Dr Mitch Ghens IV Nutrition 2016

Parenteral Nutrition Workshop
Mitchell J. Ghen,D.O., Ph.D.
Objectives of the I.V. Nutrition Program
• Know when I.V. Nutrition is useful for your patient
• How to safely make and administer I.V. therapies
• Knowledge of the basic components and which to use in specific conditions
• Side effect recognition and the remedies
• How to monitor and assess a patient’s progress
with the necessary equipment and nutraceuticals
Nature Versus Nurture?
“597 out of 603 gene-disease
associations are not replicated in more
that three independent studies.”
Hirschhorn, et.al. Genet. Med.
4:45-61
Review of Micronutrient Deficiency
Marginal
Subclinical
Normal Energy
Preliminary
Biochemical
Low Energy, Impaired
Biochemistry
Physiologic
Non-specific Symptoms,
Classical Deficiency
Anatomic
Fatal if Untended
Carbohydrate Metabolism
Oxidative Stress
Coenzyme Q10 Synthesis
Ketosis
Mineral Deficiency
Vitamin Deficiency
Neurotransmitter Metabolism.
Urea Cycle
Amino Acid Deficiencies
Bacterial Dysbiosis
Glutathione Status
Fatty Acid Oxidation
Specific Vitamin Deficiency
Detoxification
Energy Production.
GENETIC TESTING -POLYMORPHISM
GENETICS/POLYMORPHISM
The Facts.
• 70% of Americans are on 1 Prescription drug.
• 50% are on at least 2 prescribed drugs.
• One in four woman 50-64 are on an
antidepressant.
• 13% of the overall population are on
antidepressants.
The Facts.
• 88% of people over 64 take at least
one prescribed medicine.
• Every day 290 people are killed by
FDA-approved prescription drugs.
• 20% of U.S. patients are on 5 or
more drugs a day.
Safety
• Nurse...R.N. LPN
• HIPPA/OSHA
• Compounding Pharmacy
• Ph
• Precipitates
• Chairs
Safety
• EPi/Ammonia
• Vitals/Wt.
• U/A
• I.V. Bag-Plastic vs. Glass
• Tubing...Drop Rate, Calculation
Safety
• Osmolarity
• I.V. Form
• Temp. Of the Room = 68: Food.
• Which I.V. To give first....Why?
• Allowing a menu approach.
Safety
• I.V. Poles, Ceiling chains
• What to ask..Pre,Post and the next visit.
• Post I.V. instructions....H2O,Selenium...etc.
• Hand Washing,Antiseptic Hand Sanitizer.
• Crash Cart...Up to date?
Safety
• BLS,ACLS
• Fire Plan
• Antidotes List
• Recognize appropriate Diluents.
• Don't mix Sodium Bicarbonate and
Calcium.
G6PD Deficiency
•
People of Mediterranean heritage, including Italians,
Greeks, Arabs, and Sephardic Jews, also are
commonly affected. The severity of G6PD deficiency
varies among these groups — it tends to be milder in
African-Americans and more severe in people of
Mediterranean descent.
•
Kids with G6PD deficiency typically do not show any
symptoms of the disorder until their red blood cells
are exposed to certain triggers, which can be:illness,
such as bacterial and viral infections certain
painkillers and fever-reducing drugs certain
antibiotics (especially those that have "sulf" in their
names)certain antimalarial drugs (especially those
that have "quine" in their names)
• Preservative
• Bags
versus preservative-free
versus bottles
• Adjusting
/ buffering pH
◦ Use HCl 1:500 or NaHCO3
G6PD Deficiency
•
•
•
•
•
•
•
Paleness (in darker-skinned children paleness
is sometimes best seen in the mouth,
especially on the lips or tongue)
Extreme tiredness
Rapid heartbeat
Rapid breathing or shortness of breath
Jaundice, or yellowing of the skin and eyes,
particularly in newborns
Enlarged spleen
Dark, tea-colored urine
G6PD Deficiency
•
G6PD deficiency is closely linked to favism, a
disorder characterized by a hemolytic
reaction to consumption of broad beans
•
Vitamin C may cause red blood cell rupture
(erythrocyte hemolysis) in G6PD deficient adults
after massive intravenous infusions (40 to 100
grams within a few hours, or in extremely large
oral doses. There are no reports of this hemolysis
problem when oral intake by G6PD deficient
persons is less than 6 grams per day in G6PD
deficient adults or in healthy adults at any dose.
What you
must know about osmolarity!
Osmolarity
•We
will discuss using the term osmolarity, expressed as mOsm/mL
(milliosmoles/milliliter), since most data are given in those terms.
•What is an osmole (or milliosmole)?
1 gram molecular weight of an atom or molecule = 1 mole (or mg
m.w. = 1 mmole)
1 mmole x number of species formed in solution = mOsm
Let’s examine NaCl as an example:
•m.w. Na
= 23 grams/mole (mg/mmole)
•m.w. Cl = 35 grams/mole (mg/mmole)
Total weight per 1 mmole = 58mg
How many species are formed when it dissolves?
•2 species are formed1 mmole x 2 species = 2 mOsm
A solution that is isotonic with most body fluids should be about 0.310 mOsm/mL
•So, with
NaCl:
Osmolarities of common ingredients:
ingredient
Gluconate 10%
• Cyanocobalamin (B-12) 1mg/mL
• Folic Acid 10mg/mL
• Magnesium Sulfate 50%
• Multi-trace Elements (MTE-5)
• Potassium Chloride
• Pyridoxine HCl (B-6) 100mg/mL
• Selenium Trace 200mcg/mL
• Sodium Bicarbonate 8.4%
• Thiamine HCl (B-1) 100mg/mL
• Water for Injection
mOsm/mL
• Calcium
0.72
0.31
0.2 - 0.33
4.06
0.13
4.00
1.11
0.09
2.00
0.92
0.00
Worksheet to calculate total osmolarity
IV additives
nutrient added
(mLs)
mOsm/mL
(multiply times:)
Amino Acids (FreAmine III 8.5%)
0.81
X
mL
=
Ascorbic Acid 500mg/mL
5.8
X
mL
=
B-6 (pyridoxine) 100mg/mL
1.11
X
mL
=
B-12 (hydroxycobalamine) 1000mcg/mL
0.31
X
mL
=
B-complex 100mg/mL
2.14
X
mL
=
2
X
mL
=
Calcium gluconate 10%
0.72
X
mL
=
Sodium EDTA 150mg/mL
1.34
X
mL
=
Folic acid 10mg/mL
0.2
X
mL
=
Germanium 100mg/mL
0.25
X
mL
=
Glutathione 100mg/mL
0.38-0.76
X
mL
=
Heparin 5,000 U/mL
0.46
X
mL
=
HCl (hydrochloric acid) 2mg/mL
0.11
X
mL
=
Lactated ringer's
0.28
X
mL
=
Magnesium sulfate 500mg/mL
4.06
X
mL
=
Magnesium chloride 200mg/mL
2.95
X
mL
=
Mineral Mix (Dr. Shrader's)
0.57
X
mL
=
Molybdenum 500mcg/mL
0.8
X
mL
=
Pantothenic acid 250mg/mL
0.85
X
mL
=
Potassium chloride 2mEq/mL
4
X
mL
=
Selenium 200mcg/mL
0.09
X
mL
=
Taurine 50mg/mL
0.5
X
mL
=
Zinc 10mg/mL
0.5
X
mL
=
mL
=
Sodium bicarbonate 8.4%
TOTALS FOR ADDITIVES:
Total mOsm
Osmolarity worksheet:Vitamin C Protocol
IV additives
mOsm/mL
(multiply times:)
nutrient added (mLs)
Total mOsm
Amino Acids (FreAmine III 8.5%)
0.81
X
mL
=
Ascorbic Acid 500mg/mL
5.8
X
12 mL
=
69.60
B-6 (pyridoxine) 100mg/mL
1.11
X
5 mL
=
5.55 B-12
0.5
X
(5) mL
=
(IVP at end of IV)
B-complex 100mg/mL
2.14
X
2 mL
=
4.28 2
X
mL
=
Calcium gluconate 10%
0.72
X
2 mL
=
1.44
Sodium EDTA 150mg/mL
1.34
X
mL
=
Folic acid 10mg/mL
0.2
X
mL
=
Germanium 100mg/mL
0.25
X
mL
=
Glutathione 100mg/mL
0.5
X
(3) mL
=
(IVP at end of IV)
Heparin 5,000 U/mL
0.46
X
mL
=
HCl (hydrochloric acid) 2mg/mL
0.11
X
mL
=
Lactated ringer's
0.28
X
mL
=
Magnesium sulfate 500mg/mL
4.06
X
5 mL
=
20.30
Magnesium chloride 200mg/mL
2.95
X
mL
=
Mineral Mix (Dr. Shrader's)
0.57
X
1 mL
=
0.57
Molybdenum 500mcg/mL
0.8
X
1 mL
=
0.8
Pantothenic acid 250mg/mL
0.85
X
2 mL
=
1.7
Potassium chloride 2mEq/mL
4
X
mL
=
Selenium 200mcg/mL
0.09
X
mL
=
Taurine 50mg/mL
0.5
X
mL
=
Zinc 10mg/mL
0.5
X
mL
=
Sodium bicarbonate 8.4%
Method of Safely determining
I.V. Flow rate.
•
•
•
•
You need to Know I.V. Connector set
drops Per minute.
Hypertonic fluids are tolerated better.
Although Isotonic can go the fastest.
Give 2-4 m's/minute as the rule!
Use Butterfly for Short Infusions less
than 2 Hrs.
Administration guidelines based on osmolarity:
*mOsm/mL:
IV push
IV drip
•Small
Large vein*
1300
800
Medium vein* Any vein*
950
400
600
340
vein: 1 – 4mm (hand, scalp, ankle)
•Medium vein: 4 – 10mm (medial, cephalic, some hand veins)
•Large vein: 10+mm (medial, subclavian)
Contraindications
Allergy to any component – some say allergy
to a nutrient is impossible…
•
Ascorbate from corn may retain traces of corn antigen
•
Glutathione (GSH) from recombinant DNA technology
•
Anaphylaxis from B12 – microbial antigens or B12 itself?
Other reactions:
•
IV administration of NAC in patients with
elevated levels of heavy metals may result
in redistribution of metals to the CNS.
•
Deficiency of RBC G6PD may result in
hemolysis.
•
The use of nutrients in patients with severe
environmental illness may result in allergic
phenomena.
Diluent Options:
•
Sterile water
• exception: normal saline should be used for
hypotonic solutions (e.g., MTE, H2O2)
•
D5W
• Use to avoid highly ionized solutions (e.g., lipoic,
phosphatidyl choline)
•
Normal saline
• Used for DMPS, due to administration requirements
Additional considerations:
•
Administration of cold IV solutions may cause discomfort.
•
Mixing solutions too far in advance of administration time
may alter ingredient potency.
•
Remember contraindications.
•
Vitamin B12 should be administered either SQ or IM.
•
GSH & Lipoic should be given alone.
• Dose and rate of administration
• Adding a preservative to GSH may result in oxidation.
Additional considerations (cont.):
•
Compounded phosphatidyl choline may cause severe
patient reactions.
Magnesium: rapid administration may decrease blood pressure
(warm feeling/fainting)
• Sulfonamide allergy: MgCl may be substituted for MgSO4
(headaches may indicate sensitivity to sulfonamides or sulfites)
•
•
Hypoglycemia may be prevented by eating a meal 1 to 3 hours
prior to administration – especially with vitamin C
A light-proof bag or foil minimizes decomposition of
vitamin C during a prolonged infusion.
• Folic acid
•
Additional considerations (cont.):
•
IV push administration:
• Discomfort minimized with gentle massage above injection site
• Proper needle positioning in vein avoids infiltration (burning)
• Never administer trace minerals by IV push – severe reactions to zinc,
molybdenum
•
Sodium content may cause complications in some patients
(e.g., CHF)
•
Trace minerals combined with nutrients in reduced form may result in oxidation (i.e., decreased potency of GSH, vitamin C, other antioxidants).
Complications of General I.V. Therapies.
•
Infiltration.
•
Phlebitis.
•
Systemic Infection.
Speed Shock.
•
•
•
Air Embolism.
Pulmonary Embolism
Complications of General I.V. Therapies.
Pulmonary Edema.
• RunAway IVs
• Hematoma.
• Electrolyte Imbalance.
•
ABC’s of Giving an I.V.
•
Document Sheet
•
•
•
•
•
Name
Date of Birth
Rx for I.V.
Condition of Patient
Allergies
Pre-testing Reviewed
• Doctor should sign off
• Explanation of Patient – Informed Consent
• What, Why and How
• Schedule Patient Follow-up
• Day of I.V.
