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Seasonal Affective Disorder and how to manage it

Seasonal Affective Disorder and How to Manage It

November 23, 2020 - By Adam Miller, LADC at Family Practice on the River

Where have you gone, Mr. Sun?


“Keep your face always toward the sunshine - and shadows will fall behind you” Walt Whitman


On a clear morning in Acadia National Park on Cadillac Mountain, one can watch as the sun rises from out of the water. As you face the rising sun, shadows begin to form behind you and the air begins to change. You and those around you are the first people in the United States to have sunlight fall upon you. The people that inhabited that land long before European colonizers arrived call themselves “Wabanaki” or “People of the Dawnland.” 


There's power and magic in being the first to have light. But, as with all things, what goes up must come down. 


Maine, placed on the far eastern flank of our timezone is the first to experience light but, in turn, it is also the first to experience darkness. It is the place where the fire of day is extinguished first and the land surrenders to the realm of night. 


So what happens when the sun is lower in the sky and its visits are shorter? 


What happens when the long shadows behind you begin to overtake you?


We have evolved to be fearful, or at least leery, of the night. Being hypervigilant in the darkness kept us alive for millions of years. Nighttime is when the things that eat us typically are on the prowl. If we are out and about at night our bodies naturally respond to darkness by producing hormones like cortisol that make fighting or fleeing more instantaneous. But, now we have no predators beyond our own making (except for house cats who would totally kill us if they could). Even as adults our senses tell us there could be danger in rooms that are pitch black even if we are familiar with the room!


Since humans are diurnal, or day dwellers, our brains also produce sleep chemicals called melatonin when darkness begins to fall. But we are staying up later, we are ignoring signals to go to sleep when the sun goes down, and the daytime has moved inside due to electricity. Human technological progress has confused our bodies. Evolution takes a very long time (think millions of years) and the nervous system has not caught up with our modern circumstances. So when our waking hours are dominated by darkness or the prospect of early darkness, our stress levels go up, we are sleepier sooner (signals that we duly ignore or actively try to reverse) and we experience increased levels of anxiety and depression. And added to this are unhealthy choices that we make to cope like drinking way more coffee than usual, drinking less water, and eating ALL the flaming hot Cheetos. Don’t even get me started on the discount Halloween candy and the Christmas tree-shaped Reese’s peanut butter cups that have found their way to the shelves. Thus, we have a recipe for a fairly unhappy individual.


In the middle of fall we “fall back” an hour. This loss of an hour of light at the end of the day, the time when most people are active, coupled with the fact that our part of the planet has angled itself away from the sun, can cause something called “SAD” or Seasonal Affective Disorder. In northern climes, SAD can affect up to 15% of the entire population. So, of every 100 people that are out and about, 15 of them are abnormally tired, unusually irritated, and are straight up not having a good time. This doesn’t include people who are experiencing other forms of depression, generalized anxiety, bipolar, grief, or the financial burdens that are part of the American Christmas experience. 


We wonder why most people become a little less pleasant after the Christmas tree comes down. There are things that can be helpful, though. Light therapy has proven to be helpful for many people. You can go online and purchase a daylight lamp for somewhere in the ballpark of $30 to $40 if you are so inclined. Selective Serotonin Reuptake Inhibitors or SSRIs like fluoxetine and sertraline have proven effective as has taking supplemental vitamin D. Physical exercise is vitally important. Counseling is effective in the sense that it really helps to talk about these things and destigmatize the way you are feeling. 


Counseling can help identify patterns of struggle and ways of dealing with it.


So here we are, tucked-in for a long winter’s nap and dreaming of the days we can complain about it being too hot and the sun burning us. Our phrases will go from “I love living in Maine” during the summer and early fall to “why do we live here?” in the late fall and winter. Spring is coming again, however. It always comes back (or at least mud season does). Our part of the planet will angle itself back toward our sun again and life will return. Hang on and, as PBS legend Red Green says, “keep your stick on the ice.”

