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Advanced Applications in Medical Practice – 2018 Post-Portland: Webinar - 1

Advanced Applications in Medical Practice – 2018 Post-Portland: Webinar - 1. Dr. Paul S. Anderson Curriculum Developer for AAMP October 2018. Q’s.

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Advanced Applications in Medical Practice – 2018 Post-Portland: Webinar - 1

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  1. Advanced Applications in Medical Practice – 2018Post-Portland: Webinar - 1 Dr. Paul S. Anderson Curriculum Developer for AAMP October 2018

  2. Q’s 1/ Oxalates - any good ways to help speed up removing these. We cut out the foods, and added in Epsom salt baths, Mg/Ca when eating oxalate foods...but seems like a slow go. Aaron W. Miller, et.al Host-Microbe Biology: The Induction of Oxalate Metabolism In Vivo Is More Effective with Functional Microbial Communities than with Functional Microbial Species. mSystems. 2017 Sep-Oct; 2(5): e00088-17. PMID: 28951890 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613171/ (c) PS Anderson 2018

  3. Q’s 2/ Eosinophils - stuck at 1.0 - took all the potential triggers out of the diet (at one point she was just eating vegetables) as well as tried a parasite tincture (patient can't afford stool testing). what else would keep it stuck at 1.0.( ref range is 0.0 - 0.3 international units). • Can take a long time • This level is almost never a “bad” cause [cancer etc.] • If in a child watch for frequent infections as it can be cause for working up an immunodeficiency (c) PS Anderson 2018

  4. Q 1. The reference for glyphosate binding to aluminum and pulling past the GI barrier a. Does Stephanie seneff talk about this? Yes: https://people.csail.mit.edu/seneff/glyphosate/Seneff_AutismOne_2014.pdf 2. In terms of drainage, what is suggested? Homeopathics (UNDAs), lymph massage? (c) PS Anderson 2018

  5. Q • Does stainless steel pots have cadmium? Yes - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284091/ but there are Cd free products • Is a tick bite ITCHY It can be but normally “very mild” • Can women pass spirochetes to men. Or is it more men to women? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/ “we have shown that Borrelia spirochetes are present in semen and vaginal secretions of patients with Lyme disease.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482345/ (c) PS Anderson 2018

  6. Q • What does short term Doxy mean in kids? (Leone said short term) Under 30 days, normally 10-14 • Dopamine: You said if you have too much you will have addictive behavior. What if you don’t have enough and your body wants more, doesn’t that create addictive behavior? Yes. Can go both ways • Cistus Tea: Klinghardt– 6-8 cups a day. What about the polyphenols in the tea? Can this be too harsh for some people? Sure. Only used in those who tolerate • How often do you think KPU is a problem in people – or rather KPU is a result of Lyme disease. So deal with Lyme then KPU resolved? GREAT QUESTION! (c) PS Anderson 2018

  7. Coagulation 1. Hypercoagulability – Best screening lab options. Dr. Corson had a power point slide including the following tests: Fibrinogen, Antithrombin Activity III, D-Dimer, Protein C Activity, Protein S Activity, Activated Protein C Resistance, Factor II Activity, Alpha-2 Antiplasmin, Plasminogen Activase Inhibitor -1 (PAI-1), Lipoprotein a, Homocysteine (cardio), Lipid panel, Prothrombin Fragment 1+2, Thrombin – Antithrombin Complexes (TATs). This is a long list. Is it a sufficient screening test Fibrinogen and HSCRP, assuming most of us are already testing homocysteine, lipid panel and Lp(a) for other work up purposes? If fibrinogen is out of range that are the most useful remaining tests to run when considering a budget. Beyond the reference range, are there optimal lab ranges to desire for all the hypercoagulability tests or is it just important to focus on the reference range. 2. Hypercoagulability treatment – What is your favorite supplemental treatment option? Dr. Corson mentioned Nattokinase 100 mg soft gels 2 TID and Hemoguard Supreme 2 caps BID for 3 months. Do you track treatment success with follow-up fibrinogen test and how quick should I expect changes in symptoms? (c) PS Anderson 2018

  8. Coagulation HYPERCOAGULABILITY: 1. Dr. Corson- slide on lab workup for hypercoagulability has numerous labs listed (slide #22 on day 2 lecture). If needing to order a trimmed down panel for cost savings for the pt, what would be recommended. 2. I have utilized the "Thrombotic Marker Panel" by Quest which includes D-Dimer, Fibrin Monomer, Prothrombin Fragment 1.2, Thrombin- Antithrombin (TAT) Complex. Sometimes I have found only one marker elevated (usually the TAT), the rest normal. With that being said, that combined with clinical signs of hypercoagulability, is that sufficient for dx and to initiate tx? 3. When do you decide to treat hypercoagulability with Heparin as opposed to Lumbrokinase (in addition to of course treating underlying causes)? Is there a certain threshold in the labs that you use to go with Heparin? (c) PS Anderson 2018

