Keys to Ending Fibromyalgia


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Keys to Ending Fibromyalgia

  1. 1. Understanding Fibromyalgia A Holistic Approach to Chronic Pain and Fatigue Ferguson Family Chiropractic Exit 9 – The Crossings, Clifton Park 383.5595
  2. 2. According to a paper published by the American College of Rheumatology, Fibromyalgia affects 3 to 6 million – or as many as one in 50 – Americans. For unknown reasons, between 80 and 90 percent of those diagnosed with Fibromyalgia are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life. <ul><li>Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases ( NIAMS), , Questions & Answers About Fibromyalgia, Publication Date: December 1999, Revised: June 2004. </li></ul>
  3. 3. Fibromyalgia is a complicated condition. Many physicians who are not familiar with this disorder feel there are no clear-cut answers. However, people need effective relief, support and guidance.
  4. 4. FIBRO: from fiber or fibrous – tissues. MY: from myo – meaning muscle. ALGOS: from algia – meaning pain. IA: meaning state of, or condition. Here is how the word “Fibromyalgia” breaks down:
  5. 5. Fibromyalgia simply means a condition which is characterized by pain in the muscles and soft tissue fibers of the body.
  6. 6. • It is the third most prevalent rheumatologic disorder (after osteoarthritis and rheumatoid arthritis). • It represents 5% of family practice office visits and 20% of rheumatism visits. Incidence of Fibromyalgia:
  7. 7. • Approximately 90% of Fibromyalgia patients are women between the ages of 40 and 60 years with an average age of 49. • Of the 10 to 20% of cases that affect males, the presentation (of symptoms and care of) is no different than that for women. Incidence of Fibromyalgia: Source: Cox, James, M., Low Back Pain: Mechanism, Diagnosis and Treatment , Chapter 7, pg. 251
  8. 8. According to Dr. Frederick Wolfe, respected rheumatologist and author of Diagnosis of Fibromyalgia, there is a great deal of misdiagnosis occurring, especially a tendency to use Fibromyalgia as a “ wastebasket diagnosis .” <ul><li>Source: Wolfe, F., Diagnosis of Fibromyalgia , Journal of Musculoskeletal Medicine 1990: 7(7): pp. 53-69. </li></ul>
  9. 9. “ Anyone with widespread and/or poorly localized musculoskeletal pain, without signs of an actual disease, are just lumped into the general category of ‘Fibromyalgia’ by their medical physician. This is very unfortunate and also very avoidable .” Source: Bennett, R.M., “Myofacial Pain Syndromes and Fibromyalgia Syndrome: A Comparative Analysis”. Man Med 1991; 6(1): pp. 34-45
  10. 10. <ul><li>Source: Wolfe, F., “Diagnosis of Fibromyalgia,” Journal of Musculoskeletal Medicine 1990: 7(7): pp. 53-69. </li></ul>People with Fibromyalgia will experience widespread pain of at least three months duration. Some people are often unable to continue in certain kinds of work due to this widespread pain.
  11. 11. • Chronic fatigue • Tiring easily • Morning stiffness • Urinary urgency • Anxiety or stress Other Symptoms Include: Source: Wolfe, F., “Diagnosis of Fibromyalgia,” Journal of Musculoskeletal Medicine 1990: 7(7): pp. 53-69.
  12. 12. • Irritable Bowel Syndrome • Sleep disturbance • Tingling and numbness • Excessive menstrual bleeding • Gastrointestinal symptoms <ul><li>Source: Wolfe, F., “Diagnosis of Fibromyalgia,” Journal of Musculoskeletal Medicine 1990: 7(7): pp. 53-69. </li></ul>In addition to:
  13. 13. Approximately 75% of Fibromyalgia sufferers experience sleep disturbance, which can range from insomnia to wakefulness, to non-restorative sleep. <ul><li>Source: (Wolfe, F., and Bennett, R.M.), as well as: Duarte, M., “Primary Fibromyalgia Syndrome and Myofacial Pain Syndrome: Clinical Features and Criteria for Diagnosis. Chiro Tech 1989; 1(3): pp. 97-100. </li></ul>The discomfort will be aggravated by extremes in temperature as well as humidity.
