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Deborah Howell (Host): You know, there's been so much in the news lately about genetic testing today. We'll find out what Gene site is and how it can help us with medicine management and figuring out what medicine is good for certain diagnoses. I'm Debrorah Howell, and my guest today is Elizabeth Johnson, a family nurse practitioner and a perinatal mental health nurse practitioner at Deaconess Hospitals Center for Healing Arts. Today we'll be talking about genetic testing and gene site. Welcome, Elizabeth.

Elizabeth Johnson: Good morning.

Deborah Howell (Host): Good morning. Great to have you on.

Elizabeth Johnson: Thank you.

Deborah Howell (Host): So tell us a little bit about your role at the Center for Healing Arts. I understand you work in the Wellness and Counseling Department, and part of your role is to help patients manage their medicine.

Elizabeth Johnson: Yes, I've been in this role a little over a year now since moving here from the Chicago area, and my role is really looking at the diagnosis and treatment options for women that are struggling mentally and emotionally. A lot of my women, although not all of them, are pregnant or trying to get pregnant. Postpartum going through menopause or other hormonal changes of life that are impacting their mental health. So part of my niche is just really navigating what treatment options may be best, specific to medication or medications, adding or subtracting, starting or stopping. Based on really how that person is struggling and what their need is at that time in their life.

Deborah Howell (Host): Of course, it's all so fluid, especially during the pregnancy period of a Woman's life. So how do you help them really manage their medicine?

Elizabeth Johnson: My first step is approaching to find out in depth more of their struggles and really, kind of navigating what their diagnosis really is. And although I'm not wanting to be hung up on labels or names or judgments of a person's struggle, I think where it becomes really important to identify is it can impact or change how I may treat that person, for example. You know, some women will come to me with symptoms of anxiety, but really they have unrooted or untreated ADHD or vice versa.

They may come to me struggling to focus and concentrate and get all their tasks done, and they're constantly overwhelmed and they have a lot of untreated, anxiety that's really making them feel unproductive and scattered throughout the day. So step one is always gonna be to listen and figure out really, what's kind of the layers and the roots of their onion.

Deborah Howell (Host): Yeah. Yeah. And maybe what's worked for them in the past and really what Hasn't.

Elizabeth Johnson: And where have they sought care or how have they sought care and what avenues of care have they not explored medicine or not?

Deborah Howell (Host): Let's talk a little bit more about diagnosis. How do you know what drug is good for what diagnosis of depression and or anxiety? I mean, there are so many medicines out there.

Elizabeth Johnson: There's a lot of research and there's a lot of studies and there's a standard practice of care that I rely on. Just like a heart doctor may rely on standard of care and quality of care and gold standard, treatments or initiating of treatments, and adding to treatments based on research and studies. So in many ways, I really try to align, mental healthcare with other, medical, struggles and not putting mental health in a silo or in a separate bucket as society and many of us do. We legitimize high blood pressure and of course we're gonna treat that, but maybe not legitimize our depression symptoms or our trauma or those mental health struggles.

So there are studies and there's a lot of standardization of care in terms of diagnoses and linking what class of medications may be right. based on that diagnosis. But I will say one thing that does make mental healthcare a little bit unique is that there's a lot of variance, in how people respond to medication. There's also a large role that our family genetics play, into how we feel and how we struggle, just like genetics play a role in diabetes. So it's complex, but it's also in some ways, not fly by the seat of your pants and, Oh, try this. Oh, try that.

Oh, I'm a Guinea pig. Oh, you know, that can be really disheartening when you're struggling mentally and emotionally. So I think there is a lot of science that we, try to put behind our decisions. Now, at the end of the day, my patient's story and their feedback and how they're feeling is always gonna trump and. How I may treat that patient. Are you thriving? Are you feeling better? Are you doing okay? Does this medicine or does this treatment hurt you at all? What does that look like?

So it's not a perfect science, but it's also not just a shot in the dark. Oh, here, try this, now try that kind of mentality that I feel in years past, maybe we've, been guilty of in the medical profession.

Deborah Howell (Host): Well said. So to the meat in the matter. Now, what is Gene site and how does it help your patient?

Elizabeth Johnson: So for years now we've had various different, genetic testing available to really look at how a person may metabolize psychiatric medications. And based on that data, then we look at, how fast or how slow they might break a medication down and risk of side effects. Now there's limitations to these tests and I'm happy to discuss that throughout our conversation. But really, gene site is the name of one of those tests. And quite honestly, the test I use mainly because compared to the other genetic testing available, they do have the ability.

And the science to test more DNA, than some of the other tests out there. So Gene site, it's a test that really helps me strategize if a patient, is struggling to find the right medication for them, or maybe they've never been on medication for their mental health and they're really fearful, or they've heard horror stories and they wanna say, what could potentially help you as the clinician know what's best for my body? What potentially could cause a side effect. Is there a way that through this testing, maybe we could avoid that? So that's really what the testing is for.

So not only looking at risk of side effects, it does look at the rate at which you break each psychiatric medication down and where that's important is if you break something down really fast, the medication has been excreted or removed. Basically the medicine is gone, quicker than others and so it can lack effect and it doesn't mean you can't use that medication, but it may change how I would dose it for that patient. So somebody that said to me, Oh, nothing works for me. Nothing ever does. I don't feel anything. Nothing works for me.

