January: A New Year, A New You!

The first month of the calendar year is named after Janus, the Roman god with two faces – one looking back and one facing forward.  Aptly, the month of January is our opportunity every year to look back on the previous twelve months while looking forward to the coming year.

As a family physician, January is the month when I receive the most requests for “something to help me lose weight.” Other times it’s for help to stop smoking, but that is nearly always accompanied by the express desire to not GAIN weight when they stop smoking.  The old formula of “too much going in, not enough going out” doesn’t seem to impress people much.  So, they frequently ask for something they can “take” to help them, one way or the other.

What if I told you that:

  • I could address BOTH challenges with one simple application of something to both of your ears once a week?
  • That in order to lose weight, you must actually EAT, and eat frequently?
  • That you not only are what you eat, but what you eat can actually boost metabolism and work in your favor?
  • That certain types of exercise are better for you and more efficient for weight loss and toning?

Press Needles are used for both smoking cessation and appetite suppression, and the location on the ear is the same for both issues. To re-set the thermostat of your metabolism, it is far better to eat small frequent meals, focusing on whole grains, fresh foods – as close as possible to how they appear in nature – and healthy fats.  Adding extra protein and drinking lots of water (64 oz. a day or more) can also help accelerate your body’s natural weight-loss response.  Tai chi, yoga, and pool-style exercises have been clinically proven to be far better styles of exercise for improving metabolism. There are also some preferred supplements that will also help with your weight-loss/lifestyle changes.

All of these are reasons to seek help through Direct Primary Care.  I can take the necessary time to walk you through changing the way you think so you can more effectively change the way you eat/drink/sleep/behave. You CAN do this without lining the pockets of the pharmacy benefit managers and pharmaceutical company CEOs. Just give us a call!



New Year Resolutions

Have you contemplated your New Year’s Resolutions for 2018 yet? Most folks want to get healthier, quit smoking or drinking soda, or want to start exercising and lose weight. And you’ve probably been told that all those goals should be pursued under the direction of – you guessed it – your physician. But do you know why?

There are so many options out there. Want to quit smoking?  “Use vaping as a substitute,” you may have heard. But studies are showing that vaping is no better (and maybe a little worse) for you than cigarettes. Patches help, but if you smoke with a patch on you can flood your system with nicotine, which doesn’t help with the smoking cessation attempts, and can even impact your blood pressure or heart health! You can take prescription medication, which – at best – has up to a 60% success rate. You still need a prescription for these medications, and smoking cessation programs are most successful under the direction of your physician.

What about weight loss? I remember an old Garfield cartoon where Garfield was thinking, “Diet is just  DIE with a T.” Tens of billions of dollars are spent annually on over-the-counter supplements, and there are fad diets galore. But are they healthy for you? There’s a lot of misinformation out there, and people can actually become malnourished while on some diet plans. So, what are you to do? It’s always best to pursue any major health changes under the direction of your physician.

Fitness centers abound, so there’s little excuse for not exercising. And these facilities have fitness experts who can help guide you along the path of what exercise you should apply.  But there are situations where excessive exercise can be quite detrimental for people with certain conditions. And therefore (you know this is coming), you should always consult your physician before starting an exercise regimen.

I already told you about the 21 Days That Changed My Medical Career. The 21-Day Challenge weight management program through nutraMetrix worked for me, big-time, as well as for my staff.  It will work for you, too, with some guidance from me as your physician. We will target the problems you have, and use either some parts of the 21-Day Challenge, use all parts of the 21-Day Challenge, or we might even use NONE of those strategies and choose to explore other options.

If appetite is a problem, we can use ear acupuncture for cravings and appetite. Are proper food choices challenging for your condition? Our Wellness Coach, Rebekah, can help guide you to the particular foods ideal for YOUR body. What exercise programs are safe for you and your medical conditions? You have your personal physician (Me!) to consult for that.

We are also poised to do ear acupuncture for smoking cessation. This tried-and-true method has far better success rates than any pharmaceutical product of which I am aware. Sure, you can seek ear acupuncture for smoking cessation from other sources. But you are NOT guaranteed a personal physician who graduated from an accredited U.S. medical school, who studied physiology and biochemistry from university professors, and who learned anatomy on a human cadaver. T DPC Clinics you have the dual benefit of a formally-trained physician who ALSO now brings the techniques of Traditional Chinese Medicine to bear on you and your Western health problems.

