Dr. Joel Keenan, MD

09/30/2022

Finding a Cat in the Gutter: Preventing our leading cause of death -- heart disease.

What do Sean Connery, Humphrey Bogart, the battle for Guadalcanal, the FBI Hostage Rescue Team, 8 dead congressmen, 9 dead senators, the 1960's and the Flintstones have to do with heart disease? In this funny informative 45 minute talk, I'll explain, and will show you how we can all avoid our leading cause of death.

Here's the link -- I hope you enjoy the show!

https://youtu.be/4y740wGPWUI

03/08/2021

I just sent this email to my patients; I hope you find it helpful!

Hi folks,

You just finished a good healthy dinner. You feel good. But you also want dessert. You want something sweet. Now what? Break open a box of cookies? Cheesecake? Ben & Jerry’s?

You don’t need to go there! We’ve got a better idea that tastes good and is good for you!

I’ll tell you about it below.

I was reading about cherries – bing cherries (sweet) and tart cherries. Because I have a patient struggling with gout and cherries can reduce the risk for that.

Reading up on that, I found that cherries are in the vast healthy group of foods that act as antioxidants, fighting inflammation and its consequences by opposing free radicals.

Free radicals are molecules with an unpaired electron, which means they are unstable and eager to bond with other molecules.

Lots of things cause free radicals, including exercise. They are not bad unless they are out of balance with antioxidants, which neutralize them.

But if there is an imbalance between free radicals and antioxidants, then oxidative stress and chronic inflammation occur, which are implicated in diseases including cancer and atherosclerosis, the basis for heart disease.

So antioxidants are a crucial pillar in the foundation of health. Especially for us, modern humans who are exposed to lots of oxidative stress from pollution, pesticides, other chemicals, and ordinary stress, antioxidants should be part of our diet at every meal.

Fruits, vegetables and legumes of all kinds are the overwhelming excellent source of antioxidants for us. That said, take a look at the USDA’s list of the top 21 food sources of antioxidants:

1. small red beans
2. wild blueberries
3. red kidney beans
4. pinto beans
5. cultivated blueberries
6. cranberries
7. artichokes
8. blackberries
9. prunes
10.raspberries
11.strawberries
12.red delicious apples
13.Granny Smith apples
14.pecans
15.sweet cherries
16.black plums
17.russet potatoes
18.black beans
19.plums
20.gala apples
21.dark leafy greens

It’s a good reminder of some foods so good for us that we might overlook. When’s the last time you had a plum, or an artichoke, or a bing cherry?

Which brings me to our question: What can we have for dessert that tastes great and is good for us?

Heidi showed me a jar of Eden Foods organic cherry butter, made of tart Montmorency cherries. It’s like a paste. You can put it on toast, bagels, pancakes, crepes, waffles, baked goods – any place you’d use jelly, you can use this instead.

You can get organic cherry butter at www.vitacost.com, or at your local health food store.

So: Want something sweet and healthy after dinner? Try organic cherry butter on a rice cake or a whole grain cracker! Or mix some with plain yogurt. Or for breakfast add it to oatmeal. Or for lunch add several tablespoons to a can of baked beans. You’ll love it.

And while you’re eating your treat loaded with antioxidants, you can think: I’m not cheating, or hurting myself. I’m getting healthier. Because you are.

All the best,
Joel Keenan, MD

Click here to review Dr. Keenan on google.com

Buy discount vitamins, supplements, health foods, beauty products & more. Vitacost.com is your place for healthy living & eating!

01/23/2021

Hi folks,

Yesterday Dr. Jennifer Cutts, York Hospital’s interim CEO, sent an excellent, detailed email to hospital staff describing plans for Covid vaccinations. I’ve copied that below, and want to highlight its most important point:

Maine residents aged 70 and older should go to the hospital’s website at noon on Tuesdays, to check for availability for a vaccine clinic held the following Saturday in Kittery. Here is the link for the website: https://www.yorkhospital.com/vaccines/.

Please take a couple of minutes to read Dr. Cutts’ email below; it’s clear and so informative.

All the best,

Joel Keenan, MD

Good afternoon,



We understand that our community is eagerly awaiting information about the Covid-19 vaccine and wanted to provide you with some FAQs on vaccine availability. Thank you in advance for your patience as we stand up this long-awaited and critically important community service.



Where are we in the vaccine roll out process right now?

