Monthly Archives: January 2011

The Top 5 Places to Catch the Flu

Here we are just into the opening weeks of a new year, and influenza is well into its annual assault on America. Germs aren’t hard to find this season, but where they hide might surprise you.

At the Office
We spend more than a third of our lives at the workplace. This tops our list for flu exposure. Depending on the layout of where you work, you may find yourself uncomfortably close to a sneezing, sputtering coworker. Perhaps you share a telephone with several others. Breath is heavy with moisture and creates a nice warm place for bacteria and viruses to multiply in the telephone mouthpiece. So you may be sharing more that simply a telephone.

Keyboards also get pretty germy. Our fingers are moist and a bit oily, and leave a film on the keyboard surface. This is a perfect place to grow germs. Keyboard use is a good way to both leave and pick up germs. One study found more germs on a keyboard than a toilet handle. Where is that can of Lysol?

How about that break area at the workplace. Which refrigerator gets cleaned more often, the one at home, or the one at work? Washing coffee mugs at work usually takes a quarter of the time and half the amount of soap that the same mug would get at home. Not surprisingly, they don’t get too clean and can be a source of influenza germs. Has that sponge in the break room been replaced since the company opened? Old sponges smell bad for a reason. Old magazines in the break room have been read by generations of people, few of which wash their hands. Put those same magazines in a doctor’s waiting room, and they get to heroic levels of germs rather quickly. Magazines don’t do too well in the washing machine.

DSC_3958photo © 2005 Michael | more info (via: Wylio)

At Home
We all try pretty hard to not leave used tissues lying around the house – these are the hand grenades of the germ world. Germs are sneaky and inventive in their hiding places. The remote control gets handled by many greasy hands – chips and TV anyone? The kitchen at home is cleaner than the one at work but still contains more germs than the bathroom. When is the last time you cleaned the cabinet door to the kitchen waste basket? How about the refrigerator handle? Care to guess how many germs get tracked in on your shoes from the outside?

On the Go
Start with your own car. Rarely do we risk an accident by sanitizing the steering wheel after a good sneeze. Anyone else drive your car? Public transportation in its many forms also serves as a germ reservoir. From elevators and escalators to city buses, large numbers of often sick people pass though, leaving more than a footprint. Who last pushed that elevator button? Who last used the hand rails? I need to take a break and wash my hands.

Airplanes are particularly worrisome as far as influenza virus is concerned. The air in a commercial jet is re-circulated, perhaps better put, recycled. A couple hundred people are shoulder-to-shoulder and breathing the same recycled air. The air is filtered but lots of interesting germs can be cultured right off the filter. There is not enough space to separate you from the germ factory sitting next to you, and it’s always next to you, isn’t it? The aircraft bathroom holds the record for the “germiest” of public bathrooms – all of the usual sources of germs in one-tenth the space. The interesting roaring sound the aircraft toilet makes actually can put colonic bacteria (ecoli) into the air for all to breathe.

Your Retail Life
At least they have figured out shopping cart handles and placed disinfectant wipes close by. You might wipe more than just the handle, as the last user could have had a sick child in the cart seat.

Credit Cardsphoto © 2008 Andres Rueda | more info (via: Wylio)

Everybody knows money is dirty, but credit cards get handled a lot more and are never cleaned. How about the keypad in the grocery line with the credit card swiper? None are cleaned on any kind of regular schedule.

The gas pump handle also sees a lot of hand traffic but no cleaning.

Finally, your cell phone is not always your best friend. Pass it to friends to make a call, show a picture or share a Facebook comment – lots of hands, no cleaning.

Although it seems tempting, I don’t recommend you actually live your life in a bunny suit. Your immune system is designed to help you survive the various insults. You can give it a big help with a yearly flu shot.

Be well,

Dr. B

Prostate Screening at a Glance

With an aging population in the United States, many Baby Boomers are “coming of age.” Estimates are that 10,000 of them reach the age of 65 daily.

Prostate problems in general are very common and confusing. No doubt, the confusion will increase due to so many more men experiencing prostatic enlargement and possible cancers. More than 50% of men over age 50 are affected by prostate enlargement. By the age of 80 years, 90% of men will have an enlarged prostate.

The diagnosis and treatment of prostate problems has changed a great deal over the last 20 years but continues to lack clarity or consensus. Benign enlargement of the prostate gland causes urinary frequency, urinary retention and incomplete emptying of the bladder. Similar symptoms may be initial signs of prostate cancer as well.

Early detection of any cancer is key to successful treatment. The confusion is with testing procedures that are less than perfect. A wide variety of treatments, none of which achieve dominant success over other modalities, and some evidence that many of these cancers do not need to be treated because of their slow growth, confound diagnosis and management of prostate problems.

