Video of the Week: Looping Your Strap

We recently had a request for a video on how to create a loop with your strap for use with some of Baxter's other videos. Yes, we are listening!

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Friday Practical Pointers: You Should Care About Your Immune System

by Baxter

The Wounded Man by Gustav Courbet

It�s that time of year again, when it seems like everyone is getting sick with a cold or flu. Maybe you yourself have been laid up for the last few weeks with a lingering cough and fatigue. On top of that, maybe you or a close friend or family member has just been diagnosed with cancer or an autoimmune disease, such as rheumatoid arthritis. Turns out your immune system is involved in all these situations. 

You see, your immune maintains your good health on several levels. It identifies and tries to eliminate foreign invaders in your body, including viruses, bacteria, and parasites that make it past the skin, lungs, and gut lining of our bodies, as well as foreign bodies, such as dirt or slivers, that get under our skin. It also scans our body fluids for early cancer cells and eliminates many of them. In doing this, it attempts to distinguish between the cells that make up our �self� from those that don�t. And when it doesn�t do that well, the immune system sometimes turns on our own tissues, as in auto-immune conditions, such as rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, type 1 diabetes and Grave�s disease (a thyroid condition). 

The immune system consists of:

1. Bone marrow. This produces a variety of cells, some of which the immune system uses to protect us. 
2. Specialized white blood cells. These develop in the bone marrow and in the thymus gland and become the various specialized white blood cells, such as T cells. 
3. Circulatory system. This moves the white blood cells around the body to where they are be needed. 
4. Lymphatic circulation and vessels. These reclaim body fluids that have escaped from our capillaries, as well as any unwanted molecules or organisms that might be in that fluid. 
5. Lymph nodes. These filter the lymphatic fluid flowing through our lymph vessels and trigger the immune response when infectious organisms, dirt molecules, or cancer cells are detected 
6. Specialized immune tissue or outposts along the digestive track, such as the tonsils in the throat and Peyer�s patches in the small intestines. These act like lymph nodes outside of the normal lymphatic circulatory vessels. 

The immune system works in concert with many other important systems of the body, including the circulatory system, nervous system and endocrine system. Of particular interest to us yoga practitioners is how our immune system interacts with our nervous system. When you are stressed out and your nervous system triggers the Fight or Flight response, your immune system is put on temporary hold, as your body has bigger, immediate threats to deal with. Once the danger has passed, and your nervous system switches to the Rest and Digest response, your immune system is turned back on and can once again provide its protective services. 

Although it may be obvious from what I have already laid out for you, we should care about the immune system because it is our primary defense against infection, invasion, and even cancer. And because it is interconnected with so many other systems of the body, when it is functioning optimally, it positively impacts the whole body. Conversely, when it is not functioning well, we get sick more easily, cancer cells may not be cleared effectively, and the immune system may sometimes even attack healthy parts of our bodies. So there are three big reasons to pay attention to keeping it healthy as we age! 

Next week, I will share with you specific techniques that Nina and I recommend for doing just that, which will go into more detail than what I have recommended in the past (see Yoga and the Immune System). 

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Beth Gibbs Joins Yoga for Healthy Aging!

by Nina

I�m excited to announce that we�ve invited Beth Gibbs to join our staff and she has accepted. That means you�ll be hearing from her regularly from now on, probably once a month. And from now on, she�ll write under the name �Beth� and be listed on our About Us page. 

We invited her to join us both because we�re big fans of her writing (wasn�t Enough so powerful and moving?) and because she has some expertise in areas that we don�t due to different yoga training (mudras, certain breath practices, yoga for menopause, etc.). Fortunately our invitation coincided with her New Year�s resolution to do more writing. 

Let me tell you a little about her. She told me that she is a lifelong lover of movement and spent the first two and a half decades of her life dancing: tap, ballet, African and modern. She says she can dance to anything except heavy metal, and still dances in her spare time.

Beth started her yoga practice in 1968, six months after her son was born and she�s been practicing ever since. She took her yoga teacher training with Joseph Le Page�s Integrative Yoga Therapy School in 1995 and her master�s degree in Yoga Therapy and Mind/Body Health is from Lesley University in Cambridge, MA. She currently teaches therapeutic yoga classes to children and adults with a specialty in classes for seniors in the Hartford, Connecticut area. She is a senior member of the IYT teaching faculty and directs the school�s Professional Yoga Therapist Internship Program. 

