Conditions We Treat
Adult internal medicine, preventive care, and concierge longevity medicine in Folsom & El Dorado Hills, CA. The full breadth of what a board-certified internist manages — chronic disease, mental health, hormonal, sleep, weight, and cardiovascular prevention.
Direct Primary Care from $149/mo · Concierge Longevity Program from $349/mo · HSA-eligible (DPC)
Cardiometabolic Conditions
The leading drivers of disability and early mortality in the United States are cardiometabolic — high blood pressure, abnormal lipids, abnormal glucose handling, and the visceral fat that ties them together. A small-panel concierge primary care practice has time to actually manage these well: lifestyle counseling that fits a real life, medication titration that doesn't require six-week follow-up waits, and the advanced lab work (ApoB, Lp(a), fasting insulin, hsCRP) that traditional insurance-based care often leaves out.
Hypertension (High Blood Pressure)
One in three American adults has hypertension. Most are not at goal. Effective management involves accurate home blood pressure measurement, addressing sleep apnea where present, sodium and weight optimization, and stepwise medication titration. As your concierge primary care physician in Folsom, we have the time to dial this in across visits, not abandon it after a single check.
Type 2 Diabetes & Prediabetes
Type 2 diabetes is largely preventable and, in many cases, reversible — particularly when caught at the prediabetes stage. We use HbA1c, fasting glucose, fasting insulin, and HOMA-IR to define metabolic state precisely, then build a plan around dietary patterns, resistance training, sleep, and (when indicated) GLP-1 medications. Continuous glucose monitor data is welcome and integrated into the plan when patients use them.
High Cholesterol & Advanced Lipid Management
Standard cholesterol panels miss the actual driver of atherosclerotic risk — particle count and lipoprotein(a). We routinely run ApoB and Lp(a) on adults under our care, then pair the lab data with risk calculators, family history, and (where indicated) coronary calcium scoring. Lifestyle and lipid-lowering therapy decisions are made on the full picture, not on LDL alone.
Metabolic Syndrome & Visceral Adiposity
Metabolic syndrome — abdominal obesity, hypertension, dyslipidemia, and insulin resistance — is the single biggest predictor of cardiovascular events and chronic disease. We manage it as the systemic problem it is, with attention to diet quality, resistance training, sleep, and pharmacotherapy when appropriate.
Non-Alcoholic Fatty Liver Disease (NAFLD/MASLD)
Up to a quarter of US adults have fatty liver disease. Most don't know it. We screen with liver enzymes plus metabolic context, follow with non-invasive imaging (FibroScan, MR-PDFF) where indicated, and address the root drivers — insulin resistance, refined carbohydrate intake, and visceral adiposity.
Obesity & Weight Management
Medical weight management — including GLP-1 medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) — is part of comprehensive primary care for adults who meet criteria. We start with an honest assessment of metabolic state, set realistic goals, and combine medical therapy with the habit work that determines whether the result lasts. See the GLP-1 program page for details.
Hormonal & Reproductive Health
Hormonal medicine is one of the areas where small-panel concierge primary care delivers the most. The questions are individual, the optimization takes time, and the lab interpretation requires nuance — none of which fit comfortably in a 15-minute insurance visit.
Low Testosterone & Men's Health
Testosterone replacement therapy (TRT) is appropriate when biochemical and clinical hypogonadism are both confirmed. We work up symptoms thoroughly — total and free testosterone, SHBG, LH, prolactin, hematocrit, and PSA — and discuss the full risk-benefit picture before initiating therapy. For men where TRT is not the right path, we cover sleep, body composition, and lifestyle interventions that often move the needle without medication.
Perimenopause & Menopause
Perimenopause is undertreated in American medicine. The symptoms — hot flashes, sleep disruption, mood changes, brain fog, vaginal symptoms — affect quality of life for years and are often dismissed. Menopausal hormone therapy (MHT) is appropriate for many women and dramatically underused. We discuss MHT options, alternatives, and the recent evidence on cardiovascular and cognitive effects honestly. See the HRT program page for the women's hormone management approach.
Thyroid Disorders
Hypothyroidism, Hashimoto's thyroiditis, and subclinical thyroid disease are common and often poorly managed. We work up symptoms with a full thyroid panel — TSH, free T4, free T3, antibodies — not just TSH alone — and adjust therapy on both labs and how the patient actually feels.
Sexual Health & Erectile Dysfunction
Erectile dysfunction is often the first sign of vascular disease. We work up causes appropriately and treat both the underlying contributors and the symptom itself when indicated.
