Monthly Archives: August 2011

How to Cope With the Back-to-School Routine

'tired' photo (c) 2008, nigelpepper - license: it is almost September again. How is that possible? Wasn’t Memorial Day just last weekend? It’s time for the start of another school year, which is a stressful time in my house and I’m guessing yours as well.

It isn’t exactly a secret when school starts; we’ve known the date for months. We’ve been hitting the back-to-school sales for weeks, so it’s not like we weren’t thinking about it. One would think with all this advanced warning and preparation, we would have this down to an art. However, my third and eighth grade kids will tell you we don’t.

Why is the start of the school year so physically and emotionally challenging? Perhaps it is sleep, specifically the lack of it. Bedtimes for most students slowly drift into the late evening hours as summer progresses, and the kids never see a sunrise.

Despite the best of intentions, bedtimes do not adjust easily or painlessly when school begins. The two- or three-hour sudden change in bedtime amounts to a good case of Jet Lag; colorfully named “desynchronosis.” The rule of thumb is it takes one day to adjust for every hour changed. Common symptoms of desynchronosis include fatigue, irritability, headache and mild depression. This describes how my kids feel on the first few days of school – and you thought it was normal.

But what time they go to bed isn’t the whole story. When they get up is important, too. “Sleep latency” is the medical term for being awakened and feeling like “something the cat drug in.” This depends on when in a sleep cycle you wake up. Being awakened during deep sleep or REM sleep is disorienting and amplifies sleep latency (the cat thing).

If you wake up during light sleep you feel almost human. There are actually alarm clocks that monitor your sleep and wake you up only when you’re sleeping lightly. So a wake up range would replace the wake up time. Have to get up at 7 a.m.? Set your range for 5:30-7 a.m. and it might make you feel better. Counterintuitive isn’t it?

But sleep patterns are not the only thing to consider when kids go back to school; change in activity is a factor as well. During the summer, kids move rapidly from interest to interest to keep themselves amused. They are working with an attention span that is as short as five minutes in young kids and 20 minutes for teenagers. When school starts they are suddenly trapped like rats for hours on end. Their activities are chosen by their teachers, who share neither their restlessness nor their short attention span. This too takes several days to readjust.

What about summer meals? What summer meals? The kids are going five different directions and grab something when they occasionally make a pass through the kitchen. Frequent small feedings, heavily loaded with “carbs” and taken at liberty, are the rule. Their young digestive systems tolerate this surprisingly well. With the start of school and scheduled, regulated meal times, blood sugars are predictably plummeting. The result is more restlessness, fatigue and irritability.

Like so many other things in life, the solution to adjusting to the back-to-school routine is practice, practice, practice. Think about the school day, wake up times, meal times and bed times. You can still fit in some fun and readjust your sleep and meal schedules at the same time. A two- or three-day head start will make all the difference. No, that doesn’t mean you have to do homework before school starts. Let’s not be ridiculous.

Take care, and good luck with your new wake-up regimen.

Dr B


10 Reasons Not to Exercise

I was a great exerciser for most of my life. Recently I seem better at making up excuses not to exercise than to actually exercise.

As a motivation tool for myself I have listed all my good reasons for not exercising. You may find a few of your favorites. Hopefully you will see my folly and get back on a program yourself. So after a little reflection, here are my favorites.

1. I am middle aged and don’t need to pretend I’m young.
2. I am too busy to exercise – work, child rearing, keeping the house livable doesn’t leave time for exercise.
3. I don’t get enough sleep as it is without getting up an hour earlier to exercise.
4. My back hurts. You may substitute knees, hips, or your big toe – pick your favorite, or least favorite, body part
5. It’s too hot to exercise (115 F in Phoenix as I write). Of course too cold, humid, windy, rainy or generally inclement works equally well. It could also be too light or too dark for that matter.
6. I have a big meeting tomorrow and I need to be well rested.
7. I’ve been married for 17 years and my wife still likes me (even without exercise).
8. My weight is good and I look like I exercise (I actually stole that one from my wife a decade ago).
9. No matter how much I exercise I still don’t look like Arnold (or Halle).
10. If I can’t do the exercise I want, why bother.

