PPI medications are among the most commonly prescribed in the world, and have virtually banished ulcer disease to the dustbin of history.   Prilosec and Nexium are the ones you know best, but there are many other brands.

Recently, I have defended PPI medication long-term use against a barrage of negative press suggesting a whole host of side-effects that would descend on those who chose to continue on these medications for long-term acid suppression.

Fortunately, there are some studies being done to investigate this issue further and a recent well-done trial from Finland shows the safety of PPI medications and the lack of connection between PPI’s and dementia.

This is not the last word on the topic, but we shall take a more level-headed approach to the issue and try to maintain a semblance of balance and calm in the face of ‘sexy’ topics and criticisms.

Read more >>>>HERE<<<<


A patient writes:

My friend told me he had a TIA in his left eye, something I had not heard of.   Can you tell me more?

My response:

A TIA (Transient Ischemic Attack) is a brief episode of blood loss to an area of the central nervous system, which results in transient symptoms that then resolve to baseline without injury.  This is opposed to a stroke which leaves damaged nerves and results in residual symptoms.

A TIA in the central retinal artery that supplies blood to the retina (nerve of the eye) will result in transient loss of vision in the affected eye.  Termed Amaurosis Fugax (latin translation ‘darkness fleeting’), the patient experiences complete loss of vision in the eye that is perceived  as a shade being pulled down, but symptoms can vary with a grayness or blackness that lasts for several seconds to minutes.  It resolves completely with normal vision restored.

Amaurosis is a serious condition in that it indicates the potential for future TIA events or even strokes, so an evaluation is essential to determine the cause of the event and to institute preventive measures.

If you have loss of vision in an eye, even if transient, it is an urgent issue that requires attention.  Never ignore such symptoms.   Immediately check each eye by covering the other eye and checking your vision.  Determining if the vision loss is in one eye or is affecting both eyes in the same visual field is an important distinction, so doing this test yourself at the time of symptoms is a key element in diagnosis.   Check out your vision this way and you will help in determining the diagnosis and the proper evaluation to be done.


Recovering from a difficult surgery, a prolonged hospitalization, or dealing with a chronic and complicated illness is a challenge.  It often gets a bit disheartening as the weeks and months trudge on.

It’s just such situations that remind me of Aesop’s fable of the ‘Tortoise and the Hare’.   We all remember the story of the slow plodding tortoise being raced by the fast hopping hare, but I think because bugs bunny and other rabbit icons have become such fixtures in our minds, that we tend to think that the rabbit made out; well, he didn’t.   It is the slow and steady tortoise the reaches the finish line first and wins the day.

So….when it’s seeming like the challenges keep coming, always remember what I tell my patients……”Remember…the tortoise won the race.”


Macular Degeneration is the most common cause of vision loss as we age.   The conditions runs the gamut of mild findings in the eye on examination by the ophthalmologist (called drusen of the retina), to more severe changes that include new blood vessel development.

New treatments, injections into the eyeball that stall the vision changes and reverse the blood vessel growth, have been a major advance, but identifying this condition before it becomes more active is a key component.

To identify if you are developing issues with Macular Degeneration, use the famous AMSLER GRID.   This simple printed graph paper will allow you to monitor your vision and to identify Macular Degeneration early or to monitor any changes in it.

Download an AMSLER GRID >>>HERE<<< and put it on your refrigerator or in your bathroom, to keep an eye on your own vision.


This year, for the first time in my career, I have had three adult  patients seek hospital treatment for significant scorpion bite symptoms affecting their bodies more generally, including generalized tingling and numbness.

This is very unusual to me, and suggests  that the potency of neurotoxin in the current scorpions in Scottsdale is greater than in past years.

Typical symptoms of scorpion sting consist of pain as the site of the sting as well and numbness and tingling in the affected limb.  These are by far the most common symptoms.  This is considered a Grade I level of symptoms and requires only Ibuprofen or painkillers for pain relief and a tetanus shot if not had within 10 year (this can wait a few days until given).

