There appears to be an outbreak in our community of a benign (non serious) viral infection caused by a virus called Coxsackie. This infection can manifest itself in two ways.

First it may be seen as hand, foot, and mouth disease. The most common manifestation of this disease in children causes symptoms of fever, runny nose, sore throat, and poor appetite, all beginning about 4-5 days after exposure. Several days after these symptoms occur, a blister-like rash forms in the mouth, on the palms of the hands, and on the bottom of the feet. It takes about a week for the rash to clear up.

The other manifestation of this disease is called herpangina, where along with the fever and fussiness, the mouth has painful blisters, but no involvement of the hands or the feet.

This virus usually occurs in children under 10 years of age, but as it is doing now, it can occasionally occur in middle and high school students as well as young adults. It is spread by direct contact with nose and throat secretions, blisters, and feces of infected people.

Contagiousness begins with the onset of the first symptoms and continues for about 5-7 days. The virus may remain in the stool for several weeks.

There is no known cure for this infection. Because it is caused by a virus it just has to run its course. Treatment of the symptoms includes over the counter pain medications such as Tylenol (acetaminophen) or Advil (ibuprofen). Lifetime immunity may occur, but not always. Pregnant women who have been exposed to this illness should consult with their doctor.

Most of us who treat children with this disease feel that they can return to day care or school when the fever is gone and the child feels well. This usually takes about one week from onset of the first symptoms. Thorough hand washing in general, particularly after changing diapers, is important in limiting the spread of this disease.



Anemia is a condition where blood lacks an adequate number of hemoglobin rich red blood cells, thus decreasing the amount of oxygen which is so vital to the proper functioning of our bodily tissues. Within each red blood cell is a protein called hemoglobin which is rich in iron and gives blood its red color. Hemoglobin is what enables red blood cells to carry oxygen from the lungs to all tissues of the body and carries carbon dioxide from the tissues back to the lungs.

Anemia is the most common of all blood conditions affecting some three and a half million Americans, especially women, children and the chronically ill. It most commonly causes weakness and fatigue.

There are several main causes of anemia, one of which is due to blood loss, which can be slow and happen over a long period of time. Common causes of this would include problems with the gastrointestinal tract, such as colon and stomach cancer, ulcer disease, gastritis (inflammation of the stomach), and hemorrhoids. Heavy menstruation is another common cause. Rapid blood loss from surgery or injury can also cause anemia and usually necessitates immediate blood transfusion as a life saving measure.

Decreased or faulty production of red blood cells can also contribute to anemia. Some of these common conditions include certain vitamin and iron deficiencies, bone marrow diseases (often associated with some cancers), and chronic kidney and thyroid disease.

Destruction of red blood cells faster than the body can produce them also causes anemia. Such conditions can also be due to chronic liver and kidney disease, as well as inherited diseases such as sickle cell anemia and a blood disorder called Thalassemia.

Some of the more common symptoms of anemia are: fatigue, weakness, pale skin, shortness of breath, and dizziness.

Often, the diagnosis of anemia is made on a routine blood test, where the patient had no obvious symptoms. This can occur because the anemia develops over a very long time allowing the body to compensate for the lack of oxygen to its tissues.

Once the diagnosis is made, further tests will be done to help determine the cause and best treatment for the anemia.

Anemia will be treated according to what has been determined to cause it. Iron supplements for iron deficiency anemia or folic acid and vitamin C supplements may be all that’s necessary to cure some types of anemia. In other cases, curing the underlying disease will help to improve the anemia.

Blood transfusion may be necessary for more severe forms of anemia to rapidly increase the number of functioning red blood cells and help to more quickly alleviate the symptoms of the disease.

See your doctor if you have any of the above mentioned symptoms and expect a complete workup and proper treatment plan.

Zika Virus

zika virus

I’m quite concerned when the deputy director of the Centers for Disease Control and Prevention states that what authorities are learning about the Zika virus is “scarier than we initially thought.” There is certainly no need to panic at this time, but it does appear that this is a disease that we may eventually have to deal with in our locale. Fortunately, as of this writing, there have been no documented cases of mosquito borne Zika infection originating in California, only a few cases involving people who have returned after traveling to Zika infected areas outside of the U.S.

