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


Hernia patients who seek treatment immediately are more likely to enjoy a quick recovery

One of the more common conditions treated by NCMA’s General Surgery physicians involves hernia repair surgery using laparoscopic surgery. While the national statics indicate most people wait to treat a new hernia, best outcomes among NCMA patients occur for those who seek treatment sooner rather than later.

Hernia repairs have always been common and routine surgical procedures and technologies to treat hernias have advanced as a result. Information provided by the National Center for Health Statistics indicates that more than five million Americans currently suffer from a hernia – and three million new cases are reported annually. While the only effective treatment for a hernia is surgery, only about 750,000 Americans will actually seek treatment.

What is a Laparoscopic Procedure?

A laparoscopic or ‘minimally invasive’ surgical procedure is a technologically advanced option to traditional or open surgery – giving patients the opportunity to enjoy a quicker recovery. Laparoscopic surgery makes it possible to treat conditions like hernias using very small incisions, usually only millimeters in length. The general surgery physician then incorporates the use of specialized surgical instruments including a laparoscope – or a fiber-optic instrument – that is inserted in the abdominal wall. This device transmits images to a video monitor, allowing the surgeon to see the operative area on the screen.

Dr. Allen Cortez, General and Laparoscopic Surgery / Trauma Care“The minimally invasive approach to hernia repair is preferable to open surgery,” said NCMA General & Laparoscopic Surgeon, Allen W. Cortez, MD. “A hernia can be painful, unsightly and if left untreated can cause life threatening complications. I recommend that patients with hernia symptoms seek treatment sooner, rather than taking the wait-and-see approach.”

The minimally invasive approach to hernia surgery makes it possible for patients to be treated on an outpatient basis using local or epidural anesthesia rather than general anesthesia – expediting the recovery process. Surgery can take less than 45 minutes to complete and patients usually go home within a few hours of surgery, and are able to return to normal activities in only a few days.

What causes a hernia?

Hernias are generally caused by a weakness in the abdominal wall or groin area, and there are many causes for a hernia, including:

• age
• chronic coughing
• pregnancy
• constipation
• lifting heavy weight
• sudden weight gain

Hernias can also be congenital in nature, and those usually involve the belly button or appear as umbilical hernias, groin or inguinal hernias. Patients are especially susceptible to hernias following abdominal surgery which can weaken the tissue surrounding abdominal muscles, leading to a breach or separation. Women who undergo C-sections or hysterectomies, or men who have abdominal surgeries are most susceptible.

If left untreated, hernias can become so advanced that they require emergency surgery. A hernia becomes a particularly serious issue when it protrudes to the point that it cannot be pushed back into the abdomen or groin.

When to Consult a Physician

Patients need to seek treatment any time a newly discovered lump in the abdominal wall or groin area appears. These types of symptoms are also accompanied by pain and obvious swelling. “Patients who opt to wait to see a physician risk the hernia becoming larger which can be more difficult to repair,” explains Dr. Cortex. “If we can catch it in the early stages, it’s a much less involved surgery, but if it becomes larger and protrudes through the intestinal wall even more, complications are possible.”

NCMA’s General Surgery Team treat and manage a full spectrum of surgical procedures. In addition to general surgery services, physicians also have expertise, special interest and experience in the following areas: colon and rectal surgery, endocrine surgery, surgical oncology, trauma surgery and vascular surgery. For more information visit our website or call (707) 579-2100.

NCMA Docs Make a Difference: Dr. Harendra Punatar and the NBIAA

DMADNorthern California Medical Associates (NCMA) Cardiologist Harendra Punatar, MD, FACC, gives back to the community through his volunteer work with the North Bay Indo-American Association (NBIAA). NBIAA is a non-profit organization founded in 1990 in the North Bay area by the local residents of Santa Rosa, Rohnert Park, Petaluma and Novato. Dr. Punatar’s brother Suresh was one of the original founding members. NBIAA’s mission is to “bring India to the North Bay” by organizing cultural, religious, and educational events that are of interest to the growing Indian community in the region.

