CHRONIC DISEASE MANAGEMENT
We use the latest guidelines to reduce blood pressure further than in previous guidelines in those patients with an ASCVD risk over 10%, diabetes or heart failure, because you have a 25% less chance of dying of heart attack with a blood pressure under 120/80 than 140/90. We use the latest advance in blood pressure management: unattended office blood pressure, which correlates very well with ambulatory and home blood pressures and with future heart attack, without the patient inconvenience of those other methods. In patients with difficult to control or early onset high blood pressure we seek secondary causes such as sleep apnea, hyperaldosteronism and renal artery stenosis.
We treat cholesterol to the latest more strict guidelines depending on other heart attack risk factors and history, using multiple classes of medications including statins, ezetimibe, bempedoic acid, PCSK-9 and others as needed.
We use the latest significantly improved test for insulin resistance which detects a tendency towards diabetes when the A1c and fasting blood sugars are still normal. You can start weight loss and reducing dietary sugars earlier to avoid or delay diabetes.
We treat diabetes with the several most recommended medications, including GLP-1's and SGLT2's which have significant benefits on other health conditions.
We routinely check for the earliest evidence of kidney disease, microalbuminuria, which raises the chance of heart attack by at least 40%, the risk of dying from heart disease by 55% and the risk of death from all causes by 65%. We treat microalbuminuria with different classes of medications as appropriate.
We detect liver fibrosis, the first new major independent risk factor for heart disease, using the recommended blood test screening followed by the definitive Fibroscan liver ultrasound to diagnose and monitor liver steatosis (fat) that leads to fibrosis and the fibrosis, as we address the causes and use specific medication treatments as necessary. We are one of the first primary care offices in the Bay Area to provide Fibroscan testing in our office.
We test for poor T4 to T3 thyroid hormone conversion which can cause fatigue despite a normal TSH and free T4 level, and we treat very symptomatic very low free T3 while monitoring closely to avoid abnormal weight loss.
We treat magnesium deficiency syndrome which usually includes migraine headaches.
We refer to specialists for any HIV-related preventive medication or chronic treatment.