Zika infection is usually pretty mild. Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. Pregnant woman are at greatest risk of complications to their fetuses and there are reports of associated Guillain-Barre syndrome (a rare paralysis of the body in infected adults).

On April 18th, the office of the Santa Cruz County Mosquito and Vector Control (MVC) released a report to the County Board of Supervisors about its local response to mosquitoes, including our native variety, which at this time does not transmit Zika, as well newly discovered more invasive species that have been found in other parts of California and have the potential to transmit Zika. These newer mosquitoes are, unfortunately, more aggressive and tend to bite more during daylight hours. The MVC office is increasing surveillance by setting out more traps throughout the county and asking for the public’s help in reporting any increased activity of mosquitoes biting during the daytime.

At this time the MVC advises us to:

  • Wear long sleeved shirts, pants, socks with shoes, and repellants when outside and anytime mosquitoes are present.
  • Dump and drain standing water sources around your property.
  • Report, to the MVC at 454-2590 any neglected swimming pools and other backyard standing water sources, as well as the observance of day biting mosquitoes.

These are a few of the safe, insect repellants even during pregnancy:

  • DEET (Off! Deep Woods, etc) is the gold standard repellant and is safe for kids over 2 months.
  • The stronger the DEET concentration the longer the time of protection.
  • Picardin (Natrapel, etc.) Less oily feel and odor than DEET but equally effective.
  • Oil of lemon eucalyptus (Cutter Lemon of Eucalyptus, etc.) for age 3 years and older.
  • Permethrin can be used on clothing or gear but not on skin.

If you are using sunscreen, apply it before using an insect repellant. When applying any repellant to children, spray it onto your hands and then apply to a child’s face.

Even if they do not feel sick, travelers returning to the United Sates from an area with Zika, should take steps to prevent mosquito bites for up to 3 weeks so as to not spread Zika to mosquitoes that could spread the virus to other people.

Again, no major need for worry about Zika virus in our community at this time, but it will probably arrive in the near future and we must be alert to this problem and begin to practice good mosquito bite protection practices.

portrait of an young woman coughing with fist

Everyone has at one time or another experienced a common cold manifested by such symptoms as nasal and sinus congestion, runny nose, mild sore throat and cough.  This common infection may last from a few days to one to two weeks. It is always caused by a virus and therefore patience, and not antibiotics, is the main treatment.

Bronchitis can be thought of as any cough that is not caused by pneumonia or asthma.  The main symptom of bronchitis is a cough without a fever.  People with bronchitis usually just have a cough and do not feel particularly sick and are able to continue their normal daily activities.  One can expect coughing from bronchitis to last from one to three weeks. Again, this is a virus infection and antibiotics are usually not necessary. If a cough does last more than several weeks, or is associated with fever, it would be wise to visit your doctor.

Sinusitis is an infection of the sinuses which are air filled pockets around the nose in the skull.  This infection is usually preceded by a common cold.  It too is usually caused by a virus, but after lingering for one to two weeks may turn into a bacterial infection.  One of the key factors in determining the proper treatment for a sinus infection is the length of the symptoms.  If you have had a cold for one to two weeks and are experiencing pain or pressure in the sinuses along with yellow or green nasal mucus and perhaps a fever, then antibiotics may be helpful.

A sore throat is often a symptom of a cold, but can sometimes be a bacterial strep throat infection.  A good rule of thumb is that if a sore throat is associated with a bad head cold, and especially with a cough, it is usually caused by a virus and needs no prescribed treatment.  If however, one has a sore throat without cold symptoms or cough but does have a fever and a past history of prior strep infections, then the most likely culprit is the strep germ which needs to be treated with antibiotics. Strep is much more common in children than in adults.

Over the counter medications for adults can be helpful in alleviating the miserable symptoms of respiratory infections.  The following are the basic ingredients of all the myriad combinations of cold and flu drugs found on pharmacy shelves:

  • Acetaminophen (Tylenol) or ibuprofen (Advil) may be used to reduce fever and to alleviate aches and pains.
  • Pseudoephridine (Sudafed) is a decongestant to help relieve nasal and ear congestion.
  • Guaifenesin (Robitussin or Mucinex) is an expectorant to help loosen mucus. (Dinking lots of liquids may work just as well.)
  • Dextromethorphan is a cough suppressant which may help ease a persistent cough.

