Centered on Health 7-17-25 - Occupational medicine What does it encompass with John Dougherty

Centered on Health 7-17-25 - Occupational medicine: What does it encompass with John Dougherty, PA-C.

Episode Transcript

Speaker 1 (00:01):
It's now time for Centered on Health with Baptis' Help
on use Radio.

Speaker 2 (00:06):
Wait forty WYJAS. Now here's doctor Jeff Tubble.

Speaker 1 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptist Help Here on news radio eight
forty WAJS. I'm your host, doctor Jeff Tublin, and we're
joined from the studio by our producer, mister Jim Benn.
He's awaiting your calls this evening to talk to our guests.
Our phone number if you want to call in and
join the show is five oh two, five seven one

(00:33):
eight four eighty four. That's five oh two, five seven
one eight four eight four. In twenty twenty one, large
trucks were involved in five nine hundred and four fatal crashes,
which was up eighteen percent from twenty twenty three. And
these occur a lot of times on rural or interstate
highways and many many of these involved injuries or deaths

(00:55):
to people in the other vehicle. And the safety of
this is overseen in part by our occupational medicine providers.
So we're lucky tonight to have John Doherty, who has
been on our show before. But we're very fortunate in
addition that he has come out of his semi retirement
to fill us with all of his knowledge about occupational medicine.

(01:16):
John received his BS and Personnel supervision at IU Southeast
and his BA and PA degrees at the University of Kentucky. John,
Welcome to Centered on Health.

Speaker 2 (01:27):
Thanks Jef. Great to hear from you again. I always
enjoy our time, our discussions. And how are you doing
this evening.

Speaker 1 (01:34):
I'm doing great, Thank you, And like I said, we
really appreciate you taking the time out of this busy
time for you to join us and to talk about this.
This actually very interesting topic. So I know that we're
going to focus on this in a little bit, but
just for our listeners who might decide to call in
or have a question, can you remind our audience what

(01:56):
the field of occupational medicine is.

Speaker 2 (02:00):
Well, Jeff. Occupational medicine is a very all encompassing field
and medicine in that we deal with all aspects of
worker safety, but primarily the medical care for people who
are injured or who develop illnesses acutely during their shift

(02:22):
when they're working, or from chronic hazards that they're exposed
to over a lifetime. In certain careers. We do that
through bout this houth that several clinics statewide in the
state of Kentucky as well as one in southern Indiana
at the River Ridge Clinic that's between Jeffersonville, Indiana and Charlestown, Indiana.

(02:45):
But we cover all kinds of things that you would
see in an urgent care, such as trauma, lacerations, broken bones, sprays, strains,
eye injuries, all kinds of different injuries, many of which
happen at home often and people will go to their
primary care doctor to an urgent care. But where it

(03:08):
becomes different is when it occurs at work because it
involves all kinds of other factors such as workers comp
insurance versus private pay and personal insurance. And also it
deals with one aspect that's unique to occupational medicine is
that the medical provider has to make some decision as

(03:29):
whether that worker is safe to return back to work
after an injury, or if they need to be off,
or if they need immediate specialists referral in cases of
a major fracture or head injury, things like that, or
if they need diagnostic testing. So that's we're kind of
a nickname it where the urgent care but for work

(03:50):
related injuries. So that's the main focus of occupational medicine itself.
But the reason why I was glad to I was
asked to be on the show this evening is one
of the things I've never spoken about in my other
discussions on the show has been commercial driver health and safety,

(04:11):
And believe it or not, one of the primary services
our clinics offer to the community is the medical certification
of either commercial drivers who are required by their various
states and under federal and all a carry what's called
a commercial driver's license, or for individuals who just work
for a living and they utilize either a vehicle that

(04:35):
falls under the Department of Transportation standards either by weight
or size, or whether they tow something like equipment have
the equipment hoing and so that individual driver may not
need a commercial license, but he would still need to
meet the same medical requirements that a holder of a
commercial driver's license does. And that's one of the primary

(04:57):
services we provide throughout all of our clin and it's
in the state of Kentucky and in southern Indiana. So
that's kind of why, especially in the summer and as
you brought out the number of fatality accidents, and not
all of those involved a driver who became suddenly impaired,
but they're obiviously our cases, and that's what we're trying

(05:19):
to prevent by having driver safety and performing the medical examinations.