Which is a very common complaint that I hear, and sometimes it's not necessarily that the medicine didn't work, but maybe the dosing and the timing of dosing was not appropriate to that person's metabolism of that medication. So metabolic rate, now it's the opposite. If you find somebody as I. Poor or a slow metabolizer. Those medications can circulate and circulate and circulate, and that can cause amplified side effects. It can cause the patient to report symptoms like feeling numb or feeling like a zombie, feeling like they're doped up.

So being a poor metabolizer is no funny either, but I think garnering the person with the knowledge is the first step in power to know how to manage it.

Deborah Howell (Host): Yeah, agreed a hundred percent. Now, you mentioned some limitations. Is Gene site good for everyone? Or if not, who's a good candidate for it?

Elizabeth Johnson: I wouldn't say that there's people that quote aren't a good candidate for it. However, I think it's important to talk about what this test does not do. this test does not diagnose, and a lot of people will ask me, so, oh, you're testing my DNA. Does that mean you're gonna tell me that I'm bipolar? Does that tell you that I have PTSD? Does that tell you? And, simply put, this is not a diagnostic tool. This is a tool that I use in figuring out treatment options.

So I always like patients to clarify because there's so much confusion around genetic testing and different genetics can provide a diagnosis. This does not. So first all it's not diagnosing you. Second of all, there's other factors besides DNA that may influence my choice to give or not give a medication. Okay? So for example, let's say you have type two diabetes. You've really struggled with your weight and you have type two diabetes. There may be medications that show up on this gene site that looked to be a very good medication for you.

But if I know that drug causes weight gain and high blood sugar, I'm not gonna give it to you. You've already got high blood sugar and you're already struggling with your weight. So this tool it's not the holy grail in the only way I would make a medication choice. but you certainly still have to look at the patient's holistic healthcare and their whole struggles. All of their mechanics because our heads are attached to the rest of our bodies, so you certainly need to take into account not only their DNA, but really what are your other diagnoses and what are your other medical issues.

The other thing you need to pay attention to that this genetic testing does not touch. What other medications are you taking? So again, I could find on your genetic test that a certain drug looks really good for you, but if I know it interacts with the blood pressure pill that you have to take. I'm not gonna provide it. So at the end of the day, I love this as not being the only roadmap to making choices, but it's kind of like, a few street signs along the way can kind of guide me and provide some tools. so Those are the main limitations.

Now, I will also, That just because of medication may end up, being one that looks genetically better for you or genetically not good for you in terms of side effects or lack of efficacy. It doesn't mean that you still won't see any improvement. So I always tell people the risk to this testing is that you can kind of get a little bit of tunnel vision. You just focus on those drugs that are identified as the better ones. And then some patients don't even wanna consider the other medications that may not be at the top of their best list. So I always discourage patients from that.

And so when they question, why would you give me this medicine? it's not at the top of my good list. Well, there's other factors and it's still maybe at the clinician's discretion worth. Trying. so it's not an exact yes or no science. I use it as just one tool along the decision making tree. Now I also tell you, just as a side note my rule of thumb is I don't test every patient. Not every patient that sees me gets gene site, however, I think people deserve to know what technology is out there, and I actually have a lot of patients that don't wish to have it, and that is okay.

And there's other patients where I'm the one saying, hey, I really think we need this, or I think I need to get this gene site because I'm not sure where to go from here. And. I like every patient to know the technology is out there, that we offer the testing, the pros and cons of the testing, cost of the testing, all of it, but not everybody has to get it or needs to get it that comes and sees me.

Deborah Howell (Host): Got it. Which begs the question, you mentioned cost. Does insurance help with coverage for genetictesting?

Elizabeth Johnson: Often, yes. there's actually phenomenal coverage with it. and any office like my own that offers it usually has information that you can get connected directly with billing on the lab and to see how much will this lab cost. Now I'll speak for Gene site, that specific test, they offer a lot of resources and they are really good with letting people know in advance how much they may owe, if they owe it all. There's a lot of patient assistance and they also have kind of a neat program where let's say you got tested five years ago.

Although your DNA didn't change in the last five years, technology has improved. We're testing more DNA and there's been quite a few more drugs that have hit the market that weren't on your test five years ago. So something like Gene Site, they will retest you anytime in the future if you need it at no cost. So that's kind of a nice feature too.

Deborah Howell (Host): For sure, for sure. Well, we've come to the end of our time, but I'd like to offer you the chance to add anything else you'd like to our conversation?

Elizabeth Johnson: Gene site or not, I just encourage any and all to not be afraid to look at yourself in the mirror and if you're struggling and seeing things in your mind, your emotions, your actions, your behaviors, you're thinking that you are struggling with. It's okay to speak up and to speak out and medications may be so helpful, but maybe not, but not doing anything certainly doesn't help. So I just wanna empower anybody that's listening or hearing or knowing anybody that is struggling is that there are resources in person, online, at our fingertips, people reaching their hands out, willing to help, but really takes the willingness of the person struggling to accept it too. So I just empower anybody listening to just reach your hands up and let us help you out.

Deborah Howell (Host): Yeah, don't go it alone. This is some excellent information. Elizabeth, thank you so much for being with us today to talk about genetic testing and the benefits of Gene Site, we really do appreciate you being.

Elizabeth Johnson: Thank you.

Deborah Howell (Host): And that wraps up this episode of the podcast series from Deaconess, The Women's Hospital, A Place for All Your Life. To schedule an appointment or to learn more, please visit deaconess.com/theWomen'sHospital/services/centerforHealingArts. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women Hospital podcasts. And for more health tips and updates, follow us on your social channels. I'm Debrorah Howell. Thanks for listening and have yourself a terrific day.