Mental Health & Cognitive
Adult primary care is the front line for most mental health concerns in the United States. We manage anxiety, depression, ADHD, and sleep disorders for established members of the practice, and refer to psychiatry when the case warrants it.
Generalized Anxiety & Depression
Both are common, both are highly treatable, and both benefit from a physician who has time to listen. We use evidence-based screening (PHQ-9, GAD-7), discuss the full range of options — therapy, medication, lifestyle, lab workup for contributing causes — and adjust over time. Medication management when appropriate, with attention to side effects and titration.
Adult ADHD
Adult ADHD is frequently undiagnosed in people who managed in school but struggle with the executive demands of adult work and family life. We evaluate, diagnose, and treat adult ADHD with both stimulant and non-stimulant options where indicated, with appropriate monitoring.
Insomnia & Sleep Disorders
Sleep is the foundation that everything else — metabolic health, mood, cognitive function — sits on. We work up insomnia, screen for sleep apnea (which is dramatically underdiagnosed in adults), and manage with cognitive-behavioral approaches and medication where appropriate.
Cognitive Function & Brain Health
Mid-life is when interventions to protect cognitive function in late life have the most leverage. We address the modifiable contributors — sleep, vascular risk factors, hearing, social engagement, exercise, glucose control — and coordinate cognitive screening when concerns arise.
Preventive & Longevity Medicine
The strongest interventions in adult medicine are upstream — preventing disease before it manifests. The Concierge Longevity Program is built around this. Every member of the practice gets the same preventive backbone, regardless of program.
Cardiovascular Disease Prevention
Cardiovascular disease is still the #1 killer of American adults. The tools to prevent it have gotten dramatically better — ApoB, Lp(a), coronary calcium scoring, advanced imaging — and most adults have never had any of them. We integrate all of them into a personalized plan, not a one-size-fits-all guideline.
Cancer Screening
Standard age-based screening (colonoscopy, mammography, low-dose CT for eligible smokers, cervical) plus optional advanced screening — multi-cancer early detection (MCED) blood tests like Galleri, whole-body MRI options like Prenuvo or Ezra — interpreted in the context of your full risk picture. We don't sell the tests; we help you decide which actually matter for you.
Sarcopenia & Functional Aging
Loss of muscle mass and strength is the single biggest predictor of disability and dependence in late life. We screen with simple objective measures — grip strength, gait speed, sit-to-stand — and build resistance training and protein adequacy into the longevity plan.
Bone Health & Osteoporosis
DEXA-based screening at appropriate ages, attention to vitamin D, calcium, weight-bearing exercise, and pharmacologic therapy when indicated. Often integrated with hormonal management for menopausal women.
Comprehensive Annual Physical
An executive-style annual physical is the cornerstone of preventive primary care. Full cardiometabolic workup, longevity-relevant biomarkers, age-appropriate screening, and physician-interpreted results — not a 15-minute appointment with lab results sent through a portal.
Cardiovascular
Beyond risk-factor management, the day-to-day cardiovascular work of internal medicine — symptoms, rhythm, vascular concerns, coordination with cardiology when warranted.
Atrial Fibrillation & Palpitations
Workup of palpitations and irregular heart rhythms — symptom characterization, ECG, ambulatory monitoring (Holter, patch monitors, Apple Watch / Fitbit data review), thyroid evaluation, electrolyte work. Anticoagulation decisions and rate-control strategy for established AFib, with cardiology coordination as needed.
Chest Pain & Symptomatic Evaluation
Outpatient evaluation of chest pain — risk stratification, ECG, lab work, stress testing or coronary CT angiography (CCTA) when indicated, referral to cardiology for higher-risk presentations. Acute or severe chest pain belongs in the emergency department.
Syncope, Lightheadedness & Orthostasis
Workup of fainting and lightheadedness — orthostatic vitals, ECG, lab work, cardiac monitoring as indicated. Common causes (dehydration, medication effect, vasovagal, orthostatic hypotension) and red flags requiring cardiology or neurology referral.
Heart Failure (Stable)
Co-management of stable congestive heart failure with cardiology — medication optimization, weight monitoring, electrolyte and renal surveillance, lifestyle counseling.
Peripheral Vascular Disease & Venous Disease
Workup of leg pain, claudication, varicose veins, and venous insufficiency. Ankle-brachial index, vascular referral when needed.
Pulmonary & Respiratory
Adult respiratory care from acute infections to chronic conditions, with attention to sleep-related breathing disorders that often hide in plain sight.