Speaker 1 (05:26):
You know, it's so fascinating what you're saying because of
a couple of reasons. One is, this is just one
aspect of what occupational medicine covers, which is clearly by
the things you mentioned, so so VASc And I just
want to remind our listeners that you've been on the
show before and if they look on the iHeartRadio app
for Centered on Health, there are shows where you've talked

(05:48):
about getting back to work after an injury and how
important those things are. So I encourage people to listen
to that. And then I found it with this topic
when I was looking. You know, Kentucky employed twenty eight
thousand heavy and heavy truck and tractor trailer drivers, which
puts us second in employee employment nationally of truck drivers.

(06:08):
So do you see this as a big problem for
us here in Kentucky.

Speaker 2 (06:15):
Well, the problem certainly exists in drivers who don't respect
the need to maintain their health. Because what I tell
anyone who comes into my clinic, whether it's for their
first time driver exam or if it's many of them
come in, UH, for they have to have the medical

(06:37):
exam before they even start their training. If they're going
to go to driving school to learn to drive commercial vehicles,
the process starts with a medical examination and so they
have to answer comprehensive medical history questions and then for
someone like me or one of our other medical providers
to review that medical history. Uh. And it's federal form.

(07:01):
So some people might come in and think, wow, I'll
check note everything and not really write down all of
their history or any medical conditions or medications that they're on.
But if they read the fine print on the form,
if they withhold information or if they deceive the examiner,
if they could lose the right to drive permanently for
the rest of their lives as far as commercially. And

(07:23):
also they can do jail time and be fined by
money for large expective as you know, with federal violating
federal laws. So thankfully that's something in my career. I've
been doing this for twenty seven years. As far as
occupational medicine, twenty five of that in occupational medicine, but
twenty seven years as a physician assistant. But thankfully, there's

(07:45):
only probably not even a tenth of one percent of
people who have had to deal with in the past
who take that route. But conversely, people who are entering
the field may not know or understand the importance of this.
And I've been doing the process of doing these medical
exams for commercial drivers and otherwise has existed for over

(08:09):
two decades. However, the federal government, the Department of Transportation,
started an initiative in the late two thousand for twenty
ten and later to standardize the exam and also standardize
who could do these exams, and then have a standardized

(08:31):
educational class or program that all examiners would be required
by law to take, and then they'd have to maintain
that education and the ability to do the exam. Many
drivers historically used to just go to their family doctor
if they were there for the sniffles or something, or
for their annual checkup, and say, hey, doc, can you

(08:51):
fill out this form for me because I'm a truck driver.
And many of them would do it, and that's fine,
and many of them probably took it, hopefully took it
here and reviewed all the pertinent information. But in twenty fourteen,
it became a mandate by the Department of Transportation and
the Federal Motor Carrier Safety Administration that only certain types

(09:13):
of medical professionals could do exams, and that they would
be required to take a class and then take a
national standardized test, and then they'd have to review that
every five years, and then after ten years would have
to retake the exam. So since twenty fourteen, I've had
the review and had to retake since the exam the

(09:33):
second time just a few years ago. So and it's
very comprehensive and kind of stressful because if that's what
you do for a living, and if you don't pass
the test, then you can no longer do those exams.
But that's where the federal government, at least during that
time period, the Federal Motor Carrier Safety Administration, which regulates

(09:57):
commercial driving of all aspects of it's from higher pressure
to hauling the weights that can be hauled, but especially
the medical aspects of it. Twenty fourteen, it became very
serious that and we saw that as an opportunity to
increase the safety of our roads, and as you've noted,

(10:18):
there's been many fatalities in twenty twenty one and also
over one hundred and fifty thousand accidents motor vehicle accidents
a year that involve a commercial driver may not be
the driver's fault, and it may not be due to
a medical reason. The nice thing is is that since
then we've gradually seen a decrease in these instances, So

(10:41):
even though it's still a vast occurrence, those numbers are dropping.
So part of that is, I hope it's based on
what we're doing in the medical side of it, to
have dedicated examiners who maintain their education and their knowledge
base and are take it seriously when they do an

(11:02):
exam to certify their perspective driver.

