In this first lecture of his 5-lecture series for IMMH in Santa Fe, NM, Dr. Cady reviews the absolute need to get the biological basis right in confusing and confounding cases. Using real patient stories, he illustrates the blending of functional testing, food allergy testing, and hormonal interventions.
Natural Treatments for ADHD - December 7th, 2016 - Saint Marys HospitalLouis Cady, MD
This lecture, presented December 7th, 2016 for the Parent Support Group for children with ADHD and Sensory Processing Disorders, was presented at Saint Marys Hospital in Evansville, Indiana. In this one hour presentation, Dr. Cady broke down some of the alternative treatments for ADHD, grounded in the peer-reviewed literature, that do not involve the prescription of typical psychiatric medication for ADHD. He emphasized, natural, holistic treatments to treat deficiencies and restore balance of nutrients and specific essential fatty acids.
This is the second of five lectures given by Dr. Cady in Santa Fe, NM for the 2012 IMMH conference. It covers the need to identify the hormonal deficiencies of a patient, and ways to remediate them.
This is the 2016 version of Dr. Cady's fundamental lecture on the thyroid and its hormone replacement, particularly as it pertains to mental health as well as medical health.
Medicine: A State of CRISIS, a State of CHANGELouis Cady, MD
Dr. Cady returns this year to repeat and update one of the most talked about presentations of the 2015 IMMH conference. In this presentation, Dr. Cady deconstructs the pressures and challenges facing patients, physicians, and all health care practitioners in today's practice environment. The role of integrated practice and functional medicine as a "differentiating factor" in one's practice is reviewed. The need for patients to adapt a healthy life style and take responsibility for their health for their own economic self-preservation is also touched on.
Natural Treatments for ADHD - December 7th, 2016 - Saint Marys HospitalLouis Cady, MD
This lecture, presented December 7th, 2016 for the Parent Support Group for children with ADHD and Sensory Processing Disorders, was presented at Saint Marys Hospital in Evansville, Indiana. In this one hour presentation, Dr. Cady broke down some of the alternative treatments for ADHD, grounded in the peer-reviewed literature, that do not involve the prescription of typical psychiatric medication for ADHD. He emphasized, natural, holistic treatments to treat deficiencies and restore balance of nutrients and specific essential fatty acids.
This is the second of five lectures given by Dr. Cady in Santa Fe, NM for the 2012 IMMH conference. It covers the need to identify the hormonal deficiencies of a patient, and ways to remediate them.
This is the 2016 version of Dr. Cady's fundamental lecture on the thyroid and its hormone replacement, particularly as it pertains to mental health as well as medical health.
Medicine: A State of CRISIS, a State of CHANGELouis Cady, MD
Dr. Cady returns this year to repeat and update one of the most talked about presentations of the 2015 IMMH conference. In this presentation, Dr. Cady deconstructs the pressures and challenges facing patients, physicians, and all health care practitioners in today's practice environment. The role of integrated practice and functional medicine as a "differentiating factor" in one's practice is reviewed. The need for patients to adapt a healthy life style and take responsibility for their health for their own economic self-preservation is also touched on.
Female Sexual Interest/ Arousal Disorder- ManagementSujoy Dasgupta
Invited lecture by Dr Sujoy Dasgupta in a Webinar on "Female Sexual Dysfunction" organized by FOGSI Sexual Medicine Committee, Falidabad, Palwal and Yamuna Nagar OBGYN Society, held in August, 2021
This is the first of four CME lectures delivered by Dr. Cady at the 4rth Annual Integrated Medicine For Mental Health Conference in Chicago, IL at McCormick Place, September 21, 2013. In it, he deconstructs the facts and fallacies surrounding the thyroid axis, what should be measured, why it's important, and what happens to patients with suboptimal thyroid status.
The scientific literature, quoted right up to the day before the conference started, is extensive and well sourced.
Any practicing physician, and certainly any interested patient(s) should familiarize himself or herself with this content.
New Concepts in Micronutrient Adequacy and Health Optimization - Cady = May 1...Louis Cady, MD
In this presentation, Dr. Cady revisits the BioPhotonic Scanner and current concepts in lack of nutrient adequacy in the contemporary diet. The role of appropriate supplementation with vitamins, minerals, and antioxidants is reviewed.
Introduction to Integrative Medicine for Mental HealthLouis Cady, MD
This is the first of three lectures that Dr. Cady will present in Sao Paulo, Brazil, for Laboratorio Great Plains. In it, he reviews key concepts of integrative medicine, functional testing, and a rational style of thinking through a patient's problems down to the fundamental level. IgG food allergies, depression, low testosterone, and nutrient deficiencies are all covered
The Integrative Treatment of Depression, Schizophrenia & Autism - IMMH 2015Louis Cady, MD
This is the first of three lectures given by Dr. Cady at the 6th annual Integrative Medicine and Mental Health Conference in San Diego, on September 18, 2015. In it, Dr. Cady deconstructs the contributing factors to either exacerbating or causing a diagnosable mental disorder. The use of understanding the pathophysiology of the entire body, and not just firing antidepressants and other psychotropic drugs blindly into the patient without thinking, is clearly reviewed.
This is the second of three lectures Dr. Cady presented in San Diego at the Integrated Medicine and Mental Health Conference, on September 19, 2015. This lecture reviews common variances in practice from some of the professional societies and sets them in clear contrast to the peer reviewed medical literature, taken on balance. The use of alternative forms of therapy besides levothyroxine (Synthroid ® ) are reviewed: Armour, Westhroid, Naturethroid, and T3 or liothyronine (Cytomel ®). Decreased coronary risk factors with a decrease in TSH, showing adequately treated subclinical hypothyroidism, is reviewed. Need for iodine discussed.
2 & 3 together hormones, allopathic psychiatryLouis Cady, MD
Dr. Cady's update lecture for World Link Medical - August 17, 2012. Topics: use of hormones in functional medicine (and psychiatry) as well as "pedal to the metal" allopathic psychiatry.
The Do It To Yourself Treatment of Depression - Webinar #3Louis Cady, MD
This is the third in a series of five webinars. The first was on staying alive by boosting your immunity during COVID 19. The second was on not screwing yourself up inside your head. This third one encompasses a romp through the peer reviewed medical literature looking for supplements and nutrients that you could use to self treat depression at home, CAREFULLY. Numerous cautions and warnings are included.
The driving impetus to this program is that many people - due to social isolation and their mental health care, or medical practitioners' offices being closed down - have not been able to get help or succeed in optimizing their treatment for depression. There are multiple useful nutrients for both depression and anxiety in nature's abundant pharmacopeia, and this webinar touches on just a few of them.
I hope you enjoy it.
How to Transition from Allopathic to Integrated Practice - IMM Brazil 2015Louis Cady, MD
In this lecture, Dr. Cady compares and contrasts the significance differences, both conceptually and practically, between the conventional practice of medicine and a more rational, functional, integrated approach. Tactical concepts and didactic tools to make the transition are reviewed.
The Physician In Spite of Himself (returns!) -San Antonio 2014Louis Cady, MD
In this first of four lectures delivered at the IMMH Conference in San Antonio, Texas - September 19, 2014 - Dr. Cady touches on themes from last year's presentation and introduces fun and exciting new ways to look at function medicine. This year's talk heavily emphasizes the role of nutritional supplementation in supporting the structure and function of the human body. Updates from clinical cases encountered last year are also covered. General topics in this presentation include:
- the importance of evaluating and balancing the thyroid axis
- the importance of sex steroids and DHEA
- the importance of antioxidants, mineral, multivitamins, and essential fatty acids in optimal health
- the need to clearly identify, articulate, and treat the differences between something that is a pure "psychiatric" condition and the covert masqueraders which may actually represent undiagnosed and untreated physiological/medical conditions until addressed.
Thyroid, Adrenals, and Sex Steroids - A Balancing ActLouis Cady, MD
This was the second presentation gibven on MZarch 29, 2019 at the Manlove Psychiagtric Group and Brain Injury Institute spring conference in Rapid City, SD.
In this presentation, Dr. Cady carefully goes over the necessity of integrating and overview and awareness of hormones and their levels in the elucidation of what truly is going on with the patient.
This was an overview lecture only. Dr. Cady will be presenting a 16 hour CME program in Austin Texas on June 22 and 23 for the National Procedures Institute, and will explore all aspects of all relevant hormones and what can be done to manage and optimize them.
SEND IN THE SHRINKS - Olicer CME Seminar 2029lcadymd1
OK. This was a fun one.
