San Diego Physicians Answer Your Most-Asked Questions
The county's medical experts break down some of the field’s most complex and pressing inquiries surrounding heart disease, Medicaid, cancer treatments & more
Heart disease is the leading cause of death in the US. Scripps Clinic electrophysiologist Dr. Doug Gibson; Kaiser Permanente cardiologist Dr. Bahram Khadivi; and Dr. Jia Shen, cardiologist and director of the Bankers Hill cardiovascular clinic at UC San Diego Health, weigh in on why—and what advancements might help change that stat.
Why is heart disease so prevalent in America today?
Dr. Doug Gibson: The simplest way to think about it is that, for most of modern human history, we haven’t had easy access to unlimited resources such as food, [and] we had to expend more physical energy to acquire these resources. We got more exercise, and we didn’t have processed foods at the convenience store down on the corner. Modern human genetics are largely the result of that scarcity that we all lived through as human beings over the last 500 years. These genetics don’t do well with easy access to unlimited resources and lack of exercise. The end result is that, because of the agricultural and industrial revolutions, humans have had to expend less effort to acquire resources such as food. This has resulted in more risk factors associated with cardiovascular disease, such as high blood pressure, diabetes, and obesity.
Generally, cardiologists will advise patients at risk for heart disease to achieve or maintain a healthy weight. GLP-1 or semaglutide medications have made the news in recentyears as a revolutionary weight loss solution—but I can’t help think of the fen-phen craze of the 1990s, which supported weight loss but turned out to damage the heart valves. Has research been done on GLP-1s’ impact on heart health?
Dr. Bahram Khadivi: Weight loss by lifestyle modification tends to be more permanent because new habits have been formed. This avoids medications and their side effects. However, there are some patients that truly struggle, and we will take any avenue for weight loss, because we know it will help them. These medications are indicated for patients who have risk factors for heart disease, and [we] also take into account body mass index. Widespread use of these medications is concerning as we don’t know [enough about potential] long-term side effects, such as loss of muscle mass and effects on vision.
Dr. Jia Shen: GLP-1s are very popular for weight loss, but they also have cardiovascular benefits. [Previously,] some diabetes medications were shown to improve [blood] sugar but also lead to worse cardiac outcomes, so a lot of the newer diabetes medicines have to prove that they’re not harmful to your heart. Because of that, [researchers] measure cardiovascular outcomes when they’re testing these medicines in the population. [A landmark trial] looking at semaglutide in diabetics found about a 26 percent risk reduction in cardiovascular endpoints. Then they took that one step further and asked, “Well, do we find [a similar] benefit in people that have obesity, but not diabetes?” It was true—there was about a 20 percent relative risk reduction in cardiovascular outcomes.
We find that not only do people lose significant amounts of weight with [semaglutide]—I believe it is around 15 percent of their total body weight—they also have vast improvements in their blood pressure, cholesterol, triglycerides, and inflammation. Their whole cardiometabolic panel gets better. These medications, we feel, are very safe and very good for the heart, and I will prescribe them as a heart medication for people that need them.
Courtesy of Scripps Health Dr. Doug Gibson
What are some of the latest breakthroughs in the field of heart disease treatment, and what innovations will we see in the future?
Dr. Bahram Khadivi: Our ability to treat structural heart disease—we often think of blocked arteries as heart disease, but heart disease can also involve the structures of the heart, such as heart valves and muscle. Historically, diseased valves were treated with open heart surgery, [but] we now have the capability to treat multiple heart valve disorders minimally invasively. This field has really come a long way, and we can avoid open heart surgery for many patients. Structural heart procedures are done [by accessing] a blood vessel in the groin, neck, or upper arm.
Half of the procedures that I perform today were not available 10 to 15 years ago. This is also true for robotic surgery, where [what was once] a large, open surgery can now be accomplished through small incisions. Everything is headed towards the minimally invasive route.
Dr. Jia Shen: There’s always something new in cardiology. For people that have really advanced disease, we have a mechanical device that can take the place of their heart. If the heart cannot pump anymore, we can put in something called a BiVAD—a biventricular assist device, or a mechanical pump—that can actually bypass the heart completely.
With transplantation, we take out the old heart and give you a new heart. One new innovation is that we now have a special machine that pumps the heart [outside of the body]. We can take the organ and put it onto this machine, and it keeps it good and alive longer so that we can actually travel greater distances to give that heart to a potential recipient. It’s very high-tech and very sci-fi.
I think one of the things that will transform the field more is the use of artificial intelligence. UCSD is looking at different algorithms that can identify heart disease in ancillary scanning—so let’s say you get a CT for something else. We can use AI to comb through these images to see if you could have an increased risk of heart disease, so maybe we can identify that disease earlier in young patients.
Dr. Doug Gibson: In general, I would say genetic-based therapies are most exciting. Any illness that is the result of a single gene mutation is on the target list for a real cure in the near-to-intermediate-term time frame.
In my specific discipline, the most exciting advance is pulsed field ablation, a new way to treat abnormal heart rhythms, specifically atrial fibrillation. I’m a cardiac electrician, if you will—the formal job title is cardiac electrophysiologist. I specialize in abnormal heart rhythms. We treat arrhythmias by threading catheters through the veins in your leg up to your heart. We then use these catheters to destroy the abnormal heart muscle that causes the abnormal heart rhythm. We used to [utilize] heat or cryotherapy to destroy the abnormal heart muscle. We did it this way for many years, and it worked, but it could be dangerous, and it suffered from a lack of adequate success.
