Can lifestyle changes dramatically cut Alzheimer’s risk?

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

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

Older woman sick

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

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

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

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

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

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

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

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

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

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

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

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

Take care.

Dr. B

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

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Common sense health tips from Mom

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

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


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

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

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

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

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

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

Washing hands - woman

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

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

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

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

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

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

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

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

Take care,

Dr. B

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

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Ebola: nasty virus with no known treatment

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

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

Sick man in hospital

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Take Care.

Dr. B.

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

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How to avoid common golf injuries

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

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

Golf caricature

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

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

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

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

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

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

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

Female golfer lining up putt

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

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

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

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

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

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

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

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

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

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

Dr. B

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

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Water remains No. 1 among fortified drinks

It’s summer at last, following a particularly  long and unrelenting  winter.  It grinds you down until a general hopelessness sets in that spring will never arrive.

Sports drinks - women

A Phoenix newspaper reported recently that 17 dogs died of heat stroke in a local pet hotel. Apparently one dog chewed into a wall, cutting the power to the air conditioner. In the desert, summer heat must be taken quite seriously.

Summer has definitely arrived, which means it’s the perfect time to discuss hydration.

Given the proliferation of the so-called science of hydration, one would expect only a Ph.D. could make an intelligent buying decision in the beverage isle at the local grocery store.

Au contraire!

Do not underestimate the genius of the human body. The fluids in your body are very closely monitored, and the kidneys have a rather broad operating range to make the most out of almost any drink, because they are mostly water.

Since it is hard to sell mostly plain water, other alternatives come in a lot of colors with a variety of micronutrients, vitamins, minerals and salts. And the appeal of these drinks are enhanced by some clever bottle shapes and contraptions.

Gatorade was the original mostly water-based sports drink. It initially came in powder, one flavor (lemon lime), and you had to add the water. It was a simple mixture of sugar, salt, artificial color and flavor.

It was the brainchild of several scientists at the University of Florida (the Gators) College of Medicine, who were asked by the football coach to make a rehydration beverage. It was originally going to be called Gator-Aid, but the inventors thought the “Aid” would trigger FDA scrutiny and require scientifically validated testing.

Gatorade was intended for a different commercial direction where outlandish beverage claims were tolerated (“Open Happiness”…). If you are not doing heavy exercise in the Florida heat, you can plan on an extra 3.5 pounds per year from drinking Gatorade daily.

In case you didn’t know, Gatorade is a PepsiCo product and has 70 percent of the sports drink market in the U.S.

Following Gatorade, vitamin-charged drinks were the next wave of performance water. And while in 25 years of medicine I have never diagnosed a single case of scurvy, pellagra, beriberi or rickets, the country is no doubt fractionally safer from these scourges.

Excess vitamins, with very few exceptions, have no proven benefit to your health. For the record, breakfast cereals have been vitamin fortified since Tony the Tiger (of course he and Frosted Flakes are great! – he’s a cartoon).

Drinking water - man after workout

And now there are cleverly designed bottles with the dry vitamin powder in a container at the top. Give it a twist, shake, and the result is a freshly-made vitamin fortified super drink. For pure placebo effect, this is hard to beat.

Is there good science behind these drinks actually increasing performance – no.

But if slightly modified, these mostly water beverages can sell as sports drinks – think of the potential, and they have! The list includes morning drinks, calming drinks, energizing drinks, drinks that make you smarter, stronger, braver and just a better human being.

And if it were that easy, I would say “sign me up.” I could sleep in, buy a selection of hi-tech beverages and live a long and healthy life. Unfortunately, you actually have to do the work, which means you need to sweat.

My favorite rehydration drink is an inch of OJ in a big glass of ice water. It’s low in calories, thirst quenching, tastes pretty good, is almost free, and most importantly – it’s mostly water.

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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Fourth of July Safety Precautions

The annual Fourth of July celebration is an explosive mixture of heat, dehydration, alcohol, and gunpowder – what’s not to like?

This holiday has long been a favorite of young men, who seem to have an unholy fascination the past 1,400 years for things that blow up. Fireworks were invented by the Chinese about 700 AD.


This holiday falls at the peak of summer, which means it’s hot in most areas of the nation, and way past hot here in the desert (Arizona).

Outside activities are usually the order of the day. A Fourth of July BBQ is often part of the fun, and there are those who can spend a pleasant hour or two discussing the intricacies of homemade BBQ sauce.

Cold beer tastes especially good on a hot day and helps wash down some of that great BBQ. Since beer is mostly water, it seems a sensible approach to keeping up with the inner rain forest your clothes have become.