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NCMA's cardiologist Dr. Patrick Coleman with Dr. Punatar

NCMA’s cardiologist Dr. Patrick Coleman with Dr. Punatar

Soon after its founding, the NBIAA grew in popularity and became a primary avenue for connecting Indian community members. Events became well-attended and information about upcoming events spread quickly via word-of-mouth. In the late 90s, doctors began to notice a significantly higher propensity for heart disease and diabetes within the community. In fact, these diseases were almost twice as common in Indians in the North Bay than they were in other groups! Due to the disturbingly high prevalence of these diseases, Dr. Punatar began organizing free, annual NBIAA Health Fairs 15 years ago to spread awareness about disease prevention and treatment.

“The data on diabetes and heart disease made for a startling discovery. Members of the Indian community are on average more affluent than other groups in the area, and what we realized was that with that affluence came an increase of poor eating and exercise habits—both of which can be major health risks,” says Dr. Punatar.

He continues, “People in the community were worried and asking lots of questions about their health. The Health Fairs started as a way to meet the demand for health education. Originally, diabetes and heart disease have been the main topics of focus at the health fairs, but over the last five years we’ve really broadened the discussion to cover other prevalent health related subjects. The fairs have been extremely successful. We’ve come to expect about 100-2150 attendees every year!”

NBIAA Health Fairs are run entirely by volunteers with substantial support from NCMA and Medtronic. At the fairs, NCMA nurses and physicians offer free lipid health screenings with immediate results. In just a few minutes, these screenings reveal cholesterol and A1C hemoglobin levels in the bloodstream necessary to diagnose diabetes. During the health screenings, yoga and Tai Chi instructors offer free classes in other rooms to promote healthy exercise habits. At each fair, Dr. Punatar also arranges for two speakers to come and present for one hour each. Past presenters include NCMA Drs. Hopkins and Coleman and renowned physicians from all over the country.

The last NBIAA Health Fair took place on April 18th, 2015, at the Medtronic Cardiovascular at 3850 Brickway Blvd in Santa Rosa. The event focused on common food allergies, free lipid panel health screenings as well as yoga and Tai Chi classes.

Dr.-Punatar-PhotoDr. Punatar obtained his medical doctorate at Miraj Medical College in Miraj India and went on to complete his residency and fellowship training in cardiovascular disease from Coney Island Hospital in Brooklyn, NY. He has been a valued member of NCMA’s team of expert cardiologists for over 23 years, and he regularly sees patients in Santa Rosa and Petaluma. Dr. Punatar is also the proud father of two bright young women—one who is currently completing her residency training at UCSF Benioff Children’s Hospital in Oakland and the other is finishing her medical school at George Washington University in Washington, DC.

To schedule an appointment with Dr. Punatar, call (707) 573-6199, and visit for more information on the NBIAA and upcoming events.


Free Heart Smart Presentation – March 5th

Dr. Noel Santo-Domingo

Dr. Noel Santo-Domingo

Join us for NCMA Ukiah Cardiology’s free Heart Smart program—a heart screening and presentation that will provide you a new understanding and practical approach to transform your heart health and well-being. The event takes place March 5 at the Ukiah Senior Center located at 495 Leslie St., Ukiah, CA. Screenings start at 8 AM and NCMA Cardiologist Noel Santo-Domingo will present from 10:00-11:00AM. Contact (707) 569-7862 to RSVP. We hope to see you there!

Click here to view in full

Click here to view in full

NCMA Cardiologist Jaime Molden Explains Latest in Catheter Ablation Treatment for Atrial Fibrillation

 Jaime Molden, MD, FACC, FHRS Electrophysiologist

Jaime Molden, MD, FACC, FHRS

Northern California Medical Associates (NCMA) Cardiology offers expert atrial fibrillation care from leading specialists in the North Bay region. Cardiac Electrophysiologist Jaime Molden explains the current guidelines for treating atrial fibrillation with catheter ablation—an invasive, nonsurgical procedure that may reduce patient reliance on toxic medications.

Atrial fibrillation (Afib) is a common, potentially life-threatening heart condition in which the upper heart chambers beat out of sync with the lower chambers, causing an irregular heartbeat. Although the arrhythmia causes only a small increase to one’s risk of early death, the condition can evolve when left untreated over time and become very serious. In addition to life-changing symptoms of fatigue, palpitations, shortness of breath, inability to exercise, chest pain, and syncope, patients with Afib live with increased risk for an array of serious life-threatening health problems including stroke, cardiomyopathy, and heart failure.

