Monthly Archives: August 2010

What Are The Odds? Injured Motorcyclist is Beneficiary of Happy Coincidence

Dr. Andy Parker, vice president of U.S. HealthWorks, was going home to Seattle after a relaxing long weekend at his cabin in British Columbia. Heading south on Highway 1, Dr. Parker and his wife, Dawn, were making good time through the canyon highway as the midday sun was beating down on their pickup truck. As they drove through the mountainous terrain in BC, they admired the gorgeous scenery and could easily see why this highway is a favorite for motorcyclists, especially on warm summer days.

A short time after they passed through Lytton, they noticed a person sitting by the side of the highway. Andy kept driving, thinking nothing of it, but Dawn caught a glimpse of something that wasn’t right – a person in a muddy ditch off the shoulder of the road. She told Andy and he pulled over and made a U-turn when the road was clear.

Andy parked the truck and went into the ditch to find a motorcyclist who had missed a turn, dropped off an abrupt shoulder and crashed his bike in the mud. The biker, Tom Aitken, was conscious, but in a lot of pain. Dr. Parker had prior experience as an emergency room doctor, and was trained in Advanced Trauma Life Support (ATLS), which is recognized as the standard of care for initial assessment in trauma cases. He rapidly did a clinical survey on the injured biker. Dr. Parker determined there were no life-threatening injuries; however, Tom’s right leg was fractured with his right foot rotated 180 degrees, completely backwards. 

With no cell reception in this remote area, Tom’s motorcycling companion rode off to find a place to call 911 for an ambulance. Meanwhile, Dr. Parker started work on stabilizing the patient. As he did so, he heard a familiar voice above him say “Hey Andy, what are you doing down in a ditch?” It was Dr. Steve Sorsby, regional medical director and president of U.S. HealthWorks Medical Group of Washington – another physician. Tom’s unlucky day had taken a turn for the better – he had not one, but two, physicians to help him.

By coincidence, Dr. Sorsby, an avid motorcyclist, was on vacation and happened to be riding north on Highway 1 with his son, Jason. They were making a much-anticipated ride to see the remote coastal town of Hyder, Alaska. Both were very excited as it was their first time to this popular stretch of road for motorcyclists.

Seeing the accident scene, Dr. Sorsby stopped to see if his help was needed. “I couldn’t believe when I looked down into the ditch and saw Dr. Parker in the mud, performing a trauma assessment!” he said afterwards. “What were the chances?”

“Get down here and help me with Tom,” Dr. Parker called, and Dr. Sorsby willingly climbed down into the muddy ditch to render assistance. The two U.S. HealthWorks doctors proceeded to stabilize the injured Tom and were soon joined by an off-duty EMT from the Vancouver area. The RCMP (Canada’s Royal Canadian Mounted Police) arrived, closed the highway, and, together, all waited for the ambulance.

But time was critical for Tom. The physicians were unable to assess if there was any blood supply to the lower leg as his heavy riding boot was still on and they had no way of cutting it off without causing Tom further excruciating pain. The doctors needed to put the bones back in place and rotate the foot back into its normal position. With each passing moment, Tom’s leg was in greater danger of sustaining permanent damage.

The ambulance finally arrived, but they didn’t have any IV morphine. They did, however, have nitrous oxide (“laughing gas”). Lacking any other analgesic options to help reduce the fracture pain, the physicians determined they would use the nitrous oxide while they rotated Tom’s foot back into a normal position.

Tom was instructed to deeply breathe in the gas through a face mask, and his leg was successfully rotated into a normal position. As his pain eased, his riding boot, pant leg, and sock were cut off to evaluate the injured area. It was an open fracture, and part of one lower leg bone had been protruding through the skin just above the boot until the fracture was reduced and the leg was rotated back to its normal alignment. The doctors proceeded to dress the wound and get the leg splinted. Tom was placed on a backboard with a cervical collar in place and loaded onto the waiting ambulance, which transported him to Lytton, where he was airlifted to a hospital.

The RCMP re-opened the highway and Drs. Sorsby and Parker went their respective ways, delayed a bit, but certainly for a good cause.

