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I hope 2023 is off to a good start for you! I wanted to share a few tried and true warming ideas that are regulars in my household. Fire CiderFire cider is a very old home herbal recipe. The basis is to infuse warming herbs and spices, usually in apple cider vinegar, then strain after a few weeks and use liberally throughout the wintertime. It can be used in cooking (where you would use vinegar), as a shrub (vinegar drink usually with seltzer water) or just as a small daily tonic. If you prefer, you can buy fire cider from local herbal companies such as Wise Woman Herbals, or at your local health food store.  Other warming practices:You can also try topical application of capsaicin products (the hot sensation in Icy Hot) or black cumin seed oil or black pepper oil to areas of poor circulation such as hands and feet. Be careful with the oils as you will want to test your skin after you have diluted the oil (diluted with a neutral oil such as almond or jojoba) as the oils are very concentrated and can cause a burning sensation if too strong or left on too long. One drop of concentrated essential oil to ten drops of carrier oil should be adequate, but test your own sensitivity level. The last idea I wanted to share will sound very odd, but I've noticed it really helps me keep up good circulation through this winter so far… and that is cold plunging. Yes, it's a bit of a fad with the biohackers, but I really think there is something there! After taking a long, hot sauna, I plunge for anywhere from a brief dip to three minutes. (If you try this you need to test out your own response, as you want to avoid feeling too chilled afterward.) I noticed improved resilience to our cold weather even after the first day, and have continued to feel more comfortable this winter doing a sauna-plus-plunge once or twice a week. A word of cautionThese are just ideas I think are safe and appropriate for most anyone to try in their life. This is generalized information and not medical advice. Be especially cautious if you have any peripheral vascular condition, such as Raynaud's disease (see below), as some folks are especially sensitive to temperature changes in their extremities and need more customized support.  I wish you a wonderful entry into 2023, and all the best for you coming year!
I also wish that all who are starting new resolutions, behavioral changes, intentions, and new practices act from a place of self-compassion, self-love, and listening to what our bodies need. There are more than enough negative messages about what we "should" do or be (or buy) out there. In case you haven't heard this recently, you are enough. Your body is a good body. We, and our bodies, are always doing the best we can, with the resources we have available. We all deserve rest, replenishment, and the ability to take good care of ourselves. Please let me know how I can be of assistance to you while you take care of yourself in 2023, Dr. Angela Cortal
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Although I function more as a specialist than a primary care physician, I thought I would put the word out there to be aware of what types of screening exams and tests may be due as we close this year out and begin another. Though the below-mentioned screenings and tests generally are not subject to deductibles and are usually zero co-pay/co-insurance, you still may want to plan accordingly (i.e. if you have a large deductible that will start back up January 1) as any follow-up exams, tests, and visits that may be necessary based on results do not fall under those guidelines. Here's a non-exhaustive list:
As you can see, a lot of the recommendations are personalized based on your past medical history and any pertinent familial risk factors. If you haven't checked in with your primary care provider in a while, ask them what they think you are due for, and go from there. Let’s end on a warm note:The antidote in my household to all this cold, wet weather has centered around vitamin D supplementation, warming soups and stews, and a kettle of hot water always ready to brew some tea on the stove. Here's a little Golden Milk recipe that is widely known and used for warming when the winter weather sets in. Because I, like most people, can't stand the book-length intro that seems customary on most recipe sites, I thought I'd share a thumbnail recipe here, with a link to the full details here if you'd like to read more.  Over the course of this winter season I will share a few more of my favorite home recipes for warming your body from the inside out.
I wish you a warm and toasty winter season, Dr. Angela Cortal Here's the update for fall of 2022...  I am currently up to my eyeballs in planning our prolotherapy medical brigade which will be happening this October in the Cancun area of Mexico.