  14. 14. So you can see if the types of symptoms you have are related to Fibromyalgia, please fill out this survey with me now:
  15. 15. If you do, let me tell you what it means. If you have more than one symptom, or the one symptom you have occurs more than once per week, you have a situation you should be concerned about. It’s never normal to have a symptom. A symptom is your body’s way of communicating to you that something is not right and needs to be checked. Do you have more than one symptom?
  16. 16. Would you check your car if the engine light went on? Symptoms are a warning that something is wrong. There is no such thing as a normal symptom.  You would check your car to make sure it did not get worse. Your body deserves the same attention.
  17. 17. Today you have two choices regarding your health. You can do the same things you’re currently doing, and get the same results, or you can try something new and do something different and get a different result. The Choice is Yours.
  18. 18. If I could show you today how to get rid of your problems by doing something natural and affordable, would you do it? Raise your hand if you would.
  19. 19. <ul><li>Source: (Wolfe, F., and Bennett, R.M.), as well as: Duarte, M., “Primary Fibromyalgia Syndrome and Myofacial Pain Syndrome: Clinical Features and Criteria for Diagnosis. Chiro Tech 1989; 1(3): pp. 97-100. </li></ul>Characteristic Symptoms of Fibromyalgia and their Prevalence (Pain Symptoms) Widespread Pain 98% Neck 85% Low Back 79% Mid Back 72%
  20. 20. <ul><li>Source: (Wolfe, F., and Bennett, R.M.), as well as: Duarte, M., “Primary Fibromyalgia Syndrome and Myofacial Pain Syndrome: Clinical Features and Criteria for Diagnosis. Chiro Tech 1989; 1(3): pp. 97-100. </li></ul>Persons with Fibromyalgia also have the following percentages: 15 or More Painful Sites 56% Headaches 53% Difficulty with Menstruation 41%
  21. 21. Source: Modified from Wolfe, F., et al, by the American College of Rheumatology. People with Fibromyalgia will also have tender points at these locations on their body.
  22. 22. If you experience tenderness in any number of these locations, it may indicate that you are suffering from Fibromyalgia. Only by being examined by a trained physician, can the diagnosis be properly made.
  23. 23. The following trigger points of Fibromyalgia appear in this diagram in order of frequency. Source: Sabley, B.J., Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome , 1999, p. 16.
  24. 24. A Chiropractor, because he or she works with their hands, can recognize and detect these tender points.
  25. 25. 1. A drug-free approach: natural therapies that support the body’s innate ability to heal itself, or 2. Drugs such as: Lyrica ® , Cymbalta ® , Elavil ® , Endep ® , Flexeril ® , Prozac ® , Paxil ® , Zoloft ® , Advil ® , Motrin ® , Aleve ® , etc. There are two possible approaches to treating Fibromyalgia: Source: Cox, James, M., Low Back Pain: Mechanism, Diagnosis and Treatment , Chapter 7, pg. 251
  26. 26. Elavil ® , Endep ® , and Flexeril ® are widely used at night to modulate sleep disturbance. However, it appears that in long-term therapy the benefits may be lost and the side effects are often daunting. Source: Cox, James, M., Low Back Pain: Mechanism, Diagnosis and Treatment , Chapter 7, pg. 251
  27. 27. Source: Campbell, S.M., Gatter, R.A., Clark, S., et al. A Double-Blind Study of Cyclobenzaprine versus Placebo in Patients with Fibrositis [Abstract], Arthritis Rheumatology 1986; 29: pg. 1371. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin ® , Aleve ® , Advil ® , including generic ibuprofen, and acetaminophen, etc., are often not sufficient to relieve the aching and discomfort. Drugs only mask the symptoms.
