Drug testing in the state of Colorado is playing a role in preventing drug abuse. This state like many others are plagued with drug related problems. This is especially true when it comes to workplace drug use. This state has not enacted any laws that require employers to perform this test.

The Colorado Supreme Court does, however support employers who feel the need for this testing. Throughout society the possibilities of drug use is overlooked. It is a real condition that needs to be dealt with. This abuse affects families and workplaces around the state of Colorado.

There are many facilities within the state that offer employers the service of drug testing. They perform hair follicle test and other formats for this process. The importance of this issue is paramount and eventually affects everyone. Here are 5 reasons that our society needs to focus on the prevention of drug abuse:

1 – Drug abuse can lead to death

Drug use typically stems from the chronic use of illicit or prescription drugs which can lead to death. Employers who hire companies for this testing also have a responsibility to keep employees safe. Colorado Drug Testing Centers service areas from Alamosa to Denver. They are equipped for hair follicle testing for employment. There are cases where this testing saved the life of the abuser.

2 – Drug abuse can lead to violence

One of the reasons that hair follicle testing for employment is important is the things it prevents. Many drug abusers have problems with violence. Fortunately for employers in the Aurora area there are 4 top centers to select from in this category.

3 – Drug abuse can lead to theft

Drug testing helps employers to avoid theft of their products. It is common for drug users to steal in order to support their habits. Hair follicle drug testing and urine testing are typical tests to detect drug use.

4 – Drug abuse taxes local hospitals

Handling the thousands of drug-related hospital visits in Colorado can be costly. This is one reason why focusing on this problem is important. Cities like Denver are overwhelmed financially with uninsured drug visits.

5 – Drug abuse can lead to traffic accidents

There are a number of accidents caused by drug abusers in Colorado. These accidents are responsible for taking the lives of many innocent victims. Numbers rise each year of these accidents of roadways.

By: Frank A Wall

The best lotion for extreme dry skin will be one that contains the highest concentration of active ingredients that are proven to be effective. There are products on the market today that contain cutting-edge compounds that have been shown to nourish and moisturize the skin, as well as reduce wrinkles and fine lines. It’s just a matter of finding the right ones.

Generally, dry skin is caused by a lack of lubrication resulting from clogged or damaged oil glands. The best lotion for dry skin will work to open the oil glands and replenish lost moisture. Skin damage can be caused by a variety of factors, including exposure to the elements, smoking, poor diet, and most commonly, exposure to the sun. If you are experiencing extreme dryness, it’s a good idea to consult your dermatologist as dry skin can sometimes be a symptom of underlying conditions such as diabetes and thyroid ailments.

If you do suffer from dry skin there are some easy steps you can take to help lessen damage. Avoid washing with tap water as most tap water is treated with chemicals which can affect the skin. Also avoid excessive washing, as washing actually removes essential oils along with dirt. And of course you’ll want to use a cream which contains essential oils, extracts and moisturizers, as this is the best lotion for extreme dry skin.

You will also want to avoid temperature extremes and stay out of overheated rooms as drastic changes in temperature can evaporate moisture on the skin. If you can avoid going out in the cold of winter or the heat of summer, you’ll be doing yourself a favor. You can also improve your skin condition by maintaining a healthy diet and being sure to drink enough water. Keeping your body properly fueled and hydrated is one of the main keys to maintaining softness. Even the best dry skin lotion will only be able to help so much if you aren’t watching what you eat and drink.

When it comes to treating dry skin, products which contain natural botanicals are usually the best solution. Ingredients such as grapeseed oil, babassu, maracuja and wakame are all soothing and healing and they are also rich in antioxidants which can help reduce inflammation, improve circulation and aid your overall health. The best lotion for extreme dry skin will contain these natural ingredients which replenish the body’s natural moisture and improve overall health and appearance.

As with any product, the more you can learn about the options available, the better off you’ll be. When it comes to choosing the best lotion for extreme dry skin, always read the manufacturers information carefully and determine exactly what ingredients are used in each product. And keep in mind your individual needs so that you can be sure the product you choose will address them fully.

By: Laura Sherman

Introduction: Like other aspects of health care, dental products containing fluoride have been around for so long that they are seldom questioned by health professionals. Over 35,000 articles have been published on various modalities and effects of fluoride, making fluoride well studied but often boring. It works; let’s move on is how dentistry and medicine largely view it. But, when the popular media, internet or patients raise questions, it might be good to have a short reference manual at hand. Several good resources are available and listed in the appendix, but here is a quick and dirty summary of fluoride when you need a quick fact. Just make sure you combine it with another controversial substance – Caffeine.

