Diagnostic and Therapeutic Scope at CWI

by Louis B. Cady, M.D.


Information on what we diagnose and treat, including psychiatric disorders (our roots), extending into the functional medical realm of optimizing human physiologic function for patients with subtle - and sometimes dramatic - health problems.

The practice of medicine, psychiatry, psychotherapy, and various healing modalities at CWI is a function of both my growth as a physician and as a human being and the collegial and collaborative relationships with the clinical staff at CWI that I am privileged to share.

THE BACKGROUND

When I first started practice in 1993 in Evansville, my professional practice was basically “conventional psychiatry.” While it wasn’t exactly a “take two Prozac and don’t call me in the morning” style of practice, it was fairly conventional in that it was exclusively limited to basically medications and psychotherapy – both individual and group types.

Things began to change upon my exposure to an incredibly well educated and comprehensively minded local practitioner who is an esteemed colleague of mine, and my exposure to – of all places – a local health food store: Adele’s, founded by Adele Cottrell. Adele herself is practically an Evansville institution, and her store was frequented by the healthy living crowd way before “organic foods” and the new emphasis on healthy eating and adequate vitamin intake was popular.

One of the early benefits of that newfound exposure was my small hyperactive munchkins, whose stimulant medication I occasionally began supplementing with particular amino acids (bought right off the shelf at Adele’s). In all my practice history, I’ve never yet had a parent who said, “Sure Doc, I’d love for you to give my kid more Ritalin!”

Not only parents, but all of my patients, I discovered, responded well to the integration of natural treatment strategies when psychiatric – or other – medication was called for. Thus began my straying outside the previously neatly delimited concept of what “psychiatric practice” was about. And for this, ironically, I owe a permanent debt of gratitude to my late psychotherapy supervisor at Mayo Clinic, Dr. John Graf.

Dr. Graf was widely considered one of the two most astute psychotherapists at Mayo Clinic (the other Consultant was a full bore Freudian analyst – and I had the rare pleasure of having both of them as my psychotherapy supervisors during my last two years at Mayo). What was not widely known about Dr. Graf was that (a) he was an expert psychopharmacologist, and (b) he was tremendously humble. When he didn’t know the answer to something, his strategy was, “Let’s go check the literature.”

Back then, “checking the literature” was a typically a trek to the residents’ call room where a primitive computer and connection to the internet was available. We would search on the progenitor of the current Pub Med search site – a site which I urge all of my patients to use (and have just hyperlinked for you) – and plug the holes in our knowledge base.

This increased my own intellectual humility, a realization that I could not possibly be expected to know all the answers, and an obedience to, and respect for, the world’s “peer reviewed medical literature.”

Fortunately or unfortunately, this led to a mixed blessing. The good news was that if I researched what was “out there” in the intellectual playground of the world’s medical literature, I stayed up to date and current. The bad news was that I was one of the few doing it. This automatically began to put distance between me and my previous style of medical/psychiatric practice, as well as open up a knowledge gap between me and other medical practitioners.

Another interesting development was that, because of a performing career at the piano, good “stage presence” and a certain ability to string words together while standing up in front of a bunch of people, I began doing more extensive lecturing, first for Welborn Hospital when it was in existence, and subsequently for pharmaceutical companies as well as a few opportunities for “motivational speeches.

My success as a speaker led to the opportunity to go to multiple medical meetings, and like a bee buzzing from one flower to another, cross-pollinating them, to pick up wonderful little nuggets and tidbits of wisdom from my colleagues. It was during this period of time that the second major formative influence on my expertise as a psychopharmacologist occurred: I got to meet and essentially train with Stephen Stahl, MD., Ph.D., the founder of the Neuroscience Education Institute, and the man who is generally recognized as the current international “rock star” of psychopharmacology. I mentally downloaded every nugget I could from him at every chance I could get and every meeting with him I could attend, and learned state of the art psychopharmacological concepts that I then promptly brought home to the Evansville area.

The increase of knowledge – accumulated from my peers and my intellectual superiors and mentors – inevitably led to more therapeutic potency from my efforts and, predictably, to more patients that wanted assistance. In short, I quickly outstripped my ability to be a “one-shrink shop.”

THE EVOLUTION OF THE PRACTICE

I was blessed to have Bill McAdams, LCSW, DCSW, join me in practice early on as a psychotherapist and as a co-evaluator. We began a process – still in use to this day at CWI, of “collaborative evaluations.”

This process basically involves the prospective psychiatric patient coming in and spending two full hours with a trained mental health practitioner to obtain the “biopsychosocial database.” It is impossible for any psychiatrist, no matter how good he or she is, to accurately diagnose and prescribe without the FULL PATIENT DATABASE. I am somewhat fanatical about that, because I detest making mistakes and exposing patients to potential side effects of medications – or incorrect medications – if I do not have a true sense of the historical and psychiatric landscape.