After 48 years of full-time work in management and program planning, in broadcasting and a variety of not-for-profit organizations, she is delighted to be �free-tired,� and pursuing her passions of yoga and writing. She is also the author of Ogi Bogi, The Elephant Yogi, a therapeutic yoga book for children with a companion manual for adults who work with children, and has produced an introduction to yoga nidra CD titled, �Release, Relax and Let Go.� For more information on her work see, www.proyogatherapeutics.com.

Here are all the posts that Beth has done so far for us:

It's Complicated: Moving Toward Equanimity
Enough
Yoga Therapy for Perfectionism

About Mudras for Healthy Aging
Yoga for Menopause: Managing Hot Flashes
Menopause as a Transformative Experience

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Techniques for Improving Cardiovascular and Heart Health

by Baxter and Nina

Nancy Ruby, Age 58, by Melina Meza

In today�s post, we are providing recommendations for using yoga tools for their preventative benefits on your cardiovascular system and heart. So start by considering your health status as it relates to heart and cardiovascular health. If you�re healthy then you can follow our recommended techniques. But if you�re having cardiovascular problems or have risk factors for developing heart problems, such as untreated hypertension (high blood pressure) or coronary artery disease or angina, then you should consult your family doctor or better yet your cardiologist about whether you can practice yoga. If your doc clears you to try yoga, we recommend you then consult with a yoga therapist for special techniques and recommendations for your unique situation. See About Yoga for Heart Health and Circulation and Heart Health and Yoga: An Overview for background information about yoga and heart health.

Cautions: While you are practicing these techniques, if you become short of breath, break out in a cold sweat, experience chest pain with or without nausea or have any other symptoms that are worrisome, stop practicing immediately. If you are in a class, notify your teacher, And if your symptoms don�t resolve promptly, seek medical attention right away.

How Often to Practice. In general, we recommend that you practice 5 to 6 days a week to promote cardiovascular health. Practice a vigorous sequence, including active poses and/or flow sequences, at least 3 days a week but no more than every other day (your body needs time for recovery and repair). On other days, you practice gentle or restorative sequences, which are safe to practice every day, or pranayama, meditation or philosophy studies, which are also safe on a daily basis. 

How Long to Practice. If you are newer to yoga, start out with shorter sessions of 10-15 minutes. Then, if your schedule allows, gradually lengthen the amount of time you spend each day in practice, working you way up to 30-60 minutes sessions to increase the effects of both exercising and relaxing your cardiovascular system. For more experienced practitioners, you can start off with longer practices of 30-60 minutes. For everyone, feel free to shorten or lengthen a practice on any given day to accommodate changes in your work and home schedules. 

Balance Your Practice. To vary the effects and challenges to your heart and circulatory system, we recommend that vary your active practices by including both static poses and dynamic sequences. And include as many of the categories of yoga poses as you to ensure your practice is well rounded.

To rest your heart and lower overall stress, we recommend that you also add in gentle and restorative poses, if time permits. And allocate a few minute of simple breath work near the end of your practice, practicing both stimulating forms that emphasize the inhalation, such as 2:1 ratio breath, to work your heart and relaxing forms that emphasize the exhalation, such as 1:2 ratio breathing. Finally, remember to practice Savasana, either with simple breath awareness or with a guided relaxation, to finish your practice. 

It�s also a good idea to include a short meditation of 3 to 5 minutes, either at the start or end of your practice, or at both times. (Of course, you can always meditate at another time in the day, if that works better for you.)

Stress Management. One of the most effective ways to influence your CV system over time is to practice stress management techniques, including meditation, pranayama, restorative yoga, and focused relaxation, as often as you can manage, every day, if possible. While we can�t say that any of these techniques are better than others, you may find that one or two work best for you. So, if possible, practice all of them periodically to be familiar with all of them. You can practice any of these stress management techniques as a part of your regular asana practice or alone, at a different time of day.

