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Bioidentical Hormone Replacement Therapy

  • Post-War Cape Cod Style and Ranch Homes (1940s-1960s)

    Compact homes on generous lots, often with galvanized steel plumbing that is past its service life and small bathroom footprints where even modest expansions require relocating plumbing stacks and upgrading electrical service.


  • Split-Level and Colonial Homes (1960s-1980s)

    The dominant housing type in Dix Hills, these homes present framing and waterproofing constraints at floor transitions in split-levels, and master baths undersized by current standards in colonials - both often intersecting with load-bearing walls that must be assessed in the design phase before layout decisions are finalized.


  • Homes Updated in the 1980s-1990s

    More flexible layouts and copper plumbing, but outdated tile systems, inadequate ventilation, and original fixtures are still common findings once walls are opened.


  • Newer Construction and Fully Renovated Properties

    Modern infrastructure is already in place; renovation work centers on design updates and layout refinements rather than systems replacement.


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Michelle Middleton, PA-C, Founder, SPOKEmed
Michelle Middelton, PA-C, Founder, SPOKEmed

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"Testimonial"

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The SPOKEmed Microbiome Approach

What sets our microbiome testing apart:

Medical Expertise

Your results are interpreted by a healthcare provider with clinical experience, not just an algorithm.

Comprehensive Analysis

We look at the full spectrum of microorganisms, not just a limited set of bacteria.

Personalized Plan

Your recommendations are tailored to your specific microbiome composition and health goals.

Ongoing Support

We help you implement changes and monitor your progress with follow-up consultations.

For optimal results, we recommend you retest after 4-6 months to track improvements and make necessary adjustments to your plan.

Hormone Replacement Therapy

Address hormonal imbalances that can make losing weight challenging

Gut Health & Microbiome Testing

Discover how your gut health may be affecting your weight loss efforts

Health Coaching

Get the accountability coach and support you need for lasting change

The Personal Journey that Changed Everything

Michelle's approach to health coaching comes from authentic experience. She personally used the Habits of Health® Transformation System to lose weight and regain the energy and confidence she had been missing This wasn't just about looking better, it was about feeling better, sleeping better, and having the mental clarity to show up fully in her life and relationships.

When Michelle speaks about blood sugar stability, the frustration of failed diet attempts, or the challenge of maintaining healthy habits while caring for everyone else, she's not reciting textbook knowledge. She's sharing wisdom gained from her own transformation and from helping hundreds if not thousands of women achieve similar results.

This personal experience allows Michelle to connect with her patients in a way that most clinical providers cannot. She understands the emotional aspects of weight management, the guilt that comes with prioritizing self-care, and the hope that emerges when you finally find an approach that works with your body rather than against it.