Hector Lopez: Lessons from the Ring

It’s 5:30 a.m. in Santa Ana and the sun is just about ready to rise. So is a somewhat sleepy Hector Lopez.

Although Lopez won’t head into work for a while, he must get to the gym as soon as possible for morning training. Lopez knows he has a long day ahead of him, so he shakes off that tired feeling and climbs out of bed. He’s doing it for the kids.

A longtime sales consultant with U.S. HealthWorks, Hector Lopez trains boxers at the TKO Youth Boxing Club in Santa Ana.

A longtime sales consultant with U.S. HealthWorks, Hector Lopez trains boxers at the TKO Youth Boxing Club in Santa Ana.

Lopez, a longtime sales consultant with U.S. HealthWorks, spends his days making sales calls for the company’s three Orange County clinics, where he highlights services to potential patient groups and cheerfully maintains relationships with current customers.

He loves his day job and plays a key role in helping people understand how U.S. HealthWorks can be a valuable resource to businesses and individuals throughout Orange County.

But it may be Lopez’s role outside the office that actually helps people the most.

For the past 20 years, Lopez has volunteered time as head coach at TKO Youth Boxing Club in Santa Ana. The club, founded in 1994, was created for youth in tough neighborhoods to provide a positive influence that would steer them away from gangs, drugs and teen pregnancy.

Providing guidance in life and boxing skills to this group of kids comes relatively easy for Lopez, a former amateur boxer who became interested in coaching when he learned about the organization.

There’s no denying that this is a major commitment – one that he has in addition to a full-time job and being involved with his family. But Lopez is passionate about the cause and believes in it wholeheartedly.

Hector Lopez has been training undefeated boxer Ronny Rios for many years at the TKO Boxing Club.

Hector Lopez has been training undefeated Featherweight boxer Ronny Rios for many years at the TKO Boxing Club.

“I really believe that if we give back, we’ll save these kids from the street,” Lopez said.

He is particularly grateful for the support of U.S. HealthWorks – an employer that encourages his volunteer work and has provided assistance to the gym. Some of his U.S. HealthWorks colleagues have volunteered at TKO events, and the company donated shirts for an upcoming bout Sept. 19.

TKO Youth Boxing currently trains 80 male and female boxers, all under the age of 21. Most of them never step into a ring for an official fight, but they learn invaluable lessons about working hard, setting goals and building character.

Of course, there are boxing success stories among some of the more talented and ambitious TKO boxers. One of those who has already earned considerable notoriety is Ronny Rios, an undefeated featherweight contender that Lopez has coached for 11 years.

Ronny Rios has a 23-0 record as a professional boxer.

Ronny Rios has a 23-0 record as a professional boxer.

Rios, who is 23-0 and a ranked Featherweight boxer, says he can’t imagine having anyone else as a coach.

“Hector and I make a great team. He’s always there when I need him, and he listens to what I have to say,” Rios said. “He’s the most straightforward person I’ve ever met – he tells it like it is.”

Rios, who won a Bronze medal at the 2008 Olympic Trials (and came within two points of making the U.S. Olympic team that competed in Beijing), has had such a successful partnership with TKO Boxing and Lopez. Even as a professional, he continues to live in Santa Ana and train with Lopez at the neighborhood gym.

Not only does Lopez consider himself (and his fellow coaches) a coach to Rios and many other TKO youth, he often assumes the role of father figure and mentor as well.

“A lot of these kids talk to me more than they talk to their own parents sometimes,” explains Lopez.

Lopez’s dedication to the group has led to multiple appearances in the Olympic Trials, and there are current boxers on track for a possible berth in the 2016 Olympics in Rio de Janeiro.

There’s also a short film about the boxing organization – “Center Street Rising” – that illustrates how the club has provided an alternative to dangerous gang life.

“We are very lucky and blessed to be doing this and making a difference,” Lopez said.

Though his days are packed from start to finish, Lopez never considers complaining or believing he has too much on his plate. TKO has a mission, and he is grateful to be part of it.

