Mark J. Pamer, D.O., LLC

01/02/2026

2026 Medicare Deductibles have increased.

Medicare Part A (hospital): $1,736
Medicare Part B (outpatient care): $283
Medicare Part C (Medicare Advantage Plan): Varies per plan.
Medicare Part D (drug plan): $615
• Plan Variation: Plans can set a lower deductible or have no deductible at all.
• When it Applies: You pay 100% of drug costs until you meet your plan's deductible (or the maximum $615).
• Part of New Cap: Meeting this deductible counts toward the new $2,100 annual out-of-pocket spending limit for all covered prescriptions.

11/28/2025

Interesting finding of gut bacteria and insomnia.

We're learning more and more about how parts of our bodies are linked and working together – and now a new study reveals connections between gut bacteria and the risk of insomnia.

11/28/2025

Very interesting study on link of gut bacteria, certain low vitamin B levels, environmental toxins, and Parkison's disease.

Researchers have suspected for some time that the link between our gut and brain plays a role in the onset of Parkinson's disease.

11/22/2025

Starting our move to just 4 buildings over, from 573 to 537 NW Lake Whitney Place, Suites 103-105. We are still in our office and seeing patients. The official new opening day for new site will be in early December 2025. Until then, it's Doan's Back Pills!

11/14/2025

Why is lung cancer screening important? Because the earlier you find it, the longer you live. Lung cancer has the highest mortality but is usually caught late. Lung cancer screening has the most effectiveness compared to mammogram, colonoscopy, or prostate cancer screening, however. It requires fewer screened patients to save one life compared to the other cancers, but is the least performed cancer screening of any of them.

If you are between ages 50 and 80 and smoked within the prior 15 years or still smoke (adding up to at least 20 pack-years), ask your health care professional about low dose annual CT lung screening.

10/28/2025

We continue to celebrate Halloween week. Today was Cowboys and Indians.

09/25/2025

09/15/2025

Dr. Pamer thought he'd take up music so he played a tune but a big hook came from the side of the stage. He's back at the office seeing patients now.

07/28/2025

We don't charge a facility fee. The notion that hospital employed physicians offer to superior care to independent physicians is absolutely nonsense. In fact, no one is knocking on our exam door in 12 minutes to remind us the visit is over. We take the time needed to care for the patient.

Hospitals can charge patients hundreds of dollars in facility fees — even for routine outpatient appointments. Some residents of Florida’s Treasure Coast have had enough.

06/21/2025

A patient asked me this week if BEETROOT JUICE can help her breathe or exercise better? YES! Read on...

I wrote two versions of the answer: One for non-medical people (first) and the secondy for medical people (see lower half):

NON-MEDICAL PEOPLE
Answer: Yes, it might. Beetroot, especially in the form of beetroot juice, has been studied for its possible health benefits, especially in people with lung conditions like COPD (chronic obstructive pulmonary disease) and PAH (pulmonary arterial hypertension).
Beetroot is rich in dietary nitrate, which the body turns into nitric oxide. This helps blood vessels relax, lowers blood pressure, and helps your muscles use oxygen more efficiently. While it doesn’t directly improve pulmonary function tests (PFTs), it may help some people feel and perform better during physical activity.

What the Research Shows:
• In COPD patients:
Several studies have shown that beetroot juice can help people walk farther and feel less tired during exercise. This is likely because of better oxygen delivery and muscle performance—not because it opens the airways or changes spirometry results.

For example, one study found that drinking beetroot juice helped COPD patients walk longer during a walking test. Blood pressure also improved. However, lung function numbers (like FEV1) did not change.

• In PAH patients:
Some early research shows that beetroot juice might help people with PAH breathe more efficiently during exercise. It may reduce how fast they breathe, but it’s still unclear whether it improves how far or how long they can exercise. More research is needed.

• In healthy people:
Beetroot juice can increase nitric oxide levels, but there’s no proof it improves breathing or lung function in people without lung disease.

