How to Begin a Bone and Muscle Strengthening Program Smartly

By Guest Blogger Kim Miller, ACE Certified Trainer and Wellness Coach. 904 501- 6002

Gain Bone Strength and Muscle Tone Even if You’ve Never Trained

It’s never too late to gain strength. Our bones and muscles have an innate capacity to respond to stimuli by growing in size, density and strength. Here’s how to begin. In the beginning stages of a weight training routine, it’s necessary to take 3-4 weeks to learn proper technique while keeping the weights light.

Think of this process as setting the stage for smart progressive gains in strength, muscle tone, and muscle density. Skipping these two factors of proper technique and light weight in the initial stage increases injury occurance which is the number one reason people stop training. Don’t let this be you.

Keep the weight light enough that you can practice good form without any struggle. The temptation to increase the weight amount will be looming, but realize it is the tendons and ligaments of the body that really need sensible conditioning in these opening weeks. Be patient. Be Smart.

To Hire a Trainer or Not ?

If there was ever a time to hire a trainer it’s in the opening weeks of a weight training routine. A good trainer will show you what machines to use, how to set them up, and what weight to start with. A really good trainer will help you in those opening weeks to make sense of a routine suitable for you. This should involve asking many questions about your lifestyle, how much time you can commit to exercise, what type of job you have, past injuries, health status, motivation levels, reasons for initiating a strength program and other pertinent information that willhelp develop a plan that is suited for you and you’ll likely implement consistently.

A really good trainer will also add perspective on how best to adhere to the program and will transition you through various aspects of learning to strength train. A good trainer is well worth the money as making sense of the implementation of a strength routine is paramount when considering that most people do not continue a strengthening program for longer than a few weeks.

Going It Alone? If, for some reason you need to begin a strength program on your own, most gyms have attendants that can show you how to use the machines. There should be no cost for them to show you how to set up each machine. If you never strength trained before in your life, and you will be training on your own, have the gym’s attendant or preferably a personal trainer show you these five exercises.

Getting Started On Your Own

Leg Press- press through the heels and keep head back.

Latissimus Dorsi Pull Down-keep chest upright throughout and lean slightly back.

Chest Press- keep head back and engage chest muscles to press.

Seated Shoulder Press With Dumbells – back supported and palms facing in.

Standing Bicep Curl Against Wall- knees slightly bent and stand against wall for support.

Repetitions and Sets

Practice 15 repetitions of each exercise in the order as desribed above. Repeat this cycle one more time. Practice slowly and deliberately and use a light enough weight that 15 repetitions are not a strain.

How Often

Practice this routine 2-3 times a week for the first three weeks preferably having a day or two off in between. Increase the weights by no more than 15% each week. Remember, your goal in the opening weeks is to practice good form and allow your tendons and ligaments to get adjusted to the increased workload to come.

When you leave the gym you should feel like you could easily continued doing more. Don’t be tempted to increase your weights, repetitions or sets. This is a mistake that will ultimately increase the likelihood that you will dread going to the gym your next session. We are not just training our bodies, but we are also training our minds. It’s a process of adjustment and by honoring this you’ll increase the likelihood of making strength training a lifelong habit.

Look for part II of this series on smartly beginning a weight training routine for bone strength and increased muscle tone. Until then, keep in mind that our true wealth is in your health. Best of luck to you!

E-mail or call me for any questions you may have. I will be happy to help!

Kim Miller, Ace Certified Trainer and Wellness Coach. 904 501- 6002

Last updated April 1, 2010

St.John’s Wort–The P450 Superwoman


St. John’s Wort is a widely used botanical that has many interactions with commonly prescribed medications.  In fact the the United States Food and Drug Administration issued a  health advisory about St. John’s Wort.

St. John’s Wort increases the level of enzyme system in the liver called the P450 system.  In medical school, the P450 system seemed to be the super enzyme that accomplished everything–wife, mother, powerful leader –oh sorry, that was Condeleeza Rice…Actually the P450 is responsible for breaking down many toxins in the body.  If you are interested in trivia, or in taking my medical school biochemistry tests for me, you would be interested to know that St. John’s Wort induces the cytochrome P450 isoenzymes CYP3A4, CYP2C9, CYP1A2 and the transport protein P-glycoprotein.  When these cytochrome P450 enzyme levels are increased, the breakdown of certain medicines is enhanced.  These medications include warfarin, cyclosporine, digoxin, theophylline, HIV protease inhibitors and birth control pills.  So blood concentrations of these medications may be decreased if you are also taking St. John’s Wort. 