As of February 2024, instead of burning abnormal heart tissue to get rid of it, we use something called pulsed field ablation. [It’s] a once-in-a-career revolutionary shift in the way we treat atrial fibrillation. Instead of heating or freezing abnormal heart muscle, we’re delivering microsecond— soon to be nanosecond—pulses of energy to the cardiac tissue. [Those pulses eliminate] only the abnormal heart cells that we are targeting. This results in less collateral damage and the ability to deliver what we know to be the effective dose safely, [meaning] shorter, safer, and more effective procedures. Adoption of this new technology has been widespread and robust. At Scripps, we participated in preclinical research and the pivotal clinical trials that led to FDA approval. This allowed us to get early access to the technology for clinical use.
Courtesy of Sharp HealthCare Sharp HealthCare President and CEO Chris Howard
Incoming Cuts to Medicaid Questions
The July 4th passage of the Trump administration’s “One Big Beautiful Bill Act” will have significant impacts on Medicaid in the US. Sharp HealthCare President and CEO Chris Howard explains how it may affect patients in San Diego.
Chris Howard: One-third of San Diegans are covered by Medicaid, which is known as Medi-Cal here in California. Medicaid provides health insurance coverage for low-income adults, children, pregnant women, elderly adults, and people with disabilities. It’s a federal-and state-funded health insurance program, so the states provide funding for a portion of it and the federal government provides a different portion for it.
What are the planned cuts, and how will they impact San Diegans?
Chris Howard: The passage of the 2025 federal reconciliation bill, known as HR1, puts many individuals at risk of losing their healthcare coverage. New eligibility and work requirements and coverage restrictions will result in more people being without insurance. In many cases, these are people who qualify for Medicaid, but they’ll lose their coverage because they aren’t able to complete the cumbersome paperwork process.
It’s also important to note that HR1 made significant changes to the Affordable Care Act’s health insurance exchanges, like Covered California, where small business owners, part-time and gig workers, young adults, and others who don’t have health benefits through their employers can shop for and purchase private insurance plans, often at reduced cost, some of which has been subsidized through tax credits. In San Diego County, there are more than 164,000 people who have purchased their health insurance through Covered California, and 88 percent of those people received tax credit help to reduce the costs. So, as this bill takes that away, some of those individuals will decide that healthcare is too expensive, and then they won’t buy it.
HR1’s restrictions on tax credits and its new renewal and validation processes [are] going to make it more difficult for people to receive healthcare insurance coverage. For Sharp, being the largest provider of medical services in San Diego County, we are keenly aware of how significant the loss of this coverage would be for the most vulnerable patients. This includes patients from fragile newborns in our neonatal intensive care units to people receiving end-of-life care in our hospice homes.
All of our local healthcare systems are dedicated to providing exceptional health care regardless of an individual’s ability to pay. But this will place extreme pressure on hospitals, in particular, and unfortunately, that could lead to decreased services or other challenges as hospitals simply try to bear the cost of this care without compensation. The entire healthcare system in San Diego County will be extremely burdened.
Is there anything providers and institutions can do to help mitigate these effects?
Chris Howard: Advocacy is our first and foremost priority. There is much that remains unknown about how the bill is ultimately going to impact Sharp and other providers in California, in part because some of the provisions of the bill don’t take place until later years. But what we do know is, of the San Diegans that are covered by Medi-Cal, a portion of them in the future will not have health insurance coverage. And so our focus right now is on county and state budget decisions being made in response to the decreased funding from the federal government for Medicaid services, and we’re closely monitoring these developments, advocating to minimize negative impacts to our patients, the community, and Sharp.
At the end of the day, the state will have to find funding sources for the healthcare that it desires to provide. We know the current status of the state budget, and we know it’s extremely challenged. The daunting part, though, is that the net impact of HR1 will be to reduce federal funding, in this case to the state of California. And so, moving forward, the state, perhaps the county, will have to understand what, if any, additional funding sources there are for healthcare coverage, because it’s going to fall on the state, in particular, to address that. That will be a headline in the coming years: How much can California fund relative to its Medicaid program, and who will pay for that?
Courtesy of Palomar Health Dr. Jonathan Bear
Groundbreaking Cancer Treatments Questions
Radiation oncologist Dr. Jonathan Bear explains the ins and outs of brachytherapy, an innovative approach to treating prostate cancer at Palomar Health.
What is brachytherapy, and what cancers does it best treat?
Dr. Jonathan Bear: The way that we treat most cancers is with external radiation, so we have a machine that delivers radiation, or high-power x-rays, through the body to get to the tumor. While we have great technology and modern treatments and we can really deliver accurate radiation, we still have to go from the outside to the inside. You can’t give an infinite amount of radiation, because, though we would get rid of the tumor, we’d harm the patient’s [healthy tissue].
Brachytherapy is internal radiation. “Brachy” is Greek. It means “close”—so the radiation is right up next to the tumor, exactly where we need it, and that allows us to deliver less radiation to the other organs and go to higher doses. High-dose-rate brachytherapy starts with a patient under anesthesia. I put catheters through the skin and do a CT scan so we can plan the radiation in three dimensions, and then we hook each of those catheters up to a radiation machine. The beauty is, because you have [multiple] channels and a computer that’s helping you, and each channel can be dosed differently, you can really steer the dose and get a lot of accuracy. The whole procedure, from start to finish, takes about three to four hours.
