Dr Andrew Greenland: 0:01

Welcome to Voices in Health and Wellness. This is the podcast where we explore what care looks like when it's reimagined by those who dare to ask deeper questions. Today I'm joined by Dr. Ivan Cichowicz, a board-certified adult and uh geriatric psychiatrist based in Florida. Ivan is the co-founder of Mindful Behavioral Health, an outpatient psychiatric service practice focused on adult and geriatric mental health. He's also a primary investigator in brain health research at Cognivita. Brain Health. So with that, Ivan, I'd like to welcome you to the show. Thank you very much for joining me today.

Dr Ivan Cichowicz: 0:36

Oh, thank you, Dr. Greenland, for having me on. I really appreciate the opportunity to just talk to you about all this stuff.

Dr Andrew Greenland: 0:42

Wonderful. So perhaps we could start at the top a little bit about your journey, if we will, because I know you're wearing a few hats right now between your outpatient practice research at Cognivita and launching a new dementia education platform. Can you kind of walk us through how all this fits together in your world?

Dr Ivan Cichowicz: 0:58

I mean, so I started as an outpatient psychiatrist with um, you know, love for geriatrics, and little by little my patient population, I think just because I'm here in Florida, the capital of retirement, um, ended up seeing a lot of patients with a lot of cognitive disorders. And it was always trying to figure out, you know, what to do and how to incorporate that and how hard it was to just kind of get the whole system to be able to support these patients. And this is how kind of we ended up here. Um, ended up shifting from more traditional just depression, anxiety, kind of therapy treatments to more underlying cognitive issues. And I'll use an example of the psychiatrist that I know and of the psychiatrist that I work with, a lot of times, if there's cognitive issues, a lot of them are like, uh, I just I don't feel comfortable, I don't want to deal with it. And uh was trying to figure out how can we help more people, and this is how we've started to incorporate all these things from being more involved with cognitiva, which we're trying to create an online community where we can help educate, teach, um, uh about everything that's changing in brain health and cognitive disorders now, and then just trying to incorporate more of I'll use the word kind of brain health and cognitive health into our practice.

Dr Andrew Greenland: 2:25

Got it. And maybe to rewind a little bit, talk about your kind of journey into this whole world from from the outset, because it's always interesting to hear how people have ended up doing the work that they do and the specialism they choose. What kind of inspired this whole journey?

Dr Ivan Cichowicz: 2:39

So when I was in medical school, I remember I rotated with in the PMNR or physiotry department, because I had an interest in that. But I quickly learned that I didn't enjoy working with athletes as much as I thought I was, and I really enjoyed working with the geriatric population that was just getting physical therapy. So fast forward to psychiatry residency, and just out of coincidence, out of the four years of psychiatry residency, on three of those years, my supervisors were geriatric psychiatrists. So I just spent a lot of time surrounded by geriatric psychiatry and talking about it and being invited to geriatric psychiatry-related stuff, and it just sparked a big interest. And the other part here is, you know, I love a challenge. And what is more challenging than trying to figure out not only the brain, but dementia, which has been so hard to treat. So this is kind of how I ended up here. And then, of course, more recently, you know, just frustrated because trying to figure out what to do, how to help these patients, and you, you know, are exposed to people like Dr. Bredison and his like protocols for cognitive disorders, and that just opened a whole new world of opportunities. And we've started to incorporate a lot of his ideas and teachings into like our practice and just started having very good results, which just kind of I'll use the word, makes you even more motivated to continue working on all these, I'll say, lifestyle interventions or um, I'll say like integrative kind of like mental health and how it's a big part of the picture that we just weren't focusing on.

Dr Andrew Greenland: 4:26

Got it. Um we'll come back to Dr. Bredison's work in a moment because I'm a Bredison person myself and I think it's one of our kind of common interests. So we'll definitely delve into that a little bit. But can you tell us how your week looks these days? I mean, what does what does a typical week look like? And I guess there is no such thing as a typical week. But I'm just curious to know how these things pieces fit together in the big jigsaw puzzle of your world.

