R. Erik Hartvigsen, MD, FAAFP

R. Erik Hartvigsen, MD, FAAFP A true partner in health who you can reach 24/7 and see same- or next-day. He sees fewer patients, which means more time for each one.

Dr. Hartvigsen, Board Certified Family Medicine physician, offers a different approach to primary care. Patients appreciate same/next-day appointments that start on time and aren't rushed; plus they can usually reach his 24/7. His practice also offers other services, including comprehensive, advanced health screenings and diagnostic tests, that go far beyond those found in concierge medicine practices. Dr. Hartvigsen develops a personalized wellness plan based on the results of the wellness program. His MDVIP-affiliated practice is open to new patients.

04/07/2026

March Post. A week late as took grandkids for Spring Break.

American College of Cardiology/ACC released
their new Heart Disease prevention guidelines.
Interesting take as MDVIP had us doing inflammation markers over 6 years ago. Still nothing real simple like a table that is an easy read.
First off, is trying to clarify/classify people at highest risk for heart attack and stroke. Then applying recommendation on what testing should be done.
Highest risk patients have are this with LDL over 190, known coronary disease, diabetes mellitus, prior stroke, and those with Coronary Calcium Scores over 300. This group gets the most intense treatment with a goal to get LDL below 55 mg/dl.
Those without all of these risks are supposed to do well on less intense treatment. ACC still puts statins like Crestor and Lipitor as their preferred drugs. The higher the risk, the higher the dose.
Left out are items like Bempedoic Acid and Ezetimibe that work well together. Some who can’t tolerate statins tolerate these well. Leqvio an every 6 month shot also works, but I have yet to find a drug plan to allow its use. Patients come
In all shapes and sizes, our treatments need to be more flexible.
Combination therapy with injectables like Repatha and Praluent with, or without a statin is becoming more common. Stroke and heart patient had total cholesterol over 450, got to goal on Repatha and Lipitor.
New and needed discussions are about the 50% of patients who have events with normal lipids. The role of inflammation starts to grow with the new guidelines.
Lipoprotein a, is a genetic marker for really grumpy vascular disease. We all need this test once in our lives. Currently, I am tracking down patients old labs to put on Problem lists to remind me who is lucky, and who isn’t.
Apolipoprotein B. A true marker of how lipid get laid down in our arteries is new. I try to get this number down below 60, when able. Below 90 confers some protection.
Blood Pressure. Now trying to get to 120/70-80
mmHg. Really hard to do when everyone was used to 140/90. Lower is better.
Lipid Panel. Still important. The new thing is calculating TG/HDL ratio. Triglycerides to HDL ratio, when less than 2, indicates low Insulin Resistance. IR-insulin resistance is the BIG driver of vascular damage. It also is big in cancer and dementia research.
Myeloperoxidase and HS-CRP. Two inflammation markers made in the blood vessel walls. The higher the score, the more acute risk of an event (stroke or heart attack).
Coronary Artery Calcium Score. A CT scan of the heart. More calcium, usually more artery blockages. Helps guide doctors to recommend more intense treatment. A few of my patients have ended up getting heart catheterization,
and stents due to this. Big save for them! Mine was 79 last year. 26 years of trusting stains, kept me from Dad’s fate, heart attack #1 at 48.
Homocysteine. A metabolic marker for heart disease and metabolic syndrome. Treating this lab below 9 is huge on preventing stroke, and heart attack. Some of my worst patients with bypasses found out late, that this test was over 15 mg/dl.
It is best treated with a vitamin supplement.
At the end of the day, the more abnormal tests you have, the more help to prevent vascular disease (heart and brain). The more risk factors you have the more to want to work with your doctor and nutritionist to get to goal. Risk factor wise, male s*x, being over 50, in poor shape, and smoking are still the ones that get addresses first. Obviously age marches on, and s*x assigned at birth still drives male heart disease. These are not modifiable. This all added for completeness.
We are back to testing for all of these with annual exams again. These labs also help us stratify risk for Alzheimer’s dementia.
Bonus fact. MDVIP marched out testing for p-Tau a marker for Alzheimer’s. Big Pharma is excited about new infusion therapies. So far, all my patients do not qualify for risk of stroke, or markers for bad outcomes. P-Tau should become more helpful going forward. I still recommend people seriously consider doing the Montreal Cognitive Battery annually. This test, in the public domain catches decline earlier than testing I was taught in training.
Hope this will help some of you

Thanks,
Dr. H

02/16/2026

February Post

Late Winter and Spring Rashes.

Had a patient present with a scaly red rash last week. Turns out he was worried he may have Measles. Didn’t want to spread it to grandkids, family or friends.
With the Big Measles outbreak in SC, that seems valid. The hard part was explaining how I was sure it wasn’t measles, but a benign skin rash. A lot of this goes to pediatric rashes and some seen on adults.
To review the rashes we will start with the Big 6 pediatric rashes and review some Bonus adult rashes.

