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Genetic biomarkers help docs choose medications

Which drug is best? There’s a test

Full Article Bend Bulletin
Winters had always been rough for Diane Smith.

Since her mom died a decade ago, they’ve been all but unbearable. Her depression would get progressively worse until the anniversary of her mother’s death: Valentine’s Day.

This year — its heavy snowfall forcing her to shovel constantly — was shaping up to be particularly bad. But, somehow, the despair never came.

“I would have been hospitalized at that point because I would have been so despondent,” said the 61-year-old Bend resident, “and I just got through it miraculously.”

Last spring, her doctor performed a test that turned up a genetic mutation he believes was making her antidepressant less effective. He put her on a supplement designed to augment the medication.

A plethora of tests exist that identify, usually through a mouth swab, whether patients’ unique genetic makeups affect how well specific medications work for them and whether they could produce dangerous side effects. This emerging sector of medicine is called pharmacogenetics, or pharmacogenomics. Although it’s been slow to catch on among medical providers, research on the subject is robust.

More than 100 Food and Drug Administration- approved medications list relevant genetic factors that could affect their safety or effectiveness. The FDA lists on its website more than 200 genetic biomarkers and drug pairings and their potential consequences for patients.

Dr. Richard MacDonell, Smith’s doctor and a primary care physician in Bend who offers pharmacogenetic testing, said traditional medicine works by trial-and-error: You take patients through several different types of medications for their condition, tweak the dose here and there, until you find one that works without terrible side effects. The process can take months. A look at their genetic makeup, however, can narrow things down much faster.

“The question is, ‘Can we be smarter about it and tailor it instead of just shotgunning?’” MacDonell said.

Article from Bend BulletinBy Tara Bannow, The Bulletin, @tarabannow

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Reaching and Maintaining Your Optimal Weight

Each New Year inspires many of us to focus on losing weight. The year 2017 will be no different – except for the fact that scientists are finding out more about what can help us reach and maintain the optimal weight for our individual body types.

Maintaining an ideal weight is different for everyone. Some want to become healthier while others want to look good in trendy clothes. Since there’s no perfect regimen that fits everyone when it comes to reaching and maintaining the perfect weight and size, it’s imperative that we consider all of the factors in your body type and lifestyle.

For example, you may need to perfect a diet plan and exercise regimen that you can live with for the long term before you jump into what’s trending. If you don’t find a plan you can stick to, you won’t be able to maintain success.

You need to understand various ways of pinpointing exactly what it is that will help you overcome a defeatist mindset when it comes to losing weight. Find new ways to think about your weight and implement a plan for the New Year that won’t leave you frustrated and back to square one by the middle of the year.

Weight Loss Is More Than Just Aesthetics

Sure, it’s great to think about looking in the mirror and seeing the newer, slimmer you. But it’s not always about looking good in a new pair of jeans. The bigger picture includes your long term health and how those extra pounds affect your body.

Simply gaining a better understanding about how obesity can ruin your health should be a major incentive in helping you reach your weight loss goals. Major health problems such as heart disease, cancer, strokes, diabetes and even depression can occur when you’re overweight or obese.

The good news is that when you lose the weight in a healthy manner, you can greatly reduce the risks of developing these devastating problems. Your weight and your health combine to create catalysts for either a healthy – or an ailing – life.

It may cause you to abandon all hopes for future success – or to look at the future with a positive, can-do attitude. Those with weight issues are far more likely to develop depression or experience negative impacts on their lives, which keep them from achieving what they’re mentally capable of.

Your BMI (Body Mass Index) is a determination of your body fat in relation to your height and weight. It’s a sobering fact that the higher your BMI tests, the more likely you are to develop a devastating disease.

Excess weight can affect all areas of the body – including neurological problems such as headaches, vision loss and stroke – plus depression and eating disorders. You may also develop respiratory problems such as asthma and pulmonary hypertension.

In the Gastrointestinal area of your body, reflux disease, gallstones, colon cancer and fatty liver disease may develop. Within the urological region of the body, excess weight may lead to diabetes and diabetic kidney disease and the pancreas may develop pancreatitis or cancer.

The circulatory system of the body may run into such issues as hypertension, high cholesterol and blood clots, while also causing back issues and joint problems. In women, excess weight can cause issues with reproduction, while men may develop prostate problems or erectile dysfunction.

It’s alarming to realize that excess weight can cause all of the above problems, but knowing what you’re up against can also be a catalyst toward losing the weight and developing healthier eating habits.