Speaker 1 (11:06):
Well, we're gonna we are sure you are doing that excellent,
and we're going to hear about how you do that
with these employees, and we're going to take a short break.
I want to let everybody know you're listening to Senate
on Health with Baptist Health here on News Radio eight
forty whas. Our phone number is five oh two, five
seven one, eight four eighty four. If you want to
call in and join the conversation. We're talking with John

(11:27):
Doherty about occupational medicine. We'll be right back. Welcome back
to Send It on Health with Baptist Help here on

(11:48):
news radio eight forty whas. I'm your host, doctor Jeff Tublin,
and we're talking with John Doherty tonight about occupational medicine.
Our phone number is five oh two five seven one,
eight four eight for our producer, mister Jim Finni is
on the phone ready to take your calls. So, John Rich,
before we went to the break, you were talking about
the medical exam, and just can you give us a

(12:11):
general sense of is this like a typical once over
that you would get like a once a year visited
a primary care physician or the components differently, And where
do the standards come from of what conditions are acceptable?
Because we all have medical things, what conditions are acceptable
and what or not? Who makes that decision?

Speaker 2 (12:32):
A good question, Jeff, and I'm glad this is a
good point of the discussion to talk about what we
actually do the exam from the point when someone comes
in and says, hey, I need to have a driver
medical exam. Many people just nickname it the dot exam,
which obviously dot's Department Transportation, but it's more it's the
National Register of Certified Medical Examiners. Certified medical examination is

(12:57):
the formal term, but when someone comes to one of
our offices, as I mentioned earlier, they'll feel like a
standard federal form. It's designed by the Federal Motor Carrier
Safety Administration. It consists of four pages. Typically the first
page is felt out by the driver with their information
and where they list their medications. The second page has

(13:21):
thirty two questions, very pointed questions, and each one talks
about various medical conditions, varying from if someone has heart issues,
if they have hypertension, high blood pressure, in other words, diabetes,
and neurologic disorders. So that's where if they're comprehensive with

(13:43):
their history, then the examiner such as myself will review
all that information and what I try to tell the
drivers because many of them may as I mentioned earlier,
some of which may not want to be forthcoming, or
many aren't very good medical historians. Sometimes they have to
call their spouse in the middle of these stamps to

(14:05):
get a list of their medications, and you probably encounter
that in your practice as well. But once we have
feel like we have the information that we need, then
we do an examination. It's similar to like a sports
physical or if people have undergone that, or a generalized physical,
pretty much head to toe observational looking for visible disabilities. Obviously,

(14:33):
if someone's missing a limb, then that's pretty self apparent.
Or if they have all their limbs but they don't
have movement adequate enough for them to safely drive and
do all the components of commercial driving, then that may
become an issue. Then at that point, that's where the
examiner differentiates between what we call regulatory items. These are

(14:57):
things that are absolute that if someone does or does
not have, then they cannot be cleared. Now, if it's
a temporary condition, say someone just had a heart attack
and they had open heart surgery or had stints put
in to treat them for their heart attack, their my
cardiolin function, that doesn't ever permanently pull anyone off the road,

(15:21):
but they may have to have a period of time
where they have to demonstrate that they have recovered adequately,
that medications that they were prescribed to treat their condition
are working, and that there aren't side effects that will
affect their ability to be attentive to driving. And that
brings me to the point that I wanted to make

(15:41):
is that the things we typically focus on, and when
I say we, I mean the thermotor Carrier Safety Administration
and all the examiners, we're looking for conditions where sudden
driver incapacitation could occur. So that could be many different conditions.
It could be or a logic someone have a stroke

(16:02):
while driving, if they have a heart attack while driving,
and if it causes their heart to beat irregularly to
the point that they have that they collapse, that's very
unfortunate if that happens to the driver, obviously, but if
the driver's doing seventy miles an hour on Interstate fifty
five going around hospital Curve, then we've got a problem

(16:25):
or many people at the problem at that point. So
that as an examiner, that's kind of the things we're
looking for, and it's not just cardiact. That could be
many neurologic conditions like seizure disorder. There's certain many categories
of seizure disorder where someone would be permanently unable to
be a commercial driver. But there are certain seizure condition

(16:45):
thing like a one time seizure due to an explainable
event a driver could eventually retain their ability to have
their medical clearance CARDIACT. We've covered that. The other is
others that we kind of that we definitely look at
are diabetes. The different types of diabetes. There's the type

(17:06):
one where there's lack of insulin or a lack of
insulin production in the body and someone's blood sugar is
high and it has to be treated for their entire
most of their life. That usually is a bigger risk
because blood sugars can suddenly drop when someone gives their
insulin to themselves to treat their diabetes. And so that's

(17:29):
what we look for. Many years ago, during the time
that I've been doing this type one diabetics, it was
very difficult, if at all, that they could be cleared
to drive. In fact, that was one of the regulatory
things that disqualify to drivers. But in the last few years,
because of the technologies that have become medically better insulins,

(17:52):
the longer acting ones, the ones that have different times
of action in the body, and also the ability for
a driver or anyone to continuously monitor their blood sugar
via their phone with a sensor attached to their body
where they can get real time information of their blood sugar.