• Pre Vitals
• U/A
• What the Patient ate prior
•
Basic Needs
•
•
•
•
•
•
A Designated Room
A Designated Prep Area
A Trained Nurse(s)
I.V. Apparatus
I.V. Components
Emergency Kit/Crash Cart
Basic Needs
•
•
•
•
•
•
•
Refrigerator
Closed Dark Cabinets
T.V/Music/Movies
Recliner Chairs
Lakeside cart
I.V. Poles/Ceiling Chain
Rolling Chairs
Basic Needs
•
•
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•
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O2 Tank with Masks and Nasal Cannula
Stethoscope/BP Monitor/Temperature/
O2 Sat.
Magazines
Wi Fi
Food: Apples, Bananas
Heating Pad
Cold Packs
Designated Room
Make the time enjoyable and Social
•
•
•
•
•
•
Size
Design-Nursing View
Chairs: Comfortable and Functional.
(Where do I buy these?)
Color of Room
Amenities: Magazines, audio tapes,
newsletter, T.V., I-Pods,DVD Players
Temperature Control
Prep Area
•
•
•
•
•
•
Close to I.V. Suite
I.V. Pole or Chain to hang 3-4 Bags
Sink/H2O
Refrigerator
Cabinets with Compounds
Counter Space
Tips
•
No Smoking Sign
•
No Cologne
•
First Visit Do’s and Don’ts Sheet
•
WOW Your Patients - Be Creative!
I.V. Apparatus
•
•
•
•
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Poles or Chain
I.V. Solutions Needed: 250 ml, 500 ml.,
1000ml, Sterile H2O, 250 ml., 500 ml. NSS,
250 ml, 500ml D5W, 1000 ml Lactated
Ringers
I.V. Connectors with and without Filters
Angiocaths, Butterfly’s - 19g, 23g, 25g,
Micropore Tape
Emergency Prep
•
•
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•
•
•
Emergency Plan on Wall in the I.V. Suite
Epi with Syringe Taped on Fastened to
Wall in Strategic Areas
Emergency Kit/Crash Cart-With Check
Sheet - Perform Weekly and/or After Any
Use of the Kit/Cart
Fire Plan in Room
Side Effect Sheet with Antidotes
Ammonia Inhalants Next to Epi on Wall
What to Do with the Pre-Work Results if They are Abnormal
•
Repeat Abnormal Labs
•
Review, in light of history and physical
•
Treat x one month and repeat
Set-Up
•
•
•
•
•
•
Patient Timely Escorted to I.V. Suite
Solution Prep (Done earlier?)
Vitals, Side Effects, Current Condition,
Discussion of Nutraceutical Program,
Offer Amenity
Urinalysis
Offer Drink
Heat Pack (Heating Pad) if needed
ABC’s of Giving an I.V.
•
Monitoring for Side Effects
•
Ask the right questions
•
Things that must be within reach
•
•
•
•
•
Cramps
Dizziness
Sweaty
Nausea
Disorientation
• Epi 1-1000
• O2, Mask & Cannula
• Laryngascope with multiple sizes of endotracheal tubes
• Calcium
• D50
ABC’s of Giving an I.V.
•
Adverse Reaction Reporting
• Physician needs to be aware of any adverse reactions and
sign off
• Physician should re-see the patient prior to any further I.V.s
• Adjust the protocol accordingly
Everyone should be at least certified in basic CPR
and at least one member should be advanced
certified.
• Save time
•
• Make I.V.s night before and place in refridgerator
• Light Sensitive I.V.s should be covered in tinfoil or made in
dark bags
ABCs of Making an I.V.
•
•
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•
•
The Prep Room
Focus: 1 person with nothing else to do
Lay out all materials first
Choose the correct I.V. solution
Draining the bag
Placing the components in the bag
Labeling the bag
Check the bag for incompatibilities
Cover and protect the bag
Place the bag in a safe place prior to use
(refridgerator)
Thinking Through a
Case
THE HISTORY
THE GHEN HYPOTHESIS
•
•
•
•
•
•
Cellular Nutrition
Hormone Equilibrium
Cellular Oxygenation
Energy Balance
Psycho-Social Spiritualization
Detoxification
CELLULAR NUTRITION
• Where were you born?
• Have you had any night vision changes?
• How many colds do you get a year?
• What alternative practitioners have you seen?
What was their treatment regimen?
•
How often do you shower/wash your face
and hands?
CELLULAR NUTRITION
MISCELLANEOUS
•
Bad breath all the time?
•
Do you sunburn easily?
•
How is your appetite?
•
Do you have bruxism?
•
Do you have present tooth decay? How often do you brush,
floss and irrigate?
•
Do you have a pet? What kind?
•
Do you have dandruff? For how long? How severe?
HORMONE EQUILIBRIUM
•
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•
•
Compare your libido today to the "You" of 5-10 Years
ago.
Men: Erectile Dysfunction?
Any decrease in the amount of semen.
Temper or emotional changes.
Women: vaginal dryness?
What time do you get to bed?
Do you sleep through the night or awaken often?
What time do you leave and return from work?
What was your weight at age 18?
Women: Are your periods regular, spontaneous and
cyclic?
CELLULAR OXYGENATION
•
How often, what type, how long and where do
you exercise?
•
Can you climb two levels of stairs without
being short of breath?
•
Where and when was your last PFT?
•
Can you hold your breath for more than a
minute?
ENERGY BALANCE
•
•
•
•
•
What is your favorite color?
What is your least favorite color?
What kind of music do you enjoy listening to? Has your preference changed in the past 5
years?
Compare your energy today to the "You" of 5
years ago. Compare to age 18.
Do you receive or have you ever received
professional energy balance treatments?
PSYCHO-SOCIAL-SPIRITUALIZATION
Do you pray and/or meditate?
Have you noticed any reduction in mental clarity?
Do you presently, or have you ever experienced
depression, crying spells, extreme nervousness,
thoughts of suicide, inability to concentrate, sense of
insecurity, undue fatigue, sleep walking, frightening
dreams, overuse of psychotropic drugs, extreme
shyness, anxiety, or a short attention span?
What changes have you seen in the mirror over the
last five years? Do you dislike them?
DETOXIFICATION
Have you ever been exposed to pesticides? What kinds?
How would you classify your life time exposure
to antibiotics? Explain.
Any air fresheners at work or at home? What type?
Ever worked in an industrial area or factory?
Ever performed farm work or lived near one?
Exposed to chemicals in any way? Explain.
DETOXIFICATION
Do you dry clean your clothes? Who picks
them up? How do you handle them?
Polish your shoes? If so with what?
Do you have your house or lawn pest
controlled? How often? What chemicals?
Do you dye or perm your hair?
What kinds of personal grooming products or
cosmetics do you use?
DETOXIFICATION
How many minutes every month do you talk on a cell
phone? Bluetooth? Up to head?
Do you live within five miles of a radio tower, microwave
tower, power generating station, or a high voltage electric
sub station?
Do you use a microwave oven? If yes, do you leave the
room when it is on?
Do you have a shower filter, what type?
What kind of car do you drive, how many hours a week
do you drive?
How many hours a month are you on an airplane or train?
DETOXIFICATION
•
•
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•
•
•
•
Do you have excessive body odor?
Do you have brittle nails?
Are you finger nails and toenails healthy in
appearance?
Do you have gray hair? When did it begin
to turn gray?
Are you sensitive to cold weather?
Do you have floaters in your eyes?
Do you have changes in taste and smell?
THE ANTI-AGEING PHYSICIAN'S
PHYSICAL EXAM
• Skin
turgor
• Lipofucin deposition
• Balance considerations
• Mental Status Exam
• Tartar on teeth
• Raised pimples on the back of the arms
• Nail signs
• Tongue signs
THE ANTI-AGEING PHYSICIAN'S •
•
•
•
•
•
•
Décolletage
Muscle tone
Skin sagging on triceps area and inner thighs
Lines around (vertical) mouth
Arcus senilis.
Zinc tally
Vibration sense 128cps
THE ANTI-AGEING PHYSICIAN'S
PHYSICAL EXAM
•
•
Retinal thinning
Bruise easily
•
Nails thickening
Decrease perspiration
•
Macroglossia...Large tongue. Amyloidosis
•
Apthous Ulcers....Irritable Bowel Disease
•
THE ANTI-AGEING PHYSICIAN'S PHYSICAL EXAM
• Grey
hair
• Loss of hair
• Lines in face
• Lines on hands
• Collagen Loss.....Deepening N/L Folds;
Sunken eyes
• Abdominal girth
• Neck skin laxity
• Skin discolorations and telangectasias
Pre-I.V. Therapy Work-up
C-Reactive Protein
CBC
Complete Metabolic Profile
G6PD
Lipid Profile
Thyroid Profile
Fibrinogen
HbA1C
Vitamin D
Hormones
Homocysteine
Ferritin
RBC Mg
PSA
Our World is Toxic
WHAT IS A TOXIN
• Autism rates are on the rise
• 1 in 68 children
• 29% increase from two years ago
• More case being discovered?
• Alabama lowest 1 in 175
• New Jersey highest 1 in 45
• Diagnosis-average 4 years old
Toxic
A Toxic state of the body,
is one that has a burden
of toxic materials
that have affected your body's
cellular functioning in a negative way.
BODY BURDEN BEGINS IN UTERO
• Umbilical cords pumps 300 qts of blood a
day from the placenta
• Placenta is supposed to protect the cord
blood
• Pollutants and pesticides pass freely
• 200 chemicals in umbilical cord
• 100 cord blood samples-100% had
mercury
HOW ARE BABIES GETTING THESE
TOXINS?
Air, water, food, vaccines
Pesticides…
Teflon-carcinogen
Stain-oil repellants in fast food
packages
• Clothes-dry cleaning
•
•
•
•
HOW ARE BABIES GETTING THESE
TOXINS?
• Textiles
• Perfumes & colognes
• Personal grooming aids
• 287 chemicals detected-180 cause cancer
• 217 are nervous system toxic
Dysbiosis
Oxidized Fats
Caffeine
Hormones
Allergens
EMF’s
Stress
Food Preservatives/Additives
Pesticides
Heavy Metals
Immunotoxicity
Reproductive/ Developmental Toxicity
Endocrine Toxicity
Plasticizers (Phthalates)
Solvents
Neurotoxicity
Genotoxicity/
Carcinogenesis
Hepatotoxicity/ Nephrotoxicity
Genetic Variations
Detoxification
Amino Acids
Enzymes
Antioxidants
Minerals
Vitamins
Open Routes of
Elimination!
•Kidneys
•Skin/Sweat
•Liver
•Regular BM’s
WHAT TYPES OF CHEMICALS WERE
FOUND
• Mercury
• Polyaromatic hydrocarbons
• Pollutants of gasoline and garbage that increase
cancer
• Polybrominated dibenzodioxins & furans
• Brominated fire retardants; by-products of plastic
production and incineration
• Perfluorinated chemicals
• Teflon breakdown; scotch guard; increases cancer
and birth defects
WHAT TYPES OF CHEMICALS WERE
FOUND
• Polychorinated dibenzodioxons and furans
• Byproduct of PVC production; industrial;l bleaching
and incineration; increases cancer and endocrine
disruption
• Organochlorine pesticides
• DDT, chlordane banned in USA
• Polybrominated diphenylethers
• Flame-retardant furniture; computers; TVs; interferes
with brain development and thyroid function
WHAT TYPES OF CHEMICALS WERE
FOUND
• Polychlorinated naphtalenes
• Wood preservatives; varnishes; machine
lubricating oils; waste incineration-liver
and kidney damage
• Polychlorinated biphenols
• Industrial insulators and lubricants-banned
in USA in 1976
TOXINS
• Who is more predisposed to
problems
• Additive or geometric math?
CHILDREN'S VULNERABILITY
• Greater pound for pound compared to adults
• BBB not fully developed
• Lower levels of chemical binding proteins
therefore more chemicals meets the target organ
• Baby organs developing rapidly can’t handle toxins
• Liver is not fully developed
THE FACTS
• US industry manufacture and import 75,000
chemicals
• 3000 of the chemicals that are brought by the
companies represent 1,000,000 lbs per year
• Probably more chemicals are in umbilical cord
than tested because of the cost prohibitive
nature of the studies…$10,000 per sample
THE TOXIC SUBSTANCES CONTROL ACT OF 1976 WAS TO ENSURE SAFETY OF COMMERCIAL
CHEMICALS
• 63,000 existing chemicals were deemed
“safe as used” with no safety scrutiny
• Government has to approve new chemical
within 90 days of a company application
• The act has nothing to ensure safety or reduce
pollution to the womb
USUAL SOURCES OF TOXIN EXPOSURE
• Electrical insulations
• Scotch guard
• Garbage incineration & plastic waste
• Car emissions
• Coal burning plants
• Tonalide and galaxolide-musk fragnance in cord blood
PROBLEMS WITH EXPOSURES
• Embryo 3 weeks later is “only 1/100 size of a drop of a water”
• Adults-what is the straw that breaks the
camel’s back?
