Long Time No See. Oh Look a Book

To those still subscribed to this blog, I’m sorry for the hiatus. My last post was about how great summer is going to be and all of the blogging that I was looking forward to. Well that didn’t happen and it is nearly the new year. What have we been doing? Why are we so lazy?

In short, Dr. Plaxco continues to work on his business degree and I have started a new role in a rural health clinic. That is not all, I also finished my first book of fiction and it is set to be released through Amazon/Kindle in March. There is plenty of personal stuff too, don’t even talk to me about the house at this point.

The book is “Realm of Health” and is set to release over 3 dates. Hardcover release is March 1st, Paperback is to be released on March 15th (Ides of March), and the Kindle edition is set to release on March 30th (Physician’s day) and is available for pre-order now.

The story is of a Young Healer, Kinslow, welcomed into the Realm of Health and indoctrinated into a culture that is foreign to his own. Kinslow navigates his first Healer role and finds that his training was incomplete for what the reality of his Healer Role is to be. Kinslow is forced to face this reality with an open mind and a brave heart as he travels throughout the Realm of Health to better understand and thrive as a healer within the wide and complex web cast by the City managing the Realm.

This book was intended to be a satirical analysis of the 21st-century US Healthcare system, as embodied in the fictional world known as the Realm of Health. The full complexity of the real-world system is too vast to fully capture, so the Realm of Health is a simplified version, but remains elusive to the young healer (new graduate) to grasp. The young healer is Kinslow whom is indoctrinated through gaslighting and peer pressure. The City represents the payer systems that set the rules for payment (credits) while simultaneously failing to communicate the rules to the healers within the system. While the Universities and Cathedrals (medical schools and corporate clinics/hospitals) are seemingly independent from the City, they are controlled through credits and debts that are set by the City.

When I envisioned this book, I was thinking “US Healthcare meets Gulliver’s Travels.” This book was the second in a trilogy of books that I began during the COVID-19 Pandemic. My time off this summer allowed me to refocus on necessary projects around the farm and to reengage my creative writing. Look forward to the other 2 books in the series (‘Building the City’ and ‘After the Realm’) over the next few years, but read and enjoy or hate the Realm of Health.

Dedication – To the professional who has sacrificed their youth to learn how to help strangers live a healthier life; To those who have fought to hold the standard of care against the endless barriers, bureaucracy, and politics; and to the families, friends, and colleagues who have supported these fine individuals. This book is for you all.

Side note for the personal stuff – I reflect on the stoic virtues (Wisdom, Courage, Temperance, and Justice) and cognitive biases often.

National Health Awareness: Lung Cancer August 2025

Happy mid-August, everyone.

August brings to our awareness specific conditions to include Children’s Eye Health and Safety, Gastroparesis, National Breastfeeding, National Immunizations, Psoriasis Action, and Summer Sun Safety months. Additionally, World Lung Cancer Day, World Breastfeeding Week, National Health Center Week, Contact Lens Health Week, and International Overdose Awareness Day.

This month, we will focus on lung cancer.

While discussing cancers of the lung, we will focus on primary types and exclude cancers that metastasize and travel to the lung. Cancers of the lung include small cell (oat cell) and non-small cell types (which include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma). Other cancers of the lung include the lining (mesothelioma), the mesenchymal cell lines (sarcoma), and the white blood cell lines (lymphoma). This list is not intended to be exhaustive as I am not a pulmonologist or oncologist. As a primary care provider, my focus is on the prevention and identification of disease. So then, let’s talk about risks and prevention first.

DO NOT SMOKE! Seriously, this is one of the main risk factors for lung cancer. Inhaling carcinogens through cigarettes (and likely vaping) increases your risk of developing cancer. As marijuana smoking becomes more prevalent, I anticipate more evidence linking any inhalation of chemicals as a risk factor for lung cancer. Smoking is such a risk factor that we calculate pack-year histories (number of packs per day X number of years). The current recommendation is for a low-dose CT scan annually for anyone 50-80  years old with a 20-pack-year smoking history within the last 15 years.  Small-cell is an aggressive cancer, and its main risk factor is smoking!  I personally lost a grandfather to this cancer, and he was a heavy smoker.

Limit radiation exposure. We live on a planet that generally shields us from cosmic radiation; however, we find natural sources of radiation, create radioactive material, and fly closer to cosmic radiation as part of our modern world. Radiation damages our DNA and leads to mutations. Mutations are generally not a good thing; instead of becoming a superhero, we mainly just develop cancers. I was fairly pissed to learn this myself as I grew up with the TMNT, Fantastic Four, Spiderman, X-Men… sadness. Limiting exposure is our best bet to decrease our radiation exposure whenever possible.

Oddly enough, we use radiation to screen for and manage cancer. When it comes to radiation, dose matters. A body scan with the TSA is a 9-minute flight, a dental X-Ray is a 3-hour flight, a chest X-ray is a 33-hour flight, and a brain CT is a 667-hour flight. https://www.xrayrisk.com/calculator/calculator.php can help quantify your risk based on the diagnostic studies that you will undergo. A common question is whether a mammogram increases your risk of cancer; the answer is very minimally. The baseline risk of cancer for a 40-year-old female is 37.5% and the risk increases to 37.504% after a mammogram. Meanwhile, an abdominal CT increases that same woman’s risk to 37.58%. The absorbed dose matters, and we measure it in sieverts (Sv). An abdominal CT exposes the patient to 8mSv of radiation, which is 20 times more radiation than a mammogram (0.4mSv). One dose of 1 Sv of radiation is believed to cause fatal cancer in 5% of people exposed, but one dose of 5 Sv would be lethal to 50% of those exposed.

