Lifestyle and longevity medicine to help you stay strong as you age, and spine and brain care from a board-certified neurosurgeon who also performs surgery. Visits are by video, phone or in person.
Lifestyle and longevity medicine
A 75-minute visit covering all six pillars of lifestyle medicine, which labs to check, and which medications and supplements have evidence behind them. You leave with a written plan within three business days.
Not sure yet? Book a free 15-minute call.
Select a pillar to see what we work on.
Spine and brain surgery
A full evaluation from a neurosurgeon who performs minimally invasive spine surgery, including outpatient procedures. You get clear recommendations on conservative care, surgical options, and care after surgery and over the long term. Imaging, procedures and surgery are billed separately.
Every spine and brain visit starts with a free 15-minute phone call. I'll find out where your imaging was done and have it sent over, so your consult can be booked once I've reviewed it.
If surgery is the right choice, we'll go over where it would take place, and whether it can be done as an outpatient procedure, at your consult.
Smaller incisions and, for many procedures, going home the same day.
Learn moreTreatment recommendations for tumors, aneurysms, hydrocephalus, Chiari malformation and more.
Learn moreTold you need spine or brain surgery? An independent review, and if surgery is the right step, I can perform it.
Learn moreSpine trauma and brain injury after accidents, falls and sports injuries, including concussion.
Learn moreAn injection of your own platelet-rich plasma into a painful disc, an option to consider before fusion surgery. See the evidence.
Learn moreFor attorneys and organizations: record review, case consultation and expert opinions. Call for a quote.
Learn more
Board-certified neurosurgeon and Diplomate of the American Board of Lifestyle Medicine, with 20 years of complex cranial, neurovascular and spine surgery, including 16 years at Kaiser Permanente and a decade teaching Stanford neurosurgery residents.
Read my bio and CVRequest a video, phone or in-person time. Spine and brain visits begin with a free phone intake call so your imaging can be gathered first.
You get a secure link to the patient forms: consent, financial policy, a records release for spine and brain visits, and short health questionnaires.
We go through your history, imaging, labs and habits, and decide on next steps together.
Within three business days: my recommendations, any imaging or lab orders, prescriptions and referrals.
Optional 30-minute visits to review new labs, adjust the plan and keep momentum.
Heart disease, type 2 diabetes and many other chronic conditions are shaped by daily habits, and changing those habits often improves them. A longevity consult looks at all six pillars, the markers that predict how well you will age, and the short list of medications and supplements with real evidence behind them.
These are the six areas the American College of Lifestyle Medicine uses to prevent, treat and often reverse chronic disease. Your plan touches all six, with one or two chosen as the place to start.
Lifespan is how long you live. Healthspan is how long you stay strong, clear-headed and independent. The goal is to close the gap between the two, and the plan starts with numbers we can track.
Cardiorespiratory fitness (VO2 max) is one of the strongest predictors of how long people live. We estimate yours and build a plan to raise it.
Strength and muscle mass decline from midlife onward. Resistance training and enough protein help you stay independent into your 80s and 90s.
Atherosclerosis, insulin resistance and bone loss build silently for decades. Finding them early is what makes lifestyle changes and simple medications work.
Blood pressure, sleep, hearing, blood sugar and physical activity all shape cognitive aging. As a neurosurgeon, this is the part I care about most.
| Marker | Why it matters | What we do with it |
|---|---|---|
| ApoB and Lp(a) Heart and vessels | ApoB counts the particles that drive plaque. Lp(a) is a largely inherited risk factor that most people have never had measured. | Lp(a) once in a lifetime; ApoB as a treatment target alongside LDL. |
| Blood pressure Heart and brain | The most important modifiable risk for stroke and dementia. | Home readings, sodium and potassium, activity, sleep, and medication when needed. |
| HbA1c, fasting glucose and insulin Metabolic | Insulin resistance shows up years before diabetes. | Nutrition, post-meal walking, strength work; optional short trial of a glucose monitor. |
| Waist and body composition Metabolic | Visceral fat predicts risk better than weight alone. | Waist-to-height ratio at every visit; body composition scan when useful. |
| VO2 max and grip strength Fitness | Both track closely with longevity and independence. | Field tests or formal testing, then a zone 2 and interval plan. |
| Sleep and sleep apnea risk Recovery | Short or disrupted sleep raises cardiometabolic and cognitive risk. | Screening questionnaires, home sleep testing referral, a routine you can keep. |
| hs-CRP, kidney and liver panels Inflammation and organs | Baseline checks for inflammation and organ function. | Reviewed with your other labs to set priorities. |
| Bone density, vitamin D, B12 Aging well | Fracture risk and nutrient gaps are common and fixable. | DEXA when indicated; replace only what is low. |
| Age-appropriate screening Prevention | Colon, breast, cervical, prostate, lung and skin screening remain some of the most effective ways to catch cancer early. | We check what is due and coordinate with your primary care physician. |
Most of the benefit comes from the six pillars. Some medications have strong evidence when you need them, and a short list of supplements is worth considering. Many others cost more than the evidence supports. A few examples are below, each rated by the strength of its evidence.
