At one time or another, all of us have experienced abdominal pain. It is one of the most common complaints seen in emergency rooms.

Most of the time, it is not caused by a serious medical problem, but when it is serious it can be life-threatening. In this article, I’d like to differentiate between mild pain symptoms and more serious symptoms that would cause you to seek urgent medical care.

There are an abundant number of causes of abdominal pain too numerous to mention in this article, but there are many signs and symptoms of abdominal pain of which you should be aware.

What are the most common causes of abdominal pain?

- Indigestion, constipation, ulcers, and gas.

- Stomach flu and food poisoning.

- Food allergies and lactose intolerance.

- Gallstones and kidney stones.

- Urinary tract infections, pelvic infections, ovarian disease, endometriosis, and menstrual cramps.

More serious causes include:

- Aneurysm (swelling with possible rupture) of the aorta.

- Decreased blood supply to the intestines (ischemic bowel).

- Appendicitis, diverticulitis, and cholecystitis (infections of the appendix, the colon, and the gallbladder respectively).

- Bowel blockage (obstruction).

- Cancer of any of the intra abdominal organs especially of stomach, colon, or liver.

- Pancreatitis (inflammation of the pancreas).

- Pneumonia.

- Heart attack.

Seek immediate medical help or call 911 for abdominal pain that involves:

- Severe sudden abdominal pain.

- Vomiting blood, having blood in your stool, or if your stool appears tar colored.

- Tenderness over your abdomen, or if it feels rigid when you touch it.

- Pregnancy either confirmed or suspected.

- A recent injury to your abdomen.

- Pain and difficulty breathing.

- Mild abdominal pain that does not improve within 24-48 hours, or becomes more severe or frequent, especially if occurring with vomiting.

- Diarrhea for more than several days, especially with fever or blood.

- Fever over 100 degrees with your pain.

I have tried to simplify the complex subject of abdominal pain. Obviously, this is not all-inclusive, but my goal has been to have you understand those symptoms that should prompt immediate medical attention. This information is from my personal experience to serve as a guideline in dealing with abdominal pain.

As I always say, in spite of anything you may have read or heard about, if you have any symptoms that concern you, or just doesn’t seem right, seek medical care.

Of course, as with most problems with your health, it’s much better to deal with them sooner rather than later.


As part of my cancer treatment journey, I have developed a pretty severe case of peripheral neuropathy of my feet. I was warned that the chemotherapy could cause neuropathy, but I didn’t know it would be quite this uncomfortable.

Peripheral neuropathy is caused by damage to certain nerves — mostly the sensory nerves — which deal with touch, pain, and heat. Most of the time, the problem starts in the fingers and toes and can worsen to include the feet, legs, and hands.

Causes of peripheral neuropathy include:

- Diabetes (the most common cause).

- Chemotherapy.

- Alcoholism.

- Vitamin deficiencies.

The most common symptoms are:

- Pain, burning or tingling of fingers, toes, hands and feet.

- Muscle weakness and balance problems.

- Loss of sensation to touch.

- Difficulty using fingers for tasks such as buttoning one’s clothing.

Measures that may help relieve the symptoms of neuropathy:

- Acupuncture, massage, physical therapy and reflexology.

- Relaxation therapy.

- Prescribed medications such as pain medicine, lidocaine patches, capsaicin cream, and anti-depressant and anti-seizure medications.

- Vitamins and supplements such as vitamins B1, B6, B12 and alpha lipoic acid. Check with your doctor for proper doses and any other treatment options.

How to take care of yourself:

- Because neuropathy can cause poor balance, remove throw rugs and clear up any clutter.

- Put grab bars near shower, bathtub or toilet.

- Protect your hands and feet where sensation is decreased and be aware of very hot or cold temperatures.

- Don’t drink alcohol.

- Check hands and feet for cuts, scrapes, burns or any other signs of injury.

If you think you are having any of the symptoms of neuropathy see your doctor for evaluation and suggested treatment.


According to a recent public health alert, California is experiencing an epidemic of pertussis, with over 5,000 cases reported this year.

Santa Cruz County has had at least 60 known cases (twice the number as last year) and probably many more cases, which have not been reported or have yet to be diagnosed.

