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The Problem with Medicare 'Advantage' Plans: They are Awful! 1. There is no 'Advantage' to a Medicare Replacement plan. They are truly awful for most patients that enjoy the freedom to choose their provider, choose high quality over cheap and value the quality of the prescriptions that they receive. The advertised Medicare "Advantage" is the commission that the insurance company and their sales agents pull from your benefits from Medicare. You convert from a standard insurance model directly to an HMO model. Traditional Medicare is the best insurance that you can get. When you fall for the 'you DESERVE more benefits, you can count on the fact that someone has their hand in your pocket. Medicare covers a variety of services, pays for them and leaves you with a 20% 'Co-pay' of the negotiated fee schedule. You can elect to get insurance for this, as I do, to insure against catastrophic events. The pharmacy coverage is inexpensive, and is best shopped for your individual needs. NOTE WELL: When an insurance company offers you benefits that traditional Medicare does not, it means that they are taking money out of the funds that you may need for real medical care. NOBODY gives you 'free grocery money,' 'free dental coverage,' 'free gym membership.' The fund have to come from somewhere and it is out of what they take from their coverage for physical therapy, pharmacy and physicians. If you fall for this one, you may find yourself dealing with doctors and facilities that are somewhat below your expectations, to say, the least. In short, a. They offer 'new Medicare benefits,' such as cheap gym memberships, sun glasses, gym shorts, and what not. b. These 'benefits' are cheap compensation for the thousands of dollars in moneys that they take off of the top from the government, for 'management.' c. The government makes out because they limit what you can receive in treatment, resulting in lower quality, poorer availability, and decreased accessibility, decreased mobility. In short, there is NO ADVANTAGE to the Medicare Advantage Plans!!! 2. They take several thousands of dollars right off of the top from a fixed amount that the government pays them to 'administer' the plan. This is a poetic way of saying that they are paid to deny you coverage that you would otherwise receive, and you get second or third class coverage. 3. Regular 'Red white and blue' Medicare is the best insurance that you can get. When they cut it down with the Advantage Plan, it is clearly to your 'Disadvantage.' You lose the ability to see who you want, where you want and you have to choose from their list of contracted doctors. The card may say IPO, but if you have to 'pick their doctors' it is clearly a Medicare HMO. Recommendation: 4. I recommend to my patients that they use regular Medicare and shop for the appropriate pharmacy program to supplement Medicare. You do this by looking at your medications, the most expensive first, and then find which plan covers that medication cluster. 5. Then, you pick a different Supplemental plan. It can NEVER be the same one as your pharmacy plan, or they will roll you into their Medicare Advantage plan, without your consent or knowledge. If this were another industry, it would not be permitted. 6. As an example: a. United Healthcare for supplemental with BCBS for Pharmacy b. Mutual of Omaha for supplemental with Aetna for Pharmacy c. Cigna for the supplemental, with UnitedHealthcare for the Pharmacy There are many possibilities, most work well. Above all, do not let the insurance sales people talk you into using the same company because it is 'convenient.' It is convenient in guaranteeing them a more juicy commission. I am not an insurance agent, but this approach has served my patients well for the past 30 years. Further, This is exactly what I am doing for myself. David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute

We have an arrangement with Nutritional Frontiers to give you direct and full access to their full line of nutraceuticals. At Stages of Life, we stock a number of their products but it is impossible, or at least impractical to stock them all. That being said, we can share our affiliate number with you. Register using this affiliate number and you have full access to the Nutritional Products quality line of supplements. Using the instructions below, you can order items that we use, items that we would like to stock and items that are of individual interest that would otherwise be impractical to stock. For Nutritional Frontiers: Log onto: www.nutritionalfrontiers.com Click the 'login' icon, which is a little person with a head. Register and use our affiliate code: Register using the ‘Affiliate ID’ below: Code: 18368 This is an example of one of our favorite products. Useful for viral upper respiratory tract infections. A well balanced mushroom derivative. copyright 2023 Stages of Life Medical Institute To become a patient, follow this link Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

