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Calcium, Mitochondria and Neuroendocrineimmunology

What do Calcium, a "frigid mother", a 'strange' immune system and energy metabolism have in common?

Many of you hear it coming - Schizophrenia.

Such a bizarre neurological disease process that many feel once cracked (or the way to crack it), will lead to the understanding of the underpinnings of obesity, cancer and many autoimmune disorders, let alone segue into a tremendously prodigious time for the understanding & treatment of other neuropsychiatric illnesses.

An 'old' theory of how to cause it, was to have a 'frigid' or unattached mother -- this is now a MOSTLY discredited and almost forgotten hypothesis of a psychoanalytic origin, which still contains a kernel of truth: mitochondria in humans are transmitted via the maternal line.

This leads to the mound of overwhelming (clinical, genomic, theoretical) evidence that seems to point to mitchondrial changes that impair (to varying degrees of 'penetrance') cellular energy metabolism, transcription/protein-folding/protein-degredation, mechanisms of cellular death and aging.

This in turn leads us to (and from) deranged cellular calcium processing and what it does to other cellular mechanisms (including back to the mitochondria) and processes that affect higher-level systems including immune- and endocrine- systems. These in-turn, effect responses to stimuli, sensory processing, the stress response, methyl-pool processing, the HPA-axis (not just in the stress response), neuronal migration, pruning, and other more 'emergent properties' of the system like direct/complex behavior and therefore development of adaptive/mal-adaptive coping mechanisms and the like.

The paragraphs above, that almost-insultingly superficially skim the pathophysiological basis for this disease, could easily be stated in the context of speaking about any of the protein-opathies (Tau, amyloid or alpha-synuclein), bipolar disorder and many other neurolically-based diseases.

A unifying study of the current level of knowledge of affected systems, pooling the wealth of information already known about calcium metabolism, mitochondrial energetics, the neuro-immune and neuro-endocrine links to this neuropsychiatric problem, in a Manhattan project-like structured environment using state-of-the-science medical bioinformatics, would advance medicine in various fields not just applicable to neuropsychiatric disease.

It is to these applied clinical and theoretical research ends that I wish to apply much of my own personal efforts (and will be facilitating along with other research) in my new position as adjunct faculty at the University of Notre Dame and the Indiana University School of Medicine and as Chief of Psychiatry at Madison Center & Hospitals.

Thoughts?

Rant about current state of psychiatry in our country

What is going to happen to us and our patients?

Physician specialists that treat psychiatric disorders (AKA Medical Directors of Insane Asylums AKA Psychiatrists) in our country are rushing quickly towards a wall of emerging neuropsychiatric/genomic/neuro-immune and neuro-endocrine discoveries, culture changes and fresh syntheses of cognitive neuroscience. Our current cadre of physician-specialists are hurtling at this vast, seemingly impenetrable wall in the not-so-distant future with only a half-assed understanding of: valid/evidence-based psychotherapeutic tools, understanding of evidence-based complementary medical interventions (to include but not limited to nutrition/exercise physiology -- well studied by the NIH among others), and a handful of drugs.

All of these (drugs, ignorance and poor training) carry enormous risks and fewer and fewer benefits as emerging medical literature clearly shows.

Are we just going to rely on newer medicines to make up for our CURRENT shortcomings?

Why not shore-up our deficiencies with what we the knowledge we ALREADY have, and rely less on increasingly demonstrable nefarious interventions of questionable OVERALL efficacy and poor long-term safety.

Let me not be confused for a psychiatrist who disdains medications. On the contrary, my disdain is of those who do not know enough to prescribe an antispasmodic and low-dose benzodiazepine in combination with psychotherapy and appropriate specialist referrals to their anxious/PTSD patients with 'IBS'.

All psychotropic medications available to us at this time can each be life-saving and improve patients' quality of life tremendously. Each of these medications also carries enormous risk - some even more than that (that is likely why they can make such a drastic difference in so many patients; because they are so 'powerful').

As the de-facto experts in the field of psychopharmacology, "with great power, comes great responsibility".