(18:15):
So now that with those technologies around, then the Federal
Motor Carrier Safety Administration with all their different medical committees,
have over time basically created an environment where many drivers
could become certified people who wanted to be commercial drivers
with type two diabetes one. That's usually what we used

(18:37):
to call adult onset, but we see it in teenagers
as well. But the ones where the actual production of
insulin is not a problem, it's just the insulin resistance,
and that would be in your people who might be
overweighthed or who have a genetic predilection to diabetes and
things like that. Most usually those drivers can clear pretty
easily as long as they can demonstrate that they're under control,

(19:00):
that they're seeing their medical professional regularly, and that they're
taking their medicines. It does no good to get on
a medication for diabetes or any condition if you're not
going to take it, and it's very much more hazardous
in someone who's a commercial driver. So those are the
things we look at in a way we assess your
in the exam. We obviously checked vision when I first

(19:21):
got into doing occupational medicine and driver exams. Back twenty
some one years ago, we had an ode saying that
a driver had to have two good eyes and one
good ear, and that pretty much was it. But since
that time it's become a lot more elaborate. Vision. Obviously,
you have to pass vision, which is twenty forty. Typically

(19:42):
we want that in each eye, and it can be
with contact lenses or glasses, but you have to at
least pass technically with both eyes. But if you have
a permanent, stable visual condition in one eye where you
might be blind or not, have twenty forty vision and
it can be corrected as long as it's stable. We

(20:03):
can receive information from the treating ophthalmologists, and there's a
form from the Federal Other Carrier Safety Administration that the
ophthalmologists can fill out and that driver can subsequently be
cleared medically. As far as hearing, you can even wear
hearing aids, but you have to have functional hearing in
at least one ear, and we define that by the
driver being able to hear a whisper from six feet

(20:26):
or they can bring us a report of an audiogram
from their audiologists. But other factors that we do. We
check blood pressure. There is a range that we find
that's either allowable or not. And if you're on medication,
no problem. You can be cleared to be a commercial driver,
but you have to maintain control of your blood pressure.

(20:48):
And some drivers have medical conditions where their blood pressure
might require two or three even four medications. So that's
the role of the examiner to make sure that these
drivers are taking their medication and keeping their blood pressure
under control. One unique thing that I've seen recently, this

(21:09):
is a recent phenomenon that I've noticed in the last
few years, is that we're having young and otherwise healthy
young men and women come in for an exam and
their blood pressures will be off the charts and their
heart right will be well over one hundred and so
then I have to question them because that's definitely unusual,
but many of them. The prevalence of the energy drinks

(21:32):
and nicotine use outside of even smoking a cigarette, it's
at the bait and chewing tobacco. Different things with nicotine,
because nicotine, as you know, is one of the most
powerful stimulants that you can put in your body, as
well as one of the most powerful powerful drugs that
affects blood pressure. So having a twenty one year old

(21:56):
athletic appearing person sitting on your exam table, and my
medical assistant tells me their blood pressure and their heart rate,
and I'm going, Lord, what's going on here? So? And
then then what I questioned the the candidate And they'll say,
I'll ask I'll come up front and said, did you
have a monster before you came in here? Or a

(22:17):
red bull? And how'd you know that? So? Or did
you right? So? Uh? Uh So. Obviously those are temporary
and reversible uh issues, But to counsel someone that what
they're doing to their body, that might if if there's
any motivation and all, some people might ignore what you

(22:39):
or I tell them in the medical office, But if
they're going to lose their job, if they don't maintain
their health, then that's usually something people will listen to.
So uh sometimes that's the only way we can get
and get them to behave So uh, John, we're gonna
we're going.

