Monthly Archives: July 2010

Sunshine – Friend or Foe?

Sunshine is necessary for human survival and the survival of every other plant and animal on the planet. But are we supposed to spend time in the sun or just enjoy the secondary benefit – that our planet isn’t a frozen ball of rock in deep space? The pendulum of medical opinion on sun exposure seems to swing regularly. We have all met someone with a deep tan who looks like a human Shar Pei at 45.

The case against spending time dozing in the sun, like a lizard, is strong. Sunlight has a lot of ultraviolet radiation. This radiation penetrates the skin and damages the DNA. Damaging DNA is a bad thing to do because sometimes the cells will die, and occasionally they will turn cancerous. Skin cancer is clearly associated with sun exposure. Unfortunately, the time your skin is most susceptible to sun damage is before you are old enough to read the sunscreen bottle. If that isn’t bad enough, ultraviolet radiation also breaks down the elastic elements in the skin. Destroy enough elastin, and you resemble that Shar Pei.

For the last 20+ years, the entire medical community has been yelling, “Stay out of the sun!” Then a funny thing happened – we started looking at vitamin D and cancer.

A bit of background. Vitamin D is made in the human body by sun exposure on your skin. The more intense the sun exposure, the greater the level of vitamin D produced. Doctors have known since the Mayflower that low vitamin D levels cause rickets. In modern times, most of us have seen skin cancer but never a single case of rickets, thus the advice, “Avoid the sun.”

About 10 years ago, scientists were studying sun exposure and deaths due to skin cancer. This was a pretty detailed and serious study. They found the expected modest increase in the number of skin cancer cases but a substantial decrease in deaths from all causes. Some head scratching ensued. The scientists then decided to measure vitamin D levels by areas of the country and compare them to various causes of death. They found people in sunny places like California and Arizona had less cancer, heart disease, multiple sclerosis, rheumatoid arthritis, and even Alzheimer’s disease. Places like Minnesota and North Dakota had less skin cancer but more of everything else.

Vitamin D acts as a hormone in the body and has its fingers in numerous biologic reactions. The current thinking is vitamin D protects against a number of different diseases. Unfortunately, vitamin D supplementation is a recent development. It hasn’t been around long enough to actually prove protection against all these various diseases (from cancer to Alzheimer’s).

Today I would tell you a modest dose of sunshine on a daily basis is a good thing. You should live longer for it. Move to Arizona or Florida; become a nudist. If that doesn’t fit in your life plan, you might just want to stick with vitamin D supplements.

– Dr. Don Bucklin, National MRO – a.k.a. “Dr. B”

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The Sizzle on Heat Illness

Summertime…and the living’s easy. Well, not exactly easy, especially if you live in Phoenix, Ariz., like I do and spend time outdoors. It’s about 110 degrees in the shade, of which there is precious little.

It might be a good time to talk about heat illness.

Heat illness comes in two flavors – heat exhaustion and heat stroke. 

The milder illness is heat exhaustion. That means that the heat is getting the best of you, but all body systems are still working.

Think of the last time you did heavy work outside in the summer and overdid it. You probably felt a little sick, nauseated, had a headache, were drenched with sweat and felt weak, maybe experienced some muscle cramps. This was the beginnings of heat exhaustion.

You may not have known what to call it, but you knew if you didn’t cool down, you could get a lot worse. You go inside and drink some fluids, throw some cold water on yourself and rest. As long as relief from the heat is close by, you recover in a couple of hours. 

Heat stroke is the more serious heat illness. This is a true medical emergency and requires immediate action and a 911 call. 

In heat stroke, your body has been overwhelmed by the heat, and your heat controlling systems break down. Body temperature can climb above 105 degrees. Much above that and real damage is done, up to and including death.

In heat stroke, you stop sweating. Sweating is your body’s evaporative cooler. When this stops working, your temperature goes up in a hurry. People with heat stroke have hot, dry, red skin. They commonly feel sick, have a headache, experience nausea and may be confused because high body temperature affects brain function. As the body temperature climbs more, victims may suffer a seizure.

