Chemical dependency

Alcoholism, Substance Abuse

Go to now (or  Try to go to a meeting today and every day, but at least 3 times per week.  Woman should try to go to an all female group.  In a bit you should get a sponsor and pick a home group.   We offer several treatments for acute withdrawal including the Bridge device and presently do Vivitrol which keeps people from getting high and helps them to not be craving.  Suboxone is a reasonable choice for opioid dependent people who still have chronic pain. has a list of Suboxone providers.



Make the house smoke free.  Do not smoke as short. If you smoke more than a pack a day and you are trying to quit completely today, then nicotine patches, gum or lozenges may help.  We frequently prescribe buproprion for people who smoke because of their nerves.  Chantix is sometimes appropriate.


Obesity (adult)

Drink a glass of water before you eat or drink anything. try to walk for at least 20 minutes each day.  Do not skip breakfast. Limit alcohol to not more than 1 drink each day.  Try to go to bed, in the dark, with the TV off, for at least 7 hours each 24 hour period.  No food in the bedroom (only water).  One should have at least 4 vegetable servings each day.  If you are going to snack, try vegetables without dip or hand sized fruit. We should check to be sure you are not hypothyroid or diabetic.  Do not place more servings on the table than needed for the people who are eating. Reduce bread, potatoes, fried foods, gravy and cheese. A meat serving is 4 to 6 oz.  DASH and Zone diets are sustainable.



Take a walk in a peaceful place.   Make a list of everything that bothers you, then divide the list into too small to be worth worrying about, stuff you need to take care of, and outside of your control.  We previously used Valium, Xanax, etc but now we are supposed to use the antidepressants if medicine is needed.


Arthritis, Gout, Fibromyalgia

We usually need some blood tests to document severity and cause.  Reasonable activity is usually helpful. Exercise in Warm water is usually good.  Medications are different depending on disease and severity. If 2 regular Tylenol not more than 3 times a day will make it better, then it should be safe to continue that.


Atrial Fibrillation

Can cause strokes, it may feel like your heart is running away.  An EKG is usually needed to document what is going on and in many cases medication is appropriate for control.


Attention Deficit Disorder

Sometimes more rest and better activity schedule can make it better.  ADD can also be treated with non habit forming medications.


Benign Prostatic Hypertrophy

We have medications available to reduce the likelihood of needing surgery or a catheter.



Blood Clots

May cause swelling in one leg, shortness of breath or chest pain.  If you have a family history of blood clot problems you should try to get additional details.  We usually need some tests to evaluate.


Bronchitis, Asthma

If anyone smokes in your house or you smoke see information for smokers.  Prescription inhalers often help breathing to improve.  Singulair helps relieve asthma.



Regular visits with a mental health provider can be very helpful; however, in many cases SSRI and SNRI medications can be as helpful with less cost.



See also obesity discussion if applicable.



Headache, Migraine

Dealing appropriately with stress tends to help.  We try to differentiate between different types of headaches to optimize the treatment.  We do not prescribe Narcotic pain medications, but can usually achieve reasonable control.



Less ice cream, cheese, fried food may be appropriate.  Atorvastatin is very effective and available for less than $10/month.  For people that have muscle pain with statins, we have had good results with the addition of CoQ10 and vitamin D.



Can make life hazardous, getting proper rest can help but medications are usually needed to be taken every day for control.  If not under good control should not drive or be on the roof.


Erectile Dysfunction (ED) may sometimes be adequate; however, small doses of Cialis, Viagra, or Levitra may be very helpful.


Gastroesophageal Reflux Disease (GERD)

Avoid alcohol, coffee, grease, chocolate, spicy food and overeating.  Zantac two times a day frequently will help but we need to look for other diseases and sometimes use stronger medicine.


Herpes Zoster

Painful patch of blisters on 1 side of the body.  Call now, you may have shingles, if so we have a prescription to make it go away. If it is just starting the medicine works well, after a few days it does not help as much.  There is a vaccine to reduce the likelihood but it costs $200.





Stay away from salty snacks and ham.  Get at least 20 minutes of activity to clear your mind each day. Magnesium oxide OTC is sometimes helpful at lowering blood pressure.  We previously wanted the bottom number to be less than 90 but now we mostly just want the top number to be less than 140. We have good medicine to lower blood pressure if it is too high.  High blood pressure causes strokes, heart attacks and damages kidneys.  Sleep apnea and overactive adrenal glands can cause hypertension.



If present, you must stay on your medication every day or you will not do well.  Periodic testing is indicated if cold, tired, gaining or losing weight, cholesterol is too high or your medication is changed.


Heart Disease

Ideally we want to prevent these problems.  Myocardial infarcts are more common in patients with diabetes, high cholesterol or blood pressure and smokers which all are problems we try to control.  Evaluation of chest pain to determine what is the underlying problem is a core area for internal medicine physicians.  Heart failure usually requires some restriction on salt intake but we have good medicines to help with control.



Hot flashes, vaginal dryness, osteoporosis can all be related problems and have a variety of worthwhile interventions.


Peripheral Nerve Disorders

Secondary to diabetes or from vitamin deficiency, sometimes from too much pressure on the nerve.  The cause for the nerve disorder needs to be determined and then we should be able to reduce or eliminate the problem.



Back pain had been treated with significant amounts of opioid pain medications but treatment now includes: acetaminophen, NSAIDs, oral steroids, muscle relaxants, and anti-depressants.  Yoga, physical therapy, chiropractic can be helpful.  Tens, nerve stimulators and acupuncture are also used.



The present recommendation is Nasal steroids; however, Singulair frequently can help and is available as a generic now.


Skin Infections

Staphylococcus aureus is frequently a cause for recurring infections or possibly underlying diabetes.  Hibiclens or Betadine for the body and Bactroban nasal if the nose is involved have been helpful at clearing.


Vitamin Deficiency

Vitamin D deficiency is most common in this area and most people would be healthier if taking 5000 units every day.  If a person is on a reasonable diet they probably do not need any other vitamin supplements.