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15/Oct/2021

Patients who are new to our clinic are often surprised to see that we sell vitamins (we refer to them as supplements) in all our offices. Well, we feel that supplements are an excellent natural treatment.

Here is why…

Believe it or not, there are many symptoms that can manifest due to vitamin or mineral deficiencies.  For example, patients who are constantly tired can benefit from supplementing their diet with a B-Vitamin complex.  There are many B-Complexes to choose from, but we would like to add that all vitamins are not created equal.

In general, the vitamins found in your local drugstore or grocery store are not high quality.  These are not strong enough to raise blood levels of B vitamins and are not even in the correct form for your body to absorb them.  The fastest way to check to see if you are taking the correct form is by looking at the Vitamin B12 in the complex.  You want your B12 to be in the form of Methylcobalamin.

However, most drugstore vitamins are going to be in the cheaper to manufacture form of Cyanocobalamin.   The good news, however, is that you cannot overdose on B vitamins.  They are water soluble, so any excess that your body does not use is simply eliminated in your urine.

Another typical symptom that we see is inflammation.  Inflammation can be pain in joints, muscles, or many other areas.  One typical deficiency that can add to inflammation is Vitamin D deficiency.  Most people know Vitamin D as the “sunshine vitamin”.  In reality, almost all of the population is deficient in Vitamin D.

Most of us work indoors and do not spend time outdoors without sunscreen or clothing that covers our skin.  In order to produce Vitamin D, the body requires regular exposure of the trunk (or mid-section of the body) each day…so, you would have to spend time outside in a bikini without sunscreen.

Supplementing Vitamin D can bring down levels of inflammation all over the body.  However, to reiterate, you must have a high-quality D supplement in the correct form for your body to absorb it.  Vitamin D is an oil-soluble vitamin, which means that you must have your blood levels monitored by a doctor to ensure your levels do not get too high.

Next in the lineup of symptoms is muscle cramps and restless legs.  We have patients that complain of muscle cramps during the day, and of course those who experience this at night.  Sometimes these muscle cramps and restless legs are due to a deficiency in Magnesium.  Magnesium is important for many functions in the body and helps with bone and teeth structure.

What most people do not realize is that Magnesium is a smooth-muscle relaxer.  Meaning that by taking Magnesium you may be able to eliminate muscle cramps and restless leg issues. Magnesium comes in multiple forms as well.  The Magnesium we are referring to here is di-magnesium malate.  If you are experiencing muscle cramps, you can try Magnesium supplementation.

The list of symptoms from vitamin and mineral deficiencies go on and on.  Most of our patients have some type of deficiency because let’s face it…no one eats perfect 100% of the time.  If you think you might have a deficiency, feel free to contact our office and arrange for testing.

If you are an established patient, just ask at your next visit about testing your vitamin levels.  If you decide to take a supplement, we recommend high-quality, pharmaceutical grade supplements like the ones we carry in our office.


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14/Oct/2021

Everyone who comes into our office has asked this question at least once, “How much does Hormone Replacement Therapy cost?”.  Well, the answer here is that it can vary.

There are some variables in whether or not you have health insurance, what type of therapy you elect to use, and of course, your budget.  The following details apply for women seeking hormone replacement therapy, before or after menopause.

First, let’s look at using your health insurance.  In our Hormones by Design offices, we do not accept health insurance for the office visit but will gladly use your health insurance for lab work once you are established as a patient.  Therefore, the cost for the office visit is usually around $100.

Labs can be sent to your health insurance if you like, or you may pay for them yourself.  We have exceptionally low lab prices.  You can see all of them at https://hormonesbydesign.com/hbd-labwork-waco/.

Second, you must consider the type of therapy that you choose.  The overwhelming majority of our patients choose monthly injection therapy.  This is where the patient comes into our office for a lab draw about 3 days before their scheduled appointment, the labs are sent off, and results come back by appointment time.

