CDL drivers who take insulin

Game Changer!

 

Today , FMCSA will publish in the Federal Register a new final rule regarding the diabetes standard for commercial drivers.

The rule is 165 pages long and I have a lot of reading to do, but here is the nitty gritty:

FMCSA revises its regulations to permit individuals with a stable insulin regimen and properly controlled insulin-treated diabetes mellitus (ITDM) to be qualified to operate commercial motor vehicles (CMVs) in interstate commerce. Previously, ITDM individuals were prohibited from driving CMVs in interstate commerce unless they obtained an exemption from FMCSA. This rule enables a certified medical examiner (ME) to grant an ITDM individual a Medical Examiner’s Certificate (MEC), MCSA 5876, for up to a maximum of 12 months. To do so, the treating clinician (TC), the healthcare professional who manages, and prescribes insulin for, the treatment of the individual’s diabetes, provides the Insulin-Treated Diabetes Mellitus Assessment Form (ITDM Assessment Form), MCSA-5870, to the certified ME indicating that the individual maintains a stable insulin regimen and proper control of his or her diabetes. The certified ME then determines that the individual meets FMCSA’s physical qualification standards and can operate CMVs in interstate commerce.

So if you or someone you know is an insulin dependent diabetic CDL driver, call our office to schedule your physical. If you have any questions regarding this rule change feel free to call Dr. Kevin E. Crowley at 859-635-6666. Our office is conveniently located in Alexandria, Ky. in Campbell County.
DATES: This final rule is effective November 19, 2018.

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DOT drug test

Changes for 2018

As of January 1, 2018, the FMCSA changed some of the drugs it requires testing for. It is still considered a 5 panel test as follows:

  • Marijuana (THC)
  • Cocaine
  • Amphetamines
  • Opioids
  • Phencyclidine (PCP)

Under ‘Opioids’, previously ‘Opiates’, DOT testing will continue to include confirmatory testing, when appropriate, for Codeine, Morphine, and 6-AM (heroin).  But now they added initial and confirmatory testing for the semi-synthetic opioids Hydrocodone, Hydromorphone, Oxycodone, and Oxymorphone to this Opioids group.  Some brand names for the semi-synthetic opioids include OxyContin®, Percodan®, Percocet®, Vicodin®, Lortab®, Norco®, Dilaudid®, Exalgo®.

Under Amphetamines, DOT testing includes confirmatory testing, when appropriate, for Amphetamine, Methamphetamine, MDMA (ecstasy) and MDA (ecstasy metabolite)  To this Amphetamines group, they added initial testing for MDA and removed testing for MDEA.

Since January 1st, the FMCSA has required confirmation testing for 14 drugs under a 5‑panel test.  Broken out, here is what DOT drug testing looks like:

  • Marijuana (THC)
  • Cocaine
  • Amphetamines
  1. Amphetamine
  2. Methamphetamine
  3. MDMA
  4. MDA
  • Opioids
  1. Codeine
  2. Morphine
  3. 6-AM (heroin)
  4. Hydrocodone
  5. Hydromorphone
  6. Oxycodone
  7. Oxymorphone
  • Phencyclidine (PCP)

If you need a DOT or non DOT drug test give our office a call today at 859-635-6666. If you have specific questions regarding the testing procedure please ask for Dr. Kevin E. Crowley. We are located in Alexandria, Ky. in Campbell county.

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Drug Testing

 

Our office is now performing DOT and non DOT drug testing. If you need a drug test for pre-employment, DOT random, return to work or if your school requires it for your childs athletic participation give us a call at 859-635-6666 to schedule. If you have specific questions regarding the testing procedure ask to speak with Dr. Crowley. For more information regarding DOT testing visit https://www.fmcsa.dot.gov/regulations/drug-alcohol-testing/overview-drug-and-alcohol-rules

 

 

 

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My favorite low back stretch

When it comes to low back stretches less is more. I don’t mean that you as the patient should be stretching less, but that as your doctor I have to be careful not to overwhelm you with the amount of stretches that I prescribe. When I first started practicing I would give my low back pain patients on average 10-12 stretches specific for their problem and would follow up with a core exercise plan that they could eventually start once their current pain subsides. What I quickly learned was that sometimes the more I would give the less that would get done. Over the years I have scaled back the initial amount of stretches that I give to my patients to about 3-5. I still stress the importance of core strengthening and sometimes I will even demonstrate some beginner exercises to my patients (some days this is the only exercise I get).

