Archive for the ‘Medical Issues’ Category

Genomind

Genetic Testing

Genomind

 

The Genecept Assay Test Panel at a Glance

Pharmacodynamic

GENE PHYSIOLOGICAL ROLE IMPACT OF MUTATION TREATMENT IMPACT
Serotonin Transporter
(SLC6A4)
Protein responsible for reuptake of serotonin from the synapse Inhibition of this protein by SSRIs,
which may lead to increased risk for non-response/side effects
Use caution with SSRIs; atypical antidepressants or SNRIs may be used if clinically indicated
Calcium Channel
(CACNA1C)
A subunit of the calcium channel which mediates excitatory signaling Associated with conditions characterized
by mood instability/lability
Atypical antipsychotics, mood stabilizers, and/or
omega-3 fatty acids, which may help to reduce excitatory signaling, may be used if clinically indicated
Sodium Channel
(ANK3)
Protein that plays a role in sodium channel function and regulation of excitatory signaling Associated with conditions characterized
by mood instability/lability
Mood stabilizers and/or omega-3 fatty acids, which may help to reduce excitatory signaling, may be used if clinically indicated
Serotonin Receptor 2C
(5HT2C)
Receptor involved in regulation of satiety Blocked by atypical antipsychotics,
resulting in metabolic side effects
Use caution with atypical antipsychotics; inositol may be used to mitigate risk for weight gain if clinically indicated
Melanocortin 4 Receptor
(MC4R)
Receptor that plays a role in the control of food intake Increased risk for weight gain and higher BMI, which is exacerbated by atypical antipsychotics Use caution with atypical antipsychotics
Dopamine 2 Receptor
(DRD2)
Receptor affected by dopamine in the brain Blocked by antipsychotic medications and is associated with risk for non-response/side effects Use caution with antipsychotics
Catechol-O-Methyltransferase
(COMT)
Enzyme primarily responsible for the degradation of dopamine in the frontal lobes of the brain Altered dopamine states can have emotional/behavioral effects and impact response to dopaminergic agents Dopaminergic agents or TMS may be used if clinically indicated for Val/Val patientsUse caution with dopaminergic agents in
Met/Met patients
Alpha-2A Adrenergic Receptor
(ADRA2A)
Receptor involved in neurotransmitter release Associated with improved response to stimulant agents Stimulant agents may be used if clinically indicated
Methylenetetrahydrofolate Reductase
(MTHFR)
– A1298C
– C677T
Predominant enzyme that converts folic acid/folate to its active form (methylfolate) needed for synthesis of serotonin, dopamine, and norepinephrine Associated with varied activity and conversion of folic acid/folate to methylfolate Supplementation with L-methylfolate may be used if clinically indicated
Brain-derived
Neurotrophic Factor
(BDNF)
Important for proper neuronal development and neural plasticity Impaired BDNF secretion, which may be associated with altered SSRI response in Caucasians Increased physical activity/exercise may be beneficial for Met carriers if clinically indicated
μ-Opioid Receptor
(OPRM1)
Opioid receptor affected by natural and synthetic compounds Activated by opioids and associated with varied analgesic response, dosage, and abuse/addiction risk Use caution with opioids; non-opioid analgesics may be used if clinically indicated
Glutamate Receptor
(GRIK1)
An excitatory neurotransmitter receptor in the brain Associated with response to topiramate for alcohol abuse Topiramate may be used for treatment of alcohol abuse if clinically indicated

 

Pharmacokinetic

GENE PHYSIOLOGICAL ROLE IMPACT OF MUTATION TREATMENT IMPACT
CYP450
(CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5)
Enzymes that metabolize medications in the liver Large number of psychiatric medications are metabolized by CYP450s Dose adjustment (an increase or decrease) may be required

 

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Cleveland Heart Labs

Learn More about the comprehensive labwork Dr. Jones recommends for our patients!

