Yes….George Benson had it right…..with his 80’s hit ….Give Me The Night…..especially when it comes to taking your blood pressure medication

A recent large-scale study from Spain shows that taking your blood pressure medication before bed is significantly healthier than taking your medication in the morning. Other studies have hinted at this, but this study is clearly confirming what we think.

Why this works is that many body systems have a circadian rhythm that turns an late at night or in the early hours of the morning and having slightly higher dosages of medication at those times provides protection against elevated blood pressure, stroke, and heart attack.

So…from now on….take your blood pressure medications at night and get the benefits without needing additional dosing.

Read more >>>>HERE<<<<


I had several patients forward me the video on the new BUTTERFLY ULTRASOUND. This device, which attaches to an iphone, is a $2,000 attachment to the iphone that works as an inexpensive ultrasound unit.

I have checked it out, having become aware of it from my daughter-in-law who is in her Emergency Medicine Residency training program at UCSF.

The ultrasound has become an essential diagnostic device in the E.R., as it allows for rapid assessment of internal derangements that indicate bleeding, blood accumulation, fluid accumulation, blood clots, etc… She has become skilled at using the ultrasound in rapid fashion to assess patients with life-threatening issues and to rapidly rule-in or rule-out various conditions that would otherwise require time-consuming testing.

Although very useful in the emergency setting, it is not clear that it would be as useful in the general office setting, as the test results are not explicit enough for subtle findings or complex diagnostics. Still, in an underserved area, where excellent ultrasound is not readily available, I can see this being a game-changer (rural areas, underserved countries).

I’m a fan of technology, and the iphone is an amazing hand-held computer that has multiple uses, but for now, the Butterfly does not sting like the bee……in the general medical office just yet.


As often happens in my practice, I have patients who tell me about the latest technology that helps with their medical condition or with issues of mobility.

The latest is the WHILL MOBILITY DEVICE which is the latest in wheelchair mobility. It’s benefits are many, but most importantly is the simplicity of it’s controls, its ability to work in small spaces, and it’s overall cool design.

I must say, my patient was raving about this device. HE had issues with a joystick due to his tremor, but this device has a simply interface allowing for more accurate ability to safely control motion,

Insurances won’t cover this device, but if you can afford it and if you need it to remain more independent, you need to get yourself a WHILL

Take a look >>>>HERE<<<

Latest excitement about medications and dementia

A patient emailed me:

Hi Doc,

Should I be concerned and switch my anti-depressant since it’s on the list of medications potentially causing dementia?  I tried other medications in the past but they didn’t work as well & I felt awful and went back to Paxil.  I’ve been on it for 18 yrs now, so maybe it’s too late. 

Good news…I found my car keys and know where they gošŸš—


I responded:

This is not a major concernā€¦..there is a ā€˜questionableā€™ associationā€¦..but no proof of connection.

All medications have different kinds of ā€˜questionableā€™ statistical  associations of different sortsā€¦.Advil/Aleveā€¦..with stroke/heart attackā€¦..ā€¦ā€¦aspirinā€¦.with bleeding issues. The list is endless.

This is a ā€˜sexyā€™ topicā€¦so it gets quite the attention, but the over-riding focus should be on the definitive benefits you are getting now.  If they are definite in your mind, then you should continue to stay on the medication unless we hear clear-cut evidence.


PSā€¦Driving your car is 10,000 times more risky then your medications.


The headline in the NYTimes today about the failing pediatric cardiac surgery program at University of North Carolina reminded me of back in training when, as a lark, we would call the operator of the hospital and ask them to page the wards for “Dr. HODAD”……

It would be early evening…and over the pager system throughout the hospital we would chuckle as we heard….” Paging Dr. Hodad…Paging Dr. Hodad…..please call the operator’.

We were juvenile back then and we liked having a bit of fun given the crazy hours we kept. Dr. Hodad was no Hopkins surgeon….the name stood for Hands Of Death And Descruction.

Yes….there were surgeons who were considered a danger to their patients, and we would affectionately call them Dr. HODAD..……there still are around no doubt. Fortunately, they are few and far between, but self-policing among medical professionals is notoriously tricky.

That is why you depend on your primary doctor to help you find the best specialists and surgeons to treat your conditions. It is often less about going to the right doctor, as opposed to avoiding the wrong one. Fortunately, there are few of those, but you need to avoid them…and depend on us to help you avoid such an event. Just ask.