Dr.D

Dr.D

%AM, %751 %17 %2018 %10:%Apr

Dorothy DeGuzman, M.D., M.P.H.

Attended Emory University School of Medicine and graduated in 2007 with a joint MD/MPH in global health. She then completed residency at Lawrence Family Medicine Residency in 2010 and stayed on an extra year to complete a high risk OB fellowship. After completing training she and her husband moved to rural western North Carolina, she worked there for 6 years doing full spectrum family medicine including C-sections. She enjoys hiking, cooking and spending time with her two young sons.
%PM, %267 %29 %2018 %22:%Mar

Antidepressants Grid 2018

An antidepressant gird with dosing and side effects.  

PDF file is loading ...

%PM, %895 %12 %2018 %12:%Feb

Release Notes and Updates

Release Notes and Updates published that have updates on dot phrases, Acute Workflow pages, etc.

2018

2017

%PM, %236 %01 %2018 %20:%Jan

Thomas Fire - Archived Information

Archived as of 01/01/2018 when GoFundMe Campagain was closed:

Support Our VCMC Residency Fire Victims

Check out Tipu Khan's effort to support our local community on CBS LA Channel 2

Our beautiful VCMC family is in pain. The Thomas fire has devastated many families in our small community.
Drs. Lambing, Baker, David, Bale, Weber, Jones and some of our clinic and Hospital staff have completely lost their homes in the fire.
They left with a few belongings in their bags and the clothes on their backs. Please help us in raising money to give them a chance at rebuilding their lives.

 Visit The VCMC GoFundMe Fire Relief Page to donate now.  All money will be used to support rebuilding our community.

Want more information on the status of the fire?

Here are some useful resources complied by Danny Cox:

Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)

CDC Infection Control Isolation Guidelines PDF

%PM, %885 %13 %2017 %12:%Nov

Ian Wallace, M.D.

Dr. Wallace completed a BA in Geology at Carleton College in 1995 and then worked in software engineering for several years.  He attended medical school at the Univeristy of Colorado School of Medicine from 2006-2010 involved extensively in the rural medicine training program.  He completed his residency at Ventura County in 2013 followed by 6 months of fellowship training in advanced procedures for endoscopic skills.  From 2014-2016 he worked and taught with the family medicine faculty at Contra Costa Regional Medical Center.  He joined the Ventura Family Medicine Residency Faculty in June of 2016 to help develop an endoscopic training program for the residents.  When not in the GI lab or the clinic he enjoys being at the beach with his family exploring the tide pools.

%PM, %881 %13 %2017 %12:%Nov

Daniel Cox, M.D., M.S.

After completing a BS and MS in Earth Sciences at Stanford University in 2004, Dr. Cox worked in a vascular surgery research lab before attending medical school at the University of California, San Francisco. He subsequently completed a residency in Internal Medicine at UCSF in 2014 before working in homeless primary care in downtown LA. He joined the VCMC family after completing a 1-yr fellowship in Hospice & Palliative Medicine at UCSF in San Francisco. He enjoys teaching communication skills to rotating residents on the Palliative Care Team. When at home in Ojai, he enjoys yoga, trail running, and spending time with his wife and growing family. 
%PM, %867 %25 %2017 %12:%Sep

Ventura Global Health Fellowship

Mission

The Ventura faculty group is excited to partner with Ventura Global Health Project in offering a fellowship in global health. Our fellowship is designed to provide a hands-on global health experience at several international locations. Our goal is to support sustainable long-term solutions to medical care in the communities we serve. We are fortunate to have locations which are staffed by Ventura graduates who reside on location. We strive to develop affiliations that “teach the teacher” through support and training of local clinicians and staff as well as international residencies in family medicine.

Application Timeline

  • Applications accepted - October 15th
  • Deadline for application submission - December 15th
  • Announcement of positions - January 15th

Positions

  • Up to 4 fellows per year

Locations

  • We will work with fellows to develop the best mix of location and duration at each site, all international experiences are voluntary
    • Core location options
      • Ventura, California
      • Santo Thomas De La Union, Guatemala
      • Monrovia, Liberia
      • N'Djamena, Chad
    • Other available sites
      • Haiti
      • Ethiopia

 

Ventura - Primary Contact - Wallace Baker MD 

Educational and clinical experience in Ventura California. This experience will include work in an urgent care and average of 3 days per week with elective opportunities 2 days per week in ultrasound training, inpatient infectious disease and outpatient TB and HIV clinic. Call opportunities for inpatient medicine and ER may exist. The core urgent care setting is in an urban underserved location with a moderate sized Mixteco population. Fellows will also be expected to lead residency interest group meetings and provide didactics on global health topics at residency core conference. We strive to be flexible and cater our on-site curriculum to the educational and career goals of the fellow as much as possible.

