Category: Health

Acne is a common problem that gives too many people too much grief. Many conventional acne (or acne vulgaris) treatments—antibiotics, oral steroids, hormonal birth control pills, and isotretinoin (sold with brand name Accutane)—have serious, sometimes downright scary, side effects. There may be cases when these nuclear options are necessary, but I know many folks would prefer to try diet, lifestyle, and more natural interventions first.

The good news is that as common as skin issues like acne are today, they are not an inevitable part of the human condition. Grandfather of the ancestral health movement Loren Cordain asserts that acne is basically unheard of in traditional-living societies. This strongly suggests that modern lifestyle factors underlie much of what we see today. And if that’s the case, then there are steps we can take to cut acne down at the source.

I’ve always believed that there is a deep connection between skin health, gut health, and inflammation. I’m not surprised when people tell me that their acne, psoriasis, eczema, and other skin conditions are “miraculously” resolved after going Primal. The Primal Blueprint is designed to support a diverse, well-balanced microbiome, reduce chronic inflammation, and provide epigenetic signals that optimize health. It makes sense that clearer skin would be one of the benefits.

Some skin is finickier than others, though. I can’t promise that dropping grains and sugar, swapping out pro-inflammatory oils for better fats, and working on sleep hygiene is doing to solve the acne puzzle for everyone. If you’re struggling to “love the skin you’re in,” as the saying goes, here are some things to try.

What Causes Acne?

Acne doesn’t have a single root cause, which is one of the reasons it can be tricky to address. Sebum (oil) production, pore blockage, bacteria like Propionibacterium acnes (aka P. acnes), and inflammation each play a role. Androgens increase sebum production, and hormonal changes related to puberty, menstruation, pregnancy, PCOS, or menopause often lead to outbreaks.

Although many treatments target what’s happening on the surface, your skin’s appearance and condition are part and parcel of the body’s overall health. Systemically speaking, hormonal balance (or lack thereof) and associated nutrient levels strongly influence the production of oil, the skin’s vulnerability to invasive bacteria (and presence of “good” defensive bacteria), the natural production and turnover of skin cells, and, of course, underlying inflammation. It doesn’t help that we live a modern existence full of inflammation triggers: pollution in the air and water, harsh personal care products, chronic stress, and lack of sleep to name a few. There’s also a strong genetic component to acne, and some folks simply appear to be more vulnerable, unfortunately.

Acne sufferers frequently need to try a variety of dietary, lifestyle, and topical interventions before (hopefully) finding what works for them. Pharmaceuticals may become necessary, and I’m not looking down on anyone who goes this route. I know how much of a psychological toll chronic acne takes. But I’m strongly biased toward starting with more natural holistic approaches when possible.

How to Treat Acne Naturally

This is a non-exhaustive list of remedies that are backed by science and that members of the MDA community have told me worked for them.

Diet and Acne

This is where everyone should start, in my opinion, regardless of what else they’re trying concurrently. There’s absolutely no doubt that what you eat is reflected in your skin (although I’m happy to report that chocolate doesn’t seem to cause acne). You could go the route of doing a total elimination diet with systematic reintroduction to identify potential triggers, but that’s an onerous process, frankly. Instead, you can just try these first:

Glycemic load

Of paramount importance is checking your carb intake. Both observational and experimental studies link greater intake of high-glycemic carbohydrates to more frequent and more severe acne symptoms. High-glycemic load diets probably promote acne through several metabolic pathways, including by stimulating insulin-like growth factor 1 (IGF-1) and androgen and causing inflammation. For some people, acne is significantly improved simply by lowering the glycemic load of their diet, and I’m sure that this is a big reason why going Primal helps so many. If high-carb foods, especially of the hyperprocessed, nutrient poor variety, have snuck their way back onto your plate, you know what to do.

Dairy

Anecdotally, dairy seems to cause skin eruptions for many of you, an observation confirmed by a recent meta-analysis which reported that folks who drink more milk are more prone to acne. The American Academy of Dermatology also recommends that acne sufferers limit dairy intake.

For what it’s worth, skim milk seems to be more problematic than whole milk. Also, in that meta-analysis, there was no significant relationship between acne and cheese or yogurt consumption. I hear all you cheese lovers rejoicing at that news, but hold up. I’d still recommend cutting out all dairy for at least a few weeks to see if it helps. If you notice your skin clearing up, continue the no-dairy experiment for a while longer. Then, if you wish, you can start adding back dairy a little at a time, starting with fermented dairy (yogurt, kefir) and cheese (fermented or unfermented).

Other food sensitivities

I can’t tell you how many readers have confided they struggled for years, even decades, with acne before switching to a Primal diet and finally getting relief. Many of them traced the root of their problem to gluten. Others were particularly affected by dairy, soy, or eggs. Occasionally, random food sensitivities were the issue.

Consider keeping a food journal to see if you can spot any patterns between what you’re eating and your acne flare-ups. When you identify likely culprits, try cutting them out for a few weeks and see what happens with your skin.

Supplements

Beyond the power of a clean, anti-inflammatory diet, I suggest adding a good comprehensive supplement as well as extra zinc, vitamin B complex (especially vitamin B3), vitamin A, and vitamin D to assist with regulating oil production and further boosting the skin’s natural repair abilities. Research has especially supported the role of zinc deficiency in acne. Women who are pregnant, nursing, or have recently weaned are particularly at risk because of higher need for zinc.

Also make sure you get plenty of omega-3s through small, oily fish or supplementation. Some folks report good experiences with adding evening primrose, an anti-inflammatory omega-6 as well.

Finally, a good probiotic can help your body (and skin) balance its own “good” bacterial defenses. Various Lactobaccilus and Bifidobacterium strains have been shown to improve skin health.

Gut Health

Speaking of probiotics, if you want healthy skin, you need a healthy gut. There is a strong gut-skin connection, and skin problems like acne, rosacea, and psoriasis are often the outward manifestation of gut dysbiosis or intestinal permeability (“leaky gut”). You have nothing to lose by adding sauerkraut, kimchi, and other foods containing probiotics and prebiotics to your meals. If you’re not sensitive to dairy, try kefir, one of my favorite sources of probiotics. You can even try doing a yogurt mask since topical probiotic treatments could be beneficial.

