LDN Video Interviews and Presentations

 

Sara, shared her experience dealing with various health issues, including hypermobility, MCAS, CCI, endometriosis, and tethered cord. She explained that CCI affects the alignment of her skull and spine, causing pain and affecting her cranial nerves. Tethered cord, a newer diagnosis, is scheduled for surgery to release the condition in July. Sara has experienced symptoms since childhood, including dizziness, hand discoloration, and migraines. Her daily life is unpredictable, with varying levels of pain and difficulty recovering from injuries. Additionally, she has had allergic reactions without a clear cause. Despite the challenges, she remains resilient, working as a special education teacher and managing her health as best as she can. 

 

Linda Elsegood: Today we're joined by pharmacist Dr Dawn Ipsen who's the owner of two pharmacies in Washington state. Kuslers Pharmacy and Clark Pharmacy. Could you tell us what it was that inspired you to become a pharmacist? 

Dawn Ipsen: I knew early on as a high schooler that I wanted to have a doctorate degree in something and was sort of a little bit torn between pharmacy and optometry and with long heartfelt discussions and soul-searching I became a pharmacist and very early on in my career not only was I trending towards being a pharmacist but I had an opportunity to intern at a compounding pharmacy and just absolutely completely fell in love. It was the art and the science and the way of being able to help individual patients in manner of which no other pharmacist in my area was able to do so, of providing very personalized therapies. I was able to really listen to patient needs and work with their doctors, to formulate the exact therapeutic tool that they needed to improve their quality of life. That is really what has driven me in my career. 

Linda Elsegood: When did you open your first pharmacy? 

Dawn Ipsen: I had been a pharmacy compounding lab manager for about 10 years for the Kusler family. When they were ready to go do other things in their life I was given the opportunity to purchase Kusler's Compounding Pharmacy. It had been a pharmacy I had worked at as a staff member for 10 years and took over as the owner and I've now owned that pharmacy for almost 10 years. In January it will be 10 years. That was my first pharmacy. 

I was doing all my good work up at my Snohomish Pharmacy and suddenly had a random phone call on a Friday afternoon in which the Clark family was looking for a new owner for their pharmacy. They were ready to retire and go do other things as well. I've also owned Clark's compounding pharmacy down in Bellevue Washington for six years. I've been an owner for almost 10 years total and have had multiple locations now for about six years. We service not only the entire state of Washington but we also work within nine other states as well. Our boundaries go quite deep and it's a really great way to help all types of patients all over the nation. 

Linda Elsegood: What would you say is the most popular form of LDN that you use the most? 

Dawn Ipsen: I would say primarily we use the most customized strengths of capsule formulations of low dose naltrexone (LDN). It gives patients really great consistency yet opportunity to get the doses titrated in appropriately where they need it to be. What's really great about how we approach our making of capsules is we use hypoallergenic fillers. We're also able to work specifically with patients who have sensitivities. We can customize what that filler might be and I think that's really what sets our pharmacies apart and why doctors and patients choose to work with us. 

We are experts in autoimmune and chronic inflammatory diseases and therefore we're very used to working with patients where the normal just isn't what they need and isn't what's best for them. We can customize that to be appropriate for them. Along with capsules of course, we are able to do transdermals. That's really popular in pediatrics, especially for patients with an autism spectrum disorder. We are able to make flavored liquid tinctures of it so patients are able to use various small doses to titrate up doses. We also make sublinguals. I would say capsules are pretty popular for us. 

Linda Elsegood: What kind of fillers are you asked to use? 

Dawn Ipsen: Most of the time I will steer a patient towards microcrystalline cellulose (which is a tree based cellulose). It is very hypoallergenic for a lot of patients. However, some patients know they have tree allergies and those patients primarily prefer rice flour. I do have a couple of patients, but very very rare that actually do better on lactose filler. They tend to not be my autoimmune patients. They tend to be patients in the chronic pain spectrum area. 

We have also worked with other fillers, like tapioca flour. We can be very customized into our approach of how patients need it. I've got one patient that comes to mind that loves magnesium as their filler and that's very relaxing for their muscles. I've also seen probiotics being used. There is not one right answer to how we do things. We are that pharmacy that is able to have a conversation with a patient. We talk about what their needs are and customize it based on that approach. 

Linda Elsegood: From the prescribers that you work with, do you have many consultants that you fill scripts for? 

Dawn Ipsen: We definitely do. What's also kind of a little side thing that I do. I've always been very passionate about teaching. I'm on faculty at University of Washington School of Pharmacy and also Bastyr University which is one of the top naturopathic doctor schools in the nation. I teach there during summer quarter. I teach nationally to providers continuing ed-based content that is often LDN in nature or ties into LDN. Especially with autoimmune and chronic pain and chronic inflammatory conditions. We consult a lot with doctors. I probably work with three or four hundred functional med type providers on any monthly basis even on being able to customize therapies for their patients. We are really big in the post COVID syndrome arena of helping patients that are really struggling and LDN. We're finding it pairing quite nicely in that condition as it's very inflammatory based. 

We work quite heavily within the MCAS arena for patients who have a lot of mast cell instability and need other therapies. LDN is one of the tools that is used quite frequently by those types of providers and for those specific kinds of patients. 

Linda Elsegood: Do you work with any pain specialists, dermatologists, rheumatologists, gastroenterologists? 

Dawn Ipsen: We do. Honestly, I'm quite proud of our little Seattle area of Washington because we do have MDs that are pain specialists that are now really turning towards using LDN in their toolbox of things they have available for patients. They're getting quite savvy at it. They're doing a really great job. It is super exciting. I have some dermatologists. I consult a lot with my functional med providers that are seeing dermatology conditions like psoriasis. I have an email I need to work with a doctor on after this to help them with this patient with a psoriasis case. We are seeing it in the GI world as well for Crohn's and irritable bowel disorder. Those chronic inflammatory conditions. I would say the MD pain specialists are really turning around over here. Obviously with the opiate crisis that has occurred in our nation I think most doctors of any type of credentialing or medical training or experience are quite interested in what LDN is doing for their communities and what opportunities it affords for patients who are trying to make sure they aren’t addicted to opiates but yet have something to improve quality of life and their day-to-day living. Low dose naltrexone (LDN) has been an amazing tool for that. 

Linda Elsegood: I'm always excited to meet different LDN prescribers and nurse practitioners who are providing lots of scripts. When you get an MD or a DO that is prescribing LDN and it is completely out of their comfort zone, I always think yes, you know we've got another one on board. We're making it right. We're getting it. MDs are already working outside of the box. That is normal for them to look into LDN it's not normal for MDs to look at LDN but as you know I've interviewed so many people and so many MDs when they have a patient that they can't help and fix their issues. They've tried everything and they feel as if they've failed this patient and then they try LDN. Once they have had amazing results with the first person it's then so easy for them to look into prescribing not only for other patients with that condition but for any autoimmune disease, chronic pain, mental health, etc. I mean it's really amazing and this is where people like yourself come into play. The hand-holding with doctors because a lot of them haven't got time to do the homework. They're very busy and they need somebody to tell them exactly what it is, how to prescribe it, what to look for, what to do and have somebody on hand to say, like you said, I've got a patient with psoriasis. What do I do? Can you help me? That is the way to get more doctors involved is the pharmacist doing the hand holding. 

Dawn Ipsen: There is a local psychiatrist in our area that works with younger adults with substance abuse disorders and teenagers that are having a lot of trouble with mental health. I had an opportunity to get him thinking about LDN and his patient population. I love when I get to reconnect with him every few months because he just raves He finally has a tool that actually does something. He felt the antidepressants and all these other things were not really fixing any of the issues or fixing the symptomatology. We still have the same abuse issues, we still have the same addiction issues and we still have the same levels of depression and suicide risk. But with LDN he's finding that he's actually causing positive change in his patient population and that's the only thing he really changed within his practice. 

We're really affecting the health of our community in a very positive manner with something that's really safe and low risk and not expensive. It doesn't get any better than that. It's the best compliment I could ever have. 

Linda Elsegood: It's really nice when patients take all their information to the doctor. Once you've got a doctor really hooked on prescribing LDN they can change the lives of hundreds of patients. Dr Phil Boyle uses LDN in his fertility clinic He also uses it in women's health for things like endometriosis, polycystic ovary, painful periods, heavy periods. Right across the board he uses LDN. He gets patients coming to see him with women's health problems who also have Hashimoto's or long COVID etc. 

Dawn Ipsen: I refer to his work all the time. I get questions a lot from local providers such as we have somebody who wants to become pregnant or they did become pregnant and they're on LDN and they want to know what the standard of care is and can we continue, and what's the risk and benefit are. It is so great to have providers like him out there that have been doing this work for so long that we can very confidently share those case experiences and history of using the medication long term for those patients. 

