You’re not imagining it. The majority of individuals who suffer from chronic pain also suffer from depression, and the majority of people who suffer from depression also suffer from chronic pain.
At first glance, these statements may seem like a double-dose of bad news for any patient suffering from fibromyalgia, painful autoimmune disorders, or any other serious, chronic pain condition.
But there is some good news to be found here. Recent medical studies of patients dually diagnosed with chronic pain and depression are revealing that these patients have a unique disease process. And this discovery is pointing toward some promising new diagnosis and treatment options.
The idea that patients with chronic pain in many cases also suffer from depression is hardly shocking, but you may be surprised by the numbers:
Of the 47 million people who suffer from chronic pain each year, over half also meet the diagnosis criteria for a Major Depressive Disorder, and
Fully two-thirds of the millions of individuals who are diagnosed with depression every year are also suffering from chronic pain.
A UNIQUE DISEASE PROCESS
Medical researchers are arriving at a new understanding of the physiological relationship between chronic pain and depression. A growing body of evidence is revealing that the disease processes occurring in a person who has been diagnosed with both chronic illness and depression are quite distinct from the processes occurring in someone who is suffering from only one of these conditions. I expect that this new understanding will lead not only to changes in treating individuals who are dually diagnosed but also to improved protocols for diagnosing and treating patients who currently are diagnosed with only chronic pain or depression.
CSS
The new term “Central Nervous System Sensitization Syndrome (CSS)” describes the unique process governing the interplay of chronic pain and depression within an individual. CSS is an inflammatory condition that damages the structure and undermines the functioning of the nervous system. It is both “neurodysregulatory” and “neurodegenerative.” Neurodysregulation refers to the extent to which CSS interferes with the healthy functioning of the body’s nervous system, undermining neural activity in the brain, spinal cord and other neural pathways throughout the body. Furthermore, when a person’s nervous system is operating sub-optimally, their hormonal and immune systems are likely to falter, which in turn, can lead to even more complicated health problems. Neurodegeneration refers to the actual injury and destruction of neural tissue in the brain and body. Both conditions (neurodysregulation and neurodegeneration) can cause or exacerbate physical pain, emotional suffering, and erode mental clarity. The mediating factor in this process is the production and release of inflammatory substances in the brain.
FACTORS THAT CONTRIBUTE TO CSS
CSS is a complex syndrome; many factors can contribute to its development, and it can manifest in a variety of ways. Underlying conditions that can increase an individual’s susceptibility for developing CSS include Lyme disease, hormonal dysfunction, periodontal disease, post-traumatic stress disorder (PTSD), mold-toxicity disorders, chronic viral infections, celiac disease, heavy metal burden and sleep disorders such as sleep apnea.
AN INFLAMMATORY CASCADE
To protect us, these underlying problems activate an inflammatory cascade within the body and brain. Here’s an example of how it works: A patient with celiac disease remains untreated for years. Consequently, inflammation develops, which disrupts the healthy functioning of her gastrointestinal system. This, in turn, compromises her ability to digest and absorb essential nutrients, eliminate waste and toxic substances, and keep out harmful substances. With her ability to absorb essential nutrients undermined, she develops nutritional deficiencies in magnesium, essential fatty acids, essential amino acids, and calcium. These deficiencies weaken her immune system and lead to more pain and depressive symptoms. In response to her gastrointestinal system’s inability to prevent the entry of harmful substances, the body responds with even more inflammation. It does this to create a hostile environment for the invading toxins, but the reaction also works to intensify the patient’s pain and depression.
CSS helps to explain why the symptoms of so many chronic conditions overlap and why obtaining an accurate diagnosis and effective treatment plan can be so challenging. In my practice, I often see patients who have been “correctly” diagnosed with one condition (accurately in the sense that the patient met the diagnostic criteria), but the patient’s health remained compromised because an underlying problem had not yet been identified or addressed. For instance, I have seen several patients who have been diagnosed and treated for fibromyalgia, but whose symptoms never improved until their underlying condition of mold toxicity was treated. Similarly, patients are sometimes accurately diagnosed and treated for thyroid disease, but the patients fail to regain their full health and vitality until their celiac disease is addressed.
