Category Archives: Latest Healthcare News

Flu shot might also help prevent a heart attack

Here we are in the run-up to another flu season, where many people will happily trade a few dollars for a dose of the magic vaccine.

After all, a 103-degree fever, bad dreams, and feeling like yesterday you played linebacker in an NFL game without padding, can be pretty persuasive. Once you tangle with flu, you will be a flu vaccine believer ever more.

Despite all the TV, internet, newspaper and radio attention, only one-third of adults get vaccinated, and only 50 percent of adults with heart disease get the shot. Heart attack

But there is good reason to change that.

Last year at the end of the flu season came some news straight out of left field: influenza vaccine prevents heart attacks. Few people heard it, and even fewer believed it. Most doctors thought it was one of those strange results that would fail to pan out under serious scientific scrutiny. I thought the same.

This year the story of flu shots preventing heart attacks re-emerges, and this time there are good studies backing it up.

Let’s talk about inflammation first. Inflammation has been one of the hottest areas of research in the last decade. It started when we discovered a high C-reactive protein, a blood test showing inflammation was associated with heart attacks. Hmmm!

The more we looked, the more we found inflammation causing trouble. In virtually every system we can find examples of this. Cervical inflammation causes cervical cancer. Brain inflammation causes multiple sclerosis. Less exotically, joint inflammation causes destruction of the joint which we call degenerative arthritis.

Inflammation of the heart valves from Rheumatic fever causes them to become deformed and not work properly. Almost anywhere we look in our bodies, inflammation causes bad stuff. There is even a theory that inflammation causes aging – but that’s another blog.

It turns out that inflammation is bad for blood vessels, too. To understand that, we need to talk about Atherosclerosis: “hardening of the arteries.” That is an unfortunate name for changes that inflammation causes in blood vessels.

It should be called narrowing of the arteries, or plugging of the arteries. Plugged arteries don’t let blood through – that’s a bad thing. No blood results in that tissue dying. Inconvenient if it is heart tissue or brain tissue.

Inflammation of the artery wall starts the whole process of accumulating abnormal cells and cholesterol in the blood vessel wall. This causes the gradual narrowing of blood vessels. Acute (sudden) inflammation can cause the smooth lining of the arterial wall to rip, causing a blood clot and blockage.

What does all this have to do with the flu vaccine? Inflammation is the body’s response to infection among other things. Influenza infection causes a massive amount of inflammation in your respiratory system and we see changes in the bloodstream during the course of infection.

Influenza is a significant insult to patients with borderline blood flow to their heart.   It is the proverbial triple whammy. The infection stresses the heart and increases the need for good blood flow. The infection also causes fluid in the small airways, decreasing the oxygen levels in the blood. Finally, the inflammation can trigger an interruption in the blood flow of a crucial coronary artery.

Looking at patients with known heart disease, getting the flu shot cuts down the risk of major cardiac event over 50 percent. If we take all  comers – the healthy, the train wrecks, and everyone in between – a flu shot cuts down heart attacks and similar by a third.

Those are numbers that could get the flu vaccine approved as heart treatment.  Much of what we do to protect the heart – eat right, exercise, take blood pressure or cholesterol pills – gives a similar reduction in cardiac risk (30 to 50 percent).

It does all that and it even keeps you from getting the flu. Petty cool, huh!

Stay healthy.

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy/ FreeDigitalPhotos.net

 

What do we really know about full moons and their effects?

Halloween is a few days away and people around the country are getting their spook on; and not all of them are young.

The proliferation of orange Halloween lights continues its unlikely assault on the more somber tones of the night.

Since I live near the desert, we get creepy sound effects: coyote, and great owls on the hunt, eyeing not your candy bag, but a much more personal treat – cats and small dogs are best kept indoors. But no haunting is complete without a full moon.  Full moon Halloween

The full moon has held a dark fascination for mankind as long as there have been any. We can all remember a huge full moon, hanging so unnaturally close over the horizon. An alien world without air or life, yet intimately involved with our teeming planet.

The moon moves the tides about with an unseen hand, and the lunar cycle is woven into the human condition. Lunar, lunacy, lunatic …  these suggest a darker madness than our sunny psychiatrists can fix with Prozac.

Not so long ago during my training, the world was a little more mysterious and nurses and doctors openly discussed the full moon driven chaos in labor, delivery and the emergency department.

