Archive for the ‘Routine Health Care’ Category


As we prepare to leave the old year behind us and greet the New Year, I would like to propose the following health related resolutions:

  1. If you smoke – quit.
  2. If you drink alcohol, do so in moderation and do not drink and drive.
  3. Develop a routine exercise program and stick with it.
  4. Improve your diet – increase fruits and vegetables and decrease fats and carbohydrates.
  5. Buckle up every time you enter your car.
  6. Don’t talk on your cell phone while driving – not only very dangerous, but now also illegal.
  7. Don’t climb ladders alone, have someone with you, (personal experience speaking).
  8. Get regular dental checkups and eye exams.
  9. If you are overweight try to lose weight, but if you can’t at least remain physically fit.
  10. Use sun screen when outside during the sunny months.
  11. Routinely exam your skin for any unusual changes.
  12. Keep your immunizations up to date including all the usual ones that babies and children receive, as well as a diphtheria-tetanus booster every ten years for adults and a yearly influenza vaccine.
  13. Have your blood pressure checked at every health care visit.
  14. Routine health maintenance screening exams to be discussed with your doctor and should include:
  • Pap test for women beginning at age 21.
  • Cholesterol level test starting at age 20.
  • Mammogram for women beginning at age 40.
  • Blood sugar test starting at age 45.
  • Colon screening (colonoscopy) beginning at age 50.
  • Prostate exam for men starting at age 50.
  1. See your doctor sooner rather than later if you have a strong family history of any significant medical problems such as cancer, heart disease, diabetes, high blood pressure etc.
  2. Avoid stress, relax, and do your best to try to enjoy your life whatever your circumstances.

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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.

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As we prepare to begin a new year, I’d like to share with you some highlights from my columns this past year.

Upper respiratory infections:These infections which cause coughs, sore throats and congestion, are almost always caused by a virus infection and shouldn’t be treated with antibiotics. If symptoms continue to worsen, especially accompanied by a fever, see your doctor for evaluation and treatment.

Hepatitis C:Baby boomers (those born between 1945 and 1965), should be tested for hepatitis C as more than two million Americans currently are infected with this disease and many who are, are unaware of it.

Advanced directives:Sometimes referred to as “living wills,” advanced directives direct physicians as to your wishes for medical treatment if you were to be incapacitated and unable to make decisions on your own. Talk with your doctor about this important document.

Swallowing pills:If you have trouble swallowing them whole, most pills, capsules, or liquid medications, can be crushed and mixed in most any type of food. Check with your pharmacist to ensure that your particular pill or capsule can be mixed with food.

Hearing loss:If you are having problems with your hearing, make an appointment with a qualified audiologist and have a routine hearing test. Technological advances have made hearing aids an excellent option to restore hearing.

Hydration:To keep your body healthy, drink a glass of water or other low- or non-calorie beverage with each meal and between each meal, and drink water before, during, and after exercise.

Constipation:First try life style changes such as adequate liquid intake, and regular exercise. Maintain a high fiber diet to include beans, whole grains, fresh fruits and vegetables, and less dairy, red meat and processed foods.

Childhood immunizations:Immunizations are safe. Many well-controlled scientific studies have all concluded that there is no scientific or statistical relationship between immunizations and autism.

Vision disease:See your doctor immediately if you have any obvious visual change. People between the ages of 18 and 50 should have routine eye exams every two years and every year after the age of 50. Children need routine eye exams as well. Ask your child’s doctor about the frequency.

Hair loss:Losing some 50 to 100 hairs a day is considered normal. If you are experiencing what you consider to be hair loss of more than or sooner than you expect, talk to your doctor or dermatologist. Do this before spending a lot hard earned money on worthless treatments which are so frequently advertised to the public.

Nonprescription pain medication:You may choose from Tylenol, Advil, Aleve, or common aspirin to relieve most simple pain. Taken in the recommended dosage, Tylenol, which is effective and has less potential side effects, would be my first choice.

Generic drugs:With only a very few exceptions, generic drugs are equal in almost all aspects to the equivalent brand name drug and are much less expensive.

Diverticulitis:If you have worsening pain in the left lower abdomen, or no improvement of such pain for a few days, seek medical help immediately.