1. First disease. Measles from Rubeola virus. Preventable with a vaccine. Red flat patches and bumps that begin on head and spreads.
2. Second disease. Scarlet fever from Strept throat. Sandpaper rash on the abdomen. Treatable with antibiotics.
3. Third disease. Rubella/German measles. Rubella virus. Lighter colored red patches and bumps.
Preventable with a vaccine. Starts behind ears and spreads.
4. Fourth disease. Now pretty much ignored. Felt to be very mild red patchy rash from Staph infection. Severe form is Staph scalded skin syndrome. Treatable with antibiotics.
5. Fifth disease. Erythema infectiosum. Parvovirus B-19. Slapped cheek rash. Variable lacy to papular rash on arms. Resolves on its own. Causes arthritis in adults.
6. Sixth disease. Roseola infantum. Human Herpes
Virus 6 or 7. High 3 day fever that resolves with a faint pink patchy rash on neck that spreads. Resolves on its own. Sometimes called baby measles.

Other rashes.
1. Hand, Foot, and Mouth disease. Viral rash from Cocksackie A virus. Oval vessicles and small blisters on mouth and bottom. Later spread to hand and feet. Resolves on its own.
2. Chicken Pox. Varicella virus. Vessicles and blisters on face and trunk that spreads to extremities. Very itchy rash. Resolves on its own.
Preventable with vaccine.
3. Papular purpuric gloves and socks syndrome.
Causes by variant Parvovirus B-19. Hands and feet turn red and have small and mid size bruising. Can be painful rash. Resolves on its own.
4. Laterothoracic exanthem. Mostly seen on small children. Associated with Ebstein Barr virus, and sometimes COVID-19. Eczema like patches with scales and seen under arms and on side of the chest. Resolves on its own. Average age is two. Affects girls twice as often as boys.
5. Papular acrodermatitis of childhood. Gianni-Crosti syndrome. Commonly seen on face elbows and knees of 6 month olds to 12 years old. Was thought to be related to Hepatitis B. Now more associated with Enterovirus. Resolves on its own.
6. Pityriasis rosea. Classic Fir tree pattern rash on the back. When the doctor is lucky, has a Herald Patch on the abdomen first. Last associated with HHV-6. Resolves on its own.

COVID-19 has its own special rash with multiple skin features. Can be measles-like patches, or faint blisters, and sometimes target like patches on arms and legs. Resolves with time.

There you go. 12 rashes to memorize and impress all of your friends. Most will go away within a month of presentation. Which is why all Dermatologists, like to see our referrals, about 4-6 weeks after we see them. Should be gone, or it will be gone on another week.

Thanks. Hope this helps someone.

Dr. H

01/27/2026

January Post

Peripheral Neuropathy
JAMA review article for this month addresses peripheral neuropathies. The most common of these is diabetic neuropathy. Almost all or medical resources tend to be to relieve pain. A noble goal, but many patients want to know why we can’t cure the problem. I am blessed/cursed to treat a number of patients who have peripheral neuropathies, and they want something that may help heal the problem, not just cover up symptoms.
To that goal, the later part of this post may give some ideas.
Most peripheral neuropathies I see, are in the legs.
Diabetes is the most common cause. Other causes are explored and ruled in or out. My usual approach is to look for nutrition and toxin induced causes. Address some rare causes, ask neurology to check for omissions, and try to get relief. The JAMA/Journal of the American Medical Assn, has a comprehensive work up this week.
Glucose, HbA1c , lead levels, B-12, folate, homocysteine, thyroid panel, serum protein electrophoresis, alcohol screen, B-6 levels for toxicity, copper level for deficiency, and CBC, Liver panels.
Take a good history for medicines like amiodarone, HIV meds and HIV, chemo like cis-platin, paclitaxel.
Next step is Nerve Conduction Tests w Electromyogram. Helps catch other causes. Rarely need to do peripheral nerve fiber density biopsies, but they help finalize causes is very rare causes.
Neurology consults should bring final diagnosis and treatment. Often it means end of the line. I now am the focus of treatment and hope.
Treatments have traditionally been aimed at stopping burning, stinging, crawling, raw skin sensations. Meds like Gabapentin and Lyrica can help. They are tricky to use, cause weight gain, sedation, and many stop these. Old antidepressants like Elavil often are effective, but have the same side effects. Cymbalta/duloxetine and Effexor/venlafaxine are somewhat better tolerated.
Treatment directed at the inflammation to the nerve and myelin sheath are more controversial. Myelin sheath is like insulation on a lamp cord. Lose it, and the wire/nerve short circuits. A reasonable analogy.
Trwatmwnt hopea to restore the myelin/insulation.
So, here is what my patients and I have tried with varying levels of success, and minimal side effects.

1. Alpha Lipoic Acid, 800-1600 mg a day.
Originally tried for chemotherapy associated
neuropathy.
2. Omega-3 Fatty Acid. 1200 mg each day.
3. Methylated B-12, Folate, and B-6/Metanx, and
Methylaide. 1-2 Capsules each day.
4. Magnesium Glyconate or malate 400 mg each
day.
5. Vitamin D3/K2 1000-10,000 IU each day.
6. Removal of heavy metals. Chelation in some
cases.
7. Nattokinase or Lumbrokinase. Used in Eastern
medicine to reduce inflammation. Careful as
these can act as blood thinners. I only
recommend this with doctor supervision.
8. Infra-red laser light therapy. Helps with
Inflammation.
9. Electro-mechanical, or hydraulic, wave therapy.
We use StemWave in our office.
10. Caution: scam therapies are rampant for
neuropathy. NeuroGo at $150 for an under
powered machine. Similar technologies at
major centers do work. Buyer beware.

Hope this helps some people out there. Patients may read about a treatment before the doctor finds out about it in our journals or meetings. Good doctors discuss and keep trying.

Dr. H.

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

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