Introduction
We've all been there: you go to the doctor with a concern, only to leave feeling invalidated and dismissed. This can be particularly challenging when you are already struggling with health issues that affect your mental and emotional well-being, such as unexplained weight loss, chronic pain, or even stress and anxiety. While healthcare professionals are generally trained to take all patient symptoms seriously, the reality is that not every interaction lives up to that standard.

This blog aims to empower you with ten strategies to confront a doctor who doesn't take your symptoms seriously. Because your health—both mental and physical—is too important to let someone else overlook.

1. Be Prepared
Before you meet the doctor, make a list of all your symptoms, how long they've been occurring, and any other related information. The more concrete evidence you can provide, the harder it is for a doctor to dismiss your concerns.

2. Keep a Symptom Journal
Having a written record of your symptoms can help reinforce your case. In your journal, document each symptom, its frequency, and severity. This data can serve as essential evidence in discussions with your healthcare provider.

3. Take Someone With You
Sometimes a second voice can help you feel more empowered and less isolated in a medical setting. They can also help remember important details you might forget.

4. Use "I" Statements
When explaining your symptoms, using "I" statements can personalize your experience and may help make the doctor more empathetic to your situation. For example, say, "I feel like my concerns aren't being taken seriously," instead of "You're not taking me seriously."

5. Be Firm But Respectful
Being assertive doesn't mean being confrontational. Clearly state your symptoms and concerns, and don't back down if you feel they are being dismissed.

6. Request Specific Tests or Referrals
Sometimes doctors may overlook tests that could help diagnose your condition. If you've done your research and believe a specific test could be beneficial, don't hesitate to ask for it.

7. Don't Be Afraid to Get a Second Opinion
If you feel your symptoms are still not being taken seriously, it may be helpful to consult another healthcare professional for a second opinion.

8. Use Social Proof
If you know others who have experienced similar symptoms and received treatment, mention these instances. Sometimes, showing that your symptoms are not isolated cases can help validate your concerns.

9. Know Your Rights
Understand that you have the right to quality healthcare, which includes being listened to and taken seriously by your healthcare provider. Familiarize yourself with patient rights in your jurisdiction so that you can advocate for yourself more effectively.

10. Consider Reporting the Incident
If you feel your concerns are continually being dismissed, you may need to take further action by reporting the healthcare provider to an overseeing authority.

Conclusion
Navigating the healthcare system can be daunting, especially when you feel dismissed by the very professionals who are supposed to help you. Remember that your health is invaluable, and you have every right to be heard and treated with respect. Utilize these strategies to ensure that your voice isn't just heard, but that it also compels action for your well-being.

Our time has come to an end and we are wrapping up our week at the Institute for Functional Medicine’s Annual International Conference in sunny Florida.
 
We jumped at the opportunity to attend this in person, the first time in 4 years (thanks covid). Our time together was memorable and brought us into alignment of where we see our practice growing and how we will continue to bring integrative medical approaches to the Des Moines medical community.

​So here’s the short list of what we are coming home with after this week...
 

Photo Credit: Whitney Warne, Ivory House Photography, 2023.

This past year has been a year of redemption; a year of me reclaiming my highest self. 

Recently I asked the Divine Powers that Be, How am I supposed to shine my light?

I waited in the space (there is no time in a meditative space, just being).

A song came through on my meditation playlist. One I have never heard before. One I most certainly didn’t put in the que. ​

As an “experienced mom,” I didn’t anticipate needing intervention feeding the newest addition to our family. However, after two weeks of exclusive breastfeeding, my nipples looked like they’d been in a bar fight, my baby was struggling to return to birth weight, and I had a mysterious pain that would radiate down my arms when my little piranha would latch on. My mysterious pain was dubbed “Lightening Nipple,” by Sarah Lee, not an official diagnosis code, but you get the point… Feeling like I was nearly ready to throw in the towel and being an enneagram 7 suffering from a perpetual case of FOMO, I was more than willing to meet with Crystel, IBCLC, IFM’s very own lactation consultant.

I’m not going to lie, it’s weird showing your boobs to your co-worker, that is NOT OK in most workplaces, but IFM isn’t most workplaces. ;) Our session started off discussing my baby's normal eating patterns, and growth history. We took a pre-feeding weight, to better estimate how much milk baby is consuming in a feeding. Then Crystel assessed baby’s pallet, latch and my poor battered nipples. She had recommendations for all of our problems (not the annoying kind of recommendations, the helpful kind). During the feeding session, she offered me a drink, she looked over the breast pump I brought with me, and we just chatted away… almost as if I was fully dressed. Ha! After the feeding session, baby went back on the scale to see how much weight was gained. The weight change is equivalent to how many ounces consumed, hence the term “weighted feeds.”