As my practice expanded, I was fortunate to add a second therapist to my practice: Linda Simmons, LCSW, a woman of such talents and academic credentials that she is the former chairperson of the entire Department of Social Work at the University of Southern Indiana. In the spring of 2009, Lisa Seif, LCSW, CADAC, CSAMS joined me in practice as a therapist as well.

FURTHER EVOLUTION

As my practice evolved even further, I began getting what I considered “Mayo Clinic” referrals. These are “end of the line” referrals, either sometimes by physicians, or sometimes by patients or relatives themselves picking up the phone and calling in. Probably the best recollection I have of that type of referral was when, as a sleep deprived resident at 3 a.m. in the morning on my internal medicine rotation at the (Rochester, Minnesota) Saint Mary’s Hospital, I received a referral from the emergency room with a prescription slip scrawled on by her physician. It said, simply, “Time to go to Mayo.” And indeed, for that patient, it was.

As a result, one of the things that we do at CWI is “de-stigmatization.” We have found, for example, that if a woman comes in who is depressed, overweight, has no sex drive, has “brain fog,” swears that she’s not eating excessively but can’t lose weight, and is increasingly helpless and hopeless, it may not be classic depression.

This follow numerous cases where – as a result of the holistic training and multiple medical meetings I’ve been to, plus lectures I’ve given over the last decade – the primary underlying problem is NOT psychiatric. It may be “low thyroid.” Or “burned out adrenals.” Or yeast growing in the gut. Or IgG food sensitivities where the food that the patient is eating is setting them up for inflammatory reactions and opening up tiny holes in the gut wall. Or an extensive viral loading (now unquestionably documented in the peer reviewed medical literature) leading to the SYNDROME of chronic fatigue or fibromyalgia. Incredibly, because of the new additions to CWI, we now actually have the ability to do something about all of these conditions.

ADDTIONATIONAL EDUCATION AND TREATMENT MODALITIES

While I have had talented colleagues join me, my own training has not stood still. In 2003, I completed Age Management Medicine training at Cenegenics Medical Institute in Las Vegas, NV. Cenegenics is the pre-eminent institution for age management treatment in the world, having been featured on 60 Minutes, written about extensively in GQ magazine, and has the largest patient base of 15,000 patients worldwide, 1500 of whom are physicians or their families. During this training, I learned about optimizing hormonal levels of both men and women – from their thyroids all the way down to their gonads.

Additionally, I’ve taken additional training in the use of SPECT scanning with my friend and colleague Dr. Daniel Amen, M.D., the world’s leading expert and innovator in the use of SPECT brain imaging for functional analysis of exactly what the brain activity and its impact on mood, emotions, and function. Dr. Amen and I have a lively collaboration between his clinics in Newport Beach, CA and Reston, VA, and the Cady Wellness Institute.

CURRENT CAPABILITIES AND FUTURE DIRECTIONS

As a result of the serendipitous gifts and professional associations I have been privileged to receive, the fund of knowledge in my “intellectual sandbox” has expanded considerably. Therefore, when patients come to CWI for “psychiatric problems” or simply because they feel lousy and want a holistic and comprehensive workup, my abilities have been amplified through the enthusiastic and joyful collaboration I share with all of the clinical staff here.

In 2010, as I revisit this essay, the future has never looked brighter. Our current therapeutic interests range from the “conventional psychiatric problems” of depression, mood disorders, and ADHD all the way to more subtle manifestations of sub-optimal endocrine functioning, viral loading, chornic pain, chronic fatigue, and fibromyalgia. We are about to launch a major educational and treatment initiative in chronic fatigue and fibromyalgia: two conditions that women have been discriminated against and told – for decades – that “it’s all in their heads.”

Our goals remain to both destigmatize as well as forcefully and synergistically treat “psychiatric issues” (which, from the work of Dr. Amen we can now largely localize to specific patterns of brain dysfunction), more nebulous issues of “chronic fatigue” or “just not feeling right” (about which the world’s peer reviewed medical literature is now speaking more clearly), and the predictable and inevitable consequences of aging (as hormones fall to less than optimal levels).

From the founding of Cady Wellness Institute in 2005, to its current existence and therapeutic capabilities in 2008, it has been an incredible adventure. I am deeply grateful to my expert colleagues, my wonderful teachers and mentors, the staff and colleagues at the Mayo Clinic and Cenegenics Medical Institute, and most especially, to the hundreds and thousands of patients who have trusted me or my staff with their lives so that they can truly live the lives they were meant and destined to have and achieve to the limits of their God given mental and physical abilities.

Louis B. Cady, M.D. – March 9, 2008, revised February 22, 2010

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