Mark's Musings - January 13

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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In Appalachia, Crafting a Road to Recovery With Dulcimer Strings (1,327 views)

My first post of 2020 is a wonderful story of hope, innovation, and doing something that is locally / culturally relevant. Hindman KY (pop. 770) has been ravaged by the #opioid epidemic but has also used something unique to their region to provide opportunity for #recovery - handcrafted stringed instruments. Following were some key takeaways for me:

1. The importance of "social determinants"
2. A "Culture of Recovery"
3. "Idle time is detrimental to people in recovery"
4. "Giving somebody something to do has proved to be a powerful step in their recovery”

Every city has it's own unique story. And it's own unique way of helping people. It just requires one person to have an idea for new stories to be written. This is another key insight from the article: "The art of crafting an instrument by hand requires keen focus, attention to detail and commitment to a goal — qualities that can help during recovery, in concert with therapy, peer-support groups and other rehabilitation work, experts say." So a culture of recovery includes not just an activity but taking into account and helping the whole person. Giving somebody something to do is a good start but only part of the solution.

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Taking Care of Yourself (155 views)

Are you a caregiver for someone in #ChronicPain or in #Recovery? Self-care is the first - and most important ongoing - step to ensure you can be their helpmate. Although this article is from the National Alliance on Mental Illness, their advice is universally helpful with ways to maintain your ability to help others. Recharging "can help keep you from becoming consumed by your responsibilities." Maybe you used the holidays to recharge. Maybe the holidays were even more draining than usual. However you start 2020, this is a reminder that the only way you can be strong for others is if you're strong yourself. Protecting your physical health is of paramount importance. Interestingly, four of the five items included in this article (exercise daily, eat well, get enough sleep, practice relaxation exercises - the fifth is avoid alcohol and drugs) are actions I advocate for patients to use. They're obviously just as necessary for those taking care of the patients.

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These Phrases Will Help You Reframe a Negative Mindset (272 views)

Thanks for sharing, Heather Martarella, PsyD. Some great advice included in the 20. My favorite? "This is not permanent." My second favorite is "List the facts" because switching from emotional to analytical can provide perspective (my third favorite).

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U-Haul to Implement Nicotine-Free Hiring Policy for Healthier Workforce (186 views)

Interesting development ... Starting on Feb 1, U-Haul International, Inc will implement a "nicotine-free hiring policy" in Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Pennsylvania, Texas, Utah, Vermont, Virginia and Washington. It is a part of their "Healthier You" corporate approach to wellness (health, mindset, nutrition and fitness). While current employees will not be impacted by this new policy, there will be a strong emphasis on nicotine cessation assistance. I thought this statement shows they understand how personal wellness impacts the business bottom line - "If we take care for our Team Members, they will take care of our customers." It will be interesting to see if this is a growing trend. I still remember plane rides with smokers in the back. Now smoking is not just banned from planes but the airports terminals as well. I'm thankful for both.

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As PM Finland’s Marin could renew call for shorter work week (481 views)

Given how a New Year promotes introspection, I'm sure many people made the resolution for a better work-life balance. Finland's "centre-left" prime minister is considering codifying that with a "flexible 6-hour, 4-day workweek." Apparently Sweden has had that approach since 2015 and "the results showed that employees were happier, wealthier and more productive as they were still fully paid and customers were more satisfied." Honestly, I tend to agree with her political opposition that the idea is “unrealistic” based on my personal experience and mindset, nurtured by the U.S. and my parental/mentor work ethic. This will be an interesting debate to follow. Will a country thrive or barely survive with people working less? The only four day work-week (with 100% pay and full benefits) I'm familiar with in the U.S. is when each of the days is 10 hours - not 6 hours. Ms. Marin is new to her position so she has not had to traverse the obvious (and not-so-obvious) political and pragmatic obstacles. I completely understand the need for work-life balance but I'm not sure this is the path forward. But I'm open to evidence to the contrary.

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Stop Being Boring... (857 views)

If you don't know my friend Claire C. Muselman yet, invest five minutes and read her anthem of change for #WorkersComp. Then invest another ten minutes to digest it, Then make tangible decisions to actually change (no talking, just doing). She nails it! Here are Claire's suggested ways to make a difference:

• Target your power of influence
• Influence them to help you
• Teach people how to think
• Challenge growth
• Role model the way and be the change

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The Way - Remedy (e-Prescribing) (136 views)

Expansion of e-prescribing is a good thing and something I have advocated for several years. It reduces the possibility of fraud/abuse (direct electronic vs. physical) and increases both accuracy (no legibility issues, edit checks when entering the data) and efficiency. In fact, I can't think of any negative side effects. Thanks to "The Way" for the hat tip on the six additional states that started requiring e-prescribing on Jan 1 with more to come in 2021. For more details read the "OPIOIDS" section in this Dec 29 CNBC article.

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Breathalyzer for weed, backed by Philly investor, could be a ‘game changer’ for legalization efforts (1,642 views)

2020 is going to be the year for #marijuana breathalyzers. This will start to bridge the gap of presence vs. impairment. Although not as reliably sensitive to actual impairment as BAC for alcohol, the version from Hound Labs claims it can "detect whether someone has smoked or ingested a marijuana edible within the last three hours." Other companies like SannTek and Cannabix Technologies Inc. also have products. And with a potential $10B annual market for such devices, there are likely to be even more manufacturers coming aboard. For a great overview on the implications to employers and #WorkersComp, check out the Jan 8 article on WorkCompCentral (subscription required).

