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

Why Vitamin D??? Well, for starters, Vitamin D-3 is not a vitamin at all.  Vitamin D is a family of steroidal hormones that the body needs to maintain an ever increasingly appreciated number of bodily functions. Vitamin D occurs in 3 morphologies- Vitamin D1, Vitamin D2 and Vitamin D3. Vitamin D-2 is made in the gut from the precursor, Vitamin D-1 (which is essentially inactive.) Vitamin D-3 is the active hormone, and requires sunlight to convert from Vitamin D-2. As a moiety derived from cholesterol, low levels may be related to the use of cholesterol lowering medications, such as the statin family, and Vitamin D-3 is structurally similar to estrogen, testosterone and other adrenal hormones. Vitamin D-3, in doses of at least 2,000 IU/day will decrease the risk of breast cancer by 50%; reduce the risk of prostate cancer by 50%.  Getting therapeutic levels, as demonstrated by quantitative blood work, the typical dosage for adults is closer to 5000 IU per day. Pharmaceutical-grade Vitamin D-3 costs about $6 per month. It should be taken in the morning with a fish-oil capsule, to enhance absorption. It is absorbed best if pre-suspended or dissolved in olive oil. Higher doses are indicated in the presence of rheumatoid arthritis, M.S., and other auto-immune disease processes. Vitamin D-3 (cholecalciferol) is being shown to help prevent multiple sclerosis, osteoporosis and even prostate cancer. (See Daily Health News, March 29, 2004 and July 26, 2005.) Now it turns out that it may do even more — vitamin D and calcium may help prevent premenstrual syndrome (PMS). In the Nurses’ Health Study II (a large study of nurses that has been ongoing since 1989), women who consumed higher levels of these two nutrients faced a lower risk of premenstrual symptoms such as fatigue, irritability, mood swings and stomach cramps. Doses of Vitamin D-3 (2,000 IU) have been shown to reduce the risk of breast, prostate, colon and pancreatic cancer by as much as 50%. Recent studies have shown that vitamin D deficiency is very, very common, indeed.  It may be a co-morbid factor in the development of chronic pain as well as contributory to the development of a host of auto-immune disease. ___________________________________________________________ Who needs additional amounts of vitamin D? Anyone with inadequate caloric or nutritional dietary intake or  increased nutritional requirements. Older people (over 55 years), especially women after menopause. Pregnant or breast feeding women. Those who abuse alcohol or drugs. People who have recently undergone surgery. People with recent severe burns or injuries. The single best way to find out if you need supplemental Vitamin D-3 is to get a blood test through your doctor. D (cholecalciferol/ergocalciferol) Vitamin D-3 is the principal regulator of calcium homeostasis in the body. Vitamin D-1 and Vitamin D-2 are the inactive precursors to the active Vitamin D-3. It is essential for skeletal development and bone mineralization. Vitamin D-3 is a selective estrogen blocker, which may be the action that results in protection from certain cancers. Vitamin D is a pro-hormone with no hormone activity. It is converted to Vitamin D-3, if you have adequate Vitamin D-2 in your blood stream, and then you lay out in the sun. Vitamin D-3 is the form that has biological activity. The active form of the vitamin is 1-25-dihydroxyvitamin D, usually referred to vitamin D-3. It is synthesized in the skin from 7-dehydrocholesterol via phytochemical reactions requiring UV light (sunlight). Inadequate exposure to sunlight contributes to vitamin D deficiency. Adequate sun exposure, however, results in increase skin wrinkling and skin cancer. Increasing evidence suggests that vitamin D may also contribute to antioxidant function by inhibiting lipid peroxidation. The mechanism of the antioxidant effect is unknown. Vitamin D-3 deficiency in adults can lead to osteoporosis, which results from an imbalance between bone resorption and bone formation. Decreased vitamin D levels result in decreased production of the active vitamin form, vitamin D3. Vitamin D enhances the efficiency of calcium absorption. Chronic vitamin D deficiency results in a decreased calcium absorption and secondary hyper-parathyriodism. Vitamin D-3 has also been found to have anti-carcinogenic activity, including apoptosis in many types of cancer cells. It has also been useful in the treatment of psoriasis when applied topically. Vitamin D appears to demonstrate both immune-enhancing and immunosuppressive effects. Supplemental vitamin D-3 is available, inexpensive, and avoids the ill-effects of daily sun exposure. For more information, click on the image, below: David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute

Pregnenolone is an Adrenal Hormone, essential to life as the root hormone for all other Adrenal Hormones. It is converted directly from cholesterol, then it is converted to progesterone and on to DHEA, Cortisol, Testosterone, Estriol, and Estradiol, just to name a few. A hormone is a chemical entity that acts directly a class of signaling molecules. Inducing or inhibiting a gene to produce a protein, to cause a cell or tissue to behave in a predictable manner, or after having been secreted by one tissue, it would cause a tissue in a remote portion of the body to have a change in physiology or behavior. Little understood as a primary hormone, low pregnenolone levels are often seen in patients with Adrenal Insufficiency, low levels may be present in patients receiving 'statin' drugs to lower cholesterol. Additionally, low levels occur in patients who receive oral, injectable and inhalational corticosteroids. This Misunderstood Wonder Hormone is Important for Memory, Cognition and Sexual Health Of note, low levels of pregnenolone may be associated with memory impairment and cognition, low levels of sex hormones and may be associated with dementia. At Stages of Life Medical Institute, we have been testing our patients over the age of 60 for pregnenolone levels, and using a device called a "Cognivue" to assess cognitive impairment. Over the past 2 years, we have found that low levels of Pregnenolone were associated with mild to moderate cognitive impairment, and with treatment with pregnenolone, the cognitive impairment measured on the COGNIVUE improved in a matter of a few months. Additionally, the use of oral pregnenolone can increase progesterone levels in women who have post menopausal hypogonadism, that is low estradiol and progesterone. We monitor pregnenolone levels most commonly, twice yearly. It is an inexpensive blood test and yields a tremendous amount of value. We typically start our patients on 60 mg twice daily, but it should be taken concurrently with a fish oil. The reason for this is that pregnenolone is oil soluble and the stomach is a water environment. Pregnenolone will not absorb well unless it is taken concurrently with an easily absorbed oil. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 www.suffernomore.com

https://amzn.to/3LoCgDs If this sounds a bit dramatic, it really is an understatement of fact! You pay attention to the extra sanitary steps necessary to prevent UTI's. In women, it is time consuming but necessary. You are careful and yet you cannot rid yourself of the interval urinary tract infection. Antibiotic therapy is often necessary to clear things up. The side effects are an expected inconvenience, the expense of time lost from work is an even greater inconvenience. The loss of kidney function that can result with each and every kidney infection is an expense that we cannot afford, and every year, a significant number of persons (mostly women) die of URINARY SEPSIS. I will share one little trick, in this post. There will be more in the near future. The problem may have more to do with your laundry than you realize. In these modern days, when conveniences have become necessities, and the necessities become essentials, we may hardly notice when an obvious problem stares directly at us, in the face!. Our washing machines may be killing us with 'energy efficiency' and 'water savings.' We have been sold on a fairy tale that you can adequately kill bacteria and clean clothes without getting the water very hot, or using much detergent or water. Your underwear are simply not getting clean in our 'ENERGY STAR' appliances. A case in point: Would you clean old fashioned diapers in your washing machine, with your favorite shirts? The water cannot get hot enough to damage the bacteria, and the rinse cycle doesn't even get the soap entirely out of your garments. Take a few pairs of 'clean' underwear, drop them into a near-boiling pot of water, simmer for a few minutes and then see what floats to the surface! Lots of waxy looking material that doesn't look like underwear. Medical tip to treat chronic UTI's: It is expensive and nearly impossible to get a non-'Energy Star' appliance, these days. In a sort of twisted way, the environmentalists (of which I may be one) inadvertently make people sick, while feeling good about the way they fouled things up. Through a bit of trial and error, personal and family need for a solution to the UTI problem, my wife came up with a very easy and incredibly affordable way to put a dent in the problem. It is a simple additive to the laundry that costs no more than a few cents per wash. This magical bottle costs far less than $10 and was a part of the solution to our family's UTI issue. Add this to each wash, and the bacteria count on your clothes drops incredibly. It contains no bleach, it has no scent, and it does not damage the color in your clothing. Give this a try, it is cheap, easy and 'the doctor told you to do it!' More suggestions to come. Urinary Tract Infections can be life threatening, and I have a few suggestions for you to use and/or keep around the house until you need them. David S. Kle in, MD FACA, FACPM Stages of Life Medical Institute Longwood, Florida 32750 407-679-3337