There was no doubt in our mind that the full moon had an influence on people’s psyche. The “knife and gun club” seldom disappointed us on such nights. Police waiting in the ER would do their best to shock the house staff (young doctors in training). All a howling good time.

If you have any belief in the zodiac, the constellations involved are 30 or 50 light years away and have a millionth the effect on human beings that the full moon has, gravitationally.

Like houses, gravitational force is all about location, and the moon is in our closest celestial neighbor. Full moons are associated with quite a variety of things, from the fanciful, like Shape Changers (werewolves), to the reasonably sounding connection with homicide rates. Other phenomena supposedly connected with full moons are epileptic seizures, ER admissions, deaths, births, murders, and all manner of mayhem.

Sensible people find it easy to believe, at least a little, in the full moon’s effects. This probably has to do with “the unseen force rule” (that I just made up). All of us are exposed to unseen, highly complex, but unperceived forces every second: radio, television, navigational and the internet surround us constantly.

So it is not such an intellectual reach to think that forces strong enough to deform the planet (tides) might have some measurable effects on people or their psyche.

This has been investigated in some depth; inquiring minds want to know. Hopefully not too many tax dollars were spent on werewolves, but there have certainly been a lot of studies on full moon effects on people.

These scientific or semi-scientific studies have tracked admissions to the ER or labor and delivery. They have looked for full moon correlation to the frequency, severity and cause of injury (assault vs. a fall).

Studies have been done in labor and delivery, police records, psychiatric admissions, and almost anything else you can think up. At this point we can say with absolute scientific conviction that the full moon is probably not associated with changes in people’s mental health or behavior, or at least not big ones.

In case you are unconvinced by the efforts of science, and think the world has room for some immeasurable spookiness. This Halloween, I’m sorry to say, will not bring a full moon.

The full moon next occurs on Nov. 17. The next full moon on Halloween will be 2020. So there is plenty of time to plan for a truly interesting Halloween party; that doesn’t include orange Christmas lights.

May your treats be more numerous than the tricks.

Take care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy/ FreeDigitalPhotos.net

 

U.S. HealthWorks Names Dr. Pucek New Chief Medical Officer; Appoints Dr. Peplowski Senior Vice President for National Medical Policy and Innovation

Dr. Mark Pucek. U.S. HealthWorks

Dr. Mark Pucek. U.S. HealthWorks

U.S. HealthWorks, one of the largest operators of occupational healthcare centers in the nation, announced today that Dr. Mark Pucek has been named Chief Medical Officer (CMO) and Dr. Bernyce Peplowski has been promoted to Senior Vice President for National Medical Policy and Innovation, a new position at the Company.

U.S. HealthWorks has 208 centers and worksite locations in 19 states and employs more than 2,700 people. The centers offer occupational health services, as well as physical therapy, chiropractic and urgent care.

“Dr. Pucek and Dr. Peplowski are stepping forward to help lead this organization as we continue to build on our vision to be the leading outpatient occupational healthcare company in the nation with a sterling reputation for both quality and service,” said U.S. HealthWorks CEO Daniel D. Crowley.

Dr. Pucek’s previous position with U.S. HealthWorks was Regional Medical Director for the Southeast and Southwest. He has been a member of the U.S. HealthWorks Medical Executive Committee since 1998 and was named Chairman in November 2012.

Dr. Berynce Peplowski, U.S. HealthWorks

Dr. Berynce Peplowski, U.S. HealthWorks

During his tenure on the Medical Executive Committee, Dr. Pucek played a large role in the development of national and regional policies and procedures related to medical professional conduct, best medical practices, medical formulary decisions, and quality of care.

“Dr. Pucek stands out as a leader in our organization, and it was an easy decision to promote him to Chief Medical Officer,” said U.S. HealthWorks CEO Daniel D. Crowley. “Dr. Pucek has strong ideas about how to run our centers with a focus on quality and service. I look forward to having him fully engaged in his new role.”

Dr. Pucek was Founder/Owner/Center Medical Director for Houston Center for Occupational Medicine. In 1996, it was the first occupational medicine practice center acquired by U.S. HealthWorks.

A resident of Dickinson, Texas, Dr. Pucek received his medical degree from the University of Texas Medical School at Houston and attended the University of Texas at Austin for his undergraduate studies.

