Neuroveda Podcast for Complex Health

Dr Shae Datta, MD, is a Sports NeuroTrauma Neurologist and the current Director of Concussion & Neuro-Cognition at New York University, Long Island. Dr Datta specializes in helping people heal from brain injuries, especially including traumatic brain injuries and concussion (also called mTBI = mild traumatic brain injury). In this incredible episode, we wind our way first through the anatomy and physiology of the central nervous system, meaning the brain, spinal cord and associated microglia, astrocytes, relay neurons and the glymphatic clearance system of the CNS. Dr Datta then illuminates an understanding of the gut-brain axis with a special focus on psychbiotics, naming some of the specific types of probiotics that impact mood, cognition and the nervous system. She notes, ‘unhappy gut = unhappy brain’. The show returns to prognosis after brain injury and that every head injury is a unique story and very dependent on functional level, age, stress, co-morbidities, prior TBI and history of migraines. She reviews a bit of the TBI evaluation, which, barring a bleed in the head visible on CT, can often present with subtle findings regarding balance and ocular or vision changes that can potentially reflect outsized cognitive, sensory and/or motor challenges. We end the show with an exploration of a wide variety of treatments, some common (physical and occupational therapy) and some unique to Dr Datta’s integrative training: choline, creatine, vitamins and others. Learn more from Dr Datta from her co-authored chapter on TBI in the Integrative Neurology textbook in the Andrew Weil Series:  https://www.elliottbaybook.com/book/9780190051617 To see Dr Datta as a patient, find her at NYU Langone: https://nyulangone.org/doctors/1720493141/shae-datta

As the daughter of a public school teacher/administrator and an electrical engineer, who was also the commander of the local Black Panther Party, Nzinga was raised as an advocate who always knew she would become a doctor and a teacher. In medical school, her world was upended by a psychiatry rotation that drove her into mental health care within the context of social & political factors. Compassion, connection, and relationships drive health. Coming correct to substance use disorder treatment means bringing the compassion and resource we offer cancer patients and the biological, social, & cultural interventions we use to manage the lifelong chronic illness that is diabetes. We wouldn’t drop off a newly diagnosed diabetic who just spent 5 days in the ICU stabilizing their blood sugar into their old neighborhood without medication, education, and connection to ongoing care and social support because this doesn’t make any sense. Why do we do this with people suffering with substance use disorders?  With joy, humor incredible wisdom, and a take-no-prisoners attitude, Nzinga points out how perceptions of safety or threat (not necessarily present-day reality as intergenerational trauma informs current day perceptions) can drive behavior. We discuss ‘safety pie’ and how equity means the hungriest person gets the biggest piece and some people might not get any today because they had a lot yesterday and just don't really need it.  Nzinga pulled all of this brilliance together into the company she co-founded and serves as Chief Medical Officer, Eleanor Health, which offers wrap-around harm-reduction care for people with substance use disorders. Lest you think she’s an idealistic hippie, you have to know that in its first year open, Eleanor Health reduced hospitalizations by 85% for its served population- better than you find with any pharmaceutical.  Please listen to this show- the majority of us have people in our lives who have suffered or are suffering in various stages of substance use disorders. Learning how to come correct and that Eleanor Health is available in multiple states across the country is elemental for us to heal ourselves, each other and our communities. https://www.eleanorhealth.com/ http://www.nzingaharrisonmd.com/

Dr Sri Ganeshan, MD and physician scientist, dives into the weeds on folate and mitochondria Please note, even though we discuss folate doses in depth, we are NOT recommending that using folate in any form is right for you or your child. A podcast conversation is never a replacement for personalized and direct medical care.  Did you know mitochondria is involved in fighting viral infections including COVID? Listen all the way through to get this info!  It’s a soup-to-nuts discussion about the types of folate, functions of folate across the lifespan, location of receptors on the body, deficiency symptoms, genetics of folate (including MTHFR), and supplementation options (including oral and/or injectable). Dr Ganeshan then discusses the FRAT test (Folate Receptor Antibody Test) which is a blood test that evaluates autoimmune activity against the folate receptors, possibly interrupting folate uptake & usage, especially by the brain, which has been associated with neuroinflammatory conditions like autism and chronic infections. He discusses the role of dairy in triggering autoinflammatory conditions. Regarding mitochondria, Dr Ganeshan weaves around mitochondrial structure, numbers, locations, functions and dysfunction/ deficiency symptoms by complex in the electron transport chain (thyroid dysfunction, diabetes, cancer, schizophrenia, bipolar disorder, Parkinson's, Alzheimer's and others). Historically, mitochondrial disease that is severe has a genetic contribution and is found in childhood, but secondary dysfunction that may be environmentally triggered and found as mitochondrial dysfunction in children or adults. He discusses some of the subtle (aka vague) lab findings as well as the gold standards for mitochondrial evaluation (muscle biopsy and/or genetics). MitoSwab test per research is 85% as accurate as the much more invasive muscle biopsy and can be completed with a simple cheek swab and shipped in the mail for assessment. It can be used with children 2 years old and up. Finally, we review treatment options for supplements and the importance of protecting from light and oxygen to reduce oxidation.  We close with some interesting patient cases of children with autism and an adult with Parkinson's.  Put on your science hat! This is a fun, technical, ride through these two vital aspects of our metabolism.  Of note, Center for Healing Neurology does offer both FRAT & MitoSwab testing. Please schedule an appointment if you are interested in this testing. 

