Conditions Treated

A thorough history and a careful and detailed physical examination are of primary importance in the evaluation of abdominal pain, with well selected diagnostic tests to complement these. As with chest pain, or headache or shortness of breath, the patient’s story is primary, physical examination secondary, with clinical testing providing the factual data. Each aspect of the examination is equally vital.

Dr. Cooke still has her well-worn copy of one of the cornerstone medical texts on the evaluation of abdominal pain, “Cope’s Diagnosis of the Acute Abdomen”. Years spent in the emergency room helped to hone her diagnostic acumen. Abdominal pain presents a particularly broad differential diagnosis due to causes ranging from the benign to the sublime to the catastrophic.

From time to time, Dr. Cooke receives patients who come with an expectation that only alternative therapy will be offered. One woman came several years ago, not having seen a physician in many years, with a complaint of several days of abdominal pain. Within 20 minutes of questioning, Dr. Cooke was quite certain that her symptoms suggested appendicitis, although her physical exam was in no way typical for appendicitis. Delicately, she expressed her suspicion to the patient and the patient’s husband. She contacted the emergency room, transmitted her assessment, and gave recommendations for further evaluation. The lack of physical findings postponed diagnosis in the ER. Fortunately, by the time the patient’s exam evolved, the surgeons were able to remove the diseased appendix. That patient, now the proud owner of a Bikram yoga center in Minnesota with her husband, still maintains contact with Dr. Cooke.

Sometimes the doctor’s most challenging task is to convince a patient or their family of the value of conventional diagnostic or therapeutic procedures. Dr. Cooke strives for a balanced approach, bridging the interface between the conventional and the complementary.

Non-scarring alopecia is a type of hair loss without permanent destruction of the hair follicle. This may result from hormonal factors, chemical exposures, infectious causes, autoimmune conditions, hereditary factors, and nutritional factors.

There are 3 phases in the life of the hair follicle: growth, involution and resting phase. Under normal circumstances, about 75 hairs are shed daily at the end of the resting phase as about the same number enter the growth phase. Telogen effluvium, a massive loss of hairs in the resting phase, is the most common cause of diffuse hair loss. High fever, pregnancy, psychological traumas, thyroid disorders, or a major illness, among others, may all predispose to diffuse hair loss.

Nonscarring alopecia is typically diagnosed by scalp biopsy and laboratory review and treated by withdrawal of offending agents, reassurance with “tincture of time”, and sometimes medication. Dr Cooke takes conventional modes of diagnosis and treatment into account. She reviews the nutritional profile in depth, with examination of the multiple nutritional and hormonal factors such as hidden thyroid disorder and sex hormones which may influence hair loss. Nutrition and dietary supplementation, hormonal management, and acupuncture for stress reduction, may all play a part in the treatment plan. She has helped a number of women on their return to hair regrowth.

Nutrients which may play a part: Biotin, zinc, iron, protein content and assimilation in the diet, sea vegetables, and others.

Arthritis is a term which simply denotes joint inflammation. The causes may be many, from autoimmune processes (e.g., rheumatoid arthritis), to degenerative bone disease (osteoarthritis), to metabolic causes (such as gouty arthritis). Its symptoms may range from aches and pains to debilitating immobility.

Conventionally, arthritis is treated with any of a range of medications, both over-the-counter and prescription. Physical therapy, glucosamine-chondroitin supplements and even injectables and surgery are among the options in therapy today. All of these have there place.

In addition to the complete history and physical examination, Dr. Cooke reviews the diet history carefully for pro-inflammatory elements. A trial of dietary simplification alone has helped many patients reduce pain and regain mobility. One gentleman in his late 60s regained his hand grip with one month of dietary modification. Other supplements and foods can be used to aid elimination of toxins and reduction of inflammation. Fish oils and cherry concentrate have gone a long way toward helping others. Here, too, acupuncture is a boon for arthritis sufferers.

Broadly speaking, autoimmune disease is a situation in which the body fails to distinguish between “self” and “other”, and as such, makes antibodies against its own cells and tissues. These diseases span a gamut of organ systems, ranging from autoimmune disorders of the connective tissues (e.g., rheumatoid arthritis and systemic lupus erythematosus), to those affecting the gut (celiac disease, ulcerative colitis, Crohn’s colitis), the endocrine system (Type1 diabetes mellitus,
Hashimoto’s thyroiditis, Addison’s disease of the adrenals), the skin, the blood, and more.