  9. 125 mg heparin troche: • https://jamanetwork.com/journals/jama/article-abstract/311725 (c) PS Anderson 2018

  10. A “Brief” Case… (c) PS Anderson 2018

  11. Q Here is a case that I'd really value your insight and experience on. Have tried to be as brief as I can: Maya, Female 34, Mother of 2 girls (6, 10). Very bright, kind etc.. Very lean - 5'5 110lbs, minimal body fat, little muscle No regular exercise Chief concern: chronic gas/bloating, foul stool & breath, constipation. Stool floats. Phx acid blocker use. Complaining of hair loss, fatigue Hypothyroidism (2005 to present). Synthroid0.55mcg Phx of anorexia - still seems obsessive about food. Suspect she binges on baked goods and fruit - extreme cravings and often "confesses that she's given in to eating things she shouldn't" at each of her appts. Pancreas: amylase elevated 121 (30-110) for past 2 years. Mild inflammation seen on u/s Chronic iron anemia Phx Depression 2014-16 rx: Escitalipram x 9 months. Current mood seems stable IgG food testing Sept 2018 - minimal sensitivities (scallops, shrimp, egg whites) - I expected there to be more... (c) PS Anderson 2018

  12. Q GI MAP CDSA results Sept 2017: • H. Pylori - high • Citrobacter - high • Pseudomonas - high • Blastocystishominis - present • Geotrichum - high • Steatrcrit - high (20) • sIgA - low • Anti gliadin IgA - high (c) PS Anderson 2018

  13. Q Over past year, here is what I've rx'd: • Digestive enzymes (incl. ox bile) - some reduction in gas/bloating • Sacc. Boulardi - to increase sIgA - it's come up but not much • Eradication: Candibactin AR/BR (Metagenics) - x 1 month - poorly tolerated, only managed to do 2 weeks • Liver Support pre and during eradication • Biofilm busting - pre and during eradication - NAC 900mg tid • GiMicrobx (Designs for health) + oil of oregano 2 caps bid - well tolerated • Mg Oxide prn for constipation (c) PS Anderson 2018

  14. Q • Activated charcoal 1 cap/day • Parasite botanical tincture - 30 days worth - 1 tbsptid - well tolerated • Cut out gluten - although she admits to still eating it + a lot of fruit • Low FODMAP diet - stuck to it for 1 week, then went off on own • Regular exercise (walking, swimming etc) - has been inconsistent • Adrenal support (Adrenal complex incl. glandulars) x past 3 months - well tolerated but no uptake in energy Re-ran GI MAP CDSA in Sept 2018 with some change but not as much as I'd hoped. Still complaining of diarrhea/constipation, fatigue, bloating (c) PS Anderson 2018

  15. Q H. Pylori - still high Entabmoebahystolica - high (new finding) Citrobacter -resolved Pseudomonas - high Blastocystishominis - still present Geotrichum - resolved Opportunistic bacteria - 2 strains in high amounts, 7 detectable Defensive bacteria - 5 strains low, 2 elevated Steatrcrit - normal sIgA - improved but still low Anti gliadin IgA - still high (b/c I'm quite certain she is still eating gluten!) Blood work (Sept 22 2018) Amalyse still elevated, WBCs/neutrophils elevated ferritin 27 (full iron panel not done by MD) Creatinine LO (1.6) TSH 1.32 FT3 2.8 (LO) FT4 13 (MD runs bloodwork. Never complete thyroid workup with RT3 and antibodies) (c) PS Anderson 2018

  16. Q So, here's what I'm wondering: 1. I'm not sure why these microbes aren't budging 2. Should she get her MD to rxivermectin + Alinia to get rid of the parasite (I'm in Ontario - no rx'g rights for antibiotics and I'm not licensed for IVs) 3. Should I put her on a stronger biofilm buster (ALA, NAC, BIsmuth?). If so for how long 4. Should I use Biocidin and if so for how long? 5. Should I be using more binders (Charcoal?) (c) PS Anderson 2018

  17. Q 6. Her thyroid remains sub-optimal despite the synthroid and the gland doesn't seem to be converting T4 to T3. Should I provide cofactors for the gland's support? How much is thyroid impacting her GI issues? 7. How would the elevated amylase fit into this. Elastase levels were normal in both CDSAs and steatocrit now normal 8. How much could the phx of anorexia have impacted her migrating motor system or defensive flora - is that a bigger factor than I'm imagining here? 9. I suspect she is sabatoging the protocols with her eating habits...hard to fix this short of feeding her myself ;o) (c) PS Anderson 2018

