Tag Archives: occupational health

From Everett, WA To Treating Patients in Rural Vietnam

Dr. Randall Franke of U.S. HealthWorks Medical Group in Everett, WA, recently had the opportunity to travel to Vietnam to provide medical services to the poor. Below is an account of his trip.

'SE Asia' photo (c) 2009, Rolling Okie - license: http://creativecommons.org/licenses/by/2.0/

Providing medical attention on a two-week journey into rural Vietnam communities has forever changed my life.

On August 25, the journey began for me and two other physicians along with nurses, dentists and pharmacists. Our medical group also consisted of 30 pre-med, pre-nursing, and pre-pharmaceutical students from the University of Washington; many of whom acted as translators. Also making the trip was my son, Alex, a high school senior. Though missing his first week of school, I knew Alex would benefit from this experience as much as I would.

The two weeks were like nothing any of us had ever experienced. My patient visits were not at my modern U.S. HealthWorks medical center in Everett, WA, but rather in spartan, temporary health clinics that we set up in rural areas both in the north and south.

In preparation for our journey to visit and treat patients in Vietnam, our team had trained weekly for several months to prepare for our trip. Despite the training, it still didn’t totally prepare us for our Vietnam experience.

Our days in Vietnam began in the early morning. We would board a bus at 5 or 6 a.m. and travel 60 miles or more in a very time-consuming drive that typically lasted two to three hours before we reached the people in these outlining areas. Once we reached our destination, set up would take an hour most mornings. We would begin seeing patients between 8-9 a.m. and wouldn’t stop providing medical assistance until early evening.

As we set up our mobile clinics each day, hundreds of Vietnamese people would be lined up eagerly waiting to receive medical attention. The large daily crowds were skillfully managed by our students many of whom were Vietnamese Americans. Patients would be registered, and their vitals signs would be taken by our students.

After the preliminary work was completed, the next step was being seen by one of the three physicians. Once a patient had seen a doctor, they were directed to another part of the mobile clinic for medications, and in some cases, additional treatment including dental care.

Approximately 65 percent of the patients that we saw were senior citizens. Their health issues included chronic hypertension, vision problems, skin conditions and other medical conditions that had gone untreated due to the lack of healthcare access.

In our two-week span, we set up eight mobile clinics and saw an estimated 1,600 patients. It was a heavy work load each day, but providing healthcare to these long lines of patients was well worth it. We were able to provide much-needed medical attention to people who unfortunately don’t have access to regular healthcare. We also had the opportunity to meet with students from Hanoi Medical University. Everyone was extremely friendly.

It was an incredible learning opportunity for all of us and one I would like to repeat. I’m eager to return again and hopefully offer an increasing scope of services to a very appreciative group of patients.

~Dr. Randall Franke, U.S. HealthWorks Medical Group

The Quiet Revolution In Lighting

There has been little notice of the planned phase out in the United States of most incandescent light bulbs in the next two years. We are actually behind several other countries that are already well along in the process of replacing regular incandescent bulbs for LED and Compact Fluorescent lights.

The impetus behind this change is energy efficiency.

Florescent and LED lights are 4 to 10 times more efficient than incandescent bulbs. They also last much longer than incandescent bulbs. Most common incandescent bulbs – 40 watt through 100 watt – will be unavailable by 2014.

Thomas Edison is perhaps rolling over in his grave.

This change has been visible when we make semi-regular pilgrimages to the local hardware store. More and more shelves are filled with these funny looking spiral shaped bulbs (at 2-3 times the price).

Just the other day a company nurse asked me about the health effects to expect from increased exposure to florescent lighting. Health effects from florescent lighting, I asked nervously, looking over my shoulder at my office lighting. Perhaps a little research is in order.

It doesn’t take long on the Internet to find some ominous sounding quasi-scientific concerns regard fluorescent lightening. Let’s explore some.

Seizure risk: Fluorescent lights traditionally are driven by magnetic ballasts and flicker at 100 to 120 times per second. Like movies, which are a series of still pictures flashed on the screen at 24 times per second, almost all people are unable to perceive the flickering of the light (anything over 16 flashes per second is seen as continuous light). Theoretically the light flickering could trigger a seizure. This is more of a theoretical concern, than something neurologists are treating. Since compact florescent lights use electrical ballast, there is no flickering, thus no seizure risk.