Two things must be immediately done: get the victim out of the heat and call 911. While you are waiting for the paramedics, here is what you should do to help the victim:

  • Lay the person down
  • Dampen his/her clothes and put the victim near a fan (that’s artificial sweating)
  • Put the person in lukewarm water (85 degrees, not 60) if you can
  • Put ice packs around the groin area and trunk    

How do you avoid heat-related illness? Most of this is common sense, at least in the desert:

  • Try to avoid the heat
  • Stay indoors during the hottest part of the day (noon to 4 p.m.)
  • Take regular breaks from the heat; find a cool spot to rest
  • Stay well hydrated
  • Wear loose-fitting cotton clothing, which acts alike a radiator when it gets damp
  • Hydrate often (yes, I said that twice). If you’re not urinating, you’re not drinking enough water. 

Heat illness is very preventable. Time your activity during the summer months, drink a lot of non-alcoholic fluids and keep an eye on each other.    

– Dr. Don Bucklin, National MRO – a.k.a. “Dr. B”

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Symptoms of heat illnesses

As the mercury soared this week in many areas around the country, our Dr. B was on ABC 15 Phoenix’s Sonoran Living where he discussed the symptoms of heat illness and what measures you need to take if you start experiencing them.  You can watch it here.

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Questions About Extreme Heat Answered

1.    What happens to the body as a result of exposure to extreme heat?
People suffer heat-related illnesses when the body’s temperature control system is overloaded.  The body normally cools itself by sweating.  But, under some conditions, sweating is just not enough.  Very high body temperatures may damage the brain or other vital organs.  Several factors affect the body’s ability to cool itself during extremely hot weather.  When the humidity is high, sweat will not evaporate as quickly, preventing the body from releasing the heat quickly.  Other conditions that can limit your ability to regulate your body temperature include old age, youth (ages 0-4) obesity, fever, dehydration, heart disease, mental illness, poor circulation, sunburn, prescription medications and alcohol use.

2.    Who is at the greatest risk for heat-related illnesses?
Those at greatest risk include infants and children up to age 4, people 65 years and over, overweight people or people on chronic medications or with chronic diseases.

3.    What is Heat Stroke?
Heat stroke is the most serious heat-related illness.  Body temperatures can rise quickly, sometimes in 10-15 minutes, as high as 106 degrees.  Death or permanent disability can occur if not treated immediately.

4.    Warning signs of a Heat Stroke
Warning signs may vary, but may include the following:

  • An extremely high body temperature (above 103  degrees F)
  • Red, hot and dry skin (no sweating)
  • Rapid, strong pulse
  • Throbbing headache
  • Dizziness
  • Nausea
  • Confusion
  • Unconsciousness

5.    What should I do if I see someone with any of the warning signs of Heat stroke?
If you see any of these signs, you may be dealing with a life-threatening emergency.  Have someone call for immediate medical assistance,while you begin cooling the victim.

  • Get the victim to a shady area
  • Cool the victim rapidly,using whatever methods you can.  For example, immerse the victim in a tub of cool water; place the person in a cool shower; spray him/her with cool water from a garden hose; sponge the person with cool water; or if the humidity is low, wrap the victim in a cool, wet sheet and fan him/her vigorously.
  • Monitor body temperature and continue cooling efforts until the body temperature drops to 101-102 degrees
  • If emergency personnel are delayed, call an Emergency room for further instructions.
  • Do NOT give the victim alcohol to drink
  • Get medical assistance as soon as possible.

6.    What is Heat Exhaustion?
Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.  Those most prone to heat exhaustion are elderly people, those with high blood pressure and those working or exercising in a hot environment.

7.    Warning signs of Heat Exhaustion
The warning signs of heat exhaustion include the following:

  • Heavy sweating
  • Paleness
  • Muscle cramps
  • Tiredness
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Fainting

The skin may be cool and moist.  The pulse rate will be fast and weak, and breathing will  fast and shallow.  If heat exhaustion is untreated, it may progress to heat stroke.  Seek medical attention if symptoms persist more than one hour.

8.    What steps can be taken to cool the body during heat exhaustion?

  • Drink cool,nonalcoholic beverages
  • Rest
  • Take a cool shower, bath or sponge bath
  • Seek an air-conditioned environment
  • Wear lightweight clothing

9.    What are heat cramps and who is affected?
Heat cramps are muscle pains or spasms – usually in the abdomen, arms, or legs – that may occur in association with strenuous activity.  People who sweat a lot during strenuous activity are prone to heat cramps.  This sweating depletes the body’s salt and moisture.  The low salt level in the muscle causes painful cramps.  Heat cramps may also be a symptom of heat exhaustion.  If you have heart problems or are on a low sodium diet, seek medical attention for heat cramps.

