I am impressed with the complexities of sleep. It affects so many aspects of our health--our immune system, our mood, our weight, our ability to heal, just to name a few. When sleep goes awry and insomnia comes knocking at the door, it can be challenging to figure out what each person needs to restore restful sleep...because of all the complexities involved! All of this to say, the appropriate remedies for sleep are highly individual. Today I am sharing my favorite three sleep remedies that work for me, but you may need something different if you are experiencing insomnia.
If you suffer with insomnia and are looking for natural sleep support, you are warmly invited to attend our Relax & Renew Restorative Sleep workshop on Wednesday evening, December 9th from 6-8 p.m. at 2BWell in Springfield (click here to register).
When I was a child, I would lay awake in bed spontaneously exploding with laughter. My mind raced round and round with all sorts of hilarious ideas, and I sometimes found it difficult to go to sleep. As an adult, my mind still occasionally races with thoughts at night making it difficult to go to sleep (albeit the thoughts are usually not as funny these days). My favorite natural sleep remedy for this situation is White Chestnut flower essence. I put two drops in a small amount of water and within minutes, I find it is easier to slow the thoughts and allow my mind to rest. What I love about this remedy is that it does not make me groggy. I can take it in the middle of the day without any risk of tiredness. It just calms my mind so I can sleep.
I also find good, old-fashioned chamomile to be calming. I am not as fond of the tea so much as the fresh tincture that I make fresh from my garden. I usually start my calendula plants indoors around December. They are slow growing! I love growing chamomile through the spring and summer and harvesting the blossoms into a jar of vodka. I collect the blossoms in this jar throughout the season, adding more vodka to cover as necessary. Later in the summer, I strain the tincture through a coffee filter. It is a truly delightful natural medicine with a fresh taste unique from tea or tincture made from dried blossoms. I then bottle this up to use throughout the year. I use about a dropperful in water before bedtime to calm my mind. It tastes sweet and mixes very well with my third favorite sleep remedy--inositol.
Inositol is a B-vitamin, and it also tastes sweet. It, too, helps to calm the mind at night. So, you can see why white chestnut, chamomile and inositol may be a great sleep option for someone like myself who has a busy mind. I do a lot of thinking throughout the day, so these three supplements help calm my mind down so I can get some restful sleep at night. Like the other two supplements, inositol is generally well tolerated and doesn't leave me with a groggy feeling in the morning.
Do you suffer from insomnia? If so, can you identify what keeps you awake at night?
This morning, I went for a walk in the upper pasture with our dog Wilkie and our puppy Gilly. There is a pleasure in seeing how nature turns to autumn--dried poke berries, an old passion fruit left clinging to the vine, seeds dropping off a withered, brown stalk. The cool, moist morning air felt good in my lungs and on my face. It has been a busy week, and the walk in pasture gentled my heart and reminded me of the joy in simply being. To my dogs, it was better than Christmas morning.
As I walked through the pasture, I thought of how our different coughs can be like the weather. Some are cool and damp like this morning. Others are feverish, dry, and constricted like a sharp desert sand storm. In the past several years, I have come to appreciate how coughs differ and how individualizing herbal formulas for each cough yields success beyond what can be found in many over-the-counter formulas. What type of herbal cough syrup would a cough like today's weather need? Ginger and cinnamon chips could offer warmth. Maybe I would add some members of the mint family for their drying and warming properties--horehound and hyssop, but easy on the horehound as it can truly be bitter. Perhaps a gentle touch of elecampane for the same purpose. Like the puppy, add a little sweetness with fennel to make the formula more palatable.
Does it sound complicated? It's not really. The basics of syrup making can be easily learned and then knowledge of seven to nine herbs can get you far in this process. Not to mention, it is fun! Are you intrigued? Then, I warmly invite you to join us on Saturday, November 7th for a class on "Herbal Cough Syrups & Understanding Western Herbal Medicine." In this class you will have the opportunity to make and experience the difference in various cough syrup recipes. We will also discuss how to formulate your own cough syrup formulas and learn nine basic respiratory herbs. We'll look at the science of these herbs as well as the older herbal literature to understand how to individualize your formulas. At the end of the class, you will get to take home an extensive handout and your homemade herbal cough syrup. For more information on how to sign up, please visit my events page.
