Sam Neville | Being Stress Resistant

You may have an unmitigated, relentless ambition that keeps you going, but sometimes, that internal drive pushes you to slow down, get fatigued, experience brain fog, or experience low self-worth. When your battery loses your energy, how can you move forward? In this episode, Samantha Neville, a Family Nurse Practitioner, delves into being stress-resistant and what you can do to stay resilient despite the stressful environment. She explains the relationship between hormones, gut health, and mental and physical health. If you enjoy this episode, spread the word because people need this help. If you like our podcast, hit like and share now because it helps us reach more people. Get ready to learn with Samantha!

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Sam Neville | Being Stress Resistant

I’ve always been a person motivated by an internal drive, an unmitigated, relentless ambition that keeps me up at night. I’ve run into a problem with that drive. It’s slowed. Fatigue crept in, brain fog, and even low feelings of self-worth. Do I even deserve the things that I get? Am I losing my edge? It’s scary because that drive keeps me providing for my family and creating opportunities for others. It’s what I do. I want more. I just can’t seem to get to it. What happened to that little spark? Does it sound familiar?

In my research to discover some helpful pathways, I ran into other colleagues, investors, entrepreneurs, and real estate agents who were experiencing the same thing. The cure came down to a physiological thing that I could not avoid, time, age, gravity, and the impact of my ambition on my body. The doctors told me that I had low hormones and I needed therapy. What a good word because sometimes we don’t need a cure. We just need therapy so that we can keep on keeping on.

It’s been life changing so I wanted to bring my care provider to the show to share some wisdom and education with you. There’s no one better than Samantha Neville, a nurse practitioner in the Springfield, Missouri area. She’s worked in surgical, orthopedics, cardiac, and ICU, has extensive experience in GI endocrinology, and finds passion in helping patients with hormone, thyroid, weight loss, and anti-aging.

You’ll find our conversation to be most beneficial. It’s educational, entertaining, and sometimes shocking. This episode is clean, meaning it has a G rating but we put an explicit rating on the episode because it can get quite clinical at times. In case you are a mom or a dad driving around little ears, I didn’t want you to have uncomfortable conversations with your kids before you were ready. If you enjoy this episode, please spread the word because people need this help. If you like our show, please hit like and share because it does help us reach more people. Get ready to learn with Samantha Neville.

Sam, thank you for being here. This is super exciting for me because this episode is a little different than what we normally do. This is a real estate show. It serves a lot of entrepreneurs and real estate agents who I know from being one for the past several years that we do a lot of unhealthy things. Doctors do unhealthy things. You described some unhealthy things that you did.

Whenever somebody gets introduced to the real estate business, sometime in that first year, it usually comes out like, “That’s why we drink.” It’s an extremely stressful position. You’ve got the top three things that people don’t like to do or are the most afraid of. One of them is public speaking. The second one is dying. The third one is buying a house. Those three things are the most stressful, fearful type of things.

We find ourselves in a situation where we’re operating with high cortisol levels constantly all the time. We’re trying to serve people and mitigate disasters a lot of time, which is why side note, Zillow will never replace the real estate agent. I don’t know how technology could replace all the conversations that I have on a daily basis. Thank you for what you do.

We’ve met because my family got a membership at the place where you practice. It’s Command Family Medicine. It’s how we’ve known Dr. Luke since he got started. He started Command Family Medicine and then we got to meet you through that company. Sometimes when you have a relationship with a doctor and then they bring on some new doctor, it’s the same with a real estate agent. People get used to you and they have a hard time working with the person that you’ve handed them off to or referred them to.

I never experienced that with you. You are so knowledgeable and caring. You also educate while you’re doing it. A lot of people may not want to do that in the medical field. There might be people who say, “I don’t care what you’re doing here. Get it done so I can get out of here.” In real estate, I’ve always done that. I’ve always recognized the power of other professionals who educate while they practice. Thank you for doing that.

I also wanted to say thank you for a life-changing gift in hormone therapy that I’m going to be very open and talk about on this show because I’ve seen such an incredible benefit from it. I’ve always said that I’m going to be one of those guys that grows old gracefully. Some people are going to fight it, kicking and screaming. I’ve changed my mind. I want to fight aging kicking and screaming. I feel so much better when I’ve got testosterone coursing through my body. Thank you.

I’m glad you’re feeling better.

How long have you been in the medical field? What made you decide to go that route?

I’ve been in the medical field for many years. I started in ‘03. As soon as I graduated high school, I knew I wanted to go into healthcare. I knew it because 3 or 4 of my aunts were nurses so I was around it a lot. A lot of people were like, “Why’d you start?” It’s because my aunts were nurses and then my grandpa and grandma got cancer. We took care of them in their house with hospice. Seeing that caring behavior is why I went into healthcare in general.

Were you a teenager at that time?

I was. That was very influential. My personality in general is a caring nature person. That’s how I was raised. It was a good fit for going to healthcare. I started as a nurse. For ten years, I was doing nursing. I knew that I wanted to do something more after ten years. I felt like I had a calling to do something more in general.

