One Health Direct Primary Care

05/30/2026

Cardiovascular risk isn't one number.

The deeper workup showed:
→ Elevated Lipoprotein(a) [Lp (a)] — a genetic risk factor linked to increased risk of heart disease and stroke
→ High ApoB — reflecting a higher burden of atherogenic particles
→ Strong family history
→ Untreated hypertension

➡️This changed the entire risk conversation.

Some patients with "normal" cholesterol may still carry significant cardiovascular risk that standard screening doesn't fully capture.

❓Questions worth asking:
* Do you have a family history of early heart disease or stroke?
* Has your Lp(a) ever been checked?
* Do you know your ApoB?
* How are sleep, blood pressure, insulin resistance, and metabolic health affecting risk?

Heart disease develops over years. Earlier identification means more opportunities for prevention.

Follow for more information

05/22/2026

🙄It’s getting harder and harder to find certain doses of estradiol patches..😳

Meanwhile I’m over here wondering…When demand for testosterone replacement keeps rising in men — aging population, more diagnoses, direct-to-consumer clinics, lifestyle shifts…

Will we see the same thing happen? 👀

Hormone shortages don’t usually happen because people suddenly “want hormones.”

They happen because of:
→ Manufacturing complexity
→ Limited manufacturers
→ Supply chain disruptions
→ Increased demand outpacing production
→ Regulatory or quality control issues

Estradiol patches have had recurrent shortages partly because transdermal systems are harder to manufacture and fewer companies produce them.

As hormone optimization discussions grow for BOTH men and women… it’s a fair question:❓Are testosterone therapies immune to the same pressures?

Food for thought. 🙃

PMID: 37660750 — Drug shortages: trends, causes, and solutions.
PMID: 24603674 — Drug shortages: a complex health care crisis.

05/22/2026

🗣️Common concerns in midlife…Weight gain, fatigue, poor sleep, and feeling like your body has changed overnight.

Many women are told:
• Eat less
• Exercise more
• It’s stress
• It’s aging
• Your labs look “fine”

But symptoms deserve context.
In some patients, contributors may include:
✓ Sleep apnea
✓ Insulin resistance before diabetes develops
✓ Changes in body composition and visceral fat
✓ Perimenopause and hormonal shifts
✓ Chronic stress and poor sleep
✓ Cardiometabolic risk factors
✓ Loss of muscle mass over time

✅The workup matters. ✅Questions matter.
✅History matters.

AND…Evaluation should go beyond the scale and beyond standard screening labs when symptoms persist.

❓❓What symptom do you wish more healthcare professionals took seriously in women over 40?

➡️➡️Follow for more case-based education on perimenopause, metabolic health, heart disease prevention, and understanding the “why” behind symptoms!

PMID: 11874812, 16227462, 39076340.

05/20/2026

GLP-1 medications work. I love them! But losing weight TOO fast isn’t always the goal.

Rapid weight loss may increase risk for muscle loss, fatigue, and declining strength — especially if protein intake and resistance training are ignored.

I want my patients losing fat while preserving muscle.

If you’re on a GLP-1, ask:
✔️ Am I eating enough protein?
✔️ Am I maintaining strength?
✔️ Am I monitoring body composition instead of just scale weight?

Because long-term health > rapid weight loss.

PMID: 40151468 | 40471104 | 33485495

05/18/2026

Final update on our patient… 🩺

For treatment:
✅Rosuvastatin (Crestor) 40 mg ✅Ezetimibe (Zetia) 10 mg

PLUS:
✔️ nutrition changes
✔️ stress management
✔️ sleep optimization
✔️ blood pressure control
✔️ lifestyle changes

➡️➡️➡️Results:
LDL: 186 → 65
ApoB: elevated → 70s

❤️The biggest win was changing overall cardiovascular risk trajectory.

PMID for case series videos: 28444290; 33257928; 18997196; 30307554; 30586766; 28444290

Education only — not individual medical advice.

05/16/2026

Part III of our case series…Before treatment, we want to understand why CV risk is elevated.

That may include:
🧪 ApoB → atherogenic particle burden
🧬 Lipoprotein(a) → inherited cardiovascular risk
🔥 hs-CRP → inflammation
🩸 Fasting insulin → insulin resistance
🫀 Urine microalbumin → vascular health
😴 Sleep evaluation → untreated sleep apnea can worsen cardiovascular risk
📊 Body composition → visceral fat matters
🫀 CAC score → is plaque already present?

PMID 28444290; 33257928; 18997196; 30307554
Education only, not medical advice.

05/15/2026

An LDL of 186 is concerning...But her REAL cardiovascular risk is much bigger than one cholesterol number.

This patient also has:
➡️high blood pressure
➡️prediabetes
➡️poor sleep
➡️visceral fat
➡️chronic stress
➡️strong family history
➡️possible sleep apnea
➡️perimenopause transition

Many women in perimenopause can appear
“low risk” on standard calculators while underlying cardiovascular risk is actually increasing.

Because traditional ASCVD calculators do
NOT tully account tor:
❎Advanced cardiac labs
❎menopause transition
❎metabolic dysfunction
❎inflammatory risk

This is why advanced testing and sometimes
CAC scoring can completely change risk assessment and treatment conversations.

✅✅✅Follow along for Next video:
What labs would we order next and why?

PMID: 30379355, 33104254, 31939789

05/14/2026

Not every patient with high cholesterol is ready to start a statin.

And whether you agree with that decision or not - the conversation shouldn’t stop there.

This new case series walks through a common clinic scenario: high LDL, elevated BP, prediabetes, family history, poor sleep... and years of refusing medication….

So how do we actually evaluate her risk?
And what can patients realistically do to improve it?

We’re breaking it down step-by-step.
Follow along for Part 1: “LDL 186 — now what?”

05/13/2026

Thank you Asheville Area Chamber of Commerce and Jessica Niblack Kanupp for having me on The Asheville Rise Podcast! We had so much fun!

At The Asheville Rise, we’re honored to spotlight women whose leadership is shaping a stronger, healthier, and more connected community.This week, we’re feat...

05/05/2026

This is one of the most commonly missed causes of neuropathy in clinical practice.
A patient presents with:
• numbness
• tingling
• burning pain in the feet

And the labs come back “normal”:
-A1C normal
-B12 normal
-Thyroid normal
So what’s next?

- Most people stop there. But that’s where you can miss it.
Vitamin B6 (pyridoxine) is rarely checked - and that’s a problem.

➡️➡️Both low AND high B6 levels can cause:
• peripheral neuropathy
• burning sensations
• sensory changes (often worse at night)

✅In this case, the patient had:
Low B6 due to likely poor absorption + long-term PPI use.

When symptoms don’t match the labs...Expand the lens. Not all neuropathy is diabetes or B12 deficiency. Sometimes it’s a micronutrient gap that wasn’t checked.

Evidence (PMIDs):
PMID: 25137514
PMID: 28716455
PMID: 16320634
PMID: 14681857