Note: This information is only up to date as of December 2020 and is subject to change. 

It goes without saying that this year has been a challenging one in many ways. The Covid-19 (SARS-CoV-2) virus has now spread widely within our population and penetrated deeply into our collective psyche. There has been tragic loss of life especially for those who are more susceptible. This has included the elderly and those who have comorbid chronic medical conditions or who are immunosuppressed. Despite this fact, for much of the population the risk of serious morbidity or mortality from Covid-19 is quite low. 

Now after nearly a year since the virus emerged, the FDA has recently approved 2 vaccines to combat the virus. Consequently, I have been getting a lot of questions from patients about my opinion about the vaccines. I hope to give you some general information from the published trial for one of the vaccines (Pfizer) so that you can make an informed decision for yourself. If you would like to review the published article yourself from the New England Journal of Medicine click here. 

To summarize, the trial published for the Pfizer Vaccine appears to show the following:
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• The vaccine was given in 2 doses separated by 21 days.
• The population tested during the trial included individuals 16 and up and didn't include immunocompromised individuals. 
• The vaccine was tested and monitored for safety and efficacy for a period of 2 months.
• The vaccine showed a decrease in symptomatic infections by greater than 90% over a 2 month period but asymptomatic infection rates were not measured. 
• Common side effects from the vaccine included fever, fatigue, pain, and headache. Side effects were more frequent in younger individuals.
• The antibody response from the vaccine was lower for older individuals than younger individuals.
• The ability of the vaccine to prevent the spread of the virus was not tested. 
• All participants in the trial were not tested on a regular basis to see if they were positive for the virus. 
• Actual trial data is not publicly available for independent review.

Since the trial results was published and the general public have begun receiving the vaccine it appears that some serious anaphylactic allergic reactions have occurred according to some news reports that I have seen.  This was not reported in the published study from what I could ascertain. 

In addition, you should also be aware that vaccine recipients will be tracked and possibly have their information shared with state and federal regulatory agencies. 

Finally, I am not here to promote a particular treatment or a vaccine. Due to highly varying risk factors between individuals it is up to each person to determine if a particular treatment is right for them after they have considered the risks, benefits, and alternatives based on accurate information. The fear, uncertainty, and physical suffering caused by this virus should not preclude or supersede the right of each person to determine what medical treatment is right for them. 

Covid-19 treatment and testing is offered at my office. Feel free to call for more information. 

Like everyone I have been carefully watching the Coronavirus outbreak that started in Wuhan China and has now spread to other countries including the United States.

There were some initial brave Chinese medical personnel who tried to raise the alarm about the virus. One such health worker, an ophthalmologist named Li Wenliang who later died from the virus, reported on his social media his concern for a flu-like virus that had emerged in the hospital where he worked. According to the Guardian he may have been targeted by Chinese police for spreading false rumors about a mysterious illness that later turned out to be the "Coronavirus." 

Now the virus has continued to spread and has caused terrific loss of life and hardship across Asia, parts of Europe, and now the U.S. While there is still a chance that the American people can for the most part remain untouched by the virus the future is uncertain and now is the time to prepare.

While information about the virus is still sketchy I will attempt to sum up some information that is out there so you can get prepared. 

My first piece of advice is to remain calm and don't panic. Getting into panic mode will only decrease your ability to think rationally and paralyze you when action is needed to be taken. 

Secondly, the virus has tended to cause a much higher mortality rate among elderly individuals that are in nursing homes or are immunosuppressed. While this is not good news for those individuals who fit that description it does mean that mortality rates are not as high for most people. I have seen estimates of mortality of about 2% when patients have access to advanced medical care in first-world countries. Hopefully, this will mean that there will be a lot less loss of life then originally feared. 

If the virus does reach pandemic proportions and becomes widespread it is important to know what to look for. The virus seems to present with symptoms slightly different than many respiratory viruses. The most common symptoms may include fever, cough, and shortness of breath with significant involvement of the lower respiratory system (ie. the lungs). The lungs of infected individuals can sometimes be so significantly damaged by the virus or by the immune system response to the virus that individuals can develop viral pneumonia or even acute respiratory distress syndrome which is even more ominous. These diagnoses can be detected with a CT scan. 

