A 49 year old HMO patient and very busy business owner came in complaining of left heel pain for 3 months prior to seeing me (now about 7 months ago). He was interested in EPAT & EMTT treatment as a more regenerative solution to his heel pain (plantar fasciitis). He had completed 8 weekly EPAT/ EMTT treatments and noted his pain was 95% better. He doesn't even think about his foot now. He feels the heel is still improving even though the treatments have stopped. His last treatment (#8) in the original series was 7 weeks ago. He said he would like two more treatments one week apart and he recently just finished those and noted the pain is essentially gone (though his heel was sore after the last treatment for a day).
When he began this program he was 229 lbs. on 12/20/22 and he was 224 lbs. (2 months later). He had some blood in his urine 3/23/23 and went to the ER and he was diagnosed with 4 mm and 7 mm right sided kidney stones. He recently had the surgery with removal of one stone and destruction of the other. He was a little sore on his right side. His most recent weight was 220 lbs.. So he lost more weight in the last 1-2 weeks since having his surgery than in the two months prior.
His blood pressure was still elevated at his most recent visit 150/102.
HEALTH PROBLEMS
Esophageal spasm – caused by turkey, bread, ice cold water
Heel pain – right heal pain better
Hypertension
Kidney stones right kidney
Overweight
Sleep – better but needs more of it.
DIET
BREAKFAST: COFFEE + INFLAMX 1-2 SCOOPS AS MEAL REPLACEMENT DAILY
LUNCH – SOUP AND SALADS, BEANS, TUNA, TURKEY
DINNER - 1/4 ANIMAL FOOD, 1/2 VEGETABLES, 1/4 GOOD STARCH – LOTS OF BEANS
MEDICATION
Flomax .4 mg BID
SUPPLEMENTS
Algae Oil 2/d (omega-3s from algae)
Adrenal Health Packet 1 in morning (adrenals, energy)
Affirm 2/d (nitric oxide)
Arterosil 2/d (glycocalyx building in endothelium - inner lining of the artery)
Freedom 2/d (anti-inflammatory)
Homocysteine 2/d (lowers homocysteine, stroke and cardiovascular risk)
Metabolic Synergy 2/d (multivitamin/mineral)
Vitamin C 1000 mg (Costco) 2/d
Vitamin D 5000-10,000 IU (Costco) 2/d
IV 1-2 after surgery MJBVIs
COMMENT:
While I was happy his heel pain was better, I was not satisfied he hadn't lost more weight over the first 2 months. If you look at the blood parameters below you see a mild improvement in all of his blood work over the 2 months of treatment (in parenthesis is the most recent test) that correlates with his mild weight loss. At least all the parameters are going in the right direction. So he just has to keep this pace or pick it up for speedier reductions in his abnormal blood tests (or raising levels if deficient).
He is a busy business owner who is relatively young (49) with a growing business (& family) and he has some cardiovascular risk with an elevated CRP 3.7 (3.13), homocysteine 11.9 (10.2), a pre-diabetic A1C of 5.9 (5.8), Vit D 32 (38.6), TestT 240.3 (271.3), TestF 3.1 (5.3), borderline hypertension 133/85 (most recent 150/102), elevated macroalbumin/globulin ratio of 29.2 (< 3.5 is normal) which you see in hypertension. It means leaking of protein through the inner lining of the kidney artery which effects endothelial function negatively. He is also low normal in vitamin B12 447 (509) and vitamin D 32 (38.6) and is deficient in testosterone 240 (271) total and his free testosterone is low at 3.1 (5.3). His thyroid was normal and the good news is his coronary calcium score was "1" which means a low mount of atherosclerosis (calcified plaque) currently in his coronary arteries.
So why am I not completely satisfied with just his heel pain going away and that he has a low calcium score of "1"?
1) He is in an inflammatory state with the excess weight, elevated CRP at 3.7 (3.13), homocysteine 11.9 (10.2) and his A1C at 5.9 (5.8) all of which signify increased inflammation and probably reduce circulation which will make it more likely that his left heel pain/plantar fasciitis, may return!
2) He is living a very stressful busy life running a business and has a young family and I don't
see the health "buffers" of a good exercise program and good diet that healthfully loses weight and reduces his cardiovascular and diabetes risk.
3) He is trying and a repeat blood draw showed mild improvement in most parameters CRP 3.7 (3.13), homocysteine 11.9 (10.2), a pre-diabetic A1C of 5.9 (5.8), Vit D 32 (38.6), TestT 240.3 (271.3), TestF 3.1 (5.3),....at this pace though it could be 2-3 more months before really significant progress happens. I think he can speed it up a bit and "secure" his success.
