LDN Video Interviews and Presentations

Pain Specialist Dr Pradeep Chopra Feb 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

My name is Pradeep Chopra. I'm a pain specialist, and my area of interest is complex pain, pain conditions. So I'm just one of those weird guys who like treating complex pain conditions. Someone has to do that. Right? So I took up that job. No, I don't have any, this is a standard disclaimer. I don't have any conflict of interest. 

We're going to talk about naltrexone, it's the oddest drug you'll ever see. So we'll talk, and we'll talk about naltrexone, and then I'll talk about low dose naltrexone. And Dr Goldstein will talk about very low dose naltrexone. And then he's gonna talk about ultra-low dose naltrexone.

Is there an ultra low dose Not yet. Not yet. Okay. So let's talk about naltrexone for a minute. This was in 1984, it was approved with the FDA for the treatment of alcohol addiction and opioid addiction. And I believe even with heroin addiction, it didn't take off as the drug for detoxification for various reasons, mostly political reasons.

Now they found that in 1982 naltrexone affects cell growth differently depending on which dose you use. So at a low dose, it affects cell growth differently from a high dose. In the mid-1980s, we were hit with the HIV epidemic, and there was no solution to it.
And what happened was. In New York, there was this neuroscientist neurologist by the name of dr Bihari, and he was working at a detox centre, and he saw two kinds of HIV patients. There was a sexually transmitted HIV, and then there were heroin addicts who are sharing needles. So we had two different kinds of HIV.

So the patients who had HIV from addiction were given naltrexone, obviously because he was trying to detox them, but people who had sexually transmitted HIV were not given naltrexone. What he noticed was that the incidence of lymphomas and kaposi sarcomas, like immune conditions, were far less in the, in the patients who had been given naltrexone as compared to those who had not been given naltrexone. So that was one of his observations that he saw. And then later on, of course, different scientists picked it up, and they did some research on it. So what is naltrexone? It's a reversible competitive antagonist at the mu and Kappa receptors so that we know that it's a reversible antagonist. It also works on the Delta receptor to a certain degree, but it's the active metabolite. So when this gets metabolized to six-beta naltrexone it is also working the same as naltrexone to a certain degree. The plasma half-life is six hours.

So for the half-life of the metabolite is about 13 hours. So in general, you know, half-life times four is what is where it takes the full drug to be metabolized. So it takes about 24 hours for it to be metabolized. So remember this fact that this is an important take-home fact. Now commercially available Naltrexone is a 50-milligram pill. And the dose you should have recommended those is 150 milligrams a day. We're not talking about that today at all. Today we're going to talk about 1.75 milligrams to 4.5 milligrams. I'm going to talk about that. A lot of Goldstein is going to talk about some really crazy low doses.

I think you basically sniff naltrexone. Anyway. So the dose we're talking about is four and a half milligrams of low dose naltrexone. That's LDN in short. Now, remember, it gets fully eliminated in 24 hours. So let's talk about LDN.

LDN is, again, it blocks the Mu receptors, but it does it transiently. So it's such a low dose, instead of giving somebody 150 milligrams, you're giving them four and a half milligrams. So it blocks the immune receptors very, very, very transiently.
It's so transient that it’s enough to cause a positive feedback mechanism, to increase the production of endogenous opioids, also known as endorphins. So in these patients, what happens is endorphin levels, and enkephalin levels are increased persistently. So let me go through that again. When you use LDN, you're blocking just a few Mu receptors for a very short time, and so the body in turn, by positive feedback, produces more endorphins and enkephalins. 

So what happens when it produces increased levels of endorphins is it promotes healing, inhibits cell growth, and it reduces inflammation. And I'll go through all of those again. It also works on something called the opioid growth factor, also known as a Met(5)-enkephalin.
The opioid growth factor is a pentapeptide and endogenous pentapeptide produced in the body. Uh. Opioid growth factor activates a specific receptor called the opioid growth factor receptor. So you have OGF opioid growth factor that activates opioid growth factor receptors.

This forms a complex called the growth factor-opioid growth factor receptor complex. There is an increase in the number and density of OGF receptors. So what's happening is because there's so little endorphin, so little. There's so much endorphin being produced that there's an increase in the number of and density of the OGF receptors of this complex. This combination regulates tissue growth, wound repair, it inhibits certain cancers. I'm not going to talk about cancers. I'm a pain guy. I'll talk, talked a little bit about pain stuff, but there's tons of literature on it, working on cancer, especially pancreatic cancer, head and neck, squamous silicones, ovarian cancers, and they must be at least 20 papers on the treatment of skin warts for some reason.
I'm not sure why, but um, they're like at least 20 papers. Let's talk about the cell called the glial cell. Glial means glue. So the nervous system, the brain and the central nervous system are made up of—70 % to 80% of the brain. Our central nervous system is made up of glial cells. And the idea being like, okay, so the rest 20% are neurons and the, and it's packed by cells called glial cells, which were in the old times known as glue.

They didn't know what it was for but now we know that glial cells have a very important role to play. They are part of the immune surveillance under basal conditions. So the glial cells in the central nervous system which actually make up most of the brain, are part of the immune system.

When, when these glial cells get activated they get really angry. They release inflammatory cytokines and chemokines. So you don't want to piss off these glia cells. Neuroinflammatory conditions ……  there's a lot of work being done on Alzheimer's, complex regional pain syndrome, chronic pain conditions where actually the theory being is that these glial cells are the culprit.

These substances, in turn, increase the excitability of the nearby neurons. So in reality, if this is a neuron in the brain, the glial cells are almost right next to it, grabbing onto it. If you ever look at it under a microscope, they're literally next to the neurons. So when these glial cells release inflammatory chemicals, they cause inflammation of the neuron itself.

So let's confuse you a little bit more, I'll bring this all together. Don't worry. So toll-like receptors, toll-like receptors are a class of proteins that play a key role in innate immunity in the immune system. They are usually expressed by macrophages and dendritic cells when there's an infection these microbes are recognized by TLRs. There are about 10 of them which activate the immune system. The one we are interested in as a TLR4, this is predominantly expressed with the microglia. Remember I told you about the glial cells, the different types of glial cells, and one of them is called the microglia.

The expression of toll-like receptors is increased under neuroinflammatory conditions. Now, this is a key thing, remember, opioids caused glial cell activation by acting on the TLR4 receptors. And that causes increased proinflammatory cytokines. Now you must have heard of opioid hyperalgesia and you know this whole thing about why opioids are not good and all that, that's controversial. We'll talk about it later on. But what happens is in patients who are in high, especially high doses of opioids, glial cells get activated. And when these glial cells get activated, they cause inflammatory cytokines to be produced. And that is the basic theory between certain pain conditions that don't respond to treatments is because of this.

And one of the theories behind opioid hyperalgesia is this, is that they're causing glial cell activation. So the idea was that, okay, so if glial cells are getting activated, if I use something to deactivate these glial cells, I'm golden. I can do something, but I can help patients with their dementia or their pain.

So opioid antagonists, like Naloxone or naltrexone block TLR4 signalling, which in turn decreases glial cell activation, which decreases neuroinflammation. This is a very powerful sentence because we don't have any other glial that are de-activators in the market right now. We don't. And this is probably the only drug is a disease-modifying agent. Everything else is not a disease-modifying agent. This is the one that works on the TLR4 signalling, which in turn decreases glial cell activation, which then decreases neuroinflammation. So LDN blocks release of proinflammatory cytokines, including interleukin-6, 12, TNF alpha and NF- k-beta.
It modulates T and B lymphocyte production, which is an immune system, and it also causes a shift in the immune system response from TH2 to TH1. So I'm going to summarize the mechanism of action over here: It is the reversible antagonism of the opiate receptors resulting in increased production of endorphins, which then up-regulates the OGF, the opioid growth factor and opioid growth factor receptor access. So in short, uh, when you give someone LDN, it causes a reversible antagonist on the opioid receptor, which causes OGF or OGFr axis, to increase it blocks TLR signalling, which then decreases glial cell activation, which decreases the production of cytokines and then hence decreases neural inflammation.

LDN also blocks release of proinflammatory cytokines, including interleukin-6, 12, TNF alpha and NF- k-beta. It regulates cell proliferation through p16 and p21 dependent inhibitory kinases. This is more for cancer research. The only part that where I want to just talk about cell proliferation is - there's been some really good data on how it works in patients with diabetic ulcers, it has been shown to improve that. 

So let's talk about pain. Let's say what are the uses of low dose naltrexone, where can you use it? If you look up, if you ever look it up in a textbook, or if you look up online, they're like 30 different conditions. I just picked up the ones that I'm a little more familiar with.
The first one being pain, especially neuropathic pain. So we know pain. There are different kinds of pain. nociceptive pain, which is structural pain, there’s neuropathic pain, which is nerve pain. Most of our pains are a mix of both nociceptive and neuropathic—the differences, which one is more. So, for example, if somebody had back pain, he has both structural pain as well as neuropathic pain.
And so this patient, if you can take away the neuropathic component, you're going to get somewhere with this patient. It works on immune conditions like Crohn's disease, ulcerative colitis, Hashimoto's and cancers, works on autism, Lyme disease, and fibromyalgia. So I'm going to break it down to specific conditions.

In Crohn's disease. This study was done. I'll give you the ref, the citation in a minute, but this was an amazing study on Crohn's disease by Jill Smith.  And what they did was they saw a remission in two-thirds of the patients and 89% of the patients reported improvement to some degree. That's a huge figure in Crohn's disease, and they've been able to actually show colonoscopy pictures of before and after, and you can see how it improves. She did this work with Ian Zagon, who's one of the pioneers of LDN. So these are the two citations if you're interested. (See presentation).

So for IBS, they took 42 patients. It was an open-label study. We gave them low dose naltrexone, just 0.5 milligrams for four weeks. And there was an improvement of 83%. 83% of medicine is huge. I mean, we are looking for a 50% improvement. So they went onto a phase two trial. This was a phase two trial, 50 patients, four weeks. patients reported a hundred, 140% increase in the number of pain-free days. Clinical improvement, bowel urgency, stool consistency, number of stools per day were also reported by week four in both genders, males and females. They've never been able to show a difference. LDN between males and females, if there's any difference in how it works.

LDN and fibromyalgia, actually, there's been another study after this one. This was done in Stanford, by Jared younger. but after that, there'd been a couple of other studies. So, and this was a pilot study, single-blind crossover trials, ten patients with fibromyalgia.
You know, I don't know if you remember those, those things called Palm pilots? Well, half the room remembers. It was like a cell phone without the phone part of it. And so they gave these ten patients Palm pilots, and they said, record your pain all day long. And so they would enter it all day long and then bring them up, and then they would download the data.

So they took ten patients with fibromyalgia, gave them four and a half milligrams daily for eight weeks. It reduced fibromyalgia symptoms, diffuse pain, the sensitivity of mechanical stimulation greater than 30%. Their ESR dropped, indicating a general inflammatory process going on in fibromyalgia, had the greatest reduction of symptoms in response to low dose naltrexone.
I don't want to go into autism today because it's not my field, but this was a book written by Jacqueline McCandless called “Children with starving brains”. And there's some really good information on the use of LD in autism. And I don't think it works in everyone, but it works in more than 50% of the cases.

So I started early and back in 2005 and I was getting a lot of pushback from people like, Oh, this is an addicting drug. People were confusing naltrexone and methadone, I don't know, but I would get pushback from physicians saying, Oh, this is an addictive drug.
So finally, and I didn't have the funds to do whole big research, so I wrote two case reports which we published in 2012. Well, I, you know, I was seeing a lot of complexes or pain syndrome patients, and we really don't have any great tools to treat this condition as one of the most horrible pain conditions known to mankind. We didn't have any tools to treat this.  There were two cases. The first case was a 48-year-old male with CRPS. I know this is one case, but this is what we mean. I've been saying since 2005, and this is what people around the country are now seeing. So it's not just this one case that I'm talking about.

He had CRPS to his foot, which spread to his entire body, developed blisters, dystonic spasms, yet failed everything. This is what he looked like when he came to my office. You had all these scabs, you had these blisters, uh, and you can see the difference in colour over here. Started him on LDN. Two months later, he had improved physical activity, decreased frequency and duration of pain.
I mean, it's a pain didn't go away, but he was much more functional. it didn't change his dystonic spasms. LDN does not work on dystonic spasms as far as I know. This is what he looked. Uh, finally, and you can see a huge difference. This is just LDN. There was nothing else.

This is a 12-year-old girl, she's now much older, had Ehlers-Danlos syndrome, CRPS in the right foot, unstable ankle joint, started around four and a half milligrams once a day. It improved her dystonia, decreased her pain and symptoms of CRPS after two months. This is what she looked like when I first saw her. You can see how red the foot is and how it's dystonic. This was just stuck like this, that you couldn't fix it and we thought it's never going to get better, and this is eventually, this is what happened. 

