campbell integrative family medicine revolution practice ... · integrative medicine - a holistic...

Ellie Campbell DO Campbell integrative Family Medicine

Revolution Practice, LLC

CMT Conference Oct 2018

1) History and Definition of Integrative and Functional Medicine

2) Root Cause Resolution and the role of antecedents, triggers and

mediators

3) Tools for the exam room: the functional medicine matrix and timeline

4) Putting it all together! Concierge medicine and Functional Medicine :

an opportunity for improved patient outcome and revenue

5) The Scholarship Program in concierge care

6) Resources to learn, implement and share functional medicine

2 © Ellie Campbell 2018

© Ellie Campbell 2018 3

1995-2014 USA 17.141%


By comparison, AUSTRALIA spent 9.422% of GDP and ranks

#3 for men and # 7 for women in life expectancy and CANADA

10.45 % #8 for men and #10 for women

USA

life expectancy #31

Is it ETHICAL to continue to practice in

a broken system that spends too much

money and gets such poor outcomes

compared to the rest of the world???

Or is it time for a

PARADIGM REVOLUTION?


A system of diagnosis

followed by an

algorithmic approach

to a treatment

© Ellie Campbell 2018

10

The IF the primary driver of chronic disease is the complicated interaction between

genes, activities of daily living (lifestyle), and the environment, DRIVEN BY INFLAMMATION THEN our allopathic paradigm addresses these very poorly.


12

Integrative medicine -A holistic medical discipline which takes into account

• the lifestyle habits of a patient.

• treat the whole person rather than just the disease.

• mind, body, and soul of a patient are taken into consideration to promote healing and well-being.

Integrative medicine is a combination of modern healthcare

practices for Dx/Tx, often including acupuncture, yoga, massage, nutrition, exercise, structural therapies

. Foundational belief that poor lifestyle choices are the root cause of many modern chronic diseases, and that drugs and surgery are not the solution.


Functional medicine is a systems biology–based approach to health care that focuses on identifying and addressing the root cause of disease.

It embraces much of the philosophy of Integrative medicine as described above

BUT ALSO

Views the body as one integrated system, not a collection of independent organs divided up by medical specialties. It treats the whole patient, not just the symptoms.


Marries current progress in

basic medical sciences

with clinical medicine to address

the growing problems associated with

chronic disease.


Roger Williams PhD (B5 and Folic Acid)

Linus Pauling PhD (how atoms become molecules)

Weston Price DDS (anthropologist)

Jeffrey Bland PhD • Institute For Functional Medicine in 1991

Mark Hyman MD

Josh Axe DC (online…your patients read

him!)


Mission of IFM • educate

and • provide clinical support for the implementation of

functional medicine across disciplines within the

healthcare sector.


Whaddya Have? that you need to get rid of

Whaddya need? that you are missing,

in order to get better

Whaddya GOT?? Whaddya NEED??


A framework and paradigm to address the underlying causes of chronic disease using a systems approach to root cause resolution.

We don’t ask WHAT your diagnosis is, we ask WHY you have symptoms

We look for antecedents, triggers and mediators


environment, lifestyle, diet, activity patterns, psycho-social-spiritual factors, and stress.

These lifestyle choices and environmental exposures can push us toward (or away from) disease by turning on—or off—certain genes



Transgenerational fear


In 90 DAYS of TLC !! 48

GENES up-regulated and 453

down-regulated after the

intervention. Ornish 2008

IF EPIGENETICS ARE CONTROLLED BY

ENVIRONMENTAL TOXICANTS ALLERGY AND SENSITIVTY INFECTION DIET AND LIFESTYLE

SHOULDN’T MEDICAL DOCTORS AND

PRACTITIONERS BE ADDRESSING THEM???


