Patient had been to multiple facilities with no clear diagnosis and lot of work up for other unrelated diagnosis.  (Sign of failed Healthcare System of America.. Lot of tests but no physician time that can save the patient from harm)


Patient presented to the clinic with complaint of cough and then during the discussion said "I also have swelling in the legs" . Physical examination revealed swollen lymph nodes and we saw that patient's earlier clinician(non-physician) missed the signs and instead diagnosed the swollen lymph nodes  as a  mass (it was not. It was  lymphadenopathy) and planned a biopsy and did that too (probably) with no conclusions.

Long story short we rescue the patients and we diagnosed active TB  in the very first visit itself and hence this post. 


First. TB is a preventable disease and, barring instances of extreme drug resistance, is 100% treatable. But making sure patient adheres to the treatment plan is the key.


Unlike other practices we focus on getting things right so we order Quantiferon gold test and only when required we order radiology tests to confirm. 

We have found that skin tests are prone to false positives due to earlier exposure to the TB disease. 

Once we have diagnosed, we make sure patient gets the best treatment at the Denver's best TB clinic and continue to monitor patient for all the primary care needs other than TB treatment. 


Symptoms of TB

Typical symptoms of TB include:

  • a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody
  • weight loss
  • night sweats
  • high temperature (fever)
  • tiredness and fatigue
  • loss of appetite
  • swellings in the neck

You should see a Dr. Kamat if you have a cough that lasts more than three weeks or you cough up blood.

TB that affects the lungs (pulmonary TB)

Most TB infections affect the lungs, which can cause:

  • a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody
  • breathlessness that gradually gets worse

TB outside the lungs

Less commonly, TB infections develop in areas outside the lungs, such as the small glands that form part of the immune system (the lymph nodes), the bones and joints, the digestive system, the bladder and reproductive system, and the brain and nerves (the nervous system).

Symptoms can include:

  • persistently swollen glands
  • abdominal pain
  • pain and loss of movement in an affected bone or joint
  • confusion
  • a persistent headache
  • fits (seizures)

TB affecting other parts of the body is more common in people who have a weakened immune system.



Treating TB

With treatment, TB can almost always be cured. A course of antibiotics will usually need to be taken for six months.

Several different antibiotics are used because some forms of TB are resistant to certain antibiotics.

If you're infected with a drug-resistant form of TB, treatment with six or more different medications may be needed.

If you're diagnosed with pulmonary TB, you'll be contagious for about two to three weeks into your course of treatment.

You won't usually need to be isolated during this time, but it's important to take some basic precautions to stop the infection spreading to your family and friends.

You should:

  • stay away from work, school or college until your TB treatment team advises you it's safe to return
  • always cover your mouth when coughing, sneezing or laughing
  • carefully dispose of any used tissues in a sealed plastic bag
  • open windows when possible to ensure a good supply of fresh air in the areas where you spend time
  • avoid sleeping in the same room as other people 

If you're in close contact with someone who has TB, you may have tests to see whether you're also infected. These can include a chest X-ray, blood tests, and a skin test called the Mantoux test.


Care Plan.

We work in Denver's TB Clinic to create an individualized care plan to treat and cure you.   Please talk to Dr. Kamat on what is your care plan and keep your follow ups with Dr. Kamat. 




What is depression?

Depression is a disorder that makes you sad, but it is different than normal sadness. Depression can make it hard for you to work, study, or do everyday tasks.

How do I know if I am depressed?

Depressed people feel down most of the time for at least 2 weeks. They also have at least 1 of these 2 symptoms:

They no longer enjoy or care about doing the things they used to like to do.

They feel sad, down, hopeless, or cranky most of the day, almost every day.


Depression can also make you:

Lose or gain weight

Sleep too much or too little

Feel tired or like you have no energy

Feel guilty or like you are worth nothing

Forget things or feel confused

Move and speak more slowly than usual

Act restless or have trouble staying still

Think about death or suicide


If you think you might be depressed, see your doctor or nurse. Only someone trained in mental health can tell for sure if you are depressed.