· Throughout December and January, the State of Maine has been focusing on vaccinating people in Category 1a – defined as healthcare workers, residents and staff of long-term care facilities, public safety personnel, and Covid-19 Response personnel.

· York Hospital has participated by offering vaccine to our hospital Caregivers, as well as independent healthcare workers and public safety personnel. We have vaccinated 85% of our employed Caregivers so far, which is a terrific response, and bodes well for the future safety of our Caregivers and patients.

· Maine has now indicated that we may begin to vaccinate people in Category 1b, starting with Mainers age 70 and older. Once more vaccine becomes available, and once advised by the State, we will expand to other categories of residents in Category 1b (including adults with high-risk medical conditions and certain critical front line workers).



Where can my patients get their vaccines?

· In general, Maine has identified 5 different types of places for residents to obtain vaccines – hospitals, federally-qualified health centers, retail establishments such as drug stores, large employers, and community-based clinics.

· In York County, there will be a large community vaccine clinic in Sanford, that will be able to vaccinate 600-1000 patients per day. A similar large clinic is planned for Scarborough.

· York Hospital is going to offer a vaccine clinic tomorrow, Saturday, January 23, at our Kittery campus.

· We are planning to offer Saturday vaccine clinics for the next few weeks, subject to vaccine availability.

· Our goal is to partner with our community to offer daily vaccine clinics in a suitable space, once more vaccine is available. Intense planning is underway.



All of my patients are asking me about getting vaccinated. How can I help them get an appointment?

· Community information and appointments at York Hospital are available online:

https://www.yorkhospital.com/vaccines/



All of the appointments are booked. How can I get my patient or loved one on a wait list?

· We are not offering a wait list at this time. All appointments are offered on a first come, first served basis.



How often should I be checking the website to see if appointments become available?

· We receive our weekly vaccine shipments on Mondays. The vaccine comes with a sensor that alerts us to any temperature issues in transit. Once we receive our doses and confirm them safe to use, we will plan to post new appointment times on our online booking platform on Tuesdays at noon, for the following Saturday clinic.



Many of my patients live in New Hampshire. Can they sign up to receive vaccine from York Hospital?

· No. At this time, and at the State of Maine’s direction, the community 1b vaccine we have is reserved for Maine residents.



How much vaccine is available?

· We are expecting about 300 doses per week for the next few weeks. This is subject to change depending on how much vaccine the federal government sends to our state.



When will more vaccine become available?

· It is not yet clear. On a weekly basis, the federal government notifies states as to how much vaccine they will receive, and then the State of Maine determines how much to send to each site.

· So far, there are only two vaccines available – Pfizer and Moderna. Once other manufacturers’ vaccines are approved, we expect more vaccine to be available for our community.

· It is probably safe to assume that supply will be limited until at least April.



Please let us know what additional information you need, and we will do our best to provide you with answers.



With gratitude and best wishes for a safe and healthy weekend,

Jenny

Welcome to York Hospital! We are committed to providing exceptional care to our patients and their families throughout all of southern Maine.

01/19/2021

Hi folks,



Dr. Shah’s Maine CDC update just ended. Here’s the latest:



Maine residents 70 and older can begin registering for Covid vaccination now.



But at the moment (325 pm Tuesday), openings for registration are available only in Presque Isle, about 5 hours by car from York. That availability will change, day by day, as more vaccine arrives in Maine.



Please check daily one of the options I’ve listed below, to get registered for your vaccine.



MaineHealth offers several options:



Call 877-780-7545. I suggest you use this option only if you don’t have internet access or cell phone access, for texting.


Text that same number, 877-780-7545, with this message: “MaineHealth”. You’ll receive a link you can follow on your phone, to check daily for appointments at various facilities.




Go to this website, and check it every day for new appointment openings:
https://www.mainehealth.org/Coronavirus-COVID-19/Vaccine



Northern Light Health offers vaccinations at multiple sites in central and northern Maine; right now there are slots open only in Presque Isle. Click here if you’d like to take a long drive (I don’t recommend that. I think adequate supply will be nearby soon):



https://covid.northernlighthealth.org/publicvaccine



Maine CDC will next expand eligibility to those under 70; I will keep you posted when that happens.



All the best,



Joel Keenan, MD

01/16/2021

I sent this Covid vaccine update to my patients this afternoon; I hope you find it helpful.

Hi folks,

On this cold gray January weekend, Heidi and I hope you’re warm and well. Here’s a vaccine update.