For more information, visit TKOboxing.org.

Suggested method for picking a Physical Therapist

To use therapy or not, that is the question. At least that one has been largely settled in the last few years with many people opting for therapeutic treatment.

Physical therapy is about movement and how to make that happen. It’s a good thing for injured people and measurably speeds healing and reduces the cost of care.

Physical therapy - hand

A recent study put a price tag on this. Adding therapy to musculoskeletal injury treatment can save the carrier over $2,000 per claim with quicker release and reduced disability.

The list of things improved by exercise is twice as long as your arm. Movement is good; it keeps the blood going round. Movement is good even if you are injured, old, obese, skeletal-thin or have almost any disease or injury you can name.

Now that we have established that therapy is a good thing, where can you get it? That remains a more unsettled question.

There are two main schools of thought:

  1. Use the therapist that works with your doctor.
  2. Use a therapist that has nothing to do with the treating doctor.

Both carriers and providers are concerned about the cost of care. We know that good outcomes, achieved with the quickest and least expensive path, will bring long term success to the companies we serve, their employees, patients and ourselves. Insurance carriers are entirely in agreement on these goals, but how to get there?

Physical therapy 1

As an insurance company, if you believe providers work by formulas, putting a few dollars ahead of all else, then you put procedures in place to eliminate any possible self-dealing. Keeping the provider and the therapist far apart might be one of those procedures.

In your mind, one of the biggest challenges to closing a case quickly, economically and successfully, is self-referral and endless therapy.

If you think having the doctor and therapist talk about the patient’s progress is good, you approve and even encourage the therapy being done in the same clinic as the medical provider.

Separating the doctor and therapist converts meaningful verbal communication to a review of indecipherable reports, often received after the patient has left. These reports are not written to communicate clinical information with the doctor. Instead, they are designed to get a therapist’s bills paid. When an outside therapist has ever called me, and that happens once every 50 patients or so, it’s only been to get a signature or ask for more therapy.

My relationship with the therapist who works with me in my U.S HealthWorks clinic is different. If we just consider MRIs, over 50 percent of the ones I order are first suggested by my therapist. Those MRIs are about 85 percent positive for surgical pathology.

Am I simply late on the draw? No, it’s because our therapist spends more time with the patient, and has a different relationship with them. The physical therapist is seen by most patients as being “on their side” and they talk more openly with the therapist.

This is too important and expensive a resource not to take full advantage of it. Do an MRI sooner, save weeks of therapy before the operation, and save thousands of dollars on the case.

Our therapist also doesn’t like to waste her time. If someone has recovered, she walks into my office and asks me to see them after therapy and release them. She does this even if more therapy visits have already been authorized.

What is going on here? Our therapist and I are both judged by the same ruler – getting the patient better with the most speed and cost effectiveness. She doesn’t have a practice to support, nor do I. If we do a good job together and the patient gets better, the rest will follow.

Do the numbers support this? We manage to get 81 percent of new cases closed within 30 days. In the 17 percent of new injuries that need therapy the average length of therapy was 5.5 visits if done by my therapist, and 9.5 if done by an outside therapist.

The partnership between a skilled occupational medical physician and the equally skilled therapist, both working with the same goal, is the most effective way to rapidly get injured people better.

I tell the patient that we will treat them from the inside with medications, and from the outside with therapy and exercise. Even intuitively that sounds like a “can’t lose” strategy.

Take care,

Dr. B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Images courtesy/ FreeDigitalPhotos.net

Benefits of eating breakfast

I have always liked the expression: “breakfast of champions.” It kind of channels the way your day really should start.

During my formative years at the skydiving drop zone, I would grab a cup of joe at the local fast food joint at first light, and mumble, “this tastes like rhinoceros bile” while climbing to altitude.

Young woman eating fruit

I would hand my empty cup to the pilot, and jump. The cool air on a summer morning felt just like jumping into a cool electric blue pool. Definitely a great wake-up call!  Bad coffee and a skydive, that was my “breakfast of champions,” or at least my view of it, as a 20-year-old.

