Can Acupuncture Help with Your TMJ Pain?

Drugs are hardly the only solution when it comes to TMJ pain. Take acupuncture, for instance.

New research in the Journal of Acupuncture and Meridian Studies offers some new evidence that the therapy may provide at least temporary relief from TMJ problems by rebalancing the energy (Qi) along the meridians.

The temporomandibular joint, or TMJ, is a hinge for your jaw. There’s one on each side of your head. Injury, misalignment, and behaviors like bruxing can damage these joints and adjacent structures and cause them to work incorrectly.

Here’s how the TMJ functions normally:

Here’s how it looks in one type of dysfunction:

TMD can lead to ongoing problems with headaches and pain in the jaws, face, neck, and shoulders. You may have ringing in your ears or other hearing issues. You may feel toothache-like pain. You may have popping, clicking, or grating sounds when you chew. It can become hard to even open your mouth.

Suffice it to say, TMD is no fun.

But back to the study, in which 43 TMJ patients were separated into two groups. For four weeks, one group was treated with traditional acupuncture; the other, with sham acupuncture (no needle penetration). Meridian assessments were taken before and after each session.

acupuncture diagram of headInterestingly, both groups experienced less pain. Both groups experienced a decrease in Yang energy.

But only those who received real acupuncture maintained Yin energy levels over the course of the study. They were also more able to open their mouths on their own without pain.

According to Traditional Chinese Medicine (TCM), Yin and Yang energies must be balanced to maintain good health.

Increasingly, the medical establishment is accepting acupuncture as a valid treatment for various forms of pain. In fact, earlier this year, the FDA gave it a preliminary endorsement for pain management.

On a similar note, the Joint Commission – a major medical accreditor – also now recognizes acupuncture as an effective stand-alone or combination treatment for TMD. According to commentary in Integrative Medicine: A Clinician’s Journal, this turnaround provides great opportunities for integrative pain treatment.

[Integrative clinicians can] use it to convince naysayers by showing them that the evidence behind these services and practitioners in pain treatment has been prevetted by a conservative organization that serves as medicine’s police force. Notably, the pharmacologic approaches are appropriately—if only for alphabetical reasons—listed prior to pharmaceuticals. Clearly these typically more high-touch, time-, and human-intensive approaches are not relegated to the past role of if all else fails, try acupuncture.

Of course, there are other therapies that can help, as well, in providing long-term relief from TMJ problems without drugs and without surgery. The key, as ever, is to identify the cause and address that through treatment suited to that specific cause. In some cases, that might be appliance therapy; in others, DTR; in others, neural prolotherapy.

One size seldom fits all.

Image by Mot

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Guest Post: Dental Ozone Is for More Than Just Fighting Pathogens

Our thanks to the office of St. Louis biological dentist Dr. Michael Rehme for letting us share this post from their blog. The original is here.

ozone moleculeWhen you hear about ozone in dentistry, it’s usually about its power to fight infection. That power comes courtesy of a third oxygen atom that turns “breathing” oxygen (O2) into ozone (O3). This makes the molecule unstable. It really wants to lose that extra atom and become “regular” oxygen once again.

That instability is what makes it such a powerful antimicrobial. That third atom readily attaches to bacteria, viruses, fungi, and parasites, interfering with their function. Ozone also stimulates oxygen metabolism and activates the immune system, further defending against harmful microorganisms.

So ozone is ideal for treating infectious conditions such as gum disease and dental caries (tooth decay). It’s also used to support healing from dental surgery and preparing teeth for restorations.

What you don’t hear about so much in dentistry is ozone for treating pain, such as from tooth sensitivity or TMJ disorders. Yet here, too, it may have a role to play.

A new study in the Journal of Oral Rehabilitation focuses on this – in particular, treating chronic pain in the chewing muscles. The trial compared treatment results between two groups of women, one that received ozone therapy, one that received sham ozone as a placebo.

Both groups experienced improvements, actually.