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Eat Fat Get Thin

“Everyone seems to be talking about fat these days. That fat somehow is good now and can help with weight loss and disease prevention.  How can that be true when for decades we all were told that fat was the bad guy?” asks this week’s house call. “What are its benefits? Are there any downsides to eating more fat?”

To see full article visit: http://drhyman.com/blog/2015/12/27/separating-fat-from-fiction-10-fat-facts-you-need-to-know/

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Perlmutter’s Guide to the Glycemic Index

Perlmutter’s Guide to the Glycemic Index

Whether you are sick, well, overweight, metabolically compromised, experiencing brain issues, or just want to preserve your mental wellbeing, understand that the Glycemic Index plays a pivotal role.  Choose foods with a lower GI while making sure they are gluten-free. This will maintain healthy levels of blood sugar and insulin. These are the keys to enhancing general health as well as brain health and function.

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Management of Stomach Pain Associated with Medication

Question: I have bad stomach pain after taking a drug for a bladder condition. I was also on Prozac, Elavil and Lorazepam at the time, for bladder and depression issues. I stopped the Prozac because I wanted to take less drugs, because now I also have to take Prevacid. So, currently I am taking Prevacid, Lorazepam, and Elavil (lowest dose of each) Would cymbalta work for me for the stomach pain? The doctors are calling it nonulcer dyspepsia.

— Ellen

Answer: I’m not clear about whether you are still on a med for a bladder condition, but I’m presuming not. Meds that effect the bladder usually also have some effects on the stomach. I’m guessing that the bladder condition is interstitial cystitis, but there are several other possibilities.

Prozac can result in stomach spasms and pain, either when first starting it or when going off. Tapering Prozac more slowly would help if that was the case. Starting it back would initially help and then tapering at 1-2/week would be less likely to cause problems. Cymbalta has been found to help with pain of various types, but Elavil also helps by similar mechanisms. Increasing the dose of Elavil should be tried before adding Cymbalta, which shouldn’t be mixed with Elavil (i.e., Elavil would best be tapered off before adding Cymbalta).

Make sure you find out what was causing the stomach pain. Sometimes the cause remains unclear in which case you need to monitor any possible related symptoms or changes and be periodically reevaluated.

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Treatment Options for Irritable Bowel Syndrome (IBS)

In long term management of Irritable Bowel Syndrome (IBS), diet is more important than medication. You need adequate fiber to maintain a soft, formed, moist, preferably daily bowel movement. Inadequate bowel motility causes constipated stool that irritates the bowel wall and causes colon spasms. Eating too large a meal (especially a fatty meal) causes spasms of the colon via the gastro colic reflex. Some people are intolerant of certain foods – milk products, wheat, and lettuce are common examples. Of course, good sleep, physical fitness and general stress management are essential to the management of IBS.
Muscle in the intestine is controlled by the autonomic nervous system and therefore doesn’t respond to the same relaxants as skeletal muscle. Some antidepressants – Paxil of the SSRI’s and the tricyclics have relaxation of the intestines as a potential side effect by blocking the parasympathetic system. Paxil may help IBS with predominantly diarrhea. Zoloft is more stimulating to the intestine and might help IBS with constipation. Medications that increase norepinephrine (Effexor, Cymbalta, and Wellbutrin) can also decrease intestinal bowel activity by activating the sympathetic nervous system. Both of these effects can decrease the spasms associated with IBS.
Intestinal muscle is especially sensitive to serotonin and medications that block a certain serotonin receptor (5HT3) are strong intestinal wall relaxants (Lotrinex and Zofran). Conversely IBS with predominantly constipation responds to the more recently available stimulant of a particular serotonin receptor (5HT4) called Zelnorm. Opiods Lomotil (Imodium) at the milder level, and Paregoric at the strongest level are powerful relaxants that are sometimes used for severe spasms of the colon. Anticholinergics (especially Levsin) work better for stomach spasms but have some relaxant effects for spasms of the colon. Levsin has the advantage of coming in a quickly acting sublingual (under the tongue) tablet.
Benzodiazepines that reduce general arousal and anxiety have an indirect effect on gastrointestinal muscle. The only one that may have more direct relaxant effect would be Klonopin (clonazepam) since it is the one that decreases serotonin release. Xanax is better for depression. Klonopin is best for obsessing and especially racing thoughts.