Guatemala - Primary Contact - Zack Self MD

This experience will consist of 3 months in the rural Guatemalan village of Santo Tomas De La Union, a village of 15,000 people. The host site consists of 4 inpatient/ER beds, an OR, 3 outpatient clinic rooms and an onsite pharmacy. The fellow will perform clinical duties such as outpatient care, ER and inpatient medicine as needed. Educational opportunities will include on site and online ultrasound training, education on local tropical diseases, cultural orientation and others. Research opportunities exist.

Spanish language capability preferred.

Chad - Primary contact - James Appel MD

This experience takes place in in the N'Djamena Chad, the capital city with a population of 2 million. The host site, Guinebor Hospital, has 40 beds and performs 100-150 deliveries and 80-100 major surgeries per month. The patient population is mostly Muslim and Arabic speaking while the staff speaks French and Arabic and several other dialects. The clinical experience will consist of general surgical training, operative OB, basic orthopedic procedures and inpatient medicine/infectious disease. The educational focus will be primarily on meeting general surgery and operative obstetrical needs in a resource limited setting.

Language translation will be provided.

Liberia - Primary contact - John Fankhauser MD

This experience takes place in an 85-bed mission hospital located on the coast of West Africa near Monrovia, Liberia.  The hospital is a general acute care hospital.  There are 15-20 Emergency room visits and 130 outpatient clinic visits daily, 25-30 surgeries per week, and 80-100 deliveries per month.  There is a new family medicine residency program.  The first class of 3 residents started in July 2017.  The fellow’s focus will include learning to care for patients in a tropical, resource limited setting, as well as teaching residents, PA’s and midwives.  The fellow will participate in ER patient management, outpatient clinic care, team rounds on pediatrics, med/surg, and OB wards and didactic teaching in residency seminars.

Ethiopia - Upon inquiry - Primarily a teaching opportunity for family medicine residents.

Haiti - Upon Inquiry. Primarily a teaching opportunity for family medicine residents.

 

Additional Curricular Opportunities

  • Certification in tropical medicine through the West Virginia School of Tropical Medicine.

Requirements

  • Applicants will have successfully completed medical training in a US allopathic or osteopathic medical school and residency program.
  • Be eligible for medical license to practice in California in good standing
  • Be eligible for hospital privileging at Ventura County Medical Center
  • Be eligible for medical malpractice coverage
  • Have health Insurance prior to program commencement
  • Have Travel Insurance prior to international travel
  • Spanish language skills are preferred but not required

Financial

  • Compensation consists of a salary while performing urgent care shifts in Ventura (approximately $27,500), along with a Ventura Global Health Project Grant ($42,500) to offset all travel and living expenses at international sites.
  • An additional $5,000 stipend is available to fellows with a spouse as well as an additional $10,000 stipend available for fellows with children or spouse + children.
  • “Moonlighting” options may be available in Ventura for additional revenue
  • Vacation – Up to 4 weeks of vacation available per year. This cannot come from the time spent in Ventura unless taken from elective educational time, max 4 days per month. Fellows are encouraged to take vacation time between rotations.

Contact

We welcome inquires! Please send all inquiries to:
This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.

Applications

Please send all applications for the fellowship to both:
This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.
This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.

Applications should include a cover letter stating the reasons for your interest in the fellowship as well as your curriculum vitae and 3 references.

%PM, %950 %16 %2017 %14:%Aug

Rheumatology Review of Systems

Rheumatologic ROS is negative for:
Malar rash, photosensitivity, alopecia, mucosal ulcers, Raynaud's phenomenon, SQ nodules, sense of skin tightening in hands, face or torso, other rashes
No hx of red eyes, photophobia, iritis, uveitis, conjunctivitis, redness or discoloration of sclera, dry eyes or dry mouth
Hx pleurisy, sharp chest pains that increase with deep breath, lung fibrosis, pneumonia, cough phlegm, hemoptysis, DVT, PE
Chest pains, Hx pericarditis, heart murmur
Abdominal pain, nausea, vomiting, diarrhea, constipation, melena, hematochezia, Hx hepatitis, tranfusions or drug use, ulcerative colitis, Crohn's Disease
Hematuria, proteinuria, renal failure, bladder infections, kidney stones, hypertension
Headaches, trouble finding words
Focal weakness, trouble combing hair or getting out of chairs
Burning or tingling in feet
Monocular blindness, dysarthria, dysphagia, seizures or stroke
History of Low WBC, low platelets, anemia 

 

 

Courtesy of Dr. Bob Gonzalez

%PM, %942 %27 %2017 %14:%Jul

The Zwolak Collection

I sort my phrases like this:

.h_ : hpi

.e_ : exams

.p _ : procedures

.ap_ : assessment and plans

HPI:

DM2

DM2:

No dry mouth, polyuria, polydipsia.  Medication compliance: _.

