Month: September 2019

September 29, 2019

Promise me you won’t freak out.  I’ve been debating an issue for years.  It’s one of those issues that you can’t talk about because people freak out.  It’s really a debate best held between physicians.  In time I suspect religious authorities and the legal profession will chime in.

Before I go on, let me tell you a little story.  Tonight is the beginning of the Jewish New Year.  As is our custom, Renee prepared a holiday meal and we had family and friends over. Renee out did herself.  It wasn’t a meal; it was a feast.  After dinner, Renee stated that she wanted the meal to be special because it probably will be the last holiday we celebrate in our home.  We are moving to North Carolina in the spring.

As my readers know, I’ve been depressed over my physical circumstances.  The idea that tonight is a “last time” event is depressing.  Renee started me thinking about all the “last time” events we will be celebrating in the months to come.  

As we plan to sell our home and establish our North Carolina life, I am forced to think of all the friends and patients I’ll be leaving in Illinois.  So, I sat down to write an email to Dr. Pamela Wible which led to this blog.

First, let me state that, while moving can be depressing, leading to a lot of last times, it can also be exhilarating.  Moving can be full of new chances, new joys.  Moving can be full of joy.

Now, drum roll, I’ll get to the point.  Dr Wible is an expert on physician suicide.  I told you not to freak!  I’m not committing suicide, I’m just moving to North Carolina (my UVa. friends may think so).  The question I’ve been debating for years is, “If a terminally ill patient or one with a progressive neurological disease decides to end his/her life when life is no longer worth living, is that called suicide?”

Tough question, huh?  Physicians are committing suicide at a ridiculously high rate and Dr Wible is the expert, so I sent her this question.  I figured its time to seek her opinion.  Remember, I asked you to “not panic.”  I fully suspect that I will piss a lot of people off.  The reality is that the question needs an answer and will probably never have one.  

So why open this can of worms?  Over the years, I’ve had terminally ill patients, patients degraded by their diseases and in severe pain, take their own lives.  Their deaths were listed as “suicide” and suicide has an extremely negative connotation. It leaves a horrid legacy for the surviving family members.  When dealing with a life ending disease, it should not.

I am moving to North Carollina with my wife, daughter and son, granddaughter and future grandson.  I have four other children and 3 more grandchildren. I told you not to worry, I have a lot to live for and hopefully a long time before my Parkinson’s steals the quality and joys of life from me.

“All natural” are two of the most abused words in the English language.  Advertising firms have successfully made “All Natural” synonymous with “healthy/good for you” and “safe!”  If only that was true.

Vitamins, minerals, herbals and homeopathic products are often touted as all natural and come with an assortment of miraculous promises and outlandish prices.  Rather than immediately recognize the obvious lie (pills don’t grow in nature; they are manufactured on a production line), patients fall for the premise behind the lie and spend a small fortune on questionable pills.

“All natural” vitamins, minerals and cofactors come in the fruits and vegetables you find in your local grocers or farm stands.  If you have money to burn, buy a Vitamix or Ninja and make delicious, “all natural” drinks.  You control the content and quality.

If you don’t have money to burn, eat the whole fruit or vegetable.  If your doc has diagnosed a true vitamin deficiency, he/she will often prescribe the specific vitamin at an appropriate dose, to be bought at a known and trusted vendor. 

Here’s an article from 2012 reviewing one specific product. In 2019 all you have to do is go to the internet and you will be bombarded by adds for products like the one described below.

May 25, 2012

Now I’ve seen everything.  I’m outraged and disgusted by the unscrupulous marketers that prey on my elderly and the unsuspecting patients who seek health in a bottle and instead pay good money for snake oil.

I’m equally frustrated by the fact that these same patients either shun conventional medicine or can’t afford the pills that have been proven to improve or even save lives.  Recently, I’ve written about the harm done by Pharma’s TV advertisement of their merchandise.  You’ve all seen the commercials proclaiming that product “X” can save your sex life, helping you be ready at a moment’s notice while warning of the dangers of a four hour erection, loss of vision, back pain, or worse.

The purveyors of snake oil have no such restrictions and make no mention of any negative associated with their products.  Today, my patient brought in the “dietary supplement” her father purchased at the cost of $70 FOR 64 OUNCES (my children tell me typing in all caps means I’m yelling).  Product “Y” claims to be full of trillions of “redox signaling molecules” essential to life.  Product “Y” claims to be natural.  It comes with very specific instructions and is to be taken 2 ounces once or twice a day ($2 – $4 a day).