Avoid asbestos inhalation (or contact). Asbestos was a useful product until we figured out that it caused cancers (lung, larynx, ovarian, stomach, and colorectal). Asbestos was used for insulation, brake pads, tile, pipes, and tampons. Asbestos tampons were manufactured for a good while as well, and some people are still angry as they increased bleeding (manufacturers were pleased as it increased the use of the product). The parallels between Asbestos and plastic are quite humorous from a certain point of view, as our history is starting to repeat itself, with microplastics being linked to cancer and hormonal dysregulation risks. The difference between plastic and asbestos currently is that asbestos has an established history as a major risk for mesothelioma, so the industry stopped using the chemical to reduce the risk of litigation and profit loss (and because laws and regulations were established).

As mentioned above, inhaling any chemicals is probably a bad idea if you are trying to decrease your risk. Another risk factor for developing lung cancer is air pollution. Smog, coal dust, hydrofluorocarbons (HFCs), silica, etc., all increase the risk of lung damage and lung cancer formation. An aside, NASA has looked into this issue and has identified several plants that decrease the ambient carcinogens in our air. Plants such as spider plants, aloe vera, peace lilies, snake plants, rubber plant, bamboo palm, and English ivy clean the air of benzene, ammonia, formaldehyde, xylene, carbon monoxide, toluene, and trichloroethylene. Some of these plants also decrease the mold spores in the environment.

So far, we have discussed risk factors for lung cancer but not symptoms. Generally, persistent cough, changes in ease of breathing, and chest pain are common reasons to get evaluated. Fatigue, weight loss, pain, and voice changes are less specific but may prompt further evaluation. Coughing up blood is dramatic, but usually turns out to be bronchitis. If you are worried or have any of the symptoms above, come on in for evaluation.

Evaluation usually involves the initial test of choice: a chest X-ray, then followed by a chest CT and possibly a biopsy. If cancer is found, a PET (positron emission tomography) scan can identify any areas in the body with increased metabolic rate, which could be metastatic disease (signs that the cancer has traveled outside of the lung).

Treatment can include surgery, chemotherapy, and radiation, depending on the type of cancer, location, and goals of therapy. Not all cancer is curable, and sometimes pain and suffering reduction is the goal of therapy; palliative and hospice care are the right choice for many patients. When caught early, aggressive treatment may be the best option. When cancers are late-stage and aggressive, aggressive treatment may worsen the quality and duration of life. The treatment goal is to maximize a high quality of life of remaining years. Hope is profitable, and unfortunately many people undergo therapies that can be harmful at a very high cost. Having a conversation with the oncologist regarding cost of therapy, complication rates, quality of life years, and whether they would undergo the treatment if they had this disease is important. Sometimes, undergoing treatment to prolong life to get your affairs (living will and updating beneficiaries) is the best that you can do.

I hope that this topic is not too much of a bummer.
Life is precious because it ends. We all have an intrinsic risk of cancer formation throughout our lives. The best that we can do is to mitigate our risks, recognize when something has changed in our bodies, and get evaluated.

Please have a healthy and productive day. Take care of each other. We are all in this together.

Path to Homestead: Summer Break

Summer Break as a kid was amazing. Summer break meant no school, time to do whatever you wanted, and great weather for swimming. The only thing that held us back was the lack of transportation. As an adult, I have not had a summer break since college. When I joined the military, my summers were spent training, working, or attending medical school.

I find myself with two months free this summer. My kids have one of the months off with me before they go back to school. We look forward to some water park, beach, and arcade days ahead. This should also allow me the headspace to reset and re-engage in creative projects and the blog.

The homestead is making progress, though I doubt that the farm will be fully self-sufficient or self-sustaining while I work full-time. The days off from work are necessary recharge moments. If we skip the time to recharge or to connect with friends and family, we all become less pleasant and less productive. For the summer, I will focus on maintaining and finishing projects.

Hügelkultur – In previous blog posts, we described the hügelkultur plans and designated the plots as HG1 (established 2024) and HG2 (established 2025). We have a copious growth of corn and squash in the HG2. The HG1 plot has been very productive for our root and leaf vegetables. In particular, kale and turnip production is ridiculously high. This is encouraging, and I still plan to dig and create HG3 and HG4 so that we can do the crop rotation between plots as part of sustainable farming practices.

Memorial pond and gazebo – Our memorial space is complete with a self-sustaining, solar-powered pond overseen by a deck and gazebo. We held a memorial for my wife with her friends and colleagues. My girls said that this felt like Mom, and I feel like we were safe to honor the person that she was and the mother that she was while also recognizing the strain that we all felt through the divorce, her hospitalizations, and her death. The idea of an event space has come up. This area would be wonderful for weddings and parties in the summer.

Fruit trees – Our fruit trees have all survived, though several were gobbled by elk. In the next few years, we hope to have our fruit forest to supplement our apple and pear orchards. In our backyard, I have planted several peaches, plums, raspberries, strawberries, blueberries, and cherries along our Hügelkultur proof of concept. Until recently, they were all vibrant without watering. This has been a relatively dry year, so I am sure that the hügelkultur logs are feeding the trees with nutrients and stored water as intended.

Poultry (Chickens, ducks, turkeys) – In early spring, we received 10 ducks (9 female and 1 male) and 8 turkeys (mixed run) in the mail. They have grown, but there were some losses of turkeys. We are excited to have our chicken eggs supplemented with duck eggs. The Turkeys will be a welcome holiday meal. However, the survival rate of turkeys was less than 50% so future iterations of these anti-brilliant, yet very social, birds will need to be reexamined. However, it appears that we have at least 1 male turkey, so we will see how this all goes. The ducks all survived and are happy with any body of water that they find. I will need to muck out their area and replace the hay bedding soon. The used bedding will decompose over time. Chicken manure is highly acidic and takes about a year to become beneficial for the soil. Duck manure is immediately bioavailable.