The virus appears to be spread both through direct contact and respiratory droplets and the incubation period may be as long as 15 days. That means that a person could be a carrier of the virus for sometime before symptoms develop. The virus spreads easily and has proven to be very difficult to stop once it gains a foothold. 

The most common strategies recommended for preventing the spread of this virus include using proper hygiene, proper hand washing, and limiting exposure to respiratory droplets through use of masks. One strategy that doesn't get a lot of attention but is very important is to simply not touch your eyes, mouth, or nose. The virus can only cause an illness if it can get inside you. 

Unfortunately, the treatment for Coronavirus is mostly supportive at this juncture and no medication has been proven to be effective although many different antiviral agents are being tried. A vaccine is reportedly being targeted for development although vaccine development is typically not a short process. 

Despite the lack of specific proven treatments it probably makes sense to make sure your physical health and diet are the best they can be. Since the virus appears to affect people that are immune compromised the most, making sure that your immune system is in good working order is critical. This includes making sure you are getting all the vitamins and nutrients you need and that you have low inflammation in your body in general. Some of the biggest contributors to inflammation include high stress, poor sleep, obesity, and poor diet. Decreasing your blood sugar and increasing your insulin sensitivity is very important as diabetics are far more susceptible to illness. 

Finally, it stands to reason that everyone should be prepared with basic medical supplies and access to food and water should shortages develop. This is a time for Americans to come together to help each other instead of becoming more divided. The virus is no respecter of persons. It doesn't care who you are and neither should we care. 
 











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Cold and flu season has finally arrived and is in full force. I don't like to see patients getting sick; I would rather them be healthy. I would also prefer to help patients strengthen their physical resistance to illness and develop an increased capacity to rapidly dismiss sickness when it occurs.

During this time of year, some patients seem to get sick more frequently than others. Many of these patients blame their propensity for illness on bad genes, an inherent immune system deficiency, or just plain bad luck. Unfortunately, it is not usually one of the aforementioned factors that is the root cause of the susceptibility to disease. The truth is that the ability to resist illness and to maintain optimal health is not a given. Optimal health is created, not inherited. Achieving real health necessitates following a daily health routine that is purposeful. The purpose of this routine is to develop strength, increase energy, and enhance resilience. This routine can and should become just as automatic as setting an alarm clock. It should become a habit, or even better, a health reflex.

One of benefits of optimizing your health is an increased capacity to stay healthy. I am often asked by patients why I don't seem to get ill even when I am constantly exposed to sick people. While I do still get sick, I have developed some strategies that seem to have helped me stay healthier. Here are some of my top recommendations for staying free of colds and flu that don't include taking supplements or prescriptions.

1. Don't touch your face: This is my personal favorite way to try to limit infectious respiratory illness, but most people don't think about this obvious strategy. There are very few ports of entry for viruses and bacteria. Your skin is an effective barrier to these organisms. This leaves primarily your mouth, nose, eyes, and respiratory system as avenues of entry. I focus on trying to not touch my face. If I have a significant itch I use my undershirt or a paper towel as a barrier to scratch through. For more information on this technique and other preventative strategies visit the CDC website.   
2. Lower your blood sugar: It is quite clear that diabetes and elevated blood sugar has a dramatic effect on your body. Eating significant amounts of processed foods and carbohydrates suppresses your immune system and can make you more susceptible to infection. In today's landscape we are saturated with these foods. They are very addictive and feed binge eating behaviors. Thus, the most important strategy to lower your blood sugar is to remove processed foods and eat real food including healthy meats, vegetables, and fats.
3. Lower your weight: In addition to having increased problems with blood sugar regulation, people that are overweight have higher levels of inflammation and may have weaker immune systems. If you are above your ideal weight, I would treat that as an emergency and begin to work on it immediately.
4. Wash hands frequently: We all know about this advice. Naturally, washing your hands will lower the number of organisms your are exposed to. The only problem with this approach is that when you touch a dirty surface you are once again contaminated. For example, opening the bathroom door by touching the handle most likely means that you already acquired new organisms on your hands. In addition, using soap and water significant decreases but doesn't entirely eradicate virulent organisms. Therefore, I always assume my hands are dirty.
5. Sleep: Getting fewer than 6-7 hours of sleep is associated with elevated stress hormones such as epinephrine and cortisol which are known to suppress the immune system. There are few things that will be better for your health than getting adequate sleep. You will also be more efficient with your time when you are awake. A trick you can do is to set an alarm to help you prepare to go to bed. Ideally, this preparation time should start an hour before bedtime and should include turning off electronics and using dim lighting, such as lamp lights.
6. Stress: Chronically elevated stress hormone levels suppress the immune system. Stress is a natural part of life and should be expected. However, chronically elevated stress is a poison to every part of the body and should be addressed immediately.
7. Anxiety/Depression: There are few conditions that I have seen have more negative impact on a person than anxiety and depression. They have significant impacts on health in almost every way. If you are struggling with these conditions please find help immediately.
8. Exercise: Getting regular exercise and learning to keep moving is very important for health. In addition, it may help strengthen your immune system. Just start small and get 15 minutes of exercise per day. You will feel much better almost immediately.
9. Social Support: Some research has shown that having strong social support can help people resist disease. Getting involved in something like your local church or some other purpose-driven activity where you are serving others may be helpful for your health. 
10. Don't poison yourself: This seems like an obvious one but there are certain habits like illicit drug use, smoking, and heavy alcohol consumption that increase susceptibility to illness. If you are struggling with one of these poisons please seek help immediately.

