http://www.soundinternalmedicine.com/

Sound Internal Medicine, 31815 Southfield Road Suite 23B, Beverly Hills, MI (2025)

10/01/2025

FOUR years of ⚓️Sound Internal Medicine⚓️ and I truly cannot imagine doctoring in any other way (🚴‍♀️commute hair included.) Thank you to my patients, colleagues, family, and community for keeping the dream alive. Happy birthday 🎉

02/20/2025

⚓️Insurance does NOT equal healthcare⚓️

Breaking my social media hiatus to share a DITL of a doctor battling insurance on behalf of her patients.

A long-time patient with genetic high cholesterol and severe plaque buildup leads a very healthy lifestyle but needs lipid-lowering therapy. After 15 years of trial and error, she finally found a tolerable and effective combo: fluvastatin 40mg + ezetimibe. She has been stable on this for several years and is doing great.
Now, her insurance has deemed fluvastatin “non-formulary,” increasing her cost to $300+/month.
Cue the prior authorization nightmare:
* 20 minutes of online forms → redirected to phone
* 72-minute hold → gave up.
* Patient calls → gets me a “special physician number” → voicemail says “Thank you for calling Irvine Apartments Management Group.”
* 48 more minutes on hold the next day → I finally get a representative to say“You need to fill out this faxed form instead.” —> Fax is received at 5:30pm. It contains the same forms I submitted online. Great, I’ll fill it out tomorrow.
* Log in at 5:00am next day to new fax —> “your request has been denied due to failure to submit forms in a timely fashion.”
* Submit forms anyway with full documentation of office notes, labs, imaging, specialist notes. (Photos 1 and 2)
* 6 hours later —> Denial! (Photo 3)

4+ hours wasted fighting for a generic med. The appeal is next.

As a DPC doctor with only 200 patients, I have the time and bandwidth to fight for them like family. But remember: when insurance says your doctor “didn’t do something,” it’s often by design—to create friction, delay care, and avoid paying for treatments their members already fund with massive premiums.

⚓️Insurance ≠ Healthcare⚓️

09/16/2024

Going on vacation as a solo DPC doctor always makes me a bit nervous. I usually try to schedule travel for long weekends and I prefer to answer patient messages and calls while away. Last week though, my wonderful friend and colleague covered my calls so and I could celebrate our 10 year wedding anniversary without worry or interruption.

When I sent the email to my patients informing them of my upcoming absence and coverage plan, I received a barrage of messages back: “Have a great trip!” Well-deserved!” “You should take more vacation!” “It’s about time!” “Send us photos!” “Can’t wait to hear about it!”

I am so grateful for the relationships and care (for both patient AND doctor) that direct primary care allows. I appreciate the opportunity to occasionally disconnect from work and connect with my husband. Thank you to our village that cared for our children ( ) and my patients ( ) And if you’d like, here are a few photos from and my anniversary trip to and

08/16/2024

Excerpt from an auto-transcribed voicemail from one of my patients (identifying information at top of message has been cut off.) This message made me smile because it is so representative of DPC and the relationships we have with our patients. And of course I’ll be happy to give him a few syringes to use as props in the play!

07/26/2024

TGIF! But maybe make it a mocktail at tonight's happy hour? A new study published in the American Cancer Society’s journal in July 2024 provides sense of just how many cancer cases and deaths are due to drinking.

Researchers estimate 40% of all cancer cases in the United States in people 30 and up were due to “potentially modifiable risk factors,” including cigarette smoking, physical inactivity, consumption of processed meat, viruses, excess body weight, alcohol drinking and more.

While the majority of the preventable cancers and cancer deaths were directly related to smoking and obesity, 5% of cancers were due to alcohol consumption.

Specifically, the study found clear causation between alcohol and the following cancers and cancer deaths;

⚓️Mouth, throat, and larynx cancer
⚓️Esophageal cancer
⚓️Colorectal cancer
⚓️Liver cancer
⚓️Breast cancer

They also found an association (but not causation) between alcohol consumption and prostate and pancreatic cancers.

While some research has associated drinking with a lower risk of certain cancers, including kidney, non-Hodgkin lymphoma, and thyroid cancer, it may be outweighed by potential harms.