• A carcinogen is 10x more potent for a
baby than an adult
PROBLEMS WITH EXPOSURES
• Some chemicals are up to 65 x more powerful
• Most chemicals can’t be detoxified by another
agent
• Heavy metals can be detoxified
HOW DO WE EXPLAIN
•
•
•
•
•
•
•
•
Autism is 10 x increased
Male birth defects are 2 x increased
Asthma is 2 x increased
ALL is increased by 62%
Childhood brain cancer increased by 40%
Preterm birth 23% increase
Infertility 5-10% increase
Sperm count down by 1% per year
MORE FACTS
• 7 new chemicals approved each day
• Can changes be passed down fro generation to
generation
CORD BLOOD
• Dioxin-endocrine cancers in female, men increase in
DM
• Methylmercury-decreased brain function
• PCBs-permanent IQ decrease
• DDEs-low birth weight; byproduct DDT
SO WHAT ABOUT THE EPIGENOME
Low levels of PCB=Increase in Excitatory
Neurons
Trace Elements in Cord Blood could create
Mental/Physical Problems Later in Life.
88
MINORITY COMMUNITIES HAVE HIGHER EXPOSURES
TO ENVIRONMENTAL POLLUTANTS
MoreHazardouswastesites.
ToxicDumping.
CongestedCommunities,ClosertoHighways.
EmploymentHigherinToxicChemicalPlants.
FarmWorkersExposure;Andbringtoxinshomeontheir
clothing.
89
CheaperPersonalCareProducts.
PHTHALATES IN OUR LIVES
Heart Disease, DM, Liver Problems.
Structural damage to your Brain.
Increased risk of fat formation and obesity.
Altered Immune Function.
Early Puberty, Ovarian Dysfunction.
Stimulation of Prostate Cancer
90
WHERE IS ALL THIS BPA?
Plastic Water Bottles.
Plastic Gallon Milk Bottles.
Plastic Microwavable Plates, ovenware, and utensils.
Tooth Sealants.
Canned Foods, Soda Cans, because they often have
Plastic linings in the cans.
91
Baby toys,bottles,pacifiers,and sippy cups.
OTHER PLACES YOU'LL FIND
PHTHALATES!
Processed Food Packaging.
Hoses.
Raincoats.
Shower Curtains.
Vinyl Flooring and wall coverings.
Lubricants and Adhesives.
Detergents.
Beauty Products like nail polish, Hair Spray,
Shampoos, Deodorants and fragrances.
92
WHAT TO DO?
Buy and Eat Organic,Pasture Raised,Grass Finished.
Fish Wild Caught,Sustainable.
Eat more Raw fruits and Vegetables,7 Servings/Day.
No artificial additives,food colorings,or artificial
sweeteners.
Store food and drink in GLASS!
Use a filter for your water and take your water with you to work.
93
WHAT TO DO?
Avoid Plastic Wrap and Canned foods.
Use Natural Cleaning Products.
Use ORGANIC Personal Grooming Products.
Don't use Air fresheners.
Don't use Fabric Softeners.
Don't use ANY Synthetic Fragrances.
No Teflon Pots and Pans. Use Ceramic or Glass Cookware.
Green Type of Flooring.
94
Use Fabric Shower Curtains.
PERSONAL CARE PRODUCTS
Hundreds in your system before leaving the house.
Increases Breast Ca; Autism; Reproductive Issues.
82,000 Ingredients in our Health care products.
95
PERSONAL CARE PRODUCTS..THE
OFFENDERS!
Phthalates.
Formaldehyde..DMDM;Hydantoin;Diazolidinyl Urea;Imidazolidinyl
Urea;Quateternium-15;Methenamine..
Increase in Ca in small continuous Exposures
BHA and BHT..Endocrine Dysfunction.
CoalTars...Pigments;Ca;Heavy Metals.
DEA...Creamy and Foaming Products..Can Contain Nitrosamines.
(MEA,TEA).
96
PERSONAL CARE PRODUCTS..THE
OFFENDERS!
Perfume.
PEG-1,4 Dioxane
Petrolatum. Contaminated with PAH.
Siloxanes-Soften Moisturizers..Hormone Disruptors.
SLS.
Triclosan.
97
INDOORS...TOXIC TOO!
We Breathe 3,000 Gallon of Air a Day.
Children breathe Pound for Pound More susceptible to air pollution.
Acid Rain;Snow,Fog...Sulphur Dioxide +Nitrogen
Oxide...From Power Plants and Vehicles. Lung
Damage and Plants, Animal,Fish,damage.
Indoor up to 100 Times more Pollutants than outside.
98
IMPROVE INDOOR AIR QUALITY
Open Doors/Windows.
Hepa Filters.
Put your Bedding in the Sun.
Use Nothing Artificial.
Turn off Fans.
Hardwood Floors;Tile.
99
PLANTS TO IMPROVE INDOOR AIR
QUALITY
Plants Filter,VOC's,
Formaldehyde,Benzene,Xylene;Airborne Fecal
Matter; Chemicals.
Aloe
Gerber Daisy.
Golden Pothos.
Spider Plant.
Snake Plants.
Chrysanthemum.
Boston Fern.
100
SOLUTIONS:
Avoidance.
General Measures.
Liver Support-P.O..,I.V.
H. Metal Detox.
Get rid of Memory Foam.
101
DETOXIFICATION
•
•
•
•
•
•
Have you ever been exposed to
pesticides? What kinds?
How would you classify your life time
exposure to antibiotics? Explain.
Any air fresheners at work or at
home? What type?
Ever worked in an industrial area or
factory?
Ever performed farm work or lived
near one?
Exposed to chemicals in any way?
Explain.
DETOXIFICATION
•
•
•
•
•
Do you dry clean your clothes? Who picks
them up? How do you handle them?
Polish your shoes? If so with what?
Do you have your house or lawn pest
controlled? How often? What chemicals?
Do you dye or perm your hair?
What kinds of personal grooming products
or cosmetics do you use?
DETOXIFICATION
•
•
•
•
•
•
How many minutes every month do you talk on a
cell phone? Bluetooth? Up to head?
Do you live within five miles of a radio tower,
microwave tower, power generating station, or a
high voltage electric sub station?
Do you use a microwave oven? If yes, do you leave
the room when it is on?
Do you have a shower filter, what type?
What kind of car do you drive, how many hours a
week do you drive?
How many hours a month are you on an airplane
or train?
DETOXIFICATION
•
•
•
•
•
•
•
Do you have excessive body odor?
Do you have brittle nails?
Are you finger nails and toenails healthy in
appearance?
Do you have gray hair? When did it begin to turn
gray?
Are you sensitive to cold weather?
Do you have floaters in your eyes?
Do you have changes in taste and smell?
BACKGROUND – HOW’D WE GET HERE?
•
Since WWII, production of industrial chemicals has risen dramatically
•
The U.S. generates/imports approx. 42 billion pounds per day, leaving
Americans awash in a sea of synthetics
•
Over 80,000 chemicals are registered with the Environmental
Protection Agency (EPA) for use
• Over 3,800 are classified as “high use”
•
Chemicals are now pervasive in our food, indoor/outdoor air and
water
•
Prescription medications are present in our water supply
ENVIRONMENTAL WORKING GROUP
• EWG
tested “in utero” “non-exposed”
persons for 210 chemical compounds
(Archive.ewg.org/reports/body burden)
• 167
toxins detected
• In
total the ten test subjects carried an
average load of 91 chemicals that were:
◦
◦
◦
◦
◦
◦
Linked to cancer in humans or animals
Toxic to brain and nervous system
Interfere with the hormone system
Associated with birth defects or abnormal development
Toxic to the brain/nervous system
Toxic to the immune system
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, NATIONAL
INSTITUTES OF HEALTH, NATIONAL CANCER INSTITUTE –
“PRESIDENT’S CANCER PANEL”
•Panel
recommendations to the average person to reduce cancer risk, including:
◦Eat organic. They emphasize this “is vitally important” for children who “are far more
susceptible to damage from environmental carcinogens and endocrine-disrupting compounds
than adults.”
◦“Choose foods, house and garden products, play spaces, toys, medicines, and medical tests that
will minimize children’s exposure to toxics.”
◦Become aware of and reduce as much as possible preconception and prenatal
exposures.
◦Remove shoes before entering the home.
◦Wash work clothes separately from other family laundry.
◦Filter home tap or well water.
AVENUES OF EXPOSURE
Ingestion
◦Food
• (www.foodnews.org)
• (EPA List of Mercury in Fish – www.cfsan.fda.gov/%7Efr/seamehg.html)
◦ Water
• Inhalation
◦ Indoor/Outdoor Air pollution
◦ Smoking
◦ Dust
• Dermal Absorption
◦ Personal Care Products
◦ Workplace Exposures
◦ Water (see handout “Common Contaminants in Tap Water”)
• Drug Use/Abuse
• Amalgams (mercury-based dental fillings)
•
WHY SOME PEOPLE RETAIN MORE TOXINS
THAN OTHERS
Genetic differences in phase one and phase two
enzymes (“polymorphisms” – see “Ten Americans”
video)
• Nutrient deficiencies
• High sugar, low protein diet
• Stress, trauma
• Heavy metal presence
◦ Especially Mercury Fillings
• Increased/ongoing exposure to multiple chemicals
resulting in bioaccumulation
•
CHEMICAL SENSITIVITY ALWAYS DUE TO
OVERLOAD
•
•
•
•
•
•
•
Adverse physical or mental reactions
from exposure to ambient levels or
chemicals
Headaches
Brain fog, confusion or memory issues
Fatigue
Shortness or breath
Muscle weakness, spasms or collapse
Bowel response
IMPACT OF TOXICITY ON THE BODY
Immune System
◦Auto-immune, viral infections, allergies, chronic fatigue
• Nervous System
◦MS, Alzheimer’s, Parkinson’s disease, memory decline
• Endocrine System
◦Thyroid, Adrenals, male and females fertility, endocrine
related cancers, diabetes
• Cardiovascular System
◦Heart disease, Atherosclerosis, Stroke, Blood Pressure
• Cancers
• Chemical compounds are mitochondrial toxins –
exposures result in multi-symptomatic mitochondrial
dysfunctional disease states
•
PRIMARY SYSTEM TARGETS OF
ENVIRONMENTAL TOXINS
• Immunological
◦ Reduces white cell function – infection fighting
◦ Increase in allergic reactions and hypersensitivities
•Resulting in: allergies, chronic infections,
autoimmunity, chronic fatigue, fibromyalgia, cancers
IMMUNOTOXICITY HISTORY
•
•
•
•
•
•
Allergies typically show first
◦ Food and environmental
Chemical reactivity usually begins after other
allergies
Chronic viral or fungal infections
Rarely is low CMI revealed with frequent colds or flu
Diminished NK activity
Certain cancers
◦ Lymphomas and other B-cell malignancies
PRIMARY SYSTEM TARGETS OF ENVIRONMENTAL
TOXINS (CONTINUED)
•
Neurological
◦ Toxic encephalopathy
• Brain fog, confusion and memory problems
◦ Psychiatric diagnoses
• Anxiety, mood disorders, depression
◦ Resulting in chronic neurologic and psychological
problems
• Examples: MS, Alzheimer’s, Parkinson’s disease,
memory decline, seizures,
NEUROTOXICITY HISTORY (CONTINUED)
•
Alteration in cognitive abilities
◦ “Brain Fog”
•
Sensory changes
◦ Paresthesias, numbness
•
•
Tremor, clonus, fine motor difficulties
Mood alterations
◦ Depression, anger, etc.
•
Coordination changes
PRIMARY SYSTEM TARGETS OF
ENVIRONMENTAL TOXINS
•
Endocrinological
◦ Effects the production, transport, acceptance,
activity and metabolism of hormones
◦ Can mimic hormones
•
Slows the body’s ability to eliminate excess
hormones
◦ Resulting in multi-endocrine difficulties
ENDOCRINE TOXICITY
(PATIENT HISTORY)
•
Sleep disturbances or change in energy level or
mood
•
Alteration in weight, appetite, bowel function
•
Sexual interest and function change, menstrual
changes
•
Infertility (both male and female)
•
Temperature perception and handling changes
•
Diabetes
CLASSIC PRESENTATION (SYMPTOMS)
• Inability
to handle caffeine
◦Can’t drink it after noon without insomnia
• Inability to handle medications or botanicals
◦“I’m very sensitive”
◦Must take very small doses of medications
• Non-responsive to therapies that have a high degree
of effectiveness for their diagnosis
• History of Asthma
• Obvious occupational , hobby related or residential
exposures prior to illness
• Tremors, Paresthesias
• Poor hand-eye and foot-eye coordination
• Temperature swings
• Repeated loss of consciousness with chemical
exposure
Toxic Man
No Toxins
Lead
Mercury
Arsenic
Cadmium
Aluminum
Iron
Lead
Mercury
Lead
Mercury
Arsenic
Lead
Mercury
Arsenic
Cadmium
Lead
Mercury
Arsenic
Cadmium
Aluminum
Lead
Mercury
Arsenic
Cadmium
Aluminum
Iron
NO TEST CAN SHOW TOTAL BODY
BURDEN OF HEAVY METALS!!!
