Monthly Archives: November 2011

Best of Our Blog: Winter Weather and Flu Shot Myths

Periodically, we re-post some of your favorite blog posts. We’re offering two that are timely today: precautions to take for winter weather and flu shot myths.

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.

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Top Ten Flu Shot Myths: Don’t Fall for Them

It seems most people won’t get a flu shot this year – many turning to what can only be called the Top Ten Flu Myths. Here goes:

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Enjoying My Favorite Holiday: Thanksgiving

Thanksgiving is my favorite holiday. The perfect Thanksgiving holiday consists of making the house smell good, cooking a wonderful feast, being surrounded by family and friends and counting your blessings. All quite doable, and I’m even the cook in the family.

And what a feast it is.

The average Thanksgiving dinner meal is 3,000 calories. And that doesn’t count my gingered cranberry sauce with pecans and pineapple (good enough to eat with a spoon), but I digress.

Three thousand calories is what a large strong man would burn doing heavy physical labor – maybe throwing hay bales. Most of us don’t plan on lifting anything heavier than a beer stein on Turkey day.

Scientists who have run out of useful research have turned their staggering intellects to our simple Thanksgiving fare and have discovered some interesting facts.

When it comes to these dinners, the more guests you have, the more consumption per person.

The average Thanksgiving dinner participant will eat an extra 35 calories for each guest seated at the table; a case of “the more, the merrier.” More people means more conversation and more time at the table, with predictable results. Distraction also can run up the calorie count. Watch football during dinner and you will add 140 calories to your meal.

Your digestive system has been around far longer than Stove Top Stuffing and still worries about lean times. Being able to gorge on a high fat meal just might get you through the next ice age. So your stomach expands in response to the sight and smell of food. Low fiber, high calorie foods classically associated with Thanksgiving dinner also are rapidly absorbed, giving you room for more.

Those hoping to offset the caloric onslaught by fasting for a day of two, just make it worse and eat more at the Thanksgiving table. Thanksgiving gluttony has even developed its own vocabulary: “uncomfortfull” or “Turkey-Hangover” are two examples.

But there is hope and a few tricks to get you through the meal with less than mortal damage to your diet.

First and foremost, don’t starve! Going to the Thanksgiving table hungry is the recipe for trouble. Eating a bowl of cereal or a cup of soup several hours before dinner will pay dividends.

Eat slowly. Give your body a chance to tell you it’s full. Feelings of satiety are basic hormonal signals that travel much slower that nerve conduction. Your body is talking to you; you just need to pause and listen.

Under normal circumstances you could spend a bit more time with the vegetables, and be ahead. But Thanksgiving recipes have a way of even making vegetables calorie-dense.

Consider an appetizer. With a bit of planning, a well-chosen appetizer will slow down the kamikaze attack on the mashed potatoes and gravy.

Take your time and enjoy the day. The day is about counting blessings more than just food. The cook won’t complain if you don’t have “thirds.”

Happy Thanksgiving!

Dr. B

Photo © Stephaniefrey | Dreamstime.com

A Tragic Afternoon at the Reno Air Races

Editor’s Note: Exactly two months ago, U.S. HealthWorks doctor Anne Coatney was thrust into a tragic situation at the most unexpected time. Her story and how she handled it follows.

This sun-drenched afternoon in Reno, Nevada, was supposed to be the start of another memorable weekend for Anne Coatney. A big fan of aeronautics, she was back in a familiar place, her eyes transfixed on the sky as she sat in Box 68 at the annual Reno Air Races.

But for Coatney, a doctor for U.S. HealthWorks Medical Group in Seattle, the day turned tragic as a plane crashed into the viewing stands.

That Friday, Sept. 16, as Dr. Coatney attentively gazed up at the sky during the featured Unlimited Race, fear engulfed the tens of thousands of spectators as a vintage World War II-era fighter plane, traveling in excess of 450 mph, careened out of control.

'Taxi' photo (c) 2006, Dylan Ashe - license: http://creativecommons.org/licenses/by-sa/2.0/
For a moment, it appeared to be headed right for the very box that Dr. Coatney occupied with 13 friends and acquaintances.

“Practically everyone hit the deck around me, but I just stood up and watched it,” recalls Dr. Coatney. “I thought, ‘Oh my gosh, I may die!’ Everyone was fearful for their life.”

There was little advance warning when the modified vintage airplane slammed into the tarmac at Reno-Stead Airport, resulting in the worse accident – 11 deaths, 74 injured – in the history of American air race events. Before this year’s disaster, 18 pilots had lost their lives at the Reno Air Races since 1972, but never a spectator.

The plane piloted by Jimmy Leeward crashed near the grandstands around 50 yards away.

