How to Avoid Being Sick for the Holidays

It might be a little late to completely avoid all manners of illness. It’s hard to reverse time and become a vegan retroactively since you were born.

But in the matter of infectious diseases, the main culprit in what I like to call “holiday seasonal crud,” is largely in your hands.


First, let’s define the usual suspects. We have influenza, a virus in a tough casing. Colds are caused by hundreds of different viruses (rhinovirus, adenovirus and others), while pneumonia can have both viral and bacterial causes. And everyone’s favorite –  gastroenteritis – is a virus (rotavirus) causing intense misery, with the main symptoms being watery diarrhea and vomiting..

You might wonder why upper respiratory infections seem easiest to get during the holidays. It’s kind of an accidental diabolical system. Around the holidays everything changes. Our houses, left open and ventilated in warm weather, get buttoned up tight in the winter. Businesses do the same, and have less air exchanges and more foot traffic.

Lots of people are out shopping and running holiday errands. And every crowd you find yourself in typically has people coughing, sneezing and carrying on like Typhoid Mary.   The low humidity lets microdroplets produced by coughing and sneezing stay airborne longer and spread wider. It becomes the perfect microscopic storm.

These microdroplets are tiny particles and hard to filter effectively. Your only protection from airborne attack is to have a good immune system and a flu shot. The flu shot takes at least nine days to produce immunity, so the sooner, the better.


But a large portion of holiday crud is not caught through the airborne route. Rather we touch things and then touch our face. Kids touch their face almost every minute. The average adult touches their face every 5 minutes or so.

Although it’s innocent and unconscious behavior, sweeping hair out of your face or rubbing tired eyes is a highly effective way to transfer live viruses and bacteria to your face, and right into your body.

Certain areas are especially germy during the holiday season and you should take extreme care in these locations.

Airplanes: Airplane bathrooms are heavily contaminated with infectious disease bugs.  The forceful blue spray when flushing an airplane toilet actually puts E. coli bacteria into the air. To maintain breathable atmosphere at 30,000 feet the air is pressurized. That means the airplane vents a little air and most of it is recycled. The air is filtered during the recycling, but some believe viruses can colonize the filter and contribute to the spread of disease. And that is not even taking into account the sick passenger 3 inches away from you.

Shopping: Many of the stores you frequent are great places to get sick. Germy shopping cart handles finally have gotten some antiseptic wipes that many stores now provide. Better save a few wipes for elevator and ATM buttons, gas pump handles, and even your cell phone. All have heavy hand traffic and no routine cleaning.

Home: At home sweet home, the kitchen has more bacterial than the bathroom. Do you remember the last time you cleaned the refrigerator handle? How about the cabinet handle that hides the kitchen garbage can?

Avoiding holiday sickness needs to be a multi-front defense. To tame the airborne risk of catching influenza, a flu shot is still the best defense.

Stop transferring germs from frequently handled (and germy) surfaces around you by establishing a firm rule to wash or clean your hands before scratching your nose.  A little sleep and exercise will also keep your immune system in top-fighting shape so you can enjoy the holidays.

Healthy Holidays to you!

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/



Consider altering the usual Thanksgiving dinner eating ritual

As we approach this annual holiday and its focus on food, we could certainly discuss pride in our Thanksgiving table setting, or mashed potato and gravy lust, and I bet you would envy my gingered cranberry sauce with pecans!

But let’s face facts: Thanksgiving dinner is all about gluttony.


It might reassure you to know that the “seven deadly sins” are not necessarily deadly. They certainly are not charming personality attributes, but mortal wounding of your very soul is unlikely from simply overeating.

Gluttony makes the “sin” list because you are in theory taking food away from people who need it. It kind of gives new meaning to parental threats about unclean plates and China.

Thomas Aquinas, a prominent medieval church figure, was a “splitter” and came up with a whole list of gluttonous behavior. You can not only eat too much, but you can eat too soon, too eagerly, excessively daintily, or wildly (like a beast). Even doing all these simultaneously does not rise to mortal sin-hood, but it is an amusing mental picture.

The average Thanksgiving dinner is a whopping 3,000 calories and over 200 grams of fat. Over the course of the day most people snack their way to a total of 4,500 calories.

You could easily burn through those calories with 20 hours of housework, a 30-mile brisk walk or five hours of pick-up basketball.

