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Canadian Homeopathic Conference – Toronto 2016
Best Medicine: In’s and Out’s of Integrative Medicine
CAM
Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine
CAM
NCCAM - the thoughtful "combining of mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness."
CAM
“The practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing”
Health
Health is not simply the absence of disease. Health is best defined as a positive state of dynamic balance in which a person functions well and interacts with their environment smoothly and efficiently.
Health is an investment, not an expense. The investment in time, effort, and money must be realized every single day.
Nomenclature
A Paradigm Shift: Traditional/conventional medicine may soon be considered "alternative“. Complementary medicine - once regarded as “traditional” - is often applied in "integrative“ settings and even more often provides the basis for first line therapy (versus drugs or surgical intervention).
The Future
The Future of Healthcare
- Integrative: best evidence-based practices combined
- Personalized: “know patient right down to their genes”
- Mind-Body Medicine- Lifestyle
Tumour Model
Surgery
Radiation
Chemotherapy
Physician
Tumour
Patient
Conventional medicine
- Tumour is to be removed and destroyed
- Doctor is in control. Patient has little say, participation in decision making, or role to play in their healing
Tumour Model
Immune Enhancement
Prayer
Surgery
Chemotherapy
Radiation
Vitamins &
Supplements
Exercise
Stress Reduction
Avoidance of Toxins
Emotional Support
Healthful Diet
SELF
MeditationParticipant
Physician & other
Practitioners
T
Integrative Approach
- Tumour removal and destruction is likely part of the process
- Other healing modalities are integrated
- There is a formed relationship between the patient and a support network of practitioners
Who Seeks Care at P3 HealthPreventive Health / Executive Health / Concierge Care
Chronic Illness
P3 Health
Personalized:
A model that reflects the customization of healthcare, with medical decisions, practices and products tailored to the individual patient.
The Promise of Personalized: - Cost-effective- Improved health outcomes for individuals and
populations
Personalized
Personalized
P3 Health
Participatory:
A method by which networked patients shift from being passengers to drivers of their health, and in which providers encourage and value them as full partners.
P3 Health
Preventive:
A movement that focuses on protecting, promoting and maintaining health, as well as forestalling the development of disease, disability and death.
Preventive
An ounce is worth a pound
- Cardiovascular risk assessment- Reduction in Cancer risk - Surveillance- Anti-aging
Life Extension
Squaring the Curve:
Represents the ideal of postponing the decline in health associated with age so that people enjoy a good quality of life and die as healthy as possible as late as possible - interventions should aim to improve both quality and length of life, not merely to prolong life at all costs
100%
Vitality
QOL
Wellness
AGE yrs
25 50 75 100 125
Inflammation
Oxidation
A.G.E.s (Sugar)
Life Extension
Squaring the Curve:
- Telomeres: - Oxidative Stress:- AGE’s:- Inflammation:
Chronic Illness
Managing Chronicity's
- Lyme disease- CFS / FMS / IBS- Post Concussive Syndrome- Chronic Pain- Peri/Post Menopause- Andropause- Mental Health- Etc.
Essentials for an Integrative Practice
Collaboration
EMR
Electronic Medical Record
- digital version of a paper chart that contains all of a patient's medicalhistory from one practice
- Keeps everyone on the “same page” literally and figuratively
- Customizable IAP’s and forms - Observational clinical data to
determine efficacy of elements of IAP
I.A.P
Integrative Action Plan
- Summary of prescribed treatments - Helps guide the patients
expectations- Acts as an internal billing travel slip- Establishes compliance- Specifies duration of treatment and
intended follow up
MOA
Mechanism of Action
- Homeopathy does not seem to be compatible with the current mechanistic-molecular paradigmatic model
- The mechanism of action of HM is still unexplained but appears to have a regulatory effect and possesses an unknown structure (if any)
Obstacle to Cure
Functional laboratory assessment
- Helps assess impact of the IAP including the homeopathic remedy
- Homeopathic prescription wont have a lasting effect without solving obstacles to cure; often nutritional / micronutrient
Diagnostics
Bioimpedance
- Helps to evaluate the physical health of a patient
- Able to discern ICM/ECM, lean vs fat tissue, water compartmentalization, and phase angel vs age/gender matched
- Helps to decide potency
Diagnostics
Bio Terrain
- Helps to evaluate the health of a patient and how prone they are to disease
- Helps to decide potency - Helps motivate the patient
Diagnostics
Intestinal Biome
- Provides insight into gut flora by identifying commensal bacteria
- Identification of parasites- Biomarkers indicating levels of
digestive and absorptive functions, as well as potential issues with gut inflammation and immunology
Diagnostics
Micronutrient Testing
- Provides individuals status of Antioxidants, B Vitamins, Digestive Support, Amino Acids, Essential Fatty Acids, Heavy Metals, and Minerals
Diagnostics
Inflammatory Cytokines
- Provides insight into potential causes of chronic inflammation including autoimmune disorders, viral infection, allergy and asthma, and cardiac disorders.
