Let the Sun Shine In

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Well, cosmologically speaking, we are still in the Dawn of the Age of Aquarius – (being an “age” is about 2,160 years).  Sun’s out, guns out.  Perhaps it should be more aptly be named the Age of Cancer.

The CDC Skin Cancer Trends state that from 2002 to 2011 skin cancer among men increased by 1.5% per year and 1.1% per year among women.  Mortality from melanoma increased by 0.7% in men ( data not available for women).

In 2010, according to the CDC Sun-Protective Behavior Rates, 70% of adults said they usually or always practice on of the three sun protective behaviors (sunscreen, sun-protective clothing, or seek shade).  Women outperform men and those 25 years or older outperform those 18-25 years old.  Only about 13% and 7% of teen girls and boys, respectively use an effective sunscreen when they were outside for more than an hour on a sunny day in 2013.  About 1/3 of teens aged 14-17 had a sunburn in the past year.

When UV rays reach the inner layer of skin more melanin is produced that moves to the outer layers and becomes visible as a tan – this indicates injury to the skin, not health.

Risk factors associated with the development of skin cancer include

  • A lighter natural skin color
  • Family or personal history of skin cancer
  • Exposure to the sun through work or play
  • A history of sunburns, ESPECIALLY EARLY IN LIFE
  • A history of indoor tanning
  • Skin that burns, freckles, reddens easily or becomes painful in the sun
  • Blue or green eyes
  • Blond or red hair
  • Certain types and a large number of moles

The six skin types, based on how they tan / burn:

  1. Always burns, never tans, sensitive to UV exposure
  2. Burns easily, tans minimally
  • Burns moderately, tans gradually to a light brown
  1. Burns minimally, always tans well to a moderately brown
  2. Rarely burns, tans profusely to dark
  3. Never burns, deeply pigmented, least sensitive

Types I and II are at the highest risk.  I put myself at a IV.5.

The CDC seeks to dispel the myth that a “Base Tan” is a good thing in the Burning Truth initiative. It also states that tanning beds injure thousands of people each badly enough to go to a hospital and creates risk for aging of the skin and melanoma.

To reduce the risk of skin cancer:

  • Stay in the shade – not to be confused with throwing shade
  • Wear clothing that covers the arms and legs
  • Wear a hat!
  • Wear sunglasses – hipster and safe
  • Use sunscreen of at least SPF 15 with both UVA and UVB protection– that graduation speech
  • Avoid indoor tanning

In 2012, the FDA established regulations for the labeling of sunscreens – as described by FDA scientist Raynold Tan (no kidding!!).

  • A labeling maximum SPF value of “50+” Those with an SPF 2-14 can only claim to prevent sunburn not aging or skin cancer
  • “Broad Spectrum” means it protects from both UVA and UVB
  • Those that are both broad spectrum and SPF of 15 or greater can claim a reduced risk of skin cancer and early aging.
  • Two water resistant claim periods of 40 and 80 minutes will be allowed but “waterproof” and “sweat proof” will not.
  • Labelling as “instant protection” and protection for greater than two hours will not be allowed without proof to the FDA – read here reapply every two hours.

Finally, is the “Sun Safety for America’s Youth” toolkit available from the CDC.

Protect yourselves this summer and let love steer the stars.

Wheelchair Pilot Program

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This is just a friendly reminder to our referring providers who need to submit a new request on behalf of a PHC member for wheelchair related items or specialty items, that we have launched a new process to streamline these requests for members within our core counties for Solano, Napa, and Yolo.

Found on our website at www.partnershiphp.org you may download the In-Home Requisition Form and submit the completed form directly to PHC via fax at 707-863-4118, rather than submitting the request to a DME Provider.

Upon receipt Partnership HealthPlan will make arrangements for an in-home assessment to be completed. This process will help reduce the authorization wait time for both members and network providers, and overall improve member satisfaction!  We thank you for your continued support of our members and support of this new process.

Deborah McAllister RN BSN

Director of Utilization Management

MANAGING PAIN AFTER SURGERY – NEW GUIDELINES

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Managing the acute pain that accompanies operative procedures is a challenging and risky process.  Studies suggest that opioid medications started for short term management of pain increase the risk of long-term use by up to 44%1. To provide guidance on a more evidence-based set of pain management strategies post-operatively, the American Pain Society has recently issued an updated guideline. 2  Below are highlights of the 32 recommendations that they have made.

Multimodal therapy should be considered for all patients undergoing surgery. These options should be fully discussed with the patient and their families prior to surgery. These modalities include:

  • Systemic pharmacotherapy including NSAIDS and/or acetaminophen, gabapentin or pregabalin, IV ketamine, or opioids (preferably oral)
  • Local, intra-articular or topical therapies including local anesthetics at incision, or intra-articular anesthetic
  • Regional anesthetic techniques- e.g. regional or paravertebral blocks
  • Neuraxial anesthesia such as epidurals rather than general anesthesia
  • Non-pharmacologic therapies including TENS and cognitive behavioral therapy (CBT)

Use of TENS and cognitive behavioral approaches may decrease the total need for opioid medications, and should be considered unless contraindicated.

If opioids are used, oral dosing is preferable over IV routes. Avoid long-acting opioids. Do not use opioids, long or short-acting, prophylactically pre-operatively. In addition, every patient started on opioid pain management therapy should be given a tapering plan prior to discharge. It is often adequate to discharge the patient on NSAIDs or acetaminophen rather than opioids. If discharged on opioids, tapering off within two weeks is appropriate. This can be done by decreasing the opioid dose by 20-25% of the discharge dose every day or two till off. Patients who were on opioids pre-operatively should be tapered back to the maintenance dose within two weeks.

NSAIDS and/or acetaminophen should be used along with or in place of opioids where possible and dosed therapeutically. Concerns about use of NSAIDs and the risk of non-union of bone or anastomotic leakage is not supported by the literature.

Use of gabapentin and pregabalin should strongly be considered as part of multimodal pain management post-operatively. Both reduce opioid requirements. IV ketamine also has moderate evidence to suggest it is effective and lowers opioid requirement.

For thoracic and abdominal surgery, consider use of epidural anesthesia rather than general anesthesia. Epidurals are associated with improved pain management scores post-operatively and have fewer complications than general anesthesia

 

1 Alam A. et al, “Long-term Analgesic Use after Low Risk Surgery”. Archives of Internal Medicine, 2012, 172(5): 425

2 Chou R. et al “Guidelines on the Management of Post-Operative Pain” Journal of Pain, 2016 17(2): 131

Scott Endsley MD, Associate Medical Director, Quality

Is there a link between global climate change and health?

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Is there a link between global climate change and health?  Yes, and it is not just that rising sea levels inundating low-lying areas and warmer temperatures leading to new infectious conditions.  It turns out that the two most impactful actions we can take as individuals to reduce carbon dioxide production improve the health of us as individuals, as well as the planet.  What actions are these?  Read on to find out. Continue reading →