Paladin Family Practice

06/04/2026

A one-time infusion that permanently lowers your cholesterol. That's the promise behind a new gene editing therapy that just had results published in the New England Journal of Medicine.

The treatment is called VERVE-102, made by Eli Lilly. It's a single IV infusion that edits one gene in your liver called PCSK9. That gene controls how much LDL cholesterol your body keeps in your blood. Turn it off and your LDL drops.

In this trial, at the highest dose, LDL fell up to 62%. One infusion. Effects held steady over the follow-up period.

The idea behind it is interesting. Some people are born with this gene already switched off naturally. They carry very low cholesterol their entire lives and have dramatically lower rates of heart disease. This therapy is trying to give that same advantage to people who weren't born with it.

Now, the caveats. And there are real ones.

This was a very early, very small study. 35 patients. Side effects were mostly mild, but the follow-up period is short. Larger trials haven't started yet. We don't know what 5, 10, or 20 years looks like after this kind of edit.

And here's the part that deserves serious thought: this is permanent. You can stop taking a statin. You can't un-edit your genes. Permanence is the selling point, but it's also the risk. If something unexpected shows up down the road, there's no off switch.

I'm sharing this because the science is worth watching, not because I think anyone should be lining up for it. This is how medicine advances. Slowly, carefully, with a lot more data still needed. I'll keep following it.

https://www.nejm.org/doi/full/10.1056/NEJMoa2601283

This post is for educational purposes only and does not constitute medical advice. Talk to your doctor before making any decisions about testing or treatment.*

05/31/2026

You've probably heard that fiber is good for your gut. And it is. But the science is more nuanced than most people realize.
A 2021 Stanford study published in Cell compared two approaches: a high-fiber diet versus a high-fermented-foods diet. The results weren't even close.

The high-fiber group saw inconsistent results. Microbiome diversity didn't reliably increase, and some participants actually saw a rise in inflammatory markers. The benefits depended heavily on what their gut microbiome already looked like going in.
The fermented foods group? Microbiome diversity increased across the board.

Multiple inflammatory markers dropped. The results were consistent across virtually all participants.

We're talking about foods like sauerkraut, kimchi, kefir, and kombucha. Low-sugar varieties, eaten consistently. Not a supplement. Not a pill. Just real food.
This doesn't mean fiber is bad. It's still important long-term. But if you're trying to reduce inflammation and improve gut health, fermented foods appear to be a more reliable starting point for most people.

https://med.stanford.edu/news/all-news/2021/07/fermented-food-diet-increases-microbiome-diversity-lowers-inflammation.html

This post is for educational purposes only and does not constitute medical advice. Talk to your doctor before making any decisions about testing or treatment.

05/28/2026

They are not uninsured because they do not work.

Often, they are uninsured because they do.

They work full time. They are self-employed. They run small businesses. They work for small businesses that cannot afford traditional health benefits. Or they have insurance, but the deductible is so high that every visit, lab, scan, and prescription still feels like cash-pay medicine.

These are the people who often fall into the gap.

They may make too much to qualify for Medicaid, but not enough to comfortably afford private health insurance. And when something goes wrong, they are forced to do the math before they get care.

“How much will the visit cost?”

“What if I need labs?”

“What if I need an ultrasound, CT scan, or MRI?”

“What if the medication is too expensive?”

So they wait.

Not because they do not care about their health.
Not because they are irresponsible.
They wait because the system has made healthcare feel financially dangerous.

This is one of the places where Direct Primary Care can make a real difference.

At Paladin Family Practice, members pay a predictable monthly fee for direct access to primary care. No per-visit fee. No surprise bill for asking a question. No rushed appointment where you barely have time to explain what is going on.

But the value goes beyond access.

One of my favorite parts of building this practice has been shopping around locally for affordable labs, imaging, medications, and specialist options. Sometimes the difference between one facility and another can be hundreds or even thousands of dollars.

That means we can ask practical questions before money is spent:

Do we really need this test?
Where is the most affordable place to get it?
Can we use a cash-pay lab price?
Is there a medication coupon?
Is there a lower-cost pharmacy option?
Can this be handled here instead of urgent care?