The gist: Maine CDC will announce this week preliminary details about how the vast majority of my practice – people over 65 and those under 65 with various medical conditions – can get vaccinated, beginning about February 1. I’ll keep you posted. Most of my patients who are New Hampshire residents can register for the vaccine beginning next week; details below. And, Florida is a free-for-all. I have a suggestion below about that, too.

OK, details:

As you know, the vaccine rollout has occurred slower than expected. The president and his HHS Secretary, Alex Azar, blame the states: “The federal government has distributed the vaccines to the states. Now it is up to the states to administer. Get moving!” And, “Some states are very slow to inoculate recipients despite successful and very large scale distribution by the Federal Government” [sic], and “We have too much vaccine sitting in freezers in hospitals with hospitals not using it.”

At briefings Wednesday and Friday, Maine CDC Director Navir Shah flatly disputed those statements.

For each week of the vaccine rollout, Dr. Shah said, Maine has received less vaccine than promised, with negligible increases in doses, week over week. Virtually all doses allotted have been administered. There is no backlog in Maine hospitals.

Further, the federal government’s recent decision to release all available vaccines, rather than hold some in abeyance for second doses, has not yielded an increase in available supply for the states.

That, Dr. Shah said at yesterday’s briefing, is because the federal government had already been drawing from the second dose reserve supply for several days.

Compared with other states, Maine remains efficient at vaccine administration, as does New Hampshire. That matters because the federal government allots more doses to states that are more efficient.

My own view, for what it’s worth: Nobody is at fault for slow vaccine administration. We have more people than doses; it takes time to produce them. We have to wait.

But not for long. The vaccine administration criteria changed last week, and with it the projected schedule.

Here’s where we stand in Maine with recent federal and state revisions:

Phase 1a, vaccinating health care workers, finishes by the the end of this month.

Phase 1b, beginning by February 1 and as soon as this coming week, now includes those 65 and older and those under 65 with medical problems that place them at higher risk for complications with a Covid infection.

There is some ambiguity about those thresholds for phase 1b:

1. The age cutoff is reported variously as 65 or 70. For example, Governor Mills called the threshold 65 and 70 in the same press conference given Wednesday. And the Maine CDC website describes 1b this way: “People aged 65 and older: Given the limited number of vaccines, people 70 and older will be vaccinated first…Maine will then move to residents aged 65 to 69.”

2. The medical complications allowing vaccination under age 65 are reported in two lists, one noting firm evidence supporting its list, the other noting less firm evidence. It’s not clear whether both lists apply to phase 1b.

My advice about these ambiguities: Don’t worry. The majority of my practice fall in the 1b category. That means I expect most of you will be vaccinated by April 1, when phase 1b is projected to finish.

Basic questions about phase 1b administration remain: Where will doses be distributed -- to pharmacies or to hospitals? Who will administer them? How will registration occur?

I expect answers to these questions and others in the next few days. I will keep you posted.

Following phase 1b comes 1c, when other essential workers, including teachers, are vaccinated; and then in May or June comes phase 2, when healthy people under 65 are eligible.

In his briefing yesterday, Dr. Shah noted we may have higher than expected vaccine production, which would shift all these projections favorably; we’ll see.

New Hampshire redefined phase 1b as Maine did. So most of my patients living in New Hampshire – over 65 or under 65 with various medical conditions – can register for vaccination on a website created for that purpose, beginning Friday, January 22. Vaccinations for that group will begin 4 days later, on the 26th.

Here is the link for that website: https://nh.gov/covid19

Meanwhile, Florida essentially merged phases 1a with 1b, permitting immediate vaccination of those 65 and older concurrent with healthcare worker vaccinations. Given the vast imbalance of supply and demand, the effect has been the equivalent of throwing vaccines off the back of a pickup truck while the driver shouts “Come and get it!”

Publix pharmacy has partnered with the Florida Department of Health to administer vaccines there. If you are spending the winter in Florida, please check this website daily, to register for vaccination when it’s available near you:
https://www.publix.com/covid-vaccine?utm_source=vanity&utm_medium=direct&utm_term=covidvaccine&utm_campaign=PCN19449

All this may be more than you wanted to know. I wanted to get into the weeds this morning because so many of you have called or emailed for details.

Ironically, we are at the pandemic’s peak right now. Dr. Shah noted yesterday that of all the hospitalizations caused by Covid so far, 20% of them have occurred in the past month. This is a dangerous time.