10.    What should I do if I have heat cramps?

  • STOP all activity and sit quietly in a cool place
  • Drink a clear juice or sports beverage
  • Do not return to strenuous activity for a few hours after the cramps subside because further exertion may lead to heat exhaustion or heat stroke
  • Seek medical attention for heat cramps if they do not subside in 1 hour

11.    Can medications increase the risk of heat-related illness?
The risk for heat-related illness and death may increase among people using the following medications:

  • Psychotropics, which affect psychic function, behavior or experience (such as haloperidol or chlorpromazine)
  • Medications for Parkinson’s Disease, because the inhibit perspiration
  • Tranquilizers, such as phenothiazines, butyrophenones, and thiozanthenes
  • Diuretic medications or “water pills” because they affect the body’s fluid balance

12.    How effective are electric fans in preventing heat-related illness?
While electic fans may provide comfort, but they will NOT prevent heat-related illness.  Taking a cool shower or bath or moving to an air-conditioned place is a much better way to cool off.

13.    How can people protect their health when temperatures are extremely high?
Remember to KEEP COOL and Use common sense.  Drink plenty of fluid, replace salts and minerals (with sports drinks), wear appropriate clothing and sunscreen, pace yourself, stay cool indoors, schedule outdoor activities carefully, use a buddy system.

14.    How much should I drink during hot weather?
During hot weather, you need to drink more liquid than your thirst indicates.  Increase your fluid intake, regardless of your activity level.  During heavy exercise in a hot environment, drink 2-4 glasses (16-32 ounces) of cool fluids each hour.  AVOID alcohol drink, because they will cause you to lose more fluid.

15.    What about salt tablets?

DO NOT take salt tablets unless directed to do so by your doctor.  The easiest and safest way to replace the loss of salts and minerals is through your diet.  Drink fruit juice or a sports beverage when you exercise or work in the heat.

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Hit Me with Your Best (Tdap) Shot

We’re all aware of the importance of tetanus shots, and now there’s a vaccine to prevent tetanus while also fighting other serious ailments at the same time.

Multiple health organizations are now recommending that adults have a one-time dose of something called Tdap. This is a combination vaccine that contains tetanus, diphtheria and pertussis vaccines. The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) all recommend this vaccine.

As usual, something prompts me to think about certain topics. Why this one? Ok, I admit it…I was not paying attention and I grabbed some papers with a partially closed staple in them. As it ripped through the tip of my finger, I knew I would need to recall when my last tetanus vaccine was. And, as a healthcare worker, I did know that I had not yet had a Tdap. So, my weekend included a sore arm….

There is no vaccine for just pertussis alone, and this ailment, like tetanus, is one I’m sure we’d all like to avoid. Pertussis is known as the “whooping cough,” and this bacterial infection is passed from person to person. It’s generally not serious in adolescents and adults, but can be very dangerous to young children.

The symptoms of whooping cough come in 3 stages:

• The first begins much like your common cold – runny nose, sneezing and coughing. The cough will last 1-2 weeks, getting worse instead of better.
• In the second stage, you will have uncontrollable coughing spells, frequently vomiting after coughing, and you will emit a “whopping” noise when you breathe in. Patients can even stop breathing or turn blue in the face from lack of air during these cough episodes. This can last 2-6 weeks.
• During the last stage, the symptoms actually start to lessen. The coughing spells decrease in frequency and severity.

The course of this illness can be 6-10 weeks. Adults, teens and vaccinated children will generally have milder symptoms, like those of bronchitis.

Pertussis is spread by the “spray” of our secretions in the air, when we sneeze, cough or talk. We can also get it from sharing our cups and silverware. Initial symptoms will appear in 7-10 days after the exposure, and we will be contagious from 2 weeks prior to the start of the cough until 3 weeks after the cough starts, or until we have completed a 5-day course of appropriate antibiotic therapy.

Here is an information sheet on Tdap from the CDC. It discusses who should and shouldn’t have the vaccine, as well as the side effects.

If you are due for a tetanus vaccine and have not had your Tdap, consider receiving one at your nearest U.S. HealthWorks center. Then the only whooping you will hear is out of glee because you know you’ll be pertussis and tetanus-free.

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

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A Cup of Joe, Stuff of life or Poison?

In this country, we drink 400 million cups of coffee per day.  We consume over 45% of the world’s coffee production.  For the record, some of the Scandinavian countries consume three times more coffee per person.

