XIMED IPA and Health Excel IPA plans now accepted

New for 2019. We are happy to report that our office is now accepting XIMED IPA and Health Excel IPA plans. These required referrals by your primary care physician which should be obtained prior to your office visit.

Medicare Advantage / Medi-Medi Contracts

  • Anthem Blue Cross: HMO Medicare Advantage Plan (MA) & Anthem Medi-Blue Plus plan (Health Excel only)
  • Brand New Day: HMO Medicare Advantage Plan (MA) & Medi-Medi
  • Humana: HMO Medicare Advantage Plan (MA) & Medi-Medi
  • Alignment Health Plan: Effective 01/01/2019 – HMO Medicare Advantage Plan (MA) & Medi-Medi

Medicare Advantage / Medi-Cal Contract

  • Care 1st/Blue Shield of CA: HMO Medicare Advantage Plan (MA), Cal MediConnect & Medi-Cal


Yoga as a complimentary health approach

Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve function. Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility.

In a 2011 study, also funded by NCCIH, researchers compared yoga with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The results showed that both yoga and stretching were more effective than a self-care book for improving function and reducing symptoms due to chronic low-back pain.
Conclusions from another 2011 study of 313 adults with chronic or recurring low-back pain suggested that 12 weekly yoga classes resulted in better function than usual medical care.

If You Are Considering Practicing Yoga
Do not use yoga to replace conventional medical care or to postpone seeing a health care provider about pain or any other medical condition.
If you have a medical condition, talk to your health care provider before starting yoga.

Everyone’s body is different, and yoga postures should be modified based on individual abilities. Carefully selecting an instructor who is experienced with and attentive to your needs is an important step toward helping you practice yoga safely.
Carefully think about the type of yoga you are interested in. For example, hot yoga (such as Bikram yoga) may involve standing and moving in humid environments with temperatures as high as 105°F. Because such settings may be physically stressful, people who practice hot yoga should take certain precautions. These include drinking water before, during, and after a hot yoga practice and wearing suitable clothing. People with conditions that may be affected by excessive heat, such as heart disease, lung disease, and a prior history of heatstroke may want to avoid this form of yoga. Women who are pregnant may want to check with their health care providers before starting hot yoga.

RA studies


Do you have rheumatoid arthritis and are interested in research trials?

CLICK HERE to learn more.



Prolotherapy (proliferative therapy), also known as sclerotherapy, ligament reconstruction therapy, and fibro-osseous injection therapy, is a recognized procedure that stimulates the body’s natural healing processes to strengthen joints weakened by traumatic or over-use injury. Joints when ligaments or tendon attachments are stretched , torn, or fragmented, become hypermobile and painful. Traditional approaches with surgery and anti-inflammatory drugs often fail to stabilized the joint and relieve this pain permanently.
Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new fibrous tissues, resulting in permanent stabilization of the joint.


PRP is a component of your blood (plasma) with concentrations of platelets above normal values.
PRP typically contains 3-8 times the concentration of normal platelet levels. After injury, platelets are on the front line of the healing response and play a critical role by releasing growth factors. These growth factors influence tissue repair in a variety of different cell types including tendon, muscle and cartilage cells.
PRP was first used in dental and oral surgery to improve soft tissue healing in the 1990s. Its usage in the treatment of musculoskeletal injuries and sports medicine has increased over the past decade.

With a precise injection of your own platelets directly on the site of the torn or stretched ligament or tendon, prolotherapy creates a mild, controlled injury that stimulates the body’s natural healing mechanisms to lay down new tissue on the weakened area. The mild inflammatory response that is created by the injection encourages growth of new ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area. Injection of varicose veins and other similar abnormalities creates a mild inflammatory response causing them to contract so that they become smaller or even vanish.

It is your own platelets but more concentrated.

PRP is prepared by centrifuging your whole blood sample. The centrifugation separates the platelet rich plasma from platelet poor plasma and red blood cells because of differences in specific gravity.

• In our practice, we follow the Harvest System protocol (Harvest Technologies)
-20 mL of whole blood is drawn to generate 3 mL of PRP for small applications, elbow, foot, ankle.
-60 mL of whole blood is drawn to generate 7-10 mL of PRP for the hip, buttock and shoulder.

