FAQ

1.  What are the hours of operation at Robinhood Integrative Health, and how can I make an appointment?

OFFICE HOURS:  Monday-Thursday 8:30-5 and Fri 8:30-2:30.  The office is closed for lunch from 12-1 Monday-Thursday.  The office is closed for a meeting every second Wednesday of the month from 12-1:30.

STORE HOURS: Monday-Wednesday 8:30-5, Thursday 8:30- 7pm, Fri 8:30-4.  The store remains open during lunch hours. The store is closed for a meeting every second Wednesday of the month from 12-1:30.

Call (336) 768-3335 to make an appointment.

2. What is Integrative Medicine?

Answer. Integrative Medicine is relationship-based care, informed by evidence and experience.   It is a system of comprehensive care that emphasizes wellness and healing of the whole person, with special emphasis on patient participation, and attention to mental and spiritual health.

Integrative as it suggests, is the integration of different streams of healing including traditional (allopathic) medicine. At RIH, if we were to say what stream we are closest to, it would be functional medicine. Functional medicine is science-based, personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease. RIH believes biochemical individuality should also be noted when treating patients.

Some say that traditional medicine has lost its way in some respects; as it is overly influenced by pharmaceutical companies.  The majority of scientific studies in major medical journals are funded by the pharmaceutical companies. With traditional medicine, the individual can be forgotten, and the disease is treated in a one size fits all approach.  Much of medicine is “name the disease, and reach for a pharmaceutical product”. Many diagnoses come about because a drug is developed.

For example, osteopenia. This word was not in the medical lexicon until bisphosphonates were developed, and now it is suggested that everyone needs this type of medicine for that condition. Why not ask what lifestyle changes can be made to manage this condition instead?  Another example is the mass treatment of stomach issues with medicines such as Nexium and Prevacid. A recent study in the Journal of Gastroenterology noted 70 healthy volunteers with no stomach complaints were placed on the above medicines for 12 weeks. 70 % of the participants had GI symptoms after stopping the medicines. So, there are other ways to look at health that include different kinds of approaches to healing.

To throw out all traditional medicine would be a mistake, but to think it has a monopoly on health would be an equally egregious error.  At RIH, we look for causes for why a person feels a certain way, or why certain symptoms are present. This approach to medicine, even from a biochemical level point of view is very exciting, and gives us great hope to provide overall wellness for our patients.

3.  What is a Bioidentical Hormone?

 Answer:  When we refer to bioidentical, we are referring to the molecules of the hormones we prescribe which are the exact same as the body produces at the molecular level. Some people use the term “natural”, but that can be misleading as there are natural hormones such as Premarin but it only has a bioidentical component but also horse estrogens.  Premarin has helped many women, and it is natural, but it is not fully bioidentical.

4.  I have heard a lot about hormones, and the Women’s Health Initiative (WHI) study. Are hormones safe for me?

The 2002 WHI study completely reversed thinking on hormones.  After the study, most physicians stopped prescribing hormones, and 50% of women stopped taking hormones. It was a two edged study because it revealed that Provera (a nonbioidentical progestin) was actually a major cause of some serious side effects such as increase in breast cancer.

The study involved older women 14 years out from menopause, and was trying to determine whether or not oral estrogen was good for them (cardiac wise).  The outcome was that oral estrogen was not good for them (cardiac wise).  Oral estrogen increased clots, strokes, and heart attacks. Our belief is that those were good findings, women should not take Provera, and older women especially with hypertension should not take oral estrogen.   However, doctors and the press do not make a distinction between Provera (a fake progestin) and bioidentical progesterone (which has never been shown to cause the above problems). Transdermal (through the skin) estradiol can be used in women who should not take oral estrogen.

So, who would benefit from hormone replacement? Nearly everyone benefits from having their hormones optimized.  Hormone optimization goes beyond just taking estradiol, progesterone, testosterone, and other hormones.