Though your best bet for your health is likely staying sober, this may not be realistic for some. In that case, practice moderation. If you can stay within the recommended daily guidelines for alcohol (1 standard drink for women, 2 standard drinks for men), the researchers estimate that 80% of alcohol related cancer deaths could be prevented.

Stay healthy and happy FriYAY!

Source: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21858

07/11/2024

We are in peak summer here in Michigan and loving all the🌞! Make sun-safety a priority now so you can be sure to enjoy our beautiful Michigan summers for years to come.

☀️UVA rays (or Aging rays) can prematurely age your skin, causing wrinkles and age spots.
☀️UVB rays (or Burning rays) are the primary cause of sunburn.

Both UVA and UVB rays can contribute to skin cancer, so it is important to make sunscreen a habit:

⚓️Apply sunscreen to dry skin 15 minutes before going outside and reapply every 2 hours at minimum.

⚓️Most adults need about 1 ounce — or enough to fill a shot glass — to fully cover their entire body. Most people are applying less than half of what they need to achieve the SPF listed on the label.

⚓️Don’t forget the tops of your feet, your neck, your ears, your lips, and the top of your head.

⚓️⚓️Chemical sunscreens work like a sponge, absorbing the sun’s rays. These formulations tend to be easier to rub into the skin without leaving a white residue.

⚓️⚓️Physical sunscreens work like a shield, sitting on the surface of your skin and deflecting the sun’s rays. Opt for this sunscreen if you have sensitive skin or are concerned about possible hormone disruption from chemical sunscreen. Historically they left a white residue on the skin, but newer formulations reduce this significantly.
�⚓️⚓️⚓️Which is the best sunscreen for you? THE ONE THAT YOU WILL USE CONSISTENTLY. In our house we love EltaMD products for the adults and Blue Lizard or Badger for the kids. What is your favorite sunscreen? 🌞

04/03/2024

The air is warming, the trees are budding, the flowers are blooming…and the allergies are raging! It is officially spring in Michigan!

⚓️What can you do?⚓️
-Frequent baths for pets
-No shoes inside and frequent vacuuming
-Nasal saline rinses
-OTC Meds like nasal steroid drops and oral antihistamines (we can help you navigate the overwhelming Target aisle!)
-Prescription medications (we can help here too!)
-Immunotherapy (we can refer you to a trusted allergist)

⚓️Did you know?⚓️
-The popular OTC spray oxymetolazone (Afrin) can cause “rhinitis medicamentosa” or rebound dilation of the nasal blood vessels after continued use, leading to dependence on these sprays.
-Tetrahydrolazone (Visine) works in a similar way for eye redness and is also not recommended for more than a few days. However, oloptadine (Pataday) drops are now OTC and are fantastic!
-Fexofenadine (Allegra) is currently the only truly non-sedating antihistamine approved by the FAA for use by pilots in-flight.
-Certain acid reflux medications like famotidine (Pepcid) can actually help treat allergy symptoms.
-Decongestants like pseudoephedrine (Sudafed) can raise blood pressure and should be avoided in those with hypertension. They can also dry up milk supply for our lactating mothers.

⚓️There is absolutely no need to let allergies ruin your spring. Reach out to your trusted internist at and let us help you get the most enjoyment out of Michigan’s long-awaited spring season.⚓️

02/03/2024

The #1 discussion in the exam room this past week? The year of January. And more specifically, the blah feeling that accompanied it.

This January was especially gloomy and grey. In many, all the grey can trigger Seasonal Affective Disorder. SAD is a subset of major depressive disorder that is characterized by its recurrent seasonal pattern.

In addition to the diagnostic criteria for major depressive disorder, winter-pattern SAD symptoms may include:
⚓️Oversleeping (hypersomnia)
⚓️Overeating, particularly with a craving for carbohydrates
⚓️Weight gain
⚓️Social withdrawal (feeling like “hibernating”)
 What can you do?

⚓️Expose yourself to bright light in the morning. Sun is ideal, but since it is usually still dark when we wake, it can be helpful to have a SAD lamp of at least 10,000 luxe. This activates certain eye/brain cells that help regulate metabolism, mood, and the circadian rhythm. Morning light exposure can also improve sleep.