However, the study hypothesis that bio-oxidative ozone application to the sites of most severe pain would produce better results than sham bio-oxidative ozone application at predetermined points was supported. Bio-oxidative ozone application appeared to be superior to sham bio-oxidative ozone application and differences were significant. [emphasis added]

Pain intensity went down and patients’ pressure pain thresholds went up. They also experienced ”significantly better results” with respect to their ability to move their jaw compared to the placebo group.

masseter muscleThe follows earlier research suggesting that ozone may be more effective than drugs for treating TMJ pain. In one such study, 87% of patients receiving ozone therapy either improved or recovered completely. Only about a third of the patients in the drug group showed improvement, and none recovered completely.

Why should ozone help with pain? Dr. Frank Shallenberger, among others, has suggested that chronic pain results from a lack of oxygen utilization. “Reverse this,” he says, “and an area of chronic pain will become normal again. Reverse this, and an area of chronic degeneration will begin to regenerate exactly as it was supposed to in the first place.”

Cells need oxygen to heal. Ozone stimulates the healing response.

This makes it even more valuable to dentistry – and medicine – than ever. Powerful. Effective. Non-invasive. Safe. What more could you ask for in a treatment?

Masseter image by Anatomography

Sleep Like Your Health Depends on It (Because It Does)

bedA recent article over at CNN offers a good reminder that running a sleep debt can have far greater effects than daytime sleepiness and general grouchiness.

It can mean more accidents due to weakened reflexes and an unfocused mind. It can mean weight gain. It can mean a higher risk of depression, anxiety, diabetes, heart disease – in general, a shorter, unhealthier life span.

Recent research has also supported the suspected link between Alzheimer’s and sleep loss. A study in Brain, for instance, found that when sleep is constantly interrupted – as in cases of obstructive sleep apnea (OSA) – more of the proteins suspected to cause Alzheimer’s build up in the brain. (Normal sleep helps clear them.)

What’s more, research in the Annals of the American Thoracic Society found that those who are genetically susceptible to Alzheimer’s appear to be at greater risk of the cognitive decline that OSA and other forms of sleep disordered breathing can contribute to.

Many don’t realize that dentists are in a unique position to help identify sleep breathing problems and even, in mild to moderate cases, offer solutions that can enhance both oral and systemic health. Many signs of OSA can show up in the mouth, from inflamed tonsils to scalloping along the tongue, from tooth wear from bruxing (grinding the teeth during sleep) to headaches and other TMJ symptoms. If exam findings suggest OSA, a sleep test may be recommended for diagnosis.

Dental options for treating apnea provide welcome alternatives to CPAP. Most often, dental treatment involves appliance therapy – comfortable devices that typically keep the airway open by gently pulling the lower jaw forward. On the whole, research suggests that oral appliance therapy (OAT) can be at least as effective as CPAP, yet much more comfortable and well-tolerated.

We may also recommend diet, activity, and other lifestyle changes to support improved sleep, as well as additional therapies such as acupuncture or chiropractic care. As ever, everything depends on the individual and the specific causes of their symptoms. After all, it’s causes we want to address.

While tending to symptoms can bring short term relief, only attention to causes can bring about good long-term results.

Many people don’t even realize the impacts a little lack of sleep can cause. We all know those who like to brag of only getting four to six hours of sleep a night, almost like it’s a competition. Yet according to a 2003 paper in Sleep, such folks are likely unaware of what they’re losing in the course of gaining those extra waking hours.

Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign.

For the sake of your health, happiness, and those around you, it is worth a quick conversation with your dentist to identify warning signs or offer suggestions for improving your sleep. And if dental factors aren’t at the root of your running a sleep debt, here are some great tips from Harvard Medical School on getting a better night’s sleep.


Image by ellas quezada

How Thermography Can Help You Take Charge of Your Health

Most of us are raised with a rather reactive and passive relationship with healthcare. You see your doctor or dentist only once something goes wrong and expect them to fix it.

But functional and biological medicine remind us that by the time you get symptoms, most conditions are fairly well advanced – and often more costly to treat. Fortunately, there are a number of technologies available to help us spot potential problems before they get to that point.

Thermography is one of those technologies – one that we’ve just recently begun making available in our office via the Texas Thermography Clinic.

Thermography is a radiation-free way to scan your body for early signs of dysfunction or imbalance on the cellular level. It’s been used by European integrative doctors for over 30 years and was FDA-cleared for use in the US in 1997.

