All areas of study and action have their virtuoso. That person who is ‘first among equals’; George Washington was most famously, known by this phrase.

So too in medicine, there are great specialists and then there are others who are acknowledged as being just a slight cut above those of highest caliber. Here in The Valley, we have so many wonderful physician specialists that it makes medical practice here a pleasure, and it gives me confidence in the care you are getting from these skilled professionals. You can access that list on the RECOMMENDED PROVIDER list on our website.

Among those who are recommended, there are some who are the virtuosos. I have found them through professional relationships, but more often from patients who have told me of someone they ran into here or in their hometown, and I have accumulated a list of them. If for some reason you need a medical or surgical virtuoso, be in touch and we’ll either have that name…or we’ll find it.

For now, enjoy this musical performance by the virtuoso who got me thinking about this topic ….accordianist Alexandr Hrustevich …something truly special.

Listen >>>>HERE<<<<


Despite this, there is a grass-roots effort to discredit these medications based on the concerns that they cause a multiplicity of side effects including dementia most importantly.

These has been very little signal among users that these issues are developing, and to add to the scientific understanding, the American Heart Association undertook an extensive review of the literature to reassure that these medication have an overall excellent safety profile.

Statin medications are among the great discoveries of the last century, and have had a strong impact in reducing heart attack and stroke risk in the US.

This report confirm the excellent safety record of statin medications and is consistent with my experience. These medications are safe, effective, and rarely cause side effects of concern.

Don’t miss out on one of the great inventions of the 20th Century. If you decide to avoid them…perhaps you should toss out your computer, cell phone, and the internet as well. Join the future of those who believe in the science….statins are safe and effective.

Read more >>>HERE<<<


Now that the electronic medical record is on-line and patients share in the information doctor’s kept ‘secret’ in the past, there are a lot of people who wonder about the diagnosis and comments in their chart.

Although the ideal chart would be purely a documentation of all the facts related to a patients conditions, it is in fact a much more complicated issue.

The chart serves many masters, most of which are practical and relate to insurance issues, billing, and prescription and test ordering. After those considerations, the chart is meant as an accurate repository of the medical history and to allow a quick summary of considerations that related to background health issues in the day-to-day care of the patient.

I often have a patient ask me, “Why does it say I have this diagnosis or symptom when I don’t think it is accurate?’ Sometimes they are correct and the information is there in error, but most of the time the information in contained in the chart to allow for consideration of various possibilities based on history and previous symptoms. To jog the memory, or to keep in mind as past conditions relate to current health complaints.

Doctors are aware of the potential fictional nature of the medical record, despite contending that it is an objective list of the various health issues at hand. We try our best to include all pertinent and important current and past medical history, but sometimes, the truth is a bit more complicated.

Twain remarked about something said from by friend…..”If it’s not true…it should be.”

Read more Twain >>>HERE<<<


I have an amateur interest in aviation so I am following the MAX 8 concerns with great interest.

Among the issues raised with the MAX 8 is the interaction of automated technology and imperfect data input. Simply put: An excellent but completely automated system can be undone by imperfect data input, resulting in automatic ‘corrections’ that amplify the error.

All of us are going to be seeing these issues of interactions of expert systems in our day to day life, and how they can malfunction with small inaccuracies of input data. It is really the problem of AI (artificial intelligence) which is so very useful, but which does not provide the judgement needed to correct errors that don’t fit in standard models.

This is exactly what an expert internist provides. Like the most-seasoned pilot, and expert clinician has seen so many variations of ‘normal’ situations that they can ignore data that is inconsistent, trusting their judgement when crucially important, over a test results that doesn’t ‘fit’.

Like Will Rodgers said long ago: Good judgement comes from experience and at lot of that comes from bad judgement. My bad judgement days are behind me (read intership, residency, and my first years in practice). Although I’m in no way ‘perfect’, I am perfecting my knowledge by having an enormous volume of experiences.

A busy doctor is ‘practicing’ all of the time. Gaining knowledge incrementally with each encounter. Every year I see a few new things that I’ve never seen before. Integrating this into my storehouse of knowledge improves my performance with time and I know it is allowing me to ‘pilot the ship’ of medicine more ideally.


