The Fisher Institute - patient directed specialty care

08/02/2026

So many reasons to celebrate right now!

📚 School starts this week!
🎉 The Fisher Institute is celebrating one year of helping patients understand their health and live better lives.

To kick off the fall, I plan to talk about GOUT this week. Football season and Thanksgiving like to create a little chaos for people living with this condition.

And because everyone needs a little fun, I'm sharing my favorite photos from a year ago. It was during my headshot session with the wonderful Emily Porter. 😊

Here's to another year of education, compassion, and good intentions!

07/29/2026

Does anyone have suggestions on where to have an educational presentation/workshop for patients and providers? I would love to share my knowledge in person and provide supportive communities for my isolated patients. My goal has been to build an office with a space dedicated to this. Finances have delayed this dream unfortunately. I am open to any and all ideas except please don't write "grand rounds" for a multitude of reasons I should not have to elaborate on. DM me if you prefer to discuss in private.

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07/26/2026

I had a wonderful weekend at the EDS society global learning conference spending time with old and new friends. I truly appreciate everyone who has shared their experience and knowledge.

I am privileged to have my education and try to stay on top of research while traveling. On my flight, I read the below article, which I think many patients may find reassuring.

For context, the most common question I get asked is the value of ANA testing, specifically "do I have lupus?". My consistent answer is that its value lies in the situation it was tested in. Specifically what symptoms and findings were present to initiate testing in the first place. An ANA is not a diagnostic test and only assists in confirming a suspected clinical diagnosis. It can be positive for many different reasons and occurs in otherwise healthy individuals. When it is negative, it is extremely unlikely to have lupus based on a statistical measure called negative predictive value.

This weekend was a perfect reminder that medicine for me is always about whole people, not just a single test result.

https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.25682

07/10/2026

I plan to post more after school starts! Has anyone else noticed unusual amounts of viral activity this spring and summer? It has been creating an unusual pattern in my patients and new patient requests. I was going to make a sarcastic list of possibilities but I will restrain myself from spreading false information.

06/24/2026

It has almost been a whole year of practice! I am so proud of myself and so grateful to all the people who put their lives in my care. Thank you all for your trust and support!

Now after canceling all advertising about 9 months ago, I had been able to keep up with new requests until I got bombarded with doctor referrals. In order to maintain order, we now require all patients fill out a new patient form at my website. I have to apologize to everyone because I am getting so many requests it is hard to keep up. Please give me some grace while I sort through files and determine urgent versus non-urgent care. I truly appreciate your patience and understand your concerns.

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06/06/2026

No affiliation.

Since the beginning of the COVID-19 pandemic, the number of people living with postural orthostatic tachycardia syndrome, or POTS, has doubled—and many of them are saying that the recommended treatment is making things worse.

Often caused by viral illnesses, it's a condition that leads to an abnormal rise in heart rate and is associated with symptoms like dizziness, brain fog, and fatigue. POTS patients are often encouraged to remedy these symptoms through exercise. But many sufferers say exercise worsens their condition.

Learn more about this complex disorder, and how some are seeking relief: https://on.natgeo.com/PT0qbV

05/30/2026

My apologies for the delay in sharing this post—it has been a busy week.

Last weekend, I had the privilege of participating in as well as speaking at Evansville’s first *Running with the Zebras 5K*, an event dedicated to raising awareness and supporting research for Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD).

A heartfelt thank you to Lillie Price for the incredible work she put into organizing such a meaningful event and bringing together a community grounded in resilience. Meeting patients and families seeking answers, connection, and encouragement was impactful.

As a physician, experiences like this serve as an important reminder that beyond education and training, listening, advocating, and simply showing up for patients and families can make a meaningful difference. I left feeling humbled, grateful, and inspired. I look forward to continuing to learn along side this community as I strive to provide thoughtful, informed, and compassionate care.

05/28/2026

Due to an overwhelming amount of provider faxed referrals without proper communication of our Cash Pay only practice, all new patient requests must go through our website "new patient form". You may have referrals faxed to other local hospital departments or private practices for insurance processing.

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05/16/2026

🦓 As we get closer to “Running with the zebras” 5k in support of Ehler Danlos Syndrome (EDS) & Hypermobility Spectrum Disorder (HSD), I wanted to share a few running tips for individuals with hypermobility. This is for all athletes, whether you are a turtle or a hare. I am a “jogger” a.k.a. lazy zebra runner.

One of the most important things to remember: your warm-up matters. Because our muscles, connective tissues, and even blood vessels tend to be a bit more “stretchy,” it can take extra time to prepare the body for aerobic activity. I recommend a **slower, dynamic warm-up**—think weight-bearing movements without weights for a few rounds or even a slow, intentional 3-5 minute walk before increasing intensity. You may feel more muscle burn and lightheadedness when you avoid this key step.

I’m also a strong advocate for **strength training** in hypermobile patients. I know it can feel intimidating when joint instability is part of daily life, but building strength is essential. The key is finding the right balance between strengthening and stretching. This is one reason I often recommend **physical therapy (PT) early after diagnosis**. PT helps develop body awareness—even as adults—which can reduce unnecessary stress across joints over time.