So let's talk about real life. How do you and your practice use LDN? You start two milligrams in the morning  and I have them take it for four weeks,  I'm sorry, two weeks. I have them take it for two weeks. And I'll explain to you why. One of the things about low dose naltrexone is when you introduce the LDN, it does cause some headaches and causes some insomnia. I don't want to give them four and a half milligrams, and then they'll come back and say, but then I can't, I'm not going to take this drug anymore because it causes headaches or I can't sleep.

So I introduce it slowly. And there are some patients who are very sensitive to drugs. So I like to start at two milligrams, and then I use a compounding pharmacy that has the big scored pills. Um, and then I increase it to four and a half milligrams. They can take it in the morning or at night. Some patients will tell you that makes them sleepy and then some will tell you that it makes them, keeps them awake. So depending on that, you can decide they can take it at night or take it in the morning. In the past, the literature talked a lot about taking it at night at ten apparently at 10:00 PM at night, because then it, your endorphins are the highest at 2:00 PM at 2:00 AM in the morning. But now we don't think it's necessary, all you need to do is take it at once a day.

The usual side effects are headaches, insomnia, and colourful dreams. And I don't tell them about the colourful dreams on the first visit. I'll mention it later on once they've started to improve. So they're more receptive to it. But I do warn them about the headaches and insomnia. Generally, all these side effects go away.

They all go away. Rarely colourful dreams might persist. Um, so all you get is a free movie every night. Now don't be in a rush to see effects. You're not going to see an effect overnight. It takes a while. Um, I usually tell them to expect at least wait four or five weeks to notice a difference.

The common thinking among physicians, in fact, the last conference that was our thinking was I used to do it for three months. I said, give them a trial for three months. But physicians around the country now use it for six months. That's what they feel is the trial. Um, now sometimes you get a patient that'll come back and say, I just couldn't take this drug.
It made me really nauseous because, you know, you're, all of a sudden you're producing a boatload of endorphins in these patients, and so they don't like that effect. Some don't like it. Don't give up. What I do is we, we then back off to 0.5 milligrams a day. And they'll leave it there for a few weeks to a few months, and then maybe go up by another half a milligram to one milligram.
And that might be all that they need. So there are, we do have a bunch of patients who are at say one or two milligrams. On the flip side, if you don't see an effect that four and a half milligrams. There's no harm in going up a little higher. We've had physicians have used six milligrams. I've, I've never had gone higher than six, but I know of physicians have gone up to 12 milligrams, and I've still seen a benefit.

As long as you block the new receptors transiently, you're good. And it should be once a day. You can’t give it, give it to them three times a day or four times a day. You, you have to block it and then all of a sudden the naltrexone goes away, and you're left with a boatload of endorphins. 

It must be ordered from a compounding pharmacy.  It can be a pill, liquid, or cream. The cream, I brought it up because in autistic kids use some, they have a problem. So, but Jacqueline McCandless had mentioned she was using it as a cream in autistic kids. As I said, it doesn't matter what time of the day you take it as long as you take it once a day.

Then, when it's compounded, one of the things, most compounding pharmacies are now aware of how to make LDN, and they know exactly how to make it. They know the whole process.  but one thing to be careful was, is that you don't want an extended-release LDN. And because then that beats the purpose - It should be an immediate release LDN. So there's a, there's a big question about fillers that you should use with LDN. Uh, the one filler you can use is called avicill acidophilus and calcium carbonate, sucrose, lactose are used. Um, some patients are intolerant to certain fillers.

So if you, if you prescribed LDN to somebody, they're like two milligrams or four and a half milligrams, and they start having this bizarre reaction. Think of the filler. Say, if they come back and they say like, I get this flushing or I get this itching, or I feel really, really nauseous is probably not the LDN is probably the filler in that.

So the question that I get a lot is, Oh, the patient has an early, and I'm sorry, we can give this patient opioids, and they really worry about that. What if they need surgery or what if there's an emergency or they need an opioid? When in the beginning when they first, when some of us started using LDN, we were all nervous about this issue, but we've got now about two decades of experience on this thing, and we know that it's fine to take an opioid and.

Personally, I've tried it myself. I took an LDN, and Vicodin together, nothing happened. Uh, it was prescribed to me legally. Okay. But, but what I'm trying to say is that the number of mu receptors that are blocked is so small. I mean. LDN, four and a half milligrams early, and from 150 milligrams of naltrexone, you're blocking so few new receptors that if you gave someone a vitamin or a Percocet, it's really not going to make a difference.  They're not going to have a withdrawal effect. And most emergency room physicians don't even care about it. They'll give them whatever they need, and they're probably gonna get some boatloads of morphine or fentanyl or whichever. So it's okay for them to take it. But if you have a choice. Supposing the patient has an elective surgery coming up and as a question like, okay, what should I do?

Remember I told you his half-life was, um, was four hours, six hours, and then you multiply that by four. Um, so I tell them to stop 24 hours before the surgery and then start their LDN after their last dose of whichever opioid they were given for the, for postoperative pain. You can do that but just being very careful, it doesn't really make a difference. So we've never, I've never read in the literature and talking to multiple physicians. We've never seen withdrawal on patients taking LDN and a low dose of opioid. This is really good web research. You can go to this as an organization called re LDN research trust.

It's a nonprofit organization that, um, you'll find tons of literature on it. In fact, they published a book also. Thank you.

We have time for questions right.
Yes. So, the question was, if patients who have fibromyalgia and are on other drugs, have you been able to get them off that right? Yes. So you don't stop the Lyrica, you don't stop whatever Gabapentin or whatever they are on, don't stop it, but you just add LDN to it.

So the question she asked was, have you ever had patients present with hypomania or bipolar disorder for LDN? No, we haven't seen any issues like that.

I don't really start patients on patients who are already in opioids. I don't start them on low dose naltrexone because it beats the purpose. You're blocking them, your receptors, you're, it's, you're activating the glial cells at the same time as you're trying to deactivate those glial cells by blocking the toll-like receptors. So it kind of beats the purpose 

Diabetic for diabetic neuropathy? Yes. Same dose, approximately four and a half milligrams. So you're killing two birds with one stone. You're helping their tissue. Uh, they have fiber tissues here. You're helping that, and it does work on diabetic neuropathy.

Dr Asher Golstein (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Asher Goldstein: My name is usher Goldstein. I'm a pain management physician, and physical medicine and rehabilitation is my first board. Anaesthesia pain is my second board. I practice in Hackensack, New Jersey, so it was a little bit of a trip to come here, but well worth it. I feel that LDN has changed my practice significantly.

I came into it three years ago, and it was sort of a disaster with one patient, didn't go anywhere, and then circled back to it about a year ago, and it's been really, really helpful. Unlike Dr Chopra, I do not seek out the complex pain patients, but, okay, Usually, I get them. And for those patients that, you know, you want to pull your hair out for, you know, so it's been very helpful and been helpful for the fibromyalgia patients, the patients who happen to have back pain and IBS or and crone or those patients with CRPS or knee pain.

 I've been treating some entities that don't directly relate to pain just because LDN has the ability to treat it. And I had a patient come to me who had fibromyalgia and had never come to me before. And, and I treated her performance. I started her on the LDN, and I'm like, two months later she comes to me, and she goes.

Does LDN treat breast cancer? And I'm like, well, what's the story behind the question? She said, well, I didn't tell you, but I had breast cancer, and I had a double mastectomy about five years ago. And they've been following my numbers, you know, for five years. I, every couple of months I go to my doctor, and they draw blood, and they look for tumour markers, and everything's been, you know, stable at 130.

And oh, we've been okay. And then, I went like, two weeks ago. And my doctor called me up and said, I need to speak to you. And I came in yesterday and she said, what are you doing? And she's like, what do you mean? She said some did you do something that changed? And so she said to her, well, why you're asking me?

She said because your numbers went from one 30 to like 22. And she said, what'd you do? And she said, nothing. I'm just taking LDN. She said, well, go back to Dr. Goldstein, ask him the question, and I said, well, you don't actually say that LDN treats cancer, but you know, it can be very helpful. And so hopefully her cancer never comes back even after five years.

But I can just say that you know. That was black and white. You know, her numbers just dropped. And the only thing that she changed; she didn't change anything else. We just added LBN on. And from her fibromyalgia perspective, it's been helpful. I've had patients that had much better response and patients that have not had a response, but her pain went from like a seven or eight in a total body pain to about a five.

So she's much more functional, and she's not taking any opiates, which is great. And I'm, she's happy. One issue that I had Dr. Chopra didn't mention is that because it's so cheap to manufacture, to make, you know about a buck a pill, or, you know, $60 for 90 days, which is what my compound pharmacy charges.

It's very hard to get money for research. And then, so you've asked about a head to head trial. Who, who's paying for that. Right. The drug, this thing has been manufactured since 1982 it's off-patent. It's very cheap. There's no money in it. When there's no money in it, nobody's paying for any trials unless you can convince the government to pay for a trial.

So there are not going to be any head to head trials because all the other drugs have money and this has no money. We always put it in like, no financial interest. Nobody has a financial interest in this because nobody's making any money on LDN. Right? So that's the catch 22, you know, it's helpful, but everybody wants to research.

They want strong research. They want, you know, a thousand patients and they want double head blinded and placebo. You can't do that. There's no money unless, you know, Bill Gates writes a check. There's no money in it, you know? So that's that. That's, you know, it's, so patients have to pay for their medication.

It's not expensive, but sometimes, you know, 30 bucks a month can make a difference. And the insurance companies, unless it's an accident, they do not cover the medication every once in a while that goes through, but very rarely. So I just, I just tell the patient straight up, but you're just going to, you have to pay for out of pocket.

Q: Is low dose naltrexone approved by the FDA for chronic pain or for pain? 

So naltrexone is approved by the FDA period at 150 milligrams dose. Okay. So do you think you need to get approval for a four and a half milligram dose? The answer is no. Not FDA approved for four and a half, but nobody's, nobody's applying for that because there's no money in it.

Right, right, right. So. 150, four and a half. And I'm going to be talking about one microgram, you know?

All right. A byproduct of what I do, I treat, I don't have a problem with treating my patients with opiates. Okay. So I still do, I, I do procedures, I do injections. I send my patients to acupuncture, the chiropractor, you know, it's like, what is Dr. Goldstein doing?

I'm doing everything because pain is not simple. And everybody, you need to have a big toolbox. And as part of what has happened in the past couple years, you know, so patients started asking me, you know, please, can you take me off the opiate? So I said, Oh, sure. And so I started, you know, doing stuff like, as best as I could. And then about a year and a half ago, I said, there's got to be a better way. So I asked some people questions, and I took a course by SAMHSA. SAMHSA is an excellent organization, and it was like an eight hour, online course and wasn't too expensive and CMEs and everything else.

And then I got certified, and I got knowledge of how to take patients off their opiates. And the bottom line is it takes me if the patients listen to me, it takes me about four hours, to take patients off their opiates. Now I'm not taking patients off complex substance abuse. I'm not taking them off cocaine and heroin, or, you know, but if it's just heroin or it's just oxycodone.

Then I can help them up. So, okay, so ultra-low-dose naltrexone and MAW, and it's me. That's what I do. I'm at Holy name Hospital, which is in Teaneck, New Jersey, which is a town that I live in, but I have a private office in the next town over, which is Hackensack, New Jersey. Okay. There we go. So no commercial interests or conflicts because there is no money to be made here.

And ultra-low-dose naltrexone is not currently, there you go, an FDA recommended treatment, all you know, but many drugs we prescribe off label because we know they have more than one use. And this is the case in this drug. Okay, what do we call it? Right? 

No. This one. Yeah, that's not working. Oh, there it is. Okay, so naltrexone is the 50 to 150 that's what it was. Prescribed them naltrexone, you know is five. You know, we talked about a 0.5 Dr Chopra talked about 12, and some people talk about 16, but the current sweet spot is about four and a half milligrams.

Then there is, we'll skip here—Ultra-low dose naltrexone. Which is a one to 20, but I actually don't go above 12, and then there's a little higher from 50 to 500 is very low dose naltrexone. So these are basically the four categories of ???naltrexone not track somewhat what we call it. And there are some of the edges of each category. tere's, you know, it's a little blurry, a little grey, but that's fine. Also just keep bear in mind with the lower levels of naltrexone, the theories of how we give it out and what dosages, and you know, where we start and where we end. It's still evolving. It's evolving. Like I said, three years ago when I started, with one patient, I ran into a disaster because I was told two milligrams, four milligrams, six milligrams, eight milligrams in one month.

