Category Archives: Urgent Care

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

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What It’s Like To Be a Provider at U.S. HealthWorks

We recently asked our providers to share stories about their experiences in providing care at U.S. HealthWorks. We thought this piece from Dr. Donna Diziki, Center Medical Director of our Edison, NJ, clinic, was a great example of what’s it like to practice medicine and be part of the U.S. HealthWorks team.

Work.

The word conjures up images of sweaty men on chain gangs hammering railroad ties.

Life’s work.

Now that image is quite different in your mind’s eye – sunshine on a flowering meadow, commitment, fulfillment.

But how do you merge these two visions?

As physicians, we must decide our paths early on in our training. Sometimes this path has no exit or detours, such as choosing to be a surgeon, and we follow the colleagues before us. With these career choices, there is little control over the work; rather, the work steers the provider.

Others have the luxury of career options and ways to broaden the spectrum of their training. In my opinion, these are lucky ones. These doctors can venture down alternate routes on their career paths and find amazing destinations where fulfillment and growth are possible and encouraged.

Not all of us are meant to be solo providers, so the tricky part is finding a place where one can practice medicine in a meaningful way and be allowed to grow in a position. How do you find such a place?

U.S. HealthWorks has given me that elusive blend of a fulfilling medical practice coupled with an opportunity to fill my need to develop new skills in the areas of management, business practices and marketing. I joined the company hoping to be able to have a little control of the daily running of a medical office without the financial burden of opening my own clinic. What I have found is a company that encourages me to push my boundaries to make our collective futures successful.

The Managing Physician program at U.S. HealthWorks allows the participating physicians to play a vital part in the management team. It is a reflection of the company’s commitment to support physicians, and it enables them to be professionally successful. The program empowers me to learn new skills, innovate new policies and motivate staff. U.S. HealthWorks offers me the tools I need to lead and flourish in both the business and medical arenas. When the local centers are successful, the company is successful.

I have the utmost respect for the employees of U.S. HealthWorks. How many companies would entrust a physician with operating a medical office where the only rules are “Do your best” and “We will give you what you need to succeed”? They have the faith that the physician will perform to his or her potential, and the company will assist in areas that need cultivating. We have open access to upper management at all times – this awe-inspiring fact makes U.S. HealthWorks a truly unique place to work.

There’s that word again. Work. Some days it feels like the chain gangs are toiling on the railroad. But most of the time, working at U.S. HealthWorks is more in line with what I see as my life’s work: working for a company committed to our mutual success, fulfilling my needs as well as the needs of those we serve.

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.

Carbuncles, Furuncles and Boils – Oh My! Fighting Infections of the Skin

Red, swollen, itchy and painful skin.

It irks us and causes us to worry about our health, our appearance and our environment. We question: Did I hit myself? Am I allergic to something? Did something bite me?

We hear on the news that there are flesh-eating bacteria and killer boils. Our neighbor is in the hospital for an infection – should we worry?

Relax. Our skin is the largest organ in our body and is well-suited to the task of keeping bacteria where it belongs – outside of our body.

We’re constantly in contact with bacteria. Some bacteria even live on our skin full time. Strep and staph species are the most common organisms. Also common are a variety of fungi that enjoy the warm, moist folds of our body. When there is balance, these hitchhikers cause no problems.

But when we have high bacterial counts on the skin, get cut, get stressed, are sick for another reason, scratch at a bug bite, pick at a pimple, stay in a wet bathing suit too long or use a lot of sticky lotions on our skin, the balance can shift and infection may result.

Most of the infections that occur as a result of these imbalances are caused by the usual culprits – yes, those hitchhikers – strep and staph. They burrow into cuts, scratches, bites, burns, hair roots and other places that you cannot even see, and they multiply like crazy! The skin inflames trying to get rid of the bacteria – it swells and gets red and hot, trying to stop the infection. Most of the time in a few days, it goes away. Sometimes you need to see a physician for antibiotics, and occasionally hospitalization is necessary to completely get rid of the infection.

With all of this scary stuff out there, how can we help the skin do a better job protecting us?

Unfortunately, there is no medication or injection that we can take to get rid of the bacteria on our body. Even if we are exposed to someone with a skin disease, there is no scientific evidence that taking a pill will prevent us from getting the same disease.

Prevention of skin infections requires a more conscious and active approach on our parts. Remember, you are exposed to bacteria everywhere in your life from the cup you are drinking from to your keyboard. Healthcare professionals and public servants should also be aware of weapons, badges, belts, uniforms, notepads and stethoscopes.

What can you do to help?

