On July 1, 2005, looking around at boxes piled in my office at my new medical institute, I paused and wondered, “What the heck am I doing here?”
Two months previously, I had presented a lecture series called “The Road to Wellness” in Evansville, detailing the new focus of my practice as it has evolved: “Integrating Mind and Body for Peak Performance.” But I was not always a paragon of mind/body integration, and I had been, quite frankly, ignorant of many of the themes of the peer reviewed medical literature.
Here, in as much – or as little – detail as you choose to know, is the story of the Cady Wellness Institute.
The beginnings of the Cady Wellness Institute were not auspicious. Indeed, my beginnings as a physician were not auspicious. In fact, my beginning as a physician was an abysmal failure.
I grew up venerating physicians and wanting to be one. I liked “Marcus Welby” and “Medical Center” – with my hero Dr. Joe Gannon, M.D. I joined a Medical Explorer Post in my Scouting career, and then nearly flunked out of algebra in high school shattering my goals to continue to take math and science courses to prepare for a medical career. I later learned that a math teacher who just couldn’t get across the concepts had prematurely sidetracked my “physicianly” aspirations. Reluctantly, I set aside any hopes of pursuing my dreams.
As a junior and senior in high school, I was very good at two things – English and playing the piano. At that time, a career as a concert pianist seemed more exciting than teaching English (with apologies to all my English teaching friends!) I opted for Door Number 1 and started my higher education with the intention to be a professional musician – which I attained. Along the way, I no doubt significantly developed “right brain” abilities and an increased ability to conceptualize and “think outside the box.”
Following my graduate degree in music, I discovered two things: first, nobody was buying what I was selling. There were no jobs. Secondly, I wasn’t nearly as bad at math as I thought. In fact, I discovered that I was more than passably talented in it much to my astonishment. I started pre-professional studies with the plans of becoming an optometrist, but due to the influence on me by some of my previous piano students (who were physicians) in Kansas City, I decided to pursue medicine. I began the two additional years of academic studies to finish the pre-medical requirements, none of which I had satisfied in my previous university career.
During those two years, sandwiched in between them like the crème filling of an Oreo cookie, I was actually hired to do what I had trained for. I served as Artist in Residence in Piano and an Assistant Professor of Music at Howard Payne University in Brownwood Texas, taking pre-med courses when I could, both during the school year and in the summers when I was “off.”
Two interesting things occurred in those three years. First, I discovered a book by Zig Ziglar entitled See You at the Top. That book featured Zig’s now famous aphorism: “You can have everything in life you want, if you just help enough other people get what they want.” How profound! The second thing that was significant is that I was invited to develop the Continuing Education Division’s program in photography, from scratch, at Howard Payne (pronounced “Hard Pain” in TEX-an). This further honed by skills in communicating and developing lecture materials for the general public. In other words, I learned how to “talk plain.”
My medical studies at the University of Texas Medical Branch in Galveston, TX, were fascinating, and I graduated with my Doctor of Medicine degree in 1989. I was then licensed for the independent practice of medicine in 1990 after taking the FLEX exam in Minnesota, where I was finishing my psychiatric internship year at Mayo Clinic.
When I interviewed at Mayo, the Consultants there were very interested in my liberal arts background. Mayo, in fact, definitely strove to attract residents of diverse backgrounds, who were more than just lab rats through college. I definitely qualified on that score! The residency was amazingly intense, and amazingly educational. In my first year, I did the rotating internship in psychiatry, which meant one-half year of psychiatry, and one-half year of primary medicine and neurology. I delivered babies, attended sick children in the emergency room, cared for patients dying of cancer, ran anti-coagulation protocols at night on critically ill medical patients, and saw every type of neurological illnesses you could imagine.