Speaker 1 (22:54):
To take another short We're gonna we're gonna get John'm
gonna hold for one second. We're going to take a
short break, and I want to here and the rest
of that thought when we come back. But I want
to let everybody know you are listening to send it
on Help with Baptist Help here on news radio eight
forty whas our phone number five oh two, five seven one,
eight four eighty four. We're talking to John Doherty about
occupational medicine. We'll be right back. Welcome back to send

(23:32):
it on Help with Baptist Health here on news radio
eight forty WHAS. I am your host, doctor Jeff Tublin.
If you're just joining us, we're talking tonight with occupational
medicine expert John Doherty, and we're talking about commercial licensing
and medical exams to approve people for those license John,
welcome back. I wanted to ask you, you know, when

(23:54):
I think about drivers and I think about these long
hours and these road trips that they must beyond, you
think about people getting tired, and so one of the
conditions that I would imagine would be an issue would
be if you get these episodes of fatigue from obstructive
sleep apnea. So is that one of the conditions that

(24:15):
you look for or treat or can you tell us
a little bit about that?

Speaker 2 (24:20):
Definitely, Jeff. In fact, that's one of the biggest areas
that we focus on as far as our screening of
the individual with questions that we ask them and what
we see on physical just physical findings that we notice
with people that might have obstructive sleep at ME and
for those who may not know what that is, obstructive

(24:44):
sleep at ME as a conditioned where someone during their
time of rest, when they go to bed, they're not
getting adequate sleep because they have partial or and sometimes
even near total obstruction of their airway once their muscles
in their throat relaxed and they're trying to go to sleep.

(25:05):
Definitely very common or more common in people who are
overweight increased body mass index. But the conditioned it's dangerous
period whether you're a commercial driver or not, because it leads,
as you mentioned, to the brain not getting adequate sleep.

(25:26):
And one of the things you see will be people
who are drowsy during the day. They think they slept
all night and you say, hey, did you sleep good,
and I think, yeah, I got eight hours. But they
may be chronically fatigue. They may fall asleep even at
stoplights and things like that, or fall asleep the minute
they get home from work and turn on the TV
and around. But the issue is is that people their

(25:50):
perception is is that they might be sleeping fine, but
the signs and symptoms are there and they actually are sleeping.
In many cases, their brain will wake their body up,
sometimes hundreds of times in an evening for even just
brief periods, because the brain doesn't want you to die

(26:11):
while you're sleeping, So if it perceives that you're not breathing,
your brain will wake you up. So over a port
period of time, while you're sleeping, your brain does not
go into its levels of sleep for it to adequately
get rest. So again, it's an issue even if you
weren't a commercial driver. It's an overall health issue because
chronically ignoring that can lead to sudden cardiac death, congestive

(26:35):
heart failure, lung disease, all kinds of different issues. So
that's why for that's one of the big conditions we
screen for when we see commercial drivers, and we use criteria.
We don't just willingly. Sometimes I've gotten accused of, well,
you're picking on me because I'm fat. No, it's yes,
we know that being overweight or having an elevated body

(26:58):
mass index is one of the big or risk factors,
but we look at all kinds of factors, such as
next circumference, whether someone has medical conditions that go secondary
to sleep avenue. So the good news about someone who
does eventually get diagnosed, and we'll talk about that in
a second, how it's diagnosed, but that there's many different

(27:20):
therapies for treatment, including focusing on your weight loss and
your overall health. But the way it's diagnosed typically, and
in our office, we don't treat the condition and it's
not our role to diagnose. But it would be malpracticing
my part if I did not identify to someone that, hey,
you have many of the risk factors, and we have

(27:43):
a criteria. There's eight. There's an acronym we follow called
stop bang and each and each letter stands for a
different parameter that we look for. So if you have
three of those eight parameters, you're at risk of actually
having obstructive sleep avenue. So when driver, yeah, what.

Speaker 1 (28:02):
Are some of those parameters for our listeners who are
thinking about this.

Speaker 2 (28:06):
Some of the ones are some that I mentioned. One
of them is the elevated body mass index. Uh. The
other is drowsing, daytime drowsiness or what we call hyper
somnolence or daytime hypersominalance. But that's kind of a misnomer
because someone who works night shift and sleeps during the day,

(28:26):
that would not apply to them, but it's are they
are they sleepy when they should normally be awake And
as you mentioned that they're going to be driving their
semi truck for eight hour shift, are they going to
be a tennive and awake during that time frame? So
that we also look at the size of the throat opening.
Uh what's called the Malm Potty score, and it's a
score of one to four. Someone who has a one

