The Avante TimesVolume 6, Issue 2 Fall 2010

Avante’s Values

* Integrity* Innovation* Team Approach* Community* Honesty* Compassion* Respect* Progressive* Personalized Care* Value

Inside this Issue

Ageless Remedies 2

Calendar ofEvents 3

Myofascial Pain & The Alaskan 3

Naturopathic Approachto Allergies 4

Updates in Women’s Health 5

Falling into Alignment 6

Who’s Who at Avante 8

Avante Medical Center, LLC

Jason J Harmon, ND, FABNO

Avante has great news! We have opened our new clinic at the Providence Health Park location, we congratulate Dr. Bethany Buchanan, DNP, FNP on completing her doctorate in nursing and we welcome two of our profes-sion’s top leaders to our clinic!

Dr. Jana Nalbandian, ND comes to Avante from Bastyr University’s naturopathic medical school and medical clinic where she was the Department Chair of Clinical Sciences for 7 years and Clinical Supervisor at Bastyr Center for Natural Medicine for 13 years. She has also had an extremely success-ful private practice in Seattle since 1991. She will be Avante’s new Medical Director and will bring her expertise to Avante where she will specialize in woman’s health care.

Also joining Avante is Dr. Deb Kiley, DNP, FNP. Dr. Kiley has practiced as a family nurse practitioner since 1983. She has an extensive background in primary care with specialty work in wellness, ENT, physical medicine and pain management. In addition, she was a professor in the UAA School of Nursing FNP Program and has educated and mentored many of Alaska’s nurse practitioners. She brings her considerable experience and enthusiasm for caring for Alaskans to Avante starting this fall.

Please see our website for their full bios.

Our new Providence Health Park lo-cation is now open and is an excep-tional clinic addition to our Northern Lights location. Please see our website for pictures and details. Have a wonderful fall!

Avante Has Great News This Fall!

www.avantemedical.com

A Naturopathic Approach to MenopauseJana Nalbandian, ND, MT, ASCP

Menopause is a natural process that all women experience with the winding down, and ultimate cessation, of men-ses. With its many treatment modalities, naturopathic medicine is the perfect “medicine of choice” to help the body transition through menopause with minimal symptoms.

To start our discussion, we need to define and understand what menopause is and the phases of menopause all women experience. Menopause is defined as the cessation of menses 12 consecutive months following the final menstrual period. The average age of menopause is 51 with a range from 40 to 58 years old. There are three phases of menopause: 1) Perimenopause (climacteric), which lasts on average 4 years, is when the periods become ir-regular; 2) Menopause; and 3) Post-menopause, beginning one year after the cessation of the menstrual cycle. Depending on one’s health, lifestyle and genetics, symptoms associated with menopause such as hot flashes, night sweats and sleep disturbance are transient and resolve with no or minimal treatment.

During the perimenopausal years, progesterone starts to decrease before estrogen, leading to irregular menstrual cycle bleeding and changes in the number of days between cycles. As the hormones start to decline – especially estrogen – hot flashes, the most common symptom associated with menopause, can develop along with night sweats. There is a long list of potential symptoms (you may have one, some or none of the symptoms) associated with menopause, including the following: sleep disturbance/insomnia, vaginal dryness, mood swings, headaches,

(cont. on pg 7)

The avante timesPage 2

Ageless RemediesStephanie Friess, ANPMany of us have something on our skin we would just as soon be without — a mole, a pockmark, a crop of freckles. Others regret an impulsively acquired tattoo or live with a birthmark they wish could be removed, and of course everyone eventually gets wrinkles.

Until recently, almost all of these issues were difficult, if not impossible, to remove without cosmetic surgery. However, tech-nology has now given us dermatologic cosmetic lasers, a group of highly specialized tools developed in the past decade that have revolutionized the practice of dermatology and led to innovative treatments for a host of skin conditions. Today, lasers can smooth a complexion pitted by acne or chicken pox scars, treat active chronic skin conditions such as acne and psoriasis, and diminish the appearance of spider veins, cherry spots, age spots and birthmarks. We can now erase tattoos, unsightly moles and, of course, diminish wrinkles.

