Dr. Ruscio, I see that you frequently use supplemental DHEA/Preg in most patients for adrenal support including fatigue/brain fog. What dose(s) do you typically use since you aren’t testing levels? Any risks to empirically treating?
Good question Allie. I used to be meticulous regarding dosing, then I realized this was your typical superfluous practice seen in functional medicine. I use about 30 drops of preg and 15 drops of DHEA each per day. Divided among 2-3 doses. Example Preg 10 drops 3x. Sometimes a little more or less depending on how someone responds initially and/or if they have a history of reactivity.
A small percentage of people are sensitive to DHEA and will react with a racing heart, sweaty palms, insomnia or like reactions. In these cases, I simply use other supports: herbal, vitamin, etc… In those with known PCOS, I usually avoid DHEA. Some with reflux are also bothered by the alcohol, so again I’ll use other methods.
I see no danger if you are working to find the minimal effective dose over time. Some are strongly against ever using these without lab testing and I know of no data that shows this to be the case. What I do know is many people are using oral DHEA OTC and seem to be just fine. I’m open on this, but it appeared in a clear area where we could simplify things. I’ve had no regrets since my switch about 4 years ago.
Don’t Rush During Your Charting – Take Time to Reflect and Learn
There is so much one can learn if they take time to review a patient’s chart notes. I spend a few minutes reviewing a chart before and after every office visit. During this time I am:
Looking for trends and patterns
Questioning my current beliefs
Searching for blind spots
Digging for ways to simplify the process
Reflecting on what the most efficient next step is
Thinking on what I would do if this next step does not work
Updating my differential diagnosis
Checking that there are not treatment recommendations that the patient is still on even though no benefit has been produced
Considering if any retesting is needed
I truly believe that much of what clinicians are paying to learn from seminars and clinical training programs can be discovered right here. In fact, I feel I am living proof of this. Despite doing MUCH fewer seminars and training over the past 4 years, my clinical results have improved measurably. A large part of this was because of learning from the cases right in front of me.
There is an old saying which applies:
You can have five years’ experience once or one years’ experience five times.
Make sure you aren’t repeating the same thing, year after year, but rather learning from that experience.
I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next practitioner question of the month.
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