Static Poses. The more physically challenging a pose is, the greater the workload is for your heart, which is a particularly good way to exercise the heart and CV system. So try to practice the following on a regular basis:

• Standing poses that are challenging for you to maintain, such as the Warrior poses and Extended Side Angle pose (Uttitha Parsvakonasana)
• Poses where you bear weight on your arms, such as, Plank pose, Side Plank Pose (Vasithasana) and Downward and Upward-Facing Dog poses.
• Any strength building poses (see Techniques for Strength Building)
• Inverted poses (see below)

How Long to Hold Poses. If you are newer to yoga, start out with shorter holds of 3-6 breath cycles, and gradually work up to longer holds of 90 to 120 seconds over time. If you already are experienced, hold the poses until you become slightly fatigued, and gradually work your way up to longer holds. For everyone, always come out if you start to have any symptoms of muscle fatigue or the warning symptom listed above. 

Dynamic Poses and Flow Sequences. If you are not already practicing dynamic poses or flow sequences, start by practicing short mini-vinyasas, such as Downward Dog to Plank or Mountain to Arms Overhead to Forward Bend, for 6-10 rounds to begin to get used to more continuous movement. Next, begin to link several mini vinyasas together into longer sequences with sustained movement. For the classic flow sequences, Sun and Moon Salutations, we recommend starting out with 2-4 rounds and gradually working up to 10-20 rounds.

For pacing, start out by moving at a more leisurely and mindful pace, with your breath rate comfortable. As you become more accustomed to these longer vinyasa style practices, you can increase your pace of movement gradually to increase the work on your CV system, which would be reflected by a reasonable increase in your heart rate and breath rate. But maintain mindful awareness as you practice.

For more experienced practitioners, you can challenge yourself by starting out a faster pace than you normally would take, but maintain a mindful awareness of how your body is handling the new pace. 

Inverted Poses. Because inverted poses help return blood from parts of the body below the heart, and also can affect the blood pressure feedback system of the body (see Why You Should Love Your Baroreceptors), we recommend that you include these poses in your practices. In your active practices, include active inverted poses, even partial ones, such as Downward-Facing Dog pose (Adho Mukha Svanasana), Standing Forward Bend (Uttanasana), and Widespread Standing Forward Bend (Prasarita Padottanasana). Work your way gradually up to longer holds of 90 to 120 seconds, as you would with other active poses.

We also recommend that you practice restorative inverted poses, such as Legs Up the Wall pose and Supported Bridge pose. You can include these in your active practices, practice them as part of a restorative practice, or even practice them on their own. Try to include them in a general practice or a dedicated practice 2-3 times per week. If you are new to yoga, start out by holding these restorative inverted poses for 30 seconds and gradually work your way to longer holds of 5 to 10 minutes, as long as the pose is comfortable. For experienced practitioners, use your present practice times as a starting point and, if it works for you, gradually increase your time in the poses. For the restorative inverted poses we recommend that work toward 10-minute holds to trigger the Relaxation Response. And if you are still comfortable, feel free to stay in poses even longer For example, some experienced yoga practitioners will stay in Legs Up the Wall pose for 20 minutes (Nina does!). 

Restorative Poses. We recommend that you integrate 1-2 restorative poses into your active practices, either at the very start or finish the practice. We also recommend that you practice a full restorative sequence periodically to fully rest your heart and cardiovascular system. Try this once a week to start with. If you enjoy it, do it more often.

If you are newer to yoga, hold the poses for 1-2 minutes and gradually lengthen your time in the poses. For experienced practitioners, use your present practice times as a starting point and, if it works for you, gradually increase your time in the poses. 

You may need to experiment a bit to refine your timing for these poses. For some restorative poses, such as Supported Child�s pose (Balasana) or a supported twist, you�ll find that 4-5 minutes is long enough and that you become uncomfortable after that. However, for Savasana and Reclined Cobbler�s pose, which are typically very comfortable for longer holds, we recommend that work toward 10-minute holds to trigger the Relaxation Response. And if you are still completely comfortable, feel free to stay in poses even longer. For example, some experienced yoga practitioners will stay in Reclined Cobbler�s pose (Supta Baddha Konasana) for 45 minutes (Baxter does!).

Equanimity Practices. Because these practices may help you avoid getting stressed out in the first place, they are helpful for promoting cardiovascular health. Start by finding which practice or practices work best for you: meditation, pranayama, and studying yoga philosophy. Then practice as often as you can, even daily if possible.