Asthma
Mild and moderate persistent adult asthma — diagnosis, action plan, controller and rescue therapy, allergy contributors, pulmonary referral when severe.
Chronic Obstructive Pulmonary Disease (COPD)
COPD evaluation and management — spirometry, inhaler optimization, smoking cessation support, vaccination strategy, oxygen and pulmonary rehab referral when indicated.
Sleep Apnea
Obstructive sleep apnea is dramatically underdiagnosed in adults and is a major driver of hypertension, atrial fibrillation, daytime cognitive impairment, and cardiovascular risk. We screen with validated questionnaires (STOP-Bang, Epworth) and refer for home or in-lab sleep study when indicated. Coordination of CPAP, oral appliance, or other therapy.
Chronic Cough
Workup of cough lasting more than eight weeks — common causes (post-nasal drip, GERD, asthma, ACE-inhibitor effect), imaging when warranted, ENT or pulmonary referral when needed.
Acute Respiratory Illness
Bronchitis, pneumonia, sinusitis, post-viral cough, COVID-19 (acute and post-acute), influenza. Direct management with appropriate antibiotic and antiviral stewardship.
Kidney & Urologic
The kidney and urinary tract — chronic monitoring and acute issues that come up across adult life.
Chronic Kidney Disease (CKD)
Identification and staging of CKD, attention to the drivers (hypertension, diabetes, NSAID use), medication adjustment for renal function, and nephrology referral at appropriate stages.
Kidney Stones
Acute stone management coordination, metabolic workup for recurrent stones (24-hour urine, stone analysis, parathyroid screen), and prevention strategy.
Urinary Tract Infections
Uncomplicated UTI in adult women, complicated UTI workup, recurrent UTI evaluation, and post-menopausal genitourinary syndrome contributors. Prompt treatment for established members.
Benign Prostatic Hyperplasia (BPH) & Men's Urology
Workup of urinary symptoms in men, prostate-specific antigen (PSA) interpretation, BPH medical management, urology referral when warranted.
Urinary Incontinence & Pelvic Floor
Stress, urge, and mixed incontinence in adults — workup, lifestyle interventions, pelvic floor physical therapy referral, medication when appropriate.
Hematuria & Proteinuria
Workup of blood or protein in the urine — appropriate imaging, repeat testing, and urology or nephrology referral for higher-risk findings.
Musculoskeletal & Pain
Most musculoskeletal complaints can be managed by primary care without specialist referral — and benefit from a physician who has time to think about the contributors.
Low Back Pain
Acute and chronic low back pain workup — red flag screening, imaging only when indicated, evidence-based conservative management, physical therapy referral, attention to ergonomic and movement contributors.
Osteoarthritis & Joint Pain
Knee, hip, shoulder, and hand osteoarthritis — diagnosis, conservative management, weight optimization, physical therapy, intra-articular injection coordination, orthopedic referral for advanced disease.
Rheumatoid Arthritis Screening
Initial workup of suspected inflammatory arthritis — RF, anti-CCP, ESR, CRP, ANA — and prompt rheumatology referral when warranted.
Gout
Acute gout management, uric acid-lowering therapy decisions, dietary and metabolic contributors, coordination of long-term prevention strategy.
Fibromyalgia & Chronic Pain
Diagnosis and longitudinal management of fibromyalgia, with attention to sleep, exercise tolerance, mood, and pharmacotherapy options.
Tendonitis, Bursitis & Sports Injuries
Common overuse injuries — rotator cuff, plantar fasciitis, tennis and golfer's elbow, IT band syndrome. Conservative management and physical therapy coordination.
Carpal Tunnel & Compression Neuropathies
Workup of hand and arm numbness — exam, NCS/EMG referral when indicated, splinting and conservative management, surgical consultation when needed.
Neurological
The neurological symptoms that bring adults to primary care — most can be evaluated and managed without specialty referral, and the ones that need it get triaged quickly.
Headaches & Migraines
Tension, migraine, cluster, and mixed-pattern headaches. Identification of triggers, abortive and preventive therapy, lifestyle contributors, neurology referral when the picture warrants it.
Vertigo & Dizziness
Workup of dizziness — distinguishing vertigo from presyncope from disequilibrium, BPPV diagnosis and Epley maneuver, ENT or neurology referral when needed.
Numbness, Tingling & Peripheral Neuropathy
Workup of paresthesias — diabetic neuropathy, B12 deficiency, thyroid disease, alcohol-related, idiopathic. Appropriate testing and treatment of contributors.
