Newsletter

Dr. M’s SPA Newsletter Volume 16 Issue 19 – Pain

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Pain

Do we listen to its signal?

Pain: Your Body’s Built-In Warning System

Pain is one of the body’s oldest and most important protective mechanisms. It isn’t your enemy. It is a messenger.

Imagine walking barefoot across your living room and accidentally kicking the corner of the coffee table. The sharp pain that shoots through your toe isn’t there to punish you, it is there to protect you. Within fractions of a second, nerves carry a signal to your brain, telling you that cells and tissue have been injured. Your body immediately encourages you to stop what you’re doing. Protect the area and allow it to heal.

This is acute pain, and it serves an essential purpose for both protection and survival.

The problem arises when we stop thinking of pain as information and begin viewing it as something that simply needs to be eliminated. Over the past several decades, this mindset has increasingly influenced modern medicine. Around the turn of the century, pain was widely promoted as the “fifth vital sign,” emphasizing the importance of recognizing and treating it. While this movement helped address the undertreatment of pain, it also contributed, in some settings, to an emphasis on suppressing pain rather than understanding why it existed in the first place.

From an evolutionary perspective, pain is not a design flaw, it is a sophisticated communication system. It evolved to capture our attention, protect us from further injury, and encourage behaviors that promote healing. When we focus solely on silencing the signal without investigating its source, we risk missing the very message our bodies are trying to deliver, and deliver it will.

Pain is information

Every pain signal is your body’s way of saying, “Something isn’t quite right.”

Sometimes the cause is obvious like a sprained ankle, a cut, a burn, or a broken bone.

Other times the message is much more subtle.

….

Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 18 – Autism and Microbiomes

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Autism and Diagnosis

Metabolites and Phenotypes

In a brand new paper entitled. “Elevated Microbially-Derived Metabolites in Autism: A Possible Diagnostic Screening Test for a Distinct ASD Phenotype,” Dr. Flynn and colleagues investigated whether specific urinary metabolites produced by intestinal microbes could serve as predictive biomarkers for autism spectrum disorder. The study proposes that a large subset of children with autism may represent a biologically distinct phenotype characterized by markedly elevated microbial metabolites, which the authors term ASD-MDM (Autism Spectrum Disorder associated with Microbially-Derived Metabolites).

The investigators analyzed urine samples from 52 children with ASD and 47 typically developing (TD) controls, ages 2–11 years. They measured microbial metabolites derived primarily from phenylalanine metabolism, tryptophan metabolism, and yeast metabolism. These were chosen because decades of autism, microbiome, and metabolic research have repeatedly implicated abnormalities in microbial metabolism of aromatic amino acids, especially phenylalanine and tryptophan, along with evidence of elevated fungal/yeast metabolites in subsets of children with ASD.

The findings were striking. Children with ASD demonstrated significantly higher concentrations of many microbial metabolites than controls. Some metabolites were elevated by hundreds to thousands of percent, and in certain children concentrations were reported to be 100–1000 times higher than the highest levels observed in any control participant. Twenty-three of twenty-four measured microbial metabolites were higher in ASD participants. Ninety percent of the ASD participants (45 of 50) had one or more extremely elevated MDMs. Particularly notable were elevations in compounds related to p-cresol, p-cresol sulfate, phenylacetylglutamine, indole derivatives, and arabinitol, suggesting abnormalities in microbial metabolism involving aromatic amino acids and yeast overgrowth…. Also, Inflammation and Allergy.

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 17 – Processing Death

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DEATH

or Better Yet, Live for Today

Recently, there has been more death and morbidity in my life than usual.
There is no easy way to discuss this topic. Death is finite and simultaneously infinitely painful for the survivors. Everyone learns in the moment how to deal with death. There is no on-the-job training. We are not born ready to accept this reality.

It is simply thrust upon us.

While I deal with illness and death more frequently than the average American, an occupational reality, it never becomes easy. Each loss has its own weight. Each reminds us of truths we would rather not face.

I found myself sitting quietly with these recent events and wondering what I would want for myself and my family if this had happened to me today. What would I have wanted for my friends and family if I had died at 17? At 35? At 55?

What words would I say to my parents if I could speak to them one final time?
What would I want my children to know?
What would I hope my friends remembered?

As these thoughts swirled in the sadness of loss, I kept returning to one simple idea:

Live every day as if it could be your last, with honor and respect for yourself and others…..

Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 16 – Fake it Till You Make it

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Fake It Till You Make It?