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Age-Related Muscle Loss and Sarcopenia: An Interview with Dr. Chris Adams

by Nina

Muscle Man Standing by Hans Baldung

Although we haven't heard from Dr. Brad Gibson lately, he is still consulting with me behind the scenes and also gives me a heads up when he comes across some information he thinks we might want to share with you. And recently when his colleague Dr. Chris Adams, who is a medical researcher studying muscle aging and sarcopenia, was in town, Brad arranged for me to meet Chris because he knew I'd be very interested in the work that Chris is doing. And I was! But I was very good and didn't pester Chris too much over our dinner, but instead approached him afterward to see if he would let me officially interview him. The result is this post today! Thank you so much, Chris, for taking the time out of your busy schedule to educate us all on this important topic. (By the way, Chris says that although he doesn't do yoga, his wife does. And he's becoming aware that he himself needs to start.)

Nina: Let�s start by having you address what sarcopenia is. We here at YFHA understand that muscles change as we age, losing mass and density in everyone to some extent. Is sarcopenia the name of this natural process? Or is sarcopenia the disease stage of this process, the way osteopenia is the disease stage of natural bone loss associated with aging?

Chris: In general, sarcopenia is a condition of being of advanced age and having an amount of skeletal muscle mass that is significantly lower than the average muscle mass of the general population. However, there are several competing definitions of sarcopenia, and, at this point, there is no general agreement on how to specifically define lower than average muscle mass in older people. In addition, comparing an older individual's muscle mass to the general population can be misleading. Because people come in many shapes and sizes, the amount of muscle mass varies widely from individual to individual. Also, as you noted, we all lose muscle mass to some degree as we age. An older person who was very muscular as a younger adult may have experienced quite significant muscle loss with age, even though their muscle mass as an older adult appears normal relative to the general population.

In addition to underestimating the number of people who have lost muscle mass with age, sarcopenia does not consider the most important aspect of muscle aging, the loss of strength. Between the ages of 30 and 40, nearly all people, even elite athletes, begin to experience a loss of muscle strength. Over the following decades, strength continues to erode while muscle mass typically declines to a lesser degree. As a result, reduced muscle quality (i.e., strength per unit muscle mass) is a hallmark of the aging process. By the age of 70, almost everyone will report that they are not as strong and probably not as muscular as when they were 25 years old. 

The most important question for older people is not whether their muscle mass is lower than the general population, but whether they remain strong enough to accomplish the physical tasks that they wish to accomplish. Fortunately, the field of muscle aging seems to be moving away from strict considerations of muscle mass and moving towards a greater focus on muscle quality and functional outcomes. I think this transformation will be necessary before muscle aging is able to take its place in the mainstream of medical practice. Right now, muscle aging is scarcely addressed by the medical community. 

Compared to the field of muscle aging, the field of bone aging is much more advanced in every way, and in contrast to the term sarcopenia, the term osteopenia is very useful. Osteopenia and its more severe form, osteoporosis, describe well-defined stages in a disease process, can be easily diagnosed, and have real prognostic value, or, in other words, they are clearly associated with clinically meaningful outcome, fracture. It is also worth noting that the definitions osteopenia and osteoporosis are based on the strength of bone (bone density) rather than the amount of bone, which, like the amount of muscle, can vary widely from person to person and is rather beside the point.

Nina: Is there a theory of why this happens?

Chris: Yes. The fundamental underlying process in muscle aging is called skeletal muscle atrophy. In skeletal muscle atrophy, skeletal muscle cells, or muscle fibers, become smaller and weaker, leading to a loss of muscle mass, quality, and strength. Skeletal muscle atrophy can be generalized (affecting most or all of the muscles in the body) or it can be localized (affecting only one or a few muscles in the body). Aging typically promotes generalized skeletal muscle atrophy.

It is important to know that skeletal muscle atrophy can be caused by many things in addition to aging. Other common causes of skeletal muscle atrophy include malnutrition, muscle disuse (e.g., sedentary lifestyle, bed rest, orthopedic injuries, osteoarthritis, stroke, spinal cord injury, and other neurologic disorders), certain illnesses (e.g., cancer, diabetes and several other endocrine disorders, heart failure, COPD, kidney failure, cirrhosis, rheumatoid arthritis, critical illness, and chronic infections such as HIV/AIDS) and certain medications (e.g., prednisone, cancer chemotherapy, and hormonal prostate cancer treatments). If a person develops a condition that causes skeletal muscle atrophy, then that condition will accentuate the loss of muscle mass, quality, and strength during aging.