History: Fluoride has a colorful history that started in Colorado Springs in 1901. A young dentist, Dr. McKay, moved to town and found two things that alarmed him. One, everyone in Colorado Springs had brown mottled teeth. Second, almost no dental decay existed. At a time when dental decay was rampant back east, this indeed was a remarkable finding. He was able to attract the attention of a prominent dental researcher who then found other areas in the country where the condition was repeated. Soon the correlation between brown stains and lack of caries was established.

Later the cause of the staining was found to be high levels of fluoride in various water sources. The director of NIH at the time, Dr. Trendley Dean, then made the intuitive leap that fluoride at low enough levels may reduce decay rates but not produce unsightly brown staining. In a feat of epidemiological research, he found the junction that maximized caries prevention while minimizing fluorosis. Dean’s fluoride level of 1ppm was later tested in Grand Rapids Michigan in 1944. Eleven years later caries rates where shown to be reduced 60% with no significant side effects. The age of fluoridation was born. In 1964, Stanly Kubrick’s Dr. Stangelove made water fluoridation a communist plot. In 1967 Crest introduced fluoride toothpaste. The rest is history…

Mechanism of Action: Fluoride has two modes of action. When ingested, approximately 50% of fluoride is deposited into the teeth and bones, 50% is excreted. In bones, fluoride moves in and out as bones remodel. In teeth, fluoride incorporates into enamel and does not remodel once it is formed. As the tooth if formed and calcifies, fluoride is incorporated into the crystal structure of the enamel along the protein scaffolding laid down by specialized cells called ameleoblasts. At 1 ppm, fluoride does not interrupt the crystal formation of the tooth, but at levels above that some disruptions in crystal formation begin to occur. At 2ppm, visible disruptions in tooth structure can occur, and at 4ppm and above, ameleoblast cell alteration causes significant amounts of disrupted protein matrix.

The enamel structure warps, loses its translucence and may chip and picks up food stain. This condition, coined Fluorosis runs a spectrum of severity, but does not make the tooth more susceptible to decay. Fluoride only works systemically while the teeth are forming. Fluoride does not cross the placental barrier and is a trace element in breast milk, so rarely are primary teeth effected, Permanent teeth begin calcifying at birth for first molars, about 2 years for central incisors and about 4-6 years for second premolars. Introduction of systemic fluoride at various ages and at various amounts then accounts for the level of caries resistance and fluorosis seen in the adult dentition. Often ingestion of fluoride toothpaste during the toddler years affects the front permanent teeth esthetics. From the early studies out of Grand Rapids, it is obvious systemic fluoride plays a role in caries resistance. But in this day and age when water fluoridation is available to about 60% of the US and fluoride toothpaste is ubiquitous, considerable debate exists about how much systemic fluoride plays in modern day caries resistance.

The second mode of action is Topical. Topical fluoride describes the fluoride ion being present in the mouth and available to tooth surfaces. On the tooth surface a constant demineralization is occurring due to plaque acid and to a lesser extent acidic foods (which are usually well buffered by the saliva). In these areas, the negatively charged fluoride ion is attracted and serves as a catalyst to begin a remineralization of tooth structure with salivary calcium and phosphates. Enamel is formed of hydroxyapatite crystals, but in the presence of fluoride ion, the hydroxy ion is substituted and a fluoroapatite crystal is formed on the outer enamel. The fluoroapatite crystal is less soluble and more acid resistant, thereby becoming more caries resistant. The more often fluoride is present in the saliva, the more caries resistant teeth become. This is especially true of newly erupted teeth that have not yet reached full mineral content. These teeth are especially prone to decay, but benefit the most from topical fluoride.

Topical fluoride comes in many forms. Water fluoridated at 1ppm will increase salivary fluoride 100 to 1000 times and remain high for 1 -2 hours. The more water washing over the teeth the longer the balance is tipped to remineralization. The same action to an even greater salivary concentration occurs with regular use of toothpastes, mouthwashes or professionally applied fluorides. While higher dosed fluoride modalities will target and help to reverse hypomineralized tooth structure or “white spots,” frequency of exposure to fluoride will lessen caries rate most dramatically.

