Flu Season Revisited

In many ways Influenza is an impressive force of nature that has successfully adapted to human efforts to defeat it – ever since there were humans.

The early efforts were common sense and as primitive as the times – stay away from the cave where everyone got sick and died. That was somewhat successful, until someone in your cave succumbed. The influenza virus couldn’t be too deadly, or it could wipe itself out in a single season.

Child getting a shot

The simple tug of war between the influenza virus and humans has evolved over the eons.

The virus resides safely in birds, pigs and various domestic animals where it continuously reinvents itself. Third World countries do not engage in industrial farming. A pig or cow is the most valuable possession they own, the one that will feed the family; so they keep it within close range.

The virus, always mutating, always changing, is always around your house and family in various unsuccessful forms. By luck, the virus stumbles on a change that makes it contagious to you, and equally importantly, makes it able to be passed person to person by airborne transmission (juicy coughing).

A star of sorts is born. A new influenza virus is ready to go on its world tour.

Fortunately, we know the trick in the 21st century and have WHO and CDC scientists close by to take samples of the new bugs. We hold a few auditions and pick the top-three contenders for world infamy.

Then over the course of three months we make pure colonies, break them up into the pieces most stimulating to our immune systems, and create about 160 million doses of four kinds of flu vaccine (regular, high-dose for the elderly, intradermal, and nose spray).

Now the fun part begins. We have a couple of nasty flu viruses waiting in the wings for their opening, and we must somehow convince most of the population to get vaccinated, preferably in the next four weeks. A vast network has distributed the 160 million vaccines to virtually every community in the country.

And sadly, often times that’s where they sit.

Syringe n needle

A certain percentage of the population doesn’t need much convincing. They are in poor health and know a bad case of flu will be the end of them. People who have had influenza in the past are eager to avoid a repeat of that experience.

But the rest of us, lucky in the past, perhaps foolish in the present, don’t put getting a flu shot very high on the list. I will go on a diet tomorrow, quit smoking as soon as work settles down, and get a check-up next week. Yet the weeks go by and the multimillion dollar influenza vaccine, the magic bullet against the current strains of flu, sits in the refrigerator.

So we remind everyone that 15,000 to 40,000 people will die in the U.S. of flu this winter. We talk about herd immunity – protect your friends and loved ones.

And a wave of demand slowly builds and some of that vaccine gets used.    Some of us get sick with the flu and motivate our friends. People start noticing friends absent from work and school, resulting in a few more getting vaccinated.

In the end, most of the vaccine is used – some way too late – and we still manage to lose 15,000 to 40,000 people, and ponder how to do better next year.

The CDC recommends influenza vaccine for everyone before the start of the flu season. That is a sensible and simple recommendation.

Do it today, and you can save yourself, and start that diet next week.

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

Enterovirus 68: The New Kid in Town

There is a new virus in town. It might not be your specific town right now, but it certainly could be arriving soon.

It is a member of a group of viruses well known to doctors and patients alike.  The Godfather of the group is poliovirus, an intestinal infection with the bad manners to sometimes leave you paralyzed. Jonas Salk put a stop to that nonsense, though it unfortunately still exists in several developing countries.

Virus alert

Another member of the group causes hand, foot and mouth disease, which sounds much worse than it is. The remaining enteroviruses are a frequent cause of upper respiratory infections, conjunctivitis and other miserable but unexciting minor illnesses.

The new guy is Enterovirus 68, whom we have known about for a while, but has not distinguished itself as the cause of any significant mayhem – at least until now. In early September, 12 states had reported suspected outbreaks of Enterovirus 68 and it’s expected to spread nationwide.

Enterovirus68 is not the next Ebola, but it can give you a heck of a chest infection – the chest cold from hell, so to speak. Being a virus, we don’t have great specific medications against it, but never fear; nobody does supportive care like we do supportive care.

What exactly is supportive care anyway? Think of it as the ultimate babysitter, ever watchful and vigilant, intervening at the least sign of trouble. If oxygen gets a little low, we’ll hook some up for you. Breathing too much work? We can do that for you as well.

The point is to keep you going long enough to make some antibodies and kill this stupid virus. You will ultimately heal yourself; we just need to buy you some time, hence “supportive care.”

How do you get Enterovirus 68? This is not a fly-through-the-air virus. This is a forgot-to-wash-your-hand-before-eating virus. There is a medical term for this, which is descriptive, in that mater-of-fact way gross medical things often are:  fecal-oral transmission.

