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Supercharge your brain and ditch anxiety and depression for good!


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Dr. Vivian DeNise of Patients Medical and Dr. Sandlin Lowe of The Amen Clinic New York explain the causes of anxiety and depression, the cutting-edge technology that can be used to diagnose …

Dr. Vivian DeNise of Patients Medical and Dr. Sandlin Lowe of The Amen Clinic New York explain the causes of anxiety and depression, the cutting-edge technology that can be used to diagnose deficiencies in the brain that cause these conditions and several non-invasive holistic medical approaches that we use to treat.

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  • For some people it can become excessive and that is when it becomes problematic
  • It affects 18% of the population , that’s about 40 million people over the age of 18Untreated children are at a higher risk to perform poorly in school, miss out on important social experiences and engage in substance abuse
  • People with anxiety disorders are 3-5x more likely to go to the doctor.
  • If you are experiencing anxiety or depression, you may be blaming it on something that is happening to you – like bills or a toxic relationship, but there may be internal causes that are predisposing you to be anxious or depressed as well.
  • The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on each side of the windpipe
  • Hashimoto’s is the most common cause of thyroid disease. According to the World Health Organization 72% of the world population is iodine deficient. It has been noticed in people who swim in indoor pools have an increased incidence in hypothyroidism due to the cholrine replacing iodine.
  • Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover from that stress or combined stresses. It was first recognized by Dr. Hans Selye in 1936 and was called the general adaptation syndrome.
  • First lets discuss what the adrenal glands are and what they do. They are 2 small triangular shaped glands that sit on top of the kidneys . They are considered the “anti-stress” glands of the body. But in traditional medicine it is often the forgotten gland.
  • During a crisis they work together to dilate bronchi (air passages in the lungs), and blood vessels to the muscle, which brings more blood and oxygen to the tissues in need of it, increases heart beats and strength of contraction, and cause other physiologic changes to help the body respond to stressful situations via “flight or fight”. For example if your driving your car and another driver cuts in front of you what helps you react is your epinephrine and cortisol
  • Aldosterone is the major hormone controlling the sodium and potassium levels, and thus fluid balance, within your bloodstream, cells and interstial fluids. Sometimes this lead patients to crave salt.Cortisol controls or greatly influences the metabolism of fats, proteins, and carbohydrates to maintain blood glucose within a narrow optimal range and keep it there even under stressful conditions. Cortisol along with DHEA are primarily responsible to make Estrogen, progesterone and testosterone after menopause. Does this sound like an umimportant gland to you?
  • Ok so now we see the importance of the adrenals in acute stress and stresses be it diseases, physical, chemical, thermal or emotional. Adrenal fatigue can evolve over months to many years, but it occurs when the adrenal glands decrease their output of the steroids, leaving the body open to aging and disease.
  • Cortisol competes with the receptor sites for thyroid, thus causing the thyroid hormone being made to be stored or production to be decreased. The same holds true for progesterone. In addition, when cortisol increases your body produces more free radicals. This damages your neurons and decreases your body’s ability to think and remember. When this happens your body’s ability to change short-term memories into long term is hindered. High levels of cortisol are also associtated with deterioration of the hippocampus, the part of your brain that processes memory.
  • NMDA receptors regulate pain control, learning, memory, and alertness. Causes are the aging process, low cholesterol levels, hypothyroidism, high cortisol levels, and a pituitary tumor
  • All hormones start as cholesterol
  • Acetylcholine is your neurotransmitter of memoryGABA is a calming neurotransmitterNorepinephrine gives you energy and helps you deal with stressNerve growth factor stimulates nerve development in the brain
  • Post partum Estrogen is decreased 2000 times greater than before the cycle begins as well as a decrease in progesterone as well as thyroid. I have been called many times by new mothers telling me that they just got back from their 6 week post partum check up and the ob gave them prozac, was it safe for breast feeding!!!
  • Relaxing the smooth muscle is impt so that your body can break down food into nutrients that are absorbed to be used. Not only that but sleep is essential, we all have had sleepless nights where perhaps you are worrying about the bills, the kids, whatever…to get through the next day is usually quite a struggle. Insomnia is a huge problem for everyone especially someone who is dealing with anxiety and depression.
  • As an aside, men can have low progesterone as well.
