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.

Advocate for Women’s Heart Health

Throughout her life, cardiologist Dr. Kimberly Brayton, has strived to make the biggest impact in the field of health care. She has only been with Northern California Medical Associates (NCMA) since March and already is advocating for community awareness of women’s heart health.

During Dr. Brayton’s first week at NCMA, she was a guest speaker at a Women and Heart Disease event for WHAM (Women’s Health at Memorial), a women’s philanthropy group. “It’s going to be an important part of my practice,” she says. “Community events like this are especially important for women’s groups, as well as on-going provider education, and especially emergency room front line providers and primary care physicians.”

Originally from Petaluma, Dr. Brayton began studying health policy in law school.

“It felt like health policy would have more of an impact than treating individual patients, a more global impact is what I had envisioned.” While she found that good in theory, “I really didn’t find it so satisfying on the ground.” She discovered that while participating in tenant and landlord disputes, she really liked direct services to clients, something she hadn’t anticipated.  What she really wanted was patient contact.

“It turned out that on a day to day basis what’s more interesting for me is to feel like I’m making a difference in individuals’ lives. I found that much more fun than my policy classes. It felt much more meaningful. I derive more joy from the face to face interaction. It’s more satisfying.”

Dr. Brayton applied to medical school while still in law school. She took the bar exam and started medical school two weeks later. While in medical school, Dr. Brayton maintained an interest in public health in general. And because heart disease is the number one killer in the U.S., for men and for women, it made sense that to impact a greater number of patients she would focus on cardiology.

“It would be interesting to me medically, but I would also be treating a population where there was potential for a greater impact.” Historically speaking, women have not been well-represented in the medical profession. Although the field of cardiology is male dominated, it’s getting better, Dr. Brayton says. Medical school classes in general have started to even out in terms of men and women, but in sub-specialties like cardiology, there remains a pretty marked imbalance.

“It’s true for cardiology as much as any other type of medicine. Which means that the type of data we tended to accrue over the last 20- 30 years gives us a lot of insight into men’s cardiovascular disease, but much less so for women, both in terms of the presentation of the disease and the appropriate management. And whether therapies are equally effective for men and women is less clear.”

Heart disease is the number one source of mortality for women. In fact, more women who have a heart attack will die from it compared to men. Dr. Brayton says “There are a lot of factors that contribute to that. Part of it is that women’s symptoms are not the same as for men. Women less often have crushing chest pain so they don’t realize they are having a heart attack, and part of it is media portrayal of a heart attack, which is always the male experience of having crushing pain. So awareness is a problem. The awareness of women’s symptoms of a heart attack is lower. It’s true on the patients’ side, in that they don’t come in quickly enough, and it’s also true for providers, where their clinical suspicion of heart disease is lower because it’s not a typical presentation of symptoms.”

That makes it difficult for the physician to make the correct diagnosis and treat women’s heart conditions appropriately, which leads to worse outcomes for women. “What that highlights for me is the importance of continuing to be an advocate and make sure that women are included especially on the research side. That’s been an interest of mine since I’ve been doing health services research, and then drug development research; how do we make sure that women are well-represented in clinical trials?”

Kimberly Brayton MD

Dr. Kimberly Brayton

Dr. Brayton finished her fellowship at UC San Francisco in 2013, and continued with a post-doctoral fellowship in health services research at Stanford University, which she finished in 2014. For the next two years she was intermittently practicing medicine while doing clinical research in cardiovascular drug development. But again, something was missing. “I found the research and drug development interesting and thought it would have an impact, but I had the same problem I always had– there was not enough patient contact. For me, it was pretty clear I needed to get back into clinic. At NCMA, this is exactly what I want to be doing.”

Dr. Brayton’s husband is also a cardiologist with NCMA, Dr. Vishal Patel. They have an 11- month old son, Aash, and they are expecting their second child in July. They also have a 6-month old puppy. When Dr. Brayton is not pursuing one of her many interests, she is “chasing her son around.” The family also enjoys hiking adventures to see the countryside.

Visit Dr. Brayton’s profile to learn more and call (707) 573-6199 to make an appointment.

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.

