Category Archives: Healthcare Trends

California Healthline: Use of Urgent Care Growing in Southern California

Two of our esteemed doctors, Drs. Alesia Wagner and Franz Ritucci, spoke with California Healthline recently about the growth of urgent care. Check out what they had to say:

Use of Urgent Care Growing in Southern California
By Stephanie Stephens, California Healthline Regional Correspondent

Having matured from their early 1970s image of “Docs in a Box,” urgent care centers are growing in popularity with patients who would rather not wait to see a doctor — whether in an office or in the emergency department.

Urgent care’s growth is partly attributable to immediate and projected shortages of primary care physicians. California barely meets the nationally recognized standard for the number of primary care physicians. According to a July 2010 California HealthCare Foundation report, only the Orange, Sacramento, and Bay Area regions meet the recommended supply. Los Angeles falls just below.

Read the rest of the article here


Smokeless Tobacco: Safer or Still Risky?

The use of smokeless tobacco has grown over the last few years, primarily in the under 21 age group. As smoking has been socially less acceptable and the overwhelming amount of evidence of tobacco’s serious health effects are slowly acknowledged, tobacco companies have spent increasing amounts of advertising dollars on smokeless tobacco.

A significant portion of those users are adolescent males, and their numbers are growing by 30-50% since 2006. Of the estimated 10 million users of smokeless tobacco, 3 million are under the age of 21. Young users start as early as the sixth grade and are regular consumers by high school. The Center for Disease Control reports that the largest increases in smokeless tobacco use has been in the 18-24 age group.

A Lesson from the Pastphoto © 2010 Ted | more info (via: Wylio)

Smokeless tobacco contains nicotine and around 30 cancer-causing substances just like tobacco that is smoked. A common misconception is it is somehow different or safer. Nicotine is rapidly absorbed through the mucosa in the mouth, easily attaining higher and possibly longer-lasting nicotine levels than cigarette smoking. Manufacturers have packaged, flavored and marketed their smokeless products to entice young people. Due to the addictive nature of nicotine, surveys show that users commonly move to higher levels of use due to their increasing tolerance.

Many of these users simply do not understand the serious risks that ingesting tobacco retains. In many respects, it is equal to or worse than smoking tobacco.

The World Health Organization International Agency for Research on Cancer reported in 2008 that those who ingest tobacco have an 80% higher risk of developing oral cancer and 60% higher risk of contracting pancreatic and esophageal cancer. The high risks of developing ulcers of the esophagus or stomach, heart disease, high blood pressure, fetal abnormalities if used during pregnancy, are the same as smoking tobacco.

Smokeless tobacco wreaks havoc on the teeth, tongue and gums. More tooth decay and oral ulcers are common. A precancerous condition known as leukoplakia occurs in about half of all users within the first three years of regular use. If these white patches or plaques are identified early, it may be treated if tobacco use is stopped.

Quitting smokeless tobacco can be just as difficult as smoking due to the addiction to nicotine. The same options are available to users such as nicotine replacement products. Consult your healthcare provider to see if one of the prescription medications and counseling can help you quit.

Nicotine is a strong addiction and is difficult to overcome; nonetheless, it can be done with an organized approach. The profound and devastating health problems are entirely avoidable.

– Dr. Bruce Kaler

How to Quit Smoking

Smoking is basically a two part problem. The physical addiction to nicotine is very strong. If it wasn’t, it wouldn’t be so hard to quit. Medications (i.e. Chantix, Wellbutrin or Nicotine replacement in gum or patches) can be helpful to address the physiologic addiction.

Nicotine gum or patches substitute small amounts of nicotine to allow a weaning and gradual easing of withdrawal symptoms when quitting. Chantix and Wellbutrin work in a way that is both imperfect, not well understood, but probably most effective in fooling the center in the brain that controls nicotine desire. Neither has any nicotine but favorably affect neurotransmitters, chemical messengers between brain cells. This is similar to the way antidepressants have a positive effect on mood and anxiety. The net result is less interest in the seductive power of nicotine.

The second part of quitting is the habit or simple automatic behavior. Once you can see past the strong addiction to nicotine, you have to learn to cope with the stressors (boredom, anxiety, etc.) for particular situations in a different way. Changing your behavior is more straightforward but requires a plan and structure. Creating new habits in place of the old ones takes some persistence but is very attainable.

cigarettephoto © 2006 Bruce | more info (via: Wylio)

Here’s a simple behavior modification tip for quitting smoking:

1) Make a very specific list of the time of day “when” you smoke and “why” you smoke at that time. You can map out a typical day in writing. It should be in writing, but you need not share it with anyone. It is simply for your own edification. Writing it down allows you to be clear with all the tough moments throughout your day giving it careful review.