So use one excuse a week and it will be a long time before you exercise.

More seriously, most of these are easily swatted away and I have done that myself many times.

A few to discuss:

No. 10 is a real struggle for many. I had two back surgeries that put a stop to my running and weightlifting. It took some pondering, but rollerblading is easy on the back and aerobic exercise. Aging and injuries do force you to lower the exercise bar, but throwing in the towel is not necessary. If you can only walk, do that. Almost anyone can swim for exercise, the weightlessness makes it joint friendly.

Looking like you exercise is not the point. Living longer and being able to participate is the point. Exercise can make some wheelchair bound people walk again. You can be fat, thin, short, tall, old or young and still make your life better with exercise.

Most studies show exercise helps joint pain. This is true even with relatively advance degenerative joint disease. It also helps you lose weight, lessening pain.

Hopefully, I will think of these counterpoints tomorrow morning when I wake up with an excuse at my lips.

I will recognize it for the excuse it is and move anyway. If doesn’t work, Sheba, my Siberian Husky, will remind me she needs exercise also and doesn’t take excuses.

Take Care.

Dr. Bucklin

Auburn (Washington) Reporter: Head Injuries

Head Injuries Remain Major Problem for Football Players
By Dr. Bruce Kaler, U.S. HealthWorks

Head injuries in athletes resulting in concussions occur more frequently than previously thought. We are learning more about the problem and the important consequences.

Each year more than 300,000 U.S. athletes suffer some form of traumatic brain injury. High school athletes comprise 60,000 of these injuries. The consequences vary a great deal and can be physical, emotional and intellectual.

Best of Our Blog: A Cup of Joe and Carpal Tunnel Syndrome

We’ve culled through the statistics and pulled together some of our most-read blog items since we launched. Below are two of the favorites.

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.
Read More

Carpal Tunnel Syndrome Made Clear in 10 Paragraphs

Carpal Tunnel Syndrome (CTS) is an occupational medical diagnosis that often gives employers, patients, and sometimes even medical providers, undue levels of frustration. Like a lot of other things in medicine, reasonably simple concepts are hidden behind Latin words. You just need a basic understanding of how things are put together – in other words, anatomy.

Let’s start with the hands. The hands are absolute miracles of micro-engineering. They are capable of generating tremendous force, while being compact and delicate enough to pay a violin. They pull this off by putting the muscles that work the fingers in the forearm. These muscles are connected by cables, called tendons, to the fingers. Contract a muscle in the forearm, it pulls the cable (tendon) and moves the finger. I never fail to be impressed by the cleverness with which the human body is put together.

Read More

Best of Our Blog: Rusty Nails and Working the Late Shift

We’ve culled through the statistics and pulled together some of our most-read blog items since we launched. Below are two of the favorites.

Rusty Nails, Dirty Wounds and Tetanus

This morning I heard a newscaster lament, “I was cut with rusty metal, and there is a national shortage of tetanus vaccine.”

Despite his concerns, this is not exactly certain death. Growing up in Southern California, I spent most of my youth barefoot, tangled with more than a few rusty nails and was on the tetanus-shot-a-year plan. This experience prompted an interest in the whole rusty nail tetanus connection.Read more

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.
Read more

Dangerous Bath Salts All the Rage and We’re Not Talking “Mr. Bubble”

On the heels of synthetic marijuana (K2/Spice), the basement chemists are already at it again. This time they are passing something off as a bath product when it is a designer drug based on amphetamine.

Designer drugs are actually an offshoot of a legitimate search for better medications. Whenever we, the medical community, find a medication that works, we try to improve it. I would like to tell you that the entire medical/pharmaceutical industry has nothing but the noblest of intentions, but a great deal of money is made on a “new” medication.