What was it? Was it maybe a feeling that you were not learning what you wanted to learn or you needed to be stimulated by a different part of the field?

It’s all of the above. It’s stimulation, wanting more knowledge in general. I’m always educating myself. Also, knowing that our healthcare system is broken and seeing that. As a nurse, it frustrated me. I thought, “I can’t do anything to that extent as a nurse. I can work in the healthcare field but I can’t change it much.” That’s why I went and got my Nurse Practitioner degree. That has allowed me to do a lot more work independently with Dr. Luke at Command. I’ve been a nurse practitioner for eleven years.

I started my first career at the major hospitals here in this area. I knew that at that point, it wasn’t working for me because insurance dictates what we are allowed to do and not allowed to do. A lot of patients come to you and they’re like, “I don’t feel right but insurance doesn’t allow us to run specific labs or testing. If you don’t have a specific diagnosis for this, you can’t run those tests.” A lot of patients are like, “There is something wrong with me but our normal labs don’t pick it up.” At that point, I was like, “I got to do something different.” Command is a direct primary care clinic so we can run labs whatever we want.

Let’s talk about that for the people who may not know what that is. It’s revolutionary. I have a good friend who is a state legislator and an orthopedic surgeon. During his time as a Missouri legislator, he advocated strongly for direct primary care as a way to help families. It’s this relatively new system that allows people to pay a membership fee to have a doctor. Things like prescriptions, limited medicines, and things like that can be paid for above and beyond your monthly subscription. It almost is reminiscent of the 1-800-Doctors who do house calls. You don’t do house calls.

We do sometimes.

It’s when it makes sense or when the person can’t get there. It seems to be a lot more community-based. I found it refreshing that we could book a call and it’s all part of the monthly membership. That’s what direct primary care is.

You pay a monthly membership and with that membership, you have about 24/7 access to me. I do sleep so 24/7 is in reality whenever I’m awake. If a patient has something going on after 5:00 PM, they’ve done something to themselves, and they don’t know if they should go to urgent care, can they come in and we suture them up, I’ve come in and sutured people up after hours several times. Command has been helpful to have that access to knowing that there’s a different way to practice medicine, not just as a nurse practitioner but as Dr. Luke created it.

His cousin created the EMR system or the Electronic Medical Record that we use. His family is entrepreneurial in general. Having him as my collaborator, he has been very helpful to me, allowing me to do what I love, which is hormones, functional medicine, and weight loss. Those things are very passionate to me. At Command, everything goes back to hormones or the endocrine system. Not everything but if you take care of those things, it does help blood pressure, cholesterol, and headaches. All of those things go back.

Also, weight loss, depression, and mental health issues.

You can go back to your endocrine system or hormones, and those things are all affected based on your stress and what you eat. How we function in life, stress does affect all things. If we know why or how it’s happening, it helps us better manage life in general.

Even sleep. I was reading that if a man has a certain percentage of less sleep than what he needs to have, his testosterone levels could be over twenty years, a senior man. That’s what I got in my life with the stressful real estate career and maybe not taking care of my body. I always tried to go to the gym as often as I could. Dr. Luke had identified low testosterone in me years ago. I was like, “I don’t want to go through this treatment.”

I resist anything that doesn’t belong in my body. I try to hit it with natural means. I tried for a long time with diet and exercise. I was able to get it to boost up some but I couldn’t get it past that. I started having some mental health issues. When you research, it’s like, “It could be low testosterone.” One of the agents in our office went into a local clinic and they got some information and blood testing. They invited us to come and be part of a presentation for a very specific type of testosterone pelleting.

I knew that you up at Command did that service. It made sense. Rather than start a new relationship, I was like, “Let’s go talk to you guys about this.” What convinced me to go ahead and say yes to the treatment was the presentation. I can handle my mental health issues. I have my entire life and I’ve mastered them for the most part to the point where I can function and succeed wildly. I’m so good at helping other people pass them because I’ve mastered it on my own.

Your willpower is only as strong as our environment. Constantly in that environment, my willpower falters. I’m like, “I need some help.” What I learned in that presentation was it can seriously affect your predisposition for Alzheimer’s and also heart disease. That’s when I had a wake-up call. I was like, “Let’s go do this.” The thing that I was most impressed about when I came to you for treatment was you asked me way more questions than they did.

You seem to care not only about my physical body but about what it means relationally to get pellets in your body and have your testosterone increase three times. It is a massive change in your body and it is a fountain of youth I found. After the pelleting, I would wake up and do 100 push-ups before I left the house. I had the drive. Another thing that you said is, “We need to check your spouse’s levels too and make sure they’re okay because your sex drive is going to increase and theirs may not. That could cause a massive relationship issue.”

I’ve seen it cause relationship issues in my friends who maybe haven’t had that kind of conversation. I was so thankful for you to have that conversation because Kelly and I were like, “Are you ready to do this,” and she was so lucky for me and her. Even that is a source of joy, to have that part of your life come alive again and have your cognitive abilities come alive in a different way. Looking at my body in the mirror, I was like, “This stuff should be against the law.” Seriously, I felt like I had atrophy. My body was wasting away. It seemed like a few weeks on these pellets and I was like, “This is crazy.”