On another occasion, I had to tell a woman on a neurology floor that she was going to die of metastatic breast cancer which was in her brain. The thing that I took the most pride in was that after breaking the news to her and her family as gently and calmly as possible, I wrote her an order for low dose Klonopin to deal with her understandable anxiety at the news, and I used my fledgling skills at psychotherapy to comfort her and her family in their time at Mayo while she was in the hospital. I later received a very nice letter from her daughter telling me of her mom’s passing, and again thanking me for my kindness.
The emphasis at Mayo on taking care of the whole patient and dealing collaboratively and respectfully with your colleagues seemed to be almost in the air that you breathed there. It permeated the culture. And it permeated me – and to this day I believe it continues to guide the way I practice medicine.
I received one other gift from Mayo: Dr. John Graf. I met Dr. Graf as a first year resident. He was a large, imposing, bear of a man, with a foreboding and serious countenance but a wry grin and a twinkle in his eyes. He was widely regarded in the department as one of the most skillful psychotherapists there. By his own confession, he was self-taught. He read voraciously, loved his books, and loved to loan them. Periodically, all residents and consultants in the department would get a mailing from Dr. Graf – something he simply blanketed the department with – forlornly noting that some of his books were missing. He apologized for not remembering to whom he had loaned them, but asking for their return.
The interesting thing about Dr. Graf, however, is that he was only an expert psychotherapist, but the “inside scoop” was that he was an expert in psychopharmacology. Because of my admiration for him, I began aggressively campaigning for him to be my psychotherapy supervisor in my first year. I didn’t get him for my second year, but by my third year, I succeeded.
One of the events which sticks out in my memory just like it was yesterday was when Dr. Graf and I were reviewing a particularly vexing case, and a question about which medication to use came up. There was a subtle point about this question that was eluding both of us. Dr. Graf said, “Let’s go check the literature.”
This was a revelation. It suddenly occurred to me that although he was brilliant, Dr. Graf simply couldn’t know everything. Simultaneously, it became apparent to me that he wasn’t the least bit ashamed of it. He seemed, in fact, impishly amused and excited to find that there was a new bit of data for which he could search… something new that he could use to assist him in helping other patients.
From that day on, my response to any question which comes up for which I don’t know the answer has been: “I don’t know; let’s check the literature.”
Aside from Mayo, I had the opportunity to moonlight in a certain burg in Minnesota, filling in on the weekends for a psychiatrist who, although he was quite good, had one main weakness. He hated children. The weekends, therefore, became my ongoing continuing education into what worked and what didn’t in kids, kindling a lifelong fascination with my munchkin crowd of patients.
In 1993, I finished my residency at Mayo Clinic and moved to Evansville, Indiana, to assume a position with Welborn Hospital. It was, as I described to friends, ”my first real job.” I also told people that my orientation was that I would see whoever walked, staggered, or hallucinated across my threshold. It was a wonderful and stimulating practice. Concomitant with the child, adolescent, and adult psychiatry that I was practicing, two other opportunities presented themselves to me, and I became the Medical Director of the Mulberry Center Disordered Eating Program and, simultaneously, the Medical Director of the Sleep Diagnostic Center of Indiana, capping my interest in sleep disorders medicine which started when I was a resident at Mayo Clinic. Both of these Directorships gave me a marvelous “inside view” to the lives and the rich clinical history and challenges of people who struggled with both of these issues. And, I told people, it was a great racket. Some of the patients who had troubled with binge eating disorder or bulimia were obese, and they were therefore “setups” for obstructive sleep apnea. They went into my sleep medicine practice.
Other patients had an amazing history of being totally normal in terms of mood and eating until they became depressed, triggering a hyposerotonergic [“low serotonin level”] cascade of misery. I also saw men and women who struggled against overpowering difficulties controlling issues of food intake and who clearly described a sort of biological drivenness to overeat that they could not control. Part of me began to wonder: what is the biological basis for this? They were perfectly normal before, and now they weren’t. What changed?
Meanwhile, as I began treating my munchkins, I started looking around for other alternatives besides an over-reliance on stimulant medications. People aren’t born with “Ritalin deficiencies” or “Prozac deficiencies.” What then, was the cause of what I was seeing in my practice?
