#(google it if you’re curious; i’m not a physician)

[dihalect]

my current episode of house features a teenage supermodel. and generally i don’t put much stock in punitive “justice”, but with the way house is acting, i think one billion million gajillion years in the hellpit would be fair

[brownsugar-dreams]

Hey just curious because I really am considering med school but how do you have the time to do sugar dating and whatnot and running your business while in med school? And how does being in medical school effect your sugar dating life?

I love this question! It is pretty difficult in the beginning to sugar date during med school. You’re starting at a new school, new curriculum, and most likely a new city/state to adjust to. There’s a flow and a schedule-balance I had to attain before attempting to sugar date. I am fortunate to be able to hire help with my business and even with the help I just barely make deadlines. I couldn’t imagine if I had started my M1 year during the early stages of the business plus trying to sugar.

Calendar for Sugar Dating+Life Goals

It helps massively to have a schedule. I use Google calendar daily. My school gives us our class schedule for the entire year with the in-person classes denoted (1-2 per week). So I schedule my other obligations/projects/study time around the class schedule. It’s the only possible way I’m able to get things done productively. Even if you don’t have a business you will have interest group meetings, info sessions, physician panelist events, networking events etc. that you likely want to attend and it’s easy to miss those events if they’re not on your calendar.

It also makes it easier to schedule out your sugar dates (when you eventually start sugar dating because, again it’s doubtful you’ll be able to properly for at least the first month). I like the calendar format because it helps with scheduling goals, deadlines. I made a virtual scheduling course about effectively organizing and managing your schedule using layers. When you have lots of obligations, projects, and goals it’s easier to accomplish them when you use an organizer. It’ll also show you the time you do have available for sugar dating, self-care, etc.

I’m about 2 months in and just started settling into the flow of my schedule and have been passively sugar dating. I went out for dinner the other night at a popular restaurant downtown, met some out of town men on a business trip that paid for my dinner and I wasn’t actually actively freestyling, just wanted to treat myself to a nice dinner. So it’s exciting to see what will happen when I update my schedule to make time to actively sugar date.

I’ve met so many women in my class that have either sugar dated before or are interested in sugar dating, so I try not to worry too much about stigmas. In terms of sugar dating affecting med school I think it makes getting gifts and money from men easier. They’re always wanting to give accomplishment gifts and financial support because in their eyes you are beauty and brains. So it’s definitely possible to sugar date during med school, just always prioritize school. There are other ways to make money from home that aren’t too schedule consuming if you had to. Feel free to pm me if you want to know more about med school/the application process or just life as a med school student.

P.S. I made a med school rant podcast episode partly inspired by this asks and similar ones. Check it out if you get a chance!

[galvanizedfriend]

KC Bingo 2020: Drabble

Because there were so many winners on the @klaroline-events 2020 Bingo, I'm helping out @itsnotacrimetoloveyou with some of the drabble awards. Hope you guys don’t mind this. You were in for an exclusive Luiza piece and instead you get me! lol I promise I’m doing my best.

This is for @klavscaroline and her GORGEOUS manip with the theme "Rome".

Years of fighting as a gladiator had Niklaus prepared when he is caught with the Emperor’s wife, Caroline, in the Sanitarium after dark.

So I have to clarify that my knowledge of Ancient Rome is extremely limited, and even though I DID consult with Prof. Google for some of the stuff in the drabble (like to find out what a sanitarium was and how Emperors and Empresses were addressed at the time), I'm sure it's all shades of wrong. Hopefully I'm not offending anyone, but just take this as a grain of salt, ok? Ok, then.

Also, I added a TWIST to the plot. lol Sorry? I think?

Your manip was way too gorgeous, @klavscaroline, and I could never match it, but I hope you like this. :) Also, congrats on your full card and THANK YOU for always making such amazing KC content!

x-x-x-x-x-x-x-x-x-x-x-x-x-x

Caroline slows down her purposeful steps and smooths out the concern creasing her expression into practiced aloofness before she enters the sanitarium.

To her luck, there's only one patient there, accompanied by the physician who's seeing to his wounds. The other fighter was killed in combat at the arena, his body simply carried out to be ditched in a shallow grave somewhere.

The man has been undressed of his tunic, left in only a loincloth hiding his modesty. A light sheen covers his sun-tanned skin from the exertion, dirty blonde curls matted to his forehead. Normally, these would be sights that would make Caroline's insides twist rather inappropriately. Now, however, all she can focus on is the blood. All over the man's discarded tunic, all over his torso, gushing from a wound on his shoulder.

She swallows back the bile that rises to her mouth, suddenly raked with nausea. When his piercing blue eyes meet hers, her heart gives a violent lurch. Despite her nerves, she lets out a relieved breath. Thank the gods.

"My queen," the physician says, blinking with surprise. It's not common for the Empress to go down to the sanitarium, especially after a fight, especially on her own, and especially when there's a man being treated there. It’s not a very womanly environment, the smell of blood and sweat staining the air.

"The Emperor wants to know what's his best warrior's condition," she announces solemnly with as bland an expression as she can muster.

"Just a superficial wound, my queen," the physician offers. "No damage to the muscle tissue. Provided it doesn't get infected, he should heal well."

"Then what are you doing there, standing? His wounds need cleaning and dressing. Go see to it."

"Y-yes, of course," the man stammers, startling out of inertia. "I will be back in a moment."

The man scurries out of sight, leaving the two of them alone.

Klaus arches his eyebrows at her, an amused smile playing on his lips.

Caroline's pretense calm explodes into nerves. "How can you be so careless?" she snaps.

"Is that the Emperor asking?"

She simply ignores his attempt at a humorous jab and proceeds with the scolding. "You fight like a lunatic, Klaus. One of these days -"

"I will die. And so will every other man on this land," he says with a lightness that does not belong to a man with an open wound on his shoulder. "I can assure you, however, that my death shall not happen at the arena."

She huffs out in indignation. "Your hubris really knows no bounds."

"You say that based on a little scratch?"

"A little scratch!" she parrots, taken with heat as she walks over to him. The physician left a basin with clean water and a towel beside it. Caroline wets the towel and proceeds to clean the wound, being as gentle as possible, even though he hardly deserves it. Not that it makes a difference; Klaus keeps his too-sharp eyes trained on her, his features as bland and agreeable as ever. Doesn't even wince when she rubs the towel against the cut. It looks terrible, but it is definitely not as bad as she'd envisioned as she watched the combat from the stands. "Do you feel no pain?" she asks, a light thrum of fear coloring her voice.

"Of course I feel pain."

"Doesn't that hurt?" She touches the towel across the wound again, most of the blood now gone from his shoulder.

"Yes. But pain is good. Pain reminds us to be afraid," he says, lips curling upwards a tad more, eyes glowing with fire and danger. Oh, Niklaus..., she thinks. Such a force of nature. Caroline had no mercy on her poor heart when she got herself involved with him.

"Pain makes you reckless," she admonishes.

"No. What makes me reckless is the fear of pain. I try to avoid it."

She scoffs. "You could have me fooled." She puts the towel down, her fingers grazing over a pair of scars not far from the new one he'll likely get. Sometimes, at night, while he sleeps, she counts the scars on his back, his arms, his legs... There are so many. She swears he gets a new one every day, growing them as though one who grows hair. Some small and almost imperceptible to less attentive eyes, eyes not used to roam over the plains and valleys of his body with such regard; some so large they bring a chill to her heart, thinking of how close she's come to losing him. "Soon enough there won't be a single unblemished patch of skin on your body."

He holds her hand, presses her palm down against his chest, above his heart. Its strong, steady beats give her a measure of comfort. "Does that concern you?"

Caroline’s lips twist. "What do you think?"

With a swift and agile move, Klaus wraps his arms around her and pulls her up on to the gurney, rolling over so that her body is pressed down underneath his. A man with a gash on his shoulder and dozen other bruises should be howling in pain right now, but Niklaus merely smiles, a large and predatory grin that looks absolutely sinful on his rosy lips.

Still, Caroline's heart drums away in her chest, her eyes flitting nervously to the entrance. "What are you doing?" she grits out. "He'll be back -"

"In a bit," Klaus remarks with all the calm in the world. "He went all the way to the dispensary for his dressing items. The Emperor's best warrior can only be treated with the best. If I get an infection, it will be his head hanging outside the walls."

"Someone could walk in -"

"Yes?" he edges his face closer, his mouth hovering an inch away, chest to chest, hip to hip. "And what would you do?" he whispers, warm breath ghosting her lips.

"I would..." Caroline breathes out, the hand that should be shoving him away sliding up to his hair. "Scream."

She pulls his head down, cutting the final space between them, mashing Klaus' mouth against hers in a plundering kiss. All the worry, all the prayers she made for the gods to protect him, the breath she held as she marched down to the sanitarium after watching him being helped out of the arena - it all bleeds out of her in that kiss. She relishes the taste of him, that urgent and hungry tongue that wrestles her into submission.

Another day she could've lost Klaus; another day he lives to make her heart swell with joy and lust.

"Now would be the moment to scream."

Klaus jumps from the gurney like thunder, grabbing his sword in the process and pointing it straight to the throat of the intruder. Caroline's heart stutters to a stop.

The Emperor stands there, totally unfazed by the sharp sword aimed at his neck, his classic stoic expression unmoved. He merely cocks Klaus a curious eyebrow. "Not contented enough with sleeping with your Emperor's wife, Niklaus?" he asks flatly. "Are you going to commit regicide and fratricide all at once now to add to your list of misdemeanors?"

Klaus puts down his sword. The light wince as he does so does not escape Caroline's eyes. He's in more pain than he's willing to admit, the arrogant bastard.

"You know better than to sneak up on me like that, Elijah," Klaus grumbles.

"And you know better than to straddle my wife in a sanitarium, Niklaus." He turns his pointed gaze to Caroline, then. "I expect this kind of barbaric behavior from him, but you, Caroline? I'm disappointed."

She averts his gaze, her cheeks burning with embarrassment as she stands to her feet, fixing her tunic and her hair. "He grabbed me," she says, the excuse weak to her own ears. "I was merely here to check that he hadn't lost a limb or bled to death with his carelessness."

Elijah lets out a weary sigh. "You two are free to conduct your activities however you please, so long as it's away from prying eyes. That was the deal. I have far too many responsibilities to suddenly find myself dragged into a scandal between my wife and my brother." He fixes his dark eyes on his younger brother then, a smile finally breaking onto his handsome face. "I would so hate to have to punish you for your indiscretions, Niklaus."

"You don't seem fazed by the prospect, brother."

"Then don't test me. How's your wound?"

"A scratch."

"It's not just a scratch," Caroline cuts in sharply. "The physician said it's superficial, but it's at risk of infection."

"How much longer do you intend to keep putting your life at risk at the arena like you’re a common gladiator, Niklaus?" Elijah asks.

"How much longer until you find me a real war to fight?"

"I know you were far too restless to sit through our childhood lessons, but let me remind you that the general idea is to keep the Empire at peace."

Klaus snorts. "You and your philosopher's heart."

Caroline feels her blood boil at his derision. "Most men choose to fight so that they can preserve their lives and that of their families," she starts, spitting fire at him. "You, on the other hand, run in the opposite direction. Like a madman without a purpose, you chase mortal danger like that is the sole purpose of your existence. And then you laugh at your brother's concern - at my concern. Like we're idiots for even caring. If you can't grow yourself a philosopher's heart, perhaps you should at the very least grow yourself a conscience."

Klaus stares at her with wide eyes and parted lips, somewhat taken aback, while Elijah's mouth ticks up into a smile, a flicker of humor and warmth in his brown eyes.

"I am ever glad to have wedded such a wise woman. If my appeals fall on deaf ears, perhaps hers might reach you," he says. "I have business to see to. Please, refrain from fornicating out here. And Niklaus..." he waits until his brother has turned back to him. "Get this wound cleaned up and dressed, soon."

With all the grace and poise befitting of the Emperor, Elijah turns around and leaves.

Klaus gives her a near diffident look under his fair lashes, having the decency to appear guilty.

Caroline folds her arms across her chest. "I can't keep watching you challenge men to try and kill you every fortnight."

"I'm a warrior, Caroline. My brother's a diplomat, a ruler. I'm a fighter. He's the brain, I'm the muscle. You knew that when you married him... When you married us."

Caroline puffs out in frustrated derision. "I married him because I had to. Because it was the bargain he stroke with my father. But perhaps I made a mistake, then, when I fell in love with the wrong brother."

"Don't say that," he retorts, genuinely stricken. "You know I'm a jealous man."

"Oh? Are you challenging Elijah next, then?"

"Of course not. If I killed my brother, the Empire would descend into chaos and I would be forced to take his place and murder my way through countless political intrigues, which would leave me with little to no time for the one thing I'm truly passionate about."

"Arenas," she offers with disdain.

"You." Klaus' eyes soften then, no longer wild with raw excitement; something tender and gentle shining through the stormy blue. A look, she knows, only bestowed to her. It tugs directly at her heart, and she feels a glow of affection rising through the anger and the concern. "I'm addicted to you, Caroline. The arenas are a mere distraction. You are the sun of my life."

