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June 01, 2020

QUESTION: To mask or not to mask?

To mask, or not to mask- that is the question. If you’re feeling confused about whether you should wear a mask, when and what kind, you’re not alone.  Like many things having to do with COVID-19, the recommendations have changed since the start of the pandemic, and now- believe it or not- wearing a mask has become politicized!   Let’s leave politics out of this discussion and stick to what we know from science.

Part of the confusion has come from conflating the two very different purposes for wearing a mask:  to protect the wearer from getting infected by others and to protect others from getting infected by the wearer.  Protecting the wearer is more difficult:  it requires personal protective equipment (PPE) including medical a grade respirator, such as an N-95 mask that has been tested for a leak-proof fit to the face of the wearer, meticulous putting on and taking off of the mask, eye protection, gloves and a gown.  Protecting others by blocking outward transmission, called source control, is much easier and can be achieved with cloth masks.

What is source control? Suppose you find a dandelion in your garden with an intact seed head, ready to be scattered by the next gust of wind. You want to prevent those seeds from landing in your garden and making new dandelions.  One way is to put a net over your garden to keep the seeds out. It would have to be very fine mesh, tight to the ground on all edges, but not so tight as to break your plants. Alternatively, you could try to catch each of the little seed parachutes one by one after the gust.  Or, you could put a small paper bag over the seed head- source control- and prevent the dispersal in the first place. 

We know that the COVID-19 is caused by the SARS-CoV2 corona virus. It hijacks the infected person’s cells to replicate, then bursts out of the cells into body fluid in the lungs, nose and mouth.  You may have seen the green laser images showing how far the tiny droplets released by coughing or sneezing can travel. Studies have shown they are produced not only by coughing or sneezing, but also by normal speech, which can create thousands of droplets per second. Other studies have shown each droplet can contain hundreds of thousands of viruses and that the droplets linger in the air for 8-15 minutes. We know the virus is transmitted primarily through these droplets in the air, and to a much lesser extent, by touching surfaces where they have landed.

Research has shown that people can transmit the infection before developing any symptoms and that a significant percentage of infected people - somewhere between 20% and 40%- never have symptoms at all. The result is that nearly half of the cases are transmitted by people unaware they have the infection.

 There is currently no effective treatment or vaccine for COVID-19.  It seems unlikely there will be a vaccine for many more months that has been proven to be both safe and effective. With over 100,000 Americans killed by COVID-19 in just 2 months- April and May 2020- the only way we have to combat COVID-19 is to control the spread of the virus. 

Source control through wearing face coverings in public is a key part.  The more people that wear masks the more effective they are.  In Asia, where face covering is commonplace and not controversial, masks are not just protective barriers, they are symbols. They affirm the wearer’s civic-mindedness and conscientiousness and signify the wearer takes the pandemic seriously. Cases and death per capita are a fraction of ours in places where mask wearing is common, such as Hong Kong, South Korea, Taiwan, and the Czech Republic.

We are not any of those countries. We have a different culture here, one of rugged individualism, self-reliance, and independent thinking.  Making public sacrifices for the common good is not always an American priority, especially when it seems like our personal liberties are at risk.  We tend to bristle at the thought of anyone requiring us to wear a mask. At the same time, we have laws and regulations to protect us from harming each other. Think of seat belts, motorcycle helmets, and stop signs. We aren’t allowed to poison the air or water, even on our own property, because of the effect on our fellow citizens.

What kind of mask?  Cloth masks, preferably made of multiple layers of a finely woven material, work well for source control.  Leave the N-95’s masks, which are still in short supply, for first responders and health care personnel who working closely with patients.  Avoid masks with exhalation valves because they do not filter the air going out and thus permit droplet release, putting others at risk.   Always remove your mask by the ear loops or elastic strap- not the part that covers your face.

Can businesses require customers to wear masks?  Yes- just as they can require them to wear a shirt or shoes. Do I need to wear one outside?  If you are more than 6 feet from any household member, probably not. Are there downsides to wearing a mask? Yes- they can be hot and uncomfortable and make your glasses steam up.  Some fear they give a false sense of security, leading people to go out more often or relax other measures. Masks work best when combined with social distancing, frequent hand washing, and testing and contract tracing.

The bottom line is masks are recommended or required because COVID-19 is highly contagious, there is asymptomatic or pre-symptomatic transmission, and there is empiric evidence from places where mask use is common that it works.   So, even if you think you don’t need to wear one because you’re never going to get COVID, please put one on in public.  It’s not to protect you, it’s to help prevent spread of the disease.  Do it for others.  It’s a way to say I care. 

Stay in place, keep your space, and cover your face.

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May 01, 2020

Question: Should I get tested for COVID-19?

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We constantly hear that widespread testing is one of the prerequisites to getting our state and country opened up, yet it wasn’t that long ago that most people who thought they might have COVID-19 were told to self-quarantine and not get tested.  Only those with the greatest need were eligible because testing for the disease got off to a very rocky, slow start in this country.  The initial test kits recalled, by the CDC, and there have been shortages of supplies essential to performing the tests.  There are still many areas where testing is not widely available, but fortunately, that is not the case in Nevada County.

There are two kinds of tests for COVID-19:  those that detect the virus and those that look for antibodies. The viral tests, called PCR tests, use a specimen from the nose, throat or lungs and detect infection. The antibody tests use serum and show whether a person has been exposed to the virus at some time in the past.  Antibodies are what our bodies create to give us immunity to infections, but they take about 2 weeks to appear, so a negative antibody test does not rule out current infection. The serology tests available today, none of which has been fully vetted, can tell us if we have had the infection, but not if we have enough or the right kind of antibodies to make us immune to a second round. Antibody tests are useful for epidemiology and predictive models.

The good news is both viral and antibody testing are available at Yubadocs Urgent Care and other facilities in the community, with more capacity expected in the near future. So, if you think you may have COVID-19, please get tested.