House updates – This summer, we continue to improve the house. There are things that I can do, and there are things that I would prefer be contracted. Room renovations, such as the guest room, continue, and we are nearly done with the sheet rock. Once we have mudded and textured, we will paint and trim. Adding the doors for the mini-closets and entertainment center/projector, some art and décor, and an armoire will finish this room. The last step will be to strip, sand, stain, and finish the floor. The guest room is unrecognizable when compared to when we purchased the home. I had an electrician come to update our electrical box. The original box was 180A main split between three separate 60A breakers. This was confusing, but it was deemed adequate when they installed our solar system. The frequent breaker tripping, not to mention the hot tub board burning out, made me dubious of their conclusion. The new 200A main breaker with built-in surge protection and GFCI has been a welcome upgrade. It is amazing to be able to do our laundry without tripping the main breaker (side note: if you ever buy an old home, one of the previous folks may have misinterpreted the main breaker tripping as a need for a higher amperage breaker for the dryer/appliance). We are planning a roof replacement and extension for a covered deck; this will be contracted out.

Projects to finish on my time off – While I have 2 months off, I will clean up my messes from projects, as well as complete 2 projects that are well overdue. The house siding is approximately 50% complete. I need to rent a boom lift to add ventilation to the attic and to reach the peaks on the East and West sides of the house. The other project will be to finish the outbuilding roof next to the barn. The demolition and concrete pylon pour was last year, but the divorce drained me of the funds and will to finish that project. With 2 months off, I should be able to finish the roof and get the tractors in a dedicated covered area.

Harvesting the wheat vs allowing self-seeding is a choice that I haven’t made yet. We have enough to harvest whatever we want for bread. Nearby, I have the beginnings of a flower field. Over time, I hope that the area will be beautiful, as well as an area that I can graze for grain and oats.

It sounds like a lot for 2 months, but I will prioritize spending time with my kids while I let other folks do some work on the roof replacement and expansion. Last week, we prepared for a play that my oldest daughter wrote, directed, and composed the music for. Both of my daughters are in the play, and it is my youngest daughter’s debut on stage. Today is showtime, and I am very proud of them. It is amazing to watch them make something from nothing. I don’t want to miss anything that they are doing, so when my kids are sleeping or at school, that’s when I will work on the guest room, outbuilding roof, and siding.

I know that my friends and I enjoy writing this blog and look forward to resuming the work. Please feel free to reach out to us at RevHealthDoc@gmail.com for any questions or comments.

National Health Awareness June 2025

June is my birth month. This year I listened to my friends and therapist and prioritized my needs (fishing and steam sessions have been wonderful). Thus, the blog took a few weeks’ break as a result and will serve for June and July.

In previous Junes, we discussed aphasia, Alzheimer’s disease, migraines and headaches, and PTSD. This year, we will focus on myasthenia gravis.

Myasthenia gravis is an autoimmune disease that interferes with signals at the neuromuscular junction, causing muscle weakness. Before you start thinking you may have myasthenia gravis, take a moment to think about how often you have exercised in the past month. Sometimes, muscle weakness is caused by inactivity and not from a disease like myasthenia gravis.

The neuromuscular junction is where the signals from the nervous system activate a mechanical event in the muscle, thoughts to action. The electrical signal is a series of electrolyte shifts that travel from one end of the nerve to the other. Once the signal reaches the end of the nerve cell, the message is converted to chemical messages in the form of neurotransmitters such as acetylcholine. The neurotransmitters cross the neuromuscular junction to find a matching receptor, in this case, the muscarinic receptors. The receptor is a G-coupled protein that activates an exponential cascade of chemical reactions that cause the muscle to act.

In the case of myasthenia gravis, the immune system has decided that the acetylcholine receptor is an enemy and has created acetylcholine receptor antibodies that block the ability of the nerves to trigger muscular action. The more times the muscle is told to act, the less effective the message becomes, and the muscle becomes progressively weaker. This is why eye drooping is one of the first symptoms and why we look for fatiguability on the exam. Having the patient repeat the process of squeezing as hard as they can and then relaxing allows us to observe the fatiguability of a muscle. The next step is lab work to identify the antibodies as well as to scan for any thymus tumors (10-21% of people with myasthenia gravis will develop a thymoma, depending on which journal you reference).  

Https://pmc.ncbi.nlm.nih.gov/articles/PMC3469795/

https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-8-340

Treatment begins with blocking the breakdown of acetylcholine. Steroids, immunosuppressant medications, and plasma and antibody treatments are also effective in decreasing the autoimmune response. Many treatments have emerged since I was in medical school to include monoclonal antibody treatments.

Bottom line, myasthenia gravis is rare but manageable with medications. There is no cure for this disease at this time. Unlike genetic diseases that can be corrected with gene editing, autoimmune diseases are very difficult as it is the patient’s unique immune system that causes the problem. Lastly, if you feel weak, eat right (Mediterranean diet) and go exercise consistently for a few months to see if you are just out of shape before coming to the doctor to get checked for myasthenia gravis.

I hope that the rest of June treats you well. Thanks for reading!

June brings our awareness to Alzheimer’s and Brain, Cataract, Myasthenia Gravis, Aphasia, Congenital Cytomegalovirus, Migraine and Headache, Scleroderma, PTSD, and Scoliosis Awareness Month. Additionally, it is Men’s Health and Safety Month. June also brings Cancer Survivors Day, Family Health and Fitness Day, Bone Marrow Donor Day, Men’s Health Week, Autistic Pride, Sickle Cell Day, Helen Keller Deaf-Blind, and HIV Testing Day.

Path to Homestead: Water, Earth, Fire, Air

In the last installment of Path to Homestead, I discussed purchasing an Eco-Worthy solar-wind hybrid system. This will power the koi pond and will heat our tropical greenhouse. Let’s discuss lessons learned regarding ponds and water management (water), the soil and concrete (earth), solar (Fire), and the wind turbine and air circulation (Air).