Nurse with syringe

It arrives like sudden enlightenment – so “that’s why Mom made such a big deal of washing hands before dinner!” Mom grew up with (or heard about) polio, and washing your hands before eating could be a life or death decision. She remembers and wants you to as well.

Enterovirus 68 is getting a lot of attention simply because it is new. In the vast majority of patients that catch it, it’s simply a bad cold and medical care is pretty optional.

However, for the few that have other respiratory or immunological diseases, Enterovirus 68 is a threat. For someone with asthma, this virus, like many respiratory viruses, can get serious enough to land you in the hospital, even on a ventilator.

Most people with asthma and other chronic respiratory problems are very attentive to signs of a worsening chest infection.

Of the bugs in the news today, Enterovirus 68 is relatively well behaved, and you will get over it. We don’t have a vaccine yet; that development is probably a few years away.

In the meantime, I would remind you that Mom’s advice was usually sound – extra hand washing never hurt anyone!

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

Pain Medication in America

We’ve heard it, we’ve thought it, and occasionally we’ve even said it – “Life is a pain.” Some of us even decide to do something about it; so we get some pain pills.

“Life pain” is not exactly  what opiate pain pills were designed for, but they do put you out of your misery for a while. Life pain is more often stress, anxiety, depression, exhaustion, disappointment, fear and perhaps a smidgeon of existential funk.

Pill capsules

Those are a lot of symptoms to relieve with one pill, but we’ve tried. Valium was the 1970s answer for all of the above and more. In the ‘80s we tried Xanax, the ‘90s it was Prozac, and in the Millennium, it’s Vicodin.

Are we treating disease or just the misconception that life should be a soft drink commercial? Are we (doctors) not responsible for training our patients that there isn’t a pill for virtually everything?

Did the message get garbled and become “there is a pill for everything.” And who is in charge of the Unrealistic Expectations department – doctors, patients or both?

At least Valium, Xanax and Prozac have limited toxicity and addiction potential. Yet that’s not the case for Vicodin and other favorite opiates (narcotics).

Narcotic addiction made the cover of Consumer Reports last month. That’s a little strange because that publication is known for protecting the consumer from the evils of bad toasters or slow laptops. Dangerous narcotic medications have evidently raised the alarm in all quarters.

And there have recently been some very public deaths of some of our most celebrated citizens that involved prescription narcotics. That always helps to shine a bright light on a problem.

Pain is a strange phenomenon. I have had some unfortunate experience with pain, thanks to pushing my physical limits and the two resultant  low-back surgeries. Pain is not measurable like blood pressure or BMI. In fact, you can list every characteristic you can think of, and you still won’t have a working model of pain.

Acute pain is easy. Break your arm in three places and it’s going to hurt. Pain will be the center of your universe for a week or so. It will be hard to do anything without some pain control. Narcotic pain pills are good in that instance, and blessedly the pain is short lived.

These same pain medication pills are a lousy candidate for pain that lingers, like the ache in my back from surgery 12 years ago. The wear and tear on our bodies is inevitable because we’re living in them for such a long time.

Most problematic is that you adapt to narcotic pain medication after just a few short weeks – it’s the nature of the beast – and that same dose of medication stops controlling your pain or putting you in a good mood.

Bottle of pills

An ever increasing dose will be required to chase those elusive targets. In the meantime, you will be dealing with some other narcotic side effects: constipation, lethargy and respiratory depression.

Get the dose high enough, or add some alcohol, or our old friends Valium/Xanax, and you may even stop breathing. Usually this is unplanned, and a paramedic team is not hanging out in the room with you, which dramatically decreases the survivability of respiratory arrest.

Human beings have been struggling with opiates since the poppy plant was discovered.   And while narcotics offer the sweet promise of relief from all torments, like Ulysses’ Siren’s call, only darkness and death await.

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

 

 

Modern Plumbing: The Answer to Ebola epidemic

The Ebola virus continues to rage now in five West African countries. The death toll is close to 2,000 people, but that number could grow exponentially.  Thomas Frieden, the head of the Center for Disease Control and Prevention (CDC), believes there could be 20,000 infections soon.

Frieden feels we are losing the best opportunity to contain the deadly virus. The nature of Ebola is that every day more people are infected, and it becomes more difficult to trace contacts and contain the epidemic. If you think it’s difficult to control today, just wait until next week!

Sick man in hospital

The United States has infrastructure that makes it unlikely we will ever see more that a very rare Ebola patient on American soil.