And patient had no, positive response. So I stopped and, and it took me about two years to come back. Okay. So low dose naltrexone. So I use it for medication-assisted withdrawal. I tell the patients to come in to stop taking their medications 18 to 24 hours before their appointment time. They come in to see me. They're a little uncomfortable. So we want to get them, there's a scale called the COWS scale that runs from zero to 24 we want them to be uncomfortable around 15. In 12 to 18 but 15 so the reason we want that is because when we give Suboxone, we want them to feel it working.

So if they, it's too mild, they're not in enough withdrawal, and they don't feel it working. And if it's too severe, they just take a pill before they come in. Cause it does just not help cause they're just uncomfortable. So 18 to 24 hours. And so they come in and then, I start the medications to the withdrawal with Suboxone.

But that's not what we're talking about here. We're talking about ULDN. So when patients come that are my patients and they've been taking, or somebody else's patients, if they take medication for a long time and say, okay, we're ready to come off. I said, okay, when do you want to schedule this? And they say, well, we want to do it in June because I have my daughter's wedding in May.

And I'm scared to come off my opiates before June. June is like four months from that. I said, perfect. I'm not going to rush you. You're going, it's fine. We're going to start you on ultra-low dose naltrexone. Why so? Because when they, when patients go through the MAW, so they, they have sometimes had some side effects during that period of time in the office or before they offer it to us right after the office.

And one of the issues is anxiety. You know, the literature says prescribed Klonopin for the anxiety. So I'm like, why do I want to prescribe Klonopin to another controlled substance to help the side effect from this controlled substance? It's like a whole really bad cycle. So instead, I give ultra-low dose naltrexone.

They stabilize after six to eight weeks and when they come off when they do the MAW, when they come off their opiates, there are almost no side effects. Almost no side effects. So it's very helpful for that. And then in general, the second reason, besides a medication-assisted withdrawal is to enhance the analgesic effects of opiates in general.

So I find that if patients, my patients are like, Nope, I'm not coming off my Percocet, I take Percocet five times a day and I'm fine. I'm like, okay, what am I going to say? You know, just, that's what's working for you. That's what's working for you. But I give, I say, you know. Take the, ultra-low-dose naltrexone.

And what happens is that patients tend to drop one or two pills a day overtime. They just, they find that the opioid works better or they need it less. Whatever reason, they tend to drop it. So instead of five times a day are taking it three to four times a day. Okay. And then hopefully we can then convince them once they know about the molecule to come off  the opioids totally.

And then go on LDN to treat whatever their pain. Okay, so this is just a slide of inpatient detox versus office space detox. Basically inpatient detox. It's very expensive. You're away from your home. There's a lot of treatment, and you have no familial safety net. Maybe you need it for the really hard quote-unquote addicts to go away.

But you find that for most patients or mild to moderately or whatever, they're there, they have an addiction. But in the office, it's much cheaper. It's not even $5,000. It's probably around $2,000. It's 10 to 12 office visits over four weeks. And that includes both me and the mental health professional, not just me.

So it's not that bad. And then you have your family around, and you don't have to go away, and you can still work, and you can still go to school, and you can still do whatever you need to do. So I'm a big fan of Ultra low dose naltrexone. None of the commercial pharmacies will give you LDN.

So you have to go to a compounding pharmacy to get LDN. And then ultra-low-dose naltrexone don't even the compounding pharmacies have a lot of difficulty with it. So you have to go to a very good quality compounding pharmacy to get a quality ultra dose naltrexone because it's so small.

Okay. So 0.5 micrograms, right. You know, so 150 milligrams is the regular naltrexone for that, that's prescribed. And then the low, low dose naltrexone this four and a half. And then ultra-low dose naltrexone A four and a half milligrams to one microgram, like passing the floor at a very, very small dose.

And then I increase one to two micrograms every seven days to about 12 to 15 micrograms. And I tell them. Usually, it comes in a liquid. I tell them, put it up sublingual under the tongue for about a minute, then swish it around and swallow it. That's, you know, that works. Okay. So that's the ultra-low dose naltrexone.

And this is the very low dose naltrexone. I use it in two different ways. So when my patients are on Suboxone, right? So I get them onto some level of Suboxone. It stabilizes their withdrawal from the medication. Then at a certain point, I want to get them off Suboxone. I don’t want them, What? What did I do? I traded Percocet for Suboxone, so we started titrating down. So usually when they get to four milligrams of Suboxone, I then add in 100 micrograms of naltrexone. And then as the Suboxone comes down, I increase the naltrexone, and then we get to zero, and we were at 0.5 for LDN starting dose.

Now my starting dose is lower than Dr. Chopra’s starting dose. I start, and you know, as I said, it's just different. It's everybody. Eventually, we all get the 4.5 or somewhere around there, but I start my patients on 0.5 and slowly work them up over seven weeks to four and a half milligrams. I just found that that works for me, and I have less side effects, fewer complaints as headaches, but almost everybody has vivid dreams, which is, you know, most people like, they're like, cool, that works for me. The other way, is sometimes I can't get the patients to go down to four milligrams of Suboxone. They're like they're an eight or ten and just that's where they are. So I decreased the Suboxone to the lowest level tolerated, and then I begin at a hundred micrograms, and then I increase to up till I get the 400 micrograms, and then I just stop the Suboxone.

And usually that works just fine. Every once in a while, it doesn't work, but usually, that works fine. So either it's the plateau or the steady decrease, and that's how I use the very low dose naltrexone. Okay. So we talked that Dr. Chopra spoke about opioid hyperalgesia. This is my patient who had opioid hyperalgesia, and you're going to see, so 55-year-old male motor vehicle accident and crush injury to the right femur.

He was in New York city standing by a fire hydrant when a bus jumped the curb, a New York City bus and pinched him between the bus and the fire hydrant. Okay. And this was a guy who, you're the very traditional guy. He worked really hard, worked for his family. He was a man of the house. And so multiple surgeries, he had a little bit of lower back pain, but he was taking four milligrams of dilautid. That,s a lot a day.

And that's what he was on. All right. And he was telling me his pain is eight out of 10. He's still depressed, he's not working. And this is like really, you know, messing them up. So MAW was six months ago, not three and a half. I'll take this light. And MAW, I finally convinced him, it was like four years, finally convinced him that I said, you gotta just come off the medication and I'm going to, I said to him, I'm going to do a spinal cord stimulator for you, and we'll take care of the pain.

I said, because enough, enough of this, I, I know I can control the pain with a spinal cord stimulator. Or a peripheral nerve stimulator actually for him. So he came off and then he's on Suboxone six milligrams a day, and his pain is 1. So the opiates were causing his pain! Okay. Good mood participating at home, and he's looking for part-time work.

So medication-assisted withdrawal can actually not just take patients off opioids, but it can actually help with their pain. Okay. Thank you.

Michelle Resendez FNP-C - 15th Jan 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Michelle  Resendez is a certified family nurse practitioner. She combines her love for alternative and natural medicine alongside traditional medicine.

She has successfully treated patients with a diverse range of health conditions that have not responded well to conventional medical treatments.

She said" I first learned about LDN about 10 to 12 years ago, first learned about it from a naturopathic medical. The first patients I treated had thyroid conditions, Hashimoto's, Graves thyroiditis. And so I was really using it to try to the modulator assist the thyroid in functioning better. And from that point, it really expanded and opened the horizons, treating other things.

So we found that people with thyroid conditions, if they're taking thyroid medication, usually have to reduce the amount of thyroid medication.

When I start someone on Low Dose Naltrexone (LDN), easily around 0.5 to one milligram at night, and I will either reduce their thyroid medication in half, or I will just reduce, if they're on a T three medication, I'll reduce that down.

 A lot of times, their autoantibodies will start going down, and that will help the thyroid function better.

Sometimes you'll get some adverse side effects like tremors or palpitations, or just feel a little bit more excitable than her used to feel.

I have a lot of patients start noticing the effect almost immediately within a couple of days. Depends on what condition I'm treating.

A osteoarthritis type pain or structural type pain people usually notice the effects within a week of taking that.

Once they move out to one or two milligrams, they start feeling some relief.

Antibodies are a little bit more resistant, and it might take, two to three months to see antibodies go down with LDN. And that's because of the treatment approach for that is really multifactorial.

And the LDN is just an adjunct to that. And usually, we do lifestyle modifications and diet and, and other interventions to help those antibodies come down as well.

Anyone starting Low Dose Naltrexone (LDN) can experience negative side effects. The most common would be that when they get a rebound effect it at night with those endorphins kicking up, they can get some anxiety. They can get some insomnia.

Patients that we treat for viral conditions or reactivation syndromes like Chronic Fatigue Syndrome, they can actually get more severe adverse side effects such as sweating, fevers, flu like symptoms, feeling sore throat, things like that.

All of that is expected and typical. I don't like to stop treatment if they're experiencing those side effects because that's telling you that it's working. We're getting the endorphin release that we're looking for, and we're getting the immune system enhancements that we're looking for.

Those side effects are what I would consider good responses.

I haven't had anyone had any side effects that  I would consider to be adverse like hives—rashes, vomiting, anything so severe that I'd have to stop them on it.

I treat GI conditions as well. I've had probably the most success with gut issues. It's one of my top responders. Some of my earlier patients were Crohn's patients.

LDN seems to work pretty well for the exhaustion, the fatigue and the pain.

The conditions that I treat teenagers for could be anything from Attention Deficit Disorder, Depression, pain conditions, allergies, sleep issues.

Some of my kids are on the autism spectrum, so I do treat that as well.

I do have quite a few teens and young children on LDN. And I'll actually have them on liquid if they're too young to swallow a pill or won't tolerate a gummy or a sublingual lozenge.

I do have a traditional medical doctor referring to me, Neurology, Cardiology, Rheumatology. Dermatology because there's a lot of dermatologic conditions that can be treated very successfully with both topical LDN called Xeno top and then oral LDN.

The skin conditions I am treating it for it would be the Legos, Psoriasis, Rosacea, Eczema. Those are probably the top of all the skin conditions that respond really well to it. It takes normally 3 months to see results.

There's trials to find if there are some food triggers associated with that.

A lot of it is when they're having fires and because it's triggered by something and I want to find out what that trigger is.

And then the LDN just helps the body heal itself. So it's keeps them in a remission state.

When I first see a patient I typically wll do labs tests first that looks at allergies, hormones, thyroid, inflammatory markers, genetics, things like that. I try to find triggers if I can identify any and remove those before then starting on LDN. I like to see how they respond first to that.

I like to do things in stages so we can really see how impactful each thing is at each stage. So I'll take away the food triggers first if I can identify them and then add LDN onto that at some point.

Right now we've just moved into our new office. So my business partner and I have been here for three months. I'm at a two-month waiting list right now. Once we hire some more back-office staff, I'll be able to stack more appointments and that will trim down for maybe a month or two and then we'll probably get booked up again. I do keep appointments open early morning and sometimes I'll see patients after my last appointment for the day. If there's something urgent or somebody's not responding favourably to meditation or something.

I leave those time slots available for that so I can get people in if I really need.

I would say on average, patients see me every three months. That would be somebody who is stable, doing well on their regimen and not needing any further testing or imaging or interventions done.

So some patients I will see on a monthly basis if they have a lot more chronic illnesses and conditions because I like to do those steps, plan out, maybe CBO treatment, diet.

Also with hormones, thyroid continue to add things to optimize how they're doing and their quality of life.

I have some come in annually. They're probably not my patients on LDN. They're probably more. They're doing our mono treatments, pellets, injections. Yhey're doing other treatments other than just LDN.

Summary from Dr Michelle  Resendez YouTube interview. LDN Radio Show Listen to the video for the full interview.

Sherry - 1st Jan 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today. I'm joined by Sherry who uses LDN. Thank you for joining me today, Sherry. 

Sherry [00:01:07] Thank you for inviting me. 

Linda Elsegood: [00:01:10] Could you tell our listeners what is it you take LDN for?

Sherry [00:01:16] I have the autoimmune disease, lupus. I have degenerative arthritis and fibromyalgia. These are three of the main concerns in my health, which has caused chronic pain. And it's really brought me to a place of disability, not being able to work and to enjoy life. And my health just kept deteriorating. And so a few months ago I was introduced to the alternative medication of low dose naltrexone. 

Linda Elsegood: [00:02:08] Can we just stop there for a minute? Let's find out first of all, before you found LDN, what was it like, and how long did you have all these conditions? I mean, have you had them all your life? Have they only been the last few years? Start at the beginning of your journey. 

Sherry [00:02:28] probably about 25-30 years ago I started having issues of where I would get a rash all over my body and then begin just feeling really bad and tired, and everything on my body hurt. It would happen maybe two or three times a year, or if I had gotten a virus or a urinary tract infection, I would get these symptoms. And it took several years for it to progress to where I was having these symptoms every month, every two weeks. And it took quite a while for doctors to diagnose the condition as lupus. And it is a progressive type of illness, not like it happens once and then you get better.