One may purchase a sinus rinsing system called Neil Med which can be found at all pharmacies. This is a natural treatment using a salt based solution to mildly flush out the sinuses helping to clear out the mucus as well as acting as a decongestant.  I have found this to be one of the very best treatments for bad colds and sinus infections.

See your doctor if you have a fever for more than 3-4 days or if your fever is 103 degrees or higher.  Your doctor will determine whether antibiotics are necessary to treat you.  At the very least, your doctor may prescribe medication which will help to alleviate your symptoms and make you feel more comfortable.

Palliative and Hospice Care

There seems to be some confusion when it comes to understanding the difference between palliative care and hospice. They are both distinctive medical disciplines and often work together.

Hospice care comes into play when a patient has a terminal illness and all treatment options have been exhausted. It is really for those who have been determined to be in their last six months of life. The goal of hospice care is not to cure the underlying disease but to support the quality of life. Hospice care is usually provided by a team of health care professionals who maximize comfort for terminally ill patients while also addressing physical, social and spiritual needs.

Hospice care is most commonly provided at a patient’s home, with a family member typically serving as the primary caregiver, but, it is often available where ever the patient is, whether at hospitals, nursing homes or assisted living facilities. The hospice care team is usually available 24 hours a day, 7 days a week.

Palliative care is medical care based on the goal to relieve pain and suffering, reduce symptoms, ease stress, and mainly to improve a patient’s quality of life during a serious illness and is not limited to end of life issues. People who are actively being treated for a disease can receive palliative care at any stage of their illness whereas hospice is thought of as end of life care.

This is an important distinction because many people think of palliative care as end of life care and therefore is often not requested when it’s most needed and helpful. Recent studies are showing the benefits of beginning palliative care soon after the diagnosis of a serious illness or when an ongoing illness worsens.

The palliative care team works closely with the patient’s primary treating physician in caring for the patient. While the patient’s treating physicians may be trying to prolong life, palliative care’s goal is to maximize quality of life. It has been shown that palliative care can actually extend a patient’s life for a number of months.

Identifying and managing pain is one of the main priorities of any palliative care program. Cancer is the most common disease which needs adequate pain control usually with opiate drugs like oxycodone and morphine and its derivatives. Palliative care also seeks to improve many other troublesome sources of physical discomfort such as shortness of breath, constipation, and insomnia.

With the help of a social worker, palliative care also deals with psychological and social services both for the patients and their care givers, as well as helping with practical problems like coordinating doctors visits and even arranging transportation.

Our community is blessed to have a number of top notch palliative and hospice care providers. Talk with your physician for further information.

Rare Diseases

Rare Disease Day

Kudos to state Senator Bill Monning who has introduced a resolution to the state Senate recognizing the last day of February as Rare Disease Day in California, coinciding with a similar national observance. This action should help to inform the public about the challenges faced by those living with rare diseases.

There are approximately 7,000 rare diseases that have been identified, which in reality, involve a very limited number of people. A rare disease is defined as one that affects less than 200,000 (and usually considerably less) people in the United States and where treatments and cures are equally rare, mostly because of lack of interest and funding.

I thought I would describe a few interesting sounding rare diseases from A to Z, most of which even I myself have never heard of (much less able to spell):

