What are the opening hours?

Monday 9am - 5pm Tuesday 9am - 5pm Wednesday 9am - 5pm Thursday 9am - 5pm Friday 9am - 5pm

http://www.mdvip.com/doctors/rerikhartvigsenmd?utm_campaign=listing-yext&st-t=rep_&utm_source=facebook&utm_medium=organi

R. Erik Hartvigsen, MD, FAAFP, 100 Wildewood Park Drive, Columbia, SC (2026)

12/23/2025

December Post

Topic I keep seeing in journals and self
help articles is that of micro-plastics.
Important, difficult, worrisome, and hard to manage problems. Hope to raise awareness, and give some practical advice to minimize exposure for all of us.
Microplastics/MP are everywhere. They are organic chemicals from oil/petroleum. They exploded
In importance during and after World War 2.
Nylon, plastic toys, perfumes, packaging, and food stabilizers are all made from these chemicals. They make our lives easier, but also carry a health risk.
MPs can disrupt hormones causing aging, infertility, cancer, inflammation, and vascular disease. We all consume them. The goal is to reduce and eliminate them as much as possible. The average person consumes a credit card sized amount of MPs each week. They even affect our insulin resistance. I get to work on this as my liver shows signs of damage from MPs.
The goal would be a compound that digests MPs and eliminates them. We are not aware of such treatment yet. So, reducing, and substitution are our current strategy.
Steps to reduce MPs exposure.

1. Try to stop using plastic water and drink bottles.
Never consume drinks from hot bottles. Leach
more plastics.
2. Change out plastic and vinyl cutting boards
boards. Use wood or bamboo instead.
3. Use your refrigerator water filter for cooling and
drinking water. Installing a commercial water
filter also helps.
4. Avoid shark, tuna, salmon and swordfish.
Search out herring, sardines, mackerel for lower
MPs in food. The higher up the food chain, the
higher the burden.
5. Store food in glass containers with silicon seals.
Avoid plastic, and styrofoam containers.
Never microwave food in plastic or styrofoam.
Worst possible MP sin!!
6. Consider returning to metal baskets/brewing
cups for coffee or tea. Plastic K-cups, are really
bad plastic offenders. My wife is not a fan. Will
keep working on her conversion back.
7. Use wooden cooking utensils. Metal are usually
OK as well. Plastic utensils leach plastic as you
cook.
8. Avoid Teflon and most non-stick cooking pans
and pots. Use stainless steel, or ceramic
coated cookware.
9. Use metal flasks and canteens, instead of
plastic drink bottles. Requires planning ahead.
Requires planning to refill or make your own
Sportsdrinks.
10. Vacuum and dust weekly. Removes
microplastic dust that we breathe in all the time.
While you are at it, do the same thing in your
car.
11. Avoid canned fruits and vegetables due to the
coating in cans. Try to buy fresh or frozen.
12. Consider buying meats wrapped in butcher
paper rather than plastic wrap.
13. Consider not collecting receipts at the grocery
store and gas station. The ink turns out to have
MPs. Who knew?
14. Paper bags, or bamboo fiber containers instead
of plastic bags. Better to recycle trees, than
dinosaur fossils.

Doing as many of these things as possible reduces your MP exposure. How well this is influances your health can be tracked by tests like Myeloperoxidase, homocysteine, and C reactive protein. Lowering these inflammation markers
Should lead to better health and longevity.