For the record, lust-related activity is good for 300 calories an hour, or perhaps more realistically 150 per half hour. And that is just working through dinner calories, not the whole day’s food orgy. And by the way, who feels like basketball after a big dinner?

So your best hope is a preemptive strike. This means, perhaps counter intuitively, eat a very light lunch. Because lunch fare is much less calorically dense than traditionally holiday food, you will come out ahead.


Balancing your plate is also useful. Put a variety of foods on your plate, including vegetables and salad. Don’t go back for seconds on your favorites until you have eaten these less sinful foods.

Savor the meal by chewing slowly so you can really taste everything. Afterall, that is the point, and it allows you to recognize much better when you are actually full.

Another suggestion is consider using a smaller plate. If a plate-full is the expectation for the meal, you can limit the damage.

Remember the holiday season is a war not a battle; a marathon not a race. There are numerous opportunities for food-centric celebration over the next five weeks. Some restraint shown today means tomorrow you can play.

As for the rest of the deadly sins – we can consider them on New Years.

Have a great Thanksgiving.

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/



The Science (and logic) of Napping

“Naps and girls are two things you intensely disliked as a child, and can’t get enough of now,” quipped the NPR host of “Wait. Wait. … Don’t Tell Me!” Of course, most men would agree.

How are naps faring in our modern 24/7 plugged-in society? Do you even know where you left your nap-blankie? That may be saying something.   

Naps are decidedly un-American. We are doers, not nappers. We are a nation of Type A, overachieving manic individuals with (5-hour) energy to spare. We don’t need a nap; just give us another cup of coffee!

Nap 1

Despite our forced smiles, bravado and eternal youth, heart attacks remain the No. 1 cause of death in this country. We just might need to slow down a bit; perhaps naps deserve a re-examination.   

My introduction to naps was at the hands of some black-belt-level nappers – true masters. Back before the drug wars disturbed the ambience, I regularly flew down to Baja, Mexico and did a little charity work in a dirt-floored clinic (it’s a wonder that tetanus wasn’t the national past-time).  

After seeing most of the population of Baja in the morning, we sat down to an immense lunch. And after lunch there was the mandatory siesta, which is a sacred rite. It wasn’t just us on nap time – the whole town closed down. You simply could not transact business between noon and 3 p.m.

Refreshed from a siesta, everyone was back to work and often went strong until 9 or 10 at night. To an impatient American, siesta seemed like truly madness; and they no doubt thought the same of me.     

There is actually some science to napping. This came about quite naturally. After decades of research into innumerable arcane (dull) subjects, sleepy scientists discovered, much to their surprise, that they felt better after a nap. 

Now this might not be exactly the intellectual leap of discovering penicillin in mold, but science is where you can find it. And there has been a veritable juggernaut of nap research ever since.  

The power nap is the most documented. We know sleep goes through regular cycles, lighter stages progressing into deep sleep. If your nap ends while in deep sleep, you wake up disoriented – the classic “where am I?” feeling.

If you wake up still in the first two lighter stages of sleep, you feel refreshed and good.  A 20 to 25 minute nap usually is just about perfect. You have measurable improvement in alertness, productivity and mood. This post-nap boost more than makes up for the loss in work output during napping. 

Memory has been intensely studied by neuroscientists; we all could use a little more mental RAM these days. They have designed studies that manipulate sleep and nap schedules, and the subjects did regular tests of memory, coordination and response time. All were improved and most significantly a nap helps with memory formation almost as much as a full night’s sleep.   

The multi-taskers among us (MTs raise your hands) are particularly helped by an afternoon nap. Information overload is reversed and post-nap performance can reach the peak levels of the day.

Napping also has cardiovascular benefits. In the time between lying down to nap and actually falling asleep, the blood pressure and pulse drop significantly, and remain low through the duration of the nap. This is a brief part of your day, but has a disproportionate benefit to your health. 

Napping could change your life. If your excuse for not getting up early and getting some exercise is fear of wearing yourself out, here’s your answer. And if you eat a fast-food lunch for lack of anything better to do, then skip the Big Mac and take a nap instead. 

Nap man

I may have to add siesta time to my clinic schedule (in Scottsdale, Arizona). I could ask patients to assess pre-nap vs. post-nap – when did they receive the best care? Then we have ourselves a real scientific study! 

