The diagnostic process is one of collecting disparate data points, pattern recognition, and organizing the various elements into a meaningful hypothesis.
- The process begins with comprehensive listening. Your story, the evolution of your symptoms, your diet, environment, family history, and more, all are taken in to account. This is traditional Western medicine which has been forsaken by assembly-line medicine. William Osler, broadly considered to be the father of modern Western medicine said famously, “Listen to your patient. He’s telling you the diagnosis.”ehensive listening.
- Nutrition and diet: Your dietary patterns will be reviewed in detail. Health recovery and health maintenance must address diet. Dr. Cooke is familiar with practically all the schools of thought on diet and will do her best to steer you toward a diet prescription appropriate to your metabolic type and health goals. She holds by the old Hippocratic teaching, “Let thy food be thy medicine.”
- Environmental exposures: Your memory will be jogged by the environmental intake form. Many people are the extent to which environmental factors.
Virtual visits in the comfort of your home, office, or hotel are easily scheduled. Many people are welcoming the convenience that remote visits offer. Whether for a brief assessment of an acute issue, longer follow up visits, or even a new patient appointment, please notify the office if this is your preference.
While history is as much as 90% of the diagnosis, a comprehensive physical examination is an important complement to form a whole picture of your health profile. The doctor typically spends 90% of the initial appointment on history taking, and begins the first follow up appointment with the complete physical. As a clinical preceptor in physical diagnosis to medical students at the Columbia division of NY-Presbyterian Hospital for 22 years, Dr. Cooke has constantly honed her skills in physical examination.
Every single analyte on the standard lab reports is meaningful if you look at it within broad context. Beyond looking at reference ranges on the side of the report, representing the 95% confidence interval, one must consider optimal ranges. Dr. Cooke owes a debt of gratitude to Nicholas Abrishamian, PhD, biochemist, with whom she reviewed lab reports of dozens of patients over the course of months in 2002-2003. With a strong foundation in nutritional biochemistry, Dr. Abrishamian generously imparted many of his insights into laboratory interpretation.
Heart rate variability
Heart rate variability (HRV): Originally developed for the study of arrhythmias and syncope, members of the holistic medical community seized upon HRV more than 2 decades ago as a measure of autonomic nervous system resilience. Even an ostensibly regular heart rate and rhythm, when parsed down to milliseconds, reveals a beat to beat variability in optimal states of health and this is a good thing. As we age, all systems grow progressively fixed, rigid, and this is also reflected in the electrical conduction system of the heart. The HRV is a useful benchmark to follow as subjective improvements develop. We must look for objective correlates of subjective states in illness and health.
EKG/resting electrocardiography: This is available through the office and may be indicated depending upon your symptoms and risk factors.
Integrative Functional Medicine: Integrative Functional Medicine is a therapeutic approach toward health, wellness and prevention which emphasizes health of the whole person. It does this through consideration of:
- genetic and lifestyle factors
- avoidance and elimination or remediation of irritant factors such as allergens, environmental toxins, heavy metals, stress factors
- restoration of normal digestive ecology through diet and nutraceutical support.
This orientation to medical diagnostics and therapeutics has become the cornerstone of today’s integrative and complementary physicians.
The tools of functional medicine include:
- a thoughtful consideration to the patient’s story complemented by physical examination
- the dietary history and optimization of nutrition through dietary modification and herbal or nutritional supplements where indicated
- dietary and detoxification strategies toward rebalancing the digestive tract
- stress reduction
These approaches do not exclude ongoing traditional medical approaches.
Ondamed Pulsed Electromagnetic Field Therapy (PEMF) by biofeedback: ONDAMED is a biofeedback device that a practitioner uses to determine which frequencies of sound, as well as the accompanying weak pulsed electromagnetic fields, cause a response in a patient’s autonomic nervous system. Temporary stimulation by these frequencies, combined with the patient’s cognitive and non-cognitive participation, promotes relaxation, muscle re-education, and rehabilitation that returns the body to its former state of wellness. You can learn more about Ondamed PEMF and its broad application at this website: https://ondamed.net/us/
Alpha-stim Micro-current stimulation: Sixty percent of patients that come to a general practice office complain of some form of bodily pain. Transcutaneous electrical nerve stimulation or (TENS) devices currently in use are employed chiefly in physical medicine/rehabilitation and physical therapy practices for musculoskeletal disorders.
The Alpha-Stim TENS unit, designed by Daniel Kirsch, PhD, in 1981, has been used by Dr. Cooke in her practice since 1999. While there are many microcurrent devices on the market, few have won the hearts and minds of physicians or have conformed to such an extensive body of peer-reviewed research as the Alpha-Stim. It has proven itself useful in the adjunctive treatment of insomnia, depression, anxiety, and pain disorders. It is in fact the only TENS device cleared by the FDA for all 4 of these indications. Under the guidance of Daniel Kirsch, PhD, founding president of Electromedical Products, International, the Alpha-Stim has gained a steadily increasing reputation for stellar performance.
We use the body’s electrical microcurrents diagnostically in conventional medicine through the use of devices such as EKG (electrocardiogram), EEG (electroencephalogram), EMG (electromyogram) and others, to read the electrical field activity of the heart, the brain, the muscles, or other. When there is disease, injury or inflammation, there is typically a disturbance of the normal electrical field of the surrounding tissue. The Alpha-stim microcurrent technology acts through helping to restore electrical equilibrium to the tissue, thus speeding the healing response.