I was invited by me physician colleague, Randall Oliver, MD, to present this lecgure at the CME lecture series he had arranged in Evansville. As the title would suggest, this is a presentation looking at psychiatric and psychopharmacology topics in primary care medicine. The conclusion of this lecture, if the participants mastered it, they could prescribe psychiatric medications with greater finesse than most board-certified pychiatrists.
It was a wonderful, "tuned in" and "there to learn" audience. It was a privilege to present to them.
SEND IN THE SHRINKS - 2009 Oliver CME seminarLouis Cady, MD
This one was fun.
I was invited by Dr. Randalll Oliver, MD, Founder of the Oliver Heachache and Pain Clinic in Evansville, to present to an audience of primary care practitioners about how to use pysychiatric mediations ("psychopharmacology") in clinical practice.
Along the way, I covered, ADHD and treatments, depression, anxiety, erectile dysfunction, hypoadrenia, and even touched on hypothyroidism. Although this presentation was in 2009, all of the drugs covered are stills in use, and, at times.... stupidly.
This presentation deconstructs the intricacies of selecting and antidepressant, particularly in the SSRI class.
These are the final two lectures given by Dr. Cady in Salt Lake City, UT on June 1, 2012. The first lecture deals with the use of hormones in traditional psychiatry and medicine, as supported by the peer reviewed literature. The second lecture, which is in this slide deck "back to back" with the first one, is on what Dr. Cady refers to as "Pedal to the Metal Allopathic Psychiatry." That is - using medications with finesse and, when indicated, with forcefulness. Functional and integrated medicine does not mean sitting around eating fruits, nuts, and flakes, but rather using the best techniques and tools that we have available to us from all fields of medicine (including traditional, classical allopathic medicine).
Thyroid On My Mind - IMMH, San Antonio 2014Louis Cady, MD
In this lecture, the 2nd of 4 delivered at the Integrated Medicine and Mental Health Conference in San Antonio, TX, Dr. Cady carefully reviews the literature regarding thyroid status and optimization. Multiple citations from the peer-reviewed medical literature are referenced and cited. At the conclusion of viewing this presentation, the viewer should be able to recognize the absolute fallacy of checking just TSH, and recognize the necessity of looking at the entire thyroid axis in terms of diagnosis and treatment. Relevant in depression and cognition are reviewed.
Female Sexual Interest/ Arousal Disorder- ManagementSujoy Dasgupta
Invited lecture by Dr Sujoy Dasgupta in a Webinar on "Female Sexual Dysfunction" organized by FOGSI Sexual Medicine Committee, Falidabad, Palwal and Yamuna Nagar OBGYN Society, held in August, 2021
This is the first of four CME lectures delivered by Dr. Cady at the 4rth Annual Integrated Medicine For Mental Health Conference in Chicago, IL at McCormick Place, September 21, 2013. In it, he deconstructs the facts and fallacies surrounding the thyroid axis, what should be measured, why it's important, and what happens to patients with suboptimal thyroid status.
The scientific literature, quoted right up to the day before the conference started, is extensive and well sourced.
Any practicing physician, and certainly any interested patient(s) should familiarize himself or herself with this content.
New Concepts in Micronutrient Adequacy and Health Optimization - Cady = May 1...Louis Cady, MD
In this presentation, Dr. Cady revisits the BioPhotonic Scanner and current concepts in lack of nutrient adequacy in the contemporary diet. The role of appropriate supplementation with vitamins, minerals, and antioxidants is reviewed.
Introduction to Integrative Medicine for Mental HealthLouis Cady, MD
This is the first of three lectures that Dr. Cady will present in Sao Paulo, Brazil, for Laboratorio Great Plains. In it, he reviews key concepts of integrative medicine, functional testing, and a rational style of thinking through a patient's problems down to the fundamental level. IgG food allergies, depression, low testosterone, and nutrient deficiencies are all covered
The Integrative Treatment of Depression, Schizophrenia & Autism - IMMH 2015Louis Cady, MD
This is the first of three lectures given by Dr. Cady at the 6th annual Integrative Medicine and Mental Health Conference in San Diego, on September 18, 2015. In it, Dr. Cady deconstructs the contributing factors to either exacerbating or causing a diagnosable mental disorder. The use of understanding the pathophysiology of the entire body, and not just firing antidepressants and other psychotropic drugs blindly into the patient without thinking, is clearly reviewed.
This is the second of three lectures Dr. Cady presented in San Diego at the Integrated Medicine and Mental Health Conference, on September 19, 2015. This lecture reviews common variances in practice from some of the professional societies and sets them in clear contrast to the peer reviewed medical literature, taken on balance. The use of alternative forms of therapy besides levothyroxine (Synthroid ® ) are reviewed: Armour, Westhroid, Naturethroid, and T3 or liothyronine (Cytomel ®). Decreased coronary risk factors with a decrease in TSH, showing adequately treated subclinical hypothyroidism, is reviewed. Need for iodine discussed.
2 & 3 together hormones, allopathic psychiatryLouis Cady, MD
Dr. Cady's update lecture for World Link Medical - August 17, 2012. Topics: use of hormones in functional medicine (and psychiatry) as well as "pedal to the metal" allopathic psychiatry.
The Do It To Yourself Treatment of Depression - Webinar #3Louis Cady, MD
This is the third in a series of five webinars. The first was on staying alive by boosting your immunity during COVID 19. The second was on not screwing yourself up inside your head. This third one encompasses a romp through the peer reviewed medical literature looking for supplements and nutrients that you could use to self treat depression at home, CAREFULLY. Numerous cautions and warnings are included.
The driving impetus to this program is that many people - due to social isolation and their mental health care, or medical practitioners' offices being closed down - have not been able to get help or succeed in optimizing their treatment for depression. There are multiple useful nutrients for both depression and anxiety in nature's abundant pharmacopeia, and this webinar touches on just a few of them.
I hope you enjoy it.
How to Transition from Allopathic to Integrated Practice - IMM Brazil 2015Louis Cady, MD
In this lecture, Dr. Cady compares and contrasts the significance differences, both conceptually and practically, between the conventional practice of medicine and a more rational, functional, integrated approach. Tactical concepts and didactic tools to make the transition are reviewed.
The Physician In Spite of Himself (returns!) -San Antonio 2014Louis Cady, MD
In this first of four lectures delivered at the IMMH Conference in San Antonio, Texas - September 19, 2014 - Dr. Cady touches on themes from last year's presentation and introduces fun and exciting new ways to look at function medicine. This year's talk heavily emphasizes the role of nutritional supplementation in supporting the structure and function of the human body. Updates from clinical cases encountered last year are also covered. General topics in this presentation include:
- the importance of evaluating and balancing the thyroid axis
- the importance of sex steroids and DHEA
- the importance of antioxidants, mineral, multivitamins, and essential fatty acids in optimal health
- the need to clearly identify, articulate, and treat the differences between something that is a pure "psychiatric" condition and the covert masqueraders which may actually represent undiagnosed and untreated physiological/medical conditions until addressed.
Thyroid, Adrenals, and Sex Steroids - A Balancing ActLouis Cady, MD
This was the second presentation gibven on MZarch 29, 2019 at the Manlove Psychiagtric Group and Brain Injury Institute spring conference in Rapid City, SD.
In this presentation, Dr. Cady carefully goes over the necessity of integrating and overview and awareness of hormones and their levels in the elucidation of what truly is going on with the patient.
This was an overview lecture only. Dr. Cady will be presenting a 16 hour CME program in Austin Texas on June 22 and 23 for the National Procedures Institute, and will explore all aspects of all relevant hormones and what can be done to manage and optimize them.
SEND IN THE SHRINKS - Olicer CME Seminar 2029lcadymd1
OK. This was a fun one.
I was invited by me physician colleague, Randall Oliver, MD, to present this lecgure at the CME lecture series he had arranged in Evansville. As the title would suggest, this is a presentation looking at psychiatric and psychopharmacology topics in primary care medicine. The conclusion of this lecture, if the participants mastered it, they could prescribe psychiatric medications with greater finesse than most board-certified pychiatrists.
It was a wonderful, "tuned in" and "there to learn" audience. It was a privilege to present to them.
SEND IN THE SHRINKS - 2009 Oliver CME seminarLouis Cady, MD
This one was fun.
I was invited by Dr. Randalll Oliver, MD, Founder of the Oliver Heachache and Pain Clinic in Evansville, to present to an audience of primary care practitioners about how to use pysychiatric mediations ("psychopharmacology") in clinical practice.
Along the way, I covered, ADHD and treatments, depression, anxiety, erectile dysfunction, hypoadrenia, and even touched on hypothyroidism. Although this presentation was in 2009, all of the drugs covered are stills in use, and, at times.... stupidly.
This presentation deconstructs the intricacies of selecting and antidepressant, particularly in the SSRI class.