Conventionally, treatment is aimed at either immunosuppression (e.g., methotrexate in rheumatoid arthritis), anti-inflammation (corticosteroids or nonsteroidal anti-inflammatories) or simply to reduce symptoms – palliation. In other instances, replacement therapy is the key (eg. insulin replacement in type 1 diabetes).

Dietary review and assessment of gut function is primary in Dr. Cooke’s assessment of autoimmune disease. An elimination diet is introduced and the patient is monitored. Also, stress reduction techniques tailored to the patient’s needs are helpful here. The approaches espoused by functional medicine (detoxify, restore, rebalance) are utilized by Dr. Cooke through the use of diet
and nutraceuticals.

As we are compelled to adapt continually to new technologies, changing lifestyles, changes in the environment, not to mention information overload, and as more seniors are postponing retirement, many are seeking creative ways to optimize and preserve optimal brain function and general vitality.

Conventional medicine recognizes the importance of the basics: diet, exercise, avoidance of cigarettes and drugs which compromise circulation, to name a few. However, in the modern world, preventive and therapeutic strategies for maintaining and even improving cognitive function,
emotional health and physical well-begin are in great demand.

The research evidence is mounting in support of the notion that we are much larger than the body we inhabit and that the mind and emotions reach beyond the brain. From Proverbs, “A merry heart doeth good like a medicine.” From Carolyn Myss, “Your biography becomes your biology.” Dr. Cooke brings a sound knowledge of physiology and nutrition as well as a rich background in mind-body techniques, hypnosis and medical acupuncture to the mix. She wants you to enjoy the same growth, vitality and joy which she seeks on her journey.

Cancer is a term broadly applied to describe the uncontrolled proliferation of a particular cell type which may manifest as a localized tumor or, by means of spread through the blood vessels or the lymphatic vessels, as an invasive and disseminated disease. These cancer cells compete with the body’s healthy cells for nutrition and, if unchecked, at their extreme, will overtake the body’s vital processes such that the healthy part of the body perishes.

Surgery, chemotherapy, radiation, and newer immune therapies are the mainstay of current cancer treatment. Many people fear the ravages of treatment to the same degree that they fear the disease.

Dr. Cooke has helped support a number of patients during their treatment. She will insist on communication with the oncologist in so doing. Simple nutritional interventions can go a long way toward mitigating the adverse effects of chemotherapy and radiation treatment. Also, acupuncture is a helpful adjunct to the treatment of nausea and dry mouth resulting from chemotherapy and radiation.

Constipation is the most common digestive disorder in the general population in the US. It is said that in countries where the squat-toilet predominates, it is practically an unknown.
It is traditionally treated through the use of bulking agents in the diet, increased fluid intake, laxatives, stool-softeners, behavioral modification, among others.
Careful review of diet, exercise, environmental factors, and stress factors often reveals the key to the cure for this problem. Dr. Cooke has helped many of her patients achieve a normalization of bowel function with conservative interventions. Although acupuncture may be a helpful adjunct here, too, instructing the patient in the self-Application of acupressure often yields rewarding results.

In the digestive tract, food is processed and prepared for absorption, assimilation, and elimination. The small intestine, measuring about 23 ft in length, is the primary site where nutrient absorption takes place. Add this to the large intestine which is about 4 ft in length, it is no wonder that so many adults suffer one form or another of digestive complaint.

Medications of various classes are the mainstay of traditional medical therapy for digestive disorders, with an increasing appreciation for the value of behavioral and dietary modification.

Dr. Cooke has helped many of her patients recover normal digestive function after months and even years of upset. A meticulous history of the problem, its origins and accompaniments, is essential. Then dietary modification, nutritional supplements, and possibly medications are employed. Acupuncture has proven to be helpful to a variety of digestive disorders.

Dysmenorrhea, or painful menses, is one of the most common complaints among reproductive age women. Primary dysmenorrhea refers to crampy, recurrent, menstrual pain in the absence of demonstrable pelvic disease, such as endometriosis, uterine fibroids, pelvic inflammatory disease, or adenomyosis. The latter comprise some of the causes of secondary dysmenorrhea.

Treatment: Primary dysmenorrhea is conventionally treated through the use of nonsteroidal anti-inflammatory medications and sometimes hormonal preparations. Increasingly, nutritional supplements such as fish oil, vitamin B1, B6, and vitamin E, are finding common currency in the therapeutic stock-in-trade, as well as heat applications.