We would like to help our patients find a way to introduce themselves to the wonderful world of healthful snacking and simultaneously getting a good dosage of essential carbohydrates (ECH). Advertised on television, almost 8 to 10 times an hour, "Vegetable and Fruit" supplements are more prevalent now, than ever. Many of these products will cost between $45 and $110 per month. If you want to check out 'Garden of Nature,' you can use this link. I think you can save a significant amount of money and get additional nutritional benefit from doing this one, yourself. Convenience in a can, capsule or tablet, I think that you can do better, by making your own smoothie in the kitchen or at work. There are a few simple tips from my "WMD." She is not weapon-of-mass-destruction, but more like: "Wife of the MD." The WMD, my wife, is better known to the grand children as "BIRDIE." So, for our first of many smoothie recipes, we will start with: Birdie's Basic Smoothie 1/2 banana (FROZEN) 1/2 cup plain Greek yogurt. Sugarless is best 1 cup low fat milk or rice milk 1 cup of frozen fruits and greens, e.g. berries, kiwi, spinach, kale, pineapple, mango Add a few ice cubes, if your banana or fruit was not frozen. Use your Ninja TWISTi Blender on high-speed. It comes out tasty enough for the Doc to enjoy. Like so many men, I would rather clean the gutters than eat Kale, but this smoothie is entirely different. Note Well: Use frozen fruit, but the frozen banana is what makes it nice and creamy. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 407-679-3337 www.suffernomore.com

The sweetener fructose, sometimes labelled as 'high fructose corn syrup,' is found in many processed foods, soft drinks and confections. NOTE WELL:  This is the carbohydrate found in those wonderful fruit drinks that we feed our little children. This may be one of the main issues leading to pediatric obesity. 1. It has  been found to cause leptin resistance, one of the hormones found to control hunger, thereby linking it directly to weight gain and obesity. Shapiro A, Mu W, Roncal CA, et al: Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high fat feeding. Am J Physiol Regul Integ Comp Physiol. 2008. 2. Fructose corn syrup (HFCS) has been found to be as addictive, if not more addictive than alcohol, tobacco, opiates and cocaine. 3. When combined with salt, and saturated fats, (e.g. candy, ice cream, coffee creamer), it is even more addictive. 4. Sadly, pediatric obesity is a leading risk factor for adult obesity. Due to both development of unhealthy eating habits, it changes the nature of the insulin receptor, leading to insulin resistance syndrome, pre-diabetes, and the game is heading for a big time disaster. 5. Focus on Hemoglobin A1c as a primary medical indicator of how well the patient is doing ignores the fact that A1c remains within what is now considered to be 'normal' for at least 10 years before the patient is handed the 'DIABETES' diagnosis. Insist that your doctor monitor insulin to glucose ratios several times a year. In health, the lower the insulin level, the better. Optimal insulin levels are below 10, best if below 5. When insulin levels climb above 15, it is time to take action. Glucose levels optimally should be below 85. When the level creeps above 90, it is time to take action. The insulin receptor is very, very complex. There are hundreds of places in insulin receptor metabolism that are vulnerable to dysfunction. This is why the approach to lowering blood sugar is not as easy as a selection of a single medication. You simply have to use the right approach to fix the problem, AS IT EXISTS. Actions to be taken: Avoid eating prepared foods that contain high fructose corn syrup, dextrin, dextrose or 'added sugar.' Look to 'Weight Watchers' for diet suggestions. For the money, it is a great program. Supplements should include a balanced chelate containing the appropriate amounts of zinc, selenium, chromium and vanadium. NOTE: Too much can be dangerous. Ask your physician for advice. Suggestions from Stages of Life will be listed, below. You can do this on your own, if you pay close attention not only to the dose of the mineral, but also the form that is in. The chemical moiety affects absorption, toxicity and dosing. Herbal products that improve insulin resistance include olive leaf extract, green tea extract, inositol. and bergamot. There are many others, and I plan to discuss them, later. When starting an insulin resistance or diabetes mellitus nutraceutical program, it is best to start with the basic replacements, and then introduce them one at a time, observing morning (fasting is best) glucose levels. You can do this with a finger stick