In Evansville, I became acquainted with a health food store, of all things, named “Adele’s.” This was the eponymous name of an enterprise given to it by Adele Cottrell, a by-then sprightly 80 year old who had been widowed many years previously and, after her husband passed away, began looking at the literature for vitamins and natural healing. [She is now a sprightly 90 year old!] I also learned of two other physicians in town who were using products from Adele’s for their patients. Thinking back to Dr. Graf’s comment, “I don’t know, let’s go look it up in the literature,” I began doing online searches through the National Library of Medicine on such topics as vitamin supplementation, as well as the use of compounds such as l-tyrosine and dl-phenylalanine to supplement the treatment of ADHD in kids. I tried this in my practice and it worked.
One theme of my practice from about 1993 to 1998 was that the world, in general, did not believe in “Adult ADHD.” I was seeing patients on the alcohol recovery unit who were clearly and severely ADHD, and I recall that when I suggested that they be put on Ritalin to calm them down, it was almost as shocking to the staff as if I had written “Cocaine is good!” on their walls with a can of spray paint. Nevertheless, papers were being published in the world’s medical literature clearly establishing the validity of this diagnosis. One significant shift in the diagnostic paradigms of the day was that “DSM-IV” came out in 1994, moving away from a diagnostic paradigm where the inattentive and hyperactive features of ADHD were all “mushed” together, and clearly separating them into an inattentive domain and a hyperactive/impulsive domain for the first time. Given that most adults with ADHD do not have trouble “playing nicely and cooperatively with others,” or “sitting in their chairs quietly,” this syndrome had been overlooked in adults for years, because people had been looking for the hyperactive and “wigglesome” symptoms, instead of the ones of inattentiveness and disorganization which bedevil most adults with ADD.
I still recall how I first came to treat Adult ADD. I had just started my practice, and in the newspaper, Welborn Hospital (where I was working at the time) was advertising my practice as “Child, Adolescent, and Adult Psychiatry” – which it was. One night, ABC’s 20/20 program featured a story on adult ADHD. The next day my phone started ringing. My intuitive office manager at the time, Kelly Bradford, came back and said, “Do you treat adult ADHD?”
I actually had never thought about it before, but I recalled talking with one of my child psychiatry buddies at Mayo who said that he saw it all the time in the community mental health center where he worked. I paused. “Sure,” I said, “Make them an appointment.” I then promptly called up a local bookstore, asked for a book on Adult ADHD, and went out and bought it that night. And I read it quickly! What I learned was fascinating, and supported by good clinical literature. But it was not common knowledge at the time, and it was clear that I was going to be going against the prevailing opinion of the “medical establishment” if I started treating “adults with ADHD.” Knowing, however, that there was plenty of scientific justification to validate what I was doing gave me confidence and so I sallied forth, prescription pad in hand.
In 2002, things really took a turn toward the holistic. I went to the Institute for Functional Medicine’s conference in Ft. Lauderdale and took in the total gamut of the integrative approach to medicine. What simultaneously appealed to me, startled me, and irritated me was that what I was hearing was based on clear and obvious citations from the peer-reviewed medical literature that Dr. Graf was always suggesting that I check, the science was good, and I had heard almost none of it before. What I had heard from my colleagues about these subjects had been consistently negative and dismissive. One of the therapists in my practice asked me about what the meeting had been like.
I reflected. (Psychodynamically attuned shrinks do that a lot.) I told him, “It’s kind of like Dickens. ‘It was the best of times; It was the worst of times.’” I went on to explain that the “best of times” had been what I had learned and the new diagnostic and therapeutic modalities that I now knew I could employ. The “worst of times” was that I recognized that I could no longer do things the same way. Not only would it be intellectually lazy of me to ignore the advances in the medical literature and up to date clinical practice, but it would unethical and immoral as well.
