Paladin Family Practice

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

12/19/2025

Interesting new research out of Harvard Medical School adds another layer to the gut microbiome and mental health conversation. Researchers found that a common gut bacterium can incorporate an environmental chemical called diethanolamine, or DEA, into one of its molecules, turning it into a trigger for inflammation.

DEA is found in a range of everyday products, including some shampoos, soaps, detergents, cosmetics, and industrial cleaners. It is commonly used because it acts as an emulsifier and surfactant, helping oil and water stay mixed, improving lather and texture, and extending shelf life. When this altered bacterial molecule activates the immune system, it increases inflammatory signals like IL 6, which have been linked to depression and other chronic disease.

The takeaway is straightforward. This is one chemical worth being aware of. We cannot avoid every exposure, but when there is a plausible link to inflammation, limiting exposure where practical is reasonable.

Study provides explanation for one bacterium’s link to mental health

12/08/2025

New federal rules are finally catching up to how people actually use care. Starting in 2026, many patients will be able to pair a high deductible health plan with a Direct Primary Care membership and use HSA dollars for the membership fee itself, up to about $150 per month for an individual or $300 per month for a family, with those caps expected to adjust over time.

For 2025, you can put up to about $4,300 per year into an HSA as an individual or $8,550 as a family, plus an extra $1,000 if you are 55 or older. Using those pre tax dollars for your DPC membership (within the monthly limits), plus labs, imaging, and other qualified expenses, can stretch your healthcare dollars a long way.

More here: https://blog.atlas.md/2025/11/the-complete-guide-to-hsas-and-dpc-what-doctors-need-to-know/

12/07/2025

As if you needed another reason to get off the couch and move: new research from the Framingham Heart Study suggests that being physically active in midlife and even later in life may help delay or prevent dementia. This cohort has been followed carefully for decades, with detailed exams and expert review of who does and doesn’t develop dementia, which makes the findings more trustworthy. Translation: it is not too late to start moving your body.

This cohort study uses data from the Framingham Heart Study to evaluate whether higher physical activity levels in early adult life, midlife, or late life are associated with lower risk of all-cause or Alzheimer disease dementia.

12/04/2025

Vitamin D insufficiency is incredibly common, especially now that most of us spend our days indoors. Here in Virginia, we sit around 36 to 39 degrees north latitude, which means that in the late fall and winter the sun is often too low in the sky for your skin to make much vitamin D, even if you get outside.

When it is safe to be in the sun, a rough rule of thumb: for fair skinned people, about 10 to 15 minutes of midday sun on arms and legs a few times a week can help. For darker skinned people, it often takes more time in the sun, sometimes 20 to 40 minutes or more, because higher melanin levels block more UV light.

I am also often asked about vitamin D2 vs D3. D2 (ergocalciferol) usually comes from plants and fortified foods. D3 (cholecalciferol) is the form your skin makes from sunlight and is generally better at raising and maintaining vitamin D levels over time, so D3 is usually the preferred supplement unless there is a specific reason to use D2.

This is general information only and not personal medical advice. Talk with your own doctor before changing supplements or sun habits, especially if you have a history of skin cancer or other medical conditions.

11/17/2025

You may have heard about a new blood test for Alzheimer’s disease that recently received FDA clearance. Alzheimer’s is a progressive brain disorder that affects memory, thinking, and behavior. It is one of several causes of dementia, a broad term describing decline in cognitive abilities severe enough to interfere with daily life. Other forms of dementia include vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed types, which often overlap. Alzheimer’s stands out because of the characteristic buildup of abnormal proteins in the brain, called amyloid and tau, that damage and destroy nerve cells over time.

The new test, called Elecsys pTau181 (pronounced ee-LEK-sis pee-tow one-eighty-one), measures a specific form of the tau protein in the blood that tends to increase when Alzheimer’s-type changes are present in the brain. It is approved for adults aged 55 and older who have symptoms or concerns about cognitive decline. The test’s main role is to help rule out Alzheimer’s-related pathology in primary care. If the test result is negative, it strongly suggests that Alzheimer’s is not the main cause of symptoms. However, a positive result does not confirm the diagnosis on its own. Further testing, such as imaging or spinal fluid studies, is still needed for certainty. The goal is to give clinicians an earlier, less invasive way to decide who might need additional evaluation or referral to a neurologist.

For those who do have Alzheimer’s-type disease, treatment options have evolved. The long-standing medications, including donepezil, rivastigmine, galantamine, and memantine, help with symptoms like memory or focus but do not stop the disease itself. In the past few years, new therapies have emerged that target the buildup of amyloid plaques directly. These are monoclonal antibody infusions such as lecanemab (leh-KAN-eh-mab, brand name Leqembi) and donanemab (doh-NAN-eh-mab, brand name Kisunla), designed to clear amyloid from the brain. Clinical trials suggest that these medications can slow cognitive decline by roughly 25 to 35 percent over 18 months in patients with early Alzheimer’s disease, which is meaningful but not curative. They also require careful monitoring because of potential side effects like brain swelling or bleeding.