There's been so much upheaval in our social, political & physical world that it's timely to remember what determines our health, which is not necessarily what happens in the doctor's office. This was one of our first shows, originally released Jan 2, 2020, because the importance of talking about how our health flows (or doesn't) from our economic structure.  Dr Stephen Bezruchka, MD, MPH, teaches us that healthcare as an industry doesn’t inevitably result in a healthy population. In fact, despite spending the most money of any country in the world on healthcare, we are #36 in lifespan, just behind Chile. Dr Bezruchka peels down the layers of what creates population health, namely, how the health of a population is not just the health of many individuals together and dives deeply into the roles consumerism (including marketing, advertising and social media), and social and political structures have played in constructing our health crisis which can be summed by noting that only two counties in the world currently suffer from shortening lifespans: the US & Syria. Listen in to understand how we got here, why we are still here, how to ask the right questions, and some considerations (like nurse-new family partnerships) for changing our trajectory. Notes: · Book: Triumph of Injustice by Saez & Zucman: https://www.elliottbaybook.com/book/9781324002727 · Hawaii Department of Health Report on the Social Determinants of Health: https://health.hawaii.gov/chronic-disease/files/2013/12/CD_BurdenReport_FINAL.pdf · Bill Moyers article on the intentional consolidation of wealth which has driven economic inequality from 2011: https://www.thenation.com/article/how-wall-street-occupied-america/ · Books: The Spirit Level and The Inner Level both by · UN health of nations report and the “Health Olympics”: https://inequality.org/research/health-olympics-medals/ · The United Kingdom strategy for addressing loneliness & social disconnection:article: https://www.gov.uk/government/news/pm-launches-governments-first-loneliness-strategy; the actual report: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/750909/6.4882_DCMS_Loneliness_Strategy_web_Update.pdf · US Health in International Perspective: Shorter Lives, Poorer Health from January 2013: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2013/US-Health-International-Perspective/USHealth_Intl_PerspectiveRB.pdf

It's the right time to repost this incredible episode in which the beauty of Islam is beamed through the words and spirit of Sufi Imam Jamal Rahman. It was one of our opening podcasts on January 2, 2020 and is in the top 3 of my favorite podcasts we've ever produced. Listen in and heal.  From 1/2/2020:  Sufi Imam Jamal Rahman reveals insights from Rumi, Hafiz and other poets into the ways that Koranic verses can nourish personal, community, racial, economic and environmental healing. According to the Koran, a good life is built “50% of the visible and 50% of the invisible” meaning rooted in the work of the heart and the spirit. This can be supported by building in internal circle of love within oneself and/or an external authentic community centered in care for one another, trust in each other’s inherent vulnerability and common aspirations of truth and patience. Imam Rahman also shares practices to incorporate therapeutic silence, embracing emotions without attachment and having the moral courage to talk about where religion has gone astray. His perspective is deeply informed by his nearly two-decade long partnership in the Interfaith Amigos with Pastor Donald Mckenzie and Rabbi Ted Falcon. Find more about Imam Rahman from JamalRahman.com, InterfaithCommunitySanctuary.com, InterfaithAmigos.com and enjoy 50-60 short videos (2-6 minutes each) about Islam, Sufism, and various meditations on his YouTube channel at Call of Compassion Northwest by searching his name Jamal: https://www.youtube.com/results?search_query=call+of+compassion+nw+jamal

Dr Manish Butte, MD PhD, is a pediatrician & Division Chief of Immunology, Allergy & Rheumatology, and is also a surprisingly down-to-Earth kind of guy. In this show, he causally lays it all out there from the perspective of a scientist and compassionate clinician who works at the edges of what we know regarding genetics and rare diseases to give us a view of the whole playing field of immunology, including allergy, autoimmunity and infection (especially the post-infectious drive towards autoimmunity). We discuss Lyme, EBV (Epstein Barr Virus) and the ways in which the B cells & T cells function to mount, address & recede from their battle stations (did you know regulatory T cells even a part of the initial cytotoxic T cell response to infection?). Dr Butte then dives into the mechanobiology components of T cell activation (did you know stiff vs soft, aka swollen/edematous tissues vs non-traumatized tissue, trigger different T cell responses?) with some fascinating conjecture about the interaction between hypermobile tissues & T cell activity. We seem to end the conversation with a deep discussion about IVIG (IV immunoglobulin G) and rituximab which address aberrant antibodies but then truly finish with some discussion about the importance of immunogenetics and COVID antibody & T-cell evaluations. All in all, a fabulous show for which we are grateful for Dr Butte's generous participation. 

