- To Change Your Mind - Details Matter
CorePsych DC: Parker Reopens Near Tyson’s
ADHD Rules: Always Target Context
September 18, 2010CorePsych DC – Medical Team Introduction
October 16, 2010
New DC Digs, Second Floor
Scarcity creates value, – and what's scarce is a desire to accept what is, and then work to change it for the better, not deny that it exists.
Seth Godin, Linchpin
DC Beckons Me Back – True Confessions
I do have to fess up, once again, right here and now – I loved my recent four years ['03-'07] in DC setting up the Amen Clinic and working with our outstanding Amen DC clinic team. The SPECT brain science and Amen's brain insights provided numerous great conversations with many highly informed colleagues, – and the patients that came in those Amen DC doors were already thinking deeply into the next box. Many of them had “already tried everything else – several times.” That experience confirmed my expectations: the science works. Looking is always better than guessing, – and soon will become the standard of care.
SPECT at Tyson's |Looking At Function
Amen is undeniably a brain thought leader who works diligently to consider good evidence and applied next steps with mind/body interventions. I will be continuing to use Amen DC cameras [this post from 2006] for “scans only” and will provide my own SPECT reading and reports in this new CorePsych DC office – as I have from Va Beach since winding down with Amen. “Scans only” is an administrative phrase we use internally for patient referrals – to request only the SPECT images, without the interpretive readings provided by the Amen Clinic docs. Simple: They take the SPECT ‘picture,' they send the scans to me. I not only read the SPECT findings with you in the office, but often suggest additional comprehensive testing to take those macro SPECT results to the deeper molecular level of brain function evidence.
These additional tests provide undeniable added value with even more explicit biomedical intervention options.
Tyson's Is An Easy Connection
Last DC tour I flew up, stayed in northern VA for 3 days, and flew home from Reagan on Friday. This tour will be only one day to start [will fly in Tues PM], in the office only Wednesdays for now, – and will fly back to Va. Beach Wed nite. Our DC office, here on Boone Blvd, just a click south of Tyson's [see this map] will make it easy to find – and is invitingly quiet, just outside the hustle and traffic of Tyson's ‘downtown.' [Between Leesburg Pike and Old Courthouse Rd, a short hop off of Gallows, just south of Tyson's.] Long term plans? Manage CorePsych activities in both sites by building exemplary treatment teams.
Beyond SPECT
Our medical team in Va Beach sets a different standard for highly targeted, highly specific and scientific long term care – down to the neurotransmitter measurement level. Our offices are on the frontier – using applicable science, where everyone should be, and will be, in a few years. Psychiatry is about long-term balanced relationships – with understandings that arise beyond that first blush of an interesting evaluation. Neurophysiology matters. The patients I see are themselves the best spokesmen – they join me in advancing the science.
The Dr Lawson Connection
The best part of these new office connections are my fresh, delightful colleagues – most especially Dr Lynese Lawson with Proactive Wellness Centers. Dr Lawson captains an established anti-aging and wellness practice who specializes as well with applied bioidentical hormones. I'll be renting a room from Dr Lawson and will have a personally trained Certified Family and Child Nurse Practitioner there for just for the psychiatric medical follow up after treatment and stabilization. If you have the opportunity to meet Dr Lawson passing through our offices, you will not be disappointed. She is thoughtful, smart, authentic, and deeply into the applications of new medical findings – and has a great sense of humor!
Address:
Proactive Wellness – CorePsych
8229 Boone Blvd, Ste 280
Vienna, VA, 22182
Appointments for the near term: First available at CorePsych DC: Nov 3 Wed.
Call Patient Care: Sarah at 757.473.3770 x203
Strong suggestion: Make your appointment up there ASAP, that one day is already filling.
I am very much looking forward to this different tour in DC – it's my kind of town.