Since PRP originates from a concentrate of your own blood, safety concerns are minimal.
As with any injection, sterile technique is performed to avoid infection

Any pain involving an injection will vary according to the structure to be treated, the choice of solution, and the skill of the physician administering the injection. The treatment may result in mild swelling and stiffness. The mild discomfort passes fairly rapidly and can be reduced with pain relievers such as Tylenol. Anti-inflammatory drugs, such as aspirin and ibuprofen, should not be used for pain relief because their action suppresses the desired inflammatory process produced by the injection.

Each patient must be evaluated thoroughly with patient history, physical exam, X-ray exam, and full laboratory work up before treatment will be administered. With this information, your physician can evaluate your potential success with this therapy. Success depends on factors which include the history of damage to the patient, the patient’s overall health and ability to heal, and any underlying nutritional deficiencies that would impede the healing process.

• Chronic tendinopathies
-Elbow (lateral and medial epicondyle, a.k.a. tennis and golfer’s elbow)
-Shoulder (tendinosis, partial thickness tears)
-Hip (gluteal, adductor, and proximal hamstring tendons, a.k.a. bursitis)
-Knee (patellar tendon, a.k.a. jumper’s knee)
-Foot/ankle (Achilles, peroneal, plantar fascia)
• Chronic pain from osteoarthritis
-Knee (often of value after treatment with steroids or viscosupplementation no longer helps)
-Shoulder (glenohumeral and acromioclavicular)
-Ankle and foot
• Muscle
-Subacute and chronic symptomatic intrasubstance muscle tears

The treatments should be administered every one, two, or three weeks, as determined by your treating physician.

The anticipated rate of success depends on a number of variables, including the patient’s history and ability to heal, and the type of solution used. In patients with low back pain with hypermobility, 85% to 95% of patienst treated experience remission of pain with this form of therapy. In comparison, the Journal of Bone and Joint Therapy reports on a 52% improvement in patients treated surgically for disc involvement. Varicose veins can usually be 90% to 100% eliminated. Spider veins can usually be improved 70% to 90%.

FDA approves new medicine for AS and PsA

Novartis announced on January 15 2016 that the US Food and Drug Administration (FDA) has approved Cosentyx® (secukinumab) for the treatment of two new indications – adults with active ankylosing spondylitis (AS) and active psoriatic arthritis (PsA). AS and PsA are both life-long, painful and debilitating inflammatory diseases that affect the joints and/or spine. If not treated effectively, both conditions can lead to irreversible joint and/or spinal bone damage caused by years of inflammation.

Cosentyx is the first in a new class of medicines called interleukin-17A (IL-17A) inhibitors to treat both AS and PsA. The two new indications follow the earlier FDA approval for Cosentyx in January 2015 to treat adult patients with moderate-to-severe plaque psoriasis, and European approval for AS and PsA in November 2015.

More than 9,600 patients have been treated with Cosentyx in clinical trials across multiple indications, and over 15,000 patients with psoriasis have already been treated in the post-marketing setting. The safety profile of Cosentyx was shown to be consistent with that seen in clinical trials across multiple indications.

Six food choices to help ease arthritis pain

Foods to trybroccoli
Remember, there’s no magic food. But growing evidence suggests that following a healthy diet and adding in specific foods and spices could help fight inflammation and joint pain. Here are six food choices that may be helpful:

