Primary Care

Primary Care2019-03-24T21:42:07+00:00


On your ever-growing list of priorities, making a doctor’s appointment when you are feeling well may not be at the top. At Wright Surgical Arts Primary Care Clinic we are committed to providing comprehensive, expert care in a warm and personalized environment.

There are many good reasons to develop an ongoing relationship with a primary care provider instead of waiting until a health issue arises. Our providers offer a wide range of Men’s & Women’s primary care services, including: health maintenance screenings, annual physical exams, routine women’s care, Endocrinology, Dermatology, Bioidentical Hormone Therapy, acute care and chronic disease management. Our primary care providers can see patients starting at age 14 and older. Whether you are looking to schedule a yearly physical, hormone therapy, or management of a chronic condition, our highly trained and compassionate team is ready to help.
  • Health Maintenance Screenings
  • Annual and screening pap-smears
  • Medication management
  • Acute and chronic disease management
  • Routine woman’s care
  • Endocrinology: diabetes, thyroid disorders
  • Hypertension
  • Immunology
  • Autoimmune conditions
  • Environmental and food allergies
  • Gastroenterology
  • Weight loss
  • Acne
  • Skin cancer
  • Skin checks
  • Accutane
  • Eczema
  • Moles
  • Rosacea
  • Psoriasis
  • Allergic dermatitis
  • Sebaceous and epidermal cyst removal
  • DHEA
  • Thyroid
  • Melatonin
  • Pregnenolone
  • Progesterone
  • Testosterone
  • Estrogen
  • Psychiatric care
  • Medication management
  • Depression
  • Post-Partum Depression
  • Anxiety
  • Adult attention deficit disorder

Premera Blue Cross
First Choice Health
Kaiser Permanente

Coming Soon:
United Healthcare

Frustration Free

We know how frustrating it can be to not have the information needed to stay healthy. Our goal is to provide you with the information you need, relieving your frustration. From the moment you make an appointment, each staff member’s mission is to treat you with care, dignity, and respect. Maintaining quality, lasting relationships with every patient is a top priority.

We have a significant amount of information here for you and can provide more when you come talk with us. Our aim is to work with you, creating the best plan that is tailored specifically to you. As a comprehensive stop for women’s & men’s primary care our practice offers the best technology, treatment methods, and medical knowledge women need to navigate almost any medical concern and remain healthy for years to come.

Annette McClendon, ARNP-FNP

Health Services Specifically for Men & Women

Just because you are a man doesn’t mean how you look doesn’t matter! Learn more about all of our surgical and non-surgical options for men.

It would be awesome if there was a simple pill we could take that would halt the aging process. Unfortunately there isn’t and aging will happen to all of us. But even though we are going to age doesn’t mean that we cant take care of ourselves increasing our longevity.

As we age our hormones are critical to how we age and we can better manage our aging if we manage our hormones. By balancing our hormones we can look and feel better, be healthier, and avoid disease and disability. At Wright Surgical Arts we believe that you should be enjoying your lifestyle, keeping up the same activities, enjoying time with family, and an incredible sex life long into your 80’s!

Health is not just about your hormones, it is multifactorial and includes:

  1. Hormonal Balance
  2. A nutritious and balanced diet
  3. Exercise and activity
  4. Keeping stress at bay

Hormones Changes As You Age

Hormones typically begin to decline when a woman is in her late 20′s. How quickly or how slowly a woman ages depends on the rate of decline of these hormones. What this means is that hormones don’t decline because we age. Rather, we age because our hormones decline. Getting these hormones to healthy levels is the key to healthy aging!

At what point in your life did you feel healthiest and most energetic? Typically most women feel that they were in their prime at the ages of 20 and 30. You slept better, had more energy, felt less tired, and did more with this energy. Your skin looked fresh and great, your sex drive was strong, it was easier to build muscle, and you were able to keep the weight off. The reason you felt great during these times was that your hormones were balanced and your body was working as it was supposed to. Although we can’t reverse the clock making you younger we CAN make you feel like you once did. With balanced hormones, healthy diet and exercise this is possible.