cp
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14 Comments
David Summers, a 37 year old MS patient from Murfreesboro, Tennessee was a score of 8.0 on the Expanded Disability Status Scale (EDSS) when he had the Combination Liberation Therapy and Stem Cell Transplantation at CCSVI Clinic in March of 2012. Having been diagnosed in 1996 he had been in a wheelchair for the past decade without any sensation below the waist or use of his legs.“It was late 2011 and I didn’t have much future to look forward to” says David. “My MS was getting more progressive and ravaging my body. I was diagnosed as an 8.0 on the EDSS scale; 1 being mild symptoms, 10 being death. There were many new lesions on my optic nerves, in my brain and on my spinal cord. My neurologist just told me: ‘be prepared to deteriorate’. I knew that he was telling me I didn’t have much time left, or at least not much with any quality.” David had previously sought out the liberation therapy in 2010 and had it done in a clinic in Duluth Georgia. “The Interventional Radiologist who did it told me that 50% of all MS patients who have the jugular vein-clearing therapy eventually restenose. I didn’t believe that would happen to me if I could get it done. But I have had MS for 16 years and apparently my veins were pretty twisted up”. Within 90 days, David’s veins had narrowed again, and worse, they were now blocked in even more places than before his procedure.“I was so happy after my original procedure in 2010. I immediately lost all of the typical symptoms of MS. The cog fog disappeared, my speech came back, the vision in my right eye improved, I was able to regulate my body temperature again, and some of the sensation in my hands came back. But as much as I wanted to believe I felt something, there was nothing below the waist. I kind of knew that I wouldn’t get anything back in my legs. There was just way too much nerve damage now”. But any improvements felt by David lasted for just a few months.After his relapse, David and his family were frustrated but undaunted. They had seen what opening the jugular veins could do to improve him. Because the veins had closed so quickly after his liberation procedure, they considered another clinic that advocated stent implants to keep the veins open, but upon doing their due diligence, they decided it was just too risky. They kept on searching the many CCSVI information sites that were cropping up on the Internet for something that offered more hope. Finding a suitable treatment, especially where there was no known cure for the disease was also a race against time. David was still suffering new attacks and was definitely deteriorating. Then David’s mother Janice began reading some patient blogs about a Clinic that was offering both the liberation therapy and adult autologous stem cell injections in a series of procedures during a hospital stay. “These patients were reporting a ‘full recovery’ of their neurodegenerative deficits” says Janice, “I hadn’t seen anything like that anywhere else”. She contacted CCSVI Clinic in late 2011 and after a succession of calls with the researchers and surgeons they decided in favor of the combination therapies.“I went to CCSVI Clinic in India without knowing what to expect” says David, “but I basically had one shot left and this was it. I was becoming pretty disabled, and I couldn’t think very clearly”. David was triaged with a clinic intake of other MS patients and had the liberation therapy on March 27, 2012. They also drew bone marrow from his hip bone in the same procedure. When he woke up from the procedure, he again felt the immediate effect of the widening of the veins. “In case anyone doesn’t believe that the liberation therapy works, I can tell them that this is much more than placebo effect.” The MS symptoms described earlier again disappeared. Four days later he had the first of the stem cell injections from the cultured cells taken from his hip bone during the liberation therapy. The first transplant was injected into the area just below his spine. Over the next 4 days he would receive about 100 million stem cells cultured in specific growth factors for differentiated effect.He was not quite prepared for what happened next. A few hours after the first transplant, he was taken back into his hospital room and was transferred to the hospital bed. “I’m not completely helpless when it comes to moving from a chair or a bed”, says David, “One of the things I can do for myself is to use my arms to throw my leg into a position to be able to shift the rest of my body weight over to where I’m going. But this time to my amazement, I didn’t have to pick up the dead weight of my leg and throw it. It moved on its own, exactly where my brain told it to go”. Shortly after his first stem cell transplant procedure, some motor function in his lower body had returned. “This was the first time in 10 years I had any sensation or motor function below my waste so it was quite a shock.”In the next month, most every motor nerve and body function has either returned or is on its way to recovery. “It’s been over a decade since I’ve had any power over my elimination functions. Now it’s all come back. I have total bladder control”. He’s also working out every day, following the physiotherapy routine given him by the clinic. “For years, I haven’t been able to work out without getting sick for a couple of days afterward. Now I have muscles popping out all over the place where I haven’t seen them since my MS became progressive…and I can work out as hard or as much as I want. With my ability to do the hard work my balance is improving each day and I’m able to take steps unassisted. I’m definitely going to be coming all the way back.”Dr. Av Gupte, the neurosurgeon who has now done over 2000 adult autologous stem cell transplants for various neurologic disease conditions says that the stem cells in David’s body will continue to work their healing process for the next year. “With the incredible progress I’ve seen so far, I won’t need a year”, says David. “It’s only been a little over two months and I have most everything back. I can’t wait to get up each day to check out my improvements. My right hand is completely back to normal without any numbness and the left is on its way. I have good strength in my legs now and I’m working on the balance”.Other MS patients treated with the combination therapy over the past 18 months have seen similar improvements but none have been as disabled as David. “If I can come back from where I was, most everyone with MS could too. For me, CCSVI Clinic has been my miracle and I can’t say enough about the doctors, researchers and staff who are helping me to recover. For me, MS was my previous diagnosis”.For more information please visit http://www.ccsviclinic.ca/?p=904
Intuniv has been a God-send for my son, to the point where we have been able to lower his Focalin dose and even skip it some afternoons (which makes him eat more, which he definitely needs to do!). He sleeps, his tics are gone, he’s pleasant, he even made the honor roll for the first time ever!