Let’s examine what we know.

The urethra (the tube you pee out of), unfortunately runs right through the middle of the prostate. So when the prostate swells, as they all do with increasing age, it chokes off the urine flow. Enlargement of the prostate is suspected when urinary symptoms such as the following are experienced: urinary frequency, stopping and starting urinary stream, straining to urinate, and getting up at night to urinate regularly. A weak urinary stream and dribbling may also indicate enlargement. The challenge is that prostate cancer, prostate infections or common urinary tract infections can also cause similar symptoms.

Discovery of prostate cancer can be as simple as the basic urine analysis, digital rectal exam, and Prostate-Specific Antigen (PSA) blood test. Normal findings in all of these tests are reliable in eliminating possible cancer; however, positive results raise the suspicion of cancer in men over 50 and need to be carefully evaluated. PSA tests in particular are well known for false positives due to the ability of benign prostatic enlargement to cause elevations in the results. Blood in the urine could be an early clue of cancer requiring further evaluation or biopsy.

Treatment of benign prostatic hypertrophy is usually with medications that can slowly reduce some of the problem of obstruction of urine outflow from the bladder by the prostate enlargement. Some herbal remedies have had some limited success as well; however, studies are unable to reproduce consistent benefit. Medications can help most men who struggle with small frequent urination, but side effects like dizziness and low blood pressure occur in some.

When medical treatment does not work or seem suitable, surgical procedures may be helpful. There are several minimally invasive treatments that can achieve good results with low risks and good improvement in urinary flow. Each case must be evaluated on an individual basis with a urology specialist to tailor the appropriate option to the individual patient.

Cancer detection in the prostate is still a challenge. It can be difficult to diagnose the presence of prostate cancer as well as whether it is a more aggressive or slow-spreading type. The PSA blood test is still the best screening test even though it has limitations. Following the progression of this test value with consideration for the individual, age, family history, along with other risk factors has the best predictive value.

There remains a difference of opinion among experts regarding watchful waiting for screening and active surveillance for cancer. There is additional uncertainty in prostate cancer treatment as many of these are very slow growing. An old adage suggested that older men died “with” prostate cancer rather than “of” prostate cancer. The amount and location of cancer detected (whether it has spread outside of the prostate gland), age of the patient, risk factors and other illness will strongly influence how aggressive treatment should be. Because of the variations of slow and more aggressive prostate cancer, treatment needs to be an individualized decision between each patient and his treating providers. Surgery, radiation, and chemotherapy are all tools that can bring a best outcome for any given individual.

With aging Baby Boomers, benign prostate enlargement and cancer will increase in prevalence. Thankfully, there have been many new developments in treatment. The particulars of screening and detection remain a controversial area, but being informed and vigilant is the best way to protect yourself and the aging males in your family.

– Dr. Bruce Kaler

5 Surprising Places the Flu Can Linger

KSAZ FOX 10 in Phoenix stopped by U.S. HealthWorks Center Medical Director Dr. Donald Bucklin’s office this morning to talk to him about 5 places where you can catch the flu. Check out the segment here.

What Would You Do If A Colleague Came To Work With The Flu?

Last week, our very own Dr. Steve Sorsby spoke with Q13 FOX in Seattle about dealing with co-workers who are sick and how to prevent spreading illness at work. Check out what advice he had:

What Would You Do If A Colleague Came To Work With The Flu?

By Angela King & Q13 FOX News Online
January 11, 2011

Does it drive you crazy when your colleagues come to work sick? They’re coughing and sneezing all over the place, forgetting to cover their mouths? What would you do in that situation? It’s not always easy to tell your fellow adults to “cover up”, but it might be worth thinking about, especially now.

The flu is starting to emerge on the east coast and in the south. It usually doesn’t peak here in the northwest until February. Doctors aren’t anticipating a severe flu season like the one we saw last winter. Since 2009, H1N1 has killed thousands of people, and sickened many more worldwide. (Read the rest here)

Combating Household Germs

Do you know your kitchen sink may be as dirty as your toilet bowel?

The kitchen sinkphoto © 2009 Alan Cleaver | more info (via: Wylio)

Given the amount of use, high traffic of organic material and moisture with relatively warm temperatures, the kitchen sink is a perfect breeding ground for many germs. Most people forget to sanitize their kitchen sink and don’t appreciate the potential bacterial source it is for contaminating food, utensils and hands. Many household areas where there is high traffic and surfaces that are touched frequently by family members can be potential sources of germs and contaminants. Most of these high traffic areas are taken for granted or cleaned only occasionally, but rarely sanitized.