The reasons why people undergo any form of cosmetic surgery are highly personal and individual. They are rooted in an appar-ently universal human desire to appear as attractive and as healthy as possible, especially in a culture that puts a premium on youth. Looking attractive and healthy is often equated with looking young – or at least younger. Most people do look older than their years because 90 percent of the visible signs of aging are derived from damage caused by overexposure to the sun. Photo-aging, as it is called, puts many more wrinkles on people’s faces than chronological aging or “just getting old.”

New high-energy carbon-dioxide lasers that literally evaporate skin cells recently have become the most feverishly hyped weap-on on the war on wrinkles. Medical lasers have been in existence for more than 30 years, and in 1994 the first “Ultra Pulse” laser was introduced. But until very recently their use in dermatology was limited. This frontier has expanded with amazing speed. Today, thousands of physicians have added cosmetic lasers to their practices. And lately is seems that hardly a week goes by without a magazine article or television news story featuring these amazing tools. The most popular of these perform a proce-dure known as laser resurfacing.

Just as the name implies, laser resurfacing is simply a way to resurface the skin. Laser technology can get rid of just about any skin blemish the patient deems undesirable, with little to no down time or the expense and pain of surgery. Laser resurfacing performed with a carbon dioxide laser is so called because the laser beam passes through a chamber filled with carbon dioxide (CO2) gas. Invented in the early 1960s, the C02 laser is one of the most powerful tools of this modern industry. It is extremely versatile and prized for its capacity to cleanly and precisely vaporize tissue. It works on skin by emitting a wavelength that is absorbed by water – the main component of skin cells. The beam heats, boils and instantly evaporates water inside the cells. Firing in millisecond bursts, the laser vaporizes skin cells, which literally vanish before the heat in them travels to adjacent tis-sues. There is no bleeding or swelling of the skin.

All skin resurfacing procedures work in essentially the same way – by removing the layers of skin that contain the wrinkle or other flaw, and creating a wound. The wound heals by generating new skin cells that will create a smoother, less flawed surface. Hu-man skin is comprised of three layers, the innermost being the subcutis or fatty layer. Above it lays the dermis, the skin’s fibrous support structure. The dermis consists of a meshwork of protein strands – the collagen and elastin. These look very much like the threads that make up a woven cloth. Through these fibers run networks of blood vessels and nerves composed of hair follicles connected to sweat glands and oil-producing sebaceous glands. The dermis is further divided into the thick lower or reticular dermis and the thin upper or papillary dermis.

The effect of any resurfacing technique depends on how deeply a peeling agent penetrates this multi-layered structure. Light sa-lon peels, which involve the application of a very low concentration of glycolic acid, remove the superficial layer, which is quickly replaced by a fresh new surface in the ordinary course of cell birth and maturation. Superficial “lunchtime” chemical peels are performed with stronger glycolic acid solutions that take off the entire epidermis along with any flaws it might contain. Light peels improve the skin’s surface texture and remove superficial flaws, but they have little effect on wrinkles, which are caused by the breakdown of collagen fibers in the dermis. Wrinkles can be significantly improved by medium to deep peels employing a strong acid (35% to 50% trichloroacetic acid solutions) or with dermabrasion or laserabrasion.

As the body heals, it replaces the treated areas with a new, unblemished and significantly smoother surface. Wrinkles and sun damaged skin or age spots seem wiped away. Fine wrinkling around the eyes and pucker lines around the mouth disappear.

www.avantemedical.com

Bring your whole family to Avante!

(cont. on pg 7)

Calendar of Events

Bones for LifeTime: 6:30 p.m. to 8 p.m.

Dates: Every Wednesday between Sept 8th and Nov 17th. NO CLASS OCT 20TH

$25 per class or $200 for 10 classesRegister with Grant Gibbs at 278-8811

Bones for Life is a program for stimulating bone strength through natural movement and weight-bearing posture. Please wear comfortable clothes that are easy to move in.

Natural Pantry Walk-ThroughDates: Sept. 15th, Oct. 20th, Nov. 17th, Dec. 15th

Time: 6 p.mLocation: Natural Pantry (36th & Old Seward)

Please join licensed acupuncturist and oriental medicine specialist, Tina Harmon, as she guides you through the Natural Pantry, helping you learn how to read labels and what those long, confusing words really mean for your health.

Avante Book ClubSept 14th: “Slow Death by Rubber Duck: The Secret Danger

of Everyday Things” by Rick Smith and Bruce LourieTime: 7 p.m.

