Transcription
Let's get the ball rolling. Hey, so this is a special little session for people that are curious about the patient process in my clinic because we get this question a lot, and I thought I would, uh, just kind of answer it. So, um, I want to talk a little bit about the details of how the clinic works and then show you guys some sample labs so you can see what kind of lab testing we tend to do and, you know, kind of explain how the whole process works basically. It's the little goal of today.
So we certainly have a lot of paperwork that people have to do. So, you know, we, we obviously want to, um, you fill out all this new patient paperwork. And then the first session that you have in my clinic is with Mark Herbert. And Mark is our new patient intake person. Gosh, you know, Mark was in my training program in a very first year that I started teaching online, which is 2006, 2007. And he was the only practitioner that stayed on the Tuesday morning 8 AM call for nine years in a row. That is some, you know, consistency. Anyway, so after nine years of working with me every Tuesday, I hired Mark, uh, because he's basically the most knowledgeable person about what I do in the world. And Mark does the new patient intakes now. So he talks to you, explains what the procedures are like, takes the history, gets all the notes that we're going to need, starts to determine what lab tests you're going to need to take. And that's the first session is with Mark Herbert. He's a wonderful fellow, very knowledgeable about diet and exercise. And, um, you know, it's funny because, um, I was very hesitant to, you know, bring someone else into the clinic that would work with me. And he actually does a better job at that new patient intake session than I ever did. He takes great notes, he does all the lab work, he just, he just figures everything out. So anyways, that's how the first session goes.
And then, um, after you talk to Mark and you figure out what labs you're going to order and you, you go through that whole process with my other staff, then when the lab test results come back, then your second appointment is with me, always, uh, to review the labs and create all the treatment plans. And, um, a couple rules about that, just generally. If you're International, we always want to have your Skype address. And we do a lot of work with Skype. And I've had patients literally all over the world. We have Panama and China and Dubai and all over Europe and Canada, Mexico, Central America. Work with patients all over the world on a regular basis, which is kind of fun. Um, I don't, there's, we have patients in South Africa and Zambia, Ecuador, uh, Kazakhstan. We have patients everywhere. So you can do this. It doesn't matter as long as you can get on Skype, you can work with me if you're International. And, uh, I welcome that and it's fun. You know, to, oh, we have patients in Israel and Egypt. I'm just thinking about all these different patients all over the world. Anyways, I love that and it's really nice to work with International people. Have patients in Pakistan. Um, some countries we don't have, but many, many countries. And I think all continents. We're working with lots of people in Australia and New Zealand. Um, so anyways, uh, we work with people all over the world. And, um, when you're scheduling a new patient consult, you got to, you know, fill out your paperwork three days before. Make sure we have everything organized. And you do your first session with Mark. And then you do all the follow-ups with me.
And, um, you know, once we talk the first session, we go over your lab work, which is usually the longest time that we talk. You know, it's oftentimes an hour to really get through all the labs and explain everything. Then we start to design programs. And then I usually do follow-up with patients about every two months. It's very typical. And then we retest the labs, you know, as appropriate, depending on what we find and kind of go from there. And so I don't have any kind of preset agenda with patients. We just start working together and and see where the lab testing leads us. And, you know, all the programs that I design are based on tests. And I'm going to show you some of those tests tonight and you can get a general sense of what they look like and what they're like. Um, and there's a lot of different options, you know, which is why we, you know, want to basically screen people and make sure that we're ordering the right test for the right person, um, depending on what your concerns are. So I'm going to show you a bunch of different labs. You can see what they look like. Um, and then when the labs come back, you know, we design supplement protocols, lifestyle changes based on the testing.
So here's a typical lab. This is an adrenal stress profile. And we order these a lot with people, um, based on salivary cortisol. They track your cortisol levels. I'll show you here, uh, morning, noon, afternoon, and nighttime. And then they add up all the cortisols together and the cortisol sum. And then they check your DHEA. So this is a, you know, looks at the adrenal hormones and how they're being produced, what's happening there. And then this particular test is what they call a 205 panel. So it also includes markers for different types of estrogen, estradiol, estriol, as well as progesterone. And then melatonin and testosterone. So you can do adrenal panels only. You can do adrenals with the female hormones. Couple different options there.