The goal of the farm is to have as much self-sufficiency as possible and to create a beautiful space, a sanctuary. The tropical greenhouse was constructed from hog panels, a repurposed raised garden, a repurposed bathtub, and plastic sheeting. I am cultivating Yuzu, oranges, lime, and lemons in the greenhouse while raspberries and asparagus already thrive there. Next to the greenhouse was a wallow that the pigs had dug. I had repurposed that hole for a pond with a small solar-powered waterfall (unfortunately, this was found to be underpowered). The pigs subsequently poked holes in the liner last year, and it has been less than beautiful.

My prior posts on the tropical greenhouse –

My prior posts on the pond –

Repairing the pond (water) was on the list for this year. The sanctuary provides a place to reflect and meditate (“special water” – Wreck-It Ralph 2). The plan was to improve the original design and prevent further punctures by pigs or wildlife. Problems: Underpowered pond pump for the filtration and waterfall needs; the pond liner was easily punctured by hooves; the pond was not deep enough (when it was leaking) to maintain temperature over winter. Solutions: The solar-wind hybrid system with its 2kWh battery backup can power a proper pond pump in the summer (sun/fire) and winter (wind/air); underlayment and garden fabric with a layer of sand and rock to protect the liner; dig (earth) the pond deeper with more defined shelves for pond plants, sand, and rocks.

The Eco-Worthy solar-wind hybrid system is pretty simple to assemble compared to most farm projects, however, it would have been overwhelming if I had tried to tackle the project when I first started DIY projects. Solar panels need a solid frame and mount to survive wind and animals. I calculated the ideal angle for my solar panels based on our zip code (https://footprinthero.com/solar-panel-angle-by-zip-code), which gave me the ability to calculate how far apart the anchors for the mounting hardware needed to be from each other. Once I knew that distance, I added a few inches to each side and came up with my slab size. I dug out a spot and calculated the concrete needed (https://www.calculator.net/concrete-calculator.html) for the solar panel slab next to the tropical greenhouse. The location allows for the most sunlight and does not interfere with the view of the pond. The Math be Mathing- many of us carry a portable computer with a calculator app and 24/7 access to online calculators with us at all times! Once the concrete cured and hardened, the hardware for the mounts was installed, followed by the solar panels (I had purchased 2 extra panels for the system, but failed to get the y-connectors, so there was a break while they were shipped).

I stayed busy while I waited for the components. I built a little utility house for the batteries and control boxes to protect the electrical components and controllers from the elements. I pumped the remaining water from the pond into buckets so that the new pond could benefit from the microbiome contained. A happy surprise was that the koi were still alive and thriving in the pond, and they had thousands of tadpoles and frogs as companions. The rocks and décor were removed, and the ruptured liner was removed. I moved the old underlayment to dig the pond deeper in specific areas, like the bottom and the shelves. I missed the water lilies, and having the shelves would provide a stable place for the planters. The underlayment was put back, the old liner was used as another barrier, the new liner was placed, and yard fabric and underlayment geotextile were placed as a barrier to future punctures. Some rocks were placed to hold everything in place as the water was replaced.

The connectors arrived, and the final wiring was completed. I installed the upgraded pond pump and turned the inverter on. The waterfall cascade was full flow, the eddies started, and the pond began to circulate. I added back sand, rocks, and décor to the pond. The inverter has another power plug, so the tropical greenhouse has possible power for heating in the winter. Once the summer rolls around, I will provide a “State of the Farm” update with photos of the progress. The goal this year will be to expand the sanctuary with a gazebo, fence, and BBQ/cooking area near the pond. A nice place to stargaze on clear summer nights.

As a side note, when my wife was hospitalized, and before she asked for divorce, she was at risk of dying from liver failure. At that time I had asked her what I could do to honor and memorialize her. A gazebo on the property (she wanted it next to the creek on a spot that technically wasn’t on our side of the property line) with a small memorial garden. In part, I am creating this space in loving memory of her and the person that I married and had children with. Our daughters deserve to remember the good and heal from the not-so-good. I create this space not to be ‘nice’ but because we need a loving environment where we can heal and say goodbye with her friends.

I know that my friends and I enjoy writing this blog and look forward to resuming the work. Please feel free to reach out to us at RevHealthDoc@gmail.com for any questions or comments.

National Health Awareness: Thin Bones – May 2025

Welcome to May! This year, we will focus on osteoporosis. In previous posts, we have covered hypertension, fitness, work wellness, mental health, and lupus. You can check those blog posts out below.

Osteoporosis is a condition of decreased bone density. Our body is a dynamic place of constant remodeling. For our bones, we have cells that build bones (osteoblasts) and cells that break down bone (osteoclasts). This interplay of creation and destruction allows us to heal bone with bone. This is unlike any other tissue in our body; usually, we just scar. Osteoporosis is common in the elderly, with 12.6% affected, but it can occur at any time in our lives. For the elderly with osteoporosis, hip fractures are often the first in a line of dominoes leading to death (17-33% die within the first year), especially if the fracture is not managed emergently.

If osteoclast destructive activity is higher than osteoblast reconstructive activity, the bones thin and become more brittle. Osteoporosis is the most severe thinning, osteopenia is the intermediate thinning between normal and osteoporosis.

Risk factors for developing osteoporosis include diet (low calcium and vitamin D), activity (sedentary life makes everything weak), smoking, alcohol consumption, chronic corticosteroid use, and malabsorptive conditions (celiac, etc.). Age and genetics are also major contributors to an individual’s risk of developing osteoporosis, so discussing and calculating your risk with your provider is important. The fracture risk assessment tool (FRAX) is helpful to determine the risk of severe fracture (https://frax.shef.ac.uk/FRAX/tool.aspx?country=9).

