Physical Therapy Involves ‘Motion is Lotion’

As a physician, I am often asked questions about things out of my realm of expertise. Certainly if one is about to give birth, you don’t go to an ophthalmologist or dermatologist.

However, when questions come my way related to either of my two specialties – internal medicine and non-operative orthopedics – I’m always pleased to provide direction.

Physical therapy 1

One area that I see as a common ailment in my day-to-day practice is issues related to muscles, bones and joints. Certainly it is one of most common reasons people see their primary care physicians and show up to the Emergency Room as well as to Urgent Care.

My interest in musculoskeletal medicine came from my interest in sports. And as I advanced in my career and study of medical science, one thing struck me as quite remarkable: how are physical therapists able to get patients back to their pre-injury state so rapidly from a point of significant dysfunction?

To me, physical therapists were near miracle workers. As an intern, I was practically mystified by how they achieved such positive results in such short order.

What I was watching was the end result of a physiological process on the cellular level called mechanotransduction. This word does not connect to anything in a spell check and it may as well be a foreign language.

Specifically, it is a term that describes an intricate process that has developed over millions of years of evolution wherein injured tissues, from soft tissue like muscles and tendons to hard tissues like bone, all use it.

Physical therapy 2

It is a complex process that takes place when there is movement of tissues by one another. The cells glide by each other, flip certain signals on the surface of the injured cell that alerts the nucleus to direct the ribosomes to initiate a “healing protein” of sorts.

This “healing protein” is directed toward repairing the injured tissues. It was German physician, Julius Wolff (1836-1902), who first described mechanotransduction as a process that is induced when cyclic loading was applied to bone.

To keep it easy for myself and the patients I treat, I refer to mechanotransduction as “motion is lotion.” It’s an easy, clever enough catch phrase that patients seem to like and remember well.

So get out there and put that intricate process to use by way of “motion is lotion.” You’ll prevent further injury, repair tissues that need healing, and live longer.

Remember that the American College of Sports Medicine (ACSM) recommends 2½ hours of cardiovascular exercise a week, so get after it. However, also remember that a physical therapist comes into play in instances when injury occurs.

The correct amount of loading and motion to the injured areas needs to be applied and you will likely need some help at the start with a structured rehabilitation process as recommended by a physical therapist.

Although regular exercise is important to our overall health, injuries sustained from repeated action (overuse injuries) are among the most common types of musculoskeletal injuries seen across all ages, so be careful.

Dr. A.K. Misra, MD, is the Medical Director for U.S. HealthWorks in South San Francisco.  He specializes in an Internal Medicine and Sports Medicine.



Former Navy accountant balancing large family and new role with U.S. HealthWorks

As a medical coder, Julie Brown is responsible for ensuring that U.S. HealthWorks properly bills insurance companies for services provided, which is no easy task.

“It is amazing how detailed and precise Julie is every single day,” said Coni Petty, who is Julie’s supervisor from the Coding and Reimbursement Department in Alpharetta, Georgia.

U.S. HealthWorks employee Julie Brown and her husband J'erome have seven children and live in the Atlanta area.

U.S. HealthWorks employee Julie Brown and her husband J’erome have seven children and live in the Atlanta area.

That precise training comes from Julie’s 20 years spent in the Navy. Stationed in six different states and at eight different bases, Julie was responsible for keeping track of the Navy’s finances at each stop. That included ordering supplies and ensuring bills were paid on time.

“I didn’t want to leave the military,” Julie admitted. “But when it came time to go, the Navy gave me the perfect training to find a job with U.S. HealthWorks.”

While her work is challenging and demanding at times, there’s little rest for Julie when she arrives home. She is the mother of seven children. However, at one point in her young marriage, being a mother was no guarantee.

Husband J’erome Brown was told he would never have kids of his own. So when Julie got pregnant, the couple was a bit surprised.

“My husband asked me jokingly, ‘‘whose kid is it?’” laughs Julie.

With the odds seemingly against the couple, what has transpired is somewhat amazing. Nearly 14 years after the birth of their first child, the Browns now have a large family.

Julie Brown, bottom right, spent 20 years in the Navy before coming to U.S. HealthWorks.

Julie Brown, bottom right, spent 20 years in the Navy before coming to U.S. HealthWorks.

“My husband wanted 13 children once we found out he could have kids, but after we got to five, we realized it was a lot to handle,” Julie confessed.

Raising Michael, 13, George, 11, Donovan, 10, Alex, 8, Solomon, 6, Corban, 5 and Magdalene, 3, is a full-time job for most. But for Julie, it is only half of her responsibilities.

“I’ve always wanted to be in the medical field, but being a doctor or a nurse wasn’t really my thing,” she said.

Since joining the U.S. HealthWorks team in August, Julie has quickly earned the respect and admiration of her co-workers.

“As a mother of seven, you might expect to see her frazzled, coming into the office with messy hair and maybe even slippers,” jokes Petty. “But Julie couldn’t be further from that. She is always on top of things and never misses a beat in her work.”

Julie signed up with the Navy right out of high school in Salem, Oregon, for the opportunity to go to college.

