Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

Welcome to the WOEMA WINDOW, our e-newsletter sent to members by email on a monthly basis. The newsletter links to this page. Below are the items that appeared in the June 2018 issue.



Attention Residents: Apply for a Scholarship to WOHC!




Calling all OEM Residents!

WOEMA is inviting resident physicians to WOHC 2018 to present posters on occupational, environmental, and preventative medicine research or projects that have been conducted.  Selected residents will display their abstracts at WOHC 2018 and a review panel will award a first prize ($250) and a second prize ($125) to the presenters.



FREE CME: WOEMA Webinar Series

Tuesday, July 10, 12:00 PM PDT




Topic: The MTUS & Drug Formulary: Report Writing to Avoid Denials of Treatment Requests

Speaker: Steven Feinberg, MD

This webinar will help participants learn how to effectively use the MTUS and the Drug Formulary to avoid utilization review and IMR denials. With effective report writing, there is less stress on both the treater and the injured worker and medical care is expedited with early authorization of treatment.

Learning Objectives – after this webinar participants will be able to:

  • Have a better understanding of the MTUS treatment guideline.

  • Understand the MTUS Drug Formulary and how to effectively use it.

  • Write reports that lead to early authorization while avoiding denials of care.


Dr. Steven Feinberg is a physiatrist and pain medicine specialist practicing in Palo Alto. He is an Adjunct Clinical Professor and teaches at the Stanford University, Pain Service. He is also a past president of the American Academy of Pain Medicine. He currently serves on the WOEMA Board of Directors and Dr. Feinberg served as the Panel Chair of the ACOEM Chronic Pain Guidelines Panel Chapter, 2008 Update.



Western Occupational Health Conference 2018




The 2018 Western Occupational Health Conference will take place at the Park Central Hotel in San Francisco, CA


Earn CME with Worksite Tours!

Golden Gate Bridge

This tour offers participants a unique, behind-the-scenes look at occupational health and safety exposures of the Golden Gate Bridge. This tour will cover in detail the occupational health programs that have been developed to mitigate exposures. The tour will include a visit of the grounds and short walk on the bridge.

Live Fire Burn at the San Francisco Fire Department Training Facility

Tour the Treasure Island Training Facility of the San Francisco Fire Department and observe fire suppression activities during a live fire burn. Participants will learn about safety precautions during fire suppression activities, personal protective equipment for fire suppression, and standard procedures employed during fire suppression of a structural fire.



Guest Experiences  – Chocolate Tour & San Francisco Exploratorium

Bringing guests to WOHC? While you’re in session, have your guests enjoy a walking tour of San Francisco’s best chocolate spots, or enjoy an afternoon at the Exploratorium


Co-Morbidities in Occupational Medicine – Treating the Whole Person: Part One – Hypertension

an editorial by Sarah Mansell, MD


It is vitally important that as Occupational Medicine Providers we treat the whole person by looking past the presenting injury to the underlying medical issues. Doing this ensures that we provide the best care for our patients, optimize their outcomes, and enable earlier return to work.

The global epidemic of diseases such as diabetes, obesity, and hypertension have in turn increased the risk of cardiovascular disease, stroke and kidney failure. Likewise, chronic pain, mental illness, and alcohol abuse are factors that make comprehensive medical care even more important. By treating the whole person we ensure that treatment plans will benefit our patients and prevent unnecessary complications.

In this series of articles I outline important issues regarding these common co-morbidities, pitfalls to avoid and current recommendations for treatment.

Hypertension is a major issue in the USA. The CDC estimates it affects around 1/3 of the adult population and it is the most common comorbidity seen in Occupational Medicine. It is the second leading cause of death in our nation due to the greatly increased risk of cardiovascular disease and stroke. Hypertension in the presence of dyslipidemia, insulin resistance, and obesity lead to metabolic syndrome, a pro-thrombotic, inflammatory state which also greatly increases the risk of cardiovascular disease. In 2017 the American College of Cardiology changed the guidelines for the diagnosis of hypertension to any BP reading to > 130/80.