The technology itself is based on your body’s ability to thermoregulate. This ability to keep a steady temperature is controlled by your autonomic nervous system.

When your internal temperature changes, your hypothalamus is signaled to initiate changes to bring your temp back to its norm. You sweat; your blood vessels widen or contract; your muscles and other organs generate heat – that kind of thing.

So by making a sort of heat map of your body, thermography aims to shed light on this key aspect of your body’s self-regulating abilities.

Alfa thermometryTexas Thermography Clinic uses a particular type of thermography known as thermometry. This technique uses a lightweight, infrared sensor to measure the temperature of your skin. The scanner is somewhat similar to a wand thermometer that a nurse or doctor swipes across your forehead to check for fever. But with thermometry, more than 100 points are checked, including points on the teeth and jaws.

This is followed by a 10 minute period in which you’re exposed to a cold stimulus. Then the thermographer takes readings of those same 100+ points again. Differences in the readings reflect how well your organs and tissues are functioning and how they deal with physiological stress.

Both sets of readings are run through a sophisticated computer program which maps out the temperature patterns of your body. That information can help your doctor identify imbalances that you can address proactively – through follow-up diagnostics and, as appropriate, treatment – before they can become bigger problems.

You can see how this is a perfect fit with our holistic, biological approach. Prevention is the foundation.

A Look Back at…Biocompatibility & Dental Implants

Updated from the original post for August 4, 2016

Replace a Tooth by Mimicking Your Body’s Nature

Dr. Masoud Attar & Dr. Hamid Shafie

Dr. Attar with dental implant expert Dr. Hamid Shafie at a 2016 implant seminar in San Francisco

As we say on our home page, perfection is our passion – which is perhaps the biggest reason why Dr. Attar consistently pursues additional training and education. You can’t achieve perfection without being a perpetual student.

In fact, there’s a quote well-known in dental circles, by a fellow named G.V. Black, who’s considered the father of operative dentistry: “The professional man has no right other than to be a continuous student.”

Among the best learning opportunities Dr. Attar has had over the past year was a seminar in San Francisco that focused on replacing missing teeth with zirconia (ceramic) implants.

As a biological office, we constantly strive to use the most compatible materials for our patients. We know many of you have worked hard to eliminate metals from your mouth. We also believe when you’re looking for a way to replace your missing tooth, you shouldn’t have to compromise. While many offices place conventional metal alloy implants (usually titanium), we use only ceramic for the dental implants we place.

Here are 6 reasons why:

  1. Biocompatibility

    While any material placed in the body has the potential to react, zirconia appears to be very biocompatible for most patients. The firm bond that establishes itself between the bone and the ceramic implant is believed to be bio-inert. This means your body doesn’t react with an inflammatory response as it would with a foreign body.

    In contrast, research shows titanium-based implants both corrode and degrade, generating metallic debris. This debris may have harmful biological effects over time, including the development of renal hepatic injury and renal lesions.

    Additionally, an increasing number of individuals with titanium implants, dental or orthopedic, present with allergies, sensitivities and other skin and immune reactions that necessitate removing the implant from the body. These reactions happen over time with continued exposure to the metal. An allergy or reaction to a dental implant may cause pain, inflammation, infection, bone loss and implant removal. Material testing for implant materials should be considered, especially metals.

  2. Maintenance

    dental implant illustrationRegardless of the type of implant material you select, much attention should be giving to keeping the gum tissue around it clean. Like teeth, implants can fail if bacteria accumulate along the gum. To complicate the matter, tissue doesn’t attach to an implant in the same way it attaches to your natural teeth.

    But research indicates the lack of electric conductivity in ceramic implants makes it harder for bacteria to stick. This makes it easier to maintain healthy tissue with proper cleaning technique. And unlike a bridge, which can be hard to floss effectively, an implant, for all practical purposes, is like a tooth. You can, and should, floss like you do with your natural teeth.

  3. Meridian flow

    Because they’re biologically inert, zirconia implants may offer the best option for maintaining meridian flow from tooth to organ, and organ to tooth. This is especially important to those who employ the principles of acupuncture and pay particular attention to their body’s meridian flow and blockage.

    Not familiar with this concept? You can learn more about it here.