At the molecular level, muscle aging is still poorly understood. The molecular mechanisms are no doubt complex, and they are difficult to study because they occur so slowly. In all likelihood, muscle aging reflects an accumulation of small molecular changes in skeletal muscle that persist over many years. We and others are working to understand how aging affects skeletal muscle at the molecular level, and our laboratory recently discovered the first example of a protein that is required for the loss of muscle mass, quality and strength during aging. The protein is called ATF4, and it is a transcription factor that alters skeletal muscle gene expression in a manner that causes muscle atrophy. This finding of ATF4 provides an important clue that should help us uncover other molecular aspects of muscle aging over the next few years.

Nina: You told me earlier that there is a great variation in the way individuals lose muscle mass, depending on their body types, and so on. Could you briefly explain that?

Chris: Variability in muscle mass and strength in older individuals is at least partially explained by genetic, environmental, and behavioral factors that determine: 1) the amount of peak, or young adult, muscle mass and strength, and 2) the absence or presence of other causes of skeletal muscle atrophy. There may also be genetic variability in the rate at which proteins such as ATF4 reduce muscle mass and strength during aging, but that is speculative at this point. 

Nina: Are there effective interventions for halting or slowing the progression of muscle loss?

Chris: Unfortunately, at this point, there are no available interventions for halting or slowing muscle aging, and a medicine for skeletal muscle atrophy does not yet exist. However, a healthy lifestyle can significantly reduce a person's risk for developing additional causes of skeletal muscle atrophy. For example, exercises such as yoga prevent muscle disuse, a very potent cause of skeletal muscle atrophy.

Nina: How effective is target muscle building in the presence of muscle loss?

Chris: It can be very effective, especially when we are younger. It becomes more difficult to rebuild muscle as we grow older.

Nina: For people who are aging, what would you recommend as the best ways to maintain muscle strength as we age?

Chris: At this point, the recommendations are pretty general and would consist of: 1) maintaining a healthy diet, 2) resistance exercise, such as yoga or weight lifting, assuming there is no medical contraindication to exercise, and 3) avoiding preventable or treatable risk factors for other conditions that cause skeletal muscle atrophy, such as smoking, alcoholism, hypertension, obesity, high LDL cholesterol, etc. 

There is a large unmet need for more specific recommendations, and scientists such as Blake Rasmussen at University of Texas-Galveston are doing some very nice and important work to develop specific exercise recommendations for older people, as well specific dietary recommendations, particularly for protein intake, which is especially important for muscle health. In addition to that work, we and others are working to develop nutritional products that are enriched in dietary compounds that help maintain muscle mass and strength during aging. For example, our laboratory recently discovered two natural compounds that reduce ATF4 activity in skeletal muscle of elderly mice, leading to increased muscle mass, quality and strength. One of those compounds, called ursolic acid, is naturally found in apples and several other edible fruits and herbs. The other natural compound, called tomatidine, is a metabolite of a compound that is found in tomatoes, especially unripe, green tomatoes. We are optimistic that compounds such as ursolic acid and tomatidine will someday form the basis for specially designed foods that help promote healthy aging. In addition, we are hopeful that compounds such as these will lead us to medicines that can halt or reverse the effects of muscle aging.

Nina: Besides our muscles getting weaker as we age, they also get stiffer. Is this increasing stiffness due to the same changes that make our muscles weaker?

Chris: That's a very interesting question. To my knowledge, the answer is unknown. I am also not aware of any ongoing research in this area, but it is certainly an important issue, and it would be a great area for research.

Nina: In our previous conversation, you said to me about bones something that I didn�t know, which is that bones age in a similar way to muscles in everyone (not just in people who are prone to develop the �disease� osteoporosis). Can you say a bit more about that? And what is the relationship between the changes in the muscles and the changes in bones that result from aging?

Chris: In most circumstances, muscle and bone go hand-in-hand. Muscle strength and bone strength require similar nutrition and exercise, and both are weakened by poor nutrition, disuse, serious illness, and aging.

Nina: Should that information about the connection between aging of muscles and bones affect our thinking about how to maintain both muscle and bone strength as we age?

Chris: Yes, a healthy lifestyle that includes exercises such as yoga can be beneficial for the strength of both muscle and bone.