Stress and Sleep

Stress causes a cascade of hormonal actions that, over time, deplete essential nutrient stores, especially minerals like zinc. We can’t always control the stressors in our lives, but most people, if they’re being honest, could put more effort into getting better sleep. Consider it an investment in your appearance as well as overall health. They don’t call it beauty sleep for nothing! Additionally, take up stress management methods that bolster the parasympathetic relaxation response to further support hormonal balance.

Topical Remedies

Finally, work on your skin’s surface. Don’t be discouraged if finding the products that make your skin happy takes a process of trial and error. What works for one person’s skin will aggravate the next. Here are some places to start.

Nicotinamide: Aka niacinamide, this topical form of vitamin B3 can reduce inflammation and help acne and improve skin’s overall condition.

Willow bark: Contains a compound called salicin, which the body converts to salicylic acid. Aspirin works in the same way, so you can make a paste out of crushed up aspirin (the plain white pills, not the coated capsules) to use as a spot treatment or face mask. Or, of course, you can purchase creams and toners that contain salicylic acid, just watch for other gnarly ingredients.

Essential oils: Certain essential oils are particularly good for clearing up acne. Tea tree oil and thyme oil are two. Always dilute them appropriately in a non-comedogenic carrier oil. Jojoba oil is a good one.

Other botanicals like calendula and feverfew: Can be soaked and spread over the face with a cotton ball after washing in order to calm skin.

Apple cider vinegar: Diluted so as not to burn skin, exerts anti-bacterial and pH-balancing effects.

Zinc creams: For fungal acne specifically. Look for zinc pyrithione on the label (the same active ingredient in many dandruff shampoos).

Steaming: Visit the steam room at the gym or lean over a bowl of hot water with a towel draped around your face to open pores for a good cleansing, natural oil extraction, or absorption of botanical agents. Don’t scald yourself, obviously.

Pure water: Those with the worst skin conditions like severe acne or rosacea can benefit from rinsing with distilled rather than tap water.

Takeaways

Skin disorders are complex. The idea here is to take a holistic approach to supporting healthy skin. Although these suggestions might not serve as a cure-all, they are the best way to get at the root causes of the physiological imbalances behind acne. Furthermore, the natural topical options can support your lifestyle efforts without depleting skin of its natural moisture or defenses.

The remedies I mentioned here are not the only ones you might try, and severe or prolonged cases may respond best to a combination of treatments, including medications. Even if it takes a while to find your clear skin solution, the upside is that everyone benefits from cleaning up their diets, building a healthy gut, sleeping well, and reducing stress even if your skin issues are especially stubborn. No matter what your specific challenge, the following are always good practice:

• Support a healthy gut microbiome.
• Eat a nutrient-rich diet.
• Avoid harsh cleansers and products that might irritate your skin.
• Avoid foods that promote inflammation.
• Get healthy sun exposure.
• Practice practical prevention: Avoid touching your face as much as possible and frequently wash items that touch your face (pillowcases, helmets, etc.).

What say you, MDA community? I know I just scratched the tip of the iceberg here. Tell me about your personal successes and challenges. What’s your secret for healthy skin? Maybe your advice can help someone else.

If you’d like to add an avatar to all of your comments click here!

When people think of comfort food there’s a good chance that mac and cheese comes to mind. This creamy, gooey, and cheesy dinner time meal can easily transport you back to childhood days when you wished every meal could be mac and cheese. While we don’t suggest having mac and cheese every night, this keto cauliflower mac and cheese recipe is a great option for when you’re craving that nostalgic taste.

Made with a helping of cauliflower this recipe leans into a variety of spices, such as paprika and mustard powder while also being topped off with our new No-Dairy Cheez Sauce. If you’re looking to switch it up you can also swap out half of the instructed cauliflower for butternut squash, which is perfect for the fall season.

How to make keto cauliflower mac and cheese

First, preheat your oven to 350 degrees Fahrenheit. Then, in a bowl, combine the avocado oil, garlic powder, onion powder, paprika, black pepper, thyme, mustard powder and salt. Fold in the cauliflower until the spice mixture coats all of the pieces of the cauliflower. Lay the cauliflower out in a single layer on a baking dish or sheet pan. Roast in the oven for about 30-40 minutes, or until the cauliflower is tender and golden. Allow everything to cool slightly.

Place the cauliflower in a bowl and pour the No Dairy Cheez Sauce on top along with the milk. Stir to combine and then stir in the almond flour. Pour the cauliflower mixture into a greased 9×9 baking dish.

Crush up your pork rinds in a bag. Crush them so that about half of the pork rinds form a coarse powder and the rest crushed up a bit less in order to give the mixture texture. Pour the pork rinds into a bowl and combine with the parsley and almond flour. Pour this mixture on top of the cauliflower and spread it all over the top of the cauliflower.

Place the baking dish in the oven and bake for about 15-20 minutes, or until the pork rinds are golden. Allow to cool slightly and serve!

Print

If you’d like to add an avatar to all of your comments click here!

Contributed by: Anjali Sharma 

Introduction 

Delicious sweets and dishes are essential to festivities! 

Most of India’s celebratory dishes are also deep-fried and extra salted, or they are cooked with sugar or other sweeteners like jaggery and honey. These delicious dishes all share one thing in common: a high carbohydrate and saturated fat content.

Overindulging in these treats throughout the festival season might make most individuals gain weight. However, diabetics risk high blood sugar levels and related problems.

On the other side, diabetics are more likely to have low blood sugar levels when fasting on holidays like Navratri. Studies that examined Indians during festival times found that diabetics’ blood sugar regulation deteriorated, particularly around Diwali and pre-Diwali festivals like Navratri and Durga Puja.

Does this imply that managing diabetes and attending festivals are incompatible? No, not always. It is still feasible to take part in celebrations while managing your blood sugar levels with little planning and dedication. Keep reading to learn more about the measures you must take to manage your diabetes throughout the holiday season.

How to manage diabetes during the festive season?

Choose dishes and sweets with natural sweeteners

To celebrate the occasion fully with family and friends, one would undoubtedly prefer to consume as much sugar as possible. However, people with conditions like diabetes should avoid the treats due to their high sugar content. 

Therefore, it is recommended to use natural sugar substitutes instead, such as jaggery, dates, or figs. 

These substitutions are not only nutritious but will also assist with sugar cravings. Iron-rich jaggery aids in liver cleaning by removing harmful impurities from the body. Additionally, dates and figs are very nutritious and give the body great energy.

Portion size should be small 

During the festive season, most pantries are stocked with treats like candy, dried fruits, snacks, and other potentially unhealthy items. As a result, it might be challenging to keep track of what and how much you’re eating. Before you realise it, you’ve overindulged. 