Low Dose Naltrexone: Low dose naltrexone has won increased support for its adjunctive use in a wide array diseases, something which Dr. Cooke brought to her practice in 1999. Naltrexone, an opiate receptor blocker, was first marketed to treat opiate overdose and later found application in the treatment of depression and alcoholism at a 25 to 50 mg dosage. It was later discovered that taken in fractional dosage of 3 to 4.5 mg, in the absence of opiate intake, it had the effect of boosting levels of the naturally occurring opiate-like chemicals in the brain, chiefly beta-endorphin and meta-enkephalin. These neurochemicals, released into circulation, have an anti-inflammatory action and also boost natural killer (NK) cell activity; that is, the NK cells comprise roughly 5% of the white blood cells in circulation which scavenge for virus and defective cellular material, possibly nascent cancer cells.
Given this mechanism of action, it was found that naltrexone could significantly aid people with a variety of diseases such as autoimmune illnesses, multiple sclerosis, some chronic viral infections, and even some cancers. While a number of collateral benefits of naltrexone have been documented, there are certain precautions of usage to which the patient must be alerted.
Bernard Bihari, MD, was one of the early clinical research pioneers in the broad application of low dose naltrexone. Dr. Cooke had the privilege of sitting with him in his office on two occasions and consulting with him many times by telephone, asking lots of questions, sharing clinical observations, in those early years of using LDN. His generosity of spirit is fondly remembered.
3rd LDN Conference Doctor Interviews: YouTube Video
Acupuncture was introduced in the 18th century when French and Jesuit missionaries returned to France from Indochina, bringing with them ancient texts to translate and study. The first schools of medical acupuncture were established by physicians in France where acupuncture has enjoyed continuous study and practice within the French medical community for over 150 years. That tradition was brought to the United States by Joseph Helms, MD, a Johns Hopkins and UCLA-schooled physician, who took the full 4 year training within the French acupuncture school.
The vast majority of physicians practicing acupuncture in this country began their study of acupuncture with Joseph Helms, MD, who inaugurated Medical Acupuncture for Physicians in 1980. The original course was accredited through his UCLA, then Stamford, and most recently through Helms Medical Institute, accredited by the ACCME. Medical Acupuncture for Physicians lays a broad foundation for its practitioners spanning the spectrum of acupuncture paradigms, ranging from French energetics to Five Elements to Traditional Chinese Medicine. In addition, it includes more neuro-anatomically-based interpretations such as Craig PENS (percutaneous electrical nerve stimulation) and myofascial trigger point technique. Adding to their medical background in anatomy, biochemistry, physiology and pathophysiology, physician acupuncturists continue to make an important contribution on both research and clinical fronts, deepening our contemporary understanding of acupuncture’s effects.
The American Academy of Medical Acupuncture, represents the vast majority of physician acupuncturists in the US today. It convenes an annual symposium, publishes a peer-reviewed and indexed journal, and lobbies for increased recognition of medical acupuncture within the hierarchy of traditional allopathic medicine.
Dr. Cooke initiated her study of acupuncture through the Medical Acupuncture for Physicians program in 1995. She has participated in numerous continuing education seminars towards deepening her acupuncture knowledge and skills since that time. As new scientific evidence emerges to support the age-old notion that we are much larger than the bodies we inhabit, the role for acupuncture in the evolving modern paradigm gains ground.
Dr. Cooke first brought hypnotherapy to the practice in 2001, originally for smoking cessation, in combination with ear acupuncture. It was so successful for a number of people, that requests came in for hypnosis for other issues. It is something Dr. Cooke enjoys doing very much. Dr. Cooke developed an induction method, a composite of various techniques to which she had been exposed through yoga nidra, meditation, through early acting classes, as well as her hypnosis training, which has been quite successful in putting people in an optimally relaxed and suggestible state. The patient is asked to tape the hypnosis as it is ongoing on their smartphone so it can be replayed as recommended. It can be a useful technique for working through subconscious blocks that stand in the way of living in to your health goals.
IIV nutrient therapy has become part of the stock-in-trade of many complementary medical practices over the past 40 years. This is not administered “on demand” as is common on the street in many urban centers today. The appropriateness of IV therapy is assessed in each person’s case. The more common therapies available in Dr. Cooke’s office include multivitamin drips, IV vitamin C, IV glutathione, IV phosphatidylcholine, to name a few. Indications may vary widely. The overarching goals of these therapies are to support microcapillary circulation, to assist detoxification processes in the liver more intensively, and to boost energy. These seldom provide a permanent solution to a given illness, but can give an important leg up on the situation. Dr. Cooke is judicious in their use.
Travel medicine is the preparation of travelers for health maintenance and disease prevention for foreign or wilderness travel. Conventionally, it is thought of chiefly as the application of vaccines indicated for travel to specific regions of the globe, such as Yellow Fever vaccine or other travel vaccines, and “packaging” of remedies (antibiotics, antimalarials, antidiarrheals, etc.) for possible health care challenges during travel.
Dr. Cooke will provide conventional travel services, as well as integrative preventive strategies to minimize your disease risk during travel. Whether doing UN relief work in high risk zones, or trekking in the Himalaya, many of her patients have attested to the benefits they achieved from following her simple instructions. One UN worker reported that she was the only one in her group who didn’t get sick during 6 months in Kosovo. Another fellow was the only one to escape illness during several weeks trekking in Nepal.
Remote audio and video consultation by telemedicine is now possible for first time patients during the pandemic, as well as for follow up appointments for established patients. Going forward into the future, the doctor intends to expand the offering of remote services.
Clinical advocacy and individualized research
If you or your family member has a challenging health issue, looking for fresh eyes on the case, and assistance in putting together the pieces of the puzzle, negotiating the maze of the health system remotely, Dr. Cooke can help in this regard and has done so for several people over the years. This service is not reimbursable by insurance and is subject to a separate fee structure.