And I'll show you another kind of test that's available. We do a lot of these. This is a month-long panel. It's called a 207 or 208, depending on what we're doing here. But basically, these are salivary tests for women who are having a menstrual cycle that want to map out their cycle. And these are really great labs. So you do a saliva sample every other day for a month. And then they get all these results back. And they basically map out, um, what your, uh, ovarian production of these hormones is for the whole month. So you can see here, up, up here is her estrogen levels, down here her progesterone. And each dot is a day in the month. And you end up being able to see the whole cycle. Very helpful test for women with fertility problems or PMS type problems, or women that want to map their cycle for some reason. And you can see every cycle is completely different. And the salivary month-long panels are just a, a really, really wonderful test. And not often done, you know, in conventional medical practices. They don't usually use these at all. And I can't think of anything more in, in, you know, informational than to map out the whole monthly cycle. Because oftentimes women have symptoms that are on different days of the month. And you can't really tell from a single sample test what's going on. So anyways, you can see how each one of these labs on these different patients of mine from the past is a little bit different. And the interpretation, you can literally be day by day, meaning that we're looking at each day of the month, then resetting the cycle based on what we see in the month-long pattern. And I was trained on these for years with Dr. Timman. So I'm pretty good at interpreting these now. I spent a lot of time focusing on that.
Okay, so you have the month-long panels. You have the day-long panels for the adrenals. And then there's some other new testing technologies that have come along. There's one that's available now. It's called a Dutch test. I'm going to show you an example of that here. So a Dutch test is, um, stands for dried urine. And it's also checking cortisol levels. You'll see some of the same hormones, DHEA, cortisol, estrogen, testosterone, progesterone. But it's doing it from a urine sample. And this test is a little more complex. Give all look at that. Woah, there's like pages of information on here. But they summarize it in these little graphy things and little chart things. So you can get, again, a general sense of what's going on with, uh, DHEA, estrogen, progesterone, testosterone. So there's advantages and disadvantages to all these different tests. There is no one best test, I don't think. So there's salivary adrenal. There's salivary female hormones. There's the dried urine adrenal. The dried urine female hormones. There's the month-long panels. The month-long panels for women are done from salivary only. Um, so you have lots of different options. And these Dutch tests also include melatonin, testosterone. And, you know, they look at DHEA and and cortisol in a couple different ways as well.
Okay, so as you can see, there's lots of different options. Just depending on where we're at with the patient, what makes the most sense. Some of it has to do with cost. Some of these tests are more expensive than others. Some of it has to do just, you know, what we're trying to find. And then, um, let me show you. As you all who have followed me know, my favorite test. Got too many examples here, I think. But, uh, here's another adrenal test. As you can see that one. This one is where the person is all low. Just show you. See cortisol levels are just hovering in low all the time. That's an exhausted person. And sometimes you see the levels really quite high, you know. And so the treatments are completely different. If you see a high cortisol, you want to bring it down. If you want to see a low cortisol, you want to bring it up. And so, you know, the labs really are instructive in terms of how you're going to fix things. I, I honestly don't know how I would run a practice without the testing. You know, this is such a, a vital and critical part of what we do here.
So let me show you, uh, a couple other case studies here. So we do a lot of organic acids testing, which you guys may have heard me talk about before. Here's a typical organic acids profile. Looks like this. And, um, that's my favorite test. It's a great test. Don't run them on everybody, but it's a really great test if you, if you have the bandwidth for it. So, um, the organic acids test looks at a variety of different things. It looks at fat burning, meaning can you burn fat or not? Oops. You know, some people can't burn fat, like this patient here. Um, carbohydrate metabolism. That's, you know, blood sugar regulation. Energy production for people who have fatigue all the time. And in fact, you can see on this patient, um, oh gosh, this is bad news. Look at this. So on this organic acid profile, you see all these markers are low in here. That whole section is low. So that means this person can't burn fat. Carbohydrates make them tired. And their energy production levels are low. So they're going to have a lot of body fat and be tired all the time. And this is what we call a hypometabolism. It's something you really got to fix. So anyway, organic profiles are important for that energy, fat burning, carb burning. They also look at B vitamins. You can see they test for methylation, B12 and folate. There's markers here for B6 and biotin. Whole bunch of B vitamin things. They also look at neurotransmitter markers. So not the neurotransmitters themselves, but the urinary byproducts of the neurotransmitters are expressed right here. And then, and the second part of this neurotransmitter section here are the inflammatory markers that would mean that your brain is inflamed. And you could have depression or anxiety or compulsive overeating because of the inflammation in other parts of your body that's damaging the brain cells. Again, you can have stress-related brain markers here for serotonin or dopamine, or you can have the inflammatory markers present.