Grade II symptoms include the above as well as generalized numbness and tingling.  These can occur within minutes to a few hours and can last several hours.  Treatment is the same as above and many patients will seek hospital attention for these generalized symptoms.  This is reasonable to do, but care is once again supportive and no additional medications are given.  Monitoring of the patient over the next several hours is the key Emergency Room treatment to make sure symptoms do not progress.

Grade III and IV symptoms are much more dramatic and include:  blurred vision, trouble swallowing, excessive salivation, fever, trouble breathing.  If these develop it is a critical emergency and 911 needs to be summoned.  I’ve never seen this in my career, but it is important to be aware.

Remember, nobody has died from a scorpion sting in Arizona since 1968, so that is some comfort….but do be aware that scorpion stings are more potent currently.



Many of you heard me planning to go  to the Great American Eclipse ….well…we made it.

It was an awesome experience, as you’ve heard from many quarters, and I would echo those reports, but even stronger in me was my feeling of a connection to those discoverers in the past (ancient and more modern), as well as the every day scientists who develop knowledge and determine the nature of our universe with such precision, that the entire event was understood and timed to such accuracy.

I like to tell patients that I am a Hopkins-trained medical scientist, and that connects me to the scientists of the past and present, who use knowledge to gain power over the world we inhabit.   Einstein, Salk, Darwin….these are heroes to me and the eclipse is a validation that the universe is knowable and that those who pursue such knowledge and who share it with us all, give us power to control our destinies.


Choosing healthy food is a challenge.  Not because unhealthy food tastes so good, but because some things that seem healthy may not be.   As I’ve said  many times before in this blog, writers such as Gary Taubes have exposed the lack of proven research to demonstrate the healthiest aspects of diet. Gary Taube’s Good Calories, Bad Calories is probably the most enlightening book on this topic.

Among the latest trends that are of questionable value is the explosion of juice bars across the country.  Although juicing vegetables and grasses can be healthy, if that flavor appeals to you, more often people are ordering highly caloric and highly sugary juices that are more harmful to your health that you realize.   Yes….fruit is healthy, but removing the pulp, skin, and other nutrients and just drinking the juice, can be no better than drinking soda pop.

This recent article in the Washington Post exposes the concern and has some good insights on the topic.   Read >>>>HERE<<<< and reconsider before you splurge on that tasty fruit juice at your local juice shop.



The world of healthcare is in flux in many ways; more in the delivery and payment than in the scientific aspects of the enterprise.   This is leaving the  public and physicians themselves uncertain about the future of how medical care will be delivered and how insurance will provide coverage for that care and support the system that underpins its delivery.

The changing landscape will be filled with a lot of new ideas and developments, but during this time-frame, our office will remain very much as it always has; a place of high quality and ‘high touch’, delivering the best healthcare in the valley in a authentic manner that is familiar to anyone who has seen their doctor over the past few decades.

I’m confident we are on our way to a better system that is more comprehensive in the care of everyone in the U.S., but during this transition time, we will remain steady and certain in our approach.   Expect…and get….the excellence.



Statin medications (Lipitor and Crestor) have been mainstays in the treatment of cholesterol for the past 30 years.  They have a proven track record of safety and effectiveness in preventing heart attacks and strokes.  Although serious side effects from these medications are very very uncommon (I’ve never seen any in my practice over 30 years), minor side effects, like muscle aches happen fairly frequently.   This is definitely something we’ve observed, but a recent study has called this connection into question.

In a seminal study in THE LANCET, a major British Medical Journal, patients who were on statins and were told that they might cause muscle pains, experienced more muscles pains (even though they were not on a statin….they were on placebo.)   We call this the NOCEBO effect, which is the opposite of the PLACEBO effect.

In the PLACEBO effect, being told that taking a medication can cause positive/curative symptoms, patient tend to feel better.  The NOCEBO effect, is just the opposite.  When patients are told a prescription can cause negative side effects, they are more likely to experience those.

Read more about this study >>>>>HERE<<<<