Insecurity, Codependence, and the 2020 Election

Insecurity, Codependence, and the 2020 Election

October 30 2020 - By Adam Miller, LADC at Family Practice on the River

I am the product of a broken home. In that home, there was a considerable amount of physical and verbal violence toward me, my siblings, and my mother. I internalized what I was witnessing and learned some dysfunctional lessons about myself, the world, and the nature of what love is. One of the lessons that I learned and took to heart is something along the lines of “peace must be maintained at all costs at all times.” In my efforts to wrest peace from the pain I adopted the role of class clown. I felt my job was to assuage tension by saying something funny. It was and has remained an emotional sleight of hand. It has gotten to the point where it is a profound struggle to know what it is I actually feel about something. I have gotten my sense of security from those closest to me when they are happy. Not only is there something wrong, but it’s almost certainly my fault, and I need to bend over backward to make them happy! 


My recovery requires me to recognize this dysfunctional thinking and work on it every day.


The type of interaction that is most likely to send me, and others with this type of internalized self-belief, into a hole of discomfort, is confrontation. Any kind. Even just watching it between others. Because of my own trauma, the feelings that are elicited from confrontation are visceral and overwhelming. I have the deepest urge to get as far away as possible or, if I can’t bailout, I

will stop at nothing to make sure my vision of peace is restored. This is not a heroic restoration of peace. Sacrificing basic needs for the benefit of procuring peace ( ie, no confrontation) leaves one anxious, insecure, and unfortunately, deceitful. People with this kind of self-belief can be chameleons in the pursuit of making sure everybody is pleased with them. It is exhausting and

there are millions of us like that! 


So what happens when you feel this way in this current cultural climate? 


We are exposed to confrontation, fighting, fear, and anger all around us. Family is divided because Grandma loves Trump and Uncle Steve not only loves Biden but believes deeply that the current president is the embodiment of all the things that are wrong with this country. This election cycle goes beyond merely stressful. It has triggered some serious relationship trauma for people. This climate causes a profound sense of loss of control. A lot of typical coping methods are ineffective. Making jokes about it is uncouth and can be deeply offensive to people. Attempting to broker peace between feuding loved ones is futile. Not taking a side is seen as a tacit endorsement of one side or another. 


The middle ground is more and more sparsely populated leaving you exposed. Eyes are looking at you and not only asking if you are going to vote but for whom. 


General elections are stressful by themselves but, this one is another animal. 


The cultural stakes have been raised immensely. We aren’t talking about a tax plan or budgetary stuff, we are using phrases like “the right side of history.” This is serious. You and I cannot solve the political climate by ourselves. We cannot cure racism by ourselves. We can’t broker harmony between Democrats and Republicans. We can, however, work on unlearning some of those lessons about ourselves and the world that make this climate more painful. We can learn that love is not something that can simply be turned off. We can learn that life is worth the pain and true intimacy are worth the discomfort. We can learn that confrontation can be healthy and even necessary. We can learn that joy is something we can choose. We can learn that being attached to the approval of other people is holding us down. 


We can learn that we are valuable in and of ourselves.


A good counselor can help you identify these things and begin the process of unlearning. When all appears to be burning down around you both in the country and in your family know that this will pass. Not only will this pass, but it will also be better on the other side. This is not new. There is a religious verse that says, “There is nothing new under the sun.” 


In other words, this planet has seen this from humans time and time again. 

The important thing for us is that we do not lose ourselves in it. 

Family Practice on the River. What sets us apart?

What sets us apart at Family Practice on the River

October 26 2020 - By Patrick Butcher, Practice Manager

Recently I was asked this question: "Why should people come to your practice?” “What’s the draw for a new patient?” As I sit in my office on a rainy October day I started to write and answer the question, “Why us?”


A few things come to mind:


-First and foremost, we are proud to be in full compliance with all CDC and State of Maine guidelines for keeping our patients and staff safe. We are also fully equipped with enough PPE in the event we see an increase in Covid-19 cases this Fall/Winter.


-We are offering The Influenza Vaccine FLUBLOK Quadrivalent 2020/2021 Formula for your Flu Shot this season-one of the most comprehensive Flu Shots available. Learn more at www.drugs.com


-When you arrive for your visit, we will conduct a safety-review with you prior to entering the building. This only takes a couple of minutes but helps ensure we are all kept as safe as possible.


