18 AMA Cat-1 CE (8-Pharmacology and 4-Ethics) – 18 WA/CA/HI State Cat-1 CE

*CONO Applied for

Morning Theme:

 

How do our Patients Get so Sick?

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8:00 - 8:15 AM Jeremy Phillips: Introductory Remarks and Welcome
8:15 - 9:15 AM Dr. Anderson : The “Normal” Immune System and where it breaks down in Patients with Chronic Illness

In this presentation Dr. Anderson will discuss the common insults that sideline the normal immune response and lead to chronic infections. Common effectors such as mycotoxins, chemical insults, autoimmunity, metal toxins and others will be discussed.            

9:15 - 10:15 AM Dr. Ingels: Lab Testing for Infectious Diseases

Lab testing for infectious disease has been an evolving field with the implementation of newer technologies to isolate and identify various infectious diseases as the etiology of illness. Most physicians get little training during their medical education on these laboratory tests and are left to learn out in clinical practice. While some lab methods have been well established and have high degrees of sensitivity and specificity, other newer methods are still being evaluated and will be discussed to help inform attendees when certain lab tests should be run relative to others to help make an accurate diagnosis of an infectious agent.

10:15 - 11:00 AM Break
11:00 - 11:45 Dr. Gedroic: The Microbiome: What’s Gone Wrong?

Chronic disease is on the rise despite astounding advances in biomedical research.  Experts now point to the microbiome and the epigenetic effects of chronic inflammation at the “root cause” of many of today’s chronic illnesses.  The Human Microbiome Project began in 2007 through the NIH and heralded a new age of understanding in medicine.  One in which the trillions of bacteria, fungi, parasites, and virus hosted by the microbiome became the source of internal inflammation and chronic disease states.  Understanding this inner biome is critical to our thinking, diagnosis, and ability to recover patients from both acute and chronic illnesses today. 

11:45 - 12:45 AM Dr. Parpia: Preventing the “Failed Patient” – A Discussion of the Cell-Danger Response.

The patient who will fail simple antibiotic therapy typically has the tendency to express these four issues:

  • Mast Cell Activation
  • Ligamentous laxity
  • Problems of detoxification
  • Inappropriate T-Cell modulation
  • The Cell Danger Response
    • Inflammation is the body’s normal response to danger (pathogens, environmental toxicants)
    • The body’s inflammatory response is meant to be transient-when that response is ongoing and especially when the inciting event persists the normal tamping down of inflammation doesn’t occur
    • When inflammation persists and the Healing Cycle is not completed the clinical presentation is an outcome of their genetic tendencies
12:45 - 1:15 PM Tom Fabian, Ph.D., CNT - Medical Presentation - Non-CME Diagnostic Solutions Laboratories

The Role of Advanced GI Assessment in Optimizing Gut & Immune Health 

Advanced gastrointestinal assessment with comprehensive stool testing provides clinicians with critical insights into gastrointestinal infections, dysbiosis, and physiological imbalances that can contribute to immune dysfunction in patients with chronic infections.  By identifying specific factors, such as pathogens, dysbiosis patterns, digestive deficiencies, intestinal barrier dysfunction, and altered immune responses, clinicians can support patients with highly targeted approaches for improving immune function.

1:15 - 2:30 PM Lunch

Afternoon Theme:

 

Chronic Viral Illness

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2:30 - 3:30 PM Dr. Ingels: Persistent Viral Illness

Viruses are ubiquitous agents and common commensal organisms in the human body. However, when the right circumstances present themselves, these innocuous agents can become pathogenic and trigger infection or autoimmune disease. Research shows that many viruses, including EBV, HHV-6 and others can cause diseases like multiple sclerosis, persistent fatigue, arthritis, lupus and more.

This lecture will review RNA and DNA viruses and how they are able to invade human cells and initiate pathogenic changes that lead to illness. It will also cover how we can utilize diet, nutrition and herbs to help control viral replication and maintain homeostasis in the body.

3:30 - 4:00 PM Bob Miller, CTN - Medical Presentation – Non-CME Functional Genomics

Infection and the Cytokine Storm

Bob Miller will be discussing how genetic predispositions, environmental factors and endogenous mediators can raise the pro-inflammatory cytokine IL-6, and when viral infections occur, raising them further, potentially creating a Cytokine Storm. Bob will review how to use functional genomics to find where weakness may be occurring and how to compensate for the weakness and interventions to lower IL-6 levels.

4:00 - 4:45 PM Break
4:45 - 5:15 PM Dr. Anderson: Antiviral Drug Pharmacology

In this presentation Dr. Anderson will discuss the pharmacology of and implementation of common and novel antiviral compounds. The typical agents for HHV Viri as well as unique antiviral and immunomodulatory substances such as Ivermectin and other drugs will be discussed.

