Howard Health & Wellness: Corey Howard, MD

What is Concierge Medicine? Simply put, concierge medicine is a healthcare model that allows patients and physicians to work directly together without the usual barriers typically experienced when going to the doctor. It’s easy and convenient. Instead of making numerous calls to an office, only to be put on hold or told the doctor can see you in a few weeks or months, our office goes above and beyond to ensure you receive the kind of service you truly want. We are kind, compassionate, and most of all, responsive to your needs. This is true whether you are a new patient or someone we have been following for years. Dr. Howard treats every person as an individual, with all attention focused on you. We work through any issues you may have, creating solutions and plans that are reasonable and flexible. There is a single fee that covers all office visits and any interactions you will have with Dr. Howard. This includes live and telehealth visits, phone calls, texts, emails, and any other way you choose to interact with our office. Our fee is not covered by insurance, and we do not accept insurance plans of any type, including Medicare. We strongly suggest that you maintain your insurance for laboratory testing, imaging, consultations with specialists, and hospitalizations if needed (although we hope it isn’t necessary). Our office does not charge copay or coinsurance, eliminating a big hassle and barrier to exceptional care. Individual and personalized care takes time and attention, which is why we limit our membership to optimize the time spent with you. What can I expect before, during, and after a visit with Dr. Howard? Before your first visit, you will have the opportunity to meet Dr. Howard, his nurse Faith, and see our office. During this “Meet and Greet,” you will learn more about the practice and what to expect. Prior to your first visit, we do our best to obtain your past medical records (when available). You will complete our set of forms, and your vitals will be taken. During your first visit, we typically spend between 1-2 hours reviewing your history, performing a comprehensive examination, and creating an individualized plan for you that may include ordering tests and/or imaging. At checkout, Dr. Howard’s assistant, Faith, will arrange for the testing and give you a follow-up date to review everything that was ordered. Additionally, during that first visit, you will gain access to our electronic health record portal where you can view test results and the “Care Plan” created by Dr. Howard. If you have any questions after the visit, simply reach out to the office by phone, email, or call/text Dr. Howard directly. Our goal is for you to feel completely satisfied and cared for by our office. Dr. Howard is board-certified in Internal Medicine, fellowship-trained in Gastroenterology (though he no longer practices as a gastroenterologist), and board-certified in Anti-Aging, Functional, and Regenerative Medicine. He has completed life coach training, attended professional cooking school for plant-based cooking, and has a wealth of life experiences that help him connect with all his patients. He uses this training and his extensive experience over his 27-year career to optimize your health and well-being. Issues We Treat/Evaluate: • Testosterone therapy for men • Menopause hormone treatment • Weight loss using peptides • High blood pressure • High cholesterol • Heart disease • Osteoarthritis • Osteopenia/osteoporosis • Diabetes • Intestinal issues • Lung issues • Thyroid problems • Recommendations on immunizations • Cold/flu and other acute illnesses • Screening for colon cancer, breast cancer • And pretty much any medical issue you might have Concierge Services: • 24/7 connection to our office and Dr. Howard • Same-day/next-day appointments as needed • Variety of visit types: live, telehealth, phone only, email, text (we connect with you the way you want to) • Coordination of care with specialists • Extended time directly with Dr. Howard for all appointments • Comprehensive care throughout the year, not just during your “Annual” exam

