Monthly Archives: October 2010

Phoenix Business Journal: Legalized Marijuana and Workplace Drug Policies

Arizona will vote next week on Proposition 203, which would legalize medical marijuana. Dr. Donald Bucklin, who oversees all drug testing for U.S. HealthWorks, shared his insights in last week’s Phoenix Business Journal on how this could affect businesses’ drug testing policies.

My View: Legalized marijuana – Will drug testing go up in smoke?

By Dr. Donald Bucklin
October 18, 2010

Juggling the need for a drug-free workplace with the rights of employees may get a lot more complicated in Arizona after the November election.

They say those who don’t understand history are doomed to repeat it.

The state of Arizona has a rich and interesting relationship with medical marijuana. The current Proposition 203 is the most recent of four similar propositions that have been on the ballot in the past 14 years.

To read the rest of the article, click here.

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U.S. HealthWorks Doctors Receive Media Awards

Last week, U.S. HealthWorks honored Drs. Alesia Wagner and Donald Bucklin for their tireless efforts successfully representing our company in the media.

Dr. Wagner was recognized as our Top Media Representative, showing up for TV interviews in far away lands (Bakersfield) at 5 a.m. and actually sounding coherent at that hour!

Dr. Bucklin, who is a prolific writer and generates so many knowledgeable articles and blog entries faster than we are able to edit, was named Top Editorial Contributor.

We are very grateful to have such talented and committed medical leaders at USHW. Thank you, doctors!

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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

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Sacramento Business Journal: Office Policy Could Go Up in Smoke

By Dr. Donald Bucklin

Juggling the need for a drug-free workplace with the rights of employees might get a lot more complex in California after Nov. 2.

That’s when Proposition 19, the initiative to legalize marijuana for recreational use — not just medical reasons — will be voted on by Californians. Polls show it could very well pass.

Should the measure become law, every employer will be asking, “How does this impact my drug testing policies and my hiring process?”

As it’s currently written, Proposition 19 says that employers would retain all existing rights to address consumption of marijuana that impairs employees’ work performance.

But legalized marijuana could create significant conflicts, particularly if an employer is unprepared and doesn’t have a clear drug use policy. That’s because many employers have a zero-tolerance stance when it comes to employee drug use, conducting drug testing before and during employment.

Read the rest of the column here (subscription required).

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Obesity’s Burgeoning Burden on Employers

America is fat and getting fatter. It’s hard to be more than a block from a fast food franchise unless you’re deep sea diving or mountain climbing.

The subliminal message is: How bad can it be?

Any child can walk into a burger joint and purchase 1,200 calories of cooked animal fat for pocket change. The child doesn’t even need to show ID or a parental permission slip. As a society, we seem to be saying a big, sloppy, cholesterol-laden cheeseburger is much safer than cigarettes, driving, PG-13 movies or beer.

Is it really? And why should employers care? Because you have to spend a couple extra dollars on XXL uniforms?

Obesity in the workplace has a much more profound effect on the company than just a few extra dollars for uniform fabric.

Let’s make sure we’re all on the same page. We medical types use something called the Body Mass Index (BMI), which is a measurement of a person’s weight to height. The higher the BMI, the more overweight a person is. The standard definition of weight class is:

• BMI of 25 or less – normal weight
• BMI of 25 to 30 – overweight
• BMI over 30 – obese

Obesity is among the most common of medical conditions in the United States. Close to 75 percent of our population is overweight or obese. Unfortunately this high-risk condition of being overweight is rapidly becoming “normal” in this country.

Obesity, the more serious condition, occurs in more than 25 percent of the population. The care associated with obesity is thought to be more expensive than that caused from smoking cigarettes or alcoholism.

Employers get hit from several directions with the burden of obesity. In this country, the employer partly or mostly pays health insurance, and the costs associated with obesity make this an increasingly expensive proposition.

It’s well known being overweight or obese is associated with much higher risk of hypertension, heart disease, stroke and Type 2 diabetes. The added strain of carrying around this extra weight also takes its toll on the joints and spine. Chances of osteoarthritis of the knees, hips and back are greatly increased.

Add up all this extra disease and the total cost of obesity is well over $100 billion per year. And we wonder why our insurance premiums continue to go up.

If the direct medical costs of obesity don’t break an employer’s back, the injury rates among obese employees just might. Employees having a BMI over 40 file twice as many workers’ compensation claims and have 12 times more lost work days from these work injuries.