David S. Klein, MD, FACA, FACPM The market is full of powders that make all manners of claims, nearly all of which are impossible to document. What cannot be debated is that millions of people use them, in powder form, making shakes for a variety of reasons. Another thing that is not debatable is that people do not buy anything, month over month unless they derive some benefit from it. This product does just that. It delivers a remarkable slug of protein, anti-oxidants, phytonutrients and micronutrients. Within a very short period of time, the typical patient starts to 'feel better.'' Pro Lean Greens is a high quality supplement that is manufactured in the United States under the strictest of manufacturing conditions. It is only sold in health care professional's offices. The price is very reasonable, particularly when compared to the well known capsules advertised about every 10 minutes on television. No enormous advertisement budget translates into lower cost to the patient. In the powder form, mixed with water or something tasty like almond milk, Pro Lean Greens Chocolate delivers many times that amount of nutrients than do the capsules advertised on television and the monthly cost is around half as much. If you want to give this a try, you can order it on stagesoflifevitamins.com or you can get it online using our code "18368" and open an online account with them. Of course, you can stop by our store, we would love to meet you! Note: if you go to the Nutritional Frontiers Order site, use our code 18368 to create your own account, and you can choose from other flavors, and other products as well. I will feature products that I have personally tried, and if you leave me feedback on others, I'll be happy to personally get it, try it, evaluate it and stock it in the SOLMI Store. Pro Lean Greens Features: Great tasting, easy-to-mix powder. Combines nutrient rich vegetables, fruits and herbs with enzymes, and probiotic cultures. Supports the body’s ability to cleanse, detoxify, and rejuvenate. Supports the body’s antioxidant defense system and immune system functioning Supports detoxification and G.I. Tract health. Now with a Complete Detoxification Matrix! Spirulina Whole Plant Powder, Chlorella Powder, N,N-Dimethylglycine HCl,Patented Trademark Ingredient: Emothion® S-Acetyl-L-Glutathione, and N-Acetyl-L-Cysteine! – Spirulina and Chlorella are both sources of blue-green algae, which has a rich nutrient profile and is a potent antioxidant. Spirulina supports healthy functioning of the liver and immune system to aid in detoxification. Chlorella supports cell reproduction, as well as restorative processes that promote healthy organs and tissues. Chlorella also aids the body in the breakdown of unwanted materials like heavy metals and supports proper digestion by promoting the growth of beneficial bacteria and assisting in the elimination of unwanted materials from the body. Antioxidant Support – Red Raspberry supports capillary strength. – Cranberry supports urinary tract health and function by keeping unwanted materials from adhering to the walls of the bladder. – Blueberry supports eye, urinary tract and cardiovascular health, and gastrointestinal function. – Bilberry has traditionally been used to support proper functioning of the eye. It helps to synthesize compounds that maintain artery walls, support connective tissue health and strengthen capillaries. – Grape Seed Extract plays a role in the stabilization of collagen and maintenance of elastin, thereby supporting organ, joint, blood vessel, and muscle functions. Digestive Support FOS aids in the elimination of unwanted substances and supports G.I. Tract health. Fructooligosaccharides (FOS) are considered a soluble fiber and pre-biotic that support the growth of beneficial bacteria. Since FOS is not digested it increases the material in the digestive tract and promotes regularity. Immune System Support Oat Beta-Glucans support immune system function. Non-allergenic Oat Beta-1,3-Glucans extracted from oats are a highly researched polysaccharide with immune supporting properties. They support the activity of macrophages that clear away cellular debris and other unwanted materials by digesting them. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 copyright 2023 Stages of Life Medical Institute