1. An understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness;

2. Incorporating a patient-centered rather than a disease-centered approach to treatment;

3. Seeking a dynamic balance among the internal and external body, mind, and spirit;


4. Addressing the web-like interconnections of internal

physiological factors;

5. Identifying health as a positive vitality - not merely the absence of disease- and emphasizing those factors that encourage the enhancement of a vigorous physiology;

6. Promoting organ reserve as the means to enhance the health span, not just the life span, of each patient

7. Functional Medicine is a science based profession


Assimilation: digestion, absorption, microbiota/GI, respiration Defense and repair: immune, inflammation, infection/microbiota Energy: energy regulation, mitochondrial function Biotransformation and elimination: toxicity, detoxification Transport: cardiovascular and lymphatic systems Communication: endocrine, neurotransmitters, immune messengers Structural integrity: subcellular membranes to musculoskeletal integrity


Where does the SYMPTOM come from? ie what are the antecedents and triggers

What keeps is GOING? • ie what are the mediators

And what can be done to CHANGE a

dis-eased homeostatic BALANCE point

the patient is locked into? • ie what are the underlying points of leverage

where the intervention can be most effective?


Simply addressing Chief Complaint

and History of Present Illness to arrive at a DIAGNOSIS

RATHER: a comprehensive story filtered through the lens of antecedents, triggers and mediators to understand key imbalances


The most important precept to remember

about Functional Medicine is that restoring

balance—in the patient’s environmental

inputs and in the body’s fundamental

physiological processes—

is the key to restoring health.


Phytonutrients and supplements (incl EO and homeopathic remedies)

Meditation Diet Vitamin and Mineral therapy (oral and IV) Manipulative therapies Acupuncture and TCM/Ayurveda Surgery Drugs Exercise including yoga and Tai Chi Counseling Oxidative and regenerative therapies Detoxification strategies (including chelation)


G= Gather Information

O= Organization Information

T= Tell the Complete Story Back to

the Patient

O= Order and Prioritize

I= Initiate Treatment

T= Track Outcomes


The Functional Medicine Timeline

The Functional Medicine Matrix


Factors the predispose to acute

or chronic illness

Discrete events or entities that

provoke disease or symptoms

Contribute to the

manifestation of disease


TRADITIONAL ALLOPATHIC MODEL:

Chief Complaint: 54 y/0 WM Substernal Chest pain, DOE HPI: 3 months duration, worse with exercise,

relieved by rest. Underlying obesity, HTN and hyperlipidemia

TREATMENT: stress test +/- echo and CXR, give handout on BMI risk and lower CHOLESTEROL with statin, aspirin, +/- ACE-I, NTG;

come back when you need PCI /CABG


LIPIDS

INFLAMMATION

CORRUPTED

CHOLESTEROL


Review the Matrix and Time line

Test genetics: ApoE, KIF6, Haptoglobin, Cyp450, MTHFR

Test underlying root causes:

Vit D deficiency, OSA, IGT, dyslipoproteinemia, grief,

dental disease and meridians, inflammatory markers,

toxicants esp. heavy metals

TREATMENT: TLC!!! Therapeutic lifestyle changes,

begin GF diet, targeted supplementation, dental

consult, chelation therapy, emotional support,

coaching and counseling. Meds for now, wean off as

possible © Ellie Campbell 2018

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FuncMed Tree

Matrix

ATM

Genes

Organ Dysfxn

S & S

Post MI >50 y/o; Creat <2.0 Overall 26% reduction combined endpoint (death, MI,

CVA, revasc, angina hosp) p=0.0002 NNT 6.5

DIABETICS: blew them away

Overall 51% reduction combined endpoint (death, MI, CVA, coron revasc, angina hosp) p<0.001 5 yr NNT 5.5

43% Reduction in MORTALITY p=0.011 5 yr NNT 12


TACT2 trial recruiting [email protected] $37 million award 2016

TACT (Trial to Assess Chelation) 2013 Dr Gervasio (Tony) Lamas Post MI >50 y/o; Creat <2.0

Overall 26% reduction combined endpoint

(death, MI, CVA, revasc, angina hosp) p=0.0002 NNT 6.5


mailto:[email protected]

Framing Root Causes as ATM:

USING our PARADIGM OF

ANTECEDENTS TRIGGERS MEDIATORS


IMPROVE CLINICAL OUTCOMES

(GET BETTER RESULTS, NO CVA/MIs)