My serendipitous education continued. I began doing a lot of clinical testing through Immunolaboratories in Ft. Lauderdale, FL, as well as Great Smokies Diagnostic Labs, their daughter company, Genovations, and Metametrix Labs. The data that I obtained from my “hard to treat” cases was astonishing, and has literally meant the difference in some of my patients between being considered permanently mentally disabled versus simply being slightly delayed due to their biological abnormalities – which have since been corrected.
Interestingly, one of the sessions that I attended in Ft. Lauderdale at the Institute of Functional Medicine Conference had been a presentation by Dr. Alan Mintz, the CEO and Medical Director of Cenegenics Medical Institute in Las Vegas. I hadn’t really realized that Dr. Mintz would be presenting there, and I had a “ticket” to another breakout session. (What I discovered was that this was the same Dr. Mintz who had been e-mailing me for several months after I had visited the Cenegenics web site.) I remember standing outside the door to his session, looking for someone to swap my ticket with, because without the appropriate ticket, I wouldn’t be able to get into his session! Fortunately, I was successful, and another life-changing educational incident occurred.
The, program which Dr. Mintz presented, included a retrospective study of a large number of patients who had been treated with the Cenegenics age management protocol, including hormonal optimization using (as appropriate) testosterone, estrogen, progesterone, DHEA, and aggressive vitamin supplementation. Other things, which were being used included the pro-active addition of Indole-3-carbanole, which is proven, scientifically and in the literature, to inhibit the development of breast and other cancers. I was astonished at the success and the incredible improvement in quality of life the patients in this study experienced.
The final piece of the puzzle snapped into place for me when, about five or six months after I heard Dr. Mintz, I realized that I was cognitively and physically slipping. I had previously prided myself on a reasonably well-functioning mind and the will power to get myself out of bed in the morning to exercise. [I had done the Body for Life program before, gotten great results, and was back at it again. But I couldn’t make myself keep going. Not only was I perpetually slapping the snooze bar in the a.m. because I didn’t want to get out of bed until the last possible moment, but I recognized, one day driving through a car wash, that I hadn’t memorized the six digits on the receipt to punch in to the access device. Being a psychiatrist who does mental status exams, I realized that being unable to recall 6 digits forward was clearly abnormal. I glanced down again, made sure I stored them in my memory, and punched them in without incident, but the experience worried me.
Therefore, I made my own appointment for my own age management evaluation at Cenegenics. What I found, among other things, was that I had low levels of DHEA, which is a hormone in the blood. It’s dirt cheap, widely available in this country without a prescription (but not in Europe), and very effective. The danger is that it must be supplemented only to physiological levels, and not to excess. My Cenegenics physician – who later became my age management medicine instructor there two months later – put me on that, plus a well-balanced regimen. I also learned about low-glycemic eating, and changed my diet radically. Within two days my energy came back on line and I started to clear mentally.
Coincidentally during my evolving understanding of age management issues, I had the privilege of having a naturopath, Dr. Whitney Gabhart, working in my office in Evansville for a period of time. From Dr. Gabhart, I learned that most patients who had their thyroid declared “normal” by their primary physicians could still have much mischief going on. I learned far more about intestinal dysbiosis, autoimmune thyroiditis, and chronic fatigue syndrome. I also had the opportunity to see patients who Dr. Gabhart was treating get radically and dramatically better. The ironic thing for me, as a classic trained, Western-trained “M.D.” is that I was watching a health care practitioner who could not even be licensed independently get people well and do things that nobody in town could do to help them. When I see people getting results like that, I sit up and start taking notes.
In the two years prior to opening the Wellness Institute, I began to gradually dip my toes in the increasingly inviting waters of an integrated, holistic, and functional approach to medicine. I carefully read the peer-reviewed medical literature, and became aware of the pejorative and dismissive way that conventional medical practitioners reject what is, in reality, mainstream medicine.