"Individualized care" is a cliche phrase in healthcare marketing today. What does it exactly mean? For many of my clients, it means that they don't want to be given the same standard care that everyone else gets. For other people, it means they want me to take the time to listen to them as a person instead of as a diagnosis. They want a healthcare plan that is just as unique as their situation.
This can be a tall order in conventional medicine because it is based on standardized care. It is a system that is designed to treat a statistically significant portion of the population presenting with x, y, or z diagnosis. Most medical delivery systems of today aim to treat the majority of people quickly and effectively. It's a fairly good idea if you are among the majority, but what if you are an outlier on the bell curve?
The beauty of what I get to do every day is that I get the gift of time to look beyond disease and diagnoses. My visits are 45-90 minutes completely of actual face-to-face time. I don't fill the entire day with visits. For me, it takes time, consideration, and study to provide individualized care.
The diagnosis is certainly important, but there is so much more to the story than that. Innovative healthcare providers that are challenging the system of "quick and high volume" to truly deliver this deeper level of individualized care.
Let me give two examples of what "looking beyond the diagnosis" looks like for me...
First, many people have been diagnosed with hypothyroidism. Typically, a prescription is written for a thyroid medication with follow up monitoring of blood work and evaluation of symptoms to adjust the prescription dose. But what is beyond the diagnosis is the why. Why did the hypothyroidism occur? What is the underlying cause? The answer to these questions can be highly individual, and it can take additional testing, a very through history to scout out these answers, and time to remove the underlying cause(s). In some, but not all cases, the hypothyroidism can resolve when the underlying causes are removed.
Second, let's say you have a cough secondary to a cold and I were to formulate an herbal cough syrup recipe for you. I would not simply grab a bunch of herbs that are good for coughs & colds in the recipe. I need to know your individualized expression of that cough. Is it a dry, barking cough? Are you suffocating from the mucus in your throat? What are your concomitant symptoms? Are you feeling flushed and hot or do you feel icy cold or both? When is the cough worse--morning, day, evening, night? Is it chronic or acute? These individualized pieces are all put together to form a recipe that works for your cough. Someone else with that same cold may need a completely different recipe because how the two of you express the disease is different even though it is the same disease.
This is what individualized care looks like for me.
As some of you may know, this is a year of transition for me. I have been moving from Tulsa, Oklahoma to the Missouri Ozarks. I began my practice in Missouri in October of last year and officially will conclude my practice in Tulsa this October. April through June, I moved my home to a small farm in Missouri. In short, it has been a busy year, and one of the largest transitions of my life. Such transitions are not sprints, but rather marathons that require pacing.
One of my touchstones this year is "Find a Place of Rest in the Middle of Things." It is a guiding principle I once learned at a training in the Metta Institute. We can always tell ourselves that we will get rest once the weekend/vacation/next year comes, but sometimes that is not enough. For me, it has meant that I need to find places to pause, rest, and be present throughout. Paradoxically, the rest can help me to work more efficiently instead of working continuously through. This is no easy concept and I struggle with it. I love the work I do in life, so I have more stamina to keep pushing through...BUT, it helps if I take the time to rest. Rest for me is not surfing the internet or watching television; that is simply tuning out and escaping. Rest for me has been enjoying a restorative yoga class, taking a 15 minute nap, being quiet, allowing myself to laugh and smile, talking to friends and family, journalling or allowing my whole self to completely do one thing mindfully--like cooking a delicious and healthy meal or create a piece of art. I must admit I can work on incorporating this principle a little more often, but I'm glad I accomplished the rest that I did throughout.
This past week, I let myself enjoy a full week long stay-cation (that's a vacation where you stay at home.) I highly recommend trying one of these! There is no stress in packing to go somewhere or with travel, and the dress code is quite lax. I'm not ending this vacation feeling like I need a vacation from my vacation; I simply feel restored and relaxed. I feel ready to embrace my life work again with increased mental acuity and a re-examined perspective. It has reminded me just how important it is periodically to rest. My other great epiphany this vacation is to loosen my reins on timelines for my goals. I am a very goal-driven person, but I think it is time to simply be for awhile, to put down roots in my new home, and give life a chance to unfold organically for awhile. I know eventually where I want to end up, but pushing too hard right now won't get me where I want to be. As the saying goes, it's time to just go with the flow.