(28:49):
or a two is considered normal. Someone with a three
or a four meaning that we can't see the anatomy
of the back of the throat adequately. So if someone's
sitting up and you're looking at their throat with a
light and you can't see the back of their throat,
you can only imagine what happens when that person lays
down to go to sleep. They're not going to have

(29:10):
any capability of moving air in and out of their airways,
or at least a very limited So that's where we
hear people who snore. The s of the stop bang
is the very first one is snoring. Now, not everyone
who snores has sleep apnea, but it is a symptom,
just like a running nose is a symptom of a cold.
So if someone reports that they snore and they have

(29:32):
an elevated body mass index, then the examiner has to
have a heightened suspicion that that person may have sleep avenea.
So again it's not our role to diagnose it, but
if we suspect it, we can require the driver to
contact their medical provider and see if they need further testing,
which would be what's called an overnight polysomnogram or what

(29:55):
we call a sleep study. And we would not most
examiners don't want it to take on the factor of
ordering it ordering that test, because then we would have
the responsibility of treating the patient. But we can give
them a temporary medical clearance to drive, and then a
meaning that we clear them for a certain period of time,
and during that timeframe they have to go see their

(30:17):
primary doctor or go see as someone who specializes in
sleep medicine to see a if they need to be tested,
and two, if they are tested, if it shows that
they have certain levels of obstructive sleep ATNION, then they
have to be treated. Now, for a commercial driver, that
might be a hassle because as you know well know

(30:37):
from many of the commercials on TV that the primary
treatment for obstructive sleep apnea is the sepath devices, the
continuous positive airway pressure, and that's a bulky device. Typically
you have to wear a mask when you sleep and
so forth. So for a commercial driver who drives over
the road and cross country, that can be a pain.

(30:58):
But they also make a portable sleep device, seapath devices.
There's also a new technology that's come out in the
last few years where people who do not tolerate, uh
the seapath device, there's a device called Inspire and that's
where devices with a stimulator that keeps your airway muscles

(31:20):
open while you sleep. And it does require a surgical
procedure performed by a sleep specialist. But that's another technology
that's come about just in the years that I've been
practicing medicine. Because so, but you can see where that
becomes can potentially be a hassle for someone and someone
may not tell us that they're snoring or that they're

(31:42):
not sleeping. Well, uh so again it's up to the
examiner for us to when we see those factors, we've
got to have a heightened awareness that uh that that's
a problem because the driver Yes.

Speaker 1 (31:59):
Well, yeah, I was just going to say that I
appreciate that you have this criteria because I think one
of the misnomers or the misconceptions about obstructive sleep apnea
is that you have to have an elevated BMI to
have that, and that's not true. So there are other
things people should be aware of it, Like you're mentioning,

(32:21):
I am going to take a very quick break, our
final break, and we're going to come back and talk
to you a little bit more. You're listening to Senate
on Health with Baptist Health here on news radio eight
forty whas our guest tonight, John Doherty. We're talking about
commercial driver licensing and occupational medicine. Remember to download the
iHeartRadio app. It's free, it's easy to use. We'll be

(32:42):
right back, Welcome back to send it on Health with
Baptist Health here on news radio eight forty whas. I'm
your host, doctor Jeff Talblin. We're talking tonight with John

(33:05):
Doherty about occupational medicine, commercial licensing, and a bunch of
other topics related. Remember to download the iHeartRadio app to
re listen to this or any of our previous segments
and have access to all the other features the app
has to offer, and especially some of our previous shows
from John about work injury and getting back on the
job and John in that line, we did have a

(33:26):
question that was submitted for me to ask you, which
is about working from home. Ever since COVID, a lot
of people have been working from home and has that
changed the landscape of occupational medicine at all, like our
employees only eligible if they have an in office job,

(33:46):
or what happens if someone has a problem from home.

Speaker 2 (33:51):
From working from home. That's an interesting question because I
actually during COVID, our clinics were so open and seeing injuries,
and in fact, some industries were very busy and manufacturing.
Some shut down temporarily in the initial phases. But I
actually had a couple of injuries where people felt One

(34:15):
a woman who worked from home. Her office was downstairs
and she fell down her steps and she injured herself,
and her employer did consider that a work related injury
because her office was at home. Fortunately she wasn't seriously injured.
She I think she sprained an ankle if my memory
serves me correctly. Correctly, and plus it didn't affect her

(34:36):
ability to do her job as far as with it
being a sprained ankle, But I did treat her for
her injury and subsequently was able to ultimately return her
back to work and release. But that's a unique question,
and yes it did. I'm sure there were other providers
that dealt with it. We initially the scary part because
as medical providers, you'd be aware of this as well.