2) Then decide what you are going to do instead of smoking “at 9:40 a.m. when you have your break.” The structure and planning ahead provides a type of handrail to get through the difficult moment. Some ideas could be: eating hard candy, baby carrots, celery sticks, chewing gum, going for a walk, making a phone call. Any activity except for smoking will do. You must write it down so you can outline what you do accurately and make a definite plan in anticipation of the moment. Don’t leave it to the impulse of the moment.

Many people who quit smoking are not successful the first time. Anyone who has quit after the first try remains the lucky exception. Most people need a few times before they stop for good. So don’t view your past efforts as failures. The next time you are ready to give it a try, you are more likely than ever to succeed in being tobacco free – forever.

This small investment pays big dividends no matter what method you use to quit. Obviously, consult your physician to see if one of the helpful medications is right for you.

Ultimately, you have to change your behavior. It may seem daunting, but you can do it.

– Dr. Bruce Kaler

Dr. Bucklin: Radiation and Your Health on FOX Phoenix

This morning, our own Dr. Donald Bucklin appeared on KSAZ-TV (FOX Phoenix) to talk about radiation’s effects on health.

Check out his interview here

Diabetes Dangers

You may have heard that diabetes is one of the fasting-growing diseases in this country. Why the sudden popularity – is this the medical equivalent of a pet rock? Should we worry or invest?

Here we’re talking about Type 2 diabetes, more commonly called adult-onset diabetes. This is a whole different beast than Type 1 or juvenile diabetes (insulin dependent). It’s 10 times more common, and thankfully, a lot less serious than insulin dependent diabetes.

Why talk about Type 2 diabetes? Because it’s largely preventable.

A few basics: glucose is a particular type of sugar that your body runs on. It is the common fuel for everything that takes energy, from running and jumping to simply thinking. It’s the gas in your car. Your body is understandably particular about having enough circulating glucose; you may need some at any moment, like making the next heartbeat.

Sugarphoto © 2006 Uwe Hermann | more info (via: Wylio)

A large percentage of what you eat is simply to supply fuel for your body’s needs.

Glucose in the blood stream does you no good – it needs to get into your cells, which are the little engines of life. Insulin’s job is to make glucose go into cells where it provides energy for all of life’s processes.

When there is too much glucose in the blood stream, the kidneys try their hardest to retain it, but it leaks out in the urine. This leakage of glucose brings water with it, resulting in the usual symptoms of diabetes: thirst, frequent urination and weight loss.

Why weight loss? You are urinating sugar. On the surface this seems the ideal situation – eat and drink all you want, and get rid of the excess sugar. Where do I sign up?

Unfortunately, this is not the type of weight loss you need. You want to lose fat, not fuel. Also, the complications of diabetes make this a much less desirable diet plan. Think heart disease, kidney disease and stroke.

So why does being overweight lead to diabetes anyway?

Obesity causes resistance to insulin. It changes the cells so the insulin you have doesn’t work as well. Since the insulin doesn’t work as well, you transport less fuel into your cells. The cells are literally starving while the blood glucose level climbs.

An interesting segue: cyanide, the poison used in the gas chamber, is a drastic example of a similar mechanism. In the presence of cyanide, your cells can’t use the fuel you have. You starve to death in the land of plenty.

Kind of makes you think twice about that donut, doesn’t it? Sorry about that.

So if you are obese and you don’t want diabetes, you can make more insulin or eat less food (glucose). Unfortunately, there are limits to creating more insulin. The cells can become so resistant to insulin that you can’t make enough to do the job.

So why is diabetes such a bad thing anyway? To put it simply, high blood sugar wreaks complete havoc on your blood vessels. The tiniest blood vessels get the worst of it. They get inflamed and plug up (atherosclerosis). There are lots of tiny blood vessels in the kidneys, the brain and the heart. When these blood vessels plug, the cells they supply die. Some of those cells are my favorites – the ones in the brain, heart and kidneys. When these cells die, it’s called a stroke, a heart attack or kidney failure. There are also some tiny vessels in the eye, so your sight doesn’t fair too well either.

You probably have heard that this type of diabetes runs in families. There is an inherited tendency for Type 2 diabetes. If one of your parents is diabetic, you have a much higher risk of developing Type 2 diabetes. It is only a tendency – it is far from a certainty. Type 2 diabetes is unusual in normal weight adults, even with a family history of diabetes. It’s difficult to change your parents, but you can certainly do something about excess body weight.

So now you know enough about Type 2 diabetes to take charge of your fate. A little care about diet and exercise will keep you on friendly terms with your favorite cells.

Take care,

Dr. B

As the Peak of Flu Season Hits, Study Shows Importance of Hygiene

With the peak of flu season usually occurring this month, a recent study on the spreading of flu can teach us an important lesson about hygiene.

The study, published by the National Academy of Sciences, looked carefully at the H1N1 flu season in 2009. They studied schoolchildren, classmates and their families as the epidemic was happening. They suspected that many children were spreading the flu to their classmates in school.

Their findings actually disproved that school was an important source of infection. They found instead that the close contact of friends who played together outside of school was a common source of illness. Typically, children who played together outside of school have more close contact with each other. They use little hygiene such as hand washing or covering a cough.

Hand Washingphoto © 2010 Anthony Albright | more info (via: Wylio)

It was striking that children did not get sick from just sitting next to a classmate in school who was sick. This went against the prevailing wisdom of closing schools to prevent the spread of flu.

In reviewing households with sick children, most of the time adults in the household did not get sick from their children. They were probably making a special effort to limit exposure to the obviously ill family member. Again, the study results suggest the more likely source of infection was in the community at large where efforts at hygiene were forgotten or non-existent.

Day 59, Project 365 - 12.18.09photo © 2009 William Brawley | more info (via: Wylio)

We know that the flu virus does not fly through the air attacking a person over the shoulder while they look the other way. If someone coughs or sneezes on you point-blank within a couple feet, mucus droplets are broadcast with the virus; however, the most common denominator is you. We are the last link to acquire the infection. By touching our own hands to our face and mouth, we’re most likely to get the illness. Hands touch so many public places and surfaces that we forget that our own hands are such germ-laden instruments. Washing hands before eating or food preparation remains one of the most important means of protecting yourself from illness.

The researchers noted that the flu virus spreads very rapidly among school age children. The results reinforce that it is not the classroom or seating arrangement that is the problem. It is more likely due to the fundamental lack of hygiene practices in children and adults in the community that facilitate spread of the disease.

We all can learn a lesson from this study, so be sure to wash up.

– Dr. Bruce Kaler

Energy Drinks – Boost or Bust?

The popularity of energy drinks over the last 15 years is astounding but not surprising. Targeted at a market segment of the young and on the go, the drinks promise increased alertness and stamina. A single major brand whose name is recognized by everyone recently announced that they sold more than 4 billion cans worldwide in over 150 countries. That was just one brand in one year!

Energy drinksphoto © 2008 Tambako The Jaguar | more info (via: Wylio)

Although their primary demographics are young adults and athletes, the average person on the go is often looking for a morning boost or mid-afternoon energy. So why not grab an energy drink? Is it really a good boost or a bad bust?

The active ingredient that provides energy is typically caffeine and lots of it. It is very common for an energy drink to contain 2 to 5 times the caffeine in a cup of coffee or an average soft drink. There is also a lot of sugar as well. The amount of sugar is equivalent to 4 to 8 teaspoons of sugar in a single 8-ounce serving. There are other ingredients that contribute to the energy effect including guarana, an herb that metabolizes to caffeine. Other herbs such as ginseng have an energizing effect in humans although somewhat inconsistently. Naturally occurring amino acids taurine and carnitine have variable effects in different people. Some of the B-vitamins can provide a pick-me-up in some individuals. The amounts and sensitivity to these effects vary a great deal across the population.

There is no argument that energy drinks provide “energy” – temporarily; however, it is short-lived and typically results in a rebound “lack of energy” from caffeine withdrawal and the blood sugar level plummeting following the ingestion of concentrated refined sugars such as high fructose corn syrup and sucrose. Too much caffeine can be very harmful, especially in selected individuals or under specific circumstances of strenuous exercise or relative dehydration. It has a direct effect on increasing blood pressure to dangerously high levels, rapid heart rate, anxiety and insomnia. This clearly puts people at risk for heart attack or stroke.

A disturbing trend is to mix energy drinks with alcohol. The combination has potentially dangerous side effects. Caffeine does not change the amount of impairment from alcohol. One may feel more alert and less sedated but remain as slow to react or make poor decisions due to the effects of alcohol.

tall drinksphoto © 2008 Melody Gutierrez | more info (via: Wylio)

There is little protection or warning for consumers about potential side effects. According to the Food and Drug Administration, energy drinks are supplements and not subject to the same regulations as medications, soft drinks or even food products. They are not obligated to disclose how much an active ingredient is contained in a single serving. Soft drinks are required to have no more than 71 mg of caffeine per serving and most contain much less.

As dangerous as the short-term effects are, there is no research regarding the long-term effects of regular use of energy drinks. It is very possible that regular consumption of high doses of sugar and stimulants leads to bigger problems. One has to doubt the wisdom and safety in the regular use of these products.

What is the alternative? There is no substitute for adequate sleep, regular exercise and a balanced diet. If you suffer from chronic fatigue, there may be an important metabolic reason, which needs evaluation by a medical professional.

Energy drinks are everywhere and seem seductive, even benign. It is still important to be aware. Is it worth the risk?

– Dr. Bruce Kaler

Head Injuries in Young Athletes

Nearly 1.2 million young athletes play football in the United States each week. Fifty percent of them are likely to have a concussion some time in their high school playing career. Thirty-five percent will have more than one head injury. Which one will be mild, improving uneventfully, and which will result in severe disability is impossible to predict.

Cosmos vs. Diablas football game in Golden Gate Park, San Francisco, CA _K8P0872photo © 2007 Mike Baird | more info (via: Wylio)

We have learned over the last few years that these injuries are more frequent and have an effect on the injured athlete for a much longer period of time than previously thought. Recent research tells us these young people are at much greater risk to develop problems later from seemingly mild head injuries.

More young people are participating in organized sports than ever. There are intrinsic differences in the young athlete that make them more vulnerable to injury because both the brain and body are still growing and have not reached their full mature potential. Approximately 60,000 sports-related head injuries occur to high school athletes each year. High school football has been compared to notoriously dangerous jobs such as coal mining.

Part of the challenge for responsible adults working with young athletes is the athlete’s lack of maturity and experience. It creates greater liability for injury and difficulty in even recognizing subtle yet important signs. Young athletes often hide their injury or pain because of the eagerness to return to play, avoid embarrassment, not let their team down or try to meet unrealistic expectations. This is particularly important with head injuries as there may be no visible sign of the injury. The athlete may deny their symptoms of headache, confusion, dizziness with a determined attitude to return to play.

Research over the last couple years has pointed to the importance of subtle signs which may be the only clue. Even seemingly mild blows to the head may lead to more serious injury. Certainly repeated small injuries increase the risk of serious complications.

The exact cause of concussions is not well understood but there are some recognizable patterns in symptoms and behavior. Common symptoms of post concussion syndrome include:

• Headache
• Dizziness
• Fatigue
• Memory loss
• Light sensitivity
• Difficulty concentrating

X-ray skullphoto © 2010 Erich Ferdinand | more info (via: Wylio)

Behavior can be minimally or profoundly affected by head trauma. Personality change, irritability or anxiety is not unusual. Other changes can be difficulty regulating emotions, poor coordination, or temporary learning disability. The precise cause of symptoms remains unclear and is a source of disagreement among researchers.

More emphasis on preventing these common but serious injuries is needed. This must include attention to good technique and understanding how to play the game well. Knowing the rules and use of proper protective equipment is also mission-critical.

We have learned that rest of both mind and body is important to allow the brain to heal. There is no exact formula for this. Each person must be cautiously evaluated on a case-by-case basis. Working together with your healthcare provider to formulate a plan for rest and transitional activity can ensure a rapid recovery and help prevent future injury.

– Bruce Kaler, M.D.

Bed Bugs: Hazardous to Your Health or Just an Irritating Insect?

Bed bug infestations seem to be on the rise. So much so that some hotels are now putting warning cards on their rooms’ nightstands – tips on how to identify and avoid the little critters.

Just the mention of this unwelcome little parasite is enough to make many adults itch, so a small dose of fact may help dispatch this goblin.

What Exactly Are Bed Bugs?
They are insects; small but easily visible to anyone looking. They are brown in color, a half inch long and 1/8th inch wide. They usually hide during the day and are active at night. Having an exoskeleton, they must shed their skin, like a snake, to grow.

bed bugs on the box springphoto © 2009 lauren | more info (via: Wylio)

This is handy to know because the shed skin will be lying around and is more easily found than the hiding bed bugs. They live for about six months and reproduce with the usual enthusiasm, as is common in the insect world.

These little guys are blood suckers, like mosquitoes. In fact, they share many characteristics with mosquitoes. Both species are attracted to carbon dioxide in your exhalation and both favor feeding in darkness. The bed bug pierces the skin with a feeding tube, injects a little fluid that stops blood clotting, and sucks up their dinner a.k.a. your blood. This occurs infrequently, once or twice weekly, and the amount of blood taken is microscopic, so you don’t need to worry about anemia or bleeding to death.

During World War II, bed bugs were almost universal. In a short time after the war, bed bugs were almost eradicated. This great victory was made possible by the liberal use of DDT (yes, that DDT). Looking back, one might wonder if the treatment was worse than the disease. Now DDT is gone (almost), and bed bugs are back. Don’t make an emergency trip to a third world country to buy some DDT, however – other insecticides are much less toxic and still do the job.

How Do People Get Bed Bugs?
The eggs are almost invisible. They cling to clothing, bedding and furniture. This is called hitchhiking. Using a piece of contaminated clothing or sleeping on contaminate bedding can transmit the infestation. My 12-year-old daughter is practically a poster child for what not to do. She does sleepovers among an ever widening circle of friends and is constantly trading clothes.

Adolescent bed bugphoto © 2010 Rick | more info (via: Wylio)

What are the Health Consequences of a Bed Bug Infestation?
The first thing to point out is the word infestation, not infection. The bugs are not living in you. They live in the bed and bite you once in a while. The worst heath issue is a serious case of “the willies” (that is a technical term for totally freaked out).

Other than the anxiety, bed bugs, at worst, give you a red blotchy rash that might itch a bit. Bed bugs are not a vector for disease. You will not catch malaria or HIV from bed bugs. The bite is almost painless and any itching or irritation gets better on its own.

How Do You Get Rid of Bed Bugs?
Dispatching the creatures is more pest control than medical. You need an exterminator, not a doctor. Bedding should be washed in hot water and bleach, and cloth furniture should be thoroughly vacuumed. The eggs are easily washed off during normal showering. Some insecticide that is less toxic than DDT may be applied in your home.

The risk of bed bugs to your heath is minor. Armed with a few facts, we are effectively immunized against the worst of “the willies.”

Take care,

Dr. B

Are TSA Scanners More Than Embarrassing?

As you may have heard recently, flying hasn’t been this exciting since the Wright brothers took off from Kitty Hawk.

That’s because now just getting through recently imposed security procedures requires considerable bravado. The new X-ray based devices give Transportation Security Administration (TSA) employees delightfully detailed pictures of your every physical nuance.

But what are the health risks of these new body scanners? Are they dangerous?

Peep Showphoto © 2008 Steve Jurvetson | more info (via: Wylio)

Interestingly enough, it is much easier to find a platitude than an actual value of radiation exposure for these scanners. Every official source having anything to do with the devices says that you get more radiation in an airplane flight at 30,000 feet in two minutes than in a backscatter scanner. But what in the world does that even mean?

As you probably suspected, radiation is bad for you. This is a rather recent discovery in medicine, dating back only 100 years. For those who still had doubts about radiation’s badness, 1945’s atomic bombing of Hiroshima and Nagasaki brought that point home.

The trouble with radiation, in any dose, is it can cause damage to DNA, which is pretty important stuff, maybe the most important stuff in the known universe. It’s literally the blueprint for your entire being. Damaged DNA can be non-viable or can even be the start of cancer.

The dose of radiation for a backscatter scanner has been measured between 0.005 and 0.009 milli-rem (mrem). This needs to be put in context. Background radiation is all around us, fortunately in low doses. We breathe low levels of Radon gas and spend time in the sun – both are radiation sources. For comparison, a chest X-ray is about 6 mrem, and a year of normal sunshine exposure adds up to a cumulative total of 60 mrem.

So the dose of radiation from backscatter scan is actually quite low. This scan adds some immeasurably tiny risk of cancer. The concern seems to be more a perception of risk, rather than actual risk. The average patient will happily undergo a chest X-ray, roughly 1,000 times the radiation of a scanner, when he has high fever, cough and can’t breathe. The difference between radiation from a chest X-ray and a scanner is perhaps the medical radiation dose gets you a good diagnosis and effective treatment. The scanner gets you nothing personally, unless you count not getting blown up.

Little doubt, the whole new security process will be re-thought, re-engineered and hopefully improved as more and more people voice their displeasure.

I can’t help thinking that a completely incompetent would-be terrorist, who couldn’t even blow up his underwear bomb, has altered the course of history.

Take care,

Dr. B