Search found 922 matches

by Robert Swotinsky MD
Wed Jan 29, 2020 6:02 pm
Forum: Drug and Alcohol Testing
Topic: Explanation for shy bladder - Avoidant paruresis
Replies: 1
Views: 3755

Re: Explanation for shy bladder - Avoidant paruresis

"Avoidant paruresis" is a descriptive term, not a diagnosis. For example, the DSM-5 does not list "avoidant paruresis." There is no consensus about diagnostic criteria, clinical findings, or effective treatment. It is a technical-sounding term that some use instead of "shy bladder," and has equal me...
by Robert Swotinsky MD
Sat Jan 25, 2020 3:14 pm
Forum: Drug and Alcohol Testing
Topic: Methamphetamine
Replies: 9
Views: 8126

Re: Methamphetamine

In federally regulated testing, laboratories must quantitate at least 100 ng/mL amphetamine in order to report a positive methamphetamine result. This requirement was put into place because of an analytic problem identified in the early 1990s in which a few specimens with large concentrations of eph...
by Robert Swotinsky MD
Sat Jan 18, 2020 2:43 pm
Forum: Drug and Alcohol Testing
Topic: Fitness for duty upon MRO review
Replies: 6
Views: 6927

Re: Fitness for duty upon MRO review

While the employer may seek help in this process by using vendors - e.g., local occupational health provider, MRO, etc. -- the employer is generally held primarily responsible for assuring a safe workplace. If the employer determines that an exam is unnecessary, so be it. In the event that the emplo...
by Robert Swotinsky MD
Fri Jan 17, 2020 6:33 pm
Forum: Drug and Alcohol Testing
Topic: Fitness for duty upon MRO review
Replies: 6
Views: 6927

Re: Fitness for duty upon MRO review

...is the MRO’s recommendation the final say? Or is it just that...a recommendation? The MRO notifies the employer or other responsible party of the concern. The employer or other responsible party then follows up on that notification. And even though the test was reversed, are both negative and po...
by Robert Swotinsky MD
Mon Jan 13, 2020 9:18 pm
Forum: Drug and Alcohol Testing
Topic: Safety advisories for impairing medications
Replies: 4
Views: 4432

Re: Safety advisories for impairing medications

As of 11/13/17: 40.1235(e) You must also advise the employee that, before informing any third party about any medication the employee is using pursuant to a legally valid prescription consistent with the Controlled Substances Act, you will allow 5 business days from the date you report the verified ...
by Robert Swotinsky MD
Sun Jan 12, 2020 9:48 pm
Forum: Drug and Alcohol Testing
Topic: Safety advisories for impairing medications
Replies: 4
Views: 4432

Re: Safety advisories for impairing medications

If an individual is taking a prescribed drug which CAN result in cognitive impairment (ie. opioids), what would be required for the MRO to verify (or overturn) the result to a full negative (as compared to a negative with a safety-advisory)? Whose responsibility is it, in the end, to make sure that...
by Robert Swotinsky MD
Thu Dec 26, 2019 4:06 pm
Forum: DOT Physicals
Topic: Peripheral neuropathy; monoclonal gammopathy
Replies: 1
Views: 3661

Re: Peripheral neuropathy; monoclonal gammopathy

Peripheral neuropathy is a tough one for reasons that include: - An older version of the FMCSA DOT Medical Examiner declared it as disqualifying. This was an FMCSA guideline that I believe was not adhered to by many medical examiners. - Many truck drivers report peripheral neuropathy. - The severity...
by Robert Swotinsky MD
Wed Dec 25, 2019 8:52 pm
Forum: Drug and Alcohol Testing
Topic: Invalid & positive, criminal case
Replies: 2
Views: 3294

Re: Invalid & positive, criminal case

The "canceled" outcome is consistent with workplace drug testing standards of practice: In a workplace test, if the collector performed two separate collections using one CCF, that is a fatal flaw and the test should be canceled. A test's forensic suitability may vary by setting. In the case as pres...
by Robert Swotinsky MD
Thu Dec 19, 2019 3:15 pm
Forum: Drug and Alcohol Testing
Topic: Meth/Amphetamine positive with Trazodone
Replies: 1
Views: 2957

Re: Meth/Amphetamine positive with Trazodone

pls provide more context.

What were the concentrations?

Are you someone who tested positive? An employer? Someone being asked to interpret the results?

What sources on the internet are you referencing?
by Robert Swotinsky MD
Thu Dec 12, 2019 5:37 am
Forum: Fitness-for-duty (e.g., preplacement) exams, non-DOT
Topic: Hazardous waste surveillance question(s)
Replies: 2
Views: 5167

Re: Hazardous waste surveillance question(s)

Consider the following core components: A history and physical exam. Pulmonary function tests. Complete blood count. Blood chemistry screen that includes liver-related enzyme tests. Urinalysis (basic). Resting EKG (baseline, periodic if at/above 40 yo) Audiogram (Routine chest x-rays are not recomme...