Pleasant dreams,

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 is Worse than Ebola

Though it’s begun to quiet down, lately we have had 24/7 coverage of Ebola; all Ebola, all the time.

I suspect if someone came home from a visit to South Africa and developed the hiccups, they would immediately be surrounded by big men in biohazard suits and forced into quarantine (never mind the fact that South Africa has no Ebola, and hiccups are not a symptom of Ebola).

For the record, Influenza, commonly known as the flu, causes far more deaths than Ebola in the U.S. – by a very long shot. So far we have had exactly one death due to Ebola in the country – but anywhere from 3,000 to 49,000 people die of flu each year.


In the U.S., Ebola is only a threat to the healthcare workers treating the very sick Ebola patient. By good fortune, a patient with Ebola is only infectious when he is sick. Sick people go to the hospital where healthcare workers are at risk. A sick Ebola patient is pretty juicy – wet cough, vomiting and diarrhea. All fluids are highly infectious. Cough hard enough and you spray whomever is in front of you. This is not airborne transmission, it is more like being spit on. These large droplets do not stay in the air. They fall to the floor, and the virus dies when they dry.

So if you work on the Ebola isolation unit of the designated tertiary care hospital, extreme care is needed.

Those of us who aren’t treating patients in the isolation unit should be far more worried about the flu. This is a much more evolved virus. It has been interacting with human immune systems for thousands of years, and has progressed after going through about a bazillion virus cycles. Influenza is an unstable virus with a high mutation rates (“mutation” means a change in the virus). Most of the random changes don’t work out, but even a million monkeys typing for a million years do come up with something. The flu virus has enough successful mutations that it adapts and often becomes immune to last year’s vaccine. This is why you need a new flu vaccination each winter.

From a virus’s point of view, airborne transmission is ideal, and the flu has this figured out. A coughing fit in a room will likely expose most people in the room to flu. The virus remains suspended in the air indefinitely, and it is perfectly happy to dry out and still remain infectious. People in the very early stages of flu can spread large amounts of the virus before they feel bad enough to get treatment. Thus getting exposed to influenza this winter is a likelihood, and prudence would indicate vaccination was a great idea.


Getting exposed to Ebola outside of a hospital setting is extremely unlikely. How many people will encounter a person just back from West Africa who happens to vomit on them while on their way to the hospital? That qualifies as cosmic bad luck – less likely to occur than winning the Megabucks lottery.

Don’t let the overlap of symptoms concern you. Almost all viruses start out the same way. Some achiness, headache, fever and respiratory symptoms. Later you get the specifics, the rash of measles, the nausea of gastroenteritis, or the severe headache of meningitis.

So a reasonable reaction to flu season is vaccination. If you are not in healthcare, the chance of meeting Ebola is vanishingly small.

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/

A Life of Service: U.S. HealthWorks Dr. Dean Shoucair Commemorates 31 Years with Military

Treating soldiers behind enemy lines is terrifying. It is harrowing, scary, and extremely dangerous for any medical doctor. No place is safe, ever, and the attacks are relentless. There are attacks from rockets and mortars and improvised explosive devices every day.

But someone’s got to do it.

For Dr. Dean Shoucair, the Regional Medical Director for the Midwest for U.S. HealthWorks, combining his calling to practice medicine with 31 years in the U.S. military has led to a remarkable career that demonstrates a life of service and sacrifice.

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In his role with U.S. HealthWorks, Dr. Shoucair oversees 10 clinics in Illinois, Wisconsin and Minnesota, where he mentors and advises medical staff and encourages growth through acquisitions. He also seeks partnerships with residency programs and government entities to bring top medical talent to U.S. HealthWorks.

“I went into medicine because I wanted to help people, and I felt like I could make a direct impact that way,” he said. “It’s a good feeling – the best feeling in the world – to help relieve pain and suffering. When people are injured or sick, they just want to know they’ll be OK.”

A career in medicine is impressive on its own, but Dr. Shoucair has also been on the front lines of military conflicts, taking care of American soldiers (and on occasion, Western European soldiers and Iraqi civilians) in Iraq, Korea, Kuwait, Germany, Kazakhstan and Qatar. He’s treated injuries as routine as ankle sprains and as severe as traumatic brain injury and amputations following attacks from rockets and mortars.

For an emergency room military doctor, resources can be limited and conditions unexpected. There may only be one or two doctors, a few nurses or physician’s assistants and a small tent for medical equipment.