  28. 28. There is strong doubt associated with the use of pharmaceuticals in the treatment of Fibromyalgia, for example: 56.6% of patients using Elavil ® , and at least 46.3% of patients using Flexeril ® show no improvement . <ul><li>Source: Wolfe, F., The Clinical Syndrome of Fibrositis. American Journal of Medicine , 1986, 81 (suppl 3A): pp. 7-14. </li></ul>
  29. 29. Antidepressants <ul><li>Side effects : Insomnia </li></ul><ul><li>Fatigue </li></ul><ul><li>Irritability </li></ul><ul><li>Anxiety </li></ul><ul><li>Muscle spasm </li></ul><ul><li>Digestive problems </li></ul><ul><li>Depression </li></ul>
  30. 30. • Trauma or stress The causes of Fibromyalgia include: • Irritated nerves • Lack of exercise • Nutritional deficiencies, or • Toxicity
  31. 31. A multifaceted healthcare treatment plan including exercise therapy, stress reduction, nutrition and Chiropractic care, has shown the most promise for Fibromyalgia sufferers. Source: Cox, James, M., Low Back Pain: Mechanism, Diagnosis and Treatment , Chapter 7, pg. 251
  32. 32. Let’s take a look at the following natural approaches, which have proven to be effective in handling the problem of Fibromyalgia.
  33. 33. Research has indicated that more than 80% of patients with Fibromyalgia are not physically fit. Source: Goldman, J.A., “Hypermobility and Deconditioning: Important Links to Fibromyalgia/Fibrositis,” South Med J 1991; 84: 192-1196 1. Exercise
  34. 34. Although it is understandable that Fibromyalgia patients do not want to exercise because of fatigue and pain, if they do so, the prognosis is greatly improved.
  35. 35. <ul><li>Source: Wigles, S., Stiles, T., “Effects Aerobic Exercise versus Stress Management Treatment.” </li></ul><ul><li>Scandinavian Journal of Rheumatology . 1996; 25: pp. 77-86. </li></ul>Cardiovascular exercises are, by far, considered most effective and should be included in any treatment program. Aerobic : 15-20 minutes daily; Resistance : 3x/week
  36. 36. A recent study followed 40,000 post-menopausal women for seven years. Those who regularly engaged in moderate activities had a 41% longer lifespan than those who did not exercise. Source: Journal of the American Medical Association, as featured in Consumer Reports on Health , April 1998.
  37. 37. A seven-year study by the University of Minnesota involving 12,000 men found that those who walked or did similar exercise for an average of just 20 minutes a day were 37% less likely to die of coronary disease than those who exercised less than that. Source: Journal of the American Medical Association, as featured in Consumer Reports on Health , April 1998.
  38. 38. Exercise to Tolerance <ul><li>May need slow and steady increase in </li></ul><ul><li>intensity and quantity. </li></ul><ul><li>- decreased spasm/restriction </li></ul><ul><li>-increase energy, mood </li></ul><ul><li>-decreased pain, fatigue </li></ul><ul><li>-increase sleep regularity </li></ul><ul><li>-decreased blood pressure </li></ul><ul><li>-decreased depression </li></ul><ul><li>Annals of Rheumatic Disease 2001; 60:21-6 </li></ul>
  39. 39. Many Fibromyalgia patients remember a specific triggering event associated with an abrupt onset of the symptoms of Fibromyalgia. 2. Stress Reduction
  40. 40. These events often include physical stress, such as an illness or a virus; or emotional stress, such as marital difficulties, loneliness, job dissatisfaction, boredom, lack of purpose in life, etc.
  41. 41. Stress is destructive to the body due to the over release of hormones from the adrenal glands. The adrenal hormone cortisol acts like cortisone and reduces inflammation. When under prolonged stress, one’s immune system becomes weakened and this, along with cortisol imbalances, can contribute to the symptoms of Fibromyalgia.
  42. 42. What are some things you can do to naturally reduce the harmful effects of stress? • Go for a walk • Laugh more • Yoga, Pilates, TaiChi, stretch • Massage • Accountability partner, support • Epsom salt bath
  43. 43. Sleep <ul><li>Rhythm </li></ul><ul><li>Early as possible: 11pm – 1am Adrenal rejuvenation </li></ul><ul><li>REM </li></ul><ul><li>Power naps </li></ul><ul><li>Protein + fruit before bed </li></ul><ul><li>Exercise? </li></ul>
  44. 44. California State University found that a 10 minute walk is enough to increase energy, alter mood and affect a positive outlook for up to 2 hours. Thirty-one million people walk for exercise on a regular basis. Source: Stress: 63 Ways to Relieve Tension and Stay Healthy . Inlander, Charles, B., and Moran, Cynthia, pg. 45.
  45. 45. Researchers at Loma Linda University showed that comedy lowers the body’s level of stress, thereby lowering blood pressure and increasing white blood cells and one’s immunity. Source: Stress: 63 Ways to Relieve Tension and Stay Healthy . Inlander, Charles, B., and Moran, Cynthia, pg. 45.
  46. 46. <ul><li>Source: Stress: 63 Ways to Relieve Tension and Stay Healthy . Inlander, Charles, B., and Moran, Cynthia, pg. 45. </li></ul>A study reprinted in Men’s Health showed toddlers laugh 400 times a day while adults only laugh 15 times.
  47. 47. Reducing caffeine, taking Vitamin C and B complex, and other nutrients can help offset stress and will rebuild the adrenal glands.
  48. 48. Eat and drink only those things that are healthy for your body. Stay away from any junk food. 3. Nutrition and Diet
  49. 49. <ul><li>317 studies show deficiencies in nutrition and/or “trigger foods” (toxicities) </li></ul><ul><li>-Corn, wheat, dairy, trans fats, citrus, nuts, soy & sugar </li></ul><ul><li>Elimination diet </li></ul><ul><li>-Eliminate 2 weeks, then reintroduce -76% show some improvement </li></ul>
  50. 50. Besides avoiding junk food, you need also to avoid “trans-fatty acids”. According to Walter Willet, M.D., of the Harvard School of Public Health: “Eating trans-fatty acids, particularly margarine, kills from 30,000 to 100,000 people every year from heart disease.” Source: Willett WC, Ascherio A., Trans Fatty Acids and Coronary Heart Disease: Are the effects only marginal? American Journal Public Health 1994; 84:722-724.
  51. 51. Trans-fatty acids (or “trans-fats”) include: Margarine, vegetable shortening (e.g. original Crisco ® ); fried foods: doughnuts, french fries, and other deep-fried fast food items. Trans-fatty acids are also widely used in commercially prepared foods containing partially hydrogenated oils: crackers, cookies, cakes, pastries, microwave popcorn and other snack foods. Source: Article written by Jane Borchers, Preventive Cardiology Clinic, Stanford Hospital and Clinics, October 2004
  52. 52. Drink lots of spring water. The recommended amount of water that you should consume in a day can be determined by taking your weight and dividing it in half: 140 pounds ÷ 2 = 70oz. (or nine 8oz. cups) This is the number of ounces of water that you should be drinking on a daily basis.
  53. 53. In a study published in Environmental Science and Technology , drugs such as antibiotics, hormones, strong pain killers, tranquilizers, and those used in chemotherapy, have been measured in surface, ground, and tap water. In fact, the U.S. water supply has contained 10 times the antibiotics as the German water supply! You must drink spring or filtered water! Source: USA Today Health , November 8, 2000,; Environmental Research Foundation, #614 “Drugs in Tap Water,” September 3, 1998,
  54. 54. Supplements that Complement <ul><li>Omega-3 Fatty acids (Fish Oil) = essential to cells and nerve cells James Chestnut, D.C. </li></ul><ul><li>Probiotics = prevent yeast overgrowth; immune & digestive support Carolyn Dean, M.D. </li></ul><ul><li>Multivitamin/mineral = healthier cells James Chestnut, D.C. </li></ul><ul><li>Vitamin D = muscle pain relief; immune support James Mercola, D.O. </li></ul>
  55. 55. Aluminum toxicity may play a role in symptoms experienced by magnesium deficient Fibromyalgia patients, as magnesium is required by the body to help block the toxic effects of aluminum. Source: Sabley, Billie, J., Ph.D., Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome , 1999, pg. 11. 4. Toxicity
  56. 56. <ul><li>Source: Russell, I.J., Michalek, J.E., Flechas, J.D., et al. Treatment of Fibromyalgia Syndrome with Super Malic: A </li></ul><ul><li>Randomized Double-Blind, Placebo Controlled, Cross-Over Study. Journal of Rheumatology , 1995; 22() pp. 953-958. </li></ul>A double-blind study, published in the Journal of Rheumatology , found that the use of malic acid with magnesium to be beneficial in the treatment of Fibromyalgia.
  57. 57. Malic acid can act as a most potent aluminum detoxifier, and it is especially effective at decreasing aluminum toxicity in the brain. Source: Sabley, Billie, J., Ph.D., Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome , 1999, pg. 11.