Memory Concerns & Cognitive Screening
Office-based cognitive screening (MoCA), workup of contributing factors (sleep, mood, medications, thyroid, B12, vascular), and neurology or memory clinic referral for concerning patterns.
Tremor
Workup of essential tremor, drug-induced tremor, hyperthyroid tremor, and screening for Parkinson disease.
Stroke Risk & TIA Recovery
Cardiovascular risk reduction in patients with prior TIA or stroke, anticoagulation management for atrial fibrillation, blood pressure and lipid optimization.
Gastrointestinal & Liver
The day-to-day GI work of internal medicine — symptoms, screening, and coordination with gastroenterology when needed.
GERD & Reflux Disease
Gastroesophageal reflux — workup, lifestyle interventions, PPI and other medications, escalation pathway when refractory.
Irritable Bowel Syndrome (IBS)
Diagnosis, dietary approaches (low-FODMAP), gut-directed therapies, and gastroenterology coordination when the diagnosis isn't clear.
Constipation & Chronic Diarrhea
Workup of stool pattern changes — celiac and inflammatory bowel disease screening, lifestyle and medication review, prokinetic and laxative strategy.
Inflammatory Bowel Disease (IBD)
Crohn's disease and ulcerative colitis screening and longitudinal co-management with gastroenterology.
Liver Function & Hepatitis
Workup of elevated liver enzymes, hepatitis B and C screening (universal screening recommended for adults), fatty liver disease, autoimmune liver disease screening.
Hemorrhoids & Anorectal
Common anorectal complaints — appropriate workup, conservative management, colorectal referral when indicated.
H. pylori & Peptic Ulcer Disease
Testing and treatment of H. pylori, evaluation of dyspepsia, coordination of upper endoscopy when warranted.
Hematology, Nutrition & Deficiencies
The blood-count abnormalities and nutritional deficiencies that show up on routine labs — most are addressable from primary care without hematology referral.
Iron Deficiency & Anemia
Workup of iron deficiency anemia, including evaluation for the cause (menstrual losses, GI losses requiring colonoscopy), iron repletion strategy (oral vs IV), and follow-up to confirm correction.
Vitamin B12 Deficiency
B12 deficiency screening and treatment, evaluation of pernicious anemia, dietary contributors, and oral vs injection repletion.
Vitamin D Deficiency
Vitamin D testing and repletion, common in adults at northern latitudes, indoor lifestyles, and certain medication regimens.
Bleeding & Bruising
Initial workup of easy bruising or bleeding — CBC, coagulation studies, platelet count, hematology referral when indicated.
Lymph Node Concerns
Evaluation of enlarged lymph nodes — clinical exam, appropriate lab and imaging workup, prompt referral for concerning features.
Infectious Disease
Common adult infectious disease — both the acute illness work and the chronic conditions that need ongoing attention.
COVID-19 & Long COVID
Acute COVID-19 management, antiviral therapy when indicated, and longitudinal management of post-acute sequelae (long COVID) — fatigue, brain fog, exercise intolerance, dysautonomia.
Influenza, RSV & Other Respiratory Viruses
Vaccination, antiviral therapy when appropriate, and management of complications.
Lyme Disease & Tick-Borne Illness
Diagnosis and treatment of acute Lyme disease, longitudinal management of post-treatment Lyme symptoms, infectious disease referral for complex cases.
Shingles (Herpes Zoster)
Acute shingles treatment, post-herpetic neuralgia management, and Shingrix vaccination strategy for adults 50+.
Sexually Transmitted Infections
Screening, diagnosis, and treatment of common STIs — chlamydia, gonorrhea, syphilis, HSV, HPV, HIV. PrEP evaluation when appropriate.
Tuberculosis Screening
TB skin test or IGRA when occupationally or epidemiologically indicated, latent TB treatment when warranted.
Skin, Allergy & Dermatology
Common adult skin conditions and allergic disease that primary care manages directly, with dermatology referral for anything beyond.
Acne, Rosacea & Eczema
Adult acne, rosacea, atopic dermatitis, contact dermatitis. Topical and oral therapy, skincare counseling.
Psoriasis
Mild to moderate psoriasis management, screening for psoriatic arthritis, dermatology coordination for biologic therapy.
Skin Cancer Screening & Suspicious Lesions
Office skin exams, identification of suspicious moles or lesions, prompt dermatology referral for biopsy when warranted.
Allergic Rhinitis
Seasonal and perennial allergies, identification of triggers, antihistamine and intranasal steroid optimization, allergy referral for immunotherapy candidates.