It’s not just for men. Women do need testosterone too. When I do hormone stuff, I do hormones for women and men. Testosterone is a sense of well-being. For men specifically, it helps them be who they should be. I do that honestly for mental health but also for physical health. If your cholesterol is high, it increases your risk of heart disease. There’s a lot if you aren’t paying attention to your levels in general. Men’s testosterone starts falling around 35.

It’s way earlier than I would have thought.

A lot of people don’t want to admit it because they still feel pretty good but after 35, it does start dropping. After 45, it’s dropping. Most men, a lot of times, if you have low testosterone, you don’t want to get off the couch. You feel tired. You don’t have any oomph to do what you normally are meant to be doing.

It’s not just sex drive. It’s a mental drive to conquer the world, which is what I always try to do.

It has a little bit to do with sex drive and a lot to do with your mental health and physical health.

Talk to me a little bit about the process. I don’t want this to be like a commercial for Command Family Medicine, although I would highly recommend it, but what I’m trying to get at is educating people on the process. This other company that I was going to said, “Here’s the standard set of pellets. You get this many if you’re this weight and age.” You asked me questions like, “How do you feel about this? What’s this area of your life like?” It seems like you try to target a dosage that’s appropriate for the patient rather than the profile that the patient falls under.

There are two schools of thought when you’re talking about hormones. At Command, I started doing hormones several years ago. I started looking at functional medicine and the underlying disease process. Functional medicine is looking at why things are happening, not just treating whatever disease process with a prescription. It’s figuring out what is going on. For six years, I’ve studied intensely functional medicine. In functional medicine, a lot of things go back to your diet and exercise. It goes back to your hormone levels.

Even with healing. Hypothetically, let’s say you injured your shoulder or something, and you get PRP, which is Platelet-Rich Plasma, which is a healing property of joints, ligaments, or tendons. If your hormones aren’t balanced, you’re not going to heal nearly as quickly and as well as you would. It goes into all facets of everything we do medically.

Patients would come to me and say, “I don’t feel good.” Labs would be normal. They’re like, “I still don’t feel good.” I was like, “There’s more to it than typical labs that we do in healthcare in general.” If you go to a normal primary care clinic, insurance dictates what you can do. They’re like, “Your labs are normal. You’re fine.” You have to get hormones and a lot of people don’t specialize in hormones.

If you go to a normal primary care that hasn’t studied hormone therapy, you’re probably going to not have a good outcome or they may put you on an oral medication. Men might get injections, which is inappropriate if they have a low testosterone level. It’s not the same if you’re not focusing on hormones for that specific person. Your family history and relationship history, if you’re not looking at all those details, could I give you a prescription and say, “Here you go?” Absolutely.

I don’t function that way because that’s not how I’m trained. I have six years of training in figuring out what works for you and doing more individualized care versus looking at men in general and treating them with a dose. I’m looking at you specifically and saying, “Here’s what’s the best option for you.” I’m looking at labs, checking labs every three months, making sure that things are where they should be, and increasing or decreasing the dose, which is different with direct primary care or a smaller company.

The new company that I’ve started, Evoke Health and Wellness, is specifically for hormones, functional medicine, and weight loss. I can spend more time with patients with hormone-specific things. It’s different than primary care. In some of the bigger organizations, you have fifteen minutes to tell them what you need. A lot of times, you don’t have enough time to explain it. You can’t educate in that 10 to 15 minutes if you even get 15 minutes. We spend 60 minutes to 1.5 hours, and sometimes 2 hours with our patients. That way, we can educate.

I do think the other difference is that as a nurse practitioner, I’ve been trained for many years on how to educate. When you’re trained as a nurse, you’re trained to educate patients. That’s our training. As you go as a nurse practitioner, you’re trained in family medicine or whatever avenue you go down. You’re trained on how to treat patients’ illnesses. I’ve had ten years of education on how to educate patients. I have my medical training, which is a nurse practitioner pathway to train patients on how to treat diseases. I have a benefit. I do think a lot of times, nurse practitioners have better education skills because that’s part of what we’re taught in general before we even get into the medical stuff.

My brother-in-law is a nurse practitioner. He’s that family guy that we go to like, “I’m trying to be a good parent here. Should I take this to the doctor?” He does exactly what you described. He educates. I never knew that about nurse training. Thank you for that. That’s interesting.

I won’t say physicians don’t do it but that’s not what they’re trained to do. They’re trained to go see a lab, get a diagnosis, and treat it. It’s not part of their training to educate. It’s not part of our training to talk about diets either. Nurses were not taught. You have to do a special training for education in nutrition, which I’ve done too. A lot of people think that it is something we’re taught but it’s not something we’re taught in school.

You have such a varied experience in your training. In addition to hormones, you are also a specialist in GI issues. What else?