These are the final two lectures given by Dr. Cady in Salt Lake City, UT on June 1, 2012. The first lecture deals with the use of hormones in traditional psychiatry and medicine, as supported by the peer reviewed literature. The second lecture, which is in this slide deck "back to back" with the first one, is on what Dr. Cady refers to as "Pedal to the Metal Allopathic Psychiatry." That is - using medications with finesse and, when indicated, with forcefulness. Functional and integrated medicine does not mean sitting around eating fruits, nuts, and flakes, but rather using the best techniques and tools that we have available to us from all fields of medicine (including traditional, classical allopathic medicine).
Thyroid On My Mind - IMMH, San Antonio 2014Louis Cady, MD
In this lecture, the 2nd of 4 delivered at the Integrated Medicine and Mental Health Conference in San Antonio, TX, Dr. Cady carefully reviews the literature regarding thyroid status and optimization. Multiple citations from the peer-reviewed medical literature are referenced and cited. At the conclusion of viewing this presentation, the viewer should be able to recognize the absolute fallacy of checking just TSH, and recognize the necessity of looking at the entire thyroid axis in terms of diagnosis and treatment. Relevant in depression and cognition are reviewed.
Learn how powerfully movement can influence mood and memory. As the Western population ages and we struggle with an unprecedented level of mental illness, movement is even more important than ever before.
Hormones and Mental Health - Thyroid and Testosterone.pptxLouis Cady, MD
In this presentation for the Psychiatry Redefined program, Dr.
Cady breaks down and deconstructs the accepted, unthinking, "practice guideline based" notions of thyroid and tesotsterone, with there seemingly "normal" levels and dosing, versus what the actual peer reviewed medical literature says. In this presentation, do use of all forms of thyroid, and all forms of testosterone are reviewed. The idiocy of "T4 only treatment" is covered. The use of T4, T3, a combination of T4 and T3, and all of the porcine and compounded products is review.
In terms of testosterone, dr. Katie reviews the concept of "do you want to be optimal or do you want to be normal." He notes that it is "normal" for oil in cars to deteriorate and break down with age. It's also "normal" for men's and women's testosterone (as well as thyroid) to go down with age. The question is, "do we want to do anything about it?"
Logical ways of intervening in both the thyroid and female and male gonadal axes are covered. There is scrupulous attention paid to the thyroid hormone pathways, and the relevance of reverse T3 versus free T3. Similarly, in terms of women, the downstream effect of estradiol coming from testosterone is also reviewed.
Hormones, Cognition, and Mood Changes in Older AdultsLouis Cady, MD
HORMONES, COGNITION AND MOOD CHANGES IN OLDER ADULTS. This is Dr. Cady's lecture from the Age Management Medical Group meeting in las Vegas, NV, PRESENTED 12 2 2012.
Lifestyle Medicine: The Power of Personal Choices, North American Vegetarian...EsserHealth
Learn about the leading chronic diseases in America and how Lifestyle Medicine can radically shift the burden of disease in your life and western society at large.
Similar to Scratching Your Head Psychiatry: Practicing OUTSIDE of the Allopathic Box (20)
What is the nature of QUALITY in medicine -for ASQ 11 14 2023.pptLouis Cady, MD
In this presentation, Dr. Cady deconstructs the tensions and stressors on both patients and health care providers in today's system.
This presentation reviews checklists foe liminating mistakes, the actual number of mistakes that are being made in medical practice, and what patients and their loved ones can do for self protection.
This isn't a "bash the doctor" presentation. It's a thoughtful, careful exploration of stresses and ramifications to the current US healthcare system.
This was a Grand Rounds program for St. Marys Hospital (now Ascension St. Vincent) in Evansville delivered on April 2, 2014. It is uploaded to my slideshare site as a public service to patients and mental health practitioners.
We are actually no longer using TMS at Cady Wellness, having transitioned to the attempting maximum stabilization of our patients with nutraceuticals, hormones, and the latest advance in psychopharmacology. This includes intramuscularly administered ketamine, which has been transformative in many of our patients.
The Moral Imperative of Integrative Medicine 2022.pptLouis Cady, MD
Presented to Psychiatry Redefined Meeting - September 10, 2022
Three cases are reviewed - two with MTHFR deficiencies and pharmcotherapy challenges; one case with schizophrenia solidly treated with clozapine but also with additional antidepressant (vortioxetine) and functional, integrative medicine techniques.
CORONOFOBIA - Passos práticos para equilibrar as defesas do corpo e da menteLouis Cady, MD
Esta palestra, apresentada em 29 de maio de 2021 para o Congresso de Medicina Integrativa para a Saúde Mental 2020, promovido pelo Laboratório Great Plains no Brasil, enfocou coisas simples e de bom senso que os pacientes (e seus médicos) podem fazer para se manter seguros e viver durante o Pandemia do covid.
Os seguintes conceitos holísticos foram revisados:
- sono adequado e por que é tão importante;
- o uso de melatonina, cientificamente validada como tendo atividade antiviral (referências citadas);
- a importância de diminuir o estresse e técnicas para fazê-lo;
- a necessidade de "comer frutas e vegetais" como sua mãe e sua avó ensinaram devido à ingestão de carotenóides e antioxidantes ((referências citadas);
- o uso adequado de suplementos vitamínicos / nutricionais (referências citadas).
O foco desta apresentação não foram medidas heróicas para salvar vidas na unidade de terapia intensiva para pacientes gravemente enfermos com COVID, mas, sim, técnicas de bom senso, práticas, baratas e (em alguns casos) GRATUITAS para melhorar você e seus pacientes 'saúde e resistência às doenças.
THE MORAL IMPERATIVE OF INTEGRATIVE MEDICINE - O IMPERATIVO MORAL DA MEDICINA...Louis Cady, MD
Neste programa, o Dr. Cady baseia-se em uma série de casos clínicos para ilustrar a necessidade absoluta e moral do tratamento de precisão de nossos pacientes com todas as ferramentas disponíveis para uso por meio da medicina integrativa.
O uso de testes de polimorfismo MTHFR, testes convencionais e laboratoriais e testes farmacogenômicos foram revisados.
Os casos apresentados ilustram a trágica dificuldade de um menino com deficiência de MTHFR que estava prestes a desviar sua vida; um paciente esquizofrênico com vários problemas de medicina funcional que precisavam ser resolvidos (levedura, glúten, sensibilidade alimentar de IgG); uma estudante universitária a quem foi dito "não há nada de errado com você; seus laboratórios estão bem", embora ela tenha manifestado todos os sintomas relevantes de hipotireoidismo; e um CEO do sexo masculino de 42 anos que estava "tão cansado que parecia morrer" e que, na verdade, estava funcionalmente com pouco testosterona. O último caso revisado foi de um adorável garotinho que tinha autismo e foi recuperado por meio de uma abordagem focada e intensa de medicina integrativa.
Dr. Cady deconstructs some the medical literature about the use of nutrients - and the evidence of what happens in the presence of their insufficiency. Everything for decreased viral replication to decrease brain shrinkage is covered. The role of antioxidant and carotenoids, measured by the Pharmanex Biophotonic Scanner, is reviewed.
Please note - there is no representation that any nutrient or supplement can treat, prevent, mitigate, or cure any medical condition. It does seem, however, upon reflecting on the medical literature, that there seems to be a lot of evidence for therapeutic effect in the presence of good levels of nutrient, and harm to patients if they have insufficient levels.
Subtitle: The Moral Imperative of Integrative Medicine
This presentation, two hours in length, was delivered to the A4m MMI Audience in their Frontiers of Neurology - Module 3.
The following topics are reviewed:
- ADHD, Autism, Depression, Schizophrenia
- the impact of neuroinflammation on all of these.
- confounding factors and the ways to mitigate them: Omega6/Omega 3 imbalance in the Western diet, MTHFR polymorphism, the use of elemental lithium, the presence of intestinal dysbiosis and the role of gluten/dairy IgG Food allergies.
- pharmacogenomic testing
The Moral Imperative of Integrative Medicine - IMMH 2020Louis Cady, MD
IN this presentation, Dr. Cady reviews several of the handful of functional, integrative medicine techniques required for a holistic and comprehensive management of psychiatric issues. MTHFR, hormone balance, diagnosis and treating intestinal dysbiosis, need for trace elements, and hormones (including thyroid, testosterone and estradiol) are reviewed.
This brief webinar, a gift to the local Jewish community and Temple Adath B'Nai Israel here in Evansville, IN, reviews the tradition of mindfulness and the interdigitation of Buddhist practices with some Jewish traditions. Dr. Cady reviews the downstream effects of stress, how meditation and mindfulness are useful tools and techniques, and actually how to practice it. Multiple references without being complicated or overdone are provided.
