Paladin Family Practice

02/14/2026

Nearly everyone needs more hip mobility and here are some great hip focused movements.

02/12/2026

Getting started with exercise is one of the hardest parts. A lot of people feel like if they are not going all out, joining a gym, or training for something specific, it does not count. That mindset keeps people stuck.

A recent Nature article makes a simple point that I think is encouraging: going from doing nothing to doing something is where a lot of the benefit lives. Short bouts of movement, sometimes called “exercise snacks”, plus basic daily activity can meaningfully improve health over time. 

What that looks like in real life:
• Start small on purpose. Ten minutes counts. A brisk walk. A few flights of stairs. A short bike ride. Something you will actually repeat.
• Build toward a base: aim for about 150 minutes per week of Zone 2. That is the pace where you can talk in short sentences but you are breathing heavier. 
• Once you have that base, add a little intensity once a week to help your VO2 max. Example: 4 rounds of 4 minutes hard with 3 minutes easy between. Or 8 rounds of 1 minute hard with 1 to 2 minutes easy. Warm up first. Cool down after.
• If you are starting from zero, do not worry about perfect zones. Just move. Consistency wins.

Practical takeaway: you do not need a perfect plan to get real benefits. Start with small, repeatable movement, then gradually build. Over time, improving VO2 max and maintaining it later in life is one of the best investments you can make in long term health and independence.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

https://www.nature.com/articles/d41586-026-00237-0

02/10/2026

Screen time, including smartphone use, is an area of ongoing research, and we are learning more every year. As a dad, I know it can be a contentious topic at home. I also think most of us have to work on using screens in a way that helps our lives instead of quietly draining our attention. I try to keep up with the data, and I found this new JAMA study published in January 2026 interesting. 

Researchers used objective phone tracking from a large US teen study (not self reported estimates) and looked at phone use during school hours. The headline: many teens are still spending about an hour a day on their phones at school, and a big chunk of that time is social media, with video and games also showing up. 

Why it matters: attention is a limited resource. If it is getting pulled away repeatedly during the school day, learning is harder, stress goes up, and it is tough to build good habits.

Practical takeaway for families:
• Make the rule simple: phone away during class, period.
• Use Focus or downtime settings to block the biggest distraction apps during school hours.
• Explain the “why” to your kid in plain language: less stress, better grades, more freedom after school.
• Start small and be consistent. Consistency beats intensity.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

https://jamanetwork.com/journals/jama/fullarticle/2843506?guestAccessKey=338edf15-28ca-460a-a073-5d184373bab2&utm_medium=email&utm_source=postup_jn&utm_campaign=article_alert-jama&utm_content=etoc-tfl_&utm_term=020326

02/04/2026

I came across a fascinating case and I wanted to share the story.

An 81 year old endurance runner just set a world record in the 50K for his age group. Two weeks later, researchers brought him into the lab to see what was under the hood. The headline was not “youthful luck” or some secret supplement. It was years of steady training that preserved a surprisingly strong aerobic engine, plus muscles that were still very good at using oxygen efficiently. In plain terms, his fitness held up because he kept building it, and he kept showing up.

The takeaway for the rest of us is simple and encouraging. VO2 max is not just for elite athletes. It matters for health, stamina, and long term independence, and it can be preserved much later in life than most people assume.

A practical way to train it:
1. Build your base with about 150 minutes per week of Zone 2. That is the pace where you can talk in short sentences, breathe heavier, and still keep going. Brisk walking, incline walking, cycling, rowing, and light jogging all count.
2. Add one hard session per week once your base is consistent. Examples: 4 rounds of 4 minutes hard with 3 minutes easy between, or 8 to 10 rounds of 1 minute hard with 1 to 2 minutes easy. Warm up first, cool down after.
3. Start where you are. Consistency beats intensity when you are getting rolling. If you have heart or lung disease, or you have been inactive, talk with your clinician before pushing intervals.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Aging is associated with declines in cardiorespiratory fitness and endurance performance, but this association is usually confounded by age-related declines ...

02/03/2026

I have been keeping an eye on the metformin and aging conversation, and I wanted to share a quick update with you.

This is not brand new, but I recently came across a 2024 study in Cell (link I am sharing). Researchers gave metformin to older male macaque monkeys and found signs of slower biological aging, especially in the brain, plus better performance on memory type tasks. Interesting, but it is still animal research, so it is not proof for humans.

What about people: metformin has a long track record in type 2 diabetes, and a lot of studies have linked it to better outcomes and sometimes lower mortality compared with other diabetes treatments. But we do not yet have solid proof that it helps healthy people live longer. That is what future longevity focused trials are trying to answer.