Location: Avante Medical Center (NL Location)

Upcoming Books:

October 19th: “Clean: The Revolutionary Program to Restore the Body’s Ability to Heal Itself” by Alejandro JungerNovember 16th: “How We Decide” by Jonah Lehrer

This book club, moderated by Christine Sagan, ANP, is a great way to investigate new ideas about your health in a low-key, peer-oriented setting.

Page 3Volume 6, Issue 1

2009- Voted “Best Doctor” by Anchorage Press

For more information, class updates, additions or reschedules, please visit our website.

Brendan Van Valkenburgh, MTPT, NCLMT

Pain is an integral part of all our lives and an important piece to the puzzle of our continued health and happiness. It works as an alarm to draw our attention to areas or issues that may need our immediate attention.

But what happens when you have done everything you and your healthcare team can think of to address the problem and the pain alarm is still go-ing off? Sometimes the pain is a mere nuisance, but can become a down right catastrophe. Often when patients are at a point of constant pain – at any level – they are placed on pain medications to cope enough to go about the day in the hopes that the problem will simply correct itself.This is not the way to treat pain effectively. At Avante, our providers bombard the issue of the “chronic pain alarm” from an integrative stance, draw-ing from every viable resource available. One of the greatest tools at your disposal in the eradication of chronic pain is our experienced team of myofascial trigger point therapists.

Myofascial pain and dysfunction is something we all experience in our lives in the form of things such as growing pains, knots, “throwing out your back,” or migraines. For Alaskans, this experience of discomfort/pain may be even more present. In the spring and summer months, many Alaskans push their bodies to pack in every day of fun in the sun. We do the same in the fall and winter to exercise and stay healthy and stave off the cabin fever of the darker months. Even for those of us with a more sedentary lifestyle, we deal with stressful traffic and road construction in the warmer months and falls on the ice and chronic couch potato-ism in the colder part of the year.

In any case, adhesions form in our muscle tissue and the structures, and tissues that work in symphony with this system both limit our mobility and give rise to acute and chronic pain. When the perpetuating factors of our daily lives – such as sleep position or the way we work and play – are compounded by certain regrettably common structural anomalies (e.g., first metatarsal deficit disorder or short hemi-pelvis), it may only take that twist of the ankle, moving those boxes or picking up that hankie to flip on that “chronic pain alarm” switch that can be so frustrating turn off.

Luckily, our team of myofascial trigger point therapists is highly trained to help you identify the source of your pain and the possible reasons it has been so hard to leave behind. We will work with you to treat the pain in our office setting and send you home with the tools to empower you to stay pain-free!

Myofascial Pain and the Alaskan

Page 4 The Avante Times

www.avantemedical.com

You will find health at Avante!

A Naturopathic Approach to AllergiesMarkian Babij, N.D., FABNO

Allergen: Any substance that can cause an allergy.Allergy: A disorder of the immune system.

In treating allergies, naturopathic medicine seeks to identify the contributing factors and organ weaknesses that lead to a confused immune system. The immune system is comprised of two principle components — the innate and adaptive im-munity. Our first line of defense responding to a wide variety of microorganisms is part of our innate immune functioning. These cells are primarily involved in destruction of infected and cancerous cells. Innate immunity is from our ancestral roots and is present in most animals.

The adaptive immunity is acquired through interactions with our environment. The Thymus gland educates and deploys detective-like cells to track and remember harmful bacteria as well as benign substances like food and pollen. Our complex immune system uses specialized messengers called cytokines that play a key role in selection, initiation and modulation of appropriate immune responses.

The Cause?The risk factors for allergy can be placed in two general categories, namely host and environmental factors. Host factors include heredity, gender, race and age. The environment impacts many individuals over time as we become exposed to a virtual barrage of allergens, pollution and engineered foods. When the immune system is overactivated or weakened, our immune response is more likely to behave erratically. The allergen binds to a preformed antibody, which then triggers the release of inflammatory chemicals such as prostaglandins and histamine. There is often a predisposed sensitivity that can worsen with overexposure of the insulting agent. Over time, the insulting agent matures into a full-blown allergy, or an adaptive immunity disorder. The top allergens are often agents we are exposed to for prolonged periods of time. Allergies can result from contact with a specific allergen such as pollen; however the immune system can become overwhelmed with several smaller issues that culminate into a large burden on immune function. Epidemiological studies have shown that all types of allergic diseases are more common in polluted areas than in unpolluted ones. In North America, wheat is in the top five most common food allergies, however in many Asian countries rice is a common food allergy.