I hope you will find the time you need to rest as well, whether that be a vacation, stay-cation, or simply finding the rest you need in the middle of things. If you need some ideas to get started, I would recommend the spring 2015 edition of Yoga International magazine. This is 128-pages of great ideas to relax and unwind. If you don't participate in yoga or find yoga intimidating, don't worry. This issue is not just about yoga poses, but includes several helpful ideas to promote relaxation.
I recently pulled out seeds from my freezer to do a seed rotation. With all the change and forward movement that spring brings, it can be easy to feel off-balance. There has certainly been a lot of change in my life as I have been preparing to move to Springfield. I'm using the seed rotation to help re-establish some rhythm in my body and to support my health through all these changes.
I was first introduced to the concept of seed rotation while attending the National College of Natural Medicine. While I have not seen any placebo-controlled, double-blinded studies on this technique, I have empirically found it to be very helpful for many women in the clinical setting, particularly when trying to regulate an erratic or symptomatic menstrual cycle. Don't be scared away men! Seeds can be helpful for your hormone balancing, as well.
What does have good scientific evidence are the health effects of lignans in seeds. Lignans are a class of phytoestrogens that have high antioxidant effects. These phytoestrogens can help lower the effects of estrogen in the body by binding up estrogen receptors and exerting a far weaker estrogen effect. Seeds are also rich in fiber, which can have beneficial effects on cholesterol levels, support better bowel elimination, and to help reduce risk of certain types of cancer. Seeds also provide essential fatty acids that can help with hormone synthesis.
Seed rotation is typically timed with the menstrual cycle. If you do not have a menstrual cycle and/or if you are male, you can still use seed rotation; you can time it with the month or some people use the lunar cycle. If you are using your menstrual cycle, day one is the first day of bleeding. If you are using the lunar cycle, you can use the full moon as day one.
On day 1-14, grind raw pumpkin and flax seeds in a dedicated grinder (i.e. a coffee grinder or spice grinder). Add one tablespoon to a salad, smoothie, yogurt, applesauce or other food of choice. Do this twice a day. Store any unused seeds in the freezer to prevent them from going rancid.
On day 15-end of cycle, grind raw sesame and sunflower seeds in the grinder. Take one tablespoon, twice a day similar to above. Again, store your seeds in the freezer.
Optional: Some people also choose to take fish oil on days 1-14 and switch to evening primrose or borage oil on days 15-end of cycle. If you are taking medications or have a chronic health condition, please check with your healthcare provider before adding supplements.
I generally find that many hormonal issues have improvement after 2-3 months. It is not an instant fix, but has been well worth the time and patience of many who have tried it. It is also one more way to remind ourselves to connect to cycles and rhythms in our lives.
It has been a busy and wonderful week! Last Saturday, I taught two workshops about herbal skin care and this Thursday from 6-8 p.m. I will be part of an Integrative Cancer Care Workshop at 2BWell (learn more and register at http://www.2bwellspringfield.com/events/integrative-cancer-care-workshop-feb-26/). Believe it or not, these workshops actually have something in common; many commercial skin products contain potential carcinogens and/or estrogen mimickers. I am certainly no fashion diva, but as a natural healthcare provider, I care about what people are putting on their skin because it might play a role in a person's future health, along with many other factors. In cancer treatment, patients may be prescribed estrogen blocking medications; these medications will work better if we reduce exposures to estrogen mimickers from the environment, as well. Just as a doctor wouldn't prescribe an estrogen blocking medication and bio-identical estrogen at the same time, I believe we should also be reducing the estrogen effects from others sources as well.
For this blog post, I would like to share a brief except from my skin care handout from Saturday's workshops...
"The skin has been perceived by many as an impenetrable barrier; however, many of the chemicals used on our hair and skin can end up in our blood and body fat and can have several health consequences beyond skin reactions. There is an old saying that goes “Don’t put anything on your skin that you wouldn’t put in your mouth.” Unfortunately, the regulations for cosmetics and personal care products are far weaker than regulations for food and drugs.
The skin is our largest organ. While it can provide some barrier protection against infection and injury, it also has the profound capability to absorb many substances including personal care products. The skin is vital to our immune system and key to our ability to eliminate unwanted waste products. It is teaming with micro-organisms that can actually protect us, if we don’t weaken them by overusing anti-microbial products. Our skin can reflect our internal and emotional health, as well as impact our self-image.