What the evidence shows us from numerous trials is that it translates to better outcomes as far as what we’re trying to accomplish, which is curing the cancer and minimizing side effects.
We can treat most cancers with brachytherapy. It’s most commonly used in prostate cancer and gynecological malignancies. It’s also used in lung cancer and gastrointestinal malignancies, where brachytherapy can be applied directly inside the airway or digestive tract. [At Palomar,] we’re going to start with prostate brachytherapy, and then we’re going to move on—probably toward the end of year—to gynecological cancers.
Palomar is the only hospital in San Diego County offering high-dose-rate brachytherapy for prostate cancer. What are the limits to accessibility?
Dr. Jonathan Bear: You need to be specially trained to do this procedure—it takes a lot of time and effort compared to external radiation therapy. So really what it comes down to is the training time, the effort, and the expertise. Brachytherapy is a team-based approach. It’s not just me, [the radiation oncologist]—you have to have a urologist. I have a bunch of nurses and OR staff; we have a physicist who helps with dosing the radiation. Not too many centers have the highly skilled team that’s required in order to successfully do this procedure.
What research is Palomar currently doing to push this and other cancer treatments forward?
Dr. Jonathan Bear: We’re growing our cancer clinic. We have a research team that is contracted through Palomar. We don’t have a clinical trial [for brachytherapy] right now, but that’s definitely on the horizon—I anticipate we will have trials opening up relatively soon.
Courtesy of University of Michigan Dr. Karandeep Singh
Advancements in Healthcare-Related AI Questions
Kaiser Permanente San Diego Assistant Area Medical Director Dr. William Tseng; Dr. Karandeep Singh, chief artificial intelligence officer at UC San Diego Health; and Shane Thielman, corporate senior vice president and chief information and digital officer at Scripps Health, share the latest advancements in AI and explore what the future might hold.
What new AI tools have you implemented at your hospital group?
Dr. William Tseng: One system that we implemented within the last year is the KP Intelligent Navigator. When you share your symptoms through our app, the system uses AI to assess how urgent your situation is. If it detects something critical, it won’t let you wait for a message or an appointment; it will direct you right away to the hospital or appropriate care.
The system has a built-in clinical alert feature. For example, if a patient says, “I’m having chest pain and it’s getting worse. Can I make an appointment tomorrow?” the system recognizes that as urgent. Instead of letting it sit in the queue for a routine reply, it directs the patient to seek immediate care and escalates the message for a physician follow-up.
From October of last year through March of this year, the system processed nearly three million encounters, averaging about 19,000 each day. The system is about 96 percent accurate, meaning it is very good at correctly identifying what is an emergency, with very few false alarms.
Dr. Karandeep Singh: If we want to measure the quality of care that we deliver as a health system, we have to actually look at patient charts and see, for example, “Hey, for this patient who had a bacterial infection that resulted in sepsis, did we give them all the right things that they needed?”
Amazingly, health systems are only required to read 20 charts a month to see if they did a good job—I say “amazingly” because that’s not nearly enough charts to actually get a sense of where your opportunities are to improve. And so one of the exciting areas that we’re right now getting into which is a space that I think we are leading in—is using AI to help us do that first pass and read those charts. Basically, we don’t have to only measure our quality on 20 patients; we can measure it on hundreds of patients. We don’t have to be constrained by the fact that we don’t have enough person power to do that. We can take a first pass with AI and get over 90 percent accuracy compared to having experts reviewing the same charts.
We are now piloting AI that reads through [a patient’s complete medical history] and gives doctors a kind of executive summary, so that once you have a holistic understanding of what is going on with this person, you can strategically figure out what order you’re going to read their chart in, rather than just reading things front to back. It’s much more efficient to read a chart when you actually know what you’re looking for.
Shane Thielman: We’re working with our radiologists to use a technology that takes their dictated findings and automates the clinical impression in their documentation. The idea there is to help reduce their time in documentation but also lighten some of the cognitive burden by automating and streamlining repetitive tasks. The radiologist is still signing off on that clinical impression, but the intention is to take that dictation and pull out the clinical impression in the radiologist’s notes. That’s been a more recent development.
Courtesy of Scripps Health Shane Thielman
What does the future hold for AI in healthcare? What developments might we see in the next 10, 20, even 100 years?
Shane Thielman: I’ll start off by saying I’m not much of a futurist—with the pace of advancement of technology in general and specifically AI, it’s difficult to think beyond probably the next two to three years. The rate of change will probably not ever be as slow as it is today. We’ve taken a very deliberate and serious approach to how we evaluate any proposed AI solution, with a level of caution and a degree of risk aversion so that we’re not unnecessarily impacting patient safety, the experience of our patients, and the reputation of the organization, while also building experience with using AI.
One area that I might highlight is that, historically, it has taken many years—oftentimes between 15 and 20 years on average—to translate evidence-based research into standard clinical practice. My hope is that AI will help us [identify the] connections and relationships between intervention, treatment, and outcomes in medical data and translate those into care processes more rapidly.