  • Magnesium, folic acid, B6,B12, L tryptophan are all intrinsically related to the formation of neurotransmittersFolic acid is low in 1/3 of depressed adults.The elderly are at risk for low B12 and women on oral contraceptives or synthetic estrogen replacement are at risk for being low in B6Even if you are on medication the medication may not work as well if you are nutrionally depleted that’s why some time you don’t think the medication is working.Also, with the typical on the run diet of fast pace and fast food, not only aren’t you eating nutritionally but you don’t even have the time to digest what you are.
  • Symptoms increase late morning or before mealtimes and is improved by eating. Treatment includes avoidance of caffeine, refined sugar and high glycemicindes foods so you do not get those highs and lows. Supplements that can help are chromium, magnesium, and B vitamins.
  • Symptoms increase late morning or before mealtimes and is improved by eating. Treatment includes avoidance of caffeine and refined sugar so you do not get those highs and lows. Supplements that can help are chromium, magnesium, and B vitamins.
  • Type I is IgE mediated and is where symptoms appear immediatelyType II is IgG mediated and the symptoms may not appear for hours or even daysFood allergies have increased by 400% in the last 10 years. About 75 million Americans or ¼ of the population have allergies
  • Stress promotes production of Interleukin-6 which causes more inflammation. When there is inflammation cytokines are produced. Cytokines are cell messengers that travel through the body and trigger inflammation in different areas of the body. Such as the joints, mucous membranes of airways, the GI tract and the brain. These areas send out more cytokines and hence more inflammation ensues
  • I don’t know if anyone heard a few weeks back in the media, the diary associations have asked to FDA to allow apartame and other artificial sweetners to be added to milk and dairy products without being labeled. The twisted logic was the children would make better choices by eating and drinking more dairy.
  • This is also known as the Chineese food complex of symptoms as per the FDA
  • First a few words about allergies, the adrenal glands are implicated in most types of allergies. Most allergies involve an inflammatory process and one of the major anti inflammatory in the body is cortisol. Frequently, the allergen is merely the straw that breaks the camels back. The allergen would not cause the person any trouble if he had an adequate level of his own adrenal production of the anti inflammatory glucocorticoids aka cortisol
  • Diseases that can be triggered or worsened include CFS, Fibromyalgia, Brain Tumors, MS, Epilepsy, Parkinsons , Alzhiemers, Lymphoma, Birth Defects, Diabetes, Cancer
  • Once you have determined what you are allergic to you may rotate foods back in having them once every 4 days.
  • Candidiasis can be secondary to vaginal infections, history of antibiotic use, oral contraceptives, glucocorticoids. If candidiasis occurs there can be a thin film lining the GI tract which would prohibit vital nutrients from being absorbed.
  • Tryptophan is a Serotonin precursor and is not to be used by patients on SSRI’s, MAO inhibitors, and Amitriptiline
  • Transcript

    • 1. Dr.Vivian DeNise, Patients MedicalDr. Sandlin Lowe, Amen Clinic NewYork
    • 2.  A full-service, holistic medical center Integrate modern medicine with
    • 3.  Promote healing and prevent disease Focus on the root cause of symptoms Avoid a “Band-Aid”
    • 4. Defining Integrative
    • 5. Reference sheets with supporting information.And the event
    • 6. Introducing our speakers:Vivian DeNise, DOABAARM, FAARMIntegrative Internal MedicineHolistic
    • 7.  Completed her medical degree at NewYorkCollege of Osteopathic Medicine Certified in Integrative Medicine with theAmerican Academy of Anti-Aging Medicine(A4M) Earned her Fellowship in Anti-Aging andRegenerative Medicine (FAARM) and hasbeen certified by the American Board ofAnti-Aging/Regenerative Medicine(ABAARM)
    • 8.  Specialties include BrainWellness Anxiety Depression Thyroid Disorders Balancing Adrenal Function Detoxification Hormonal Imbalances Nutritional Deficiencies Weight Loss Gastro-Intestinal Problems Women’s and Men’sWellness Pediatrics And many more!