1. Broccoli, Brussel sprouts and cabbage. These veggies are part of the cruciferous family, and they are chock full of a compound called sulforaphane, which helps slow broccolidown cartilage damage in joints due to OA, according to a 2013 study involving mice. Admittedly, it’s an early study. But veggies are always a healthy choice.
Try adding broccoli, Brussel sprouts or cabbage to your salad or stir-fry. Other foods rich in sulforaphane include kale and cauliflower.
2. Fatty fish. Fatty fish like salmon, tuna, trout, and mackerel are rich in omega-3 fatty acids, which help fight inflammation and boost heart health. Try adding fish to your diet a couple of times a week. If you’re not a big fan of fish, ask your doctor whether it’s worth taking an omega-3 supplement. Studies have found that omega-3 supplements reduce inflammation in rheumatoid arthritis (RA), but whether they help people with OA isn’t clear.
3. Garlic. Garlic is a member of the allium family—which also includes onions, and leeks. These items contain a compound called diallyl disulfide that may help with a number of diseases—including arthritis. “This compound may have some effect in limiting cartilage-damaging enzymes,” says rheumatologist Scott Zashin, MD, a volunteer clinical professor at the University of Texas Southwestern Medical School in Dallas, and author of Natural Arthritis Treatment. One study noted that people who regularly ate garlic and its relatives had less evidence of hip OA on x-ray images.
4. Tart cherries. Some people with osteoarthritis have found relief from products made from tart cherries. The ingredient in cherries cherriesthat helps with OA symptoms is the same one that gives this fruit its red color—anthocyanin. A 2013 study of tart cherry juice found that the drink improved symptoms of OA, although not much more than a nontherapeutic drink (placebo). Dr. Zashin conducted two small studiecherriess using a gel made from tart cherries called CherryFlex. One of the studies showed that patients with OA who used this cherry concoction had significant symptom relief. “We found that some patients can actually go off their anti-inflammatory drugs,” he said. However, he cautions that larger trials are needed to confirm that it is the cherries that make a difference in OA pain—and not a placebo effect. Never stop taking your medicines without first talking to your doctor.
5. Turmeric. One of the best-researched inflammation fighters isn’t a food at all, but a spice. Turmeric contains a compound called curcumin. A 2012 review published in the International Journal of Molecular Sciences said that “curcumin could be beneficial in the management of chronic inflammatory-related joint disease, including OA” but authors warned that there is a considerable lack of data regarding side effects and safety. The compound has, however, been used for centuries in India to ward off inflammatory diseases. You’ll find this yellow spice in Indian cuisines—particularly curries—or you can add it to your own dishes.
6. Vitamin C. Antioxidants in vitamin C may slow the progression of OA, research finds. A 2011 study from the University of South Florida reported that people who took vitamin C supplements were 11 percent less likely to develop knee OA than those who didn’t take the supplements. You can safely get vitamin C from fruits like strawberries, kiwi, pineapple, or cantaloupe. However, do not take supplements with much higher doses than the recommended daily allowance of 65 to 85 micrograms, because in large doses vitamin C can increase the risk of kidney stones.


Foods to avoid
Some people find that certain foods aggravate their OA. For example, people have reported that eating foods in the nightshade family – such as eggplant, tomatoes, potatoes and most peppers – increases their pain, although studies haven’t confirmed this.
When it comes to your diet, eat what works for you. I have some patients who find that when they got off gluten and dairies their joints feel better. If you think a particular food is aggravating your OA, try eliminating it from your diet and see how you feel.
Foods high in saturated and trans fats – such as red meat, fried food and packaged baked goods — should be avoided. They are unhealthy in general, and can lead to weight gain, which can make OA symptoms worse.
And if you tend to wash down your meal with a sugary soda – don’t. A 2013 study revealed that OA of the knee tended to get worse in men who drank a lot of sodas.

FDA approves new medication for osteoarthritis pain

FDA approval of Zorvolex was based on a double-blind placebo-controlled study which enrolled patients ≥ 40 years of age with clinically and radiographically confirmed (Kellgren-Lawrence grade II-III) hip or knee OA. Eligible patients were chronic NSAID and/or acetaminophen (APAP) users with baseline Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) pain subscale score ≥ 40 mm by visual analog scale and an osteoarthritis flare (≥ 15 mm increase in WOMAC pain subscale score following discontinuation of NSAID/APAP at screening).
Zorvolex 35 mg three times a day significantly improved WOMAC pain subscale scores from baseline at 12 weeks compared with placebo. Zorvolex 35 mg bid provided numerical improvement in pain at week 12 compared with placebo. Zorvolexc 35 mg three times a day and 35 mg twice a day improved the average total WOMAC score in treated patients over 12 weeks compared with placebo. The most frequent side effects Zorvolex-treated groups were diarrhea, headache, nausea, and constipation. The inclusion of patients with a documented requirement for analgesic therapy (osteoarthritis ‘flare’) at baseline and the high rates of rescue medication usage in the placebo group may have impacted the study outcome for the Zorvolex treatment groups.