As a GROUP why do we lag in researching/using micro-current DCS (direct-current-stumulation) or rTMS (repetitive transcranial-magnetic-stimulation) in combination with an aggressive psychotherapeutic milieu and even hormonal manipulation and consult with a personal trainer when necessary in our patients. Instead of piling-on more and more of the same and contributing to the morbidity of our patients by contributing to treatment resistance (see STAR-D trial data) and overall medical morbidity/mortality data due to medical ramifications of poor lifestyle choices and pharmaceutical side-effects.

So many men who come to the practice with decreased libido (no body bothered to ask them the 'hard' questions), irritability, depression, fatigue, several failed or part-responses to SSRI's and SNRI's and a simple testosterone panel shows either low free/bio-available testosterone, low total testosterone or all of the above. Do they still need psychotherapy? Some do. Long-time problems in marriage (direct or indirect damage of the low testosterone) coupled with problems in day-to-day functioning at work, loss of drive, problems with friends and hobbies -- yep some of them DO need psychotherapy to learn how to get back into the swing of things and 'deal' with "stuff"; some may need additional escitalopram (or whatever the 'appropriate' anti-depressant would be for him).

Which leads me to the next piece of the rant - which one would be the more appropriate antidepressant for him at this time? How do we chose it? This is a basic therapeutics question for a medical student right? We look at risks and benefits from side-effects and possible interactions in conjunction with the medical history (genetics?, allergies?, past hx of reactions/interactions?). Right? Since we are told that study after study demonstrates EQUAL efficacy to treat depression, how ELSE do we choose between what to ADD to this guys treatment of his depression. We need to look at how else we might shine a light on this VERY IMPORTANT PIECE OF THE PROBLEM (rhetorical at the moment as there are a few 'alternatives' out there but mainstream medicine and evidence-based medicine states they are not 'ready for prime time'). Are there blood/urinary metabolites/salivary or other excretions that might be able to help guide medical intervention?

As psychiatrist we need to be MORE.

We need to recapture the allure of the physiological: the wonder for and mastery over the neuro-immune interactions that we already know about, let alone be ready for all of the mounds of data being produced and published in the medical literature daily. We need to rehash and refine our comprehension of the neuro-endocrine doctrines which WERE TAUGHT TO US IN MEDICAL SCHOOL (for many of us, this was many moons ago!) let alone all of those fascinating inter-relationships being found-out daily and added to our current vast understanding of these things (which far outweighs what we use pragmatically on a daily basis with our patients -- and could be).

And yet, we must not loose that special place we have in clinical-medical science -- singular among the vast medical specialists and sub-specialists - something that seems almost magical to some of our colleagues (and now that we have evidence-based medical literature demonstrating that it's "advanced science that [was once] indistinguishable from magic") - we need to regain that position of authority over the mastery (within medicine) of these techniques. Not to the exclusion of our psychology colleagues and other cognitive therapists, but complimentary to them - and to any other colleagues (acupuncturist, medical massage therapists, yoga instructors, personal trainers) who can help us add value to the treatment and decrease the risks and bad outcomes in our patients.

We need to be more. What is going to happen to us and our patients?

I am optimistic of both. But we need to have a 'fire' stimulate (more than financial gain or the threat of litigation) and drive change. This 'fire', in my personal opinion, needs to be something akin to that which we all had when first learning of all of these things in medical school and residency training - matched by a maturing sense of accomplishment with each patient and continued learning (with each patient and by self -study, CME, etc).

There is so much to read and so little time...but I am optimistic.

Neuropsychiatric Summary

"Neuropsychiatric disorders represent the second largest cause of morbidity and premature mortality worldwide. The World Health Organization has estimated that, collectively, neuropsychiatric disorders comprise 13% of all reported diseases. These disorders include major depression, anxiety, schizophrenia, bipolar disorder, obsessive-compulsive disorder, alcohol and substance abuse, and attention-deficit hyperactivity disorder and account for 50% of the disability in less developed and developing countries.

Approximately one in five Americans will experience an episode of a psy- chiatric illness such as schizophrenia, a mood disorder (depression and bipolar disorder) or anxiety in any given year.