He’s been on it for a year now. However we keep having to increase the Intuniv dose to get the same effect and his pediatrician is no longer comfortable with the amount he has to take. We’ve been cheating and giving him 5mg, then 6mg, for several months even though his ped didn’t want to go past 4mg. Our daughter’s shrink is willing to officially prescribe it higher but it costs us a bunch of money to see him, money we don’t have right now.
FYI, I am a healthcare professional so I am able to monitor his blood pressure at home without a problem (I don’t want to give details on my job for anonymity’s sake).
How high a dose have you seen kids on? (off label). What can I do about my son’s high metabolism for this drug? It’s weird… he used to metabolise Focalin at an incredible rate, but now it seems to have switched off….
Anne,
When I reach the bottom of the therapeutic window and things just aren’t working right, even tho I love the med, I consider augmentation strategies and look carefully at neurotransmitter testing to see what I am missing. Remember: each of these meds are quite specific in their most prominent effect on exactly targeted neurotransmitters.
As discussed in several other posts on Intuniv, neurotransmitters and ADHD [codified here] glutamate is the target for Intuniv. Dopamine, norepinephrine even serotonin, can significantly improve ADHD symptoms – so my choice on the edges of practice: measure, don’t speculate, and if you are pinched with finances the NT testing is covered by many insurances. Some other NT may be the real problem.
cp
Hi Dr. Parker
My son is 12 y/o. He was diagnosed with ADHD in 2005 in second grade. His first grade teacher found him to be an anxious child. We’ve been on Concerta for the entire time, with the exception of a trial with Strattera, which did not work-his middle school teachers confirmed he was unable to stay on task. We are back on Concerta, an extremely low dose of 18 mg. It seems to help, but he still has sleep issues and some emotional lability. He continues to have struggles socially and some anxiety, but nothing my current psychiatrist feels we should be treating.
My question is: What is a better plan? I feel like we are spinning our wheels. My son feels frustrated and does not like the Concerta-he feels ‘nervous’ on it, even though the dose is low. I’m not too, too happy with stimulants due to his anxiety-what would be a better treatment option? Would Intuniv work even through Strattera did not? I understand Vyvanse is supposed to be an easier medication to tolerate.
I feel very lost and frustrated. Any help would be greatly appreciated.
Incidently, he still wets the bed at night 5/7 nights and has occasional day time accidents.
Thank you.
Veronica
Veronica,
Your boy does need a more comprehensive work up, including IgG testing for food sensitivities [see this CorePsych Blog post on IgG and brain] and an assessment to evaluate for comorbid depression, and, without knowing more details, just might improve with a change in meds. Kids with the ongoing wetting problems both day and night are almost always suffering with food allergies – most often milk and wheat.
If he does have unrecognized and untreated food allergies or any other immune dysfunction it is highly likely no psych meds will work predictably until they are identified and corrected.
cp
Hi,
Do you know if Guanfacine contains gluten? My son is on it for ADHD and we are trying to eliminate gluten and casein. He has been tested and is majorly intolerant to casein and also but not as much to gluten. He is also taking morning supplements which consist of Amino acids, mag, vit B6, OPC-3 and inositol and lastly his guanfacine pill. He complains of a stomach ache. I give it to him at the same time as I give him breakfast. Is it the supplements causing this the belly ache or gluten from the guanfacine? Thanks so much!
Darla,
Sorry don’t know that one on Gluten/Guanfacine – I would first back off on the supplements go low and slow for a couple of weeks, then slowly increase to tolerance.
cp
Hello Dr. Parker,
At some level I always knew something was not right with my 7 year old son, he was behaving very much alike his uncle, my only brother who always struggle focusing, was easily frustrated with what I considered little challenges like reading a book or following instructions, always with a short fuse for everything and everybody, also forgetting everything and loosing things.