Linda Elsegood: There have been so many of our members who were skeptical about using LDN during pregnancy. Doctor Boyle is always very generous with his time. I will send him details and he will answer the patient and share his experience. You know we used it once up until birth rather and breastfeeding, etc. We have those people who have done two or three pregnancies using LDN who are happy to talk to other people. This is my experience with 20 years as the charity next year, which is totally amazing, but I’ve found that word of mouth and with the education it is just spreading. 

Dawn Ipsen: Linda, you've done an amazing job with the LDN Research Trust and I thank you for that. You have made the Research Trust, its website, resources and its books into a trusted referral point that I can use with our doctors and our patients who are wanting that next level of information beyond what I'm able to say to them. They want to go see those studies themselves. They want to go read the book themselves and I know that without a doubt I can send them to your resources for them to receive complete in-depth and correct information. Thank you, Linda. You're doing amazing things and this is all because of you. 

Linda Elsegood: How can people contact you? 

Dawn Ipsen: We have two locations in Washington State. We have Kusler's Compounding Pharmacy in Snohomish Washington and the website there is www.Kuslers.com; and then we have Clarks Compounding Pharmacy in Bellevue Washington. That website is www.clarkspharmacywa.com. The WA stands for Washington. We are happy to help patients all over and talk with doctors that need guidance and assistance in learning more. I love being an educator and I love being here to support my community. 

Linda Elsegood: Any questions or comments you may have please email me Linda 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.

 

 

Linda Elsegood: Welcome to the LDN Radio Show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. Today I'd like to welcome our guest Pharmacist Suzanne Rosenberg from Community Compounding Pharmacy in Oregon. 

So could you tell us what made you decide to become a pharmacist? 

Suzanne Rosenberg: When I was in undergraduate school at Temple University in Philadelphia, which is my hometown, I worked at a pharmacy and I loved it. I loved working with people. I just loved everything about it and so when I graduated with my degree in psychology I applied to Northeastern University in Boston, Massachusetts and started pharmacy school two months later. I received my pharmacy degree from Northeastern. 

Linda Elsegood: Have you always stayed in the Oregon area? 

Suzanne Rosenberg: After I graduated pharmacy school I got in my car and drove to Portland, Oregon to visit some friends. I never left. That was 27 years ago. I've been practicing as a pharmacist exclusively in the Portland, Oregon area. 

Linda Elsegood: When did you buy the pharmacy? 

Suzanne Rosenberg: I moved to Portland and I worked for small independent pharmacies. I got really interested in herbal medicine. There was a company called Wild Oats that opened a large store and they had an idea where they put a pharmacy with naturopathic medicine in this grocery store with a yoga studio. They asked me to manage it. I did for six and a half years. I managed this pharmacy and turned it into a compounding pharmacy. Then another local chain recruited me and I did that for four and a half years. Then I decided that I had all these ideas of things that I wanted to do. Fifteen years ago I started Community Compounding Pharmacy in Lake Oswego, which is a suburb of Portland. It's a compounding only pharmacy. We predominantly work with integrative practitioners which I've been working with for over 23 years. I work with naturopaths, functional medicine doctors, integrative practitioners all over the West Coast. We started mainly in Portland, in the Northwest, but now we work with integrative practitioners up and down the West Coast.

Linda Elsegood: Please tell us about your pharmacy. How big is it? Do you do sterile and/or non-sterile compounding? 

Suzanne Rosenberg: We're fortunate that we only do non-sterile compounding. We're about 10,000 square feet. We have about 45 employees. We're open six days a week and we ship all over the nation, predominantly on the west coast and certain states on the east coast. Mostly on the west coast; Colorado, Arizona, Alaska, Hawaii. On the east coast: New York, Maine, Vermont, Connecticut. We are pretty much licensed mainly on the east and the west coast. We have been fortunate to have an extremely amazing staff that really supports our patients and our doctors and one of our focuses at Community Compounding is education. If you go to our website what you'll find is that we really focus a lot on education. We do that in two ways. One is we actually offer continuing education twice a year for the naturopathic community, although nurse practitioners are able to get the Continuing Education Credits as well. We actually just had one on Saturday and LDN was a big topic because it is for most ailments. One of our topics uh was PANS and PANDAS which is predominantly a childhood situation where they get inflammation. Low dose naltrexone (LDN) is a treatment for that and one of our doctors, Dr. Sarah McAllister spoke on Saturday at this conference and brought up LDN. In addition to that we also make it a priority to offer education for our patients. Patients have access to our pharmacist. We have four pharmacists on staff each day. One of the things that we really pride ourselves on is making sure that if a patient calls and has a question that their questions are answered in real time. In addition to that, every prescription, before it goes out, gets a personal phone call from one of our pharmacists to counsel them and make sure that they understand what this medication is used for, how to properly take it and just ask any questions that they may have before that prescription goes out to them. 

Linda Elsegood: Education is key. I would say pharmacists, even though they’re busy people have more time to do the research than doctors do. You are the people that educate the doctors and do the hand-holding and explaining to the doctors. They are not experts in drug interactions. That's the job of the pharmacist. We find the pharmacies that spend the time on educating their doctors help so many patients because you get a new doctor on board. How many patients does that new doctor prescribe LDN for? Then that doctor meets up with other doctor friends and they invariably end up talking about problem cases. Then LDN comes up and it's easier for the pharmacist who deals with that doctor to mention LDN because of a light bulb moment. I was talking to a colleague who talked about LDN but I don't know much about it, I don't know how to prescribe it. Without the pharmacist being so well educated themselves about LDN they wouldn't be able to convert the doctors into LDN prescribers. 

Suzanne Rosenberg: I’m trying to convert doctors in Oregon. Oregon is kind of one of the meccas of alternative medicine. In Portland and in Oregon in general we have a lot of information. We have a really tight integrative community here and it's really neat to see. They teach each other, they're supportive of each other. It's a really neat place. I feel very fortunate that I get to practice in Portland, Oregon and in the northwest. It's a really special place. Especially as an integrative pharmacist. My entire pharmacy is an integrative pharmacy. Our model is different from some of the other compounding pharmacies in the city who I have a ton of respect for. Ours is different in the sense that a lot of the other compounding pharmacies will market to doctors who are more focused on allopathic. We do work with allopathic practitioners. We are the main compounding pharmacy for OHSU. Alll of their LDN from Oregon Health and Science University or at least most of it they have a tight relationship with us. Our model is different in the sense that we really only market and seek to educate alternative practitioners at this point. 

We are licensed all over the nation and I personally will travel. I have another woman, Holly, who also helps me. And we meet with naturopaths, functional medicine doctors, integrative practitioners, doctors who are interested in learning alternate ways of treatment. What we see as our role is to go out throughout the nation and meet with these doctors. That's really our focus. We work with doctors all over the nation. We actually will travel and we do what we call a lunch and learn. On our website you can actually go onto our website and there's a doctor portal on there. In that doctor portal you can actually request lunch and learn. We go and we sit and we meet with these doctors. We go over integrative products that we have. A lot of them have never heard of these formulas. Because we work so closely with the integrative practitioner group in the northwest we're actually creating formulas, including using LDN. We've been using a lot of LDN topically at Community Compounding. We have a formula now that we're really proud of that is a topical LDN for lichen sclerosis with some herbs in it, as well as, some hormones. We also use LDN topically when it comes to psoriasis and eczema. We use that in conjunction with a product called Ketotifen which is a mast cell stabilizer. What we do is we use LDN orally but we've also been utilizing a lot in our topical preparations. And we use a lot of integrative treatments for hair loss, skin conditions, gut, gut health and will intake different products and combine them for these new products that a lot of doctors haven't heard of because they're predominantly products that we've created with doctors in the northwest. It's really neat to go out and share these products with our doctors. All of this stuff actually is available in this doctor portal on our Community Compounding Pharmacy website; you'll find it. You will need to ask for access. My assistant will send you a code within 24 business hours. You'll have access to all of our prescription pads, all of our research articles that we have in there, and recommendations for treatments. 

I have a pamphlet about a talk that I had done in January in Hawaii for some naturopaths. It is is a little pamphlet of our top 20 formulas that our pharmacists love. Not all of them are things that we do every day but they're things that patients have come back to us and said, “Wow this really works.” Or they say, “A doctor says that formula is amazing.” Then they start telling their colleagues. That's a new thing that we just came out with a couple months ago. It was serendipitous. We didn't intentionally plan to put this together but I did it for a talk and handed it out to some doctors and they loved it. So now we have a list of the top 20 formulas that we wanted to share and we'll be adding to that regularly as things come up. A place to get a lot of information is on the doctor portal. 

Linda Elsegood: You mentioned Dr. Sarah McAllister, (you can put her name in YouTube you will see that I interviewed her many years ago. Maybe even as many as 15 years ago.) It's been a long time since I have spoken with her. She is a very nice young lady. 