Dr Ivan Cichowicz: 4:47

So right now it's about four days of, I'll use the word traditional clinical practice. So it's seeing patients, face to face, you know, some of it online. And then one day a week, I'm focusing on building our gonna say dementia education platform and dementia education programs. Um, I mean, research is just always there in the background, it's integrated into like the day-to-day. So this afternoon I'm here after this, I'm just doing an eval for one of our research patients. But the gist of it is really that clinical practice component, and that's just, I'm gonna say, you know, from the time you wake up to the time you go to bed, this is what we're mostly doing.

Dr Andrew Greenland: 5:32

Got it. Um now you mentioned that many dementia patients come to you with mental health pro symptoms, even though the neurologists are prescribing the donezilla mementine and telling them there's nothing else to do. How are you trying to shift that conversation? Because this is this is part of my world as well. I'm seeing dementia patients on these drugs, but I'm very curious to hear your take on this.

Dr Ivan Cichowicz: 5:52

I mean, so the classic patient here who I see is someone who was told by the neurologist or the primary care doctor, there's nothing you can do. Take this medicine, they pat them on the back and they say, I see you in a year. And of course, this causes a lot of like anxiety, you know, distress. Your ego is like, what the heck is you know my future? And a lot of my patients say, Look, I've waited all my life for retirement, and now I'm here and I'm told I have dementia and there's nothing we can do. So a lot of them come into the practice for two reasons. One, they're extremely anxious and overwhelmed, and they're just looking, I'll use the word for an outlet. And two, sometimes the neurologists and the primary care docs just don't know what else to do for these people. And they're like, Oh, why don't you go see, you know, Dr. Chikkowicz? He, you know, he does a lot of dementia work, kind of thinking, well, he'll help calm them down, he'll listen to them, he'll talk to them. So this is how I started getting, I'll use the word, people coming my way. And now what we do is when they come in, we tell them, look, we're not promising anyone cures or anything along those lines, but we are saying with some work and some effort and some lifestyle modifications, we can actually help make your quality of life significantly better. And I want to clarify, I'm still an advocate for medicines. I'm not gonna tell someone, you know, just don't take medications for any X or Y reason. No, I think when you have an illness, you you want to do everything that you can to cure it, but we always want to look at the risk and the benefits of what we're doing. And I'll use the word lifestyle modification really has very little risk to it.

Dr Andrew Greenland: 7:37

So, in terms of the kind of um the different things that you do for them, and you mentioned about the the anxiety and the stress that come with the diagnosis and this kind of take the medicine and disappear into the sunset and come back. What else are you doing with them specifically to help them through?

Dr Ivan Cichowicz: 7:55

I mean, so number one of all of this, it's education. It's just helping patients understand exactly what they have, what does that mean, and what the most recent science says about what we can do and what we can't do. And education is important in two ways. One, it helps people understand what's going on, but number two, it also helps them avoid being caught up in all these, I'll use the word like online scams that are out there now nowadays. Because I see so many of my patients who say, Look, I've signed up for this or I, you know, paid for that. And it's like, look, none of that stuff is where you want to be putting your energy on. Let's put your energy on what we know can make a difference. And we're talking about, you know, exercise, sleep, healthy eating, and these things are gonna provide much more bigger bang for your book than any quick online fix. And hey, I'm a fan of some supplements, I am a fan of some of the technology out there, and I think technology keeps you engaged and can keep you coming back to the things that really help. But there's so much quick fixes, you know, do this, take this, and you're gonna be cured. That I again it's a struggle because a lot of our patients get taken advantage of, they're desperate.

Dr Andrew Greenland: 9:19

Right here. So um, you know, the Bredison thing is a commonality that we have, and in my world, I'm working at it from kind of a functional medicine perspective, an integrated medicine perspective. It's a programmatic, for those people who don't know, it's a programmatic approach to optimizing brain health. So you've talked about some of the approaches that you have. How do you cover off all the other things that Dr. Bredison would like people to do to optimize their brain health?