This miraculous substance, cheap at about a dollar an ounce, is salt water.  Yes, the label lists the ingredients as distilled water and Sodium Chloride (salt).  The label also proclaims that the product may have a chlorine odor as the product has trace amounts of natural chlorine.  Yes, the miraculous product appears to be chlorinated, distilled and then salted water.

Salt water for a little over $1 an ounce.  What will they think of next?  By the way, this product is sold to all comers.  If the FDA had assessed this product, the product warnings would have alerted patients with heart disease and hypertension to the perils of taking salt water.  Yes, salt is essential to life; but too much salt can kill you if you have congestive heart failure.

A little (or a lot of) skepticism goes a long way!  Remember, the life you save be your own.

September 28. 2019

I just got off the phone with my buddy.  I went to Doerfler’s butcher shop to pick up dinner and tomorrow’s meals.  My buddy loves their hot dogs and I picked him up a few.  We both love lamb and they have lamb burgers.  I bought a few of them.

I’m back on a modified Keto Diet.  My friend stated that my problem was that I eat too fast.  I jokingly said that I eat fast because there is not enough time in the day to eat everything I wanted to eat.  His observation was accurate and started me thinking, analyzing why I rush through meals.  Afterall, I love food.  You’d think I would eat slowly and savor the taste.

The reality struck me like a ton of bricks.  I HATE BEING LATE!  I hate it so much that for 35 years I ran a “no appointment necessary” medical practice.  My practice was busiest at lunch and dinner time as sick people tended to use their lunch break to see me or come in after their shift were done.

I HATE BEING LATE meant that, for 35 years, I inhaled my meals.  I’d see patients in room 1 and 3, order the test they needed and then run back into the kitchen to consume fuel (food).  Then I would hurry back to finish up rooms 1 and 3 and move on to the next patients.

Despite inhaling my food and literally running through the halls, patients still had significant waits.  As a physician, you can either give your patient the time he/she needs or treat by the clock, terminating the visit in 8 minutes and moving on. I actually had a physician employee who wanted an 8-minute alarm in each room.  He did not last long!

I can’t imagine working in an appointment practice. Determining how much time a patient needs is impossible.  There is an “Oh, by the way . . .” phenomena that turns a 15-minute appointment into a schedule buster.

Doctor – “Mr. B, you have a strep throat.  I want you to fill this prescription and take the antibiotic twice a day until its done.  Use Tylenol as needed, drink lots of fluids and call me if you have any problems.  Do you have any questions?  Stop at the desk for written instructions.”

As the doc is leaving the room:

Patient – “Oh, by the way doc, I’ve had several episodes of chest pain lasting up to fifteen minutes.  I forgot to tell the nurse.  I’m sure it’s indigestion.”

There goes your schedule.  Thirty minutes later the paramedics are pulling out of the lot and the patient’s heart attack is being treated.  Eight-minute visits just don’t work.

The next time your doc keeps you waiting, understand that most of the time he/she is treating patients who often have complex, time consuming problems.  Read a book, text a loved one and be happy your doc takes the time you need when addressing your health care needs.

I will work on eating my meals slowly, savoring the taste and allowing my satiety center to kick in and remind me that I’m full.  I will work on eating a more appropriate diet and get healthy.  I’ll continue to exercise every morning.  What do you need to do to enhance your health?

Listening!  It’s not hard to listen, is it?  Most of us don’t need any special equipment.  You can listen anywhere.  You don’t have to get dressed in a suit and tie to listen.  So why don’t people listen?

Patients often don’t listen.  They feel pressure to tell their story or make their point.  Often, they have consulted Dr. Google and think they know the answer and what they want.  Others have emotionally bought into an idea and don’t want to discuss it.  They simply want a substance (or don’t want one) and there is no convincing them no matter how strong the data is.

Physicians often don’t listen.  Their excuse is often that they don’t have time, rushing from one patient to another.  One of the most dangerous problems in medicine is called “anchoring.”  When you anchor, you lock into the first item on the differential diagnosis list and fail to entertain the other less obvious diagnoses.