Christopher M. Adams, MD, PhD is a physician-scientist, a Professor of Internal Medicine and Molecular Physiology and Biophysics at the University of Iowa, and Founder and President of Emmyon, Inc., a biotechnology company focused on discovery and development of nutritional and pharmaceutical compounds that reduce skeletal muscle atrophy and improve muscle function. His clinical practice is in internal medicine and endocrinology. His research primarily focuses on molecular mechanisms and treatment of skeletal muscle atrophy. He received his MD and PhD degrees from the University of Iowa in 1999, and then completed an internship and residency in Internal Medicine, a fellowship in Endocrinology and Metab.olism, and post-doctoral training at the University of Texas Southwestern Medical Center before joining the faculty at the University of Iowa in 2006. He was elected to the American Society for Clinical Investigation in 2013.

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Video of the Week: Downward-Facing Dog pose to Plank Pose

In this mini vinyasa, you move between Downward Facing Dog pose and Plank pose with your breath. This is great way to warm up for longer holds of Downward-Facing Dog and to build upper body strength in Plank pose.

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Friday Practice Pointers: Get a Diagnosis!

by Baxter

Self Portrait with the Portrait of Doctor Farill by Frida Kahlo*

As I was reviewing all the information that we have shared with you over the years on our blog regarding yoga for medical conditions, I was struck by the fact that I had not clearly and unequivocally stated the most obvious caution of all. It was easy to forget this most important caution when there is so much positive information coming out each week on studies showing yoga�s benefit for a wide range of medical conditions, from osteoporosis to Parkinson�s Disease and post-cancer treatment. I�ve even shared with you fairly clear ways to think about the use of yoga tools for medical conditions- as preventative, curative, maintenance, supportive or palliative, and rehabilitative (see 5 Ways Yoga Can Affect Your Health). And we have written about applying yoga tools for conditions here ranging from bunions to low back pain and diabetes. 

But there is one caution that is crucial for all of this: 

If you feel that you are developing some medical condition or illness, you should be evaluated by the appropriate health care provider�be it an orthopedic surgeon for your shoulder pain or a psychologist for your feelings of depression�and get an accurate diagnosis! 

This might seem like common sense. And yet, over and over again, I meet people who are using yoga to address a health issue who have never even been to their family doctor, let alone a specialist, to find out if their suspicions about what is going on are correct. There is an old saying �The doctor who treats himself has a fool for a patient.� You are doubly or triply foolish if you are not a doctor and doing the same thing! Also, despite their best intentions and offers of help, your yoga teacher is not trained nor licensed to diagnose what ails you, even common things like low back pain that might seem their bread and butter. Even those who are certified in the new field of yoga therapy are not permitted to diagnosis your injury, illness or disorder (see Drawing a Line in the Sand: Where Yoga Teachers Should Not Go).

I certainly understand the reluctance of many to go see a doctor when you may not have health insurance, or have a plan that covers very little of the cost that might be involved in finding out what is going on. But a delay in finding out what is going on or making an incorrect self-diagnosis could leave you worse off in the long run and cost you even more. So, here is what I recommend:

1. If you think you are becoming ill (obvious exceptions are common colds and such), see a board-certified medical doctor doctor as soon as you can and get an accurate diagnosis. 
2. If you are injured and are not improving in 4-6 weeks, do the same.
3. Once you have a diagnosis, ask your doctor or health care expert if yoga is safe to add to any treatment they recommend (see Talking to Your Doctor).
4. Once you have a diagnosis, discuss what you know about your condition with your yoga teacher or yoga therapist, and ask them to help you craft a plan using yoga to assist in supporting better health and healing. 
5. If you don�t already have a teacher or yoga therapist, look for one in your community with experience, preferably working your specific diagnosis. 
6. Once you have a diagnosis and clearance from your health team, consider using the recommendations we make here on this blog for your specific issues. But even if you choose to try out some of our suggestions, I still strongly recommend you work with a teacher or yoga therapist when you first start our applying yoga tools, especially if you are newer to yoga.
7. If you are in the midst of a diagnostic work-up and your doctor is okay with you trying or continuing restorative or gentle yoga, then certainly, with appropriate common sense caution, do that. The stress reducing benefits of such practices are typically supportive for just about any condition you might be diagnosed with. 

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