Julie Brown re-enlisted in the Navy at a Tampa Bay Rays baseball game.

Julie Brown re-enlisted in the Navy at a Tampa Bay Rays baseball game.

“I thought it would be a great chance to earn money for college, but then I ended up staying in for two decades,” Julie proclaimed.

After she made it through basic training, Julie says the Navy gave her two choices.

“I was given the option to be a cook or go into accounting,” Julie said. “I can’t cook, so it wasn’t much of a decision to make.”

During a training stop in Florida, Julie was introduced to J’erome, a Navy instructor. The two hit it off instantly. Once they married, the couple decided to settle down near J’erome’s family in the Atlanta area. Coming from a big family of 12 children, J’erome wanted his wife and children to be close to his 11 brothers and sisters.

Having so much family close by would have been built-in daycare if Julie had ever been deployed.

“I was told I would be heading overseas 10 times since having our first child,” Julie said. “But each time we packed up and made arrangements for the kids, I was released and was able to stay home. It was quite a relief.”

With a mini Navy of their own at home in Acworth, Georgia, the family is kept on a tight and rigorous schedule.

Between shuttling kids to football practices, karate classes and school, Julie also makes time to volunteer at the Acworth Women’s Center that helps young mothers and their families.

Balancing it all is not easy for the Brown family, but Julie says she wants to set an example for the children.

“I like to show them what is possible if you put in the work. I tell them, ‘I got straight A’s in college while raising all of you, so there is no reason you can’t get straight A’s too!’” she said.

Julie gets a great sense of reward from her time at work and volunteering, but her biggest joy comes when she arrives home.

“After a long day, there is nothing quite like all of the hugs, kisses and art work I get from my kids,” she said.

Controlling Cholesterol: A key to good health

Not a month goes by without hearing about bad cholesterol, good cholesterol, and even very bad or very, very bad cholesterol.

You can’t make this stuff up. Most of us just came to grips with margarine, which was supposed to be good for us, but it’s actually bad for us. And butter is bad as well, but not as bad as margarine. Got that?

Health Chart

I don’t think there is actually a conspiracy to confuse, some dark plot to keep health information securely inside the physician’s guild. It is rather the nature of research and of humans.

Scientists get understandably excited when their life’s work comes to fruition. They   want their answer to be a really important answer, one that will remain a cornerstone of medicine for half an eon.

Those hopes can make a researcher’s conclusion seem much more important than it perhaps really is. Then the medical media machine gets busy, breathlessly reporting every new health finding.

The result can be that some health-conscious people, thinking they are prudent by keeping up on health news, become frustrated by conflicting information.

Cholesterol is an important molecule in our bodies; the base molecule for many hormones. Estrogen, progesterone, cortisol and testosterone are all made from cholesterol. Without it, you wouldn’t know which sex you were, among other problems.

Your body is able to make cholesterol for this purpose. So dietary cholesterol is not only unnecessary, it can be harmful.

Cholesterol does not go round and round in your blood stream buck naked. It travels in various packages, which have different destinations, and are named by size.

Breakfast food

Low density lipoprotein (LDL) is the classic “bad cholesterol” that blocks (plugs) blood vessels. When the blood vessels are blocked by cholesterol in the brain they cause a stroke. When the same thing happens in the heart, the block causes a heart attack. Very LDL (VLDL) is smaller than LDL, but is considered bad cholesterol.

High density lipoprotein (HDL), the classic “good cholesterol,” is the street sweeper of the cholesterol world. Its function is to scavenge cholesterol from the vessels, and recycle it to make hormones or be excreted by the liver.

If you hope to live a long time, getting your cholesterol under control is one way to do it.

Here is the next level of complication. Animal fat is highly saturated, and is the biggest contributor to LDL and heart disease. One way to get LDL cholesterol down is to remove as much red meat and dairy from the diet as possible.

Less saturated fat means less cholesterol and LDLs, which equates to having less chance of heart disease.

Exercise has many benefits, and one of them is reduction of LDL, and an increase in the good cholesterol (HDL), which is a double-down on benefits.

Alcohol in modest amounts raises HDLs also. One drink a day is the correct dose. If you want your drink to be even more effective, try red wine. Besides increasing your HDL, it is full of other heart healthy pigments, another bonus.

Body weight also affects cholesterol. Obesity is associated with both increased cholesterol and cardiovascular disease. Diet and exercise can reverse obesity.  Fortunately, the cholesterol in your blood changes faster than your body weight when you start on a diet.

While double cheese burgers and pizza are best saved for special treats, there are other foods that provide many benefits. Nuts in general are low in cholesterol and saturated fat, yet high in unsaturated fat and protein.

If all this seems a little unnecessarily dense, that is the nature of the beast. Perhaps math is more straightforward. Less Red Meat + more exercise + a little wine and almonds = long life = a fighting chance at better health.

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/

Ebola scare: No Reason for U.S. to Panic

A new case of Ebola has been diagnosed in Dallas, Texas, and apparently the man in question did not arrive in a biohazard suit on a plane direct from Western Africa.