In these examples, the point is to identify what was setting off the neuro-inflammatory syndrome known as CSS. In sum, conditions such as fibromyalgia, chronic fatigue syndrome, peripheral neuropathies, and PTSD and depression associated with pain, may be better understood not as diseases unto themselves, but as manifestations of Central Nervous System Sensitization Syndrome.
TREATING CHRONIC PAIN
Unfortunately, some of the most common ways of treating chronic pain can, in some cases, make a patient’s situation worse. For example, the long-term use of opioids such as morphine and oxycodone, and benzodiazepines, such as Valium, Klonopin, and Xanax, appear to exacerbate the inflammatory processes throughout the brain. Increased inflammation may promote or exacerbate pain and depression and can make both conditions even more difficult to resolve.
TREATING CSS
To combat the damaging effects of CSS, your treatment plan needs to include neuroregenerative therapies, such as sufficient sleep (7 to 9 hours per day), exercise (15-30 minutes aerobic activity per day), meditation (20 minutes per day), good nutrition (primarily low-carb diet with plenty of vegetables, fruit, low-fat protein, and supplements such as fish oil, Vitamin D and magnesium), and medication, as prescribed by your doctor. Second, all underlying medical problems need to be properly identified by completing a comprehensive medical history with your physician and undergoing laboratory testing as appropriate. Otherwise, the symptoms of CSS may persist even if other symptoms are being addressed. Finally, your treatment plan should include time with your physician to evaluate your progress and to discuss strategies that help you achieve your health goals. This may include treatments for sleep disorders, medication changes, physical therapy, acupuncture, psychotherapy or nutritional counseling.
The intersection of chronic pain and depression is complex, but medical research is beginning to show us a way forward. CSS is a new model of disease that I believe will help better equip us to identify the factors that are causing a patients’ pain and suffering. It also provides us with an incentive to adopt a more integrative treatment approach that will help more of our patients regain optimal health.
Have you or someone you know been battling with co-occurring chronic pain and depression? Has the possibility of CSS been discussed with the treating physician? If you have concerns you would like to discuss, call 703-532-4892 and schedule an appointment with one of our physicians.
When you ask your doctor what you can do about your arthritic knees, painful Achilles tendon or torn rotator cuff, you’re likely to be told about using ice or pain medication. Your physician might even discuss surgical options. But there is a very effective, non-surgical treatment that your medical provider may not mention -– prolotherapy. Why isn’t it discussed? Prolotherapy technique is difficult to learn and requires extensive specialized training; thus very few doctors are familiar with its benefits and even fewer are truly qualified to administer the procedure.
That having been said, if you are suffering from chronic joint pain or a muscle, ligament or tendon injury, you should at least consider prolotherapy. “Why?” you might ask.
“Because it’s a safe, efficient, and non-surgical way of healing the micro-tears in the fibrous tissue that connects joint capsules, tendons and ligaments to bone. This connective tissue supports the proper functioning of every joint and muscle in the human body”, explains Dr. David Wang. “When, through trauma or disease, these attachments are damaged, the joint can become weak and unstable, leading to increased pain and potentially further injury. Furthermore, the body’s ability to heal these injuries is not great because tendons, ligaments, and cartilage have a poor, natural blood supply.”
How does it work? With prolotherapy (short for “proliferative therapy”), a proliferant, often dextrose (sugar), is injected into the injured area, causing a proliferation, or increase, of growth factors that activate the body’s cells to heal the injury. A more recent innovation, platelet-rich plasma (PRP) therapy, is considered by many to be a particularly powerful type of prolotherapy, and has seen growing success among many professional athletes as well as the general public. PRP directly harnesses the body’s own growth factors by concentrating the platelets, which are where the growth factors are stored and released to activate tissue healing. MRI and sonography studies have clinically demonstrated the regeneration of healthy tissue in areas treated with prolotherapy.
Says Dr. Wang of the resulting benefits, “The result of the injection process is that the injured tendons and ligaments heal more completely, which in turn strengthens the entire joint area, allowing people to return to their normal activities faster, with less pain and greater confidence than they would ever be able to do otherwise.”