And then one of my favorite markers on this test and favorite markers of all time, and really should be everybody's favorite marker, is right here. And that is, um, usually abbreviated as 8-OHDG. 8-OHDG, or if you want to say it the fancy way, it is 8-hydroxy-2-deoxyguanosine, something like that. So anyways, 8-OHDG is a marker for oxidative stress. Oxidative stress puts you at high risk for cancer, heart disease, diabetes, inflammatory conditions, autoimmune diseases, you name it. So 8-OHDG, critical marker to check on people. You want to know what your oxidative stress levels are like. There it is, right there. I personally think the $300 to $400 cost of this test is worth it just for this one marker. This is really important. Right? Oxidative stress is at the heart of all chronic degenerative diseases that we suffer from in, uh, in our modern world. It's diabetes, cancer, and heart disease. It's an important marker. Uh, organic acid profile also looks at liver detoxification pathways. We can see how well your liver is getting rid of stuff. You can look at glutathione levels and other detox pathways in phase two. It has a sweeping section here on bacterial and yeast overgrowth in the gut. So can't say enough good things about organic acids. Great test.
And then if that's not enough, and you want to just go crazy easy, and you can afford it, because this is expensive, you can do an Ion panel. So the Ion panel, I just imagine, I mean, I'm kind of making this up, but I just imagine that one day they were sitting around the lab and someone said, okay, let's just make like the best test. And we forget about what it costs. And, you know, we're just going to like put everything on one panel. That's basically what the Ion panel is. It's just everything you could imagine on a test. And usually these tests that I'm about to summarize in the Ion panel, ordered separately. But you can order it all as one big fancy panel. And, um, you know, I have some patients that'll do an Ion panel once a year. You know, if you can afford it, what the heck? It's probably cost about as much as buying a new set of tires for a fancy car. It's not that expensive. But, um, you know, it's, it's incredible technology. So the Ion panel looks at all the amino acids. Can you believe that? So I mean, there's just pages of information. These are the building blocks of all your proteins, right? These are really important. So lays out all your aminos in beautiful black and white. It checks for homocysteine, which is implied in many different disease processes. It looks at these various nutrient elements, the minerals like magnesium and calcium and zinc and potassium. It looks at the toxic metals, the bad ones, cadmium, lead, and mercury. Can see those. It looks at really great nutrients, uh, like CoQ10 levels, different fatty acids, vitamins like vitamin E, vitamin A, beta-carotene. It again looks at, um, here's our favorite marker from the other test that I mentioned, 8-OHDG. Okay, it's showing up again here as well. Great marker for oxidative stress. It checks your vitamin D levels. Like I said, this is going to go on for a while. Okay, this is a lot of information on this report. It checks your fatty acid levels. Man, that is so important. You could, you could talk for hours just about fatty acids. I mean, that's pretty mission critical for normal human physiology. Um, looks at saturated fats and all the odd chain fats and all this kind of stuff. And then it has within it an organic acids profile as part of the panel. So in addition to all these other things, you've got what we just talked about on the organics. And then it just keeps going on. Here's the rest of the organics profile. And then they do these summaries, basically, of the various systems that they're analyzing. So cardio for fatigue, metabolic syndrome risk factors, that's, you know, for people gaining weight or pre-diabetic. Uh, mental emotional stress factors. They summarize. They look at the GI microbial balance, intestinal yeast absorption capacity, toxin exposure, detox impairment, antioxidant levels, again, mitochondrial. And these are just summaries. Fatty acid insufficiencies, methyl group problems, tryptophan metabolism, that would have to do with your serotonin and brain function. And then this whole other big section on, um, you know, it's like a summary of what they think you need supplement-wise. So anyways, that's the, that's the kind of mother of all tests here, the Ion panel. It has just so many different variables. It's hard to even imagine. It is a little expensive, though. Most people can't afford that. So we don't order that all the time. Um, I guess you would order that if you really wanted the information and you could afford it. Um, um, but, you know, we definitely want to be circumspect and careful about what you don't want to overtest. Okay? I mean, and it's not always necessary to do every test. So we want to be, you know, not choosy, but, you know, we want to select and do testing that as it's appropriate for certain people and not overdo it.