Suzanne Rosenberg: She's amazing. Her talk was amazing. If anyone's interested in learning more about our talks you can go online. This one we just had recently, so in about two weeks the lecture will be available. If you're interested in learning or you know can't attend any of our webinars they are in person and they are also webinar based. You're more than welcome to visit our website. You don't need to log into the doctor portal and you can get access to these conferences. We do two conferences a year. Some of our other topics that we cover are women's health, Ehlers Danlos, mold, PANS and PANDAS. We had mitochondrial health on this last one. I would say at least 60 percent of our talks have LDN in those talks because it's so prevalent now in treating so many things. We've done a lot with the gut. We've had a lot of gut talks at these conferences. Another phenomenal naturopath in Portland, but you will see that in a lot of these treatments LDN is indicated for a lot of these patients. It is a hot topic not only in terms of autoimmune which is kind of what traditionally I would think of it being used for but now we're seeing it in so many other ways to support our immune system that is pretty much in every conference whether it's at every talk maybe sometimes women health not so much. It's a hot topic at our talks. 

Linda Elsegood: What about chronic pain and opioid addictions and people off of opioids? 

Suzanne Rosenberg: We have an amazing doctor in Portland who is a naturopath. She works at the pain clinic at OHSU. She's an amazing doctor, amazing naturopath, an amazing human being. We worked very closely with her and she prescribes two things. Well, several things through us. One of the main things she prescribes through us is LDN. She does a lot of our topical pain creams as well. We also do topical pain creams for patients who are in chronic pain and the goal is to get them off of their narcotics and switch them over to LDN. I just had a patient yesterday who actually this was this was an unusual patient this was a patient who was not seeing one of these doctors, but has done her own research and is starting on a really low dose of LDN and is working with a doctor who has basically been brought in through the patient request of prescribing LDN. So here's a doctor who knew very little about LDN and here's a patient who's educating their doctor on their own. These two came together and I was counseling the patient and she was really up on her LDN. There's a lot of information out there. It was really neat to see and she was telling me, “Yeah my doctor doesn't know a lot about it so she's going to help me you know. We're gonna do this together.” That is an unusual situation but we see that too. It was a really neat conversation. 

Linda Elsegood: Regarding women's health: Dr. Phil Boyle has been using LDN in his Fertility Clinic for 20 plus years now with great success. He also uses it for endometriosis, polycystic ovaries, painful periods, heavy periods, all these things that women have to endure is found to be very very helpful. 

Suzanne Rosenberg: This is also a phone call I had yesterday with a nurse practitioner. I was on the phone all day long as are my pharmacists. They are answering questions, coming up with formulas. We had a nurse practitioner call me yesterday. Again, someone I've known for 20 years and she has a patient who has severe pelvic floor pain. What we're doing for this patient is a formula. This particular patient had actually some inflammation. They had burning pain. We were doing a suppository for her. She has mast cell and we're doing cromolyn and she had already been on diphenhydramine and ketotifen which are antihistamines. I suggested that she adds some naltrexone to it. So we'll see what happens. These are the kind of formulas we're always thinking when we're having a situation where a patient is in pain and we're trying to oh wait, and put some lidocaine in there as well, um but when a patient is in pain and we're putting things together naltrexone is always something that I'm starting to incorporate into these products because I'm finding that we're getting great results. I mean the Lichen sclerosis formula has been a huge success for us and this was a formula that we had been playing around with for years. We've been working with glycyrrhiza which is licorice root, which is a common treatment for lichen sclerosis. There was a product on the market for many years that contained licorice root. This new formula that we've created is a combination of estriol, glyceriza, aloe and naltrexone and some vitamin E. It's a steroid free cream and we have been working and trying to find something that is steroid free for lichen sclerosis and this is really the first time that we're getting feedback from our doctors and our patients, our doctors primarily because you can see it. You know they try it on one patient, they try it again and they're calling me and saying what was that formula that I called in for lichen sclerosis? I need it for this patient because it works so well. That's kind of how we get our feedback. We're really excited to have that and I'm finding that when I'm creating formulas now I'm thinking a lot more of putting naltrexone in these formulas even if they're not for other areas of the body. 

Linda Elsegood: Your patients that use it for a dermatological condition, how long do you normally find it takes before they experience any improvement? 

Suzanne Rosenberg: We are at a disadvantage because we don’t have a lot of patient follow-up. Usually pharmacists hear really amazing things or we hear things when there's an issue. We don't get to see patients all the time so it's hard for me to say but I know there's a research study that PCCA did specifically on naltrexone in their zematop product for eczema. It is something that you can Google and it has some dates and some time frames. 

What we do for our eczema and psoriasis cream is we actually add ketotifen to it as well. So it's a combination of naltrexone, ketotifen in their zematop product. Typically if patients don't get results after a month they usually stop. Most of our patients are getting results within a couple weeks. I have spoken to lots of patients with skin conditions. They seem to be the people that take the longest to respond, to notice improvement. Some of them may take six months. They stick with it and it takes that long. A lot of these patients are on LDN orally so they'll be on LDN orally for a while and then we'll start the cream. They've already had the advantage of being on LDN. 

One of the things that I did want to share with you guys is that one of the things that we decided to do as a compounding pharmacy, especially post COVID, is our focus was really on becoming efficient. By that I mean having patients wait for their medications is no longer an option. We really wanted to make sure that efficiency was a priority of Community Compounding. One of the things that we did because we work very closely with the mast cell activation community in the northwest is we decided to start finding ways to have our turnaround time shortened. We really value our employees. They are making large batches of capsules and it is actually physically challenging. It's a lot of work. About six months ago, one of the things that we decided to do is we decided to invest in a tablet press and we are now pressing two drugs at Community Compounding. One of them being naltrexone. We are one of the few compounding pharmacies in the United States that is making low dose naltrexone tablets. Our low dose naltrexone tablets are a little different from some of the other compounding pharmacies because we work so closely with the mast cell activation community. We're very aware of allergens and food sensitivities and potential allergens for these patients. When you make a tablet you have to put a binder in there. A binder is something that holds it together and most binders are pretty inert unless you have mast cell activation or severe allergens. These patients can't tolerate many things including such things that you and I could tolerate easily. What we decided to do is we decided to not use any binders in our tablets. Our tablets only contain two ingredients. They contain a cellulose that we specifically use that is GMO free and allergen free. It's kosher. It's made from organic materials. The only other ingredient in our product is the drug. It is a GMO organic material, cellulose, called flow cell and naltrexone. If a patient is a vegan, if a patient is allergic to silicon dioxide (which is a very commonly used for most tablets), there's no issues with taking these tablets. The best part about these tablets is that they are scored. What happens with these tablets is they can be cut very easily. As you know most compounding pharmacies, including us, make naltrexone capsules which are great and we've been making them for 15 years. Of course capsules can't be accurately split. You can open one up and kind of guesstimate which we don't typically recommend as a pharmacist but it can be done. With these tablets you can use a pill cutter and we do recommend using a pill cutter because we use no binders. We press them really hard. So they're very hard. We do tell all of our patients that they will need a pill cutter. They can cut them right down the center so they know that they are getting 50 percent of that tablet. As an example, we only make three strands. We don't make a 1.5 because we make a one, a 3 and a 4.5. The one we make because we have so many patients who are super sensitive to medications, a lot of our patients will start on the 0.5 dose. It's not the most common but it's definitely common enough that it was something that we wanted to be able to offer this option. For the super sensitive patient you would use the one milligram tablet. You will have them cut that in half and start with a 0.5 and ramp up slowly to the desired 4.5 milligram dose or three milligram. Wherever they land. The three milligram tablet we made because that can be cut in half and they start with the 1.5 milligram tablet, half of that which is the 1.5. Half of the three and slowly ramp up to the 4.5 and then we do the 4.5 as the maintenance dose. What's really nice about it is that this saves patients a significant amount of money when they're using these tablets because as you know compounding pharmacies are very labor intensive. Any time that you can decrease labor in a compounding pharmacy what you're doing is you're significantly decreasing the labor dollars and then the goal is to be able to save the patient's money. The only way to do that as a compounding pharmacy is to decrease labor. What is important about it is that we have the same staff that we had here a year ago but people are working better not harder now. 

We now have an R&D team, which is a research and development team, that helps us when we have new products that we want to create and there's an issue with something, if we want to bring in a new base and we want to play with it, we have an entire team now who works on all these products. We have an IT team now. We just came up with a new IT team, where my staff in each department has their own IT specialist. The point that I'm trying to make is that as a result of the tablet machine and other ways that we've become more efficient we're actually a better compounding pharmacy. We are offering better customer service than ever. Our turnaround time is now one to two business days. I now have more time to go out and meet with doctors, educate, network and learn. The tablets are great for so many reasons. For the patients, for the pharmacy and for our ability to educate and really reach out to more people. We are really excited about these tablets and they've been a huge success for us. They've really been a great relationship builder, too. Doctors are able to use my local pharmacy for my estriol vaginal cream but also use Community Compounding for tablets and then we create these relationships. 

