Tag Archives: U.S. HealthWorks

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.

 

U.S. HealthWorks Names Jeanne Osterlund As Vice President of Sales

U.S. HealthWorks, a leading operator of occupational healthcare and urgent care centers, announced today that it has promoted Jeanne Osterlund to Vice President of Sales.

Osterlund has been in sales management for more than 20 years, including the last 15 with U.S. HealthWorks. For the last three years, she has served as National Sales Director for U.S. HealthWorks, which operates 190 clinics and worksites in 17 states.

Osterlund will be responsible for leading efforts to create and enhance client relationships at medical centers around the country.

Before joining U.S. HealthWorks, Osterlund was with HealthSouth where she managed sales for all their San Diego divisions.

“Jeanne has provided focused leadership in growing client relationships for many years,” said Diane Yu, Vice President of Sales and Marketing. “She has a wealth of knowledge and expertise in the occupational health field; and helps us connect clients with the care their employees need.”

“I appreciate the opportunity to continue developing our talented team around the country,” Osterlund said. “We work on providing the best customer service to our clients and the right care to our patients so they can get back to productive work as quickly as possible.” 

Osterlund earned a BA in Business Management at New Mexico State University.

 

How to Avoid Flesh-Eating Bacteria

“Flesh-eating bacteria consumes woman” Sounds like a National Enquirer headline, not some real-world nightmare.

Flesh-eating bacteria is a euphemism for Streptococcus Pyogenes. Yes, that’s Streptococcus, as in “strep throat.” These are not unusual bacteria, they are pretty much part of the human condition. It would be easy enough for someone to swab their arm and find some strep among the jillions of bacteria that are normally on our skin.

So this isn’t the worst bug you can imagine. You have already been in contact with this bug lots of times. There’s no getting away from it. There are just places this bug should be, and others where it definitely should not be.

In this age of antibiotics, we physicians have forgotten a lot of what we knew about wound care. We have come to believe that wound care isn’t very important because we can always throw antibiotics at it. That usually works out OK for all involved.

Unfortunately, when it fails, it fails spectacularly.

If you want to know wound care, talk to a surgical intern. Wound care is a lot more that simply sewing. In fact, an old surgical adage is: “the more you know, the less you sew.”

The first rule of wound care is get it clean. This means get any dirt, foreign material or dead tissue out of the wound. You need to pay attention to the mechanism of the injury. Was it a cut, rip, saw or burst wound. Some of these mechanisms cause a lot of dead tissue to be present in the wound.

Any saw wound grinds up tissue as well as cutting it. Saws make sawdust. This ground-up or killed tissue needs to be removed from the wound if you are going to close it. Otherwise you have created a perfect area for bacteria to grow deep in the body. Dead tissue is pretty hard to clear infection from since it has no circulation.

Sometimes wounds should be cleaned and left open. Modern society doesn’t like open wounds, they look terrible, are hard to take care of, and sometimes scar badly. But they almost never get badly infected because they can freely drain.

To understand this problem, you need to know the body is built in layers. All the muscles are surrounded by a fibrous capsule that allows them to slide over each other.

Since the muscles slide over each other, there aren’t many blood vessels supplying this area. So we have a passageway that isn’t well defended and makes travel easy for infection.

This particular bug can get so aggressive that is dissolves the fibrous capsule around the muscle, allowing it to spread even easier. Once this gets going, it is very hard to stop. The anatomy is simply working against you. As the infection spreads, the toxin can overwhelm the body and problems develop with blood pressure and circulation.

The condition of the patient to start with has a lot to do with the body keeping itself out of trouble. Anything that depresses your immune system adds to the risk. That can be something well known like HIV or diabetes. It can also be physical exhaustion, something that many young people flirt with frequently.

So don’t stay up late worrying about flesh-eating bacteria. It takes a whole bunch of bad luck, an especially nasty wound, questionable surgical procedures, and a poorly functioning immune system to put you in this situation.

Take care.

Dr. B.

Alcohol and Your Brain

It has finally been proven what all young people have instinctively known – drinking makes you smarter. A pause here while I peek cautiously around my computer for the expected stoning.