As Flu Season Ramps Up for October it’s Time to Get Vaccinated

Northern California Medical Associates, Family and Internal Medicine Physicians suggest getting this year’s flu vaccine, which is more likely to prevent most flu strains this year, according to experts.

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Penn State Milton S. Hershey Medical Center reports that this year’s flu vaccines are set to be a good match to most probable flu outbreaks. The flu vaccine is never 100 percent effective, even when scientists have done their homework to predict which strains will be most active. But this year experts are more certain that the CDC’s recommended vaccine with help to prevent flu outbreaks – an improvement over last year’s flu season. And, flu shot recipients who still get the flu will supposedly benefit by its effect to reduce the severity of symptoms.

Flu Season is Serious Business

According to the Centers for Disease Control and Prevention (CDC) so far, the flu activity so far is low in the United States – and it’s hard to image that we’re already half way through the flu season. But as is typical each year, flu outbreaks don’t really begin to get off the ground until October, just as kids head back to school and the cooler weather forces everyone indoors. These conditions tend to lead to more exposure to flu germs that spread much easier in close quarters. Although flu symptoms can cause some people to only miss a few days of work or school, every year it also contributes to millions of more serious illnesses, hundreds of thousands of hospitalizations and thousands of deaths.

The CDC estimates that an average of 36,000 people will die of flu this year in the U.S. alone, potentially more if new flu strains pop up that prove to be resistant to current antiviral drugs. With this in mind, prevention is the key to staying healthy. First on the list for prevention from the Internal Medicine Physicians of Northern California Medical Associates is a yearly flu vaccine for every person over the age of six months.

“While there is no way to prevent everyone from getting the flu, and vaccines are not always effective all of the time, getting the most current vaccine is the best way to protect against flu,” says NCMA’s Dr. Thomas Guyn. Vaccination can reduce incidents of flu illnesses and help to avoid missed work and school, as well as prevent hospitalizations in most people.

Important ways to avoid the flu

Stay healthy – A healthy immune system is important for prevention of any cold or flu, and it certainly helps to reduce the duration of sick time when an infection occurs. The most obvious ways to stay healthy includes;

• eat right, eat fresh foods to maximize nutrients
• get plenty of exercise to maintain health and maximize potential for staying resistant to viruses
• get enough rest, at least 8 hours sleep for adults, 9 hours for teens, 10-12 for younger children
de-stressify, stress is a known contributor to ill health and can damage the immune system
• take preventive measures such as frequent hand washing, avoid close contact with sick people
• avoid touching eyes, nose and mouth

What to do if you get the flu

For those who cannot avoid the flu, there are drugs that can treat flu symptoms called ‘antiviral’ drugs which work to make the illness milder and help a person feel better faster. They can also help to prevent serious flu-related complications, like pneumonia.
The Family and Internal Medicine Physicians of NCMA typically recommend that anyone with flu-like symptoms stay home and avoid contact with others for at least 24 hours after the fever has subsided (without the aid of fever-reducers). If symptom persist or worsen, seek medical help right away.

About NCMA Family and Internal Medicine

Northern California’s premier provider of medical and surgical care north of the Golden Gate has been serving individuals and families since 1975. NCMA’s Family and Internal Medicine Physicians diagnose, treat, and manage a full spectrum of health conditions.

NCMA Health Connect – Creating Better Connections With Our Patients

NCMA pic

– Click above to learn how to create your account –

Northern California Medical Associates (NCMA) is announcing NCMA Health Connect, our new on-line secure patient portal allowing you more access with your NCMA medical providers.

NCMA Health Connect will help us correspond with you securely, keep information up-to-date, and is available 24/7 from the comfort of your home or business.

Start connecting today. Once you sign-up, you will be able to:

• Request an appointment
• Review your medical summary
• Message your doctor’s office securely
• Pay your bill on-line

NCMA’s main goal is always to serve our patients in better ways. We hope you will take advantage of our new NCMA Health Connect.

For more information & to learn  how to create your account, click below and view announcement poster:
Northern California Medical Associates (NCMA) is announcing NCMA Health Connect, our new on-line secure patient portal allowing you more access with your NCMA medical providers. NCMA Health Connect will help us correspond with you securely, keep information up-to-date, and is available 24/7 from the comfort of your home or business. Start connecting today!