Tom required two operations to pin the leg, but his leg was saved. Both Tom and his wife expressed many thanks to all the Good Samaritans who helped him in his time of need.

P.S. If there are any math wizards out there, we would really like to know the odds of a motorcyclist getting help after a crash by not one, but two, physicians who were first and second on the scene of a remote crash site; and who, coincidentally, are colleagues in the same medical group and have known one another for years! The odds must be astronomical….. Maybe Tom should buy a lottery ticket!


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“Fooling” the Drug Test System

The following question was posted on the website Marijuana.com (as the National Medical Review Officer for U.S. HealthWorks, I could hardly resist posting a reply):

Will I be observed at Healthworks Medical Group?

I have a drug test that is supposed to be at “US Healthworks Medical Group” through my school in Los Angeles, CA.

I am wondering if I will be in the room alone or is it possible I can be observed?

I assume that only probation type tests would have someone standing behind the individual doing the test, but I just wanted to confirm that as I would rather sneak in a sample than take my chances with a detox drink.

The test is due by next Friday. I have smoked high quality chronic since 2004 for about everyday and I have stopped since last Thursday.

I am 5’8 and 150, probably average metabolism and dont work out too much.

Anyways, confirmation of the legality/possibility of being observed would really relieve some of my stress. Its bad enough not smoking!

Thanks for your help!

While in general, I applaud preparation for any test, this is not the type of preparation that assures a positive outcome. This is one test you can’t study for.

1) Let’s start with the “detox drink.” If there is still someone on the planet that believes this clean-out business is real, I’m surprised. THC is the active ingredient in marijuana, and it is a fat soluble chemical. So a clean-out drink would have to dissolve all the fats in the body to actually have a chance of getting rid of the marijuana. Unfortunately you need some of that fat – it insulates your nerves; short circuits are called seizures. It also pads your feet; try walking on unpadded foot bones. Dissolving all the fat would be invariably fatal. From a purely economic standpoint, if this were even possible, the market would be in the weight-loss industry, not some tiny Internet company trying to beat drug screens.

2) What’s to stop someone from bringing in someone else’s clean urine for the test? Actually plenty. Urine is stored in the middle of the body. It comes out at body temperature, and we immediately check that. If you can prove you’re dead, and your body is room temperature, we might consider accepting a room temperature specimen. Otherwise, no way. So, like Goldilocks, the urine’s temperature has to be “just right.”

3) If you somehow manage to smuggle in someone else’s urine and it is positive, you, as the official “donor,” are stuck with the results. This is not without some humor.

4) Lastly, there is the issue of the observed collection. Observation is not usually needed to prevent fraud; we’re pretty good at catching donors trying to pass off somebody else’s specimen.

I close with a nod toward the eternal struggle between opposing forces. As long as there are drug screens, there will be people trying to beat them. Many of the people trying to beat them are on drugs, which probably lessens their success rate. Simultaneously, the labs are working on technologies that prevent this undermining of the system. Oral fluid testing is becoming more popular as every test is observed, and saliva is a good fluid to perform drug testing on.

The only truly effective way to pass a drug test is to stop using drugs and have enough time pass for them to be out of your system. Every unemployed person should seriously consider this as part of their plan to return to the world of the employed.

Good luck,

Dr. B


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The Incredible, In-Edible Egg?

Eggs are back in the headlines this week. For a change, we’re not discussing their health benefits (the Atkins folks like them) or their heart risks (too much cholesterol). This week, we’re not really talking eggs at all. We’re discussing a small bacterium that is hitchhiking on some eggs – salmonella.

Salmonella is the unwanted guest of some Midwest industrial egg producer, and the FDA is pretty upset about this. You might be too.

Salmonella is a bug, or more properly a bacterium. It is one of many microscopic organisms that can cause illness in humans.

Salmonella is not always a problem. There are people walking around right now with salmonella bacteria in their colons, perhaps as many as 25% of us. These people are not sick, and do not have diarrhea. It all depends on the dose. A few salmonella living peacefully in your colon is fine, but let them be the majority organism and diarrhea will soon follow.