Multiple chemicals in cosmetics have been found to have endocrine-disrupting activity (i.e. phthalates, triclosan, and parabens) and several ingredients can be potential carcinogens. Each of these chemicals are reported to be safe at small doses by themselves. What has not been clearly studied is how the combination of these thousands of chemicals used daily over decades can do to our health. When a woman is diagnosed with breast cancer, she can’t point to a single cosmetic product with carcinogenic or endocrine-disrupting ingredients as a cause, because she has simply had too many of these exposures in too many products to even determine if it might be part of the cause.
Many products are marketed as “natural” or “herbal” or “containing organic ingredients” while also including mostly synthetic chemicals. We can avoid this confusing marketing and simply make our own products so we can know what we are being exposed to. For products we don’t make, we can research on www.ewg.org/skindeep to explore the safety of the products we do choose to buy."
I have recently heard of several cases of influenza locally. There are reports coming out that this year's flu vaccine still has some anti-flu activity but it is not as effective as was hoped. Therefore, both vaccinated and non-vaccinated people have been asking for tips about how they can stay well this winter season.
You probably know the basics already--proper handwashing, plenty of sleep, adequate hydration, regular exercise, and time to relax and manage the daily stress of life. They are so important and foundational that they are worth mentioning again, though...
The picture above is a black elderberry plant. Elderberry has been shown to inhibit the activity of human influenza A. It's inhibition activities compare favorably to the popular medication Tamiflu according to one study. (Roschek B, Jr, Fink RC, McMichael MD, et al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry 2009;70:1255-61). Influenza and other viruses use hemagglutinin to bind to the epithelial cells of the respiratory tract. Elderberry helps to neutralize this hemagglutinin activity and prevent viral binding to your cells. (http://cms.herbalgram.org/herbclip/pdfs/070752-297.pdf). Furthermore, the flu virus uses an enzyme called neuraminidase to enter the cell once it is attached. Elderberry also has the ability to inhibit neuraminidase activity (http://www.biomedcentral.com/1472-6882/11/16#B4).
If you research elderberry on the internet, you may come across several warnings stating this is a toxic plant. Not quite so. Eating the red berries can be toxic, so you want to make sure you are using the black elderberry (Sambucus nigra). Eating raw berries (even black) can cause nausea, vomiting and diarrhea if over consumed. Thus, it is recommended that you consume properly dried berries or cooked preparations. It is often prepared as a syrup, which has been cooked. These berries have been consumed for centuries. It is said that Charlemagne decreed that an elder be planted in every yard for its medicinal value (it has several other health-promoting properties as well). Historically, this plant is considered to be a protector of children and infants and has been used to treat many croupy coughs of infants. Therefore I wouldn't be afraid of using this plant, just don't eat the red berries, consume raw, and use with moderation, backing off with nausea or loose stools.
On a typical day in my office, it is not uncommon for me to see a patient seeking integrative naturopathic support during their cancer treatment. Imagine a patient named Carey. Let's say Carey is a 55 year old female presenting with metastatic colon cancer, currently undergoing chemotherapy. The first thing I might observe is that Carey is under a lot of stress. She was recently diagnosed with cancer and quickly started treatment with her oncologist. She presents in my office today with a bag of supplements recommended by friends, family and health food store clerks. She is not sleeping well and states she lost her appetite since being diagnosed. She shares that her dad died earlier this year, which has been a tremendous loss for her. Now being diagnosed with metastatic colon cancer, she worries about her own children losing their mom. She's doing her best to juggle work, to stay strong for her family, to care for her mom, and to cope with the side effects of her treatments. She has been severely constipated and hasn't had a bowel movement in two weeks! She needs her job because she depends on it for her health insurance. Carey states she hasn't had time to exercise or care for herself the past several years.
The viewpoints of several health paradigms spin in my head as she shares her story. The impact of stress, inflammatory cytokines, and their role in cancer progression comes to mind. Lowering these inflammatory cytokines by addressing her stress will help her outcomes. I imagine what her visit with her oncologist might have been like and what the oncologist might have considered in selecting a treatment for my patient. I reflect on what I have been taught about safety of combining chemotherapy with dietary supplements as I go through each dietary supplement in her bag. We discuss supportive options to help address the chemotherapy side effects she now faces, while I weigh what we can safely use with her prescribed treatment. Her lack of sleep can be contributing to low melatonin levels and decreased functioning of her immune system. I know that cancer survival rates drop with malnutrition, lack of exercise, and poor performance status. I think about what my Chinese Medicine professor taught me about the connection between grief and the organ systems of the lungs and large intestines (colon).
