Uncovering Childhood Mood Disorders with Dr. Kenneth Bock

Intro and All About Brain Inflammed

Mimi: Dr. Bock, thank you so much for coming on today. I’m so excited to talk about your new book, Brain Inflamed, and it’s Uncovering the Hidden Causes of Anxiety, Depression, and Other Mood Disorders in Adolescents and Teens. This is a topic right up my alley, because I have a lot of teens in my house. I have a lot of kids. And I know a lot of kids that are dealing with a lot of issues, emotional issues, so I love the fact that you’re addressing something that, especially now in COVID, that’s not really talked about. Mental health is not talked about enough, and figuring out why and what’s going on. So thank you so much for coming on. I guess my first question is, I’d just love for you to just dive into, I know this is your, I don’t know what number book, but it’s not your first book. Number five, five book. Okay, good. So I would love for you to talk about why. Why this book right now?

Dr. Bock: That’s a very good starting question, actually. So this book, the genesis actually… So my last book was actually 2007, Healing the New Childhood Epidemic, where I disclose autism, ADHD, asthma, and allergies. And because of that book, 1998, after my first book, The Road to Immunity, I was doing some research on immune modulators, transfer factor, I was asked to give a lecture at an autism conference. I was put on at the end. They didn’t know me then. They put me on at the end of the day, you know, and I put together this lecture. I think everybody really liked it.

And all of a sudden, parents started bringing kids to me. And my integrative medicine approach, which happened to be quite effective for many kids in the spectrum. And you can imagine, late ’90s, that was really when it was coming out, and kids weren’t getting better. So parents started bringing kids to me from all over the country, and then eventually all over the world. And I have thousands and thousands of autistic kids I’ve treated. I have many in college now. You would never know they’re autistic. It’s really quite gratifying.

That’s amazing.

So I wrote that next book, 2007, Healing the New Childhood Epidemics. I kind of tied together the four As: autism, ADHD, asthma, and allergies. And looking at the underlying things, toxicants, oxidative stress, and chronic inflammation. And the subset of autistic kids, for sure, and ADHD, certainly asthma and allergies, have chronic inflammation.

So fast forward, as people are coming from all over the world, they’re coming with their families, they ask me, “Hey, I have a son or a daughter. They don’t have autism, but they have anxiety, depression, OCD, panic disorder, mood dysregulation,” what have you. And I was happy to see them. And sure enough, the same kind of comprehensive, integrative medicine approach, playing a medical detective, trying to figure out what was underneath, I helped a lot of these kids.

And I started seeing a lot of the same things in these kids as in the autistic kids. Obviously there are different phenotypes. They express themselves differently. These kids didn’t have autism. But the underlying disruptions and balances, insufficiencies were there. And so that led me to seeing thousands of kids like this. And then I felt like I didn’t want to write another book. I mean, I know a lot of doctors, this is my fifth book, but just write a book, and the next book, and it’s very successful. I just really wanted to wait until I had something to say. And I felt like now is the time.

I’ve been doing this for over a decade, really, intensely, with these. And I just felt like I put it together, and this was kind of my statement book. And I feel like, quite frankly, it’s the best thing I’ve ever done. I’m really thrilled with it. There’s so many millions of kids affected by this all over the world.

In fact, if I can share this. I hope it doesn’t sound like boasting. It’s really exciting. I’ve just heard two days ago from my agent, it’s already been published in Bulgarian and in Korean.

Oh, awesome.

I just heard two days ago we have contracts for it to be published in Chinese, Russian, and German. Which is really exciting, because it just goes to show you, these problems are not just in the US. They’re all over the world. And obviously I see thousands of kids, but my whole thing of why I’m writing this book is to raise awareness so these kids are not, basically, their lives are not relegated to psychotropic meds and therapy. When, if you can figure out what’s underlying it and causing purely, in some of the cases, purely psychological symptoms. Sometimes no physical symptoms at all. Like Lyme disease.

Correct.