We have a responsibility in healthcare to continue to evaluate technology and tools that help improve care and outcomes, increasingly with a focus on delivering care in a cost-effective manner. I think that AI can really help contribute to those aims. It has the potential to help us identify disease sooner, which can lead to improved access to care and personalized treatment in order to more effectively manage and address the disease earlier. I think it has the potential, as well, to enable proactive and preventative care and help to identify patients that are at risk to offer them access to care interventions that, ultimately, will probably help them manage their condition more effectively over time.
Dr. Karandeep Singh: One place where I feel like it could really help is, when you receive a new diagnosis or you’re a caregiver of someone, there’s often this real feeling of loneliness. When someone has an advocate—a family member with them who’s asking all the right questions—they often have better outcomes. Having an AI [system] as a patient advocate, a kind of a sidekick that can help you navigate the broader system, could be a critical thing. [It would] not just tell you what you want to hear but actually tell you, “Here’s what’s next on the agenda for this year. Here’s why.”
My wildest dreams are that you get a new diagnosis and you’ve got your own AI that’s searching up all the clinical trials, helping you figure out how to get enrolled. At that moment when you’re in grief and you have all this stress on you, you really need something or someone that can take action and keep track of everything.
One other thing I’ll add is that, in the last five years, there have been tremendous advances with personalized treatments. Some of these things seem like science fiction, but because of advances in gene editing and advances in AI, there is a lot of potential that things we view today as incurable may be curable. Modern medicine in 100 years or 200 years may be unrecognizable because of the level of personalization we can do against things like cancer, and that’s an incredibly important use of AI that has sped things up.
Courtesy of Kaiser Permanente Dr. William Tseng
Conversely, what are the limits of AI?
Dr. William Tseng: AI won’t replace physicians, but, in time, physicians who understand AI will replace those who don’t. AI is most powerful, really, when it makes healthcare interactions feel more and not less human.
AI is an assistant. It is not a doctor. Physicians need to supply the wisdom behind its output and refine what it produces, because AI won’t always get it right.
Currently, AI is still largely language-based. It’s two-dimensional, not three-dimensional or tactile. It can ask questions, but it cannot yet fully recognize the unspoken: the silence, the tears, the nonverbal responses that carry so much meaning. Medicine is more than just words. It’s the touch of a hand in times of need. It’s delivering both good and bad news with humanity. No patient should ever hear a cancer diagnosis from a bot. That moment belongs to a physician, someone who understands, who is empathetic, who can share in the patient’s tears. These are the human connections that define healing, and they are far beyond the reach of AI.
Amelia Rodriguez is a writer and journalist and winner of the San Diego Press Club's 2023 Rising Star Award and 2024 Best of Show Award, she’s also covered music, food, arts and culture, fashion, and design for Rolling Stone, Palm Springs Life, and other national and regional publications. After work, you can find her hunting down San Diego’s best pastries and maintaining her five-year Duolingo streak.
Before, during, and after the Fourth of July, San Diegans can commemorate America’s 250th anniversary with an abundance of stars, stripes and local celebrations. America The Beautiful: 250 at The Rady Shell and Lamb’s Players Theatre’s revival of American Rhythm will look back at the many songs which define our country. Liberty Station’s Anchored in Freedom celebration and the Independence Day Carnival offer community-centered fun and loads of family-friendly activities. And who can possibly forget the Big Bay Boom, which will resume its reign over San Diego Bay as the state’s biggest fireworks show. Outside of the holiday festivities, this week brings the yearly return of Little Italy’s Summer Sera and the Athenaeum Summer Festival, as well as a slate of championship matches for All Elite Wrestling.
Sip on refreshing beverages and savor a panoramic rooftop view this Friday from 6-8 p.m. during the 21-plus Sunset & Spritz at Margaritaville Hotel San Diego Gaslamp Quarter’s 5 O’Clock Somewhere Bar. There will be a live DJ (until 9 p.m.), appetizers, pool and cabana access, a photo booth, and a cash bar (until 11 p.m.). To accentuate the summer theme, guests are invited to dress in white, pink, and orange attire. Tickets are $29 and come with a welcome aperol spritz.
616 J Street, Gaslamp
The 250 Grand Tasting Menu at Amaya
July 3 & 4
Bring a patriotic palette to the Fairmont Grand Del Mar for The 250 Grand Tasting Menu at Amaya this Friday and Saturday from 5-8:30 p.m. Patrons will be treated to a five-course tasting menu, curated to exhibit a selection of standout regional flavors and culinary concepts that have shaped our country’s distinct food heritage. The meal will also include beverage pairings with each course, such as wine, cocktails, and artisanal drinks. Reservations are $330 per person (with tax and 20% gratuity) on OpenTable.
Don Toliver thrives at being the life of the party (and the “After Party”). His fifth album Octane, released in February, is indicative of his thrill-seeking nature. As with his earlier releases, Octane sees Toliver operating in the space between hip-hop and R&B, with warbling vocals and blaring beats that are best heard at a high volume. This Tuesday at 7:30 p.m., Toliver will play at Pechanga Arena, with rappers SoFaygo, Chase B and SahBabii—who had a guest verse on Octane standout “K9”—as special guests. Tickets start at $156 for this concert.