  58. 58. Malic acid <ul><li>plays an important role in improving overall muscle performance, reversing muscle fatigue following exercise, reducing tiredness and poor energy levels, as well as improving mental clarity; a beneficial treatment for sufferers of fibromyalgia and Chronic Fatigue Syndrome (CFS), which produces similar symptoms. </li></ul><ul><li>Source: apples, supplementation </li></ul>
  59. 59. Magnesium <ul><li>Food sources: </li></ul><ul><ul><li>Magnesium: Green veggies, beans, peas, nuts, seeds, unrefined whole grains </li></ul></ul><ul><li>Oral Mg (300-600mg) + malic acid (1200-2400mg) for 4-8 weeks = all reported significant relief of pain within 48 hours… </li></ul><ul><li>J. of Nutritional Medicine </li></ul>
  60. 60. • Aluminum cookware • Aluminum soda cans • Table salt • Antacids and baking soda • Underarm anti-perspirants/ deodorants Where does aluminum toxicity come from?
  61. 61. Toxic habits that contribute to poor overall body efficiency include: smoking tobacco, drinking coffee, soft drinks and alcohol… Source: Goldberg, Paul A., “Fibromyalgia: Understanding Its Causes and Resolutions”, Today’s Chiropractic , May/June 1998, pg. 88.
  62. 62. … and a variety of prescription and non-prescription drugs.
  63. 63. A more complete Fibromyalgia treatment would include cleansing the body of toxic chemicals as well as taking malic acid and magnesium.
  64. 64. 5. Nervous System Connection <ul><li>Brain scans prove: </li></ul><ul><li>The pain is real </li></ul><ul><li>There is a decreased threshold for pain (increased sensitivity) </li></ul><ul><li>There is abnormal pain processing in spine & brain stem </li></ul><ul><li>The central nerve system has increased sensory input </li></ul><ul><li>“ Blood flow” abnormalities; directly correlated with severity of symptoms </li></ul>
  65. 65. The specific re-alignment of the spine to reduce pressure on the nerves is called an adjustment . Nerve pressure reduction through spinal adjustments
  66. 66. Nerve Signals: Mind/Body Connection <ul><li>In the body, intelligence or information is transferred through the nerves of the Autonomic and Somatic nervous systems. </li></ul><ul><li>Pressure on the nerves, results in interference to the intelligence/ information communicated through the nerves, and therefore impacts the function of cells, organs, systems and the body. </li></ul>
  67. 67. Subluxation = nociception Blocks Proprioceptors, bypasses cerebellum and Initiates stress response Proprioceptors Stimulates cerebellum <ul><li>Cerebellum: </li></ul><ul><li>Coordinates- </li></ul><ul><li>-movement </li></ul><ul><li>-thought </li></ul><ul><li>-emotion </li></ul><ul><li>-stress reduction </li></ul><ul><li>-rest of the brain </li></ul><ul><li>Stress Response : </li></ul><ul><li>Immune resp . </li></ul><ul><li>thought </li></ul><ul><li>learning </li></ul><ul><li>serotonin </li></ul><ul><li>stress hormone </li></ul><ul><li>blood sugar </li></ul><ul><li>cholesterol </li></ul><ul><li>heart rate </li></ul><ul><li>blood pressure </li></ul><ul><li>fear/anxiety </li></ul><ul><li>depression </li></ul>Seaman, D.R. Dysafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. JMPT 1998 21 (4)
  68. 68. <ul><li>Increased nociception = sensitization  lowered firing thresholds, leading to non-noxious stimulus like light touch resulting in pain </li></ul><ul><ul><ul><ul><li>James Chestnut 14 Foundational Premises for Scientific & Philosophical Validation of the Chiropractic Wellness Paradigm. p. 25 </li></ul></ul></ul></ul>
  69. 69. Physical stress causes tension to build up in the muscles and joints of the body. This tension causes alterations in the normal structural alignment of the spine. Tension build-up can actually cause greater irritation and heightened sensitivity of the nervous system.
  70. 70. Have you ever had a pebble in your shoe? The pebble irritated a nerve. Nerves are extremely sensitive.
  71. 71. Numerous research studies have shown that stress-related problems responded favorably to Chiropractic care. For example, in a study done on 75 male and female subjects, Chiropractic treatment caused a marked drop in high blood pressure after only one minute. Source: Journal of Manipulative and Physiological Therapeutics , Volume 2, No. 4, August 1998.