Salmonella enters the body by eating food contaminated with live salmonella bacteria. Like everything we eat, it is chewed and dropped into an acid vat (your stomach). This acid bath kills most bacteria, including salmonella, by the time the partially digested food leaves the stomach. Like I said, it is all a matter of dose. Eat something with heavy salmonella contamination, and enough will survive your stomach to make it into your colon. There, they will rapidly multiply and a rather nasty case of diarrhea will occur. Since this is from an active infection in the colon, the diarrhea often contains blood and puss.

In adults this is a very uncomfortable disease but not a deadly one. Most adults beat salmonella with a brief course of oral antibiotics and fluid replacement, like your favorite sports drink. Adults usually recover rapidly.

Like so many other illnesses, salmonella hits young children and the immuno-compromised much harder. They sometimes need hospitalization for hydration and treatment.

Avoiding salmonella sounds like advice from a food handler’s course. It is commonly present on raw chicken as well as eggs. Never eat chicken raw, or use a utensil used on raw chicken without first washing it. All those restaurants’ menus with warnings against eating undercooked meat or fish are not just conversational. They are meant to help you avoid salmonella. Meat has to get to 140 degrees for 30 minutes to kill salmonella. Cool, red centers in steaks do not do the job.

In the meantime, I’m not putting raw eggs in my smoothies for awhile.

Take care,
Dr. B


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A Tale of Two Co-Dependent Squirrels

We had some unexpected furry guests visit U.S. HealthWorks recently.

A gentleman came in with his girlfriend to one of our clinics for injury care, and in tow were their unique pets – sugar gliders, which they kept in a knapsack around the man’s neck. Not sure what a sugar glider is? Think Rocky the flying squirrel from “Rocky and Bullwinkle.”

Photo courtesy of Wikipedia

The man said that the squirrels suffer from separation anxiety and cannot be left alone. Also, the critters apparently have to travel in pairs.

One of our doctors at the clinic informed the couple that the squirrels are not allowed to be in the medical facility for health and safety reasons. The man and woman insisted on keeping the squirrels with them during the exam but were told again that it is not allowed. The couple subsequently left with their Rocky look-a-likes in hand.

The following day, the couple showed up at another nearby U.S. HealthWorks clinic – with their squirrel companions, of course. Our position was again reinforced, and thankfully the problem was solved when someone at the clinic took the squirrels outside until the exam was completed.

The lesson to be learned here is that it’s best to leave your critters at home when you visit the doctor, unless you’re headed to the veterinarian of course.


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The Care and Feeding of Your Colon

Like your heart, your colon is an organ that you totally ignore when it’s working, but it can make you plenty miserable if it doesn’t. 

Let’s start out with a mental picture. Put a tennis ball in a sock. Now try to make it come out the end of the sock by squeezing the sock. Got the picture? (Sorry).

That is how the colon works. 

The colon is a hollow tube about 8 feet long. The walls of the colon have muscles that form constricting rings. When these muscles contract in waves, it causes the colon to squeeze, working from one end to the other.

The colon does a couple of pretty important jobs. The remnants of digestion that enter the colon have the consistency of thin mud. Excess water is absorbed into the walls of the colon. Without this function, you would have a permanent case of diarrhea. Vitamin K is also absorbed in the colon, which is useful in keeping you from bleeding to death from the minor injuries of daily life. Pretty important stuff for such a lowly organ.

The American diet does not make for a happy colon. The reason for this is our food is “too good” that almost 100% of it is absorbed. One might say that the American diet is the rocket fuel of foodstuffs. There is so little indigestible material that it almost eliminates the need for a colon.  Therein lies the rub.

This low residue diet might be OK on dog food labels, but in humans it results in highly compact, low volume stools. The colon has to squeeze pretty hard to get that moved through the tube. Sometimes it squeezes so hard, the wall tears (the sock rips). That is how diverticula are formed (little pockets in the walls of the colon).

Another unfortunate effect of highly concentrated diets is the passage through the colon is very slow. Keep in mind that the stuff that goes into the colon is the stuff the body didn’t want. This causes whatever bad stuff you ate (like toxins or pesticide residue) to have more time to cause trouble. 