Sleep Time by Nutritional Frontiers It costs 80 cents per day, or less. Great Value. It is a balanced sleep aid, inexpensive and of tremendous quality. About the Ingredients Gamma aminobutyric acid (GABA) is a naturally occurring amino acid that works as a neurotransmitter in your brain. Neurotransmitters function as chemical messengers. GABA is considered an inhibitory neurotransmitter because it blocks, or inhibits, certain brain signals and decreases activity in your nervous system. When GABA attaches to a protein in your brain known as a GABA receptor, it produces a calming effect. This can help with feelings of anxiety, stress, and fear. It may also help to prevent seizures. As a result of these properties, GABA has also become a popular supplement in recent years. This is partly because it isn’t available from many food sources. L-Taurine- is an essential amino acid is a GABA-receptor agonist, meaning it produces a GABA-like effect in the body. GABA is a sedating, inhibitory neurotransmitter. In animal studies, application of taurine with GABA, or taurine with glycine produced stronger effects than taking either glycine or GABA alone. Taurine is can be used to enhance sleep quality. Suntheanine® (L-Theanine) stimulates activity in the brain known as alpha waves, which are associated with a relaxed but alert mental state. Human clinical trials have shown Suntheanine® to promote an alert state of relaxation without drowsiness, as indicated by an increase in Alpha brain waves, and a decrease in Beta brain waves. Suntheanine® is protected by over 40 U.S. and international patents for its various physiological efficacies and L-isomer specific production processes. L-Glycine- is a non-essential amino acid. It has been used to protect brain cells after ischemic stroke. Glycine is also thought to promote a sense of well-being and reduce anxiety. Research has shown that glycine can subjectively and objectively improve sleep quality. In a study where people’s sleep was restricted, glycine also reduced daytime sleepiness. 5-HTP- stands for 5- hydroxytryptophan, and is used by the body to make serotonin. 5-HTP is not found in food sources, the body manufactures 5-HTP from tryptophan, an amino acid found in dietary protein. Many conditions have been shown by studies to be helped by 5-HTP supplementation, including insomnia, depression, fibromyalgia, obesity (by reducing appetite), and headaches. 5-HTP should always be used under the supervision of a healthcare practitioner. In addition, the lowest possible dose should be used first and the dose should be titrated up slowly. 5-HTP should not be taken concurrently with pharmaceutical anti-depressants unless otherwise directed by your healthcare practitioner. Vitamin B-5 (D-Calcium pantothenate)- is a water-soluble B vitamin with numerous biological roles. Vitamin B-5 is used by the body to manufacture, among other things, coenzyme A which is an important compound for energy metabolism and the production of fatty acids, cholesterol, and the neurotransmitter acetylcholine. D-Calcium pantothenate is the preferred, metabolically active form of B-5 used in higher quality nutritional supplements. Vitamin B-6 (Pyridoxal 5-phosphate)- is a water-soluble B vitamin that performs many functions in the body. B-6 – dependent enzymes assist in the biosynthesis of the important neurotransmitters GABA, dopamine, serotonin, epinephrine, and norepinephrine. Pyridoxal 5-phosphate is the preferred, metabolically active form of B-6 used in higher quality nutritional supplements. Melatonin- is a hormone naturally produced by the body to regulate circadian rhythm (sleep-wake cycle). Melatonin secretion may be disrupted by aging, hormonal changes, and night-time exposure to light, among other things. Melatonin supplements are well known for their ability to combat insomnia. A Marvelous Sleep Aid. No Side Effects. Reasonably Priced. Ingredients, below: Supplement facts Supplement Facts Serving Size: 2 Capsules Servings Per Container: 30 Vitamin B6 10 mg (as Pyridoxal-5-Phosphate) Pantothenic Acid 10 mg (as Calcium-D-Pantothenate) Gamma Amino Butyric Acid (GABA) 500 mg Glycine 500 mg Taurine 250 mg L-Theanine (as Suntheanine®) 100 mg 5-Hydroxytryptophan (5-HTP) 50 mg (from Griffonia simplicifolia Seed Extract) Melatonin 3 mg Other Ingredients: Hypromellose (Capsule), Rice Flour, Vegetable Stearate. Warning: Consult a healthcare professional if you are pregnant or nursing, experiencing long-term sleep difficulties; before use in children; before use in those with a medical condition, and those taking medication. Do not drive or operate machinery when taking melatonin. Use: As a dietary supplement, take 2 capsules one hour before bedtime, or as directed by your healthcare practitioner. It is a marvelous sleep aid, well tolerated and very affordable. David S. Klein, MD, FACA, FACPM If you want to give this a try, you can order it on stagesoflifevitamins.com or you can get it online using our code "18368" and open an online account with them. Of course, you can stop by our store, we would love to meet you! Note: if you go to the Nutritional Frontiers Order site, use our code 18368 to create your own account, and you can choose from other flavors, and other products as well. I will feature products that I have personally tried, and if you leave me feedback on others, I'll be happy to personally get it, try it, evaluate it and stock it in the SOLMI Store. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 copyright 2023 Stages of Life Medical Institute