What You Eat Is Important

We were designed for nutritious healthy foods. But today we have to fight GMO and processed foods, bioengineered produce, and food ladened with significant levels of pesticides and bad hormones. Here are some keys to a healthy lifestyle:

  • Maintain a Balanced Diet – Protein, complex carbs, fat…it is important to know what you are eating.
  • Don’t Make to Many Changes at the Same Time – Too many changes too close together can make it challenging and will increase your chances of failure.
  • Take a Daily Vitamin – A good daily vitamin can help balance out the smaller things your body may be lacking.
  • Other Supplements May Be Needed – There is more your body needs that a daily multivitamin cant supply such as: fish oil, Vitamin E, C, and D3. Vitamin D has numerous health benefits as well as cancer prevention. Ask us for more information on the vitamins you may need.
  • Eat Clean – Making food at home that is unprocessed without preservatives is much healthier. Add fresh vegetables and fruits to your diet. Knowing what is in your food will help you feel better physically and mentally. It is rewarding to eat healthy, although it is unpractical to eat like this everyday when you begin to make it a habit you will begin to feel better about your self and your body. Small steps for success.

Be Active

When people start thinking about being active and starting to exercise, it is often associated with dieting. We are not fans of dieting, we are all about lifestyle changes. Exercising often becomes monotonous, doing the same routines at the gym everyday. If you are doing the same thing day in and day out you will get burnt out and stop. What we prefer is for you to be active. Being active means you are out getting your heart rate to an appropriate level. That doesn’t have to just be the elliptical at the gym, although that works great! You can go biking, hiking, walking, climbing, running, etc… Get Creative! Do what works best for you. Studies have shown that 3, 30minute cardio work outs a week had the same benefit as taking zoloft. Meaning, working out significantly boosts your mental wellbeing too! Everything works better with healthy eating and activity. Your heart, blood flow, brain, and mood. When your body is working in a healthy manner you are able to handle the stressors of life better.

Avoid Stress

You are probably thinking, ‘easier said then done!” But when your hormones are balanced, as well as healthy eating combined with physical activity, you will be able to handle stress significantly better. Here is what stress can do to your health:

  • Stress can cause brain deterioration such as alzheimer’s and dementia.
  • Stress compromises the immune system leaving your body open to attack from bacteria and viruses.
  • Stress can fast track the aging process not only on the inside but to your face and skin.
  • Stress can deplete your bodies valuable nutrients leaving you open to disease and sickness.
  • Stress can also deplete your hormones interrupting the interrelationships that your hormones have with each other that help keep you healthy and give longevity.

If you know what stressors you have in your life then half the battle is done. Now it is just learning how to cope with them. If you don’t know then sit down and think through your routines and work life and once you discover what they are, you can begin the process of kicking stress to the curb.

Treatment at Wright Surgical Arts

We’re here to help you get the exact personalized care you need. We will test your labs to find out what your hormones are currently, and then will create a customized hormone care plan just for you. Contact us to learn more about healthy aging and how we can create a safe and effective treatment program that is specifically suited to you.

DHEA (also known as Dehydroepiandrosterone) is produced by your adrenal glands, and it’s no wonder they call DHEA the “mother of all hormones.” It is the most abundant steroid in our bodies and serves as the foundation for male and female sex hormones (androgens and estrogens). DHEA is a precursor hormone, meaning that it is required for production of many others. Without it, your body can’t make testosterone. DHEA should not be overlooked when balancing your hormones overall.

DHEA Facts

  • You can find DHEA in every cell of the body.
  • DHEA declines with age
  • DHEA is a precursor hormone. Needed to make testosterone and many others
  • DHEA supports the immune system, and protects against cancer, Alzheimer’s disease, osteoporosis, depression, and heart disease.
  • DHEA is available over the counter but proper dosing is key as well as quality of the product.

Other Benefits Of DHEA

It’s no surprise that since DHEA is in every cell that it is extremely important in supporting good overall health. There are numerous studies showing that low DHEA levels are present at the onset of disease, which has led researchers to conclude it is critical for proper immune system function. Low or deficient DHEA levels are found in almost every illness and DHEA has been found to block carcinogenesis which is means it helps to block the beginnings of cancer.

