Paladin Family Practice

04/23/2026

Texas just launched an investigation into Lululemon over PFAS ("forever chemicals") potentially in their activewear.

Here's the full announcement: https://www.texasattorneygeneral.gov/news/releases/attorney-general-ken-paxton-launches-investigation-lululemon-over-potential-presence-toxic-forever

Why should you care? PFAS are a class of synthetic compounds that don't break down in the environment or in your body. They accumulate in your blood, organs, and tissues over time. The research linking them to thyroid disease, hormonal disruption, reproductive harm, and certain cancers is growing fast. And your skin is your largest organ. It absorbs what you put on it.

A company built on "wellness" potentially exposing customers to endocrine disruptors through direct skin contact during exercise, when your pores are open and absorption increases. That's a problem.

Attorney General Ken Paxton issued a Civil Investigative Demand (“CID”) to Lululemon USA Inc. (“Lululemon”) as part of an investigation into whether the company has misled consumers about the safety, quality, and health impacts of its products.

04/20/2026

If you have been following the GLP-1 weight loss conversation at all, this is a pretty big moment. There are now two FDA approved GLP-1 pills for weight loss. Not injections. Pills.

The Wegovy pill (semaglutide) launched earlier this year, and just a couple weeks ago the FDA approved a second one called Foundayo (orforglipron) from Eli Lilly.

Foundayo is interesting because you can take it any time of day with no restrictions on food or water. No fasting before your dose. No waiting 30 minutes to eat. Just take it and go about your day.

Now, the pills are not quite as powerful as the injectable versions. But for a lot of people they could be a great fit, especially for maintenance after hitting a goal weight or for people who want a simpler daily routine. Self pay pricing for both pills starts around $149 per month depending on the dose.

Practical takeaway: The landscape has changed. There are more options now than there were even six months ago, and the right fit depends on your goals, your health history, and what you are realistically going to stick with.

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.

Under the new priority voucher program (CNPV), the FDA has approved a new oral GLP-1 drug, Foundayo, offering an alternative to Wegovy and injectable GLP-1s for weight loss.

04/16/2026

Measles cases are climbing in the U.S. again this year. I am not here to scare anyone, but it is worth understanding what this actually looks like clinically.

What is it?
Measles is caused by a paramyxovirus and is one of the most contagious infections known. If an infected person walks through a room, the virus can linger in the air for up to two hours. About 9 out of 10 unvaccinated people who are exposed will get infected.

What are the first signs?
It does not start with the rash. Symptoms show up 7 to 14 days after exposure and look like a bad upper respiratory infection: high fever (often over 104), cough, runny nose, and red watery eyes. Doctors call this the "three Cs" prodrome: cough, coryza, conjunctivitis.

About 2 to 3 days in, you may notice small white spots inside the cheeks near the back molars called Koplik spots. They look like tiny grains of salt on a red background. They are not always present, but when they are, they are essentially unique to measles and show up before the rash does.

The rash appears 3 to 5 days after the first symptoms. It starts at the face and hairline, then spreads downward over about 48 hours. By the time the rash shows up, the person has already been contagious for several days.

How is it diagnosed?
The clinical picture is usually enough to raise suspicion. Confirmation is done through blood testing for measles IgM antibodies or PCR from a throat or nasal swab.

Does the vaccine work?
One dose of MMR is about 93% effective. Two doses bring that to about 97%, and protection is considered lifelong for most people. Breakthrough infections can happen, especially during large outbreaks, but vaccinated people tend to have milder illness with fewer complications. About 3% of current cases this year are in vaccinated individuals.

Is there a treatment?
No specific antiviral. Treatment is supportive: manage the fever, stay hydrated, and watch for complications. Vitamin A is sometimes given, especially in children, because it has been shown to reduce severity.

How serious is it?
For most people, measles is miserable but self-limited. Recovery takes about 7 to 10 days. Complications happen in roughly 30% of cases overall, but the majority of those are things like ear infections and diarrhea. The serious ones are less common: pneumonia occurs in about 1 in 20 children, encephalitis in about 1 in 1,000, and death in roughly 1 to 2 per 1,000 infected children, usually from respiratory or neurologic complications.

Practical takeaway: if you have had two doses of MMR, you are very well protected.

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.

Learn about this vaccine-preventable disease that once was common in childhood and is known for a splotchy rash and high fever.

04/14/2026

I have been keeping an eye on the GLP-1 weight loss conversation, and this one caught my attention.

A recent study found that about 1 in 10 people have genetic variants that make medications like semaglutide (the active ingredient in Ozempic and Wegovy) significantly less effective. That is not a small number. If you have tried one of these medications and felt like it was not doing what everyone else said it would, it might not be a willpower thing. It might be a biology thing.

