Category Archives: Uncategorized

Charge Description Master (CDM)

The Charge Description Master (CDM), or chargemaster, is a comprehensive listing of items that could be billed to a patient, payer or healthcare provider.

Effective July 1, 2004, the State of California established the Payer’s Bill of Rights, which requires that each hospital:

  1. Make a copy of its CDM available to the public
  2. Have available by request a list of the 25 most common procedures or services and three room rates

In compliance with California Law, a hardcopy of Coalinga Regional Medical Center’s chargemaster is available to the public for viewing Monday through Friday from 10 a.m. to 3 p.m. (excluding holidays) by visiting:

Patient Financial Services
Coalinga Regional Medical Center
1191 Phelps Avenue
Coalinga, CA 93210
Phone: xxx-xxx-xxxx

Back Pain

One of the most common ailments that affect almost everyone sometime during their lifetime is back pain. Most cases of back pain are minor and self-limited. Other times severe or persistent back pain may be a symptom of a serious disorder that requires prompt evaluation and treatment. Musculoskeletal back pain (such as strains and sprains) is by far the most frequently seen by healthcare practitioners. This type of pain may be minor and annoying or quite severe and debilitating. Conservative therapy such as rest, ice, heat, and anti-inflammatory medications such as ibuprofen, pain medications such as acetaminophen, massage, stretching, and possibly physical therapy for persistent symptoms is indicated. Recovery usually takes days to weeks.

Other causes of back pain may stem from disease processes in other organ systems including the lungs, heart or aorta, kidneys, pancreas, or gut. For example, pneumonia or pleurisy may cause back pain that is worsened by breathing. Severe tearing pain between the shoulders or lower down the back may be caused from a dissection (tear) or aneurysm (bulging) of the aorta (the large vessel exiting the heart and supplying the body with blood). A heart attack or myocardial infarction that affects the posterior portion of the heart may cause quite severe back pain. Kidney infections or kidney stones may be the origin of excruciating back pain that often radiates down to the groin. Associated symptoms may include fever or vomiting. Inflammation of the pancreas (pancreatitis), ulcers, and gall bladder disease are examples of GI ailments that can present as back pain. A pinched nerve (often from a bulging or ruptured disc in the back) may cause quite severe pain radiating down the leg and occasionally is associated with weakness and/or numbness in the affected leg. Any numbness in the groin area or problems with bowel or bladder function should be evaluated promptly.

How is a patient supposed to determine if his or her back pain is being caused by a simple back strain or sprain or by some of the more serious conditions outlined above? As a general rule, the more benign, self-limited back disorders are milder in intensity, intermittent, associated with activity and relieved by rest. Improvement is often noticed by using over-the-counter medications such as ibuprofen or acetaminophen. The more serious causes of back pain often present as more severe pain that is not relieved by rest and often is serious at night. Frequently other associated symptoms are present such as fever, chills, sweating, vomiting, cough, shortness of breath, etc. As always a visit to your local primary care provider is in order if the origin of the pain is unclear or the pain is severe or persistent.

Article written by Gary Towle, MD



Did you ever feel sad or blue? How about trouble sleeping or no energy? Everyone occasionally experiences these problems, but if these moods seem to occur without provocation or start to affect your daily life, then you may have a depressive disorder. Transient periods of sadness, crying, insomnia can occur naturally in a healthy individual in the settings of job loss, divorce, death of a loved one, etc. However, if someone is experiencing extended periods of a sad mood, feelings of low self-esteem, helplessness, hopelessness, inappropriate guilt, impaired concentration or memory, or has lost interest in participating in activities that were previously enjoyable to them, or is experiencing thoughts of suicide, then they may have a major depressive disorder. This illness may affect one’s family life, school, work or occupation, as well as their general health. Diminished appetite as well as insomnia occur frequently. Depression can occur at any age but most often affects individuals in the 20-40 year old age group. Depressive episodes can last weeks, months, or years.