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April 01, 2020

QUESTION: What should I do if I have an urgent medical problem or minor injury during the COVID-19 shelter-in-place order?

A:  At Yubadocs we know that other medical problems and injuries are not put on hold just because of COVID-19.   We know you may need to be seen and are doing everything we can to keep you safe during your visit.

  • Telemedicine visits are an option for some problems. Book through our website

  • We are asking patients to call ahead if they have a fever, cough or shortness of breath.  If they do, we check them in from their vehicle and bring them in through a separate entrance.

  • Any patient is welcome to do the entire check-in process from their vehicle and stay there until a room is available.

  • In accordance with CDC and California guidelines, we have every patient and visitor in our clinic wear a mask and are enforcing social distancing. 

  • Our staff is wearing the proper PPE (personal protective equipment), including masks & gloves and, when appropriate, face shields and gowns.  This helps keep them and you healthy and infection-free.

  • Throughout the day we are diligently sanitizing every surface touched by human hands.

  • Before starting the workday, we take each staff member’s temperature and screen for respiratory symptoms.  Anyone with a fever or symptoms is tested for COVID-19 and sent home for self-quarantine per CDC guidelines


Yubadocs is keeping our usual hours during the pandemic:  8-6 Monday through Friday and 9-4 Saturday and Sunday.


Here are things you can do to keep yourself safe:

  • Stay at home except for medical reasons or grocery shopping

  • If you do go out, wear a cloth face mask in public

  • Practice social distancing:  stay at last 6 feet away from other people

  • Wash your hands frequently

  • Avoid touching your face with unwashed hands

  • Cover coughs and sneezes

March 01, 2020

The New Coronavirus (COVID-19)

Unless you have been meditating in a cave or made a decision to avoid the news over the past couple of months, you have no doubt heard about the new coronavirus that is rapidly spreading across the world.  The disease it causes has been named COVID-19, short for Coronavirus Disease 2019. Coronaviruses are a family of viruses named for the spikes that protrude from the surfaces of the actual virus, as seen under an electron microscope. In humans, coronavirus illnesses cover a wide spectrum, ranging from the common cold to the headline-grabbing SARS (Severe Acute Respiratory Syndrome) epidemic in 2003 and MERS (Middle Eastern Respiratory Syndrome) outbreak in 2015. COVID-19 is an illness ranging from mild, cold-like symptoms to very serious lung infections that can lead to death, especially in vulnerable populations such as the elderly and those with other medical problems.

While humans have lived with various types of corona virus for years, the specific one that causes COVID-19 is new to humans.  What makes the COVID-19 newsworthy is its mortality rate and how quickly it spreads.

 The World Health Organization reports there are now almost 90,000 confirmed cases globally with the vast majority- about 80,000- in China. Of those Chinese cases, 2,900 died. This 3.6% mortality rate is extremely high – about 36 times that of the common flu – but I think it will to drop after we better study the disease.  The basic reason: quite probably many people who have COVID-19 aren’t diagnosed.

This lack of diagnosis happens for a couple reasons.  First, some people have mild symptoms that mimic a cold, or no symptoms at all, so they don’t get tested.  Second, until very recently, testing could only be done through the The Centers for Disease Control and Prevention in Atlanta (C.D.C.), and the criteria were very restrictive, so likely many who had the infection weren’t tested. 

The disease has mushroomed to more than 67 countries with significant numbers of cases in South Korea, Italy, Iran and Japan. Because of this, there are screening procedures and travel restrictions in many countries around the world. The C.D.C. is advising against all non-essential travel to China, South Korea, Italy and Iran, and has warned older and at-risk travelers to avoid Japan.

Symptoms of COVID-19 include fever, a cough and in the more serious cases, shortness of breath.  If you have a fever and/or respiratory symptoms and have been in one of the 5 high-incidence countries in the past few weeks, or if you have been in close contact with someone who has or who might who have COVID-19, you should contact an urgent care clinic or your primary care physician and arrange to be evaluated.

But please don’t just show up at the clinic or your doctor’s office- call first so you can be evaluated without exposing others.  The clinic or your PCP can then prepare for your arrival, and will contact the Nevada County Public Health Department, which will arrange for the appropriate testing and public health measures. 

COVID-19 is getting worldwide attention and is making headlines daily.  But the reality is that while it constantly in the news, currently it is nowhere near as great a risk to your health as influenza- the common flu.  The number of cases of COVID-19 is increasing daily, but as of this writing, there were 88 cases and 6 deaths in the US. To put this in perspective, the C.D.C. estimates  there have been 14,000 deaths from influenza so far this season, with over 250,000 people hospitalized more than 25 million infected.  And this has been a relatively mild flu season- there were 62,000 deaths in 2017-18.

The initial symptoms for COVID-19 and influenza are similar.  But there are some significant differences between the two infections.  Unlike influenza, little is known about COVID-19, there is no vaccine to prevent it and no anti-viral medication proven effective against it.  Research is just starting on COVID-19, but it appears that people can pass the virus before they have any symptoms, and that some people have the infection and never develop any symptoms. 

Officials think the virus may have been spreading undetected in the Seattle suburbs for the past 6 weeks while the federal government resisted calls for more widespread testing.  This led to a reported delay in diagnosis of the first community acquired case in the US, a woman from Solano County who was hospitalized at UC Davis.  In addition, test kits have been in short supply as the  first test kits sent to state public health departments were defective.  There is now a limited supply of tests in California available through the California Department of Public Health, with that supply expected to ramp up soon.

The chance of becoming infected with COVID-19 if you are not travelling outside the country is still low.  That being said, there are steps to take to reduce your risk.  As with most respiratory infections, wash your hands frequently with warm water and soap, scrubbing for 20 seconds, then rinsing.  Avoid close contact with people who are sick and stay home if you are feeling ill. Cover your mouth when coughing and disinfect surfaces in your home and office.  These same steps will reduce your chances of getting the common flu.  And there is a vaccine to help prevent influenza, so if you haven’t had one yet this season, please get one!