My boy was just diagnosed with ADHD in the inattentive group, he is being for the last 3 weeks on 30mg of Vyvanse and now we are switching to 20mg because he was getting to be very emotional and anxious at school. (Besides that, he is doing great at school, focusing and getting his work done.) The only thing is that he STILL offers resistance to do almost anything, at the end he does it and gets excited about it, but it is a battle to get him going. Some times looks to me that his first choice in any situation or proposal is to focus in the negative of it and be sad about it (not a tantrum) almost to the tears (and sometimes actual tears). Is that part of the ADHD? it will change with the medication or requires therapy? it is something else or just an annoying part of his personality?
After his diagnosis I decided to educate myself to better help him and maybe even help my brother. During that investigation I found your blog and I am fascinated with all the information you kindly share here, I just ordered your book. I am so excited to learn more!.
Browsing your blog I found this link: Adult Executive ADHD: “Those Wrecked by Success” that you did on July 16, 2009 at CorePsych Radio. When we were younger I thought my brother had problems and needed professional help but never thought of myself, but the more I read the info in that link, the more I felt that the depression diagnosis that my family doctor gave me, is just wrong.
There is any way that I can get the full content of that talk? I think that could be the answer to my personal quest of finding why in the latter years I: have a continuous internal fight with myself trying not to procrastinate and be productive, feeling guilty for not doing all the things I need to get done (a never ending list), having such of high standards for myself (as a mother, spouse, professional…) and everybody around me, having little patience and a lot of trouble controlling my temper. Very often I overreact and when I get mad it is like a train at full speed that I know it will hit a brick wall if I don’t shut my mouth, but I just can’t do it and after I say very hurtful things to people I love and drive arguments to the extreme, I just end up feeling like the worst person on this earth. Then, I feel like there is no fix for my ways and I just wants to disappear… to get a new chance to start everything all over again with people that doesn’t know me, not to do those things that I regret later that get people to know the real me (my despicable me).
I want to have a neat house but even trying hard to clean and organize I end up having a messy, messy one. It is like everything gets in my way and I loose the focus of the priorities. I am constantly setting goals but having little achievements because I can not find the time. I love to over-schedule my days, even when it is not much in my plate I find the way to get it full and get stressed. Often I am late and always running. Even though I like people and having friends, when they call me or invite me, I tend to evade their calls and many invitations… weird. I think I feel more comfortable being alone, but then I freak out for not having close friends.
I analyze and over analyze things from every possible angle, everything! from business opportunities to designs, situations, comments or arguments with friends or family members. And then evaluate and re-evaluate my reaction to it and second guess it, some times for days. I have a hard time letting go thoughts related to that. I also get very anxious thinking of stuff, for example people I love and their safety, economical stability, the future… I tend to feel overwhelmed with normal life challenges and need the reassurance of my husband to get going, but when I am on it, it looks so simple and easy to deal with that just remembering that I needed the reassurance makes me feel ashamed.
I am 37 years old, I was an excellent child at school, good grades, responsible, reliable and independent. I got a degree in College in Marketing and Graphic Design. I have a very strong entrepreneur spirit, I had my own small businesses many times. I once worked as an employee and I was the best one, giving everything and always going the extra mile for everybody.
I am curious and a fast learner, to everybody I am very capable to get anything I set my mind to, but I secretly struggle with the simplest things in life… like not having that noise in my head that is like static that prevents me to clearly hear and organize my thoughts, control my temper and don’t feel that intense anxiety.
I know there is a lot here but not many details… but, what do you think? …depression? …ADHD? …something else?.
Right now I am not on any kind of medication for the depression diagnosis, I tried once with Lexapro but I didn’t notice any improvement of what I just described to you, instead I had no energy, I was tired and slow, and felt like I was becoming an emotional flat line, so I stopped taking it after a little more than a week.
Can you help me?. Thank you so much!
Monica
Monica,
Yes, girl, you clearly have some hope! Even with all this info it still requires a good meeting to get the multiple other details straight. The most frequently missed ADHD diagnoses are very similar to your history, but without an eval I would be guilty of just taking a shot – bottom line surely sounds like ADHD even with your great school history and entrepreneurial spirit.
To somewhat answer your several questions:
1. Remember you can consult with me long distance, I can review a more comprehensive questionnaire and over the phone even ask you the more medical questions. Sarah is the connector on the CorePsych Blog Services page.