Have a very happy and healthy New Year!

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Obamacare, Affordable Care Act, California

Ready or not here it comes. The first stages of implementation of the Affordable Care Act are only a few weeks away. Its goal is to provide health care coverage to some 55 million Americans who currently have no health coverage and to expand coverage to those who are underinsured. This monumental plan takes effect January 1, 2014.

Universal coverage is the goal of the plan and will be attained in two ways. First is the individual mandate which requires anyone without any type of health care coverage either through the government or an employer, to purchase an individual policy or face a financial penalty, referred to as a tax. The second way is that employers of more than 50 full-time workers will be required to provide insurance or pay a penalty of $2,000 per worker. If you are one of the millions covered by employer purchased insurance plans, Medicare or Medi-Cal you need not make any changes.

Those who have no employer offered health insurance and thus have to purchase their own coverage may see an increase in rates next year, but it is projected that almost half of these people will be eligible for tax credits to offset the increased premiums. Health insurance marketplaces called exchanges will allow consumers to compare costs and benefits among the available plans and to see if they qualify for tax credits to offset the price of their insurance premiums. These new plans are, for the most part, private (not public) and will compete to earn your business based on price, benefits and quality of service.

You can enroll beginning October 1 at the official website at http://www.coveredca.com, or by telephone at 888-975-1142 toll free.

People with incomes between $23,000 and $94,000 for a family of four, can receive financial help on a sliding scale to help offset costs. The same help is available to single individuals earning up to $46,000.

Those with very low incomes will be enrolled in Medicaid (Medi-Cal in California). As of January 1, 2014 Medi-Cal eligibility income levels will rise to $15,900 for individuals and $23,550 for families.

The first open enrollment period will last from October 1, 2013 to March 1, 2014. One may sign up via the internet, telephone, mail, or in person at designated centers. Once enrolled, it could take several weeks for the new coverage to take effect.

The law states that people cannot be denied coverage or charged higher premiums because of preexisting conditions. However, premiums may vary depending on age, tobacco use, geographic location and family size.

The new law requires that insurance policies cover the following 10 essential benefits:

– Hospitalization and rehabilitation services.

– Outpatient care (office visits) and emergency care.

– Prescription drugs and laboratory services.

– Preventative (wellness) care and mental health services.

– Pediatric and maternity/newborn care.

The law also eliminates lifetime limits on medical expenses, prohibits insurers from dropping or denying coverage, provides for your child to be covered on your policy until age 26, and caps annual out of pocket expenses up to an estimated $6,400 for individuals and $12,800 for families.

This is a monumental change in health care coverage. Soon there will be a significant change in health care delivery. Stay tuned.

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Athlete drink

I’m often asked by patients how much water they need to drink each day. The Institute of Medicine has calculated that men need about 13 cups or three quarts of liquids and women need about nine cups or two quarts of liquids daily. We also ingest approximately 2 ½ cups, or 20 percent of our daily intake of liquids from food, especially fruits and vegetables. In addition, beverages that we commonly drink such as coffee, juice, milk and soda are composed mostly of water.

Water makes up 60 percent of our body weight. Every cell and system of our body depends on water. Lack of water causes dehydration, a condition that occurs when the body receives an inadequate amount of fluids, which in turn slows down and eventually shuts down vital bodily functions.

Our bodies constantly lose water from perspiring, breathing, urinating and having bowel movements.

Various factors determine just how much more water we may need to drink, such as:

– Environment — Hot weather, especially with high humidity, increases perspiration. Even in frigid weather, water is lost from our bodies when breathing during activities such as skiing or hiking.

– Exercise —Also increases perspiration. The more prolonged and intense the exercising, the greater the fluid loss is.

– Illness — Intense or prolonged vomiting and/or diarrhea can lead to life-threatening dehydration. This is an unfortunate cause of death in many developing countries.

– Pregnancy and breast feeding — Increases women’s fluids needs.

After hours of prolonged exercise with heavy sweating we lose electrolytes, especially salt. This is when drinking a sports drink is recommended because it will not only replace the lost water but also the depleted electrolytes. Electrolytes lost through sweat from mild to moderate exercise, can be replaced from the food we eat.

