Jan 8th, 2020
Second Meeting with Dr. Lowe – Amen Clinics
Three months have passed since I first met Dr. Sandlin Lowe, MD, it was meant to be that we meet again as per their request.
We had two phone calls to discuss my case progress, and it was an audio call at two separate times on the same day.
I will summarize the outcome as soon as I can, and until then, the below audios are given
First call (morning)
Second call (afternoon)
9/28/2019
SPECT Analysis Session – Amen Clinics
I have met with Dr. Sandlin Lowe, MD at Amen Clinics in New York, who is a Neuropsychiatrist and expert in Translational Clinical Neuroscience and Therapeutics.
He analyzed my SPECT and spent educational and sharing time with me after having checked my medical records (and checked my website as well)
(I got his permission to share the our video below)
The videos are recorded in sequence and are cut off as the mobile decides to cut them off without my control.
The SPECT Scan did show that my left temporal lobe (where surgery took place) that is not functioning well is bigger than the surgery itself. In other words, something is not ideal, and it might not be primarily due to the brain resection. My personal guess is that the area that is showing no-function is four times bigger than the brain surgery area.
I wished of course I had an SPECT Scan before surgery to compare, because guess I’ll never know when did that area show such degrade in performance.
This is about one-hour session.
SPECT Scan Images
All points below are written exactly as received in the reports from Sandlin Lowe, M.D.
SPECT Study Findings
I have received the report on the 30th of September, 2019. Two working days after my meeting with them.
Brain SPECT imaging basically shows us three things: areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that do not work hard enough. With this information, together with the clinical information obtained through our extensive history-taking process, psychometric testing, and clinical evaluation, we are able to develop a more comprehensive, effective, and integrated treatment plan. SPECT scans help delineate the brain physiology underlying psychiatric problems and may or may not fully correlate with the clinical DSM-V diagnoses, since the DSM-V is based on historical symptom clusters and not on underlying brain systems. This is part of why SPECT scans can be so helpful.
Findings
This is a good-quality scan. The most significant finding is severe hypoperfusion of the left temporal lobe accompanied by a non-filling defect in the left temporal fossa, likely corresponding to the patient’s history of brain tumor status post-excision. There is also severe hypoperfusion of the left occipital lobe, moderate hypoperfusion of the inferior orbital prefrontal cortex, right temporal lobe, and internal cerebellum, and mild hypoperfusion of the dorsal parietal cortex and the prefrontal pole. These findings suggest past brain injury; correlation with patient history, previous neuroimaging, and clinical findings is recommended.
Consider further evaluation if clinically indicated.
There is mildly increased perfusion of the anterior cingulate gyrus and severely increased perfusion to the middle cingulate gyrus.
- Decreased left and right temporal lobe tracer activity seen with concentration
- Decreased tracer activity in the left and right inferior orbital prefrontal cortex seen with concentration, and decreased prefrontal cortex pole tracer activity seen with concentration.
- Decreased left and right parietal lobe tracer activity seen with concentration
- Decreased left occipital lobe tracer activity seen with concentration
- Decreased internal cerebellar tracer activity seen with concentration
- Evidence of cortical atrophy is noted, and A combination of findings suggest past brain injury. These findings include:
- Decreased prefrontal pole activity
- Decreased cerebellar activity
- Decreased temporal lobe activity
- Decreased parietal lobe activity
- Decreased occipital lobe activity
- Increased tracer activity in the anterior cingulate gyrus seen with concentration
- Very mild scalloping seen with concentration
Conclusion
- Decreased left and right temporal lobe tracer activity seen with concentration.
This abnormality may be associated with several different symptoms including mood instability, irritability, memory problems, abnormal perceptions (auditory or visual illusions, periods of deja vu), periods of anxiety or irritability with little provocation, periods of spaciness or confusion, and unexplained headaches or abdominal pain. We have found abnormalities in this part of the brain to be helped with anticonvulsant medication when clinically indicated. Decreased activity in the temporal lobes may also be associated with learning problems, especially reading comprehension difficulties and auditory processing problems.