Ultraviolet radiation: Ultraviolet radiation is often raised as a concern with fluorescent lights. UV light is emitted from some fluorescent lights in relatively greater amounts. There are a handful of rare dermatological conditions that have been suggested to be worsened by high UV emitting florescent lights. Even a few that are improved. The florescent bulbs can be constructed to emit various light frequencies for different applications. High output UV lights are used to simulate sunlight in aquariums, terrariums and tanning beds. The UV exposure approximates sunshine, perhaps useful for the “winter blues.” Florescent lights can be manufactured with double walls to eliminate almost all UV light. The color of the light is also becoming more of a choice; gone are the days of harsh blue-white light showing every skin imperfection. Florescent lights now are designed to emit a more amber glow, longer wavelengths, a light that flatters people and interiors.

Aside from UV radiation, which is completely manageable with light design, there is little evidence they will otherwise cause you injury.

After looking at risk from UV radiation, we quickly travel into so-called “emerging science.” That is a euphemism for information that is not explained by conventional scientific thinking. Not surprisingly, the diseases mentioned as having some possible connection to florescent lighting are among the least understood diseases. Autism and Lupus are examples of such diseases. There is no scientific support for such claims.

The wholesale change to florescent lightening may provide a few surprises, but not health ones.

So, I am not buying cases of incandescent bulbs to horde or sell on eBay. Florescent lights are well researched and improved in design every year. Your house and job will be a little more efficient for the change – and you might ultimately have a little more jingle in your pocket.

Take care,

Dr B

K2 — Not Just A Mountain Anymore

Synthetic cannabis first appeared about 8 years ago in Europe. It goes by the names Spice and K2. It is a designer drug, which means the basic marijuana molecule was altered to change its behavior. Often the goal is to increase the strength of a drug as in Ecstasy – made on the amphetamine blueprint. In the case of marijuana, the characteristic altered was the recognition that it was marijuana. A minor structural change can make a molecule unrecognizable. This was a marijuana that can’t be tested for.

It is not so much surprising that an enquiring mind could come up with a variation on the basic THC molecule, but that it was considered worth doing. Marijuana has not become an endangered species in recent years with various medical marijuana laws in 14 States.

While pot “scientists” were busy creating in their labs, the pharmaceutical laboratories were working on spoiling their plans. Tests specifically designed to recognize the synthetic marijuana molecule were developed. That isn’t too arduous a process as the initial screening test is an antibody test. An antibody to identify the new synthetic marijuana molecule is easily made. The confirming test, GCMS, only needs some synthetic marijuana to analyze, and it can happily identify synthetic marijuana down to the nanogram amount.

Of course getting around pesky government laws was the goal of this designer drug. The government simply wrote new laws outlawing this drug.

If you are concerned about the use of K2 or Spice, these can be included in your drug testing panel. Call your U.S. HealthWorks representative to enquire.

Take care.

Dr. B

Urine Drug Screening 101

Pre–employment drug testingphoto © 2011 Francis Storr | more info (via: Wylio)I see a lot of drug screens. As the National Medical Review Officer for 36,000 companies, I spend a lot of time answering questions about them. The most frequent category of question involves the numbers seen on positive urine drug screens results. I will review what these numbers mean and what they can and cannot tell you. I will try to clear up the cloudy urine, so to speak.

We’ll start with cut off levels. There is a simple concentration level that determines the “line drawn in the sand.” Any value equal or above the limit is positive, and those below the limit are negative, kind of like Black Jack.

Now to complicate matters, every positive drug screen goes through two different testing procedures. The first is called an immunoassay – this test is highly sensitive and not very specific. They can detect several variations of a drug (drugs break down into several parts in the body). In the case of marijuana, the cut off of the immunoassay is 50 ng/ml. Either the test is positive (above 50 ng/ml) and goes on to further testing, or it’s below 50 ng and is reported as negative. There is never an immunoassay numeric result.