And just in time for you to make good that New Year’s Resolution, here’s what we’re doing in 2018: If you want to utilize acupuncture (for any purpose), you can add on a Wellness Package to your membership. The “Wellness + Acupuncture” package is $35/month for one person, and $60/month for two or more people on the same membership. This subscription gets you a complete package, with 24/7 availability to BOTH your personal physician and your personal wellness coach! It also includes the cost of acupuncture; otherwise, the Wellness Package is $30/month for one, $50/month for two or more of same membership.

That’s right – for only $35 a month, you can meet your health resolutions head-on and finally have success in 2018. Here’s to a healthy New You!


Deer Me!


It was bound to happen sooner or later, with the abundant amount of deer roaming loose in the Ozarks.  These gals and guys don’t bother to look both ways when crossing a street, I’ve noted, and when you drive a quiet hybrid car, they must tend to think that the headlights are a large lightning bug approaching.

I was driving home one evening, just me and the little dog in her seatbelt-strapped-in carrier, minding my own business, on a winding wooded country road.  We were only going about 40-45 miles per hour, since we’d just turned left at a near 90-degree turn and were gathering up a little speed to head up a hill.  Out of Nowhere – which apparently is my name for the wooded area just at the bottom of the hill on the driver’s side heading home – out of my peripheral vision came barreling toward me the largest un-antlered deer I’ve ever seen. It may have been a small elk for all I know.  At any rate, no time to stop, I realized it was going to hit me. I instinctively swerved as I stomped on the brake pedal, and braced myself as the deer slammed into me.  “I am going into the ditch,” was my thought, and so I held on, steering the car so that the passenger side wheels would not go into the ravine part of the ditch.  I did not want to roll the car. Slowed to a crawl now, I drove forward for a few feet, thinking I might be able to drive out of the ditch, but as I heard the undercarriage of HAL (my Prius) being scraped and smelled a hot car I thought best to stop.  (Yes, I named my Prius after the computer on 2001: A Space Odyssey. http://www.imdb.com/title/tt0062622/ )

I sat for a moment, reasoning; I can’t drive this car out of this ditch, the ravine is too deep, and I can’t back up because there are large rocks in the ditch that have already scraped the undercarriage.  I looked at the space between my driver’s side door and the road.  I could probably open the door about 5 inches, and I’m no slender girl.  So I unbuckled myself, and my little dog’s carrier, put her in the back seat and crawled over to get out on the passenger side. I looked back down the road and, sure enough, there lay the deer – in the opposite lane of traffic, lying right across it like he/she was taking a nap and hogging the entire lane to him/herself. Along came a fella in a pickup truck who pulled over and got out to make sure I was okay.  I assured him I was fine, but I wasn’t so sure about either my car (I didn’t want to confuse him by referring to HAL) or the poor deer.  He looked back down the road and then offered to go move the deer.  I agreed that would be helpful for others who may be traversing the road that evening.

My Good Samaritan walked down to the deer and was standing near it, to judge – I suppose – how he was going to move this large animal.  Then, surprising both of us, it suddenly sprang up and ran back into the wooded area from whence it came.

The next day my right trapezius started to ache, like I’d lifted something heavy.  By the time I got to the office I considered either seeing if I could get a same-day massage from Infinite Touch Integrative Therapies (https://www.facebook.com/InfiniteTouchLLC/?fref=ts) or get trigger point injections into the shoulder.  But then Rebekah Anglin walked into our office.


Rebekah is the Wellness Coach who works out of our office on Thursdays and Fridays.  Her business is multi-faceted, but among other things, Rebekah uses essential oils and does auriculotherapy.  Now, I don’t know the physiology of essential oils, nor homeopathy, nor of acupuncture, reflexology or auriculotherapy.  But I know that if I can avoid leaving the office during a busy scheduled day, and I don’t have to have a needle shoved into my muscles, I am all for trying it.

First she concocted a muscle rub using a couple different essential oils mixed with carrier oil and it was rubbed into the aching muscle.  After about 15-20 minutes, I didn’t really notice the muscle as much.  A couple hours later I lay down on her table and she touched my ears.  Weird, but so cool.  There was one spot on the ear that – as soon as she touched it – I felt a lightning bolt go into my right shoulder.  There was another place that when she touched both ears, I felt an aching in my neck. Then, using a cotton-tipped applicator, she applied essential oil(s?) to those areas.  After asking my feet a couple of questions (don’t ask!), I got off the table and resumed work.  I felt terrific, until about 4:00 that afternoon when the aching in the shoulder resumed.  I took the oil combination she’d given me and rubbed more of it on the spot.  That night, before bed, I rubbed some more on, just for good measure, though I could longer feel the aching.