This is why I think medical weight loss needs to be more than writing a prescription and sending you on your way. It needs follow up, someone paying attention to how you are actually responding, and a plan B if the first approach is not working.

Practical takeaway: if you are on a GLP-1 and not seeing meaningful results after a few months, do not just assume it is not going to work for you. Talk to your doctor about it. There may be a dosing adjustment, a different medication, or a different approach that fits your biology better. The worst thing you can do is give up without having that conversation.

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.

Top stories featured on ScienceDaily's Health & Medicine, Mind & Brain, and Living Well sections.

03/22/2026

Real talk for the guys who've been quietly googling their symptoms at 11pm:

✅ Unexplained weight gain? We do evidence-based medical weight loss, real strategy, not just "eat less and move more."
✅ Wondering about your testosterone? TRT is available as an add-on for $109/month, including medication and supplies.
✅ Want to actually know your numbers? Common labs through Quest cash pricing very affordable.

No judgment. No runaround. Just a doctor who takes this stuff seriously.
📲 Questions? Text me at 540-406-8688. Ready to get started? Enroll at https://paladinfamilypractice.com/patient-signup/

03/20/2026

🌸 Happy First Day of Spring, Shenandoah Valley.

Spring here is something. The mountains wake up. The redbuds bloom. The air smells like life again.

It also makes a lot of people miserable. That is just the truth.

Why it happens
Your immune system sees pollen and panics. It is not a threat. But your body does not know that. Tree pollen hits first. Then grass. Then weeds. If you live here, you feel all of it.

What helps at home
Shower at night. Rinse the pollen off before bed. Try a saline nasal rinse. It is cheap, safe, and it works. Close your windows on high pollen days. Check the pollen count. Start your antihistamine before symptoms hit, not after.

When you need more
A nasal steroid spray is usually the most effective option. Antihistamines help with sneezing and itching. If nothing works, allergy shots are worth talking about.

When to come see me
If you are not sleeping. If over the counter options are not helping. If you are wheezing. If you are just not sure what is going on. That is what I am here for.

More info from the AAFP here: https://www.aafp.org/pubs/afp/issues/2011/0301/p620.html

📲 Text me at 540-406-8688 with questions, or enroll at https://paladinfamilypractice.com/patient-signup/

This post is for educational purposes only and does not constitute medical advice. Talk to your doctor before making any decisions about testing or treatment.

03/18/2026

Sick kid at 8pm. Do you:

A) Wait until morning and hope it's nothing
B) Hit the ER and spend 3 hours and $400 finding out it's nothing
C) Message your doctor directly and get a real answer

At Paladin, option C is actually on the table. After hours, I screen messages for urgency personally. Urgent concerns get a response as soon as possible, and there's a direct emergency line that reaches me 24/7.

Membership-based care means predictable pricing and no surprise bills. Just clear, direct care when your family needs it. 🏡
📲 Text me at 540-406-8688 with any questions, or enroll at https://paladinfamilypractice.com/patient-signup/

03/17/2026

🍀 Happy St. Patrick's Day.

I come from O'Sullivan stock. County Cork. Good people. Strong people. The kind who crossed an ocean and built something from nothing. I am proud of that blood.

The Irish gave the world great writers, great fighters, great craic, and a stubborn refusal to quit. They also gave their descendants something less celebrated. We call it the Celtic Curse.

What is it?
Hereditary hemochromatosis. The body absorbs too much iron. Not a little too much. Way too much. Over time that iron builds up in your liver, your heart, your joints, your pancreas. Left alone, it does real damage.

It is one of the most common genetic diseases in the United States, showing up in about 1 in 200 people with Caucasian ancestry, with roughly 1 in 10 being a carrier. Most have Celtic roots. Most have no idea.

Why the Irish?
The mutation is ancient. Researchers found it in 5,000-year-old human remains in Northern Ireland, carried by people who built megalithic monuments. It has been in Irish bones for a very long time.

Why did it spread?
Good question. One theory is that it gave an advantage when diets were iron-poor. Another is that it helped people shift from meat to grain. A third is that it may have helped fight parasites. Nobody knows for sure. What we do know is that it worked well enough to survive thousands of years of Irish history, including a famine that killed a million people.

Is there a benefit to being a carrier?
Maybe. Like sickle cell and malaria, or CF and cholera, the hemochromatosis gene may follow the same pattern. Nature trades one risk for another. Some research suggests carriers may have lower rates of atherosclerosis and better iron levels during growth and early adulthood. There is also interesting data showing a related variant appears more often in elite endurance athletes and is linked to higher aerobic capacity in male athletes. The full picture is still being worked out. But it is not crazy to think the Irish survived on that gene for a reason.

