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The end comes from the beginning

Being board certified in Internal Medicine and Pediatrics and working in a full spectrum primary care practice I get to see all types of people every day. Yesterday, for instance, I took care of a two week old and then went across the hall to care for a 99 year old. I absolutely love that part of my job.

That age difference also allows for me to gain a unique perspective on the choices we all have to make. I literally will walk out of one room having told a middle aged woman she has lung cancer to the next room only to find out a teenage girl had her first cigarette recently. I’ll counsel a diabetic on starting insulin then go meet a sixth grader who is 85lbs overweight.

When you can see the end of every new beginning it impresses upon me the urgent need to change our destiny. We must learn to choose differently and to choose wiser.

Watch this video and see what I mean. I warn you though it doesn’t pull any punches. I have seen a patient at every stage portrayed in that man’s life even the last one. At each stage we can choose differently and avoid the ending.

Come see us and learn about our wellness program and our nutritional counseling. This doesn’t have to be your destiny or the destiny of your child.

How does this happen?


Cabbage and beef stew

cabbage soup


  • 1 lb. ground beef 
  • 1/2 teaspoon garlic salt
  • 1/4 teaspoongarlic powder
  • 1/4 teaspoonblack pepper
  • 3 clovesgarlic, finely chopped
  • 1/4 cup chopped onion
  • 2 stalks celery, chopped
  • 1 (8 ounce) can kidney beans, un-drained
  • 1/2 head cabbage, chopped
  • 1 (28 ounce) can diced tomatoes, liquid reserved
  • 2-3  cups of water (to desired consistency)
  • 4 beef bouillon cubes
  • chopped fresh parsley (, to garnish)
  • 2 tbsp. dried marjoram


  1. In large pot or dutch oven, brown beef and onion.
  2. Add all ingredients except parsley.
  3. Bring to boil.
  4. Reduce heat and simmer, covered, for 1 hour.
  5. You may add extra water if you like a thinner soup.
  6. Garnish with parsley to serve.
  • Recipe modified and taken from:

Zucchini Noodles with Lemon-Garlic Spicy Shrimp

Zoodles with Spicy Shrimp

Zucchini Noodles with Lemon-Garlic Spicy Shrimp
Serves: 2
  • 1½ teaspoons olive oil
  • Pinch crushed red pepper flakes
  • 4 oz peeled and deveined shrimp
  • 2 cloves garlic, sliced thin and divided
  • 1 medium zucchini, spiralized
  • pinch salt and fresh black pepper
  • ¼ lemon
  • ¼ cup halved grape tomatoes
  1. Heat a medium nonstick skillet over medium-high heat.
  2. Add 1 teaspoon of the oil and crush red pepper flakes, add the shrimp and season with pinch salt and pepper; cook 2 to 3 minutes.
  3. Add half of the garlic and continue cooking 1 more minute, or until the shrimp is cooked through and opaque.
  4. Set aside on a dish
  5. Add the remaining ½ teaspoon oil and garlic to the pan, cook 30 seconds then add the zucchini noodles and cook 1½ minutes.
  6. Add the shrimp and tomatoes to the pan and squeeze the lemon over the dish.
  7. Remove from heat and serve
This recipe was SO easy and delicious!!
We prepared ours with 2 zucchini instead of one and only one clove of garlic for some extra "noodle" with more focus on lemon instead of garlic.

This is a great, light dinner for two!


Exertional Headaches

“Pretty much every time I’m done with soccer practice I have a headache.”  Sam, a 20 year old college soccer player, had finally decided it was time to get this problem checked out.  “And usually the harder and hotter the practice the more intense the pain.  Sometimes it makes me a little sick at my stomach and it usually hangs on for several hours.”

Or there is the thirty something man whose concern overcame his feelings of awkwardness: “So, lately when I’m getting intimate with my wife, at some point, bam!, my head feels like it explodes… makes it kind of hard to stay interested if you know what I mean.”

These kind of exertional headaches are not a new medical issue.  Around 450 BC the famous ancient physician, Hippocrates, wrote, “One should be able to recognize those who have headaches from gymnastic exercises or running or walking or hunting or any other reasonable labor or from immoderate venery [sexual indulgence]”.

The first big job of sorting through these kind of headaches is dividing them between those that are a painful, but not dangerous, nuisance, and those that have some other serious cause behind them such as a brain tumor, aneurysm, or other significant abnormality.  The former are called primary exertional headaches (PEH) and about 90% of exertional headaches fall into this category.

To make this distinction between PEH and those that are called secondary exertional headaches (SEH) where there is an underlying abnormality, some kind of brain imaging, such as an MRI, is usually needed.  PEH is more likely to occur in hot weather or at high altitude, or if alcohol or caffeine have been consumed prior to or during exercise.  The good news is that PEH tends to stop occurring after three to six months.  Also, sometimes a change in exercise regimen or treatment can help prevent PEH.

There is yet another type of exertional headache – migraine triggered by exertion.  These occur in individuals who have migraines and find that there typical migraines are sometimes triggered by exercise or sex.

Added together, how common are these exercise-related headaches.  Estimates vary from a few percent to a study that indicated that 35% of a large test group experienced exercise-induced headaches at some time. Of course if someone has had previous concussions, the incidence of exertional headaches is even higher.  In one study 96% of post-concussion football players had exertional headaches.

What does a typical exertional headache feel like?  They are typically felt on both sides of the head, are throbbing or pulsatile in quality, and can last anywhere from five minutes to 48 hours after arising during or after physical exercise.  Triggers can include exercise, cough, sneeze, straining at stool, or having sex.

In PEH, preventive meds such as the anti-inflammitants naproxen and indomethacin, or beta blockers such as propranolol can sometimes greatly reduce the frequency and intensity of PEH’s.

So the bottom line is, if you get significant headaches when you exercise, get it checked out.  Up to one in ten may turn out to have a significant underlying cause.  And even the others may be worth treating or preventing to keep you from needlessly limiting your exercise and marital venery.