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October 01, 2019

Question: Why has vaping been in the news so much lately?

A deadly new illness related to e-cigarettes, or vaping, has been spreading across America– one so serious it has prompted the Centers for Disease Control, the nation’s leading health agency, to issue a Clinicians Alert and activate its Emergency Operations Center. The outbreak began in June 2019, and since then, there have been more than 500 hundred cases of the mysterious lung illness and at least eight deaths, including two in California.

Electronic cigarettes, also called e-cigarettes, vape pens, or pod mods, originated in China and were introduced in the US in 2006.  The devices have a cartridge that holds a liquid containing nicotine or THC dissolved in a solvent or oil, and an atomizer that heats the liquid to create a steam-like vapor that is inhaled.  Many contain one or more of the thousands of available flavorings. E-cigarettes aim to provide a sensation similar to smoking, but because they do not reach combustion temperature, no smoke is created, and the user is not exposed to the tars and other toxins created when tobacco is burned.  Called vaping to distinguish it from smoking a conventional cigarette, it has been promoted as posing fewer health risks than smoking and as an aid to help quit cigarettes.   

It hasn’t exactly worked out that way.  It may be true that in the long run, vaping nicotine is less harmful than smoking cigarettes.  But nicotine is addictive and most adult smokers who vape never quit cigarettes.  More concerning is the fact that vaping rates have skyrocketed in recent years, especially among youth. E-cigarettes are now the most frequently used tobacco product among teenagers, far surpassing traditional cigarettes.   Approximately 12% of middle and high school students were e-cigarette users in 2017, meaning they said they had vaped within the past 30 days. By 2018, usage shot up to about 21% of high school students and 5% of middle school students. The vast majority had never smoked tobacco, but they were much more likely to start than those who had never vaped. Sleek devices with flavored cartridges are marketed to adolescents. JUUL, a popular vape device that comes in fun flavors, looks like a flash drive and can be charged in a USB port, is especially concerning because it delivers high levels of nicotine, making it extremely addictive.


The most frequent symptoms of the new illness are cough, shortness of breath, and fatigue; other symptoms included fever, chest pain, weight loss, nausea, and diarrhea. Patients show up at urgent care facilities and emergency rooms with flu-like symptoms and trouble breathing after suffering for several days to a week.  At first, the illness looks like a serious viral or bacterial pneumonia, but tests show no infection.  Conventional treatment for pneumonia is not effective, and patients are more likely to need to be in an ICU and require a ventilator. Treatment has been complicated by patients’ lack of knowledge — and sometimes outright denial — about the actual substances they might have inhaled.

Experts agree this illness is a completely new phenomenon and not something that has been around for years but is just now being recognized. It often strikes otherwise healthy teenagers and young adults. 

The exact cause is not yet understood, but the cases have in common the use of e-cigarettes.  Some of the patients vaped nicotine, some used a cannabis-based product, and some a combination.  Researchers are suspicious that new toxins are formed when the various chemicals in the cartridges are heated.  Vitamin E oil is a substance commonly found in cartridges and is associated with the severe and sudden respiratory problems in some of the cases.  Meanwhile, lobbyists and trade association officials are scrambling to blame unregulated products.


Although there is still much more to learn about this illness, the link to vaping is indisputable.  The prudent approach is to stop vaping, at least until the cause is understood.  No responsible physician would recommend a return to smoking, and there are several safe alternatives to help quit altogether.  Nicotine patches and gum and effective anti-smoking programs can easily be prescribed by your doctor or at your local urgent care facility.  Kicking the habit is the best thing you can do for your health.  

September 01, 2019

QUESTION: I am suffering from back pain. Why and what do you suggest I do?

If you suffer from back pain, you are not alone!  Low back pain is one of the most common reasons Americans visit their health care provider, a fact that I see played out every day at Yubadocs Urgent Care clinic. Almost 9 of 10 adults have back pain at some point in their lives, and it can be scary.  The good news is the pain usually goes away on its own, most people recover in a week or two, and there are many things you can do to prevent low back problems.

There are many possible causes of low back pain, but strained back muscles, tendons and/or ligaments is the cause more than 85% of the time. This often is caused by doing too much for too long without enough conditioning or stretching.  It can also happen because of improper lifting. To avoid injury, be sure to lift with your legs, not your back, and get help if what you need to lift is heavy.  Avoid carrying heavy bags including backpacks and purses unless they are centered properly along the spine.

There are several lifestyle factors that increase your risk of having back problems. Smoking is one.  Research shows smoking can slow down circulation and reduce the flow of nutrients to joints and muscles, including in your back.  Being overweight is another.  Suppose you are 30 pounds over your ideal weight.  Now imagine that 30 pounds is a backpack.  Think of what carrying around a 30-pound pack 24 hours a day would do to your back.  Excess weight in the stomach is worse because it pulls the pelvis and lumbar spine forward, straining the lower back.  Not smoking and dropping extra pounds and are important for overall health, including your back. 

Although most low back pain goes away on its own, professional help is sometimes needed.  There are red flag warnings for when a doctor visit is needed.  You should be seen if you recently had a fall or injury to your back, if you have numbness or weakness in your leg or foot, or pain or numbness in your buttocks or genitals. Other reasons include unexplained weight loss, a fever or feeling sick in other ways, or if you have cancer, osteoporosis or a weakened immune system. See a doctor urgently or go to the emergency department if you lose control of your bladder or bowels.

A visit to an urgent care facility or to your regular doctor is in order for pain that gets worse, instead of better over time.  A good medical history and physical exam are usually all that is needed to evaluate back pain present for less than a month. Less than 1% of people seen in in their doctor’s office or an urgent care center for low back pain need immediate advanced imaging (CT or MRI). Unless one of the red flag warnings outline above is present, results from these tests do not change initial treatment and may complicate things by revealing what are called “incidental findings”- anatomic variations not necessarily causing pain that are found in people with no symptoms thaty can lead to further unnecessary tests or treatment.