What makes musicals like Wicked, Cats, Chicago, and Jersey Boys so timeless is the legion of excellent songs that makes fans out of those who’ve never even watched the show. This Friday at 7:30 p.m. during Blockbuster Broadway! at The Rady Shell, conductor Evan Roider, the San Diego Symphony Orchestra, and veteran vocalists Alex Getlin, Jessica Hendy, Scott Coulter, and John Boswell (also on piano) will perform an all-star theater soundtrack. In addition to the shows named above, audiences can expect songs from A Chorus Line, The Phantom of the Opera, Annie,and more. Tickets range from $57 to $129 for this concert.
222 Marina Park Way, Embarcadero
America The Beautiful: 250 at The Rady Shell
July 4
One night after recognizing the brilliance of Broadway, The Rady Shell will ring in the United States’ landmark anniversary with America The Beautiful: 250 this Saturday at 7:30 p.m. Conductor Byron Stripling, joined by a five-performer ensemble and the San Diego Symphony Orchestra, will lead a night of ballads that best resemble the red, white, and blue, including songs sourced from the Great American Songbook. After the show, concertgoers are invited to watch the nearby Big Bay Boom from their seats. Tickets range from $71 to $139 for this concert.
222 Marina Park Way, Embarcadero
Athenaeum Summer Festival at Athenaeum Music & Arts Library
Ryan Hardison is a freelance arts and entertainment writer and recent graduate of San Diego State. When he's not staring at his laptop, he's likely eating an adobada burrito or getting sunburnt at the beach.
“This is insane!” the guy filming it seems to proclaim. “It’s the best fireworks show ever!” a companion confirms, inspiring a debate lasting over a decade.
All told, 7,000 fireworks exploded in the span of 25 seconds over San Diego Bay on July 4, 2012. A Michael Bay amount of unison. $125,000 worth of shells, cakes, Roman candles, and skyrockets had been placed on a barge—enough for 17 minutes of decorative sky flares—and…
Boom.
The sky looked like someone had set a giant Rorschach test on fire. Or as if whatever we all see in our Rorschachs—butterflies, clowns, tongue kissing, dads—was being electrocuted and lifted heavenward, amen. It was shocking how bright it was, how much it sizzled the local cosmos. Could’ve been one of those sci-fi films where a hole is ripped open between warring universes. But angstier, more metal—the work of some methy creator in a sleeveless concert tee.
The sound?
Lou Reed once released an entire album that contained 64 minutes of mindflaying guitar screeches and machine noises. No regular songs, just a fascinating amount of ear distress. His record label reps no doubt heard the melodic outro of their careers, but everyone else was in pain and stumped. That album still sounded better than the bay did that night. The bay sounded like a god who struggled with emotional regulation had blown his speakers and was working through the anger stage of AV grief.
In the left frame of the video, a middle-aged woman is attempting to drag her husband off by the hand. In no way does he want to go, possibly because he had missed the time Roseanne Barr sung the national anthem at a Padres game, simultaneously disemboweling and amusing America through the power of song. He would not willingly abandon an equally worthy San Diego trainwreck.
Another woman in the video appears to have just filled her beer, rushing to sit down for the show. She pauses mid-sit and returns to the full and upright position to properly bear witness. What was supposed to be prolonged entertainment has been so radically shortened that she will have to find another reason to drink. Lucky for her, drinking will be the only way to adequately process.
Locals remember the conspiracy theories. People wondered if the fuses had been tripped by a saboteur who was sympathetic to dogs, fish, or the growing suspicion that late-stage capitalism is a gorgeously branded but impossible dream sustained by remarkably efficient top-tier wealth retention and the soft compliance of fireworks-watchers who can no longer afford a house, a beer, or the personal impacts of human reproduction.
Speaking of being terrified of babies, babies were terrified. The children who witnessed it probably still can’t go near a candle store. But those kids will be tougher, perfectly scarred kids. They’ll write better songs.
That night helped us absolutely dominate the national news cycle. For a hot minute, we became America’s water-skiing squirrel. Now, years later, when you Google “fireworks gone wrong,” San Diego is always a top contender, along with that poor Nebraska family who nearly wiped out a couple generations in their front yard, their minivan somehow turning into a howitzer of recreational TNT.
There is still debate as to whether Big Bay Boom 2012 is the worst or greatest fireworks show of all time. But the advanced parts of civilization arrived at the truth as quickly as the women in the video did. It was undeniably amazing.
First of all, the point of Fourth of July fireworks isn’t “the intricate choreography of sky fire over a guaranteed amount of show time.” It’s about creating a vivid memory shared with some people you like, love, or would like to love.
BBB2012 used large-scale chemical fire to create the ultimate memory.
Sure, some people who iron their jeans subjected their family to a sermon about how San Diego managed to botch America’s birthday like a Disney princess-for-hire who smelled of quite a few Sauvignons.
The rest of us saw how perfectly it nailed the actual feeling of being an American. Because only a miniscule percentage of us bake postcard apple pies where every inch of crust is perfectly laminated like the wood in an Irish bar. Very few of us can paint on par with Picasso. The rest of us—despite truly believing in our America-activated abilities to achieve greatness in almost any field of our choosing—burn pies. We try to paint only to realize it looks like our fine motor skills have entered active death.
That’s why BBB2012 was the most perfectly American fireworks show ever: A wildly ambitious idea galvanized thousands upon thousands of people to both work on it and come to hold a beer and gawk at it, only to have it fail in the most glorious TMZ-level spectacle.