If they’re lucky, military doctors on larger bases will have medical trailers that are essentially pre-fabricated hospitals with all the equipment needed.

“They can put these trailers up on top of a mountain, in the middle of a desert, or a jungle – it doesn’t matter where,” said Dr. Shoucair, who has been deployed five times. “The hospitals can be up and running in 24 hours. The military is a well-oiled machine.”

As a young man growing up in Detroit, Dr. Shoucair didn’t always envision a life of military service.

“I enlisted in the Army when I turned 18 because I needed money for college. I joined as a military policemen and Spanish linguist, and I thought after my three years of active duty I’d be out,” Dr. Shoucair said.

After those three years, he obtained a bachelor’s degree in Psychology from the University of Michigan on an ROTC scholarship. Shortly after graduation he was commissioned as a Second Lieutenant in the Adjutant General Corps in the Army.

Fast forward through a tour of duty in South Korea and service in the Detroit military entrance processing station, and Dr. Shoucair earned the title of Captain.

Despite a solid career in the military, he wanted to do more. So in 1994, Dr. Shoucair transitioned to the Michigan Army National Guard so he could pursue his medical career.

He earned his medical degree from Michigan State University and completed his residency in occupational, preventive and environmental medicine. He then worked as a medical director for an occupational medical program in Illinois for a few years, enjoying the chance to live a “normal” life with his family.

But in 2003, Dr. Shoucair got deployed for the first time as a military doctor. He was sent to Iraq, working in the emergency room and holding a role as the Chief of Preventive Medicine. His first tour extended into 2004, and he went back again in 2005-2006.

Although serving overseas can be a stressful, dangerous and demanding situation, Dr. Shoucair has not backed away from his call of duty. There aren’t many active duty doctors to choose from, so the Army has to pull from Reserves and the National Guard.

“There’s a huge need, and that’s why I’m still doing this after 31 years. I could’ve left earlier, but I know they need me, and I assist as much as I can,” he said.

Dr Shoucair_pic 1

Dr. Shoucair’s latest deployment ended in July 2013 after an intense year-long tour that included time – again as an emergency room doctor – in Kuwait, Qatar, Kazakhstan, Germany and Texas.

After three decades, Dr. Shoucair has risen to the rank of Colonel, Chief of Professional Services and flight surgeon for the U.S. Army.

He admits that transitioning back to civilian life after being in a combat zone is difficult. Accustomed to fearing for his life on a daily basis, it requires some adjustment time to get used to a day-to-day civilian routine again.

Dr. Shoucair strongly believes his family has helped him through his deployments and transition periods. His wife, Camille, has been by his side for 22 years through medical school and military life, helping to raise their two teenage boys and support him when coming back from tours of duty. He credits her support for being able to accomplish what he has.

But ultimately this is a commitment that he has made – and one that he values and believes is an honor.

“The whole experience is humbling. It’s important to me to take care of those young soldiers overseas,” Dr. Shoucair explained. “The ones in the line of danger are young soldiers … those are the real heroes, the ones who voluntarily put their lives at risk day in and day out.”

Images courtesy of Dean Shoucair


What to do when chest pain occurs

I remember being on call in the emergency department numerous times in my career, attending to the care of chest pain patients.

On many occasions we would “save the day” for patients who were having chest pains ranging from angina to a heart attack, which happens when the heart is not getting enough blood.

Chest pain

These (acute coronary syndrome) cases can be fast moving and extremely time sensitive. In fact, there was a sign in the emergency department that said “Time is Muscle” – referring to the linear relationship between the time cardiac muscle tissue does not get oxygen and its resultant death as a result of a heart attack.

While very often patients were having a heart attack or angina pain of some type, there were also times the work up to that end was completely unrevealing.

As a young Internist in training, while I felt relieved these specific patients were not in a life-threatening situation, I would wonder what else could account for heart-attack-like symptoms, yet not be a heart attack.

While the list can be lengthy, one of the more common issues that accounted for these symptoms was the digestive system. Sometimes something as simple as a local anesthetic and a combination of antacids given orally would halt the chest pain symptoms.

So what happened? Often times these patients had extremely bad acid reflux and sometimes other digestive problems such as painful esophageal muscle spasms.

