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InternalMedReview – Inflammation Induced Chronic Fatiguing Illnesses

October 18, 2017

This is the state of the science regarding genomics and neuro-inflammation due to Lyme and Mold exposure. The premise is that the common presenting symptom of fatigue is caused by chronic inflammation, which can now be objectively measured and treated when due to a biotoxin exposure. This is breakthrough research and links inflammation, brain injury and underlying genomics. We are the only group in the world to publish these findings based on years of careful research. – Andrew Heyman, MD

We hear so much about genetics vs. genomics here at A4M/MMI, but the bottom line is that a huge leap was just made this month in our main mission. One of our leading faculty members, Andrew Heyman, MD who is also the Program Director of our Fellowship at George Washington University, just had his research published in The Internal Medicine Review’s October Issue.

Dr. Heyman along with another one of our expert faculty members, Dr. Richie Shoemaker, partnered in this research initiative and have worked tirelessly to gather this data. They are the only group in the world that has collected this amount of data in the chronic illness arena. As we continue to review the model of genomics, what is causing chronic disease – between genetics, DNA, RNA, etc. we have begun to become aware of an overlap with other conditions that we usually blame on lifestyle like obesity and diabetes, etc.

Is the presence of mold or moisture in our surroundings starting to shift our immune response?

Below we provide a summary on some exciting new insight into chronic diseases.

Inflammation Induced Chronic Fatiguing Illnesses: A steady march towards understanding mechanisms and identifying new biomarkers and therapies.

Ritchie C. Shoemaker1,4*, Andrew Heyman2, Annalaura Mancia3 and James C Ryan4
1Center for Research on Biotoxin-Associated Illnesses, Pocomoke, MD, USA
2Integrative Medicine, George Washington University, Washington DC, USA
3Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
4ProgeneDX, LLC, Deerfield Beach, FL USA

This breakthrough peer reviewed publication outlines the Chronic Inflammatory Response Syndrome (CIRS), an evidence-based model of assessment and treatment of Chronic Fatigue utilizing objective biomarkers, structural Brain MRI and transcriptomics, and moves medicine away from a ‘symptom only’ approach to managing the fatigued patient. CIRS is a neuroregulatory-inflammatory disease process found in genetically susceptible patients (20% of US population), initiated by exposure to a biotoxin(s) such as a water damaged building, Lyme disease, ciguatera, pfistera and many more. A final common pathway of immune dysfunction ensues, including abnormal findings such as Transforming Growth Factor Beta (TGFb), Vasoactive Intestinal Peptide (VIP), Melanocyte Stimulating Hormone (MSH), split products of complement activation, Matrix Metalloproteinase (MMP9) and others now available for use as clinical diagnostics. In cases of cognitive decline, new technology for brain MRI analysis, NeuroQuant, can pick up small changes in brain structures consistently shown in CIRS.

This work is based upon two randomized controlled trials applying a specific series of assessments and treatments designed to restore normal health status by:

1) eliminating the exposure
2) resolving immune dysfunction
3) repairing damage to the central nervous system

The CIRS protocol finally gives the practitioner a clinical roadmap for some of their most complex patients presenting with fatigue, especially those suffering from Lyme disease. This article offers clear, concise guidance on the diagnostic and therapeutic approach to define both an initial infectious process and a subsequent inflammatory illness and outlines how genomic testing can determine predisposition to chronic stages of Lyme after acute illness through use of Next Generation Sequencing to bring transcriptomics to the Lyme community.

The goal of this important scientific work is to help practitioners reduce uncertainty in their management of the CIRS patient and to ensure a rigorous, evidence based assessment and treatment process is applied utilizing both conventional and Integrative treatment strategies. It represents a new era in clinical medicine by applying a novel language of neuroimmune and genomic profiling, in order to guide health providers in their treatment of Lyme disease, mold exposure and other biotoxins.

Future research will focus on refining the treatment protocol, determining the role of transcriptomics in chronic inflammatory processes and exploring the relationship and overlap between CIRS and other common conditions such as cardiovascular disease, diabetes and obesity, chronic pain syndromes, concussion and brain injury, and neurodegenerative disorders.

On Friday, December 15, 2017 during our 25th Annual A4M World Congress, Dr. Heyman will be lecturing at our VIP breakfast symposium titled See the Forest through the Trees: Protocols for Lyme Disease, where he will cover what can reduce symptoms, of Lyme, strengthen the immune system, and potentially treat the entire illness.

If you are interested in furthering your coverage of the treatment of Lyme and other chronic illnesses, Dr. Heyman and Dr. Shoemaker have a two part online advance course that we offer.

When can I finally retire? Doctors, where did all your money go?

October 11, 2017

Besides hearing that physicians and healthcare practitioners are always looking for the latest and greatest ways to treat their patients, one of the other things we constantly hear is the need for how to thrive in this crazy healthcare market.

Doctors no longer retire at the same age and with the same financial status that they used to. We hear from doctors that going to medical school no longer has the same luster it used to and that some actually discourage their own children from doing so. Why, if it is such a noble cause? Well, they tell us it is due to all of the financial burden/loans they can incur as well as the fact that they are not able to make up the difference after graduating like they used to with the new insurance reimbursement decreases and regulatory changes. Many argue it is not worth the liability.