Natural hormones are unique to each person. Hormone regulation begins to change for women around 35-55. If a woman continues to cycle after age 55 it can increase the risk of breast cancer. ​ Traditionally trained physicians typically give synthetic hormones and only for a short time. These hormones cause many problems because they send incomplete messages to the body. This leads to an imbalance of hormones. Many symptoms of menopause include the following: Hot flashes Night sweats Vaginal dryness Anxiety, mood swings and depression Decreased libido Painful intercourse (because of vaginal dryness) Urinary tract problems including incontinence Osteopenia/osteoporosis Aching joints Memory lapses (sometimes called "brain fog") Weight issues Estrogens have over 400 functions in the body and these include (not an exhausted list): Regulates body temperature Helps prevent Alzheimer's disease Improves sleep Helps cholesterol profile Helps to maintain memory Insulin sensitivity Sleep Muscle mass Improves heart functions decreasing risks of heart issues Improves mood Increase sexual interest Helps the skin And many more Three main estrogens include Estrone (E1), Estradiol (E2), and Estriol (E3). The predominant estrogens in a young women include E2 and E1. Estriol is present typically post menopause. Estriol is important because it may protect against breast cancer. It also helps maintain vaginal health by improving vaginal pH and promoting a healthy bacterial balance. ​ Additional important hormones include progesterone and testosterone. Progesterone helps to regulate mood, sleep, bone health and weight. Synthetic progesterone (Progestins) are not a substitute for what the body makes and may lead to more problems. Testosterone boosts sexual interest and improves muscle mass. It also helps with memory and can reduce body fat. Additionally, it supports healthy skin. Menopause Hormone Therapy To determine if you are a candidate for hormone replacement therapy by Dr. Howard, you will need to be fully evaluated. This means that Dr. Howard will check your blood and possibly your, saliva, and urine to evaluate your hormone levels. He will do this after completing a thorough history and physical exam. Also, he strongly recommends that you are up to date with your gynecologist and mammogram.​ Based on your symptoms and lab results, we may suggest a complete plan to balance your hormones. The different forms of therapy include: Topical creams you place on your skin Capsules. (typically progesterone) Pellet therapy From there Dr. Howard will check your hormone levels with blood tests or other labs every three months. This ensures your hormones are balanced for you. No reason exists to live and possibly suffer with the symptoms of low hormones. Schedule your evaluation today and Dr. Howard will help determine what hormone therapy would be best for you.

Testosterone levels begin to decline in men starting around 30 years old and continue to decline for the rest of your life. There typically is a shaper decline starting around 40 years old. A study from the Journal of Clinical Endocrinology and Metabolism in 2002 found that these levels can drop. On average, the decrease is about 48%. Testosterone replacement in men can provide many benefits. Symptoms of low testosterone include: Fatigue, loss of energy Change in mood, especially depression or low mood Agitation, anger or bad temper (these can also occur when testosterone levels are too high) Decreased sex drive Decrease in memory or concentration Decrease in intensity of orgasms Weight gain Joint aches Bone loss Decline in physical abilities Loss of fitness Erectile dysfunction Proper evaluation is essential in the management of low testosterone in men. This includes blood tests and possibly saliva or urine tests. These results help create the right treatment plan. Your history is vital when starting this process as Dr. Howard wants to understand the nature of the problem. Dr. Howard must perform a complete physical examination that includes an examination of the prostate. Every man who walks in does not necessarily need testosterone. Some clinics give testosterone without a full evaluation frequently leading to care that is not optimal for you. It may also be wrong for people who do not need testosterone. Heart disease can actually cause erectile dysfunction because it initially affects the smaller arteries in the penis. This means you need further cardiac evaluation BEFORE you get prescribed testosterone therapy. Typically, Dr. Howard will evaluate your hormones through a blood test. However, he may also suggest saliva and/or urine testing to evaluate your levels. If you have not had basic blood tests, you should get them done. These tests include checking your blood counts, electrolytes, liver and kidney function, thyroid levels, and prostate cancer testing (PSA). You should also check your cholesterol and other heart health risks. In addition, you would also get testosterone (free and bioavailable), sex hormone binding globulin and estradiol. Advanced testing may include dihydrotestosterone, which researchers mainly find in your saliva. This hormone can cause hair loss. The tests may also check your DHEA and cortisol levels, which are stress hormones. Once we review these levels, you can discuss your different options. Options for men include: Topical gel or creams Injections into your muscles Pellet therapy. Dr.Howard performs a procedure to insert a long-acting form of testosterone, typically into your buttocks. This type of therapy usually lasts up to 3-6 months in most men. You do need to have follow up blood work to determine your levels and to follow up on your blood count and PSA. Call the office today to learn if testosterone therapy is right for you. ​