Hope this helps,
Dr. Hh

12/01/2025

November Post

Decided to cover a strange condition I see in the office from time to time. COMISA. Co-Morbid Insomnia and Sleep Apnea. See many patients with each problem. The scary thing is the people who have both, but don’t want help with the one they don’t understand.
The combo causes the worst of both the poor sleep, fatigue, increased risks of injuries, and increased problems from hypertension/HTN, diabetes/AODM, and heart disease/CAD. This minimizes the huge impact these two problems contribute to depression and anxiety that worsen quality of life. Overall, would recommend getting this checked out, if the question arises about COMISA.
There is a bidirectional increased risk from these problems. Ten percent of Insomnia patients have COMISA. 30-50 percent of OSA patients have insomnia. This is associated with increased risks of HTN, AODM, CAD and stroke/CVA. Chronic pain and depression rates are also higher in this group.
This risk arises from overstimulation from sleep deprivation increases in adrenaline and cortisol. Initially patients note fatigue, low energy, irritability, and weight gain. Later, they pick up the associated diseases.
Diagnosis is found based on high index of suspicion, and testing. Pittsburgh Sleep index and Epworth Sleepiness Scales, combined with STOP-BANG questionaires point the way to Sleep
Testing at home, or in lab. Partner interviews often are the breakthrough point to the diagnosis.
Sleep Onset Latency longer than 30 minutes points to insomnia. Frequent awakenings at night can be due to either disease.
Treatment is to treat both problems. In a perfect world, patients work on Cognitive Behavioral Therapy for insomnia and sleep improves. CPAP treatment then fixes the breathing problem.
In the real world, we still treat w CPAP or surgery, and the sleep component with medicines. Persistence and discipline wins the prize of resolving both problems.
Insurance doesn’t like the better Benzodiazepine Receptor Agonists like Belsomra and the like. It may take up to 12 months to get a patient on the best treatment regimen.
Treated, COMISA patients are able to live a better life, and remain compliant with a complex treatment regimen.

Hope this is helpful for you or a friend,

Dr. H

10/27/2025

October Post will examine the MTHFR
polymorphism condition.

Frequently, I am requested to assess this condition as a potential cause of treatment-resistant depression, fatigue, brain fog, or difficult-to-control migraine headaches. Rarely, am searching for reasons for blood clots, stroke risk, or cancer development risk. The effects of this gene mutation can be far-reaching. However, with proper management, it does not have to be debilitating for those affected.
MTHFR, a genetic defect involving a Single Nucleotide Polymorphism, affects the body's methylation process by altering the coding for methylene tetrahydrofolate reductase. Methylation is a cellular process where the body attaches a methyl group to a chemical to facilitate breakdown and elimination or to produce hormones and neurotransmitters. The body utilizes methyl groups as a form of energy currency. When this cycle is disrupted, problems arise.
Symptoms associated with MTHFR issues include depression, anxiety, concentration difficulties, body aches, and fatigue, primarily resulting from inflammation caused by the buildup of metabolites and toxins that are not efficiently eliminated. Increased inflammation can lead to heart attacks and stroke, even in individuals with normal lipid profiles.
Treating this condition and monitoring Homocysteine level reduction can decrease the risk of heart disease.
For fatigue and headache management, treatment with methylated vitamin B6 and B12 can enhance methylation, clearing brain fog and headaches.
In cases of depression and mental health concerns, medication efficacy improves, and brain neurotransmitter levels increase.

The first step is to undergo testing. We utilize the MTHFR gene assay in our laboratory and develop a treatment plan based on the results.

There are two primary defect patterns:
C-677T, the more intense form, and
A-1298C, the less intense form.
Lifestyle modifications and supplementation are crucial. However, using the wrong supplement and only partially adopting lifestyle changes can result in suboptimal responses.
Effective MTHFR supplements contain methylfolate and methylcobalamin, along with other beneficial B Complex vitamins. We recommend a specific supplement in our office.

Lifestyle changes to optimize response include:

1) consuming three meals per day for regular fueling.
2) incorporating 70-100g of protein into the diet daily.
3) avoiding starchy vegetables like potatoes and corn.
4) seeking fermented foods such as sauerkraut, kimchi, yogurt, and kefir to support beneficial bacteria in your intestines.
5) using healthy oils like olive, avocado, and coconut oils.
6) avoiding seed oils that raise inflammation,
7) limit enriched and processed foods that contain synthetic folate, which can “plug up” methylation machinery.
8. Reduce alcohol to less than 2 drinks a day. Limit caffeine to 100 mg a day.
9. Avoid highly processed foods. More than 3-5 ingredients, and/or chemical names on the list.
10. Avoid artificial sweeteners. Aspartame, sucralose and saccharin. Stevia is OK.
11. Try avoiding gluten and dairy. Very hard to do.
If your problem won’t budge, this may make the difference.
12. Exercise as weight training and some
cardio. Aim for 30 minutes a day.

Supplements to support methylation.

1. Methyl folate
2. Methyl cobalamin
3. Magnesium malate, or glycinate.
4. Vitamin D3 with K2.
5. Fish oil/omega 3 fatty acids.

A hard to explain condition, that when treated, can improve longevity and decrease suffering.
Hope this was helpful.

Dr. H

09/22/2025

September Post

For September, I have been asked to write about Menopause and Hormone Replacement Treatment.
It is an odd area of medicine that has seen rapid abandonment by most doctors. More and more life
coaches, pharmacists, and physician extenders have taken to treating patients. The lab ordering has gotten easier, and more seductive. It is not as easy as it appears at the seminars.

People promising all kinds of great results. The packages that are sold to patients tend to be very expensive and complex. When this all breaks down, their primary care doctors end up trying to find a cost effective alternative.
I have inherited a lot of pellet disasters, salivary hormone lab failures, and breast cancer patients due to undelivered promises.

Patients need someone who will care for them regardless of results. Counsel them on good preventive care and follow up. Most important of all, the patient needs support when “one size, doesn’t fit all”, even when you pay an arm and a leg for the care.

First things first. Bio-identical hormones do not prevent cancers. My wife, Cheryl, can attest to that, and all the other promises made by weekend practitioner trainings. 2017 was a year that began with an overdue mammogram/MMG, and fortunately led to complete remission for the last eight years. All HRT carries risk. The benefits are many, when done well.

Have a safety net for HRT/Hormone Replacement Therapy. Ladies still need a once a year check in with their doctor. They need Pap and Pelvics.
They need MMGs. They need DXA scans for bone health. Someone needs to educate them as to if they have dense breasts (MRI of breasts).

They need lifestyle counseling about alcohol, to***co, high fat diets, over processed foods, hormone disrupting chemicals, high sugar intake, and monitoring insulin sensitivity and estrogen metabolism. All of these factors impact cancer development.
Women often begin to have problems with their hormones in their early to mid forties. Periods missed, heavy bleeding, insomnia. Libido tanks, and the perimenopause monster is on the loose.

Doctors can start to treat this early. Many options exist. Not all have to involve hormone levels. When things aren’t working, then it is time to consider hormone testing. My approach has been molded by many of my patients as well as learned doctors I with whom I have worked. Estrogen/E2, the primary female hormone helps with women’s curves and is the happy hormone. Progesterone/Pg, the second hormone helps with pregnancies and calming the body down. It is what helps with sleep and reducing anxiety. Testosterone/T, is lower in women, but drives libido and decision confidence.

My goal of treatment is for patients to feel better, and have their symptoms improve as much as possible. Generally, Estrogen levels around 100-200 make hot flashes, dryness, painful inter-course, and bad skin, better. Fatigue and body aches also improve with this. Progesterone levels 10-30 tend to restore good sleep, and calm anxiety.
Testosterone levels between 40-50 usually restore libido, and confidence with making decisions. I realize that sounds misogynistic. Women have reported it to me. Thus, I use it as a monitor.

Not addressed with HRT, is the mystery that is middle aged spread. Too many doctors lay that on the hormones. With the advent of GLP-1 and GIP agents, that doesn’t have to happen. GLP levels and Growth hormone decline, and this can be fought with dedication to diet, exercise, and when needed, meds. Some clinics also run Cortisol levels. These are hard to interpret. Patients really need a “cortisol rhythm”done to see if all stresses of life are driving cortisol. “Wired and tired” syndrome needs specialized therapy to get people back to “rest and digest” mode. There are no quick easy fixes here. Primary care doctors and therapists can help on the road to improvement.

There are those who live for their Progesterone to Estrogen ratios. Simply put, a ratio less than 60:1 is estrogen dominance. More weight gain, periods, cancer risk, and bloating. A ratio of over 3-500:1 is progesterone dominance. More
hot flashes, dryness, and body aches. The ratios are helpful, but some women will be mildly progesterone dominant and feel like a million bucks. The ratios are helpful, but the provider still needs to discuss treatment and think.

Hormone failures often come down to hormone disruption from food, additives, and metabolism.
Here is where the relationship becomes paramount, as patient and provider/doctor, work to solve this difficult puzzle.

For those who want to do their own calculations:
Pg is reported as pcg/ml or no/ml. 1 nannogram equals 1000 pcg.
Ex. Progesterone 20 ng/ml
Estrogen. 100 pcg/ml
That becomes. 20,000 divided by 100 equals 200.
Normal Pg/E2 ratio. No treatment change based on labs.

Lastly, there are people who cannot take HRT.
Breast, Ovarian, and Uterine cancer survivors should never use HRT. Some
oncologists allow it, very long after treatment.
That is another discussion, for another day.
Severe liver disease, uncontrolled blood pressure, and blood clotting problems are usually other reasons to avoid HRT.

Hope this has been helpful.

Thanks,
Dr. H

08/25/2025

August Post
For August, will cover Hypertension/HTN. Basic issue for many Americans. New guidelines are out at the end of the month. Nothing earth shattering.
I will mostly concentrate on identifying, and self care strap for HTN. First point, HTN rarely causes any symptoms. This it is still caused the silent killer.
Hypertension can cause a lot of serious damage and death. Thus, it is important to find and treat.
Deaths from kidney failure, heart failure, stroke, heart attacks, and the slow fade of post stroke care and stroke induced dementia are pretty sobering.
Blindness and limb loss from untreated HTN with peripheral artery disease, is further depressing.
We can treat HTN, and in some cases reverse it. Make no mistake: Ignoring HTN is not a good option. We are better about White Coat Syndrome.
Now, when protein spills from the kidneys, we treat.
The only way to know if you have HTN, is to measure your BP/blood pressure. It must be in a calm room, with correct equipment, and a proper sized cuff. Going forward, normal is 120/70.
Borderline HTN, is 110-130/70-80 mmHg.
Stage 1 HTN is 130-139/80-90 mmHg.
Stage 2 HTN is all over 140/90.
Patients with stage 2 HTN are now recommended to go on two medicine once a day meds. We titrate treatments about every 4 weeks.
Hypertension is further broken down to Urgencies and Emergencies.
HTN urgency is stage 2 HTN without end organ damage. ( no headache, delirium, chest pain, swelling or signs of heart failure or attack. This can be managed with med change and close follow up in 1-7 days.
HTN emergency is stage 2 HTN w end organ damage. We usually hospitalize these patients and gingerly lower Bp over 3-5 days. Lowering too fast and too much can lead to stroke.
HTN measurements are the systolic Bp, how hard the heart pumps blood out into the arteries.
Diastolic Bp is the pressure in the arteries between each heartbeat.
Tips for success you can do at home.
1. Lose weight towards BMI of 24, or normal for age
and size.
2. Engage in exercise for 150 minutes each week.
Walking counts. Jogging or climbing stairs
strengthen the heart more.
3. Decrease, or stop alcohol. Alcohol is a big
factor in hard to control Bp cases.
Max. Men, 2 drinks
Women, 1 drink a day.
4. Sleep well. Get 7-10 hours of good sleep. Be
sure you are not a terrible snorer. If you are, get
that checked out.
5. Decrease Sodium in the diet. Seek potassium
and magnesium in your diet. Hint: eat more
fruits and vegetables.
6. Learn about the DASH diet. Dietary approach to
stopping hypertension. Printed guide to what I
am covering here.
7. Get a home BP cuff to follow BP at home. This
diary can help guide treatment changes.
8. Avoid processed foods. They increase
inflammation, and drive up BP. Whole foods are
better. Ingredient lists over 3-5 items are over
processed.
9. If meds are prescribed, take them as directed.
Keep follow up appointments so that
complications don’t sneak up on you.

Some patients will have hard to control/resistant hypertension. BP that doesn’t normalize, or takes 4
or more meds to control need further evaluation for secondary hypertension. There are labs and imaging that help doctors find the secondary cause. Obstructive sleep apnea is common, can be treated and improve survival. Other causes deal
with hormones and blocked arteries.
Using a therapist or coach can allow you to explore Vagal stimulation exercises, and mind body techniques to possibly beat HTN. Just be honest with yourself if these steps are not working.

Hope this helps you,

Dr. H

07/27/2025

July Post will be about our new treatment machine that we have been settling in to use for orthopedic and sports medicine injuries and pain problems.
Stemware (SM) is one of a number of new pulse wave treatment machine that have become bigger in mainstream medicine over the last few years.
We find it most helpful for painful conditions that will not respond to anything else. We have had a few patients that appeared headed to surgery, but StemWave treatments prevented surgery.
StemWave operates by mechantransduction. An electrical pulse creates a wave that then travels through water and gel into the deep tissues where injury is causing pain. It is similar to lithotripsy where a pulse is focused on a timy spot to break up kidney stones. The SM wave is lower intensity and focused on a larger target. This allows a healing energy instead of the stone destroying energy.
SM uses this Electrohydraulic Shockwave to pe*****te tissues and create its effects.
SM waves increase nitric oxide and causes vessels to dilate/widen, to improve blood flow. This allows nutrients to flow to the injury, and debris/waste to flow away. The wave breaks down scar tissue to promote healing and normal functioning. SM waves improve cellular metabolism and growth. The waves also increase new blood vessel growth into the injured area. Lastly, SM waves stimulate healing peptides to decrease pain, and rush healing factors to the injured/wounded area.
We have had some impressive success with this machine. Plantar fasciitis, usually a difficult problem, responds nicely. Often, get to avoid injections. Shoulder impingements also respond well to this. Ankle sprains, knee arthritis and low back pain have done well with SM. Biggest success came treating a patient with a Psoas strain who had failed 6 weeks of PT. Was better after the second session. Healed by the 6th session.
Results are promoted as 30% improved after two treatments, and 80-100% improved by 6-8 treatment. We have see very encouraging, similar results.
Cost can be an issue. We offer discounted packages to lower that cost. Investing $$ versus
$$$$$ for surgery makes it worth the try. Side effects are mild in most cases. Each treatment starts with a mapping session to identify the area most likely to benefit treatment.
This has been a great tool to bring back enjoyment of treating patients. More robust than the old Motrin, Flexeril, and stretches from my training.
Hoping to see more use in sports medicine this fall.
This technology is used at Alabama and Oklahoma State for their athletes. NFL team, Washington Commanders also use StemWave.
Hope this gives some leads to improved treatments for you as well.

Thanks, Dr. H

06/17/2025

June MDVIP Post.
Kidney stones and preventing them. Had a patient last week patiently waiting on Urology to schedule her routine stone follow up. Suddenly awoke with terrible left flank pain, and lower abdominal pain.
She didn’t see blood in the urine, but developed diarrhea that made diverticulitis more likely.
Called for a morning appointment, and we got her in. Exam favored diverticulitis except for colicky cramping pain similar to labor pains from her younger days. Her urinalysis was clear.
Covered her pain, and got antibiotics started, and
ordered her CT. Later that afternoon was found to have a large ( bigger than 5 mm ) stone on the left.
Got Urology to see her urgently, and stone was removed and she feels much better. Now we move on to prevention of any more stones.
Kidney stones usually show with colicky pain, blood in the urine, nausea, and inability to find a comfortable position. Rarely see fever and chills. Often see sweats from the pain. My patient’s case was somewhat atypical. Training, and a CT saved the day.
To prevent kidney stones doctors want to know what type (salt) the stone is made of. This helps define the finer points of treatment.
Most stones are made of Calcium Oxalate. Hers was as well. So, trying to make easy to follow points out of a lot of confusion.

1. Drink plenty of fluids, water is best. Look to get
in 50 or more ounces of intake a day. Always
look at your urine to be sure it is clear. Darker
means higher stone risk.
2. Limit Vitamin C to 1000mg or less. Your body
breaks this down to oxalate.
3. Avoid, or totally stop drinking tea. Has very high
oxalate content. Ironically, lemon and lime juice
lower oxalate in the urine.
4. Avoid Colas. Pepsi or Coke have high phosphate
levels that drive dehydration and stone
development.
5. Avoid high fructose corn syrup. Found in many
processed foods and drinks. Powerade still has
this. Gatorade went back to cane sugar: safer.
6. Substitute lemonade for tea and sodas. Lower
risk for stones. Lemon or lime water are an easy
alternative.
7. Learn what foods have oxalate in them. Then
limit to less than 50 mg intake a day. There are
multiple tables that can help with this. We have
one at our office.
8. Be cautious about animal protein, particularly
purines. Just like with Gout, lower purine diets,
decrease attacks.
9. Keep follow up appointments with your doctor to
keep up to date with new information.
10. Random points. Avoid grapefruit juice, more
stones. Enjoy one cup of coffee each day.
Polyphenols on coffee lower stone risk. Second
cup, tilts the scale in favor of more stones from
dehydration.

Hope this helps. Deep dive turned up 10 points to reduce kidney stones.

Dr. H

06/01/2025

Remember the guy who wouldn't take the flag pole down on his Virginia property a while back? You might remember the news story about a crotchety old man in Virginia who defied his local Homeowners Association and refused to take down the flag pole on his property along with the large American flag he flew on it.

Now we learn who that man was. On June 15, 1919, Van T. Barfoot was born in Edinburg, Texas. That probably didn't make news back then.

But twenty-five years later, on May 23, 1944, near Cyrano, Italy, That same Van T. Barfoot, who had in 1940 enlisted in the U.S. Army, set out alone to flank German machine gun positions from which gunfire was raining down on his fellow soldiers. His advance took him through a minefield but having done so, he proceeded to single-handedly take out three enemy machine gun positions, returning with 17 prisoners of war.

And if that weren’t enough for a day's work, he later took on and destroyed three German tanks sent to retake the machine gun positions.

That probably didn’t make much news either, given the scope of the war, but it did earn Van T. Barfoot, who retired as a Colonel after also serving In Korea and Vietnam, a well-deserved Congressional Medal of Honor.

What did make news was his Neighborhood Association's quibble with how the 90-year-old Veteran chose to fly the American flag outside his suburban Virginia home. Seems the HOA rules said it was OK to fly a flag on a house-mounted bracket, but, for decorum, items such as Barfoot's 21-foot
flagpole were "unsuitable".

Van Barfoot had been denied a permit for the pole, but erected it anyway and was facing Court action unless he agreed to take it down.

Then the HOA story made national TV, and the Neighborhood Association rethought its position and agreed to indulge this aging hero who dwelt among them.

"In the timeI have left", he said to the Associated Press, "I plan to continue to fly the American flag without interference."

As well, he should. And if any of his neighbors had taken a notion to contest him further, they might have done well to read his Medal of Honor citation first. Seems it Indicates Mr. Van Barfoot wasn't particularly good at backing down.

If you've read this post and don't share it, - Guess what -You need your butt kicked. I share this with you because I don't want MY butt kicked anymore and I'm tired of seeing those who hate our country march in our streets, tear down our statues, burn our stores, loot our businesses and have a free hand to do whatever they want.

WE ONLY LIVE IN THE LAND OF THE FREE BECAUSE OF THE BRAVE AND BECAUSE OF BRAVE MEN LIKE VAN BARFOOT!

05/27/2025

May post will address Prostate cancer. I see enough cases to worry about it for my patients.
I have practiced for 35 years and watched a very laid back approach to this disease overcome the medical community at large.
President Biden being diagnosed with metastatic Prostate cancer has sent shock waves through organized medicine. My colleagues in primary care have over the years loosened up on ordering PSA tests and nearly abandoned re**al/prostate exams.
Urologists have held the line on still annually testing. Now, the world wonders how our President didn’t get tested for over 4 years.
Could be he declined it. Could be he refused it. More patients ask to skip this than you would think.
USPTF has not recommended screening for over 10 years. Argument being, not changing outcomes. AUA opinion differs greatly from this. A balanced shared decision making approach at least lets me lay out my case.
At the end of the day, I recommend PSA testing and re**al exams. Then, I can interpret PSA levels related to prostate size/volume. Repeat testing, allowances for prostate infections, and MRI paired biopsy completes our work up plan.
Found early enough, and with low grade disease, prostate cancer is indeed very beatable. Using staging and Gleason scores helps determine who needs more aggressive care. President Biden’s was reported to be Gleason 9/10. As size of tumor, spread , and cell aggressiveness determine this score, it can be argued that doctors missed an opportunity. If it can happen to a President, it can happen to any one of us. Thus, get screened every year.
Prevention involves avoidance of alcohol excess, to***co use, obesity, and diabetes. Know your family history. For me, Dad and paternal
Grandpa both had prostate CA. I had exam, PSA, and Galleri Multiple-cancer early detection testing. All negative. Multiple cancer early detection/MCED testing will become a great tool in the next few years. Insurance doesn’t cover it yet. May be worth the investment for those at higher risk.
Final word on prostate cancer; don’t die of embarrassment. Get checked. Chase down blood in the urine with your doctor. Get slow flow and prostate pain checked out. Do not put up with 2-3 trips to the bathroom every night. Could be a big prostate. Could be cancer. Could also be heart failure, diabetes, sleep apnea, or high calcium. Just get it checked. Wives and siblings, get your men to their doctors.
Hope this helps some one.

Dr. H

04/29/2025

April post will address fatigue and low energy. Had a blog follower ask how I approach this. Like most doctors, I have my most common suspects, then I expand the dragnet to look for other causes until my patient and I have found a way to resolve the fatigue. This list will not be encyclopedic, but should encourage people to work with their doctors when up against a hard to resolve problem.
Most patient who want a work up for fatigue, or low energy will be found in the basic work up. CBC/blood count, complete metabolic profile, full thyroid profile, urinalysis, B-12 level and folic acid levels.
History and exam are too often overlooked. Meds can cause fatigue or interfere with body functions.
Prior infections can drag down the cellular machinery, ( long COVID ), or Hashimoto’s disease.
Dry skin and constipation point to hypothyroidism.
Family history may tease out Celiac disease.
Surgical history may reveal inability to absorb iron.
Medicines like Nexium, may impair calcium and magnesium absorption.
Patient concerns drive the next steps
In work up. Heavy metal exposures or parasite exposure depending on work or travel history push the work up to look for these things.
Inflammation concerns may push the work up to search for micro-inflammation. The MDVIP panel looks for inflammation on a cellular level. This may uncover a way to treat low energy, or heart disease, or both.
Genetics like folic acid metabolism, can be affected
by our genes. Methyltetrahydrofolate reductase deficiency is an example where genes keep us from using raw materials and worsen fatigue. Easily treated once it is discovered.
To order all the potential tests is cost prohibitive.
A tailored approach, can in 3 to 4 steps, find answers.
Other considerations for fatigue would be issues like dehydration, sleep deprivation, poor nutrition, and lack of regular exercise. Mental issues like depression and anxiety disorders can cause fatigue. How it is broached in the evaluation needs to be done with sensitivity.
Treatment is straightforward. Find the root cause, and repair, replenish, or remove what is needed.
This approach has helped find better treatment for Hashimoto’s thyroiditis, inflammatory heart disease, gluten sensitivity and iron deficiency, and other difficult diseases and syndromes.
I hope this post helps people consider working with their providers to improve their health.
I also encourage patients to consider working with their primary doctor, and a functional doctor when a diagnosis remains elusive. This may be an issue where teamwork does make the dream work.
As always , I welcome coments.

Thanks,
Dr. H

R. Erik Hartvigsen, MD, FAAFP

12/23/2025

12/01/2025

10/27/2025

09/22/2025

08/25/2025

07/27/2025

06/17/2025

06/01/2025

05/27/2025

04/29/2025

Address

Opening Hours

Telephone

Website

Alerts

Shortcuts

Share

Category

Monday	9am - 5pm
Tuesday	9am - 5pm
Wednesday	9am - 5pm
Thursday	9am - 5pm
Friday	9am - 5pm