I hope you enjoyed some of my top personal tips for staying free of colds and the flu. This list is by no means exhaustive.

My vision for every person is that they avoid useless suffering and have more joy and happiness in their lives. If you find that you are getting ill on a regular basis try some of the steps above and see if they help. If you are following all these steps and are still getting regularly ill then check with your doctor.

Last of all, BE the BEST YOU!

You are not alone!

As a physician I have the privilege to speak to people about their innermost struggles. I am often struck by the amazing bravery and forthrightness of some of my patients. On occasion, after barely an introduction has been made, eyes become quickly moistened, tears are expressed, and the most personal of information is shared. Some of it can be shocking and terrifying. I hear stories of abuse, trauma, betrayal, regret, and self-destruction. Some of it is self-inflicted, much of it is not. Some of it is inherent in the human condition.

People are struck with catastrophic illness or face eminent death. There is a lot of loneliness, despair, and disconnection. There is great fear. There is bitterness and resentment against the world. Far too many people ask themselves if life is worth living. They want to become extinct. They don’t want to remember any more.

Out of a pit of nihilism some seek to take revenge against the world and God by punishing His creations, by inflicting pain, suffering, and death. They would rather destroy than create. They want to be remembered for going out in a ball of flame and a hail of bullets.

Many people feel that they are drowning in a stormy sea without hope of rescue. They are constantly overwhelmed and anxious. They tell a story of powerlessness, fear, loss of control, self-loathing, and desperation. They are crying for help but don’t know where to turn or how to express it. They are looking for an outstretched hand.

These people are all around us, but we just don’t know it. We all have egos that cover over our innermost selves from others and even ourselves. We want others to know but at the same time we don’t. We fear peer rejection and vulnerability above almost anything else. We keep others at a safe distance from our true selves so that we can’t possibly be hurt or helped. We fear frailty and death.

My interactions with people have taught me that we are not alone and that someone’s apparent outward composure does not always correlate with their level of inner composure. All of us have things about ourselves that we despise and feel powerless to change. We push up against a wall that will not budge. We may have lost hope and given up trying. We may feel a lack of purpose or meaning. We may be bored with life.

Many try to cope with these negative feelings by seeking immediate relief, immediate gratification. The substitutes or stand ins for negative feelings can come in the form of substances, behaviors, or food. We can also try to hide from these feelings by retreating or withdrawing out of society. We can sleep too much, work too much, or exercise too much. These are all attempts at avoidance and distraction. They are attempts to avoid self-responsibility. They are ultimately self-focused and selfish. They are a refusal to bear our own cross and carry it up the hill. They are focused on losing or having less of.

I have experienced many of these same feelings around many areas of my life. One of these areas that I have been pretty open about is my struggle with compulsive eating. I have personally lost several hundred pounds over my life. In two stints I have lost more than 80 lbs. And like nearly everyone else who has tried to lose weight I have gained the weight back on many occasions.