Hormone replacement pellets are small (rice sized) and are placed under the skin to release a specific, measured amount of hormones. Pellet therapy delivers consistent and physiologic (meaning what your body would make) levels of hormones and can last for several months. Both estradiol and testosterone are available in pellet form. Pellet Protocol During your initial consultation Dr. Howard will take a detailed history. He will discuss nutrition and fitness. Then, he will order baseline tests. These tests may include blood, saliva, and urine samples. This testing helps to determine which method of hormone regulation may be best for you. Dr. Howard places the pellets in the upper buttocks after numbing the area with a local anesthetic. The procedure takes only 10-15 minutes. The pellets dissolve over time and can last 3-6 months typically. For women, Dr. Howard strongly recommends balancing estrogens and add progesterone and usually testosterone based on your individual tests. Dr. Howard may suggest extra creams. He will talk with you about this and answer your questions about hormone therapy. Pellet Therapy: An Overview Pellet therapy is a type of hormone replacement therapy (HRT). In this method, Dr. Howard will place small pellets under the skin to deliver hormones. These pellets contain Estradiol and often Testosterone. They gradually release hormones into the bloodstream, mimicking the body’s natural hormone production. Benefits of Pellet Therapy for Men and Women Men: • Testosterone Regulation: Pellet therapy is primarily used in men to regulate testosterone levels. Low testosterone can cause many problems. These include low energy, a decrease in sex drive, depression, and less muscle mass. • Steady Hormone Levels: Unlike injections that can cause hormone levels to change, pellets release hormones steadily. This leads to more consistent symptom relief. • Convenience: With pellets, men avoid the need for frequent injections, which can be painful and inconvenient. Women: • Hormonal Balance: Pellet therapy is used to balance hormones like estrogen and testosterone. This can help alleviate symptoms of menopause, such as hot flashes, mood swings, and vaginal dryness. • Improved Libido and Energy: Many women report improved libido, energy levels, and mental clarity with pellet therapy. • Bone Health: Estrogen is crucial for maintaining bone density. Pellet therapy can help reduce the risk of thinning of your bones and fractures. How is Pellet Therapy Performed? Consultation: The process starts with a detailed consultation and lab tests. These tests check hormone levels and find the patient’s specific needs. During the procedure, Dr. Howard numbs the skin with a local anesthetic. Dr. Howrad makes a small cut in the hip or buttocks area. Then, a special device designed specifically for pellet insertion inserts the pellet. The small cut is then closed with adhesive tape. You do not need sutures. Post-Procedure Care: Patients are advised to avoid strenuous activities for a few days to allow proper healing. The pellets typically last 3-5 months. Benefits Over Traditional Treatments Women: • Consistency: Unlike patches and creams that need daily or twice a week use, pellets offer a steady release of hormones. This helps avoid fluctuating hormone levels. • Convenience: Pellets remove the daily hassle of using creams or changing patches. They make it easier for each person to go about their normal daily activities without worrying about if a patch will stay on or if the cream will rub off. • Skin Reactions: Patches and creams can cause skin irritation or allergic reactions in some women. Pellets bypass these issues entirely. Men: • Steady Hormone Levels: Injections often cause highs and lows in testosterone levels, leading to mood swings and varying energy levels. Pellets offer a more stable release, enhancing overall well-being. • Reduced Frequency: Testosterone injections usually need to be administered weekly or bi-weekly. Pellets, however, last for several months, reducing the frequency of medical visits and improving compliance. • Natural Delivery: Pellets mimic the body’s natural hormone secretion more closely than injections, leading to better symptom management and fewer side effects. Conclusion Pellet therapy is a convenient, consistent, and effective option for hormone replacement in both men and women. It offers key advantages over traditional treatments like patches, creams, and injections, making it a popular choice for those seeking a more natural, hassle-free solution. By providing steady hormone levels and improving quality of life, pellet therapy is a valuable option for addressing hormonal imbalances.