Dr Ivan Cichowicz: 9:43

I mean, so in all honesty, we I'll use the word, don't have the maybe uh ability to do the full Bredison protocol with everyone. But what we tell people is this exists and it's not about being perfect. It's the more things we can do, the better chances you have. Okay. So and and a good example is w some of the Bredison protocols is let's say with ketosis. So I'm not gonna give someone a hard time if they're struggling, but I'll try to get them, look, one week a month, let's try to get you there. And let's see if you can do one week a month, then the rest of the time it's okay. And little by little, because they see that there's improvement, it's easier for me to get them to say, well, I'm gonna do like, you know, two weeks or ten days, and from there I can get them to do three weeks and four weeks. And it's the same thing with exercise. And I think these are the lower hanging fruits. And once I get results there, then I can talk to them about more complicated things that a lot of them say, Oh, that's a big effort, like you know, having their house checked for mold, um, you know, checking if they have sleep apnea, because a lot of times patients are resistant to this. There's like, you know, that's not gonna make a difference. So I try to start with the simpler things that I feel patients can just start to feel better pretty quickly. And to me, those two things are exercise and diet.

Dr Andrew Greenland: 11:16

In your experience, what are the things that patients find most challenging to do on the protocol that uh that you've kind of picked up on?

Dr Ivan Cichowicz: 11:24

I mean, so number one is I'll use the word the buy-in. So there's two types of patients. Patients who are, you know, you explain this to them, and they go out, they buy the books, they read them, and they literally start tackling everything at once. Um and those are easy though. I worry about burnout because they're trying to do a a lot all of the time. And then they're patient the patients who kind of say, Oh, that sounds like amazing, but don't do anything. So I find that sometimes it's the anxiety about what if it doesn't work, or the anxiety about what if I can't do the things that I have to do to get better, because they'll come back to, but is there not a pill that I can take that makes it better? Because that's easy, it's straightforward, you don't have to put an effort. So the real challenge is convincing people that if we change how you deal with your life, you can get better and explain to them why. So if we can bring down inflammation in your body, that's gonna be good for your brain. And even though we can't say that that's gonna cure your cognitive issues, it's gonna make your cognitive function better. So even if we bring down inflammation 10%, I try to tell them, you're gonna be 10% better. And the more that we work on that, the better that you're gonna get. So the bigger challenge is that first step. I think once they start doing the steps, they start to notice that there is improvement in how they feel. And and the other challenge is sometimes getting buy-in from family. Because sometimes the patient is like, I want to do it, but then they tell me, look, my significant other still, you know, wants to have donuts every morning for breakfast, and it makes it hard on me to to kind of say no. So it it's uh, I'm gonna say, usually about a month to a month and a half of I'll use the word kind of behind the scenes work, of trying to push people and educate them and showing them, you know, information and talking about other patients who've had success until we can I'll use the word kind of get them there. And then once they start following up, then they can start feeling better, and then they'll say, like, oh, I'm gonna go see if I can find a dentist who can help remove like any like old feelings that I have in my mouth. But I usually feel that it works best when we start like a little bit at a time.

Dr Andrew Greenland: 13:57

Okay. Now you just mentioned buy-in, which is really, really important. What about the the the the reverse situation where a lot of patients are often brought in by their relatives, and actually trying to get uh the buy-in from the patient can be the challenge because they've kind of been brought there, not necessarily your willing partner, but sometimes it's um there's a bit more resistance.

Dr Ivan Cichowicz: 14:18

So the one thing that I found is when the patients don't come in, it's that they're brought in by their family. The easiest place to start was with modifying diet, and the way we address this is by convincing the family member who brought them in to just say, Look, we're just not gonna do pancakes for breakfast anymore. We're gonna, you know, have eggs or w you know, avocados, whatever it is, and trying to just start there, because it can be very hard for someone who has I'm gonna use the word like either mild dementia, because usually when they have NCI, I can talk people into this without too much, I'm gonna say, back and forth. But when they have mild dementia, they're usually more at the like, you know, what's the use? I'm just gonna eat ice cream all day, or I'm just gonna watch whatever news channel they like, or watch, you know, Netflix. So those can be very challenging. And this is where family again can be just super useful because if the significant other says we're going out for a walk, they'll usually kind of like go out for a walk, or I made arrangements with the neighbors to go out for dinner. Works a whole lot better when than when they're here telling me you have to convince the patient that he needs to call his friends and and talk about his week. That is just very hard to do. It's a matter of convincing family to help facilitate some of these things.

