Current News

Winter Safety

The Lion King said it best when it comes to a healthy winter season in the Rockies: “Be Prepared!”

Driving is the number one source of injuries and fatalities in winter:  Be sure your vehicle has all-weather tires in good condition, good wipers, and a full tank of windshield spritz.  Keep a warm coat, gloves, hat, and boots in the car at all times just in case you need to “hike out” of someplace.  Take storm warnings seriously, slow down in icy conditions, and always wear your seat belt.

Cold Exposure and Sports or Heavy Work:  Cross county skiing and snowshoeing are among the very best activities for healthy exercise. On cold days, it is a common mistake to overdress.  This causes perspiration, and wet plus cold equals trouble.  So, use modern fabrics that wick moisture away from the skin and dress in layers so you can easily add or subtract clothing as conditions dictate. Be able to protect yourself from wind, which is a hazard worse than cold alone.  Your body can generate a great deal of heat with exercise...a light thermal shirt and a good windbreaker might be plenty of clothing while snowshoeing or laboring in zero degree weather.  But, you will need more warmth during your stop for lunch. Downhill Skiing causes wind.  So as the temperature drops to zero, it can easily reach minus 25 degrees wind chill during a run.  That is frostbite territory, so keep all exposed skin covered in that type of situation.  The outside temperature is 10 below?  Unless you are very well prepared, head to the warming house.  The wind chill during a run could go below minus 40!

Altitude and Conditioning:  Good conditioning, good hydration, and no booze are the keys to work or play at 10,000 feet in winter.  But, to adapt to high altitude and cold, you may need a few more things. Calorie usage can be huge, so carry a day’s worth of quality snacks just in case.  Water does you little good if it is frozen solid!  Keep it close to your body heat in a backpack. Become acclimated to the altitude before intense exercise.  Make sure your equipment is tuned.  Get warmed up and stretch before a ski run.  Do not over-ski your conditioning level…muscle fatigue and failure causes more falls and knee injuries than moguls do…and…have fun out there!

Alan W. Burgess, MD
Medical Director
HealthONE Clinic Services

ALL EMPLOYERS!  Get Ready NOW for The Employee Choice of Physician Law!

The change to the Colorado Workers Compensation Act (known as HB-1176) goes into effect January 1, 2008. Although relatively simple to comply with, it is important that employers plan ahead and prepare for this change well in advance of the start date.  In summary:

- Employees must be provided a choice of two health care providers to get treatment for a work-related injury
- The providers must be at two distinct locations without common ownership
- Injured workers may make a one-time change to a new provider on the employer’s designated list by providing notice within 90 days of the injury, if they have not yet reached maximal medical improvement
- An injured worker can go anywhere for care if the employer fails to provide or properly communicate their list of providers
- Communication of designated provider choices is crucial…multiple means of communication both in general to all employees and specifically to each employee at the time of injury is recommended
- Exceptions to the law exist but apply only to a small fraction of employers (rural areas, employers who are health care providers, employers who have fully-staffed on-site health care facilities)

For more information (click here)


 

What’s New for the Injured Employee

Occupational medicine is a unique medical specialty for one reason: its practitioners serve two masters.  The prevention, diagnosing, and treating workplace injuries and illnesses requires working for employers (who fund the system and may require assistance in injury or exposure prevention at the worksite), and the employee (who need expert medical management to maximize the ability to return to full function as soon as possible).

HealthONE in conjunction with Colorado Rehabilitation and Occupational Medicine has joined forces to pilot an integrated approach to patient care in the Aurora area.  Combining primary occupational medicine doctors who excel at injury treatment and case management with experts in the rehabilitation of complex cases is just the first step.  What’s been enhanced is preventive medicine services, expert causality analysis, early identification of complex cases, and “interventional care with a conscience”.

It is well understood that good general health of employees translates into fewer injuries and decreased overall health care costs.  In addition to on-site lectures from experts in preventive health, HealthONE is expanding its “H2U” program to Denver employers, creatively called H2U@work. The goal is to assess the health risk of employees and implement strategies to “reach the hard to reach”: motivate those at high risk to choose healthier lifestyles.

One “bug” in the workers compensation system is that interventional treatments, such as injections, are reimbursed well by the health plans and tend to get over-utilized.  These treatments are cutting edge and very useful when medically indicated, but strict utilization and effectiveness controls we believe will sharply reduce costs while still allowing selected patients the benefits of the procedures.  Hence the name, interventional care with a conscience.

We expect that integrating prevention, injury management, and expert rehabilitation of complex cases will result in improved patient outcomes at a lower cost.  In effect, we are attempting to bring occupational medicine back to its roots.

For more information about the HealthONE Occupational Medicine Clinics, please visit our website at www.healthoneclinics.com

Alan W. Burgess, MD
Chief Medical Officer
HealthONE Clinic Services

Battling Frigid Weather: Ways to Conquer the Cold

Despite the warm fall, we all know the cold is coming.  Actually, any temperature below 65 degrees can be unsafe, depending on several factors.  Basically, there are three potential health consequences of cold exposure: hypothermia, frostbite, and aggravation of existing diseases.