Where I try to focus are GI issues, hormone issues, and endocrinology, like thyroid types of things. Endocrinology can be thyroid or hormones. I try to stay in that realm. I like that realm because a lot of what we experience as patients comes from that realm.

You feel like maybe you can help people the most if you hang out there.

We do a lot of musculoskeletal injections, procedures, and all that fun stuff, which we do a lot of at the clinic. I do a lot of specialty testing like hormone testing and gut health testing that a lot of patients don’t even know that’s even out there. Even providers don’t even know it’s out there.

Talk about that a little bit.

In my nurse practitioner schooling, I did my non-thesis on probiotics. I thought probiotics were super fascinating and that probiotics are very helpful for everything. I used it to prevent specific diarrhea for antibiotic use. In doing my non-thesis on probiotics, I learned that it was very important. The gut is a pathway to mental health, hormone balancing, and everything.

If you don’t have good gut health, you’re not going to have good hormone production down way pathways. It disrupts women’s progesterone levels. A lot of times, if somebody has bad GI issues, you’re going to have a lot of hormone issues as women. You also have it as men but not as much hormone disruption but for women, it’s a big deal.

I always felt like the more you learn about it, the more it seems like we’re controlled by the bacteria that are hanging out in our bodies. It’s like if you’re craving sugar or bad things. These microbes are craving certain types of food or sugars so that we can give them to them.

There’s some fascinating research on the microbiome of the intestines. They’ve had some research where they took two mice, which I’m not comparing humans to mice. One was obese and one was thin. They took the microbiome out of both of those and swapped it around. The obese mouse became thin and the thin mouse became obese because of the microbiome. It’s very fascinating. Sometimes, specific things do transfer like microbiome and gut bacteria. I anticipate that they find which microbiome affects our weight because it does affect our weight based on how disrupted our microbiome is.

When they say you are what you eat, nobody realizes that means bacteria also. When I was a kid growing up in the ‘70s and ‘80s, it was like, “Give the kids some antibiotics.” I was on Augmentin for ten years of my life for sinus infections. It has a super high-powered antibiotic that would give me stomach aches and stuff like that. The doctor was like, “Be sure you have some yogurt with it.”

“We need to fix your microbiome.”

“I seem to be fine there. I’m not going to let you put any more needles in me or whatever you have to.” It’s fascinating. Talk to us about the study that you’ve done. You can learn in books and school but you had a lot of practical education in the GI world, too.

I have a lot of specific training in anti-aging. My extra education, if you were continuing education, is A4M, which is an anti-aging institution. When you’re talking about anti-aging, you’re looking at the whole person and how we can keep you as young and healthy as possible. When we look at that, we have to look at the microbiome. When we look at the microbiome of the intestines, it does point to everything else.

Our microbiome, if disrupted, will affect your hormones but will also affect your mental health. There are more serotonin receptors in the gut than there are anywhere else. If our microbiome and gut are disrupted, it will affect our mental health. It also will affect our immune system and hormone production. If we have a bad diet in general or we’re eating out all the time like fast food, it will affect everything in our system.

Think about it. If it affects your mental health, that affects how you can show up as a mom or a dad, a spouse, a leader, or a service provider of some kind. People reading this are thinking, “I’ve got to fix this part of my life.” This isn’t to create more stress but while people are thinking about that, let’s give them some tips. Let’s start with probiotics. If you’re looking for a probiotic or introduce a better schedule than what you have had in the past, what’s the first thing you should do?

I’ll go back to what I train my patients. There are steps that were taught what you should do first before you even look at the microbiome, which is mental health. If we’re talking about the microbiome, probiotics, and getting a good probiotic, don’t buy probiotics and multivitamins at Walgreens, CVS, or Walmart because they’re just trying to get your money.

If you’re going to get a good probiotic or multivitamin, get it from Mama Jean’s or a supplement store because they take more pride in what they have on the shelf than what you would see at a big retail location. It’s mainly because they do a lot more quality checks. If I’m going to go down the functional medicine pathway of saying, “Let’s make sure what goes in your body is good,” I want to make sure that if you’re going to take a multivitamin, it’s going to be a quality multivitamin.

Make sure that you get a good supplement. The probiotic that’s been world-studied is Saccharomyces boulardii, which is a yeast probiotic. You have to get that one specifically but if you get a probiotic, make sure that you get a probiotic that has 4 or 5 different strains. You don’t want to just have lactobacillus. You want to make sure that there’s a mixture of 4 to 5 strains.

Why? What’s the benefit there?

There’s a ton of different microbiome in your gut. If you’re only giving it lactobacillus, which is one, you’re not changing the imbalance of the microbiome so you want to make sure that you get something that has several different strains.

How long does it take to manifest a change in your microbiome if you decide to take a probiotic?

Probably about a month, you should see a difference. The way you see a difference is more of what your stools look like. Bowel movements will be a little bit easier. They’ll be softer. If you have chronic constipation, that does say there’s something going on in your intestines or microbiome that needs to be looked at. I hate the term IBS but with IBS, diarrhea, or constipation, there’s something going on. I’m looking at what’s going on.