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Not Just Apples vs. Pears: Now It Is Metabolic Syndrome

Metabolic Syndrome was the headline issue at last week’s annual meeting of psychiatrists (APA). What is it? Do you fit the criteria? What can you do about it? What Is It? Metabolic Syndrome is common and it increases your risk of dying from a heart attack by 3 1/2 times. If you or a loved one meet the criteria you can do something about it. I’m sure I have been embarrassing people lately when I whip out my tape measure and measure their waist – at the level of the umbilicus. It turns out that abdominal fat is much more of a health problem (the apples) as opposed to hips and butt fat (pears) which has no increased heart risk. In fact, recently the big "booty" has been in fashion. But a waistline of 35" or more in women or 40" or more in men is one of the 5 criteria for Metabolic Syndrome. (If you have any 3 of the 5 criteria you get the diagnosis). The 2nd factor is increased blood pressure and the standard now is tougher, 130/80. If either systolic is >130 or diastolic is >80 you have elevated blood pressure. The other 3 criteria require a fasting blood test (8 hours with nothing but water). Fasting blood sugar should be 100 or less. Triglycerides should be less than 150 and good cholesterol (HDL) should be 40 or more in men and 50 or more in women. These tests are simple and inexpensive and everyone should know where they stand. A family history of any of these problems increases your risk. Metabolic Syndrome and Psychiatry Why are psychiatrists taking a lead role in expanding public awareness? It turns out that some of the medications we commonly use can increase the risk of any or all of these factors. Three commonly used antidepressants used long term can cause weight gain. Some antidepressants can increase blood pressure but most striking is the group of mood stabilizers called Atypicals. Some of these medications can seriously increase risk of weight gain, increase fasting sugar, increase triglycerides and increase bad cholesterol. A consensus panel including members from the American Psychiatric Association and Endocrinologists convened in November of 2004. They concluded that the medications Clozaril and Zyprexa have a significant risk of causing Metabolic Syndrome. Seroquel and Risperdal have a lesser risk and Geodon and Abilify have the lowest risk. But the FDA is cautioning doctors to screen for these problems and to monitor patients that are on any of the medications from this category. Doctors consider the benefits vs. risks of all the medications that we prescribe. Ironically the "Atypicals" are among our most useful medications. At higher doses they treat the most severe symptoms of mania and schizophrenia, but they are also used for refractory depression and anxiety disorders, including hair pulling and skin picking. In fact, they are the most versatile of any group of medications used for stress disorders. Although we can’t say with absolute certainty that some of these medications are a lot safer than others, the consensus panel and clinical experience strongly suggest that this is the case. It will take large comparison studies to prove it. What Can You Do About Metabolic Syndrome? If you meet criteria for Metabolic Syndrome and you are on one or more of these medications you shouldn’t just stop them. You may want to consider changing if you are on the higher risk medications. Or you may discuss with your physician some of the behavioral and medical options to help reduce your risk. Of course the main cause for the Metabolic Syndrome is our fast food, sedentary life style. Dieting is not the answer – I will address that issue in my next article. Heart disease is by far the most common cause of premature death in men and women. Even if it doesn’t kill you it will lower your quality of life. Don’t wait for your doctor to pull out his blood pressure cuff and measuring tape. Be proactive! Take action now to find out where you stand on all 5 criteria.


Metabolic Syndrome Criteria (If you answer “yes” to 3 or more of these questions you could be diagnosed with Metabolic Syndrome.) 1. Is your waistline 35" or more (for women) or 40" or more (for men)? (Measured at the belly button, not under the gut!) 2. Is your blood pressure above 130/80? (either systolic is >130 or diastolic is >80) 3. Is your fasting blood sugar above 100? 4. Are your triglycerides above 150? 5. Is your HDL cholesterol less than 40 (for men) or 50 (for women)?

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