Cardiologists have been helping patients manage their Afib for decades primarily with anti-arrhythmic drugs (also known as AADs or “rhythm drugs”). While these drugs are proven effective, the degree of efficacy varies from patient to patient, and side effects from taking these medications over extended periods of time can cause serious complications. Catheter ablation for Afib first became a viable treatment option in the early 1990s, and researchers and cardiologists have studied its efficacy ever since, fine-tuning the procedure throughout the process. Today, catheter ablation is gaining traction in the treatment of Afib as it has shown to help certain patient groups return to healthy heart rhythms while reducing their reliance on medications, which can have significant side effects.

NCMA Cardiologist Jaime Molden, MD, studied cardiac electrophysiology during his fellowship at Cedars Sinai Medical Center in Los Angeles. Dr. Molden regularly treats patients with Afib and he is a leading specialist in the area of catheter ablation techniques.

Dr. Molden explains, “Treating Afib remains a challenge to cardiologists today. There are three types—paroxysmal, persistent, and permanent—and treatment varies depending on which type the patient has. Paroxysmal is generally described as lasting less than 48 hours at a time. Persistent Afib lasts more than a week or requires an intervention to terminate it. Permanent Afib lasts longer than a year. Paroxysmal Afib patients have better treatment prognoses than persistent and permanent patients, but both paroxysmal and persistent Afib can become more frequent over time if untreated or treated ineffectively. Since many treatments are available but none that will work the same for every patient, treating Afib demands cardiologists’ full attention to detail in each individual case.

Treatment of Afib is always individualized to the patient. Many patients want to get off of their anti-arrhythmic medications altogether, and others want to simply minimize symptoms. When symptoms persist, more catheter ablation procedures can often get patients to where they want to be, with the type of Afib playing a significant role in the efficacy of the treatment. Patients with paroxysmal Afib can achieve excellent results with a single ablation procedure.

In the procedure, we use several different diagnostic catheters and an ablation catheter to map out and treat the areas of the heart that are causing the abnormal rhythm. In the vast majority of patients, arrhythmia is triggered by pulmonary veins firing electrical signals in an irregular, chaotic pattern. With catheter ablation, lesions (‘burns’) are made around the opening of each pulmonary vein until there is no electrical conduction into the vein. What we are essentially doing is cutting off ‘communication’ between the misfiring vein (or veins) and the heart by modifying the tissue in a precise area. We can then test the results to ensure that there is no conduction between the heart and the misfiring vein. After catheter ablation, a patient’s pulmonary veins will still fire an electric signal that would normally cause arrhythmia, but the signal cannot pass through the ablated tissue, and sinus rhythm (normal rhythm) is maintained.

Catheter ablation for atrial fibrillation is becoming more widely used within the medical community for several reasons. It likely has a more favorable success rate than anti-arrhythmic drugs. Analysis of landmark Afib trials like AFFIRM, RACE and RACE II suggests that rhythm control with drugs and cardioversion benefit the patient by maintaining sinus rhythm, but the toxicities and adverse effects associated with AADs negate the positive effects. The subset of patients who responded well to the treatment, meaning that their normal rhythm was maintained with little adverse reactions to the drugs, had lower morbidity rates than the overall population of patients in the study. This suggested that non-pharmacologic therapies might allow us to achieve the larger benefits of maintaining sinus rhythm.

While studies into the efficacy of catheter ablation are ongoing, results from recent research demonstrate that approximately 60-70% of patients with paroxysmal Afib can enjoy freedom from arrhythmia after a single procedure. With two or more procedures, the efficacy increases further. The research also indicates a higher success rate for paroxysmal patients when compared to rates for persistent or permanent Afib patients. Patients with paroxysmal Afib, accordingly, are better candidates for the procedure than those living with the persistent types.

The risks associated with catheter ablation are serious, but the propensity for major complication is approximately 2% with the overall complication rate in the range of 5%. Compare that number with the propensity for complications associated with anti-arrhythmic drug treatment, and the risks of catheter ablation look even better. While rhythm drug treatment has a lower rate of life threatening side effects than ablation, almost a third of patients on these medications eventually experience an adverse event caused by their treatment, like severe heart rate slowing or the precipitation of other abnormal heart rhythms. Over 10% of patients either find the treatment too intolerable to continue or altogether ineffective.