It just continued to get worse as I aged, and I developed more degenerative arthritis in my spine and my hands, which also inhibited me from being able to do a lot of physical activity. I was a nurse and you use your hands quite a bit. And that became very difficult to do. And then I started with the chronic muscle pain and fatigue of fibromyalgia that impacted more of my lifestyle. As time went on, I ended up taking early retirement from a job so that I could rest for a little while, and maybe reduce the stress level in my life to see if that would help. I found a job that I could do sitting down and using my computer, but still having to deal with the symptoms of chronic pain, fatigue and then flare-ups from any types of stress or viral illnesses or bacterial illnesses. So it really inhibited my life quite a bit. In 2018, I was awarded a disability determination, and that same year I couldn't do my job anymore even though it was a sit-down job. I just got to where I couldn't do full-time work. It just affected every part of my life, even my extracurricular activities within the community or with church or friends. 

I went to see a rheumatologist, and a couple of years ago and a new drug called Benlysta came out that was the first, uh, treatment for lupus; and I've been getting infusions every month and that has helped tremendously. It's cut back on the number of flare-ups I have with lupus. But degenerative arthritis and the fibromyalgia still had a great impact. And it was to the point where I could not even walk a mile. Or if I had to go to the grocery store and I had to walk around the big shopping centre, I'd make sure to hold onto the cart if I had pain in my back and my legs, and it would just make me have to sit down or, at times lie down. If I had family meals, a holiday celebration where I would do a lot of food preparation, after a short period of time, I just had to go lay down. The pain was just so tremendous in my body because of arthritis.  

Linda Elsegood: [00:07:53] can I just ask you, Sherry, how difficult was it to be diagnosed with fibromyalgia because it hasn't been recognized as a condition for that many years?

Sherry [00:08:03] That's very true. It is difficult, because as far as being recognized, and even lupus, it is the great disguise there. It was hard for them to finally put a diagnosis on me. And you find in your mind that you question whether you are going crazy or something, and what's going on with me? I know I have these feelings. So you finally find other people who are experiencing the same thing you are, and you realize you aren’t the only one that felt that way. And so yeah, it is a very difficult thing going through a disease process that is not truly recognized. 

Linda Elsegood: [00:09:28] And then you, of course, we're told about LDN. I mean, how easy was that to get a prescription and have it filled.

Sherry[00:09:38] That was another story. I had been referred to pain management because the doctor said, well, there's nothing else we can do for you. Go to pain management. And that was getting injections and getting on opioids. For some reason, it did not work on me. I guess maybe I'm just different. But the steroid injections didn't work. And as part of pain management, you also are sent to a psychiatrist to be able to find better ways to deal with chronic pain. And it was through that - that psychiatrist had dealt with other patients whose opioids and injections and all did nothing for the pain. And she said, they were put on a drug, it's off label use, but maybe this will help you. And so I started to do some research on it and talked with my pain management doctor asking if she knew about this use of naltrexone. She had never heard of it before. Then I talked with my rheumatologist and he said he had heard of it, but he's never used it for any of his patients, but he was willing to try it on me. And luckily there was the LDN Research Trust website and all the information that's for providers and patients.  He was able to be directed to that, and as he's educating himself with the use of this drug, he sent my first prescription to my pharmacy. I had no idea that it had become compounded, and my pharmacy didn't know either. So they actually made a mistake and gave me 50 milligrams of naltrexone. I'm thinking it was because I was on opioids at one point. So that was a farce. And then I finally found a pharmacy that did compounding for naltrexone, and that pharmacist was extremely helpful. He directed me to some more LDN research, information so I could educate myself and become part of the lupus support group of those who use LDN. He was an immense source of education and comfort, so I finally was able to get the medication through a compounding pharmacy in our area. 

I even talked with my primary care physician, telling her about the experience that I've been having with low dose naltrexone, and she says, this is what we need to hear. We need to hear about treatments like this, and they're not hearing it. And so anyway, my little part, I'm sharing the website information.

Linda Elsegood: [00:13:30] at what dose did you start on when you started, Sherry

Sherry [00:13:34] He started me on 4.5 milligrams right away, so I was taking that at bedtime, and immediately for the first couple of weeks, I saw no difference in the pain. I did start sleeping and dreaming, and I hadn't dreamt in quite a while, and sleeping through the night was very restorative.

It was about maybe six weeks of taking the 4.5 milligrams at bedtime that I started noticing in the day time that my pain level was decreasing. It wasn't as bad. It was tolerable. I had been where I would be from a six to eight pain score level every day, and at times more when I had to overdo things too much on my feet, or too much physical activity. I just had to go to bed and there was nothing that really helped me to take the edge off. After about six weeks, I noticed it's starting to work for pain and I was just full of joy about it. I just felt new. I felt renewed. My pain level about six weeks into LDN has gone to a three to a five every day, and that's for me, that's tolerable. That works. And I'm just overjoyed with that. And because of that, I've been able to walk for more than two miles, and hold on to a thing, or lie down, or use some other pain medication to help take the edge off. Those were the first experiences. I was just really just thrilled and told my doctors about it and they were extremely happy about it. Yeah. It set a whole new outlook on life. I don't expect that I would be 100%  a new body, a new person, but my life is definitely tolerable now in my body. 

Linda Elsegood: [00:16:49] And do you have a virus? Would you like to explain what happened when you had a virus? 

Sherry [00:16:57] Yes. It's now six days ago, I started having a respiratory virus, the cough, the congestion and all that. Usually, with lupus, those are triggers to a lupus flare-up. I didn't really know what was going to happen, but when it triggers a lupus flare-up, I get a rash over my total body and my skin becomes very painful. I have increased muscle and joint pain, fatigue, headache. It's not very nice.  It's bad enough you're not feeling well because you have a virus, then you have that on top of it. So six days ago I started with this virus then two days later I woke up and I had a lupus rash all over my body, the same type of experience that I would have prior, with the pain and fatigue, and all that went along with it. I called my rheumatologists and I reported to him what it was. Usually, he would prescribe a taper of prednisone over one to two weeks and my symptoms would be gone, the rash would be gone. And when the rash leaves, 10 days later my skin starts to peel off. The prednisone helps with the pain and the fatigue, but it usually takes about one to two weeks for me to get through an episode of a flare. 

I called my doctor as I was beginning this flare up and he didn't want to start any prednisone. He wanted to be sure that I did not have any type of infection, and afraid of it suppressing my immune system and then the virus really taking over. I agreed and I said I will call back and be reevaluated, so no prednisone next time. And then the rash and the fatigue and the pain exacerbated. And by that evening, ready to go to bed, I took in my LDN, as a backup.  We decided to give me the doses of one-milligram capsules so I could play with the dose and see if I could have a good reaction on just three milligrams of naltrexone, or if I really needed five or six milligrams of Naltrexone tab That's when I found that when I was on the three milligrams I had more disruption in sleep and more discomfort in my muscles and joints. So I went up to five milligrams and I was taking that pretty regularly and I was feeling good. And then I got the virus when I was on five milligrams of LDN. So when the flare started, that night when I went to bed, I took five milligrams of LDN. And when I woke up the next morning, my rash was almost gone. I mean, I could barely, barely notice it. I mean, it was just a shadow of it. And as the day went on the pain and the rest of the rash were totally cleared up. All the symptoms were diminishing. I still had the cold symptoms, cough and stuffy nose and all that, but the lupus flare was fading without prednisone. And that just is another surprise, to be able to do that without having prednisone. It’s just a miracle that that could happen. And every night I still continue with the five milligrams of naltrexone.

And every day, the lupus symptoms, the flare-ups, have diminished. I'm still working through the virus. You could probably tell, I sound probable still a little congested, but to me, it's a miracle. I  called and reported to my doctor and said, I know it's hard to believe, now I don't have the symptoms anymore and I didn't take any kind of prednisone. So that's where I am today. 

Linda Elsegood: [00:23:47] Well, What, amazing story. Truly truly is, and I'm sure those people listening who have lupus or degenerative arthritis, fibromyalgia is going to be so inspired by you, and thank you so much for sharing your story. Sherry. 

Sherry [00:24:08] Oh, I appreciate you giving me the opportunity. I hope this can help someone. I know it's so discouraging for some of these diseases, not getting the help you need.

Linda Elsegood: [00:24:21] Well, thank you for having been our guest today. 

Sherry [00:24:25] Okay. Thank you very much. 

Linda Elsegood: [00:24:29] This show is sponsored by our members who made donations. We'd like to give them a very big thank you. We have to cover the monthly costs of the radio station, software, bandwidth, phone lines, and phone calls to be able to continue with our Radio Show.

And thank you for listening.

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.

 

Judy - 22nd Jan 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Shivinder Deol, MD - 27th Nov 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Dr Shivinder Deol, who's an MD, certified in family medicine and anti-ageing and regenerative medicine. Dr Deol has served at Bakersfield, California community as medical director of the anti-ageing and wellness centre for over 35 years. He specializes in integrative preventative and family medicine as a primary care provider.

Thank you for joining us today, Dr Deol.

Shivinder Deol: Thank you for having me. 

Linda Elsegood: So could you give us your background? Where did you train?

Shivinder Deol: Sure. I studied in a private school in India, one of the top leading medical schools for some medical college. Graduated from there in 1975 and then I came. I did a course a year off a residency in India, and then I came and joined a University of Tennessee, Memphis and did my training in medicine, psychiatry, and family practice.

And then, I've been in practice, since 1982 in Bakersfield, California. I've taken extensive courses in regenerative medicine and anti-ageing. So my training, even though it was initially more family practice, and I'm board-certified three times and family medicine, but my interest went towards more integrative medicine and functional medicine. For the last 15, 20 years I've been doing more of that. 

Linda Elsegood: When did you know you wanted to get into medicine? Were you very young?

Shivinder Deol: No, I wanted to be an army man. My family is a strong army. But my mother wanted someone to be a doctor. So my older sister, then my brother, passed out and did not go into medicine. So my mom said:" You got to do it." And I said: "okay". I got into medicine, but I'm so glad I did because I think it was my calling and I really had an incredible journey.

You know helping people, learning and growing myself with medicine.  

Linda Elsegood: I mean, things have changed, haven't they? I mean, you must have seen it from when you first qualified. What was it? 1975 where you went to the doctors, you told the doctor what was wrong and they, I remember it well.

I got married in 76 that people had their symptoms treated. But they never actually had the root cause treated in those days, which then eliminated the need to treat the symptoms. So, you know, what is it you actually do in your practice? If a patient came to see you with complicated symptoms, why would you start?

Shivinder Deol: You know, we would just, you know, and it was a great business for physicians and all patients came in, they got better and it was just an ongoing process, drug after drug after drug, and then treating.

So no one really was treating the whole body or looking at the real cause of a disease. It was taking care of symptoms now and we'll worry about the things later. 

Linda Elsegood: Yes. So what do you do now? 

Shivinder Deol: Now my focus is changed more.  When a patient comes in, my focus is more nutritional based, first and foremost supposed thing I'm really interested in finding. So this to me, the most important thing anybody can do is improve their nutritional status because a body is constantly working and regenerating itself.

So we estimate we have close to 30 trillion cells, but out of that, almost 700 billion cells are being built every single day of life. And we have hundreds of nutrients and the food that they're eating, which is processed, and with cold storage and with cooking, microwave, we've destroyed a lot of the nutrients that the body does not get all the raw material it needs for all its needs that all the regenerative and repair needs on a daily basis.

So my focus is nutrition and then I do a lot of things with detoxification, removing chemicals, toxins, poisons, reducing inflammation in the body through Iv therapies, chelation, all kinds of different things, hyperbaric. And then we do more stuff at balancing hormones and neurotransmitters to optimize health, brain health, heart health, and overall, you know, endocrine help.

So we do a variety of things to help the body improve rather than just fixing. A sore throat, some,  my aim is if I can prevent a single heart attack, a single stroke, single cancer, we do a lot of protection for breast cancer, for instance. So, basically, if we can reduce any of these massive major diseases, it's far better than, you know, treating the simple sore throats and colds and allergies that most people will have, but they don't really affect on lifespan with these scans.

Linda Elsegood: Okay. What kind of testing do you do when you're probing the patient to find out the wrinkles? 

Shivinder Deol: Yeah. So basically, you know, the insurance companies, of course, we are all kind of stuck with insurance companies to some degree. So the standard blood work that insurance companies cover, I do that but for instance, in a standard blood test, a lot of doctors will do as a free T4 and a TSH. But the key hormone and thyroid, for instance, is there a free T3 which is the active hormone and not T4. So unless we look at three-T3   and reverse T3, you really know what the thyroid function is.