Fluoride varnish works on a microscopic level to form Calcium fluoride microcrystals visible as small globules on the surfaces of fluoride treated teeth. “This calcium fluoride may serve as a source of fluoride for the formation of fluoroapatite, and the latter phase is formed when pH drops in plaque, not during topical application.” (Rolla et al Adv Dent Res 1994) Since the amounts and size of calcium fluoride globules relates to pH, an acidulated fluoride gel applied for a short period of time likely produces the same reservoir of calcium fluoride as a varnish that sticks to teeth longer. Studies comparing the caries reduction of the two modalities show no clear superiority. Fluoride varnish that is induvudualy packaged, dispensed in metered dosages and applied on a three to six month basis may have advantages over a weekly fluoride rinse or professionally monitored, semi annual gel trays. The issue on modality delivery is nore likely a choice of convenience for the provider and compliance for the patient.

Lastly, Fluoride comes in different salt solutions so it can remain stable until solublized into the active fluoride ion in water or saliva. Neutral Sodium Fluoride is most common in toothpastes because it has long shelf life and can be easily flavored. Stannous Fluoride is less stable and more disagreeable in taste, but the Stannous or Tin ion has shown some trends towards reducing gum inflammation. Other compounds exist, but the active ingredient remains the fluoride ion.

Dosages: Like any nutrient or drug, fluoride has levels of effectiveness and toxicity. The National Academy of Sciences has set the adequate intake or AI of fluoride to be 0.05mg/kg/day. Based on 1ppm fluoridated water and minimal intake of fluoride from dental products, most children will approximate this AI based on caloric needs and fluid intake based on weight.

The Food and Nutrition Board of the Institute of Medicine has set an upper limit or UL of dietary fluoride for children. This UL is set to prevent moderate (cosmetically objectionable) fluorosis. The UL is essentially double the normal fluid intake for children. In extremes of diet where most of the caloric intake is coming from beverage manufactured with fluoridated water, fluorosis may occur.

Fluoride toxicity may occur at approximately 5mg/kg in a single dose for children. This intake, usually from eating toothpaste, results in stomach ache, vomiting, sweating and hypersalivation. Although the evidence is lacking, a lethal dose is around 32mg/ kg. At this dosage death would result by cardiac arrest in 2-4 hours. First aid would be to induce vomiting and give a binding agent for fluoride, milk in the home or activated carbon lavage in the hospital. A typical 4.3 oz child’s toothpaste contains about 132 mg of fluoride. If a year old child weighing 10kg ate the entire tube at a sitting (without somehow vomiting her guts out at half a tube), this would be less than half the potential fatal dose. The American Dental Association recommends no product that is bulk packaged (toothpaste, mouthwash) contain more than a total of 264mg of fluoride.

For Fluoride varnish, a single dose application contains 0.5mg. About half of that, 0.25mg, is recommended for children less than three years old.Fluoride Controversies: As long as fluoride has been used to prevent dental decay, groups have been protesting its use and assigning negative side effects. Many, but of course not all possible side effects have been studied. Below is a short synopsis of those findings.

Cancer- A well known antifluoride person, Yiamouyiannis, gained popularity claiming fluoride caused cancer in the 1970′s. Studies by Yiamouyiannis claimed fluoridated cities had higher cancer rates, and these widely advertised studies gained the ear of congress. Multiple more rigorous studies found severe flaws in the original study and no correlation of fluoride to cancer deaths. But, in 1990, four male rats died of bone cancer in an NTP study after ingesting 79ppm F water. The study authors concluded “equivocal evidence” linking high fluoride to bone cancer. This ignited a fire storm until the study was repeated with no recurrence of that cancer rates. A special committee appointed by the US Public Health Service later reached agreement that all available human and rat studies showed no detectable cancer risk from fluoride intake.

Bone Fracture or Osteoporosis – Widely circulated images of Indian adults with crippling skeletal fluorosis led to the much publicized view that dental fluorosis was an early indicator for skeletal fluorosis causing bone fractures and osteoporosis. In some parts of India and other areas, unregulated water containing fluoride in excess of 25 ppm does cause bone fragility, this condition is unknown in the US. A town in Texas reported a water fluoride content of 10 ppm water fluoride, but bone scans of lifelong residents showed only the barest increase in bone density. In fact, elderly people where prescribed 30-60mg of fluoride per day to increase bone density in the 1970′s. Fluoride did increase bone density but did not prevent bone fractures. Extensive reviews of the literature show in fact no clear evidence to say fluoride exposure through water and other sources either causes or prevents hip fractures. If there is an effect one way or the other it is too small to be detected in the 14 epidemiologic studies to date.