**Running Tips for Hypermobility:

🏃‍♀️ **Use shorter strides** to reduce stress across unstable joints. If you want to go faster, think quick feet like a roadrunner rather than over-striding.

👟 **Wear stable, supportive shoes** that help provide consistency and confidence.

⚠️ **Protect your joints during the run.** Avoid pushing through sharp pain and pay close attention to joints that tend to feel unstable or vulnerable.

💧 **Stay well hydrated**, and consider replenishing electrolytes after the race.

🛌 **Prioritize recovery.** Give yourself a rest day before and after the race to allow your body time to recover.

🥗 **Focus on nutrition surrounding the race.** Healthy carbohydrates, fresh fruits, fresh vegetables, and lean protein can support performance, recovery, and endurance.

🚴‍♀️ **Cross-training matters.** As training progresses, utilizing any type of bicycle, elliptical, or water-based exercise can help maintain endurance and strength without over-stressing unstable joints.

On a personal note, I also navigate my own hypermobility challenges: over-pronation at my ankles, knee hyperextension, hypermobility in my hips and low back with pelvic floor weakness and prior lumbar and cervical disc herniation, and lastly shoulder instability/subluxation.

** When I run, I mentally go through a cyclical checklist:

1️⃣ **Ankles:** I focus on pushing through my big toe to help maintain alignment and stability.

2️⃣ **Knees:** I keep a slight bend during heel/midfoot strike to avoid locking into hyperextension.

3️⃣ **Back/Belly:** I gently lift my pelvis forward and “zip up” my core by pulling the front of my pelvis toward my ribs.

4️⃣ **Shoulders:** I pull my shoulders back then down then slightly forward, keeping movement controlled and focused on core engagement to reduce excess strain.

**Then repeat.**

It sounds complicated—and honestly, sometimes it is—but focusing on these details becomes a helpful mental checklist. In many ways, it’s distracting while doing something that can be uncomfortable, yet ultimately so good for my body.

Best of luck to everyone participating on race day! I look forward to seeing all of your stripes!! 🦓❤️🧡💛💚💙💜

05/11/2026

🌵 Sjögren’s syndrome: when your eyes and mouth decide hydration is officially optional. 🌵

This autoimmune condition causes severe dry eyes and dry mouth — but it is far more than just “feeling a little dry.” Patients often describe their eyes as feeling like sandpaper is trapped under their eyelids making it impossible to wear contacts if needed. Eating something as simple as crackers or bread without fluids can become nearly impossible because saliva production is so impaired.

Importantly, this is *not* caused by dehydration, allergies, or medications. In Sjögren’s syndrome, the immune system attacks the salivary (spit-producing) and lacrimal (tear-producing) glands. What many people do not realize is that Sjögren’s can also affect nearly any organ system in the body, including the lungs, kidneys, nervous system, joints, and blood vessels.

Sjögren’s syndrome affects an estimated 1–4 million Americans, representing approximately 0.1–1% of the population. While autoimmune diseases are receiving more attention publicly, they are still relatively uncommon overall. That said, there are strong genetic tendencies, and it is very common for me to see clusters of autoimmune diseases within families. Unfortunately, like many rheumatologic conditions, women disproportionately carry the burden. Sjögren’s affects women nearly 10 times more often than men, with the average age at diagnosis around 50 years old.

Luckily, there are well-established classification criteria for Sjögren’s syndrome, and textbook presentations often emphasize severe “sicca” symptoms — dry eyes and dry mouth. Blood tests are extremely helpful, however as I always say: laboratory testing is only as accurate as the clinical context surrounding it. 🧐

The standard evaluation typically includes:
• ANA by IFA
• SSA (Ro) antibodies
• SSB (La) antibodies

If these tests are negative but suspicion remains high, the ACR/EULAR classification criteria recommend a salivary gland (lip) biopsy to help confirm the diagnosis.

One of the biggest misconceptions in medicine is that negative blood work automatically excludes autoimmune disease. Approximately one-third of Sjögren’s patients are “seronegative,” meaning their standard antibody testing is negative despite active disease.

Recent studies continue to reinforce this reality. In patients with abnormal Schirmer testing (low tear production) and reduced salivary flow (low spit production), a significant percentage of seronegative patients still demonstrate positive salivary gland biopsies confirming Sjögren’s syndrome.

A few important diagnostic pearls:
• Anti-Ro/SSA antibodies are highly specific but not perfectly sensitive, meaning false negatives absolutely occur.
• Anti-SSB antibodies alone are no longer considered diagnostic.
• Rheumatoid factor (RF) is present in roughly half of patients and may correlate with more severe disease activity.
• ANA positivity >1:320 combined with RF can sometimes support the diagnosis in select seronegative patients.

As physicians, we must continue recognizing both the classic and systemic presentations of Sjögren’s syndrome. Not every patient reads the textbook cues before showing up to clinic.

💦 The good news is that this disease *is* treatable. However, managing Sjögren’s properly requires a full team approach involving rheumatology, ophthalmology, dentistry, primary care, and other specialists depending on organ involvement. Even more encouraging: there are several promising therapies currently being researched. I may or may not have already reached out to some of those research teams a little prematurely… whoops.