Monday, October 17, 2011
In my opiate detoxification program, 80% of patients get totally off Suboxone within 6 weeks. It is important to note that some patients reach a "wall" when coming off Suboxone. Usually they are on a small fraction of a 2/.5mg tab or film.
If that "sticking point" is your issue, please call to see what your options are.
Joel Nathan, MD
New York, NY
www.joelnathanmd.com
Phone: 212-410-6832
Labels: Suboxone detoxification
Tuesday, October 11, 2011
Adding Longevity Treatment to Addiction Medicine Treatment:
When finally asking for help with addiction issues, my patients have usually stopped taking care of themselves. Their diet and exercise has been put on the back burner. Their health has become secondary to their addiction.
My practice gets people back on a fast track. I evaluate my patients for detox as well as renewing their diet, exercise and hormonal regimens. Did you know that opiates stop the production of testosterone?
The concept of optimizing hormones in early recovery is as unique as my concierge care addiction practice.
Call me at 212 410 6832. Get well sooner and stay well longer.
This is ABSOLUTELY the Newest Way to Detox.
Joel Nathan, MD
New York, NY
www.joelnathanmd.com
When finally asking for help with addiction issues, my patients have usually stopped taking care of themselves. Their diet and exercise has been put on the back burner. Their health has become secondary to their addiction.
My practice gets people back on a fast track. I evaluate my patients for detox as well as renewing their diet, exercise and hormonal regimens. Did you know that opiates stop the production of testosterone?
The concept of optimizing hormones in early recovery is as unique as my concierge care addiction practice.
Call me at 212 410 6832. Get well sooner and stay well longer.
This is ABSOLUTELY the Newest Way to Detox.
Joel Nathan, MD
New York, NY
www.joelnathanmd.com
www.evolve-medical.com
Labels: Drug Detoxication, hormone optimization
Monday, October 10, 2011
Promising New Way to Treat Pain: Low Dose Naltrexone
Although not FDA approved for this indication yet, it is becoming community standard and there is a growing area of interest and research in low dose naltrexone in pain relief.
Naltrexone sits like a bandage over the opiate receptor so that one does not feel opiates. We all love our endorphins, so the spin on this is as follows:
Instead of the usual dose of 50mg of naltrexone per day, low dose naltrexone (1mg -3mg) taken orally per daily partially blocks the opiate receptor and tricks the body into making extra endorphins that you can feel. Thus low dose naltrexone can help pain, elevate mood and enhance immunity.
Please ask your doc about this. It's proper induction and use is complex. Naltrexone comes in 50mg tabs, so I use a compounding pharmacy can make the smaller dose in capsules.
"Danger, Will Robinson, Danger...Danger" (From "Lost in Space" a TV show of mid to late 1960's).
Naltrexone can elevate liver function tests. Liver function tests need to be followed at least 4 times a year. More frequently if you have a history of liver issues or are on meds that can effect the liver. Do not take naltrexone if you are on an opiate already or are dependent on opiates. It will pop off all your opiates and you'll know the meaning of severe opiate withdrawal.
Your doc can help you start this new way to treat pain. You can do a literature search on the web on low dose naltrexone and see what I am talking about.
Joel Nathan, MD
Although not FDA approved for this indication yet, it is becoming community standard and there is a growing area of interest and research in low dose naltrexone in pain relief.
Naltrexone sits like a bandage over the opiate receptor so that one does not feel opiates. We all love our endorphins, so the spin on this is as follows:
Instead of the usual dose of 50mg of naltrexone per day, low dose naltrexone (1mg -3mg) taken orally per daily partially blocks the opiate receptor and tricks the body into making extra endorphins that you can feel. Thus low dose naltrexone can help pain, elevate mood and enhance immunity.
Please ask your doc about this. It's proper induction and use is complex. Naltrexone comes in 50mg tabs, so I use a compounding pharmacy can make the smaller dose in capsules.
"Danger, Will Robinson, Danger...Danger" (From "Lost in Space" a TV show of mid to late 1960's).
Naltrexone can elevate liver function tests. Liver function tests need to be followed at least 4 times a year. More frequently if you have a history of liver issues or are on meds that can effect the liver. Do not take naltrexone if you are on an opiate already or are dependent on opiates. It will pop off all your opiates and you'll know the meaning of severe opiate withdrawal.
Your doc can help you start this new way to treat pain. You can do a literature search on the web on low dose naltrexone and see what I am talking about.
Joel Nathan, MD
www.joelnathanmd.com
Labels: joel nathan md, low dose naltrexone, naltrexone, pain
Monday, January 26, 2009
NY Society of Addiction Medicine Conference / Jan 24, 2009
New concepts I learned that may help you.
1. When a doctor says "no" to giving a patient a controlled substance or in giving into early refills he is saying "yes" to sobriety.
