primary care physician

Avoiding painful bladder stones and what to do if you get them

Dr. Lazar

Michael J. Lazar, MD – Urologist

NCMA’s Santa Rosa Urology and Dr. Michael Lazar provide diagnostics, treatment and management of a full spectrum of urologic health conditions including bladder stones.

Bladder stones are exactly what they sound like; hard stone-like pieces of concentrated urine which have crystallized and clumped together. Interestingly enough, in developing nations bladder stones are fairly common in children – and sadly as a result of dehydration, infection and a low-protein diet. In the U.S. bladder stones tend to occur primarily in adults, and men over the age of 30 are the most vulnerable.

How stones get in the bladder

While water makes up the majority of urine content, about five percent is made up of minerals and salts along with proteins and other waste products. When urine becomes overly concentrated due to dehydration, infection or other problems the color will vary from dark amber to brown depending on the types of waste and minerals it contains.

Bladder stones can become so large or numerous that they block the tube (called a urethra) that urine flows through from the bladder. A blocked urethra may cause slow and/or painful urination or it might make urination impossible. Sometimes bladder stones cause no problems at all — even when stones become quite large. However, real problems begin to develop as stones irritate the bladder wall or block the flow of urine, causing a variety of symptoms including:

  • Pain in lower abdomen
  • Painful and frequent urination
  • Difficulty urinating or interruption of urine flow
  • Blood in urine
  • Cloudy or abnormally dark-colored urine

A variety of causes

In the case where prostate gland enlargement causes bladder stones in men, the urethra has become compressed by the enlarged prostate, which in turn interrupts urine flow, causing urine to remain in the bladder, leading to bladder stones.

Sometimes damaged nerves can be the culprit. In a healthy person nerves work to carry messages from the brain to the bladder muscles, telling the bladder muscles to constrict or relax. If these nerves are damaged due to stroke, spinal cord injury, Parkinson’s disease, diabetes, a herniated disk or other health problem – the bladder may not empty completely, again leading to bladder stones.

Bladder stones can also develop if the bladder becomes inflamed due to urinary tract infections or even radiation therapy to the pelvic area. Bladder catheters can also cause bladder stones as can objects that accidentally migrate to bladder, such as a contraceptive device or stent. When this happens mineral crystals tend to form on the surface of these foreign objects, leading to stones. And finally, stones that have formed in the kidneys can occasionally travel down the ureters into the bladder and, if not expelled by natural means, can grow into larger bladder stones.


While medications are rarely used to dissolve the stones, drinking eight 8-ounce glasses of water or more per day will help to increase urination, which may help smaller bladder stones pass naturally. A qualified urologist will remove larger stones using an instrument called a cystoscope, which is a small tube that passes through the urethra to the bladder – and some more troublesome stones may need to be removed by surgery. For patients with enlarged prostate and bladder stones, transurethral resection of the prostate can be performed where the stone or stones are removed.


The best way to prevent bladder stones from forming in healthy people is to be mindful to always stay hydrated and to seek early treatment for urinary tract infections or other urinary tract conditions.

In addition to bladder stones and general urologic medicine services, NCMA’s Santa Rosa Urology and Dr. Michael Lazar also specialize in urologic oncology, reconstructive urology, male infertility/erectile dysfunction and high intensity ultrasound for prostate cancer. To learn more visit our website or to make an appointment with Dr. Lazar call (707) 546-5553.

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.

FacebookJoin us on Facebook!

TwitterFollow us on Twitter!

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!

Press Democrat Honors Dr. James Leoni and Family

Dr. James Leoni, NCMA Primary Care Physican

Dr. James Leoni                                                 NCMA Primary Care Physician

The Leoni’s have been practicing medicine in Sonoma County for three generations. With six physicians and two nurses in the family, one might say  helping others is in their blood. Dr. James Leoni is a primary care physician with Northern California Medical Associates and his son James Jr. seems to be following in his footsteps.

For over half a century, the Leoni family has made its mark on Petaluma by helping and healing generation of  people in the community. The patriarch of the family, Angelo Leoni (James’ father) reflects on his exceptional family with always a hint of humor, “I never encouraged them to be doctors. They did all this foolishness all on their own.” Dr. James Leoni credits his success and passion for the medical field to his father who stood as a driving force in his studies and still stands as his role model as a physician, father and son.

Click here for the full Leoni article.