What is Anti-Aging/Functional Medicine? Anti-Aging Medicine Anti-aging medicine aims to slow, prevent, or reverse the aging process to extend the lifespan and improve the quality of life. This field combines various approaches, including: • Hormone Replacement Therapy (HRT): Balancing hormones like estrogen, testosterone, and thyroid hormones to maintain vitality and mitigate the effects of aging. • Nutrition and Supplements: Emphasizing diets rich in antioxidants, vitamins, and minerals to promote cellular health. • Lifestyle Modifications: Encouraging regular exercise, adequate sleep, and stress management to support overall well-being. Functional Medicine Functional medicine addresses the root causes of disease through a holistic approach. It involves understanding the interactions between genetic, environmental, and lifestyle factors that influence health. Key aspects include: • Personalized Treatment Plans: Tailoring interventions based on individual genetic makeup, biochemistry, and lifestyle. • Comprehensive Assessments: Utilizing detailed patient histories, laboratory testing, and other diagnostic tools to identify underlying health issues. • Integrative Therapies: Combining conventional medicine with alternative treatments such as acupuncture, herbal medicine, and mind-body techniques. • Focus on Prevention: Emphasizing proactive measures to prevent disease rather than just treating symptoms. Regenerative Medicine Regenerative medicine seeks to repair or replace damaged tissues and organs, aiming to restore normal function. It employs cutting-edge technologies and treatments, including: • Stem Cell Therapy: Using stem cells to regenerate damaged tissues, potentially treating conditions like arthritis, heart disease, and neurodegenerative disorders. • Platelet-Rich Plasma (PRP) Therapy: Injecting concentrated platelets from the patient’s blood to promote healing and tissue regeneration. • Tissue Engineering: Creating biological substitutes to restore, maintain, or improve tissue function. • Gene Therapy: Modifying or replacing defective genes to treat genetic disorders. Integration of These Fields These three fields often overlap, providing a comprehensive approach to health and wellness. For example, a treatment plan for an aging patient might include hormone replacement therapy (anti-aging), a personalized diet and lifestyle plan (functional medicine), and stem cell therapy for joint pain (regenerative medicine). By combining these methods, we aim to improve longevity, enhance quality of life, and promote optimal health. A more holistic evaluation gives us the chance to stop or even reverse disease progression. This approach allows Dr. Howard to work closely with each patient, dedicating the time needed to improve overall health. What can I expect during my visit? You will meet directly with Dr. Howard, either in person or virtually through one of several easy-to-use platforms. A typical visit lasts 1-2 hours. It begins with basic questions and gradually becomes more detailed. We will review your lifestyle habits, medical records, lab results, and discuss advanced screening for heart disease, thyroid issues, and hormones. If in person, we will perform a physical exam and order any necessary tests. Everything will be clearly explained, and by the end of the visit, you’ll have a personalized plan to improve your health. Sometimes supplements or medications may be recommended based on the findings. You will also have a way to reach Dr. Howard and your follow-up appointment will be scheduled before you leave. What are some of the non-traditional evaluation and treatments that Dr. Howard offers? Nutritional testing and counseling Hormone evaluation- Blood, saliva or urine (sometimes multiple methods Hormone Therapy-creams, patches, injection or long-term/depot forms such as pellets Advanced heart disease testing Detailed thyroid testing Peptide therapy (see below for more details) Peptide Therapy Peptide therapy involves the use of specific peptides, which are short chains of amino acids, to enhance various physiological functions and promote health. These peptides can mimic or influence the behavior of naturally occurring peptides in the body, thereby providing targeted therapeutic effects. Peptide therapy is gaining popularity for its potential to address a wide range of health issues with relatively low risk of side effects.