– Click Here –

Thanks, and welcome to NCMA Health Connect.

SRHN Allergy Center Discusses the Type of Allergy Season to Expect During Northern California Drought

The Allergy Center at Santa Rosa Head and Neck Surgery (SRHN) reminds Sonoma County residents of the imminent allergy season.

The Allergy Center at Santa Rosa Head and Neck Surgery (SRHN) reminds Sonoma County residents of the imminent allergy season.

The Allergy Center at Santa Rosa Head and Neck Surgery (SRHN) reminds Sonoma County residents of the imminent allergy season. Due to the extended drought that California has experienced over the past year, the density of allergens in the air is expected to vary from years with normal rainfall. Sonoma County, with its diverse plant life and warm weather, is already a hot bed for pesky allergens, and a recent test conducted by AccuWeather shows that allergenic grass pollens are currently highly concentrated in the area.

More than 50 million Americans suffer from uncomfortable allergy symptoms each year, and Sonoma County residents are no strangers to pesky allergens that concentrate the air during the months of spring. March, April, and May are the peak months for many allergy sufferers, and the upcoming spring may prove to be one of the worst seasons for allergy sufferers on record. A recent article in the Press Democrat cites findings from AccuWeather that show the current concentration of pollen in the area to be very high.

The extended drought affects the density and type of allergens in the air in several ways. Typically with less rainfall, fewer plants blossom in spring leading to less new pollens being introduced into the atmosphere; however, due to the extended absence of rain, old pollens remain in the air since there hasn’t been enough rain to wash them away. Wind patterns can also spread mold allergens and pollens that haven’t been washed away to new regions, introducing new types of allergens to areas that would normally be free of them.

When symptoms of allergies arise such as itching, sneezing, watery or burning eyes, congestion, and coughing, having an allergy test with a specialist is the best way to determine the source of your symptoms and how to relieve them. It’s common for people to just assume that their symptoms are allergy related, but sometimes they are not, and when they are a result of allergic reaction, only a test can tell which allergens are causing symptoms.

Variations in the concentration of pollens and molds in the air can also cause allergic reactions in people who have never experienced allergies before. Most allergic reactions happen when the body’s immune system reacts to a ‘false alarm’ and attempts to fight off an otherwise harmless substance. The body is exposed to small levels of allergens everyday, and only when exposure to an allergen surpasses the body’s unique threshold do symptoms arise.

The drought in California has shown to increase the concentration of pollens in the air, and perhaps because of this high concentration, the Allergy Center has recently seen an increase of allergy diagnoses for patients that come in with ‘cold-like symptoms that just won’t go away.’ These patients are often surprised that their symptoms are due to allergies, having never experience allergic reactions before. After proper diagnosis, an allergy specialist can administer a specific remedy that has shown most effective at combating the patient’s specific allergies.

The Allergy Center at SRHN offers a unique, collaborative care model to patients suffering from symptoms of allergies. Experienced Allergy Specialist and SRHN allergy clinic manager Linda Biggers works alongside SRHN Otolaryngologists, ear, nose, and throat (ENT) surgeons, to provide patients with integrated, multi-specialist care. Linda is a member of the American Academy of Otolaryngic Allergy and has additional training in immunotherapy from ALK Abello, the world leader in allergy vaccination. A Sonoma County native, Linda is especially familiar with the types of allergens in the area.

Allergy Clinic Manager & Clinician

Allergy Clinic Manager & Clinician

Linda explains, “At the Allergy Center at SRHN, we offer skin testing for identifying inhalant allergies, and it takes, on average, only 30 minutes to receive a detailed, specific results report after the test. Once the results are in, we can start our patients on their own personalized treatment plans. I urge all Sonoma County nasal allergy sufferers to seek diagnosis with a nasal allergy specialist to ensure that they receive the best treatment, and so that they can enjoy the rich atmosphere our Northern California home has to offer.”