What can you do? To minimize the additive effect of environmental stressors on the immune system, remember that while you sleep you heal. Create a safe haven in your bedroom and ensure that you have a hypoallergenic bedroom. Wash sheets and dust often! Rotate food choices to ensure that the body is not bombarded with a constant food source, such as wheat or rice. Switch to eco-friendly cleaning products and remember that every small choice makes a difference when they all add up. Supple-ments such as Vitamin C, Nettle and Vitamin E, and flavonoids such as catechin and quercetin act to stabilize mast cells and decrease histamine.

Allergy testing via the blood is a great tool in screening for allergies. Once we determine specific immune reactions in the blood, patients are often referred to our allergy department for Provocation/Neutralization. In this method of testing, pa-tients are exposed to substances under the skin and the allergic response is then measured. A vaccine is then made from the known antigen discovered during the testing. The vaccine is then used to neutralize the allergen associated with the allergy symptoms. This vaccine acts like a teacher in educating the immune response, thereby reducing any dysfunction contributing to an immune reaction to that particular allergen.

Allergies are due to an overactive immune response. This happens because of a complex interplay between heredity, en-vironmental pollution, aggravating foods, insufficient antioxidants, an overwhelmed liver and exhausted adrenal function. Each allergy picture is different, as is treatment. An allergy will most certainly improve with a Naturopathic approach. Often some small clean up, nutritional considerations, and focused liver and adrenal support will improve overall immunity.

Volume 6, Issue 1 Page 5

A Naturopathic Approach to Allergies

2009- Voted “Best Doctor” by Anchorage Press

Christine Sagan, ANP

Recommendations have been recently updated regarding cervical cancer screening, and there is good news for women who dread that yearly pap. Although women have been trained to have an annual exam for their paps, the American College of Obstetricians and Gynecologists released new guidelines in 2009 that reflect new scientific evidence that there is no benefit from such yearly screening. In fact, the benefit of reduction in cervical cancer is equally found with less frequent screening.

The starting age was also moved to 21 to avoid unnecessary treatment of teens. Previously it was age 18, or three years after becoming sexually active. The rate of infection with human papillomavirus (HPV), which can cause cervical cancer, is high in teens who are sexually active. However, the immune system typically clears HPV within one or two years among younger women.

Recent research has shown an increase in premature births among women who were treated for precancerous HPV-related lesions with excisional procedures. New information concludes that young cervixes should be left alone, avoiding unnecessary procedures. Of course, teens should not wait to get tested for sexually transmitted diseases if there is a concern.

The new guidelines are for the average healthy woman, not women with immune compromise. Here are the highlights:- First pap at age 21- Paps every other year instead of annually- Women 30 and older who’ve had three consecutive negative tests and no abnormal history need to be re-screened only once every three years.- After no abnormal pap result for 10 years and three or more negative results consecutively, women can stop the test at age 65 or 70.

Of course these are guidelines, and each individual’s health and sexual history need to be taken into account. Risk factors such as multiple partners and past history of abnormal paps require more frequent screening. Women who have had a hysterectomy for benign disease may discontinue pap smears.

Previously the guidelines recommended annual pap exams for women under age 30, followed by one every 2-3 years if the previous three exams were negative. There is a recommendation to screen women for HPV at age 30 and, if they meet the above guidelines and HPV is negative, they should not be screened more often than every three years. Annual screening triples interventions, such as biopsies of the cervix, when compared to triennial screening.

The U.S. Preventative Screening Task Force – a governmental panel of experts – released information about the age and frequency of mammo-grams last year. They recommended starting screening at age 50 instead of age 40 and continuing every other year. They went so far as to say they are against routine screening for women ages 40-49:

“It was found that there is convincing evidence that screening with mammography reduces breast cancer mortality, with a greater absolute reduc-tion for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years. The evidence reviewed by the USPSTF indicates that a large proportion of the benefit of screening mammography is maintained by biennial screening, and changing from annual to biennial screening is likely to reduce the harms of mammography screening by nearly half.” This continues to stir up debate, and not every institute will support this recommendation. Women who have a history of breast cancer with a first-degree relative should start screening earlier.