Around the holidays I’ve thought about my parents. Maybe like yours, they lived through the depression and World War 2. The older I get, the more impressed I am by how quietly they and their peers lived their lives. How graceful they were. How inured to adversity they had become.

As the finish line comes dimly into view, I hope we draw sustenance from their example, and follow their lead.

All the best,

Joel Keenan, MD

All Information on the Coronavirus Covid-19 in New Hampshire

01/12/2021

I sent this vaccine update to my patients last night; hope you find it helpful.

Hi folks,

I’ve had several calls and emails asking about when and how to get covid vaccines.

I’ve been in close and regular touch with the York Hospital staff who coordinate with Maine CDC, the group responsible for distributing vaccines received from the federal government.

We’re now in phase 1a of vaccine distribution in Maine, focusing on health care workers and nursing home and assisted living residents. That group should complete both doses of the vaccine this month. (I had my first dose a couple of weeks ago and will receive my second on the 20th.)

Phase 1b vaccinates those over 75 and frontline essential workers such as teachers, police, firefighters, other first responders and grocery store staff. That phase will likely begin in Maine near the end of this month or early next month.

Phase 1c, which may be a few months away, vaccinates those 65-75 and those under 65 with comorbid medical conditions putting them at higher risk for complications with infection.

Finally, phase 2 vaccinates everyone else, which may not happen until this summer.

New Hampshire and Florida, the other two states where most of my patients live right now, have similar rollout plans.

Several factors explain the slow administration of vaccines. Among them, states have not received enough doses from the federal government. And states lack the capacity to administer all the doses available at once.

But I should note Maine’s (superb) CDC director, Dr. Nirav Shah, said today Maine’s delivery of vaccines has been excellent, between 82-93% of all available doses having been administered, so far. You can view Dr. Shah's updates 3 times a week on Maine public television or radio or by going to www.mainepublic.org.

Each state has been graded on its efficiency at using vaccine doses allotted to it. By that measure, Maine and New Hampshire do well, ranked 8th and 9th nationally. Florida has struggled, in the middle of the pack.

Five days ago, the federal government allotted funds to help states administer vaccinations. That will help, but not right away.

And the incoming Biden administration signaled it will focus on delivering all available vaccines for first doses, anticipating production of second doses to accommodate the inevitable demand for them. That may shorten the timeline above.

So where does this leave you?

Depending on your age, living situation and medical history, you’ve received your vaccine, or you’ll get vaccinated next month, or this spring, or at the latest, this summer.

As soon as a vaccine is available for you, I will tell you. I will keep in close touch with you about where, when and how that will happen.
I know how important this is. I share your frustration: Finally, a solution is here – but not yet.

Please know: We will be careful. We will draw on our last ounces of patience. And we will get this done.

All the best,

Joel Keenan, MD

Maine's premier, independent public media resource.

01/02/2021

Here's an email about nutrition I sent my patients; I hope you find it helpful!

Hi folks,

Describing a speech by President Carter in 1980, Kirk Scharfenberg, a Boston Globe editor, wrote one of the most famous headlines in American history: “Mush from the Wimp.”

Scharfenberg could have been talking about the 2020 dietary guidelines for Americans published last month by the Department of Agriculture.

The guidelines, updated every five years, are supposed to offer evidence based recommendations for a healthy diet.

Instead, we got advice like this, about eating meat:

“Most intake of meats and poultry should be from fresh, frozen, or canned, and in lean forms (e.g., chicken breast or ground turkey) versus processed meats (e.g., hot dogs, sausages, ham, luncheon meats).”

Hot dogs, sausages, ham and luncheon meats – processed meats – cause heart disease and cancer. They are not safe to eat, at all.

And the guidelines said this, about eating added sugar:

“A healthy dietary pattern limits added sugars to less than 10 percent of calories per day. Added sugars can help with preservation; contribute to functional attributes such as viscosity, texture, body, color, and browning capability, and/or help improve the palatability of some nutrient-dense foods.”

If you drank a can of Coke every day, you could meet those guidelines. And you would almost certainly join 2/3 of Americans who are overweight or over 1/3 who are obese, putting you at increased risk for heart disease, diabetes and cancer.

Among advanced developed nations, the United States leads the world in overweight and obesity. There is no value to added sugar in our diet, or to processed meats.