And, you know, I'll tell you a little story when I, about about 15 years ago, um, I was working with one of the wealthiest families in the world. Um, this family owns, you know, huge percentages of this whole planet. And so, you know, for them, and it was the mom, the dad, and two kids. For them, $5, $10, $15, $20,000 was an insignificant amount of money. Um, and so I was a pretty young doctor at the time. And and I thought, well, I mean, they don't really care what this stuff costs. Why don't we just do every test on every one of these family members? And how, wasn't trying to rip them off, I wasn't trying to be exploitive. I just thought, well, we got the opportunity, why don't we do that? And, you know, what ended up happening? It really blew up in my face because it was just too much information for everybody. It was too much information for me. It was too much information for them. We just overdid it. So I'm really, I really try to be careful about what tests we order and to order what we have to order at the right time. I think that's part of the art of doing this job. It's not just to order every test on everybody, but to figure out what are the essential components and where do we really want to start. And yes, we could escalate more, you know, do more testing later if we need to. But let's try to, you know, and not, like I said, not from a budgetary standpoint. Even if you have unlimited funds, is you can still end up getting too much information on people and it's overwhelming. And people just, you know, they don't know what to make of it.
You can also do food allergy testing. And, uh, these are usually done from either a blood spot or a blood draw. And you can test all the different foods you may be allergic to, whether it may be egg or milk or peanuts. In this example, you can see almonds and mustard and strawberries. Bummer if you're allergic to strawberries. So that's another test. And a lot of people have food allergies. That can be a big problem. Sometimes we want to address food allergies as well.
And then I'll show you. There's a couple of different, uh, versions here of the stool testing. I'm going to show you some samples. That is not it. Sorry. That's I opened up so many files. I got kind of overly excited when I was preparing for this. Let's see if I can find a, hang on a second. Sorry. I saw one a second ago. I'll find it here. Oh, there we go. This is a good example right here. So this is a standard stool test that we order frequently, a GI pathogen with H. pylori. So it looks for parasites, bacteria, and yeast. This one is normal. And these are really helpful. And this is old school microbiology, right? Where they look under a microscope at bugs, try to find them. And, you know, a lot of things have changed over the years. And there's new technologies. The new technology on the stool testing, I still run both of these kinds of tests depending on the patient and the circumstances. But the new kind of stool testing technology is called a GI-MAP test. And this is done from, it's a stool sample, but it's a single stool sample. And they run the DNA for the organisms. So what that means is that, um, it's just exactly like what what happened at a crime scene, right? And you've seen this on TV a million times where, you know, someone gets murdered and then they find a, you know, a hair in the bathtub or something, or a hair in the back of the car. And they, they always say, okay, take that to the DNA lab and run the DNA on that hair and we'll figure out who the murderer is. So, um, the, the same, same exact technology. You take a, a human hair and you run it through DNA and you can tell pretty much who the person is, right? So they can run DNA for parasites. Who would have thought? What a clever idea. So basically, they take the stool sample, they amplify the DNA in the stool sample. And if you have H. pylori, it's just like a crime lab, right? They just say, oh, you have H. pylori, that's your problem. And so pretty straightforward. Um, those tests are, they've been around for a while in different kind of incarnations. And, um, certainly become one of my favorites to do. And the stool testing, uh, you know, based on PCR or, uh, the DNA test looks for various parasites. You can see like Crypto, E. coli, Giardia. They look for H. pylori, various bacteria that can cause autoimmune type illnesses. And then they have a really great, uh, section on yeast and fungal organisms. They also look for secretory IgA, which is the immune response in the gut. Calprotectin, which is a marker for gluten sensitivity. Elastase-1, which is a pancreatic enzyme marker, see if you need enzymes. Lactoferrin, which is an inflammatory marker. So it's a nice comprehensive test. And again, sometimes the PCR technology is better, sometimes the standard stool testing is better, sometimes we do them both depending on where the person is at.