Talk to your provider about your thoughts on cervical and breast cancer screening. The decision should be individualized and informed. If you chose to change to every other year, it is still important not to lose touch with your regular health maintenance. It is important to have a yearly general check-up to review your health goals with your provider. This visit includes physical, breast and pelvic exams. Most insurance plans have provisions for preventative care, and a wellness visit is included.

Our goal at Avante is to keep you well, so please continue to keep prevention as a priority in your health. All the nurse practitioners and female naturopathic doctors at Avante provide comprehensive women’s health care. This includes paps, mammogram referrals, STD screening, contra-ceptive counseling, hormone balancing and general medical exams.

Updates in Women’s Health

Page 6 The Avante Times

www.avantemedical.com

Take some healing home!

Mission StatementHealing begins when you enter Avante!

Avante Medical Center, LLC offers a beautiful and healing environment, which contains world-class medical provid-ers, excellent staff, and extensive integrative and conventional medical services for the whole family. We provide care to our clients living with acute and chronic health challenges, combining the best of science and nature, tailored and personalized to your individual medical needs. We focus on the value of our clients’ experience, providing adequate time with our providers, resulting in thorough and comprehensive medical care. Our goal is to educate, empower, and

enrich your health through a caring, professional and unique medical experience.

Tina Harmon, L.Ac.

In acupuncture and Chinese medicine, the fall season is connected to the lungs and the element of metal. The metal ele-ment is connected to the feelings of courage, righteousness, and self-worth. One way to connect to these positive feelings is to utilize the power of the breath. By deep breathing, one can create a strong expansion and contraction through the diaphragm and open areas of the body that are tight, restricted, and overstressed. Breath brings life and oxygen to every cell, creating internal strength and power, and ridding the body of toxins. Our breath can affect our posture and alignment just as our posture and alignment can affect the quality of our breathing.

Throughout our day-to-day tasks and activities, the awareness of our alignment usually does not get acknowledged until we are experiencing pain or discomfort. The first step in changing this is to establish a mind-body awareness and con-nection.

We are all familiar with the concept that what we do on a daily basis either “makes us or breaks us.” This includes what we eat, what we think, and how we move. Within this structure, there is an organized pattern that supports the integrity of the system as a whole. This organizational pattern is present in every cell and can be affected by trauma, strain, emotions, or our thoughts, and ultimately determines how we move and feel.

A common postural pattern in today’s society is the “hunched over” look. This consists of the head straining forward, the shoulders rolling inward, the rounding of the mid-back, the low back compressing and the pelvis rotating and elevating to one side or another. Postural misalignment can be rebalanced through toning and strengthening of weaker areas of the body, while releasing and opening the restricted areas of the body. The balance between contraction and relaxation throughout the body can be understood by the concept of tensegrity. This concept describes a structural-relationship between the muscles, fascia, tendons and bones; this interrelationship keeps us moving as a unit. When one area of the body is out of alignment it will affect the whole structure. Where pain originates is not always the point of release; one must take into account the whole structure. It becomes about moving with ease and taking the path of least resistance. Posture is not static but dynamic; unique to each person and their daily activities.

The next time that you are walking, running, sitting at your desk, or driving, consider focusing on your breath and expand-ing through the chest. Bring the shoulders back and down, retract the chin slightly back, elongate the lower spine, and gently engage your core. How does this make you feel? Our alignment is important in everything we do preventatively and actively.

Proper alignment can bring us energy, grounding and presence. How we carry ourselves can say a lot about where we are in our life: physically, mentally, emotionally and spiritually. It is not just about the structural changes that we make, but also about having our actions, intentions and goals being in alignment with our dreams and our purpose. Fall out of tension and fall into alignment.

Falling into Alignment

Volume 6, Issue 1 Page 7

Much of this improvement is due to the laser’s effect on collagen, the fibrous protein that makes up the skin’s built-in support fabric. In a mechanism that is still not entirely understood and that does not occur to the same extent in any other form of cosmetic surgery, collagen fiber visibly contracts in response to the laser beam. This actually shrinks the skin over the facial structure. The skin will continue to rebuild and replenish itself from the inside out, gradually replacing affected fibers with new collagen for several months after the treatment. Laboratory examination has shown that the collagen fibers in laser-treated skin are generally more abundant and more regular in shape (in other words, more like “young” collagen) than in skin that has not been treated with the laser.