Direct Primary Care is not insurance. It does not replace major medical coverage for emergencies, hospitalization, surgery, or major procedures.

But for day-to-day care, chronic conditions, urgent concerns, lab work, medication questions, and cost-conscious guidance, it can be a powerful solution.

Helping patients in this gap is one of the most rewarding parts of my work.

That is exactly who Paladin Family Practice was built to serve.

Learn more or sign up at:
www.PaladinFamilyPractice.com

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

05/24/2026

Memorial Day weekend, Shenandoah Valley. Flags out, coolers stocked, and every grill in the Valley is about to get fired up. It's also the weekend somebody's going to find out the lid handle is hotter than they thought. Every year I see the same handful of burns walk through the door, so here's the rundown.

The four ways people actually burn themselves at the grill:

Grease flare-up while flipping something fatty
Grabbing the grate, lid, or a metal handle that's hotter than it looked
Lighter fluid flash (usually with eyebrow and forearm hair as collateral damage)
Reaching across the grill and brushing an arm against the edge

What to do, in order:

Get away from the heat. Pull off any rings, watches, or bracelets near the burn before things swell. Run cool (not cold, not ice) tap water over it for a solid 15 to 20 minutes. Most people quit at two minutes because it doesn't feel like it's doing anything. It is. That's the step that decides how deep the burn ends up.

Once it's cooled, cover it loosely with a clean non-stick pad or even plastic wrap in a pinch. Ibuprofen helps with both the pain and the inflammation.

Things not to do, no matter what your uncle says:

Butter, mustard, toothpaste, ice cubes, raw potato. None of it. They either trap heat or set you up for an infection.
Leave the blister alone. That dome of skin is the best dressing you're going to find. If it pops on its own, trim the loose skin with clean scissors and cover it.

Go to the ER if:
The burn is on the face, hands, feet, ge****ls, or wraps around a joint
It's bigger than your palm
The skin looks white, leathery, or charred (deep burns often don't hurt much, which is the part that fools people)
It happened to a small child, an older parent, or someone with diabetes
There was a flash and now you're hoarse or coughing

05/18/2026

A new study out of UC San Diego tracked over 11,000 kids from ages 9 through 17. It's the largest study of its kind ever done in the U.S.

The findings: teens who use cannabis show slower development in memory, attention, language skills, and processing speed compared to their peers. The effects are dose-dependent, meaning the more they use, the more they fall behind. And THC exposure was specifically linked to worsening memory over time.

This matters because the adolescent brain is still actively developing. The prefrontal cortex, which handles decision-making, impulse control, and working memory, isn't fully mature until your mid-20s. THC disrupts endocannabinoid signaling during this critical window, and the deficits compound over time.

Cannabis is more accessible and more potent than it was 20 years ago, and a lot of kids (and parents) assume it's harmless because it's legal in many states. Legal does not mean safe for a developing brain.

MONDAY, April 20, 2026 (HealthDay News) — W**d can blunt teenagers’ brain development across a range of skills, including memory, attention, language and proces

05/05/2026

Big news in autoimmune disease research.

A study just published in Nature found something scientists have suspected since the 1950s but could never prove.

Some autoimmune diseases may be partly driven by DNA mutations your immune cells pick up over your lifetime. Not inherited. Acquired. These mutations can knock out the natural brakes on your immune system. When the brakes fail, your body attacks itself.

Right now, most autoimmune treatments work by turning down the whole immune system. Helpful, but blunt. If this research holds up, it could open the door to precision treatments that target the broken cells and leave the healthy ones alone.
We are a long way from that being standard care. But this is the kind of science that changes direction.

https://www.sanger.ac.uk/news_item/hidden-mutations-in-immune-cells-linked-to-autoimmune-disease/

This post is for informational purposes only and does not constitute medical advice. Always consult your physician regarding your individual health concerns.

Mutations in immune cells may be the missing piece in the autoimmune disease puzzle.

