Hello,
I appreciate the opportunity to meet with you so we can assess if we are both good fits for working together. This letter is designed to prepare you for your Discovery Session, and provide you with some information about how I work, the tools I use, the intake process, and the labs I often use so that our time during the Discovery Session is more efficient.
I use a combination of a detailed intake process (an excel file with 10 tabs and hundreds of inputs), genetic data/analysis, and specific labs together in an integrated approach to bring the picture of what is happening physiologically into focus. The intake process is designed to take in all the context / nuance – while the genetics and labs give me extensive objective data - to try and understand the set of issues a person in play.
A. The Intake Process
The intake file consists of 10 tabs, and each is designed to provide me clues of how you arrived to where you are today, and what may be involved in being unwell. I also ask you to provide a written case history in an email or word document so I can have more context to your history.
1. Symptom Scoring (frequency and severity): for over 300 specific symptomologies
2. Family History - what has been present in your lineage may provide clues
3. Summary of Diagnosis - helps provide me with a timeline of what has happened in what order
4. Diet - summary of what has worked, not worked. What you react to also provides clues
5. Goals - helps me understand what you want to get accomplished and what is most important to you
6. Toxic / Infectious Exposures - very helpful to understand what your body has dealt with and what may still be being dealt with and what additional testing may be indicated.
7. What Has Helped / Not Helped - I rely on as objective information as much as possible (genetics, labs) , but specific responses to specific interventions when interpreted through the lens of biochemical pathways can often be a reliable way to understand and confirm where and why your physiology may be stuck.
8. Implementation Priorities - this helps me balance things like cost, simplicity of protocol, convenience, and reactivity - to understand if you are suited for blends, individual supplements, or need filler free brands.
9. Current Supplements - helps me understand what you are currently taking. Sometimes the best first step is removal and simplification of things.
10. Agreements - what we both agree to do to support each other in this work together.
B. Genetic Data and Analysis
1. I primarily use Functional Genomic Analysis as a software platform for genetic analysis and supplement with some other specialty resources like Genetic Life Hacks and others as needed.
2. The data sets I typically use and request clients to get are: both the FGS (Functional Genomic Analysis) Genetic Test Kit $319 (practitioner order only) and 23andme Genetic Test Kit - Ancestry Service Only, $49-119. Combined I can see about 2,000 genes across 125,000+ locations. The FGA kit gives me about 90% of what I need.
3. I can also use data sets from Ancestry, Heritage, etc but they don’t provide the coverage the above 2 do, but if you have them available I can use them as complementary pieces.
4. I can take Whole Genome Sequencing data that you have converted into txt files - and these are often good enough without a need to having the kits for Functional Genomic Analysis and 23andme combined data sets. To date this usually yields around 2,000 genes across 55,000 locations (45% of what the 2 above kits provide).
C. Labs - Below are the labs i most commonly use
Usually most people already have some subset of these labs, so if there is consistency, there may not need to be repeat testing for these labs done in the near term. Different labs are often done at different phases of recovery as well. Most clients require a small subset of the below based on the issues in play.
1. MicroNutrient Panels - Vibrant America, Genova Nutreval, Spectracell - provide a solid base of information related to vitamins, mineral, amino acid, fatty acid, and anti oxidant status. My favorite is Vibrant America, $500. Blood draw is required, available in US only.
2. Hair Mineral / Heavy Metals Testing - Doctors Data has an excellent one, available through vendors on amazon, for $140. Provides a supplemental view of minerals and heavy metals that complements the MicroNutrient Panels well.
3. Organic Acids, $270, urine sample. Important gut markers, like clostridia, candida, and fungal/mold. Also covers metabolic markers for the Krebs Cycle, Fatty Acid Oxidation, Neurotransmitters, Oxidative Stress, and some functional nutritional markers for : B1, B2, B5, B7, B12, Vit C, CoQ10, NAC. Can be part of Vibrant’s Bundles (3 for $700, or 5 for $1,000).
4. Vibrant America Oxidative Stress Panel - 16 biomarkers across various types of oxidative and reactive radicals: prostaglandins, aldehydes, lipid peroxidation, hydroxyl radicals, nitrative radicals, DNA damage markers, protein oxidation, and advanced glycation end products. A few supplemental genetic markers are also provided. $500 stand alone, urine and saliva sample required. Can be part of Vibrant’s Bundles (which result in ~40% savings).
5. Stool Testing: A variety of good stool tests are available, my preferences are the detailed data behind the Thorne Gut Health Test $199 self order from Thorne Website, or Vibrant Americas Gut Zoomer, $500 stand alone, or available in Vibrant Bundles. Genova, GI MAP 360 also have offerings here, although I find them less robust. Specialty tests by Doctors Data, and Parawellness Research (parasites) are sometimes considered.