Avante is now proud to be a part of this fast-growing field. We now have the state of the art SmartXide DOT laser. The SmartXide repairs damaged skin with minimal down time. It is a safe and non-invasive procedure, promoting fast and natural healing, repairing damaged skin and restoring your skin to a more youthful state.

Avante is now offering the latest in laser skin resurfacing technology with both our SmartXide and Intensive Light Pulse Therapy lasers. You can call for a consult to discuss your concerns and assess if either of these are an option for you.

Ageless Remedies (continued from page 2)

Menopause (continued from page 1)

depression and anxiety, memory changes, urinary problems, decreased libido and fatigue. No two women experience menopause the same, and all of the above symptoms are minimal to mild in most women, resolving as the body adjusts to its new hormonal status.

What can naturopathic medicine offer to help minimize the symptoms of perimenopause and menopause? If you look at treatment approaches as moving up the ladder of intervention, the first rung of the ladder is the foundation that will help the body return to balance. This approach ad-dresses lifestyle issues including diet and nutrition, exercise and stress management. If any of these elements are out of balance, the incidence of hot flashes will increase.

Diet and nutrition are critical in minimizing symptoms. The most obvious foods and drinks that aggravate hot flashes are coffee, alcohol, sugar and spicy foods. Eating a diet high in plant foods – including fresh fruits, vegetables and legumes – provides the body phytoestrogens (plants that act like weak estrogens). The most studied food phytoestrogens are soy containing flavonoids and flaxseed containing lignans.

Next is exercise, which has been shown to directly decrease hot flashes. Only 20 minutes three times a week may reduce hot flashes significantly. If needed for nutritional supplementation, a high quality vitamin for women over 40 may be recommended. Stress can also be alleviated with ex-ercise, yoga, meditation and participating in any activities that give you joy.

To specifically address the symptoms of hot flashes you move up the ladder of intervention, choosing botanical medicines that have a mild estro-genic effect, including Black Cohosh, the most researched herb for menopausal symptoms. There are many herbs that contain phytoestrogens such as alfalfa that can be used in combination with Black Cohosh, depending on each individual woman’s needs. Along with the weekly estro-genic botanicals, specific botanicals can be used for any of the above-mentioned symptoms of menopause, including botanicals for nervousness, anxiety, insomnia and depression.

Naturopathic medicine is based on a principle of addressing the whole person. Each visit is comprehensive, addressing all of the systems in the body. A treatment approach is specific to the needs of the individual woman and treatment and intervention is intended to restore hormonal balance in the body and alleviate symptoms. There are many approaches, with only a few basic modalities mentioned in this article, so if you are looking for a natural, non-toxic approach to transitioning through the perimenopause and menopausal years, naturopathic medicine has a lot to offer.

2009- Voted “Best Doctor” by Anchorage Press

915 W. Northern Lights, Anchorage, AK 99503Phone: 907.770.6700 Fax: 907.770.6707

www.avantemedical.com

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Who’s Who at Avante Medical Center

Clinic photos © Ken Graham Photography.com

Markian Babij, ND, FABNONaturopathic Oncology, Internal Medicine

Grant Gibbs, CMnTPTMyofascial Trigger Point Therapy

Jason J Harmon, ND, FABNONaturopathic oncology

Tina Harmon, L.Ac.Acupuncture, Chinese Herbal Medicine

Judy Hartford, CMTPTMyofascial Trigger Point Therapy

Christine Kallander, ANPAdult and adolescent care

Lee Anne Hellesto, ANPFamily practice

Christine Sagan, ANPFamily practice

Sandra Schaeffer, CMTPTMyofascial Trigger Point Therapy

Torrey Smith, NDFamily practice

Natalie Wiggins, NDFamily practice, pediatrics

Bethany Buchanan, DNP, FNP Family practice

Ina Cloud, MA, ATAllergy Treatment

Gary Ferguson, NDMen’s Health

Cathy Floyd, MA, ATAllergy Treatment

Stephanie Friess, ANPFamily Practice, Internal Medicine

Jana Nalbandian, NDWomen’s Health

Brendan Van Valkenburgh, MTPT, NCLMTMyofascial Trigger Point Therapy & Massage