See someone right away if you want to hurt or kill yourself!

If you ever feel like you might hurt yourself or someone else, do one of these things:

Call your doctor or nurse and tell them it is urgent


Call for an ambulance (dial 9-1-1)


Go to the emergency room at your local hospital


Call the National Suicide Prevention Lifeline: ( dial 1-800-273-8255)


What are the treatments for depression?

People who have depression can get 1 or more of the following treatments:

Medicines that relieve depression

Counseling (with a psychiatrist, psychologist, nurse, or social worker)

A device that passes magnetic waves or electricity into the brain


People with depression that is not too severe can get better by taking medicines or talking with a counselor. People with severe depression usually need medicines to get better, and might also need to see a counselor.

Another treatment involves placing a device against the scalp to pass magnetic waves into the brain. This is called "transcranial magnetic stimulation" or "TMS." Doctors might suggest TMS if medicines and counseling have not helped.

Some people whose depression is severe might need a treatment called "electroconvulsive therapy" or "ECT." During ECT, doctors pass an electric current through a person's brain in a safe way.



When will I feel better?

Both treatment options take a little while to start working.

Many people who take medicines start to feel better within 2 weeks, but it might be 4 to 8 weeks before the medicine has its full effect.


Many people who see a counselor start to feel better within a few weeks, but it might take 8 to 10 weeks to get the greatest benefit.


How do I decide which treatment to have?

You and your doctor or nurse will need to work together to choose a treatment for you. Medicines might work a little faster than counseling. But medicines can also cause side effects. Plus, some people do not like the idea of taking medicine.

On the other hand, seeing a counselor involves talking about your feelings with a stranger. That is hard for some people.


If the first treatment you try does not help you, tell your doctor or nurse, but do not give up. Some people need to try different treatments or combinations of treatments before they find an approach that works. Your doctor, nurse, or counselor can work with you to find the treatment that is right for you. He or she can also help you figure out how to cope while you search for the right treatment or are waiting for your treatment to start working.

 Our Plan and Support for you.

Recently we realized that many of our patients have depression and hence we have started screening depression. Please ask for a depression screen every time you are in the clinic. If we diagnose depression we have in house tele-medicine to connect you to a caring counselor to start your sessions from the clinic itself. Please ask your clinician to help you set up with VICI.  Once you are set up with VICI your medication management can be done by us while you continue to improve using counseling.  We have seen remarkable improvement in patients who use counseling as well as medication.  We are also starting an integrative medicine approach using 5000 year old science called Ayurveda. Please talk to the front desk.

Kidney Stones

What are kidney stones?

Kidney stones are just what they sound like: small stones that form inside the kidneys. They form when salts and minerals that are normally in the urine build up and harden.

Kidney stones usually get carried out of the body when you urinate. But sometimes they can get stuck on the way out. If that happens, the stones can cause:

Pain in your side or in the lower part of your belly

Blood in the urine (which can make urine pink or red)

Nausea or vomiting

Pain when you urinate

The need to urinate in a hurry


How do I know if I have kidney stones?

If your doctor or nurse thinks you have kidney stones, he or she can order an imaging test that can show the stones.

What if I have kidney stones?

Once we have confirmed the stones, we also order additional type of tests to ascertain type, size and location so that we can create an individual treatment plan to get rid of the stones and also teach you how to prevent kidney stones in future.

Each person's treatment is a little different. The right treatment for you will depend on:

The size, type, and location of your stone

How much pain you have

How much you are vomiting


If your stone is big or causes severe symptoms, you might need to stay in the hospital. If your stone is small and causes only mild symptoms, you might be able to stay home and wait for it to pass in the urine. If you stay home, you will probably need to drink a lot of fluids. Plus, you might need to take pain medicines or medicines that make it easier to pass the stone.

Stones that do not pass on their own can be treated with:

A machine that uses sound waves to break up stones into smaller pieces. This is called "shock wave lithotripsy." This procedure does not involve surgery, but it can be painful.


