Insurance – Medical Necessity – Part 1

Center for Environmental Medicine is a medical practice providing health care to families and individuals from a holistic approach; applying therapies studied from allopathic (conventional or contemporary medicine whose practitioners prefer to claim “The Standard of Care”), alternative, integrative, complementary and functional medicine or CAM.  These services in the health insurance industry may sometimes fall under the category of “not medically necessary” and is further addressed below.  This is true for all practices.  Additionally, with strictly conventionally practices you will see tests and services that do not meet medical necessity.

The ultimate purpose of our work is to serve and help people regain health and sustain wellness.  Our vision is to create a center that seeks to reach out to the public, to assist in the healing process through detoxification and restoration of the inherent balance in the body with the safest therapies available. Ultimately the goal is to treat the whole body which includes emotional and spiritual health. Our methods may include nutritional biochemistry, lifestyle modification, bodywork, chelation therapy, and bioenergetics.  We address target amino acid which ultimately accesses the balance of neurotransmitter and adrenal support. We provide diagnostic laboratory tests including esoteric tests not generally accepted by mainstream medicine.  We seek to exchange ideas, educate and assess all with a holistic, open-minded and functional medicine approach.  Every member of the health care team, which includes the patient, must understand when we give our best, then we ask for a patient who comes with integrity and interest in resolving their health issues. 

Many people look to their insurance in helping to meet their health care needs.  While we cannot guarantee coverage, we have a good understanding of what information insurance is seeking in order to process a claim efficiently, accurately, and to the benefit of the insured.  We will ask for assistance from the patient in providing supportive assessments related to history which is how we accomplish meeting strict requirements by the insurance company to meet medical necessity.  To be clear, it isn’t always possible.  When insurance is not available, we provide the patient with viable options which may help to accomplish their goals.

The term “medical necessity” is often misunderstood by the patient.  Understanding the definition of this term prior to medical treatment often relieves a patient of frustration as they plan their strategy of an affordable health goal. 

From Wikipedia, a free web encyclopedia related to medical information, medical necessity is a legal doctrine related to activities which may be justified as reasonable, necessary, and/or appropriate, base on evidence-based clinical standards of care.  Definitions to each plan are outlined within the insurance contract to the individual consumer. 

The insurance company may only pay for items and services that are “reasonable and necessary for the diagnosis or treatment of illness or injury…”  Your doctor may have a different opinion outside of this definition based on his clinical experience and scope of practice.  While the insurance company’s goal is to cover specific benefits only, the doctor’s goal is to achieve your healthcare goals. Your insurance company allows for your right to choose the type of care you select, but they reserve the right to make the final determination if they will pay for a service or not.  Ultimately, it is your responsibility to understand what your insurance benefits are. 

Benefits are based on the patient’s specific contract.  Co-pays by law are due before insurance can be billed.  In some cases, a laboratory test may be only partially covered.  In all cases we tell a patient in advance that we do not guarantee coverage, inform them what is usually not covered and allow them to make the choice of how they approach their health.

Center for Environmental Medicine


Alzheimer’s Prevention

Alzheimer’s, one of the most feared age related diseases of our time, has the attention of scientist who are intensively researching every aspect of the age-related dementia.  Once Alzheimer’s takes hold, there is no known cure. There are new drugs available that seem to provide some preventive measures and several theories as to what causes Alzheimer’s.  The prevailing thoughts include toxins accumulate within cellular structures causing damage, interruptions in blood flow, and that inflammation is a key player in the destruction of functional tissue.  Beta-amyloid, a protein, triggers inflammation in the brain of Alzheimer’s patients causing mild memory impairment or confusion. 

Vascular dementia and Alzhiemer’s may share the disruption of normal cholinergic function or acetylcholine.  In someone at risk for stroke, elevated C-reactive protein can be an indicator.  Unfortunately, there are no test that accurately measures acetylcholine in the brain.  Phosphatidyl-choline is the precursor for acetylcholine.  Some doctors and nutritionist are aware of its importance and suggest the natural agent phosphatidyl-choline to their clients.  The neurotransmitter acetycholine responsible for memory, sleep and cognition, may decline as a result of neurodegenerative process associated with aging. 

Phosphatidylserine also is a key component in brain function and an integral component of every cell membrane.  One of the vital functions of phosphatidylserine is it boosts the levels of acetylcholine, helps release dopamine, and reduces the stress hormone cortisol.

While reduction of cortisol is important if needed, phosphatidylserine should be taken only under the direction of a doctor because cortisol levels need to stay within the normal range.  Too much phosphatidylserine at the wrong time of day can produce undesirable results.   