Going back to our tennis-ball-in-a-sock-analogy. If we wanted to make this easier, we could replace the tennis ball with a dozen marbles. Just a little squeeze would easily move the marbles through the sock. This is what happens when we add indigestible material (fiber) to the diet. We don’t make the colon work so hard, so it doesn’t get traumatized and cause diverticulae. Also, the transit time through the colon is faster, so some of toxic substances that enter the food chain (pesticides, cattle hormones) spend less time in your colon – that means less colon cancer.

Constipation of course, is also not a problem. The fiber traps cholesterol and removes it from you body. This is in addition to any cholesterol-lowering program you are on.

There is a veritable plethora of benefits to providing some fiber to the diet. “But,” you say, “Who has time for bran muffins and food with the consistency of sawdust?” Here we have an easy answer. There is a grain grown in India that has a husk that is indigestible, and when ground up, mixes well with almost any water-based beverage – psyllium. It is sold under various brand names (Metamucil among others). Simply take a rounded tablespoon and mix it with some juice and/or water. Drink it down morning and evening, and it will keep your colon busy and out of trouble. 

A happy colon will make a happier you.

Until next time,

Dr. B


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Low Back Injuries Unveiled

Low back injuries are among the most common of industrial injuries. I have experience not only as doctor, but, unfortunately, also from the other side of the operating table as a patient – twice in fact!

Let’s talk anatomy and demystify these injuries. I’m kind of a nuts and bolts guy, so don’t let the term anatomy put you off.

The spine essentially sits on the pelvis. A vertical spine is sitting on a horizontal pelvis, like an upside down T.

The L5-S1 disc is the cushion the spine sits on. Put stress on the spine and where does it break? Where the spine joins the pelvis. That is the weak spot. See, anatomy made easy.

The forces most damaging to the spine are uneven or imbalanced forces. Think of balancing a brick on a champagne flute. If the brick is not exactly balanced on the glass, the brick will fall, and the glass will break. That explains why weight always needs to be kept close to the body, and balanced or centered.

Another force on the spine is due to the power of levers. You know this from daily life: the longer the lever, the more the force – you grab a really long wrench for a really stuck bolt. The distance the weight is held from your spine is the length of the handle of the lever. If you don’t want to “break-loose” your spine, keep the lever short, the weight close.

Now that we have a simple mental picture of the spine, some other things make more sense.

How do we lift to protect the back? Keep your back straight when lifting (don’t tilt the vertical). Keep the weight centered and close. We offer a step-by-step guide on the U.S. HealthWorks website on how to lift safely.

Can we protect the low back by wrapping it up (i.e. wearing a back brace)? No. You can wrap as much elastic around this junction (remember the inverted T), and it still will be the weak spot. Back braces don’t prevent injuries.

We make the spine stronger by doing back exercises or “core” exercises. One proven set of exercises is the Williams Flexion Exercises. Pilates is another popular option.

This idea works if you have a strong back or a weak one, whether you are 20 or 80. You can always get stronger.

Stay healthy.

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


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H1N1 Pandemic is Over

This week, the World Heath Organization (WHO) declared the H1N1 pandemic over.

Wasn’t it just a year ago that people were fighting for H1N1 shots? We didn’t know too much about this influenza virus at the time, except that it killed young people.

I was giving talks about H1N1 telling people that “Swine Flu” parties were a bad idea. A Swine Flu party is when someone gets the flu, he/she invites all of their friends over, everybody shares cocktail glasses and big sloppy kisses, and they all do their best to catch the flu. The point is to get the virus early before it mutates into something worse – which, luckily, H1N1 never did.

Novel strains of influenza have, in the past, been devastating. Even in a normal year, influenza kills 36,000 people in this country, and over a half million in the world. Pandemic strains of influenza have killed tens of millions in the past, a truly terrifying prospect.

We were all introduced to the concept of “pandemic influenza” last winter. Most people equated pandemic with severity, but pandemic only really refers to prevalence. If something is pandemic, it is widespread, not necessarily deadly. The H1N1 virus was pandemic, but fear of the virus was even more pandemic.

Companies had influenza plans – they gave careful thought to how they would operate with 40-60% less staff. How do you run a hospital on half staff, or a police department, or a nuclear generator?