Prescribed only after an evaluation shows they fit you. A consult does not guarantee a prescription.
For elevated ApoB or LDL and cardiovascular risk. Decades of outcome data.
When home readings stay high despite lifestyle changes. Protects the heart, kidneys and brain.
Worth considering for the right person. Dosing is set in your plan.
Improves strength and muscle gains from resistance training, especially after 50. Inexpensive and well studied.
Helpful when your level is low. Little benefit from extra if your level is already normal, so we test first.
These are a few examples. After your longevity consult you get the complete list to review, with each medication and supplement rated by evidence and matched to your labs, current medications and goals.
NAD boosters (NMN, NR), resveratrol, most "anti-aging" stacks, detox products and proprietary blends. The human evidence is thin, the dosing is unclear and the cost adds up. If you take something already, bring it and we will look at it together.
Safety first. Supplements can interact with prescription drugs, including blood thinners, and are not regulated like medications. Bring a list or photos of everything you take. I recommend products with USP or NSF third-party testing.
Ready to start? Book a longevity consult, or begin with a free 15-minute call.
Book a longevity consult, $395Start with a free 15-minute callI have 20 years of experience in complex cranial, neurovascular and spine surgery, and I perform minimally invasive spine surgery, including outpatient procedures. I'll explain what surgery can do for you and what the alternatives are. Every spine and brain visit starts with a free 15-minute phone call. I'll find out where your imaging was done and have it sent over, so your consult can be booked once I've reviewed it.
For neck and back pain, sciatica, pinched nerves, disc herniations, spinal stenosis, degenerative disc disease and brain conditions. The consult fee is $1,500. Imaging, procedures and surgery are billed separately.
I perform minimally invasive spine surgery through smaller incisions, with less muscle disruption. Many procedures are done as outpatient surgery, so you go home the same day when it is safe.
Treatment recommendations for conditions such as brain tumors, aneurysms and other vascular lesions, hydrocephalus, Chiari malformation and subdural hematoma.
Told you need spine or brain surgery, or told nothing more can be done? I review your imaging and records and give you an independent opinion. If surgery is the right step, I can perform it, including minimally invasive and outpatient spine procedures.
Spine trauma and traumatic brain injury after car accidents, falls, sports and work injuries, including concussion.
Platelet-rich plasma uses your own blood. It can be injected into a painful disc for chronic low back pain, or used for some tendon and joint problems. I offer it only when it fits your condition.
When you need something I don't provide, I send you to the right person and share what I found.
Not sure which visit fits? Book a spine or brain consult and we will sort it out together.
Book a surgical consultBook a brain consultRequest a second opinionBack pain treatment
If your back pain comes from a worn or torn disc and months of therapy haven't helped, an injection of your own platelet-rich plasma (PRP) into the disc may be worth trying before fusion surgery. In carefully selected patients, studies have reported meaningful improvement in about half to 70% of people, and some avoid or delay surgery. Others don't improve. Intradiscal PRP is still considered experimental, with a good safety record so far, and we'll go over the evidence together at your visit.
I review your history, exam and MRI to find the likely pain source and rule out problems that need surgery.
Sometimes a diagnostic test is used to confirm which disc is causing the pain.
A small amount of your blood is drawn and spun in a centrifuge to concentrate the platelets.
The PRP is placed into the disc through a thin needle under X-ray guidance, as an outpatient procedure.
Soreness for a few days is common. Activity and therapy build up gradually. In studies, relief usually appeared over 2 to 6 months, not right away.
I evaluate whether intradiscal PRP fits your case and perform the injection myself. Careful patient selection is the most important part of the process. If PRP doesn't help, surgery is still an option.
The studies below are the main clinical research to date, newest reviews first. Most are small. Results range from strong, lasting improvement to no difference from a placebo injection.