America isn’t about immaculate, storyless wins. It’s about how the framework of a country is solid enough that we can accidentally detonate our entire lives—a few times—and still probably be OK.
No one has America’d quite like San Diego did on that day. It was performance art. Lou Reed’s heart slow-clapped. Any brief municipal embarrassment quickly became a pride of our people. I can only hope the same for the Nebraskan yard family whose Dodge Aerostar became a hyperactive Death Star.
P.S. Local writer Maya Kroth compiled a quite great oral history of that night for Thrillist. The bottom lines for me were—it took nine months to prepare, no one was hurt, and even though the pyrotechnics company tried to zero out the bill, Big Bay Boom founder H. P. “Sandy” Purdon refused and paid them in full. This year will mark the 25th Anniversary of the yearly Big Bay Boom.
Troy Johnson is the magazine’s award-winning food writer and humorist, and a long-standing expert on Food Network. His work has been featured on NatGeo, Travel Channel, NPR, and in Food Matters, a textbook of the best American food writing.
If absence makes hearts (and stomachs) grow fonder, then shuttered restaurants quickly become the hottest tickets in town—something a number of iconic institutions found out after taking very public hiatuses after historically long runs. For instance, following a lengthy (and extremely flip-floppy) closing process after 92 years in business, Las Cuatro Milpas reopened two blocks away in Mercado del Barrio. Similarly, Carlsbad butcher shop Tip Top Meats reopened in the same location (albeit a smaller space) after the death of founder Joachim “Big John” Haedrich in 2023. Finally, after a whopping decade out of business, Sami Ladeki and chef Alfie Szeprethy brought back Roppongi to its original Prospect Street space, where it was the talk of the town in the late ’90s. All came back under the same proprietors, so they weren’t third-party nostalgia-licensing deals. The algorithm may have ravaged our attention spans away from all but the newest and shiniest, but this proves there’s still hope for our collective prefrontal cortex.
Other local eateries honored their pasts by bringing in new perspectives. The Lion’s Share in Embarcadero, Milton’s Deli in Del Mar, Dudley’s Bakery in Santa Ysabel, and J-K’s Greek Cafe in La Mesa handed over the keys to new owners willing to take on a big task: maintain the soul of icons through particularly rough economic circumstances for restaurants, navigate big feelings from longtime regulars (who often don’t take kindly to change), and make some necessary changes to keep going for another few decades. Taking over a project in process can be a lot harder than starting from scratch. But building that feel-good nostalgia doesn’t happen overnight, so it sure helps to have a well-established playbook of success passed down from those who came before.
Courtesy of Sugarfish
The Expansion Class Arrives
It wasn’t just restaurant groups from Los Angeles that decided to put down roots en masse, although San Diego saw plenty of LA transplants recently (Sugarfish, Mr. Charlie’s, For the Win, Katsuya Ko, Bacari). Global brands like Chef Fei, Zuma, and Pepper Lunch have locations of their own on the way, and upscale Canadian eatery Joey joined to the inescapable gravitational pull of Westfield UTC’s culinary cosmos for its first spot in America’s Finest City. Good to see the rest of the world is catching up with what we’ve been seeing the last few years—San Diego is a dining destination already on the rise.
Choosing To Not Choose
Between the never-ending news cycle of doom and perimenopause brain fog, I’m at the stage in life where I’m more than happy to let someone else make a decision for me, especially when it comes to what’s for dinner. And based on the way a lot of menus look right now, I’m not alone. It seems like half the places I visit offer some version of a prix fixe, omakase, or tasting menu. Restaurants are embracing the curated experience to solve the problem of affordability (a fixed menu reduces food and labor costs, guarantees an acceptable check average, etc.) and critical thinking in one fell swoop. Omakase (meaning “I leave it up to you”) is far from a new concept in high-end Japanese sushi culture, but now that it’s popping up everywhere from coffee experiences to grab-and-go sushi and sandwiches, it’s gone from somewhat niche to nearly omnipresent.
Courtesy of Rikka Fika
Local Coffee Hit the World Stage
The world got an up-close look at San Diego’s coffee industry when we hosted the premier specialty coffee expo World of Coffee for the first time this April. San Diego’s long and rich coffee history stretches back to the late 19th century. Things percolated fairly quietly for around a century before really picking up steam. Today, there are nearly 200 specialty roasters and cafes across the county, with many earning national accolades like the Good Food Award (Steady State Roasting, 2020; Bird Rock Coffee Roasters, 2023, 2021, 2019, 2017, 2016), Roaster of the Year by Roast Magazine (Mostra Coffee, 2020; Bird Rock Coffee Roasters, 2012), and the Specialty Coffee Association Coffee Design Award for packaging (Rikka Fika, 2026). Now that we’ve moved past the comically insufferable coffee snob era of the early 2000s, even java newbies can feel comfortable walking into pretty much any coffee shop in San Diego, asking questions, trying a few things, and feeling confident they’re going to get great service and a great beverage.
Beth Demmon is an award-winning writer and podcaster whose work regularly appears in national outlets and San Diego Magazine. Her first book, The Beer Lover's Guide to Cider, is now available. Find out more on bethdemmon.com.