-If you do not have a mask, no worries, we will provide you with one.

-When you enter the practice, you will immediately be taken to an exam room that has been freshly disinfected. No waiting in a crowded lobby.


-Due to Covid-19, we have also been offering Telehealth for patients since the beginning of the outbreak and will continue to do so.


-In addition to Telehealth, we offer “in-person” office visits Monday-Thursday, so you have options.


-You will never come in for an appointment only to find out you are seeing a different provider. You will always get to see your provider (no waiting weeks or months to see your PCP either).


-You will always be able to see one of our providers either the same day or the next business day.


-Our providers try awfully hard NOT to rush you in and out. That is why we schedule 20 minutes for our regular visits (more than most providers) and 40 minutes for a new patient or a physical.


-We have an in-house billing specialist if you ever have any questions about bills or insurance.


-We love technology! We use an Electronic Healthcare Record System (EHR) for your records. We also text your next appointment information to your cell phone as well as send a reminder text the day before your appointment. We also have a terrific Facebook Page and Website chocked full of helpful information.


-And finally, a HUGE difference between us and most other practices is that your Personal Healthcare Information (PHI) stays protected right here! Our in-house billing specialist sends all your bills directly to your insurance company. Most practices (large and small) send your information electronically to companies outside of the U.S. to be processed and then back to the U.S. for final payment. This means your name, address, phone number, date of birth, e-mail address, insurance information, medical treatments, and medical diagnoses are electronically sent back and forth between the United States and foreign countries every time you are treated! We are not okay with this and doubt you are either-so we do not do it.


I hope the above information has been helpful to you. 


Whatever your preference is for a PCP, we have a great group of providers…………an MD, 2 Nurse Practitioners, and another Doctor joining us soon! We also have a Full-Time Counselor on board!


So, as I close, I truly wish good health, safety, and happiness for all.

We are stronger than we realize. 


We will get through this. All of this. Together.


Take Good Care 😊 - Patrick Butcher, Practice Manager

Adam Miller, LADC at Family Practice on the River

Letting Go: The second in a series designed to support your whole health from the team at Family Practice on the River.

October 2, 2020 - By Adam Miller, LADC

Think back to what feels like forever ago (pre-COVID) when we could all travel freely. 


Now assume you are approaching the check-in counter at the airport to weigh your checked baggage. You are praying that it doesn’t weigh more than 50 pounds because that is going to cost you a lot of money. You place your luggage on the scale. A single sweat bead rolls down your brow. You hold your breath until the number reads, “49.5 pounds.”


You let out a deep sigh of relief and a smile overtakes your face. Just then, somebody offers you a big stone that weighs well over 20 pounds. You would have to put it in your checked bag, of course, because it won’t fit in your carry on. 


Would you accept that stone?


Why do we accept so much emotional weight that doesn’t belong to us? We go through life accepting these kinds of stone all-the-time! Some of us are quite prolific at gathering stones. (I have a nice stone collection myself.)


There are even stones that I have to let go daily because I keep choosing to pick them up again. These are stones around which I have crafted a personality and defensive strategies that no longer serve me.


A lot of the emotional weight that you carry belongs to you -the death of a child, the loss of a job, the end of a marriage. These are things that need to be grieved and borne by you. You have to “go through” those things. But what about someone yelling at you? Your co-worker calling you out on a mistake you made? Something embarrassing you said in the fourth grade? These are stones that we collect that are unnecessary. 


We collect them because oftentimes they will confirm a belief we have about ourselves or the world. “I’m not smart,” “I’m ugly,” or, “I don’t deserve to be loved.”  Most of us carry the emotional weight that actually belongs to somebody else. Perhaps your primary caregiver was verbally and physically abusive toward you, and you have grown up with the belief that you are unlovable because of their behavior. Even worse is believing that is what love looks and feels like. Maybe, because of that weight and that self-belief, you find yourself attracted to people that are unavailable and abusive to you, and you end up in a relationship after a relationship like that. In reality, the weight of the choices of your abuser belongs to them and them alone. 


You have the choice to challenge that belief and let that stone go. What was done to you does not need to define you or shape the way you see yourself.