Make sure you discuss St. John’s Wort or ANY supplement or herbal remedy you may be taking with your doctor.  It may be that the levels of other medicines you are taking may be higher or lower than desired because of interactions with St. John’s Wort.
Last Updated March 24, 2010

A Foreign Language: The Medical Billing System


I can sum up the biggest problem with the health care system in one word: bureaucracy.  The regulations that doctors have to memorize, in addition to plain old medicine (which in my experience is complex enough!) looks like the indecipherable ingredients on the back of a processed food bag: CPT/ICD codes, HIPPA compliance, Red Flag rules, CMS oversight, meaningful use of EMRS, prescription drug plan overrides, pre-authorization, high fructose corn syrup, red dye #3 and MSG.  Both MSG and physician regulations give me a major headache, and leave me with less energy to give to my patients (That’s why I blog!! To relieve stress!!)

I have spent years trying to learn the French language and suddenly figured out that I did not need to learn French when I was already fluent in another foreign language:  medical billing. 

Over a quarter of my overhead as a primary care physician goes toward paying for staff, software, transmission companies and other costs related solely to medical billing.  I frequently get resumes from billing clerks in other fields who think that because they did billing for an auto parts store or a plumber, they can get paid even better doing medical billing.  These billers believing erroneously that all physicians do is send a bill to the patient and get paid large sums of money by expending minimal effort.

The fundamental belief held by Medicare, Medicaid and other other insurance companies is that physicians will not be honest in their billing practices.  That is the reason the physician must code for an office visit, procedure or surgery using the right modifiers, codes and service locations in the right boxes of the form (called the HCFA form) to prove that he or she did not commit fraud and abuse.  Next the doctor has to pay for an electronic system to submit the form containing all the diagnoses and level of service.  Finally the doctor then has to pay for another service to transmit all the claims to the right insurance company.  The insurance companies are counting on our ignorance and hope that doctors will do what they typically do:  give up and just not bill.  I know that I, and most physicians, underbill the level of care of an office visit so that they don’t get audited by Medicare or other insurance companies.

An office visit can be rejected (not considered a “clean claim”) if the physician’s NPI number, Medicare numbers and the ICD and CPT codes are not just right.  Certain numbers (which is always a mystery to the doctor and billers) have to go in certain boxes, or else the the claim is rejected. 

Trying to call Medicare or an insurance company to ask a question about a claim takes several hours.  If you call Medicare back (and assuming you actually get through–make sure you have a couple of free hours on your hands to wait on hold), you will get a different answer from a different claims specialist. 

The key to all this complexity is very simple: doctors don’t understand the system and will often give up and just write off the office visit.  That saves the the insurance company or Medicare a bundle.  

I am not sure why coding the diagnosis hypertension to the most specific decimal point makes a bit of difference in the time and complexity of the care I provided to a patient.  Does my level of care make a difference if the patient has hypertension with kidney disease versus hypertension with heart disease?  Since they are equally complex patients, why does Medicare want me to distinguish their diagnoses? And why penalize me if I just bill using plain old hypertension, not otherwised specified (NOS)?   And why does Medicare have to know if the blood pressure is controlled or not controlled?  Do I or the patient get bonus points if the patient eliminates salt from his diet and gets his blood pressure controlled? 

Actually, some day doctors will be penalized for their patients have uncontrolled diabetes or cholesterol. I am not sure why I should be responsible for a patient who does not eat healthy or exercise, but the government is set on “outcomes” and “pay for performance,” which means that those patients who are non-compliant will not have doctors who are willing to take care of them.

Conversely, a patient may have underlying complex hypertension, but, if the blood pressure is controlled, I will spend less time on that medical problem and bill a lower level office visit.  So why does the detailedness of the diagnosis code (“to the highest specificity”) make a difference?  

Why make the doctor and billing specialist (and believe me, this person has to be a specialist) spend the extra time to put two decimal points on a diagnosis code that is of no relevance to the patient’s care?  Would it not make sense to spend the doctor and the staff”s time teaching patients about a no added salt diet to control hypertension rather than figuring out the right hypertension code to the highest specificity?  Like there isn’t any waste in the medical system there? 

Even more confusing is the fact that every year certain CPT and ICD codes and diagnoses are eliminated or converted to different codes.  That means every year the doctor has to buy new books and learn about new codes to the highest decimal point specificity, or risk having claims rejected.  Why do codes have to be changed from year to year?  The patient with hypertension and kidney disease still has the same ailment, but little did he know that his diagnosis code has changed! 

For example, if the diagnosis code for uncontrolled (“Malignant”) hypertension is changed, and I don’t want to spend $600 to buy coding books that particular year (I won’t be able to afford to buy them next year–that is the absolute truth) that tells me you have changed the diagnosis code and I use the old diagnosis code, why is my claim denied?  Have I not provided the same service to the patient, whether the high blood pressure is controlled, uncontrolled, two decimal points, one decimal point, with kidney disease (further broken down into kidney disease stages one through five),  has salad dressing on the side and a partridge in a pear tree?

I have looked in coding books frequently, trying to find a code for what my patient has.  The books themselves are mazes and not set up the step by step way doctors think.  If you look under “Disease” multiple completely unrelated diseases of many different organ systems are listed.  How would one know to even look in that section? Furthermore, there are diagnoses for illnesses that I know do not actually exist. Many codes are “V” codes or represent preventive medicine issues, which are not paid for by most insurance companies, including Medicare.  So why list them?   Somebody was actually paid to make up those diagnoses and assign codes to them.  Such a waste of manpower.