When it comes to stretching we all want the most bang for our buck so to speak. Life is busy and if we have a 20 minute stretching routine that we are supposed to be doing 3 times a day guess what…more often than not it doesn’t happen. So, after I demonstrate the 3 or so stretches for the patient, nowadays I follow up with “If you only have time to do one low back stretch this is the one you want to do” and I show them one stretch. The stretch is a hip flexor stretch. Tight hip flexors are one cause of chronic low back pain. People who spend most of their time seated during the day especially need to be doing this stretch.

Do this stretch several times throughout the day and every time you get out of the car.

If you have ever gotten up from a seated position and walked bunched over like an eighty year old (no offense to the eighty year olds), you would benefit by doing this stretch throughout the day. It is easy, takes about 20 seconds for both sides and is best done standing up. When you do this stretch you should feel it in the front of your hip and in your lower back. They say 21 days make a habit so for three weeks try this stretch…your back will thank you. If you have any questions regarding your back and whether or not chiropractic can help give Alexandria Chiropractic Center a call today at 859-635-6666 and ask to speak to Dr. Kevin E. Crowley.

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The lazy persons guide to good health.

Do you work out five days a week and know the macronutrient and micronutrient breakdown of your daily meals? When you get your annual bloodwork results back form your doctor is there a gold star on it? Do you hang it on the fridge next to your childs artwork? At the end of the week do you crave cucumber water and vegetables with hummus? If so good for you…but read no further because you would seem to be a disciplined, dedicated person who knows how to follow a schedule and plan and this article is not for you. This article is for the person who always has a good excuse for not going to the gym, a person who just can’t seem to stick to a diet and someone when you ask them how many calories they consumed today, their response is…”a lot I think”. In general this article is for those of us who are all about easy. Now obviously the effort put into something factors into the results but if you want to do the bare minimum and still get some health benefits then read on.

First lets talk about your diet. The word itself sounds restrictive so instead lets call it our daily foods. Everyone has heard about how we should eat and what we should eat and to be honest on most days we do the exact opposite. There are only a few absolutes when it comes to eating healthy all the rest is bonus. Is organic better than non-organic? GMO or non-GMO? Free range vs. commercial? The bottom line is eat what you can afford. Wash your produce and enjoy. If you are pregnant maybe pay a little more attention to the packaging but for the rest of us…throw it in the cart. Drink water. Usually I recommend dividing your weight in half and shooting for that number in ounces daily. Keep a water bottle in front of you because if you’re like me if it’s not in front of you, chances are you won’t drink, and you can be thirsty and mistake it for hunger. Have a ballpark idea of how many calories you should be eating. If you can’t tell me if your are eating closer to 1500 calories or 4500 calories we may have a problem. You can figure out how much you should be eating by looking up a BMR calculator and if you want to loose weight simply subtract 250 from that number and that is your new caloric goal. After a couple of weeks step on a scale to see if you are losing 1-2 pounds per week. If not you have options. You could subtract another 250 calories per day or you could increase the number of calories you burn in a day by exercising a little more each day. Or the best option is a little of both. As far as what you eat, use common  sense and be honest with yourself. For example let me ask you a couple of  questions about daily nutrition scenarios and you try and answer the best you can.

You find yourself running late in the morning and really don’t have time to fix anything for breakfast. You should…

a) stop at a drive thru on the way to work.

b) just skip breakfast and eat a big lunch

c) eat a tablespoon of peanut butter and grab a banana.

d) eat a cold piece of leftover pizza.

This is a trick question because any answer would be accepted as long as you stop at the grocery store on the way home and pick up some easy morning foods such as smoothies, bagels, an egg white carton, veggies, fruit, yogurt, oatmeal etc. so it doesn’t happen again. You are going to have days when you have to grab and go, the trick is to always have healthy choices to grab.

It’s Friday night. You’ve been good all week with what you ate. In fact you think you may have eaten something healthy that you couldn’t even pronounce (Quinoa). You meet up with your friends for a drink. Do you have:

a) Water or diet soda.

b) a glass of wine.

c) some thin beer with no taste but only 4.5 grams of carbs.

d) whiskey

Another trick question. You can drink what ever you want in moderation and unless you are on some sort of ketogenic diet DO NOT look at the label on the beer for nutritional information. It’s beer. Enjoy. If it makes you feel better there are articles espousing the health benefits of both wine and beer. There are even health benefits in whiskey https://www.organicfacts.net/health-benefits/beverage/whiskey.html

I had to look this up.

There are more carbs in beer than in liquor, and it may surprise you but a 12-ounce serving of Guinness sets you back 125 calories—just 15 more than the same serving of Bud Light. And if you choose Bud Light over Guinness you need to reassess your priorities and whether or not you really even want a beer. The bottom line is, part of the reason to eat healthy during the week is so you can cheat a little on the weekends and not feel guilty. If you eat 40 small meals (including snacks) in a week, don’t be afraid to let 10 percent (4) of those meals to be cheat meals. Just for the record I don’t mean eat an entire pizza, but an extra slice. Constantly beating yourself up over a temporary lapse in judgement concerning your diet is no way to live, so don’t do it. Instead come to the realization that we are human and mistakes will happen.