Now they have more pharmacies to network with if they have issues that come up with their patients. It could be that their compounding pharmacy doesn't carry a product that we carry and that happens often. Some things are expensive to carry and that creates new networks We work with other compounding pharmacies and share formulas and that has been a really nice way to network with doctors and our patients. 

Linda Elsegood: Can you tell people your website so that they can go and find out more about you. 

Suzanne Rosenberg: It is www.communitycmpd.com Or you can also type in Community Compounding Pharmacy in Oregon and you will find us. We are licensed in the whole west coast, most of the east coast. 

 

 

The LDN 3: To Purchase with discounts before 1st September 2022 Go to ldnresearchtrust.org/ldn-book-3 for full details

 

 

LDN Webinar 18 May 2022 (LDN; low dose naltrexone)

LDN Questions Answered Live by

Pharmacist Dr Masoud Rashidi - LDN Specialist
Dr Sato-Re
Dr Mathewson

Sponsored by Innovative Compounding Pharmacy icpfolsom.com

 

Dr John Kim, LDN Radio Show 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'm joined by Dr. John Kim from Georgia Integrative Medicine Clinic in the US. Thank you for joining us today. 

Dr John Kim: Oh, you're welcome. It's my pleasure and honour to share this wonderful therapeutic known as low dose naltrexone. 

Linda Elsegood: Thank you. So could you tell me your qualifications, please? 

Dr John Kim: I am a physician originally trained in family medicine, then Chinese medicine, integrative medicine, preventive medicine, public health. I think before I went to medical school, I was doing basic science research in biochemistry, and I was a Howard Hughes Medical Research Fellow for pharmacology. 

Linda Elsegood: And when did you first hear about LDN? 

Dr John Kim: So this interesting part is that I have gone through two residencies, two fellowships; including an integrative medicine fellowship with Dr Andrew Weil at the University of Arizona. Those times spent in training I'd not heard of LDN. I did not learn about LDN actually until a patient of mine came to me and said, “Hey, listen, I have a thyroid issue, and I've done this research, and I just can't get a doctor to prescribe me LDN or low dose naltrexone. Would you at least do the research for me? Because you're one of the few doctors that listen to patients. And you have an open mind?” So I said, sure, let me do the research. And when I did the research, I was very surprised by the fact that this has been well-documented and utilized extensively since Dr Bihari’s use in New York, and all evidence seems to indicate very little risk and all possibilities of benefits.

So I told the patient, yeah, sure, let me go ahead and I'll prescribe the medication, and it's going to be a bit of an exploration on both parts. And amazing things began to happen. Not only her thyroid issues began to reverse and over several years not only her thyroid issues reversed, but she conceived and delivered a baby.

And so. That person made me think a lot about the possibility of what else is possible with LDN. Me being a cautious practitioner I had to go very slowly for the next about five, six years; and I would target other patients with thyroid conditions. And I began to see a pattern that I can't do with other medications. Because with all the medications in conventional medicine, we can replace thyroid hormone in different forms, but I don't have a possibility or ability to reverse illness, reverse thyroid disease. We just let it go until it goes into total failure, and you just up the dose. And in this case with LDN, I began to see patients whose doses can be halved, and other patients would basically become drug-free. And then other cases I would see the antibodies related to hypothyroidism lowered in number.

Linda Elsegood: And did any of your patient's experience negative side effects when first starting LDN?

Dr John Kim: In the beginning, none of the people really experienced any of the side effects, but as I began to use LDN more in-depth, I began to see side effects. One of the things I've run into is that typically the LDN low dose naltrexone in the literature is considered between 1.5 and 4.5. But I've noticed that in patients with what I call low endorphin reserve, where a patient has been sick for a long time, patients not feeling well for a long time, their daily activity is compromised; in those patients, I've seen that the 1.5 milligrams can have a paradoxical effect. Patients can not sleep. You tend to create insomnia. And I think that's well documented. In patients with PTSD, the LDN also can cause vivid dreams related to the PTSD; or further, create trauma. And in such cases, I began to experiment with lower doses. So I would begin using 0.5 milligrams or even lower. Now today I start even at 20 micro micrograms, and then I'll do a rapid ramp to get them to 1.5 milligrams. 

Other side effects that I've seen is some nausea. I have patients that could not even tolerate one microgram of low dose naltrexone; they just feel really, really bad and in pain. So again, I think that their endorphin reserve is quite low and they’re not tolerating this dose. 

Linda Elsegood: And you were talking about thyroid conditions. Have you prescribed for other autoimmune conditions now? 

Dr John Kim: Yes. Oh, you know, it's thyroid Hashimoto's thyroiditis. One of the first things that I started treating when I saw the effectiveness of LDN for treating thyroid conditions - I said, Hey, if it works for Hashimoto's thyroiditis and the mechanism is through correction or modulation of our immune system, why not? Why wouldn't it be a shift in theory, work for Graves’ disease? So I began to treat patients with Graves’ disease.

Graves' disease is very interesting because the response to LDN in Graves' disease is maybe somewhat lower than with Hashimoto's thyroiditis. I have several patients who are doing very well, and they are in remission from Graves' disease with using nothing more than low dose naltrexone.

As I can understand the mechanism by which LDN works I decided that maybe we can do more. Again, the literature also helps us. So I began to treat patients with MS and we just got some amazing results, including one patient who is actually in remission from MS. She almost was not able to walk, and now she's climbing Mount Kilimanjaro and travelling all over the world and being able to enjoy a very high quality of life. And then other rheumatological conditions, such as psoriatic arthritis and many, many other conditions. 

One thing that I really noticed is that through my practice I'm beginning to see LDN beyond just what we accept in literature. For example, I have some patients with dementia and Parkinson's disease and LDN I believe has helped to mitigate or slow down, or some cases reverse - not fully - but some effects of dementia and Parkinson's disease.

Linda Elsegood: What about cancer?

Dr John Kim: Cancer is one area that I think - I recently accepted a position with Miami Cancer Institute with the Baptist Health of South Florida, and the reason for that is that in my current private practice, I think that my experience with autoimmune diseases have been extensive and I've seen excellent results with low dose naltrexone for treating autoimmune conditions. But for cancer, to be honest, I just don't have enough patients coming to me who have cancer, and the patients that I've treated with cancer, I am not able to say that it works or doesn't work with cancer.  What I have seen is studies, especially by Dr. Berkson in New Mexico, who is combining the low dose naltrexone and alpha-lipoic acid. So I began doing that as generally part of my treatment of cancer, but I'm looking forward to my new position where I will be able to see more of those patients.

Right now, I have developed a bit of reputation to help patients with autoimmune conditions. I see a lot of patients with autoimmune and different kinds of autoimmune conditions, and that has really helped me to understand the function and utility of LDN for autoimmune diseases. So what's interesting to me is all the cases where I am using LDN may be somewhat different from other people. One of the things that I've utilized LDN for is the gene for insomnia because one of the things that LDN does is to increase REM sleep, decrease sleep disruption; and also enhances people’s ability to fall asleep. And that's one of the reasons I think, unfortunately for the patients with PTSD, that doesn't work as well, because these may get them back to the conditions or memories that are very traumatic because it's very, very vivid. 

The other things that I’m treating are things like tinnitus, migraine, endometriosis, and infertility. What I'm seeing is that LDN has multiple chemical functions. So one is, its modulation of proinflammatory cytokines through the clear cell in the central nervous system. And that's the primary response to invaders if you will, in our central nervous system. And as such LDN is a very valuable tool. 

But in addition, it seems like LDN has other functions, such as it seems to have a very calming effect on the nerves. So LDN can be, I think, used very effectively for treating neuropathies of all different kinds. Also, as I mentioned earlier, it's almost like an adaptogen all by itself, so I often use LDN to treat patients with a mood disorder because having more endorphins seem to make patients respond better to the conventional and nonconventional treatments of depression and anxiety. Because it's kind of hard to feel depressed when you're feeling good, and endorphins give you that edge that feels good. So while you feel good, it's difficult for you to feel either anxious, or feel good and depressed at the same time. 

Linda Elsegood: What do you do with patients that are already on strong opiate painkillers when they come to you? 

Dr John Kim: So those patients are very interesting. About 50% of my practice is treating patients with severe pain using neuro-anatomic techniques, and I don't prescribe any narcotics at all. But we have a good track record of helping patients to get off narcotics, and in this case, we use a phenomenon of low dose naltrexone, utilizing microdose naltrexone, also known as ultra-ultra-low dose naltrexone. And in this case, we use micrograms of naltrexone. Again, as I said, the usual dose that people use of naltrexone is about 1.5 milligram to 4.5 in LDN amounts. But it's very interesting because you can take microgram doses, which is a thousand times less than milligram doses, and there are studies that demonstrate that a microdose of naltrexone results in better pain relief, and it also lessens the side effect.  I have a couple of patients treated with this ultra-low dose of naltrexone, and they’re doing great. Great, great, great response. Because I have chosen not to prescribe for narcotic, they still go to their pain doctor, and the pain doctors are quite pleased because usually if you just give narcotics alone, the doses have to go up, up, up, up, up, and that's when you have overdose phenomena and people get in trouble. But in this case, what happens is that with the combination of the low dose naltrexone and the neuro-anatomic approach to pain that I developed over 20 years, we can actually reeducate their central nervous system and lower the dose of narcotic, while the patient is reporting much-improved pain. Such techniques, actually, I think to warrant a lot of research oncoming because of the obvious problem with the narcotic overdose that is going on in our country. As a matter of fact, there's medication right now that is being studied combining ultra-low-dose naltrexone and narcotic medication. It's not been approved yet, but there'll be interesting how the Oxytrex will work for patients. 

