PSYCHIATRY
Douglas Zelisko, M.D. • Board Certified Psychiatrist
45 South Main Street Suite 111, West Hartford, CT 06107
P: 860.615.3629 | F: 860.318.2085 | E: support@drzelisko.com
Welcome back, Chloe. Our goal is to get you feeling focused, energized, and grounded before you head back to Coastal Carolina in August. To do that, we have to look at the full picture of what is happening in your body and your brain.
The Reality of Your Labs
Your recent bloodwork provided a very clear explanation for why you have been feeling exhausted, anxious, and unmotivated:
- Your body is in "Fight or Flight": Your stress hormones (DHEA-S and Testosterone) are highly elevated. This means your nervous system is constantly on high alert, which drains your energy and makes emotional regulation very difficult.
- Your brain is starved for Iron: Your Ferritin (your body's iron storage) is at 13 ng/mL. This is a severe deficiency. Low ferritin causes chronic fatigue, brain fog, and poor concentration. It directly mimics ADHD.
- Your immune system is inflamed: Your allergy markers are high, meaning your body is fighting systemic inflammation, which further drains your cognitive energy.
Medication: Expectations vs. Reality
Psychiatric medications (like ADHD stimulants) can be excellent tools, but they are not magic pills.
If we prescribe a stimulant to a body that is severely depleted of iron, chronically inflamed, and struggling with POTS, the medication will likely backfire—making your anxiety, heart rate, and exhaustion much worse. We cannot out-prescribe a physical deficiency. To eventually explore medication safely, we must build a healthy physical foundation first. This requires your active participation.
Your Daily Protocol (The Exact Blueprint)
To heal your nervous system and improve your focus, you must commit to the following lifestyle fundamentals:
1. POTS & Hydration Timing
Because of your POTS, your cardiovascular system needs extra support to keep blood flowing properly to your brain.
- Waking (0-15 mins): Drink 16 oz of water immediately upon waking up (ideally before you even get out of bed) to help stabilize your blood pressure for the morning.
- Morning to Noon: Consume an additional 24 oz (totaling 40 oz by 12:00 PM).
- Afternoon to 7:00 PM: Consume remaining 40-60 oz. Stop heavy fluids at 7:00 PM to prevent nocturia and sleep disruption.
- Electrolyte Requirement: Plain water is insufficient. You must add sodium (such as an LMNT packet, Liquid I.V. Sugar-Free, Nuun, or 1/4 tsp sea salt + a squeeze of lemon) to at least 2 bottles of your water daily to maintain blood volume.
2. Fueling Your Brain (Exact Timing)
Your brain cannot manufacture dopamine or serotonin if it doesn't have the building blocks (calories, protein, and iron).
- Breakfast (Within 60 mins of waking): Must eat a high-protein/iron-rich meal. Strict rule: No coffee on an empty stomach to prevent cortisol/adrenaline spikes.
- Maintenance (Every 3-4 hours): Eat a balanced snack or meal to prevent blood sugar crashes and subsequent stress loops in your body.
- Morning Supplement: Take L-Tyrosine to support dopamine synthesis.
- Night Supplement (30-60 mins before bed): Take Magnesium Glycinate to calm the nervous system for sleep.
3. Nervous System & Therapy
Your body is currently stuck in a high-stress loop. We need to signal to your brain that you are safe to free up your cognitive battery.
- Sleep Hygiene: Maintain a consistent sleep schedule. Do not let your body oversleep out of stress, but ensure you get a solid 8 hours to allow your brain to clear out inflammation.
- Brain Training (Therapy): We will use our sessions to do ERP (Exposure and Response Prevention) to manage your OCD rituals. Compulsions steal a massive amount of your daily focus and energy.
- Grounding (Clinical Application): Use these specific techniques based on your trigger:
- For OCD Rumination (5-4-3-2-1 Method): Name 5 things seen, 4 touched, 3 heard, 2 smelled, 1 tasted. (Use to immediately break cognitive thought spirals).
- For Baseline Anxiety (Box Breathing): 4s inhale, 4s hold, 4s exhale, 4s hold empty. Repeat 4 times. (Use morning and night to lower baseline heart rate).
- For Acute Anger/Panic (Temperature Shift): Splash freezing cold water on your face or hold an ice cube. (Use during intense relationship stress to "reboot" the vagus nerve).
4. Environmental & Immune Support
Your immune system is wasting energy fighting allergens. The resulting inflammation directly worsens ADHD-like symptoms and brain fog.
- Oral Allergy Syndrome (OAS): Your labs confirmed cross-reactivity between tree pollen and certain nuts/seeds. Pay close attention to raw nuts, seeds, or certain raw fruits that make your mouth itchy or worsen your brain fog, and avoid them. (Cooking these foods often destroys the triggering protein).
- Air Quality: Keep your bedroom environment as clean and allergen-free as possible. Use a HEPA air purifier if you have one, and avoid sleeping with the windows open during high pollen days to give your immune system a break at night.
The August 12th Goal: College Readiness
We have a tight timeline before you return to Coastal Carolina. The habits you build over the next few weeks are your blueprint for a successful semester. We will use our upcoming sessions to adapt this routine for your dorm/apartment and class schedule.
Immediate Next Steps:
- Follow up on today's PCP Labs: Ensure the results from the bloodwork your PCP (Robin Bansal) ordered today are sent to our office.
- Commit to the Protocol: Stick to the hydration, eating, boundary-setting, and supplement routine outlined above.
- Track Your Symptoms: Notice how your focus and anxiety change as you support your physical body this week.