The following tests are measuring
the amount of metals LEAVING
the body, NOT the total IN the
body!
Envy Organics
Protocols you need to know!
Replacement with PC
•
•
•
•
•
•
•
Increases aging in animals by 36%.
Worked even in advanced aging rats.
Oral Absorption 20%.
I.V. absorption 100%.
Improve liver Enzymes
Enhances Cognition
Caution with concomitant use of PS>
What you need
to Know About Silver!
Treatment Protocol Lyme disease.
The Rules
Silver is NEVER diluted.
You can add Methylcobalamine,MSM or Xylitol.
1-2 cc's/minute is the limit.
Only use empty bag from STERILE WATER,
or have it made for you in ready to go darken Glass.
Check the color BEFORE giving the I.V.
The Rules
Connector sets with .22 micron filters.
Ask the questions to determine if a patient is
likely to have a reaction.
DO NOT make the bags before the patient gets to the clinic.
For aggressive 3-4 week treatment,
place a PICC or midline.
It is unnecessary to use ANY additive if PICC or midline is in place.
The Rules
Replete Glutathione first.
Always Treat P.O. while using I.V. route.
Make sure Selenium -200Mcg. Are taken P.O. daily.
If a Patient has an untoward reaction.......
I.V.Safety of Silver
T1/2..9Secs.
EPA Nothing present at 3ppm.
23 ppm with a 9 sec.T1/2 =No BioActive Silver
in the blood stream in 30 secs.
PC Exchange Therapy
•
•
•
•
•
•
20 ml Syringe with a 19-23 Gauge needle.
PC 250 mgs./5ml
Draw 5-10 ml’s (250 mgs.-500mgs.)
Aspirate into prepared syringe of 5-10ml’s
of PC equal amount of Patient’s Blood.
Agitate Syringe with Blood-PC Mix.
Re-Infuse contents over 2-3 mins.
I.M. S.Q. Meds
•
•
•
•
•
•
Vitamin D- 50,000iu’s/cc
Desferal-500Mg.’s/vial
Imferon 50 Mg.’s/cc
Testosterone Cypionate, Ethanate,
Proprionate
DHEA- 10Mg.’s/cc
Progesterone-100Mg.’s/cc
I.M. S.Q. Meds
•
•
•
•
•
•
MIC
Silver Hydrosol
Dexamethasone
Magnesium Sulfate
B12
B-Complex
Vitamin D3
•A
true steroid with first order, mass-action,
kinetics
•Affects more than 200 genes
•How much from sun to body exposure? Is it
enough?
•Remarkable reduction in all cancers
•Diagnosis of cancer in summer time – A real
benefit
•Prevention – How much is the dose?
•Early cancer intervention improve mortality
Vitamin D3 Cont…
•
Sunlight and melanoma …..The Myth!
•
Sources – Fatty fish, cod liver oil, egg yolk
sunshine and supplementation
•
What should patient ask if oncologist
says, “NO”, to Vitamin D?
Vitamin D3: Conditions by Deficiencies
•
Osteoporosis
•
Cardiovascular Disease
•
Insulin Resistance
•
Metabolic Syndrome
•
Depression
•
Breast and Colon Cancer
•
Pre-eclampsia
Vitamin D3 continued:
•
•
•
•
•
•
•
Low Birth weight
Upper respiratory infections
Influenza
Weight Loss
Chronic Fatigue Syndrome
Childhood asthma and allergies
Cognitive Function
Vitamin D3 continued…
•
NHANES (National Health and Nutrition Examination
Survey) – Vitamin D insufficiency from 55% in 1988 to 1994
to 77% in 2001 to 2004.
•
7 large randomized trials – calcium plus Vitamin D3 results
in a decrease of overall fracture risk by 8% and a reduction
of risk of hip fracture by 16%.
•
A study shows decrease of risk of falls by 19% and a risk of
non-vertebral fractures by 20%
•
28 published studies show highest levels of D3 have a 43%
decrease in cardiovascular disorders
Vitamin D3 continued…
•
•
•
•
Type 2 Diabetes decreased by 55% and
Metabolic Syndrome by 51%
Studies suggest that very low levels of Vitamin
D3 are associated with 77% more likely to die
than those of a normal level
Very low D3 associated with 45% more
coronary artery disease and 78% more stroke
and 2 times more heart failure
Highest levels of D3 patients have a 52%
decreased risk of death due to CVA
Vitamin D3 continued….
•
40% lower risk of developing colorectal cancer
•
Less than 40 nmol per liter had significantly lower
depression as measured by the Beck Inventory
•
Low levels associated with increased fat infiltration in
muscle tissue and subcutaneous and visceral adipose
tissue with increased waist circumference and insulin
levels elevation
•
If low in pregnant women, more prone to
preeclampsia, low birth weight, poor post natal growth
and increase in autoimmune diseases
Vitamin D3 continued…
•
In infants the use of D3 significantly decreases the
incidence of Type 1 Diabetes
•
Study indicates there is a 142% reduction in heart attacks if high and 2.4 times more heart attacks if low
levels
•
Deficient women have 253% increase of colon cancer
•
January 2008 study noted women with the lowest level
of D3 have 222% increase risk of getting breast cancer
•
High Vit D3 reduces the risk of breast cancer by 52%
Vitamin D3 continued…
Men have 52% reduced incidence of
prostate cancer with high levels of D3
• Levels between 60 ng/ml to 100 ng/ml are
optimal
•
PC Exchange Therapy
•
•
•
•
•
Can do this therapy 1-2 times a week.
30-40 treatments.
Augment with Oral PC.( Capsules
Phoschol vs. Powder).
Can follow each I.V. Treatment with
Glutathione Push
Re-evaluate.
PC
Hep B
Memory loss-25mg increases memory in college kids
Eczema
GB disease
Manic depression
Weight loss
High cholesterol
PMS
Decreased immunity
Amino Acids Glutathione
• Compound synthesized from Cysteine
• Detoxifies various carbon compounds....environmental
pollutants
• Found in virtually all living cells
• Decreases with age
• Considered a neurotransmitter
• Immune metabolism/transport amino acids across
membrane
• Human lymphocytes contain more than 3 times the
amount than mouse lymphocytes
• High levels in animal thymus
• Poor oral absorption - need use of precursor
Amino Acid Glutathione..
• Improves macrophage function
• Necessary for integrity of the red
blood cells and involved in
production of red blood cell membrane....BC Pill causes
increase in RBC producing extra glutathione peroxidase
• CML, Lymphoma, Polycythemia Vera have increased CGS level
• GSH may be a co-factor in thyroid function
• Six enzymes involved in GSH metabolism can result in
neurologic dysfunction
• Intracellular antioxidant
• Helpful in neurologic diseases, radiation, ASA overdose,
alcoholism, heavy mercury toxicity, and arsenic, brain injuries,
Parkinson’s, emotional disorders, chronic kidney failure
I.V. Protocol for Glutathione Push
•
•
•
•
•
Safe
Dosage: 500-2500 mg
A mix in 5-10 ml of sterile water
Push over 3-5 minutes
Repeat 2-3 times per week
Easy Myers
•
•
•
•
•
•
•
•
MgCl. 5 ml Ca Gluconate. 3 ml
Methylcobalamin 1 ml
B6. 1 ml Dexpanthenol. 1ml B-Complex. 1 ml Ascorbic Acid. 9 ml
Sterile H2O. 30 ml
•
•
Make in a 60 ml Syringe Total: 50 ml
Meyers Cocktail 1
•
•
•
•
•
•
•
Vitamin C – 5 g
Magnesium Chloride– 3 ml
Calcium Glycerophosphate – 3 ml
B6 – 1 ml
B5 (Dexpanthenol) – 1 ml
B complex – 1 ml
Add iodepen – 1 ml
Meyers Cocktail 2
•
•
•
•
•
•
•
•
B complex – 2 ml
Selenium – 400 ug
B5 (Dexpanthenol) – 500 mg
Magnesium Sulfate – 1 g
HCl (1:500) – 2 mg/ml – 5 ml
Vitamin C – 5 g
B12 – 1000 mg
Saline (0.45%) – 125 ml
Additions to Meyers Cocktail 2
•
•
•
AMP – 50 mg (2 ml)
Glycyrrhiza – 2 ml
Germanium – 100 mg
Note: Give Meyer’s Cocktail over 30-45
minutes
Meyers Cocktail 3 (WBC Stimulation)
•HCl
(1:500) – 2 mg/ml – 5 ml
•B12 – 500 mg/ml – 0.5 ml
•B Complex – 0.5 ml
•B5 (Dexpanthenol) – 250 mg
•Magnesium Sulphate – 0.5 g
•Vitamin C – 1 g
Note: Total 10 ml. Push over 10 minutes.
“DO NOT INFLITRATE”
General Vitamin/Mineral Repletion
• Magnesium
• Procaine
• Vitamin
Chloride – 2 g
Hydrochloride – 5 ml
C – 50 g, 100 ml
• Multimineral
•B
Complex – 2 ml
• B5
(Dexpanthenol) – 1 g
• Calcium
• In
– 1 ml
Chloride or Calcium Glucanate – 1g
500 ml of Sterile Water
General Vitamin/Mineral Repletion 2
•
Selenium – 400 ug
•
Vitamin C – 75000 mg
•
Calcium Gluconate – 5 g
•
B Complex – 5 ml
•
B12 – 3000 ug
•
Magnesium Sulphate 50% - 2000 mg
•
B6 – 300 mg
•
In 1000 ml Sterile Water
General Vitamin/Mineral Repletion 3
•
Selenium – 400 ug
•
Vitamin C – 75,000 mg
•
Calcium Gluconate – 500 mg
•
B Complex – 5 ml
•
Vitamin B12 – 1000 ug
•
Magnesium Sulphate (50%) – 2000 mg
•
Vitamin B6 – 3 ml
•
In 1000 ml of Sterile Water
Super Immune Cocktail
• Vitamin
• B6
•B
C – 25,000 mg
– 200 mg
Complex – 1 ml
• Calcium
Gluconate (10%) – 20 ml
• Glycyrrhiza
(8 mg/ml) – 7 ml
• Magnesium
Sulphate (50%) – 4 ml
• B5
• In
(Dexpanthenol) – 750 mg
500 ml Sterile Water
Super Immune Cocktail Notes
•
Near end of bag,
◦ Add 20 ml of Glutathione (50 mg/ml)
◦ Add 10 ml of Taurine
◦ Push 5000 ug of B12
•
When bag complete, start piggy back 100 ml of
Normal Saline with
◦ 2 ml of multi-mineral formula
◦ 1 ml of zinc (5-10 mg/ml)
Chelation Protocol:
•
•
•
•
•
•
•
•
250cc's Sterile H2O
Vit. C. 10cc's
Procaine. 7cc's
B-Complex 1cc
B6 1/2cc
Mag. Cl. 6cc's
EDTA 10cc's. 1.5 Grams B5 1/2cc
Antiviral Cocktail
•
Selenium – 400 ug
•
Vitamin C – 50,000 mg
•
Calcium Gluconate – 5 g
•
Magnesium Sulphate – 2 g
•
B6 – 300 mg
•
In 450 ml Sterile Water
Antiviral Cocktail Additions
•
•
•
Glycyrrhiza (8 mg/ml) – 7 ml
Germanium – 500 ug
ACE – 6 ml
Macular Degeneration Cocktail
• Vitamin
C – 15000 mg
• B6 – 3 ml
• Magnesium Chloride – 120 mg
• B12 – 3000 mg
• Zinc – 10 mg
• B1 – 100 mg
• B3 – 100 mg
• B5 (Dexpanthenol) – 1000 mg
• Manganese – 400 ug
• Copper – 2 mg
• Chromium – 400 ug
• Selenium – 400 ug
• Taurine – 10 ml
Antihypertensive Cocktail
•
•
•
L-arginine – 6-10 g
In 100 ml of normal saline given over 1
hour
Follow with Magnesium Sulphate (50%) –
2-3 g over 30 minutes
Executive Stress IV Formula
•
•
•
•
•
•
•
500 cc of sterile water
Vitamin C – 25,000 mg
Dexpanthenol – 300 mg
B6 – 300 mg
Glycerhizzic acid – 8 mg/cc – 10 cc
Methylcobalamine – 1 cc – 5 mg
Magnesium sulfate – 3000 mg
Executive Stress IV Formula (cont)
•
•
•
•
•
•
•
Calcium gluconate – 1000 mg
Zinc – 5 mg
Niacinamide – 100 mg
KCl – 10 meq
Procaine – 7 cc
At the end 500 mg of alpha-lipoic acid
Follow with glutathione – 2000 mg Push over
3-5 minutes
Time to Think
Question #1
Typically, gross Hematuria after giving
Argentyn 23 I.V. is caused by?