Bottom Line:
Beetroot juice might help people with COPD or possibly PAH improve their exercise tolerance and breathing efficiency, but it does not improve actual lung function (like FEV1 or FVC). It’s not a cure or replacement for regular treatment, but it may be a helpful addition for some patients.

My usual disclaimer: As always, talk to YOUR doctor before starting any supplement, especially if you have other health conditions or take medications.

Your friendly neighborhood phlegm slinger,
Dr. Pamer

MEDICAL VERSION FOR COLLEAGUES:
Beetroot (typically as beetroot juice) can improve exercise capacity and certain aspects of breathing in specific populations, particularly patients with chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH), but it does not directly improve lung function parameters such as FEV1 or FVC. The mechanism is primarily through dietary nitrate, which is converted to nitric oxide, leading to improved vascular function, reduced blood pressure, and enhanced skeletal muscle oxygen utilization.

In patients with COPD, randomized controlled trials have shown that beetroot juice supplementation increases exercise endurance and walking distance, likely by improving oxygen delivery and muscle efficiency, rather than by bronchodilation or direct improvement in spirometry values.[1-4]

For example, supplementation with nitrate-rich beetroot juice (12.9 mmol nitrate) acutely increased endurance shuttle walk test time and improved endothelial function in hypoxic COPD patients.[1] Similar findings were observed in longer-term studies, with improved 6-minute walk distance and blood pressure reduction.[3] However, pulmonary function tests (e.g., FEV1) were not significantly changed.[2]

In PAH, short-term supplementation increased exhaled nitric oxide and was associated with a reduction in breathing frequency during exercise, suggesting a potential benefit in ventilatory efficiency, though effects on exercise capacity were variable and require further study.[5]

In healthy individuals, beetroot juice acutely increases exhaled nitric oxide, but there is no evidence it improves baseline breathing or lung function in the absence of underlying disease.[6]

In summary, beetroot can improve exercise tolerance and some aspects of breathing efficiency in patients with COPD and possibly PAH, but it does not directly improve lung function in healthy individuals.[7]

References:

1. Pavitt MJ, Lewis A, Buttery SC, et al. Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX, a double-blind, placebo-controlled, randomised cross-over study. Thorax. 2022;77(10):968-975. doi:10.1136/thoraxjnl-2021-217147.

2. Kerley CP, James PE, McGowan A, Faul J, Cormican L. Dietary nitrate improved exercise capacity in COPD but not blood pressure or pulmonary function: a 2 week, double-blind randomised, placebo-controlled crossover trial. Int J Food Sci Nutr. 2019;70(2):222-231. doi:10.1080/09637486.2018.1492521.

3. Alasmari AM, Alsulayyim AS, Alghamdi SM, et al. Oral nitrate supplementation improves cardiovascular risk markers in COPD: ON-BC, a randomised controlled trial. Eur Respir J. 2024;63(2):2202353. doi:10.1183/13993003.02353-2022.

4. Pavitt MJ, Tanner RJ, Lewis A, et al. Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC, a multicentre, double-blind, placebo-controlled, randomised parallel group study. Thorax. 2020;75(7):547-555. doi:10.1136/thoraxjnl-2019-214278.

5. Henrohn D, Björkstrand K, Lundberg JO, et al. Effects of oral supplementation with nitrate-rich beetroot juice in patients with pulmonary arterial hypertension: results from BEET-PAH, an exploratory randomized, double-blind, placebo-controlled, crossover study. J Card Fail. 2018;24(10):640-653. doi:10.1016/j.cardfail.2018.09.010.

6. Kroll JL, Werchan CA, Rosenfield D, Ritz T. Acute ingestion of beetroot juice increases exhaled nitric oxide in healthy individuals. PLoS One. 2018;13(1):e0191030. doi:10.1371/journal.pone.0191030.

7. Chen M, Chang S, Xu Y, Guo H, Liu J. Dietary beetroot juice: effects in patients with COPD—a review. Int J Chron Obstruct Pulmon Dis. 2024;19:1755-1765. doi:10.2147/COPD.S473397.

05/11/2025

Let's dissect this. After Brian Thompson, the CEO of United Healthcare, was murdered in the street, the company started approving more claims. You might applaud United for realizing the error of its ways, right?

Enter greed.

UnitedHealth Group is now being sued by a cohort of shareholders, who claim that following the murder, the company buried a long-standing corporate directive to deny medical care, pivoting from that strategy after Thompson was killed, despite it being a core driver of profits.

If the company was no longer willing to use “the aggressive, anti-consumer tactics that it would need to achieve” its target rise in earnings, then UnitedHealth was being deceptive in sticking by its prospectus, the group argues in the lawsuit.

In April, UnitedHealth missed its earnings target. While the rising cost of care was a contributing factor, the plaintiffs believe a covert change from its policy of denying claims—often through the prior authorization process of Medicare Advantage—was a factor in the stock price failing to meet stated goals.

“As a result of defendants’ wrongful acts and omissions, and the precipitous decline in the market value of the company’s securities, plaintiff and other class members have suffered significant losses and damages,” they said.

They want United to go back to aggressively denying claims and care. They finally admitted it.

Let that sink in.

In a lawsuit, plaintiffs allege the company changed course from a long-standing policy of denying medical claims, hiding from investors its impact on profits. The insurer denies any wrongdoing and vowed to defend itself in court.

05/03/2025

I need to say this—not just as a pulmonologist, but as a parent.

The CDC just reported 216 flu-related child deaths this season. In fact, 12 children died THIS WEEK from influenza. Childhood deaths have already eclipised last year's entire flu season. In fact, that’s the highest number in 15 years—more than during the 2009 swine flu pandemic. And flu season isn’t even over yet.

This is not just a bad flu season. It’s a wake-up call.

We’re seeing more children get seriously ill and die. The simple but sad fact is: This is easily preventable. What changed? It's not the virus, it's us. Fewer parents are vaccinating their children.

Flu vaccination rates among children have dropped from 64% to just 49% in five years. That drop is heartbreaking. In 2025, children are still dying from easily preventable causes? It’s happening for a number of reasons:

1. Misinformation: Online conspiracy theories and false claims about vaccines spread doubt faster than the virus.

2. Distrust: The COVID-19 pandemic and the successful misinformation camapign from some nefarious and discredited groups left many people skeptical of public health advice.

3. Access issues: Many pediatric offices are short-staffed or no longer offer evening vaccine clinics. Many independent pediatrician offices have closed or been bought out by corporations. Reaching the front desk and making appointments at these congloerates has become harder, leading to frustrated parents.

4. Pharmacy limitations: Some pharmacies don’t vaccinate children.

5. Politics: Polarized rhetoric has made vaccines a political issue instead of a public health priority. Health decisions have become a battleground. Having people like RFK Jr., who is anti-vaccine and promotes junk science and lies, has been a disaster.

Let me be clear: The flu vaccine saves lives. It may not stop every infection, but it significantly reduces the risk of hospitalization and death. This is true in adults and children.

The season has not only been hard on children. CDC officials have described it as “highly severe,” and estimate that so far there have been at least 47 million illnesses, 610,000 hospitalizations and 26,000 deaths this season.

In a CDC analysis of nearly 5,200 adults who were hospitalized with flu this season, 95% had at least one existing health problem. But among 2,000 hospitalized children, only half had an underlying condition — including asthma and obesity. The other half had no underlying health conditions. They were healthy. Just like our own kids.

If you’ve been unsure about getting your child vaccinated, please don’t wait. Talk to your pediatrician. Ask your questions. Get the facts. Do it early in the season but get it done! Don’t let fear or misinformation make the decision for you.

We have the tools to protect our children. We just need to use them.

The good news is that flu indicators have been waning since February, and last week all 50 states were reporting low or minimal flu activity.

If this post helps even one family choose to vaccinate, it’s worth it. Please share if you feel the same.

- Dr. Pamer

Link: https://www.cdc.gov/fluview/surveillance/2025-week-17.html

Image is AI generated, not the post.