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YOUR GUIDE TO A KETO DIET

Over the last few years, you may have heard about an emerging trend in the health and lifestyle realm called the “Keto Diet”. Products are popping up in stores and social media influencers and talking about their experiences with this diet. “Keto” diet is short for ketogenic diet, which is a state where your body goes into ketosis. Ketosis is the process where your body uses fat as fuel instead of carbohydrates. The Keto diet has been used for decades for weight loss, insulin resistance, and is now even recognized as an effective treatment for certain types of seizure disorder. Scientists are now exploring the application of this diet in Alzheimer’s, cancer, and autoimmune disorders as well. As with any diet or exercise program, you should consult a healthcare provider before starting. Ketosis is the process in which your body uses fat as fuel instead of carbohydrates. A ketogenic diet drastically lessens the amount of carbohydrates (or sugars) taken in, so that the body is forced to burn up existing fat (resulting in weight loss). During this process ketones are released in the blood by the liver, which supplies energy to your body and brain. A Ketogenic diet is a low carbohydrate and high fat diet. The amount of protein taken in is usually a moderate amount. It is important that the meat and fat you consume are from high quality sources and that you avoid processed foods since this is your body's main source of fuel. In other words, skip the slim-jim and opt for a grass-fed steak or some almonds. Think about it in terms of putting gas into a luxury sports car. Would you put regular unleaded into a Ferrari? Of course not, you would use premium gas. Treat your body like a Ferrari! This is a tricky question, but to understand how to plan your ketogenic diet, you must first understand macronutrients. Keeping track of your macronutrient intake goes beyond calorie counting and will start you on your road to Keto. The 3 macronutrients are fat, protein, and carbohydrates. Each food has some specified amount of each of these macronutrients each often measured in grams. For example: a serving of almonds (about 24) has 162 calories, 14.2 grams of fat, 6.1 grams of carbohydrates, and 6g of protein. This makes almonds a perfect keto snack because of its ratio of fat to carbs. While pursuing my Masters degree, my husband renovated my 2 family house ourselves. Our kitchen renovation took the longest, which caused us to eat out often. After about 6 months of grad school, coupled with frequent fast-food trips I was 25 lbs. overweight, and I felt physically sluggish, and had a brain fog constantly. When our kitchen was finally done being renovated, we decided it was time for a change. I did the research and consulted with my primary care provider. We decided together that the Keto diet would be a great fit for me. All my immediate family has type 2 diabetes, and nearly everyone in my extended family has type 2 diabetes as well. I was a bit scared. I ended up doing a strict keto diet for 1 year, for 6 days a week. (Cheat days were my favorite). I lost over 35 pounds, regained my energy, and never felt better. The mental clarity from not consuming carbs was unreal! Even my lab work saw improvements; I noticed my LDL (bad cholesterol) go down and my HDL (good cholesterol) go up! Since then, I have done keto intermittently for periods of a few weeks at a time. I think of it as a reset when I need to clean up my diet. Even though I am not strictly keto anymore, the diet has had long lasting impacts on my health, it made me reevaluate my food choices and the origins of my meat and produce. First, talk with your primary care physician to see if a ketogenic diet is right for you. Some patients with gastroesophageal reflux disease, or patients who have had their gallbladder removed may have a tough time with this diet. Your provider should evaluate your lab work prior to starting keto. Then, start with a food diary for one week before starting keto. Logging your daily intake can help you re-evaluate your diet. I use My fitness pal app to log my daily intake. Then, you will want to find the macro ratio that works for you. My ideal macro ratio for intake per day was 90g fat, 20g carbohydrates, and 70g protein (this was for strict keto). I used ruled.me/keto-calculator/ to find the macros that worked for me based on my age, weight, activity level, and weight loss goals. Your ideal ratio will be tailored to you so be sure to consult a nutritionist or use a calculator. The My fitness pal app was an invaluable tool to tracking my macros and keeping myself in ketosis! There are great resources online, and cookbooks with great recipes. The Keto Diet: The Complete Guide to a High-Fat Diet, with More Than 125 Delectable Recipes and 5 Meal Plans to Shed Weight, Heal Your Body, and Regain Confidence by Leanne Vogel is a great resource to me. Some insurance plans will cover nutritionist visits to get you started. Remember to listen to your body. Good luck on your journey to keto should you decide to embark!     Amanda Y. Buzynski, FNP, APRN-RX, MSN, SAFE
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CORONAVIRUS: MEN VS. WOMEN