Question #2
A patient getting an I.V. Experiences a headache,what
are the likely causes,and what is the most dangerous
cause.Describe your interventions.
Question #3
Your patient gets hives during an I.V. what are the likely
ingredients to have caused this reaction?
Question #4
Cramps 6 Hours after a chelation I.V.
What treatment intervention is appropriate.
Question #5
Which drug is most likely to have caused your patient's
CPK to elevate?
What other considerations should you take into account?
Question #6
List the reasons for giving a patient an I.V. Without
having their blood work.
Question #7
Why would it be inappropriate to give I.M.
testosterone to a patient with elevated liver
enzymes.
Question #8
Fibrinogen monitoring when replacing
Testosterone could lead you to using this
Neutriceutical.
Question #9
High doses of I.V. Vitamin C should be used with
caution in patients with which disorders?
Question #10
The best I.V. for a patient with an elevated CReactive Protein (Cardio) would be which?
Question #11
Which of the following are toxicants.
H2O, SLS, Polysorbate 80, Saline, or Tea.
Question #12
This hormone has been shown to be deficient in
D.M. heart tissue and should be replaced.
Question #13
If a patient is asymptomatic with a 6
Hgb.,what should your IV program look like.
Question #14
regarding IV's - couple of patients with flushing
reaction to Glutathione (turn red,feel nauseated,
feel chest tightness) - of course no more injections,
but what could it be- it did not seem to be allergic
reaction, Glutathione is compounded and
preservative free.
Question #15
What common drink increases homocysteine
Question #16
Combination of this spice along with IV.......
may help to arrest Parkinson's disease
Question #17
Dose of vitamin C to become oxidative and
produce hydrogen peroxide
Question #18
Non-alcoholic fatty liver disease-Which IVs would
be most appropriate and which IM injection should
also be instituted
Question #19
Breast cancer is 600% higher in women with
low.......
Question #20
Discuss your approach to pancreatic cancer
Question #21
Describe your treatment for glioblastoma
Question #22
Describe your treatment protocol for fibromyalgia
Question #23
Do not put folic acid in IVs to be used for cancer
patients
T/F
Question #24
Plastic that is BPA free is safe
T/F
Question #25
Why is breast cancer particularly higher in
non-dominant arm
Question #26
Eating this food has a strong correlation to liver
cirrhosis and liver cancer; greater than ETOH
More issues with eating pig
PRRS
NIPAH virus
PERV
Menangle virus
Question #27
What increases the excretion of fluoride by 78% ?
Question #28
Low doses of this heavy metal has been shown to
cause cancer
Question #29
What components in an IV would you use for
thyroid support
Question #30
Patient gets a staph infection from blood
transfusion around his hip prosthesis. Describe
your IV protocol along with accompanying oral
protocol
Question #31
A fractured cell membrane can lead to many
chronic diseases. Describe your IV and oral
protocol
Question #32
A patient has acute Herpes zoster. Discuss a
sensible IV and PO protocol.
Next, discuss the IV and PO protocol if this was
post-herpetic neuralgia
Question #33
Describe an IV protocol for longevity
Discuss PO protocol
• Which
of the following is true about IV
Administration of Glutathione?
1.It can cause Chest Pain
2.It can cause Hives/Rash
3.It cannot be mixed with Vit. C
4.All the Above
5.None of the above
What you probably don't
but need to know!
The best nutraceutical for the peroxynitrate
free radical is:
a. Vitamin E
b. Alphalipoic acid
c. Hydroxocobalamin
d. Carnosine
The best antidote for cyanide poisoning is:
a. Vitamin E
b. Alphalipoic acid
c. Hydroxocobalamin
d. Carnosine
Before using the nutraceuticals received
from a compounding pharmacy it is best
for you to:
a. Filter
the solution with a .5 micron filter
b.Filter the solution with a .2 micron filter
c.Skin test the patient with each of these
d.None of the above
What crosses the blood-brain barrier AND the
blood-retinal barrier 550 times more powerful than
Vitamin E and 11 times more powerful than betacarotene and neutralizes singlet oxygen?
D5W is best described as which type of solution?
•
•
•
•
•
A. Hypotonic
B. Hypertonic
C. Isotonic
D. Isotonic but rapidly becomes
Hypotonic.
E. None of the Above.
An Early sign of Intracellular Fluid Volume excess is:
•
•
•
•
A. Headache, N/V and Excessive Sweating
B. Bleeding, Bloody Urine
C. SOB, Chest Pressure.
D. Confusion, Blurred Vision, Drowsiness
Your nurse in their assessment should look for signs of
hypervolemia.
•
•
•
•
A.Vein engorgement in the hands higher
than heart after10 seconds.
B. Crackles in the chest.
C. SOB, Edema, Wt. Gain.
D. All the Above.
How much K is excreted by the body every Day?
•
•
•
•
A. 10-30 mEq's.
B. 10-50 mEq's
C. 20-60 mEq's
D. 20-120 mEq's
PRETEST 24:
IV Vitamin C has been shown:
•
•
•
•
A. To become oxidative in high doses by
producing H2O2.
B. Can Potentiate the effects of several
chemotherapy drugs.
C. Has shown to significantly improve the
quality of pts. On chemotherapy.
D. All of the above.
The Harvard Nurses Study of 77,000 Nurses over 12 years said.
•
•
•
•
A. 2 or More glasses of milk a day reduces
hip fracture by 65%.
B. 2 or more glasses of milk a day reduces
hip fracture by 34%.
C. 2 or more glasses a milk a day
increased hip fracture by 45%.
D. It didn't matter if the person drank
milk or not.
Functional Evaluations
Functional Status Evaluations
Antioxidant assays
Protein oxidation
DNA/RNA damage markers
ROS assays
Lipid peroxidation
Antioxidant Assays
Glutathione assay
Catalase acvity assay
Superoxidedismutase (SOD) assay
ORAC (oxygen radical antioxidant capacity) assay
HORAC (Hydroxyl radical antioxidant capacity) assay
Protein Oxidation
Carbonyl protein assays
Protein nitration assays
Advanced glycation end-product assays
Advanced oxydation protein products (AOPP) assay
DNA/RNA Oxidative Damage Markers
8-OHG RNA Damage Markers ELISA
8-Ohd G DNA damage markers (ELISA)
AP Sites quantitation kit
DNA double strant break assay
Reactive Oxygen Species Markers
Invitro ROS/RNS assay
Intracellular ROS assay
Hydrogen peroxide and peroxidase assays
Lipid Peroxidation
MDA
4-HNE (4-hydroxynonenal) assays
8-Iso-prostaglandin F2a assay
OXIDATIVE DAMAGE PROFILE
A Logical Approach to a case
How to Think Through a Case
•
•
•
•
•
•
•
H&P
Lab Tests
What’s your ultimate Goal..or Really your
Patient’s
Don’t Think Price.
How much can your Patient take by mouth.
Start Slow BUT make a difference
Immediately.
What can you do I.V. and save some Oral
Pills?
How to Think Through a Case
•
•
•
•
Go Step by step threw EVERY aberrant
fact.
Group Variables into sections for a more
coherent approach. i.e. Crp,
Homocysteine, Lipo a etc.
Involve the patient BUT you make the
treatment decision!
Go slow….Consider Half the dose for
the first 10 days then build it up.
A simple Method for developing a Complete Tx.
Protocol
•
FAMED VIP with HELP ME
•
•
•
•
•
F=FATTY ACIDS
A=AA
M=MINERALS
E=ENZYMES
D=DIET
•
•
•
V=VITAMINS
I=IMMUNOMODULATORS
P=PROBIOTICS
•
•
•
•
•
•
H=HERBALS
E=ENDOCRINE
L=LIFE EXTENDERS
P=anti-PLATELET aggregators
M=MITOCHONDRIA ENHANCERS
E= ESSENTIALS
Weird But Real Signs:
• Women-Index Finger < Ring Finger.
• Women- > 5Ft.
• Women-Legs that are Stocky.
• Smell-Lemons,Bananas,Cinnamon.
• Women-Shortest Arm Spans.
Weird But Real Signs:
• Ear Lobe Crease Sign:
• Abs Large in your 40's.
• Women-D-Cup in 20's.
• Women-Small Calf Size.
• Blood Type;A,B,AB.
Weird But Real Signs:
• Receding Hairline + Baldness+ Ear Lobe
Crease Sign+ Yellow Fatty Deposits around
Eye=57% Risk of a M.I.
ANTI-AGING PROGRAM
•
•
•
•
•
•
•
•
•
•
•
Remove intracellular toxins
Remove extracellular toxins
Improve intracellular communication
Decrease inflammation
Prevent protein folding
Support phase one and phase two liver
detoxification
Support optimal cellular membrane function
Mitochondrial support and protection
Improve intracellular pH
Decrease excessive oxidation
Decrease A.G.E.
Why Bother in the First Place?
•
•
•
•
•
Bioavailability
Disease State Issues
Improved Response Rate
Reaching a Therapeutic Goal Otherwise
Difficult
Better Control and Monitoring
Physiology of Medicines Causing Vitamin
Deficiency
•
•
•
•
•
•
Impaired absorption
Increased excretion
Direct competition or antagonism
Interferences with synthesis of an enzyme
Genetic replication and transcription
interference
Carrier hormonal effects
Biochemistry You
Need To Know!
DMPS
•
•
•
•
•
•
Binds Pb, Cd, Hg, Ag, Sn, As
Orally (50 - 60% absorbed) or IV
Less toxic than BAL
Excreted by kidneys and cleans them
Extra-cellular
Not cross blood brain barrier
DMPS
•
•
•
•
•
Not FDA approved for Pb detox
Not approved for manufacture in US but
approved for compunding
Does not cross the BBB
In US approved for over 50 yrs for Hg
Decreases Hg, CH3Hg, Ag, Cu, Pb, Ni, As,
Zn, Cd
DMPS
IV Provocation
• Stop mineral and SH-containing
supplements for 24 hours prior to dosing
• Fast for 8 hours
• Empty bladder
• Slow IV push DMPS 3-5 mg/kg over a 10 –
20 minute period
• Some use a maximum of 250 mgs
DMPS
IV Provocation and Treatment
•
•
•
•
•
•
Some use a maximum of 125 mgs to reduce side
effects
If mix with 100 cc NS, pull air out of bag to decrease
oxidation
Drink 1-1.5 liters of purified water
Collect urine for 12 hours and then a provocative
after every 20 treatments
No minerals the day of IV
If needed, a light meal (no fish) may be consumed 3-4
hrs after getting DMPS
DMSA
Detoxification - 14 day cycle
• No minerals 24 hrs prior to or during
taking of DMSA
• 10 mg/kg tid for 3 days
• Off for 11 days
• Average is 5-10 cycles
• Take minerals and SH-containing
supplements 24 hrs after last dose
DMSA
Detoxification - for sensitive/ill patients
• 500 mg per day 3 times weekly for 6 wks
• Then take 2 weeks off
• No minerals 24 hrs prior to or during taking of
DMSA
• Take minerals and SH-containing supplements
24 hrs after last dose
Perform provocative test about every 5th
cycle
Half-life
•
•
•
25 DAYS -- BLOOD
40 DAYS -- SOFT TISSUE
20 YEARS -- BONE
Myocardial Toxic Metal
Levels in IDCM Patients1
Endomyocardial Metal Concentration
Metal
Hg
Sb
As
(Times control)2
22,300
12,840
250
IDCM; n = 13
2 MVP controls; n = 10
1
J. Am. Coll. Cardiol. (1999) 33:1578-83
The Krebs Cycle
Carbohydrate Metabolism
Oxidative Stress
Coenzyme Q10 Synthesis
Ketosis
Mineral Deficiency
Vitamin Deficiency
Neurotransmitter Metabolism.
Urea Cycle
Amino Acid Deficiencies
Bacterial Dysbiosis
Glutathione Status
Fatty Acid Oxidation
Specific Vitamin Deficiency
Detoxification
Energy Production.
Live Longer
Mechanisms of Calorie Restriction-- NAD+/NADH
•
How to increase the NAD+/NADH
Ratio?