People were hoarding antiviral medications. They did their best to talk their doctor into prescribing them several hundred dollars worth of Tamiflu, “just in case.”

The WHO and various counties’ heath department were magnificent. Through a worldwide effort, they identified the virus, and designed and produced millions of doses of vaccine, all in a few short months.

The H1N1 pandemic was a near miss. We heard the bullet. The influenza virus still contains the potential to change into something nasty, and it is highly contagious. This time we were lucky and had the chance to run a worldwide pandemic emergency drill, making us that much more prepared next time. And if history is any indication, there will most likely be a “next time.”

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


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Behind the Scenes at KNX in Los Angeles

Our very own Dr. Alesia Wagner stopped by KNX 1070 NEWSRADIO this week to talk to Bob McCormick about various health topics. Check out Dr. Wagner in action:

Dr. Wagner and Bob McCormick

 

Dr. Wagner in studio


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Whooping Cough Outbreak May Be Worst Such Epidemic in 50 Years

An epidemic of pertussis, or “whooping cough,” has descended on California. As of last week, seven deaths have been blamed on the disease and 2,174 cases have been reported.

Graphic courtesy of the Los Angeles Times

On Monday, the California Department of Public Health said that compared to last year at this time, there are six times the number of reported cases, and we could be on the edge of the worst epidemic in 50 years.

What’s more, there’s legitimate concern that this will soon spread to other states around the country.

For many years, the last pertussis vaccine was given when children started school (approximately age 6). In more recent years, the Center for Disease Control and Prevention has recommended a booster vaccine (called Tdap) to prevent the illness for all adolescents and adults.

So what are the symptoms of whooping cough?

Stage 1

The first stage, also known as the catarrhal stage, lasts 1-2 weeks. It resembles a simple upper respiratory infection. Cough, runny nose, sneezing, body aches, and low grade fever are the most common. Many believe they simply have a cold.

Stage 2

After 2 weeks, the cough becomes more severe. This is the beginning of stage 2; it can last as long as 6-10 weeks. Coughs will come in paroxysms, or bursts of rapid, harsh coughs, as the infected person is trying to expel thick mucus. The coughing will increase in severity over two weeks and then very slowly diminish. At the end of the cough, as the person inhales, you will hear the characteristic whooping sound. The cough can be so severe that one can lose their “breath” and even turn a little blue (cyanosis), from a lack of oxygen. Frequently, the cough is so harsh that the person will vomit at the end of the coughing spell. These coughing attacks occur more frequently at night; some will have as many as 24 attacks of coughing in 24 hours.

Stage 3

When the coughing begins to diminish in severity and frequency, it is considered the third stage. But remember, this stage can last many weeks.

How is pertussis transmitted?

Whooping cough is highly contagious and is spread among people by direct contact with fluids from the nose or mouth of infected people. People contaminate their hands with respiratory secretions from an infected person and then touch their own mouth or nose. In addition, small bacteria-containing droplets of mucous from the nose or lungs enter the air during coughing or sneezing. People can become infected by breathing in these drops. Adults can get the disease, and generally, they get a milder case than children. 

How can you tell you have pertussis?

Your doctor can make the diagnosis. Your history and physical examination will provide information that will lead your physician to make the diagnosis. A special test for the bacterium, Bordatella Pertussis, can be sent to your local lab to get confirmation.

How do you treat pertussis?

Since whooping cough is caused by a bacterium, it is treated with antibiotics. There is no clear evidence that treating with antibiotics after the first couple weeks will be of any benefit to the patient. There is no proven treatment for the severe coughs, though many will try various cough preparations.

So, if you are experiencing these symptoms and you have not been vaccinated, see your physician.

What is best way to avoid getting pertussis?

  • Get vaccinated! Ask your doctor about the Tdap vaccine for adults and children.
  • Wash your hands frequently.
  • Avoid contact with people who are coughing.
  • Disinfect common areas such as work stations and door knobs.

The physicians at U.S. HealthWorks Medical Group are available to help with vaccination, evaluation and treatment.

 – Dr. Alesia Wagner, Regional Medical Director, U.S. HealthWorks Medical Group of California


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