Dr Andrew Greenland: 15:51

Yeah, no, I hear you. I I share the same exactly the same experience as myself. It's that's why it's so interesting talking to you as a fellow Bredison person. Um and what's your kind of take on the patients that come in on the drugs and how do you frame that? Because I think a lot of patients say sometimes think, well, the Bredison Protocol is an alternative to the drugs, they want to stop taking them. How do you kind of have that conversation with patients and what's your kind of take on them?

Dr Ivan Cichowicz: 16:14

So the the way I look at it is look, you know, everything working together can be extremely helpful. And if you're on the medicines and you want to stay on the medicines, that is perfectly fine. If you're on the medicines and you don't want to take the medicines anymore, I kind of tell them that can be our goal, but in order to get to that goal, we need to do some of the work behind you know these Bredison protocols so we can get there. So it's kind of like if you put in the effort now, we can then work on on getting you off the medicine. I I guess my bigger challenge, to be honest, Andrew, is because we work as a lot of times as a collective, so these patients see me, they see the neurologists, they see their primary. My apprehension sometimes with messing too much with these medicines is it causes distress and anxiety in some of the other docs. So as long as these medicines are not causing distress and the patient doesn't have an issue, I would rather leave them where they are and just work on, like you said, you know, this more integrative or like Bredescent protocol type of way of managing symptoms than trying to tell them, look, this is better than the medicine or worse, because I don't want them going back to the neurologist and getting into arguments about what you did, what you didn't do. It just then the patient care gets a little bit more fragmented.

Dr Andrew Greenland: 17:46

Do you have any sense of the kind of patients that tend to do well on the protocol from your experience and your kind of observations of seeing individual patients playing out their own kind of case studies?

Dr Ivan Cichowicz: 17:57

Um, I mean, so at this point, I'm gonna say like the people who really, really do the best are the people who have any degree of motivation. And when I have someone who comes in saying, I have a friend, a family member who was seeing you, and I know you changed some things and they're doing better, and I can see it, I think those people do really well. Because again, they they're motivated, they're willing to put in the work. Those people do really well. Um and not only to be honest, in patients who have dementia, but sometimes even in patients who have depression and anxiety, following basically kind of the same protocol, though people will get better also. And this is why I I think this is so powerful. You know, if you treat your body better, your your brain is gonna work better. The hardest part is is the the motivation and the buy-in. So the I'm gonna say the more motivated you are, the better you work because it's just it's so much more effective if you I'll use the word like do significant changes to your diet than if you just eat one less donut every day. When you eat one less donut, you're not gonna notice a big difference. And I get it, some people need to start there, but when you can significantly change diet, exercise, social connections, I mean these things make a big difference. When my patients say, like, yeah, now that I'm going out twice a week, I actually kind of look forward to stuff and being out of the house, I enjoy things.

Dr Andrew Greenland: 19:31

I agree. I think my observations are very similar. It's uh so gratifying hearing it from your side, and obviously you're in a different country to me, which makes this interesting. Um, you've mentioned about the team. This this kind of is a team sport, really. You've mentioned the kind of interplay between you, the psychiatrist, and you're as you the psychiatrist, the neurologist in the primary. How does that work out? And how do how do we get good kind of team dynamics in managing these patients?

Dr Ivan Cichowicz: 19:57

So I think the best thing that has happened, I'll use the word on my end, is there's an endocrinologist in the area who is also very well educated in these protocols, and we can always work together with patients. So that part is, I'll use the word, very rewarding and satisfying. And then also because of where I'm located, there's um uh I'll use the word, there's a lot of direct primary care, which is more a lifestyle modifications, more holistic, more disease prevention. And working with these docs is a little bit easier. Um the the bigger problem is when you run into, I'll use the word the big corporate medical structure, um, because they just don't have time to like engage on this stuff. It's more like I don't want to hear, you know, any of that, that's nonsense. Just take your medicines and you know, see you in the month. And and that does create sometimes a little bit of a challenge. Uh the big positive is I think things are changing for the better.

