northern california medical associates

Long wet winter leads to concerns over exploding mosquito populations in Northern California

By all indications, and due to months of wet weather, there is a booming mosquito season underway in Sonoma County. While officials call for diligence, asking homeowners to scout for any open water sources that can be emptied or eliminated, healthcare providers are looking at potential health concerns. Along with the annoying buzz of mosquitos is the buzz associated with potential infections stemming from their itchy bites, namely Zika and West Nile.

The Buzz on Mosquitoes

“One good thing is that we don’t need to be too concerned about Zika,” explains Dr. William A. Markoff NCMA Family Practice Physician. “This virus has been linked to birth defects in Central and South America but authorities tell us that the mosquitoes known to transmit this virus are not in our area. Concerns over mosquito transmitted viruses this year remains focused on West Nile Virus, which – while most people suffer few to no symptoms, can cause serious problems in others including neurological issues.”

West Nile Virus Symptoms

Last year there were 442 cases of West Nile reported in California, with 10 of those in the nine-county Bay Area. West Nile Virus generally results in mild flu-like symptoms in some people, while others have no symptoms and suffer no consequence at all. A small segment of the population seems to be vulnerable to the more serious symptoms that includes swelling of the brain and potentially; death. Although there is a vaccine to prevent it, West Nile Virus can also be fatal to horses, and particularly birds.

Of the 176 known mosquito species in the United States there are roughly 20 mosquito varieties common to Northern California, and most of those will be out in force this year. Early mosquito prevention is key to protecting public health. This means scouting property for pools of standing water that mosquitos might find inviting and keeping an eye out for other potential incubating sites including wet tarps, tires, plastic containers, tin cans, jars, buckets, etc. District managers have also begun ground and aerial spraying to control mosquito activity where necessary.

Don’t scratch that itch

The best – and most difficult advice to take following a mosquito bite is; don’t scratch. Scratching creates openings on the surface of the skin which allows bacteria in and can cause infection. To relieve the itch and lower chances of an infection there are some time-honored techniques which include:

  • Clean the bite area with soap and water (or dab with a cotton swab dipped in rubbing alcohol)
  • Apply an anti-itch cream
  • Use Aloe Vera to soothe and heal the itch
  • Make a thick paste of baking soda & water and apply to affected area
  • Take an over-the-counter antihistamine if itching persists

“Although extremely rare, if a mosquito bite does result in a fever or causes vomiting, or shortness of breath it would be advisable to seek medical attention immediately,” adds Dr. Markoff.

About NCMA Family Medicine

NCMA Family Medicine physicians provide services at offices in Lakeport, Santa Rosa, and Petaluma. NCMA philosophy is based on the fact that early screening and detection can result in less acute episodes of illness that can be devastating both physically and financially. Family medicine physicians provide primary health care for people at every stage of life. For more information about Dr. Markoff and all NCMA medical services visit the website at


New Research Highlights the Need for Men to Be Proactive About Getting Screened for Prostate Cancer

NCMA’s Dr. Michael Lazar of California HIFU discusses the latest research on prostate cancer and provides insight into the importance of early detection and the newest treatment options

Dr. Michael Lazar

Dr. Michael Lazar

When it comes to prostate cancer and knowing when to get a checkup, the standard for recommendations are all over the board. New research suggests that avoiding the issue altogether is not a good option for any man, particularly for those with prostate cancer running in the family. “Screening is simple process that allows us to look for cancer before any symptoms become obvious to the patient,” explains Dr. Michael Lazar, HIFU Prostate Services Medical Director. “This process can help us discover the cancer at an earlier stage while the patient has the opportunity to take advantage of newer, less invasive options for treating prostate cancer.”

The Research

Swedish researchers this month released findings on a study involving 50,000 men – all brothers of men diagnosed with prostate cancer. The study was to determine the prostate cancer risk to men with a family history of the disease. Although the study made the distinction of determining whether men with a family history of aggressive cancer were more at risk than those whose relatives had a less progressive form (referred to as ‘indolent’ in the study), they discovered that the odds were about the same for both groups.

Ultimately, findings revealed that in men who had both a father and a brother with prostate cancer of either variety, the risk of developing any form of prostate cancer was nearly 50 percent. Bottom line according to researchers, “…is that men whose father or brother have an indolent, untreated prostate cancer are probably not aware that this also increases their own risk of developing aggressive prostate cancer.”