The kitchen is not the only source but remains the single biggest reservoir of germs in the house. This is the area that gets a lot of traffic from adults, children, animals, and dirty and decaying food. As an area that is so intimate to our daily lives, it is easy to see how we can contaminate ourselves with germs in this room.

Kitchen towels and sponges are also very contaminated objects that easily transmit contaminants to hands and other surfaces. A dirty or musty sponge is used on most surfaces without a thought to how it is likely transporting and spreading germs. The towel that is used on your hands or counters to mop up spills also harbors germs. Also, don’t let dirty dishes stay in the sink overnight breeding germs. If your kitchen is as busy as most, the sink and countertops should be sanitized once a week or more often.

Commercially available products can be convenient for this purpose. Economical solutions of ¾ of a cup of bleach to one gallon water can be used on a cloth or in an inexpensive spray bottle on most counters or sinks.

• It is important to remove any food particles or organic material before this is done. Then let air dry.
• Cleaning cutting boards as well with a sanitizing solution is also important – just wash, rinse and allow to air dry.
• Towels should be cleaned and rotated frequently. They could be replaced entirely with a paper towel.
• A sponge can be sanitized in the microwave for 30 to 60 seconds. A well used sponge should also be replaced every 2 weeks.
• Hand washing is still an important part of good hygiene during food preparation.
• Plastic garbage can liners can help control spills and leakage from the trash collection.
• One last spot in the kitchen/dining area that is often overlooked is the salt and pepper shaker. Handled frequently by many people and never cleaned, they can harbor illness producing bacteria and viruses, so don’t forget to sanitize these as well.

The bathroom is another culprit when it comes to germs; however, the locations of the germs are again often overlooked. Toothbrushes easily harbor germs because of the moisture and usage. They should be located where they are not close to the toilet and where they air dry after each use. A single toilet flush can send a fine spray of mist several feet contaminating other areas of the bathroom.

bathroom paintedphoto © 2006 cara fealy choate | more info (via: Wylio)

• Since most bathrooms are quite compact, closing the lid before flushing will help.
• Storing personal hygiene products, towels and toothbrushes away from the toilet is prudent.
• A new toothbrush should be used every 2-3 months.
• If you have recently been sick, you may want to switch to a new toothbrush sooner.
• Toothbrushes can only be rinsed thoroughly with water and allowed to air dry completely.
• Areas of caulking between sinks, counters or tubs, and enclosures commonly accumulate high bacterial and mold counts due to their intrinsic traffic, chronic moisture and difficulty cleaning. Applying the same techniques of cleaning as in the kitchen with focus on the problem areas is necessary.

Other areas in the house that can be a problem are door knobs, computer keyboards and remote controls. They all get a lot of traffic from contaminated hands. Actually the amount of germs here are less than some of the previously mentioned areas. Nonetheless, a periodic wipe with a disinfectant like alcohol, bleach solution or one of the commercially available products for disinfectant cleaning is very smart. Also, change bed linens and rotate towels weekly.

Still, the most important and basic technique is covering a cough or sneeze and regular hand washing. Hand washing after using the bathroom or cleaning these areas, before food preparation or eating, is still the gold standard for prevention. Hand sanitizers can be useful in areas of the house where water is not available; however, 15-20 seconds of simply rubbing your hands thoroughly with soap and water is something that germs can’t beat.

– Dr. Bruce Kaler

Working the Night Shift and Getting Enough Sleep

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

Night shift workers simply get less sleep. In many industries, rotating work schedules often do not allow for adequate time off. Most notable are the transportation industries such as railroads, commercial trucking and airlines. The National Highway Traffic Administration estimates more than 100,000 police-reported crashes occur annually due to driver fatigue, resulting in 1,550 deaths and 71,000 injuries in 2008. The monetary losses exceeded $12 billion. Motor vehicle accidents are more likely after 11 p.m. and greatest between 1 a.m. and 7 a.m.

In non-transportation industries, 25% of night shift workers reported that their work schedules do not permit sufficient sleep time, and 33% reported getting less sleep than needed to do their best work.

Asleepphoto © 2008 David Joyce | more info (via: Wylio)

All shift workers do not suffer from sleep disorders; however, the longer a given individual is on the night shift, the more likely he or she will suffer some medical consequence or have issues with productivity. The effects of sleep deprivation on alertness, judgment and productivity have been quantitatively compared to the effects of alcohol. Just the loss of several hours of sleep can result in impairment comparable to several drinks. This worsens with increasing sleep loss. The message is that sleep deprivation from night shift work is fairly common and associated with physical and emotional distress. The net result is increased accidents, injuries and loss of productivity.

