In the clinic

We are accepting new patients 18 years of age and older.

Please call the office to schedule an appointment.  

We require everyone in the office to properly wear a face mask (covering nose and mouth) at all times.

Please do not come into the office if you are infectious or probably infectious, especially with COVID or monkeypox.

If you are ill, please let us know at the time you schedule your appointment. We have a separate protocol to see you if you are sick.

We are also conducting televisits. Please sign and return these forms: About Telemedicine. Consent for telemedicine.

Updated August 13, 2022:

COVID

COVID vaccines are recommended for individuals >5 years old to prevent severe disease and death. Keep in mind that vaccination has decreased efficacy against variants compared with the original strain, and the current circulating variants result in a much higher viral load than the original strain.  Therefore, you can still contract COVID after vaccination.  Rapid antigen tests can currently be obtained free-of-charge and are highly recommended for determining COVID positivity.  We are seeing false negatives early in disease course, so waiting a day or two and retesting is recommended.  Most vaccinated COVID cases appear to be mild cases, however, rarely, you may still develop severe disease and should still seek care with your doctor.  You are also contagious and may spread this to someone who can have severe or fatal consequences from COVID.  This virus does not care about your species, age, gender, beliefs, health, prior infection or prior vaccination status. With each infection, this virus is mutating and outpacing the gains we have made in our diagnostics, treatments, and vaccination efforts.  Therefore, please continue to mask (n95/kn95 or equivalent) and distance.  It is critical that everyone does his/her part at this time. 

Monkeypox

  • Monkeypox has been declared a public health emergency by WHO (July 23, 2022) and by the U.S.'s HHS (August 4, 2022). 

  • As of August 10-12, the US has 11,177 confirmed cases. California has 1,945 cases. LAC has 797 cases. Pasadena has 8 cases.

  • This monkeypox virus is being transmitted from human-to-humans, and primarily by close skin-to-skin contact, body fluids, respiratory droplets (uncommon) and contaminated materials such as bedding. There is a risk of pre-symptomatic or asymptomatic spread.

  • Monkeypox is usually a self-limited disease with symptoms lasting as long as a month.

  • Patients can be asymptomatic or have the following typical symptoms:

    • Rash (can be widespread or single lesion, can be in the mouth, genital, or peri-anal or any location on skin)

      • The rash will go through several stages, including scabs, before healing.

      • The rash can initially look like pimples, blisters, shingles, syphilis and may be painful or itchy.

    • Fever/chills

    • Swollen lymph nodes

    • Fatigue

    • Muscle aches and back ache

    • Headache

    • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

    • Severe proctitis (rectal pain) - new features with this 

    • Severe urethritis (pain with urinating)

    • Urinary retention

    • Severe pain

    • Encephalitis

  • Severe cases requiring hospitalization occur in about 9% of cases.  Death is rare but can occur (cases reported in non-African countries).

  • Risk for severe disease are in the following populations:

    • People with immunocompromising conditions (e.g., HIV/AIDS, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)

    • Pediatric populations, particularly patients younger than 8 years of age. There have been at least 80 pediatric cases reported.

    • Pregnant or breastfeeding women

    • People with a history or presence of atopic dermatitis, people with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis])

    • People with one or more complication (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)

  • Treatment via vaccines (JYNNEOS) or antivirals (TPoxx) are limited in availability. These are therefore limited to those with severe disease or at high-risk.

Other infectious disease of concern

  • Polio has been detected in NYC.

Things everyone should do

  • Wear a mask. This is the #1 most effective way to prevent transmission. 

    • n95 grade or better is recommended.

    • Do not touch the outside of your mask. It is considered contaminated. There are many videos on proper mask wearing.

    • With mask wearing, most people forget to hydrate. Please remember to drink adequate amounts of fluids

  • Social distance.

  • Stay in well-ventilated environments. Invest in a HEPA air filter, which can help filter viral (and bacterial) particles.

  • Clean your hands and environment.

    • Wash your hands with soap and water for at least 20 seconds. Hand sanitizer is ok to use if your hands are not soiled. Hand sanitizer should have >60% alcohol content to be effective.

    • Avoid touching your eyes, nose or mouth with unclean hands.

    • Disinfect frequently touched surfaces (ie. doorknobs, computer keyboard, phone).

    • Put the lid on the toilet before you flush to prevent aerosolization of toilet bowl contents.

  • Avoid close contact with people who are sick.  

  • Get plenty of rest.

  • Do not do anything risky. This is the time to focus on taking care of yourself. Please do not ignore any health concerns. Please call the office as you would normally for any problems that may arise.

  • Get a pulse oximeter for your home.