How It All Started

PresenceMD was born out of a desire to be there at the beginning. I’m an ER doc and have been for 20 years. I see the end result of disease processes. I see the dialysis, the heart attacks, the strokes. Once something like that happens, I’m in damage control mode. I’ve spent decades stepping in once things have reached the breaking point.

Unfortunately, once the heart attack or stroke has happened, a lot of damage is done. When I tell someone that they now have diabetes, their whole world changes. It goes from just grabbing a snack to a nagging thought of “what is this going to do to my blood sugar?” Your world changes at that moment, and I’ve given life changing news thousands of times in my career. I’ve done it so often, it just feels… routine. It is routine to me, but to the person who’s life just changed, it’s anything but another day. It’s Before. And now After.

Obesity medicine came into my life very personally, and I’ll share that story in another post. But the reason I decided not just to be a patient but to actually learn the science, become an expert, and start practicing obesity medicine is the chance to be in the Before.

Metabolic dysfunctions that lead to obesity start years or decades before I would meet patients in the ED with their emergencies. Those changes started so long in the past, and there were so many chances to change them if we had the tools.

With the development of GLP1 medications and their successors, we finally have effective tools to impact obesity. We also have learned so much about it. When I was in medical school, we were told that weight = calories in - calories out, and that was it. We know now that model is so outdated, it belongs in the shelf with polyester show pants and taco shaped cowboy hats.

Now, I can work with patients at the start of this dysfunction. We can address the underlying problems that create the dysregulation that leads to the inflammation and weight gain and damage. We can change how bodies process and store energy. We can be smarter and more intentional about how we feed our bodies, move our bodies, and rest our bodies.

It feels strange at this point in my career to go back to the beginning. I’ve spent two decades fighting the end stages of diseases, trying to patch up broken bodies and coax just a little more time out of them. After all this time, I’m excited to spend some time at the beginning, preventing these outcomes so I don’t have to tell so many people they have diabetes or kidney failure or will need an amputation.

This is also a place of healing for me. I’m tired after 20 years of night shifts and holidays and weekends. Horses have always been my safe place, no matter where life took me. I’ve enjoyed so much this new entrance into the reined cow horse world and am so grateful for the people who welcomed me with open arms. This feels like a really great place to begin this new adventure, around people who want to be healthy so we can all be the old lady in the show ring some day. It would be a real privilege to be able to say I kept people healthy enough to still live their passions, rather than just hear stories of what they used to love.