Breakfast is probably the most misunderstood meal of the day. The public’s view of a good breakfast covers the gamut from a quad-espresso, through biscuits and gravy, to steak and eggs.

Of course, another popular item on the breakfast menu is “nothing at all” – almost a third of us choose to skip breakfast entirely. Most overweight folks believe skipping breakfast is a no-brainer toward weight loss. After all, who gets up feeling like eating?

It turns out that most of your day is set up by your breakfast or lack of one. We have known for a long time that skipping breakfast wasn’t the best choice for obesity – people get heavier, not lighter. It seems we make up those calories, and then some, by snacking more on worse food as the day progresses.

When we look at people who skip breakfast, they keep unsavory company. People who skip breakfast are more likely to smoke, drink and be overweight. These people are also less likely to exercise, and perhaps not surprisingly, they are more likely single. Yes, being single is a significant risk factor for increased mortality for all causes (cancer to suicide).

But we have gone down the guilt-by-association road before. Coffee was considered an unhealthy beverage for years just because most people had a cigarette with their morning coffee. By the way – it isn’t the coffee that is unhealthy!

And it is certainly possible that some of these risk factors are tangled up with each other and are unfairly maligning skipping breakfast. For instance, maybe smoking cigarettes makes breakfast taste bad, or when you wake up with a hangover you sure don’t feel like eating.

Breakfast food

But recent studies have controlled these variables and isolated the breakfast/no breakfast phenomenon. That means they make the breakfast and no-breakfast groups equal in other risk factors, like smoking, drinking and obesity.

When we do that there are more heart attacks among the no breakfast eaters. There are also changes in your body that are linked to things like heart attacks and strokes. Non-breakfast eaters have higher blood pressure, worse cholesterol and stress hormones.

We know this to be a fact, but we are still struggling with the whys and wherefores.   Current thinking is that the overnight fast is stressful to our systems and we need fuel pretty soon after waking up.

Prolong the fast and typical stress changes can be seen in the blood. One of the things you learn in medical school is the importance of homeostasis – keeping an even physiologic keel.

Bodies (and children) seem to like routine. People don’t do well when they go to bed at radically different times or alternate starving with feasting like a Viking. A lot of energy is spent on evening things out that could better be used for something else – like building muscle or learning something new.

One of the great health victories of the 21st century is whole grain cereals. It is difficult to find non-whole grain cereals even amongst those designed to attract kids (choco-sugar-bomb-marshmallow whatever…).

Do something decent for yourself in the morning:  A bowl of cereal with skim milk is a great start. Need some variety? Try fruit yogurt or get creative and throw juice, frozen fruit, yogurt and a banana in a blender – it’s a slice of breakfast heaven.

Have a good morning.

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Images courtesy/ FreeDigitalPhotos.net

No need to panic regarding possible spread of Ebola

Ebola has recently become cause celebre. For all the attention it’s getting, one would expect it will be more common than influenza in a few short months.

Are we on the road to post-apocalyptic ruin and visions of “bring out your dead,” straight out of Monty Python?

To put things in perspective I suggest comparing Ebola to lightening.

Sick man in bed

Getting hit by lightning has a fatality rate that will certainly give Ebola a run for its money. And Ebola, like lightening, is totally harmless if you are not in the immediate vicinity. Close enough to touch is too close in both cases.

Lightening kills a couple of dozen folks in the U.S each year. So far Ebola has killed none. Common sense will usually save you from lightening – thunderstorms are poor occasions to be climbing towers, flagpoles or standing on mountaintops. It is likewise a poor time for adventurous vacations to Third World countries in western Africa.

And I think you should be about 1/20th as worried about Ebola as you are about lightening, proportionately  speaking.

Ebola is probably not coming to get you. We have been studying Ebola for almost 40 years and know quite a lot about it. It is a rather rare and fragile virus. Unlike influenza or MRSA, it doesn’t lie there on stainless steel all dried out and infect you a week later. It will degrade simply with drying. Virtually any common cleaning agent kills this virus.