These lab results are then used to craft a combination of hormones into an injection solely for that patient.  For patients that choose injection therapy, the cost per month is included in the office visit, so it is generally only the $100 per month.  No matter what therapy you choose, progesterone is almost universally needed for every patient.

This is given orally via a prescription.  The cost of a progesterone prescription varies according to each patient’s insurance.  Typically, the cost ranges from $20 per month and up.

Lastly, you need to consider your budget.  Here at Hormones by Design we will always take your budget into consideration.  We don’t ever want a patient to feel that regaining a more youthful quality of life is not attainable due to cost.

There are many ways with which to do hormone replacement.  We want to work with you to find the therapy and the price that is sustainable for you.  We strive for amazing care at affordable prices.


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10/Feb/2021

Thyroid hormone replacement therapy is used to treat which of the following conditions?

A lack of thyroid hormone can cause a whole list of uncomfortable symptoms including:

  • weight gain/loss
  • hair loss
  • acne
  • drop in energy in the morning or evening (or both)
  • body aches
  • depression
  • and much more

At Hormones by Design, our licensed providers not only specialize in bio-identical hormones, but they also specialize in the diagnosis and treatment of thyroid-related issues.

Thyroid hormone can be replaced in several different ways.  Patients can choose from custom-compounded formulas or commercially available prescriptions.  Either way, replacing thyroid hormone can help eliminate the list of symptoms above and get your energy back!

Call and schedule your new patient appointment with us today and let’s get started making you…a more optimal you.

 


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24/Jan/2021

One common question we get is, “What is Hormone Replacement Therapy?” (HRT) Our reply is simply that it is what the name says. Your doctor is using prescription drugs to replace your body’s hormones.

What is in hormone replacement therapy?

This is the truly important question.  HRT can be accomplished with a variety of prescriptions.  Most physicians use synthetic hormones like those found in Premarin.  Premarin is actually made of pregnant horse (mare) urine.  So, it is not the same as what the human body requires.  Our physicians use bio-identical hormones.  This ensures that the hormones are the same molecular structure as the hormones your body makes.

How is hormone replacement therapy accomplished?

In other words, the patient wants to know how this therapy is administered.  Well, that is the choice of the patient.  Most of our patients chose our unique monthly hormone injections.  These are customized to the patient based on current lab results and patient symptoms.  Patients report feeling better faster and enjoy being able to change their dose if needed at their next appointment.

What hormones are used in HRT?

In general, female patients can receive Estrogen, Progesterone, and Testosterone.  While male patients receive only Testosterone.

When do I need HRT?

HRT can start as early as necessary.  Symptoms can start in your 30’s and 40’s with what is called perimenopause.  This goes all the way up to your 50’s when menopause typically starts. Symptoms are generally the biggest indicator of your need for HRT.

Where can I get HRT?

A qualified doctor/healthcare provider must prescribe HRT.  Hormones by Design has a highly trained and qualified provider in each of its locations to serve your HRT needs.

Who needs HRT?

Both women and men can benefit from HRT.

Hormones by Design treats women and men with bio-identical hormone replacement.  We have locations in San Antonio, Boerne, and Waco, Texas.  Visit our website at www.hormonesbydesign.com.

 

 

 


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24/Jan/2021

You have finally reached menopause.  Your first thought is “Yeah!  No more periods!”, and then the symptoms of menopause hit.  You begin experiencing one or more of the following:

  • Hot flashes
  • Night sweats
  • Trouble sleeping
  • Anxiety
  • Lack of sex drive
  • Lack of energy
  • Vaginal dryness
  • Foggy thinking
  • Mood swings
  • Weight gain

These symptoms, along with lab work showing that your hormone levels are low, indicate that you are a candidate for starting Hormone Replacement Therapy.

Menopause does not have to be a miserable time in your life.  You could get back the vitality that you had in your 20s and 30s with Hormone Replacement Therapy.

