NCMA welcomes internal medicine & geriatric specialist Rachel Mayorga, MD

Dr. Rachael Mayorga NCMA Healdsburg physician Dr. Rachel Mayorga is a primary care doctor who specializes in internal medicine and geriatric medicine. Her practice focuses on individualized preventative and long-term wellness.

Dr. Mayorga’s practice philosophy is based on the principles which enable patients to enjoy greater access to and more quality time with their doctor. Her practice is particularly suited for people seeking a doctor who will spend time with them to design a personalized plan for health.

Board certified in Internal Medicine and in Geriatric Medicine, Dr. Mayorga is a specialist in “Healthy Aging,” and has lectured and participated in community outreach programs. Dr. Mayorga collaborates with her patients to customize a care plan focused on their unique health needs and life goals.

Dr. Mayorga received a Fellowship in Geriatric Medicine from Rush-Presbyterian, St. Luke’s Medical Center, Chicago, Illinois. She completed residency in internal medicine at St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, and graduated with an MD from the University of Utah School of Medicine, Salt Lake City, Utah.

NCMA’s Internal Medicine & Geriatric Physicians diagnose, treat, and manage a full spectrum of health conditions. In addition to general internal medicine services, they also have expertise, special interest, and experience in gastroenterology, endocrinology, health screenings, diabetes management and care, immunizations, women’s health and much more. To schedule an appointment call 707.385.0222.

Dr. Parul Kohli Provides Insight into the Importance of Strength Training for Older Adults

Northern California Medical Associate’s Internal Medicine Physician Dr. Parul Kohli discusses the latest research highlighting the impact physical activity can have on aging and the importance of adding strength training to the exercise routine.

Dr. Parul Kohli discusses the latest research highlighting the impact physical activity can have on aging and the importance of adding strength training to the exercise routine.“Aging well is a challenge for all of us, but there are things we can do to improve the odds of staying healthy for life,” says NCMA’s Dr. Parul T. Kohli.  “Research is showing more and more that there are simple, yet important steps that can be followed to maintain good health and reduce the risk of disease and disability as we age.” Top priorities Dr. Kohli’s recommends for her patients include;

  • exercise
  • healthy diet
  • regular health screenings
  • getting vaccines
  • getting enough restful sleep
  • remaining socially active

To this list Dr. Kohli may also suggest strength training as an important factor for patients who hope to remain fit and active for life. A new study conducted by Penn State Milton S. Hershey Medical Center and published this month suggests that in addition to aerobic exercise, strength training can play an important role in improving the quality of life for patients including; preventing early death, improved resistance to cardiovascular disease, dementia and chronic diseases such as diabetes, and even some types of cancer.

“Over the years, many different studies have validated the benefits of physical activity in older adults, and stressed the importance of building overall body strength, which helps to improve muscle mass and optimize physical function,” says Dr. Kohli.

Improvements as a result of strength training have been observed in chronic conditions such as osteoporosis, low back pain and of course, obesity. The new Penn State study revealed that older adults who strength trained at least twice a week had 46 percent lower odds of death for any reason than those who did not. They also had 41 percent better chance of avoiding cardiac death and 19 percent improvement in the odds of dying from cancer.

Incorporating Strength Training to Your Fitness Routine

Adding strength training to a regular fitness routine doesn’t necessarily mean going to the gym every day of the week, or enlisting the aid of heavy barbells to enhance strength. Very small changes in muscle strength can have a significant impact on overall functionality and improve a person’s quality of life, particularly for patients who already experience some form of muscle weakness.

“Increasing strength in small ways can make it easier to do common tasks such as climbing stairs, opening jars, getting out of a chair and even walking around the block,” explains Dr. Kohli. “Exercise focused on the lower body is particularly important as it will help to improve balance – and maintaining good balance is key to avoiding falls – which can be a real game changer for an otherwise healthy older adult.”

According to the National Institute on Aging twice a week strength training for 30-minute periods is optimal, and exercising different muscle group is best for each session. Beginning with light weights and building up gradually over a period of time is the best way to get used to strength exercises, build muscle mass, and avoid potential injury.

About Dr. Kohli and Santa Rosa Internal Medicine

Dr. Kohli for PR 2

Dr. Parul T. Kohli

NCMA’s Internal Medicine Physicians diagnose, treat and manage a full spectrum of health conditions. In addition to general internal medicine services, Dr. Kohli focuses on comprehensive “whole patient” care. She provides compassionate care continuing across the whole spectrum- from preventative health to chronic disease. To learn more visit our website or to make an appointment call (707) 546-2180.