Webinar 5: Designing Your Future: WHAT'S COMING NEXT?Louis Cady, MD
In this capstone webinar presentation, closing out Dr. Cady's series on dealing with COVID 19, he turns his attention to a nunmber of interesting thems:
- what's the REAL case fatality rate of COVID 19
- How is it likely that society will reopen?
- What's going to happen in education and medicine?
- What's going to happen when the robots and AI arrive?
- What's the future going to be out 500 years?
HOW TO SAVE MONEY ON YOUR HEALTHCARE: An Integrative Medicine ApproachLouis Cady, MD
In this webinar, the fourth in a series of five from Dr. Louis Cady and the Cady Wellness Institute, we focus on the actual dollars and cents of health care expenditures, and the societal and PERSONAL costs of poor health maintenance behavior. We examine the essentially passive US medical system, that would rather drug a symptom than fix the underlying problem.
Great attention is paid on not shaming the patient or the doctors as they exist in the current system. Both groups "do not know what they do not know." Confirmation bias is rampant.
This webinar points the way to living a more vital, energetic life, with a minimum of cost, grief, and misery.
HOW TO COPE WITH THE PSYCHOLOGICAL IMPACT OF COVID 19 AND SOCIAL DISTANCINGis...Louis Cady, MD
In this presentation, Dr. Cady will review:
- What did Sparky learn about not being an emotional support animal?
- "Do it to yourself psychotherapy." Learn the following:
- What are the wrong - and the RIGHT ways of any sort of "behavioral therapy"?
- How to use a journal to think RATIONALLY and “get out of your head.”
- How to get out of your HEAD and into your LIFE.
- We'll cover all 10 of David Burns’ cognitive distortions, customized and gift-wrapped for dealing with COVID 19.
- We will cover actionable examples of how to reprogram yourself.
We will review What are the 3 P's of Positive Psychology and Learned Optimism?
The Cady 5 "5P’s” and “How to shrink yourself."
Can we find the GOOD in COVID?
This presentation is meant to be provocative and to challenge you mentally, intellectually, and emotionally. Some of the great thinkers and exemplars of human performance and possibility are featured.
BOOSTING YOUR IMMUNITY During the COVID 19 PandemicLouis Cady, MD
In this presentation, presented as a live webinar on Monday, April 27th, Dr. Louis Cady of the Cady Wellness Institute reviewed practical, common-sense things that can be done to boost your immunity, with documentation from the peer-reviewed medical literature. Dr. Cady also reviews supplements and nutrients that are established in the peer-reviewed medical literature as having antiviral capabilities. These include Vitamins C,D, and E, Zinc, carotenoids and antioxidants, probiotics, the reishi mushroom, elderberry, cannabidiol (CBD - not marijuana or weed!).
Points presented are scrupulously documented from the medical literature. This presentation does not guarantee or represent that using ANY of these nutrients will "keep you from getting infected or dying" from COVID 19. They are presented for your thoughtful consideration.
Tratamento holistica de ezschizophrenia - São Paulo, Brazil April 20, 2019Louis Cady, MD
Esta é a versão em inglês da apresentação do Dr. Cady feita na UNIP (Campus Paraiso - São Paulo, SP Brasil) para o Congresso de Saúde Mental de 2019 (Conferência sobre Saúde Mental). Foi entregue em 20 de abril de 2019.
Nesta apresentação, o Dr. Cady analisa brevemente a história da esquizofrenia, a falha do bloqueio do receptor de dopamina D2 como uma cura universal na esquizofrenia, e várias intervenções holísticas que podem impactar forte e positivamente os sintomas da esquizofrenia. Incluídos na pesquisa do Dr. Cady estavam o papel dos ácidos graxos essenciais, deficiências nutricionais (particularmente vitaminas do complexo B), o perigo de supercrescimento da cândida, testes farmacogenômicos, polimorfismos da MTHFR e muito mais.
Foi uma honra e um privilégio entregar esta apresentação em
São Paulo.
Para mais informações no Brasil sobre este tema, ou para solicitar uma gravação em vídeo / áudio da conferência, entre em contato com Luiz Dias do Laboratório Grandes Planícies no Brasil.
Slides, até o apêndice, são traduzidos por Luiz Dias.
The integrative treatment of schizophrenia brazil 2019Louis Cady, MD
This is the English language version of Dr. Cady's presentation given at UNIP (Campus Paraiso - Sao Paulo, SP Brazil) for the 2019 Congresso de Saude Mental (Conference on Mental Health). It was delivered April 20, 2019.
This presentation also includes extra slides in the appendix that were not presented, and, unfortunately, these slides of the appendix have not been translated in the Portuguse version of this presentation.
In this presentation (Portuguese presentation will also be posted next), Dr. Cady briefly reviews the history of schizophrenia, the failure of the dopamine D2 receptor blockage as a universal cure-all in schizophrenia, and various holistic interventions which can strongly and positively impact symptoms of schizophrenia. Included in Dr. Cady's survey were the role of essential fatty acids, nutrient deficiencies (particularly B vitamins), the danger of overgrowth of candida , pharmacogenomic testing, MTHFR polymorphisms, and more.
It was an honor and a privilege to deliver this presentation in
São Paulo,.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
Natural Treatments for ADHD (TADH) in Sao Paulo, Brazil, for Laboratorio Grea...Louis Cady, MD
In this presentation, given at UNIP (Campus Paraiso - Sao Paulo, SP Brazo) for the 2019 Congresso de Saude Mental (Conference on Mental Health), Dr. Cady reviewed the prevalence, inheritability, and social ramifications of ADHD (TADH in Brazil). He specifically reviewed multiple holistic interventions, including limiting "electric screen time,"good quality diet with adequate amounts of essential fatty acids and critically important trace elements, and the use of pharmacogenomic testing as well as functional, integrative medicine testing, all to better characterize logical and reeasonmable points for holistic intervention.
This presentation was simultaneously translated into Portugue for the attendees, but unfortunately the slides were not available in translated form.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
This lecture was presented on March 29, 2019 in Rapid Citry, South Dakota, for the conference co-sponsored by the Manlove Psychiatric Group and the Brain Injury Center.
It reviews the uptick in diagnosis of ADHD, the raiontale for its concern, causative factors, and how it can be worked up holistically and in a balanced, not necessarily medication-oriented way.
Use of high dose fish oil, iron supplementation, and how to overrcome nutritional deficiencies are discussed.
Medical Discussion of the Endocannabinoid SystemLouis Cady, MD
In this lecture, given in Evansville, IN, on April 22nd, Dr. Cady reviews the scientific rersearch on the endocannabinoid system and the rationale for appropriately using it as a nmodality to optimize the structure and function of the body. This is a NON-BRANDED presentationb, and deals ONLY with the "ECS."
This is the lecture delivered on September 8th, 2018 in Dallas Texas for the 2018 IMMH Conference. It's always a thrill to present there.
In this presentation, I cover the "conventional" way practitioners look at thyroid, contrasting it with a different OPTIMIZING approach. Risks vs. benefits of thyroid supplementation are reviewed. Specific thyroid meds and doses are cited.
In this Grand Rounds presentation, delivered to the Dept. of Psychiatry of the University of Cincinnati, Dr. Cady reviews the multiplicity of potential causes, as well as the multiplicity of pharmacological, psychological, and holistic interventions.
Among the topics covered are the following:
- the multidimensional matrix of causality posited to be relevant for schizophrenia
- the deficiency of the "dopamine hypothesis of schizophrenia and the overly simplistic mental model that has been programmed into at least two generations of practitioners
- the rationale for looking at other things besides "drugs" or "psych meds"
- an admonition to the practitioner to not forsake the origins of our profession where the dyadic relationship is honored; further, to be aware of how therapeutic impasses with schizophrenic patients may be frustrating to the practitioner and interfere with treatment;
- the relevant exploration and use of Vitamin D, omega e fatty acids, N-acetyl cysteine, gluten & casein free diets, *elemental* lithium, antifungals.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Scratching Your Head Psychiatry: Practicing OUTSIDE of the Allopathic Box
1. IMMH - Santa Fe, NM
– September 22, 2012
SCRATCHING YOUR HEAD PSYCHIATRY I:
How to Think OUTSIDE the Allopathic Box…
[and why you would want to…]
Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute
Adjunct Professor – University of Southern Indiana
Adjunct Clinical Lecturer – Indiana University School of Medicine
Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana
(c) 2012 Louis B. Cady, M.D. - all rights reserved
2. Louis B. Cady, M.D. – historical statement of
support, conflict of interests
• Abbott Laboratories
• Bristol-Myers Squibb (Serzone)
• Celltech (Metadate CD)
• Cephalon (Provigil)
• Elli Lilly (Prozac, atomoxetine research)
• Forest Pharmaceuticals
(Celexa, Lexapro, Namenda, Viibryd)
• Glaxo-SmithKline (Wellbutrin)
• Janssen (Concerta, [Reminyl]/ Razadyne)
• McNeil (Concerta)
• Pfizer-Roerig (Zoloft, Pristiq)
• Sanofi~aventis (Ambien)
• Sepracor (Lunesta)
• Searle Pharmaceutical (Ambien)
• Shire Pharmaceuticals (Adderall, Daytrana, Vyvanse,
Intuniv)
• Shionogi & Co., Ltd. (Kapvay)
• Takeda Pharmaceuticals (Rozerem) Note: All of Dr. Cady’s presentations for this
• World Link Medical conference are sponsored by Great Plains Dx Labs
• Wyeth-Ayerst (Effexor, Pristiq)
4. “There are things
known and there are
things unknown, and
in between are the
doors.”