Given all this coffee drinking, it’s no surprise that this is one of the most researched beverages on the planet.  And yet there is almost universal confusion on the health consequences of coffee drinking.

The problem is, we started our coffee studies 40 years ago when we were just starting to suspect cigarettes were a bad thing.  The early coffee studies showed people dying of heart attacks, mouth, throat and lung cancer.   It turns out in those days, coffee drinking was accompanied by cigarette smoking, and the control group didn’t drink coffee or smoke.  So all the bad stuff that we thought was associated with coffee drinking, was actually associated with smoking, and had nothing to do with coffee.

In case you think studying coffee is a light weight task for the scientists that got “C”s; coffee has more that 1,000 different chemicals identified.  Apparently a few of them cause cancer in rats.  In fact, it’s pretty hard to pick 1,000 chemicals and not have a few of them be bad for somebody.

Coffee does some well-known bad stuff.  It can be associated with anxiety and sleep disturbance.  It modestly raises both blood pressure and pulse.  It increases the acid in your stomach, and it stains your teeth.  That is the crime list for coffee.

Ah, but the benefits.

Coffee, first and foremost, increases memory, performance and wakefulness.  That just might keep you awake at the next meeting, thus keeping your job, which is a major health benefit.  All this wakefulness results in a lower risk of Alzheimer’s disease.   Some gastrointestinal cancers occur less frequently in coffee drinkers; especially throat, liver and prostate cancers.  Parkinson’s Disease is less frequent among the well-caffeinated.  Type 2 diabetes also is reduced in coffee drinkers.  Caffeine is also known to potentiate pain medication (it makes it work better).

All in all, coffee is a lousy replacement for a good night’s sleep, and should be avoided by those with sensitive stomachs.  For the rest of us, a cup a Joe is a safe warm spot in a cold and stressful world; and that’s another health benefit.

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

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It’s Lyme Time

Many of you may be venturing outdoors this summer for trips to a nearby lake or camping out in the wilderness. This means it’s time to take precautions in order to prevent serious infections, especially Lyme disease.

Lyme disease is an infection caused by bacteria and is spread by the bite of a deer tick. It’s important to understand that not all deer ticks are infected, so not all tick bites will cause the disease.

Ticks can be found almost anywhere outdoors, but they’re mostly in grassy and heavily wooded areas. The most common hosts for ticks are deer, humans, dogs, cats, cattle, horses and some mice. Deer ticks are very small—about 1/16th inch—and brown/black or rust/red in color. The endemic areas in the U.S. are the Northeast, the Mid-Atlantic, Wisconsin and Minnesota.

Here are some of the signs and symptoms that can start 2 days to several weeks after a bite:

  • A rash (occurs in about 50% of patients) – red, quickly enlarging and takes on a bull’s eye or ring-like form. It can be itchy or warm.

  • Flu-like symptoms – fever, chills, sore throat, conjunctivitis, fatigue, swollen glands, muscle aches, ear ache.
  • Without antibiotics, the disease can advance to involve more body areas, such as the heart, joints and nervous   system.

Lyme disease can be hard to diagnose at times. Not all patients develop a rash, and the symptoms can be vague or variable.

Despite this, the key thing to be aware of is prevention. Here are some tips to remember:

  • Wear light-colored clothing so that the tick can be more readily seen.
  • If practical, wear long pants/sleeves while in the woods, and tuck your pants into your socks for extra protection.
  • Use a repellant containing DEET (be careful with children).
  • Inspect your skin after possible exposure, especially hair-covered areas.

If you do find a tick, try removing it using tweezers and grasping the tick body (as close to the skin as possible) with a steady, upward motion until it comes out. Then wash the area with a skin disinfectant.

During this time of year, be sensitive to the risk of a deer tick bite. Protect yourself and enjoy the great outdoors!

-Donna Diziki, D.O., U.S. HealthWorks

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Salt, as with most good things… in Moderation

Now that we have all enjoyed a good barbecued meal for the 4th of July, lets discuss a few important points regarding that salt shaker.

We at U.S. HealthWorks know that many meal options include foods ranked high in sodium, and as a culture, we tend to salt up without thinking about the consequences.  As we watch news reports on obesity, diabetes and hypertension, we forget how significantly many of our food choices impact our health.  Many of us are keenly aware and monitor the medications and supplements we consume, however forget the power behind the product we consume every day… food.