Blood glucose:

Fasting:        _ of 7 high (max: _ )

Breakfast:   _ of 7 high (max: _ )

Lunch:          _ of 7 high (max: _ )

Dinner:        _ of 7 high (max: _ )

Vaccine: _ Pneumovax, _ Tdap, _ Flu.

Foot exam: Date: _ ; Concerns today: _ ; Checks feet at home: _

Retinal scan: Date: _ : Abnormalities: _

Meds: Metformin, _

WWE:

_ yo F G_P_ Menarche _

1. Pap: Last pap: _ Abnormal pap: _ Menses: _ Vaginal complaints:

2. Breast: Last mammo: _ Abnormal mammo: _ Lumps: _ Discharge: _ Family hx breast cancer: _

3. Bone: DEXA: 6/14 osteopenia Calcium intake: _

4. Sex/Contraception:

5. Domestic violence:

Cold:

_ yo _ w/ _ day h/o of _, nasal sx: _ ear pain: _ ST: _ Cough: _ Fever: _ Rhinorrhea: _

Tx: _

Flu shot: _ Tobacco exposure: _ Sick contacts: _

Depression:

1. Depression:
Sleep:
Interest:
Guilt:
Energy:
Concentration:
Appetite:
Psychomotor:
Suicidality/Homocide:

Treatment:
Support:

 

ROS:

Constitutional: No Weight Change, No Fever, No Fatigue
ENT/Mouth: No Nasal Congestion, No sore throat, No Rhinorrhea
Eyes: No Vision Changes
Cardiovascular: No Chest Pain, No SOB, No Palpitations
Respiratory: No Cough, No Dyspnea
Gastrointestinal: No Nausea, No Vomiting, No Diarrhea, No Constipation
Urinary: No Urinary Frequency, No Dysuria, No Urgency
Musculoskeletal: No Arthralgias, No Myalgias
Skin: No Skin Lesions
Neuro: No Weakness, No Paresthesias
Psych: No Anxiety/Panic, No Depression, No Insomnia
Heme: No Bruising, No Bleeding
Endocrine: No Temperature Intolerance, No hair loss

 

EXAMS:

General:

Gen: NAD, age appropriate.
ENT: TM clear, nares clear, pharynx clear
Lymph: No cervical lymphadenopathy
Endo: Normal thyroid
CVS: RRR, nml PMI, no M/R/G
Pul: CTA, no W/R/R, no fremitus
Abd: +BS, soft, NT, ND
Ext: no C/C/E
Psych: affect normal

 

Back pain

MSK: TTP: Back ROM (degrees): Flex: _ Ext: _ Side Bend: _ Rotation: _
Strength:
Right: HF: 5/5 Q: 5/5 H: 5/5 PF: 5/5 EHL: 5/5
Left: HF: 5/5 Q: 5/5 H: 5/5 PF: 5/5 EHL: 5/5
Neuro: DTR:
Left: L3/4: 2/4 S1: 2/4
Right: L3/4: 2/4 S1: 2/4

Sensation: Left: _ Right: _

DM foot:

Monofilament Foot Exam
Right Foot :
Great toe Normal
1st MT Normal
3rd MT Normal
5th MT Normal
Heel Normal

Pedal Pulse Normal

Left Foot
Great toe Normal
1st MT Normal
3rd MT Normal
5th MT Normal
Heel Normal

Pedal Pulse Normal

Skin :
Ulcers Normal
Calluses Normal
Edema Normal
Onychomycosis Normal
Charcot foot Normal
Erythema Normal
Check feet at home: YGen: NAD, age appropriate.
ENT: TM clear, nares clear, pharynx clear
Lymph: No cervical lymphadenopathy
Endo: Normal thyroid
CVS: RRR, nml PMI, no M/R/G
Pul: CTA, no W/R/R, no fremitus
Abd: +BS, soft, NT, ND
Ext: no C/C/E
Psych: affect normal

Knee

Gen: NAD
Skin: Knee no calor, effusion, rubor
MSK: neg lachman, A/P drawer, mcmurray, varus/valgus gap, patellar grind.