04/28/2026

It’s the same old game. Doctors treat patients. No middleman. Patients are happy. Third parties see a way to get involved. They create chaos. Preach how they can fix the chaos. They jump in a…

04/27/2026

New cholesterol guidelines just came out for the first time since 2018, and there is one change in particular I want to talk about. The American Heart Association is now recommending that every adult get tested at least once in their lifetime for something called lipoprotein(a), or Lp(a). Most people have never heard of it, and almost nobody has been tested for it.

Lp(a) is a type of lipoprotein, which is basically a particle that carries cholesterol through your bloodstream. It is similar to LDL (the one most people know as "bad cholesterol"), but it has an extra protein attached to it called apolipoprotein(a). That extra protein is what makes Lp(a) different and, honestly, more concerning. It does three things that regular LDL does not do as aggressively: it promotes plaque buildup in your artery walls, it drives inflammation inside those plaques, and it interferes with your body's ability to break down blood clots. So it is not just depositing cholesterol. It is making your arteries more inflamed and more clot-prone at the same time.
Here is the part that surprises most people. Your Lp(a) level is about 90% genetically determined. Diet and exercise do not really move it. You either have high levels or you do not, and you have probably had whatever level you have your entire life without knowing it. About 1 in 5 people worldwide have elevated Lp(a), and if your level is above 125 nmol/L (or about 50 mg/dL), your cardiovascular risk starts to climb. Above 250 nmol/L, that risk roughly doubles.

The other important thing is that a standard cholesterol panel does not include Lp(a). Your doctor has to order it separately. So you could have perfect looking cholesterol numbers on a routine panel and still be walking around with a significant hidden risk factor.

Practical takeaway: if you have never had your Lp(a) checked, it may be worth asking your doctor whether it makes sense for you. It is a simple blood test, it only needs to be done once in your lifetime since the level stays relatively stable, and it could change how you think about your heart health going forward. If your level does come back high, it is also worth mentioning to your parents, siblings, and kids, since they may share the same genetic risk.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Lp(a) is a genetic independent risk factor for heart disease. Knowing your Lp(a) levels can help you reduce your risk of heart disease for you or someone you love.

04/23/2026

Texas just launched an investigation into Lululemon over PFAS ("forever chemicals") potentially in their activewear.

Here's the full announcement: https://www.texasattorneygeneral.gov/news/releases/attorney-general-ken-paxton-launches-investigation-lululemon-over-potential-presence-toxic-forever

Why should you care? PFAS are a class of synthetic compounds that don't break down in the environment or in your body. They accumulate in your blood, organs, and tissues over time. The research linking them to thyroid disease, hormonal disruption, reproductive harm, and certain cancers is growing fast. And your skin is your largest organ. It absorbs what you put on it.

A company built on "wellness" potentially exposing customers to endocrine disruptors through direct skin contact during exercise, when your pores are open and absorption increases. That's a problem.

Attorney General Ken Paxton issued a Civil Investigative Demand (“CID”) to Lululemon USA Inc. (“Lululemon”) as part of an investigation into whether the company has misled consumers about the safety, quality, and health impacts of its products.

04/20/2026

If you have been following the GLP-1 weight loss conversation at all, this is a pretty big moment. There are now two FDA approved GLP-1 pills for weight loss. Not injections. Pills.

The Wegovy pill (semaglutide) launched earlier this year, and just a couple weeks ago the FDA approved a second one called Foundayo (orforglipron) from Eli Lilly.

Foundayo is interesting because you can take it any time of day with no restrictions on food or water. No fasting before your dose. No waiting 30 minutes to eat. Just take it and go about your day.

Now, the pills are not quite as powerful as the injectable versions. But for a lot of people they could be a great fit, especially for maintenance after hitting a goal weight or for people who want a simpler daily routine. Self pay pricing for both pills starts around $149 per month depending on the dose.

Practical takeaway: The landscape has changed. There are more options now than there were even six months ago, and the right fit depends on your goals, your health history, and what you are realistically going to stick with.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Under the new priority voucher program (CNPV), the FDA has approved a new oral GLP-1 drug, Foundayo, offering an alternative to Wegovy and injectable GLP-1s for weight loss.