A recent article was brought to our attention about an orthopedic surgeon, which hits very close to home as a lot of our members and attendees are also in the orthopedic field. This surgeon whose practice is in Tennessee had always planned to retire at 70 years old.1

In fact, a recent MDLinx survey shows that most physicians plan to retire between the ages of 65 and 70 but the majority do not have enough money saved up to maintain their lifestyle. According to this physician, most doctors choose 65-70 as retirement age because this is the age they begin to lose the steadiness in their hands or when their backs begin to get sore.

At 66, Dr. Deborah St. Clair says she is “barely hanging on” to her career and trying to save as many pennies as she can to retire. She does not believe she will be able to carry on past one more year and she fears that her “early” retirement based on her original date of 70 will end up costing her. She has only gotten to about half the savings she wishes she had achieved before having to retire from her practice.

It was a short 10 years ago that Dr. St. Clair’s practice was flourishing. She is now losing money and feels lucky to get 20 hours a week in the office. The small rural town where she lives has less than 17,000 residents which is not yielding as many patients as she was used to seeing. Unfortunately, although this rural location may differ from other doctors located elsewhere, what does add to the negative change is true for all healthcare practitioners: the changes in insurance and the regulatory issues.

The local hospital near Dr. St. Clair has had to dramatically increase its rates and has been forced to make patient stays shorter. The higher rates have caused patients with catastrophic coverage or high co-payments to have to avoid the hospital completely.

Physicians are said to have an average student debt load of $183,000, and certified financial planner Anthony Criscuolo at Palisades Hudson Financial Group explains that some physicians “get a much later start” than other professionals when trying to save for their retirement because “many of them are dealing with crippling debt when they’re fresh out of medical school.” As mentioned above, doctors are also getting squeezed by insurance reimbursement rates so they are not maintaining the incomes they expected to maintain as they approach their retirement age. “They’re really getting it at both ends,” Criscuolo explains.

Fidelity Investments studied 360 physicians and nearly half said that they can’t afford to contribute the maximum to their retirement plans at work. This article explains a lot more about reaching the right retirement savings goals as a physician, taking into account things like selling your practice and what a physician can do for financial security. All of this is very scary as we tend to think being a doctor is an amazing thing.

In an effort to keep potential doctors from getting discouraged or keeping our current doctors treating patients and doing their best, we have input some great time and energy into our new Practice Enhancement Training (PET) modules. PET was designed to help you as a healthcare practitioner “Optimize your Income” and “Exceeding your Patient’s Expectations”. PET’s goals are to help you BEFORE retirement.

If you are interested in how you can start enhancing you practice today, sign up for the next LIVE PET course in December at our 25th Annual World Congress!

1MDLinx Internal Medicine. Mindy Ligos. Managing Your Money. Real Stories from Real Doctors. Part 3-Where did all the money go? Prepping for retirement. https://www.mdlinx.com/internal-medicine/article/1152. September 2017. Accessed October 11, 2017.

Weight Loss

October 9, 2017

Many of our patients who don’t usually partake in the practice of medicine other than their regularly required annual physician visits, would be appalled to learn the truth about the lack of nutrition training in medical school.

Our A4M fellows and faculty assure us every day that most traditional physicians practicing medicine in our country today are not given ample time or training on nutrition during their many years as students.

Globally, studies indicate that more than two billion adults and children across the globe are overweight or obese, and suffer from related health problems. This number equates to one-third of the world’s population.

The saddest part about this topic is that our own country is suffering from an obesity epidemic where more than one in three U.S. adults and one in six children (ages 2-19) are obese; this data includes that one in 11 young children (ages 2-5) are obese.1

Obesity is one of the leading causes of preventable death and as physicians, we would be lying if we did not say these numbers do not reflect in our practices.

How many obese patients do you see? How many of your patients are overweight?

Do you feel fully equipped to discuss eating, diets, and exercise with them?

We know from experience that this is not an easy topic. Harvard Medical School published an article on habits to encourage weight loss that we have shared with our community. It brings to light the fact that “eating healthier” is not so much the mystery here; it is more the changing of a person’s everyday habits that make them able to combat being overweight.

Eating slower, consuming more even-sized meals and making the time to prepare healthier meals while at home were among the likely habit-changing suggestions in this article2. A daily weigh-in on a digital scale was suggested as more effective than calorie tracking since evidence of weight loss on an actual scale proved to remove weight and keep it off. But the most surprising habit listed was regarding sleep.

Sleep, another topic we have covered in our education at A4M was classified as a habit tied to weight loss. Studies show that the shorter time someone sleeps, the more at risk they are to becoming obese or overweight. Recent articles suggest that these people are up eating…and those same people who are up and eating, are not eating kale and nuts. They are eating the things that hurt like ice cream, chips, and cookies.

If you want to learn more about fighting weight and helping your overweight patients with their related health issues, we can help. We will provide you with proven clinical strategies that can be used to optimize your patients’ health and provide diagnostic, preventive, and therapeutic interventions. Visit us this December at our 25th Annual World Congress and get actively involved in fighting this epidemic and ultimately changing your patients’ lives.

1National Center for Health Statistics. NCHS Fact Sheet: National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/data/factsheets/factsheet_nhanes.pdf. January 2016. Accessed October 4, 2017.
2Harvard Health Publishing, Harvard Medical School. 5 Habits that Foster Weight Loss. https://www.health.harvard.edu/heart-health/5-habits-that-foster-weight-loss? February 2017. Accessed October 4, 2017.