Problems in the right temporal lobe have been associated with social withdrawal, social skill struggles, and depression (more inwardly directed difficulties as opposed to left-sided problems). If clinically indicated, it may be helped by anticonvulsant medications. An alternative supplement might be GABA to help inhibit erratic firing. If memory problems are the primary issue, then we often prescribe acetylcholine-esterase inhibitors, Namenda or a group of supplements to enhance memory, such as gingko biloba and Phosphatidyl serine - Decreased tracer activity in the left and right inferior orbital prefrontal cortex seen with concentration, and decreased
Decreased activity in the inferior orbital prefrontal cortex during a concentration task is often associated with impulsivity, a short attention span, distractibility and difficulties with organization and planning. We have seen a strong correlation between this finding and ADHD and ADD, especially when this occurs during the performance of a concentration task. This pattern, if clinically indicated, is often responsive to psychostimulant medication - Decreased left and right parietal lobe tracer activity seen with concentration
This finding has been associated with toxic exposure, brain trauma, infection or Alzheimer’s disease. The parietal lobes have also been implicated in attentional issues, direction sense, doing complex tasks and orienting oneself in space. Clinical correlation is essential. - Decreased left occipital lobe tracer activity seen with concentration
This finding has been associated with toxic exposure, brain trauma, infection or anoxia. The occipital lobes are involved with vision and visual processing. Problems in this part of the brain can be associated with visual learning or visual processing problems. Clinical correlation is essential. - Decreased internal cerebellar tracer activity seen with concentration
The cerebellum is the most intensely active structure on the SPECT scan of a healthy individual. There is growing literature describing behavioral disturbances associated with abnormalities of cerebellar structure or function. This supports the belief that the cerebellum is involved in coordinating higher-order processes such as planning and impulse control and other complex behaviors because it is known to send projections to various regions of the cerebral cortex, especially the frontal and prefrontal cortices. We are currently investigating the clinical significance of this finding and to identify any associations between specific abnormalities of internal cerebellar activity and concrete behavioral disturbances. - Evidence of cortical atrophy is noted, and A combination of findings suggest past brain injury. These findings include:
1. Decreased prefrontal pole activity
2. Decreased cerebellar activity
3. Decreased temporal lobe activity
4. Decreased parietal lobe activity
5. Decreased occipital lobe activity
Cortical atrophy may be seen in aging, as a result of trauma, anoxic events, vascular disease, strokes and chronic toxicity (alcohol, drugs, inhalants, toxic exposure, chronic hypoxia, metabolic diseases). Developmental disorders affecting neuronal migration in utero may also result in this appearance. Cortical atrophy is suspected if there is decrease in activity in the region of the Sylvian fissures (lateral aspects of temporal lobes where the lobes touch the frontal and parietal cortices) as well as in the region of the longitudinal fissure (the line where the two cerebral hemispheres meet). In addition, there may be scalloping and evidence of proportionate ventricular enlargement. Disproportion between atrophy and ventricular enlargement may present in a number of conditions, some of which may be amenable to intervention. Ventricular enlargement of a degree greater than that of cortical atrophy requires close clinical correlation - Increased tracer activity in the anterior cingulate gyrus seen with concentration
This finding is often associated with problems shifting attention that may be clinically manifested by a combination of symptoms such as cognitive inflexibility, obsessive thoughts, compulsive behaviors, excessive worrying, argumentativeness, oppositional behavior or getting stuck on certain thoughts or actions. We have seen an association with this finding and obsessive-compulsive disorders, oppositional defiant disorders, eating disorders, addictive disorders, anxiety disorders (especially when combined with increased basal ganglia activity), Gilles de la Tourette’s and chronic pain. If clinically indicated,it may be helped by anti-obsessive antidepressants that increase serotonin in the brain. Certain forms of structured behavior modification techniques have also been found to help lessen activity in this part of the brain. - Very mild scalloping seen with concentration
This finding occurs when the brain, on the outside surface, view appears scalloped or dehydrated. It is often associated with toxic exposure (such as to drugs, alcohol or environmental toxins), infection or oxygen deprivation at some point in the past. We have also seen it in widespread trauma
Physician Section
Please refer to your SPECT images that we discussed and where I marked the most relevant findings for you.
Mohammed is an intelligent and charismatic man who is struggling with the sequelae of an astrocytoma resection from his left temporal lobe. I won’t recapitulate the history here so please see the History Section above for full details.