Dr. Cooke has had great success in treating women with simple nutritional modification. Acupuncture has also been demonstrated to help many women to eliminate their painful cramps.

Bibilography:
Title: Factors predisposing women to chronic pelvic pain: systematic review.
Author: Latthe P; Mignini L; Gray R; Hills R; Khan K
Source: BMJ. 2006 Apr 1;332(7544):749-55. Epub 2006 Feb 16.

Title: Acupuncture in patients with dysmenorrhea: a randomized study on clinical
effectiveness and cost-effectiveness in usual care.
Author: Witt CM; Reinhold T; Brinkhaus B; Roll S; Jena S; Willich SN
Source: Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8

Title: Acupuncture for the management of primary dysmenorrhea.
Author: Helms JM
Source: Obstet Gynecol 1987 Jan;69(1):51-6.

By current estimates, up to 33% of people seeking attention in primary care clinics report significant fatigue. The doctor must distinguish between recent fatigue, prolonged fatigue (greater than one month duration), chronic fatigue (greater than six months duration), and chronic fatigue syndrome, the latter two not necessarily being the same.

The possible causes for fatigue run the gamut of the differential diagnosis, whether infectious, immune or autoimmune, nutritional, endocrine, or medication-related causes. The detailed history of the fatigue, its context, accompaniments, pattern over time, is critical to unlocking the mystery.

In addition to a careful history, physical examination, and lab tests, more detailed nutritional
assessment and environmental considerations may offer clues, along with specialized lab
evaluation and special studies. The therapy is determined by the cause. However, nutritional
optimization, graded exercise and energetic exercises, tonic herbs, and acupuncture may all play
a part in your return to vitality.

A painful disorder of the soft tissues, fibromyalgia is the most common cause of generalized musculoskeletal pain in US women between the ages of 20 and 55 years. Its clinical diagnosis is based chiefly on history and physical examination, with a typical symptom complex of fatigue,
headaches, sleep disorder, and mood disturbance.

Systemic disorders such a Lyme disease and hypothyroidism may be associated, but it must be stressed that no one illness is ever pin-pointed as the cause of fibromyalgia. It often overlaps with other autoimmune or connective tissue disorders.

While no highly effective therapy has been documented in either the conventional or complementary literature, a number of complementary interventions may prove helpful. Acupuncture, AlphaStim microcurrent stimulation, nutritional interventions, gut rebalancing, among others, have demonstrated efficacy.

An estimated 60 million Americans are affected by hypertension. Blood Pressure readings regularly above 140/90 mm Hg, is categorized as hypertension. The term essential hypertension means hypertension due to no apparent cause, not secondary to another disease process. Untreated hypertension is a major contributing factor to heart disease, stroke, and to disease of the microvascular circulation of the kidneys and retina which can lead to renal insufficiency and blindness.

Hypertension is the leading indication for prescription drug use in the US. And medication continues to be the mainstay of treatment.

While Dr. Cooke endorses the use of medication in the treatment of hypertension, she also maximizes the use of other strategies to minimize drug therapy while striving for the conventional benchmarks of blood pressure control. Weight reduction, relaxation techniques, addressing sleep disorders, engaging diaphragmatic breathing exercises, investigation of red blood cell magnesium levels, may all play a part. A small number of nutraceuticals and botanicals may contribute to blood pressure lowering. Acupuncture is especially helpful in addressing tension states which may aggravate high blood pressure.

Female infertility is increasingly commonplace with complex medical, psychosocial and economic aspects. The World Health Organization (WHO) classifies ovulatory failure into 3 groups. The largest of these, comprising 70 to 85% of infertile women of reproductive age, secrete normal amounts of gonadotropins (reproductive pituitary hormones) and estrogens. However, FSH levels during the follicular phase of the cycle (typically, the first 14 days) is low. Some of these women ovulate occasionally or sparsely. Another 10 to 30% are classified as having ovarian failure.

Enormous gains have been made in the field of Assisted Reproductive Technologies. In addition to the use of hormonally active agents, and surgical strategies, new possibilities have opened up in the realm of egg-donation, and more.

While the tools of Assisted Reproductive Technology used by infertility specialists have been very successful, a back-to-basics approach used by Dr. Cooke has helped many of her patients on their path to motherhood. Review of diet, blood sugar balancing, stress factors, assessment for subclinical hypothyroidism, as well as acupuncture, have proven very rewarding.