  4. Esthetics

    In contrast to titanium implants’ grey color, ceramic implants are white. This may not seem like a big deal because, let’s face it, they’re implanted in the gums. But in patients with gum tissue recession or thin gums, the grey cast of titanium can become visible. Ceramic implants, on the other hand, retain a natural look with no grey shadow or show through.

  5. Biomimicry in Design

    Ceramic implants have been optimally designed to mimic your natural tooth. Like your tooth, ceramic implants are a one-piece design. There’s no abutment connected with a fixation screw as you commonly see in titanium implant designs.

  6. Functionality

    When you’re looking at replacing a tooth, you want it to be successful. You don’t want to have to revisit this tooth again. To succeed, it must hold up with how you use your mouth, especially the forces of chewing. By creating the diameter and length to that of natural teeth, ceramic implants are foundationally tempered to withstand chewing force.

Any way you look at it – functionally, aesthetically, holistically – when opting for implants, ceramic is clearly the best option for mimicking your natural teeth.

Want to Beat Tooth Decay? Address the Cause

There are plenty of reasons to say no to fluoridation, but what about fluoride applied directly to the teeth?

If the idea is to prevent decay, a new study in the Journal of Dental Research suggests that, at best, it may minimize damage but not prevent it all together.

fluoride varnish For this study, researchers followed 1248 young, caries-free children over the course of three years. (“Caries” is the clinical term for tooth decay.) Half the kids got a “preventive package” of fluoride varnish, fluoride toothpaste, toothbrush, and standard dental education every 6 months. The other group got education only.

By the end of the study, 39% of the kids in the control group had developed caries. So had 34% of those who got fluoride.

The mean number of cavities was 9.6 in the control group…and 7.2 in the fluoride group.

The “success” of fluoride here is clearly underwhelming.

The trial had high retention and compliance rates but failed to demonstrate that it did keep children caries free. There is evidence from the trial that once children develop caries, the intervention does slow down its progression. [emphasis added]

So what if, instead of trying to mitigate damage we were to actually prevent it by addressing its cause?

That cause is, of course, the overconsumption of sugars. In the rush to fluoridate, this tends to be forgotten. As another paper in the JDR put it,

The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. However, this is to misunderstand that the only cause of caries is dietary sugars. These provide a substrate for cariogenic oral bacteria to flourish and to generate enamel-demineralizing acids. Modifying factors such as fluoride and dental hygiene would not be needed if we tackled the single cause—sugars. [emphasis added]

Other research suggests that caries can be prevented by limiting sugar intake to less than 3% of your total daily calories. (For a 2000-calorie per day diet, that’s just 60 calories or about 15.5 grams of sugar a day; for a 1500-calorie diet, a mere 45 calories or about 11.5 grams. To put that in perspective, there are 39 grams of sugar in a 12-ounce can of Coca-Cola and 47 grams in a bag of Skittles.)

At the same time, increasing intake of nutrient-dense whole foods further supports your teeth’s natural ability to remineralize, protecting them from the oral pathogens (“bad bugs”) that cause decay. Toothpastes containing theobromine may also be helpful as a part of a good, overall home hygiene plan.

Bottom line? Decay and cavities are not inevitable. But preventing them isn’t up to fluoride. It’s up to you.

Image via healthcare-news

Acupuncture & Dentistry

acupuncture points on headWhen it comes to complementary medicine, acupuncture is often the first therapy people think of. After all, traditional Chinese acupuncture has a long and rich history – 2500 years, in fact.

Yet despite the test of time, the US has been slow to accept its benefits.

Those benefits certainly have a role to play in dental care, spelled out nicely in a 2014 literature review in the journal Medical Acupuncture.

Focusing on systematic reviews and research articles written in English, researchers plugged in key words specific to dentistry: acupuncture in dentistry, myofacial pain, temporomandibular disorders, xerostomia, dental pain and gag reflex.

As you may know, this Eastern practice uses specific points on the body’s energy highway – the meridian system – to stimulate the nervous system. This stimulation changes the way the nervous system processes pain signals and encourages the body to release its own painkillers, namely serotonin and endorphins.