The mental image people have of Ebola is Fukushima, where the nuclear crisis left the soil and everything contaminated for 100 years. That just isn’t the case.

These viruses don’t crawl, fly, or teleport; they just lay there. They are in dangerous high concentrations only on the fluids leaking from a badly infected person. That means you would have to touch this fluid without gloves and immediately wipe the sweat off your brow or rub your eye.

I don’t think it takes much medical training to know not to touch your face when your hands are dripping with diarrhea or vomit from another person (or yourself for that matter!).

The internet lives on excitement and Ebola is certainly an exciting subject. But rest assured, you have more to fear from global warming than Ebola.

Rationally yours,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy/ FreeDigitalPhotos.net

Put Vaccines on Your Back-To-School Shopping List

The start of another school year is looming and by now hopefully you have bought a few school clothes, an assortment of notebooks and pens, perhaps a backpack and freedom from disease.

Yes, freedom from disease. Did you know that belongs on your back-to-school list? We call them immunizations and these days we seem to talk more about immunization fears than about diseases they prevent. That is a luxury.

Child getting a shot

Despite 30 years of research on a population group so huge that any association with vaccine-caused disease would be spectacularly obvious, we still don’t have a shred of evidence that autism or related issues are caused by vaccines. But we sure know of some diseases that are vaccine preventable.

One of the first children’s vaccines that really changed the world was the Salk vaccine for polio 60 years ago. Polio was an infection of the intestinal tract, which was highly contagious and had the nasty habit of damaging the nerves in the spinal cord and brain.

This damage resulted in weakness, paralysis or permanent brain damage. Three doses of vaccine when young will make over 99 percent of people immune. Compare that to a lifetime in a wheelchair or iron lung (we call them ventilators these days). Polio vaccine isn’t a hard sell.

Of more recent vintage we have a meningitis vaccine (H Flu). This germ was responsible for a lot of miserable kids: upper respiratory colds, bronchitis or ear infection. Occasionally, severe pneumonia, or meningitis, even caused death.  A very small amount of vaccine and all of that goes away.

A 3-in-1 vaccine for measles, mumps and rubella has almost completely banished them from the U.S. and most of the developed world.

Talking about infectious disease, public health likes to talk about herd immunity, and they’re not talking Big Macs. This is about people as a herd. Infections are tough to control because they are easily passed from person to person, often before they even know they are sick (due to an incubation period when they feel OK).

Infectious germs don’t live indefinitely in one person. The person either conquers the infection or dies of it. In either case the germ dies, unless it can find a new victim.

Once a high percentage of the population is immune to the illness, someone infected would probably not encounter anyone to give it to. You don’t need everyone to be immune for everybody to benefit.


Now medicine is starting to think of vaccines in new and exciting ways.   Research identified a specific virus (human papilloma virus) as a major cause of cervical cancer.

A vaccine was developed to immunize against HPV infections and is being given to virtually all young women. These women who received the vaccine before becoming sexually active will never be infected by HPV and will never have cervical cancer. The HPV vaccine is the first “cancer vaccine.”

Many scientists who specialize in immunology and cancer believe this is the future of cancer – we will use vaccines to teach your body’s defenses not to let cancer even start.

Anyone who has ever had cancer cut out, radiated or poisoned with chemotherapy will appreciate the simple elegance of a vaccine to not let it start.

So when the school nurse tells you that your child needs a vaccine, spend a moment thinking about the disease it prevents, and thank her for reminding you.

Take care and don’t forget to get your flu shots later this summer.

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Images courtesy/ FreeDigitalPhotos.net

How to survive working the night shift

I spent 15 years doing rotating shifts, which included many nights working as a physician in the emergency room and previously as a law enforcement officer.

Those experiences give me plenty of insight regarding the effect of working nights on human physiology. What I didn’t appreciate until recently was the many things you can do to help improve the night shift situation, which I will get to in just a bit.

Woman sleeping

First, let me cover what is difficult about working nights. Sticking to science, I think it is fair to assert that life has been present for a very long time, probably at least several hundred million years (counting single cell organisms) and at least a few million years for humans, including our early ancestors.