So what informs these recommendations from our government?

The meat and dairy industry fund research that supports government dietary recommendations. In 2017 a major journal, the Lancet, published a large study about diet called PURE. It argued that total fat intake did not cause heart disease, compared with carbohydrate intake.

But the study did not account for the quality of carbohydates consumed. We know refined and processed carbohydrates, and added sugar, cause atherosclerosis leading to heart disease. If you compare fat to those carbohydrates then sure, fat will look pretty good by comparison.

But if you compare fat to the complex carbohydates found in vegetables, or even the simpler carbohydrates found in fruit, there is no contest: fruits and vegetables are far better for us than fat.

Yet studies like PURE inform comments like this one, found in UpToDate, an online medical journal used by many physicians (including me) to help guide their practice:

“Intake of total fat was not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.”

That inference comes from a poorly designed study. Better evidence supports making plants – all kinds of fruits, vegetables, and legumes – the heart of our diet.

Want a good example of something you can try that tastes great, is easy to make and is so good for you? Amie Valpone, whose website is The Healthy Apple!, came up with this (scroll down to see a photo of this dish):


Green Bean Buddha Bowl with Tahini Drizzle
Servings
4
Ingredients
 4 baked sweet potatoes
 1 head Cauliflower cut into small florets
 sea salt and pepper
 2 tbsp Avocado Oil divided
 1 cup green beans cut into 1 inch pieces
 1 cup red cabbage
 1 head curly kale or 2 cups baby spinach
 2 honey crisp apples thinly sliced
 2 tbsp warm tahini
 1 large Lemon juice only
 1 tsp Lemon Zest
 1 tsp Fresh Parsley finely chopped
Servings:
Units:
• Course Salads & Sides
Instructions
1. Preheat the oven to 400 degrees F.
2. Pierce the potatoes with a fork to create small holes. Prepare the sweet potatoes on a rimmed baking sheet and set aside.
3. Prepare the cauliflower florets on a separate rimmed baking sheet; drizzle with 1 Tbsp. of the oil, salt and pepper.
4. Roast the potatoes and cauliflower for 30-40 minutes or until very tender. Remove from the oven; set aside to cool then set aside. Cut the sweet potatoes into ½ inch-1 inch chunks.
5. Meanwhile, steam the green beans on the stove top.
6. In a large bowl, massage the kale with the remaining 1 Tbsp. oil until the leaves are tender and dark green.
7. In a large bowl, combine the potatoes, cauliflower, green beans, cabbage, kale and apples. Drizzle with the tahini and lemon juice. Garnish with the lemon zest and parsley and season to taste with salt and pepper. Serve.

Hope you try it; hope you like it!

All the best,

Joel Keenan, MD

12/25/2020

Here's an email I sent my patients this morning; I hope you find it helpful!

Hi folks,

Merry Christmas, happy Chanukah and happy holidays to you and all of yours!

Yesterday the York Hospital Walk-In Clinic administered Covid vaccines all day. Matt Bennett had helped organize it. Mary Leisentritt, with others, gave the shots, including mine. I sat down for 15 minutes after getting the vaccine waiting for side effects. (None. But the next day I have a sore arm. Use your nondominant arm for your vaccine.)

As I waited, Dr. Jennie Cutts, the hospital CEO, scheduled my second dose, a few weeks from now. Was she doing this all day on Christmas Eve, I asked? Yes. If she asked others to work that day, she should too, she said.

How’s that for leadership?

I spoke with Matt and with Dr. Cutts about when YOU can get vaccinated. They both told me they expect all the doses allocated for hospital staff will be used; that they are in daily contact with Maine CDC about when the next batch will be delivered; that they don’t yet have a definite date for that; and that they will keep us informed by email. As soon as they know, we will, too.

As you may know, the Pfizer vaccine requires extremely cold storage, complicating its delivery to vaccination sites. The Moderna vaccine, which we use, doesn’t face that limitation. I hope that means we can expect prompt delivery of the next batch. In any case, I’ll keep you apprised.

I had worried all year that I might see a sick patient with Covid, get infected, then see you, and infect you inadvertently. I’m grateful that did not happen, and that now vaccinated, the risk of that happening falls dramatically. But we’ll continue the precautions we have in place until all of you are vaccinated.

Meanwhile, Heidi and I just finished our first year connected with MDVIP. We notice two big changes: We have far more time, and a context – your annual two part wellness evaluation that most of you have done – to focus on food, on nutrition, to promote your health and to help solve the challenges you face.

