These FAQs are designed to provide a better understanding how we work

What can I expect in the initial evaluation when I see Dr. Heffner?

During the evaluation appointment, which usually lasts for 1.5 – 2 hours, a detailed complete history is obtained. This includes information regarding the current mental health symptoms and concerns that you are experiencing and which lead you to seek assistance in regaining and maintaining your mental health (or physical health, in the case of those seeking more help with Functional Medicine concerns). It also includes a history of past mental and physical health conditions and treatments, a physical Review of Symptoms, a developmental, family and social history which includes a history of substance abuse and trauma/loss, a full Mental Status Examination and possibly a physical examination, should it be indicated. Review of any previous laboratory testing as well as the online Medical History and Biochemical Imbalance Screening which had been emailed to potential patients at the time that the appointment was scheduled. Often, functional and specialized testing may be requested following the obtaining of the full history. It is generally the case that medication or specific treatments are not recommended following the first appointment pending results of the testing.

What are the signs of hypothyroidism?

There are multiple causes of hypothyroidism; however, the general physical symptoms are quite similar. The underlying cause cannot be determined just based on the symptoms; detailed specialized blood testing including free and total T4, free and total T3, reverse T3, TSH, Thyroid Peroxidase Antibodies, and Antithyroglobulin Antibodies. In addition, Wilson’s Low Temperature Syndrome is a condition in which a person’s body temperature is significantly lower than the typical 98.6ยบ F; it is caused by difficulty converting T4 into T3, instead producing excessive reverse T3 and signs of a functional hypothyroidism although standard thyroid testing often does not identify it as being present. Functional Medicine approaches can guide and assist with multiple forms of hypothyroidism.

Physical symptoms of hypothyroidism include: 

  1. Fatigue
  2. Increased sensitivity to cold
  3. Constipation
  4. Dry skin
  5. Unexplained weight gain
  6. Puffy face
  7. Hoarseness
  8. Muscle weakness
  9. Elevated blood cholesterol level
  10. Muscle aches and pain
  11. Pain, stiffness or swelling in your joints
  12. Heavier than normal or irregular menstrual periods
  13. Thinning hair
  14. Slower heart rate
  15. Depressed mood
  16. Impaired memory

There are other conditions that often are related to hypothyroidism; they include:

  • Infertility or frequent miscarriage
  • Acne
  • High cholesterol
  • Irregular periods
  • Low libido
  • Fluid retention
  • Difficulty swallowing
  • Respiratory difficulties
  • Iron-deficiency
  • Glaucoma
  • Frequent headaches
  • family history of autoimmune disease, such as celiac disease or gluten intolerance, lupus, Type 1 Diabetes, Inflammatory Bowel Disease, Multiple Sclerosis, etc.
  • Family history of goiter
  • Family History of prematurely gray hair
  • Family History of Elevated Cholesterol

Why are Functional Laboratory Tests being recommended for Psychiatric conditions?

Many Psychiatric conditions are related or even caused by physical conditions, including nutritional deficiencies, gastrointestinal infections or imbalances, food allergies or sensitivities, thyroid dysfunction, adrenal fatigue, biochemical imbalances, mold reactions, Lyme disease, autoimmune disorders and many others. If these are not looked for, they will not be discovered and often the conventional treatments do not address the underlying causes of the symptoms. It is like putting a band-aid over a cut rather than taking out the knife that caused the bleeding to happen to begin with.

What is Holistic and Integrative Psychiatry? How is it different from other types of Psychiatry?

Holistic, Integrative and Functional Psychiatry looks to find the underlying cause of a person’s mental and emotional symptoms and address that cause rather than just treat the symptoms themselves. Treatment techniques are also often different than in conventional psychiatry – which predominately uses specific types of talk therapy and prescription medications. In Holistic Psychiatry, multiple forms of treatments are offered and are individualized to the specific person based both on the underlying cause(s) of their condition as well as the patient’s preferences for treatment. There is typically not a single way of treating any problem. Treatment options may include the use of Advanced Nutrient Therapy, Nutritional or Lifestyle Modifications, Supplements, Herbs, Amino Acids, Stress Management Skills, Biofeedback, Neurofeedback, Essential Oils, detoxification methods including far infrared sauna and ionic footbaths, Hyperbaric oxygen therapy, Cranial and Intranasal near infrared light, Cranial Electrical Stimulation and more, including prescription medications. 

Do I have to change my diet and lifestyle with this type of treatment?

There is no single way to address a person’s condition. Modifications in diet and lifestyle are discussed and education regarding the reasons that these changes may be helpful is provided. There are many options, and if a person is completely set against making any changes in their nutrition, sleep, amount or type of movement, and stress management, this type of treatment will likely be less beneficial for them. It is important for each person to accept responsibility for their own health. No doctor or healthcare provider can “cure” a person who has a chronic condition alone but true health and wellness is the result of a collaboration between the person with the condition and their helpers. The actual meaning of the word “Doctor” is from the Latin word meaning “teacher” – education is the primary role of the physician but unless the individual works with the program recommended by their healthcare provider there is no change.

Why do you often recommend Nutrigenomic Testing?

Nutrigenomic testing is still in its infancy, however, we are beginning to understand some of the information that can be gained from a person’s genes, together with their symptoms and laboratory testing, in order to understand some of the underlying causes and/or some treatments that may be beneficial. As the years go by, more knowledge will be gained and true personalized medicine/treatments will be possible.

Usually the recommendation for obtaining Nutrigenomic Testing is not a first line option. However, if there have been limited benefits from treatments that generally are effective or there is a family history of problems suggesting a genetic contribution, Nutrigenomic Testing can prove very useful. In addition, many people have gotten their genetic data done through companies such as or other similar companies and would like to have more knowledge about themselves. Dr. Heffner is able to consult with people regarding the interpretation of this data.

Do you take my insurance?

Holistic Child and Adult Psychiatry is an out-of-network medical practice. We do not participate in any insurance plans due to the nature of the services we provide and the amount of time we spend with each patient, which are significantly different than in conventional psychiatric or medical practices. If you wish to have your insurance reimburse you for any of our fees, please contact the insurance plan and ask if you have out of network benefits. A detailed invoice that includes the CPT codes and ICD-10 codes required by insurances is available .

Initial evaluations, either for Psychiatric or Functional Medicine conditions, typically are 2 hours in length. On-line information via the Biochemical Imbalance Screening Test and Living Matrix Medical History Questionnaires are requested to be completed before your initial appointment. Please also complete the Consent for Treatment, Policies and Procedures and Privacy Policy forms from the Home page of this website to the appointment, or email or fax them beforehand.

Follow-up appointments are either 30 minutes for a straightforward review of progress, simple lab results or medication/supplements without significant counseling or complications. For more complicated follow-up situations, counseling or therapy, reviewing complicated lab reports (such as genetics, Organic Acids, and several specialty tests), or other reasons requiring a longer times, 60 minute appointments are necessary.