The Season of Gratitude

Thanksgiving is coming, and it’s supposed to be a day focused on gratitude.  However, your first thoughts may have instead filled you with anxiety and overwhelm.  The planning, the cleaning, the cooking, the in-laws, the travel, the overeating.  Our brains are wired for negative thinking, and this helped our ancestors survive in an unpredictable world.  Currently, most of us are fortunate enough to live in a safe environment where our daily survival is not a concern.  Instead, these patterns of negative thinking create an unpleasant reality and make us more susceptible to depression, anxiety, chronic pain, and even chronic disease.

Did you know that you can reprogram your brain with a daily gratitude practice? Gratitude makes you feel happier, improves your relationships, and makes you more productive.  It also decreases your blood pressure and your cortisol levels and improves immune function.  A 2008 UCLA fMRI study of gratitude showed increased levels of serotonin and dopamine as well as increased activity in the hypothalamus, which regulates sleep, appetite, temperature, and mood regulation.  Low levels of serotonin are associated with depression and anxiety, and low levels of dopamine are associated with obesity and addiction.  Those who practice gratitude on a regular basis, have better sleep, improved metabolism, more energy, less pain, less stress, and improved overall physical and mental health.

Choose a time each day to sit down and write out five things that you are grateful for.  These don’t have to be big things like family and health, which you might mention around the Thanksgiving table.  You can write down little things that bring you joy.  The process of searching for things that you’re grateful for, changes your brain and becomes habitual.  Do this every day during the month of November, and you will truly have something to be grateful for on Thanksgiving.

Do I Need an Antibiotic?


It’s cold and flu season, and both are caused by viruses.  Viruses cause the majority of illnesses, most of which make us feel absolutely miserable from head to toe, often with fever, body aches, weakness and fatigue.  Some of them cause vomiting and diarrhea.  Others cause runny nose, headache, sore throat, and cough.  These infections can drag on for weeks, especially if we don’t allow our bodies to rest and recover.  Unless it’s influenza, your symptoms will come on gradually over a few days and will start improving after a week.  Sometimes, after a week or two of a viral infection, a secondary bacterial infection develops, such as a sinus infection, ear infection or pneumonia.  If you have been sick for over a week, and instead of feeling gradually better, you suddenly get worse, with fever and severe pain in one ear or on one side of your face, you should see a doctor to see if you need antibiotics.  If you have a bad cough, especially if it’s difficult to breath, you should see a doctor.  If your symptoms are severe on the very first day with high fever and severe sore throat, you should see a doctor.  For cold symptoms, I recommend a cold medication containing a decongestant, such as Mucinex-D, a nasal steroid spray twice daily, such as Nasacort, and a nasal vasoconstrictor, such as Afrin, for two days only (after that, it can make your congestion worse).  I also recommend Elderberry to help your immune system fight the viral infection; even for influenza, Elderberry works as well as Tamiflu.  And don’t forget to get your annual flu shot!  Even if you still get the flu, it will not be as severe if you’ve had the flu shot.



It’s Back-to-School time, the season of busy.  Following the summer vacations, relaxation, and time home with family, we catapult ourselves into after-school activities, athletic practices and games, school projects, PTA, scouting, etc.  We wear our busy like a badge of honor.  When acquaintances ask how we are, we exclaim, “BUSY!”  We believe that this sense of overwhelm is the inevitable result of the items on our to-do lists, but is it really?  The truth is that we create a lot of unnecessary anxiety with our thoughts: “I have a MILLION things to do!”  “There’s NEVER enough time!”  “We’re gonna be late!”  The first step is realizing that you don’t actually have to DO anything.  Sure, you might not like the consequences if you stopped showing up to work, feeding your children, or paying your taxes, but it is ultimately your choice.  Once you admit that you actually WANT to do everything on your list (or at least delegate it out), you take back your power, and your stress level will fall.  And it doesn’t have to be perfect.  It’s okay to be late, to bring store-bought cookies to the PTA Bake Sale, or to throw a frozen pizza in the oven instead of cooking.  But why the heck does a doctor care if you’re busy?  When you are busy, overwhelmed, anxious and stressed, your stress hormone, cortisol, increases.  When your cortisol level is high, your blood pressure, blood sugar, and weight all increase, which puts you at increased risk of heart disease, heart attacks, strokes, and stomach ulcers.  Also, your immune function drops, making you more susceptible to infections and even to cancer.  You can still do all the things, but the frenzy is optional.  For your mental and physical health, give up the busy, doctor’s orders.