This leads to the important question—‘When is the use of rhythm drugs warranted?’ New official Afib treatment guidelines in the US now include a treatment route for Afib that removes AADs from the process altogether, allowing patients to opt for ablation before they’ve tried AAD therapy. This is exciting progress, as the new guidelines demonstrate a trend towards replacing a standard treatment with a potentially better one. With that said, we do not have a curative treatment for Afib in 2014. The treatment for this disease will continue to be a combined approach utilizing the existing medicines in as safe a way as possible while applying catheter ablation techniques to the patients who prove to be good candidates.

A trial run with medications is still generally seen as the first option for Afib patients. Also, patients with persistent or permanent Afib may not be eligible for the ablation procedure depending on various cardiac and overall health factors. Catheter ablation for treating Afib has settled in as a viable treatment for patients that meet the right criteria, both without and in conjunction with medications. For some patients, catheter ablation may offer the best outcomes.”

Click here to view Dr. Molden’s complete presentation on Afib catheter ablation from NCMA’s annual symposium.

NCMA offers patients excellent quality and convenience in its comprehensive cardiac and vascular testing services. All procedures are performed by highly skilled and trained registered sonographers, registered nuclear technologists, and/or registered nurses and medical assistants, under the support of our physicians. NCMA’s nuclear and echocardiology laboratories are accredited by the Intersocietal Accreditation Commission. To learn more about NCMA Cardiology or Dr. Molden, please visit, or call (707) 573-6166 to schedule an appointment.


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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SNM’s Quality Care Award Goes to NCMA’s Kenneth Murachanian, M.D. for providing the highest quality care in the western region

Sutter Medical Network (SMN) announced the recipients of this year’s esteemed Quality Care awards on December 17th. Our very own Kenneth Murachanian, M.D. from the prestigious group of NCMA’s Santa Rosa Internal Medicine was awarded the highest recognition as the best internal medicine physician for providing quality care in the western region.

Dr. Murachanian’s award was presented to him by Dr. Michael van Duren Vice President of the Clinical Transformation Program at SMN.

Dr. Murachanian’s award was presented to him by Dr. Michael van Duren Vice President of the Clinical Transformation Program at SMN. The SMN Quality Care Award is presented to a total of three primary care physicians in each region (one family medicine physician, one internal medicine physician and one pediatrician) with the highest overall Quality Pay for Performance mean scores compared to all other eligible clinicians in his or her region.

Dr. Murachnian and SRIM care staff were recognized for working diligently to ensure that patients receive the preventive care and screenings that they need — an important factor for patients who are very selective about the healthcare they choose to pursue.

All SMN affiliated medical foundations and IPAs that reported quality data to Sutter Health in 2013 were eligible to participate in this award opportunity. Congratulations Dr. Murachanian!

Northern California Medical Associates (NCMA) Welcomes Jaime Molden, M.D. Cardiac Electrophysiologist to the NCMA Cardiovascular Services Team

Northern California Medical Associates’ (NCMA) Cardiovascular Services is delighted to welcome Dr. Jaime Molden to the elite Fountaingrove Cardiology team. Dr. Molden previously served as Medical Director of Electrophysiology at Dixie Regional Medical Center in St. George.


Jaime Molden, M.D. Dr. Molden earned his medical degree from the University of Chicago’s Pritzker School of Medicine, where he was recognized with the Dylan Award in Medical Ethics. Returning to California, and following internship and residency in internal medicine at Harbor-UCLA Medical Center in Torrance, Dr. Molden joined Kaiser Permanente Southern California in Los Angeles as an internist. In 2009 he completed a fellowship in cardiovascular disease at Harbor-UCLA Medical Center during which time he also served as a clinical instructor. Dr. Molden went on to complete the Clinical Cardiac Electrophysiology Program at Los Angeles’s Cedars-Sinai Medical Center in 2010.

Dr. Molden currently holds board certifications in clinical cardiac electrophysiology, cardiovascular disease, nuclear cardiology and internal medicine, as well as, advanced cardiac life support and has authored numerous clinical publications.

Cardiology and More

Dr. Molden is trained to diagnose and treat a variety of heart and cardiovascular conditions including congenital heart defects, congestive heart failure, heart disease, coronary artery disease, heart attacks, arrhythmias, high cholesterol, high blood pressure and many other heart-related conditions. As an electrophysiologist, Dr. Molden is able to also provide advanced diagnosis, treatment and management of electrical- based diseases and disorders of the heart. His education and experience in electrophysiology allows him to perform specialized surgical procedures such as ablation and drug therapy to manage complex arrhythmias.