Acid reflux (a.k.a. heartburn) can have a very slow and largely minimally symptomatic course for many years as well. However, the heartburn can also be fast moving and mimic a heart attack.

So what should a person do? Always seek the immediate care of a doctor if there is any hint of chest pain because dangerous things such as a heart attack or aortic rupture need to be ruled out first.

Women - chest pain

Severe acid reflux has been blamed as the cause of chest pain in the past (unfortunately and sadly resulting in high mortality), when in fact that was not the case, but rather acute coronary syndrome was in fact occurring.

Once the more dangerous things have been ruled out, one can focus on issues like acid reflux – a condition which affects millions across our nation and has long term, serious potential implications. Left unchecked, it can result in esophageal cancer. So if a person has chronic acid reflux, they must get it carefully attended to by a physician.

One of the medications that has been effective in helping control acid reflux are the category of proton pump inhibitors, which are of the strongest type of medicines available. But there are some caveats to them; they must be taken on an empty stomach and then followed by eating.

Without these two pre-conditions, they either don’t work at all or aren’t very effective. I often recommend to patients they take this medication first thing upon awakening and then follow with breakfast about 30-45 minutes later.

But patients must keep in mind that prolonged use of proton pump inhibitors has some other complications, so keep your physician informed if you have started them on your own so they are used for the appropriate period of time.

There are other medications that can help with the symptoms of acid reflux, all of which are available over the counter. Each has its own particular mechanisms of action and directions on use, yet they (like proton pump inhibitors) can result in people developing “rebound hyperacidity.” Consult with a physician when starting not just these medications, but any new medication.

Preventative Measures

One aspect of internal medicine that is not given enough attention, both at the educational level as well as in practice, is proper preventative measures and interventions. That leaves much of what we do as internists reactive in nature and after the fact.

Patients should be mindful of the following

  • Mental Health: High levels of stress are often associated with  hyperacidity, a condition of excessive acidity
  • Weight: Obesity can often contribute significantly to the worsening of hyperacidity
  • Diet: Certain foods can trigger hyperacidity
  • Lifestyle: Smoking and drinking are directly correlated to hyperacidity

In summary, always be mindful of acute symptoms and seek immediate care from a physician for any fast moving process that’s taking place. It will go a long way toward prevention of this completely manageable and preventable problem.

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.

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David Kobrinetz Joins U.S. HealthWorks as National Director of Telemedicine

VALENCIA, Calif. – U.S. HealthWorks, a leading operator of occupational healthcare and urgent care centers in the nation, announced today that it has appointed David Kobrinetz as National Director of Telemedicine for the Company.

David Kobrinetz is the new National Director of Telemedicine for U.S. HealthWorks.

David Kobrinetz is the new National Director of Telemedicine for U.S. HealthWorks.

Mr. Kobrinetz will lead the Company’s initiatives to develop and implement a telemedicine program to improve healthcare access for American workers and their families, expanding on the company’s mission of delivering The Right Care, Right Away.

Mr. Kobrinetz joins U.S. HealthWorks with more than 25 years of experience developing innovative strategies for domestic and international healthcare organizations, including payors, providers, physician management, pharmaceutical, telemedicine and healthcare technology firms. He earned Master’s degrees from the University of Southern California and a Bachelor’s of Arts degree from the University of Maryland.

“We are excited to have David join our team to develop this new platform that enhances access to care,” said Daniel D. Crowley, Chief Executive Officer of U.S. HealthWorks. “Telemedicine is rapidly gaining acceptance with patients, employers, payors and government agencies. It is recognized as an effective method of delivering quality care cost-effectively. U.S. HealthWorks patients will have the ability to consult with a board-certified doctor at any time, from any location, in addition to receiving care at one of the company’s 218 clinics in 19 different states.”

“U.S. HealthWorks is an innovative company whose motto is the right care, right away, and telemedicine is a natural extension of that philosophy,” said Mr. Kobrinetz. “By integrating a telemedicine program for medically appropriate Occupational Medicine, Urgent Care and Primary Care with its established centers, U.S. HealthWorks can improve access to care treatment and recovery and help patients return to work and life quickly and cost-effectively.”