Any positive initial test (immunoassay) will undergo a second testing of a different type-GCMS confirmation. This stands for Gas Chromatography Mass Spectrogram (don’t worry – there won’t be a test later). This is an extremely specific test that identifies one single drug variant in the urine. Because it identifies a single molecule type, the cut off level is low, 15 ng/ml in the case of marijuana. The GCMS result is the only number reported. The lab reports the test as negative if it is below 15 ng/ml. If it is above 15 ng, a quantitative number is given, like 38 or 300.

That is a lot to write down, but we are just talking a cut off level. We see cut off levels everywhere in life – 90% in school gets you an “A,” 89% a “B.” Driving 75 mph on the highway gets you there, while 80 mph gets you a ticket.

So, let’s say we have a drug screen that is positive for cocaine at 300 ng/ml (the cut off cocaine is 100 ng/ml on GCMS). Every day a company wants to know if the donor was under the influence at the time of the drug screen. The simple answer is: “I have no idea.”

That information isn’t available with a urine drug screen. The reasons are several. The most important is the concentration of drug in the urine is not the same as the concentration of drugs in the brain. Drugs in the urine don’t affect you; drugs in the brain do. The other reason a drug screen won’t reveal impairment is there are too many variables (unknowns). Among these are the donor’s dose, timing, body weight, food and drink intake, kidney and liver function. All affect the level of the drug in the system. So for a given value in urine, the donor could have arrived at that by taking hundreds of different combinations of drug amount and timing before the drug screen. So we can say the cocaine was definitely present in the urine, and it was a positive drug screen. The positive result cannot tell you if the donor is a long-term cocaine user or used it once in his life right before the drug screen. And it can’t tell you whether he was impaired (high) at the time of the drug screen.

So a urine drug screen only places the person into a user or a non-user group. We unfortunately don’t have chronic users groups and tried-it-only-once user groups to pick from.

– Dr. B

Working the Night Shift and Getting Enough Sleep

The struggle to get adequate daytime sleep when working nights is familiar to many of us. In fact, 15 million workers – or 20% – of the American workforce work other than the typical 9 to 5 shift. Some are swing shift, some graveyard and some even rotate shifts between days and nights. Many people simply do not acclimate to this unnatural pattern of waking and sleep. The resulting sleep deprivation leads to increased short-term illness and long-term medical problems. A much higher incidence of accidents and mistakes are associated with sleep deprivation. The loss of productivity alone is estimated to be in the billions of dollars.

Night shift workers simply get less sleep. In many industries, rotating work schedules often do not allow for adequate time off. Most notable are the transportation industries such as railroads, commercial trucking and airlines. The National Highway Traffic Administration estimates more than 100,000 police-reported crashes occur annually due to driver fatigue, resulting in 1,550 deaths and 71,000 injuries in 2008. The monetary losses exceeded $12 billion. Motor vehicle accidents are more likely after 11 p.m. and greatest between 1 a.m. and 7 a.m.

In non-transportation industries, 25% of night shift workers reported that their work schedules do not permit sufficient sleep time, and 33% reported getting less sleep than needed to do their best work.

Asleepphoto © 2008 David Joyce | more info (via: Wylio)

All shift workers do not suffer from sleep disorders; however, the longer a given individual is on the night shift, the more likely he or she will suffer some medical consequence or have issues with productivity. The effects of sleep deprivation on alertness, judgment and productivity have been quantitatively compared to the effects of alcohol. Just the loss of several hours of sleep can result in impairment comparable to several drinks. This worsens with increasing sleep loss. The message is that sleep deprivation from night shift work is fairly common and associated with physical and emotional distress. The net result is increased accidents, injuries and loss of productivity.

Since night shift work is necessary, how can we manage the side effects and prevent some of the problems that arise? Educating management and workers regarding the risks and being proactive can have a positive impact. Workers will benefit from healthy habits, diet and exercise. If they are having difficulty sleeping, they should consult a health care provider to asses any underlying medical conditions or medications that can influence sleep patterns.