You might think Crystel has a pretty easy gig cuddling sweet newborns and pampering their mama’s, but don’t be fooled we put her to work! By the end of our appointment, she was ready to change clothes after being exposed to poop, pee, and spit-up; in that order. It was like watching an episode of “Dirty Jobs.” Only much, much cuter.

It was determined my baby had a slight lip and tongue tie, so we were referred to a pediatric dentist for further evaluation. Often the referrals we give at IFM are to the exact same providers we take our own family to. So, I felt confident we would be going to the right place. We went to the pediatric dentist a couple weeks later. The lip and tongue tie revision was simple and by 2 weeks post op, my nipples were healed, my baby was gaining weight, and I was no longer afflicted with “Lightning Nipple.” Whew.
​
I’m so thankful to work for (and personally utilize) a clinic that offers so many services that benefit patients of all ages. So, if you’re a new mom, an experienced mom; if you’re expecting, or you have a 6 month old; if your baby is struggling to gain weight or you’re finding yourself suffering from an awful case of “Lightening Nipple.” You need Crystel, IBCLC, she will guide you on your individual, beautiful breastfeeding journey. You have a choice in your healthcare, choose better, choose Integrative Family Medicine.
​

Do you have sharp, stabbing pain in your nipples? Does your baby have a thick white coating on their tongue that is not easily removed with your clean finger?

You might want to be seen to evaluate for thrush in your baby's mouth and also yeast on your nipples. Mom and baby are almost always treated together unless mom exclusively pumps.

Thrush usually continues to worsen over time unless treated. Moms may not believe they have yeast on their nipples because they are waiting to see white plaques like the baby's tongue. Don't keep waiting for that to appear! Moms usually have shiny skin on their nipples, irritated red or bright pink nipples.

Many times, the first thing I hear is, "I think the latch has gone bad." If the latch was well established and randomly is painful-- and the baby may be refusing to latch, there's my sign to be particularly looking for yeast. If you have a brand-new baby, a newborn- yes, the baby can get yeast in the mouth right away. A 4-day old infant could possibly have yeast growing on their tongue.

If mom was leaking milk prior to delivery and may not have been changing her breast pads often or washing her bras in hot soapy water, then the yeast will grow.

Yeast is normally found on our bodies. It grows and flourishes in wet, warm, and dark places. Yep, your bra is a wonderful place for yeast to feel at home.

How do we prevent thrush/yeast infections? Air out your nipples whenever possible, especially at night. Change your nipple pads often, just like you would a feminine pad. Wash your bras every day, especially if they are damp. Wash in hot, soapy water.

How is thrush treated?
There are several ways to treat. It usually depends on what the provider is used to. Most commonly I see moms prescribed an oral antifungal called Diflucan. (Don't drink alcohol when you take this, it will make you sick!) Or they will prescribe APNO, also known as Jack Newman's all-purpose nipple ointment, also known as triple nipple ointment, also known as magic nipple cream (mostly by me, lol).

​I prefer to see moms treated for yeast on nipples locally with APNO, so the other healthy yeast in their body stays put.
APNO needs to be sent to a compound pharmacy which is a special pharmacy that puts powders and liquid medication together and makes special creams and concoctions. They're pretty much wizards. It may take several hours before your APNO is ready for pick up.

Compound pharmacies in the Des Moines area include:
Hy-vee Windsor Heights
5 Star Pharmacy Des Moines
Central Iowa Compounding Urbandale
Precision Compounding Urbandale

On top of APNO after feeds, clotrimazole 1% is usually encouraged prior to feeds on your nipples. This way it also coats the baby's mouth when they latch. Where do we buy clotrimazole? Pretty much any pharmacy or store. It is over the counter and may be found in the foot fungus isle. Yes, it could be used for foot fungus. Not that foot fungus is on your nipple--or is it :)

For oral thrush in babies the go to medication used to be liquid nystatin. Yay Nystatin! Recently doctors realized that babies kept returning after being treated with nystatin. So, sometimes they treat with fluconazole or gentian violet. But it is a practical option to start out with the least invasive antifungal, so yes, your baby may start out with Nystatin treatment.