| Study | Design | What it found |
|---|---|---|
| Madrazo-Ibarra et al., PM&R, 2026 | Meta-analysis of 11 randomized trials, 623 patients | No significant difference between PRP and comparison treatments, with a trend favoring PRP at 3 and 6 months. Certainty of evidence rated very low. Two serious adverse events, both in PRP groups. |
| Manchikanti et al., Pain Physician, 2024 | Systematic review and meta-analysis of PRP and stem cell disc injections | Concluded intradiscal PRP may be effective for discogenic pain, supported by Level III evidence. |
| Navani et al., Pain Physician, 2024 | Multicenter crossover randomized trial, 40 patients | PRP and bone marrow concentrate improved pain and function more than placebo through 12 months, with no adverse effects. Small and open-label. |
| Schneider et al., The Spine Journal, 2022 | Systematic review | About half of patients (22 of 42) had more than 50% pain relief at 6 months or later. Overall evidence rated very low quality. |
| Schepers et al., Interventional Pain Medicine, 2022 | Randomized trial, 89 patients without Modic changes | No significant difference from a control injection at 12 months. One disc infection occurred in the PRP group. |
| Akeda et al., Journal of Clinical Medicine, 2022 | Double-blind randomized trial, PRP releasate vs. steroid | Pain improved about as much as with a steroid injection at 8 weeks. |
| Zhang et al., Stem Cells International, 2022 | Prospective trial, single injection, 31 patients | 71% (22 of 31) had clinically significant improvement in pain and function at 48 weeks. Patients were strictly selected, with pain confirmed by discography. |
| Akeda et al., Medicina, 2022 | Long-term follow-up of 11 patients | 91% still had meaningful improvement in pain and disability at about 5.9 years. Disc height decreased slightly (about 14%). |
| Zielinski et al. | Multicenter placebo-controlled trial, stopped early at 26 patients | No difference between PRP and saline at 8 weeks. |
| Cheng et al., Regenerative Medicine, 2019 | 5 to 9 year follow-up of patients from the 2016 trial | Significant, clinically meaningful improvements in pain and function. Six patients had surgery during follow-up. |
| Tuakli-Wosornu et al., PM&R, 2016 | Double-blind randomized trial at Hospital for Special Surgery | PRP improved pain, function and satisfaction more than a control injection at 8 weeks. Function gains held at 1 year. |
Results depend heavily on choosing the right patient and the right disc. With strict selection, studies report meaningful relief in about half to 70% of patients, and some show it lasting for years. Serious complications have been uncommon, mainly rare disc infections. The best-controlled trials still disagree, so intradiscal PRP remains experimental: a reasonable option to try before fusion, not a guaranteed fix. It has not been proven to regrow a damaged disc.
| Condition | Evidence | Summary |
|---|---|---|
| Tennis elbow (lateral epicondylitis) | Moderate to strong | Steroid injections work faster in the first 2 months. PRP gives better pain relief and function at 6 months and beyond. |
| Plantar fasciitis | Moderate | Similar to steroid in the short term, with better long-term pain relief in heel pain lasting more than 12 weeks. |
| Knee osteoarthritis | Mixed | Several meta-analyses favor PRP over hyaluronic acid and steroid injections. A large, well-designed 2021 trial of 288 patients (RESTORE) found no benefit over saline at 12 months. PRP has more minor side effects than placebo. |
| Disc-related low back pain | Limited | Promising in selected patients, with mixed results in randomized trials (see above). |
Important to know. PRP is made from your own blood using devices cleared by the FDA. The FDA has not approved PRP as a treatment for back pain or any specific condition, so its use here is considered off-label, and intradiscal PRP is still considered experimental. Most insurance plans consider PRP investigational and don't cover it. PRP is self-pay, quoted per treatment, and you receive a Good Faith Estimate before any procedure. Results vary, and no outcome is guaranteed.
Wondering whether your back pain could respond to PRP, or whether surgery makes more sense?
Book a PRP evaluationBook a surgical consultAfter your visit is booked, you'll get a secure link to complete these forms online. Most people finish in about 10 minutes. Please don't send forms or health information through this website or by regular email.
Standard questionnaires show how you're doing before care and at each follow-up. They take 5 to 10 minutes.
Questions about a form? Call 650-454-5954, Monday to Friday, 9 am to 5 pm.
For attorneys, insurers and organizations who need a neurosurgeon's opinion on spine and brain conditions, including trauma. I am board-certified in neurosurgery, with 20 years of experience in complex cranial, neurovascular and spine surgery, including 16 years at Kaiser Permanente, and I provide medical-legal evaluations and expert testimony in personal injury cases.
Review of medical records, MRI, CT and X-ray studies, with a written summary of findings and care.
A call to talk through the medical facts of a spine or brain injury case and the treatment involved.
Neurosurgical opinions on diagnosis, treatment and future care for spine trauma and traumatic brain injury.
Every case is quoted individually. Call 650-454-5954, Monday to Friday, 9 am to 5 pm, or request a quote call online.
Prices are listed below. There is no membership fee or subscription. See the patient forms for the full financial policy.
Spine or brain · begins with a free 15-minute phone intake
Good Faith Estimate. If you are uninsured or not using insurance, you have the right to a written estimate of expected charges before your visit. Ask the office, or see .
Insurance. Visits are self-pay. You receive an itemized superbill to submit for possible out-of-network reimbursement, and many patients pay with an HSA or FSA card.