Practical takeaway: if you have prediabetes, diabetes, insulin resistance, or fatty liver, metformin may be a useful tool when it fits your situation. If you are healthy and thinking about longevity, the fundamentals still matter more than any pill: strength training, daily movement, waistline control, sleep, protein, fiber, and limiting alcohol. It is possible that in the future, metformin (or a related medication) ends up with a role in anti aging care, but we are not there yet.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

https://www.sciencedirect.com/science/article/pii/S0092867424009140

01/30/2026

A new JAMA study looked at people with atrial fibrillation who were having their heart rhythm reset with a cardioversion. Everyone in the study already drank coffee, and they were assigned to either keep drinking caffeinated coffee (at least about a cup a day) or avoid coffee and caffeine for six months. The group that kept drinking coffee had fewer returns of their abnormal rhythm over the next six months (47% vs 64%), and there was no meaningful difference in side effects between groups. The takeaway: for many people, moderate coffee does not appear to be harmful for atrial fibrillation and may even be helpful in some situations, but if caffeine clearly triggers your palpitations, trust your body and skip it.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

01/28/2026

Big congratulations to Dr. Sara Kepple. I am grateful for her support and guidance as I started Paladin Family Practice. She was generous with her time, honest about what works and what does not, and always encouraged me to stay focused on a patient first approach. Warrenton is lucky to have her.

Dr. Sara Kepple offers affordable primary care – without a deductible.

01/15/2026

GLP 1 meds like semaglutide are becoming a lot more common for weight loss, and they can be very effective. One issue people worry about is losing muscle along with fat. 

Big takeaway from this Mass General review: protect your lean mass by pairing these meds with a high protein diet and consistent exercise, especially resistance training. 

My general rule of thumb is to avoid “crash” loss and keep the pace to about 2 pounds per week max.

This is general education, not medical advice. Talk with your physician about what is right for you.

In a Grand Rounds presentation, Mass General Brigham researchers reviewed data on the impact of weight loss paradigms, including GLP-1 medication, on body composition and fat mass.

01/13/2026

Paladin Family Practice clinic update (and a quick thank you)

As we roll into the new year, I want to say thanks. The practice has grown because of your trust, and I do not take that lightly. We have had 100 percent patient retention, and I’m grateful for it. Taking care of you and your families is the whole point of this work.

Here’s what we can do right now, and what’s coming next.

Available in the office now
• Rapid testing for strep, COVID, and flu
• Urinalysis testing
• Wound swabs sent for culture when needed
• Vaginitis testing sent out for lab analysis, and many swabs can be self collected
• Intramuscular antibiotics when appropriate
• Intramuscular corticosteroids for moderate allergic reactions when clinically appropriate

Coming over the next few months
• Knee and shoulder joint injections with corticosteroid and lidocaine
• Suturing for simple lacerations
• Incision and drainage of abscesses
• Self collected cervical cancer screening for appropriate patients

Keeping costs reasonable
Affordable care is still a priority, especially for patients without insurance or anyone watching expenses closely.
• Quest continues to offer strong cash pricing for labs
• I have an option for affordable cash CT scans through Hagerstown Imaging
• I have a relationship with Revive Rx Pharmacy, a large compounding pharmacy that can offer high quality compounded medications, including more affordable GLP 1 options and hormone therapy when appropriate
• I will keep pushing to find the best cash prices I can

Support as we grow
As we grow, I plan to hire an administrative assistant around early summer. This will improve scheduling and coordination and keep my focus where it belongs: patient care.

New year reminder
If you’ve been putting off a visit, labs, blood pressure follow up, sleep issues, weight loss goals, stress, anxiety, or that symptom you’ve been living with, this is a good time to address it. My job is to make it straightforward and manageable.

Thanks again for being part of this practice. I’m looking forward to building and improving what we offer this year.

12/30/2025

What was a niche aspect of medical care just a few years ago has exploded to thousands of practices across the country. In direct primary care, medical providers don’t take insurance. Instead, their patients pay a monthly subscription fee. In exchange they get easier access, longer appointments, a...

12/21/2025

There is some genuinely good news in women’s health. Cervical cancer screening is finally getting easier.

For decades, screening meant an in office pelvic exam and a Pap smear. That process works, but it has also kept many women from getting screened at all. We know the consequences. Cervical cancer is largely preventable, yet thousands of women in the U.S. are still diagnosed every year, most of them having missed routine screening.

The big shift is toward HPV testing. HPV causes more than 90 percent of cervical cancers, and testing directly for the virus is more accurate than looking for abnormal cells after damage has already started. What is new, and important, is that women can now collect the sample themselves using a simple swab. The science is solid. Multiple studies show self collected samples are just as effective as clinician collected ones for detecting high risk HPV.

This is not about lowering standards. It is about removing barriers. More options mean more women get screened, and that saves lives.

I am pleased to announce that Paladin Family Practice will begin offering HPV self collection testing starting in January. For the right patients, this is a safe, evidence based alternative that puts more control back in your hands while keeping screening effective.

As always, the goal is simple. Catch problems early or prevent them altogether.

https://www.washingtonpost.com/opinions/2025/12/18/cervical-cancer-self-testing-hpv/

Advances in screening can save lives.

12/19/2025

VDH is investigating a potential measles exposure in the Central and Southwest Regions of Virginia. We encourage individuals in those areas to check the locations of potential exposure sites and to learn more about what to do in case of a measles exposure at: https://ow.ly/yopK50XLaQZ