About U.S. HealthWorks

U.S. HealthWorks, a subsidiary of Dignity Health, is one of the country’s largest operators of occupational healthcare centers. With 218 centers and worksites in 19 states and more than 3,400 employees – including approximately 800 medical providers – U.S. HealthWorks centers serve more than 14,000 patients each day throughout the country. U.S. HealthWorks centers help employers control work-related injury costs through quality medical care and effective management of claims and lost work time, specializing in early return-to-work programs, injury prevention and ergonomics programs. For more information, please visit U.S. HealthWorks is also on Facebook and Twitter.


Put Limits on Halloween Candy Eating

Halloween is the second highest per capita spending holiday. Any year now we will see pumpkins before the Easter Bunny has even visited.

And the rite of Trick Or Treating has been looked at as a social phenomenon. But the quality of the research mostly amounts to YouTube videos of enormous piles of Halloween candy.

Halloween candy in pumpkin

Clearly, serious scientific inquiry is sadly lacking, and for that I have requested the assistance of my 11-year-old daughter, Lauren, an expert in all things Halloween.

Through careful measurement of the capacities of various Halloween candy conveyances such as plastic pumpkins and ghostly bags, adjusting for stride length and youthful enthusiasm, we have arrived at the semi-scientific, fun-sized average candy haul of 143 pieces on Halloween night. That is just over five pounds of candy (fun-sized bars are 17 grams).

These so-called “fun-sized” bars are intended to be the moral equivalent of cookie crumbs; which they say don’t count. But what do they know; they all have a body mass index problem.

The fun-sized bar is about a third of the weight of the full-sized candy bar. For me, fun-sized means two bites, perhaps three for my daughter. That is about 50 calories a bite!

Candy bars

While I wouldn’t be inclined to buy a full-size Baby Ruth candy bar, much less consume it in one sitting, I am perfectly capable of eating three fun-sized bars (who am I kidding, four or five). The fun-sized bar just looks so small and harmless; it doesn’t set off dietary alarm bells in my brain.

Buying a whole candy bar involves commitment. You have to want it, find it, pay for it, and feel guilty about it – there is emotional and financial investment here. Fun-sized candy bars are commitment free, just a little dalliance for your sweet tooth; sort of a spin the bottle of the candy world.

And if the lack of commitment isn’t tempting enough, the variety is almost overwhelming: beautiful shiny wrappers, tantalizing textures and tastes, chocolate, licorice and taffy, sweet tarts and candy corn.

But they do add up – it’s roughly 90 to 100 calories per fun-sized bar. It is not hard to eat five or 10 in a day when the candy bowl is convenient and visible.

Halloween candy eaten at work from a community bowl spreads the crime out over several people. This is more in theory than in practice because typically a few people eat almost all the candy! You avoid being identified as the glutton. However, your body will know.

An extra 500 to 1,000 calories per day is pretty common during Halloween season. Do that for a week and you have built a shiny new pound of fat. If you want to neutralize the effects of this extra 500 or 1,000 calories you can always get a little more exercise, five hours of walking or an hour of running should do it. An hour and a half of jump roping or Taekwondo will rid you of those extra 1,000 pesky calories. Is anybody up for two hours of rollerblading?

It should be obvious by now that if you want to stay lean, it’s not a “shock and awe” kind of battle. It’s more guerrilla warfare. You are in it for the long haul, and you accept partial and uneven victories and save some fight for tomorrow, and next year.

For me, that means carefully select and slowly eat two fun-sized bars per day – maximum – and tomorrow I will exercise (though not for two hours).

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/


Dr. Bujanda: Living the Dream in his Flying Machine

Young boys often harbor huge dreams. Growing up in Venezuela, Jorge Bujanda grew up enamored with two things: becoming a doctor and flying airplanes.

Dr. Jorge Bujanda of U.S. HealthWorks, built his own plane in an arduous process that took  nearly seven years and over 5,000 hours.

Dr. Jorge Bujanda of U.S. HealthWorks, built his own plane in an arduous process that took nearly seven years and over 5,000 hours.

But unlike most kids, his youthful ambitions became reality through an interesting and ambitious path that he mapped out at a young age.

Dr. Jorge Bujanda has been in the medical field for more than 40 years and is currently the Vice President of Quality Management for U.S. HealthWorks. He’s a valuable member of the company’s medical team and works out of its corporate headquarters in Valencia, California.

In his spare time, Dr. Bujanda likes to fly his four-seat Velocity XL airplane. But what makes the flying so much more enjoyable is that he built his airplane from start to finish; an arduous process that took him nearly seven years and over 5,000 hours.