I was 155 pounds when I got married right before medical school. I was pretty physically active and played a lot of sports. During medical school I exercised less and ate poorly. I experienced more stress due to the rigors of school. I unconsciously resorted to eating as a way to cope with negative emotions and stress after a long day. When I got to residency and started having children the stress only got worse. During my medical training my wife and I dealt with some pretty trying circumstances like surviving hurricane Katrina. Eventually, during a particularly harrowing portion of my residency I ballooned up to 240 lbs. I experienced a lot of self-doubt and became depressed about my weight which began to have a significant impact on my health. I developed sleep apnea and significant anxiety. I worried a lot and felt overwhelmed.

Somehow, I came to a place where I had had enough. I was tired of feeling crummy and I resolved to make a change. It was around this time that I had begun to research the Ketogenic diet which is now popular but at the time was not well known. Over a whole year I lost about 80 pounds with this diet. I tracked my carbs, fats, and calories diligently. I tried to stay at about 1000 calories and for the most part I stayed committed and consistently lost weight. I felt great and my physical symptoms disappeared. I did feel better about myself, but I still had negative feelings that arose due to life circumstances. This, of course, is unavoidable.

Then, I made a mistake. I subconsciously wished, like many people do, that I could just go back to eating like a “normal” person, that I could eat naturally only to satisfy hunger. I thought that I could in a sense return to a point in the past where eating did not fulfill other wants, needs, or desires. It is almost like I wished that I could once again return to a state of innocence and to have never partaken of the forbidden fruit. But just like an alcoholic who can never expect to go back to drinking like a regular drinker so a compulsive eater cannot expect to do so either. Once the apple has been eaten it cannot be uneaten.

Eventually, the memory of the pain of what it felt like to be significantly overweight faded and it became easier to rationalize going back to eating like I had previously. I had become focused on loss, the loss of food choice and the loss of pleasure of eating.

In a way, I longed for weight to not be a challenge anymore. I suffered weight loss mental fatigue and got tired of fighting. I just wanted to be able to relax. As a result, I began to seek food more as a source of comfort and a relief from inner distress. I would binge eat frequently. I relaxed, took it easy. I indulged. I was focused on self.

The result of this is that in relatively short order I lost control of eating and regained all the weight that I had lost. I was right back to 240 pounds within about 1 year or so. Like the proverb says I was “as a dog” that “returns to his vomit” or like a pig, that is washed, that returns to wallowing in the mud.

It wasn’t until I started my own medical practice in 2015 that I started working on losing weight again. Since my previous weight loss, I had since gathered hundreds of peer reviewed articles about weight loss and various diets. I was and continue to be very fascinated with helping people become stronger physically rather than enabling their compulsions with medicines. I wanted to help patients by sharing my research about diet and weight loss, but I couldn’t effectively convey how to lose weight from a practical standpoint when I was still very overweight.

Once again, through sheer determination and will power over the period of about 1 year I lost about the same amount of weight in about the same amount of time and using the same diet. I also incorporated intermittent fasting and long fasts into my routine.

I have since continued to struggle with weight. I have gone up and down 10-20 pounds and still binge eat on occasion. This is largely due to the fact that I have at times let my guard down and indulged in my previous habits. I have found that inertia is incredibly powerful. It is much easier to continue eating healthy once you get in a groove and vice versa for satisfying unhealthy compulsions.

Because of my struggle losing and maintaining weight loss I have also invested a lot of time researching “weight loss maintenance” which is the least successful part of weight loss programs. The evidence that I discovered was not only not encouraging, it was bleak. Only about 2-3 percent of people that lose a significant amount of weight manage to keep the weight off over a 5-10 year period. Most of the others gain it all back or more.

Many people have repeated the cycle I had repeated over and over again. They despair and may eventually give up as I have been tempted to do on many occasions. They may take long weight loss sabbaticals until the physical and emotional consequences becomes too much to bear. They may then find the will power to make yet another attempt to lose weight out of a reaction to this suffering and pain.

Unfortunately, by this time weight loss has often become simply a means of escape. There is often a lack of sufficient vision or purpose. It is like an inmate being let out of prison only to find that out they are much more comfortable with the familiar controlled circumstances of prison life than the uncertain and unrelenting challenge of making their own way toward a higher life. In the short term it is sometimes easier to stick with the pain you know rather than the pain you don't. But the paths are not equal in their sum total of pain and joy.

So if you struggle with weight what can you do?