Get Screened

According to the American Cancer Society men are best advised to check with their healthcare provider about when or whether to be tested for prostate cancer. They recommend that men should not be tested without first learning about the risks and possible benefits of testing and treatment. The turning point for serious consideration is for men around 50 years of age, so they can determine for themselves if testing is the right choice. Men who have a father or brother who had prostate cancer prior to the age 65 should get with a healthcare provider sooner.

Education is Key to Taking Advantage of New Treatment Options

Prostate cancer is the leading solid organ cancer in the USA and the second most common cause of cancer related death. Many prostate cancers can be managed conservatively, particularly in elderly men. But larger tumors, those with higher Gleason score and rising PSA levels should be treated more aggressively – particularly in younger men who fit this profile. Prostate cancer is usually managed with an attitude of active surveillance followed by options include; radiation therapy, surgery to remove the cancerous gland, freezing (cryotherapy), or high intensity focused ultrasound (HIFU).

About HIFU

HIFU is the newest FDA approved non-invasive treatment for prostate cancer which uses ultrasound energy or sound waves, to heat and destroy specifically targeted areas of tissue. During HIFU the sound waves pass through healthy tissue without causing damage. However, at the focal point of the sound waves (like a magnifying glass focusing the rays of the sun), the tissue temperature is raised to 90 degrees Celsius, destroying the targeted cancerous tissue.

“HIFU is most effective for men who have early stage, localized prostate cancer that has not spread or metastasized outside the prostate,” explains Dr. Lazar. “Many patients who have had radiation therapy, brachytherapy or external beam radiation and experience a rise in PSA have discovered that the cancer is back. These patients may also be candidates for HIFU as long as the cancer has not spread to the bone or other organs.”

About Dr. Lazar and California HIFU

Dr. Michael Lazar, a Santa Rosa urologist and prostate cancer expert, is the only Northern California physician recognized as a leader in the use of high-intensity focused ultrasound (HIFU) for prostate cancer. He has been successfully treating patients with HIFU since 2007. Dr. Lazar formed California HIFU in order to offer minimally invasive prostate cancer treatment to men with the Sonablate.

For more information about HIFU treatment which is now available in San Francisco, or to make an appointment call: (707) 546-5553. Visit us online to learn more at:


NCMA’s Dr. Steele Shares Insights Concerning the Hazards of Too Much or Too Little Sleep

Northern California Medical Associate’s Dr. Marco Steele discusses the importance of getting enough rest and offers some options for people with chronic sleep issues.

TiredA new study out from Biological Psychiatry points out the importance of getting the correct amount of sleep. Findings reveal something that Northern California Medical Associate’s pulmonary specialist and board certified sleep expert Dr. Marco Steel is all too familiar with. “Many people believe that it’s too little sleep that can make the body susceptible to illness, where in fact it is both too little and too much sleep that can eventually lead to health problems.”

The report indicates that both sleep disturbances and long sleep duration lead to increased incidents of inflammation, a condition that contributes to both depression and many medical illnesses, according to study editors. Considered a ‘public health problem’ by the Centers for Disease Control and Prevention sleep disturbances such as insomnia have been associated with increased risk of inflammatory disease. In fact, the Institute of Medicine studies have correlated chronic diseases including hypertension, diabetes, depression and obesity, along with several types of cancer and increased mortality with people who also suffer from sleep disorders and sleep deprivation.

Getting the right amount of shut-eye

Biological Psychiatry’s analysis demonstrated that both sleep disturbance (defined as ‘poor sleep quality or complaints of insomnia’) and prolonged sleep durations of more than eight hours create elevated levels of proteins in the bloodstream that leave patients vulnerable to the ravages of inflammation. They also suggest that treatments targeting sleep behavior could be a strategy for reversing the inflammation and reducing the risk of inflammatory illnesses. For some people, getting the right amount of sleep can only happen with the help of an expert.

“Sleep problems such as chronic snoring, sleep apnea, insomnia as well as restless legs syndrome are actually quite common. Sometimes the best way to get back to having a good night’s sleep is to work with a specialist,” says Dr. Steele. “Good sleep is essential for maintaining optimal health. For example, without the right amount of sleep, a person’s hormone levels can become affected, causing mood swings and issues such as weight gain.” If insomnia persists for several hours each night for more than a couple of months, it’s a good idea to get a medical consultation.