⚓️Adopt Nordic traditions. In the Nordic countries there are winter days when the sun never rises beyond the horizon. Despite this, the Nordic people are experts in combatting SAD. They follow the principles of frulistliv (getting outdoors no matter the weather) and hygge (coziness and togetherness.) An added bonus is if you can identify an outdoor winter activity you look forward to all year! 🎿🏂⛸⛄️

⚓️Double down on nutrition. Mood and nutrition are intricately linked, as the gut produces 90% of the body’s serotonin. By eating a minimally processed, nutrient-rich, whole food diet, we can ensure we have the phytonutrients and prebiotic fiber we need to stabilize blood sugar and optimize neurotransmitter production.

⚓️Get your labs checked. If I am your doctor, I can make sure you have adequate Vitamin D, Vitamin B12, and iron, and prescribe supplementation if necessary.

⚓️Get treated! SAD is a real medical condition and deserves to be treated without shame or judgment. Depression can’t be “outsmarted” by just “trying harder.” If your symptoms are interfering with your quality of life, I can refer to therapy or prescribe a safe and effective antidepressant with close follow up and support.

01/16/2024

Motion is Lotion!

Osteoarthritis, the progressive breakdown of cartilage and other soft tissue within the joint, is one of the leading causes of hip and knee pain in adults.

Previously thought to be due to ‘wear and tear’ or ‘overuse’, it is now understood that OA is due to a complex interaction of metabolic, genetic, chemical, and mechanical factors. This explains why OA can run in families and is often seen in those with sedentary lifestyles. Risk of OA is also increased in those who have had previous ligament/tendon injury and/or surgery, such as in former athletes.

As with all ailments, prevention through lifestyle is everything.

How to prevent OA?
⚓️Move! Our bodies were designed to MOVE! Make movement a priority throughout the day. This is one reason why more active cultures have lower rates of OA than those of us in westernized society.
⚓️Resistance train using progressive overload (ie: lift heavier weights gradually over time) to keep joints strong
⚓️Build flexibility and resilience through regular stretching and mobility work
⚓️Maintain a healthy body weight
⚓️Avoid excessive consumption of ultra-processed foods and added sugars
⚓️Manage stress to the extent possible
⚓️Aim for 7-9 hours of sleep each night for maximum restoration, anti-inflammation, and rebuilding of important metabolic processes

By age 70, mostly everyone has some degree of OA. While OA cannot be cured, it can be managed. Pain and dysfunction from OA tends to wax and wane in the earlier stages.

Management is directed at reducing pain and improving function via:
⚓️Activity! Frequent and regular activity promotes blood flow and joint lubrication, thereby reducing stiffness and inflammation. MOTION IS LOTION!
⚓️Physical therapy can strengthen the muscles and soft tissues supporting the arthritic joint, allowing for improved function
⚓️Oral, topical, and injectable medications can reduce inflammation and pain
⚓️Certain supplements have data suggesting they may reduce inflammation and pain
⚓️Regenerative treatments such as PRP show promise
⚓️If needed, surgery can be life-changing

Stay active to prevent OA and keep those joints healthy for years to come!

12/28/2023

Here is the community’s most discussed/recommended/debated content from this past year.

⚓️BOOKS
The Comfort Crisis by Michael Easter
You Can’t Screw This Up by Adam Bornstein
Dopamine Nation by Anna Lembke, MD
Outlive by Peter Attia, MD
The Gospel of Wellness by Rina Raphael
Hot & Bothered by Jancee Dunn
The Menopause Manifesto by Jen Gunter, MD

⚓️NEWSLETTERS
Growth Equation - https://thegrowtheq.com/articles/
Lucy McBride, MD - https://lucymcbride.substack.com
Emily Oster, PhD - https://emilyoster.substack.com
Jacqueline Nesi, PhD - https://technosapiens.substack.com
Brady Holmer - https://www.physiologicallyspeaking.com

⚓️PODCASTS
Medicine Re-Defined #55 and #56 - Nicole Harkin, Preventing Cardiovascular Disease and Lifestyle Interventions for a Healthy Heart �The Drive #40 - Tom Catena, MD, The World’s Most Important Doctor
The Drive #226 - Arthur Brooks, Ph.D The Science of Happiness
The Balanced Bodies Bluerint #11 - Hormones Demystified, The Quackery of Functional and Integrative Medicine
Barbell Medicine #225 - Pain Management and Exercise