Linda Elsegood: Do you keep them on the ultra-low dose, or do you increase it over time? 

Dr John Kim: As their narcotics amount goes down, then I march it up because, with low dose naltrexone, I think that there is a benefit. I think the key is to start the patients depending on their narcotic history and narcotic use history and their functional assessment of the endorphin reserve status, and then trying to match that clinically. And then generally I march them up. LDN really has been an invaluable partner for me to get my patients well, 

Linda Elsegood: You also mentioned alpha-lipoic acid. What do you use as a protocol? Do you have a general protocol for it?

Dr John Kim: Absolutely. Dr Berkson's protocol of using LDN and alpha-lipoic acid is published; anyone can look it up. I believe that he uses IV though, so I researched more talking to pharmacists, and it seems like that protocol has a side effect that people can pass out. Also, if the GI system is working, I feel like that is the first thing that we should do.

So with alpha-lipoic acid, I generally like to utilize the controlled release form or slow-release form, and that also depends on the person's ability to take alpha-lipoic acid, because if you give 600 milligrams to everybody, some people who are very sensitive to it may pass out or get hypoglycemic symptoms because alpha-lipoic acid can be a powerful agent to lower blood sugar levels in diabetic patients. It also helps with neuropathy. I know that alpha-lipoic acid and LDN are a very powerful combination to reduce inflammation in the nerves. 

And that makes it interesting because most of the medications that we use do not necessarily work well in what we call a high-hydrophilic or -hydrophobic environment. A hydrophobic environment means that it's not easy for charged molecules to enter and do its job. LDN seems like it can penetrate very easily. Alpha-lipoic acid also is fat-soluble, so those two are very important. I believe that Dr Berkson’s protocol for utilizing alpha-lipoic acid may have to do with the function of keeping the blood sugar low, therefore allowing the tumour growth to be inhibited. But I think that again, a lot of studies need to be done. And that's one of the reasons I have accepted this new position in Miami for the Miami Cancer Institute. And I'm hoping that as the director of integrative medicine I will be given permission to explore the possible roles of using low dose naltrexone and other proven therapies in a system-wide manner. 

Linda Elsegood: Do you use vitamin D as well? 

Dr John Kim: Yes, of course, of course, I do use it. If it's low, I do supplement it. It's not a part of my protocol. Part of my protocol for cancer also includes fat-soluble vitamin C, that would be ascorbyl palmitate, because otherwise, you have to go through the vitamin C injections. I think that there are multiple responses you can get from vitamin C. So for example, high doses of vitamin C injections, that's been documented by Dr. Jeanne Drisko in the University of Kansas medical centre - I think that that research shows that the vitamin Cs can help the formation of hydrogen peroxide. And then the hydrogen peroxide goes after the tumour cells. In the dose that I'm using, I don't believe that vitamin C dose is high enough to do that. So it doesn't replace the need for IV vitamin C treatment. But again, it has to do with my current practice setting, that IV therapeutics is not very easy for me at this time. And by using the fat-soluble vitamin C, what I'm doing is overcoming the required amounts that can be taken in by the body.  There are no formal studies that fat-soluble increases the amount yet, but it makes sense to me. I think that fat-soluble forms of therapy can be extremely valuable.

Oh, another example of that is S-Ethyl glutathione where the ethyl group is attached to glutathione. Multiple people have tried to play with the different formulations, but I think that the actual chemical alteration to make the molecule more hydrophobic is probably cost-effective and the best solution for some of the molecules, to encourage them to go where they need to be going to do their job. 

Linda Elsegood: And you were saying that you weren't taught about LDN in medical school. Do you think that's likely to change anytime soon? 

Dr John Kim: I don't think so. I think about integrative medicine and how it is now being discussed, or at least covered more in elite medical schools. So if you look at the distribution of integrative medicine in the United States alone, really it's reserved for what I call first-tier medical schools like Harvard, Vanderbilt, Duke, Yale. But it has not really penetrated a lot of the regular schools with the exception of maybe the University of Arizona, where Dr Andrew Weil started the program. Even there, I think medical students have a lot on their plate. I don't think they get enough about nutrition. I think that the medical education system is arcane. What I would like to see is breaks in mores in residence level, where after doctors graduate medical school, they get trained. That's where the doctors learn to be doctors.

What I've done with my recent book, in some sections, I've even published the patients’ lab results - not patient's identity - but their lab results, so that they can see after treatment with LDN that the TSH would start low, and then the TSH would normalize. T-3 would be high and then it would normalize and then it would also see the antibody levels all responding. 

Linda Elsegood: I understand that there is a medical school in Oregon that actually teaches LDN to the medical students. So that has to be a start, probably. 

Dr John Kim: It has to start somewhere. I think that for me that integrative medicine means working with patients, and that has really helped me to learn about an LDN. The nature of my practice is about 50% dealing with intractable pain. The other 50% is dealing with patients who have complex problems that they really can't get answers on. And what I found is that LDN doesn't cure everything. I think that it's dangerous to say one thing can do everything. Like, if you do LDN, you don't still need to practice good medicine. 

But LDN can be an amazing tool for autoimmune diseases especially. A lot of the tools that we have are not benign tools, or you cannot use steroids forever, you cannot use immunosuppressants forever. And I think that LDN also helps you to understand the nature of the disease. I'll give you an example. I had the longest time thinking why, how can LDN work for HIV? So when I began to read more about HIV, I found out that HIV actually is not strictly an immune deficiency condition. It's really immune derangement, meaning that the immune system is not functioning the way it's supposed to be functioning. So similarly we can postulate, we can guess we can think about cancer. Is it also possible that a cancer patient's immune system is deranged? It's not doing what it's supposed to do?

So in my practice, in the beginning, when people have an autoimmune disease, we would just use LDN. And then inevitably we would have patients for whom LDN isn't good enough. It's not doing the job by itself. So what I have done is more research, more reading, and more talking to other people, and I found out something very fascinating. What I found out is that if you have an autoimmune disease, it makes sense to check the person's autoimmune profile. And what I mean by this is not by doing conventional testing of things like C reactive protein, doing and an ANA check, or ordering an immune profile. And of course, I do that. Part of my assessment is to screen for their developing other autoimmune conditions before placing them on LDN. 

But if the patient does not respond to LDN, I think that sometimes, doing additional testing, either allergy testing to see if there’s an allergy to both respiratory allergens -  things like fungus, trees, grass, as well as food allergens. Both IgE and IgG can make sense, because again, if we're looking at autoimmune diseases as immune derangement, then you're looking for places that immune system is not functioning the normal way. I think the LDN is a powerful tool, but as I said, there are patients who don't respond to LDN alone. 

One patient had a double rheumatoid condition, and LDN alone wasn't doing it, acupuncture wasn't doing it. So what I finally did is testing on the food section, and the patients stopped eating that food; and I used immunotherapy to reteach the body to forget, to let go of the allergens that person had. And the amazing thing happened. Both of her rheumatologic diseases disappeared to the point when she went back to her rheumatologist and said, Oh, we made a mistake. We're sorry. And the patient said, Hey, you mean to say that my lab and my x-ray were all conspiring together? That's unbelievable. That's not likely. I think it's more likely the LDN plus the immunotherapy that Dr Kim asked me to do, is working together. And it's resulting in this remission. 

Linda Elsegood: You've mentioned your book. Would you like to tell us the title of the book and when it will be available? 

Dr John Kim: I'm hoping that the book will be available in December. The press release went out some days ago. The title of the book, I put it as “Understanding Low Dose Naltrexone Therapy” and then its subtitle is “A Cure For All”. I mean the illnesses of cancer, and chronic diseases.  I have to contact my old editor and see if she is available to take the job, because she edited my first book and she did such a great job, so I want to see if she can edit this book as well.

Linda Elsegood: Do you expect that you're going to be moving? Can patients still come and see you before you move, or are you fully booked? 

Dr John Kim: I think patients are still coming to see me, and my understanding is that - when I interviewed with them, they assured me that even though I'll be in the cancer centre and seeing mostly cancer patients, I will not be forbidden to see other patients. I'm really hoping that it will be the case because I feel like the autoimmune approach that I've developed can help patients, and especially patients who are not good candidates for conventional medicine in terms of long term steroid use, or the immunotherapy itself can be very harsh to some patients. So I'm hoping that I would be allowed to do that. 

