Sunday, October 11, 2015

Sharon Katz brings em in at the Giant!

Sharon Katz, owner of the expanding Collaborative Care, gave a brilliant presentation yesterday, October 10, about meds.


 We met Julie, a student at Philadelphia University, who is studying to become a healthcare practitioner.
 Ada and I both enjoyed the tiramisu coffee. 

This is just an excuse, I said to Ada, to eat all this delicious free food. 


Thanks to Robin Franklin, Community Room Coordinator, for providing the beverages and healthy snax.

Guests included

 Ruthie was a very interested participant, as was
Rich Fleisher, XDO. That means, he used to be a DO, in the practice of radiology at Lower Bucks but retired.

Helen Kirschner was a rapt audience member. Helen runs our Daytime Meeting here at the Giant. 


Sharon discussed the changing world of mental health. She went back to school so she could become a prescribing nurse practitioner.  

The world of shrinks, she said, is shrinking! Only 3 percent of recent grads from Jefferson Medical School here in Philly became psychiatrists.

And the older docs don't know how to use all the electronic devices that are so important. Sharon tells them her practice will help them. Then all the records will be available as long as the patient gives her consent.

Older docs are good b/c they have experience. Younger are good also as they've just graduated from med school. Doogie Howser, MD? 

Image result for doogie howser

Sharon would love to prescribe for people on Medicare and Medicaid but these govt-funded agencies will not allow a nurse practitioner to do it.

She takes ins. thru Magellan, a large management company, which she likes a lot. 

She teaches primary doctors how to prescribe. Your primary doctor, when seeing patients, should offer a questionnaire asking If you enjoy things the way you used to, are you sleeping well, and about your energy level.

I have a childhood friend now living in Columbus, OH, who can't get her meds right. Will tell her about the genetic assay tests that most insurance co's now pay for.

Sharon likes several of em, including Genomind.

These tests reveal how your liver metabolizes meds. 

Another reason she encourages older docs not to retire is b/c they "dump their practice" onto other agencies, such as her own, which is why she now has offices in Abington on York Road, the Executive Mews in Willow Grove, and a gorgeous one in Bala Cynwyd, former office of the great shrink David Kalkstein who moved to Delaware.

The new way of diagnosing is "symptom-based." There's a questionnaire for Anxiety. The GAD7. You ask 7 questions such as Do you worry a lot?

Image result for nail biter

Yeah, I've gotta get to the Giant now for today's guest speaker. I have about arf an hour.  Read the post here.

"We knew this was coming," said Sharon about the new electronic media. "Come work for me," she tells em, "and we'll help you."

Yes, we need more psychiatrists!


Plus, "We have the crisis of the aging Baby Boomers."

She made a good point when she said if you don't treat adolescents who have mental health problems, they will turn to illegal drugs - opiates - and then you've gotta get em off the drugs before you medicate them.

When you have a stranger come into your home, say, a plumber, if they're an addict, they will go into your medicine chest or top drawer, take some of your opiates but leave a few in the bottle, thinking you won't know. Your teens will also do this. 

When we hosted our "Substance Abuse and Bipolar Program" in 2011 with Barry Lessin and his buddy Chad Coren, we were told the same thing.

She tells her teens, "We're not judging you, we just want to help you."

Sharon was inundated with patients when Creekwood closed, which is one reason she expanded, as did Philmont Guidance under "Danny Hartman," she said. 

"Good companies expand," she said. "Bad ones fold." 

Life Counseling is a good place to go, as is NHS in Lansdale. 

When a patient says "Nothing works!" that's when they get the assay test.

"There are a lot of different shifts on the way we do treatment. Now it's scientifically based," she said.

Collaborative Care was chosen to p'pate in a research study by Genomind, based nearby in Chalfont, PA.

65 patients were used in the study. 

Tests include 

Serotonin receptor site activity... determines if you need a higher dose based on how your liver metabolism- normal, medium, high

Serotonin transporter site 

Calcium and sodium channel blockers

Dopamine D2 Receptor Sites important for BP patients

Attention span - often diagnosed with ADHD when it's BP all along

MPHFR as they may bring on symptoms - must test these when necessary

Sharon prescribes certain vitamins "to make the brain come alive."

B-Complex - for Energy and Focus

Deplin - works within two weeks

Enlyte

Omega-3 Fatty Acids 

SAM-E - potentiates Dopamine (makes it stronger)

Inisol - attention span

COMT - attention span 

Asians react differently to meds than caucasians. One patient was up on all night on Benzos b/c she didn't metabolize em the same way as caukies. 

Different ethnic backgrounds must be treated differently. 

Sharon doesn't usually use antidepressants w/ bipolar patients as it activates them. Instead, she augments the mood stabilizer with vitamins. 

She likes a new med called Brintellix.

For sleep, she likes

Melatonin, 3 and 6 mgs. Take and hour or two before bedtime.

Image result for person yawning

I didn't yawn... did you?

Benedryl

Remeron, a weight-gainer antidepressant

Trazodone, don't take if you have cardio issues, up to 100 mg

Elavil, also good for physical pain like fibromyalgia

Fibromyalgia was finally given a name. For years, doctors didn't believe it was a real illness. Patients suffer from neuromuscular pain.

Sharon believes it stems from early life adversity. Sexual and/or physical abuse. Traumas. It leaves physical scars on the body. You might rub that part of your body that was abused. Sharon had a patient who kept rubbing her shoulders, which was where she'd been held down.

Emotional trauma leads to nerve conduction to body. Must be released by talking about it. Can also take meds such as Effexor, an SNRI which affects diseased nerves. Or Cymbalta.

Elavil is also used for migraines. 

Muscles have "gaba receptors." So she uses long-acting gabapentin - Neurontin.


She talks to drug reps and gets freebies from them

Image result for drug rep




  Sharon Katz, prescribing nurse, helps hundreds of patients.


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