The rules of the coding system involving medical decision making, physical exam bullet points and past medical/social/family history are so complex that coders and doctors can’t possibly agree with the level of service that can be billed. For example, I can bill a higher level office visit if I ask the  patient about her family history.  Maybe that is a poor use of time if I am already aware of the family history or if the family history is irrelevant to the patient’s medical condition.  Either way, it doesn’t matter, because I can bill a higher level visit if I ask and document the family history in my note.  Some doctors learn to play the billing game well, which does not mean they provide better medical services.   Their billers just know how to bill more effectively.

President Obama claims there is so much fraud and abuse in the medical system that eliminating it will pay for a new health care system.  I believe the fraud and abuse are in the unnecessary bureaucracy utilized to ensure all the complex rules of billing are followed.  If changes in the health care system require more bureaucrats to carry out the system, then the point of changing the system to save money has been lost.

So many health care dollars would be saved if a straightforward  billing system were in place.  Patients should be furious that this money, which could be put to use to expand services to more patients, instead is being spent on bureaucrats who exist simply to make sure that the doctor is learning and using the foreign (billing) language correctly. 

Literally millions of dollars could be saved if so many people did not exist simply to monitor the doctor, with the underlying assumption that doctors by nature must be corrupt and require this type of oversight.  That money is better spent towards actual health care, not health care billing.

Last Updated by Dr. Vee on May 2, 2010

Statins and Beta Blockers Deplete CoQ10


Coenzyme Q10 is a natural substance found in abudance in cells of the body that provides energy to the body and helps the immune system.  CoQ10 also acts as an antioxidant in the body.  Antioxidants are substances that attack and remove free radicals, dangerous substances which cause damage to cells and can eventually result in cancer, aging or cell death.  CoQ10 protect cells from stress from environmental toxins (e.g. cigarette smoke) or aging.  It is in this way that Coenzyme Q10 is believed to help the body fight cancer, prevent heart disease, and combat aging. 

CoQ10 is found in mitochondria, the parts of cells that generate energy. CoQ10 is involved in the generation of energy called adenosine triphosphate (ATP) in cells.  ATP is the energy currency that allows cells to carry out all their myriad functions, including muscle contraction, protein synthesis and other vital cell functions.

Two forms of CoQ10 exist. The more common form is called ubiquinone. The active or oxidized form of CoQ10 is called ubiquinol.  Young people convert ubiquinone to the active component ubiquinol quite readily.  However, ubiquinone is less easily converted to ubiquinol as people get older.  Until recently, ubiquinol was unstable and could not be manufactured as a supplement.  Now ubiquinol is available, but is typically more expensive than the ubiquinone form.

CoQ10 are found in large numbers in the power centers of the body, the liver and heart.  In the liver, CoQ10 is made in a pathway similar to the way cholesterol is made.  So when a person is on a statin, which inhibits an important enzyme that makes cholesterol, the CoQ10 pathway is also impaired.  It is believed that two important classes of medications, the statins (simvastatin, atorvastatin, pravastatin, lovastatin) and beta blockers (atenolol, metoprolol) decrease (up to 40 %) the production of CoQ10 in the body.

Eating antioxidants in Super Foods such as pomegranate juice is a good way to replenish CoQ10 in the body. Some experts feel that older patients on statins or beta blockers should take CoQ10 supplements to replace the reduced levels of CoQ10 in cells.  Some experts feel that people who have high blood pressure should consider supplementation with CoQ10 as well as Vitamin D3.  Athletes (and wannabe athletes) may want to consider adding CoQ10 supplementation to optimized exercise endurance and muscle recovery.

Last updated March 19, 2010 by Dr. Vee

Garlic–The Russian Penicillin

Garlic is believed to help reduce blood pressure and the risk of heart disease.  Garlic is also being investigated for it’s potential anti-cancer properties. 

Slicing, chopping, mincing or pressing garlic before cooking will enhance the beneficial effects of garlic. Garlic should be eaten raw, or stand for ten minutes before heating, in order to preserve it’s beneficial antioxidant properties. 

Garlic was applied topically as a paste by both the British and Russian armies during World War II to prevent infections.  So garlic is commonly called the Russian penicillin!

Wait, is that garlic ICE CREAM?!  Let me know if you have ever tried garlic ice cream and what you think of it!
Last Updated on March 20, 2010


Tomatoes have lycopene, an antioxidant similar to Vitamin A, which provides that bright red color to tomatoes.  Lycopene is believed to have anti-inflammatory and anti-cancer properties.  It helps prevent prostate cancer.  Lycopene is absorbed better when tomatoes are cooked or when combined with olive oil.  Lycopene is also found in strawberries, watermelon, guava, apricots and pink grapefruit.

Last updated by Dr. Vee on March 19, 2010