Alcohol is unfortunately a diuretic, making you lose fluids that would be more profitably used sweating away excess heat. Between the heat, dehydration and alcohol, does anyone remember to apply the sunscreen?

Halfway to heat exhaustion and sun burnt, fireworks now seem like a good idea. Fortunately, many men had the foresight to stock up their personal arsenal!

Firework injuries don’t just take place on the Fourth, but also the 30 days before and after Independence Day. In the U.S., the yearly firework injury tally is almost 10,000 people.

Eyes are one of the more common firework injuries and 15 percent of firework eye injuries result in permanent vision loss. Ever notice the pictures of our solders in war zones – they always have goggles on?

Hand trauma is the next most common firework injury; the explosive force of even small fireworks can easily mangle hands. That is a bad injury because hands are intricate, necessary for most things, and difficult to make 100 percent again.


The only way to avoid hand injuries is to not hold the firework in your hand when lighting. Everyone has a scary story about the firework fuse that burned 100 times faster than the rest. Do that one too many times and it will be more than just a story.

Even the lowly sparkler can throw an ember into the eye or do some skin damage. Did you know they burn close to 2,000 degrees? Some close adult supervision is necessary. While supervising you may want to run around with a sparkler also.

Assuming you haven’t lit yourself on fire, the intense summer sun may make you wonder about skin protection. Sunscreen lasts 2-3 hours during outside activities, sometimes even less when swimming.

Put it on the first time long before you go out, and remember to reapply every few hours. If you get distracted, iPhone uses can seek a little help: “Siri, remind me to use sunblock at noon and 3 p.m.” Siri doesn’t want to see you get a bad sunburn.

One more consideration at these all-day parties – food poisoning. The meats and veggies are relatively safe, as are the chips. However, be afraid of room-temperature potato salad or anything with a lot of mayonnaise in it.

Keeping a few things in mind can make Fourth of July a truly delightful holiday. Don’t sunburn to a crisp, drink yourself into a stupor, collapse from heat exhaustion, or blow a finger off.

That leaves enjoying good friends, good food, a professional fireworks show, and good times.

Happy Fourth.

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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Merits of Physical Therapists partnering with Doctors

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

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

Physical therapy 1

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

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

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

There are two main schools of thought:

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

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

Physical therapy 2

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

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

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

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

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

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

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

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

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

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

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

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

Take care,

Dr. B.

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

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Cautionary tips for safe beach vacation

Did you know that sharks feed at night? The first time I heard that was from a sadistic dive master … five minutes before a night dive!

Despite her obvious joy in unnerving me, she was stating the truth – sharks actually do feed at night. This could be considered a good thing though, since people overwhelmingly prefer to swim in the ocean while the sun shines.

Family at beach

This sensible system created by nature keeps the people and the sharks generally away from each other. Your chance of being killed by lightning is 20 times higher than being killed in a shark attack. So, don’t let sharks ruin your day at the beach.

Most beach injuries caused by ocean critters are much less exciting than shark attacks. Sea urchins look like black pin cushions with 2-inch needles and are usually attached to rocks. They don’t bite, sting or move, but if you slap one, the brittle spines will break off and imbed under your skin.

These spines aren’t toxic or poisonous, so it’s really just a thick hard splinter. It might be difficult to remove, but if it doesn’t get infected, and will eventually dissolve. This injury is not dangerous, just merely irritating.

Jellyfish are occasionally encountered at the beach while swimming or just strolling at the waterline. If they are present in any number, lifeguards will typically warn swimmers and close the beach. However, jellyfish can be found almost any time.

Jellyfish have stinging cells in their tentacles that are usually still present, even if the jelly is dead and washed up on the beach. Touch one with your bare foot and you will be sorry.

These stinging cells shoot microscopic arrows into your skin that are filled with venom. The pain can be minor or extreme, depending on the type of jellyfish. If you get unlucky with a sting, the first thing to do would be scraping the tentacles off yourself with a credit card, being very careful not to touch the darn things with your fingers.

Next, apply some vinegar to deactivate any remaining stinging cells. Try a baking soda and water paste as well. If you are not in Australia, where a few species of jellyfish can actually kill or make a person very sick, you will most likely recover uneventfully.


If you are swimming and feel an occasional sting on your skin, you are likely encountering jellyfish that have been broken up by the surf. Even a small touch can sting you a little.

Stingrays are occasionally found at the beach as well. They are not aggressive and will not attack. Step on one, however, and it will slap you with its tail on your foot.

The tail has a barbed end with a toxin (poison) coating, so stepping on one would really hurt. The barb often breaks off in the wound and needs to be removed by a doctor.

