Patient Advocates Here to Help You and Your Family Navigate the HealthCare System

University of Arizona College of Nursing

RN Patient Advocates is the only nationally recognized Patient Advocacy education program created specifically for qualified RNs endorsed by a leading College of Nursing: The University of Arizona.



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“In a year’s time after taking the RNPA Learning Intensive, my career, my health, my family, my very life has been transformed. I am forever grateful” — Karen DiMarco, RN, iRNPA

“The way of the future of absolute must if you want to make and be the difference in righting the wrongs of healthcare. Kare is a wonderful mentor who has put her soul into this program. Passion, Vision, Perseverance.” — Lana Benton, RN, iRNPA

“The forethought, experience, openness, philosophy and preparation provides all the tools, thought process, and confidence to begin and succeed as an iRNPA.” — Leta Gill, RN, iRNPA

“My experience attending the iRNPA program was a refreshing one, to say the least. This program was packed with life changing information that is not readily taught or available to RN's. This program equipped me with the tools I need to be an iRNPA!  If you are ready for a change after working for many years in the clinical setting, and are driven to help patients and families, this is the program for you!  Karen is a wealth of knowledge that is unmatched in the advocacy process.” — Jamie Long

“Thank you so much for putting together such an incredible RN PA intensive course!  It is truly intensive but so worth it!  I learned a lot and will be using the Medical Time Line and lab spreadsheet with as many clients as i can.  All great information and can’t wait to get my speaking engagements lined up now that I have your fantastic power points!” —  Nan Wetherhorn, Health Care Advisor,

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Always tired and wondering why? Need lots of caffeine to keep going? Lots of stress in your life? What’s going on here?


adrenal fatigueYou might be experiencing a condition known as Adrenal Fatigue or non-Addison’s hypoadrenia and it is diagnosable and treatable. 

The previous post explaining your Adrenal Gland and its importance mentioned a hormone it produces called cortisol.  

Cortisol (which is produced from cholesterol) gives us energy in the morning, helps to keep us going during exercise, daily work and stress.  It is the “fight or flight” hormone, or what gives us the “shivers” in near accidents in traffic. 

When you experience periods of stress – either physically or mentally induced – your adrenal glands respond by producing high levels of cortisol to help your body meet the challenge. However, when that stress – or the challenges – are prolonged, the adrenal glands become “fatigued” and cannot produce normal amounts of cortisol at the usual times of day.  

What does this look like? You may look and act relatively normal with adrenal fatigue and may not have any obvious signs of physical illness, yet you live with a general sense of unwellness, tiredness or "gray" feelings.

Common symptoms include:

• Cravings for sugar

• Cravings for salt on food when you eat

• Feel dehydrated and thirsty and require plenty of water

• Difficulty falling asleep at night, sleep lightly or wake early or often

• Difficulty relaxing, nervous, anxious or hyperactive

• Often spacey, or foggy thinking, even memory loss

• Low libido

• Weight gain, especially in abdomen and waist area

• Losing muscle tone

• High blood sugar

circadian rythmWhat to do?  First step is to get diagnosed.  Before you see your doctor, you might want to take this Adrenal Fatigue Questionnaire to see if this might be happening to you.  Clinically, this is diagnosed by a Salivary Cortisol Assay which measures your cortisol output at 4 times during the day (cortisol typically waxes and wanes during specific times of the day).  Blood tests for this show only extreme conditions and will not reflect this pervasive fatigue.  Some physicians do this test, others do not.

Work with a physician who is knowledgeable in treating this condition and who can direct you to the proper supplements – such as the B vitamins, Vitamin C, the proper form of calcium among others.  You can call your RN Patient Advocate to help find a physician to help with this.

Can you learn to rest and relax again?  Can you increase your exercise (this can raise cortisol levels)?  You might eat frequent small meals and avoid caffeine as much as possible.

Reduce your stressors in your life as much as possible.

Adrenal Fatigue is reversible.  It takes time but you can feel energy again.

Want to know more?



Smaller than a walnut, no heavier than a grape…affects every function in our bodies. What? Your Adrenal Glands! Unsung hero of our bodies.


adrenalsYour adrenal glands sit atop your kidneys and orchestrate your whole metabolism.  Little gland with a huge role.  These powerful little hormone producing glands manufacture and secrete almost 50 different hormones, including steroid hormones such as adrenaline, cortisol, aldosterone, and the precursors to estrogen and testosterone that are absolutely essential to our health and vitality.

Protective: the anti-inflammatory and anti-oxidant adrenal hormones like cortisol helps to minimize negative and allergic reactions, such as swelling and inflammation, to alcohol, drugs, foods, environmental allergens, and stress.



Let’s look more closely at one of those hormones: cortisol - a life sustaining adrenal hormone that influences, regulates or modulates:

  • Blood sugar levels
  • Fat, protein and carbohydrate metabolism
  • Immune responses
  • Anti-inflammatory actions
  • Blood pressure
  • Heart and blood vessel tone and contraction
  • Central nervous system activation

Too Much Cortisol for extended periods?

Higher and more prolonged levels of cortisol – with chronic stress for example – can have negative effects:

  • elevated levels of inflammation in your body (can lead to chronic illness)
  • foggy brain
  • decreased bone density
  • sleep disruption
  • hypertension
  • decreased immune function
  • slow wound healing
  • increased abdominal fat
  • a condition called “adrenal fatigue”

Want to learn more?

Homocysteine – what is it? Why do we need to know? Ask your heart.


homocysteine2Since 1990, the National Library of Medicine has posted thousands of scientific studies showing that homocysteine is a significant risk factor for disease.

What disease?  Higher levels of homocysteine raise the risk of premature cardiovascular disease affecting the heart, brain, and peripheral blood vessels.  Elevated homocysteine may speed the progression of atherosclerosis (hardening of the arteries) in the arteries in your heart and the rest of your body. 

Osteoporosis: Women with high homocysteine levels were found to have significantly lower bone mineral density in the hip than control subjects.

Alzheimer’s Disease: Rising levels of homocysteine may predict impending cognitive decline and Alzheimer’s disease.

Depression and elevated homocysteine appear to be related as well.

Elevated homocysteine levels have now been correlated with a wide array of illnesses, including the ones listed here as well as stroke, schizophrenia, macular degeneration, cervical cancer, and birth defects.

homocysteineSo what is it?  Homocysteine is an amino acid (protein) that your body makes from another amino acid called methionine – found in protein-dense foods that you eat on a regular basis, such as sunflower seeds, eggs, and fish.

Normally, homocysteine gets converted into two really helpful compounds: SAMe (S-adenosyl methionine- you may have read about the use of SAMe in treating depression) and glutathione, your body’s master antioxidant. 

Sounds good, right?  However, in order to convert the homocysteine to these helpful compounds, you need sufficient folate, B12, Vitamins B 2 and 6, zinc, trimethyglycine and magnesium.

What can we do? Step one: ask your doctor about checking your homocysteine level.   Step two:  if your homocysteine level is high, ask to have the levels of folate, B12, B2, B6, zinc, magnesium (as RBC magnesium) and trimethylglycine checked.  If they are low, it is both simple and inexpensive to replenish your body’s stores of these nutrients.

Want to learn more? 

RN Patient Advocates, PLLC

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Phone: 520-743-7008

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