Cost remains another consideration. These drugs are priced around $25,000 to $30,000 per year, not including infusion and monitoring costs. They are typically reserved for patients in the earliest stages of the disease, confirmed through biomarker testing or imaging. For now, these therapies represent an important step toward disease-modifying treatment, but they are not a cure and their benefits vary between individuals.

This new blood test may eventually help more patients and families identify the cause of memory loss earlier and discuss options sooner. But it is still just one piece of a larger diagnostic puzzle. As always, evaluation and treatment decisions should be made with your physician based on your full clinical picture and personal goals.

Disclaimer: This article is for general informational purposes only and is not medical advice. Please consult your healthcare provider for individualized guidance.

https://www.fiercebiotech.com/medtech/roche-nabs-fda-clearance-alzheimers-biomarker-blood-test

11/13/2025

You may have heard about the recent announcement of a new federal program called TrumpRx, which could make a meaningful difference for patients struggling with the high cost of weight loss and diabetes medications. As a family doctor caring for many self-pay patients, I see firsthand how cost can limit access to these newer therapies. This deal is a promising step toward making them more affordable.

For context, many of the GLP-1 medications such as those made by Eli Lilly and Novo Nordisk have been highly effective for weight management, diabetes control, and even for improving sleep apnea that is caused or worsened by excess weight. The problem has been cost. Until now, most self-pay patients faced monthly prices of $500 to over $1,000, far out of reach for many families. Even the manufacturer coupon programs rarely brought the cost below $500 a month.

Under the new TrumpRx initiative, these prices are expected to drop significantly. For self-pay patients using the TrumpRx program, monthly costs for injectable medications will start around $350, with a plan to fall closer to $245 per month within the next two years. That is roughly a 40 to 50 percent reduction compared to current cash prices. For government-insured patients, the news is equally positive. Medicare beneficiaries could see co-pays as low as $50 per month, and state Medicaid programs will have the option to expand coverage at the same reduced government price of about $245 per month.

The clinical benefits of these medications are substantial. GLP-1 receptor agonists not only help with weight loss but also improve blood sugar control, reduce cardiovascular risk, and can significantly decrease the severity of sleep apnea by lowering body fat around the airway. Studies have consistently shown double-digit percentage weight reductions, which in turn improve overall metabolic health. By making these medications more accessible, this deal has the potential to improve long-term health outcomes and reduce complications from obesity and diabetes across the country.

In short, this is encouraging news for patients, especially those who have wanted to begin treatment but have been unable to afford it. For our self-pay population, TrumpRx could open the door to therapies that were previously out of reach, offering a real chance at better health and a higher quality of life.

Disclaimer: This information is for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider to determine whether these medications are appropriate for you.

The deals are among the most politically significant announcements to date in the Trump administration's efforts to rein in high U.S. drug costs.

11/10/2025

A recent study presented at the American Heart Association’s 2025 conference suggested that long-term melatonin use might be linked to a higher risk of heart failure. It has made headlines, but this is an exploratory study, not proof of cause and effect.

Melatonin is one of the most commonly used sleep aids in the U.S. People take it in many different doses, sometimes far above the typical 1 to 3 milligrams recommended for short-term use. Yet surprisingly little is known about the long-term effects of taking it daily for years.

An exploratory study is an early type of research that looks for possible patterns or associations but cannot prove one thing causes another. It provides early, fact-finding evidence that points scientists toward areas worth studying further. Many more studies would be needed to confirm any real link between melatonin and heart failure.

This particular study was observational, meaning researchers looked back at medical records instead of running a controlled experiment. They relied on prescription data, which does not represent the millions who buy melatonin over the counter in varying strengths and formulations. That limits how well the results apply to the general public. The study also did not explain any biological mechanism that would connect melatonin use to heart failure, which makes the findings more of a question than a conclusion.

It is also worth noting that earlier studies have often found protective effects of melatonin on the heart, including improved blood pressure control, antioxidant activity, and better sleep quality in people with heart disease. So the picture remains mixed.

For now, the takeaway is perspective, not panic. Long-term use of any sleep aid deserves careful thought. Good sleep hygiene and behavioral approaches should come first, such as keeping a consistent bedtime, limiting screens before bed, and managing stress or caffeine intake. Supplements can help some people, but they should never replace healthy habits or medical guidance.

This post is for informational purposes only and is not medical advice. Please contact your physician before starting, stopping, or changing any supplement or medication.

Research Highlights: A review of 5 years of health records for more than 130,000 adults with insomnia who had used melatonin for at least a year found they were more likely to be diagnosed with heart failure, require hospitalization for the condition ...