Dual-energy X-ray absorptiometry (DEXA) scans are used to screen for osteoporosis and score bone thinning severity. All women 65 and older and men 70 and older are recommended to have osteoporosis screening. DEXA scans are also helpful to assess osteoporosis in those with concerning fractures, height loss, cancer, or concerning X-rays.

Treatments for osteopenia and osteoporosis focus on providing the building blocks (calcium, phosphate, vitamin D), increasing osteoblast activity (weight-bearing exercise, hormonal therapies, anabolic medications), and decreasing osteoclast efficacy (bisphosphonates and antiresorptive medications).

https://link.springer.com/article/10.1186/s40199-017-0167-z

The treatments for osteoporosis are not always tolerated. Sometimes the treatments lead to bone death (avascular necrosis). For patients who have osteoporosis, the treatments are still worthwhile. As above, up to 33% of those who break their hip will have died within 1 year. Death is usually not from the fracture itself, but the consequences of organ failure, infection, clots, or errors mount heavily on the elderly body. In the case of the elderly with osteoporosis, tripping can be a life-threatening event.

Recently, we lost Harley Miller, MD. He worked tirelessly well into his 80s to provide healthcare to his community in Lewis County. I am sad that he did not get to retire and enjoy his remaining years. He is of a generation that saw medicine as a vocation, a calling that they devoted their lives. Thank you for everything that you did for this community, Dr. Miller, you are missed.

For all of May, these are the other conditions represented: American Stroke, Arthritis, Cystic Fibrosis, Better Hearing and Speech, Global Employee Health and Fitness, Healthy Vision, Hepatitis, Lupus, Melanoma/Skin Cancer Detection and Prevention, Mental Health Awareness, Asthma and Allergy, Celiac, High Blood Pressure, Osteoporosis, Physical Fitness and Sports, Teen Pregnancy Prevention, Older Americans, Occupational Safety and Health, and Children’s Mental Health. Additionally, there are some notable days and weeks in May to include World Hand Hygiene, ME/CFS and Fibromyalgia, National Asian and Pacific Islander HIV/AIDS, World Arthritis, Preeclampsia, Senior Health and Fitness, Don’t Fry Day, No Tobacco Day, Physical Education and Sport Week, North American Occupational Safety and Health, Children’s Mental Health, Food Allergy, Women’s Health, Stuttering.

Stay healthy and find happiness in the little things around you. Please feel free to reach out to us at RevHealthDoc@gmail.com for any questions or comments.

Path to Homestead: Spring into action 2025

Over the Winter, we reflect on the year that has passed and look forward to the year to come. In the last path to homestead post, we discussed pivoting from pigs to sustainable agriculture (hügelkultur and greenhouses for vegetables and fruit trees). This post is to detail the progress and the successes we are seeing as Spring warms up.

The greenhouse was productive over the winter. The upgrades to power, heat, and water access have enabled vegetable cultivation and provided a means to nurture cuttings from our productive plants. As an experiment, I buried some of the raspberry cuttings in the clay ground outside, some in the compost pile outside, some in the hydroponic barrel in the greenhouse, and some in the hydroponic rocks in the greenhouse. The most voluminous observed were in the barrel, the compost, hydroponic rocks, and then the clay. I have now planted them all in clay now that the weather is warming up as they are already hardened off. We will see which set is most productive this year.

The past year had many unexpected expenses. We utilized credit cards with high reward point returns while paying off the balance immediately, maximizing points and interest payments. Additionally, we waited for discounts to purchase equipment and needed products to maximize those points’ usage . One of the products was an Eco Worthy solar-wind hybrid system to power the decorative pond and to heat our tropical greenhouse. The installation is still in progress, but we are excited for the upgrade. As of this writing, the concrete slab was poured, the solar panels were installed, the wind turbine anchor/slab was poured, the electronic housing was built, and wiring is underway.

The Hügelkultur project continues. Corn and squash did well last year, which we will call the fruit side, in hügelkulur plot #1 (H1). Our second plot (H2) is dug, the logs are in the base, mulch has been laid, and a layer of dirt and another layer of mulch will make the plot ready for planting. This year, we plan to plant roots and leaf in H1 while we plan to plant legumes and fruit in H2. There are sprouts in the greenhouse (cabbage, kale, swiss chard, cauliflower) and the potatoes stored in the basement that are ready for H1. In the house, I have tomatoes and beans ready for H2. We hope that the peppers that are in the greenhouse are ready by May for planting in H2. The ambitious me says that I will make 2 more plots this summer so that I can have dedicated H1-4 for Leaf, Legume, Fruit, and Root cycling, but the realist in me says that I want to go fishing and have a social life again so H3 and H4 can wait.

A second hügelkultur line was dug, trees (Plum, Peach, and Cherry) and blueberries were planted on the north side of the mound while strawberries were planted on top of the mound. On the south face, I hope to plant vegetables like leeks, garlic, and lettuce. I am toying with the idea of adding pumpkins to the base on the south side and allowing them to grow into the grass or over some landscaping fabric. It may be worth an experiment this year.

My daughters and I have built raised gardens for vegetables. We chose vegetables that were difficult to protect in the field last year. These included radishes, peas, lettuce, garlic, and carrots. The sprouts are doing well, but we learned how cats can crap all over our best laid plans. My daughters wanted easier access to fresh fruits and vegetables (closer than a football field away). I took the opportunity to teach them how to build their own raised beds as well as to cultivate vegetables.

A side note to dote on my kids a bit. They are very responsible kids, and they are building personal resilience after a particularly challenging year. Despite innumerable personal losses, they have demonstrated incredible courage to distance themselves from those who cause pain and conflict rather than promote healing throughout their parents divorce process, and through the death of their mother.  We were really happy to have my Dad visit and go on a hike with us in Rainbow Falls. Thank you to all who focused on supporting my kids. Thank you to everyone who didn’t attack me. I was supporting two households through my work while rebuilding a farm and farmhouse. Attacks on the family could have hurt and devastated my kids. Lessons are learned, and I am thankful for you showing who you are during this time.

