Archive for September 2017

Lab appointments

We love that we’re growing and continuing to serve the needs of an expanding community. 

In order to fully meet the needs of our patient’s busy schedules, we will transition to having all lab draws scheduled by appointment only.  This allows us to prepare in advance and have the appropriate orders and equipment available. It will shorten patient wait times tremendously.  Our lab hours will remain 8am-12pm and 2-4pm Monday through Friday. 

We will continue to offer injections and vaccines on a walk in basis from 8:30am to 12pm and 2-4pm Monday through Friday. 

If you need labs drawn prior to an upcoming visit please call the office to schedule your next appointment!



The lowly prostate – in a young adult it’s a walnut-sized gland that forms part of the male reproductive system.  It sits below the bladder and wraps around the urethra, the tube through which urine exits the body.  Generally it grows with age… and there’s the problem.  Most middle-aged and elderly men come to know the prostate as a source of troublesome urinary symptoms.  They may have experiences such as standing at a public urinal slowly emptying while three teens come and go taking care of their business with firehose-like efficiency.

This common condition of non-cancerous enlargement of the prostate is called benign prostate hyperplasia or hypertrophy (BPH).  It is considered essentially a normal part of the aging process in men and is hormonally dependent on testosterone. An estimated 50% of men demonstrate BPH by age 60 and the number increases to 90% by age 85 years.  About half of these men with enlarged prostates have moderate-to-severe symptoms including urinary frequency, urgency, nocturia (awakening at night to urinate), weak urine stream, or a sensation of incomplete emptying.  The other half escape with minor versions of these symptoms.

Eventually the chronic partial obstruction of the bladder outflow can lead to complications such as urinary retention.  Here, a person may routinely fail to fully empty the bladder or may completely obstruct at some point and have to go to the ER for catheterization to get relief.  Additionally, renal insufficiency (loss of kidney function), recurrent urinary tract infections, blood in the urine and bladder stones may occur.

So the question becomes, if this is so common, when does one need to do something about it?  The answer to this is somewhat subjective – basically, when the symptoms are bothersome enough for it to be worth it to you to take a daily medicine to treat it.  There are a variety of types of BPH meds from ones that relax the grip of the prostate on the urethra to those that slowly shrink the prostate over 3-6 months to others that partially relax an overly twitchy bladder.  If meds are unsuccessful then a urologist may suggest any of a variety of procedures, with the trans-urethral resection of the prostate (TURP) being the best known.  It is not-so-affectionately known as the roto-rooter procedure by some.

It is important to realize that BPH doesn’t make you any more prone to cancer than the next person your age.  The two conditions (BPH and prostate cancer) are separate.  However they can produce some of the same symptoms, and they can both cause an elevation of the prostate blood test, PSA, which is often used for cancer screening.  Thirdly, the prostate can also become infected, often causing more of a sudden onset of urinary symptoms such as frequency and burning with urination.  This condition is called prostatitis.

All-in-all BPH is an inconvenient reminder of aging for the typical male.  But if the level of symptoms is really putting a crimp in your day (and night) and your walnut seems to have become a small orange, it may be time to talk things over with your doctor.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835


Maryville Daily Times features Dr. Jaclyn Hone and Direct Primary Care

Dr. Jaclyn Hone listens to to Lydia Pair's heart at Trinity Direct Family PracticeThe Maryville Daily Times featured an article on Trinity’s Direct Primary Care program in Maryville and the great work that Dr. Jaclyn Hone is doing there.  Check out the article below.  If you are interested in how DPC might work for you give us a call at 980-8551 in for the Maryville office and 244-1800 for the Hardin Valley office.

Direct medical care reinforces relationship between doctor, patients


The Black Dog of Depression

            “I am the most miserable man living.  If what I feel were equally distributed to the whole human family there would not be one cheerful face on the earth.  Whether I shall ever be better, I cannot tell.  I awfully forebode I shall not.  To remain as I am is impossible.  I must die or be better.”  That quote is by none other than Abraham Lincoln.  Likewise, Winston Churchill referred to his depression as his “black dog.”  Most depressed patients aren’t quite so striking in their descriptions.  They may complain of a loss of interest in things that used to seem important to them, or a general fatigue, or frequent tearfulness, or just a persistent irritability.

Depression may be the 3rd most common psychiatric disorder behind anxiety and phobias, with approximately 15 million Americans experiencing a depression each year. So, since we can all have some bad days or a period of sadness, what, from a medical perspective, defines an actual depression?  According to the most common psychiatric definition, as contained in something called DSM 5, a major depression involves: A depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period.   Overall functioning must also be impaired by the change in mood.  In addition, at least 5 of the following symptoms must be present:

  • Depressed mood
  • Decreased interest or pleasure
  • Weight change of 5% or more (up or down)
  • Sleep disturbance
  • Psychomotor agitation or retardation – consistently slowed movements or agitated movements
  • Fatigue
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death and/or suicide

As you read through that list, some of you may be seeing a description of yourself or someone you love.  Before we take a moment to look at what can be done about it, let’s first ask how does someone get here – what causes someone to get depressed?  That can be a complicated question as depression is often the result of any combination of several factors.  Everything from genetics to circumstances and how we think about those circumstances can play a role.  Sometimes chronic stress and anxiety or even physical illness or loss can trigger a depression.

The wide range of causes of depression plays into the several kinds of treatment that are employed.  Primary care doctors are sometimes called the psychiatrists of the masses since the majority of depression treated medically is carried out in primary care offices.  When seeing your primary care physician for possible depression, a number of physical contributors such as hypothyroidism , low testosterone, or medication side effects can be ruled in or out.

If these physical causes are not a significant factor and a major depression is diagnosed, several treatments can be considered.  Starting with simple approaches, regular exercise such as a brisk walk has been shown in studies to sometimes help as much as a prescription antidepressant.  Likewise, informal counsel with any mature friends or family can be helpful.  Pastoral counsel from a trusted pastor is often a further aid in working through a depression.

Beyond these helps, specific medical interventions can be considered.  Formal counsel can often provide further tools to battle depression.  Finally, prescription meds can have their place as well.  These are far from 100% effective and it can sometimes take time to find the one that is most effective for a given individual, but at times they can be enormously helpful.

Depression, as Lincoln said, can be absolutely miserable, both for the individual, and for those around them.  Ideally, it should be responded to as aggressively and directly as a heart attack, since in its own way it can be just as devastating.  So if you suspect the black dog of depression is sinking its teeth into you, get it checked out.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835