The advice that I give my patients when it comes to eating healthy is to make sure that  you have healthy options on hand at your house at all times. If not you will end up eating whatever is laying around (Oreos, goldfish (the snack that smiles back), your children’s Halloween candy, chocolate icing etc.) Make small changes over time instead of drastically revamping your entire food source all at once, because that is setting yourself up for failure. For more tips check out a similar post.https://www.alexandriachirocenter.com/blog/2014/01/resolutions/

I may do a follow up regarding the minimum amount of exercise needed to be effective for weight loss…or I might just be lazy and skip it 😉

Dr. Kevin E. Crowley

 

 

 

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Omega 3 or Omega 6…and I didn’t even know there was a 9.

Health Fatty Acids

We have all heard that we should be adding essential fatty acids to our diet but exactly how much, and what kind can be confusing. The body can make most of the fats it needs from our everyday diet. The three basic Omega 3 fatty acids are ALA (alpha linolenic acid), EPA (eicosapentaenoic  acid) and DHA ( docosahexaenonic acid).Both EPA and DHA can be converted from ALA, but how well this conversion takes place is not really known. The two Omega 3 fatty acids that are typically recommended are EPA and DHA.

Omega 3 fatty acids are considered anti-inflammatory where as Omega 6 fatty acids are typically considered pro inflammatory and are present in processed foods and vegetable oil. The average person in the United States gets plenty of 6 in there diet with the exception of GLA which is considered a good Omega 6. In fact recent studies show that the ideal ratio of 6s to 3s should be 4:1 or less, and currently the average American has a ratio closer to 25:1  There are not many food sources of GLA so supplements with Evening primrose oil, Borage oil and Black currant oil are usually taken by people wishing to increase GLA levels. So if it is recommended that you should increase good fatty acids in your diet, just what should you be doing?

First of all a healthy diet consisting of green leafy vegetables, nuts, extra virgin olive oil for cooking and in salad dressings would be a great place to start. Eat more oily fish, walnuts, flax seeds, and omega-3 fortified eggs. And if at the end of the day you want to take a supplement, choose one that contains a higher amount of EPA (300-500 mg) and DHA (400-600 mg) per serving.  Most quality fish oil will meet this criteria or even better a supplement with concentrated omega-3s, as EPA and DHA can be as high as 90%. Look for brands that contains omega-3s as free fatty acids (best), triglycerides or phospholipids.

As for Omega 9 fatty acids, they are described as non-essential, because our bodies can make them from other things we eat, and we don’t have to depend on direct dietary sources to obtain them. The main omega-9 is oleic acid, found in olive oil, canola oil, peanut oil and sunflower oil. And since your body can make its own, you don’t need to take a supplement with Omega 9 in it. Save your money.

In the next post I will talk about the benefits of each fatty acid and whether or not it is worth the time and money to supplement. In the mean time if you have any questions  regarding fatty acid supplementation feel free to call Alexandria Chiropractic Center at 859-635-6666 and ask to speak with Dr. Kevin E. Crowley.

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New CDL medical exam rules for 2018

Dr. Kevin E. Crowley is a certified medical examiner.

There are a couple of new rules that the FMCSA is implanting for 2018. The one that most drivers will be happy to hear is starting in July 2018, drivers will no longer be required to carry a medical card or submit it to the state for licensing. The electronic registry will verify certification. So say goodbye to the paper cards. Another change that is coming is the ability to extend your exams. For instance, if  you receive a certificate that’s only valid for three months due to high blood pressure, you have to go back for a whole new exam in three months. It’s no longer acceptable to just go back for a blood pressure check and extend your exam for the rest of the year. So do everyone a favor and have your blood pressure under control before you come in for the exam. If you are currently taking medicine for hypertension don’t forger to take it on the day of your exam. Another change that is coming is for the medical examiner. We now must send your results to the national registry within 24 hours. The FMCSA made this a rule so that you’ll be able to get your results quickly, with minimal downtime. For more information visit www.fmcsa.dot.gov/

 

Call today to schedule your CDL physical. We have early Saturday appointments available for our drivers if needed. If you have a specific question regarding the medical requirements for the physical be sure to call Alexandria Chiropractic Center at 859-635-6666 and ask to speak with Dr. Kevin E. Crowley.

 

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Hypertension and your CDL

These are the numbers to remember.

