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George Juan, M.D.

LANGUAGES SPOKEN

English, Mandarin, Taiwanese

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EDUCATION

Medical School: Karol Marcinkowski Univ Med Sci.

Medicine Residency: New York Methodist Hospital

Pulmonary & Critical Care Fellowship: New York Methodist Hospital

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SPECIALTIES

Pulmonary Disease: Diagnosis and treatment of lung conditions

Critical Care Medicine: Provision of life support or organ support systems

Sleep Medicine: Diagnosis and treatment of sleep-related breathing conditions

CERTIFICATIONS

American Board of Internal Med (ABIM)

ABIM Pulmonary Disease

ABIM Critical Care Medicine

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MEDICAL CENTER AFFILIATIONS

John Muir Medical Center, Walnut Creek 

John Muir Medical Center, Concord

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PERSONAL INTERESTS

Point of care ultrasound

Robotic bronchoscopy

1️⃣ Before Your Procedure

 

Fasting: Nothing to eat or drink after midnight.

Take only approved morning medications with a small sip of water.

 

  • Medications:

    • Stop blood thinners before the procedure 

      • Clopidogrel/Plavix: 5-7 days

      • Apoxaban/Eliquis: 48-72 hrs

      • Rivaroxaban/Xarelto: 48-72 hrs

      • Dabigatran/Pradaxa: 3-5 days

      • Warfarin/Coumadin: 5 days, ensure INR < 1.5

    • Diabetes medications

      • Stop SGLT2 inhibitors 3 days before the procedure

        • Empagliflozin/Jardiance

        • Dapagliflozin/Farxiga

        • Canagliflozin/Invokana

        • Ertugliflozin/Steglatro

        • Sotagliflozin/Inpefa

      • Metformin: hold morning of procedure

      • Stop GLP-1 medications 1 week before the procedure 

        • Dulaglutide (Trulicity)

        • Semaglutide(Ozempic, Wegovy, Rybelsus)

        • Liraglutide (Victoza, Saxenda)

        • Exenatide (Byetta, Bydureon)

        • Lixisenatide (Adlyxin)

        • Tirzepatide (Mounjaro, Zepbound)

    • Antihypertensives

      • ACE inhibitors / ARBs (lisinopril, losartan): hold morning of



 

2️⃣ Day of Procedure

Arrival: Check-in 2 hours prior to scheduled

What to Bring: Photo ID, insurance card, and a responsible adult driver (you cannot drive after anesthesia).

Attire: Loose clothing, no jewelry or valuables.

You’ll meet your anesthesiologist and pulmonologist to review your plan and consent.
 

3️⃣ During the Procedure

Performed under general anesthesia in a fully monitored setting.

Typical duration: 60–90 minutes

The team uses Ion robotic navigation to guide biopsy tools to small peripheral lung nodules with CT-based accuracy.
 

4️⃣ After the Procedure

You’ll recover in the PACU for 1–2 hours under observation.

You need to have a ride home. You will not be permitted to drive yourself home after general anesthesia. 

Expect mild sore throat, hoarseness, or minor blood-streaked sputum for 24 hours.

Resume clear fluids once your gag reflex returns; advance diet as tolerated.

Do NOT drive, drink alcohol, or make major decisions for 24 hours.

Call immediately if you develop:

Shortness of breath or chest pain

Fever > 101 °F

Persistent or heavy bleeding
 

5️⃣ Follow-Up

Pathology results are usually available in 3–7 days.

Our office will contact you when the results are back to review them and to discuss the next steps.

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©2026 by Muir Pulmonary Critical Care and Sleep Medicine.

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