If you're a patient managing joint/chronic pain, you've probably heard some version of "you need to move more." Movement matters enormously, but how you move, and whether you're building any real strength in the process, is what actually changes things long-term. That's the gap I want to talk about.

​Chronic pain has a way of slowly shrinking your life. You protect the thing that hurts, you move less, and over time the muscles that are supposed to support your joints and spine get weaker, which makes the pain worse, which makes you move less. It's a cycle that treating symptoms alone won't break. Research on conditions like low back pain, osteoarthritis, and joint degeneration consistently shows that progressive strength training, meaning building the muscles that actually support vulnerable areas, reduces pain and improves function in ways that rest, adjustments, and medication often can't sustain on their own.

I know this personally. I was diagnosed with scoliosis when I was 11, and for years the message was clear: manage it, limit yourself, and if it doesn't get better, look into surgery. I went through the full cycle. Physical therapy, chiropractic care, massage, pain medication. Some of it helped a little, for a little while. But nothing stuck. It wasn't until I started strength training that things actually shifted. Building the muscles supporting my spine, learning how my body moves, and addressing the weakness underneath the pain made a difference that years of other treatments couldn't. That experience is a big part of why I do this work.

If you've been told to exercise but haven't found an approach that actually feels manageable or safe, that's exactly where I can help. I work with people at all levels, especially those dealing with chronic conditions to build strength in a way that's individualized, intentional, and progresses at your pace.

-Bryan Adams
AdamsTrain LLC

​Perimenopause is the transitional phase leading up to menopause and typically lasts 2–12
years before a woman's final menstrual period. During this time, hormone fluctuations are
common and can contribute to a variety of significant symptoms. Menopause is officially defined as 12 consecutive months without a menstrual period.

Both perimenopause and menopause bring significant hormonal changes that can affect
metabolism, bone density, muscle mass, sleep quality, energy levels, and overall health.
Nutrition plays an important role in managing these shifts and supporting health as a whole.

More than any other life stage, consistency is key. Eating balanced meals that include protein, healthy fats, and fiber can help support satiety, stabilize blood sugar levels, and promote a healthy metabolism. Protein is essential for preserving muscle mass, fiber supports digestive health and manages cholesterol levels, and healthy fats aid in vitamin absorption and hormone production.

If I can offer one tip that makes the most difference for the women we see in our practice that are in their 40’s, 50’s and beyond it’s this, focus on consistent meal timing throughout the day. Consistent meal timing can prevent excessive hunger, reduce overeating in the evening, and minimize late-night snacking. In the typical American diet, dinner is the largest meal of the day. Shifting meal timing to support bigger meals earlier in the day helps with metabolism and cravings. Rather than focusing on restrictive diets or a medicine cabinet full of supplements, the most effective approach is to prioritize whole foods, balanced and consistent meals, regular physical activity, stress management, and healthy sleep habits. These foundational lifestyle habits can help support overall health and quality of life throughout perimenopause and menopause.

Collagen
Collagen supplements continue to grow in popularity, and for good reason. Collagen is the most abundant protein in the body and serves as a key structural component of the skin, hair, nails, bones, joints, and even the digestive tract.

Most common protein sources and cuts of meat are not significant sources of collagen because collagen is primarily found in animal skin, cartilage, and connective tissues, which are often discarded during processing. As a result, many people do not consume large amounts of collagen through their regular diet.

While research is still emerging, several high-quality studies suggest that hydrolyzed collagen, particularly marine-derived collagen from fish, may help improve skin hydration and elasticity. Because collagen molecules are too large to penetrate the skin's surface and reach the deeper layers where collagen production occurs, oral supplementation appears to be more effective than topical collagen products for supporting skin health.

Research also indicates that collagen supplementation may support joint and bone health.
Studies have found that consuming approximately 10-15 grams of collagen daily can help
improve joint function and reduce joint pain. Additional research suggests that hydrolyzed
collagen may increase bone density and strength, and decrease discomfort associated with aging and physical activity.

Collagen supplements can also serve as a convenient protein source. It is a simple, minimal ingredient protein that is easy to digest for individuals who have difficulty tolerating traditional protein powders containing whey, or other additives. However, collagen should not be relied upon as a primary protein source. Most collagen powders provide about 10 grams of protein per two tablespoons and do not contain all of the essential amino acids needed to support muscle protein synthesis. For this reason, collagen supplements are best used to complement a diet that includes a variety of high-quality, food-based protein sources.

- Bethany Frazier, dietitian
​Kansas City Dietitian Collective

Winter arrived in full force to welcome in 2021 with snow blanketing the ground. And with snow, along came the excitement for sledding. While sledding can be a fun winter activity for children and adults alike, it is important to take some precautions to keep everyone safe.

1. Sled during daytime hours. Avoid sledding at night or in poorly lit areas to reduce the chance of injury.

2. Dress warmly. Hats, mittens/gloves and appropriate winter gear are advised to prevent hypothermia. Children are at a greater risk of hypothermia than adults.