The prevalence of these disorders, and their personal and societal costs, has fueled a half century of research aimed at elucidating the etiologies and pathophysiological mechanisms of these devastating disorders with the ultimate goal of designing pharmacotherapies that can correct the underlying neurochemical defects.

Many drugs in use today for treating neuropsychiatric disorders are refinements of compounds identified over 40 years ago and found to be effective by highly empirical and serendipitous observations. As the biochemical mechanisms of action of the effective agents were elucidated, theories were put forward concerning the neurochemical bases for the disorders. Thus, in the 1960s, the dopamine hypothesis of schizophrenia and the monoamine theory of depression were introduced, based in large part upon the abilities of antischizophrenic drugs to block dopamine receptors and antidepressant drugs to increase synaptic levels of monoamine neurotransmitters.

These concepts have continued to guide drug development efforts to this day. More recent research, particularly the identification of gene polymorphisms influencing a multitude of biochemical pathways, has revealed a molecular complexity of these disorders that was unappreciated until the past decade. It is increasingly clear that neuropsychiatric disorders arise from interactions of multiple predisposing genes of variable penetrance over- laid by diverse experiential and environmental influences."

First step in the treatment of mitochondrial disorders, reversing biological aging and towards improved energy management in higher mammals

This is an executive summary of concepts that I have slowly been thinking about for over 20 years but which congealed in my mind's eye, while deployed to the war and were finalized on April 12, 2003.

Because we are, like all other life on this planet, dependant on energy, the mechanisms for energy management that we have intrinsically in place are of paramount importance to our longevity.

Just like the experiments which show that younger individual’s internal time-keeping mechanisms run slightly faster and correlate to measures of overall biological age (not chronological age) of their brains, the intrinsic ‘energy’ of life in older individuals is running out and our internal clock is slowing to a stop as the energy from our biological machinery is literally grinding to a halt.

All life expectancy across animal species on the planet is linear (small animals live fast and die quickly while larger animals live slower, have slower metabolisms and live longer) with only a handful of outliers – quite conspicuously all animals that actually fly (birds and the mammalian example: bats).

It seems that the higher power/energy requirements for flight have self-selected animals whose energy management systems are extremely efficient; made so by millions of years of evolutionary refinement and design.

Through the use of mitochondrial gene transfer we can not only treat a variety of known genetic defects currently causing the death and diminished quality of lives to millions of people world-wide, but also look forward to improving overall outcomes in many diseases not traditionally thought of as mitochondrially-based, like psychiatric diseases, heart disease, obesity and diabetes among many others.

Starting with mammal (chiroptera) mitochondria, we can then utilize molecular engineering techniques to incorporate and swap out human mitochondrial genes for the bat’s original mitochondrial genes, while maintaining the original membranes that give these animals the unique lower proton leakage that provide them with higher energy efficiency.

This would be one of many first steps necessary to provide for humans a longer life span in the context of better energy management and lower free radical production and leakage via more efficient mitochondria.

This is not science fiction but present day science-fact and would relieve unquantifiable amounts of human suffering and lead to the ultimate achievement of the human potential.

This is a network of ideas and concepts I am developing (click & explore):

Cycle of Domestic Violence Blog

Domestic violence is a horrific beast that rears its’ ugly head in families from all walks of life. In 2008 alone, Montgomery County reported 3,433 domestic violence incidents. This number only represents the incidents that were reported to the authorities, which means there are many other silent, suffering victims among us. Domestic Violence knows no boundaries and no one is “immune” to experiencing the devastation of an abusive relationship. We all would like to think that we will never find ourselves in such a hurtful relationship, however, you may have friends, family, or neighbors that are in the midst of an abusive relationship, yet when among others, they may be wearing a happy mask to hide the hurt. We’d like to think that we could spot a perpetrator of domestic violence a mile away, and yet, both batterers and victims look like you and me- they could be that charming coworker, the outgoing hair stylist, the well-respected government official… they could be anyone! And while victims are generally reported as being female, males too can be victims of domestic violence. Likewise, domestic violence can occur in both heterosexual and homosexual relationships.