Other natural agents may include quercitin, Vinpocetine and pregnenalone and acetyl l-carnatine. (See article Antioxidants: The Powerful Trio Part 3).  Information regarding the role of DHEA may be found in “The Metabolic Plan”  by Stephen Cherniski.  He makes a compelling argument on the aging model. 

Summary noted by Life Extention, July 2003 as follows:

Meta-analysis shows NSAIDs help prevent Alzheimer’s disease

A review of nine studies published in the July 19 2003 issue of the British Medical Journal has found that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) offers some protection against developing Alzheimer’s disease. Nonsteroidal anti-inflammatories are a class of drugs used chronically by individuals with arthritis or other painful conditions, and include aspirin and ibuprofen.

The review analyzed studies published between 1966 and October of 2002 that evaluated the NSAIDs’ ability to prevent Alzheimer’s disease in a total of 14,654 subjects. Studies examining exposure to other pain relievers or in which vascular dementia was the primary outcome were excluded from the analysis.

The researchers separately analyzed studies that determined Alzheimer’s disease risk in users of all NSAIDs, in users of aspirin, and in users of NSAIDs according to duration of use. They found that individuals over the age of 55 who used NSAIDs experienced three-fourths risk of developing the disease than that of subjects not taking the drugs, and that the longer the drugs are used, the greater their benefits appeared to be. When aspirin use alone was evaluated, a small but nonsignificant benefit was found, however, this finding may have been due to the smaller number of studies that specifically evaluated the protective effect of aspirin. The appropriate dose and duration of use of nonsteroidal anti-inflammatories to prevent Alzheimer’s disease remains to be determined.

If you are interested in being proactive against age related disease, consider the benefits of working with the alternative medical doctor who specializes in nutrition and therapies that address the toxic world we live in.  Exactly the kind of work we do.


Neurotoxicity Explained

Everybody knows that you need good elimination habits to function optimally but few have only a basic understanding of what that means.  In a society that is becoming more focused on health and nutrition, a closer look at a group of toxins, called neurotoxins, is needed.

While elimination routes include kidney, gastrointestinal, skin and exhaled air, the liver is the most vital of body functions in the process of elimination of neurotoxins.  Common sources of neurotoxins include metals, biotoxins (viral, fungal or parasitical sources), man-made chemicals called xenobiotics that include pesticides, preservatives and excitatoxins such as MSG, aspartame, and food colorings. 

Neurotoxins are absorbed by nerve endings and travel inside the neuron to the cell body in the mammal nervous system.  As a result, they cause disruption in vital functions of the cell such as axonal transport(1) of nutrients, mitochondrial function and proper DNA transcription.

In the liver, elimination of most all products are expelled with the bile into the small intestine.  Unfortunately, because of the lipophilic and neurotropic nature of neurotoxins, most of these toxins are reabsorbed in the small intestinal wall by nerve endings of the enteric nervous system (ENS).  The ENS tissue is the same as the brain in the embryonic stage and then separates, hence sometimes referred to as the brain away from the brain.  Once these toxins are reabsorbed, they can be transported back to the brain, the liver, subclavian vein or uptake by bacteria in the bowel resulting in cause or exacerbation of illness caused by neurotoxins.

Obviously, the issue is complex.  Risk factors that can contribute to the sluggishness of the liver include allergy, poor diet of high carbohydrate and low protein, occupational exposure, prolong illness, surgeries, constipation, metal absorption and genetics to name a few.  

Solutions include evaluation of liver function for Phase I and Phase II detoxification, evaluation of toxic levels, and implementing a detoxification program.  It must include proper protein, a good mineral base and balanced electrolytes which can help displace metals. Other nutrients and food sources, including a mercury-free EPA/DHA fish oil, aide in binding up these toxins so they can be eliminated. Improving the diet, elimination and reduction of metal sources and other risk factors are a start but it needs to be done right. 

1  Axonal or axoplasmic transport is the movement of mitochondria, lipids, neurotransmitter regulation, proteins, and other cell parts to and from a neuron’s cell body through the contents of a cell that are enclosed within the plasma membrane or cytoplasm. contact for proper testing and guidance

Heavy Metal Burden-Cadmium, Lead, Mercury Plus More

In the toxic environment we live it, it is hard to imagine one being able to escape the potential dangers that threaten us in our air, water and food.  Some believe, as I do, that the health of this nation, evidenced by the escalation of heart disease and chronic acquired diseases, is in direct relationship to the accumulation of the toxins within.  High levels of metals, drugs, and manmade compounds can be found in our environment.
 We hear about the effects of global warming more than we hear about how toxins are dismantling this nation of its richest resource–health.  As stewards of this earth and our bodies, we need to understand the problem and do our part to protect our families, community and self.  We aren’t hopeless or helpless in this age of information unless we choose to be. 