Neuropathy is dysfunction or damage (or both!) to the nerves and is a source for movement disorders as well as burning, tingling and numbness. It's a condition that can result from so many different triggers. Did you know ~40% of neuropathies remain 'idiopathic' in cause, meaning of unknown origin? In this podcast, MD Dan Olesnicky walks through them all. Step by step, he discusses the central vs peripheral nervous system (the peripheral being the end 'rootlets' of very small nerves that can enervate our hands and feet but also wrap around our gut and heart), and then goes into mono vs polyneuropathy. We talk about everything from mechanical compression to toxic insult to acute or chronic infection to hereditary sources for neuropathy. Then we talk about treatment options, including the innovative treatments he offers in his clinic that include stem cell and PRP (platelet rich protein) injections into nerve trigger points that has given some of his toughest neuropathy patients relief. Dr Olesnicky shares some elements of the cardiac neuropathy he experienced from Lyme Disease and how this has resolved with IV stem cell therapy. Fascinating N of 1 case! 

Dr Ilene Ruhoy is the Medical Director of the new Ehlers-Danlos Syndrome Center at Mt Sinai in South Nassau, New York. In this podcast, Dr Ruhoy shares the structure, goals and approach to EDS patient care. Dr Ruhoy lays out the challenges that EDS and hypermobile patients encounter in experiencing connective tissue disorders, getting a diagnosis and the work that is happening at the EDS Center to center complex and chronically ill patient care. It starts with a triad structure binding together clinical practice with the illustrious Dr Anne Maitland, surgery led by Dr Paulo Bolognese, as driving and driven by research. Then, Dr Ruhoy dives into the nature of the connective tissue and reviews one research study underway to evaluate these connective tissues for infectious source but also postulates other potential sources starting with genetic vulnerabilities as acted upon by pollution, trauma and other triggers. This might be a one-two punch that can result in complex and chronic disease.  What is Ehlers-Danlos Syndrome? https://www.ehlers-danlos.com/what-is-eds/ EDS Center at Mt Sinai: https://www.southnassau.org/sn/chiari-eds?srcaud=Main

Health is well beyond just a medical status and is inherently political. Dr Sharad Kohli, MD, has been working in primary care with underserved populations for over 15 years. He shares his story of transition from wanting to provide good healthcare to realizing that health required other services like voting rights, access to healthy food and exercise opportunities. The transition was complete in the further realization that going upstream to work on the criminal justice system, gun rights, immigration and poverty requires attention to provide care that truly targets health. This work was formalized in the non-profit IM4US (www.IM4US.org) which has a yearly conference and continues to support all members of healthcare teams to serve underserved patients well. Further, Dr Kohli reviews their incredible integrative pain program, which focused on complex trauma as a potential trigger for substance use and targeting addiction prevention. He also reviews the importance of community and group visits for building resilience and healing with inevitable cycles of health & illness. It's an uplifting show that touches on decolonizing medicine, looking at personal bias, and presents one real-life model for how good medicine is being offered in one Austin, Texas clinic. Dr Kohli is brilliant, engaging & humble.  Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition Elana Curtis* , Rhys Jones , David Tipene-Leach , Curtis Walker , Belinda Loring , Sarah-Jane Paine and Papaarangi Reid https://equityhealthj.biomedcentral.com/track/pdf/10.1186/s12939-019-1082-3.pdf

Why are chronic, persistent infections like Lyme, Bartonella, Babesia and others like long-COVID and Epstein-Barr Virus so difficult to diagnose and treat? Infectious Disease specialist, Dr Bela Chheda, MD, walks us step by step through testing options including Elisa, Western Blot, PCR, Immunoblot (Igenix, Vibrant America), FISH testing for Babesia (Igenix), and some of the uncommonly tested parts of the immune system like the T-cells (InfectoLab). She also reviews how these bacteria can hide deep within tissue compartments and intracellularly,  and that they can change themselves to hide from our immune system as well as changing our immune system itself. This flows right into the discussion about treatments with a focus on antibiotics: when to start them, when to stop them, how long they may be used for and what they can or can't do for recovering from chronic persistent infections. Dr Chheda explains why the CDC-criteria for Lyme disease set in the 1990's to target surveillance of population health lacks the sensitivity to find the cases of Lyme disease out there that can be responsive to treatment and discusses the critical importance of interpreting all test results in the clinical context of the individual patient. This one-hour show cracks the nut on how to think about testing and treating of these tricky vector-borne diseases that can trigger a chronic persistent infection that impedes optimal health.