Mohammed, the rest of this report will flesh out the broader based treatment plan we discussed, as well as additional potential options if they are needed.
Here are the “Next Steps” I’d recommend you focus on first
1. Continue your current supplement regimen
Add to it:
- Huperzine A 400mcg per day
- Phosphatidyl Serine 300 to 600mg per day.
You can purchase the “Huperzine A” from Willner Chemists. They are located at 100 Park Ave (corner of East 41st Street)
Status Update
Started Phosphatidyl Serine 300 on October 1st .
Starting Huperzine A in Jan 2020
2. Continue to maintain Ketosis
and continue the CBD oil (aim for 300 mg of Cannabidiol per day). On this regimen, very slowly reduce the Trileptal. Watch for any changes in intensity or duration of your partial “micro” seizures
Status Update
Started on October 1st. I took around six times more of my previous dosage. While the doctor recommended this brand, I did not change my current brand, and I had positive outcomes
However, this does not mean that I am seizure free yet, and my recent EEG shows I am not fully in control yet.
3. Purchase the TENS 7000 2nd Edition Digital TENS Unit
The one with 5 Modes and Timer with extra electrode pads.
Program the device and use it for right median nerve stimulation, as outlined below. Instructions for TENS 7000 device use in Right Median Nerve Stimulation
Set your TENS device as follows for both Channel 1 (the left forearm) and Channel 2 (the right forearm):
- Mode is Normal for all treatments
- Wave Width 260 microseconds for all treatments
- Timer for 30 minutes each session for 2 to 3 sessions a day
- Vary the Rate (Hz) for each 30-minute session: 14Hz or 40Hz
NOTES
Place the adhesive pads over the median nerve at the right wrist with about an inch between them along a line from the wrist.
follows the palmaris longus tendon (towards the ante cubital fossa—the bend of the elbow).
Turn on the device and slowly increase the current (power) until you feel twitching in the muscles of the thumb or hand or you feel pain at the adhesive pad site. Dial back the power slightly; this will be your current setting for the 30-minute treatment. Aim for two to three 30-minute treatments per day.
Status Update
On October 1st, I started using it twice a day, the same way the doctor proposed. The below image shows where I put it on my hand, and I verified this photo with Dr. Lowe over the email to ensure I am doing it right.
He also added, “You want to either feel pain (then dial down the current) or see or feel twitching in the hand, thumb or fingers.”
4. Essential Fatty Acids
The following essential fatty acids and phospholipids, along with the Butyrate and Prometol detoxify membranes and restore and support brain function and health. You can purchase them from www.bodybio.com. (I was given a code for a discount.)
BodyBio Essential Oils along with Calcium Magnesium Butyrate and Prometo
- BodyBio PC liquid, the 16-ounce bottle (www.bodybio.com)
Take 2 Tablespoons per day for 3 months. - Calcium Magnesium Butyrate
Take 3 capsules with breakfast and 3 capsules with supper for 3 months - Prometol
Take 2 capsules with breakfast and 1 capsule with supper for 3 months. - BodyBio Balance Oil
Take 2 tablespoons once per day, preferably with protein, throughout the year
(to read more about distortions in the lipid bilayer cell membrane see Dr. Kane’s website or the NeuroLipid Research Foundation)
Status Update
I started BodyBio on October 16th
I started Prometol on October 10th
I delayed Calcium Magnesium Butyrate as I have another “similar” product
I Still did not buy the BodyBio Balance Oil
6. Evaluate you for Craniocervical Syndrome
As we discussed, we want to evaluate you for craniocervical syndrome (CCS).
Please make an appointment with Dr. Scott Bender (office phone: 203.967.8888) in Stamford, CT to be evaluated (please see the YouTube videos by Dr. Scott Rosa). CCS can complicate head trauma, prolong Post-Concussion Syndrome symptoms and play a role in the development of certain dementia.
I am already arranging it in New York
I have learned than Dr. Royamond Damadian is the one who actually made the MRI’s back in the 80s. Appoints are not close, I found . Initially, the soonest possibility (which is not confirmed yet) is in January or February of 2020.
If I get that appointment confirmed, I will be meeting with Dr. Royamond himself, seeking to know what he believes my brain is telling him.