Pertussis, also called whooping cough, is a highly contagious infection of the lower respiratory tract, involving the lungs. It usually manifests as a mild persistent cough, but can advance to a severe cough. Often in children, this cough is followed by a high-pitched intake of breath that sounds like “whoop” – thus the name “whooping cough.”

Pertussis is caused by a germ which is a bacteria and not a virus. It is passed from an infected person who sneezes or coughs and therefore spreads infected tiny droplets into the lungs of anyone who may be nearby.

Once in the lungs, the germs can cause an infection, thereby creating inflammation and narrowing of the lung’s breathing tubes. This produces the cough and the characteristic whooping sound.

Infants are particularly vulnerable because they are not fully immune to whooping cough until they’ve received at least 3 immunization shots.

This leaves those 6 months and younger at greatest risk for catching the infection.

The pertussis vaccine one receives as a child wears off in 5 to 10 years, leaving most teenagers and adults susceptible to the infection during an outbreak.

Also, more parents are choosing not to vaccinate their children, thus lowering the number of immunized individuals. This, coupled with the fact that newer vaccines are less potent than the older ones, has increased transmission of pertussis.

The diagnosis of pertussis is often delayed or missed in infants because early symptoms are often mild and the serious cough may not begin for days or even weeks later.

A severe infection in infants can be fatal, although this is thankfully rare. Three infant deaths due to pertussis have been reported in California since the beginning of the year.

One must consider pertussis for anyone with a cough lasting more than 2 weeks, especially when the person generally feels well, coughs worse at night, and has prolonged coughing spells.

The vaccine for pertussis is combined with the tetanus and diphtheria vaccines which are routinely given to children in their first years of life, and to adults every 10 years.

Besides infants, those who especially need the vaccine protection are pregnant women in their third trimester because they will soon have contact with their unprotected infant.

Mothers have been found to be the greatest source of transmitting whooping cough to the newborn. Infants can also be protected by vaccinating those people who have close contact with them.

This “family” protection has been highly successful in protecting susceptible infants.

Tests are available to diagnose pertussis. The decision whether or not to test should be left to your doctor.

Antibiotics can be effective especially when given soon after symptoms begin. After several weeks of symptoms, they are much less effective.

Family members can also be prescribed preventative antibiotics. Remember that pertussis is caused by bacteria and can usually be treated with an antibiotic, but if you just have a bad cough from something like routine bronchitis, which is caused by a virus, antibiotics are not effective.

Your doctor will be able to determine the proper diagnosis and treatment.

Bottom line: I recommend to immunize your children and keep immunizations up to date for yourselves.


I am in remission of my multiple myeloma cancer. The three months of chemotherapy last fall and winter did a great job in knocking out most of those cancerous plasma cells which were taking over my body. The stem-cell transplant I was originally to have following chemotherapy has been canceled. I will have my blood tested regularly to monitor my remission. My thanks to Dr. Michael Wu and his wonderful caring staff at the Palo Alto Medical Foundation oncology department who did a superb job treating my disease.

I discovered that one doesn’t necessarily have to leave Santa Cruz for state-of-the-art cancer care that I found right here through my group at PAMF. I sure wasn’t used to being — nor particularly enjoyed — being on the patient side of the doctor/patient relationship. It was a humbling experience and has taught me more about patients and patience along my journey.

Unfortunately, I am suffering from a fairly severe neuropathy of my feet from the chemo drugs, and this is currently adversely affecting my ability to walk normally. I do, however, feel it’s a small price to pay for my successful cancer treatment. I’m told the neuropathy should improve with time. I’ll try to be patient, (not one of my virtues however).

Another little complication I had in the past month, most likely unrelated to my cancer or treatment, is a condition of my heart called constrictive pericarditis. This occurs when the sac of tissue surrounding the heart (the percardium) becomes inflamed and tightens in on the heart, causing the heart to pump less efficiently.

This threw me into mild heart failure with significant shortness of breath, swelling of lower extremities and general fatigue. Dr. Neil Sawheny, one of my cardiologist partners at PAMF, is treating me for this unexpected complication and I seem to be responding well and improving day by day.

In general , my overall well-being is improving significantly. I feel as though my life as I once knew it is being slowly restored. Once my neuropathy shows signs of improvement, I hope to return to work at least half-time.