5:15 - 5:45 PM Clinical Panel: “Challenges in the Chronically Infected Patient Population”

Morning Theme:

 

Immune Disruption and Strategies to Manage it

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8:30 - 9:30 AM Dr. Moorcroft: Bartonella and Other Coinfections

Tick-borne co-infections are becoming increasingly appreciated as causes of human disease and morbidity. Once thought to be relatively rare, researchers are now finding that co-infection of ticks, such as Ixodes scapularis, occurs “more frequently than expected, resulting in enhanced human exposure to multiple infections that can cause more severe symptoms and sometimes make diagnosis more difficult” [Dunn 2014]. This knowledge has helped clinicians better define the often-complex presentation of patients with persistent tick-borne disease and opened new pathways for effective treatment and management of these patients.

Along with this greater understanding of the frequency of tick co-infection, other researchers have also looked for more effective treatment approaches for persistent co-infections. In the past 2 years there have been research breakthroughs in the utilization of both pharmacologic and botanical anti-microbials that have led to significant improvements in patient outcomes, decreased patient suffering and decreased burden of illness to society.

9:30 - 10:30 AM Dr. Gedroic: Parasites, Immune Regulation and MCAS

The rise of Mast Cell Activation Syndromes parallels the chronic imbalances we are witnessing in the microbiome today.  Mast cells and the inflammatory mediators of the Th2 arm of the immune system are often recruited to downregulate a chronically dysregulated mycobiome or to defend against parasitic infestation by a biome that has compromised defenses.  The specific elements of the immune system that is recruited to defend against parasites is not as well understood and involves key players that stimulate fibrosis and the “weep and sweep” phenomena.  Understanding this critical immunology is essential to understanding the “root cause” of MCAS and the rising tide of mast cell disorders.

10:30 - 11:15 AM Break
11:15 - 12:00 PM Dr. Ingels: Allergic Phenomenon in the Chronically Ill Patient

Allergies affect more than 25 million Americans each year and represent immune intolerance to environmental exposures to foods, mold, pollen, animal danders and other chemicals. Loss of immune tolerance is an important mechanism in the development of allergies and autoimmune disease and suggests and imbalance of Th1/Th2 pathways. The number of people with allergies grows each year and may attributed to changes in climate, sterilization of food and our environment or alteration in our genetic expression of certain genes.

Persistent allergy symptoms can lead to further illness such as chronic bronchitis, otitis media, sinusitis, gastroenteritis and other chronic infections. It is important for the clinician to recognize allergic illness as a precursor to other more serious illnesses, so early intervention can be employed to mitigate the risk of further disease.

12:00 - 12:45 PM Ingels: Immunotherapies in Chronic Infectious Illness

Research shows that many infectious agents can trigger autoimmune disease through molecular mimicry. The immune system reaction to fighting infection can cross react with human cells and tissue, leading to multiple symptoms including joint pain, myalgia, encephalitis, gastroenteritis and more. Such agents as streptococcus, EBV, Borrelia burgdorferi, HHV-6, Klebsiella pneumoniae, Proteus miribilis and others are well-documented to be a cause of autoimmune disease.

Many diagnoses such as multiple sclerosis or fibromyalgia do not have known underlying causes and are often treated symptomatically with little to no understanding of what led to the pathology. The clinician should investigate whether some of these infectious agents are underlying one’s illness so that proper targeted therapy can be implemented to control symptoms and get at the root cause of their illness.

12:45 - 1:15 PM Kent Holtorf, M.D. - Medical Presentation – Non-CME

Peptide Therapy for Chronic Tic-Borne Illness, CFS, MCAS, CIRS and other Multisystem Illnesses

Integrative Peptides

What the audience can expect to learn: Modulatory peptide therapy that addresses the abnormal TH1/Treg-TH2/Th17  immune shift and subsequent vicious cycles of dysfunction, which are hallmarks of these illnesses, is an essential strategy for successful long-term treatment. Failure to address this immune dysfunction is a common cause of treatment failure. While treating these multisystem diseases can be daunting, directed therapy that restores the common underlying immune dysfunction will provide you with the ability to successfully treat these complex patients.

1:15 - 2:30 PM Lunch

Afternoon Theme:

 

When Chronic Infection affects Pediatrics

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2:30 - 3:15 PM Dr. Ingels: Childhood Infections

More than 50% of all children in the United States are living with a chronic illness, many of which are some type of persistent infection. Chronic bronchitis, otitis media, strep throat, gastroenteritis, impetigo, sinusitis, urinary tract infections and PANS are commonly seen in clinical practice. The clinician should be aware of the most efficient way to identify and treat these infections to minimize morbidity in the pediatric population.

Many of these infections are preventable, so the clinician should be able to help educate parents on strategies to reduce these infections which will lead to better quality of life for children and reduced healthcare costs.

3:15 - 4:15 PM Dr. Moorcroft: PANS / PANDAS

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS/PANDAS) is a common the cause of acute behavior changes, including OCD, tics, regression and restricted eating, in children though many are unfamiliar with it and those who have heard of it are often suspicious. Practicing clinicians, school team members and parents need to be aware of this condition as it is a common and treatable cause of childhood morbidity.