    • 9. Introducing our special guest speaker:Dr. Sandlin LowePsychiatristAmen Clinic
    • 10.  Completed his medical degree atTulaneUniversity in New Orleans On Faculty of NYU School of Medicine inPsychiatry as well as Physiology andNeuroscience Departments Consulting Neuropsychiatrist to NYU School ofMedicine Brain Research Laboratories Collaborating Psychiatrist at NYU LangoneCenter for Neuromagnetism Chief of PsychiatryAssessment Services at NYUWoodhull Medical and Mental Health Center Co-founder and Director of the GlobalAlliancefor Innovation in Neuroscience, Inc (GAIN)
    • 11.  Specialties include Dementia Traumatic Brain Injury Autism and Spectral Disorders
    • 12. Patients Medical and Amen Clinic NewYork have joined forces!Now, you have the benefit of working with both centers now with anintegrated experience including: Comprehensive physical and exam with Board CertifiedIntegrative Physician, Dr.Vivian DeNise Complete blood work and holistic health history Access to Amen Psychiatrists SPECT imaging and other unique diagnostics Customized treatment protocols that blend conventional andholistic therapies, proven effective for treating a range of medicaland psychiatric
    • 13. …between physical and mental/emotional
    • 14. www.patientsmedical.comNon- Pharmaceutical Treatment Approacheswith Dr. Sandlin Lowe
    • 15. A Holistic and Integrative Approach to Evaluation andManagement of
    • 16. Brain SPECT
    • 17. ICD 10 CRITERIA FOR DEPRESSIONDepressive episodeIn typical mild, moderate, or severe depressive episodes, the patient suffersfrom lowering of mood, reduction of energy, and decrease in activity. Capacityfor enjoyment, interest, and concentration is reduced, and marked tirednessafter even minimum effort is common. Sleep is usually disturbed and appetitediminished. Self-esteem and self-confidence are almost always reduced and,even in the mild form, some ideas of guilt or worthlessness are often present.The lowered mood varies little from day to day, is unresponsive tocircumstances and may be accompanied by so-called "somatic" symptoms,such as loss of interest and pleasurable feelings, waking in the morning severalhours before the usual time, depression worst in the morning, markedpsychomotor retardation, agitation, loss of appetite, weight loss, and loss oflibido. Depending upon the number and severity of the symptoms, adepressive episode may be specified as mild, moderate or
    • 18. ICD 10 CRITERIA FOR DEPRESSIONRecurrent depressive disorderA disorder characterized by repeated episodes of depression as described fordepressive episode without any history of independent episodes of moodelevation and increased energy (mania).There may, however, be brief episodesof mild mood elevation and overactivity (hypomania) immediately after adepressive episode, sometimes precipitated by antidepressant treatment.Themore severe forms of recurrent depressive disorder (F33.2 and F33.3) havemuch in common with earlier concepts such as manic-depressive depression,melancholia, vital depression and endogenous depression.The first episodemay occur at any age from childhood to old age, the onset may be either acuteor insidious, and the duration varies from a few weeks to many months.Therisk that a patient with recurrent depressive disorder will have an episode ofmania never disappears completely, however many depressive episodes havebeen experienced. If such an episode does occur, the diagnosis should bechanged to bipolar
    • 19. NOT A SINGLE DISORDER BUTA CLUSTER OF CLOSELY RELATED DISORDERSKNOWINGTHE SPECIFIC SUB-TYPE IS CRITICALTO EFFECTIVETREATMENTDR. AMEN HAS IDENTIFIED 7 NEUROBIOLOGICAL SUB-TYPESType 1) Pure AnxietyType 2) Pure DepressionType 3) Mixed Depression and AnxietyType 4) Over Focused Depression and AnxietyType 5) Cyclic Depression and AnxietyType 6) Temporal Lobe Anxiety and DepressionType 7) Unfocused Depression and
    • 20. THE 7 SUB-TYPES EMERGE FROM 3 MAJOR PATTERNS SEEN ONBRAIN SPECT IMAGESDecreased prefrontal cortex activity at rest, especially on the left side isa consistent SPECT finding in depressionThe severity of depression is often related to the degree of frontalhypometabolismResearchers have also seen increased limbic system activity as well indepression (thalamus, amygdala, cingulate gyrus, and deep temporallobes)When depressed patients perform a concentration task the leftprefrontal cortex often activates to normal
    • 21. SPECT BRAIN IMAGING CAN BE HELPFUL INTHE DIAGNOSIS ANDTREATMENT IN COMPLEX OR RESISTANT DEPRESSIVE DISORDERS BY:1) Differentiating it from other disorders,2) Enhancing compliance by the patient being able to “see thechanges in the brain,”3) By determining the neurobiological sub-type of the depression3 MAJOR PATTERNSOF SPECT BRAIN IMAGES ARE OF
    • 22. www.patientsmedical.comThis subtype is often associated withmoodiness, negativity, low energy,sleep and appetite problems and poorconcentration. It often responds best todopaminergic or noradrenergicinterventions such as buproprion,imipramine or desipramine.