The next morning, it was as if the accident had never happened.

Now, I’m not about to stop taking Edarbi, which I take for my hypertension.  But if I have any further problems with this right shoulder, I’m making an appointment with Rebekah Anglin.  You can too, simply by calling her at (573)836-1197 or emailing: rebekah.a02@gmail.com.  She not only can work miracles (in my opinion) with essential oils and auriculotherapy, she can help you manage what ails you using nutrition.

I’m betting that deer could use her services!

A Healthy Immune System, and “Good” Nutrition

Good health isn’t just a matter of not getting sick, it is about maintaining a healthy immune system. A healthy immune system keeps us from getting sick, but we have to build it up. The building blocks of a healthy immune system are the food we put in our bodies and the healthy habits we use to maintain them.

Good nutrition is the foundation to maintaining a healthy immune system.

What is “good nutrition?” If we listen to advertisements, we should be eating Cheerios for breakfast, a Slim Fast shake for lunch and a Smart Choice frozen dinner every evening. I love what author Michael Pollan says in his book, In Defense of Food (and I paraphrase): if it has to be labelled “healthy,” it probably isn’t. Let’s dump all the “knowledge” we have from advertising and start thinking about how our food was originally provided to us.

What kind of food did our ancient ancestors eat? (Sure, they didn’t live half as long as we do. But that’s because they didn’t know about bacteria and viruses, and they had to worry about getting attacked by wolves and other beasts.) Fresh food is best. Pollan suggests only shopping on the outer perimeters of the grocery store (if we have to go to the grocery store at all, that is), and that’s good advice. Eliminate processed food from your diet; it has been processed so much that they have to fortify it with vitamins and minerals! Processed foods that have more than 2 or 3 ingredients should key you in to the fact that they are manufactured, not fresh.

“Fresh” means that the food should look as close to nature as possible, as if you harvested it yourself from your garden or orchard. If you choose to blend it or cook it in your kitchen, then that’s up to you. But I doubt you’ll need to add corn-derived chemical products to it, or throw in any preservatives. Another good tip Pollan provides in his book is don’t buy anything to eat that doesn’t rot. You could put a Twinkie in a time capsule and 100 years later when they open it up it should be just as “fresh” as the day it was manufactured. There is something scary about that.

It is good to know the source of your fresh food as well—to make sure it is not genetically modified (not to be confused with hybridization, which is different) and what chemicals have been used in the soil or on the plant. Just in case, always wash it, even if it claims to be washed. Remember too that the farther something had to travel, the less ripe it had to be before it got to the store. If you can get produce out of your own backyard, that is best of all. Learn how to preserve seasonal foods in such a way that you don’t deplete them of all their nutritional value.

And don’t forget water! Our bodies are composed primarily of water, so it is essential for your kidneys, your skin and your immune system to get plenty of clean water. If you are not sure about the supplements in your water, get it tested. Your county should be able to provide you with the ability to test your water source.

Exercise is important as well. Because your immune system requires an operating healthy heart, and your heart depends on a decent cardiac workout, try to get a minimum of 30 minutes of exercise daily, earlier in your day if able. Get the heart pumping, and the lungs breathing. It will help your metabolism, your immune system, and will also improve sleep quality, another important factor in maintaining a healthy immune system.

While it varies from individual to individual, many studies show that the closer you can get to 8 – 9 hours of restful sleep, the better it is for the immune system. And restful sleep means exactly that—restful. Learn good sleep hygiene and make sleep a priority as it is a critical part of good health.

Finally, avoid those chemicals and compounds that we KNOW can cause problems. Our bodies are constantly battling off cancer cells. When our systems are stressed, the immune system cannot keep up and cancer gets out of control. If we know that the chemicals found in cigarettes have the potential to cause cancer, it is best to avoid those chemicals. If we know that certain exposures can lead to cancer, it is best to protect ourselves from those exposures as much as possible. Don’t assume that the EPA or your employer or landlord will take that responsibility—it’s your body and your responsibility to make sure you treat it right, so don’t make assumptions about the quality of the air you breathe or the potential exposures. Take it upon yourself to have your environment checked when you’re able, and to avoid the things you know you should avoid.

Try to put at least one of these suggestions into effect this week. Add other changes gradually and it won’t FEEL like a lifestyle change, even though that’s exactly what it is. You owe it to yourself—and your immune system!