Approximately 35% of Americans suffer some form of insomnia during the course of the year. Sleep disorder is one of the most common complaints presenting to primary care physicians. Insomnia is characterized by difficulty in getting to sleep, staying asleep or waking up to early. It may also be a function of sleep which is of poor quality and chronically non-restorative.

Conventional treatment incorporates both behavioral approaches, sleep hygiene, and medication.

One school of thought defended by some researchers is that a chronic sleep deprivation requires 6 weeks of consistent, restorative sleep for recovery. Dr. Cooke has had many successes with sleep disorder through combination of conventional and complementary approaches. Acupuncture, Alpha-Stim microcurrent stimulation, dietary modification, nocturnal continuous positive airway pressure (CPAP) when indicated by overnight sleep study, among other modalities, have helped many of her patients regain restorative sleep.

Irritable bowel syndrome is a disorder characterized by unexplained, irregular or altered bowel habits and recurrent abdominal pain. While the jury is still out on its definitive causes, some people with IBS have evidence of microscopic inflammation, chronic infection, abnormal bacterial balance in the colon, or stress factors which aggravate their condition.

Conventionally, IBS is treated through the use of dietary bulking agents and medically with medications such as spasmolytics, and sometimes antidepressants.

Dr. Cooke reviews your history with respect to onset of the IBS symptoms, its recurrence pattern over time, and reviews your diet. She has sometimes identified chronic infections which, when treated, significantly lessened and even resolved IBS symptoms. Breathing exercises and relaxation techniques, as well as acupuncture, have all helped at various times to manage the stress component of this condition.

Lyme is a bacterial illness typically transmitted by certain tick species. Its classical symptoms include fever, headache, fatigue and a “bull’s eye” rash. However, fewer than 50% of people with Lyme disease recall either a tick bite or a rash. Its affects range from trivial to severe depending upon early diagnosis, the patient’s general health, (i.e., elderly, immunosuppressed, etc.), and the possible presence of other infections. Occasionally, those afflicted with Lyme disease are also infected by other tick-borne infections such as Human Anaplasmosis (aka Human Granulocytic Ehrlichiosis; Human Monocytic Ehrlichiosis, Babesia , Bartonella, and possibly Mycoplasma fermentans.

The diagnosis is based chiefly on clinical history and examination, aided by lab studies. The traditional medical approach usually recommends several weeks’ antibiotic treatment.

Dr. Cooke, having completed a mini-fellowship sponsored by the ‘Turn the Corner foundation’ (www.turnthecorner.org) in collaboration with the ILADS group (www.ilads.org), has deepened her working knowledge of Lyme and related diseases. Antibiotic therapy is the mainstay of Dr. Cooke’s treatment for those infected with Lyme disease. Judicious use of probiotics, antioxidants, and nutritional strategies, can ease the side effects of antibiotic therapy. Referral to Lyme-literate practitioners, whether for second-opinion, psychiatry, or neuropsychological testing, is available for added patient support and assurance.

Men are minority consumers in the general medical outpatient setting. By most estimates, women represent 60 to75% of outpatient consumers in the US. We will leave the reasons for this to the sociologists.

Whether it’s a decrease in energy, or systems running down, running aground, or sleep just not what it used to be, or body aches, etc, it is Dr.Cooke’s pleasure to work with her male clients. She sees a number of engineers, artists, academics, business professionals, and others, among her male clients.

During her clinical years at Tulane Medical School, she enjoyed her rotations in neurology, general medicine, and urology at the Veterans Administration Hospital of New Orleans. This experience, along with growing up on a farm, extensive travel, and a general appreciation for variety as the spice of life have helped her to develop an ease of approach to men and women alike.

Formally defined by the cessation of menstrual periods, menopause represents the typical loss of estrogen-producing ovarian follicles. While the average age of menopause is 51.4 years, it may start at age 40 for 5% of women, and after 55 years for another 5% of women. The menopausal transition begins with varying menstrual cycle length experienced in perimenopause, to skipped periods, to complete menopause with one year from last period.

Hot flashes, nightsweats, sleep disturbance, mood swings, joint pains, vaginal dryness, diminished libido, and impaired balance are just some of the symptoms which may develop with the menopause. Antidepressants and hormonal preparations are the mainstay of conventional therapy for the alleviation of symptoms.