(34:58):
We didn't know a lot about the was going on
when COVID first hit so many companies in the occupational
medicine realm. We became the de facto consultant for companies
safety directors and stuff. How can we work and do
our job and keep our employees safe because at that
point people were many were dying initially before we knew

(35:21):
about it, and people otherwise healthy people were becoming critically ill,
and so you could lose an entire large percentage of
your workforce. And if you're a manufacturer with an assembly
line and just pressing two or three people will be
an issue. So, yeah, that's a great question. I'm glad
someone brought that up, But yeah, I did. As an

(35:42):
anecdotal thing, I did treat at least one I think
maybe a second one where someone injured themselves at home
from their home office, you know, And it brings out
an interesting question.

Speaker 1 (35:54):
It is, and it brings up another just kind of
interesting thing about this field in general, which is it
cots to sort of change and move kind of with
the times, right, So jobs change and technology changes, so
you know, things that people have to deal with change,
And I wonder have you seen, you know, as our

(36:16):
population age and people are working in the workforce longer,
are you seeing a change in the type of injuries
or needs medically because of that.

Speaker 2 (36:28):
Yes, definitely, especially when we see older, more advanced age
individuals who maybe have retired but for economic reasons, they
decided to return to the workforce, and unfortunately, maybe there's
nothing available in the job that they did for thirty years,
so they may end up working at Amazon or UPS
sorting packages or driving a delivery truck or something like that.

(36:52):
So yeah, we're seeing that, especially people have degenerative issues.
They may have spinal problems, and normally would they function
fine day to day, especially if they're retired, but then
when they start all of a sudden doing repetitive motion
that they hadn't done throughout their life and now they're
doing it for eight to twelve hours a day, five

(37:12):
days a week. Then yeah, we're seeing that, and they
may have an acute component to it, but certainly a
thirty year old version of that person would have been
less likely to suffer an injury versus a sixty year
old version. Conversely, I'm seeing a much younger at much
younger ages, I'm seeing degenerative changes in spines and things

(37:34):
like and knees and shoulders because of people who are
very athletic and active. We want people to be active,
but if you were aggressively, if you played competitive sports
starting when you were a young child, and you played
through college, then you're going to have that's a long
period of time that you're doing repetitive activities that wear

(37:55):
your joints out. So by the time you're in your
mid thirties early forties, you may have the act of
a sixty or seventy year old. So yeah, we have
seen that as well, and that's a trend I've noticed
during the last few years in my career. And I'm
sure I can't quote you any studies through that, and
I'm sure that I'm not the only provider that's noticing that.

Speaker 1 (38:16):
Well, we have a few seconds left, and I know
that this is much bigger topic than this, But because
it is so hot outside and people may be working
at their jobs outside or in hot indoors, what are
the warning signs of somebody getting overheated that we should
be paying attention to, And just the last few seconds
that we have.

Speaker 2 (38:36):
With major if someone with advanced the most serious what
we'd call heat stroke or heat illness, anyone, if they
have a rapid heart rate, they have the inability to sweat,
If they start having neurologic issues, fainting, pale skin, clammy skin,
then that's those are major. Those are someone that would

(38:57):
probably require advanced medical attention. Someone who's just hot, red skin,
their body temptures raising and they're still amert and active,
but they're feeling tired and overheated. Those are people that
can usually do well if they're removed from the heat
and removed from physical activity. The key, since you brought
that up, is hydrate, hydrate, hydrate.

Speaker 1 (39:20):
And hydrate again, Well, John, thank you so much. I
know we try and expand the things we talk to
you about because you just as you mentioned at the beginning.
The field is so large, and I know we'll probably
have you back, So that's going to do it. For
another segment of Centered on Health with Baptist Health, I'm
your host, doctor Jeff Tomlin. I want to thank our
guests over and over again, John Doleraty for being here

(39:41):
and educating us so much. I want to thank our
producer mister Jim Finn and all of you the listeners
join us every Thursday night for another episode. Have a
great weekend. Programs for informational purposes only and should not

(40:02):
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace a physicians medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
regarding specific medical conditions. To find a Baptist Health provider,

(40:26):
please visit Baptistealth dot com