The Local 1014 Health Line - Summer 2019

ISSUE 8 Summer 2019

THE 1014 HEALTH LINE

Photo by Dave Mills

Board of Trustees Message New Website Launch Testosterone Therapy Explained Firefighter’s Physical Exam Checklist

INSIDE

Protecting Firefighters & Their Families...FOR LIFE

BOARD OF TRUSTEES MESSAGE

BOARD OF TRUSTEES MESSAGE

The Local 1014 Health Trust is pleased to present the Summer 2019 Edition of The Health Line.

In this edition of the Health Line, we have provided two critically important articles we would like to highlight. The first is an article about testosterone therapy and some of the questions you should be asking your physician prior to beginning therapy. The second is a perforated form for members to bring to your annual physical exam. The form is meant to assist healthcare providers in the evaluation, treatment, and ongoing observation of the health and wellness of Firefighters.

The ONLY health plan that is FOR FIREFIGHTERS

BY FIREFIGHTERS, The Local 1014 Health Plan is tailored to meet the unique needs of our members and their families. We know that our members are at higher risk for disease like cancer than the general population.

That is why prevention and monitoring is key to keeping our members healthy.

Additionally, we are proud to announce the launch of our new website! Our goal with this new interactive website is to provide our members an easier way to learn about The Local 1014 Health Plan’s benefits and services and allow for easy access to important forms and documents for the Health Plan. Please visit www.local1014medical.org to access our partner benefit providers link VSP and EPIC Hearing and allow easy access to our member portal through Member XG. We hope you find the new website with a fresh look, easy to access information for you and your family.

The Local 1014 Health Plan is tailored to meet the unique needs of our members and their families.�

TESTOSTERONE THERAPY

WHAT YOU NEED TO KNOW ABOUT TESTOSTERONE THERAPY Many of our members have been inquiring about the use of testosterone therapy. While millions of men use a prescription testosterone injection or gel as forms of testosterone replacement therapy (often referred to as TRT therapy) to restore normal levels of the manly hormone, there are many legitimate safety concerns. The ongoing pharmaceutical marketing blitz promises that low T treatment can make men feel more alert, energetic, mentally sharp, and sexually functional.

“Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs,” says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School.

TESTOSTERONE HELPS MAINTAIN MEN’S:

Photo by Bernie Deyo

• • • • • •

BONE DENSITY FAT DISTRIBUTION MUSCLE STRENGTH AND MASS FACIAL AND BODY HAIR RED BLOOD CELL PRODUCTION SEX DRIVE

Although some men believe that taking testosterone medications may help them feel younger and more vigorous as they age, few rigorous studies have examined testosterone therapy in men who have healthy testosterone levels. While testosterone therapy can help reverse the effects of hypogonadism, it’s unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy.

Additionally, testosterone therapy has risks.

For example, testosterone therapy may: • Contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts • Cause acne or other skin reactions • Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer • Enlarge breasts • Limit sperm production or cause testicle shrinkage • Increase the risk of a blood clot forming in a deep vein (deep vein thrombosis), which could break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism) • May impact your risk of heart disease, though research on this isn’t clear

TESTOSTERONE THERAPY Continued If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits. Your doctor will likely measure your testosterone levels at least twice before discussing whether testosterone therapy is an option for you.

Your doctor will also likely suggest natural ways to boost testosterone, such as losing weight and increasing muscle mass through resistance exercise.

Remember to take a cautious approach • TAKE STOCK OF YOUR HEALTH FIRST • GET AN ACCURATE ASSESSMENT • BE MINDFUL OF UNKNOWN RISKS OF TESTOSTER ONE REPLACEMENT THERAPY • HAVE REALISTIC EXPECTATIONS

Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it’s at its peak. Confirm a low reading with a second test on a different day.

After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry.

Ask your doctor to explain the various side effects for the different formulations of testosterone. The different treatments include testosterone injections, gels and patches. Know what to look for if something goes wrong.

Perhaps most importantly, remember that testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness.

Source: Harvard Health Publishing: “Is testosterone therapy safe? Take a breath before you take the plunge”, Published 2014, 2018 https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge Source: Lessons From the Testosterone Trials, Endocrine Reviews, Volume 39, Issue 3, June 2018, https://academic.oup.com/edrv/article/39/3/369/4924422

HEALTH GUIDE

A HEALTHCARE PROVIDER’S GUIDE TO FIREFIGHTER PHYSICALS

YOUR PATIENT IS A FIREFIGHTER FIREFIGHTERS FACE UNIQUE OCCUPATIONAL HEALTH RISKS DUE TO THE DEMANDS OF THEIR JOB

Firefighters routinely operate in harsh work environments Firefighters wear more than 70 pounds of equipment Firefighters breath compressed air Firefighters represent a distinct subset of the general population Photo by Bernie Deyo

TAKE THIS HEALTH GUIDE WITH YOU TO YOUR NEXT PHYSICAL EXAM

It is meant to assist healthcare providers in the evaluation, treatment, and ongoing observation of the health and wellness of Firefighters. The recommendations in this document are supported by ongoing clinical research of Firefighters’ health and by the expertise of the providers caring for them. These recommendations are offered as assistance for healthcare providers making clinical decision regarding the medical fitness and/or treatment of Firefighters. They are not to take the place of your medically reasonable, appropriate and necessary medical evaluation of the Firefighter.