Neuro

Neuro:
CN II-XII grossly intact, EOMI, PERRLA

DTR: Ach Pat Bi Tri BR
Right: 2+ 2+ 2+ 2+ 2+
Left: 2+ 2+ 2+ 2+ 2+

(_ right, _ left) babinski; (_)clonus; (_)hoffman's; (_) Rhomberg

MM Str: HF Q H DF PF EHL | D T B WE FF IO
Right: 4 4 4 5 5 5 | 5 5 5 5 5 5
Left: 2 2 2 0 1 0 | 2 2 2 2 0 0
Sensation: grossly intact to light touch throughout

TRANSFER/GAIT: deferred, difficulty performing with PT

Newborn:

Gen: healthy appearing newborn in no distress
HEENT: no caput or cephalhematoma, normal ears: no pits or tags, nares patent; fontanelles level
Eye: Red reflex present & equal
Clavicles: no crepitus noted
Mouth: Lip and palate intact, good suck
Pul: CTA Bilateral, no W/R/R
CVS: RRR, normal S1/S2. no murmur/rub/gallop
MSK: Good muscle tone, Neg Barlow, neg Ortolani
Abdomen: Soft without organomegaly or masses noted, umbilicus clean and dry
Back: Normal spine without significant sacral dimple.
Vasc: Femoral Pulse: Present and palpable equal bilaterally
Anus: Patent
Genitalia: Normal __male.
Skin: No rashes noted. Minimal sacral melanocytosis
Neuro: Intact moro, suck, and grasp, toes upgoing bilaterally

OMM:

Osteopathic:
Cranial: OA RRSL
Cervical: C4-7 RRSR C2-3 RLSL
Thoracic: T1-4 RLSR T5-9 RLSR T10-12 RLSR, ropey, hypertonic
Lumbar: L1-5 RRSR

Treatment Abbreviations: Art= Articulatory, BLT= Balanced Ligamentous Tension, CS=Counterstrain, HVLA= High Velocity Low Amplitude thrust, FPR=Facilitated Positional Release, ME= muscle energy, MFR=Myofascial Release, MI=Muscle Inhibition, RR=Rib Raising, ST=Soft Tissue.

PSYCH:
Arousal: Alert
Attentiveness: fully attentive
Appearance: well-dressed and well-groomed
Attitude: cooperative, not guarded
Activity: calm, not restless, no abnormal movements, good eye contact
Orientation: Fully oriented
Mood: euthymic, not dysphoric, euphoric, apathetic, anxious or angry
Affect: normal range, not restricted, flat, or labile
Verbal: normal expressive and receptive language function
Thought process: organized, goal-directed. Pt did not require redirection.
Thought content: no delusions, no suicidal/homicidal ideation
Perceptions: not responding to internal stimuli
Insight/Judgment: good insight, judgment appears to be good

Sports PE

BMI _ %
Gen: NAD, age appropriate.
ENT: TM clear, nares clear, pharynx clear
Lymph: No cervical lymphadenopathy
Endo: Normal thyroid
CVS: RRR, nml PMI, no M/R/G
Pul: CTA, no W/R/R, no fremitus
Abd: +BS, soft, NT, ND
GU: normal penis, testicles. No hernia. Tanner: _
Ext: no C/C/E
Psych: affect normal
Skin: acne_ Tinea pedis _
MSK:
Strength:
Upper extremity:
Right: Deltoid 5/5 Biceps 5/5 Triceps 5/5 Wrist flex 5/5 Wrist ext 5/5 Interossei 5/5 Thenar 5/5
Left: Deltoid 5/5 Biceps 5/5 Triceps 5/5 Wrist flex 5/5 Wrist ext 5/5 Interossei 5/5 Thenar 5/5

Lower Extremity:
Right: HF: 5/5 Q: 5/5 H: 5/5 PF: 5/5 EHL: 5/5
Left: HF: 5/5 Q: 5/5 H: 5/5 PF: 5/5 EHL: 5/5
Neuro: DTR:
Left: L3/4: 2/4 S1: 2/4
Right: L3/4: 2/4 S1: 2/4

Neuro: Neg rhomberg, intact finger nose

No Vision Test results this visit.
 