First-aid treatment would be to soak the foot in hot water. The toxin breaks down with heat, but just be careful not to burn yourself. These wounds also have the possibility of getting infected. It would probably be easier to just shuffle your feet when walking in shallow water and scare them away.

A sunburn is about a million times more common than the more interesting but painful creature mishaps. But get good sunburn and it will ruin your trip.

Avoiding a sunburn is all about prevention. It doesn’t matter whether the sunblock’s SPF is 20, 100, or more waterproof than a flipper. You must reapply the sunblock because it actually breaks down in the sun’s rays. It gets used-up. Reapply every four hours, otherwise you will become best friends with ibuprofen, and lose interest in all vacation activities (don’t touch me!).

The beach can be a really great family vacation. It keeps the kids entertained and may even bring out the child in you. Family beach days are precious. Use a little precaution, keep up on the fluids, and you will make them memorable as well.

Take care,

Dr. B.

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

Image courtesy/


U.S. HealthWorks Physical Therapist and Family Lend Helping Hand to Philippines

Although he has lived in the Houston region for nearly three decades, Alex Gutierrez still has very strong ties and feelings toward his native homeland in the Philippines.

Arielle and Alex Gutierrez

U.S. HealthWorks physical therapist Alex Gutierrez and his daughter, Arielle, both did volunteer work in the Phillipines.

A physical therapist at U.S. HealthWorks in northwest Houston, Gutierrez has fond memories as a young boy growing up in the Philippines, where he was raised in a modest, tight-knit family.

So, naturally, Gutierrez was anguished last November when Typhoon Haiyan devastated the Philippines, which has the fifth largest coastline of any country in the world. Typhoon Yolanda wreaked havoc on the Philippines, devastating large portions of the country and killing more than 6,000 people.

After the initial shock subsided and he made sure family members and friends living in the Philippines were OK, Gutierrez took swift action, becoming one of the primary organizers in the Houston area for a Philippines relief effort.

Arielle Gutierrez taught young students while providing aid to the Philippines.

Arielle Gutierrez taught young students while providing aid to the Philippines.

He helped create a dinner/dance, recruiting co-workers at U.S. HealthWorks, his entire family, and many of his Houston friends for the charity effort on behalf of the Gawad Kalinga (GK) organization, a nonprofit group similar to the Habitat for Humanity in the U.S.

Gutierrez’s GK volunteer group, along with the Houston Royal Oaks Lions Club, decorated a large hall and cooked a spaghetti dinner for more than 200 people. It turned out to be a fun, festive evening for a great cause. The event raised $13,000 for GK and $5,000 for the Lions Club. The money was targeted entirely for the Philippines relief effort.

Gutierrez was thrilled at the outcome and what it meant for his entire family, which includes his wife (Josephine), two sons (Alexander Jr., Anthony) and Arielle, his daughter.

U.S. HealthWorks physical therapist Alex Gutierrez helped organize a fund-raising spaghetti dinner for Gawad Kalinga.

U.S. HealthWorks physical therapist Alex Gutierrez helped organize a fund-raising spaghetti dinner for Gawad Kalinga.

“To have my children get involved and to see them feel so great after giving back was very special to me,” he said. “I was so happy that it gave them a feeling of being connected to the Philippines. It really strengthened our bond as a family.”

Many of the same people were mobilized again in early May, preparing food and selling it again for a festival in Houston. The proceeds again went to GK, which has been at the forefront for several decades in providing support for families in the Philippines.

Gutierrez initially became involved with Gawad Kalinga three years ago when his daughter Arielle was invited by the organization to join its GK Heroes of Poverty Eradication (HOPE) Ambassador Scholarship Program to be the organization’s voice in the U.S. and help raise funds for GK projects.

One of Arielle’s successful fundraising initiatives was organizing a two-day Physical and Occupational Therapy Continuing Education Seminar. With U.S. HealthWorks’ sponsorship and assistance from Agnes Masiglat, the Regional Vice President of Therapy Services, the seminar was a great success. It was well attended by therapists from U.S. HealthWorks and other PTs and occupational therapists from the Houston area.

U.S. HealthWorks’ sponsored a Physical and Occupational Therapy Continuing Education Seminar as a fund-rasing effort.

U.S. HealthWorks sponsored a Physical and Occupational Therapy Continuing Education Seminar as a fund-raising effort.

A goal of the GK scholarship program is also to develop in the Filipino-American youth the love and care for the poor and to reconnect them to their parents’ homeland through a GK immersion program in the Philippines.

For her hard work and dedication to the GK cause, Arielle was chosen for the two-week immersion program in several of GK’s communities, schools, building sites and projects in the Philippines.

