine physician serves as the bridge between the health care sector and the business sector. This unique role of the occupational medicine physician can help reduce costs for businesses while maintaining the highest quality of care in this time of economic challenges.

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Did the ‘Sex and the City’ Crew Get Travel Vaccinations?

Recently, I went to the movies to see “Sex and the City 2” with my husband, who surprisingly enjoyed the film as much as I did. In the movie, Carrie, Samantha, Charlotte and Miranda travel to Abu Dhabi for an exotic, all expenses-paid getaway.

While the movie naturally made international travel look luxurious and easy, it got me thinking about all of the steps folks should take when they travel to foreign countries.

At U.S. HealthWorks, we offer medical guidance when it comes to international traveling, such as administering the appropriate vaccines. Travel medicine is an important part of any trip outside of the United States, as it can help prevent deadly overseas diseases. We also help patients if they have any questions regarding what medications they should take with them on their journey.

Vaccination isn’t the only important health concern when it comes to traveling abroad. As the “Sex and the City” women saunter through the sweltering desert on camels and later sip on fancy cocktails, I thought about how in real life, heat illness is a probable hazard. Alcohol can lead to dehydration, so rather than throwing back cosmopolitans like the leading ladies, you should instead choose the less sexy option – water or electrolyte drinks.

So while your next foreign getaway may not be as extravagant as the one in the movie, who says there’s nothing more in style than international travel that’s safe?

– Alesia J. Wagner, Regional Medical Director, Southern California

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