I’m looking at food allergies, microbiome imbalance, stress, and different things to say why you have that specific diagnosis. Not that you have it and give you a prescription but what can we fix to balance out the IBS symptoms? It is a symptom in that case. You could have an actual Crohn’s, ulcerative colitis, or something but hopefully, by the time you get to a doctor, you know that something’s different. You were talking about cortisol levels. When we’re talking about hormone production or health in general, we’re talking about mental health and building stress resistance. If I can tell anybody anything about hormones or weight, it’s trying to build stress resistance.

What does stress resistance mean?

I usually tell patients, “This is what stress resistance is.” If you hear that, you’re like, “That sounds fantastic but what does that mean?” Stress resistance is training your body to perceive stress differently. Stress will always be there. You’ll always have jobs, kids, and coworkers. Stress is stress. We will always have it. We can’t decrease our stress unless we change our occupation, which a lot of people don’t. Train your body to see stress differently and lower that cortisol level.

There’s a lot of research on how to do that. One way is doing meditation, prayer, calming your mind, and not having an agenda. Sometimes, do that in the morning to relax and say, “Let’s start our day and calm down.” I have patients say, “I don’t have time to go on a walk.” Walking outside for 30 minutes does help build stress resistance or doing yoga or Pilates exercises that aren’t for exercise but help our mental health. Learning how to relax and taking deep breaths is the way to help build stress resistance.

I have patients who are like, “I don’t have that time to do it.” One thing that I teach my patients is a lot of people have Apple Watches. The Apple Watch will say, “Meditate or take a deep breath.” That’s because it’s showing that your heart rate is high. They can tell something’s going on or your watch can. If your watch shows that, at that time, take that cue, take some good deep breaths, relax, and try to lower your heart rate and cortisol level because your body’s showing signs of high stress. If you can start training your body to respond to that stress in a different way, you’re building stress resistance.

I would be frustrated at my watch for going off all the time and interrupting me. You’re right. That’s great advice. If somebody doesn’t have time to take a walk, that should be an indication right there that this is what’s wrong. This is your diagnosis. You need time for a walk.

If your cortisol is going up because you’re stressed, whether it’s due to your occupation, family, or whatever you’re trying to get done, eventually it will get worn out so you can get low cortisol levels eventually because your body’s like, “I don’t know what to do anymore.” Your adrenals are like, “I’m done. I’m not going to work anymore.” You’re stressed, wired, and tired. There are adaptogenic herbs that you can take to help with that, which is a big term. There are a lot of things you can do to help with lowering cortisol levels or encouraging that balance in your system with specific herbs and foods that you can eat to help with that specifically.

Legal herbs.

Ashwagandha. There are some good ones out there. There are a lot of adaptogenic herbs that you can take that are super helpful. The second thing that I tell patients, besides cortisol as number one or stress resistance, is gut health. Number three is weight management or hormones. Those things are third on the list of trying to address. If you don’t address your cortisol level or high stress, it will affect your gut health and your gut health will affect your hormones, which will affect your mental health. It’s a big vicious circle.

We’ve helped people understand what they need to look for in a probiotic and start that as soon as possible if they want some benefit in 30 days. Somebody reading this and thinking, “Maybe I should get my hormone levels checked.” First of all, how do they do that? second of all, what questions should they ask a care provider to make sure they’re finding a good one?

It’s hard because if you have normal traditional health insurance, a lot of primary care providers might check hormones or may not and refer you out. If you’re not trained to do hormones, you can get a provider that orders hormones and says, “They’re normal.” I get patients’ labs all the time and the providers are like, “Your hormones are normal.” I look at them and I’m like, “No. You’re probably having some insomnia or hair loss. This is probably what’s happening.” They’re like, “Yeah, but I was told they were normal.”

If you’re not trained to look at hormone levels, you may get inaccurate advice because providers are not trained to do it. They look at a scale and say, “You should be between A and Z.” If you’re between those numbers, they’ll say, “You’re fine.” If it’s not balanced or it’s not for your time of the cycle or men’s age, it does matter. In normal healthcare, you don’t have time to look at that.

How do you find somebody who knows that?

You can look at reviews online or go to Command Family Medicine or Evoke Health and Wellness. My specific company specializes in hormone review. There are also different ways of doing hormone testing. You could do serum, which is a blood test. You can do a DUTCH Test, which is a saliva and urine test. You can do a lot of different types of testing. Women, if you’re still having menstrual cycles, I would do a DUTCH Test because it tells you how you’re breaking down hormones and what pathways. Some pathways are good. Some pathways are not. If you’re doing a serum, it doesn’t always pick those things up.

To find somebody who does them, I would look at reviews and profiles if they do hormone management. I wouldn’t trust anybody who doesn’t mention that they do hormone management. We can all draw hormone labs but whether you know what you’re looking at besides the basics like, “You’re in these numbers,” all providers can say that. They say, “Your estrogen or testosterone is within these numbers,” but it doesn’t mean that they’re balanced and you aren’t affecting your health.