1. Stay healthy. Eat right, rest, exercise, avoid tobacco, use alcohol in moderation. Keep chronic illnesses like diabetes under control.
2. Use hand sanitizer liberally.
3. Wash your hands with soap often.
4. Wipe down phones, desktops, keyboards, stethoscopes, pens and other accessories regularly with sanitizer wipes.
5. Change clothes at work or as soon as you get home to avoid contamination of the household.
6. Bacteria can get trapped on the skin by oils and clothing. Avoid soaps and body washes that have moisturizers.
7. Change loofah-type sponges often to avoid trapped bacteria. If your skin gets dry, use a moisturizer after you shower only on the areas that need it.

Do all that you can, and if you have a red, angry skin lesion that worries you, do not hesitate to let a physician evaluate you. We are happy to help.

— Debra Cooper, DO, Managing Physician for U.S. HealthWorks


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Acute & Chronic Pain and the Human Condition

Injuries occur in all kinds of people: young, old, healthy or debilitated. The good news is almost everyone recovers from injuries. Occasionally, when a significant injury occurs in someone with extensive underlying degenerative disease, acute pain can gradually evolve into chronic pain. Acute and chronic pains are two very different animals, and the evaluation, treatment and therapeutic goals are different.

Acute pain is what we’re all too familiar with. It is usually the result of tissue damage, such as a cut finger, burn or a turned ankle. The pain usually lasts until the tissue has healed to some degree. Even this, the simplest kind of pain, is a bit mysterious. A broken bone takes several months to heal but only hurts for a couple of weeks. Acute pain is usually pretty bad – it gets your attention and makes you stop doing whatever it is that makes you hurt. That, in fact, is the point. The body is trying to limit self-destruction. The body is hard wired to take care of itself – an interesting notion.

The medical evaluation of acute pain is usually pretty straightforward. Since tissue damage causes the pain, we just need to find the damaged tissue, figure out how badly the tissue is damaged, and finally, fix the damage. I may have slightly over-simplified, but you get the idea. We treat the body part that hurts.

Chronic pain is a considerably more challenging beast. There is no new tissue damage, or no tissue damage that wasn’t there two months ago, when you weren’t in much pain. So, from a doctor’s perspective, we don’t have anything to fix. Talk about having one proverbial arm tied behind our back. The next problem is that time is not our ally. Most acute pain lessens with time; strangely enough, chronic pain doesn’t. Next month or next year is likely to hurt just as much. The persistence of pain complicates its management because all narcotic pain meds become less effective with time and continued use. That means you get less relief from more medication. Medication doses can get scarily high chasing chronic pain – not a safe or productive pathway.

So, we look at the bigger picture. For your foot to hurt requires nerves in the legs, the spinal cord and a brain to get the message. If you’ve done a lot of treatment to the painful foot without benefit, it’s time to consider the nerves or the brain. When we try to block pain at the nerve, we might try a TENS unit to block transmission of the pain signal. This is an electrical device that uses pads on the skin to block pain with a low voltage electrical field. This actually works, and unlike pain pills, if it works it will keep on working. You don’t need a bigger machine or more electricity in the future. Doing a nerve block with an anesthetic or steroid is also an example of blocking the transmission of pain at the nerve.

Finally, we look at the brain. We have all said at some point, “I’m feeling no pain.” What we meant was our brain wasn’t working well enough to feel pain (usually the result of youthful overestimation of alcohol tolerance). Feeling no pain because you are unconscious also works in anesthesia. This is an imperfect solution as it is obviously hard to work while unconscious. That has prompted the search for medications that will selectively alter pain reception without sedation.

A surprising number of different classes of medications seem to do this for many patients. One of the first medications used “off label” for pain was amitriptaline, which is a 35-year-old tricyclic antidepressant. Many of the newer antidepressants called SSRIs (Prozac, Cymbalta and Celexa) have also been used with some success for pain management. The anti-seizure medications used for epilepsy treatment are also remarkably helpful for many patients in pain. Specific examples of these medications are Neurontin and Tegretal.

Chronic pain is a different beast than acute (new) pain. Some of the best approaches involve treating the transmission of pain at the nerve or the perception of pain at the brain. If you have a chronic pain condition, there are new approaches that may change your life.

Dr. B


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H1N1 Pandemic is Over

This week, the World Heath Organization (WHO) declared the H1N1 pandemic over.

Wasn’t it just a year ago that people were fighting for H1N1 shots? We didn’t know too much about this influenza virus at the time, except that it killed young people.