Upper extremity:

Skin: no effusion or calor of shoulder.
MS: Upper extremity:
Right: Deltoid 5/5 Biceps 5/5 Triceps 5/5 Wrist flex 5/5 Wrist ext 5/5 Interossei 5/5 Thenar 5/5
Left: Deltoid 5/5 Biceps 5/5 Triceps 5/5 Wrist flex 5/5 Wrist ext 5/5 Interossei 5/5 Thenar 5/5
ROM: intact
Neuro: Reflexes:
Right: Biceps 2/4 Triceps 2/4 Brachioradialis 2/4
Left: Biceps 2/4 Triceps 2/4 Brachioradialis 2/4

WWE:

Gen: NAD, age appropriate.
Lymph: No cervical, supraclavicular, axillary lymphadenopathy
Endo: Normal thyroid
Breast: Normal breast tissue. Normal nipple. Normal contour. Absent peau d'orange.
CVS: RRR, nml PMI, no M/R/G
Pul: CTA, no W/R/R, no fremitus
Abd: +BS, soft, NT, ND
GU: Normal meatus & introitus. Normal vagina. Normal cervix. Anteverted uterus. Normal adnexa.
Skin: Normal vulva, perineum.
Psych: affect normal

 

 

Preoperative evaluation :
Procedure:
( )low (X) Medium ( )High risk surgery

Date: to be determined
(X) No active cardiac conditions: Unstable coronary syndromes, decompensated heart failure, significant arrhythmias (AV block Mobitz II or higher, SVT with RVR, symptomatic bradycardia), severe valvular disease

Risk factors: ischemic heart disease, compensated or prior heart failure, diabetes mellitus, renal insufficiency, and cerebrovascular disease
(X) None present ( ) 1 or 2 () 3 or more

Symptoms: ( ) denies chest pain/pressure, dyspnea, dizziness, LOC, coughing, problems with bleeding/bruising or anesthesia before

Exercise tolerance:
(X) 4 METS without symptoms; can ascend a flight of stairs, or walk rapidly on level ground at 4mph, or run a short distance, or do heavy housework
( ) Unable to do 4 METS, <4 mets: performs light housework

Recommendations:
(X) Based on 2014 AHA/ACC Guidelines for preoperative evaluation patient faces acceptable preoperative cardiac risk for this procedure, no further evaluations or treatment needed. Defer to Surgeon regarding full discussion of the risks, alternatives, and benefits of the particular procedure

-Pre-OP labs ordered and normal (see above)
-No NSAIDs x 7 days prior to surgery
-Recommended cessation from EtOH

CHDP:
ASQ:
Communication:
Gross motor:
Fine Motor:
Problem Solving:
Personal-Social:
Interpretation / Concern / Plan:
Dental assessment performed: No problem suspected, no referral needed
Nutritional Assessment Performed: No problem suspected, no referral needed
Age appropriate anticipatory guidance was reviewed: No problem suspected
Age appropriate developmental assessment was performed: No problem suspected
Age appropriate vision and hearing assessed: No problem suspected
Age appropriate Hgb and Hct assessed: No intervention needed
Lead exposure evaluated: No problem suspected
Urinalysis: No problem suspected or Not indicated
TB risk assessed: No need for intervention
BMI Percentile: _%ile
Smoking:
- Second hand smoke exposure: Yes [_] No [_]
- The patient uses tobacco: Yes [_] No [_]
- The patient/parent was counseled about risks of tobacco use: Yes [_] No [_]
The patient is enrolled in WIC: : Yes [_] No [_]
- If yes, Ht. Wt. and Hgb and Hct checked
Vaccines: Vaccination status was evaluated. Age appropriate vaccines were recommended as follows: as above
Follow Up is recommended in _ months.

 

AP Colds:

Supportive care: Encourage fluids, activity as tolerated, honey for cough, salt water gargles, nasal saline.
Tylenol or ibuprofen as needed for discomfort or fever > 102.5
Return if no improvement in 2-3 days.

 

AP vasectomy

The patient has been counseled on the procedure as well as risks, benefits, and alternatives. The procedure is considered irreversible and if they desire it to be reversed, it will require a much more invasive surgery. The patient understands that 1 in 500 to 1000 vasectomies fail and that he will be required to use a backup method on contraception for 20 ejaculations and 3mo until sterility can be microscopically confirmed.

 

AP Well adult:

Discussed wellness, R&B of vitamins, safety, D&E, vaccines, dentist, sunblock & safe sex.

 

 

 

Page 1 of 34