Many pathogens that children are commonly exposed to can trigger PANS/PANDAS, including streptococcus, Borrelia burgdorferi, Bartonella species, and many viral illnesses. Understanding the potential triggers and autoimmune component of this condition allows clinicians to create appropriate treatment protocols and prevent relapses. It is critical to understand most cases of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS/PANDAS) require a three-pronged treatment approach – antimicrobial treatment, immunomodulatory treatment, psychotherapeutic treatment.   

4:15 - 4:45 PM Paul Harch, M.D. - Medical presentation - Non-CME

Hyperbaric Oxygen in Corona Virus Infection

Summit to Sea Presented by New Leaf Hyperbarics

4:45 - 5:30 PM Break
5:30 - 6:00 PM Clinical Panel – “Immune Disruption, Allergy and Pediatrics”

Morning Theme:

 

Relieving Toxicity Throughout the Case

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8:30 - 9:30 AM Dr. Parpia: Detoxification Before and After Therapy
  • People who become chronically ill have a high toxic load such as:
    • Lyme and co-infection neurotoxins and biotoxins
    • Mycotoxins
    • Heavy metals
    • High EMR exposure or high sensitivity to it
    • High heavy metal burden
    • Environmental toxin burden such as high perchlorate, PCBs, glyphosate and other chemicals
  • Detoxification SNPs are higher in Lyme group
  • If there are SNPs in the genes of detoxifications, toxins may remain in the body, and create an environment that is not as healthy as one where the toxins are removed
    • CYP Genes
    • SOD and GST Genes
    • PON 1 Gene
9:30 - 10:30 AM Dr. Moorcroft: The Glymphatic System and Brain Detoxification

The glymphatic system is a recently defined brain-wide paravascular pathway for cerebrospinal fluid (CSF) and interstitial fluid (ISF) exchange that facilitates promotes clearance of extracellular proteins and excess fluid from the interstitium which serves a similar function to the peripheral lymphatic system. Age and trauma related changes in the function of this system, specifically aquaporin-4 channels can lead to significant disruption of extracellular and intracellular solute clearance, leading to accumulation of extra- and intra-cellular protein aggregates such as amyloid β and tau. 

This system is primarily active during sleep, specifically N3 deep sleep and during wakefulness glymphatic clearance has been documented to be decreased by up to 90%. Research has shown that non-optimal sleep can lead to a decrease in overall glymphatic clearance and optimal sleep as well as wakeful, very low stress states, such as during meditation can improve glymphatic clearance. This knowledge of how sleep impacts this system as well as many common disease processes negatively impact sleep can go a long way for the practicing clinicians seeking to help their patients maintain their cognitive faculties and minimize the impacts of aging on the brain.

10:30 - 11:15 AM Break
11:15 - 1:15 PM Dr. Anderson: Specific Medical Detoxification Strategies

In this presentation Dr. Anderson will discuss specific medical detoxification strategies for helping patients lower their body burden of metal and chemical toxicants. Appropriate and legally defensible testing for metal toxicants, screening for chemical toxicants and other related testing will be discussed. Oral chelation therapies and safety issues as well as detoxification and support for chemical toxicants will be highlighted. Eliminatory support such as emunctory therapies will also be covered.

1:15 - 2:15 PM Lunch

Afternoon Theme:

 

Staying Engaged and Positive – Patient and Physician

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2:15 - 3:15 PM Dr. Moorcroft: The Healing Mindset

The impact of one’s mindset of health and healing is of utmost importance to outcomes, though poorly understood. Most clinicians are familiar with the placebo effect, but do not harness its power in clinical practice. Many overviews report on the placebo as physiological changes associated with positive expectations of both inactive and active medical treatments; when in reality, the placebo effect can and does have the potential to create negative outcomes as well. 

Growth mindsets have been associated with improved performance. Mindfulness practices have been associated with improved outcomes in psychiatric illnesses, hypertension and cognitive dysfunction, to name a few. Knowledge of the potency of one’s health mindset and tools for use in clinical practice are critical for practicing clinicians seeking to optimize their patient’s response to treatments and overall health.

3:15 - 4:15 PM Dr. Anderson: Managing the Chronically Ill Patient (and their Doctor…)

In this presentation Dr. Anderson will delve into one of the most subverting factors in the care of the chronically ill patient: Burnout and other issues affecting both patient and physician. He will call upon his extensive experience in managing chronically ill patients as well as broad experience mentoring other physicians in this area. Appropriate setting of expectations and boundaries as well as managing time, clinical information and your own mental health will be discussed.

4:15 - 4:30 PM Brief Comfort Break
4:30 - 5:00 PM Clinical Panel – “Toxicity and Mental Health in Chronic Infectious Illness”
5:00 PM Adjourn