What’s a fellow to do?  I always told my patients that, if they felt I wasn’t listening, to call a time out and call my attention to what they were saying.  When I suspected that my patient was not listening to me or a consultant, I would ask them to repeat, in their own words, what they had heard.

Listening to each other is vital.  Listening with an open, non-anchored mind is essential to developing a healthy body, relationship and lifestyle.  Knowing who you are listening to is critical.  Listening to the static on the internet can be dangerous.  The scourge of measles, once eradicated, is back because people are listening to the wrong sources.

Below is an article published in 2012. Reading THE ART OF LISTENING has reinforced my need for exercise.  I need  endorphins and with persistent exercise, I’ll get them.  

Listen to me.  You want to do everything you can to stay healthy!  You want to clean up your act, eat an appropriate diet, exercise and take the time to enjoy life now, while you can.  Also, say a little prayer.  G-d may be listening.  Tell him chronic illness is not fun and ask for a little help for you, me and the rest of mankind.

The Art Of Listening

Posted on August 31, 2012 by livewellthy

August 31, 2012

Over the last two days, I have addressed the question, “As patients, which qualities in your physicians do you value most?” Yesterday’s article focused on the value of “time.”  Today, I want to focus on the value of listening.  One of the most important skills a physician can develop is the skill of listening to both what a patient says and doesn’t say.  Listening takes time but its value is immeasurable.

In prior articles I have strived to help my readers understand how doctors think.  One of my most popular articles reviewed the decision making process involved in formulating a “differential diagnosis.”  Recently, I was formulating a differential diagnosis for a patient suffering from a sleep disorder.  The diagnostic possibilities were many.  My patient, in typical teenager fashion, was a boy of few words.  When he did answer my questions, his answers were vague.  Luckily, his mother was present for his exam.

Mothers are great diagnosticians.  After all, they know their children better than anyone.  In my experience, once you get mothers engaged in the diagnostic process, they stand a good chance of coming up with an accurate diagnosis on their own.  This particular mother inspired today’s article.  Listening to her was a pleasure; and, sure enough, she made my job easy by coming up with the most likely diagnosis.

My patient’s sleep disorder stemmed from his exercise routine.  In today’s vernacular, my patient was “cut.”  He obviously spent a great deal of the time exercising.  The problem was that his hours of exercise occurred in between 7 -9:30 p.m.  Exercise stimulates endorphins.  Everyone knows about a “runner’s high.” 

According to Wikipedia, “Endorphins (“endogenous morphine”) are endogenous opioid peptides that function as neurotransmitters.^[1] They are produced by the pituitary gland and the hypothalamus in vertebrates during exercise,^[2] excitement, pain, consumption of spicy food, love and orgasm,^[3][4]and they resemble the opiates in their abilities to produce analgesia and a feeling of well-being.”  They also will keep you awake!

Mom, without realizing it, led me to a diagnosis that might have taken many visits and tests to uncover.  She saved a lot of time, money, and hassle.  I’m glad my listening ears were on and functioning fully.

The takeaway message is clear:  listen long enough and you will find gems of value in every walk of life.  The true gems in this story are the endorphins.  If they can keep a young man awake, what can they do for you?  What are you willing to do to get them?  All it takes is a daily exercise routine and patience.  Just remember, you want your endorphins in the morning!

Tuesday was a remarkable day.  I woke up in pain at 4 am as is my usual habit.  It turns out that 4 am is an excellent time to think and compose your thoughts.  The world is very quiet at 4 am.

 Eventually I took my pills.  I take a handful of pills 4 times a day.  When you are sick, life revolves around taking your medication.  I sat down to write.  I had been on ZDogg’s web site the day before and I wanted to write an article thanking the “nurses” that had made my job easier over the years.

Next I made breakfast and then went in the living room (now my makeshift gym) to exercise.  So far, my day was like any other day and I’m sure I’m boring you.  So, I’ll get to the point.

As stated above, Tuesday turned out to be a remarkable day.  My friend/patient picked me up for our weekly lunch.  We went to the Onion Pub.  The food was OK.  The company great.  

The “remarkable” event came next.  My patient/friend had a surgical consultation at 2 p.m. and I accompanied him as a patient advocate would.  The nurse roomed us and the surgeon, a longtime associate and consultant, came in.  I listened.  I watch the reaction of my friend/patient and listened to the surgeon’s explanation.