Dr Andrew Greenland: 21:04

Sorry, carry on.

Dr Ivan Cichowicz: 21:05

And particularly with dementia, because I feel a lot of patients, you know, there are um all these medicines, and I mean, they're not really that much better. And I have seen patients do much better on medication. This is why I I don't wanna diss the medicine in any way. I have seen patients improve, but long term they they still struggle with symptoms. So we need to have other alternatives than just say, you know, we're gonna help you for a little bit and then you know, pat on the back, just come in once a year and we'll document that you're getting worse.

Dr Andrew Greenland: 21:42

Yeah. So I guess I don't know how um far down the disease process a lot of the patients that you are seeing are, but what role do you see for early intervention, if not even prevention, and lifestyle education playing in the future of dementia care?

Dr Ivan Cichowicz: 21:58

I mean, so I I think. The future is in prevention. This is one of those diseases that, if you ask me, the best way to treat it is by never letting it kind of get a hold in the first place. And this is where, again, big fan of, like I said, diet and exercise, but sleep. Sleep just becomes a very, very important part of dementia prevention. You know, when we're sleeping, it's when our brain is kind of clearing all the amyloid kind of like plaque out of our brain. Um, so I think prevention is just super important. I'm also like a big fan of these new studies for lithium orotate, um, used as a supplement to help. Again, not that this is gonna cure someone who has like, you know, I'm gonna say Alzheimer's, but it just can make a big difference in brain health from everything that I've read. So doing these things is, I'm gonna say, almost more important than treating people. And what I mean by that is because there's millions of people who we can help if we just get them to be a little bit healthier. And they don't have to worry about do we have new treatments in the future? If you never end up having the disease, that's not a concern to begin with.

Dr Andrew Greenland: 23:16

I mean, do you feel um obviously why wider than just dementia, which we will be talking about mainly today? Do you think the field of psychiatry is shifting more towards functional integrated approaches in some of the other conditions, or is it still quite fringe?

Dr Ivan Cichowicz: 23:29

I mean, uh I'll use the word, it is still a little fringe, but there's a lot uh, you know, coming out in terms of functional medicine. You know, there's a recent study now with the keto diet for schizophrenia, and the results, again, we're not talking about curing disease, but we're talking about patients doing a whole lot better. And these are patients who are extremely sick and have significant issues interacting in society. So whatever we can do to move that needle in the right direction makes a big difference. And when you can see that there's improvement in an illness that is so hard on the brain, like schizophrenia, you can just put that together with any illness of the brain will likely have improvement with ketogenic profiles. Now, there's a lot of studies, there was a recent profile for treating depression, and the difference in depression with ketogenic diet versus normal diet was not that significant. But but again, I don't want to just say because you didn't see a huge change in one study, it means nothing, because we've had other studies that have shown big change. And what we're talking about is we don't really know what depression is. Depression is a bunch of symptoms, and they could be caused by a bunch of different things, just like swollen legs could be caused by a bunch of different medical conditions. And the question is, are there one of these types of depression that just respond more to metabolic changes than others? And because we don't still know which one is which, I'm a big fan of treating all as if they were, and that way we're just we're making people healthier in general. Um the Bredison team just recently came out with their paper on their recent trial, and I was listening to one of their YouTube discussions, and I think one of the interesting things, which I do see a lot here in my practice, is that not only were people saying that their cognitive function was better, but they have less joint pains. They their diabetes medicine got you know cut in half or completely removed, their blood pressure is better. And Al Gazura just puts a smile on your face when you're like, there you go. Not only are you better from a cognitive point of view, but now you don't have to take those three diabetes medicines every day. Um because this is kind of what we're here for, to kind of like it's not just load people up with medicines, it's help them live better lives. Um so I think this is the other like rewarding part of this and why it's important, even if it doesn't, again, if it doesn't cure everything.

