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.


The value of genetic testing more broadly is controversial, but I think everyone has an interest in knowing if they are at increased risk for cancer.

If you satisfy criteria for testing (positive family history that is considered ‘significant’ by insurance standards) then you can get genetic testing at our office through Myriad labs and your insurance will pay for most (or all) of the testing.

But…if you don’t qualify by specific criteria, you can order genetic testing yourself, for $225 from Millennium labs, and with a simple cheek swab, you can find out if you have increased genetic risk for breast cancer/ovarian cancer (BRCA genes) or 30 other genes associated with cancer risk.

If you are interested….order >>>>HERE<<< and tell them your physician’s name (Doctor Lakin) and they will confirm the testing is to be done and you’ll get results in 2 weeks.


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.