People should aim to eat smaller portions and stay away from binge eating. This will assist those with diabetes in maintaining healthy blood sugar levels. To prevent any health-related concerns, intake of small portion sizes should be done on a regular basis. Choosing the proper time to eat is a good idea. Drinking at odd hours, such as late at night, is to be avoided because it might harm one’s health.

Monitoring your macronutrient (protein, fat, and carbohydrate) intake over the holiday season can also be a fantastic method to maintain stable blood sugar levels. 

You may still enjoy sweets and fried foods while staying under the daily recommended carb and fat intake limits by keeping track of your intake of carbohydrates.

Pick healthy drinks 

When it comes to maintaining blood sugar management, beverages like juice and soda are equally as dangerous as sweets. These drinks include a lot of added sugar, which can instantly raise your blood sugar levels.

Choose healthier substitutes instead, such as coconut water, low-fat lassi, or smoothies prepared from fruits with a low glycaemic index (GI), such as berries, apples, and oranges.

If drinking alcohol is a staple of the celebration, try to restrict yourself to one drink or stay away from it entirely. Alcohol can have an odd influence on your blood sugar levels, causing it to either rise or fall and cause difficulties.

Finally, remember to stay hydrated by drinking lots of water, which can assist to stabilise your blood sugar levels.

Stay active 

Making time for fitness in your schedule might be challenging with all the holiday enthusiasm. There is no getting around the fact that regular physical activity and exercise are essential for maintaining healthy blood sugar levels.

Therefore, aim to schedule at least 30 minutes of brisk activity each day. If you are unable to visit the gym, you can exercise at home (walking, running, or cycling).

Take medicines on time if any

When it comes to ensuring that your blood sugar levels remain stable throughout the festival season, our medications are your best companions. You can prevent issues with high and low blood sugar by taking your medications as directed and on time.

Talk to your doctor about your holiday activities so they can change the dosage of your medicine as necessary. If you are on insulin, change the dosage according to how many carbs you eat at each meal after consulting the doctor.

Keep a check on your blood sugar levels 

Your blood sugar levels might change over the festival season due to a variety of circumstances. Your ability to manage your blood sugar can be impacted by factors such as diet, exercise, sleep, stress, etc. Keep checking your glucose (sugar) levels often, many times a day if necessary, to prevent blood sugar spikes or decreases.

To make tracking easier, record all of your glucose levels in a journal. If you detect significant variations in your blood sugar levels, take remedial action or get in touch with your doctor.

Timely health check-ups

It is advised to undergo prompt and frequent health examinations, particularly blood sugar levels to detect diabetes. Only if the illness is detected in time may a prompt medical intervention be started. One must also keep in mind that timely and frequent health check-ups enable one to not only monitor one’s health but also to respond promptly.

Final thoughts 

In conclusion, it is appropriate to note that while food plays a significant role in celebrations, especially during holidays, it is necessary to keep health concerns in mind. This warning is especially important for diabetics since being healthy involves celebrating every day of the year, not just on certain holidays.

This Durga Puja, one should make an effort to defeat the demon of diabetes by choosing healthy foods, combating ill-health, and ultimately succeeding.

Book The Full Body Good Health Test Today!

After 11 days in a St. Paul, Minnesota, skilled nursing facility recuperating from a fall, Paula Christopherson, 97, was told by her insurer that she should return home.

But instead of being relieved, Christopherson and her daughter were worried because her medical team said she wasn’t well enough to leave.

“This seems unethical,” said daughter Amy Loomis, who feared what would happen if the Medicare Advantage plan, run by UnitedHealthcare, ended coverage for her mother’s nursing home care. The facility gave Christopherson a choice: pay several thousand dollars to stay, appeal the company’s decision, or go home.

Health care providers, nursing home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home.

Half of the nearly 65 million people with Medicare are enrolled in the private health plans called Medicare Advantage, an alternative to the traditional government program. The plans must cover — at a minimum — the same benefits as traditional Medicare, including up to 100 days of skilled nursing home care every year.

But the private plans have leeway when deciding how much nursing home care a patient needs.

“In traditional Medicare, the medical professionals at the facility decide when someone is safe to go home,” said Eric Krupa, an attorney at the Center for Medicare Advocacy, a nonprofit law group that advises beneficiaries. “In Medicare Advantage, the plan decides.”

Mairead Painter, a vice president of the National Association of State Long-Term Care Ombudsman Programs who directs Connecticut’s office, said, “People are going to the nursing home, and then very quickly getting a denial, and then told to appeal, which adds to their stress when they’re already trying to recuperate.”

The federal government pays Medicare Advantage plans a monthly amount for each enrollee, regardless of how much care that person needs. This raises “the potential incentive for insurers to deny access to services and payment in an attempt to increase profits,” according to an April analysis by the Department of Health and Human Services’ inspector general. Investigators found that nursing home coverage was among the most frequently denied services by the private plans and often would have been covered under traditional Medicare.

The federal Centers for Medicare & Medicaid Services recently signaled its interest in cracking down on unwarranted denials of members’ coverage. In August, it asked for public feedback on how to prevent Advantage plans from limiting “access to medically necessary care.”

The limits on nursing home coverage come after several decades of efforts by insurers to reduce hospitalizations, initiatives designed to help drive down costs and reduce the risk of infections.

Charlene Harrington, a professor emerita at the University of California-San Francisco’s School of Nursing and an expert on nursing home reimbursement and regulation, said nursing homes have an incentive to extend residents’ stays. “Length of stay and occupancy are the main predictor of profitability, so they want to keep people as long as possible,” she said. Many facilities still have empty beds, a lingering effect of the covid-19 pandemic.

When to leave a nursing home “is a complicated decision because you have two groups that have reverse incentives,” she said. “People are probably better off at home,” she said, if they are healthy enough and have family members or other sources of support and secure housing. “The resident ought to have some say about it.”

Jill Sumner, a vice president for the American Health Care Association, which represents nursing homes, said her group has “significant concerns” about large Advantage plans cutting off coverage. “The health plan can determine how long someone is in a nursing home typically without laying eyes on the person,” she said.

The problem has become “more widespread and more frequent,” said Dr. Rajeev Kumar, vice president of the Society for Post-Acute and Long-Term Care Medicine, which represents long-term care practitioners. “It’s not just one plan,” he said. “It’s pretty much all of them.”