machine, or your physician can order the glucose and insulin blood work. Try to stay consistent with all medicine usage and try to get the blood work done at a consistent time of the day. Start with a complete vitamin and mineral product. It need not be expensive, but the quality of the ingredients is of paramount importance. When you buy 'store brand' products, they tend to move toward the cheapest ingredients and they are not necessarily consistent in potency. Down to basics without iron is where I prefer to start. We have a sister product with iron, but it can cause constipation and iron deficiency is not all that common. Down to basics is very strong, and should be taken two capsules with breakfast and two capsules with lunch. If causes upset stomach, start with 1 capsule twice daily, and then increase 1 capsule per day, per week, until you get to 2 capsules twice daily. After a month of the Down to Basics, you ADD to the multivitamin an additional dosage of vanadium & chromium, with cinnamon and alpha lipoic added. The product is called "DiabetStat." One of these twice daily with meals is as much as you should take. DO NOT TAKE additional zinc, vanadium or chromium, as the combination of the Down to Basics with Diabet Stat gets you to the safe limit of these minerals. After a month on the Down to Basics and Diabet Stat, you can start Berberine 500 mg twice daily, inositol 500 mg (2 twice daily) and Olive Leaf Extract David S. Klein, MD, FACA, FACPM Stages of LIfe Medical Institute Longwood, Florida, 32750 suffernomore.com Tel: 407-679-3337

Foot pain is an extremely common complaint. Often the result of 'shoe trauma,' attractive yet uncomfortable high heels, tight shoes and daily wear and tear, the result can be an annoying interference with your daily activities. Get relief of inflammatory foot pain using an inexpensive, rapid acting cream. The most common joint affected by arthritis is the MP joint of the great toe.  If left untreated, it can result in the deformity known as a bunion. As with most minor annoyances, if left alone and ignored, it will get worse over time and become an increasingly important impairment to comfort. Arthritis here can result in pain with walking, standing, reaching overhead.  Over time, arthritis at this point can result in bunion deformity and reduced flexibility of the foot. Over 20 years ago, I developed a transdermal high-concentration MSM salve, to treat my daughter's horse. The creature suffered from inflammation of the knees & hocks. The alternative was veterinary injections, costing over $400 each, and horses, after all, have four of these joints to inject. The salve penetrated horse-hide, and is being used to this day on horses and other animals. With humans, I have had very good response using the high concentration MSM cream, Kink-Ease.  Begins to ease pain in about 5 minutes, it does not stink or stain, and it is very inexpensive. Best applied before climbing into bed, it should be used several times, daily.  Effects last 2-4 hours, or more. After a day or two, the duration of action increases to 3-4 hours, and often longer than that. The major side-effect is that the cream acts as a skin softener. If you use it on your feet, the callouses will soften, and the skin exfoliates. Nobody seems to mind this side effect. For more information: Visit our vitamins store for more! David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute Longwood, Florida 32750 www.suffernomore.com

Nothing makes for better education than experience, and my family has had some interesting insights that I'd like to share. The typical dip and read urinalysis, performed for many decades is outrageously inaccurate. It relies on 50 year old technology. Performed in an enormous number of physician's offices, emergency rooms, and there are home kits for the 'do it yourself' customer, the test is a quick way to get affirmation of an infection. That is, if it is positive, you probably have an infection. The problem is that the test is inaccurate and will detect a UTI between 50-60% of the time, that is, it is wrong nearly as often as it is correct. Manufactured in China, these strips will miss urinary tract infections, perhaps as frequently as 50% of the time. Urinary tract infection leads to urinary sepsis (blood poisoning, to some) and is a leading cause of death. Do you really want to rely on a $15 dip stick if your life or kidney function depended on it? A problem in the senior population, it is also a real problem with children. Missing almost 50% of UTI's in young children with fevers. Missing Chronic Urinary Tract Infection can result in preventable death and kidney damage. Natural, non prescription treatments will follow in the next UTI Blog Post Note Well: If someone close to you starts feeling oddly, for no other apparent reason such as stroke or heart attack, consider urinary tract infection as a possible