- Jim Morrison
5. Is there a need to think “outside of
the box?”
• Patients not getting better with all the “right”
drugs.
• Heroic psychopharmacology not working.
• Chiropractic adjustments and nutritional
interventions not working.
• Dietary interventions not workiing.
• ECT and TMS not working.
• And the patient is still not improving despite
your best care…
9. Selecting Your Perspective
• The diagnosis may be wrong.
• The treatment may be wrong.
– (or insufficiently potent)
• The presumptive “medical stability” of the
patient may be wrong.
• The patient’s hormones may be out of the
optimum range.
10. Cady Wellness Institute – July 2005
The Reasons:
• Conventional medical practice had failed me twice.
• A lot of “psychiatric cases” WEREN’T “psychiatric.”
• Nobody was integrated.
• Nobody was looking at ALL of the peer-reviewed
literature.
14. CURRENT PRACTICE OF MEDICINE:
What a patient had to say about her “specialists”:
“They just monitor my
degeneration.”
15.
16. Greben’s “Seven Habits”
• Empathy & concern
• Warmth
• Interaction
• Ability to arouse hope
• Expectation of improvement *
• “Not to despair”
Required to GET THE
• Reliability & Friendliness DATA
*Requires clinical depth and breadth of knowledge –
as well as step-by-step logical decision making.
“On Being Therapeutic” [Canadian Psychiatric Association Journal.
Vol. 22(1977) 371-380.
17. Context for thinking AND practicing
“outside the box”
• If you don’t know it and can’t do it, who CAN
locally?
• Can YOU learn it and do it?
• If you can’t do it (because of licensure) –
who can you partner with and/or refer to?
• The focus of this lecture is to make you
AWARE of what can be done, not
necessarily to insist that you do everything
presented.
18. Consultations with “complementary
and alternative” practitioners
• US, 2004. 36% of US adult >18 yoa
– National Center for Complementary and Alternative
Medicine survey, 2004.
• http://altmedicine.about.com/od/alternativemedicinebasics/a/CAMus
• Canada – 1.2 million adults, or 13% of the
population of Ontario. N = 32,598 surveyed.
– Williams, Kitchen, e al. Alternative health care consultations in Ontario,
Canada. BMC Complementary and Alternative Medicine 2011, 11:47
19. Today’s Medical Practice
Challenges – presenting in mental
health settings…
• Obesity, diabetes, auto-immune, inflammatory and
chronic diseases increasing
• Inflammatory triggers increasing
• Novel viruses and infective organisms
• Unresponsive/resistant infections
• Weakened immune systems
• GI decline/inflammation
• Poor quality /foods/nutritionals
• PEOPLE COMING IN NOT WORKED UP.
20. A case of depression? Symptoms at
presentation:
• 43 year old aerobically fit MWM competitive cyclist/
pharmaceutical rep. Drinks protein shakes (whey).
• Mind and emotions:
– Depression
– Difficulty with memory, attention,
– Short attention span
– Weakness, fatigue, loss of energy
• Miscellaneous:
– Fatigue
– Apathy/lethargy
– Sleep apnea (previously reviewed)
– Difficulty getting out of bed in the a.m.
– Recurrent apthous ulcers
21. Classic “atypical presentation”
• History continued:
– Exhausted/fatigued with multiple vague symptoms for 3
years. Taking naps in car in afternoon while working.
– Intermittently nauseated for last two years. MD ignored
him.
• Known ADD. Started on Vyvanse by family
doc.
• Past history: at 41 yoa – dx’ed with Rocky
Mountain Spoted Fever. Tx’ed with Doxycycline
– Ulcer dx by GI doc, with + h. pylori.
• Rx: Macrobid + Flagyl.
– “Pins & needles sensation under skin began – May
2009 (Antihistamine tried – didn’t work. )
22. Diagnostic Interventions and Trial Tx
• Sleep study – non revealing
• IgE food allergy possibility per dermatologist. Anti-
histamine used. Sxs would stop then come back.
• Soreness – consulted pain management doctor.
No help.
• Testim tried (low normal T) – no help.
• Cholecystectomy – Sept 2009
• Severe constipation Dec 2009 – went days
without bowel movement
• Colonoscopy – benign. Possible “small bowel
bacterial overgrowth.” ABX used.
• Dx’ed with possible Lyme’s – more ABX.
23. Other past dx/tx procedures:
- CT brain – normal
- CT abdomen – normal
- HIDA scan – abnormal
- (Gallbladder subsequently removed)
- MRI – lower lumbar – essentially normal but
with slightly bulging disc
- MRI – thoracic and cervical – good
- Colonoscopy & sigmoidoscopy – benign.
- Muscle biopsy – “nerve damage”
- Stress EKG and Stress Echocardiogram – wnl
24. More symptoms at presentation
• dry/brittle skin; puffy wrinkled skin
• dark circles under eyes
• persistent rash with pins and needles sensations on skin
• “heaviness” in legs; shortness of breath
• exhaustion with minor exertion
• certain foods cause ill feelings
• difficulty losing weight
• Needs to drink coffee to get going in a.m.
• Tired 1 – 3 hours after eating
• Feels faint or weak.
• Rates self as overweight
26. Working hypotheses, treatment
• Anemia – etiology unclear
• Hypoadrenia
• Rule out post-viral fatigue syndrome
• Subclinical hypothyroidism
• Possible symptoms of low testosterone
• Possible IgG food sensitivities (dairy?)
• Probable candida (by history)
• Low Vitamin D
• History of depression and ADHD – on tx.
• History of Lyme Disease – allegedly tx’ed.
27. Initial treatment planning
• Consider transition to Armour
• Consider testosterone
• Dairy free diet. (based on history)
• Start Xymogen IgG 200 DF
• NutraProbiotics – one daily
• Get more labs, including IgG
28. Interventions and follow-up
• 6/14/2011 – Start NO DAIRY DIET.
Baseline medications (incl. Lexapro, T4),
continued. Probiotics. Minimize exposure to
brewer’s yeast.
• 6/30/11 – better energy. “allergic shiners”
gone. (Labs reviewed)
– Rx: started DHEA – 50 mg SR; 5HTP – up to
100 mg daily for documented low serotonin.
Slight increase in thyroid Rx. Start Nystatin.
31. Other interventions and current status
• Testosterone cypionate – 100mg cc IM q wk.
• Armour thyroid – (needed it for a while), then didn’t
• Supplements – in addition to high potency MVI twice daily
(including Zinc)…
– Adrenal supplementation – 2 twice daily
– DHEA 50 mg SR daily
– B-12 – liquid
– Vitamin C – 2500 mg per day in 4 – 5 divided doses
– Vitamin D – 5,000 IU daily
– IGF2000 DF (Xymogen) – one scoop periodically.
– Calcium and 5HTP
– Coenzyme Q10 400 mg per day
• Continue 70 mg Vyvanse and 20 mg Lexapro
32. Zinc & Testosterone
• Low Zinc- associated with low testosterone
– Tsai, E.C., Boyko, E.J., Leonetti, D.L., & Fujimoto, W.Y. (2000).
Low serum testosterone level as a predictor of increased visceral
fat in Japanese-American men. International Journal of Obeisty
and Related Metabolic Disorders, 24, 485-491.
• Per USDA, 60% of US men between 20 –
49 years of age do not get enough.
• Fast food = low zinc = testicular tissue
inflammation = dec. testosterone
– El-Sewedy MM et al. J Pharm Pharmacol. 2008 Sept;60 (9):1237-
42.
33. Low Vitamin D linked to depression
[Muhlestein JB et al. Am Heart J, 2010; 159(6):1037-43.
