Enoch Choi, MD  
Male, 46
Palo Alto, CA

Specialties: Family Medicine

Interests: sinusitis, Migraine, Low back pain
Palo Alto Medical Foundation
Urgent Care
Palo Alto, CA
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7 Ways to Protect your Skin

Jul 30, 2008 - 6 comments

Skin Cancer


Skin care


skin protection





Spending time in the sun is the best thing about the summer, but unfortunately the worst thing for your unprotected skin.  Not only can it lead to skin cancer, it can result in premature wrinkling, discoloration, and changes in texture.  Here are some ways to avoid the harmful effects of the sun without having to hide from the bright warmth of summer:

1) Slather on sunscreen every day.  No matter how long you spend outdoors, sunlight streaming indoors can expose you to damaging UVA rays.  A liberal application of SPF 15 or greater can prevent it.

2) Use a sunscreen that you'll put on -- work it into your daily habits.  Sprays are often the easiest to apply, but difficult to apply to the face without stinging the eyes.  Many facial moisturizers include sun protection.  Look for the "seal of recognition" from the American Academy of Dermatology or Skin Cancer Foundation.

3) Duck & cover up.  The mid-day sun is strongest, avoid it.  Long sleeves and long pants or dresses are excellent sun protection.

4) Apply sunscreen in all sun exposed areas.  Although folks worry most about the face, all exposed areas are potential areas where cancer can start unless they're well covered with sunscreen.  Even in supposedly well covered areas such as under the shade of hats or under rashguards, sunscreen is needed.  Sun can reflect upwards exposing shaded areas, and wet rashguards lose much of their sun protectant abilities.

5) Apply sunscreen a half hour before going out, every 2 hours and after any water exposure.  Sunscreen wears off after 30 minutes in the water, and is rubbed off after toweling dry.

6) Leave tanning beds to the leather industry.  If you just HAVE to look darker, use sunless self-tanning products so your skin doesn't end up as tough as your shoes.

7) Don your birthday suit on your birthday.  At least once a year, check all over your body for anything changing, growing or bleeding -- skin cancer is very treatable when caught early.

Also, if you have any questions, feel free to visit MedHelp's new Skin Cancer community located at: http://www.medhelp.org/forums/show/290.

Fluoroquinolones increase risk of tendon rupture in elderly, transplant recipient, steroid users

Jul 08, 2008 - 40 comments





side effect





This new box warning via FDA is something i've been aware of for some time in patients using ciprofloxaxin, levaquin (levofloxacin), Moxifloxacin (Avelox), ofloxacin (floxin), gatifloxacin (tequin), and i'm glad it'll be highlighted on labeling, showing it's increasing incidence:

risk of tendinitis and tendon rupture is further increased in those over age 60, in kidney, heart, and lung transplant recipients, and with use of concomitant steroid therapy. Physicians should advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their doctor about changing to a non-fluoroquinolone antimicrobial drug. Selection of a fluoroquinolone for the treatment or prevention of an infection should be limited to those conditions that are proven or strongly suspected to be caused by bacteria.

Read the complete MedWatch 2008 Safety Summary, including a link to the 'Information for Healthcare Professionals' page, at:


Critical Incident Stress Debriefing in Silicon Valley

Apr 14, 2008 - 1 comments





Critical Incident Stress Debri



It's wonderful to know that in Silicon Valley, there's a group called Kara
that is available for Critical Incident Stress Debriefing by their volunteers.  Very responsive, and can mobilize their volunteers very rapidly.  I'll be adding comments in the coming days to this journal as I reflect on their help in a difficult situation at my children's school

1st annual Sutter Health EpiCare User Group meeting

Apr 10, 2008 - 1 comments





electronic medical record


electronic health record





schlepped over to Concord, CA for a full day meeting with 300 physicians across Sutter.  Great talks from Phil Strong (who organized the day and who i worked on his startup in the past), Elliot Wong (my urgent care subject matter expert team lead), Albert Chan (PAMF physician champion), Steven Lane (Sutter Ambulatory EHR lead).

the most important thing from the day was to tell the 2 developers Sal Abiezzi (fellow PAMF MD) and I had lunch with, that the most important thing wasn't new and snazzy features.  The most important thing is to make our current use of EpiCare more efficient, decrease the number of clicks it takes me to get through the day so i can spend more time with patients.