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What the 2014 Flu Season Means For Adults over the Age of 65


Dr. Thomas Guyn

National attention for the 2014 flu season has so far focused on the growing number of H1N1 flu virus cases, striking with most severity among young and middle-aged adults.  These reported cases have resulted in multiple hospitalizations, including many requiring intensive care unit (ICU) admission as well as a few fatalities. There is no way to predict which influenza viruses will ultimately predominate over the 2014 season. Although H1N1 may be the strain that’s getting the most attention, there is still a need to get a yearly influenza vaccine.

People who are over the age of 65 typically have a weaker immune system, making this age group much more susceptible to the flu. “In fact, getting the flu when you’re over the age of 65 can have very serious consequences, including severe illness and death,” says Dr. Thomas Guyn, NCMA SRIM. “Up to ninety percent of flu-related deaths and more than half of flu-related hospitalizations typically occur in people age 65 and older.”

Influenza Facts for 2014

Early indicators are that the current flu season is turning out to be a virulent one. The Centers for Disease Control (CDC) noted in January that more than 50 percent of flu-related hospitalizations and 90 percent of flu-related deaths occur among people over 65. While it is true that the flu vaccine may not protect everyone – as vaccines typically have a 60 percent rate of effectiveness – and lower immune response can reduce effectiveness in some older Americans, opting out of getting a vaccine is not the best choice, especially given the high risk elderly patients can face.

Why You Should Get an Annual Vaccine

A flu vaccine is designed specifically to protect against those flu viruses that research indicates will be most common during the season. The vaccine is updated every flu season and a person’s immunity will wane over a 12 month period, which is why it’s important to get a flu vaccine every year. Immunity kicks in about two weeks following vaccination.

There are options as to how to receive a flu vaccine, and for those who may be squeamish about needles, there are options for that as well:

  • Regular flu shot: This option comes in the form of a shot in the upper arm or shoulder and is good for most everyone, even for those who have a long-lasting medical condition like diabetes.
  • Intradermal flu shot: If anyone who simply does not like needles, this vaccine is a good alternative. It uses a much smaller needle that only goes into the skin, and does not penetrate the muscle. It works as well as the regular flu shot, and it is acceptable for people age 18-64.
  • Nasal-spray flu vaccine: This method involves breathing the vaccine in through the nose. This is an option typically reserved for healthy folks between the ages of 2 and 49, and unlike the regular flu shots which are made up of killed viruses this one has live viruses.

“Since people over the age of 65 are more vulnerable to the flu due to a weakening immune system they are also at an increased risk of getting pneumonia, a common complication of the flu.  We would also recommend getting a pneumococcal vaccine which will protect against pneumonia,” says Dr. Guyn. “This is just another good way to support the health of our patients.”

Protecting Yourself from the Flu

In addition to getting the flu vaccine the CDC suggests six basic practices to help avoid the flu:

  1. Avoid close contact with people who are symptomatic.
  2. Stay at home if you are sick.
  3. Cover your mouth when you cough or sneeze – use a tissue or deflect coughs into the inner part of the elbow to avoid contaminating hands.
  4. WASH YOUR HANDS frequently. Hot water and soap are the best options but alcohol-based hand gel is a good emergency substitute.
  5. Avoid touching your eyes, nose, and mouth – especially when out in public.
  6. Watch your health. Getting plenty of rest, eating right and regular exercise will help boost the effectiveness of your immune system.

Tips for managing the flu

When flu-like symptoms appear, particularly in people who are 65 or older and people who suffer from chronic conditions such as asthma or diabetes, it is advisable to consult a healthcare provider right away. Antiviral medicines are available and may shorten the flu by one or two days, helping to prevent more serious complications such as pneumonia. This are best prescribed as soon as symptoms become apparent; fever, sneezing, body aches, stuffiness, or coughing.

The two FDA-approved antiviral medications for flu are:

  • Relenza (zanamivir): People age 7 and older can take this. It is inhaled into the nostrils and is not appropriate for people with asthma or chronic obstructive pulmonary disease (COPD).
  • Tamiflu (oseltamivir): Tamiflu can be taken by almost everyone and it comes in pill or liquid form for adults and teens over age 13.

Dr. Thomas Guyn of NCMA’s Santa Rosa Internal Medicine specializes in general internal medicine and is currently accepting new Medicare patients. Dr. Guyn served as a hospitalist at Santa Rosa Memorial Hospital prior to joining Santa Rosa Internal Medicine. There he acted as a liaison between patients as their primary care physician and specialist physicians. Many of the patients he worked with were seniors. He has experience with a wide range of diseases affecting seniors and works extensively with geriatrics facing many medical issues including the flu. He is available by appointment and can be reached by calling (707) 544-3411 or (707)546-2180.

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