Sustaining Health. Treating Root Causes. Functional Medicine.

Anne Sherman, MSN
Family Nurse Practitioner, ANCC Board Certified
Institute of Functional Medicine, Member

Functional Medicine


Functional Medicine is the practice of identifying and treating underlying causes of symptoms.  It also is truly preventive, because dysfunction/imbalance of systems typically occurs long before disease is evident.  Identification relies on history, physical exam, and laboratory testing.  Usually, when the following areas are functioning at their best, symptoms improve:

  • Gut Health: ability to digest, absorb and excrete food
  • Immune Function: sensitivities, allergies, and immune regulation
  • Structural Integrity: skin, bone and cardiovascular integrity
  • Biotransformation: ability to metabolize well and rid your body of toxins
  • Hormones and Communication: regulation of mind and body functions through neuro/endocrine systems
  • Energy Production: ability of each cell to produce energy to function properly
  • Genetic Predispositions: this is an emerging field. Genetic information can give us some clues to unraveling sickness and sustaining health.


Treatments fall into four categories, typically in the order listed :

  • Optimize nutrition, exercise, sleep, and stress management
  • Supplementation of existing nutrients
  • Herbal remedies
  • Pharmaceuticals (IE: prescription medications).  As a nurse practitioner, I am able to prescribe medications.


In order to find solutions that work for you, your role in this partnership includes (to the best of your ability/circumstance):

  • Being honest about what you can or cannot do.
  • Listening to your body and tell me what is happening.
  • Consuming clean food and water.
  • Keeping your environment free of chemicals/contaminants.
  • Being active.
  • Nurturing healthy relationships.


Colds and Flu

Focus is on ensuring a properly functioning immune system to prevent illness, and fight infection. I avoid antibiotics unless absolutely necessary. Supplements that have been shown to be antibacterial are offered as an option when appropriate.

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Health Screening

I use the US Preventive Task Force recommendations for health screening. And more. I go into detail regarding lifestyle, ability to detoxify, and early signs of inflammation. As we are learning, over time these problems lead to diabetes, cardiovascular disease, Alzheimers, and osteoporosis. You will need to go to a gynecologist for paps.

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Vaccinations

I do not provide vaccinations at my office. However, I will remind you of when they are recommended and discuss your concerns with you (both medical and religious). The decision is a personal one, but should be well informed. A healthy immune system is essential to safe vaccination. So, before getting vaccines I review the individual's vitamin D and other factors.

Genetic Predispositions

Epigenetics is the exploding science of how environment turns genes on and off, affecting our health. While we are still learning, certain genetics can be part of a wellness initiative, or used to help understand specific health problems in the long term.

Fatigue, "Brain Fog", and Mitochondrial Function

Solutions are multifactorial and may include endocrine (thyroid/adrenal), toxins, nutritional deficiencies, impaired mitochondrial function, immune, infection, and more. Solving these problems can take a bit of detective work.

Weight Gain

The standard approach is to address calories in and calories out. We delve into the details: eating habits, sleep, exercise, adrenal function, thyroid, inflammation, hormones, and more. The goal is sustainable life changes, not fad diets. It takes time, but it lasts a life time.

PMS, PCOS, Acne

Cycle problems and hormone imbalances are often a sign of other problems. A functional approach usually involves testing hormones (via saliva, urine, or blood spot) and/or charting cycles. Solutions vary from food choices to bioidentical hormones.

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GERD (symptoms can include heart burn, difficulty swallowing, cough, sore throat...)

Untreated, GERD can lead to esophagitis and worse. The long term effects of a PPI (pill to lower stomach acid) can include bloating, increased risk for cardiovascular disease*, vitamin B12 deficiency, and more. The functional approach is to help the gut work well by ensuring adequate stomach acid and enzymes for digestion, a healthy mucus barrier, and relief of leaky gut and dysbiosis. Stool testing is often very helpful as a first step.

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Anxiety, Depression, ADD

SSRIs (antidepressants) are now in the top 3 most often prescribed medications--they are showing up in our drinking water! There are alternatives. Ensuring adequate neurotransmitter function, particularly along with a good counselor, can provide relief.

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Brain on Fire: PANDAS, PANS, Autism, Functional Movement Disorder...

Functional Medicine looks to root causes, so is not too concerned about what you call it, and there is no medical diagnosis (label) for these syndromes. In many cases, there seems to be a immunomimicry or other mechanism causing high levels of oxidative stress: The Brain is on Fire. The science is emerging, so interventions are often "off label". My approach is to optimize function (EG gut, hormones, detoxification...), to control oxidative stress (through antioxidants and mitochondrial function), and to find ways to moderate immune function (EG: address infection, low dose naltrexone).

COVID


Prevention, as with any virus, is best. Make sure that you(r):
  • Vitamin D level is optimal (60-80 ng/mL)
  • Zinc level is normal
  • Get regular and good quality sleep.  Most people need at least 8 hours a night.
  • Eat a healthy diet.  Avoiding high glycemic foods/simple sugars as found in baked goods and pastas. Eat lots of vegetables.
  • Manage your work load to avoid chronic stress.
  • Wear a mask in crowded or close encounter situations that are unavoidable, and distance yourself, be in well ventilated areas when possible.  See "Vaccinations" below for why this is true whether you are vaccinated or not.
  • Use a nasal spray such as https://cofixrx.com which keeps germs that enter through your nose (like COVID often does) from taking up residence and multiplying. (Available through my office, email sustainablepathsnp@sbcglobal.net, or through CharmEHR if you are a patient.)
I do not recommend elderberry or other immune stimulants, particularly long term, because they can overstimulate your immune system, which theoretically can be compounded by the action of COVID.

If you have a known exposure to COVID or a high risk event (such as wedding), for 3 days take:
  • A booster dose of vitamin D (up to 20,000 IU) *
  • Zinc 30-50 mg *
  • Vitamin C 2-5,000 mg *
  • L-lysine 2,000 mg *
  • Use CoFixRX
  • Follow CDC guidelines regarding quarantine
NOTE: These are adult doses, and assume no underlying medical conditions.  Check with your practitioner if you take medications or have liver or kidney problems.

IF YOU DEVELOP ANY SYMPTOMS, contact a health care provider immediately. Early treatment greatly improves the chances of a milder case of COVID. The first 24-48 hours of symptoms can be critical.

NOTE: It is difficult to sort through the literature, and we are constantly learning new things. Unfortunately, providers are sometimes limited by their employers regarding treatment options in an effort to ensure that there is continuity of care, to centralize evaluation of the literature (it is time consuming), and to limit liability. However, there are protocols available developed by well qualified physicians that can be helpful. DO NOT attempt to procure medications through the internet or other possibly dangerous sources, or follow protocols without assistance. Protocols are “one size fits all”. Health care providers who are able to use the protocols can modify them to your particular circumstances. For example, some commonly used supplements and “off label” medications are generally quite safe, but there are certain individuals for whom they would NOT be safe, or for whom dosage needs to be adjusted because of medical history or other medications.

Vaccinations: There is much we do not yet know about vaccination long term effects, and there is much yet to be learned from reporting of adverse events via VAERS.  While adverse events seem to be rare, there is likely under reporting, and those effects can be severe (including 11,000 deaths through January 2022: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html).

Vaccines do not prevent you from getting COVID (particularly as mutations continue), but they do reduce severe disease and death from COVID. Medical history is very important in considering whether the vaccine is right for you. We are only starting to learn the relative risks from the vaccine versus getting COVID. Finally, the nature history of pandemics is for new varieties to be less dangerous, and we are seeing that "play out"--though Omicron still can cause significant illness and has caused some deaths.

If you have not yet gotten the vaccine but choose do so, as with all vaccines I suggest that you make sure your immune system is "up" for the challenge by ensuring you are currently well, your vitamin D and zinc levels are optimal, and you have a good level of B vitamins.
My journey to functional medicine is rooted in my family: health issues have caused me to delve deeply into many areas of function medicine to address problems when conventional medicine did not have solutions.  

I have a life-long commitment to research and education:
I am forever a home school mom, taught nursing, and mentor high school students doing research projects.

I love teaching my patients, especially young adults just starting to take on responsibility for their own health.  My dream is develop an active network of education and support to help real people make real changes.

I am intellectually curious.  If we don't have solutions, I am willing to explore.  This has lead to me learning about not only functional medicine, but appropriate use of integrative/alternative approaches, "off label" use of low dose naltrexone (LDN), and other options.  My conventional education is from UW-Milwaukee.  I am Board Certified in Family Practice.   I will soon receive a Certificate in Functional Medicine through the Institute of Functional Medicine (typically a 5-7 year process).  

I believe in Creating a Sustainable World
.  (Click Here for more information).

I want to work with you.

 

Making Appointments

Office hours are part time, and vary in order to be able to offer morning and afternoon times every day of the week, and some evenings. Please email or call to make an appointment (see Contact tab).

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Preparing for Appointments

There are many things you can do to make the most of your appointment time.

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Video/Long Distance Visits

First appointments are done in person except in very rare situations. Subsequent appointments can be done via secure web video (IE: Telehealth) unless a physical assessment is necessary.

 

Follow Up

After each appointment I will share our plan with you via a HIPPA secure patient portal. Non-urgent communication is also best accomplished through the patient portal.

Supplements

Supplements are substances that our bodies need to function properly. These may be obtained through the food we eat or isolated in capsule form. Herbs are plants that typically have multiple mechanisms of action that change gene expression or other functions. Technically, vitamins, minerals, trace elements, amino acids, herbs, or homeopathic remedies are not classified as drugs. However, these substances can have significant effects on physiology and must be used appropriately.

Many conventional providers avoid using supplements.  Some of the reasons are:

  • Supplements are not tested or regulated in the same way as pharmaceuticals.
  • Supplements are generally not as strong and need to be taken more often than prescribed medications.
  • Supplements/herbs are often provided in combinations, increasing the possibility of undesired effects or overdosing.
  • Different forms of supplements/herbs have different effects, so they are not interchangeable with respect to dosing.
  • Conventional providers are not commonly educated regarding supplements and their uses.

I, like most functional medicine providers, recognize these cautions, but choose to include supplements because:

  • Use of these substances can supply nutrition to support the physiological and biomechanical processes of the human body. 
  • Often the side effects are less with supplements than with prescription medication.
  • Herbs often have multiple mechanisms of action, creating a broader scope of benefits than a single action drug

Please Note: 

Supplements have side effects and can interact with drugs, too.  It is important to keep all of your healthcare providers fully informed about all medications and nutritional supplements, herbs, or hormones you may be taking.

I am out of network for all insurance companies. Labs done at in-network labs are paid for same as if ordered by an in-network provider (except some HMOs). You can use your HSA, Visa, MasterCard, Discover, American Express and direct bank transfer, or check to pay. You can also submit my charges to your insurance company (except for Medicare). Copays and deductibles vary by insurance policy. If you need a payment plan, please let me know!
After we have met a few times, we will contract for an expected number of visits for the remainder of the year, and will schedule those visits right away.  There will be a "lump sum" at that point. The memberhship plan will include urgent visits, discounts, and other benefits.
Laboratory


Labs often charge insurance companies a much higher rate than they charge individual patients. (A typical discount is over 90%!)   It is the law that if the lab charges your insurance company, they cannot later charge you a different rate.  It is best to know your coverage ahead of time.  If the test is through Genova, see  (see https://www.gdx.net/patients/billing-and-payments/insurance) regarding coverage.

Some Common Laboratory Locations:

  1. https://www.vibrant-america.com/for-patients/ . Labs are drawn in my office.  The minimum charge is $200, cash, but the charge for each lab is what you usually pay after insurance (sometimes 90% discount over "retail"), so this price includes many tests and is often same or cheaper than going through insurance and you can still submit to your insurance for possible additional reimbursement.
  2. ACL: Found in any Aurora clinic that has laboratory.  See https://www.aurorahealthcare.org/locations
  3. Centers for Diagnostic Imaging:  https://www.mycdi.com/wisconsin/locations__services
  4. LabCorp Patient Service Centers:  The “Find a Lab” locator on www.LabCorp.com provides the most current PCS locations.  Sites include Thiensville, Milwaukee, Wauwatosa, New Berlin, and Kenosha.
  5. Quest Diagnostics: Layton PSC at 4852 S 6th Street, Milwaukee, WI 53221 (in the Airport Business Park).  See https://secure.questdiagnostics.com/hcp/psc/jsp/SearchLocation.do?newSearch=FindLocation
  6. Wisconsin Diagnostics:  Found in most Froedtert clinics.  See http://www.wisconsindiagnostic.com/Downloads/PSCList042716.pdf
Some Laboratories Used for Functional Assessment:

If you don’t have insurance or have an HMO:

  • Always find out ahead of time what the lab will charge (this should be done by a phone call to the lab’s billing department).
  • You may ask for a cash rate.  Many labs offer a discount if paid in cash.
  • Depending upon the tests, there are some online self-order laboratories that can be comparatively inexpensive.
  • http://selfpaypatient.com/selfpayhealthcaremarket may be helpful to you in finding resources, including various share plans.

  • 10602 North Port Washington Road, Mequon, WI, United States