And I can show you a couple other examples. You can just see what they look like. These are actually real labs of mine where the names have just been blanked out. So you can see like this patient here, it's a pretty recent patient. Citrobacter and Klebsiella, those are two bacteria that are autoimmune triggers potentially. And she had Dientamoeba fragilis and Endolimax nana, which are two parasites. And a Candida overgrowth. Ouch. That's a lot of gut stuff going on. And that's going to of course, you know, ricochet around the body and cause all different kinds of problems. So those are the basic tests we do. Hormone evaluations, as I mentioned, estrogen, progesterone, testosterone. We do melatonin, cortisol, DHEA. You can do month-long panels, day-long panels. You can do salivary or urine. Bunch of options there. On the stool testing or the GI testing, or the PCR test, which you can see right here for GI testing. You can also do food allergies. For GI testing, you can also do, uh, let me show you here. Remember, part of the organics profile includes, oh, here's a good one. Oh, there's a really good example of an adrenal profile. See this one here? Look how high the cortisol in the morning is. 82. Yikes. Supposed to be around a 20. So that's someone who's cranking out tons of cortisol. Tons of cortisol. That does not feel good. Okay. Um, here's another little test. Okay. And then on the organics profile, in, in addition to looking for bugs on the stool, the organics profile, the latter part of it here has this whole compounds of bacterial or yeast or fungal origin. And then it has a yeast marker down at the bottom here too. So you got a lot of GI information on there.
And then I'll just show you one more time as a little reminder here. The Ion panel is the like everything under the sun and then some panel. And I'll just show you by section that might be the easiest way rather than, uh, I skip through all the graphs part. I'll just show you the end. You can see that things are actually tracking. They're looking for cardiovascular function by measuring things like homocysteine and antioxidant levels and magnesium, all the things that are important for your heart. They're measuring for fatigue based on looking at energy production, fat burning. They're looking at risk factors for metabolic syndrome or, um, pre-diabetes, those kinds of problems. They're looking at emotional stress variables through a combination of different things. They're looking at bacterial overgrowth, yeast overgrowth, absorptive capacity of the gut, toxin exposure. And the nice thing about this test too, is you get to see things like mercury and aluminum and cadmium and all these different levels. Okay. And you can see how toxic the person is. And then whether they can detox well or not, as well as oxidative stress, mitochondria, acids, essential fatty acids, and then methyl groups. So that one's complicated, like I said earlier. Sometimes it's too much information. And we want to keep things simple. Um, I do have a few patients who who order that test once a year, you know, and they just want to know what their overall nutritional status is like. And they can afford, afford the money to to spend on it. I don't know the exact cost of it these days. I haven't looked it up recently, but, you know, it's a grand or two to do this whole panel. It's pretty pricey. So most people don't end up doing it. And we don't even suggest it unless there's some extreme reason for it.
But I do like to run some kind of hormone evaluation, some GI workups if we need to. Not everybody needs a GI, but we do it if we need to. And then organic acids. And then depending on the patient's age too, like if it's a child, we might just run an organic acids only. Um, or we just had a two-year-old kid the other day with tummy problems, just running some GI testing to see. Um, we have a teenager right now also with GI problems. We're not going to test his hormones. He's like 15 years old. And he, he wouldn't take anything anyways, even if we wanted to try to balance him out. So we just ended up doing, uh, you know, the GI testing only on him. Turned out he had H. pylori. Kids are already better now. So, you know, we try to gauge where the patient is at and then figure out how the testing should work from there. And that's the basic, you know, gist of it.
And then, um, what Mark and I both try to do together is figure out lifestyle changes. Um, how to make sure that, you know, people are eating well and figuring out how to sleep well. And they're, um, you know, able to take breaks and and get good quality exercise. And all the lifestyle factors that go into creating a healthy body. Okay. So those are the basics on the labs. Hormones, GI including pathogens and foods. Hormones include sex hormones, sleep hormones, stress hormones, etc. Organic acids testing, which looks at energy production, fat burning, toxins, um, looks at oxidative stress, B vitamin markers. There's a lot of ways you can interpret these organic acids profiles. You can just look at nutrient deficiency syndromes. Sometimes you can see genetic issues that'll show up on the test when some of these numbers are really far off. Gives you a lot of insight. And then the deluxe panel, if you will, of, you know, would be the Ion test.