The international measles outbreak has rightly stirred concerns among the general public in the US, questioning their own protection and immunity against measles. Do I need to worry?

Here is the answer:

If you were born before 1957, then you did not get vaccinated…but you did get the measles with near certainty as there was no vaccine and the measles was ubiquitous throughout the US and was impossible to avoid. Because it is so very contagious, everyone (99% of people were infected) is essentially immune

The modern measles since dose vaccine was begun in 1962 and carried out through 1967. This single dose immunization was approximately 90% effective, but immunity may have wained for this ‘notch group’….1957-1967. This group should consider testing for immunity with a blood test (Rubeol IgG testing….Rubeola is the old name for measles)…or just get a booster of MMR. That is the other option.

Finally, for those after 1968 and later, they are immune based on having obtained the standard 2 dose measles vaccinination, which was the schedule developed for that birth-year and beyond. 1968 and beyond is also 99% effectively immune.

So…is you are in the notch group, you could consider a lab test or 2nd MMR vaccine.

WHERE DO YOU FIND THAT about mental health?

The internet has plentiful resources for an array of topics in psychiatry, but like most of you, I often find a Google search less than helpful due to adds and other methods that game the searcher and prevent them from finding, fact-based resources of information.

As I’ve indicated in the past, among the ways to improve the quality of your searches on Google, you can type in the topic you are looking for plus an additional search word like:

NIH (which stands for National Institutes of health)



Or the like.

Here is a nice resource for mental healh information on the web, a list of sites provided by the University of San Francisco Psychiatry Department

Look >>>>HERE>>>>


Although my patients know that Cathy Kurth, AD is the audiologist we recommend the most, many patients still are not inclined to use a hearing aid for a whole host of reasons.

With the FDA approval of the BOSE HEARING AID, one of those impediments to getting a hearing aid has been eliminated, in that you can buy this hearing aid without seeing an audiologist.

Yes…that’s right…you can now just go buy a hearing aid that is of the highest caliber and adjust it using the BOSE SOFTWARE TECHNOLOGY that works with your smart phone.

You will be seeing this available in the near future…so look for it if you are interested.


A recent report from The Washington Post about researcher Piero Anversa’s falsified heart research at Harvard Medical School is a tragedy.

Not only has this researcher duped the general scientific community, his 31 scientific papers suggested a new area of research for young cardiologists, and those who are following this path and chasing a red herring.

Doing great research is a challenge and a burden.  Pursuit of greatness can alter the objective mentality that is needed for a true scientific mindset.  See my recent comments on James Allison, PhD, the latest Nobel Prize winner in medicine.

Anversa is not alone.  There is an entire website devoted to withdrawn research.   Review it  <<<HERE>>>>   You will be amazed how much of what is taken for accurate results is ultimately withdrawn from the scientific literature, and often without such fanfare.



The internet is full of untruths, especially when it comes to comments and concerns about statin therapy.

There is a grass-roots effort by the non-medical community to impugn the CHOLESTEROL HYPOTHESIS, a foundational concept in cardiovascular medicine that hold that higher level of cholesterol (LDL/bad fraction) increases the risk of heart disease and lowering this number reduces the risk.

So….they comment on data that is critical of this concept or that suggests statin therapy is ineffective, or worse, causes dementia and other major health problems.

Nothing could be further from the truth, and the latest study in the NEJM on PRALUENT, a new type of injection medicine to lower cholesterol, has demonstrated definitively that lowering LDL cholesterol to levels previously unobtainable (25-50) and provide improved benefits in the heart and prevent death.

PRALUENT, and it’s sister medication REPATHA, are a new set of medications that focus on reducing cholesterol via the PCSK9 receptor pathway.  This is markedly different than the mechanism of action from statins, but it achieves the fundamental same goal….reduction of LDL cholesterol.

In this latest study, we finally have ‘endpoint’ results that show longer life in patients who have had an acute MI and who are put on PRALUENT.

The exact patients who benefit most from the $600 per month injection therapy (every 2-4 week self-injections) will become clear with additional study, but one this is for certain…the lynchpin CHOLESTEROL HYPOTHESIS continues to hold and inform us on ways to increase longevity in heart disease patients.