A special kind of surgery that makes very small holes in your skin. During this surgery, the doctor passes tiny tools through the holes and into the kidney. Then he or she removes the stone. This is called "percutaneous nephrolithotomy."


A thin tube that goes into your body the same way urine comes out. Doctors use tools at the end of the tube to break up or remove stones. This is called "ureteroscopy."


How to prevent kidney stones from forming? 

One simple thing you can do is to drink plenty of water. You might also need to change what you eat, depending on what your kidney stones were made of. If so, your doctor or nurse can tell you which foods to avoid. Your doctor or nurse might also prescribe you new medicines to keep you from having another kidney stone.


Please tell me more about what dietary modifications I need to make?

It depends on the type of the stone. Ask us to do 24 hours urine test to understand what dietary contributing factors are responsible.  Based on that we can suggest changes. 


Some of the generic modifications we suggest are as follows.

From the viewpoint of diet, alterations in fluid, calcium, oxalate, potassium, phytate, animal protein, sucrose, fructose, sodium, and supplemental vitamin C intake may be beneficial. We therefore recommend the following for all patients with calcium oxalate stones:

Sufficient fluid intake distributed throughout the day to produce at least 2 liters of urine per day, including drinking at night (although it is not essential that the patient wake up several times per night to urinate). This will increase the urine flow rate and lower the urine solute concentration, both of which may protect against stone formation.


To reach this goal, the best strategy is to recommend how much additional fluid the patient should drink based upon his or her 24-hour urine volume. As an example, if the total urine volume is 1.5 liters, then we recommend two additional 8 ounce (240 mL) glasses of fluid each day to reach the goal of at least 2 liters of urine output per day.


Adequate dietary calcium intake. While excessive calcium intake should certainly be avoided, dietary calcium restriction is not appropriate, as it may increase the risk of stone formation and also lead to reduced bone mineral density. Several servings of dairy or other calcium-rich foods to reach 800 to 1000 mg/day are encouraged.


Avoiding excessive animal protein in the diet. Although it has not been proven that a low-protein diet will reduce the incidence of stone formation, a high-animal protein diet is a risk factor for renal stones in men and older but not younger women [13].


Limiting dietary sodium to 100 mEq/day. A low-sodium diet can enhance proximal sodium and calcium reabsorption, leading to a reduction in calcium excretion.


Increasing dietary potassium intake, as this is associated with substantially reduced risk in men and women.


Limiting dietary sucrose and fructose.


Limiting intake of high oxalate foods and supplemental vitamin C in patients with calcium oxalate stones. However, excessive restriction of oxalate is not likely to be helpful; patients should continue to consume a wide variety of fruits and vegetables.


Drug therapy is indicated if the stone disease remains active (as evidenced by the formation of new stones, enlargement of old stones, or the passage of gravel) or adequate improvements are not realized in urinary chemistries despite attempted dietary modification over a three- to six-month period.

Initial drug therapy varies with the metabolic abnormality that is present:

Thiazide diuretics for reducing urinary calcium excretion

Allopurinol for high urine uric acid

Potassium citrate or potassium bicarbonate for low urine citrate

Bipolar Disorder

What is bipolar disorder?

Bipolar disorder (sometimes called "manic depression") is a brain disorder that causes extreme changes in mood and behavior. Bipolar disorder can run in families.

What are the symptoms of bipolar disorder?

People with bipolar disorder can feel much happier or much sadder than normal. If you have bipolar disorder, you might feel very happy for many days and then feel very sad.

When your mood is very happy, you can also:

Get angry quickly

Be more active than normal

Feel like you have special powers

Feel like you don't need sleep

Make poor choices without thinking

Start lots of things and not finish them


Other times, your mood might be very sad for most of the day, every day. When your mood is very sad, you can also:

Lose or gain a lot of weight

Have trouble falling asleep or sleep too much

Feel very tired

Not enjoy things

Feel bad about yourself

Think about death or hurting yourself


People with bipolar disorder might have trouble at work or school. They might not get along well with their family and friends.