In recent years, medical researchers have found that peptides are crucial for keeping our cells working properly and regulating our immune system. Peptides are small proteins, and our bodies naturally produce thousands of them to maintain good health. However, as we get older, our production of peptides decreases, which can affect how well our bodies function. Taking peptide supplements or undergoing peptide therapies can help restore these levels, leading to benefits like better metabolism, faster healing, and improved weight management. Researchers have also discovered that some peptides play key roles in metabolism, fat storage, insulin production, and inflammation, all of which influence weight gain and loss. Dr. Howard stays updated on the latest peptide research and is excited to offer peptide therapies to patients in Florida. These therapies have shown promise in clinical studies for helping people lose weight and keep it off. Semaglutide for Weight Loss Overview: Semaglutide is a GLP-1 receptor agonist initially developed for the treatment of type 2 diabetes. It has gained significant attention for its effectiveness in promoting weight loss in individuals with obesity or overweight. Science Behind Semaglutide: GLP-1 (glucagon-like peptide-1) is a hormone that plays a critical role in regulating appetite and glucose metabolism. Semaglutide mimics the effects of GLP-1, leading to increased insulin secretion, reduced glucagon levels, and slowed gastric emptying. These actions collectively result in reduced appetite and caloric intake, contributing to weight loss. Recent Research and Benefits: 1. Cardiac Risk Reduction: • Studies have shown that semaglutide can significantly reduce cardiovascular risk in patients with type 2 diabetes. It has been associated with a lower risk of major adverse cardiovascular events (MACE), including heart attack and stroke. 2. Inflammation: • Emerging research suggests that semaglutide may have anti-inflammatory effects, which can be beneficial in reducing the risk of chronic diseases linked to inflammation. 3. Dementia Research: • Preliminary studies are investigating the potential neuroprotective effects of GLP-1 receptor agonists like semaglutide. Some animal studies suggest that it may help reduce the accumulation of amyloid plaques in the brain, which are associated with Alzheimer’s disease. 4. Fertility Research: • While research is limited, there is interest in exploring the impact of semaglutide on fertility. Some studies suggest that weight loss and improved metabolic health from semaglutide therapy could positively influence reproductive health. 5. Other Benefits: • Semaglutide has also been shown to improve glycemic control and reduce the risk of developing type 2 diabetes in individuals with prediabetes. Tirzepatide for Weight Loss Overview: Tirzepatide is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist. It is currently being studied for its potential in treating type 2 diabetes and obesity. Science Behind Tirzepatide: Tirzepatide combines the effects of GIP and GLP-1 receptor agonism. GIP enhances insulin secretion and has been shown to have direct effects on fat metabolism. GLP-1 receptor agonists, as mentioned, reduce appetite and improve glucose control. The dual action of tirzepatide results in significant weight loss and metabolic improvements. Recent Research and Benefits: 1. Cardiac Risk Reduction: • Early clinical trials indicate that tirzepatide may reduce cardiovascular risk factors, such as high blood pressure and cholesterol levels. Its impact on MACE is currently under investigation in large-scale studies. 2. Inflammation: • Tirzepatide may have anti-inflammatory properties, which could reduce the risk of chronic diseases associated with inflammation. Research in this area is ongoing. 3. Dementia Research: • Similar to GLP-1 receptor agonists, tirzepatide is being studied for its potential neuroprotective effects. Animal models have shown promising results in reducing markers of neurodegeneration. 4. Fertility Research: • The impact of tirzepatide on fertility is still under investigation. Weight loss and improved metabolic health from tirzepatide therapy could potentially enhance reproductive health, similar to other weight loss medications. 5. Other Benefits: • Tirzepatide has shown superior efficacy in weight loss compared to existing GLP-1 receptor agonists in clinical trials. It has also demonstrated significant improvements in glycemic control and insulin sensitivity.