Since night shift work is necessary, how can we manage the side effects and prevent some of the problems that arise? Educating management and workers regarding the risks and being proactive can have a positive impact. Workers will benefit from healthy habits, diet and exercise. If they are having difficulty sleeping, they should consult a health care provider to asses any underlying medical conditions or medications that can influence sleep patterns.

Good sleep hygiene can be very beneficial in acclimating to night shift work. Some tips include:

• Have a quiet sleep area with black-out curtains.
• Avoid caffeine, nicotine or alcohol before sleep.
• Try using sunglasses during the morning drive home to minimize light exposure.
• Refrain from a large meal, excess fluids or vigorous exercise prior to sleep.
• Avoid radio and TV when attempting to get to sleep.
• Although melatonin has been touted by some as a sleep aid, it is not FDA-approved and has inconsistent results as a sleep aid. It does not provide any improved alertness during the subsequent work shift.
• Sometimes, short-term use of a prescription hypnotic drug can be beneficial for those struggling with disordered sleep.
• Controlled and timed exposure to light during the work shift has also been beneficial in some to reset circadian rhythms and restore a better sleep/wake pattern.
• Power naps before the work shift increase alertness, increase reaction times, productivity and do not usually interfere with the daytime sleep for the night shift worker.

Although somewhat unnatural, the night shift has become a necessary part of our working lives. Getting adequate sleep is integral in keeping alert, staying productive and reducing the risk of injuries while on the clock.

– Dr. Bruce Kaler

Baby, It’s Cold Outside: Winter Weather Precautions to Take

Winter is here! Anyone out and about in the cold, wet weather is at risk for some temperature-related injury if they do not follow some basic common sense precautions. Understanding what things make you at risk can help prevent mild and severe cold-related problems.

Barry’s Cabinphoto © 2009 Richard Faulder | more info (via: Wylio)

Body Temperature
The biggest danger in winter weather is the actual temperature and the length of time of exposure to the cold. Wet clothing and wind can greatly enhance the dangerous effects of the cold temperatures – even 50 degree weather can be problematic with some wet clothes and wind.

The metabolism of your own body is your only source of heat. Fortunately it is very good at producing heat and regulating body temperature with an elegant thermostat mechanism. The brain initiates sweating to cool your body, and induces shivering and increased hormone production to maintain adequate heat in response to external cold temperatures.

Hypothermia
This can be very mild or very severe. In the mildest form, the heart rate increases and breathing gets faster. When you are too cold, shivering and other involuntary movements to stay warm start happening without even thinking about it. Poor coordination and not thinking clearly are common, which can impact your immediate safety and outcome. If the hypothermia progresses, the senses and mental status are even more dulled, and even the shivering or willingness to move diminish.

Serious heart, lung and other vital organ complications ensue due to decreased blood flow. Children are more prone to hypothermia due to their small size and smaller reserves for heat production and energy storage compared to adults. Young infants do not have the ability to shiver, and being unable to express themselves are more vulnerable to prolonged cold temperatures without any obvious warning signs. Elderly adults may also have less capacity or resistance to cold temperatures being unable to respond quickly to environmental changes, decreased metabolic reserves, chronic illness, or some medications. It is well known that certain medications such as antidepressants, narcotics, general anesthesia, some blood pressure meds, and alcohol consumption all impair the ability of the body to regulate temperature.

Frostbite
True frostbite is when exposed tissues actually freeze and form ice crystals in the cells of the respective tissue. This leads to severe tissue damage and even death; however, most of us will only encounter mild forms of this process, which starts with swelling, turning pale, and numbness of the skin. Hands, feet and face are the most common areas involved because of their exposure and because they are farthest from the heart and warmer core temperatures.

Blisters that are clear or blood-filled, discoloration of the skin, swelling and redness indicate more advanced problems. Getting to medical care is paramount if clues suggest serious complications.

Frostbite occurs in the workplace in industries using cold storage of common refrigerated and frozen food products. Overzealous use of an ice pack on an injured knee or sprained ankle can cause accidental frostbite, especially when in direct contact with the skin without some dry cloth to mediate the effect on bare skin. Ice packs should be applied intermittently for only a few minutes at a time.

Treatment
Re-warming the body part or individual is the most important treatment for the consequences of cold exposure. It is important to avoid re-freezing if this is a risk. In fact, re-warming a truly frozen part should be delayed until you reach some place where re-freezing is no longer a risk. Warm, dry clothes and blankets do wonders to eliminate the continued loss of heat.