    • 23. www.patientsmedical.comThis subtype is often associated withsadness, negativity, irritability,cognitive inflexibility, worrying, andgetting stuck or locked intonegative thought patterns.It often responds best to theserotonergic antidepressants suchas fluoxetine, sertraline, paroxetine,and venlafaxine.
    • 24. www.patientsmedical.comThis is often the most serious subtype andit is often associated with sadness,irritability, rage (toward others or self insuicidal behavior), mild paranoia, atypicalpain (atypical headaches or abdominalpain) and insomnia. We have seen thissubtype often made significantly worse byserotonergic medications.Anticonvulsants, such as gabapentin ordivalproate are often better choices.
    • 25. www.patientsmedical.comNON-PHARMACEUTICAL APPROACHESTOTHETREATMENT OF DEPRESSION:Applied Field EnergyTreatments1) ElectroconvulsiveTherapy (ECT)2) Transcranial Magnetic Stimulation (TMS)3) Cranial Electrical Stimulation (CES)4) Transcranial Direct Current Stimulation (TDCS)
    • 26. www.patientsmedical.comElectroconvulsiveTherapyTranscranialMagneticStimulation
    • 27. www.patientsmedical.comCranial ElectricalStimulationTranscranial DirectCurrent Stimulation
    • 28. www.patientsmedical.comNON-PHARMACEUTICAL APPROACHESTOTHETREATMENT OF DEPRESSION:Life Style Changes1) Exercise2) Weight Reduction3) Diet and Nutrition4) AvoidingToxic Substances5) Transcendental Meditation
    • 29. www.patientsmedical.comNON-PHARMACEUTICAL APPROACHESTOTHETREATMENT OF DEPRESSION:Nutraceuticals and Supplements1) Omega 3 Fish Oils – DHA and EPA2) Multivitamins (B-Complex and Folate)3) Vitamin D4) Minerals andTrace Elements5) Amino Acids6) Antioxidants7) ProBiotics
    • 30. www.patientsmedical.comPharmaceuticalTreatments Nutraceutical AlternativesMost studied:S-adenosyl-methionine (SAMe),St. John’s Wort (SJW), theomega-3 fatty acids, and folicacid (5-methyltetrahydrofolateor MTHF)Promising:5-hydroxytryptophan (5HT),inositol, rhodiola, and chromium4 Classes of Antidepressants1) SSRIs2) Atypical Antidepressants3) Tricyclic Antidepressants4) MAOIs (Monoamine OxidaseInhibitors)
    • 31. www.patientsmedical.comIntelligent combinations ofamino acids, antioxidants, andother biologically active agentstargeted for specific brainconditions and dysfunctions.
    • 32. Human Umbilical CordMesenchymal Stem Cells(hUCMSC)Trophic Factors from hUCMSCCellular and
    • 33. www.patientsmedical.comThe Integrative Medical Approachwith Dr. Vivian DeNise
    • 34. It is a reaction to stress andat times is
    • 35.  Anxiety disorders are the most commonmental illness in the U.S. Major Depressive disorders are the leadingcause of disability in the U.S. fromages 15-44.3yrs In children, anxiety disorders affect 1 in
    • 36.  Bipolar disorder Eating disorders Headaches Irritable BowelSyndrome (IBS) Sleep disorders Substance abuse Stress Adult ADHD (AttentionDeficit/HyperactiveDisorder) BDD (BodyDysmorphic Disorder) Chronic pain
    • 37.
    • 38.  Thyroid Disorders Adrenal Dysfunction Hormonal Imbalance Poor Gut Health Food Allergies Poor Nutrition Lack of Exercise Psychological Factors Medications Alcohol and/or DrugAbuse
    • 39.