◦ Calorie Restriction (via glucose starvation)
◦ Prolonged Exercise (via Gluconeogenesis)
◦ Supplementation with oxaloacetic acid
Mechanisms of Calorie Restriction-- NAD+/NADH
• Will
mimicking the increase in NAD+/NADH also mimic the effects of
calorie restriction?
•What
◦
◦
◦
◦
◦
should we expect
Increased Lifespan?
Better Glucose Regulation?
Gene Expression?
Cancer reduction?
Tissue Protection?
Test, Test, Test, Test, Test!
Oxaloacetic Acid (OAA)
A Human Metabolite
“
The Krebs Cycle
(Citric Acid Cycle)
OAA & Gene Response
Gene
Symbol
Foxa1
Foxa3
Foxq1
Foxq1
Gene Title
forkhead
forkhead
forkhead
forkhead
Affymatrix
Gene
Number
2891
13370
6994
30006
Change in
Gene
Change in
Expression
Gene
Calorie
Expression
Restricted to benaGene to
Control
Control Gene function
30% Increase
100% Increase
110% Increase
190% Increase
40% Increase
regulation of transcription,
DNA-dependent // inferred from
electronic annotation
70% Increase
cell glucose homeostasis //
inferred from mutant phenotype //
regulation of transcription, DNAdependent // inferred from mutant
phenotype /// cellular response to
starvation // inferred from mutant
phenotype
210% Increase
regulation of transcription,
DNA-dependent // inferred from
electronic annotation
220% Increase
regulation of transcription,
DNA-dependent // inferred from
electronic annotation
OAA & Cancer
•
•
Calorie Restriction decreases cancer risk
◦ Currently one of the most effective broad-based
methods to reduce cancer risk
Oxaloacetic Acid Supplementation prevents
Human Lung Cancer cells from reproducing
◦ In vitro results
◦ Does not affect normal cells
◦ Prevents replication of cancer cells by increasing
intercellular debris, but does not kill the cells.
◦ Cancer cells did not reproduce after OAA solution
removed for six weeks.
Farah 2007
OAA & Tissue Protection
•
OAA protects mitochondrial DNA in the brain
Yamamoto 2003
•
retinal pigmented epithelium (RPE), damaged in agerelated macular degeneration (AMD) are protected
by zinc and OAA
Wood 2003
•
pancreatic islet cells and neurons are protected by
OAA
◦Chang 2003, Berry 2006
•
OAA is a powerful anti-oxidant
◦Desagher 1997, O’Donnell-Tormey 1987
Conclusion: OAA is a Powerful Calorie
Restriction Mimetic
Studies indicate Oxaloacetic Acid:
• Increases Lifespan (25%, p << 0.001)
• Lowers Glucose levels to normal,
activates AMPK
• Has similar Gene Expression to CR
• May reduce Cancer risk
• Is a powerful anti-oxidant and protects
mitochondrial DNA, pancreatic and neural
tissues.
Cases you need to know!
Case 1:
•
•
A 32 year old female is pre-op for surgery
for breast augmentation. She is sent to you
for a consult because on her pre-op labs she
has a 8.4 hemoglobin. She states, and her
history supports, that this has been going on
for 5 years. Since this is a general anesthesia
procedure, it is required that a 10.6
hemoglobin or greater before she is a
surgery candidate.
What may be some specific causes of her
anemia and how can combined therapies
correct this?
Case 2:
•
Your IV sales person has informed you
that a 25 year old male, who is pre-op for
a tummy-tuck, does not understand the
necessity for his doctor’s recommendation
to get a multi-vitamin mineral IV
procedure.
•
What are the reasons you give this
individual for your prescription suggestion?
Case 4:
•
•
33 year old woman receiving pre and
post-surgery IV for breast augmentation
surgery. Pre-surgery IV occurred with no
problems. During the post-surgery IV (1
week after surgery), after ½ of the IV bag,
patient complained of severe dibilitating
pain in left arm and left breast.
What are the diagnostic considerations in
this case and the appropriate treatment
interventions?
CASE 5:
•A
54 year old woman gets IV nutrition
weekly. On her 15th treatment she
developed some itching of her palms and
soles of her feet.
Describe the potential diagnosis.
Describe the appropriate treatment for the
problem.
Case 5A
•
•
A 42 year old male experiences significant
fatigue after a multi Vitamin/Mineral I.V.
He notices that this fatigue lasts for 48
Hrs. post treatment. What are some of
the possible explanations for this
problem.
What are some of the treatment
considerations.
Case 6:
•
•
You have 4 recliners in your IV room suite.
All chairs are filled except one, and a patient
arrives for her second treatment. The IV
nurse presently greets the patients and seats
her in the empty chair. The nurse goes to
the prep room to obtain her IV bag on the
counter top, returns, properly preps the
patient’s arm, inserts the IV and begins the
treatment. The room is well lit, pleasant
music is playing, fruits are available for the
patient.
What is wrong with this picture?
Case 7:
•
An otherwise asymptomatic 39 year female
patient comes to your office for a general
wellness and fitness building program. During
your results consult you discover the patient
has a CRP high sensitive level of 19.
•
What would be an appropriate treatment
protocol for this case? When would you then
re-test to see if the program is being
effective?
Case 8:
•
A patient is on 2 antidepressants and you
want to check her neurotransmitter
markers by 24 hour urine before you start
your nutrient and IV program.
•
How long before doing the 24 hour urine
s h o u l d yo u re m ove t h e p a t i e n t ’s
antidepressants?
Case 9:
•
•
A 57 year old female enters your office after
seeing a nutritionist for several months. Her
physical presentation, originally to her
physician, suggested premature aging
secondary to high amounts of free radical
damage. The reason for the patient’s seeking
your opinion is because she feels no better
and still notices continued physical
deterioration.
How can you determine whether your
nutriceutical program is adequate?
CASE 10:
•
•
A 52 year old man comes in for his 6th I.V.
treatment. At the end of his bag the nurse
pushes slowly Alpha Lipoic Acid. The past
treatments there was no problem. However, this
time he complained of severe burning sensation.
Two days later he sees you in the office still
complaining of pain to the touch and you note
the following. The IV site was the Rt. Antecubital
fossa. There is redness noted proximal and 3 cm.
distal to the infusion site.
What is the most likely Dx. and what is your Tx.
Proposal.
Case 11:
•
•
A 32 year old male patient has had an ongoing staff
infection for the past year. Efforts by infectious
disease consultants, with use of multi type antibiotics,
has been futile. You choose to treat this patient with
intravenous silver . The patient, after 20 minutes into
treatment, begins to become extremely restless,
anxious and mildly diaphoretic. Although afebrile at
the beginning of the treatment, you note he has a
temperature of 100 F.
What are your potential diagnoses and treatment/
antidotal considerations?
More Basics You Need To Know!
Daily Pre Work-UP
•
•
•
•
•
B.S.
U/A
B.P. Pulse Respirations Pulse Oximeter
Weight
Question the patient.
How Often Should You Treat
•
•
•
•
•
1-3 times a week for initial repletion
Serious Disorders may require 4-5 times a
week
After initial results are realized by: Testing,
History or Physical exam reduce Frequency
to 1-2 times a week for a Reasonable period
of time.
Optimal Formula: Increase P.O. Program
while SIMULTANEOUSLY Decreasing the I.V.
Program
TIP:Vary your I.V. Solution if 3 or> times a
week
Test-Retest
•
•
•
•
•
See the patient after the first week of
Therapy
Recheck the Electrolytes/CBC
(If normal to begin with) in 2 weeks
Review the progress at 1 month and RePrescribe the I.V. Program with adjustments
as required.
Encourage the Patient
Recheck any of the original abnormal labs at
1 month. Especially inflammatory markers
Lyme Protocol
BIOFILM
90% of all bacteria live within a biofilm
Biofilms have DNA mixed in the protein to
protect itself
Silver Nanoparticles bind to any exposed
DNA or RNA exposed and therefore distorts the biofilm
Co-Infections
Bartonella Burgdoferi and Babesia B. succumb to
Silver Hydrosol if the Silver Hydrosol reaches the
Bacterium.
Macrolide + Silver Hydrosol is just if not more
effective as Ciprofloxacin,for Bartonella,
Mycoplasma.
Babesiosis
Malaria like Protozoan.
No article describes the use of Silver,But
Protozoan Diarrhea has been studied and is
eradicated by silver.
Other Species
Borrelia Afzelii
Borellia Garini
Diagnostic Considerations
Lyme Titre-Igm,Igg
Band Determinations
PCR
Culture
CD57 (HNK1/Leu7)
CD57
Levels Below 180-Highly Probable for Relapse.
Use for Tx. Planning
Low in ONLY T.B. and Chronic Lyme.
Protocol Considerations:
Eliminate Infectious organisms
Full Thyroid testing
Full Hormone Testing
Fix the Gut
Gut Repletion
Glutathione precursors,NAC
Niacin-30 Mg.s/Day Lining of the gut.
General Protocol
Generalized aches and pains at bedtime...Test.
Stop Conversion to Estradiol
Check Adrenal Function.
Silver is processed by the liver use 200 Mcg.of
Selenium/Daily
General Protocol
Vit. E to prevent Selenide from oxidation.
Silver and Aluminum are antagonistic and ceate
exothermic reaction..fever.
If the saliva is very acidic..patient could have
sensitive feeling..P.O.
Start P.O. doses first to clear spirochete and LForms
General Protocol
1-2 Drops in eyes, Twice a Day.
Spirochete hides in Tears, Saliva and Semen
P.O. has good absorption in the MALT and GALT.
Do Gut Silver Hydrosol Protocol.
I.V. Protocol
Place Midline or PICC Line.
Use 4 Day Cycle, weekly. For 3 weeks
Day #1-Multi Vit./Mineral.
Day #2-#4..Silver Hydrosol in ascending doses
Week 4- 3 days in a row of Ceftriaxone.
1500,1000,500.
Notes on I.V. Protocol
Cont. Oral Silver Throughout Tx and Post IV.
Protocol.
Drip no faster than 1-2 Ml's/min.
No Calcium supplements during or 48 Hrs.
after Ceftriaxone use.
Give 800-1,200 Mg.'s of Tetrahydrofolte to
clear any residual of Ceftriaxone.
Notes on I.V. Protocol
Silver Hn.
ydrosol-2 Tablespoons Twice/Daily for 3 Months.
Cysts in RBC's eliminated by Silver Hydrosol..Life of the RBC consideratioIt takes
3 Mins.to de-activate an infected RBC..GO SLOW!!!
Too Rapid infusion..Gross Hematuria.
TAKE A HANDS ON COURSE.
Summary
1.
2.
3.
4.
5.
6.
7.
Antimicrobial
ImmuneSupportive
Anti-PlateletAggregation
SynergisticwithotherTreatments
SafetyofSilverHydrosol
NoOvertResistanceNoted
MultipleRoutesofAdministration
Immune Supportive:
Do you really know Vit. C
Vitamin C
•
•
•
•
•
•
Anti-oxidant or Pro-oxidant?
Ascorbic acid oxidized to dehydroascorbate
We lack L-Glutonolactone oxidase
Glutathione needed for re-entry
Simmians consume 10-20 times more than is
recommended for humans
An adult goat makes approximately 13,000
mg a day under normal health conditions
Vit C
Cytotoxic
Decreases Liver,Ovarian,Pancreatic and
Glioblastoma
Decreases CRP by 76%
Decreases PSA by 77%
Decreases CEA
Vitamin C Actions and Therapeutic Uses
•
•
Actions
◦ Reducing agent
◦ Electron donor for 8 different enzymes
◦ Anti-oxidant
Therapeutic
◦
◦
◦
◦
◦
◦
Immune support
Adjunct to antibiotics
Low sperm count
Macular degeneration
Cancer
Altitude sickness
Vitamin C Cont….
How to find your optimal dose for your
patient
LD50 11.9 gms/kg
Some Other important tests you
should know.
Heart Disease is the Leading Cause of Death in the United
States, Stroke is Third
1,000,000
Leading Causes of Death for American Women
Total Leading Causes
of Death in the US
750,000
631,636
559,888
500,000
250,000
137,119
121,599
72,449
0
350,00
0
300,00
0
250,00
0
200,00
0
150,00
0
100,00
0
50,00
0
0
315,00
0
82,00
0
Heart
Disease
National Center for Health Statistics 2006.
Stroke
71,00
0
65,00
0
Lung
Cancer
COPD
41,00
0
Breast
Cancer
National Heart, Lung and Blood Institute, 2006
Copyright 2009 diaDexus, Inc. All rights
reserved.
180
Coronary Artery Disease (CAD):
The Diagnosis Often Comes Too Late
62%
46%
0%
Adapted from Levy et al in Textbook of Cardiovascular Medicine, 1998.
70%
Copyright 2009 diaDexus, Inc. All rights
reserved.
