Paladin Family Practice

05/05/2026

Big news in autoimmune disease research.

A study just published in Nature found something scientists have suspected since the 1950s but could never prove.

Some autoimmune diseases may be partly driven by DNA mutations your immune cells pick up over your lifetime. Not inherited. Acquired. These mutations can knock out the natural brakes on your immune system. When the brakes fail, your body attacks itself.

Right now, most autoimmune treatments work by turning down the whole immune system. Helpful, but blunt. If this research holds up, it could open the door to precision treatments that target the broken cells and leave the healthy ones alone.
We are a long way from that being standard care. But this is the kind of science that changes direction.

https://www.sanger.ac.uk/news_item/hidden-mutations-in-immune-cells-linked-to-autoimmune-disease/

This post is for informational purposes only and does not constitute medical advice. Always consult your physician regarding your individual health concerns.

Mutations in immune cells may be the missing piece in the autoimmune disease puzzle.

04/28/2026

It’s the same old game. Doctors treat patients. No middleman. Patients are happy. Third parties see a way to get involved. They create chaos. Preach how they can fix the chaos. They jump in a…

04/27/2026

New cholesterol guidelines just came out for the first time since 2018, and there is one change in particular I want to talk about. The American Heart Association is now recommending that every adult get tested at least once in their lifetime for something called lipoprotein(a), or Lp(a). Most people have never heard of it, and almost nobody has been tested for it.

Lp(a) is a type of lipoprotein, which is basically a particle that carries cholesterol through your bloodstream. It is similar to LDL (the one most people know as "bad cholesterol"), but it has an extra protein attached to it called apolipoprotein(a). That extra protein is what makes Lp(a) different and, honestly, more concerning. It does three things that regular LDL does not do as aggressively: it promotes plaque buildup in your artery walls, it drives inflammation inside those plaques, and it interferes with your body's ability to break down blood clots. So it is not just depositing cholesterol. It is making your arteries more inflamed and more clot-prone at the same time.
Here is the part that surprises most people. Your Lp(a) level is about 90% genetically determined. Diet and exercise do not really move it. You either have high levels or you do not, and you have probably had whatever level you have your entire life without knowing it. About 1 in 5 people worldwide have elevated Lp(a), and if your level is above 125 nmol/L (or about 50 mg/dL), your cardiovascular risk starts to climb. Above 250 nmol/L, that risk roughly doubles.

The other important thing is that a standard cholesterol panel does not include Lp(a). Your doctor has to order it separately. So you could have perfect looking cholesterol numbers on a routine panel and still be walking around with a significant hidden risk factor.

Practical takeaway: if you have never had your Lp(a) checked, it may be worth asking your doctor whether it makes sense for you. It is a simple blood test, it only needs to be done once in your lifetime since the level stays relatively stable, and it could change how you think about your heart health going forward. If your level does come back high, it is also worth mentioning to your parents, siblings, and kids, since they may share the same genetic risk.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Lp(a) is a genetic independent risk factor for heart disease. Knowing your Lp(a) levels can help you reduce your risk of heart disease for you or someone you love.

04/23/2026

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

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

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

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

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

04/20/2026

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

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

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

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

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

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

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

04/16/2026

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

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

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

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

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

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

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

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

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

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

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

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

04/14/2026

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

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

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

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

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

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

03/22/2026

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

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

03/20/2026

🌸 Happy First Day of Spring, Shenandoah Valley.

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

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

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

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

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

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

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

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

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

03/18/2026

Sick kid at 8pm. Do you:

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

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

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

03/17/2026

🍀 Happy St. Patrick's Day.

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

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

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

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

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

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

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

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

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

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

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

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

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

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