    • 40.  Anxiety/panic attacks Brittle nails Coarse, dry hair Cold hands and feet Constipation Decreased memory Low libido Depression Diffuse hair loss Dizziness/vertigo Dry, itchy ear canals Endometriosis Fatigue Fluid retention Gall stones Headache Increased appetite Infertility Insomnia Iron deficiency/anemia PMS Poor circulation Slower reflexes Swelling in body Weight gain And many others…
    • 41.  Aging LowTSH High ReverseT3 Hashimoto’sThyroiditis Mineral deficiency such asIodine, Zinc, Selenium,Copper and Iron Vitamin Deficiency such asVitamins A,B2,B3, C and D3 Hormonal Imbalance such asLow Estradiol Medications: Beta Blockers,Birth Control Phtalate,Lithium, Chemotherapy Diabetes Heavy metals such as Lead,Mercury Toxins such as PCB’s,Pesticides, Phtalates Stress Poor Diet Excessive Alcohol
    • 42.  Chest pain Excessive sweating Hair loss Heart racing Heat intolerance Heightenedanxiety, irritability, moodiness or depression Increased bowelmovements Muscle weakness Staring gaze Shortness of breath Weight loss Insomnia Light or absentmenstrual cycles Puffiness around
    • 43.
    • 44.
    • 45.
    • 46. Secretes Epinephrine (adrenaline) NorepinephrineThese are secreted in crisis
    • 47. www.patientsmedical.comZonareticularisDHEA (S)ZonafasiculataCortisolZonaglomerulosaAldosterone
    • 48. www.patientsmedical.comHypothalamusAnteriorPituitaryAdrenalCortexCRHACTHCortisol-
    • 49.  Essential for maintaining blood sugar levelsin the proper balance Powerful anti-inflammatory Decreases the effect of white blood cells Direct effect on the heart and blood pressure Influences behavior, mood, excitability Regulation of adrenal sex
    • 50.  DecreasesT4 leading toa decrease inT3 alsoknown as Hypothyroidism Increases Insulin andInsulin Resistance Decreases Estrogen andProgesterone Binge eating Confusion Fatigue Irritability Low Energy Sleep
    • 51.  Pregnenalone DHEA Estrogen Progesterone
    • 52. www.patientsmedical.comDHEAPROGESTERONEANDROSTEINDIONETESTOSTERONEDHT5 alphareductaseESTRONEAromataseAromataseCortisolALDOSTERONECholesterol PregnenaloneESTRADIOL
    • 53.  Enhances nerve transmission and memory Help repair nerve damage Increases resistance to stress Modulates the neurotransmitter GABA Modulates the NMDA receptors Promotes mood elevation Regulates the balance between excitation andinhibition in the nervous
    • 54.  Aging Menopause Smoking
    • 55. www.patientsmedical.comDHEAPROGESTERONEANDROSTEINDIONETESTOSTERONEDHT5 alphareductaseESTRONEAromataseAromataseCortisolALDOSTERONECholesterol PregnenaloneESTRADIOL
    • 56.  Norepinephrine Serotonin Dopamine Acetylcholine
    • 57.  Increases NMDA receptors by 30% Enhances transmission of Dopamine Increases the availability of Acetylcholine Increases availability of Serotonin Increases GABA Increases Norepinephrine Increases sensitivity to Nerve Growth Factor Increases Choline Acetyltransferase Turns on Progesterone Receptors Increases
    • 58.  Increases energy, mood and a feeling of well-being Increases verbal fluency and articulation Increases manual dexterity and speed Decreases distractibility Increases short and long term memory Decreased depression Decreased risk of Alzheimer’s
    • 59.  Balances Estrogen Has a positive effect on sleeping Helps prevent anxiety, irritability and mood swings Relaxes smooth muscle in your
    • 60.  Antidepressants Hypothyroidism Deficiency inVitaminsA,B6, C and Zinc Excessive Arginineconsumption Saturated Fat Sugar
    • 61.  Nutrition Food Allergies Infection Disease
    • 62.
    • 63.  Anxiety Depression Fatigue Bloating Flatulence Diarrhea/ Constipation Migraines Weight gain or
    • 64. www.patientsmedical.comDecreasedAbsorption ofVitaminsDecreasedimmuneresponseDecreasedproductionofSerotonin
    • 65. The Leading Cause ofDepression and Anxiety in the
    • 66. Excessive rapid fall in blood sugar releasesepinephrine and norepinephrine causing a fight orflight
    • 67.