As Medicare Advantage enrollment has spiked in recent years, Kumar said, disagreements between insurers and nursing home medical teams have increased. In addition, he said, insurers have hired companies, such as Tennessee-based naviHealth, that use data about other patients to help predict how much care an individual needs in a skilled nursing facility based on her health condition. Those calculations can conflict with what medical teams recommend, he said.

UnitedHealthcare, which is the largest provider of Medicare Advantage plans, bought naviHealth in 2020.

Sumner said nursing homes are feeling the impact. “Since the advent of these companies, we’ve seen shorter length of stays,” she said.

In a recent news release, naviHealth said its “predictive technology” helps patients “enjoy more days at home, and health care providers and health plans can significantly reduce costs.”

UnitedHealthcare spokesperson Heather Soule would not explain why the company limited coverage for the members mentioned in this article. But, in a statement, she said such decisions are based on Medicare’s criteria for medically necessary care and involve a review of members’ medical records and clinical conditions. If members disagree, she said, they can appeal.

When the patient no longer meets the criteria for coverage in a skilled nursing facility, “that does not mean the member no longer requires care,” Soule said. “That is why our care coordinators proactively engage with members, caregivers, and providers to help guide them through an individualized care plan focused on the member’s unique needs.”

She noted that many Advantage plan members prefer receiving care at home. But some members and their advocates say that option is not always practical or safe.

Patricia Maynard, 80, a retired Connecticut school cafeteria employee, was in a nursing home recovering from a hip replacement in December when her UnitedHealthcare Medicare Advantage plan notified her it was ending coverage. Her doctors disagreed with the decision.

“If I stayed, I would have to pay,” Maynard said. “Or I could go home and not worry about a bill.” Without insurance, the average daily cost of a semiprivate room at her nursing home was $415, according to a 2020 state survey of facility charges. But going home was also impractical: “I couldn’t walk because of the pain,” she said.

Maynard appealed, and the company reversed its decision. But a few days later, she received another notice saying the plan had decided to stop payment, again over the objections of her medical team.

The cycle continued 10 more times, Krupa said.

Maynard’s repeated appeals are part of the usual Medicare Advantage appeals process, said Beth Lynk, a CMS spokesperson, in a statement.

When a request to the Advantage plan is not successful, members can appeal to an independent “quality improvement organization,” or QIO, that handles Medicare complaints, Lynk said. “If an enrollee receives a favorable decision from the QIO, the plan is required to continue to pay for the nursing home stay until the plan or facility decides the member or patient no longer needs it,” she explained. Residents who disagree can file another appeal.

CMS could not provide data on how many beneficiaries had their nursing home care cut off by their Advantage plans or on how many succeeded in getting the decision reversed.

To make fighting the denials easier, the Center for Medicare Advocacy created a form to help Medicare Advantage members file a grievance with their plan.

When UnitedHealthcare decided it wouldn’t pay for an additional five days in the nursing home for Christopherson, she stayed at the facility and appealed. When she returned to her apartment, the facility billed her nearly $2,500 for that period.

After Christopherson made repeated appeals, UnitedHealthcare reversed its decision and paid for her entire stay.

Loomis said her family remains “mystified” by her mother’s ordeal.

“How can the insurance company deny coverage recommended by her medical care team?” Loomis asked. “They’re the experts, and they deal with people like my mother every day.”

Related Topics

Contact Us

Submit a Story Tip

When Sara Laub’s period was late, the New York City resident shrugged it off. She’d used an intrauterine device, or IUD, for three years and knew her odds of getting pregnant were extremely slim. But after 10 days had passed, Laub, 28, took a home test in early July and got unwelcome news: She was pregnant.

Laub went to a Planned Parenthood clinic because she knew someone could see her immediately there. An ultrasound found no sign of a developing embryo in her uterus. That pointed to the possibility that Laub might have an ectopic pregnancy, in which a fertilized egg implants somewhere outside the uterus, usually in a fallopian tube.

Such pregnancies are rare, occurring roughly 2% of the time, but they are extremely dangerous because a growing embryo might rupture the narrow tube, causing massive and potentially life-threatening internal bleeding. Laub was experiencing no pain, bleeding or other obvious symptoms of trouble. Still, a Planned Parenthood staffer recommended that she go to a hospital emergency department right away.

An arduous end to a pregnancy that threatened her life

Laub didn’t realize it, but she was embarking on a lengthy — and very expensive — treatment to end the pregnancy. Even in a state that strongly supports a person’s right to make her own choices regarding pregnancy — New York legalized abortion in 1970, three years before Roe v. Wade made it legal nationwide — Laub’s experience shows the process can be arduous.

An ectopic pregnancy in the fallopian tube is never viable. But following the June reversal of Roe by the Supreme Court, reproductive health experts say treatment may be dangerously delayed as some states move to limit abortion services.

Some of those consequences are already being noted in Texas, where strict abortion limits were instituted last fall before the Supreme Court’s decision. Since abortion is now allowed in Texas only in medical emergencies, doctors may wait to perform abortions until pregnant patients are facing life-threatening complications in order to comply with the law.

“In Texas, we saw people not treating ectopic pregnancies until they ruptured,” says Dr. Kristyn Brandi, an obstetrician-gynecologist in Montclair, N.J, who is board chair of Physicians for Reproductive Health, which supports abortion rights.

The 2021 Texas law banned most abortions at about six weeks of pregnancy. University of Texas-Austin researchers interviewed doctors about the impact of the law on maternal and fetal care. Even though treatment of ectopic pregnancy isn’t explicitly prohibited under the Texas law, uncertainty around what is permitted may lead doctors to delay urgently needed care. A specialist at one unnamed hospital said the facility no longer offers treatment for certain ectopic pregnancies.

About half of states have enacted restrictions on abortion or are trying to do so.

Laub, who is being identified here by her middle and last name because of her concerns about privacy, says she couldn’t help thinking about the recent Supreme Court decision as she went through diagnosis and treatment.

“As scary as my ordeal felt at the time, I was acutely aware that I was fortunate to have easy access to treatment, and elsewhere women with my condition face much worse experiences,” Laub says.

What led to her $80,000 bill

At Lenox Hill Hospital’s emergency department on New York’s Upper East Side, doctors ran more tests and gave Laub two options: one or more injections of methotrexate, a cancer drug that destroys rapidly dividing cells and is often used to safely end an ectopic pregnancy, or surgery to remove her fallopian tube, where the fertilized egg was lodged. (In some other cases, surgeons may remove the embryo but be able to preserve the fallopian tube.)