Good sleep hygiene can be very beneficial in acclimating to night shift work. Some tips include:

• Have a quiet sleep area with black-out curtains.
• Avoid caffeine, nicotine or alcohol before sleep.
• Try using sunglasses during the morning drive home to minimize light exposure.
• Refrain from a large meal, excess fluids or vigorous exercise prior to sleep.
• Avoid radio and TV when attempting to get to sleep.
• Although melatonin has been touted by some as a sleep aid, it is not FDA-approved and has inconsistent results as a sleep aid. It does not provide any improved alertness during the subsequent work shift.
• Sometimes, short-term use of a prescription hypnotic drug can be beneficial for those struggling with disordered sleep.
• Controlled and timed exposure to light during the work shift has also been beneficial in some to reset circadian rhythms and restore a better sleep/wake pattern.
• Power naps before the work shift increase alertness, increase reaction times, productivity and do not usually interfere with the daytime sleep for the night shift worker.

Although somewhat unnatural, the night shift has become a necessary part of our working lives. Getting adequate sleep is integral in keeping alert, staying productive and reducing the risk of injuries while on the clock.

– Dr. Bruce Kaler

The Employment Physical in an ADA World

The employment physical is alive and well, but it’s changed in focus since Americans with Disabilities Act (ADA) became law.

In years past, the “pre-employment physical” was performed with a person’s hiring contingent on passing the exam. While the goals of this practice were good—matching an employee’s physical abilities with the job—it sometimes led to discrimination. Because of this, the pre-employment physical has evolved into the “post-offer physical.”

Despite the change in when the physicals take place, there is still a lot of value to the employer who conducts post-offer physicals. That’s because establishing a baseline physical condition is important in workers’ compensation claims. An employee’s hearing loss, arthritic back or hernia are all able to be documented at the time of a physical examination. Testing such as an audiogram provides an objective measurement of employees’ hearing. This can prevent the fraudulent claim of a pre-existing condition as a new work-related injury. With the cost of an audiogram around $20, you can do a bunch of them and still save money if only one or two injuries are prevented.

Establishing a baseline also helps quantify the severity of an injury. It can be frustrating when an employee’s back injury gets treated longer than seems reasonable. The pre-employment physical can uncover degenerative back disease and determine if the injured employee’s true baseline was morning pain and stiffness. This enables the provider to treat only the aggravation and discharge the employee when he has returned to his true baseline. All too often, the provider seems to be trying to return the employee to a condition he may not have been in 20 or more years ago. This is an imaginary baseline where there is zero back pain and the skies are always sunny.

On a more positive note, the employment physical is an investment in your employee’s health. Conditions such as high blood pressure, diabetes and heart disease can be found during this physical. The employee can be directed to get treatment for these types of conditions, preventing a heart attack or stroke in the future. At U.S. HealthWorks, our providers also talk to the employee during the physical about smoking, diet, exercise and other preventive medicine issues. Most of our centers also do urgent care, so the employee can be seen for these health conditions if they desire. We even have a reduced fee for those without insurance or primary care provider.

A relationship is established during the physical between the provider and the employee. This is beneficial if the employee needs treatment for a work-related injury. This is a valuable benefit to both the employer and employee. We make it a priority to get the employee treated as quickly and cost-effectively as possible. A good relationship with the provider gets maximum cooperation with the treatment plans from the employee. This gives the best results for both the injured employee and his/her employer.

It may sound simple, but these physicals also ensure that the employee knows where the clinic is. The excitement caused by a work injury often prevents the giving and following of accurate directions. It helps greatly if the employee has already been to the clinic. Employers have invested time and effort into picking and working with your chosen clinic and doctor. If the patient gets lost, the care will suffer.

The employment physical is a cost-effective means of preventing injuries, making sure injured employees get the right care while also keeping employers fully informed.

Until next time,

Dr. B

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Doctors Honored for Commitment to Serving Patients

Every member of our staff does exceptional work every day, but there are some employees that seem to excel beyond expectations.

This spring, we recognized a few of those stand-out team members at our 2nd U.S. HealthWorks Medical Symposium in Pasadena.