Bartonella. Bartonella rage or something, where it’s so intense they can be homicidal, and it’s scary in the house. If you don’t diagnose that, all the psychotropic meds and therapy in the world might help them a little bit. Never going to get them well. And yet you figure it out, they get well, and you can start peeling away the psychotropic meds and stuff. So I really felt like, and the earlier the better, because when the brain’s inflamed, the more it’s inflamed, the longer it’s inflamed, some of the degeneration can set in. It can be really, really chronic. So the earlier the better. And that’s where this whole thing is to raise awareness, so that people are aware.

Right. No, because you don’t associate it, right? Usually when you’re dealing with a child that has mental disorders, you just immediately just go to your psychiatrist and get medicines, and you kind of don’t think that there’s another underlying cause to it, right? Like there’s something else. And so that’s great that you’re bringing it up.

I’m happy that you’re doing so well, but at the same time, that means that there’s a lot of kids that are suffering, right? Which is unfortunate. But you know what I loved in your book, because I went to a school in New York City, at IAN, and one thing they taught you is about the toxins. And I did this 10 years ago.

Actually, on a side note, I actually heard you speak in person in New York City right after the Four As book was launched, like in 2008 at the place down, it was like a health, wellness day. And who owns it? It’s some, like, fashion designer.

Donna Karan.

Yeah, it’s Donna Karan’s… I was there. I was there. It just hit me. I knew that. When I talked to your son, I was like, “Oh my god, I’m so excited, because your dad is somebody I’ve been following for like 15 years.” So I was very excited to get that call, because I definitely have been following you because of the ADHD thing. And it’s been like a passion of mine, and kind of following that. And Dr. Hyman also talks about brain inflamed all the time too. So it’s something I’m definitely aware of and whatever.

So I loved, in your book, about how you talked about the immune kettle, because I always refer that to people when I talk to people. I’m like, “Whatever’s happening in your life is like a culmination of, like a pot that’s boiled over.” So can you talk about your immune kettle, because I always use that analogy too. And what things go into the immune kettle that can cause it to boil over.

Definitely. It’s interesting. I first brought that up in The Road to Immunity in 1997. Now the illustration in this book was like a cauldron bubbling over, which I… It’s such a key to chronic illness, because the layers, for people who may be exposed to this for the first time, it’s like thinking of your body, your whole person, as a kettle. Whether it’s a cauldron, a kettle, and there are various layers of this kettle. And it’s when you get to the top of the kettle and overflow, that’s when you get symptoms. And so frequently, the most obvious trigger is a lot of stress. And so stress throws you over the kettle, and you overflow with symptoms, and what happens? Everybody says it’s stress.

But what they don’t recognize in that is all these other layers of the kettle, such as genetic predisposition, which can really vary in size. Some people are lucky and have really good genes, so that layer is very small. Whereas, some people with, unfortunately, maybe a lot of polymorphisms or various mutations or various genes that can cause them problems, that can raise them much higher in the kettle. Because the higher in the kettle you are, the less reserve you have, the less resilient in some way you can be somewhat. We’ll talk about that later. I’m really big on resilience and flexibility. I think it’s really key to life, and happiness, and health. So the genetic predisposition.

Then you layer that, let’s say, to nutritional deficiencies and insufficiencies. You frequently talk about frank deficiencies, but many people are insufficient in nutrients, like vitamin D, or zinc, or magnesium. And they may not be frankly deficient by blood test results, but they may be at the bottom of normal, and their doctor tells them they’re fine. Well, for them they may not be fine. Everybody has these individual needs. You may need more vitamin D3 or B6. You may need it more than me or vice versa. And so a vitamin D of 30, which is said to be normal, is at the bottom of normal. For me, I want to see 40, 50, 60. So it’s different. It’s different.

Then you have allergies and sensitivities. You can have hormonal imbalances, like thyroid or adrenal. You can have immune imbalances, which are very big, and immune dysregulation, which causes inflammation, and you can have infections. There’s a lot of different things. And infections are actually quite a big one, because even if there’s inflammation and autoimmunity, a lot of times under that are infections that are covert, or not seen. Like tick-borne, or whatever, strep, or what have you.

And so you can have all those layers. And so if you have a lot of those, and some of those are very big, you can be laying very near the top of the kettle. You get a relatively small stress can throw you over. It turns out you can’t handle stress. Well, I mean, psychologically maybe your system can’t handle stress, but a lot of it may be that you have so many other layers. So if we can be conscious and aware of the other layers. And then it’s like peeling the onion. Take care of the layers. Make sure they’re nutritionally sufficient. Look at the potential, some genetics, and maybe if there’s weaknesses there, try to help, because what we do is nutritional modulation of genetic expression. Maybe we can help the expression, in terms of the genetics, be better.

We can deal with food allergies and sensitivities, your inhalants, like pollens or dogs. We can deal with hormonal deficiencies or imbalances. And we can basically do everything. And certainly infections, if we can be aware of them and diagnose them, and hopefully do the right testing. You know, because some of the tick-borne testing, as you know, is inadequate. And if we can make those diagnoses of Lyme or Bartonella, or even other more esoteric coinfections, mycoplasma, strep. And look at autoimmunity, immune deficiencies, autoimmunity. All that stuff. You’d be amazed. You lower the person in the kettle, and then they get that same stress, and they don’t get symptoms because they don’t go over the top and boil over.

So that is the point that I think it’s important. Stress is so important. I mean, stress causes disruption of the integrity of the gut, you know, “leaky gut.” Stress affects the integrity of the blood-brain barrier, which separates the peripheral immune system and body from the brain and keeps the inflammatory mediators and toxins out. But that also can get disrupted by stress and all these other layers. But yet, one has to remember that stress is key. And all these kids that I have with all these mood disorders, yeah, do they need therapy? They may need CBT. They may need some medications. But if you only do that and don’t do the others, they’ll never get well. And that’s the whole point I want to make in this book.

And sometimes a panic disorder is a panic disorder. Sometimes a kid, a boy, a girl, a teenager, breaks up with him suddenly, and he’s totally depressed. And hopefully not suicidal, but sometimes. And it was really that. That was the main thing. But if you miss these other things that are there, it just compounds everything. And it really prevents these kids from getting better.

I also want to make a point that this is not only for kids. It’s written, you know, you always have to select your niche when you write a book, and you work it out with the publishers and everything like that and your agent. But the reality is, these concepts apply to adults and kids, just as they do to adolescents and teens, but this book-

So do you see both teens and adults in your practice, not just-

Yes, yes.

You do both. Okay. The other thing is, you had mentioned, which I really had not seen before, because I think you created it, about the mood dysregulation spectrum. So can you talk about that? Is that what you use as a diagnostic tool?

No, it’s not really like a psych, like in the DSM-5. It’s not in that, because I created it, and obviously it’s something. I created it for parents to be aware of the diversity of symptomatology and the different intensities because I dealt with so much of the autism spectrum disorders, and there you have a spectrum. Now it’s all lumped together. Used to be, before the DSM-5, it was Asperger’s disorder, which was the milder version which, a lot of social quirkiness. Then there’s PDD, Pervasive Developmental Disorder, which was not quite as severe as frank autism, sometimes where a kid is mute, or a kid is really aggressive, or stimming. So when I looked at all these kids with their various symptomatology, it came to me that there really is a spectrum there. I call it the phenotypes. It’s how it expresses itself.

So I wanted to try to figure out, and I spent a lot of time, and I’m really kind of, I was happy that I came up with this. I felt like I was hopefully being able to get it across, that kids can present in different ways. The same underlying conditions could create different symptoms, different phenotypic expressions. Your genes, we call genotype. Your physical is your phenotype.

And so somebody could have Lyme disease, for instance, and have mainly anxiety and panic disorder and insomnia. Where another could have severe mood dysregulation with rages, especially as I was saying, Bartonella, you could see that as well. So by creating the mood dysregulation spectrum, I wanted parents to see that there were certain parts, it went left to right, and they can all see this on the BrainInflamed.com site.

There’s a site and people can actually download my template and they can actually map their kid. That was one of the things I wanted to do. You can map your own kid as to where they fit. Then you can compare it to some of the templates I put together. There are only templates. It’s obviously not all the same, to give you maybe a sense, with the questions and clues in the book at the end of each chapter, maybe which path you could pursue. Not diagnose, but pursue with someone to help you diagnose it.

Because you start on the left with moodiness and irritability. Listen, all teens have that. So I had a little bit of it in the normal range, then a little bit higher, I call it teenageitis, which is just like, that’s the teen that is a bear at home. It’s like, “Oh my god.” And then they had a sleep over, and they say to you, “Boy, your kid-“

He’s the best kid, yeah.

“Your kid is unbelievable. I mean, like-“

I have one of those.

Right? “So polite. I mean, the nicest kid. God, I wish…” You’re saying, “You’re talking my kid? You’re talking about my kid?” You know that, right?

Yes, I know that. I have one of those.

So I think it’s important to recognize that whole concept and not pathologize it. That’s the thing. Because it’s also clues to me, when I’m trying to figure out these kids. If a kid is really great in school and only that way at home, it speaks more to behavioral, not as much the other stuff. They could have other stuff, but when you can turn it on and off like that, it’s usually, there’s some behavioral component. And I have it sometimes where it’s so bad and I say, you know what? I think you need to… Where it’s really bad maybe at school and not as bad other places. And I say, “You know what? I think you maybe need to look at either some abuse or some teacher that’s really nasty.” And a lot of times it’s found. So that’s where that could be helpful the other way.

And then as you go through the symptoms of anxiety and depression, OCD, panic attacks, and then you get into the more severe, really severe mood swings with aggression and rage and psychotic thoughts or actions, it gives parents a chance to see just how bad it is, where we may need medications. And I always say, “Medications are okay if they’re not your only treatment.”

Right.

You may have to minimize symptoms for a while so the kid can function, so that we don’t have a kid that’s going to really hurt their sibling while we’re getting to what’s under it. And that’s my point. And unfortunately in medicine, as you probably know, doctors don’t have enough time. They want to get the symptoms, put a diagnosis, and give them medication, without looking for the root causes.

For the cause.

And that’s the whole point of this book, is to make sure we’re aware of that.

That’s great. And so, if someone were to come to you and they don’t know what’s wrong. They either are coming to you because they have a mood disorder that they realize could be related to something else, or they just don’t feel well or whatever. They have symptoms. Is that typically what happens? They come to you and they don’t know. They’ve been around the block to a lot of doctors and they can’t figure it out. If that’s the case, where do you start? Where do you start testing them? Do you automatically out of the gate test them for Lyme, or do you test them for deficiencies? Where do you even start?

Firstly, I take a history. My initial interview is an hour and a half, looking at their records. Sometimes it takes even longer. Sometimes it can take up to two hours. We give an hour and a half, and sometimes we actually have to extend and I do it after hours, because they come in with so much information. But the key is a really careful, detailed history. And we have them fill out forms that are very detailed. And then I look them over and ask questions.

And I did this at the end of every chapter to try to give them the sense of those questions. Is this long-standing? It is recurrent? Was it very sudden? Like we were talking before. Somebody that you knew maybe, it was very sudden, overnight. That’s a really big clue to me. That’s not usual. I mean, if a kid’s got anxiety that goes back when they’re younger, and it’s chronic versus a kid that is… I have these stories of kids that are A students, lots of friends, great in their family, great athlete. Wake up in the morning an alien. I mean, total alien. Crying, screaming, separation anxiety, won’t go to school, clinging to the parent, OCD rituals, perhaps meltdowns. Out of nowhere. That is a very different entity. That needs to have a huge workup, looking for infectious etiology, autoimmune, because of the likelihood of autoimmune brain inflammation or infectious.

So I really base the testing on the history and the physical. History much more. I always do a physical, though in COVID you couldn’t do a physical. I mean, you could see them and talk to them, but you know. The point being is that yes, if this is really severe, I’m going to do infections, especially if they live in endemic areas. But Lyme, as you probably know, and coinfections, it’s every state. I mean, obviously I live in an endemic area two hours north of New York in the Hudson Valley, Connecticut, you know, Northeast isn’t… And then of course Northern California. It’s various places. But it’s everywhere. And I see patients from all states and all countries that have tick-borne disease. So I think, the bottom line is, I always think about that. And I do a full tick-borne, especially when it’s severe symptoms.

And then I have to look at metabolic imbalances and nutritional insufficiencies and deficiencies. All the things that can cater to inflammation. Even allergies can do that and sensitivities. So I really do quite a thorough workup. Of course, I do that in conjunction with the parent to make sure that’s okay, because some of the specialized integrative labs I use to look at subtleties is not always covered by insurance.

Covered, I know.

Some of them are. Some of them are regular labs. But nowadays I’m also looking, so I look a lot at autoimmunity, anti-neuronal antibodies to look at brain inflammation, autoimmunity. With all this research I’m doing in my lecturing about the blood-brain barrier, it’s so important. There’s a protein called the S100B protein that actually, if it’s elevated, it can be consistent with disruption of the blood-brain barrier, which is helpful to me, in terms of some ways to try to shore it up.

I’m looking for clues. I mean, do I check everything, everybody? No. I don’t have the protocol, so to speak. I adjust it. But will I look at thyroid and thyroid antibodies for autoimmunity? Yeah, there’s certain things that I’m going to be looking at. Especially if there are symptoms suggest it. I mean, fatigue, constipation, dry skin, dry hair, hair loss. All that stuff that could suggest low thyroid. I’m clearly going to do that.

But even with Lyme, there’s a lot of Hashimoto’s, a lot of autoimmune, thyroiditis, and thyroid inflammation with Lyme and tick-borne, and Epstein-Barr, the viral things. I’m going to look at Epstein-Barr, CMV. So yeah, it’s a very thorough, because the truth is, it’s rare for me not to find stuff. I mean, it’s almost unheard of. Somebody saying, “Oh, you’re looking for it.” Yeah, well, if you don’t look.

In the first book in 1997, in The Road to Immunity, I said, “If you don’t look, you won’t see. And if you don’t listen, you won’t hear.” So it’s easy to say, “Oh, you’re just getting all these labs?” Well, I just don’t get willy nilly labs. I like to get labs that can inform my next steps. You know what I mean? I don’t just get a lab to get a lab if I’m not going to do anything with it.

Right.

I like labs that will allow me to help make a decision or a confirmation of what I feel clinically. Because sometimes I’m going to treat tick-borne when I really feel, based on where they vacation, where they live, was there a tick bite, other people, all that kind of stuff. So the labs are confirmatory. But I will treat clinically, if I really feel that that’s what’s going on. I always say, “I treat the kids, and I treat adults too. But I treat the kids, and teens, and adolescents. I don’t just treat labs.”

So if someone, if you figured out that they either, you know they have Lyme, or you figure out that there is Lyme or coinfections, what’s your typical route? I know it’s so individualized, right? Because some might have parasites on top of it or EBV, whatever, or mold, but typically do you do more antibiotics? And if so, is it a port we’re all pulsing, or do you kind of do more in additional, like supplements? What’s your typically protocol?

I would say I’m truly integrative, so I use antibiotics. In fact, when I first came, my beginning practice goes back to 1983. So it goes a long way. It’s 38 years now. And I began my practice in the old days as a holistic family… I don’t like that word anymore, because holistic is bantered about in every which way, but we called it holistic family practice. And we dealt with a lot of kids in those days with recurrent ear infections and tubes. So I would try to get, if they had bad candida problems and food allergies, I’d get them off the antibiotics and help them, strengthen their immune so they don’t get sick anymore.

So I actually started that way. And now you look back at my evolution. I use a lot of antibiotics because I take care of so much tick-borne disease. But they require antibiotics, adequate doses and lengths of time. So a lot of time they require combinations, not just one, and you have to be aware of the coinfections, because if you only look at Lyme, you’re going to miss a lot of the others.

But we use herbs with it. I use a lot of antimicrobial herbs. I use a lot of immune modulators. I make sure we protect the gut big time, so I use a lot of probiotics and cobiotics, like [inaudible 00:25:45], sometimes spore-based probiotics. So really aggressive that way to protect, so they don’t get antibiotic-induced diarrhea. I do a hepataprotectors, which are liver protective herbs. And obviously do all the things to heal the gut. Whether there’s dysbiosis, heal the leaky gut, and the same thing with a leaky blood-brain barrier. And then try to help them in terms of asymptomatology.

So I’d rather do it naturally with some of the herbs and nutrients we use to relax with the anxiety and for the mood dysregulation. There are things we can do for OCD. But when they’re really bad, the medication as well.

I had a whole chapter on meds in Healing the New Childhood Epidemics, where I begin the story of a mother who just refused meds. And this kid was really severe. And finally, the grandfather came and said, “You come to see this guy. He’s an expert. You pay him all this money. And you don’t listen to him. Why don’t you give it a chance?” And it was an anti-psychotic. It was like a Risperdal, or whatever. And this kid was really aggressive, needed it. I mean, takes a while for the things we do to take traction in really sick kids. And the kid got such a good response. She calls me up crying. And I’ll never forget that, because it was the grandfather that said, “Why don’t you listen to him? I mean, the guy makes sense.” And so I tell the story that medications are okay in the context of a whole program, not-

As a solution.

Yes, that’s right. Right. So the antibiotics, yes, obviously. Nowadays, as you know, in the last couple years we found out that it’s okay to use Doxy in kids which, we could never use Doxycycline in kids less than eight, because we thought it might harm their teeth, like Tetracycline. Turns out it doesn’t, which has really helped us, because coinfections respond better to Doxycyline than some of the other meds. So it’s been a freedom that’s been really helpful in littler kids. Obviously you can use them in the adolescents and teens. And there’s Azithromycin, and Ceftin, and Rifampin for Bartonella. I mean, all those things.

Yeah, you just rotate them through. That’s what I did.

Yeah, but it’s not just willy nilly. I’ll leave them on it, and I like to watch progress, and if somebody’s progressing. You always have to think about obviously biofilm, so we have to use biofilm busters, because that’s where they hide behind. And you have to use intercellular medications, not just extracellular ones that get in the cell, because that’s where they hide.

And also the round bodies, they way they morph, and spirochetes. So sometimes the Metronidazole, Tinidazole, or Alinia. And the key is you do it long enough is how you do it. I’m not just pulser, I treat for lengths of time. But then there are sometimes you have to pulse in the treatments for the round bodies, and sometimes you pulse stop. It really varies.

And then you add the herbs. And there’s a very nice recent study that showed some of the herbs that are effective for [inaudible 00:28:34]. So there’s more and more information coming out. This was a nice article about herbs being effective for [inaudible 00:28:39]. And so a lot of times we combine the herbs with the antibiotics.

But what I like to do is, once I get them off antibiotics, have them on herbs, and then frequently move to homeopathics. We have some of these homeopathic series for specific infections. And you’re allowed to do three at a time every three days. So sometimes you do the kind of killing at the microbial, but then the homeopathic allows the system to really, part of it is detox, and you really try to get rid of it. Because when you kill an organism, you know you have a lot of debris. You have to be able to clean up the debris.

To detox it out.

Yeah.

Do you find, especially with the supplements, or even with your eating, I’m sure you’re going to suggest what you should be eating or not eating. At least I found this with my kids. What tricks do you have to get them to do it? Like getting a boy to give up pizza.

It’s very hard. This is a very good point. I actually talk about this in the book. And it’s because I think it’s helped me be as effective as I am with the kids, because I deal with thousands of them. So firstly, to not be an arrogant doctor. So I get down with them. And with the autistic kids, I used to get on the floor with them. And I take them and I look them in the eyes. I look at them. It’s a way of, whatever.

Connecting, yeah.

For these teenagers and stuff that come in with this stuff, and they may be sitting on the couch and like, eh. They don’t want to be there, I suppose. I say, “Okay, listen. What can I help you with? I can wave a magic… What can I help you with? Why do you think your mom or your dad brought you here?” And then maybe I get something, maybe not. I said, “Okay.” Then I’ve gotten from them what’s bothering them. So I said, “Would you like me to help you with this anger you’re feeling?” “Yeah, yeah, yeah.” “Would you like me to make it easier with your friends?” “Would you like me to make it easier to learn in school because you can’t pay…” You know.

And then I try to reach them, and I also try to get things that they like, if I can figure it out. Like I know, because I have my own teens and because I coach teens. I get a kid that loves basketball, I can really get him basically, if he’s a point guard, talk about going left. If you know anything about basketball, be able to go to the hole, all this stuff. Then I can make a little light of it. And all of a sudden they perk up. “Wow, this dude…” So I try to reach them.

And I said, “What happens? You’re really gassy. And it’s a pain. You don’t want to be gassy with a girl. If I can help you with that, would that be good?” “Yeah, yeah, it might be really good. Yeah.” So it’s like, sometimes it’s pulling teeth, but I think a lot of times they leave and say, I hear them, they say, “He was pretty cool.” And I’m not being obnoxiously cool, I’m just-

Yeah. Finding their why, to give them a reason to do it.

Yes. And then, and I tell them quite frankly. I say, “Listen. I’m not going to be with you every minute shaking a stick and hitting you and making you do what I’m telling you. I can give you all the recommendations in the world that really may help you. But if you don’t do it, there’s nothing I can do.” And I say, “So I’d rather not waste your parents’ time and money and my time, if you don’t want to do anything. If you’re really not going to do anything, you want to stay this way, fine. But from what I’m hearing, I don’t think you want to be this way. It’s kind of a bummer.” You know? I wouldn’t want to. Especially if I had a dude telling me that maybe he can help me feel better.

And you’d be surprised, and then I say, “It’s not easy. I don’t have a magic medicine.” I mean, maybe an antibiotic makes it a little bit easier. But I talk about diet, and obviously we can’t go to everything right away with teens. But if I can show them how it might affect, even if I just say, you know, forget about the pizza but just say sugar and processed food. Sugar feeds these bacteria. And sugar feeds these bugs in your belly are not good. So maybe you can just stay away from the sugar. Try to cut the sweets out. And then eventually we go to the white breads and the pizza and the gluten and stuff. And if they start feeling better, then you get buy-in.

And I generally have pretty good success. So if I get that early stuff, I get buy-in, and then they realize, “Hey, wow.” And I say, “Hey, listen. I mean, it’s up to you. Now you know that you can feel better. If you don’t want to feel good, nothing I can do. At least you know what you can do.” So part of it is doing it enough. But it really is connecting with them. It’s not being aloof. Just saying, “I’m the doctor.” It’s not going to work.

No, it doesn’t work. This has been amazing. Is there anything we haven’t covered that you would like to mention or bring up that you think is important?

No, I mean, I think basically the thing that I would really want to emphasize is the fact that just being aware of this. So for parents to try to educate themselves. And the book, I think, was written really, people say it’s a very easy read. I had a terrific person help me write it, great stories, and really take the information, which sometimes if I think it’s simple, maybe not simple, but make it simple enough to understand so that it’s really accessible. So that people have a sense, an awareness of what may be affecting their teens and adolescents. And that at the end of every chapter there are these clues and questions after I’ve described these things in the chapter, that you can ask yourself. Or maybe go to your doctor and present it to your doctor and say, “Hey, wow.” And go to BrainInflame.com and maybe draw your patient’s mood dysregulation spectrum and you’ll see how it’s done and get a sense of, “Aha, this looks like maybe it could be this. Maybe it could be that. These questions line up.” It may not only be one thing. There’s overlap.

So for the very reason that it’s not that it’s every kid but that, if you can figure this stuff out, I want to emphasize, you have the opportunity to change the trajectory of your child’s and your family’s lives. And that’s why, for me, this work is so gratifying. It’s like, my staff is worried about me retiring. I can retire, of course, but I say, “Why would I retire? I get the opportunity to make such changes in kids’ and families’ lives that, it’s so gratifying to me.” I tell that to my kids. I say, “Hey, I feel like if I would go tomorrow, I feel like I’ve been doing kind of God’s work, and I feel like I’ve made a contribution.”

And I may want to work a little less as I go forward. I do love tennis and golf. I’m an avid golf player. Much better tennis player than golfer, unfortunately, but the point being is, I would not want to stop this. I have a great nurse practitioner with me now who I love and who’s helping to take care of the kids, and she’s just a dream. And I actually have my son working with me, which even great. And my daughter. As she always said, I never mention. I love my daughter to pieces, but my son is actually working, and he’s really one who really arranges these things. I don’t really have the time to do it, but he’s great. He loves it.

And so it’s such a good thing. It’s like, why would I retire, because when I look and I see kids’ and parents’ lives, and parents tell me, “God, I never thought he or she would be where they are now.” I mean, I’m talking about kids that have been out of school for two or three years.

Oh, wow.

I’m talking about kids that are in their rooms, not leaving their rooms, because of OCD and mood dysregulation. I’m talking about potentially some kids urinating, defecating in a room. I’ve had families where the kid could not be with a certain family member or two, and they had to move out. So severe. I’m talking about that. So when you can change that, the trajectory, and not just with psych meds and therapy because that wasn’t working, but really figure out, “Wow, they had tick-borne disease, and they have autoimmunity and brain inflammation, and maybe autoimmune thyroiditis,” whatever it is. And wow, we can make a change.

And you see it takes time. And then using something like IV. That’s one thing I want to say that I want parents to know there’s realistic hope. Because as bad as it can be, like we use for the most severe kids, if there’s brain inflammation, autoimmunity, and I have ways of looking at that on labs that can confirm it, we can use IGIV, which is a very strong treatment. It’s a two day IV of immune globulins. It’s an IV. It’s expensive. It’s intense. There are potential side effects. The major ones are really almost never seen. Anaphylaxis, and we do a lot of hydration to save, because it’s a load on the kidneys. But headaches and vomiting are not uncommon a day or two after. But it can make a huge change. It may not only be one, it may need three, four, five, or six treatments, but for the most severe cases, it can really make a difference.

And so I really would want to leave people with this whole thing of realistic hope. Not saying that everybody gets a hundred percent. I just had this talk with a patient yesterday. We were talking about, I usually do a number. I say, “Overall, from zero to 10, zero’s the worst, bedridden, can’t do anything. Ten is like optimal best. Where were you when you started?” She says to me, “Well, I was probably a two or three.” “And where are you now?” “Well, now I’m a six or seven.” That really helps me. Or, “Now I’m an eight.” Wow, that really helps me. It’s come a long way.

And getting to a 10 is not always easy when somebody’s been chronically ill. I mean, certainly getting to an eight is a huge, huge difference. We try to get them to a nine or a 10, but that whole concept for someone, when they’re at a one or a two, and it’s so severe, I want parents to realize that yes, I see kids like that, and there is realistic hope. I wouldn’t guarantee. I could never guarantee as a doctor anything.

But I mean, I’ve treated thousands of kids, you really… A lot of these parents were told there’s nothing they can do. And I see parents that, when they first see me and I listen to them, they start crying. I have tissues right by them, because they said, “You’re actually listening to me. You’re not telling me I’m crazy. You’re actually taking the time. You’re looking at the labs.” I say, “Of course I’m looking at the labs.” They say, “Nobody else looks at the labs. They just get their own.” And I said, “No, no. I need to look and see what you had.” To me it’s amazing that this seems like, in some way I feel like I practice common sense medicine.

Yeah, exactly. Well, we are blessed to have you. I have goosebumps listening to your stories about saving people. But thank you for all that you do. I really appreciate your time.

Thank you so much, Mimi. It’s been a pleasure to be with you. Thanks.

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