INCREASE REVENUE TO THE PRACTICE • Opportunity for testing non-covered labs

• Opportunity for testing US with CIMT (non-covered)

• Opportunity for retailing supplements

• Opportunity for home sleep apnea testing

• Opportunity for pathogenic oral flora testing

• Consider creating “all inclusive packages”


VIRTUALLY ALL OF MY PATIENTS GET GENE TESTED

• MTHFR

• APO E

SELECTED PATIENTS ALSO GET TESTED

• CYP 1A2

• CYP 2C19

• KIF6 (Kinesin family member 6)

• 9P21

• 4q25, Hp, IL-1,IL-6, IL-17A, ETC ETC ETC


The root of all medical evil


AMERICAN BODIES ARE ON

FIRE WITH INFLAMMATION

IN FACT INFLAMMATION IS

PROBABLY ALL 3: • ANTECEDENT

• TRIGGER

• MEDIATOR


Risk of

Disease

Low

Risk Moderate

Risk

Presence

of Disease

High

Risk

Disease

Activity

Oxidation Disease initiation/

Plaque growth

Plaque maturation/

Vulnerable plaque

Acute coronary syndrome


Learn how to determine whether active arterial plaquing exists • using vascular US

• and CIMT testing

The carotid arteries are a window to the

view systemic atherosclerosis

NB: CIMT is NOT done by mobile US screenings or even by most radiology departments!

Need special tech.

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Size matters –test for size/number • Whereas LDL itself is NOT correlated to CVD risk ,

lipoprotein particle size and particle number are

correlated

sdLDL is BAD


Lipoprotein(a) is a really bad actor

Test for Lipo(a) !!!!

• DIRECTLY CAUSES MI

• Drives CV risk despite statin therapy

• Inhibits fibrinolysis

• Is decreased slightly by niacin

• (future role for PCSK9 inhibitors)


ORAL HEALTH MATTERS MORE THAN EVER

Since 2014, GOOGLE SCHOLAR articles

“oral flora cardio”= 689; “dental cardiac” =15,800;

“oral microbiome CVD”= 2670; “periapical abscess coronary disease”= 1,200


ORAL HEALTH MATTERS

MORE THAN EVER

Test for OSA


Do Not Smoke BMI <25 TC <200 mg/dL BP <120/80 FBG <100 mg/dL EXERCISE:

• 150 min. moderate

• or 75 min vigorous exercise PER WEEK

(=only 11 min per day!!) Diet 4 of 5 (DASH diet)

• 4.5 cups/d of fruit and veggies • ≥ 2- 3.5 oz fish/week • ≤ 3 -12 oz sugar sweetened beverages/week • ≥ 3 -1 oz servings of fiber rich whole grains/day • ≤ 1500 mg salt/day


Time for a paradigm shift in our care model

Our crisis management approach is no

longer sustainable. It is time for primary care

to shift from lumenology to arteriology.

PCPs think cardiologists are

managing prevention and

cardiologist thinks PCPS are!! We must ALL put more resources in to

prevention BECAUSE IT WORKS!!!


ROOT CAUSE RESOLUTION

WHADDYA GOT?

WHADDYA NEED?

ANTECEDENTS

TRIGGERS

MEDIATORS

TIMELINE and MATRIX


TO CONTINUE TO PRACTICE IN A BROKEN PARADIGM

TO SUPPORT A MODEL THAT IS DRIVING DOCTORS TO BURNOUT, BANKRUPTY OR SUICIDE

TO SUPPORT THE PHARMA MACHINE THAT IS SUPPORTING THE EDUCATION OF FUTURE PHYSICIANS

THAT THE CURRENT SYSTEM DOES NOT GET PATIENTS BETTER OR PREVENT DISEASE?


Wouldn’t you rather have tools and

a system to change and improve

your patients symptoms and

reduce their risk of chronic

inflammatory disease????