She bites back on a smile. The same wicked tongue that lashes out at enemies with the more depraved of curses can also worship and conjure the sweetest of promises. "If what you say is true... Then, as your queen, I command you to stay away from the arenas until your wound is fully healed and no longer at risk of reopening. You shall stay with us, at the royal chambers, where you can be cared for by the Emperor's physician. The Emperor demands so."

Klaus smirks lazily. "Well, we wouldn't want to vex the Emperor."

"No, we absolutely wouldn't." She checks that her clothes are all perfectly in place, squaring her shoulders and straightening her posture as she prepares to leave. "Now lie down and wait for the man to return. Then ask your servants to prepare your relocation. It might be awhile before you go back to your own home, so bring whatever you might need. I shall have a warm bath ready for when you arrive."

Klaus walks over to her, taking her hand and lifting it up to his lips. "That's very kind of you, my queen," he says, the thrum of his voice traveling through her like a lightning bolt.

"Yes, I am infinitely generous." She edges closer, narrowing her eyes with malicious intent. "And expect to be rewarded for it."

She waltzes out to the sound of Klaus' rich laughter. Oh, how she loves that sound...

[etherealbuccky]

Always & Forever: Two

Summary: Soulmates are linked through identical marks. Some are large and distinctive making it easy to find each other. Some, however, are very small and easy to miss. Mila Jones was born with a small crescent moon on her wrist, whereas Bucky Barnes saw his appear on his wrist at the young age of 10. despite all odds being against them finding each other, they do. Forcing both of them to make important decisions and figure out what they really want out of life. Can she be happy with a mobster? Will they give love a chance?

Bucky made his way into his office with Steve just two steps behind him. Walking in he saw Nat was already waiting for them with a bored look on her face.

“Mila Jones, just moved here from DC and lives alone in SoHo. Mom’s a lawyer, dad’s a physician. Law degree and works for Stark as a contract manager. No record, nothing out of the ordinary. Her address and additional info are in the folder. Why the hell are we looking into her again?” she asked with the same bored expression.

“Not important. Thanks for getting the info so quickly.”

The red head just nodded at this and walked out of the office.

“You can’t keep her a secret forever you know.” Steve said with a knowing look in his eyes.

“I know, I just want to keep it a secret ‘till we figure it out.”

“What’s there to figure out? She’s your soulmate. Not everyone is lucky enough to find theirs especially with a mark as small as yours. Go after her Buck, you deserve a bit of happiness.”

“Steve did you hear a word Nat just said? This girl grew up in a happy home with two accomplished parents and has no record whatsoever. What the hell is she gonna want with a mobster? It ain’t gonna work Stevie.” He said with a sigh.

Sam walked in looking uncharacteristically serious. “Rumlow just hit two of our guys. We need to deal with this before he gets outta hand.”

Bucky’s face was suddenly devoid of emotion. “Get Barton, Odinson and Maximoff” He said while grabbing his gun and tucking a knife into his sleeve.

After a while the six men were standing in front of a seemingly abandoned warehouse. Bucky turned to his men with a serious expression.

“I’ll do the talking and see if the punk takes the easy way out. If not and any of his men draw their weapons you give em hell. Rumlow is mine.” Of course no one ever takes the easy way out, he thought as he was driving back to his brownstone in Brooklyn heights covered in blood and with bruised and bloodied knuckles. But at least he made it known that no one touches his people and lives. After a long shower he slipped on a pair of black sweatpants and a grey T-shirt. Sitting down at his kitchen table and pouring himself a drink he looked over the file Nat had given him that afternoon. She was beautiful, no doubt. Quite a few year younger than him too. She had curly black hair, big brown eyes and plump pouty lips. Her umber skin had a certain glow to it, like she radiated sunshine. He could stare at her face all day, but he wouldn’t let himself. How could she ever love him? Who in their right mind would agree to becoming his and having a target on their back for the rest of their lives? Finishing his drink, he decided that he was going to meet her the next day and explain why it could never work. They go their separate ways, and everyone is happy. Going to sleep that night all he could see were those pretty eyes and that damn mark on her wrist.

The rest of her day was spent deep in thought. She found him, or rather he found her, and she ran off like a mad woman. This was not at all how she had imagined her first meeting with her soulmate. She imagined them meeting in a bookstore or a coffee shop, as cheesy as that was. She imagined shy introductions and starting off as friends. Getting to know each other and gently explaining that she could never be in a relationship. Not after him. They would be non-romantic soulmates. There for each other in a way that was far more reliable than romantic relationships. No jealousy, no drama, no heartbreak.

She got home after a rather busy day at the office and ordered a pizza before stepping into the shower and removing all of her makeup. After moisturizing and changing into a black hoodie and some matching sweats the delivery guy was at the door. Her night was spent stuffing her face and wondering how they would meet again. Would they meet again? Did she throw away their chance by running away? Only time will tell, she supposed. Going to bed later that night all she could think about were those slate blue eyes and the itty bitty moon on his wrist. About the man who was destined to be hers but never could be because she was broken beyond repair.

The next morning she was having coffee in her small apartment, dressed in black pencil pants and a white silk blouse. She was wearing her favorite lipstick and smooth jazz was playing in the background. It was a good morning. All she could think about was whether or not she’d see him again. Checking her watch she put on her coat and left for work. When she stepped out into the cold she saw a pair of familiar eyes looking right at her. He was dressed in a black three-piece suit and has his hair pulled into the same low bun. God he was beautiful. He looked at her in a way she couldn’t quite decipher but it still sent a chill down her spine. He opened the door to the range rover he was leaning against and motioned for her to get in the car.

“Please, let me drive you to work. It’s too cold to be walkin’ doll.” He said with a cocky grin. He hoped she couldn’t see through his act, his heart was racing awaiting her reaction.

“Obviously your social skills are ever worse than mine, and that’s saying something.” She smiled and stuck out her hand. “My name’s  Mila, nice to meet you. This is the part where you introduce yourself and tell me how you figured out where I live. Fingers crossed it isn’t creepy.” She said with an amused look on her face. One on one interactions she could always handle easily. Groups are what scare her into being an awkward stammering mess.

“Bucky Barnes.” He said taking her hand in his and lifting it to his lips to place a kiss on her knuckles. He saw her getting flustered at the gesture and it made his heart swell in his chest. Cute, he thought. “Let me just drive you to work please, I’ll explain everything over lunch later if you’ll join me.” She knew she shouldn’t trust strangers but it was freezing out and she was far too curious about him to decline. So she got in the car and let him drive her to work. The journey was mostly silent. Until he asked her what time she would like for him to pick her up and what kind of food she likes. “12.30 is when I have my break and anything’s fine really.” She said with a small smile as they pulled up in front of the building.

“Alright then, see ya at 12.30.” He said with a small smile which she gladly returned. He reached over her to get the door for her and only then did she realize how amazing he smelt. She has to force herself to lean away from his body and she hurried off muttering a quick goodbye. Driving back to his office all he could think about was how great she smells and how good that lipstick looked on her. He had to force himself to stop staring at her beautifully plump lips. What was he getting into?

12.30 came around quickly and she hurried towards the elevator saying a quick goodbye to her coworkers. Stepping out of the building, she saw him right where she left him. Looking right at her with those beautiful blue eyes. She thanked him for opening the door for her and he gave her a small smile. This smile was a lot less easy than the one he gave her this morning. He looked anxious. They pulled up to a nice looking Italian place and he got out first to open her door for her. They got out and walked in. The place was completely empty, despite her knowing it was damn near impossible to get a reservation here. This convinced her even more that the allegations were true. One quick google search at the office earlier and she found out he’s a very dangerous person. A string of murders throughout the city ever since he allegedly took over a Brooklyn based mob. None of the crimes were linked back to him in the form of evidence of course, which is why he was here right in front of her. She looked at him questioningly and he just smiled and said he thought it would be better to have some privacy. She nodded, thinking he must not want to hide what he does for a living from her. They were seated immediately and he asked her if she preferred red or white wine.

“I don’t drink.”

“At all?” He asked surprised. She just nodded and asked for an iced tea while he ordered a red wine. She was fidgeting and he noticed. It worried him. Did she already find out who he really was? Was she scared of him already? Worries flooded his mind until he heard her speak softly.

“I know who you are, what you do. I googled you at the office earlier. I thought I’d let you know to save you from having to explain. You look nervous enough as it is.” He forced himself to keep his composure. “I can neither confirm nor deny these allegations.” He said with that stupid cocky smirk. “Cut the crap Barnes, I can see you’re nervous. But, as it is we are allegedly perfect for each other. So, I won’t judge you for how you make a living. However, I really don’t want any part of it.” He nodded in understanding. She looked at him expectantly, waiting for him to say something, anything.

“I get that you don’t want anything to do with my business. However I would like to get to know you. No expectations, just getting to know each other.” She found the uncertainty in his voice endearing. She should tell him, she supposes. “I’d like that too, I should tell you though, I’m not at a place where I can be involved with anyone romantically.” She said quietly.  “I accept everything that you are, if you accept that we can only be friends.”

He wanted her to be more than a friend. Especially because she was so accepting of who he was and what he does. But he had to try, for her. He gave her a small smile and agreed to her terms. “Fair enough.” He said with a voice that raised the hairs on the back of her neck. Lunch came and they talked about anything and everything. She found him surprisingly easy to talk to and he liked hearing her laugh. She told him about her love for jazz, the books she’s currently reading because she can never just read one at a time and how she was an only child. He told her how he came to take over his dad’s business when a hit took out both of his parents. He had just graduated college at the time. He has three sisters two of them are married and moved away to London and Amsterdam respectively. They couldn’t take this life anymore. The eldest of the three however, Rebecca, still lived in Brooklyn and they have dinner together every Sunday.  It was almost time to go and they were drinking coffee, he remembered he needed to lay down some ground rules with her.

“Doll, before I forget,” She felt her cheeks heat up at the pet name. “If I’m gonna be in your life you’ll need protection. My line of work is unpredictable. You’ll have a driver to take you to and from work. I’ll have people looking out for you at all times and make sure no one can get to you. I know being associated with me can be risky business but I can more than handle it.” It was as if she was only now realizing what she had agreed to but she pushed down the bad thoughts and put on her brave face.

“I can handle myself just fine you know.” She said with a small smile.

“Then let me do it for my own peace of mind. Please, Mila.” Her name coming from his lips was like music to her ears as she pushed those feelings down too. She couldn’t let herself think like that.  “Alright. I agree to you terms, but I have some of my own.” He nodded for her to continue. “You can’t just show up without letting me know beforehand, If we meet it’ll never be at each other’s houses because that’d be risky. Also, we keep this between us. The less people that know about us being soulmates the less messy anything can get.”

“Agreed. I’ll admit showing up at your house and job was a bit reckless. Steve is outside he’ll take you back to work and take you home later too. Your driver starts tomorrow.”

“Who’s Steve?”

“My right hand man, my closest friend. You can trust him, probably more than you can trust me.” He said the last bit with a sweet smile.

“So I can safely assume he already knows about me?”

“Yeah he does, I tell him everything.” She nodded slowly before letting him guide her outside after dropping far too much money on the table. Outside was one of the men she saw the first time she met Bucky. He was blonde, tall and quite muscular. He gave her a warm smile and reached out his hand. “Hi there, I’m Steve Rogers nice to meet you, again.” He chuckled. She returned the smile and shook his hand. “I’m Mila Jones, but you already knew that.” He just smiled at that and opened the passenger side door for her. She gave Bucky one last look and he smiled at her saying “I’ll text you.” She nodded and got in the car giving him one last smile. The drive back to work with Steve was nice. He was really funny and easy to talk to. He asked her what time he should be there to pick her up and gave her a tight hug before he left.

The rest of her workday was pretty uneventful. It was 4PM when she went to get some coffee downstairs and felt her phone vibrate. It was a text from Bucky.

Bucky: Dinner tomorrow?

Mila: How did you get my number?

Bucky: Don’t ask any questions, and I won’t tell any lies ;)

Mila: Fine, don’t tell me.

Bucky: So I’ll have Lance pick you up tomorrow at 7?

Mila: Sure, sounds good. Where are we going? And is Lance the poor guy driving me around?

Bucky: One of my places, less prying eyes. Yes, Lance will be your driver.

He says it like it’s normal to own several restaurants. She thought to herself.

Mila: Okay, see you then.

She got her coffee and finished reviewing the remaining documents, adding remarks here and there. Packing up and taking a few documents to review later at home, she said goodbye to her colleagues and got on the elevator with Wanda. They talked about upcoming deadlines, Yvonne from marketing’s horrible lipstick and about meeting for brunch on Sunday. She got out on the ground floor hugging Wanda goodbye as she had to be at the underground parking lot. She expected to see Steve but saw Bucky instead. Raising an eyebrow at him he just gave her a smile and opened the car door for her. Once in the car she couldn’t stop herself from asking.

“I thought we had a deal?”

“I know, I know. I just had a no good horrible fucking trash day and I needed a distraction. So, can you do that for me please?” He asked looking frustrated and sad all at the same time. “Sure, while we’re breaking the rules anyways, let’s go to my place. I make a mean lasagna. It’s bound to lift your spirits.” She smiled at him and he couldn’t help but smile back. They got to her place and looking around he saw white walls, a cozy living area to the left and a small kitchen to the right with a round dining table dividing the two areas. He saw an open door right ahead, revealing a large bed and a vanity. She had a lot of plants around the apartment and a record player in the corner. Books were scattered everywhere.