Since life evolved under the influence of light from the sun, we’ve experienced several hundred million years of light influencing life.

Before electricity, almost no one worked nights. However, with the advent of electric lighting 150 years ago, suddenly we were able to work nights as well. But the absence of proper sunshine in our lives when we work nights exposes us to increased incidence of diabetes, heart attacks, strokes and even cancer.

Yikes, you might be thinking: “I need to get off these nights shifts.” But there’s no need to panic if you work evenings. The increased risks we are seeing are not really that high, but my point is people working nights should at least be aware of the possible health-related consequences.

Additional effects include weight gain from the influence of poor quality sleep affecting hormones, and a lack of Vitamin D, which is important in our overall health.

One hormone very important to sleep management is melatonin. You can buy it over the counter, but I don’t recommend it. Our body makes the real stuff naturally and it’s much more preferable over popping pills. Our bodies produce melatonin when we get exposed to decreasing light. Melatonin helps induce sleep and kicks in when you want to be heading to bed.

As sunshine – specifically the blue wavelength within  – is sensed by specialized cells in our eyes, our production of melatonin starts shutting off and serotonin and cortisol start to kick in. You want serotonin (the “happy feel good” hormone) and cortisol, the stress coping hormone, to be naturally produced when you wake up.

Doctor making clipboard notes

These days, human beings are still possessed with a physiology evolved from millions of years of sunshine and darkness guiding our circadian rhythms, yet now must also contend with artificial light influences and night shifts.

Artificial lighting can emulate sunshine and either interfere or aid our health. LED TVs, cell phone screens, iPads, and other household and personal electronics are increasingly exposing us to artificial “sunshine,” which plays havoc with our hormones and health.

So what is a night shift worker to do?

1. Master the light genie! Managing light to prevent its potentially disruptive influence when you are going to sleep and exploiting it when you wake up will do wonders.

I have insomnia patients wearing amber-tinted glasses that filter out the bioactive blue wavelength light. (Amazon sells Uvex or Solar Shields … if you wear glasses get the wraparound kind to cover your glasses). Wear the glasses toward the end of your shift, keep them on when you drive home, and until you go to bed.

2. Use a Sleep Mask: Get a high quality sleep mask to keep free from the influence of light that might stray into your bedroom. Amazon sells great ones for about $25-$30 and your sleep and health is worth it.

3. Build a Cave! Make your bedroom dark, cool and quiet. Use blackout shades or even put aluminum foil on your windows, anything to make your room dark. Wear ear plugs so it is quiet and consider augmenting your AC so it is cool.

4. Make your sunshine even when it is night! Purchase some full spectrum LED light bulbs. They are pricey at about $40 a bulb, but will save you money in energy costs and help produce serotonin, cortisol and stop the melatonin, so you will be ready for work.

These four suggestions should be helpful to night workers, who are often fighting fatigue and desperate for sleep.

Pleasant dreams!

Dr. Sean O’Mara is an Area Medical Director for U.S. HealthWorks in the Minneapolis area.

Images courtesy/ FreeDigitalPhotos.net

Can lifestyle changes dramatically cut Alzheimer’s risk?

The Alzheimer’s International Conference was in Copenhagen last week; and there was a lot of news to share.

In truth, Alzheimer’s disease is seldom out of the news because it affects 5 million people in the U.S. and is the most common form of dementia. It is a relentless and progressive attack on the brain.

Older woman sick

As the population ages we are expecting the amount of Alzheimer’s to triple in the next 30 years to more than 16 million. It is now the sixth leading cause of death in the U.S., and kills more people each year than breast and prostate cancer combined.

It is a nearly universal experience to fear for our minds when we forget our keys or where we parked the car. We whisper to ourselves: “Could this be the start of Alzheimer’s?” Sometimes we cover this genuine instant of terror with some quip, tossed over our shoulder to ward off bad luck.

But the truth is, we all need to do one thing: Relax.