At Hormones by Design, we recommend and utilize Bio-identical Hormone Replacement (BHRT).  BHRT uses hormones that are the exact same molecular structure as the hormones that your own body produced when you were younger.  Most of our patients opt for our unique monthly hormone injections.  This allows for a customized dose to address lab values and symptoms that the patient is experiencing.

Hormones by Design treats women experiencing the symptoms of menopause and even perimenopause (that comes before menopausal age).  We have locations in San Antonio, Boerne, and Waco, Texas.  Visit our website at www.hormonesbydesign.com.


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We have all heard of it and many of us suffer from it…PMS or Pre-Menstrual Syndrome.  Symptoms such as bloating, hunger, headaches, and moodiness can begin anywhere from 5 to 11 days before menstruation.  Most women (about 90%) get some sort of PMS symptoms each month and this is especially true for women in their 30s.

What are the symptoms of PMS?

Physical symptoms of PMS can include:

  • Swollen or tender breasts
  • Bloating or a gassy feeling
  • Cramping
  • Headache or backache
  • Constipation or diarrhea

Emotional symptoms of PMS can include:

  • Mood swings
  • Irritability
  • Increased appetite or food cravings
  • Feeling tired
  • Sleeping too much or too little
  • Trouble with concentration or memory
  • Tension or anxiety
  • Depression, feelings of sadness, or crying spells
  • Less interest in sex

How/why does PMS occur?

After ovulation, progesterone and estrogen increase to prepare the uterus for pregnancy.  If pregnancy does not occur, these levels begin to decline quickly.  It is the decrease in progesterone that triggers symptoms such as the increased craving for chocolate and the mood swings.

How do I test for PMS?

A qualified bio-identical hormone replacement center can do a simple blood draw to test your hormone levels (preferably on days 19-21 of your cycle).  This test and your symptoms will let your doctor know how to treat you.

How can I treat PMS?

Once your labs results have come back, your doctor may want to prescribe you supplemental progesterone for all or part of your monthly cycle.  This increase in progesterone can combat many of the physical and emotional symptoms of PMS.

What can I do at home to help control PMS?

  • Exercise—this helps your body deal with stress and releases endorphins that help create a positive mood.
  • Get enough sleep—sleep is critical to your body’s ability to deal with stress and succeed in repairing any cellular damage that occurs during the day.
  • Eat healthy—make good food choices (at least most of the time).  Meat, veggies, and fruits should makeup the bulk of your diet.

Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In San Antonio, call (210 305-5077. In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with our Family Nurse Practitioner, Nancy Beebe.


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Time flies the older we get.

It feels like one day we are chasing toddlers and the next we are nearing menopause. Two common symptoms that usher in this phase of life are hot flashes and night sweats.  For most women, establishing care with a qualified bio-identical hormone center makes these symptoms more manageable.

However, there are patients that cannot take bio-identical hormones (or simply do not want to).  What can those patients do? Here are some natural options for alleviating the frequency and severity of hot flashes and night sweats.

  1. Exercise Many scientific researchers have proven that exercise stimulates the release of feel-good hormones called endorphins. Brisk walking, jogging, and swimming are good aerobic activities that can help release tension in the body and mind.
  2. Relax and Mediate Practice deep abdominal breathing. Sit in a quiet spot to inhale and exhale slowly for just 15 minutes. Controlled breathing (characterized by slow and deep breaths) can calm and relax the body.  Waking up in the middle of the night because of night sweats?  Using this technique may help calm you.
  3. Keep a Diary – Keep track of the time of episodes, the stress level or emotional state when it occurs, food and drinks consumed prior to occurrence, clothing worn, sleeping conditions (if it’s a night sweat), activities done and other elements that might have triggered the episode.  This can help you avoid those triggers.
  4. Supplements – There are pharmaceutical grade supplements available that will help you through these symptoms.  For example, I recommend Xymogen’s Femquil.  This supplement helps your body deal with xenoestrogens (hormone disrupting compounds found in the environment) and promotes healthy hormone balance.  (More on Xymogen below).