“I know it ain’t much but I love it.” She said while walking into the kitchen.

“No, No. I love it. It’s cozy.” He said with that beautiful smile of his. She walked back taking of her coat and stretching out her hand to take his too.

“Make yourself comfortable, I’ll start cooking”

“No doll, I don’t like feeling useless. Let me help. Just tell me where you need me.”

“I wouldn’t wanna ruin your suit Buck. Is it alright if I call you Buck?”

“Doll, you can call me whatever you want.” He said with a wink. She just laughed and threw an apron at him. He took off his suit jacket and waistcoat and rolled up the sleeves of his shirt putting on the apron. The night was spent cooking, laughing and making fun of each other. The ate with Nina Simone drifting through the small apartment and after having some ice cream while she gave him a few book recommendations and showed him her record collection. Their fun was cut short when Bucky got a call from Steve and had to rush off. He gave her a tight hug and promised to see her tomorrow for dinner. 

She did the dishes with a heavy heart. Bucky was nice, he made her feel comfortable and he seemed to relax around her too. She knew it was only a matter of time before one of them fell for the other hard. Yet all she could think about was how she lost Tommy and a feeling of guilt washed over her. Life can really be a cruel joke sometimes, she thought. After a long shower and finally going over the documents she went to bed thinking of how nice it felt to hug Bucky. Little did she know that a certain mobster was thinking about the same hug while washing the blood from under his fingernails. All he could think was how nice it had felt, and how small the chance of her being this kind to him would have been if she saw him right now. Blood covered his hands face and most of his shirt and none of it was his. He hoped she would never have to see this side of her. 

That night he didn’t sleep a wink. She consumed his every thought. He had only just met her, how was this even possible. “Guess that’s how I knew she really is my soulmate.” He muttered to himself while taking a sip of his Bourbon. He couldn’t help but wonder why she didn’t want a relationship. Was she hurt badly? Did she just not want to be with him? He doubted that the latter was her reason seeing as she has been nothing but honest with him so far. Night faded into morning and he watched the sun rise while images of her lips and those gorgeous brown eyes flooded his mind. Pools of honey, he thought to himself.

[prxcticallypxrfect]

Activity Update: 4/16 - ???

Just a heads up, my activity is going to be a little spotty going forward!  Details under the cut -- though tw, health wank

SO.  Long story short, due to schedule issues, and insurance issues, I haven’t been able to see one of my doctors in awhile.  Because of that, they’re not refilling my medication, which, you know, fair, I get it.  THAT SAID, they’re only open once a week, and only during hours where I have class/work.  And the medication is one that can cause some wicked withdrawal symptoms if stopped abruptly (google “cymbalta discontinuation syndrome” if you’re curious).  Unfortunately, I’ve been out of the medication for nearly a week, and won’t be getting in today (Mondays are the one day a week they’re in the office!), so withdrawal is starting to hit.

I’m looking into other physicians, but haven’t had any luck so far (again, some insurance complications), and unless I can convince my boss to let me take time off work to see this doctor...

tl;dr, things are about to get pretty rocky.  I’ve been off this medication before, and let me tell you, it’s not a lot of fun e__e

I’m going to continue to try to be around, of course, but given that I don’t see this being resolved in a timely manner, I’m not sure how productive I’m going to be.  This may lead to me being very selective about which threads/asks I reply to, so please know that it’s nothing personal!  I’m not dropping anything, but some things may take a backseat for awhile, as I’m only going to be writing what I have muse for/can handle at the moment.

Thank you all for bearing with me.  I love you all dearly <3

xx Tegan

[droesslervalente1996]

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[paleorecipecookbook]

A Functional Medicine Approach to PCOS

In this episode we discuss:

Dr. Nett’s transition from conventional to Functional Medicine

What is polycystic ovary syndrome?

Addressing underlying causes

How useful is a diagnosis of PCOS?

Treatment of PCOS

[smart_track_player url="http://ift.tt/2AccrCJ" title="The Functional Approach to PCOS" artist="Chris Kresser" ]

Chris Kresser: Hey, everybody, it's Chris. Welcome to another episode of Revolution Health Radio. This week I have a special guest, Dr. Amy Nett, who works with me at California Center for Functional Medicine and is also on the Kresser Institute faculty and helps me teach the ADAPT practitioner training program. Amy how long have you been with us now at CCFM? I don't remember the exact month that you joined? Dr. Amy Nett: Well, I think you and I started working together even before CCFM was officially in existence, so over three years now I think. Chris: Wow, time flies. I mean it seems like you've been there forever. It's amazing how far we've come in that last three years. It tripled in size, I think, in three years, in terms of staff and growth. Amy: Absolutely, and then watching that clinician training program, watching you develop that from the ground up and seeing that grow has been really exciting too, so you've been busy. Chris: Definitely. We've all been busy. It’s been fun, a great ride. Before we dive into today's topic, which I'm really excited about, we're going to talk about PCOS, and you pointed out to me that I really haven't written that much about this topic or spoken about it, which surprised me because it's such a big concern for women, and it's something that in my mind I thought I had covered, but I hadn’t, so we're going to dive into that today. But before we do that, given that it's been three years now, and so now you have a lot more experience in Functional Medicine, you're helping me teach in the Kresser Institute, but you didn't come from a Functional Medicine background, you came from radiology and practicing within the conventional system, I'm sure some of the listeners, particularly practitioners, would be curious how that transition has been for you now looking back to where you were five years ago and where you are now and what that's been like for you both professionally and personally.

Addressing the root causes of PCOS.

Dr. Nett’s transition from conventional to Functional Medicine

Amy: Yes. As you said, I've trained in a very conventional medical setting at Georgetown University Medical School and then Stanford University for radiology, both residency and then also fellowship in diagnostic radiology. We talked about, last time I was on the podcast, I think, the first time I was on the podcast quite a few years ago, that it didn't align with my values and it also didn't work for me when I was having my own health issues, so being able to work in the Functional Medicine setting, I think all of us thrive a lot more when our work is actually in alignment with our own values and beliefs. It's great to be able to work with something that I'm passionate about and being able to share these things with patients and learn from my patients. I mean, you know a lot of our patients are so educated and well read, and they're sifting through things, that I love it when patients bring something new to us that we get to dive into and learn about. Chris: Absolutely. I've always said my patients are my greatest teachers. Amy: Yes. Chris: As long as we're open to the case. It has always blown me away that the attitude of some physicians and clinicians is like ... we both had the experience of patients coming in telling us that they've been excited about something and gone to their doctor only to see the eye roll or the shaking of the head, so you stop doing Google research, and to some extent I get that, but as a practitioner myself, I get really excited when I hear about something I didn't already know about because Functional Medicine is extremely effective and powerful, but with the complexity of patients that we see, I'm eager to learn about any new thing that could help that I possibly can. Amy: Yes, I agree. Again, having come from a more conventional background, I was used to this approach of using medications and looking for really clear treatments, and then from you I learned more about herbal approaches, but then we have these really sensitive patients, and we're realizing that we need to find different ways to work with symptoms, that it's not just supplements and medications, that it can be ... you and I have both gotten into this DNRS program, like a limbic system healing. I mean, these are things that I wouldn't have considered five years ago. Chris: It wasn't part of your radiology residency at Stanford, was it? Amy:  No. I think that would have gotten some eye rolling. Chris: Yes. But the thing is, there's actually, maybe not directly with this particular methodology, but there's tons of research showing how mindfulness-based stress reduction or mindfulness in general can benefit all kinds of conditions, and when we understand basic physiology of the nervous system and how the psychoneuroendocrinology system, or psychoneuroendocrinology immunology, as we call it, basically that term is trying to say it's all connected. The nervous system plays such a huge role in every aspect of health, and if we're running around like a chicken with our head cut off all day, it's not just going to affect our brain and our nervous system. It's going to affect every aspect of our health and well-being. Certainly, the more experience I get as a practitioner, the more I keep coming back to the basics. It's easy to forget that. We have all these powerful Functional Medicine tests and tools, it's easy to go down those rabbit holes and not pay enough attention to the basics. Amy: Yes, absolutely. And you know, for better or worse, the body is so interconnected, and once one system gets out of balance, the rest will fall. Chris: Yes, absolutely. That's probably a good segue into the topic, because PCOS is multisystem illness, and stress certainly plays a role. I'm sure we'll be talking a little bit about that. But why don't we just begin with the basics because I think there's some misunderstanding about PCOS, and let's just start with what it is, what defines it, what we know and don't know about it, and go from there.

What is polycystic ovary syndrome?

Amy: Yes, absolutely. There's still a lot we don't know about it. PCOS, or polycystic ovary syndrome, basically is a metabolic disorder with hormonal imbalances. It's actually the most common form of hormonal imbalance. We would also call this an endocrine disorder, “endocrine” just referring to hormones, so an endocrine disorder, the most common one in women of reproductive age, probably affecting somewhere between about 5 to 15 percent of women. There are some controversies around the diagnostic criteria. There are different ways to make the diagnosis, so I think that's one of the reasons we don't have a clear idea on exactly how many women this is affecting. The main hormone disruption that we're seeing in PCOS, or polycystic ovary syndrome, is higher-than-normal levels of androgens in women. Androgens, you can think of as the “male hormones.” These are things like testosterone, DHEA, and these hormones are responsible for giving some of the male characteristics. As women we normally have these hormones, but in PCOS we tend to see higher levels of the androgens. Chris: It's probably good to point, just to jump in here, the syndrome ... It's interesting about syndromes like irritable bowel syndrome, fibromyalgia syndrome, premenstrual tension syndrome, they're different than diseases which tend to have either a clearly defined etiology, single known cause or pathological mechanisms we understand, whereas with something like PCOS or any of those other syndromes, it's more like a description of a clinical picture, right? Signs and symptoms that are common, so we can actually group them together and see it, but we don't really know what necessarily, what the driving mechanisms are. We have ideas, but we're not sure. Amy: Yes, absolutely. And the research just suggesting that there's probably a lot of different factors that go into polycystic ovary syndrome. Some of it is going to be a genetic predisposition. Some are going to be environmental, and then diet and lifestyle may affect how the syndrome, like you said, the signs and the symptoms actually manifest. Chris: Right. So they've got higher levels of androgens, and then of course insulin and blood sugar. Let’s talk a little bit about that. Amy: Yes. So similarly, again, we're seeing this as a metabolic disorder. So we're seeing higher than normal levels of insulin, and this often goes along with insulin resistance. And so when you have insulin resistance, which is common in diabetics, so we're normally talking about insulin resistance on the pathway of developing type 2 diabetes or in the setting of diabetes, so we're also going to see high blood sugar in the setting of insulin resistance. But the most common thing that normally brings it to our attention is actually absent or infrequent periods, again due to the hormonal imbalance that we're seeing. Chris: That's a common complaint amongst women that I see, and I know you see in your practice, and certainly stress seems to play a pretty big role there with women who are not eating enough calories to support their activity level or burning the candle at both ends. I completely agree with you that this is probably a complex multifactorial syndrome that actually has different etiologies and different patients depending on their unique blueprint. Amy: Yes. Which makes it a little bit more difficult to diagnose and treat, but certainly whenever I have a woman coming in with either what we call amenorrhea, so not having menstrual cycles, or oligomenorrhea, where you have infrequent menstrual cycles, I think this is something that we want to consider. The other way this can present is infertility or even subfertility, so just a difficult time trying to conceive. Chris: Yes. And then those skin problems are very common, often connected to the androgens or other hormonal imbalance, of course, and excess hair growth or even the opposite, hair falling out, alopecia, which can also be a consequence of excess androgens. Here's a key difference between Functional and the conventional medicine approach here, with a syndrome like this, and we can use IBS as an analogue. Irritable bowel syndrome in conventional medicine, you go to the doctor, you describe your symptoms, they in turn give you a diagnosis that essentially summarizes your symptoms, your bowel is irritable, you have irritable bowel syndrome, and then the treatments are basically all oriented around managing the symptoms. If there is pain, you might have an analgesic. If there is constipation, you might get a promotility drug for this diarrhea, you might get an anti-diarrheal, and that's the basic approach. But in Functional Medicine, where that's obviously not what we're doing, we're trying to address the root causes and the underlying mechanisms that contribute, so talk about that in the context of PCOS. What is the best way of addressing this from a Functional point of view or even thinking about it? Amy: Yes. We need to think about then how was the diagnosis made? Because you've just listed quite a few symptoms, and then the thing that you and I haven't even mentioned yet is polycystic ovaries, which is actually the name of the condition. That part is a little bit confusing because I've actually had patients come into my office and say, “Oh, I have PCOS.” And I say, “Okay. How was that diagnosis made?” And they say, “Well, an ultrasound.” Initially one of the common features in polycystic ovary syndrome was an appearance of polycystic ovaries. Technically, they aren’t actually ovarian cysts, they're actually follicles that were seen, and then they have a very classic appearance in the setting of typical PCOS. But that actually isn't even used as diagnostic criteria, but it's something worth mentioning because that's where the name comes from, polycystic ovary syndrome. But basically, clinically, I'm going to be using all of the information that you and I just mentioned. I'm going to be looking for absent menstrual periods, maybe that excess facial hair growth you mentioned, or hirsutism, thinning of hair on the scalp and along the temples, maybe obesity, insulin resistance, and then I'm going to want to measure the androgen level, those sex hormone levels of testosterone, DHEA. I sometimes will look at the appearance of the ovaries, but the most classic criteria are really just, are there high androgens and is there absent periods, or at least what we call anovulatory periods? You might have bleeding, but it's not ovulating or producing an egg, which would allow for pregnancy, which is where we see that fertility issue coming up. Chris: I think the key thing to point out here is when we're looking at this functionally, we're not just thinking about how we're going to deal with the symptoms, but actually trying to identify what the mechanisms are, which is what we’re speaking to, and then address those mechanisms because we know that's the only chance we have in actually reversing the condition, rather than just helping somebody to live with it. Both of those goals are sometimes are necessary, but it's just a different approach to how we're going to get to that goal. In other words, are we going to help people live with the symptoms by addressing the causes or by just suppressing the symptoms?