I was not Dr Segal.  I was not patient Segal.  I was there in a role I never imagined playing.  It was fascinating.  I could listen and process without typing in a computer.  I could listen and process without talking.  I could identify the moment that the surgeon’s medical jargon lost the patient who could no longer follow the conversation.  I noted the anxiety rising in my patient/friend. 

As a third-party observer, I could bring the two parties together, alleviating my friend’s anxiety and interpreting what the surgeon was saying.  I could also clue the surgeon into what my friend/patient was feeling and why.

More importantly, my friend/patient (or is he a patient/friend?) occupied my otherwise boring day with a mentally stimulating opportunity to shed my “invalid” status and add some modicum of validity to my day.  Thank you.

As an aside, by now you should have noticed that on occasion I type “patient/friend” and at other times I type “friend/patient”. My new role can be confusing.  To add to the confusion, this particular friend has also taken on the role of caregiver, watching over my needs, taking me to lunch and reminding me of how much care I’ve provided over the years.

Some of you have commented that my posts had become depressing and that they were worried about me.  Chronic illness is depressing.  Neurodegenerative disorders that slowly steal your abilities are even more depressing!  But friends like this one are more powerful than the highest dose of Prozac.  And maybe, just maybe, this patient/friend who has transitioned to friend/caregiver has helped me discover a new way to help those in need and, perhaps, give old retired physicians a chance to use their skills on behalf of others.

It’s certainly something to think about at 4 a.m.

I’ve started watching ZDogg again.  He is a brilliant educator, entertainer and, at times rebel who is better than ANY of my medical schoolteachers. Today, as he often does, he pays homage to nurses.  Feel free to skip the commercial and go straight to the video.  Just click on the word nurses and you will be taken to the video.

I want to take a moment to thank all the incredible nurses that worked for me and with me over the years.  There are far too many to name.  You know who you are.  In my book, the term “nurse” includes medical office assistants (MOA), licensed practical nurses, and an assortment of other individuals trained to care for patients.

During the last few years of my practice, I was blessed to work with Olga and Darlene.  Not only did they take care of my patients, they also took care of me.  They still call to check on me and offer their help.  While they do not have the education of an R.N., they have the skill and dedication needed to care for the sick and injured. 

I want to thank all of you for taking such excellent care of my patients!  I especially want to thank Olga and Darlene.  As my Parkinson’s and back pain worsened, they did everything they could to make my job easier.  Darlene always knew how to make me laugh and lift my mood.

There is one other remarkable “nurse” I want to thank.  Over the years I worked with Ewa, I witnessed the birth of one of the most dynamic healthcare providers I’ve ever worked with.  Ewa ran my Concierge Practice.  Many of my concierge patients stayed in the program because of the exceptional care and management of their needs provided by Ewa.

The moral of this story is that nurses and those who function like nurses are essential members of the healthcare team and should be recognized for the role they play. Unfortunately, docs, their patients and their staff often forget to say “thanks.”

The next time your doc is running late or you’re upset over some other office issue, don’t take it out on the nurse!  She’s there to care for your needs, not to be reamed for something out of her control.

September 24, 2019

My readers have spoken.  Several have complained that my recent articles have been depressing.  While chronic illness often leads to depression, talk therapy helps alleviated it. I’ve been talking it out on paper.

It’s time to get back to the basic premise of this blog, to educate as many people as I can both about living with illness and prevention of illness.  Today’s article was first published in 2011 and is just as valuable today as it was then.

Differential Diagnosis

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians.  Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list.  While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct diagnosis is made and the patient recovers. 

The differential diagnosis (DD) is one of the cornerstones of modern medicine.  The DD is a list of possible causes of an illness/disorder.  It is formulated based on probabilities and ranked according to the severity of the illnesses on your list.  From the time you walk into your physician’s office, the physician begins building a DD.  He begins collecting data the minute he walks into the exam room.  The patient’s demeanor, dress, movements, speech, skin pallor and posture are just a few of the things a physician observes, even before he begins to interview the patient.  During the interview (history taking), a DD begins to take shape.  The DD is refined during the exam.  Often, laboratory and x-ray results help to further illuminate the DD.  Once formulated, the DD serves as the basis for a treatment plan.