And so, um, you can look on the website for our current charges. But it's pretty straightforward. We have a new patient fee for that first hour when you're connecting with Mark and getting everything going. And then I just charge for my time. Once the labs come in, and we get on the phone and talk about what's happening, um, or get on Skype if you're International. You know, you just bill my hourly rate for my time. We spend an hour, you get billed for an hour. You spend a half an hour, you get billed for a half an hour. And then I do like to follow up with people, obviously. Once we do the lab interpretation, I usually talk to patients about every two months is probably about average, um, for 20, 30 minutes, something like that, as a follow-up until we, you know, all the way through the programs. Some people need more attention, some people need less. But I'd say on average, we talk to our patients around every two months in the beginning. And then as people progress and they get healthier and they need less help, you know, we end up going to probably, uh, once a year follow-up for my long-term maintenance patients. I have some patients that have been with me for 20 years, you know, we fixed a problem 20 years ago and they want to stay healthy. And so they stay engaged and they do, you know, a yearly adrenal test or a yearly GI test or whatever their main issue is so that we can keep them healthy.
And, um, my idea is that, you know, there's certain patients that come in, they just want to get fixed and the problem goes away and we don't hear from them again, which is fine. There's other patients who we help and then they want to stick around because they see the benefit in some kind of ongoing yearly check-in. And I really enjoy the yearly check-in patients a lot. Is people I've gotten to know quite well over the years. And, um, it's nice to see people's health stay steady. I was talking to this one patient this week. She's in her 70s. And as long as she can ski for three or four hours a day, she feels like she's really healthy. I love her. And, uh, it's like, great, you're skiing. She's like, yeah, I'm skiing. Like, okay, I guess you're healthy this year. Let's check that box off, you know. And, you know, our agreement is if there's a year where she can't ski three or four hours every day, then, you know, we're going to get a little more aggressive about treating her. And right now, I put on our super minimal maintenance program. So it's fun to work with people on a wellness level. People like the 15-year-old kid with a stomach problem, I'll probably never hear from him again, hopefully. You know, so some people come in and out and we don't really have much follow-up. And then other people stick around sometimes for years. Um, I don't, you know, I like fixing problems that are present. And then I also like developing the long-term relationships with patients. So I'm kind of happy either way. And we have plenty of patients, you know, coming. So we're not, um, trying to hold on to people or anything like that. But the people that want to stay, it's really nice to develop more long-term relationships with. And I have a lot of patients that come back after five years or six years, and they've, you know, had a baby and now they're tired again and they want to figure out what to do. And it's a really nice kind of practice that we have. I really enjoy it quite a bit.
So I, I practice, you know, two, two and a half days a week typically. Uh, I don't take a lot of vacations. We're usually around, you know, I have a lot of teaching schedules I have to follow. So sometimes I'm out of town teaching. Um, this year I'm going to be doing a lot of international travel and teaching. But, um, you know, in general, we have a pretty active and lively little clinic. So if you guys are curious about working with me, you can go get more information on the website. I'll show you what the website is. It's Kishwellness.com. And you can go into, uh, Services, client consultations, and see how it works to become a new patient. As long as you're near a telephone or near Skype, you know, we can work together. We do have people all over the world that are doing this stuff, which is great.
And let's see if there's a couple of questions. Um, oh, Linda asked, do you use the NutraVal or SpectraCell lab tests, or do the tests you use cover all of that? Well, enough so. Yes, the tests that I use cover pretty much everything that I need. The NutraVal and the SpectraCell, we don't use, usually do not go against those tests, but I feel like I'm more, I'm more comfortable with the ones that I use in terms of their accuracy and reliability and whatnot. Okay. All right. If you have more questions, feel free to email the office. We'll be happy to get back to you all. And have a great rest of your evening. I'm kind of keep it short tonight. Oh, but one last announcement before you go is we are, or I am going to be doing a series of webinars, patient education webinars. So we've got all the topics lined up and we'll start to fire out some dates for you. That'll be, you know, specific educational classes for the year. Okay. Have a great rest of your evening, everyone. Thanks for joining us. All right. Bye for now.