The influenza (flu) season is upon us.  In these days of powerful antibiotics, impressive hospitals and expensive diagnostic equipment, the influenza virus still kills otherwise healthy adults and children. It kills, in the US, nearly as many persons as who perish in automobile accidents, yet we assume that the ‘guardians in white coats’ will save us this potential killer. Well, the reality is that we have very few options to treat this viral infection, once it takes hold.  We can, however, take steps to improve the immune system and thereby reducing the chances of contracting the illness or minimizing the potential for devastating morbidity. These simple PREVENTIVE steps include: Adequate zinc intake, i.e. 25 to 50 mg of a zinc chelate per day. NOT ZINC OXIDE, as this molecule does not absorb well, at all. Age-appropriate dosage of B-complex vitamins. As we age, we actually need more of the vitamins as we absorb less as a percentage of ingested amount. Another ravage of aging. Vitamin C, 500 mg two or three times daily. Keep these five products handy. They work together to give rapid and profound symptomatic relief. For treatment the flu or other viral upper respiratory disorders, it is best to start early in the illness. NAC (n-acetyl cysteine) 500 mg three times daily. Licorice Root Extract 450 mg, twice daily. Lactoferring containing Colostrum 500 mg TWO capsules Four Times Daily, while acutely ill. Mushroom extract capsules (these can be tricky) One capsule twice daily. That being said, we can share our affiliate number with you. Register using this affiliate number and you have full access to the Vital Nutrients product line. I will be reviewing and featuring their products, from time to time, when one of them 'stands out' as necessary due to public health situation, newsworthy events e.g. COVID, or for routine 'notes from the Doc.' Using the instructions below, you can order items that we use, items that we would like to stock and items that are of individual interest that would otherwise be impractical to stock. For Pure Encapsulations: Log onto https://patientdirect.pureencapsulationspro.com/ Register using the ‘Affiliate ID’ below: Code: 079057 Guaifenesin (Mucinex) once to four times, daily. Drink plenty of water (this assists in clearing the secretions, which can plug up the airways and lead to pneumonia) I personally believe that the flu vaccination is important.  Not because it necessarily prevents all flu infections (it doesn’t) but it does enhance the immune system so that if it is infected, the disease is milder. If you choose not to take the vaccine, in many ways, it is like taking a nice long road trip, without seat belts. The vaccine does not prevent the disease, it only makes it more survivable, and survivable with lesser permanent damage (scarring of the lungs.) Translation: Less likely to be fatal. copyright 2023 Stages of Life Medical Institute To become a patient, follow this link Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

We have an arrangement with Pure Encapsulations to give you direct and full access to their full line of nutraceuticals. At Stages of Life, we stock a number of their products but it is impossible, or at least impractical to stock them all. That being said, we can share our affiliate number with you. Register using this affiliate number and you have full access to the Vital Nutrients product line. I will be reviewing and featuring their products, from time to time, when one of them 'stands out' as necessary due to public health situation, newsworthy events e.g. COVID, or for routine 'notes from the Doc.' Using the instructions below, you can order items that we use, items that we would like to stock and items that are of individual interest that would otherwise be impractical to stock. For Pure Encapsulations: Log onto https://patientdirect.pureencapsulationspro.com/ Register using the ‘Affiliate ID’ below: Code: 079057 This is an example of one of our favorite products. Useful for viral upper respiratory tract infections. A well balanced mushroom derivative. copyright 2023 Stages of Life Medical Institute To become a patient, follow this link Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Well, after years of procrastination, delay and denial, I have finally agreed to invest the time and effort into sharing ‘tricks of the trade’ that your doctor may not have shared with you.   In all fairness, your doctor probably did not have all of the data to share with you, or, more likely, you spend your medical visits in the company of the nurse practitioner of physician’s assistant, while the doctor is elsewhere, ‘supervising.’ It was not the doctor’s fault that he or she is forced to practice this way, but the reality is simple:  The government and the insurance industry has forced the medical industry to ‘package to price.’  The same thing happened to the nickel (and dime) candy bar.  As economic pressures pushed the price up, at certain break-points, the candy bar shrunk in size. in the medical industry, the shrinkage first occurred in time spent with patients more patients per hour then, treat several patients at once using physician extenders finally, see the extender, damned the doctor. As the profession found itself going down the tubes, the quality of the domestic medical school applicant diminished, and now we find ourselves wondering:  “where did all of the good doctors go?” It is obvious, in most parts of the country, that you are putting your life in your hands when you are admitted to the hospital.  Due to the ever-increasing administrative demands, many of the better doctors have abandoned hospital practice. The hospitals have been forced to hire physicians trained abroad (language barrier is now an interesting challenge) and hospital related deaths/errors/disasters has increased tremendously. Take home message: “Take preventative health very seriously.  It may be your only defense against medical/hospital incompetence.” The purpose of this blog will be to share interventions that the public can perform in the effort to get healthy, be healthy, and stay healthy. In a commercial aircraft, you are told: "In case of cabin decompression, put on your mask, first." Now, more than ever, it is imperative that you take charge of your own health, Lord knows, you can't trust the system to look after your best interests. About David S. Klein, MD, FACA, FACPM David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Retired from the Medical-Radio business after 21 years, Dr Klein is currently practicing in Longwood, Florida, entirely in the office setting.

One more piece of a very complicated diabetes and pre-diabetes puzzle. Quan X , Wang J, Liang C , et al: Melatonin inhibits tunicamycin-induced endoplasmic reticulum stress and insulin resistance in skeletal muscle cells. Biochem Biophys Res Commun . 2015 Aug 7;463(4):1102-7. Melatonin is a Pituitary Weight Loss Hormone Melatonin is a naturally secreted hormone. Blood levels decrease as we age, as less and less is secreted by the pituitary. By no means is melatonin 'just for sleep.' It is a small hormone that finds its' way into many aspects of physiology, including blood sugar balance, insulin balance and weight control. Melatonin is an Anti-Depressant, as well as a sleep aid, weight loss medication and maybe more! Melatonin use has been demonstrated to have anti-depressant effects. The question is, "Is Melatonin a direct acting anti-depressant, or is restoration of sleep and normal sugar/insulin levels the effect that relieves depression?" Regardless, melatonin has demonstrated measurable effects as an anti-depressant. More to come. Melatonin is CHEAP The most interesting problem with melatonin is that most of the products on the market are of such poor quality that they are unlikely to be effective. In spite of the fact that it is inexpensive, the vast majority of the melatonin products may not have any melatonin in them, at all. Sad as it is, the industry is not well-regulated. The best products are manufactured to pharmaceutical specifications. Oddly, the finest products cost little more than the worst of the lot. Be careful and wise in your choices. OK, now that I know some of the benefits, how is it used properly, what are the risks? The typical dosage of melatonin in my practice is 10 mg at bed time, for starters. Some individuals will find that they need 20 mg, but 80% of the time 10 mg does the trick for sleep. It is taken EVERY NIGHT at bed time. If it is taken 'as necessary for sleep,' it does not train the system to be regular and the outcome is inadequate. In situations where a little 'extra kick' is necessary to induce sleep, use GABA (gamma-amino butyric acid) 750 mg at bed time. Risks: When starting Melatonin, some individuals will get vivid dreams. When this occurs, it may indicate that the sufferer is having difficulty entering REM sleep, often due to some type of trauma. The mind tries to avoid the recurring nightmare and avoids REM. When the melatonin is administered it PUSHES the brain into REM and this can result in a nasty dream or two. It most frequently resolves after 3 to 4 days of use. The very highest quality melatonin costs about twenty five cents a night! Ours is manufactured for us by a GMP pharmaceutical company, assayed for purity and content. David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute To become a patient, follow this link Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