As we learn more and more about the novel coronavirus, COVID-19, we encounter new information on what seems like a daily basis. As with any new virus or epidemic, we are overloaded with articles, studies, conspiracy theories, and blog posts at every corner of the internet, and real life. One aspect that doesn’t seem to be discussed as often, is the possible difference between men and women, and how COVID-19 may effect each sex differently, or if it does. With many viruses and illnesses, there is usually slight (sometimes major) differences of symptoms where men and women are concerned. Not to mention, long term side effects. The longest term side effect of course, being death. Something we have learned, through various studies and research data, is that more men are documented as dying from COVID-19, when compared to women. In a large sample study in China, 70 percent of infected patients who passed away due to coronavirus were men. And again, in another study, conducted by the World Health Organization (WHO) showed that 63 percent of COVID-19 related deaths were men. New York City also came out with some statistics showing that men were dying at twice the rate of women, according to the city’s health department. Interestingly, men and women are contracting the virus at the same rates, but again, the contrast in coronavirus deaths are notable. Now, when discussing dissimilarities between the sexes, there are obviously biological differences to account for, but societal and behavioral disparities should not be ignored. Some experts account for the difference in coronavirus related fatality rates to be due to the hypothesis that men tend to engage in riskier behavior when compared to their female counterparts. For example, claims that men are more likely to ignore social distancing guidelines, like wearing a mask, hand washing or the famous six foot rule. Another claim is that men are less likely to take symptoms of coronavirus seriously. Interestingly enough, similar findings occurred during the modern world’s last viral outbreak, SARS, back in 2003. Although SARS did not change the global landscape in the same sense that COVID-19 has, statistics again show that more men died from the virus when compared to women. Another theory for why men are more affected by coronavirus, is that COVID-19 has a high fatality rate among the elderly population, and since elderly men are more likely than elderly women to be afflicted by heart disease, then that could very well account for the difference in deaths. As well as coronary heart disease, other health factors that affect elderly men more than elderly women include diabetes, hypertension, nicotine dependence, obstructive pulmonary disease, and heart failure. Not to ignore that men, in general, have shorter life spans than women. One factor that is thought to account for this disparity, not just in the case of coronavirus, but other viruses in general is the biological differences in both innate and adaptive immune responses. According to the CDC, the Centers for Disease Control and Prevention, “women generally mount stronger innate and adaptive immune responses than men,” because the X chromosome carries a higher “density of immune-related genes.” Due to the differences in the mortality rate between men and women infected with COVID-19, there are now two new clinical studies that have launched in the United States, with others taking place globally. In Los Angeles, at the Cedars-Sinai Medical Center, doctors have been attempting to treat men with female sex hormones and observe their body’s response, and of course if these hormones assist in the struggle against coronavirus. Physicians in this particular study are dosing the male patients with progesterone. The female sex hormone, progesterone is said to have anti-inflammatory properties and will hopefully be able to prevent damaging overreactions of infected patients’ immune systems. A lead physician at the hospital even commented that they noticed a vast difference in men and women at Cedars-Sinai, stating 75 percent of patients on ventilators at their location are men. This same physician noted that pregnant women seem to have an easier time when diagnosed with coronavirus, despite being immunocompromised. It’s believed this is because pregnant women have an abundance of estrogen and progesterone. This is what spurred the start of the study. A second clinical study that emerged and has been taking place at the Renaissance School of Medicine at Stony Brook University located in Long Island. It is very similar to the first study, and was created out of similar observations regarding pregnant patients. The main difference is they will be treating male patients with estrogen, rather than progesterone. While we wait for the results of some of these studies, let us all remind ourselves to engage in safe behavior. Don’t forget to wash your hands, and don’t forget your hand sanitizer at home. Remember if you are experiencing symptoms to self isolate, and let us all come together to do our part in lessening the spread of this virus. Even if “come together” might mean coming together on a ZOOM call.