Wound Care & Minor Procedures
Routine wound care, suture removal, ingrown nails, and other minor outpatient concerns.
Autoimmune & Rheumatologic
Initial workup of autoimmune conditions and longitudinal co-management with rheumatology.
Suspected Autoimmune Disease
Initial workup for unexplained fatigue, joint pain, rash, or multi-system symptoms — ANA, RF, anti-CCP, ESR, CRP, complement studies — and prompt rheumatology referral when warranted.
Polymyalgia Rheumatica
Diagnosis and management of polymyalgia rheumatica in older adults, with rheumatology consultation for complex or refractory cases.
Sjögren Syndrome
Evaluation of dry eyes and dry mouth, autoimmune workup, ophthalmology and rheumatology coordination.
Lupus Screening
Initial evaluation when systemic features suggest lupus, with rheumatology referral for confirmed disease.
Sexual & Reproductive Health
Sexual and reproductive health concerns that internal medicine handles, separate from the perimenopause and low-T sections above.
Contraception Management
Birth control counseling, prescription, and management for established members. IUD coordination with gynecology.
Polycystic Ovary Syndrome (PCOS)
Diagnosis and longitudinal management of PCOS — metabolic workup, fertility and endocrine considerations, gynecology and endocrinology coordination when warranted.
STI Screening & Treatment
Routine and symptom-driven STI screening, partner-notification counseling, treatment.
Erectile Dysfunction
Evaluation of cardiovascular contributors (ED is often the first sign of vascular disease), hormonal workup, and treatment options.
Vaccinations, Preventive Services & Travel
The preventive backbone — vaccinations, screening, and travel medicine — for adults across the life span.
Adult Vaccinations
Influenza, COVID-19, Tdap, shingles (Shingrix), pneumococcal (Prevnar 20, PPSV23 as applicable), HPV (eligible age groups), hepatitis A and B, MMR, varicella, RSV (eligible age groups). Personalized vaccine plan.
Tobacco Cessation
Evidence-based tobacco cessation — counseling plus pharmacotherapy (nicotine replacement, bupropion, varenicline). The single highest-leverage preventive intervention available.
Alcohol Use Counseling
Screening and brief intervention for alcohol use, evidence-based reduction strategies, naltrexone and acamprosate when appropriate.
Travel Medicine
Pre-travel consultation, destination-specific vaccinations, malaria prophylaxis, traveler's diarrhea prevention and treatment, altitude considerations, prescription medications for travel.
Pre-Operative Clearance
Internal medicine pre-operative evaluation for adults undergoing elective surgery — cardiovascular risk assessment, medication management, anticoagulation bridging coordination.
Geriatric & Aging-Specific
The aging-specific issues that adults 65+ face, integrated with our concierge longevity approach for those who choose that program.
Polypharmacy Review
Comprehensive medication review with attention to age-related risks (Beers criteria), simplification when possible, deprescribing when clinically appropriate.
Falls Risk & Prevention
Falls risk assessment, gait and balance evaluation, vision and hearing review, home environment counseling, physical therapy referral.
Cognitive Screening
Office cognitive screening (MoCA, Mini-Cog), evaluation of reversible contributors, and memory clinic referral when indicated.
Advance Directives & Goals of Care
Advance directive completion, durable power of attorney for healthcare, code status discussions, POLST when appropriate.
Hearing & Vision Coordination
Routine hearing and vision screening, prompt referral when concerns arise. Hearing loss is a major modifiable risk factor for cognitive decline.
Acute & Day-to-Day Concerns
The reachable-when-something-comes-up part of being an established member — without a phone tree.
Acute Illness
Upper respiratory infections, urinary tract infections, sinusitis, bronchitis, gastroenteritis, conjunctivitis. Evaluated promptly when established members reach out.
Headaches, GI Upset, Skin Issues
The everyday concerns that don't fit a category — workup and management without a six-week wait for an appointment.
Medication Refills & Adjustments
Prompt refills for established members, dose adjustments based on labs and symptoms, prior authorization handling.
Lab and Result Interpretation
Calls and messages to discuss new test results — not a portal note saying “normal.” If something matters, we explain why and what comes next.
Ready to Start?
If any of the above describes what you're working with — or if you simply want adult internal medicine done with the time and continuity it deserves — we'd be glad to talk.
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Established as a small-panel Direct Primary Care & Concierge Longevity Program practice serving Folsom, El Dorado Hills, Granite Bay, Roseville, Sacramento, Cameron Park, Rocklin, Orangevale, Fair Oaks, Loomis, and the greater Sacramento area.