Depression is another result that people who are overweight often experience. Some become socially isolated and others may drown their sorrows by eating more or developing eating disorders.

This condition can lead you into a downward spiral of negative mental mindset and alterations in your brain chemistry. You may also see levels of cortisol (stress hormone) increase, leading to fat accumulation in the stomach area.

Resorting to medications to help with depression from being overweight often exacerbates the problem by causing more weight gain. Even a seemingly simple condition such as snoring loudly (sleep apnea) can result in sleepiness during daytime hours and increase your chances of heart attacks and strokes.

One of the most devastating problems that can occur with obesity is diabetes. Those who have a family history of diabetes should be extra careful about weight gain. Health care providers have even come up with a term for diabetes and weight gain called diabesity.

If a high blood sugar level remains uncontrolled, you may also develop kidney failure and blindness – or the necessary amputation of limbs. Diabetes is a major health problem resulting in obesity and claims a huge number of lives each year.

A shorter lifespan is another result of being overweight. When moving around becomes a problem other issues set in and health declines. The fact is that excess weight can not only ruin your health, but also cut years off your lifespan.

Rather than thinking of the aesthetics of losing weight, think about the issues that can occur if you don’t lose those extra pounds. Make a plan now to lose the weight that’s been keeping you from living the life you’re meant to live.

Tips to Organize Your Way to Healthy Eating

Have you looked in your pantry, refrigerator, or freezer lately? Do you lack motivation to eat at home because of what you see? A disorganized array of frozen mystery meats; herbs and spices with unknown best by dates, and a plethora of canned goods you didn’t realize was in your pantry. If this sounds like you, you are not alone. Many of us get caught up with our to do lists, and keeping up with our nutrition takes a back seat to our busy lives. You can take control over your kitchen again and regain your motivation to prepare meals at home. Here are a few tips to get you started.

  1. Set aside 30 minutes to tackle one area in your kitchen. One area includes your refrigerator, or your freezer, or one pantry.
  2. Have a game plan as to how you are going to organize that area. You are looking to make it easy to find things and for this area to look appealing to help motivate you to eat at home.
  3. Donate or throw away food items that you are not wanting to eat because they are      unhealthy for you. Don’t force yourself to eat unhealthy, processed food because you  stocked up at your last Costco trip and it shouldn’t go to waste. Your health should not have to pay the price for the compulsive purchase of unhealthy food.

The biggest challenge is getting started. Don’t wait another day to decide to do something for your health. Start today and consider organizing your kitchen. Your environment can support the eating habits you wish you had. If this is a job you don’t want to tackle alone, give me a call. A pantry/kitchen makeover is a service I happily offer and would love to help you organize your way into healthy eating.

Eris Craven, MS, RD, LD
My MD Personal Medicine

Lower your LDL levels

To avoid heart attack, numerous scientific research studies have found it important to reduce LDL cholesterol levels below 100, and some studies indicate further reduced risk when levels are reduced to 80 or lower. 

Dr. MacDonell works with patients at risk to reduce their LDL using a variety of practices, including dietary changes and statin drugs when indicated.  He can monitor results as you make lifestyle changes to ensure you are seeing improvements over time.


Download this article that describes the Novel Agent that lowers your LDL levels and helps with the treatment of lipid disorders and reduction of heart disease.

Are you at high risk on your LDL levels?

To avoid heart attack, numerous scientific research studies have found it important to reduce LDL cholesterol levels below 100, and some studies indicate further reduced risk when levels are reduced to 80 or lower. 

Dr. MacDonell works with patients at risk to reduce their LDL using a variety of practices, including dietary changes and statin drugs when indicated.  He can monitor results as you make lifestyle changes to ensure you are seeing improvements over time.


Download this article for a possible new way to look at, and evaluate your LDL levels.

Prevention of Malaria in travelers

“Self treatment of a possible malaria infection is only a temporary measure; prompt medical evaluation is imperative.”

The Centers for Disease Control and Prevention provides useful information about malaria risk.  (  Every year, millions of US residents travel to countries where malaria is present. About 1,500 cases of malaria are diagnosed in the United States annually, mostly in returned travelers.

Travelers to sub-Saharan Africa have the greatest risk of both getting malaria and dying from their infection. However, all travelers to countries where malaria is present may be at risk for infection.

If you are considering travel outside of the U. S. Dr. MacDonell can help you determine if malarial transmission is a risk   He can then direct you to the best resources for prevention and discuss the pros and cons of various antimalarial drugs.

Download this article that outlines sources, prevention, and treatments of malaria.