Hypothermia is defined as a lowering of body temperature below 95 degrees.  This can be caused by any situation of rapid body heat low.  Even though a healthy person can increase heat production by six times with cold exposure, a wind of 30mph will increase heat loss by five times.  Also, not wearing proper clothing - for actual or potential weather conditions - can quickly cause trouble; if a hat is not is worn, one-half of the body’s heat production can be lost through the head at an outside temperature of just 39 degrees. Wet clothes can increase heat loss twenty times.

Several factors aggravate hypothermia.  Alcohol increases heat loss, and is a very common cause of hypothermia.  Smoking pollutes the body with over 10% carbon monoxide, which increases the fatality rate in victims by decreasing tissue tolerance for cold.  Exhaustion impairs heat production, since shivering produces great amounts of heat.

When body temperature goes below 90 degrees, it no longer can maintain heat production so further cooling happens rapidly. This is associated with depression and decreased judgement and coordination.  The mortality rate is 20% with body temperatures in the 80s, over 50% in the 70s.  First aid should be to stop heat loss by removing wet clothing, removing from wind, insulate from cold ground, and covering head and body with blankets.  Share body heat inside of a sleeping bag, and if conscious, provide warm liquids.  Arrange immediate transportation to a hospital.  

Frostbite becomes a risk to exposed skin when the temperature drops below 20 degrees, and a serious risk below zero.  Good defenses include, appropriate protection for hands, feet and face, as well as periodic re-warming.  If frostbite occurs, protect the part (without trying to thaw it) while transporting to emergency room.

Chronic illness, such as heart disease, asthma, diabetes, and circulatory diseases can be exacerbated by cold exposure.  These illnesses decrease adaptability to cold and other outdoor stresses such as altitude.  Age extremes (over 70 and under 3 years) can be problem for the same reason.  Malnutrition markedly impairs cold tolerance, and a starving person can become fatally hypothermic at room temperature.

Is there a cold weather limit to being outside?  Assuming no wind and you are dry, a person can work and play for extended periods in almost any temperature.

• Continual activity (but not to the point of sweating) helps maintain heat production while staying dry.
• Layered, loose clothing which can be removed or added with good head and hand protection are important.
• Stay near a warming area.
• Most importantly, assume the worst.  Weather changes quickly, especially in Colorado.  Even if you only plan to drive to work, be sure hats, gloves, boots, and a coat are in your car all winter. You can almost bet your car will decide to break down during the worst possible weather with the least help around. 

Altitude Illness

Altitude sickness is a brain malfunction which can occur at altitudes above 8,500 feet.  Symptoms always include headache and nausea, but can progress to vomiting and loss of mental concentration.  Some people are more susceptible than others, but it can happen to anyone if their behavior pushes their tolerance for altitude beyond their limit. Those behaviors are lack of acclimatization, rapid ascents, over-exertion (relative to conditioning level), dehydration, and alcohol consumption.  So, the immediate treatment is rest and fluids.  Then moving to a lower altitude rapidly resolves the problem.  Sometimes, medical evaluation and treatment is required.

Summer Safety – Heat

With summer fast approaching, it is important to be aware of body overheating and proper hydration.   With the proper clothing, humans can tolerate a 140 degree span in outdoor temperatures (from -20° to +120°).  However, our body temperature only does well over a 14 degree span (between 90° – 104°).  By 107 degrees, coma is impending and 109° can be fatal - only 10 degrees from normal!

So, our body’s cooling system is crucial to survival.  Since exercising muscle can increase energy consumption by 20 times (75% of which is converted to heat), the cooling efficiency must be at 100% to keep the body temperature at a normal 99 degrees. 

The following can interfere with the cooling system:  dehydration, improper clothing, sun exposure, certain medications, poor conditioning/acclimatization, and over-exertion.

Remember to maintain hydration, especially during exercise.  Sixty-four ounces of water daily is normal, but in Colorado’s high altitude, our bodies may require much more.  And, alcohol in any form is dehydrating.

If you experience lethargy, confusion, and nausea, you should urgently seek water, rest, shade, fans, and water sprays.  Dry skin, delirium, vomiting, and fever make heat illness a 911 medical emergency. 

About Dr. Alan Burgess:

Doctors Corner is authored each month by Alan Burgess, MD, Medical Director for HealthONE Clinic Services.  Dr. Burgess has practiced in healthcare for over 25 years in both private practice and various staff, advisor and director positions for organizations including, Xcel Energy, HealthMark , Frontier Airlines, and Presbyterian St. Luke’s Medical Center. 

Dr. Burgess studied at the University of Illinois, Chicago and is American Board of Internal Medicine certified.  He has earned Level II Workers’ Compensation certification, and is a certified Medical Review Officer.

His special areas of interest include Corporate Medicine, Occupational Health and Safety, Drug Testing, Preventive Medicine and health promotion in all areas of medical care from primary care to safety and industrial health.