Addressing underlying causes

Amy: Right. You and I are both going to use that standard Functional Medicine approach where someone comes in, they're complaining of any of these symptoms that we just mentioned. We think about PCOS as a diagnosis, and then the question is, what is causing some of these imbalances? You and I are probably going to have patients come in to us already on a Paleo diet, grain-free, maybe dairy-free diet and there is some interesting research at UCSF that's ongoing. There's a study that started in 2015. I think expected completion is in 2020, where they're looking at a Paleo diet as a treatment approach for women with PCOS. Certainly once we have someone on a Paleo diet, once that piece is handled, we're still going to want to look at a really comprehensive blood panel. I'm going to want to look at some nutrient levels on that including vitamin D, B vitamins. I'm going to want to look at thyroid function on a comprehensive blood panel, and then we’ll also do gastrointestinal testing, so that's going to be stool testing, SIBO breath testing. I might also consider heavy metal testing. Also, non-heavy metal toxic burden testing, looking for toxins that might come from plastics manufacturing or from petrochemicals, these toxins in the environment that are fairly ubiquitous and we’re exposed to on a daily basis because some of these toxins, heavy metals included, are endocrine disrupters or hormone disruptors. Chris: Absolutely. Unfortunately, they're ubiquitous in the environment and I think we already have a lot of research suggesting harm. But I think that's only going to increase as we gain more understanding because we've already learned that some of our concepts for how toxicity works are really outdated. We know, for example, that a low dose of a toxin can have a completely different effect than a higher dose of that toxin, and that explains why the low dose effects of toxins were missed in studies for so long, because they were just looking for the same type of effects that happen at the high dose and they weren't seeing those, so they assume that the low dose was safe. But now we know that the low dose can cause completely different and sometimes even opposite effects, so they've gone back and started studying these toxins again at lower doses and they're finding that things like BPA, for example, can cause a lot of harm even at lower doses than most of us are exposed to. I think that's going to be a bigger part of the story as we go forward. Let’s talk a little bit about the thyroid function and cortisone, and we started by saying that we’ve both come to realize that regulating the nervous system is really crucial and not surprisingly plays a role here. Amy: Yes. And you've talked a lot on prior podcasts and also written on the blog a lot about the HPA axis, the hypothalamic–pituitary–adrenal axis. As we said at the beginning, sort of for better or worse, the body's incredibly complicated, so the HPA axis could actually more thoroughly be thought of as the HPTAG axis, so that's the hypothalamic–pituitary–thyroid–adrenal–gonadal, in this case ovarian, axis, but so the thyroid, the adrenals, and the ovaries all have this sort of interconnectedness or communication. I don't know of any strong evidence showing that thyroid or adrenal dysfunction directly causes PCOS, but I've seen so many times that correcting thyroid and adrenal issues improves menstrual cycles and improves those symptoms that are otherwise consistent with PCOS. Chris: Right. And we have tons of research connecting high and dysregulated cortisol with insulin resistance. We know that high cortisol causes all kinds of cellular resistance, including to thyroid hormone. We know that a disrupted HPA axis can reduce signaling across the board for all the different hormones, so to me ... I mean, this is one of the interesting things I think about Functional Medicine research is we often hear claims like, “Oh, there's no research to support Functional Medicine.” Well, you can't really do research on Functional Medicine per se. Functional Medicine is just a way of looking at things. It's a systems approach, and so if we say that a primary tenet of Functional Medicine is that we look for the root causes and underlying mechanisms of disease, then you go into the scientific literature and you say, “Okay, is there any is research that links the HPA axis dysfunction to any of the mechanisms that we suspect cause PCOS?” And then when you do that, sure, there is tons of research. It's interesting to me how we have to ... it's such a paradigm shift. We have to be continually revising our way of talking about it, and you know this and I know this, but I think a lot of people who are looking at Functional Medicine from the outside and who haven't really embraced that paradigm, they don't think about it that way. Amy: Yes, it's true, and I think the other thing from what you're saying in terms of these connections, the other thing is I would be reluctant to make a firm diagnosis of PCOS if there is thyroid or adrenal dysfunction that I would want to correct those before sort of coming down on that diagnosis.

How useful is a diagnosis of PCOS?

Chris: Right. And especially because it's kind of ... like most syndromes, it's in some ways a diagnosis of exclusion. Now, you're eliminating other things that could explain those more straightforward diseases or pathologies that are more clearly defined, and if you can't do that, then the signs and symptoms left over fall into that bucket of PCR. I guess that leads to the next question which is, how useful is the diagnosis of PCOS, especially if it's from a Functional Medicine perspective? In the conventional model, not to sound like too much of a cynic here, but in some cases, the usefulness of a diagnosis is primarily related to the drug company making more money selling drugs for that condition. We know that, like in the case of Viagra, erectile dysfunction, an advertising agency made up erectile dysfunction, or ED, as a condition as a way of selling more of our Viagra, which was an accident. Viagra was discovered during the development of a different drug, and they just happened to notice that it was having this other effect, and then they created this whole syndrome called “erectile dysfunction” to drive selling that drug, but in Functional Medicine that's not how we approach things. So is PCOS even useful from a Functional perspective? Amy:  I don't know. I actually don't really find it all that useful of a term. I find that individual components are helpful in the sense that if there is insulin resistance, I want to identify that and correct it. If there is anovulation, I want to identify what's causing the hormonal imbalance. But no, I don't really think that PCOS is a particularly helpful term in the Functional Medicine setting, and then this is in part because, as you said, it's a syndrome. It's a collection of signs and symptoms that we put together in a pattern and then put a label on, but there is such a wide spectrum of how women actually present, how this manifests, and the causes. So I'm treating each of my “PCOS” patients differently based on their individual physiology. Chris: Right, yes. It might be useful in the sense that someone who has it can come in and say to you or me, “I've got PCOS. I've been diagnosed with PCOS” and then you and I immediately have a sense of what they're dealing with. It maybe shortens the conversation a little bit, but I agree. It’s not necessarily useful outside of that context. Nevertheless, let's talk about how it is diagnosed just so that people understand what defines this syndrome from a conventional perspective? I think there are three criteria that have to be satisfied. Amy: In the medical literature, there are a few different criteria and a few different ways that PCOS is defined. There is not a uniform, agreed-upon diagnosis, but I think the most common combination is having, number one, high androgens, so again, those sex hormones like testosterone, DHEA. Number two would be anovulation, or absent ovulation, and again this is why we tend to see irregular menstrual cycles. I want to quickly add here that a normal menstrual cycle can actually be anywhere from about 21 to 35 days. I have a lot of women who come in and say, yes, I have irregular cycles. They are 24 to 30 days. That's completely normal. Most of us are not clockwork 28 days. It's only about 10 to 15 percent of women who really have that clockwork 28-day cycle. I'm looking most often for cycles that are longer than 35 days. And then the third criteria that again, isn't necessary to make a diagnosis but is having a polycystic ovary appearance on ultrasound imaging. But again, I don't find this the most useful, and again, partly some women who have polycystic ovaries actually don't have any of these other symptoms. This is why we think, well maybe there's a genetic or epigenetic predisposition towards PCOS and these women who have a polycystic ovary appearance but don't otherwise have manifestations of this syndrome are just managing this with diet and lifestyle. Chris: Right. When we think about diagnosis, all the caveats we've already discussed included, what else do we want to consider and look at, given that we know what these various mechanisms are that are involved? What else are you looking at in patients from a testing perspective? Amy: One of the most important things I'm going to be looking at is the blood sugar marker, so I'm going to be looking at insulin resistance, so I want a blood panel that's going to include glucose, hemoglobin A1c, a fasting insulin level. I might look at fructosamine level also, and then because PCOS and insulin resistance can also be associated with metabolic syndrome, which can be associated with high cholesterol and increased cardiovascular disease risk, I'm also going to want to check at least a basic lipid or cholesterol profile on my patients, and then we may or may not get into some of those more advanced cardiovascular disease markers like LDL particle number. Chris: Yes, all of that. All of the basic tests that we run on pretty much every patient that comes through the door. All of the GI testing, the blood panels, nutrients, and then maybe heavy metals and other toxins, depending on their exposure. Amy: Right.