Our Care Providers

Angel Borges
Angel Borges
Medical Assistant
No Overview Provided

Michael Quay
Michael Quay
Mental Health Counselor
My name is Michael Quay. I graduated from Georgia State University with a M.S. in Rehabilitation Counseling in 1991. Initially, I worked with private sector workers’ compensation cases (primarily back injuries) then I was able to progress to serving as the Crisis Intervention Coordinator for a Public Mental Health Center. Here I coordinated the center’s emergency services which included consults to local jails & hospitals to evaluate primarily depression and suicide. In addition, I carried a caseload of 35-40 adults with a variety of mental health diagnoses. Over the years I developed an ability to work with borderline personality disorders due to their high frequency of using the center’s emergency line. After five years I moved on to serve as the clinical coordinator for a hospital based geriatric psychiatric day treatment program. Most of the clients were 65-90 and suffered depression and anxiety. The next two years I had the privilege of serving as the Children’s Pastor (Birth to 5th Grade) for a church with a Sunday attendance of about 1500. Over the next year I was ministering in Angeles City, Philippines as a missionary working with local church children’s workers. Finally, from 2003-2012 I had the honor to work as a School Based Behavioral Specialist (SBBH now SBS) working for the Hawaii Department of Education at three High/Intermediate Schools in East Hawaii. Most of my clients were Special Education, Oppositional-Defiant with A.D.D. My caseload was almost exclusively male & these were my favorite clients of all. I was a Certified Rehabilitation Counselor (C.R.C.) from 1991 to 2001. Also I was a Nationally Certified Counselor (N.C.C.) from 1996 to 2004. Those same years (1996-2004); I was a Licensed Professional Counselor (L.P.C.) in the State of Alabama. Recently, I became a Licensed Mental Health Counselor (L.M.H.C.) in the State of Hawaii. Among my interests professionally are depression, anxiety, A.D.D./Defiant Teens (especially males), families who have end of life issues with parents, marital counseling, & life care planning (not estate planning BUT working out your life plan). I am more of a person-centered therapist who believes YOU are the expert on your life. I do cognitive-behavioral mostly with teens & children. In addition to my years as a mental health professional, I am a U.S. Army Captain, Retired; who had the honor to go to Airborne School.

Marisa Takiguchi
Marisa Takiguchi
Nurse Practitioner
Marisa was born and raised here in Honolulu, HI. She is a board-certified Family Nurse Practitioner. She attended the University of Hawaii at Manoa and obtained both her Bachelor's of Science in Nursing degree and her Doctorate of Nursing Practice degree. In her spare time, she enjoys spending time with family, friends and her maltese.

Paige Turner
Paige Turner
UH
"A Building With Four Walls And Tomorrow Inside"

Pamela Finch
Pamela Finch
Medical Assistant
"Make life beautiful" -- Shea McGee

Mark Causin
Mark Causin
Physician
If the path be beautiful, let us not ask where it leads

Chris Apostolides
Chris Apostolides
Physician Assistant
Your body is your most priceless possession...so go take care of it! Physician Assistant practicing Emergency Medicine for over 15 years. Masters of Science from Towson University, 2005. Certified by National Commission on Certification of Physician assistants since 2005.

Christina Robbins
Christina Robbins
Physician Assistant
Butterflies can't see their wings.

Isaiah Mallari
Isaiah Mallari
Nurse Practitioner
As a board certified Family Nurse Practitioner, Isaiah is both diligent in his practice and his passion of giving back to others. Isaiah received his Master of Science in Nursing from Hawaii Pacific University. Prior to joining NIU health as a provider, he worked in a number of critical care settings for the past 7 years and became a Certified Critical Care Registered Nurse. Having witnessed his father pass away at such a young age in the intensive care unit, it drove him to serving to this capacity. In his free time, he enjoys surfing, CrossFit, yoga, and trying out new restaurants.

Paul Coelho
Paul Coelho
Chief Nurse Executive
Dr. Paul Coelho was born and raised on the Island of Oahu. He received his Masters of Science in Nursing from the University of Hawaii at Manoa, and later obtained his Doctors of Nursing Practice from Hawaii Pacific University. He is board-certified as a Clinical Nurse Specialist by the American Nurses Credentialing Center. Paul is licensed as an Advanced Practice Registered Nurse with prescriptive authority in Hawaii. His medical specialties of interest and expertise include cardiology, HIV/AIDS care management & prevention, urgent care, and nurse management & leadership. Paul believes that NIU Health will provide him a platform to continue his passion for nursing practice and his dedication to improving the health and well being of the people of Hawaii. Paul considers a work-play balance important to maintain optimal physical and mental health, therefore, he enjoys hiking, running, surfing, playing tennis, and yoga.