They will tell you to use the dropper to drop the liquid in the sides of their cheeks and on the tongue. We don't want the medicine to be put in a bottle and bypass the mouth all together, then we are defeating the purpose, TREATING THE MOUTH!

Speaking of the mouth. Commonly we see the yeast travel down the digestive tract all the way to the anus.  The yeast will set up shop around the rectum and look bright red with red raised spots. Oh yeah, it's very contagious and will find other warm, dark, wet places to grow.

Wash any binkies or nipples with hot soapy water and boil them every day. Change your nipple pads often, wash your bras often, air out your nipples at night, even if it gets messy!

Thanks for reading!

​There are several types of anemia. Anemia has a significant impact on your overall health and well being—primarily your heart. Today we are going over a few common types of anemia, their causes, symptoms, and what to expect if you are found to be anemic.

Anemia due to lack of B-12 can occur in people who have had gastric bypass/gastric sleeve surgery, chronic inflammatory bowel disease, long term PPI use (Omeprazole, pantoprazole, etc.,) and long term use of certain other medications. B12 plays a vital role in the development of red blood cells. B12 is found mainly in red meat, fish, eggs and dairy. B-complex vitamins are commonly taken for energy and focus (think Red Bull!)

Anemia due to lack of red blood cells from loss of blood: This includes women during pregnancy, after the baby is born, if they have heavy, frequent periods, and patients that have undergone recent surgery. It can also happen if there is internal bleeding, most often in the intestines.

Iron-deficiency Anemia: Iron is a vital element used to bind oxygen to hemoglobin. This is what carries oxygen to all of the cells in your body. This means that without enough iron, your heart needs to work harder to cycle the anemic cells throughout your body to provide them the necessary oxygen.

Children can also become anemic if they drink too much milk, don’t eat enough iron-rich foods, or have an increased lead level. This is why we check a lead level and hemoglobin around age one.

Although a direct link has not been completely established between anemia and heart failure, there seems to be a correlation. Low iron storage causes people to have a low capacity for aerobic activity. This means that your heart has to work harder to give you enough oxygen to exercise, walk up the stairs, push a shopping cart at the store—basically anything! 

• Symptoms of anemia can include:
• Chronic Fatigue
• Shortness of breath without exertion
• Dizziness
• Palpitations/fast heart rate
• Chest pain
• Cold intolerance

So what can we do?
Work with your provider to get your blood count and iron panel checked if you are symptomatic or in one of the high risk categories listed above. Many times we will recommend iron supplements or B vitamin supplements/injections. If you have great difficulty absorbing oral iron, you may need to have IV infusions of iron. For B vitamins, we have injections available for replacement for those who can’t absorb it orally. 

For kids, they should not have more than 24 ounces (3 cups) of milk per day. If a woman is having problems with heavy periods, it is important to treat the cause of the blood loss in addition to treating the deficiency.

Our hearts are very important, so let’s take good care of them!
​Stay Well !!! 

Semaglutide is a medication that helps control blood sugar levels and is used in the treatment of type 2 diabetes. In a previous article, we discussed the general characteristics of semaglutide, how it works, the benefits and risks of using it. In this article, we will discuss the outcomes of studies on semaglutide, and how it can improve health outcomes.

Effect on Diabetes and Weight.
Semaglutide has been shown to reduce the average blood sugar level over a period of three months, which is measured by hemoglobin A1c. It has also been found to reduce weight across multiple studies. However, we will focus more on the other risk reductions provided by semaglutide.

Effect on Cardiovascular Disease
People with diabetes have an increased risk of cardiovascular disease and, therefore, are at risk for a heart attack. Studies have shown that semaglutide can help lower this risk. In a study conducted by Marso et al, the first occurrence of death from cardiovascular causes was reduced by 26% in those who took semaglutide versus those who did not. A similar result was seen when they compared the difference in the same outcome when comparing oral use of semaglutide versus placebo. The risk was lowered by 21% in this study. These studies showed that, while not perfect, controlling diabetes with semaglutide did improve primary cardiovascular event risks. The occurrence of these events still occurring in those that were taking the medicine shows the complexity of this disease and that there is more to it than just controlling diabetes and/or weight as this medicine also showed a reduction in patient’s weight.