Laub opted for the methotrexate injection. After getting the shot, patients need certain follow-up blood tests for several weeks to confirm that the pregnancy is ending or has ended. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two more follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.

The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be a fraction of that total. It now appears Laub will owe a little more than $4,000.

That still seems like a lot, she says.

“On the one hand, I feel grateful that I was able to get treated when I was not in an acute state,” Laub says. “But it’s an awful feeling to know that the decision I made as to the best path forward for care comes at such a high cost.”

The hospital points out that its charges were reduced by Laub’s insurer discount. “Charges are based on the specific services provided in the treatment of the patient,” says Barbara Osborn, vice president of public relations at Northwell Health, a system that includes Lenox Hill Hospital. “Any amount due from the patient is based upon the benefit design and cost-sharing provisions of the patient’s insurance plan.”

Understanding hospital charges can be a head-scratcher since they often don’t appear to align with the actual cost of providing care. That’s true in this case. According to a breakdown by WellRithms, a company that analyzes medical bills for self-funded companies and others, Lenox Hill Hospital charges $12,541 on average for the surgery that Laub underwent, based on publicly available data that hospitals submit to the federal Centers for Medicare & Medicaid Services. But in this particular case, the hospital charged Laub’s health plan $45,020.

“Hospitals will charge whatever they can,” says Jordan Weintraub, vice president of claims at the Portland, Ore., company. “They put it on the payer to deny items, rather than billing appropriately.”

Even more revealing is how much it actually costs the hospital to perform the surgery. According to WellRithms’ analysis of the federal data, Lenox Hill’s cost to perform the laparoscopic procedure is $3,750. The average cost statewide is $2,747.

Nationally, the average outpatient charge for the surgical procedure Laub received is $13,670, according to data from Fair Health, a nonprofit that manages a large database of health insurance claims. The average total sum paid by the health plan and patient is $6,541.

Charges can vary widely from city to city

Surgical charges for managing an ectopic pregnancy vary widely depending on location. But the charges don’t necessarily correlate with the ease of access to medical care to end a pregnancy. In the New York City metropolitan area, for example, the average charge is $9,587, while in San Francisco, the average charge is $20,963, according to Fair Health. Both New York and California have generous abortion access laws. Meanwhile, locations with more restrictive abortion standards don’t necessarily charge more for ectopic pregnancy surgery. For example, in the Dallas area, the average charge is $14,223, while in Kansas City, Mo., it’s $16,320 — both lower than the average charges in Chicago ($18,989) or Philadelphia ($17,407).

Many women opt for methotrexate rather than surgery to treat an ectopic pregnancy. The drug is successful between 70% and 95% of the time without requiring surgery.

The drug is often administered in a hospital emergency room setting because OB-GYNs are unlikely to keep the cancer drug in their offices, experts say. After the injection, patients return home, but must be followed closely for the next days or weeks until embryo is reabsorbed and the pregnancy ends, because until that happens, the risk remains of a life-threatening rupture of the fallopian tube. In addition, patients must get bloodwork at intervals after an injection to confirm that their pregnancy hormone levels are falling.

After receiving her first injection at the emergency department, Laub was told she needed to return for follow-up bloodwork in three days, and then again after each injection of methotrexate she might need. Charges for those emergency department visits were likely significantly higher than the charges would have been had Laub received follow-up care from an OB-GYN in an outpatient setting. The hospital charged between $4,700 and $5,400 for each of those follow-up visits. Laub’s share of the cost was about $500 each time.

Osborn defended the hospital’s approach — requiring Loeb to return to the ER each time for her treatment.

“Ectopic pregnancies, which can be life-threatening conditions, require close surveillance and management to ensure a successful resolution,” Osborn says. “The emergency setting allows for immediate availability of critical surgical services, as was ultimately necessary in this patient’s case.”

But Dr. Deborah Bartz, an OB-GYN at Brigham and Women’s Hospital in Boston, questions whether each stage of that “close surveillance” really had to happen in the emergency room setting. “It would be really nice,” Bartz says, “if instead she could have been worked into the outpatient setting with a protocol for managing surveillance.”

KHN (Kaiser Health News) is a national, editorially independent program of KFF, the Kaiser Family Foundation.

After retiring several years ago, Deb Borst found she had plenty of time to enjoy nature, one of her favorite pastimes.

She enjoyed gardening with friends and walking around Reeds Lake, in East Grand Rapids. She was always on the lookout for beautiful birds.

On many days, she’d log anywhere from 8,000 to 10,000 steps.

She’s also been very active in her church. She spent over 20 years in leadership at The Other Way Ministries. And after retirement, she became a spiritual director, meeting with people who want to live more contemplative lives.

Borst is a widow and mom to two wonderful adult kids. She has one grandson and an adopted Liberian family.

“They call me honey,” she said. “So that’s my nickname.”

No matter how busy she got, she always made time for hiking, walking in the woods and visits to the farmer’s market.

Leading a healthy, active life is important to her.

“I’m a summer girl,” she said.

An unexpected diagnosis

In spring 2021, her journey took an abrupt turn when she went to the emergency department for what she believed to be kidney stones.

At Spectrum Health Zeeland Community Hospital, scans suggested something additional might be going on.

Most CT scans for kidney stones don’t include a look at the lungs, but this one just so happened to include part of the lower lobe of her left lung. And that’s where an astute radiologist recommended Borst undergo an additional scan, just to be safe.

“For me, this is my God story,” she said. “Because I see so many pieces that came together in ways that are just beyond my imagining.”

Borst said she vividly remembers the phone call from her doctor, after the second scan revealed a suspicious area on her lung.

“That was certainly a scary conversation to have,” she said. “But I also have absolute confidence in my doctor and knew that he would refer me to a good team. And indeed, he did.”

Within a week she had an appointment at Spectrum Health, first with a pulmonologist who read the CT scan and told her about other tests to expect.

“It put my mind at ease right away to know what was next,” she said.

The care team then scheduled her for a robot-assisted bronchoscopy with Gustavo Cumbo-Nacheli, MD, pulmonologist and critical care physician at Spectrum Health.

The procedure identified a small spot on the lower left lobe of her lung.

Doctors identified the nodule, about the size of a grape, as a carcinoid tumor, a slow-growing type of cancer.