I was giving talks about H1N1 telling people that “Swine Flu” parties were a bad idea. A Swine Flu party is when someone gets the flu, he/she invites all of their friends over, everybody shares cocktail glasses and big sloppy kisses, and they all do their best to catch the flu. The point is to get the virus early before it mutates into something worse – which, luckily, H1N1 never did.

Novel strains of influenza have, in the past, been devastating. Even in a normal year, influenza kills 36,000 people in this country, and over a half million in the world. Pandemic strains of influenza have killed tens of millions in the past, a truly terrifying prospect.

We were all introduced to the concept of “pandemic influenza” last winter. Most people equated pandemic with severity, but pandemic only really refers to prevalence. If something is pandemic, it is widespread, not necessarily deadly. The H1N1 virus was pandemic, but fear of the virus was even more pandemic.

Companies had influenza plans – they gave careful thought to how they would operate with 40-60% less staff. How do you run a hospital on half staff, or a police department, or a nuclear generator?

People were hoarding antiviral medications. They did their best to talk their doctor into prescribing them several hundred dollars worth of Tamiflu, “just in case.”

The WHO and various counties’ heath department were magnificent. Through a worldwide effort, they identified the virus, and designed and produced millions of doses of vaccine, all in a few short months.

The H1N1 pandemic was a near miss. We heard the bullet. The influenza virus still contains the potential to change into something nasty, and it is highly contagious. This time we were lucky and had the chance to run a worldwide pandemic emergency drill, making us that much more prepared next time. And if history is any indication, there will most likely be a “next time.”

– Dr. Don Bucklin, National MRO – a.k.a. “Dr. B”


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Whooping Cough Outbreak May Be Worst Such Epidemic in 50 Years

An epidemic of pertussis, or “whooping cough,” has descended on California. As of last week, seven deaths have been blamed on the disease and 2,174 cases have been reported.

Graphic courtesy of the Los Angeles Times

On Monday, the California Department of Public Health said that compared to last year at this time, there are six times the number of reported cases, and we could be on the edge of the worst epidemic in 50 years.

What’s more, there’s legitimate concern that this will soon spread to other states around the country.

For many years, the last pertussis vaccine was given when children started school (approximately age 6). In more recent years, the Center for Disease Control and Prevention has recommended a booster vaccine (called Tdap) to prevent the illness for all adolescents and adults.

So what are the symptoms of whooping cough?

Stage 1

The first stage, also known as the catarrhal stage, lasts 1-2 weeks. It resembles a simple upper respiratory infection. Cough, runny nose, sneezing, body aches, and low grade fever are the most common. Many believe they simply have a cold.

Stage 2

After 2 weeks, the cough becomes more severe. This is the beginning of stage 2; it can last as long as 6-10 weeks. Coughs will come in paroxysms, or bursts of rapid, harsh coughs, as the infected person is trying to expel thick mucus. The coughing will increase in severity over two weeks and then very slowly diminish. At the end of the cough, as the person inhales, you will hear the characteristic whooping sound. The cough can be so severe that one can lose their “breath” and even turn a little blue (cyanosis), from a lack of oxygen. Frequently, the cough is so harsh that the person will vomit at the end of the coughing spell. These coughing attacks occur more frequently at night; some will have as many as 24 attacks of coughing in 24 hours.

Stage 3

When the coughing begins to diminish in severity and frequency, it is considered the third stage. But remember, this stage can last many weeks.

How is pertussis transmitted?

Whooping cough is highly contagious and is spread among people by direct contact with fluids from the nose or mouth of infected people. People contaminate their hands with respiratory secretions from an infected person and then touch their own mouth or nose. In addition, small bacteria-containing droplets of mucous from the nose or lungs enter the air during coughing or sneezing. People can become infected by breathing in these drops. Adults can get the disease, and generally, they get a milder case than children. 

How can you tell you have pertussis?

Your doctor can make the diagnosis. Your history and physical examination will provide information that will lead your physician to make the diagnosis. A special test for the bacterium, Bordatella Pertussis, can be sent to your local lab to get confirmation.

How do you treat pertussis?

Since whooping cough is caused by a bacterium, it is treated with antibiotics. There is no clear evidence that treating with antibiotics after the first couple weeks will be of any benefit to the patient. There is no proven treatment for the severe coughs, though many will try various cough preparations.

So, if you are experiencing these symptoms and you have not been vaccinated, see your physician.

What is best way to avoid getting pertussis?

  • Get vaccinated! Ask your doctor about the Tdap vaccine for adults and children.
  • Wash your hands frequently.
  • Avoid contact with people who are coughing.
  • Disinfect common areas such as work stations and door knobs.