A doctor with 19 years of emergency medical treatment experience, Dr. Coatney took a quick look around her immediate area, then sprinted straight for the crash scene.

As she rushed to the accident location, in her path were debris from the plane, and several dead bodies, including a person in a wheel chair, but she remained focused on getting to those she could still help.

“I was running toward the crash. Your adrenaline takes over and you just react on instinct. I didn’t know I could run that fast,” Dr. Coatney said. “I immediately was looking for someone in charge and, luckily, I found him quickly. I told him I was an emergency room doctor and he told me to go to the red zone, where the most critically injured people were being taken.”

The first person Dr. Coatney encountered was a 54-year-old man who was in mild shock. His right arm was severed at the elbow and he had an open skull fracture. Because she had no medical equipment, soothing words and makeshift treatment were all Dr. Coatney could immediately provide.

“All I had were my hands,” she said.

She kept those hands busy, trying to stop the flow of blood while keeping the man calm and taking some vitals with the aid of her watch. For bandages, Coatney used cloth given to her by helpful spectators who were cutting up nearby curtains from the box seats. Eventually she managed to stop the man’s bleeding in several places.

After helping load the man into a helicopter, she was off to the next injured person, a woman who had two fractured legs, open wounds, internal bleeding, and was in Level 2 shock. Dr. Coatney later treated a 29-year-old woman who had problems breathing due to shrapnel sticking out of her chest. Her leg was fractured and she had a collapsed lung.

Exhausted and back at her hotel that evening, Coatney called the hospital and checked on all five patients she had treated.

Dr. Coatney said her three years of residency at an emergency department in downtown Detroit, where caring for 20 gun-shot wound patients a night was not unusual, helped prepare her for Reno.

“I have learned how to remain objective and just do what I was trained to do,” Dr. Coatney said. “I thank God I had such good emergency training from my ER director in Detroit. It helped me be ready for a disaster like this one.”

Dr. Coatney has been coming to the Reno show for 19 straight years. It was quite an ordeal, but Coatney insists that she will be back in Reno next year and sitting in Box 68 once again.

“When you look back on what happened, you just think that you were lucky to live through it,” Dr. Coatney said. “It makes you look at things differently and you think that every day is a gift. It was a life-changing moment. But I’m absolutely coming back. I’ve gotten to know so many people that come to Reno every year and I’m part of the aviation community.”

To Report or Not to Report – That is the Question

This is a question supervisors, bosses, and HR specialists ask themselves constantly, albeit quietly.

Everyone wants zero injuries and companies have been known to insist on watchful waiting before committing to medical care and a reportable injury. This is a risky game but I offer some guidelines that should help you avoid some of the deepest pitfalls.

Does this “injury” need medical care?

I will start with the disclaimer that the safest thing to do is have any injury evaluated. The injured employee will do better and you and your company will stay out of trouble. But, if I were a supervisor, I would want some help in trying to sort the serious from the nonsense.

In looking at a possible injury, the first thing an employer naturally considers is who the employee is. They are thinking of his HR file: attitude, reliability, productivity, attendance. Essentially, are they a great employee, or a marginal one? That approach may guide you in determining whether the employee will be here next year, or will get a promotion, but is the wrong place to start for work-related injuries as it has nothing to do with the outcome from a specific event.

So put down the HR file and start somewhere else.

A good place to start is with the “mechanism of injury.” That is a term for “what happened” – the employee got hit with a hammer, fell down, or lifted something heavy. Would you expect a serious injury from this particular circumstance? How much force is involved? For example: If someone falls off the loading dock onto concrete, and doesn’t land gracefully on his or her feet, a fracture is more than possible, even expected. The opposite circumstance is someone hitting his elbow against a doorframe while walking through an opening. That would not be expected to produce a major elbow injury.

So consider the force put upon the body at the time of injury. Rule 1: Big force causes big injuries. That tells you to be very concerned about even an apparently minor injury if there was major force involved. An employee falls off the roof — have them checked out, even if he attempts to brush it off.

Injuries come from outside forces acting on the outside of the body. Since the body is conveniently covered with flesh and blood, there is often physical evidence of this injury. Especially in an extremity, there will often be swelling, a black-and-blue skin coloring, tenderness and sometimes “it just doesn’t look right” – because there is a minor deformity. If it doesn’t look right, beware.

All of these suggest more injury rather than less. So the second rule is if it looks injured, get it checked out sooner. The third rule is to minimize downside risk. In medicine downside risk is a tragically bad outcome, disability, death, medical complications – of course, all very bad stuff.

Doctors are trained to instantly think the worst, and go about proving to ourselves it isn’t that bad. That approach avoids missing something important that will cause great grief if missed.

In essence, you ask yourself: “What is the chance of this becoming a big problem if it doesn’t get treatment quickly?” That is, admittedly, difficult to do without a lot of medical background, but we can suggest a few scenarios.

A head injury with even brief loss of consciousness or appearing dazed is concerning. This is a brain injury. Brain injuries are always serious, because they can turn out very badly very quickly. This employee needs to be evaluated even if he or she claims to be fine. The downside risk is too great not to aggressively look for trouble.

Broken bones can have really lousy outcomes if not taken care of. Quite often the injured employee can tell you they have a broken bone. They hear or feel the bone break. Believe them and get them checked out promptly. Foreign bodies in eyes are a very common industrial injury. The employee will tell you they have something in their eye. They are almost always right. If a foreign body is not removed it will become harder and harder to remove and put your eye and vision at risk. It’s always worth trying to wash it out at work, and if that solves the problem, no worries, but don’t waste more than 10 minutes trying to wash it out. If you can’t get it out right away, it needs to be removed by a doctor.

All employers attempt to separate the truly injured from the minor stuff.

A little common sense when combined with some thought about mechanism of injury, signs of injury, and downside risk will go a long way toward helping you make safe decisions. Of course, the safest course of action is to have a medical provider evaluate the injury right away, which is our recommendation.

We are a phone call away if you need specific and immediate advice.

Take Care.

Dr B.

Medical Marijuana Hits a Speed Bump

After the almost continuous progress of medical marijuana toward legalization by states, the federal government is threatening to use the trump card of federal law to override state laws.

'marijuana joint' photo (c) 2008, Torben Hansen - license: http://creativecommons.org/licenses/by/2.0/
California medical marijuana dispensaries have been told to cease operations within weeks or face federal prosecution. This has always been a possibility and, while many are surprised and yell “unfair,” many more are surprised it has taken so long. Marijuana, for the record, remains an illegal federal schedule 1 drug.

Medical marijuana occupies a curious and singular position as a “quasi pharmaceutical.” Like prescription medications, it has uses in the treatment of certain diseases. Like prescription medications, it has the potential for abuse.

The federal government sees the potential harm from abuse overriding any benefit of medical marijuana. This is not to say there is no benefit, but the therapeutic ratio tilts toward more harm than good.

The unique position of medical marijuana is further demonstrated by the individual state laws that regulate the prescription and dispensing of marijuana. For the rest of the pharmacopoeia, the DEA regulates all aspects of the medication. The drug manufacturer must make the drug of a certain purity level, it must be free of other harmful chemicals, and must be of a certain strength that is measurable and virtually identical batch to batch. It also must be proven effective for the condition for which it is approved. Those prescribing are highly regulated (medical doctors) as are the pharmacists and pharmacies that dispense medications.

Medical marijuana is also unique in its “sig” (medical language for prescribing instructions). If you look at medication bottles you have had, they give specific directions (i.e., take 1 tablet 3 times per day with food). The instructions for medical marijuana are to essentially use as much as you need, as often as you need, for as long as you need. I can think of no other medication either over the counter or prescription that has that latitude of use.

That being said, marijuana does have some benefit as an appetite stimulant for people with diseases like cancer or HIV who can benefit from that stimulant. It also can benefit patients experiencing nausea from such things as chemotherapy. However, experience has shown us that 90% of patrons of medical marijuana dispensaries don’t have cancer, HIV or what the mainstream medical community sees as serious diseases that cannot be successfully treated with conventional medical treatments.

What it comes down to is the present patchwork solution to marijuana legislation is simply unworkable, requiring a resolution at the federal level. It needs to be either treated like a drug, a medication or classified like alcohol.

Treating marijuana like a medication would involve marijuana being produced by licensed drug companies, in a standardized fashion, with frequent inspection and quality assurance programs. Marijuana, the medication, needs to have standardized levels of THC (Tetrahydrocannabinol), ensuring patients get the same effective dose each time they use it. This would be sold and distributed by pharmacies, with licensed and trained pharmacists. This is unlikely for a number of reasons, not the least of which is that smoking anything causes lung cancer and large pharmaceutical companies or large pharmacies don’t want that liability or damage to their reputation.

Treating marijuana like alcohol at least on the surface appears workable.

This would involve some standardization of product, federal or state inspection and presumably paying state and federal taxes.

Restrictions could be placed on the sale or use of marijuana by underage people.

What we have now is not a solution, but an anti-solution. We should start with a clean slate and appoint a blue-ribbon panel of recognized experts to analyze the risk and benefits of marijuana use. These experts could examine or commission serious scientific research and make reasoned decisions based on fact, not opinion.

Take care,
Dr. B