She is under the care of a medical oncologist and now me, a naturopathic doctor. In our first visit, I know she will have better outcomes if we can get her further integrative support. Ninety minutes was barely enough time to hear her story and collect her medical history, review all the supplements she has been given, recommend some functional tests, and address side effects and overall naturopathic recommendations. Getting assistance with healthy and appetizing meals would do her well. Social support could aid her in her mother's care, time management, and find community and financial resources to support her through her own treatment. In her efforts to "stay strong," she's holding in a deep amount of grief and fear that comes pouring out in our appointment. Who can she share these feelings with on a frequent and regular basis so they don't build up so large inside of her? Exercise would help decrease her stress, improve energy levels, and contribute to improved survival outcomes; an exercise specialist with knowledge of oncology could help safely get her started without wearing her out and contributing to further fatigue. She could also benefit from a restorative yoga and relaxation exercises. Given the relationship between the colon and grief, a Chinese medicine approach might be synergistic in her treatment. These are areas I have a basic working knowledge of, but she would thrive working with a specialist in each of these areas. I see a village of support that could greatly improve the quality of her life and potentially her cancer outcomes. I worked for a place that offered all of these services under one roof and I witnessed how patients benefited from this integration of care.
I love that I have been exposed to all these different paradigms of healing--conventional medicine, naturopathic medicine, Chinese medicine, mind-body medicine & counselling, physical medicine therapies, nutrition, yoga. I can appreciate that each of these paradigms will look at this patient with a different set of eyes. I know that Carey needs more than I can alone provide and that she will thrive if her practitioners work and communicate together. Carey, like many patients, may not be able to utilize all these different professionals, but she will benefit from adding what she can. In the meantime, I will point her to books, resources, and give basic recommendations to get her started.
Whether it is cancer or any number of other chronic diseases, there is synergy to be gained through integration. It is a situation where one plus one is more than two. One practitioner may see something the others don't see. Each paradigm has its limitations, even mine. It goes back to the old saying that goes--"If all you have is a hammer, then everything appears as a nail." Bring in the other tools, because we've got more than nails here. We have the beautiful intricacy of human life.
Naturopathic healthcare is one of many paradigms of healing. I personally believe there is no one single healing paradigm for every person and every situation. It is hopeful to know that if one paradigm can't explain "what's wrong" that other paradigms may offer answers and effective approaches to healing.
The naturopathic paradigm originates from the beliefs that (1) nature (fresh air, clean food, light, hydrotherapy, exercise, rest) is healing, and (2) we each are endowed with a vital, healing force that works well when obstacles (i.e. excesses of the diet, lack of sleep, emotional stress) are removed. Think about the chronic illnesses that have become more prevalent in industrialized countries--type II diabetes, heart disease, allergies, gastric reflux, hormonal irregularities. These types of illnesses are often secondary to changes in our culture's diet, lifestyle and environment. These chronic illnesses that come from industrialized living often respond well to naturopathic care, because we seek to remove the underlying cause (or obstacle) that got in the way of optimal health.
The history of naturopathic care is intertwined with the European Water Cure movement which used hydrotherapy. Hydrotherapy is the use of water in healing. When I mention hydrotherapy, most people envision enemas, colonics, or maybe a hot tub. While it might include enemas and colonics in some naturopathic clinics, hydrotherapy includes a diverse array of water applications. Instead of the hot tubs of America, this tradition relied more heavily on cold water applications because it stimulates the body's blood flow. Healthy blood flow supports nutrients being delivered to the tissues and waste products being carried away, thus supporting the health of the body.