(citation from Dr. Shaw)
• 7,358 patients >/= 50 yoa with CV diagnosis
and NO HX of depression
• “Vitamin D levels were significantly
associated with an increased risk of
depression, compared with optimal vitamin
D levels.”
• Optimal level: > 50 ng/ml
– Normal 31 – 50 ng/ml
– Low: 16 – 30 ng/ml; “very low = < 15 ng/ml
34. 8/1/2011 follow-up: strict dairy free diet
• “Some days I don’t feel as hot in terms of
energy level. But it has improved. I’m
thinking more clearly.”
• Lost 8 lbs (by desire)
• Rode bike in extreme heat on Sunday for 1
hour.
• “I’m able to get out and do things that I feel
like doing –working around the house,
hanging around my family, and going
fishing.”
35. 9/13/2011
• Went out and rode three hours on his bike
for first time in years.
– “But I came home and crashed.”
• Working full time as rep. No longer
napping.
• Lyme disease diagnosed based on new
labs. Treatment started.
36. 9/13/2012
• Vigorous. Working around the house.
• No limit to activities (or distance for his
rides)
• Career going well
• Biking going well
• Enjoying life.
37. Do we really need all those
supplements and vitamins???
B12, Magnesium, Zinc, fish oil…
38.
39. Modern Medicine’s Paradigm:
Two Standard Deviations – “if you are not
sick, then you must be well.”
“NORMAL”
OPTIMAL?
OPTIMAL
40. Definition of “normal labs”:
“When your lab
values are as
crappy as
everyone else’s.”
- Neal Rouzier,
MD (World Link Medical Seminar II
– Spring 2011)
41. “There are more things in Heaven
and Earth than are dreamt of in
your earthly philosophy, Horatio.”
- Hamlet
43. Let me tell you some more stories.
Once upon a time….
44. The Case of the Phrustrated
Pharmacist…
• 58 yo married Caucasian R.Ph.
• CC: “Seeking definitive diagnosis and
appropriate treatment to improve my energy
level and mood instability. [sic]”
• Active issues:
– Concentration problems
– Weight gain
– “feeling like a slug”
– “no sex drive” - “for years”. Problem in marriage.
45. “Relevant” symptoms
• Lack of/loss of interest in things
• Low energy
• Appetite increase
• Feelings of worthlessness
• “memory problems” (Concentration??)
• Frequent negative thinking
46. Other interesting data:
• Multiple speeding tickets.
– “My worst one was not that long ago, but the
guy gave me a break or I would have lost my
license – I was going at least 30 mph over the
limit.”
– Has had 4 – 5 speeding tickets. “I’ve had a
heavy foot.”
• Previously diagnosed with ADD by family
physician
47. Medications at presentation:
• Effexor – 37.5 mg XR one in the a.m.
• Ritalin LA – 20 mg in the a.m. for ADD
• Levothyroxine – 0.1 mg “with everything
else in the a.m.”
• Simvastatin 20 mg – in the a.m.
• FemHRT, Flonase, Celebrex ( 200 mg daily
x 5 years)
• Pepcid – 20 mg daily
48. Historical data
• Excellent student in high school
• Excelled in pharmacy school
• “hate it that my memory is getting bad.”
• “It’s true that I do cope with shopping.”
• Recalls ADD symptoms since childhood.
Diagnosed self based on review of a checklist of
ADD symptoms from a patient’s mother.
• Having muscle aches and cramps. (Statin?)
• Presents with lab drawn by primary doctor – Jan
2010 of total testosterone of 10 ng/dL (!!!)
49.
50. Mental Status Examination:
• Alert and pleasant, but depressed
• Stressed about her fatigue and lack of focus
• Rating Scales:
– Showed 5/9 symptoms of depression
– DSM-IV, ADHDRS , Jasper-Goldberg, Amen
Clinic 6-type ADHD questionnaire – all
consistent with significant INATTENTIVE
SYMPTOMS.
• Notes NO LIBIDO.
51. Diagnoses, workup, treatment
• ADD - inattentive type
• Hypoadrenia (probable)
• History of MVA x 2 with mild HNP
• Hyperlipidemia – wrong dosing – change to HS
• Hypothyroidism – change T4 to empty stomach
• Menopausal – with unknown levels of most
hormones; certainly needs more T – started at 1
mg up to 4 mg topical per day after recheck
• TESTING: conventional labs ordered
• Patient told to GET MAMMOGRAM
53. One month follow-up 5/18/2010
• PAP done. Mammography – not yet.
• Got labs done (reviewed).
• Hadn’t consistently gone up on testosterone
• RX:
– Added Cytomel to T4 - 5 MICROgrams SR up
to 10 MICROgrams SR q a.m.
– DHEA – 25 mg extended release (GNC) q a.m.
– INCREASE testosterone up to 4 mg per day
• New labs in 6 weeks.
54. 2nd follow-up 7/13/2010 – on 5
MICROgrams SR Cytomel
• Hugged me upon encounter. Thanked me for
“transforming my life.”
• Mind is working dramatically better
• Passed on-line testing the first time, compared to peers,
who did not.
• Energy is better.
• Has started asking her Medicare patients about complete
TFT’s
• Stress was from “performance problems and thinking I was
losing my mind.”
• No labs yet due to expensive colonoscopy.
55. Can you change ADHD symptoms
without changing ADHD meds?
Patient presents on ongoing, BASELINE dosing of:
-Ritalin – 20 mg LA in the a.m.
-Effexor – 37.5 mg XR in the a.m.
Now on: 5 MICROgrams Cytomel SR (w/ T4) + 4 mg Testosterone
ADHD Ratings - April ADHD Ratings - July
• DSM-IV: 6/4 • DSM-IV: 2/0
• ADHD-RS: 27/20 • ADHD-RS:11/12
• JGRS: 44 • JGRS: 13
57. Follow-up 2/11/2011
• Libido: ““Better than it was, but not
passionately horny all the time.”
• Ongoing back pain – sent to D.C. colleague
• Cytomel changed to one 10 MICROgrams
SR dose in a.m. with her 0.1 mg T4
• Not using Testosterone consistently – told
her to do so
• Started Pregnenolone – 100 mg SR “for
memory.”
58. Follow-up 5/10/2011
• Progesterone 20mg/cc, compounded, transdermal, started.
• Continued on testosterone (2 X/wk) and Cytomel SR (10
ug) + 0.1 mg T4 + 100 mg Pregnenolone
• Ritalin LA 20 mg (getting “wear off” and “slump” at 6
hours); Effexor – 37.5 mg XR
• Craving carbs – started on low dose Topirimate
DSM-IV ADHD-RS Jasper-
Goldberg
3/ 4 as child
6/4 – intake 4/2010 27/20 - intake 44 – intake
2/0 – 7/13/2010 11/12 - 7/13/2010 13 - 7/13/2010
0/0 – 11/11/2010 11/12 - 11/11/201 15 - 11/11/201
0/0 - today 10/9 - today 19 - today
59. Phrustraded Pharmacist Follow-up
2/28/2012
• On weight watchers: has lost 24 lbs.
• “I’ve got my organizational skills back.
Things are back together again.”
• No more energy sag in the afternoon. (Note
also the good diet).
• Enjoying life. Participating in Corvette Club
with her husband.
61. 163.688 children and adolescents (86 studies)
14,112 adults (11 studies)
Inattentive subtype most common
Dx similar irrespective of parent or teacher rating, or a best estimate
diagnostic procedure
Kids: {5.9 – 7.1%; young adults 5%}
62. 165 respondents out of 259 children in British Columbia
ADHD diagnosed in 131 (out of 165) from 259 eligible.
68.7% having comorbid psychiatric disorder: 51 kids
with LD, 45 with ODD/Conduct DO, 27 – other dx
FINDINGS: “ADHD has a significant impact on
multiple domains of health-related quality of life
measures: in role function, behavior, mental health, and
self-esteem.”
63. The Disorganized Daughter – intake 7/18/12
• 29 year old married Caucasian female – ref
in by family and Dad.
• “I don’t even know where to begin. From
puberty on, I’ve struggled with quite a bit of
depression.”
• Per mother: “severe insomnia, mood swings,
periodic fits of rage followed by
sadness/crying; difficulty concentrating; flight
of ideas, trouble managing daily activities;
little impulse control”
64. Disorganized daughter – more history.
• Significant history of alcohol and opioid abuse and
dependence. (now on ultra low-dose Saboxone)
Also abused Ambien.
– “Used them so I could SLEEP.”
• History of bipolar in the family
• Hospitalized in March 2012 due to “I quit sleeping
and began to hallucinate.”
• History of not sleeping well and having to use
opioids to self treat.