To help people understand, you’ve had such a surgeon business at Command that you’ve had to open up your department. This is proprietary to you. You have your company up in Springfield called Evoke. Are you already taking patients?

I am.

Are you taking them to the Command office?

I am remodeling my space to do hormone management and weight management at the location in Springfield.

You’ve had to be a real estate investor due to this because you’re remodeling a space. You said in our conversation that you did some flips and things like that. What’s your experience in real estate?

I love real estate. If I wasn’t a nurse practitioner, I’d probably do real estate. I bought 4 or 5 houses. I flipped and remodeled them. We had some contractors help us out but I love being hands-on. I lay floors. I’m going to lay laminate and tile, you name it. I love doing that stuff. I like to build stuff. My dad was great at teaching me how to build and work on cars, and all sorts of crazy stuff. I love doing that stuff. It’s the mechanic and solving problems in my brain. I love to do that. We bought several houses, flipped them, and sold them. We bought more houses, flipped them, and sold them. I enjoyed doing that. Probably after my Evoke, if adventure settles down a little bit with hormones, I probably will invest some more and flip them.

You need a good team. You need to say yes or no because you can have a real estate agent finding the deals for you. You can have a contractor doing the deals for you. What a lot of people don’t realize is Arnold Schwarzenegger became a millionaire by investing in real estate. This was before he’d even won any titles. He’s at the gym on a payphone working these deals while he is trying to go get wealthy. There was no money in bodybuilding at the time. Most people don’t realize that about him.

That gave him the freedom to be able to choose the movies that he wanted and do all the things that he wanted because he was already a millionaire in real estate. You can still do it. You don’t have to wait. If you wait, it’s the worst thing you could do. Property rates are going high. You’re on my health team. You need people on your professional real estate team. Maybe we could work something out. Come in, get some pellets, and then immediately learn about investing in real estate. In our team, there’s a lot we could do.

You got out of surgery. It’s supposed to be taking 2 or 6 weeks off, and you’re less than 2 weeks off. You’re out there working. I don’t want to get you in trouble but what I do want to say is that so you are a person who treats people who are redlining constantly. You are on call 24/7. You’ve got all these things. How do you balance your life as smart and educated as you are and see the value of treatment in a slower lifestyle but also redlining constantly?

I’m not doing a great job at it. It’s mainly because I started Evoke. I have to work my full-time job at Command along with trying to create a new business, as well as having a family. Having surgery was probably the best thing that could have happened to me because it forced me to slow down a little bit. I’ve had to take two weeks so I don’t rupture sutures and things like that. My brain is still going and that’s my personality. My brain needs to be functioning in general. It’s important to take time. I’m learning that as I teach patients, we educate but as moms, women, and healthcare providers, we’re not great at taking our advice sometimes. I know that I should sit still for six weeks but I’m not going to, I’m sure.

It’s like a doctor who’s smoking cigarettes while working.

I’m not going to do that. I’m not sure I’m taking my advice because there’s a shift in trying to take care of patients. I care so much for my patients. They’re my family. For them to not get something taken care of would break my heart more than not getting something else done. I’m going to take care of my patients before. My family is number one. I still take a lot of time to make sure that I’m taking care of my kiddos and my wife.

Outside of that, if I have a spare second, I’m going to be working because I feel like that’s what my brain needs to do. I don’t think everybody’s the same way. A lot of people do need to take some time. If you’re building a company and trying to get it off the ground, there will be times in which you’ll be very busy but I do take time to take deep breaths. If I notice that my watch is going off, I try to calm down.

If in the middle of teaching a patient, I’m super excited about hormones and weight management and I feel myself getting amped up in the conversation, I’ll take a deep breath and try to relax. I’m trying to tell my body, “It’s okay.” I don’t always take that 30 minutes a day to go on a walk, do yoga, or things like that but I do try to take several minutes throughout the day to try to reduce my cortisol the best I can.

It seems you get a ton of joy from helping people. I did the same thing until you got to the wall where you can’t anymore and you’re not serving anybody.

You have to take a break.

That’s why I understand. I’ve talked to my pastor about this. Pastors in general are probably some of the most abused human beings on the planet because they don’t get credit for the true value they give to the people that they serve. They take sabbaticals. Professors are the same way. In our society, whether you’re a pastor or an educator, you get credit for taking time off and going to learn, which makes you a better pastor. When you fill yourself up, you have the ability to pour out. Teachers are the same way.

I realized that when I was growing my business as fast as I was, that was something that I did not do because I didn’t take the time to learn. You can be your own weakest link. You can be the person in your business that you need to fire because you’re not the person that needs to be employed in the position that you’re in. I had to fire myself from a variety of positions that I was in because I was lazy at it. It was my company but I wasn’t the right person for the position.

I’d show up to work and be like, “I’m going to poke this problem with a stick for two hours and complain about it before I do something about it.” I should have had somebody in there to do that. The hero business model that you’re creating for yourself is not scalable. I know because I’ve also had that problem. That’s why I ended up in your office.