Some liquids can act as a diuretic, which means they cause you to urinate more liquid than you’ve taken in. Caffeine is often implicated, but is really a weak diuretic. Alcoholic beverages on the other hand, especially at higher quantities, can be very potent diuretics causing dehydration which is a major cause of a hangover.

A rough guide as to whether or not you are consuming enough water is to check your urine color. If it appears light yellow, like lemonade, you’re probably well-hydrated but if it is very dark yellow, like apple juice, you need to drink more water.

To keep your body healthy:

– Drink a glass of water or other low or non-calorie beverage with each meal and between each meal.

– Drink water before, during and after exercise.

Bottoms up!

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As we begin a new year, I’d like to share with you a selection of highlights from some of my columns this past year:

Antibiotics:Antibiotics are useful for bacterial infections only, and not for viral infections, such as the common cold, bronchitis and sore throats.

Strokes:If you are having any symptoms that you think might be caused by a stroke, do not hesitate — seek help immediately from the nearest emergency room.

Insomnia:Remedies for sleep problems include lifestyle and behavioral therapies, alternative medicine and prescription medication.

Sleep apnea:This condition needs to be treated, as it leads to a greater risk of heart attacks.

Depression:This is a true medical illness treated with therapy or medication, sometimes in combination.

Asthma:Although it can be deadly, asthma is easily treated with proper medication and close follow-up with a doctor.

Sun exposure:Take the harmful effects of the sun seriously and use sunscreen liberally and frequently. Cover up as much as possible when in the sun.

Cholesterol:To help prevent heart attacks and strokes, keep cholesterol at a normal level.

Coffee:On the whole, coffee is much more beneficial than harmful to your health.

Backpacks for students:Lighten them up. Heavy packs cause neck and back problems for kids.

Influenza vaccine:Flu shots are useful to prevent influenza and can be given from fall to spring. It’s still not too late.

Head injuries:Concussions should be taken very seriously, as they can be deadly and can lead to long-term brain disability.

Calling in sick:Staying home when ill not only helps you recover quicker, but also prevents spreading the illness to your co-workers or fellow students.

Stress:Dealing with stress can help prevent poor health.

The full columns and all others I have written can be found here on my blog at https://valleydoctor.wordpress.com.

Have a very healthy and happy new year.

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Patients seeking medical care today are having more frequent exposure to non-physician providers, such as physician assistants and nurse practitioners. Both of these groups of health care practitioners are professionals licensed to practice medicine under the supervision of a physician.
They can perform a wide variety of medical duties, from basic routine medical care to highly technical procedures. They may also work as surgical assistants to a surgeon. Their patients can range from newborns to the very elderly. They can be found in virtually every medical and surgical specialty.

In rural areas that are short of physicians, they often work independently, conferring with a supervising physician as necessary and as required by law. Their responsibilities are determined by their experience, their working relationship with the supervising physician and state laws.

The first physician assistant program began in 1965 at Duke University Medical Center in North Carolina. Many of the first students in this program were Navy corpsmen who had received considerable training and on-the-job experience in the Vietnam War but had no options to use their talents upon return home to the U.S.

The nurse practitioner program began at the University of Colorado, also in 1965. Unlike physician assistants, nurse practitioners first receive their registered nurse degree and then go through further training to practice medicine under a physician’s supervision.

Both nurse practitioners and physician assistants can:

**Take medical histories and perform physical exams.

**Prescribe medication and order medical tests.

**Diagnose and treat illnesses.

**Counsel patients and promote wellness.

**Perform minor surgical procedures independently.

**Assist in surgery.

Their practice may also include administrative services, education and research.

Both groups have to pass a national certification exam, be continually reexamined after a number of years and also complete a prescribed number of continuing medical-education hours to maintain their licenses.

Physician assistants and nurse practitioners can be found serving a wide variety of medical needs in settings from remote rural areas to major urban centers. They work in physicians’ offices, hospitals, clinics, the armed forces and government agencies.

I have worked with nurse practitioners and physician assistants for the major part of my career, dating back to the mid-1970s. They have been a tremendous asset to my practice, as well as to the many physicians who call upon their talents and skills.

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