Labs and medications are billed separately by the lab or pharmacy, usually through your insurance. I will tell you which tests are worth it before ordering.
| Spine, brain and specialty services | Fee |
|---|---|
| Surgical consult, spine or brain. Full evaluation with recommendations for conservative management, surgical options, and post-operative and long-term care | $1,500. Imaging, procedures, surgery, and hospital or surgery center fees are billed separately |
| Brain consult and treatment recommendations | Quoted case by case |
| Second opinion, spine or brain | Quoted after a look at your records and imaging |
| Spine or brain trauma consult | Quoted case by case |
| PRP evaluation, including intradiscal PRP for back pain | Quoted per treatment after evaluation |
| Expert consultation (attorneys and organizations) | Request a quote |
I'm a neurosurgeon with 20 years of experience in complex cranial, neurovascular and spine surgery. I earned my medical degree at the Medical College of Wisconsin, where I was elected to Alpha Omega Alpha, then completed my surgery internship and neurosurgery residency at Case Western Reserve University and University Hospitals of Cleveland. I stayed on as a clinical instructor in cerebrovascular neurosurgery before moving home to California.
For 16 years I was an attending neurosurgeon at Kaiser Permanente in Redwood City, a partner from 2013, and a teaching attending for Stanford neurosurgery residents from 2016. I brought minimally invasive approaches into routine use there, including BrainPath parafascicular brain surgery, lateral (XLIF) and MIS-TLIF fusion, and tubular spine decompression, and I've worked with spine device companies on instrument design. Today I'm a neurosurgeon at Sierra Coast Interventional Pain, caring for spine conditions and traumatic injuries, and I perform minimally invasive spine surgery, including outpatient procedures.
Over the years I saw that many of the conditions bringing people to surgery had been building for a long time, shaped by sleep, activity, diet, stress and relationships. That led me to become a Diplomate of the American Board of Lifestyle Medicine. When you ask me whether you need surgery, you get an answer from someone who has spent 20 years in the operating room and who also knows what else can help.
I grew up in Granada Hills and now live on the Peninsula, where I'm raising three kids and a beagle named Samba. Off duty I ski, mountain bike, play pickleball, cheer for the 49ers, tend the backyard chickens and try out new material at the Rooster T. Feathers comedy club in Sunnyvale.
Choose a visit, pick video or in person, and request a time. The office confirms by email within one business day. Prefer to call? Reach the office at 650-454-5954, Monday to Friday, 9 am to 5 pm.
No. I work alongside your primary care physician and send them a copy of your plan if you'd like. I handle prevention, lifestyle and longevity questions; your PCP remains your home base for everyday medical care.
In-person visits are at the Daly City office on Monday mornings. More locations are coming soon. Intradiscal PRP is performed by Dr. Lavery after an evaluation; other PRP injections are referred to trusted providers.
California residents who are physically in California at the time of the visit. Before your first video visit, you'll be asked for your consent to receive care by telehealth. If you are traveling out of state, we will move your visit or switch it to in person.
No. If you have labs from the past year, upload them with your questionnaire. If not, I order what is useful after we talk, so you aren't paying for tests you don't need.
Visits are self-pay. You receive an itemized superbill for possible out-of-network reimbursement. Labs, imaging and medications usually go through your insurance as normal.
If a medication is clearly indicated and safe for you, yes. Some decisions wait until labs come back. I don't prescribe on request without an evaluation.
Either works. I can review MRI, CT and X-ray studies you already have, or order new imaging when it would change the plan. You get a secure link to send images and reports after your visit is confirmed.
No. I've operated for 20 years, so I can tell you directly when surgery is the right call. When it isn't, or when something else is worth trying first, I'll say that too. If you do need surgery, you can have it with me.
Your MRI, CT scans and X-rays are the most important part of a spine or brain consult. On a free 15-minute call, I find out where your imaging was done and have it sent to me. Once I've reviewed it, we book your consult, so the visit is spent on your options instead of waiting for films.
Yes. I perform minimally invasive spine surgery, and many procedures are done as outpatient surgery so you can go home the same day. Where your surgery takes place is discussed at your consult. A surgical consult comes first; the consult fee is $1,500. Surgery, imaging and facility fees are billed separately, and you receive a Good Faith Estimate before any scheduled procedure.
Yes. Accident and injury cases are reviewed case by case. Check the box in the booking form and let the office know your attorney's contact details when they reply.
It depends on the condition. PRP has the best evidence for tennis elbow and some tendon problems, mixed evidence for knee osteoarthritis, and early, mixed evidence for disc-related back pain. See the evidence. I recommend it only after an evaluation, and it is usually not covered by insurance.
Reschedule or cancel at no charge with at least 24 hours' notice. Later cancellations and missed visits are charged in full.
No. For a medical emergency, call 911. For new or worsening symptoms, contact your primary care physician or urgent care.