“This is a tremendous honor to be named to a critical leadership position with a dynamic medical group like U.S. HealthWorks,” Pucek said. “Our goal is to continue growing our network to provide high-quality healthcare services throughout the country. We remain focused on efficient delivery of quality care and superior customer service.”

In her new role, Dr. Peplowski will develop national medical initiatives to create the benchmark for how medicine is practiced in the occupational medical clinic setting.

“Dr. Peplowski is well known in our industry and regarded as one of the key thought leaders,” Mr. Crowley said. “She has earned tremendous respect in our industry for her expertise and knowledge. This new position will be a challenging one. But Dr. Peplowski has great ideas and the energy to make them reality.”

Dr. Peplowski joined U.S. HealthWorks in September 2012 as Vice President and Chief Medical Officer for California. She was previously Medical Director for the California State Compensation Insurance Fund.

Before joining State Fund, she was the Chief Medical Officer and Executive Vice President for Zenith Insurance Company. She worked for the Southern California Kaiser Permanente Medical Group from 1994 to 2006, including seven years as regional chief and physician director for occupational medicine and disability management.

“I look forward to the new challenges that lie ahead with U.S. HealthWorks. This is a wonderful opportunity to represent U.S. HealthWorks in another capacity,” Peplowski said. “While it is easy to get distracted by so much that is changing in healthcare today, this organization has remained focused on helping workers get back to work.”

Dr. Peplowski, whose career in occupational medicine spans nearly three decades, received her bachelor’s degree from Duquesne University, a master’s degree in environmental and occupation health from California State University at Northridge, and a doctor of osteopathic medicine degree from the Philadelphia College of Osteopathic Medicine.

 

The Therapeutic Dilemma

To use therapy or not, that is the question. At least that one has been largely settled in the last few years with many people opting for therapeutic treatment.

Physical therapy is about movement and how to make that happen. It’s a good thing for injured people and measurably speeds healing and reduces the cost of care.

A recent study put a price tag on this. Adding therapy to musculoskeletal injury treatment can save the carrier over $2,000 per claim with quicker release and reduced disability.

The list of things improved by exercise is twice as long as your arm. Movement is good; it keeps the blood going round. Movement is good even if you are injured, old, obese, skeletal-thin or have almost any disease or injury you can name.

Now that we have established that therapy is a good thing, where can you get it? That remains a more unsettled question.

There are two main schools of thought:

1. Use the therapist that works with your doctor.

2. Use a therapist that has nothing to do with the treating doctor.

Both carriers and providers are concerned about the cost of care. We know that good outcomes, achieved with the quickest and least expensive path, will bring long term success to the companies we serve, their employees, patients and ourselves. Insurance carriers are entirely in agreement on these goals, but how to get there?

As an insurance company, if you believe providers work by formulas, putting a few dollars ahead of all else, then you put procedures in place to eliminate any possible self-dealing. Keeping the provider and the therapist far apart might be one of those procedures.

In your mind, one of the biggest challenges to closing a case quickly, economically and successfully, is self-referral and endless therapy.

If you think having the doctor and therapist talk about the patient’s progress is good, you approve and even encourage the therapy being done in the same clinic as the medical provider.

Separating the doctor and therapist converts meaningful verbal communication to a review of indecipherable reports, often received after the patient has left. These reports are not written to communicate clinical information with the doctor. Instead, they are designed to get a therapist’s bills paid. When an outside therapist has ever called me, and that happens once every 50 patients or so, it’s only been to get a signature or ask for more therapy.

My relationship with the therapist who works with me in my clinic is different. If we just consider MRIs, over 50 percent of the ones I order are first suggested by my therapist. Those MRIs are about 85 percent positive for surgical pathology.

Am I simply late on the draw? No, it’s because our therapist spends more time with the patient, and has a different relationship with them. The physical therapist is seen by most patients as being “on their side” and they talk more openly with the therapist.

This is too important and expensive a resource not to take full advantage of it. Do an MRI sooner, save weeks of therapy before the operation, and save thousands of dollars on the case.

Our therapist also doesn’t like to waste her time. If someone has recovered, she walks into my office and asks me to see them after therapy and release them. She does this even if more therapy visits have already been authorized.

What is going on here? Our therapist and I are both judged by the same ruler – getting the patient better with the most speed and cost effectiveness. She doesn’t have a practice to support, nor do I. If we do a good job together and the patient gets better, the rest will follow.