The risk of primary hypertension increases with age and is more common in people of African American or Hispanic heritage. It is linked to smoking, poor diet, excessive alcohol use, inactivity and obesity. In an Occupational Medicine setting the most common cause of secondary hypertension are medications, particularly nonsteroidal anti-inflammatories, cough and cold remedies and the OCP. It is also worth being aware that a wide range of medical issues such as Cushing’s disease or renal artery hyperplasia can cause elevated blood pressure.

As long standing, or poorly controlled hypertension leads to chronic kidney disease, caution is advised before prescribing nonsteroidal anti-inflammatories. These medications can acutely increase blood pressure, worsen underlying congestive heart failure and lead to acute worsening of kidney function. In this situation it is imperative to know the GFR so appropriate dosing of antibiotics or other medications can be made.

Although we encourage our patients to stop smoking, lose weight, drink less, move more and eat less salt, most of the time we will see people or are on, or need to be on medications. The major classes of medications are diuretics, ACE inhibitors or ARBs, calcium channel blockers and B blockers. Although these are usually prescribed by the Primary physician, it is worth considering them from an Occupational Medicine point of view.

We see workers who perform jobs in dangerous, hot, sweaty environments such as firefighters climbing ladders wearing heavy equipment. It would not be advisable to be using a diuretic in such a person due to the risk of dehydration and a vasovagal episode at height. Likewise, if you are seeing a person with exposure to chemicals or smoke with a chronic cough, it is important to recall that cough is a common side effect of ACE inhibitors. Calcium channel blockers can cause marked peripheral edema – also of concern if the worker is climbing scaffolding or on their feet for much of the day.

Finally, as hypertension is a risk factor for other serious diseases such as cardiovascular disease and stroke, it does increase the risk of complications during surgery. It is advisable to encourage the patient to get their blood pressure under control before having surgery for a work place injury. By addressing hypertension in the Occupational Medicine setting, it allows us to prescribe more thoughtfully, avoid potential poor outcomes, and ensure the best care for our patients.



WOEMA Annual Election of Officers & Directors



In accordance with WOEMA bylaws, the Nominating Committee of Scott Levy, MD (Chair), Roman Kownacki, MD, and Robert Blink, MD, submitted the proposed slate (link below) for the 2019 Board of Directors and Officers. It will be presented to the WOEMA membership at the Annual Business Meeting on Friday, September 14, 2018 at 5:30 PM, at the Park Central Hotel in San Francisco during the Western Occupational Health Conference (WOHC)



Attention: B-Readers Needed! NIOSH Certification Course offered by WOEMA




San Francisco, CA, September 11- 13, 2018

OSHA issued a final silica standard to reduce lung cancer, silicosis, chronic obstructive pulmonary disease, and kidney disease among 2.3 million workers exposed to respirable crystalline silica. The new rule lowers permissible exposure limits (PELs), mandates control measures, worker training, and a written control plan, and comprises two standards, one for Construction and one for General Industry and Maritime. OSHA will begin enforcing most provisions of the standard for general industry and maritime on June 23, 2018.

About 676,000 workplaces come under the scope of compliance. One significant requirement of the new rule: employers must provide medical exams to monitor highly exposed workers and give them information about their lung health. The exam consists of a chest X-ray with interpretation by a certified B Reader, among other requirements. Medical exams must be made available to exposed workers at least every three years, or more frequently if recommended by the healthcare professional. B Readers are involved with epidemiologic evaluation, surveillance, and worker monitoring programs involving many types of pneumoconioses. The goal of this course is to offer training with the intent of producing competency in radiographic reading by evaluating the ability of readers to classify a test set of radiographs, thereby producing readers who have the skills and ability to provide accurate and precise ILO classifications.

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