This post elicited a thought-provoking response from Dr. David Benjamin:

"The effects of smoked MJ usually wears off by 3 hrs. (see Heustis et al) Moreover, just as with alcohol, impairment is based not just on blood concentration but on coping skills, tolerance, expectation and circumstances.  Detecting the smell of MJ on the breath only implies prior exposure and can by no means be used to "prove" impairment.  Orally ingested MJ may not show up on the breath unless their is regurgitation into the mouth.  Validation of portable breath testers for MJ must be fully validated and tested against placebo controls, by scientists not affiliated with government or device manufacturers.  Let's get real here, folks! No-one should smoke and drive, that's just stupid, but my concern is about false arrests based on unreliable testing devices "hyped" by manufacturers and law enforcement, much the same as field sobriety tests (FSTs), which are not very good at detecting impairment from MJ. As other knowledgeable people have posted, don't take any breath tests or do any FSTs.  Why would you want to risk generating inculpatory evidence against yourself.  You have the right to refuse these tests, this is America, exercise this right."

And a different kind of product for a different kind of problem: "Michigan town buys 'Nasal Ranger' to track down stinky marijuana plants."

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Babying your back may delay healing (164 views)

Thank you Anne Asher for sharing this article from Harvard Health. I love the title and how the article starts and ends: "Exercise and movement may help your nervous system to make this adjustment more rapidly ... Movement seems to be the stimulus to normalize pain responses in the nervous system." In other words ... As I've said many times before ... "Motion is Lotion." So I completely agree with Anne's comment that "bed rest" is usually the wrong solution to back pain. If you have back #ChronicPain, and especially if you're considering surgery, please invest five minutes and read this article. These were the four strategies suggested:

Don't take the pain lying down: While it may be tempting to stay in bed, doing so can make the pain worse over time and actually reduce flexibility and muscle tone, not to mention increase the risk of depression. It might also raise the risk that you will develop blood clots in your legs.

Treat the pain: Using hot or cold packs and over-the-counter pain medications won't cure the problem, but they can help make the pain more tolerable. Check with your doctor to make sure any medications you choose are appropriate and safe for you.

Strengthen your body: While it might not be advisable to hit the gym when you are suffering with severe back pain, your doctor may be able to give you a list of exercises that can help you maintain and build muscle strength and help ease the pain.

Seek out a physical therapist: These professionals can help you safely work past pain and teach you exercises to improve your mobility and flexibility.

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Why Your Muscles Love a Quick Workout (113 views)

And while we're talking about "motion is lotion," here is some helpful info from my gym, Planet Fitness, about quick workouts. Don't let the fact you only have 10 minutes deter you from using those 10 minutes to get more fit (I use a "7 Minute Workout" app on my phone). "A study ... found that it's possible to gain muscles mass (most frequently in the core and legs) with just 12 weeks of short, high-intensity workouts." Whatever level and duration of activity you can do is a worthy investment. Don't let the perfect be the enemy of progress.

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California eyes selling its own brand of generic prescription drugs to battle high costs (404 views)

Since Gavin Newsom became governor this time last year it's obvious he wants California to become it's own country ... This well-balanced article talks about the pros and cons of #California #GenericDrugs. Given the lack of details, I would qualify this announcement as a "vision", not a "plan." And one that may never happen. But it's certainly a lively conversation starter. And maybe there is already an example for how it can be done - "More than 1,000 hospitals in 46 states are a part of a nonprofit company called Civica Rx, which formed in 2018 to manufacture generic injectable drugs used in hospitals to lower costs and create a stable supply of the medicines. The nonprofit delivered its first generic drug to hospitals in the fall, an antibiotic that had been in short supply."

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Is There An Upside To Medical Marijuana Use? (143 views)

A decrease in the use of opioids (codeine, morphine, heroin) and cocaine. A decrease in workplace fatalities. A decrease in traffic fatalities. A decrease in suicide rates. What do they have in common? Studies that potentially link those results to legalization of #marijuana. Whether it's a causal or correlation relationship is not clear. And of course this is statistical analysis, not clinical studies/trials. But it builds on other analysis that has shown opioid overdoses and mortality rates declined in states with accessible medical #cannabis ("Access to medical marijuana reduces opioid prescriptions") and is something policymakers look at when forging ahead on legalization / decriminalization efforts ("Marijuana legalization 2020: These states could legalize weed in the new year"). One thing is guaranteed - the conversation continues. In my interactions on this subject around the country since 2014, it's obvious to me most of the people in my audiences are at the middle part of the bell curve where their opinion could be swayed in either direction based on new evidence. This kind of analysis might be the kind of evidence that will convince some to make a binding decision.

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In addition, I published three blogposts:

• "Mark's Musings - December 16" on December 18
• "The First Step Never Taken" on January 8 by WorkersCompensation.com
• "The Paths to Society’s Recovery from Opioids" on January 10 by WorkCompWire

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.