You can try one or all these options.  They are all safe and do not involve the use of hormones.  Need more information on what you can do to help with your hormonal symptoms?  You can still see a qualified bio-identical hormone center.  On occasion, problems with your thyroid can cause symptoms like hot flashes or night sweats.  A simple blood test can help your doctor determine what you need (whether vitamin or prescription) and how much.

Interested in ordering the Femquil mentioned here?  Xymogen provides our pharmaceutical grade supplements we use in the office.  Simply go to Xymogen.com, Patients, Xymogen Xpress, and register.  Call or email our offices to get your Referral Code.  Physician Code is always: Miskell.

Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with Family Nurse Practitioner, Nancy Beebe.


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The health of your gastrointestinal tract (GI tract) affects your entire body.  One of the main supplements that I recommend to my patients is a good quality high-dose probiotic. Why you ask? Let me tell you…

Your gastrointestinal tract is a complex ecosystem containing thousands of species of bacteria. These bacteria can be found in your stomach and small intestines, but the majority are found in your colon.  Collectively these areas make up your “microbiome.” These intestinal flora aid in digestion, synthesize vitamins and nutrients, metabolize some medications, support the development and functioning of the gut, and enhance the immune system.

There are times when this balance of beneficial bacteria gets out of balance such as with the extended or recurrent use of antibiotics, poor dietary habits, or recent infection.  This is where the use of a probiotic becomes advantageous.  A good multi-strain probiotic can help to recolonize the GI tract to the proper balance of beneficial bacteria.  But how do you recognize a high-quality probiotic?

Here’s how:

  1. It is multi-strain.  This means that it has more than one type of bacteria in each capsule. The one I recommend the most contains Lactobacillus acidophilus, Lactobacillus plantarum, Bifidobacterium longum, & Bifidobacterium lactis.
  2. It is packaged so that oxygen cannot reach the capsules or is consistently refrigerated (even during transport) so that the organisms cannot get overheated and die.
  3. It is high dose.  For maximum results the GI tract needs maximum exposure.  For those patients that have GI issues or tend to have weakened immune systems, I recommend 100 Billion CFU (the measurement for bacteria is Colony Forming Units) daily.  Other patients that simply need to maintain GI health can take the 100 Billion CFU capsule every other day or just several times per week.

Some foods also promote healthy and abundant GI flora.  For example, sauerkraut and kimchi are fermented foods that contain probiotics.  Other foods provide the precursors to probiotics called “prebiotics”.  Those are foods like: asparagus, onions, garlic, cabbage, and artichokes.  These foods are mainly carbohydrates that cannot be digested by the body, but are food for the probiotic (or good) bacteria.  Following these guidelines will get you to a better place with your bowel movements (diarrhea or constipation), vaginal health, skin health, and even a healthier immune system.

Here’s to a healthy microbiome!

May you have continued good health,

Dr. Melissa Miskell


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Bone Health 101

I have quite a few patients that are concerned about their bone health, and the first question they normally ask is “how much calcium should I be taking?” The answer is that amounts vary according to the patient, and you should not be taking calcium alone.

The first question you should ask is what is bone made of? Bone is composed of several calcium-based minerals and collagen. This means that if you are going to take a supplement to support your bones, you need to take multiple supplements.

Here’s the basics of bone health:

1. Calcium is still a necessity. However, not all calcium supplements are created equal. My preference is for what is called MCHC (Microcrystalline Hydroxyapatite Concentrate). This is a standardized, and safe-source bone extract from New Zealand bovine, that contains a crystalline calcium and phosphorus matrix. It is also what your bones are made of.

2. Vitamin D3. Yes, you need Vitamin D3 (cholecalciferol) to support bone health as well. Vitamin D’s best-known role is to keep bones healthy by increasing the intestinal absorption of calcium.