'Alcohol is a drug - 9,948 views' photo (c) 2005, Joe Cashin - license: http://creativecommons.org/licenses/by/2.0/It’s all a matter of amount, like so many things in life: water, money, acetaminophen (2 gets rid of your headache, a handful, your liver).

Alcohol is an interesting drug, and is best thought of as a drug. The first ounce is a stimulant in most people, but after that, it acts as a depressant. Given enough alcohol, the brain starts working badly, becomes sleepy, then comatose, then dead if you drink enough.

A study looked at problem-solving in individuals with blood alcohol of 0.07 percent or less; that’s a glass of wine or a beer. For background, 0.08 percent is the legal definition of “under the influence” if you are driving. Sensitive tests of coordination can detect performance deterioration in as little as 0.04 percent.

But this study was testing mental problem-solving, not driving skill. It found, much to everyone’s surprise, that a modest amount of alcohol helped. Bet that made a few scientists stop and scratch their heads. Kind of like the faster-than-light- neutrinos … which weren’t. Both run contrary to most of what we think we know.

This inspired a lot of intense, probably not alcohol enhanced, consideration of the way the mind works. The conventional theory of problem-solving is reflected in every aspect of our society. To be a better problem solver, you get some training in a particular area like medical school or engineering. You preload the brain with a lot of facts and conditioned pathways. You think about a problem hard.

The brain is wired to solve all types of problems in this way, and alcohol doesn’t help. But people, societies, and companies have all become more sophisticated. Those answers, that anyone with the proper training can come up with, simply aren’t good enough anymore. Companies have come to value “out-of-the-box” thinking.

This goes by many names, non-linear, right-brained or lateral thinking. The essence is using unrelated information to solve problems in a new and hopefully better way.

The theory to explain a possible benefit from a little alcohol suggests that our thoughts are less focused after one drink. We are less likely to use normal conditioned neuropathways, and more open to unique solutions. Stepping back, you notice more forests for the trees and all that. A low dose of alcohol can encourage non-linear thinking.

Do you need alcohol to be non-linear? Not really. We have many other, non-linear approaches. This is something we use every day. If I am really stuck, I will “sleep on it.” Almost like magic I wake up with the answer.

The notion – “I get my best ideas in the shower” – is another example of opening up our mind to non-linear thinking. Ever tried to look directly at a faint star and found it invisible until you looked away at another star that was close by?

We are built to solve problems in both linear and non-linear fashion. If you get stuck, look away, take a shower, sleep on it, or perhaps try a glass of wine or a pint.

It’s good to have options. Now for a nap.

As always, take care.

Dr. B.

Summer and Sun

It’s summertime and I have sunshine on the brain (pretty hard not to at 111 degrees!)

Sunshine and thinking people have a “complicated relationship.” First, it is undeniably the giver of life. Without sunshine, Planet Earth would be close to absolute zero. Even the gases would be solid.

'Sun' photo (c) 2007, Jalal Hameed Bhatti - license: http://creativecommons.org/licenses/by-nd/2.0/There would be no life at all, unless crystal growth counts. Yet this life-giving radiation is a source of wrinkles, aging, and the occasional cancer. Icarus syndrome, perhaps.

A suntan is the most visible effect of time spent in the sun. The ability to suntan is, like so many other things in life, fundamentally unfair (blame it on your parents). Melanin is the stuff of suntans. It is pigment made by your skin cells in response to ultraviolet radiation. It protects your skin cells from genetic damage.

The amount of melanin you start with is hereditary. If your people hail from Ireland, you have so little melanin that you can sunburn just thinking about a sunny day. If your blood calls Persia home, beach volleyball is your friend.

Suntans have not always been popular. As recently as a couple of generations ago, a suntan was considered evidence of an outdoor career, i.e. farm labor.

People went to extremes to appear pale; not only avoiding sun exposure, but applying somewhat poisonous bleaching chemicals to their skin.

Fast forward to the ‘70s and suntans are back in fashion. The “California look;” all blond and suntanned, seizes the public consciousness. Rickets almost disappears; and unemployed doctors go into dermatology.