Do the numbers support this? We manage to get 81 percent of new cases closed within 30 days. In the 17 percent of new injuries that need therapy the average length of therapy was 5.5 visits if done by my therapist, and 9.5 if done by an outside therapist.

The partnership between a skilled occupational medical physician and the equally skilled therapist, both working with the same goal, is the most effective way to rapidly get injured people better.

I tell the patient that we will treat them from the inside with medications, and from the outside with therapy and exercise. Even intuitively that sounds like a “can’t lose” strategy.

Take care,

Dr. B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

 

Labeling Obesity A Disease Good Start to Finding a Solution

When I heard the recent news that the American Medical Association decided to label obesity as a disease, my initial thought was – what took so long?

This decision seems a little curious because we are 10-plus years into the well-established epidemic.

A third of us are obese, and another third are overweight, so the horse has definitely left the barn. At this point I imagine it was probably a spirited AMA debate whether to proclaim obesity a disease or just the new normal.

The elevation of obesity to disease-hood is an open admission that our approach to the problem has largely been a failure. Roughly 45 million people diet each year. They use one of dozens of popular diet plans, all promising to deliver a transformation that results in effective long-term weight loss.

When these are evaluated for effectiveness, the only consistent result is dieting is a great predictor of long-term weight gain. The experience is a remarkably constant 5-10 pound weight loss in the first six months, followed by gaining those pounds back and adding more over the next two to five years.

A medical truism is if a disease has many treatments; it means no one treatment is very effective. If any single treatment worked really well, we would all use that one.

And so it goes with weight loss. There are hundreds of different diets, medications, and surgeries, weight-loss coaches, foods and supplements. One can go to the gym, a doctor or have specially prepared diet foods delivered right to their doorstep.

The results are predictable – temporary weight loss, then gain it back and then some. For the record, see-saw weight loss is worse than just maintaining the same overweight status.

The AMA is not the first medical group that has decided obesity is a disease. Medicare did the same in 2004, which did nothing to slow the progress of obesity in the last decade.

Now another medical organization put their weight behind calling obesity a disease. But the question lingers – will anything change?

Right now obese people are one of the last groups openly discriminated against. Studies have shown that obesity has a measurable negative effect on being hired for a job, income, and successful long-term social engagements.

Despite evidence to the contrary, obesity is seen naively as a character defect. “Why don’t you just stop eating?” That’s what most people think when they see an obese fellow traveler on our planetary voyage. That is, unless they have spent some time being overweight themselves.

The same could be asked of the alcoholic or habitual cigarette smoker. Just don’t drink; just don’t smoke! Do so only at risk of being told where to go, or getting a more direct and physical response, which ironically may require a bag of frozen peas.

How much luck would we have if we told the alcoholic to only have five shots a day, or only drink alcohol that was on the plan or delivered to his doorstep?

Obesity is a medical problem that we are only just barely starting to figure out. This is somewhat surprising to most because we have been eating and putting clothes on all our life.

It doesn’t take a PhD to tell us that some people can pretty much eat whatever they want and stay pretty trim. Obesity is partly genetic. Now that we have sequenced the entire human genome (DNA) we may soon have a better understanding of how to help.

On the opposite field of psychiatry, obesity has psychological aspects in both cause and effect. That too is actively being researched.

The endocrinologists are also busy. Gone is the simple idea that fat cells are just inert storage tanks for excess calories, perfectly happy to shrink away to nothing with a little dieting effort. These cells are surprisingly hormonally active, and that too is an area of active research.

Society at large has also been looked at with a critical eye. The dramatic rise in obesity has occurred parallel with the steady rise of countless fast food restaurants and advertising. Unemployed cigarette company scientists would tell us it’s simply a coincidence, but we wonder.

The AMA proclaiming obesity a disease is both everything and nothing. The sun will come up tomorrow and the majority of Americans will still be overweight. Diet gurus will continue to hawk their answers and the scientists will still be seeking the magic weight loss pill.

But this does bring the whole obesity, weight loss problem into some healthy sunlight. A few of the biggest weight loss charlatans will slink away. More money will be invested in bigger ideas.

And the best news of all – we just might learn something that is helpful.