  18. Q - Lichen Wondering if you have had any success treating Lichen Sclerosis. This is my first case I had a 56 yo, new patient yesterday presenting with LS for past 2 years. Treated with Clobetasol (twice a week) Vagifam, Replens - nothing has provided much relief. Still having extreme itchiness and vulva is sensitive to touch, fabrics. Tissue tears easily Vaginal atrophy: Premarin - oral + topical. Induced a period for first time in 6 years. LMP prior was 2012. Cut dose back to just oral Long history of chronic emotional/mental stress d/t alcoholism in family and with current husband. People pleaser, everybody's go-to etc. Little self-care practices GI: chronic gas/bloating < after eating. No mucous/blood. Chronic constipation. I'm requesting a CDSA (c) PS Anderson 2018

  19. Q - Lichen Want to look at IgG food sensitivities to see if that contributing to chronic inflammation Historical blood work shows a very low TSH over past 3 years (0.03). MD has never run complete thyroid panel. I've requested the following as I've found a few clinical papers demonstrating the relationship b/t autoimmune (thyroid, systemic) and LS Thyroid Panel: TSH, Free T3, Free T4, Reverse T3, Anti-TPO, Thyroglobulin - historical issues with thyroid (very low TSH, recently Low T3) Autoimmune Panel: ANA, Rheumatoid Factor, Tissue Transglutaminase Inflammation: Hs-CRP, ESR, Fibrinogen Complete Blood Count (CBC) Is there anything else I should be considering in this case? Do you have any clinical pearls? (c) PS Anderson 2018

  20. Live Questions (c) PS Anderson 2018

  21. More AAMP? (c) PS Anderson 2018

  22. AAMP Scottsdale 2019 Regenerative Therapies in Medicine – How to make them maximally effective! 17or moreAMA Cat-1 CME (Pharmacology and Ethics hours pending) (c) PS Anderson 2018

  23. Joining me: • Jessica Petross, MD • Tyna Moore, DC, ND • David Milroy, DC, ND • Brenden Cochran, ND (c) PS Anderson 2018

  24. Concept Areas Regenerative Therapies in Medicine – How to make them maximally effective! While there are many “Technique” classes for regenerative therapies (to learn the hands on use of the therapy) there are few that truly look at “how” to make these therapies work to their maximum benefit for patients. So regardless of the reason for the therapy (orthopedic, cosmetic, regenerative etc.) the underlying need to create the environment of a “receptive patient” maximizes the result and outcome. (c) PS Anderson 2018

  25. Concept Areas Since you already know (or can learn) the technique portions of regenerative therapies easily at specialty seminars, Dr. Anderson and AAMP (after being asked by numerous practitioners) have devised this encompassing CME to look at all the factors you can control to optimize regenerative therapy outcomes. Expert, experienced faculty will focus on enhancing patient outcome when receiving Stem Cell, PRP, Prolozone, Aesthetic, Prolotherapy, Trigger Point and many others: (c) PS Anderson 2018

  26. Therapy Areas • Immune function optimization to promote regeneration – Including common stealth infections and biofilm influences on poor healing • Hormonal influences on regeneration and healing – Assessing and using bio-identical hormones to support healing • Laboratory assessment of patients to locate deficits and how to correct them • Nutritional, Genomic and Dietary influences including the use of specific diets, time restricted eating, nutritional supplements and more (c) PS Anderson 2018

  27. Therapy Areas • Use of adjunctive therapies to enhance outcomes such as Heat, Hyperbaric, Light / LASER therapies and others • When to include IV or Injection therapies to enhance outcomes (and what to use) • Many other supportive integrative therapies ***Even if you refer out for these therapies making sure they work maximally for your patient can be a full time job! Both the primary provider of regenerative therapies and the referring provider can benefit from the information provided at AANP Scottsdale 2019. (c) PS Anderson 2018

  28. Double Tree Resort by HiltonFriday, May 17th – Sunday, May 19th, 2019 (c) PS Anderson 2018

  29. Thank you! We look forward to seeing you in Scottsdale for the AAMP CME conference series! https://aampSCOTTSDALE.com/ (c) PS Anderson 2018

  30. AND: We have AAMP scheduled for the coming TWO years! • SCOTTSDALE (SAME RESORT) 2019 AND 2020 • Regenerative Therapy Optimization May 17 – 19, 2019 • (Topic and weekend TBD) May 2020 • SEATTLE (HILTON AIRPORT CONF. CTR.) – We moved from PDX to SEA. • Integrative Oncology October 25 – 27 • (Topic TBD) October 9 – 11, 2020 (c) PS Anderson 2018

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