Sunblock was invented in response to all this healthy glow; our schizophrenic thing with sun again. And someone decided to dice up the ultraviolet spectrum, forever confusing even smart people. Truth in advertising, SPF reform, hasn’t caught up with the sunblock industry yet, although the FDA is threatening. Smear this on and take 20 years off your skin.

Sunshine is made of infrared, visible and a couple hundred wavelengths of ultraviolet radiation. Infrared keeps you warm and cozy, like a lizard on a sunny rock. Visible light makes things look good, avoids broken legs, and gives you an excuse to wear cool sunglasses. Ultraviolet radiation is the pesky part. It is higher energy radiation and can breakdown the DNA in your skin, which keeps dermatologists employed.

When we talk ultraviolet radiation (UV), we are mostly talking about UVB (280-320 nm). UVB is blocked by the ozone layer and sunblock (mostly). It will give you a bad sunburn, and perhaps worse – old, saggy, wrinkled skin, age spots or cancer.

But UVB also stimulates vitamin D production; which is a free radical scavenger with anti-cancer properties. It also stimulates melanin production, which is the ultimate sunblock.

UVA is the latest thing. It is a little higher frequency than B (UVA 320-400nm). It comes down on us all daylight hours in all seasons. It is not blocked by the ozone layer or by most sunblocks. UVA oxidizes melanin which darkens it, gives you some quick color, but no sunburn protection. Oxidized melanin doesn’t stop UV anything. You need more melanin, not just a different color of melanin. UVA doesn’t directly damage DNA – it creates free radicals, which may be worse.

There is a great deal of research being done on new sunblocks effective against both UVA and UVB. Living in the desert we have learned to live in peace with the sun. Sunblocks, shade, Gatorade and cool sunglasses are a part of our lives. I draw the line at funny little sun umbrellas, not until I’m much older.

As always, take care.

Dr. B

Smiling and the Grim Reaper

It seems your chosen world view has a lot do with how long you get to keep this view.

A curious little study out of Wayne State University looked at old pictures of baseball players and rated their smiles. They were sorted into groups with nonexistent smiles, a little smile, or a full 100-watt display of their pearly whites.

'Smile!' photo (c) 2006, eperales - license: http://creativecommons.org/licenses/by/2.0/Being scientists, they spent a lot of time looking these people up and finding out everything they could about their health, starting with making sure they were alive. Most of the well-known risk factors for early death, like obesity, hypertension and smoking, were standardized. That means they fiddled with the groups until they all looked alike for common risk factors, and only differed by smile factors.

So far this sounds scientifically reasonable.

And the researchers found good stuff, at least for the smilers. No smile got you an average of 73 years, a little smile 75 years, and a big smile 80 years. The average life expectancy for people born at this time was 78 years. So in effect, a frown robs you of five years of normal life, and a smile gives you two bonus years.

Now how much fun can the years 79 and 80 be anyway? This used to be my response when well-meaning people criticized my “Halloween Cigar”. Of course, you would have to ask a 79-year-old, but you could easily spend 2 years doing all the bad things you had to stop to get there.

This smile study was not an outlier. Some pretty good research has been done on attitude and health, attitude and marriage, and even attitude and cancer survival. People with good attitudes simply do better; it’s a scientific fact.

Interestingly, these pictures in the Wayne State study were posed, not candid shots.

Presumably someone said, “Smile for the camera” or “Say ‘cheese’” – or something like that. These young players picked “the look” they wanted to show the world. We don’t know if the smilers actually were people who smiled a lot, or were just better at following directions.

So the million dollar question is: do you get the bonus if you make yourself smile? Fake it until you make it? That’s what we all wonder when we read this kind of stuff.

That is a surprisingly hard question to answer. How might you make yourself a smiling person? Perhaps medicine has an answer; better living through pharmacology, smiles from Prozac.

There is precious little evidence that Prozac and its friends will statistically make you live longer. However, untreated depression dramatically shortens your life.

How about psychotherapy, a little head adjustment until you smile? Talking to someone often helps when you are feeling blue. There just isn’t good evidence that people utilizing psychotherapy live longer.

And this is not to pooh-pooh anti-depressants or psychotherapy because both are life-saving therapy for many people.