So I look at more in the functional way of looking at health and so we do a lot of hormone testing, but the best way to test hormones are either through a saliva test or a comprehensive urine analysis. And typically insurances don't cover that. We do testing for heavy metals and for chemical toxicities.

So there's a really nice chemical toxicity test that looks at literally hundreds, if not thousands of different chemicals that we have been exposed to. We do food allergy testing, again, not the one that's covered by insurances, which is an immediate food has to be, but more a delayed food sensitivity test.

We look at a comprehensive digestive stool analysis. Look at gut health, gut inflammation, and see if there's an imbalance between the good and the bad bacteria in the gut. So a variety of other specialized tests that we do that can look at the body in a more natural matter. So trying to hit the cause rather than just the symptoms or repair.

Linda Elsegood: And you mentioned hyperbaric oxygen there. For people that are not familiar with hyperbaric oxygen, could you tell us what it is and how it works and what results you have seen?

Shivinder Deol: Sure. So hyperbaric oxygen is basically,  you're in a large chamber, which we are pumping in oxygen under pressure and under the, if you have some, some people remember the physics, the Boyle's law.

They've been, we put pressure, any of the gases are absorbed deeper and greater into the tissues. So when we pump in the oxygen, it goes into every joint, every fluid in the body, including the spinal CSF (cerebral spinal fluid). And so this increase oxygenation. It helps you the healing process in the body.

So if you can put oxygen into any tissues, the body starts to repair process and also discourages cancers, infections of all kinds of any chronic diseases. If we can put the oxygen, the body will start the repair process and use, any of the toxic effects off infections or, other pathologies.

So it's a great way to treat strokes or heart disease or traumatic brain disease, injuries of any kind, surgeries of any kind. So, for any surgery, if you were to get a hyperbaric treatment one before and two or three treatments after surgery, you cut down healing time in half, you cut complications in half.

So it's a very nice way to help repair the body. Also, injuries of all kinds, helps repair, very, very nice treatment, and very safe. I've been offering that for over 20 years. 

Linda Elsegood: Is it covered by insurance in the US?

Shivinder Deol: Unfortunately not. There only seven indication for which a Medicare will pay for and things like diabetic ulcer are non-healing ulcers, but you know, severe diseases they are willing to pay.  For minor issues, you know, they will not pay.

So it is typically a cash payment.

Linda : Elsegood: Is it very expensive?

It depends. So in our office, we charge to believe by the $150 to $200. There are some places, where they are in the three, $400 range. And some places, if they are using a smaller chamber, low pressure, they even offer it for like $125 a soul. But if you use a high-pressure chamber, you know, it's going to be about 150, $200, at least, if not more.

Linda Elsegood: Hmm. It's that for an hour?

Shivinder Deol: That's for an hour. But by the time you get in and out, it's going to almost be an hour and a half. So it takes about 10 minutes To get the pressure optimized in by us, then to brings the pressure down. So it's almost like an hour and a half a treatment. 

Linda Elsegood: I actually had hyperbaric oxygen when I was first diagnosed but it took me about an hour to get there and an hour to get back. It was very, very tiring because fatigue was bad. But I have claustrophobia and I was not really thinking about it, but it was quite a big tank and I think it sat about eight people. So I sat in this tank and I was thinking how am I going to feel when they close the door?

I'm really nice. And then they came out with these masks you had to put over your face. Oh, that was a testiness itself. But I, I have kind of got used to.

Shivinder Deol: We don't use a mask for this reason because it is so much closing feeling and our chamber has three different windows that you can look throughout.

So yeah, there is some claustrophobia, but it's really not that bad. 

Linda Elsegood: This small porthole but they are up high. So you couldn't actually see out. You could just see the other people who were in there with you for that.  Was quite an experience but unfortunately, it was run by a charity and it closed down many, many years ago now, which is a shame because I think they did some really good work though. So with the testing, one of the things that people quite often ask me about is Candida. Do you do Candida testing? 

Shivinder Deol: Of course, and Candida is almost like cancer. So candida basically get thin, and it's very hard to clear Candida out of the body. So yes, we do quite a bit of testing for candida because I think of candida as a very severe, but just to be insidious, it's very quiet, a low-level infection that can just, go on for years causing a lot of damage. But people not even, sometimes be aware of it, and in the long run, can lead to greater complications in losing potentially cancer.

We made it, we believe that it may be a cause of.

Linda Elsegood: Well, so many people have asked me that they do a saliva spit test in a glass of water or something and I don't know how accurate that is. But people tell me that they try these remedies to get rid of it and they can't, and they've been to doctors and they've still got it. You know, if you have a persistent Candida problem, how do you go about fixing it?

Shivinder Deol: Well,  basically that is several things. But candida loves sugar. In fact, every bad bug cancer loves sugar. So to treat any chronic infection, the first thing you have to do is cut out the sugar, cut out the carbs, and remember all carbohydrates except fiber break down to sugar, all of them. So people will cut out sugar, but they don't reduce the carbohydrates, and it's still on getting sugar in the body.

And as long as you're getting sugar, the candida is going to be almost impossible to kill. So the diet, again, comes in really important on a low carb diet. And then we may want to make the environment on hospitable for candida. So whatever the candida likes, we would cut that.

So keeping the body made more alkaline, keeping the body more oxygenated. So using oxygen and ozone therapies. And really helped clear it up candida. But Candida will generally require a prescription medicine plus several strong probiotics, Saccharomyces, and several antifungal herbal supplements to help fight the candida.

And it's a longterm treatment. It's not a quick course of treatment that'll help clear it. 

Linda Elsegood: Wow. 

Shivinder Deol: It requires a long process treatment. Yeah. 

Linda Elsegood: I didn't realize that it was so difficult to get rid of. 

Shivinder Deol: It is. 

Linda Elsegood: So how long ago was it when you first heard about LDN? 

Shivinder Deol: I think it's been, well, over ten years or even longer than that, that I've been using and that I heard about LDN.

And I think, I'm not sure if I heard it in a conference or if one of my patients came to me originally initially and asked me about it, but I think it was over ten years that I used it and the first patient that I actually use it on happened to have such a dramatic result that kind of opened my eyes.

So this lady had severe Hashimoto's thyroiditis and her tilters were in several. And so we treated her with the LDN plus a few other things, lifestyle changes, iodine, cut out gluten and so on. And her tilters started coming down dramatically, and about a year, year and a half or titers were back to completely normal.

So we had cured her now, Hashimoto's, and this was, I believe, strongly related to the use of LDN. And, so that was a very strong eyeopener for me on this, on LDN and its potential efficacy. And since that time, I've used it on a whole bunch of other patients for a whole variety of other conditions. But fortunately for me, that I had, my first patient responded so well that, it really made me a believer.

Linda Elsegood: You said that you've treated in lots of conditions with LDN. Do you have any other case studies that have been remarkable in your practice? 

Shivinder Deol: Yeah, a few others. So I have a patient with severe ms. Was very fatigued, but she's got severe tremors and she was extremely fatigued, and so I put her on LDN, and within days she could tell the improvement in energy level and the fatigue had improved very, very nicely. But unfortunately, I did not see, or she did not see any improvement in her tremors. But as far as the energy level and a mood, she comes in smiling every time. Poor thing is shaking a lot, but she's smiling. And so it improved certain parts. I had another patient who came to me from New York and stayed with me for one week.

She was on heavy pain medicine, fentanyl and morphine for 30 plus years for back pain. I got her detoxed completely within one week, and I use an IV, NAD, which is an incredible nutrient to help with the detoxification, increasing energy level and then up, put her on LDN. And this lady wrote to me about a couple, three weeks ago saying she felt so wonderful and that she has not had a single pain medicine.

In fact, she said, I don't even take Advil orTylenol but rarely for pain now. And she was really grateful that she had done so well and all for 30 years, her life was all around pain, medicine, pain medicine, and so that was a very nice response. 

Linda Elsegood: Oh, that's amazing because if you're in constant pain the whole time, it must make you feel a little bit irritable and short with people because you have to deal with that level of pain. You can't live your life normally in pain. It's not possible. Is it? 

Shivinder Deol: Right. But see, unfortunately, that reality is, what people don't realize is that acute pain and chronic pain are not the same pain.

And it's a completely different set of effects, a completely different disease, acute pain. So somebody has an acute practice, acute injury, acute surgery, that's a completely different, set of effects in the body versus somebody who's had chronic bad back pain or neck pain or whatever for 10, 20, 30 years.

 There our need for pain medicines are different. They are now just dependent on getting that  pill, of course, rather than the true pain itself. So it's become more of a withdrawal-type pain and not a lot of ease. Opioid receptors are tight, are doubted out, and so the effectiveness goes down.

But when we use something like LDN, we recharge our opioid receptors. We reactivate them. We produce a resounding amount of receptors so that we are having much better, pain relief without the need for any external medicines.  

Linda Elsegood: It always amazes me how such a small amount of naltrexone can actually be more powerful than the fentanyl and morphine.

It's hard to understand.

Shivinder Deol: It really is. But you know,  I'm a true believer of this. The body is a true miracle. And the ability of the body to repair and regenerate itself is just incredible. Our challenges that we have, that our diets are horrible. We are living in a really toxic lifestyle. And then we have all these other stresses that are influencing neuro-transmitters and our chemicals and our hormones.

The body doesn't get the opportunity to repair and regenerate itself. So when the state garbage out of the body on necessity, medicines and toxins out, we balance some of the nutrients. We helped the body produce its own good nutrients and endorphins. The repair process becomes really dramatic and the body can pretty much heal anything.

So I see a lot of miracles, but it's really not a miracle. That's what the body is designed to do is to help. He looks healthy all the time, regardless of what's going on. So we are great healers.  

Linda Elsegood: And you were going to give us another case study before I butted in.

Shivinder Deol: I did not understand. 

Linda Elsegood: You were going to tell us of another case study. Another patient. 

Shivinder Deol: Oh yeah.  A cancer patient. Basically patient comes to me with metastatic cancer. LDN is great in supporting cancer. You can literally help stop cancers from spreading.

So this patient basically the doctors told him that just go home and die and he's a relatively young guy and he doesn't want to die. You know, who does? So he came in, you know extremely tired, extremely tired, and just basically depressed, no energy and kind of giving up. But the wife is wonderful.

Wife is so supportive of him. And so we've started him on a high dose, intravenous vitamin C, 75 grams three times a week. And he started feeling a little bit better. And then I added LDN to his regimen. I've got him on a lot of different things. So put him on a keto diet, very strict Keto diet.

And so we put LDN on, and his mood has improved a lot that he can tell, and he is now able to start to do a few things. So I don't know what the status of the cancer is. It's too early for me to do any scans on him, but I'm certainly hopeful that with his mood outlook, comparing his energy is improving that maybe we're going to get a decent result on his very widespread metastatic cancer.

...

Linda Elsegood: Well, I believe we've now come to the end of the show, so that has been amazing. When very quickly, would you like to tell patients how they can contact you if they wish to make an appointment? 

Shivinder Deol: Sure. My website is antiagingwellnesscenter.com. 

My email is support@antiagingwellness center.com and, the office phone is 661 325 7452.

Linda Elsegood: And do you have a waiting list? That's the other question.

Shivinder Deol: Do I have, what? 

Linda Elsegood: A waiting list? Do people have to wait to see you? 

Shivinder Deol: No, well we basically work people in. My philosophy always has been that we are in a service industry. We are providing a service. And  in the service industry, if you have, your electricity is gone, and you call the electrician, and he comes a month later, it doesn't work.

Or your car is broken down, you know? So if someone comes in that needs to be seen now, I'll see them the same date. I don't care. They may have to wait a little bit. We may have to work a little harder, but we take care of somebody who needs to be seen when they need to be seen. So I don't keep awaiting this for this reason.

Linda Elsegood: Oh, that's wonderful! Well, once again, thank you very much for having been our guest today, 

Shivinder Deol: Linda. Thank you very much and you take care.

Linda Elsegood: This show is sponsored by Dickson's chemist which are the experts in LDN at associated treatments in the UK. Dickson's chemist, the most cost-effective for LDN in all forms within the UK and Europe maintaining safety standard of what is required. Why would you choose to get your LDN from anywhere else?

Call 01414046545 today to speak to a LDN experts 

Any questions or comments you may have, please email me, 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.

Pharmacist Kim Hansen, LDN Radio Show 30 Oct 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is pharmacist Kim Hansen. She's from the Town and Country Compounding Pharmacy in New Jersey. Thank you for joining us today, Kim. 

Pharmacist Kim Hansen: Oh, it's my pleasure. Thank you for having me. 

Linda Elsegood: So when did you first decide you wanted to become a pharmacist? Was it something you'd always wanted to do?