*For all intents and purposes of this blog, I will refer to the batterer as “he,” however as mentioned before, batterers can be both male and female.

For those of us who haven’t experienced domestic violence, it seems as though the solution is simple enough… why don’t the victims just leave? Unfortunately, the act of leaving isn’t as simple as many people think. Oftentimes, victims have been isolated from their support systems by the batterer because he wanted to remain in control of the victim and by “butting” out friends and family, the victim is forced to rely on the batterer for everything from day-to-day interaction to money for groceries.

We often think that domestic violence constitutes only emotional, sexual, psychological and physical abuse, however another form of control and abuse comes in the form of withholding or restricting financial resources. Many times the batterer will coerce the victim into quitting her job to gain more control and may even disguise this controlling tactic by saying something like, “I just want to take care of you and don’t want you to have to work.” This can be so damaging because even if the victim has the desire to leave, she may no have control over the financial resources that would make leaving the relationship more feasible. And when children are involved, the situation only becomes more difficult because the victim wants to be able to provide for the children, however without the financial means and without a solid support system, this task may feel nearly impossible.

Another important aspect of victims remaining in the violent relationship has to do with the “cycle of domestic violence.” The act of abuse is often cyclical in nature and begins with the tension building stage where the victim may sense negativity from the batterer and feel as though it is necessary to tip-toe around, trying not to bring much attention to herself and trying to avoid the actions that tend to irritate the batterer. This period of time can last anywhere from a matter of minutes or weeks and eventually builds up and leads up to the next stage in the cycle, which is when the violent outburst occurs. The batterer will often justify his actions by stating, “I wouldn’t have hurt you if you hadn’t… (fill in the blank).” The important thing to remember as the victim is that there is never a justifiable reason to be battered and beaten, no matter what the batterer may say.

The next part of the cycle is the piece that brings the victim right back to the battering relationship. After the violent incident has occurred, the batterer reels the victim back in during a period of time that is described as the honeymoon phase. It is during this seemingly pleasant period that the batterer will “wine and dine” the victim and may apologize saying, “I’m so sorry I hurt you! That is the last time I will ever do that- I am a changed man!” While this period may last a significant period of time, the cycle tends to continue through to the tension building, violent outburst, and then back into the honeymoon phase.

This cycle mixed with the social isolation and financial instability makes leaving the abusive relationship feel utterly impossible. Fortunately, there are resources in our community as well as all throughout the country that will help victims get away from the violence or that will offer support until the victim is ready to leave.

YWCA of Dayton: (937) 222-SAFE (Local Domestic Violence Hotline)- Assists in explaining options as well as in safety planning. http://www.ywcadayton.org

National Domestic Violence Hotline: 1-800-799-SAFE- The National Domestic Violence Hotline links individuals and services using a nationwide database of domestic violence and other emergency shelters, legal advocacy and assistance programs, and social services programs. The hotline provides crisis intervention, information about other sources of assistance, and referrals to battered women’s shelters. http://www.ndvh.org

Springboro Medical Wellness: (937) 619-0444- Domestic Violence Counseling http://www.healingbodyandminds.com

Stimulants and Sudden Cardiac Death

Now the FDA wants to shoot holes in a study that, yes, has limitations, but is the FDA pushing the limitations aspect of the study as a way to possibly politically cover themselves when they have approved these medicines for treatment in the most susceptible of populations - our children.

It must be said that these medications can be life-changing (for the better) for many individuals-improving their overall functioning and quality of life; but that they are over-used, over-prescribed and misused/abused is undoubtable.

Read below, an article that discusses the FDA's reservations with the recent study in the Archives of Psychiatry (one of the nation's leading medical/psychiatric journals), that discloses an increase in the incidence of sudden death in individuals taking stimulants.

FDA questions heart risk findings on ADHD drugs

The FDA said the study published on Monday in the American Journal of Psychiatry found there may be an association between use of stimulant medications used to treat attention deficit hyperactivity disorder (ADHD) and sudden cardiac death in healthy children.