Allergy treatment at SRHN may include nasal-sprays, antihistamines, decongestants, immunotherapy, allergy eye drops, and more. Outside of treatment, allergy sufferers can reduce their symptoms by keeping windows closed, limiting time spent outdoors, showering after exposure to pollens, vacuuming frequently, and keeping pets off of furniture and clothing. Since activities like mowing the lawn and gardening can drastically exacerbate symptoms, it is best to avoid these activities during peak allergy season.

Santa Rosa Head and Neck Surgical Group (SRHN) is Sonoma County’s leading provider of otolaryngologic (ENT) healthcare. The ENT surgeons provide non-surgical evaluation, as well as surgical expertise in chronic ear surgery, reconstructive plastic surgery, tumor removal, thyroid and parathyroid conditions, sleep apnea, sinus problems, and more. With a team of audiologists at the Hearing Center, an allergy specialist at the Allergy Center, and a clinical aesthetician all at one location, SRHN provides comprehensive care with physician collaboration for all ENT healthcare needs.

The Allergy Center at SRHN, located at 1701 4th Street, Suite 120, Santa Rosa, offers the latest available treatments in immunotherapy and allergy medications. To schedule an appointment with Linda Biggers or an ENT doctor, please call (707) 523-7025.

Sonoma Medicine Publishes “Office-Based Balloon Sinus Dilation” by Dr. Stefan Zechowy

A veteran member of NCMA’s Santa Rosa Head and Neck Surgical Group (SRHN), Dr. Zechowy is an expert Otolaryngologist specializing in nasal and sinus surgeryear surgerysleep apnea surgery, as well as thyroid surgerySonoma Medicine Magazine recently published Dr. Stefan Zechowy‘s article detailing the efficacy of the state-of-the-art Balloon Sinus Dilation (BSD) procedure.



"Office-Based Balloon Sinus Dilation" Preview

Click Here to read Dr. Zechowy’s full article as published in Sonoma Medicine’s Fall 2014 Issue.

Dr. Reza Sepehrdad joins Northern California Medical Associates Cardiovascular Services Team


Sepehrdad, MD

Dr. Reza Sepehrdad, Interventional Cardiology

Northern California Medical Associates (NCMA) Cardiovascular Services proudly welcomes Reza Sepehrdad, MD, to the elite team of physicians at FountainGrove Cardiology in Santa Rosa. With interventional cardiology as his primary specialty, Dr. Sepehrdad has completed three fellowships in different cardiology subspecialty areas from UC Davis.

Dr. Reza Sepehrdad is a board certified cardiologist who practices the most current, innovative treatments in cardiovascular medicine. During medical school at New York Medical College, Dr. Sepehrdad distinguished himself from his fellow classmates, earning six research awards in six years. Dr. Sepehrdad obtained his residency training from UC Davis before going on to complete fellowships in cardiovascular medicine, interventional cardiology, and vascular medicine and peripheral arterial interventions from the same school. While completing his fellowship in cardiovascular medicine, Dr. Sepehrdad worked as an Emergency Room/Urgent Care Staff Physician for the VA Northern California Health Care System.

Dr. Sepehrdad carries professional society memberships with the American College of Physicians, the American College of Cardiology, and the Society for Cardiac Angiography and Interventions. He has also written papers on a variety of medical topics for multiple respected publications such as Cardiac Interventions Today, American Journal of Medicine, Cardiology in Review, and more. Dr. Sepehrdad is fluent in English and Farsi, and is partially fluent in Spanish. In his free time, Dr. Sepehrdad enjoys exercising, cooking, and spending time with his wife and family.

Dr. Sepehrdad plays an integral role in the team of highly qualified cardiologists at FountainGrove Cardiology. Providing treatment and services for everything from cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, this highly qualified staff maintains its commitment to deliver the most current, innovative treatment in cardiovascular medicine and the best possible patient outcomes.

Dr. Sepehrdad practices cardiology and interventional cardiology at FountainGrove Cardiology in Santa Rosa, and he is currently accepting new patients. For more information about NCMA Cardiovascular Services, visit Call (707) 573-6199 to make an appointment with Dr. Sepehrdad or any other NCMA doctors at FountainGrove Cardiology.