⚓️SOCIAL MEDIA
Nutrition - .adrian.chavez https://www.instagram.com/dr.adrian.chavez/
Cardiology - https://www.instagram.com/daniellebelardomd/
Cardiology - https://www.instagram.com/nicoleharkinmd/
Dermatology - https://www.instagram.com/drdrayzday/
Women’s Health/OBGYN/Menopause (local!) - https://www.instagram.com/talkinggyno/
Women’s Health/OBGYN/Menopause - https://www.instagram.com/drjengunter/
Urology & Sexual Medicine - https://www.instagram.com/drrachelrubin/
Pedatrics - https://www.instagram.com/askdrjessica/
Pain Psychology - https://www.instagram.com/therealdoczoff/

Here’s to a healthy, happy, and informed 2024! Happy New Year!

12/10/2023

Migraines!

Long misunderstood, science is making great strides in finally understanding the pathophysiology of migraines and developing treatment options for both relief and remission.

Little known migraine facts:
1. Most “sinus headaches” are actually migraines with vasomotor symptoms that cause congestion, runny nose, etc.
2. Women who have migraine with aura (aura = an alteration to your senses prior to onset of migraine) may NOT take estrogen-containing birth control because it increases risk of stroke.
3. Common OTC meds used to treat migraines (ibuprofen, Tylenol) can paradoxically cause a secondary headache called analgesic headache.

Not all migraines need a visit to a neurologist. You can see your internist first about your migraines. We will start by asking a series of questions, doing a physical exam, and possibly ordering some testing to confirm the diagnosis of migraine versus other types of headache. We will also rule out “the scary stuff” to put your mind at ease.

From there, we will help you come up with a treatment and follow-up plan. Treatment plans are individualized to the patient and his/her specific migraine pattern. These recommendations may include lifestyle changes like treating sleep apnea or increasing your water intake, supplements like the holy grail combination of magnesium glycerinate + riboflavin + Coenzyme Q10, or prescription medication to treat acute migraine and/or prevent future migraines. And fear not, we can always refer you to a headache-specialized neurologist if needed.

What should you do?
1. Keep a headache diary for 2 weeks. Write down when you have a migraine, how you would describe the sensation, how long it lasts, what makes it better and worse, and what your day was like before and after (ie: diet, sleep, stress, other associated symptoms.)
2. Make an appointment with your internist armed with this diary!

And residents, we will soon be discussing headache management at Thursday didactics.

12/05/2023

A few weeks ago I emailed all 200 of my patients and informed them the office would be closed because I was getting a colonoscopy. At the time, the motivation behind this overshare was to a) schedule their care accordingly and b) encourage some of my more reluctant patients to consider scheduling their own scopes.

Upon reflection, there was more to it. The foundation of has always been relationship-based care. I want my patients to feel comfortable confiding in me and trust that I will have their backs. I want them to know that I understand what it is like to be a patient and empathize with all it entails. If I am not vulnerable and authentic with my patients, why should they be vulnerable and authentic with me?

My patients know I have Crohn's Disease. I hate Crohn's. I spent Mother’s Day weekend in the hospital. I had to back out of the because I was too sick to train. I have spent COUNTLESS hours on the phone with insurance, doctors, hospitals, pharmacies, etc. My medicine costs >$30,000 per dose and, while it’s currently covered by BCBS, it is not covered by Medicare.

I am not grateful for Crohn's. Not at all. However, I AM grateful that my experience as a patient has better equipped me in supporting my own patients. When my patient had to cancel her Disney Cruise because she needed emergency surgery, I cried with her and advocated to her trip insurance for a full refund. When another patient’s insurance company outright denied her MS treatment, I made it my mission to help get the meds covered. When a third patient had her 3rd hospitalization in as many months due to complications from a a botched medi-spa procedure, I visited her frequently and gave all her nurses my cell number.

No one wants to get sick. No one wants to be a patient. No one wants to waste their precious time and money and energy navigating our dysfunctional behemoth of a healthcare system. BUT - everyone has their stuff. Nearly 30% of my patients are doctors and they all have their stuff. You have your stuff and I have my stuff. And if and I can support my patients through their stuff, then it is all worth it in the end.

Sound Internal Medicine

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