The physicians at U.S. HealthWorks Medical Group are available to help with vaccination, evaluation and treatment.

 – Dr. Alesia Wagner, Regional Medical Director, U.S. HealthWorks Medical Group of California


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The Sizzle on Heat Illness

Summertime…and the living’s easy. Well, not exactly easy, especially if you live in Phoenix, Ariz., like I do and spend time outdoors. It’s about 110 degrees in the shade, of which there is precious little.

It might be a good time to talk about heat illness.

Heat illness comes in two flavors – heat exhaustion and heat stroke. 

The milder illness is heat exhaustion. That means that the heat is getting the best of you, but all body systems are still working.

Think of the last time you did heavy work outside in the summer and overdid it. You probably felt a little sick, nauseated, had a headache, were drenched with sweat and felt weak, maybe experienced some muscle cramps. This was the beginnings of heat exhaustion.

You may not have known what to call it, but you knew if you didn’t cool down, you could get a lot worse. You go inside and drink some fluids, throw some cold water on yourself and rest. As long as relief from the heat is close by, you recover in a couple of hours. 

Heat stroke is the more serious heat illness. This is a true medical emergency and requires immediate action and a 911 call. 

In heat stroke, your body has been overwhelmed by the heat, and your heat controlling systems break down. Body temperature can climb above 105 degrees. Much above that and real damage is done, up to and including death.

In heat stroke, you stop sweating. Sweating is your body’s evaporative cooler. When this stops working, your temperature goes up in a hurry. People with heat stroke have hot, dry, red skin. They commonly feel sick, have a headache, experience nausea and may be confused because high body temperature affects brain function. As the body temperature climbs more, victims may suffer a seizure.

Two things must be immediately done: get the victim out of the heat and call 911. While you are waiting for the paramedics, here is what you should do to help the victim:

  • Lay the person down
  • Dampen his/her clothes and put the victim near a fan (that’s artificial sweating)
  • Put the person in lukewarm water (85 degrees, not 60) if you can
  • Put ice packs around the groin area and trunk    

How do you avoid heat-related illness? Most of this is common sense, at least in the desert:

  • Try to avoid the heat
  • Stay indoors during the hottest part of the day (noon to 4 p.m.)
  • Take regular breaks from the heat; find a cool spot to rest
  • Stay well hydrated
  • Wear loose-fitting cotton clothing, which acts alike a radiator when it gets damp
  • Hydrate often (yes, I said that twice). If you’re not urinating, you’re not drinking enough water. 

Heat illness is very preventable. Time your activity during the summer months, drink a lot of non-alcoholic fluids and keep an eye on each other.    

– Dr. Don Bucklin, National MRO – a.k.a. “Dr. B”


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More Workplace Healthcare Options for Los Angeles in Vernon, Commerce

Last week, we announced the acquisition of both Technimed Occupational Medicine healthcare centers, located in Vernon and Commerce.  The acquisition of these centers expands the number of U.S. HealthWorks operated medical centers to 66 in California and 134 nationwide. 

Now employers and employees in the vicinity of 3364 East Slauson Avenue in Vernon and 4730 Eastern Avenue in Commerce can access quality injury and illness diagnosis and treatment, preventive services, pre-employment and post-offer exams and testing, and return-to-work programs.

The acquisition of these two centers enables us to better serve our Los Angeles-area clients and patients and we are very pleased to welcome the Technimed team into the U.S. HealthWorks family.

Dr. David B. Landers, the founder of Technimed said, "Having been in this market for over 25 years, it was very important to us that we transition to a recognized leader in the industry, one who will take good care of our patients and clients.  U.S. HealthWorks is uniquely positioned to provide a statewide network for employers, as well as, having real-time electronic access for employer clients, who are, more and more, frequently using online resources to better manage their claims. U.S. HealthWorks has it all, so our choice of a successor was a simple one.”

-Dr. Leonard Okun, National Medical Director

U.S. HealthWorks Acquires Ocala, Florida Medical Center

Today, we announced the acquisition of the Medero Medical Caring for Workers Center in Ocala, Florida.  It’s our 12th location in the state.

Last year, U.S. HealthWorks acquired five of the six Medero Medical clinics and now we’ve added this one at 1109 SW 10th St. (SR 200) in Ocala.  The center provides occupational health services, including injury and illness diagnosis and treatment, preventive services, pre-placement and post-offer exams and testing, and return-to-work programs.

We’re excited to expand our footprint in Florida and add the superb Medero medical team to our family of 159 clinics and worksite stations nationwide.

-Dr. Leonard Okun, National Medical Director