2. You, my friend, will love Rules. It is a book for you – you are definitely in there if you connected with the wrecked by success piece – a whole section in there on that aspect.
3. If you get the wrecked by success idea and unhappily arrive at your own moment of context – missed at this moment by every other ADHD practitioner in the USA [that I know], you will get this ADHD Context Video and blog post.
4. Sounds like you might have some depression, either secondary or primary lurking around, – could assess in an interview.
5. Beyond just the meds there are many other very interesting answers on the Testing Options page.
Chin up, you have many cool options.
cp
Thank you very much for such a fast response Dr. Parker, I’ll be contacting Sarah today.
m.
Dear Dr. Parker,
Can you discuss the benefit verses the risks in people with brain injury and these scans?
After sustaining a concussion (unconscious) a second insult (repeatedly unconscious), diagnosed with Post Concussive Syndrome, drugged with Prozac resulting in Serotonin Syndrome and an extended coma, I had SPECT scan which was perfectly Normal. No resting verses active test was performed.
If SPECT is the best test we have, how did it fail to detect anything on a brain that clearly had recent and repeated insults? CAT and MIR were also normal, yet Brief Head Injury tests, Neuro-psych, balance tests and personality changes all pointed to brain injury.
Has the rate of cancer increase to people who have undergone such tests been determined yet and if so what is the risk of that? Because brain injury is a “clinical diagnosis” what, if any value does SPECT have to the population who have already been diagnosed and are progressing in their recovery?
Thank you for your insights Dr. Parker.
Ally,
SPECT is very useful in seeing the specifics and if yours was “perfectly normal” after a serious injury with concussion I would begin to question, after all the scans I have seen, the skills of the reviewer or the actual scans process. I would suggest that you may have had an MRI or CAT, which very often shows as “normal,” but most often we actually see the challenges with SPECT… also depends on the software. Often you can’t see the subtlety of the injury just with the tomographic scans so we use a more advanced 3-D software to show the actual cortical architecture.
Cancer not reported in the literature. The detraction for spending more money with SPECT is the fact that it does not do as good a job of suggesting treatment as does neurotransmitter testing. The two bugaboos with TBI: Diagnosis and treatment are both addressed with SPECT, and for more subtle challenges with treatment plans, neurotransmitter [and often hormone testing for adrenal, as well as immune testing to facilitate healing] will be in order.
I just reviewed a very interesting person in VT who had SPECT, good primary intervention, but did not improve over years… and was discovered to have significant gluten and casein sensitivity which significantly contributed to his ongoing tragic symptom picture.
cp
This makes sense Dr. Parker. I was shocked when I read the results after all I had suffered within a 2 year period. I KNEW that the SPECT test had been done wrong when I read that they were suppose to have done a resting vrs active series and they did not do that which I feel you are confirming for me. The hosptial that ran the test has some obvious conflicts of interest in that they sent me home with 9 worsening symptoms of Brain Injury 48 hours post trauma, and then gave me SSRI’s contraindicated for BI which caused Neuroleptic Malignant Syndrome based on the symptoms I had that are NOT present in Serotonin Syndrome. I was unable to metabolise the SSRI’s and other drugs they gave me and the poisioning caused total organ failure and a 10-coma resulting in a worse brain injury based on the other non-invasive testing.
So it is not the test itself that is ineffective in detecting brain injury, but more so that the the hospital that did the SPECT and had a vested interested in having it be ‘normal” what they did to me or that they simply do not have sensitive enough equipment to attempting to be diagnoising brain injury with their SPECT scan or the tech who read them.
Based on what you suggest here, it is important to know if it is advanced 3-D software that shows the actual cortical architecture. This is very helpful information. I am unable to subject myself to another test in the event that I may be risking my health for a diagnosis that is clinical and I already have. I tried to have the SPECT scans I have re-read at the AMEN clinic, but they are not the same as the ones they read so unfortunately, I was unable to secure a second opinion from a different tech.
The information about gluten is very complex and I don’t understand it. I eat for my blood type and there is no gluten in my diet.
I use the Free Amino Acids you featured on the site awhile back and I have to say, of all the treatments I have tried it is the only thing that has made me feel noticably better. I really recommend them.
Thank you for your help Dr. Parker!
Ally,
Thanks for your comments – and glad to hear you are turning the corner a bit. Yes, we often saw challenging readings from around the country with inferior software wherein folks just couldn’t see the details as well as we have it set up at the Amen cameras – with their specific software the scans are simply more readable.
cp