Caring for Your Kidneys

Don’t Tell the Cardiologist, but the Kidney Rules


In the first year of medical school, we learned how the human body works. All the anatomy and physiology was focused on the healthy, well-working human body. We learned what goes on at the molecular stage on to the macro-biologic. Second year we learned pathology—disease states, infections, when things even at the molecular stage (or especially at the molecular stage) goes awry. There was some snootiness between professors during the first year, but when the specialists came to speak to us in lectures, this is where it got a bit more heated.

It was a standing joke that the cardiologists (heart doctors) made fun of the nephrologists (kidney doctors), and the nephrologists made fun of the cardiologists.  “All the kidney does is go ‘drip, drip, drip” the cardiologists would laugh.

“All the heart does is pump. How hard is that?” the nephrologists would retort.

Meanwhile, the neurosurgeons (brain surgeons) rolled their eyes (and they knew which cranial nerves controlled the roll!)

The heart IS a pump, albeit an electrical pump. If something goes wrong with the electrical wiring, the heart is in trouble. If the heart muscle is starved of “food” (oxygen) it will die off downstream of where the food supply is halted. If the doors are stiff and creaky and don’t close like they should the pump may back up depending on the severity of the hinge problem. And if the pressure is too high for the pump to pump against, the heart muscle has to work harder. This pump is pretty important because the brain really needs the oxygen that the heart pumps to it.  It is a beautiful design and works great, pumping blood to the brain and the rest of the body about 70 times per minute, 4,200 times per hour, 100,800 times per day. The heart tolerates a lot of abuse, from cigarette smoking to drinking energy drinks to high cholesterol diets.

The kidneys, on the other hand, filter the blood. I liken them to an automatic drip coffeemaker. The water is the blood coming in to be filtered. The brewed coffee in the carafe is like the blood as it exits the kidney. If the filter clogs up, or if the water goes through too slowly, the quality of the coffee is not as divine as it is when the filter works nicely and the water is forced through quickly. But, filtering the blood is not all that the kidneys do; they tightly regulate electrolytes. Sodium, potassium, even glucose are all very tightly regulated.  The kidneys also regulate blood pressure. This is why so many medications for blood pressure work in the kidneys. The kidneys even make hormones that do important things like stimulate the manufacture of blood cells and bring calcium into the bones. They do so much that most people have a pair of them—though you only really need one.

When the kidney(s) don’t work like they should, and it gets so bad that the toxins are not filtered out, a patient is put on dialysis. Kidney dialysis was first discovered by Dr. Willem Kolff and is the process by which one bypasses the diseased kidneys and uses a machine to filter the blood. http://www.nytimes.com/2009/02/13/health/13kolff.html?pagewanted=all&_r=0.

When the kidney(s) fail, and one requires dialysis, unless you qualify for a kidney transplant, you are looking at usually only 5-10 years of surviving on dialysis (though some folks manage to live a lot longer).

Take care of your kidneys! Don’t smoke – remember that smoking affects the blood vessels and contributes to plaque formation in important arteries. Nicotine can also cause contraction of the smooth muscle in the arteries. There is an important artery that runs to the kidneys; so, let’s not put a crimp in that hose.

Drink enough water to stay well hydrated, but not too much.  4-6 glasses (3-4 pints, or 1.5 liters) a day is good. Eat fresh food—avoiding processed foods helps you avoid the sodium (salt) that is used for preserving the food. Keep active—walk, swim, cycle.  Watch your blood pressure.  Every household should have a reliable blood pressure cuff, and know how to use it. Take your home blood pressure cuff into your primary care doctor and have it checked for accuracy.  Then make sure your kidney function (the blood work) is checked periodically. Some people are very susceptible to over the counter arthritis medicines (Non-Steroidal Anti-inflammatories or NSAIDs) such as Ibuprofen and Naproxen. Even if you don’t have high blood pressure, but DO take these medications on a regular basis, your kidney function should be checked to make sure the medications are not having an ill effect on the kidneys. And, try your darnedest to avoid diabetes. Not only diabetes but also the medications for diabetes are exceptionally hard on the kidneys.

So, don’t tell the cardiologist, but the kidneys rule, and the heart would be nowhere without one.


Summer Sun & Fun: Don’t Forget the ‘Lytes

My husband is a stubborn man. Handsome and smart, but stubborn.

My husband is also a rancher. He works outside from nearly sun up to sun down. He fixes fence, works on equipment, works a fair number of goats and cattle, puts up hay, mows, string-trims—he has even been known to pick blackberries. The last several summers he has experienced episodes where he “just doesn’t feel good.” He will be cold in the air-conditioned house, shiver, have muscle spasms and complain of a headache. Last summer it was particularly bad.