 Repetitive motion injuries such as carpel tunnel syndrome and tendonitis in various joints are also more common. Obesity is even a risk factor for workplace violence.

Treatment for obesity has historically been fraught with failure. The sheer caloric load stored in a significantly overweight person is impressive. A pound of fat holds about 9,000 calories, so a person who is 50 lbs. overweight has a reserve of almost 500,000 calories to burn.

Since it’s difficult to keep the body burning an extra 1,000 calories a day, it takes quite awhile to make a dent in the fat calories. This makes it imperative to concentrate on the effort of maintaining normal body weight. Like most problems in life, prevention is easier and less expensive than repair.

For those who are already obese, only a long-term strategy has much chance of success. The person has to stop adding weight and stop adding to the problem. This can be an effort in itself, but it’s a prerequisite for success.

Once weight gain is stopped, activity and intake can be calculated to make some progress on the fat storage issue. Real progress on this is something that is measured in months and years, not weeks.

On that note, maybe I’ll skip that cheeseburger and fries for lunch.

Take care,

Dr. B

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‘Air goes in and out, blood goes round and round, and urine runs downhill’

Thus began one of my more entertaining lectures in medical school. At the time I was about half-way through medical school, so I just barely knew enough to know that this was a bit of an oversimplification. I laughed hard at the time, as did my classmates, but this got me thinking. There was a simple elegance to this concept, almost Zen-like. The human body was put together with a series of conceptually simple functional systems.

On that same note, here are some oversimplified health beliefs and the truth to them:

Air Goes In and Out
The lungs are in many ways like a tree. The trunk is the windpipe, the branches the bronchial tubes, and the leaves the alveoli. The leaves are where a tree goes about breathing. The trunk and branches are of little use without leaves. The leaves are the most sensitive parts of the system; serious tree diseases usually affect the leaves. In the body, we absolutely depend on free exchange of gases at the alveoli. Put toxin into them, and they are the first to go. The tree will eventually die.

Blood Goes Round and Round
Blood needs to circulate. If it doesn’t, stuff dies. If the blood that supplies the heart doesn’t go round and round, we call it a heart attack. In the brain, this is a stroke. We should do everything in our power to avoid blockages like these. Blockages are caused by excess: too much blood pressure or cholesterol, too much eating or smoking, too much weight or sugar, even too much work. It’s all about balance in life.

What Goes In Must Come Out
The first association that comes to mind is the digestive system. This, most simply, is a long tube where food goes in one end and waste comes out the other. A certain balance is implied – too much in and not enough out, and trouble will ensue. We also might use this to consider nutrition – good food in, good heath comes out. Calories also go in and must come out, otherwise you get bigger.

Use It or Lose It
This has application to almost every system. Our muscles must be used or they deteriorate. Spend a month in bed and even simple walking is a great effort. You must stay active if you wish to continue a vital life.

Our immune system is also a fan of this rule. Kids raised in too clean an environment have unstimulated immune systems that don’t work well. Two dogs keep a house dirty enough for proper development of the immune system. Asthma is rare in kids from two-dog households.

We are even finding mental exercise prevents deterioration of the mind. Risk for Alzheimer’s is lower the higher a person’s education level.

It is very easy to get caught in the details of “pop health talk” – the vitamin of the week, the micro nutrient of the moment, or a single exercise that will change your life. Maintaining good heath is actually rather simple and something you can do on your own without these fads: keep moving, keep breathing and strive for balance in your habits.

Take care,

Dr. B

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Are Blood Pressure Pills Addicting?

A high blood pressure reading is occasionally seen when someone comes in for an unrelated reason (sprained ankle, cough, VD). When I mention this to the patient and ask if they have had high readings in the past, the answer is often “Yes.” When asked if they were under treatment, the answer is too often “No.”

Now, one elevated blood pressure reading does not a hypertensive make. But often people have had several medical providers tell them their reading was “a little high.”

So, in a moment of curiosity, I ask, “Why not?” One surprising answer is the following: “Once you start, you have to keep taking them.” In a rare moment of clarity, I ask, “You think blood pressure pills are addicting?” I get a nod. It does seem reasonable from the dire warning to not stop your BP medication (deep serious voice), that you may not even want to start it.

So let’s talk about blood pressure and BP medications for a minute. Blood pressure is just a pressure, like in your car tire or your garden hose. What would happen if you have too much pressure in your tire or your hose? It pops. There, that’s most of what you need to know.