5.  What is a Compounding Pharmacy?

Answer:  The FDA while under oath before the Senate in 2007 said: “FDA believes that pharmacists engaging in traditional compounding provide a valuable medical service that is an important component of our pharmaceutical armamentarium. The FDA regards traditional pharmacy compounding as the combining or altering of ingredients by a pharmacist in response to a licensed practitioner’s prescription, which produces a medication tailored to an individual patient’s special medical needs”.

6.  What are the benefits of using a Compounded Pharmacy?

Answer:  As the FDA statement above says, dosage can be individualized, and different routes of delivery can be utilized. Compounding pharmacists are monitored by their respective state boards.  Bioidentical hormones from compounding pharmacists are NOT safer than bioidentical pharmaceutical products.but non-bioidentical hormones (such as Provera) are a different story since (they are the causes of the breast cancer and heart disease).

 

7.   I have heard of Low Testosterone, but what is Andropause?

Answer:  Andropause is the gradual decline of testosterone that men experience without realizing it.  In some ways it would be better if men’s levels fell suddenly then they would be more inclined to do something about it.

8.  Breast cancer runs in my family. I am only 26, and I am concerned. What can you do for me?

Answer:  There are many things young woman can do who are concerned about breast cancer.  Performing a thorough breast exam on a monthly basis (starting in your twenties) is a good practice as they can help identify hormone imbalances which can be corrected. We recommend the HALO PapTest, and Thermograms also help discover early changes in the breast.  Eating healthy foods and dietary supplements are beneficial. Exercise and attaining optimal weight are also a part of having good breast health.  Refer to Optimal Health.
9.  I have problems every month with my period.  Is hormone replacement just  for old people?

Answer:  Hormonal imbalances are often at the heart of problems with your periods. Even though your hormones are at the highest levels of your life an imbalance can exist and be corrected.

10.  Can RIH help me address thyroid problems?

Answer:  Yes!  If you have been on thyroid medicine for several years, and your blood tests are normal, but you still have fatigue, weight gain, dry skin and hair, puffy eyes – perhaps the tests you have had are not reflecting what is actually happening at the cellular level. RIH can help!

I have found that replacing thyroid is a good way to get the  energy machinery (mitochondria) of the cells optimized. The supplement list I give you often corrects some of the deficiencies along with healthy eating. There are other things that create inefficiency in conversion of T4 to t3 such as pesticides, heavy metals, bisphenol A, and other toxins and other contaminants in our cells. One has to start somewhere and getting the cells performing correctly and straightening everything else out often allows one to stop the thyroid 18 months or so down the road.

11.   I have been prescribed Bioidentical Hormones, how do I tell if something is not balanced? These are uncommon but these guidelines help you to sort out symptom if you have any.

What are the typical symptoms of estradiol excess for women?

  • Tender breasts
  • Irritability, mood swings and anxiety especially before your period
  • Migraine headaches before your period
  • Weight gain
  • Fluid retention in hands or feet
  • Abdominal bloating
  • Insomnia and/or restless sleep
  • Heavy period
  • Painful period
  • If you are using a patch or pill call or email.  drbhot@rihealthmd.com

What should I do if I notice any of these symptoms? If you are on creams do the following:

Premenopausal Women

If your symptoms are noticed throughout your entire menstrual cycle reduce  your estradiol dosage by 30%.

If your symptoms appear only in the second half of your cycle increase your dosage of progesterone by 30%.

Postmenopausal Women

Initially increase your progesterone dosage by 30% for a month. If your symptoms are relieved then continue this dosage.  If you are still having symptoms then increase your dosage in 30% increments allowing a 2 weeks  between each increase until your symptoms are relieved.  Continue this regimen as needed until you have reached a 100% increase. If you are still having symptoms after you have increased your progesterone 100% then reduce your estradiol dosage by 30%.

If these actions do not bring resolution to your symptoms please make an appointment 336-768-3335.

What are the typical symptoms of progesterone excess for women?

  • Breast deflation
  • Fatigue
  • Irritability and muscle aches
  • Fluid retention in hands or feet
  • Bloating
  • Sleepiness or lethargy
  • Lowered libido
  • Vaginal dryness
  • Mild depression

What should I do if I notice any of these symptoms?  If you are on cream:

Reduce your dosage of progesterone by 30%.  Watch for a month to see if the symptoms subside.  If these actions do not bring improvement  make an appointment 336-768-3335.