Pharmacist Kim Hansen: Absolutely.  I was working in a small independent pharmacy, a traditional retail pharmacy when I was in high school. And on occasion the pharmacist there would say, Hey, Kim, go mix these two creams. Or Hey Kim, go mix these two liquids. I was hooked. I knew that's exactly what I wanted to do. And from that point on I headed for pharmacy school and that was my path. I knew it immediately. That's what I wanted to do.  

Linda Elsegood: So where did you study?

Pharmacist Kim Hansen: Rutgers college of pharmacy in New Jersey. 

Linda Elsegood: So you haven't moved far? 

Pharmacist Kim Hansen: I've travelled far, but I haven't moved far. 

Linda Elsegood: So once you started compounding,  what were the main medications you were doing at that time?

Pharmacist Kim Hansen: Back in the day, it was usually combining a couple of creams together. That was before we had a lot of the manufactured products that we have now. A lot of times compounds start off that way, then they end up being manufactured items later. I used to have to make a topical minoxidil solution. I used to have to make up progesterone capsules way back in the day. Suppositories for progesterone. This was 20 some years ago. So it was before I knew of LDN.  I was doing compounding before that. Mostly progesterone and topical dermatological items that were not commercially available.

Linda Elsegood: How did you hear about LDN?

Pharmacist Kim Hansen: I think it was at a compounding seminar is the first time I'd ever heard of it. It was being discussed for autoimmune issues. I started seeing prescriptions for it about seven or eight years ago. Usually, it was just capsules, usually, it was the three different dose levels that we know differently now. It started gaining traction more for me within the last three years. But I did see it back seven or eight years ago.

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

Pharmacist Kim Hansen: Right now we do capsules and oral suspensions. Most often it's the capsules that patients are happy with. We also do a cream for patients with autism, and occasionally it's added to pain gels as well.

Linda Elsegood: What is the filler of choice for people?

Pharmacist Kim Hansen: Generally speaking, patients are happy with acidophilus. I do have patients that don't want that. And then we usually use micro crystal and cellulose, but if they have a specific filler question or need, we're happy to accommodate that.

Linda Elsegood: And what strengths do you do now in the capsules? 

Pharmacist Kim Hansen: I think our lowest is a hundred microgram capsule because that patient prefers that to be in a capsule form versus the liquid form, anywhere up to 10 milligrams and anything in between. 

Linda Elsegood: And the patient population, what would you say the top conditions that LDN is treated for from your pharmacy? 

Pharmacist Kim Hansen: Hashimoto's, pain and depression. 

Linda Elsegood: So talk us through those three, Kim, the experience that you've seen from those patients. 

Pharmacist Kim Hansen: I'll start with Hashimoto's. We do notice patients are getting to a dose that is appropriate for them and are feeling better. They also require less thyroid hormone.

If someone is on thyroid hormone and start LDN, that should probably be monitored more closely than before you started the LDN, because you'll find that as the inflammation reduces, the thyroid level changes and you may need to change your dose. Usually, it's a reduction in the thyroid dose when it comes to the pain medication using it for that.

I have patients who have had their lives changed. They were in a tremendous amount of pain before, and they were put on other pain pills. Any medications usually were just adding to their pill burden, but not really giving them relief or quality of life that they were looking for. I have patients who weren't able to do any of their activities of daily life and now are doing things that they haven't done in 20 years. To me, that makes things tremendously rewarding to know we can be a part of that success story.  I should also mention when discussing pain with patients, I have patients who have become tolerant to opioids. So we also find that LDN is a way to help reduce the opioid burden and help people get off of those and still maintain their pain relief. I view those two things together like pain and sometimes patients are looking to get off the opioids for relief of their pain. So it actually does both. 

The other I  touched on was depression. I have patients who are using an increasing schedule of LDN and also weaning off usually their SSRI or antidepressant drug. And they're finding if they wean very slowly off the antidepressant and titrate upwards very slowly with the LDN, they're able to get off of the antidepressant and still maintain a non-depressed state. They're happy to be off the medication and be able to use LDN, which we know works in a different way and usually has a better overall effect than the actual medication worked for them. 

Linda Elsegood: Ultra-low-dose naltrexone helps combat the opioid crisis. Could you talk us through how, when people come to your pharmacy, whether it's been addicted to prescription drugs for many years, how LDN plays a part in getting them off the opioids, but still controlling the pain? 

Pharmacist Kim Hansen: I won't get into a specific schedule because it is so dependent on each patient. I will say that we usually start patients on the microdose or the low dose, ultra-low-dose naltrexone, usually in a suspension form, and they'll be on whatever their dose is usually for about a month. And then after they're stabilized with that, the pain management expert will slowly increase the dose of their ultra-low-dose naltrexone and also decrease their opioid dose usually by about 10%. Again I don't want to give schedules and hard limits because every patient is so different in their ability to reduce. It's very varied as far as that goes, but I have many patients who have been on rather strong doses of opioids that have been on that for years, have been able to slowly titrate up on the naltrexone and slowly wean down on the opioid and have had success and be pain-free and opioid-free. That's huge to have that happen. We had one hospice nurse  (certainly hospice nurses are very well versed in pain and pain origins and pain protocols) who herself had her own pain issue. We walked her through this process of slowly starting the ultra-low-dose naltrexone and scaling that up over time and reducing the dose of the opioid over time. Now she’s opioid-free and as pain-free. And it definitely helped her increase her quality of life and also to be able to do the things that she couldn't do before.

So that's a huge story. I mean, someone who is on opioids, to be opioid-free is huge. 

Linda Elsegood: Definitely. For people listening out there who are in a lot of pain, because I'm told nearly daily that there is somebody who is in terrible pain, but they were already on very high doses of an opioid that doesn't seem to be working, you know?  Of course, the problem with opioids is your body gets used to them, and you have to keep increasing the dose to get the effects you were having. So anybody who has chronic pain for whatever reason, or fibromyalgia or having an autoimmune disease that has a pain component to it, how would they go about.

finding a doctor who would prescribe LDN and one that would understand about the ultra-low dose, who would be able to help them transition from the opioids to the ultra-low dose?

Pharmacist Kim Hansen: Two awesome ways to find that out. One is LDN research trust. There are lists of physicians and practitioners on there that are knowledgeable in what we're talking about here. You can also ask your local compounding pharmacist because we are a treasure trove to know who is actually prescribing it in order to be able to send patients.

It works both ways. The prescriber sends the order to us as they know that we'll do a quality compounded product. I can then refer patients back to other practitioners because I know that they're knowledgeable in this and then they've attended our seminars and that we can work together with them in order to get the best outcome for the patients. So it works both ways.  

Linda Elsegood: I was quite surprised when Dr Sam was telling me how quick the process is because I thought it would be a long, slow process. But he was talking just a few weeks, which was, wow. People that had been on opioids for many years, to, find relief like that, it just amazes me that something.so small and so simple seems like tickling the pain with a feather in those ultra-low doses rather than using a really big mallet, which is the opioids, for it to work. It just is mind-blowing, isn't it? And of course, the price, LDN is not expensive, and many people have to pay for it themselves. And it's not a price out of the reach of most people. We still have people who do not have money, they're sick, they're not able to work. And if it's a choice between food or LDN, that's a problem. But we're looking at around $30 a month, depending on where you have it compounded. It's an affordable drug, isn't it? 

Pharmacist Kim Hansen: Absolutely. We try to maintain that because we do understand that patients are in pain and you don't want them to have to choose between therapy and their food or their bills or whatever that is. We want patients to get the relief that they need.

We've kept what we're doing affordable so that we can make sure that it's available to as many patients as possible. Usually, you'll find whatever pharmacy you use, if you're going to be starting a titration and working your way upwards, usually that pharmacy will put together a kit.

So you've got maybe two different doses of a capsule in there so that you can gradually increase to the dose that you are working towards. And then once you arrive at the dose that's working for you, then that pharmacy can make that dose into one pill so that it becomes more economical if that makes sense.

Linda Elsegood: Yeah. I had a lady email me this morning, I think she had Sjogren's syndrome, and she was doing really well. She'd worked up to three milligrams. It did really well. She's now on 4.5 and she's not sleeping,  not feeling as well. And I was trying to explain that with LDN it's not, the higher the dose, the better the benefit. It's what suits you best. And if at three milligrams, she felt really good, why would she need to go to 4.5? It's not working. It's making her feel ill, so she should go back to where she was in a good place. There is so much misinformation out there that people seem to think that this magic 4.5 is the goal that everybody should be on. Have you noticed that with your patients? 

Pharmacist Kim Hansen: Absolutely. I've had patients tell me the same story that you're describing here. Everybody has in their mind that more is better and that the goal is to get to a certain number because that's where the best results are.I am always cautious about making sure I explain to patients, hey, we're dispensing a kit to you. This initial kit is usually good for 49 days or seven weeks, but if at some point halfway through this kit, let one of us know that you're experiencing relief or you're not experiencing anything at all. If you are at a dose where it seems to be optimized, I don't want you to have to continue to go up because the goal isn't to make it more, the goal is to get relief, and if you're getting relief at a lower dose, then stay there because it's very easy to overshoot that and you'll lose the benefit. So, in this case, absolutely more is not better.

Linda Elsegood: Do you have any stories of people who are on a very low dose that have stuck to that's the right dose for them? 

Pharmacist Kim Hansen: Yes, a patient with diabetic neuropathy who was using the kit and they had gotten to a higher dose, and they weren't feeling so good on that. He backed off the dose he had gotten to, I think it was three milligrams. He went up to the next step, said I don't feel as good as I did on the dose before that. Then we know where you should be. And we had him go back to the dose he had come from,  he's much happier there, and he's able to function.

Whereas he was in pain and uncomfortable before. 

Linda Elsegood: What I was getting at there was, I know quite a few people that are on 1.5 or two, which I mean is low for low dose even, isn't it? People tend to think anything under three is no good, but even that is too high for some people. Not everybody gets there. As you were saying with the man with his diabetic neuropathy, you don't have to panic. Or thinking that you know you're not taking the right dose. I know some people think that it's not a therapeutic dose if it's under three, but that is a myth, isn't it? 

Pharmacist Kim Hansen: I would agree with that. Every patient is different and how they respond to it. So even if you have identical twins. A member of your trust that lectured about this, their one set of neighbours. They completely matched as people go, and the same age, same condition, same everything else. If you go down the line and, person A got results more quickly than person B. So person B was discouraged thinking that they weren't going to find the same relief that person A got.  Having to start over with patient B, and go a little bit more slowly, titration was the key for her. So whereas a lot of times you'll see dosage regimens that, every week we're going to increase by whatever the increment is. Sometimes patients will need to go even more slowly than that and maybe increasing every two weeks or maybe every month, whatever that takes. And again, not everyone is the same. So if you get to a dose rate, like, I didn't feel anything the whole way. Sometimes you can, wash it out, start over, and go more slowly and find results there. It's just so dependent on each patient and just because you haven't gotten the answer that you want and you've gone up to 4.5 sometimes the answer isn't going up a higher dose. Maybe it's starting over and going up at a slower pace.  

Linda Elsegood: Some people feel quite discouraged starting again, but by doing it very, very low and moving up very, very slowly the fallout rate isn't as high, and the success rate goes up. You know, 20% of people didn't have the relief they were looking for, but that 20% has reduced, hasn't it? We are getting a better success rate now, understanding there are people who do need to look at LDN differently. 

Pharmacist Kim Hansen: Completely agree. Back in the 80s when we were doing 1.5 and three and 4.5, that was such a rigid structure that you probably lost a lot of patients who didn't have success and or probably had side effects that they weren't pleased with. Changing our thinking with the results we have now, knowing that going more slowly and doing slower increases or lower increases is actually beneficial overall. Yes. Patients who have tried with not finding their success before; it doesn't mean you won't have success trying it in a different fashion.

Linda Elsegood: Exactly. And then there's the other school of thought where you have to take it at night. You know, it's not gonna work for you if you take it in the morning. We now know that's not true. Is that what your experience has been? 

Kim Hansen: I would say that's true.I think yes, at the beginning of the push was, Oh, you have to do it at night because your body does repair at night but you know, here's no reason why you can't do that during the day. And there are also reasons why you would want to do something twice a day and do split dosing. Some disease states and some patients do better when they're split dose.I find that is the case with using it for the antidepressant purposes, sometimes a split dose is better for that patient versus the whole dose at one time of day regardless of morning or evening. Again, individualized treatment, and you have to listen to the patient and listen to what they're saying to you so that you can work on a treatment plan together. 

Linda Elsegood: And you were saying about the topical cream for children with autism. Do you have many children with autism? 

Pharmacist Kim Hansen: We're in New Jersey, unfortunately, we have one of the highest percentages of autism in children. So yes, I do see it, not as often as I once did, but I do see it, and usually, they're not amenable to swallowing pills. So usually the parent is putting on cream at night when they go to sleep, and they don't even know what's being applied.