• Very active child.
• “No diagnosis of ADHD” ever made.
65. DX/RX – 7/18/2012
1. Severe bipolar disorder, rapid cycling type
(with sleep deprivation and psychosis)
2. Opioid dependence – (on saboxone taper)
3. History of severe PTSD
4. POSSIBLE ADHD
5. LABS ordered
6. RX:
– started on 3 mg of Invega, then 6, then 9 as
tolerated.
– Referred for therapy once bipolar settled.
66. Rating Scale review – 7/18/2012
Results scoring
DSM-IV 1/3 – as child 9/9 = max (I/H); 6 = dx
6/8 – now as adult (same)
ADHD-Self Report 20/33 36/36 = max
Jasper-Goldberg RS 94 0 – 120 = range; 70 is cut-off for
likely dx of Adult ADHD
Amen Rating Scales 9 symptoms on Inattentive (6 symptoms required for diagnosis)
9 symptoms on (5 sxs required for diagnosis)
overfocused
6 symptoms temporal lobe 6 symptoms required for diagnosis
subtype
7 symptoms “limbic” (5 symptoms required for)
10 symptoms “ring of fire” (5 symptoms required)
subtype
Fatigue Severity Scale 56 36 is cut off (63 = max)
Epworth Sleepiness 22 10 is cut off (24 = max)
Scale
67. Two follow-ups
• 7/31/12 – used the Invega, got overly sedated, got
better, stopped it – got worse. Sleep disrupted. On
it for two days prior to seeing me and feeling better.
• 8/28/2012 – dramatically better; in therapy
– On Invega 6 mg per day +Benztropine 1 mg three times
daily. Start Lamotrigine with plan to cross titrate.
– Labs showed anemia with very low iron
– Has gained 0.8 lbs.
– Dx’ed with subclinical hypothyroidism – started on Armour
– Started on PNV with Fe and DHA
– Viewed as stable enough to take Quotient test
68. Follow-up – disorganized daughter
• 9/18/2012 – absolutely stable. Feeling great.
• Concerned about weight increase (5 lbs)
• On Invega at lowered dosage of 3 mg + 50
mg Lamotrigine per day.
– (had sleep walking)
• DHEA – 25 mg ER (GNC) – 1 in a.m. + ¾
grain Armour in a.m. Now has more energy
and is getting things done.
• Quotient test reviewed…. (done before appt)
72. STATS:
•ATTENTIVE 7.5% (!!!) of the time
•Impulsive 47.5% of the time
•Distracted 32.5% of the time
•Disengaged 12.5% of the time
73. Patient’s response to the Quotient
results:
• “Wow, that’s really bad isn’t it?!”
• Asked if she had had severe problems with
attention in school.
• “Well, there’s actually
something I’ve never told
you…”
74. More history, more treatment
• “I actually used cocaine [therapeutically] before
school( in high school) to concentrate.”
– Set the curve in all of her finals in her junior year.
– Stopped it in her senior year
– Used opioid (Lortabs) throughout college to study
and focus. (“It made me awake and helped me
do stuff.”).
• Now concerned about her ability to focus.
• Brother, in law school, recently dx’ed with
ADD. On Adderall. Doing much better.
75. A question and treatment
• “Would one of the things about ADHD be
that when I sit down with my kids I can’t even
complete a single ‘craft’ activity? My
husband has to finish it. I can’t even do it.”
• RX:
– Increase Lamotrigine to 100 mg per day
– Stop Invega 3 mg in two weeks.
– Start Vyvanse at 10 mg, going up by 10 mg
every day or so to 50 mg. (Aliquot;Goldilocks)
– Increase Armour to one grain; cont DHEA 25 mg
76. Key take-aways from this case
• Don’t let a substance abuse disorder give
you a constricted field of logic.
• Affective disorders and ADHD can coexist.
• Frequently ADHD’ers have used illegal drugs
or tried their kid’s stimulant.
• Avoid Puritanical blame/self-righteousness:
– Many ADHD’ers (and affective disorder patients)
fall into alcohol, marijuana, and other drugs in an
attempt to self-treat
• Treat the primary problem first.
77. The Accidental Toxic Metals Test
• 7 year old biracial child. Dx’ed with ADHD
before appointment.
• Serious reactions to stimulants.
• Chronically thin, but “eats as much as my
fifteen year old.”
• Lives at home with mother and father (who
works at a smelter)
• Mental Status Examination: obviously
hyper. Chatty. Somewhat obnoxious.
• Psych testing – normal IQ
78. Hair analysis (instead of Organic Acids)
done d.t. staff error!
• Later learned of clothes washing and bathing
practices, and derioration of child from early
development to present
79. The Story of Alan
• 2/24/2010 – “ADHD hampers his ability to focus and
comprehend information. He becomes overwhelmed.
Lacks confidence in reading. Teacher believes he is
capable.”
• Past history: “a busy child. “Couldn’t keep him in a chair.”
• ADHD dx in kindergarten. Multiple Rx since, incl. Abilify
• At presentation:
– 20 mg Adderall XR in a.m., 3 mg Intuniv in a.m., 5 mg Abilify at 4
pm.
– “Heart is racing” for two months.
– Hx of stimulant rebound and having to push the dose
– Stools like tar since starting on Abilify.
• Rating scales:
– DSM-IV 9/8 before meds; DSM-IV 9/4 ON meds
80. Treatment summary and new developments
• Medications adjusted. Stimulant lowered
and L-tyrosine started with it (inc. to 1 gram
twice daily ).
– Changed to Concerta + Ritalin (a.m.), Intuniv,
Risperdal, and Depakote (250 mg 3x/day)
• 11/9/10 and 12/6/10 – “meltdowns” at
school. States “I am going to KILL you,”
when he is upset. Kicking the table at
school and not looking at the teacher.
• OAT test and IgG Food Allergy panel
ordered.
82. Organic acid testing – 12/23/2010
Pertains to energy production, Kreb cycle, B vitamins, CoQ10, Mg
83. Interventions
• 1/5/2011:
– School insisting he is “autistic” (meltdowns)
– At appt. told to remove wheat, peanuts, and
milk from diet
– Started on CoQ10, B-50, ALA, Vit C & E
• 2/8/2011 – Alan - “for the first time I think
the medicine is getting right.” (no changes
made to Rx). Barlean’s Lemon Zest oil
added.
84.
85. Winding up of case
• 4/1/2010 – five weeks of “awesome behavior” at school
with “no blow-ups whatsoever.”
– “The school authorities are amazed.”
– Won STUDENT OF THE WEEK (!!)
• 5/31/2011 – concluded school year; no blow-ups.
• 8/30/11 – some blowups, but not the “explosive kind like he
had last year.”
• 12/21/11- scored “distinguished” in math and “proficient” in
reading. (continues supplements and diet)
• 2/17/2012 – “Tired.” RX: lower Concerta from 54 to 36
mg
• Having more meltdowns at school. New labs ordered.
89. Organic acid test – 6 26 2012
• Arabinose c/w candida
• All B-vitamin markers improved
• Coenzyme Q10 high normal
• HVA, VMA, 5HIAA – all increased.
• Vit C low but c/w water solubility and a.m. spec.
90. Alan – conclusion 7/31/2012
• Concluded school year well.
• “Was more interactive and playing on the
playground.
• Went up on state testing 17 points in
reading. At grade level in math.
• Playing outside more, riding his bicycle.
• Vitamin C increased 500 mg twice daily
• Start on Curcumin/turmeric for inflammation
• STABLE. See back 9/30/2012.
91. A case of near catatonic depression: G.
Photos of all patients, even though used with
permission, have been removed from this
presentation on the internet
92. Gerladine: history
• 42 year old WF in committed relationship
with SO. Previous severe depression.
• “Depression gradually coming back.”
• Previously admitted to local psych hospital,
diagnosed with “bipolar” and put on lithium.
• History of severe trauma as a child.
• Incapable of working with her therapist.
• Near catatonic. Has considered ECT
• Masked facies. Shut down. Nearly suicidal.
93. Medical issues – in addition to depression
• Known
– Menometrrorhagia with Fe deficiency anemia
• Had to have an iron infusion 3 years ago.
– Mild symptoms of OSA; previous poor w/u
– Obesity (with food cravings)
– Severe ADHD symptoms (Quotient) (w/ history)
• Likely
– Hypoadrenia
– Rule out hypothyroidism
– Probable drop in testosterone
– Rule out return of iron deficiency anemia.
97. Jan 2012 – not much better
• Still off of work & depressed. Concentration
still poor. Having to “pay extra attention” so
she can drive correctly.
• Might get fired from work if not better.