What can you do for low back pain? First, maintain your normal level of activity as much as possible. Bedrest used to be the standard advice, but studies have shown that it not only doesn’t help, but it can delay recovery.  So, stay active!

Put heat on your back for 20 minutes every 2-3 hours and follow it with gentle stretching.  Cold packs on the same schedule relieve pain for some, so use them if you find they help. 

Sleeping on a comfortable mattress can be a game changer when it comes to back pain.  If you sleep on your side, draw your knees up slightly and put a pillow between them.  If you sleep on your back, putting a pillow under your knees will help maintain the normal curve of your lower back and take some strain off your spine.

Exercise is often recommended for low back pain because it reduces pain, and helps maintain or restore flexibility, strength and endurance. It doesn’t seem to make much difference in preventing or curing short episodes of low back pain, but many studies have shown that it helps when pain has been present more than a month. It also helps prevent chronic back pain, which is back pain present continuously for more than 3 months.

What kind of exercise? Examples of exercise programs that are known to be beneficial include walking, aerobic exercise, swimming, stretching, Pilates or other core strengthening, and exercises with a mind-body component like yoga or Tai Chi. As with any movement-based activity, injuries and other adverse events occur with exercise.  So, consult with your health care professional, and choose exercises you enjoy.

Fortunately, most all people’s low back pain will be gone within a few weeks.  If it lasts longer, it is time for a visit to you doctor or your local urgent care center.

August 01, 2019

Question: How can I stay safe and still enjoy the river?

Nothing says summer in Nevada County quite like a day at the river. As the founding president of SYRCL, and a board member for more than 30 years, the Yuba is dear to my heart. It’s the best place I know of to recharge one’s spirit and cool off on a hot day. 


But a river can also be dangerous, especially this year. Snow pack in the Sierra is far above normal because of our very long and wet winter. This means runoff from snow melt will make our Sierra rivers higher than normal for quite some time this spring and summer.


While it may appear calm, the current under the surface can be quite strong, especially early in the season. Every year there are drownings and near-drownings on the Yuba. Some are related to alcohol: people with judgement or coordination impaired by alcohol jump or fall in. Others occur when people are so anxious to get back in the river after a long winter and are simply caught unaware by the fast-moving water and swept away.


If you see someone in distress and can help without endangering your own life get that person out of the water as quickly as possible and CALL FOR ASSISTANCE. If the victim is unresponsive, open the airway and give two rescue breaths by mouth to mouth that make the chest rise. If the person remains unresponsive, begin CPR. (Do you know CPR?)


Whether you drive to a picnic spot near Bridgeport or hike the back trails along Edwards Crossing, there are a few other things to keep in mind to make sure you have a safe and enjoyable time. 


First, be sure to stay hydrated. Our bodies are about 60% water, and water is key to optimal functioning and peak performance. The first symptoms of dehydration can be vague – a headache or feeling tired, lightheaded, or cranky – rather than the classic dry mouth and thirst. But if you experience any of these symptoms while playing outside, take a few minutes and have some water, an electrolyte drink or some other beverage. 


Each year, winter water moves rocks and changes the depth of pools. Be sure you know how deep the water is at your favorite spot this year before jumping in. Diving into the Yuba is dangerous due to the possibility of hitting your head on the bottom and ending up with a head injury or a broken neck.


A common river injury is cut feet from broken glass. Please don’t take glass to the river! If you see any glass left behind and can safely remove it, please do. You could be saving someone a trip to urgent care for stitches. 


Wear sturdy shoes. Slippery rocks and unstable ground can mean scrapes, cuts, sprains, pulled or strained muscles, or broken bones. Consider taking a walking stick for stability, slow down when the terrain is uneven, and watch out for exposed roots and jutting rocks. 


Take along plenty of snacks. Protein bars, trail mix and fresh fruit can replenish energy after exerting yourself in the outdoors. Just remember the Golden Rule of the River – if you pack it in, please pack it out!


We hope you have a safe and fun outdoor season, but should you find yourself suffering from the not so pleasant effects of too much sun, bee stings, poison oak, cuts, abrasions or other medical problems requiring urgent care, know you can count on Yubadocs to get you back in one piece and on the road or back to the river again. 

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July 01, 2019

QUESTION: With heat waves across the world, are there heat related illnesses?

Summer means more time outside, with many reasons to do so, be it walking, swimming, hiking, gardening, or more demanding activities such as recreational sports or occupations.  And, while the great outdoors offers many health advantages, such as increased levels of Vitamin D and the many benefits of being active, there can also be a downside to too much time in the sun.

Heat cramps, heat rash, and heat exhaustion are common among athletes as well as for those who work outside for a living including firefighters, those who serve in the military and construction workers.  Many times, simply replenishing fluids can alleviate symptoms, but extended periods of exposure, coupled with a lack of fluids, can lead to a more severe condition, known as heat stroke.  Heat stroke can damage vital organs including the brain, heart, kidneys, and liver, and in a small percentage of cases, can lead to death (about 2% of heat stroke victims die from the malady.)  

While the human body has a remarkable ability to adjust to the cold, it is not designed to accommodate an increase in body temperature by more than a few degrees.  When the mercury on the thermostat shows nothing but red, some people will be best served by staying indoors – especially those taking medications that can exacerbate heat related illness. 

Luckily the human body has the ability to acclimate, so those who are often exposed to elevated temperatures will show an increased tolerance and the ability to work in high temperatures for longer periods of time.  However, a few precautions must be taken to avoid some of the dangers of overexposure. 

First, bring along and drink plenty of water or make sure you will have access to other fluids.  Staying hydrated is the antidote to long term exertion in the heat.  If water does not appeal to you, some sport drinks can be helpful in replacing both salt and electrolytes and is a suitable alternative. Contrary to widespread belief, alcohol and sugary drinks do not keep the body hydrated.  In fact, they interfere with the body’s ability to regulate temperature, and very cold drinks can lead to stomach cramping.  