It's an intense training program. We have online training, a full day of in-person training before the patients show up, then three very full days of constant patient care. It is the very most condensed way to learn full upper and lower extremity prolotherapy, and is an amazing opportunity both for those wanting to learn prolotherapy for the first time, and also for those that are newer in the field and want to get a ton of hands-on practical experience, guided by experts in the field. In addition, I will be teaching the introductory On Point course in September. I am also in talks to plan a new course, which will be geared towards those who already have a basic understanding and clinical experience in prolotherapy. More details to come as I confirm those details. If you are a healthcare provider who is looking to get into this field, I hope you have already found my training page and gotten onto my email list. That is the way I keep everyone up to date as to the upcoming injection therapy opportunities. Lastly, I have a limited ability to offer private training, in any of the injection therapies that I cover in the other courses (scar adhesion, trigger point, prolotherapy). These are arranged directly and can be held at my clinic or yours. Please email hello {at} drcortal.com and we can start chatting about what you are looking for. Have a very lovely day, Dr. Angela Because of new rules and regulations affecting those working in the medical and educational fields, I wanted to include a few bits of information for you all here. If you are still having difficulty finding a site for your vaccination, or are not sure where to go for shot #2 (if you got Pfizer or Moderna), check this site to find clinics and pharmacies near you: https://covidvaccine.oregon.gov/ Over the past 8-10 months I have not been shy in sharing my views on vaccination. I am fully vaccinated. I support covid vaccination as a public health measure. As research has been accumulating for the last almost-year, it still appears that all vaccine options available to us are safe and effective. Seeing the stats coming out of hospital covid floors and ERs is frankly disturbing. Being non-vaccinated is the new "preexisting medical condition." Current infections are hitting these folks very, very hard. I have been, and continue to recommend, that if someone is able to get vaccinated, then they should seek that option as a layer of protection. with vaccine requirements come interest in exemptions I want to share this information publicly, so that if you or someone you know is seeking a medical exemption for covid vaccination, you are aware of what your provider legally can and cannot do for you. Let me say that my covid vaccine information is coming from the CDC, and indirectly from the vaccine manufacturers themselves (it's all there on the CDC site). Medical exemption means that there is a medical reason that a healthcare provider recommends against a treatment, in this case vaccination. In fancy medical terms is means you have a contraindication for getting vaccinated. So let me share with you the contraindications for getting a covid vaccine:
So there you have it, folks. Those are the medical contraindications. Here is a nicely laid out table showing each vaccine and its ingredients:  [Source: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html Appendix C above and Appendix B below] So this means that yes, I can write a medical exemption* if someone has had a documented anaphylactic reaction to any of the covid vaccines, or their ingredients. Employers may add additional qualifying exemptions at their discretion, so for patients wanting to discuss a medical exemption at their visit, I am asking them to bring any relevant information from their HR so we can review this information together. what about other types of allergies? Being allergic to basically anything else under the sun that is not an ingredient of one of the covid vaccines is not a medical contraindication. Even having had an allergic response to a different type of vaccine. This may be surprising for some, but the reason is that if there are completely different ingredients, then there is no reason to think someone is allergic to say a tetanus shot and one of the covid vaccines. Take a look at the table below for additional information.  yeah, but will you sign it anyway? I haven't gotten this question yet from patients, but I imagine it's only a matter of time. If you do not have one of the contraindications listed above, and your HR doesn't provide any other qualifying conditions you may meet,** then no, I will not sign the medical exemptions. I say this for several reasons. One is that a medical exemption is a formal medical recommendation i.e. a prescription. I'm giving a prescription not to vaccinate in this instance. Which requires a medical necessity, so now we're back at square one- proving the medical necessity. The second point is that for me to falsify medical documents is fraud. That is very serious when you have a medical license to protect like I do. There are already many healthcare providers making fraudulent health claims out there, and are being investigated by government entities. For the health, sanity, and longevity of myself and my practice, I would very much like to not be among those ranks. I'm not being "chicken little" about this. A colleague who I went to school with is currently waiting for her court date in jail, with the charge being falsifying vaccine cards. This is all very serious and I won't be committing fraud because someone asks me to. That just won't happen. So if you can, get your shot. If you can't, and we can document that, I can exempt you. And if you're just choosing not to, I wish you the best and hope you are taking many additional safety measures. But please don't ask me to be a part of it. Take good care of yourself, now more than ever, Dr. Angela  * Presuming your place of employment does not restrict the type of provider who can sign them (i.e. such as saying only MDs and DOs can sign it).