Treatment of PCOS

Chris: So let's talk a little bit about treatment. Obviously, this will depend. I mean, this is another big difference in conventional and Functional Medicine. In conventional medicine, usually it is three minutes focused on the disease, so different patients with the same disease will get the same treatment, whereas in Functional Medicine, we treat the patient rather than the disease, and I think PCOS is a fantastic example of why that's necessary. Why don't you say a little bit more about that in that context? Amy: Yes. Well, this is a little bit painful because unfortunately, most women with irregular periods who go in to see their conventional Western medical doctor are probably going to be given an oral contraceptive pill to “normalize” for cycle. We could have a separate podcast on an oral contraceptive pill. The bottom line here, I'm not a fan. I wouldn't recommend these. Oral contraceptives don't address any of the underlying causes associated with PCOS or lower the risks that are associated with PCOS, like the blood sugar imbalance or the decreased fertility. It's true that oral contraceptive pills do cause regular vaginal bleeding, but it's really important to know that that's not a period. It's just bleeding that's induced by the combination of estrogen and synthetic progestin in the pill. We'll leave that for another day, but oral contraceptive pills are used in conventional medicine really to mask or hide the symptoms of PCOS. That's your conventional treatment, but from a Functional Medicine perspective, we're going to want to come back to all of the test results that we just talked about running. So the gut testing, the comprehensive blood panel, the heavy metal burden, the non-heavy metal toxic burden because we want to look at anything that could be contributing to hormonal disruption, immune imbalance, chronic inflammation. Chris: Right. For one woman, it might be primarily an issue of insulin resistance and metabolic dysfunction and so for her, the treatment, it might be low-carb or a ketogenic type of diet, intermittent fasting, and other interventions to regulate blood sugar, whereas for somebody else, if you do some testing and you find, “Wow, you’ve got SIBO and you've also got pretty significant mercury toxicity complicated by high levels of arsenic and lead,” then maybe those are going to be the primary focus to begin with. Amy: Yes. We're going to use all of those tests, but we did to try to tailor the treatment approach. To each patient, it's going to look a little bit different. I mean there are some basic nutrients that we will want to think about in terms of supporting just regular menstrual cycles, some that can be a little bit more targeted to PCOS, but diet and exercise are just top of the list in addressing these symptoms. Chris: Cool. Let's talk a little bit more about the whole spectrum of treatment options. If we were to rank them in terms of importance, what would you say is at the top of your list? And go from there. Amy: I'm going to stick with diet and exercise as the two most important pieces in terms of addressing PCOS. Chris: Oh, geez, Amy. That’s so boring. Amy: I know it is. Chris: Can't you be more original? Amy: I know it is. Chris: Always back to the basics, isn't it? Amy: It is always back to the basics, and it sounds like you tend to go also towards like a lower-carbohydrate and sometimes ketogenic diet with women. Chris: It depends on the situation. If a woman is obese and severely insulin resistant and her HPA axis is in pretty good shape, then yes, but if she is not significantly overweight and there’s not a lot of metabolic dysfunction and she's burning the candle at both ends and working and has young kids at home and is doing CrossFit ... circadian disruption, I'm not going to do that because generally that doesn't go well in that, so it's super, super individualized at that point. Amy: Yes, I agree. For PCOS, I'm probably going to go either moderate-carb or maybe low-carb, and rarely ketogenic. I don't love doing ketogenic diets in women long term. Short-term therapeutic, yes, but not seeing the most benefit with ketogenic long term. Chris: Yes. So how about physical activity and exercise? What are you seeing in your patients with that? Because most of our patients are not the typical patients, they're people who tend to be already a little bit more on the ball with this kind of thing. So, what are you finding is helpful? Amy: I use exercise most. The reason I recommend it in this setting is because it really improves insulin sensitivity, which is thought to be one of the driving factors in at least some cases of PCOS. So when patients ask ... and the other issue we talked about, adrenals, because a lot of patients come in under the impression of, “Oh, I have some degree of adrenal dysregulation, therefore I shouldn't exercise,” but I haven't seen that and I still think that exercise is really important. You might have to moderate. It might not be CrossFit five times a week, but even moderate strength training, resistance exercise, I think is well tolerated, even with moderate HPA axis and may even improve some of that HPA axis. And so, I think doing anything you enjoy and doing exercise to the degree that it leaves you feeling refreshed and better rather than depleted. Chris: What about diet in terms of, as you said, moderate-carb or low-carb, but what else? Anything particular in the diet from the research or just your experience with PCOS? Amy: Well, and then just to clarify, I'm sure all of your listeners know, but of course we're talking about this within a Paleo context, so grain-free and dairy-free, particularly. We said acne is really common in PCOS, and they see that dairy is a really common trigger for acne. I think dairy has to be out for at least 30 to 60 days strictly before we even consider reintroducing that and then maybe a full-fat dairy can fit in there. The other thing that I like is intermittent fasting because again, it improves insulin sensitivity. It can also improve the lipid profile, but as you mentioned, we do have to look for adrenal dysregulation because intermittent fasting is also a mild form of stress on the body. Chris: Yes for sure. The devil's in the details, as they say. I've seen some research suggesting higher fiber intake, soluble fiber, non-starch polysaccharides, and resistant starches could be helpful here, and that may be through the connection with the gut flora, and it may also be due to the impact it has on insulin levels and blood sugar. We know that fiber intake can significantly affect blood sugar and glucose sensitivity in some people. Amy: Yes. Chris: Another thing to just keep in mind because sometimes when people hear low-carb, they end up going low-fiber too, and that's generally not a good idea, especially with this condition. Amy: Yes, I agree. I think, given if you’re doing a low-carbohydrate diet, you can still use prebiotic supplements, which is the other way to get around that. Chris: Absolutely or some combination. All right. What about supplements or nutrients that have been shown to be depleted or beneficial to use with PCOS? Amy: Yes. I think the number-one nutrient that I would put on top of my wish list if I have to prioritize supplements for a patient would be magnesium, in particular magnesium glycinate, is something I recommend for almost all of my patients and certainly any of my female patients with menstrual irregularities. It's difficult to obtain adequate magnesium through diet alone and it plays such an important role in improving the functions of insulin, leptin, thyroid hormones. It's essential in the production of estrogens and progesterone. It can also be calming on the nervous system. Chris: It's definitely something I've talked a lot about because if you look at the symptoms of magnesium deficiency, they are the symptoms that are extremely common. Of course that doesn't mean that ... correlation and not causation. You and I have both seen how often magnesium alone can make a huge difference for somebody. It makes a big difference, too, what type is used and what form. A lot of the magnesium oxides that are typically used in multis or over-the-counter supplements is not very well absorbed and can bring a lot of water into the bowel which can cause that loose stools or diarrhea that some people experience from it. That generally means that it's not really being absorbed very well, so just keep that in mind when you think about magnesium. Vitamin D is always a discussion when it comes to hormone regulation and immune function. What about that with PCOS? Amy: As you mentioned, vitamin D actually is more like a hormone than a vitamin and really important in hormonal and also immune balance and immune function. With vitamin D though, I like to check a blood level before starting someone on a vitamin D supplement. I feel pretty safe just recommending a magnesium glycinate supplement around maybe 400 milligrams daily with dinner, but vitamin D, I want to see a blood level before making a dosing recommendation because this is a fat-soluble vitamin, so the levels will potentially build up and accumulate. There's a pretty wide variety, or wide range, in terms of the amount of vitamin D supplement that people need. Chris: Absolutely. We both see people. I just had a patient last week who is at 100, and this previous doctor had … or, I think, a book that he had read had suggested that everyone should drive their level up to 110, which just made me so angry. Heart disease is the number-one killer; high levels of vitamin D drop calcium into your arteries and stiffen them and put you at high risk for heart disease, so that’s a really, really bad idea, and yet that idea is still out there so much. It’s like “the more is better” thing. It’s crazy. Amy: Yes. That's true. If you have a patient who needs to supplement with higher levels of vitamin D or if someone listening is supplementing with higher levels, maybe more than 5,000 IU daily, I’ll include vitamin K2 in there as well to help with getting calcium to the bones rather than depositing them in the arteries. Chris: Absolutely. The synergy of all of the fat-soluble vitamins is super important, and we know that taking both vitamin A and K2 in particular raise the toxicity threshold of vitamin D and vice versa. Taking vitamin D and K2 dramatically increases the toxicity threshold of vitamin A, so it's really good to have all those coming in and that's why we love cod liver oil so much since you get both, not the K2, but the A and D. Zinc is another nutrient that has a really interesting role in women's health, both men and women, but I see a lot of zinc deficiency in women. Let's talk about that a little bit. Amy: Yes. And again, zinc is one of those nutrients that if someone comes with irregular menstrual cycles, whether it's PCOS or not, I'm probably going to start them on something like at least 30 milligrams of zinc. Again, I might look at a blood level. Testing zinc levels isn't quite as straightforward as testing vitamin D levels--and even that isn't all too straightforward. Chris: Yes. Amy: But zinc is pretty important. It helps with supporting the normal menstrual cycle and in particular in the setting of PCOS, zinc plays a really important role in ovarian follicle development. We said that's one of the primary issues with PCOS is we don't see normal follicle development, and that's how you get production of the egg and ability to conceive. Animal products are some of the best sources of zinc, so this is going to be even more common in vegetarians. The other thing is if women, especially if someone's coming to you with a diagnosis of PCOS, maybe she was put on oral contraceptive pills and then has come in for a Functional Medicine take on things, oral contraceptive pills can deplete zinc as well. That could actually exacerbate the PCOS signs and symptoms. Chris: Certainly. I've had some interesting discussions with Chris Masterjohn recently about zinc, and when it comes to nutritional sciences, usually the smartest guy in the room and has done really deep dives with all these nutrients. He’s come to the idea that for women, in particular, that zinc should be 90 or 100 for optimal function. I regularly see women with zinc in the 50s and 60s, I don’t know about you, Amy, and just getting that level up makes a really big difference. But it's important to do it the right way, not to take a high dose of zinc forever and ever. Just like vitamin D, that can be problematic because zinc suppresses copper and can actually induce a copper deficiency over time, so definitely something to be aware of. Just because your zinc is in the “normal” lab reference range doesn't mean you have enough of it. All right. I'm thinking we should talk B vitamins. If we’re in the discussion about hormones and detoxification of hormones, we need to talk about B vitamins. Amy: Yes. And again, when we do the comprehensive blood panel that you and I do with all of our new patients, we get quite a few different markers on that blood panel that give us an idea as to whether or not B vitamins are adequate. You and I also both often do a urine organic acids test, which gives us even more markers to know whether or not B vitamins are sufficient. And so, the things that I'm going to look at in particular on the comprehensive blood panel, I'm going to look at the serum levels or the blood levels of B12 and folate. I'm also going to look at homocysteine, methylmalonic acid, and MCV, or mean corpuscular volume, which is the size of the red blood cells. If any of these markers are off, I'm going to think about using active forms of B12 or folate, and I might use just a B-complex vitamin because we know that we need these B vitamins for our detoxification process. This is somewhat dependent on something called methylation, which you and I have done a podcast on before, but we need to make sure that the body is normally clearing these hormones out as well. Chris: Absolutely. We've talked about diet and exercise as being crucial. We talked about addressing all of these other root cause mechanisms, and then we've talked about nutrients like zinc, magnesium, vitamin D, B vitamins. So what about specific botanicals or nutrients, nutraceuticals, that are targeted more towards altering hormone balance? Sometimes when we address all those other things that we just talked about, you get 100 percent improvement. Other times there is still some lingering dysfunction imbalance that we need to address. So what then? Amy: Yes. Inositol is actually one of my favorite supplements to use in a PCOS patient, and I'll even start a woman on inositol while we're working on all of these other pieces. If we know that she has ... basically, we're sort of working under the diagnosis of PCOS, again we said a sort of questionable utility to make this diagnosis, but inositol, it's a chemical compound in the body. It looks a little bit like glucose. There are several different forms of inositol. The two most common are called myo-inositol and D-chiro-inositol. Myo-inositol is the predominant form of inositol in our bodies, and there have actually been some review articles that were published recently, one published in 2016 that looked just at randomized controlled trials of myo-inositol and D-chiro-inositol, and it showed that myo-inositol alone helps to improve insulin sensitivity and also supports normal follicle development. It seems to address both the sex hormone imbalance to some extent and also improve the insulin sensitivity, so two of the primary drivers in PCOS. The role of D-chiro-inositol is a little bit more controversial, but again some of these studies looking at these review articles suggest that myo-inositol and D-chiro-inositol in a physiological ratio of about 40 to 1 may more quickly restore than normal hormonal and metabolic parameters, at least in overweight women with that diagnosis of PCOS. Chris: Yes. I've definitely seen a lot of women benefit from that and this actually highlights an important point too. Now we talk in Functional Medicine about the importance of addressing the root cause, and that's definitely true, but if we think of this as like a tree with roots and then a trunk and branches, yes, we want to look at the roots and ultimately address those roots because that's the best way to create lasting change. But that doesn't mean we can't also address the branches, and the more troublesome the symptoms are and the more they interfere with the patient's life, the more necessary it is to sometimes give the patients some immediate relief with something like this. Because in some cases the symptoms can be so challenging that they actually themselves can become an underlying cause or contribute to an underlying cause. For example, if someone is in so much pain or they're so inflamed that they're not able to sleep, then that sleep deprivation becomes an underlying cause in itself. It perpetuates the condition, and so in that situation, using something that can reduce the pain and inflammation and help the patient sleep, even though those are kind of symptomatic interventions, is actually useful and part of the whole framework of Functional Medicine. Amy: Yes. And inositol, I mean again, because we think that two of the potential underlying factors driving PCOS are the sex hormone imbalance and the insulin resistance, here is something that is potentially correcting or restoring both of those parameters. Chris: There are always different approaches to use depending on where the patient is and what they need most. And then of course there are other things that depend more on the specific mechanism, so I know sometimes we use berberine or other botanicals that can have an effect on blood sugar. Amy: Berberine is another good one because it does improve insulin sensitivity. It upregulates insulin receptors and stimulates glucose uptake into the cells and might also improve acne, which is another really common complaint in PCOS. But with berberine, I do have some caution in using it long term because it has antimicrobial properties. We really want to think about the pros and cons in terms of using berberine long term and we may decide that there is value to using it to improve the insulin sensitivity and blood sugar levels, but we need to know or at least be very conscientious about supplementing them with prebiotics, probiotics, and really supporting gut health otherwise. Chris: Definitely. You know from a Chinese medicine perspective, you wouldn't use herbs like berberine for just indefinitely over a long period of time. They're more in the category of therapeutic use, but they can still be useful in that way. Sometimes getting the blood sugar into a normal range while the patient's making those other adjustments to diet and lifestyle, and then once they've made those adjustments successfully, you can withdraw the berberine or whatever it is, and they can still stay there. That's kind of that root–branch thing that we're talking about. What about pharmaceuticals? Any that you think play a role here in some cases? Amy: Yes. Metformin is a prescription medication that improves insulin sensitivity, and it's most commonly used in diabetic patients. But it's also pretty commonly prescribed to women with PCOS to improve the insulin sensitivity. I think this is actually a pretty effective medication, and some women tolerate it really well and it will do the job of improving insulin sensitivity. I'll occasionally use metformin with some of my patients. The caution I have around this one is number one, it will deplete vitamin B12, so I'm going to make sure anyone on metformin should be supplementing with active forms of B12, so methylcobalamin, hydroxocobalamin. And the other thing is, metformin is associated with most common gastrointestinal side effects, so I’ll sometimes see nausea, gastrointestinal discomfort, abdominal pain, or bloating. It doesn't always work for patients, and you and I also have the practice where a lot of patients come say, “No, I don't want to use prescription medication.” I would say most of my patients don't want to take metformin, but I think it is a pretty good option, especially when we're starting to get around that pre-diabetic level. Chris: Yes. I mean, some drugs are better than others, and some drugs actually do seem to have more of a relationship with the core mechanisms, actually addressing some of the root mechanisms that we've talked about. Low-dose naltrexone in that context, and metformin is an interesting medication. It's shown to have a lot of interesting effects on insulin sensitivity and glucose tolerance. It's being studied right now for cancer. We’ve talked a little bit about the metabolic theory of cancer in my podcast, and I think the jury is still out and there's some controversy there. But there are some studies that suggest that metformin may slow the growth of certain cancers because it limits the availability of glucose to those cancers. So definitely interesting and may be worth consideration if all else fails. The difference is, you are going to do, in most cases, everything else before you go there, whereas the conventional approach might be the first step rather than exploring all these things. Amy: Yes. I think in a conventional setting, you'll probably get a prescription for all contraceptive pills and metformin. Chris: Yes. That's the basic standard practice there. Amy, I know your practice has been mostly full for the past year, actually for a couple of years, it's been pretty full not shortly after you started, and the good news is, lately, we have made some changes to CCFM where we have brought in a nurse practitioner, Tracey, who is fantastic, and also a health coach, Danielle, who is also fantastic, and that has expanded our capacity and our ability to serve more patients because we have an additional layer of support now where patients can have appointments with either Tracey or Danielle in between appointments with us, and they just were able to get their questions answered even more promptly and just have that added layer of support. Now given that, you have a few openings in your practice again, which is fantastic, and tell us what kind of patients you're working with these days and where your interests are and how that's evolved for you over these last three years. Amy: Yes. I feel like our practice does tend to draw sort of the more complex patients, and so I don't know that I have a typical patient per se. We do get a lot of patients who come having been sick for quite a while, maybe having seen 15 or 20 other physicians and being told that's all in their head, which is always heartbreaking when you hear that story. I generally do a general Functional Medicine approach and work a lot with gastrointestinal issues, autoimmune diseases, allergies, do a lot with hormones, also bioidentical hormone replacement therapy, when appropriate. More recently I've gotten into working with cognitive decline or mild cognitive impairment along the Bredesen protocol, heavy metal detoxification or a more general detoxification, and working with mold-related illness. These are all things that I have been focusing on the past couple of years. Chris: And something that's been really great too, as we've seen CCFM grow, we now have five clinicians—Dr. Schweig and myself as the co-directors, and then you, and then the latest additions have been Dr. Ramzi Asfour who is an infectious disease doctor who worked for the WHO for many years and living in different places around the world treating infectious disease. It's been so incredible to have him on staff and to be able to learn from him and his deep experience with infectious disease. And then Tracey Clow or Tracey O’Shea, I should say, she just got married, she's a nurse practitioner that's IFM certified and has worked in pain clinics and is a phenomenal practitioner and resource. What I'm particularly enjoying is that we get to talk, share, communicate, and learn from each other all day. We have this kind of multiplier effect where if someone comes to see one of us, they're actually in some way getting the shared experience of five different clinicians. Amy: Yes. It's been great getting everyone's input, and in particular, because, I mean, you and I will often get to ... as we talk about Functional Medicine, peeling the layers of the onion, we'll end up burning into a chronic viral infection, tick-borne illness and Lyme disease is its own specialty, and it's great having Dr. Schweig and Dr. Asfour to help manage these really complex cases. Chris: Absolutely. I think we've developed a really interesting format where we have this collaborative model where we're all sharing and learning from each other, and when you have a question, you come to me or Dr. Schweig, and when we have a question we all help each other out. We all have different backgrounds. It's been amazing to have your radiology expertise because that often comes up. Patients will bring in scans and they will have questions about what the right diagnostic approach is for that, and we can ask you, and when it's more on the infectious disease spectrum, Dr. Schweig and Dr. Asfour. In the nutritional realm of lipids and all of the things that I have gone down rabbit holes for, I'm happy, always happy to share. I think it’s a unique model that we have. I don't see this at a lot of other clinics, and I'm really happy with how that's continuing to unfold as we add additional practitioners and continue to grow. All right. So, anything else, Amy, before we finish this up? Amy: I think we covered it all. Chris: Great. Well, it's been great to have you on the show again, and for those folks who are looking for additional help and would like to work with Amy, Dr. Nett, you can head over to ccfmed.com, and then when you get there you can click on patients and then click on working with Chris and Amy Nett, and then you get all the information you need about how to apply to become a patient and where your path takes you. I wish you well and I hope that you continue to cultivate vibrant health and wellness. Amy: All right. Thanks so much for having me on the podcast today, Chris. Chris: It’s been a pleasure. All right. So, I know we've been doing a couple of interviews recently, but continue to send in your questions at http://ift.tt/1DErq19. I will be returning to the Q&A format shortly. I like to mix it up, it keeps it interesting. Again, take care, everybody, and we'll talk to you next time.