And the other part is that I have this idea that some forms of cancer may involve the host, the patients. Developing all that I said about the immune derangement, that maybe their immune system is obsessing over something else, maybe food allergens; or they have an undiagnosed autoimmune condition. I've seen that once you develop cancer, you stop looking because cancer is such a deadly condition, you want to zone in on that. What I'm hoping to do is be allowed to do other observations, observe their autoimmune conditions. It can be more formal in terms of formal research, or it can be just the clinicians’ observations.  

I  remember a long time ago in London, the cholera epidemic was controlled by a Mr Snow or Dr Snow, that did not know the mechanism. He just used epidemiology to isolate the wells that were likely to be responsible for cholera. He didn't know the exact mechanism, but all he had to do is shut down those wells, the old water pumps, and then he was able to help. The field of medicine relies on collaboration and cooperation, and that's part of the reason I've accepted the position in Miami. But I think there's still room for one person to make an

observation, then through communication through books or through organizations like your organization, to reach out and ask these questions that no one else has asked. 

Linda Elsegood: Thank you. And thank you very much for your time, and sharing your experience. 

Dr John Kim: Thank you for the opportunity.

 

Any questions or comments you may have, please email us at Contact@ldnresearchtrust.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.

Pharmacist Rosella Pirulli Menta, LDN Radio Show 19 June 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'm joined by a pharmacist and naturopathic doctor, Rosella Pirulli, mentor. Thank you for joining us today. Rosella.

Rosella: Thank you for having me.

Linda Elsegood: Now you said that you got an extraordinary story to tell us:  Your journey. Would you like to explain that to us?

Rosella: Well, I went to St John's University in Queens, and that's where I got my degree in pharmacy and when I started working at a pharmacy in the Bronx of New York I wasn't very happy with just filling prescriptions and checking them and I felt that was not for me. I felt that, if I was going to have a profession and be successful, I wanted to show my children a different way to have a great life and also to be a part of a profession that helps people feeling amazingly well.

So that was my goal and so I only worked in that type of scenery for a few years and then I decided to look into other avenues. I went into homoeopathy where I did get a certificate in homoeopathy and I also looked into supplemental products because I really enjoy the supplements and teaching people how to take the correct supplements, especially if they are on certain medications that require supplements because of the problems that supplements can cause as a side effect. And the first thing I did learn was when patients were taking stands that they need to coQ10 we had a lot of patients that would complain of muscle weakness, fatigue and so I said: " You know what? I need to help patients with  drug issues and side effects." And that was the first step. And then patients would come into the store and I had a lot of patients that would complain about half flashes. And so I said, let me look into that avenue. And so, I started to dwell on how I could start a career in compounding and in that store I really couldn't do it as well but I did get my training to PTCA, and they are an FDA approved facility where I got most of my training from compounding and also in the avenue of bioidentical hormones. And then from there Rye Beach pharmacy took me on because they had a full compounding lab at the time and so they asked me if we did the store for a few years afterwards to be more in compliant, because we're now accredited by the board of PCAB and we also 700 compliance, soon to be 800 compliant by the end of the year.

But in the interim, I had to move to Florida where I worked part-time for Rye Beach pharmacy, and then I worked for a pharmacy in Florida so I had my license there as well. And I was commuting back and forth. I would come here and market to doctors because when I did graduate, I received my bachelor's in pharmacy, but I also, not knowingly, I minored in marketing, so I was I guess then I knew I was going to market, which is great because I enjoy networking.

That's like the passion for me to get doctors together, doctors and pharmacies together. It's my passion to help people get to know each other and there's always room for other avenues. So that's my enjoyment. And right now, I do have my own office where I see patients, I do phone consults as well and I also review blood work with patients. I'm really close to many of the doctors. So that's where I learned more about LDN because I went to PTCA conference and learned about LDN and how important it was for patients in different disease states.

Linda Elsegood: So, you are a supermom. You have five children.

Wow. How does it fit in with a career?

Rosella: Well, it's amazing because my kids understand that we're a team. That's it. We're a team. We work together and we all love each other so much. So my kids are so amazing with each other. They all help each other out.

So the oldest is 22. That's my daughter. My son's 20. My other daughter's 18. And I have a 15-year-old and ten years old. So we are constantly figuring things out and make it work and I think that makes them stronger and closer to the family 

Linda Elsegood: Wow, wonderful! And when did you first really get involved with LDN?

Was it at that PCCA meeting? Had you heard about LDN before then?

Rosella: I heard about it before then because we had a specific doctor that was a Lyme specialist that was working with LDN. So I asked her why was she prescribing LDN and she said it was because she had a lot of patients that were immunocompromised and fatigued, and the LDN is really helpful because it increases immune response. So I said:" That's really interesting. I'd like to learn more about it." So I did some research on it, I spoke with other doctors that were writing for it, why they were writing for it and I had one particular patient that had Crohn's disease. I asked him if he would want to try it and he's been on it ever since. So this is, at least six years that he's been on LDN. He's doing really well and will not stop it. That's for sure. I also took an autoimmune class on LDN. Not only is it great for pain. I actually had another patient that came to see me. She had a severe car accident. She had a lot of neurological issues going on and was on many other pain medications. So I helped wean her off of those pain medications and put her on LDN. Her starting dose was at 1.5 mg. We went up to 4.5 mg and then I said to her: "Let's try 5 milligrams and see if that works for you." That's when she started getting a side effect. She felt very strange. She said in mind a little weird. We went back down to 4.5 mg and she's been on 4.5 mg since about two years now. She's very happy with it. Every once in a while she has to take a Lyrica or something else.

It depends on the stressful situation in our lives, but, I mean, she's off most of her other pain meds because LDN is really working well for her.

Then I have a few other patients that I'm looking into the fertility aspect of it because I do work with a lot of fertility doctors and a lot of them don't know about LDN.

So I did more research on it to see how effective it would be. So right now I'm working with an endocrinologist who's going to start his patients on LDN and see how they do. A lot of people are fascinated by it and they want to try it. They want to help patients this way and I'm happy about that too.

Linda Elsegood: Well, there was a paper released last week by Dr Scott Zashin. He's a rheumatologist in Texas for Sjogren's Syndrome. That was quite good. The more papers and research that people do, it's going to make prescribers more confident in prescribing LDN.

Rosella: I forgot to mention I do have an ALS patient that is using it. This is amazing because he wasn't able to move his fingers and he wasn't speaking. Now it took a little bit of time. He can move his fingers, he can speak a little bit. At one point he didn't have the LDN. His doctor didn't authorize it because I think he was away and he wasn't speaking. So his sister said they need it because this was the only thing that they noticed that he needed. So I called the doctor, and I said:" Just put like PRN refills because this man is doing well with it.

Linda Elsegood: Interesting. So what I was going to say was, how long has the pharmacy been compounding LDN?

Rosella: Let's see. They've been in business for over 50 years and compounding around maybe 15 years.

Linda Elsegood: And what forms do you compound LDN in?

Rosella: Capsules right now for the most part and some creams. I haven't done any sublingual yet, but I think it's worth a try for some patients.

Linda Elsegood: Sublingual is quite a useful tool when people have gut issues that obviously absorb differently and bypasses the stomach so that is hell in some patients, but maybe all your patients can tolerate the capsules quite well. What filler do you use?

Rosella: We use acidophilus. Most patients don't have any issues with that.

Linda Elsegood: Yes. Do you know roughly what patient population you normally treat or is it all autoimmune condition patients?

Rosella: It is hard to say because I'm not in the lab that much. There are a few days that I do work in the lab when they need me but basically working in my own office and I work with a lot of bioidentical patients. So my thought is to really work with thyroid issues and help patients with Hashimoto's.

From what I've read and what I've seen with other patients, LDN really helps to decrease the antibodies in Hashimoto's patients. So that'll also help them with their thyroid. That's going to be my push as well as other autoimmune diseases. And I was looking into other inflammatory diseases like endometriosis, PCOS because I feel that LDN may have a good positive result with those patients as well.

Linda Elsegood: It certainly does. I can speak from experience myself, and with endometriosis worked amazingly.

Rosella: Good to hear. Very good to hear.

Linda Elsegood: I would also like to mention when you treat thyroid patients with LDN, you have to be very careful of the levels of the dose if they're taking thyroid medication because normally they have to start reducing the dose as you increase the LDN.

That is something to look out for. This is why we always say to people who have thyroid conditions to keep in constant contact with the prescriber because you can hit some problems if you are taking too much of your thyroid medication.

Rosella: I agree with you on that. I do work with a lot of patients and I have one endocrinologist that we monitor thyroid and we compound different strengths of thyroid T3,  T4 depending on their blood levels. So we do look at that TSH really carefully and free T3. We also look at FT4, but mainly I look at the TSH and FT3. That to me is very important. I could see a difference in patients if their level changes just a bit. They can start having hair loss or weight gain and fatigue.