Effect on Cholesterol and Triglyceride Levels
Semaglutide has also been found to improve cholesterol and triglyceride levels, which are part of metabolic syndrome. Metabolic syndrome is a condition that consists of weight gain, diabetes, high blood pressure, and high cholesterol. Studies have shown that semaglutide can help reduce free fatty acids, VLDL, LDL (bad) cholesterol, and triglycerides compared to other diabetes treatments. It also demonstrated a reduction in blood pressure overall. By improving blood sugar control, reducing one’s weight, reducing LDL (bad) cholesterol and triglycerides, as well as improving one’s blood pressure, the treatment of metabolic syndrome as a whole improves and the overall risk that that diagnosis carries goes down as evidenced by the cardiovascular outcomes above.

Studies on Semaglutide
The evidence provided in this article is a sample size of studies that have occurred and are occurring to study semaglutide in greater detail to see how truly effective it is against these kinds of diseases. It is very reassuring thus far, and it is a general rule that if various other studies show consistency with their outcomes, then this medicine is truly doing these kinds of things to the human body, which is fantastic news as diabetes, obesity, poor cholesterol control, hypertension, and vascular disease, among other illnesses, have plagued our society for far too long.

Conclusion
In conclusion, semaglutide is a significant contributor to helping people get their lives back on track. Although it is not the only answer to diabetes, obesity, poor cholesterol control, hypertension, and vascular disease, it has been found to provide promising results in controlling these conditions. We encourage readers to read the cited articles and to discuss with their providers in order to put anything they have questions about in context, as these studies are not perfect, and the data coming from them is realistic meaning that not every single thing we want to be better is going to be better.

• Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–1844. doi: 10.1056/NEJMoa1607141. 

                    https://www.nejm.org/doi/full/10.1056/nejmoa1607141

• Husain M, Birkenfeld AL, Donsmark M, Dungan K, Eliaschewitz FG, Franco DR, Jeppesen OK, Lingvay I, Mosenzon O, Pedersen SD, et al. Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2019;381(9):841–851

                   https://www.nejm.org/doi/10.1056/NEJMoa1901118?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

• Capehorn, M., Ghani, Y., Hindsberger, C. et al. Once-Weekly Semaglutide Reduces HbA1c and Body Weight in Patients with Type 2 Diabetes Regardless of Background Common OAD: a Subgroup Analysis from SUSTAIN 2–4 and 10. Diabetes Ther 11, 1061–1075 (2020).

          https://link.springer.com/article/10.1007/s13300-020-00796-z#citeas

​

​If you're looking for a new medicine that can help you with diabetes and weight loss, you may want to consider semaglutide. This medicine belongs to a class of drugs called GLP-1 agonists, which are used to stimulate cellular receptors in your body. Semaglutide is a natural hormone that's produced by your body after eating a meal. It increases insulin production and sensitivity of insulin receptors, which helps regulate your blood sugar. It also acts on your stomach and brain to slow down your digestive system and reduce your appetite.

Semaglutide is one of several GLP-1 agonists that are used to manage diabetes. However, semaglutide has also been found to be effective for weight loss and reducing the incidence of cardiovascular and cerebrovascular diseases. It comes in three different brands, including Ozempic and Wegovy, which are injectable, and Rybelsus, which is taken by mouth. Injectables tend to be more effective than oral medications because they are not subject to first-pass metabolism, which can reduce the efficacy of the drugs.

Semaglutide is particularly effective at promoting weight loss. Clinical studies have shown that people taking this medication have lost at least 10% of their initial body weight. This is because the drug reduces hunger levels, which leads to smaller portions and fewer calories consumed. The drug also improves insulin resistance, which helps regulate blood sugar and reduces the risk of developing cardiovascular and cerebrovascular diseases.

The most common side effects of semaglutide are nausea and constipation. These side effects are also common with other GLP-1 agonist drugs. Semaglutide is not recommended for people with a personal history of pancreatitis, MEN-1 syndrome or medullary thyroid carcinoma, or a history of recurrent gallbladder disease.

One issue with semaglutide is that it may not be covered by insurance if you're using it for weight loss without a history of diabetes. However, the drug is widely covered for people with diabetes or insulin resistance. Other supporting diagnoses may also qualify for coverage, but this can be complicated.

Semaglutide is a powerful tool for achieving ideal health. It not only improves diabetes and weight loss, but it can also lead to improvements in high blood pressure, high cholesterol, sleep apnea, joint disease, fatty liver disease, and depression, as well as other psychological illnesses. This medication can help you improve your diet, energy levels, and health habits, leading to a transformation in your body both externally and internally.

In conclusion, semaglutide is a promising new drug that can help you with diabetes and weight loss. If you're interested in learning more about it, talk to your doctor to see if it's right for you.