What to expect from an expert

Most experts agree that adults should sleep at least seven hours per night on a regular basis in order to maintain optimal health. For someone with persistent insomnia going to a sleep center can help a patient identify the problem and offer solutions for a variety of issues including;

  • Chronic Snoring
  • Insomnia
  • Narcolepsy
  • Pediatric sleep disorders (night terrors, sleep walking, etc.)
  • Restless leg syndrome
  • Sleep apnea

“Some adults may need a longer sleep duration exceeding nine hours per night,” says Dr. Steele. “People who need more hours can include young adults and people suffering from a chronic illness. There are some adults who are naturally short sleepers that continue to feel alert and refreshed on less than six hours per night, but that’s a fairly small percentage of the population. The best advice is to talk to your doctor if you are concerned about your sleep patterns, or if you feel constantly fatigued. For an ongoing sleep problem, seeking out the help of an accredited sleep center might be the best solution.”

About Dr. Steele and NCMA’s Sleep Centers


Dr. Steele

NCMA Pulmonologist James Marco Steele, MD provides diagnostics, treatment and management of a full spectrum of pulmonary diseases. He is Board Certified in Sleep Medicine, Pulmonary Medicine, Internal Medicine as well as Critical Care by the American Board of Internal Medicine (ABIM). For more information, visit the NCMA website or call (707) 525-3786.

NCMA Docs Make a Difference: Dr. Adelina Stateva and GAP Community

Northern California Medical Associates (NCMA) Podiatrist Adelina Stateva, DPM, demonstrates the spirit of volunteerism in her involvement with GAP Community, a non-profit philanthropic organization with global outreach. GAP Community is committed to providing tools to empower the disadvantaged people in our world to actualize their hopes and dreams. Through leadership training, international projects, and financial contributions, it is the goal of GAP Community to help people realize that, in any situation, circumstance, or struggle, faith, hope, and love can prevail.

IMG_1392049Dr. Stateva first traveled with GAP to Kayamandi, South Africa in 2007 on an international project to better the living conditions of the locals. The area is tragically known to be one of the rape capitals of the world, and its communities are deeply affected by violence, poverty, and HIV. The goal of the trip was to provide youth leadership training, and to help determine the best use of the organization’s financial contributions.


IMG_1625GAP Community’s training exercises are geared towards helping participants set practical goals that will lead them to achieve their dreams. Upon reflecting on her first trip, Dr. Stateva recalled her amazement at the hope and fortitude exuded by the children in the area. Even growing up in an environment plagued by frequent tragedy, the children in Dr. Stateva’s leadership training classes expressed enthusiasm for their futures. Dr. Stateva also worked closely with her fellow GAP volunteers to fund a housing project renovation for HIV sufferers in Kayamandi.

Dr. Stateva explains, “There really are few experiences in my life that have been more inspiring than the work I have done in South Africa with GAP Community. I’m very grateful for the kids I got to know during my time there. The active learning style we use is designed to give children the confidence and insight necessary to overcome limiting beliefs and difficult circumstances that prevent them from achieving their goals and dreams. I thought the kids in Kayamandi would be discouraged by their rough environments and exposure to atrocities at such a young age. Instead I found them energetic and spirited with high hopes for their lives ahead of them. Everyday in leadership training, they were engaged and excited to learn.

“All GAP members are responsible for raising their own funds for the international project trips, and for the South Africa trip in 2007 we collectively raised a healthy surplus that we wanted to share with the local community in Kayamandi. We found a home for people living with HIV that lacked ample space and facilities. The occupants had to share tiny rooms, and the single bathroom was outdoors a ways away from the main housing building. Using the restroom at night meant risking being attacked or raped.

“As a group, we decided to use our funds to expand the housing project and to install indoor plumbing. When I returned with GAP Community again in 2011 we were rewarded with the sight of the completed renovations. The residents are now living in a much safer environment while they recover from illnesses, and the facility we built can accommodate many more people than it could before.”

In addition to the housing renovations and leadership training, Dr. Stateva cites other successes that have come about thanks to GAP Community’s trips to Kayamandi. In recent years, conversations about HIV amongst communities in Kayamandi have become more common, and more privileged South Africans have begun to contribute more of their time and resources towards mending the HIV problem. In the aftermath of the apartheid era, separation and prejudices remain commonplace in South Africa, but groups like GAP that strive to spread HIV awareness have helped lessen the stigma and bring people closer together.