Dr. Cooke takes each woman’s given menopausal symptoms and particular concerns into account in designing a menopausal support regime. Bio-identical hormone therapy is often recommended but only after a complete due-diligence of potential pitfalls or contraindications. Herbal formulae, detoxifying diet strategies, Alpha-Stim microcurrent, supplements and acupuncture have all proven valuable at various times to her menopausal patients.

Mid-line weight gain accompanied by insulin-resistance tied to rising blood sugar, elevated blood lipids, high blood pressure, associated with vascular inflammation and atherosclerotic coronary vascular disease, represent the growing epidemic of Metabolic Syndrome.

Weight reduction, diet, exercise, and medication for lowering of blood sugar, cholesterol, blood pressure, and prevention of heart attack comprise the conventional approach to treating metabolic syndrome.

Dr. Cooke uses these approaches while maximizing the role of diet and nutritional supplementation in the task. Aiming for clear clinical and laboratory benchmarks with the doctor’s support will aid you on your path to well-being.

Bibilography:
Title: The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians.
Author: Manson JE; Skerrett PJ; Greenland P; VanItallie TB
Source: Arch Intern Med 2004 Feb 9;164(3):249-58.

Title: The metabolic syndrome.
Author: Eckel RH; Grundy SM; Zimmet PZ
Source: Lancet 2005 Apr;365(9468):1415-28.

Migraine headaches affect millions of Americans annually. They are often experienced as a debilitating, recurring headache which may last from minutes to hours to days at a time. They typically are felt on one side of the head, frequently accompanied by nausea, light-sensitivity, sound-sensitivity, and even feelings of faintness.

Traditionally, migraine headaches are treated through the use of daily medication or as-needed medication, or a combination of both.

Dr. Cooke begins by thoroughly reviewing the possible triggers to migraine, including foods and additives, environmental factors, and hormonal influences. She will outline a treatment plan which may include acupuncture, dietary and hormonal approaches, or vision therapy, as a complement to standard medical therapy. The vast majority of her patients who walk in with a headache, walk out headache-free for that session.

Sometimes, a headache may be a sign of a more serious condition. A headache which awakens you during sleep, or one which is new and different or worse than any other in the past, or associated with fever, or following a blow to the head, ear pain, eye pain, or confusion, for example, may require immediate evaluation through your local doctor or the nearest ER.

Nutrients which may help: feverfew, a medicinal herb from the sunflower family used frequently throughout Europe for headaches, magnesium, or hormone replacement therapy in menopause.

Interventions: Sleep study to rule out sleep apnea or other related conditions.

Parasites were little known to average Americans and little spoken of until recent years. However, as we have become increasingly globalized, a new spectrum of organisms have found their way to our lives, dinner tables, and our homes. Giardia and amoeba were the 2 parasitic organisms most commonly encountered, though infrequently, in the US.

Testing for parasites is done typically through blood and stool specimens. However, testing methods are notoriously inaccurate. Subtle elements of the medical history and of conventional lab studies may provide tip-offs of parasitic infection.

Dr. Cooke utilizes conventional diagnostics and also uses specialty laboratories. However, once again, it must be stressed that the history is the most critical element leading to the diagnosis. A skillful application of antibiotics and probiotics, botanical remedies, and dietary modification will typically bring the patient to a cure. One young lady had suffered for over 10 years with a periodic diarrhea following foreign travel. She had seen numerous specialists over the years who dismissed her as having irritable bowel. However, the history revealed two critical elements: a regular periodicity to her bouts of diarrhea; and nocturnal awakening with the need to defecate. Both of these features are virtually ringers for parasitic infection. Following 2 short courses of antibiotics with probiotic support she was permanently rid of her bouts of diarrhea for over 3 years until the time of this writing.

Rashes may develop in response to contact allergies, systemic allergies, or to infections (bacterial, fungal, viral or parasitic) or autoimmune causes, among others.

The old joke about rashes is “if it’s wet, dry it; if it’s dry, wet it; if they’re on steroids, take them off; if they’re not on steroids, put them on.” Conventional treatment reaches far beyond these both diagnostically and therapeutically, with stunning successes. However, there are always those who either don’t respond to conventional interventions, or for whatever reason, reject conventional intervention. Dr. Cooke has worked with a number of patients in this category.