6. Toxin Panels (Mycotoxins, Environmental/Chemicals, Heavy Metals, PFAS); available in Vibrant Bundles
a. Mycotoxins / Mold - Commonly clients test positive for mold exposure, and various chemical exposures that have not been resolved. These are urine tests and can be bundled or ordered separately. Vibrant’s Mycotoxin test has 36 specific markers, which outpaces Mosaic (12) and Realtime (13), and provides more value from my view.
b. The chemicals panel by Vibrant is unique and covers things others from Mosaic do not - specifically like DDT that I see high in folks with regular/high seafood intake or marijuana handling/use.
c. Heavy metals is an inexpensive add-on at $60. All are urine based, and included as part of Vibrant’s bundled offerings.
d. PFAS – a new and unique offering from Vibrant that covers all the forever chemicals.
7. Neurotransmitter Tests - I like Vibrant America's, it has 25+ markers for things like tryptophan and, 5htp, serotonin, gaba, glutamate, phenylalinine, tyrosine, dopamine, dopac, epinephrine, serine, taurine, glycine, etc.
8. Infection Panels - Lyme, co-infections (HHV-6, Cytomegalovirus, HSV1, HSV2, Mycoplasma, etc)
9. Cytokine Panels - i like Cyto Dx here which helps assess how active the inflammatory cascades and immune response are in driving inflammatory cascades. IL-1B, IL-2, IL-5, IL-6, IL-8, IL-10, IL-13, TNFA, NFKB, SCD40L, Rantes, CCL3, CLL4, INFG. Blood Draw, around $260.
10. Amino Acid Panels (Urine and Plasma) - often helpful in long term chronic illness to profile what amino acids are being over consumed from specific metabolic states associated with chronic illness. I can see ammonia issues, M1 phenotype metabolics, conversion issues, and sulfur related issues here.
11. Food Sensitivity Panels - there are two basic types here - water soluble protein testing, and water + fat soluble protein testing. The inexpensive IgG, IgE testing typically covers 100's of foods but only for water soluble proteins (Vibrant, Mosaic, etc) - while Vibrant’s Food Zoomer testing covers both.
12. NAD Testing: Jinfinity offers intracellular NAD Testing ($200), while US Biotek offers plasma NAD+, NADP, NADH, NADPH, and associated ratios ($140).
13. Iron Panels: Serum Iron, Iron Saturation, Ferritin, Ceruloplasmin, Intracellular Iron (available on Vibrant's MicroNutrient Panel). Excess unbound iron or iron handling issues result in Hydroxyl Radical Formation. Few people understand the basics of how iron is used and transported: In Gi tract to serum blood, then from serum blood across the cell membrane inside the cell – the cytoplasm (intracellular iron – seldom measured), and then once inside the cell there are only two ways for iron to get inside the mitochondria where most of it ends up going in the end for hemoglobin, co factors (iron sulfur cluster), Kreb Cycle, and the Mitochondrial Electron Transport Chain. In the cytoplasm, inside the cell, there is only one exit door back to serum blood – the regulation of this exit door is critical so excess iron doesn’t build up in the cell and cause oxidative stress.
14. Miscellaneous: CBC, CMP, HS-CRP, Homocysteine, GGT, LDH (pyroptosis marker along with IL-1B, IL-18)
a. SDMA/ADMA - $20 blood draw, explores if arginine mis handling is present (NOS Uncoupling).
b. MPO, PLA2 - $40 blood draw, proceed the prostaglandin pathways – linked to mast cell activation.
15. Vibrant’s Neural Zoomer – important markers for specific anti bodies that provide clues to neuronal excitation issues, and also a host of infection markers. Available in bundles.
16. Vibrant’s Hormone Zoomer – comprehensive assessment of hormones. Available in bundles.
17. Immune Panels - various ones from 10 markers to 95
18. Porphyrins Testing (Heme Pathway) – both blood, and urine (more appropriate most of the time).
Any many more specialty tests as needed (Mitoswab, Ceramides, etc) , but the above form a good basic menu to pick from to get started – and the genetics and symptoms provide a good roadmap where to begin the testing.
D. The Integration of the Intake Process, Genetic Analysis, and Laboratory Findings:
It is the integrated approach across the intake process, genetics, and labs that provides me high confidence in terms of understanding what is happening physiologically. The work is detailed across dozens of pathway maps and hundreds of genes in some of these pathway maps. The nutritional assessment helps see what important cofactors may be missing, metabolic states that over / under consume some nutrients, and potential absorption / transport issues (either genetic or gut impairment or both). Specific genetics combined with symptoms can point me to validating what may be happening with labs. In reality, most people who find me already have some genetic data (23andme, ancestry, etc) and some labs, and these combined with the intake information already point to some things to get tested. During our first in depth session - i will explain to you what the existing data is suggesting, and what tests would be of highest value to order next. Some folks would like to have a 'complete' set of data before we begin our work together - and i certainly support some of the basics: Genetic Data, Nutritional Status (Micronutrient Panels, Gut Panel, Organic Acids, CBC, CMP, Iron, Etc), but what is next is largely individual and informed by the intake process (history, exposures, what has / has not helped, etc) , genetics, and existing labs. You are welcome to schedule a brief session to order labs (15 mins) or genetics before we begin our real in depth work. I will also order labs and genetics during discovery sessions if we have time - and we have both decided to move forward in working together.
