Sermorelin is a synthetic peptide that stimulates the secretion of growth hormone (GH) from the pituitary gland. Growth hormone plays a crucial role in muscle growth and repair, as well as fat metabolism. By increasing GH levels, Sermorelin can potentially enhance muscle mass and strength. Additionally, GH can help with recovery and may contribute to a more youthful appearance.
While Sermorelin itself does not directly build muscle, its ability to stimulate GH release can lead to increased levels of insulin-like growth factor-1 (IGF-1), a hormone that promotes muscle hypertrophy and is involved in the regulation of muscle growth. However, it's important to note that the use of such substances for performance enhancement is often regulated and may be prohibited in competitive sports. Use of Semorelin is off label. It ?is not covered by insurance and ?provider will request you to sign an indemnification clause. Long term risks remain to be seen. 

Hormone Pellets are a form of hormone replacement therapy (HRT) that involves implanting small pellets under the skin to release hormones, typically estradiol or testosterone, into the bloodstream. General benefits and risks associated with HRT can be applied to this form of therapy. They are often inserted 3-4 times per year.

Benefits of Hormone Pellets

• Symptom Relief: Hormone pellets can alleviate symptoms of low testosterone.
• Convenience: Pellets provide a steady release of hormones over several months, eliminating the need for daily medication.
• Potential for Improved Bone Density: Similar to other forms of HRT, hormone pellets may help maintain bone density.

Risks of Hormone Pellets

• Increased Risk of Blood Clots: Hormone therapy can increase the risk of blood clots, which may lead to conditions like deep vein thrombosis or pulmonary embolism.
• Cardiovascular Risks: There is an increased risk of heart attacks and strokes associated with certain types of HRT.
• Breast Cancer Concerns: Combined estrogen and progestin therapy has been linked to an increased risk of breast cancer.
• Local Complications: Pellet insertion can lead to local reactions or infections at the site of implantation.

Hormone Pellets are a form of hormone replacement therapy (HRT) that involves implanting small pellets under the skin to release hormones, typically estradiol or testosterone, into the bloodstream. General benefits and risks associated with HRT can be applied to this form of therapy.
This is the cost per insertion. This is often four times a year. 

Benefits of Hormone Pellets

• Symptom Relief: Hormone pellets can alleviate symptoms of menopause or low testosterone, such as hot flashes, night sweats, and decreased libido.
• Convenience: Pellets provide a steady release of hormones over several months, eliminating the need for daily medication.
• Potential for Improved Bone Density: Similar to other forms of HRT, hormone pellets may help maintain bone density.

Risks of Hormone Pellets

• Increased Risk of Blood Clots: Hormone therapy can increase the risk of blood clots, which may lead to conditions like deep vein thrombosis or pulmonary embolism.
• Cardiovascular Risks: There is an increased risk of heart attacks and strokes associated with certain types of HRT.
• Breast Cancer Concerns: Combined estrogen and progestin therapy has been linked to an increased risk of breast cancer.
• Local Complications: Pellet insertion can lead to local reactions or infections at the site of implantation.

Up to 60 minutes with provider monthly plus the medication shipped to your home. 

Once dose is stablized, purchase 3 month supply in advance. Still have access to up to 60 minutes monthly with practitioner for coaching and diet adjustments as needed. 

Direct Primary Care (DPC) is a healthcare model that offers an alternative to traditional fee-for-service insurance billing. In DPC, patients pay their healthcare providers a flat monthly fee, which covers a broad range of primary care services. This model emphasizes a direct financial relationship between patients and their primary care providers, eliminating the need for insurance billing for routine services.
Key Features of Direct Primary Care:

1. Flat Monthly Fee: Patients pay a consistent monthly fee, which typically covers all or most primary care services, including office visits, consultations, and basic lab work.
2. No Insurance Billing: DPC practices do not bill insurance companies for services. This reduces administrative overhead and allows providers to focus more on patient care.
3. Enhanced Access: Patients often have better access to their providers, including same-day or next-day appointments, longer visits, and direct communication via phone or email.
4. Personalized Care: With fewer patients per provider, DPC allows for more personalized and comprehensive care, fostering stronger patient-provider relationships.
5. Transparent Pricing: Costs are clear and predictable, with no hidden fees or surprise bills.

Advantages Over Traditional Insurance-Based Models:

• Cost-Effectiveness: By eliminating insurance middlemen for primary care, DPC can reduce overall healthcare costs for patients, especially those who require frequent visits or have chronic conditions.
• Reduced Administrative Burden: Providers spend less time on paperwork and more time on patient care, improving job satisfaction and patient outcomes.
• Improved Patient Satisfaction: Patients often report higher satisfaction due to better access, more time with their providers, and a more personalized approach to care.
• Focus on Preventive Care: The model encourages preventive care and early intervention, which can lead to better long-term health outcomes.