Someone once said, “When you hear hoof beats, think horses, not zebras.  During my training, my residency director would often criticize me by remarking that I was always looking for zebras in a herd of horses.  I would always respond by pointing out what a pity it was that he would never see a zebra.  From my perspective, a gifted diagnostician keeps an open mind and a fluid differential diagnosis.  Case in point:   

A 15 year old has a sore throat, fever and enlarged cervical glands.  Her strep test is positive.  She obviously has a strep throat and should be treated with amoxicillin.  Three days after she starts on her antibiotic, she breaks out in a horrendous rash.  Now her diagnosis is acute allergic reaction.  The doctor treats her rash and places her on a different antibiotic.  She gets worse.  Why?

The diagnosis was obvious but only partially correct.  The differential diagnosis of a sore throat with swollen glands and a positive strep test is extensive.  If your physician anchors his diagnosis to the positive strep test, he misses the diagnosis of mononucleosis.  The diagnosis of the rash seems obvious.  The patient was on amoxicillin and must have developed an allergic reaction.   Again, if mononucleosis (mono) is in your DD, amoxicillin is contraindicated.  Ninety nine percent of patients with mono will develop a rash when given amoxicillin.  If mononucleosis is included in the DD, another antibiotic is prescribed.  The patient does not get falsely branded as allergic to amoxicillin.

Helping patients understand the process and complexity of formulating an accurate differential diagnosis is important for a multitude of reasons.  In today’s stressful financial times, patients look for cost saving short cuts, including avoiding tests and follow up visits.  As stated above, tests help refine the DD and follow up visits help verify the DD or help modify it as new information is obtained.  Patients often stay at home believing they know what is wrong based on their own DD, founded on their life’s experience and Google.  Unfortunately, the stakes are high and too many lose.  Some die.  Even worse, patients leave the doctor’s office with a diagnosis and a treatment, only to get worse.  Because the doctor told them what they have and what to do, they stay at home waiting to get better rather than following up when they worsen.

There is an important take home message!  Your doctor’s diagnosis is always provisional.  You may well have what your doctor told you.  You may also have something else, something further down the DD list or maybe not even on it.  It is critical that the patient, like the doctor, keep a fluid list of possibilities.  It is also important that the patient take an active role in helping the physician formulate an accurate differential diagnosis.  Please, don’t hesitate to add your two cents.  It is one place where two cents is still valuable.

Posted by Live Wellthy at 4/6/2011 6:44 AM

September 23, 2019

What was the most important and memorable day of your life?  Was it the day you met your wife?  Married your wife?  Perhaps it was your children’s birthdays.  Or was it the day your loved one died?  The day you won the lottery?  There are lots of answers and the answers often change depending on your current circumstances.

Mine is the day G-d first talked to me.  I’ve never been very religious.  I would say I’m more spiritual than religious.  In the early days of my practice of medicine, I often had trouble relating to patients whose faith was a mainstay in their lives.  I would support their religious beliefs as they related to their health and that of their families but doubted that their fates were going to be modified by prayer or ceremony.  My science would save them.

Then several things happened.  First, I got a call from Good Shepherd Hospital.  The nurse told me that my DNR patient, we’ll call him Mr. Q, was dying and she wanted me to come over and see him.  Mr. Q knew and accepted the fact that he was going to die.  His wife knew he was going to die.  This was pre-hospice times and he was hospitalized to die in peace. DNR means DO NOT RESUSITATE.

I explained all of the above to the nurse who still insisted that I come in to see my patient.  The nurse was so adamant that I left the office and drove over to see MR. Q.

Here’s the interesting part.  Upon entering Mr. Q’s room, I knew I had to keep him alive!  My gut screamed at me.  I did the unthinkable.  I turned to Q’s wife and told her that I was going to rescind his DNR.  I told her I didn’t know why I had to resuscitate him, I just knew I had to.  I called a code, intubated my patient and sent him to the ICU.

He was alive.  I was in trouble.  I had broken the rules I lived by.  I probably broke multiple medical rules.  When Mr. Q woke up, he scribbled horrible things on the communication board.  They weren’t nice.  He was mad! I explained that, while I did not know why, I needed him to live another 24 hours.  I promised that I would take the tube out in the morning and let him go.  I told him to trust me and he did.

At the funeral, his wife pulled me aside.  She told me I did not know he had a son.  He had not talked to his son for many years and didn’t even mention his son when discussing family history.  His son flew in the night he was in the ICU.  They spent hours together (after the tube was removed) and healed the wounds that had festered for years.

I expected to hear from the Chair of the Department of Family Medicine, the ethics committee and medical staff president.  I expected trouble.  It never came.  I learned one of my most valuable lessons.  I learned to trust my gut.  I learned that no matter how much I thought I was in control, that G-d could always take over and guide my care.

I had several other instances where I could clearly see G-d’s hand in my patient’s care.  I discovered a powerful prayer group in Lake Zurich and will swear I saw an inordinately high number of miracles in my practice.

Then it stopped.  I stopped hearing from G-d.  The leaders of the Lake Zurich prayer group died.  Miracles seemed to vanish.  I grew to believe that G-d went on a protracted vacation.  My calling/profession went to hell.  The almighty computer linked to the insurer/government took control.

I got sick.  Here I am today.  More questions than ever and fewer answers.  Is G-d on vacation?  Am I losing my hearing and just can’t hear him? I am on the back nine and will fight to make the most out of every hole.  One thing I know for sure; I’m supposed to write this blog.  Perhaps visiting the past and writing will help answer my questions.  

Next week starts the Jewish New Year, a time of reflection and atonement for past and future transgressions.  I wish you all a healthy and happy New Year.

The Back Nine

Once again, I find myself looking through my old blogs searching for inspiration and wisdom.  This morning, I found an article from 2014 that was inspired by Mr. Wonderful.  My old readers will remember Mr. Wonderful (W).  Let me take a minute to introduce Mr. W to my new readers.

Mr. W is an older gentleman who has turned his life and health around using a vast assortment of tools he keeps in a notebook.  He has hundreds of positive quotes and inspirational axioms that he uses to bolster his will power and keep him moving in the right direction.

I continue to feel lousy and uninspired.  I force myself to exercise in the morning but do not enjoy it.  I force myself to sleep with my CPAP but really see no benefit (yet). The only things that come naturally and create joy are being with my family, writing this blog and eating.

A great deal of my problem is my weight.  I am approaching the size of a blimp.  I need to shop in the “Big and Tall” section, only I’m not tall.  My shirt could serve as a tent and house a family of four.  My buddy, Will Power, still hasn’t shown up.  Hopefully, the article published on April 23, 2014 will help me find the will to get my weight down to a more respectable level and help me find the path back to health and Wellth.

I’m definitely on the back nine and I want to play every hole I can.  So, what can I do?  One thing Mr. W used to say is, “If you fall down five times, get up six times.” I didn’t fall down, I got knocked down by Parkinson’s, my back surgery and the loss of my profession/calling.  I keep trying to get up but, so far, have been unsuccessful.

I called Mr. W yesterday and we are going to lunch next week.  Hopefully he’ll bring his book.  He’s been a patient, mentor and friend for years.  I’m sure seeing him will help me get up and move on.

I hope this blog will find its way to others, like me, who need a bit of inspiration and wisdom to get them back on their feet.  If writing about the transition from doc to patient and the insights a patient/doc helps one person, then I’ve done my job.

April 23, 2014

Mr. Wonderful was in today.  We spent a little time discussing the “Three Wise Men” article and I told him I was looking for the secret ingredient that awoke my three wise men.  I was particularly interested in his opinion as Mr. Wonderful was not so wonderful once upon a time.

Mr.Wonderful’s transition from an average patient, overweight, out of shape and on lots of meds to his current healthy state was nothing short of a miracle.  In answer to my questions, Mr. Wonderful stated, “I’m on the back nine and want to play every hole I can!”

If you’re a golfer over the age of 50, let Mr. Wonderful’s wisdom serve as your motivation to get and stay healthy.  If you’re not a golfer, find your reason to live longer and healthier and start developing a healthier lifestyle.  

As a doc, taking care of healthy individuals is a lot more fun than taking care of the aged and ill.  Are you on medication?  Would you like to be medication free?  Are you winded on walking several blocks?  Would you like to have more stamina?  Do your joints ache?  Would you like to be pain free?

Jenna and I are here to help you start your journey to health. (At least we used to be).  All you have to do is come in and let us partner with you.  There’s no time better than now.