Source: http://chriskresser.com November 28, 2017 at 10:12PM

[lindarifenews]

Google now showing ‘specialists’ tab in health condition knowledge cards on mobile

At one point or another, chances are you’ve turned to “Dr. Google” to shed some light around a health concern. Whether you’re trying to self-diagnose a medical condition or are just curious about a particular disease you heard on a show, we rely on Google to provide us with answers to our many health-related questions. In fact, 1 in 20 Google searches are health-related, and Google knows it has a responsibility to serve the most accurate medical information for these 170 million-plus daily searches.

I’ve always been passionate about healthcare, probably due to the fact that I’ve lived among nurses my entire life (my mother, sister and wife are all nurses). For the past 10 years, all of my marketing experience has been within the healthcare industry. Every day I’m searching for something health-related on Google. I was very excited when I discovered this latest enhancement as I believe it will benefit patients the most. In reality, most patients don’t know what type of doctor they should seek for certain medical conditions. This update to Google’s health condition cards will help provide that direction and will essentially close the loop on the digital patient journey.

Google Health Knowledge team’s mission

Similar to Google’s mission statement, the goal of the team behind their Health Knowledge Graph is to “Make health information universally accessible and useful. Allow anyone in the world to receive key, top quality health info in a fluid and intuitive fashion.”

It’s so important now, more than ever, for these results to be of the highest quality. After all, the wrong medical advice could potentially result in a perilous outcome. This is why Google has invested so much time into tailoring these health knowledge results over the years, to give users only the best information, displayed for easy consumption.

History of Google Healthcare Knowledge graph and its new update

This has been an ongoing effort with Google, and like everything else they do, it appears in iterations and small tweaks until they get it right.

February 2015: Google launched the healthcare condition cards, appearing in search results when users search for a common medical issue with a short summary of the condition and few facts as to how it comes about, symptoms, treatability, and more.

December 2015: Google added a new segment to their condition cards, a “Treatments” tab where users could find a list of remedies for their specific ailment.

June 2016: Adding a “Symptoms” tab to their healthcare condition cards, Google provided users with increased autonomy by allowing them to search their specific symptoms and receive a list of possible illnesses they may have.

Most Recently: Google began rolling out a “Specialists” tab on their health conditions cards on mobile search results only, which provides users with an easy path to finding the right doctors who specialize in the condition they’ve searched for.

With this new updated feature, users are also offered the option for these results to be local to them, so long as you grant Google permission to access your location.

Opportunity for healthcare marketers

The addition of a “specialists” tab could increase the frequency of healthcare providers appearing in local search results. Here are five high-level SEO tips to help you capitalize on this opportunity:

Make sure your doctor or healthcare facility web pages follow best practices for local optimization.

Add as much content to your physician or healthcare facility Google My Business profile.

Build out online profiles across the top healthcare directory sites (Healthgrades, Vitals, WebMD, etc.) and make sure the information is consistent across all profiles.

Incorporate Schema on your doctor and healthcare facility pages, specifically the Schema markup for Physician and LocalBusiness properties.

With all of the YMYL algorithm updates over the past few years, it’ll be especially important for doctors to ensure they have a strong online reputation and demonstrate expertise in their medical area via citations from reputable health care authorities and sites (E-A-T).

With this feature only appearing on mobile search results thus far, it will be important to keep an eye on these condition cards as this could just be something Google is testing. Personally, I believe this new addition is here to stay. Down the road, perhaps they’ll even incorporate a mechanism for scheduling appointments directly within these cards. Only time will tell, so we shall see.

The post Google now showing ‘specialists’ tab in health condition knowledge cards on mobile appeared first on Search Engine Land.

Google now showing ‘specialists’ tab in health condition knowledge cards on mobile published first on https://likesfollowersclub.tumblr.com/

[andreacaskey]

Google now showing ‘specialists’ tab in health condition knowledge cards on mobile

At one point or another, chances are you’ve turned to “Dr. Google” to shed some light around a health concern. Whether you’re trying to self-diagnose a medical condition or are just curious about a particular disease you heard on a show, we rely on Google to provide us with answers to our many health-related questions. In fact, 1 in 20 Google searches are health-related, and Google knows it has a responsibility to serve the most accurate medical information for these 170 million-plus daily searches.

I’ve always been passionate about healthcare, probably due to the fact that I’ve lived among nurses my entire life (my mother, sister and wife are all nurses). For the past 10 years, all of my marketing experience has been within the healthcare industry. Every day I’m searching for something health-related on Google. I was very excited when I discovered this latest enhancement as I believe it will benefit patients the most. In reality, most patients don’t know what type of doctor they should seek for certain medical conditions. This update to Google’s health condition cards will help provide that direction and will essentially close the loop on the digital patient journey.

Google Health Knowledge team’s mission

Similar to Google’s mission statement, the goal of the team behind their Health Knowledge Graph is to “Make health information universally accessible and useful. Allow anyone in the world to receive key, top quality health info in a fluid and intuitive fashion.”

It’s so important now, more than ever, for these results to be of the highest quality. After all, the wrong medical advice could potentially result in a perilous outcome. This is why Google has invested so much time into tailoring these health knowledge results over the years, to give users only the best information, displayed for easy consumption.

History of Google Healthcare Knowledge graph and its new update

This has been an ongoing effort with Google, and like everything else they do, it appears in iterations and small tweaks until they get it right.

February 2015: Google launched the healthcare condition cards, appearing in search results when users search for a common medical issue with a short summary of the condition and few facts as to how it comes about, symptoms, treatability, and more.

December 2015: Google added a new segment to their condition cards, a “Treatments” tab where users could find a list of remedies for their specific ailment.

June 2016: Adding a “Symptoms” tab to their healthcare condition cards, Google provided users with increased autonomy by allowing them to search their specific symptoms and receive a list of possible illnesses they may have.

Most Recently: Google began rolling out a “Specialists” tab on their health conditions cards on mobile search results only, which provides users with an easy path to finding the right doctors who specialize in the condition they’ve searched for.

With this new updated feature, users are also offered the option for these results to be local to them, so long as you grant Google permission to access your location.

Opportunity for healthcare marketers

The addition of a “specialists” tab could increase the frequency of healthcare providers appearing in local search results. Here are five high-level SEO tips to help you capitalize on this opportunity:

Make sure your doctor or healthcare facility web pages follow best practices for local optimization.

Add as much content to your physician or healthcare facility Google My Business profile.

Build out online profiles across the top healthcare directory sites (Healthgrades, Vitals, WebMD, etc.) and make sure the information is consistent across all profiles.

Incorporate Schema on your doctor and healthcare facility pages, specifically the Schema markup for Physician and LocalBusiness properties.

With all of the YMYL algorithm updates over the past few years, it’ll be especially important for doctors to ensure they have a strong online reputation and demonstrate expertise in their medical area via citations from reputable health care authorities and sites (E-A-T).

With this feature only appearing on mobile search results thus far, it will be important to keep an eye on these condition cards as this could just be something Google is testing. Personally, I believe this new addition is here to stay. Down the road, perhaps they’ll even incorporate a mechanism for scheduling appointments directly within these cards. Only time will tell, so we shall see.

The post Google now showing ‘specialists’ tab in health condition knowledge cards on mobile appeared first on Search Engine Land.

Google now showing ‘specialists’ tab in health condition knowledge cards on mobile published first on https://likesandfollowersclub.weebly.com/

[thesoftdumbass]

The Joys of Laser Tattoo Removal

Pietro Maximoff X Reader oneshot

Words: 1370

Summary: Pietro Maximoff has a tattoo that he got when he was drunk, and he wants it gone. What happens when he comes to you for help?

Characters: Reader, Pietro Maximoff, Wanda Maximoff, Sam Wilson, Natasha Romanoff, Steve Rogers

Warnings: Lasers, secondhand embarrassment, not much else.

Author's Note: Hi there! This is my first attempt at a writing challenge, set forth by the lovely @sgtbxckybxrnes and I had fun! I have to tell you, I know nothing about laser tattoo removal other that what I found from quick searches on Google. This was inspired by an episode of How I Met Your Mother. This is in Pietro's POV, sort of. You'll see what I mean. I hope you like it! My prompt was This. Never. Happened.

(Gif credit to owner)

"I can't believe this is happening," groaned out Pietro in his accented voice. He was staring at his reflection in the mirror, trying to clearly see his marked skin. His friends were all laughing loudly from the living room, which was not at all helping his hangover. Pietro walked out of the bathroom to face the room of laughing idiots.

Pietro woke up this morning, and disregarding his pounding head and dry mouth, he felt good. After his break-up, Piet was finally feeling like the world was back in order. At least until he spotted the road-runner tattoo'd on his left bicep. His parents would be so disappointed.

As Pietro walked into the room, his roommate and best friend Sam made a comment.

"So why a road-runner, Wile E. Coyote?" This earned more laughs.

"Shut up, Sam."

"What? I'm just really curious."

"I ran track in college, and apparently drunk me thought it would be funny to play a prank on sober me. I really don't want this stupid tattoo." Pietro all but murmured the last part.

Pietro's sister Wanda who had been oddly silent this whole time spoke up.

"Why don't you have it taken off? My dermatology office does a laser treatment to remove tattoos."

"That's a good idea, Wanda! I'll do that," Pietro exclaimed.

"Good. When you do, make an appointment with Doctor (Y/L/N). They are the best in the business," Wanda insisted.

Pietro was on his way to the appointment he set up for laser tattoo removal. As he walked onto the elevator in the doctor's building, Piet noticed a woman in the back of the lift. She seemed intelligent, she was beautiful and Pietro decided to try to flirt with her.