Can you benefit from prolotherapy? If you have pain that you can localize and literally “put a finger on” (e.g. inner edge of the knee, base of the skull, etc.), then there is an excellent chance that prolotherapy can help you. Some common painful conditions involving the network of joints, muscles, ligaments, tendons, and other connective tissue that can improve with prolotherapy include:
Arthritis, affecting any joint, including the knees, hips, hands, feet, and the spine
Prolotherapy is not a cure-all, but it can offer a minimally-invasive, non-surgical way of relieving, and in some cases resolving, chronic pain conditions. When performed in combination with advanced imaging technology such as diagnostic musculoskeletal ultrasound (sonography), the treatment can be delivered with an unparalleled precision of about 0.2 mm, thereby maximizing safety and effectiveness.
The best way to find out if you are a good candidate for prolotherapy is to receive a comprehensive evaluation from a physician who is an expert in treating musculoskeletal pain of all types, and who also has extensive training in prolotherapy. A knowledgeable physician can rule out other possible causes of your pain through appropriate medical testing, and can provide you with an accurate diagnosis first before recommending the most effective treatment.
Does your doctor tell you to exercise and eat right? Most docs do, but this one walks her talk big time. Lisa Lilienfield, MD, is an accomplished athlete who has won numerous awards for power-lifting and previously held the Maryland State Women’s Master Level record for deadlift. She is also a certified spin-cycling and yoga instructor.
In addition to those personal accomplishments, she was chosen by Washingtonian magazine as one of the best physicians in the Washington, D.C. area. Her board certification is in family medicine but she is also a licensed acupuncturist and osteopath as well as a professor at Georgetown University School of Medicine’s Department of Community & Family Medicine.
Dr. Lilienfield practices at The Kaplan Center for Integrative Medicine in McLean, Va. The motto on their website defines the practice: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This quote, taken from the constitution of the World Health Organization, is Dr. Lilienfield’s focus also.
The Kaplan Center specializes in hard-to-diagnose problems. They deal with complex medical cases – unraveling symptoms and signs, but most of all, understanding the whole person. Holistic health is emphasized; including the role of nutrition, physical exercise, sleep, hormonal balance, and the mind-body connection.
“We look at the patient’s family history, medical history, medications taken, lifestyle, vitamin deficiencies, sleep problems, adrenal, and other endocrine problems. We do a thorough workup, then develop a plan. Sometimes a change in diet or sleep is all that is needed. The body wants to heal itself — you can help it to resolve problems,” Dr. Lilienfield said.
Many patients she sees have underlying nutritional deficiencies. A typical example of a patient might be one who comes in concerned about chronic back pain. They may be taking anti-inflammatory medications. But the real cause may just be a lack of magnesium. When that deficiency exists, that person may exhibit all kinds of muscle pain and problems. The anti-inflammatory medications can cause gastritis and bleeding, which results in the patient receiving yet another medication. The patient winds up with a complex set of symptoms from a simple underlying problem.
Another body system to be considered is digestion. Antibiotics can destroy the good, healthy bacteria that allow bad bacteria to overtake the intestines and result in acid reflux, diarrhea, or constipation. Food sensitivities, such as gluten intolerance, are often seen in combination with thyroid dysfunction. Food sensitivities can also create additional difficulties involving the intestines and bowel. You can develop irritable bowel syndrome and if you are not absorbing enough good stuff, immune system problems can result.
Quality of sleep can also affect the functioning of the body. Dr. Lilienfield points out that if a patient has sleep apnea, the body may not be able to recover from stress and that weakens the function of the adrenals. The patient becomes exhausted. If no stage-four sleep is obtained, then fibromyalgia can develop. With sleep apnea, if the person is not getting enough oxygen at night, the functioning of all the glands is affected. Sleep apnea may lead to even more serious conditions, like heart disease or stroke.
A difficult-to-diagnose case was that of a woman from the Richmond area. She exhibited signs of thyroid malfunction but registered as borderline on standard tests. She was taking medication for low thyroid function but was not responding. She was fatigued to the point that she had to stop working. She had been to multiple doctors, was losing her strength and vitality and knew something was wrong. Dr. Lilienfield took a closer look and found that adding the hormone triiodothyronine (T3) to her medications allowed her body to utilize the hormone thyroxine (T4) she was already taking. The woman regained her health and is back full time in her job. “I can’t tell you how many of my patients have responded to a mere change in the combination of thyroid medications,” Dr. Lilienfield said.
This holistic perspective epitomizes Dr. Lillenfield’s perspective of medicine. “My emphasis is to help my patients find a balance in life – in mind, body, and spirit,” she said.