Dr. Stateva was born and raised in Bulgaria and she moved to the United States when she was 15 years old. Upon completion of high school in Brooklyn, NY, Dr. Stateva attended Connecticut College, graduating with a Bachelor of Arts in Biochemistry. In 2002 she graduated from Temple University School of Podiatric Medicine. Shortly thereafter she began residency at Palo Alto, VA where she also taught at Stanford University and continued residency at Hahnemann University Hospital in Philadelphia. She moved to California in 2005 to begin her practice in Santa Rosa, and she joined NCMA in March 2014.

Dr. Stateva and her husband, a professional chef in Santa Rosa, dedicate time to go on mission trips with GAP Community when they can. The couple has had one daughter since their last trip to South Africa. Dr. Stateva remains engaged with GAP locally, helping with fundraisers and informing people of the great volunteer opportunities the organization offers. Visit for more information on GAP Community, and visit to learn more about Dr. Stateva and NCMA.

New Research Highlights the Connection Between Brain and Heart Health, Encouraging People to Get Fit

Northern California Medical Associate’s Cardiovascular Services discusses the latest research on heart health and offers some pointers for patients interested in improving both heart and brain function.

fitness is a factor for people of all ages and this research pointing out that heart health may also impact cognitive, or brain function helps to drive home the importance of taking an active approach to managing heart health, for patients and physicians alike. The Journal of the American Heart Association just released research indicating that a healthy heart may have major benefits for preventing the decline in brain function often associated with aging. Findings indicate that people who work to maintain optimal cardiovascular health have better brain processing speed and less cognitive decline over time. The study followed 1,033 participants with an average age of 72, for about six years.

To facilitate the study researchers adopted the American Heart Association’s “Life’s Simple Seven®” definition of cardiovascular health. These guidelines include tips for maintaining optimal heart health and include recommendations for tobacco avoidance, ideal levels of weight, physical activity, healthy diet, blood pressure, cholesterol and glucose.

“We have long understood that regular physical activity combined with avoiding alcohol and tobacco, and maintaining a healthy diet helps to reduce risk of strokes and heart attacks,” says NCMA Cardiologist Dr. Allan Garfield. “Studies like this help to underscore the importance of taking an active approach to heart health. If adopting a regime as recommended by the AHA helps to improve heart heath as well as brain health over the long haul, that’s a win-win for our patients.”

Heart Health is a Serious Concern

According to the AHA cardiovascular disease is the leading cause of death globally. More than 17.3 million deaths are attributed to the disease annually, and more than 800,000 people in the U.S. died from heart disease, stroke and other cardiovascular diseases in 2013 alone (the most recent data available).

Lack of physical activity is a major risk factor for cardiovascular disease, a trend that is wide spread among the population. According to the statistics, a full half of all Americans fail to get enough exercise, much less the recommended 150 minutes/week of vigorous to moderate physical activity. “This number might look challenging at first, but when you break it down to a daily routine, we’re talking just over 20 minutes per day – a number most everyone is capable of achieving,” Dr. Garfield pointed out. The AMA also recommends incorporating weekly strengthening activities, at least twice a week.

Increasing Activity Levels has Many Benefits

Adopting a more active lifestyle can have a very positive impact on a person’s health, regardless of age or if they suffer from chronic illness. Even people with high blood pressure, high cholesterol and diabetes who pursue a more active lifestyle are much less likely to die prematurely than their inactive counterparts. Studies have proven that as people become more active, health benefits go well beyond just heart health. Physical fitness is known to reduces the risk of many diseases associated with aging including;

  • bone loss high blood pressure
  • stroke
  • breast cancer
  • diabetes
  • arthritis
  • cancer
  • depression
  • anxiety

Ultimately, fitness is a factor for people of all ages and this research pointing out that heart health may also impact cognitive, or brain function helps to drive home the importance of taking an active approach to managing heart health, for patients and physicians alike.

About NCMA Cardiology Services

From cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, the NCMA’s Cardiovascular Services team is dedicated to delivering the highest quality care and the best patient results. The professional staff not only maintains its commitment to patients’ health and well-being but maintains a tradition of excellence and expertise in the practice of the most current, innovative treatments in cardiovascular medicine. For more information, visit the NCMA website and to make an appointment call 707-573-6166.


More info:

The above post is reprinted from materials provided by American Heart Association. Note: Materials may be edited for content and length.

NCMA FountainGrove Cardiology Welcomes Vishal Patel, M.D.