Second, having access to a fan to circulate and cool down the air can be helpful as well as having a mister or taking a dip in a pool, creek, or slow-moving river to lower your body temperature.   

And of course, taking cover in the shade can help keep you cool in extreme heat. 

Your body will let you know if you are over exposed or over exerted.  Pay attention to early warning signs including cramps, a rash, fatigue, headaches, or light-headedness.  If these symptoms are present, get into the shade as soon as possible.  Remove excess clothing and use whatever means available to cool down.  Put ice packs or a cold, wet cloth on your head and neck.  

If symptoms persist, seek treatment at your local urgent care or emergency facility.

The human body is a remarkable, adaptive machine.  Treat it well!  Use sunscreen to protect your skin and keep your body cool as it works hard to help you enjoy these dog days of summer. 

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June 01, 2019

Question: How do I know if my cut or scrape needs medical attention?

Everyone gets a cut or scrape now and then, whether it’s you slicing your finger instead of that onion or your child scraping her knee while learning to ride her bike. Most minor wounds can be taken care of at home, but some require professional attention. How do you know which is which?


If the bleeding stops with a few minutes of pressure and the edges stay together during normal movement, you probably don’t need stitches. But, if the wound is all the way through the skin and you can see the fatty layer when the edges are spread, if it is still bleeding after 10-15 minutes of pressure, if bone or tissue is exposed, or if scarring is a concern – for instance, a cut to the face – a trip to your doctor or local urgent care center is in order. Wounds that open when a joint is bent need stitches and an expert eye to see if there is damage to tendons, ligaments, or nerves. And you should see a professional if there is dirt or anything else in in the wound, like gravel or a splinter. 


Closing a wound with stitches can reduce scarring and decrease both the time it takes for the wound to heal and the chance that it will get infected. Just like stitches in cloth, medical stitches in your body, or sutures, are threads that hold things together. Sutures are made of many different materials, including nylon, polypropylene, silk and steel. Some are made from synthetic material designed to dissolve when placed under the skin or in the mouth. And certain lacerations that need professional attention are best closed with surgical staples or medical superglue. 


Skin wounds should be washed as soon as possible after the injury with warm water and mild soap. Avoid hydrogen peroxide, betadine, and alcohol as they kill not only germs, but also normal cells – and they sting like crazy. 


People with diabetes have a lower threshold for seeing a medical professional for a skin injury because they have an increased risk of infection. Anyone with a wound showing signs of infection, which include redness, pus, swelling or worsening pain, should consider seeing a doctor.


Dog, cat and other animal bites frequently become infected, especially those on the hand or foot. Animal bites should be evaluated by a medical professional, especially if there is any question about the animal’s rabies vaccination status. 


If your wound does need professional care, time is of the essence. Wound edges start to seal off quickly, making it difficult for them to bond to each other, and if the wound is dirty, 


Infection can start within a few hours. How long after an injury a wound can be stitched, stapled or glued depends on the situation. A cut from a clean sharp edge, like a kitchen knife, that has been thoroughly washed and bandaged at home may be sutured from 12 to 24 hours after the injury depending on the location of the cut. But a dirty wound, or one that needs to be numbed with local anesthesia to be cleaned properly, should be treated right away.


Whether or not you have had stitches, keep your wound covered with a clean, dry dressing. Leaving a fresh scrape or cut open to the air to heal is not a good idea because unlike normal skin, an open wound cannot protect itself against dirt, germs or drying out. So, change the dressing twice a day or right away if it gets wet or dirty. It’s OK to get the wound wet when you shower or bathe, but don’t leave a wet dressing on it. If the wound is on your hand, wash your hands whenever needed and put a fresh, dry dressing on after. You can put a small amount of antibacterial ointment or cream on each time you change the bandage, but not too much – it’s easy to overdo this. 


No matter how careful we are, scrapes and cuts are bound to happen. Fortunately, when thoroughly cleaned and (sometimes) sewn back together, our bodies heal quickly and are ready for the next adventure. 


May 01, 2019

Question: I may have been exposed to measles. What do I need to know?

In the late 1950’s and early 1960’s, back when the U.S. population was 180 million, there were 3 to 4 million cases of measles each year in America, along with 48,000 hospitalizations and about 500 deaths from measles. 


A measles vaccine combined with mumps and rubella vaccines – the MMR – was introduced in 1963, and it quickly became a standard part of children’s health care. By 2000, there were only 86 isolated cases in the entire nation, and there had been no continuous transmission of the infection for more than 12 months. The disease was declared eliminated in our country, and it is highly unlikely your doctor has ever seen a case of measles. 


However, measles has been in the news frequently in 2019 because it is making a comeback in the U.S.


Measles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, or direct contact with infected nasal or throat secretions. The virus remains contagious in the air for up to 2 hours and longer on surfaces. That means the virus can still infect others 2 hours after a contagious person has left the room. An infected person sheds the virus and is contagious for 8 to 10 days, starting a few days before feeling sick. Following an exposure, 90% of susceptible people will develop measles.


Symptoms usually start 10 to 12 days after exposure but can be anywhere from 6 to 21 days. These symptoms include a fever, loss of appetite and just not feeling well, followed by dry cough, runny nose, and red or watery eyes. White spots sometimes appear on the insides of the cheeks. The illness might be mistaken for the common cold if not for its most well-known symptom – a rash that usually starts on the face and head and spreads downwards. It typically appears 2 to 4 days after the fever begins and 14 days after exposure.


The virus causes far more than discomfort. Complications range from mild ones, such as diarrhea, to more serious ones, such as ear infections, pneumonia, blindness, and encephalitis (swelling of the brain that can cause permanent brain damages). 


A significant number of people who get measles die from it – about 150,000 around the world, according to the World Health Organization. However, once infected, there is little to be done except to let the virus run its course and to take precautions to help prevent the spread of the disease.


Most people born in the United States after 1970 received the MMR vaccine and are immune to the virus, however, segments of the populations who are not vaccinated are at risk of infection. People born before 1957 were likely exposed to measles and have developed their own natural immunity. Anyone who has had measles is also immune.