Pain and Depression: A Fire in the Brain
/in Conditions/by Gary Kaplan, DOYou’re not imagining it. The majority of individuals who suffer from chronic pain also suffer from depression, and the majority of people who suffer from depression also suffer from chronic pain.
At first glance, these statements may seem like a double-dose of bad news for any patient suffering from fibromyalgia, painful autoimmune disorders, or any other serious, chronic pain condition.
But there is some good news to be found here. Recent medical studies of patients dually diagnosed with chronic pain and depression are revealing that these patients have a unique disease process. And this discovery is pointing toward some promising new diagnosis and treatment options.
The idea that patients with chronic pain in many cases also suffer from depression is hardly shocking, but you may be surprised by the numbers:
A UNIQUE DISEASE PROCESS
Medical researchers are arriving at a new understanding of the physiological relationship between chronic pain and depression. A growing body of evidence is revealing that the disease processes occurring in a person who has been diagnosed with both chronic illness and depression are quite distinct from the processes occurring in someone who is suffering from only one of these conditions. I expect that this new understanding will lead not only to changes in treating individuals who are dually diagnosed but also to improved protocols for diagnosing and treating patients who currently are diagnosed with only chronic pain or depression.
CSS
The new term “Central Nervous System Sensitization Syndrome (CSS)” describes the unique process governing the interplay of chronic pain and depression within an individual. CSS is an inflammatory condition that damages the structure and undermines the functioning of the nervous system. It is both “neurodysregulatory” and “neurodegenerative.” Neurodysregulation refers to the extent to which CSS interferes with the healthy functioning of the body’s nervous system, undermining neural activity in the brain, spinal cord and other neural pathways throughout the body. Furthermore, when a person’s nervous system is operating sub-optimally, their hormonal and immune systems are likely to falter, which in turn, can lead to even more complicated health problems. Neurodegeneration refers to the actual injury and destruction of neural tissue in the brain and body. Both conditions (neurodysregulation and neurodegeneration) can cause or exacerbate physical pain, emotional suffering, and erode mental clarity. The mediating factor in this process is the production and release of inflammatory substances in the brain.
FACTORS THAT CONTRIBUTE TO CSS
CSS is a complex syndrome; many factors can contribute to its development, and it can manifest in a variety of ways. Underlying conditions that can increase an individual’s susceptibility for developing CSS include Lyme disease, hormonal dysfunction, periodontal disease, post-traumatic stress disorder (PTSD), mold-toxicity disorders, chronic viral infections, celiac disease, heavy metal burden and sleep disorders such as sleep apnea.
AN INFLAMMATORY CASCADE
To protect us, these underlying problems activate an inflammatory cascade within the body and brain. Here’s an example of how it works: A patient with celiac disease remains untreated for years. Consequently, inflammation develops, which disrupts the healthy functioning of her gastrointestinal system. This, in turn, compromises her ability to digest and absorb essential nutrients, eliminate waste and toxic substances, and keep out harmful substances. With her ability to absorb essential nutrients undermined, she develops nutritional deficiencies in magnesium, essential fatty acids, essential amino acids, and calcium. These deficiencies weaken her immune system and lead to more pain and depressive symptoms. In response to her gastrointestinal system’s inability to prevent the entry of harmful substances, the body responds with even more inflammation. It does this to create a hostile environment for the invading toxins, but the reaction also works to intensify the patient’s pain and depression.
CSS helps to explain why the symptoms of so many chronic conditions overlap and why obtaining an accurate diagnosis and effective treatment plan can be so challenging. In my practice, I often see patients who have been “correctly” diagnosed with one condition (accurately in the sense that the patient met the diagnostic criteria), but the patient’s health remained compromised because an underlying problem had not yet been identified or addressed. For instance, I have seen several patients who have been diagnosed and treated for fibromyalgia, but whose symptoms never improved until their underlying condition of mold toxicity was treated. Similarly, patients are sometimes accurately diagnosed and treated for thyroid disease, but the patients fail to regain their full health and vitality until their celiac disease is addressed.
In these examples, the point is to identify what was setting off the neuro-inflammatory syndrome known as CSS. In sum, conditions such as fibromyalgia, chronic fatigue syndrome, peripheral neuropathies, and PTSD and depression associated with pain, may be better understood not as diseases unto themselves, but as manifestations of Central Nervous System Sensitization Syndrome.