The Optimal Level of Cholesterol is much higher than the doctor may be telling you. The article referenced below is very interesting and insightful. Your doctor will likely disagree with their data, even after observing over 12.8 million adults over a period of greater than 10 years. Life Expectancy Life expectancy or longevity is a 'U' shaped curve when plotted against cholesterol level. That is, there is a range whereby the 'optimal total cholesterol' is associated with the lowest all-cause mortality. It is slightly different between men and women, and there is an age factor, as well. Click on the above graph to go to the article from the National Library of Medicine. One thing to consider when listening to opinions on cholesterol levels and 'statin' use is that statin trials were mainly performed in persons at a high risk of heart disease, especially in men with manifest CVD, in whom heart disease mortality constituted approximately 50% of all deaths. According to the authors, "Total cholesterol (TC) had U-curve associations with mortality in each age-sex group. TC levels associated with lowest mortality were 210–249 mg/dL, except for men aged 18–34 years (180–219 mg/dL) and women aged 18–34 years (160–199 mg/dL) and 35–44 years (180–219 mg/dL). The inverse associations for TC < 200 mg/dL were stronger than the positive associations in the upper range." Critical review of the graphical data would show that a patient is at greater risk of death having 'low cholesterol' than having a very high level. Somewhat at odds with the general consensus? When you are told "the lower the cholesterol, the better," you may not be getting the very best advice. The Functional Medicine Difference. Functional medicine doctors have a unique approach to health care. The number one pillar of functional medicine is a prevention-based approach. We want to create the best conditions for your health to prevent chronic diseases so you can enjoy a long, healthy, high-quality life. . A functional medicine doctor also takes a comprehensive approach to patent care, focusing on the root causes of conditions instead of just treating the symptoms. David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

An essential accessory for the Asthmatic What is an asthmatic without the obligatory 'inhaler.' Used by physicians for many decades, these portable devices have delivered life-saving medications at the moment that the medication is needed. Sprayed directly into the mouth, timed precisely with inspiration, and after significant practice, the asthmatic might get it right. The Philips Respironics Optichamber There is a simple device, remarkably inexpensive, that takes much of the worry out of timing the 'squeeze.' Teaching a child to do it right is very difficult, expensive if you consider the waste of medicine that is involved in 'practicing.' The Philips Respironics Optichamber makes it very easy to administer the bronchodilator and increases the amount of medication delivered to the lungs by around 60%. I have patients that are able to get by with one puff instead of two on their Ventolin, saving more than a few dollars by reducing the frequency of inhaler refill. I found that you can get these with a detachable mask, something that might be worth having around, but it works very well if you place the mouthpiece directly in your mouth. The Inhaler, mine is Ventolin (albuterol, Ventolin is the better of the generics) attaches on the opposite side of the chamber. Attach your inhaler mouthpiece to the opening in the spacer. Shake the inhaler, before each use. Exhale and just as you begin to inhale slowly, you actuate the inhaler into the chamber. Precise timing is not essential as it is without the Spacer. This device is equipped with a high volume whistle that fires if you inhale 'too fast.' Perfect feedback, actually. My First Impression I was admitted in January 2023 with asthmatic respiratory failure after a two week long bout of pneumonia (Mycoplasma Pneumoniae.) I had been doing well, I thought, working full time in the clinic. One Thursday afternoon, however, I was escorted out of the office and ended up in the hospital. Antibiotics, oral steroids and 3 days later, I had a discussion with the respiratory therapist who was giving me my nebulizer treatments. He looked at my inhalers and asked: "Hey, Doc, where are your spacers?" Well, it is not my field of expertise, but I know better now. The spacer makes the inhaler work like a champ. The Test Being a bit skeptical, I needed to be convinced. The RT suggested that I try two puffs without the spacer, and see how well I'm breathing. He was withholding the nebulizer, I might add. Then, he told me to take one 'hit' on with the spacer. I did as I was told, and moments later, the effect was unlike any I had previously experienced with the albuterol. I did not take a