If the case gets confirmed, then most likely I will be seeking to take an appointment with Dr. Scott Rosa D.C., B.C.A.O, in New York, who seems to be an expert in Image Guided Atlas Treatment.
If I get that appointment confirmed, I will be meeting with Dr. Royamond himself seeking to know what he believes my brain is telling him.
If the case gets confirmed, then most likely I will be seeking to take an appointment with Dr. Scott Rosa D.C., B.C.A.O, in New York, who seems to be an expert in Image Guided Atlas Treatment.
Please check the Fonar website as they have pioneered the use of upright MRIs in assessing the cranial skull base alignment with the cervical atlas (C1), the axis (C2), and other cervical vertebrae. Misalignment of this critical junction can affect brain glymphatic function, CSF flow dynamics, and blood flow to the brain.
Another option is to see Dr. Tod Cahill, D.C. at the Al Das Medical Clinic. Palm Jumeirah, Shoreline building #10, Dubai, UAE.
Phone: +971 4 451 8877; Fax: +971 4 454 1135
7. External Counter Pulsation
Look into External Counter Pulsation (ECP or EECP). This therapy is a safe, non-invasive therapy that has remarkable clinical benefits to the appropriate patients.
They offer it in the UAE at Royal Medical Systems, fze, C1 408 B, Ajman free zone, Ajman
UAE, P.O. Box Num: 40421.
Phone: 022-69999644. Contact: [email protected]
Status Update
I am still working on this, as I’m trying to allocate time and cash before I start this track
8. Fetal Neural Stem Cells Stemedica
Lastly, look at the Fetal Neural Stem Cells Stemedica has developed (www.stemedica.com).
Nikolai Tankovich, MD, PhD is President and Chief Medical Officer. Alex Kharazi, MD. PhD is the Chief Technology Officer. Stemedica Cell Technologies, Inc., 6350 Nancy Ridge Drive, Suite 106, San Diego, CA 92121, Phone: 858-658-0910; Fax: 858-658-0986
Status Update
I am still working on this, as I’m trying to allocate time and dollars before I start this track
Diagnosis
Current diagnosis are
- Malignant neoplasm of temporal lobe
- Mild cognitive impairment, so stated
- Attention-deficit hyperactivity disorder, other type
- Personal history of traumatic brain injury
- Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus
Medication
Recommended Medications
When possible and practical, we generally start with a more natural approach first, combining the use of targeted nutraceuticals, focused psychotherapeutic modalities, healthy nutrition, regular exercise, normalization of sleep, a good daily schedule, clarity regarding current priorities and sense of purpose, etc., then go to traditional medication if needed.
The non-amphetamine stimulant Provigil (modafinil) or Nuvigil (armodafinil) often will improve cognitive and executive function as it enhances electrotonic coupling of the cortical interneurons (they asked me to look at an attached paper in a folder that was given to me, specifically the one by Dr. Linas).
In many people with attention/focus issues the effective dose is 200mh to 600mg per day, often in divided doses.
Nutritional Plan
Recommended Nutritional Plan
You should also restore your microbiota (the organisms that live throughout your gastrointestinal tract) by using a good probiotic. The one I suggest is Progurt.
Dissolve 1 sachet of Progurt probiotics in 6 ounces of water, stir and drink. Later take 1 Tablespoon (15ml) of the prebiotic and stir it into your tea, or coffee, or water, then drink. Do this first thing in the morning before breakfast for 5 days, then 1 day a week for 15 weeks.
For complicated GI issues speak with the Progurt Naturopaths. Please contact Robert Beson of Progurt and discuss your issues with him and let him design a probiotic and mineral/salts regimen for you.
Exercise Plan
A regular exercise regimen
The health benefits from physical exercise are truly amazing.
Solid research has shown that regular exercise helps:
- Protect brain cells against toxins, including free radicals and excess glutamate
- Helps repair damaged DNA
- Reduces the risk of cognitive impairment
- Heart disease and stroke
- Improves cholesterol and fat metabolism
- Improving blood, oxygen and glucose delivery to tissues;
- Reduces risk of diabetes, osteoporosis, depression, colon and breast cancer.
Regular exercise is as effective as 12 sessions of psychotherapy.
