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Serving the San Francisco Bay Area, CA
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Norovirus Infections

Noroviruses are the most common cause of gastroenteritis(inflamed stomach and intestines) in the U.S.  It is estimated that there are 20 million cases worldwide, 70,000 hospitalizations and about 800 deaths per year in the U.S. This year, a new and particularly virulent strain, the G11.4 Sydney strain, has been wrecking havoc in the U.S. and elsewhere. Symptoms include vomiting, diarrhea and stomach cramps.  Less common symtoms include fever, chills, headache, muscle aches, and general weakness or fatigue. The virus is highly contagious and spreads via feces.  Contaminated hands then touch food or other objects. Norovirus season is year round. The virus is resistant to extreme temperatures and most germicides, including alcohol, chlorine, and chlorhexidine.  The virus can survive on hard surfaces for 12 hours or more, on fabrics for 12 days, and in standing water for months, and perhaps years.  Washing carefully with soap and water is considered the best way to decontaminate. After exposure to this virus, the incubation period is 1-2 days before symtom onset.  For most people the infection lasts 1-2 days.  Severity of illness varies from person to person and may be mild to severe. There is no cure except the cure of time.  No vaccine is available, and a person can be infected repeatedly. Treatment is symptomatic, i.e. we can treat the symptoms, but not cure the disease. Mild nausea can sometimes be relieved by drinking ginger containing beverages, such as ginger tea, or by eating fresh or candied ginger. Drinking liquids in small amounts that are quickly absorbed by the stomach lining may also help to reduce nausea and promote hydration.  Liquids with...

Why finish antibiotics?

Why it is always important to always finish antibiotics as prescribed? This is a common question.  The answers that you usually hear are: 1) The infection may return if incompletely treated. 2) There is an increased risk of development of antibiotic resistance when infections are not fully treated. What you probably never heard is this: The actual explanation as to why a full prescribed course of antibiotics should always be completed is that infections are not necessarily stopped when symptoms have resolved. Bacteria are generally killed by antibiotics when they are “awake” and active, taking in nutrients so that they can grow and reproduce. When they are dormant, or asleep, they are not affected by antibiotics. They must be awake and, in a sense, ingesting the antibiotic in order to be killed. In any given infection or population of bacteria, a portion of the bacterial community are dormant. When a person stops taking antibiotics prematurely, they run the risk that any remaining dormant or sleeping bacteria will then awaken, feed, grow and reproduce. This is why antibiotics should never be stopped early just because a person is feeling...

Home Hospice Services

Our Physician Comes to You We offer rapid response for most hospice requests anywhere throughout the San Francisco Bay Area. Why Patients and Their Families Call Us Requests for our service are usually made when no established primary care physician is available for an immediate response home visit, and the patient has become physically ill and is potentially suffering. In most cases, patients have already made the decision for hospice care. In other cases, we are asked by family or friends to help them with this decision process. With a physician housecall, ample time is made available for thorough communication and decision-making by all those involved. If hospice is determined to be the best option, physician orders are written and a hospice service is then contacted immediately. In many cases, hospice home care providers may arrive same day to begin the process. What We Can Do For You Comfort Medications -24 hour delivery or pharmacy pickup Analgesics (pain relief) Antiemetics (nausea & vomiting relief) Anxiolytics (for anxiety & insomnia) Oxygen -24 hour delivery (for relief of shortness of breath) We can arrange in-home services including: Hospice visiting nurse services Caregiver/attendants (periodic or 24 hour) Skilled nursing care (periodic or 24 hour) Our Promise to You We are highly experienced with palliative and hospice care, and understand the challenges that are faced when making the decision for this option. We respect patient’s wishes to remain at home, maintain their dignity, and to prioritize comfort care first while forgoing life-sustaining...

Flu Shot? or Not

“Flu shots”, also known as influenza vaccines, only protect patients from influenza, nothing more. Flu shots, or influenza vaccines, are given annually just prior to the flu season, usually in mid to late Fall for those who reside in the northern hemisphere. Each year these vaccinations are reformulated to target the prevailing influenza virus types predicted to be epidemic for that season. Some influenza virus types cause more serious infection than others, so that severity of influenza illness may change from year to year. Some people are at greater risk of serious infection than others, such as those with underlying serious medical conditions, and those at the extremes of age. However, even susceptibility patterns may vary, as we saw recently the the H1N1 influenza virus. With H1N1, serious illness occurred more commonly in healthy young people, including teens and adults through age 49, pregnant individuals and infants. For the United States, vaccination recommendations are provided by the Center for Disease Control, or CDC. These guidelines are utilized by most physicians and other providers when caring for patients. Influenza vaccines are usually protective for influenza, however because each year the vaccine is reformulated based upon vaccine predictions, it occasionally fails to protect against certain virus strains. The vaccine is not a guarantee of protection. As of 01/11/2013 the vaccine has been reported by the CDC to cover 62% of influenza virus strains. The CDC also is reporting an exceptionally early start to the influenza season for 2012-2013. The circulating virus strains are unusually virulent, and have already caused widespread disease in several states. United States Center for Disease Control Summary...

“Flu” Confusion

There is much confusion surrounding the word “flu”. Many incorrectly use the word “flu” to refer to nonspecific viral winter time illnesses, including colds and stomach viruses. In medical jargon speak, “flu” means “influenza” and nothing else. A result of this confusion is that many people mistakenly believe that “flu shots” protect against more than just influenza, which is not the case. Common cold viruses are not the same as influenza viruses, although they share many of the same symptoms. Common colds usually consist of mild symptoms, including: congestion sore throat cough fever Influenza can cause these symptoms and more. Influenza more commonly causes: high fever intense intense body aches and pain (myalgias) runny nose and/or congestion rarely nausea and vomiting in addition to cough and sore throat. While most common colds are self limited, and usually do not progress to more serious infection, influenza can, in some cases lead to pneumonia and serious respiratory compromise, as well as severe dehydration and even death in a small, but significant, percentage of cases. Influenza is highly contagious. It is spread by respiratory droplets either by inhaling or through direct mucosal contact with droplets, for example hand to mouth. ***A person may become contagious 24-48 hours prior to becoming ill with symptoms, so that you can spread it to others well before you realize that you have the illness. A average of about 36,000 deaths nationwide each year are attributed to influenza, although this figure is debated. This number varies each season based upon the behavior of prevailing virus types. The worst season on record was the 1918 “Spanish Flu” epidemic...