Thyroid Function, Kidney Function, Autism, Down Syndrome, child development – At various times in our history, claims have been made to suggest exposure to fluoride caused various maladies. No review of the literature suggests any such cause and several studies specifically looking for links have found no evidence to indicate fluoride as a toxin related to any disease. Many books or non peer reviewed articles in circulation dating back the 1950′s claim other wise. Such references may contain evidence from anti fluoride proponents including: The Natick Study 1997, Thyroid Power harperesource 2001, Drs. Richard and Karilee Shames, Dr. R.D. Masters and M. Coplan, Dr. Hardy Limeback.

Professional Topical Fluoride Applications – Clinical Efficacy and Mechanism of Action. B Ogaard, L Seppa, G Rolla. Advances in Dental Research 8(2): 190-201. July 1994.

Dentistry,Dental Practice and the Community 6th Ed. Brain Burt and Stephan Eklund. Elsevier Sanders. St. Louis. 2005

Fluoride Technical Study Group report 1/10/2003. Fort Collins. Archived with the City of Fort Collins Utilities.

By: Dr. Greg Evans

People sometimes take the drastic decision that of listing and selling their houses. What compels them to list and sell their homes?

“Should I list and sell my home?” – is a question many people face. Not often, but when the situation does come, some drastic steps have to be taken and some tough decisions to be made. I once moved out to a different city and had to decide whether to list and sell my home. In fact more than once, I had to list and sell my home because, well, I found better deals and for many other reasons that are presented here. And I can understand the reason people get cold feet. Taking such a drastic step is no child’s play. But when I had to list and sell my house, I made a list of reasons, actually wrote them down, and I’ll share some of those reasons here with you today. This will help you make a decision.

A change in lifestyle – I was in a good enough position to quit my job and pursue my passion of writing, but the noisy neighborhood full of young couples and their kids wasn’t conducive to the functioning of a creative mind. So I decided to list and sell my home and move to a quieter locality. And this had one more advantage – I got a bigger house. You can get a bigger house too if you search long enough. It was more expensive but bigger, so big that it was in fact cheaper by area. One more reason people move is due to financial crisis. If you are finding it hard to make ends meet, then you should perhaps consider moving to a two bedroom house instead of four. I would list and sell my home if that meant a significant financial shot in the arm.

This can also happen when kids move out and the parents now find the house to be ‘overkill’ – too big to clean up and look after. Relationships are another common reason why people list and sell my house. Another common reason is health-related issues – proximity to a hospital, better and cleaner neighborhoods, and proximity to a health and fitness club or any other reason.

By: Luis Pezzini

There have been two recent different studies on nutrient powerhouse vitamin D, and more importantly what it means if you’re body is low in vitamin D.

One involves supplements and bone health for older people; the other sounds a warning about our rapidly dropping levels of this vital nutrient. Both are worthy of attention.

Over the course of the last 20 years our vitamin D levels have decreased dramatically.

A lack of this vital nutrient has been associated with the sudden increase in childhood cases of rickets.

In adults lack of vitamin D has been linked to lower bone mineral density, as well as tied in recent research to cancer, heart disease, infection and poor overall health.

The estimates by a team from the University of Colorado Denver School of Medicine suggest three out of every four Americans has vitamin D levels below what is believed necessary for optimal health.

We need vitamin D as it helps the body absorb calcium. Bone cells actually have vitamin D receptors. Bone density is higher, and fractures lower in patients who get enough vitamin D.

The most natural source of this fat soluble nutrient is exposure to ten minutes of sunlight during the less intense (avoid the 10 am to 2 pm peak time) hours of the day, two to three times each week.

However, as we’re often covered in sunscreen (shown in research to block vitamin D synthesis), spending more time indoors or avoiding the sun altogether, getting this nutrient from the sun isn’t as easy as you think.

What’s more, for those of us who are living at latitudes of 52 degrees north deal with winters where the ultraviolet light isn’t of the right wavelength to make vitamin D at all.

No matter what your age, if you’re overweight or obese, you’re also less able to make this nutrient from sun exposure, and as we age, our skin is less able to absorb vitamin D from the sun, so older people depend more on food sources (or supplements) for this key nutrient.

Which brings us to the Swiss research review, also published in the same Archives of Internal Medicine.

This work pooled data from 12 different trials involving over 42,000 subjects and found that fractures that didn’t involve the spine were 20% less likely and hip fractures 18% less likely in those over 65 who were taking supplements from 482-770 international units (IU) per day of vitamin D.