  • Aarskog syndrome is an extremely rare genetic disorder marked by stunted growth that may not become obvious until the child is about three years of age, facial abnormalities, musculoskeletal and genital defects, and mild intellectual disability.
  • Blue rubber bleb nevus syndrome (BRBNS) is a rare blood vessel disorder that affects the skin and internal organs of the body.
  • Dysplasia epiphysealis hemimelica, is a rare skeletal developmental disorder of childhood.
  • Fibrodysplasia ossificans progressiva (FOP) is a very rare inherited connective tissue disorder characterized by the abnormal development of bone in areas of the body where bone is not normally present, such as the ligaments, tendons, and skeletal muscles.
  • Keratosis follicularis spinulosa decalvans (KFSD) is a rare, inherited, skin disorder that affects men predominately and is characterized by hardening of the skin in various parts of the body.
  • Olivopontocerebellar atrophy (OPCA) has historically been used to describe a group of disorders that affect the central nervous system and cause a progressive deterioration of nerve cells in certain parts of the brain.
  • Paroxysmal nonkinesigenic dyskinesia (PKND) This group of neurological conditions is generally characterized by involuntary muscle contractions that force the body into abnormal, sometimes painful, movements and positions.
  • Trismus-Pseudocamptodactyly syndrome is a very rare inherited disorder characterized by the inability to completely open the mouth causing difficulty with chewing and/or the presence of abnormally short fingers.
  • Zollinger-Ellison syndrome (ZES) is characterized by the development of a tumor that secretes excessive levels of a hormone that stimulates production of acid by the stomach which can cause stomach ulcers or cancer. By the way, Dr.Ellison, who discovered this syndrome, was the chief professor of surgery during my days attending medical school at The Medical College of Wisconsin.

These are but a few interesting sounding rare diseases from which a limited number of people are afflicted. But for those unfortunate ones who are, and because of being so rare, treatments or cures are not easy to come by. Again, thanks to Senator Monning whose resolution could create a better awareness of rare diseases and increase desperately needed research.



Since a previous article concerning my relapse with multiple myeloma cancer and the effects of chemotherapy, and after much thought and soul searching, I have decided to retire from the practice of medicine.

Having just turned 70 years old and having practiced medicine for the past 43 years (28 of those years in my current practice of urgent care medicine in Scotts Valley), I think it’s time to move on.

At this time I do feel very well, all things considered. I look forward to having some more time to spend with my wife Beth and my daughter Emma, as well as to pursue other interests, such as restoring my good old ’71 Volkswagen bus.  Beth is a musician and music educator and I’m sure I’ll spend more time as her “roadie”.

Being a doctor is something that I had wanted to do since childhood, and it was an honor to follow in the footsteps of my father and grandfather. I have never regretted my decision to enter the medical field. I can’t imagine having pursued a more personally  rewarding and satisfying career.

The difficult part of this decision is that up to this very day, I have thoroughly enjoyed practicing medicine and never really thought about retiring. However,  besides the health issue, there is also the struggle with the time consuming and impersonal electronic medical record, the seemingly daily burdensome rules and regulations coming from a variety of sources, and the constant concern of  malpractice, all of which I will not miss.

But, what an honor and privilege it has been to practice medicine. I have found tremendous satisfaction in treating patients,  being able to alleviate suffering, curing illnesses of all sorts and even saving lives. I have enjoyed the one on one interaction I’ve had with patients and having the opportunity of getting to know them and appreciate them for who and what they are.

I’ve been in Scotts Valley long enough to have taken care of children who are now coming to the clinic with their own children. I’ve been saddened when people whom I have come to know have passed away but,  on the other hand, I’ve enjoyed watching families grow and witness their changing dynamics. In    the past 28 years at Scotts Valley, I figure I’ve had over 100,000 patient visits and therefore have been able to treat a significant number of people from Scotts Valley, the San Lorenzo Valley, and surrounding areas. I’ve always enjoyed walking into a local store or event and seeing the familiar face of a patient and be able to talk with them  and to see and know them outside of the medical setting.

I will miss my wonderful supporting clinic staff with whom I have spent much of my recent life and who had become like a family to me. I am also honored to have been associated with as fine a group of physicians as there could ever be, 30 of them when I first began my work with the Santa Cruz Medical clinic in 1987, and now numbering some 210 physicians with our Palo Alto Medical Foundation affiliation.

Most importantly, I want to thank each and every one of you patients who trusted me and allowed me to care for you over the years. It’s my interactions with you that I will miss the most.

However, I am not going away completely. I will continue this medical column as I have many more topics to share with you and much more to say. As I have previously mentioned, I plan to publish a book  incorporating the most interesting articles. I’m excited about continuing this work.

Since I won’t be seeing you in the clinic, I look forward to seeing you out in the community.

My very best wishes to you all and remember, life is a gift, gives thanks for each and every day.