"Because of the study's limitations, parents should not stop a child's stimulant medication based on the study," an FDA statement said.

Stimulant medications used to treat ADHD include Novartis AG's Ritalin and Shire PLC's Adderall and Vyvanse.

See/read the article HERE

Folic Acid, Biochemistry, Food, Disease AND YOU

Office sent me to do another talk on L-Methyl Folate yesterday. I love giving these talks as it ends up being a very practical guide as to how biochemistry permeates our day-to-day activity in very simple ways. It's for clinicians but as Medical Director for The Center, I am scheming with the practice manager on how we might have similar informational talks open for the patients/public.

FOOD - you know you gotta have some.

Folic Acid (along with B12) are important vitamins that occur in our diet (we make a little bit of folic acid in our bodies and get the rest from our food--not B12 which we get solely from our diet).

As most science-fiction shows are apt and ready to remind us we are 'Carbon-Based Lifeforms'. It turns out that we 'stitch' together our carbon units like strings of pearls and like rungs in complex 3-D ladders -- one carbon at a time, most of the time. This '1-carbon' metabolism is fueled by the food we eat--YES! you ARE what you eat!

Unlike other machine-examples made by man, we as AUTOPOIETIC (pronounced auto-po-yetik) machines. We: self-build, self-repair and make other copies of ourselves; with just the building blocks found in our food.

When you put gas in your car, no matter how clean it is and how much 'octane' and additives it has, your car's paint job doesn't get any better, or rust spots don't go away -- YOU ON THE OTHER HAND, will improve your skin's tone and the sheen in your hair and the energy in your stride and the swiftness of your thinking, depending on the 'fuel' you put in your 'gas tank'.

The processes of breakdown and buildup of materials in our bodies are summed up and called metabolism (catabolism for breakdown + anabolism for buildup).

And this brings us to Folic acid and B12. We use several important vitamins as co-factors (mortar and additives if you will) for the buildup and breakdown of our bodies and our components. These two substances in particular, add to what is called the Methyl pool (CH3).

(uh oh feel eyes glazing over already -- but wait...)

Back to stitching pearls and stuff... we use this CH3-thingy as one of several important sources for those carbon-pearls I mentioned above. Folic acid and B12 'grease' these gears and provide some of the 'teeth' in those gears and help metabolism move along.

Learn more about how L-Methyl Folate can help certain neurological disorders like depression here and Alzheimer's Disease here and neurological symptoms of diabetes here.

Father's Day, Stress, Fish Oil and Brain Stimulation

Well - had an awesome father's day - spent it with my wife and some of my kids (from previous marriage).

You will always want to minimize stress-- did you know that stress has been conclusively shown to decrease brain size-- no matter what type of stress we are talking about (Physiological stress: a cold, a burn, surgery, etc; Psychological stress: divorce, losing your job, finances, school, etc). Stress from a divorce affects everyone - especially if they are contentious; even in divorces like mine which are over 10 years old.

RELAX! - So to offset these current stressors that most of us seem to be exposed to (especially in these harder financial times): relax!!! Try and find some pleasure in your day. It doesn't have to cost you a lot of money - it could be leaving your work environment for lunch and going outside and eating your sandwich away from the stress/noise/smell/chaos of work.

READ! - it has been shown that the more education/stimulation your brain gets the better protected you are against the effects of stress on your brain - and things like dementia. Got an Amazon Kindle DX for father's day from my parents, kids and wife (it's expensive) - and it is awesome! I can now REALLY geek-out and carry over 3000 books with me and my medical literature (articles), and get the newspaper (NYT) and the NEJM delivered directly to the device. Yes, I am reading a lot! ;)

TALK! - talk to your friends, family - anyone who will listen (and is reasonable) - we tend to withdraw when under stress as a defense mechanism (like other animals, when we feel attacked we go on the defensive--be a 'superior'/'advanced' animal and go the other way)! I'm very lucky I got kids (most of them anyway) who love me and I am married to my best friend.