By joining Northern California Medical Associates’ (NCMA) Cardiovascular Services team Dr. Molden becomes an important part of a highly recognized team of dedicated professionals, all working together to deliver the highest quality care with the best patient results.  Providing treatment and services for everything from cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, this highly  qualified staff not only maintains its commitment to patient health and well-being, they also follow a tradition of excellence and expertise to deliver the most current, innovative treatment in cardiovascular medicine.

Making an appointment

Dr. Molden is pleased to be accepting new patients at NCMA’s Fountaingrove Cardiology office in Santa Rosa. For more information about NCMA visit our site at, and to arrange for an appointment call (707) 573-6199.


Northern California Medical Associates is Northern California’s premier provider of medical and surgical care north of the Golden Gate and has been serving individuals and families since 1975. Every highly skilled professional comprising the NCMA team shares a strong commitment to preventive programs and health screening designed to promote and maintain everyday health. NCMA has successfully built a legacy of excellence that is recognized nationwide.

Dr. Thomas Guyn and Dr. Vishal Goyal join Northern California’s elite team of Physicians in Santa Rosa

Northern California Medical Associates (NCMA, Northern California’s premier provider of medical and surgical care in the North Bay, welcomes Internal Medicine physician, Dr. Thomas Guyn, and Cardiologist, Dr. Vishal Goyal. NCMA employs only the most highly respected primary care physicians and specialists in Sonoma, Lake and Mendocino Counties.

Dr. Thomas Guyn, internal medicine physician with NCMA

Dr. Thomas Guyn, internal medicine physician with NCMA

NCMA welcomes Dr. Thomas Guyn to an elite team of physicians at NCMA’s Santa Rosa Internal Medicine office. Dr. Guyn makes the transition to NCMA after he served as a hospitalist at Santa Rosa Memorial Hospital (SRMH). Dr. Guyn acted as a liaison between patients during their hospital stay and their primary care and specialist physicians. As a hospitalist, Dr. Guyn has experience with a wide range of diseases and worked extensively with geriatrics and general internal medicine. Formerly, Dr. Guyn held a private practice as well as performing medical consultant services and acute care medicine. With a desire to serve out-patients and hospitalized patients more on a long-term basis, Dr Guyn is making the transition to an internal medicine physician at NCMA’s Santa Rosa Internal Medicine office.

Dr. Guyn completed his undergraduate studies at Chico State University and went on to UC Santa Barbara for graduate studies in genetics and protein structure. After finding a passion for medicine and travel, Dr. Guyn completed his medical degree at the University of Rome Medical School in Rome, Italy. During his stay in Italy, Dr. Guyn met his wife and they now have two grown children. Dr. Guyn’s interests include environmental health, where he has earned a Masters of Arts in Value and the Environment (MAVE) from the University of Lancaster.

During his free time, Dr. Guyn enjoys spending time with his children, running, and pottery.

Dr. Guyn’s specialty is in internal medicine and is immediately available for appointments. Call to (707) 544-3411 to schedule an appointment.

Dr. Vishal Goyal, cardiologist with NCMA

Dr. Vishal Goyal, cardiologist with NCMA

NCMA additionally welcomes Cardiologist, Dr. Vishal Goyal to their cardiovascular services team at FountainGrove Cardiology in Santa Rosa. Dr. Goyal specializes in invasive and non-invasive cardiovascular medicine including disease prevention, diagnostic cardiac catheterization, pacemaker implantation, echocardiography and nuclear cardiology.

Dr. Goyal received his undergraduate degree from UC San Diego in Economics. He then earned his Medical Degree from Saint Louis University School of Medicine with a Distinction in Community Service. Dr. Goyal then went on to complete his internship at UC Davis Medical Center. During his fellowship, Dr. Goyal was named Chief Fellow from the University of New Mexico Health Science Center.

Dr. Goyal recently moved to Sonoma County with his wife and young daughter and they are excited to be back in their native California. Dr. Goyal and his family enjoy road cycling and gourmet cooking.

“I am very excited to return to Northern California and I look forward to becoming an active supporter of the Sonoma County community,” states Dr. Goyal.

Dr. Goyal is accepting new patients at NCMA’s FountainGrove Cardiology office in Santa Rosa. To set up an appointment call (707) 573-6199. For more information about NCMA and our physicians visit our site at