A lot of thinking has gone into the question of why that single photographic smile makes you live longer. That’s a difficult area to study with hard science. People have suggested that smilers have more friends, a better social support system, and better marriages. But smiling for a picture may just be a short-hand way of asking if someone’s basically OK.

The problem ultimately is a lot of us don’t consider ourselves smilers, but we’re otherwise pretty normal and getting along OK. We certainly don’t feel the acute need for Prozac or psychotherapy.

If asked, we would probably smile for a picture. So, who knows, that may get us the bonus years after all.

Take care.

Dr. B.

Staying Safe in Extreme Heat

When sustained heat waves hit a region, heat related injury and health ramifications can be serious, including sunstroke and even major organ damage due to heat.

'Sun' photo (c) 2007, Jalal Hameed Bhatti - license: http://creativecommons.org/licenses/by-nd/2.0/According to the Center for Disease Control, extreme heat is blamed for 700 deaths each year in the U.S. They tend to happen in small epidemics when we are confronted with heat waves as we are experiencing this time of year. Some experts predict this may be more commonplace due to overall global climate changes.

Heat exhaustion is a relatively common reaction to severe heat and includes symptoms such as dizziness, headache and fainting. If left untreated, it can progress to heat stroke. When severe, it requires medical attention. The severe form manifests when someone can no longer cool their body after profuse sweating, leading to dry skin, a body temperature above 103 degrees Fahrenheit, heat rash, muscle cramps, confusion and sometimes unconsciousness. Profoundly dangerous effects to the central nervous system and circulation can happen quickly when warning signs are ignored.

Humans cope with heat by expelling some heat through their breath and perspiring. The evaporation of moisture off the surface of our skin dissipates the internal heat. High humidity makes this very difficult because the cooling effect is seriously impaired. The published Heat Index estimates how it feels and how much the humidity can increase the effect of a given temperature, which can be 15 degrees or more when humidity is high.

Urban areas are known to be “islands of heat.” The vast amount of concrete and asphalt absorbs and radiates the heat to a great extent. The increased density of people and heat producing machinery put urban dwellers at much greater risk than their rural counterparts. This is particularly dangerous when a heat wave lasts more than two days. The nights do not cool down due to the stored heat and people do not get a break from the prolonged heat. More urban heat related deaths occur at night.

Who is affected most?

Elderly, the very young, people with chronic illness are most vulnerable. Some medications may make people more sensitive to the heat (diuretics, beta blockers, mental health meds) Discuss your concerns with your physician to see if any special precautions are recommended. But even healthy people who have to work or exercise in extreme heat are subject to dangerous effects.

The single most helpful thing you can do in extreme heat is spend several hours a day in air conditioning. If you do not have air conditioning, plan to spend time with someone who does. Many public buildings are available that have climate control such as libraries, schools, shopping malls, coffee shops. Fans do help with the evaporation/cooling process. They can also be more detrimental when simply blowing more hot air around. It can be comparable to a convection oven, magnifying the bad effects of the heat. During periods of extreme heat stay indoors and avoid direct sun. Slow down and avoid strenuous activities.

Even healthy, well-conditioned athletes are vulnerable to dangerous effects of heat.

What can you do?

If you have to work outside you need a plan — wear loose fitting, lightweight, light colored clothing. Use a wide brimmed hat to protect the head and face. Drink plenty of fluids. Water is the best. Alcohol and caffeinated beverages should be avoided as they can make things worse. Eat light food in smaller amounts but more often. Take frequent breaks to get out of the direct sun and catch up on fluids. Water consumption is top of the list. Two liters a day is a good start for a normal healthy person. In extreme heat the need goes up dramatically. Some sports drinks without caffeine can be suitable but should not be the sole source of fluid replacement.

With only a small bit of planning and common sense you can survive the heat wave comfortably and safely.

Dr. Bruce Kaler

Even the Lowly Appendix is There for a Reason

What are we doing with an appendix? Ever wondered that? I’ve taken out quite a few of them and often thought they were about the most useless organ in the human body. We considered them a biologic time bomb.