Kelly H. Harfouche, founder of KQ Aesthetic Society, knows firsthand that cosmetic treatments like fillers, neurotoxins, and microneedling, can not only enhance a person’s appearance and restore confidence, they have the power to truly change a person’s life. An expert injector has the ability to tailor treatments to each individual patient’s anatomy and goals for personalized results. Harfouche, a board-certified nurse practitioner, has spent nearly a decade perfecting her craft as an aesthetic injector and integrating her multifaceted artistic skills with precision patient care. Her commitment to continual education and training, plus a passion for helping people look—and feel—their best, set KQ Aesthetic Society apart in a sea of local medspas.
For many people considering nonsurgical treatments, the intent is to look refreshed and refined. KQ Aesthetic Society’s philosophy eschews a cookie cutter approach that bases treatments around units, instead working to understand each person’s unique goals, then curating a treatment plan to fit that vision. Harfouche focuses on “inclusive luxury,” the belief that everyone deserves access to aesthetic treatments, respective of budget restrictions. She develops long-standing trusted relationships with her patients, and works with each one to achieve their aesthetic objectives and address the underlying causes of their concerns.
“For me, forming an honest and open relationship with every patient who walks through the door is essential. This means understanding them on a deeper level and meeting them where they are to define and achieve their individual goals,” she says.
Drawing on her artistic background, which inspired her transition into medical aesthetics, Harfouche sees each client as a “unique canvas.” Rather than relying on standardized procedures, the practitioner’s distinctive approach combines her profound understanding of the physiological and anatomical changes associated with aging with an unwavering commitment to ongoing education about the newest products and their mechanisms of action. Her goal is to make each patient feel beautiful in their own skin and to embrace their individuality.
She has also pioneered a way to combine her talent for aesthetic artistry with her philanthropic nature. Harfouche is one of only a handful of providers using dermal fillers to treat patients with lip asymmetry and scarring resulting from cleft lip surgery. Patients travel from around the country for this transformative treatment, noting increased confidence and a restored identity. She hopes to eventually launch a training program to help fill the void in this space.
“My passion has always been connecting with people and giving back in any capacity that I can,” she says. In the rapidly advancing landscape of aesthetic medicine, you can place your confidence in Harfouche and KQ Aesthetic Society to deliver exceptional care. To learn more or book a consultation, please visit kqaestheticsociety.com.
Summer has officially kicked off, and San Diego is celebrating the sunny season with a myriad of fun events. From San Diego Pride week and a fairytale performance at Civic Theatre to a Santigold concert and Comic-Con, there are dozens of opportunities to make memories worth adding to your scrapbook. Here are all the best things to do in San Diego this July:
Divine inspirations, operatic ballads, and symphonic pop production elevate Rosalía’s Lux to heavenly levels. Hear angelic vocals ascend—in up to 13 languages—during her performance at Pechanga Arena.
Enjoy a night of feel-good indie rock and sing-along anthems at the Cal Coast Credit Union Open Air Theatre courtesy of Young the Giant and special guest Cold War Kids.
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Santigold collects genres like gold stars: musical accouterments that brighten her uniquely alternative sound. See her live in concert with dancehall producer Troy Baker Sound at Humphreys Concerts by the Bay.
Two male government workers pursue a secret romance amid the Lavender Scare in the San Diego Opera’s production of “Fellow Travelers” at the Balboa Theatre.
Audrey Hepburn. Marlon Brando. Salvador Dalí. What do these icons have in common? Each was the enigmatic focus of a Cecil Beaton portrait. Step inside Cecil Beaton’s Fashionable World, an alluring showcase of 20th-century style at San Diego Museum of Art.
Courtesy of San Diego Pride
More Fun Things to Do in San Diego This Month
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The Little Italy Mercato will trade morning rays for golden-hour glow through its free Summer Sera, an expansion of the neighborhood’s farmers market with live music, artisanal finds, and a fetching amount of pet activities.
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San Diego Pride week starts with a Dyke March and ends with the two-day “Pride Shines On” festival. The days in between? Run a 5K, march in the parade, visit the rainbow-lit St. Paul’s Episcopal Cathedral, and more.
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Dress up for a Mediterranean-themed tea time at the Estancia La Jolla, a laid-back yet refined afternoon planned for the resort’s monthly Tea in the Garden series.
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Nerd culture’s biggest gathering returns to the Convention Center. San Diego Comic-Con welcomes fans of everything from comic book cinema to ultra-rare collectibles for panels, exhibits, sneak peeks, and much more.
Ryan Hardison is a freelance arts and entertainment writer and recent graduate of San Diego State. When he's not staring at his laptop, he's likely eating an adobada burrito or getting sunburnt at the beach.
You’re coasting home after a weekend in Rosarito Beach—still riding the high of vitamin D and Baja Med—and then comes a slap back into reality: brakelights and gridlock exhaust.
Small wonder, given that San Ysidro is the busiest land border crossing in the western hemisphere (fourth-busiest in the world). Otay Mesa’s no breeze either; it’s the busiest commercial port in California and second-busiest across the entire southern border. Smart Border Coalition says that each day last year, 41,800 vehicles crossed into the US at San Ysidro; 17,800 crossed at Otay Mesa, along with 1,023,000 commercial trucks.
Diana Pazos, a San Diego resident and adolescent psychiatrist working in Tijuana, says the northbound border wait at the San Ysidro crossing is often three to five hours Saturday through Monday—delays that modern humans and multinational maquiladoras alike aren’t built to endure. At the current Otay crossing, “commercial trucks may be in line for six hours or longer,” she says.