You can’t be a hero to all the people all the time. You cannot have transformational relationships constantly. You are going to profit off of the transactional relationships that you have to help people where they’re at. A certain percentage of those relationships will be incredibly transformational. Those people become your family because you know they would do the same for you, hopefully. It’ll be interesting for you as you grow out Evoke to balance those transformational with transactional relationships.

I’ve gotten to debates with people about using the word family in your business. Some people don’t like it at all but I do. I do like to treat my team like a family but you don’t choose your family. In some cases, you do. You choose your spouse or children in some cases if you have adopted children but for the most part, they’re the people that you decide you want to stay together with regardless of what happens. That’s the real distinction in business.

There are some patients that you may have who you may not want to stay together with. How would you deal with me challenging you on the word family or your scalable business model? How do you maintain the level of care that you have for your clients and also separate yourself from them so that you can have moments of peace? How do you manage that with such a growing business and a strong desire to love and care for your patients?

In 2023, I’ve learned to do that a lot better.

How so?

As a direct primary care, patients have my access 24/7. Even in direct primary care, females tend to get taken advantage of by patients. It’s not necessarily men are not caring but the estrogen in us makes us a little bit more compassionate. We get stuck in that with direct primary care. In 2023, I’ve decided, “I’ve got to set boundaries.” I did have to, with at least Command, set boundaries to say, “I’m not going to answer text messages that are not urgent after hours.” Even though I felt like I probably should, I wait until the next business day because if I don’t, I sometimes feel like I might lose my mind. I’m texting patients constantly.

Your real family needs you.

Since starting Evoke, it’s been a lot more busy because of building a business. I’ve gone to a lot of different continuing education on business development and how to structure a business the right way to start it versus a year into it and then figuring out you’ve screwed it up.

You’ve managed your expectations this way but we’re changing our policy and taking something away from you that’s an emotional withdrawal.

It’s been a lot to start. Even before I’ve grown the business, I’m learning how to create a business based on going to these different conferences but I’m also learning how to train staff when I hired them from the start so that it is how it should be and that they can run the business by themselves. As I get a little bit further in the process, hopefully, I’ll have less time that I’m seeing patients and more time with my family. I’ve structured that because I knew at Command how much I work with patients. With the new business, my intention is not to be on call and able to have a business where maybe I work two days a week for hormones and not have to work in primary care, focusing on specific patients and then the rest of the time, enjoying life.

How are you going to do that? What’s your ultimate goal? You’re already a successful and sought-after care provider. You’re starting your business so you can care for more people in that specific field and hopefully, leverage a little bit of your talent to produce more income for yourself so that you can generate more freedom, invest in more real estate, or whatever it is that you want to do. What is your end game? At what point will you retire or not see patients? What’s next for you? What are you barreling towards?

In 5 to 10 years from 2024, I will have a company that I can be hands-off but in doing so, there have to be other providers who are trained similarly to me and can treat patients similarly. It is coming up in health in general. There’s a lot more, in Springfield even, hormone management facilities because we’re realizing it’s very important.

I’ll start the right way and make sure that I get paid for my education and paid for the quality of care that I give. The pay structure will be different based on the knowledge and the care that you give. One thing I didn’t learn is not always basing your pay structure on everybody else in the area. That was very interesting. I went to a Mattox conference. The guy started with PRP Penile Injections. Men who can’t do testosterone and can’t get an erection can do PRP or Platelet-Rich Plasma in the penis.

As opposed to Viagra, is it better than that?

It is better than that. PRP is your plasma, like your blood. It’s not introducing anything foreign to your system.

Convincing a guy to get an injection, how do people deal with that? They’re like, “Nah, I’ll take a pill.”

It’s because those patients typically have tried everything else and they know that none of this is working. Sorry about that but you had to get an injection.

“Sorry, Matt. This is what we’ve got for you. It’s the last treatment we can give you.” I don’t mean to make light of it because it’s a serious problem for people.

It’s a painless treatment, even though it sounds terrible. You do numbing and different things. The injection lasts about six months. It’s a good option for patients. The guy that I went in with taught us how to create a business. That was his first business adventure. He said the same thing that you said. He created a billion-dollar company. He sold it and created more billion-dollar companies. It’s been interesting to hear how he structured his companies. Also, the advertisement and pay structure that went into it. The conference I went to was for PRP for joint injections and orthopedics but it was also based on the business side of things. In general, Platelet-Rich Plasma runs about $1,500 for a joint.

Is it for one injection?

It’s location. At Command, it’s cheaper because you get that for a membership. The point of the whole thing was don’t base your pricing on everybody in your area. Based on your education, ability, and skill. Even if you’re higher than everybody else because of those abilities, you’re going to benefit long-term. It helps your business structure based on your quality and abilities. Doing conferences and learning how to create a business was super fascinating and very helpful for me.

It’s awesome that you’re doing that because most doctors do not make good business people.