'DSC06003' photo (c) 2010, Andy G - license: http://creativecommons.org/licenses/by-sa/2.0/Given any other excuse to be in the abdomen – ulcer surgery, hysterectomy –doctors always took a little extra time and removed the appendix while we were there. We figured we were saving the patient an appendectomy in the future.

Most body parts have rather obvious use: the heart, the brain or left elbow.
But the lowly appendix seemed only good for teaching interns a surgical procedure.

But that might not be the whole story.

The appendix is a hollow tube about the size and shape of your little finger. It is attached to the base of the large intestine (colon) and is a pathway to nowhere. It is a short tube that just ends: think of a long skinny balloon before it’s blown up. The tube contains the same stuff that the colon holds, liquid feces. It adds about a teaspoon of capacity to your colon.

When an appendix gets in trouble it’s due to the tube getting plugged. A fecolith
(colorful term) lodges in the passage way and plugs the plumbing. Swelling starts because of the blockage and if the swelling gets bad enough the appendix will rupture. This ruptured appendix leaks puss and liquid feces into the peritoneal cavity.

The result is not surprising: massive infection. The usual course of appendicitis is initially losing your appetite, feeling sick, and having pain in your upper abdomen. The pain gradually moves to the right lower abdomen, near the belt line. From the onset of symptoms, an inflamed appendix rarely leaks before 24 hours. That means there is plenty of time to get some medical attention.

But the question remains: why in the world do we even have this thing?

Science has discovered mysterious immune-modifying cells in the appendix. These seem to serve a function in training our immune system. It is important for the body to get straight which germs to fight against and which ones to peacefully coexist.

Besides possibly having an immune system function, the lowly appendix turns out to be a well-built tubular structure handy for rebuilding internal body parts. Urinary tract reconstructions frequently make use of the appendix. So we stopped removing a normal appendix when we were there for another reason.

The whole treatment of acute appendicitis has been evolving. Traditionally there was one, and only one treatment for acute appendicitis – remove it. Recent studies show antibiotics work in treating the acute appendicitis, and work as well as surgery. It’s certainly a heck of a lot easier on the patient to use antibiotics.

Once again, the more you study the human body, the more you appreciate the design. We’ve learned that even something as lowly as the appendix is there for a reason.

As always, take care.

Dr. B

Best of Our Blog: Sun Poses Long-Term Dangers to Outdoor Workers

With the summer and its heat approaching, almost everyone will be out in the sun more than they were during the winter.

For 9 million Americans, being outside and in the sun is not just for summer fun – it’s a part of their job.

'sun grass' photo (c) 2010, David DeHetre - license: http://creativecommons.org/licenses/by/2.0/Workers in farming, landscaping, construction, recreation and even postal workers will spend hours in the sun – and consequently be exposed to potentially harmful levels of ultraviolet radiation.

Ultraviolet radiation, and specifically UVB, is the main environmental hazard to the outdoor worker. Most workers’ shifts include the peak intensity hours of UV exposure – 10 a.m. to 2 p.m. Since this type of radiation, UVB, easily penetrates clouds, it can reach worrisome levels even on days where little sun is visible. It easily passes through glass and can be reflected into areas of apparent shade.

UVB penetrates through the tough, dead outer layers of skin, into the replicating layers. It is there that it interacts with the living tissue, not entirely in a negative fashion – UV radiation on unprotected skin produces Vitamin D. Many believe, and there is some evidence to back it up, that there are anti-cancer properties in this potent antioxidant vitamin.

But radiation on living tissue also has a biologic cost. UVB radiation causes DNA damage and is officially listed as a carcinogen. This damage is cumulative. Ultraviolet radiation and skin cancer share a similar relationship to that of cigarette smoking and lung cancer. According to the Skin Cancer Foundation, those who work outside are twice as likely to contract skin cancer as indoor workers.

To protect workers from this hazard, we need to reduce the dose of UVB radiation.

The obvious solution for employers is to instruct workers to avoid sun exposure and seek shade when available. When possible, employers can rotate or stagger work shifts so that employees spend less time working during the sunniest parts of the day.

While the suggestion that people wear long-sleeve shirts during high temperature periods usually is greeted with derision, in fact there are a variety of new fabrics with high Sun Protection Factor values that are light weight, breathable and durable.