Danine Dela Cruz
Danine Dela Cruz
Medical Assistant
Beauty begins the moment you decide to be yourself

Maricel Mercado
Maricel Mercado
Medical Assistant
Be your own kind of beautiful

Dr Tony Trpkovski
Dr Tony Trpkovski
CEO and Founder of NIU Health
Co-founder / CEO Doctors of Waikiki Board Certified Internal Medicine Best of USA-Best Physician 2016 Best of Kauai –Best Physician 2010-2011 Wright State University June 1994 to June 1997 Internship and Chief resident in Internal Medicine Miami Valley Hospital, Dayton Ohio “Sts Cyril and Methodius” Medical School Hospital Feb 1993 to Feb 1994 Internship General Medicine, Skopje, North Macedonia University of Sts Cyril and Methodius, School of Medicine Graduated Jan 1993 Skopje, North Macedonia Republic of North Macedonia: full scholarship faculty of medicine 1984-1993 “Always laugh when you can, it is cheap medicine.”

Alexis Barroga
Alexis Barroga
Nurse Practitioner
Alexis has always had a passion to help people and that’s why she pursued a career in Nursing. After earning her Bachelor of Science in Nursing at the University of South Alabama, she worked in a Surgical Trauma Intensive Care Unit in a Level 1 Trauma Center. It was a great learning experience but she was eager to learn more about patient care outside of the hospital setting. She became a Certified Family Nurse Practitioner because she wanted the opportunity to build rapport and play an active role in the overall health of her patients, ensuring they receive the right treatment and care to live long healthy lives. Alexis is beyond excited to join NIU Health and provide quality and cost-effective health care to her Hawaii Ohana. Her in-laws (grandma, parents, sisters, aunties, uncles, nephews, nieces, cousins) all live on island so she understands firsthand how difficult and expensive health care is. She believe’s this is something that has been missing from the healthcare system and she feel’s so blessed to be able to be a part of it.

Kasey Kam
Kasey Kam
Nurse Practitioner
Kasey is an Adult-Gerontology Primary Care Nurse Practitioner who first found his passion for healthcare while caregiving for his late father and grandparents. He went on to work at Straub Medical Center and a national nursing agency where he enjoyed working with the young and elderly alike. He is excited to be part of the NIU Health team because of the unique ways he’ll get to engage patients. He received his Doctor of Nursing Practice from the University of Hawaii at Manoa. In his downtime, he enjoys cooking Japanese, Italian, and local-style foods. Tomato gardening is his new favorite hobby.

Jamie Noguchi
Jamie Noguchi
Nurse Practitioner
Jamie has called O'ahu her home since the beginning, born and raised here on the island. She attended University of Hawai'i at Manoa for both her undergraduate and graduate degrees, completing UH Manoa's accelerated nursing program to become an Adult-Geriatric Nurse Practitioner. Due to being very close with her grandparents and witnessing their later years of life, her career experience has been focused largely in neurology and primary care, with a special interest in the ever-developing field of dementia and cognitive impairment. She especially enjoys building lifelong relationships with her patients, and seeing families grow over the years with thriving health. She is very excited to join NIU HEALTH because of its fresh take on providing quality, consistent healthcare to everyone. Its philosophy looks toward the future, is fair and affordable, and presents a solution that works for all types of socioeconomic situations. And now more than ever, that is exactly what the world needs.

Amanda Buzynski
Amanda Buzynski
Nurse Practitioner
Amanda Y. Buzynski, FNP-BC, APRN-RX, SAFE is a Queens, NY Native. She is a Family Nurse Practitioner and a Forensic Examiner. In 2019, Amanda received her Master of Science as a Family Nurse Practitioner from D’Youville College in Buffalo, NY. She has gained seven years of experience at the Erie County Medical Center emergency department; a level 1 Trauma Center. Currently, she works on the island of Oahu, in the emergency department at Queens Medical Center. Amanda has spent the last few years as a “Stop the Bleed” instructor and has taught the life-saving educational program at schools, community events, and even brought the training to rural Sierra Leone during a medical mission trip. Her hobbies include travelling, learning about new cultures, and learning how to cook the cuisine from the countries she visits. She has a special interest in nutrition as an adjunct therapy for many chronic diseases. Amanda believes that access to healthcare is a human right, and that NIU health is a revolutionary way to expand access to healthcare to the people of Hawaii. She is very excited to be a part of the next phase of healthcare with NIU Health.