While DPC offers many benefits, it may not be suitable for everyone. It typically does not cover specialist care, hospitalizations, or emergency services, so patients often need a high-deductible insurance plan for catastrophic events. However, for primary care needs, DPC can provide a more accessible, affordable, and patient-centered approach compared to traditional insurance models.

Knee, Elbow, Shoulder.
Injection with Lidocaine and methylprednisone. 
Limited to 4 injections/12 months. 
Not guaranteed to be helpful but many people do feel better after an injection. 

Risks and Benefits of Joint Injections
Joint injections, particularly those involving corticosteroids, are used to manage pain and inflammation in various musculoskeletal conditions. The benefits include:

• Pain relief: Corticosteroid injections effectively reduce inflammation and alleviate pain in joints affected by conditions like arthritis or bursitis.
• Improved mobility: By reducing inflammation, these injections can enhance joint mobility and function.

However, there are also risks associated with joint injections:

• Infection: Although rare, infection is a potential complication if proper sterile technique is not followed.
• Tendon rupture: This is more likely with injections around tendons like the Achilles tendon.
• Cartilage damage: Long-term use of corticosteroids may lead to cartilage degradation.
• Post-injection flare: A temporary increase in pain and inflammation can occur after injection.
• Skin and soft tissue effects: These include atrophy, depigmentation, and bruising.

Key Considerations

• Technique: Proper injection technique is crucial to minimize risk
• Patient selection: Injections should be avoided in certain conditions, such as active infections or severe osteoporosis.
• Monitoring: Patients should be monitored for potential side effects post-injection.

15-30 minute visit

Don't have time to get an honest opinion about your Osteopenia? How worried should you be? Here you can book a time for Elizabeth Duke, NP to review your bone density results, health history, your history of falls, diet and exercise. You will need to provide your bone density results and answer questions about your habits. Then within 72 hours you will obtain a tailored care plan based on the information you have provided. 

• Fracture risk assessment
• Nutrition evaluation and guidance
• Lifestyle modifications
• Education
• Fall risk assessment
• Safe exercise program tailored to your level of fitness.
• Prevent spinal deformity
• Prevent frailty

This is an asynchronous visit. In person appointments are also available via telehealth or at the office in Bangor.

Join Our Informative Class: "Bone Health Strategies"

Date: 5/26/25 and 5/27/25 at 6-730pm
Location: Online


 Instructor: Elizabeth Duke, NP

Are you confused about the conflicting information regarding Osteoporosis and Osteopenia? Calcium and Vitamin D? You're not alone! With so much debate and controversy, it's hard to know what to believe. Our comprehensive class will help you navigate through the noise and provide you with reliable, evidence-based information.

What We Will Cover:
DAY 1: 
BONE HEALTH 101

PREVENTION MEASURES

DAY 2:
 CALCIUM, PROTEIN, AND BONE HEALTH MEDICATIONS AND EXERCISES

GADGETS

• Interactive Q&A Session:

Get your questions answered by an experienced Family Nurse Practitioner. 

Why Attend?

• Gain clarity on the latest research and guidelines 
• Learn how to make informed decisions about your health 
• Empower yourself with knowledge from a trusted healthcare professional 

Registration Information:
Cost: $ 100 for both days.

 Don't miss this opportunity to enhance your understanding of Bone Health.  Secure your spot today and take a step towards better health!

For more information, contact Elizabeth Duke, NP at 207-326-2995.

For established patients, this is a lengthier visit for when things are not going well. Taking about 30 minutes, there has been a change of plan and may require work behind the scenes with insurance companies in addition to the time spent with you exploring risks associated with alternative plans. Visit still includes interpretation of bone density if it has been done in since the last visit. Interpretation of applicable labs. Review of medications and risks. 

For established patients, this is a brief visit for when things are going well. Taking about 15 minutes it is an annual or biannually followup for medication refills. Includes interpretation of bone density if it has been done in since the last visit. Interpretation of applicable labs. Review of medications and risks. 

Initial visit regarding bone health. Includes imaging review, health history. Existing patient not seen more than 3 years. 

Here you can book a time for Elizabeth Duke, NP to review your bone density results, health history, your history of falls, diet and exercise. You will need to provide your bone density results and answer questions about your habits.

• Fracture risk assessment
• Nutrition evaluation and guidance
• Lifestyle modifications
• Education
• Fall risk assessment
• Safe exercise program tailored to your level of fitness.
• Prevent spinal deformity
• Prevent frailty

Telehealth OR In person appointments are available.

Women are complicated. Moon phases, etc. Premenopausal evaluations take a long time. This is a 1.5 hour slot to really get to the nitty gritty.