TREATING CHRONIC PAIN
Unfortunately, some of the most common ways of treating chronic pain can, in some cases, make a patient’s situation worse. For example, the long-term use of opioids such as morphine and oxycodone, and benzodiazepines, such as Valium, Klonopin, and Xanax, appear to exacerbate the inflammatory processes throughout the brain. Increased inflammation may promote or exacerbate pain and depression and can make both conditions even more difficult to resolve.
TREATING CSS
To combat the damaging effects of CSS, your treatment plan needs to include neuroregenerative therapies, such as sufficient sleep (7 to 9 hours per day), exercise (15-30 minutes aerobic activity per day), meditation (20 minutes per day), good nutrition (primarily low-carb diet with plenty of vegetables, fruit, low-fat protein, and supplements such as fish oil, Vitamin D and magnesium), and medication, as prescribed by your doctor. Second, all underlying medical problems need to be properly identified by completing a comprehensive medical history with your physician and undergoing laboratory testing as appropriate. Otherwise, the symptoms of CSS may persist even if other symptoms are being addressed. Finally, your treatment plan should include time with your physician to evaluate your progress and to discuss strategies that help you achieve your health goals. This may include treatments for sleep disorders, medication changes, physical therapy, acupuncture, psychotherapy or nutritional counseling.
The intersection of chronic pain and depression is complex, but medical research is beginning to show us a way forward. CSS is a new model of disease that I believe will help better equip us to identify the factors that are causing a patients’ pain and suffering. It also provides us with an incentive to adopt a more integrative treatment approach that will help more of our patients regain optimal health.
Have you or someone you know been battling with co-occurring chronic pain and depression? Has the possibility of CSS been discussed with the treating physician? If you have concerns you would like to discuss, call 703-532-4892 and schedule an appointment with one of our physicians.
Chronic Joint, Tendon or Ligament Pain? Have You Tried Prolotherapy?
/in Conditions/by Kaplan CenterWhen you ask your doctor what you can do about your arthritic knees, painful Achilles tendon or torn rotator cuff, you’re likely to be told about using ice or pain medication. Your physician might even discuss surgical options. But there is a very effective, non-surgical treatment that your medical provider may not mention -– prolotherapy. Why isn’t it discussed? Prolotherapy technique is difficult to learn and requires extensive specialized training; thus very few doctors are familiar with its benefits and even fewer are truly qualified to administer the procedure.
That having been said, if you are suffering from chronic joint pain or a muscle, ligament or tendon injury, you should at least consider prolotherapy. “Why?” you might ask.
“Because it’s a safe, efficient, and non-surgical way of healing the micro-tears in the fibrous tissue that connects joint capsules, tendons and ligaments to bone. This connective tissue supports the proper functioning of every joint and muscle in the human body”, explains Dr. David Wang. “When, through trauma or disease, these attachments are damaged, the joint can become weak and unstable, leading to increased pain and potentially further injury. Furthermore, the body’s ability to heal these injuries is not great because tendons, ligaments, and cartilage have a poor, natural blood supply.”
How does it work? With prolotherapy (short for “proliferative therapy”), a proliferant, often dextrose (sugar), is injected into the injured area, causing a proliferation, or increase, of growth factors that activate the body’s cells to heal the injury. A more recent innovation, platelet-rich plasma (PRP) therapy, is considered by many to be a particularly powerful type of prolotherapy, and has seen growing success among many professional athletes as well as the general public. PRP directly harnesses the body’s own growth factors by concentrating the platelets, which are where the growth factors are stored and released to activate tissue healing. MRI and sonography studies have clinically demonstrated the regeneration of healthy tissue in areas treated with prolotherapy.
Says Dr. Wang of the resulting benefits, “The result of the injection process is that the injured tendons and ligaments heal more completely, which in turn strengthens the entire joint area, allowing people to return to their normal activities faster, with less pain and greater confidence than they would ever be able to do otherwise.”
Can you benefit from prolotherapy? If you have pain that you can localize and literally “put a finger on” (e.g. inner edge of the knee, base of the skull, etc.), then there is an excellent chance that prolotherapy can help you. Some common painful conditions involving the network of joints, muscles, ligaments, tendons, and other connective tissue that can improve with prolotherapy include:
Prolotherapy is not a cure-all, but it can offer a minimally-invasive, non-surgical way of relieving, and in some cases resolving, chronic pain conditions. When performed in combination with advanced imaging technology such as diagnostic musculoskeletal ultrasound (sonography), the treatment can be delivered with an unparalleled precision of about 0.2 mm, thereby maximizing safety and effectiveness.