Dr. Vishal Patel

Dr. Vishal Patel

Dr. Vishal Patel, M.D. is joining NCMA’s Fountaingrove Cardiology, an elite team of cardiologists who practice the most current, innovative treatments in cardiovascular medicine. Dr. Patel is board certified in interventional cardiology, cardiovascular disease, and endovascular medicine. He is certified board eligible in nuclear cardiology and certified
with the American Registry for Diagnostic Medical Sonography Physicians’ Vascular Interpretation. Dr. Patel is a recipient of the JoAnn McWhoter Award for Excellence in Clinical Cardiology and also received the St. Mary’s Medical Center
Outstanding Teaching Award.

Dr. Patel received his medical degree at Baylor College of Medicine in Houston,
Texas, and completed his residency in internal medicine at the University of
California at San Francisco, San Francisco, CA. Dr. Patel also pursued subspecialty
fellowship training in interventional cardiology and cardiovascular disease from the
University of Texas Southwestern Medical Center in Dallas, Texas.

When Dr. Patel is not working he enjoys spending time on outdoor adventures
with his wife, son, and new puppy. He loves to garden, cook, and explore the
Sonoma County food and wine scene.

3536 Mendocino Ave. Suite 200
Santa Rosa, CA 95403
To make an appointment with Dr. Patel call (707) 573-6199

Northern California’s premier provider of medical and surgical care since 1975
employing the most highly respected primary care physicians and specialists in
Sonoma, Lake and Mendocino Counties.

Parul T. Kohli, M.D. joins Santa Rosa Internal Medicine

new doc 1Northern California Medical Associates (NCMA) is proud to announce that Parul T. Kohli, M.D., has joined Santa Rosa Internal Medicine, a group of eight prominent internal medicine physicians. Dr. Kohli is a board certified internist who worked for a multi-specialty group at CMMC hospital in Lewiston, Maine. She worked primarily with adult
patients in both outpatient and acute/critical care and was involved in teaching and supervising family medicine residents.

Dr. Kohli for PR 2

Dr. Kohli received her medical degree at the University of Calcutta, India, Department of Internal Medicine and was among the top threein her class. She continued at the University of New York, Buffalo, tocomplete her residency training in internal medicine. Dr. Kohli focuseson comprehensive “whole patient” care. She provides compassionate care continuing across the whole spectrum- from preventative health to chronic disease. Dr. Kohli enjoys spending time with her family traveling and outdoor activities like biking, skiing and kid’s soccer. She practices
yoga and enjoys walking, new doc 3running, music and dance.

Have a Holiday Healthy Heart – Avoiding Common Contributors to ‘Christmas Coronary’

Northern California Medical Associates (NCMA) Cardiovascular Services provides some insights into the specifics of who might be most vulnerable and shares some tips on the most common holiday stressors to avoid.


In a year-long study conducted back in 1999 researchers discovered there were consistently more deaths from heart disease during the winter than there were during the summer. In fact, up to one third more deaths were recorded during the months of December and January than during the summer months. “As cardiac specialists we have known for quite some time that there are certain times of year that seem to trigger deadly cardiovascular events,” says Dr. Thomas Dunlap from NCMA Cardiology. “These events happen more often during the holidays and into the New Year.” This sad phenomenon is commonly referred to as the “Merry Christmas Coronary” and “Happy New Year Heart Attack”.

Holiday Heart Failure Blues

Heart failure, a condition where the heart fails to pump as much blood as the body naturally requires, accounts for about two percent of total healthcare costs in industrialized countries. Risk of death from heart failure within five years of diagnosis can be as high as 30-50 percent. Heart failure is also the leading cause of hospitalization for people 65 and over.

Although the reasons for an increased likelihood of heart attacks during the holidays varies widely there is a list of contributing factors that researchers have been able to pin-point as most likely causes including:

• Sudden weight-gain due to holiday overeating
• An increase in salt consumption with salty treats and overly process meat products
• Consumption of fatty meals that can have adverse effects on vascular function
• Excess use of alcohol during the holidays – binge drinking – which can precipitate arrhythmias such as atrial fibrillation
• Emotional stress
• Persistent fatigue and lack of sleep

Other well-known factors that can increase a person’s potential for seasonal heart complications include respiratory issues due to wood burning stoves and fireplaces – which releases toxic particulates into the air. These types of airborne pollutants have been associated with an increase in cardiac events and can also contribute to high blood pressure. Sudden and excess physical exertion such as snow shoveling is also something that can lead to a cardiac event during the winter months.