The risk was reduced most at the higher doses, though adding calcium supplements didn’t seem to have any added protective effect against fractures.

The current Institute of Medicine recommended intake of vitamin D is 400 IU a day for those aged 51-70, and 600 IU per day for anyone over 71 – though these levels are currently (and rightfully according to many experts) under review, with new recommendations due by May 2010.

The upper limit for vitamin D, according to the IOM’s current standards is 2,000 IUs a day.

There are many experts who suggest both children and adults get at least 1,000 IU of vitamin D per day, though you should speak with your own doctor before you make any changes to your diet or start taking any supplement.

Eating a diet with the right amount of vitamin D isn’t the easiest thing to do, which is an other reason so many are low in vitamin D, but you can make a conscious effort to add more vitamin D rich foods to your meals (like Salmon, Shrimp, Cow’s milk, Cod and Eggs) and this will certainly help.

By: Kirsten Whittaker

Many people in Denver aren’t really sure what body waxing is. They hear the words Body and Waxing and the only thing that comes to mind is a Brazilian wax because they’ve heard it discussed so many time in the movies or in the celebrity gossip columns. But there’s a lot more to body waxing than that one small area so I thought I’d explain some of the other ways that waxing is used for hair removal so you can maybe understand it’s benefits a little better.

Women typically use waxing as a way to remove hair from eyebrows, the hairline, their lips or chin, their underarms, legs, feet and toes. Waxing is a much better method of hair removal because it removes the hair clear down to the follicle and leaves your skin hair free for a much longer period of time than simply shaving or plucking. Shaving can also irritate your skin but waxing leaves your skin feeling soft and smooth as a baby’s bottom.

More and more men are also opting to use waxing to remove body hair and they use it in the same areas as women but they’re also interested in removing arm, back, and chest hair. A lot of athletes prefer to remove body hair before competitions and then there are other men who just prefer their appearance better without all of that body hair.

For both men and women, when you shave the hair from you body it grows back quickly and it’s usually very dark and coarse. This is because you’re cutting it off bluntly in the middle. But when you wax, you actually pull the follicle out from the root so that when the new hair does start to grow back it’s tapered on the end which makes it much softer and finer. So each time you wax, the hair grows back a little lighter and finer.

So you see, waxing isn’t just for that one area of the body, although Brazilian and Hollywood waxes are certainly the trend these days. But for anyone who is looking for a longer lasting method of hair removal, that won’t irritate the skin the way shaving and depilatories do, then waxing is the best, least expensive solution. Which is why more and more people in Denver are throwing away those razors and scheduling appointments for body waxing.

By: Elle Wood

If you get a nail fungus, it is just tough to get rid of. Medication really doesn’t penetrate the toenail and a lot of times you end up spreading it to your other toes. When you cut your toenails, either cut the one with the fungus last or wash the clippers in alcohol between cutting each of the toenails to clean off any fungus. See, if you cut a toenail with fungus on it, the fungus can get stuck on the clippers. Then when you go to cut another toenail, you get the fungus on another toe. So don’t do that, that’s rule #1. You also don’t want to clean the dirt out from under the nails because there is a good possibility of cross contamination, just like with the clippers. If you do that, clean whatever you are using with alcohol.

Fungus looks like a discoloring or a thickening of the nail. There normally isn’t any pain involved but it just looks ugly. If it gets too bad, the nail could fall off because the fungus sort of detaches it from the nail bed.

Going to the podiatrist, the doctor may try to cut the nail short enough to get rid of the fungus, just kind of dig it out. There are a few commercially available antifungals that can be prescribed but, really, they just don’t work all that well. I’ve made some compounds with iodine, terbinafine, an antifungal tablet, and DMSO. Honestly, I haven’t seen any prescription product work really well, or any over the counter antifungals either.

I’ve recommended this treatment a couple times since reading about it on the internet. My customers, the ones who followed it, say that it works. So what you need to do is go to the grocery store and buy a couple bags of Epsom salts, toenail clippers, and a nail file. Cut the infected nail as short as possible and then file it down, on the top of the nail, making it thin over the fungus. Make sure you don’t go too deep when you file, if you do, it hurts.

A minimum of once a day, two is better, and three is even better, soak your toes in hot water with a good amount of Epsom salts, maybe ? cup or something in a shallow pan. The water needs to be as hot as you can tolerate. Soak them for at least 20 minutes, 30 is better. So, try for three times a day for 30 minutes in hot water. To make it even better, just pour that Epsom salt right on the toenail. Get as much touching that infected toe as possible, bury it if you have to.