That was the whole point of the conference. Everybody who was in there was either physicians, MPs, or PAs who wanted to create their business but they didn’t know what to do.

I’ve experienced it in my career and serving people in the medical field who want to be in real estate. For the most part, family practice doctors are decent business people because they have to run a business. Dr. Luke is a real estate investor. That’s how I met him. He seems to be good at business. Dentists are great at business because they have to run a business. There are very few surgeons that I’ve met aside from the one that I talked to you about.

Most surgeons whom I’ve met might hire a professional to do the things that they don’t have time to do like a real estate agent or someone to manage their money. They don’t listen to advice typically. For the most part, in my experience, I have dealt with a lot of people who had a God complex. I’ve found a lot of surgeons that do. They’re successful. They’ve saved a lot of lives. There’s something that happens there to their personality. God bless them for saving lives. Have you experienced that at all? What are your thoughts on that?

Family practice providers typically are more down to earth. They love what they do and they love people. Hopefully, I don’t offend anybody but surgeons, especially cardiac or neurosurgeons, they’re the best of the best. They almost have to have a God complex because they are doing something that most people will never do or experience. They have to have some confidence.

Intrinsic reward or identity that reinforces their decision to go to work every day.

That’s very common. I would also say that MPs or PAs are not great at business either. It’s nothing we’re taught. Even in school, we’re not taught how to do a lot of billing structure. If you want to create your business, you essentially are doing it from the ground up. In general, I don’t think a lot of people are taught that unless you go to school to do that.

We’re not taught to manage a checkbook. For Millennials, that’s a thing that you write numbers on. You take it to the bank and they give you money. Let me ask this. Are there any resources that we can go to or trusted publications, websites, magazines, podcasts, or anything that we could listen to or look at that would help educate the layperson on some of this stuff if they wanted to know more?

As far as research, PubMed is a great place to go.

What is PubMed?

It’s a specific website that is medical information. I have patients come in and say, “I googled this,” and they’re dying of cancer.

They’re terrified, I know.

Don’t Google it. PubMed is a great resource. Good websites that are medical-based are incredibly important. Find somebody in the community with whom you can have a trusting relationship. Say, “If I want this done, where do I go?” There are people in Branson and Springfield that you could reach out to. Most providers are very willing to talk about it, give you education, and tell you where to go or what to do.

We all have our physicians that we refer to because we’re familiar with how they practice and the things that they do well in certain circumstances. I may refer patients to a finger specialist because I know that they do a good job on hands or something. When you’re in the field, you get to know everybody in the field the best that you can and you can make good recommendations.

Ethically, you should be good at what you’re good at and refer the rest. That’s true among people who care about what they do. They want the best outcome for their client or patient.

Finding a healthcare provider who’s passionate about what they do is very important.

How do you know that?

I don’t know that you do. Let’s go back to mental health. I talked to a lot of young adolescents quite a bit and they’re like, “Counseling is fantastic,” but not all young people will go to counseling. In general, finding somebody who meets your personality and that you feel comfortable talking to is very important. It’s the same thing with finding a primary care provider or somebody who specializes in hormones. You may see a different provider and you’re like, “That didn’t feel right,” but you might find somebody in the same genre of medicine that you’re like, “That hit me the right way. I got a lot out of that.”

You probably don’t know until you’ve met them, or referrals. A lot of my patient panels are based on patient referrals. I haven’t had to try to get new patients in a very long time and it’s word of mouth because friends say, “Samantha does this up there. You should check her out.” They come and enjoy what they hear. They feel comfortable with what I do or how I do it. My relaxed personality is helpful too.

I saw a colleague of mine that I don’t see very often. He’s from the Springfield area and we talked like, “What’s new with you?” I was talking to him about my testosterone pelleting. He was like, “I do the same thing. It’s with Dr. Sam up in Springfield.” I was like, “That’s who I go to.” He went on and on about how great you were. I was like, “I already know,” which is why you’re here and why I wanted to share you with the world. This show is a summation of all the people that I find fascinating and all the things that I love. Thank you for caring about your patients and my family being one of them. Thanks for taking some time away from yours to share this with everyone else.

I love it. Thanks for inviting me.

We’ll keep contact info for Evoke so people can get a hold of you. Get in before she gets too many patients. She can only care about several people. Thanks again. I appreciate you.

Thank you very much.

Important Links

• Samantha Neville
• Command Family Medicine
• PubMed
• https://YouTube.com/@WorleyRealEstateNetwork
• https://www.LinkedIn.com/company/WorleyRealEstateNetwork
• https://WorleyConsulting.TextRetailer.com/qc/tlkA3RcG9W
• https://Vrolio.Typeform.com/CocktailnDreams

About Samantha Neville

Samantha Neville NP-C Is a Family Nurse Practitioner who has been practicing since 2012. Samantha has extensive experience in Endocrinology, with a focus on male and female hormones, thyroid function, gut health, and weight loss. She is a member of the American Academy for Anti-Aging and Medicine (A4M) and American Society for Reproductive Medicine (ASRM).