Take Care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

 

Image courtesy of Raktim Chatterjee / FreeDigitalPhotos.net

U.S. HealthWorks Receives Public Health Service Award from San Diego County’s Health and Human Services Agency

Dr. Leonard Okun, U.S. HealthWorks

The San Diego County Health and Human Services Agency recently awarded U.S. HealthWorks Medical Group a “Director’s Award,” given annually to organizations that take a leadership role in promoting public health.

The award was presented to U.S. HealthWorks at the County’s Live Well, San Diego! event for “extraordinary achievement in protecting and promoting the health of residents in San Diego County.”

Dr. Leonard Okun, the National Medical Director at U.S. HealthWorks, accepted the award on behalf of U.S. HealthWorks Medical Group.

“We appreciate the recognition from San Diego County and our long partnership in serving the needs of county employees and residents,” Dr. Okun said. “The entire team at U.S. HealthWorks is dedicated to providing high-quality service and, with San Diego County, creating a great environment for residents to live healthy lives.”

U.S. HealthWorks has provided occupational healthcare to San Diego County employees for 35 years and has been active in supporting local efforts to promote public health, including an annual free blood pressure screening for residents.

U.S. HealthWorks, which provides services at 190 centers and work sites in 17 states, operates 11 centers in San Diego County.

About U.S. HealthWorks

U.S. HealthWorks, a subsidiary of Dignity Health, is one of the country’s largest operators of occupational healthcare centers. With190 clinics and worksites in 17 states and more than 2,700 employees – including approximately 800 medical providers – U.S. HealthWorks centers serve more than 12,000 patients each day throughout the country. U.S. HealthWorks centers help employers control work-related injury costs through quality medical care and effective management of claims and lost work time, specializing in early return-to-work programs, injury prevention and ergonomics programs. Visit us at www.ushealthworks.com. U.S. HealthWorks is also on Facebook and Twitter.

 

 

 

 

 

U.S. HealthWorks Appoints Ramon Ocon As Vice President of Tax

U.S. HealthWorks, a leading operator of occupational healthcare and urgent care centers, announced today that it has named Ramon Ocon as the company’s Vice President of Tax.

Ocon has worked in the tax profession for more than two decades, and has been with U.S. HealthWorks for the past seven years. Ocon played a pivotal role in establishing a formalized tax department for the company.

In his new role, Ocon’s duties will include providing guidance in tax planning and compliance, working closely with corporate development, finance, and legal departments.

Before joining U.S. HealthWorks, Ocon worked in the entertainment industry and was a tax auditor for the California Board of Equalization for 10 years. In 1997 and 1998, he received the “Superior Achievement Award” for contributing to the improvement in auditing techniques and educating taxpayers on the tax laws and regulations.

“Ramon has done an outstanding job meeting the demands of our organization and the complexities involved with operating in 17 states,” said Robert Hutchison, Chief Finance Officer for U.S. HealthWorks.

“I’m excited about taking on additional responsibilities with U.S. HealthWorks,” Ocon said. “The company is a leader in delivering quality healthcare and brings that same quality approach to ensuring that we comply with all tax and reporting laws in the jurisdictions we serve.”

Ocon has Bachelor of Science degree in Accounting from California State University, Los Angeles, and earned a Master of Science in Taxation from Golden Gate University in San Francisco.

 

The Importance of Preventive Medicine

This is National Public Health Week. Who knows where these things originate. Unlike a second cousin or great uncle day, very few greeting cards are passed around among the public heath minded.

Of course, that is not to say their efforts don’t deserve a card or two.

Preventive medicine deals in the health of the group, not the individual. Wholesale healthcare, if you will, paints with broad strokes. This is very attractive to people who concern themselves with the cost of healthcare, as preventive medicine gives you more bang for the buck.

A typical lung cancer patient will receive hundreds of thousands of dollars in surgery, radiation and chemotherapy, and all too often for a few extra months of life spent in physical misery. Preventing lung cancer is comparatively cheap and easy – it’s an oil change versus a new engine.

Smoking causes close to 90 percent of the lung cancer in this country. So someone figured out we could avoid a lot of lung cancer simply by reducing cigarette smoking. Through a combination of advertising, taxes and laws, smoking rates have been cut in half over the last 40 years (from 42 percent to 20 percent).

These efforts are literally saving tens of thousands of people a very nasty struggle with lung cancer. The cost of this: some anti-smoking advertising, much of which the tobacco companies pay for. Raising taxes on cigarettes discourages smoking while producing tax revenue for other worthwhile projects.