Is there a test for bipolar disorder?

No. There is no test. But your doctor or nurse should be able to tell if you have it by talking with you and your family. He or she will ask about your mood and what you have been feeling and doing. Your doctor or nurse might also do an exam and order blood tests to look for other problems.

How is bipolar disorder treated?

Bipolar disorder is treated with medicine. Medicines sometimes take a while to start working. Plus, it sometimes takes a few tries to find the right medicine or combination of medicines.

You and your doctor will work together to find the medicine that works best for you. All of the medicines for bipolar disorder affect the brain. They can:

Keep your mood stable and prevent big mood changes

Calm your mind

Make your sadness go away


Medicines sometimes cause side effects.

You might also need to stay in the hospital for a short time. When a bipolar disorder mood episode starts, you might be at risk of hurting yourself or others. You might hear voices that other people do not hear. You might believe things that are not true. But if you are at the hospital, the doctors can treat these symptoms and keep you safe.

Some people whose bipolar disorder makes them feel very sad might need "shock treatment" to get better. Doctors call this treatment ECT. During ECT, doctors pass a small amount of electricity (called an "electrical current") through a person's brain in a safe way. This causes chemical changes in the brain that relieve severe depression.

In addition to medicine, psychotherapy (counseling) can help. This involves meeting with a therapist to talk about your feelings, thoughts, and life. There are different types of psychotherapy. In general, they all focus on helping you learn new ways of thinking and behaving, so you can better cope with your bipolar disorder.


Is there anything I can do to prevent big mood changes in the future?


Yes. After your symptoms have gone away, you will probably:

Keep taking medicine every day to help prevent big changes in your mood and behavior

Go to psychotherapy sessions to help you get along better with family and friends

Bacterial Vaginosis

Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge. BV is not a sexually transmitted infection (STI), but it can increase your risk of getting an STI such as chlamydia.




The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong fishy smell, particularly after sex.

You may notice a change to the color and consistency of your discharge, such as becoming greyish-white and thin and watery.

But 50% of women with bacterial vaginosis do not have any symptoms.

Bacterial vaginosis does not usually cause any soreness or itching.


If physician feels that you have BV, she asks you to provide vaginal fluid sample. This sample collection can be done at our clinic and it is then sent to a lab for DNA amplification probe that tests for following infections.

 Candida species
 Gardnerella vaginalis
 Trichomonas vaginalis

The results then are typically available in two business days and if your sample is positive for any of these infections, appropriate medication is called in to your pharmacy. Your pharmacy will call you. 


You can get your results from the lab directly if you have an online account with them. You can also request a copy from us on your secure email or on the portal. 


Depending on the test results, we call in one of these medications to your pharmacy.

Metronidazole 500 mg orally twice daily for seven days

Metronidazole 250 mg orally three times daily for seven days

Clindamycin 300 mg orally twice daily for seven days

Why get treated:

The condition is not usually serious, but you'll need to be treated with antibiotics if you do have BV because BV increases your risk for getting other sexually transmitted diseases.



To help relieve symptoms and prevent bacterial vaginosis returning: 

  • use water and plain soap to wash your genital area
  • have showers instead of baths
  • do not use perfumed soaps, bubble bath, shampoo or shower gel in the bath
  • do not use vaginal deodorants, washes or douches
  • do not put antiseptic liquids in the bath
  • do not use strong detergents to wash your underwear
  • do not smoke


What to do if you still do not feel better after treatment?


Please book an appointment from online and see doctor once again face to face.  


At the time of office visit, please present your insurance card.  We bill your visit to the insurance card you present. 

In the event of an error in your insurance, please let our front office staff know.

We are in network with most insurances. However individual plans may vary and not known till a claim is adjudicated.

We are a smoke free facility.

We need every patient to finish all the forms online and check in online if possible. 

Most visits start on time, so please plan to be at the office, fifteen minutes before your appointment.

Habitual no show patients are terminated from the patient panel.

We charge a no show fee.

If you are not able make the commute, or take time off for commute , explore tele medicine available now.