One of the most misunderstood pieces of advice in our culture is the phrase “fake it until you make it.”
At face value, it sounds dishonest. It sounds like pretending to be something you are not. It sounds like confidence without competence.

But after nearly three decades in medicine, I have come to believe there is a deeper truth hiding inside that phrase.

Most success in life is not built on pretending. It is built on being willing to step into situations where you are not yet fully prepared, knowing that growth happens only when you are slightly or deeply beyond your comfort zone.

If I am being honest, much of my professional life has felt this way, and the depth vacillated based on the context.

When I finished my pediatric residency at the University of Virginia, I was 29 years old and knew just enough to realize how much I did not know. Medical school and residency provide an enormous foundation, but they also expose you to the staggering volume of knowledge that exists in the world. And that volume has only skyrocketed in the past 30 years.

The farther I traveled in medicine, the more I realized the horizon kept moving, often unattainable.
One experience from those early years remains crystal clear, almost like a scar from a wound.
I had been asked to give a lecture to the pediatric residents at UVA on electrolyte solutions and exercise physiology. I spent time preparing and thought I knew the material reasonably well. I walked into the room feeling confident.

Then the questions started….. and a literature review.

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 15 – Virus and Food

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Should You Feed A Viral Illness?

This Nature news article discusses emerging evidence that eating may acutely enhance immune responsiveness, particularly through effects on T cells, the learning part of the adaptive immune system. The paper centers on the old saying “feed a cold, starve a fever,” suggesting there may actually be biologic truth behind at least the “feed a cold” half of the proverb.

The article reviews a new study in mice and humans showing that T cells, key adaptive immune cells responsible for recognizing and attacking pathogens, behave differently depending on recent nutritional status. Researchers found that T cells from recently fed organisms proliferated more rapidly and mounted stronger activation responses compared with those from fasting states. In essence, nutrient availability appears to act as a metabolic “permission signal” for immune activation.

….
Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 14 – The Adult Chair


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The Adult Chair, the Adolescent Chair and the Child’s Chair

The Adult Chair by Michelle Chalfant is a practical framework for emotional maturity, self-awareness, and healing old patterns that unconsciously drive adult behavior. The central premise is that most people move through life reacting not from their grounded adult self, but from unresolved emotional states formed during childhood and adolescence. She organizes this idea into what she calls the “three chairs”: the Child Chair, the Adolescent Chair, and the Adult Chair.

The Child Chair represents the emotional self formed in early childhood. This is the place of vulnerability, fear, shame, abandonment, loneliness, and unmet needs. When people react from this chair, they often feel helpless, emotionally flooded, overly dependent on validation, or afraid of rejection. Many adult relationship conflicts, according to Chalfant, are actually wounded children (in adult bodies) interacting with each other while wearing grown-up clothing and carrying iPhones. Same child like nervous system. Better accessories. Think of the statement: lipstick on a pig, you cannot dress up dysfunction and make it disappear.

The Adolescent Chair reflects the defensive coping strategies people develop to protect the wounded child. This includes control, perfectionism, blame, avoidance, rebellion, people-pleasing, passive aggression, and emotional shutdown. The adolescent self seeks power and protection but often creates disconnection and conflict. Chalfant argues that many high-achieving adults unknowingly operate from this chair, appearing successful externally while internally driven by fear, insecurity, or the need for approval.

The Adult Chair is the goal….

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 13 – Birth Order


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Birth Order

Birth Order Is Biology, Not Birthright – so says a new paper in MedRxIV (Kramer et. al. 2026)

Here is a short field guide to how sequence shapes the immune system, and maybe the brain in children.

We’ve treated birth order like personality trivia.
First-borns are “responsible.” Youngest are “free spirits.” Middle children… well, we forgot them.

This paper suggests something more interesting: birth order is a biologic exposure.
Not destiny. Not diagnosis. But signal.

Across a very large dataset, the researchers mapped birth order against hundreds of diseases. The effects are small for any single child. But the pattern is consistent at a population level.
Children are not born into identical biology, even within the same family.
Each pregnancy changes the mother. Meaningfully. Immunologically. Successively.
Each fetus inherits a slightly different environment.
Epigenetics in full swing.
It turns out that sequence matters.

What Changes Across Pregnancies?

Three levers move, quietly, predictably:

1) The Maternal Immune System Learns
Pregnancy is not passive. It is negotiation. The first pregnancy = naïve immune system learning tolerance. Subsequent pregnancies = trained, adapted immune responses
That training alters: cytokine tone, antibody profiles, placental signaling
The fetus is downstream of all of it.

2) The Placenta Is Not a Copy-Paste Organ…
Dr. M

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