The pigs are still with us. I am trading the adult female for fence work and will grow out the 3 remaining piglets for slaughter. I am looking forward to summer and fall without animals (besides chickens). Again, the realist is ready for fishing and social time.

I know that my friends and I enjoy writing this blog and look forward to resuming the work. Please feel free to reach out to us at RevHealthDoc@gmail.com for any questions or comments.

National Health Awareness: Public Health April 2025

The month of April brings awareness to many specific conditions (the full list is at the end). The separation of politics from science, religion, law, and medicine would be ideal, but human biases are intrinsic to our species. The continuous reevaluation, discernment and updating of knowledge is the scientific method. Public Health is undergoing a revolution, of sorts, currently under the guidance of the new administration. Today’s blog post is about Public Health, a broad topic that encompasses preventive services and evidence-based interventions, such as vaccinations, smoking cessation, and alcohol avoidance.

Measles and Polio have returned in recent years. These deadly and debilitating diseases were expunged from the US with effective vaccination campaigns allowing us to believe that we were safe from them. The declination in vaccination rates has opened the door to hosts of previously conquered foes that returned to wreak havoc. Mistrust and fear are behind the vaccine decline. The COVID-19 pandemic worsened this mistrust of vaccines through a series of political decisions that muddied the science. Recovering from these kinds of events requires transparency, humility, and deliberate trust building.

Below is an adult annual physical ‘smart phrase’ that I use in my practice. It is a distillation of the United States Preventive Services Task Force (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations) and Centers for Disease Control (https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html) recommendations.

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Recommend:

-yearly wellness visit

-annual blood pressure assessment

-Annual depression and anxiety screening

-Colon cancer screening at 45 years old based on routine risk

-(Male only) Consider prostate cancer screening with PSA (55-69-year-old)

-(Female only) Mammogram 40-74 years old every 1-2 years (USPSTF recommends every 2 years, ACR recommends every 1 year)

-Cervical cancer screening 21-65 years old based on ASCCP guidelines

-DEXA (female – 50-64 with risk factors, 65 or older); DEXA (male – 70)

-One-time HIV (13-64 years old) and Hep C (18+ years old) screening

-Sexually transmitted infection screening based on increased risk; Gonorrhea and Chlamydia (sexually active females until 24 years old)

-safer sex practices

-avoid tobacco products

-Eliminate or minimize alcohol consumption

Recommended vaccines:

-Td booster vaccination every 10 years

-Shingrix series at 50 years old

-PPSV20 at 65 years old or one time for chronic disease (DM2, CKD, Alcoholism, cigarette smoking, immunodeficiency, cancer)

-HPV Vaccination (9-26 years old recommended, 27-45 years old shared decision-making if at increased risk)

-yearly influenza vaccination

-yearly COVID vaccine

-RSV vaccine (60+ with risk factors, 75 or older)

Discussed diet and exercise recommendations: limit carbohydrate and saturated fat intake, maintain calorie balance, and exercise 150-180 minutes weekly with 2 days of strength training in large muscle groups (300 minutes weekly for weight loss).

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The discussions that we have with our patients are to state the evidence-based recommendations and to help promote their health under those guidelines. In an ideal scenario, the discussions and decisions between the physician and patient would be enough. The relationship is built on trust. Meaningful use and metric-based reimbursements have introduced money and politics into the physician-patient health discussions. Higher vaccination rates led to higher payment. Politically and from a public health perspective, this makes sense. However, it resulted in eroding of public trust. The elephant in the room is the belief the financial incentive to vaccinate introduces a vaccine bias for the physician.

To be clear, I am pro-vaccination, but I recognize that there is a motivation to vaccinate. Currently, the COVID and Influenza vaccines are the vaccines that I must continuously reevaluate based on the available evidence of efficacy (how well the vaccine works to prevent the disease, complications, and death), disease prevalence (how much of the virus is around), and disease risk (is the virus dangerous). When I was in the military, and the goal was to have soldiers mission-ready, it made sense to vaccinate every service member and their families for national security reasons. With individualized vaccination discussions, we may not meet the rates that get us paid as physicians depending on the populations that we serve or the resources that we have available. Patient and provider political affiliation also has a bias towards vaccination rates, which is a can of worms that no one wants to open.

Over time, through the scientific method and recognition of our own biases, we hope to promote preventive services that are truly evidence-based and individualized for our patients. I am reassured that as the Measles outbreak emerged, a previously anti-vaccine political figure has decided that the MMR vaccine is the best defense against Measles. I hope that over time, trust can be regained so that our profession can best serve the population.

Please feel free to contact us at RevHealthDoc@gmail.com with any questions or comments.

Full List-

April asks us to focus on Alcohol, Irritable Bowel Syndrome, Medicaid, National Autism, Cancer Control, Donate Life, Facial Protection, Interprofessional Healthcare, Minority Health, Sarcoidosis, Occupational Therapy, Oral Cancer, Parkinsons, Sexual Assault and Prevention, STI, Stress, Testicular Cancer, and Child Abuse Prevention. There are also weeks of focused awareness on Public Health, Oral, Head, and Neck Cancer, Pediatric Transplant, Pediatric Sepsis, National Infertility, Immunization, Every Kid Healthy, Patient Experience, and Infant Immunization Week. There are also days that hone our focus on specific topics including Autism, Health, Youth HIV and AIDS, Prescription Drug Take Back, Healthcare Decisions, Hemophilia, Meningitis, DNA, and Safety and Health at Work.