Dr Andrew Greenland: 26:16

Agreed. And I would tell patients it's not just a program to help them with their brain health, it is a more holistic approach to their overall health, and it's not a bad program for anybody, regardless of whether you have dementia. If you actually look at the different pillars, it's actually a very sensible, holistic health plan for you know longevity and uh vitality and long life. So I think it's a great program. Now tell us a bit about your education platform that's either in the pipeline or I don't know where that where you are with it, but just tell us a little bit about what you're working on.

Dr Ivan Cichowicz: 26:44

So it's it's in the pipeline. I'm hoping to be ready around April. But the idea is we're kind of making it in, I'll use the word 12 we we call it little pillars where people can focus on, and we're trying to get people to focus on one area at a time so it doesn't become too overwhelming. And it's gonna be educational videos and support groups. So the idea is because lifestyle modification is hard, if we can support people and make them part of a community, then they can push each other and help each other and just make this whole change in lifestyle al almost like I'm gonna say like a family plan as opposed to like an individual endeavor. And and all this came out because, you know, I keep looking at studies, and the problem with a lot of these studies is people who get education don't do better because they can't incorporate that education into their daily life, or they do it for two or three weeks and then they're done. The people who do better are the people who get education and support. But not everyone can afford to have a nutritionist or a dietitian, to have a personal trainer, to have a doctor monitoring how they sleep. So if we can educate a group of people and then unleash those people onto each other and have them support, and now with you know the internet and all these LLMs, everyone can learn more and say, hey, I you're struggling with this. I I found this out, and then the MDs, we can just be in the background making sure that the information provided is accurate, clarifying if things come up that are not correct, and just pushing people day by day to like incorporate this stuff into their life. So that's the the the kind of the whole idea. And then we're trying to make it a little bit, I'm gonna use the word more cool, by trying to incorporate technology into it. And educating people about you know different apps that they can use to track things, different devices that can let them know if their sleep quality is better or not, you know, and and and again, and just try to stimulate people to be able to use the word kind of compete against each other and show each other what their progress is.

Dr Andrew Greenland: 29:11

Well, I certainly wish you all the best with that project. Very happy to put it on the bio page when it's ready to go to promote it. Sounds like a really good piece of work. So and it's coming up, April is not far off.

Dr Ivan Cichowicz: 29:21

So not far off, though we're kind of like scrambling with everything right now.

Dr Andrew Greenland: 29:26

So as we both know, doing the clinical work is one thing, but building sustainable systems around it, that's another challenge entirely. So, from a business perspective, clinic perspective, what's working really well for you in the work that you do?

Dr Ivan Cichowicz: 29:38

So I'm gonna say everything that is dementia related is doing really well. Now, I acknowledge I'm you know in South Florida, which is kind of the retirement capital of the world. So there is a lot of interest and a lot of need in everything that is dementia related. The bigger challenge is one, how do we get in front of uh of patients? Because doing functional medicine, functional psychiatry, like if I see 12 patients in a day, it's like a it's a busy day. I I I don't do these like you know 40 or 50 patients a day, so that means I can't really help a bunch of people. And also my patients need a lot of support. I don't just meet with them, you know, give them a bunch of handouts and a plan and send them home. No, I'll meet with them again, you know, in two weeks, maybe, and then in another two weeks, and then once they're settled in and they feel that they're doing better, we'll maybe meet once a month or once every three months. So the big challenge is how do we make it so we can have people or we can have enough people getting help? And I try to talk to other doctors, but a lot of them just don't want to touch anything that has to do with dementia, with like a 10-foot pole. They're like, that's you know, overwhelming, complicated. Uh, I don't want to go there. And this is where kind of cognitiva came up when we're trying to figure out how we can address the situation because my worst online reviews are from people who call and they say, the next appointment is in like six months. You know, what do they think that I have six months to wait? Uh, but I I don't have a good solution for that. So hopefully this will help.