A 2008 study in the Journal of the American Geriatrics Society measured serum DHEA in 940 men and women ranging from age 21 to 88, and followed them from 1978 until 2005. The researches found that low levels of DHEA were associated with a shorter lifespan, and a higher incidence of disease. Low or deficient DHEA levels are found in almost every illness and DHEA has been found to block carcinogenesis, meaning it helps block the beginnings of cancer.

Hypothyroidism or under active thyroid means your thyroid is not making enough thyroid hormone. According to recent studies, more than 27 million adults have been diagnosed with hypothyroidism in America. Our providers will perform thyroid hormones test to determine what does of medication is right for you. Our goal is for you to maintain consistent levels of thyroid hormones within your body.

Symptoms of Hypothrydoidism:

  • Poor memory and concentration
  • Slow pulse rate
  • Coldness fatigue weight gain
  • Hair loss
  • Constipation
  • And many more

About Melatonin

Melatonin – also known chemically as N-acetyl-5-methoxytryptamine, is a naturally occurring compound found in animals, plants, and microbes. 

In humans, melatonin is secreted by the pineal gland, a small endocrine gland located in the center of the brain but outside the blood–brain barrier. Many biological effects of melatonin are produced through activation of melatonin receptors, while others are due to its role as a pervasive and powerful antioxidant, with a particular role in the protection of nuclear and mitochondrial DNA.

Melatonin and Anti-Aging– Research has supported the anti-aging properties of melatonin. Some studies have shown that melatonin plays a crucial part in the aging process and that it may help with anti-aging. Melatonin has been shown to increase the average lifespan of laboratory animals by 20% in some studies. It has been reported in one study, that it may treat age-related change in expression of some 13 genes. Consuming melatonin may neutralize oxidative damage, decrease inflammation, and delay the neurodegenerative process of aging. Melatonin supplementation in the evening in perimenopausal women produces an improvement in thyroid and pituitary function as well as depression associated with the menopause.

Melatonin and Antioxidants – Melatonin is a powerful antioxidant. Melatonin is an antioxidant that can easily cross cell membranes and the blood–brain barrier. This antioxidant is a direct scavenger of radical oxygen and nitrogen species including: OH, O2−, and NO. Melatonin works synergistically with other antioxidants.   Unlike other antioxidants, melatonin does not undergo redox cycling. Redox cycling may allow other antioxidants (such as vitamin C) to act as pro-oxidants, counterintuitively promoting free radical formation. Melatonin, once oxidized, cannot be reduced to its former state because it forms several stable end products upon reacting with free radicals. Therefore, it has been referred to as a terminal (or suicidal) antioxidant.  Melatonin has been shown to prevent the damage to DNA by some carcinogens.  Melatonin’s antioxidant activity may explain its effectiveness in some types of Parkinson disease and cardiac arrhythmia.

Melatonin and Your Immune System – Positive immunological effect is thought to be the result of melatonin acting on high affinity receptors (MT1 and MT2) expressed in immunocompetent cells. In preclinical studies, melatonin may enhance cytokine production, and by doing this counteracts acquired immunodeficiencies. Some studies also suggest that melatonin might be useful fighting infectious disease including viral and bacterial infections, and potentially in the treatment of cancer.  Endogenous melatonin in human lymphocytes has been related to interleukin-2 (IL-2) production and to the expression of IL-2 receptor. This suggests that melatonin is involved in the clonal expansion of antigen-stimulated human T lymphocytes.

Melatonin and Circadian Rhythm Disorders and Insomnia – Younger children hit their peak melatonin production at night, and some researchers believe that the level of melatonin peaks earlier as we get older. This may explain why older adults go to bed earlier, wake up earlier, and have more sleep problems than children do.  Melatonin has shown good results in treating insomnia in older adults, delayed sleep phase syndrome (DSPS) and non-24-hour sleep-wake syndrome as well as jet-lag, rotating or night shifts negative effects.  

Melatonin is an anti-oxidant and suppressant of tumor development that is produced at night; when someone works in artificial light, they generally have lower melatonin and may be more likely to develop cancer. Melatonin supplements may simulate the melatonin production at different times that does not occur during regular sleeping hours for people who work night shifts.