PHYSICAL EXAM CHECKLIST

RECOMMENDED YEARLY SCREENING Vitals: BP, HR, RR, Wt, Body Fat Percentage Multi-System PE: skin, mouth, thyroid, vascular, neurologic and musculoskeletal Labs: CMP, CBC, Lipid Panel, TSH, Urinalysis, HbA1c Testing: 12-lead EKG, eye exam, hearing test, oxygen saturation Family History: CVD, sudden cardiac death, diabetes and cancer Personal Health Behaviors: tobacco use, alcohol, exercise, dietary CARDIOVASCULAR HEALTH AND FITNESS Significant cardiovascular demands of firefighting lead to acute coronary events that account for 45% of deaths among on-duty firefighters, in contrast to 15% of all deaths occurring on conventional jobs. Myocardial infarction is the leading cause of death of Firefighters, and these events occur almost exclusively in susceptible Firefighters with underlying cardiovascular disease (CVD). It is therefore prudent to thoroughly screen for, and aggressively treat, all CVD risk factors, including diabetes, in this very high-risk group of patients.

Ischemia is best evaluated by an imaging exercise stress test (nuclear or echocardiography) beginning at age 40 or earlier for clinical suspicion. Exercise stress testing without imaging is not recommended as it may fail to identify one-third of those who may need cardiac intervention (angioplasty or bypass surgery).

Echocardiography is recommended once as a baseline to evaluate significant cardiac structural abnormalities, including LVH and HCM. CANCER Chronic exposures to heat, smoke, and toxic flame retardants through inhalation, ingestion, and skin absorption put firefighters at risk for many cancers. The National Institute for Occupational Safety and Health (NIOSH) performed a multi-year study of nearly 30,000 Firefighters to better understand the potential link between firefighting and cancer.

The Firefighters studied showed higher rates of certain types of cancer than the general U.S. population in digestive, oral, respiratory, and urinary cancers. Providers should be especially vigilant to conduct cancer screening efforts in these particular areas. The following cancer screening recommendations for Firefighters do exceed those of the USPSTF guidelines for the general population. It is because of our extensive clinical experiences dealing with Firefighter health issues that we are strongly advocating for these screening tests in this high-risk group. We rely on your medical judgment to prescribe the most appropriate screenings in this unique patient population.

Colonoscopy or other appropriate colon cancer screening beginning at age 40.

Annual PSA with digital rectal exam between 40-45. Sufficient information regarding the risk and benefits of screening and treatment should be discussed.

Annual pap smear.

Annual mammograms beginning at age 40. Discuss screening at an earlier age if there is a family history or any patient concern. Annual testicular exam and instruction about self-examination.

Annual head to toe skin examination and appropriate dermatology follow-up.

Urinalysis annually for microscopic hematuria.

MUSCULOSKELETAL INJURIES The high intensity and dynamic work environment of firefighting leads to a high incidence of musculoskeletal injuries. Low back injuries represent approximately 50% of all job-related musculoskeletal injuries among Firefighters. These include strains, sprains, and intervertebral disc injuries, often leading to significant morbidity with the possibility of permanent disability. Obesity and deconditioning are strong predictors of musculoskeletal injuries.

Address underlying musculoskeletal issues. Assess for full range of motion, low back strength and flexibility as well as core muscle strength Refer as necessary for treatment Encourage flexibility and core strengthening exercises BEHAVIORAL HEALTH The mental and physical stress of firefighting and repeated exposure to trauma can lead to depression, anxiety, acute stress reactions, post-traumatic stress, and suicidal ideation. Self-medication with alcohol and drugs can result in substance abuse disorders Behavior health screening LUNG DISEASE In the line of duty, Firefighters are often exposed to carbon monoxide and other inhaled toxins, or irritants that may lead to acute respiratory issues such as hypoxemia or bronchoconstriction. Repeated exposure may cause chronic pulmonary disease and abnormal lung function. Changes in lung function and the development of lung disease may be detected with baseline and periodic assessment and should include the following tests.

Spirometry: Baseline and annual pulmonary function testing in those with a history of respiratory health problems and in healthy individuals; to include FEV1, FVC, and the absolute FEV1/FVC ratio.

Chest x-ray: Baseline chest x-ray in those with any respiratory symptoms or disease and in healthy individuals. Repeat chest x-rays every 5 years or sooner if medically indicated.

SLEEP DISORDERS Sleep disorders are highly prevalent in Firefighters and include sleep apnea, insomnia, shift-work disorder, and restless leg syndromes. It is imperative to screen Firefighters for these disorders since they substantially increase the risks for motor vehicle accidents, cardiovascular disease, diabetes, depression, dementia, and anxiety in Firefighters.

Assess sleep and use of sleep medications.

Screen for sleep apnea and consider sleep study as indicated.

INFECTIOUS DISEASES Firefighters are often first on the scene of an emergency and may be exposed to HIV, hepatitis (A, B and C), TB and other infectious diseases.

Establish immunity by vaccination record review and/or titers and update vaccines including Tdap, MMR, HBV, and Varicella.

Consider hepatitis A vaccine.

Baseline and periodic screening for HIV, HBV, HCV and other communicable diseases.

Provide annual influenza vaccine.

Source: Firefighter Safety Through Advanced Research May 2017

NEW WEBSITE

CHECK OUT THE LOCAL 1014 HEALTH PLAN’S NEW WEBSITE After months of hard work and dedication, we are pleased to announce the launch of our brand-new website!

Visit our new website at:

www.local1014medical.org Our goal with this new interactive website is to provide our members with an easier way to learn about The Local 1014 Health Plan’s benefits and services and allow for greater access to important forms and documents. This mobile-friendly website provides you and your family a convenient way to manage your health from anywhere.

Among the new features, the site provides links to our partner benefit providers like VSP and EPIC Hearing and access to our member portal through Member XG. We hope you find the new website’s fresh look beneficial for you and your family.

CONTACT INFORMATION: The Local 1014 Health Plan 3460 Fletcher Avenue El Monte, CA 91731 800-660-1014 medicalplan@local1014.org local1014medical.org

Photo by Juan Guerra