“So to me, that was the good news,” Borst said.

But it would need to be removed.

Robot-assisted surgery

After several more tests to rule out any spread of the cancer, Borst soon met with Geoffrey Lam, MD, cardiothoracic surgeon at Spectrum Health. Dr. Lam developed a plan for robot-assisted surgery to remove the tumor.

“Deb was a healthy woman, nonsmoker, with no risk factors for cancer,” Dr. Lam said. “We saw something at the base of one of her lungs and a biopsy found an early-stage cancer.”

Robot-assisted surgery could help her get back to normal much sooner than traditional surgery, Dr. Lam said.

“I really wanted to try and avoid a big incision or big operation, because she didn’t have a lot of risk factors for cancer,” he said.

The care team scheduled Borst for a robot-assisted lobectomy in Dr. Lam’s office.

“He did such a wonderful job of creating three-dimensional images for us,” Borst said. “And that’s when I found out that my tumor was the size of a grape. Suddenly it became kind of real and something that we could picture.”

The surgery was completed in under two hours.

Afterward, Dr. Lam visited Borst in recovery. He said she had excellent, healthy lungs—and her good physical health would aid in her overall recovery.

But the assist from robotics also played a role.

In cases such as Borst’s, traditional open surgery involving spreading of the ribs could have resulted in five to seven days in the hospital and another two to three months of recovery.

With robot-assisted surgery, she spent just three days in the hospital.

“I had surgery on a Monday and by Thursday was home,” Borst said.

Doctors recommended she not push herself too hard too soon, although she could resume some normal physical activities.

Within three weeks, she was back to walking and enjoying much of her normal routine.

“I can’t begin to tell you what a wonderful surgeon and man he is,” Borst said of Dr. Lam. “He was so kind and compassionate with me, with our family. And at the same time, he just had this humble confidence about him.”

A quick recovery

It didn’t take long for Borst to get back into a rhythm.

“I started watering my flowers as soon as I got home and my daughter said, ‘Mom, you need to back off a little bit. Not quite so fast,’” she said. “But I was able to resume my normal activities very quickly.”

Doctors found the majority of Borst’s tumor was a mycobacteria infection, and only a tiny piece was carcinoid cancer.

“I feel like a living miracle,” Borst said. “And I am grateful beyond words for the work of every person on the medical team. From those who first read my CT scan to those who cared for me on my last day in the hospital. It was quite the journey.”

Less than a month after returning home, Borst found she could tackle one of her favorite hiking trails: Rosey Mound, in Grand Haven, Michigan. It features impressive climbing dunes and a variety of inclines.

Now, one year post-surgery, Borst and her doctors agree: Her recovery has been quite amazing.

“I had very little pain throughout my recovery,” Borst said. “And if I had pain, it was very manageable.”

She said she remains deeply grateful to God for the outcome—and for her providers “being so personal with me, respecting me, trusting me and being willing to answer questions.”

She recently celebrated her 73rd birthday.

“I hope I’m good to go for a long time, because I have many things that I would still love to do,” she said. “I want my life to be a testimony and continue to just be so grateful.”

In the U.S., about 75,000 children develop severe sepsis each year.

“It can affect a child or adult of any age,” said Adam Nicholson, MD, director of safety and improvement and pediatric emergency medicine physician at Spectrum Health Helen DeVos Children’s Hospital.

“It remains one of the leading causes of death in children worldwide, even with advances being made in treatments and mortality.”

But there is reassurance for parents: The chances of your child developing sepsis out of nowhere, without warning, is unlikely.

“(Sepsis) is more common in children who have a longer-range illness—immunocompromised, for instance,” Dr. Nicholson said. “This doesn’t usually come out of nowhere to affect an otherwise healthy child. It can, but is much less common.”

It’s certainly wise for parents to be aware of what sepsis is, but if a child doesn’t have an underlying health condition that makes them more vulnerable, there is typically less cause for concern.

Dr. Nicholson offered some additional insights about sepsis and talked about what parents should know.

What is sepsis?

Infection can happen when bacteria, viruses or fungi enter the body. Sepsis is a life-threatening condition that can occur when the body begins to respond strongly to that infection by attacking its own tissues.

Some sepsis symptoms include fever, lethargy and trouble urinating, but the condition can also lead to serious problems in vital organs such as the heart, lungs or kidneys.

“When we see extremely severe cases, it can lead to multisystem organ failure,” Dr. Nicholson said. “It can progress to septic shock, which may cause a dramatic drop in blood pressure that can lead to severe organ failure or death.”

Getting medical assistance via antibiotics and intravenous fluids can greatly increase the chances of survival, he said.

Bottom line: Sepsis is always the result of an infection.

“The immune system is overwhelmed and can’t maintain other vital organ function,” Dr. Nicholson said.

What are signs and symptoms?

In its early stages, sepsis can look like any other illness that causes a fever, Dr. Nicholson said.

“For the large majority of kids, it is a fever,” he said. “But that won’t be the only indicator. When we start seeing other signs of illness affecting the child, we start to think about sepsis possibly causing this.”

Some examples: the child’s skin color looks pale or unusual, or the child is unusually sleepy or lethargic. If a child is having trouble urinating, that could indicate trouble.

When a child is in the hospital, care teams can use screening tools to monitor vital signs, such as breathing, heart rate and oxygen level. This can help spot problems.

If a child has a fever, over-the-counter medication will usually help.

“With sepsis, this isn’t always the case,” Dr. Nicholson said. “A period of observation can usually give us time to decide if they have a more serious infection.”

What does treatment entail?

“When we identify there are signs of sepsis, we typically will start early with aggressive treatment,” Dr. Nicholson said.

This can include IV fluids that get into the vascular system, improving blood flow to vital organs, and antibiotics.

“In large part, sepsis is due to a bacterial infection,” he said. “When there is a sign or symptom, a course of antibiotics early on can improve outcomes.”

After that, doctors work to determine if any organs are affected. They then develop personalized treatment plans.

Can specific conditions lead to sepsis?

Patients who have a suppressed immune system or an underlying medical condition are at higher risk for sepsis.

“Very young infants, under the age of 30 days, who don’t have a fully functioning immune system can also be at risk,” Dr. Nicholson said. “And also, children who have conditions that require they have hardware in place—for example, a heart valve or central line.”

How is sepsis diagnosed?

Sepsis is diagnosed by a physical exam that includes checking heart rate and vital signs.