The basics of how I work with genetics and labs in a very simplified view is described next. Imagine an enzyme/gene – it turns compound A into compound B. It requires cofactors (e.g. B6 and iron) while also using cysteine residues in its structure to function. The gene can be inhibited / compromised in various ways: genetic mutations, lack of one or more of its cofactors, and ‘contaminants’ that effect its performance – typically through degradation of its structure, in this case, lets say cysteine residues. We can test metabolites before and after this gene, to assess its level of function. In this example, if its functioning at 50% of normal capacity – then the question is why ? Genetic compromise, lack of cofactors, reduced ability to produce cysteine residues, or specific contaminants that degrade its structure. Its pretty common knowledge how to find genetic information , and pretty easy to assess nutritional status, but most practitioners do neither. The final and most important piece is the structural integrity and contaminants – which requires the practitioner to understand the enzymes structure and what it is vulnerable to in terms of contaminants. Hypothetically, what if the enzyme was vulnerable to certain compounds that are supposed to be ‘cleaned up’ by other enzymes or the person has certain mutations that cause the person to produce more of the specific contaminants (genetic upregulations). And what if the person had reduced ability to produce and protect cysteine residues. I use dozens of pathway maps to see how systems functions and look at specific issues at specific points – using labs to validate the pathways level of functioning. Multiple this by 2,000 – this is the nature of how I work and investigate what are people’s inherent systemic weaknesses across systems – their own personal kryptonite.
Client / Practitioner Fit
I encourage you to read the FAQ’s tab on my website. In complex chronic illness – I won’t fight the complex illness and the client. The complex illness is enough to deal with – I won’t arm wrestle with clients – if that’s what happens – they simply get removed from my practice.
I also want to speak to a somewhat toxic dynamic in the world of complex chronic illness. One where on the practitioner side – many make claims of miracle cures, promises from their secret protocol, enrollment into their supplement subscription plan, and high end ‘treatments’. Many of these people found their way into this arena – to make money, not to help people. They are entrepreneurs, you tuber’s, social media proliferators, who are using chronic illness as their arena. My intent is simple – find out what is wrong and get you better. I don’t mark up labs, supplements, nor promote anybody or anything. I keep it simple and clean. I give you my best honest effort, in exchange for your payment for my services. It’s a basic clean energy exchange. Narcissism takes all shapes and forms (grandiosity, entitlement, shaming, self absorption, self importance, etc) and it exists in both the practitioner and patient population – it will be removed from my practice.
On the client/patient side, many have accumulated emotional, financial and physical trauma – and this has led some to become resentful, jaded, entitled, and even manipulative themselves after being victimized. My expectations for clients are that you come with an intent to heal, an intent to provide valuable input and feedback, and an intent to do your best to follow the plan that we develop together. If you intend to send me emails requesting free treatment advice – either subtly or directly, please move on – just because you have been misled or mistreated by others doesn’t mean you are entitled to free services from me. Its simple, you pay for my time, and I am sorry if you have been taken advantage of by other practitioners. You will be removed from my practice if this occurs. Clients who travel to Italy, Germany, New Zealand, Japan, yet tell me its too much to take 3 doses of supplements per day are removed. Life is too short, and a healthy vibrant life even shorter – I won’t invest in clients like this. I won’t fight both the client and the complex illness.
If you are somebody who wishes to use your social media profile, or followers, or community as leverage – please move on; you will be removed. I have had people contact me and directly and indirectly ask for free services in exchange for recommending me to their followers, or promoting me, etc. I don’t ask for referrals. I don’t offer discounts if you refer people to me. I don’t believe in that way of doing business.
It is common that clients come with some practitioners already on their team. It can be helpful to have a team that has specialties in certain areas that are directly relevant to the issues in play. And it can also make treatment more difficult. Inevitably, different practitioners, have different training and skills, different patient populations, and different experiences and observations, as well as belief systems. If a client is taking 4 items to solve problem a, and also taking 4 items to solve problem b, if these items are pulling against each other forward progress is compromised. I don’t oppose multi practitioner teams unilaterally – and it can make treatment more complicated. Sometimes things are best resolved in steps – so that the client is not asked to do things that oppose each other. Getting clarity on how I fit into a multi-practitioner team up front is very helpful in terms of my role, expectations, etc. If you just want me as an alternative voice, to look at genetics, or assess something specific - that is something i can certainly do - as opposed to lead the treatment plan. Alignment up front saves alot of time and frustration for both parties.
Our Discovery Session
I view our discovery session as one where i am investing time and energy into you to understand your history, case, and you as a person to see if i think we are a good fit with how i work and how you like to work with practitioners. I expect you to do the same. Ask me questions about how i work, the tools, analysis and approaches i use. I won’t give treatment or testing advice during these Discovery Sessions - but will certainly speak to the generalities of cases / issues in terms of what i will be looking to understand. I have decided to lengthen these discovery sessions from 30 minutes to 60 minutes – to better represent the effort and time needed to understand each other, our goals, our intent.