• Has seen hematologist; s/p iron infusion
• Evaluated for TMS & tx started
• New RX:
– Progesterone 50 mg SR at bedtime (sleep)
– Cytomel – 5 MICROgrams 2x/d (“feels more
energetic”
98. Follow-up 2/21/12
• Low Vitamin D level found on lab (14) –
started Tx between last appt. and this one.
• Also ¼ grain Armour thyroid added.
• Therapist: “This is the best I’ve seen you in
two years.”
• “The first week I haven’t gained weight.”
Not wanting to eat as much.
• Journaling daily.
• Concentration definitely improved.
• RX: Cytomel tapered and Armour increased
99. Geraldine – 3/12/12
• 3/12/12
– Has returned to work. Peers tell her that she
“looks different in the eyes.”
– Sleep has improved.
– “A miraculous Wednesday – 4 ½ weeks into
TMS – when “everything seemed to improve.”
– Lost 2.2 lbs in the last 3 weeks.
• 4/19/12
– Depression in full remission. Looks well.
100. Weights and drugs – 6/28/12
Relevant weight hx Nausea
• 2/21/12 - 252.6 lbs • Bupropion lowered to 300
– the first week she hasn’t mg XL
gained. • Focalin XR decreased to
• 3/12/12 - 250.4 lbs 20 – 25 mg XR
– (Topirimate added)
• 6/11/12 - 220.8
• 6/28/12 - 214
9/10/2012 – doing great. Dealing with stress in her life with
breakup with SO and move to new house. Coping well.
101. Photo of patient G. on her motorcycle
September 9, 2012
Photo used with patient’s permission
102. Teaching points:
• Imperative to get ALL the diagnoses RIGHT, and
to not miss any (including medical).
• Don’t reflexively “blame the patient” for failure at
weight loss.
– (women with metabolic syndrome, low DHEA, and low
thyroid can’t just ‘lose weight’)
• Even TMS is not likely to work adequately without
stabilizing the biological platform.
• Incredible change and improvement are possible
when both medical/hormonal stabilization
accompanies accurate psychiatric treatment.
103. The case of
Michael
• 53 yo MWM ref by
pastor
• “I’ve been trying to
Photo of patient on
do a good job since motorcycle with sword
I’ve been saved.
My family and
church think that I’m
dangerous and
trying to get
martyred.”
104. CURRENT history
• Three months prior to intake, “received a
revelation” about the way he was living.
• He determined that with his name, Michael,
he was to function as an angel of God and
warn people about the end times
(accompanied with his sword on his
motorcycle).
• One month prior to intake, had words with
police officer; next a.m. 10 police took him
to local psych hospital for eval.
105. • Kicked out of high school d.t. racial violence
• Parents: “difficult to control” as a child
• “Problems with his temper” since childhood
• Began drugs at 13 – 14 yoa
• 21-22 yoa – “I was running around with a shotgun
thinking I was Billy Bad Ass.”
• Robbed a local license branch. Prison for 5 years.
• Previous heavy drug use, incl. K-2 (smoking it)
• Had MI while driving truck 4 ½ months ago.
• Implantable defibrillator (+ CABG x 3 and heart
valve replacement) Now can’t drive. Depressed.
• Went to church on Easter Sunday. Selling 5 – 6
lbs of “dope” per week. Converted. Changed.
106. Family Psych History:
• Father – violent
• PGM – “the wild one” – would physically
slap people
• Sisters – 3 out of 4 involved with drugs, all
clean now
• Oldest sister – “the hoarder”
– Family had to pay $12,000 to haul 100 cubic
tons of junk out of her house.
– Then she did it again. Now living in hotel
• NO Family history of bipolar
107. Mental Status Examination:
• Tall, intense man – mustache and stubble.
Coherent.
• Wearing baseball white cap with a cross hand-
drawn on the front and labeled “White Knight.”
• “I don’t think Batman has anything on me; he’s
Hollywood but I’m the real deal.” “I can’t do
anything about this – it’s a revelation from God.”
• Re: the sword – “the police were kind of upset
about it, but it’s legal and there’s nothing they can
do about it.”
• Notes that God speaks to him from within, “but not
in a wacky way.” Somewhat circumlocutory.
108. Rating Scale review – 8/3/2012
Results scoring
DSM-IV 6/8 v– as child 9/9 = max (I/H); 6 = dx
6/6 – now as adult (same)
ADHD-Self Report 13/17 36/36 = max
Affective 8 symptoms GAD; 5 “Worry + 3 is GAD.” 5/9 for
symptoms of depression depression
Amen Rating Scales 7 symptoms on Inattentive (6 symptoms required for diagnosis)
10 symptoms on (5 sxs required for diagnosis)
overfocused
10 symptoms temporal 6 symptoms required for diagnosis
lobe subtype
7 symptoms “limbic” (5 symptoms required for)
12 symptoms “ring of fire” (5 symptoms required)
subtype
Fatigue Severity Scale normal 36 is cut off (63 = max)
Epworth Sleepiness normal 10 is cut off (24 = max)
Scale
109. Relevant recent history:
• VPA – 500 mg ER – 4 at bedtime when
originally hospitalized.
– Made him “drunk.” Stopped it.
• Then started on Seroquel XR 50 mg. Did
NOT work.
– “He was running around all hours of the night.”
– Actually more disinhibited.
– Had sword on his bike during this time.
• Wife had him ED’d on 7/16/12.
•
110. Diagnosis????
• Bipolar, manic? ADHD? GAD??
Depression? OCD? Low serotonin state?
• My impression:
– ADHD – lifelong; currently MJ self-treating
– History of polysubstance abuse and
dependence; unknown residual effect of K2
– Meets criteria for GAD and depression
– OCD’ish? Obsessive. Sister a severe hoarder.
– Doubt bipolar. (51 yoa at onset.)
111. Treatment and follow-up
• Viibryd – 2.5 mg (1/4 of a 10 mg tablet) as
test dose, then ½ x 4 – 5 days, then one
tablet. Go up in sample pack as tolerated.
• Then, Focalin – 5 mg XR – start with one in
the a.m. As able, increase to no more than
4 capsules
• See back – three weeks.
112. Treatment and follow-up 9/5/2012
• “Whatever you have him on is working – the last
two weeks have been wonderful.”
• “He has lost that ‘being confrontational and
argumentative.”
• On 40 mg of Viibryd – “I settled down and
calmness came over me.”
• On Focalin 5 mg XR – focus has radically
improved.
– “Able to cut down my weed.”
• General: appetite improving. Sleeping well
at night.
114. Key learning points from this case
• Avoid the “easy”, obvious diagnosis.
• Respect the concept of “executive dysfunction”
with ADD (as well as cingulate gyrus hyperactivity
with obsessionality and low serotonin)
• Know characteristics of mental disorders
• “mood swings” and manic like behavior does not
equal a de facto diagnosis of bipolar
• Good people can use MJ/Rx to “self-treat”
• Good people can do bad things with ADHD.
• Avoid being judgmental
• Start dosing LOW. Educate patient.
• Can normalize patients in one month.
115. So what the
heck am I
supposed to
do with this
stuff?
116.
117.
118. What I would like for you to get out of
this talk…
1. Acknowledge that you are the best.
2. Expand your paradigms!
3. Too much of a good thing is NOT wonderful.
4. Know your stuff: 1 out of 20 (minimum) of your
adult patients will be ADD/ADHD.
5. Find colleagues to partner with: Doctors of
Chiropractic and Naturopathy. Nutritionists.
6. “There is no substitute for victory.” - Gen.
Douglas MacArthur
7. MUST deal with the biological no matter HOW
GOOD you think your drugs are!
119. “But my patients don’t know about
this and aren’t asking for it….”
“It’s not the
consumers’
job to know
what they
want.”
- Steve Jobs
120. Questions for you after this
presentation and weekend…
• If not me, who?
• If not now, when?
• If I am too afraid to act, why?
• What can I do?
• Is is acceptable to not do all that
is required to get the patient
better?
121. “If you’re
going to be
thinking
anyway, you
might as well
thing big.”
- Donald
Trump
122. Perhaps the ability not only to acquire
the confidence of the patient, but to
deserve it, to see what the patient
desires and needs, comes through the
sixth sense we call intuition, which in
turn comes from wide experience and
deep sympathy for and devotion to
the patient, giving to the possessor
remarkable ability to achieve results.
...William J. Mayo, 1935
123. Contact information:
Louis B. Cady, M.D.
www.cadywellness.com
www.indianaTMS-cadywellness.com
Office: 812-429-0772
E-mail: lcady@cadywellness.com
4727 Rosebud Lane – Suite F
Interstate Office Park
Newburgh, IN 47630 (USA)