A good counselor or therapist can help you figure out what weight belongs to you and what weight you are carrying unnecessarily. Better yet, they can help you learn how to let that weight go! 


Let’s face it: all of our checked emotional baggage is sitting dangerously close to 50 pounds as it is. Don’t accept any weight that is going to cost you something.

Adam Miller, LADC at Family Practice on the River

Coping with Change: A new series designed to support your whole health from the team at Family Practice on the River.

September 4, 2020 - By Adam Miller, LADC

We are creatures of habit. Even the most spontaneous among us do the same things each day - in the same places, around the same time, with the same people, and so on and so forth. For the human species, routine and predictability are equal to safety. 


For many of us, life was going along well, and then 2020 showed up and threw everything off. To quote the very popular Broadway musical, Hamilton, "The world has turned upside down!"


This year, no matter who you are or what you were doing, each of us has been forced to cope with change on both the macro and micro levels. 


So what can we do about this? 


Here are some affirmations that might be helpful:


1. Know that you were built for this! To some extent, the world is happening TO you. But remember: YOU are also happening to THE WORLD. You have more power than you think you do.


2. It’s okay to laugh. Hitting three red lights when you are late for work is maddening, but hitting all 47 of them is downright comical. It’s good (and usually helpful) to laugh at ourselves every now and then.


3. Nietzsche said,” He who has a why to live can bear almost any how.” What is your “why?” Do you enjoy volunteering?  Going to religious services or spiritual retreats? Spending time with your family? Exercising and enjoying the outdoors?  It is the perfect time to focus on these things to help give you a sense of direction and meaning.


4. Stay connected (as much as possible) with those you love. Even if the connection cannot be physical, it is important that our circle is intact. They need you as much as you need them.


5. Take care of your body. Give it the right food, drink enough water, and sleep on a schedule.


6. Regarding media: Watch what you consume. Too much social media - or any of the 24-hour news channels, will leave you anxious and downtrodden. Spend ample time reading, watching, or listening to something that feeds your soul.


7. Remember that this season will pass. Hopefully, we will have learned something valuable about ourselves; the changes that are long overdue will be made in the world and we will be able to love one another a little more fully.


8. It’s okay to ask for help if you need it. You are never alone in this. There are many resources that can support you in this time - from your healthcare provider to a counselor, to a host of different online groups. 


We hope that these reminders help to guide you. As always, we are here to help and offer our support in any way that we can.

New Practice Procedures - COVID19 Safety Measures

May 27, 2020

As we re-open for face-to-face appointments, please be aware of our new health and safety measures.

  1. Call to book your appointment for a face-to-face or telehealth session. Please review your insurance and prescreening health questions with our team at that time.
  2. To minimize risk to our patients and staff, no visitors are allowed at this time. Please come to your appointment alone. The exception will be if you need physical assistance. Once in our care, we will ask the person assisting you to please wait in their vehicle. We will call them when you are ready to leave.
  3. Please call our office at (207) 502-7386 when you have arrived for your appointment. Do not come into our office or stand outside the door. A member of our team will let you know when to enter the office. When possible, we want you to be the only person in our waiting room area.
  4. A member of our clinical team will take your temperature and ask you several screening questions upon your arrival to your appointment.
  5. We ask that you wear a mask to your appointment. If you do not have a mask, a bandana or scarf is acceptable. Please cover your nose and mouth, and use the hand sanitizer provided in the office.
  6. Our rooms are routinely cleaned per CDC guidelines before and after each patient visit.
  7. When you check out, please make any payments with our team and you will be given instructions and an appointment for follow up care, as needed.

We look forward to serving you safely and efficiently. Please reach out to our team if you have any questions or concerns.


-The Family Practice on the River Team


Book your appointment today at 207-502-7386

Telehealth Services Available 

March 15, 2020

Telehealth services are now available for established patients via our online portal called DOXY.me. You will need to schedule your appointment with our team first by calling 207-502-7386. You will then be instructed on how to use the online portal for your specific appointment time.


You will need access to a smartphone, tablet, or desktop computer with internet access. Telephone appointments are also available for patients who do not have internet access.

Find out more about how to use DOXY here. 


Call to book your appointment today at 207-502-7386