3. Consider wearing a helmet. Yes, the American Academy of Pediatrics recommends considering a helmet, just as children do for skiing. Sledding can lead to concussions and other serious injuries.

4. Avoid sledding near trees, bodies of water and fences.

5. Young children should be supervised at all times.

6. Teach children how to roll off of a sled that will not come to a stop on its own.

7. Children should ride upright with feet first and in the forward -facing position. This will decrease the likelihood of a head injury.

8. Avoid pulling children on sleds behind vehicles.

Have fun and enjoy the snow this winter!
Dr. Jennifer Teegarden

If you have a teenager at home, you likely know all too well about sleepy teens.  Teenagers need on average about 9 to 10 hrs of sleep at night, but most of them aren’t getting this amount of rest consistently.  Teenagers are growing, not just physically, but their brains are also developing, increasing their need for more sleep.  
 
So, why are they not getting the recommended amount of sleep?  Well, most teens brains are engineered to want to stay up late and sleep in.  However, most middle schools and high schools start early, with most teens arriving to school each morning by 8 am and some as early as 7 am. This translates into early wake times.  Sports, late evening practices, extra – curricular activities and increased amounts of homework often mean late nights for many teens.  
 
Lack of sleep or sleep deprivation in teens can have significant consequence and affect them in a variety of ways.  Teens lacking in sleep may often be more moody or irritable.  Parents may also notice an increase in more risk – taking behaviors such as fast driving, smoking, and drinking alcohol with chronic sleep deprivation.  There has also been an association between lack of sleep and an increase in reported car accidents and teens falling asleep at the wheel.  School performance often suffers as well and should be a red flag if parents are noticing a change in their teen’s grades. Attention, memory, and decision making all are affected by not getting enough zzz’s.  

So, if this sounds all too familiar with your teen, what can you do to help?  Well, there are a number of actions parents can take to help their teens get the rest they need.

1. Sleep schedule:  yes, teens can benefit from a sleep schedule.  Having a nightly routine and sticking to it.  A consistent bedtime and wake time can help.
2. Avoid oversleeping: (insert teen eyeroll).  Sleeping in might just be your teen’s favorite weekend pastime.  However, sleeping in until noon on Sundays is going to make it difficult to get to bed on time Sunday evening.
3. Early afternoon naps: If your teen is tired after school and he or she has time to nap before their evening practice or activity, a 30 minute nap can help provide some much needed rest.
4. Avoid screens: now, this is a hard one.  Avoiding use of TV’s, smart phones and other screens at least 1 hour prior to bedtime is advised.
5. Avoid caffeine: teens should have limited caffeine consumption.  Avoiding all caffeine during the afternoon and evening hours can help as well.  
​
If your teen is persistently tired despite implementing some actions to increase their rest, or you notice excessive snoring, contact their primary care physician for further evaluation and recommendations.

Sweet dreams!
Dr. Jennifer Teegarden

There has been a lot in the news recently about voluntary recalls of Zantac (ranitidine).  In short, the FDA found trace amounts of N-nitrosodimethylamine (NDMA), a probable carcinogen (cancer-causing compound), in some lots of the medication by several manufacturers.  
 
While the headlines are scary, this topic deserves a little unpacking.
 
First, let’s gain a little perspective.  According to the FDA, the levels of NDMA in many tested ranitidine products are similar to those consumed through "common foods like grilled or smoked meats.”  For some people, this statement is quite reassuring, while others are thinking, “What?!  My favorite grilled meat can cause cancer?”.  Well, yes and no.
 
Cancer is caused when damages to DNA result in uncontrolled over-growth of a cell or tissue.  Most of the time, our cells recognize the damage and either fixes the DNA or destroys the cells that have gone rogue.  A person’s overall risk of cancer is based on a number of factors including genetics and environment exposures https://www.cancer.gov/about-cancer/causes-prevention/risk/substances.  While some exposures can be avoided (tobacco smoke, excessive sun exposure), others are more difficult to avoid since they are present in the environment, including the air we breathe and the food we eat.  
 
Health Suite 110’s stock of ranitidine was not affected by these recalls as we are stocked by a different manufacturer.  That said, the FDA recommends “patients taking prescription ranitidine who wish to stop should talk to their health care professional about other treatment options. Consumers taking OTC ranitidine, which is used to prevent and relieve heartburn associated with acid indigestion and sour stomach, may consider using other OTC products approved for their condition. FDA’s testing of samples of alternatives such as Pepcid (famotidine), Tagamet (cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) show no NDMA in these medicines”. 
 
You can read more about the recall and specific lots affected on the FDA website: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine. 
 
For patients who prefer to switch from taking Zantac, these medications are not all interchangeable.  While Zantac, Pepcid and Tagament are all histamine-blockers (H2-blockers), things like Prevacid and Prilosec are proton-pump inhibitors (PPIs) and have different implications.  H2-blockers are generally felt to be safe for long-term use, while long-term use of PPIs can increase the risk for C.diff, pneumonia and osteoporosis.  If you require antacid medication on a daily basis, be sure to discuss with your physician.  Sometimes there is an underlying cause that can be treated (H. pylori infection, obesity, food triggers) and other times the risk of taking a medication long term far outweighs the risks of not taking it, particularly for folks who have pre-cancerous changes in their esophagus from long term reflux (Barrett’s esophagitis).
 