Hormonal imbalances can disrupt every aspect of your life, from mood to energy levels to overall health. Now is the time to say goodbye to: 

• Low Libido
• Hot Flashes
• Night Sweats
• Weight Gain
• Irritability
• Sleep disturbances
• vaginal dryness
• mood swings
• irregular periods
• joint pain
• loss of hair
• dry skin
• brain fog
• and more...

This is your chance to regain control over your health and well-being. Together, we can create a treatment plan that helps you feel like yourself again. Start your journey to balance and vitality today. 

Sometimes hormones are NOT the best option for your symptoms. That is OK. I am willing to explore other options as well.

You should have labs prior to this appointment. If you have already had these labs please email these to me via the portal or fax/mail to the office. 

We do offer Dutch Testing, saliva testing, in addition to traditional labs.

Don't have insurance? I can pass along my lab savings to you using my Access lab account. 

Skin lesion removed and sent to pathology. Includes anesthetic injection and dressing post removal. Provider will coordinate referral for larger resection if malignant. 

If it is black or gray, dont spray. It could be melanoma.

Initial Consult with dermoscopy is $150. This is the additional fee for removal of skin lesion and sent to pathology.

Initial visit with goals of care planned, collection of past history, examination if needed.  Review of membership options available to men including HRT, peptides, weight loss, erectile dysfunction, fertility and hair loss treatment options. Plan of care development. If planning TrT note this is a controlled substance and may require an annual in person face to face visit. Can provide good faith estimate of a monthly membership inclusive of labs and medications. 

Includes medication delivered to your home, Excludes labs. 
Due to cost of medication as med is more concentrated, the price is higher. 
Membership provides access to practitioner between visits for common health problems such as evaluation of a URI. 

After initial membership cost includes semaglutide, syringes, alcohol swabs delivered to your home. Excludes labs. 
Membership allows access to provider for common health problems between visits, for example treatment of a URI. This is $275 per month until you reach maintenance. 

Includes medication delivered to your home, Excludes labs. 
Maintenance is after ?you have reached goal weight. 
Membership provides access to practitioner between visits for common health problems such as evaluation of a URI. 

Includes medication delivered to your home, Excludes labs. 
Membership provides access to practitioner between visits for common health problems such as evaluation of a URI. 

Includes syringes, alcohol swabs, medication shipped to your home. Excludes labs. 
Monthly Fee after initial consultation.
Provides access to provider between visits for common health issues; for example treatment of a sinus infection, or antiviral for cold sores. 

Initial evaluation includes past history, development of plan of care. Month 1 medication depending on current costs. Good faith estimate provided would include attentive care plan until you are on your way to a healthier eating pattern and exercise program.

This is the first consultation. Labs have been done prior and are reviewed, collection and confirmation of past medical history is documented. Plan of care is developed. Often appointment lasts 90 minutes.

Skin Cancer is a real issue in the state of Maine. Melanoma is on the rise; Maine has the 12th highest incidence in the country. Dermoscopy can help with earlier detection of melanoma as well as other types of skin cancer including squamous cell carcinoma and basal cell carcinoma.

• Asymmetry: One half of the mole looks different from the other half.
• Border: The edges of the mole are uneven, irregular, or poorly defined.
• Color: The color of the mole is not uniform and may include shades of brown, black, tan, red, white, or blue.
• Diameter: The mole is larger than 6 mm (1/4 inch) or about the size of a pencil eraser.
• Evolving: The mole or spot is changing in size, shape, color, or thickness over time.

When in doubt, check it out. 
If you have a skin lesion worrisome for melanoma, provider can remove it and send for pathology and expedite referral to dermatology.

Schedule a time to speak to provider to ensure this is the best fit for you. 

Phone, in person or telehealth f/u doing well with medication refill. ?

Cryotherapy is used to remove several types of skin lesions, including:

• Warts: Common, plantar, and anogenital warts can be effectively treated with cryotherapy.
• Seborrheic keratoses: These benign growths are commonly treated with cryosurgery, especially when multiple lesions are present.
• Actinic keratoses: These precancerous lesions can be destroyed using cryotherapy.
• Solar lentigines: Also known as sun spots, these can be treated with cryosurgery.
• Molluscum contagiosum: A viral infection causing small bumps on the skin, which can be treated with cryotherapy.
• Skin tags: Benign growths that can be removed using cryosurgery.

Cryotherapy involves freezing the lesion with liquid nitrogen, causing the affected tissue to die and eventually fall off.

This is for up to 14 lesions. If there are more you may have additional fees. 

If your skin lesion is black or gray, don't spray. This needs to be removed shave method. If positive for melanoma you will need larger resection. 

Price includes medication, supplies and access to Duke for up to 60 minutes monthly for other health needs. By paying in advance you do get a discount off monthly cost. 

Access to Duke up to 60 minutes monthly includes med shipped to your home. Prepay 3 months saves.