How do you make pressure go down? Let out some air, close the garden valve (or hose bib for those who like technical words). So BP medications work in some pretty common sense ways. Let some air out, is just another way of saying diuretic. By making you pee a lot, the pressure in your body is reduced – you can almost feel the pressure go down. Or we can slightly slow the heart rate, kind of like turning down the garden hose valve. Sometimes we want to make the heart beat less forcefully, making a smaller pump, if you will. There are a few other ways to turn down the blood pressure, but you get the idea.

So, are blood pressure medications addicting? No. They make your blood pressure go down and keep it lower as long as you keep taking the medication. If you stop taking your meds, your blood pressure will just go back up to where ever it would be if you didn’t treat it. Blood pressure is just maintenance, like changing your oil. It’s a good idea to keep changing your oil as long as you want your car to keep running. Your car is not addicted to oil changes – it will just run longer if you do them. Same with your heart. It isn’t addicted to BP meds – it just will run longer if you take them.

Generic BP pills are available, so they don’t need to be too expensive. They don’t make you tired or weak, give you headaches, or hurt sexual function. There are enough different types of medications that there is truly something for everyone.

But medications aren’t the only way to control blood pressure. It unfortunately often works out that the patient isn’t doing all the life changes that will get the blood pressure down. Sometimes the doctor doesn’t even tell you about this stuff.

If you lose 20 lbs. and start an exercise program, we can always stop the medications. Weight loss helps control blood pressure, along with sweating and reducing stress.

Blood pressure medications aren’t addicting or magic. They work in pretty straightforward ways. The next time you have a high reading, ask your doctor about specific treatment, whether it be medication, lifestyle or both. No sense walking around waiting for something to “go pop.”

– Dr. B

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Carbuncles, Furuncles and Boils – Oh My! Fighting Infections of the Skin

Red, swollen, itchy and painful skin.

It irks us and causes us to worry about our health, our appearance and our environment. We question: Did I hit myself? Am I allergic to something? Did something bite me?

We hear on the news that there are flesh-eating bacteria and killer boils. Our neighbor is in the hospital for an infection – should we worry?

Relax. Our skin is the largest organ in our body and is well-suited to the task of keeping bacteria where it belongs – outside of our body.

We’re constantly in contact with bacteria. Some bacteria even live on our skin full time. Strep and staph species are the most common organisms. Also common are a variety of fungi that enjoy the warm, moist folds of our body. When there is balance, these hitchhikers cause no problems.

But when we have high bacterial counts on the skin, get cut, get stressed, are sick for another reason, scratch at a bug bite, pick at a pimple, stay in a wet bathing suit too long or use a lot of sticky lotions on our skin, the balance can shift and infection may result.

Most of the infections that occur as a result of these imbalances are caused by the usual culprits – yes, those hitchhikers – strep and staph. They burrow into cuts, scratches, bites, burns, hair roots and other places that you cannot even see, and they multiply like crazy! The skin inflames trying to get rid of the bacteria – it swells and gets red and hot, trying to stop the infection. Most of the time in a few days, it goes away. Sometimes you need to see a physician for antibiotics, and occasionally hospitalization is necessary to completely get rid of the infection.

With all of this scary stuff out there, how can we help the skin do a better job protecting us?

Unfortunately, there is no medication or injection that we can take to get rid of the bacteria on our body. Even if we are exposed to someone with a skin disease, there is no scientific evidence that taking a pill will prevent us from getting the same disease.

Prevention of skin infections requires a more conscious and active approach on our parts. Remember, you are exposed to bacteria everywhere in your life from the cup you are drinking from to your keyboard. Healthcare professionals and public servants should also be aware of weapons, badges, belts, uniforms, notepads and stethoscopes.

What can you do to help?

1. Stay healthy. Eat right, rest, exercise, avoid tobacco, use alcohol in moderation. Keep chronic illnesses like diabetes under control.
2. Use hand sanitizer liberally.
3. Wash your hands with soap often.
4. Wipe down phones, desktops, keyboards, stethoscopes, pens and other accessories regularly with sanitizer wipes.
5. Change clothes at work or as soon as you get home to avoid contamination of the household.
6. Bacteria can get trapped on the skin by oils and clothing. Avoid soaps and body washes that have moisturizers.
7. Change loofah-type sponges often to avoid trapped bacteria. If your skin gets dry, use a moisturizer after you shower only on the areas that need it.

Do all that you can, and if you have a red, angry skin lesion that worries you, do not hesitate to let a physician evaluate you. We are happy to help.

— Debra Cooper, DO, Managing Physician for U.S. HealthWorks

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