second inhalation, as it was entirely unnecessary. The principal advantage to the spacer is efficiency. The principal disadvantage is bulk. It does not fit neatly in my trouser pocket. It is the Essential Accessory for the Asthmatic. The spacer increases the efficiency of the inhaler by 40 to 60% The device is probably a reasonable device to carry in a purse, folio or whatever the garment that men are seen carrying through the airports. I bought three of them, leaving one at the office, one in my bathroom and one in my car. I have been a physician for 42 years, and I rarely pick up pearls of wisdom as I did from that Respiratory Therapist. It is now a frequently used piece of armamentarium in the treatment of my patients with asthma and chronic bronchitis. I provided a link to an Amazon page where you can see the instructions for use. I chose not to use the facemask, for my own situation. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750

Meniere's Disease is an inner ear disorder that presents with dizziness, vertigo, hearing loss and ringing in the ears (Tinnitus.) Meniere's disease can happen at any age. But it usually starts between 40 to 60 years of age. Home Treatment of Menier's Disease and Vertigo Vertigo can present without hearing loss or tinnitus, and can result from a variety of inflammatory causes but most commonly results from inflammation of the organs of balance in the ear. Tricks that may give you some relief of the vertigo! Either way, you can help reduce the severity of the symptoms by a few simple steps. 1. Avoid salty foods and avoid adding salt/salt products to your food. 2. Avoid (excessive) Caffeine and Caffeinated beverages. 3. Avoid refined sugar and high carbohydrate foods. 4. A little trick that I found that can give remarkable improvement involves a common ultrasonic toothbrush! Use a PHILIPS ultrasonic toothbrush, as follows: a. Get a rubber eraser, the type that goes on the end of a pencil, pink/pyramidal in shape. Inexpensive. b. Push it over the bristles of one of the toothbrush attachment. c. Apply to the mastoid process (bone behind your ear). d. The toothbrush will buzz, but pause every 30 seconds, move from ear to ear. (4 cycles, 2 minutes total) NOTE WELL: Do this while lying on your back or sitting squarely in a chair, as it can cause you to get dizzy. 5. We offer a supplement, "Eyes and Ears," that contains vinpocetin & huperzine. These two phosphodiesterase inhibitors can reduce the symptoms, as well. It is not expensive and may offer some relief. When I first developed Meniers Disease over 20 years ago, I used this combination and it offered me great relief. While nothing works for everybody, it pays to know what your options might be. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 www.suffernomore.com

Why Low Fat Foods Actually Make You Fat As alarming as it might seem, those ‘common sense’ nutritional recommendations that we have taken as ‘fact’ may actually result in tremendous damage to our patients. The wonder food that provides low-cost, low-fat protein to our patients is also delivering a pair of insidiously acting poisons that are fattening our patients, like so many cattle. Lessons from the farm: Cattle will graze until they are sated. They will eat and become meaty. Cattle are then given corn and soybeans, in a feed lot. Cattle become ‘beefy’ when allowed to graze. Cattle become ‘fat’ when given low-fat diets consisting of soy and grain. Death by Soy: Soy Isoflavones are making you fat Humans are not all that dissimilar to cattle. When given soy and corn, cattle become fat. When given soy and carbohydrates, humans become fat. The ‘low fat,’ low-cholesterol soy diet fattens cattle, and the same ‘low fat’ diet fattens humans. When the medical community opted to support the elimination of cholesterol from the American diet, the population was set on a path towards wholesale obesity. To the Europeans, soy and corn are considered to be ‘cattle feed,’ and are therefore beneath human consumption. Europeans will not permit the introduction of soy into their diet, and the resulting difference between the North American and European populations is striking. Soybeans are harmful to human metabolism due to the presence of two chemicals that cause direct, metabolic harm, to human physiology. These chemicals, daidzein and genistein, inhibit thyroid function, bind essential minerals, thereby preventing absorption from the gut, and directly inhibit certain digestive enzymes. In short, this is exactly opposite of what we have been told is ‘healthy.’ Soy is, however, cheap. It is the cheapest source of protein, phytochemicals, and cooking oil. This cheap source of protein is fattening you up! Foolishly, we place our infants on soy-formula instead of milk, we diet our way into obesity with a plethora of protein meals, shakes and ‘low fat’ meals. When our grand-parents ate their meat & potatoes, gravy & butter, they rarely became obese. As children, it was truly rare to encounter an obese child. Old school photos rarely demonstrated a single fat child. Magazine photos, movies, newsreels rarely demonstrated obese adults. In the movies of the 30’s, 40’s and 50’s, the ‘fat kid’ or ‘big man’ would not be considered to be particularly corpulent, by standards of today. Health Foods that can do Damage The physiological effects of the isoflavone daidzein and genistein result due to the competitive antagonism of the enzyme, Thyroid Peroxidase. This enzyme is critical in thyroid hormone production. Further, these isoflavones inhibit the enzyme 3,3’5’-deiodinase, which is instrumental in the conversion of T-4 to T-3. Daidzein and genistein inhibit the production of thyroid hormone and inhibit the conversion of (inactive) T-4 to (active) T-3. Soy also binds up zinc, thereby rendering unavailable, this essential mineral. The protease trypsin is inhibited by these isoflavones, thereby harming normal digestion of protein. The soy isoflavones are estrogen agonist-antagonist. That is, the soy isoflavones work against estrogens in females. This is actually beneficial for the treatment of symptoms attributed to PMS. By acting as estrogen antagonist, patients can decrease the complaints of “hot flashes.’ The chronic use of the isoflavones as estrogen antagonist may have unfortunate long term effects. By antagonizes estrogen effect on bone, skin, and other tissues, the soy isoflavones may accelerate the development of osteoporosis and fibrocystic disease of the breast. The mild estrogenic effects in males can be very detrimental. The soy isoflavones, or ‘soy estrogens’ as they are sometimes called, can increase in male breast tissue. The estrogens also result in balding and testicular wasting. The net physiological effect of the inhibition of thyroid function: ‘Normal serum thyroid values,’ e.g. T-3, T-4, TSH Hypothyroid with ‘normal blood studies.’ Antagonism of protein digestion in the gut with resulting dyspepsia and reflux esophagitis. Mixed agonist-antagonistic effects on estrogen metabolism, with resulting central obesity, gynecomastia, erectile dysfunction. Soy is present in many processed foods, including: Soy meal, Soybean oil. Soy milk. Non-dairy creamer. Many “low fat” prepared foods. Bread (soy meal is often mixed with the flour). ‘Veggy burgers,’ some hamburger meats. ‘Lecithin’- short for soya lecithin (as opposed to the more expensive egg lecithin, used in Europe. To a lesser extent, these isoflavones can be found in Chick Peas (Garbanzo Beans,) and Peanuts. Pinto Beans also have a lesser isoflavone content. Some health foods and supplements are rich in thyroid-inhibiting isoflavones, including Black Cohosh, Grape Seed Extract, and Ginko Biloba. Other foods that are of concern include: Candy, American chocolate (Europeans use egg lecithin) “Low fat” and “diet” foods “Natural” Vitamin products. “Natural” Vitamin E. “Natural” Co-Q10. Muscle-building supplements. Crackers, cakes, cookies. “Light, vegetarian cheeses.” Deep fat fried foods (cooked in Soybean Oil). Salad dressings. Sausage, hot dogs. Bologna, Spam. Salami. “Bacos’.” “Bacon bits.” Processed delicatessen products. Peanuts. Some Herbal teas. Grapes, some wine (grape seed) The net effect on human physiology is remarkable. To prove the point to the skeptic, a person takes their temperature, then drinks a cup of coffee with non-dairy creamer. After 60 minutes, re-determination of temperature will demonstrate a drop of 0.3-1.0 degrees Fahrenheit. The effect of dietary soy can be observed in sequential body temperature readings, and foods with suspect isoflavone contamination can be identified. The effects of dietary soy will manifest within an hour after ingestion, and can last as long as 24 hours. It may take several days to eliminate the isoflavones from the system. In summary, epidemic obesity is probably the single greatest public health threat to our society. As we look for fancy medications and expensive interventions, the answer may be as simple as soy/peanut avoidance. We are and have been ‘healthying’ ourselves to death. January 21, 2008 David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute. 1917 Boothe Circle, Longwood, Florida 32750 407-679-3337 © 2008 David S. Klein, M.D. All Rights Reserved. Any use, reproduction or dissemination of information in this article in its entirety or part is allowed only with the following specific attribution: David S. Klein, M.D. at http://www.stages-of-life.com/. This article is intended for general information purposes only and is not a substitute for specific medical advice. Please consult your health care provider to determine how this information pertains to your specific medical situation. David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute