Dr Kelly Neil on the LDN Radio Show 15th May 2019

Linda Elsegood: Today my guest is Dr Kelly Neil, who's a family nurse practitioner. She was trained by one of our medical advisors, Dr Jill Kotel, who had a practice in California.  Kelly took over Dr Jill Cottel’s practice when she moved to Virginia. She’s done amazing things as we'll find out.

Thank you for joining us today. Kelly. 

Dr Kelly Neil: Thank you, Linda, the pleasure's all mine. 

Linda Elsegood: So tell us about your practice. 

Dr Kelly Neil: As you just alluded to, Dr Cottel left about a year ago and it was very sad when she left. She trained me to join her practice and then her family moved to Virginia.  I was very blessed to be on her coattails. I felt like she was kind of the superhero and I was on her cape for about a good year. But unfortunately, her family moved to Virginia, and she actually asked me did I want the practice? And at first, I said no, because I did not want to carry a payroll in the state of California. But what we could not do, we could not abandon the telehealth practice. So we closed the Poway Integrative Medical Centre. We had to close that LLC for obvious reasons. But we transferred over those that wanted to join our integrative medical centre. So on her website was the link to this entity.

I was just very blessed. You asked me if I wanted to be on the radio show about a year ago. And I just didn't think that I was ready because I thought it was kinda disingenuous because I had all of her practice.  I did certainly have my own patients, but a year later, I feel like, okay, now I can sit at the adult table. I could sit and have a sense of self now. The practice has certainly grown, and I have now several hundred patients that are not only LDN but also high dose naltrexone. So HCMC is devoted to just the entity of naltrexone. The practice has grown well, and it's a true testimony to not only the foundation that Jill has left me but also to the practice itself.

Linda Elsegood: With your telemedicine. I think 

Dr Kelly Neil: Telemedicine practice is basically all of California, at the moment.

Linda Elsegood: And would you be looking to expand?

Dr Kelly Neil: I am, I'm also boarded in the US territory of Guam. I'll be evaluating that territory shortly, but I need to kind of get a feeling if that's where we want to open up. There are a lot of complexities there currently. 

Linda Elsegood: And you know, obviously California is a very big place and you've got several hundred patients you currently look after. Do you have other members of staff helping you with those consultations? 

Dr Kelly Neil: Well, I think any great company, you don't work in a vacuum.  I cannot do this alone. So the website is a true testimony to the web designer. And that's LA Bannon, the chief IT director. You know, you spend your whole life getting your kids off your payroll and then all of a sudden they start coming back. That's actually my son, and he’s represented on the website too. My son is the chief IT director. Hee does a great job of making sure that we stay compliant in all the nuances of care in a world that has made me dizzy sometimes. 

I could not do this alone, but with regards to the consultation, I do them personally.

I'm the only health professional in the company. All of my emails are directly answered by myself, and they're all answered within 24 hours. I use my patients as my board of directors because the reason we went completely telehealth was that it became evident that patients were more and more reluctant to come into a brick and mortar location. The patients were deciding that they could benefit more and wanted an option for evening hours. They even wanted to be able to make their own appointment schedule. I keep a patient portal, so they make their own appointments online. They wanted more accessibility to me and not necessarily to go through the staff.

All of these questions were answered via a questionnaire. It became obvious not only from a cost-containment standpoint, but the best choice was also to have more fluidity. The website designer made it possible to do that through the nuances of the intake form. So I did not work in this business alone. It was truly the result of a team.  

Linda Elsegood: Wonderful. So you were talking about high dose naltrexone, and I know that Jill did an amazing talk at the 2016 conference. Using fifty-milligram tablets for the Sinclair method, is that what you are doing as well? 

Dr Kelly Neil: Yes, it's almost a little over 50% of that populace.  I'll be giving a national talk here in October. I'll be coming back from Guam to probably give that lecture. It's doing really, really well. It's another passion. So it's nice that HRMC is devoted to not only the low dose but also the high dose. So yes, it's remarkable. A protocol that not only low dose has changed lives, but certainly, I've seen it change lives with alcohol use disorder. I wish it had more traction in common medicine, but not yet. When we touch lives with this pharmaceutical element, it has a positive ripple effect on the families. That's what's really exciting. The positive ripple effect on the families just help them decrease their alcohol use

Linda Elsegood: For the listeners who may not be aware of the Sinclair Method, it's for alcohol use disorder. Could you give us a brief explanation of how you implement the 50 milligrams?

Kelly Neil: Sure. Once I've established the patient's need for it, they come to seek treatment, It's my responsibility to make sure that the candidate has a need. I started out traditionally with 25 milligrams the first day, 25 milligrams the second day, then usually just jump right into the 50. The whole goal is to evaluate what type of drinker they are. 

Paraphrasing, there are traditionally three types of drinkers. Those that tend to drink every day in excess. They drink too much. There's a second type of drinker that does not necessarily drink every day, but when they do a type of drink, they drink maybe too much. So those are my Superbowl Sundays, my weekend warriors. But when they drink, they kind of let the crack in. So we have to get the crack and backups. They tend to not need the Sinclair method, but they do qualify for naltrexone. I won't necessarily dose them every day, but when I do those, some do take the medication prior to the consumption of alcohol.

And then the third type of drinker are those that are the hybrid of both that drink every day and then also binge drink. So your original question is, how do I dose them? It's basically what type of drinker they are. My goal for them is that by 30 days into the consumption of alcohol, their consumption is down 50%. They send me a drink log via either the portal or via email. If I do not get their consumption down, it tells me as a provider, I do not have them dosed correctly.

I treat alcohol use disorder very similar to if I was treating hypertension if I was treating them for diabetes. Alcohol use disorder is no different than if it was a different type of diagnosis. So if their consumption is not coming down, then my responsibility is to go up on the medication.

50 milligrams is just a launching dose. I may have to go up to 75 sometimes I may even have to go up to 100 milligrams, but I do not exceed 150. 

So that's what HHC is very good about, that I am always accessible to the patient in email correspondence. That's what makes us successful especially in alcohol use disorder. Once they start on the medication, they have so many questions and they need to be accessible to me to answer these questions. They may feel like they're in a world of their own and they feel very isolated. And there is no shaming at this table. If I were to treat them for diabetes, there's no shaming. If I was to treat them for hypertension, there's certainly no shaming. If I was to treat them for alcohol use disorder my responsibility is to up their medication if their consumption is not going down. Did I answer your question?

Linda Elsegood: You did give a very, very good answer. We will give people your details afterwards, and I'm sure you'll get some questions. 

Linda Elsegood: So for the low dose naltrexone?

Dr Kelly Neil: It's just as intriguing because they'll come to the table with, let's say, interstitial cystitis, or with fibromyalgia, and then the great thing is it will help so many other things they didn't even think about. Whether it is depression, whether there are multiple arthroses, or even whether this is just a positive ripple effect or it's in their minds, I'm even asking, Hey, how's the erectile dysfunction? They'll come to the table with one thing and we're helping with a whole myriad of other things. 

Linda Elsegood: And what age group do you treat?

Dr Kelly Neil: So the youngest I've treated or have been treating is 12  It's a little prickly when they're younger than that because the consent forms have to be consigned by adults and all of that. So the youngest one is about 12 

Linda Elsegood: What would you say the main condition is that you treat with LDN?

Dr Kelly Neil: Hands down is fibromyalgia. The second one after that one would be chronic pain, sometimes together. 

Linda Elsegood: If we look at fibromyalgia, and we've learned over the years that people with fibromyalgia tend to be in the group that is ultra-sensitive to all drugs, and it could be LDN as well. What is the dose you normally start patients on?

Dr Kelly Neil: 1.5 

Linda Elsegood:  And do you find sometimes that's too high and you have to go lower or are all your patients able to tolerate 1.5 okay? 