Needing to bake a couple hours of commute into the States doesn’t just affect vacations; tens of thousands of people cross the border each day for doctor’s appointments, work, school, you name it. The clog has personal and commercial ramifications.
But change is coming. Construction has begun on a new border crossing in Otay Mesa, which is expected to significantly reduce wait times across all San Diego border crossings, bolster binational trade, and improve the air pollution levels in the area.
Nikki Tiongco, an 18-year Caltrans veteran who oversees the Otay Mesa East project (aka Otay 2) for the agency, says the new border crossing will also be among the most high-tech, efficient, and secure border crossings in the nation.
“We have already completed the roadway network within the Otay Mesa East region,” says Tiongco. Part of this project included building State Route 11, an extension of SR 905, which has been open to the public since August and will feed traffic to the new entry port. Otay 2 comes with a 21st century upgrade, too. Miles of fiber-optic cables have been installed underground, which gives the port the brainpower to efficiently sort and streamline traffic as cars approach the border. (Unlike the San Ysidro border, where lanes get organized by vehicle type, Otay 2’s lanes will be interchangeable. For example, if the system indicates that a high number of commercial trucks is heading to the border, passenger lanes could be converted to cargo lanes in real time.)
Otay 2, driven by a binational collaboration among government agencies (Caltrans, SANDAG, General Services Administration, and U.S. Customs and Border Protection), receives both federal and state funding, plus hefty contributions from Mexico. So far, funds from the $1.3 billion project have helped build new bridges and roadway interchanges that will guide traffic to the crossing. At this stage in the process, Caltrans is “laser-focused on building the facility itself,” Tiongco says.
Now, to the juicy part: the prospect of a “20-to-30-minute border wait time” at Otay 2, according to Tiongco. Currently, there are three standard ways to cross the border at San Ysidro: Ready Lanes, General Lanes, or SENTRI Lanes. Most travelers use either the Ready or General lanes. SENTRI Lanes require a form of pre-approval from the US federal government plus an additional fee. According to CBP, the average wait time in 2025 at the San Ysidro crossing, was as little as 15 minutes in the SENTRI Lanes, 45 minutes in the Ready Lanes, and 1.5 to 2 hours in the General Lanes. Those are best-case scenarios that vary based on lane type and time of day.
Otay 2 is about 12 miles east of the San Ysidro crossing and 2.5 miles east of Otay 1. Those not wanting to spend that much extra time on the road to drive to the new border crossing, despite the allure of an under-30-minute wait, are still expected to see some benefits. Tiongco says Otay 2 will “provide a relief valve” overall by spreading the burden across the three border crossings. As a result, SANDAG says, wait times at San Ysidro and Otay 1 could be cut in half.
It’s not just your time waiting at the border that matters. Multinational corporations that relocated their manufacturing plants (maquiladoras) to Northern Baja have claimed for years that the long delays at Otay 1 eat away at their profits. More than 600 maquiladoras, used by companies such as Samsung and Panasonic, currently use Otay 1 to transport products to US and international markets. Ambassador Alicia G. Kerber-Palma, the consul general of Mexico in San Diego, says the project will facilitate more than $60 billion in cross-border trade annually.
Previous reports say that Otay 2 also has the capacity for around 12,000 passenger cars and 1,500 commercial trucks daily. A shiny, new element to this port: Commercial and personal vehicles that choose to cross will pay a dynamic toll on both sides of the border. The fee will increase during busy hours and decrease during slower periods, Tiongco says. Caltrans estimates that the toll could range from $4 to $30 for passenger vehicles and higher for commercial trucks. Drivers will be able to see current rates before they reach the actual border crossing.
And, with these changes, there are environmental benefits, too. “With shorter wait times at all three ports, there’s less idling and congestion, which should significantly reduce air pollution on both sides of the border,” says Kerber-Palma. The main factor driving improved air quality would be decreasing dirty emissions from idling diesel trucks. This county’s air could use some sprucing up, anyway. A 2026 report from the American Lung Association named San Diego as the fifth-most particle-polluted county in the US. The bulk of that dirty air comes from the heavy-duty trucks and ships that pass through the area.
Otay 2 is not only expected to curb the acceleration of air pollution in San Diego; if the state’s legislature passes California Senate Bill 10, the border crossing could also restore local water quality. This bill would use a portion of Otay 2 toll revenues to fund ongoing maintenance of the South Bay International Wastewater Treatment Plant. Current media reports say, however, that it’s increasingly unlikely that SB 10 will become law.
Otay 2 has been in the works for over two decades and is finally nearing the finish line. Construction estimates show that it should be up and running in 2029. Tiongco says this border crossing is “a good example of how the state, federal and local governments are working together and with Mexico to advance our mutual goals in the region.”
AVRP Studios’ tradition for Design Excellence and Innovation began in 1976 with Doug Austin, FAIA, in Solana Beach, California. The firm has since grown to complete major projects throughout the United States and Canada. We think of ourselves as a family and we care deeply about people. We want to inspire, help make their lives richer and more complete through our efforts. We believe that architecture is one of the most important art forms because of the impact it can have on the lives of those it touches. We’re delighted to have been recognized with over 150 awards for design excellence.
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