Engine installation is quite a detail-oriented process that requires patience, skill, and knowledge.

Engine installation is quite a detail-oriented process that requires patience, skill, knowledge, and plenty of time.

In 2003, with the backing of his wife Ygebor, and their children – Daniel, Francisco, Melissa and Alan –  the daunting task of building an airplane became his objective.

“Although very rewarding, building an airplane is a huge project. I spent most weekends not going anywhere because I was in my garage working on the plane, and that is something you can’t rush,” Dr. Bujanda said. “I received lots of support and understanding from my family; they sacrificed as well. Now that the airplane is built, it’s something we all enjoy.”

Building airplanes is actually nothing new. At age 7, he was following instructions and carefully putting together plastic model airplanes.

At about that same age, the resourceful youngster used his aunt’s typewriter to craft a letter that he mailed to airplane dealerships. The successful ploy combined both his ambitions.

Dr. Bujanda in his garage at home, meticulously assembling the pedal-control system.

Dr. Bujanda in his garage at home, meticulously assembling the pedal-control system of his four-seat Velocity XL airplane.

“I composed a letter asking for catalogs, saying I was a physician interested in purchasing an airplane,” Dr. Bujanda said. “After that, I remember receiving catalogs from manufacturers like Piper and Cessna for years and using their photos as posters in my bedroom. I have been interested in aeronautics as long as I can remember.”

His route to becoming a doctor took a more traditional path than flying. Jorge was born in Bloomington, while his father attended Indiana University on an American oil company scholarship. Jorge spent very little time growing up in the U.S. because his family returned to South America.

He eventually followed his dream, attending medical school in Venezuela. He received post-graduate training in internal medicine at a university hospital that also treated injured workers. That was his first exposure to occupational medicine.

After practicing in Venezuela for years, Dr. Bujanda moved with his family to Los Angeles in 1989. He began working for Advantage Care Medical Group, serving as both Director of Quality Assurance for its eight clinics and Medical Director of its Medical Legal Division.

With the help of family and friends, Dr. Bujanda transported his airplane from a location is his garage at home to a nearby airport.

With the help of family and friends, Dr. Bujanda transported his airplane from a location is his garage at home to a nearby airport.

When U.S. HealthWorks acquired Advantage Care in 1996, Dr. Bujanda assumed a similar role. Currently, he is responsible for the company’s overall quality program, participates in several medical and operational management committees, and is a permanent member of the Medical Executive Committee.

While enjoying a successful medical career, the desire to fly still remained. A gift from his wife eventually moved him to building and flying radio-controlled models. At some point, Dr. Bujanda had randomly picked up a Kitplanes magazine and realized he could build an airplane. The seed was planted!

Years later and after months of research, Dr. Bujanda purchased a kit on June 25, 2004. He spent two weeks of supervised building at the Velocity Aircraft headquarters in Sebastian, Florida, becoming familiar with the use of composites. Eventually, all the parts were transported by trailer to his spacious garage at his Southern California home.

The garage became his sanctuary, the place he would slip away to during most weekends and some weekday evenings. This huge undertaking of meticulously assembling a plane piece by piece was certainly a labor of love.

There was plenty of testing to be done, including taxi testing at the Fox Airfield in Lancaster.

There was plenty of testing to be done, including taxi testing at the Fox Airfield in Lancaster, Calif.

In the early stages of that process, Dr. Bujanda also had one other major task – learning to fly. He took flying lessons, and eventually earned his private pilot’s license in 2005. He continued flying regularly for the next six years, sometimes visiting Velocity to fly planes similar to the one he was building.

Dr. Bujanda finished assembling his plane in a hangar at Fox Airfield in Lancaster, a 15-minute drive from his home. After the required final FAA inspection, he was ready for the big day; the first official flight.

Conditions were ideal on Sunday, November 27, 2011; no wind, blue sky, with some light clouds. Followed by a chase plane for safety purposes, Dr. Bujanda climbed to 6,000 feet, got to a speed of 160 miles per hour, and gave his plane a good workout during the 30-minute test flight that concluded with a smooth landing.

Conditions were ideal on November 27, 2011, for the inaugural flight for Dr. Bujanda's plane, which went through a 30-minute test flight that concluded with a smooth landing.