Dr Kelly Neil: No, that's a good question. I have been humbled, sometimes I tend to be a little aggressive, so sometimes I've actually had to drop back. That has been a traditional recipe and a launching point for me. But yes, that has come back and bit me a couple of times where it has been too heavy. And may also have been the tablet form. Someone came back about a month ago. They had a little bit of headache and some nausea. So, I not only had to drop it back but also had to change it from tablet form to liquid form. That's what makes it still intriguing, not only the delivery system but also the dosage. So yes, I have been too aggressive at times. 

Linda Elsegood: And how long would you say it takes for a fibromyalgia patient to notice improvements?

Dr Kelly Neil: It depends on the second and the third diagnosis. If it's just completely inflammatory, then usually by the time I get to three milligrams, they should have already seen some types of improvement. If there's also something like neuropathy, it may take some time. Unfortunately three to six months, because of those nerve pathways and the connection properties, it's going to take a while for those connections to heal. It's my responsibility to set forth those expectations. So often they'll come to this table, or have done their homework, and they're thinking, Hey, it's good to do this, this, this, and that. Well, I have to sometimes revise the expectation that yes, you should start to see these great things, but it's really not going to cook dinner. It's the level of expectations we set.So your original question is, when do I start to see positive effects, usually within the first couple of weeks, but it depends on the ailments because the neuropathic ones can sometimes take three to six months. And that's where it gets discouraging for them. I just have to keep them in the game.

Linda Elsegood: Exactly. And I found that people with psoriasis as well, some people have noticed improvements quite quickly, but there are others who stay the same for like six months, which must be really disheartening. You keep looking at your skin, and you can see it's not improving and then suddenly after six months, you can start to see clear bits of skin coming through and it must be hard to be patient. We did a survey years ago, and there were some people that noticed no improvement in the form of no deterioration, which is if you've got a progressive disease and it's stabilized, that's still a win. Some people were noticing after as long as 12 to 15 months amazing things were happening. So we always say to people, even if you don't think it's working, give it 18 months. If you can afford it, it's not an expensive drug, and it's not doing you any harm. Why not stick with it and see. But the number of people who then have stopped taking it, we have found come back and restart because they had forgotten, they had this symptom or that symptom cause it had gone. And it wasn't until they stopped that it came back. Have any of your patients stopped and then restarted. 

Dr Kelly Neil: Yes. And let's stay with psoriasis for just a moment before answering a second question. Because psoriasis that's a trigger event can be brought on, like let's say by a strep infection. It's improving then all of a sudden, they get a second element that will set the trigger. That's really disheartening for them, especially with women who have that element of vanity.

 Let's say increased stress or demise or a wedding or mischief in their family, those elements with psoriasis can have that ebb and flow. The LDN research trust fund, you guys did that study with psoriasis. Hey, thank you so much. Because when those studies come out, I cut and paste those URLs into my patient portal and send it out to all of my patients just to kind of keep them in the know, because they feel that they're a part of something that's bigger than themselves. They feel like there’s an end then when you have these surveys and then they also get to.be a part of your surveys. So again, thank you so much on behalf of us because it is a family, a growing entity, and they want to be a part of that too, so thank you. But with the element of psoriasis, that will be something that is going to be an ebb and flow because the triggers are going to be different with regards to the patient starting and stopping LDN. There is that drug-drug interaction because of the opioids absolutely. But sometimes I'll give my patients a standing prescription to start and stop or to taper back up. They're almost hesitant. They really don't want to go back down to start back up on their LDN. They do know how but they really don't want to stop it because that tapering process takes so long sometimes to get to their therapeutic level, but they do know where it is. If they're having upcoming hip surgery or an upcoming back surgery they know, there's what I have. Certainly, I haven't coined it, but we've called it their, their sweet spot where they know where there is, especially when I'm dealing with depression because it's sometimes an ambiguous dose, an ambiguous element.