That's why  I do tell my patients it's so important that we monitor them, get blood levels done every few weeks to see where they are.

Linda Elsegood: The internet is an amazing tool. It helps people do their own research, but the warning is you can't take notice as gospel truth from just a person on the internet who's not a doctor, not a prescriber, but who is giving advice.

We always say the proper advice is to speak to a pharmacist or a prescriber. You people have had years of training and experience where it's all well and good listening to other people, but when you are talking about your health, you should be talking to a medical professional.

Rosella: Correct. I agree with you on that.

Linda Elsegood: Yes. I mean, it's quite scary. We had an email from a lady who had been given some kind of advice from a friend of a friend of a doctor and their advice was totally wrong. And also you should not buy LDN off the internet. It's illegal. Naltrexone is a prescription-only drug, and therefore you need a prescription to make sure all the safety standards are met.

You said that you were PCAB accredited. So just to explain to people what you have to go through to prove that your pharmacy and your compounding is spot on with the regulations.

Rosella: The regulations are intense and immense. It took us, at least about two years and we're still perfecting it to pass all of the inspection qualifications because if we're ever audited, yes.  PCAB is a credentialing organization. It takes some time for us to make sure we follow every different legality as to having our compounding lab as perfect as possible. Every aspect of it is really important. We have SLPs, and we have meetings every week to make sure that we're following our SLPs. Keeping every temperature in the lab correct, the airflow. We have to make sure that they're wearing their masks, their hats,  jackets and gloves and everything has to be precise and follow to the T. If we ever get inspected, they could definitely find us for anything that they feel that is necessary. We're trying our best to make sure we keep up with it. It's very intense. It really is. That's why we always offer our doctors to come to visit the lab or patients. We have them look through the window because they can't come into the lab and see how we are following protocol per se.

Linda Elsegood: And what are your thoughts on people purchasing LDN off the internet?

Rosella: I just found out that they're selling a prescription item on the internet, and I'm appalled. I don't know how they're doing it. I feel the same way as you. Being that we're a credential lab and we work really hard to keep up with all the laws and the regulations, I don't know where this lab is. It's making the LDN. I have no idea. I would not recommend it at all.

Linda Elsegood: Exactly. The MHRA, which is the medicines regulatory body here in the UK quoted something like 85% of drugs that are shipped into the UK without a prescription is counterfeit. Mostly they're just fillers, they are harmless but some of them are actually lethal.

They're very dangerous. Don't play Russian roulette with your life. Get LDN from a reputable compounding pharmacy.

Rosella: I agree with you. We require to keep it as clean, pure and stable and it's really important to deal with the pharmacy credentials because you never know what you're getting out there. We work hard and we respect it.

Linda Elsegood: And not only that. You have your LDN tested so you have to prove in a 4.5 capsule that there is 4.5 of Naltrexone.

Rosella: Yes, we do.

Linda Elsegood: So if there were no checks, it could be 1 mg, 6 mg, or it could just all be fillers.

Rosella: Exactly. You're right. We do send it out for testing. We send out batches every day of different types of compounds, and then we get our results back within the right range, and we're happy we dispense it. So it's important that we do that.

It can cost up to $200 or more depending on what you're testing.

Linda Elsegood: So pain. Are you using any ultra-low-dose naltrexone yet? It's quite relatively new still. I don't know if that's something that your doctors yet know about.

Rosella: No, I don't think so.

I really haven't heard of that either. So how low is the dose then because I'd like to speak to my doctors about that.

Linda Elsegood: Well it's micro-dosing. It's probably 0.01  kind of thing. But it's really interesting. People who are on high doses of pain medication and have been for years, it's awful how it's not just America, it's all around the world how people are becoming addicted to these pain medications. I know that the whole idea is to try and get patients off the pain medications, but the withdrawals can be quite horrendous. So by using this ultra-low-dose naltrexone in micro-dosing, you can use that alongside with opioids.

They don't have to be off the opioids, but such a small dose makes the opioids far more effective. So it makes them work better, and therefore the patient is able to reduce the amount that they're taking. If you look at it as a sliding scale, you slowly increase the ultra-low dose, and we're still talking microdosing here, and then they can gradually reduce their opioids until they're on the LDN.

Most pain specialists say that they can get their patients off the opioids completely.  Some say that they just take it when they need to. They're not taking it constantly. So I think that is something that's really interesting and something new to many people but how wonderful to get these people off pain medications.  I've spoken to many people who've been on Morphine, Fentanyl, patches, and cocktails of medication and they say that they're still in pain. It doesn't work. So if we can get LDN out there and use to help these people to come off all these pain medications.

how wonderful is that? Tell us what do high doses of painkillers long term do to the body?

Rosella: They can cause a whole host of things, bone loss, blood pressure issues. It depends. I'm looking at patients that not only the opioids but if they take a NSAID what it could cause in the long run. I just believe that most of these medications,  some patients become suicidal too. Depression is another problem, weight gain. So many different things that opioids cause.  I think that if we can help patients come off of them and give them more supplementation and also LDN in a combination that'd be great.

Even Curcumin, Boswellia. There are so many amazing products out there that patients don't know about. They're just scared to come off of their opioids because of the dependency.

Linda Elsegood: Definitely. So how do patients get hold of you for a consultation?

Rosella: On the website. There is the introduction of what I do. I have a video there as well and there's also an evaluation form they can download. So on the website, there is an appointment maker there called shore, so they can make an appointment with me and it makes it really convenient for them.

Most doctors that know what I do, tell the patients to call me or go on the website or email. I have my business cards and I have that for them and that's how they get in touch with me. They used to call here. I have an assistant, her name is Tiffany, and she helps me with setting up appointments, and she's also a technician that helps to fill our scripts.

So that works out really help me.

Linda Elsegood: And do you have a waiting list, or can you see patients quite quickly?

Rosella: It depends on the month because I do marketing two days a week. So that's why it's really convenient for them to make their own schedule. It could range from a week waiting, maybe two weeks at most, then I try to fit them in. So for instance, if they can't see me within the special time frame that I have, which is usually between like eight in the morning and six,  I see them on the weekends if I can. I'll set up that schedule for patients. So I try to make it convenient, try to fit people in as quickly as possible.

Linda Elsegood: And where are you situated?

Rosella: Where am I situated? I'm in the Rye, New York. In Westchester County.

Linda Elsegood: Is it wheelchair friendly for patients too?

Rosella: Well, it is. We are a hybrid store, so downstairs is mainly where we have the retail establishment.

We have home health care and our vitamin line where we have a pharmacist that's full time working in that area. We also have the upstairs where my lab is, and where also is my office and other offices as well. If a patient needs to see me and can't walk up the stairs, there is another office downstairs that I could see them in. That works out for those patients.

Linda Elsegood: Wonderful! And could you just tell us your website?

Rosella: It's www.ryerx.com.

Linda Elsegood: Wonderful. Wow. We need to end of the show.

Rosella: Oh, great. I just wanted to clear something up. I'm not a physician. I'm a naturopath, so I cannot prescribe. I just wanted to clarify that if you don't mind.

Linda Elsegood: No, that's absolutely fine.

 Just explain what a naturopath does.

Rosella: Well, I took some courses in it, and I basically learned more about supplementation. It's a little bit different. I wanted to become a naturopathic physician, but I didn't have the time. I was basically between the kids and working full time.

I didn't go into that avenue. But it's been mainly as like learning about supplementation, helping patients with that as well as a little bit of nutrition. So I would like to go into clinical nutrition as well, but we'll see if I can cross that path when I get a chance to, once all the kids are in college, I guess, I don't know.

I'll figure it out.

Linda Elsegood: Do you test for supplementation to find out what people are low in?

Rosella: We do some blood work for sure. New York is really tough when it comes to other types of testing, so we can only do blood tests and that's how we test and we just saliva testing for the hormones. We are limited to a lot of different types of testing unless a patient lives in Connecticut or New Jersey, then we can test them with the different kits that we have.

Linda Elsegood: What about vitamins? Can you test for vitamin levels or not in New York?

Rosella: It could be tested for sure because we work with a lot of doctors that do a lot of IV therapy and they test all sorts of vitamins.

It depends on the lab that does it. But here are many labs that do testing for vitamins.

Linda Elsegood: Do you find that people in New York are deficient in vitamin D? Do you get enough sunshine there?

Rosella: I would say that everyone is deficient in vitamin D, everyone in America must be, but definitely in New York.

And then, once we rectify that, they feel better. We get them to a certain level, and they could stay on the supplementation for a good long time. Usually, I don't recommend that they come off of it, but if they have levels to go higher than  50, with the doctors ok, we'll bring down the dose a little bit.

Linda Elsegood: How would a patient feel if the vitamin D levels were low?

Rosella: Some patients tell me that they feel achy, others tell me they feel tired or depressed.

Some patients don't have any symptoms at all, so it just depends on the person. I know when I had my levels low, I would feel a little down and when it was a rainy day, I wouldn't feel myself. But now that my levels are normal it doesn't bother me.