I think nutrition is an underrated and crucial part of preventing and solving medical problems. I have spent part of this year working toward nutrition board certification, and I’ll keep you posted on my progress.

And we just have more time for you, as things come up, whenever they come up. I’m so glad I don’t have to watch the clock when we meet or talk on the phone. We hope you find that helpful.

Heidi and I will spend the next week out of the office. But please know we’ll check messages continuously and get back to you the same day you call. And as always, if you need me right away, you have my cell. Don’t hesitate, please.

With 60 mph wind gusts coming in today, we’ll spend Christmas at home. Instead of visiting some of you as we had planned, we’ll call to say hi.

At the end of this sad and stressful year, we hope this day finds you and yours peaceful, warm and happy. Heidi and I are so grateful for your confidence in our care. Thank you for that.

All the best,

Joel Keenan, MD

12/14/2020

Here's an email I sent my patients on December 13 with some details about the Moderna vaccine. I hope you find it helpful!

Hi folks,

We’ve had several calls about Covid vaccines: Are they safe? How can we get vaccinated? Who’s first in line? When are they available?

Here’s what we know, after speaking with York Hospital’s infection control staff:

In our area, the Moderna vaccine will be available and distributed by York Hospital to the community. At first, front line health care workers, such as ER and ICU staff in direct contact with Covid patients, will be vaccinated. Those vaccinations will likely begin this month.

The Moderna vaccine, manufactured in Portsmouth, is now pending FDA approval, likely to come this week. Administered in two doses, it’s extremely effective. Because it doesn’t require the extremely low temperature refrigeration needed for the recently approved Pfizer vaccine, York Hospital will receive the Moderna vaccine once it’s shipped.

Both vaccines are safe. You may have read about two cases of a severe (anaphylactic) reaction to the Pfizer vaccine, reported in England. In both cases, the patients involved carried Epi pens to manage allergic reactions, indicating they were at higher than normal risk for allergic reactions in general. And as you know, all medications carry a risk of adverse reactions. Disclosure of those events is part of the normal vetting process.

I don’t yet know how the vaccine will be administered; ie, whether the pharmacy staff or I will do that. I’ll let you know as soon as I do.
Initial vaccine shipments in Maine will accommodate a small fraction of our population. Yesterday’s Times reports Maine anticipates receiving about 40,000 Pfizer doses and 35,000 Moderna doses by the end of this year. Since both vaccines require two doses, that means we’ll initially vaccinate just under 40,000 people in our state of 1.3 million.

York Hospital, coordinating with Maine CDC, will determine which group of people are eligible for vaccination and when. I’ll keep in close touch with you about those details, too.

I want to have all my patients vaccinated as soon as possible, focusing first on those at highest risk: people over 65, and those with underlying respiratory or cardiac conditions, and those who are immunosuppressed. Please know: I’ll contact you as soon as I have more information, to get that done.

Meanwhile, Thanksgiving and the change in weather combined to produce over the last 2 weeks an 80% increase in the rate of infections in our state and a 50% increase in hospitalizations. York County has the highest concentration of new cases in Maine.

But we continue to maintain among the lowest per capita rates of infection nationally. The frustrating precautions we’ve all adopted still work. Just two patients in my practice have contracted Covid so far, and I’m happy to tell you they both recovered nicely. Please hang in there. We are getting through this.

Heidi and I continue managing your care as much as possible via telehealth, to minimize your risk of exposure. But some things need face to face care, and we are here for you, in the office, at home, wherever works for you.

Finally, a word about our Thanksgiving. Because Heidi came up with the great idea to see who might enjoy a brief visit from us that day, we wound up driving around and saying hello to just over a half dozen folks spending that day alone. Heidi also prepared a small bouquet of flowers for each visit. We just had a great time saying hi, out in the front yard, and catching up and talking about the good old days before masks and toilet paper shortages. It turned out to be one of the warmest Thanksgivings we’ve ever had.

We’d like to do that again, for Christmas. If you plan to spend that day alone this year, please don’t be shy. Please let us know. We’d love to stop by and say hi.

Whether we see you or not, we know – because many of you have told us – how difficult this time of year can be. So many of us have over the years lost the loved ones who had made these holidays precious. Please know we’re thinking of you and hope you’re well.

All the best,

Joel Keenan, MD