EAT WELL! - do NOT just eat when you are stressed or upset or under attack -- EAT WELL -- when we are stressed, no matter what the cause, our body goes into defense mode - that means we will crave simple foods (do not want to make things complicated if we are going to run/hide/fight) so we look for 'comfort' foods -- simple carbs or complex carbs with a high glycemic index/load -- again, be the 'advanced' animal and go the other way - load with protein in the morning and throughout your day - take in plenty of nuts, fish oil and other good sources of fat --all of these will reset your fight or flight response and help you be cool and energized to face those exact stressors that are pushing your buttons.

LOVE YOURSELF! -- that sounds psychobably but its still true - take care of yourself. Show yourself some love, some healing.

And teach your kids to do the same!

FDA panel cautiously OKs antipsychotic drugs for kids

Three widely used antipsychotic medications appear safe and effective overall in treating children and teenagers with schizophrenia or bipolar disorder, a U.S. advisory panel said on Wednesday.

The Food and Drug Administration's panel of outside experts backed wider use of the pills -- Eli Lilly and Co's Zyprexa, AstraZeneca's Seroquel and Pfizer's Geodon -- but expressed concern over long-term effects the medications may have in younger patients.

The drugs are already approved for adults and are given to youngsters at a doctor's discretion, reaching $10 billion in combined annual sales. FDA approval would allow the drugmakers to market them specifically for children and teenagers.

CLICK HERE FOR THE FULL ARTICLE

I must say that as a double certified and triple-board eligible neuropsychiatrist, we should all have significant concerns with prescribing these 'major tranquilizers' to anyone, especially those whose brain isnt even finished myelinating. These medications can be life-saving and very appropriate for certain individuals in certain cases - but the fact remains that we have very little long term data on kids and that these are medications that cause significant metabolic changes in our bodies and brains; they should NEVER be prescribed lightly. Our healthcare system in our country is NOT setup to allow Psychiatrists enough time to take into account all of the general medical considerations for these patients and be reimbursed for doing such things, therefore they will be tempted to cut corners (not weighing the patients at each visit, or taking full vital signs, or tracking growth on growth charts, etc) -- let alone the poor GPs which can and do perform these things but get on average 8 min and 3 problems per patient or else it has to be a different visit, etc.

We must NEVER take lightly changing someone's body chemistry/metabolism let alone their BRAIN chemistry and metabolism - and yet we have parts of our country that for lack of other better incentives to have physicians move into the state or graduates from their medical schools go into psychiatry, will short-change patients by having a psychologist take a course in medications and begin to prescribe medicines to adults AND CHILDREN in their states!

For those of us who are conscientious about the enormous physiological data to consider (hormonal, immune, neurological and behavioral) when prescribing these medications, it baffles the mind that someone would even ethically DARE to do this without the proper training or patient-specific data and ability to scientifically/medically interpret that data on a patient-to-patient basis.

Notice in the news article cited above that there is no clear/quick OK-DOKEY for Risperdal - as this is one of the worst ones for changing (indirectly) peoples hormones. Unfortunately it is prescribed often (I myself wrote out several prescriptions today to maintain patients on doses I have inherited them on while I work them up). Again, for some patients, after weighing the risks vs benefits and with proper medical monitoring and metabolic/hormonal screening, it will be life-saving and beneficial--but people flock to our clinic because unfortunately many places rarely even weigh their patients, let alone do blood-work or routine physiological follow-up.

I once heard an 'old' general psychiatrist tell me that "I never met a personality without a body" -- meaning that the mind lives in the soma or body (yeah, the brain is part of our body-I'm biased, I think its the most important part). Without some measures of how your body is doing (to include your brain and its functions) we cannot tell how your mind can be/should be working.

These are powerful medicines and can help, but they should not be prescribed flippantly nor nonchalantly-- A LOT of forthought, medical workup and medical follow-up needs to be added and our healthcare system currently is not set up to support that, with general psychiatrists, fully licensed in their respective states to practice medicine, not being credentialed by certain insurance companies to bill for general medical procedures--so things like blood work or ekg's or eeg's slipping through the cracks or no incentive (actually dis-incentives) to weigh their patients or take blood pressures, heights, calculate BMI's and TRACK ALL OF THOSE THINGS THAT THE MEDICINES THEY ARE PRESCRIBING CAN CHANGE FOR THE WORSE; or the GP who IS credentialed to bill for these things, but has their own set of dis-incentives to actually talk to the patient, and spend the time necessary to do the other piece that psychiatrists as trained physicians CAN DO.

In our country, we have allowed ourselves as patients and physicians, to be split apart - physicians, dult licensed by the state medical boards, not being credentialed by the insurance company to BILL for services is a financial thing, not a medical thing. This sets up dis-incentives for doctors to 'do the right thing' -- which, even when I went to meedical school, was to get the "VITAL" signs. Not just because of vital as in vita (life) but as in these are 'vital' to know about someone.

We must not allow insurance and pharma or any other strong political group to continue to get in the way of the doctor patient relationship-- we need to provide sound, preventive-medicine/wellness-type care in a "do no harm" environment that is open to scientifically-sound integrative medicine centers of care.

In the most technologically advanced democracy that this world has ever seen, it is inconceivable that we even have these dichotomies of care and schisms between those patients who have the luxury of 'concierge-tyoe services and doctors (take the time, do the work up no matter what is needed and without haveing to jump through hoops for 'pre-certification' by a bean-counter whose job is to bar you from getting the test/procedure in the name of good resource management-- not good medicine--and get the medicine/treatment/procedure you actually do need).

Have your doctor TAKE THE TIME to do the medical/lab workup necessary; get to know you; look up prior experiences with meds/labs; and to follow you going forward with labs, ekg's, hormone panels,etc.

Fracture risk doubled after obesity surgery

The dramatic and sustained increase in bone turnover that occurs following surgery for obesity, or "bariatric surgery," translates into a significantly increased risk of fractures, especially in the hands and feet, according to a study presented today at The Endocrine Society's annual meeting in Washington, DC.

CLICK HERE FOR FULL ARTICLE

Sleep deprivation tied to weight gain-

Failure to get a full night's sleep can lead to weight gain or compromise the beneficial effects of a reduced calorie diet on total body fat, according to presentations at SLEEP 2009, the annual meeting of the Associated Professional Sleep Societies, underway this week in Seattle.

CLICK HERE FOR FULL ARTICLE

Weight training may enhance quality of life for some back-pain patients, researchers say.

USA Today (6/10, Lloyd) reports that, according to a study presented at a sports medicine meeting, "weight training and improving overall body strength could help" people manage "nagging back pain." Researchers from Canada's University of Alberta found that "weightlifting enhanced quality of life for back-pain patients by as much as 28 percent," with "more frequent training" leading "to better results." For the study, the team examined "240 men and women who had had no back surgery, damaged vertebrae, or nerve root problems. All had chronic, non-specific lower-back pain as a result of injury to soft tissue in the lower back." For the "first three weeks of the 16-week study, participants worked out with low levels of weight and fewer repetitions to prevent further injury." During "the last 13 weeks," participants undertook "a heavier, more demanding program" in order "to develop strength." The authors emphasized that "the benefit comes from bench presses for the chest, lateral pull-downs for strengthening the back, and leg presses," all three of which "were correlated with pain reduction."

Study indicates levels of depression may be higher in adolescents having later bedtimes.

Following a USA Today story, NBC Nightly News (6/9, story 10, 2:10, Williams) reported that a study presented at a sleep conference "shows the importance of" teenagers "getting enough sleep." Science correspondent Robert Bazell explained, "This latest study from Columbia University surveyed more than 15,000 teens and found that levels of depression and thoughts of suicide are higher in kids who have later bedtimes on school nights."

        In the Los Angeles Times (6/9) Booster Shots blog, Shari Roan added that adolescents "with parental-mandated bedtimes of midnight or later were 25 percent more likely to suffer from depression and 20 percent more likely to have suicidal thoughts. The study supports the idea that inadequate sleep could lead to depression," according to lead author, James Gangwisch, PhD.