Sitting in front of a computer that never forgets anything, never tires, never has an “off day,” gives us unrealistic expectations for the flesh and blood hard drive in our heads. If we remembered every moment, recorded the full bandwidth of our vision and other senses, our brains would be overwhelmed and shut down.

While a cerebral reboot might sound refreshing (rinsing off my brain with cool water has always sounded good), forgetting is actually a blessing that keeps us functioning.

We have been trying to get a handle on Alzheimer’s for literally 100 years. In medical school (several decades ago), Alzheimer’s was briefly thought to be an aluminum storage disease. So using an overabundance of caution, the med school students only drank beer out of bottles!

The anatomy behind Alzheimer’s has been known from the first. Neuro tangles are exactly what they sound like, and plaque. The trouble is, we don’t know if these are the causes of the disease or the result. We have even discovered some treatments that clear away the neuro tangles, but it doesn’t seem to help patients. I guess this year we are favoring more egg than chicken.

But there is good news. The medical community looked up from our single-minded pursuit of the perfect medication and found lifestyle changes were actually effective.   Ironically, these are all the same things we have been talking about to prevent heart disease.

Preventable measures include a sensible diet that is low in fat, exercise, achieving ideal body weight, management of hypertension or diabetes, and of course, not smoking. These choices limit damage to the blood vessels and protect the heart. The interesting thing is atherosclerosis (hardening and narrowing of the arteries) is not the mechanism for Alzheimer’s to our knowledge, but if it works – and it does – why argue?

One additional lifestyle choice to prevent Alzheimer’s is to exercise the brain. That can be done through reading a challenging book, engaging in thinking games like crosswords or Sudoku, or studying almost anything that is new to you. This not only discourages Alzheimer’s, but makes life a lot more interesting.

This year we found the first proof that lifestyle changes dramatically cut your Alzheimer’s risk. These are more effective that any medication we have come up with to date.

And while you are busy preventing Alzheimer’s, you are also discouraging heart disease, so that means you will live long enough to enjoy all the memories you have collected.

Take care.

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy/ FreeDigitalPhotos.net

Common sense health tips from Mom

A couple of decades ago we all read a book celebrating the useful lessons gained in kindergarten. And while that covered many essential life skills, it short-changed the moms of the world, who taught us everything most of us know about health and illness.

I’m a doctor and when my kids are sick the first thing I think is: “What would mom do?”  Sometimes I combine mom’s advice with some antibiotics, but I’m kind of a belt and suspenders guy.


What mother didn’t earn her stripes suggesting – a few jillion times – that we eat our vegetables? Good advice, and if followed we would all live healthier, happier lives; albeit with less culinary excitement. Can you really die of boredom?

On the dietary side, one thing mom didn’t tell us, of course, was to drink red wine. But drinking red wine in moderation could raise our HDLs, our good cholesterol, and perhaps undo some of the damage from artfully hiding, but not eating, our vegetables.

I believe it was my mom that first taught me to wash my hands. During my surgical training, a full pre-op scrub was only a modest improvement on her good technique.

Washing hands has become even more important in this world of antibiotic-resistant bacteria. Methicillin-resistant Staphylococcus Aureus (MRSA), a type of staph bacteria that is resistant to certain antibiotics, and hospital acquired superbugs have been the scourge of even first-class medical institutions, and have caused much suffering and death.

These bugs have resisted almost all attempts to control, but surprisingly enough, the humble low-tech act of hand washing makes a huge difference.

Hands get into everything. We use them to explore our universe, much like a cat uses its whiskers. We touch surfaces and other people, and without thinking, rub our eyes or scratch our nose. The medical term for this is auto-inoculation; you have just inoculated yourself with whatever germs your hands have picked up in their travels.

Washing hands - woman

Does hand-washing really make a difference? The two leading causes of childhood death worldwide are pneumonia and infectious diarrhea. Studies have shown that hand washing cuts the deaths from diarrhea by 50 percent and pneumonia by 25 percent. Those are big numbers for such a small and easy act.