“We have lab markers that help us direct care,” Dr. Nicholson said. “Basic labs often are helpful to understand if there is a higher likelihood of infection going on. And more targeted labs can identify specific infections that may cause sepsis to occur.”

When should you see a doctor?

“Knowing that fevers are very common in children, I always tell parents if you are concerned about how your child is behaving with fever—lethargic, skin color is abnormal, limited urination, not eating or drinking—call your physician for guidance and observation,” Dr. Nicholson said.

For most children, a fever will respond well to over-the-counter medications such as Tylenol or ibuprofen, he said.

“The fever should go down and they will become more playful and active,” he said. “If this does not help, parents need to use their best intuition or seek care at an urgent care or emergency department.”

If a child has a fever of 102-103 degrees or higher, as well as other symptoms, parents should contact their physician for guidance.

“The large majority of these children will respond well to home care with typical over-the-counter medications,” Dr. Nicholson said.

Sharing best practices

Helen DeVos Children’s Hospital is participating in a multi-center quality improvement incentive through the Children’s Hospital Association, focusing on improving pediatric sepsis outcomes.

“The goal is for all institutions to implement best practices in terms of diagnosis and treatment to reduce mortality and hospital stays with sepsis,” Dr. Nicholson said.

Helen DeVos Children’s Hospital applies multiple initiatives to ensure early sepsis diagnosis and proactive treatment. For instance, physicians connect all patients brought in via the emergency department to an electronic sepsis screening tool that works in the background at all times.

If there are signs of sepsis, physicians are alerted.

“This sets off a chain of command where a sepsis huddle will take place on the patient’s behalf, and additional labs and treatments might be necessary,” Dr. Nicholson said.

A mellow melody floated through Dave Duggan’s apartment in his Kentwood, Michigan, senior community.

His cup of morning coffee steamed close at hand as he sat peacefully, focused on the rising sun.

His thoughts wandered to gratitude.

“Meditation aligns my brain for the day,” he said. “And it helps with fasting.”

Fasting has been an integral part of Duggan’s weight loss journey—a journey that began somewhat by chance.

“I stumbled into Lifestyle Medicine at the Downtown Market in Grand Rapids,” he said. “For years, I had been trying to lose weight, without success. But then I found this program and it all came together.”

These days, Duggan closes up his kitchen at 6 p.m. every evening. He holds off on breakfast until at least 14 hours later.

“I was more than 300 pounds back in November 2021,” he said. “And now, eight months later, I am down 70 pounds and still losing.”

It all began with that first step.

Changing a lifestyle

When Duggan first visited the Lifestyle Medicine team in late fall 2021, he met with Carolyn Vollmer, MD, a physician with Lifestyle Medicine.

“We meet patients where they are,” Dr. Vollmer said. “And then we strategize the right changes for each patient, customized to the individual.”

That’s because everyone is different, Dr. Vollmer said.

“We take a holistic approach,” she said. “We talk to the patient about their personal goals, what has meaning for them. We look at their chronic disease burden, their habits in terms of exercise and diet, sleep patterns, substances they use. Lifestyle habits are all interwoven.”

If you don’t get good quality or enough sleep, for example, you’re more likely to eat more calorically dense processed foods during the day to keep your energy up.

Lifestyle Medicine’s board-certified physicians, registered dietitians and health coaches partner with patients to shape personal lifestyle prescriptions.

When Dr. Vollmer met with Duggan, she learned he had gained weight in recent years. He also had high cholesterol and sleep apnea.

Duggan told her he wanted to lose weight to help prevent disease and reverse existing conditions.

They talked about nutrition, exercise, meditation, fasting and mindfulness.

“There’s good science behind fasting at least 12 hours,” Dr. Vollmer said. “Most people can do it easily enough if you think of the time you sleep as most of the fast.”

Cooking is the other part of the puzzle. It lets you control what’s in your food.

On this front, Duggan has enjoyed using his Instant Pot, a multi-cooker that gives him plenty of preparation options.

But what you cook is just as important as how you cook.

“We recommend Mediterranean or plant-based diets, eliminating processed foods and refined sugars—and generally becoming a label reader in the grocery store,” Dr. Vollmer said. “Mindful eating means putting away distractions at mealtime, slowing your pace and chewing slower, enjoying the taste.

“And we need to move every day. Even just walking 20 to 30 minutes daily.”

Feeling better

Duggan has been intrigued with the program from the start.

“I’ve learned a lot,” he said. “I enjoy cooking, so I was interested in the culinary classes that Lifestyle Medicine offers.

“I learned about added sugars. I was already a vegetarian, but I learned that some of what I was eating and drinking—fruit juices, yogurt with fruit on the bottom, kefir, jarred sauces, and ketchup—still had sugar in them.”

One of his first moves was to eliminate sugars.

“With that alone, I lost 10 pounds in the first month,” he said.

Duggan also learned much about the benefits of a plant-based diet. He went from vegetarian to vegan, eliminating milk and other dairy products from his kitchen. He substituted nut milks and expanded on vegetables in the dishes he cooked.

“Both of my parents passed of cancer,” Duggan said. “But with our lifestyle, we can do something about preventing cancer and heart disease.

“As I get older—I’m 67 now—I think about that more. We can’t control the genetics that we inherit, but we can control lifestyle choices with diet and exercise. And healthy lifestyle choices have been found to trump genetics when it comes to disease prevention.”

Duggan also added exercise to his weight loss journey, opting for regularly scheduled workouts at a wellness center.

As he began to shed pounds, he noticed that his hip pain—a constant issue when he weighed 300 pounds—had become less severe.

“I wasn’t necessarily losing weight because of exercise,” he said. “Diet is what does that. But exercise has many other benefits for my health.”

His sleep improved. His cholesterol numbers went down. His energy levels went up.

“I was turning back the clock to my younger self,” he said.

He began to feel better inside, too.

“As I started to feel more energetic, healthier … I had to buy smaller sizes in clothes,” he said. “My self-esteem got healthier.”

Helping others

Enthused with his progress, Duggan wanted to share his story and encourage others.

“People learn by watching what we do, rather than what we say,” Duggan said. “It was important to model the behaviors I wanted to teach others.”

As a resident of a senior community, he reached out to other residents to talk about his new lifestyle. He touched on the plant-based diet, meditation, fasting and exercise.

But he also added a social connection. He began recording a podcast and filmed YouTube videos about his weight loss journey.

Music also helped him.