Let me explain that. Mainstream medicine is that, which, in my opinion, is published in the peer reviewed medical literature. If things are published in the Journal of the American Medical Association, the New England Journal of Medicine, the Mayo Clinic Proceedings, and other prestigious journals, that means that these papers have passed muster with editorial reviewers. Too often “mainstream medicine” reflects “what I learned in medical school a decade ago and, by the way, I haven’t bothered to check the peer-reviewed literature lately.”
Considering that people’s lives and health are at stake, that sort of “laissez-faire” intellectual investment does not sit well with me. On almost any exploratory trip through the literature, I find new references and new insights that can assist me in my work with others. I now consider the world’s medical literature my own intellectual playground, and I love roving through it to find things to help my patients.
Here are several things that are done at Cady Wellness Institute which are not widely known about, discussed, or practiced in conventional medical practices, and yet are solidly supported in the scientific literature:
- Complete thyroid evaluations to rule out sub-syndromal hypothyroidism
- Review of essential fatty acids, when indicated, to quantitate current levels and assess for the need for supplementation
- Testing for delayed sensitivity food reactions – something which is clearly relevant and valid, but which is a relatively new “theme” in the medical literature over the last ten years – so hardly anyone knows about it
- Stool exams and antibody assessments for the possibility of intestinal dysbiosis (something that many people end up with because of a lifetime of use of conventional antibiotics without re-feeding the gut with the “friendly bacteria” needed to keep things in balance)
- Testing for levels of vitamins and nutrients called a “functional intracellular analysis.” This is a test which gives a rational and precise readout on what the levels of vitamins are actually like inside your cells.
In terms of working with my colleagues, I believe that a collaborative approach is best. We have on staff a talented acupuncturist, therapists, and an ADHD coach. In the future, we will be adding other health professionals.
In house, we have two testing modalities that are not widely available elsewhere. One is an inspired gas analysis machine that will measure how many calories your body is burning on a daily basis. This value is useful in monitoring response to exercise and weight training, as well as simply looking at what the levels are that you can’t exceed if you want to lose or maintain weight.
Another program we have is a computerized neuropsychological testing program that is useful for getting a “baseline” on your brain, and then measuring cognitive changes over time. We can also measure improvements in brain function after the institution of supplementation, prescription medications, and/or hormone replacement strategies.
And, at its fundamental core, it all goes back to that Zig Ziglar quote I read so many years ago: “You can have anything you want in life if you just help enough other people get what they want.”
What I have wanted in life is to be able to practice medicine the way it should be practiced, with only the needs of the patient (not insurance companies) at the core of the physician-patient dynamic. I want to be able to order the tests I need to figure out what’s going on with patients and to aim at getting them well. In large measure, that is the way my practice has gone.
My patients want to get better. And they have. MANY of them have. And so, the “Ziglar dynamic” is alive and well at Cady Wellness Institute
At times, I confess, I tend to brood a bit about how different this practice seems from most others I am familiar with. I am aware that anytime somebody “steps out of line” or goes out on the bleeding edge of practice in any endeavor, there is criticism. I have seen this with my friend and colleague, Daniel Amen, MD. Dr. Amen has published multiple books, authored many scientific papers published in prestigious journals, and still is deliberately misquoted by supposedly informed physicians who have their own particular axe to grind.
Two of my mentors, John Assaraf and Murray Smith, pointed out to me that as long as what I am doing and the Cady Wellness Institute is doing is moral and ethical, as long as we are charging a fair amount for the services delivered, and as long as what we are doing brings about positive changes for society, I have nothing to worry about. So I’ve decided to stop worrying about “what other people will think” and, instead, to follow my passions… as well as the clear direction of the medical literature, unknown to many of my colleagues, the media, and the general public.
It is our pleasure, at the Cady Wellness Institute, to serve our patients and our clients. We look forward to the possibility of being of assistance to you – either personally, in our Newburgh, Indiana location, or by the extended reach of this web site and public health education initiatives that we will be conducting using modern technology to spread the information.
Thank you for dropping by, getting acquainted, and reading the story of the development of the Cady Wellness Institute.
Louis B. Cady, M.D.