DEFENSE AND REPAIR

IFM www.functionalmedicine.org ICIM www.icimed.com AAEM www.aaemonline.org AMMG https://www.agemed.org ACAM www.acam.com A4M www.A4M.com ABIHM--->ABIM http://www.aihm.org


http://www.functionalmedicine.org/

http://www.icimed.com/

http://www.aaemonline.org/

https://www.agemed.org/

https://www.agemed.org/

http://www.acam.com/

http://www.a4m.com/

http://www.aihm.org/

http://www.aihm.org/

Introduction to Functional Medicine

AMA Accreditation Statement

The Institute for Functional Medicine

designates this enduring material for a

maximum of 1.5 AMA PRA Category 1

Credits™.

https://www.ifm.org/learning-

center/introduction-functional-medicine/


http://www.functionalmedicineuniversity.co

m/public/department151.cfm

Founder:

Ronald Grisanti D.C.,D.A.B.C.O.,

D.A.C.B.N.,M.S., CFMP


http://www.functionalmedicineuniversity.com/public/department151.cfm

http://www.functionalmedicineuniversity.com/public/department151.cfm

https://www.schoolafm.com/

Founder: Tracy Harrison


https://www.functionalmedicine.org/afmcp/ho

me/

Applying Functional Medicine in clinical practice

1-2X a year CME

March 04-09 2019 Chicago

34.5 hours of CME $3,500


https://www.functionalmedicine.org/afmcp/home/

https://www.functionalmedicine.org/afmcp/home/

Functional Forum ON LINE first Monday of every month –hold a meet up group

Lecture to your community: become the expert in your space

Share your message: put your business card in wellness books at the library or bookstore

“Accidentally” leave your website on the screen at the Apple store

Host a Walk with a Doc or Shop with a Doc event


CAMPBELL FAMILY MEDICINE CUMMING GA

2005 CASH–ONLY PRACTICE

Charge by the hour…3 years failure

2008 CONVERTED TO SOLO, CASH ONLY

MEMBERSHIP BASED CONCIERGE MODEL 3FT/ 3PT STAFF

Chris Ewin MD 1:2:1 MD


200 ACTIVE CASES @ $250/month

WORK IN OFFICE 3.5 DAYS/WEEK

(time for family, travel, lecturing, teaching, networking, volunteering)

GROSS REVENUE $750,000+

TITHE: 5% CASH 5% SERVICE


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FREE IS VALUELESS

BASED ON HABITAT FOR HUMANITY

SWEAT EQUITY

15 HOURS OF COMMUNITY SERVICE

=3 MONTHS OF MEMBERSHIP RIGHTS

$50/HOUR EQUIVALENT

CARE WITH DIGNITY

WIN/WIN/WIN


THE ANTIDOTE TO PHYSICIAN

BURNOUT

THE SOLUTION FOR THE

BROKEN SYSTEM

A SUCCESSFUL NEW

PARADIGM © Ellie Campbell 2018

75

DPC/membership practice

PLUS

Functional Medicine


AFTER 12 YEARS, many mistakes and many successes,

I BELIVE THAT FUNCTIONAL MEDICINE

PRACTICED IN A CONCIERGE MEDICAL MODEL

CAN SAVE DOCTORS AND OTHER PROVIDERS

SAVE THE PATIENT’S

LIVES AND LIVLIHOODS

SAVE MONEY


8 HOUR NON-CME BUSINESS DEVELOPMENT COURSE

HOW TO ATTRACT PATIENTS • INCLUDING FREE MARKETING STRATEGIES

HOW TO DESIGN A CASH PRACTICE • CONCIERGE, MEMBERSHIP, PROGRAMS

COACHING ROLE-PLAY EXERCISES • TO CONVERT PROSPECTS TO PATIENTS

• TO ENGAGE PATIENT WELLNESS BEHAVIOR


www.DaoCloud.com


http://www.daocloud.com/

http://www.daocloud.com/

THANK YOU MICHAEL TETREAULT

The Dream

The Vision

The Implementation

The Fellowship

OF CONCIERGE MEDICINE TODAY


campbell integrative family medicine revolution practice ... · integrative medicine - a holistic...

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