Melatonin and Obesity – Melatonin is involved in energy metabolism and body weight control. Many studies show that chronic melatonin supplementation in drinking water reduces body weight and abdominal fat. It is interesting to note that the weight loss effect of melatonin does not require the subject to eat less and to be physically more active. A potential mechanism is that melatonin promotes the recruitment of brown adipose tissue as well as enhances its activity. This effect would raise the basal metabolic rate by stimulating thermogenesis, and heat generation through uncoupling oxidative phosphorylation in mitochondria.

Melatonin and Headaches, CNS and Mood Disorders – Melatonin has been shown to be effective in treating certain forms of chronic pain syndromes, fibromyalgia, irritable bowel syndrome, chronic fatigue, tinnitus, migraine and cluster headaches, restless leg syndrome, amyotrophic lateral sclerosis, depression, seasonal affective disorder, bipolar disorder and other disorders in which circadian disturbances are involved.

Melatonin and Cancer – A systematic review of unblinded clinical trials involving a total of 643 cancer patients using melatonin found a reduced incidence of death. Another clinical trial is due to be completed in 2012. Reduced melatonin production has been proposed as a likely factor in the significantly higher cancer rates in night workers. Melatonin also has been shown to exhibit protection from damaging effects of radiation.

About Pregnenolone

Pregnenolone is an endogenous steroid hormone involved in the steroidogenesis of progestogens, mineralocorticoids, glucocorticoids, androgens, and estrogens as well as the neuroactive steroids. As such, it is a prohormone and, although it also has biological effects of its own, it behaves namely as a neuroactive steroid in its own right with potent anxiolytic effects. Pregnenolone and its sulfate, like DHEA and its sulfate, as well as progesterone, belong to the group of neurosteroids that are found in high concentrations in certain areas of the brain, where they are synthesized. Neurosteroids affect synaptic functioning, are neuroprotective and enhance myelinization. 

Pregnenolone has been shown to act as a positive allosteric modulator of the GABAA receptor with slightly less potency than allopregnanolone (its 3α,5α-isomer). Accordingly, it has anxiolytic effects, similarly to other neurosteroids like allopregnanolone and tetrahydrodeoxycorticosterone (THDOC). Interestingly, unlike pregnenolone, pregnenolone sulfate is a negative allosteric modulator of the GABAA receptor as well as a positive allosteric modulator of the NMDA receptor. In addition, pregnenolone sulfate has been shown to activate the transient receptor potential M3 (TRPM3) ion channel in the podocyte and pancreatic islets causing calcium entry and subsequent insulin release.

Clinical Implications

Pregnenolone and its sulfate ester has been shown to relieve anxiety, improve cognitive and memory functioning.

About Progesterone 

Progesterone (P4) is a steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species. Progesterone exerts its primary action through the intracellular progesterone receptor. In addition, progesterone is a highly potent antagonist of the mineralocorticoid receptor. Progesterone has a number of physiological effects that are amplified in the presence of estrogen.

Progesterone should always be treated in conjunction with balanced estrogen. Progesterone helps to protect again heart disease, menopause syptoms, pre-menstrual symptoms, breast diseases, osteoporosis, and many others. There are progesterone receptors in numerous sites throughout the body including areas like the brain and uterus (as well as many others). 

In bioidentical hormone replacement therapy, progesterone is mainly used to balance and enhance the effects of estradiol (E2) effect, decreasing the risk of uterine and breast cancer.


More than 90% of women over age 45 suffer from low testosterone. Research shows levels of testosterone drop 50% between the ages of 20 and 40. Other key hormones drop drastically as well. This loss, which continues as you age, takes a huge toll in stamina, appearance, mental acuity, general health, and zest for life. Yet testosterone can be a life changer in these areas—without a prescription. 

Is Testosterone Loss a Problem for You

You may be surprised. The majority of women in their 40’s, 50’s, and beyond have low testosterone.

  • Have you had trouble losing weight since turning 40?
  • Does your brain sometimes feel foggy?
  • Have you been told you have osteoporosis or osteopenia?
  • Do you feel fatigued most of the time?
  • Do you feel less sexy than you used to?
  • Do you have mood swings?
  • Has your hair become thinner and drier?