She also helped in some home-building efforts in depressed areas. As a University of Houston elementary education student, Arielle enjoyed teaching underprivileged children in the GK schools the most. What made the journey even more gratifying was doing the volunteer work in Nueva Ecija, where her father grew up.

“It was a wonderful experience for Arielle – a time for her to get to know her Filipino roots and give back,” Alex said.

One year later, Alex was beaming with pride as his once “shy” daughter was speaking passionately, discussing her Philippine experience at a GK HOPE Ball Gala attended by approximately 300 people.

The entire Gutierrez family - Alex, wife Josephine, Alexander Jr., Anthony and Arielle all worked at the fund-raising spaghetti dinner.

The entire Gutierrez family – Alex, wife Josephine, Alexander Jr., Anthony and Arielle all did volunteer work at the fund-raising spaghetti dinner.

“It was a very moving speech by Arielle, who was the event’s main speaker,” Alex said. “Going to the Philippines with Gawad Kalinga was a tremendous experience and really helped her develop as a person.”

For the Gutierrez family, giving back is definitely a labor of love.

Best gift for Father’s Day – A healthy Dad

Father’s Day is rapidly approaching and as usual we are flummoxed by the thought of buying something that might make dad happy (good luck with that).

Of course, the best gift on Father’s Day is the gift of good health. A little extra life to enjoy surely beats a tie or even one of those amazing nitrous oxide, canister-driven, automatic corkscrews. Well, maybe not the corkscrew – fathers are still boys at heart, and boys love their toys!

Father's Day 2

Men, including fathers, are not the most health-conscious group in society. Blame it on testosterone or on conditioning (high school sports), because men are trained from an early age to tough it out and suck it up. That seems almost ridiculous in our new and enlightened world, but enlightenment is not evenly distributed across the sexes.

Men have “enjoyed” a shorter average lifespan as long as we have been keeping track.  The difference is almost five years (women live to 80.4 and men to 75.3 on average).

As the life spans of both sexes have steadily lengthened, the gap has stubbornly persisted. It is not just average length of life that is different. Men also spend more of their short life sick.

Most of the leading diseases — cancer, heart disease, emphysema – are significantly more lethal in men, by 30 to 50 percent on average.

When it comes to trauma, accidents, suicide and homicides, men are in a league of their own. Men have close to a 400 percent “advantage” over the fairer sex. Even humble influenza has a higher death rate in men.

Breast cancer is one of a very few exceptions, but for the unfortunate 300 men in this country who come down with male breast cancer each year, it is far deadlier than its female counterpart.

It might be surprising that the source of the gender gap has remained elusive. When talking about violent ends, testosterone is the usual suspect. Strangely enough, studies have shown in low-testosterone males that replacement testosterone decreases heart disease rather than increasing it.

Lifestyle certainly has something to do with it. Young males in their pre-dad years have been known to hang out in unsavory places with unsavory people. More men still smoke than women, but the women are catching up, and getting similar smoking-related diseases.

Father's Day

Women in general eat a better diet than men. A better diet is one that includes more vegetables and whole grains, and less red meat. Obesity is affecting both sexes, but the fat distribution on men is abdominal, which has a higher association with heart disease than women’s hip distribution.

Type A personality was invented to describe the aggressive, tightly-wound male personality. There is a well-known cardiovascular risk to this personality. As women have made their way into the business world, some of them have channeled the female god of war, and tried on a B-plus personality for size.

That leaves genetics; the lonely Y chromosome, still unique to men. This is an unopposed chromosome that right away makes it suspect (because all genes are expressed). Many scientists believe we will find some genes on this abbreviated chromosome that help explain the shorter life of men.

But you can’t just put baby greens on a plate and say, “Happy Father’s Day, look at the nice meal I made you!”

If you seriously want to help dad evolve into a longer-living creature, a good start would be putting the discussion into terms he can relate to.

Many dads take better care of their cars than they do themselves. The principles of good car care are readily transferred to dad care. No self-respecting dad would drive around while never going faster than 25 mph. Dads know that the engine will load up; all it needs is a few RPMs to burn the deposits out.

Some vigorous movement is good for bodies as well as cars, because it keeps things like heart vessels from loading up (with cholesterol). Dad probably doesn’t buy the cheapest gasoline he can find, and skip oil changes for his favorite car. He understands maintenance counts. Consider a doctor check-up a tune-up for your body.

Whole grains, fresh vegetables, nuts and berries are all pretty good if you put enough Tabasco on them.

And if that doesn’t fly, buy dad a really sweet card, a good bottle of red wine, and plenty of canisters for that nitrous-driven, top-fuel corkscrew!

Happy Dad’s Day.

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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