 Heavy metal burden is the unintended consequence of industry worldwide dating back to the Industrial Revolution in the 1700’s.  The economy that was created unquestionably changed the world…and it is still changing our world today.  The cost of healthcare continues to rise and some believe that the collection of heavy metal entities in the body contributes to acute and chronic disease, primary introduced into the body by oral or inhalation means.  Cadmium is the most toxic element to man, then lead, then mercury.   Toxins that are manmade chemicals contribute as well.  Little is considered as people wash with scrubs or work with unprotected hands in harsh chemicals.

The economy of healthcare is found in the treatment of disease.  While an enormous amount of money annually goes to research, the title of drugs is at the top of the lists.  One thing for sure, there is a drug for almost everything.  Illness is sometimes considered a synonym for disease or sometimes viewed as the subjective perception of the patient or an objectively defined disease.  If the objectively defined disease is illusive, then the problem exists only in the mind of the patient. Or does it?  

Environmental doctors and those interested in prevention of disease take a different look at the disease model. First, they consider the patient might be right!  Their symptoms might actually be an underlying cause even thought the cause may be illusive and unrelated to emotional or mental illness.   You don’t have to be a doctor or struck with illness to share wisdom.  It is easier and less expensive to prevent disease than to treat it. 

The alternative doctor looks at the body and sees it wondrously made. Food and nourishment is required to fuel and maintain the machine.  The cleaner sources the food comes from, and the more nutritious the source, the better.   If the body is unable to function properly because of enzyme and nutritional deficiencies, should you add a drug to make the process happen or inhibit another process to provide an artificial balance?  In alternative medicine, the practitioner strives to restore the balance.  Removing a toxin is preferred to adding a drug and reasonable nutritional support including a healthy diet. 

One area of alternative medicine many patients have benefited is detoxification programs including those specifically designed to remove xenobiotics (manmade chemicals including plastics and pesticides) and chelation for heavy metal burden.  A healthy BMI (body mass index) is important because toxins store in fat.  If your attitude reflects little dedication for long term effects of healthy living, then you need read no further.  If you understand investing in your health has long term rewards, then you should consult a trained practitioner in chelation to get the best care.

 For example, some professionals use blood tests but results reflect recent exposures and typically not chronic exposures. Others use hair analysis which typically reflect chronic exposure but not body stores of toxic metals.  Fecal tests can be influenced by dietary and metabolic factors.  Challenge tests may fail to produce an expected response in glutathione deficient patients, provide the best results for elevated and very elevated levels.  The challenge test, with the preferred chelator,  is the preferred test.  Often multiple toxic metals are present and increase the duration of the chelation processEach additional toxic metal lowers the toxic threshold for every other metal resulting over time in dysfunction of multiple organs and tissues, impaired chemical detoxification, excessive free-radical formation, and chronic conditions such as chronic fatigue syndrome and fibromyalgia.  Also, increased oxidative stress, related to elevated heavy metals may precondition you for heart disease.  

The impact of how heavy metal burden affects a person depends on their sensitivity. Type O blood patients seem to provide few symptoms and these are the patients who take the least care of themselves because they “feel fine”.  “Feeling fine” does not necessarily reflect the truth which is why health checkups are important.  Areas of concern may be when you see elevations of cholesterol, dysfunction of blood sugar, mental confusion and fatigue.  For example, trace mineral depletion is caused by disruption of transport by heavy metals competing for receptor sites on transport proteins and metallothioneins and by binding sulhydryl groups on many enzymes.  This process may be so gradual, you may fail to recognize the onset of persistent fatigue, decreased mental acuity, or increased issues with metabolism, yet your doctor may not know how to test for these or why they might be important.  In contrast, the type A blood patient is very sensitive and notes many more symptoms because they tend to be more sensitive to their environment.



Termite Extermination-Informed Consent

Pesticides kill insects and pests but can also have a devastating effect on the human species.  When a panic-stricken friend called to say she had a termite infestation and the exterminator wanted to pour 350 pounds of pesticide in and around her home, I realized most people do not know how to get enough information for informed consent.