“I drank a bunch of water,” he would tell me.

“When was the last time you urinated?” I asked. Blank look. “How about electrolytes?” I sighed, “Men!”

Each time you suffer from heat-related illness, it gets progressively worse. My husband KNOWS he needs to replace his electrolytes, drink BEFORE he gets thirsty and has to keep an eye on his urine. But, he gets too busy to really think about it. Time goes by quickly, he’s sweating buckets and is dehydrated and sick before he realizes it.

Don’t be like my husband! If you are going to be working or playing outside, make sure you really DO have both water and something with electrolytes. I love Gatorade. Do you know why? Gatorade was created by a brilliant physician especially for heat-related strenuous activity, like football practice. I love the Gatorade story.

Yes, there are other options to Gatorade, and you may use those as well. Just be sure you have plenty of both water and an electrolyte replacement with you—and be sure to utilize them. Avoid alcohol. It makes the dehydration worse, and replaces the oxygen in your blood stream with something that your organs can’t readily use like they can oxygen. If you are going to drink alcohol, be sure to drink an equal amount of water (i.e.: 12 oz. of beer = 12 oz. of water = repeat). Caffeine, while a mild diuretic (it makes you pee) is not necessarily dehydrating; but, it doesn’t really help either. Avoid soda—do you really want to risk making kidney stones in this situation? Of course you don’t!

Protect yourself from the sun. Yes, you need vitamin D. However, the damage to your skin today can send you to my office years down the road with some nasty skin cancers. Clothing helps some but doesn’t fully protect you. Some clothing comes with Sun Protection Factor (SPF). Light colored clothing helps to reflect the sun; dark colored clothing absorbs the heat from the sun. As far as sun block is concerned, you want either zinc oxide or titanium dioxide present in your sun block. You want protection from both UV-A and UV-B rays, and you want a high enough SPF that you don’t have to be applying it every 15 minutes.

It doesn’t take long to burn without protection. So apply sunscreen and reapply often—even if it says it is waterproof.

Don’t forget to protect your eyes. Apparently damage from sun exposure is accumulative. That is, even small amounts over the years add up, just like the radiation damage from X-rays. This can increase your risk for cataracts or macular degeneration. Per the American Optometric Association, sunglasses should block 99-100% of UV-A and UV-B and screen out 70-90% of light http://www.aoa.org/patients-and-public/caring-for-your-vision/uv-protection?sso=y.

Don’t forget certain medications can increase your sensitivity to light. Family physicians, like myself, are notorious for prescribing medications and forgetting to tell you that you’ll be more sensitive to the sun with the medication. The list is hefty—everything from some antibiotics to high blood pressure medications to meds for rheumatoid arthritis, diabetes, depression, even Benadryl is on the list. I suggest that you simply assume your medication will cause sun sensitivity, and be sure to protect yourself more than usual. If you generally wear only SPF 15, upgrade to SPF 30 or 45; and, make sure the sunblock contains either zinc oxide, titanium dioxide or both.

Fans may feel good, but they really aren’t much help. If you have an elderly neighbor without air conditioning, a fan is a nice thought but to really provide help, I like the misters that gently cool you down with water. Cool baths, showers, even cool compresses will do a better job to keep the body temperature down.

Know the signs/symptoms of heat exhaustion and heat stroke. Heat cramps may be the first symptom of dehydration, and they will generally be in the major muscles of the body (thigh, leg, abdomen, back, arms). The cramps will generally not occur until after the activity. If you then progress to lightheadedness, sweating, nausea/vomiting, weakness and headache, you’re experiencing heat exhaustion. To prevent this from progressing to heat stroke, the activity must be stopped. The person must be rehydrated and needs to be cooled. Progression to heat stroke (hyperthermia) will manifest with confusion, disorientation, cessation of sweating and coma. This is dangerous and needs to be treated as a medical emergency as it can lead to death. The very young, the very old and animals are most at risk. Don’t be a jerk and think that a little exposure to the hot car won’t hurt.

I’m even a little worried about my turkey hen. She’s a heritage Black Turkey. The other night, she was standing and panting in the shade on the east side of the porch. Panting is not a normal turkey activity. She was fluffed out, holding her wings and feathers away from her body. I should have hosed her down. She wouldn’t have enjoyed it, but it may have been what she needed to cool her.

While we have the capability in our office to run IV fluids, I sure hope we don’t need to do that for any of you this summer. It’s pretty darn hot out there. Don’t make me say I told you so.