One of the oldest fabrics, cotton, has long been recognized for its skin protective value in the hottest climates. Cotton long-sleeved, loose-fitting shirts and pants, and broad-billed hats are some effective clothing options for outdoor workers. In dry climates, the fabric actually soaks up sweat and is an effective evaporative cooler.

Sunblock provides UV protection, but the level of protection is almost universally overestimated.

The most common error people make is using high Sun Protection Factor, sweat-proof sunblock and applying it only once. Sunblock generally loses effectiveness after about two hours due to sweating, the friction of clothing and deterioration due to sunshine. And too often, too little is applied. An ounce is recommended to get advertised protection. But remember, sunblock isn’t “liquid shade.”

These common sense protective measures can help safeguard you and your employees year round, but particularly during the summer months when, in most parts of the country, exposure to UVB radiation is highest. With awareness and a few simple steps, we can help workers avoid the short-term sting of a sunburn and the long-term consequences of too much sun exposure.

Dr. Donald Bucklin

Surgery vs. The Medicine Man

There is an eternal struggle in healthcare, that of the surgeon vs. the medicine man.

This is not obvious from outside the professions, but the evidence is all around us. The surgeon is a much more glamorous specialty; life and death sometimes literally rest in a surgeon’s hands. The surgeon is richly rewarded for sometimes heroic efforts, and is among the highest paid and most respected of any specialist.

'Medicine Cost' photo (c) 2011, Images Money - license: http://creativecommons.org/licenses/by/2.0/The medicine man (internist) spends time in the much less dramatic pursuit of disease prevention and cure through medications. This is a quiet and thoughtful profession, but much like the tortoise and hare, the medicine man is winning.

This struggle was highlighted last week by studies showing that antibiotic treatment is as safe and effective as surgery for acute appendicitis (and a whole lot less miserable for the patient).

That is the exact opposite to the training surgeons received for the last 50 years. We believed that antibiotics never cured an appendicitis, it just made it harder to diagnose, thus delaying surgical treatment until after it burst (peritonitis).

So we will see a lot less appendectomies in the future. Score: Medicine 1,
Surgery 0.

Thinking about life and death surgery, the cardiovascular (heart) surgeon has no equal.

But the triple bypass is steadily losing ground to prevention and alternative treatments. Medications like statins to reduce cholesterol and blood pressure medications are keeping the vast number of patients from even getting coronary artery disease. Even if you get coronary artery disease, the chances are that your treatment will be an angioplasty/stent rather that having your “chest cracked.”

There is a reason they call it chest cracking! That’s 2/0, in the Medicine Man’s favor – if you are keeping score.

Ulcer surgery used to be one of the most commonly performed operations. Then came the invention of Tagamet, a class of acid reducers light years ahead of antacids (acid neutralizers). Then came the proton pump inhibitors (Prilosec), which was the knockout blow that virtually eliminated ulcer surgery.

Cancer has always been first and foremost a surgical disease. What is more appealing than cutting the cancer out? These days, the answer is a lot of things. Prostate cancer was always treated with prostate removal, and a frequent complication was impotence.

Now oral medications like antiandrogens, or alternative treatments like radiation, have dramatically decreased the number of prostates we remove, and the number of people needing Viagra is also reduced.

Breast cancer was first treated with the big operation: radical mastectomy. This evolved into simple mastectomy, now lumpectomy, or even just needle biopsy. Medical treatment for breast cancer does a better and less traumatic job of curing many of these unfortunate problems for women.

In fact, just about pick your cancer, and the treatment has dramatically moved from surgical to medical in the last 30 years.

But never fear, orthopedics can be a safe haven for underemployed surgeons. A pill for a broken bone is still a while away. But I wouldn’t quite classify it with teleportation; we may come up with something.

Having trained in general surgery, and then practiced occupational medicine for the last 30 years, the sweep of change I’ve seen has been dramatic. Every year we find new magic pills that retire another scalpel.

Call me a wimp, but I’ll take my Lipitor and Tenormin; and eat walnuts if I want to hear a cracking sound.

Take care.

Dr. B.