cause. Ignoring this, it nearly cost my wife her life in July of 2023. IT WENT SOMETHING LIKE THIS: My wife and I were enjoying our 5th wedding anniversary by taking a trip to Portugal. A marvelous vacation it was, right up until the day before we were to return home. She had an unfortunate fall, fractured her right ankle, and became somewhat immobile. The following day, she started having 'morning chills,' thinking that it might have been a reaction to the previous nights' dinner. Resolving quickly, we thought nothing of it. The next day, we flew home, believing all was well. The next day she felt normal at 8:00 a.m. but became febrile with a temperature of 102 deg. blood pressure dropped to 80/palpable and she was in and out of consciousness. Oxygen saturation was down to 82%. When we arrived in the emergency room 30 minutes later, she was in shock. Treated with fluids, quickly, and given intravenous hydrocortisone to treat her adrenal failure (Addison's Disease) she 'bounced back,' delirious, but communicative. I had mentioned to the ER internist that my wife had darker urine than baseline, fever, chills, and a change in consciousness. I insisted that they treat her for urinary tract infection. Evaluation was rapid, including chest CT and abdominal CT, but her blood work was pending and her 'urinalysis' was negative. Informed by the ER physician that UTI was effectively ruled out, I insisted that they look a little closer at UTI as her problem. When her White Blood Cell count (WBC) returned at 33,000 with a decrease in kidney function to an eGFR of 27, they took a closer look at the abdominal CAT scan and found that she had pyelonephritis on the right kidney (infection of a highly significant nature) and started her on intravenous antibiotics. Five days in the hospital, she recovered. Her infection, however, was not gone........ The Monday following her hospitalization for a 'cryptogenic' bacterial UTI, I took her to my medical office, did a repeat urinalysis with a much higher quality screen, and it was NEGATIVE! On suspicion that the technology was flawed, I sent the urine to be analyzed by PCR, and we found that she had large amounts of a bacterium called 'enterococcus.' I had already started her on doxycycline, and she seemed to improve even more. We repeated her urinalysis weekly, it was negative for 3 weeks in a row, with positive PCR each time. She had a mixed infection with E. Coli and E. Faecalis, and I added amoxicillin to her mixture. Referred to a urologist, she is scheduled for cystoscopy with ureteroscopy to see if there is an anatomic issue with the right kidney and/or ureter. This little recent bit of personal history has changed my medical practice significantly. Urinary Tract Infection is not easily ruled out with a simple $15 dip stick test. In the past month, I have sent samples for PCR if the patient had even trace WBC in the urine, and 50% of the time, the PCR was positive for E. Coli or one of the less frequently encountered pathogens. I am now performing PCR on negative dip stick evaluations, if the patient is showing mild to moderate mental status changes, and if the symptoms are severe, they go straight to the emergency room. The number of patients found to be walking around with mildly symptomatic urinary tract infections was astounding. What was eye-opening was the fact that when we found infection, the patients all reported confusingly mild symptoms that in retrospect, were suggestive of UTI. I have picked up almost a dozen 'occult' urinary tract infections in the past 3 weeks. One very fortunate patient had become wheel chair bound, and it was blamed on her Parkinson's Disease. I sent her to the ER with the diagnosis of urinary sepsis, and following IV antibiotics (started before the PCR results returned as positive) she is now walking again and in physical rehabilitation to regain strength. The commercial insurance companies do not routinely cover urine PCR unless it is done to rule out sexually transmitted diseases. For the practitioner, if you include an STD panel with the urine PCR, it has a high likelihood of being covered, if not, the test can cost $600 or more. In the future, it is my hope that the insurance carriers will follow the lead of Medicare, and cover this service. I am fortunate in that I own a laboratory that has the capability of performing the testing, but for my patients that do not, the laboratory owners have agreed to reduce the price to a more affordable level of $240. The commercial diagnostic laboratory can be reached at: www.floridalaboratoryanalysis.com I will update this blog post, as more information becomes available. I will add published references and such, for validation of the data mentioned above. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute Longwood, Florida 407-679-3337