And while technically, acupuncture means to “puncture with a needle,” stimulation can be achieved using a variety of techniques – for instance, moxibustion, electroacupuncture, acupressure, cupping, or microsystem acupuncture.

Whatever the technique, research shows that such stimulation

  • Normalizes physiologic functions.
  • Eases pain.
  • Modulates the limbic-para-limbic-neocortical network.
  • Increases local microcirculation.
  • Protects the body from infections.

Back in 1979, the World Health Organization endorsed acupuncture to treat just 43 symptoms. Less than two decades later, that list expanded to 64. By 2003, controlled trials had shown acupuncture to be effective in treating a number of dental conditions, including

  • Dental pain.
  • Dental anxiety and gag reflex.
  • TMJ/TMD.
  • TMJ clicking and locking.
  • Chronic muscle pain or spasm.
  • Atypical facial pain.
  • Headache/Migraine.
  • Dry mouth.
  • Nerve pain.
  • Paresthesia.

“In dentistry,” write the authors of the review,

the ability of acupuncture has been proven for managing various chronic orofacial disorders. There are numerous reports of randomized controlled trials on the analgesic effect of acupuncture for postoperative pain caused by various dental procedures and by other chronic disorders. According to the literature, acupuncture is more effective than a placebo or sham acupuncture.

Of course, as they say, more studies still need to be done. But we think it’s a good bet that, as an adjunct to good dental care, acupuncture offers promise as a nontoxic, safe alternative for treating dental symptoms with few, if any, side effects.

Image by Elizabeth Briel

Your Mouth Is the Gateway to Your Body

In honor of October’s designated status as National Dental Hygiene Month, we’d like to share an excellent video we recently ran across – “Gums to Guts: Periodontal Medicine,” Professor Mark Ryder’s talk on oral health and its relationship to the body’s systematic health.

It not only offers great visuals and useful info on markers of health and disease; it supports the importance of seeing the mouth as an integrated part of the body, not a separate feature.
 

 
If it’s been awhile since your last hygiene visit and exam, remember this key message: The mouth is a gateway to the body and has much to do with what’s going on in your body. Good oral health not only supports good body health and wellness; it’s a key factor in it.

Replace a Tooth by Mimicking Your Body’s Nature

Dr. Masoud Attar & Dr. Hamid Shafie

Dr. Attar with dental implant expert Dr. Hamid Shafie at a recent seminar in San Francisco

As we say on our home page, perfection is our passion – which is perhaps the biggest reason why Dr. Attar consistently pursues additional training and education. You can’t achieve perfection without being a perpetual student.

In fact, there’s a quote well-known in dental circles, by a fellow named G.V. Black, who’s considered the father of operative dentistry: “The professional man has no right other than to be a continuous student.”

One of the most recent seminars Dr. Attar attended was in San Francisco and focused on replacing missing teeth with zirconia (ceramic) implants.

As a biological office, we constantly strive to use the most compatible materials for our patients. We know many of you have worked hard to eliminate metals from your mouth. We also believe when you’re looking for a way to replace your missing tooth, you shouldn’t have to compromise. While many offices place conventional metal alloy implants (usually titanium), we use only ceramic for the dental implants we place.

Here are 6 reasons why:

  1. Biocompatibility

    While any material placed in the body has the potential to react, zirconia appears to be very biocompatible for most patients. The firm bond that establishes itself between the bone and the ceramic implant is believed to be bio-inert. This means your body doesn’t react with an inflammatory response as it would with a foreign body.

    In contrast, research shows titanium-based implants both corrode and degrade, generating metallic debris. This debris may have harmful biological effects over time, including the development of renal hepatic injury and renal lesions.

    Additionally, an increasing number of individuals with titanium implants, dental or orthopedic, present with allergies, sensitivities and other skin and immune reactions that necessitate removing the implant from the body. These reactions happen over time with continued exposure to the metal. An allergy or reaction to a dental implant may cause pain, inflammation, infection, bone loss and implant removal. Material testing for implant materials should be considered, especially metals.

  2. Maintenance

    dental implant illustrationRegardless of the type of implant material you select, much attention should be giving to keeping the gum tissue around it clean. Like teeth, implants can fail if bacteria accumulate along the gum. To complicate the matter, tissue doesn’t attach to an implant in the same way it attaches to your natural teeth.

