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Listen to our Thyroid Podcast on YouTube: Patients have trouble finding doctors to prescribe 'natural' thyroid replacement medicines. Natural Products seem to be out of fashion in the Mainstream Medical World. Physicians are trained in treating patients with disease states and rarely get meaningful training on preventive medicine. Bad enough as this is, fewer physicians, still get any training or experienced in treating diseases states with 'naturally occurring medicines.' Specialization in treatment with molecules 'not new to nature' is what is most commonly available. Natural Thyroid replacement treatment with Thyroid USP, glandular thyroid or desiccated thyroid extract is actually the first manner in which hypothyroidism was treated, and it remained that way for decades. After the introduction of Synthroid, things changed. Fewer and fewer physicians used the older medication, and eventually, few became aware that it actually existed. My patients and those of fellow 'functional medicine physicians' are quite aware of the advantages of using the more natural approach. Yes, the natural thyroids have both T-3 and T-4 while the currently available preparations provide only T-3 (Cytomel being an exception.) But few are aware that T-2 and T-1 are also present in glandular thyroid preparations. T-2 and T-1 may actually be important in weight-related issues, something of particular concern to patients with under active thyroid diseases. Thyro Complete by Nutritional Frontiers I am pleased to introduce a high quality product that may help individuals that are unable to convince their physician to prescribe NP Thyroid, Armour Thyroid or Adthyza. My patients receive regular, periodic thyroid levels, that is, determining serum T-3, T-4, TSH, TPA and ATG. Many have the free T-3 and free T-4 components checked, as well. These patients might benefit from the addition of a glandular product like this, if they are not taking the components in another form. I believe that it would be best to add this to a T-4 product to round it out, if the patient/physician pays attention to regular blood work, at least until stability is achieved. For those patients that are unable to get a natural thyroid product, I would use this alone for a period of 4-6 weeks, and then get a TSH, T-3 and T-4 level. Adjust the dosage, accordingly. SUPPLEMENT FACTS Available Bottle Sizes: 60 Amount Per Serving: 2 Capsules Servings Per Container: 30 Amount Per Serving: Iodine (Thorvin™)‡ 130 mcg (Ascophyllum nosodum)(L)(Kelp) Zinc 10 mg (as Zinc Bisglycinate Chelate) (TRAACS™) Selenium 250 mcg (as Selenium Glycinate) (Albion™) Copper 0.1 mg (as Copper Bisglycinate Chelate) (TRAACS™) L-Tyrosine 450 mg Thyroid (Bovine, New Zealand, Freeze Dried) 200 mg Sensoril® Ashwaghanda Extract 150 mg (Withania somnifera)(Roots and Leaves) (Std. to 10% Withania glycosides) ForsLean® Coleus forskohlii Extract 125 mg (Root)(Std. to 10% Forskolin) Hypothalamus Tissue (Bovine, Argentina) 25 mg Pituitary Tissue (Bovine, Argentina) 25 mg Other Ingredients: Vegetable Cellulose (Capsule) Minerals: Iodine (Thorvin™) is a deep water exclusive Icelandic kelp, Thorvin’s Laminaria digitata is higher in total nutrients, particularly iodine, potassium, and specific amino acids. A highly bioavailable form, Thorvin’s Asco Iodine content averages 780 parts per million (ppm), the highest on the market. Zinc (TRACCS™) is essential for the conversion of T4 to T3 and also lends itself to the integrity and functionality of the T3 receptor itself. Selenium (Albion™) is required for thyroid hormone production, activation and metabolism. It is an essential component of deiodinase enzymes which convert T4 to T3. Copper (TRACCS™) plays an important role in the production of thyroid hormone and also acts as an antagonist to Zinc, helping to promote a balanced mineral profile. Amino Acid: L-Tyrosine is a building block for the production of thyroid hormone. Thyroxine is a tyrosine-based hormone, which is also comprised of iodine. Herbal extracts: Sensoril® Ashwagandha: Recent studies have indicated that in addition to the support provided by Sensoril® for healthy cortisol levels (which will in turn support a healthy level of T3 hormone) it may also support T4 production directly. (1) Coleus Forskohlii (ForsLean® Brand) Extract: Supports thyroid function directly and also supports lean body mass through ergogenic activity.* It stimulates AMP (adenosine monophosphate), which then stimulates metabolism for greater fat burning.* You can get this product through a direct association with our office. This is easily obtained by simply registering at Nutritional Frontiers, and use our associate number. David S. Klein, MD, FACA, FACPM 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 Open an online account with them. Of course, you can stop by our store, we would love to meet you! David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute

Introduction Are you struggling to achieve your weight loss goals despite diet and exercise? We'd like to introduce you to a potential solution that may help you on your journey to a healthier you – Contrave is a prescription weight loss medication designed to support individuals in their weight management efforts. Weight Loss Challenges Many people face obstacles when trying to lose weight. Factors like genetics, metabolism, and lifestyle can make it difficult to shed those extra pounds. Contrave is here to offer additional assistance in your quest for a healthier lifestyle. After ruling out metabolic issues that cause weight gain, such as elevation in blood insulin level, high blood estradiol levels and hypothyroidism, hunger may be safely reduced in an attempt to lower weight through caloric restriction. That is, make dieting a little easier by making you less hungry. How is this possible? Medications exist that have been proven safe for other uses that reduce the desire to eat, smoke or consume alcohol.. When used appropriately, they can help you reduce your appetite. Contrave works by suppressing your appetite, helping you consume fewer calories. It also enhances your metabolism, making it easier for your body to burn fat. This dual-action approach can assist you in achieving your weight loss goals more effectively. Contrave is a prescription medication that is used to assist in weight loss and weight management. It is a combination of two active ingredients: bupropion and naltrexone. Here, we'll explore the benefits of Contrave in helping individuals achieve their weight loss goals. Dual Mechanism of Action. Contrave's unique advantage lies in its dual mechanism of action. Bupropion, an antidepressant and smoking cessation aid, helps reduce appetite and cravings, making it easier to consume fewer calories. Naltrexone, primarily used to manage opioid and alcohol dependence, complements this by dampening the reward system associated with food, reducing the pleasure derived from overeating. This dual action can provide greater control over eating behaviors. Effective Weight Loss. Clinical studies have shown that Contrave can lead to significant weight loss when used in conjunction with a reduced-calorie diet and increased physical activity. Participants in these studies typically lost more weight than those who followed the same lifestyle changes without the medication. Improved Health Outcomes. Contrave not only aids in weight loss but also contributes to improved health outcomes. Losing excess weight can reduce the risk of obesity-related conditions such as heart disease, type 2 diabetes, and hypertension. It can also alleviate joint pain and sleep apnea, enhancing overall well-being. Individualized Treatment Plans Healthcare providers can tailor Contrave treatment to each patient's unique needs. They assess factors such as medical history, current medications, and potential side effects to ensure a personalized and safe weight management plan. Clinical Studies. Contrave has undergone rigorous clinical trials to ensure its safety and effectiveness. In these studies, participants experienced significant weight loss when combined with a healthy diet and exercise. Potential Benefits. Contrave may not only help you lose weight but also improve your overall health. Weight loss can lead to a reduced risk of obesity-related conditions such as heart disease and type 2 diabetes. Safety Considerations. It's essential to use Contrave under the guidance of a qualified healthcare professional. They will assess your individual health needs, medical history, and potential side effects to ensure your safety. Contrave is typically prescribed to individuals with a body mass index (BMI) above a certain threshold and who have struggled to lose weight through other methods. It is not suitable for everyone, and your doctor will determine if it's right for you. Lifestyle Changes. While Contrave can be a valuable tool, it should be combined with a balanced diet and regular exercise for the best results. Your healthcare provider will work with you to create a personalized weight loss plan. Take the First Step. If you're ready to take control of your weight and improve your health, consult with a healthcare professional today. They can evaluate your situation, discuss whether Contrave is right for you, and guide you on your journey to a healthier and happier life. Remember, it's essential to prioritize patient safety and ensure that the medication is used responsibly and under proper medical supervision. Always consult with a healthcare professional before starting any weight loss medication or program. In conclusion, Contrave offers a multifaceted approach to weight loss and weight management. Its dual mechanism of action, proven effectiveness, and potential for improving overall health make it a valuable option for individuals struggling to achieve their weight loss goals. However, it's crucial to consult with a healthcare professional to determine whether Contrave is appropriate for your specific circumstances, as it may not be suitable for everyone and should always be used under medical supervision. Contrave is available from our in-house pharmacy. At a substantial discount to the patient, it is probably the most affordable modern weight loss medication available. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Tricks of the trade often come from feedback from the Patient. This one is a winner, inexpensive and came from one of my most loyal and pleasant patients! With its potent antibacterial properties, Manuka honey offers benefits that may improve wound healing, provide cough relief, and many other such claims. Manuka honey is native to New Zealand. Viral upper respiratory tract infections (URI) will cause nasal congestion and post nasal drip. This will irritate the throat, tonsils, uvula and cause cough. The cough itself can cause sore throat. Using a cough suppressant is sometimes helpful but topical relief can help you get some well-needed rest and do so without causing additional troubles. Generally, I use Halls Cough and Cold lozenges. They keep well wrapped in my pocket. If left out, the packaging can stick to the lozenge making it harder to use. This makes a good first line OTC product. One of my patients saw me open one of the Hall's drops, and offered me one of her Manuka products. (Many thanks, if you get a chance to read this.) It changed my approach to self-treatment. The Manuka lozenge adds a little 'kick' to the process by soothing the throat mechanically and may give you a slight antiviral effect to help things heal. The good news is that they work together. Manuka is made from honey, a very special honey, and has the potential of affecting blood sugar. Diabetics should use with due caution. Neither of these products is addictive, of course, and both are inexpensive. I buy my cough drops in the large jar, above. With a family with young grand children, somebody is usually a little sick, so we stay well stocked. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Start Savings TODAY Health Savings Accounts (HSAs) have gained popularity in the United States as a tax-advantaged way for individuals and families to save and pay for healthcare expenses. These accounts come with several advantages and disadvantages, which are important to consider when evaluating their suitability for your financial situation and healthcare needs. If you have even a modest amount of money that you can set aside for the future, consider using the HSA. While it may seem like a modest amount of money to set aside, incrementally it can be substantial by the time you reach retirement. It costs very little in administrative fees to use most brokerage firms. The advantage is that any unused contributions roll over to the next year, and the years that follow, growing with time. Insurance companies generally take any unused funds at the end of the year, and keep them. Advantages of HSAs: Tax Benefits: One of the primary advantages of HSAs is the tax benefits they offer. Contributions made to an HSA are tax-deductible, and any interest or investment gains within the account are tax-free. Triple Tax Advantage: HSAs offer a triple tax advantage, as contributions are tax-deductible, earnings are tax-free, and withdrawals for qualified medical expenses are tax-free. This makes HSAs a powerful tax-advantaged savings tool. Flexible Use: Funds in an HSA can be used for a wide range of qualified medical expenses, including doctor's visits, prescription medications, dental care, and even some over-the-counter items. The flexibility in spending is a significant advantage. Portability: HSAs are portable, meaning you can take the account with you if you change jobs or insurance plans. This allows you to continue using the funds for healthcare expenses in different situations. Roll-over: Unlike Flexible Spending Accounts (FSAs), HSA funds roll over from year to year, so there's no "use it or lose it" requirement. This provides long-term savings potential. Disadvantages of HSAs: High Deductible Requirement: To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP). These plans come with higher deductibles, which can be a disadvantage if you have significant healthcare expenses. Limited Contribution Amounts: There are annual contribution limits for HSAs. While they have increased over the years, they may not be sufficient to cover all medical expenses, especially for those with chronic conditions. Not for Everyone: HSAs may not be suitable for individuals with high healthcare needs or low income, as they may struggle to fund the account adequately or face financial strain from the high deductible. Penalties for Non-Qualified Expenses: If you withdraw funds from your HSA for non-qualified expenses before age 65, you'll face a 20% penalty, in addition to paying income tax on the withdrawal. This can deter misuse but may also limit access to your savings. Investment Risk: While HSAs can be invested in stocks, bonds, or mutual funds for potential growth, there's also the risk of losing money due to market fluctuations. Some individuals may prefer more stable savings options. Complex Rules: HSAs come with rules and regulations that can be confusing for some people. It's essential to understand the eligibility criteria, contribution limits, and qualified expenses to make the most of the account. If you enroll in Social Security you will be automatically enrolled in Medicare Part A, which will disqualify you from contributing to an HSA. Using a brokerage firm for your Health Savings Account (HSA) has certain advantages over going through an insurance company. Here are some of the key benefits: Investment Options: Brokerage HSAs typically offer a wider range of investment options compared to HSAs provided by insurance companies. With a brokerage HSA, you can invest in a variety of assets such as stocks, bonds, mutual funds, and exchange-traded funds (ETFs). This can potentially lead to higher returns on your