Avoiding the Avoidable

“The best prescription for adults, particularly older adults, for avoiding a heart issue during the holidays is to not over-eat, stay away from overly fatty and salty foods and curb the intake of alcoholic drinks,” says NCMA Cardiologist Dr. Patrick Coleman. “Healthy people can make simple changes to reduce their heart failure risk by engaging in moderate physical activity, not smoking and take steps to maintain a healthy weight.”

Also at the top of the list of known precautions that can be taken to avoid holiday heart failure includes – managing existing health issues that are cardiovascular risk factors such as hypertension, smoking, diabetes and high cholesterol. Patients with preexisting health issues may do well do avoid exposure to severely cold temperatures and resist participating in outdoor activities on days when air pollution alerts are issued. Doctors also recommend that these patients consider flu shots where appropriate.

Keeping Heart Healthy for the Long Term

In a new study reported recently in the American Heart Association journal ‘Circulation: Heart Failure’ researchers say that participating in more than an hour of moderate or half an hour of vigorous exercise per day may cut a person’s risk of heart failure in half (about 46 percent). Of the 4,500 adults that participated in this study who reported that they walked briskly, avoided obesity, maintained a moderately active leisure time, drank in moderation and didn’t smoke, had half the risk of heart failure as adults who did not optimize these same risk factors.

Researchers in another recent study that echoes similar results conducted by the Friedman School of Nutrition Science and Policy, Tufts University, followed 4,490 men and women age 65 and older who had no obvious signs of heart failure. In this study researchers discovered that adults who walked at a pace of at least two miles per hour had a lower risk of developing heart failure. The most significant findings associated with reduced rates of heart failure coming out of this study included:

• participate in leisure activities that burned more than 845 or more calories/week
• don’t smoking
• modest alcohol intake of one drink or more a week (not to exceed 1-2 drinks/day)
• avoid obesity

According to the American Heart Association, a healthy diet and lifestyle are the two best strategies to employ against cardiovascular disease. This holiday season can be the best time to commit to a healthier lifestyle by adopting an overall plan for making choices and taking the simple steps that lead to long-term benefits of a healthy heart.

About NCMA Cardiology Services

From cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, the NCMA’s Cardiovascular Services team is dedicated to delivering the highest quality care and the best patient results. The professional staff not only maintains its commitment to patients’ health and well-being but maintains a tradition of excellence and expertise in the practice of the most current, innovative treatments in cardiovascular medicine. For more information, visit the NCMA website.




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Northern California Cardiologists and Emergency Medicine Expert Provide an Update On STEMI (Severe Heart Attacks) and Sepsis Protocols

New developments to aid in the diagnosis and timely treatment of severe heart attacks and related infectious conditions were the topics discussed recently at the Regional STEMI Program and Sepsis meeting at the John Ash Restaurant at the Vintner’s Inn Event Center.

Drs. Patrick Coleman, Thomas Dunlap and Tucker Bierbaum

Drs. Patrick Coleman, Thomas Dunlap and Tucker Bierbaum

Dr. Thomas Dunlap and Dr. Patrick Coleman, cardiologist with Northern California Medical Associates, Inc. and Dr. Tucker Bierbaum with Emergency Medicine at St., Joseph Health System’s Santa Rosa Memorial Hospital, co-hosted the biannual dinner meeting. They observed that both STEMI and Sepsis conditions present in similar ways and require time-critical intervention to avoid large area heart damage and progressive infections that can result in mortality.

According to Drs. Coleman and Dunlap, the medical community has come a long way in implementing timely procedures to treat patients with STEMI. “Cardiologists in the late 1990’s and early 2000’s began treating heart attack patients with intravenous stents, catheterization and balloon angioplasty – as well as drug-covered stents and balloons — for faster, more effective intervention — as opposed to just prescribing drugs to open clogged arteries which can take longer to do their job. The heart continues to suffer damage as long as the arterial occlusion remains. This new treatment strategy yields remarkable benefits in terms of less heart damage and improved patient prognoses.”

Dr. Dunlap said, “The STEMI Program has instilled a pervasive sense of urgency in people involved in administering the heart attack response protocol, and our efforts are paying off. The new STEMI treatment approach has been so successful that it’s not uncommon for patients that get picked up by EMS personnel at referral hospitals in Petaluma or Healdsburg to have their lifesaving device implanted within the next 90 minutes. There is still plenty of work to be done to increase STEMI response efficiency even further.

Dr. Coleman addressed the necessity of adhearing a standardized response protocol. “The urgency of any heart attack situation requires that all caregivers involved, including the paramedics, firemen, ED triage nurses, ED physicians, and cardiologists, perform precise tasks with efficient command and expertise.”

full table

All of the presenters at the meeting emphasized the vital importance of education and teamwork in an era marked by new techniques, technology and procedures. “It’s our job as cardiologists to educate everyone involved about their essential roles in saving heart attack patients’ lives,” Dr. Coleman added. “We know what needs to happen for STEMI patients to be treated effectively. Only through unified countywide planning and optimal utilization of local emergency facilities can we give patients their best chance for survival.”

A key barrier to the proper diagnosis of STEMI (ST-segment elevation myocardial infarction, or a severe heart attack) is that while EMS personnel and paramedics in the field can take EKG readings on site, or as they transfer the patient in an ambulance, they do not have the expertise or authority to read the tape and determine whether a STEMI incident has occurred. Only a cardiologist seeing the tape can make this assessment.

When a suspected heart attack victim is received by EMS personnel, they immediately call ahead to the nearest regional center emergency department (ED) to alert the cardiologist on duty so cath lab team members can be assembled in advance to save time.

“Without proper diagnosis, paramedics cannot know with certainty how to proceed and implement the correct treatment protocol unless a cardiologist miles away at a regional emergency department catheterization lab reviews the EKG tape,” Dr. Coleman continued. “So the quest has been to find a way to transmit EKGs to the cardiologist for precise interpretation while the patient is still in transit.”

Most facsimile machines are only capable of transmitting relatively low-resolution images. However, today’s cell phones have high-resolution cameras that can produce detailed images fine enough for an accurate STEMI diagnosis. Now a picture can be taken of the EKG tape in the field and transmitted to a physician in seconds, cutting the time interval for obtaining a diagnosis and treatment authorization during the journey from the field to the hospital, while also enabling the EMS to start appropriate medication therapy enroute.

The ability to transmit the photo image depends upon physical access to the nearest cellular signal relay tower. But even in remote areas beyond cell reception a moving vehicle often will enter an active cell zone within a few miles and be in a position to relay the picture before arriving at a hospital. HIPPA patient security and privacy considerations are avoided by asking the patient for permission to send the photo via a cell call prior to transmitting it.

In another innovative example, a Cotati-based medical transport company (ProTransport-1) has introduced ambulance technology that uses Google Glass camera-equipped spectacles worn by emergency technicians that transmit what they’re seeing to awaiting hospital staff.

The Google Glass system in the ambulances will allow EMTs, paramedics and nurses to transmit live video to receiving health care facilities during transports. In addition to mobile, visual evaluations, this versatile technology can improve the efficiency of patient care, documentation, navigation, dispatch communication and many more operational processes in the health care, ambulance and EMS industries.

“We’ve learned how to do many things well and still want to find ways to do them better, by focusing on a single process with ramifications based on how what you do will save lives, time and reduce costs,” Dr. Dunlap explained. “New communications technology is helping us expedite patient care before they arrive at the ED.”

Dr. Dunlap said the incidence of STEMI has decreased over the years, while the incidence of non-STEMI MI’s has gone up (1.6 cases per 1,000). Delays in treatment for STEMI come with a human cost per hour. Studies show that up to 40 lives can be saved for each hour medical personnel do better at identifying causes and administering proper treatment. For example, in door-to-balloon angioplasty therapy to unblock arteries, any time saved below 90 minutes makes a big difference in the 30-day mortality rate.

He said referral hospitals are good at processing patients quickly for transfer, and all regional medical centers have a reputation for rapid assessment of a patient’s condition, reducing the time required to implement treatment in receiving hospitals.
In an ideal scenario, ambulances equipped with EKGs would transmit the tape to the ED at the receiving hospital while adhering to standard protocols for drug stabilization and transfer from referral hospitals. The majority of the work will be done at the STEMI receiving hospital based on a single call from the field. This enables a classification of the case by level of evidence and severity.

The treatment ladder protocol for regional programs has been developed in consultation with Dr. David Lee at Stanford University with the goal of identifying a patient with ST elevation MI and directing the transport team to a STEMI-designated receiving hospital with a cath lab within 1.5 hours or less.