Just a reminder of the FMCSA requirements for maintaining proper blood pressure for your medical exam. In order to be qualified for a two year certificate you must have a blood pressure of 140/90 or less without medication. If your blood pressure is 140-159/90-99 you will receive a one year certificate and upon recertification you must be less than 140/90  or you will receive a one-time three month recertification.
If your blood pressure is 160-179/100-109 you will receive a one- time three month certificate and upon recertification your blood pressure must be less than 140/90 for a one year renewal.
If your blood pressure is greater than 180/110 you will not receive certification and once you get your pressure below 140/90 you will receive a six month recertification.

FMCSA Regulations.

Remember, once you are on blood pressure medicine the longest recertification you can get is one year. If you have any questions about the rules and regulations concerning blood pressure or any other issues with your CDL medical exam please call Alexandria Chiropractic Center @ 859-635-6666 and ask to speak with Dr. Kevin E. Crowley.

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Exercise is a CORE letter word.

Sometimes when I mention to my patients that they should start exercising regularly as part their overall health plan they look at me as if I just called them a nasty name. Most people try to stay active during nice weather, will stretch…when they remember to and try to eat right….most of the time. But when I ask them if they exercise on a regular basis they just moan and tell me they don’t have the time. But if you can find 15 minutes just three times a week you are on your way to a core strengthening routine and a healthier back. You don’t need to join a gym and you don’t need any special equipment. In fact you can do this routine in your pajamas lying on the floor if you like.

I recommend starting out slow with only a few different exercises. Slowly increase your intensity and switch up your routine about every 3-4 weeks. I will give examples of some of the core exercises that I give, but obviously you can just google or youtube some beginner exercises.

These are some of the simplest exercises and can all be modified to fit your fitness level. You will want to work up to 2-3 sets of 10-12 reps. If you do this you will notice a significant improvement in about 4-6 weeks. If you have any questions regarding low back pain or if you need a more structured home exercise program  give Alexandria Chiropractic Center a call at 859-635-6666 and ask to speak with Dr. Kevin E. Crowley.

 

 

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Pinched nerve in neck

123123123 Often times patients will come into our office complaining of neck pain that radiates into their shoulder and even into their hands/fingers. They almost always are on some sort of over the counter or prescription medicines including hydrocodone, naproxen, prednisone just to name a few. The pain can be dull or sharp, constant or intermittent, and sometimes they can have tingling or numbness into their arm. Sometimes there is a history of trauma but the majority of the time when I ask them what do they think caused the pain, the most common response is “I have no idea.” I begin to ask questions about any change in activities at home or work, any new work out routines, any new changes in their work station or even a new pillow. And very often there are no coinciding factors that can explain the pain.

In the example above the condition is easy enough to diagnose. I bet everyone reading this post, ( all nine of you), would say it’s a pinched nerve and you would be right. The tougher question is what is doing the pinching. There are several things that can cause a nerve to be pinched or compressed. For instance the following picture is a possible cause of a pinched nerve, although I have not seen it in my practice…yet.

spock_neckpinch25

The red shirts always get it.

Bone spurs, thin disc and inflamation=DDD

Degenerative Disc Disease is common in the over 50 crowd.

Some can be ruled out simply by the age of the patient. For instance arthritic degeneration can cause a narrowing of the opening that the nerve exits causing compression (spinal or foraminal stenosis), but you wouldn’t expect this in 20-40 year olds. Another example would be a herniated disc putting pressure on the nerve as it exits off of the spinal cord. Usually, but not always, that person would have a history of some sort of trauma to the neck. Other causes can be inflammation around the nerve root and muscle tension which is much more common in the above mentioned  20-40 crowd quite often from poor posture due to over texting. Often times in someone who is 50 plus it can be a combination of all of the above which is called degenerative disc disease.

There are some simple orthopedic tests that I can do in the office that can often times rule out or rule in the causes. Sometimes if there is no relief with a couple of treatments I may want to order diagnostic studies (x-ray, mri or emg). These studies will confirm the presence of arthritis, disc herniation or inflammation. A small percentage of patients with a mri that is positive for inflammation and foraminal narrowing may be referred out to see if they are a candidate for epidural steroid injections (esi’s). Only a small percentage of patients that come into my office with symptoms of a pinched nerve will go on to need surgery, although that is a possibility.

Most often times with a combination of chiropractic treatments, stretching, ice and some in office physiotherapeutic modalities (ultrasound, traction, ems) most patients receive relief from their pain. If you or someone your know has been diagnosed with a pinched nerve or think you have a pinched nerve give Dr. Kevin E. Crowley a call today at 859-635-6666 to schedule an appointment.

 

 

 

 

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