If you sit at a desk all day or do something where you can just soak your feet all day, that’s fine. Keep them in the water as often as possible and just keep heating the water in the microwave or adding hot water. Try putting a towel under one end of the pan so that the water is deeper towards the toes and your heal is out of the water. It’s not necessary to do this but soaking the heal of your foot for a long time will have the tendency to soften the skin of your heal and that could cause pain when you walk, you want your heal to be tough.

When doing this treatment, you want to keep your feet out of shoes and socks as much as possible. The fungus grows in a warm, moist environment so avoid that situation. Wear sandals as much as you can and keep your toes dry between treatments. Try to keep your feet out of shoes, put them on at the last minute before work, take them off at lunch, take them off while driving, things like that until the fungus is gone.

After you are done soaking, you don’t have to throw away the water with the Epsom salts in it. You can use the same water for a few days, maybe even a week. Just add some water as it evaporates.

You also want to file that nail down just about every day. You want there to be as little room or as thin a nail possible between the water and the fungus. That just makes it easier for the Epsom salts to do their work. So file, cut, file, cut, keep it short and thin.

I’m not going to tell you that this is going to take care of the fungus overnight, or even in a week. This is a tough one, this nail fungus. It can take over a month for this to work. Another thing that you may want to try is putting Vicks Vapor rub on your toes in the morning after your soak and before bed. Some people say that the Vicks prevents the fungus from growing but I don’t really have any proof either way on that one.

By: West Conner

Stress and anxiety solutions are needed now! A good friend of mine is often heard saying that life in the new millennium is often lived “Mach V with your hair on fire.” He has a view of American culture like no other — he spent the better part of the last 2 decades as a missionary in India. Coming home on furlough was always a bit of “culture shock” for he and his family (just as going to India was culture shock for me and my family!) It’s good to be busy, to live with purpose, and to accomplish something bigger than yourself. Hard work and a life’s calling are blessings, albeit sometimes “in disguise.” But life is accelerating and we need to recognize our limits and carve out time to rejuvenate and nourish ourselves with what is most important. If we don’t, we’ll flame out. We’ll buckle under the stress. And our health will suffer the consequences.

KNOW YOUR LIMITS

A life principle I’m learning is illustrated by the recently departed King of Pop, Michael Jackson. The principle is this: Know when to stop. (I’m not trying to be cute here.) Michael was a good-looking young man before he invited a few too many cosmetic surgeries. My humble opinion is that he should have stayed the hand of the plastic surgeon early on. Many folks agree that his appearance would have improved had he known when to stop!

PROFUSION AND TECHNOLOGY

I grew up hating to have to dry the dishes. But there was no such thing as dishwashers then; it had to be done. And actually, with the right attitude, drying the dishes afforded our family the opportunity for discussion and relationship. A modern convenience, the dishwasher, has taken that away. Same goes for T.V. “then and now.” We ate dinner around the table, T.V. off. My Mom reminded my brother and I to take time to chew our food rather than inhale it. We did the best we could, but we were boys. Now, it’s more common to see everybody on the couch facing the same direction watching the tube. Or if we’re at the table, shouldn’t cell phones and texting be disallowed? Isn’t something important being lost here? Does anybody else feel impoverished by the piracy of time perpetrated by the advent of email?

In 1970 we had about 8,000 choices at the grocery store. Now we are inundated by 90,000 choices at a SuperTarget. When confronted with such massive abundance, how much time is needed to decide what we DON’T want? When are the limits for packing more and more busyness (and stuff) into less and less time (and space) going to be taken seriously by a culture addicted to “more” and “New”? The dishwasher was a good idea, but it deliver on its promise to give us more time for ourselves; it merely freed up time for us to choose to be busier elsewhere. So I’m thinking it’s not the dishwasher’s fault.

ADRENALINE AND STRESS

The point of this discussion is that life lived “Mach V with our hair on fire” pummels our adrenal glands. From atop of our kidneys, these little powerhouses crank out “adrenaline.” Living “Mach V” puts these glands in the pressure cooker. Most people I know (patients and friends — adrenal glands owners all) have adrenals that are under attack and over-taxed. And, of course, I am no exception. In fact, I may be the poster child! In our culture “being busy” is a badge of honor. Unfortunately, I’ve worn this badge since I started a 4:30 am paper route in sixth grade. And somehow I never got off the treadmill.