To escape this revolving door in regards to our compulsive behaviors requires a shift in our vocabulary and our approach. For example, I don’t like the term “weight loss.” It implies a deficit and that something is missing. Nobody likes to lose anything. We like to gain. I like to focus on what someone is gaining when they make a significant change in their life.

The proper vision of “weight loss” in my view is the increased physical, emotions, and spiritual capacity someone gains from proper health choices that helps them serve themselves, their families, and the community to the highest degree possible. It is a commitment to love rather than fear. It is a commitment to serve the highest meaning and purpose, to walk the road less traveled, and to help others along the same road.

The change in vision also starts by acknowledging with honesty that you have been powerless to control your eating and all the efforts you have made have been unsuccessful. It means acknowledging that you need help and that will-power is not enough. It means that thinking about how to lose weight or reading more self-help books is not enough otherwise you would have figured it out by now. It means when it comes to weight loss you are figuratively lost and will not find the way out by yourself.

Ask yourself. If you were the CEO of your own weight loss company would you fire yourself? Ask yourself. Who is my higher power? Is it food or some other substance or behavior? You can know who your higher power is by what you think about or what indulgence in when you are stressed or have negative emotions. Your God is what you believe will give you comfort and relief. It is where you put you trust. It is safe and secure and reliable. It is your deliverer. For an alcoholic it is the bottle. For a compulsive eater it is binge eating. It is Don Corleone. It is a deal with the devil and the road to unhappiness and regret. It is a shortcut.

To get the necessary strength means to have the correct lens to look through. It starts not by focusing on how to lighten your burden but on how to strengthen your back. It starts by writing down with real commitment and purpose what the ultimate vision for yourself is. Ask yourself if you could visualize the ultimate version of your self what would it be and how would you go about transforming yourself into such a person? If you still cannot come up with a vision of your future potential self then think about a potential future version of yourself that if you met in person you would be in awe of or you would be strongly tempted to worship. That is the person you should be but are avoiding.

Focus on your future self. The God of compulsive behavior is to desire immediate relief and to avoid responsibility for the future potential of yourself and that of others. It is a lack of faith in your future potential. It is a life ruled by fear rather than love. It is self-rejection, self-hatred. It is a self-condemnation of your value. Will you sell your birthright and your soul for a mess of pottage? I certainly have at times and you may have done so as well.

The true God represents the highest way. The way that sacrifices the short-term fix of today for the transcendent future for you and humanity. It means letting go of earthy pleasures, the search for power and prestige, and the desire to remove the hard realities of life such as pain and death. It means letting go of resentment and bitterness about the reality of the situation you are in. It means letting go of blaming others. It means being honest with yourself and that you need help beyond yourself. It means letting go of your ego and being vulnerable and acknowledging your weakness.

Once you have realized this then there is potential for real magic to happen. The key for me has been to realize that out of the greatest suffering comes the opportunity to help others will similar suffering. Be a true hero. Transcend your greatest weakness and you can help others transcend theirs. Walk the path of strength and you can strengthen others. Have sufficient love to stick out your hand to all those that are suffering who you could help. Offer them hope and a way out.

Rely on a greater power and greater vision than yourself because you will set your sights to low. Love yourself and others. Make a covenant with your vision of a higher power and to your future self and to others that you will do everything it takes to accomplish this vision and that you will leave yourself no outs. As Yoda from Star Wars famously said: “Do or do not, there is no try.” Ask for courage. Say the serenity prayer.

Don’t focus on hunger as a loss. It is a friend, not a foe. It is future strength. Don’t focus on the loss of not being able to eat junk food. Focus on the strength that will be gained from eating the right foods. Be thankful for the blessings you have received as a result of other’s contribution to alleviating your suffering and making your life easier. Choose to live in abundance and not in depravity.

Trade your expectation for a “normal” life for an appreciation of the potential and opportunity of a “celestial” life, one that is hard won.