        According to HealthDay (6/9), Jonathan Pletcher, MD, "an adolescent medicine specialist from Children's Hospital of Pittsburgh," who was not involved in the study, pointed out, "There's a bi-directional relationship between depression and sleep." He added, "Teens who get less sleep may be more anxious and more likely to feel badly." Dr. Pletcher explained that "besides increasing the risk for depression and suicidal thoughts, a lack of sleep can affect a child's focus and learning," and may make teens "more impulsive." Meanwhile, Gangwisch noted that "a dearth of sleep is also associated with obesity and type 2 diabetes."

Breastfeeding lowers risk of MS relapse: U.S. study-- the interlinkages of the immune system, the hormonal system (endocrine) are many and complex...and those are the few we know about and can kinda understand.

Read the following article regarding the change in the disease in women who breast feed and suffer from Multiple Sclerosis.

http://www.reuters.com/article/healthNews/idUSTRE5575OK20090608

Healthy diet may boost men's fertility-Everything from good insulin secretion and glucose control to the amount of micronutrients (i.e. folic acid) are of immense importance for fertility. Read the following article for more:http://www.reuters.com/article/healthNews/idUSTRE5575AW20090608

Adult type 1 diabetics have higher depression rates-The links between depression and diabetes have been well documented for a long time. This new study continues that trend; diabetes is a metabolic disorder that affects all cells of the body- especially the in the most sensitive organ of the body (the brain).http://www.reuters.com/article/healthNews/idUSTRE5574T120090608

We physicians and allied health professionals at the Springboro Medical Wellness & Neuropsychiatric Center, always have your wellness in Mind TM

We expressly believe that, together, we can be The difference between living and BEING TM so that there can be the healing of body and MINDS.TM

The Springboro Medical Wellness & Neuropsychiatric Center is a specialized practice dealing exclusively in the union of Integrative Medicine, Psychosomatic Medicine, and Age Management Medicine; all highly vested in preventive medicine.

Integrative Medicine is a growing field of medicine in which the patient and providers work together to develop a diagnostic and therapeutic program that draws on a variety of traditions, expertise and modalities to address an individual’s needs; specifically, it is an approach to medical evaluation and treatment that intentionally uses conventional medical treatments alongside other practices (eg. nutritional supplements, herbal remedies, massage, acupuncture, energy work, etc.) for maximum patient benefit. Protocols developed in this framework, may include one or more modalities of treatment (on and off-label), diagnostic testing (conventional and otherwise), naturopathic and allopathic/pharmaceutical therapies, as well as, referrals to other allied health professional and healing practitioners.

Psychosomatic Medicine integrates interdisciplinary evaluation and management involving diverse specialties including but not limited to endocrinology, immunology, psychiatry, psychology, neurology, surgery, gynecology, pain management, pediatrics, dermatology and psycho-neuro-endocrine-immunology. Clinical situations where psychological processes act as a major factor affecting medical outcome and affecting medical compliance and/or surgical results (i.e. Asthma, Diabetes, Alzheimer's, PANDAS, Menstrual Irregularities) are areas where Psychosomatic Medicine has competence and has demonstrated expertise and effectiveness in the medical literature.

Age Management Medicine is defined as preventive medicine focused on regaining and maintaining optimal health and vigor. This medical specialty incorporates well-known and accepted markers of disease-risk into proactive patient management and uses hormone modulation for the endocrinologically "normal" by identifying hormone levels that yield superior health outcomes. Example: for most hormones, this is simply the upper 33% of the normal range for a patient's age. The exceptions are insulin and cortisol that should be modulated to the lower 33% of the normal range.

These combined medical specialty practices/disciplines recognize that successful therapies/outcomes necessitate a healthy lifestyle including optimal low glycemic index nutrition, reduction in maladaptive behaviors & behavioral changes, appropriate hydration, control of addictive behaviors, appropriate nutrient supplementation, and the absolute need for physical exercise; they focus on the synergy of all these elements in order to enhance vitality and extend our health span and optimal mental and physical functioning. While we may or may not be able to increase longevity, prevent premature disability and death we aggressively strive to and are able to significantly enhance quality of life.