Photo credit: FDA

Sodium plays an important role in maintaining the body’s fluid balance, it is essential for muscles and nerves to function properly and it is a leading dietary factor in the aggravation of hypertension and its consequences.

The FDA guidelines call for less than 2,400 mg of sodium per day — about 1 teaspoon of table salt. Surprisingly, most of our salt intake doesn’t come from the salt shaker; it’s hidden in many of the foods we buy at the grocery store.


Frozen Dinners
The American quick meal!  Always easy and quick, but they are loaded with sodium, many over 800 mg of sodium.  A tiny 5 oz frozen turkey and gravy dinner packs a whopping 780 mg of sodium.

Tip:  Beware the “lighter” version may have less salt, but it’s no guarantee. Read the labels to be sure. Many times “Lighter” refers to fat only, and may be packed with salt and sugar to make the meal more tasty.

Packaged Deli Meats
One look at the sodium content in packaged meats should stop you in your tracks.  If you are already dealing with a diagnosis of hypertension it might literally stop you in your tracks! Beef or pork salami (2 slices) can pack 604 mg of sodium.

Tip: Be a label reader. There’s no way around it — different brands and different meats have differing amounts of sodium. And beware: a “healthier” packaged meat may actually have more sodium than its higher-fat counterpart. Some brands have meats with 50% less sodium.

Marinades and Flavorings
Notoriously high-sodium offenders include teriyaki sauce (1 tablespoon) which contains 690 mg of sodium, and soy sauce (1 tablespoon), which may contain up to 1,000 mg of sodium.

Tips: Even “lower-sodium” soy sauce packs a wallop, so use sparingly. Go for vinegar and lemon juice to enhance flavor — they naturally have less sodium. And try orange or pineapple juice as a base for meat marinades.

Spicing It Up
Adding spices to an entrée can be an easy way to forgo the salt shaker. Just make sure there’s no hidden sodium in your selection. For example, canned jalapeno peppers (1/4 cup, solids and liquids) contain about 434 mg of sodium.

Tip: Go for the pepper in its natural form to ditch the sodium used in processing. Or use herbs and sodium-free spices instead.

The Obvious Offenders
These snack-time favorites are always going to have a high salt content. Here’s how a 1 oz servings compare:
•    Potato chips = 149 mg
•    Cheese puffs = 258 mg
•    Pretzels = 385 mg

Tip: Even “baked” or fat-free snacks can pack the same amount of sodium or more, so read the label.  Again remember, low-fat often means high sodium and/or sugar.

Condiments Do Count
If you think those little extras you add to your food don’t count, think again.
•    Ketchup (1 tbsp) = 178 mg
•    Sweet relish (1 tbsp) = 121 mg
•    Capers (1 tbsp) = 255 mg

Tip: Go for low-sodium or sodium-free condiments. Or get creative with your substitutions: Try cranberry relish or apple butter for a naturally lower sodium choice.

Food Label Claims
Can’t keep up with the jargon? Here’s a cheat sheet:
•    Sodium-free: Less than 5 mg of sodium per serving
•    Very low-sodium: 35 mg or less per serving
•    Low-sodium: Less than 140 mg per serving
•    Reduced sodium: Sodium level reduced by 25%
•    Unsalted, no salt added, or without added salt: Made without the salt that’s normally used, but still contains the sodium that’s a natural part of the food itself.

‘Dos’ When Dining Out
•    Ask how food is prepared.
•    Choose a restaurant where food is made to order.
•    Ask that your meal be prepared without any forms of sodium, then add a dash of low-sodium seasoning you brought from home.
•    Request unsalted butter for your bread.

Who Should Go Low-Sodium?
Eating less sodium can help lower blood pressure in some individuals. It can help reduce the risk of heart disease, as well. For people with high blood pressure, eating high-sodium foods raises their risk of heart disease, stroke, and kidney damage.  Again, for most of us, it is about balance and moderation.

Track Your Sodium Intake
As with anything related to your health, ultimately it’s up to you to make wise and healthy decisions.  Wellness is more than an annual physical provided by your employer or insurance carrier; it is the state of balance we all should strive toward by educating ourselves, involving your physician as a resource and moving forward with decisions that improve your life.  We want you to be healthy and happy for a long time.

-Troy Manchester, M.D. Regional Medical Director, Northern California

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