Let’s take a look at the adrenal glands and their functions: The adrenal cortex (the outer layer of adrenal tissue) synthesizes corticosteroid hormones from cholesterol made in the liver. Cortisol, one of these hormones, is released from the adrenal glands in direct response to stress. The adrenal medulla (the inner portion of the adrenal gland,) makes adrenaline (epinephrine), which is also part of the acute stress response (also known as the fright-fight-or-flight response).

There are some by-products of cortisol metabolism that have a sedative effect. These by-products may contribute to an overall feeling of depression. If the fight-or-flight response continues to be stimulated day after day and never shuts off, the continuous release and breakdown of cortisol may contribute to persistent and severe depression, as well as feelings of anxiety, helplessness and impending doom. Such stress-induced depression often results in sleep disturbances, loss of sex drive and loss of appetite. It may also increase susceptibility to certain personality or behavioral disorders.

Studies show that chronic activation of stress hormones may alter the operation and structure of brain cells that are critical for memory formation and function.

The effects of stress are widespread throughout the body. When stress produces ongoing symptoms in one or more organs that are predominately under the control of the autonomic (vegetative) nervous system, the condition is referred to as “autonomic (vegetative) dystonia.” Fundamentally, this disorder represents the inseparable connection between the mind and the emotions.

A SUMMARY SO FAR — A CHECKLIST OF SYMPTOMS STRESS (AND STRESS ALONE!) CAN CAUSE: headache, chest pain, pounding heartbeat, high blood pressure, shortness of breath, muscle aches, back pain, clenched jaws, tooth grinding, stomach upset, constipation, diarrhea, increased sweating, tiredness, sleep problems, weight gain or loss, decreased libido (sex drive), menstrual spotting, and skin breakouts. On the emotional side, chronic adrenal overactivity is proven to correlate with persistent and severe depression, anxiety, a morbid bend toward negative thinking, and a sense of helplessness and impending doom. People may overeat, under-eat, abuse drugs, drink alcohol excessively, experience relational problems and anger outbursts, or withdraw socially.

SOME ANSWERS FOR STRESS FROM “THE POSTER CHILD” — ME!

During most decades since junior high, I had no need for an alarm clock. My guts would wake me up. “Driven,” I think they call it. “Highly productive” is a kinder euphemism. I’ve done some wonderful things, to be sure, but one cannot continue at 140% capacity for a lifetime! This is why I now listen to classical music almost exclusively, eliminate (most but not quite all) caffeine from my diet, and use magnetic resonance stimulation on a daily basis, often with the SLRS system to “massage my brain” while my body’s cells are charging up. With magnetic resonance stimulation normal autonomic tone is restored. That means there is balance between my “fight or flight” nervous system and my “rest and digest” nervous system. It’s truly an “anti-stress” and “anti-anxiety” machine. I can virtually guarantee I’ll sleep deeply and restoratively and improve my body’s ability to drink in the oxygen it needs every single day!

Choose now to take care of yourself. Know your limits. Know when to stop and rest, and give yourself permission to do so.

Important Note — Read This!

Obviously if you are experiencing any of these symptoms it would be dangerous to simply “chalk them up” to stress.

You need to see a competent, licensed health care provider to make sure that any serious or life-threatening conditions are ruled out. The information contained in this article is for informational purposes only and is not intended to diagnose, treat, cure or prevent any disease or illness. This information is not a substitute for competent medical or chiropractic care.

By: Dr. Joel Carmichael

Income Trust

For a Medicaid recipient, Colorado imposes a cap on gross income for purposes of Medicaid eligibility. This amount of this cap changes each year. For 2010, the income cap is $2,022 per month in total gross income.

For purposes of income calculations, only the applicant’s income is counted, not the spouse’s income.

For applicants whose income exceeds the cap, an income trust is required. The income trust is a form developed by the State which requires an applicant’s income to be placed into the trust each month.

Then, the only permissible withdrawals from the trust each month are the Medicaid recipient’s patient payment to the care facility, the spouse’s monthly income allowance, if any, and the recipient’s personal needs allowance of $50.00 per month.

$20 per month is permitted to be retained in the trust each month to cover bank charges. Any accumulation in the trust must remain in the trust and be paid over to the State after the recipient’s death.

We have seen cases where the State has requested payment of the trust account balance prior to the recipient’s death, either in periodic lump sums or by regular payments. The trustee will also have to provide an accounting of the trust administration. Anyone can act as trustee. However, no trustee fees are permitted to be paid from the trust.