Even if they take a capsule and they put it into a smoothie or whatnot, kids are wise to that because they're probably on a whole bunch of stuff and they're eyeing up every meal that comes to them, making sure nothing's been hit, so they're pretty wise to it. You'll find that the cream is helpful in those cases and yes, it does work.

Linda Elsegood: And have you come across children with juvenile arthritis or pediatric Crohn’s who are taking LDN? 

Pharmacist Kim Hansen: I have heard of it, but not in my experience here. 

Linda Elsegood: And no children or adults with asthma allergies. 

Pharmacist Kim Hansen:  I had heard of it of course but no experience of that directly here.

Linda Elsegood:  It's amazing, isn't it? Initially, going back,15 and a half years when I started the trust, it was mainly people with MS. Then it went to Crohn's, then fibromyalgia, it was just exploding. But we didn't know too much at that point what it did for chronic pain that wasn't autoimmune. We knew it helped with cancers. We didn't know about all the mental health issues and of course, it's used in fertility clinics as well, and for women's health, for painful periods.  There's a name for that, PCOS, polycystic ovaries. Dr Phil Boyle uses it in his clinic to help women get pregnant. They take it during pregnancy, during breastfeeding, have really happy, contented babies, he says, and they have less chance of needing IV antibiotics for chest infections and things, which is apparently quite common in babies when they're firstborn. And he said, as a rule of thumb those babies are far more content when they come back for checkups,  than babies that haven't been exposed to LDN, which I think is quite interesting, isn't it? 

Pharmacist Kim Hansen: I agree completely with that. When I have a patient that's here, and I'm showing them the list of disease states or conditions that this is helpful for. And of course, their question is always, how could one thing be good for all of these? And I love that question because that means that you're thinking, okay. And you're sceptical, and that's fine, but then when you explain that a lot of these systems are all tied together and how pain and depression are linked by the same pathways as is your immune system, as are a lot of different things, inflammation, all tied together.

When you can explain and have them understand how the different systems in your body interplay, that's when the light bulb goes off because traditionally here in the United States you go to the foot doctor for your foot problem, you go to the GI doctor for your stomach problem, you go to the neurologist for the neurology problem. And really they're not all communicating.  When you look at the thread of symptoms that a patient is dealing with it's like you're missing the overall theme of inflammation or whatever that is. And LDN is helpful for that. So, therefore, it's helpful for all of those conditions. It's not because things are tied together. That's why it's helping you. I hope that made sense.

Linda Elsegood: It does. Now there are other things you can do to help inflammation as well as taking LDN. What do you suggest patients do?

Pharmacist Kim Hansen: For inflammation? Well, it's very important. I always remind patients that their diet is everything. If you look at the glycaemic index, it's scaled anywhere between zero and a hundred and sugar is at the top as being a hundred you would like to keep your dietary choices below a 50 because they are less likely to cause an insulin spike or have a glycaemic effect on your sugar. So if you keep your food items below a 50 more often than above 50 you're reducing the fire in your system. So the whole point of taking naltrexone is to reduce the fire in your body, as explained before.  Everything is connected. You can't expect the pill to do all of the work either. Reducing inflammation that you're adding to the system is also part of it.

You can't walk around eating the standard American diet of high carb and high sugar and poor nutritional value and not have inflammation if you're going to continue to feed the inflammation fire, of course, you're asking the LDN or the naltrexone to help with your symptoms.

Sometimes just reducing a lot of the inflammation that way is helpful and it certainly helps to augment what the LDN is doing. I also find that high-quality C-- products, the full spectrum ones are also helpful at reducing inflammation. Using the LDN in combination with the C--, you get the beneficial additive effects. I have patients who have needed to use that combination, and they've gotten their quality of life back.  

Linda Elsegood: it's funny what you were saying about fruits. My mother was in the hospital, and she was a type two diabetic, but her kidneys were in a very poor state, and she had to have insulin. She had quite a bit of insulin three or four times a day. When she was in the hospital, she asked for a banana. And they bought her a banana. And she said, Oh no, I, I don't like eating bananas a little green and underripe. I like them when the skin is going brown, and it's mottled and inside is all nice and squidgy. And they said, no, you can't have one like that because it's going to affect your insulin because it's very, very high in sugar when it's that ripe. That is correct. The nurse was trying to say very nicely, but it is higher in sugar, and I think my mother was thinking, a banana is a banana. The nurse was trying to say, you can have a banana but you mustn't have it when it's overripe.  Because it's too high in sugar. 

Pharmacist Kim Hansen: When I tried to talk to patients about that, of course, nobody ever wants to hear they have to make changes and give up their banana or wherever it is they're eating. Everybody likes what they eat, but when you explain it and say, Hey, these are inflammatory, what you're doing is adding to your inflammatory burden.  I'm not saying completely avoid the bananas, but if you know that you had had a banana that day cause you had to have it, maybe look at the bottom of the list to make sure that maybe we're balancing that out and making a choice that has less of a glycemic load than maybe the banana or something else. That's not to say that you should never have banana again, but maybe making choices to balance out your day versus choosing everything above 50 if you reduce the amount. Because they are both 50 and take below 50 reducing the amount of inflammation in your system, which is good for all sorts of things, Alzheimer's, heart disease, cancer risk, all of these things driven by inflammation. And why would you not want to reduce those risks? 

Linda Elsegood:  It's altering the way you look at food. Instead of being a diet which people don't stick to. It has to be a lifestyle change, doesn't it?  So it becomes a habit. You know you have good habits instead of bad habits. 

Pharmacist Kim Hansen: Agreed. If you call it a diet, people assume that is a restriction on their lifestyle. If it is health maintenance and it's on a different connotation or inflammation reduction. If you look at it that way, rather than, oh, I'm on a diet. Well, you know what? I'm trying to reduce the inflammation in my body. You'll find that you'll get fewer headaches if you get rid of sugar and carbs, which of course includes bread. There are healthier slices of bread that you can eat, more of the whole grains here.  I was amazed by this too. Everybody's under the misconception that, Oh well I, you know, I'll avoid the white bread cause I know that's not good for me and I'll just eat the wheat bread. It's no better. It really isn't any better. It's like a point or two different on this scale. What you need to do is either do it like a whole grain bread or switch to something that's grain-free, like Ezekiel bread, which has a low-glycemic index. If you're trying to make that effort, there are smarter choices that you can make.

So you don't feel like you're on a diet where you're restricted and being punished. There are ways to explain things.. You just have to be careful about continuing to pile inflammatory product after inflammatory product. It leads to all of the other health problems that I mentioned before.

We're all leading stressful lives, and probably you're not exercising as you should, and not resting as you should, and you're just adding more and more burden to your system to be able to detoxify. Helping your body do its best is certainly a better management tool all around.

Linda Elsegood: Well we've run out of time Kim, can you believe that's 30 minutes gone?

Pharmacist Kim Hansen:  I can't believe you wanted to listen to me. Wow. I'm so happy. 

Linda Elsegood:  Awesome. Thank you so much for having joined us. I really appreciate it. 

Pharmacist Kim Hansen: I'm so grateful to have been asked, and it's my pleasure. If you have any questions, certainly please give me a call and I'm happy to share anything I know. 

Linda Elsegood: Thank you.

At Town and Country Compounding Pharmacy in Ridgewood, New Jersey, owner, pharmacist, John and his team are passionate about low dose naltrexone. They have compounded LDN for over 15 years. And they're committed to compounding high-quality medications and serving as an educational resource for patients and practitioners alike. Visit https://tccompound.com/ or call (201) 447-2020 with any questions or comments you may have. Please email me at ontact@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.

Pain Specialist Neel Mehta, MD - 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Dr Neil Metta from New York. He's a pain specialist. And all the different things he's done are absolutely amazing. Thank you for joining us today. 

Neel Metha, MD: Thank you, Linda, for having me. This is a real pleasure. 

Linda Elsegood: So could you tell our listeners, what experience you've gained so far in the pain field?

Neel Metha, MD: Well,  I think it'd be helpful to have a little bit of background about me and understand why I've chosen this line of work. I am an anesthesiologist by training and  have gone on to do fellowship training in pain management. During my time in medical school, I was fascinated by anesthesiology and orthopaedics and had a real hard time trying to decide how I'd go forward in my career.

I ended up choosing anesthesiology for a number of reasons. During my training in anesthesiology, I had the fortune of working in a great pain management centre here at Weill Cornell. And I  learned a lot about the suffering of patients and of the limited options that we had.  I also had some time in the obstetric ward to treat women in labour and suffering from pain and saw how we had great options for them. So I saw a lot of potential.  I ended up choosing to do pain management because I thought it gave me an aspect of treating a broader range of patients rather than just women in labour. When I came out, I still was amazed that other than some nerve blocks, and some various medications that had been around for years, such as Gabapentin and Lyrica and traditional opioids, there really weren't any other novel ways to treat pain.  I was always sorting out, questing and thirsty for new and better ways that were safer and, and had fewer side effects, and really trying to minimize opioids even before this opioid crisis existed. The opportunity to do that has really been a lifelong goal and continues to drive how I work in research here.

Linda Elsegood: Well. I'm sure the ladies who were in labour really appreciated your help having been there myself. It is called labour for a reason, isn't it? 

Neel Metha, MD: The gratification that you got almost instantaneously was so rewarding. And I do miss that aspect. But now I get to treat both sexes. 

Linda Elsegood: Yes.  A question I'd like to ask. It’s been many years since I had my children and epidurals were the main thing for pain in those days. What options are there now? 

Neel Metha, MD:  So epidurals still remain the mainstay of traditional labour. But the cocktail using those epidurals has evolved. So the idea of being numb from the waist down really has, has been eliminated. And now you have what we call walking epidurals where patients can actually ambulate during their time before they're in active labour and pushing. We are trying to minimize the number of opioids that we use as well by doing things like combined spinal epidurals that allow sort of more instantaneous pain relief if someone has progressed a little bit further in labour and then have an epidural to back it up. And then the most headway's been done in C-sections where the surgical techniques have really sort of stayed the same.

But the anaesthetic techniques have improved. So using fewer opioids, doing things like transverse abdominal pain blocks, nerve blocks of the abdominal area muscles, and also realizing just how much opioid is needed and using multimodal therapy, you can almost eliminate the number of opioids. So some of my colleagues have done tremendous work where they have been able to actually cut down on the number of days that someone has to stay in the hospital just for pain, and that has made real improvement, both for the quality and cost of healthcare-related to having a baby.

Linda Elsegood: Wow. It's amazing. So now you treat both genders. Do you treat children as well, or are you just an adult physician? 

Neel Metha, MD:  I do treat children. I generally start at around age six, although the mainstay of my care is, is adult. Just recently I have had the good fortune of recruiting a great colleague,  who actually did training with me, but then was working elsewhere, and her name is Dr. Veronica Kuru Lo. And she's an anesthesiologist and a specialist in pediatric pain. So she is now our new director of pediatric pain management at Cornell, and a really unique opportunity, the only one of its kind in New York City, to have multimodal pain management therapy for paediatrics, both on an inpatient and outpatient basis.

Linda Elsegood: I myself have MS, and I used to have very bad pins and needles and very painful numbness, and people used to say about pain, I haven't got pain, but I've just got this really bad pins and needles. And then one day somebody said, well, isn't that painful? Well, yes, but I wasn't classed as pain per se, but sort of fake pain, you know, pins and needles,  but anyway, what kind of pain do you treat? Many autoimmune diseases have pain in different forms. You know, it can be a dermatological pain. It can be a fibromyalgia type pain, or an MS pain, or these pins and needles. You know, what do people present to you? What kind of pain?

Neel Metha, MD: Well, working in an academic medical centre, essentially a tertiary care centre, we see the full spectrum of pain. So the majority of my cases are going to be spine and musculoskeletal related conditions. Things like nerve-related pains due to disc herniation or sciatica in lay term or spinal stenosis or osteoarthritis of the joints, whether it be spinal joints or hips and knees and ankles. But also we treat headaches. We treat neuropathic conditions like shingles and trigeminal neuralgia, postherpetic neuralgia, postsurgical pain conditions like post-laminectomy syndrome, you know, failed surgeries for the spine that continued to have neuropathic pain or post breast mastectomy surgeries that lead to chronic pain.

Also, the things you've mentioned, like MS and fibromyalgia, so really a potpourri of conditions and the symptoms range from as simple as an ache as you've mentioned, could be paresthesias or pins and needles. It could be a burning electrical type of pain. And often, we use the description of the pain from the patient to help us focus on what is the underlying dose diagnosis and what's the underlying treatment for this particular condition. It helps us tease out just how much is coming from one condition versus another because as you know, you could have a diagnosis of MS. But also have a disc herniation. And trying to differentiate the two causes and how you would treat them may differ quite significantly. Finally, we do a lot of cancer-related pain as well, whether it is active cancer and things like a tumour, or compression of a nerve or tumour burden.