Measles is still common in other parts of the world, and it is thought that many of the recent outbreaks in the U.S. were caused by travelers who picked up the virus abroad and infect non-immunized individuals here. It is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated. This is because of community immunity, also called herd immunity.


If a certain proportion of the population is protected, the germ – in this case, the measles virus – doesn’t find enough susceptible people to take hold in the community. So even if there is an isolated case, no epidemic occurs. 


This means that the fraction of the population that has immunity is protecting everyone, including those who are too young to be vaccinated and those who cannot be immunized due to being immunocompromised. But to achieve community immunity for measles at least 90 to 95% of the population must be immune. A disease like polio is less contagious, and only 80 to 85 percent of the population would need to be vaccinated for herd immunity to work.


If you are unsure whether or not you are immune, you can be tested for immunity to the disease by your primary physician or an urgent care center such as Yubadocs. It is especially important to know your status if you plan to travel internationally or have been exposed to others who may be carrying the disease.


Unlike influenza vaccine, which reduces the risk of influenza illness between 40 to 60%, two doses of the measles vaccine is 99% effective. Measles vaccine does not wane with age, and it is never too old to get vaccinated.

April 01, 2019

Question: Is it possible to contract Lyme Disease from a tick in Nevada County?

ANSWER:  Yes, ticks love the climate in Northern California as much as we do. The only kind of tick found locally that can carry Lyme disease is the Western black legged tick (a.k.a. Ioxedes pacificus, or deer tick). While only 48 cases of Lyme disease have been officially reported to the Nevada County Department of Health over a sixteen-year period, some 300,000 cases have been reported to health departments nationwide. Due to misdiagnosis and under-reporting, many researchers believe the number is as much as ten times higher. Lyme Disease can be difficult to diagnose. Symptoms can mimic a number of other diseases, including multiple sclerosis (MS), fibromyalgia, ALS, chronic fatigue syndrome, autoimmune diseases including lupus and rheumatoid arthritis, thyroid disease, and psychiatric disorders, among others.


If you do find a tick attached to you, remove it with very fine pointed tweezers, grasping the head as close to your skin as possible and gently pulling it straight out in a firm, steady motion. Don’t grab it by the body, as you can squeeze germs out of the tick and into you. If you do get a deer tick bite, consider consulting with your doctor or visit your local accredited urgent care clinic because of the possibility of contracting Lyme disease. In some cases, an antibiotic to prevent Lyme disease may be indicated.


Should you develop a rash or any other symptoms after a tick bite, see your physician or urgent care provider. Lyme disease can be treated successfully with antibiotics, and the earlier it is diagnosed and treated, the better.

March 01, 2019

Question: When is it appropriate to go to an emergency department, and when is an urgent care clinic a better choice?

ANSWER:   If you need an ambulance to get to a doctor, you need an emergency department (ED). If you have a life or limb- threatening medical problem, or an injury involving an amputation or a severe wound, you need to go to the ED. Examples are a possible heart attack, signs of a stroke, severe shortness of breath or bleeding, coughing up or vomiting blood, and suicidal or homicidal feelings. ED’s specialize in managing catastrophic injuries and illnesses and must be staffed and equipped to do so 24 hours a day, 7 days a week. That is one reason care in an ED is so expensive.


When you need attention now, but your problem is not life or limb-threatening and you are not able to see your primary care physician, urgent care is often a more affordable and timely solution. Urgent care centers specialize in promptly diagnosing and treating sudden health care needs such as simple fractures, sprains and strains, lacerations, abrasions, bites and boils. They also regularly treat eye, ear, and throat problems along with respiratory infections, flu and viruses, gastrointestinal disorders, sexually transmitted infections, and urinary tract infections. They are also a great resource for camp, school and sports physicals. Most treat workers compensation injuries, many provide travel medicine consultations, vaccinations, and dispense some prescription medications. Accredited urgent care centers such as Yubadocs must have X-ray, ECG and lab services available onsite and meet rigorous quality standards.

February 01, 2019

Question: I believe I have a sinus infection, what should I do?

ANSWER:   Sinus infections, or sinusitis, affects one in eight adults every year. In addition to common cold symptoms, facial pain or pressure is the hallmark of sinus infections. Sinus pain happens in the cheeks, forehead or around the eyes, and typically gets worse with bending over. You may also experience pain in the upper molars and loss of sense of smell.


Like colds, the vast majority of sinus infections resolve on their own in 10 days or so with appropriate treatment at home. Home treatments are designed to thin out mucous and open up the passageways between your sinuses and your nose. Drink plenty of fluids and breathe in steam from the shower. Irrigate the nasal passages using a saline rinse with a neti-pot or an over the counter saline nasal spray. Open the passageways by using a decongestant to shrink the swollen mucous membranes. Herbal decongestants are helpful, both in steam and teas. The most effective pharmaceutical is oxymetazoline nasal spray (over the counter Afrin and other brands). But be careful – use it no more than twice a day and no more than 3 days in a row, or 6 doses total, then skip a day. Otherwise, you risk having rebound congestion.


If symptoms persist more than 10 days, a bacterial infection may have come in on top of the viral infection and medical treatment may be needed. If you improve but then get worse again see an urgent care facility such as Yubadocs. Other signs the infection has spread beyond your sinuses are fever, severe headache, swelling or redness around the eyes, visual changes, pain with eye movement, stiff neck or an altered mental state.

January 01, 2019

Question: I think I might have bronchitis. What should I do?

ANSWER:   Acute bronchitis is characterized by a cough lasting at least 5 days caused by inflammation of the airways. This temporarily narrows them, making it hard to breathe. Typical symptoms include chest congestion, coughing, fatigue, wheezing. It often follows a common cold, and symptoms can overlap, with runny nose, sore throat and headache of the cold initially, and those of bronchitis developing later.