FDA approves Otezla for psoriatic arthritis

The U.S. Food and Drug Administration approved Otezla (apremilast) to treat adults with active psoriatic arthritis (PsA) in March 2014.
PsA is a form of arthritis that affects some people with psoriasis. Most people develop psoriasis first and are later diagnosed with PsA. Joint pain, stiffness and swelling are the main signs and symptoms of PsA. Currently approved treatments for PsA include corticosteroids, tumor necrosis factor (TNF) blockers, and an interleukin-12/interleukin-23 inhibitor.
“Relief of pain and inflammation and improving physical function are important treatment goals for patients with active psoriatic arthritis,” said Curtis Rosebraugh, M.D., M.P.H., director of the Office of Drug Evaluation II in the FDA’s Center for Drug Evaluation and Research. “Otezla provides a new treatment option for patients suffering from this disease.”
The safety and effectiveness of Otezla, an inhibitor of phosphodieasterase-4 (PDE-4), were evaluated in three clinical trials involving 1,493 patients with active PsA. Patients treated with Otezla showed improvement in signs and symptoms of PsA, including tender and swollen joints and physical function, compared to placebo.
Patients treated with Otezla should have their weight monitored regularly by a healthcare professional. If unexplained or clinically significant weight loss occurs, the weight loss should be evaluated and discontinuation of treatment should be considered. Treatment with Otezla was also associated with an increase in reports of depression compared to placebo.
The FDA is requiring a pregnancy exposure registry as a post-marketing requirement to assess the risks to pregnant women related to Otezla exposure.
In clinical trials, the most common side effects observed in patients treated with Otezla were diarrhea, nausea, and headache.

NEWS (Sept 23rd 2014): Oral OTEZLA® (apremilast) Approved by the U.S. Food and Drug Administration for the Treatment of Patients with Moderate to Severe Plaque Psoriasis

Immunossuppressive therapy during pregnancy maybe safe to fetus

Women with chronic autoimmune diseases who take immunosuppressive medications during their first trimester of pregnancy are not putting their babies at significantly increased risk of adverse outcomes, according to a Vanderbilt study released online by the journal Arthritis and Rheumatism. The paper is one of the first to describe risks for medications used to treat autoimmune diseases when taken during pregnancy, according to first author William Cooper, M.D., MPH, Cornelius Vanderbilt Professor of Pediatrics and professor of Health Policy at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn. Women with rheumatoid and psoriatic arthritis, ankylosing spondylitis, lupus, scleroderma, and inflammatory bowel disease who filled prescriptions for immunosuppressive treatments during pregnancy were included in the study. The drugs studied included hydroxychloroquine, tumor necrosis factor (TNF) inhibitors and other immunosuppressives such as sulfasalazine and azathioprine. When compared with the women who had medication treatment before, but not during, pregnancy the risk ratios for adverse fetal outcomes associated with immunosuppressive use during pregnancy were not statistically significant, the authors reported.

Recommendations on calcium intake

In an assessment of the scientific literature, reported as a perspective piece today in the New England Journal of Medicine, a UC San Francisco researcher says patients and health care practitioners should focus on getting calcium from the diet, rather than supplements, when possible. “Osteoporosis may result from inadequate calcium intake and it’s quite common for certain segments of our population, such as the elderly, to consume less than the recommend amount,” said Douglas C. Bauer, MD, UCSF professor of Medicine, Epidemiology and Biostatistics. “But a high calcium diet should be the preferred method to receive adequate amounts of the nutrient. The Institute of Medicine’s recommended dosage for post–menopausal women over the age of 50 and men over 70 is 1,200 mg per day. “If it is not possible to consume enough calcium from the diet, the use of calcium supplements is most likely safe and not associated with cardiovascular outcomes,” he said.

This article reviews recommendations regarding calcium intake and uncertainty about benefits as well as potential risks of calcium supplementation. In particular, some studies have suggested an increased cardiovascular risk, but findings have been inconsistent.