4) You might wonder if I am treating his low testosterone...no not yet...Why? Because he is a young man at 49. If you start him on testosterone now, even though it may help some of his symptoms then you are essentially telling him to take it for life! When you give testosterone, you inhibit the feedback loops of how hormones are secreted. So, if I give him testosterone now, aside from him losing 10-15% of his testicular volume, it will suppress his own testosterone production and shut down the feedback mechanisms that tell his testis to produce testosterone. If he had exhausted efforts in trying to lose weight and be more fit and still felt very poorly then maybe I would give him testosterone at such a young age. But that is not the case. Not yet at least!
I ask my male patients and him "...are you ready to be on testosterone probably the rest of your life and need a physician to get a prescription for it?" I give men a choice. They decide. If he can lose 30-40 lbs. over the next 6-12 months on his own I will be willing to bet his testosterone levels improve, especially if he includes regular strength training. If I can get him to build muscle mass through strength training his testosterone may improve more. Also, herbal type testosterone boosters can help (Support T).
I also want him to do some intermittent fasting to "reset" himself like every month or every other month for a year until he gets to his desired weight. This will also reduce overall inflammation which will help his heel pain not return. I frequently recommend the Prolon 5 Day Fasting Mimicking Diet to achieve this. I like people to do it for 5 days each month for 3-6 months or until they achieve their desired weight and health goals.
So when I say "Treating the Whole Patient from 'Heart to Heel' "...This is what I mean! And if I help this patient with his weight, cardiac, diabetic and inflammatory risk factors his heel pain has less of a chance of returning.
So if you come and see me for some pain syndrome I will try, though I may not succeed, to get you to look at all of the reasons your body is creating the pain starting with your diet (elimination diets/modified fasting page 2), exercise or lack thereof, supplements, maybe correcting hormone deficiency and risk factors to vascular disease, diabetes, gut health, environmental insult, weight issues and even cognitive decline.
Yep a "Heart to Heel Work-up!"
Basic Men's Health Work Up (minimum labs; these are cost prices from Evexia a lab with significantly discounted cash prices we use through Lab Corp. Note prices are subject to change. I share them to give an estimate of cost. If you have a PPO some of these might be paid for pending your deductibles. If your are covered by Medicare all these tests are presently done at no charge except the SmartVascularDX which now is cash at $199).
Metabolic Panel (kidney and liver function, electrolytes, protein) ($7)
CBC (blood count - red and white blood cells) anemia, infection ($5)
Urinalysis (protein, sugar and red and white blood cells in the urine) ($10)
Vitamins (minimum) - vitamin D ($18), B12 ($9), B1 ($35) / Can do B2 ($72), B6 ($25), Vit C ($45), E ($25), A ($25)
Minerals (minimum) - Zinc ($10), magnesium RBC ($10) / Can do selenium ($22), copper ($17))
Coenzyme Q10 ($21) - cellular energy production and antioxidant
Omega - 3 Fatty acids (omega check - $21))
Hemoglobin A1c ($8) - diabetes risk (5.6 or below)
Insulin ($10) - Fasting - insulin resistance (< 10 then < 5)
DHEA ($15) - hormone from adrenals that improves well being, energy
Pregnenolone ($40) - hormone from adrenals for memory loss or pain
Testosterone- free, total, bio-available ($27)
Thyroid (free T3 ($10) &, T4 ($8), TSH ($6)
***Lab Corp prices subject to change. Can check with the office (916-489-4400) for current costs. Examples given to give an idea of cash outlay on typical lab studies for male subjects***
Inflammation Panel - for cardiovascular risk (plaque stability and endothelial function / CRP, MPO, LpPla2, F2Isoprostane, ADMA, MAC/Albumin, Ox LDL, cholesterol, HDL, LDL, Trig, C/H LDL-P, LDLs) ($154.00)
SmartVascularDX: Measures the immune response pathway for endothelial damage and gives a five year cardiovascular risk assessment ($199.00)
Optional Tests Frequently Added: BNP-heart failure ($38), D Dimer-clotting ($30) and Troponin (heart damage) ($50) - if significant cardiovascular risk, Covid or post-vaccine issues are suspected.
Chlelation Challenge for Heavy Metals (lead, cadmium, mercury, aluminum, etc.) with DMSA and Calcium EDTA (usually for hypertension, cardiovascular and dementia risk) - optional
Coronary Calcium Score - Heart Scan - (Sacramento Heart) - Established Health Associate patients have a discounted cash price for this test. Call Kirk Hamilton for more information. 916-489-4400
...And a complete head-to-toe physical with me including a prostate exam.
Note: Kirk Hamilton PA-C see patients starting at 7:00 a.m. straight through until 5:00 p.m.. Lunchtime office visits (12:00-2:00 pm) are available as well for Kirk Hamilton’s patients.
Kirk Hamilton PA-C
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com