Regular vs. Diet Soda

Whether you’re at the beach, on a boat, or at a BBQ, summertime is all about sipping on sodas.  It can be hard to resist a cold, sweet, bubbly beverage on a hot day.  You’re probably already aware that soda contains a ton of sugar and that sugar can increase your risk of obesity and type 2 diabetes, but did you know that it can also increase your risk of heart disease, liver disease, depression, anxiety, ADHD and dementia?

“No problem, Doc, I’ll just have a diet soda!”  Not so fast.  In addition to the increased risks of bladder cancer, kidney disease, and heart disease associated with artificial sweeteners, they ALSO increase the risk of developing obesity and type 2 diabetes.  Our brains cannot distinguish between sugar and artificial sweeteners, so when you taste something sweet, both your dopamine and insulin levels will increase.  Dopamine is the “pleasure chemical” in the brain which promotes habit formation and can lead to addiction.  Insulin is a hormone which decreases your blood sugar by storing it as fat, and when levels are high, your body is literally programmed for weight gain.

So, how about reaching for a cold, bubbly beverage without the sweet, such as carbonated water over ice with a spritz of fresh lemon or lime?  Once you make the decision to give up soda, you really won’t miss it, and your body and brain will thank you.

Health Insurance is not actually Insurance

Honestly, I have never been a big fan of insurance.  I am not much of a gambler, and paying for insurance feels like betting on my own misfortune.  I have never purchased insurance for a cell phone or appliance.  I would rather save the money and make an effort to take care of my possessions.  I reluctantly have car insurance, home owner’s insurance, disability insurance, life insurance and health insurance.  The only insurance I have ever used is health insurance, and that’s because health insurance is not actually insurance.

Typically, insurance works by charging a large amount of people a low fee to protect against an unlikely catastrophic event, such as a house fire or a totaled vehicle.  Health insurance was previously used this way.  Patients paid their doctors directly for medical care and turned in their own insurance claims when needed.  Routine medical care was affordable for most, and doctors would often write off bills for patients in need.  Insurance was used for major surgery, hospitalizations, or cancer treatment.  Health insurance has morphed into a comprehensive pre-paid healthcare plan with unaffordable premiums.  Many families spend over $20,000 annually on health insurance premiums and STILL pay out-of-pocket for all of their medical care due to high deductibles.  Insurance is meant to protect against financial catastrophe, but in the case of healthcare, insurance IS the financial catastrophe.  Patients do not realize that their doctors are receiving ever lower reimbursement and are spending over half their time engaged in meaningless insurance paperwork to get paid and to get the appropriate treatment for their patients.  They cannot understand why their healthcare quality continues to drop as they pay more and more.

Imagine if your car insurance worked like your health insurance.  You would be forced to pay $1000 per month for car insurance, but it would cover gas, oil changes, car washes, tires, windshield wiper blades, regular maintenance, and repairs.  Of course, the prices for all of these services would increase dramatically, and you would have no way of knowing the price until months later.  Also, you would pay a $20 co-pay for all services and would be responsible for the first $3000 of costs each year.  However, after paying that first $15,000, all costs associated with your car would be FREE!  Keep in mind that you would need to stay in-network.  You may have a habit of swinging into the Wawa every morning on your way to work, but one day you learn that Wawa is now out-of-network, so now you are responsible for paying $250 for a tank of gas.  Of course, you could drive 15 miles out of your way to get your tank of gas covered at 7-eleven, after you pay the co-pay and deductible.  Also, you have to go inside, wait in line, show the gas station attendant your car insurance card, and fill out five pages of paperwork prior to filling your tank.

Americans have been brainwashed to believe that our current healthcare system is the only way to pay for healthcare.  Of course, this is not true.  The main reason that healthcare is unaffordable is because of the health insurance companies and all of the administrative middlemen who profit off this system.  The only way for this system to change is for doctors and patients to demand better.  If doctors stopped billing insurance and instead offered affordable cash prices for medical care, patients would not need to purchase these expensive pre-paid healthcare plans and could opt instead for affordable catastrophic plans or for health-sharing plans, such as Sedera, for as low as $136 per month.  In my Direct Primary Care practice, patients get all the primary care they need for $75 per month, and I help them navigate the system to find the best prices on screening and diagnostic testing, medication and other treatments.