181
Limitations of Total Cholesterol and LDL Alone in Predicting Coronary Heart Disease
Framingham Heart Study - 26 year follow-up
data
35% of persons who develop CHD have total cholesterol < 200 mg/dL
2.
80% of the MI patient population had similar cholesterol levels as those who did not have an MI
3.
The median LDL level in CHD is 150 mg/dL
4.
As little as 25% of premature CHD is attributable to elevated LDL-C values
182W, Atherosclerosis 1996
1Castelli
2Genest
1
1.
J Jr, et al. J Am Coll Cardiol 1992
1
1
2
Copyright 2009 diaDexus, Inc.
All rights reserved.
Rupture-Prone Plaque, not Severe Stenosis, Causes most Acute MI and Cardiac Death
Up to 76% of all CV Events are due to Plaque Rupture
Sudden Cardiac Death
100%
76%
Proportion (%)
80%
60%
40%
24%
20%
0%
Rupture-prone plaque
Severe Stenosis
Type of culprit lesion
184
Copyright 2009 diaDexus, Inc.
All rights reserved.
Kolodgie F, et al. ATVB 2006.
Stenotic Plaques May Be Stable or Unstable
Thick Cap with Small
Necrotic Lipid Core:
“Stable Plaque”
Early Plaque with Lipid Pool
Thin Cap: Unstable or
“Rupture-Prone” Plaque
185
Adapted from Kolodgie F, et al. Arterioscler Thromb Vasc Biol 2006.
Ruptured Plaque with Thrombus in Lumen
Copyright 2009 diaDexus, Inc.
All rights reserved.
Contrasting Histopathological Characteristics of a Stable versus Ruptured Plaque
Minimal Necrotic
Lipid Pool
Thick Fibrous Cap
Large Necrotic Lipid Pool
Thin Fibrous Cap
Lumen
Lp-PLA2
Lumen
Lp-PLA2
Stable Plaque
Ruptured Plaque
•Low Lp-PLA2 content (dark staining)
•High Lp-PLA2 content (dark staining)
•May have significant stenosis
•May have minimal stenosis
•Thick fibrous cap / high collagen content
•Thin fibrous cap / low collagen content
•Minimal necrotic lipid pool
•Large necrotic lipid pool
•Few inflammatory cells
•Many inflammatory cells
Davidson MH, Jones PH. Am J Card Suppl 2008.
186
Copyright 2009 diaDexus, Inc.
All rights reserved.
Additive Risk for Incident CHD and Stroke by Lp-PLA2 when added to hs-CRP
Heart Attack
Stroke
p<0.001, 95% CI 3.1-41.4
p=0.001, 95% CI 1.7-10.3
Risk Ratio
1.4
1.2
1.0
hs-CRP
hs-CRP
bottom
Ballantyne ettop
al, Circulation. 2004 and personal
communication
Lp-PLA2 top tertile
(n>12,000, 6-8 yr f/u,
194 ischemic strokes)
11.4
Risk Ratio
4.2
(n>12,000, 6-8 yr f/u,
203 coronary events,
LDL < 130 mg/dL)
5.5
5.8
Lp-PLA2 bottom tertile
hs-CRP
top
1.0
hs-CRP
bottom
Lp-PLA2 top
tertile
Lp-PLA2 bottom
tertile
Ballantyne et al, Arch Intern Med. 2005
Lp-PLA2, in combination with hs-CRP, demonstrates increased clinical utility.
187
Adjusted for demographics, current smoking status, blood pressure, diabetes and HDL
ARIC Study data
In Summary - Lp-PLA2 as a Biomarker in CHD and Stroke
•
Lp-PLA2 is specific for vascular inflammation and is a
circulating measure of the progression of ruptureprone plaque.
•
Elevated Lp-PLA2 plasma levels correlate with a
doubling of risk for CHD and stroke in multiple
published epidemiological studies.
•
Lp-PLA2 levels can be used to identify patients who
require more aggressive treatment, including lipidlowering therapy.
•
Therapeutic intervention can lower Lp-PLA2.
Copyright 2009 diaDexus, Inc.
All rights reserved.
191
ORGANIC ACIDS
Humans excrete over 700 organic acids in
the urine.
• Measuring these can give us an
understanding of metabolic pathways,
blockages, deficiencies and excesses.
•
Urinary Metabolic Testing
• Organic
Acids
Markers for -
• Energy Production
• Vitamin/Mineral
Deficiencies
• Neurotransmitter
Metabolism
• Detoxification
Need
• Bacterial Dysbiosis
•Environmental
Pollutants
Markers for
exposure of •Xylene
•Toluene
•Benzene
•Styrene
•Phthalates
ORGANIC ACID ANALYSIS:
A POWERFUL CLINICAL TOOL
•
•
A picture of cellular metabolism
measuring biochemical intermediates
Monitoring metabolic pathways giving
insight into specific nutrient deficiencies
based on Biochemical Individuality
Comparison of Urine, Saliva and Blood Hormone Testing
•
•
•
•
•
Hormone General Facts
Pulsatile
Varying T1/2 lives
Time of application of topically applied
hormones
There are more than 20 circulating
estrogens
Comparison of Urine, Saliva and Blood
Hormone Testing
•
•
•
•
Serum
Test direct assessment of a circulating
hormone
Bioavailable is rarely measured
Need 2 or 3 blood draws for increased
accuracy
Comparison of Urine, Saliva and Blood
Hormone Testing
•
•
•
•
•
Saliva
Measures free active form by RIA
Also needs 4 measurements in a day for
activity measurement, i.e., Cortisol
Serum content of progesterone is higher
than RBC membrane content (RBC
membrane content makes available to all
target tissues and saliva)
RBC never exceeds plasma levels
Comparison of Urine, Saliva and Blood
Hormone Testing
• Salivary levels were found to be very high
and variable compared to a placebo,
therefore, false impression of overdose
• SHBG in saliva
• CBB in saliva
• Maybe not reliable at all
Comparison of Urine, Saliva and Blood
Hormone Testing
Advantages of 24 Urine Hormone Testing
Averages out all 3 above
Highest specificity and capable of looking at metabolites
◦ Gas Chromatography
◦ Mass Spectra Meter
• Reflect secretory activity of the endocrine gland
• Best biochemical assessment of ovulation based on progesterone
production:
• Plasma is next, saliva is least accurate
• You need to look at estrone metabolites
◦ 4 OH estrone = increased breast and prostate carcinoma
◦ 16 alpha OH estrone = unsafe uterotopic
◦ 2 OH estrone = anti-estrogenic
◦ 2:16 ratio, Careful how you interpret this!
•
•
•
Comparison of Urine, Saliva and Blood
Hormone Testing
•
You need to look at estrone metabolites
•
•
•
•
4 OH estrone = increased breast and prostate carcinoma
16 alpha OH estrone = unsafe uterotopic
2 OH estrone = anti-estrogenic
2:16 ratio, Careful how you interpret this!
•
Looks at downstream metabolites
•
24 hour urine, lower levels of estriol:
lower than sums of estrone and Estradiol.
This equals an increase in breast cancer
Comparison of Urine, Saliva and Blood
Hormone Testing
Iodine increases estriol and decreases estrone and
Estradiol
• Increased high levels of estrogen in the urine than
expected may equal Hyperexcretion Syndrome.
Consider 600 mcg of CoCl
• Looks at downstream metabolites
•
◦ Example: Saw Palmetto….DHT
◦ PCOS upregulates enzyme to DHT
Cell Membrane EFA'S
EFAs and PEOs — The Essential Difference
EFA = Essential Fatty Acid = PEO Parent Essential Oil —“EFA” Often Used
INCORRECTLY by referring to DERIVATIVES
• Parent omega-6 (LA) – essential
• Parent omega-3 (ALA) – essential
LA and ALA are the only 2 essential (body can’t synthesize) fats
• DHA from fish oil is NOT an EFA – NOT essential – body makes AS NEEDED
• EPA from fish oil is NOT an EFA –NOT essential – body makes AS NEEDED
***< 5% (approx. 1%) of all PEOs Converted into Derivativesa,b,c***
Contrary to popular belief, your body makes the derivatives AS NEEDED, such as
DHA and EPA, with at least 95% staying in parent form.
a. Salem N, Lin Y, Brenna JT, Pawlosky RJ. Alpha-linolenic acid conversion revisited. PUFA Newsletter, December 2003. [Link]
b.. Pawlosky RJ, Hibbeln JR, Novotny JA, Salem N Jr. Physiological compartmental analysis of alpha-linolenic acid metabolism in adult humans. J Lipid
Res 2001;42:1257-65. [Medline]
c. Goyens PL, Spilker ME, Zock PL, Katan MB, Mensink RP. Conversion of alpha-linolenic acid in humans is influenced by the absolute amounts of
alpha-linolenic acid and linoleic acid in the diet and not by their ratio. Am J Clin Nutr 2006;84:44-53. [Medline]
Fish Oil Doesn’t Work
Fish oil is exclusively omega-3 derivatives with at least a 10-fold
overdose factor. Therefore, prophylactic use has no basis in human physiology.
Spector, A.A., “Plasma Free Fatty Acids and Lipoproteins as Sources of Polyunsaturated Fatty Acid for the Brain,” Journal of Molecular
Neuroscience,Vol. 16, 2001, pages 159-165., “Most of the plasma free fatty acid (EFA) is derived from the triglycerides stored in the
adipose tissue [bodyfat].” Note: Organs, including the brain use these EFAs for structural incorporation. “Metabolism of essential fatty
acids by human epidermal enzyme preparations: evidence of chain elongation, “R.S. Chapkin, et. at., Journal of Lipid Research,Volume
27, pages 954-959, 1986, Markides, M., et al., “Fatty acid composition of brain, retina, and erythrocytes in breast- and formula-fed
infants,” The American Journal of Clinical Nutrition, 1994;60:189-94 and Agneta Anderson, et. al., American Journal of Endocrinological
Metabolism, 279: E744-E751.
407
Most omega-6 being used by food processors
is adultered for long shelf-life.
rendering at least 50% nonfunctional!
Therefore, we need lots of FULLY FUNCTIONAL
parent omega-6 to compensate +++
ONLY conservative amounts of parent omega-3
(NOT derivatives)
Why Focus on the Cell Membrane?
• Immune
Function
• Inflammatory
• Nutrient
Control
Movement
• Dermatitis
• Wound
• Hair
•
Healing
Loss
Thrombocytopenia
The Cell Membrane
Encourage n-6 Series 1...Evening primrose oil, Borage.
Black Current Oil,
• Encourage n-6 Series 1..B vitamins.
• Watch Desaturase activity: B-Blockers enhance
activity.
• Ratio in DIET 4:1 Omega 6 to Omega 3
•
From The Advanced Guide to Longevity Medicine, ed. Ghen, MJ, 2001, p. 227
Time For More Cases You
Need to Know!
CASE 12:
•
A referral of an wonderful 8 year old
Downs child was made to you because she
has had ongoing MRSA infections and both
the Pediatric Surgeon and the ID Specialist
have been frustrated treating this child for
almost 6 years for recurrent infections.
•
What treatment options do you have to
offer?
Case 13:
•
•
An 18 year old male patient has a history
of severe migraine headaches since 12
years of age. He has had a hiatus of several
years since his last headache. However, 3
weeks ago, he was admitted to the hospital
for a severe classical migraine with
neurologic sequelae. After morphine drip
he was released but enters your office on
several analgesics PO but still have
debilitating headaches daily. His hospital
work-up was unremarkable.
What would you consider as a further
work-up and what treatment options
would you pursue?
Case 14:
A 42 year old female for rhinoplasty, breast augmentation and
tummy-tuck is in the pre-op area. She is found to have a pre-op
blood pressure of 168/98. She is on no anti hypertensive meds
and has no history of the same. Her pre-op work up supports a
normotensive individual. The anesthesiologist gives pre-op
sedatives intravenous, however, on reexamination 20 mins later,
blood pressure is 186/110.
• You are called in as a consultant to see if there is anything that
you may offer to reduce this blood pressure in a reasonable and
safe amount of time so that the patient can continue with the
surgical plan.
•
Case 15:
•
During DMPS chelation a 52 year old male
patient develops a significant headache.
The nurse does another set of vitals
noting them all to be normal. The finger
stick blood sugar, just obtained, is 94.
•
What should your treatment choice for
this individual include?
Case 16:
•A
seventeen year old male arrives for his regular IV therapies to
help in his anti-inflammation program, being given to him
secondary to contusion of the spinal cord creating a lower body
paraplegia. His blood pressure at the start of his 5th IV was
110/84. His blood pressure check after his IV multivitamin
mineral treatment notes to be 170/100.
• What
is the possible diagnosis?
• What are your treatment considerations?
CASE 17:
•A
32 Year old Boxer comes in for his regular
IV Drip of multivitamins and minerals. During
his pre IV exams 4+heme is noted on the
multi-Dipstick test strip. Interestingly, No
gross hematuria is recorded by the nurse.