I’ll give myself a break to work a bit less since I’ve now been practicing medicine for the past 40 years, 27 years in urgent care Scotts Valley. I love my staff, my patients, many of whom I’ve come to know quite well. Most of all, I love the satisfaction I receive in helping make people feel better and in maintaining their good health.

My thanks to all of you who have mailed get-well cards or sent email messages for my recovery. I am a strong believer in the power of prayer and I know your prayers for me have been heard.

My personal lesson from my cancer experience is this: If you have any health symptoms that seem unusual to you or are lasting longer than you think they should, see your doctor for a work up. If everything checks out OK and your symptoms soon improve, then be thankful.

If something serious like cancer is found, the sooner it’s treated the better the outcome. This a proven fact. Also, for those many of you who are healthy, give thanks every morning that you can begin a new day.

My best wishes to you for long healthy lives.


Osteoporosis literally means “bones with holes.” It occurs from bone losing calcium faster than it can be replaced. New bone creation doesn’t keep pace with the removal of old bone. The bone is weaker, less dense, and easier to break than healthy bone.

There are come common risk factors and you they are unchangeable. For instance, your sex. Women, especially post menopausal, are much more likely to develop osteoporosis then men, but men aren’t off the hook. There are at least 2 million men with osteoporosis and this will increase as men begin to live longer. The older you get, the greater the chance of developing osteoporosis. You’re also at a greater risk if any close relatives have had osteoporosis and Caucasion and Asian women are at a greater risk.

The reduction of sex hormones, estrogen for women and testosterone for men, also contribute to osteoporosis. Dietary factors associated with osteoporosis include low calcium intake, eating disorders and stomach bypass surgery. Certain medications, especially corticosteroids such as prednisone and cortisone, can contribute to osteoporosis.

Lifestyle choices also can put you at a greater risk for osteoporosis. Smoking tobacco and drinking alcohol, especially more than two drinks a day, will put you at greater risk, as will a sedentary lifestyle and a lack of exercise.

Bone fractures, especially of the hip and spine, are the most common complications of osteoporosis. A fall can easily break a hip, causing disability and even lead to death. Spinal fractures can occur with or without an injury. Sometimes a sneeze or cough can cause a fracture.

The best way to diagnose osteoporosis is to measure bone density. This can be done by a machine that uses low levels of x-ray to measure the strength of your bones. Your doctor can order this for you.

Osteoporsis can be treated with drugs called biophosphonates. Your doctor would have a choice of one of several of these drugs to treat you. Use of the sex hormones estrogen for women and testoterone for men can also be useful in treating osteoporosis. Some controversy exists over the use of these hormones. Your doctor will explain the risks and benefits.

So, to avoid osteoporosis, avoid excessive consumption of alcohol, don’t smoke, try to avoid falls, exercise regularly, and consume adequate amounts of calcium. It is recommended that the total daily calcium intake from diet or supplements not exceed 2,000 mg. daily for people over age 50. Consume adequate amounts of vitamin D, which is necessary for your body to absorb calcium. Talk to your doctor about what dose would be best for you.


Over the course of my emergency/urgent care career I’ve dealt with many different injuries and illnesses seen commonly during the summer months. I’d like to share some of my thoughts on making this a very safe summer for everyone.

Sunscreen – Almost everyone who spends time out in the sun must wear sunscreen to block the harmful, damaging effects of the sun’s ultraviolet rays on our sensitive skin. Use a sunscreen that offers protection against both UVA and UVB rays and has an SPF rating of at least 30. Apply it liberally and often (at least every two hours). Parents, protect your kids’ precious skin.

Insects – Beware of the many summer bugs lurking out there. For mosquito protection, use a repellant that contains DEET, which when used as directed is safe for adults and children over 2 months of age. Regarding the stinging insects such as yellow jackets, wasps and honey bees, avoid them if they are in your vicinity. If you do get stung by a honey bee (which is the only one of the stinging insects that leaves a stinger behind in your skin), remove it as quickly as possible by any means possible. It is now okay to just pull it out with your fingers and not waste time finding something with which to scrape it off. Immediately apply ice to the sting. When out in a woody or grassy area always check your entire body for ticks when you get home. If you find one, remove it as soon as possible by getting a pair of tweezers, grabbing the tick close to the skin and pulling it straight out.