We began by honoring those who have led the way for others. Six individuals received the Leadership Award, which recognizes those who have gone above and beyond treating their patients. They have exhibited exceptional management skills in both their clinics and within their communities. These recipients demonstrate a powerful, personal commitment to the success of U.S. HealthWorks:

  • Syed Saquib, MD – Irwindale
  • Steve Nall, MD – Northside
  • Edward Demmi, MD – Medero
  • Carlos Garrett, MD – City of Industry
  • Donna Diziki, MD – Edison
  • Minh Nguyen, DO – Hillcrest (no photo)
  • David Rollins, MD (no photo)
  • Thomas Savoie, MD (no photo)

Next, we awarded four outstanding physicians with the Employer Relations Award. These folks have collaborated successfully with our business partners and the community in order to reach their health care needs. These honorees have ensured quality patient care, including excellent communication, treatment and follow up:

  • Richard Amegadzie, MD – Rahway
  • Rodolfo Ruiz-Velasco, MD – National City
  • Scott Bischoff, MD – Stafford (no photo)
  • Cori Repp, MD – Bradenton (no photo)

Then there are those U.S. HealthWorks superstars who embody everything you’d want in a team player. The Team Player awards celebrate the invaluable support these individuals have given to their co-workers and respective clinics. These recipients have exceeded expectations by doing more than what is asked of them and by making their clinics a more effective and positive working environment:

  • Betsy McKendry, MD – Southcenter
  • Bruce Hoang, DO – Santee
  • Robert Wagner, MD – Berkeley (no photo)
  • Bernard McDermott, DO – Oxnard (no photo)

Lastly, there are just some people who are the glue that supports and holds a medical community together. Our Outstanding Physicians Assistant awards are for those who have shown exceptional leadership in serving clients. These honorees have gone beyond day-to-day patient care by demonstrating exemplary service to the PA profession and the community:

  • Victor San Roman, PA – Riverside
  • Shauna Cole, PA – Kearny Mesa (no photo)
  • Karen Manitsas, PA – Oakland (no photo)

Congratulations to all of our award winners! We can’t thank you enough for the services you provide every single day.

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 

Two U.S. HealthWorks Doctors Named to Leadership Roles with the Osteopathic Physicians and Surgeons of California

We’re excited to announce that two of our physicians have taken on leadership positions with the Osteopathic Physicians and Surgeons of California (OSPC).

Dr. Alesia Wagner, the Southern California regional medical director for USHW, was re-elected to the OPSC Board of Directors as the new secretary-treasurer.  

“It’s a great feeling to have my peers vote to keep me on the board of directors for another year,” said Dr. Wagner. “I’ll continue to work hard to keep OPSC operating as one of the best medical organizations in the state.”

Dr. Minh Nguyen, managing physician at our San Diego Hillcrest clinic, has been appointed as the chair of the OPSC’s Workers’ Compensation Committee.

“I’m honored to have been confirmed to serve on OPSC’s Workers’ Compensation Committee,” said. Dr. Nguyen. “Workers’ comp issues are of vital importance to all employers, especially here in California, as we work to make it more cost effective for everyone.”

As a division of the American Osteopathic Association, the OPSC’s mission is to help osteopathic physicians provide better, quality healthcare for patients, and to educate the public to better understand osteopathic medicine and its contribution to total healthcare.

– Dr. Leonard Okun


U.S. HealthWorks Medical Group extends occupational medicine expertise to Tucson employers

This week we’re announcing the acquisition of all three Tucson Occupational Medicine healthcare centers, which brings the number of U.S. HealthWorks medical centers in Arizona to six.

The medical centers located in Tucson at 1661 W. Grant Rd., 2945 W. Ina Rd #103, and 888 S. Craycroft Rd #150 are occupational health facilities focused on providing injury and illness diagnosis and treatment, preventive services, pre-placement and post-offer exams and testing, and return-to-work programs. Terms of the transaction, which was effective February 19, were not disclosed. These are the first centers for U.S. HealthWorks in the Tucson area.

We’re excited to expand our footprint in Arizona with these highly regarded centers, and we look forward to serving clients and patients in the Tucson area. We welcome the medical staff and employees of these centers to the U.S. HealthWorks team.

Dr. Scott Krasner, founder of Tucson Occupational Medicine, will remain as center medical director.

-Dr. Leonard Okun, national medical director