Watch for these symptoms
Fatigue. Joint pain. Brain fog. A bronze tinge to the skin in advanced cases. Symptoms often do not appear until around age 50 in men, and about a decade later in women, because menstruation naturally keeps iron levels lower. By then, damage can already be done.

Treatment is simple
You give blood. A pint is removed once a week, just like donating blood. It may take months to years of weekly phlebotomy to bring iron down to normal. Then it is done about four times a year to keep it there. Caught early, most people do very well and live a normal life.

Should you get tested?
If you have Irish, Scottish, Welsh, or broader Northern European ancestry, yes. A simple blood test checks iron and ferritin levels. Family members of anyone diagnosed should be tested too.

Come talk to me. This is exactly the kind of thing I am here for.

For more, read this AAFP patient guide on hereditary hemochromatosis: https://www.aafp.org/pubs/afp/issues/2002/0301/p865.html

📲 Text me at 540-406-8688 with questions, or enroll at https://paladinfamilypractice.com/patient-signup/

This post is for educational purposes only and does not constitute medical advice. Talk to your doctor before making any decisions about testing or treatment.

03/13/2026

Most people don't realize how low the bar has gotten for "good" healthcare until they experience something different.

At Paladin Family Practice, new patients can usually get in within 1 to 2 weeks. Urgent issues? Same day or next business day. And when you reach out, you're messaging me directly, not a portal that routes to a nurse who routes to a coordinator who maybe tells me three days later.

Direct access to your doctor shouldn't be a luxury. That's just how it should work.
If you're tired of the runaround, I'd love to show you what care actually feels like.
📲 Text me at 540-406-8688 with any questions, or enroll directly at https://paladinfamilypractice.com/patient-signup/

03/11/2026

What if your doctor actually had time for you?

That's the idea behind Direct Primary Care, or DPC. It started in the late 1990s when a physician in Seattle named Dr. Garrison Bliss got fed up with insurance-driven medicine and started seeing patients directly, on a simple monthly membership fee. No middlemen. No billing maze. Just a doctor and a patient.

The model quietly spread for years. Then it caught fire. Today there are nearly 3,000 DPC practices across all 50 states, and the movement keeps growing, because patients and doctors alike are hungry for something better.

At Paladin Family Practice, that's exactly what we're building right here in the Shenandoah Valley. A place where your doctor knows your name, answers your texts, and actually has time to take care of you.

Want to learn more about the DPC movement? Check out dpcfrontier.com.
Ready to join us? Visit www.paladinfamilypractice.com or text me at 540-405-8688.

02/26/2026

I am guest hosting Walk with a Doc on Wednesday, March 11 from 11 A.M. to 12 P.M. at the Valley Health Wellness & Fitness Center.

Topic: Seasonal Allergies: What Helps and When to Get Checked

We will meet in the Fitness Center lobby and head outside for an easy group walk. Please arrive 10–15 minutes early to check in. The event is free and all are welcome.

02/25/2026

Finally. Someone is talking about the food supply like it actually matters.

Reuters reported that US health regulators are considering a petition to re evaluate the “generally recognized as safe” (GRAS) status for a long list of processed food ingredients, including certain refined carbohydrates and sweeteners like corn syrup. In plain language: some ingredients that have basically been treated as “safe by default” may soon face a higher bar, with more evidence required to keep them in our food. (I will include the Reuters link with this post.)

I see this as a step in the right direction. Refined carbohydrates and ultraprocessed foods are highly likely to be one of the biggest drivers of the US obesity epidemic and the downstream problems we all see: fatty liver disease, type 2 diabetes, hypertension, heart disease, and more. The US food environment is brutal. Cheap, hyper palatable, calorie dense food is everywhere, and it is engineered to be hard to stop eating. That reality fuels a massive portion of our healthcare spending.

When I was working in the hospital, this was impossible to ignore. Day after day, the majority of what we were treating traced back to preventable chronic disease, most often diet related illness, smoking, or both. You see the same patterns on repeat.

Artificial dyes deserve scrutiny too. They are not nutrition. They are marketing.

This will be a difficult battle. The food industry is extremely powerful and has a lot of money to throw around. Efforts like this will need more support to hold up over time. We all deserve to live in a healthier environment with better food options, not the current saturation of highly addictive processed foods in every store and drive throughs on every corner.

Practical takeaway (simple and effective): I like Michael Pollan’s advice.
• Shop the perimeter of the grocery store most of the time.
• Avoid or limit foods that need nutrition labels.
• If you do buy packaged food, keep it boring: short ingredient list, protein and fiber forward, minimal added sugar.

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.

The Food and Drug Administration will consider a petition to revoke the safety status of dozens of processed refined carbohydrates unless food companies can prove they are safe and not contributing to health issues and obesity, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said in r...