Termites not only eat the wood structure of your home but can penetrate the soil and lay eggs.  A contact pesticide, the safest form of pesticide will not reach the target areas which are the nest and eggs and the queen termite nor protect your investment.   Often at least two persistent pesticides are recommended to resolve the problem.  They are called persistent because they linger in the environment and can be toxic to birds, aquatic and wildlife.  The mechanism of action to kill the pests is by affecting the nervous system. 

Suggested research:

FIND the Material Safety Data Sheet on line. 

GOOGE search: product name MSDS

Wikipedia is a good source for information on any subject

Also read material on line about each product suggested by your exterminator. 

Termidor is a persistent pesticide.  One of the most recommend products for termite control and extinction is Termidor.  The active ingredient (fipronil) is about 0.06% of the solution.  The concentration is much lower than most insecticides and has virtually no odor.  The termites cannot see, smell or taste the product and therefore do not avoid it.  The product is engineered to be slow-acting so once they contact, ingest and share it with their nestmates, the problem is well on its way to being resolved.

Pyrethroid pesticide is a contact pesticide.  One of probably the safest of all the pesticides is Bifenthrin.  It can be used indoors including food handling areas like restaurant kitchens, on and around building exteriors, plants and lawns.  It is a synthetic pesticide comparable to the natural pesticide pyrethrum which is made from chrysanthemum flowers.  It is not harmful to pets when dry, but has been found to be moderately toxic to birds and highly toxic to fish.  Plants do not absorb this pesticide.  Mechanism of action is by paralyzing the central nervous system and is effective as a contact pesticide for spiders, mosquitoes, cockroaches, ticks and flears, pillbugs, chinch bugs, earwigs, millipedes and termides. 

Tim-Bor & Borrada D are inorganic borates.  These products are used as wood preservatives to stop and prevent rot and insect attack. They are water soluable inorganic borage salts with insecticidal and fungicidal properties.  These borates are effective against subterranean, dry and damp wood termites, carpenter ants and Powder Post beetles and more.  The mechanism of action is a slow acting stomach poison and contact poison to decay fungi.  As a wood preservative, the insects or larvae feed on, tunnel or digest wood thus accumulating the active ingredient.  This is not the first choice for treatment.  This product protects from decay fungi as well.

Imidacloprid-Imidacloprid is a chlorinated neonicotinoid insecticide that acts on the nicotinic acetylcholine receptor which inhibits degradation by acetylcholine-esterase.  It has relatively low toxicity to most animals other than insects due to the specific receptor named above and is a topical treatment for dogs and cats for fleas.  The product breaks to inorganic molecules in water and soil and therefore is not considered a persistent pesticide but is reported to degrade into toxic, persistent, 2-chloropyridine.  It can stay in the environment for 2.75 years.  In the body 96% of the chemical is eliminated in 48 hours.

To help avoid infestation, remove all loose wood from under the house and keep the area dry. 

Other pesticides may be recommended by the exterminator.  Do your homework and make an informed choice of remedy regarding the problem of termite infestation.


Food Allergy – Fixed and Aquired Part 1

Food allergy is believed to be the single most contributory factor of chronic disease and therefore warrants consideration when evaluating the patient.  Immune reactions to ingestants are much more complex than inhalants which tend to be a fixed allergy.  To the physician who understands the basic history and complex symptomology of food hypersensitivity, evaluation has a relevant place in determining cause of disease and impaired health in many patients. 

There are two major types of food allergy–fixed and cyclic. Other responses such as IgA and IgM will not be addressed here.  A fixed food allergy is designated as a IgE response that occurs each time the food is consumed regardless of how long it has been avoided and may include anaphylactic reaction.  A cyclic food allergy reaction is designated as IgG response and is related to frequency and quantity of the consumption of the offending food.  The initial consumption of the food gives a stimulus that the patient may enjoy and as this wears off, the undesirable symptoms begin.  Often the patient erroneously believes because they do not notice a symptom immediately, that the food is safe.  Theoretically food sensitivity or IgG response is the only allergic condition that can be perfectly controlled.  This is a bold statement without regard to conditions which can increase the sensitivity of the patient such as leaky gut syndrome. 

If symptoms improve with fasting for several days, then food allergy should be considered.  If symptoms worsen after a meal or symptoms are temporarily relieved after certain foods are consumed, food allergy should be considered.  And if cravings for favorite foods are common, food allergy should be considered.

A personal history should be taken to include home and occupational environment, all organ systems, and detailed history back to childhood.  Medications and supplement list should be compiled and alcohol intake should be evaluated.  The tests and methods to determine food sensitivities all have limitations but a combination of these tests often produces a treatment plan with good outcomes. 