2. Many patients say when will their agitation, depression or out of focus feeling in early recovery stop. The new evidence is that during use new connections form between neurons in the brain. The neurons increase in number and density. This may be due to some learning that the using person is doing in making a connection between drug use and pleasure. It takes time in recovery for these neurons to come back to normal.
3. In the addicted brain, the brain's frontal lobe (the part that makes decisions as to do something or not) is not functioning correctly. One sees value in things that may not be healthy for them. Therefore, the sponsor, therapist, healthy close friend or physician becomes a healthy frontal lobe substitute for the recovering person. As one recovers, this improves, but the recovering person's thinking can always use a helping and caring person to share their goals, secrets and feelings. This is just to "check things out" to make sure they're on the right track.
Your comments on the above would be helpful to me. You can write to me at:
joel.a.nathan@gmail.com . All emails are confidential and will be answered if you request an answer.
New concepts I learned that may help you.
1. When a doctor says "no" to giving a patient a controlled substance or in giving into early refills he is saying "yes" to sobriety.
2. Many patients say when will their agitation, depression or out of focus feeling in early recovery stop. The new evidence is that during use new connections form between neurons in the brain. The neurons increase in number and density. This may be due to some learning that the using person is doing in making a connection between drug use and pleasure. It takes time in recovery for these neurons to come back to normal.
3. In the addicted brain, the brain's frontal lobe (the part that makes decisions as to do something or not) is not functioning correctly. One sees value in things that may not be healthy for them. Therefore, the sponsor, therapist, healthy close friend or physician becomes a healthy frontal lobe substitute for the recovering person. As one recovers, this improves, but the recovering person's thinking can always use a helping and caring person to share their goals, secrets and feelings. This is just to "check things out" to make sure they're on the right track.
Your comments on the above would be helpful to me. You can write to me at:
joel.a.nathan@gmail.com . All emails are confidential and will be answered if you request an answer.
Thursday, January 01, 2009
New Year 2009: A new beginning and a recommitment to recovery
The holidays are over and if you're still partying, it's really no party any longer. Consider talking with friends, family or medical professional regarding any concerns you may have regarding your substance use.
If you think you may have a drug or alcohol problem, feel free to call. I'll call you back personally. If you are possibly a candidate for outpatient detoxification, we can talk about how our services may be of help to you.
Sincerely,
Joel Nathan, MD
Addiction Medicine Physician
NABU Medical Services, PC
New York, NY 10028
phone 212 410 6832
Monday, December 22, 2008
Missing Link in Addiction Treatment?
After working with hundreds of patients in helping them to detoxify from drugs including alcohol, I've heard the following issues after detox:
1. My energy is low.
2. I still can't sleep well.
3. I am gaining too much weight.
4. I am craving sweets.
5. I am craving my drug of choice.
6. Libido, when does it come back?
7. I'm restless, irritable and discontent.
Sound familiar?
Call me, get some answers.
Joel Nathan, MD
212.410.6832
It's a lot more than just detox.
Proactive Addiction Medicine Care
NABU Medical Services, PC
www.NabuMed.com
After working with hundreds of patients in helping them to detoxify from drugs including alcohol, I've heard the following issues after detox:
1. My energy is low.
2. I still can't sleep well.
3. I am gaining too much weight.
4. I am craving sweets.
5. I am craving my drug of choice.
6. Libido, when does it come back?
7. I'm restless, irritable and discontent.
Sound familiar?
Call me, get some answers.
Joel Nathan, MD
212.410.6832
It's a lot more than just detox.
Proactive Addiction Medicine Care
NABU Medical Services, PC
www.NabuMed.com
Labels: 2.
Monday, November 03, 2008
NABU Medical Services, PC
Chemical Dependency …is it a pain?
Pain is a natural signal we get when there is an injury to attend to in our bodies. It certainly gets our attention and makes us seek help for the painful condition. When you have a history of chemical dependency, there is always the question of what to about the pain.
If there is a history of current or past chemical dependency the answer is: try non-narcotic pain medications first and if they are not strong enough, go to the least strong narcotic pain medication next. I would tell your health care provider that you would prefer non-narcotic pain management, but if only narcotics would do than that would be fine. This is a change for me in my recommendations. I have seen patients who have been denied appropriate pain management because of a history of chemical dependency. In fact, those patients not in recovery yet, may need more opiate medication than the normal person. If your healthcare practitioner is not prescribing appropriately, you can ask your chemical dependency doc to consult with them.
If narcotics are needed, at least do not get a prescription for your pain medication of choice; get one for a different narcotic. This way you will not get the reward of getting the narcotic that got you into trouble before. You may, of course, become addicted to this other narcotic; it is just that it is not your old friend that will bring back memories from the past. This is kind of like switching brands of cigarettes when first trying to cut down on tobacco smoking.