"Hello. Did it hurt when you fell from Heaven," he asked with a smirk.

"No, but I scraped my knee crawling out of hell."

At that, the elevator doors opened and you walked onto the same floor that Pietro needed to be on. Piet felt a slight embarrassment at your rebuttal to his pick-up line, but shrugged it off a moment later. It's not like he would ever see you again, right?

Walking in through the right doors into the Doctor's waiting area, Pietro made his way to the reception desk at the back of the large room. His sister Wanda was there, signing people in for their appointments. After saying hello and signing in, Pietro sat in a chair in the waiting room, scrolling through some work emails.

Wanda, who is your physician's assistant, called Pietro back to an examination room. There was a figure in a lab coat standing there, she turned around when Wanda greeted her. Pietro felt chagrin as he noticed that it was the woman from the elevator.

"Hi," he sheepishly muttered.

"Piet. This is (Y/N) (Y/L/N), your doctor. (Y/N), this is my brother Pietro Maximoff. He's having a tattoo removed," Wanda introduced, handing you his chart and not reacting to her twin's odd behaviour.

"Hello, Pietro. I'm glad I can help take that off of your arm," you spoke nonchalantly, not bringing up the elevator incident.

"Nice to meet you, Doctor (Y/L/N)."

"Please, call me (Y/N). And it's nice to meet you too.

Wanda excused herself to get back to work, leaving you in the examination room with her brother.

"Listen, I'm really sorry about before. I hope I did not offend you, I just think you're really beautiful, and you have this sense about you. I don't know what it is," Pietro voiced.

"You're forgiven, and I wasn't offended. It was a noble try, but I have to wonder. Do men really think those lines actually work on women?" you joked.

"I actually don't know, but I hear my roommate Sam using them all the time. I really cannot remember any of them working, ever," Pietro chuckled.

"Good. They're awful," you laughed out. "Well should we get started?'

"Of course, (Y/N)." Pietro rolled up his left sleeve and showed you the colorful tattoo. "I really thought drunk tattoos was something that only happens on TV."

"Oh no, I make my living off of drunk tattoos. There doesn't seem to be any scar tissue, which is good. It should be fairly easy to remove in ten sessions with me. Actually, we can start today," you tell Pietro as you examine his arm.

"That's great!" Pietro cried out. "I want this thing off of me as soon as possible."

"Okay, let me get the equipment set up and we'll be ready."

You prepare your tools and after a few minutes, you are able to begin.

"I have to warn you Pietro, laser tattoo removal can be an extremely painful process," you caution your patient.

"Pain? Ha, my middle name is pain tolerance," Pietro tries to assure you.

"Okay, don't forget I tried to tell you," you said and started the laser up.

Pietro felt a sudden burning in his arm, and he yelled out. You covered your ears at the high pitched screeching, trying to prevent your ear drums from bursting. You turned off the machinery when suddenly Wanda burst through the door, looking bewildered.

The screaming had long since stopped, but your ears were still ringing. Wanda looked around before speaking.

"Are you alright, (Y/N)? I heard screaming coming from back here," she asked

"Everything is fine, Wanda. Your brother just felt the joys of a laser on his skin," you assured her.

"But it sounded like someone was being murdered!" Wanda argued. Pietro then moaned from pain. "Piet, are you okay?"

"Yes, Wan. Everything's cool. It just hurts," Pietro replies.

"I'm sorry Pietro, but that was just on the first setting. That's probably the least it will hurt, until you learn to tolerate it," you tell Piet.

"It's fine, we can continue now. I need this off of my skin."

"If you're sure, Pietro."

"Do you want me to stay? I could get somebody else to cover the front," Wanda questioned her brother.

"No I am okay. Go do your job, you slacker," Pietro joked, trying to reassure his twin.

Wanda went back to work, and so did you. Though you could tell Pietro was still in pain, there were no more vocal reminders. When you finally turned off the laser again, you gave Pietro some care instructions to prevent any adverse reactions. After you walked back into the main room of your clinic, he brought you to the side, along with his sister.

"Listen, you two. I know you are both professionals and there are rules for these things. But, I also know that my friends can be nosy. So I want to make one thing clear. This. Never. Happened." You snickered and Pietro added on, "I'm serious."

"Of course I won't tell anybody about your appointment, other than for necessary medical reasons." Wanda nodded along to your statement. "Of course... you still have nine sessions left."

Pietro groaned, causing you to laugh again. He recovered enough to schedule another appointment with you before heading back to his apartment.

When he got home, Sam was waiting with Steve and Natasha on the couch. Natasha smirked and asked, "How was the doctor?"

"It was good I guess. I started the treatment."

"Oh really? I heard that hurts," Steve states.

"It sucked," Pietro declares. "But, there's an upside. I really like the doctor, (Y/N)."

"First names, huh? Sounds like someone's got the hots for Doctor Sexy!" Sam declares.

"Shut up, Wilson. She's just nice, and beautiful, and funny." When Pietro saw the expression his best friend gave him, he forced the dreamy smile from his face. "Don't say anything, Sam. I heard it."

"All I'm gonna say, man, is that you better not embarrass yourself in front of her," Sam said.

When Pietro wore a guilty expression, his friends immediately crowded around him. Nat wanted to help, Sam wanted juicy details for future blackmail, and Steve wanted a good laugh.

So, Pietro told them the story of his first treatment session with Doctor (Y/L/N). After cackling for a solid five minutes, they devised a plan for Piet to ask out the beautiful doctor. Let's just say that after your treatment sessions, you were happy to accept a date from Pietro.

[thebibliosphere]

Hey, I'm really sorry to bother you and I hope I'm not out of line but I just read your newest post about your stomach and I'm curious... Do you have any idea what's wrong? See, I've got something similar and for the last year and a half I've been living on rice, chicken and the few veggies that don't make me sick. I've lost a third of my original weight, but all the doctors I've gone too have no idea what's wrong! Which is why I'm asking. I hope I'm not out of line and I wish you the best day!!

Not a damn clue. My diagnosis currently ranges from “you’re overweight try losing weight” (no longer valid since I dropped fucking 20lbs in a month and likely wasn’t valid for most of my symptoms to begin with) it’s “just” IBS (a chronic condition unto itself which too few people including doctors seem to realize and dismiss as non life impacting simply because it’s “common”) leaky gut caused by allergies (previously thought to be celiac but repeatedly tested negative for) chronic GERD (somewhat more under control than it was to the point when I am off my meds which worsened the other symptoms) vocal chord dysfunction (previously misdiagnosed as asthma which before that was misdiagnosed as purely anxiety when in fact the reason I was panicking was because I couldn’t breathe) “it’s just anxiety” (which yes I have anxiety, but I’ve realized a LOT of it was being caused by allergies causing a near constant adrenaline response so that was fun. Nice to know I was on sedatives as a teenager because no one bothered to listen to me when I said eating XYZ hurt), hormonal problems (despite my hormones always being “normal”), and last but not least “I mean, it could be fibromyalgia or an autoimmune disease, your symptoms are kind of hard to pin down”. That latter part being a direct quote from a doctor. 

I’ve also had severe issues with my teeth, which since I have switched to a holistic dentist, have largely been resolved. (Still in pain, but every time he does something my health bounces up a notch so it’s a process I’ll be working with him toward fixing over the next few years. He even suspects I might have been getting mercury poisoning from some seriously dangerously over the limit leaking amalgam fillings I got in my early teens. He’s also the only dentist willing to remove my root canal teeth because they’ve never fully healed.)

So. Yea. I have some of my own possible theories that it might be SIBO which many doctors here in the US seem reluctant to even admit is a real thing (my current dr certainly doesn’t and will not test for it despite it being an easy culture test to do) and some possible genetic fuckery/immune system bullshit. Both my parents are extremely ill people with very similar issues, my dad even has an autoimmune disease he doesn’t care enough to even remember the name of so I can’t just narrow the field and test directly for that. Thanks dad.

The difference between me and them is I am actively trying to get a diagnosis and claw some semblance of health/sanity back before I turn into a hermit resigned to dying young. 

A big thing for me seems to be allergies/intolerances which have sprung up in the last few years. (Rice is the first thing doctors recommend for eating “plain” food but it’s actually a huge trigger food for a LOT of people) Eating only organic seems to have helped (suggesting a preservative allergy, which my allergist just kind of said “I believe you, but there’s no reliable test for it so just...don’t eat them”) 

Which is where you find me at now, two years down the rabbit hole of trying to get an accurate diagnosis. As for asking questions, it’s entirely okay to ask questions. I’ve pretty much wound up documenting my chronic health issues because a) it was helping me to keep track of things and then b) my blog got popular due to shenanigans and then a bunch of other people started going “HEY ME TOO” and we’ve created a sort of exhausted support group for each other and also c) the number of people who message me on a daily basis to tell me it helps them to know they are not alone is just...I’ve cried twice today at some of the messages I’ve gotten, and at the time of typing this it’s not even noon. 

I do not mind being public with any of this because gods help me if someone can figure out some small puzzle piece of their life from me falling apart then in some small way it will be worth it. Cause I know what that feeling is like. And I wouldn’t wish it on anyone. Chronic health issues are so incredibly isolating.

So yea...next step I’m off to see a natruopathic/functional medicine doctor (yes I made sure they are licensed physicians and not just crazy hippies) in the hopes that she might have some answers for me, or is at least willing to listen to me, which uh, yeah, the more you refuse to accept suffering to be your way of life, many doctor’s don’t seem to appreciate. I had my GI doctor tell me I shouldn’t google my symptoms and just accept the fact that the meds he prescribed for the chronic GERD would dissolve my intestines which, hahahahah, ha. No. I do not accept that. Not even a little bit.

[nevillwallace97]

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[riichardwilson]

Google now showing ‘specialists’ tab in health condition knowledge cards on mobile

At one point or another, chances are you’ve turned to “Dr. Google” to shed some light around a health concern. Whether you’re trying to self-diagnose a medical condition or are just curious about a particular disease you heard on a show, we rely on Google to provide us with answers to our many health-related questions. In fact, 1 in 20 Google searches are health-related, and Google knows it has a responsibility to serve the most accurate medical information for these 170 million-plus daily searches.

I’ve always been passionate about healthcare, probably due to the fact that I’ve lived among nurses my entire life (my mother, sister and wife are all nurses). For the past 10 years, all of my marketing agency experience has been within the healthcare industry. Every day I’m searching for something health-related on Google. I was very excited when I discovered this latest enhancement as I believe it will benefit patients the most. In reality, most patients don’t know what type of doctor they should seek for certain medical conditions. This update to Google’s health condition cards will help provide that direction and will essentially close the loop on the digital patient journey.

Google Health Knowledge team’s mission

Similar to Google’s mission statement, the goal of the team behind their Health Knowledge Graph is to “Make health information universally accessible and useful. Allow anyone in the world to receive key, top quality health info in a fluid and intuitive fashion.”

It’s so important now, more than ever, for these results to be of the highest quality. After all, the wrong medical advice could potentially result in a perilous outcome. This is why Google has invested so much time into tailoring these health knowledge results over the years, to give users only the best information, displayed for easy consumption.

History of Google Healthcare Knowledge graph and its new update

This has been an ongoing effort with Google, and like everything else they do, it appears in iterations and small tweaks until they get it right.

February 2015: Google launched the healthcare condition cards, appearing in search results when users search for a common medical issue with a short summary of the condition and few facts as to how it comes about, symptoms, treatability, and more.

December 2015: Google added a new segment to their condition cards, a “Treatments” tab where users could find a list of remedies for their specific ailment.

June 2016: Adding a “Symptoms” tab to their healthcare condition cards, Google provided users with increased autonomy by allowing them to search their specific symptoms and receive a list of possible illnesses they may have.

Most Recently: Google began rolling out a “Specialists” tab on their health conditions cards on mobile search results only, which provides users with an easy path to finding the right doctors who specialize in the condition they’ve searched for.

With this new updated feature, users are also offered the option for these results to be local to them, so long as you grant Google permission to access your location.

Opportunity for healthcare marketers

The addition of a “specialists” tab could increase the frequency of healthcare providers appearing in local search results. Here are five high-level SEO Company tips to help you capitalize on this opportunity:

Make sure your doctor or healthcare facility web pages follow best practices for local optimization.

Add as much content to your physician or healthcare facility Google My Business profile.

Build out online profiles across the top healthcare directory sites (Healthgrades, Vitals, WebMD, etc.) and make sure the information is consistent across all profiles.

Incorporate Schema on your doctor and healthcare facility pages, specifically the Schema markup for Physician and LocalBusiness properties.

With all of the YMYL algorithm updates over the past few years, it’ll be especially important for doctors to ensure they have a strong online reputation and demonstrate expertise in their medical area via citations from reputable health care authorities and sites (E-A-T).

With this feature only appearing on mobile search results thus far, it will be important to keep an eye on these condition cards as this could just be something Google is testing. Personally, I believe this new addition is here to stay. Down the road, perhaps they’ll even incorporate a mechanism for scheduling appointments directly within these cards. Only time will tell, so we shall see.

Opinions expressed in this article are those of the guest author and not necessarily Search Engine Land. Staff authors are listed here.