Into each life some rain must fall? As we get older, perhaps a bit less flexible and certainly more brittle, the risk of falling increases. In fact, it is one of the greatest risk to life as we enter advanced age. Changes in balance, weakness of muscle, joint stiffness contribute to instability, diabetes with associated small nerve damage results in easy stumbling, sleep problems lead to mental fatigue. The net result is an increased risk of injury due to fall. So it went with my family. My wife slipped and fell, twisting her ankle in such a way that it resulted in ankle fracture, a minimally displaced fracture of the fibula. Unfortunately, it happened while we on vacation in Portugal, and getting her back home had its’ own challenges. No weight bearing under the circumstance resulted in a 'leave no soldier behind' variant to the potato sack race through Lisbon International Airport. Wheelchairs were not to be had, and we had a plane to catch. We made it home, safe and sound, but in the process of working our way through this, my lovely wife did her own research as to what supplies, durable medical equipment/goods and combinations of the above would work well for the person recently advised to “NOT BEAR WEIGHT ON THE FOOT.” This was much easier said than done. Note this well: The most expensive place to get these products and supplies can be the DME store or the medical practices. The hospital is even more expensive, most of the time. The reason is not necessarily what you might believe it to be. In the medical world, dispensing anything along these lines most frequently requires them to have a HCPS Code, limiting the selection that your doctor can peruse, it is expensive for the manufacturers to obtain the HCPS Code, and the ‘savings’ is passed right on to you. Knee scooter: We tried several and found that the cheapest ones were entirely inadequate, unstable and may result in an even more catastrophic fall. After several efforts, she found the one that we will illustrate. Next she bought the essential cup holder. Here in Florida, you should always have something to drink available. Ambulation: It takes many weeks for the bones to heal, assuming the bones are properly lined-up and immobilized. The first thing we did was get an ‘orthopedic boot.’ There are many choices, some good, many not so great, but none of them were terribly expensive if you buy them on Amazon. If you go to the DME store, thinking that you’re going to get it cheaper with your insurance, you may be unpleasantly surprised that it is 3 times more expensive for the same item, you may be hit with co-payments, deductibles and the unfortunate “Not covered” letter. Let us start with the basics. Stability of the joint: You will need a Support boot for the joint. These are often dispensed at the Emergency Room, Orthopedic Surgeon’s office or Podiatrists practice. This works most of the time, but you are going to want to have more than one for a few important reasons. They need to air out, frequently. They start to smell badly if not aired out and cleaned , having a second boot is a luxury, not a necessity. Your call. The process of cleaning implies that they need to dry out more. The need to rotate your boots will soon become evident. We went through a few of these boots, after the initial, ER dispensed device was used. It got us home from Portugal, but now it sits in a bag in the closet, in case one of the better ones breaks. We found one that was easier to use, more comfortable and less bulky. They come with a few different options, it is an individual choice but I've used AirCast products for years and they have been highly reliable and of the highest quality. This boot has air pads that are adjustable, allowing a 'custom fit,' as it were. It was quite inexpensive and was more comfortable, fit better and is seeing the most use. Not a fashion item, it simply does the job comfortably. This might seem like a frivolity, but getting a ‘furry pad’ for the scooter will keep you from abrasions and pain in the injured limb. You simply attach the ‘furry pad’ to the scooter seat, and in comfort, you shall go. Absorbent socks are very, very handy, and will minimize the hygiene hassles that you might encounter. Buy several, or more. They wear out faster than you will believe. Lastly, most importantly, you must remove carpets from the floors. These are scooter-traps and can put you right back in the ER, if you are not paying attention. Clearly, you do not remove wall to wall carpeting, but throw carpets, designer items and such must be rolled up and put away until you can adequately navigate your home without hazard. More to come! The next blog will be on items that you need for creature comforts & hygiene, during your convalescence. Our favorite knee pillow, cast covers and more. Stay in touch. David S. Klein, M.D., FACA, FACPM, FAACPM (and a few more, but it looks silly) Stages of Life Medical Institute is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.