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Many Options to Attain
Mental and Physical Health

Some months ago, in this very space, Dr. Mona Gupta described her childhood years in Florida, when she spent a good deal of time with her physician parents as they engaged with patients who needed their special skills and training. Her mother, Dr. Shobha Gupta, continues to practice as a psychiatrist in Florida. Her father, Dr. Rajendra Gupta, a gastroenterologist, recently passed away on October 5, 2018.

Dr. Gupta

“In a sense, I began ‘making rounds’ very early in life,” she observes. “On the weekends, especially when I was not in school, I would often make hospital rounds, separately, with both parents. At times I would go off with my father, if a babysitter was not available, to an emergency in the hospital. I might, for example, be on hand to watch him do surgical procedures—which was a normal part of my life at the time.

“That world—where medical practice and family life blended comfortably, naturally—was the model I had for life and work. And, even now,” she says, “the connection between family and profession is powerful and meaningful. My parents have been models and inspirations in so many ways.”

Absent Guidance

Even in her short-term absences from her Raleigh practice—for her father’s passing, for example—Dr. Gupta remains intimately connected to activities within her practice, relying on a team of highly skilled and committed professionals to provide quality care to her patients.

One of those experts is Morrow Dowdle, PA—a certified physician’s assistant, who joined Dr. Gupta’s practice this past March.

Morrow Dowdle, PA

On a scholarship from the U.S. Air Force, Ms. Dowdle completed her PA studies at the Medical University of South Carolina, in Charleston. One of the core rotations during her PA school was in psychiatric care, she notes, “with a five-week rotation at a psychiatric facility that had a combination of both in-patient and out-patient treatment for patients.”

After completing this basic training, Ms. Dowdle was off to fulfill her three-year commitment in the U.S. Air Force, working in a primary care facility “that included a great deal of psychiatric care—but it was only after I left the military that I began specializing exclusively in providing psychiatric care.

“A physician’s assistant works under the guidance and supervision of the attending physician,” explains Ms. Dowdle. “And Dr. Gupta allows me to see and treat patients exactly as she does, and she is trained as an osteopathic physician and board-certified psychiatrist. Perhaps the main difference I notice between Dr. Gupta and other practices I’ve worked with is her strong commitment to whole health and more holistic care. She takes greater care to address physical health issues and to provide options for more holistic care than was the case in other psychiatric practices I’ve worked with.

Health&Healing: We have a special interest in this issue to explore the range and depth of testing that is beneficial for patients in need. You probably see many patients who are dealing with addictive issues such as opioid or alcohol abuse.

Ms. Dowdle: Yes, absolutely. Of course, at our first visit, we want to do a thorough assessment. And of initial importance is to determine the severity of the presenting patient’s physical dependence.

As part of this process, we do a physical exam and lab testing to see whether there is damage so severe that the patient needs to be in an in-patient facility to detox in the healthiest, most comprehensive way. In this initial exam, we will also assess the effects of possible alcohol abuse, and systematically rule out certain infectious diseases such as HIV or hepatitis if they are IV drug users.

It’s also true that many patients who have drug addictions are also suffering with various psychological symptoms—and we need to determine whether underlying depression or trauma is connected to or driving the addiction issue—or did the addiction begin first and is now causing depression and anxiety?

H&H: Thus, if a patient comes to you and says, “You know, I’m feeling very depressed. I think I need a psychiatric evaluation. Can you do something for me?” How would you respond to that request?

Ms. Dowdle: In our first visit, we want to make sure we are addressing the whole patient—so we certainly get a full background report, looking at whether depression is of recent onset or whether it dates from childhood, whether there was a triggering sort of event or circumstances, or whether it began apparently without any specific cause.

With patients in general, we always want to rule out other potential causes of their depression, such as thyroid disorders, vitamin D or B12 disorders, or anemia. Even conditions such as Lyme disease can play an important role in causing depression or anxiety symptoms—so we always want to make sure that there are no other causative events. The mind and body are one contiguous whole, and things going on beyond the brain can certainly cause psychiatric symptoms.

H&H: You have mentioned that as you engage and work with a patient, Dr. Gupta is your principal resource to report on the condition of the patient, the progress of the patient, and the problems of the patient. If she is absent for whatever reason, does that create a difficult diagnostic problem for you, especially in dealing with a new patient?

Ms. Dowdle: No. I’m very fortunate that I began my career in the military, where we worked very autonomously. It was an extremely busy clinic, and our supervising physicians had a lot of other duties and really did not have the time to allow us to be dependent on them—and thus we learned to operate quite autonomously.

I also was very fortunate when I began practicing in this specialty area to have really intense mentorship my first several months, as I practiced with a particular physician. It was, in some ways, like a miniature residency—so I’m quite comfortable working alone. Of course, there are times when I will call on Dr. Gupta, if need be, to consult with her on a particularly challenging case. She is always available when needed.

Of course, medications are often an important part of the treatment protocol, for certain patients and certain conditions. We do what is called pharmaco-genetic testing, which assesses how a patient’s genes affect the body’s response to medications. It looks at the details of metabolism, and can be very helpful in guiding us to the medication which is the best fit for the patient’s chemistry.