 

Also, metastatic disease to the bone, end of life care, also the survivors that have had trouble with treatment-related causes of pain such as post-chemotherapy or post-radiation-related neuropathies or postsurgical-related pains. We’re trying to help them regain their life. What's been a new phenomenon is we have always been very aggressive with opioids in the cancer population because we feel they're suffering and may have little time left, but now we've been able to successfully treat so many patients in modern-day medicine that they survive, but now have the potential for opioid addiction. And how do we help those patients come down off of medication and regain their functional lives again? The question is how do we classify pain?

It's often a real story that's developing as the patient is talking to us as we examine them, as we gather information and interpret results, and then make a little bit of systematic trial and error of treatment. Often this is a shared decision, you know, medical process with the patient. Because some may have thoughts on how they want to proceed and just how aggressively or what types of treatment they'd be open to. Some may only want to do things like acupuncture and physical therapy, which we offer, and some may say, I've been living with this for a long time. I want to be as aggressive as possible to treat this as quickly as we can. And that may require things like implantable devices or other types of treatments. 

Linda Elsegood: Do you treat Phantom limb pain?

Neel Metha, MD: Very much so,  Phantom limb pain, obviously in post-trauma, related conditions or even amputations from diabetic neuropathies or poor vascular conditions. Certainly, we have seen our fair share of those patients.

Linda Elsegood: When did you first hear about LDN? Was that during your training? 

Neel Metha, MD: It actually was after my training. I met some colleagues that have presented at the LDN conference, such as Chopra and Dr Samia, Dave Daddo. And they're great colleagues who have been visionaries in pain management. I know that they've been using LDN for a long time in the complex regional pain syndrome. And as I started to research the drug more and more, I realized how little was known in the pain community. And then shortly afterwards, we started to see some good papers coming out, such as the work done by Sean Mackey out in Stanford for fibromyalgia.And then also meeting some doctors, older physicians that knew about combination LDN and an opioid therapy to try to prevent  addiction and increase the strength of the medication—so learning a little bit from history about the drug.  As  I've read more and discovered more about it,my trainees have learned and enthusiastically tried to understand what it is and have really adopted it and use it in their practices, often differentiating themselves from a lot of other physicians and, seeing how it positions themselves to be more comprehensive in their treatment.

Linda Elsegood: So how long have you been prescribing it yourself? 

Neel Metha, MD: I have probably been prescribing about five years now, maybe a little bit over that. And the rate of usage has gone up significantly. What I am most fascinated by now is the wide variety of dosing that is being utilized. I think most recently a lot of people who have adopted the use of LDN have sort of based it on the papers that have come out of Stanford using a range of one milligram to four and a half milligrams. But we realized that's not a one size fits all and ultra-low-dose prescribing in the microgram strength. It's also something I've been increasing usage of. The frequency of usages is also something I'm fascinated by, whether to use once a day or all the way up to four times a day. And so the trouble is trying to understand this and research, this is where we are in this day and age.  

Linda Elsegood: And what would you say the patient's success rates have been with LDN?

Neel Metha, MD: So it's actually one of the drugs that have been a home run. I would say if I had to do a head to head comparison against something like Gabapentin for neuropathic pain, my anecdotal experience has been that it's more successful than those types of drugs for a number of reasons.

Number one, its overall efficacy has been good in terms of reduction of pain, but the biggest thing is compliance. So how easy is it for a patient to follow directions and use it, and also interaction in side effects is almost minimal. Some patients may describe some minimal side effects, but they tolerate it and go on with it.

 

But Gabapentin and Lyrica are more challenging with the side effects such as weight loss, weight gain, and sedation and dizziness are really challenging for them. And often it's frustrating for everybody because we'll try those drugs. And if a patient comes back a week later or two weeks later saying, I took one dose, didn't tolerate it, and I stopped it altogether. So our challenge in those treatments is that we just don't have anything equivalent until we discovered LDN and now we almost offer it to every type of neuropathic condition and the drug is cheap. We are fortunate that the compounding pharmacies that we work with have been able to offer it at a very palatable price compared to some of the other compounding drugs that we may use.

Linda Elsegood: And have you used it in Phantom pain? 

Neel Metha, MD: I've used it broadly in neuropathic pains. Phantom limb is something I have used it in, although I will say that my population of Phantom limb pain is much smaller than say, by trigeminal neuralgia or fibromyalgia or other neuropathic conditions. We've also been using it a lot in patients that have myofascial pain. That has become more of a centralized or hypersensitized type condition. So when they have central sensitization of their muscle pain, I find LDN very effective. 

Linda Elsegood: I was only asking about the Phantom limb pain because we have many members that are military who've lost limbs, and you know, it is worth the try, isn't it? You know, you've got to find someone who will prescribe it, but it's definitely worth a try. 

Neel Metha, MD: Absolutely. I see very little downside to it. I think often the patients, once they hear about it and talk about how we plan to use it, what's the potential for benefit and the minimal side effect, we have a very good success rate of having patients try it and be pleased with it. If you just do research on naltrexone alone on Google, sometimes it's a little scary, the types of things that come up associated with naltrexone.  I take the time to counsel patients on why we are using it and how it does differ from the other purposes of naltrexone itself. And that's very reassuring for patients. Phantom limb pain, I think, is one of those things that it's almost a no brainer to use in these conditions along with other multimodal therapies, including.

Mirror therapy, physical therapy, and then refractory conditions to consider things like ketamine and spinal cord stimulation or peripheral nerve stimulation. So there's a wide variety of treatments, but LDN should be one of the mainstays. 

Linda Elsegood: We've been going 15 years now, but it was mainly.to help autoimmune conditions. Such as rheumatoid arthritis, but we were saying it probably won't do anything for osteoarthritis, but that's not the case. It does work for osteoarthritis as well, which is quite amazing. A lot of our members are in their 70s or 80s and have been having very high doses of steroids throughout their years, since they were like 20, 30, and it's caused, crumbling of the spine. So nerves are getting trapped, and LDN seems to be working really well in those cases as well. But it sounds absolutely horrendous. I would hate that to happen to me. But I'd like to think steroids aren't as widely used now as they were. You know, 40 years ago. Would you say that's the case, that we're doing something different than a high dose of steroids over a long period? 

Neel Metha, MD: We certainly have an appreciation for the risk of high steroid use. So we know now what doses we can use at a time and how often those patients can get it. But unfortunately, the steroid is still a mainstay treatment for various conditions like osteoarthritis, especially in the, in the hands of an interventional specialist. We still believe in the continuum of care, such as things like physical therapy.  But also, the use of acupuncture, turmeric and when appropriate steroids, if you're going to give maybe localized steroid.And now a lot of things like platelet-rich plasma and STEM cell are starting, and it's the emergence of data, but you're right, LDN does work. And while it may not have 100% cure rate you can certainly lessen the burden of osteoarthritis enough for people to be able to do more in their physical therapy and be more active and lose weight and all the other things that come in a positive cycle, to help them overall improve their functional ability in their quality of life.

Linda Elsegood: Have you found a benefit using the ultra-low dose alongside opioids to make them more effective, to help patients withdrawal from their opioids?

Neel Metha, MD: So this is a healthy debate I have with a colleague of mine. He starts at a hundred micrograms and will consider ramping that up over time,  two, four times a day, and then slowly get up into potentially a milligram dose. And I tend to start the opposite. I may start at one milligram and decide whether I need to go up or down based on the symptoms that they're experiencing. The challenge that we have is there are patients that don't respond in the milligram dose but do respond in the microgram dose even with it and have an absence of side effects. And this is where I think to work with. Your organization and working with David on research in this to really pinpoint how we best identify dosing for patients is going to be fascinating. But to answer the question about how I have found it,  it has really helped patients with tolerance and actually prevention of tolerance. We use it quite frequently in traditional opioid receptor type drugs. But I also use it synergistically for neuropathic pain conditions when I use things like Tramadol.  My belief is that it's worth a chance to see. We start extremely low. We are able to get one of our compounding pharmacies to start at a hundred micrograms in a tablet form, which a patient can split in half and take 50 micrograms at a time. We see really interesting clinical data, and now we are just starting to try to put this together and see if we can publish our work on it.

Linda Elsegood: If you are a drug addict through no fault of your own because they are prescription drugs, but it still makes you addicted to these opioids and coming off, you've got to be so careful that you don't go into withdrawal. So if something like ultra-low-dose can be used to help wean people off without those awful withdrawal symptoms, in my book that's got to be amazing. 

Neel Metha, MD: Absolutely. If we can eliminate the usage or even cut down the doses to be in a safer range, I think it helps everyone, including the patients that are taking these medications, the prescribers who are trying to handle risks of these medications, the families that may be in the same households where these medications are being stored and trying to avoid the harm of getting these medications in the wrong hands. These are all potential benefits of downstream effects of LDN  

Linda Elsegood: And what's the long term effect to the body if you take high doses of opioids?

Neel Metha, MD: Well, there's a number of things. So number one to the patient itself that's taking the opioids, there's a very high likelihood of tolerance, and that's a very challenging and frustrating problem for everybody in that the same dose of medication has a diminished effect in terms of pain relief. So the natural thought would be to increase the dose. But eventually, even without the absence of addiction and addiction type behaviours, the same patient taking a higher dose has a much higher likelihood of achieving side effects that could make it unbearable to continue on that therapy. And what side effects am I referring to? Those are things like severe constipation,  not being able to function at work, missing days at work or being unproductive during their time, mood irritation and irritability to the point that they become very, difficult to be around the family, to the point of not being able to drive to work or drive in a car anymore because they're so impaired or that they sleep more, may gain weight, become less active. So overall, their quality of life may go down, even though they have the original intention of trying to improve their pain with a higher dose. And then you have the risk of addiction. And that is a potential for now using medication in inappropriate ways, combining it with things like alcohol and so forth, and then finally what is the risk of all this medication sitting in the home? So could a teenager in the household get into it and use it in a recreational way and cause harm and die?

Could it get in the hands of a young child? Could it get stolen and get into a drug addict's possession? All of these things are harmful. We can eliminate or reduce the amount of medication in circulation. There are so many downstream effects in addition to the ones that the patient would benefit from.

Linda Elsegood: Well, wonderful. We've just about run out of time. Can patients refer themselves to see you? Do they have to be referred by their own doctor, how do patients get to see you? 

Neel Metha, MD: So, for LDN, I think recently you've been kind enough to share some of our practice information. And just recently I've had a few, a couple of patients that actually have no pain, real related things, but wanted to talk about LDN usage.

And I've been happy to see them. So patients are able to make an appointment if they are not coming for a particular pain condition. I asked them to specify with our schedulers they are here to discuss LDN and I'm happy to meet with them. But for painful conditions, I have a team of.

eight other doctors that have experience with LDN. Some of them have been prescribing it for just as long as I have. So, we welcome these patients to see us if they're motivated to want to try to improve their lives without the use of opioids. We really welcome them if they're trying to reduce the amount that they take. LDN is a great drug, but there's a multitude of options that we want to present to them. And that's where we think our multidisciplinary practice will really help.  

Linda Elsegood: And what numbers should they call you on? 

Neel Metha, MD: So our office number is six, four, six, nine, six two seven two, four, six. We are located in Manhattan. We'll also offer video visits for follow-up visits. We're not allowed to do it for the initial ones, but if they are able to make the journey to see us even from far away, one time, then we can potentially continue to care for them virtually. We have had patients come from other countries and also from up to 48 States of the 50.  

Linda Elsegood: Wow. It's been amazing talking to you today, and we'll have you back at another time. 

Neel Metha, MD: Linda, thank you very much for the opportunity. It's really been a great collaboration that we have started on and I hope to continue to help everybody through our work together. Thank you. 

Linda Elsegood: This show is sponsored by Mark Drugs who specialize in the custom compounding of medications, assuring that the client gets the proper prescriptions for their unique needs and conditions. They work with practitioners integrating knowledge and treatment of experts to create comprehensive health plans. Visit markdrugs.com or call Roselle six three zero. Five two nine three four zero or  (847) 419-9898.

Any questions or comments you may have, please email me 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.

The Pain, Opioid and Ultra/Low Dose Naltrexone (LDN) Documentary - Opioids & Pain Management: How LDN can assist with treatment from LDN Research Trust on Vimeo.

The Pain, Opioid and Ultra/Low Dose Naltrexone (LDN) Documentary - Opiod Crisis: Is Low Dose Naltrexone the Answer? from LDN Research Trust on Vimeo.