Many of us are glancing out the window to see if the sky might indeed be falling. If you are not close to a window, from where I sit, it’s not.


Now, Ebola is one of the most terrifying infectious diseases ever to grace a Centers for Disease Control and Prevention (CDC) warning.

Ebola is indeed a nasty one, but I would happily take my chances with Ebola over cancer, a major heart attack, or even a badly broken heart (the kind that makes you wish you were dead).

In the United States, we are darn good at supportive care. But you have to be exposed to the disease to even have the possibility of trying out said supportive care at the local ICU. And that is distinctly unlikely.

A little light virology (study of viruses) would be helpful for many people. Ebola is a pretty easy-to-kill RNA virus. A good drying out is enough to kill it. Clorox wipes, Lysol spray and probably Mr. Bubbles can all easily overcome this fragile virus.

It does not fly through the air or otherwise do anything really scary. If you touched some wet secretion from a badly infected Ebola patient and immediately touched your face (before the secretion dried), you would be at risk – badly at risk. Otherwise, it is about as contagious as Hepatitis A. You have to eat the virus to catch the virus.

Sick man in hospital

But in this country, where indoor plumbing is universal, we put our secretions in the toilet where they belong. Simply using a flush toilet and some hand washing reduces the Ebola risk substantially.

Think about it, when was the last time you came into physical contact with a stranger who was very, very sick? Not something that happens very often in our germaphobic society. We tend to hide our really sick patients in institutions.

And that brings up supportive care. We don’t have any proven treatment specific for Ebola. But we do have the best supportive care in the world. If there is one thing our health care system can do, it’s create an all-out intensive care unit and keep you going against the odds.

In this country, Ebola would likely have a 15-20 percent mortality rate, not the 60-90 percent range in areas without great healthcare.

Like all bogymen, the idea is much scarier than the reality. A little information lights up those shadowy corners, and nothing is under the bed.

If you want to worry, let it motivate you to get a flu shot.

That way you won’t scare yourself into a heart attack when it’s just the flu!

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/


Top-10 Health Habits

Every time we turn on the TV or pick up a magazine, we’re told to do this or don’t do that, and if we follow the guidance, it will decrease our risk of some horrible disease by 17% or 29%.

If I added up all the reductions in risk I would live to be 143. Kind of puts a whole new spin on the Social Security solvency issue.

Women stair stepping

At the risk of ruffling a few feathers, I would like to suggest some order to the risk hierarchy. A logical starting place – if you plan to live a long time, and are actually doing something to facilitate it – is start here.

1. Stop Smoking (or don’t start): This is the most researched and has absolute consensus in the medical community. Smoking cuts 5 or 10 years off your life. If you do only one thing to live longer, this is the one.

2. Diet: I am reserving the No. 2 slot for what you eat, not how much you eat.

If you want to live a long time, eat grains, fruits and vegetables and avoid meats of all kinds, especially red meat. This is also very well researched and causes a dramatic decrease in Cancer and Heart Disease – the No. 1 and No. 2 killers in this country. Your life expectancy will increase by 5 or more years from this.

Breakfast food

3. Exercise every day: 20 minutes of some kind of exercise is the thing that will get you the most life for your time investment. Your life will be a few years longer, and perhaps more importantly, you will be able to do more and feel better. The cancer and heart disease rates are lower in exercisers.

4. Treat lifestyle disease: We are talking hypertension, Type 2 diabetes and high cholesterol. Some of these are a result of excessive living, some just genetic roulette – blame your parents. Treating these illnesses almost completely neutralizes the dramatic decrease in lifespan they can cause. Treating these diseases can easily add a decade to you life.

5. Weight Control: The other shoe. Not what you eat, but how much. Excessive body weight contributes to hypertension, heart disease and cancer. This can easily take a decade off your life, and make the rest of it pretty unhappy.

6. Seat Belts: Protect yourself from an untimely death in a motor vehicle. There are approximately 34,000 deaths per year in the United States from motor vehicle accidents. Seat belts have added a bunch more years than Vitamin C and the rest of the alphabet combined.

7. Deal with your depression: Depression measurably shortens life, but makes it feel way too long. The solution can be regular exercise, good friends or medications. The important thing is to do something about it. Living a long life takes the will to live – that means treat the depression.

8. Stay Married or Get Married: Married people have a measurably lower mortality rate then unmarried people. Sounds curious, but this is a well researched and reproducible fact. The subtype is a good marriage helps you live longer. Bad marriages do not. Make sure you know the difference (hint – if your spouse is your closest friend, you have a good one).

9. Sleep well: Insomnia and poor sleeping contribute to accidents, cardiovascular disease and poor health. Sleep apnea is one treatable culprit and can add years to your life.

Woman napping

10. Meditation or yoga: Plenty of evidence that regular meditation or yoga decreases blood pressure, makes the blood less sticky (fewer strokes and heart attacks from clogged arteries) and increases the wellness chemicals  in your brain.  This has a measurable increase on your lifespan.

If your goal is to be live for a long time, start at number 1 and go as far down the list as you can.

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/



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/

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/

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/



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/

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.


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. 

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