Dr Tucker Bierbaum

Dr. Tucker Bierbaum (R) of St., Joseph Health System’s Santa Rosa Memorial Hospital

Also presenting was Dr. Tucker Bierbaum, with St., Joseph Health System’s Santa Rosa Memorial Hospital. Dr. Tucker contends that Sepsis is an issue with increase prevalence and diagnosis. From 2012-13 there was an 11% increase in Sepsis in the region affecting 122 per 10,000 of population with those in the 65+ age group most severely affected, as well as those with weakened immune systems. During this time frame, Sepsis accounted for 40% of intensive care unit (ICU) costs and involved longer hospital stays. Those with Sepsis have a high recidivism rate. When not treated in time, the condition can lead to permanent renal disease.

Sepsis is one of four pathologically similar and progressive conditions beginning with SIRS (systemic inflammatory response syndrome), Sepsis (a potentially life threatening complication of infection due to the presence of bacteria or other infectious organisms in the blood stream that can spread throughout the body), Severe Sepsis (Sepsis with organ failure) and Septic Shock (Sepsis with multiple organ dysfunction or death).

For STEMI cases, two sets of protocols were discussed, including what to do during the first three-hours utilizing the initial bundle of treatment procedures, and what to do during the next three-hour period, as well as what medications have proven to be most effective in addressing this condition.

Regular meetings such as this and the quality of information provided are the keys to continuous improvement through education, as representatives from referral and regional hospitals come together to learn about new developments that can make the health care system better and improve patient outcomes.

Medical Community Steps up to Make A Difference for People in Need

As part of the 24th annual Make A Difference Day, a national day of community service, Santa Rosa’s 4th Street Laser & Surgery Center was the site for 29 free eye surgeries for Sonoma County residents ineligible for any type of insurance. The event was held on October 24th with 35 volunteers.

eye docs photo trio


Make A Difference Day is a USA WEEKEND initiative. In collaboration with Points of Light and Paul Newman’s Newman’s Own Foundation, the three organizations select ten national finalist awardees.

The 4th Street Laser & Surgery Center and Northern California Medical Associates’ Eye Care Institute ophthalmologists, Gary Barth, Robert Anderson and Daniel Rich were joined by ophthalmologist Sonja Schluter and anesthesiologist Jeff Kuhn. The other volunteers were from the Eye Care Institute staff, surgery center staff and for the first time, nursing volunteers from Memorial Hospital’s ambulatory surgery center. The volunteers involved in making the day a success vowed to return for the next Make A Difference Day. Proving volunteerism is contagious, Dr. Barth said, “success breeds enthusiasm for the project.”

Operation Access is the organizing charity behind the complicated logistics required to screen the patients medically, as well as, financially. Operation Access was founded in 1993 and arranges free medical procedures for those in need.

This is the third year that Operation Access and the Eye Care Institute surgeons have collaborated to provide free pterygium surgery primarly for field workers and laborers who develop the debilitating corneal growth due to the constant exposure to wind, dust and sunlight.

In 2014 Operation Access and the surgeons were awarded the USA WEEKEND Make A Difference Day award in a ceremony in Washington DC. Out of 1500 applicants, ten were chosen for the award. The Santa Rosa surgery day was the only one of the ten that was a medical volunteer event. The president of Newman’s Own Foundation gave Dr. Barth and Daniel Rabkin of Operation Access a $10,000 check to be used for future free surgeries.
The concept of “paying it forward” is evident in the community benefit of receiving this financial award. All those Newman’s Own products we buy locally generate the profits that are donated. The award is a perfect example of how small purchases can make a huge difference. “It’s the idea that we’re all part of the loop.” Dr. Barth said. “By winning the financial award, the money we spent comes back to Sonoma County to help provide charity medical services.

Dr. Barth also volunteers in Nepal, Cambodia, Myanmar (Burma) and India to provide free eye surgery and teaching. In those countries, health care protocols are different than in the US, making it easier to treat a high volume of patients in a short period of time. That model of high volume and high quality, is what stands out about 4th Street Surgery Center’s success. Dr. Barth re-envisioned this strategy in order to accomplish the 29 surgeries in a single day.

4th Street Laser & Surgery Center is an eye surgery Center of Excellence; nowhere else in the north bay does a free standing surgery center focus solely on eye surgery, performing almost 2,000 procedures annually. For more information about NCMA’s Eye Care Institute visit their website or call 707-546-9800 in Santa Rosa. For information about Operation Access call 415-733-0052.