“Piano,” he said. “The piano, for me, is therapy. I love music. It does something for my brain, creates new pathways. Music can reach through to people with dementia or Alzheimer’s when nothing else can. And that’s something I can bring to my community.”

After initially staying connected on a regular basis, Duggan and Dr. Vollmer now keep in touch every few months.

“That’s something that every patient determines for themselves, too,” Dr. Vollmer said. “How much accountability they want and need. We have virtual medical visits alongside the traditional in-person, so that makes it easy for patients to connect with us.”

While Lifestyle Medicine’s cooking programs are available virtually, health meetups are also offered so that groups of patients can meet with coaches.

“People can share their experiences and learn from each other,” Dr. Vollmer said. “Those are free and happen twice a month.”

Lifestyle Medicine’s physicians also connect regularly with primary care physicians to share updates on the progress of patients.

The update on Duggan? “Dave is doing everything right,” Dr. Vollmer said.

Duggan wouldn’t have it any other way.

“For me, what started out as an effort to achieve weight loss wound up opening a door of possibilities that include extended longevity and prevention and … reversal of age-related disease,” Duggan said. “I’m just getting started. It’s a lifelong and life-changing journey.”

Kelly Walski, 17, has always been a healthy teen.

She stays active and she loves playing golf and volleyball with her friends at Kenowa Hills High School.

But at one practice about two years ago, she found herself on the sidelines, hunched over in pain.

It marked the start of unexplainable bouts of pain, as well as occasional nausea and vomiting. And it seemed to come on at the most inopportune times—during practice, or even in the middle of a game.

When she tried to soldier through, she’d end up sitting on the bench.

At times, the pain would grow so severe she’d have to return home to rest.

With her senior year just around the corner—and a supportive group of family, friends and a boyfriend at her side—Kelly and her parents knew she needed to seek help.

“I was bent over in pain,” she said. “It was awful. The only thing that helped was lying down in bed.”

One night, the pain grew so intense that her parents, Krista and Kevin Walski, took her to the emergency department at Spectrum Health Helen DeVos Children’s Hospital.

She underwent an MRI and CT scan. Doctors tested her for kidney stones, but found nothing out of the ordinary. They also referred her to a gastroenterology specialist for additional tests.

Answers proved elusive.

“I almost gave up,” Kelly said.

The family returned home, remaining optimistic a cause would be identified with time.

‘She changed my life’

Kelly received a referral to the Pediatric Chronic Pain Clinic at Helen DeVos Children’s Hospital, where she met with an interdisciplinary team of providers.

This included Brittany Barber Garcia, PhD, chief of pediatric psychology and a pediatric pain psychologist with pediatric behavioral health and pain and palliative medicine at the children’s hospital.

As Kelly remembers it: “I met Dr. Barber Garcia a little over a year ago and she changed my life. She told me she knew what was wrong.”

Dr. Barber Garcia said her team has seen an increasing number of children and teens struggling with debilitating anxiety in recent years.

“There is a strong mind and body connection,” Dr. Barber Garcia said. “When we experience stress, we not only experience it emotionally, but also physically in the body.”

When a patient comes to her with several medical issues already ruled out, it can be helpful, she said.

But she also has to think like a detective, searching all the clues from previous evaluations.

A psychological evaluation showed that Kelly felt overwhelmed in certain situations, while other things in her life were also causing increased stress.

The diagnosis? Anxiety.

Kelly began working with Dr. Barber Garcia on different exercises to help her manage the pain.

“When I first met Kelly, she talked about having symptoms of panic attacks—moments of feeling overwhelmed, heart racing, abdominal pain, hotness, tingles, shaking and more,” Dr. Barber Garcia said. “She had never thought it could be something else, until we sat down and discussed anxiety and how it affects the body both physically and mentally.”

Over the course of a year, Kelly and Dr. Barber Garcia met virtually for therapy sessions about every two weeks.

“She’s the best thing that has ever happened to me, hands down,” Kelly said. “I love her.  She’s the most flexible human being ever.”

With Kelly’s boyfriend leaving for the Navy, they talked through strategies on how to cope with that change.

Dr. Barber Garcia helped Kelly understand the relationship between thoughts, behaviors and emotions, and how easy it is to get caught up in negative thinking traps.

“An original thought might be something as simple as concern about how you are falling behind on assignments in a class, and then anxiety steps in,” Dr. Barber Garcia said. “Before you know it, you’re wondering what will happen if you fail the class, and begin to think you’ll never graduate high school and become a failure.”

Anxiety can take a normal worry to a much more serious level, where it’s no longer real, she said.

Strategies like mindfulness, diaphragmatic breathing and meditation can help patients overcome these challenges.

‘Proud of myself’

Months later, Kelly hasn’t experienced a major panic attack.

She said she’s working hard to keep negative thoughts at bay, and she has finally reached a point where she can control her own body with breathing exercises and other skills Dr. Barber Garcia taught her.

After nearly a year of therapy, treatment and various exercises, her future is looking brighter.

“I’m proud of myself now,” Kelly said. “What Dr. Barber Garcia has done for me is something I wouldn’t change for anything.”

Kelly said her friends and family have been among her biggest supporters, always by her side through it all.

She said it’s important to learn to talk about mental health, despite any stigmas.

“I was against the idea of anxiety at first and thought it wasn’t a real thing,” Kelly said. “But here I am today, one of the biggest advocates for mental health at my school and for everyone around me.

“Mental illness shouldn’t have a stigma. And I hope no one is embarrassed by it.”

While she hasn’t experienced any bouts of pain lately, Kelly said it can spike sometimes. But with the techniques she’s learned in therapy, she has learned how to avoid moments of crippling pain.

“Now I know when it’s coming on,” she said. “My stomach starts to twist, but I can work through it with coping mechanisms.”

She’s already practicing golf for her senior year.

“I feel like everyone has realized this is our last year together, so we’re looking forward to hanging out and making it a great year,” she said.

She plans to attend Ferris State University after graduation, where she’ll study pediatric optometry.

“I could not be more proud of how Kelly has implemented the tools she has learned,” Dr. Barber Garcia said. “She’s really made them her own and she’s doing so much better.”

Success doesn’t always mean being completely free of symptoms or anxiety, she said. It sometimes means knowing exactly what to do when something happens, and getting through it calmly.

“She’s definitely on a path to a bright and successful future,” Dr. Barber Garcia said. “And I continue to look forward to our visits in the months ahead.”