Over time, other healing modalities were practiced by naturopathic doctors. When I attended naturopathic medical school, I had the privilege to be exposed to many different paradigms in my training, which also included herbal/botanical medicines, homeopathy, classical Chinese medicine, physical medicine, environmental medicine, nutrition, massage, pharmacology, and mind-body medicine. Did you know the some naturopathic doctors of the past didn't believe in using herbs because they considered them them "drug therapy"? In the 1850s, much of the US Pharmacopeia consisted of herbal medicines as "drug therapy" and naturopaths of that time were considered "drugless doctors." Naturopathic healthcare has changed considerably over the years. Naturopathic doctors now days have several modalities to choose from, and because of this, care can vary widely between naturopathic clinics. One clinic may focus on specialty testing, supplements and nutritional IV therapy, while another clinic may offer mainly hydrotherapy, homeopathy, and herbal support.
Visits in my office often address the obstacles to healing and how those obstacles can be minimized or removed. When conventional tests don't explain why a person is not feeling well, then I may recommend specialty tests that look more at the physiology and optimal function of the body. The visit may evolve into discussions of safely integrating natural supplements, individualized selection of herbs and homeopathics, using the mind as a tool in health and healing, and home hydrotherapy techniques. I respect the fact that there are limits to what I can provide, and sometimes a referral to a professional of another paradigm is more appropriate.
I find it is an exciting time to be a naturopathic doctor. Evidence based medicine for natural therapies and research studies are expanding in our field. Our understanding of epigentics (how environment influences genetic expression) is growing. Members of different health professions are working together more often and we are learning from one another. Each day in my professional life is filled with learning in this ever expanding field and puzzling together the pieces of health and healing. I delight in it!
If you would like to explore a naturopathic approach with Dr. Katrina Bogdon, please visit her website at www.ourhealingroots.net to learn about the appointments she offers or contact her directly at email@example.com.
Welcome to my new blog site! Posts from my previous blog can be found at www.ourhealingroots.blogspot.com. As a new chapter of my life and business unfolds, I think it appropriate to begin fresh with my blog.
My name is Katrina Bogdon and I am the owner of Our Healing Roots. LLC. Growing up, I never knew there were such things as naturopathic doctors, and I certainly never imaged being one myself. When I discovered naturopathic medicine, I was thrilled that I could go to a medical school that taught about medical science & research, natural medicines, allowed me to spend time listening to my patient's stories, how puzzle out the development of illness and remove the obstacles to healing.
I completed my Doctorate of Naturopathic Medicine at the National College of Natural Medicine in Portland, OR. It is the oldest naturopathic college in North America. I spent four years learning naturopathic philosophy, basic medical sciences, how to diagnose disease with physical exams and testing, and about several treatment modalities--herbal medicine, nutrition, homeopathy, hydrotherapy, stress management, mind-body techniques, physical medicine, pharmaceutical drugs, and minor surgery.
I am licensed as a naturopathic physician in the state of Washington, but I live and practice in Oklahoma & Missouri. After I got my license in Washington, I returned to the Midwest. Certain states such as Arkansas, Oklahoma, and Missouri do not license naturopathic doctors, so I cannot diagnose disease in these states, use minor surgery, or prescribe drugs. In Oklahoma, I completed a residency and worked in an integrative cancer setting for five and half years. My time there taught me a lot about working in an unlicensed state and how to integrate with other health professionals for the benefit of the patient.
In 2013, I began a full-time naturopathic practice in Tulsa, OK, called Our Healing Roots, LLC. I have the wondrous opportunity to sit 45-90 minutes with each person learning about their health & life stories. For many people, I bring a new paradigm and understanding of health. Health is not just the absence of a diagnosed disease. It is about feeling good in your body, having a clear mind, being emotionally well, and so much more. My goal as a naturopathic doctor is to seek the underlying obstacles standing in the way of health and to help guide people to the least invasive ways to remove those obstacles. I am also a huge supporter of integrative healthcare, and I love making referrals. Each healthcare provider brings a different set of tools, abilities, and a fresh perspective to healing. There is strength and synergy when different providers work together. People get better results and heal faster.
This past fall, I began expanding my practice to Springfield, Missouri. Beginning January 2015, Our Healing Roots, LLC will begin offering naturopathic consultations at 2BWell, in addition to my clinic in Tulsa. After living in Tulsa for seven years, I am slowly transitioning to the Springfield area in 2015, and I will close my Tulsa office on October 31, 2015. I grew up in the Ozarks and my heart is called back to the Ozarks. Thus, begins a new chapter for my business and my life...
If you are interested in using naturopathic services as part of your integrative healthcare, please feel welcome to contact me through my website.