- IL-2, IL-6, IL-8, IL-10, IFN-y, TNF-a
Diagnostics
Food Sensitivities
- While not life-threatening, some foods can bring on a wide range of unpleasant symptoms such as respiratory or gastrointestinal disorders, migraines, headaches or dermatological problems such as eczema and prove as significant obstacle to cure
Diagnostics
Toxins
- According to the U.S. Department of Health and Human Services Agency for Toxic Substances and Disease Registry (ATSDR), Environmental factors contribute to more than 25% of all disease.
Diagnostics
Genomics
- Disease specific risksCardioGenomicsDetoxiGenomicsNeuroGenomicsOsteoGenomicsHormone Genomics
- “Lifestyle” GenomicsAthletic performance / Exercise prescriptionNutrigenomics
- Pharmaco-Genomics- Cancer Genomics
Germ-line (patient’s original)Somatic (cancer tissue / cell sample)
Whole Chromosome Changes Insertion / Deletion Change = InDel
VariabilitySingle letter = SNP (Single
Nucelotide Polymorphism)
eg. Centre vs Center 15%
Whole word change = Allele
eg. Centre vs Middle 5%
Paragraph change = CNV (Copy Number Variation)
75%
Variants
Detecting Variants
- Rapid advance in sequencing technology
- NGS = NEXT GENERATION SEQUENCING
- Faster, cheaper, more accurate- Now “era of $1000 genome”- 13 yrs / $2.7 billion to complete
human genome project
Co$t
Age at onset of probable Alzheimer’s disease
Apo-E Allele
Apo-E Genotyping
- Strong associations with CVD (Cardiovascular Disease) and AD (Alzheimer’s Disease)
- E 2 (lower risk), E3 (“normal”), E4 (higher risk)
Methylation
Methylation Pathway
- Detoxification- Immunity- Maintains integrity of DNA- Energy Production- Etc.
Diagnostics
Carotid Doppler
- Beyond Framingham Risk - Emerging CV Risk Factors
(genomic, phenotypic)- Non-invasive, rapid, vascular
imaging
Diagnostics
Telomere Testing
- Telomere length and Cardiovascular disease
- Cancer, Vascular dementia- Degenerative conditions- Diabetes- Anxiety / High stress- General Chronic disease
- Changes of gene expression in response to experience, environmental exposures, behaviours
- Epigenetic changes are heritable!
Epigenetics
MBSR
Mindfulness Based Stress Reduction
- Dr. J. Kabat-Zinn “Mindfulness is paying attention in a particular way: on purpose, in the present moment, and non-judgmentally… to facilitate change in conditioned patterns of thought, behaviour”
MBSR
AWARENESS
THOUGHTS
AWARENESS
EMOTIONS
5 SENSES
PERCEPTIONS
PAIN/SUFFERING
INTUITION
BODY/SOMA
MBSR
1998 2003 2007 2009 2011 20121992
Improves
chronic pain,
symptoms in
fibromyalgia
Improves skin
clearing iin
psoriasis and
symptoms in
IBS
Reduces
stress,
anxiety &
depression
Improves
symptoms in
heart disease,
immune function
in healthy, and
HIV
Reduces BP
Improves
glycemic
control in
Diabetes
Reduces
levels of
cortisol &
stress
Leads to
epigenetic
changes in
stress
genes
Changes
brain
structure /
volume
Reduces
brain
atrophy with
age
Lengthens
telomeres,
aids in
weight loss
Improves
working
memory
MBSR - Research
Heart Math
Biofeedback
- Monitoring your emotional and physical health. Helping you improve it. - 50% drop in fatigue- 46% drop in anxiety- 60% drop in depression- 24% improvement in the ability to
focus- 25% improvement in listening ability- 30% improvement in sleep
Marketing
External Marketing
- Conventional Television- Social Media / Digital Media- Public Education: Similisan
documentary- Packages that incorporate multiple
practitioners
Social Media
Documentary
D.A.R.I
Diabetes and Related Illness
- 4 month program to help those suffering from diabetes, heart disease, stroke and cancer, and those at risk of developing Metabolic Syndrome
- A “Quarterback” guides patient through all assessment and services
D.A.R.I
Diabetes & Related Illnesses
Fully Integrated Program:• Consultation MD + CAM professional• Health coach, Holistic Nutritionist• Testing• Integrative Action Plan
• Lifestyle – diet, fitness, MBSR / H.M.• Supplements• Medications if necessary
FYB
Feel Your Best
Experiential 3 hrs• “Bootcamp”• Yoga• Meditation• Teaching Kitchen demonstration /
nutritional meal• Interactive discussion
Case Analysis
Case of a 23 y.o. Female Athlete
• Ms. C.S. 23 yo athlete presented to clinic
in fall 2015
• Sought care of Sam Gibbs (Osteopathic
Manual Practitioner) for
post-concussion syndrome
• National ski team until age 13, but 3
concussions, third “career ending”
Case Analysis
Case of a 23 y.o. Female Athlete
• Now competitive cyclist trying for national
team
• July 2015 – hit by car while cycling.
CONCUSSION AGAIN
• Ongoing symptoms: headaches,
imbalance / disequilibrium, fatigue
• Addt’l symptoms noted, prompts referral
by family MD to Dr. Cook
Case Analysis
Case of a 23 y.o. Female Athlete
• Many years of variably orange
discolouration of skin esp. palms
• Exercise tolerance dropping
• Fatigue even before concussion
• Referrals to multiple specialists
(dermatologist, endocrinologist,
internist…)
B.I.A.
Lab work up
“OHIP” bloodwork
HS-CRP 0.4TSH 1.22 with normal free hormonesTTG Ab negativeGliadin IgA sl. ElevationHgb 117 (115 – 155)MCV 102 (80 – 99)Reticulocytes 21 (20 – 85)Ferritin 81Vitamin D 88Vitamin B12 732!RBC Folate >3000Carotene 5.16 (0.19 – 1.58)
Special Labs
- Genomics (nutritional, methylation, detox)
- Functional / Orthomolecular (NutrEval)
- Microbiome Analysis
Genomics
Genomics
Genomics
Functional
Functional
Functional
Functional
Functional
Functional
Functional
Gut Biome
Gut Biome
Gut Biome
DIAGNOSES:1. POST-CONCUSSION SYNDROME2. NUTRITIONAL DEFICIENCIES
• Esp. B Vitamins due to methylation genomics (despite high serum B12)
• Anti-oxidant deficiencies (exacerbated by GSTM CNV and slow Cyp 1a2)
• Magnesium deficiency• Lactase deficient (genomic confirmation)
3. INADEQUATE MICROBIOME BIODIVERSITY / DYSBIOSIS4. MALABSORPTION (Contributing to #2)5. I.B.S.6. Stress!
Case Analysis
1. Referral Dr. Dan Demian / Sam Gibbs• Neurorehabilitation / vestibular re-training / concussion recovery• Manual therapies2. Stress Management• MBSR vs HeartMath3. Diet• PALEO – dairy free, grain free4. Custom Supplementation• Vitamins, antioxidants, botanicals• IVMT with glutathione, B12 injection then S.L. MethylCobalamin• High dose Probiotics (VSL #3 + Bio K)5. Homeopathic Helleborus Niger (more striking than any of her other symptoms, was that she was so much more dull and slow when compared to before the concussions)
I.A.P
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