    • 68. Excessive intake can cause symptoms that areindistinguishable from an anxiety
    • 69.  Type I Type
    • 70.  ADHD Arthritis Asthma Candida Chronic ear infections(inflammation) Chronic Fatigue Chronic Pain Cognitive and mooddisorders Diabetes Eczema, Acne, Hives Eating disorders Fibromyalgia Hay fever Headaches Hypoglycemia Insomnia Irritable bowelsyndrome Obesity
    • 71. www.patientsmedical.comInhalationorIngestionofAllergenInflammationProductionofCytokinesInflammationin differentareas of thebodyImmunedysfunctionAutismADHDAsthmaLeakyGutStress+ Interleukin-6
    • 72.  Aspartame
    • 73.
    • 74. MSG (Monosodium Glutamate) can cause:• Numbness• Tingling• Facial pressure or tightness• Headache• Nausea• Rapid Heartbeat• Drowsiness• Chest pain• Difficulty
    • 75. www.patientsmedical.comAlways contains MSG Glutamate MonopotassiumGlutamate Textured Protein Hydrolyzed protein Yeast Nutrient Calcium Caseinate Gelatin Glutamic Acid Flavorings such asnatural chickenflavoring Stock Seasonings Soy Sauce Broth Cornstarch Pectin Bouillion Barley MaltOften contains MSG or createsMSG during processing
    • 76. www.patientsmedical.comAspartame = AsparticAcid + phenylalanine +methanolAccounts for > 75% of adverse reactions to foodadditives reported to FDA.
    • 77. Numbness Muscle spasms Weight gain Rashes Depression Fatigue Irritability Tachycardia Insomnia Visual disturbances Hearing loss Palpitations Headaches/migraines Dizziness Seizures Nausea
    • 78. Essential Fatty Acids:Oxmega-3, GLA(borageoil, Black Currant Seeds,Evening Primrose) Quercitin Pycnongenol Curcumin*the active ingredient inTumeric Transfer factor Zinc Vitamin E-preventsoxidation of EFA’s Vitamin A
    • 79. Diary products Wheat Corn Eggs Citrus Coffee, tea, alcohol Refined sugar Food additives Known allergens Tap water Any known allergen Any food you eat morethan 3 times a week
    • 80. Candidiasis Parasites Bacterial
    • 81. Celiac Disease Crohn’s Disease
    • 82. Bypass surgery Resection of the bowel
    • 83. Lack of exercise decreasesendorphins Medications such as oralcontraceptives decreasevitamin B6 Alcohol and or drug abusedecrease folic acid andthiamine
    • 84. Magnesium Vitamin B12 B complex Omega 3 L tryptophan DHEA Theanine SAMe Yoga Sleep Deep Breathing Massages Detoxification Nutrient IV therapy
    • 85.
    • 86.
    • 87.
    • 88. Fill out the pink form now to let us know whenyou would like to see the
    • 89. Make an appointment to see Dr. DeNise so that she can giveyou a complete physical and holistic medical evaluation withblood work Once your total health (mind/body/spirit) has beenevaluated, Dr. DeNise will have you meet with Dr. Lowe, whowill do the Amen Clinic evaluations to determine the bestcourse of treatment Treatment plan will be customized for you by the twodoctors and communicated to you, giving you completesupport at all stages of your care
    • 90. www.patientsmedical.comDr. RashmiGulati, MedicalDirectorDr. Kamau Kokayi,Holistic and ChineseMedicineDr. StuartWeg, Alternative PainManagementDr. Vivan DeNise,Integrative InternalMedicine and PedsDr. Eileen DiFrancescoPsychopharmacologyDr. Gino BottinoHolistic OncologyDr. Paul A. DreschnackPlastic SurgeryDr. L. Deanna HowardHolistic GYNDr. Victor I. RosenbergPlastic SurgeryDr. Marcia A. HarrisHolistic GYN andInternal MedicineDr. Alan Coffino,NephrologyDr. Ayman MattaHolistic Ophthalmology
    • 91.
    • 92.
    • 93. www.patientsmedical.comTo get more information or to schedule anappointment,call 212-679-9667 oremail