3. Collagen. This is supported through a silicon based supplement (specifically orthosilicic acid). Collagen helps bone withstand sudden impact, and determines how “tough” your bones are.

4. Vitamin K2. Vitamin K2 (as menaquinone-7) supports calcium utilization and absorption. Some younger patients do not require added Vitamin K2 supplements.

How do you know the right combination of supplements for your bone health? Ask your doctor. The good news is that there are supplements available that contain all these ingredients in one packet, or you can purchase them separately. If you are a post-menopausal woman with osteopenia or osteoporosis, you are going to need considerably more of each of these supplements to ensure that you arrest your bone loss.

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Bone Health 101

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A brief introduction…

When most practitioners talk about “anti-inflammatory” they are generally referring to prescriptions that mask swelling such as NSAIDs like ibuprofen or naproxen.  When functional medicine practitioners talk about anti-inflammatory we are referring to the foods and supplements that prevent the cause of inflammation in the body.

Inflammation is the beginning of all disease states whether acute or chronic.  Obviously acute inflammation is necessary for the body to start repairing damage from some harm inflicted recently such as a sprained ankle or a cut finger.  Chronic inflammation is what you never want your body to experience.

First, how do I know if I have chronic inflammation? 

Chronic inflammation manifests itself in many different ways.  The most common are:

  • Joint swelling & tenderness
  • Muscle aches (not muscle soreness from exercise)
  • Abdominal pain & bloating
  • Chronic headaches
  • Constipation
  • Constant fatigue
  • Any autoimmune disorder

If you have one or more of these symptoms, you are experiencing chronic inflammation.

So I have chronic inflammation, what do I do now?

Step number one when working to combat chronic inflammation is to look at your diet.  I firmly believe that “you are what you eat.”  However, making healthy choices can be confusing.  The media and the internet are filled with conflicting information on “eat this food…but don’t eat this food…no, it’s ok to eat this food in moderation.”  So what’s a person to do?  I’m going to make this relatively simple.

A simple summary of what to eat:

  1. Eat organic, grass-fed/free-range meats or wild-caught seafood/fish
  2. Eat organic produce (this includes all fruits and veggies)

What not to eat:

Avoid as much of these as possible:

  • Grains of any type (yes, that means no bread)
  • Sugar in any form (use Stevia instead)
  • Artificial sweeteners (yes, pink ones, yellow ones & blue ones)
  • Caffeinated beverages (substitute herbal teas or better yet, just drink water)
  • Alcohol in excess
  • All dairy (yes, cheese too)
  • Eggs (food allergy testing can confirm if you must avoid these long-term)

If you have already progressed to an autoimmune disorder, then you need to be especially diligent in your eating habits and avoid everything on this list.

If you would like to get a firm answer on what exactly your food allergies & sensitivities are that are causing your chronic inflammation, see a practitioner that does testing.  In my office, we use Alletess Food Allergy/Sensitivity testing.  We welcome current patients to come in and request the test.

Focus on Curcumin

Once patients have begun to work on their diet to eliminate the foods that are perpetuating chronic inflammation, I look to one of my favorite supplements that can help reduce any remaining swelling & discomfort…Curcumin.

Curcumin is the active compound in Turmeric.  It is yellowish in color and has been a part of Indian and Asian diets for centuries.  Interestingly enough researchers began to notice that those countries had a much lower incidence of arthritis and other inflammatory diseases.  Additional research has found that Curcumin plays a role in decreasing inflammation and protecting the body from inflammation.

I never recommend starting any supplement without speaking with your physician first.  As with all medications your healthcare provider will make sure it will not interfere with any of your other medications.  I also recommend that you consult a physician on what dosage of curcumin would be best for you.


There are hundreds of clinics attempting to treat hormone imbalance. What makes us different? We listen, then we take action. Our business model makes it possible for us to start your treatment on day one. Faster treatment = feel better faster.
Hormone Replacement Therapy in San Antonio, Waco, and Boerne

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