HSA funds compared to a traditional savings account offered by an insurance company. Greater Control: When you use a brokerage HSA, you have more control over how your HSA funds are invested. You can tailor your investment strategy to your risk tolerance and financial goals, which can be beneficial if you have a longer investment horizon and want to maximize the growth of your HSA. Lower Fees: Brokerage HSA accounts often have lower fees compared to HSAs offered by insurance companies. These lower fees can result in more of your contributions being invested and growing over time, rather than being used to cover administrative costs. Flexibility: Brokerage HSAs offer flexibility in terms of investment choices, and you can manage your investments to suit your financial objectives. This can be particularly advantageous for individuals who are comfortable making investment decisions and want to grow their HSA funds over the long term. Diversification: With a brokerage HSA, you can diversify your investments across different asset classes, reducing risk and potentially improving the performance of your HSA. Diversification can be challenging to achieve in a traditional HSA savings account provided by an insurance company. Potential for Higher Returns: By investing your HSA funds in a brokerage account, you have the potential to earn higher returns over time, which can help your HSA grow faster and cover more of your healthcare expenses in the future. While brokerage HSAs have their advantages, it's important to consider a few potential disadvantages as well: Risk: Investing in a brokerage HSA carries investment risk, which means that your HSA funds can fluctuate in value. If the market experiences downturns, you may lose money, which can be a disadvantage for individuals who prefer a more conservative, low-risk approach. Expertise Required: Managing investments in a brokerage HSA requires some level of investment knowledge and experience. If you are not comfortable with investment decisions or don't have the time to manage your investments, you may prefer the simplicity of an insurance company HSA. Fees and Costs: While brokerage HSA fees can be lower than insurance company fees, they still exist. You should be aware of these fees and how they can impact your overall returns. Administrative Complexity: Brokerage HSAs can be more administratively complex than traditional HSA savings accounts. You'll need to monitor your investments, make asset allocation decisions, and potentially deal with tax reporting requirements. NOTE: With many insurance company sponsored HSA's, it is a 'use it or lose it' proposition. Any money you do not spend by being frugal goes back to the insurance company. With a bank or broker, any unused funds remains in the account and hopefully grows over the years. It remains with you, to be used for health related problems, or it becomes part of your estate. In summary, HSAs offer significant tax advantages and flexibility for those who can manage the high deductible requirement and are willing to invest time in understanding the rules. However, they may not be suitable for everyone, particularly those with high healthcare expenses or limited income. Evaluating your financial situation and healthcare needs is crucial in determining whether an HSA is the right choice for you. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Bronchitis is a common respiratory condition characterized by inflammation of the bronchial tubes, which are the air passages that connect the windpipe (trachea) to the lungs. It can be caused by viral or bacterial infections, as well as exposure to irritants like cigarette smoke, air pollution, or dust. My case followed a severe infection caused by a bacterium, Mycoplasma Pneumoniae. The inflammation in the bronchial tubes results in increased mucus production, leading to symptoms such as a persistent cough, chest discomfort, and difficulty breathing. There are two main types of bronchitis: acute bronchitis and chronic bronchitis. Acute bronchitis is often short-lived and typically caused by viral infections, like the common cold or the flu. It can resolve on its own or with supportive care. On the other hand, chronic bronchitis is a more long-term condition usually associated with smoking or prolonged exposure to irritants, or following pulmonary infections, bacterial, viral and/or fungal. Treatment for bronchitis depends on the underlying cause. In cases of acute bronchitis, treatment typically focuses on managing symptoms and includes rest, hydration, and over-the-counter medications to alleviate cough and fever. For chronic bronchitis, the primary approach is to quit smoking if applicable, and healthcare providers may prescribe medications to open the airways and reduce inflammation. In either case, it's essential to consult a healthcare professional for a proper diagnosis and guidance on managing the condition effectively. Antibiotics may be indicated, selection is guided by sputum culture, but more precisely with Respiratory PCR testing. What is sputum? Sputum is a term used to describe the mucus or phlegm that is coughed up from the respiratory tract, including the bronchial tubes, and expelled from the mouth. In the context of bronchitis, sputum plays a significant role as it is one of the hallmark symptoms of