A pharmaceutical research team will try dozens of small modifications on a particular medication. Some won’t work, some might be toxic, and occasionally one is a better medication. Maybe it lasts longer so it doesn’t have to be taken as frequently. This also, not coincidentally, happens to get around the patent. Change one atom in the drug molecule and you have a new patentable drug to compete with the original. It also won’t test like the original.

Designer drugs are just variations of illegal drugs, attempting to get a stronger effect, or at least to change it enough, to get around drug laws. Ecstasy is a minor variation on Dextro-amphetamine.

Bath Salts are another variation of an amphetamine. The chemical name for so-called “bath salts” is MDPV (Methylenedioxypyrovalerone). MDPV shares a lot of the properties of its parent drug, Dextro-amphetamine. It is a stimulant and an appetite suppressant, but in some cases acts like a hallucinogen. It is believed to be roughly four times stronger than its parent drug, and that is problematic because people dose the drug in similar quantities as amphetamine.

The stimulant effects are physical as well as psychological. The extra alertness comes at the expense of an elevated heart rate, hypertension and physical alertness similar to the uncomfortable effects of adrenalin fight-or-flight response. Not exactly the clearheaded intense focus that its users are seeking.

Some rather nasty things are occurring with higher frequency than amphetamines or Ecstasy, its closest relatives. Psychologically, MDPV can cause hallucinations, delusional thinking and severe paranoia. Physically, we have seen a rapid breakdown of muscle, usually resulting in kidney failure and death.

MDPV is illegal in only a handful of states and the federal government has not yet acted on this new drug. There are emergency scheduling laws that allow the DEA/federal government to expedite a ruling on this drug. It will likely be illegal under federal law very soon.

These days the drug screen laboratories can come up with a test for these drugs faster than they can be made illegal. Testing for MDPV is available now and is a straightforward urine drug screen. It can be added to any non-DOT urine drug screen for a modest charge. The detection window for MDPV is about three days; which is longer than the 24 hours that Dextro-amphetamine is present.

We offer full MDPV testing at U.S. HealthWorks.

Take care.

Dr. Don Bucklin, MD
National Medical Review Officer

Update: Head Injuries Remain a Major Concern for Football Players

Head injuries in athletes resulting in concussions occur more frequently than previously thought. We are learning more about the problem and the important consequences.

Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury. High school athletes comprise 60,000 of these injuries. The consequences vary a great deal, occurring both emotionally and intellectually.

Traumatic brain injury can result in short term symptoms as well as problems that are more serious and may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual, and personality traits of the injured person.

The more blows to the head that occur – even small ones – increase the risk for mental deficiencies. Significant head trauma to a football player occurs hundreds of times a week during practice and games. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A study in 2000 surveyed 1,090 former NFL players and found more than sixty percent had suffered at least one concussion in their careers. Twenty six percent had three or more. The survey revealed that players who had concussions reported more problems with memory, concentration, speech impediments, headaches, and other neurological problems than those who had not. Because these professional players had spent many prior years playing football in high school and college, the frequency of head trauma is likely under-reported. Head trauma is a problem for many of the non-contact sports as well.

Other common medical problems are being discovered as we examine concussions more closely. Depression, insomnia, attention deficit and personality changes all occur with similar frequency among high school athletes. These kinds of problems have been found to be more frequent in those who have had even one episode of head trauma.

Long-term problems may take eight years or more to develop or worsen. Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits, regardless of how quickly they subside on the sidelines. It is widely accepted that concussion symptoms can reappear hours or days after the injury, indicating that the player had not healed properly from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur.

But the question remains – how much healing time is enough? A health care provider should be involved in examining and investigating these head injuries to ensure the best outcome. Even one episode of head trauma makes the athlete more vulnerable to serious consequences for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. One recommendation is reducing the numerous head blows by enforcing practices that involve no contact. Research has shown the number of head blows during a college football season totals in the thousands for an individual player. Many football collisions have forces comparable to driving a car into a concrete wall at 40 miles per hour.

Teaching better techniques to reduce the head leading contact in tackling and blocking and providing better equipment can help reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to protect athletes of all ages. Athletes themselves should be encouraged to seek medical attention for head injures – even if they seem mild and there is no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early, and be the basis for ongoing treatment and peace of mind.

Dr. Bruce Kaler

Acne, Chocolate, Shaving and Hair – Medical Truth Behind the Myths

One of the small joys of medical school is finding out a bunch of the stuff you’ve been told is wrong.

That may not be the noblest of intentions, but joy nonetheless. My first startling discovery of this type was on the health of your eyeballs and the illumination of your reading material. Who doesn’t have memories of Mom turning on lights with the exclamation: “Quit reading in the dark; you’ll ruin your eyes!” Few of us questioned the wisdom of the advice, even if the lesson didn’t seem to stick.

I still remember cheerfully calling home and explaining to my parents the workings of the eye and the complete lack of damage from reading in poor light. Just like a camera, poor light gives bad pictures, but it doesn’t damage the camera. Yes, these were the same parents that were paying for medical school.

Another bit of mistaken medical folklore involves swimming after eating.

I remember dutifully waiting a good 30 minutes, which seemed like three hours, before swimming after eating, as advised by all sensible adults.

Living in California I heard countless stories of careless people going for a dip too soon after eating, only to be incapacitated by a cramp, and sinking like a stone into the murky depths – that would be the 8-foot end of the pool. I spent months going through every last organ in my cadaver specimen and assure you there is no cramp organ. Swim 10 seconds after your last bite, and use pool water to wash it down and you still won’t get a cramp.

Moving on to teenage years there were lots of well intentioned dietary advice for a teenager with pimples. Chocolate was the favorite food to blame for acne. This myth is so pervasive in society that one of my medical school professors specifically addressed this mistaken notion.

She told us to please find some chocolate that really caused acne (good luck, there isn’t any). She theorized that if it could be found, with a little analysis we could find the specific culprit, and remove it. That would allow us to make acne free chocolate. Think of the sales, I could pay off medical school. This perhaps takes some of the guilty pleasure out of chocolate, even more so now that we know a little dark chocolate is good for you.

About the time we were getting over the worst of our acne, we were giving our young livers a work-out with the new found joys of alcohol. I have vague memories of getting drunk on the most ridiculous beverages, cheap wine, sloe gin or anything else we could get our hands on.

Who has not poured coffee into a drunk friend expecting to sober him up enough to not be killed by his parents? Perhaps you have tried the coffee cure on yourself. Alas, coffee will not speed up the metabolism of alcohol even a little bit. You are just as drunk after 5 cups of coffee – and you have to go to the bathroom even more. The caffeine might wake you up enough to do something stupid, like drink more, or call your ex.

Getting a little older, arthritis seems more like reality, and colds are not shrugged off with the vigor of youth.

If you do get some hand arthritis, don’t blame it on cracking knuckles. Cracking knuckles causes zero joint damage, and produces no increased risk of arthritis. It’s harmless, although quite irritating to most of the people around you, which may be the point.

What about wet hair and colds? Colds are caused by viruses and not cold air or a wet scalp. Wet hair doesn’t even weaken your immune system and make you more susceptible to the first germ that passes by. The dangers of wet hair are clearly overstated.

Shaving causes hair to grow back thicker and darker. Everybody knows that. This also is medical fantasy. Bunches of studies have been done on this very subject. Shave or grow a beard, the whiskers stay the same. Same goes for legs.

How about the healthy glow from 8 glasses of water a day? Another medical myth. The origins of this belief are obscure, but the evidence is clear. Drink when you are thirsty, a little more if you are exercising.

Medical myths are common in society, and always have been. Partly it’s magical thinking, partly American pragmatism. We have only recently started making decisions based on evidence. As that gathers speed, it may spell the end for sewer dwelling alligators, or maybe not.

Take care,

Dr B (aka Dr Don Bucklin)