What are the typical symptoms of testosterone excess in women?

  • Oily skin or acne. Note if you get this, decrease your testosterone cream here don’t wait to get to the next stages
  • Excess hair
  • Acne
  • Excessive sex drive
  • Excessive clitoral swelling or sensitivity
  • Excessive aggression
  • Excessive development of muscles
  • Swelling of the feet (rare)

    You will not get here if you decrease the dose at oily skin.

Are there other symptoms I should be aware of?

Occasionally testosterone will convert to the androgen dihydrotestosterone, also known as DHT.  If you have excess DHT you will notice:

  • Male pattern hair loss
  • Excessive body hair

What should I do if I notice any of these symptoms?

Again if your skin gets oily or you notice increases in acne then reduce your dosage of testosterone by 30%.  Watch for a month for symptoms to improve.  If this action does not bring improvement make an appointment at 336-768-3335.

What are the typical symptoms of testosterone excess in men?

  • Oily hair or skin
  • Red face
  • Increase in acne  Decrease here before you get to the next stages
  • Excessive sex drive
  • Excess sensitivity of genital and/or nipple area
  • Excessive aggression
  • Sexual overstimulation, rapid state of erection
  • Reddening of the head of the penis
  • Swelling of the feet (rare)

Are there other signs I should be aware of?

Sometimes testosterone will convert to the androgen dihydrotestosterone, also known as DHT.  If you have excess DHT you will notice:

  • Male pattern hair loss
  • Excessive body hair

What should I do if I notice any of these symptoms?

Reduce your dosage of testosterone by 30% and watch for a month to see if symptoms are relieved. If this action does not bring improvement call the office at 336-768-3335 for an appointment.

What are the typical symptoms of thyroid excess?

  • Fast or pounding heartbeat
  • Anxiousness or confusion
  • Inner feeling of trembling
  • Excessive weight loss
  • Overheating and sweating
  • Excessive hunger
  • Excessive thirst
  • Excessive emotional reactions
  • Diarrhea
  • Insomnia

What should I do if I notice any of these symptoms?

If you have just started or increased your medication you may have symptoms that are mild and infrequent but they will usually subside with 2 – 3 days.

What if my symptoms persist beyond 2 – 3 days?

If your symptoms are mild, continue your medication and call the office at 768-3335 to schedule for thyroid blood work to be drawn in the afternoon.

If your symptoms are severe discontinue your medication for 2 days. After two day resume your medication at half dosage.  Within a week call the office at 768-3335 to schedule thyroid blood work to be drawn in the afternoon.

What are the typical symptoms of cortisol excess?

  • Overly emotional and agitated
  • Lack of empathy for others
  • Creates stress
  • Sleeplessness
  • Pounding heart
  • Swollen hands and feet
  • Swollen face
  • High blood pressure
  • Weight gain
  • Easy bruising
  • Skin feels thin, dry and fragile

What should I do if I notice any of these symptoms?

Reduce the dosage of cortisol by 30% for a month.  If this action does not bring improvement call the office at 336-768-3335 for an appointment.

What are the typical signs of DHEA excess for women?

  • Oily hair (often the first sign that appears)
  • Oily skin  Women, if you get this decrease your dose by 50%
  • Acne
  • Hair loss in upper scalp
  • Menstrual cycle changes
  • Body hair overgrowth
  • Yellow eyes and weakness

What are the typical signs of DHEA excess for men?

  • Acne
  • Increased estrogen production marked by fat accumulation in the breast
  • Prostate issues

Are there other signs I should be aware of?

  • Dizziness
  • Headache
  • Stress sensitivity

What should I do if I notice any of these signs?

Reduce your dosage of DHEA by 30% and watch for a month to see if the symptoms subside.  Also, avoid excessive carbohydrate intake.  If this action does not bring resolution please call the office at 336-768-3335 for an appointment .