Linda Elsegood: And what would you say about LDN and pain? Do you use ultra-low-dose naltrexone?

Dr Kelly Neil: Not yet. I would love more research on it. Or maybe I've been ignorant to know where the ultra dose low is because usually I have started right at the 1.1 0.1, or excuse me, 1.5 then go right to the three. We need to look at other alternatives other than the opioids for pain.

The reports say look at cannabis, look at CBD oil, and then also look at LDN. I'm thinking. Great. Yes. I'm thinking, praise God here. Here we go. And then the silence of crickets, crickets, crickets. Well, wait a minute, we should be addressing LDN.  I was thinking, Hey, it’s gonna take off. And then it just ended up not doing this. It's like, wait a minute. So. 

For your recent question is, what do I think of ultra-low-dose for chronic pain?, I haven't found that the ultra dose is as efficacious as me just jumping right into the full dose of low dose naltrexone because of all the properties of everything else that it has done.

Because it does so well with the 1.5 and I'm just getting right to three and then sometimes just the 4.5.

Linda Elsegood: There are many doctors about to film an LDN and pain documentary about pain specialists using ultra-low-dose naltrexone alongside opioids. They find having a minuscule microdosing of LDN alongside the opioid makes the opioid far more effective. And what they do is titrate the LDN up or the ultra-low dose, the microdosing up, and then they can decrease the number of opioids. And surprisingly enough, in a matter of weeks, people that have been on opioids for 20 years, high doses, can come off or just take a very minimal amount of LDN. So that is something that we're doing at the conference as well this year. I think you'll find it very interesting. 

Dr Kelly Neil: I would love to see the literature on that because as clinicians, we have to take full responsibility for the predicament that we're in. Definitely it's needed. I'd like to see the literature as far as the other arm of helping to keep a status of decreasing the alcohol use in the LDN. Definitely, there are dopamine responses. We're just now kind of just tipping it and breaking the nut, but we got to really open up that nut and basically jump in.

Linda Elsegood: So I will get that information to you. Well, we’ve come to the end of the show. It's been absolutely amazing. Kelly, we could have talked for another half an hour easily. How do patients contact you?

Dr Kelly Neil: Thank you so much for putting the link to my website on yours. So you're one I'm on, then I'm on two other international websites, but basically, they contact me through the website, through https://www.hadarimc.com/. That's how they contact me. So my contact information, all my intake forms are right there. 

Linda Elsegood: Okay. And is there a waiting list? Do people have to wait long to be able to have a consultation with you?

Kelly Neil: No. Usually, it's within about three days to get an appointment. Most often the rate-limiting step is the patient filling out the intake forms. The intake forms are already on my website. Just fill them out from the window and attach them to the email. It’s possible to have a consult within a couple of days. 

Linda Elsegood: I know that Jill was very careful about taking a full patient history and that does take time. So if patients are able to provide you with all that information beforehand, has to have saved a lot of time. And it also gives them the chance to think about it and make sure they've mentioned everything. 

Dr Kelly Neil: Usually, the patients come to this table knowing what they want. So if you go to an Italian restaurant, you know, you want Italian food, you're not going to go to an Italian restaurant wanting, Mexican food. This is not set up for functional medicine. This is set up for integrative medicine. It's set up truly for concierge, an element, and that makes the beauty of the process because I have already done a lot of back investigation to know really what the patients want, and it makes my workload a whole lot easier too.

Linda Elsegood: Well, we wish you every success. We will have to interview you again next year and find out how your practice is going. 

Dr Kelly Neil: I would love that. The pleasure's all mine. Thank you so much for having me this morning. Thank you.

Linda Elsegood: https://www.hadarimc.com/ is a virtual entity set up to meet the evolving needs of their patients. They are a telehealth company currently serving California. They are committed to the advancing health direction. For full details, visit https://www.hadarimc.com

For any questions or comments you may have, please email me, Linda, that’s linda@ldnrt.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.