These are signs of testosterone deficiency. If you’re over 40, you’re probably experiencing some of them. After 50, it gets worse.


  • Helps women slim down and shape up.
  • Improves women’s mood. Research shows testosterone elevates mood in depressed women as well as or better than anti-depressant medication.
  • May prevent Alzheimer’s and dementia. One in six women develops Alzheimer’s vs. 1 in 10 men. Could testosterone be the reason? A 2011 study by The Endocrine Society suggests testosterone may protect women against dementia.
  • Helps women’s hearts. Studies suggest that testosterone therapy after a heart attack may help remodel cardiac tissue due to the abundant number of testosterone receptors in the heart.
  • Increases women’s energy.
  • Lifts women’s sex life. Testosterone improves sex drive and sexual response in many women and can increase sexual thoughts, fantasies, activity, and satisfaction.
  • Builds bones and prevents (and is one of the best ways to treat) osteoporosis. Testosterone is so much safer than scary Fosamax, too.
  • Improves skin tone and texture. Women who boost their testosterone notice the difference in firmer, more elastic, less crepe-y skin. They also find thinning hair becomes thicker.

Estrogen is the female hormone with the most controversy. And really, this controversy is simply due to misinformation! It can be difficult and frustrating to find good information about hormone treatment options especially regarding estrogen. Allow us to clear up this misinformation for you.

What Is Estrogen?

Estrogen is considered the “female” hormone where testosterone is considered the “male” hormone. Estrogen is actually more than just one hormone. It’s a class of hormones: estradiol, estriol, and estrone. You have estrogen and estrogen receptors literally all over your body. Estrogen hormones play an essential role in the growth and development of female secondary sexual characteristics such as breasts, pubic and armpit hair, endometrium, regulation of the menstrual cycle and the reproductive system. During the menstrual cycle, estrogen acts to produce an environment suitable for fertilization, implantation, and nutrition of the early embryo.

Is Estrogen Good for You?

The short answer is yes. But, it is a little more complicated than that. Estrogen therapy has been confusing for women. Women were told that estrogen replacement was ok, and for years women were treated with estrogen. It was these treatments that helped to relieve their menopausal symptoms. Research was then released from the Women’s Health Initiative (WHI) showing that estrogen therapy caused serious health risks such as breast and ovarian cancers. With media attention and little knowledge about what the studies really showed, estrogen therapy all but stopped. Since then, estrogen has been the most controversial and misunderstood hormone. Unfortunately the information from WHI was misinterpreted, causing physician misinformation and proper estrogen therapy to be abandoned.

Estrogen Facts

Synthetic hormones are what cause the negative results with estrogen therapy not bioidentical hormones. Synthetic hormones have been shown to cause breast cancer, heart attack, and stroke. Recent studies have shown that natural hormones (estrogen) do not have these side effects and actually have significant health benefits.

When treating women with hormone imbalances it is KEY to use natural or bioidentical hormones NOT synthetic. Sadly many physicians are uninformed and continue to prescribe synthetic estrogen.

Hormone replacement is never just about one hormone, it is about the balance of all. Estrogen treatment also depends on balancing the treatment of other hormones, especially progesterone.

Estrogen is made up of three different kinds: estradiol, estriol, and estrone. Prescribing just one of these does not allow for proper estrogen balance. These different forms of estrogens must be balanced to give the best outcome. We use a compounding pharmacy to achieve the right dosage amounts for what you need.

Estrogen Benefits

  • Antioxidant
  • Decreases “bad cholesterol” (LDL), and increases “good cholesterol” (HDL).
  • Protects your arteries from hardening.
  • Lowers heart attack risk
  • Protects brain and memory function
  • Protects against Parkinson’s disease.
  • Increases focus
  • Helps with skin elasticity by collagen production.
  • Decreases wrinkles and helps retain skin moisture.
  • Helps keep vaginal tissue healthy and prevents vaginal dryness.
  • Decreases osteoporosis
  • Increases metabolism
  • Helps to prevent colon cancer.
  • Protects against breast cancer when used with progesterone.
  • Protects against ovarian cancer when used with progesterone.