To understand why it works, you need to know that we are covered by a thin film of oil made by glands in our skin. It helps make us pretty waterproof, but this is where the bacteria hide.

Soap works because it dissolves oil into water, allowing the bacteria to rinse away.    Neat trick! Superbug or harmless variety; down the drain they go.

I also remember mom chasing us from in front of the TV, with a “shoo” and a “get outside and get some fresh air.” Air inside the house is actually more germ-filled than outside.

Tightly closed-up houses cause winter to be unhealthier with respiratory germs than summer. Why share air when you can go out and get some fresh air?

While outside getting some fresh air, we generally ran around quite a bit. Mom managed to get us exercise, fresh air, and vitamin D with merely a “shoo” and a wave of her hand. Of course, she just might have been trying to get a little peace and quiet as well.

Mom was my first medical college professor. Her common-sense approach to health included a lot of great recommendations.

My advice to you: Wash your hands, drink a little red wine and practice pretending to eat your vegetables.

Take care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Images courtesy/ FreeDigitalPhotos.net


Ebola: nasty virus with no known treatment

As I drive home, I listen to NPR. I hear a report with one word that gives me a start … “Ebola.” I have studied influenza, so I know just enough about viruses that my heart skips a beat and I feel an instant of nothing less than terror.

I don’t scare easily, but combine a highly infectious virus, a 90-percent mortality rate, no known treatment, and you can see the problem.

Sick man in hospital

So why does Ebola seem to spring up in places like Uganda or the Congo, and not in New York City? Why does it seem to stop after infecting a dozen or a 100 people, and not decimate the globe? Is this likely to continue or should we all be investing in biohazard suits?

Ebola is a virus, the simplest form of life, designed with an economy that is almost as elegant as it is terrible. It is merely a blueprint of itself, without even the metabolic machinery for reproduction. To survive, it must hijack your cell’s ability to multiply and make millions of copies of itself, usually at the cost of your own survival.

Viruses like Ebola seem almost suicidal. They are so rapidly lethal that the virus doesn’t have much time to spread. The virus survives at times when no human is infected by living in an animal species that tolerates it, (an animal reservoir).

Less dangerous viruses, like the flu, are a little more evolved and don’t kill their host before it can spread. This is a clear benefit to both influenza and the human race.

Where Ebola hides between human attacks has been the subject of much research. Get rid of the reservoir and you get rid of the virus. The best animal candidate for the Ebola reservoir is the fruit bat.

The more usual suspects, such as small mouse-like rodents, have been ruled out. How does Ebola get started in humans? A bat drops a half-eaten piece of fruit that is contaminated with bat saliva, containing the Ebola virus.

Ebola is one nasty virus. You get the usual viral symptoms: fever and chills, headache and muscle aches, and often nausea, vomiting and diarrhea. It goes rapidly downhill from there. You often develop a coagulation disorder and start bleeding from various orifices.

Major organ systems start failing, such as renal, cardio-respiratory, and neurologic. All this occurs in less than a week. Every secretion is highly infectious, including vomit, diarrhea, saliva and blood. The body remains highly contagious, even after death.

The virus is passed by direct contact with the body or any of these secretions. In these areas washing of the body before burial, by members of the family is part of the burial ritual. This practice often infects the family members who are doing the washing.

This is called “direct contact transmission.” The secretions get on your face or your hands and the virus gets in through mouth, nose or eye. Ebola has a single weakness, which is a great blessing for all of us.

Unlike influenza, Ebola doesn’t spread by cough or airborne dispersal of viral particles. You don’t inhale it. For this reason, no one is going to infect an airplane full of people.

For that reason, Ebola is not likely to pop up in the middle of some American city. The absolute viciousness of the Ebola virus also works against it. You are simply too sick to travel.

Simple barrier protection (gown and gloves) are all you need to contain an outbreak of Ebola. These are low-tech items that are easily available and inexpensive for the remote locations where Ebola occurs.