About The Author

Wayne Westerlind is an experienced search engine marketing agency professional specializing in healthcare. As founder and CEO of West 360 Marketing, Wayne has developed digital marketing agency strategies for some of the largest healthcare organizations in the US. In addition, Wayne is a corporate marketing agency program director for New York’s largest healthcare system, Northwell Health, leading their enterprise-wide search engine marketing agency strategy for their 23 hospitals and 800 outpatient facilities.

Website Design & SEO Delray Beach by DBL07.co

Delray Beach SEO

source http://www.scpie.org/google-now-showing-specialists-tab-in-health-condition-knowledge-cards-on-mobile/ source https://scpie.tumblr.com/post/612768471409917952

[douglassmiith]

Google now showing specialists tab in health condition knowledge cards on mobile

At one point or another, chances are you’ve turned to “Dr. Google” to shed some light around a health concern. Whether you’re trying to self-diagnose a medical condition or are just curious about a particular disease you heard on a show, we rely on Google to provide us with answers to our many health-related questions. In fact, 1 in 20 Google searches are health-related, and Google knows it has a responsibility to serve the most accurate medical information for these 170 million-plus daily searches.

I’ve always been passionate about healthcare, probably due to the fact that I’ve lived among nurses my entire life (my mother, sister and wife are all nurses). For the past 10 years, all of my marketing agency experience has been within the healthcare industry. Every day I’m searching for something health-related on Google. I was very excited when I discovered this latest enhancement as I believe it will benefit patients the most. In reality, most patients don’t know what type of doctor they should seek for certain medical conditions. This update to Google’s health condition cards will help provide that direction and will essentially close the loop on the digital patient journey.

Google Health Knowledge team’s mission

Similar to Google’s mission statement, the goal of the team behind their Health Knowledge Graph is to “Make health information universally accessible and useful. Allow anyone in the world to receive key, top quality health info in a fluid and intuitive fashion.”

It’s so important now, more than ever, for these results to be of the highest quality. After all, the wrong medical advice could potentially result in a perilous outcome. This is why Google has invested so much time into tailoring these health knowledge results over the years, to give users only the best information, displayed for easy consumption.

History of Google Healthcare Knowledge graph and its new update

This has been an ongoing effort with Google, and like everything else they do, it appears in iterations and small tweaks until they get it right.

February 2015: Google launched the healthcare condition cards, appearing in search results when users search for a common medical issue with a short summary of the condition and few facts as to how it comes about, symptoms, treatability, and more.

December 2015: Google added a new segment to their condition cards, a “Treatments” tab where users could find a list of remedies for their specific ailment.

June 2016: Adding a “Symptoms” tab to their healthcare condition cards, Google provided users with increased autonomy by allowing them to search their specific symptoms and receive a list of possible illnesses they may have.

Most Recently: Google began rolling out a “Specialists” tab on their health conditions cards on mobile search results only, which provides users with an easy path to finding the right doctors who specialize in the condition they’ve searched for.

With this new updated feature, users are also offered the option for these results to be local to them, so long as you grant Google permission to access your location.

Opportunity for healthcare marketers

The addition of a “specialists” tab could increase the frequency of healthcare providers appearing in local search results. Here are five high-level SEO Company tips to help you capitalize on this opportunity:

Make sure your doctor or healthcare facility web pages follow best practices for local optimization.

Add as much content to your physician or healthcare facility Google My Business profile.

Build out online profiles across the top healthcare directory sites (Healthgrades, Vitals, WebMD, etc.) and make sure the information is consistent across all profiles.

Incorporate Schema on your doctor and healthcare facility pages, specifically the Schema markup for Physician and LocalBusiness properties.

With all of the YMYL algorithm updates over the past few years, it’ll be especially important for doctors to ensure they have a strong online reputation and demonstrate expertise in their medical area via citations from reputable health care authorities and sites (E-A-T).

With this feature only appearing on mobile search results thus far, it will be important to keep an eye on these condition cards as this could just be something Google is testing. Personally, I believe this new addition is here to stay. Down the road, perhaps they’ll even incorporate a mechanism for scheduling appointments directly within these cards. Only time will tell, so we shall see.

Opinions expressed in this article are those of the guest author and not necessarily Search Engine Land. Staff authors are listed here.

About The Author

Wayne Westerlind is an experienced search engine marketing agency professional specializing in healthcare. As founder and CEO of West 360 Marketing, Wayne has developed digital marketing agency strategies for some of the largest healthcare organizations in the US. In addition, Wayne is a corporate marketing agency program director for New York’s largest healthcare system, Northwell Health, leading their enterprise-wide search engine marketing agency strategy for their 23 hospitals and 800 outpatient facilities.

Website Design & SEO Delray Beach by DBL07.co

Delray Beach SEO

Via http://www.scpie.org/google-now-showing-specialists-tab-in-health-condition-knowledge-cards-on-mobile/

source https://scpie.weebly.com/blog/google-now-showing-specialists-tab-in-health-condition-knowledge-cards-on-mobile

[laurelkrugerr]

Google now showing ‘specialists’ tab in health condition knowledge cards on mobile

At one point or another, chances are you’ve turned to “Dr. Google” to shed some light around a health concern. Whether you’re trying to self-diagnose a medical condition or are just curious about a particular disease you heard on a show, we rely on Google to provide us with answers to our many health-related questions. In fact, 1 in 20 Google searches are health-related, and Google knows it has a responsibility to serve the most accurate medical information for these 170 million-plus daily searches.

I’ve always been passionate about healthcare, probably due to the fact that I’ve lived among nurses my entire life (my mother, sister and wife are all nurses). For the past 10 years, all of my marketing agency experience has been within the healthcare industry. Every day I’m searching for something health-related on Google. I was very excited when I discovered this latest enhancement as I believe it will benefit patients the most. In reality, most patients don’t know what type of doctor they should seek for certain medical conditions. This update to Google’s health condition cards will help provide that direction and will essentially close the loop on the digital patient journey.

Google Health Knowledge team’s mission

Similar to Google’s mission statement, the goal of the team behind their Health Knowledge Graph is to “Make health information universally accessible and useful. Allow anyone in the world to receive key, top quality health info in a fluid and intuitive fashion.”

It’s so important now, more than ever, for these results to be of the highest quality. After all, the wrong medical advice could potentially result in a perilous outcome. This is why Google has invested so much time into tailoring these health knowledge results over the years, to give users only the best information, displayed for easy consumption.

History of Google Healthcare Knowledge graph and its new update

This has been an ongoing effort with Google, and like everything else they do, it appears in iterations and small tweaks until they get it right.

February 2015: Google launched the healthcare condition cards, appearing in search results when users search for a common medical issue with a short summary of the condition and few facts as to how it comes about, symptoms, treatability, and more.

December 2015: Google added a new segment to their condition cards, a “Treatments” tab where users could find a list of remedies for their specific ailment.

June 2016: Adding a “Symptoms” tab to their healthcare condition cards, Google provided users with increased autonomy by allowing them to search their specific symptoms and receive a list of possible illnesses they may have.

Most Recently: Google began rolling out a “Specialists” tab on their health conditions cards on mobile search results only, which provides users with an easy path to finding the right doctors who specialize in the condition they’ve searched for.

With this new updated feature, users are also offered the option for these results to be local to them, so long as you grant Google permission to access your location.

Opportunity for healthcare marketers

The addition of a “specialists” tab could increase the frequency of healthcare providers appearing in local search results. Here are five high-level SEO Company tips to help you capitalize on this opportunity:

Make sure your doctor or healthcare facility web pages follow best practices for local optimization.

Add as much content to your physician or healthcare facility Google My Business profile.

Build out online profiles across the top healthcare directory sites (Healthgrades, Vitals, WebMD, etc.) and make sure the information is consistent across all profiles.

Incorporate Schema on your doctor and healthcare facility pages, specifically the Schema markup for Physician and LocalBusiness properties.

With all of the YMYL algorithm updates over the past few years, it’ll be especially important for doctors to ensure they have a strong online reputation and demonstrate expertise in their medical area via citations from reputable health care authorities and sites (E-A-T).

With this feature only appearing on mobile search results thus far, it will be important to keep an eye on these condition cards as this could just be something Google is testing. Personally, I believe this new addition is here to stay. Down the road, perhaps they’ll even incorporate a mechanism for scheduling appointments directly within these cards. Only time will tell, so we shall see.

Opinions expressed in this article are those of the guest author and not necessarily Search Engine Land. Staff authors are listed here.

About The Author

Wayne Westerlind is an experienced search engine marketing agency professional specializing in healthcare. As founder and CEO of West 360 Marketing, Wayne has developed digital marketing agency strategies for some of the largest healthcare organizations in the US. In addition, Wayne is a corporate marketing agency program director for New York’s largest healthcare system, Northwell Health, leading their enterprise-wide search engine marketing agency strategy for their 23 hospitals and 800 outpatient facilities.

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source http://www.scpie.org/google-now-showing-specialists-tab-in-health-condition-knowledge-cards-on-mobile/ source https://scpie1.blogspot.com/2020/03/google-now-showing-specialists-tab-in.html

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Google now showing ‘specialists’ tab in health condition knowledge cards on mobile

At one point or another, chances are you’ve turned to “Dr. Google” to shed some light around a health concern. Whether you’re trying to self-diagnose a medical condition or are just curious about a particular disease you heard on a show, we rely on Google to provide us with answers to our many health-related questions. In fact, 1 in 20 Google searches are health-related, and Google knows it has a responsibility to serve the most accurate medical information for these 170 million-plus daily searches.

I’ve always been passionate about healthcare, probably due to the fact that I’ve lived among nurses my entire life (my mother, sister and wife are all nurses). For the past 10 years, all of my marketing agency experience has been within the healthcare industry. Every day I’m searching for something health-related on Google. I was very excited when I discovered this latest enhancement as I believe it will benefit patients the most. In reality, most patients don’t know what type of doctor they should seek for certain medical conditions. This update to Google’s health condition cards will help provide that direction and will essentially close the loop on the digital patient journey.

Google Health Knowledge team’s mission

Similar to Google’s mission statement, the goal of the team behind their Health Knowledge Graph is to “Make health information universally accessible and useful. Allow anyone in the world to receive key, top quality health info in a fluid and intuitive fashion.”

It’s so important now, more than ever, for these results to be of the highest quality. After all, the wrong medical advice could potentially result in a perilous outcome. This is why Google has invested so much time into tailoring these health knowledge results over the years, to give users only the best information, displayed for easy consumption.

History of Google Healthcare Knowledge graph and its new update

This has been an ongoing effort with Google, and like everything else they do, it appears in iterations and small tweaks until they get it right.

February 2015: Google launched the healthcare condition cards, appearing in search results when users search for a common medical issue with a short summary of the condition and few facts as to how it comes about, symptoms, treatability, and more.

December 2015: Google added a new segment to their condition cards, a “Treatments” tab where users could find a list of remedies for their specific ailment.

June 2016: Adding a “Symptoms” tab to their healthcare condition cards, Google provided users with increased autonomy by allowing them to search their specific symptoms and receive a list of possible illnesses they may have.

Most Recently: Google began rolling out a “Specialists” tab on their health conditions cards on mobile search results only, which provides users with an easy path to finding the right doctors who specialize in the condition they’ve searched for.

With this new updated feature, users are also offered the option for these results to be local to them, so long as you grant Google permission to access your location.

Opportunity for healthcare marketers

The addition of a “specialists” tab could increase the frequency of healthcare providers appearing in local search results. Here are five high-level SEO Company tips to help you capitalize on this opportunity:

Make sure your doctor or healthcare facility web pages follow best practices for local optimization.

Add as much content to your physician or healthcare facility Google My Business profile.

Build out online profiles across the top healthcare directory sites (Healthgrades, Vitals, WebMD, etc.) and make sure the information is consistent across all profiles.

Incorporate Schema on your doctor and healthcare facility pages, specifically the Schema markup for Physician and LocalBusiness properties.

With all of the YMYL algorithm updates over the past few years, it’ll be especially important for doctors to ensure they have a strong online reputation and demonstrate expertise in their medical area via citations from reputable health care authorities and sites (E-A-T).

With this feature only appearing on mobile search results thus far, it will be important to keep an eye on these condition cards as this could just be something Google is testing. Personally, I believe this new addition is here to stay. Down the road, perhaps they’ll even incorporate a mechanism for scheduling appointments directly within these cards. Only time will tell, so we shall see.

Opinions expressed in this article are those of the guest author and not necessarily Search Engine Land. Staff authors are listed here.

About The Author

Wayne Westerlind is an experienced search engine marketing agency professional specializing in healthcare. As founder and CEO of West 360 Marketing, Wayne has developed digital marketing agency strategies for some of the largest healthcare organizations in the US. In addition, Wayne is a corporate marketing agency program director for New York’s largest healthcare system, Northwell Health, leading their enterprise-wide search engine marketing agency strategy for their 23 hospitals and 800 outpatient facilities.

Website Design & SEO Delray Beach by DBL07.co

Delray Beach SEO

source http://www.scpie.org/google-now-showing-specialists-tab-in-health-condition-knowledge-cards-on-mobile/