Most acute bronchitis is caused by infections, more than 90% of which are viral. It usually goes away on its own in one to three weeks, and antibiotics — which work only on bacteria — rarely help. What does help is plenty of rest, extra fluids, steam from a shower or a bowl of hot water, over the counter cough remedies, and boosting the immune system.


However, if you have a fever over 100.4, bloody mucous, wheezing, shortness of breath or chest pain, or if the cough lasts more than 3 weeks or keeps returning, you should visit an urgent care facility or your primary care physician. Any of those things mean it could be something more serious, such as asthma or pneumonia.


Prevention is always the best (and cheapest) medicine. So, cover your nose and mouth when coughing or sneezing, wash your hands often, stay away from people who are sick and stay home if you are, don’t smoke, avoid second hand smoke, and keep up to date with recommended vaccines to help prevent bronchitis.

December 01, 2018

Question: When do I need to take antibiotics?

ANSWER:   As a physician, I strive to use antibiotics only when necessary. Antibiotics are compounds capable of killing or inhibiting the growth of bacteria. They do nothing to other types of disease-causing microorganisms, such as viruses and fungi or the common cold. Antibiotics have revolutionized medicine and saved millions of lives but unnecessary prescribing and overuse of antibiotics has caused a resistance crisis. According to the CDC, antibiotic resistance caused an estimated 23,000 deaths annually in the US alone. Antibiotics are also one of the most common causes of reactions to medicines resulting in emergency department visits, especially for children. These include allergic reactions ranging from an annoying rash to a life-threatening condition like anaphylaxis. Of course, it’s much better to not get sick, so the best thing you can do is to safeguard against contagious illnesses by being vigilant about washing your hands, avoid contact with or wear a mask when you’re around people coughing or sneezing, stay home when you are ill and make sure you are up to date on all immunizations. If you do end up taking antibiotics, be sure to complete the course and then replenish your system with probiotics.

November 01, 2018

Question: My throat is sore, how do I know if it is time to see a doctor?

ANSWER:   If you have a severe or prolonged sore throat, a fever over 101, trouble swallowing or opening your mouth, any difficulty breathing, pain on only one side, a rash, or swelling of your face or neck, you should make a trip to your doctor or local urgent care center. 


There are many causes of a sore throat, but most are caused by viral or bacterial infections. Viruses that cause colds or upper respiratory infections are by far the most common, but antibiotics are useless against viruses. An influenza-caused sore throat usually comes with a fever, muscle aches and pains, and a dry cough.  Influenza is one of the few viral illnesses for which there is a specific treatment, but it must be started in the first few days of symptoms.


When a sore throat is from a bacterial infection, antibiotics are needed.  The most common bacterial cause is strep throat. Strep throat may cause a fever and sore lymph nodes in the neck, but typically not cold symptoms. Strep throat can result in heart or kidney disease if not treated. A rapid in office test can determine if you have influenza or strep.

October 01, 2018

Question: Do I really need to get a flu shot?

ANSWER:  Yes, prevention is always the best route in healthcare. Scientists throughout the world, including at our own Centers for Disease Control, recommend a vaccine as the best defense against influenza. Because the virus constantly mutates, the vaccine must be updated annually. Since we never know when influenza will hit our community, the earlier you can get the shot, the better. It takes a couple of weeks after vaccination for your body to develop antibodies, so getting the shot in early fall, before the full onset of the flu season, is a good practice. We have made tremendous advances in our understanding and treatment of the flu in recent years. Despite that, over 80,000 people died of it in the US last year according to the CDC, making it one of the worst flu seasons in recent memory. It was driven by a strain of the virus that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly. Research shows the vaccine not only lowers the chance of getting the flu but makes the illness less severe and saves lives. October is a great month to visit Yubadocs to be vaccinated, and most insurances will cover the cost of the shot. 

September 01, 2018

Question: How are the smoky conditions affecting my health?

ANSWER:  Forest fire smoke produces microscopic particles. They can irritate your eyes and respiratory system, causing coughing and trouble breathing, and symptoms similar to a sinus infection, such as headaches, sore throat, a runny nose and even tiredness. If you’re healthy, you’re usually not at a major risk from short-term exposures to smoke. But these fine particles can aggravate chronic heart and lung diseases, such as asthma and COPD. The Air Quality Index is a scale of 0 to 500; the higher the number, the more pollutants. An AQI of 50 or less is thought to indicate good air quality, while an AQI of greater than 100 is considered unhealthy for sensitive groups, and unhealthy for everyone when greater than 150. In 2017, Western Nevada County had 81 days when the AQI was over 100, and 19 days when it was over 150.


Should you find yourself having difficulty catching your breath, with an unexplained cough or a flare up of a known health condition, see your doctor or visit an accredited urgent care center such as Yubadocs. We can examine you, test your lung function, diagnose the problem and prescribe or adjust your medications.

August 01, 2018

Question: How do I know if the head injury my child suffered is a concussion?

ANSWER:  Some signs that a person has suffered a concussion include any loss of consciousness, a blank stare or stunned appearance, confusion, difficulties with memory, speech or answering simple questions. If your child complains of headache, nausea, vomiting, blurred vision or just does not feel right, s/he probably has sustained a concussion and should be checked out by a medical professional.

Concussions are caused by a blow to the head or the body that is hard enough to cause the brain to be shaken around in the skull. You do not have to be hit in the head or knocked out to have one. Concussions are an injury to the brain and are potentially serious, so should not be ignored. Most concussions cause functional disturbances rather than a structural injury to the brain. This means they can be diagnosed by an in-person exam, but not by CT or MRI scans.  Typically, treatment for a mild concussion will mean removal from play, physical and mental rest and an over the counter pain reliever, if needed. A more serious injury needs more immediate attention. If there is any doubt, a visit to an urgent care clinic such as Yubadocs is worth the peace of mind.

July 01, 2018

Question: It’s summer and my kids are prone to injuries, how can I tell if the injury is bad enough to go to urgent care?