the condition. When a person develops bronchitis, the bronchial tubes become inflamed, and the body responds by producing excess mucus as a protective mechanism. This mucus can be clear, white, yellow, green, or even blood-tinged, depending on the severity and the underlying cause of the bronchitis. The color and consistency of sputum can provide valuable information to healthcare providers when diagnosing bronchitis. For example, yellow or green sputum is often associated with bacterial infections, while clear or white sputum may indicate a viral cause. Blood-tinged sputum could be a sign of more severe irritation or inflammation in the airways. Monitoring changes in sputum can help healthcare professionals determine the progression of the condition and guide treatment decisions. Sputum analysis, along with other clinical assessments, aids in tailoring the most appropriate treatment plan, whether it involves antibiotics for bacterial bronchitis, antiviral medications for viral bronchitis, or bronchodilators and anti-inflammatory drugs to relieve symptoms and reduce inflammation. Clearing that pesky mucus from the lungs. First things first, get the junk out! The Flutter Valve for Mucous Clearance 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 Incentive Spirometer for Increasing Depth of Breathing 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.Sel The 'Spacer' for an Inhaler to Increase Efficiency of Asthmatic Inhalers 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. The need for self help became obvious after my first hospitalization for pneumonia: 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 spacer-facemask, for my own situation. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750

COVID is back. Get ready, prepared and do not get caught by surprise. We have had 3 Covid patients in the past week that 'got it' on an airline, coming back from Italy. Products you must have on hand! As of the present date, the COVID-19 pandemic remains a global health crisis of immense significance. While substantial progress has been made in understanding the virus, developing vaccines, and implementing preventive measures, the situation remains dynamic and complex. One of the primary concerns in the current COVID-19 situation is the ongoing threat posed by the emergence of new variants of the virus. These variants can potentially impact the virus's transmissibility, severity, and vaccine effectiveness. Vigilance in monitoring and responding to these variants is crucial to stay ahead of the virus and adapt vaccination strategies and public health guidelines accordingly. Covid-19 Vaccination: is it right for me? Vaccination efforts have been a cornerstone of the global response to COVID-19. While numerous countries have made significant progress in vaccinating their populations, vaccine distribution disparities and hesitancy continue to be challenges. Further, it is becoming obvious that the COVID vaccines have limited durations of effectiveness. Through research done at the Stages of Life Medical Institute , looking directly at COVID-19 antibody levels, it was clear in 2021 that the vaccine would provide protection for as little as 90 days to a maximum of 150 days. Additionally, protection did not mean that an individual would not get sick, it simply meant that the severity of the illness would be reduced. In a word, you can run, but you cannot hide. The riskiest places to be are airports, airliners, movie theaters and other tightly enclosed spaces. Supplies to have on hand, if and when you get COVID-19 Hand washing will be the most effective way to protect yourself. The virus is largely fecal-orally transmitted, as is the nature of other COVID viruses. Yes, there are other COVID viruses, well known to the medical community, but particularly well known in the Veterinary community. Masks may or may not provide any protection at all. This is a matter of personal preference, but wearing one may remind you to wash your hands frequently and not take any unnecessary chances. Eating at restaurants should be done with caution. The virus does not survive well on hot foods, but can last a good while on cold foods. Wipe off your eating utensils, drink hot beverages and eat hot foods, preferentially. You can catch COVID just as easily from a sick child as from an adult. Do not share plates, portions of food or drink from the same glass. Other than that, get re-inoculated if it has been 6 months or longer . If you are adverse to getting the shot, this is a free country, at least for the time being. Booster or not, we are all at risk. Recommendations for those who get sick (Keep these on hand, just in case) Over-the counter ( Available with us at www.stagesoflifevitamins.com) \ Guaifenesin 400 mg by mouth (1 capsule, four times daily) Licorice Root Extract (1 capsule twice daily Lactoferrin Containing Colostrum (2 capsules four times daily) Prescriptions, if your physician so agrees: Plaquenil, hydroxychloroquine (200 mg, Take 2 tablets twice a day for the first day, then 1 tablet twice daily, for two weeks.) Benzonatate (100 mg by mouth twice daily, as necessary, for excessive cough.) Naprosyn (500 mg by mouth twice daily) Paxlovid (I'm not real impressed with this one) Our practice remained open, every day, during the COVID pandemic. We saw our patients in the office, in the most traditional manner. The only person that got sick during this period was me , and I got it while on vacation, not paying attention to the recommendations, above. The hydroxychloroquine is an anti-inflammatory, works well within the first 20 minutes or so of ingestion. The Naprosyn works with it through a separate mechanism. The over-the counter medications are incredibly effective, particularly if taken early in the disease. Have them handy, ready for use. I think we're winding up for a busy season. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Support for Memory Issues Inexpensively Huperzine A, sometimes known by its' chemical name selagine or the brand name, Cerebra. It has been around for many decades. It was originally used as a prescription medication for vascular dementia. As a phosphodiesterase inhibitor (PDE inhibitor,) Huperzine A is safe for general use, few side effects have been observed and it has many uses other than for support of memory. Huperzine A is a derivative of the Chinese club moss. As a cholinesterase inhibitor, is can be useful in treatment of memory impairment, focus impairment and dementia. It may take up to 6 months to fully appreciate the benefit in patients with Alzheimer's. Side Effects Side effects can include: diarrhea, vomiting, dry mouth, constipation, sweating, and blurred vision, slowing of heart rate and should be used with caution in patients with stomach ulcers. A gentle 'kick' for male sexual performance. Huperzine A is an inexpensive way to enhance male sexual performance, as well The older we get, the better we used to be? Well, Huperzine may help you in the memory, focus and performance categories and do so inexpensively. We are offering an independently assayed, quality product, very inexpensively. It will work with other products, prescription or over the counter. Start with one tablet twice daily. After a week or so, take one with breakfast, dinner and one an hour or so before 'show time.' David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Managing High Uric Acid, Naturally, for a Healthier Life. Levels over 5.5 increase risk of heart attack and death. High uric acid is more than an indicator of gout. It has classically only been associated with gout, a severe, inflammatory joint condition that often manifests initially in the big toe. However, recent research has linked high uric acid levels with many other chronic health conditions. Elevations of Uric Acid over 5.5 mg/dl are associated with dramatic increases in cardiac disease & mortality. The risk is far greater than the risk associated with elevated cholesterol, yet most patients never have their uric acid level tested, and fewer still receive treatment to lower it to safe levels! This article reviews the topic nicely: Serum uric acid and risk of cardiovascular mortality: a systematic review and dose-response meta-analysis of cohort studies of over a million participants This article is one of the best that I've reviewed on the topic. Over 66 million people in the United States have high uric acid levels, even though most do not know it. It can go undetected because many people do not have symptoms until it is well advanced and presents as an acute gout attack. A significant problem with modern health care is that most primary care physicians do not screen patients for uric acid levels, even those that are at high risk. What is Uric Acid? Uric acid is a breakdown product from purines, a protein component, as well as component of DNA. There are foods that contain higher amounts of purines than others. Furthermore, our body will raise uric acid after ingestion of fructose (corn syrup), sugar, or from alcohol consumption. Once purines metabolize to toxic uric acid, the body needs to eliminate uric acid from the body largely through urine and to a lesser extent, through feces. Elevation of Uric Acid will damage the kidneys, damage the lining of the arteries & arterioles resulting in disease in the kidneys themselves and to other end organs such as the heart. Certain health conditions or genetics can make elevations in uric acid more likely to occur, but the best management practice for high uric acid is a functional medicine approach. 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. What can be done? Allopurinol is a prescription medication that has been used for many decades to treat gout. The approach that is taken at Stages of Life Medical Institute (SOLMI) is to start with 100 mg taken twice daily. Repeat blood work in 90 days, adjust the dosage to achieve a level between 5.3 and 5.5. If the level is lower, all the better. Uloric is another prescription medication used to treat elevations in uric acid (hyperuricemia). The dosage there is 40 mg, daily.\ Alternatively, we use an over the counter preparation called "Uric Acid Balance" in patients that prefer to use 'all natural approaches,' and it works very well. The dosage is 3 capsules every morning. Combining intelligent choices in diet and life-style, achieving a safe level of Uric Acid is easy and delivers lifelong dividends. In short, elevations of Uric Acid over 5.5 mg/dl will result in atherosclerosis, kidney disease, and joint disease. David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute

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