Category Archives: Healthcare Trends

Protecting Your Business’ Most Valuable Assets

Every businessperson does what they can to protect their company. Strategic planning is a part of every move to ensure the likelihood of success. Insurance provides all sorts of protection. But even so, we sometimes forget to protect our most valuable resources – our people. People are the backbone of any organization. In today’s economy each person can be mission critical in carrying out the effective operations of any business, large or small.

Earlier this year, the California Department of Public Health (CDPH) declared an epidemic of whooping cough (Pertussis), a highly contagious bacterial illness spread by coughs and sneezes. Transmission can also occur indirectly through touching contaminated shared surfaces in common areas. The work environment is a potential place for Pertussis to spread quickly.

Although Pertussis most significantly impacts the health of infants and children; adults who get infected with the bacteria can potentially be off work for months due to severe coughing attacks. Employees may also spread infection to their children, who can become severely ill. The employee may require time to care for their family and need to take time away from work.

In response to the high levels of Pertussis in the community, the CDPH is recommending that all Californians make sure that they are immunized against this disease, especially if they are in contact with infants and children. Many adults may require “booster” vaccinations to achieve immunity.

The Tdap vaccine which became available in 2005 offers the best protection against whooping cough. The threat of Pertussis affecting employees and the potential effect on businesses is clear. Vaccination is the best defense against whooping cough.

– Dr. Minh Q. Nguyen, Area Medical Director


HCG and Weight Loss (Or Lack Thereof)

Where I work in Scottsdale, Arizona, is probably second only to Hollywood in the med-spa business. 

It’s reassuring to know that day or night, weekend or even holiday, in an emergency I can get a walk-in Botox shot or an HCG supplemented diet. I sleep better knowing these things.

Hypodermic Needle Stomach Injection 3-1-08 8278photo © 2008 Steven Depolo | more info (via: Wylio)

The HCG diet ads are so plentiful, I don’t even hear them anymore. It was with mild surprise one day when I realized they were actually talking about injecting people with HCG as part of a diet. HGH seemed plausible, but HCG?

For those that think acronyms are a silly, HCG is Human Corionic Gonadotrophin and HGH is human growth hormone. HCG is a pregnancy hormone, and it is secreted by the placenta and helps keep progesterone levels high to maintain the pregnancy. It’s the hormone that is tested to confirm pregnancy. HCG doesn’t seem a likely candidate for injecting non-pregnant people, even males, to assist in weight loss.

This is the second or third cycle for this particular medical diet fad. It tends to re-emerge roughly every 25 years, which perhaps not coincidentally, is about once every generation. If you remember HCG not working in the 70s, you are not likely to pay for it today. How in the world did this pregnancy hormone get hooked up with weight loss?

For that we have to travel back in time to the early 1950s and to India. India was a brand new country at that time, having just emerged from British rule. There were still some British medical types hanging around acting like they owned the place. One such British endocrinologist was Dr. Simeons. He did studies on pregnant Indian women on starvation diets (pleasant thought – not! There is no mention on why Dr. Simeons didn’t do this research on pregnant British women in London. Medicine was a lot more wild and wooly in those days, which are thankfully passed. But I digress…)

Anyway, he injected these starving pregnant women with HCG and they seemed to lose more fat than protein. He also studied overweight males with Froelich’s Syndrome (pituitary failure). They were also put on a 500 calorie diet and given HCG shots. They also managed to lose considerable weight. He theorized that giving supplemental HCG in extreme diets hastens weight loss and spares protein-producing for a more healthful weight loss. This doesn’t even make medical sense, but this became quite the fad in Italy where Dr. Simeons had a clinic. Pretty soon everyone was injecting all manner of HCG preparations in the pursuit of lean living.

Rapid weight loss that spares protein and preserves vigor is the holy grail of the dieting world. Many attempts to prove Dr. Simeons’ theories about HCG-assisted weight loss have failed to reproduce any measurable benefit from the HCG. It seems the severe 500 calories restriction diet was the actual cause of the weight loss, and it had nothing to do with HCG. That is not too surprising since HCG is a pregnancy hormone.

Lose weight nowphoto © 2009 Alan Cleaver | more info (via: Wylio)

Injecting HCG as part of a diet was popular in the 50s, in the 70s, and now in the first decade of the new millennium. HCG is still little more than an expensive placebo. Its popularity seems to be related to the income it produces rather that any measurable medical benefit, other than to fetuses. It’s really hard to sell an unusually harsh diet, but combine it with a magic weight loss shot with a medical name, and you have an industry.

Take care,

Dr. B

U.S. HealthWorks’ Dr. Thomas Miller recently spoke with KXLY-TV in Spokane about the HCG diet. His interview can be found here.

U.S. HealthWorks Doctor Talks Touchscreens and Flu

U.S. HealthWorks’ Dr. Clyde Wilson spoke with KING-TV in Seattle about the dangers of catching the flu from touch screen devices such as the iPhone, Droid and iPad.

His interview can be found here.

Can Your iPhone, Droid or Touchscreen Device Transmit the Flu?

According to British researchers, mobile phones harbor 18 times more bacteria than a flush handle in a typical men’s restroom.

And Stanford University research suggests that the risks of transmitting pathogens from glass surfaces to a person’s skin are relatively high. Especially considering that 30 percent of the virus or germ will get on your fingertip when you touch the infected screen.

Since we were little, our mothers admonished us to wash our hands and cover our mouths when we sneezed – pretty good advice in this germy world; however, we received that guidance before anyone had ever heard of a touchscreen device.

But just how are infectious diseases passed from person to person?

People with upper respiratory infections sneeze and cough, blow and snort – spreading germs all over the place. These germs can live on surfaces, sometimes for hours or even days, just waiting for someone to touch them and rub their nose. The fancy word for this is autoinoculation, meaning you gave yourself the disease.

Washing your hands before eating is a good start, but I would take it a step further and wash your hands before you touch your face – always.

What about that smartphone on your hip – the one with the touchscreen?

If you are like me, you pick it up whenever it rings and put it to your mouth. I can almost hear my mom saying, “You don’t know where that cell phone has been!” You also pass it around freely to share the latest music, video or photo.

But when is the last time you disinfected your phone? Do you even think of it as an object capable of transmitting respiratory germs? How would we even go about doing germ warfare with your smartphone?

Clearly, boiling your phone is a really bad idea. I have personally tried the immersion technique – in a lake and in a toilet (two different phones … I’m not stupid), with identical results. In the medical world, we autoclave instruments to make them sterile, a kind of a steam pressure cooking. I haven’t yet tested that method, but I expect it would be a variation on the drowned phone phenomena.

Operating rooms use ethylene chloride gas sterilization to kill germs on sensitive electronic equipment. This would probably work well on the average smartphone, but it is a rather expensive and cumbersome technology for personal cell phone cleaning. Maybe this is a business opportunity for someone: set up ethylene chloride sterilizing equipment in a truck and sterilize cell phones for five bucks a piece. Franchise anyone?

But let’s be practical.

We can be a little bit low tech here and still get most of the bad germs off the touchscreen. There are a number of germicidal wipes available at drug or grocery stores. You can even grab one when you get your grocery cart. Take one that is moist, not dripping wet, and wipe off the screen of your touchscreen device periodically. It’s as easy as that.

Most wintertime respiratory infections are the result of us touching germy surfaces and then touching our face. The germy surface can be the counter, the grocery store cart or even your cell phone. Get in the habit of washing your hands before you touch your face, and give your cell phone the occasional swipe.

Stay well,

Dr B.

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Phoenix Business Journal: Legalized Marijuana and Workplace Drug Policies

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

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

By Dr. Donald Bucklin
October 18, 2010

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

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

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

To read the rest of the article, click here.

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Sacramento Business Journal: Office Policy Could Go Up in Smoke

By Dr. Donald Bucklin

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

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

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

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

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

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

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Obesity’s Burgeoning Burden on Employers

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

The subliminal message is: How bad can it be?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Take care,

Dr. B

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

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

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

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

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

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

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

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

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

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

Take care,

Dr. B

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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.

Because the muscles are in one place and the hand in another, the tendons connecting the two must pass through the wrist. Where they pass through the wrist is a snug fit, and therein lies the problem. The tendons pass through a “tunnel” in the wrist, made of the arrangement of the wrist bones (carpals). This tunnel is shaped like a “U.” On the sides and floor are bones, and the roof is covered by a thick, gristly strap. Through this tunnel is where 9 tendons and the median nerve pass.

These tendons and the median nerve normally peacefully cohabitate. They are probably doing that right this minute in your body. The tendons are surrounded by lubricated jackets (like a bicycle brake cable), so they slide through the wrist with ease. If the tendons should swell because the tunnel doesn’t stretch, pressure is put on the nerve, which sometimes shorts circuits.

Since this nerve supplies the thumb, index and long fingers with sensation, these are the areas that become numb. There is also shooting pains in the wrist from pressure on the median nerve.

The most important thing to realize about CTS is this is a dynamic situation. Tendons can get more or less swollen in a matter of a few days. Sometimes all it takes to reduce swelling is a wrist brace or a change of work duties. Sometimes it takes more effort involving medication (anti-inflammatories) and physical therapy. Occasionally a cortisone shot fixes the problem. As a last resort, we cut the strap (cut the gristly hood of the carpal tunnel). This allows more room for the tendons and nerve.

It is important to treat CTS sooner rather than later. Early on, it will be easier to get the swelling out of the tendons, and the damage to the nerve will be minor and completely reversible.

Why do people get CTS, or conversely, why don’t we all have CTS? There are wide individual variations on what it takes to get a case of tendon swelling in the wrist. Some people get swelling in their wrist after one month of doing repetitive work; others will never have a problem. We do know that you narrow the carpal tunnel when your wrist is in ulnar deviation. That makes it a tighter fit and probably contributes to CTS.

Ulnar deviation is bending your wrist to the side. If you are sitting at a computer, you are doing that right this minute. This occurs because the keyboard is narrower than your shoulders; so you have to bend you wrist in ulnar deviation to line up your fingertips with the keyboard. This has caused the development of “V”-shaped ergonomic keyboards, which can be very useful in treating or preventing CTS. I am using one to type this article.

 So CTS is more like a dimmer switch than a light switch. It comes in a great variety of stages. It is relatively easy to get some swelling out of a wrist and get someone healed at an earlier stage. The earlier the intervention, the more likely it will easily and quickly resolve.

Dr. B

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Does It Hurt to Get a Flu Shot?

Our own Dr. B demonstrates how easy – and relatively painless – it is to get a flu shot.  Watch: