Devin A. Mikles, MD
Choices Integrative Healthcare of Sedona
2935 Southwest Drive; Sedona, AZ 86336
Phone 520 203 4844; Fax 520 203 4497
High School: Heidelberg American, Heidelberg, Germany; Mt. Vernon, Alexandria, Virginia; Tulsa Central, Tulsa, Oklahoma; Herrin Township, Herrin, Illinois College:
University of Colorado, Boulder Campus University of Colorado, Colorado Springs Campus Graduation/Degree: December 21, 1979, Bachelor of Arts. Honors in Biology, Magna cum Laude, Presidents and Deans list of outstanding students Phi Beta Kappa
Medical School: University of Colorado School of Medicine, University of Colorado Health Sciences Center Denver, Colorado; Graduation/Degree May 24, 1984, Doctor of Medicine Honors: Neuroanatomy
Internship: Transitional Medicine; Presbyterian/St. Luke's Medical Center Denver, Colorado, 6/23/84-6/22/85; Director of Program: Alan Schocket, MD; 1601 East 19th Ave.; Denver, Colorado 80203
Residency: Internal Medicine; AMI Presbyterian/St. Luke's Medical Center, Denver, Colorado, 7/l/85-6/30/87; Director of Program: Theodore Eickhoff, MD; University of Colorado Health Sciences Center; 4200 East 9th Avenue; Denver, Colorado 80203
Where have you been certified?
National Board Examinations Parts 1, 11 & III
Diplomate, American Board of Internal Medicine, September 12, 1989
Years in practice: Full time since 1987.
Colorado #26906 (since 1985)
Arizona #20374 (since 1991)
My experience with CFS/FMS patients.
I have been seeing CFS and FMS patients regularly for 10 years. My understanding of these problems has grown immensely in that time and I continue to look for greater understanding of these disorders and for ways to treat and cure them.
How many approximately CFS patients have I had?
How many FMS patients?
What are my success rates?
This depends on many factors, including other co-existing disease states, and the patients willingness and /or ability to cooperate with diagnostic investigations, healthcare financial status, etc. In patients that are willing and able to go through the process of testing and trials of therapy, we see excellent responses (able to return to full functioning) in about 50%, good responses (much better and able to return to some normal activities) in about 25%, fair responses (improved, but still not able to function at their pre-disease state) in 20%, and poor responses (no significant improvements) in the remaining 5%.
What happened to them? Are they OK?
Some are in complete remission and are fully and gainfully employed. Some are very high functioning, but require more rest and less than full time employment. Others do well, but working causes reoccurrence of symptoms. Some are stable and have an improved level of health. Some have not improved.
The kinds of things we have tracked down.
Many other diagnoses have been made. Some people were found to have other illnesses. Some examples are hypothyroidism, candida infections, hemochromatosis, porphyria, lupus, rheumatoid arthritis, Sjogrens syndrome, idiopathic hypophosphatemia, hepatitis B & C, post traumatic stress disorder, depression, hormonal imbalances, adrenal insufficiency and others. Keep in mind that CFS and FMS are actually terms used to categorize patients with a certain set of symptoms and findings, and they may have a variety of disorders. There are many causes of fatigue. Many patients have their symptoms begin after exposure to one or more of a variety of toxic agents. This can be very difficult to ferret out, and very expensive. With regard to FMS that is confirmed (other disorders ruled out), I have identified at least 6 subsets of patients that respond to different therapies depending on the inciting agent(s) or event(s).
What methods we use to make a diagnosis.
A comprehensive written history-taking tool is used. A full physical examination is done. Specific testing is ordered relevant to the individuals history and physical findings. After the initial evaluation, we meet with the patient to review the findings and make specific treatment recommendations. Often some form of treatment is begun at the conclusion of the first visit if that is appropriate. Patients may choose to be seen by one or several other members of our clinic team to have evaluations pertinent to systems of healing other than conventional medicine. Some see only one of our medical doctors.
Our treatment approach.
This depends on the findings and the diagnosis. We use an integrative approach in general, but we are sensitive to the specific wishes, financial and insurance limitations that the patient presents to us. Everyones treatment program is individualized to his or her problems. There is no rigid treatment protocol, but we have make some general recommendations to most individuals that w feel are useful in any disease process. For more information on what we offer, please see our website: www.choiceshealthcare.com
What is the cost of the initial evaluation?
First visits for new patients are $225 to $300 (doctors office visit only; testing procedures not included). We bill most insurance including Medicare. First visits typically last a minimum of one hour (seeing the doctor only). We do not participate with any HMOs, as there is not any significant market penetration of those organizations on our area. We do see HMO patients, but they generally have to pay a higher percentage out of pocket. Most insurers do not cover some of the alternative therapies we provide.
What is the cost of subsequent appointments?
Depends on the complexity of the visit and the types of services rendered this can be anywhere from $20 to $150
What is the typical amount of time before you can be seen?
Currently there is about a 2 to 3 month wait to see me as a new patient. We schedule all patients for adequate follow-up visits so that there is no loss of continuity in care. There is no significant wait to see others in the clinic. Again, please see our website to review the information on the other members of our team.
I try to answer all email within 24 hours excluding weekends and time away from the office is at all possible. The longest I have been in usual circumstances is 72 hours.
What medical testing labs do we work with?
We use local labs and imaging services for standard testing and imaging. We use a variety of reference and special laboratories for unique testing (this includes Diagnos-techs, Doctors Data, Great Smokies Lab, Mayo Clinic Lab, Metamatrix, Nichols, Smith-Kline Beecham, and a few others.
For example, we have ordered all of the following tests multiple times over the years:
+ Porphyrin Analysis Test
+ Lactulose/Mannitol Small Intestine Permeability Test
+ Hair Test For Heavy Metals
+ Fungi Antibody Test
+ ELISA Food Allergy Test
+ Organic Analysis Test
+ Liver Detoxification Profile
+ Comprehensive stool digestive analysis (CDSA) with Parasitology
How much do we charge for tests?
We do not charge patients for tests, except for simple ones that we do in the office. Unlike other practices, we do not think that we should be increase the cost of care to patients by adding a surcharge to the testing procedures on tests that are sent elsewhere to be run. We let patients pay directly or help the patient to have them billed to their insurance carrier if possible.
If someone complains of CFS/FMS, are you willing to Rx them an antifungal drug for 45 days, and discontinue use if there is no significant improvement?
If there is clinical evidence of fungal disease, that would be appropriate.
If someone complains of CFS, are you willing to Rx him or her Wellbutrin SR for 45days, and discontinue use if there is no significant improvement?
Wellbutrin is an anti-depressant drug that may be useful in some CSF patients that have evidence for noradrenaline problems, so yes, that may be appropriate.
If someone complains of CFS, are you willing to Rx him or her Provigil for 30days, and discontinue use if there is no significant improvement? Provigil is a wakefulness-promoting agent for oral administration and is indicated to improve wakefulness in patients with excessive daytime sleepiness associated with narcolepsy. Sleep study (polysomnography) and Multiple Sleep Latency Testing may be required to ascertain the usefulness of this drug in specific patients, however, if there is substantial evidence of low nonadrenaline levels, this may be something to try.
If someone's liver phase I is upregulated and phase II is not keeping up, what would you do about it?
There are two problems that cause of upregulation of phase I activity:
Induction of the cytochrome p450 enzyme system of the liver which can be caused by exposure to xenobiotics (environmental toxins), endotoxins (gut-related), and a variety of other agents including tobacco, alcohol, certain drugs, certain vegetables and other foods.
An increased free radical load in the body for a variety of reasons.
In part, the obvious answer to the question of what to do includes cleaning up the home and work place, and removing bad health habits from your life. Increasing the intake of antioxidants is also important in this situation. There are also ways to nutritionally support phase II liver detoxification of the liver that help to decrease the load of toxic molecules in the system. In this situation, there are certain tests of intestinal function that should be considered as well.
When you receive a test result back from a lab, do you automatically send a copy to the patient?
We usually have patients return to discuss important test results face to face, so that adequate explanation and information can be given, and appropriate treatment based on results can be discussed. A copy of test results is offered at the time of that visit. Alternatively, phone consultation regarding test results is available, and we like to have the patient receive a copy of the test results by mail or fax so that they have the information to refer to during the phone conversation. We do not feel that it is advisable or fair to ask patients to try and interpret medical tests by themselves.
What does one need to do to get a copy of tests? Just ask. We are happy to provide a copy of all test results.
Within what period of time is it sent? Usually within the next business day.
Do we have an administrative assistant that patients communicate with via telephone? Via email? Yes.
How long will it take for them to respond? Usually by the next business day.
Will they always respond? Yes!
My two favorite books on CFS are: The Doctor's Guide to Chronic Fatigue Syndrome: Understanding, Treating, and Living with CFIDS by David S. Bell, and Alternative Medicine Guide to Chronic Fatigue/Fibromyalgia by Burton Goldberg and the Editors of Alternative Medicine Digest.
My two Favorite FMS books are: From Fatigued to Fantastic!: A Manual for Moving beyond Chronic Fatigue and Fibromyalgia by Jacob Teitelbaum, and Fibro-myalgia: A Comprehensive Approach by Miryam Ehrlich Williamson
My favorite CFS web site: http://www.cfs-news.org/
My favorite FMS web site: http://www.sover.net/~devstar
Also http://www.teleport.com/~semerson/fm.html is a good one that looks at both problems.
What about the www.beatcfsandfms.org web site?
This seems to be a very comprehensive site with information about CFS, FMS and GWS.
Are you willing to copy much of my past patient test data, remove the patient name, and send it to a researcher who compiles that with other Doctor's data and places it on the Internet to be studied by all, after I have gotten a release from the patient along with having them fill out an extensive questionnaire and after I have been compensated for compiling the data (by the research study), to help CFS/FMS research? Of course.
Will you fill tubes of blood for tests that the patient acquires and manages? This is not something that we do.
Are you compatible with my HMO/Insurance company? Please feel free to call and ask a member of the clinic administration team about your specific insurance carrier.
TO FURTHER INTERVIEW DR. MIKLES:
If the patient wishes to outline your case and have specific preliminary questions briefly answered, please send your inquiry to:firstname.lastname@example.org.
We can take phone calls from prospective new patients, however, due to the demands for time from our current patient load, we ask that you be organized when you call, and limit this call to 5 minutes.