Usually Ebola is picked up by a single member of a family living in an area near fruit bats. This infected person rapidly worsens and may transmit the virus to household members as they attempt to take care of the victim. This causes a spread to a few 100 people, and the alarm sounds. The most recent outbreak involved three regions of 3 countries that were next to each other.

To contain the outbreak, the area is quarantined by health workers, taking full viral precautions (biohazard suits). Medical support is provided for the victims, and a few may be lucky enough to recover. After all contaminated fluids, bedding, and deceased patients are incinerated, the outbreak is over.

Several vaccines are being developed to fight against the Ebola virus and hold promise for the future.

Ebola is ultimately a victim of its own lethality. Patients with Ebola are much too sick to travel, which limits its range. Its outbreaks are furious, but localized – one more exotic horror in a land far away.

My advice is invest your worry time in the next influenza epidemic, which at least you have some control over. And one more piece of advice – don’t adopt any stray fruit bats!

Take Care.

Dr. B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy/ FreeDigitalPhotos.net


How to avoid common golf injuries

Phoenix is a veritable golf Mecca. By last count we had 247 courses. If you didn’t need to worry about making a living, playing one new course every weekend would keep you occupied for nearly five years.

This time of year, tee times start with the sun just peeking over the horizon – it’s 5:30 a.m. and already 90 degrees! The sunrise nicely silhouettes the saguaro cactuses, which remind you where the grass stops and the desert begins. The rough really is rough here, complete with reptiles.

Golf caricature

But even in Phoenix the most common golf injuries do not involve rattlesnakes or golf balls (directly).

Golf is perhaps more than anything else a game of inscribing consistent fine arcs in the air by both club and ball flight. Rotation is the order of the day.  Specifically, rotation with both feet firmly planted in the grass.

In a sense, you wind yourself up and uncoil. In a well lubricated machine this happens without a hitch. Unfortunately, muscle, joint and bone don’t have lubrication ports.

The low back is the most frequent body part to complain in regards to golf, rebelling against the otherwise smooth ballet of motion.

The lower back is one of the most complex structures in the body. Ligaments are the straps and cables that hold the bones in place. It’s important to know that ligaments will physically shorten if not stretched out regularly. That means joints lose motion.

The tightest joint ends up being the weak link/the Achilles heel. The good news is the vast majority of golf-related low back injuries resolve in a few weeks. They seldom involve ruptured discs, which come from (axillary) loading the spine.

Some regular back stretching is a good preventative measure. If your schedule permits, some yoga would also keep you out of trouble, and probably help your game. Williams Flexion exercises are well proven and take only five minutes every morning.

Female golfer lining up putt

The shoulder is the next most common golf injury. Shoulders are very unique. Mechanically they are almost universal joints that possess an extreme range of motion because the joint is not a classic ball and socket, but rather a ball held against a slight depression.

There are no socket walls to limit motion in the shoulder. The joint stability is entirely based on ligamentous support. Yes, those same ligaments will shorten without regular stretching.

If you did an experiment with your healthy shoulder, and didn’t raise your arm for a month, you would not be able to raise it without six months of physical therapy.    Tight ligaments can get torn during a golf swing. Unlike the low back injuries, shoulder injuries due to golf are often surgical in extent.

To avoid shoulder injuries, the prevention is regular exercise and stretching.

The elbow is the next most common golf injury. Strangely enough, golf can give you a serious case of tennis elbow.

The muscles in the back of your forearm, the ones that extend your wrist, attach at a knob called the lateral epicondyle. Microscopic tears can develop at the attachment of the muscle to bone.

Treatment can be as simple as taking a few weeks off and avoiding palm down lifting. However, if pain persists, some therapy or a shot of cortisone usually takes care of it. Surgery is rarely required.

Speaking of time off, approximately 50 percent of the golfers on the PGA tour have missed play for a month or more due to golf-related injuries.

It is perhaps less obvious that physical preparation is needed for golf, as opposed to football. Yet don’t be fooled – golf has very real injuries that can ruin your day, or summer.

Take care and good luck trying to hit that little white ball straight!

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Images courtesy/ FreeDigitalPhotos.net