    But research indicates the lack of electric conductivity in ceramic implants makes it harder for bacteria to stick. This makes it easier to maintain healthy tissue with proper cleaning technique. And unlike a bridge, which can be hard to floss effectively, an implant, for all practical purposes, is like a tooth. You can, and should, floss like you do with your natural teeth.

  3. Meridian flow

    Because they’re biologically inert, zirconia implants may offer the best option for maintaining meridian flow from tooth to organ, and organ to tooth. This is especially important to those who employ the principles of acupuncture and pay particular attention to their body’s meridian flow and blockage.

    Not familiar with this concept? You can learn more about it here.

  4. Esthetics

    In contrast to titanium implants’ grey color, ceramic implants are white. This may not seem like a big deal because, let’s face it, they’re implanted in the gums. But in patients with gum tissue recession or thin gums, the grey cast of titanium can become visible. Ceramic implants, on the other hand, retain a natural look with no grey shadow or show through.

  5. Biomimicry in Design

    Ceramic implants have been optimally designed to mimic your natural tooth. Like your tooth, ceramic implants are a one-piece design. There’s no abutment connected with a fixation screw as you commonly see in titanium implant designs.

  6. Functionality

    When you’re looking at replacing a tooth, you want it to be successful. You don’t want to have to revisit this tooth again. To succeed, it must hold up with how you use your mouth, especially the forces of chewing. By creating the diameter and length to that of natural teeth, ceramic implants are foundationally tempered to withstand chewing force.

Any way you look at it – functionally, aesthetically, holistically – when opting for implants, ceramic is clearly the best option for mimicking your natural teeth.

Building Trust in the Mind-Body Connection

senior woman sitting Our body talks to us. Got a sore back and a stiff neck? Could be your body’s way of saying, “Don’t sit hunched over the computer so long.” That stomach acid coming up your esophagus at night? Your body saying, “Hello, how many times must I tell you not to lay down right after you eat?” And more troubling, unexplainable fatigue and a gnawing feeling about it.

But it doesn’t end there.

A recent study shows our active listening to the body’s conversation goes into our psyche where it gets turned into feelings about our health. And researchers have determined that those feelings may have greater implications for our health outcomes – including mortality – than even medical tests do.

Recycling data collected a decade ago from 1500 participants gathered for a study on the relationship between stress and health, researchers evaluated their blood tests for active oral herpesvirus and matched the results to a self-assessment questionnaire.

Oral herpesvirus was selected because most people are exposed to at least one species of these viruses in early life. Herpesvirus is also a marker of decreased cellular immunity and one that advances inflammation in the body.

To be clear, having a herpesvirus “doesn’t mean you’re sick,” explained one of the study authors in a press release.

It’s probably been dormant in your cells for most of your life. But because it reactivates at a cellular level and prompts the immune system to fight it, it becomes a great marker of how the system is working.

And what did the researchers find?

That poor self-rated health was associated with more reactivation of these latent herpesviruses, which was associated with higher inflammation, and we know those two things are associated with morbidity and mortality, as well as some cancers, type 2 diabetes, and cardiovascular disease.

This study is a powerful reminder of the mind-body connection, which is just as important to dental care as medical care. It underscores the importance of our listening deeply to what patients say when sharing their symptoms.

While clinical tests can measure physical, physiological or biochemical data, they can’t speak much to what the patient is experiencing.

Tests don’t pick up subtle markers of disease – symptoms such as fatigue, headaches, sleep disturbances, degree of discomfort, and how often symptoms appear. For that information, direct input from the patient is required.

Too often patients share with us how they’ve seen multiple dentists who looked at them like they’re crazy when they told them they started getting sick after mercury was placed. They consulted doctors, answered questions, took various tests. “Nothing” was found.

When doctors and dentists can’t explain it, patients may leave those offices feeling it’s all in their head. But for all of you have ever felt that way – or feel it now – you you aren’t crazy.

You were right. You had feelings of disease. We encourage you to trust that. And to keep trusting that.

And seek care from a biological dentist or integrative physician who understands that; who has the right knowledge and technology to evaluate potential causes of your problems; who will work with you to map a path towards healing.

Image by Jason Parks