ANSWER:  If swelling and pain symptoms from an injury do not improve, consider a trip to an urgent care center. It can be difficult to tell a sprain or strain from a break without an x-ray. A good guideline is if you cannot bear weight enough to take 4 steps, you need an x-ray. For upper extremity injuries if there is any deformity, an x-ray is needed. If there is tenderness of a bone, as opposed to muscle or other soft tissue, or if there is loss of normal function, an x-ray is needed. The risk of a fracture is increased in those under 12 and over 55. If there is a fracture, the main risks of waiting a day or two are that bone fragments that were properly aligned may become displaced and further injury could occur. A broken bone will not start to heal in one or two days, so there is no risk then of having to re-break it, but it will after a week or two.

Accredited and Certified Urgent care facilities such as Yubadocs are required to have x-ray equipment on-site. Treatment varies and some injuries can be managed from start to finish at an urgent care center, while others require referral to a specialist for possible surgery.

June 01, 2018

Question: How can I best prepare for a safe day at the Yuba River?

ANSWER:  As the founding president of SYRCL, the Yuba is dear to my heart. To help ensure you have a great day, bring plenty of water and be sure to use sunscreen. Stay hydrated, bring healthy snacks and wear sturdy river shoes to avoid slips and sprains. We see many people at Yubadocs for sprains and broken bones from slippery rocks. Please do not take glass to the river! You could be saving someone a trip to urgent care for stitches. The Yuba can also be dangerous. Every year there are drownings or near-drownings. Some are related to alcohol, others occur when people are caught unaware by the fast-moving, cold river and swept away. If someone is in distress and you can help without endangering your life, get that person out of the water and CALL FOR ASSISTANCE. If the victim is unresponsive, open the airway and give two rescue breaths by mouth to mouth that make the chest rise. If the person remains unresponsive, perform CPR. Jump in, don’t dive in. You could hit your head on the bottom and end up unconscious or with a broken neck.

May 01, 2018

Question: I have what I think is poison oak on my face, but now my eyes are swollen. What should I do?

ANSWER:  You should see a doctor. If the rash is moving toward your eyes, they can swell shut. It is not only disfiguring, but can interfere with your vision.  You may need a steroid in your bloodstream via pills or a shot. Creams are ineffective in this situation, and getting them in your eyes can be harmful. Urgent care facilities such as Yubadocs see poison oak year-round and can provide accurate information and useful treatments that are far more effective than anything you buy over the counter. If you show signs of infection or have swelling around your eyes, face or genitals, you should see a doctor right away. Untreated poison oak usually resolves on its own in 3 weeks, but healing is delayed by infection. Secondary infection is the most common complication and can happen where there is raw skin from scratching or broken blisters.

April 01, 2018

Question: I have a runny nose and don’t feel well. How do I know if this is a cold or allergies?

ANSWER:  Features of allergies and the common cold overlap and determining which is the cause of your symptoms can be a challenge. But, here are some guidelines.

· A cold generally lasts five to ten days and is more likely to occur in fall or winter. On the other hand, allergy symptoms last for as long as you are exposed to whatever you’re allergic, which could mean weeks, an entire season, or for some people, all year.

· Tell-tale signs of a cold are fever, muscles aches and feeling like you’re coming down with something. Allergies generally don’t cause fevers or muscle aches, while a cold, which is a viral infection, can.

Many times, over the counter medicine, such as a steroid nasal spray with or without a non- sedating antihistamine pill, is all you need. If that doesn’t do the trick, if you’re not sure what you have, or if your symptoms are severe, come visit us at Yubadocs. We can help diagnose, treat and guide you to recovery.

March 01, 2018

Question: I am a 35-year-old woman. I have to pee more often than usual, and it burns when I do. What’s going on?

ANSWER:  Although I cannot diagnose without seeing you, it sounds like you have a urinary tract infection (UTI).  Nothing says Urgent Care like a UTI!  If you’ve ever had one, you know the quicker you are seen and treated, the better.  Yubadocs can diagnose your problem, prescribe the proper medication, and provide you fast relief.  And, you are not alone - UTI’s are one of the most common problems for which women see a doctor! Women have more than a 50% chance of getting a UTI in their lifetime.  During childhood, the risk for girls is 8%, and during pregnancy, about 4% to 5%.  UTIs are caused by bacteria and treated with antibiotics.  The specific medication and length of treatment depends on the type of UTI you have and your medical history.  Drinking lots of fluids and urinating frequently are recommended as  this helps flush out the bacteria. You can relieve the burning and frequency with over the counter phenazopyridine, but this provides only temporary symptom relief and does not cure the infection.

February 01, 2018

Question: I’m so excited that I am in a new relationship! What steps can I take to make sure my relationship is not only heart healthy but also safe?

ANSWER:  Healthy and supportive relationships— whether social, familial or romantic—help people feel happier, have higher self-esteem, more self-confidence, and live longer.  A stable and loving physical relationship has additional benefits to our physical, mental and emotional health.  Sex can lower blood pressure, reduce stress, improve sleep, and boost the immune system.  But before you get started, Yubadocs urges you and your partner to consider getting that clean bill of health so you can begin your new relationship with confidence!  Yubadocs performs confidential evaluations to eliminate any fears about sexually transmitted infections.  A simple blood and urine test will give the results in just a few days.

January 01, 2018

Question: I’m feeling flu-like symptoms, what should I do?

ANSWER:  Come in and be seen, we are open 7 days per week!  There are medications available to combat the flu.  Unlike antibiotics, which kill existing bacteria, they prevent viruses from multiplying.  To be effective, these antivirals must be taken early in the illness- ideally within first 72 hours of symptoms.  Influenza can be serious, especially for seniors, children, and those with other medical problems.  According to the CDC, every year thousands of people die from influenza or complications of it, and many thousands more are hospitalized.  Yubadocs can help!  We can test for influenza onsite, give you the results during your visit, along with a prescription, if needed.  This flu season is hitting hard, already.

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