Dr Andrew Greenland: 31:22

Um, just tell us a little bit about Cognitive again, if you wouldn't mind.

Dr Ivan Cichowicz: 31:26

So again, it's gonna be an online platform. We're gonna do education, we're gonna do groups uh where we support people with cognitive disorders, caregivers, just I'm gonna say bring longevity seekers, education, support, and then we're gonna try to create an online community for everyone to push each other and almost I'll use the word kind of gamify it, so you're always motivated to come back and show what your progress has been.

Dr Andrew Greenland: 31:55

Got it. Okay. So um that will hopefully help with the scaling thing. But apart from the scaling and reaching more people, what are some of the other challenges in running the business, the practice, and the work that you do?

Dr Ivan Cichowicz: 32:07

So the the other part that always you know is an issue is the traditional American healthcare system um and you know the functional medicine system. The the way medicine works is you know it's fee for service. So basically, the way to make money is to see the most amount of patients in the less amount of time. And whenever you try to break that model, it it's always going to be hard. Um number one, it's the finances again are are not as good as if you just see volume. You can move to cash, but then of course you are only helping a small segment of of the population. And to make it even more complicated, so some of the things that I really like to do is I like to do cognitive batteries. So I know where people are when they're starting. We can do them a few months later, we can do them six months later, we can do them a year later, and we can actually show people, regardless of if you feel that things are better, worse, or the same, we have objective measures of what's going on with cognitive functioning. Um, but a lot of the stuff is just not covered by insurance or payers. In order for it to be covered, it just like you know, you need to have had recently had a TBI or had a stroke, or there just needs to be so much information in those notes that we can we can't get this stuff approved. So we tell patients, look, we're selling it at the lowest, I'll use the word like price that we can manage, but it's still frustrating when someone says, I'm not able to afford this, and therefore we don't have uh an actual marker of where we're at. And and my thing is, you know, I like many mental status exams. I like the mocha, but you have to have like cognitive issues that are significant for that to show up. If you're just worried because cognition is not as good as it used to be, but you're not, I'll use the word bad, we can miss a lot of stuff just because we're we're not doing the right, I'll use the word the right testing or the right screening. And those are the screens where we kind of struggle. So I like, you know, the Crayon system, the CNS Vital signs. These are like amazing platforms. It's just it's not as easy to get insurance companies to agree that these are great ideas. So that's always the hardest part, you know, trying to mix in good treatments with what I would say not making financially burdensome on patients.

Dr Andrew Greenland: 34:49

Got it. So what what for you is the biggest time drain in all the things that you do? Um, if you had to kind of specify, what would it what would they be?

Dr Ivan Cichowicz: 34:58

So there's two time drains. One I really enjoy, and this is I'll use the word learning about this all new aspect of health that we really kind of like never focused on when we were in medical school. So this is you know listening to podcasts just like yours, it's reading books, it's you know, I'm gonna say even social media, LinkedIn, there's just so much information out there. It it is time consuming. And I get why some people say, like, I just don't want to be bothered because it it does take away from you know other things that you could be doing. So that is a time drain, but it's a nice time drain. The the other, I'll use the word negative time drain is again it's managing when you come up against the system and all the time it takes to work this. So easy examples is trying to get visits covered that all that we did was functional medicine. Insurance will sometimes look at the chart and say, Oh, I'm not paying for that. Um, there was no prescription like provided, and you're trying to remind the insurance and psychiatry is more than just writing a prescription. I've had situations where insurance companies just deny bills because it's dementia. Psychiatry shouldn't be treating dementia, and it's trying to remind them, well, but I'm a geriatric psychiatrist. This is literally what I do most of the day, treat behavioral issues and dementia. Um so that pushback is the part that is a lot of times the most frustrating when you're a geriatric psychiatrist and you get an insurance saying there's no need for you to be treating anyone with dementia. Um if you change the diagnosis to you know mental health primarily, we'll we'll be happy to pay.

