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Autonomic Dysfunction

Autonomic dysfunction Philadelphia

Autonomic Dysfunction Philadelphia

Dr. DePace was a full Clinical Professor of Medicine and at Jefferson subsequently and then Hahnemann Hospital/Drexel University.

Dr. DePace has published over 100 articles and abstracts in peer review literature.  He has written two books.  His first book written in 1992 was published by W.W. Norton, New York, NY, The Heart Repair Manual: The Philadelphia Formula for Reversing Atherosclerosis.  Heart Repair ManualDr. DePace has expertise in treating patients with atherosclerosis and was one of the pioneers in developing techniques noninvasively to stabilize and reverse atherosclerotic plaque in individuals with established vascular disease.  His scoring system predated the Framingham risk profile scoring system to risk stratify patients and was published in his 360-page book.

Dr. DePace has done research in valvular heart disease, coronary artery disease and has published extensively on noninvasive cardiology including echocardiography and stress testing.

Dr. DePace treats thousands of patients yearly with various cardiac abnormalities and is a diagnostician.  He has obtained boards in lipidology which is the study of cholesterol.  As being board certified in lipidology, he can treat complex abnormalities of cholesterol both with natural substances and with pharmacology.  His book, The Heart Repair Manual, did focus on abnormal lipids extensively along with diet and lifestyle changes.

An area of interest to Dr. DePace has been autonomic dysfunction, also known as dysautonomia.  The autonomic nervous system is the part of the body that controls the things that one does not normally think of.  These are involuntary actions such as digestion, breathing, and the heart beating.  Abnormalities of autonomic function can cause disabling symptoms and impair one’s quality of life and, when they become severe and disrupt the cardiac autonomic system, can actually be life threatening.  Dr. DePace, himself, suffered from abnormalities of dysautonomia, approximately, 15 years ago when he had recurrent fainting episodes which did not improve over six months.  He also had chronic fatigue which he, eventually, was able to get over.  He then began to research the area in detail.  His textbook, Clinical Autonomic Dysfunction, by Springer Publishers, (measurement, indications, therapies, and outcomes) was recently published in 2015.  It is the only textbook of its type and is written predominantly for medical physicians and doctors but can be used by physiologists, nurses, and other health care professionals.

In 2019, Dr. DePace will be publishing his third book: Clinical Autonomic and Mitochrondrial Disorders – Diagnosis, Prevention, and Treatment for Mind-Body Wellness. Stay tuned for updates on the Publication date.

In the field of autonomic dysfunction or dysautonomia, Dr. DePace sees a large number of patients daily from various parts of the country who have not had results with treatment, seek second opinions, or have not even had a diagnosis.  Many of them are labeled as having psychiatric or psychological issues when, in fact, they have abnormalities of the autonomic function. One of such serious ailments is Postural Orthostatic Tachycardia Syndrome (POTS).

In POTS, there is a sudden increase in heart beat a on standing, exercise intolerance, tiredness, and many other symptoms.

The autonomic nervous system is the part of the nervous system that innervates mostly all of the organs of the body.  There are two principal components.  One is the parasympathetics which he refers to as the “brakes” of the body.  It is very protective and actually can slow down arrhythmias or prevent them from occurring for example.  The other part is the sympathetic nervous system which is the fight or flight.  This involves the adrenaline portion of the body and he describes this as the accelerator of the body.  Normal people should have a normal balance of braking and acceleration in their body.  When one component is dominant, symptoms can occur and disease entities and organ systems can suffer.  For example, patients with depression or chronic fatigue may have too much of the parasympathetic or the brakes on in the body.  Individuals with high blood pressure or arrhythmias and tachycardias may also have too much sympathetic activity or the accelerator.

Dr. DePace attempts to do a full clinical evaluation on the patient and review their records in detail.  He goes through all of the prior treatment plans they have been under.  He does some basic testing of autonomic function and attempts to work with the patient in an aggressive fashion to improve any autonomic dysfunction that is discovered with a scientific approach and not one that is just empiric.  He has treated patients with Ehlers–Danlos syndrome, mast cell disorders, Marfan syndrome, post viral syndromes, patients with reflux sympathetic dystrophy and chronic pain patients, patients with post-traumatic stress, patients with severe diffuse vascular disease, and many other entities and has had tremendous experience in dealing with this.  Not always can a patient be cured but, oftentimes, their symptoms can be alleviated where they can find some clinical improvement and he attempts to maximize their lifestyle if possible.  Many patients are functionally incapacitated with autonomic dysfunction and cannot even get off the couch or out of bed.  These are patients that need to be aggressively looked at to see if there is any possibility of remediation.

Many symptoms that may reflect autonomic dysfunction include chronic headaches and migraines, depression, anxiety, chronic fatigue, severe dizziness and presyncope or pre-fainting, syncope or fainting, pounding heart and palpitations, gastroparesis and digestion abnormalities that may involve irritable bowel syndrome and can involve constipation and diarrhea, and of course peripheral neuropathies which are, oftentimes, associated with autonomic dysfunction.

Diabetics, oftentimes, have a high prevalence of autonomic dysfunction.  However, other disease disorders can be associated with autonomic dysfunction and sometimes even healthy people develop autonomic dysfunction at an early age.  The aging process causes the autonomic nervous system to degenerate in time, however, some people are predisposed to it prematurely.

If you have symptoms or signs of autonomic dysfunction, you may want to see Dr. DePace to get more clarification on the diagnosis or seek, possibly, more treatment options.  Appointments are available, but the entire medical records, or as much as can be obtained, of a patient are usually required.

Again, he emphasizes that many patients with autonomic dysfunction are misdiagnosed or labeled as having psychiatric or psychological problems when, in fact, they do have a real problem that needs to be identified and treated.  Dr. DePace sympathizes with people that are plagued with this disorder since he had a serious bout of autonomic dysfunction for approximately six months at one time.  He is well aware of a lot of the pharmacological agents and treatment modalities since he, himself, took them and could understand when a patient has side effects with various medicines or good results.

Dr. DePace has passed boards in nuclear medicine, echocardiography, cardiology, internal medicine and lipidology.  Three of the boards are recognized by the American College of Physicians at this point.  However, the other two are highly regulated peer review boards.  He has also served on the editorial board of one of the preeminent journals in cardiology, The American Journal of Cardiology, for ten years from 1996 to 2006 where he did peer review for numerous cardiology articles.  He still does active research in autonomic function and has published several recent articles and has several that he is preparing for press at the present time.

In addition, to atherosclerosis and coronary artery disease and autonomic dysfunction, Dr. DePace has always had an interest in valvular heart disease and many of his original publications dealt with aortic valve and mitral valve disease as one of his close family members had a severe mitral regurgitation or leaking problem which required operative repair.

Currently, Dr. DePace has clinical privileges at Hahnemann University/Drexel University, Our Lady of Lourdes Hospital in Camden, New Jersey, and Kennedy Health Care System Hospitals in South Jersey.  He has offices in Philadelphia, Cherry Hill, and Washington Township/Sewell, New Jersey.

One very important feature of Dr. DePace’s practice is that there is tremendous continuity of care.  His nurse practitioner who sees patients with him has been with him for nearly 15 years.  He follows his patients in the Kennedy Hospital System when they are admitted from his office and does both hospitalist work and office work which is a very rare combination for physicians to do in this era.

If you think you may be experiencing Autonomic Dysfunction, please contact one of our offices to make an appointment.