The causes of depressive illnesses are many, including psychological factors, social factors, biological factors, and hereditary. Fortunately, most cases of depression will improve with therapy. The most common treatments are antidepressant medications which can affect the chemical imbalances in the brain and psychotherapy. The most promising psychotherapy currently is Cognitive Behavioral Therapy (CBT). Often patients are treated with a combination of medications and psychotherapy. Other therapeutic strategies include meditation, music, and exercise. Substance abuse is often associated with depression and may be a cause of the depression or may be the result of an individual attempting to medicate themselves with alcohol and/or mood altering drugs. Any substance abuse issues must be addressed and treated in order for the depressive illness to be successfully treated. Anyone experiencing the above symptoms should see their primary care provider and be evaluated for a possible depressive illness.

Article written by Gary Towle, MD.


Valley Fever

Valley fever (coccidiomycosis or coccidioidomycosis) is a common fungal infection found in people living and/or working in the San Joaquin Valley area of California as well as portions of Arizona, Utah, New Mexico, Texas, Nevada, and Mexico. The disease is caused by inhaling fungal spores that are transported by the wind often associated with construction, farming, or ranching activities which have stirred up the soil. Valley fever is not passed from one person to another. Symptoms of the infection can range from unnoticeable to very severe and usually appear 1-3 weeks after exposure when an individual has inhaled the spores into his or her lungs. Common symptoms of valley fever include fever, chills, night sweats, cough, chest pain, headache, fatigue, achy muscles and/or joints or a bumpy red rash often found on the shins. Often the patient may feel like they just have the “flu.” The severity of the symptoms is often dependent on the dose of spores inhaled and the patient’s overall health status. Frequently, mild cocci or a suspicious spot shows up on a later chest x-ray. Chronic cases of cocci pneumonia may present as chronic chest discomfort, cough (with or without bloody phlegm), fever, or unexplained weight loss. Widespread or disseminated cocci infections can be life-threatening and affect the skin, bones, heart, liver, brain, or brain membranes (meninges).

There are multiple risk factors for severe pneumonia or disseminated infection. These factors include environmental exposure issues such as construction workers, farmers, ranchers, archaeologists, and military personnel on field maneuvers. Filipinos, Asians, African-Americans, Native Americans, and Hispanics are also a greater risk for unknown reasons. Aging increases risk as does pregnancy. Anyone with a compromised immune system is at increased risk such as individuals with HIV/AIDS, cancer, chemotherapy treatments, anti-rejection drug therapy for organ transplant recipients, and people on long term steroid therapy.

Treatment of mild cases is simply fluids and rest. Most cases resolve spontaneously without medication. More severe or persistent cases may need anti-fungal medication such as fluconazole. Most people are immune after a single infection but individuals with weak immune systems may develop re-infection. There is currently no vaccine available for valley fever. Anyone concerned that, they may have valley fever should contact their local health care provider for evaluation.

Article written by Gary Towle, MD.


What should I do to prepare for this flu season?

CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine is designed to protect against the three main flu strains that research indicates will cause the most illness during the flu season. Getting the flu vaccine as soon as it becomes available each year is always a good idea, and the protection you get from vaccination will last throughout the flu season.
In addition, you can take everyday preventive steps like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading influenza to others.

Read more on CDC website.

Bronchial Thermoplasty provides long-term asthma control

Bronchial Thermoplasty (BT) is a non-pharmacologic treatment for asthma that has been shown to result in significant improvements in a number of asthma control measures in three randomized clinical trials in patients with moderate-to-severe, persistent asthma. The Asthma Intervention Research 2 (AIR2) Trial, a double-blind, sham-controlled, randomized clinical trial of BT in patients with severe asthma, showed a 32% reduction in severe exacerbations, an 84% reduction in emergency room (ER) visits due to respiratory symptoms, and a 66% reduction in time lost from work/school/other daily activities due to asthma symptoms compared to a sham-treated group in the first year following the BT treatment period (day of first BT procedure until 6 weeks after the last bronchoscopy, approximately 12 weeks).

Read more on AAAAI website