Everyone is talking about monoclonal antibody serum, high tech ICUs and the Center for Disease Control’s Level 1 response – all the excitement and technology that Hollywood glorifies in thrilling movies like “The Hot Zone.”

Yet it isn’t the fancy space suits that protect us. This may come as a surprise to you, but it’s indoor plumbing and Lysol keeping us out of harm’s way.

Think about it for a minute. The fluids from an Ebola patient are the problem. They are highly contaminated with the Ebola virus – predominately diarrhea, vomit and blood. If a nation doesn’t have indoor plumbing, effective clean-up is almost impossible.

Think about the last time you had gastroenteritis (commonly known as the stomach flu). That often causes profuse nausea and vomiting, but you used the toilet and flushed it away.

If you missed a little, you likely cleaned it up with paper towels, antiseptic wipes, bagged or flushed everything, then sprayed plenty of Lysol. And you probably washed your hands multiple times throughout the whole procedure.

The end result? There wasn’t infectious fluid lying around for another person to come into contact with.

Ebola isn’t a very hardy virus. It is easily killed with routine cleanup.

We don’t have Ebola epidemics here in the U.S. because our public health system is designed to keep us clean and sanitary. We’ve been trained since childhood to wash our hands with plenty of soap and water. Hand sanitizers are everywhere you look and disinfectant wipes are now situated next to the grocery carts to wipe the handles.

We wash our clothes in laundry detergent. We have residual chlorine activity (which kills germs) in the water we use to wash our cars.

There are layers of protection that we don’t even think about that surround us every minute.

But for nations in Africa and other places that don’t have the same infrastructure and high regard for sanitation, the medical community needs to devote its energy to developing a vaccine.

In the meantime, no one’s energy should be spent worrying that Ebola could sweep our nation.

Here’s to indoor plumbing!

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

Labor Day: Work Might Just Be Good for Your Health

Labor Day is the holiday specifically intended to celebrate “the strength and spirit de corps” of the working person.

Businessmen

It was dreamed up in the 1880s, and similar worker holidays have spread around the globe. Many workers still get the day off – unless you are in retail!

While we celebrate Labor Day, the fact is our society seems to celebrate the concept of retirement much more.

Most workers sincerely believe work is bad for them: “This job is killing me,” or “this job will be the end of me” are too familiar refrains – at least when the boss isn’t around.

We are conditioned to look forward to retirement – we call them the “golden years,” after all. That might well have been the case when working meant a long day of manual labor in the coal mine or the fish cannery.

But when medicine finally started studying retired people, one thing was immediately obvious: they died more than working people. This didn’t seem like much of a discovery, given that retired people are older, and some retire for health reasons.

But retirement is actually a pretty complex process. Quitting the old 9-to-5 routine involves changes in stress, activity level, diet, sleep, intellectual stimulation, physical and psychological health, and that is just scratching the surface.

Royal Dutch Shell researchers studied 3,500 retirees for whom detailed records of health, mortality data and retirement age were all available.

The most dramatic finding of the study, published in 2005 in the British Medical Journal, was for those who retired at 55 was they had approximately double the mortality rate in the next decade than those retiring at 65. That means for the young retirees, the years 55 to 65 were twice as lethal as the years 65 to 75 for the older retirees.

And the younger decade should be a bunch healthier than the older one. So not only was the death rate much higher, it was higher in younger people who should have been healthier. Counterintuitive, isn’t it?

Circle back to changes. Retired people don’t have to get up early and go face the world; they can sleep in. In fact, the opportunity for naps goes up considerably. This was the point of retirement after all.

But the total activity during the day, when measured scientifically, goes dramatically down with retirement. We retire with plans of playing golf every day and something gets in the way – either the cost, desire or the enthusiasm for the game when it isn’t a special treat. In the end, we move less and die quicker.

A lot of sports, activities and avocations do not respond well to unlimited pursuit.  People burn out. Personally, the only activity I have maintained enthusiasm for over the last 40 years is skiing.

I suspect a big part of that is because I can only ski a few precious days each year. A famous entertainer once said:  “Always leave them wanting more.”

Work provides more than just some movement in life. For many people, work provides a reason to get up each day. It provides self-esteem, friendships and social contact. It also provides stimulation, accomplishment and an outlet for creativity. Many of our friendships started at work and for some work is the only social contact they get.

Yoga at work

So this Labor Day, take a careful look at what you do for a living, and realize this work thing is not simply trading time for money, but how you spend your life.

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

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.

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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. 

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