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Aug 21, 2017

How to Present Adrenal Lab Findings to Patients

by Dr. Dan Kalish

Adrenal Lab Test Report of Findings Session

First, it's important to go over the patient communication steps during these lab findings. Three Steps to a 30 minute session:
  • Step One: 10 minutes showing them the lab report and what all the levels mean
  • Step Two: 10 minutes verifying their symptoms and life experience make sense based on the lab results
  • Step Three: 10 minutes explaining the products, how to take them, what they are for
  • Step One: Show or draw out the hormone pathway chart, show or drawn out the Stage of Adrenal exhaustion chart.
  • Step Two: Take them through the clinical model charts and find out when their most stressful time of life was and if that correlates with the onset of health problems, keep going back in time asking, “When did these problems first start?” and “What else was going on in your life at the time?”
  • Step Three: Go over their program, design it while you are talking and explain the products making sure you cover side effects, dosing, how to take products and length of time on program they should expect to see various changes. Negotiate the right number of products for them, from three to nine supplements depending on the person and their labs.

Issues to handle during the 30 minute consultation:

You want to be sure that you address all of the concerns floating around in their head before they leave the treatment room, this will save you a lot of follow up phone calls and dramatically increase compliance. Common concerns:
  1. How long will I have to do this for? Forever?
  2. Are these supplements safe? I heard DHEA is risky to take?
  3. How much is this going to cost?
  4. Are you sure this is going to work?
  5. How long until I start to feel better?
  6. What should I expect?
  7. Why doesn’t my regular doctor know about all this?
  8. Will my insurance cover this stuff?
  9. What if it doesn’t work?
Common follow up issues:
  • Reacting poorly to supplements what to do?
    • Stop 3-­‐4 days, restart at 1/3 full dosage, do that 3 days then increase to 2/3 of full dose for 3 days then get back on complete program.
    • Stop 3-­‐4 days, restart and stay at much lower dosage than originally planned.
    • Stop supplements for adrenals, start liver support for 3-­‐4 weeks then restart adrenal program gradually.

Steps for Presenting Adrenal Lab Findings to Patients

  1. Verify their top 3 complaints and orient your conversation to address these complaints in relation to how the adrenal glands contribute. The “Big Five” are: fat, fatigued, depressed, female hormone problems and GI issues.
  2. Explain how people get exhausted adrenal glands: three types of stress create adrenal exhaustion: emotional stress, dietary stress, pain and inflammatory stress (often times the inflammation is hidden i.e. people aren’t aware of it.
  3. Explain the four lifestyle factors essential to get out of adrenal exhaustion: diet, exercise, stress reduction and sleep.
  4. Explain the place of supplement programs as essential to healing but that they take a second place to the healing power of the lifestyle changes. Taken together the combination is powerful. At least 50% and some people say as much as 80% of the repair comes from lifestyle changes. The supplements provide a major initial boost which helps people gain the energy and enthusiasm they need to put the lifestyle change in place.
  5. Let patients know it is a six to twelve month program and that as soon as their major complaints are resolved or as soon as the retesting shows their adrenals have improved significantly they can stop all the therapeutic supplements and switch to a maintenance plan that primarily emphasizes the lifestyle changes with a minimal focus on supplements. This are short term therapeutic programs designed to fix adrenal burn out that typically takes place over years of chronic stress. It is rare for people to slip back unless they come under a period of stress again.
  6. Talk to patients about their main sources of stress: emotional, dietary and pain/inflammation. Find out if some of their stresses will continue: raising young children, caring for aging parents, financial problems, work situations. Find out what are stressors that can be eliminated and see what is left that a person will just have to live with. Some patients have had their primary stress at a point in the distant past: a divorce and custody battle six years ago, going through law school while working full time 12 years ago, etc. If so, the programs are more likely to restore function quickly. If the stress is ongoing then clearly programs will go on for a longer period of time. The more stress one can reduce or eliminate the faster the programs will kick in.
The adrenal stress tests are really a single snapshot of the current moment in time. They let you know how balanced a person’s life has been between period of stress and times of rest and recovery. It is not normal to have exhausted adrenal glands! It’s a sign the person hasn’t had enough rest and recovery to correct for the amount of stress they have had throughout their life. One key element is that the stress could have been quite a few years ago.
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Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.