If you need a narcotic pain medication, then take it without guilt. Just take it as directed. If what you are prescribed is not helping, let your prescribing practitioner know this. If you cannot stop the pain medication once you no longer have pain, then you will need a detoxification from this narcotic. You do not need to suffer pain just because you have a past history of substance abuse. Yes, you would rather not have to detox again, but if the pain is not controlled, you will have a disrupted life and sleep pattern. In addition, when we are in pain, the body gives off cortisol in reaction to stress. The cortisol impairs wound healing.
So being chemically dependent does not mean you have to endure pain.
Got Primary Care?
Most of my patients with chemical dependency issues have no primary care practitioner. They become self medicators because they have no physician, physician assistant or nurse practitioner to consult for the emotional and physical issues that occur in everyone’s life.
Even if they do have a primary care practitioner, they seem to avoid regular histories and physicals. When they are older (e.g. over 45- that is not that old, I am 50 myself); they avoid the appropriate screenings. Screenings for cholesterol, high blood pressure, cancer and diabetes are important because they can sneak up on any one of us. Sometimes they avoid the doc because of shame and guilt regarding substance abuse.
So use that insurance that you have and get a primary care provider and get and stay healthier. Hey, it is important to have a healthcare professional as your advocate now and in the future. Leave the DIY (do it yourself) for home improvements.
Healthcare is a joint venture between you and your health care provider. Remember, one reason you could use up a sick day is to see your doc for preventative health. Do not take better care of your car than you do yourself
Lastly, do not forget about the dentist too. I cannot tell you how many times patients get re-started on narcotics when they have severe oral pain. Get out of dental denial! (This may be another reason for a sick day, perhaps?)
You know where I am.
Sincerely,
Joel Nathan, MD
NABU Medical Services, PC
212-410-6832
ASAM Certified
Addiction Medicine Specialist
Chemical Dependency …is it a pain?
Pain is a natural signal we get when there is an injury to attend to in our bodies. It certainly gets our attention and makes us seek help for the painful condition. When you have a history of chemical dependency, there is always the question of what to about the pain.
If there is a history of current or past chemical dependency the answer is: try non-narcotic pain medications first and if they are not strong enough, go to the least strong narcotic pain medication next. I would tell your health care provider that you would prefer non-narcotic pain management, but if only narcotics would do than that would be fine. This is a change for me in my recommendations. I have seen patients who have been denied appropriate pain management because of a history of chemical dependency. In fact, those patients not in recovery yet, may need more opiate medication than the normal person. If your healthcare practitioner is not prescribing appropriately, you can ask your chemical dependency doc to consult with them.
If narcotics are needed, at least do not get a prescription for your pain medication of choice; get one for a different narcotic. This way you will not get the reward of getting the narcotic that got you into trouble before. You may, of course, become addicted to this other narcotic; it is just that it is not your old friend that will bring back memories from the past. This is kind of like switching brands of cigarettes when first trying to cut down on tobacco smoking.
If you need a narcotic pain medication, then take it without guilt. Just take it as directed. If what you are prescribed is not helping, let your prescribing practitioner know this. If you cannot stop the pain medication once you no longer have pain, then you will need a detoxification from this narcotic. You do not need to suffer pain just because you have a past history of substance abuse. Yes, you would rather not have to detox again, but if the pain is not controlled, you will have a disrupted life and sleep pattern. In addition, when we are in pain, the body gives off cortisol in reaction to stress. The cortisol impairs wound healing.
So being chemically dependent does not mean you have to endure pain.
Got Primary Care?
Most of my patients with chemical dependency issues have no primary care practitioner. They become self medicators because they have no physician, physician assistant or nurse practitioner to consult for the emotional and physical issues that occur in everyone’s life.
Even if they do have a primary care practitioner, they seem to avoid regular histories and physicals. When they are older (e.g. over 45- that is not that old, I am 50 myself); they avoid the appropriate screenings. Screenings for cholesterol, high blood pressure, cancer and diabetes are important because they can sneak up on any one of us. Sometimes they avoid the doc because of shame and guilt regarding substance abuse.
So use that insurance that you have and get a primary care provider and get and stay healthier. Hey, it is important to have a healthcare professional as your advocate now and in the future. Leave the DIY (do it yourself) for home improvements.
Healthcare is a joint venture between you and your health care provider. Remember, one reason you could use up a sick day is to see your doc for preventative health. Do not take better care of your car than you do yourself
Lastly, do not forget about the dentist too. I cannot tell you how many times patients get re-started on narcotics when they have severe oral pain. Get out of dental denial! (This may be another reason for a sick day, perhaps?)
You know where I am.
Sincerely,
Joel Nathan, MD
NABU Medical Services, PC
212-410-6832
ASAM Certified
Addiction Medicine Specialist