It is Wright Surgical Arts opinion that estrogen therapy is healthy, with numerous health benefits if bioidentical hormones are used. We have done our research and know that estrogen is a safe and effective way to relieve your menopausal symptoms getting you back to the life you deserve.c


The Women’s Health Initiative (WHI) study enrolled more then 160,000 women starting in 1993. This study was paid for and sponsored by the pharmaceutical company that makes PremPro. Synthetic estrogens such as premarin are derived from the urine of pregnant mares, leading to the word breakdown: Pregnant Mare’s Urine. These estrogens contain many estrogens found in horses and not in humans. A lot of women are unable to tolerate the side effects of taking these horse estrogens. The study was stopped in 2002 when it became evident that there was an unmistakable increase in heart disease, breast cancer, stroke and blood clots in women taking this medication. The unfortunate conclusion was drawn that hormone replacement therapy for women is bad, and that it should be stopped. Just like that, women stopped taking estrogen.

The Truth Behind The WHI Study


  • Only the women on synthetic estrogen and progesterone (also known as progestin) suffered adverse results to their health. These synthetic progestins are also known as Premarin and Provera. Those on estrogen only did not suffer adverse effects such as cancer or heart disease.
  • Since women in the estrogen-only study had no increased risks this showed that it was the synthetic progestin (provera) that was the culprit NOT estrogen.
  • Those in the study who started hormone treatment at younger ages experienced positive results, including a decrease in breast cancer.
  • The majority of the women in the study were overweight. Fat cells contain estrogen and the more fat cells a woman has will increase their risk of cancers due this extra estrogen.
  • The results were skewed by the high percentage of women who dropped out of the study (42%).
  • The women in the study took the medication orally, which researchers later found was in part responsible for adverse results.

And the list goes on.

The Great News About Estrogen

Numerous studies have emerged since the WHI study that attest to the safety and health benefits of estrogen replacement. We have numerous articles that attest to the health benefits of hormone replacement of estrogen.

What We’ve Learned About Estrogen

Never liken synthetic estrogen with natural estrogen. Physicians and media tend tie these two together, but they are not the same. The dangers of estrogen replacement have been significantly overstated and misrepresented. What is most important is that other hormones are balanced with estrogen, especially bioidentical progesterone. Synthetic progesterone is what is dangerous in this whole equation not estrogen. Contact us to learn more about estrogen and estrogen replacement.

At Wright Surgical Arts we are committed to treating your symptoms. When you meet with us we create an individualized plan to address exactly what you need. No two patients are the same and no two treatment plans are the same.

We start by checking a detailed blood test to evaluate your current hormone levels as well as assist you by creating a plan to help you live a healthy lifestyle. As a woman your body was meant to be strong, feel good, have excellent sexual activity, mental strength, and propelled to live life with passion and enjoyment. Imbalance of hormones can limit this but balance can give you what you have been missing.

When to Expect Results

Typically, most women began to see and feel the results of treatment soon after treatment is started. Every woman is different so results can vary and also depends on your commitment to a healthier life, but below is what to generally expect. Once your hormones are balanced:

Week 1:
In the first week, you will begin to notice your mind working faster a sense of clarity. Short term memory also improves.

Weeks 2 and 3:
Those hot flashes and mood lability that drive you crazy will begin to go away. Increased excitement for life, you feel more motivated, fatigue decreases, energy levels increase, and sexual drive begins to increase.

Weeks 3 and 4:
Your works outs will be more productive, especially if you have been eating healthy and working out. You will be more driven to get out and do things.

Weeks 5 and on:
You will see obvious improved results from your workouts and improved sexual performance. You will notice it will be easier to lose weight and your muscles will become more toned. It’s during these weeks that you will feel like you are yourself again.


Tri-Cities Office
5908 Bedford Street, Suite C

Pasco, WA 99301
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P: (509) 792-1404
F: (509) 792-1405

Spokane Office
12709 E. Mirabeau Parkway,
Bldg A, Suite 200B
Spokane Valley, WA, 99216

Business Hours
Mon – Fri: 9:00am – 5:00pm
Saturday: By Appointment Only

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Welcome to Wright Surgical Arts! We offer cosmetic surgery procedures and rejuvenating medspa services to enhance your breast, body, and face located in Tri-Cities, WA and Spokane WA