If possible, get to a warm, dry location. Any external heat source could be beneficial. Placing cold hands or feet in warm, not very hot, water is helpful. In extreme situations, body-to-body contact with warm dry blankets can help the person suffering from hypothermia in a remote location.

Prevention
It’s crucial to be prepared, which doesn’t need to be expensive.

Proper clothing and supplies are important whether it is a trip downtown, day hike, or wilderness trip. Plan for the unexpected. Weather conditions in remote areas can change abruptly in the fall or winter. Bring some options with you. The best way to avoid cold related injury is to dress in layers that can be removed as conditions dictate.
Limit the time in the cold as much as possible.
Stay dry. Waterproof footwear and suitable covering for head and hands is a must.
Stay well hydrated. Drugs, alcohol and tobacco can seriously impair your judgment and the ability to tolerate prolonged exposure to the cold.

A small amount of planning can help avoid problems and keep you a lot more comfortable – and healthy – when out in the cold weather.

– Dr. Bruce Kaler

The Proper Care and Feeding of Your Heart

Why should you invest a few precious heartbeats in learning something about your ticker?

Because of atherosclerosis and heart attacks – and because heart disease is still the No. 1 cause of death in this country.

Heart anatomyphoto © 2009 K Sandberg | more info (via: Wylio)

Most of us think the heart is the most important organ in your body. While this might spark a heated philosophical debate, the heart has a certain anatomic primacy based on the simple fact you can’t live without it, even for a few minutes. And few things will ruin your day more.

Most of the important organs in your body are designed with a certain redundancy, like airplanes having two spark plugs per cylinder. You have two kidneys, but can get by on one. You can lose more than half of your liver, just as much of your intestines, blood or lungs, and live, although not with all of that occurring simultaneously. Running on 50 percent function of most organs will leave you alive to fight again.

Ah, but the heart – there can be only one.

Conceptually, the heart is simple enough. It’s a variable speed pump. The faster it beats, the faster the blood goes round and round. It is actually kind of a double pump – one side pumps blood to the lungs, the other to the body. You have to be impressed by the build quality. Most hearts are good for 70+ years and more than 50 million cycles. Very few other things in the world, either living or inanimate, last 50 million cycles.

The heart is a lot like other pumps you know. Pumps, in general, don’t run on what they pump. Think about it – the oil pump in your car uses electricity to pump oil, and a pool pump uses the same to pump water. Similarly, the heart is not nourished by the blood inside the pump; rather, it is powered by the blood in vessels on the outside, namely the coronary arteries.

Given the coronary arteries’ well known propensity to plug up, perhaps the heart might have been better designed to get its nourishment from the blood inside.

But there are sound mechanical reasons why this can’t be. The first involves the heart’s thick muscular walls. There is no way for oxygen to passively diffuse across dense heart muscles in enough concentration to keep the heart alive, let alone beating.

Then there is the problem inherent in that whole beating thing. Blood leaves the heart in an intermittent flow (squirt-stop-squirt-stop). Most tissues, including the heart, don’t tolerate this type of flow. They need continuous flow. Getting this flow smoothed out is the job of the major arteries. These arteries have muscular walls that act as shock absorbers. They expand to absorb a slug of blood and then steadily contract to keep it moving. This works much like a water reservoir supplying water continuously to a town, even though rain is episodic.

Ah, but a heart is so much more than simple plumbing.

A heart’s got rhythm. Heart cells are a type of muscle cell, and like muscles everywhere, they contract. A specialized group of heart cells is a built-in pacemaker. This supplies the tempo. Everybody has to contract at once to get anything done. When they don’t, the heart sort of quivers and stops pumping, and that’s bad.

There can be either blood flow problems, rhythm problems or both from similar things. Atherosclerosis, or plugged coronary arteries, starves the heart cells. Sometimes these cells curl up and die. Sometimes they go electrically haywire and a rhythm disturbance occurs.

So the most important care and feeding of your heart are keeping good freshly oxygenated blood flowing through your coronary arteries. You have been prewired for this to happen. All you have to do is not screw it up. To do this simply means don’t do the stuff that clogs arteries.

• Do control your blood pressure
• Do control you weight
• Do control your cholesterol
• Do control your sugar if you have diabetes
• Do control your stress
• Do not smoke
• Do laugh as often as possible; it helps immunize against stress
• Do drink some red wine – it’s good for your heart and might also help with stress
• Do get some exercise, and for heaven’s sake, don’t suffer for it. If you do, the stress might cancel the benefit of the exercise.

So while hearts may continue to be a mystery to young lovers, you now have the necessary information to understand what makes them tick.

Take care,

Dr. B