** That's really up to them to decide if they have a list that is longer than the contraindications posted on the CDC. I will follow the rules set out for me. So if your place of work says that in addition to the CDC list, having an ingrown toenail is a contraindication, sure I'll sign your medical exemption form if you have an ingrown toenail.  Please join me today as I chat with Dr. Meghan Walker of The Entrepology Podcast about hormones and their important connection to joint pain and chronic pain. This is a conversation (and a podcast!) that I'm very excited about. You won't want to miss it! Listen in <<<here>>>.
 Today I'm talking with Functional Medicine Nutritionist Andrea Nakayama about mapping joint pain; where the root causes of joint pain may stem from, and what we can do to alleviate it. It's 15 minutes you won't want to miss! Listen here.
You've already seen the big news, right?  💮 Next week I'll be starting up in my new Salem office 💮
Virtually during the month of June, then we'll be up at running at my new office on Liberty near Mission in July (960 Liberty St SE #210). Salem folks: if you didn't see my email update, click here to get on my new clinic schedule: https://www.reconstructedwellness.com/salem [for those who have not already scheduled through me or my Reconstructed Wellness main office yet] Have a great Memorial Day weekend! It's looking like good weather for a BBQ 🍖 I'm moving clinics in June! Here's the video I made for my Salem community: Starting June 1st I will be transitioning to my new office location at 960 Liberty St SE, Suite 210. It's on the corner of Liberty and Bush in SE Salem, a block from the gazebo entrance to Bush's Pasture Park and two blocks south of Mission St. I will still be practicing in Portland and Salem, and now both locations will be under the Reconstructed Wellness umbrella. So here's what this means for us: Schedule visits starting now: call Reconstructed Wellness at 503-232-3215 to schedule your virtual or in-person visits. You don't have to wait until a certain day, the schedule with my new location is up and ready to go. In-person visits at my new location begin July 1st. Starting June 1st: I will be seeing patients remotely both on Tuesdays and Wednesdays. As a Reconstructed Wellness patient, you will be able to easily see me at either location, both virtual and in-person. This doubles my virtual availability for all patients! No new patient paperwork if you see me at the other location than you're used to. Just schedule when and how you need me. Technically, Tuesdays will be through my Salem location, and Wednesdays at my Portland location, but since it's all remote that doesn't really matter. This is just an FYI as it'll mention the location in the appointment details. As always, remote visits will be at https://doxy.me/drcortal Because my new space will not be ready as early as anticipated, I will continue seeing patients in person at Natural Physicians on Thursdays through June, so if you have an appointment booked, don't worry I'll be there :) Starting July 1st: I will fully transition my entire Salem practice to my new clinic location at 960 Liberty St SE #210. Our (in-person) time frame as announced on the postcards I sent out got pushed back due to remodeling delays. At my new location I will be seeing patients Tuesdays and Thursdays, now in-person all day on Thursdays, 9 am - 6 pm. If you currently have an appointment on the books after July 1st (at Natural Physicians), feel free to call Reconstructed Wellness any time at 503-232-3215 to get that moved over. All patient appointments on my Natural Physicians schedule July 1st and later will be contacted to be re-booked on my new calendar. I will be sharing more details as we get closer to the big move, but that's enough for now. I hope you're enjoying the beautiful spring weather out there, Dr. Angela  Please join me for a short chat today with Integrative Practitioner editor, Katherine Rushlau, as we discuss evidence-informed approaches to address and reverse the root causes of chronic joint pain, including nutraceuticals and lifestyle-based interventions. This is one you don't want to miss!
Happy Friday! Time for another podcast! This time I am chatting with Gregory Anne Cox of Rebellious Wellness Over 50 about injection therapy for pain relief and joint regeneration. We also take a deep dive into hormones and how they can affect joint pain. It might surprise you! Click the image below to join in as Greg and I discuss wellness at any age!  |
I'm Dr. Angela, and I want to help you and your joints feel their very best.
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