• The
nurse presents this information to you.
Your initial reaction is? What other tests if
any do you suggest and what is your
treatment course.
CASE 18:
•
A 44 year old with Cirrhosis of the liver
receives his first IV of Multi Vitamin
Mineral and at the end receives 1000 Mg.’s
of Glutathione. After leaving the office he
develops severe shaking chills.
•
What are your Dx. Considerations and
Treatment Solutions?
Case 19:
•
During chelation with EDTA, a male 62
year old patient develops some calf
tenderness bilaterally.
•
What should you check for? What would
be your treatment considerations?
Case
•
•
A 37 Year old female comes in to see me
after having an IV a week previously. She
relates having a Muti Vitamin/Mineral I.V. that
usually takes 2 Hrs. taking 4 Plus hours
secondary to severe pain at the IV site
(Dorsum of the Hand). Examination notes a
ropey feeling vein that is slightly tender to
palpation. No other signs of inflammation are
noted.
What is the suspected cause and treatment
for this woman’s condition?
Case 20:
•
A 39 year old female receiving a multivitamin mineral IV secondary to a URI,
after 30 minutes of infusion develops a
red streaking 12 inches above the IV
infusion site.
•
What is your immediate and long term
treatment protocol?
Case 21:
•
During the third treatment of silver
hydrosol solution to a 33 year old female
patient with a post-op infection, she
develops shortness of breath.
•
What are your treatment considerations?
CASE 22:
•
A patient is receiving Multi Mineral and
Multi Vitamin mix weekly. In addition, the
patient receives Glutathione. After several
treatments the patient complains of hair
loss, loss of feeling in their limbs and you
notice white spots on their nails.
•
The first thing you should tell your nurse
is to remove the ___________ from the
IV solution.
Case 23:
•
A 62 year old male executive comes for a
general anti-aging optimal health work-up.
You discover that his cholesterol is 350,
CRP is 2.5, homocysteine is 12 (normal to
15).
•
What would be your oral and IV
treatment regimen for this patient?
Case 24:
•
While giving an injection of IM Z-tracked
iron, a patient develops a generalized
pruritic urticaria.
•
What are your treatment options?
Misc. You Need To Know!
The Placebo Effect
•
•
Your patient needs to be responsible for
their outcome
Meta-analysis of 47 studies using the
FDA database notes 80% of effectiveness
was placebo
Problems and notes you need to
know!
I.V. Drip Notes
•
In the event of anaphalactic reaction
◦
◦
◦
◦
◦
•
Stop drip immediately
Give 0.5 ml of Epi, 1:1000 subcutaneous in the opposite
arm
Remove I.V. vitamin drip and replace with 0.9 normal
saline
Monitor vitals every 5 minutes
Have protocol in place where medical director or
physician on duty is notified immediately
For cardiopulmonary arrest, institute
Code Blue procedures
I.V. Drip Notes
•
•
Infuse, if possible, with an I-Med pump at a
rate 150 ml per hour
Vitals
◦ Before infusion
◦ During infusion
◦ Post infusion
•
•
Instruct patient to drink 8 glasses of water
after treatment
Instruct patient that urine may turn bright
yellow
Side Effects
•
Painful infusion
◦
◦
◦
◦
◦
◦
◦
◦
•
•
•
•
Increase the fluid
Increase hydration
Heating Pad
Gentle pressure or rubbing
Procaine – 5-10 cc
Bicarb – 10-12 cc
Change the I.V. site
For patients quite sensitive, consider:
Slower rate
Larger vein
Smaller gauge needle (23-25 gauge)
Butterfly vs. catheter type
Side Effects
•
•
•
•
Anaphalysis
◦ See previous slide
Allergic Diathesis
◦
◦
◦
◦
Check ingredients (Beet derived)
Antihistamines
Corticosteroids
Slow I.V. drip rate
Cramps
◦ Potassium (KCl)
◦ Calcium
Circulatory
◦ Make sure patient does not cross legs during
infusion
Side Effects
•
•
•
Hypoglycemia
◦ D50
◦ D5W
◦ Eat during procedure
Hypertension
◦ See Antihypertensive Protocol
Dizziness
◦
◦
◦
◦
Check solution
Check blood pressure
Slow I.V.
Stop I.V. drip
Side Effects
•
•
•
Dysrhythmia
◦ Potassium
◦ Magnesium
◦ Slow or stop I.V. drip
Nausea
◦ Check I.V.
◦ Slow I.V.
◦ Add B6
Flushing equal downstream vasodilation –
ischemia
◦ Stop the I.V. drip
◦ Start magnesium chloride at 5000 mg over 1 hour
◦ Attach EKG or cardiac monitor
Side Effects
Fluid Overload
• Stop the I.V. drip
• Lasix
• KCl
• M.I.
• Stop the I.V. drip
• Magnesium sulphate
• O2
• Nitroglycerine – 1-150
• ASA
• Hook up to EKG
• Crash Cart near by
• Call 911
•
What you need to know to
become an anti-aging
physician
Regenerative Medicine will need to accomplish
all of the following:
•
•
•
•
Niche and microenvironment support with
nutrition, etc.
Applications to reduce exposure to noxious
substances
Hormonal balance and maintenance at youthful
levels
Mitochondrial support
Regenerative Medicine cont…
•
•
•
Applications to decrease glycation end
products and other racemic changes that
occur with aging (L – D AA)
Equilibrium of cellular electrical gradients
either by electrolyte repletion or special
electroporation
Equilibrium of cellular milieu with directed
therapies to intracellular pH stabilization
Regenerative Medicine cont…
•
•
•
Decreased production of ROS and other free
radical generators
Balance the friendly and pathogenic microorganisms within the body
Improve tissue oxygenation uptake and
utilization
Regenerative Medicine cont…
•
•
•
Biomaterials for cell scaffolds to induce
regeneration in-vivo of tissues and organs
Surgical tissue engineering and biodegradable
scaffold are essential for engineering
Multi-potent adult MSCs derived from bone
marrow stroma and connective tissue may offer
valuable prospects for cell based generation and
tissue engineering
Regenerative Medicine cont…
•
Induce tissue regeneration using therapeutic
procedures of internal medicine/nutraceuticals
based on self healing properties of
surrounding healthy tissues
Lets see what you know!
Post-Question: #1
Which combination is best for Type #1 D.M.
•
•
•
•
A. Benfotiamine, Oxoloacetate, I.V. Mini
weekly.
B. Oxoloacetate, Cr, 75 Grams Vit. C I.V.
C. Cr, Gymnemma, 50 Grams Vit. C I.V.
D. Zn, Cr, Chelation weekly
Post Question: #2
A patient develops a sudden loss of hearing while getting a
Chelation Tx. What is the likely cause?
•
•
•
•
A. Too much Zn.
th
B. Inflammation of 8 Nerve or Blood
Clot.
C. Calcium Embolus
D. Fluid in the Middle ear.
Post Question:#3
The most likely cause of hematuria after an IV.
•
•
•
•
•
A. G6-PD Def.
B. Fluid infusion too fast
C. Fluid too hypotonic
D. Both B & C above
E. None of the above
Question #4
A Pt. With Fibromyalgia would probably benefit from a ______
I.V. And Why?
Post Question #5
A pt. develops hot, swollen face during an IV. Her lungs are Clear to
A/P and her vitals are stable. What is your course of action?
•
•
What are some of the potential causes?
How can you check for the potential
causes?
Post Question #6
A Doctor calls me and states the same IV formulas he was giving
NOW are burning the same Pts. that had no problem previously.
•
•
He recently changed the compounding
pharmacy.
What is possibly going on and how do
you change it?
Post Question #7
A Pt. has Lyme disease.
•
Describe your Oral and I.V. Protocol.
Post Question#8
Which of the following solutions is more likely to cause phlebitis?
•
•
•
•
A. Sterile Water with Vit. C.
B. Normal Saline with Vit. C
C. D5W and Vit. C
D. Lactated Ringers and Vit. C
Post Question #9
A Pt. has Normal Lab work but Alk. phos. Is low. Which IV
should you administer?
•
•
•
•
A. Executive Stress Formula
B. Multi Vit and Mineral Formula
C. Chelation
D. No I.V. The pt. doesn't need any.
Post Question #10
A Pt. has an elevated 8OH d-Guanasine. What is the best
combination?
•
•
•
•
•
A. Multi IV 2-3 times a week.
B.Vitamin D Injections until reach optimal.
C.Vitamin A 50,000 units daily.
D. Carnosine 1,000 mg Bid.
E. A, B, and C above.
Post Question #11
Which of the following is true about Vit.
D?
•
•
•
•
A. It is best given 4 hours after a meal.
B. In cancer patients increase dose weekly
until hypercalcemia and then back off the
dose.
C.Vitamin D3 can reduce the risk of
cancers of colon, breast and prostate.
D. All the above are True.
Post Question #12
A cancer pt. has a high ferritin what do you think?
•
•
•
•
A. It is Non-Hemoglobin Iron, it is
oxidative, inflammatory and should be
removed?
B. Iron does Not cause increased ROS
and therefore is Not a problem.
C. Increased iron is Not associated with
angiogenesis.
D. Growth of cancer is Not dependent on
Iron.
Post Question #13
Which of the I.V. Protocols below would be best for Thymus
Stimulation?
•
•
•
•
A. Chelation protocol.
B. Multi Mineral Infusion.
C.Vitamin C IV with Glyyrrhyzic acid and
Glutathione. (Super Immune).
D.Vitamin C 75,000 mg protocol.
Post Question #14
Your Pt. has a high uric acid. What should you add to the I.V. To
Prevent Uric acid stone?
•
•
•
•
A. HCL
B. Na Bicarbonate.
C. Procaine.
D. Dexpanthenol.
Post- Question #15
Why is it not a good idea to give a hormone like HGH as a bolus,
which represents square wave pharmokinetics?
•
•
•
•
A. The dose may be too high.
B. Hormone release is episodic and
therefore a bolus is not physiologic.
C. It may make the anti-pituitary work
better.
D. Receptors can't be saturated.
Post Question #16
What is the best explanation why Vit. C works in cancer?
•
•
•
•
A. Because the cancer cell recognizes the
Vitamin C as a glucose?
B. Because it helps the telemeres shorten.
C. A cancer cell has little catalase activity.
D. A and C above:
Post Question #17
After several Argentyn 23 Infusions the Pt. develops Knots in the
veins.
•
What is treatment and the possible cause
and prevention for further problems.
Post Question #18. Pt's. Unusually sensitive to the Neuromuscular effects of
Magnesium
•
•
•
•
A. May have a Na deficiency.
B. May have a disorder of neuromuscular
transmission.
C. May be K deficient.
D. Are simply allergic to magnesium.
Post Question #19. Which of the following best describes Magnesium Intoxication?
•
•
•
•
A. A sharp drop in B.P. and resp. paralysis.
B. Eye diplopia.
C. Heavy breathing and weakness of
muscles.
D. Slurred speech and weakness.
Post Question #20. Drawing Blood for a Ca level with a tourniquet on too tight
might.
•
•
•
•
A. Raise the calcium serum level
B. Lower the calcium serum level
C. Do nothing to the calcium serum level
D. None of the above.
Post Question #21. Which of the following about Mg is True?
•
•
•
•
A. It's depletion is associated with poor
synthesis and excretion of ParaThyroid
Hormone.
B. It's depletion is associated with Acute
Pancreatitis.
C. Doses of 6 grams over 2 hours
Depress Parathyroid Hormone.
D. All of the Above
Post Question #22
Which Calcium has 3 times the elemental calcium per gram?
•
•
•
•
A. Chloride.
B. Gluconate.
C. Gluceptate
D. Oxide.
Post Question #23
Too much copper is best treated with:
•
•
•
•
A. DMSA
B. D-PENICILLAMINE
C. EDTA
D. BAL
Post Question #24. A Pt. has Microcytic Hypochromic Anemia with
depigmentation of the skin. What is the most likely deficiency?
•
•
•
•
A. Iron
B. Copper
C. Potassium
D. Manganese.
Post Question #25.
Decreased levels of this mineral
will decrease Glutathione Peroxidase.
•
•
•
•
A. Selenium.
B. Molybdenum.
C. Chromium.
D. Manganese.
Economic Considerations
•
•
•
•
•
Ask and watch dating on compounding
pharmaceuticals
Buy what you need
What to charge
Legal forms
How to market
Contact Information
Mitch J. Ghen, D.O., Ph.D.
• 561-789-1588 Cellular
• 561-674-0555 Office
• Dr. Mitch's Total Health
• 1515 S. Federal Highway
• Suite 104
Boca Raton, Florida 33432
• www.drmitchshow.com
• [email protected]