Conditions were ideal on November 27, 2011, for the inaugural flight for Dr. Bujanda’s plane, which went through a 30-minute test flight that concluded with a smooth landing.

The aircraft, named “Dr. Tuky” by his children after the “George of the Jungle” toucan character, had passed the test with “flying” colors.

His friend Craig Woolston, piloting the chase plane, radioed this message to Dr. Bujanda once he had safely landed: “Congratulations Dr. Tuky, you are now an airplane.”

Although he had remained focused on the airplane’s performance, it was still an emotional flight for Dr. Bujanda as both builder and pilot.

“There is no way to explain it,” he said. “I was all business up there and had to stick to a plan, testing instruments and controls, and making sure everything was working as expected. It didn’t hit me until I was on the ground. I was flying my homebuilt airplane. How cool was that?”

It’s very cool indeed. After 40 hours of flight testing, “Dr. Tuky” was allowed to take passengers.

The weekends are now much more pleasurable for Dr. Bujanda, who often flies to different destinations in California. He flies to visit relatives and friends and frequently flies his daughter (Melissa) to and from the University of Nevada in Reno. “Dr. Tuky” has even been used to calibrate weapons systems for the military.The aircraft was named “Dr. Tuky” by Dr. Bujanda's children after the “George of the Jungle” toucan character.

“Since its first flight, ‘Dr. Tuky’ has flown 150 hours and landed 200 times; and there’s still a line of people who want to go up with me,” laughs Dr. Bujanda. “No words can explain going up 10,000 feet in the airplane you built, have breakfast with your family 300 miles away, and walk away from it back home before noon.”

It’s a pretty cool feeling for a man who is currently living out his dream.




Fight must continue against Breast Cancer

October is Breast Cancer Awareness Month.

The constant societal attention to breasts has a very real downside. It has been the cause of women with a breast lump, wasting time in denial, rather than getting a diagnosis and treatment. The tragic irony is this delay lets the disease progress, which can make the treatment more invasive.

Breast cancer

Breast cancer is a lot of things, but it is unique in being perceived as an attack on womanhood. That is somewhat perverse, even ridiculous, because cancers of the uterus, cervix and ovary have real potential for reproductive impact, but breast cancer does not.

My family is keenly aware that this is Breast Cancer Awareness Month. I have teenage daughters, breast cancer history in the family (my mom), and 30 years of medicine for perspective.

There will be almost a quarter million new cases of breast cancer in the U.S. this year.  On average, about 90 percent of these new cases will be five-year survivors. Sadly, 40,000 women will lose their fight to breast cancer. Everyone will be touched somehow, someplace by this disease – my family certainly has.

There has been a sea of change in breast cancer treatment in the three decades I have been in practice. A male surgical associate recently told me no male could ever understand what looking in the mirror was like for a woman after mastectomy. There simply is no male counterpart.

Most breast cancer surgery in top institutions is now done by fellowship-trained female surgeons. The surgical care of breast cancer has evolved considerably in the last 25 years. We don’t open knees to fix cartilage damage anymore, we get better results with less invasive arthroscopy.

Breast surgery has similarly evolved. If the lump is the problem, in many cases just the lump is removed, and other treatments finish the job. The cure rates are as good as, or better than, the “big operations” we used to do.

Research has provided a steady stream of new treatments, new approaches to prevention, and less invasive but more effective treatments.

Team work has become the norm in many institutions for breast cancer. The breast surgeon, radiation oncologist, medical oncologist, immunology expert, dietitian, mental health professional, and most importantly the patient, all have significant roles to play in successfully treating breast cancer.

Women health issues

This is all intended to get the best individual plan/outcome for that particular patient.  Some patients find being treated by a virtual gaggle of doctors somewhat unnerving.  The mental health professional can help with that.

In the battle against breast cancer, hard won progress has been made. In the last 25 years, breast cancer mortality has decreased 34 percent. The five-year survival rate has steadily climbed from 75 percent  to just over 90 percent. The genetic basis for a few (15 percent) breast cancers has been found.

And much of that progress is thanks to a few talented people figuring out that breast  cancer could be a successful brand. In our society, this attracted energy, funding, research priority, and talent.

A couple of days ago my teenage daughter asked me her options for avoiding breast cancer, because she’s aware that Grandma had it. Since I didn’t have good answers for her, that means the fight must continue.

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/