Food Diary Evaluation:  A food diary of at least seven days, to include all fluids as well, is an important component to determine a correct diagnosis.

If a patient fasts for a period of four days, and most of the offending symptoms lessen or disappear, allergy is a contributor.  Additionally patients who tend to eat the same food over and over again, an irritation occurs in the gut resulting in small particles of the same crossing the gut barrier into the blood stream and are recognized as foreign bodies.  The immune system attacks them and sensitivity is developed, hence symptoms occur.  The diagnosis and treatment of food allergy can be accomplished by several different methods. 

Oral Food Challenge –

Food diary evaluation

Rotary diversified diet (Rinkel)

Elimination Diet  (Rowe)

4-day rotation food families (Randolph) – 74k

Commercial tests include RAST, IgE, IgG, Elisa and usually are not covered by insurance unless certain criteria are met meeting insurance standards such as eczema, psoriasis, autoimmune disease, neuropsychiatric issues, antihistimine failure, prednisone usage or under 4 years of age.

These tests along with diagnostic criteria will be discussed further in future articles as we continue to look at allergy and its impact on health.

EDTA In The News

For years, EDTA held a clean record regarding safety but in the past few years, there have been rumors concerning the safety of EDTA. Unfortunately these rumors are true.   Due to some poorly trained doctors, hospitals and pharmacies, the wrong medication was incorrectly administered to patients and they were injured or died.  EDTA has two forms with administration protocols that are very different.  The FDA has issued a public health advisory regarding this very serious recurring prescription drug error.  An article was posted by the US Centers for Disease Control and Prevention in 2006 which documented the Edetate Disodium being used instead of Edetate Calcium Disodium.  Prior to these fairly resent events, the safety of EDTA when properly administered was unopposed.  We submit that if  the doctors who caused these disasterous errors were trained by the ACAM (the Academy for Advancement of Medicine), they would be well trained and injuries would not have occurred tarnishing a record that previously enjoyed a long record of safety.  

EDTA is often used for “off label” purposes for reduction of heavy metal burden which is believed to cause free radical activity.  In alternative medicine, this activity is believed to cause injury to the cardiovascular system and contributes to arteriosclerosis.  While it cannot be claimed that EDTA improves arteriosclerosis, it is believed to increase peripheral circulation thereby improving the condition.

Edetate  Calcium Disodium is approved to treat severe lead poisoning by the FDA.  The FDA is not considering removing it from the market since it is a medically necessary drug with very few other options available to treat lead toxicity.  It can safely be administered rapidly by an IV push.  Patients with a serum level over 55 mcg/dl and symptomatic should not be given mobilization test.  See position paper reference below.

The cause of patient injury comes from an administration error regarding Edetate Disodium.  This product is mixed in an IV along with magnesium and administered over a three to four hour period.  When administered too rapidly, it lowers the calcium level reducing contractions of the heart. 

Everything about this situation is unfortunate.  Proper training is essential in eliminating these errors.  Products, if stored in the same facility should be marked and stored in separate areas. 

Legal Status of EDTA Chelation Therapy  –  See   for position paper from American College for Advancement in Medicine on EDTA Chelation Therapy (16 pages)

Included in the paper are the following:

Introduction-‘ACAM was founded in 1973 as a non-profit corporation comprised of approximately 750 licensed physicians many who were interested in and used innovative therapies for ocular vascular disease, degenerative disease and cardiovascular disease.’

Therapeutic History of Chelation Therapy- ‘In simplest of terms EDTA is a man-made amino acid widely recognized as effective for emergency use for hypercalcimia, control of ventricular arrhythmias associated with digitalis toxicity.  Due to research at the National Academy of Sciences/National Research Council in the late 1960’s EDTA was indicated for possible consideration in the treatment of occlusive vascular disorders caused by arteriosclerosis….’  Many studies published and referred to in article.

Physician Use of Innovative Therapies- discussion regarding the use of EDTA and addressing concerns thereof and the rights and ethical duty of doctors with the highest regard to public safety.

 Restriction to FDA package Insert Guidelines in Inappropriate-  regarding off label use of EDTA

 Constitutional Considerations in Restricting Choice in Medical Treatment- evolution of patient participation in decision making regarding treatment

 First Amendment Protection of Commercial Speech-  entitlement to First Amendment protection

 Conclusion-Under common law, the state may not deny any individual the right to medical care and access.