 
In summary:

• If you suffer from heartburn or gastroesophageal reflux (GERD), do not stop or change your medication without first discussing with your doctor.

 

• Talk to your doctor to discuss ways to reduce your heartburn symptoms (weight loss, avoiding food triggers and late-night eating).

 

• Consider ways you can reduce your exposure to carcinogens, including limiting intake of meat cooked at high temperatures, see below.

 
 
 
Five Steps for Cancer-Safe Grilling
1. Marinate: Studies suggest that marinating meat before grilling can decrease formation of carcinogens. 
2. Pre-Cook: If you are grilling larger cuts, you can reduce the time your meat is exposed to flame by partially cooking it in a microwave, oven or stove first. 
3. Go Lean: Trimming the fat off your meat can reduce flare-ups and charring. Cook your meat in the center of the grill and make sure to flip frequently.
4. Mix It Up: Cutting meat into smaller portions and mixing them with vegetables can shorten cooking time.
5. Go Green: Grilling of vegetables and fruits produces no carcinogens. So, add veggies and cut down the amount of meats.
 
 
Happy grilling!
Kylie Vannaman MD

For some, the holidays are a time for gathering, joy, cheer, family, friends, peace and togetherness. For others, the holidays are instead filled with isolation, stress, depression, family turmoil, heartache, and loneliness.  And maybe for the majority of us, it is a combination of the above.
 
During this season of thanksgiving, it can sometimes be difficult to maintain an attitude of gratitude. Some may feel it is only obtainable when all is going well.   According to Robert A. Emmons, Ph.D (noted to be the world’s leading scientific expert on gratitude and a professor of psychology at the University of California, Davis, and the founding editor-in-chief of The Journal of Positive Psychology), one of the five myths about gratitude is that it isn’t possible or appropriate in the midst of adversity or suffering. 

“Some argue that it’s impossible to be grateful in the midst of suffering. When life is going well, when there’s abundance—sure, then we can be grateful. But what about when we’re facing hard times? I believe not only is gratitude possible in those circumstances—it’s vital to helping us get through them. When faced with adversity, gratitude helps us see the big picture and not feel overwhelmed by the setbacks we’re facing in the moment. And as I’ve suggested above, that attitude of gratitude can actually motivate us to tackle the challenges before us. Without a doubt, it can be hard to take this grateful perspective, but research suggests it is possible, and it is worth it.”
https://greatergood.berkeley.edu/profile/robert_emmons#articles
 
Gratitude has been studied in patients after heart attacks. Gratitude at 2 weeks after a heart attack was associated with a higher self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) and improved emotional well-being 6 months later. It was concluded that gratitude may help recovery from a heart attack and that interventions promoting this positive construct could help improve adherence and well-being.
https://www.ncbi.nlm.nih.gov/pubmed/27796252
 
In another study of asymptomatic heart failure patients, gratitude journaling decreased lab results related to heart failure morbidity such as inflammation. 
https://www.ncbi.nlm.nih.gov/pubmed/27187845
 
Here is a TED talk I recently watched which involves a physician and her journey with gratitude while caring for a son with an incurable and terminal illness. Can you apply her experience to your own life’s situations? - https://www.youtube.com/watch?v=HHTmiHB6aXk&feature=youtu.be&list=PL9wE6J5iLNROCZYibeUCT9vWStvOc6EOZhttp%3A%2F%2Fyoutu.be%2FHHTmiHB6aXk%3Flist%3DPL9wE6J5iLNROCZYibeUCT9vWStvOc6EOZ
 
But how can I develop more gratitude?
I recommend a review of the following article by Dr. Emmons titled 10 Ways to Become More Grateful - https://greatergood.berkeley.edu/article/item/ten_ways_to_become_more_grateful1
 
Lastly, how can I be better prepared for the upcoming holiday season (and any “season” of life)?
I often recommend guided imagery, which is a form of meditation, as a way to practice mindfulness. By reconnecting with ourselves and being present for a short period of time, we can be better prepared for the stressors and challenges of life. 
To see if guided imagery is right for you, try listening to guided imagery audio for free on this Kaiser Permanente website - https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/FchBDoMgEADAt_iAzYZEYfFmhH6hhdsGiZIIGELt99seZ9DjC33hO-3cUy18_uxCLD22md9bqnCnLVZ8okd_Nd4zoysVAocj_o9bT-GM6IzVap2MBamlBCGsgEWPBohoUkKp8UErXjnTZxmGL2IKPpI!/
If you find these audio sessions helpful and would like more, I recommend resources from the following website - https://www.healthjourneys.com
 
“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. It turns problems into gifts, failures into successes, the unexpected into perfect timing, and mistakes into important events. It can turn an existence into a real life, and disconnected situations into important and beneficial lessons. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow. Gratitude makes things right.”
Melody Beattie

Dr. Charles Willnauer