So it's really strange how I used to feel.

Linda Elsegood: That's really interesting, isn't it? So anybody out there who would like to come and see you go online, they can find out more about you, play the video and make an appointment, come and see you and the bonuses is they can actually have a look at your compounding lab looking through the window, of course.

But that's also interesting to some people. I'm sure.

Rosella: Yes, absolutely. They love it, especially because we have a clean room as well, and it's separate from the rest of the lab, and that's where we make all the injections of HTG and b12 and they find that very interesting.

Linda Elsegood: Well, thank you very for being our guest today. We learned a lot from you.

Rosella: Thank you very much for having me and have a great day.

Linda Elsegood: Thank you.

Rosella: Thank you. Bye-bye.

Linda Elsegood: Each pharmacy has been family owned since 1946 they are a PCAB accredited compounding pharmacy growing from a corner drugstore to a wellness centre that helps patients to achieve their optimal health covering Connecticut, Florida, Illinois, Massachusetts. New Jersey, New York, Pennsylvania, and Rhode Island.

Visit www.ryerx.com, and I hope for the opportunity to earn trust.

Any questions or comments you may have, please Contact Us.  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.

Joy - US: Hashimoto's Thyroiditis (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Joy is from the United States and takes LDN for Hashimoto’s thyroiditis, to boost her endorphin levels and to control her antibodies. In 2008 she had a big crash, probably from her thyroid. It would bet getter, then get worse. By 2011 she hit rock bottom – “all the fuel went out of my tank” – her thyroid was not producing enough T-3 to have any sense of wellbeing. She believes her endorphin issues started in her teenage years. In her early 20s he was treated with full-dose naltrexone for an opiate addiction, and it made her feel terrible. So, when she heard about LDN for thyroid she was concerned, but interested. She researched LDN and found it was very effective at lowering the antibodies affecting how her thyroid was working.

When she started LDN her quality of life was maybe up to 6 out of 10, because she had just started taking a natural thyroid product; before the thyroid product she was perhaps at level 2. She found naltrexone to order from India and had it shipped to her, then she mixed it with distilled water and dosed herself. When she started LDN she had “three-dimensional dreams” that were extremely vivid, but faded after about a week.  She noticed improvements in about a week as well, and had to lower her thyroid medication by about 20%. Her antibodies decreased by about 50%, but were still a bit over the acceptable range on LDN 1.5 mg. She has been on LDN 3.0 mg for a while but hasn’t been retested.

At the time of the interview Joy had been on LDN for almost 4 months, and her quality of life bounced up to an 8. If it helped her peri-menopausal hormone issues it would be a 10, but LDN doesn’t seem to be helping with that. Linda Elsegood commented that talking with Dr. Phil Boyle she learned that LDN does help with a lot of women’s problems like endometriosis, though not necessarily menopausal problems; and that LDN helped her endometriosis improve over about 18 months.

If others are unable to find a doctor to prescribe LDN. Joy recommends they do research; and gives the warning to know the signs of overmedicating with thyroid medication, as once on LDN they’ll need to lower their thyroid dose pretty quickly. Linda Elsegood advised that importing LDN from India isn’t actually legal, but realizes it may be the only way some people can get it.

Joy would love to share her information so others can talk to their doctors about LDN. Her personal physician has some autoimmune issues, and is quite excited about LDN. Linda Elsegood pointed out that the LDN Research Trust’s doctor’s information packs have been quite successful. People print it and take it to their doctors, and the success rate is very high once the doctors read the information. Word is spreading, more neurologists are using LDN for multiple sclerosis, rheumatologists are now using it as well

Summary of Joy's interview, please listen to the video for the full story.

Keywords: LDN, low dose naltrexone, Hashimoto’s, thyroiditis, thyroid, endorphins, menopause, endometriosis, multiple sclerosis

Any questions or comments you may have, please contact us.

Elizabeth - US: CFS/ME, Lyme (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Elizabeth uses low dose naltrexone (LDN) for chronic Lyme disease, chronic fatigue syndrome (CFS), food sensitivities, and poisoning by Cipro.

When Elizabeth was very young she had anxiety and nausea, feeling on the verge of vomiting, and doctors found no diagnosis. At 12 she was taking Accutane, which interfered with her immune system and her symptoms increased through her teen years. 

She carried diagnoses of chronic fatigue syndrome, hypothyroidism, insomnia, food sensitivities, depression, anxiety, OCD, gastroparesis – all kinds of autoimmune disorders and symptoms - and was disabled. She got some improvement with a holistic treatment called NAET, but in her late 20s took ciprofloxacin (Cipro) and became bed-bound for over ten years. Unfortunately, later she took Cipro again and all her symptoms got exponentially worse.

She was diagnosed with POTS, or dysautonomia, and could not tolerate medications to heal.  She couldn’t tolerate food, heat, the sun, and couldn’t sleep. When she started LDN it made her feel like she had a bad flu, migraines, and a racing heart. Her doctor adjusted her thyroid medication to help with her heart rate and insomnia, but later was able to increase it back up. She learned that taking LDN in the morning, and a lowered dose, reduced those symptoms. Now her symptoms are 85% improved.

In addition, after 10 months, LDN has improved her endometriosis pain and cognitive functioning. She has been able to come off multiple other pharmaceutical medications, including those for her high blood pressure, antidepressants, and medication for CFS. By her research, she hopes to continue improving for up to 2 years.

Keywords:  Lyme disease, chronic fatigue syndrome, CFS, POTS, dysautonomia, hypothyroidism, insomnia, depression, anxiety, OCD, gastroparesis, food sensitivity, poisoning by Cipro, ciprofloxacin, endometriosis, high blood pressure, NAET, LDN, low dose naltrexone

Summary of Elizabeth's interview, please listen to the video for the full story.

Any questions or comments you may have, please Contact Us.  I look forward to hearing from you. Thank you for joining us today.

Dr Kathleen MacIsaac, LDN Radio Show 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr. Kathleen MacIsaac is from Florida in the United States. She first heard about LDN around 2006 while researching a different topic. It made sense biochemically, so she started using LDN in her patients, to treat fibromyalgia, chronic pain, migraine, and insomnia. She noted great response in reduction in pain and increased quality of sleep in fibromyalgia patients. More recently she is using LDN for Hashimoto’s thyroiditis; and chronic neurologic disorders including MS (multiple sclerosis), ALS (amyotrophic lateral sclerosis), and PLS (progressive lateral sclerosis). While the neurologic issues haven’t had complete resolution, the patients’ quality of life has improved, and there has been improvement in coordination, articulation, and swallowing. She has a pediatric patient on LDN for autism.

Less than 10 of her patients stopped using LDN, because they didn't notice any improvement or because they did not like a side effect, such as vivid dreams, or nausea, or some GI side effect. Those patients tended to start with milder conditions, thus less motivation to work through the side effects than ones with more debilitating conditions. There is a gap of time it takes to adapt. Most recently Dr. MacIsaac will start very low and progress upwards in dose slowly. Rather than a common titration like LDN 1.5 mg, then 3.0 mg, then 4.5 mg, she has the compounding pharmacy prepare a suspension so patients can titrate up by 0.5 mg over a longer period of time. Some patients remain on very low doses of less than a milligram, and she found it interesting that that small amount is adequate.

Linda Elsegood commented on various approaches she is aware of to lower the dropout rate for LDN, such as starting very low doses, taking LDN in the morning if there are sleep issues, and sublingual drops that are absorbed and bypass the stomach for patients with GI problems.

Dr. MacIsaac has 3 recent patients using daytime dosing of LDN for smoking and alcohol dependency issues, and it’s as if LDN doctors the brain to have less craving for nicotine or alcohol. It’s a new method of treatment for Dr. MacIsaac, and she is pursuing it further.

Linda Elsegood added that LDN is being used to treat OCD, and PMS; and Dr. Phil Boyle uses LDN in treating infertility and other gynecologic issues. Linda is aware of at least one woman whose PCOS (polycystic ovary syndrome) was improved on LDN. Linda relates that she herself had many issues with endometriosis from age 11, and a surprise added benefit when she began LDN for her MS, was her endometriosis issues cleared up. Dr. MacIsaac has found the LDN Research Trust website to be a good resource, and is learning a lot more about LDN.

Dr. MacIsaac’s practice is Healing Alternatives in Orlando Florida, and the website is http://www.healingalternativesinc.com/. The office phone is 407-682-711.

Summary from Dr. Kathleen MacIsaac, listen to the video for the show.

Keywords: LDN, low dose naltrexone, fibromyalgia, chronic pain, migraine, insomnia, Hashimoto’s, multiple sclerosis, MS, ALS, amyotrophic lateral sclerosis, PLS, progressive lateral sclerosis, autism, compounding pharmacy, alcohol, smoking, nicotine, infertility, endometriosis, OCD, PMS,  PCOS, polycystic ovary syndrome