This is where real meaning and purpose arises. Want to know how to help others and to not feel alone? Make amends for those things that you have done to hurt others. Seek out those that are suffering as you have suffered and give them hope. Help show them the way. Strengthen their feeble knees. Let them know that they are not alone. Be the light in the darkness. Draw people closer to you with your own outstretched hand and lighten their burdens. Love first and love will be returned. Be and do what is seemingly impossible and you will inspire others to do the same. Don't seek for a finish line, rather seek for a new starting line to a land of greater possibility and capacity. Invest in yourself everyday because you are worth it and others need your help.
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Start today by taking these action steps. First ask yourself what your ultimate meaning, purpose, and mission is. Then ask yourself that if you could become the person you dreamed of and that you were meant to be what would that person be doing now. Feel it, breath it, and visualize it. Write it down. Then post it on your bathroom mirror and fridge. Begin every day by focusing on the abundance this vision holds for you, your family, and to humanity. Finally, create one action step that you can and will repeat every day that will take you a little closer to becoming this person. Post it next to your vision. Forget perfection and focus on progression.  

For me losing weight and keeping it off once seemed impossible. I have now become the impossible in my own mind and in reality. I am as healthy as I have ever been not by accident but because I purposefully invest in my health every day. You can do the same. Be the impossible in your own life and health!

Have you experienced a loss of vigor, libido, sexual hair, and muscle mass?

Have you noticed depression, hot flashes, breast development, erectile dysfunction, a loss of nighttime/morning erections, an increase in fat mass, fatigue, irritability, poor concentration, or sleep problems?

If you have noticed any of these signs or symptoms then you may have low testosterone and you may be suffering needlessly. I do see patients for hormone replacement including testosterone replacement at my clinic and a lot of patients get significant relief if their symptoms are addressed adequately. Even women can benefit from testosterone replacement in select cases. 

Some of the potential benefits of replacing testosterone include improved libido, lean muscle mass, strength, bone mineral density, mood, well-being, and cognitive function. Interestingly, testosterone replacement can also help with weight loss in overweight individuals. 

So what are the causes of low testosterone?

The causes of low testosterone and/or failed sexual development are many. These can include genetic abnormalities, undescended testicles, and testicular/pituitary dysfunctions. There are also acquired conditions such as the mumps, exposure to radiation, steroids (glucocorticoids and androgenic steroids), trauma, testicular torsion, chronic illness (liver cirrhosis, kidney failure, HIV, emphysema), toxins, medicines (ketoconazole, opiates, alkylating agents, anticonvulsants, estrogens, progestins), or many others that can cause testicular failure and consequently low testosterone. 

Obesity, age, excessive exercise, acute illness, recent glucose ingestion, thyroid disorders, and diabetes may also affect the amount of bio-available testosterone. 

When should you get your testosterone level checked?

If you have any of the signs, symptoms, or conditions associated with low testosterone then you might be at risk. It only takes a simple blood test to see if you have low testosterone and whether you could potentially benefit from testosterone replacement. 

So how is low testosterone measured?

Testosterone is generally measured by checking a total testosterone blood level. Sometimes a Sex hormone-binding globulin (SHBG) and free testosterone level can be checked as well. In some rare circumstances such as failed sexual development or severe testosterone deficiency pituitary hormones such as the LH and/or FSH should be measured.

Ideally, the levels of testosterone should be checked between 8 - 10 am in a fasted state. This is more important to do in young men as there is diurnal pattern of testosterone release with higher levels in the morning. This rhythm is blunted and flattened in older men significantly. However, a substantial fraction of older men, 65 to 80 years of age, will still have higher testosterone concentrations in the morning. The reference ranges for testosterone blood levels were also established around obtaining testosterone measurements in the morning. Therefore, getting your testosterone levels checked earlier in the day will provide the most reliable results. 

Should you have repeat testosterone testing?

Up to 30 % of men with mildly suppressed testosterone will have normal testosterone on repeat measurement and 15 % of healthy young men will have testosterone below the normal range in a 24-hour period. Therefore, for many men it may be reasonable to confirm a low testosterone measurement at least twice.  

Who is appropriate for testosterone therapy?

It may be reasonable to consider testosterone replacement for symptomatic patients with confirmed deficiency. However, testosterone replacement should be avoided in patients with prostate/breast cancer, an elevated PSA test, an elevated hematocrit test, untreated severe sleep apnea, severe prostate urinary obstructive symptoms, uncontrolled heart failure, or in those desiring fertility. 

While testosterone replacement may be a consideration for many men and women there are also many natural options that should be explored.

In a future article I will explore some natural ways to increase your testosterone levels as well as testosterone replacement options. So stay tuned!

If you are considering any testosterone replacement options please consult with your physician or give me a call.