While she may suggest some conventional interventions, she has also achieved good results in some cases with complementary therapies. The skin reflects all the internal organs. It has been referred to as the “third lung.” It is intimately tied to the health of the liver and large intestine. Simple nutritional strategies for detoxification of the internal organs also bring benefit to the skin.

One woman in her sixties developed cold urticaria (itching) out of the blue, large welts forming on contact with cold. A detailed history and thoughtful prioritization of examinations led Dr. Cooke to suggest she see her dentist to investigate a possible pocket of infection underlying a tooth despite the lack of localized symptoms. Upon examination this is exactly what was found; the abscess was removed by her dentist, and the itching ceased. Another patient with chronic psoriasis had his best remission in years with a well known botanical preparation.

Obstructive sleep apnea is a frequently missed cause of sleep disorder in adults. It is characterized by a disturbance of the normal respiratory pattern during sleep, frequent arousals (for which the sleeper may have no recall), and unrefreshing sleep. The causes of obstructive sleep apnea may include overweight, alcohol excess, or hypothyroidism and its consequences, if untreated, range from fatigue and daytime sleepiness, to increased risk for hypertension, nocturnal angina, and cor pulmonale – a heart condition.

Diagnosis is typically made by polysomnography, an overnight sleep study, which Dr. Cooke is capable of ordering for her patients who haven’t already been tested. Commonly, treatment strategies include a program of weight reduction, treatment of hypothyroidism (see separate listing above), withdrawal of offending agents (e.g., alcohol), or the addition of a positive airway pressure device.

In addition to employing conventional diagnostic and therapeutic approaches, she examines nutritional, nutraceutical, and neurotransmitter factors. She has found acupuncture to be of help in treating some cases of sleep apnea, as cited in the research literature.

The thyroid gland and its endocrine hormones (thyroxine, triiodothyronine, and calcitonin) are the main regulators of growth, cellular metabolism, and bone formation. Perhaps no other gland is so
delicately poised at the interface of the internal and external environments. Not only is the thyroid vulnerable to disease states, diet, and stress factors, but it is also very sensitive to environmental toxins.

Subclinical hypothyroidism affects an estimated 5% of the general population and 15% of older women by conventional measures. Since every metabolically active cell depends upon thyroid hormone for normal function, the pattern of thyroid deficiency or excess can potentially manifest through any organ system.

Hypothyroid – Where thyroid under-function is concerned, common symptoms include hair loss, fatigue, weight gain, constipation, dry skin, brittle nails, and weight gain.

Hyperthyroid – Where over-function is concerned, rapid heart beat, sweats, jitteriness and anxiety, are among the more common complaints.

• Thyroid diseases of under or over-function are commonly diagnosed by conventional thyroid blood tests. The TRH-stimulation test, available to Dr. Cooke, is a helpful adjunct in detecting otherwise difficult-to-diagnose cases of hypothyroidism. And as always, history and physical examination are the platform on which diagnosis is based. However, lab testing with skillful interpretation are critical in this setting.

• If special studies such as thyroid sonogram and scanning are required, Dr. Cooke will make referral to an appropriate specialist.

• Dr. Cooke also uses the TRH stimulation test when indicated to assess for subclinical hypothyroidism.

Dr. Cooke makes use of conventional medication for treatment. However, at times, some people may be better served through the use of Armour thyroid or a similar combined T3/T4 formula for treatment of hypothyroidism. Also, dietary changes, nutritional supplements, and energetic exercises may aid the patient.

All of our bodily processes are supported in large part by the miraculous symphony of biochemical pathways which support growth, development, digestion, and all organ system function. Vitamins and minerals are of utmost importance to our health. They function chiefly as drivers of enzymatic processes in the body. Enzymes are the biologically active proteins which convert one biochemical from one form (substrate) into another form (product).

Traditional medicine looks routinely at a small number of vitamin and mineral levels. Whether you are challenged by disease, or don’t feel as well as you would like to or are simply interested in optimizing prevention, nutritional factors may be at play other than those which are commonly assessed.

Dr. Cooke uses both standard and complementary lab tests for nutritional assessment. As always, a thorough history and examination form the basis for the initial evaluation. Some common suspects which contribute to degenerative disease include suboptimal B-vitamin levels, low vitamin D, or low red blood cell Magnesium, among many others. One patient was able to significantly reduce her antihypertensive medication dose when we found that red blood cell magnesium was low and replaced her accordingly. Another experienced noticeable improvement in energy simply by boosting vitamin D.