Weight loss is another area where a little work spreading the word can get you huge bonuses in the public health burden. A modest decrease in a group’s average body weight produces significant reductions in Type 2 diabetes, heart disease, hypertension and osteoarthritis. How many heart surgeons could be retrained to care for the elderly or the poor?

It’s hard to tune into any media these days without seeing something about exercise. That’s because physical exercise promotes weight loss, so you get all the benefits mentioned above, and a whole lot more.

Exercise keeps you alive by cutting down on blood vessel disease, and it also helps you enjoy life by reducing depression. Your immune system works better, as does most any other system you care to name. Exercise even cuts down on cancer. If a pill did all this, they would sell it for $100 apiece and we would all stand in line to buy it.

Diet is another big part of the preventive medicine picture. We have not done as well at communicating the importance of a healthy diet as we have the dangers of smoking. Food advice has been mostly provided by the people who sell the food.

Medical providers and dietitians aren’t deeply involved in designing the original food pyramid. However, that is changing. We now have dietary advice for avoiding cancer or helping fight it. You can rev up your immune system, reverse atherosclerosis and probably extend your life span dramatically by making smart dietary choices.

Preventive medicine is worth celebrating during National Public Health Week. It’s not as razzle-dazzle as the latest PET scanner, but people are much more likely to enjoy their great-grandchildren if they commit to healthy lifestyle changes.

Take care,

Dr B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

 

 

U.S. HealthWorks Offers Patients Early Check-in on iTriage

Your smart phone just got smarter – and is going to help you check into your doctor faster. That is if your doctor is a U.S. HealthWorks doctor.

http://blog.itriagehealth.com/healthworks-offers-patients-early-checkin-itriage/

 

 

photo credit: William Hook via photopin cc

What’s Behind the Meningitis Outbreak?

I’m somewhat of an expert in spinal infections, unfortunately from both sides of the scalpel. About 10 years ago I had spinal surgery. The 1,300 skydives and years of mogul skiing wore out a disc – imagine that!

I had spinal surgery, a fusion, which made for a perfectly miserable six weeks. And then it got really interesting due to an infection inside the spine, which is never much fun. I had a second surgery to clean up the mess, then a couple of months of IV antibiotics through a port, like a cancer patient.

Life went on, but remind me not to do that again.

Spinal infections that have resulted in a national meningitis outbreak are in the news lately. They are being caused by an unusual culprit – fungus. Molds, yeast and fungus are the names for this group of slow growing organisms. They usually cause more trivial problems like athlete’s foot, ringworm, and that sort of thing.

Mold grows on cheese and you don’t call the biohazard team. They are not usually aggressive germs. But you have heard the expression: location, location, location to describe why a house is more valuable.

Some places are just more special than other places. Inside your spine is one of those very special places. It is not well defended and it’s filled with spinal fluid, which surrounds your brain (also pretty special).

How do fungi get in your spine? We (doctors) put them there; not intentionally of course.

Spinal injections of steroids are pretty common for pain control in elderly patients. These are called epidural blocks and involve injecting a small amount of fluid into your spine.

Great care is taken to avoid any skin germs getting into the spine. What we inject is supposed to also be completely sterile. Yet that is where the problem lies. The fluid that a doctor injects is often a mixture of a local anesthetic, a steroid, and sometimes other medications such as an enzyme.

These mixtures don’t come that way from the manufacturer because these medications might not have FDA approval or long-term stability when mixed. That is not to say mixing them is bad. Almost all spinal injections involve some sort of mixture.

There seems to be some fungi spores that got into the steroid/anesthetic mixture and went along for the ride when it was injected into the spine. Had the mixture been tainted with bacteria or viruses, the patient would be gravely sick within 24 hours. Fungi are much slower growing, so it sometime takes over a month for the infection to be noticeable.

When the infection finally occurs there are subtle or sometimes obvious signs of meningitis – headache, confusion, or even delirium occurs. Generalized weakness and nonspecific symptoms may also be the only clue. Treatment is antifungal medication, usually taken for a prolonged period.

Fungal meningitis is a disease with a very particular risk factor – spinal injection. If you haven’t had one in the last few months, relax and enjoy your day because there’s nothing to worry about.

Take care,

Dr. B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing Clinical Occupational Medicine for more than 25 years. Dr. B works in our Scottsdale, Arizona clinic.