Dr Andrew Greenland: 36:42

Thank you. Um obviously you've got your platform about to launch at some point. Now, I suppose what would happen if you had a sudden influx of ten times more interest in your services as a result of the success of your endeavors and your platforms? What would actually happen?

Dr Ivan Cichowicz: 36:59

So my actual goal is that if we're successful, I will be able to leverage that success to get other psychiatrists, other primary care doctors and other neurologists in particular, more interested in this functional way of treating not only mental health but cognitive disorders. Okay? Because I think my the bigger problem right now is a lot of docs, like I said, just see volumes of patients and they're like, I hear that what you're doing sounds interesting and that it could be good, but it means I have to stop doing you know, what's lucrative, I have to stop doing what I'm used to doing to like figure new stuff out and that they're the way of looking at it is, you know, the juice is just not worth the squeeze. I'd rather just keep doing what I'm doing because I have a full practice, I'm making good money. But if they can see success, if they can see excitement, I think that gets them to start asking questions about am I doing enough or what is it about this that I hadn't seen before, or that maybe I have to reconsider.

Dr Andrew Greenland: 38:13

And if you were starting again tomorrow and you're building your practice out from scratch, what would you do differently, if anything, with everything that you now know? I know hindsight's a wonderful thing. I was curious to know what you might do differently.

Dr Ivan Cichowicz: 38:25

Um so to be honest, I would the the bigger thing I would do different is I would just make sure that I were branded as more like functional psychiatry and functional cognitive medicine. Um because sometimes we get into the situation where patients come in and I talk to them about this stuff, and they do tell me, like, I'm gonna be honest, like, I'm happy that you think I should do this, but I just want you to give me pills. And I again it's nothing against this. Um I I prescribe medicines to most of my patients, but it's not what I enjoy. So the challenge would be, you know, trying to there's a bunch of other psychiatrists that can do that, and focusing more on my of my energy into that whole functional space.

Dr Andrew Greenland: 39:17

And thinking ahead for the next year or so, um, what would you where would you like to be in six, twelve months' time? I know the platforms are coming out, and that's going to be a big chunk of what you're gonna be doing over the next year. But do you have any other particular aims or ambitions um going forward?

Dr Ivan Cichowicz: 39:31

So, of course, number one, it's getting the platform up and running, getting people subscribed, and having people, I'll use the word, know what it is and everything related to the platform. But the other thing I would really like to do is little by little incorporate more, um, I'll use the word interventions that could be helpful for cognition and for brain health into my existing practice. And when I mean interventions, there's things that can be helpful. It's just some of them are expensive, they're just hard for someone to have in their own house. If there could be a place where these things could be readily available and patients could just come here, benefit from it without having to spend thousands of dollars on any of these devices or or treatments, because we could spread the cost of this between, you know, hundreds of people, that would be I'm I'll use the word like super exciting, and I would really just enjoy the having people coming in and out and seeing them take advantage of all this stuff. And and a lot of this stuff is I'll use the word straightforward and simple. Look, we know that saunas can be helpful for cognitive health. Um some interesting literature coming out about you know, red light therapy, um anything that helps people like relax and meditate, just providing educational stuff on healthy eating, but sometimes people just don't even know where to start. And having groups that focus on that, that focus on stretching, on exercise. Uh a lot of my patients, you know, can't go out and start running marathons. They're kind of chair yoga type of patients. But if you don't know where to go and learn about your yoga, it it can just be like overwhelming to begin with. Because again, the 25-year-old can just go online and figure this out, but my 70-year-olds, a lot of them are just not that comfortable getting online and just clicking everything and sending messages from their phone. So having these services all in one place, I think would be like an amazing service to the community.

Dr Andrew Greenland: 41:46

And with that, Ivan, I'd love to thank you so much for your time this afternoon. It's been such an inspiring and thoughtful conversation. I feel like I'm dealing with somebody in my world because we do very similar work, and it's very interesting to hear you sharing your experience about your approach and what you're building. So thank you very much, Ivan. Really appreciate it.

Dr Ivan Cichowicz: 42:02

Thank you, Andrew. It's a very pleasure being here.