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/ FreeDigitalPhotos.net

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/ FreeDigitalPhotos.net

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/ FreeDigitalPhotos.net


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/ FreeDigitalPhotos.net



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