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Supplements:  "You pay your money, you take your chances." 
​September 1, 2018
Americans consume large amounts of "dietary supplements" available  from almost any retail outlet, including gas-stations and pharmacies' store-sections. However supplement production and sale is unregulated.  Almost no one is watching out for consumers by studying the safety and effectiveness of these products. The FDA's consumer updates address the caveats about dietary supplements HERE .  





Where's The Pollen Coming From? 
March 5, 2018
It is March, one of the heaviest months for allergies with symptoms like sneezing, itchy red eyes, wheezing.  It's natural to think that yellow acacia trees are the cause.  But acacia and other flowering plants use bees to cross-fertilize and have larger waxy pollen grains.  Unless you have close exposure these grains won't be inhaled.  











​​The showy acacia above isn't spreading allergy, but the large Monterey Cypress behind it is releasing about one gallon of pollen per week.  It just isn't as obvious about it.















Cypress buds filled with yellow pollen. 





Do You Really Need Distilled Water to Prepare Saline Sinus Rinses?
​ - YES!
January 2018

From the FDA Website:
 for use as a nasal rinse because it’s not adequately filtered or treated. Some tap water contains low levels of organisms — such as bacteria and protozoa, including amoebas — that may be safe to swallow because stomach acid kills them. But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections. They can even be fatal in some rare cases, according to the Centers for Disease Control and Prevention (CDC).

What Types of Water Are Safe to Use?

Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”
Boiled and cooled tap water — boiled for 3 to 5 minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container for use within 24 hours.
Water passed through a filter designed to trap potentially infectious organisms. CDC has information on selecting these filters.


Mistaken Reasons for Declining the 
"Flu Shot" Influenza Vaccine -
A few patients are reluctant to receive the Influenza Vaccine 2014-15

because they've heard that only 40% of this year's influenza virus strains

can be prevented with the shots.  However, preventing 40% is still highly

desirable and the risk of the vaccine is minimal.  So, please have yourself 

vaccinated to prevent you and others from getting 


Others who decline the shot say "I got the flu shot but I got the flu anyway."

They report "stomach flu" symptoms of vomiting and diarrhea. 

"Stomach flu" has no relation to Influenza. We use the term as a shortcut

to say "gastroenteritis."  Developing the GI disease is not prevented by the

respiratory Influenza vaccine.  





Grand Rounds:  Medical Effects of Mold Exposure
California Pacific Medical Center, San Francisco


This video shows my July 15, 2014 lecture on the actual effects of mold exposure, as well as several medical myths surrounding it.    I was recovering from laryngitis & vocal quality was poor. Mold (Fungus) arises as a concern for many patients visiting an allergist.  Unfortunately, many false dangers are promoted by unqualified “experts.”  While living in damp or moldy conditions is associated with more respiratory symptoms, cause-and-effect has not been established.  Furthermore, the literature often does not distinguish between exposure to dampness vs. exposure to mold. A common unfounded health fear is that of Stachybotrys, misleadingly referred to as “Black Mold.” Most fungi (molds) which produce a colored pigment can grow as a black colony under specific environmental conditions.  Black colored mold is not necessarily Stachybotrys. Indeed, inhaling Stachybotrys is not detrimental. Stachybotrys must be eaten to cause poisoning, such as in contaminated foodstuffs. 




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Flonase, Rhinocort & Nasacort Now Sold OTC: Flonase (fluticasone) is an intranasal steroid spray. So are Rhinocort (budesonide), Nasonex (mometasone), Nasacort (triamcinolone) and others.  Online prices  for Kirkland generic fluticasone appear to be about $6 for 120 sprays, and Amazon sells this Costco product..  This is exactly the same product previously dispensed by prescription only. 


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Where do former medical assistants go? 

To medical school!


Julie Jin: Saint Louis University School of Medicine, Class of 2022

Erik Anderson: Touro University, College of Osteopathic Medicine, Class of 2022

Alvin Chou:State University of New York (SUNY) Downstate College of Medicine, Class of 2021.

Jamie Collins:UC Irvine School of Medicine, Class of 2021.

Sarah Yang: UC Davis School of Medicine, Class of 2020.

Amisha Singh: University of Arizona College of Medicine, Class of 2020.

Robert Dionisio: Chicago Medical School at RFUMS.

Hannah Oppenheim: UCSD School of Medicine, Class of 2019.

Yeriko Santillan, MD: New York Medical College, Class of 2018.

Ayelet Cohen, MD: Northwestern University Feinberg School of Medicine, Class of 2018.

Kate Bowman, MD: UC Irvine School of Medicine, Class of 2017.

Alexander Vu, MD: Case Western Reserve University School of Medicine, Class of 2017.

Vanessa Newman,DO: Touro College of Osteopathic Medicine in Vallejo, Class of 2017.
Brian Sharon: PhD/DDS/MD  program at the University of California, San Francisco.
Daniel Snyder: Sackler School of Medicine, Class of 2015.
Rudy Silva, MD: UC Davis School of Medicine, Class of 2015.
Vikki Fanslow, MD: UC Davis School of Medicine, Class of 2015.
Meagan Herda, MD: Temple University School of Medicine, Class of 2014.
Deirdre Burn, MDs: Tufts University School of Medicine, Class of 2014.
Mark Novak, MD: Creighton University School of Medicine, Class of 2013.
Lillian Chen, MD: University of Wisconsin School of Medicine, Class of 2013.
Suleiman Lapalme, MD: University of Vermont College of Medicine, Class of 2012.
Evan McDaniel, MD: University of Nevada, Las Vegas.
Ari Zadel, MD: UC Davis School of Medicine, Class of 2010.
Jennifer Brewer, MD: Oregon Health and Science University, Class of 2010.

Omar Hasan, MD: Northwestern University Feinberg School of Medicine.

​Jennis Pae, MD: Robert Wood Johnson Medical School

Kate Diesseroth, MD: Northwestern University Feinberg School of Medicine.

Tod Olin, MD: University of Texas, San Antonio.

Jennifer Jordan, MD: UC Irvine School of Medicine.

Eyal Oren, MD: Albert Einstein School of Medicine.

Hattie Grundland, NP: UCSF School of Nursing, Nurse Practitioner Program.

​Jane Bonacich, MD: Rush Medical College.

Kendra Lawrence, MD: Case Western Reserve University School of Medicine.


We always have premedical interns gaining experience while applying to medical schools. They are trained in skin testing, injections & breathing assessments.

San Francisco Bay Area Forest Fire Smoke Avoidance

November 14, 2018

•    Stay indoors as much as possible
•    Avoid  outdoor activity when the air quality is poor. Check it on AirNow:  cfpub.epa.gov/airnow.
•    Keep windows and doors closed.  
•    If you have air conditioning, put it on maximum recirculate to keep from drawing in outdoor air.
•    When driving, put air conditioning on maximum recirculate as well.  
•    Obtain a home air purifier with a CARBON filter, which adsorbs gases like smoke and fumes.  
•    Wear a N95 or P100 rated mask outdoors. Sold in pharmacies.

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Allergy & Immunology
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