  72. 72. A clinical study was done on a group of patients suffering with ulcers, comparing traditional medical care and Chiropractic care. The group receiving Chiropractic care experienced pain relief an average of 10 days earlier than the group under medical care. Source: The International Journal of Chiropractic , Vol. 8, No.3, 1997.
  73. 73. In another published study, Chiropractic care had definitive positive effects on a person’s health, including: increased cardiovascular and cardiopulmonary (heart and lung) health; decreased stress, anxiety and depression; increased energy levels; and a substantially decreased use of prescription and over-the-counter drugs. SOURCE: “Objective Physiologic Changes and Health Benefits of Chiropractic Adjustments” Journal of Vertebral Subluxation Research , April, 2004.
  74. 74. In his article “The Clinical Syndrome of Fibrositis, ” Rheumatologist Dr. Frederick Wolfe, M.D., states: “Most patients with Fibromyalgia who have received Chiropractic adjustments reported moderate to great improvement.” Source: Wolfe, F., “The Clinical Syndrome of Fibrositis,” American Journal of Physical Medicine & Rehabilitaion, 1986; 81 (Supplement 3A), pp. 7-14
  75. 75. In a study reported in the American Journal of Physical Medicine Rehabilitation , Chiropractic care scored amongst the most effective measures to treat Fibromyalgia. This is noteworthy as it shows Chiropractic care is more effective than drugs. Source: Waylouis, W.G., Heck, W., “Fibromyalgia Syndrome: New Associations,” American Journal of Physical Medicine & Rehabilitation , 1992; 71: pp. 343-348.
  76. 76. Chiropractors, because of their extensive education in the areas of spinal manipulation, nutrition, trigger point therapy, and exercise, are ideally suited for the management and improvement of Fibromyalgia, and they have the means to afford Fibromyalgia suffers the greatest relief and improvement of any healthcare provider.
  77. 77. To reduce the harmful effects of Fibromyalgia and similar symptoms, an effective treatment should include Chiropractic adjustments of the spine including trigger point therapy…
  78. 78. … Moderate cardiovascular exercise and stretching…
  79. 79. … Nutritional intervention…
  80. 80. … Rest and stress reduction.
  81. 81.  To identify subluxations through specialized, scientific chiropractic analysis & monitor nerve function  To provide a program of chiropractic care appropriate for each individual.  To educate our community on how to live healthier so they subluxate less. Our Chiropractic Vision Take responsibility for your health or: 1. life of sickness 2. not good candidate for my office
  82. 82. Our Analysis <ul><li> Because we understand the importance of the nervous system and the negative effects of subluxation, we have invested in, and trained on, cutting-edge technology certified by the Space Foundation that measures the function of your spine and nervous system. </li></ul>
  83. 83. Anne’ story May August November
  84. 84. A Gift.
  85. 85. Let me explain what the gift is: it’s the opportunity to receive, free of charge, a comprehensive wellness consultation and screening.
  86. 86. The consultation will help us find what you have done to injure your body. Bodies break down because of injury or abuse. If we can find out from your history why your health has been lost, we can plan a way to recover it. This will be the most thorough consultation you have ever received. It will be followed by a screening to determine if we can actually help you.
  87. 87. Some doctors would charge up to $300 for the time we would spend with you. However, I am offering you this as a gift, which means there would be no charge to you.
  88. 88. Let me tell you why I’m making it a gift. It’s because I don’t want anything to get in the way of finding out if we can help you. My purpose is to help as many people as possible, and I don’t want you to have any barrier.
  89. 89. To indicate you would like this gift, please check the box on the bottom of your survey, which indicates you would like a free evaluation. √
  90. 90. <ul><li>There are 4 reasons to accept this gift: </li></ul><ul><li>Health problems get worse over time if not treated. </li></ul><ul><li>You’ll feel great if we improve your health and eliminate your symptoms. Feeling great is what life is all about. </li></ul><ul><li>I’m not going to waste your time or money. If I can’t help you, I will let you know and refer you to someone who can. </li></ul><ul><li>You have nothing to lose because I’m going to do the consultation and screening for you at absolutely no charge. </li></ul>