As with all trusts, the income trust must be submitted to the State for approval. If the applicant’s gross income exceeds an upper limit, the income trust is not effective and the applicant is not eligible for Medicaid at all.
2010 income trust limits are:

REGION COUNTIES MAXIMUM

I Adams, Arapahoe, Boulder, Broomfield, Denver, Jefferson – $6909

II Cheyenne, Clear Creek, Douglas, Elbert, Gilpin, Grand, Jackson, Kit Carson, Larimer, Logan, Morgan, Park, Phillips, Sedgwick, Summit, Washington, Weld, Yuma – $6267

III Alamosa, Baca, Bent, Chaffee, Conejos, Costilla, Crowley, Custer, El Paso, Fremont, Huerfano, Kiowa, Lake, Las Animas, Lincoln, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache, Teller – $5762

IV Archuleta, Delta, Dolores, Eagle, Garfield, Gunnison, Hinsdale, La Plata, Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Routt, San Juan, San Miguel – $6130

MISCELLANEOUS FORMS.
The counties are also required to provide notice to all applicants of the Estate Recovery Program. The notice requires a signature by the applicant acknowledging receipt of the notice.

The counties also typically require releases and health insurance forms.

Next: The Functional Assessment

By: Linda J Moon

One of the most important differences between an organization that is achieving great benefits from their process improvement efforts and an organization with so-so results is the level of employee engagement. In a truly Lean organization, everyone understands that it is not enough to simply do your job well, and that everyone is expected to participate in the improvement work in every process. This article documents this type of effort in a hospital OR department with an informal program they called Fix-it Friday.

A core concept in Lean Thinking is that of a Value Stream, and the technique of Value Stream Mapping is typically one of the first steps in launching a Lean effort. In order to measure the maturity of a value stream, we’ve developed the Value Stream Maturity Scale. This pyramid suggests that a value stream matures as it progresses though different levels.

The levels, leading to sustained performance, are:

Level 1: The Value Stream is identified and ownership is assigned. Think of a typical value stream in a hospital, Medication Management. It starts at the time when the MD places the order and ends when the meds are administered to the patient. All the processes in between those two points make up the value stream.

Level 2: Flow. The value (the med) progresses from process to process in an uninterrupted fashion. Achieving flow is not a one-time event, but a progression through a series of improvement iterations.

Level 3: Standardization. The processes within the value stream are standardized to the level of work instructions. Not all processes can be standardized in a clinical setting, but those that can be standardized must be.

Level 4: Engagement. This is the Holy Grail of Lean. Staff members participate in the identification of waste and engage in projects to seek the elimination of wasteful activities.

Just think of the power of every staff member in the OR focusing on eliminating waste. Here are several examples:

During a project to redesign a Sterile Processing Department, the entire team was coming at 6:00 a.m. every day, for a week, to bring live the area after the design was finished. On Wednesday, we all arrived to realize that the OR started late on Wednesdays, so we had nothing to do for three hours. Within 5 minutes, a team member said “Hey guys, why wait for instruments? Couldn’t we do some of the 7S stuff we learned about in class?” BINGO! We split into three teams of 2 or 3 team members to work on different areas. By the time the first set arrived from the OT the team had completed three separate 7S projects, with the following results:

• We found two surgeon’s stools that were scheduled to be re-purchased,

• We identified and re-located approximately $5,000 in “orphan” instruments that were stashed in a drawer to be dealt with at a later date. Nobody knew how long they had been there.

• We reorganized the unload area for the cart wash, saving ~1 minute per case cart.

Those are just the highlights. The real value was the sense of accomplishment that followed those mini-projects. This team became unstoppable after that.

Another person who took this idea of engagement to heart was Beth. Beth was the Manager for the Cardiovascular Services Department for a large city hospital.Fridays were usually very slow days for her department. Being an outstanding cook, she organized social lunches on Fridays for all her staff. After working with us for a few months, she realized that Fridays could be a great opportunity for something more than social time. She still provided lunch, but s Beth re-branded the day “Fix-it Friday”.

Fix-it Friday meant to get together as a team, enjoy lunch, and then take one topic from the list of continuous improvement suggestions to fix it right then and there. The results were nothing short of remarkable. Beth was so successful that she was asked to tackle a very sore spot at the hospital: their overly-long Door-to-Balloon time. Under Beth’s leadership, they reduced Door-to-Balloon time by more than 60%.

There is no magic in the cases above. There is engagement. There is respect for staff and their ideas. There is leadership in finding the time to do continuous improvement.

It is not that difficult. Go ahead, give it a try.

By: Gerard Leone