Poison oak – The best protection is to recognize it and avoid it. If you come into contact with poison oak with your skin, clothing (including shoes and shoelaces), or garden tools, wash off immediately with soap and water. Poison oak oil must be washed off of your skin within a few minutes in order to avoid the dreaded rash. Remember, all parts of the poison oak plant contain the nasty oil, including the leaves, branches and roots.

Heat – Heat exhaustion is manifested by extreme sweating, fatigue and cramps. Heat stroke (a life-threatening condition) is manifested by lack of sweating, red hot skin, and a very high body temperature. Both conditions can usually be prevented by drinking plenty of liquids and avoiding direct sunlight as much as possible, especially between the hours of 11 a.m. and 4 p.m.

Water safety – 4,000 Americans drown every year, mostly men by a factor of four times more than women. Alcohol is frequently involved. Make sure the kids are supervised in the water every single minute. Watch out for rapid currents, rip tides, rocks, and always be aware of your surroundings. Boat injuries claim another 700 American lives a year. Drive your boat sensibly, have enough life preservers on board and do not drink alcohol and drive.

Bicycling – Wear a helmet! No matter how obvious this bit of advice is, I still see people riding without a helmet and I really cringe when I see children without this life-saving protection. Head injuries are often very serious, if not deadly, and are inexcusable for lack of a helmet. Be aware of your surroundings and be in control of your bike at all times. Don’t take foolish chances.

Eating – Summer picnics can be a common source of food poisoning manifested by vomiting and/or diarrhea. Food left out too long is the usual culprit. Handling uncooked chicken or eating undercooked chicken is also a common source of this illness.

Driving – We all drive more during the summer. The cheapest form of life insurance while you are in a car is the good old seat belt. Wear it! Make sure your children are in proper age-appropriate car seats. Handheld cell phone use while driving your car can be deadly and is now illegal. Don’t break the law.

Have a very enjoyable safe summer.


There’s been much in the news recently about e-cigarettes. The Santa Cruz City Council has just voted to update the city’s tobacco related ordinances which would ban the use of e-cigarettes where smoking is currently restricted and requiring the product to be sold only by vendors with tobacco retail licenses. Thus, Santa Cruz joins some 50 California state cities and counties in creating such restrictions.

E-cigarettes, also called vape pens or e-hookahs, are made to resemble cigarettes. They are battery-operated, which allows conversion of liquid nicotine into a vapor which enters the lungs and is easily absorbed into the blood stream. There’s no tobacco, flame, smoke, tar or carbon monoxide which is probably the only good thing that can be said for this product.

I’d like to touch upon some of the questions and concerns regarding electronic cigarettes.

Are e-cigarettes safer than regular cigarettes?

They are probably safer than cigarettes because of the lack of the above mentioned substances found in burning regular cigarettes. That being said, e-cigarettes are a nicotine delivery system, are highly addictive and ultimately harmful because of the effects of nicotine, which is a potent stimulant drug that is probably unsafe for children, pregnant women and people with certain heart conditions. These products are not regulated by the Food and Drug Administration and many are manufactured in China, a country not known for its quality control and safe products.

Can e-cigarettes help break the habit of smoking regular cigarettes?

There is no good scientific evidence that smoking e-cigarettes can effectively wean one off of regular cigarettes. In fact, one large study of 75,000 teen smokers found that those who were trying to quit smoking were less likely to succeed if they also smoked e-cigs and many actually ended up smoking more real cigarettes. Better ways of breaking the smoking habit would be to utilize the strategies of behavioral counseling, nicotine replacement products and prescription non-nicotine medication.

Are kids smoking e-cigarettes?

Since some 90 percent of long term smokers began smoking under the age of 18, it’s not hard to imagine the allure of e-cigarettes to our youth. The CDC has reported a disturbing trend that the use of e-cigarettes more than doubled among U.S. middle and high school students from 2011 to 2012. To make them more appealing to minors, manufacturers are making e-cigarettes in assorted eye catching colors and candy flavors like watermelon, cotton candy, and bubble gum.

So with no proven health benefits and with too many questions concerning safety and long term addiction, e-cigarettes should come with at least the same restrictions, warnings and health concerns as with regular tobacco cigarettes.

The bottom line is that for the sake of one’s health, I would strongly discourage the use of any and all tobacco and nicotine products.


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