The best way to find out if you are a good candidate for prolotherapy is to receive a comprehensive evaluation from a physician who is an expert in treating musculoskeletal pain of all types, and who also has extensive training in prolotherapy. A knowledgeable physician can rule out other possible causes of your pain through appropriate medical testing, and can provide you with an accurate diagnosis first before recommending the most effective treatment.
– David Wang, D.O.
Dr. Lilienfield Noted for Excellence in Holistic Medicine
/in News/by Kaplan CenterDoes your doctor tell you to exercise and eat right? Most docs do, but this one walks her talk big time. Lisa Lilienfield, MD, is an accomplished athlete who has won numerous awards for power-lifting and previously held the Maryland State Women’s Master Level record for deadlift. She is also a certified spin-cycling and yoga instructor.
In addition to those personal accomplishments, she was chosen by Washingtonian magazine as one of the best physicians in the Washington, D.C. area. Her board certification is in family medicine but she is also a licensed acupuncturist and osteopath as well as a professor at Georgetown University School of Medicine’s Department of Community & Family Medicine.
Dr. Lilienfield practices at The Kaplan Center for Integrative Medicine in McLean, Va. The motto on their website defines the practice: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This quote, taken from the constitution of the World Health Organization, is Dr. Lilienfield’s focus also.
The Kaplan Center specializes in hard-to-diagnose problems. They deal with complex medical cases – unraveling symptoms and signs, but most of all, understanding the whole person. Holistic health is emphasized; including the role of nutrition, physical exercise, sleep, hormonal balance, and the mind-body connection.
“We look at the patient’s family history, medical history, medications taken, lifestyle, vitamin deficiencies, sleep problems, adrenal, and other endocrine problems. We do a thorough workup, then develop a plan. Sometimes a change in diet or sleep is all that is needed. The body wants to heal itself — you can help it to resolve problems,” Dr. Lilienfield said.
Many patients she sees have underlying nutritional deficiencies. A typical example of a patient might be one who comes in concerned about chronic back pain. They may be taking anti-inflammatory medications. But the real cause may just be a lack of magnesium. When that deficiency exists, that person may exhibit all kinds of muscle pain and problems. The anti-inflammatory medications can cause gastritis and bleeding, which results in the patient receiving yet another medication. The patient winds up with a complex set of symptoms from a simple underlying problem.
Another body system to be considered is digestion. Antibiotics can destroy the good, healthy bacteria that allow bad bacteria to overtake the intestines and result in acid reflux, diarrhea, or constipation. Food sensitivities, such as gluten intolerance, are often seen in combination with thyroid dysfunction. Food sensitivities can also create additional difficulties involving the intestines and bowel. You can develop irritable bowel syndrome and if you are not absorbing enough good stuff, immune system problems can result.
Quality of sleep can also affect the functioning of the body. Dr. Lilienfield points out that if a patient has sleep apnea, the body may not be able to recover from stress and that weakens the function of the adrenals. The patient becomes exhausted. If no stage-four sleep is obtained, then fibromyalgia can develop. With sleep apnea, if the person is not getting enough oxygen at night, the functioning of all the glands is affected. Sleep apnea may lead to even more serious conditions, like heart disease or stroke.
A difficult-to-diagnose case was that of a woman from the Richmond area. She exhibited signs of thyroid malfunction but registered as borderline on standard tests. She was taking medication for low thyroid function but was not responding. She was fatigued to the point that she had to stop working. She had been to multiple doctors, was losing her strength and vitality and knew something was wrong. Dr. Lilienfield took a closer look and found that adding the hormone triiodothyronine (T3) to her medications allowed her body to utilize the hormone thyroxine (T4) she was already taking. The woman regained her health and is back full time in her job. “I can’t tell you how many of my patients have responded to a mere change in the combination of thyroid medications,” Dr. Lilienfield said.
This holistic perspective epitomizes Dr. Lillenfield’s perspective of medicine. “My emphasis is to help my patients find a balance in life – in mind, body, and spirit,” she said.
FIFTYPLUS Magazine
JULY 2011
by DIANE YORK, MS, CRC