National Health Awareness: March 2025 Bleeding Out

In previous years, we focused on HIV/AIDS and patient safety. This month, we are focusing on bleeding disorders and how to manage emergency bleeds- on a person in front of you.

Let’s start by recognizing that our blood is amazing. Blood is a combination of plasma and cells. The blood cells include white blood cells (part of the immune system), and red blood cells (transport oxygen from our lungs to vital organs). Plasma contains water, nutrients (protein, carbohydrates, fats, and minerals), and clotting factors. The clotting (coagulation) process is annoyingly complicated and redundant with checks and balances to prevent clots (thrombi) or bleeding (hemorrhage). The image below is a depiction of the clotting cascade:

images courtesy of: https://www.orthobullets.com/

The numbering system is based on when the different factors were identified, so learning the first time is a nightmare.

The interplay between clotting and bleeding disorders depends on the imbalance of the system. Genetic conditions that lead to excessive bleeding include hemophilia A (VIII), hemophilia B (IX), Von Willebrand Disease (extrinsic pathway deficit of von Willebrand factor necessary for platelet binding), and platelet disorders. Genetic clotting conditions include Factor V Leiden, Prothrombin mutations, Hyperhomocysteinemia, Protein C deficiency, Protein S deficiency, and antithrombin deficiency to name a few. Acquired bleeding conditions include thrombopenia (low platelets) and disseminated intravascular coagulation (factors are used too quickly, leading to uncontrolled bleeding).

Medications and gene therapy developed with the knowledge and work of scientists and the funding from federal grants and pharmaceutical companies. Not a political statement here, just facts. Paying for these medications, however, is difficult as they are very expensive and are difficult to obtain approval through insurances. Detailing these medications is not the aim of today’s note. Today is about helping you stop the bleeding of someone in front of you.

The principles of bleeding management include decreasing the blood flow (tourniquets and direct pressure), triggering the clotting cascade (medications or cautery), and preventing further bleeding. The stop the bleed program has the ABC algorithm of alert (call for help), bleeding (find and control the source), and compress, which is a simple and effective approach.

In the event of an active threat (active shooter or natural disaster), there are additional considerations to ensure your own safety so you can help the person who is bleeding (the casualty). You cannot help someone if you become a casualty yourself! So, recovering the person and getting them to a safe location to tend to their wounds is essential. Your primary assessment is whether the patient is alive and whether they have life-threatening bleeding. The application of a tourniquet is necessary when life-threatening bleeding is identified. The last 20+ years in Iraq and Afghanistan demonstrated the necessity of early and effective tourniquet use to save lives. Proper application of tourniquets is not comfortable for the patient, but it is better than dying. The patient can be moved to a safe location once life-threatening bleeding is addressed.

Once the patient is in a safe location, check to make sure that the tourniquets are still effective and adjust them if needed. Complete a primary survey and address issues that can become life-threatening. The primary survey includes the ABCDEs. Airway – Look for scorch marks and trauma of the chest, neck, and mouth that could compromise breathing. Breathing – assessing rate of breathing and looking for signs of collapsed lung or obstructions of breathing. Circulation – Stop the Bleeding and assess for signs of shock. Disability – Evaluating neurological function and then assessing for head injury and intoxication. Exposure – Temperature management and managing skin (wounds, burns, and exposure to infectious materials). Basic life support is at this stage of care.

In practice, this is a quick process of tourniquet management followed by assessing the airway and breathing. As you find all of the holes, you quickly clean, pack, and compress. Covering holes in the chest with airtight material (plastic is common) so that inhalation seals the wound while exhalation allows the wound to vent. Stabilizing the neck in a head or neck injury or splinting a limb so that the bone shards don’t cause more bleeding. Checking whether the patient is acting normal vs passed out but alive vs dead vs imminently (mostly or soon to be) dead. Getting the patient in a mylar burrito once the wounds are all addressed before getting to definitive (higher level or hospital) management will keep them from developing hypothermia (but you have to be aware that hyperthermia is a risk too).

Most simple cuts in will only need compression with gauze for up to 15 minutes (for people with bleeding disorders, most require less time). Stopping the blood flow for that amount of time allows other factors of the clotting cascade to work their magic.

I hope March is treating you well and that you have a better appreciation of bleeding and clotting disorders. While the basic concepts are not difficult, they can be panic inducing in the moment. Luck favors the prepared. By reading this blog, I hope that you feel a little more prepared and are stimulated to learn more. We highly encouraged these courses for anyone who may be in situations where trauma can occur: Basic Life Support and Stop the Bleed.

March brings to our awareness specific conditions. March covers Multiple Sclerosis, Bleeding Disorders, Colon Cancer, Developmental Disabilities, Endometriosis, Kidney, Nutrition, Traumatic Brain Injury, Save Your Vision, Trisomy, and Woman and Girls HIV/AIDS Month. World kidney day, National Poison Prevention Week, National Sleep Week, Patient Safety, Brain Awareness, World Sleep, Native American HIV/AIDS Day, Drug and Alcohol Facts Week, World Tuberculosis, American Diabetes Alert, and Purple Day for Epilepsy.

Stay healthy and find happiness in the little things around you. Please feel free to reach out to us at RevHealthDoc@gmail.com for any questions or comments.

Path to Homestead: Two Years in Review

The last path to homestead entry was April 2023; so much has happened since! We moved the hydroponics to the greenhouse for improved yields as the very niche wasabi project failed when summer temperature exceeded the tolerances. A larger hügelkultur pit was dug, and produced a healthy crop of corn and squash. We processed, consumed, and (mainly!) sold pork harvests. We planted dozens of fruit trees including cherry, plum, fig, olive, and peaches to complement our apples and elderberries. The tropical greenhouse was improved with air circulation from a solar-powered fan for the citrus trees (lemon, lime, yuzu, and orange). This greenhouse also kept raspberries producing all year round.

This blog is a never-ending renaissance of sorts and is heavily influenced by my scientific training and philosophy of stoicism. Living every day as though it is the last, we embrace the chaotic world as it is; with courage, moderation, justice, and temperance. Learning from the past, making educated guesses for the future, assessing that prediction as new evidence becomes available, then refining our model of the world to better fit the reality we experience. I see this model as a vaccine against ignorance and outside controls.

Failures, surprise successes, and learning points –

  1. Pigs – The pigs were very easy to cultivate, feed, and sell. They did a great job tilling the land and introducing organic material to the soil. They are also escape artists and are destructive. From a marketing perspective, the average family in this area wants bacon and a quarter of the meat harvested. However, the local laws regarding slaughter and butchering prevent cost savings for small-scale operations. As such, the pork sold has been a net zero profit product with 5-star reviews despite our $6/pound hanging weight cost.
  2. Tropical hog panel greenhouse – The plastic used for the greenhouse tears and is likely not UV stable for long term use. It was also the target of the aforementioned destructive pork minions. The greenhouse has served the purpose for short term establishment of our tropical trees. Without the swine invasions, we will see how long this one lasts.
  3. Basement Aquaponics – Wasabi was unsuccessful in the basement so we moved the aquaponics/hydroponics to the greenhouse. The first winter in the greenhouse, the water froze in the greenhouse and the system died. Power and heaters this winter have kept the plants and system alive. Wall-based pipes allowed for more hydroponic grow spaces, but obstructions led to overflowing and leaking. Keeping the flow going without overflowing the system was necessary so we modified the plastic cups to be deeper in the system while regulating the flow from the water pump. This seems to have fixed the issue and we have been growing lettuce all winter.
  4. Hügelkultur – Burying logs, covering them with compost, mulch, and cardboard before backfilling them with native soil seemed like a great idea. The first iteration was lackluster as the native soil is clay. The only plants that thrived were those that were able to survive the clay and get their roots down to the nutrient-rich layer. We adapted and mixed in topsoil to the clay as well as mulch which allowed the root systems to penetrate easier while maintaining the water balance throughout the growing season. A larger hügelkultur inspired growing plot was successful last year for growing corn and squash, we didn’t have to water which was nice.
  5. Trees – Apples were planted in abundance before we arrived and continue to produce more than we can eat. The pigs benefited from this abundance as did our pork buyers (apple-finished pork is delicious). We purchased a small grinder and press to make cider. We peeled, sliced, and dried apples for future snacks. The peels were saved to make apple cider which failed as it fermented into vinegar, so we embraced the product and made apple cider vinegar. Our apples mature at different times throughout September and October, but we lack variety of fruit selection. We had already started citrus trees but decided to start peach, plum, fig, olives, and cherries on the property.

Adjustments going forward –

  1. We are downsizing the drove of pigs and transitioning to an agriculture focus. A single pig is sufficient to feed a family for the year, we realized we do not eat that much pork. Male pigs have boar taint, and thus are not desirable for their meat. The single pig in the spring can be fed with our scraps and leftover agricultural products through the summer and fall. Processing a pig at home for personal use is laborious, but I have become efficient at it throughout this past year. The late-fall-to-early-winter processing also allows for less risk for pests and more time to process compared to warmer months. Also, a single pig is much less likely to escape and damage the other projects or gardens.
  2. Greenhouses will be used to start vegetables this late winter so that they are able to be planted earlier. In the spring and summer, we will grow our peppers and heat-loving plants with a combination of planters and hydroponics.
  3. Hydroponics usually requires liquid nutrients to feed the plants. Though I don’t intend to have fish in the greenhouse anytime soon, aquaponics is the classic solution to creating nutrients from waste. I will be experimenting with compost tea and old Korean fertilizer techniques (letting weeds and scraps rot in a vat of water to extract the nutrients) to provide the nutrients to the system and to keep the nitrifying bacteria active. Introducing weeds and scraps directly to the system is not recommended as it clogs the pipes; it is better to take the tea or nutrient-rich water and introduce it directly into the system.
  4. Hügelkultur plots worked well and we will be expanding this over the next year to 4 plots. The plan will be to rotate from root to leaf to legume to fruit and back to root. Around these plots, I planted trees on the north side. The goal is to have an abundance of fruits and vegetables so that we can establish a “U-Pick” field to support our business side of the farm.
  5. Fruit trees were planted and mulched in the fall. As we expand the hügelkultur, the northern sides will be populated with fruit trees. Cherry, fig, plum, peach, and olives have been planted so far. Additionally, I am working with the conservation society and received some free Douglas Fir and cedar saplings that I were planted along the creek to help with erosion mitigation, water management, habitat conservation, and future lumber should it be desired.

This is not an exhaustive list of the work done and planned, but highlights our learned points and the adjustments we made to reach our goal of sustainable agriculture (as well as profitable business practices!). We are still in the investment phase, and it has taken years to reach this moment. The work to do all this is not easy but has brought value to my life in the way of humility (of my capabilities) and respect for farmers (and my community). It has heightened my understanding of the mutual dependence of our society.

Stoics embrace courage, moderation, justice, and temperance. I reflect on this daily as I observe the farm as well as the larger world. Courage is not destroying and bullying to get our way, it is having the character and personal fortitude to say no to injustice and set examples for others, even at personal cost and suffering. Moderation is not being a billionaire at the expense of others. Justice must be equally applied to the population and ourselves; a just law is equitable, equally applicable to and enforced for all citizens regardless of status. Temperance is self-control and not being impulsive; allowing ourselves time to have a healthy response that we can stand behind later.

I know that my friends and I enjoy writing this blog and look forward to resuming the work. Please feel free to reach out to us at RevHealthDoc@gmail.com for any questions or comments.