It is one of the best, natural treatments for ADHD, anxiety, and depression. I
recommend that you exercise a minimum of 30 minutes 5 times per week.
In order for the exercise to be aerobic you must have a sustained increased heart rate (HR).
A target HR for you would be 80% to 85% of (220 – your age). The formula is: (220-your age) x 0.85 = Your target heart rate (THR) for the 30 minutes at least 4 times per week.
Consider incorporating any exercise you enjoy – biking, swimming, walking, hiking, aerobic classes, Cross-Fit, tennis.
Status Update
In Dec 2019, I decided to be able to run! So I started with 7-min workout on daily basic without challenges post exercise. Starting end of December 2019, I started ping-pong as a better replacement for the 7-min exercise.
Worth mentioning that this is followed by three supplements: Nitric Balance, Turmero Active and Resvero given that I no longer worry about them interacting with Trileptal which I stopped using.
Interval Training
Recommended by the American College of Cardiology to be as effective as sustained aerobic exercise. Thirty minutes of cardio five days per week is equivalent to twenty minutes of interval training 3 days per week.
Interval training is basically 90 seconds of warm-up, then a series of “bursts” of exercise. 30 seconds of going almost as fast as you can, and then 90 seconds of a moderate pace. Repeat this 8 times with a 90–120-second cooldown at the end.
Interval training can be done with any form of exercise, such as running, treadmill, elliptical, Stairmaster, swimming, biking, recumbent exercise bike, upright, or even walking.
Specific Brain-Type Physical Exercise Recommendations
The best types of exercise for your brain include coordination activities (e.g., dancing, tennis, table tennis) that incorporate coordination moves with aerobic activity. These types of aerobic activities spawn new brain cells, while the coordination moves strengthen these new connections.
For the Cerebellum: Hand-eye coordination activities: table tennis, tennis, racquetball, squash, handball, air hockey, juggling, etc. Activities for balance and coordinated movement: yoga, tai chi, fencing, Kendo, Iaido, learning new dances, gymnastics, etc. Activities that require concentration and attention to detail: calligraphy, knitting, needlepoint, drawing, coloring, painting, jigsaw puzzles, playing a musical instrument, memorization, reading more, learning a new language, etc.
Brain Fit Life Membership
BrainFitLife is our online program to help you improve your brain health anytime, anywhere. Think of BrainFitLife as your personal trainer to enhance your brain and body. It starts by taking our Brain Health Assessment where you get a Brain Fit Score and your unique brain type. You are then provided with a personalized plan to start training your brain and body, including:
- 34 brain games to improve cognitive function
- 38 unique meditation & hypnosis audios
- 160+ brain-healthy recipes
- Kill the ANTs interactive exercise
- Expert advice from certified Brain Health Coaches
- And so much more!
I’ll include a sheet in your take-home binder that provides more details of BFL’s benefits
Status Update
I use BrainHQ, and I checked with the doctor in case I could continue on that, and he responded, saying that it’s good or fine.
Brain Fit Life Membership
To Do Now: To start your membership, visit www.mybrainfitlife.com and take the Brain Health Assessment. You can then create an account with your email address and the low fee of $99/year.
In Closing
I am available by email or phone. Simple questions may be handled by a brief exchange of messages; otherwise, it is better to schedule appointments. While we do not charge for very brief issues requiring five minutes or less of my time, letter writing, form completion, record review, review of laboratory results, medication prior authorization, and other requests outside of scheduled appointments will incur a charge, depending on the amount of time needed.
I am happy to speak to and collaborate with anyone involved in your care. Please sign a release for me to send a copy of this report to
any health care professional you are currently seeing, and anyone else you would like to receive one.
Consider a follow-up scan in 6-12 months to check progress. In our experience, a follow-up scan can be a very powerful aid to track your progress and fine-tune your treatment.
Sandlin Lowe, M.D., wrote
Thank you very much, Mohammed for allowing me to participate in your care. I am optimistic that the recommendations we discussed will be very helpful to you. We will have a series of follow-up appointments as scheduled to answer any questions you may have after reviewing your evaluation and to check on your progress.
Status Update
I write the doctor about doing this Gut Microbiome Testing from Viome before going for Probiotics and he said that it’s fine/good idea. So I will do that soon.